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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  [1598 journals]
  • De Ritis ratio (AST/ALT) as a significant prognostic factor after surgical
           treatment in patients with clear cell localized renal cell carcinoma: a
           propensity score matched study
    • Abstract: Objective Our objective was to evaluate the detailed association of preoperative De Ritis ratio (AST/ALT) with postoperative clinical outcomes after surgical treatment of localized RCC. Materials and Methods We retrospectively reviewed data from 2,965 patients surgically treated for non‐metastatic RCC. Propensity scores for high AST/ALT were calculated and 430 patients with high AST/ALT were matched to 1,117 patients with low AST/ALT. The association between AST/ALT and postoperative outcomes was tested. Multivariate Cox analyses were performed to identify the independent predictors of progression‐free, overall‐ and cancer specific survival. Results According to receiver operating curve of AST/ALT to cancer‐specific mortality, we stratified the patients into two groups by a cut‐off value of 1.5. Before matching, patients with high AST/ALT showed worse progression‐free, overall, and cancer specific survival (all p < 0.001). In propensity score matched cohort with 1,547 patients, patients with high AST/ALT showed inferior survival outcomes in progression‐free, overall and cancer specific survival (all p < 0.001). On multivariate analysis, high AST/ALT was revealed as an independent predictor of disease progression (HR 1.372, 95% CI 1.003 – 1.882; p = 0.048), overall mortality (HR 1.559, 95% CI 1.069 – 2.272; p = 0.021), and cancer specific mortality (HR 1.974, 95% CI 1.250 – 3.118; p = 0.004). From the subgroup analysis according to tumour histology, high AST/ALT showed significant relationship with postoperative survival in clear cell RCC, but not in non‐clear cell RCC. Conclusion Increased AST/ALT was significantly associated with worse postoperative survival in patients surgically treated for localized clear cell RCC. Further prospective studies are needed to understand the prognostic value of preoperative AST/ALT. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-16T23:40:29.406957-05:
      DOI: 10.1111/bju.13545
  • The Origins of Urinary Stone Disease: Upstream mineral formations initiate
           downstream Randall's plaque
    • Authors: Ryan S. Hsi; Krishna Ramaswamy, Sunita P Ho, Marshall L. Stoller
      Abstract: Objectives To describe a new hypothesis for the initial events leading to urinary stones. A biomechanical perspective on Randall's plaque formation through form and function relationships is applied to functional units within the kidney we have termed the “medullo‐papillary complex” – a dynamic relationship between intratubular and interstitial mineral aggregates. Materials and Methods A complete MEDLINE search was performed to examine the existing literature regarding the anatomical and physiological relationships in the renal medulla and papilla. Sectioned human renal medulla with papilla from radical nephrectomy specimens were imaged using a high resolution micro X‐ray computed tomography. The location, distribution, and density of mineral aggregates within the medullo‐papillary complex were identified. Results Mineral aggregates were observed proximally in all specimens within the outer medulla of medullary complex and were intratubular. Distal interstitial mineralization at the papillary tip corresponding to Randall's plaque was not observed until a threshold of proximal mineralization was observed. Mineral density measurements suggest varied chemical compositions between the proximal intratubular (330 mg/cc) and distal interstitial (270 mg/cc) deposits. A review of the literature revealed distinct anatomical compartments and gradients across the medullo‐papillary complex that supports the empirical observations that mineralization proximally triggers distal Randall's plaque formation. Conclusion The initial stone event is initiated by intratubular mineralization of the renal medullary tissue leading to the interstitial mineralization that is observed as Randall's plaque. We base this novel hypothesis on a multiscale biomechanics perspective involving form and function relationships, and empirical observations. Additional studies are needed to validate this hypothesis. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-16T03:30:30.104098-05:
      DOI: 10.1111/bju.13555
  • Robotic Assisted Partial Cystectomy (RAPC): perioperative outcomes and
           early oncologic efficacy
    • Authors: David M. Golombos; Padraic O'Malley, Patrick Lewicki, Benjamin V. Stone, Douglas S. Scherr
      Abstract: Objective To report on patients undergoing robotic‐assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomic and pathologic variables as well as the overall oncological efficacy of this approach. Patients and Methods We retrospectively reviewed all patients who underwent robotic assisted partial cystectomy (RAPC) by a single surgeon between 2005‐2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumor. Clinicopathologic data and perioperative variables were recorded. Continuous variables were compared using student's t‐test. Prediction of perioperative outcomes for those undergoing RAPC for intradiverticular neoplasms was done using univariable logistic regression. Survival was estimated using the Kaplan‐Meier method. Results Median patient age was 75 years [IQR 65‐81], 18 patients (62.1%) had an ASA classification of 3 or higher, and 10 patients (34.5%) had a history of prior abdominal surgery. Median blood loss was 50 cc and median length of stay was 1 day. Two patients (6.9%) experienced a perioperative complication and five (17.9%) a post‐discharge 90 day complication, all which were minor. Positive surgical margin rate was 3.6%, and in those with muscle invasive disease a median of 12 lymph nodes were removed. Neither size of diverticulum or need for ureteral reimplant were predictive of length of stay, blood loss, or complication (p>0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncologic outcomes. Five‐year overall and recurrence‐free survival rates were 79% and 68% respectively. Conclusion RAPC confers the ability to achieve favorable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favorably with published literature. For experienced surgeons, this may represent the optimal surgical approach for organ preserving bladder surgery. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-15T00:05:34.677575-05:
      DOI: 10.1111/bju.13535
  • Active surveillance for low‐risk Non‐Muscle Invasive Bladder
           Cancer (NMIBC): mid‐term results from a Bladder cancer Italian
           Active Surveillance (BIAS) project
    • Abstract: Objective To report the oncologic safety and the risk of progression for patients with NMIBC included in an active surveillance (AS) program after the diagnosis of recurrence. Subjects and methods This is a prospective study enrolling patients with history of pathologically confirmed LG pTa‐pT1a Non‐Muscle Invasive Bladder Cancer (NMIBC) and diagnosed with a tumour recurrence. Inclusion criteria consisted of negative urine cytology, presence of ≤ 5 NMIBCs with a diameter ≤ 10 mm, absence of carcinoma in situ (CIS) or persistent gross haematuria. The primary outcome of interest was adherence to AS. Need to proceed with treatment was defined as progression in number/dimension/positive cytology/symptoms (gross haematuria persistent) or any further intervention (resection or electro‐fulguration). Finally, we assessed the up‐grading and up‐staging when transurethral resection of bladder tumour (TURBT) was performed. Results The study population consisted of 55 patients with a previous diagnosis of NMIBC (70 active surveillance events) prospectively recruited since 2008. The mean patient age was 69.8 years. Median follow‐up was 53 months. The median time patients remained under AS was 12.5 months. A disease progression was observed in 28 patients (51%). No patient experienced progression to muscle‐invasive disease. Fifteen patients (27.3%) showed an increase in the number and/or size of the tumour, 9 (16,4%) suffered from hematuria and 4 (7.3%) had a positive cytology. Only 5 (9%) patients in the whole series experienced progression to a high‐ grade tumour (G3) or presented with associated CIS. The overall adherence to the follow‐up schedule was 95%. Conclusion Our data showed that an AS protocol for NMIBC could be a reasonable option in a selected group of patients with small, recurrent cancers. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-13T21:30:28.357332-05:
      DOI: 10.1111/bju.13536
  • Role of Prostate Artery Embolization (PAE) in the Management of Refractory
           Hematuria of Prostatic Origin
    • Authors: Keith Pereira; Joshua A. Halpern, Timothy D. McClure, Nicholas A. Lewis, Isaam Kably, Shivank Bhatia, Jim C. Hu
      Abstract: Prostatic hematuria is among the most common genitourinary complaints of emergency room visits, distressful and troublesome to men and a challenging clinical problem to the treating physician. The most common etiologies of prostatic hematuria include benign prostatic hyperplasia and prostate cancer. Prostatic hematuria usually resolves with conservative and medical methods; failure of these interventions results in refractory hematuria of prostatic origin (RHPO), a potentially life‐threatening scenario. Several different treatments have been described, with varying degrees of success. Patients with RHPO are often elderly and unfit for radical surgery. Prostate artery embolization (PAE) has evolved as a safe and effective technique in the management of RHPO. Use of a superselective approach optimizes clinical success while minimizing complications. This minimally invasive approach improves patients with hemodynamic instability, serves as a bridge to elective surgery, and is a highly effective treatment for RHPO. It may obviate the need for more invasive and morbid surgical therapies. The aim of this review is to describe the current management of RHPO, the technique of PAE and review its efficacy and morbidity. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-13T02:20:35.892154-05:
      DOI: 10.1111/bju.13524
  • Redo‐buccal mucosa graft urethroplasty: Success rate, oral morbidity
           and functional outcome
    • Authors: Clemens M. Rosenbaum; Marianne Schmid, Tim A. Ludwig, Luis A. Kluth, Roland Dahlem, Margit Fisch, Sascha Ahyai
      Abstract: Objectives To determine success rate, oral morbidity and functional outcome of Redo‐buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after prior BMGU. Patients and methods We included 50 Patients who underwent Redo‐BMGU between February 2009 and September 2014. Patients’ charts and non‐validated questionnaires were reviewed. Primary endpoint consisted of success rate defined as stricture‐free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty or when maximum flow rate was
      PubDate: 2016-06-11T05:20:27.558344-05:
      DOI: 10.1111/bju.13528
  • Robotic‐assisted vs. open adrenalectomy: evaluation of cost
           effectiveness and perioperative outcome
    • Abstract: Objectives To compare Robotic assisted laparoscopic adrenalectomy (RALA) and open adrenalectomy (OA) with regard to intraoperative complications, perioperative outcome and cost effectiveness. Subjects/Patients And Methods Functional and statistical data from OA and RALA patients between 2001 and 2015 was prospectively recorded including intra‐ and post‐operative outcomes. We also utilized per‐day costs from current census reports (€540/d and €1145/d for normal and intermediate care) to evaluate treatment costs. Additional costs for RALA (€2288) were assumed in accordance with current literature. Patients were matched by ASA‐score, age, side of surgery and gender for comparison of OA and RALA. 28 matched pairs were analyzed for patient characteristics, perioperative outcomes and cost effectiveness. Statistical significance of outcome parameters were determined by student‐t‐test and Pearson's chi‐squared test. Results Due to the matching process, patient groups did not differ in their main characteristics. Length of stay was shorter for RALA (11.1 ± 4.8 vs. 6.8 ± 1.2 days, p
      PubDate: 2016-06-10T01:11:46.152834-05:
      DOI: 10.1111/bju.13529
  • Getting Personal with Prostate Cancer: DNA‐Repair Defects and
           Olaparib in Metastatic Prostate Cancer
    • Authors: Nicholas Raison; Oussama Elhage, Prokar Dasgupta
      Abstract: Despite the progress that has been made in the treatment of advanced prostate cancer, many patients with metastatic prostate cancer still progress to hormone resistance. Development of new agents has greatly expanded the treatment options for metastatic castrate resistant prostate cancer (mCRPC), however their impact on survival outcomes have been limited. There remains an acute need for improvements in the prognostic assessment and targeted treatment of mCRPC. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-09T05:58:24.850933-05:
      DOI: 10.1111/bju.13522
  • Spectrum of genomic alterations in FGFR3: current appraisal of the
           potential role of FGFR3 in advanced urothelial carcinoma
    • Authors: N. Sethakorn; P. H. O'Donnell
      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 prior and ongoing clinical investigations of this promising target in UC deserve attention. The objective of this 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 Clinicaltrials. gov 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 tumor analysis in UC may inform selection of patients for appropriate trials and further investigate the potential for FGFR3 as a meaningful clinical target for this difficult disease. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-07T10:05:45.180624-05:
      DOI: 10.1111/bju.13552
  • Evaluation and establishment of a ward‐based geriatric liaison
           service for older urological surgical patients: POPS‐Urology
           (Proactive Care of Older People Undergoing Surgery)
    • Abstract: Objective To assess the impact of introducing and embedding a structured geriatric liaison service, POPS‐Urology, using comprehensive geriatric assessment methodology, on an inpatient urology ward. Patients and Methods A phased quality improvement project was undertaken using stepwise interventions. Phase 1 ‐ A before‐and‐after study with initiation of a daily board round, weekly multidisciplinary meeting, and targeted geriatrician‐led ward rounds for elective and emergency urology patients ≥65 years admitted over two one‐month periods. Outcomes were recorded from medical records and discharge documentation, including length of inpatient stay, medical and surgical complications, 30‐day readmission and 30‐day mortality. Phase 2 ‐ A quality improvement project involving Plan‐Do‐Study‐Act cycles and qualitative staff surveys in order to create a Geriatric Surgical Checklist (GSCL) to: standardise the intervention in Phase 1, improve equity of care by extending to all ages, improve team working, and streamline handovers for multidisciplinary staff. Results Phase 1 ‐ 112 patients in the control month and 130 in the intervention month. Length of inpatient stay was reduced by 19% (mean 4.9 vs. 4.0 days, p=0.01), total postoperative complications were lower (RR 0.24 (0.10, 0.54), p=0.001). A non‐significant trend was seen towards fewer cancellations of surgery (10% vs. 5%, p=0.12) and 30‐day readmissions (8% vs. 3%, p=0.07). Phase 2 ‐ The GSCL was created and incrementally improved. Questionnaires repeated at intervals revealed the GSCL helped staff to understand their role better in multidisciplinary meetings, improved their confidence to raise issues, reduced duplication of handovers, and standardised identification of geriatric issues. Equity of care was improved by providing the intervention to patients of all ages, despite which the time taken for the daily board round did not lengthen. Conclusion This is the first known paper describing benefits of daily proactive geriatric intervention in elective and emergency urological surgery. The results suggest that using a multidisciplinary team board round helps to facilitate collaborative working between surgical and geriatric medicine teams. The GSCL enables systematic identification of patients who require a focussed comprehensive geriatric assessment. There is potential to transfer the GSCL package to other surgical specialties and hospitals in order to improve postoperative outcomes. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-04T02:15:25.916229-05:
      DOI: 10.1111/bju.13526
  • Pre‐biopsy 3T MRI and targeted biopsy of the index prostate cancer
           – correlation with robot assisted radical prostatectomy
    • Authors: Uday Patel; Prokar Dasgupta, Ben Challacombe, Declan Cahill, Christian Brown, Roshnee Patel, Roger Kirby
