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Journal Cover BJU International
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1611 journals]
  • Urinary collecting system invasion is associated with poor survival in
           clear cell renal cell carcinoma patients
    • Authors: George C. Bailey; Stephen A. Boorjian, Matthew J. Ziegelmann, Mary E. Westerman, Christine M. Lohse, Bradley C. Leibovich, John C. Cheville, R. Houston Thompson
      Abstract: ObjectivesTo evaluate the prognostic significance of urinary collecting system invasion in a large series of clear cell renal cell carcinoma patients.MaterialsPatients with clear cell renal cell carcinoma treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urologic pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan-Meier method and associations of collecting system invasion with death from renal cell carcinoma were evaluated using Cox models.ResultsOf the 859 patients with clear cell renal cell carcinoma, 58 (6.8%) demonstrated collecting system invasion. At last follow-up, 310 patients had died from renal cell carcinoma at a median of 1.8 years following surgery. Median follow-up for patients alive at last follow-up was 8.2 years. Estimated cancer-specific survival at 10 years following surgery for patients with collecting system invasion was 17%, compared with 60% for patients without collecting system invasion (p
      PubDate: 2016-10-20T10:35:23.991745-05:
      DOI: 10.1111/bju.13669
  • Additive effects of the Rho Kinase Inhibitor Y-27632 and vardenafil on
           relaxation of corpus cavernosum tissue of patients with erectile
           dysfunction and clinical phosphodiesterase type 5 inhibitor failure
    • Authors: Pieter Uvin; Maarten Albersen, Ine Bollen, Maarten Falter, Emmanuel Weyne, Loes Linsen, Hanna Tinel, Peter Sandner, Trinity J Bivalacqua, Dirk JMK De Ridder, Frank Van der Aa, Bert Brône, Koenraad Van Renterghem
      Abstract: ObjectivesTo evaluate the expression of the Rho/Rho associated protein kinase (ROCK) pathway in corpus cavernosum of patients with severe erectile dysfunction (ED) compared to healthy human corpus cavernosum, and to test the functional effects of two Rho Kinase Inhibitors (RKI) on erectile tissue of patients with severe ED, not responding to phosphodiesterase type 5 inhibitors (PDE5-i).Patients and methodsHuman corpus cavernosum samples were obtained after consent from individuals undergoing penile prosthesis implantation (n = 7 for organ bath experiments, n = 17 for qPCR). Potent control subjects (n = 5) underwent penile needle biopsy. qPCR was performed for the expression of RhoA and ROCK subtypes 1 and 2. Immunohistochemistry staining against ROCK and α smooth muscle actin (αSMA) was performed on corpus cavernosum of an ED patient. Tissue strips were precontracted with phenylepinephrine and incubated with 1μM of the PDE5-i vardenafil or with DMSO (control). Subsequently, increasing concentrations of the RKIs azaindole or Y-27632 were added and relaxation of tissue was quantified.ResultsThe expression of ROCK1 was unchanged (p > 0.05), while ROCK2 (p < 0.05) was significantly upregulated in ED patients, compared to controls. ROCK 1 and 2 protein colocalized with αSMA, confirming the presence of this kinase in cavernous smooth muscle cells and/or myofibroblasts. After incubation with DMSO, 10μM azaindole and 10μM Y-27632 relaxed precontracted tissues with 49.5 ± 7.42% (p = 0.1470 when compared to vehicle) and 85.9 ± 10.3% (p = 0.0016 when compared to vehicle), respectively. Additive effects on relaxation of human corpus cavernosum were seen after preincubation with 1μM vardenafil.ConclusionThe RKI Y-27632 causes a significant relaxation of corpus cavernosum in tissue strips of patients with severe erectile dysfunction. The additive effect of vardenafil and Y-27632 demonstrate that a combined inhibition of Rho-kinase and phosphodiesterase type 5 could be a promising orally administered treatment for severe ED.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-20T09:05:22.792984-05:
      DOI: 10.1111/bju.13691
  • Corrigendum
    • PubDate: 2016-10-18T07:12:32.327847-05:
      DOI: 10.1111/bju.13530
  • Clinical Risk Stratification in Patients with Surgically Resectable
           Micropapillary Bladder Cancer
    • Authors: Mario I. Fernández; Stephen B. Williams, Daniel L. Willis, Rebecca S. Slack, Rian J. Dickstein, Sahil Parikh, Edmund Chiong, Arlene O. Siefker-Radtke, Charles C. Guo, Bogdan A. Czerniak, David J. McConkey, Jay B. Shah, Louis L. Pisters, H.Barton Grossman, Colin P. N. Dinney, Ashish M. Kamat
      Abstract: ObjectiveTo analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data.Patients and MethodsA review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree analysis was performed to identify risk groups for survival.ResultsFor the entire cohort, estimated 5-year overall and disease-specific survival rates were 52% and 58%, respectively. Classification and regression tree analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumor-associated hydronephrosis. Five-year disease-specific survival for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (p
      PubDate: 2016-10-18T03:25:20.605334-05:
      DOI: 10.1111/bju.13689
  • Quality of life outcomes from the PATCH trial evaluating LHRH agonists
           versus transdermal oestradiol for androgen suppression in advanced
           prostate cancer
    • Authors: Duncan C Gilbert; Trinh Duong, Howard G Kynaston, Abdulla A Alhasso, Fay H Cafferty, Stuart D Rosen, Subramanian Kanaga-Sundaram, Sanjay Dixit, Marc Laniado, Sanjeev Madaan, Gerald Collins, Alvan Pope, Andrew Welland, Matthew Nankivell, Richard Wassersug, Mahesh KB Parmar, Ruth E Langley, Paul D Abel
      Abstract: ObjectivesTo compare quality of life (QoL) outcomes at 6 months between men with advanced prostate cancer (PCa) receiving either transdermal oestradiol (tE2) or LHRH agonists (LHRHa) for androgen deprivation therapy (ADT).Patients and methodsMen with locally advanced or metastatic PCa participating in an ongoing randomised, multi-centre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via 3 or 4 transcutaneous patches containing 100mcg of oestradiol/24 hours. LHRHa was administered as per local practice. Patients completed questionnaires based on EORTC QLQ-C30 with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.Results727 men were enrolled between August 2007 and 5 October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median age 74 years (interquartile range [IQR] 68-79), median PSA 44 ng/ml (IQR 19-119), and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than LHRHa (mean difference +4.2, 95% CI 1.2 to 7.1, p=0.006), less fatigue and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to tE2 arm.ConclusionPatients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynecomastia. The ongoing trial will evaluate clinical efficacy, and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:20:21.109965-05:
      DOI: 10.1111/bju.13687
  • Factors associated with Regional Recurrence Following Lymphadenectomy for
           Penile Squamous Cell Carcinoma
    • Authors: Jay P. Reddy; Curtis A. Pettaway, Lawrence B. Levy, Lance C. Pagliaro, Pheroze Tamboli, Priya Rao, Isuru Jayaratna, Karen E. Hoffman
      Abstract: ObjectiveTo identify factors associated with regional recurrence (RR) following lymphadenectomy for penile cancer in order to determine which patients might benefit from adjuvant therapy.Materials/MethodsMen who underwent lymphadenectomy for penile squamous cell carcinoma from 1977-2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of lymphadenectomy. Cox regression models evaluated the association between RFS and patient and tumor characteristics.Results182 men who underwent lymphadenectomy for penile cancer were identified. Median patient age was 62 years and median follow-up was 4.2 years. 34 men experienced RR following lymphadenectomy, of which 24 developed isolated RR without distant metastasis. Median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathologic nodal stage, pathologic inguinal laterality, pelvic nodal involvement, lymph node density >5.2%, >3 pathologically-involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (p3 pathologically involved lymph nodes (AHR 3.78, 95% CI: 2.12-6.65; p
      PubDate: 2016-10-18T03:15:20.146557-05:
      DOI: 10.1111/bju.13686
  • Efficacy of knowledge and competence-based training of non-physicians in
           the provision of Early Infant Circumcision (EIC) using the Mogen clamp in
           Rakai, Uganda
    • Authors: E.Nelson Kankaka; G. Kigozi, D. Kayiwa, N. Kighoma, F. Makumbi, T. Murungi, D. Nabukalu, R. Nampijja, S. Watya, D. Namuguzi, F. Nalugoda, G. Nakigozi, D. Sserwadda, M. Wawer, R.H. Gray
      Abstract: Early infant circumcision (EIC) is the most common neonatal surgical procedure in males.1 It has also been incorporated as a component in combination HIV prevention in 14 of Sub-Saharan African countries with high HIV prevalence and low circumcision coverage.2,3 EIC has advantages over adult circumcision due to lower adverse events, no risk of early resumption of sex and potentially lower cost4–6. Sub-Saharan African countries have low physician coverage, but comparatively higher coverage of non-physicians who could facilitate roll out of circumcision for HIV prevention. The major concern has been safety of the procedure and complications can be mitigated by adequate training using a structured curriculum7–11with a didactic and supervised practicum, step-by-step checklists and immediate feedback from mentors. Anatomic models have also been shown to enhance trainee-learning.12–15This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:05:51.922449-05:
      DOI: 10.1111/bju.13685
  • Long-term utility of adjuvant hormonal and radiation therapy for patients
           with seminal vesicle invasion at radical prostatectomy
    • Authors: Marco Moschini; Vidit Sharma, Giorgio Gandaglia, Paolo Dell'Oglio, Nicola Fossati, Emanuele Zaffuto, Francesco Montorsi, Alberto Briganti, R. Jeffrey Karnes
      Abstract: IntroductionThe literature is conflicting on the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer (PCa) demonstrating seminal vesicle invasion (pT3b; SVI).MethodsPatients with SVI during RP and pelvic lymph node dissection at two major referral centers from 1986-2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were performed to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence, cancer specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients.ResultsOverall, 3,279 patients with SVI were included with a median follow up of 148 months. Considering the whole SVI population, 1,387 (42%) received no adjuvant therapy, 1,179 (36%) received aHT, 461 (14.1%) received aRT while 252 (7.7%) received both aHT and aRT, respectively. 10 year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all p
      PubDate: 2016-10-18T02:30:24.135404-05:
      DOI: 10.1111/bju.13683
  • Application of shear wave elastography to estimate the stiffness of the
           male striated urethral sphincter during voluntary contractions
    • Authors: Ryan E. Stafford; Rafeef Aljuraifani, François Hug, Paul W. Hodges
      Abstract: ObjectivesTo investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter during voluntary activation using shear wave elastography; to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. striated urethral sphincter); and to determine the relationship between muscle stiffness and contraction intensity.Subjects and methodsTen healthy men participated. A linear ultrasound transducer was placed mid-sagittal on the perineum adjacent to a pair of electromyography electrodes that recorded non-specific pelvic floor muscle activity. Stiffness in the area expected to contain the striated urethral sphincter was estimated via ultrasound shear wave elastography at rest and during voluntary pelvic floor muscles contractions to 5%, 10% and 15% maximum. Still image frames were exported for each repetition and analysed with software that detected increases in stiffness above 150% of the resting stiffness.ResultsPelvic floor muscle contraction elicited an increase in stiffness above threshold within the region expected to contain the striated sphincter for all participants and contraction intensities. The mean(SD) ventral-dorsal distance between the centre of the stiffness area and region of maximal motion of the mid-urethra (caused by striated urethral sphincter contraction) was 5.6(1.8), 6.2(0.8), and 5.8(0.7) mm for 5%, 10% and 15% MVC respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities(5% vs. 10%; P
      PubDate: 2016-10-18T02:25:26.528424-05:
      DOI: 10.1111/bju.13688
  • The management of non-visualisation following dynamic sentinel lymph node
           biopsy for squamous cell carcinoma of the penis
    • Authors: Varun Sahdev; Maarten Albersen, Michelle Christodoulidou, Arie Parnham, Peter Malone, Raj Nigam, Jamshed Bomanji, Asif Muneer
      Abstract: ObjectivesTo review the management and clinical outcomes of uni- or bilateral non-visualization of inguinal lymph nodes following dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0). An additional objective was to develop an algorithm for the management of patients in which non-visualisation occurs.Patients and MethodsThis is a retrospective observational study over a period of 4 years comprising 166 patients with penile squamous cell carcinoma undergoing DSNB and followed up for a minimum of 6 months. All cases diagnosed with uni- or bilateral non-visualisation of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes following non-visualisation and the oncological outcomes including local and regional recurrence rates were documented.ResultsOut of 166 consecutive patients undergoing DSNB, 20 (12%) patients had unilateral non-visualisation following injection of intradermal 99mTc. Of these 20 patients, 7 underwent repeat DSNB at a later date with 6 having successful visualisation. One patient had persistent non-visualisation and proceeded to a superficial modified inguinal lymphadenectomy (SML). None of these patients experienced recurrence at follow-up. A further seven patients underwent modified SML with on table frozen section analysis of the lymph node packet; none of these patients were found to have micrometastatic disease in the inguinal lymph nodes although one patient developed metastatic inguinal node disease at a later date. Six patients elected to undergo clinical surveillance and have remained disease free.ConclusionPatients with impalpable inguinal lymph nodes undergoing DSNB with ≥ T1G2 disease should ideally have bilateral visualisation of the sentinel lymph nodes reflecting the drainage pattern from the primary tumour. In this series, 12% of patients were found to have unilateral non-visualisation following DSNB. Patients offered a repeat DSNB at a later date, were successful in localising the sentinel node in 86% of cases. Patients with favourable histological parameters can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that a SML may be carried out if there is repeated non-visualisation. Larger cohorts are required in order to validate this proposed algorithm.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:20:25.768838-05:
      DOI: 10.1111/bju.13680
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared to salvage radiation therapy in patients with pN1 prostate cancer
           treated with radical prostatectomy
    • Authors: Derya Tilki; Felix Preisser, Pierre Tennstedt, Patrick Tober, Philipp Mandel, Thorsten Schlomm, Thomas Steuber, Hartwig Huland, Schwarz Rudolf, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Abstract: ObjectiveTo analyze the comparative effectiveness of no treatment or salvage radiation therapy at biochemical recurrence (NT/sRT) versus adjuvant radiation therapy (aRT) in LN positive patients after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN positive prostate cancer (PCa) at RP with or without additional radiation treatment from 2005 to 2013 were retrospectively analyzed. Cox regressions addressed factors influencing biochemical recurrence (BCR) and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsMedian follow-up for the entire patient group was 33.8 months. Four-year BCR-free and metastasis-free survival rates were 43.3% and 86.6% for all patients, respectively. In multivariate analysis, NT/sRT (n=505) was an independent risk factor for BCR and metastasis compared to patients with aRT (n=213). The superiority of aRT was confirmed after propensity score-matching. Four-year metastasis-free survival in the matched cohort was 82.5% versus 91.8% for the NT/sRT and aRT groups, respectively (p=0.02). Early sRT (pre-RT PSA ≤0.5 ng/ml) compared to sRT at PSA >0.5 ng/ml was significantly associated with decreased risk of metastasis.ConclusionLN positive patients who received aRT had a significantly better oncological outcome compared to patients with NT/sRT independent of tumor characteristics. Patients with early sRT showed higher rates of response and better metastasis-free survival than patients with pre-RT PSA >0.5 ng/ml.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:15:35.748361-05:
      DOI: 10.1111/bju.13679
  • Impact of Suboptimal Neoadjuvant Chemotherapy on Perioperative Outcomes
           and Survival After Robot-Assisted Radical Cystectomy: A Multicenter
           Multinational Study
    • Authors: Nobuyuki Hinata; Ahmed Aly Hussein, Saby George, Donald L. Trump, Ellis G. Levine, Kawa Omar, Prokar Dasgupta, Muhammad Shamim Khan, Abolfazl Hosseini, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo evaluate the effect of suboptimal dosing on the outcomes of patients who received neoadjuvant chemotherapy (NAC) and robot-assisted radical cystectomy (RARC).Patients and MethodsWe retrospectively reviewed 336 consecutive patients with urothelial carcinoma of the bladder who were treated with NAC and RARC at three academic institutions. Outcomes were compared between 3 groups: patients who received optimal NAC; patients who received suboptimal NAC; and those who did not receive NAC. To adjust for potential baseline differences between the three groups, propensity-score-based matching was performed. The suboptimal dose group was defined as those who received fewer than three cycles of cisplatin-based chemotherapy, received decreased dosage, or one's not treated with cisplatin. Primary outcomes analyzed were recurrence-free survival (RFS) and overall survival (OS). Secondary outcomes were perioperative complications and readmissions after RARC.ResultsWithin the cohort after propensity-score matching, 69 patients received optimal dose NAC, 41 received suboptimal NAC and 69 did not receive NAC. Complication rates and readmission rates between the 3 groups did not differ significantly. On multivariable analysis, suboptimal dosing and no NAC were independent predictors of worse RFS (HR: 2.5, 95%CI: 1.2-5.7, p=0.01 and HR 2.4, 95%CI 1.28-5.16, p=0.01) and worse OS (HR 4.5, 95%CI 1.6-15.0, p
      PubDate: 2016-10-15T08:15:34.670061-05:
      DOI: 10.1111/bju.13678
  • Prostate Health Index (phi) Improves Multivariable Risk Prediction of
           Aggressive Prostate Cancer
    • Authors: Stacy Loeb; Sanghyuk S. Shin, Dennis L. Broyles, John T. Wei, Martin Sanda, George Klee, Alan W. Partin, Lori Sokoll, Daniel W. Chan, Chris H. Bangma, Ron H. N. van Schaik, Kevin M. Slawin, Leonard S. Marks, William J. Catalona
      Abstract: ObjectiveTo examine the use of the Prostate Health Index (phi)* as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicenter US study.Materials and MethodsThe study population included 728 men with PSA levels of 2-10 ng/mL and negative digital rectal examination enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of phi improves the performance of currently available risk calculators (PCPT and ERSPC). We also designed and internally validated a new phi-based multivariable predictive model, and created a nomogram.ResultsOf 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. Phi predicted the risk of aggressive prostate cancer across the spectrum of values. Adding phi significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, prior biopsy, prostate volume, PSA, and phi with an AUC of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision curve analysis.ConclusionUsing phi as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:05:52.721224-05:
      DOI: 10.1111/bju.13676
  • Understanding the role of new systemic agents in the treatment of prostate
    • Authors: Julia Corfield; Jack Crozier, Anthony Joshua, Damien Bolton, Nathan Lawrentschuck
      Abstract: ObjectivesTo examine the current literature and identify key consensus findings from the available studies to better educate urologists and medical oncologists on agents used in the treatment of metastatic prostate cancer (mPC).MethodsFollowing PRISMA guidelines, we conducted a systematic review of the available literature on reported trials of systemic therapies for mPC. Two search terms were used: ‘metastatic prostate cancer’ and ‘treatment’.ResultsA variety of agents have demonstrated improved overall survival in patients with mPC. Twenty recently documented trials were reported in the literature with a focus on enzalutamide, abiraterone acetate, docetaxel and other newer agents. These studies were grouped based on patient populations.ConclusionThe increasing number of high-quality clinical trials, with overlapping patient populations has made defining the correct therapy for men with mPC challenging for urologists and medical oncologists. The data suggests that the optimal sequence of drugs is not only unknown but also not necessarily the same for each patient. As such, we suggest a more individualized approach to the treatment of prostate cancer depending on patient and disease factors.
