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Publisher: John Wiley and Sons   (Total: 1605 journals)

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J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3, SJR: 0.378, h-index: 23)
J. of Medical Primatology     Hybrid Journal   (Followers: 1, SJR: 0.473, h-index: 28)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 0.936, h-index: 82)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 2.003, h-index: 72)
J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.655, h-index: 70)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 22, SJR: 0.439, h-index: 32)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 0.986, h-index: 56)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 23, SJR: 2.196, h-index: 55)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.602, h-index: 44)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.314, h-index: 23)
J. of Muscle Foods     Hybrid Journal   (Followers: 4)
J. of Neurochemistry     Hybrid Journal   (SJR: 1.754, h-index: 162)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 4, SJR: 1.038, h-index: 75)
J. of Neuroimaging     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 39)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.218, h-index: 113)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 2)
J. of Nursing Management     Hybrid Journal   (Followers: 17, SJR: 1.028, h-index: 34)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 3, SJR: 0.903, h-index: 45)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 18, SJR: 0.499, h-index: 37)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 13, SJR: 0.371, h-index: 30)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.632, h-index: 51)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 2, SJR: 0.729, h-index: 51)
J. of Organizational Behavior     Hybrid Journal   (Followers: 28, SJR: 2.541, h-index: 83)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 14, SJR: 1.246, h-index: 96)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.439, h-index: 46)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 3.025, h-index: 122)
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.662, h-index: 42)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.596, h-index: 53)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 1.803, h-index: 75)
J. of Petroleum Geology     Hybrid Journal   (Followers: 4, SJR: 0.471, h-index: 22)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 269, SJR: 1.206, h-index: 102)
J. of Philosophy of Education     Hybrid Journal   (Followers: 8, SJR: 0.491, h-index: 17)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 0.864, h-index: 77)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.603, h-index: 45)
J. of Phytopathology     Hybrid Journal   (Followers: 2, SJR: 0.513, h-index: 33)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 1.435, h-index: 73)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.732, h-index: 44)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 13, SJR: 1.297, h-index: 43)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 5, SJR: 0.684, h-index: 8)
J. of Political Philosophy     Hybrid Journal   (Followers: 29, SJR: 1.774, h-index: 26)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 202, SJR: 1.281, h-index: 98)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 0.932, h-index: 87)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.142, h-index: 2)
J. of Product Innovation Management     Hybrid Journal   (Followers: 15, SJR: 2.157, h-index: 72)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.358, h-index: 28)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 50, SJR: 0.473, h-index: 35)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 2)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.294, h-index: 5)
J. of Public Economic Theory     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 8)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.546, h-index: 38)
J. of Quaternary Science     Hybrid Journal   (Followers: 23, SJR: 1.543, h-index: 59)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.138, h-index: 62)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 9, SJR: 1.961, h-index: 36)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.189, h-index: 8)
J. of Religious History     Hybrid Journal   (Followers: 17, SJR: 0.133, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.32, h-index: 11)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.81, h-index: 19)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 11, SJR: 2.998, h-index: 62)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.349, h-index: 8)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.634, h-index: 47)
J. of Risk & Insurance     Hybrid Journal   (Followers: 10, SJR: 1.138, h-index: 32)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 0.79, h-index: 47)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 0.65, h-index: 27)
J. of Separation Science     Hybrid Journal   (Followers: 7, SJR: 1.092, h-index: 55)
J. of Sexual Medicine     Hybrid Journal   (Followers: 7, SJR: 1.006, h-index: 57)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.05, h-index: 67)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.737, h-index: 39)
J. of Small Business Management     Hybrid Journal   (Followers: 10, SJR: 0.988, h-index: 42)
J. of Social Issues     Hybrid Journal   (Followers: 17, SJR: 1.532, h-index: 63)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.118, h-index: 3)
J. of Sociolinguistics     Hybrid Journal   (Followers: 13, SJR: 1.511, h-index: 18)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 2)
J. of Supreme Court History     Hybrid Journal   (Followers: 7)
J. of Surgical Oncology     Hybrid Journal   (Followers: 1, SJR: 1.024, h-index: 69)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.933, h-index: 19)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.601, h-index: 29)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.36, h-index: 23)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 23, SJR: 1.167, h-index: 119)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 19, SJR: 1.673, h-index: 138)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 198, SJR: 1.555, h-index: 74)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 0.817, h-index: 56)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 4)
J. of the CardioMetabolic Syndrome     Hybrid Journal  
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 9, SJR: 1.211, h-index: 51)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 3, SJR: 0.535, h-index: 35)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 2, SJR: 0.46, h-index: 13)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.528, h-index: 25)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 2, SJR: 0.935, h-index: 40)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 30, SJR: 1.128, h-index: 25)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 11, SJR: 1.258, h-index: 44)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 22, SJR: 5.518, h-index: 75)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 15, SJR: 0.877, h-index: 47)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 21, SJR: 0.781, h-index: 80)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.521, h-index: 30)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)

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Journal Cover BJU International     [SJR: 1.381]   [H-I: 96]
   [241 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  [1605 journals]
  • Pathological factors associated with survival benefit from adjuvant
           chemotherapy (ACT): a population‐based study of bladder cancer
    • Authors: Christopher M. Booth; D. Robert Siemens, Xuejiao Wei, Yingwei Peng, David M. Berman, William J. Mackillop
      Pages: n/a - n/a
      Abstract: Objective To evaluate whether pathological factors are associated with differential effect of adjuvant chemotherapy (ACT). Patients and Methods In this population‐based retrospective cohort study, we linked electronic records of treatment and surgical pathology to the Ontario Cancer Registry. The study population included all patients with muscle‐invasive bladder cancer undergoing cystectomy in Ontario 1994–2008. Factors associated with overall (OS) and cancer‐specific survival (CSS) were evaluated using Cox proportional hazards. We tested for interaction between the following variables and ACT effect‐size: N‐stage, margin status, T‐stage, and lymphovascular invasion (LVI). Results The study population included 2802 patients; 19% were treated with ACT. Interaction terms with ACT for OS/CSS are: N‐stage (both P < 0.001); margin status (P = 0.054/P = 0.048); T‐stage (P = 0.509/P = 0.286); and LVI (P = 0.361/P = 0.405). Magnitude of effect for ACT was greater for patients with node‐positive disease [OS: hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.47–0.67; CSS: HR 0.60, 95% CI 0.49–0.72] than for patients with node‐negative disease (OS: HR 0.80, 95% CI 0.61–1.03; CSS: HR 0.79, 95% CI 0.59–1.07). ACT was also associated with greater effect among patients with involved margins (OS: HR 0.45, 95% CI 0.33–0.62; CSS: HR 0.40, 95% CI 0.28–0.57) compared with patients with negative margins (OS: HR 0.75, 95% CI 0.65–0.87; CSS: HR 0.79, 95% CI 0.67–0.93). Conclusions In this population‐based cohort study we observe evidence of interaction between ACT effect and nodal stage and surgical margin status. Our results suggest that patients at highest risk of disease recurrence may derive greatest benefit from ACT.
      PubDate: 2014-12-29T04:36:16.753374-05:
      DOI: 10.1111/bju.12913
       