      Abstract: Objective To study whether pre‐biopsy 3T prostate MRI with targeted biopsy allows for accurate anatomical and oncological characterisation of the index prostate tumour and if this translates into improved positive surgical margin (PSM) rates after radical prostatectomy. Patients and methods Retrospective analysis of all men (n=201) who underwent robot‐assisted radical prostatectomy (RARP) between July 2012‐Juy 2014 Patients were divided into a study group (n=63) who had undergone pre‐biopsy 3T MRI, followed by visual targeted and systematic prostate biopsy; and a control group (n=138) who had undergone systematic biopsy alone. The two groups were well matched regarding patient and cancer characteristics. The primary study objective was to assess the accuracy of pre‐biopsy MRI for localising the index tumour Secondary study objectives were to assess the accuracy of MRI for the maximal tumour diameter(MTD) of the index tumour focus; and accuracy of the targeted biopsy for the Gleason score and primary Gleason grade of the index tumour focus and whether PSMs were improved after RARP The reference standard was whole gland pathology of the resected prostate gland. Continuous variables and proportions were compared using the t‐test and Mann Whitney test; or contingency tables respectively. Pearson correlation coefficient and Bland Altman plots were used to compare measurement of MTD. Results MRI accurately located the index tumour focus in 73%. Accuracies stratified according to PI‐RADS category 5, 4 and 3 were 94%, 75% and 60% respectively. Accuracies stratified according to MTD of ≤ 0.7cm, ≤1cm and > 1cm were 50%, 57% and 79% respectively. There was a positive linear correlation between MRI and histological MTD [r =0.42 (95% CI: 0.16‐0.63),; p=0.002]; but MRI generally underestimated the MTD – mean (95%CI) MRI measured MTD was 1.51cm (1.29‐1.72cm) vs. pathological MTD of 2.15cm (1.86‐2.43cm) Targeted biopsy identified 37% more cancer per core than non‐targeted biopsy. Mean (95% CI) maximal core length was 8.9mm (7.8‐10mm) vs. 6.5mm (5.8‐7.2mm); study and control groups respectively (p=0.0002;non‐paired t test) Gleason scoring was significantly more predictive after targeted biopsies, with unchanged scores in 40/63 (63%) vs. 62/138 (45%) in study and control groups respectively (p = 0.001; Fisher's test). The odds of Gleason up grading were 2.5 (p=0.028) greater in the control group. The primary Gleason grade was not significantly different in the two groups [45/63 (71%) vs. 91/138 (66%); study vs. control group respectively (p =0.51, Fisher's test)]. Overall PSMs were non‐significantly lower in the study group (15.8% vs. 18.8%; p = 0.84, Fisher's test); and the MRI location of the index tumour focus correlated with the site of PSM in 70% of cases in the study group Conclusion Pre‐biopsy MRI can accurately identify the index prostate tumour, especially in those with higher PI‐RADS grades and tumour diameter. Targeted biopsy of this focus retrieves significantly more cancerous tissue per core, and is more accurate regarding Gleason scores, but not primary Gleason grade. MRI underestimates MTD and PSMs were not significantly improved in our study This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-03T10:05:33.998399-05:
      DOI: 10.1111/bju.13525
  • Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER
    • Authors: Janet E. Baack Kukreja; Maureen Kiernan, Bethany Schempp, Aisha Siebert, Adriana Hontar, Benjamin Nelson, James Dolan, Katia Noyes, Ann Dozier, Ahmed Ghazi, Hani H. Rashid, Guan Wu, Edward M. Messing
      Abstract: Objectives To determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved radical cystectomy (RC) quality of care (Quality Improvement in Cystectomy Care with Enhanced Recovery‐QUICCER) defined by a decrease in length of stay (LOS) without an increase in complications or readmissions compared to those not managed with CERP. Subjects and Methods QUICCER is a non‐randomized quasi‐experimental study. Data were collected from June 2011 to April 2015. The CERP was implemented in July 2013. The primary endpoint was LOS. Secondary endpoints were quality scores, complications and readmissions. Multivariable regression was performed. Propensity score matching was done to further simulate randomized clinical trial conditions. A CERP quality composite score was created and evaluated for adherence to CERP elements. Results There were 79 CERP and 121 non‐CERP patients included. After matching, there were 75 non‐CERP patients. The LOS was significantly different. The CERP and non‐CERP groups had a median LOS of 5 days and 8 days, respectively, p < 0.001. Multivariable linear regression revealed any complication was the most significant predictor of total hospital days at 90 days after RC. The higher the quality composite score the shorter the length of stay, p < 0.001. There was no association of the CERP and increased complications or readmissions. Conclusions Audited quality measures in the CERP are associated with a reduction of LOS without increasing readmissions or complications. The CERP is important in the future improvement of RC perioperative care and provides an opportunity to improve the quality of care provided. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-03T10:05:30.848432-05:
      DOI: 10.1111/bju.13521
  • Recent advances in immuno‐oncology and the application to urological
    • Authors: Jennifer M. Mataraza; Philip Gotwals
      Abstract: Recent advances in immuno‐oncology have the potential to transform the practice of medical oncology. Antibodies directed against negative regulators of T cell function (checkpoint inhibitors), engineered cell therapies, and innate immune stimulators such as oncolytic viruses are effective in a wide range of cancers. Immune‐based therapies have had a clinically meaningful impact on the treatment of advanced melanoma and the lessons regarding use of single agents and combinations in melanoma may be applicable to the treatment of urological cancers Checkpoint inhibitors, cytokine therapy and therapeutic vaccines are already showing promise in urothelial bladder cancer, renal cell carcinoma and prostate cancer. Critical areas of future immuno‐oncology research include the prospective identification of patients who will respond to current immune‐based cancer therapies, and the identification of new therapeutic agents that promote immune priming in tumors, and increase the rate of durable clinical responses. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-03T10:05:24.354366-05:
      DOI: 10.1111/bju.13518
  • Cost‐effectiveness of zoledronic acid and strontium‐89 as bone
           protecting treatments in addition to chemotherapy in patients with
           metastatic castrate‐refractory prostate cancer: results from the
           TRAPEZE trial (ISRCTN 12808747)
    • Authors: L Andronis; I Goranitis, S Pirrie, A Pope, D Barton, S Collins, A Daunton, D McLaren, J O'Sullivan, C Parker, E Porfiri, J Staffurth, A Stanley, J Wylie, S Beesley, A Birtle, J Brown, P Chakraborti, S Hussain, M Russell, L Billingham, N James
      Abstract: Objectives To evaluate the cost‐effectiveness of adding zoledronic acid (ZA) or strontium‐89 (Sr89) to standard docetaxel chemotherapy for patients with castrate‐refractory prostate cancer (CRPC). Patients and methods Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2x2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost‐effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium‐89 versus no strontium‐89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the NHS and included expenditures for trial treatments, concomitant medications and use of related hospital and primary care services. QALYs were calculated according to patients’ responses to the generic EuroQol EQ‐5D‐3L instrument. Results are expressed as incremental cost‐effectiveness ratios (ICER) and cost‐effectiveness acceptability curves. Results The per‐patient cost for ZA was £12,667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group experienced on average 0.03 QALYs more than their counterparts in no ZA. The incremental cost‐effectiveness ratio (ICER) for this comparison was £8,005. Sr89 was associated with a cost of £13,230, £1,365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16,884. The probabilities of ZA and Sr89 being cost‐effective were 0.64 and 0.60, respectively. Conclusions The addition of bone‐targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost‐savings). ZA and Sr89 resulted in ICERs below conventional willingness‐to‐pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost‐effective use of resources This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-03T04:00:39.500191-05:
      DOI: 10.1111/bju.13549
  • Urethral fixation technique improves early urinary continence recovery in
           patients who underwent Retropubic Radical Prostatectomy
    • Authors: Vincenzo Ficarra; Alessandro Crestani, Marta Rossanese, Vito Palumbo, Mattia Calandriello, Giacomo Novara, Silvio Praturlon, Gianluca Giannarini
      Abstract: Objectives to describe step by step an original urethra‐vesical anastomosis technique (Urethral fixation) in patients who underwent retropubic radical prostatectomy (RRP) and compare the observed early urinary continence recovery rates with those reported in a control group receiving a standard anastomosis technique. Moreover, we identified the predictors of early urinary continence recovery. Patients and methods We compared 70 patients who underwent RRP with urethral fixation technique with a contemporary control group of 51 patients who received RRP with a standard urethra‐vesical anastomosis. In the study group, the urethra‐vesical anastomosis was performed using 8 single stitches. Specifically, to avoid retraction and/or deviations we fixed the urethral stump laterally to the medial portion of levator ani muscle. Moreover, to maintain the normal position in the context of pelvic floor we fixed the urethra sphincter deeper to the medial dorsal rafe using a 3‐0 PDS stitch at 6 o'clock before completing the incision of the urethral wall. Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self‐reporting no urine leak were considered continent. Univariable and multivariable analyses were used to identify predictors of urinary incontinence at different follow‐ups. Results The two evaluated groups resulted comparable for all the pre‐operative variables. One week after catheter removal, 32 (45.7%) patients in the study group and 10 (19.6%) in the control group were continents (p=0.01), respectively. Similarly, 1 month after catheter removal, 46 (65.7%) patients in the urethral fixation group and 16 (31.4%) declared to be continent (p=0.001), respectively. Two months after catheter removal, 59 (84.3%) patients in the study group and 21 (41.2%) in the control group were continents (p
      PubDate: 2016-06-02T10:27:27.978848-05:
      DOI: 10.1111/bju.13514
  • Magnetic Resonance Microscopy May Enable Distinction Between Normal
           Histomorphological Features and Prostate Cancer in the Resected Prostate
    • Authors: Matthieu Durand; Manu Jain, Brian Robinson, Eric Aronowitz, Youssef El Douahy, Robert Leung, Douglas S. Scherr, Amelia Ng, Dominique Donzeau, Jean Amiel, Pascal Spincemaille, Arnauld Villers, Douglas J. Ballon
      Abstract: Introduction In vivo high‐resolution magnetic resonance imaging (MRI) at a microscopic level for the identification of prostate cancer (PCa) has not yet been achieved. This may be accomplished using MRI with high spatial resolution for ex vivo examination of prostate specimens. The objective was to determine imaging protocol parameters for characterization of prostate tissue at histologic length scales. Material and Methods Rapid acquisition with relaxation enhancement (RARE), spin echo (SE) and gradient echo (GRE) fast low angle shot (FLASH) data were acquired using ex vivo 3 Tesla or 7 Tesla magnetic field strengths from fresh prostatectomy specimens (n=15) obtained from either organ donor or PCa patients under Institutional Review Board approval. To achieve the closest correspondence between histopathological components and MRI images in terms of resolution and sectioning planes, multiple high resolution imaging protocols (ranging from few minutes to overnight) were tested. Ductograms were generated as part of image post‐processing. Specimens were subsequently submitted for histopathological evaluation. Results and Limitations A total of 7 imaging protocols were tested. Ex vivo 7 Tesla MRI identified normal components of prostate glands including ducts, blood vessels, concretions, and stroma at a spatial resolution of 60 X 60 X 60 μm3 to 107 X 107 X 500 μm3. Malignant glands and nests of tumor cells identified at 60 X 60 X 90 μm3 were highly comparable to low magnification (x2) histopathology. Ductograms enhanced the differentiation between benign and malignant glands. The results of this study are encouraging, and further work is warranted with a higher sample size. Conclusion We demonstrated that critical histopathological features of the prostate gland can be identified with high resolution ex vivo MRI examination and offer promise that MR microscopy of PCa will ultimately be possible in vivo. This article is protected by copyright. All rights reserved.
      PubDate: 2016-06-01T22:55:39.085473-05:
      DOI: 10.1111/bju.13523
  • If the robot is there, why not use it' Why we should use the robot for
           laparoscopic nephrectomy
    • Authors: Wayne Lam; Mollika Chakravorty, Ben Challacombe
      Abstract: Robot‐assisted laparoscopic nephrectomy (RALN) was first described over 10 years ago [1]. However, with the wide availability of established and experienced laparoscopic surgeons, investigation into the role and potential benefits of RALN has been limited. Many consider RALN to bare no additional benefits over laparoscopic radical nephrectomy (LRN) but see it as merely expensive, and regard it as ‘technical overtreatment’. On the other hand, robotic surgery improves laparoscopic dexterity with a better range of movement, three‐dimensional vision, tremor filtration, and motion scaling leading to better eye‐hand coordination. It is a tool for complex laparoscopic surgery and is indeed a very good one, but is there a role for RALN' This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-29T21:55:26.622065-05:
      DOI: 10.1111/bju.13509
  • 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
      Abstract: Objective To evaluate the Sexual Function response to 30 weeks treatment with Long Acting Testosterone Undecanoate (TU) or Placebo (P) 199 men with type 2 diabetes and either severe or mild hypogonadism. Patients and Methods Men with hypogonadism (HG) were identified from 7 primary care T2DM registers. A 30 week randomised placebo controlled study of TU was carried out in 199 of these men (P: 107, TU: 92). The patient reported outcome measure was the IIEF ‐15. Men completing the study (n=189) were stratified firstly, by baseline total testosterone (TT) / free testosterone (FT) into Mild HG (TT 8.1–12nmol/l or FT 0.18‐0.25nmol/l) and Severe HG groups (TT ≤8nmol/l and FT ≤0.18nmol/l) and secondly by intervention (P and TU) leading to 4 groups; Mild HG/P, Mild HG/TU, Severe HG/P and Severe HG/TU. Statistical Analysis Changes in sexual function score (a secondary outcome of the study) at each visit within group (cf. baseline) and between groups (TU vs P) at each assessment (6, 18 and 30 weeks) were compared using Wilcoxon signed‐rank and Wilcoxon rank sum tests respectively. Results Significant improvement in erectile function was evident only in the Severe HG group following TU after 30 weeks, this finding also present when TU was compared to P. Intercourse satisfaction and sexual desire scores were also improved in the Severe HG group following TU at 6, 18 and 30 weeks, this increase in scores also evident when compared to P. TU did not appear to significantly alter orgasmic function in any of the patient groups. Conclusions Our study suggests that benefit in sexual symptoms following TU was evident principally in patients with HG with TT ≤8nmol/l and FT ≤0.18nmol/l. We also suggest 30 weeks of treatment is necessary before evaluating improvement in erectile function. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-27T07:30:49.738261-05:
      DOI: 10.1111/bju.13516
  • Robot‐assisted Fallopian Tube Transection‐anastomosis using
           the New REVO‐I Robotic Surgical System: Feasibility in a Chronic
           Porcine study
    • Authors: Ali Abdel Raheem; Irela Soto Troya, Dae Keun Kim, Se hoon Kim, Park Dong Won, Park Sung Joon, Gim Soo Hyun, Koon Ho Rha
      Abstract: Objectives Fallopian tube anastomosis is used for basic robotic training (Intuitive Surgical) because it emphasizes the unique advantages of a robotic surgical system (fine motor movements required for intracorporeal suturing, 3D vision, motion scaling, and tremor control). Furthermore, fallopian tube anastomosis resembles robotic radical prostatectomy in regards to port placement, pelvic area approach, and urethrovesical anastomosis. The aim of our study was to evaluate the feasibility and safety of the new REVO‐I robotic platform by performing fallopian tube transection‐anastomosis in live porcine models. Material and Methods A prospective chronic animal study was carried out in four Crossbred female pigs. The primary outcome was assessment of the pigs’ 2‐week survival. The secondary outcomes were measurements of intraoperative parameters and the complications or difficulties when using the REVO‐I. Results Fallopian tube anastomosis was successfully performed in 4 porcine models. The mean operative time was 66 min (range: 46‐104 min), the mean docking time was 22.25 min (range: 14–53 min), and the mean console time was 18 min (range: 13–20 min). The REVO‐I robotic system functioned appropriately, with no technical problems or difficulties noted during the procedures. Both the surgeon and the bed‐side assistants reported ease of use and better performance with subsequent procedures. All pigs were alive 2 weeks after surgery, with no perioperative complications related to the use of the robot. Conclusions The current pre‐clinical chronic animal study revealed that the REVO‐I robotic surgical system is a feasible and safe robotic instrument that can be used by surgeons to perform skillful robotic procedures in porcine models. Our next objective is to demonstrate its safety in humans. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-26T19:45:41.212882-05:
      DOI: 10.1111/bju.13517
  • Mirabegron causes relaxation of human and rat corpus cavernosum: could it
           be a potential therapy for erectile dysfunction'
    • Authors: Serap Gur; Taylor Peak, Faysal A. Yafi, Philip J. Kadowitz, Suresh C. Sikka, Wayne J.G. Hellstrom
      Abstract: Objective To examine the effects of mirabegron, a selective β3‐AR agonist that has recently been approved for the treatment of overactive bladder, in rat and human erectile tissues with a focus on elucidating the mechanism of such an action. Stimulation of β3‐adregenic receptors (ARs) localized in cavernosal smooth muscle cells may play a physiological role in mediating penile erection, and offer a beneficial pharmacologic action for the patient who has overactive bladder and erectile dysfunction (ED). Materials and Methods Corpus cavernosal (CC) specimens were obtained from patients with ED and Peyronie's disease undergoing penile prosthesis implantation. Erectile responses were also evaluated in vivo following intracavernosal injection (ICI) of mirabegron in anesthetized rats. Mirabegron‐elicited relaxation responses (10‐8‐10‐3 M) on phenylephrine (Phe)‐induced contraction were observed in human and rat CC strips in isolated organ bath studies. The effects of inhibitors namely L‐NAME [N(G)‐nitro‐L‐arginine methyl ester (a competitive inhibitor of NO synthase), 100μM), ODQ [1H‐(1,2,4) oxadiazolo(4,3‐α) quinoxalin‐1‐one (a nitric oxide‐sensitive guanylyl cyclase (GC) inhibitor, 30μM), methylene blue (a NOS and GC inhibitör, 20μM), SR59230A (β3‐AR blocker, 1 μM), and fasudil (Rho‐kinase (ROCK) inhibitor, 0.1 μM)] on mirabegron‐induced relaxation responses were evaluated. Responses to mirabegron were compared with responses to isoprenaline and nebivolol. Immunohistochemistry was used to localize β3‐AR and ROCK in CC smooth muscle cells. In vivo rat data were expressed as intracavernosal pressure (ICP)/mean arterial pressure and total ICP. Results Mirabegron resulted in a relaxation of Phe‐evoked CC contractions in a concentration‐dependent manner and SR59230A antagonized mirabegron‐induced relaxations in human and rat CC. Other inhibitors, L‐NAME, ODQ, and methylene blue, did not affect the mirabegron‐induced relaxation responses. Mirabegron relaxation responses at concentrations (between 0.1 and 10μM) were enhanced by fasudil (ROCK inhibitor) in rat but not in human CC strips. KCl‐induced contractions in human and rat CC were partially inhibited by mirabegron. In vivo ICI of mirabegron (doses of 0.1 – 1 mg/kg) had a minor effect on ICP when compared to vehicle administration. Immunohistochemistry data showed β3‐ARs localization into the smooth muscle cells of human and rat CC. Conclusions Mirabegron markedly relaxed isolated CC strips by activating β3‐ARs independently of the NO‐cGMP pathway. There is also evidence of the existence of a close functional link between β3‐ARs and the RhoA/ROCKpathway. These results may support further clinical studies using combinations of mirabegron with ROCK and phosphodiesterase‐5 inhibitors (PDE5i) for the treatment of ED, especially in patients who do not respond to PDE5i therapy. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-26T19:45:36.786185-05:
      DOI: 10.1111/bju.13515
  • Trends in urological stone disease: a 5‐year update of Hospital
           Episode statistics
    • Authors: Hendrik Heers; Benjamin W. Turney
      Abstract: Objective To provide a 5‐year follow‐on update on the changes in prevalence and treatment of upper urinary tract stone disease in the UK. Methods Data from the Hospital Episode Statistics (HES) website (w w w hesonline . nhs . uk ) were extracted, summarized, analysed and presented. Results The total number of upper urinary tract stone hospital episodes increased slightly from 83,050 in 2009‐10 to 86,742 in 2014‐15 (4.4% increase). The use of shock wave lithotripsy (SWL) for treating all upper tract 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 2009‐10 to 18,055 in 2014‐15. Increase in ureterorenoscopy (flexible ureteroscopy) demonstrated the most rapid increase from 3267 to 6631 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 2014‐15. 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. Conclusion This study provides an update on the changing landscape of the management of urinary tract stones in the UK. It demonstrates a sustained high prevalence of stone disease in the UK 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 the UK. These data have important implications for work‐force planning, training, service delivery and research in the field of urolithiasis. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-26T02:20:38.603941-05:
      DOI: 10.1111/bju.13520
  • Outcomes of high complex renal tumor (PADUA ≥ 10) following
           robot‐assisted partial nephrectomy with a median 46 months
           follow‐up: A tertiary center experience
    • Authors: Ali Abdel Raheem; Atalla Alatawi, Dae K. Kim, Abulhasan Sheikh, Ibrahim Alabdulaali, Woong K. Han, Young D. Choi, Koon H. Rha
      Abstract: Objectives To compare peri‐operative trifecta achievement and long‐term oncological and functional outcomes between low (6‐7), intermediate (8‐9) and high (≥10) PADUA complex renal tumors and to determine predictors for trifecta achievement. Material and Methods A retrospective analysis of data from 295 patients, who underwent RPN between 2006 to 2015 at high‐volume tertiary center was performed. Trifecta achievement was the main primary outcome measurement. The perioperative parameters and long‐term oncological and functional outcomes were the secondary outcome measurements. Groups were compared using Kruskal‐Wallis H test or chi‐square. Univariable and multivariable binary logistic regression analyses were performed to determine the most important determinant variables associated with trifecta accomplishment. The Kaplan‐Meier method was used to estimate for overall survival (OS), cancer‐specific survival (CSS) and cancer‐free survival (CFS). Results Out of 295 patients, 121 (41%) had PADUA score ≥10. Patients in high complex PADUA group had a larger tumor size, higher clinical stage ≥T1b, an increased risk of malignancy, longer warm ischemia time (WIT) and increased estimated blood loss (EBL) compared to intermediate and low complex groups (p=
      PubDate: 2016-05-26T02:20:33.22828-05:0
      DOI: 10.1111/bju.13501
  • Characterizing the Safety of Clomiphene Citrate in Male Patients through
           PSA, Hematocrit, and Testosterone levels
    • Authors: Jason C. Chandrapal; Spencer Nielson, Darshan P. Patel, Chong Zhang, Angela P. Presson, William O. Brant, Jeremy B. Myers, James M. Hotaling
      Abstract: As Pharmaceutical companies increase direct marketing of testosterone products, more men are being tested for low testosterone and initiating testosterone supplementation. (1) From 2001‐2011, androgen use among men 40 years or older increased over three fold from 0.81% in 2001 to 2.91% in 2011. (2) The leading treatment for men with hypogonadism is exogenous testosterone; however it is not without risks. Though testosterone supplementation improves sexual desire and libido, it also has a negative effect on fertility. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-25T21:45:42.384792-05:
      DOI: 10.1111/bju.13546
  • Early MAG‐3 diuretic renography results after pyeloplasty
    • Authors: Alice Faure; Kevin London, Grahame H.H. Smith
      Abstract: Objectives To describe the drainage and functional outcome following paediatric pyeloplasty, one week after stent removal (seven to nine weeks after pyeloplasty) using diuretic renography. Patients and Methods Between 2009 and 2014, we assessed the functional and drainage outcomes on mercaptoacetyltriglycine (MAG‐3) diuretic renograms from 66 children (69 kidneys) who underwent modified dismembered Anderson‐Hynes pyeloplasty for UPJ obstruction. Stents were left in place for 6 to 8 weeks and postoperative renal units were evaluated with MAG‐3 renogram one week after stent removal. Surgical success was defined by improvement of drainage (T/2 less than 20 min), stable or improved function on the postoperative MAG‐3 renogram and by decreased pyelocaliceal dilatation on US at one year. Results Of the 69 kidneys with preoperative median T/2 of 33.4 min (range 7.6‐200 min), 87% (60/69) had improved drainage curves with a median T/2 of 6.9 min (range 1.6‐19 min). Thirteen percent (9/69) had persistent impaired drainage with a median T/2 of 36 min (range 24‐108 min). One girl was found with a persistent obstructive pattern (T/2= 30 min) associated with a decreased SRF (from 42 to 33%) and a persistent hydronephrosis (at 28mm). Redo‐pyeloplasty was performed 2 months after the initial procedure (and 18 days after stent removal) and renal function recovered to 47%. All other 8 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% versus 48.5% after repair, p=ns). Of the 29% (20/69) that had preoperative impaired SRF, postoperative renal function improved in 75% (from 27.5 to 43%, p=0.0002), remained unchanged in 2% and one (0.2%) deteriorated. Median postoperative follow‐up was 18 months (range 12‐90 months). Discussion There is no agreement regarding the gold standard investigation to use following pyeloplasty for ureteroplevic junction (UPJ) obstruction. Improvement in hydronephrosis on ultrasound (US) is slow and often takes more than 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. Conclusion Most of renal units have 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. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-25T08:00:26.497543-05:
      DOI: 10.1111/bju.13512
  • Estimating the risks and benefits of Active Surveillance protocols for
           Prostate Cancer: A microsimulation study
    • Authors: Tiago M. de Carvalho; Eveline A.M. Heijnsdijk, Harry J. de Koning
      Abstract: Objective To estimate the increase in prostate cancer mortality (PCM) and the reduction in overtreatment resulting from different Active Surveillance (AS) protocols, compared to treating men immediately. Subjects and Methods We use a microsimulation model (MISCAN‐Prostate), with natural history based on ERSPC data. We estimate probabilities of referral to radical treatment while on AS, depending on disease stage, with data from John Hopkins AS cohort. We sample 10 million men representative of the US population and we project the effects of applying AS protocols differing by time between biopsies, compared to treating men immediately. Results AS with yearly follow‐up biopsies for low‐risk patients (≤ T2a‐stage and Gleason 6) increases the probability of PCM to 2.6% (1% increase) and reduces overtreatment from 2.5% to 2.1% (18.4% reduction). With biopsies every three years after the first year, PCM increases by 2.3% and overtreatment reduces from 2.5% to 1.9% (30.3% reduction). Including intermediate‐risk men (> T2a‐stage or Gleason 3+4) in AS increases PCM by 2.7% and reduces overtreatment from 2.5% to 2.0% (23.1% reduction). These results may not apply to African‐American men. Conclusions Offering AS for low‐risk patients is relatively safe. Increasing the biopsy interval from yearly to up to every 3 years after the first year, will significantly reduce overtreatment among low‐risk men, with limited PCM risk. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-25T00:54:12.656075-05:
      DOI: 10.1111/bju.13542
  • Performance of Robotic Simulated Skills Tasks is Positively Associated
           with Clinical Robotic Surgical Performance
    • Authors: Monty A. Aghazadeh; Miguel A. Mercado, Michael M. Pan, Brian J. Miles, Alvin C. Goh
      Abstract: Objective To compare user performance of four Fundamental Inanimate Robotic Skills Tasks (FIRST) as well as eight da Vinci Skills Simulator (dVSS) virtual reality tasks to intraoperative performance (concurrent validity) during robotic prostatectomy (RP). Our group has previously demonstrated face, content, and construct validity of these simulated robotic skills tasks. As there is no data in the robotic environment showing a significant relationship between simulation and clinical performance, we aim to show that a positive correlation exists between simulation and intraoperative performance. Materials and Methods Twenty‐one urologic surgeons of varying robotic experience were enrolled. Demographics were captured using a standardized questionnaire. User performance was assessed concurrently in simulated (FIRST exercises and dVSS tasks) and clinical environments (endopelvic dissection during RP). Intraoperative robotic clinical performance was scored using the previously validated 6‐metric Global Evaluative Assessment of Robotic Skills (GEARS) tool. Relationship between simulator and clinical performance was evaluated using Spearman's rank correlation. Results Performance was assessed in 17 trainees and 4 expert robotic surgeons with a median (range) number of previous robotic cases (as primary surgeon) of 0 (0‐55) and 117 (58‐600), respectively (p=0.001). Collectively, the overall FIRST (ρ=0.833, p
      PubDate: 2016-05-24T10:10:26.836047-05:
      DOI: 10.1111/bju.13511
  • 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
      Abstract: Objective To investigate the clinical and pathological trends over a ten‐year period for robotic‐assisted laparoscopic prostatectomy (RALP) in a UK regional tertiary referral centre. Patients and Methods 1500 consecutive patients underwent RALP between October 2005 and January 2015. Prospective data was collected on clinic‐pathological details at presentation as well as surgical outcomes and compared over time. Results The median(range) age of patients throughout the period was 62(35‐78) years. The proportion of pre‐operative high‐grade cases (Gleason sum 8‐10) rose from 4.6% in 2005‐2008 to 18.2% in 2013‐2015 (p
      PubDate: 2016-05-24T07:10:23.116148-05:
      DOI: 10.1111/bju.13513
  • Toxicity and efficacy of salvage 11C‐Choline PET/CT‐guided
    • Authors: Andrei Fodor; Genoveffa Berardi, Claudio Fiorino, Maria Picchio, Elena Busnardo, Margarita Kirienko, Elena Incerti, Italo Dell'Oca, Cesare Cozzarini, Paola Mangili, Marcella Pasetti, Riccardo Calandrino, Luigi Gianolli, Nadia G Di Muzio
      Abstract: Objective To report the 3‐year toxicity and outcome results of 11C‐Choline positron emission tomography/computed tomography (11C‐Ch‐PET/CT)‐guided radiotherapy, delivered with helical tomotherapy (Tomotherapy® Hi‐Art II® Treatment System, Accuray Incorporated, USA) (HTT) of lymph‐nodal (LN) relapses in prostate cancer patients. Patients and methods From 01/2005 to 03/2013, 81 patients with biochemical recurrence – after surgery±adjuvant/salvage radiotherapy (RT) or radical RT and with evidence of LN 11C‐Ch‐PET/CT pathological uptake underwent HTT (median PSA: 2.59(0.61‐187) ng/ml). 72/81 patients were treated on pelvic and/or lumbar‐aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost (SIB) to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C‐Ch‐PET/CT. Nine patients were treated without SIB(50‐65.5 Gy, 25‐30 fr). Results With a median follow‐up of 36 (9‐116) months, 91.4% of the patients presented a PSA reduction 3 months after HTT. The 3 year overall, local‐relapse‐free and clinical‐relapse‐free survival were 80.0%, 89.8% and 61.8%, respectively. The 3‐year actuarial incidences of ≥G2 rectal and ≥G2 GU toxicity were 6.6% (± 2.9%) and 26.3% (±5.5%) respectively. A PSA nadir ≥0.26 ng/ml (HR:3.6; 95%CI 1.7‐7.7, p=0.001), extra‐pelvic 11C‐Ch‐PET/CT positive LN location (HR:2.4; 95%CI 0.9‐6.4, p=0.07), RT previous to HTT (HR:2.7; 95% CI 1.07‐6.9, p=0.04) and number of positive LN (HR:1.13; 95%CI 1.04‐1.22, p=0.003) were the main predictors of clinical relapse after HTT . Conclusions 11C‐Ch‐PET/CT‐guided HTT is safe and effective in the treatment of LN relapses of previously treated prostate cancer patients. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-24T02:40:35.961914-05:
      DOI: 10.1111/bju.13510
  • High PCA3 scores are associated to elevated Prostate Imaging Reporting and
           Data System (PI‐RADS) grade and biopsy Gleason Score, at MRI/US
           fusion software‐based targeted prostate biopsy after a previous
           negative standard biopsy
    • Authors: Stefano De Luca; Roberto Passera, Giovanni Cattaneo, Matteo Manfredi, Fabrizio Mele, Cristian Fiori, Enrico Bollito, Stefano Cirillo, Francesco Porpiglia
      Abstract: Objective to determine the association among PCA3 score, Prostate Imaging Reporting and Data System (PI‐RADS) and Gleason Score (GS), in a cohort of patients with elevated PSA, undergoing MRI/US fusion software‐based targeted prostate biopsy (TBx) after a previous negative randomized “standard” biopsy (SBx) Patients and Methods 282 patients, undergone to TBx after previous negative SBx and PCA3 urine assay, were enrolled. The associations PCA3 score/PI‐RADS and PCA3 score/GS were investigated by K‐means clustering, ROC analysis and binary logistic regression model Results PCA3 score difference for negative versus positive TBx cohorts was highly statistically significant. One unit of increase in PCA3 score was associated to a 2.4% increased risk to have a positive TBx result. PCA3 score>80 and PI‐RADS≥4 were independent predictors for a positive TBx. The association between PCA3 score and PI‐RADS was statistically significant (PCA3 score median value for PI‐RADS groups 3‐4‐5 was 58‐104‐146, respectively; p=0.006). A similar pattern was detected for the relationship between PCA3 score and GS; an increasing PCA3 score was associated to a worse GS (median PCA3 score equal to 62‐105‐132‐153‐203‐322 for GS 3+4, 4+3, 4+4, 4+5, 5+4, 5+5, respectively; p