      PubDate: 2016-10-06T05:46:14.003194-05:
      DOI: 10.1111/bju.13633
  • The Robotic Approach Improves Surgical Outcomes in Obese Patients
           Undergoing Partial Nephrectomy
    • Authors: Ercan Malkoc; Matthew J. Maurice, Onder Kara, Daniel Ramirez, Ryan J. Nelson, Peter A. Caputo, Pascal Mouracade, Robert Stein, Jihad H. Kaouk
      Abstract: ObjectivesTo assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses.Patients and MethodsUsing our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m2) with small renal masses (
      PubDate: 2016-10-04T01:50:11.55434-05:0
      DOI: 10.1111/bju.13675
  • Outcomes of advanced urothelial carcinoma patients following
           discontinuation of Programmed Death (PD)-1 or PD-Ligand (L)-1 inhibitors
    • Authors: G Sonpavde; G R Pond, S Mullane, A A Ramirez, N J Vogelzang, A Necchi, T Powles, J Bellmunt
      Abstract: ObjectiveTo study the subsequent therapy and disease outcomes of patients with advanced urothelial carcinoma (UC) following discontinuation of programmed death-1 (PD-1) or PD-Ligand (L)1 inhibitors.Patients and methodsWe performed a retrospective analysis to examine outcomes and systemic therapy administration following PD-1/PD-L1 inhibitor therapy in patients with advanced UC. Data were collected from institutions including demographics and therapy administered. Univariable Cox regression analyses examined clinical factors potentially associated with overall survival (OS) following PD-1/PD-L1 inhibitors.ResultsData from 62 patients was available from 4 institutions with capture of subsequent therapy and outcomes following checkpoint inhibitor immunotherapy. The median age was 65.5 years and 51 (82.3%) were male. The median duration of PD-1/PD-L1 inhibitors available from 55 patients was 64 days (range 7-669). Of these, 22 (35.5%) patients received post-PD1/PD-L1 inhibitor therapy with a variety of different chemotherapy regimens (n=16), chemobiologic combination (n=1), biologic agents (n=4) and immunotherapy (n=1). The median time from last PD1/PD-L1 inhibitor therapy to subsequent therapy was 58 days (range 14-242). The median OS of all patients following completion of PD-1/PD-L1 inhibitors was 149 days (95% CI: 75-359). Among those who received some post-PD1/PD-L1 inhibitor therapy, median OS was 182 days (95% CI: 121-372), and the median time to progression was 124 days (95% CI: 61-273) when examining from start of post-PD1/PD-L1 therapy. Among these 22 patients, the only significant baseline prognostic factor associated with OS was performance status.ConclusionsIn this dataset, 35.5% of patients with advanced UC received systemic therapy following salvage therapy with PD1/PD-L1 inhibitors. Outcomes with subsequent therapy appear similar to those historically observed in patients who had not received prior PD1/PD-L1 inhibitors. Further study of patients receiving post-PD1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-04T01:40:58.140777-05:
      DOI: 10.1111/bju.13674
  • Virtue male sling for post-prostatectomy stress incontinence: a
           prospective evaluation and mid-term outcomes
    • Authors: Matteo Ferro; Danilo Bottero, Carolina D'Elia, Deliu Victor Matei, Antonio Cioffi, Gabriele Cozzi, Alessandro Serino, Giovanni Cordima, Roberto Bianchi, Piero Giacomo Incarbone, Antonio Brescia, Gennaro Musi, Ferdinando Fusco, Serena Detti, Vincenzo Mirone, Ottavio de Cobelli
      Abstract: ObjectivesTo evaluate the efficacy and safety of the Virtue Male sling in a cohort of patients affected by post prostatectomy stress urinary incontinence (SUI).MethodsAll consecutive patients treated with Virtue® male sling at our Institution in year 2012 were included in our prospective, non randomized study.Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery with 24-hour pad weight test, ICI-Q short form questionnaire, Urinary Symptom Profile questionnaire, bladder diary, uroflowmetry and Patient Global Impression of Improvement and Patient Global Impression of Severity Questionnaire.ResultsMen age was 65.5 years. 72.4% of patients complained a pre operative mild incontinence (1-2 PPD), whereas 9 patients used 3-5 pads/day. 17 complications occurred in 29 patients (58.6%) and all were grade I.At 12 months follow up patients showed a significant improvement in 24 h PAD test (128.6 VS 2.5), pads per day used (2 VS 0), ICI Q SF score (14.3 VS 0.9), USP SUI score (4 VS 0) and outcomes remains stable at 36 months.At last follow up, PGI I questionnaire showed a median score of 1 (very much better).ConclusionsVirtue® Male Sling is an effective treatment option for low to moderate post-prostatectomy incontinence.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-03T08:20:29.821855-05:
      DOI: 10.1111/bju.13672
  • A Randomized Controlled Trial Evaluating Renal Protective Effects of
           Selenium ACE, Verapamil and Losartan against Extracorporeal Shock Waves
           Lithotripsy Induced Renal Injury
    • Authors: Ahmed R. EL-Nahas; Mohamed M. Elsaadany, Diaa-Eldin Taha, Ahmed M. Elshal, Mohamed Abo El-Ghar, Amani M. Ismail, Essam A. Elsawy, Hazem H. Saleh, Ehab W. Wafa, Amira Awadalla, Tamer S. Barakat, Khaled Z Sheir
      Abstract: ObjectiveTo evaluate the protective effects of Selenium-ACE, Verapamil and losartan against SWL induced renal injury.Patients and methodsA randomized controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (300mg/L) were excluded. SWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomized into one of 4 groups using sealed closed envelops. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 hours and 1 week post-SWL. The primary outcome was the differences between albuminuria and uNGAL. Dynamic contrast enhanced MRI (DCE-MRI) was performed before SWL, 2-4 hours and 1 week post-SWL to compare changes in renal perfusion.ResultsOut of 329 patients assessed for eligibility, final analysis was performed for 160 patients (40 in each group). Losartan was the only medications that showed significantly lower levels of albuminuria after one week (P
      PubDate: 2016-09-30T05:35:42.135099-05:
      DOI: 10.1111/bju.13667
  • Parents’ Perceptions of Counselling Following Prenatal Diagnosis of
    • Authors: Sarah Marokakis; Nadine A Kasparian, Sean E Kennedy
      Abstract: ObjectivesTo explore parents’ experiences of counselling after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.Materials and MethodsParents of a child born between September 2012 and March 2015 with posterior urethral valves (PUV) or multicystic dysplastic kidney (MCDK) completed a semi-structured telephone interview, demographic survey, and the Depression, Anxiety and Stress Scales (DASS21). Qualitative data were analysed thematically using NVivo10 software.ResultsSeventeen parents (PUV n=8; MCDK n=9) participated (response rate: 40%), and most were offered counselling during pregnancy (14/17). Parents described feelings of shock, fear and uncertainty following diagnosis, and desired early information on all aspects of their child's condition. Most participants were satisfied with the information received; however, unmet information needs relating to treatment and prognosis were identified, particularly amongst fathers and parents in the PUV group. Some parents felt relieved after counselling (12/17); however, emotional distress often persisted long after diagnosis. Parents described a need for written and web-based information resources, specialised psychological services, and parent support groups.ConclusionWhile parents valued counselling, many continued to report unmet informational and psychological needs. Early counselling addressing topics important to parents and provision of additional resources and support services may improve parents’ adjustment to their baby's diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:47.230139-05:
      DOI: 10.1111/bju.13668
  • When to perform preoperative chest computed tomography for renal cancer
    • Authors: Alessandro Larcher; Paolo Dell'Oglio, Nicola Fossati, Alessandro Nini, Fabio Muttin, Nazareno Suardi, Francesco De Cobelli, Andrea Salonia, Alberto Briganti, Xu Zhang, Francesco Montorsi, Roberto Bertini, Umberto Capitanio
      Abstract: ObjectivesTo provide objective criteria for preoperative staging chest computed tomography [CCT] in patients diagnosed with renal cell carcinoma [RCC], since, in absence of established indications, the decision for preoperative CCT remains subjective.Patients and Methods1,946 patients elected for surgical treatment of RCC and collected in a prospective institutional database were assessed. The outcome of the study was presence of pulmonary metastases at staging CCT. A multivariable logistic regression model predicting positive CCT was fitted. Predictors consisted of preoperative clinical tumour [cT] and nodal [cN] stage, presence of systemic symptoms and platelets/haemoglobin ratio.ResultsThe rate of positive CCT was 6% (n=119). At multivariable logistic regression, ≥cT1b, cN1, systemic symptoms and haemoglobin/platelets ratio were all associated with higher risk of positive CCT (all p1%, a negative CCT is spared in 37% of the population and a positive CCT is missed in 0.2% of the population only.ConclusionsThe proposed strategy estimates the risk of positive CCT at RCC staging with optimal accuracy and resulted statistically and clinically relevant. The current findings support a recommendation for CCT in patients with ≥cT1b, cN1, systemic symptoms or anaemia and thrombocythemia. Conversely, in patients with cT1a, cN0 without systemic symptoms, anaemia and thrombocythemia, CCT can be omitted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:43.908394-05:
      DOI: 10.1111/bju.13670
  • Two Year Durability after Crossover to the Prostatic Urethral Lift from
           Randomized, Blinded Sham
    • Authors: Daniel Rukstalis; Prem Rashid, William Bogache, Ronald Tutrone, Jack Barkin, Peter Chin, Henry Woo, Anthony Cantwell, Barrett Cowan, Damien Bolton
      Abstract: PurposeTo evaluate the 2 year effectiveness of the Prostatic Urethral Lift (PUL) procedure in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) assessed through a crossover study.MethodsFifty-three patients underwent sham procedure as part of the blinded, randomized L.I.F.T. study at 19 centers and elected to enroll in this crossover study. The crossover procedure involved placement of permanent implants (UroLift® System) into the prostatic lateral lobes. Patients were followed for 3 months after sham and then 2 years after crossover PUL with assessments of urinary symptom relief, quality of life, urinary flow rate, sexual function, and adverse events.ResultsAt 2 years after crossover PUL, International Prostate Symptom Score (IPSS), quality of life, BPH Impact Index, and peak flow rate improved 36%, 40%, 54%, and 77% from baseline, respectively. Each IPSS parameter on average improved significantly from baseline (p
      PubDate: 2016-09-29T09:15:24.397967-05:
      DOI: 10.1111/bju.13666
  • The Australian laparoscopic non robotic radical prostatectomy experience
           – analysis of 2943 cases (USANZ supplement)
    • Authors: Mark William Louie-Johnsun; Marcus M. Handmer, Ross John Spero Calopedos, Charles Chabert, Ronald J. Cohen, Troy R. J. Gianduzzo, Paul A. Kearns, Daniel A. Moon, Jason Ooi, Tom Shannon, David Sofield, Andrew H. H. Tan
      Abstract: ObjectivesTo analyse the Australian experience of high‐volume Fellowship‐trained Laparoscopic Radical Prostatectomy (LRP) surgeons.Materials and Methods2943 LRP cases were performed by nine Australian surgeons. The inclusion criteria were a prospectively collected database with a minimum of 100 consecutive LRP cases. The surgeons’ LRP experience commenced at various times from July 2003 to September 2009. Data were analysed for demographic, peri‐operative, oncological and functional outcomes.ResultsThe mean age of patients were 61.5 years and mean preoperative PSA 7.4 ng/ml. Mean operating time was 168 minutes with conversion to open surgery in 0.5% and a blood transfusion rate of 1.1%. Overall mean length of stay was 2.5 days. 73.6% of pathological specimens were pT2 and 86.3% had Gleason Score >7. Overall positive surgical margins (PSM) occurred in 15.9% with pT2 PSM 9.8%, pT3a PSM 30.8% and pT3b PSM 39.2%. Mean urinary continence at 12 months was 91.4% (data available from five surgeons). Mean 12 months potency after bilateral nerve spare was 47.2% (data available from four surgeons). Biochemical recurrence occurred in 10.6% (mean follow up 17 months).ConclusionThe Australian experience of Fellowship trained surgeons performing LRP demonstrates favourable peri‐operative, oncological and functional outcomes in comparison to published data for open, laparoscopic and robotic assisted radical prostatectomy. In our Australian centres, LRP remains an acceptable minimally invasive surgical treatment for prostate cancer despite the increasing use of robotic assisted surgery.
      PubDate: 2016-09-23T01:50:55.232164-05:
      DOI: 10.1111/bju.13610
  • The use of 68 Ga‐PSMA PET CT in men with biochemical recurrence after
           definitive treatment of acinar prostate cancer
    • Authors: Greta Meredith; David Wong, John Yaxley, Geoff Coughlin, Les Thompson, Boon Kua, Troy Gianduzzo
      Abstract: IntroductionEarly localisation of disease recurrence after definitive treatment of prostate cancer is vital to determine suitability for salvage treatment. Our aim was to further investigate the relationship between prostate specific antigen (PSA) level and detection of suspected cancer recurrence using 68 Ga‐PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy (RP) or radiotherapy, particularly at low PSA levels.MethodsThis retrospective single tertiary referral institution cohort study of men reviewed the results of 68 Ga‐PSMA PET/CT scans for investigation of post RP and post radiotherapy PSA recurrence following primary treatment of prostate cancer. We included men with suspected recurrent prostate cancer based on an elevated post treatment PSA level. The data collected analyzed the relationship of the pre‐scan PSA level to the probability of a positive scan finding for recurrent prostate cancer.ResultsOf the cohort of 532 men, 425 had a previous RP and 107 had prior radiotherapy. The median PSA of the RP group was 0.59 ng/mL and 5.8 ng/mL in the radiotherapy group. In the post RP cohort, the detection rate of 68 Ga‐PSMA PET/CT was 11.3% for PSA 0.01 to
      PubDate: 2016-09-23T01:41:38.598461-05:
      DOI: 10.1111/bju.13616
  • Transgenic Animal Model for Studying the Mechanism of Obesity‐Associated
           Stress Urinary Incontinence
    • Authors: Lin Wang; Guiting Lin, Yung‐Chin Lee, Amanda B. Reed‐Maldonado, Melissa T Sanford, Guifang Wang, Huixi Li, Lia Banie, Zhengcheng Xin, Tom F. Lue
      Abstract: PurposeTo study and compare the function and structure of the urethral sphincter in female Zucker lean and Zucker fatty (ZF) rats and to assess viability of ZF fats as a model for female obesity‐associated stress urinary incontinence (OA‐SUI).Materials and MethodsTwelve16‐week‐old female Zucker Lean (ZUC‐Leprfa 186) (ZL) rats and twelve16‐week‐old female Zucker Fatty (ZUC‐Leprfa 185) (ZF) rats were grouped into two groups: ZL arm and ZF arm. Intraperitoneal insulin tolerance testing was carried out before functional study. Metabolic cages, conscious cystometry, and leak point pressure (LPP) were conducted. Urethral tissues were harvested for immunofluorescence staining to check intramyocellular lipid (IMCL) and sphincter muscle (smooth muscle and striated muscle) composition.ResultsThe ZF rats demonstrated insulin resistance, increased voiding frequency, and decreased LPP compared to ZL rats (p
      PubDate: 2016-09-21T04:24:31.647568-05:
      DOI: 10.1111/bju.13661
  • Phenotypic diversity of circulating tumour cells in patients with
           metastatic castration‐resistant prostate cancer
    • Authors: Andrew S. McDaniel; Roberta Ferraldeschi, Rachel Krupa, Mark Landers, Ryon Graf, Jessica Louw, Adam Jendrisak, Natalee Bales, Dena Marrinucci, Zafeiris Zafeiriou, Penelope Flohr, Spyridon Sideris, Mateus Crespo, Ines Figueiredo, Joaquin Mateo, Johann S. de Bono, Ryan Dittamore, Scott A. Tomlins, Gerhardt Attard
      Abstract: ObjectivesTo utilize a non‐biased assay of circulating tumour cells (CTCs) in prostate cancer (PCa) patients in order to identify non‐traditional CTC phenotypes potentially excluded by conventional detection methods reliant upon antigen and/or sized based enrichment.Patients and Methods41 metastatic castration resistant prostate cancer (mCRPC) patients and 20 healthy volunteers were analysed on the Epic CTC Platform, via high throughput imaging of DAPI expression and CD45/cytokeratin (CK) immunofluorescence (IF) in all circulating nucleated cells plated on glass slides. IF for androgen receptor [AR] expression, and FISH for PTEN and ERG confirmed PCa origin of CTCs.ResultsTraditional (t) CTCs (CD45‐/CK+/morphologically distinct) were identified in 100% mCRPC patients. Using the above markers, we identified non‐traditional CTCs in mCRPC patients, including CK‐ and apoptotic CTCs. Small CTCs (≤WBC size) were identified in 98% of mCRPC patients. Total, traditional and non‐traditional CTCs were significantly increased in deceased vs. living patients at 18 months; however only non‐traditional CTCs associated with overall survival. Traditional and total CTC counts by the Epic platform in the mCRPC cohort were also significantly correlated with CTC counts by the CellSearch system.ConclusionsHeterogeneous non‐traditional CTC populations that may be missed by other approaches are frequent in mCRPC; characterization of non‐traditional CTCs may provide additional prognostic or predictive information.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-18T21:36:19.742643-05:
      DOI: 10.1111/bju.13631
  • Risk of Hospitalization Following Primary Treatment for Prostate Cancer
    • Authors: Stephen B. Williams; Zhigang Duan, Karim Chamie, Karen E. Hoffman, Benjamin D. Smith, Jim C. Hu, Jay B. Shah, John W. Davis, Sharon H. Giordano
      Abstract: ObjectiveTo compare the risk of hospitalization and associated costs in patients following treatment for prostate cancer.Patients and MethodsWe identified 29,571 patients age 66–75 years without significant comorbidity from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database who were diagnosed with localized prostate cancer between 2004 and 2009. We compared the rates of all cause and toxicity‐related hospitalization that occurred within 1 year following initiation of definitive therapy. We used multivariable logistic regression analysis to identify determinants associated with hospitalization.ResultsMen who underwent surgery rather than radiotherapy had lower odds of being hospitalized for any cause following therapy (OR 0.80: 95% CI, 0.74–0.87). Patients who underwent surgery rather than radiotherapy had higher odds of being hospitalized for treatment‐related complications (OR 1.15: 95% CI, 1.03–1.29). However, men who underwent external beam radiotherapy/IMRT (OR 0.84: 95% CI, 0.72‐0.99) had 16% lower odds of hospitalization from treatment‐related complications than patients undergoing surgery. Using propensity score weighted analyses, there was no significant difference in the odds of hospitalization from treatment‐related complications for men who underwent surgery versus radiotherapy (OR 1.06: 95% CI, 0.92–1.21). Patients hospitalized for treatment‐related complications following radiotherapy were costlier than patients who underwent surgery (Mean $18,381 vs. $13,203, p
      PubDate: 2016-09-16T00:18:44.30954-05:0
      DOI: 10.1111/bju.13647
  • Long term outcome of high dose rate (HDR) brachytherapy for intermediate
           and high risk prostate cancer with a median follow up of 10 years
    • Authors: J W Yaxley; K Lah, J P Yaxley, R A Gardiner, H Samaratunga, J MacKean
      Abstract: ObjectiveTo evaluate the long term outcome of high dose rate brachytherapy (HDR) for patients with intermediate and high risk prostate cancerSubjects, Patients and MethodsWe retrospectively analysed the prospective longitudinal cohort data base of a single surgeon series of 507 consecutive patients treated with external beam radiotherapy and a high dose rate prostate brachytherapy boost (HDR) between August 2000 and December 2009. The risk factors are based on the D'Amico classification. We measured the incidence of biochemical freedom of recurrent prostate cancer (bNED) based on the Phoenix definition of failure (nadir + 2). We also reviewed the incidence of urethral stricture in this cohort.ResultsWith a minimum follow up of 6 years and a median follow up of 10.3 years, the bNED for intermediate and high risk disease is 93.3 and 74.2% at 5 years respectively and 86.9% and 56.1% at 10 years. Patients with only 1 intermediate risk factor had a 10 year bNED of 94%, whereas patients with all 3 high risk factors had a 10 year bNED of 39.5%. The overall urethral stricture rate was 13.6%. Prior to 2005 the urethral stricture rate was 28.9% and after January 2005 was 4.2%. For the 271 men with a minimum follow up of 10 years the actual 10 year prostate cancer specific survival is 90.8% and actual overall survival is 86.7%.ConclusionsHigh dose rate prostatic brachytherapy remains an appropriate treatment option for patients with intermediate or high risk prostate cancer features, who are considered not suitable for, or wish to avoid a radical prostatectomy. From December 2004, prevention strategies decreased the risk of post brachytherapy urethral strictures.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:47:32.745397-05:
      DOI: 10.1111/bju.13659
  • Prospective study comparing Videoendoscopic radical Inguinal Lymph node
           dissection (VEILND) with Open radical inguinal lymphnode dissection
           (OILND) for penile cancer over an 8 year period
    • Authors: Vivekanandan Kumar; Krishna K Sethia
      Abstract: ObjectivesTo compare the complications and oncological outcomes between Video Endoscopic Inguinal Lymph node Dissection (VEILND) and Open Inguinal Lymph node Dissection (OILND) in men with carcinoma of the penis.Patients and methodsA prospectively collected institutional database was used to determine the outcomes in 42 consecutive patients undergoing inguinal lymph node dissection between 2008 and 2015 in a centre for treating penile cancer. Before 2013 all procedures involved open surgery. Since 2013 we have performed VEILND on all patients in need of ILND. The wound related, non‐wound related complications, length of stay and oncological safety between OILND and VEILND groups were compared. The mean duration of follow up was 71months for OILND and 16 months for the VEILND groups.ResultsIn the study period 42 patients underwent 68 inguinal node dissections (open 35, video‐assisted 33). The patients demographics, primary stage and grade, indications were comparable in both the groups. There were no intraoperative complications in either group. The wound complication rate was significantly lower in VEILND group at 6% compared to 68% in the OILND group. Lymphocele rates were similar in both the groups (27 and 20%). The VEILND group showed better or same lymph node yield, mean number of positive lymph nodes and lymph node density confirming oncological safety. There were no groin recurrence in either group of patients. VEILND patients had significant reduced length of stay by 4.9 days (p=0.0001).ConclusionVEILND is an oncologically safe procedure with considerably low morbidity and reduced length of stay at a mean follow‐up of 16 months (Range: 4‐35 months).This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:40:25.561228-05:
      DOI: 10.1111/bju.13660
  • Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair
           – demonstration of technique and matched‐pair analysis
    • Authors: Jens J. Rassweiler; Jan Klein, Alexandra Tschada, Ali Serdar Gözen