  • Docetaxel rechallenge after an initial good response in patients with
           metastatic castration‐resistant prostate cancer
    • Authors: Stéphane Oudard; Gero Kramer, Orazio Caffo, Lorraine Creppy, Yohan Loriot, Steinbjoern Hansen, Mats Holmberg, Frederic Rolland, Jean‐Pascal Machiels, Michael Krainer
      Pages: n/a - n/a
      Abstract: Objective To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration‐resistant prostate cancer (mCRPC) relapsing after an initial good response to first‐line docetaxel. Patients and Methods We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first‐line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non‐taxane‐based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome. Results We identified 270 good responders to first‐line docetaxel. The median progression‐free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non‐taxane‐based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1–22.00] and 16.8 [95%CI 13.4–21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.
      PubDate: 2014-12-29T04:35:23.556419-05:
      DOI: 10.1111/bju.12845
       
  • Non‐steroidal antiandrogen monotherapy compared with luteinising
           hormone–releasing hormone agonists or surgical castration
           monotherapy for advanced prostate cancer: a Cochrane systematic review
    • Authors: Frank Kunath; Henrik R. Grobe, Gerta Rücker, Edith Motschall, Gerd Antes, Philipp Dahm, Bernd Wullich, Joerg J. Meerpohl
      Abstract: Objective ● To assess the effects of non‐steroidal antiandrogen monotherapy compared with luteinising hormone–releasing hormone agonists or surgical castration monotherapy for treating advanced hormone‐sensitive stages of prostate cancer. Materials and Methods ● We searched the Cochrane Prostatic Diseases and Urologic Cancers Group Specialized Register (PROSTATE), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science with Conference Proceedings, three trial registries and abstracts from three major conferences to 23 December 2013, together with reference lists, and contacted selected experts in the field and manufacturers. ● We included randomised controlled trials comparing non‐steroidal antiandrogen monotherapy with medical or surgical castration monotherapy for men in advanced hormone‐sensitive stages of prostate cancer. ● Two review authors independently examined full‐text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias as well as quality of evidence according to GRADE. ● We used Review Manager 5.2 for data synthesis and used the fixed‐effect model as primary analysis (when heterogeneity low with I2 less than 50%); we used a random‐effects model when confronted with substantial or considerable heterogeneity (I2 ≥ 50%). Results ● Eleven studies involving 3060 randomly assigned participants were included in this review. Use of non‐steroidal antiandrogens decreased overall survival (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.05 to 1.48, six studies, 2712 participants) and increased clinical progression (one year: risk ratio (RR) 1.25, 95% CI 1.08 to 1.45, five studies, 2067 participants; 70 weeks: RR 1.26, 95% CI 1.08 to 1.45, six studies, 2373 participants; two years: RR 1.14, 95% CI 1.04 to 1.25, three studies, 1336 participants), as well as treatment failure (one year: RR 1.19, 95% CI 1.02 to 1.38, four studies, 1539 participants; 70 weeks: RR 1.27, 95% CI 1.05 to 1.52, five studies, 1845 participants; two years: RR 1.14, 95% CI 1.05 to 1.24, two studies, 808 participants), compared with medical or surgical castration. ● The quality of evidence for overall survival, clinical progression and treatment failure was rated as moderate according to GRADE. ● Use of non‐steroidal antiandrogens increased the risk for treatment discontinuation due to adverse events (RR 1.82, 95% CI 1.13 to 2.94, eight studies, 1559 participants), including events such as breast pain (RR 22.97, 95% CI 14.79 to 35.67, eight studies, 2670 participants) and gynaecomastia (RR 8.43, 95% CI 3.19 to 22.28, nine studies, 2774 participants) The risk of other adverse events, such as hot flashes (RR 0.23, 95% CI 0.19 to 0.27, nine studies, 2774 participants) was decreased when non‐steroidal antiandrogens were used. The quality of evidence for breast pain, gynaecomastia and hot flashes was rated as moderate according to GRADE. ● The effects of non‐steroidal antiandrogens on cancer‐specific survival and biochemical progression remained unclear. Conclusions ● Non‐steroidal antiandrogen monotherapy compared to medical or surgical castration monotherapy for advanced prostate cancer is less effective in terms of overall survival, clinical progression, treatment failure and treatment discontinuation due to adverse events. ● Evidence quality was rated as moderate according to GRADE; therefore further research is likely to have an important impact on results for patients with advanced but non‐metastatic prostate cancer treated with non‐steroidal antiandrogen monotherapy.
      PubDate: 2014-12-18T15:42:16.9154-05:00
      DOI: 10.1111/bju.13026
       
  • Patient experience and satisfaction with Onabotulinumtoxin A for
           refractory overactive bladder
    • Authors: S Malde; C Dowson, O Fraser, J Watkins, MS Khan, P Dasgupta, A Sahai
      Abstract: Objective ● To evaluate the patient experience of our dedicated botulinum toxin A (BTX‐A) service using a validated patient‐reported experience measure (PREM) and asses patient‐reported satisfaction with treatment. Materials and methods ● The first 100 patients who underwent BTX‐A treatment for refractory idiopathic detrusor overactivity (IDO) in our institution were contacted for telephone interview. They had all been assessed, injected and followed up in a dedicated BTX‐A clinic. ● Patients were asked to complete a validated PREM‐ the Client Satisfaction Questionnaire (CSQ‐8)‐ as well as a questionnaire developed in our department to assess satisfaction with the results of the treatment. ● The majority of patients received 200 U OnabotulinumtoxinA (Botox®) via an outpatient local anesthetic flexible cystoscopy technique. Results ● Complete data was available for 72 patients. Forty‐nine patients were continuing to receive BTX‐A treatment whilst 23 had opted for no further injections. ● The overall mean CSQ‐8 satisfaction score was 38.3 (SD 3.3) indicating a high level of patient satisfaction with the service offered in our institution. There was a significant difference in total satisfaction scores between those still receiving BTX‐A (mean score 29.8) and those who have discontinued treatment (mean score 25.1) (p
      PubDate: 2014-12-18T15:42:08.871009-05:
      DOI: 10.1111/bju.13025
       
  • Transperineal template‐guided prostate biopsy: 10 years of
           experience
    • Authors: Zhipeng Mai; Weigang Yan, Yi Zhou, Zhien Zhou, Jian Chen, Yu Xiao, Zhiyong Liang, Zhigang Ji, Hanzhong Li
      Abstract: Objective • To assess the efficacy and safety of transperineal template‐guided prostate biopsy. Materials and Methods • From December 2003 to December 2013, a total of 3007 patients (30‐91 years old, mean age 69.1) who met the inclusion criteria underwent 11‐region transrectal ultrasound‐guided transperineal template prostate biopsy. • The inclusion criteria included a prostate‐specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 ng/ml (range 0.2‐100 ng/ml). • The prostate cancer detection rate and prostate biopsy adverse effects, as well as prostate cancer spatial distribution were analyzed. Results • A mean of 19.3 cores (range 11 to 44) were obtained for each biopsy, and more cores were obtained in larger prostates than in smaller ones. • One to four cores were collected from each region. Prostate cancer was detected in 1067 of the 3007 patients (35.5%). The prostate cancer detection rates in groups with PSA levels of 0‐4.0 ng/ml, 4.1‐10.0 ng/ml, 10.1‐20.0 ng/ml, 20.1‐50.0 ng/ml, and 50.1‐100.0 ng/ml were 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), 56.0% (232/414), and 92.0% (241/262), respectively. • The mean positives for cancer in regions 1‐10 and region 11 (the apical region) were 46.7% vs. 52.0% (P=0.014). • Regarding adverse effects, 47.0% of the patients reported hematuria, 6.1% developed hemospermia, 1.9% required short‐term catheterization after biopsy because of acute urinary retention, and 0.03% (one patient) developed urosepsis. Conclusions • Transrectal ultrasound‐guided transperineal template prostate biopsy is safe and accurate. • The current study suggests that prostate carcinoma foci are more frequently localized in the apical region.
      PubDate: 2014-12-18T15:42:00.797458-05:
      DOI: 10.1111/bju.13024
       
