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Publisher: John Wiley and Sons   (Total: 1594 journals)

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Journal of Medical Imaging and Radiation Oncology     Hybrid Journal   (2 followers)
Journal of Medical Primatology     Hybrid Journal   (1 follower)
Journal of Medical Radiation Sciences     Open Access   (2 followers)
Journal of Medical Virology     Hybrid Journal   (6 followers)
Journal of Metamorphic Geology     Hybrid Journal   (6 followers)
Journal of Microscopy     Hybrid Journal   (2 followers)
Journal of Midwifery & Women's Health     Hybrid Journal   (18 followers)
Journal of Molecular Recognition     Hybrid Journal  
Journal of Money, Credit and Banking     Hybrid Journal   (17 followers)
Journal of Morphology     Hybrid Journal   (3 followers)
Journal of Multi-Criteria Decision Analysis     Hybrid Journal   (1 follower)
Journal of Multicultural Counseling and Development     Hybrid Journal   (1 follower)
Journal of Muscle Foods     Hybrid Journal   (3 followers)
Journal of Neurochemistry     Hybrid Journal  
Journal of Neuroendocrinology     Hybrid Journal   (4 followers)
Journal of Neuroimaging     Hybrid Journal   (1 follower)
Journal of Neuroscience Research     Hybrid Journal   (6 followers)
Journal of Nursing and Healthcare of Chronic Illne Ss: An International Interdisciplinary Journal     Hybrid Journal   (2 followers)
Journal of Nursing Management     Hybrid Journal   (15 followers)
Journal of Nursing Scholarship     Hybrid Journal   (2 followers)
Journal of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (17 followers)
Journal of Obstetrics and Gynaecology Research     Hybrid Journal   (12 followers)
Journal of Oral Pathology & Medicine     Hybrid Journal   (2 followers)
Journal of Oral Rehabilitation     Hybrid Journal   (2 followers)
Journal of Organizational Behavior     Hybrid Journal   (17 followers)
Journal of Orthopaedic Research     Hybrid Journal   (13 followers)
Journal of Paediatrics and Child Health     Hybrid Journal   (12 followers)
Journal of Pathology     Hybrid Journal   (6 followers)
Journal of Peptide Science     Hybrid Journal   (14 followers)
Journal of Periodontal Research     Hybrid Journal  
Journal of Personality     Hybrid Journal   (9 followers)
Journal of Petroleum Geology     Hybrid Journal   (4 followers)
Journal of Pharmaceutical Sciences     Hybrid Journal   (127 followers)
Journal of Philosophy of Education     Hybrid Journal   (5 followers)
Journal of Phycology     Hybrid Journal   (5 followers)
Journal of Physical Organic Chemistry     Hybrid Journal   (6 followers)
Journal of Phytopathology     Hybrid Journal   (2 followers)
Journal of Pineal Research     Hybrid Journal  
Journal of Plant Nutrition and Soil Science     Hybrid Journal   (3 followers)
Journal of Policy Analysis and Management     Hybrid Journal   (12 followers)
Journal of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (5 followers)
Journal of Political Philosophy     Hybrid Journal   (29 followers)
Journal of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (120 followers)
Journal of Polymer Science Part B: Polymer Physics     Hybrid Journal   (21 followers)
Journal of Polymer Science Part C : Polymer Letters     Hybrid Journal   (5 followers)
Journal of Popular Music Studies     Hybrid Journal   (8 followers)
Journal of Product Innovation Management     Hybrid Journal   (11 followers)
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Journal of Public Economic Theory     Hybrid Journal   (4 followers)
Journal of Public Health Dentistry     Hybrid Journal   (1 follower)
Journal of Quaternary Science     Hybrid Journal   (23 followers)
Journal of Raman Spectroscopy     Hybrid Journal   (9 followers)
Journal of Rapid Methods and Automation In Microbiology     Hybrid Journal   (2 followers)
Journal of Regional Science     Hybrid Journal   (6 followers)
Journal of Religious Ethics     Hybrid Journal   (4 followers)
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Journal of School Health     Hybrid Journal   (7 followers)
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Journal of Software Maintenance and Evolution: Research and Practice     Hybrid Journal   (2 followers)
Journal of Supreme Court History     Hybrid Journal   (5 followers)
Journal of Surgical Oncology     Hybrid Journal   (1 follower)
Journal of Synthetic Lubrication     Hybrid Journal  
Journal of Systematics Evolution     Open Access   (4 followers)
Journal of Texture Studies     Hybrid Journal   (2 followers)
Journal of the American Association of Nurse Practitioners     Partially Free   (3 followers)
Journal of the American Ceramic Society     Hybrid Journal   (20 followers)
Journal of the American Geriatrics Society     Hybrid Journal   (9 followers)
Journal of the American Society for Information Science and Technology     Hybrid Journal   (107 followers)
Journal of the American Water Resources Association     Hybrid Journal   (18 followers)
Journal of the Association for Information Science and Technology     Hybrid Journal  
Journal of the CardioMetabolic Syndrome     Hybrid Journal  
Journal of the European Academy of Dermatology and Venereology     Hybrid Journal   (3 followers)
Journal of the Experimental Analysis of Behavior     Hybrid Journal  
Journal of the History of the Behavioral Sciences     Hybrid Journal   (1 follower)
Journal of the Institute of Brewing     Free  
Journal of the Peripheral Nervous System     Hybrid Journal   (2 followers)
Journal of the Royal Anthropological Institute     Hybrid Journal   (28 followers)
Journal of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (9 followers)
Journal of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (18 followers)
Journal of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (13 followers)
Journal of the Science of Food and Agriculture     Hybrid Journal   (20 followers)
Journal of the Society for Information Display     Hybrid Journal   (1 follower)
Journal of the Society for the Anthropology of Europe     Hybrid Journal   (8 followers)

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BJU International    [119 followers]  Follow    
  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  [1594 journals]   [SJR: 1.381]   [H-I: 96]
  • Robotic management of genito‐urinary injuries from obstetrical and
           gynecological operations: a multi‐institutional report of outcomes
    • Abstract: Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynecological (OBGYN) surgery Methods A retrospective review of all patients from 4 different high volume institutions between 2002 and 2013 that had a robotic assisted repair by an urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomy: 10 open, 10 robotic, 9 vaginally, and 5 pure laparoscopic. Nine patients had alternative OBGYN operations: 3 cesarean sections, 3 oophorectomies (1 open, 2 laparoscopic), 1 robotic colpopexy, 1 open pelvic cervical cerclage with mesh and one robotic removal of an invasive endometrioma. A total of 49 gentiourinary (GU) injuries were sustained: ureteral ligation, n=26, ureterovaginal fistula, n=10, ureterocutaneous fistula, n=1, vesicovaginal fistula (VVF), n=10 and cystotomy alone, n=2. Ten patients (20.4%) underwent immediate urologic repair at the time of their OBGYN robotic surgery. Mean time between OBGYN injury and definitive delayed repair was 23.5 months (1‐297). Four patients had undergone prior failed repair: 2 open VVF repair and 2 balloon ureteral dilations with stent placement. A total of 22 ureteral re‐implants (11 with ipsilateral psoas hitch) and 15 uretero‐ureterostomies were performed. Stents were placed in all ureteral cases for a mean of 32 (1‐63) days. Ten VVF repairs and 2 primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for an average of 4.1 days (1‐26). No case required open conversion. Two patients (4.1%) developed ureteral obstruction following robotic repair requiring dilation and stenting. Average follow‐up of entire cohort was 16.6 months (1‐63). Conclusions Robotic repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be utilized successfully immediately following injury recognition or as a salvage procedure after prior attempted repair. Robotic techniques may improve convalescence in a patient population where quick recovery is paramount.
       
  • Histopathological characteristics of microfocal prostate cancer detected
           during systematic prostate biopsy
    • Abstract: To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy (RP) for unique, microfocal prostate cancer (miPCA) detected on prostate biopsy in the pre‐active surveillance (AS) era. Material and methods In this retrospective, multi‐institutional study, we analyzed the clinical records of of 131 consecutive patients who underwent either retropubic or robot‐assisted RP for miPCA at two referral centers from January 2000 to December 2011. MiPCA was defined as a neoplastic lesion present in ≤ 10% of core with not applicable or 6 biopsy Gleason score (GS). Results We observed 17 (13%) pT3‐4 prostate cancers and a single case (0.8%) of pN+ tumor. Moreover, 31 (24.1%) patients showed GS> 6 in RP specimens. Therefore, unfavorable pathological outcomes (pT3‐4/N+ and/or GS>6) were present in 40 (30.5%) patients. Median PSA density was 0.11 (interquartile range [IQR] 0.09‐0.17) and 0.16 (IQR 0.11‐0.24) in patients with favorable and unfavorable pathological characteristics, respectively (p=0.003). ROC curve showed a AUC value of 0.67 (95% IC 0.56‐0.77) for PSA density to predict the risk of unfavorable pathological outcomes. Conclusion Patients with microfocal prostate cancer (MiPCA) candidate for AS protocol should be adequately informed that in about 30% of the cases the cancer might be locally advanced and/or with GS >6. Those unfavorable pathological outcomes could be predicted by PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of understaging and/or undergrading in patients with initial diagnosis of MiPCA.
       
  • In vitro fragmentation efficiency of holmium:
           yttrium‐aluminum‐garnet (YAG) laser lithotripsy – a
           comprehensive study encompassing different frequencies, pulse energies,
           total power levels and laser fibre diameters
    • Abstract: Objective To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high‐ with low‐frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. Materials and Methods An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2–1.2 J pulse energies, 5–40 Hz frequencies, 4–20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. Results Low frequency‐high pulse energy (LoFr‐HiPE) settings were (up to six times) more efficient than high frequency‐low pulse energy (HiFr‐LoPE) at the same power levels (P < 0.001), as they produced deeper (P < 0.01) and wider (P < 0.001) fissures. There were linear correlations between pulse energy and fragmentation volume, fissure width, and fissure depth (all P < 0.001). Total power did not correlate with fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). Conclusions At the same total power level, LoFr‐HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time‐consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability.
       