      Abstract: ObjectivesTo present technique and long‐term results of retroperitoneal laparoscopic partial nephrectomy (LPN) focussing on the impact of an ergonomic platform.Patients and MethodsBetween January 2000 and May 2016, 287 patients (193 male, 94 female) underwent LPN by four surgeons. Median age was 59 (19‐85) years. Mean tumour size was 3.1 (1‐9) cm. Mean PADUA‐score was 7.3 (6‐12). Access was retroperitoneal in 235 (82%) cases. Since October 2010, we used ETHOSTM‐chair during excision of the tumour in 130 (45.3%) patients. 51 (17.7%) tumours were excised without ischemia and 226 (78.7%) tumours under warm ischemia with clamping of renal artery using an enucleo‐resection technique. We suture the resection bed and perform renorrhaphy using a barbed‐suture pre‐loaded with absorbable LAPRA‐TYTM‐clip. The impact of ETHOS‐chair was examined using a matched‐pair analysis (66 ETHOS vs. 67 Non‐ETHOS‐chair).ResultsMedian operating time was 146 (60‐325) minutes. Median estimated blood loss was 99 (10 ‐ 3000) cc, mean warm ischemia time was 17.1 (7‐47) minutes. Histology showed 240 (83.6%) renal cell carcinomas and 46 (15.9%) benign tumours. Cumulative overall disease‐free survival rate after a median follow‐up of 84 (3‐155) months was 100 % for 203 pT1 renal cell tumours, local recurrence was observed in one patient (0.4%), who was managed by radical nephrectomy. There were two conversions (0.7%) to open surgery respectively to hand‐assisted laparoscopy. Perirenal hematoma was observed in 13 (4.5%) patients. 20 (6.9%) patients required transfusions (2‐11 units). We observed 5 urine leaks (1.7%) requiring prolonged drainage. Median hospital stay was 5 (3‐24) days. Three patients developed a‐v‐fistulas successfully occluded by super‐selective embolization (1.0%). Use of ETHOSTM‐chair resulted in shorter OR‐time (134.7 vs. 168.5 min., p = 0.04) including warm ischemia time (13.1 vs. 15.9 min., p=0.01) less complications (15% vs. 29.8%, p = 0.02). Limitation of the analysis is the fact that it is not prospective randomized trial.ConclusionsLPN is technically difficult but oncologic effective. Standardization and simplification of endoscopic suturing using ETHOS‐chair significantly improved the outcome of the surgical procedure.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T22:01:01.305238-05:
      DOI: 10.1111/bju.13627
  • Perioperative and short‐term outcomes after Retzius‐sparing
           robot‐assisted radical prostatectomy stratified by gland size
    • Authors: Glen D.R Santok; Ali Abdel Raheem, Lawrence H. C. Kim, Kidon Chang, Trenton G. H. Lum, Byung H. Chung, Young D. Choi, Koon H. Rha
      Abstract: Objectiveo investigate the impact of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius sparing robot assisted laparoscopic prostatectomy (RS‐RALP).Materials and MethodsThis is a retrospective analysis of 294 patients with organ‐confined prostate cancer (PCa) treated with RS‐RALP in a high volume center from November 2012 to February 2015. Patients were divided into three groups based on their TRUS volume as follows: group 1, (n=231, 60cc). Perioperative, oncological, and continence outcomes were compared between the three groups.ResultsThe median prostate volumes for each group were; 26.1cc (22‐ 40 31), 45.9cc (41‐50) and 70cc (68‐85). Blood loss was higher in group 3 compared to group 2 and group 1; 475cc (312‐575), 200cc (150‐400) and 250cc (150‐400), respectively (p=0.001) Intraoperative transfusion rate was higher in group 3 patients (p=0.004) while complication rate did not differ (p=0.05). Console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; 100±35minutes, 92±34.4minutes and 93±24.8 minutes, respectively (p=0.70). BCR and continence rate did not differ between the three groups (p=0.89, p=0.25, respectively).ConclusionRS‐RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostate. We therefore recommend for surgeons to start at smaller sized prostate in the commencement of application of RS‐RALP technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T21:50:41.077391-05:
      DOI: 10.1111/bju.13632
  • Quality of life and pain relief in men with metastatic
           castration‐resistant prostate cancer on cabazitaxel: the
           non‐interventional QoLiTime study
    • Authors: Ralf‐Dieter Hofheinz; Carsten Lange, Thorsten Ecke, Susanne Kloss, Burkhard Linsse, Christine Windemuth‐Kieselbach, Peter Hammerer, Salah‐Eddin Al‐Batran
      Abstract: ObjectiveTo examine health‐related quality of life in men with metastatic castration‐resistant prostate cancer on cabazitaxel.Patients and methodsMen with metastatic castration‐resistant prostate cancer receiving cabazitaxel (25 mg/m², every 3 weeks) and 10 mg/day oral prednis(ol)one were enrolled (2011–2014) in the non‐interventional prospective QoLiTime study. Primary outcome was change in quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30 item) with respect to PSA response after 4 cycles of cabazitaxel. Secondary outcomes included occurrence of adverse events.ResultsOf 527 men, 348 received 4 cycles of cabazitaxel and 266 had sufficient PSA measurements. After 4 cycles, 92 (34.6%) men had a PSA decrease ≥50% (responders). Quality of life remained stable throughout the study (P=0.62). Change in quality of life did not differ between responders and non‐responders (P=0.69). Change in PSA and global health status between baseline and 4 cycles showed an inversely proportional relationship (correlation coefficient –0.14; 95% CI –0.26 to –0.01; P=0.03), with increasing PSA corresponding to lower health status. Responders showed no change in physical functioning versus baseline (–1.75, P=0.12); non‐responders showed a reduction versus baseline (–7.00, P
      PubDate: 2016-09-12T10:30:33.313897-05:
      DOI: 10.1111/bju.13658
  • Is a negative mpMRI really able to rule out significant prostate
           cancer': The real life experience
    • Authors: Nicolas Branger; Thomas Maubon, Miriam Traumann, Jeanne Thomassin‐Piana, Nicolas Brandone, Sébastien Taix, Julien Touzlian, Serge Brunelle, Geraldine Pignot, Naji Salem, Gwenaelle Gravis, Jochen Walz
      Abstract: ObjectivesTo evaluate the histopathological results after radical prostatectomy in patients that had a normal preoperative mpMRI in order to see if they had significant or insignificant disease. Moreover we evaluated the influence of the expertise of the radiologist on the results.Materials and methodsWe retrospectively included patients who underwent radical prostatectomy in our center and who had a preoperative negative mpMRI. The MRIs were considered negative when no suspicious lesion was seen or when the PI‐RADS V1 score was less than 7. We used pTNM stage and Gleason score on pathology reports, and whole mount sections to calculate tumor volume.ResultsWe identified 101 patients from 2009 to 2015. Final pathology showed that 16.9% had an extraprostatic extension (EEP), 13.8% had primary Gleason pattern 4 (4+3 and up), 47.5% had secondary Gleason pattern 4 or 5, 55.9% and 20.6% had a main tumor volume ≥ 0.5mL and ≥ 2mL respectively. When limiting the analysis to expert reading only, the numbers improved: only one patient (3.4%) had an EEP (p
      PubDate: 2016-09-12T10:30:32.058433-05:
      DOI: 10.1111/bju.13657
  • A novel infusion‐drainage device to assess lower urinary tract
           function in neuro‐imaging
    • Authors: Lorenz Leitner; Matthias Walter, Behnaz Jarrahi, Johann Wanek, Jörg Diefenbacher, Lars Michels, Martina D. Liechti, Spyros S. Kollias, Thomas M. Kessler, Ulrich Mehnert
      Abstract: ObjectiveTo evaluate the applicability and precision of a novel infusion‐drainage device (IDD) for standardised filling paradigms in neuro‐urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) (dys)function.Subjects/patients and methodsThe IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorised slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterisation, the bladder was pre‐filled until a persistent desire to void was reported from each subject. The scan paradigm comprised of automated, repetitive bladder filling and withdrawal of 100 mL body warm (37° C) saline interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping 12.ResultsVolume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flowrates and volumes. MR compatibility was demonstrated with a small decrease in signal‐to‐noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans and a decrease of 1.76% for time‐variant SNR. Automated, repetitive bladder filling elicited robust (p=0.05, family‐wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level dependent (BOLD) signal changes in such areas.ConclusionWe were able to develop a magnetic resonance (MR) compatible and MR synchronised IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in congruence to the applied stimuli. The IDD is commercially available, portable, and multi‐configurable. Such a device may help to improve precision and standardization of LUT tasks in neuroimaging studies on supraspinal LUT control, and may therefore facilitate multi‐site studies and comparability between different LUT investigations in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T10:15:29.51283-05:0
      DOI: 10.1111/bju.13655
  • PADUA and RENAL nephrometry scores correlates with perioperative outcomes
           after robot‐assisted partial nephrectomy: analysis of the Vattikuti
           Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database
    • Authors: Riccardo Schiavina; Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A. Moon, Francesco Porpiglia, Benjamin J. Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
      Abstract: ObjectivesTo evaluate and compare the correlations between PADUA and RENAL scores and perioperative outcomes and postoperative complications in a multicenter, international series of patients undergoing Robot‐assisted partial nephrectomy (RAPN) for masses suspicious of RCC.Patients and methodsWe retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international Centers that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database. All patients underwent pre‐operative computed tomography or magnetic resonance imaging to define the clinical stage and anatomic characteristics of the tumors. PADUA and RENAL scores were retrospectively assessed in each Center. Univariate and multivariate analyses were performed to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumor size, PADUA and RENAL complexity group categories and warm ischemia time >20 minutes, urinary calyceal system closure and grade of postoperative complications.ResultsOverall, 277 patients have been evaluated. The median tumor size was 33.0 millimeters (22.0‐43.0). The median PADUA and RENAL score were 8 and 7 respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low, intermediate or high‐complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low, intermediate or high‐complexity group according to RENAL score, respectively. Both nephrometric tools significantly correlated with perioperative outcomes at univariate and multivariate analyses..ConclusionA precise stratification of patients before partial nephrectomy is recommended, allowing to balance the potential threats and benefits of nephron‐sparing surgery. In our analysis, both PADUA and RENAL were significantly associated with prolonged WIT and high‐grade postoperative complications after RAPN.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-11T00:00:24.276066-05:
      DOI: 10.1111/bju.13628
  • Serum levels of enclomiphene and zuclomiphene in hypogonadal men on
           long‐term clomiphene citrate treatment
    • Authors: Sevann Helo; Joseph Mahon, Joseph Ellen, Ron Wiehle, Gregory Fontenot, Kuang Hsu, Paul Feustel, Charles Welliver, Andrew McCullough
      Abstract: ObjectivesTo determine the relative concentrations of enclomiphene (ENC) and zuclomiphene (ZUC) isomers in hypogonadal men (HM) on long‐term clomiphene citrate (CC) therapy. To determine whether patient age, body mass index, or duration of therapy were predictive of relative concentrations of ENC and ZUC.Patients and MethodsMen already on CC 25 mg daily therapy for secondary hypogonadism for a minimum of six weeks were recruited to have their ENC and ZUC levels assessed. Total testosterone (T), free testosterone, estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH) prior to initiation of and while on CC therapy were recorded for all patients. Patient demographics including age, body mass index, and medical comorbidites were recorded. Serum samples were obtained at the time of enrollment to determine ENC and ZUC concentrations.ResultsA total of 15 men were enrolled from June 2015 to August 2015. Median patient age was 36 (range 22‐70) years, median body mass index 32.0 (range 21.1‐40.3)kg/m2, and median duration of treatment 25.9 (range 1.7‐86.6) months. Baseline median total T, estradiol, and LH were 205.0 ng/dL, 17.0 pg/mL, and 4.0 mlU/mL, respectively. Post‐treatment median total T, estradiol, and LH increased to 488.0 ng/dL 34.0 pg/mL, and 6.1 mIU/mL, respectively (all p
      PubDate: 2016-09-11T00:00:21.328709-05:
      DOI: 10.1111/bju.13625
  • Diagnostic accuracy of CT urography and visual assessment during
           ureterorenoscopy in upper tract urothelial carcinoma
    • Authors: Alexandra Grahn; Miden Melle‐Hannah, Camilla Malm, Fredrik Jäderling, Eva Radecka, Mats Beckman, Marianne Brehmer
      Abstract: Upper tract urothelial carcinoma (UTUC) is a rare condition, although the annual incidence is increasing, possibly as a result of improved diagnostic performance and higher survival rates in patients with bladder cancer. Research data and technical development achieved in the last decades have led to a shift in the guidelines of European Association of Urology (EAU) and American Urological Association for diagnosis and treatment of UTUC. Computed tomography urography (CTU) has become the imaging of choice for investigation.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T07:36:46.28093-05:0
      DOI: 10.1111/bju.13652
  • The landscape of systematic reviews in urology (1998 through 2015): An
           assessment of methodologic quality
    • Authors: Julia L. Han; Shreyas Gandhi, Crystal G. Bockoven, Vikram Narayan, Philipp Dahm
      Abstract: Sir Archie Cochrane is credited with the recognition that few clinical questions in health care are appropriately addressed by consulting the results of a single study alone; instead, we should perform systematic reviews to summarize the entire body of evidence—ideally, high‐quality evidence—in order to inform patient decision‐making and health policy. His contributions provided the impetus for the founding of the Cochrane Collaboration and for the development of transparent, rigorous methods for systematic reviews. Over the last two decades, such reviews have gained increasing importance with regard to their perceived role in informing evidence‐based clinical practice. They tend to be frequently cited in the literature and thus can raise a journal's impact factor. The number of systematic reviews published in the urology literature has clearly increased.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T04:21:15.537585-05:
      DOI: 10.1111/bju.13653
  • A Qualitative Study on Decision‐Making by Prostate Cancer Physicians
           during Active Surveillance
    • Authors: Stacy Loeb; Caitlin Curnyn, Angela Fagerlin, R. Scott Braithwaite, Mark D. Schwartz, Herbert Lepor, H. Ballentine Carter, Erica Sedlander
      Abstract: ObjectiveTo explore and identify factors that influence physicians’ decisions while monitoring prostate cancer patients on active surveillance.Subjects and methodsA purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the US. We conducted 24 in‐depth interviews from July‐December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software was used for organization and further analysis.ResultsEight key themes emerged to explain variation in active surveillance monitoring: 1) physician comfort with active surveillance, 2) protocol selection, 3) beliefs about the utility and quality of testing, 4) years of experience and exposure to AS during training, 5) concerns about inflicting “harm”, 6) patient characteristics, 7) patient preferences, and 8) financial incentives.ConclusionThese qualitative data reveal which factors influence physicians that manage patients on AS. There is tension between providing standardized care while also considering individual patients’ needs and health status. Additional education on active surveillance is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:59.225621-05:
      DOI: 10.1111/bju.13651
  • Pathologic Analysis of the Prostatic Anterior Fat Pad at the time of
           Radical Prostatectomy: Insights from a Prospective Series
    • Authors: Mark W. Ball; Kelly T. Harris, Zeyad Schwen, Jeffrey K Mullins, Misop Han, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein
      Abstract: ObjectiveTo assess factors associated with lymphatic drainage and lymph node metastasis to the prostatic anterior fat pad (PAFP) in men with prostate cancer and the utility of routine PAFP analysis at the time of radical prostatectomy (RP).MethodsOur institution began to prospectively collect PAFP tissue in 2010. The PAFP was removed at the time of RP and sent as a pathologic specimen separate from the pelvic LNs and prostate. Consecutive RPs performed at our institution in which the PAFP was removed were reviewed to determine the rate of LNs in the PAFP, the rate of metastatic LNs in the PAFP, and the association of metastatic PAFP LN with clinical and pathologic features. The impact on biochemical recurrence was assessed with a Cox's proportional hazard model.ResultsIn total, 2,413 AFP specimens were available for analysis. LNs were found in the AFP in 255(10.6%) cases and metastatic LNs to the PAFP were found in 14 (0.6%) cases. Metastatic PAFP LNs were associated with anterior tumors in 11 (78.6%) cases (p = 0.01), and were present only in pre‐operative D'Amico intermediate‐ (n=6, 42.8%) and high‐ (n=8, 57.1%) risk patients (p < 0.001). Metastatic PAFP LNs were associated with extraprostatic disease in 13 (92.8%) of cases, though concomitant pelvic LN involvement was present in only 4 (28.6%) cases. With a mean follow up of 1.5 years, 3 (21.4%) patients with metastatic PAFP LN experienced BCR. Positive LN involvement in either the pelvic LN or PAFP had worse BCR than LN negative patients (p < 0.0001); however, there was no difference in BCR between patients with positive pelvic LN and positive PAFP LN (p=0.5).ConclusionMetastatic PAFP LNs are rare and always occur in the presence of other adverse pathologic features. The routine pathologic analysis of PAFP as a separate specimen, especially in low‐risk disease, may not be warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:57.770637-05:
      DOI: 10.1111/bju.13654
  • Lesion volume predicts prostate cancer risk and aggressiveness: validation
           of its value alone and matched with PIRADS score
    • Authors: Eugenio Martorana; Giacomo Maria Pirola, Michele Scialpi, Salvatore Micali, Andrea Iseppi, Luca Reggiani Bonetti, Shaniko Kaleci, Pietro Torricelli, Giampaolo Bianchi
      Abstract: ObjectiveTo demonstrate the association between MRI estimated lesion volume (LV), PCa detection and tumour clinical significance evaluating this variable alone and matched with PI‐RADSv2 score.Patients and methodsWe retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal MRI/US fusion targeted biopsy (Tp MRI/US FTB) between January 2014 and February 2016 using Biopsee® system. Suspicious lesions (SL) were bordered using a “region of interest” and the system calculated prostate volume and LV. Patients were divided in groups considering LV (< 0.5 ml, 0.5 ‐ 1 ml, > 1 ml) and PI‐RADS score (1‐5). We considered as clinically significant PCa (sPCa) all cancers with GS ≥ 3 + 4 as suggested by PI‐RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t test. MRI LV volume and HTV concordance was verified using a Bland‐Altman plot. Chi‐square test, logistic and ordinal regression model were used to evaluate difference in frequencies. The selected level of statistical significance was ≤ 0.05.ResultsThe LV and PI‐RADS score were associated both with PCa detection (p < 0.00001 and p= 0.00012) and with sPCa detection (p< 0.00001 and p= 0.00808). When the two variables were matched, LV increased the risk within each PI‐RADS group. PCa detection became 1.4 times higher for LV 0.5 ‐ 1 ml and 1.8 times higher for LV > 1 ml; sPCa detection increased 2.6 times for LV 0.5 ‐ 1 ml and 4 times for LV > 1ml. There was positive correlation between MRI LV and HTV (r = 0,9876, p < 0.001). Finally, Bland‐Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations are its monocentric and retrospective design and the limited casistic.ConclusionsThis study demonstrates that PIRADS score and the LV, independently and matched, are associated with PCa detection and with tumour clinical significance.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T13:50:20.096471-05:
      DOI: 10.1111/bju.13649
  • The influence of prostate‐specific antigen density on positive and
           negative predictive values of multiparametric magnetic resonance imaging
    • Authors: Nienke L. Hansen; Tristan Barrett, Brendan Koo, Andrew Doble, Vincent Gnanapragasam, Anne Warren, Christof Kastner, Ola Bratt
      Abstract: ObjectivesTo evaluate the influence of PSA‐D on positive (PPV) and negative (NPV) predictive values of mpMRI to detect GS ≥7 cancer in a repeat biopsy setting.Patients and methodsRetrospective study of 514 men with previous prostate biopsy showing no or GS 6 cancer. All had mpMRI, graded 1‐5 on a Likert scale for cancer suspicion, and subsequent targeted and 24‐core systematic image‐fusion guided transperineal biopsy in 2013‐2015. NPVs and PPVs of mpMRIs for detecting GS ≥7 cancer were calculated (±95% confidence intervals) for PSA‐D ≤0.1, 0.1‐0.2, ≤0.2 and >0.2 ng/ml/cm3, and compared by Chi‐square test for linear trend.ResultsGS ≥7 cancer was detected in 31% of the men. NPV of Likert 1‐2 mpMRI was 0.91 (±0.04) with PSA‐D ≤0.2 and 0.71 (±0.16) with >0.2 (p=0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with PSA‐D ≤0.2 and 0.44 (±0.19) with >0.2 (p=0.002). PSA‐D also significantly affected the PPV of Likert 4‐5 mpMRI lesions: the PPV was 0.47 (±0.08) with PSA‐D ≤0.2 and 0.66 (±0.10) with >0.2 (p=0.0001).ConclusionIn a repeat biopsy setting, PSA‐D ≤0.2 is associated with low detection of GS ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with high PSA‐D, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if PSA‐D is low.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T12:50:27.269121-05:
      DOI: 10.1111/bju.13619
  • Safety, reliability and accuracy of small renal tumor biopsies: Results of
           a multi‐institution registry
    • Authors: Patrick O. Richard; Michael A. S. Jewett, Simon Tanguay, Olli Saarela, Zhihui Amy Liu, Frédéric Pouliot, Anil Kapoor, Ricardo Rendon, Antonio Finelli
      Abstract: ObjectiveTo validate the safety, accuracy and reliability of RTB and its role in decreasing unnecessary treatment in a multi‐institution review.Materials and methodsThis was a multi‐institution retrospective study of patients who underwent RTB to characterize a SRM between 2011 and May 2015. Subjects were identified using the prospectively maintained Canadian Kidney Cancer information system (CKCis). Diagnostic and concordance rates were presented using proportions whereas factors associated with a diagnostic RTB were identified using a logistic regression model.ResultsOf the 373 biopsied SRMs, the initial biopsy was diagnostic in 87% of cases. Of the 47 nondiagnostic biopsies, 15 had a repeat biopsy of which, 80% were diagnostic. Therefore, when both were combined, a diagnosis was obtained in 91% of SRMs. Of these, 18% were benign. Size was the only factor found to be associated with achieving a diagnostic biopsy. RTB histology and nuclear grade (high or low) were found to be highly concordant with surgical pathology (86% and 81%, respectively). Of the discordant tumors (n=16), all were upgraded from low to high grade on surgical pathology. Adverse events were rare (
      PubDate: 2016-09-07T03:40:22.747368-05:
      DOI: 10.1111/bju.13630
  • Randomised trial of early infant circumcision performed by clinical
           officers and registered nurse midwives using the Mogen clamp in Rakai,
    • Authors: Edward N. Kankaka; Teddy Murungi, Godfrey Kigozi, Frederick Makumbi, Dorean Nabukalu, Stephen Watya, Nehemiah Kighoma, Resty Nampijja, Daniel Kayiwa, Fred Nalugoda, David Serwadda, Maria Wawer, Ronald H. Gray
      Abstract: ObjectivesTo assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda.Subjects and MethodsWe conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with # NCT02596282. In all, 501 healthy neonates aged 1–28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed‐up at 1, 7 and 28 days.ResultsIn all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow‐up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs.ConclusionsEIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.