  • Comparison of systematic transrectal biopsy to transperineal
           MRI/ultrasound‐fusion biopsy for the diagnosis of prostate cancer
    • Authors: Angelika Borkowetz; Ivan Platzek, Marieta Toma, Michael Laniado, Gustavo Baretton, Michael Froehner, Rainer Koch, Manfred Wirth, Stefan Zastrow
      Abstract: Objectives • To compare targeted, transperineal MRI/ultrasound‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy. • To evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/ultrasound‐fusion biopsies. Patients and methods • 263 consecutive patients with suspicion of prostate cancer (PCa) were investigated. • All patients were evaluated by 3 Tesla multiparametric magnetic resonance imaging (mpMRI) applying the European Society of Urogenital Radiology (ESUR) criteria. • All patients underwent MRI/ultrasound‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). Results • 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. • Median age was 66yrs, median PSA‐level was 8.3ng/mL, median prostate volume was 50mL. Overall, PCa detection rate was 52% (137/263). • MRI/ultrasound‐fusion biopsy detected significantly more PCa than systematic prostate biopsy (44% (116/263) vs. 35% (91/263); p=0.0023). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (p=0.0023). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (p=0.5271). • 80% (110/137) of biopsy‐proven PCa were clinically significant. • Regarding the upgrading of Gleason Score (GS), 44% (32/72) more clinically significant PCa was detected by using additional targeted biopsy compared to systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. Conclusions • MRI/ultrasound‐fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores both, especially in patients with prior negative biopsy. • Due to a high portion of additional tumours with GS ≥ 7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
      PubDate: 2014-12-18T15:39:59.56117-05:0
      DOI: 10.1111/bju.13023
       
  • The treatment of penile carcinoma in situ (CIS) within a UK
           supra‐regional network
    • Authors: Marc Lucky; Kusuma V.R. Murthy, Beverley Rogers, Stephen Jones, Maurice W. Lau, Vijay K. Sangar, Nigel J. Parr
      Abstract: Objectives To review outcomes of the treatment of carcinoma in situ (CIS) of the penis at a large supra‐regional penile cancer network, where centralisation has permitted greater experience with treatment outcomes, and suggest treatment strategies. Patients and Methods The network penile cancer database, which details presentation, treatment and complications was analysed from 2003 to 2010, identifying patients with CIS, with a minimum follow‐up of 2 years, looking at treatments administered and outcomes. Results In all, 57 patients with mean (range) age of 61 (34–91) years were identified. In all, 18 were treated by circumcision only, 20 by circumcision and local excision (LE) and 19 by circumcision and 5‐flurouracil (5‐FU). The mean (range) follow‐up was 3.5 (2–8) years. Of those treated by circumcision none subsequently developed CIS on the glans. For those who underwent circumcision + LE, five of 20 (25%) developed recurrence requiring further treatment. Of those treated by circumcision + 5‐FU, 14/19 (73.7%) completely responded. Of the five incomplete responders, two had focal invasive malignancy at repeat biopsy. One incomplete responder underwent glansectomy and four grafting. No complete responders relapsed. Complications of 5‐FU included significant inflammatory response in seven (36.8%), with two requiring hospital admission and one neo‐phimosis (5.3%). Conclusion This study suggests that patients undergoing circumcision for isolated CIS and complete responders to 5‐FU may require only short‐term follow‐up, as recurrence is unlikely, whereas longer follow up is required for all other patients. However, numbers in this study are small and larger studies are needed to support this. An incomplete response to 5‐FU dictates immediate re‐biopsy, as it carries a significant chance of previously undetected invasive disease.
      PubDate: 2014-12-15T21:59:54.564311-05:
      DOI: 10.1111/bju.12878
       
  • Does cumulative prostate cancer length (CCL) in prostate biopsies improve
           prediction of clinically insignificant cancer at radical prostatectomy in
           patients eligible for active surveillance'
    • Authors: Derrick J. Chen; Sara M. Falzarano, Jesse K. McKenney, Chris G. Przybycin, Jordan P. Reynolds, Andres Roma, J. Stephen Jones, Andrew Stephenson, Eric Klein, Cristina Magi‐Galluzzi
      Abstract: Objectives To evaluate if cumulative prostate cancer length (CCL) on prostate needle biopsy divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer on radical prostatectomy (RP) in patients with prostate cancer eligible for active surveillance (AS). Patients and Methods Patients diagnosed with prostate cancer on extended (≥10 cores) biopsy with an initial prostate‐specific antigen (iPSA) level of
      PubDate: 2014-12-15T21:59:39.989825-05:
      DOI: 10.1111/bju.12880
       
  • Modified transurethral resection of the prostate (TURP) for men with
           moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe
           and feasible
    • Authors: Philip Brousil; Muddassar Hussain, Mark Lynch, Robert W. Laing, Stephen E.M. Langley
      Abstract: Objective To report the urinary toxicity outcomes for patients at greater risk of voiding symptoms and retention who received a modified limited transurethral resection of the prostate (TURP) before low‐dose rate (LDR) brachytherapy. Patients and Method Data were analysed from patients receiving the above procedures between 2006 to present, taken from the prospective brachytherapy database of 2000 patients at the St. Luke's Cancer Centre. The limited TURP (TURPBXT) was performed at a median (range) of 64 (25–205) days before seed implantation with a median resection weight of 1.15 g. Selection criteria were based on patients with moderate lower urinary tract symptoms, poor flow or post‐void residual urine volume (PVR), or a prominent middle lobe or high bladder neck on transrectal ultrasonography. Baseline prostate cancer characteristics, uroflowmetry, International Prostate Symptom Score (IPSS) and quality‐of‐life QoL scores were collected and compared with follow‐up IPSS and QoL scores. Results Data for 112 patients was gathered from the database. The TURPBXT resulted in statistically significant improvements before LDR brachytherapy in maximum urinary flow rate (Qmax) and PVR, IPSS and QoL scores (the mean Qmax before vs after the TURPBXT was 11.3 vs 16.7 mL/s). The IPSS and QoL scores at 6 months after seed implantation were increased compared with baseline values before the TURPBXT (mean IPSS at 6 months 11.7 vs 9.2 before TURPBXT), but no difference at 1 year (mean IPSS 9), and improved scores at 2, 3, 4 and 5 years follow‐up (mean IPSS of 7.9, 5.6, 5.3 and 7.4, respectively). Conclusion The present study suggests patients at increased risk of deteriorating voiding symptoms, including urinary retention, are no longer contraindicated against LDR brachytherapy if they receive a modified TURP before seed implantation. This procedure does not appear to carry the risk of urinary incontinence thought to be associated with a conventional TURP before LDR brachytherapy.
      PubDate: 2014-12-15T21:59:26.44602-05:0
      DOI: 10.1111/bju.12798
       