  • The forgotten ureteric stent: what next'
    •  
  • ‘Measurement for Improvement Not Judgement’ – the Case
           of Percutaneous Nephrolithotomy
    •  
  • Hemi salvage high‐intensity focused ultrasound (HIFU) in unilateral
           radiorecurrent prostate cancer: a prospective two‐centre study
    • Abstract: Objective To report the oncological and functional outcomes of hemi salvage high‐intensity focused ultrasound (HSH) in patients with unilateral radiorecurrent prostate cancer. Patients and Methods Between 2009 and 2012, 48 patients were prospectively enrolled in two European centres. Inclusion criteria were biochemical recurrence (BCR) after primary radiotherapy (RT), positive magnetic resonance imaging and ≥1 positive biopsy in only one lobe. BCR was defined using Phoenix criteria (a rise by ≥2 ng/mL above the nadir prostate specific antigen [PSA] level). The following schemes and criteria for functional outcomes were used: Ingelman‐Sundberg score using International Continence Society (ICS) questionnaire (A and B), International prostate symptom score (IPSS), International Index of Erectile Function‐5 (IIEF‐5) points, the European Organisation for the Research and Treatment of Cancer (EORTC) quality of life questionnaires (QLQ C‐30). HSH was performed under spinal or general anaesthesia using the Ablatherm® Integrated Imaging device. Patients with obstructive voiding symptoms at the time of treatment underwent an endoscopic bladder neck resection or incision during the same anaesthesia to prevent the risk of postoperative obstruction. Results After HSH the mean (sd) PSA nadir was 0.69 (0.83) ng/mL at a median (interquartile range) follow‐up of 16.3 (10.5–24.5) months. Disease progression occurred in 16/48 (33%). Of these, four had local recurrence in the untreated lobe and four bilaterally, six developed metastases, and two had rising PSA levels without local recurrence or radiological confirmed metastasis. Progression‐free survival rates at 12, 18, and 24 months were 83%, 64%, and 52%. Severe incontinence occurred in four of the 48 patients (8%), eight (17%) required one pad a day, and 36/48 (75%) were pad‐free. The ICS questionnaire showed a mean (sd) deterioration from 0.7 (2.0) to 2.3 (4.5) for scores A and 0.6 (1.4) to 1.6 (3.0) for B. The mean (sd) IPSS and erectile function (IIEF‐5) scores decreased from a mean (sd) of 7.01 (5.6) to 8.6 (5.1) and from 11.2 (8.6) to 7.0 (5.8), respectively. The mean (sd) EORTC QLC‐30 scores before and after HSH were 35.7 (8.6) vs 36.8 (8.6). Conclusion HSH is a feasible therapeutic option in patients with unilateral radiorecurrent prostate cancer, which offers limited urinary and rectal morbidity, and preserves health‐related quality of life.
       
  • Is intermittent androgen‐deprivation therapy beneficial for patients
           with advanced prostate cancer'
    • Abstract: Use of intermittent androgen‐deprivation therapy (IADT) in patients with prostate cancer has been evaluated in several studies, in an attempt to delay the development of castration resistance and reduce side‐effects associated with ADT. However it is still not clear whether survival is adversely affected in patients treated with IADT. In this review, we explore the available data in an attempt to identify the most suitable candidate patients for IADT, and discuss factors that may inform appropriate patient stratification. ADT is first‐line treatment for advanced/metastatic prostate cancer and is also recommended for use with definitive radiotherapy for high‐risk localised prostate cancer. The changes in hormone levels induced by ADT can lead to short‐ and long‐term side‐effects which, although treatable in most cases, can significantly reduce the tolerability of ADT treatment. IADT has been investigated in several phase II and phase III studies in patients with locally advanced or metastatic prostate cancer, in an attempt to delay time to tumour progression and reduce the side‐effect burden of ADT. In selected patient groups IADT is no less effective than continuous ADT, ameliorating the impact of ADT‐related side‐effects, and, to a degree, their impact on patient health‐related quality of life (HRQL). Further comparative study is required, particularly in relation to HRQL and long‐term complications associated with ADT.
       
  • Muscle‐invasive bladder cancer: evaluating treatment and survival in
           the National Cancer Data Base
    • Abstract: Objective To evaluate the association between patterns of care and patient survival for the treatment of muscle‐invasive bladder cancer (MIBC) using a large, national database. Patients and Methods We identified a cohort of 36 469 patients with MIBC (stage II) from 1998 to 2010 from the National Cancer Data Base. Patients were stratified into four treatment groups: radical cystectomy, chemo‐radiation, other therapy, or no treatment. Overall survival (OS) among the groups was evaluated using Kaplan–Meier analysis and the log rank test. A multivariable Cox proportional hazards model was fit to evaluate the association between treatment groups and OS. Results In all, 27% of patients received radical cystectomy, 10% chemo‐radiation, 61% other therapy and 2% no treatment. Unadjusted Kaplan–Meier analysis showed significant differences by treatment group, with cystectomy having the greatest median OS (48 months) followed by chemo‐radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, the OS for cystectomy was similar to that for chemo‐radiation (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.98, 1.12), but superior to other therapy (HR 1.42; 95% CI 1.35, 1.48), and no treatment (HR 2.40; 95% CI 2.12, 2.72). The OS time for chemo‐radiation was superior to other therapy and no treatment. Conclusions Radical cystectomy and chemo‐radiation are significantly underused despite a substantial survival benefit compared with other therapies or no treatment. Future studies are needed to optimise care delivery and improve outcomes for patients with MIBC.
       
  • Role of urinary cations in the aetiology of bladder symptoms and
           interstitial cystitis
    • Abstract: Objectives To identify and characterise urinary cationic metabolites, defined as toxic factors, in patients with interstitial cystitis (IC) and in control subjects. To evaluate the cytotoxicity of the urinary cationic metabolite fraction of patients with IC vs control subjects and of individual metabolites in cultured urothelial cells. Subjects and Methods Cationic fractions (CFs) were isolated from the urine specimens of 62 patients with IC and 33 control subjects by solid‐phase extraction. CF metabolites were profiled using C18 reverse‐phase high performance liquid chromatography (RP‐HPLC) with UV detection, quantified by area‐under‐the‐peaks using known standards, and normalized to creatinine. RP‐HPLC and liquid chromatography (LC)‐mass spectrometry (MS)/tandem MS (MS/MS) were used to identify major CF peaks. HTB‐4 urothelial cells were used to determine the cytotoxicity of CFs and of individual metabolites with and without Tamm–Horsfall protein (THP). Results RP‐HPLC analysis showed that metabolite quantity was twofold higher in patients with IC compared with control subjects. The mean (sem) for control subjects vs patients was 3.1 (0.2) vs 6.3 (0.5) mAU*min/μg creatinine (P < 0.001). LC‐MS identified 20 metabolites. Patients with IC had higher levels of modified nucleosides, amino acids and tryptophan derivatives compared with control subjects. The CF cytotoxicity was higher for patients with IC compared with control subjects. The mean (sem) for control subjects vs patients was −2.3 (2.0)% vs 36.7 (2.7)% (P < 0.001). A total of 17 individual metabolites were tested for their cytotoxicity. Cytotoxicity data for major metabolites were all significant (P < 0.001): 1‐methyladenosine (51%), 5‐methylcytidine (36%), 1‐methyl guanine (31%), N4‐acetylcytidine (24%), N7‐methylguanosine (20%) and L‐Tryptophan (16%). These metabolites were responsible for higher toxicity in patients with IC. The toxicity of all metabolites was significantly lower in the presence of control THP (P < 0.001). Conclusions Major urinary cationic metabolites were characterised and found to be present in higher amounts in patients with IC compared with control subjects. The cytotoxicity of cationic metabolites in patients with IC was significantly higher than in control subjects, and control THP effectively lowered the cytotoxicity of these metabolites. These data provide new insights into toxic factor composition as well as a framework in which to develop new therapeutic strategies to sequester their harmful activity, which may help relieve the bladder symptoms associated with IC.
       
  • Active surveillance for renal angiomyolipoma: outcomes and factors
           predictive of delayed intervention
    • Abstract: Objective To present the outcomes of active surveillance (AS) for renal angiomyolipomas (AMLs) and to assess the clinical features predicting delayed intervention of this treatment option. Patients and Methods We retrospectively reviewed the outcomes of patients diagnosed with AMLs on computed tomography (CT) who were managed with AS at our institution. The AS protocol consisted of 6‐ and 12‐month, then annual follow‐up visits, each one including a physical examination and CT imaging. Discontinuation of AS was defined as the need or decision for an active procedure during the follow‐up period. Causes of delayed intervention, as well as the type of active treatment (AT), were recorded. Clinical features at presentation of patients failing AS were compared with those who remained under AS at the time of the last follow‐up. Predictive factors of delayed intervention were analysed using univariate and multivariate Cox regression models. Results Overall, 130 patients were included in the analysis, of whom 102 (78.5%) were incidentally diagnosed, while 15 (11.5%) and 13 patients (10%) presented with flank pain and haematuria, respectively. After a mean (sd) follow‐up of 49 (40) months, 17 patients (13%) discontinued AS and underwent AT. Patients who underwent delayed intervention were more likely to present with a higher body mass index, larger tumours and symptomatic disease. Angioembolization represented the first‐line AT after AS (64.7%), whereas partial nephrectomy was adopted in 29.4% of patients. On the univariate analysis, risk factors for delayed intervention included tumour size ≥4 cm, symptoms at diagnosis, and history of concomitant or contralateral kidney disease. On the multivariate analysis, only tumour size and symptoms remained independently associated with discontinuation of AS. Conclusions Tumour size and symptoms at initial presentation were highly predictive of discontinuation of AS in the management of AMLs. Selective angioembolization was the first‐line option used for AT after AS was discontinued.
       
  • Role of fluorodeoxyglucose positron emission tomography (FDG
           PET)‐computed tomography (CT) in the staging of bladder cancer
    • Abstract: Objective To determine whether to use 18F‐fluorodeoxyglucose positron emission tomography (FDG PET) scans in the preoperative staging of bladder cancer (BC). Patients and Methods In all, 233 patients with muscle‐invasive BC (MIBC) or high‐risk non‐MIBC being considered for radical cystectomy (RC) between 2005 and 2011 had FDG‐PET and computed tomography (CT) of the chest, abdomen and pelvis to assess for pelvic lymph node (LN) involvement or distant metastases. Sensitivity and specificity for detecting pelvic LN involvement was determined by comparing the results of the scans to the histopathology reports in patients undergoing RC. These parameters for distant metastases were determined from biopsy results or follow‐up imaging. In patients who did not undergo RC, follow‐up imaging was used to evaluate the sensitivity and specificity. Patients were excluded from analysis if they either had neoadjuvant chemotherapy or had
       
  • Outcomes of men with an elevated PSA as their sole preoperative
           intermediate or high risk feature
    • Abstract: Objective To investigate the post‐prostatectomy and long‐term outcomes of men presenting with an elevated pretreatment PSA (>10 ng/mL) but otherwise low risk features (biopsy Gleason score ≤6 and clinical stage ≤T2a). Patients and Methods PSA‐incongruent intermediate risk (Pii) cases were defined as those patients with preoperative PSA >10 and ≤20 ng/mL but otherwise low risk features, and PSA‐incongruent high risk (Pih) cases were defined as men with PSA >20 ng/mL but otherwise low risk features. The Institutional Radical Prostatectomy Database (1992‐2012) was queried and stratified into D'Amico low risk, D'Amico intermediate risk, D'Amico high risk, PSA‐incongruent intermediate risk, and PSA‐incongruent high risk cases. Prostate cancer (PCa) features and outcomes were evaluated using appropriate comparative tests. Multivariable analyses were adjusted for age, race, and year of surgery. Results Of the total 17,608 men, 1,132 (6.4%) had Pii risk disease and 183 (1.0%) had Pih risk disease. Compared to low risk men, the odds of upgrading at RP were 2.20 (95% CI 1.93‐2.52, p
       