      PubDate: 2016-09-06T00:50:47.727872-05:
      DOI: 10.1111/bju.13589
  • Prostate cancer outcomes for men who present with symptoms at diagnosis
    • Authors: Kerri R. Beckmann; Michael E. O'Callaghan, Rasa Ruseckaite, Ned Kinnear, Caroline Miller, Sue Evans, David M. Roder, Kim Moretti,
      Abstract: ObjectiveTo compare clinical features, treatments and outcomes in men with non‐metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate specific antigen (PSA).Patients and methodsThis study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi‐institutional clinical registry covering both the public and private sectors. Participants included all non‐metastatic cases from 1998‐2013 referred for urinary/prostatic symptoms or elevated PSA. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa survival, metastatic‐free survival and disease‐free survival) were compared using multivariate Cox proportional hazards and competing risk regression.ResultsOur analytic cohort consisted of 4841 men with localised PCa. Symptomatic men had lower risk disease (IR= 0.70, CI 0.61‐0.81 for high vs low risk), fewer radical prostatectomies (IR=0.64 CI 0.56‐0.75) and less radiotherapy (IR=0.86, CI 0.77‐0.96) than men presenting with elevated PSA. All‐cause mortality (HR=1.31, CI 1.16‐1.47), disease‐specific mortality (HR=1.42, CI 1.13‐1.77) and risk of metastases (HR=1.36, CI 1.13‐1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics. However, risk of disease progression did not differ (HR=0.90, CI 0.74‐1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR=3.4, CI 1.3‐8.8), those over 70 years (HR=1.4, CI 1.0‐1.8), private patients (HR=2.1, CI 1.3‐3.3), those diagnosed via biopsy (HR=1.3, CI 1.0‐1.7) and those diagnosed before 2006 (HR=1.6, CI 1.1.2‐1.7).ConclusionOur results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post‐treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-03T22:20:28.085435-05:
      DOI: 10.1111/bju.13622
  • Value of 3‐T multiparametric magnetic resonance imaging and targeted
           biopsy for improved risk stratification in patients considered for active
    • Authors: Rodrigo R. Pessoa; Publio C. Viana, Romulo L. Mattedi, Giuliano B. Guglielmetti, Mauricio D. Cordeiro, Rafael F. Coelho, William C. Nahas, Miguel Srougi
      Abstract: ObjectiveTo evaluate the role of multiparametric magnetic resonance imaging (mpMRI) of the prostate and transrectal guided biopsy (TRUS‐Bx) with visual estimation in early risk stratification of patients on active surveillance.Patients and methodspatients with low‐risk, low‐grade, localized prostate cancer (PCa) were prospectively enrolled and submitted to a 3T 16‐channel cardiac surface coil mpMRI of the prostate and confirmatory biopsy (CB), which included a standard biopsy (SB) and visual estimation‐guided TRUS‐Bx. Cancer‐suspicious regions (CSRs) were defined using Prostate Imaging Reporting and Data System (PI‐RADS) scores. Reclassification occurred if CB confirmed the presence of a Gleason score ≥7, greater than three positive fragments, or ≥50% involvement of any core. The performance of mpMRI for the prediction of CB results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, PSA, PSA density (PSAd), number of positive cores in the initial biopsy, and mpMRI grade on CB reclassification. Our report is consistent with START guidelines.Resultsa total of 105 patients were available for analysis in the study. From this cohort, 42 (40%) had PI‐RADS 1, 2, or 3 lesions and 63 (60%) had only grade 4 or 5 lesions. Overall, 87 patients underwent visual estimation TRUS‐Bx. Reclassification among patients with PI‐RADS 1, 2, 3, 4, and 5 was 0%, 23.1%, 9.1%, 74.5%, and 100%, respectively. Overall, mpMRI sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for disease reclassification were 92.5%, 76%, 81%, and 90.5%, respectively. In the multivariate analysis, only PSAd and mpMRI remained significant for reclassification (p
      PubDate: 2016-09-03T22:20:25.78864-05:0
      DOI: 10.1111/bju.13624
  • Metastatic Potential to Regional Lymph Nodes with Gleason Score ≤7
           including Tertiary Pattern 5 at Radical Prostatectomy
    • Authors: Mairo L. Diolombi; Jonathan I. Epstein
      Abstract: Objectives To determine the risk of pelvic LN metastases at radical prostatectomy (RP) with GS ≤7: 3+3=6 (GG1); 3+4=7 (GG2); 3+4=7 (GG2) with tertiary pattern 5 (T5); 4+3=7 (GG3); 4+3=7 (GG3) with T5 using the 2014 Modified Gleason grading system and the novel Grade Group (GG) system.Materials and Methods We searched our RP database between 2005 and 2014 for cases of GS ≤7 with simultaneous pelvic LN dissection (PLND). Since 2005, we have graded all glomeruloid and cribriform cancer as Gleason pattern 4 and graded mucinous adenocarcinoma based on the underlying architectural pattern consistent with the 2014 Modified Gleason grading system. All RPs were embedded in entirety, including the PLND. A total of 7442 cases were identified, of which 73 had at least 1 positive LN (+LN).Results The incidence of regional LN metastases at RP for 3+3=6 (GG1); 3+4=7 (GG2); 3+4=7 (GG2) with T5; 4+3=7 (GG3); 4+3=7 (GG3) with T5 were 0%, 0.6%, 0.4%, 4.3% and 6.3% respectively. There was a statistically significant difference in risk of +LN at RP between the Grade Groups as defined by the novel Grade Group system. There was no statistically significant difference in risk of +LN at RP for men with 3+4 (GG2) vs. 3+4 (GG2) with T5 and for men with 4+3 (GG3) vs. 4+3 (GG3) with T5. Non‐pelvic LN involvement was identified in 0.2% of all RPs. Two patients with Gleason score 3+4=7 with
      PubDate: 2016-09-02T22:40:24.93675-05:0
      DOI: 10.1111/bju.13623
  • Surgical quality of minimally invasive adrenalectomy for adrenocortical
           carcinoma: a contemporary analysis using the national cancer data base
    • Authors: Matthew J. Maurice; Matthew J. Bream, Simon P. Kim, Robert Abouassaly
      Abstract: ObjectivesTo compare quality outcomes between open (OA) and minimally invasive (MIA) adrenalectomy for adrenocortical carcinoma.Patients and MethodsIn the National Cancer Data Base, we identified 481 patients with non‐metastatic adrenocortical carcinoma who underwent adrenalectomy from 2010‐2013. OA and MIA were compared on positive‐surgical‐margin and lymphadenectomy rates (primary outcomes) and lymph node yield, length of stay, readmission, and overall survival (secondary outcomes). Using the intention‐to‐treat principle, minimally‐invasive‐converted‐to‐open cases were considered MIA. Logistic regression analysis was used to identify predictors of positive margins and lymphadenectomy. Associations between approach and the outcomes were further assessed by stage and tumor size.ResultsOverall, 161 patients (33.5%) underwent MIA. MIA was used more commonly in older, comorbid patients; for smaller, localized tumors; and at lower‐volume centers. In the intention‐to‐treat analysis, MIA independently predicted positive margins (OR 2.0, 95%CI 1.1‐3.6, p=.03) and no lymphadenectomy (OR 0.1, 95%CI 0.03‐0.6, p=.01). On subgroup analysis, the association between MIA and positive margins only held true for pT3 disease (48.7% vs. 26.7%, p=.01). A higher rate of margin positivity was observed for tumors ≥10 cm managed with MIA vs. OA, but this difference was not significant (28.2% vs. 18.5%, p=.16). Likewise, the association between MIA and no lymphadenectomy was only observed for male patients, tumors ≥10 cm, and cN0 disease. After excluding minimally‐invasive‐converted‐to‐open cases, the difference in margin positivity was less pronounced and non‐significant (OR 1.8, 95%CI 0.9‐3.4, p=.08). MIA was associated with significantly shorter median length of stay (3 vs. 6 days, p
      PubDate: 2016-09-01T00:15:23.627576-05:
      DOI: 10.1111/bju.13618
  • Renal fossa recurrence following nephrectomy for renal cell carcinoma:
           prognostic features and oncologic outcomes
    • Authors: Sarah P. Psutka; Mark Heidenreich, Stephen A. Boorjian, George C. Bailey, John C. Cheville, Suzanne B. Stewart‐Merrill, Christine M. Lohse, Thomas D. Atwell, Brian A. Costello, Bradley C. Leibovich, R. Houston Thompson
      Abstract: ObjectiveTo describe clinicopathologic features associated with increased risk of renal fossa recurrences (RFR) following radical nephrectomy (RN) and to describe prognostic features associated with cancer‐specific survival (CSS) among patients with RFR treated with primarily locally‐directed therapy, systemically directed therapy, or expectant management.Patients And MethodsRecords of 2502 patients treated with RN for unilateral, sporadic, localized RCC between 1970 and 2006 were reviewed. CSS following RFR was estimated using the Kaplan‐Meier method. Associations with the development of RFR and CSS following RFR were evaluated using Cox proportional hazards regression models.ResultsA total of 33 (1.3%) patients developed isolated RFR (iRFR) and 30 (1.2%) patients developed RFR in the setting of synchronous metastases following RN (study cohort, N=63). Median follow‐up for the series was 9.0 years after RN and 6.0 years following RFR diagnosis. On multivariable analysis, advanced pathologic stage (pT2: HR 4.36, p=0.004; pT3/4: HR 4.39, p=0.003) and coagulative necrosis (HR 2.71, p=0.006) were independently associated with increased risk of iRFR. The median time to recurrence was 1.5 years post‐nephrectomy among the 33 patients with iRFR, and 1.4 years among all patients. Overall, median CSS was 2.5 years after iRFR diagnosis, 1.3 years after RFR in the setting of synchronous metastases, and 2.2 years overall. Following primary locally directed therapy (surgery, ablation, or radiation), systemic therapy, or expectant management, the 3‐year CSS rates among patients with iRFR were 63%, 50%, and 13% (p=0.001) and were 64%, 50%, and 28% (p=0.006) among all patients,respectively. On multivariable analysis, when compared to observation, locally directed therapies were associated with a significantly decreased risk of death from RCC (HR 0.26, p
      PubDate: 2016-08-31T22:25:24.890225-05:
      DOI: 10.1111/bju.13620
  • Selective Arterial Clamping Does Not Improve Outcomes in Robotic Partial
           Nephrectomy; A Propensity Score Analysis Of Patients Without Impaired
           Renal Function
    • Authors: David J. Paulucci; Daniel C. Rosen, John P. Sfakianos, Michael J. Whalen, Ronney Abaza, Daniel D. Eun, Louis S. Krane, Ashok K. Hemal, Ketan K. Badani
      Abstract: ObjectivesTo assess the benefit of selective arterial clamping (SAC) as an alternative to main renal artery clamping (MAC) during robotic partial nephrectomy (RPN) in patients without underlying chronic kidney disease.Subjects/Patients and MethodsOur study cohort comprised 665 patients without impaired renal function undergoing MAC (n=589) and SAC (n=76) RPN respectively from four medical institutions from 2008‐2015. We compared complication rates, positive surgical margin (PSM) rates, and perioperative and intermediate term renal functional outcome between 132 MAC and 66 SAC patients after 2 to 1 nearest neighbor propensity score matching for age, sex, BMI, R.E.N.A.L. Nephrometry score, tumor size, baseline eGFR, ASA, Charlson Comorbidity Index (CCI), and warm ischemia time (WIT).ResultsIn propensity matched patients, PSM (5.7% vs. 3.0%, p=.407) and complications (13.8% vs. 10.6%, p=.727) did not differ for MAC vs. SAC. Incidence of acute kidney injury in MAC vs. SAC (25.0% vs. 32.0%, p=.315) within the first 30 days was similar. At median follow‐up of 7.5 months, the percentage reduction in eGFR (‐9.3% vs. ‐10.4%, p=.518) and progression to CKD ≥ Stage 3 (7.2% vs. 8.5%, p=.792) showed no difference.ConclusionsOur study findings show no difference in PSM, complications, nor intermediate term renal functional outcomes in patients with unimpaired renal function with SAC compared to MAC. When expected WIT is low, routine utilization of SAC may not be necessary. Further studies will need to determine the role of SAC in solitary kidney patients or in patients with significantly impaired renal function.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-31T22:20:24.904237-05:
      DOI: 10.1111/bju.13614
  • Management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary
           adverse events (UAEs) from radiotherapy for prostate cancer
    • Authors: Erik N. Mayer; Jonathan D. Tward, Mitchell Bassett, Sara M. Lenherr, James M. Hotaling, William O. Brant, William T. Lowrance, Jeremy B. Myers
      Abstract: ObjectiveTo describe the management of grade 4 Radiation Therapy Oncology Group (RTOG) urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). We hypothesized grade 4 UAEs often require complex surgical management and subject patients to significant morbidity.MethodsA single‐center retrospective review, over a 6‐year period (2010‐2015), identified men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined modality therapy (radical prostatectomy (RP) followed by external beam radiotherapy (EBRT), EBRT + low‐dose brachytherapy (LDR), EBRT + high‐dose brachytherapy (HDR), or other combinations of RT) or single modality RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto‐urethral fistula) or bladder (contraction, necrosis, fistula, ureteral stricture, or hemorrhage).ResultsWe identified 73 men with a mean age of 73 years. Forty‐four (60%) had combined modality therapy, consisting of RP + EBRT (19), high dose rate brachytherapy (HDR) + EBRT (19), low dose rate brachytherapy (LDR) + EBRT (5), and other combined modality RT (2). Twenty‐nine (40%) patients had single modality therapy consisting of EBRT (4), HDR (11), LDR (12), or proton beam (2). UAEs were isolated to the bladder in 6 (8%), the outlet in 52 (71%), and both in 15 (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion in 23 (32%). Reconstruction included: ureteral (4), recto‐urethral fistula repair (2), and posterior urethroplasty (13), of which 14/16 (88%) surgeries with follow‐up >90 days were successful.ConclusionsAlthough the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their morbidity is significant, and approximately one third of patients with these high‐grade complications require urinary diversion. Conversely only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-30T02:10:44.94212-05:0
      DOI: 10.1111/bju.13607
  • Risk Prediction Tool for Grade Reclassification in Favorable‐Risk
           Men on Active Surveillance
    • Authors: Mufaddal M. Mamawala; Karthik Rao, Patricia Landis, Jonathan I. Epstein, Bruce J. Trock, Jeffrey J. Tosoian, Kenneth J. Pienta, H. Ballentine Carter
      Abstract: ObjectiveTo create a nomogram for men on active surveillance (AS) for prediction of grade reclassification (GR) above Gleason score 6 (Grade group >2) at surveillance biopsy.Materials and MethodsFrom a cohort of men enrolled in an AS program, a multivariable model was used to identify clinical and pathologic parameters predictive of GR. Nomogram performance was assessed using receiver operating characteristic curves, calibration and decision curve analysis.ResultsOf 1374 men, 254 (18.50%) were reclassified to Gleason 7 or higher on surveillance prostate biopsy. Variables predictive of GR were earlier year of diagnosis (≤2004 vs. ≥2005; odds ratio [OR] = 2.16, P = < 0.0001), older age (OR = 1.05, P = 0.0004), higher prostate specific antigen density [PSAD] (OR = 1.19 [per 0.1 unit increase], P = 0.04), bilateral disease (OR = 2.86, P = < 0.0001), risk strata (low‐risk vs. very‐low‐risk, OR=1.79, P = 0.0009) and total number of biopsies without GR (OR = 0.68, P = < 0.0001). On internal validation, a nomogram created using the multivariable model demonstrated an area under the curve of 0.757 (95% CI = 0.730, 0.797) for predicting GR at the time of next surveillance biopsy.ConclusionThe nomogram described is currently being used at each return visit to assess the need for a surveillance biopsy, and could increase retention in AS.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-29T11:40:23.026279-05:
      DOI: 10.1111/bju.13608
  • The Role of Biobanking in Urology: A Review
    • Authors: Heather J. Chalfin; Elizabeth Fabian, Leslie Mangold, David B. Yeater, Kenneth J. Pienta, Alan W. Partin
      Abstract: In the current era of individualized medicine, a biorepository of human samples is essential to support clinical and translational research. There have been limited efforts in this arena within the field of urology, as costs, logistical, and ethical issues represent significant deterrents to biobanking. The Johns Hopkins Brady Urological Institute (JHBUI) Biorepository was founded in 1994 as a resource to facilitate discovery. Since its inception, the biorepository has enabled numerous research endeavors including pivotal trials leading to the regulatory approval of four diagnostic tests for prostate cancer. In this review, we discuss the current state of biobanking within urology, outline the specific ethical and financial challenges of biobanking as well as solutions, and describe the operations of a successful urologic biorepository.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-29T11:35:32.01481-05:0
      DOI: 10.1111/bju.13606
  • The actual lowering effect of metabolic syndrome on serum
           prostate‐specific antigen levels is partly concealed by enlarged
           prostate: results from a large‐scale population‐based study
    • Authors: Sicong Zhao; Ming Xia, Jianchun Tang, Yong Yan
      Abstract: ObjectivesTo clarify the actual lowering effect of metabolic syndrome (MetS) on serum prostate‐specific antigen (PSA) levels in a Chinese‐screened population.Materials and MethodsA total of 45,540 ostensibly healthy men aged 55‐69 years of old who underwent routine health check‐ups at Beijing Shijitan Hospital from 2008 to 2015 were included in this study. All subjects underwent detailed clinical evaluations. PSA mass density was calculated (serum PSA level × plasma volume ÷ prostate volume) for simultaneously adjusting plasma volume and prostate volume. According to the modified NCEP‐ATP III criteria, subjects were dichotomized by the presence of MetS, and the differences in PSA density and PSA mass density were compared between groups. Linear regression analysis was used to evaluate the effect of MetS on serum PSA levels.ResultsWhen larger prostate volume in men with MetS was adjusted, both the PSA density and PSA mass density in subjects with MetS were significantly lower than that in subjects without MetS, and the estimated difference in mean serum PSA level between subjects with and without MetS was greater than that before prostate volume was adjusted. In multivariate regression model, the presence of MetS was independently associated with an 11.3% decline in serum PSA levels compared with subjects without MetS. In addition, the increasing number of positive MetS components was significantly and linearly associated with the declining in serum PSA levels.ConclusionThe actual lowering effect of MetS on serum PSA levels was partly concealed by the enlarged prostate in men with MetS, and the presence of MetS was independently associated with lower serum PSA levels. Urologists need to be aware of the effect of MetS on serum PSA levels and discuss this subject with their patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-28T21:45:25.745517-05:
      DOI: 10.1111/bju.13621
  • Oncologic outcomes and complication rates after laparoscopic‐assisted
           cryoablation: a EuRECA multi‐institutional study
    • Authors: Tommy K. Nielsen; Brunolf W. Lagerveld, Francis Keeley, Giovanni Lughezzani, Seshadri Sriprasad, Neil J. Barber, Lars U. Hansen, Nicole M. Buffi, Giorgio Guazzoni, Johan A. Zee, Mohamed Ismail, Khaled Farrag, Amr M. Emara, Lars Lund, Øyvind Østraat, Michael Borre
      Abstract: ObjectiveTo assess complication rates and intermediate oncologic outcomes of laparoscopic‐assisted cryoablation (LCA) in patients with small renal masses (SRM).Patients and MethodsA retrospective review of 808 patients treated with LCA for T1a renal masses from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien‐Dindo classification. Kaplan‐Meier analyses were used to estimate 5 and 10‐year disease‐free survival (DFS) and overall survival (OS).ResultsMedian age was 67 years (IQR: 58‐74). Median tumour size was 25mm (IQR: 19‐30). The transperitoneal approach was used in 77.7% of the patients. Median postoperative hospital stay was two days. A total of 514 patients with a biopsy‐confirmed RCC were available for survival analyses. Median follow‐up time for the RCC‐cohort was 36 months (IQR: 14‐56). A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5/10‐year DFS was 90.4%/80.0% and 5/10‐year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥ 3) in 26 patients (3.2%). An ASA score of three was associated with an increased risk of overall complications (OR: 2.85; 95%CI: 1.32‐6.20; p=0.005).ConclusionsThis large series of LCA demonstrates satisfactory long‐term oncologic outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-26T03:00:33.501699-05:
      DOI: 10.1111/bju.13615
  • Prostate size, nocturia, and the digital rectal exam: a cohort study of
           30,500 men
    • Authors: Benjamin V. Stone; Jonathan Shoag, Joshua A. Halpern, Sameer Mittal, Patrick Lewicki, David M. Golombos, Dina Bedretdinova, Bilal Chughtai, Christopher E. Barbieri, Richard K. Lee
      Abstract: ObjectivesTo evaluate the utility of the digital rectal exam (DRE) in estimating prostate size and the association of DRE with nocturia in a population‐based cohort.Subjects and MethodsWe identified all men randomized to the screening arm of the PLCO trial for whom DRE results were available. Subjects were excluded with history of prostate surgery or incident prostate cancer. Prostate posterior surface area was derived from DRE sagittal and transverse estimates. Relationships between prostate posterior surface area, transrectal ultrasound (TRUS), PSA, and nocturia were analyzed using intraclass correlation coefficient (ICC), Spearman's rank correlation, and multivariable logistic regression.Results30,500 men met inclusion criteria, with 103,275 screening visits containing paired DRE and PSA data. DRE posterior surface area estimates had an ICC of 0.547 (95% CI 0.541‐0.554) and were significantly yet modestly correlated with increased prostate‐specific antigen (rs=0.18, p
      PubDate: 2016-08-23T21:45:32.692036-05:
      DOI: 10.1111/bju.13613
  • COX‐2 Inhibition for Prostate Cancer Chemoprevention: Double‐Blind
           Randomized Study of Pre‐Prostatectomy Celecoxib or Placebo
    • Authors: Jason F. Flamiatos; Tomasz M. Beer, Julie N. Graff, Kristine M. Eilers, Wei Tian, Harman S. Sekhon, Mark Garzotto