      PubDate: 2016-05-24T02:40:30.047294-05:
      DOI: 10.1111/bju.13504
  • Comparison of prostate cancer survival in Germany and the United States:
           Can differences be attributed to differences in stage distributions'
    • Authors: Alexander Winter; Eunice Sirri, Lina Jansen, Friedhelm Wawroschek, Joachim Kieschke, Felipe A. Castro, Agne Krilaviciute, Bernd Holleczek, Katharina Emrich, Annika Waldmann, Hermann Brenner,
      Abstract: Objectives To better understand influence of prostate‐specific antigen (PSA) screening and other health system determinants on prognosis of prostate cancer (PCa), up‐to‐date relative survival (RS), stage distributions, and trends in survival and incidence in Germany were evaluated and compared with the United States (US). Patients and Methods Incidence and mortality rates for Germany and the US for the period 1999 to 2010 were obtained from the Center for Cancer Registry Data at the Robert Koch Institute and the US Surveillance Epidemiology and End Results (SEER) database. For analyses on stage and survival, data from 12 population‐based cancer registries in Germany and from the SEER‐13 database were analyzed. Patients (≥15 years) diagnosed with PCa (1997‐2010), with mortality follow‐up to December 2010 were included. 5‐ and 10‐year RS and survival trends (2002‐2010) were calculated using standard and model‐based period analysis. Results Between 1999 and 2010, PCa incidence decreased in the US but increased in Germany. Nevertheless incidence remained higher in the US throughout the study period (99.8 vs. 76.0 per 100,000 in 2010). The proportion of localized disease significantly increased from 51.9% (1998‐2000) to 69.6% (2007‐2010) in Germany and from 80.5% (1998‐2000) to 82.6% (2007‐2010) in the US. Mortality slightly decreased in both countries (1999‐2010). Overall, 5‐ and 10‐year RS was lower in Germany (93.3%; 90.7%) than in the US (99.4%; 99.6%) but comparable after adjustment for stage. The same patterns were observed in age‐specific analyses. Improvements observed in PCa survival between 2002‐2004 and 2008‐2010 (5‐year RS: 87.4; 91.2; +3.8% units) disappeared after adjustment for stage (p=0.8). Conclusion The survival increase in Germany and the survival advantage in the US might be explained by differences in incidence and stage distributions over time and across countries. Effects of early detection or a lead time bias due to the more widespread utilization and earlier introduction of PSA testing in the US are likely to explain the observed patterns. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-21T09:25:47.721342-05:
      DOI: 10.1111/bju.13537
  • Analysis of the sperm functional aspects and seminal plasma proteomic
           profile from male smokers
    • Authors: M. P. Antoniassi; P. Intasqui Lopes, M. Camargo, D. S. Zylbersztejn, V. M. Carvalho, K. H. M. Cardozo, R. P. Bertolla
      Abstract: Objective To evaluate the effect of smoking on sperm functional quality and seminal plasma proteomic profile. Patients And Methods Sperm functional tests were performed in 20 nonsmoking men with normal semen quality, according to the World Health Organization (2010) and in 20 smoking patients: evaluation of DNA fragmentation by alkaline Comet assay; analysis of mitochondrial activity using DAB staining; and acrosomal integrity evaluation by PNA binding. Remaining semen was centrifuged and seminal plasma was utilized for proteomic analysis (LC‐MS/MS). The quantified proteins were used in Cytoscape 3.2.1 software for Venn diagrams construction, using the PINA4MS plugin. Then, differentially expressed proteins were also used for functional enrichment analysis of Gene Ontology categories, Kyoto Encyclopedia of Genes and Genomes and Reactome, using the Cytoscape software and the ClueGO 2.2.0 plugin. Results Smokers presented higher percentage of sperm DNA damage (Comet classes III and IV, p
      PubDate: 2016-05-21T09:20:29.809823-05:
      DOI: 10.1111/bju.13539
  • A retrospective analysis of laparoscopic partial nephrectomy with
           segmental renal artery clamping and parameters that estimate postoperative
           renal function
    • Authors: Pu Li; Chao Qin, Qiang Cao, Jie Li, Qiang Lv, Xiaoxin Meng, Xiaobing Ju, Lijun Tang, Pengfei Shao
      Abstract: Objective To evaluate the feasibility and efficiency of laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping, and to analyze the factors affecting postoperative renal function. Patients And Methods A retrospective analysis of 466 consecutive patients undergoing LPN using main renal artery clamping (Group A, n = 152) or segmental artery clamping (Group B, n = 314) from September 2007 to July 2015 in our department. Blood loss, operative time, warm ischemia (WI) time, and renal function were compared between groups. Univariable and multivariable linear regression analyses were applied to assess correlations of selected variables with postoperative glomerular filtration rate (GFR) reduction. Volumetric data and estimated glomerular filtration rate (eGFR) of a subset of 60 patients in Group B were compared with GFR to evaluate the correlation between these functional parameters in predicting preserved renal function after LPN. Results The novel technique slightly increased operative time, WI time and intraoperative blood loss (P < 0.001), while it provided better postoperative renal function (P < 0.001) compared with conventional technique. The blocking method and tumor characteristics were independent factors affecting GFR reduction, while WI time was not independent factors. Correlation analysis showed that eGFR presented better correlation with GFR compared with kidney volume (R2 = 0.794 cf. R2 = 0.199) in predicting renal function after PN.. Conclusions LPN with segmental artery clamping minimizes WI injury and provides for better early postoperative renal function compared with clamping the main renal artery. Kidney volume has a significantly inferior role compared with eGFR in predicting preserved renal function. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-21T01:40:42.058569-05:
      DOI: 10.1111/bju.13541
  • Prospective Evaluation of 68Gallium‐PSMA Positron Emission
           Tomography/Computerized Tomography for Preoperative Lymph Node Staging in
           Prostate Cancer
    • Authors: Pim J. van Leeuwen; Louise Emmett, Bao Ho, Warick Delprado, Francis Ting, Quoc Nguyen, Phillip Stricker
      Abstract: Objectives Conventional imaging techniques are inadequate for lymph node staging in prostate cancer (PC). This study aims to assess the accuracy of 68Ga‐PSMA positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging in intermediate and high‐risk PC. Materials and Methods From April to October 2015, 30 patients with intermediate (n=3) or high‐risk (n=27) PC were prospectively enrolled. Patients underwent preoperative 68Ga‐PSMA PET/CT. Both visual and semi quantitative analysis was undertaken. Subsequently, all patients underwent a radical prostatectomy with an extended pelvic lymph node dissection (eLND). Sensitivity, specificity, positive and negative predictive value (PPV and NPV) for LN status of 68Ga‐PSMA were calculated using histopathology as reference. Results Eleven patients (37%) had lymph node metastases (LNMs), 26 LNMs were identified in the 11 patients. On a patient analysis, 68Ga‐PSMA PET/CT has a sensitivity of 64% for the detection of LNMs, specificity was 95%, PPV was 88%, and NPV was 82%. In total, 180 LN fields were analyzed. For the LN‐region‐based analysis, the sensitivity of 68Ga‐PSMA PET/CT for detection of LNMs was 56%, specificity was 98%, PPV was 90% and NPV was 94%. Mean size of missed LNMs was 2.7mm. Receiver operating characteristic (ROC) analysis demonstrated high accuracy of SUV max for the detection of LNMs, AUC 0.915 (95%CI 0.847‐0.983); optimum SUV max was 2.0. Conclusions In patients with intermediate to high‐risk PC, 68Ga‐PSMA PET/CT has a high specificity and a moderate sensitivity for LNM detection. 68Ga‐PSMA PET/CT has the potential to replace current imaging for LN staging of patients with PC scheduled for radical prostatectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-21T01:35:28.35308-05:0
      DOI: 10.1111/bju.13540
  • Correlation between stage shift and differences in mortality in the
           European Randomized 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
      Abstract: A 21% prostate cancer (PCa) mortality reduction was observed in the European Randomized Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow‐up. A direct correlation between stage shift and changes in PCa‐mortality would support earlier detection through screening as the main reason for this reduction. In this study we empirically estimate how changes in the risk of being diagnosed with (advanced) PCa are related to the changes in PCa death in the ERSPC using a meta‐regression approach. In total 81% and 89% of the changes in PCa mortality could be explained by changes in PCa incidence. Although this analysis cannot show direct causal relations, results support the hypothesis that PSA screening reduced PCa mortality by detecting cancer at an earlier stage while still curable. These findings do however not open the way to unrestricted PSA based screening for PCa. A balance between harm and benefit needs to be found. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-20T22:05:28.058554-05:
      DOI: 10.1111/bju.13505
  • Detecting Positive Surgical Margins: Utilization of Light Reflectance
           Spectroscopy on ex vivo Prostate Specimens
    • Authors: Aaron H. Lay; Xinlong Wang, Monica S. C. Morgan, Payal Kapur, Hanli Liu, Claus G. Roehrborn, Jeffrey A. Cadeddu
      Abstract: Objective To assess the efficacy of Light reflectance spectroscopy (LRS) to detect positive surgical margins (PSM) on ex vivo radical prostatectomy specimens. Materials and Methods A prospective evaluation of ex vivo prostate specimens using LRS was performed at a single institution from June 2013 to September 2014. LRS measurements were performed on selected sites on prostate capsule, marked with ink, and correlated with pathologic analysis. Significant features on LRS curves differentiating malignant tissue from benign tissue were determined using a forward sequential selection algorithm. A logistic regression model was built and randomized cross‐validation was performed. The sensitivity, specificity, accuracy, NPV, PPV, and area under the receiver operating characteristic curve (AUC) for LRS predicting PSM were calculated. Results Fifty prostate specimens were evaluated using LRS. LRS sensitivity for Gleason ≥7 PSM was 91.3%, specificity 92.8%, accuracy 92.5%, PPV 73.2%, NPV 99.4%, and AUC = 0.960. LRS sensitivity for Gleason ≥6 PSM was 65.5%, specificity 88.1%, accuracy 83.3%, PPV 66.2%, NPV 90.7%, and AUC = 0.858. Conclusions LRS can reliably detect positive surgical margins for Gleason 7 or above prostate cancer in ex vivo radical prostate specimens This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-20T04:01:54.465028-05:
      DOI: 10.1111/bju.13503
  • Attitudes and Knowledge of Urethral Catheters: A Targeted Educational
    • Authors: Andrew Cohen; Charles Nottingham, Vignesh Packiam, Nora Jaskowiak, Mohan Gundeti
      Abstract: Objectives To assess the training of medical students and their confidence in urethral catheter placement, given growing evidence of unnecessary urology consults and iatrogenic injury. Methods A third‐year medical school class was queried regarding their attitudes and knowledge of catheter placement prior to and after the Clinical Biennium. The Clinical Biennium introduces hands on skills prior to clinical clerkships. Urethral catheterization is one of the skill stations that students rotate through, and urology residents provide a didactic session and supervised simulation. Confidence was self‐rated regarding catheter technique, knowledge, troubleshooting, and comfort with placement in same and opposite gender. Factual questions were posed regarding proper insertion and malfunctioning catheters. Results Ninety‐two students participated in the initial survey, 41% female and 59% male. 87% of students had never placed a catheter. Students desired high confidence in catheter skills (4.4/5). There were no significant differences in responses for those with desire to pursue urology vs. other specialties, or procedural fields compared to non‐procedural fields. Prior independent learning was reported by 38% of students and was a predictor for increased confidence across all domains (p
      PubDate: 2016-05-18T02:41:01.612208-05:
      DOI: 10.1111/bju.13506
  • Robotic assisted technique for boari flap ureteral reimplantation
           (RA‐BFUR): replicating the techniques of open surgery in robotics
    • Abstract: The video describes our approach of a Robotic assisted Boari Flap Ureteral Reimplantation (RA‐BFUR). The technique is based on the open surgical technique of Übelhör. The experience includes 11 cases with excellent results after a mean follow‐up period of more than 12 months. RA‐BFUR could be considered as a safe and effective method of ureteral reimplantation of long distal ureteral strictures. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-17T01:35:36.566988-05:
      DOI: 10.1111/bju.13502
  • Results of a randomized, double‐blind, active‐controlled
           clinical trial with propiverine ER 30 mg in patients with overactive
    • Authors: Jing Leng; Limin Liao, Ben Wan, Chuanjun Du, Wei Li, Keji Xie, Zhoujun Shen, Zhuoqun Xu, Shiliang Wu, Zujun Fang, Lulin Ma, Shaomei Han, Cornelia Feustel, Yong Yang, Helmut Madersbacher
      Abstract: Objective To compare the efficacy and safety of the 30 mg extended release (ER) formulation of propiverine hydrochloride with the 4 mg extended release formulation of tolterodine tartrate in patients with overactive bladder in a non‐inferiority trial. Patients and methods Eligible patients aged between 18 and 75 years with symptoms of OAB were enrolled in this multicentre, randomized, double‐blind, parallel‐group, active‐controlled study. After a 2‐week screening period patients were randomized at a 1:1 ratio to receive either propiverine ER 30 mg or tolterodine ER 4 mg daily during the 8‐weeks treatment period. The efficacy was assessed using a 3‐days voiding diary and patient's self‐reported assessment of treatment effect. Safety assessment included recording of adverse events, laboratory test results, measurement of post void residual urine, and electrocardiograms. Results A total of 324 patients (244 female, 80 male) were allocated into the study. Both active treatments improved the variables of the voiding diary and patient's self‐reported assessment. The change from baseline in the number of voidings per 24 h was significantly greater in the propiverine ER 30 mg group compared to the tolterodine ER 4 mg group after 8 weeks of treatment (FAS; ‐4.6±4.1 vs. ‐3.8±5.1, p=0.005). Significant improvements were also observed for the change of urgency incontinence episodes after 2 weeks (p=0.026) and 8 weeks (p=0.028) of treatment when comparing propiverine ER 30 mg with tolterodine ER 4 mg. Both treatments were well tolerated with a comparable frequency of adverse drug reactions between propiverine ER 30 mg and tolterodine ER 4 mg (FAS; 40.7% vs. 39.5%, p=0.8). More patients treated with tolterodine ER 4 mg discontinued the treatment due to adverse drug reactions compared to propiverine ER 30 mg (7.4% vs. 3.1%). Conclusions Propiverine ER 30 mg was confirmed to be an effective and well‐tolerated treatment option for patients suffering from overactive bladder symptoms. This first head‐to‐head study demonstrated non‐inferiority of propiverine ER 30 mg compared to tolterodine ER 4 mg. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-13T03:45:45.284904-05:
      DOI: 10.1111/bju.13500
  • Symptomatic and quality of life outcomes following treatment for
           clinically localized prostate cancer: a systematic review
    • Abstract: Objectives To conduct a systematic review of the risks of short‐term outcomes following major treatments for clinically localized prostate cancer. Materials and methods MEDLINE, EMBASE and the Cochrane Library from 2004 to January 2013. Study arms that included at least 100 men with localized prostate cancer in receipt of surgery, radiotherapy or active surveillance and reported symptomatic and quality of life (QoL) data from 6 months to five years after treatment were eligible. Data were extracted by one reviewer and checked by another. Results 64 studies (80 treatment cohorts) were included. Most were single treatment cohorts from the US or Europe. Prostatectomy was the most common treatment (39 cohorts), followed by radiotherapy (external beam and brachytherapy; 31 cohorts), with only one active surveillance cohort. Most frequently measured symptoms were urinary, followed by sexual and bowel; QoL was assessed in only 17 cohorts. Most studies used validated measures, although poor data reporting and differences between studies meant that it was not possible to pool data. Conclusion Data on the precise impact of short‐term symptomatic and QoL outcomes following treatment for localized prostate cancer is of insufficient quality for clear guidance to men about the risks to these aspects of their lives. It is important that future studies focus on collecting core outcomes through validated measures and comply with reporting guidelines so that clear and accurate information can be derived for men considering screening or treatment for prostate cancer. This article is protected by copyright. All rights reserved.