  • A Propensity‐Score Matched Analysis Comparing Robotic Versus
           Laparoscopic Partial Nephrectomy
    • Abstract: Purpose To compare the perioperative and early renal functional outcomes of RPN and LPN for kidney tumors. Materials and Methods A total of 237 patients fulfilling the selection criteria were included. 146 and 91 patients were treated with LPN and RPN, respectively. To adjust for potential baseline confounders propensity‐score matching was performed. A favorable outcome was defined as warm ischemia time (WIT) of 20 min or less plus negative surgical margins plus no surgical conversion plus no Clavien 3 or greater complications plus no postoperative CKD upstaging. Descriptive statistics and multivariable logistic regression analyses were performed before and after propensity‐score matching. Results Within the propensity‐score matched cohort, the RPN group was associated with significantly lower EBL (156 vs. 198 ml, MD= ‐42, p=0.025), shorter WIT (22.8 vs. 31 min, MD= ‐8.2, p
       
  • Diagnostic performance and safety of a three‐dimensional
           14‐core systematic biopsy method
    • Abstract: Objective To investigate the diagnostic performance and safety of a three‐dimensional 14‐core biopsy (3D14PBx) method, which is a combination of the transrectal (TR) 6‐core and transperineal (TP) 8‐core biopsy methods. This 14‐core method was designed to achieve both a cancer detection rate and grading accuracy of more than 95% of the three‐dimensional 26‐core biopsy (3D26PBx) method, which is a combination of the TR 12‐core and TP 14‐core biopsy methods. Patients and Methods Between December 2005 and August 2010, 1103 men underwent 3D14PBx at our institutions and they were analyzed prospectively. Biopsy criteria included an elevated PSA from 2.5 to 20 ng/mL or abnormal DRE findings or both. The primary end‐point of the present study was diagnostic performance and the secondary end‐point was safety. We applied recursive partitioning to the entire study cohort to delineate the unique contribution of each sampling site to overall and clinically significant cancer detection. Results Prostate cancer was detected in 503 of the 1103 patients (45.6%). Age, family history of prostate cancer, DRE, PSA, %‐free PSA and prostate volume were associated with positive biopsy result significantly and independently. Of the 503 cancers detected, 39 (7.8%) were clinically locally advanced (cT3a or greater), 348 (69%) had a biopsy Gleason score (GS) of 7 or greater, and 463 (92%) and more met the definition of biopsy‐based significant cancer. Recursive partitioning analysis revealed that each sampling site contributed uniquely to both the overall and the biopsy‐based significant cancer detection rate of the 3D14PBx method. The overall cancer positive rate of each sampling site ranged from 14.5% in the TR far lateral base (lb) to 22.8% in the TR far lateral apex (la). As of August 2010, 210 patients (42%) had undergone radical prostatectomy, which revealed that 55 (26%) had pathologically non‐organ‐confined disease, 174 (83%) had prostatectomy GS 7 or greater and 185 (88%) and more met the definition of prostatectomy‐based significant cancer. Conclusions This is the first prospective analysis of the diagnostic performance of an extended biopsy method which is a simplified version of the somewhat redundant super‐extended 3D26PBx. As expected, each sampling site uniquely contributed not only to overall cancer detection but also to significant cancer detection. 3D14PBx is a feasible systematic biopsy method in men with PSA
       
  • Development and internal validation of a nomogram for predicting
           stone‐free status following flexible ureteroscopy for renal stones
    • Abstract: Objective To develop and internally validate a preoperative nomogram for predicting stone‐free status (SF) following such treatment. There is a need to predict the outcome of flexible ureteroscopy (fURS) for the treatment of renal stone disease. Patients and Methods We retrospectively analyzed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteral stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF following fURS. Bootstrapping was performed to internally validate the nomogram. Results Five independent predictors of SF following fURS were stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of > 50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF following fURS using these 5 preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. Conclusion The nomogram may be used to reliably predict SF based on patient characteristics following fURS treatment of renal stone disease.
       
  • Primary invasive carcinoma associated with penoscrotal extramammary
           Paget's disease: A clinicopathologic analysis of 56 cases
    • Abstract: Objectives To investigate the clinicopathologic features, therapeutic strategies, and prognostic factors of patients with penoscrotal invasive EMPD. Patients and Methods We retrospectively collected clinical, pathological, and follow‐up data of 56 male patients with invasive penoscrotal EMPD. Histopathological features of the primary skin lesion including tumor size, surgical margin status, depth of invasion and lymphovascular invasion were examined. Results Median age was 67 years and median longest diameter of lesion was 5 cm. All patients were treated with wide surgical excision and 22 patients with clinically positive regional lymph nodes underwent therapeutic regional lymph node dissection. At the end of this study, 44.6% of patients developed distant metastasis and 39.3% of patients died of disease. Univariate analysis revealed that patients with one of the following poor prognostic factors: depth of invasion of lower dermis or deeper, presence of lymphovascular invasion and regional lymph node metastasis at diagnosis had significantly shorter cancer specific survival time. Multivariate analysis found that depth of invasion was the only independent prognostic factor. Conclusion The prognosis of invasive EMPD is significantly associated with depth of invasion, lymphovascular invasion and regional lymph node status. More aggressive therapy and more rigorous follow‐up should be recommended for patients with these poor prognostic factors.
       
  • Complications after artificial urinary sphincter implantation with or
           without prior radiotherapy
    • Abstract: Objective To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy. Patients & Methods Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurologic and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and lost of follow up. A total of 122 patients were included in the study, 61 with prior radiotherapy and 61 without prior radiotherapy. All patients had the same surgical technique from two different surgeons. All AUS were implanted with bulbar urethral cuff position. Mean follow up was 37.25 months (range: 1‐126). Results In the group without prior radiotherapy and with prior radiotherapy, revision rates were 32.8% versus 29.5% respectively (p=0.59). Median time to first revision was 11.7 months. Early complications were similar in the two groups (4.9 vs 6.5%, p=1). Erosion rates were not significantly different (4.9 vs 13.1%, p=0.13). Nevertheless, infection rates and explantation rates were more important in patients with prior radiotherapy (2 (3.2%) cases vs 10 (16.3%) (p=0.018) and 3 (4.9%) vs 12 (19.6%) (p=0.016), respectively). Finally, continence rates were not significantly different (75.4 (without prior radiotherapy) vs 63.9 (with prior radiotherapy), p=0.23). Conclusion Artificial urinary sphincter is the gold standard treatment of male urinary incontinence after re‐education failure in patients with or without prior radiotherapy. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior radiotherapy.
       
  • Urologic Chronic Pelvic Pain Syndrome Symptom Flares: Characterization of
           the Full Spectrum of Flares at Two Sites of the Mapp Research Network
    • Abstract: Objectives To describe the full spectrum of symptom exacerbations defined by interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome patients as flares, and to investigate their associated health‐care utilization and bother at two sites of the Trans‐Multidisciplinary Approaches to the Study of Chronic Pelvic Pain (Trans‐MAPP) Epidemiology and Phenotyping study. Patients and methods Participants completed a flare survey that asked them: 1) whether they had ever had flares (“symptoms that are much worse than usual”) that lasted 1 hr and 1 day; and 2) for each duration of flare, to report their: a) average length and frequency; b) typical levels of urologic and pelvic pain symptoms; and c) levels of health‐care utilization and bother. We compared participants’ responses to their non‐flare Trans‐MAPP values and across flares using generalized linear mixed models. Results Seventy six of 85 participants (89.4%) completed the flare survey, 72 of whom reported having flares (94.7%). Flares varied widely in terms of their duration (seconds to months), frequency (several times per day to once per year or less), and intensity and type of symptoms (e.g., pelvic pain versus urologic symptoms). Flares of all duration were associated with greater pelvic pain, urologic symptoms, disruption to participants’ activities, and bother, with increasing severity of each of these factors as the duration of flares increased. Days‐long flares were also associated with greater health‐care utilization. In addition to duration, symptoms (pelvic pain, in particular) were also significant determinants of flare‐related bother. Conclusions Our findings suggest that flares are common and associated with greater symptoms, health‐care utilization, disruption, and bother. Our findings also inform the characteristics of flares most bothersome to patients (i.e., increased pelvic pain and duration), and thus of greatest importance to consider in future research on flare prevention and treatment.
       
  • Novel prognostic model for patients with sarcomatoid renal cell carcinoma
    • Abstract: Objectives To demonstrate sarcomatoid differentiation is an independent prognostic feature for patients with grade 4 renal cell carcinoma (RCC) with or without distant metastases. To identify independent predictors of survival, evaluate the correlation between the amount of sarcomatoid differentiation and cancer‐specific survival, and to design a multivariate prognostic model for patients with sarcomatoid RCC. Patients and Methods We used the Mayo Clinic Nephrectomy Registry to identify 204 post‐nephrectomy patients with sarcomatoid‐variant RCC as well as 207 patients with unilateral grade 4 RCC without sarcomatoid features for comparison. All slides were reviewed by a single pathologist. Cancer‐specific survival was estimated using the Kaplan‐Meier method. The associations of clinical and pathologic features with death from RCC were evaluated using Cox proportional hazards regression models. Results For all patients with grade 4 RCC, the presence of sarcomatoid differentiation was associated with a 58% increased risk of death from RCC (p
       
  • Nanotechnology Applications in Urology: A Review
    • Abstract: Objective To discuss the current literature and summarize some of the promising areas with which nanotechnology may improve urologic care. Materials and Methods A Medline literature search was performed to elucidate all relevant studies of nanotechnology with specific attention to its application to urology. Results Urologic applications of nanotechnology include its use in medical imaging, gene therapy, drug delivery, and photothermal ablation of tumors. In vitro and animal studies have demonstrated initial encouraging results. Conclusion Further study of nanotechnology for urologic applications is warranted to bridge the gap between preclinical studies and translation into clinical practice, but nanomedicine has shown significant potential to improve urologic patient care.
       
  • Prognostic value of microRNA expression pattern in upper tract urothelial
           carcinoma
    • Abstract: Objective To examine the microRNA (miRNA) expression pattern in tumour samples from patients with progressing and non‐progressing upper tract urothelial carcinoma (UTUC) in order to identify putative miRNAs that may be used as prognostic markers. Patients and Methods We conducted a multicentre, retrospective study of formalin‐fixed paraffin‐embedded tissue samples from 150 patients with UTUC who had undergone radical nephroureterectomy. Global miRNA expression patterns were analysed in 18 selected samples from patients with UTUC using TaqMan arrays. The differential expression of five key miRNAs was validated by quantitative polymerase chain reaction in an independent cohort of 132 samples from patients with UTUC. Models to predict tumour progression and cancer‐specific survival that included miRNA expression patterns were developed by Cox regression analysis. Results Twenty‐six miRNAs were found to be aberrantly expressed between samples from patients with progressing and non‐progressing UTUC and five of these were selected for subsequent studies. The regression analysis identified tumour stage and miR‐31 and miR‐149 expression as independently associated with tumour progression and tumour stage and miR‐149 expression as independently associated with cancer‐specific survival. The risk scores derived from these miRNA models were able to discriminate two groups with a highly significantly different probability of tumour progression (hazard ratio [HR] 4.78; P < 0.001) and death (HR 276; P = 0.004). Conclusions There is a differential miRNA expression pattern between patients with progressing and non‐progressing UTUC. The identification of new miRNAs associated with a high probability of tumour recurrence and cancer‐specific survival in patients with UTUC and their combination in a robust, easy‐to‐use and reliable algorithm may help tailor treatment and surveillance strategies in these patients.
       