      Abstract: ObjectiveTo evaluate the biologic effects of selective cyclooxygenase‐2 inhibition on prostate tissue in men undergoing prostatectomy.Materials and MethodsPatients with localized prostate cancer were randomized to receive either celecoxib 400 mg twice daily or placebo for four weeks prior to prostatectomy. Specimens were analyzed for levels of apoptosis, prostaglandins, and androgen receptor. Effects on serum prostate‐specific antigen (PSA) and post‐operative opioid use were also measured.ResultsTwenty‐eight of 44 anticipated patients enrolled and completed treatment. One patient on the celecoxib arm had a myocardial infarction post‐operatively. For this reason, and safety concerns in other studies, enrollment was halted. The apoptosis index in tumor cells was 0.29% (95% CI: 0.11‐0.47%) versus 0.39% (95% CI: 0.00‐0.84%) in the celecoxib and placebo arms, respectively (p=0.68). The apoptosis index in benign cells was 0.18% (95% CI: 0.03‐0.32%) versus 0.13% (95% CI: 0.00‐0.28%) in the celecoxib and placebo arms, respectively (p=0.67). PGE2 and androgen receptor levels were similar in cancer and benign tissues when comparing the two arms. Median baseline PSA was 6.0ng/ml and 6.2ng/ml for the celecoxib and placebo groups, respectively, and did not significantly change after celecoxib treatment. There was no difference in post‐operative opiate usage between arms.ConclusionCelecoxib had no effect on apoptosis, prostaglandins or androgen receptor levels in cancerous or benign prostate tissues. These findings coupled with drug safety concerns should serve to limit interest in these selective drugs as chemopreventive agents.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-23T21:45:27.390728-05:
      DOI: 10.1111/bju.13612
  • Evolution of the Robotic Orthotopic Ileal Neobladder Formation: A Step by
           Step Update to The USC Technique
    • Authors: Sameer Chopra; Andre Luis de Castro Abreu, Andre K. Berger, Shuchi Sehgal, Inderbir Gill, Monish Aron, Mihir M. Desai
      Abstract: ObjectiveTo describe, step‐by‐step, our updated, time‐efficient technique for intracorporeal neobladder formation.Patients and MethodsThere are five main surgical steps to forming the intracorporeal orthotopic ileal neobladder: isolation of the small bowel intestine; small bowel anastomosis; bowel detubularization and suture of the posterior wall of the neobladder; neobladder‐urethral anastomosis and folding the pouch; and ureteral‐chimney anastomosis. Improvements have been made during these steps to improve time efficiency without compromising neobladder formation.ResultsA total of 65 cm of small intestinal bowel is removed for neobladder formation. Our technical improvements have demonstrated an improvement in operative time from 450 minutes to 360 minutes.ConclusionWe describe an updated step‐by‐step technique to our institution's robotic intracorporeal orthotopic ileal neobladder formation using a time‐efficient technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-30T09:10:30.423817-05:
      DOI: 10.1111/bju.13611
  • Preliminary experience using a tunica vaginalis flap as the dorsal
           component of Bracka's urethroplasty
    • Authors: L. Harper; JL Michel, F Sauvat
      Abstract: PurposeTo evaluate clinical use of tunica vaginalis flap as the dorsal component of a two‐stage urethroplasty in boys with cripple hypospadias.Patients and MethodWe performed the first stage of a Bracka two‐stage urethroplasty, using a tunica vaginalis flap as the dorsal component in 6 boys with cripple hypospadias. We analyzed their clinical characteristics and the results of this technique.ResultsThe average age of the patients was 4 years and 9 months (range: 34‐120 months). The average number of previous procedures the children had undergone was 4 (range: 3‐5). At 6 months follow‐up, all children presented significant fibrosis of the dorsal graft rendering it unusable for tubularization.ConclusionsExposure to the external environment seems to induce retraction and fibrosis of the tunica vaginalis. We believe one should be very cautious about using tunica vaginalis as the dorsal component of a two‐stage urethroplasty, as significant fibrosis might well render the flap unusable.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-26T09:15:27.77803-05:0
      DOI: 10.1111/bju.13604
  • Accuracy of ultrasound for renal stone detection and size determination:
           is it good enough for management decisions?
    • Authors: V Ganesan; S De, D Greene, FCM Torricelli, M Monga
      Abstract: ObjectivesTo determine the sensitivity and specificity of ultrasound (US) for detecting renal calculi and to assess the accuracy of US for determining size of calculi and how this can affect counselling decisions.Materials and methodsWe retrospectively identified all patients at our institution with a diagnosis of nephrolithiasis who had an US followed by a non‐contrast computed tomographic (CT) within 60‐days. Patient characteristics, stone size (maximum axial diameter), and stone location was collected. Sensitivity, specificity, and size accuracy of ultrasound was determined using CT as the standard.ResultsA total of 552 US and CT examinations met the inclusion criteria. Overall the sensitivity and specificity of US was 54% and 91% respectively. There was a significant association between sensitivity of US and stone size (p < 0.001) but not with stone location (p = 0.58). US significantly overestimated the size of stones in the 0‐10 mm range (p < 0.001). Assuming stones 0 mm – 4 mm will be observed and stones ≥5 mm could be counselled on the alternative of intervention, we found that in 14% (54/384) of cases where CT would suggest observation, US would recommend an intervention. On the other hand, when using CT would suggest an intervention, US would suggest observation in 39% (65/168) of cases. On average 22% (119/552) of patients could be inappropriately counselled. Stones classified as 5‐10 mm by US had the highest probability, 43% (41/96), of having recommendation changed when a CT was performed. The use of KUB and US increases sensitivity (78%) but still 37% (13/35) of patients may inappropriately be counselled to undergo observation.ConclusionsUsing US to guide clinical decision making for residual or asymptomatic calculi is limited by low sensitivity and inability to accurately size the stone. As a result, 1 in 5 patients may be inappropriately counselled when using US alone.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-26T09:10:27.045077-05:
      DOI: 10.1111/bju.13605
  • The Impact Of United States Preventive Services Task Force (USPTSTF)
           Recommendations Against PSA Testing On PSA Testing In Australia
    • Authors: Homayoun Zargar; Roderick den Bergh, Daniel Moon, Nathan Lawrentschuk, Anthony Costello, Declan Murphy
      Abstract: ObjectiveTo assess the impact of USPTSTF recommendations on PSA testing, prostate biopsy and prostatectomy in Australian men based on the available Medicare data.Patients and MethodsEvents were identified using Medicare item numbers for PSA (66655,66659), prostate biopsy (37219), prostatectomy (37210) and prostatectomy with lymph node dissection (37211)The occurrences of each procedure was queried per 100 000 capita for consecutive financial years over the period 2000‐2015.For each item number reports were also generated for all Australian states.For PSA testing the data was stratified for the three age groups of 45‐54, 55‐64 and 65‐74 years old.For assessment of the rate of prostatectomy the capita rate values for two item numbers of prostatectomy (37210) and prostatectomy with lymph node dissection (37211) were summed up.ResultsSteady declines in per capita incidences of all five item numbers assessed were observed for the three consecutive financial years (2013‐2015) since the publication of USPTSTF recommendation statement.These declines were observed across all Australian states.When examining the rate of PSA testing for the three age brackets 45‐54, 55‐64 and 65‐74 years old similar trends were identifiedConclusionsSince the introduction of USPTSTF recommendation statement there has been a steady nationwide decline in per capita incidences of PSA testing, prostate biopsy and prostatectomy based on the Australian Medicare data.Whether these declines are in the right direction toward reduction in over diagnosis and over treatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-25T11:30:35.752465-05:
      DOI: 10.1111/bju.13602
  • The potential role of unregulated autonomous bladder micromotions in
           urinary storage and voiding dysfunction; overactive bladder and detrusor
    • Authors: M.J. Drake; A. Kanai, D.A. Bijos, Y. Ikeda, I. Zabbarova, B. Vahabi, C.H. Fry
      Abstract: The isolated bladder shows autonomous micromotions, which increase with bladder distension, generate sensory nerve activity, and are altered in models of urinary dysfunction. Intravesical pressure resulting from autonomous activity putatively reflects three key variables; the extent of micromotion initiation, distances over which micromotions propagate, and overall bladder tone. In vivo, these variables are subordinate to the efferent drive of the central nervous system. In the micturition cycle storage phase, efferent inhibition keeps autonomous activity generally at a low level, where it may signal “state of fullness” while maintaining compliance. In the voiding phase, mass efferent excitation elicits generalized contraction (global motility initiation). In lower urinary tract dysfunction, efferent control of the bladder can be impaired, for example due to peripheral “patchy” denervation. In this case, loss of efferent inhibition may enable unregulated micromotility, and afferent stimulation, predisposing to urinary urgency. If denervation is relatively slight, the detrimental impact on voiding may be low, as the adjacent innervated areas may be able to initiate micromotility synchronous with the efferent nerve drive, so that even denervated areas can contribute to the voiding contraction. This would become increasingly inefficient the more severe the denervation, such that ability of triggered micromotility to propagate sufficiently to engage the denervated areas in voiding declines, so the voiding contraction increasingly develops the characteristics of underactivity. In summary, reduced peripheral coverage by the dual efferent innervation (inhibitory and excitatory) impairs regulation of micromotility initiation and propagation, potentially allowing emergence of overactive bladder and, with progression, detrusor underactivity.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-22T07:15:22.320644-05:
      DOI: 10.1111/bju.13598
  • Comparative testing of reliability and audit utility of ordinal objective
           calculus complexity scores. Can we make an informed choice yet'
    • Authors: Jiten Jaipuria; Manav Suryavanshi, Tridib K. Sen
      Abstract: ObjectivesTo assess reliability of Guy's, Seoul National University renal stone (S‐RESC) and S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL) and assess utility in discriminating outcomes [Stone free rate (SFR), complications, need for multiple PCNL sessions and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution‐specific instrumentation.Patients and methodsProspectively maintained database of 2 tertiary institutions was analysed (606 cases). Institutes differed in instrumentation while overall surgical team comprised – two trainees (experience 1000 cases). Scores were assigned and reassigned after 4 months by one trainee and expert surgeon. Interrater and test‐retest agreement were analysed by Cohen's kappa and Intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison.ResultsDespite some areas of inconsistencies, individually all scores had excellent interrater and test‐retest concordance. On multivariable analyses while the experience of the surgeon and surgical approach characteristics (such as access tract location, amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently independently associated with all outcomes. S‐RESC score had a superior association with SFR, the need for multiple PCNL sessions and auxiliary procedures.ConclusionIndividually all scoring systems performed well. On cross comparison, S‐RESC score consistently emerged more superiorly associated with all outcomes signifying the importance of the distributional complexity of calculus (which also indirectly amalgamates influence of stone number, size, and anatomic location) in discriminating outcomes. Our study proves the utility of scores in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training and objective assessment of surgical technique modifications.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-22T06:55:43.623573-05:
      DOI: 10.1111/bju.13597
  • Randomized controlled study of the efficacy and safety of continuous
           saline bladder irrigation after transurethral resection for the treatment
           of non‐muscle invasive bladder cancer
    • Authors: Takehisa Onishi; Yusuke Sugino, Takuji Shibahara, Satoru Masui, Tadashi Yabana, Takeshi Sasaki
      Abstract: ObjectiveTo evaluate the efficacy and safety of continuous saline bladder irrigation (CSBI) after transurethral resection of bladder tumor (TURBT) in patients with low‐ to intermediate‐risk non‐muscle invasive bladder cancer (NMIBC).Patients and methodsIn this prospective randomized study, 250 patients with primary low‐to intermediate‐risk tumors were enrolled. Patients were randomly allocated to receive CSBI (2,000 ml/h for first 1 hour, then 1,000 ml/h for 2 hours, and then 500 ml/h for 15 hours) or a single immediate instillation of mitomycin C (MMC) after TURBT. Primary end point was recurrence‐free survival, and secondary end points were progression‐free survival and adverse events.ResultsA total of 227 patients (114 in CSBI group and 113 in MMC group) remained for analysis after exclusion. The median follow‐up period was 37 months. No significant differences for patients’ characteristics were observed between the groups. Five‐year recurrence‐free rates for CSBI and MMC were 62.6% (95% confidence interval [CI]: 0.49‐0.73) and 70.4% (95% CI: 0.59‐0.78), respectively. Kaplan‐Meire analysis of recurrence‐free survival did not show any significant differences between the groups (log rank test: P = 0.53). Furthermore, there were no significant differences between the groups in terms of tumor progression rate and the median time to first recurrence. The incidence of adverse events was significantly lower in CSBI group.ConclusionsCSBI after TURBT may be a treatment option for patients with low‐ to intermediate –risk NMIBC in terms of its prophylactic effect and safety.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-22T06:55:33.361119-05:
      DOI: 10.1111/bju.13599
  • The ProCare Trial: a phase II randomised controlled trial of shared care
           for follow‐up of men with prostate cancer
    • Authors: Jon D Emery; Michael Jefford, Madeleine King, Dickon Hayne, Andrew Martin, Juanita Doorey, Amelia Hyatt, Emily Habgood, Tee Lim, Cynthia Hawks, Marie Pirotta, Lyndal Trevena, Penelope Schofield
      Abstract: ObjectivesTo test the feasibility and efficacy of a multifaceted model of shared care for men after completion of treatment for prostate cancer.Patients and MethodsMen who had completed treatment for low to moderate risk prostate cancer within the previous eight weeks were eligible. Participants were randomised to usual care or shared care. Shared care entailed substituting two hospital visits with three visits in primary care, a survivorship care plan, recall and reminders, and screening for distress and unmet needs. Outcome measures included psychological distress, prostate cancer‐specific quality of life (PCSQoL), satisfaction and preferences for care and health care resource use.Results88 men were randomised (Shared Care n=45; Usual Care n=43). There were no clinically important or statistically significant differences between groups on distress, PCSQoL, or satisfaction with care. At the end of the trial men in the intervention group were significantly more likely to prefer a shared care model to hospital follow‐up than those in the control group Intervention 63% vs Control 24% p=0.0007). There was high compliance with PSA monitoring in both groups. The shared care model was cheaper than usual care (Shared care AUS$1,411; Usual Care AUS$1,728; difference AUS$323 (plausible range AUS$91‐554)).ConclusionWell‐structured shared care for men with low to moderate risk prostate cancer is feasible and appears to produce clinically comparable outcomes to standard care at lower cost.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:35:29.712123-05:
      DOI: 10.1111/bju.13593
  • Routinely reported ‘equivocal’ lymphovascular invasion in
           prostatectomy specimens is associated with adverse outcomes
    • Authors: Elena Galiabovitch; Christopher M. Hovens, Justin S. Peters, Anthony J. Costello, Shane Battye, Sam Norden, Andrew Ryan, Niall M. Corcoran
      Abstract: ObjectiveTo evaluate the significance of routinely reported ‘equivocal’ lymphovascular invasion in prostatectomy specimens of patients with clinically localised prostate cancer.Materials and MethodsProspectively collected data from men who underwent prostatectomy for clinically localised prostate cancer were retrospectively reviewed. Rates of adverse pathological features and biochemical recurrence were compared between tumours positive, negative or ‘equivocal’ for lymphovascular invasion. Multivariable Cox regression analysis was performed to identify independent predictors of biochemical recurrence.ResultsIn 1310 consecutive cases, lymphovascular invasion was present definitively in 82 (6.3%) and equivocally in 43 (3.3%). Similar to definitive lymphovascular invasion, ‘equivocal’ lymphovascular invasion was significantly associated with other adverse pathological features, including advanced stage, higher Gleason grade, and surgical margin positivity. Biochemical recurrence occurred more frequently in patients with tumours ‘equivocal’ (61%) or positive for lymphovascular invasion (71%) than in negative patients (14.7%). In addition, patients with both definitive and equivocal lymphovascular invasion had a significantly shorter biochemical recurrence‐free survival compared to negative patients. Multivariable Cox regression analysis indicated that the presence of either definitive or ‘equivocal’ lymphovascular invasion were independent predictors of disease recurrence (HR 3.32, 95%CIs 2.3‐4.8, p
      PubDate: 2016-07-19T01:35:27.28618-05:0
      DOI: 10.1111/bju.13594
  • Comparison of spinal cord contusion and transection: functional and
           histological changes in the rat urinary bladder
    • Authors: Benjamin N. Breyer; Thomas M. Fandel, Amjad Alwaal, E. Charles Osterberg, Alan W. Shindel, Guiting Lin, Emil A. Tanagho, Tom F. Lue
      Abstract: ObjectiveTo compare the effect of complete transection (tSCI) and contusion injury (cSCI) on bladder function and bladder wall structure in rats.Materials and Methods30 female Sprague‐Dawley rats were randomly divided into three equal groups: uninjured controls, cSCI, and tSCI. The cSCI group underwent spinal cord contusion, while the tSCI group underwent complete spinal cord transection. 24‐hour metabolic cage measurement and conscious cystometry were performed at 6 weeks post‐injury.ResultsConscious cystometry analysis showed that cSCI and tSCI groups had significantly larger bladder capacities than the control group. The cSCI group had significantly more non‐voiding detrusor contractions than the tSCI group. Both injury groups displayed more non‐voiding contractions compared to the control group. Mean threshold pressure was significantly higher in the tSCI group than in control and cSCI groups. The number of voids in the tSCI group was less compared to the control group. Metabolic cage analysis showed that the tSCI group had larger maximum voiding volume as compared to control and cSCI. VAChT/smooth muscle immunoreactivity was higher in control than in cSCI or tSCI rats. The area of calcitonin gene‐related peptide (CGRP) staining was lower in tSCI as compared to control or cSCI.ConclusionsSpinal cord transection and contusion produce different bladder phenotypes in rat models of SCI. Functional data suggest that the tSCI group has obstructive high‐pressure voiding pattern, while the cSCI group has more uninhibited detrusor contractions.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:31:07.895521-05:
      DOI: 10.1111/bju.13591
  • ICUD‐EAU International Consultation on Minimally Invasive Surgery in
           Urology: Laparoscopic and Robotic Adrenalectomy
    • Authors: Mark W. Ball; Ashok K. Hemal, Mohamad E. Allaf
      Abstract: ObjectiveTo provide an evidence‐based systematic review of the use of laparoscopic and robotic adrenalectomy in the treatment of adrenal disease as part of the International Consultation on Urologic Diseases and European Association of Urology consultation on Minimally Invasive Surgery in Urology.MethodsA systematic literature search (January 204‐January 2014) was conducted to identify comparative studies assessing the safety and efficacy of minimally invasive adrenal surgery. Subtopics including the role of minimally invasive surgery for pheochromocytoma, adrenocortical carcinoma, and large adrenal tumors were examined. Additionally, the role of transperitoneal and retroperitoneal approaches, as well as laparoendoscopic single‐site (LESS) and robotic adrenalectomy were reviewed.ResultThe major findings are presented in an evidence‐based fashion. Large retrospective and prospective data were analyzed. A set of recommendations provided by the committee was produced.ConclusionsLaparoscopic surgery should be considered first line therapy for benign adrenal masses requiring surgical resection. Laparoscopic surgery should be considered first line therapy for patients with pheochromocytoma. While a laparoscopic approach may be feasible for select cases of ACC without adjacent organ involvement, an open surgical approach remains the gold standard. Large adrenal tumors without preoperative or intraoperative concern for ACC may be safely resected via a laparoscopic approach. Both transperitoneal and retroperitoneal approaches to laparoscopic adrenalectomy is safe. The approach should be chosen based on surgeon training and experience. LESS adrenalectomy should be considered an an alternative to laparoscopic adrenalectomy but requires further study. Robotic adrenalectomy may be considered an alternative to laparoscopic adrenalectomy but requires further study .This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:31:01.933677-05:
      DOI: 10.1111/bju.13592
  • Liquid biopsy: ready to guide therapy in advanced prostate cancer?
