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Journal Cover BJU International
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   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1579 journals]
  • A prospective randomised placebo-controlled study of the impact of
           dutasteride/tamsulosin combination therapy on sexual function domains in
           sexually active men with lower urinary tract symptoms (LUTS) secondary to
           benign prostatic hyperplasia (BPH)
    • Authors: Claus G. Roehrborn; Michael J. Manyak, Juan Manuel Palacios-Moreno, Timothy H. Wilson, Erik PM. Roos, Javier Cambronero Santos, Dimitrios Karanastasis, Janet Plastino, Francois Giuliano, Raymond C. Rosen
      Abstract: ObjectiveTo prospectively assess the impact of the fixed-dose combination of the 5-alpha reductase inhibitor (5ARI), dutasteride 0.5 mg and the alpha-1 blocker, tamsulosin 0.4 mg (DUT-TAM FDC) therapy on sexual function domain scores in sexually active males with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), using the Men's Sexual Health Questionnaire (MSHQ).Patients and methodsThis European and Australian double-blind, placebo-controlled, parallel-group study was conducted at 51 centres. Inclusion criteria: age ≥50 years, International Prostate Symptom Score ≥12, prostate volume ≥30 cc, prostate-specific antigen 1.5–10 ng/mL. Patients were randomised 1:1 to DUT-TAM FDC therapy or placebo for 12 months. The change from baseline to Month 12 on the total MSHQ (primary endpoint) and MSHQ erection, ejaculation and satisfaction domains (secondary outcome) was assessed, using a mixed model repeated measures analysis. Safety was evaluated.ResultsThe intention-to-treat population included 489 patients (243 DUT-TAM FDC therapy; 246 placebo). A significant decrease (worsening) was observed with DUT-TAM FDC therapy versus placebo on the total MSHQ score (–8.7 vs −0.7; standard error [SE]: 0.81, 0.78; P
      PubDate: 2017-10-16T17:40:55.355755-05:
      DOI: 10.1111/bju.14057
  • Journal information
    • PubDate: 2017-10-16T04:44:25.736992-05:
      DOI: 10.1111/bju.13644
  • National cohort study comparing severe medium-term urinary complications
           following radical prostatectomy: robot-assisted versus laparoscopic versus
           retropubic open radical prostatectomy
    • Authors: A Sujenthiran; J Nossiter, M Parry, SC Charman, A Aggarwal, H Payne, P Dasgupta, NW Clarke, J van der Meulen, P Cathcart
      Abstract: ObjectivesDespite the rapid adoption of robot-assisted radical prostatectomy (RARP), there is little evidence about the occurrence of medium-term urinary complications with this type of surgery compared to laparoscopic (LRP) or retropubic open radical prostatectomy (ORP).The aim of this study was to evaluate the occurrence of severe urinary complications within two years of surgery in men undergoing RARP, LRP or ORP.Patients and MethodsPopulation-based cohort study of men who underwent RARP (n=4,947), LRP (n= 5,479), or ORP (n=6,873) between 2008 and 2012 in the English National Health Service (NHS) using national cancer registry records linked to Hospital Episodes Statistics – an administrative database of admissions to NHS hospitals. We identified the occurrence of any severe urinary or severe stricture-related complication within two years of surgery using a validated tool. Multi-level regression modelling was used to determine the association between the type of surgery and occurrence of complications with adjustment for patient and surgical factors.ResultsMen undergoing RARP were least likely to experience any urinary complication (10.5%) or a stricture-related complication (3.3%) compared to those who had LRP (15.8% any or 5.7% stricture-related) or ORP (19.1% any or 6.9% stricture-related). The impact of the type of surgery on the occurrence of any urinary or stricture-related complications remained statistically significant with adjustment for patient and surgical factors (p < 0.01).ConclusionMen who underwent RARP have the lowest risk of developing severe urinary complications within two years of surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-15T09:50:26.13837-05:0
      DOI: 10.1111/bju.14054
  • Incidentally detected testicular lesions <10 mm in diameter: can
           orchidectomy be avoided'
    • Authors: Glenda Scandura; Clare Verrill, Andrew Protheroe, Johnson Joseph, Wendy Ansell, Anju Sahdev, Jonathan Shamash, Daniel M Berney
      Abstract: ObjectiveTo investigate the pathology of excised testicular lesions
      PubDate: 2017-10-15T09:50:23.468367-05:
      DOI: 10.1111/bju.14056
  • Utilization and Quality Outcomes of cT1a, cT1b and cT2a Partial
           Nephrectomy: Analysis of the National Cancer Database
    • Authors: Katherine Fero; Zachary A. Hamilton, Ahmet Bindayi, James D. Murphy, Ithaar H. Derweesh
      Abstract: ObjectiveTo describe utilization and compare quality outcomes of partial nephrectomy (PN) for cT1a, cT1b and cT2a renal mass using a large national database.MethodsRetrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a/cT1b/T2a renal cell carcinoma between 2004-2013. We examined utilization of PN over time and quality indicators [positive surgical margin (PSM) and 30-day postoperative readmission rates (30Day-Readmit)]. Multivariable analysis was utilized to elucidate predictors for outcome comparisons.Results43,749 patients underwent PN for cT1a, cT1b and cT2a renal mass (34,796 cT1a; 8,040 cT1b; 913 cT2a). Proportion undergoing PN increased from 30.8% in 2004 to 56.7% in 2013 (p
      PubDate: 2017-10-15T09:50:21.3199-05:00
      DOI: 10.1111/bju.14055
  • Impact of ureteroscopy before radical nephroureterectomy for upper tract
           urothelial carcinomas on oncologic outcomes: a meta-analysis
    • Authors: Run-Qi Guo; Peng Hong, Geng-Yan Xiong, Zhang Lei, Dong Fang, Xue-Song Li, Kai Zhang, Li-Qun Zhou
      Abstract: ObjectivesTo investigate whether ureteroscopy (URS) before radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUC) has an impact on oncologic outcomes.Materials and MethodsWe performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta-analysis on survival outcomes.ResultsOur meta-analysis included eight eligible studies containing 3,975 patients. The results were as follows: cancer-specific survival (CSS) (Hazard Ratio (HR) = 0.76, 95% CI: 0.59 - 0.99, P = 0.04), overall survival (OS) (HR = 0.76, 95% CI: 0.48 - 1.21, P = 0.24), recurrence-free survival (RFS) (HR = 0.89, 95% CI: 0.69 - 1.14, P = 0.37), metastasis-free survival (MFS) (HR = 1.06, 95% CI: 0.82 - 1.36, P = 0.66), and intravesical recurrence-free survival (IRFS) (HR = 1.51, 95% CI: 1.29 - 1.77, P < 0.00001). Excluding the previous bladder tumour history, the results of IRFS were HR = 1.81, 95% CI: 1.53-2.13, and P < 0.00001.ConclusionsThis meta-analysis indicated that URS before RNU did not have a negative impact on CSS, OS, RFS, or MFS in UTUC patients. However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU. Further studies are needed to assess the effects of post-URS intravesical chemotherapy on intravesical recurrence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-15T09:45:20.811552-05:
      DOI: 10.1111/bju.14053
  • Multicentre evaluation of Magnetic Resonance Imaging supported
           transperineal prostate biopsy in biopsy-naïve men with suspicion of
           prostate cancer
    • Authors: N. L Hansen; T Barrett, C Kesch, L Pepdjonovic, D Bonekamp, R O'Sullivan, F Distler, A Warren, C Samel, B Hadaschik, J Grummet, C Kastner
      Abstract: ObjectivesTo analyse the detection rates of primary MRI-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres.Patients and MethodsMulticentre, prospective outcome study of 807 consecutive biopsy-naïve patients having undergone MRI-guided transperineal prostate biopsy as the first diagnostic intervention between 10/2012 and 05/2016. MRI was reported following PI-RADS criteria. 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score (GS) 7-10 cancer in targeted and overall biopsy. Predictive values were calculated for different PI-RADS and PSA density (PSA-D) groups.ResultsCancer was detected in 68% and GS 7-10 in 49% of patients. Negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSA-D ≤0.1 ng/ml/cm3 for GS7-10 was 0.91 (±0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of GS 7-10 was significantly higher at 71% versus 59% and 61% with either approach alone (p=0.000). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (p>0.05). Limitations include variability of mpMRI reading and Gleason grading.ConclusionMRI-based transperineal biopsy performed at high volume, tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of GS 7-10 cancer. Prostate biopsies may not be needed for men with low PSA-D and a non-suspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-11T02:05:24.359062-05:
      DOI: 10.1111/bju.14049
  • Multiple growth periods predict unfavorable pathology in patients with
           small renal masses
    • Authors: Alex Jang; Hiten D. Patel, Mark Riffon, Michael A. Gorin, Alice Semerjian, Michael H. Johnson, Mohamad E. Allaf, Phillip M. Pierorazio
      Abstract: ObjectiveTo use the number of positive growth periods as a characterization of the growth of small renal masses in order to determine potential predictors of malignancy.Patients and MethodsPatients who underwent axial imaging at multiple time points prior to surgical resection for a small renal mass were queried. Patients were categorized based on their pathologic tumor grade and stage: favorable (benign, chromophobe, and low-grade pT1-2 RCC) vs. unfavorable (high-grade of any stage and low-grade pT3-4 RCC). A positive growth period was counted each time the difference in greatest tumor diameters between two images was positive. Cochran-Armitage trend test and Somers’ D association was used to determine if the number of positive growth periods was correlated with unfavorable pathology.ResultsOf the 124 patients, 86 (69.4%) had favorable pathology and 38 (30.6%) had unfavorable pathology. Those who had favorable pathology were younger than those who had unfavorable pathology (median [IQR]=61.0 [52.2-66.0] vs 68.5 [61.5-77.0], p
      PubDate: 2017-10-09T03:35:15.702995-05:
      DOI: 10.1111/bju.14051
  • STAMPEDE-ing Towards Androgen Biosynthesis Inhibition for Treatment of
           High-Risk Hormone-Naïve Prostate Cancer: Changing the LATITUDE
    • Authors: Zachary Klaassen; Declan G. Murphy
      Abstract: Since Dr. Huggins’ 1941 Nobel prize winning finding that androgen deprivation therapy (ADT) effectively controls metastatic prostate cancer (PCa), 70 years passed before CHAARTED [1] and STAMPEDE [2] demonstrated that adding docetaxel to ADT prolongs survival in men with metastatic PCa. The de novo metastatic PCa global incidence is striking: 3% in the US, 6% across Europe, 4-10% in Latin America, and 60% in Asia-Pacific [3]. Historically, ADT has been standard of care, however most men progress to metastatic castration-resistant prostate cancer (mCRPC).This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-09T03:31:36.150201-05:
      DOI: 10.1111/bju.14050
  • The impact of bladder cancer on health-related quality of life
    • Authors: Angela B. Smith; Byron Jaeger, Laura C. Pinheiro, Lloyd J. Edwards, Hung-Jui Tan, Matthew E. Nielsen, Bryce B. Reeve
      Abstract: ObjectivesTo identify HRQOL changes before to after diagnosis in older adults with bladder cancer and to compare their changes to non-cancer controls.Patients and MethodsData from the Surveillance, Epidemiology, and End Results registries were linked with Medicare Health Outcomes Survey (MHOS) data. Medicare beneficiaries>= 65 years from 1998-2013 who were diagnosed with bladder cancer between baseline and follow-up MHOS were matched with non-cancer controls using propensity scores. Linear mixed models were used to estimate predictors of HRQOL changes.ResultsAfter matching, 535 bladder cancer patients (458 non-invasive and 77 invasive) and 2770 non-cancer controls were identified. Both non-invasive and invasive cases (respectively) reported significant declines in HRQOL over time when compared to controls: Physical Component Summary (-2 and -5.3 vs. -0.4), Bodily Pain (-1.9 and -3.6 vs. -0.7), Role Physical (-2.7 and -4.7 vs. -0.7), General Health (-2.4 and -6.1 vs. 0), Vitality (-1.2 and -3.5 vs. -0.1) and Social Functioning (-2.1 and -5.7 vs. -0.8). All scores range from 0 to 100. When stratified by time since diagnosis, HRQOL improved over 1 year for some domains (Role Physical) but remained lower across most domains.ConclusionsAfter diagnosis, bladder cancer patients experienced significant declines in physical, mental, and social HRQOL relative to controls. Decrements were most pronounced among individuals with invasive disease. Identifying methods to better understand and address HRQOL decrements among bladder cancer patients is needed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-08T23:05:27.0035-05:00
      DOI: 10.1111/bju.14047
  • Cost-analysis of open radical cystectomy versus robot-assisted radical
    • Authors: S. S. Bansal; T. Dogra, P. Weston Smith, S. Amran, I. Auluck, M. S. Bhambra, M. S. Sura, E. Rowe, A. Koupparis
      Abstract: ObjectivesTo perform a cost analysis comparing the cost of robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC) in a UK tertiary referral centre and to identify the key cost drivers.MethodsData on hospital stay, operative duration, transfusion rate and volume and complication rate were obtained from a prospectively updated institutional database for patients undergoing RARC or ORC. A cost decision tree model was created. Sensitivity analysis was performed to find key drivers of overall cost and to find breakeven points with ORC. Monte Carlo analysis was performed to quantify the variability in the dataset.ResultsOne RARC procedure costs £12,449.87, or £12,106.12 if the robot was donated via charitable funds. In comparison, one ORC procedure costs £10,474.54. RARC is 18.9% more expensive than ORC. The key cost drivers were operative duration, hospital length of stay and the number of cases performed per annum.ConclusionHigh ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-06T06:05:24.33649-05:0
      DOI: 10.1111/bju.14044
  • Intraductal carcinoma of the prostate can evade androgen-deprivation, with
           emergence of castrate tolerant cells
    • Authors: Laura H. Porter; Kohei Hashimoto, Mitchell G. Lawrence, Carmel Pezaro, David Clouston, Hong Wang, Melissa Papargiris, Heather Thorne, Jason Li, , Andrew Ryan, Sam Norden, Daniel Moon, Damien M. Bolton, Shomik Sengupta, Mark Frydenberg, Declan G. Murphy, Gail P. Risbridger, Renea A. Taylor
      Abstract: ObjectivesTo determine the relevance of intraductal carcinoma of the prostate (IDC-P) in advanced prostate cancer, we first examined whether IDC-P was originally present in patients who later developed advanced prostate cancer and then used patient-derived xenografts (PDXs) to investigate the response of IDC-P to androgen deprivation therapy (ADT).Materials and methodsWe conducted a retrospective pathology review of IDC-P in primary prostate biopsy or surgery specimens from 38 men who subsequently developed advanced prostate cancer. Overall survival was calculated using the Kaplan-Meier method. To demonstrate the response of IDC-P to ADT, we established PDXs from seven men with familial and/or high-risk sporadic prostate cancer. After castration and testosterone restoration of host mice, we measured the volume and proliferation of IDC-P within PDX grafts.ResultsIDC-P was a prominent feature in the primary prostate specimens, present in 63% of specimens and often co-existing with poorly-differentiated adenocarcinoma. Overall survival was similar in patients with or without IDC-P. In the PDXs from all seven patients, IDC-P was identified and present at a similar volume to adenocarcinoma. Residual IDC-P lesions persisted after host castration and, similar to castrate-tolerant adenocarcinoma, testosterone restoration led to tumour regeneration.ConclusionIDC-P is prevalent in aggressive prostate cancer and contains cells that can withstand androgen deprivation. Thus, IDC-P appears functionally relevant in advanced prostate cancer. The presence of IDC-P may be a trigger to develop innovative clinical management plans.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-04T13:55:21.865115-05:
      DOI: 10.1111/bju.14043
  • Survival Outcomes for Patients with Localized Upper-Tract Urothelial
           Carcinoma Managed with Non-Definitive Treatment
    • Authors: Jamil S. Syed; Kevin A. Nguyen, Alfredo Suarez-Sarmiento, Katelyn Johnson, Michael S. Leapman, Jay D. Raman, Brian Shuch
      Abstract: ObjectiveTo investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non-definitive therapy, which currently remains unknown.Subjects/Patients and MethodsWe utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localized, histologically confirmed kidney/renal pelvis and ureteral urothelial carcinoma. Survival analysis using the Kaplan Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer specific mortality (CSM).ResultsWe identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age: 81 vs. 71, p
      PubDate: 2017-10-03T10:35:20.606288-05:
      DOI: 10.1111/bju.14042
  • Prognostic value of urinary PCA3 during active surveillance of low-risk
           prostate cancer in patients receiving 5α-reductase inhibitors
    • Authors: Vincent Fradet; Paul Toren, Molière Nguile-Makao, Michele Lodde, Jérome Lévesque, Caroline Léger, André Caron, Alain Bergeron, Tal Ben-Zvi, Louis Lacombe, Frédéric Pouliot, Rabi Tiguert, Thierry Dujardin, Yves Fradet
      Abstract: ObjectivesTo determine the clinical performance of the urinary PCA3 test to predict the risk of Gleason grade re-classification among men receiving a 5α-reductase inhibitor during active surveillance for prostate cancer.Patients and MethodsPatients with low-risk prostate cancer were enrolled in a prospective Phase II study of active surveillance complemented with prescription of a 5ARI. Repeat biopsy was performed within the first year and annually according to physician and patient preference. Ninety patients had urine collected after digital rectal examination of the prostate before the first repeat biopsy. The PCA3 test was performed in a blinded manner at a central laboratory.ResultsUsing a PCA3 score cut-off of 35, we observed a significant difference (p=0.0002) in the risk of being diagnosed with Gleason ≥ 7 cancer during a median of 7 years of follow-up. Adjusted cox regression and Kaplan-Meier analyses also demonstrated a significantly higher risk of upgrading to Gleason ≥ 7 during follow-up for those with a higher PCA3 score.ConclusionThe urinary PCA3 test predicted Gleason grade re-classification among patients receiving a 5α-reductase inhibitor during active surveillance for low risk prostate cancer.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T10:30:26.871031-05:
      DOI: 10.1111/bju.14041
  • The BURST Research Collaborative: an alternative research model for
           carrying out large scale multi-centre Urological studies
    • Authors: Veeru Kasivisvanathan; Hashim Ahmed, Sophia Cashman, Ben Challacombe, Mark Emberton, Chuanyu Gao, Benjamin W Lamb, Arjun Nambiar, Robert Pickard, Taimur T Shah, Daron Smith
      Abstract: Veeru Kasivisvanathan's research is funded from the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Taimur Shah would like to acknowledge funding from the St Peter's Trust for clinical research and has received support for conference attendance and speaker fees from Astellas, Ferring and Galil Medical. Mark Emberton is a National Institute for Health Research Senior Investigator (2015-) and receives research support from the UCLH/UCL NIHR Biomedical Research Centre.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T09:00:31.147527-05:
      DOI: 10.1111/bju.14040
  • Surgical Management of Penile Carcinoma in Situ: Results from an
           International Collaborative Study and Review of the Literature
    • Authors: Juan Chipollini; Sylvia Yan, Sarah R. Ottenhof, Yao Zhu, Désirée Draeger, Adam S. Baumgarten, Dominic H. Tang, Chris Protzel, Ding-wei Ye, Oliver W. Hakenberg, Simon Horenblas, Nicholas A. Watkin, Philippe E. Spiess
      Abstract: ObjectivesTo evaluate recurrence after penile sparing surgery (PSS) in the management of carcinoma-in-situ (CIS) of the penis in a large multicenter cohort of patients.Patients and MethodsWe identified consecutive patients from 5 major, academic centers treated from June 1986 to November 2014 who underwent PSS for pathologically proven penile CIS. Primary outcome was local recurrence free survival (RFS) and estimated using the Kaplan-Meier method.ResultsA total of 205 patients were identified. Treatment modalities included circumcision, glansectomy, wide local excision, laser therapy and total glans resurfacing. Over a median follow-up of 40 months (interquartile range [IQR]: 26-65.6), there were 48 local recurrences with 45.8% occurring in the first year and 81.3% occurring by year 5. Majority of recurrences were observed in the laser group (58.3%). Median time to local recurrence was 15.9 months (5.66-26.14). The 1, 2, and 5-yr RFS were 88.4, 85.6, and 75%, respectively; and the median RFS was 106.5 months (80.2-132.2).ConclusionsAmong patients with penile CIS selected for surgical management, durable responses at intermediate to long-term follow-up were noted. For those with glandular CIS, glans resurfacing offered the best outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T09:00:23.615856-05:
      DOI: 10.1111/bju.14037
  • Testing the external validity of EORTC 30904 comparing overall survival
           after radical nephrectomy vs nephron sparing surgery in contemporary North
           American patients with renal cell cancer
    • Authors: Sohrab Arora; Nicolas Landenberg, Philipp Gild, Akshay Sood, Deepansh Dalela, Quoc-Dien Trinh, Mani Menon, Craig Rogers, Firas Abdollah
      Abstract: EORTC 30904 reported that for solitary renal mass
      PubDate: 2017-10-03T08:55:20.426087-05:
      DOI: 10.1111/bju.14039
  • The accuracy of patients’ perceptions of the risks associated with
           localized prostate cancer treatments
    • Authors: Marie-Anne van Stam; Henk G. van der Poel, Jochem R.N. van der Voort van Zyp, Corinne N. Tillier, Simon Horenblas, Neil K. Aaronson, J.L.H. Ruud Bosch
      Abstract: ObjectivesTo assess localized prostate cancer (PC) patients’ understanding of the differences in outcomes and risks of radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS), and to identify correlates of misperceptions.Patients And MethodsWe used baseline data (questionnaires completed after treatment information was provided but prior to treatment) of 426 newly diagnosed localized PC patients who participated (87% response rate) in a prospective, longitudinal, multicenter study. Patients’ pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature. We used univariate and multivariate linear regression to identify correlates of misperceptions.ResultsApproximately two-third (68%, n=211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT. More than half of the patients did not comprehend that RP patients are at greater risk for incontinence (65%, n=202) and erectile dysfunction (61%, n=190), and less at risk for bowel problems (53%, n=211) compared to RT patients. Many patients overestimated the risk of requiring definitive treatment following AS (45%, n=157), and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n=333). Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with better understanding of the risks (p
      PubDate: 2017-09-28T07:55:20.487391-05:
      DOI: 10.1111/bju.14034
  • The Outcomes of Inflatable Penile Prosthesis Insertion in 247 Patients
           Completing Female to Male Gender Reassignment Surgery
    • Authors: M. Falcone; G. Garaffa, A. Gillo, D. Dente, A.N. Christopher, D.J. Ralph
      Abstract: ObjectivesTo assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria (GD).Subject/patients and methodsWe conducted a retrospective single center analysis of 247 consecutive patients. The recruitment time was between January 2001 and October 2015. A total of 328 inflatable PP were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently the cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long-term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non-validated questionnaires. The data was analyzed with non-parametric tests, a multivariate logistic regression analysis, and a Kaplan-Meier survival curve.ResultsThe average follow-up was 20 months. 88% of patients were satisfied with the result although only 77% used their device for sexual intercourse. The overall 5-year device survival was 78% with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only the type of phalloplasty significantly affected the infection risk (p = 0.013).ConclusionsPenile prosthesis implantation into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-23T03:45:21.215177-05:
      DOI: 10.1111/bju.14027
  • A Novel Tool for Predicting Extracapsular Extension During Graded Partial
           Nerve Sparing in Radical Prostatectomy
    • Authors: Vipul Patel; Marco Sandri, Angelica Anna Chiara Grasso, Elisa De Lorenzis, Franco Palmisano, Giancarlo Albo, Rafael Ferreira Coelho, Alexander Mottrie, Harvey Tadzia, Darian Kameh, Hariharan Palayapalayam, Peter Wiklund, Silvano Bosari, Stefano Puliatti, Paola Zuccolotto, Giampaolo Bianchi, Bernardo Rocco
      Abstract: ObjectivesTo create a statistical tool for the estimation of extra-capsular extension (ECE) level of prostate cancer and determine the nerve sparing (NS) approach that can be safely performed during radical prostatectomy (RP).Patients And MethodsA total of 11,794 lobes, from 6,360 patients who underwent robot¬ assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width greater than 1, 2, 3, and 4mm. A five¬ zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view a patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount and the areas identified by the decision rule.ResultsOut of 6,360 patients, 1,803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1,351 lobes (11.4%) and extended beyond the capsule for more than 1, 2, 3, and 4mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (IR 1.00 - 2.00). The 5 logistic models showed good predictive performance; the area under the ROC curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width greater than 1, 2, 3, and 4mm, respectively.ConclusionThis novel tool predict with a good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at can supports surgeons in patient counselling and preoperative planning.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-22T04:55:24.969042-05:
      DOI: 10.1111/bju.14026
  • Role of estrogen receptor alpha and beta in bladder tissue in patients
           with clinical diagnosis of benign prostatic hyperplasia
    • Authors: R. Bhattar; S. S. Yadav, V. Tomar, A. Mittal, G. Gangkak, J. Mehta
      Abstract: ObjectiveTo study the differential expression of estrogen receptor (ER) subtypes in human urinary bladder tissue using immunohistochemistry (IHC) methods and explores their correlation with various measures of LUTS.MethodsIn this prospective case control study, case group (group A) comprised of 34 patients having bothersome LUTS underwent transurethral resection of prostate (TURP). 19 age matched otherwise normal patients who underwent cystoscopy as an investigation for microscopic hematuria were categorized in control group (group B). Cystoscopy and bladder biopsy was done in both groups. IHC evaluation of biopsy specimens were done for ER subtypes (ERα and ERβ) and for Ki 67 in semiquantitative fashion. Correlations of receptors with various measures of BPH/LUTS were also assessed.Results: There was statistical significant expression of ERα (both epithelial and stromas cells) in case group as comparison to control group however ERβ expression was not significant between both groups. Ki 67 expression was also more significant in case group. When we compare clinical parameters with receptor status, IPSS, PVR and prostate size were significantly associated with epithelial and stromal ERα. However ERβ was associated only with PVR.ConclusionWe found significant correlation between bladder ER levels (specifically ERα) and various clinical measures of BPH. So we conclude that ERα is the key mediator that could be responsible for various clinical measures of BPH/LUTS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-21T01:55:45.833859-05:
      DOI: 10.1111/bju.14022
  • The impact of lymph node dissection and positive lymph nodes on cancer
           specific mortality in contemporary pT2-3 non-metastatic renal cell
           carcinoma treated with radical nephrectomy
    • Authors: Michele Marchioni; Marco Bandini, Raisa S. Pompe, Tristan Martel, Zhe Tian, Shahrokh F. Shariat, Anil Kapoor, Luca Cindolo, Alberto Briganti, Luigi Schips, Umberto Capitanio, Pierre I. Karakiewicz
      Abstract: ObjectiveTo assess the effect of lymph node dissection (LND), number of removed nodes (NRN) and number of positive nodes (NPN) on cancer specific mortality (CSM), in contemporary vs. historical patients, with pT2-3NanyM0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN).MethodsWithin the SEER database (2001-2013), we identified patients with non-metastatic pT2-3 Nany RCC who underwent RN with or without LND. Kaplan–Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used.ResultsOf 25,357 patients, 24.8% underwent lymph node dissection (2001-2007: 3,167 patients vs. 2008-2013: 3,133 patients). Median NRN was 3 (IQR 1-7). Positive nodes were identified in 17.1%: 9.3% of pT2 and 21.6% of pT3 patients, who underwent LND. Median NPN was 2 (IQR 1-2). In multivariable models, LND did not decrease CSM (HR 1.29, p
      PubDate: 2017-09-20T11:00:19.819862-05:
      DOI: 10.1111/bju.14024
  • Drugs for metabolic conditions and prostate cancer death in men on GnRH
    • Authors: Cecilia Bosco; Chloe Wong, Hans Garmo, Danielle Crawley, Lars Holmberg, , Niklas Hammar, Jan Adolfsson, Pär Stattin, Mieke Van Hemelrijck
      Abstract: BackgroundIt is unclear whether metabolic syndrome and its related drugs is affecting treatment response in men with prostate cancer (PCa) on Gonadotropin releasing Hormone (GnRH) agonists. We aimed to evaluate whether drugs for metabolic conditions influence PCa-specific mortality in men starting GnRH agonists.MethodsWe selected all men receiving GnRH agonists as primary treatment in PCBaSe Sweden (n=9,267). Use of drugs for metabolic conditions (i.e. anti-diabetes, anti-dyslipidaemia, and anti-hypertension) in relation to all cause, cardiovascular disease (CVD), and PCa-specific death was studied using multivariate Cox proportional hazard and Fine and Gray competing regression models.Results6,322 (68%) men used at least one drug for a metabolic condition at GnRH agonist initiation: 46% on antihypertensive drugs only, 32% on drugs for dyslipidaemia and hypertension and about 10% on drugs for more than two metabolic conditions. Cox models indicated a weak increased risk of PCa death in men who are on drugs for hypertension only (HR: 1.12 (95%CI: 1.03-1.23)) or drugs for hyperglycaemia (HR: 1.19 (95%CI: 1.06-1.35)) at GnRH agonist initiation. However, upon taking into account competing risk from CVD death, none of the drugs for metabolic conditions were associated with an increased risk of PCa death.ConclusionWe did not find evidence for a better or worse response to GnRH agonists in men with PCa who were also on drugs for hypertension, dyslipidaemia, or hyperglycaemia.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T10:55:35.695292-05:
      DOI: 10.1111/bju.14023
  • Real World Uptake, Safety Profile and Outcomes of Docetaxel in Newly
           Diagnosed Metastatic Prostate Cancer
    • Authors: Robert Rulach; Stephen McKay, Sam Neilson, Lillian White, Jan Wallace, Ross Carruthers, Carolynn Lamb, Almudena Cascales, Husam Marashi, Hilary Glen, Balaji Venugopal, Azmat Sadoyze, Norma Sidek, J. Martin Russell, Abdulla Alhasso, David Dodds, Jennifer Laskey, Robert J. Jones, Nicholas MacLeod
      Abstract: ObjectivesTo investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial.Subjects/patients and MethodsPatients in the West of Scotland Cancer Network (WoSCAN) with newly diagnosed mPC were identified from the regional multidisciplinary team (MDT) meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression and overall survival were compared between those patients who received docetaxel and androgen deprivation therapy (ADT), or ADT alone using survival analysis.ResultsOut of 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (HR 2.03, 95% CI (1.27, 3.25), log-rank test, p= 0.002) and had an increased risk of death (HR 5.88, 95% CI 2.52, 13.72, log-rank p=0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine times greater if chemotherapy was started within three weeks of ADT initiation (95% CI (1.22,77.72) p= 0.032).ConclusionDocetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started 3 weeks or more after androgen deprivation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T10:00:19.156196-05:
      DOI: 10.1111/bju.14025
  • Adjuvant chemotherapy after radical nephroureterectomy does not improve
           survival in patients with upper tract urothelial carcinoma: a joint study
           of the EAU-Young Academic Urologists and the Upper Tract Urothelial
           Carcinoma Collaboration
    • Authors: Andrea Necchi; Salvatore Lo Vullo, Luigi Mariani, Marco Moschini, Kees Hendricksen, Michael Rink, Roman Sosnowski, Jakub Dobruch, Jay D. Raman, Christopher G. Wood, Vitaly Margulis, Morgan Roupret, Alberto Briganti, Francesco Montorsi, Evanguelos Xylinas, Shahrokh F. Shariat,
      Abstract: ObjectiveTo analyze the outcomes of adjuvant chemotherapy versus observation in a multicenter cohort of patients with upper tract urothelial carcinoma (UTUC). The benefit from adjuvant chemotherapy after radical nephroureterectomy (RNU) is debated in these patients.Patients and MethodsData from 15 centers was collected, totalling 1,544 patients, treated between 2000 and 2015. Criteria for patient selection included pT2-4N0/x stage, or lymph node-positive disease, and prior RNU. The standardized differences (SD) approach was used to compare subgroup characteristics. Overall survival (OS) was the primary endpoint. The propensity scores (PS) techniques included 1:1 PS matching as primary analysis, added to the inverse probability of treatment weighting (IPTW) as secondary analysis. The latter was also performed with the inclusion of the covariates, i.e. with “doubly robust” estimation (DREP). Six-month landmark analysis was done to exclude early events.ResultsA total of 312 patients received adjuvant chemotherapy and 1,232 observation. Despite differences between the two groups, SD was generally
      PubDate: 2017-09-20T09:35:34.172702-05:
      DOI: 10.1111/bju.14020
  • Quality of life following brachytherapy or bilateral nerve sparing robotic
           prostatectomy for prostate cancer: a prospective cohort
    • Authors: Pierre Blanchard; John W. Davis, Steven J. Frank, Jeri Kim, Curtis A. Pettaway, Thomas J. Pugh, Louis L. Pisters, John F. Ward, Seungtaek Choi, Brian F. Chapin, Karen Hoffman, Neema Navai, Mary Achim, Sean E. McGuire, Surena F. Matin, Quynh Nguyen, Usama Mahmood, William J. Graber, Hsiang-Chun Chen, Xuemei Wang, Deborah A. Kuban
      Abstract: BackgroundQuality of life (QoL) has become an important issue in cancer care. Better data on QoL after prostate cancer treatment could help patients make an informed decision regarding the treatment of their choice.MethodsPathologically proven, non-metastatic, T1-T3bN0 prostate cancer patients were included in this prospective non-randomized study if they were to receive curative intent treatment. Sample size was at least 181 patients per cohort/treatment type. Quality of life (QoL) was recorded at baseline and each follow-up using the Expanded Prostate Cancer Index Composite (EPIC-50) instrument. The minimal clinically important difference was defined as half of the standard deviation of the baseline score for each domain. A mixed effect models was used to compare the different treatments. We here report on the brachytherapy and the bilateral nerve sparing robotic prostatectomy cohorts. Hormonotherapy was not allowed.ResultsFrom November 2007 to January 2013, 181 patients were included in the brachytherapy and 210 in the robotic prostatectomy group respectively. Among the surgical patients, 178 had bilateral nerve- sparing and were included in this analysis. Response rate to EPIC questionnaires were higher in the brachytherapy compared to the prostatectomy arm, with 82% vs. 57% at two years post treatment and 55% vs 45% at four years. In the mixed model, surgical patients had better QoL regarding urinary irritation/obstruction or bother and bowel function, and lower QoL regarding sexual function and urinary incontinence. Results were confirmed in a propensity score matched model. Patient satisfaction was significantly higher among brachytherapy patients at 1, 2 and 3 years post treatment.ConclusionThis prospective non randomized study demonstrates long-term differences in QoL domains after bilateral nerve- sparing robotic prostatectomy or brachytherapy. Difference in patient satisfaction should be further explored. These results can be used to counsel patients in the decision-making process.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T09:35:19.222199-05:
      DOI: 10.1111/bju.14021
  • Increased Accuracy of a novel mRNA-based Urine Test for Bladder Cancer
    • Authors: Renate Pichler; Josef Fritz, Gennadi Tulchiner, Gerald Klinglmair, Afschin Soleiman, Wolfgang Horninger, Helmut Klocker, Isabel Heidegger
      Abstract: ObjectivesTo evaluate the diagnostic accuracy of the Xpert Bladder Cancer (BC) Monitor, compared to cystoscopy and cytology in the oncological follow-up of non-muscle invasive bladder cancer (NMIBC).Material and Methods140 patients with a previous history of NMIBC undergoing routine surveillance at our department were enrolled prospectively (ISRCTN study registry number 37210907). Urine cytology was evaluated according to the Paris classification system. In addition, urinary specimens were analyzed using the Xpert BC Monitor, which measures five target mRNAs (ABL1, CRH, IGF2, UPK1B, ANXA10) using real-time-PCR. Descriptive analysis, diagnostic accuracy including sensitivities, specificities, predictive values [positive (PPV) and negative (NPV)], receiver operating characteristic (ROC) curves, and area under the curve (AUC) were calculated.ResultsThe overall sensitivity (0.84) and NPV (0.93) of the Xpert BC Monitor were significantly superior to that of bladder washing cytology (0.33 and 0.76, p
      PubDate: 2017-09-20T09:25:20.206997-05:
      DOI: 10.1111/bju.14019
  • Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic
    • Authors: Giancarlo Marra; Ettore Dalmasso, Marco Angello, Stefania Munegato, Andrea Bosio, Omidreza Sedigh, Luigi Biancone, Paolo Gontero
      Abstract: BackgroundThe majority of kidney transplants are performed in recipients (RTR) over 50; simultaneously their life expectancy is improving. The increasing age and number of RTR is likely to be paralleled by an increase of prostate cancer (PCa) incidence. However, little is known on the optimal management of these patients who represent a therapeutic challenge due to medical and anatomical graft-related issues.MethodsAMED, Medline and Embase were searched until November 17th, 2016 adhering to the PRISMA guidelines and the AMSTAR checklist to investigate oncological and functional outcomes of PCa treatment in RTR. Type of immunosuppression and peri-operative antibiotic use/protocols were also assessed. The search was implemented manually. Exclusion criteria were absence of full texts or absence of information allowing to differentiate oncological and/or functional outcomes of each therapeutic approach used.ResultsWe included 241 men from 27 retrospective studies published between 1991 and 2016; 7 were case-control and 20 were case series. We also considered 9 case reports, published between 1999 and 2016. Follow up ranged from 1 to 120 months. PCa was organ-confined and with Gleason Score ≤6 in 75.2% and 60.4%. Surgery was the most frequent treatment (n=186) with Cancer specific (CSS) and overall survival (OS) being 96,8% and 96,8%, respectively. Functional outcomes including continence and erectile function and complications were less frequently reported and generally comparable to standard RP.Other treatment modalities included radiotherapy ± androgen deprivation therapy (n=34; OS 88.2%; CSS 88.2%), androgen deprivation therapy alone (n=14; OS 42.9%; CSS 64.3%), brachytherapy (n=11: OS and CSS 100%), watchful waiting (n=4) and active surveillance (n=1). Overall no treatment-related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Limitations include low quality of the studies (LE III n=7; IV n=20), absence of standardized methods to report functional outcomes and complications and inconsistency in immunosuppression and antibiotics administration reports.ConclusionsOutcomes of PCa treatment in RTR are encouraging and do not seem inferior to those of non-RTR. RP was the most assessed approach whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High quality studies are needed as the level of evidence is low and results should be interpreted with caution.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-18T03:16:00.254898-05:
      DOI: 10.1111/bju.14018
  • Systematic Review and Network Meta-Analysis on the Relative Efficacy of
           Osteoporotic Medications: Men with Prostate Cancer on Continuous Androgen
           Deprivation Therapy to Reduce Risk of Fragility Fractures
    • Authors: Yeesha Poon; Petros Pechlivanoglou, Shabbir M H Alibhai, David Naimark, Jeffrey S Hoch, Emmanuel Papadimitropoulos, Mary-Ellen Hogan, Murray Krahn
      Abstract: BackgroundAndrogen deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for fractures. This analysis evaluated the relative effectiveness of osteoporosis treatments using BMD as a surrogate endpoint for fragility fractures in men on continuous ADT.MethodWe included randomized controlled trials studying bisphosphonates, denosumab, toremifene, and raloxifene in patients with non-metastatic prostate cancer on ADT for review. Primary outcomes included percentage change in BMD from baseline at total hip, lumbar spine and femoral neck sites. We also recorded incidence rates of any fractures. Network meta-analysis was done to evaluate change in BMD.ResultsOut of 270 identified articles, 13 RCTs were included for analysis. The largest BMD improvement compared to placebo at 12 months for total hip site was: raloxifene 3.70% (95% credible interval [CrI], 1.48-5.92%), lumbar spine: zoledronic acid 6.96% (CrI:-5.34-8.52%) and femoral neck: risedronate 6.77% (CrI:-6.87-20.27%). Two studies reported fractures as outcome measure. Toremifene and denosumab studies reported improved incidence of new vertebral fracture outcome vs placebo (2.5% vs 4.9%; p
      PubDate: 2017-09-18T02:45:19.355662-05:
      DOI: 10.1111/bju.14015
  • First-line therapy with dacomitinib, an orally available pan-HER tyrosine
           kinase inhibitor, for locally-advanced or metastatic penile squamous cell
           carcinoma: results of an open label, single-arm, single-center, phase 2
    • Authors: A. Necchi; S. Lo Vullo, F. Perrone, D. Raggi, P. Giannatempo, G. Calareso, N. Nicolai, L. Piva, D. Biasoni, M. Catanzaro, T. Torelli, S. Stagni, E. Togliardi, M. Colecchia, A. Busico, A. Gloghini, A. Testi, L. Mariani, R. Salvioni
      Abstract: ObjectiveTo harness the frontline therapy in advanced penile squamous cell carcinoma (PSCC), for which chemotherapy exerts moderate activity but poor efficacy. Dacomitinib is an irreversible, pan-epidermal growth factor receptor (HER) inhibitor.Patients and MethodsIn a phase 2 study (NCT01728233), patients received dacomitinib 45 mg/day, orally, continuously. Inclusion criteria were SCC histology, clinical stage N2-3 or M1 (TNM 2009), and no prior chemotherapy administration. The primary endpoint was the objective response-rate (ORR, according to RECIST v1.1). Stopping rules based on the Bayesian posterior probability (PP) to demonstrate that the ORR exceeded 20% were set.ResultsFrom June 2013 to October 2016, 28 patients were treated. Eight (28.6%) had visceral metastases, 14 (50%) had pelvic and 17 (60.7%) clinically-involved bilateral lymph nodes. One complete and eight partial responses were obtained (ORR: 32.1%, 80% credibility interval 21.0-43.0%). The median follow-up duration was 19.8 months (IQR: 6.3-25.7); 12-month progression-free survival was 26.2% (95%CI: 13.2-51.9); 12-month overall survival (OS) was 54.9% (95%CI: 36.4-82.8). The median OS of locally-advanced patients was 20 months (IQR: 11.1-not reached). The Bayesian PP of exceeding the 20% ORR target was 92.3%. Grade 3 adverse events (skin rash) were seen in 3 patients (10.7%). Tissue samples from 25 patients were analyzed. Only two patients had HR-HPV-positive tumor. EGFR amplification was found in 4 patients (equally responders and non responders) and it was confirmed in all post-dacomitinib samples. TERT mutations (60%) were found in responders only, PI3K/mTOR pathway gene mutations in 42.9% responders versus 8.3% non responders.ConclusionDacomitinib was active and well tolerated in patients with advanced PSCC and may represent an option when combination chemotherapy cannot be administered. Mutations in downstream effectors of EGFR signaling in relation to dacomitinib activity deserve further studies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-16T10:20:31.444962-05:
      DOI: 10.1111/bju.14013
  • Guideline of Guidelines – Asymptomatic Microscopic Haematuria
    • Authors: Brian J. Linder; Edward J. Bass, Hugh Mostafid, Stephen A. Boorjian
      Abstract: ObjectiveTo review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH).MethodsThis is a review of the haematuria guidelines from 1.) American Urological Association (AUA), 2.) consensus statement from the Canadian Urological Association, Canadian Urologic Oncology Group, and Bladder Cancer Canada, 3.) American College of Physicians (ACP), 4.) Joint Consensus Statement of the Renal Association (RA) and British Association of Urological Surgeons (BAUS), and 5.) National Institute for Clinical Excellence (NICE).ResultsAll guidelines reviewed recommend evaluation for AMH, in absence of potential benign aetiologies, with the work up including cystoscopy and upper urinary tract imaging. Existing guidelines vary in the definition of AMH (role of urine dipstick versus urine microscopy), age threshold for recommending evaluation, and the optimal imaging modality (computed tomography versus ultrasound). Of the reviewed guidelines, none recommend use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation.ConclusionsSignificant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, this entity represents a valuable future research opportunity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-16T10:20:22.592585-05:
      DOI: 10.1111/bju.14016
  • Prospective comparison of transperineal MRI/ultrasound-fusion biopsy and
           transrectal systematic biopsy in biopsy-naïve patients
    • Authors: Angelika Borkowetz; Boris Hadaschik, Ivan Platzek, Marieta Toma, Georgi Torsev, Theresa Renner, Roman Herout, Martin Baunacke, Michael Laniado, Gustavo Baretton, Jan Philipp Radtke, Claudia Kesch, Markus Hohenfellner, Michael Froehner, Heinz-Peter Schlemmer, Manfred Wirth, Stefan Zastrow
      Abstract: ObjectivesTo evaluate the value of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasound-fusion biopsy (fusPbx) to conventional transrectal systematic biopsy (sysPbx) in biopsy-naïve patients.Patients and MethodsThis multicentre, prospective trial investigated biopsy-naïve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa defined as Gleason pattern four or five. Here, we present our analysis after a study period of two years.ResultsThe study included 214 patients. Median number of targeted and systematic cores was six (range 2-15) and 12 (range 6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs. 43%; p=0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (p=0.296). The missing rate of significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs. 38% vs. 35%, p
      PubDate: 2017-09-16T10:15:20.850023-05:
      DOI: 10.1111/bju.14017
  • Robotic Kidney Transplantation: Comparison of the First 40 Cases of Open
           vs Robotic Transplantations by a Single Surgeon
    • Authors: Volkan Tuğcu; Nevzat Can Şener, Selçuk Şahin, Abdullah Hızır Yavuzsan, Fatih Gökhan Akbay, Süheyla Apaydın
      Abstract: ObjectiveTo compare the outcomes of the first 40 cases who underwent robotic kidney transplantation (RKT) with those of the first 40 cases who underwent open kidney transplantation (KT) in the Dr. Sadi Konuk Training Hospital.Material and MethodsBetween January 2016 and February 2017, we prospectively collected the data of the first 40 RKT cases (RKT group) and compared them with those of the first 40 open KT cases (OKT group). Comparisons were made using One-way ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi-square or Fisher Exact test for categorical variables.ResultsThere were 40 patients in the RKT group and 40 in the OKT group. Below are some statistics of the RKT group: mean operative time - 265.375±46.63 minutes; console time - 180.25±35.26 minutes; total ischemia time - 96.7±30.02 minutes, rewarming time - 54.70±17.80 minutes, and estimated blood loss - 182.25±55.26 ml. Some of the statistics taken from the OKT group are as follows: operative time - 250.25±41 minutes (p=0.129), total ischemia time - 71.79±8.55 minutes (p
      PubDate: 2017-09-16T10:10:23.444459-05:
      DOI: 10.1111/bju.14014
  • Perioperative Allogeneic Blood Transfusion Does Not Adversely Impact
           Oncological Outcomes After Radical Cystectomy for Urinary Bladder Cancer
           – a Propensity Score-weighted European Multicenter Study
    • Authors: Malte W. Vetterlein; Philipp Gild, Luis A. Kluth, Thomas Seisen, Michael Gierth, Hans-Martin Fritsche, Maximilian Burger, Chris Protzel, Oliver W. Hakenberg, Nicolas von Landenberg, Florian Roghmann, Joachim Noldus, Philipp Nuhn, Armin Pycha, Michael Rink, Felix K.-H. Chun, Matthias May, Margit Fisch, Atiqullah Aziz
      Abstract: ObjectivesTo evaluate the effect of perioperative blood transfusion (PBT) on recurrence-free survival (RFS), overall survival (OS), cancer-specific mortality (CSM), and other-cause mortality (OCM) in patients undergoing radical cystectomy (RC), utilizing a contemporary European multicenter cohort.Patients and MethodsThe PROspective MulticEnTer RadIcal Cystectomy Series (PROMETRICS) includes data on 679 patients who underwent RC at 18 European tertiary care centers in 2011. The association between PBT and oncological survival outcomes was assessed using Kaplan-Meier, Cox regression, and competing-risks analyses. Imbalances in clinicopathological features between patients receiving PBT vs. not were mitigated using conventional multivariable adjusting as well as inverse probability of treatment weighting (IPTW).ResultsOverall, 611 patients had complete information on PBT, and 315 (51.6%) received PBT. The two groups (PBT vs. no PBT) differed significantly with respect to most clinicopathological features including perioperative blood loss (median: 1000ml; IQR: 600-1500ml vs. median: 500ml; IQR: 400-800ml; P
      PubDate: 2017-09-14T03:12:05.268533-05:
      DOI: 10.1111/bju.14012
  • Multi-centre, prospective evaluation of the Seldinger technique for
           difficult male urethral catheter insertions by non-urology trained doctors
    • Authors: Yuigi Yuminaga; Jonathan Kam, Mark Louie-Johnsun
      Abstract: ObjectiveTo evaluate the safety and effectiveness of the Seldinger technique by non-urology trained (NUT) doctors for difficult male indwelling urinary catheter (IDC) insertions.Patients and MethodsIn all, 115 patients and 57 participating NUT doctors were recruited by the urologist or urology registrar, when contacted in regards to failed IDC insertion. The successful passage of an IDC by the NUT doctors using the Seldinger technique with a straight, hydrophilic guidewire was assessed in our prospective, multicentre evaluation. Instruction of this technique was via bedside teaching by the urology registrar or via video media.ResultsThe 115 patients, involving 57 NUT doctors, were prospectively evaluated across four sites; 93% (107/115) of cases had successful placement of an IDC with the Seldinger technique by a NUT doctor. No complications with the Seldinger technique were recorded. In 80 patients (69.6%), the technique was successfully performed by a NUT doctor without attendance by a urologist or urology registrar, with instruction provided from video media or prior bedside teaching by the urology registrar.ConclusionsOur study is the first to validate the safety and effectiveness of the Seldinger technique for difficult male IDC insertion performed by NUT doctors. This technique can be taught via video education and thus has important implications for health services where urological support is not readily available.
      PubDate: 2017-09-05T07:11:47.646609-05:
      DOI: 10.1111/bju.13928
  • Association between Metabolic Syndrome and intravesical prostatic
           protrusion in benign prostatic enlargement patients with lower urinary
           tract symptoms (MIPS Study)
    • Authors: G I Russo; F. Regis, P. Spatafora, J. Frizzi, D. Urzì, S. Cimino, S. Serni, M. Carini, M. Gacci, G. Morgia
      Abstract: ObjectiveTo investigate the association between metabolic syndrome (MetS) and morphological features of benign prostatic enlargement (BPE), including total prostate volume (TPV), transitional zone volume (TZV) and intra vesical prostatic protrusion (IPP).Patients and MethodsFrom January 2015 to January 2017, 224 consecutive men older than 50 years presenting with lower urinary tract symptoms (LUTS) suggestive of BPE were recruited in this multicentre cross-sectional study. MetS was defined according to international diabetes federation criteria. Multivariate linear and logistic regression models were performed to verify factors associated with IPP, TZV and TPV.ResultsPatients with MetS showed significantly increase of IPP (p
      PubDate: 2017-09-05T02:40:25.145645-05:
      DOI: 10.1111/bju.14007
  • Time on androgen deprivation therapy and adaptations to exercise:
           secondary analysis from a 12-month randomized controlled trial in men with
           prostate cancer
    • Authors: Dennis R. Taaffe; Laurien M. Buffart, Robert U. Newton, Nigel Spry, James Denham, David Joseph, David Lamb, Suzanne K. Chambers, Daniel A. Galvão
      Abstract: ObjectivesTo explore if duration of prior exposure to androgen deprivation therapy (ADT) in men with prostate cancer (PCa) undertaking a yearlong exercise program moderates the exercise response on body composition and muscle performance. In addition, we explored the moderator effect of baseline testosterone, time since ADT, and baseline value of the outcome.Patients and MethodsIn a multicenter randomized controlled trial, 100 patients previously treated for either 6 months (short-term) or 18 months (long-term) ADT in combination with radiotherapy as part of the TROG 03.04 RADAR trial were randomized to 6 months supervised exercise followed by a 6-month home-based maintenance program, or to printed physical activity educational material for 12 months across 13 university-affiliated exercise clinics in Australia and New Zealand. Patients were long-term PCa survivors with a mean age of 71.7 ± 6.4 years, and were assessed for lower extremity performance (repeated chair rise) with a subset (n=57) undergoing additional measures for upper- and lower-body muscle strength and body composition [lean mass, fat mass, appendicular skeletal muscle (ASM)] by dual X-ray absorptiometry. Data were analysed using generalized estimating equations (GEE).ResultsTime on ADT significantly moderated the exercise effects on chair rise (βinteraction= -1.3s, 95% CI= -2.6; 0.0), whole body lean (βinteraction= 1194g, 95% CI= 234; 2153) and ASM (βinteraction= 562g, 95% CI= 49; 1075) mass, and approached significance for fat mass (βinteraction= -1107g, 95% CI= -2346; 132), with larger benefits for men previously on long-term ADT. At 6 months, the intervention effects on chair rise time -1.5 s (95% CI -2.5 to -0.5), whole body lean 824 g (95% CI 8 to 1640), ASM 709 g (95% CI 260 to 1158), and fat -1377 g (95% CI -2156 to -598) mass were significant for men previously on long-term ADT, but not for men on short-term ADT. At 12 months, intervention effects for men on long-term ADT remained significant for the chair rise with improved performance (-2.0 s, 95% CI -3.0 to -1.0) and increased ASM (537 g, 95% CI 153 to 921). Time on ADT did not moderate the exercise effects on muscle strength nor did time since ADT cessation moderate any intervention effects. Similarly, testosterone and baseline values of the outcome had negligible moderator effects.ConclusionsPCa patients previously treated long-term with ADT respond more favourably to exercise in terms of lower body muscle performance and body composition (lean and fat mass, and ASM) than those with short-term ADT exposure. As a result, men who were formerly on long-term androgen suppression regimens should be especially prescribed exercise medicine interventions to alleviate residual treatment-related adverse effects.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-05T02:30:27.619669-05:
      DOI: 10.1111/bju.14008
  • Prospective Randomized Non-Inferiority Trial of Pelvic Drain Placement
           Versus No Pelvic Drain Placement after Robot-Assisted Radical
    • Authors: Avinash Chenam; Bertram Yuh, Ali Zhumkhawala, Nora Ruel, William Chu, Clayton Lau, Kevin Chan, Timothy Wilson, Jonathan Yamzon
      Abstract: ObjectivesTo determine if eliminating the prophylactic placement of a pelvic drain (PD) after robot-assisted radical prostatectomy (RARP) affects the incidence of early (90-day) postoperative adverse events.Materials and MethodsIn this parallel-group, blinded, non-inferiority trial, we randomized patients planning to undergo RARP to one of two arms: no drain placement (ND) or PD placement. Patients with demonstrable intra-operative leakage upon bladder irrigation were excluded. Randomization sequence was determined a-priori using a computer algorithm, and included a stratified design with respect to low vs. intermediate/high D'Amico risk classifications. Surgeons remained blinded to the randomization arm until final eligibility was verified at the end of the RARP. The primary endpoint was overall incidence of 90-day complications which, based on our standard treatment using PD retrospectively, was estimated at 13%. The non-inferiority margin was set at 10%, and the planned sample size was 312. An interim analysis was planned and conducted when 1/3 of the planned accrual and follow-up was completed, to rule out futility if the delta margin was in excess of 0.1389.ResultsFrom 2012 to 2016, 189 patients were accrued to the study, with 92 patients allocated to the ND group and 97 patients allocated to the PD group. Due to lower than expected accrual rates, accrual to the study was halted by regulatory entities, and we did not reach the intended accrual goal. ND and PD groups were comparable in median PSA (6.3 vs 5.8 respectively, p=0.5), clinical stage (p=0.8), D'Amico risk classification (p=0.4), median lymph nodes dissected (17 vs 18, p=0.2) and proportion of patients receiving an extended pelvic lymph node dissection (70.7% vs 79.4% respectively, p=0.3). Incidence of 90-day overall and major (Clavien ≥ III) complications in the ND group (17.4% and 5.4%, respectively) was not inferior to the PD group (26.8% and 5.2%, respectively; p=0.0008 and p=0.007 for difference of proportions
      PubDate: 2017-09-05T02:25:34.489532-05:
      DOI: 10.1111/bju.14010
  • Effects of Thiazolidinedione in Patients with Active Bladder Cancer
    • Authors: Roger Li; Michael J. Metcalfe, J.E. Ferguson 3rd, Sharada Mokkapati, Graciela M. Nogueras González, Colin P. Dinney, Neema Navai, David J. McConkey, Sunil K. Sahai, Ashish M. Kamat
      Abstract: ObjectiveTo examine the influence of perioperative thiazolidinedione (TZD) on cancer-specific outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma (UC).Design, Setting, and ParticipantsA retrospective cohort of 173 diabetic patients undergoing RC from 2005 to 2010 was identified. Of those, 53 were on TZD treatment at the time of surgery, with 33 patients taking pioglitazone. Baseline clincopathologic characteristics, as well as cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were compared between the patients on and off of TZD at the time of RC. In subgroup analysis, outcomes in patients specifically taking pioglitazone at the time of surgery were compared to those not on TZD.ResultsBaseline clinicopathologic characteristics were similar between patients on and off of TZD treatment at the time of RC. Overall, the median CSS rate was not reached in either group (p=0.7). The estimated 5-year CSS was 67.8% in the non-TZD group and 66.3% in the TZD group. On multivariate analysis incorporating patient age, pathologic T staging, and adjuvant chemotherapy, TZD use was found not to be a significant predictor for CSS (HR 1.20; 95% CI, 0.66-2.17, p=0.5). Additionally, recurrence free survival (RFS) (p=0.3) and OS (p=0.2) were also similar between the two groups without adjusting for other variables. Comparison between patients taking pioglitazone vs. patients not taking TZD yielded similar CSS (p=0.2), RFS (p=0.5), and OS (p=0.2).ConclusionsCSS, as well as RFS and OS after RC were not compromised in patients on TZD therapy at the time of RC. Additional investigation is warranted in non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) patients undergoing bladder sparing procedures to assess the safety of using TZD in the setting of active UC.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-05T02:25:33.093526-05:
      DOI: 10.1111/bju.14009
  • Analysis of Survival for Patients with Chronic Kidney Disease Primarily
           Related to Renal Cancer Surgery
    • Authors: Jitao Wu; Chalairat Suk-Ouichai, Wen Dong, Elvis Caraballo Antonio, Ithaar H. Derweesh, Brian R. Lane, Sevag Demirjian, Jianbo Li, Steven C. Campbell
      Abstract: ObjectivesTo evaluate predictors of long-term survival for patients with chronic kidney disease primarily due to surgery (CKD-S). Patients with CKD-S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort.Patients and MethodsFrom 1997-2008, 4,246 patients underwent RCS at our center. Median follow-up was 9.4 years (IQR=7.3-11.0). New baseline GFR was defined as highest GFR between nadir and 6 weeks after surgery. We retrospectively evaluated 3 cohorts: no-CKD (new baseline GFR≥60ml/min/1.73m2); CKD-S (new baseline GFR
      PubDate: 2017-08-21T04:51:21.956367-05:
      DOI: 10.1111/bju.13994
  • Does robot-assisted radical prostatectomy benefit prostate cancer patients
           with bone oligometastases'
    • Authors: Won Sik Jang; Myung Soo Kim, Won Sik Jeong, Ki Don Chang, Kang Su Cho, Won Sik Ham, Koon Ho Rha, Sung Joon Hong, Young Deuk Choi
      Abstract: ObjectiveTo investigate perioperative and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in oligometastatic prostate cancer (PCa).Patients and MethodsWe retrospectively reviewed the records of 79 oligometastatic PCa patients treated with RARP or ADT between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated perioperative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models.ResultsRARP-treated patients showed comparable postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than those of ADT-treated patients. PFS and CSS were improved in RARP-treated, compared with ADT-treated, patients (median PFS: 75 vs. 28 months, p = 0.008; median CSS: not reached vs. 40 months, p = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR] = 0.388, p = 0.003; CSS: HR = 0.264, p = 0.004).ConclusionsWe demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. However, our study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa. Therefore, to confirm our findings, large, prospective, multicenter studies are required.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-21T04:45:40.115888-05:
      DOI: 10.1111/bju.13992
  • A more extended lymph node dissection template at radical prostatectomy
           detects metastases in the common iliac region and in the fossa of Marcille