  • MicroRNA and urothelial cell carcinoma
    •  
  • A critical appraisal of complications of percutaneous nephrolithotomy in
           paediatric patients using adult instruments
    • Abstract: Objective To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24–30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES‐Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group. Results The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2–17) years. The mean (range) stone burden was 376.68 ± 265.23 (150–2400) mm2. The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone‐free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013–1.065, odds ratio = 1.04; P = 0.038). Conclusions Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter‐observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure.
       
  • Microsurgical denervation of rat spermatic cord: safety and efficacy data
    • Abstract: Objective To describe a microsurgical technique for denervation of the spermatic cord and use of multiphoton microscopy (MPM) laser to identify and ablate residual nerves after microsurgical denervation. To evaluate structural and functional changes in the rat testis and vas deferens after denervation. Materials and Methods Nine Sprague‐Dawley rats were divided into three experimental groups: sham, microsurgical denervation of the spermatic cord (MDSC), and MDSC immediately followed by laser ablation with MPM. At 2 months after surgery, we assessed testicular volume, functional circulation of the testicular artery with Doppler, patency of the vas deferens, and histology of the testis and vas deferens. Results There was a significant decrease in the median number of nerves remaining around the vas deferens with MDSC alone (3.5 nerves) or MDSC with MPM (1.5 nerves) compared with sham rats (15.5 nerves) (P = 0.003). Although, MDSC with MPM resulted in the fewest remaining nerves, this result was similar to MDSC alone (P = 0.29). No deleterious effects on spermatogenesis or vas patency were seen in the experimental groups when compared with the sham rats. Conclusion A microsurgical approach can be used to effectively and safely denervate the rat spermatic cord with minimal changes to structure and function of the testis and vas deferens. MPM can be used as an adjunct to identify and ablate residual nerves after MDSC.
       
  • Long‐term follow‐up of sacral neuromodulation for lower
           urinary tract dysfunction
    • Abstract: Objective To report our long‐term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re‐interventions and degree of success. Patients and Methods This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. Results The mean duration of follow‐up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re‐intervention. The re‐intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow‐up. Conclusions SNM appears effective in the long‐term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re‐intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re‐intervention rates will improve.
       
  • Validation of the bladder control self‐assessment questionnaire
           (B‐SAQ) in men
    • Abstract: Objective To validate the Bladder Control Self‐Assessment Questionnaire (B‐SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men. Patients and Methods This was a prospective, single‐centre study including 211 patients in a urology outpatient setting. All patients completed the B‐SAQ and Kings Health Questionnaire (KHQ) before consultation, and the consulting urologist made an independent assessment of LUTS and the need for treatment. The psychometric properties of the B‐SAQ were analysed. Results A total of 98% of respondents completed all items correctly in
       
  • Clinical role of pathological downgrading after radical prostatectomy in
           patients with biopsy‐proven Gleason score 3+4 prostate cancer
    • Abstract: Objective ● To identify preoperative factors predicting Gleason score downgrading after radical prostatectomy in patients with biopsy Gleason score 3+4 prostate cancer. ● To determine if prediction of downgrading can identify potential candidates for active surveillance. Patients and Methods ● We identified 1317 patients with biopsy Gleason score 3+4 prostate cancer who underwent radical prostatectomy at Memorial Sloan‐Kettering Cancer Center between 2005 and 2013. ● Several preoperative and biopsy characteristics were evaluated by forward selection regression, and selected predictors of downgrading were analyzed by multivariable logistic regression. ● Decision curve analysis was performed to evaluate the clinical utility of the multivariate model. Results ● Gleason score was downgraded after radical prostatectomy in 115 patients (9%). ● We developed a multivariable model using age, prostate specific antigen density, percent of positive cores with Gleason 4 cancer out of all cores taken, and maximum percent of cancer involvement within a positive core with Gleason 4 cancer. ● The area under the curve for this model was 0.75 after ten‐fold cross validation. ● However, decision curve analysis revealed that the model was not clinically helpful in identifying patients who will downgrade at radical prostatectomy for the purpose of reassigning them to active surveillance. Conclusion ● While patients with pathology Gleason score 3+3 with tertiary Gleason pattern 4 or lower at radical prostatectomy in patients with biopsy Gleason score 3+4 prostate cancer may be potential candidates for active surveillance, decision curve analysis showed limited utility of our model to identify such men. ● Future study is needed to identify new predictors to help identify potential candidates for active surveillance among patients with biopsy‐proven Gleason score 3+4 prostate cancer.
       
  • Percutaneous nephrolithotomy in England: practice and outcomes described
           in the Hospital Episode Statistics database
    • Abstract: Objective To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals. Patients and Methods We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals. Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in‐hospital mortality within 30 days of surgery. Results A total of 5750 index PCNL procedures were performed in 165 hospitals. During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis. There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention. There were 13 (0.2%) in‐hospital deaths within 30 days of surgery. Conclusions Haemorrhage and infection represent relatively common and potentially severe complications of PCNL. Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery. Complications of PCNL may be under‐reported in the HES database and need to be corroborated using other data sources.
       
  • Complications and outcomes of salvage robot‐assisted radical
           prostatectomy: a single‐institution experience
    • Abstract: Objective To determine the peri‐operative outcomes of men undergoing salvage robot‐assisted prostatectomy (RARP) and to examine the complications, functional consequences and need for additional treatments after salvage RARP. Patients and Methods At total of 51 consecutive patients underwent salvage RARP after previous failed local therapy. Biochemical recurrence (BCR) was defined as two postoperative PSA measurements ≥0.2 ng/mL. Complications at any time postoperatively were recorded prospectively using a modified Clavien system. The Kaplan–Meier method was used for survival estimation, and regression models were used to identify the predictors of BCR or progression‐free survival (PFS) and complications. Results The median age at salvage RARP was 68 years and a median of 68 months had elapsed from the time of primary treatment. The median follow‐up was 36 months. The median operation duration was 179 min with a median estimated blood loss of 175 mL. In all, 50% of patients had pathological stage 3 disease and positive surgical margins were found in 31% of patients. The estimated 3‐year BCR‐free or PFS was 57%. The overall complication rate was 47%, with a 35% major complication rate (Grade III–V). Potency was maintained in 23% of preoperatively potent patients and 45% of all patients regained urinary control. No clinical variables were predictive of major complications, but all patients with postoperative bladder neck contracture were incontinent. A higher PSA level and extracapsular extension were significantly associated with BCR or progression (P < 0.01). Conclusions Salvage RARP provides oncological control with potential avoidance of systemic non‐curative therapy. Complication, incontinence and erectile dysfunction rates are significant but frequently correctable. This reinforces the need for proper patient counselling and selection.
       
  • Robot‐assisted partial nephrectomy (RAPN) for completely endophytic
           renal masses: a single institution experience
    • Abstract: Objective To analyse the outcomes of robot‐assisted partial nephrectomy (RAPN) for completely endophytic renal tumours. Patients and Methods Medical records of patients who had undergone RAPN for a completely endophytic (i.e. 3 points for the ‘E’ domain of the R.E.N.A.L. nephrometry score) enhancing renal mass at our Centre from 2006 to 2012 were retrieved from our prospectively maintained RAPN database and used for this analysis. Demographics, surgical and early postoperative outcomes were compared with those of patients with exophytic masses (i.e. 1 point for the ‘E’ domain) and those of patients with mesophytic masses (i.e. 2 points for the ‘E’ domain). Results In all, 65 patients (mean age 56 years; mean body mass index 29.4 kg/m2; mean Charlson comorbidity index 3.2) were included in the study group, accounting for 16.7% of RAPN cases over the study period. The main surgical outcomes were: mean operative time 175 min, mean estimated blood loss 225 mL, and mean warm ischaemia time 21.7 min. Pathology showed a malignant histology in 48 cases (74%), mostly clear cell renal cell carcinoma. Two positive margins (3%) were found. Patients with a completely endophytic mass had smaller tumours on preoperative imaging (mean 2.6 vs 3.3 for mesophytic vs 3.7 cm for exophytic; P < 0.001), and higher overall R.E.N.A.L. score (mean 8.7 vs 7.6 vs 6.4; P < 0.001). There was a lower rate of unclamped cases in the endophytic group (3.1% vs 4.8% vs 18%; P < 0.001). There were no differences in intraoperative complications, length of hospital stay, positive margin rate, postoperative change in estimated glomerular filtration rate, given a similar length of follow‐up (mean 12.6 vs 15.7 vs 14.5 months; P = 0.3). Conclusion RAPN for completely intraparenchymal renal tumours can be safely and effectively performed in centres with significant robotic expertise, with surgical outcomes resembling those obtained in the general RAPN population.
       
  • Assessing the anatomical characteristics of renal masses has a limited
           effect on the prediction of pathological outcomes in solid, enhancing,
           small renal masses: results using the PADUA classification system
    • Abstract: Objective To evaluate whether assessing the anatomical characteristics of renal masses increases the accuracy of prediction of tumour pathology in small renal masses (SRMs). Patients and Methods We retrospectively reviewed 1129 consecutive patients who underwent extirpative surgeries for a clinical T1 renal mass, for which the preoperative aspects and dimensions used for an anatomical (PADUA) classification were available. Multivariate logistic regression analyses of demographic and anatomical characteristics were performed. Nomograms to predict malignancy and high grade pathology were constructed using a basic model (age, sex and tumour size), and an extended model (anatomical characteristics incorporated into the basic model), and the area under the curve (AUC) between models was compared. Results Age, sex and tumour size were significantly associated with malignancy and high grade pathology in the T1 and T1a category (except sex for high grade pathology in T1a tumours). Exophytic rate (T1 and T1a) and renal sinus or urinary collecting system involvement (only T1a) were also significant predictors of high grade pathology. Nomograms using the extended model for malignancy showed an insignificant AUC increase compared with those using the basic model (T1, from 0.771 to 0.780, P = 0.149, and T1a, from 0.803 to 0.819, P = 0.055). For high grade pathology, the extended model achieved a significant AUC increase (from 0.595 to 0.643, P = 0.014) in the T1a category, but the AUC for both T1 and T1a tumours showed merely modest competence (0.654 and 0.643, respectively). Conclusion Age, sex and tumour size are the primary predictors of tumour pathology of SRMs, and incorporating other anatomical characteristics has only a limited positive effect on the accuracy of prediction of pathological outcomes.
       
  • Five‐year outcomes after iodine‐125 seed brachytherapy for
           low‐risk prostate cancer at three cancer centres in the UK
    • Abstract: Objective To report the outcomes of >1000 men with low‐risk prostate cancer treated with low‐dose‐rate (LDR) brachytherapy at three large UK cancer centres. Patients and Methods A total of 1038 patients with low‐risk prostate cancer (prostate‐specific antigen [PSA] ≤10 ng/mL, Gleason score 6, ≤T2b disease) were treated with LDR iodine 125 (I‐125) brachytherapy between 2002 and 2007. Patients were treated at three UK centres. PSA and clinical follow‐up was performed at each centre. Biochemical recurrence‐free survival was reported for the cohort. Results The median (range) PSA follow‐up for the whole group was 5 years (4 months to 9 years). A total of 79 patients had biochemical failure, defined by a rise in PSA level: 16 patients fulfilled the ASTRO definition of biochemical failure, 25 patients fulfilled the Phoenix definition and 38 patients fulfilled both definitions. The 5‐year biochemical relapse‐free survival (bRFS) rate was 94.1% by the ASTRO definition and 94.2% by the Phoenix definition. The absence of neoadjuvant hormone therapy was predictive of inferior biochemical control as defined by the Phoenix definition (P = 0.033). Conclusions Our prospective multicentre series showed excellent bRFS with LDR I‐125 brachytherapy for patients with low‐risk prostate cancer. Further work is necessary to define the role of neoadjuvant androgen deprivation therapy in combination with brachytherapy.
       