    • Authors: Miriam Hegemann; Arnulf Stenzl, Jens Bedke, Kim Nguyen Chi, Peter Colin Black, Tilman Todenhöfer
      Abstract: The identification of molecular markers associated with response to specific therapy is a key step for the implementation of personalized treatment strategies in patients with metastatic prostate cancer (PC). Only in a low proportion of patients, biopsies of metastatic tissue are performed. Circulating tumor cells (CTC), cell free‐DNA (cfDNA) and RNA offer the potential for non‐invasive characterization of disease and molecular stratification of patients. Furthermore, a “liquid biopsy” approach permits longitudinal assessments, allowing sequential monitoring of response and progression and the potential to alter therapy based on observed molecular changes. In PC, CTC enumeration using the CellSearch© platform correlates with survival. Recent studies on the presence of androgen receptor variants in CTC have shown that the such molecular characterization of CTC provides a potential for identifying patients with resistance to agents that inhibit the androgen signaling axis, such as abiraterone and enzalutamide. New developments in CTC isolation, as well as in‐vitro and in‐vivo analysis of CTC will further promote the use of CTC as a tool for retrieving molecular information from advanced tumors in order to identify mechanisms of therapy resistance. In addition to CTC, nucleic acids such as RNA and cell free DNA (cfDNA) released by tumor cells into the peripheral blood contains important information on transcriptomic and genomic alterations in the tumors. Initial studies have shown that genomic alterations of the androgen receptor and other genes detected in CTC or cfDNA of patients with castration resistant prostate cancer (CRPC) correlate with treatment outcomes to enzalutamide and abiraterone. Due to recent developments in high throughput analysis techniques, it is likely that CTC, cfDNA and RNA will be an important component of personalized treatment strategies in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:25:58.470194-05:
      DOI: 10.1111/bju.13586
  • Raised pre‐operative INR identifies patients at high risk of
           peri‐operative death after simultaneous renal and cardiac surgery for
           tumours involving the peri‐diaphragmatic inferior vena cava (IVC) and
           right atrium
    • Authors: Tim O'Brien; Archie Fernando, Kay Thomas, Mieke Van Hemelrijck, Craig Bailey, Conal Austin
      Abstract: BackgroundThe ability to predict and therefore avoid surgery in those patients likely to die from simultaneous renal and cardiac surgery for urological tumours involving the peri‐diaphragmatic vena cava and right atrium would be valuable.ObjectiveTo identify pre‐operative factors that predict thirty‐day mortality (TDM) in patients undergoing this type of surgery.Design setting and participantsRetrospective review of peri‐operative outcomes in patients managed between December 2007 and January 2016 by a single team.Outcome measurements and statistical analysisRelationships with outcome analysed using Fisher's Exact and Mann Whitney U tests.Results and Limitations46 patients of whom 41/46 (89%) underwent surgery.20 males; 21 females. Median age 65 yrs (range 17‐95). 37 renal cell cancer, 1 adrenal cancer, 2 primitive neuroectodermal tumours and 1 leiomyosarcoma.Overall TDM 3/41 patients (7%). INR, age and eGFR correlated significantly with TDM.Mortality if INR >1.5, 3/5 (60%) compared to 0/36 (0%) if INR 1.5 and age >70 years 3/3 (100%)INR correlated with serious complications (≥Clavien 3) (INR>1.5: 5/5 (100%) vs INR
      PubDate: 2016-07-19T01:25:44.444591-05:
      DOI: 10.1111/bju.13587
  • Nanotechnology combination therapy: Tyrosine kinase‐bound gold nanorod
           and laser thermal ablation produce a synergistic higher treatment response
           of renal cell carcinoma in animal model
    • Authors: James Liu; Caleb Abshire, Connor Carry, Andrew B Sholl, Sree Harsha Mandava, Amrita Datta, Manish Ranjan, Cameron Callaghan, Donna V Peralta, Kristen S Williams, Weil R Lai, Asim B Abdel‐Mageed, Matthew Tarr, Benjamin R Lee
      Abstract: ObjectiveTo investigate tyrosine kinase inhibitors (TKI) and gold nanorod (AuNR) paired with photothermal ablation in a human metastatic clear cell renal cell carcinoma mouse model. Nanoparticles have been successful as platform for targeted drug delivery in the treatment of urologic cancers. Likewise, the use of nanoparticles in photothermal tumor ablation, though early in its development, has provided promising results. Our previous in vitro studies of nanoparticles loaded with both TKI and gold nanorods and activated with photothermal ablation have demonstrated significant synergistic cell kill greater than each individual arm alone. This study is a translation of our initial findings to an in vivo model.Materials and MethodsImmunologically naïve nude mice (Athymic Nude‐Foxn1nu) were injected bilaterally on the flanks (n=36) with 2.5 x 106 cells of a human metastatic renal cell carcinoma cell line (RCC 786‐O). Subcutaneous xenograft tumors developed 1 cm palpable nodules. Gold Nanorods encapsulated in Human Serum Albumin Protein nanoparticles were synthesized with or without a TKI and injected directly into the tumor nodule. Irradiation was administered with an 808 nm LED diode laser for six minutes. Animals were sacrificed 14 days post‐irradiation; tumors were excised, formalin fixed, paraffin embedded, and evaluated for size and percent necrosis by a GU pathologist. Untreated contralateral flank tumors were used as controls.ResultsIn mice that did not receive irradiation, TKI alone yielded 4.2% tumor necrosis on the injected side and administration of HSA‐AuNR‐TKI alone yielded 11.1% necrosis. In laser ablation models, laser ablation alone yielded 62% necrosis and when paired with HSA‐AuNR had 63.4% necrosis. The combination of laser irradiation and HSA‐AuNR‐TKI had cell kill of 100%.ConclusionsIn the absence of laser irradiation, TKI treatment alone or when delivered via nanoparticle produced moderate necrosis. Irradiation with and without gold particles alone also improves tumor necrosis. However, when irradiation is paired with gold particle and drug‐loaded nanoparticle, the combination therapy demonstrated the most significant and synergistic complete tumor necrosis of 100% (p
      PubDate: 2016-07-19T01:25:43.255177-05:
      DOI: 10.1111/bju.13590
  • A 22‐year Restrospective Study: Educational Update and New Referral
           Pattern of Age at Orchidopexy
    • Authors: Yi Wei; Sheng‐de Wu, Yang‐ca Wang, Tao Lin, Da‐wei He, Xu‐liang Li, Jun‐hong Liu, Xing Liu, Yi Hua, Peng Lu, De‐ying Zhang, Sheng Wen, Guang‐hui Wei
      Abstract: ObjectivesResearch suggesting progressive deterioration in an undescended testis (UDT) has led to the reduction in the target age for orchidopexy to 6‐12 months of age. However, it is still unknown whether changing targets have altered practice. The objective was to determine the current age at orchidopexy in China and whether changing targets have altered practice.Materials and MethodsThe demographics of orchidopexies performed in Children's Hospital of Chongqing Medical University between 1993 and 2014 were reviewed. Survey of general publics’ cognition of undescended testes and survey of primary healthcare practitioners’ current opinion on age at orchidopexy and referral patterns were performed.ResultsA total of 3784 orchidopexies were performed over 22 years. The median age at orchidopexy fell between 1993 to 2014. There was an initial drop in the age for orchidopexy between 2000‐2010(3 years old)compared with the median age between 1993‐2000(4 years old).(P
      PubDate: 2016-07-19T01:25:35.090771-05:
      DOI: 10.1111/bju.13588
  • Validation of VEGFR1 rs9582036 as predictive biomarker in metastatic
           clear‐cell renal cell carcinoma patients treated with sunitinib
    • Authors: B Beuselinck; J Jean‐Baptiste, P Schöffski, G Couchy, C Meiller, F Rolland, Y Allory, S Joniau, V Verkarre, R Elaidi, E Lerut, T Roskams, J J Patard, S Oudard, A Méjean, D Lambrechts, J Zucman‐Rossi
      Abstract: ObjectivesTo validate vascular endothelial growth factor receptor‐1 (VEGFR1) single nucleotide polymorphism (SNP) rs9582036 as a potential predictive biomarker in metastatic clear‐cell renal cell carcinoma (m‐ccRCC) patients treated with sunitinib.Materials and methodsm‐ccRCC patients receiving sunitinib as first‐line targeted therapy were included. We assessed response rate (RR), progression‐free survival (PFS), overall survival (OS), and clinical and biochemical parameters associated with outcome. We genotyped five VEGFR1 SNPs: rs9582036, rs7993418, rs9554320, rs9554316 and rs9513070. Association with outcome was studied by univariate analysis and by multivariate Cox regression. Additionally, we updated survival data of our discovery cohort as described previously.ResultsSixty‐nine patients were included in the validation cohort. rs9582036 CC‐carriers had a poorer PFS (8 versus 12 months, p=0.02) and OS (11 versus 27 months, p=0.003) compared to AC/AA‐carriers. rs7993418 CC‐carriers had a poorer OS (8 versus 24 months, p=0.004) compared to TC/TT‐carriers. rs9554320 AA‐carriers had a poorer RR (0% versus 53%, p=0.009), PFS (5 versus 12 months, p=0.003) and OS (10 versus 25 months, p=0.004) compared to AC/CC‐carriers. When pooling patients from the discovery cohort, as described previously (n=88), and the validation cohort, in the total series of 157 patients, rs9582036 CC‐carriers had a poorer RR (8% versus 49%, p=0.004), PFS (8 versus 14 months, p=0.003) and OS (13 versus 30 months, p=0.0004) compared to AC/AA‐carriers. Unfavorable prognostic markers at start of sunitinib were well balanced between rs9582036 CC‐ and AC/AA‐carriers.ConclusionVEGFR1 rs9582036 is a candidate predictive biomarker in m‐ccRCC‐patients treated with sunitinib.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-15T03:15:30.284154-05:
      DOI: 10.1111/bju.13585
  • Patient‐reported outcomes in the ProtecT randomised trial of clinically
           localised prostate cancer treatments: design and baseline urinary, bowel
           and sexual function and quality of life
    • Authors: JA Lane; C Metcalfe, GJ Young, TJ Peters, J Blazeby, KNL Avery, D Dedman, L Down, MD Mason, DE Neal, FC Hamdy, JL Donovan,
      Abstract: ObjectivesTo present the baseline patient‐reported outcome measures (PROMs) in the ProtecT (Prostate testing for cancer and Treatment) randomised trial comparing active monitoring, radical prostatectomy and external‐beam conformal radiotherapy for localised prostate cancer and to compare results with other populations.Materials and methods1,643 randomised men aged 50‐69 years in nine UK cities diagnosed with clinically localised disease identified by prostate‐specific antigen (PSA) testing (1999‐2009). Validated PROMs for disease‐specific (urinary, bowel and sexual function) and condition‐specific quality of life impacts (EPIC: 2005 onwards, ICIQ‐UI: 2001 onwards, ICSmaleSF), anxiety and depression (HADS), generic mental and physical health (SF‐12, EQ‐5D‐3L) were completed at prostate biopsy clinics before randomisation. Descriptive statistics presented by treatment allocation and by men's age and at biopsy and PSA testing time points for selected measures.Results1,438 participants completed biopsy questionnaires (88%) and between 77‐88% were analysed for individual PROMs. Fewer than 1% of participants were using pads daily (5/754). Storage lower urinary tract symptoms (LUTS) were frequent (e.g. nocturia 22%, 312/1423). Bowel symptoms were rare, except for loose stools (16%, 118/754). One third of participants reported erectile dysfunction (241/735) and for 16% (118/731) this was a moderate or large problem. Depression was infrequent (80/1399, 6%) but 20% of participants (278/1403) reported anxiety. Sexual function and bother were markedly worse in older men (65‐70 years), whilst urinary bother and physical health was somewhat worse than in younger men (49‐54 years, all p
      PubDate: 2016-07-14T09:35:30.688114-05:
      DOI: 10.1111/bju.13582
  • Robotic perineal radical prostatectomy and pelvic lymph node dissection
           using a purpose‐built single‐port robotic platform
    • Authors: Daniel Ramirez; Matthew J. Maurice, Jihad H. Kaouk
      Abstract: ObjectiveTo describe the features of the novel, purpose‐built da Vinci model SP1098 single‐port (SP) robotic platform and describe a step‐by‐step approach for perineal prostatectomy and pelvic lymph node dissection in a cadaver model.Methods3 SP robotic radical perineal prostatectomies and 2 pelvic lymph node dissections were performed on 3 male cadavers in order to assess the feasibility of the SP1098 da Vinci robotic platform. The steps of the procedure included division of the rectourethralis muscle, splitting of the levator ani muscles bilaterally, opening of Denonvilliers fascia with dissection of the seminal vesicles, apical dissection and urethral division, anterior and lateral dissection with ligation of prostatic pedicles, bilateral pelvic lymph node dissection, and creation of the new vesicourethral anastomosis. The main outcomes assessed were operative time per step, total operative time, intraoperative complications and need for conversion to conventional or open techniques.ResultsNo conversions were required. No intraoperative complications were seen. Median OR time for performing SP robotic radical perineal prostatectomy and pelvic lymph node dissection was 210 minutes (range 180‐240).ConclusionsWe demonstrate the feasibility and efficacy of a novel, purpose‐built robotic system in performing SP radical perineal prostatectomy and, for the first time, describe feasibility of robotic perineal lymph node dissection. This SP system will facilitate single port applications and allow surgeons to perform major urologic operations via a small, single incision while preserving triangulation and optics, and eliminating clashing between instruments. Future clinical studies are needed to support these encouraging outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-13T11:21:55.741357-05:
      DOI: 10.1111/bju.13581
  • Predicting Complications in Partial Nephrectomy for T1a Tumors: Does
           Approach Matter?