      PubDate: 2016-05-13T03:20:44.8947-05:00
      DOI: 10.1111/bju.13499
  • Patient‐physician‐communication and health related quality of
           life of localized prostate cancer patients undergoing radical
           prostatectomy – a longitudinal multilevel analysis
    • Authors: Nicole Ernstmann; Lothar Weissbach, Jan Herden, Nicola Winter, Lena Ansmann
      Abstract: Objectives To examine whether patient‐physician‐communication is associated with health related quality of life (HRQoL) in a sample of localized prostate cancer patients after radical prostatectomy. Patients and methods HAROW is a prospective, observational study designed to collect data of the different treatment options (Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) for newly diagnosed patients with localized prostate cancer under real life conditions. At 6‐months intervals, clinical data (D'Amico risk categories, Charlson comorbidity index) aspects of patient‐provider‐communication (standardized psychosocial care‐instrument for patients’ assessment of communication; Cologne Patient Questionnaire), and HRQoL (EORTC QLQ‐C30) were assessed. Data were analyzed by longitudinal multilevel analysis. Results Completed questionnaires for N=1.772 patients undergoing a prostatectomy were analyzed for a 3 year follow‐up period. Patients rate the patient‐provider communication generally high with slight variations over the course of treatment (3.2‐3.8). The HRQoL of the patients shows substantial variation over time and between the reported subscales (Global Qol 71,1‐77,2; physical functioning 89,1‐92,1; role functioning 81,0‐88,1; emotional functioning 74,4‐84,0; cognitive functioning 84,3‐87,7; social functioning 77,7‐84,0). The longitudinal multilevel models showed significant associations between the patient‐provider communication in terms of devotion, support and co‐therapy and functional aspects of HRQoL. Conclusion Patient‐provider communication is a valuable resource to support prostate cancer patients’ coping with the disease and to improve their HRQoL. Future interventions should be designed especially for urologists to enhance their awareness for the importance of communication and the relationship to their prostate cancer patients for treatment outcomes. This article is protected by copyright. All rights reserved.
      PubDate: 2016-04-22T09:31:01.423661-05:
      DOI: 10.1111/bju.13495
  • Chromogranin A and neuron‐specific enolase serum levels as
           predictors of treatment outcome in metastatic castration‐resistant
           prostate cancer patients under abiraterone therapy
    • Abstract: Objective To determine the impact of elevated neuroendocrine serum markers on treatment outcome in patients with metastatic castration‐resistant prostate cancer (mCRPC) undergoing treatment with abiraterone in a post‐chemotherapy setting. Patients and Methods Chromogranin A (CGa) and neuron‐specific enolase (NSE) were determined in serum drawn before treatment with abiraterone of 45 mCRPC patients. Outcome measures were overall survival (OS), prostate‐specific antigen (PSA) response defined by PSA decline ≥50%, PSA progression‐free survival (PSA‐PFS) and clinical or radiographic PFS. Results CGa and NSE serum levels did not correlate (p=0.6). Patients were stratified in a low (n=9), intermediate (n=18) or high (n=18) risk group according to elevation of none, one or both neuroendocrine markers. Risk groups correlated with decreasing median OS (median OS not reached vs. 15.3 vs. 6.6 months; p
      PubDate: 2016-03-31T09:45:47.016166-05:
      DOI: 10.1111/bju.13493
  • Interpretation of conventional survival analysis and competing risk
           analysis: An example of hypertension and prostate cancer
    • Abstract: Most clinical studies use conventional methods for survival analysis and calculate the risk of the event of interest, however, it is important to understand that the study population is also at risk of competing events, for example death from other causes. Moreover, the risk of competing events may be dependent on the participants’ characteristics. Whether competing risks are taken into account or not, is of major importance when interpreting study results.Here, we use a practical example to elucidate the interpretational differences of absolute risk estimates obtained with both conventional methods for survival analysis and competing risk analysis. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-31T09:45:31.154284-05:
      DOI: 10.1111/bju.13494
  • Guidelines of Guidelines: Thromboprophylaxis for Urologic Surgery
    • Authors: Philippe D. Violette; Rufus Cartwright, Matthias Briel, Kari A.O. Tikkinen, Gordon H. Guyatt
      Abstract: The risks and benefits of thromboprophylaxis for urologic surgery depend on both patient specific and procedure specific factors [1,2]. Clinicians and patients must trade off a reduction in venous thromboembolism (VTE) against a potential increase in bleeding. Although investigators have not addressed the issue specifically for urological procedures, high quality evidence from randomized trials has demonstrated that pharmacological prophylaxis, with for example low molecular weight heparins (LMWH), decreases the risk of VTE in patients having abdominal or pelvic surgery by approximately 50% [1]. Best estimates for LMWH also suggest, however, an increase in the risk of post‐operative major bleeding by approximately 50% [1]. Although these relative risks are likely to be somewhat consistent across patients and procedures, the balance of benefits and harms varies with the absolute risk of VTE and bleeding. In patients with a high risk of VTE and a low risk of major bleeding, a 50% reduction in VTE represents a substantial benefit (for instance, from a baseline risk of 12% to 6%) and a 50% increase in bleeding represents a minimal increase in harm (for instance, from 0.2% to 0.3%). Patients whose risk of VTE without anticoagulation is low and whose bleeding risk is high face an opposite situation. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-31T09:31:56.923376-05:
      DOI: 10.1111/bju.13496
  • Change in Platelet Count as a Prognostic Indicator for Response to Primary
           Tyrosine Kinase Inhibitor Therapy in Metastatic Renal Cell Carcinoma
    • Authors: Zachary Hamilton; Hak J. Lee, Juan Himenez, Brian R. Lane, Song Wang, Alp T. Beksac, Kyle Gillis, Amy Alagh, Conrad Tobert, J. Michael Randall, Christopher J. Kane, Frederick Millard, Steven C. Campbell, Ithaar H. Derweesh
      Abstract: Objective To evaluate change in platelet count (ΔPlt) as an indicator of response to primary tyrosine kinase inhibitor (TKI) therapy for metastatic renal cell carcinoma (mRCC). Patients and Methods Multi‐center retrospective analysis of mRCC patients undergoing primary TKI from 5/2005‐8/2014. ΔPlt was defined as post‐treatment platelet count after first cycle minus pre‐treatment platelet count. RECIST criteria were used to define partial response (PR), stable disease (SD), and progressive disease (PD). Analysis was conducted between subgroups with stable/increased (+ΔPlt) and decreased (‐ΔPlt) counts. Primary outcome was overall survival (OS) by Kaplan‐Meier analysis. Multivariable analysis (MVA) was conducted for risk factors associated with PD. Results 115 mRCC patients were analyzed, +ΔPlt 19 (16.6%) and –ΔPlt 96 (83%). More patients with +ΔPlt had Karnofsky score 2 metastases (78.9% vs. 51%, p=0.041). More patients with +ΔPlt had PD (89.4% vs. –ΔPlt 19.1%, p
      PubDate: 2016-03-24T05:00:31.954762-05:
      DOI: 10.1111/bju.13490
  • Role of oral PentosanPolysulphate in reduction of local side effects of
           BCG in Non muscle invasive Bladder Cancer patients: a pilot study
    • Authors: Suresh Yadav; Vinay Tomar, Sher Singh Yadav, Shivam Priyadarshi, Indraneel Banerjee
      Abstract: Objective Intravesical immunotherapy with Bacillus Calmette–Guerin (BCG) is indicated for the treatment of high grade Ta/T1 non‐muscle invasive bladder cancer (NMIBC); but it is associated with significant local side effects. Aim of the study was to assess the role of oral Pentosan Polysulphate (PPS) in reduction of BCG related local side‐effects. Methods 32 symptomatic patients after BCG instillation were randomized into three groups: A, B and C. Group A received placebo (vitamin B complex tablet) in t.i.d dose, Group B received PPS 100 mg t.i.d. dose and Group C received PPS 100mg o.d and placebo (vitamin B complex tablet b.i.d dose) for 6 weeks. Visual Analog Scale (VAS) for bladder pain, Overactive Bladder‐Validated 8 Question Screener (OAB‐V8) and dysuria were evaluated in three groups before and during each weekly visit of BCG instillation. Results Post treatment mean VAS score was significantly lower in Group B (4.4±1.2) and C (5.8±0.8) as compared to group A (8±0.4).Also, the post treatment VAS score was significantly lower in group B v/s group C(p
      PubDate: 2016-03-24T04:55:30.54586-05:0
      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 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
      Abstract: Objective To 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. Subjects/patients Between 1994 and 2013, 3,694 consecutive men were treated by radical prostatectomy 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 modeling, and discriminatory comparison analyses. Separate analyses were performed based on biopsy and prostatectomy grade. Results 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
      PubDate: 2016-03-24T04:25:30.657129-05:
      DOI: 10.1111/bju.13488
  • Steroid co‐introduction with docetaxel chemotherapy for metastatic
           castration‐resistant prostate cancer affects PSA flare
    • Abstract: Objective To investigate the potential relationship of steroid usage with prostate‐specific antigen (PSA) flare and the prognostic impact of PSA flare, which is known to occur in 10–20% of patients with metastatic castration‐resistant prostate cancer during docetaxel chemotherapy. Patients and Methods This study included 71 patients with metastatic castration‐resistant prostate cancer treated by docetaxel chemotherapy with co‐introduction of steroid. PSA flare was defined as transient PSA increase followed by PSA decrease. Results PSA flare was recognized in 7.0–23.9% of patients according to various definitions. Intriguingly, men with steroid intake before the initiation of docetaxel chemotherapy experienced significantly fewer PSA flares. The progression‐free survival rate in men with PSA flare was equivalent to that of PSA responders, but significantly better than men with PSA failure. Conclusions Our results suggest that de novo steroid co‐introduction with docetaxel chemotherapy induce the PSA flare phenomenon. This novel finding may account for the mechanism of PSA flare as well as being valuable for distinguishing PSA elevation as PSA flare or failure. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-17T22:35:58.589837-05:
      DOI: 10.1111/bju.13483
  • ATRIGEL® polymer‐delivered subcutaneous leuprolide acetate
           formulations achieve and maintain castrate levels of testosterone in four
           open label studies in advanced prostate cancer patients
    • Authors: Neal D. Shore; Franklin Chu, Judd Moul, Daniel Saltzstein, Raoul Concepcion, John A. McLane, Stuart Atkinson, Alex Yang, E. David Crawford
      Abstract: Objective To determine whether an LHRH agonist, ATRIGEL® polymer‐delivered, subcutaneous, leuprolide acetate (ADSC‐LA) formulations suppressed testosterone to levels ≤20 ng/dL. Subjects/Patients and Methods Data from four open‐label, fixed‐dose studies were evaluated. Male patients aged 40‐86 years with advanced prostatic adenocarcinoma, whom had not undergone prior ADT, were treated with a depot formulation of ADSC‐LA: 7.5 mg [1 month (1M); N=120], 22.5 mg [3 months (3M); N=117], 30 mg [4 months (4M); N=90], or 45 mg [6 months (6M); N=111]. Serum testosterone was sampled at screening, baseline, 2, 4, 8 hours post‐dosing, days 1, 2, 3, 7, and every week until the next dose, at which time, the sampling schedule repeated until the end of study (24 weeks for 1M and 3M, 32 weeks for 4M, and 48 weeks for the 6M dose). The primary analyses were mean serum testosterone levels and proportion of patients who achieved serum testosterone levels ≤20 ng/dL. Results Mean serum testosterone levels at the end of study were consistently ≤20 ng/dL in each study (6.1±0.4, 10.1±0.7, 12.4±0.8, 12.6±2.1 for the 1M, 3M, 4M, and 6M doses, respectively). A high proportion of patients (94%, 90%, 92%, 96% for 1M, 3M, 4M, and 6M doses, respectively) achieved testosterone levels ≤20 ng/dL within 6 weeks, and 90‐97% of patients in all studies maintained testosterone ≤20 ng/dL from weeks 6‐24. Conclusions Recent studies have demonstrated improved outcomes in prostate cancer patients who consistently attained a more rigorous level of testosterone suppression (≤20 ng/dL) with androgen deprivation therapy (ADT) than the historical standard (≤50 ng/dL). All doses of ADSC‐LA rapidly achieved and maintained mean serum testosterone to the more rigorous target level of T ≤20 ng/dL. These data suggest that ADSC‐LA delivers equivalent testosterone suppression as achieved by surgical castration. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-17T21:50:34.285074-05:
      DOI: 10.1111/bju.13482
  • Validation of the novel ISUP‐2014 5‐tier Gleason grade
           grouping: Biochemical recurrence rates of 3+5 disease may be overestimated
    • Authors: Roderick CN den Bergh; Theo H der Kwast, Jeroen Jong, Homayoun Zargar, Andrew J Ryan, Anthony J Costello, Declan G Murphy, Henk G der Poel
      Abstract: In 2014 the International Society of Urological Pathology (ISUP) supported to change the ISUP‐2005 modified Gleason scoring system, as previously proposed by Pierorazio et al.[1,2] Besides decisions on terminology and scoring of specific morphological patterns, a renumbering of the existing scores was suggested.[3] In clinical practice this comprises a transformation from a 6‐10 risk spectrum including 9 different Gleason scores (3+3=6, 3+4=7, 4+3=7, 3+5=8 4+4=8, 5+3=8, 4+5=9, 5+4=9, and 5+5=10) to a 1‐5 score with 5 grade groups (1: ≤3+3, 2: 3+4, 3: 4+3, 4: Gleason scores 8, and 5: Gleason score 9‐10). This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-12T09:27:05.035582-05:
      DOI: 10.1111/bju.13478
  • Assessment of energy density usage during 180W lithium triborate laser
           photo‐selective vaporization of the prostate for benign prostatic
           hyperplasia. Is there an optimal amount of kilo‐Joules per gram of
    • Abstract: Objectives The ideal amount of energy delivery during photo‐selective vaporization of the prostate (PVP) for optimal treatment of benign prostate hyperplasia (BPH) has not been established. The aim of this study is to assess the effect of energy density (kJ/cc) applied on adenoma during treatment on functional outcomes, PSA reduction and complications. Subjects/patients and methods After exclusions, a total of 440 patients that underwent Greenlight laser XPS 180W LBO PVP for the treatment of BPH were retrospectively reviewed. Data was collected from seven different international centers (Canada, the United States, the United Kingdom and France). Patients were stratified into four energy density groups (kJ/cc) according to intraoperative energy delivered and prostate volume as determined by pre‐operative trans‐rectal ultrasound (TRUS): group 1: 50%) at 6,12 and 24 months suggesting increased vaporization of adenoma tissue. However this did not translate into differences in functional outcomes at two years of follow‐up. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-11T07:26:36.838622-05:
      DOI: 10.1111/bju.13479
  • Increasing age is not associated with toxicity leading to discontinuation
           of treatment in urothelial non muscle invasive bladder cancer patients
           randomized to receive 3 years of maintenance bacillus
           Calmette‐Guérin: Results from EORTC GU Group study 30911
    • Authors: Jorg R. Oddens; Richard J. Sylvester, Maurizio A. Brausi, Wim J. Kirkels, Cees de Beek, George Andel, Theo M. de Reijke, Stephen Prescott, J. Alfred Witjes, Willem Oosterlinck
      Abstract: Objectives To determine the relationship of age to side effects leading to discontinuation of treatment in stage Ta‐T1 NMIBC patients treated with maintenance bacillus‐Calmette‐Guérin (BCG). Patients and Methods We evaluated toxicity for 487 eligible intermediate or high risk Ta‐T1 (without CIS) non‐muscle‐invasive bladder cancer (NMIBC) patients randomized to receive 3 years of maintenance BCG (247 BCG alone and 240 BCG+INH) in EORTC trial 30911. The percent of patients who stopped for toxicity and the number of treatment cycles that they received were compared in 4 age groups, < 60, 61 ‐ 70, 71 – 75 and > 75 years of age, using the Mantel‐Haenszel chi square test for trend. Results The percent of patients stopping BCG for toxicity was 17.9% in patients < 60, 21.9% in patients 61 – 70, 22.9% in patients 71 – 75, and 16.4% in patients > 75 years of age (p = 0.90). For both systemic and local side effects, there was likewise no significant difference. Conclusions In intermediate and high risk Ta T1 urothelial bladder cancer patients treated with BCG, no differences in toxicity as a reason for stopping treatment were observed based on age. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-06T06:48:35.963327-05:
      DOI: 10.1111/bju.13474
  • The association of eNOS G894T gene polymorphisms with responsiveness to
           α1‐blocker in men with BPH/LUTS
    • Abstract: Objective Nitric oxide (NO) has recently gained increasing recognition as an important neurotransmitter of functions in the lower urinary tract. This prospective study firstly investigated the association of eNOS G894T gene polymorphism with the responsiveness to α1‐blocker in men with benign prostatic hyperplasia related lower urinary tract symptoms (BPH/LUTS). Materials and Methods 136 patients with BPH/LUTS were recruited from urology outpatient clinics in a university hospital. Oral therapy with doxazosin‐ GITS 4 mg once‐daily was given for 12 weeks. The drug efficacy was assessed by the changes from baseline in the total International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and post‐void residual urine volume (PVR) at 12 weeks of treatment. The responders to doxazosin GITS were defined as those who had a total IPSS decrease of more than 4 points from baseline. The eNOS G894T polymorphisms were determined using the polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) method Results Patients had statistically significant improvements in total IPSS, QoL and Qmax (P
      PubDate: 2016-03-04T03:46:44.757585-05:
      DOI: 10.1111/bju.13468
  • The Final Robotic Frontier: Evolution and Current State of the
           Robotic‐Assisted Radical Cystectomy
    • Authors: Tony Tran; Nicholas Raison, Norbert Doeuk, Prokar Dasgupta
      Abstract: Radical cystectomy with pelvic lymphadenectomy and urinary diversion has long been the standard of care for the treatment of non‐metastatic muscle‐invasive urothelial carcinoma of the bladder. Historically the procedure was performed through an open technique. With the potential benefits of decreased blood loss, quicker return of bowel function, and shorter postoperative convalescence minimally invasive techniques began to be described in the 1990s. Menon et al performed the first robotic‐assisted radical cystectomy in 2003 and the first centres soon adopted the procedure (1). Yet surprisingly, unlike other robotic‐assisted procedures, the technique has not enjoyed a similarly meteoric rise. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-04T03:45:48.551536-05:
      DOI: 10.1111/bju.13471
  • Role of Survivin expression in predicting biochemical recurrence after
           radical prostatectomy: a multi‐institutional study
    • Abstract: Objective To assess the association of Survivin expression with clinicopathological features and biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi‐institutional cohort. Methods Survivin expression was evaluated by immunohistochemistry on a tissue microarray of RP cores from 3117 patients. Survivin expression was considered altered when at least 10% of the tumor cells stained positive. Association of altered Survivin expression with BCR was evaluated using Cox proportional hazards regression models. Results Survivin expression was altered in 1330 (42.6%) patients. Altered expression was associated with higher Gleason score on RP (p=0.001), extracapsular extension (p=0.019), seminal vesicle invasion (p
      PubDate: 2016-03-04T03:44:45.592206-05:
      DOI: 10.1111/bju.13472
  • Combination of PI‐RADS score and PSA density predicts biopsy outcome
           in biopsy naïve patients
    • Authors: Satoshi Washino; Tomohisa Okochi, Kimitoshi Saito, Tsuzumi Konishi, Masaru Hirai, Yutaka Kobayashi, Tomoaki Miyagawa
      Abstract: Objective To assess the value of the Prostate Imaging Reporting and Data System (PI‐RADS) scoring system, for prostate multi‐parametric magnetic resonance imaging (mpMRI) to detect prostate cancer, and classical parameters, such as prostate specific antigen (PSA), prostate volume and PSA density, for predicting biopsy outcome in biopsy naïve patients who have suspected prostate cancer (PCa). Patients and methods Patients who underwent mpMRI at our hospital, and who had their first prostate biopsy between July 2010 and April 2014, were analysed retrospectively. The prostate biopsies were performed transperineally under transrectal ultrasound guidance. Fourteen cores were biopsied as a systemic biopsy in all patients. Two cognitive fusion‐targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI‐RADS scoring system ver. 2.0 (PI‐RADS v2) was used to describe the MRI findings. Univariate and multivariate analyses were performed to determine significant predictors of PCa and clinically significant PCa. Results In total, 288 patients were analysed. Median patient age, PSA, prostate volume and PSA density were 69, 7.5 ng/mL, 28.7 cm3 and 0.26 ng/mL/cm3, respectively. The biopsy results were benign, clinically insignificant and clinically significant PCa in 129 (45%), 18 (6%) and 141 (49%) patients, respectively. The multivariate analysis revealed that PI‐RADS v2 score and PSA density were independent predictors for PCa and clinically significant PCa. When PI‐RADS v2 score and PSA density were combined, PI‐RADS v2 score > 4 and PSA density > 0.15, or PI‐RADS v2 score 3 and PSA density > 0.30, was associated with the highest clinically significant PCa detection rates (76–97%) on the first biopsy. Of the patients in this group with negative biopsy results, 22% were subsequently diagnosed as PCa. In contrast, PI‐RADS v2 score < 3 and PSA density < 0.15 yielded no clinically significant PCa and no additional detection of PCa on further biopsies. Conclusions A combination of PI‐RADS v2 score and PSA density can help in the decision‐making process before prostate biopsy and the follow‐up strategy in biopsy naïve patients. Patients with PI‐RADS v2 score < 3 and PSA density < 0.15 may avoid unnecessary biopsies. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-02T21:56:51.4284-05:00
      DOI: 10.1111/bju.13465
  • Impact of tumor size on prognosis of upper urinary tract urothelial
           carcinoma after radical nephroureterectomy: a multi‐institutional
           analysis of 795 cases
    • Authors: Shibing Yan; Liangren Liu, Qiang Wei, Hong Liao, Turun Song, Junhao Lei, Lu Yang, Zhengyong Yuan, Yonghao Jiang, Guangqing Fu, Yunxiang Li, Dehong Cao
      Abstract: Objective To evaluate the prognostic impact of tumor size on survival outcomes in upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Patients and Methods Data on 795 patients treated with RNU for UTUC from 7 centers were retrospectively analyzed with focus on tumor size. Clinicopathological features and relevent prognostic factors were compared between patients with tumor size ≤3.0cm and >3.0cm. The primary end points were cancer specific survival (CSS), disease recurrence‐free survival (DFS), and overall survival (OS). Results At a median follow‐up of 32 months, 313 (39.4%) patients died of UTUC, 321 (40.4%) developed cancer relapse, and 359 (45.1%) died of all causes. Tumor size >3.0cm was associated with unfavorablly clinicopathlogical features. On Kaplan–Meier analysis, tumor size was significantly correlated with worse CSS, DFS and OS(all p
      PubDate: 2016-03-02T21:41:20.566587-05:
      DOI: 10.1111/bju.13463
  • The safety of robot‐assisted cystectomy in patients with previous
           history of pelvic irradiation
    • Authors: Bashir Al Hussein Al Awamlh; Daniel P. Nguyen, Brandon Otto, Padraic O'Malley, Farehin Khan, Savanah Brooks, Douglas S. Scherr
      Abstract: Objective To determine the safety of robot‐assisted cystectomy in patients with an irradiated pelvis, by comparing perioperative complication outcomes after robot‐assisted cystectomy in patients with and without a history of pelvic irradiation. Patients and Methods A total of 252 consecutive patients underwent robot‐assisted cystectomy at a tertiary referral center from 2002 and 2013. Of all patients, 46 (18%) had a history of pelvic irradiation. ● Complications occurring within 30 days and 90 days of surgery were graded using the modified Clavien classification system and additionally categorized by organ system. ● Baseline variables and outcomes of irradiated and non‐irradiated patients were compared using descriptive statistics. Multivariable logistic regression models were generated to test the effect of previous pelvic irradiation on complications. Results The indications for robot‐assisted cystectomy in patents with a history of pelvic irradiation were: bladder cancer (n=30, 65%), prostate cancer (n=2, 4%), fistulas (n=5, 11%) and intractable symptoms from radiation cystitis (n=9, 20%). ● A total of 25 (54%) irradiated and 112 (54%) non‐irradiated patients had complications within 90 days (p>0.9), of which 11 (24%) and 43 (21%) had major complications (p=0.7). ● One (2%) patient with and two (1%) patients without a history of irradiation died from surgical complications (p=0.5). ● Infectious, bleeding and gastrointestinal complications were the most common events in both groups. ● In multivariable analyses, a history of pelvic irradiation was not associated with higher risk of complications. Conclusion Robot‐assisted cystectomy performed by an experienced surgeon is a reasonable option in selected patients with a history of pelvic irradiation, as complication rates do not significantly differ compared to non‐irradiated patients. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-02T21:41:08.622367-05:
      DOI: 10.1111/bju.13464
  • Complications and quality of life in elderly patients with high
           comorbidities who underwent cutaneous ureterostomy with single stoma or
           ileal conduit after radical cystectomy
    • Authors: Nicola Longo; Ciro Imbimbo, Ferdinando Fusco, Vincenzo Ficarra, Francesco Mangiapia, Giuseppe Di Lorenzo, Massimiliano Creta, Vittorio Imperatore, Vincenzo Mirone
      Abstract: Objectives To compare perioperative outcomes and quality of life (QoL) in a series of elderly patients with high co‐morbidity status who underwent single stoma cutaneous ureterostomy (CU) or ileal conduit (IC) after radical cystectomy (RC). Subjects and methods Clinical records of patients older than 75 years with an American Society of Anesthesiologists (ASA) score > 2 who underwent RC at a single institution between March 2009 and March 2014 were retrospectively analyzed. After RC, all patients included in the study received an IC urinary diversion or a CU with single stoma urinary diversion. Preoperative clinical characteristics as well as intra and post‐operative outcomes were evaluated and compared in the two groups. Moreover, the Bladder Cancer Index (BCI) was used to assess QoL. Results A total of 70 patients were included into the final comparative analyses. Of them, 35 underwent IC diversion and 35 CU with single stoma diversion. The two groups were comparable for age, gender, ASA score, type of indication and pathological features. Operative times (p
      PubDate: 2016-03-02T21:36:50.748375-05:
      DOI: 10.1111/bju.13462
  • Direct comparison of multiparametric MRI and final histopathology in
           patients with proven prostate cancer in MRI/Ultrasound‐fusion biopsy
    • Authors: Angelika Borkowetz; Ivan Platzek, Marieta Toma, Theresa Renner, Roman Herout, Martin Baunacke, Michael Laniado, Gustavo Baretton, Michael Froehner, Stefan Zastrow, Manfred Wirth
      Abstract: Objectives To compare multiparametric magnetic resonance imaging of the prostate (mpMRI) and histological findings of targeted MRI/ultrasound‐fusion biopsy (fusPBx) and systematic biopsy (sysPBx) to final histology of prostatectomy specimen (PrS). Patients and methods 105 patients with histopathologically proven prostate cancer (PCa) by combination of fusPbx and sysPBx and undergoing radical prostatectomy were investigated. All patients had been examined by mpMRI, applying the European Society of Urogenital Radiology criteria. Histological findings of PrS were compared to those of the biopsy. Whole mount PrS and MR‐images were compared directly by a uro‐pathologist and a uro‐radiologist in step‐section analysis. Results 105 patients with histopathologically proven PCa by combination of fusPBx and sysPBx (combPBx) were investigated. The detection rate of PCa was 90% (94/105) in fusPBx alone and 68% (72/105) in sysPBx alone (p=0.001). CombPBx detected 23 (22%) Gleason Score (GS) 6, 69 (66%) GS 7 and 13 (12%) GS ≥8 tumours. FusPBx alone detected 25 (26%) GS 6, 57 (61%) GS 7 and 12 (13%) GS ≥8 tumours. SysPBx alone detected 17 (24%) GS 6, 49 (68%) GS 7 and 6 (8%) GS ≥8 tumours. FusPBx alone would have missed 11 tumours (4% (4/105) (GS) 6; 6% (6/105) GS 7; 1% (1/105) GS ≥8), sysPBx alone would have missed 33 tumours (10% (10/105) GS 6; 20% (21/105) GS 7; 2% (2/105) GS ≥8). Concordance on GS between biopsy and PrS was 63% (n=65), 54% (n=56) and 75% (n=78) in fusPBx, in sysPBx and in the combination of both biopsy modalities (combPBx), respectively. Upgrading on GS between biopsy and PrS occurred in 33% (n=34), 44% (n=46) and 18% (n=19) in fusPBx, sysPBx and combPBx, respectively. Gamma correlation for detection of any cancer was 0.76 for combPBx, 0.68 for fusPBx alone and 0.23 for sysPBx alone. 84% (n=88) of index tumours could be identified by mpMRI; 86% (n=91) of index lesions in the mpMRI could be proven in PrS. Conclusions FusPBx of tumour suspicious lesions in mpMRI was associated with a higher detection rate of more aggressive PCa and a better tumour prediction in final histopathology than sysPBx alone. But combPBx has been shown the best concordance for the prediction of GS. Furthermore, the additional findings of sysPBx reflect the multifocality of PCa. Hence, the combination of both biopsy modalities would still present the best approach for the prediction of the final tumour grading in PCa. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-02T21:32:02.918525-05:
      DOI: 10.1111/bju.13461
  • The Accuracy of Prostate Biopsies for Predicting Gleason Score in Radical
           Prostatectomy Specimens. Nationwide trends 2000‐2012
    • Abstract: Objectives To investigate how well the Gleason score in diagnostic needle biopsies predicted the Gleason score in a subsequent radical prostatectomy (RP) specimen before and after the 2005 International Society of Urological Pathology (ISUP) revision of Gleason grading, and if the recently proposed ISUP grades 1‐5 (corresponding to Gleason score 6, 3+4, 4+3, 8, and 9‐10) better predict the RP grade. Patients and Methods All prostate cancers diagnosed in Sweden are reported to the National Prostate Cancer Register (NPCR). We analysed Gleason score and ISUP grades from the diagnostic biopsies and RP specimens from 15,598 men in the NPCR who were diagnosed between 2000 and 2012 with clinical stage T1‐2 M0/X prostate cancer on needle biopsy at age ≤ 70 years, had serum PSA of
      PubDate: 2016-02-25T06:58:05.674273-05:
      DOI: 10.1111/bju.13458
  • Factors predicting progression to castrate‐resistant prostate cancer
           in patients with advanced prostate cancer receiving long‐term
           androgen deprivation therapy
    • Abstract: Objectives To assess time to progression to castrate‐resistant prostate cancer (CRPC) and factors influencing longer‐term outcomes in patients receiving ADT in an extension to the Triptocare study (NCT01020448). This is pertinent as the Triptocare study did not show that urinary PCA3 score was a reliable marker of cancer stage in advanced prostate cancer and was not useful for assessing response 6 months after initiation of androgen deprivation therapy (ADT) with triptorelin 22.5 mg. Patients and methods An international, multicentre, non‐interventional, observational, longitudinal, prospective study involving patients from the Triptocare study. CRPC status of patients was collected for up to 3 years from ADT initiation. Patient treatment and assessments were at the investigator's discretion. Co‐primary endpoints were rate of CRPC 3 years after initiating ADT and median time to CRPC. An exploratory endpoint was association of Triptocare baseline variables (including TMPRSS2‐ERG score and PCA3 score) and PCA‐3 score at Triptocare last value available with CRPC onset. Results Of the 325 patients in the Triptocare study safety population, 180 patients were enrolled in the Triptocare LT study (102 received continuous and 78 received intermittent ADT). CRPC rates at 3 years were 24/102 (23.5%) and 6/78 (7.7%) patients in the continuous and intermittent ADT groups, respectively. Median time to CRPC was not reached for either group. PCA3 score status at baseline was the only variable associated with a higher risk of progression to CRPC in both the intermittent and continuous ADT groups; compared with a baseline PCA3 score ≥35, PCA3 score below the level of quantification (BLQ) had a hazard ratio (HR) of 20.04 (95% CI: 2.71–148.34) and a HR=9.44 (95% CI: 2.39–37.27), respectively. Baseline metastatic disease and testosterone were additionally associated with progression to CRPC in the continuous ADT population: HR=5.20 (95%CI: 1.68–16.06) and HR=0.995 (95%CI: 0.991–0.999), respectively. Conclusion In men with locally‐advanced or metastatic prostate cancer, a PCA3 score ≥35 at time of initiating ADT may predict a lower risk of developing CRPC in the following 3 years. This article is protected by copyright. All rights reserved.