  • Prognostic value of preoperative multiparametric magnetic resonance
           imaging (MRI) for predicting biochemical recurrence after radical
           prostatectomy
    • Abstract: Objective To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP). Patients and Methods We reviewed the clinical records of patients who underwent either standard RP or laparoscopic RP between January 2005 and December 2009 at our institution. Patients who received radiotherapy or androgen deprivation therapy before surgery were excluded. A total of 314 patients met the study inclusion criteria. Cox proportional hazard regression models were used for analyses. In accordance with the criteria in the established guidelines, a radiologist scored the probability of the presence of prostate cancer using a five‐point scale of diagnostic confidence level. The highest confidence level of any pulse sequence was considered as the evaluation result. Results MRI positivity was significantly associated with a high clinical stage (cT ≥ 2; P = 0.039), a high positive biopsy core rate (≥0.2; P < 0.001), a high biopsy Gleason score ([GS] ≥8; P < 0.001) and a high pathological GS (≥8; P = 0.005). Univariate analysis and multivariate analysis showed that MRI positivity was a prognostic indicator in the analysis that included only preoperative variables and also in the analysis including preoperative and pathological variables. Conclusion Multiparametric MRI positivity can independently predict biochemical recurrence after RP.
       
  • Benefit in regionalisation of care for patients treated with radical
           cystectomy: a nationwide inpatient sample analysis
    • Abstract: Objective To quantify in absolute terms the potential benefit of regionalisation of care from low‐ to high‐volume hospitals. Patients and Methods Patients with a primary diagnosis of bladder cancer treated with radical cystectomy (RC) were identified within the Nationwide Inpatient Sample, a retrospective observational population‐based cohort of the USA, between 1998 and 2009. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in‐hospital mortality rates represented the outcomes of interest. Potentially avoidable outcomes were calculated by subtracting predicted rates (i.e. estimated outcomes if care was delivered at a high‐volume hospital) from observed rates (i.e. actual observed outcomes after care delivered at a low‐volume hospital). Multivariable logistic regression models and number needed to treat were generated. Results Patients treated at high‐volume hospitals had lower odds of complications during hospitalisation than those treated in low‐volume hospitals. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalisation, and in‐hospital mortality rates were 0.6, 7.4, 2.8, 9.4, and 2.0%, respectively. This corresponds to a number needed to redirect from low‐ to high‐volume hospitals in order to avoid one adverse event of 166, 14, 36, 11 and 50, respectively. Conclusion This is the first report to quantify the potential benefit of regionalisation of RC for muscle‐invasive bladder cancer to high‐volume hospitals.
       
  • Prospective comparison of quality‐of‐life outcomes between
           ileal conduit urinary diversion and orthotopic neobladder reconstruction
           after radical cystectomy: a statistical model
    • Abstract: Objective To conduct a prospective comparison of quality‐of‐life (QoL) outcomes in patients who underwent ileal conduit (IC) urinary diversion with those who underwent orthotopic neobladder (ONB) reconstruction after radical cystectomy for invasive bladder cancers. Patients and Methods Between January 2007 and December 2012, 227 patients underwent radical cystectomy and either IC urinary diversion or ONB (sigmoid or ileal) reconstruction. Contraindications for ON were impaired renal function (serum creatinine >2 mg/dL), chronic inflammatory bowel disease, previous bowel resection and tumour involvement at the bladder neck/prostatic urethra. Patients who did not have these contraindications chose to undergo either IC or ONB reconstruction, after impartial counselling. Baseline characteristics, including demographic profile, body mass index, comorbidities, histopathology of the cystoprostatectomy (with lymph nodes) specimen, pathological tumour stage, postoperative complications, adjuvant therapy and relapse, were recorded and compared. The European Organization for Research and Treatment of Cancer QoL questionnaire C30 version 3 was used to analyse QoL before surgery and 6, 12 and 18 months after surgery. Results Of the 227 patients, 28 patients in the IC group and 35 in the ONB group were excluded. The final analysis included 80 patients in the IC and 84 in the ONB group. None of the baseline characteristics were significantly different between the groups, except for age, but none of the baseline QoL variables were found to be correlated with age. In the preoperative phase, there were no significant differences in any of the QoL domains between the IC or the ONB groups. At 6, 12 and 18 months in the postoperative period, physical functioning (P < 0.001, P < 0.001 and P = 0.001, respectively), role functioning (P = 0.01, P = 0.01 and P = 0.003, respectively), social functioning (P = 0.01, P = 0.01 and P = 0.01, respectively) and global health status/QoL (P < 0.001, P < 0.001 and P = 0.002, respectively) were better in patients in the ONB group than in those in the IC group and the differences were significant. The financial burden related to bladder cancer treatment was significantly lower in the ONB group than in the IC group at 6, 12 and 18 months of follow‐up (P = 0.05, P = 0.05 and P = 0.005, respectively) Conclusions ONB is better than IC in terms of physical functioning, role functioning, social functioning, global health status/QoL and financial expenditure. ONB reconstruction provides better QoL outcomes than does IC urinary diversion.
       
  • Implementation of the Exeter Enhanced Recovery Programme for patients
           undergoing radical cystectomy
    • Abstract: Objectives To describe our experience with the implementation and refinement of an enhanced recovery programme (ERP) for radical cystectomy (RC) and urinary diversion. To assess the impact on length of stay (LOS), complication and readmission rates. Patients and Methods In all, 165 consecutive patients undergoing open RC (ORC) and urinary diversion between January 2008 and April 2013 were entered into an ERP. A retrospective case note review was undertaken. Outcomes recorded included LOS, time to mobilisation, complication rates within the first 30 days (Clavien‐Dindo classification) and readmissions. Results All patients were successfully entered into the ERP. As enhanced recovery principles became embedded in the unit, LOS reduced from a mean of 14 days over the initial year of the ERP to a mean of 9.2 days. The complication rate was 6.6% for Clavien ≥3, and 43.5% for Clavien ≤2. The 30‐day mortality rate was 1.2%. The 30‐day readmission rate was 13.9%. In the most contemporary subset of 52 patients: the median time after ORC to sit out of bed, mobilise and open bowels was day 1, 2 and 6, respectively. Conclusions The ERP described for patients undergoing ORC appears to be safe. Benefits include early feeding, mobilisation and hospital discharge. The ERP will continue to develop with the incorporation of advancing evidence and technology, in particular the introduction of robot‐assisted RC.
       
  • Cryoablation for locally advanced clinical stage T3 prostate cancer: a
           report from the Cryo‐On‐Line Database (COLD) Registry
    • Abstract: Objective To assess the oncological and functional outcomes of primary prostate cryoablation for men with clinical stage T3 (cT3) prostate cancer, as although radical prostatectomy (RP) or external beam radiotherapy (EBRT) are the standard treatments for locally advanced cT3 prostate cancer some patients opt for nonextirpative prostate cryoablation instead. Patients and Methods The Cryo‐On‐Line Database (COLD) Registry was queried to identify patients with cT3 prostate cancer treated with whole‐gland cryoablation (366 patients). We assessed biochemical disease‐free survival (bDFS) using the Phoenix definition and determined reported rates of urinary incontinence and retention, sexual activity, and rectourethral fistulisation after treatment. Patients were subsequently assessed according to whether they were administered neoadjuvant androgen‐deprivation therapy or not (ADT; 115 patients, 31.4%). Results For the entire cohort, the 36‐ and 60‐month bDFS rates were 65.3% and 51.9%, respectively. Patients who received neoadjuvant ADT had statistically nonsignificantly higher 36‐ and 60‐month bDFS rates (68.0% and 55.4%, respectively) than patients who did not receive neoadjuvant ADT (55.3% and 36.9%, respectively). The after treatment urinary incontinence rate was 2.6%; urinary retention rate, 6.0%; sexual activity rate, 30.4%; and rectourethral fistulisation rate, 1.1%. Conclusions Cryoablation for patients with cT3 prostate cancer leads to less favourable bDFS than that after RP or RT for the same group of men. The after treatment rectourethral fistulisation rates for patients with cT3 disease are higher than in those with organ‐confined prostate cancer treated with cryoablation; however, urinary dysfunction and sexual activity rates are similar for men with cT3 to those reported from this same registry in men with cT2 disease. The addition of neoadjuvant ADT (though not studied prospectively here) should be strongly considered if a patient with cT3 prostate cancer is to be treated with cryoablation.
       
  • Outcomes of surgical treatment of Peyronie's disease
    • Abstract: The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer‐reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non‐systematic review included ‘Peyronie's disease’, ‘outcomes’, ‘complications’, ‘erectile dysfunction or ED’, ‘patient expectation’, and ‘patient satisfaction’; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty‐one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non‐surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug‐resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long‐term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence‐based selection of the surgical approach.
       
  • How are we doing with percutaneous nephrolithotomy (PCNL) in England'
    •  
  • Efficacy and complications of intravesical BCG in immunocompromised
           patients
    •  
  • Daily phosphodiesterase type 5 inhibitor therapy: a new treatment option
           for prostatitis/prostatodynia'
    •  
  • Total urgency and frequency score as a measure of urgency and frequency in
           overactive bladder and storage lower urinary tract symptoms
    • Abstract: The term lower urinary tract symptoms (LUTS) encompasses a range of urinary symptoms, including storage symptoms (e.g. overactive bladder [OAB]) as well as voiding and post‐micturition symptoms. Although treatment of male LUTS tends to focus on voiding symptoms, patients typically find storage symptoms the most bothersome. The core storage symptom is urgency, which drives the other main storage symptoms of increased daytime frequency, nocturia and incontinence. Although several validated questionnaires have been widely used to study urgency, few measure the two important storage parameters, urgency and frequency, in a single assessment. The total urgency and frequency score (TUFS) is a new validated tool that captures both variables and is derived from the Patient Perception of Intensity of Urgency Scale, which has been validated in patients with OAB and LUTS. The TUFS was first validated in OAB in the phase IIa BLOSSOM study, which was designed to assess the efficacy and safety of mirabegron, a β3‐adrenoceptor agonist, in 260 patients. The responsiveness of the TUFS to treatment has been confirmed in a further three large‐scale randomized controlled trials of solifenacin in patients with OAB or LUTS. Changes in TUFS from baseline to end of treatment were consistent with changes in micturition diary variables in all four studies. Furthermore, the TUFS was significantly correlated with several health‐related quality‐of‐life variables in the phase III NEPTUNE study. Thus, the TUFS appears to be useful for assessing improvements in major storage symptoms (urgency and frequency) in clinical trials.
       