    • Authors: Lydia Maderthaner; Marc A. Furrer, Urs E. Studer, Fiona C. Burkhard, George N. Thalmann, Daniel P. Nguyen
      Abstract: ObjectivesTo assess the effect of adding lymph nodes (LN) located along the common iliac vessels and in the fossa of Marcille to the extended pelvic lymph node dissection (PLND) template at radical prostatectomy (RP).Patients and MethodsAt a referral center, RP and PLND were undergone by 485 patients from 2000 to 2008 (historical cohort: classical extended PLND template) and 268 patients from 2010 to 2015 (contemporary cohort: extended PLND template including LN located along the common iliac vessels and in the fossa of Marcille). Descriptive analyses compared baseline, pathologic, complication and functional data between the two cohorts. A logistic regression model assessed the template's effect on probability of detecting LN metastases.ResultsAmong 80 pN+ patients in the historical cohort, sole location of metastasis was external iliac/obturator fossa in 23 (29%), and internal iliac in 18 (23%), while 39 (49%) had metastases in both locations. Among 72 pN+ patients in the contemporary cohort, sole location of metastasis was external iliac/obturator fossa in 17 (24%), internal iliac in 24 (33%), and common iliac in 1 (1%), while 30 (42%) had metastases in>1 location (including fossa of Marcille in 5 patients). Among all 46 patients in the contemporary cohort with ≤2 metastases, 3 had one or both metastases in the common iliac region or the fossa of Marcille.Adjusted probability of detecting LN metastases was higher, but not significantly so, in the contemporary cohort. There were no differences between the two cohorts in complication and functional outcomes.ConclusionA more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications. However, the overall probability of detecting LN metastases was not significantly higher.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-21T04:45:27.174282-05:
      DOI: 10.1111/bju.13993
  • Feasibility and safety of focal irreversible electroporation as salvage
           treatment for localized radio-recurrent prostate cancer
    • Authors: Matthijs J. Scheltema; Willemien den Bos, Amila R. Siriwardana, Anton M.F. Kalsbeek, James E. Thompson, Francis Ting, Maret Böhm, Anne-Maree Haynes, Ron Shnier, Warick Delprado, Phillip D. Stricker
      Abstract: ObjectivesTo evaluate the feasibility, safety, early quality of life (QoL) and oncological outcomes of salvage focal irreversible electroporation (IRE) for radio-recurrent prostate cancer (PCa).Patients and methodsPatients with localized, radio-recurrent PCa without evidence of metastatic or nodal disease were offered focal IRE following the consensus guidelines. Patients with a minimum follow-up of 6 months were eligible for analysis. Adverse events were monitored using the NCI Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Patient-reported QoL data was collected at baseline, 6 weeks, 3, 6 and 12 months using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and SF-12 Physical and Mental Component Summary (SF12-physical/SF12-mental) questionnaires. Oncological control was evaluated with serial prostate-specific antigen (PSA), 6-months multiparametric MRI (mpMRI) and 12-months prostate biopsy. Wilcoxon's Signed Rank Test was used to assess QoL differences over time in paired continuous variables.ResultsA total of 18 patients were included for analysis. The median follow-up was 21 months. No high-grade adverse events (CTCAE>2) or recto-urethral fistula occurred. There were no statistically significant declines observed in QoL outcomes (n=11) on the EPIC Bowel domain (p=0.29), AUA symptom score (p=0.77), SF12-physical (p=0.17) and SF12-mental (p=0.77) questionnaires. At 6 months salvage patients experienced a decline in EPIC sexual domain (median of 38 to 24, p=0.028) and urinary domain (median of 96 to 92, p=0.074). Pad-free continence and erections sufficient for intercourse were preserved in 73% (n=8/11) and 33% (n=2/6) at 6 months, respectively. The mpMRI was clear in 85% (n=11/13), with two single out-field lesions (true-positive and false-positive, respectively). Median nadir PSA was 0.39 μg/L (IQR 0.04-0.43). A total of 3 (17%) and 4 (22%) patients experienced biochemical failure using the Phoenix and Stuttgart definitions of biochemical failure, respectively. 80% (n=8/10) of the patients were clear of any PCa on follow-up biopsy, whereas 2 patients had significant PCa on follow-up biopsy (ISUP 5).ConclusionOur short-term safety, QoL and oncological control data demonstrate that focal IRE is a feasible salvage option for localized radio-recurrent PCa. A prospective multi-centre study (FIRE-trial) has been initiated that will provide further insight in the ability of focal IRE to obtain oncological control of radio-recurrent PCa with acceptable patient morbidity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-21T01:05:18.657917-05:
      DOI: 10.1111/bju.13991
  • Management of metastatic prostate cancer in the elderly: identifying
           fitness for chemotherapy in the post STAMPEDE world
    • Authors: A Thompson; M J Beresford, P Sarmah, E R Jefferies
      Abstract: The relative proportion of>75 is expected to double over the next 25 years and older men are more likely to be diagnosed with advanced disease. Meta-analysis of the eagerly awaited CHAARTED, STAMPEDE and GETUG15 trials have shown that men with newly diagnosed hormone sensitive metastatic prostate cancer (mPCa) who were treated with docetaxel in addition to ADT, showed a 9% absolute overall survival benefit at 4 years1. As such, European Association of Urology (EAU) guidelines recommend that newly diagnosed mPCa should be treated with castration plus docetaxel chemotherapy ‘provided the patient is fit enough’. However, this assessment of fitness for chemotherapy remains a clinical stumbling block.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-19T05:00:20.583005-05:
      DOI: 10.1111/bju.13990
  • Multi-Parametric Magnetic Resonance Imaging (mpMRI) Identifies Significant
           Apical Prostate Cancers
    • Authors: Alexander P. Kenigsberg; Tsutomu Tamada, Andrew B. Rosenkrantz, Elton Llukani, Fang-Ming Deng, Jonathan Melamed, Ming Zhou, Herbert Lepor
      Abstract: ObjectiveTo determine if multiparametric MRI (mpMRI) identifies significant apical disease, thereby informing decisions regarding preservation of the membranous urethra.Materials and MethodsMen undergoing radical prostatectomy between January 2012 and June 2016 who underwent a 12-core transrectal-ultrasound guided systematic biopsy, preoperative 3-T MRI, and sectioning of the prostate specimen with tumor foci mapping were extracted from a single surgeon's prospective longitudinal outcomes database. Apical systematic biopsy vs. mpMRI lesion were compared for predicting aggressive tumor in the prostatic apex defined as Prostate Cancer Grade Group>1.ResultsOf the 100 men who met eligibility criteria, 43 (43%) exhibited aggressive prostate cancer in the distal 5mm of the apex. A Likert score> 2 in the apical one-third of the prostate was found to be more reliable than any cancer found on apical systematic biopsy at detecting aggressive cancer in the apex. On multivariate regression that included Likert score in the apex, age, PSA, prostate size, and presence of any cancer on apical biopsy, only Likert score (p=.005) and PSA (p=.025) were significant and independent predictors of aggressive cancer in the distal apex.ConclusionMRI is superior to systematic biopsy at identifying aggressive prostate cancer within the distal prostatic apex and may be useful for planning the extent of apical preservation during prostatectomy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:30:30.19329-05:0
      DOI: 10.1111/bju.13987
  • Female Urethral Injuries Associated with Pelvic Fracture: A Systematic
           Review of the Literature
    • Authors: Devin N. Patel; Cynthia S. Fok, George D. Webster, Jennifer T. Anger
      Abstract: ObjectivesTo systematically review the literature of female urethral injuries associated with pelvic fracture and determine optimal management of this rare injury.Materials and MethodsUsing Meta-analysis Of Observational Studies in Epidemiology criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female pelvic fracture urethroplasty,” “female urethral distraction,” “female pelvic fracture urethral injury,” “female pelvic fracture urethra girls.” Two reviewers (CF, DP) independently reviewed the titles, abstracts, and articles in duplicate.ResultsWe identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review. There were 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair, with 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair.ConclusionsThe optimal management of female urethral distraction defects is based on very low quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is hemodynamically stable appears optimal.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:30:20.661599-05:
      DOI: 10.1111/bju.13989
  • Controlled release of IGF1 enhances urethral sphincter function and
           histological structure in the treatment of female stress urinary
           incontinence in a rodent model
    • Authors: Hao Yan; Liren Zhong, Yaodong Jiang, Jian Yang, Junhong Deng, Shicheng Wei, Emmanuel Opara, Anthony Atala, Xiangming Mao, Margot Damaser, Yuanyuan Zhang
      Abstract: ObjectivesStress urinary incontinence (SUI) diminishes the quality of life of millions, particularly women who have delivered vaginally, which can injure the urethral sphincter. Despite several well-established treatments for SUI, growth factor therapy might provide an alternative to promote urethral sphincter repair. The goal of this study was to determine the effects of controlled release of IGF1 from alginate-poly-L-ornithine-gelatin microbeads (IGF1-A-PLO-G microbeads) on sphincter tissue regeneration in a rat model of SUI.Materials and MethodsForty-four female SD rats were randomized into 4 groups: vaginal distension followed by periurethral injection of IGF1-A-PLO-G beads (VD+IGF1 microbeads): 1x104 beads/1 ml normal saline; VD+empty microbeads; VD+saline; or sham VD+saline (sham).ResultsUrethral function (leak point pressure, LPP) was significantly decreased 1 week after VD+saline (23.9 ± 1.3 cmH2O) or VD+empty microbeads (21.7 ± 0.8 cmH2O) compared to the sham group (44.4 ± 3.4 cmH2O; p
      PubDate: 2017-08-14T06:25:36.99069-05:0
      DOI: 10.1111/bju.13985
  • Chipping away at the body politic one study at a time: the case for more
           “unprofessional” online content
    • Authors: Christopher E. Bayne; Benjamin J. Davies
      Abstract: Koo et al's recent paper[1] on unprofessional online content among US urology residency graduates has received attention in the lay press and social media outlets. The paper has an Altmetric Attention score of 341[2]—good for the fifth-most online-cited paper the BJUI has ever published. Seventeen news outlets have reported the study, including MSN, Medscape, and US News & World Report.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:25:29.267848-05:
      DOI: 10.1111/bju.13986
  • Microvascular and lymphovascular tumor invasion are associated with poor
           prognosis and metastatic spread in renal cell carcinoma: A validation
           study in clinical practice
    • Authors: Jens Bedke; Johannes Heide, Silvia Ribback, Steffen Rausch, Michela Martino, Marcus Scharpf, Andrea Haitel, Uwe Zimmermann, Maik Pechoel, Hussam Alkhayyat, Shahrokh F. Shariat, Frank Dombrowski, Arnulf Stenzl, Martin Burchardt, Tobias Klatte, Nils Kroeger
      Abstract: ObjectiveTo validate microvascular (MVI) and lymphovascular (LVI) invasion as a prognostic factor in renal cell carcinoma patients (pts.)Materials and MethodsData of patients with RCC who underwent radical or nephron sparing surgery were prospectively collected from three academic centers. The occurrence of MVI and LVI was determined with standard staining protocols by experienced pathologists at the time of diagnosis. The association of MVI and LVI with clinicopathological data, metastatic spread and cancer-specific survival (CSS) was evaluated with Fisher's exact tests, binary logistic regression analyses and univariable and multivariable Cox proportional hazard regression models.ResultsMVI was present in 201 of 747 (26.9%) pts. and was associated with advanced TNM stages, high Fuhrman grades and sarcomatoid features (each p
      PubDate: 2017-08-13T04:35:19.351396-05:
      DOI: 10.1111/bju.13984
  • Focal irreversible electroporation as primary treatment for localized
           prostate cancer
    • Authors: Willemien van den Bos; Matthijs J. Scheltema, Amila R. Siriwardana, Anton M.F. Kalsbeek, James E. Thompson, Francis Ting, Maret Böhm, Anne-Maree Haynes, Ron Shnier, Warick Delprado, Phillip D. Stricker
      Abstract: ObjectivesTo determine the safety, quality of life (QoL) and short-term oncological outcomes of primary focal IRE for the treatment of localized prostate cancer. To identify potential risk factors for oncological failure.Patients and methodsPatients that met both the consensus guidelines on patient criteria and selection methods for primary focal therapy were eligible for analysis. Focal IRE was performed for organ-confined clinically significant PCa, being high-volume Gleason sum score 6 (ISUP grade 1) or any Gleason sum score 7 (ISUP grade 2-3). Oncologic, adverse event and QoL outcome data with a minimum of 6 months follow-up were analysed. Patient characteristics and peri-operative treatment parameters were compared for patients with and without oncological failure on follow-up biopsy. Wilcoxon's Signed Rank Test, Wilcoxon's Rank Sum Test and Chi-square test were used to assess statistically significant differences in paired continuous, unpaired continuous and categorical variables respectively.ResultsA total of 63 patients met all eligibility criteria and were included for final analysis. No high-grade adverse events occurred. Quality of life questionnaire analysis demonstrated no significant change in physical (p=0.81), mental (p=0.48), bowel (p=0.25) and both urinary QoL domains (p=0.41 and p=0.25); there was a mild decrease in the sexual QoL domain (median score 66 at baseline vs 54 at 6 months, p=0.0003). Compared to baseline PSA, a decline of 70% (1.8, IQR 0.96-4.8) was seen between 6-12 months. A narrow safety margin (p=0.047) and system errors (p=0.010) were identified as potential early risk factors for in-field oncological failure. In-field and whole-gland oncological control on follow-up biopsies was 84% (38/45) and 76% (34/45); this increased to 97% (38/39) and 87% (34/39) when patients treated with a narrow safety margin and system errors were excluded.ConclusionOur data supports the safety and feasibility of focal IRE as a primary treatment for localized PCa with effective short-term oncological control in carefully selected men.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-10T14:30:30.66946-05:0
      DOI: 10.1111/bju.13983
  • Evaluation of a needle disinfectant technique to reduce infection-related
           hospitalization following transrectal prostate biopsy
    • Authors: Gregory B. Auffenberg; Ji Qi, Yuqing Gao, David C. Miller, Zaojun Ye, Andrew Brachulis, Susan Linsell, Tejal N. Gandhi, David Kraklau, James E. Montie, Khurshid R. Ghani,
      Abstract: ObjectivesTo determine whether a needle disinfectant technique during transrectal prostate biopsy is associated with lower rates of infection-related hospitalization.Subjects and MethodsWe conducted a retrospective analysis of all transrectal prostate biopsies performed across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 through March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalizations based on whether or not a needle disinfectant technique was utilized. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalizations within 30 days of biopsy. Generalized estimating equation (GEE) models were fit to adjust for potential confounders.ResultsDuring the evaluated period, 17,954 biopsies were performed with 5,321 (29.6%) including a disinfectant technique. The observed rate of infection-related hospitalization was lower when a disinfectant technique was utilized at biopsy (0.60% vs. 0.90% without disinfectant technique, p=0.04). After accounting for differences between groups the adjusted hospitalization rate in the disinfectant group was 0.85% (vs. 1.12%), (adjusted OR 0.76, 95% CI 0.50 -1.15, p= 0.19).ConclusionsIn this observational analysis, hospitalizations for infectious complications were less common when the procedure included a needle disinfection technique. However, after adjusting for potential confounders the impact of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimize infectious complications.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-10T11:20:20.074208-05:
      DOI: 10.1111/bju.13982
  • Cyclic AMP-Dependent Post-Translational Modification of Neuronal Nitric
           Oxide Synthase Neuroprotects Penile Erection in Rats
    • Authors: Serkan Karakus; Biljana Musicki, Justin D. La Favor, Arthur L. Burnett
      Abstract: ObjectivesTo evaluate nNOS phosphorylation, nNOS uncoupling, and oxidative stress in the penis and major pelvic ganglia (MPG), before and after the administration of the cAMP-dependent protein kinase A (PKA) agonist colforsin in a rat model of bilateral cavernous nerve injury (BCNI) which mimics nerve injury following prostatectomy.Materials and MethodsAdult male Sprague–Dawley rats were divided into BCNI and sham groups. Each group included 2 subgroups: vehicle and colforsin (0.1 mg/kg/day i.p.). After 3 days, erectile function (intracavernosal pressure) was measured and penes and MPG were collected for molecular analyses of phospho(P)-nNOS (Ser-1412 and Ser-847), total nNOS, nNOS uncoupling, binding of neuronal nitric oxide synthase (PIN) to nNOS, gp91phox subunit of NADPH oxidase, active caspase 3, PKA catalytic subunit alpha (PKA-Cα) (by Western blot) and oxidative stress (hydrogen peroxide [H2O2] and superoxide by Western blot and microdialysis method).ResultsErectile function was decreased 3 days after BCNI and normalized by colforsin. nNOS phosphorylation on both positive (Ser-1412) and negative (Ser-847) regulatory sites, and nNOS uncoupling, were increased after BCNI in the penis and MPG and normalized by colforsin. Hydrogen peroxide and total ROS productions were increased in the penis after BCNI and normalized by colforsin. Protein expression of gp91phox was increased in the MPG after BCNI and was normalized by colforsin treatment. Binding of PIN to nNOS was increased in the penis after BCNI and was normalized by colforsin treatment. Protein expression of active Caspase 3 was increased in the MPG after BCNI and was normalized by colforsin treatment. Protein expression of PKA-Cα was decreased in the penis after BCNI and normalized by colforsin.ConclusionCollectively, BCNI impairs nNOS function in the penis and MPG by mechanisms involving its phosphorylation and uncoupling in association with increased oxidative stress, resulting in erectile dysfunction. PKA activation by colforsin reverses these molecular changes and preserves penile erection in the face of BCNI.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-07T02:55:27.390659-05:
      DOI: 10.1111/bju.13981
  • Serous-lined, stapled pouch wall plication: initial results of a simple
           and quick novel continence mechanism in troubleshooting secondary to
           continent cutaneous urinary diversion
    • Authors: Hubertus Riedmiller; Arkadius Kocot, Charis Kalogirou
      Abstract: ObjectivesTo report a novel and straightforward technique of a secondary continent outlet for continent cutaneous urinary diversion (CCUD) reservoirs without the need for further bowel resection, reducing operation time and hospitalization.Patients And MethodsFrom 2015 to 2017, 6 patients with unreconstructable, incontinent outlets (out of a total pool of n=595 CCUD patients) have undergone the technique described here at our department. It relies on the Mitrofanoff principle, using a stapled full-thickness pouch wall plication, which creates a flap-valve continence mechanism.ResultsAll patients enjoyed full continence with ease of CIC in the postoperative period and on follow-up to a mean of 12,4 months (7-18 months). No major complications were encountered in all patients and the average capacity of the reservoirs was not compromised by the procedure (540 ml preoperatively vs. 500 ml in further follow-up).ConclusionIn revisional surgery for secondary CCUD incontinence - especially if the patient has already lost a significant amount of bowel or has previously undergone radiation therapy – the technique described here represents a safe and effective alternative to restore continence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-04T10:10:20.033634-05:
      DOI: 10.1111/bju.13979
  • Comparison between the detected and undetected lesions by template-guided
           transperineal saturation prostate biopsy
    • Authors: Zhipeng Mai; Yu Xiao, Weigang Yan, Yi Zhoua, Zhien Zhou, Zhiyong Liang, Zhigang Ji, Hanzhong Li