  • Extraprostatic extension (EPE) of prostatic carcinoma: is its proximity to
           the surgical margin or Gleason score important'
    • Authors: Ruta Gupta; Rachel O'Connell, Anne‐Maree Haynes, Phillip D. Stricker, Wade Barrett, Jennifer J. Turner, Warick Delprado, Lisa G. Horvath, James G. Kench
      Abstract: Objective To examine the association between histopathological factors of extraprostatic prostate cancer and outcome. Patients and Methods Patients with extraprostatic extension (EPE) without positive margins, seminal vesicle or lymph node involvement were analysed from a consecutive radical prostatectomy cohort of 1136 (2002–2006) for: (i) distance of EPE from the margin; (ii) Gleason score of the EPE; and (iii) extent of EPE. Log‐rank, Kaplan–Meier, and Cox regression analyses were performed. Results The study included 194 pT3a, pN0, R0 patients with a median follow‐up of 5.4 years, with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with a Gleason score of ≥8 in the extraprostatic portion showed increased incidence of BCR compared with those with Gleason scores of ≤7 (P = 0.03). The proximity of the EPE to the margin (0.01–7.5 mm) did not correlate with BCR. On multivariable analysis, the extent of EPE, the Gleason score of the dominant nodule or of the EPE portion did not correlate with BCR. Conclusion Data from this study using current International Society of Urological Pathology Gleason scoring and EPE criteria indicate that close proximity of EPE to the margin is not associated with recurrence. Gleason score ≥8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.
      PubDate: 2014-12-15T21:57:05.449175-05:
      DOI: 10.1111/bju.12911
       
  • Comparison of magnetic resonance imaging and ultrasound (MRI‐US)
           fusion‐guided prostate biopsies obtained from axial and sagittal
           approaches
    • Authors: Cheng W. Hong; Soroush Rais‐Bahrami, Annerleim Walton‐Diaz, Nabeel Shakir, Daniel Su, Arvin K. George, Maria J. Merino, Baris Turkbey, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto
      Abstract: Objective To compare cancer detection rates and concordance between magnetic resonance imaging and ultrasound (MRI‐US) fusion‐guided prostate biopsy cores obtained from axial and sagittal approaches. Patients and Methods Institutional records of MRI‐US fusion‐guided biopsy were reviewed. Detection rates for all cancers, Gleason ≥3 + 4 cancers, and Gleason ≥4 + 3 cancers were computed. Agreement between axial and sagittal cores for cancer detection, and frequency where one was upgraded the other was computed on a per‐target and per‐patient basis. Results In all, 893 encounters from 791 patients that underwent MRI‐US fusion‐guided biopsy in 2007–2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis. The mean age and PSA level at each encounter was 61.8 years and 9.7 ng/mL (median 6.45 ng/mL). Detection rates for all cancers, ≥3 + 4 cancers, and ≥4 + 3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores. Per‐target agreement was 88.6%, 93.0%, and 96.5%, respectively. On a per‐target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores, respectively. Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under‐characterisation of cancer in 4.7% or 5.2% of patients, respectively. Conclusion Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target. Discordance between axial and sagittal cores is greatest in intermediate‐risk scenarios, where obtaining multiple cores may improve tissue characterisation.
      PubDate: 2014-12-15T21:56:08.7013-05:00
      DOI: 10.1111/bju.12871
       
  • Hypoalbuminaemia is associated with mortality in patients undergoing
           cytoreductive nephrectomy
    • Authors: Anthony T. Corcoran; Samuel D. Kaffenberger, Peter E. Clark, John Walton, Elizabeth Handorf, Zack Piotrowski, Jeffery J. Tomaszewski, Serge Ginzburg, Reza Mehrazin, Elizabeth Plimack, David Y.T. Chen, Marc C. Smaldone, Robert G. Uzzo, Todd M. Morgan, Alexander Kutikov
      Abstract: Objective To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). Patients and Methods A multi‐institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index
      PubDate: 2014-12-15T21:43:22.446871-05:
      DOI: 10.1111/bju.12897
       
  • Effectiveness of hexaminolevulinate fluorescence cystoscopy for the
           diagnosis of non‐muscle‐invasive bladder cancer in daily
           clinical practice: a Spanish multicentre observational study
    • Authors: J Palou; C Hernández, E Solsona, R ABascal, JP Burgués, C Rioja, JA Cabrera, C Gutiérrez, O Rodríguez, I Iborra, F Herranz, JM Abascal, G Conde, J Oliva
      Abstract: Objective To assess the sensitivity and specificity of blue‐light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white‐light cystoscopy (WLC) versus WLC alone for the detection of non‐muscle‐invasive bladder cancer (NMIBC), in routine clinical practice in Spain. Material and Methods An intra‐patient comparative, multicentre, prospective, observational study. Adult patients with suspected or documented primary or recurrent NMIBC at eight Spanish centres were included in the study. All patients were examined with WLC followed by BLC with hexaminolevulinate. We evaluated the detection rate of bladder cancer lesions by WLC and BLC with hexaminolevulinate, overall and by tumour stage and compared with histological examination of the biopsied lesions. Sensitivity and specificity was calculated. Results 1,569 lesions were identified from 283 patients: 621 were tumour lesions according to histology and 948 were false‐positives. Of the 621 tumour lesions, 475 were detected by WLC (sensitivity 76.5%; 95% CI 73.2–79.8) and 579 were detected by BLC (sensitivity 93.2%; 95% CI 91.0–95.1; p
      PubDate: 2014-12-15T06:10:49.570807-05:
      DOI: 10.1111/bju.13020
       
  • A trial of devices for urinary incontinence following treatment for
           prostate cancer
    • Authors: M Macaulay; J Broadbridge, H Gage, P Williams, B Birch, K N Moore, A Cottenden, M J Fader
      Abstract: Objective •  To compare performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (> 1yr) post treatment for prostate cancer. •  Patients and Methods •  Randomised, controlled trial of 56 men with one year follow up. •  Three devices were tested for three weeks each: sheath drainage system, body‐worn urinal, penile clamp. Device and pad performance were assessed. •  Quality of life (QOL) was measured at baseline and follow‐up with the King's Health Questionnaire. •  Stated (intended use) and revealed (actual use) preference for products was assessed •  Value‐for‐money was gathered. Results Substantial and significant differences in performance were found: •  Sheath: good for extended use (e.g. golf and travel) when pad changing is difficult. Good for keeping skin dry, not leaking, not smelling and convenient for storage and travel; •  Body‐worn urinal: generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis); not good for seated activities. •  Clamp: good for short vigorous activities like swimming/exercise. Most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. •  Pads: good for everyday activities and best for night‐time use. Most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. •  A preference for having a mixture of products to meet daytime needs; around two thirds of men were using a combination of pads and devices after testing compared to baseline. Conclusions •  This is the first trial to systematically compare different continence management devices for men •  Pads and devices have different strengths which make them particularly suited to certain circumstances and activities. •  Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. •  Device limitations were important but may be overcome by better design.
      PubDate: 2014-12-11T06:36:36.134753-05:
      DOI: 10.1111/bju.13016
       