  • Flying high as a kite
    •  
  • Cryosurgery for clinical T3 prostate cancer
    •  
  • Enhanced recovery programmes: an important step towards going lean in
           healthcare
    •  
  • Life is good with orthotopic bladder substitutes!
    •  
  • Standardising and structuring of robotic surgery curricula: validation and
           integration of non‐technical skills is required
    •  
  • Perioperative Outcomes of 6042 Nephrectomies in 2012:
           Surgeon‐reported results in the United Kingdom from the BAUS
           Nephrectomy Database
    • Abstract: Objective ● To present the perioperative outcomes from the BAUS nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in England. Patients and Methods ● All nephrectomies performed in the year 2012 and recorded in the database were analysed. These were divided into simple nephrectomy (SN), partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). ● The estimated capture rate for nephrectomy was 80%. ● The outcomes measured were 30‐day mortality (30‐DM), Clavien‐Dindo complications ≥ Grade III, intraoperative blood transfusion, conversion to open and length of stay. Results ● The overall 30‐DM was 0.55% (SN 0.53%; PN 0.10%; RN 0.52%; NU 1.27%) ● Clavien‐Dindo complications ≥ Grade III were recorded in 3.9% of nephrectomies (SN 4.3%; PN 5.4%; RN 3.1%; NU 4.5%) ● Intraoperative blood transfusion was required in 8.4% of nephrectomies (SN 5.2%; PN 3.4%; RN 11.1%; NU 8.3%) ● Conversion to open was carried out in 5.5% of minimally invasive nephrectomies (SN 6.1%; PN 4.0% ; RN 5.5% ; NU 5.6%) ●Open nephrectomy patients remained in hospital for a median of 6 days (SN 7; PN 5; RN 7; NU 8) which was higher than the median 4 day stay (SN 3; PN 4; RN 4; NU 5) with minimally invasive surgery. Conclusions ● Nephrectomy in 2012 was a safe procedure with morbidity and mortality rates comparable to or less than published series. ●The collection of surgeon specific data should be iterative with further refinement of data categories, support for the collection process and independent validation of results.
       
  • Hyaluronan‐mediated motility receptor (RHAMM) immunohistochemical
           expression and androgen deprivation in normal peritumoral, hyperplasic and
           neoplastic prostate tissue
    • Abstract: Objectives To evaluate hyaluronan‐mediated motility receptor (RHAMM) expression in normal, hyperplasic and neoplastic prostate tissue after various types and durations of androgen‐deprivation therapy (ADT). Clinical and oncological data from men with localised prostate adenocarcinoma were also assessed and compared with RHAMM expression data. Patients and Methods Data from 367 men who underwent histological evaluation of the prostate were retrospectively evaluated under six conditions: (i) benign prostatic hyperplasia (BPH), (ii) BPH treated with finasteride, (iii) prostate cancer without ADT, (iv) prostate cancer treated with neoadjuvant ADT before prostatectomy (cyproterone 200 mg/day), (v) castration‐resistant prostate cancer (CRPC), and (vi) normal peritumoral prostate tissue. Tissue microarrays were constructed and 1354 cores were evaluated for immunohistochemical RHAMM expression. Results There was no RHAMM expression in any tissue from normal patients or those with BPH or prostate cancer without ADT. There was RHAMM expression in 39.4% of prostate cancer tissues treated with ADT and in 46.2% of CRPC samples (P = 0.001). There was a significant increase in RHAMM expression with increased ADT duration in group 4, with a marked increase in RHAMM expression after 6–12 months of ADT (P = 0.04). No prognostic or clinical factors related to prostate cancer were associated with RHAMM expression. Conclusions RHAMM expression in prostate cancer is directly associated with ADT. Significant RHAMM expression occurs as early as after 1 month of ADT and progressively increases with ADT duration. When prostate cancer becomes CRPC, RHAMM expression is higher. RHAMM expression was not associated with prostate cancer prognostic factors. RHAMM overexpression may contribute to the development of hormonal resistance in prostate cancer.
       
  • Ureteral stents versus percutaneous nephrostomy for initial urinary
           drainage in children with obstructive anuria and acute renal failure due
           to ureteral calculi: a prospective, randomized study
    • Abstract: Objectives • To compare percutaneous nephrostomy (PCN) versus double J ureteric stent (JJ) as an initial urinary drainage in children with obstructive calcular anuria (OCA) and post‐renal acute renal failure (ARF) due to bilateral ureteric calculi to identify the selection criteria for the initial urinary drainage method that will improve the urinary drainage, decrease the complications and facilitate the subsequent definitive clearance of stones. • As this comparison is lacking in literature. Patients and methods • A series of 90 children ≤12 years old presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric hospital in this randomized comparative study. • Patients with grade 0‐1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication to both methods of drainage. • Stable patients (or patients stabilized by dialysis) were randomized (non‐blinded, block randomization, closed envelope method) into PCN or bilateral JJ (45 patients for each group). • Initial urinary drainage was performed under general anesthesia and fluoroscopic guidance. We used 4.8‐6Fr JJ or 6‐8Fr PCN. • Primary outcome was the safety and efficacy of both groups in the recovery of renal functions. Both groups were compared in the operative and imaging times, complications, and period for return to normal serum creatinine. Secondary outcome included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome inside each group. Results • All presented patients completed the study with intention‐to‐treat analysis. • There was no significant difference between PCN and JJ in the operative and imaging times, period to return to normal creatinine and failure of insertion. The complications were significantly more with PCN group. • The stone size (> 2cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in JJ group. • The degree of hydronephrosis affected significantly the operative time for PCN insertion. Grade two hydronephrosis was associated with all cases of insertion failure in PCN group. • The total number of the needed subsequent interventions to clear stones was significantly higher with PCN group especially in patients with bilateral stones prepared for chemolytic dissolution (alkalinization) or shockwave lithotripsy (ESWL). Conclusion • We recommend the use of JJ as an initial urinary drainage in stones prepared for chemolytic dissolution or ESWL as this will lower the total number of the needed subsequent interventions to clear stones. This is also true for stones prepared for ureteroscopy, as JJ insertion will facilitate subsequent ureteroscopy due to previous ureteric stenting. • Mild hydronephrosis will prolong the operative time for PCN insertion and may increase the incidence of insertion failure. • We recommend the use of PCN if the stone size is > 2 cm as there was a more risk of possible iatrogenic ureteric injury during stenting alongside these large ureteric stones in addition to prolongation of operative time with increased incidence of failure.
       
  • Preoperative serum cholesterol is an independent prognostic factor for
           patients with renal cell carcinoma
    • Abstract: Objective • Increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers. • The purpose of this study was to assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC). Patients and Methods • We analyzed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. • Total cholesterol levels were determined in preoperative serum using the CHOD‐PAP method. • The association with cancer‐specific survival (CSS) was assessed with Cox models. • Discrimination was quantified with the C‐index. • The median follow‐up was 52 months. Results • The median serum cholesterol was 195 mg/dl (IQR 166‐232). • Decreasing serum cholesterol was associated with more advanced T, N and M stages (P
       
  • Evaluation of urinary prostate cancer antigen‐3 (PCA3) and
           TMPRSS2‐ERG score changes when starting androgen‐deprivation
           therapy with triptorelin 6‐month formulation in patients with
           locally advanced and metastatic prostate cancer
    • Abstract: Objective To assess prostate cancer antigen‐3 (PCA3) and TMPRSS2‐ERG scores in patients with advanced and metastatic prostate cancer at baseline and after 6 months of treatment with triptorelin 22.5 mg, and analyse these scores in patient‐groups defined by different disease characteristics. Patients and Methods The Triptocare study was a prospective, open‐label, multicentre, single‐arm, Phase III study of triptorelin 22.5 mg in men with locally advanced or metastatic prostate cancer, who were naïve to androgen‐deprivation therapy (ADT). The primary objective was to model the urinary PCA3 change at 6 months, according to baseline variables. Other outcome measures included urinary PCA3 and TMPRSS2‐ERG scores and statuses, and serum testosterone and prostate‐specific antigen (PSA) levels at baseline and at 1, 3 and 6 months after initiation of ADT. Safety was assessed by recording adverse events and changes in laboratory parameters. Results The intent‐to‐treat population comprised 322 patients; 39 (12.1%) had non‐assessable PCA3 scores at baseline, and 109/322 (33.9%), 215/313 (68.7%) and 232/298 (77.9%) had non‐assessable PCA3 scores at 1, 3 and 6 months, respectively. Baseline Gleason score was the only variable associated with non‐assessability of PCA3 score at 6 months (P = 0.017) – the hazard of having a non‐assessable PCA3 score at 6 months was 1.824‐fold higher (95% confidence interval 1.186–2.805) in patients with a Gleason score ≥8 vs those with a Gleason score ≤6. The median PCA3 scores at baseline were significantly higher in patients aged ≥65 years vs those aged 90% of patients achieved castrate levels of testosterone (
       
  • Impact of the International Continence Society report on the
           standardisation of terminology in nocturia on the quality of reports on
           nocturia and nocturnal polyuria: a systematic review
    • Abstract: Objectives To systematically review and evaluate the impact of the ICS‐2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and NP. In 2002, the International Continence Society (ICS) defined nocturnal polyuria (NP) as a NP index (nocturnal urine volume/total 24‐h urine volume) exceeding 0.2‐0.33, depending on age. Materials and Methods In April 2013 the Pubmed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativity. Quality scores of items were compared between studies published before and after the ICS‐2002 report. Results The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, IQR 4‐6) but low for external validity. Following publication of the ICS‐2002 report, external validity showed a significant change from 1 (IQR 1‐2) to 2 (1‐2.5, p=0.019). Nocturia remained undefined in 12 studies. Nineteen different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n=11) of studies before and 66% (n=27) after the ICS‐2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies, respectively, after the ICS‐2002 report. Conclusion The ICS‐2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voidings between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
       
  • Factors Influencing Disease Progression of Prostate Cancer under Active
           Surveillance: A McGill University Health Center Cohort
    • Abstract: Objective To evaluate clinical and pathological factors that influence the risk for disease progression in a cohort of patients with low‐intermediate risk prostate cancer (PCa) under active surveillance (AS). Patients and Methods We studied a total of 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favorable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least 1 repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3–6 months for prostate‐specific antigen (PSA) measurement and physical examination (PE). Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least 1 core, and a predominant Gleason pattern of 4. Results For the 155 patients, the mean age (SD) at diagnosis was 67 (7) years; median follow‐up was 5.4 years (interquartile range [IQR], 3.6–9.5 years). Of these, 67 patients, 25 patients, 6 patients, and 2 patients had 2, 3, 4, and 5 repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score (GS) of 3+4, while the remaining 144 (93%) patients had a GS of ≤6. A total of 50 (32.3%) patients showed disease progression on repeat biopsies, with a median progression‐free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5‐year overall survival rate was 100%. Having a PSA density (PSAd) of >0.15, >1 positive core, and GS >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P10% showed a trend toward significance for a higher progression rate (P=0.054). On multivariate analysis, only the presence of PSAd >0.15 remained significant for a higher progression rate (P0.15 ng/ml/cc is an important predictor for disease progression.
       