      Abstract: ObjectiveTo compare the characteristics of detected and undetected lesions by template-guided transperineal saturation prostate biopsy and evaluate the potential impact of undetected lesions.Materials and MethodsThis study evaluated the characteristics of lesions in radical prostatectomy (RP) specimens, compared the differences between detected and undetected lesions by systematic transperineal ultrasound guided 11-region biopsy in tumour volume, Gleason score, surgical margin, spatial location and clinical significance, and assessed the potential impact of undetected clinical significant lesions.ResultsThe median number of biopsy cores was 24. Sixty-four percent of the clinically significant lesions (170/264) were detected. There were significant differences between the detected and undetected lesions in tumour volume, Gleason score and clinical significance. The inconsistency of lesion position between biopsy and RP specimens in the anterior and posterior zones and the left and right sides were 3.4% (7/203) and 5.4% (11/203), respectively. Of the 129 patients, 13 (10.1%) had undetected clinically significant lesions in the biopsy lying on the same side but in a different zone from the detected clinically significant lesions, whereas 23 (17.8%) cases had undetected clinically significant lesions in the biopsy lying on the opposite side from the detected clinically significant lesions.ConclusionsTemplate-guided transperineal saturation prostate biopsy could detect about two-thirds of clinically significant lesions. Most of the undetected ones were those with small tumour volume. Approximately 20-30% of patients had undetected clinically significant lesions in a different lobe or quadrant comparing with the detected ones in the biopsy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-03T13:55:18.580125-05:
      DOI: 10.1111/bju.13977
  • Intradetrusor onabotulinumtoxinA injections for refractory neurogenic
           detrusor overactivity incontinence: Do we need urodynamic investigation
           for outcome assessment'
    • Authors: Miriam Koschorke; Lorenz Leitner, Helen Sadri, Stephanie C. Knüpfer, Ulrich Mehnert, Thomas M. Kessler
      Abstract: ObjectiveTo evaluate if urinary continence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed.Patients and MethodsA consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) incontinence were prospectively evaluated. Patients underwent UDI prior and 6 weeks after onabotulinumtoxinA injections. Primary outcome was the prevalence of maximum storage detrusor pressure>40 cmH2O in continent patients 6 weeks after treatment. Secondary outcomes were treatment effects on other clinical and video-urodynamic parameters.Results6 weeks after intradetrusor onabotulinumtoxinA injections, 98 (66%) of the 148 patients with NDO incontinence became continent. Of these patients, 18 (18%, confidence interval 12-27%) had a maximum storage detrusor pressure>40cmH2O. Gender, underlying neurological disorder and high storage detrusor pressures prior to treatment seem to increase the risk for poor urodynamic outcomes.ConclusionsUrinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, since high intravesical pressures threatening the upper urinary tract might be missed in a relevant percentage of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-03T13:50:19.076503-05:
      DOI: 10.1111/bju.13976
  • Comparison between target MRI in-gantry and cognitive target transperineal
           or transrectal guided prostate biopsies for PIRADS 3-5 MRI lesions
    • Authors: A J Yaxley; J W Yaxley, I Thangasamy, E Ballard, M Pokorny
      Abstract: ObjectiveTo compare the detection rates of prostate cancer in men with PIRADS 3-5 abnormalities on 3T mpMRI using in-bore MRI guided biopsy (MRGB) compared to cognitively directed transperineal biopsy (cTP) and transrectal (cTRUS).MethodsThis is a retrospective single centre study of consecutive men attending the private practice clinic of an experienced urologist performing MRGB and an experienced urologist performing cTP and cTRUS biopsy techniques for PIRADS 3-5 lesions identified on 3T mpMRI. SPSS version 22 was used for statistical analysis.ResultsThere were 595 target mpMRI lesions from 482 men with PIRADS 3-5 regions of interest during 483 episodes of biopsy. The abnormal mpMRI target lesion was biopsied using the MRGB method for 298 biopsies, cTP method for 248 and by cTRUS for 49 biopsies. There was no significant difference in prostate cancer (CaP) detection between biopsy method in PIRADS 3 (48.9%, 40.0%, 44.4%), PIRADS 4 (73.2%, 81.0%, 85.0%) or PIRADS 5 (95.2, 92.0%, 95.0%) lesions. There was no significant difference in significant CaP detection between biopsy method in PIRADS 3 (42.2%, 30.0%, 33.3%), PIRADS 4 (66.8%, 66.0%, 80.0%) or PIRADS 5 (90.5%, 89.8%, 90.0%) lesions. There was no difference in CaP or significant CaP based on lesion location or size between the methods.ConclusionWe found no significant difference in the ability to detect CaP or significant CaP using targeted MRGB, cTP, cTRUS methods. Identification of an abnormal area on mpMRI appears more important in increasing the detection of prostate cancer than the technique used to biopsy an MRI abnormality.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:20:30.611533-05:
      DOI: 10.1111/bju.13971
  • Large institutional variations in androgen deprivation therapy utilization
           with definitive radiotherapy in a population-based cohort of men with
           intermediate- and high-risk prostate cancer
    • Authors: Wee Loon Ong; Farshad Foroudi, Sue Evans, Jeremy Millar
      Abstract: ObjectiveTo evaluate the pattern of androgen deprivation therapy (ADT) utilization with definitive radiotherapy (RT) in men with prostate cancer (CaP) in a population-based study in AustraliaPatients and methodsThis is a prospective cohort of men with intermediate and high-risk CaP captured in the population-based Prostate Cancer Outcome Registry Victoria (PCOR-Vic) treated with definitive prostate RT between January 2010 and December 2015. The primary outcome of interest is ADT utilization. Chi-squared test for trend was used to evaluate temporal trend in ADT utilization over the study period. Multivariate logistic regressions were used to evaluate the effect of patient-, tumour-, treatment-factors, and treatment institutions (public/ private and metropolitan/ regional) on the likelihood of ADT utilization.Results1806 men were included in the study – 199 (11%) favourable NCCN intermediate risk (i.e. only one intermediate risk feature, primary Gleason grade 3, and
      PubDate: 2017-07-27T07:15:48.16045-05:0
      DOI: 10.1111/bju.13969
  • Impact of warm ischemia time on postoperative renal function after partial
           nephrectomy for clinical T1 renal cell carcinoma: a propensity score
           matched study
    • Authors: Hakmin Lee; Byung Do Song, Seok-Soo Byun, Sang Eun Lee, Sung Kyu Hong
      Abstract: ObjectivesTo preserve renal function, partial nephrectomy (PN) is recommended to patients with small renal masses. However, controversy still exists as to whether prolonged ischemia time adversely affects the incidence of chronic kidney disease (CKD) after PN. We analyzed the effect of prolonged warm ischemia time (WIT) on long-term renal function following PN.Materials and MethodsWe reviewed data from 1,816 patients who underwent PN for clinical T1 renal tumor. The propensity scores for prolonged WIT were calculated with shorter WIT group (< 30 minutes) matched to longer WIT group (≥ 30 minutes) in 1:2 ratio. Multivariate analysis was performed to determine independent predictors for occurrence of postoperative CKD [eGFR (estimated glomerular filtration rate < 60 mL/min/1.732] and major renal function deterioration (MRFD) (decrease of eGFR ≥ 25% postoperatively).ResultsAfter propensity score matching, there was no significant difference in CKD-free survival between the two WIT groups (p = 0.787). Furthermore, longer WIT did not show any significant associations with postoperative CKD-free survival (HR 1.002, 95% CI 0.989 – 1.015, p = 0.765) and MRFD-free survival (HR 1.014, 95% CI 1.000 – 1.028, p = 0.055). From further subgroup analyses using more detailed cut-off of WIT (≤20, 21-30, 31-40, 41-50, ≥50 minutes) and status of preoperative CKD, no significant differences were noted in CKD and MRFD-free survival among the subgroups (all p value> 0.05).ConclusionsProlonged WIT was not associated with increased incidence of CKD and MRFD after PN.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:15:28.818591-05:
      DOI: 10.1111/bju.13968
  • Ventral-Onlay Buccal Mucosa Graft Substitution Urethroplasty for Urethral
           Stricture in Females
    • Authors: Bashir. M. B. Mukhtar; Marco Spilotros, Sachin Malde, Tamsin J. Greenwell
      Abstract: ObjectiveTo present our outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating female urethral stricture (FUS).Patients and MethodsA review of a prospectively collected database of 22 consecutive women (median age 50 years, range 34-72) with urethral stricture having VOBMGSU since June 2012 and a minimum follow up of 6 months (median 21.5, range 6-51).Data was analysed for stricture recurrence, change in median peak free flow rate (Qmax) and median post-void residuals (PVR). Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test.ResultsFreedom from stricture recurrence was achieved in 21/22 (95.5%) women. Median Qmax significantly improved from 7 ml/s (range 3.5-11) to 18 ml/s (range 5-37) (p < 0.05). Median PVR significantly reduced from 100mls (range 0-300) to 15 mls (range 0-150) (p < 0.05). Short and longer-term complication rates were low. One patient developed mild de novo stress urinary incontinence, which settled with conservative measures by 6 months.ConclusionsEarly and medium term results indicate that VOBMGSU is an excellent treatment for female urethral stricture that can avoid the need for repeat procedures regularly required after traditional endoscopic management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:15:23.403119-05:
      DOI: 10.1111/bju.13970
  • Trifecta outcomes of robot-assisted partial nephrectomy in solitary
           kidney: A Vattikuti Collective Quality Initiative (VCQI) database analysis
    • Authors: Sohrab Arora; Ronney Abaza, James M. Adshead, Rajesh K. Ahlawat, Benjamin J. Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A. Moon, T B Yuvaraja, Umberto Capitanio, Alessandro Larcher, Francesco Porpiglia, James R. Porter, Alexander Mottrie, Mahendra Bhandari, Craig Rogers
      Abstract: ObjectivesTo analyze the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database.Patients and MethodsA total of 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centers in nine 9 countries. Out of these patients, 74 underwent RAPN in solitary kidney between 2007 and 2016. A retrospective analysis of the functional and oncological outcomes was performed. Trifecta was defined as a warm ischemia time of less than 20 minutes, negative surgical margins, and no complications intraoperatively or within 3 months of follow up.ResultsAll 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) minutes. Early unclamping was used in 11 (14.9%) cases, while zero ischemia was used in 12 (16.2%) cases. Trifecta outcomes were achieved in 38/66 (57.6%) of the patients. Median (IQR) ischemia time was 15.5 (8.75-20.0) minutes for the entire cohort. Overall complication rate was 24.1% and the rate of Clavien-Dindo ≤2 complications was 16.3%. Positive surgical margins were present in four cases (5.4%). Median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at three months was 7.0 ml/min/1.72m2 (11.01%).ConclusionOur findings suggest that RAPN is a safe and effective treatment option for select renal tumors in solitary kidneys in terms of a trifecta of negative surgical margins, warm ischemia time less than 20 minutes, and low operative and perioperative morbidity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:10:31.028689-05:
      DOI: 10.1111/bju.13967
  • Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) 5-Point Likert
           Scoring System Evaluated by The Result of MRI/Ultrasonography Image-fusion
           Targeted Biopsy of The Prostate
    • Authors: Toshitaka Shin; Thomas B. Smyth, Osamu Ukimura, Nariman Ahmadi, Andre Luis Castro Abreu, Chisato Ohe, Masakatsu Oishi, Hiromitsu Mimata, Inderbir S. Gill
      Abstract: ObjectiveTo evaluate the accuracy of MRI based Likert scoring system in detection of clinically significant prostate cancer (CSPC) using MRI/Ultrasonography (US) image-fusion targeted biopsy (FTB) as a reference standard.Patients and MethodsWe retrospectively reviewed 1218 MRI-lesions in 629 patients who underwent subsequent MRI/US FTB between 10/2012 and 8/2015. 3-Tesla MRI was independently reported by 1 of 8 radiologists with varying levels of experience and scored on a 5-point Likert scale. All of lesions with Likert 1-5 were prospectively defined as targets for MRI/US FTB. CSPC was defined as Gleason score ≥7.ResultsMedian patient age was 64 years, PSA level was 6.97ng/ml and estimated prostate volume was 52.2ml. Of 1218 lesions, 48% (n=581) were rated as Likert 1-2, 35% (n=428) were Likert 3 and 17% (n=209) were Likert 4-5. According to the Likert system of grading from 1 to 5, overall cancer detection rate were 12%, 13%, 22%, 50%, 59%, and CSPC detection rate were 4%, 4%, 12%, 33%, 48%, respectively. Grading of a 5-point scale showed strong positive correlation with overall cancer detection rate (r=0.949, p=0.05) and CSPC detection rate (r=0.944, p=0.05). In comparison between the more experienced radiologists for MRI-prostate and less experienced radiologists, statistical differences were noted in overall cancer detection rate (63% vs 35%, p=0.001) and CSPC detection rate (47% vs 29%, p=0.027) in Likert 4-5 lesions.ConclusionsThe detection rates of overall cancer and CSPC strongly correlated with a 5-point grading of the Likert scale. Among the radiologists with different levels of experience, there were significant differences in these cancer detection rates.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:10:24.750424-05:
      DOI: 10.1111/bju.13972
  • Transumbilical laparoendoscopic single-site radical prostatectomy and
           cystectomy with the aid of transurethral port: a feasibility study
    • Authors: Jian Su; Qingyi Zhu, Lin Yuan, Yang Zhang, Qingling Zhang, Yunfei Wei
      Abstract: ObjectiveOur aim was to describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site radical prostatectomy (LESS-RP) and cystectomy (LESS-RC) in a single institution.Materials and MethodsBetween December 2014 and March 2016, 114 cases were performed LESS-RP and LESS-RC, including LESS-RP (n=68), LESS-RC with cutaneous ureterostomy (LESS-RC/CU) (n=38) and LESS-RC with orthotopic ileal neobladder (LESS-RC/OIN) (n=8). Access was achieved via a single-port with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port (“Zhu's port”) was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The perioperative and postoperative data were collected and analyzed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects.ResultsAll the procedures were completed successfully. No conversion into conventional laparoscopic surgery was necessary. For LESS-RP, the average operative time was 152 min. Estimated blood loss was 117 ml. Mean hospital stay was 16.4 days after surgery. For LESS-RC/CU and LESS-RC/OIN, the average operative time was 215 min and 328 min, estimated blood loss was 175ml and 252ml, and mean hospital stay was 9.4 days and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intraoperative complications were occurred in two patients (1.75%), and postoperative complications in nine cases (7.89%). 14 out of 68 (20.6%) patients who underwent LESS-RP encountered positive surgical margins. Follow-up ranged from 10-30.6 months. In prostate cancer, good urinary control was observed in 35.3%,97.1% and 100% of the patients at 1 month, 6 months and 12 months after the operation.Biochemical recurrence(BCR) was observed in 11.8% patients. In bladder cancer, two patients had local recurrence and two patients had distant metastasis.ConclusionLESS-RP and LESS-RC are feasible and safe with the aid of transurethral port. Operating through the transurethral port might overcome the challenges posed by the single port laparoscopic approach.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-22T04:06:54.9371-05:00
      DOI: 10.1111/bju.13965
  • Implementation rates of uro-oncology multi-disciplinary meeting decisions
    • Authors: Ned Kinnear; Riley Smith, Derek B Hennessey, Damien Bolton, Shomik Sengupta
      Abstract: ObjectivesTo assess implementation rates of the consensus plans made at the uro-oncology multidisciplinary meeting (MDM) of an Australian tertiary centre, and analyse obstacles to implementation.MethodsA retrospective review was performed of all patients discussed at the uro-oncology MDM at our institution between 1 January to 30 June 2015.Rates of referral for MDM discussion following a new histological diagnosis of malignancy, categorised by tumour type, were assessed.Patient records were interrogated to confirm MDM plan implementation, with the outcomes examined being completion of MDM plan within 3 months and factors preventing implementation.ResultsDuring the enrolment period, from 291 uro-oncological procedures 240 yielded malignant histology, of which 160 (67%) were discussed at the MDM.Overall, 202 patients, including 32 females, were discussed at the uro-oncology MDM.MDM consensus plans were implemented in 184 (91.1%) patients.Reasons for deviation from the MDM plan included delay in care, patient deterioration or comorbidities, patient preference, consultant decision, loss to follow up and change in patient scenario due to additional new information.ConclusionThe MDM is increasingly important in the care of uro-oncology patients, with about two-thirds of new diagnoses currently captured.There appear to be few barriers to the implementation of consensus plans, with nearly all patients undergoing the recommended management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-18T02:57:51.205491-05:
      DOI: 10.1111/bju.13892
  • Chronic spinal cord injury causes up-regulation of serotonin (5-HT) 2A and
           2C receptors in lumbosacral cord motoneurons
    • Authors: Nailong Cao; Jianshu Ni, Xiaohu Wang, Hongjian Tu, Baojun Gu, Jiemin Si, Gang Wu, Karl-Erik Andersson
      Abstract: ObjectivesTo explore if the mechanism of the voiding dysfunction caused by spinal cord injury in rats can be improved by intravenous administration of the 5-HT2A/2C receptor agonist,
      DOI , and discuss whether it can be ascribed to serotonin 2A and 2C receptor up-regulation in lumbosacral cord motoneurons.Materials and MethodsFemale Sprague-Dawley rats were used, which were divided into two groups (Spinal cord injury group VS Normal control group). Under urethane anesthesia, cystometry was performed to examine the variation of urodynamic parameters before and after successive intrathecal administration of various doses of
      DOI into the lumbosacral cord. Additionally, the changes of serotonin 2A and 2C receptors in the lumbosacral cord were investigated by immunohistochemical staining and Western blot.ResultsCompared to controls, spinal cord injured rats had higher bladder capacity and post-void residual urine volume, and lower voiding efficiency. After spinal cord injury,
      DOI improved voiding efficiency likely via affecting external urethral sphincter activity. Immunohistochemical staining and Western blot analysis showed that serotonin 2A and 2C receptors were up-regulated in lumbosacral cord motoneurons.ConclusionIn rats with spinal cord injury,
      DOI can improve voiding efficiency, and this may be due to serotonin 2A and 2C receptor up-regulation in lumbosacral cord motoneurons controlling external urethral sphincter activity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T11:50:29.562316-05:
  • Baseline and Longitudinal Plasma Caveolin-1 Level as a Biomarker in Active
           Surveillance for Early Stage Prostate Cancer
    • Authors: Spyridon P. Basourakos; John W. Davis, Brian F. Chapin, John F. Ward, Curtis A. Pettaway, Louis L. Pisters, Neema Navai, Mary F. Achim, Xuemei Wang, Hsiang-Chun Chen, Seungtaek Choi, Deborah Kuban, Patricia Troncoso, Sam Hanash, Timothy C. Thompson, Jeri Kim
      Abstract: ObjectivesTo evaluate the role of caveolin-1 as a predictor of disease reclassification in men with early prostate cancer undergoing active surveillance.Patients and MethodsWe analyzed archived plasma samples prospectively collected from men with early prostate cancer in a single-institution active surveillance study. Of 825 patients enrolled, 542 had 1 or more years of follow-up. Baseline and longitudinal plasma caveolin-1 levels were measured using an enzyme-linked immunosorbent assay. Tumor volume or Gleason grade increases were criteria for disease reclassification. Logistic regression analyses assessed associations between clinicopathologic characteristics and reclassification risk.ResultsIn 542 patients, 480 (88.6%) had stage cT1c disease, 542 (100.0%) had a median prostate-specific antigen level of 4.1 ng/mL, and 531 (98.0%) had a median Cancer of the Prostate Risk Assessment score of 1. In all, 473 (87.3%) had a Gleason score of 3+3. After a median of 3.1 years’ follow-up, disease was reclassified in 163 (30.1%). Baseline caveolin-1 levels were 2.2±8.5 ng/mL (mean) and 0.2 ng/mL (range, 0–85.5 ng/mL) (median). In univariate analysis, baseline caveolin-1 was a significant predictor for risk of disease reclassification (OR, 1.82, 95% CI 1.24–2.65, p=0.002); in multivariate analysis, with adjustments for age, tumor length, group risk stratification, and number of positive cores, reclassification risk associated with caveolin-1 remained significant (OR 1.91, 95% CI 1.28–2.84, p=0.001).ConclusionBaseline plasma caveolin-1 level was an independent predictor of disease classification. New methods for refining active surveillance and intervention may result.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T11:50:27.165897-05:
      DOI: 10.1111/bju.13963
  • Erectile Function after Stereotactic Body Radiotherapy for Localized
           Prostate Cancer
    • Authors: Robert T. Dess; Holly E. Hartman, Nima Aghdam, William C. Jackson, Payal D. Soni, Ahmed E Abugharib, Simeng Suy, Neil B. Desai, Zachary S. Zumsteg, Rohit Mehra, Todd M. Morgan, Felix Y. Feng, Daniel A. Hamstra, Matthew J. Schipper, Sean P. Collins, Daniel E. Spratt
      Abstract: ObjectiveTo elucidate the functional erection rate following prostate stereotactic body radiotherapy (SBRT) and to develop a comprehensive prognostic model of outcomes following treatment.Patients and MethodsBetween 2008 and 2013, 373 consecutive men with localized prostate cancer were treated with SBRT at a single academic institution as part of a prospective clinical trial or prospective registry. Prospective longitudinal patient-reported quality of life (HRQOL) was collected using the Expanded Prostate Cancer Index Composite (EPIC-26). Functional erections were strictly defined as “firm enough for intercourse” per EPIC-26. Detailed comorbidity data were also collected. Logistic regression models were utilized to predict 24 month and 60 month functional erection rates. Observed erection rates post-SBRT were compared with other radiation modalities (external beam radiotherapy (EBRT) and brachytherapy) using prospectively validated models.ResultsMedian follow up was 56 months (interquartile-range 37-73); response rate at two years was 84%. For those with functional erections at baseline, 57% and 45% retained function at 24 and 60 months, respectively. On multivariable analysis (MVA) for 24-month erectile function, significant variables included higher baseline sexual HRQOL (adjust odds ratio (AOR) 1.55 per 10 points [95%CI 1.37-1.74], p
      PubDate: 2017-07-15T11:45:50.081915-05:
      DOI: 10.1111/bju.13962
  • Comparison of Perioperative and Functional Outcomes of Robotic Partial
           Nephrectomy for cT1a versus cT1b Renal Masses
    • Authors: Christopher R. Reynolds; Joan C. Delto, David Paulucci, Corey Weinstein, Ketan Badani, Daniel Eun, Ronney Abaza, James Porter, Akshay Bhandari, Ashok Hemal
      Abstract: ObjectivesTo compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy in a large multi-institutional study.Patients and MethodsThe present retrospective IRB approved multi-institutional study utilized a prospectively maintained database to identify patients undergoing robotic partial nephrectomy by 6 surgeons for a solitary cT1a (n=1307) or cT1b (n=377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and median follow-up of 12.2 months were compared in univariable and multivariable regression analyses adjusting for surgeon performing the procedure and date of surgery.ResultsIn univariable analysis, cT1b masses were associated with longer operative time (190.0 vs. 159.0 minutes, p
      PubDate: 2017-07-15T02:20:25.127366-05:
      DOI: 10.1111/bju.13960
  • Sleep disorders in patients with Erectile Dysfunction
    • Authors: O. Kalejaiye; Amr Abdel Raheem, A. Moubasher, M. Capece, S. McNeillis, A. Muneer, N Christopher, G. Garaffa, D. Ralph
      Abstract: ObjectivesTo assess the prevalence of OSA in men presenting with ED at a single centre.Subjects and methodsAll men attending a specialised andrology outpatient department with a new diagnosis of erectile dysfunction were included in this prospective study. All patients completed 3 questionnaires: International Index of Erectile Function (IIEF) and 2 sleep questionnaires. The sleep questionnaires used were the ‘OSA screening’ questionnaire and the Insomnia severity index’. Their ED management was subsequently undertaken in keeping with local and European guidelines. OSA diagnosis was made based on a score of 3 or more on the OSA screening questionnaire and those patients were referred for specialist management.ResultsBetween February and September 2016, one hundred and twenty-nine men completed the study questionnaires. An OSA score ≥ 3 on the OSA screening questionnaire was found in 55% (n=71) of the patients indicating a need for specialist sleep referral. Men who scored ≥ 3 on the OSA questionnaire were significantly older (61.4yrs vs. 46.5yrs; p
      PubDate: 2017-07-15T02:05:23.65621-05:0
      DOI: 10.1111/bju.13961
  • Chitosan Membranes application on the Prostatic Neurovascular Bundles
           following Robot-assisted Radical Prostatectomy: a phase II study
    • Authors: F. Porpiglia; R. Bertolo, C. Fiori, M. Manfredi, S. De Cillis, S. Geuna
      Abstract: ObjectiveTo evaluate the feasibility and the safety of the application of chitosan membranes on the neuro-vascular bundles after nerve-sparing Robot-Assisted Radical Prostatectomy (RARP). The secondary aim of the study was to report preliminary data and more particularly potency recovery data.Materials and MethodsSingle-center, single-arm prospective study. Enrolment from July 2015 to September 2016 of all patients with localized prostate cancer scheduled for RARP with IIEF-5 score> 17 after San Luigi Gonzaga Hospital Ethics Committee (Orbassano) approval (80/2015) and patient's acceptance. All patients underwent nerve-sparing RARP with application of Chitosan Membranes on the neuro-vascular bundles.Demographics, peri-operative, postoperative data and complications were evaluated. Potency recovery data were particularly evaluated. Specifically for the purpose of the study, any referred sign/symptom of local allergy/intolerance to the chitosan membranes was recorded and evaluated.ResultsHundred-forty patients underwent nerve-sparing RARP with chitosan membranes application on the neuro-vascular bundles. The application was easy in almost all the cases and did not compromise the safety of the procedure. None of the patients reported signs of intolerance/allergy attributable to the membranes.ConclusionIn our experience chitosan membranes application on the neuro-vascular bundles after nerve-sparing RARP was feasible and safe, without compromising the length, the difficulty and the complications rate of the “standard” procedure. No patients experienced signs of intolerance/allergy attributable to the membranes. Potency recovery data were encouraging. Comparative cohort would have added value to the study. The present paper was performed pre-CE mark achievement.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T02:00:26.536451-05:
      DOI: 10.1111/bju.13959
  • The new generation super-mini percutaneous nephrolithotomy (SMP) system: a
           step-by-step guide
    • Authors: Guohua Zeng; Wei Zhu, Yang Liu, Junhong Fan, Zhijian Zhao, Chao Cai
      Abstract: ObjectiveTo present our novel miniaturized endoscopic system and describe a step-by-step guide for successful implementation of the super-mini percutaneous nephrolithotomy (SMP).MethodsThe new-generation SMP endoscopic system consists of (i) a 40,000-pixel super-mini nephroscope with an 8.0 F outer diameter and 7.5 F inner diameter dismountable sheath (ii) and a newly designed irrigation-suction sheath available in either 12 F or 14 F.The irrigation-suction sheath is a two-layered metal structure. The key feature of the irrigation-suction sheath is to allow irrigation and suction respectively (the inflow through the space between the two layers of the sheath, the outflow through the central lumen of the sheath). This property could improve irrigation and stone clearance despite reduced instrument dimension.A total of 59 patients with renal stones underwent new-generation SMP between April 2016 and December 2016. The percutaneous tract dilatation was carried out to 14 F. Lithotripsy was performed using either holmium laser or pneumatic lithotripter. Stone fragments were sucked out by vacuum suctioning through the sheath. A nephrostomy tube or Double-J stent was placed only if clinically indicated. Low-dose CT was performed to assess the stone-free status on the morning after the procedure.ResultsThe mean stone burden was 2.4 cm. 9 of the 59 patients had diabetes, and 5 had hypertension.SMP was completed successfully in all patients with a mean operative duration of 32.9 min and a mean 13g/L hemoglobin decrease. The stone-free rate was 91.5%.Complications occurred in 5.1% of the patients, all of them were Clavien I (minor fever managed by antipyretic therapy), no transfusions were needed.ConclusionThe new-generation SMP system is safe, feasible, and efficient for managing renal calculi less than 3 cm with advantages of a small percutaneous tract, less blood loss, high efficacy for stone clearance, improved visual field, short operative time and ease of operating.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-10T08:46:47.450704-05:
      DOI: 10.1111/bju.13955
  • First-line vascular endothelial growth factor inhibitors for metastatic
           renal cell carcinoma and the impact of new agents entering the treatment
    • Authors: Rohit Jain; Saby George
      Abstract: Clinical trials assessing the safety and efficacy of new therapies versus standard of care (SOC) for advanced RCC (aRCC), which includes locally advanced and metastatic RCC (mRCC), are ongoing. The current first-line standards of care for the treatment of aRCC with clear cell histology are the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) sunitinib and pazopanib[1,2].This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-08T02:55:52.200801-05:
      DOI: 10.1111/bju.13954
  • Urological Complications: Learning from the Past and preparing for the
    • Authors: Nick Simson; Thomas Stonier, Ben J Challacombe
      Abstract: Historically, the medical profession has been poor at discussing adverse events. A defensive, closed culture existed for many years, culminating in wide scale loss of public trust. Numerous NHS scandals have emerged, uncovering a culture with little transparency. Thankfully, via lessons from the aviation industry, we have made great strides in the way we discuss and learn from complications, but there remains room for improvement. Classification of complications via the Clavien-Dindo system has allowed surgeons to compare themselves to others more accurately. Public reporting of surgical outcomes via BAUS aims to improve results in accordance with the well-known aphorism “the more we are watched, the better we behave”. Complication sessions at urological meetings are commonplace, and video recording of minimally invasive surgery has allowed us to capture surgical complications like never before. Clearly though, there is a long way to go. Public reporting certainly has its faults. Patient outcomes may be related to the wider multidisciplinary team rather than surgical proficiency alone, and there is ongoing debate regarding which outcomes to measure, and around individual surgeons’ case mix. In an era of social media, we must also learn to keep apace with new ways of sharing information. In openly discussing complications however, we have never been better.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T12:42:56.460981-05:
      DOI: 10.1111/bju.13948
  • Long-term oncological outcomes and toxicity in 597 men ≤60 years of age
           at time of low dose rate brachytherapy for localised prostate cancer
    • Authors: Stephen E.M. Langley; Ricardo Soares, Jennifer Uribe, Santiago Uribe-Lewis, Julian Money-Kyrle, Carla Perna, Sara Khaksar, Robert Laing
      Abstract: ObjectivesTo report oncological and functional outcomes of men treated with low dose rate (LDR) prostate brachytherapy who were 60 years old or younger at time of treatment.Patients and methodsOf 3,262 patients treated with LDR brachytherapy at our centre up to June 2016, we retrospectively identified 597 patients ≤60 years at treatment with at least three years post-implant follow-up and four PSA measurements of which one was the baseline. Overall disease-specific and relapse-free survival were analysed together with prospectively collected physician reported adverse events and patient reported symptom scores.ResultsMedian (range) age was 57 (44-60) years, median follow-up 8.9 (1.5-17.2) years and median PSA follow-up 5.9 (0.8-15) years. Low, intermediate and high-risk disease represented 53%, 37% and 10% of cases. Ten years post-implant overall and prostate cancer-specific survival were 98% and 99% for low-risk, 99% and 100% for intermediate and 93% and 95% for high-risk disease respectively. Ten years post-implant relapse free survival using the nadir plus 2 definition was 95%, 90% and 87% for low, intermediate and high-risk disease respectively. Urinary stricture was the most common genitourinary event observed in 19 (3.2%) patients. Preserved erectile function five years post-implant was observed in 75% of patients who were potent prior to treatment.ConclusionLDR brachytherapy is an efficacious treatment with long-term control of prostate cancer in men ≤60 years at time of treatment. It was associated with low rates of treatment related toxicity and can be considered a first line treatment for prostate cancer in this patient group.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:40:18.035476-05:
      DOI: 10.1111/bju.13946
  • Robotic Radical Perineal Cystectomy And Extended Pelvic Lymphadenectomy:
           Initial Investigation Using A Purpose-Built Single-Port Robotic System
    • Authors: Matthew J. Maurice; Jeremy Reese, Jihad H. Kaouk
      Abstract: ObjectivesTo assess the feasibility of perineal radical cystoprostatectomy using the latest generation purpose-built single-port robotic surgical system.Materials and methodsIn two male cadavers, the da Vinci SP1098 Surgical System was used to perform radical cystoprostatectomy and bilateral extended pelvic lymphadenectomy. New features in this model include enhanced high-definition three-dimensional optics, improved instrument maneuverability, and a real-time instrument tracking and guideance system. The surgery was accomplished through a 3-cm perineal incision via a novel robotic single-port system, which accomodates three double-jointed articulating robotic instruments, an articulating camera, and an accessory laparoscopic instrument. The primary outcomes were technical feasibility, intraoperative complications, and total robotic operative time.ResultsThe cases were completed successfully without conversion. There were no accidental punctures or lacerations. The robotic operative times were 197 and 202 minutes.ConclusionsIn this preclinical model, robotic radical perineal cystoprostatectomy and extended pelvic lympadenectomy was feasible using the SP1098 robotic platform. Further investigation is needed to assess the feasibility of urinary diversion using this novel approach and new technology.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:31:45.801258-05:
      DOI: 10.1111/bju.13947
  • Comparative Assessment of Efficacy of OnabotulinumtoxinA and Oral
           Therapies (Anticholinergics and Mirabegron) for Overactive Bladder: A
           Systematic Review and Network Meta-analysis
    • Authors: Marcus J Drake; Victor W Nitti, David A Ginsberg, Benjamin M Brucker, Zsolt Hepp, Rachael McCool, Julie M Glanville, Kelly Fleetwood, Daniel James, Christopher R Chapple
      Abstract: ObjectivesTo compare the efficacy of onabotulinumtoxinA, mirabegron, and anticholinergics in adults with idiopathic overactive bladder (OAB) using network meta-analysis (NMA).Subjects and MethodsInformation sources were searched for randomized blinded controlled trials, of at least 2 weeks duration, comparing any dose of onabotulinumtoxinA, eligible oral/transdermal anticholinergics, or mirabegron, with each other or placebo, in adults with OAB. Bayesian random-effects models were used to synthesize the results at week 12: NMA for responder analyses and network meta-regression (NMR) for change from baseline analyses. The NMR was used to adjust for differences in baseline severity between studies. Sensitivity analysis, excluding studies considered to be at a high risk of methodological bias, was conducted.Results56 randomized trials were included in the networks. For each outcome, results are reported for all licensed treatment doses. For each NMR, results are based on patients with an average number of episodes of the outcome at baseline. After 12 weeks, all treatments are more efficacious than placebo. Patients who received onabotulinumtoxinA (100U) had, on average, the greatest reductions in urinary incontinence episodes (UIE), urgency, and micturition frequency, and the highest odds of achieving decreases of 100% and ≥50% in the daily number of UIE. When comparing onabotulinumtoxinA with other pharmacotherapies, mean differences favoured onabotulinumtoxinA 100U over all comparators for UIE and urgency (credible intervals excluded zero) and all but two of the comparators for micturition frequency. OnabotulinumtoxinA 100U was also associated with higher odds of achieving a 100% and ≥50% decrease in daily UIE than most other licensed treatments in the network. The exclusion of studies with a high risk of bias had little impact on the conclusions.ConclusionThe results indicate that, after 12 weeks, onabotulinumtoxinA 100U provides greater relief of OAB symptoms compared with most other licensed doses of other pharmacotherapies in the network.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:25:33.545841-05:
      DOI: 10.1111/bju.13945
  • Delays in the diagnosis and initial treatment of bladder cancer in Western
    • Authors: Steve P. McCombie; Haider K. Bangash, Melvyn Kuan, Isaac Thyer, Fran Lee, Dickon Hayne
      Abstract: ObjectivesTo quantify and examine the aetiology of delays in the diagnosis and initial treatment of patients with bladder cancer in Western Australia.Subjects and MethodsAll attendances at a one-stop haematuria clinic at a public tertiary-level hospital in Western Australia between May 2008 and April 2014 were reviewed retrospectively. All patients diagnosed with a bladder tumour over this period were identified. These patients and their GPs were contacted retrospectively and invited to participate in telephone interviews, with additional data collected from clinical records as required. Waiting times to presentation, referral, assessment, and initial treatment were established for patients who presented with visible haematuria.ResultsOf 1365 attendances, 151 patients were diagnosed with a bladder tumour and 100 of these were both suitable and agreed to participate in the study. For patients with visible haematuria the median waiting time from initial bleeding to surgery was 69.5 days (range 9 - 1165). This was comprised of a median (range) pre-referral waiting time of 12 days (0 - 1137), assessment waiting time of 12.5 days (0 - 207), and treatment waiting time of 20 days (1 - 69). Reasons for prolonged waiting times included poor public awareness, patient fear and anxiety, delayed and non-referral from primary care, administrative delays, and resource limitations.ConclusionMany patients experience significant delay in the diagnosis and treatment of their bladder cancer in Western Australia, and this data likely reflects national trends. This concerning data warrants consideration of how delays can be reduced in order to improve outcomes for these patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-29T07:40:29.789705-05:
      DOI: 10.1111/bju.13939
  • Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive
           prostate cancer amenable to lesion ablative therapy
    • Authors: Aurélie De Bruycker; Bieke Lambert, Tom Claeys, Louke Delrue, Chamberlain Mbah, Gert De Meerleer, Geert Villeirs, Filip De Vos, Kathia De Man, Karel Decaestecker, Valérie Fonteyne, Nicolaas Lumen, Filip Ameye, Ignace Billiet, Steven Joniau, Friedl Vanhaverbeke, Wim Duthoy, Piet Ost
      Abstract: ObjectivesTo describe the anatomical patterns of PCa recurrence following primary therapy and investigate if patients with low-volume disease have a better prognosis as compared to their counterparts.Material and methodsPatients eligible for a F18-choline PET-CT were entered in a prospective cohort study. Eligible patients had an asymptomatic biochemical recurrence following primary PCa treatment and testosterone levels>50 ng/ml. The number of lesions were counted per scan. Patients with an isolated local recurrence or with up to 3 metastases (+/- local recurrence) were considered “low-volume” and patients with>3 metastases as high-volume. Descriptive statistics were used to report recurrences. Cox-regression analysis investigated the influence of prognostic variables on the time to developing castration resistant PCa (CRPC).ResultsIn 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed) (11%), viscera (4%) or a combination of any of the previous (37%). In total, 153 patients (74%) had a low-volume recurrence and 55 patients (26%) had a high-volume recurrence. The 3-year CRPC-free survival for the whole cohort was 79% (95% CI: 43 – 55%) and 88% for low-volume recurrences and 50% for high-volume recurrences, respectively (p
      PubDate: 2017-06-24T06:07:34.178756-05:
      DOI: 10.1111/bju.13938
  • Impact of Preoperative Calculation of Nephron Volume Loss on Future of
           Partial Nephrectomy Techniques; Planning a Strategic Roadmap for Improving
           Functional Preservation and Securing Oncological Safety
    • Authors: Koon Ho Rha; Ali Abdel Raheem, Sung Yul Park, Kwang Hyun Kim, Hyung Joon Kim, Kyo Chul Koo, Young Deuk Choi, Byung Ha Jung, Sang Kon Lee, Won Ki Lee, Jayram Krishnan, Tae Young Shin, Jin-Seon Cho