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • Authors: Jonathan Lo; Nathan Papa, Damien M Bolton, Declan Murphy, Nathan Lawrentschuk
      Abstract: Objectives •  To review emerging trends in prostate cancer (PC) literature with a focus on the marketing and implementation of new technologies, and the use of PC terms Methods •  Literature search of MEDLINE for external‐beam radiotherapy, prostatectomy, deferred intervention and focal therapy articles pertaining to PC •  Observational trends of PC literature relating to the marketing of new technologies and the use of standardised language Results •  PC literature has proliferated across all treatment modalities, particularly in the research of new technologies (robot‐assisted prostatectomy, image‐guided radiotherapy and focal therapy) •  Marketing and implementation of new technologies has occurred in some instances before effectiveness and adverse effects have been determined •  Inconsistent use of terminology exists in the PC literature Conclusion •  There is an ever‐present need for editors and researchers to maintain integrity and relevance in PC research •  We advocate a standardised language in PC and inclusion of active surveillance and robot‐assisted prostatectomy as MeSH indexing to reflect current trends and needs in PC research
      PubDate: 2014-12-11T06:36:27.616729-05:
      DOI: 10.1111/bju.13015
       
  • Clinical and Genomic Analysis of Metastatic Prostate Cancer Progression in
           a Background of Post‐Operative Biochemical Recurrence
    • Authors: Mohammed Alshalalfa; Anamaria Crisan, Ismael A. Vergara, Mercedeh Ghadessi, Christine Buerki, Nicholas Erho, Kasra Yousefi, Thomas Sierocinski, Zaid Haddad, Peter C. Black, R. Jeffrey Karnes, Robert B. Jenkins, Elai Davicioni
      Pages: n/a - n/a
      Abstract: Objective Biochemical recurrence (BCR) is a widely used surrogate for disease progression in the post‐operative setting. Of the men that experience BCR after surgery, only a minority will experience progression to lethal prostate cancer in their lifetime. In order to improve treatment decisions, we sought to better characterize the genomics of patients with BCR who have metastatic disease progression. Methods and Material The expression profiles of three clinical outcome groups after radical prostatectomy (RP) were compared: NED (no evidence of disease, n = 108); BCR (PSA without metastasis, n = 163); and MET (metastasis, n = 192). The patients were profiled using Human Exon 1.0 ST microarrays and outcomes were supported by a median 18 years of follow‐up. A MET signature was defined and verified in an independent RP cohort to ensure the robustness of the signature. Furthermore, bioinformatics characterization of the signature was conducted to decipher its biology. Results Minimal gene expression differences were observed between adjuvant treatment naïve NED patients and BCR patients without metastasis. More than 95% of the differentially expressed genes (MET signature) were found in comparisons between primary tumors of MET patients and the two other outcome groups. The MET signature was validated in an independent cohort and was significantly associated with cell cycle genes, ubiquitin‐mediated proteolysis, DNA repair, androgen, G‐protein coupled and NOTCH signal transduction pathways. Conclusion This study shows that metastasis development after BCR is associated with a distinct transcriptional program that can be detected in the primary tumor. NED and BCR patients have highly similar transcriptional profiles, suggesting that measurement of PSA on its own is a poor surrogate for a lethal disease. Use of genomic testing in radical prostatectomy patients with initial PSA rise may be useful to improved secondary therapy decision‐making.
      PubDate: 2014-12-08T13:21:17.723908-05:
      DOI: 10.1111/bju.13013
       
  • Demographic and Socioeconomic Differences between Men Seeking Infertility
           Evaluation and Surgical Sterilization: From the National Survey of Family
           Growth
    • Authors: James M. Hotaling; Darshan P. Patel, William O. Brant, Jeremy B. Myers, Mark R. Cullen, Michael L. Eisenberg
      Pages: n/a - n/a
      Abstract: Objective To identify differences in demographic and socioeconomic factors between men seeking infertility evaluation and those undergoing vasectomy, in order to address disparities in access to these services. Patients and Methods Data from Cycle 6‐Cycle 7 (2002, 2006‐2008) of the National Survey of Family Growth (NSFG) was reviewed; the NSFG is a multi‐stage probability survey designed to capture a nationally representative sample of households with men and women 15 to 45‐years‐old in America. Variables analyzed included age, body mass index, self‐reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status, and metropolitan home designation. Our primary outcome was correlation of these demographic and socioeconomic factors with evaluation for male infertility or vasectomy. Results Of the 11,067 men identified through the NSFG, 466 (4.2%) men sought infertility evaluation representing 2,187,455 men nationally and 326 (2.9%) had a vasectomy representing 1,510,386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (p=0.001, 0.001) and less likely to be currently married (78% vs. 74%, p=0.010) or ever married (89% vs. 97%, p=0.002). Men undergoing a vasectomy were more likely to be Caucasian (86% vs. 70%, p=0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared to men undergoing a vasectomy (68% vs. 64%, p=0.015). There was no difference between the 2 groups for all other variables. Conclusion While differences in demographic characteristics such as age, offspring number, and marital status were identified, measures of health, socioeconomic status, religion, and insurance were similar between men utilizing vasectomy and seeking infertility services. These factors help characterize utilization of male reproductive health services in the United States and may help address disparities in access to these services and improve public health strategies.
      PubDate: 2014-12-08T13:21:08.940564-05:
      DOI: 10.1111/bju.13012
       
  • Frozen Section During Partial Nephrectomy: Does it Predict Positive
           Margins?
    • Authors: Jennifer Gordetsky; Michael A. Gorin, Joe Canner, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf, Jonathan I. Epstein
      Pages: n/a - n/a
      Abstract: Objective To investigate the clinical utility of frozen section (FS) analysis performed during partial nephrectomy (PN) and its influence on intraoperative management. Patients and Methods We performed a retrospective analysis of consecutive PN cases from 2010‐2013. We evaluated the concordance between the intraoperative FS diagnosis and the FS control diagnosis, a postoperative quality assurance measure performed on all FS diagnoses after formalin fixation of the tissue. We also evaluated the concordance between the intraoperative FS diagnosis and the final specimen margin. Operative reports were reviewed for change in intraoperative management for cases with a positive or “atypia” FS diagnosis, or if the mass was sent for FS. Results 576 intraoperative FS were performed in 351 cases to assess the PN tumor bed margin, 19 (5.4%) of which also had a mass sent for FS to assess the tumor type. The concordance rate between the FS diagnosis and the FS control diagnosis was 98.3%. There were 30 (8.5%) final positive specimen margins, of which 4 (13.3%) were called “atypia”, 17 (56.7%) negative, and 9 (30%) positive on FS diagnosis. Intraoperative management was influenced in 6 of 9 cases with a positive FS diagnosis and in 1 of 9 cases with a FS diagnosis of “atypia.” Conclusions The relatively high false negative rate, controversy over the prognosis of a positive margin, and inconsistency in influencing intraoperative management, argues against the routine use of FS in PN cases.
      PubDate: 2014-12-08T13:20:59.403107-05:
      DOI: 10.1111/bju.13011
       