      PubDate: 2016-02-25T06:54:42.391918-05:
      DOI: 10.1111/bju.13455
  • Outcomes of single versus double cuff artificial urinary sphincter
           insertion in low and high risk profile male patients with severe stress
           urinary incontinence
    • Abstract: Objectives To evaluate continence and complication rates of bulbar single and distal bulbar double cuff insertion according to low and high risk for unfavorable artificial urinary sphincter outcomes. Patients and Methods 180 patients who underwent artificial urinary sphincter implantation between 2009 and 2013 were followed according to institutional standards. Patients with previous pelvic radiation therapy, open bulbar urethral or incontinence surgery (“high risk”) underwent distal bulbar double cuff (n=123), all others (“low risk”) proximal bulbar single cuff (n=57) placement. Primary and secondary endpoints consisted of continence and complication rates. Kaplan‐Meier analysis determined explantation‐free survival, Cox regression models assessed risk factors for persistent incontinence and explantation. Results Median follow‐up was 24 months. Whereas no significant difference in pad usage/objective continence was observed after single vs. double cuff insertion, superior rates of subjective/social continence and less persistent incontinence were reported by double cuff patients (all p≤0.02). Overall, device explantation (erosion, infection or mechanical failure) occured in 12.8%. While early (0.05), double cuff patients had a 5.7‐fold higher risk of device explantation in the late follow‐up (p=0.02) and significantly shorter explantation‐free‐suvival (log‐rank: 0.003). Conclusions Distal bulbar double cuff insertion in patients with a “high risk” profile (previous pelvic radiation, urtehral surgery) leads to similar objective continence, but increased explantation rates when compared to “low risk” proximal bulbar single cuff. Randomized controlled trials comparing both devices will need to differ if higher explanations rates attribute to the double cuff device or risk factors. This article is protected by copyright. All rights reserved.
      PubDate: 2016-02-24T06:44:51.727293-05:
      DOI: 10.1111/bju.13449
  • Technical Mentorship during Robot‐Assisted Surgery: A Cognitive
    • Authors: Ahmed A. Hussein; Somayeh B. Shafiei, Mohamed Sharif, Ehsan Esfahani, Basel Ahmad, Justen D. Kozlowski, Zishan Hashmi, Khurshid A. Guru
      Abstract: Objective To investigate the role of cognitive and mental workload assessment may play a critical role in defining successful mentorship Materials and Methods “Mind Maps” project aims at evaluating cognitive function of surgeon's expertise and trainee's skills. The study included electroencephalogram (EEG) recordings of the mentor observing trainee surgeons in 20 procedures during extended lymph node dissection (e‐LND) and urethro‐vesical anastomosis (UVA), with simultaneous assessment of trainees using NASA‐TLX questionnaire. We also compared the brain activity of the mentor during this study to his own brain activity while actually performing the same surgical steps from previous procedures populated in the “Mind Maps” project.. Results During LND and UVA, when the mentor thought the trainee's mental demand and effort were low based on his NASA‐TLX (not satisfied with his performance), his EEG‐based mental workload increased (reflecting more concern and attention). The mentor was mentally engaged and concerned while he was engrossed in observing the surgery. This was further supported by the finding that there was no significant difference in the mental demands and workload between observing and operating for the expert surgeon. Conclusion This study objectively evaluated cognitive engagement of a surgical mentor teaching technical skills during surgery. Our study provides a deeper understanding of how surgical teaching actually works and opens new horizons for assessment and teaching of surgery. Further research is needed to study the feasibility of this novel concept in assessment and guidance of surgical performance. This article is protected by copyright. All rights reserved.
      PubDate: 2016-02-11T05:14:26.131408-05:
      DOI: 10.1111/bju.13445
  • Issue Information ‐ TOC
    • First page: 1
      PubDate: 2016-06-17T03:43:01.42002-05:0
      DOI: 10.1111/bju.13288
  • Issue Information ‐ JEB
    • First page: 4
      PubDate: 2016-06-17T03:43:01.931486-05:
      DOI: 10.1111/bju.13289
  • Issue Information ‐ Jnl info
    • First page: 6
      PubDate: 2016-06-17T03:43:01.497287-05:
      DOI: 10.1111/bju.13290
  • The PROMIS of MRI
    • Authors: Hashim U. Ahmed
      First page: 7
      PubDate: 2016-06-17T03:42:59.960462-05:
      DOI: 10.1111/bju.13547
  • Magnetic resonance imaging‐fusion biopsy: behind the scenes
    • First page: 8
      PubDate: 2016-06-17T03:43:02.087156-05:
      DOI: 10.1111/bju.13376
  • Time to re‐evaluate and refine re‐transurethral resection in
           bladder cancer'
    • Authors: A. Hugh Mostafid
      First page: 9
      PubDate: 2016-06-17T03:43:05.871872-05:
      DOI: 10.1111/bju.13385
  • The jury on posterior muscolofascial reconstruction is still out
    • Authors: Philipp Dahm
      First page: 10
      PubDate: 2016-06-17T03:43:04.094983-05:
      DOI: 10.1111/bju.13531
  • Analysis of genetics to identify susceptibility to secondary malignancies
           in patients with bladder cancer
    • Authors: Yair Lotan
      First page: 12
      PubDate: 2016-06-17T03:43:02.995928-05:
      DOI: 10.1111/bju.13382
  • Posterior muscolofascial reconstruction after radical prostatectomy: an
           updated systematic review and a meta‐analysis
    • Authors: A. A. C. Grasso; F. A. Mistretta, M. Sandri, G. Cozzi, E. De Lorenzis, M. Rosso, G. Albo, F. Palmisano, A. Mottrie, A. Haese, M. Graefen, R. Coelho, V. R. Patel, B. Rocco
      First page: 20
      Abstract: Objectives To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP). An updated systematic review of the literature. Material and Methods A systematic review of the literature was performed in June 2015, following the PRISMA statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the Title and Abstract fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta‐analysis of the risk ratios estimated using data from the selected studies was performed. Results Twenty‐one studies were identified in the literature search, including three randomized controlled trials. The overall analysis of comparative studies showed that PR improves the early continence recovery at 3‐7, 30 and 90 days after catheter removal, while continence rate at 6 months is statistically but not clinically affected. Statistically significant lower anastomotic leakage rates were described after PR. No significant differences were found in terms of positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. Conclusions The analysis confirms the benefits at 30 days post catheter removal already discussed in the review published in 2012 but also shows a significant advantage in terms of urinary continence recovery in the first 3 months. A multicenter prospective randomized controlled trial is currently conducted in several institutions all over the world to better assess the effectiveness of the PR in facilitating an earlier recovery of postoperative urinary continence. This article is protected by copyright. All rights reserved.
      PubDate: 2016-03-14T09:46:44.909135-05:
      DOI: 10.1111/bju.13480
  • A prospective study of the short‐term quality‐of‐life
           outcomes of patients undergoing transperineal prostate biopsy
    • Authors: Adam S. Dowrick; Addie C. Wootten, Nicholas Howard, Justin S. Peters, Declan G. Murphy
      First page: 60
      Abstract: Objective To investigate in a prospective, observational study whether transperineal prostate biopsy (TPbx) results in patient‐reported quality‐of‐life (QoL) changes from baseline in the first 3‐months after TPbx. Patients and methods Consenting patients completed the 26‐item Expanded Prostate cancer Index Composite (EPIC‐26), the Sexual Health Inventory for Men, the International Prostate Symptom Score, the Generalised Anxiety Disorder seven‐item scale, the Patient Health Questionnaire nine‐item scale, and a global question about willingness to have a repeat TPbx in a years' time. The instruments were scored using published scoring methods. Wilcoxon signed–rank tests and Mann–Whitney U‐tests were used to investigate statistically significant differences. Clinically significant differences were also investigated defined by published minimal important differences for the EPIC‐26 and changes in established categorical groups for the other instruments. Results In all, 53 patients consented to participate and completed the baseline questionnaire, in addition to at least one of the 1‐ or 3‐month follow‐up questionnaires. We found that most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, 24% had clinically worse urinary function and 18% had worse sexual function at 1 month. At 3 months, 3% of patients had clinically worse urinary function and 25% continued to have worse sexual function compared with baseline. Patients who were subsequently diagnosed with cancer based on the results of the TPbx, had statistically significantly reduced QoL for the EPIC‐26 urinary scales and reduced improvements in scores on the psychological scales at the 1‐month follow‐up compared with those who were not diagnosed with cancer. Conclusions Most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, patients should be advised that a quarter may have clinically worse urinary function and nearly 20% have clinically worse sexual function in the first month, and that sexual function deficits may continue up to 3 months. The results of this study provide a resource that the clinician can use when discussing TPbx with patients.
      PubDate: 2016-02-23T07:04:04.542696-05:
      DOI: 10.1111/bju.13413
  • The incidence and sequela of lymphocele formation after
           robot‐assisted extended pelvic lymph node dissection
    • First page: 127
      Abstract: Objective To determine an accurate incidence of lymphocele formation and its sequela after robot‐assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND) in a contemporary prostate cancer cohort. Patients and Method Consecutive patients who underwent RARP and eLND and had a minimum follow‐up of 3 months were included. All surgeries were performed by one surgeon via a transperitoneal approach, with patients uniformly receiving low‐molecular‐weight heparin. Patients were followed with serial ultrasonography (US) based on a predetermined schedule for lymphocele surveillance. Incidence and sequelae of lymphoceles were retrospectively assessed. Results In all, 521 patients were analysed. The mean (sd) follow‐up was 33.5 (22.8) months. Lymphocele developed in 9% and became symptomatic in 2.5%. All except one were detected at the 1‐month postoperative US; however, 76% regressed by the 3‐month US. If lymphocele persisted at 3 months, 64% developed symptoms associated with infection and required drainage. Having diabetes mellitus was significantly associated with a higher risk of developing an infected lymphocele. Other symptoms related to lymphocele were rare. Comparisons of patient characteristics between patients with and without lymphoceles did not show any significant prognostic indicators to predict the occurrence of lymphocele in neither univariate nor multivariate analysis in the present cohort. Conclusion The incidence of symptomatic lymphocele after transperitoneal RARP and eLND is rare. However, during follow‐up, US imaging at 3 months after surgery appears advisable. If a lymphocele is detected at the 3‐month follow‐up US discussing percutaneous external drainage with the patient appears to be wise, as it may prevent the development of a symptomatic lymphocele in two‐thirds of such patients.
      PubDate: 2016-02-17T08:46:12.242565-05:
      DOI: 10.1111/bju.13425
  • Ambulatory movements, team dynamics and interactions during
           robot‐assisted surgery
    • Authors: Nabeeha Ahmad; Ahmed A. Hussein, Lora Cavuoto, Mohamed Sharif, Jenna C. Allers, Nobuyuki Hinata, Basel Ahmad, Justen D. Kozlowski, Zishan Hashmi, Ann Bisantz, Khurshid A. Guru
      First page: 132
      Abstract: Objective To analyse ambulatory movements and team dynamics during robot‐assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events. Methods With institutional review board approval, we retrospectively reviewed 10 recorded robot‐assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). Results The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure‐related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply‐1 zone. A total of 50% of ambulatory movements were found to be avoidable. Conclusion More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence‐based OR layout that enhances access, workflow and patient safety.