      Abstract: ObjectivesTo assess the correlation of resected and ischaemised volume (RAIV), which is preoperatively calculated volume of nephron loss (VNL), with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset.Subjects and MethodsWe identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robotic PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were utilised to identify the associations between various time points of PRF and RAIV as a continuous variable.ResultsMean RAIV was 24.2 ± 29.2 cm3. Mean preoperative eGFR and eGFRs at postoperative day 1, 6 months and 3 years follow-up was 91.0 and 76.8, 80.2 and 87.7 ml/min per 1.73 m2, respectively. In multivariable linear regression analysis, the amount of changes in PRF in long-term follow-up were significantly correlated with RAIV (β = 0.261, β = 0.165, β = 0.260 at postoperative day 1, 6 months and 3 years follow-up, respectively). This study has the limitation of its retrospective nature.ConclusionPreoperatively calculated RAIV significantly correlates with the amount of changes in PRF during long-term follow-up. RAIV could lead our research to the level of prediction of the amount of PRF decline. RAIV provides appropriate evidence to explain the technical advantages of emerging techniques.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-20T13:24:15.375778-05:
      DOI: 10.1111/bju.13937
  • Development of a Patient and Institutional-Based Model for Estimation of
           Operative Times for Robot-Assisted Radical Cystectomy: Results from the
           International Robotic Cystectomy Consortium
    • Authors: Ahmed A. Hussein; Paul R. May, Youssef E. Ahmed, Matthias Saar, Carl J Wijburg, Lee Richstone, Andrew Wagner, Timothy Wilson, Bertram Yuh, Joan Palou Redorta, Prokar Dasgupta, Omar Kawa, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini, Franco Gaboardi, Giovannalberto Pini, Francis Schanne, Alexandre Mottrie, Koon-ho Rha, Ashok Hemal, Michael Stockle, John Kelly, Wei Shen Tan, Thomas J. Maatman, Vassilis Poulakis, Jihad Kaouk, Abdullah Erdem Canda, Mevlana Derya Balbay, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo design a methodology to predict operative times for robot-assisted radical cystectomy (RARC) based on variation in institutional, patient and disease characteristic to help in operating room scheduling and quality control.MethodsThe model included preoperative variables and therefore can be used for prediction of surgical times: institutional volume, age, gender, BMI, ASA Score, history of prior surgery and radiation, clinical stage, neoadjuvant chemotherapy, type, technique of diversion and the extent of lymph node dissection. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with surgical time. The data was split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated recursively on the resultant data sets until the permutation tests showed no significant association with operative time.Results2134 procedures were included. The variable most strongly associated with surgical time was type of diversion (ileal conduits – 70 minutes shorter, p66 RARCs) was important (higher volume—55 minutes shorter, p
      PubDate: 2017-06-16T03:55:24.991016-05:
      DOI: 10.1111/bju.13934
  • Safety and effectiveness of collagenase clostridium histolyticum (CCH)
           (Xiapex®) in the treatment of Peyronie's Disease using a new modified
           shortened protocol
    • Authors: Amr Abdel Raheem; Marco Capece, Odunayo Kalejaiye, Tarek Abdel-Raheem, Marco Falcone, Mark Johnson, Oliver George Ralph, Giulio Garaffa, Andrew Nim Christopher, David John Ralph
      Abstract: ObjectivesTo evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH) (Xiapex®, Xiaflex®) in the treatment of Peyronie's disease (PD) using a new modified treatment protocol which aims at reducing the number of injections needed and reducing patient visits, thus reducing the cost and duration of treatment.Patients and MethodsA prospective study of 53 patients with PD who had treatment with CCH at a single center using a new modified protocol. The angle of curvature assessment after an intra-cavernosal injection of PGE1, IIEF and Peyronie's disease questionnaires (PDQ) were performed at baseline and at week 12 (4 weeks after the last injection). The global assessment of PD questionnaire was performed at week 12. Under a penile block of 10ml of plain lignocaine 1%, a total of 3 intra-lesional injections of CCH (0.9mg) were given at 4 weekly intervals using a new modified injection technique.In between injections patients used a combination of home modelling, stretching and a vacuum device on a daily basis in order to mechanically stretch the plaque. Investigator modelling was not performed.ResultsThe mean penile curvature at baseline was 54° (30 - 90°). Of the 53 patients in the study, 51 patients (96.2%) had an improvement in the angel of curvature with a mean value of 17.36° (0°- 40°) or 31.4% from baseline (0 - 57%) after 3 CCH injections. The end mean curvature was 36.9° (12 °- 75°; p
      PubDate: 2017-06-14T01:55:18.503188-05:
      DOI: 10.1111/bju.13932
  • Mild heating and reduction of bladder spontaneous contractions
    • Authors: Darryl G Kitney; Rita I Jabr, Bahareh Vahabi, Christopher H Fry
      Abstract: ObjectivesTo measure the effect of external heating on bladder wall contractile function, histological structure and expression of proteins related to tissue protection and apoptosis.Material and methodsIn vitro preparations of bladder wall and ex vivo perfused pig bladders were heated from 37°C to 42, 46 and 50°C for 15 minutes. Isolated preparations were heated by radiant energy and perfused bladders by altering perfusate temperature. Spontaneous contractions or pressure variations were recorded, as well as responses to the muscarinic agonist carbachol or motor nerve excitation in vitro during heating. Tissue histology in control and after heating was analysed using H&E staining and DAPI nuclear labelling. The effects of heating on protein expression levels of i) heat shock proteins HSP27-pSer82 and inducible-HSP70 and ii) caspase-3 and its downstream DNA-repair substrate, PARP were measured.ResultsHeating to 42°C reduced spontaneous contractions or pressure variations by about 70%, effects were fully reversible. There were no effects on carbachol or nerve-mediated responses. Tissue histology was unaffected by heating and expression of heat-shock proteins as well as caspase-3 and PARP were also unaltered. A TRPV1 antagonist had no effect on the reduction of spontaneous activity. Heating to 46°C had a similar effect on spontaneous activity and also reduced the carbachol contracture. Urothelial structure was damaged, caspase-3 levels were increased and inducible-HSP70 levels declined. At 50°C evoked contractions were abolished, the urothelium was absent and heat-shock proteins and PARP expression was reduced with raised caspase-3 expression.ConclusionsHeating to 42°C caused a profound, reversible and reproducible attenuation of spontaneous activity with no tissue damage and no initiation of apoptosis pathways. Higher temperatures caused tissue damage and activation of apoptotic mechanisms. Mild heating offers a novel approach to reduce bladder spontaneous activity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T14:25:19.136486-05:
      DOI: 10.1111/bju.13933
  • A critical appraisal of the application of propensity score methods in the
           urology literature
    • Authors: Madhur Nayan; Robert J. Hamilton, David N. Juurlink, Antonio Finelli, Girish S. Kulkarni, Peter C. Austin
      Abstract: ObjectivesTo determine whether studies that used propensity score (PS) methods in the urology literature provided sufficient detail to allow scientific reproducibility and whether appropriate statistical tests were used to obtain valid measures of effect.Materials and MethodsWe searched OVID Medline and the Science Citation Index from inception to November 2016 to identify studies that used PS methods from 5 general urology journals. From each included article, we extracted pertinent information related to the PS methodology such as estimation of the PS, whether balance diagnostics were performed, and the statistical analysis performed.ResultsWe identified 114 articles for inclusion. Matching on the PS was the most common method used (62 studies, 54.4%). Of all studies, 103 (90.4%) described which covariates were used to estimate the PS; however, only 24 provided justification for the selected covariates. Although the majority of studies (70.2%) performed some sort of diagnostic evaluation to assess balance, few studies (24.6%) used appropriate methods for balance assessment. Only 4 (6.4%) studies that used PS matching provided sufficient detail to replicate the matching strategy. Finally, the majority (77.4%) of studies that used PS matching explicitly used inappropriate statistical methods to estimate the effect of an exposure on an outcome.ConclusionsPropensity score methods are poorly described and implemented in the urology literature. We provide recommendations for improvement to allow scientific reproducibility and obtain valid measures of effect from their use.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T02:50:23.347117-05:
      DOI: 10.1111/bju.13930
  • Centralisation of radical cystectomies for bladder cancer in England, a
           decade on from the ‘Improving Outcomes Guidance’: The case for super
    • Authors: Mehran Afshar; Henry Goodfellow, Francesca Jackson-Spence, Felicity Evison, John Parkin, Richard T Bryan, Helen Parsons, Nicholas D James, Prashant Patel
      Abstract: ObjectiveTo analyse the impact of centralisation of radical cystectomy provision for bladder cancer in England, on post-operative mortality, length of stay, complications and re-intervention rate, from implementation of centralisation from 2002, until 2014. In 2002, UK policymakers introduced the Improving Outcomes Guidance (IOG) for urological cancers after a global cancer surgery commission identified substantial shortcomings in provision of care of radical cystectomies. One key recommendation was centralisation of cystectomies to high output centres. No study has yet robustly analysed the changes since IOG, to assess a national healthcare system which has mature data on such institutional transformation.MethodsRadical Cystectomies performed for bladder cancer in England between 2003/2004 and 2013/2014 were analysed from Hospital Episode Statistics (HES) data. Outcomes including 30-day, 90-day, and one-year all-cause post-operative mortality, median length of stay, complications and re-interventions were calculated. Multivariable statistical analysis was undertaken to describe the relationship between each surgeon and the providers’ annual case volume and mortality.Results15,292 cystectomies were identified. Percentage of cystectomies performed in discordance with IOG reduced from 65.0% to 12.4%, corresponding with improvement in 30-day mortality from 2.7% to 1.5% (p=0.0235). Procedures adhering to IOG had superior 30-day mortality (2.9% vs. 2.1%; p=0.0029) to those which did not, and superior one-year mortality (25.6% vs. 21.5%; p
      PubDate: 2017-06-08T09:15:37.410012-05:
      DOI: 10.1111/bju.13929
  • Testing Radical prostatectomy in men with prostate cancer and
           oligoMetastases to the bone: a randomised controlled feasibility trial
    • Authors: Prasanna Sooriakumaran
      Abstract: Prostate cancer is the commonest cancer and the second most frequent cause of cancer death in Western men1. Men presenting with metastatic disease have a median survival of only 42.1 months2 and current standard-of-care consists of initial androgen deprivation therapy (ADT) followed by chemotherapy and novel agents once the cancer no longer responds to ADT. The burden on the health care setting of treating men with metastatic prostate cancer is vast and a recent study estimated costs of USD20,000 per man3.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:30:34.635193-05:
      DOI: 10.1111/bju.13925
  • Natural History of ‘Second’ Biochemical Failure Following Salvage
           Radiation Therapy for Prostate Cancer: A Multi-Institution Study
    • Authors: Vasu Tumati; William C. Jackson, Ahmed E. Abugharib, Ganesh Raj, Claus Roehrborn, Yair Lotan, Kevin Courtney, Aditya Bagrodia, Jeffrey C. Gahan, Zachary S. Zumsteg, Michael R. Folkert, Aaron M. Laine, Raquibul Hannan, Daniel E. Spratt, Neil B. Desai
      Abstract: ObjectivesTo describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) following prostatectomy.Subjects/Patients and MethodsFollowing SRT at two institutions from 1986-2013, 286 patients developed second BCR, defined as two rises in PSA of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses.ResultsAt a median 6.1 years following second BCR, rates of DM, CRPC, PCSS, and OS were 41%, 27%, 83%, and 73%, respectively. On multivariable analysis, interval to second BCR
      PubDate: 2017-06-05T04:28:40.46275-05:0
      DOI: 10.1111/bju.13926
  • The Pregnant Urologist
    • Authors: Susan Jane Hall; Simon Williams
      Abstract: The latest statistics show that females constitute 15% of UK Urology consultants and 30% of Urology trainees. This number is set to rise with females accounting for 60% of recent medical school intakes (1). Having young female trainees will result in a larger number of trainees working during pregnancy. Furthermore Urology as a specialty involves potential risks to the developing foetus and mother from both ionising radiation in theatre and from exposure to the potentially harmful 5 α reductase inhibitors, Povidone-iodine surgical scrub, cytotoxic chemicals such as Mitomycin, along with long working hours and on call duties.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:25:12.738456-05:
      DOI: 10.1111/bju.13927
  • Impact of preoperative risk on metastatic progression and cancer-specific
           mortality in patients with adverse pathology at radical prostatectomy
    • Authors: Katharina Boehm; Sami-Ramzi Leyh-Bannurah, Clemens Rosenbaum, Laurenz S. Brandi, Lars Budäus, Markus Graefen, Hartwig Huland, Axel Haferkamp, Derya Tilki
      Abstract: ObjectiveTo evaluate the impact of preoperative risk category on metastatic disease and prostate cancer-specific mortality (CSM) in patients with prostate cancer (PCa) with adverse pathology at radical prostatectomy (RP).Patients and MethodsThe records of 6 943 patients who underwent RP at a European tertiary centre were analysed. Biochemical recurrence (BCR), metastatic disease and CSM were assessed for patients with adverse pathology at RP, and stratified according to preoperative low- vs intermediate-/high-risk PCa groups. Kaplan–Meier, cumulative incidence, Cox regression and competing risk regression analyses were performed.ResultsIn patients with extracapsular extension, the metastatic disease rate was 1.6% vs 8% (P < 0.001) and the CSM rate was 2% vs 5% (P = 0.041) for low vs intermediate-/high-risk patients, respectively, at 10 years. In patients with pathological Gleason score ≥3+4, the metastatic disease rate was 3.0% vs 12% (P < 0.001) and the CSM rate was 3% vs 8%, respectively (P < 0.001). In patients with positive surgical margins (PSMs), the metastatic disease rate was 2.9% vs 15% (P < 0.001) and the CSM rate was 4% vs 10%, respectively (P = 0.0001). Low-risk status was a predictive factor for metastatic disease in patients with pathological Gleason score ≥3+4 (hazard ratio [HR] 0.51), pathological Gleason score ≥4+3 (HR 0.41) and PSMs (HR 0.46) and was a predictive factor for CSM risk in patients with pathological Gleason score ≥3+4 (HR 0.62).ConclusionsPatients with low-risk PCa were at significantly lower risk of metastatic disease and CSM than their intermediate-/high-risk counterparts, when adverse pathological features were identified at RP. This should be emphasized in the decision-making process after RP.
      PubDate: 2017-05-29T05:40:27.584239-05:
      DOI: 10.1111/bju.13887
  • Initial multicentre experience of 68Gallium-PSMA PET/CT guided
           robot-assisted salvage lymphadenectomy: acceptable safety profile but
           oncological benefit appears limited
    • Authors: Amila Siriwardana; James Thompson, Pim J. van Leeuwen, Shaela Doig, Anton Kalsbeek, Louise Emmett, Warick Delprado, David Wong, Hemamali Samaratunga, Anne-Maree Haynes, Geoff Coughlin, Phillip Stricker
      Abstract: ObjectivesTo evaluate the safety and short-term oncological outcomes for 68Ga-PSMA PET/CT directed robot-assisted salvage node dissection (RASND) for prostate cancer oligometastatic nodal recurrence.Materials and MethodsBetween February 2014 and April 2016, 35 patients across two centres underwent RASND for 68Ga-PSMA PET/CT detected oligometastatic nodal recurrence. RASND was performed by targeted pelvic dissection, unilateral extended pelvic template or bilateral extended pelvic template dissection, depending on previous pelvic treatment and extent/location of nodal disease. Complications were reported by the Clavien-Dindo classification system. Definitions of prostate-specific antigen (PSA) treatment response (TR) to RASND were defined as 6-week PSA
      PubDate: 2017-05-26T06:50:22.670802-05:
      DOI: 10.1111/bju.13919
  • Impact of Body Mass Index on Robotic Radical Cystectomy with
           Intra-Corporeal Urinary Diversion
    • Authors: Nariman Ahmadi; Thomas G. Clifford, Gus Miranda, Jie Cai, Monish Aron, Mihir M. Desai, Inderbir S. Gill
      Abstract: ObjectivesTo determine the impact of body mass index (BMI) on peri-operative and oncological outcomes following robotic radical cystectomy (RRC) with intra-corporeal urinary diversion (ICUD).Subjects and MethodsA total of 216 patients undergoing RRC, extended lymphadenectomy and ICUD (07/2010-12/2015) were categorized into four BMI groups according to the 2004 World Health Organization (WHO) obesity classification:
      PubDate: 2017-05-22T12:31:14.496647-05:
      DOI: 10.1111/bju.13916
  • Men's Eating and Living (MEAL) study (CALGB 70807 [Alliance]): recruitment
           feasibility and baseline demographics of a randomized trial of diet in men
           on active surveillance for prostate cancer
    • Authors: J. Kellogg Parsons; John P. Pierce, James Mohler, Electra Paskett, Sin-Ho Jung, Michael J. Morris, Eric Small, Olwen Hahn, Peter Humphrey, John Taylor, James Marshall
      Abstract: ObjectiveTo assess the feasibility of performing national, randomized trials of dietary interventions for localized prostate cancer.MethodsThe Men's Eating and Living (MEAL) study (CALGB 70807 [Alliance]) is a phase III clinical trial testing the efficacy of a high-vegetable diet to prevent progression in patients with prostate cancer on active surveillance (AS). Participants were randomized to a validated diet counselling intervention or to a control condition. Chi-squared and Kruskal–Wallis analyses were used to assess between-group differences at baseline.ResultsBetween 2011 and 2015, 478 (103%) of a targeted 464 patients were randomized at 91 study sites. At baseline, the mean (sd) age was 64 (6) years and mean (sd) PSA concentration was 4.9 (2.1) ng/mL. Fifty-six (12%) participants were African-American, 17 (4%) were Hispanic/Latino, and 16 (3%) were Asian-American. There were no significant between-group differences for age (P = 0.98), race/ethnicity (P = 0.52), geographic region (P = 0.60), time since prostate cancer diagnosis (P = 0.85), PSA concentration (P = 0.96), clinical stage (T1c or T2a; P = 0.27), or Gleason sum (Gleason 6 or 3+4 = 7; P = 0.76). In a pre-planned analysis, the baseline prostate biopsy samples of the first 50 participants underwent central pathology review to confirm eligibility, with an expectation that
      PubDate: 2017-05-21T22:10:27.615335-05:
      DOI: 10.1111/bju.13890
  • Association between type 2 diabetes, curative treatment and survival in
           men with intermediate- and high-risk localized prostate cancer
    • Authors: Danielle Crawley; Hans Garmo, Sarah Rudman, Pär Stattin, Björn Zethelius, Lars Holmberg, Jan Adolfsson, Mieke Van Hemelrijck
      Abstract: ObjectiveTo investigate whether curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM) as little is known about the influence of T2DM diagnosis on the receipt of such treatment in men with localized PCa.Subjects and MethodsThe Prostate Cancer database Sweden (PCBaSe) was used to obtain data on men with T2DM and PCa (n = 2210) for comparison with data on men with PCa only (n = 23 071). All men had intermediate- (T1–2, Gleason score 7 and/or prostate-specific antigen [PSA] 10–20 ng/mL) or high-risk (T3 and/or Gleason score 8–10 and/or PSA 20–50 ng/mL) localized PCa diagnosed between 1 January 2006 and 31 December 2014. Multivariate logistic regression was used to calculate the odds ratios (ORs) for receipt of curative treatment in men with and without T2DM. Overall survival, for up to 8 years of follow-up, was calculated both for men with T2DM only and for men with T2DM and PCa.ResultsMen with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR 0.78, 95% confidence interval 0.69–0.87). The 8-year overall survival rates were 79% and 33% for men with T2DM and high-risk PCa who did and did not receive curative treatment, respectively.ConclusionsMen with T2DM were less likely to receive curative treatment for localized intermediate- and high-risk PCa. Men with T2DM and high-risk PCa who received curative treatment had substantially higher survival times than those who did not. Some of the survival differences represent a selection bias, whereby the healthiest patients received curative treatment. Clinicians should interpret this data carefully and ensure that individual patients with T2DM and PCa are not under- nor overtreated.