    • Authors: Daniel Ramirez; Matthew J. Maurice, Peter A. Caputo, Ryan J. Nelson, Onder Kara, Ercan Malkoc, Jihad H. Kaouk
      Abstract: ObjectivesContemporary guidelines for treatment of localized renal masses suggest nephron‐sparing surgery (NSS) as an option for T1a tumors in appropriate patients. Large comparative series assessing the risk of complications between open and robotic approaches for partial nephrectomy are lacking. Our objective is to assess differences in complications following robotic (RPN) and open partial nephrectomy (OPN) among experienced surgeons.Patients and methodsWe identified patients in our IRB‐approved, prospectively maintained database who underwent OPN or RPN for management of unifocal, T1a renal tumors at our institution between January 2011 and August 2015. Our primary outcome measure was the rate of 30‐day overall postoperative complications. Baseline patient factors, tumor characteristics and perioperative factors, including approach, were evaluated to assess the risk of complication.ResultsPatients who underwent OPN were found to have a higher rate of overall complications (30.3% vs 18.2%, p=0.038) with wound complications accounting for the majority of these events (11.8% vs 1.8%, p
      PubDate: 2016-07-13T11:20:44.439266-05:
      DOI: 10.1111/bju.13583
  • Germline Genetic Variation in JAK2 as a Prognostic Marker in Castration
           Resistant Prostate Cancer
    • Authors: Ben Y. Zhang; Shaun M. Riska, Douglas W. Mahoney, Brian A. Costello, Rhea Kohli, J.F. Quevedo, James R. Cerhan, Manish Kohli
      Abstract: ObjectivesTo evaluate the prognostic significance of germline variation in candidate genes in patients with castration‐resistant prostate cancer (CRPC).MethodsGermline DNA was extracted from peripheral blood mononuclear cells of CRPC patients enrolled in a clinically annotated registry. Fourteen candidate genes implicated in either initiation or progression of prostate cancer were tagged using single nucleotide polymorphisms (SNPs) from HapMap with minor allele frequency of >5%. The primary endpoint was overall survival (OS), defined as time from development of CRPC to death. Principal component analysis was used for gene levels tests of significance. For SNP level results the per allele hazard ratios (HR) and 95% confidence intervals (CI) under the additive allele model were estimated using Cox regression adjusted for age at CRPC and Gleason score (GS).ResultsTwo hundred and forty two CRPC patients were genotyped (14 genes; 84 SNPs). The median age of the cohort was 69 years (range 43‐93). The GS distribution was 55% with GS≥8, 32% with GS=7 and 13% with GS
      PubDate: 2016-07-13T11:20:34.961192-05:
      DOI: 10.1111/bju.13584
  • Impact of ischemia time on renal function after partial nephrectomy: a
           systematic review
    • Authors: Xavier Rod; Benoit Peyronnet, Thomas Seisen, Benjamin Pradere, Florie Gomez, Grégory Verhoest, Christophe Vaessen, Alexandre De La Taille, Karim Bensalah, Morgan Roupret
      Abstract: ObjectiveTo assess the impact of ischemia on renal function after partial nephrectomy.Materials and methodsA literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol (“warm ischemia”[mesh] OR “warm ischemia”[ti]) AND (“nephrectomy”[mesh] OR “partial nephrectomy”[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two‐kidney model but with assessment of split renal function were included in this review.ResultsOf the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including 9 studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischemia time on postoperative renal function, unless this was extended beyond a 25‐minute threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function.ConclusionCurrently, no evidence supports that limited ischemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a “zero ischemia” technique. Several recent studies have suggested that prolonged warm ischemia (>25–30 min) could cause an irreversible ischemic insult to the surgically treated kidney.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-13T11:20:34.302067-05:
      DOI: 10.1111/bju.13580
  • Urethral diverticulectomy with Martius fat pad interposition improves
           symptom resolution and reduces recurrence
    • Authors: S Malde; N Sihra, S Naaseri, M Spilotros, E Solomon, M Pakzad, R Hamid, JL Ockrim, TJ Greenwell
      Abstract: ObjectiveTo assess the presenting features and medium‐term symptomatic outcomes in women having excision of urethral diverticulum with Martius fat pad interpositionPatients and MethodsWe reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as post‐operative outcomes.ResultsSeventy women with a mean age of 46.5 years (range 24‐77) underwent excision of urethral diverticulum with Martius fat pad interposition over this period. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%) and dysuria (57%). Pre‐existing SUI was present in 41% (29) of women. Following surgery at a mean 18.9 (SD 16.4) months follow‐up (median 14 months), complete excision of urethral diverticulum was achieved in 100%, with resolution of urethral mass, dysuria and dyspareunia in all patients, and urethral pain in 81%. Immediately following surgery 10 (24%) patients reported de‐novo SUI. This resolved with time and pelvic floor muscle training such that at 12 months only 5 (12%) reported continued SUI. There was 1 symptomatic diverticulum recurrence (1.4%).ConclusionsThe commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with Martius fat pad interposition results in complete resolution of symptoms in the majority of women. The incidence of persistent de novo SUI in an expert high‐volume centre is 12%.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-13T11:20:32.977848-05:
      DOI: 10.1111/bju.13579
  • Testosterone treatment is not associated with increased risk of prostate
           cancer or worsening of lower urinary tract symptoms: Prostate health
           outcomes in the Registry of Hypogonadism in Men (RHYME)
    • Authors: Frans M. J. Debruyne; Hermann M. Behre, Claus G. Roehrborn, Mario Maggi, Frederick C. W. Wu, Fritz H. Schröder, T. Hugh Jones, Hartmut Porst, Geoffrey Hackett, Olivia A. Wheaton, Antonio Martin‐Morales, Eric Meuleman, Glenn R. Cunningham, Hozefa A. Divan, Raymond C. Rosen,
      Abstract: ObjectivesTo evaluate the effects of testosterone replacement therapy (TRT) on prostate health indicators in hypogonadal men, including rates of prostate cancer diagnoses, changes in PSA levels and lower urinary tract symptoms (LUTS) over time.Materials and MethodsThe Registry of Hypogonadism in Men (RHYME) is a multi‐national patient registry of treated and untreated, newly‐diagnosed hypogonadal men (n=999). Follow‐up assessments were performed at 3‐6, 12, 24, and 36 months. Baseline and follow‐up data collection included medical history, physical examination, blood sampling, and patient questionnaires. Prostate biopsies were subjected to blinded, independent adjudication for presence and severity of prostate cancer (PCa), Prostate Specific Antigen (PSA), and Testosterone (T) levels measured via local and central laboratory assays, and LUTS severity via the International Prostate Symptom Score (IPSS). Incidence rates per 100,000 person‐years were calculated. Longitudinal mixed models were used to assess effects of T on PSA and IPSS.ResultsOf 999 patients with clinically‐diagnosed HG, 750 (75%) initiated TRT, contributing 23,900 person‐months of exposure. Mean T levels increased from 8.3 to 15.4 nmol/L in treated men, compared to only a slight increase from 9.4 nmol/L to 11.3 nmol/L in untreated men. Fifty‐five (55) biopsies were performed for suspected prostate cancer, and 12 non‐cancer related biopsies were performed for other reasons. Overall, the proportion of positive biopsies was nearly identical in men on T (37.5%) compared to those not on T (37.0%) over the course of the study. No differences were observed in PSA levels, total IPSS score, or IPSS obstructive sub‐scale score by testosterone treatment status. Lower IPSS irritative sub‐scale scores were reported in treated men compared to untreated men.ConclusionsResults support prostate safety of TRT in newly diagnosed men with hypogonadism (HG).This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-13T11:15:33.045254-05:
      DOI: 10.1111/bju.13578
  • Primary Gleason Pattern Upgrading in contemporary D'Amico low‐risk
           prostate cancer patients: Implications for future biomarkers and imaging
    • Authors: Sami‐Ramzi Leyh‐Bannurah; Hiba Abou‐Haidar, Paolo Dell'Oglio, Jonas Schiffmann, Zhe Tian, Hans Heinzer, Hartwig Huland, Markus Graefen, Lars Budäus, Pierre I Karakiewicz
      Abstract: ObjectiveTo retrospectively assess the rate of primary Gleason upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of D'Amico low‐risk prostate cancer (PCa) and PRIAS active surveillance (AS) patients and to develop a tool for HGPGU prediction. HGPGU is a contraindication in most AS and focal therapy protocols.Methods10,616 patients with localized PCa were treated at a high volume European tertiary care center from 2010 to 2015 with radical prostatectomy. Analyses were restricted to 1,819 D'Amico low‐risk patients (17.1%) with PSA
      PubDate: 2016-07-01T09:27:08.321457-05:
      DOI: 10.1111/bju.13570
  • Journal information
    • Pages: 668 - 668
      PubDate: 2016-10-18T07:12:33.603186-05:
      DOI: 10.1111/bju.13302
  • The adverse effects of smoking
    • Authors: Prokar Dasgupta
      Pages: 669 - 669
      PubDate: 2016-10-18T07:12:36.844765-05:
      DOI: 10.1111/bju.13665
  • Prostate cancer risk calculators: still much work ahead
    • Authors: Cédric Poyet; Thomas Hermanns
      Pages: 670 - 671
      PubDate: 2016-10-18T07:12:38.017942-05:
      DOI: 10.1111/bju.13497
  • Radical cystectomy and venous thromboembolism: are we doing enough?
    • Authors: Nawar Hanna; Jacqueline M. Speed
      Pages: 671 - 672
      PubDate: 2016-10-18T07:12:37.908378-05:
      DOI: 10.1111/bju.13487
  • Prostate cancer gene 3 assay in the magnetic resonance imaging
           (MRI)/ultrasonography fusion target biopsy era: a future to believe in
    • Authors: Bernardo Rocco; Luca Boeri
      Pages: 672 - 673
      PubDate: 2016-10-18T07:12:33.724423-05:
      DOI: 10.1111/bju.13544
  • Semen proteome alterations in the smoking male: a non-generalizable study
    • Authors: Kenneth J. DeLay; Wayne J.G. Hellstrom
      Pages: 673 - 674
      PubDate: 2016-10-18T07:12:34.770656-05:
      DOI: 10.1111/bju.13551
  • Final robotic frontier: the evolution and current state of robot-assisted
           radical cystectomy
    • Authors: Tony Tran; Nicholas Raison, Norbert Doeuk, Prokar Dasgupta
      Pages: 675 - 676
      PubDate: 2016-04-02T02:25:36.028283-05:
      DOI: 10.1111/bju.13471
  • Correlation between stage shift and differences in mortality in the
           European Randomised study of Screening for Prostate Cancer (ERSPC)
    • Authors: Leonard P. Bokhorst; Marco Zappa, Sigrid V. Carlsson, Maciej Kwiatkowski, Louis Denis, Alvaro Paez, Jonas Hugosson, Sue Moss, Anssi Auvinen, Monique J. Roobol
      Pages: 677 - 680
      PubDate: 2016-05-20T22:05:28.058554-05:
      DOI: 10.1111/bju.13505
  • Spectrum of genomic alterations in FGFR3: current appraisal of the
           potential role of FGFR3 in advanced urothelial carcinoma
    • Authors: Nan Sethakorn; Peter H. O'Donnell
      Pages: 681 - 691
      Abstract: Molecular analysis has identified subsets of urothelial carcinoma (UC) expressing distinct genetic signatures. Genomic alterations in the oncogenic fibroblast growth factor receptor 3 (FGFR3) pathway are among the most well described in UC and have led to extensive and ongoing investigation of FGFR3-targeted therapies in this disease, although no new drugs have yet been approved. Given the unmet need for effective treatments in advanced and metastatic UC, a better understanding of the known molecular alterations of FGFR3 and of the previous and ongoing clinical investigations of this promising target in UC deserves attention. The objective of the present review is to describe the landscape of alterations and biology of FGFR3 in UC, comprehensively summarize the current state of UC clinical trials of FGFR3 inhibitors, and discuss future therapeutic applications. Using the Pubmed and databases, articles describing the spectrum and biological activity of FGFR3 genomic alterations and trials of FGFR3 inhibitors in UC were identified. Search terms included ‘FGFR3 genomic alterations’ and ‘urothelial cancer’ or ‘bladder cancer’. Genomic alterations, including translocations and activating mutations, are increasingly described in advanced and metastatic UC. The majority of clinical trials have been performed in unselected populations; however, recent studies have reported encouraging preliminary data. We argue that routine use of molecular genomic tumour analysis in UC may inform selection of patients for appropriate trials and we further investigate the potential of FGFR3 as a meaningful clinical target for this difficult disease.
      PubDate: 2016-07-07T22:10:28.590693-05:
      DOI: 10.1111/bju.13552
  • European Randomised Study of Screening for Prostate Cancer (ERSPC) risk
           calculators significantly outperform the Prostate Cancer Prevention Trial
           (PCPT) 2.0 in the prediction of prostate cancer: a multi-institutional
    • Authors: Robert W. Foley; Robert M. Maweni, Laura Gorman, Keefe Murphy, Dara J. Lundon, Garrett Durkan, Richard Power, Frank O'Brien, Kieran J. O'Malley, David J. Galvin, T. Brendan Murphy, R. William Watson
      Pages: 706 - 713
      Abstract: ObjectiveTo analyse the performance of the Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) and two iterations of the European Randomised Study of Screening for Prostate Cancer (ERSPC) Risk Calculator, one of which incorporates prostate volume (ERSPC-RC) and the other of which incorporates prostate volume and the prostate health index (PHI) in a referral population (ERSPC-PHI).Patients and MethodsThe risk of prostate cancer (PCa) and significant PCa (Gleason score ≥7) in 2001 patients from six tertiary referral centres was calculated according to the PCPT-RC and ERSPC-RC formulae. The calculators’ predictions were analysed using the area under the receiver-operating characteristic curve (AUC), calibration plots, Hosmer–Lemeshow test for goodness of fit and decision-curve analysis. In a subset of 222 patients for whom the PHI score was available, each patient's risk was calculated as per the ERSPC-RC and ERSPC-PHI risk calculators.ResultsThe ERSPC-RC outperformed the PCPT-RC in the prediction of PCa, with an AUC of 0.71 compared with 0.64, and also outperformed the PCPT-RC in the prediction of significant PCa (P
      PubDate: 2016-02-29T22:56:38.094549-05:
      DOI: 10.1111/bju.13437
  • Risk factors and timing of venous thromboembolism after radical cystectomy
           in routine clinical practice: a population-based study
    • Authors: R. Christopher Doiron; Christopher M. Booth, Xuejiao Wei, D. Robert Siemens
      Pages: 714 - 722
      Abstract: ObjectiveTo describe the risk factors and timing of perioperative venous thromboembolism (VTE) and its association with survival for patients undergoing radical cystectomy (RC) in routine clinical practice.Patients and MethodsThe population-based Ontario Cancer Registry was linked to electronic records of treatment to identify all patients who underwent RC between 1994 and 2008; VTE events were identified from hospital diagnostic codes. Multivariate logistic regression analysis was used to determine the factors associated with perioperative VTE. A Cox proportional hazards regression model explored the associations between VTE and survival.ResultsOf the 3 879 patients included in the study, 3.6% (141 patients) were diagnosed with VTE at ≤1 month of their surgical admission date. This increased to 4.7% (181) at ≤2 months and 5.4% (211) at ≤3 months. In all, 55% of VTE events presented after hospital discharge. In multivariate analysis, factors associated with VTE included higher surgeon volume (P = 0.004) and increased length of hospital stay (LOS; P < 0.001). Lymph node yield and adjuvant chemotherapy were not associated with VTE. VTE was associated with an inferior cancer-specific survival [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.13–1.62] and overall survival (HR 1.27, 95% CI 1.08–1.49).ConclusionsOver half of VTE events in RC patients occur after hospital discharge, with a substantial incidence up to 3 months after surgery. Limited actionable risk factors for VTE were identified other than LOS. In this population-based cohort, VTE was associated with inferior long-term survival.
      PubDate: 2016-03-07T15:45:51.359963-05:
      DOI: 10.1111/bju.13443
  • High prostate cancer gene 3 (PCA3) scores are associated with elevated
           Prostate Imaging Reporting and Data System (PI-RADS) grade and biopsy
           Gleason score, at magnetic resonance imaging/ultrasonography fusion
           software-based targeted prostate biopsy after a previous negative standard
    • Authors: Stefano De Luca; Roberto Passera, Giovanni Cattaneo, Matteo Manfredi, Fabrizio Mele, Cristian Fiori, Enrico Bollito, Stefano Cirillo, Francesco Porpiglia
      Pages: 723 - 730
      Abstract: ObjectiveTo determine the association among prostate cancer gene 3 (PCA3) score, Prostate Imaging Reporting and Data System (PI-RADS) grade and Gleason score, in a cohort of patients with elevated prostate-specific antigen (PSA), undergoing magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy (TBx) after a previous negative randomised ‘standard’ biopsy (SBx).Patients and MethodsIn all, 282 patients who underwent TBx after previous negative SBx and a PCA3 urine assay, were enrolled. The associations between PCA3 score/PI-RADS and PCA3 score/Gleason score were investigated by K-means clustering, a receiver operating characteristic analysis and binary logistic regression.ResultsThe PCA3 score difference for the negative vs positive TBx cohorts was highly statistically significant. A 1-unit increase in the PCA3 score was associated to a 2.4% increased risk of having a positive TBx result. A PCA3 score of >80 and a PI-RADS grade of ≥4 were independent predictors of a positive TBx. The association between the PCA3 score and PI-RADS grade was statistically significant (the median PCA3 score for PI-RADS grade groups 3, 4, and 5 was 58, 104, and 146, respectively; P = 0.006). A similar pattern was detected for the relationship between the PCA3 score and Gleason score; an increasing PCA3 score was associated with a worsening Gleason score (median PCA3 score equal to 62, 105, 132, 153, 203, and 322 for Gleason Score 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5, respectively; P < 0.001).ConclusionTBx improved PCA3 score diagnostic and prognostic performance for prostate cancer. The PCA3 score was directly associated both with biopsy Gleason score and PI-RADS grade: notably, in the ‘indeterminate’ PI-RADS grade 3 subgroup.
      PubDate: 2016-05-24T02:40:30.047294-05:
      DOI: 10.1111/bju.13504
  • Endogenous and exogenous testosterone and the risk of prostate cancer and
           increased prostate-specific antigen (PSA) level: a meta-analysis
    • Authors: Peter Boyle; Alice Koechlin, Maria Bota, Alberto d'Onofrio, David G. Zaridze, Paul Perrin, John Fitzpatrick, Arthur L. Burnett, Mathieu Boniol
      Pages: 731 - 741
      Abstract: ObjectiveTo review and quantify the association between endogenous and exogenous testosterone and prostate-specific antigen (PSA) and prostate cancer.MethodsLiterature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective cohort studies that reported data on the associations between endogenous testosterone and prostate cancer, and placebo-controlled randomized trials of testosterone replacement therapy (TRT) that reported data on PSA and/or prostate cancer cases were retained. Meta-analyses were performed using random-effects models, with tests for publication bias and heterogeneity.ResultsTwenty estimates were included in a meta-analysis, which produced a summary relative risk (SRR) of prostate cancer for an increase of 5 nmol/L of testosterone of 0.99 (95% confidence interval [CI] 0.96, 1.02) without heterogeneity (I² = 0%). Based on 26 trials, the overall difference in PSA levels after onset of use of TRT was 0.10 ng/mL (−0.28, 0.48). Results were similar when conducting heterogeneity analyses by mode of administration, region, age at baseline, baseline testosterone, trial duration, type of patients and type of TRT. The SRR of prostate cancer as an adverse effect from 11 TRT trials was 0.87 (95% CI 0.30; 2.50). Results were consistent across studies.ConclusionsProstate cancer appears to be unrelated to endogenous testosterone levels. TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. The current data are reassuring, although some caution is essential until multiple studies with longer follow-up are available.
      PubDate: 2016-02-24T09:06:47.754987-05:
      DOI: 10.1111/bju.13417
  • Radiographic size of retroperitoneal lymph nodes predicts pathological
           nodal involvement for patients with renal cell carcinoma: development of a
           risk prediction model
    • Authors: Boris Gershman; Naoki Takahashi, Daniel M. Moreira, Robert H. Thompson, Stephen A. Boorjian, Christine M. Lohse, Brian A. Costello, John C. Cheville, Bradley C. Leibovich
      Pages: 742 - 749
      Abstract: ObjectivesTo evaluate the ability of clinical and radiographic features to predict lymph node (pN1) disease among patients with renal cell carcinoma undergoing radical nephrectomy (RN), and to develop a preoperative risk prediction model.Patients and MethodsIn all, 220 patients with preoperative computed tomography scans available for review underwent RN with lymph node dissection (LND) from 2000 to 2010. Radiographic features were assessed by one genitourinary radiologist blinded to pN status. Associations of features with pN1 disease were evaluated using logistic regression to develop predictive models. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and decision curve analysis.ResultsThe median (interquartile range) lymph node yield was 10 (5–18). In all, 55 patients (25%) had pN1 disease at RN. On univariable analysis, the maximum lymph node (LN) short axis diameter [odds ratio (OR) 1.17; P < 0.001] predicted pN1 disease with an AUC of 0.84. Although several clinical and radiographic features were associated with pN1 disease, only two were retained in the multivariable model: maximum LN short axis diameter (OR 1.19; P
      PubDate: 2016-02-23T07:17:29.603251-05:
      DOI: 10.1111/bju.13424
  • Significant reduction in positive surgical margin rate after laparoscopic
           radical prostatectomy by application of the modified surgical margin
           recommendations of the 2009 International Society of Urological Pathology
    • Authors: Andreas Maxeiner; Ahmed Magheli, Korinna Jöhrens, Ergin Kilic, Tom Lukas Braun, Carsten Kempkensteffen, Stefan Hinz, Carsten Stephan, Kurt Miller, Jonas Busch
      Pages: 750 - 757
      Abstract: ObjectivesTo verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP).Patients and MethodsThe detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan–Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed.ResultsCentral pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08–2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08–2.72; P = 0.022).ConclusionsThe impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.