  • Testosterone Therapy and Cancer Risk
    • Abstract: Objective To determine if testosterone therapy status modifies a man's risk of cancer. Patients and Methods Urology clinic hormone database queried for all men with a serum testosterone level and charts examined to determine testosterone supplementation status. Linked patient records to the Texas Cancer Registry to determine the incidence of cancer. Men accrued time at risk from the date initiating TT or the first office visit for men not on TT. Standardized incidence rates and time to event analysis performed Results 247 were on testosterone therapy and 211 did not use testosterone. 47 men developed cancer–27 (12.8%) of the men not on TT and 20 (8.1%) of the men on TT. No significant difference in the risk of cancer incidence based on TT (HR 1.0, 95% CI 0.57 – 1.9, p=1.8). No difference in prostate cancer risk based on TT status (HR 1.2, 95% CI 0.54‐2.5). Conclusion No change in cancer risk overall, or prostate cancer risk, specifically, for men over 40 utilizing long term testosterone therapy.
       
  • A Phase II, Randomized, Double‐blind, Placebo‐Controlled Trial
           of Methylphenidate for Reduction of Fatigue in Prostate Cancer Patients
           Receiving LHRH‐Agonist Therapy
    • Abstract: Objectives To investigate whether methylphenidate could alleviate fatigue, as measured by the Functional Assessment of Cancer Therapy: Fatigue subscale (FACT‐F), in men with PCa treated with an LHRH agonist for a minimum of 6 months. To assess changes in global fatigue and QoL as measured by the Bruera Global Fatigue Severity Scale (BFS) and the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36), respectively. Materials and Methods We performed a single center, randomized, double‐blind, placebo‐controlled trial with the goal to recruit 128 participants. Men treated with an LHRH agonist for PCa were screened between February 2008 and June 2012 for fatigue at our outpatient clinics using the BFS. Participants were randomized to receive either 10mg daily of methylphenidate or a placebo. Change of fatigue levels and in SF‐36 scores between both groups were compared using linear regression adjusted for baseline scores. Results The study was closed prematurely due to poor accrual. Of the 790 subjects screened, 24 men were randomized to methylphenidate or placebo (12 per group). After 10 weeks, the improvement in fatigue was greater in the methylphenidate arm than in placebo [+7.7(7.7) vs. +1.4(7.6)]; p=0.022). The within‐group analysis demonstrated a significant improvement of fatigue in the methylphenidate arm (p=0.008) but not in the placebo arm (p=0.82). The use of methylphenidate also resulted in a significantly greater improvement in QoL as measured by the physical and mental component score than placebo (p=0.04 for both component scores). Conclusion Our findings support the benefit of methylphenidate on fatigue and QoL among men with LHRH‐induced fatigue. Clinicians should be aware of its benefit and should consider discussing these findings with their fatigued patients.
       
  • Early unclamping technique during robotically‐assisted
           laparoscopic partial nephrectomy can minimize warm ischemia without
           increasing morbidity
    • Abstract: Purpose Early unclamping of the renal pedicle has been reported to decrease WIT during laparoscopic PN. Our objective was to compare peri‐operative outcomes of early unclamping (EU) versus standard unclamping (SU) during robotically assisted partial nephrectomy (RPN). Patients and methods A retrospective multi‐institutional study was conducted at eight French academic centres between 2009 and 2013. Patients who underwent RPN for a renal mass were included in the study. Patients without vascular clamping or for whom the decision to perform a radical nephrectomy was taken before unclamping were excluded. Peri‐operative outcomes were compared using χ2 test and Fisher exact tests for discrete variables and Mann‐Whitney test for continuous variables. Predictors of WIT and estimated blood loss (EBL) were assessed using multiple linear regression analysis. Results There were 430 patients: 222 in the EU group and 208 in the SU group. Tumors were larger (35.8 vs. 32.3 mm, p= 0.02) and more complex (RENAL Score: 6.9 vs. 6.1, p50 procedures: 12.2% vs. 1.4%, p
       
  • Prognosis of patients with pelvic lymph node (LN) metastasis after radical
           prostatectomy: Value of extranodal extension and size of the largest LN
           metastasis
    • Abstract: Objective To assess the prognostic role of extranodal extension (ENE) and the size of the largest lymph node (LN) metastasis in predicting early biochemical relapse (eBCR) in patients with LN metastasis after radical prostatectomy (RP). Patients and Methods We evaluated BCR‐free survival in men with LN metastases after RP and pelvic LN dissection performed in six high‐volume centres. Multivariable Cox regression tested the role of ENE and diameter of largest LN metastasis in predicting eBCR after adjusting for clinicopathological variables. We compared the discrimination of multivariable models including ENE, the size of largest LN metastasis and the number of positive LNs. Results Overall, 484 patients were included. The median (interquartile range, IQR) follow‐up was 16.1 (6–27.5) months. The median (IQR) number of removed LNs was 10 (4–14), and the median (IQR) number of positive LNs was 1 (1–2). ENE was present in 280 (58%) patients, and 211 (44%) had their largest metastasis >10 mm. Patients with ENE and/or largest metastasis of >10 mm had significantly worse eBCR‐free survival (all P < 0.01). On multivariable analysis, number of positive LNs (≤2 vs >2) and the diameter of LN metastasis (≤10 vs >10 mm), but not ENE, were significant predictors of eBCR (all P < 0.003). ENE and diameter of LN metastasis increased the area under the curve of a baseline multivariable model (0.663) by 0.016 points. Conclusions The diameter of the largest LN metastasis and the number of positive LNs are independent predictors of eBCR. Considered together, ENE and the diameter of the largest LN metastasis have less discrimination than the number of positive LNs.
       
  • Nephron‐sparing management vs radical nephroureterectomy for
           low‐ or moderate‐grade, low‐stage upper tract urothelial
           carcinoma
    • Abstract: Objective To compare overall and cancer‐specific outcomes between patients with upper tract urothelial carcinoma (UTUC) managed with either radical nephroureterectomy (RNU) or nephron‐sparing measures (NSM) using a large population‐based dataset. Patients and Methods Using Surveillance, Epidemiology, and End Results (SEER) data, patients diagnosed with low‐ or moderate‐grade, localised non‐invasive UTUC were stratified into two groups: those treated with RNU or NSM (observation, endoscopic ablation, or segmental ureterectomy). Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) rates were determined using cumulative incidence estimators. Adjusting for clinical and pathological characteristics, the associations between surgical type, all‐cause mortality and CSM were tested using Cox regressions and Fine and Gray regressions, respectively. Results Of 1227 patients [mean (sd) age 70.2 (11.00) years, 63.2% male] meeting inclusion criteria, 907 (73.9%) and 320 (26.1%) patients underwent RNU and NSM for low‐ or moderate‐grade, low‐stage UTUC from 1992 to 2008. Patients undergoing NSM were older (mean age 71.6 vs 69.7 years, P < 0.01) with a greater proportion of well‐differentiated tumours (26.3% vs 18.0%, P = 0.001). While there were differences in OCM between the groups (P < 0.01), CSM trends were equivalent. After adjustment, RNU treatment was associated with improved non‐cancer cause survival [hazard ratio (HR) 0.78, confidence interval [CI] 0.64–0.94) while no association with CSM was demonstrable (HR 0.89, CI 0.63–1.26). Conclusions Patients with low‐ or moderate‐grade, low‐stage UTUC managed through NSM are older and are more likely to die of other causes, but they have similar CSM rates to those patients managed with RNU. These data may be useful when counselling patients with UTUC with significant competing comorbidities.
       
  • Indications, results and safety profile of transperineal sector biopsies
           (TPSB) of the prostate: a single centre experience of 634 cases
    • Abstract: Objective To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. Patients and Methods A retrospective review of a single‐centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24–38 cores using a ‘sector plan’. Procedures were carried out under general anaesthetic in most patients. Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low‐risk disease diagnosed based on a 12‐core TRB (307). Results Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors. As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL). Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment. Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per‐urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. Conclusions TPSB of the prostate has a role in defining disease previously missed or under‐diagnosed by TRB. The procedure has low morbidity.
       
  • Incidence and predictors of understaging in patients with clinical T1
           urothelial carcinoma undergoing radical cystectomy
    • Abstract: Objective To evaluate predictors of understaging in patients with presumed non‐muscle‐invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. Patients and Methods We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011. In all, 60 of these cT1 patients had undergone a restaging TURBT before RC. The primary outcome measure was pathological staging of ≥T2 disease at the time of RC. Results In all, 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25–0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, P = 0.05) were independent risk factors for understaging. Conclusions Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.
       
  • Genetic polymorphisms modify bladder cancer recurrence and survival in a
           USA population‐based prognostic study
    • Abstract: Objective To identify genetic variants that modify bladder cancer prognosis focusing on genes involved in major biological carcinogenesis processes (apoptosis, proliferation, DNA repair, hormone regulation, immune surveillance, and cellular metabolism), as nearly half of patients with bladder cancer experience recurrences reliable predictors of this recurrent phenotype are needed to guide surveillance and treatment. Patients and methods We analysed variant genotypes hypothesised to modify these processes in 563 patients with urothelial‐cell carcinoma enrolled in a population‐based study of incident bladder cancer conducted in New Hampshire, USA. After diagnosis, patients were followed over time to ascertain recurrence and survival status, making this one of the first population‐based studies with detailed prognosis data. Cox proportional hazards regression was used to assess the relationship between single nucleotide polymorphisms (SNPs) and prognosis endpoints. Results Patients with aldehyde dehydrogenase 2 (ALDH2) variants had a shorter time to first recurrence (adjusted non‐invasive hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.29–2.78). There was longer survival among patients with non‐invasive tumours associated with DNA repair X‐ray repair cross‐complementing protein 4 (XRCC4) heterozygous genotype compared with wild‐type (adjusted HR 0.53, 95% CI 0.38–0.74). Time to recurrence was shorter for patients who had a variant allele in vascular cellular adhesion molecule 1 (VCAM1) and were treated with immunotherapy (P interaction < 0.001). Conclusions Our analysis suggests candidate prognostic SNPs that could guide personalised bladder cancer surveillance and treatment.
       
  • Face, content, construct and concurrent validity of dry laboratory
           exercises for robotic training using a global assessment tool
    • Abstract: Objectives To evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content, construct and concurrent validities. To evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance. Materials and Methods Participants were prospectively categorized into two groups: robotic novice (no cases as primary surgeon) and robotic expert (≥30 cases). Participants completed three virtual reality (VR) exercises using the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA), as well as corresponding dry lab versions of each exercise (Mimic Technologies, Seattle, WA, USA) on the da Vinci Surgical System. Simulator performance was assessed by metrics measured on the simulator. Dry lab performance was blindly video‐evaluated by expert review using the six‐metric GEARS tool. Participants completed a post‐study questionnaire (to evaluate face and content validity). A Wilcoxon non‐parametric test was used to compare performance between groups (construct validity) and Spearman's correlation coefficient was used to assess simulation to dry lab performance (concurrent validity). Results The mean number of robotic cases experienced for novices was 0 and for experts the mean (range) was 200 (30–2000) cases. Expert surgeons found the dry lab exercises both ‘realistic’ (median [range] score 8 [4–10] out of 10) and ‘very useful’ for training of residents (median [range] score 9 [5–10] out of 10). Overall, expert surgeons completed all dry lab tasks more efficiently (P < 0.001) and effectively (GEARS total score P < 0.001) than novices. In addition, experts outperformed novices in each individual GEARS metric (P < 0.001). Finally, in comparing dry lab with simulator performance, there was a moderate correlation overall (r = 0.54, P < 0.001). Most simulator metrics correlated moderately to strongly with corresponding GEARS metrics (r = 0.54, P < 0.001). Conclusions The robotic dry lab exercises in the present study have face, content, construct and concurrent validity with the corresponding VR tasks. Until now, the assessment of dry lab exercises has been limited to basic metrics (i.e. time to completion and error avoidance). For the first time, we have shown it is feasibile to apply a global assessment tool (GEARS) to dry lab training.
       