  • Am I normal? A systematic review and construction of nomograms for
           flaccid and erect penis length and circumference in up to 15,521 men
    • Authors: D Veale; S Miles, S Bramley, G Muir, J Hodsoll
      Pages: n/a - n/a
      Abstract: Objectives To systematically review and create nomograms on flaccid and erect penile size measurements. Methods Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample Exclusion criteria were samples with a congenital or acquired penile abnormality. previous surgery, complaint of small penis size or erectile dysfunction Synthesis methods: Calculation of a weighted mean and pooled standard deviation and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. Results Nomograms for flaccid pendulous (n = 10,704, mean 9.16cm, sd 1.57) and stretched length (n=14,160, mean 13.24cm, sd 1.89), erect length (n = 692, mean 13.12cm, sd 1.66), flaccid circumference (n = 9,407, mean 9.31cm, sd 0.90); and erect circumference (n = 381, mean 11.66cm, sd 1.10) were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. Conclusions penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research. Limitations: a relatively small number of erect measurements were conducted in a clinical setting and the greatest variability between studies was with flaccid stretched length.
      PubDate: 2014-12-08T13:20:51.201708-05:
      DOI: 10.1111/bju.13010
       
  • Predicting Post‐operative Complications of Inguinal Lymph Node
           Dissection for Penile Cancer in an International Multicenter Cohort
    • Authors: Jared M. Gopman; Rosa S. Djajadiningrat, Adam S. Baumgarten, Patrick N. Espiritu, Simon Horenblas, Yao Zhu, Chris Protzel, Julio M. Pow‐Sang, Timothy Kim, Wade J. Sexton, Michael A. Poch, Philippe E. Spiess
      Pages: n/a - n/a
      Abstract: Study Objectives To assess potential complications associated with ILND across international tertiary care referral centers, and determine prognostic factors that best predict development of these complications. Materials/Methods A retrospective chart review was conducted across 4 international cancer centers. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien‐Dindo classification system was used to standardize reporting of complications. Results 181 patients (55.4%) had a post‐operative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The AJCC stage was an independent predictor of all wound infections, while the patient's age, ILND with Sartorius flap transposition, and surgery performed prior to year 2008 were independent predictors of major wound infections. Conclusions This is the largest report of complication rates following ILND for SCCP and shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased post‐operative morbidity.
      PubDate: 2014-12-08T13:20:43.269853-05:
      DOI: 10.1111/bju.13009
       
  • Validation of the GreenLight™ Simulator and development of a
           training curriculum for photoselective vaporisation of the prostate
    • Authors: Abdullatif Aydin; Gordon H. Muir, Manuela E. Graziano, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: n/a - n/a
      Abstract: Objectives To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence‐based training curriculum. Subjects and Methods This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert‐level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Results Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence‐based training curriculum, to help trainees acquire transferable skills, was produced using the results. Conclusion This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency.
      PubDate: 2014-12-07T20:21:26.579515-05:
      DOI: 10.1111/bju.12842
       
  • Ipsilateral renal function preservation after robot‐assisted partial
           nephrectomy (RAPN): an objective analysis using
           mercapto‐acetyltriglycine (MAG3) renal scan data and volumetric
           assessment
    • Authors: Homayoun Zargar; Oktay Akca, Riccardo Autorino, Luis Felipe Brandao, Humberto Laydner, Jayram Krishnan, Dinesh Samarasekera, Robert J. Stein, Jihad H. Kaouk
      Pages: n/a - n/a
      Abstract: Objective To objectively assess ipsilateral renal function (IRF) preservation and factors influencing it after robot‐assisted partial nephrectomy (RAPN). Patients and Methods Our database was queried to identify patients who had undergone RAPN from 2007 to 2013 and had complete pre‐ and postoperative mercapto‐acetyltriglycine (MAG3) renal scan assessment. The estimated glomerular filtration rate (eGFR) for the operated kidney was calculated by multiplying the percentage of contribution from the renal scan by the total eGFR. IRF preservation was defined as a ratio of the postoperative eGFR for the operated kidney to the preoperative eGFR for the operated kidney. The percentage of total eGFR preservation was calculated in the same manner (postoperative eGFR/preoperative eGFR × 100). The amount of healthy rim of renal parenchyma removed was assessed by deducting the volume of tumour from the volume of the PN specimen assessed on pathology. Multivariable linear regression was used for analysis. Results In all, 99 patients were included in the analysis. The overall median (interquartile range) total eGFR preservation and IRF preservation for the operated kidney was 83.83 (75.2–94.1)% and 72 (60.3–81)%, respectively (P < 0.01). On multivariable analysis, volume of healthy rim of renal parenchyma removed, warm ischaemia time (WIT) > 30 min, body mass index (BMI) and operated kidney preoperative eGFR were predictive of IRF preservation. Conclusions Using total eGFR tends to overestimate the degree of renal function preservation after RAPN. This is particularly relevant when studying factors affecting functional outcomes after nephron‐sparing surgery. IRF may be a more precise assessment method in this setting. Operated kidney baseline renal function, BMI, WIT >30 min, and amount of resected healthy renal parenchyma represent the factors with a significant impact on the IRF preservation. RAPN provides significant preservation of renal function as shown by objective assessment criteria.
      PubDate: 2014-12-07T20:19:36.446816-05:
      DOI: 10.1111/bju.12825
       
  • Transperineal prostate biopsy: template‐guided or freehand?
    • Authors: Philip E. Dundee; Jeremy P. Grummet, Declan G. Murphy
      Pages: n/a - n/a
      PubDate: 2014-12-07T20:12:37.939299-05:
      DOI: 10.1111/bju.12860
       
  • Clinical significance of prognosis using the neutrophil–lymphocyte
           ratio and erythrocyte sedimentation rate in patients undergoing radical
           nephroureterectomy for upper urinary tract urothelial carcinoma
    • Authors: Hyun Hwan Sung; Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han‐Yong Choi, Hyun Moo Lee
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil–lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Patients and Methods A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0–22 mm/h in men and 0–27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I, n = 169), and those with both elevated ESR and elevated NLR (group II, n = 73). Results The median patient age was 64 years and the median follow‐up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLRs and ESRs, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status (P < 0.05). Preoperative ESR (hazard ratio [HR] 1.784, 95% confidence interval [CI] 1.173–2.712), NLR (HR 1.704, 95% CI 1.136–2.556), and prognostic grouping (HR 2.285, 95% CI 1.397–3.737 for group I; HR 2.962, 95% CI 1.719–5.102 for group II) were independent predictors of progression‐free survival (PFS) in the multivariate model (P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer‐specific survival (CSS) and overall survival (OS). Time‐dependent area under the receiver‐operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes (P < 0.05). Conclusions Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC. The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.
      PubDate: 2014-12-07T19:52:07.428341-05:
      DOI: 10.1111/bju.12846
       
  • The Swiss Continence Foundation Award: Promoting the next generation in
           neuro‐urology and functional urology
    • Authors: Ulrich Mehnert; Thomas M. Kessler
      PubDate: 2014-12-02T03:38:16.576823-05:
      DOI: 10.1111/bju.13008
       