      PubDate: 2016-02-21T23:50:07.850675-05:
      DOI: 10.1111/bju.13426
  • Do stones still kill' An analysis of death from stone disease
           1999–2013 in England and Wales
    • Authors: Francesca Kum; Wasim Mahmalji, Jemma Hale, Kay Thomas, Matthew Bultitude, Jonathan Glass
      First page: 140
      Abstract: Objectives To analyse the trends in the number of deaths attributable to urolithiasis in England and Wales over the past 15 years (1999–2013). Urolithiasis has an estimated lifetime risk of 12% in males and 6% in females and is not perceived as a life‐threatening pathology. Admissions with urinary calculi contribute to 0.5% of all inpatient hospital stays, and the number of deaths attributable to stone disease has yet to be identified and presented. Materials and Methods Office of National Statistics data relating to causes of death from urolithiasis, coded as International Classification of Diseases (ICD)‐10 N20–N23, was collated and analysed for the 15‐year period from 1999 to 2013 in England and Wales. These data were sub‐categorised into anatomical location of calculi, age, and gender. Results In all, 1954 deaths were attributed to urolithiasis from 1999 to 2013 (mean 130.3 deaths/year). Of which, 141 were attributed to ureteric stones (mean 9.4 deaths/year). Calculi of the kidney and ureter accounted for 91% of all deaths secondary to urolithiasis; lower urinary tract (bladder or urethra) calculi contributed to only 7.9% of deaths. The data revealed an overall increasing trend in mortality from urolithiasis over this 15‐year period, with an increase of 3.8 deaths/year based on a linear trend (R2 = 0.65). Overall, the number of deaths in females was significantly higher than in males (ratio 1.5:1, P < 0.001); kidney and ureteric calculi causing death had a female preponderance (1.7:1, female:male); whereas calculi of the lower urinary tract was more common in males (1:2.2, female:male). Conclusions Stone disease still causes death in the 21st century in England and Wales. This trend of increasing deaths must be placed in the context of the concurrent rising incidence of urolithiasis in the UK and the number of stone‐related hospital episodes. The primary cause of death relating to complications of stone disease for each individual case should be further investigated to facilitate prevention of complications of urolithiasis.
      PubDate: 2016-02-12T07:38:16.460214-05:
      DOI: 10.1111/bju.13409
  • Erectile dysfunction and lower urinary tract symptoms associated with
           benign prostatic hyperplasia (LUTS/BPH) combined responders to tadalafil
           after 12 weeks of treatment
    • Authors: Claus G. Roehrborn; Kathryn B. Egan, Martin M. Miner, Xiao Ni, David G. Wong, Raymond C. Rosen
      First page: 153
      Abstract: Objective To analyse the proportion of men taking tadalafil 5 mg once daily who experience a combined improvement in symptoms of both erectile dysfunction (ED) and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Materials and Methods The data from men aged ≥45 years randomized to tadalafil 5 mg once daily or placebo enrolled in one of four randomized, placebo‐controlled LUTS/BPH clinical trials were analysed (N = 927). A novel classification of ‘combined responders’ to ED and LUTS/BPH treatment was defined, based on published criteria for men who showed improvement in both International Index of Erectile Function – Erectile Function domain (IIEF‐EF) score and total International Prostate Symptom Score (IPSS). Descriptive analyses assessed the covariate distribution by responder status. Unadjusted and adjusted logistic regressions provided odds ratios with 95% confidence intervals comparing combined responders with all others (partial and non‐responders). Results Among men randomized to tadalafil 5 mg, 40.5% were combined responders (n = 189). Among placebo randomized men, 18.3% were combined responders (n = 84). Combined responders, in the total population, had the highest baseline IPSS and lowest baseline IIEF‐EF scores, corresponding to the highest level of dysfunction. The majority of men were aged ≤65 years, white, non‐obese, non‐smokers, and regular alcohol consumers. Only treatment, baseline IPSS, baseline IIEF‐EF, obesity and psychoactive medication use were significantly associated with responder status (P ≤ 0.05). Tadalafil‐treated men had 2.8 times significantly increased adjusted odds of being combined responders vs non‐responders (P < 0.001). For each unit decrease in baseline IIEF‐EF or alcoholic drink consumption per week there was a 4% significant increase in the adjusted odds of being a combined responder to tadalafil therapy. Conclusions This novel measure of combined response is useful in differentiating patients with clinically relevant symptom improvement for both ED and LUTS/BPH after treatment with tadalafil 5 mg once daily vs placebo. This combined responder measure may be useful in future assessment of treatment benefits across patient groups after various types of treatment intervention (e.g. surgical vs pharmacotherapy vs non‐pharmacological intervention).
      PubDate: 2016-02-11T01:04:49.126376-05:
      DOI: 10.1111/bju.13406
  • Abnormal Akt signaling in bladder epithelial cell explants from IC/BPS
           patients can be induced by antiproliferative factor treatment of normal
           bladder cells
    • First page: 161
      Abstract: Objectives Explanted bladder epithelial cells from IC/BPS patients produce a frizzled 8‐related glycopeptide antiproliferative factor (APF) that inhibits normal bladder epithelial cell proliferation and expression of several proteins known to be regulated by Akt signaling. • Our primary objective was to determine whether Akt signaling and secretion of specific downstream effector proteins are abnormal in specific cell fractions of IC/BPS bladder epithelial cells. • A related secondary objective was to determine whether treatment of normal bladder epithelial cells with active synthetic asialo‐antiproliferative factor (as‐APF) induces similar changes in Akt signaling and specific downstream effector proteins/mRNAs. Patients and Methods • Cell proteins were extracted into four subcellular fractions from primary bladder epithelial explants of six patients who fulfilled modified NIDDK criteria for IC/BPS and six age‐ and gender‐ matched controls. • Total and/or phosphorylated cellular Akt, GSK3β, and β‐catenin; total cellular JunB; and secreted MMP2 and HB‐EGF levels were determined by Western blot. • MMP2, JunB, p53, UPK3, and β‐actin mRNAs were quantified by qRT‐PCR. • Akt activity was determined by nonradioactive assay. Results • IC/BPS cells had decreased Akt activity, along with decreased Akt ser473‐ and GSK3β ser9‐phosphorylation and increased β‐catenin ser33,37/thr41‐phosphorylation in specific fractions as compared to matched control cells. • IC/BPS explants also had evidence for additional downstream abnormalities as compared to control cells, including decreased nuclear JunB; decreased secreted MMP2 and HB‐EGF; plus decreased MMP2, JunB, and UPK3 mRNAs but increased p53 mRNA relative to β‐actin. • Each of these IC/BPS cell abnormalities was also induced in normal cells by as‐APF. Conclusion • These findings indicate that IC/BPS cells have abnormal Akt activity with downstream protein expression abnormalities including decreased MMP2 and HB‐EGF secretion. • They also support the hypothesis that APF plays a role in the pathogenesis of IC/BPS via its effects on cell Akt signaling and HB‐EGF production. This article is protected by copyright. All rights reserved.
      PubDate: 2016-02-25T06:58:23.017877-05:
      DOI: 10.1111/bju.13457
  • Contemporary retroperitoneal lymph node dissection (RPLND) for testis
           cancer in the UK – a national study
    • Abstract: Objectives To undertake a comprehensive prospective national study of the outcomes of RPLND for testis cancer over a one year period in the United Kingdom. Patients and Methods Data were submitted online using the BAUS Section of Oncology Data and Audit System. All new patients undergoing RPLND for testis cancer between March 2012 and February 2013 were studied prospectively. Data was analysed using Tableau software and case ascertainment compared with Hospital Episode Statistics (HES) data. Results 162 men underwent RPLND by 20 surgeons in 17 centres. Mean case volume per centre was 9 (range 2 – 32) per centre and median case volume per surgeon 6 (1 – 30). Indication was residual mass post‐chemotherapy (73%); primary treatment (6%); relapse (14%); salvage (7%). Median time to surgery post chemotherapy was 8 – 12 weeks (12 weeks). 91% of procedures utilised open surgery. Median operating time was 3 – 4 hours (6 hours). Nerve sparing was performed in 67% (19% bilateral; 48% unilateral). Dissection was template in 81% and lumpectomy in 16%. 25% required additional intra‐operative procedures including 11% synchronous planned nephrectomy. 157/160 (98%) of recorded RPLND operations were completed. One was terminated due to bleeding and in two the mass could not be removed. There were no deaths within 30 days of surgery. 75% of men did not require a blood transfusion, 15% required 1 – 2 units and 10% received more than two units. 10% of men had post‐operative complications (Clavien grade 1 = 7, grade 2 = 7, grade 3 = 1). Mean length of stay was 5.5 days (range 1‐59). Histology showed necrosis in 22%; teratoma differentiated in 42%; and residual cancer in 36%. Conclusion This prospective collaborative national study describes for the first time the surgical outcomes after RPLND across the UK. The quality of RPLND in the UK appears high. The study can act as a benchmark for this type of surgery across the world. This article is protected by copyright. All rights reserved.
  • The contemporary landscape of occupational bladder cancer within the
           United Kingdom: A meta‐analysis of risks over the last 80 years
    • Abstract: Importance Bladder cancer (BC) is a common malignancy that arises through occupational carcinogen exposure. Here we analyse trends in UK to better understand contemporary occupational BC. Objective To profile the contemporary risks of occupational BC in the UK. Materials and methods Systematic review using PubMed, Medline, Embase and Web of Science was performed in March 2016. We selected reports of British workers in which BC or occupation were the main focus, with sufficient cases or with confidence intervals (CI). We used the most recent data in populations with multiple reports. We combined odds ratios and risk ratios (RRs) to provide pooled RRs of incidence and disease specific mortality (DSM). We tested for heterogeneity and publication bias. We extracted BC mortality from Office of National Statistics death certificates. We compered across regions and with our meta‐analysis. Results We identified 25 articles reporting risks in 702,941 persons. Meta‐analysis revealed significantly increased incidence for 12/37 and DSM for 5/37 occupational classes. Three classes had reduced BC risks. The greatest risk of BC incidence occurred in chemical process (RR 1.87 (1.50‐2.34)), rubber (RR 1.82 (1.4‐2.38)) and dye workers (RR 1.8, (1.07‐3.04)). The greatest risk of DSM occurred in electrical (RR 1.49 (1.19‐1.87)) and chemical process workers (RR 1.35 (1.09‐1.68)). BC mortality was higher in the North of England, probably reflecting smoking patterns and certain industries. Limitations include the lack of sufficient robust data, missing occupational tasks and no adjustment for smoking. Conclusion Occupational BC occurs in many workplaces and the risks for incidence and DSM may differ. Regional differences may reflect changes in industry and smoking patterns. Relatively little is known about BC within British industry, suggesting official data underestimate the disease. This article is protected by copyright. All rights reserved.
  • PI‐RADS 4 or more: Active Surveillance no more
    • Abstract: The introduction of multiparametric Magnetic Resonance Imaging (mpMRI) has improved the diagnosis and risk stratification of intermediate and high‐risk prostate cancer. In addition to diagnosis, mpMRI has increasing become a useful tool for monitoring prostate cancer risk of patients on active surveillance (AS) programs. A significant proportion of men on AS programs have suspicious lesions on mpMRI [1]. Accordingly, repeat mpMRI provides means of non‐invasive assessment with the potential for fusion biopsy and preferential sampling of prostate cancer tissue. In 2012, the Prostate Imaging Reporting and Data System (PI‐RADS) introduced standardized reporting of prostate mpMRI. PI‐RADS 4 and 5 lesions have been classified as “clinically significant cancer is likely to be present” and “clinically significant cancer is highly likely” respectively. PI‐RADS 4 and 5 lesions are being increasing correlated with intermediate and high‐grade prostate cancer. As recently discussed in: “Gleason Pattern 4: Active Surveillance no more” [2], patients with intermediate‐risk prostate cancer are not suitable for AS. In light of this, the presence of PI‐RADS 4 or 5 lesions on men enrolled to AS programs for prostate cancer warrants concern. This article is protected by copyright. All rights reserved.
  • What is the outcome of paediatric gastrocystoplasty when the patients
           reach adulthood'
    • Abstract: Objective To document the long‐term outcomes of paediatric augmentation gastrocystoplasty (AGC) in terms of preservation of renal function and maintenance of dryness, and to analyse the rate of complications. Patients and methods The medical records of children who had undergone AGC between 1992 and 2000 (minimum time interval of 15 years) were reviewed retrospectively. The following data were collected: age at surgery, the cause of bladder dysfunction, functioning of the AGC, any complications and the long‐term outcome of the patients. All of the patients were recontacted by telephone. Results A total of 11 AGCs were carried out between 1992 and 2000, at a median age of 11 years (range from 6.5 to 14 years). The diagnosis of patients undergoing AGC included myelomeningocele (n=4), bladder exstrophy (n=4), posterior urethral valves (n=1), irradiated bladder (n=1) and Prune Belly syndrome (n=1). Median follow‐up was 17 years (15‐19.5, all patients). Renal function was preserved or improved in 63% of patients and 80% of patients were dry after AGC. Seven of the 11 (63%) patients reported symptoms linked to haematuria‐dysuria syndrome, which was resistant to treatment in one case and requiring excision of the gastric patch. Three of the 11 patients (23%) developed a tumour on the gastric graft after a median delay of 20 years (range 11‐22) after the initial procedure. All had gastric adenocarcinoma of which two were metastatic at the time of diagnosis requiring pelvectomy with pelvic lymph nodes dissection and adjuvant chemotherapy. Seven of the 11 (63%) patients underwent excision of the gastric patch after a median time of 11 years (range 8.5‐20.5). Conclusions Our long‐term data confirmed that the majority of patients undergoing AGC had preservation of their renal function and were continent. However, long‐term, AGC was associated with a significant risk of malignant transformation and a high rate of surgical re‐intervention involving removal of the gastric patch. These results question the use of this technique for bladder augmentation, irrespective of the indication. We highlighted the importance of strict endoscopic follow‐up of all patients already having undergone an AGC and the need to inform and educated patients about tumour‐related symptoms. This article is protected by copyright. All rights reserved.
  • Preoperative nomogram to predict likelihood of complications following
           radical nephroureterectomy
    • Abstract: objectives To construct a nomogram based on preoperative variables to better predict the likelihood of a complication occurring within 30‐days of radical nephroureterectomy (RNU). patients and methods The charts of 731 patients undergoing RNU at 8 academic medical centers between 2002 and 2014 were reviewed. Preoperative clinical, demographic, and comorbidity indices were collected. Complications occurring within 30‐days of surgery were graded using the modified Clavien‐Dindo scale. Multivariate logistic regression determined the association between preoperative variables and post‐RNU complications. A nomogram was created from the reduced multivariate model with internal validation using the bootstrapping technique with 200 repetitions. Results 408 men and 323 women with a median age of 70 years and BMI of 27 were included. 75% of the cohort was of white race, 18% had an ECOG performance status ≥ 2, 20% had a Charlson Comorbidity Index > 5, and 50% had baseline CKD stage III or greater. Overall, 279 patients (38%) experienced a complication including 61 (22%) with Clavien III or greater events. A multivariate model identified 5 variables associated with complications including patient age, race, ECOG performance status, CKD stage, and Charlson comorbidity index. A preoperative nomogram incorporating these risk factors was constructed with an area under curve of 72.2%. conclusions Using standard preoperative variables from this multi‐institutional RNU experience, we constructed and validated a nomogram for predicting perioperative complications after RNU. Such information may permit more accurate risk stratification on an individual cases basis prior to major surgery. This article is protected by copyright. All rights reserved.
  • Treatment patterns, testicular loss, and disparities in inpatient surgical
           management of testicular torsion in boys: a population based study
    • Abstract: Objectives To examine temporal trends in inpatient testicular torsion (TT) treatment and testicular loss (TL), and identify risk‐factors for TL utilizing a large nationally representative pediatric cohort, stratified to established high prevalence TT cohorts (neonatal TT [NTT,
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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