  • Does prostate HistoScanning™ play a role in detecting prostate
           cancer in routine clinical practice' Results from three independent
           studies
    • Abstract: Objectives To evaluate the ability of prostate HistoScanning™ (PHS; Advanced Medical Diagnostics, Waterloo, Belgium) to detect, characterize and locally stage prostate cancer, by comparing it with transrectal ultrasonography (TRUS)‐guided prostate biopsies, transperineal template prostate biopsies (TTBs) and whole‐mount radical prostatectomy specimens. Subjects and Methods Study 1. We recruited 24 patients awaiting standard 12‐core TRUS‐guided biopsies of the prostate to undergo PHS immediately beforehand. We compared PHS with the TRUS‐guided biopsy results in terms of their ability to detect cancer within the whole prostate and to localize it to the correct side and to the correct region of the prostate. Lesions that were suspicious on PHS were biopsied separately. Study 2. We recruited 57 patients awaiting TTB to have PHS beforehand. We compared PHS with the TTB pathology results in terms of their ability to detect prostate cancer within the whole gland and to localize it to the correct side and to the correct sextant of the prostate. Study 3. We recruited 24 patients awaiting radical prostatectomy for localized prostate cancer to undergo preoperative PHS. We compared PHS with standardized pathological analysis of the whole‐mount prostatectomy specimens in terms of their measurement of total tumour volume within the prostate, tumour volume within prostate sextants and volume of index lesions identified by PHS. Results The PHS‐targeted biopsies had an overall cancer detection rate of 38.1%, compared with 62.5% with standard TRUS‐guided biopsies. The sensitivity and specificity of PHS for localizing tumour to the correct prostate sextant, compared with standard TRUS‐guided biopsies, were 100 and 5.9%, respectively. The PHS‐targeted biopsies had an overall cancer detection rate of 13.4% compared with 54.4% for standard TTB. PHS had a sensitivity and specificity for cancer detection in the posterior gland of 100 and 13%, respectively, and for the anterior gland, 6 and 82%, respectively. We found no correlation between total tumour volume estimates from PHS and radical prostatectomy pathology (Pearson correlation coefficient −0.096). Sensitivity and specificity of PHS for detecting tumour foci ≥0.2 mL in volume were 63 and 53%. Conclusions These three independent studies in 105 patients suggest that PHS does not reliably identify and characterize prostate cancer in the routine clinical setting.
       
  • Phase III, randomised, double‐blind, placebo‐controlled study
           of the β3‐adrenoceptor agonist mirabegron, 50 mg once
           daily, in Japanese patients with overactive bladder
    • Abstract: Objective To evaluate the efficacy and safety of the β3‐adrenoceptor agonist mirabegron, in a Japanese population with overactive bladder (OAB). Patients and Methods This randomised, double‐blind, placebo‐controlled phase III study enrolled adult patients experiencing OAB symptoms for ≥24 weeks. Patients with ≥ 8 micturitions/24 h and ≥1 urgency episode/24 h or ≥1 urgency incontinence episode/24 h were randomised to once‐daily placebo, mirabegron 50 mg or tolterodine 4 mg (as an active comparator, without testing for non‐inferiority of efficacy and safety) for 12 weeks. The primary endpoint was the change in the mean number of micturitions/24 h from baseline to final assessment. Secondary endpoints included micturition variables related to urgency and/or incontinence and quality‐of‐life domain scores on the King's Health Questionnaire. Safety assessments included adverse events (AEs), post‐void residual urine volume, laboratory variables, vital signs and 12‐lead electrocardiogram. Results A total of 1139 patients were randomised to receive placebo (n = 381), mirabegron 50 mg (n = 380) or tolterodine 4 mg (n = 378). Demographic and baseline characteristics were similar among the treatment groups. At final assessment, mirabegron was significantly superior to placebo in terms of mean [sd] change from baseline in number of micturitions/24 h (–1.67 [2.212] vs ‐0.86 [2.354]; P < 0.001) and mean [sd] change from baseline in number of urgency episodes/24 h (–1.85 [2.555] vs –1.37 [3.191]; P = 0.025), incontinence episodes/24 h (–1.12 [1.475] vs –0.66 [1.861]; P = 0.003), urgency incontinence episodes/24 h (–1.01 [1.338] vs –0.60 [1.745]; P = 0.008), and volume voided/micturition (24.300 [35.4767] vs 9.715 [29.0864] mL; P < 0.001). The incidence of AEs in the mirabegron group was similar to that in the placebo group. Most AEs were mild and none were severe. Conclusions Mirabegron 50 mg once daily is an effective treatment for OAB symptoms, with a low occurrence of side effects in a Japanese population.
       
  • Subclassification of upper urinary tract urothelial carcinoma by the
           neutrophil‐to‐lymphocyte ratio (NLR) improves prediction of
           oncological outcome
    • Abstract: Objective To examine the potential role of the neutrophil‐to‐lymphocyte ratio (NLR) for subclassification of localised upper urinary tract urothelial carcinoma (UUT‐UC). Patients and Methods From 2004 to 2010, 234 patients with localised UUT‐UC underwent radical nephroureterectomy (RNU). NLRs were only obtained under afebrile conditions before RNU. Patients that underwent neoadjuvant or adjuvant chemotherapy were excluded. The prognostic impact of the NLR was assessed using the log‐rank test and multivariate analyses. Results Only advanced pathological stage (>T2) and a NLR of >3 were independently associated with metastasis (P < 0.001 and P = 0.02, respectively) and cancer‐specific mortality (P = 0.002 and P = 0.006, respectively). The use of a NLR of >3 further identified a poor prognostic group, especially in patients with T3 UUT‐UC for metastasis‐free survival and cancer‐specific survival (log‐rank test, both P < 0.001). Conclusions For localised UUT‐UC, pathological stage and preoperative NLR independently predict systemic recurrence and cancer‐specific death after RNU. Using the NLR for subclassification of T3 UUT‐UC seems to further identify a poor prognostic group and may help with clinical decisions about treatment intervention in clinical practice.
       
  • Neoadjuvant chemotherapy for bladder cancer does not increase risk of
           perioperative morbidity
    • Abstract: Objective To determine whether neoadjuvant chemotherapy (NAC) is a predictor of postoperative complications, length of stay (LOS), or operating time after radical cystectomy (RC) for bladder cancer. Patients and Methods A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed to identify patients receiving NAC before RC from 2005 to 2011. Bivariable and multivariable analyses were used to determine whether NAC was associated with 30‐day perioperative outcomes, e.g. complications, LOS, and operating time. Results Of the 878 patients who underwent RC for bladder cancer in our study, 78 (8.9%) received NAC. Excluding those patients who were ineligible for NAC due to renal insufficiency, 78/642 (12.1%) received NAC. In all, 457 of the 878 patients (52.1%) undergoing RC had at least one complication ≤30 days of RC, including 43 of 78 patients (55.1%) who received NAC and 414 of 800 patients (51.8%) who did not (P = 0.58). On multivariable logistic regression, NAC was not a predictor of complications (P = 0.87), re‐operation (P = 0.16), wound infection (P = 0.32), or wound dehiscence (P = 0.32). Using multiple linear regression, NAC was not a predictor of increased operating time (P = 0.24), and patients undergoing NAC had a decreased LOS (P = 0.02). Conclusions Our study is the first large multi‐institutional analysis specifically comparing complications after RC with and without NAC. Using a nationally validated, prospectively maintained database specifically designed to measure perioperative outcomes, we found no increase in perioperative complications or surgical morbidity with NAC. Considering these findings and the well‐established overall survival benefit over surgery alone, efforts are needed to improve the uptake of NAC.
       
  • The Cancer of the Prostate Risk Assessment (CAPRA) score predicts
           biochemical recurrence in intermediate‐risk prostate cancer treated
           with external beam radiotherapy (EBRT) dose escalation or low‐dose
           rate (LDR) brachytherapy
    • Abstract: Objective To study the prognostic value of the University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) after various doses of external beam radiotherapy (EBRT) and/or permanent seed low‐dose rate (LDR) prostate brachytherapy (PB). Patients and Methods We retrospectively analysed 345 patients with intermediate‐risk prostate cancer, with PSA levels of 10–20 ng/mL and/or Gleason 7 including 244 EBRT patients (70.2–79.2 Gy) and 101 patients treated with LDR PB. The minimum follow‐up was 3 years. No patient received primary androgen‐deprivation therapy. bF was defined according to the Phoenix definition. Cox regression analysis was used to estimate the differences between CAPRA groups. Results The overall bF rate was 13% (45/345). The CAPRA score, as a continuous variable, was statistically significant in multivariate analysis for predicting bF (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.10–1.72, P = 0.006). There was a trend for a lower bF rate in patients treated with LDR PB when compared with those treated by EBRT ≤ 74 Gy (HR 0.234, 95% CI 0.05–1.03, P = 0.055) in multivariate analysis. In the subgroup of patients with a CAPRA score of 3–5, CAPRA remained predictive of bF as a continuous variable (HR 1.51, 95% CI 1.01–2.27, P = 0.047) in multivariate analysis. Conclusion The CAPRA score is useful for predicting biochemical recurrence in patients treated for intermediate‐risk prostate cancer with EBRT or LDR PB. It could help in treatment decisions.
       
  • Prevalence of the HOXB13 G84E prostate cancer risk allele in men
           treated with radical prostatectomy
    • Abstract: Objective To determine the prevalence and clinical correlates of the G84E mutation in the homeobox transcription factor, or HOXB13, gene using DNA samples from 9559 men with prostate cancer undergoing radical prostatectomy. Patients and Methods DNA samples from men treated with radical prostatectomy at the University of Michigan and John Hopkins University were genotyped for G84E and this was confirmed by Sanger sequencing. The frequency and distribution of this allele was determined according to specific patient characteristics (family history, age at diagnosis, pathological Gleason grade and stage). Results Of 9559 patients, 128 (1.3%) were heterozygous carriers of G84E. Patients who possessed the variant were more likely to have a family history of prostate cancer than those who did not (46.0 vs 35.4%; P = 0.006). G84E carriers were also more likely to be diagnosed at a younger age than non‐carriers (55.2 years vs 58.1 years; P < 0.001). No difference in the proportion of patients diagnosed with high grade or advanced stage tumours according to carrier status was observed. Conclusions In the present study, carriers of the rare G84E variant in HOXB13 were both younger at the time of diagnosis and more likely to have a family history of prostate cancer compared with homozygotes for the wild‐type allele. No significant differences in allele frequency were detected according to selected clinical characteristics of prostate cancer. Further investigation is required to evaluate the role of HOXB13 in prostate carcinogenesis.
       
 
 
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