      PubDate: 2016-03-19T07:00:50.49103-05:0
      DOI: 10.1111/bju.13451
  • Role of oral pentosan polysulphate in the reduction of local side effects
           of BCG therapy in patients with non-muscle-invasive bladder cancer: a
           pilot study
    • Authors: Suresh Yadav; Vinay Tomar, Sher Singh Yadav, Shivam Priyadarshi, Indraneel Banerjee
      Pages: 758 - 762
      Abstract: ObjectiveTo assess the role of oral pentosan polysulphate (PPS) in the reduction of bacille Calmette-Guérin (BCG)-related local side effects in patients with high grade Ta/T1 non-muscle-invasive bladder cancer (NMIBC).Patients and MethodsA total of 32 symptomatic patients receiving BCG instillation were randomized into three groups: group A received placebo (vitamin B complex tablet) thrice daily; group B received PPS 100 mg thrice daily; and group C received PPS 100 mg once daily and placebo (vitamin B complex tablet) twice daily for 6 weeks. A visual analogue scale (VAS) score for bladder pain, Overactive Bladder-Validated 8 Question Screener (OAB-V8) scores and dysuria were evaluated in the three groups before and during each weekly visit for BCG instillation.ResultsThe mean ± sd post-treatment VAS scores were significantly lower in groups B (4.4 ± 1.2) and C (5.8 ± 0.8) than in group A (8 ± 0.4). In addition, the post-treatment VAS score was significantly lower in group B than in group C (P
      PubDate: 2016-04-23T03:45:40.01385-05:0
      DOI: 10.1111/bju.13489
  • Independent surgical validation of the new prostate cancer grade-grouping
    • Authors: Daniel E. Spratt; Adam I. Cole, Ganesh S. Palapattu, Alon Z. Weizer, William C. Jackson, Jeffrey S. Montgomery, Robert T. Dess, Shuang G. Zhao, Jae Y. Lee, Angela Wu, Lakshmi P. Kunju, Emily Talmich, David C. Miller, Brent K. Hollenbeck, Scott A. Tomlins, Felix Y. Feng, Rohit Mehra, Todd M. Morgan
      Pages: 763 - 769
      Abstract: ObjectiveTo report the independent prognostic impact of the new prostate cancer grade-grouping system in a large external validation cohort of patients treated with radical prostatectomy (RP).Patients and methodsBetween 1994 and 2013, 3 694 consecutive men were treated with RP at a single institution. To investigate the performance of and validate the grade-grouping system, biochemical recurrence-free survival (bRFS) rates were assessed using Kaplan–Meier tests, Cox-regression modelling, and discriminatory comparison analyses. Separate analyses were performed based on biopsy and RP grade.ResultsThe median follow-up was 52.7 months. The 5-year actuarial bRFS for biopsy grade groups 1–5 were 94.2%, 89.2%, 73.1%, 63.1%, and 54.7%, respectively (P < 0.001). Similarly, the 5-year actuarial bRFS based on RP grade groups was 96.1%, 93.0%, 74.0%, 64.4%, and 49.9% for grade groups 1–5, respectively (P < 0.001). The adjusted hazard ratios for bRFS relative to biopsy grade group 1 were 1.98, 4.20, 5.57, and 9.32 for groups 2, 3, 4, and 5, respectively (P < 0.001), and for RP grade groups were 2.09, 5.27, 5.86, and 10.42 (P < 0.001). The five-grade-group system had a higher prognostic discrimination compared with the commonly used three-tier system (Gleason score 6 vs 7 vs 8–10).ConclusionsIn an independent surgical cohort, we have validated the prognostic benefit of the new prostate cancer grade-grouping system for bRFS, and shown that the benefit is maintained after adjusting for important clinicopathological variables. The greater predictive accuracy of the new system will improve risk stratification in the clinical setting and aid in patient counselling.
      PubDate: 2016-04-19T01:05:52.522897-05:
      DOI: 10.1111/bju.13488
  • Outcomes of high-complexity renal tumours with a Preoperative Aspects and
           Dimensions Used for an Anatomical (PADUA) score of ≥10 after
           robot-assisted partial nephrectomy with a median 46.5-month follow-up: a
           tertiary centre experience
    • Authors: Ali Abdel Raheem; Atalla Alatawi, Dae K. Kim, Abulhasan Sheikh, Ibrahim Alabdulaali, Woong K. Han, Young D. Choi, Koon H. Rha
      Pages: 770 - 778
      Abstract: ObjectivesTo compare perioperative trifecta achievement and long-term oncological and functional outcomes between patients with renal tumours of low [Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score 6–7], intermediate (PADUA score 8–9) and high (PADUA score ≥10) complexity undergoing robot-assisted partial nephrectomy (RAPN), and to determine predictors for trifecta achievement.Patients and MethodsData were retrospectively analysed from 295 patients, who underwent RAPN, between 2006 and 2015, at a high-volume tertiary centre. Trifecta achievement was the primary outcome measurement. The perioperative parameters and long-term oncological and functional outcomes were the secondary outcome measures. Groups were compared using the Kruskal–Wallis H test or chi-square test. Univariable and multivariable binary logistic regression analyses were used to determine the most important determinant variables associated with trifecta accomplishment. The Kaplan–Meier method was used to estimate overall survival (OS), cancer-specific survival (CSS) and cancer-free survival (CFS).ResultsOf the 295 patients, 121 (41%) had a PADUA score of ≥10. Patients in the high-complexity PADUA group had larger tumours (P ≤ 0.001), higher clinical stages ≥T1b (P < 0.001), an increased risk of malignancy (P = 0.02), longer warm ischaemia time (P = 0.0030), and higher estimated blood loss (P = 0.001) compared with those in the intermediate- and low-complexity groups. Seven of eight patients who were converted to radical nephrectomy had high-complexity tumours (P = 0.02). Trifecta achievement was less in the high-complexity PADUA group (P < 0.001). Renal functional outcomes did not differ among the groups at follow-up (P > 0.05). There were no significant differences between the groups for OS (P = 0.314), CSS (P = 0.228) and CFS (P = 0.532). In multivariable analysis, the American Society of Anesthesiologists classification, operative time and tumour size were independent predictors of trifecta achievement (P = 0.001, P = 0.03, and P = 0.006, respectively).ConclusionHigh-complexity PADUA tumours are associated with a lower rate of trifecta achievement; however, long-term oncological and functional outcomes seem to be equivalent among high-, intermediate-, and low-complexity tumours. Despite the perioperative outcomes; high-complexity tumours can be handled successfully via the robotic approach and the improved long-term oncological and functional outcomes might be considered useful for patients counselling.
      PubDate: 2016-05-26T02:20:33.22828-05:0
      DOI: 10.1111/bju.13501
  • Evolution and oncological outcomes of a contemporary radical prostatectomy
           practice in a UK regional tertiary referral centre
    • Authors: Vincent J. Gnanapragasam; David Thurtle, Anandagopal Srinivasan, Dimitrios Volanis, Anne George, Artitaya Lophatananon, Sara Stearn, Anne Y. Warren, Alastair D. Lamb, Greg Shaw, Naomi Sharma, Ben C. Thomas, Maxine G. Tran, David E. Neal, Nimish C. Shah
      Pages: 779 - 784
      Abstract: ObjectiveTo investigate the clinical and pathological trends, over a 10-year period, in robot-assisted laparoscopic prostatectomy (RALP) in a UK regional tertiary referral centre.Patients and MethodsIn all, 1 500 consecutive patients underwent RALP between October 2005 and January 2015. Prospective data were collected on clinicopathological details at presentation as well as surgical outcomes and compared over time.ResultsThe median (range) age of patients throughout the period was 62 (35–78) years. The proportion of preoperative high-grade cases (Gleason score 8–10) rose from 4.6% in 2005–2008 to 18.2% in 2013–2015 (P < 0.001). In the same periods the proportion of clinical stage T3 cases operated on rose from 2.4% to 11.4% (P < 0.001). The median prostate-specific antigen (PSA) level at diagnosis did not alter significantly. Overall, 11.6% of men in 2005–2008 were classified preoperatively as high-risk by National Institute for Health and Care Excellence criteria, compared with 33.6% in 2013–2015 (P < 0.001). The corresponding proportions for low-risk cases were 48.6% and 17.3%, respectively. Final surgical pathology showed an increase in tumour stage, Gleason grade, and nodal status over time. The proportion of pT3 cases rose from 43.2% in 2005–2008 to 55.5% in 2013–2015 (P < 0.001), Gleason score 9–10 tumours increased from 1.8% to 9.1% (P < 0.001) and positive nodal status increased from 1.6% to 12.9% (P < 0.001) between the same periods. Despite this, positive surgical margin rates showed a downward trend in all pT groups across the different eras (P = 0.72).ConclusionThis study suggests that the patient profile for RALP in our unit is changing, with increasing proportions of higher stage and more advanced disease being referred and operated on. However, surgical margin outcomes have remained good.
      PubDate: 2016-05-24T07:10:23.116148-05:
      DOI: 10.1111/bju.13513
  • Trends in urological stone disease: a 5-year update of hospital episode
    • Authors: Hendrik Heers; Benjamin W. Turney
      Pages: 785 - 789
      Abstract: ObjectiveTo provide a 5-year follow-on update on the changes in prevalence and treatment of upper urinary tract (UUT) stone disease in England.MethodsData from the Hospital Episode Statistics (HES) website ( were extracted, summarised, analysed, and presented.ResultsThe total number of UUT stone hospital episodes increased slightly from 83 050 in 2009–2010 to 86 742 in 2014–2015 (4.4% increase). The use of shockwave lithotripsy (SWL) for treating all UUT stones remained stable over the 5-year study period following a significant increase in previous years. There was a 49.6% increase in the number of ureteroscopic stone treatments from 12 062 in 2009–2010 to 18 055 in 2014–2015. Increase in ureterorenoscopy (flexible ureteroscopy) showed the most rapid increase from 3 267 to 6 631 cases in the 5-year study period (103% increase). The gap between the total number of ureteroscopies and SWL treatments continues to narrow. Open stone surgery continued to decline with only 30 reported cases in 2014–2015. Due to the continued rapid increase in the number of ureteroscopies performed, treatment for stone disease has continued to increase significantly in comparison to other urological activity.ConclusionThis study provides an update on the changing landscape of the management of UUT stones in England. It shows a sustained high prevalence of stone disease commensurate with levels in other developed countries. This study reveals a trend in the last 5 years to surgically intervene on a higher proportion of patients with stones. As in other countries, there is a significant increase in the use of ureteroscopy (particularly intrarenal flexible ureteroscopy) in England. These data have important implications for work-force planning, training, service delivery, and research in the field of urolithiasis.
      PubDate: 2016-05-26T02:20:38.603941-05:
      DOI: 10.1111/bju.13520
  • Early mercaptoacetyltriglycine(MAG-3) diuretic renography results after
    • Authors: Alice Faure; Kevin London, Grahame H.H. Smith
      Pages: 790 - 796
      Abstract: ObjectiveTo describe the drainage and functional outcome of paediatric pyeloplasty, 1 week after stent removal 7–9 weeks after pyeloplasty using diuretic renography.Patients and MethodsBetween 2009 and 2014, we assessed the functional and drainage outcomes according to mercaptoacetyltriglycine MAG-3 diuretic renograms from 66 children (69 kidneys) who underwent modified dismembered Anderson–Hynes pyeloplasty for pelvi–ureteric junction (PUJ) obstruction. Stents were left in place for 6–8 weeks and postoperative renal units were evaluated with MAG-3 renogram 1 week after stent removal. Surgical success was defined by improvement of drainage (half clearance time [T/2] < 20 min), stable or improved function on the postoperative MAG-3 renogram and by decreased pyelocaliceal dilatation on ultrasonography (US) at 1 year.ResultsOf the 69 kidneys with a preoperative median range T/2 of 33.4 (7.6–200) min, 60 (87%) had improved drainage curves, with a median (range) T/2 of 6.9 (1.6–19) min. Thirteen percent (9/69) had persistent impaired drainage, with a median (range) T/2 of 36 (24–108) min. Of these nine children, one girl was found to have a persistent obstructive pattern (T/2 = 30 min) associated with a decreased split renal function (SRF; from 42 to 33%) and persistent hydronephrosis (at 28 mm). Redo pyeloplasty was performed 2 months after the initial procedure (and 18 days after stent removal) and renal function recovered to 47%. The remaining eight patients were free of symptoms; hydronephrosis improved at 1 year (anteroposterior diameter decreased from 28 to 18.5 mm; P = 1.94) and SRF remained stable (44.5 vs 48.5% after repair; P = nonsignificant). In the 29% of kidneys (20/69) that had preoperative impaired SRF, postoperative renal function improved in 75% (from 27.5 to 43%; P < 0.001), remained unchanged in 2% and one kidney (0.2%) deteriorated. The median (range) postoperative follow-up was 18 (12–90) months.ConclusionsThere is no agreement regarding the ‘gold standard’ investigation to use after pyeloplasty for PUJ obstruction. Improvement in hydronephrosis on US is slow and often takes > 12 months. Based on animal studies, it is possible that missed recurrent obstruction will cause irreversible loss of renal function after 6 weeks; therefore, early postoperative assessment is desirable, but there have been few reports on urinary drainage changes with early diuretic renography after pyeloplasty. Most of the renal units had improved drainage on diuretic renography 7 weeks after pyeloplasty and 1 week after stent removal. An early diuretic renogram is a reliable method of documenting surgical success after pyeloplasty
      PubDate: 2016-05-25T08:00:26.497543-05:
      DOI: 10.1111/bju.13512
  • Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and
           functional outcomes
    • Authors: Clemens M. Rosenbaum; Marianne Schmid, Tim A. Ludwig, Luis A. Kluth, Roland Dahlem, Margit Fisch, Sascha Ahyai
      Pages: 797 - 803
      Abstract: ObjectivesTo determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU.Patients and MethodsWe included 50 patients who underwent redo BMGU between February 2009 and September 2014. Patients' charts and non-validated questionnaires were reviewed. The primary endpoint was success rate, defined as stricture-free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty, or a maximum urinary flow rate
      PubDate: 2016-06-11T05:20:27.558344-05:
      DOI: 10.1111/bju.13528
  • Testosterone undecanoate improves sexual function in men with type 2
           diabetes and severe hypogonadism: results from a 30-week randomized
           placebo-controlled study
    • Authors: Geoffrey Hackett; Nigel Cole, Atif Saghir, Peter Jones, Richards C. Strange, Sudarshan Ramachandran
      Pages: 804 - 813
      Abstract: ObjectiveTo evaluate the sexual function response to 30 weeks’ treatment with long-acting testosterone undecanoate (TU) or placebo in 199 men with type 2 diabetes and either severe or mild hypogonadism (HG).Patients and MethodsMen with HG were identified from seven primary care type 2 diabetes registers. A 30-week randomized placebo-controlled study of TU was carried out in 199 of these men (placebo, n = 107, TU, n = 92). The patient-reported outcome measure was the 15-item International Index of Erectile Function score. Men completing the study (n=189) were stratified, firstly, by baseline total testosterone (TT) or free testosterone (FT) into mild HG (TT 8.1–12 nmol/L or FT 0.18–0.25 nmol/L) and severe HG groups (TT ≤8 nmol/L and FT ≤0.18 nmol/L), and secondly, by intervention (placebo or TU), thereby creating four groups: mild HG/placebo; mild HG/TU; severe HG/placebo and severe HG/TU.Statistical AnalysisChanges in sexual function score (a secondary outcome of the study) at each visit within group (from baseline) and between groups (TU vs placebo) at each assessment (6, 18 and 30 weeks) were compared using a Wilcoxon signed-rank and Wilcoxon rank-sum test, respectively.ResultsSignificant improvement in erectile function was evident only in the severe HG group after 30 weeks of TU treatment; this finding persisted when TU was compared with placebo. Intercourse satisfaction and sexual desire scores were also improved at 6, 18 and 30 weeks in the severe HG group after TU treatment; this increase in scores was also evident when compared with placebo. TU did not appear to alter orgasmic function significantly in any of the patient groups.ConclusionsThe present study suggests that benefit in sexual symptoms after TU treatment is evident principally in patients with HG with TT levels ≤8 nmol/L and FT levels ≤0.18 nmol/L. We also suggest that 30 weeks of treatment is necessary before evaluating improvement in erectile function.
      PubDate: 2016-05-27T07:30:49.738261-05:
      DOI: 10.1111/bju.13516
  • Analysis of the functional aspects and seminal plasma proteomic profile of
           sperm from smokers
    • Authors: Mariana Pereira Antoniassi; Paula Intasqui, Mariana Camargo, Daniel Suslik Zylbersztejn, Valdemir Melechco Carvalho, Karina H. M. Cardozo, Ricardo Pimenta Bertolla
      Pages: 814 - 822
      Abstract: ObjectiveTo evaluate the effect of smoking on sperm functional quality and seminal plasma proteomic profile.Patients and MethodsSperm functional tests were performed in 20 non-smoking men with normal semen quality, according to the World Health Organization (2010) and in 20 smoking patients. These included: evaluation of DNA fragmentation by alkaline Comet assay; analysis of mitochondrial activity using DAB staining; and acrosomal integrity evaluation by PNA binding. The remaining semen was centrifuged and seminal plasma was used for proteomic analysis (liquid chromatography-tandem mass spectrometry). The quantified proteins were used for Venn diagram construction in Cytoscape 3.2.1 software, using the PINA4MS plug-in. Then, differentially expressed proteins were used for functional enrichment analysis of Gene Ontology categories, Kyoto Encyclopedia of Genes and Genomes and Reactome, using Cytoscape software and the ClueGO 2.2.0 plug-in.ResultsSmokers had a higher percentage of sperm DNA damage (Comet classes III and IV; P < 0.01), partially and fully inactive mitochondria (DAB classes III and IV; P = 0.001 and P = 0.006, respectively) and non-intact acrosomes (P < 0.01) when compared with the control group. With respect to proteomic analysis, 422 proteins were identified and quantified, of which one protein was absent, 27 proteins were under-represented and six proteins were over-represented in smokers. Functional enrichment analysis showed the enrichment of antigen processing and presentation, positive regulation of prostaglandin secretion involved in immune response, protein kinase A signalling and arachidonic acid secretion, complement activation, regulation of the cytokine-mediated signalling pathway and regulation of acute inflammatory response in the study group (smokers).ConclusionIn conclusion, cigarette smoking was associated with an inflammatory state in the accessory glands and in the testis, as shown by enriched proteomic pathways. This state causes an alteration in sperm functional quality, which is characterized by decreased acrosome integrity and mitochondrial activity, as well as by increased nuclear DNA fragmentation.
      PubDate: 2016-06-20T02:10:25.665323-05:
      DOI: 10.1111/bju.13539
  • The use of portable video media (PVM) versus standard verbal communication
           (SVC) in the urological consent process: a multicentre, randomised
           controlled, crossover trial
    • Authors: Matthew Winter; Jonathan Kam, Sunny Nalavenkata, Ellen Hardy, Marcus Handmer, Hannah Ainsworth, Wai Gin Lee, Mark Louie‐Johnsun
      First page: 823
      Abstract: BackgroundInformed consent is a crucial component of patient care. Portable video media is an emerging technology which may help improve the consent process.ObjectivesTo determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC).Design, Participants and MethodsMulti‐centre randomised controlled crossover trial. Patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15‐month period (July 2014 – December 2015). Information delivery via PVM and SVC. PVM consisted of an audio‐visual presentation with cartoon animation presented on an iPad.Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire‐8 (max score 32) and knowledge was tested using a true/false questionnaire (max score 28). Questionnaires were tested after first intervention and after crossover. Scores were analysed using independent samples t‐test and Wilcoxon signed‐rank test for crossover analysis.ResultsEighty‐eight patients were recruited. A significant 3·1 point (15·5%) increase in understanding was demonstrable favouring the use of PVM (p
      PubDate: 2016-07-21T02:31:50.693417-05:
      DOI: 10.1111/bju.13595
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