  • Anti‐Nogo‐A antibody: A treatment option for neurogenic lower
           urinary tract dysfunction'
    • Authors: Marc P. Schneider; Martin E. Schwab, Thomas M. Kessler
      PubDate: 2014-11-28T03:21:35.037447-05:
      DOI: 10.1111/bju.13007
       
  • Absorption of the Wolffian duct and duplicated ureter by the urogenital
           sinus: morphological study using human fetuses and embryos
    • Authors: Michiko Naito; Nobuyuki Hinata, Jose Francisco Rodriguez‐Vazquez, Gen Murakami, Shin Aizawa, Masato Fujisawa
      Abstract: Objectives To depict an embryological origin of the duplicated ureter and to investigate whether the urogenital sinus absorb not only the Wolffian duct but also the ureter. Materials and Methods During studies using sections of human fetuses (45 specimens), we incidentally found a specific type of ureteral duplication (at approximately 7 weeks) in which two unilateral ureters joined at the ureterovesical junction, apparently representing a morphology intermediate between complete and partial ureteral duplication. Because the existing literature lack any photographic representation of early development of the ureterovesical junction, we studied horizontal sections of 10 human embryos (approximately 5‐6 weeks of gestation) in which the ureter did not join the urogenital sinus (future bladder) but instead joined the Wolffian duct (future vas deferens). Results The sinus consistently showed a reverse Y‐shape where the arms extended posteriorly to receive the Wolffian duct. When absorption of the duct into the sinus wall reached the distal end of the ureter, the arm‐like parts appeared to enlarge posteriorly for further involvement of the duct with little or no incorporation of the ureter. Therefore, the future trigone of the bladder might develop from these arm‐like parts of the sinus posterior wall. Consequently, in the present case of ureteral duplication, it is considered that the ureters would probably have merged with the Wolffian duct at closely adjacent sites. Conclusion The present study represented the first photographic demonstration of the early development of the human ureterovesical junction.
      PubDate: 2014-11-28T03:21:26.949883-05:
      DOI: 10.1111/bju.13006
       
  • Clinical and Radiographic Predictors of the Need for Inferior Vena Caval
           Resection during Nephrectomy for Patients with Renal Cell Carcinoma and
           Caval Tumor Thrombus
    • Authors: Sarah P. Psutka; Stephen A. Boorjian, R. Houston Thompson, Grant D. Schmit, John J. Schmitz, Thomas C. Bower, Suzanne B. Stewart, Christine M. Lohse, John C. Cheville, Bradley C. Leibovich
      Abstract: Objective ● To evaluate clinical and radiographic predictors of need for partial or circumferential resection of the inferior vena cava (IVC‐R) requiring complex vascular reconstruction during venous tumor thrombectomy for renal cell carcinoma (RCC). Patients and Methods ● Data were collected regarding 172 patients with RCC and IVC (level I‐IV) venous tumor thrombus who underwent radical nephrectomy with tumor thrombectomy at the Mayo Clinic between 2000 and 2010. ● Preoperative imaging was re‐reviewed by one of two radiologists blinded to details of the patient's surgical procedure. ● Univariable and multivariable associations of clinical and radiographic features with IVC‐R were evaluated by logistic regression. ● Secondary analysis assessed the ability of the model to predict histologic invasion of the IVC by the tumor thrombus. Results ● Of the 172 patients, 38 (22%) underwent IVC‐R procedures during nephrectomy. ● Optimal radiographic cut‐points determined to predict need for IVC‐R based on preoperative imaging included a renal vein (RV) diameter at the RV ostium (RVo) of 15.5 mm, maximal AP diameter of the IVC of 34.0 mm and AP and coronal diameters of the IVC at the RVo of 24 mm and 19 mm respectively. ● On multivariable analysis, the presence of a right‐sided tumor (OR 3.3; p=0.017), AP diameter of the IVC at the RVo ≥ 24.0 mm (OR 4.4; p=0.017), and radiographic identification of complete occlusion of the IVC at the RVo (OR 4.9; p
      PubDate: 2014-11-28T03:21:18.427063-05:
      DOI: 10.1111/bju.13005
       
  • The efficacy of irinotecan, paclitaxel, and oxaliplatin (IPO) in relapsed
           germ cell tumors with high dose chemotherapy as consolidation‐ a
           non‐cisplatin‐ based induction approach
    • Authors: W Badreldin; J Krell, S Chowdhury, SJ Harland, D Mazhar, V Harding, AE Frampton, P Wilson, D Berney, J Stebbing, J Shamash
      Abstract: Objectives To determine the outcome of an expanded cohort of patients with relapsed germ cell tumors (GCT) treated with a salvage chemotherapy regimen consisting of irinotecan, paclitaxel and oxaliplatin (IPO) and assess the role of IPO as an alternative to standard cisplatin‐based chemotherapy regimens in this setting. Patients and methods The results of 72 consecutive patients were reviewed retrospectively. IPO was used either as a second‐line treatment (n=29), of which 20 patients subsequently received high‐dose chemotherapy (HDCT), or third‐line (n=43), of which 32 patients proceeded to HDCT. Results The 2‐year PFS and 3‐year OS rates for the whole cohort were 30.2% (95%CI 17.3‐40.5%) and 33.4% (95%CI: 20.1‐43.8 %) respectively. CR was achieved in 3%, m‐ve PR in 41%, m+ve PR in 18%, SD in 17% and PD in 20%. In the second‐line setting, the 2‐year PFS rate was 43.5% (95%CI: 21.7‐60.8%) and 3‐year OS 49.1% (95%CI: 24.2‐65.1%). In the third‐line setting, the 2‐year PFS rate was 21.0% (95%CI 9.5‐35.4%) and the 3‐year OS rate was 23.9% (95%CI 11.7‐38.2).According to the current international prognostic factor study group criteria for first relapse for the high and very high risk group the 2 year PFS rates were 50% and 30% respectively. There were 2 treatment related deaths from IPO, and 4 from HDCT. Grade 3 or 4 toxicities included neutropenia (35%), thrombocytopenia (18%), infection (15%), diarrhea (11%) and lethargy (8%).  Conclusions IPO offers an effective, well‐tolerated, non‐nephrotoxic alternative to cisplatin‐based salvage regimens for patients with relapsed GCT. It appears particularly useful in high risk patients and for those in whom cisplatin is ineffective or contra‐indicated.
      PubDate: 2014-11-28T03:21:09.97151-05:0
      DOI: 10.1111/bju.13004
       