      PubDate: 2017-05-17T22:25:33.980232-05:
      DOI: 10.1111/bju.13880
  • Evaluating an educational intervention to alleviate distress amongst men
           with newly diagnosed prostate cancer and their partners
    • Authors: Lindsay Hedden; Richard Wassersug, Sarah Mahovlich, Phil Pollock, Monita Sundar, Robert H. Bell, Larry Goldenberg, Celestia S. Higano
      Abstract: ObjectiveTo determine whether an education session alleviates distress for both patients with prostate cancer and their partners; and whether their partner's attendance at the session; and disease, treatment, and sociodemographic characteristics affect changes in distress levels.Patients, Subjects and MethodsWe identified men with untreated prostate cancer at the Vancouver Prostate Centre between February 2015 and March 2016 who agreed to attend our education session. The session consisted of a didactic presentation covering the biology of prostate cancer, treatment options, and side-effects, followed by a private joint session with a urologist and radiation oncologist. We assessed distress using the Distress Thermometer (DT) and compared pre- and post-session distress, and change in distress between patients and partners using matched and unmatched t-tests, respectively. We also assessed pre-session anxiety using the seven-item Generalised Anxiety Disorder measure, and decisional certainty using the Decisional Conflict Scale.ResultsIn all, 71 patients and 48 partners participated in the study. Attending the session led to a significant reduction in the median DT score for patients (4.0–3.0, P < 0.01) and partners (5.0–4.0, P = 0.02). Partners reported higher distress both before and after the session (4.9 vs 3.8, P = 0.03 pre-session and 4.2 vs 3.2, P = 0.03 post-session). The presence of a partner at the session did not affect patients’ pre- or post-session distress or the success of the session at alleviating distress. Sociodemographic and clinical characteristics had little effect on distress levels.ConclusionsAn interdisciplinary education session is equally effective at alleviating distress for both patients with prostate cancer and their female partners.
      PubDate: 2017-05-17T22:25:31.277127-05:
      DOI: 10.1111/bju.13885
  • Prognostic Utility of Biopsy-Derived Cell Cycle Progression Score in
           Patients with NCCN Low-Risk Prostate Cancer Undergoing Radical
           Prostatectomy: Implications for Treatment Guidance
    • Authors: Jeffrey T. Tosoian; Meera R. Chappidi, Jay T. Bishoff, Stephen J. Freedland, Julia Reid, Michael Brawer, Steven Stone, Thorsten Schlomm, Ashley E. Ross
      Abstract: ObjectivesTo determine the prognostic utility of the Cell Cycle Progression (CCP) score in men with National Comprehensive Cancer Network (NCCN) low-risk prostate cancer who underwent radical prostatectomy (RP).Patients and MethodsPatients who underwent RP for Gleason score ≤6 prostate cancer at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA], and Intermountain Healthcare [IHC]) were identified. The CCP score was obtained from diagnostic (DVA, IHC) or simulated biopsies (MC). Primary outcome was biochemical recurrence (BCR, PSA≥0.2 ng/ml) after RP. Prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and the overall cohort.ResultsAmong the 236 patients identified, 80% (188/236) met NCCN low-risk criteria. Five-year BCR-free survival for the low (1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (p=0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (p=0.041). In multivariable models adjusting for clinical and pathological variables with the CAPRA score, the CCP score was an independent predictor of BCR in the low-risk (HR=1.77 per unit score, 95%CI [1.21, 2.58], p=0.003) and overall cohorts (HR=1.41 per unit score, 95%CI [1.02, 1.96], p=0.039).ConclusionIn a cohort of NCCN low-risk patients, the CCP score improved clinical risk stratification of patients at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimal treatment selection in these patients with otherwise similar clinical parameters.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-08T10:50:25.202304-05:
      DOI: 10.1111/bju.13911
  • Association of Human Development Index with global bladder, kidney,
           prostate and testis cancer incidence and mortality
    • Authors: Alyssa K. Greiman; James S. Rosoff, Sandip M. Prasad
      Abstract: ObjectivesTo describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development.Materials and MethodsWe obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI).ResultsAge-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5–2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R2 = 0.78), prostate (regression coefficient −1.56, R2 = 0.85), kidney (regression coefficient −1.34, R2 = 0.74), and bladder cancer (regression coefficient −1.01, R2 = 0.80).ConclusionWhile incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes.
      PubDate: 2017-05-08T06:50:27.303028-05:
      DOI: 10.1111/bju.13875
  • A core outcome set for localised prostate cancer effectiveness trials
    • Authors: Steven MacLennan; Paula R. Williamson, Hanneke Bekema, Marion Campbell, Craig Ramsay, James N'Dow, Sara MacLennan, Luke Vale, Philipp Dahm, Nicolas Mottet, Thomas Lam,
      Abstract: ObjectiveTo develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio; which is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials.Patients, Subjects and MethodsA list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 patients with prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs; cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and eight patients.ResultsThe final COS included 19 outcomes. In all, 12 apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, and sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side-effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere.ConclusionWe have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions that should be measured in all localised prostate cancer effectiveness trials.
      PubDate: 2017-05-03T10:25:27.047931-05:
      DOI: 10.1111/bju.13854
  • Unification of favorable intermediate, unfavorable intermediate, and very
           high risk-stratification criteria for prostate cancer
    • Authors: Zachary S. Zumsteg; Michael J. Zelefsky, Kaitlin M. Woo, Daniel E. Spratt, Marisa A. Kollmeier, Sean McBride, Xin Pei, Howard M. Sandler, Zhigang Zhang
      Abstract: ObjectiveTo improve on the existing risk-stratification systems.Patients and MethodsThis was a retrospective investigation including 2248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into favorable and unfavorable groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into standard and very high-risk groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavorable intermediate risk (UIR) had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P
      PubDate: 2017-05-02T11:08:41.9696-05:00
      DOI: 10.1111/bju.13903
  • Trends in the surgical management of Stage 1 Renal Cell Carcinoma:
           findings from a population-based study
    • Authors: V White; D J T Marco, D Bolton, I D Davis, M Jefford, D Hill, H M Prince, J L Millar, I M Winship, M Coory, G G Giles
      Abstract: ObjectivesTo determine whether use of nephron sparing surgery (NSS) for treatment of stage 1 renal cell carcinomas changed between 2009 and end 2013 in Australia.Patients and MethodsAll adult cases of renal cell carcinoma diagnosed in 2009, 2012, and 2013 were identified through the population-based Victorian Cancer Registry.For each identified patient, trained data-abstractors attended treating hospitals or clinician rooms to extract tumour and treatment data through medical record review.Multivariable logistic regression analyses examined significance of change in use of NSS over time, after adjusting for potential confounders.ResultsA total of 1836 patients with renal cell carcinoma were identified. Of these, the proportion of cases with stage 1 tumours was 64% in 2009, 66% in 2012, and 69% in 2013.For T1a tumours, the proportion of patients residing in metropolitan areas receiving NSS increased from 43% in 2009 to 58% in 2012 (P
      PubDate: 2017-04-28T00:35:27.678514-05:
      DOI: 10.1111/bju.13889
  • Urolithiasis around the world
    • Authors: Matthew Bultitude
      Pages: 601 - 601
      PubDate: 2017-10-16T04:44:24.042348-05:
      DOI: 10.1111/bju.14033
  • Management of urolithiasis in South Asia
    • Authors: Mahesh R. Desai; Arvind P. Ganpule
      Pages: 602 - 602
      PubDate: 2017-10-16T04:44:24.863008-05:
      DOI: 10.1111/bju.13980
  • Stereotactic radiotherapy for primary renal cell carcinoma: time for
           larger-scale prospective studies
    • Authors: David I. Pryor; Simon Wood
      Pages: 603 - 604
      PubDate: 2017-10-16T04:44:21.25697-05:0
      DOI: 10.1111/bju.13826
  • Getting to the right biopsy in the right patient at the right time
    • Authors: Kelly Stratton
      Pages: 604 - 605
      PubDate: 2017-10-16T04:44:20.876536-05:
      DOI: 10.1111/bju.13765
  • Should we care more about SPARE'
    • Authors: Eugene K. Lee; Ashish M. Kamat
      Pages: 605 - 606
      PubDate: 2017-10-16T04:44:21.370247-05:
      DOI: 10.1111/bju.13953
  • Stereotactic ablative body radiotherapy for inoperable primary kidney
           cancer: a prospective clinical trial
    • Authors: Shankar Siva; Daniel Pham, Tomas Kron, Mathias Bressel, Jacqueline Lam, Teng Han Tan, Brent Chesson, Mark Shaw, Sarat Chander, Suki Gill, Nicholas R. Brook, Nathan Lawrentschuk, Declan G. Murphy, Farshad Foroudi
      Pages: 623 - 630
      Abstract: ObjectiveTo assess the feasibility and safety of stereotactic ablative body radiotherapy (SABR) for renal cell carcinoma (RCC) in patients unsuitable for surgery. Secondary objectives were to assess oncological and functional outcomes.Materials and MethodsThis was a prospective interventional clinical trial with institutional ethics board approval. Inoperable patients were enrolled, after multidisciplinary consensus, for intervention with informed consent. Tumour response was defined using Response Evaluation Criteria In Solid Tumors v1.1. Toxicities were recorded using Common Terminology Criteria for Adverse Events v4.0. Time-to-event outcomes were described using the Kaplan–Meier method, and associations of baseline variables with tumour shrinkage was assessed using linear regression. Patients received either single fraction of 26 Gy or three fractions of 14 Gy, dependent on tumour size.ResultsOf 37 patients (median age 78 years), 62% had T1b, 35% had T1a and 3% had T2a disease. One patient presented with bilateral primaries. Histology was confirmed in 92%. In total, 33 patients and 34 kidneys received all prescribed SABR fractions (89% feasibility). The median follow-up was 24 months. Treatment-related grade 1–2 toxicities occurred in 26 patients (78%) and grade 3 toxicity in one patient (3%). No grade 4–5 toxicities were recorded and six patients (18%) reported no toxicity. Freedom from local progression, distant progression and overall survival rates at 2 years were 100%, 89% and 92%, respectively. The mean baseline glomerular filtration rate was 55 mL/min, which decreased to 44 mL/min at 1 and 2 years (P < 0.001). Neutrophil:lymphocyte ratio correlated to % change in tumour size at 1 year, r2 = 0.45 (P < 0.001).ConclusionThe study results show that SABR for primary RCC was feasible and well tolerated. We observed encouraging cancer control, functional preservation and early survival outcomes in an inoperable cohort. Baseline neutrophil:lymphocyte ratio may be predictive of immune-mediated response and warrants further investigation.
      PubDate: 2017-03-10T21:50:29.648383-05:
      DOI: 10.1111/bju.13811
  • Clinical and patient reported outcomes of SPARE - a randomised feasibility
           study of selective bladder preservation versus radical cystectomy
    • Authors: R A Huddart; A Birtle, L Maynard, M Beresford, J Blazeby, J Donovan, JD Kelly, T Kirkbank, D B McLaren, G Mead, C Moynihan, R Persad, C Scrase, R Lewis, E Hall
      First page: 639
      Abstract: ObjectivesTo test the feasibility of a randomised trial in muscle invasive bladder cancer (MIBC) and compare outcomes in patients who receive neoadjuvant chemotherapy followed by radical cystectomy or selective bladder preservation, where definitive treatment (cystectomy or radiotherapy) is determined by response to chemotherapy.Patients and methodsSPARE is a multicentre randomised controlled trial comparing radical cystectomy and selective bladder preservation in patients with MIBC staged T2-3 N0 M0, fit for both treatment strategies and receiving three cycles of neoadjuvant chemotherapy.Patients were randomised between radical cystectomy and selective bladder preservation prior to a cystoscopy after cycle three of neoadjuvant chemotherapy. Patients with ≤T1 residual tumour received a fourth cycle of neoadjuvant chemotherapy in both groups, followed by radical radiotherapy in the selective bladder preservation group and radical cystectomy in in the radical cystectomy group; non-responders in both groups proceeded immediately to radical cystectomy following cycle three.Feasibility study primary endpoints were accrual rate and compliance with assigned treatment strategy. The phase III trial was designed to demonstrate non-inferiority of selective bladder preservation in terms of overall survival in patients whose tumours responded to neoadjuvant chemotherapy. Secondary endpoints included patient reported quality of life, clinician assessed toxicity, loco-regional recurrence free survival and rate of salvage cystectomy after bladder preservation.ResultsTrial recruitment was challenging and below the predefined target with 45 patients recruited in 30 months (25 radical cystectomy; 20 selective bladder preservation). Non-compliance with assigned treatment strategy was frequent, 6/25 patients (24%) randomised to radical cystectomy received radiotherapy.Long term bladder preservation rate was 11/15 (73%) in those who received radiotherapy per protocol. Overall survival was not significantly different between groups.ConclusionsRandomising MIBC patients between radical cystectomy and selective bladder preservation based on response to neoadjuvant chemotherapy was not feasible in the UK health system. Strong clinician and patient preferences for treatments impacted willingness to undergo randomisation and acceptance of treatment allocation. Due to the small number of participants, firm conclusions about disease and toxicity outcomes cannot be drawn.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-28T11:27:35.034547-05:
      DOI: 10.1111/bju.13900
  • Predictive value of the 2014 International Society of Urological Pathology
           grading system for prostate cancer in patients undergoing radical
           prostatectomy with long-term follow-up
    • Authors: Judith Grogan; Ruta Gupta, Kate L. Mahon, Phillip D. Stricker, Anne-Maree Haynes, Warick Delprado, Jennifer Turner, Lisa G. Horvath, James G. Kench
      Pages: 651 - 658
      Abstract: ObjectiveTo assess the relationship between the International Society of Urological Pathology (ISUP) 2014 grading system, biochemical recurrence (BCR) and clinical recurrence (CLR) after radical prostatectomy (RP), to determine whether the 2014 ISUP grading system is a better predictor of survival compared with the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.Patients and MethodsA total of 635 RP cases (1991–1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow-up (median [range] 15.25 [0.3–26] years) were obtained. Log-rank, Kaplan–Meier, Cox regression and Harrell's concordance c-indices analyses were performed.ResultsAt a median follow-up of 15 years, 276 patients (44%) had BCR and 41 (7%) had CLR. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 patients (9%), respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared with the 1992 Gleason system. Grade Group (hazard ratio [HR] 4.9; P < 0.001) and preoperative prostate-specific antigen (PSA) level (HR 1.4; P < 0.001) were independent predictors of BCR. Only Grade Group 5 (HR 12.3; P = 0.02), preoperative PSA (HR 1.6; P < 0.001), stage pT3b (HR 3.1; P = 0.03) and pT4 (HR 12.4; P < 0.001) independently predicted CLR. Harrell's c-indices showed that the 2014 ISUP grading system was a significantly better predictor of BCR and CLR as well as prostate cancer-specific death, compared with the 2005 ISUP modified Gleason system. The replacement of the secondary pattern by the tertiary pattern did not alter the prognostic efficacy of the ISUP 2014 grading system.ConclusionsThe ISUP 2014 grading system is a significant independent predictor of both BCR and CLR, outperforming the 2005 ISUP modified Gleason system. This classification system has the potential to influence clinical decision-making after RP.
      PubDate: 2017-04-30T10:04:36.925991-05:
      DOI: 10.1111/bju.13857
  • Cost-effectiveness of a new urinary biomarker-based risk score compared to
           standard of care in prostate cancer diagnostics – a decision analytical
    • Authors: Siebren Dijkstra; Tim M. Govers, Rianne J. Hendriks, Jack A. Schalken, Wim Van Criekinge, Leander Van Neste, Janneke P.C. Grutters, John P. Michiel Sedelaar, Inge M. Oort
      Pages: 659 - 665
      Abstract: ObjectiveTo assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx; MDxHealth, Inc., Irvine, CA, USA) to identify patients for transrectal ultrasonography (TRUS)-guided biopsy and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUS-guided biopsy.Materials and MethodsA decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test vs SOC in men with a PSA level of>3 ng/mL. Transition probabilities, utilities and costs were derived from the literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions.ResultsA diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade prostate cancer resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses showed that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUS-guided biopsy only slightly influenced the outcome of the model.ConclusionBased on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the SelectMDx test in men with PSA levels of>3 ng/mL may lead to a reduction in total costs per patient and a gain in QALYs.
      PubDate: 2017-04-29T01:15:41.915817-05:
      DOI: 10.1111/bju.13861
  • Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and
           results of stone analysis in 1559 patients
    • Authors: Syed Adibul Hasan Rizvi; Manzoor Hussain, Syed Hassan Askari, Altaf Hashmi, Murli Lal, Mirza Naqi Zafar
      Pages: 702 - 709
      Abstract: ObjectiveTo report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup.Patients and MethodsWe retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients’ age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997–2005 and 2006–2014, to study the differences.ResultsOf the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast® master in 524 (15.4%). In the majority of patients (97.4%) a 18–22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate.ConclusionsThis is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.
      PubDate: 2017-04-17T02:26:12.615865-05:
      DOI: 10.1111/bju.13848
  • European Section of Urotechnology educational video on fluoroscopic-guided
           puncture in percutaneous nephrolithotomy: all techniques step by step
    • Authors: Iason Kyriazis; Evangelos Liatsikos, Odysseas Sopilidis, Panagiotis Kallidonis, Andreas Skolarikos,
      Pages: 739 - 741
      Abstract: ObjectiveTo describe the most common fluoroscopic-guided access techniques during percutaneous nephrolithotomy (PCNL) in a step-by-step manner and to assist in the standardisation of their technique and terminology.MethodsA high-quality animation video was created for each of the respective fluoroscopic techniques, focusing into the parallel projection of external surgical manoeuvres and their effect in the three-dimensional space of the kidney.ResultsFour predominant fluoroscopic-guided percutaneous access techniques are available, each with different advantages and limitations. Monoplanar access is used when a stable single-axis fluoroscopic generator is available and is mostly based on surgeons’ experience. Biplanar access uses a second fluoroscopy axis to assess puncture depth. The ‘bull's eye’ technique follows a coaxial to fluoroscopy puncture path and is associated with a shorter learning curve at the cost of increased hand radiation exposure. Hybrid and conventional triangulate techniques use target projection by two fluoroscopic planes to define the exact localisation of the target in space and access it through a third puncture site.ConclusionsFluoroscopic guidance during PCNL puncture is a very efficient method for access establishment. The percutaneous surgeon should be familiar with all available variations of fluoroscopic approach in order to be prepared to adapt puncture technique for any given scenario.
      PubDate: 2017-05-21T22:10:37.386966-05:
      DOI: 10.1111/bju.13894
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