  • Inhibition of Urothelial P2X3 Receptors Prevents Desensitization of
           Purinergic Detrusor Contractions in the Rat Bladder
    • Authors: Andrew C. Ferguson; Broderick W. Sutton, Timothy B. Boone, Anthony P. Ford, Alvaro Munoz
      Abstract: Objective To evaluate whether P2X3 purinergic receptors (P2X3R) are expressed in the bladder urothelium and determine their possible function in modulating purinergic detrusor contractions in the rat urinary bladder. Materials and Methods The expression of urothelial receptors was determined using conventional immunohistochemistry (IHC) in bladders from normal Sprague‐Dawley rats. The urothelial layer was removed by incubation with protamine, and disruption of the urothelium was confirmed using hematoxylin/eosin staining on bladder sections. Open cystometry was utilized to determine the effects of both urothelial removal as well as intravesical application of a specific P2X3R antagonist on bladder properties from intact and protamine‐treated animals. Isometric contractile responses to potassium chloride (KCl) depolarization, electrical field stimulation (EFS) or chemical P2X‐activation were determined in normal and urothelium‐denuded bladder strips with and without application of the P2X3R antagonist. Results IHC staining shows high expression of P2X3R in the medial and basal layers of the urothelium. Removal of the urothelial layer disturbs normal bladder performance in vivo and eliminates the effects of the P2X3R antagonist on increasing the contractile interval and reducing the amplitude of voiding contractions. Removal of the urothelium does not affect bladder strip contractile responses to KCl depolarization or EFS. Pharmacological inhibition of P2X3R prevents desensitization to P2X‐mediated detrusor muscle contractions during EFS only in the strips with an intact urothelium. A concentration‐dependent, specific inhibition of P2X3R also prevents desensitization of purinergic contractile responses in intact bladder strips. Conclusions In the rat bladder, medial and basal urothelial cells express P2X3R, and specific inhibition of the receptor leads to a more hyporeflexive bladder condition. This pathway may involve P2X3R driving a paracrine amplification of ATP released from umbrella cells to increase afferent transmission in the sub‐urothelial sensory plexus and desensitization of P2X1‐mediated purinergic detrusor contractions.
      PubDate: 2014-11-28T03:21:00.383566-05:
      DOI: 10.1111/bju.13003
       
  • A prospective study of erectile function after transrectal ultrasound and
           prostate biopsy
    • Authors: Katie S Murray; Jason Bailey, Keegan Zuk, Ernesto Lopez‐Corona, J Brantley Thrasher
      Abstract: Objective To prospectively evaluate the effect of prostate biopsy on erectile and voiding function at multiple time points following biopsy. Materials and Methods All men who underwent transrectal ultrasound and prostate biopsy completed an International Index of Erectile Function (IIEF‐5) and International Prostate Symptom Score (IPSS) before the procedure and at 1 week, 4 weeks, and 3 months after the biopsy. Statistical analyses used were a general descriptive analysis, continuous variables using a T test, and categorical data using chi‐square analysis. A paired T test was used to compare each patient's baseline score to their own follow up surveys. Results 220 patients were enrolled. Mean age was 64.1 years with a mean PSA of 6.7 ng/dL. At initial presentation 38.6% reported no ED, 22.3% mild ED, 15.5% mild to moderate ED, 10% moderate ED, and 13.6% with severe ED. On paired T test there was a statistically significant reduction in IIEF‐5 score at 1 week post biopsy compared to pre‐biopsy (18.2 versus 15.5), p
      PubDate: 2014-11-28T03:20:50.899904-05:
      DOI: 10.1111/bju.13002
       
  • Recourse to radical prostatectomy and associated short‐term outcomes
           in Italy: a country‐wide study over the last decade
    • Authors: Giacomo Novara; Vincenzo Ficarra, Filiberto Zattoni, Ugo Fedeli
      Abstract: Objective ● Population‐based data on radical prostatectomy (RP) adoption and outcomes are available mainly from Northern America and Northern Europe. ● To estimate time trends in the recourse to RP and in short‐term outcomes after RP in Italy. Patients and Methods ● All RP for prostate cancer performed in 2001‐2010 were extracted from the Italian national archive of hospital discharge records. ● Age‐specific and age‐standardized RP rates were computed. ● The effect of procedural volume on in‐hospital mortality, complications, and length of stay was estimated by multilevel regression models. Results ● 144,432 RP were analyzed. Country‐wide RP rates increased in 2001‐2004 and thereafter remained stable, with large differences between geographical areas. ● The mean hospital volume raised in the first study years, without centralization but due to increasing RP numbers at the population level. ● The median LOS declined from 10 to 8 days over the study period (mean from 11.7 to 9.2 days). ● In‐hospital mortality dropped from 0.16% in 2001 to 0.07% in 2010. In‐hospital mortality, LOS, and the prevalence of complications increased with age, and decreased with year of surgery. ● Compared to very low‐volume hospitals, procedures performed in high volume hospitals were associated to decreased in‐hospital mortality, in‐hospital complications, and hospital stay. Conclusions ● The study adds evidence on rapidly changing trends in RP rates, on improving in‐hospital outcomes, and on their association with procedural volume.
      PubDate: 2014-11-28T03:20:42.2836-05:00
      DOI: 10.1111/bju.13000
       
  • Psychosocial interventions for men with prostate cancer: a Cochrane
           systematic review
    • Authors: Kader Parahoo; Suzanne McDonough, Eilis McCaughan, Jane Noyes, Cherith Semple, Elizabeth J Halstead, Molly M Neuberger, Philipp Dahm
      Abstract: Objective To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self‐efficacy and knowledge and in reducing distress, uncertainty and depression. Materials and Methods We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with handsearching of journals and reference lists. Randomised controlled trials were eligible if they included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psycho‐educational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. Our outcomes were an improvement in quality of life (QoL), self‐efficacy and knowledge and a reduction in distress, uncertainty and depression. We analysed data using standardised mean differences (SMDs), random‐effects models and 95% confidence intervals (CIs). Results Nineteen studies with a total of 3204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions versus usual care were included in this review. Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health‐related quality of life (GHQoL) at end of intervention. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention. At end of intervention, cancer‐related QoL showed a small improvement following psychosocial interventions. For prostate cancer‐ specific and symptom‐related QoL, the differences between intervention and control groups were not significant. There was no clear evidence that psychosocial interventions were beneficial in improving self‐efficacy at end of intervention. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention. A small increase in knowledge with psychosocial interventions was noted at three months post‐intervention. The results for uncertainty (SMD ‐0.05, 95% CI ‐0.35 to 0.26) and distress at end of intervention were compatible with both benefit and harm based on very low‐quality evidence. Finally, there was no clear evidence of benefit associated with psychosocial interventions for depression at end of intervention . Conclusions Overall, this review shows that psychosocial interventions may have small, short‐term beneficial effects on certain domains of wellbeing, as measured by the physical component of GHQoL and cancer‐related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to demonstrate a statistically significant effect on other domains such as symptom‐related QoL, self‐ efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were observed, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to GRADE, reflecting study limitations, loss to follow‐up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment modality. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well‐done and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
      PubDate: 2014-11-27T02:22:55.923765-05:
      DOI: 10.1111/bju.12989
       
  • Predicting Pathologic Outcomes in Patients Undergoing Robot‐Assisted
           Radical Prostatectomy for High Risk Prostate Cancer: A Preoperative
           Nomogram
    • Authors: Firas Abdollah; Dane E. Klett, Akshay Sood, Jesse D. Sammon, Daniel Pucheril, Deepansh Dalela, Mireya Diaz, James O. Peabody, Quoc‐Dien Trinh, Mani Menon
      Abstract: Objective To identify which high‐risk PCa patients may harbor favorable pathologic outcomes at surgery. Materials and Methods We evaluated 810 patients with high‐risk PCa, defined as having ≥1 of the following: PSA >20 ng/ml, Gleason score ≥8, clinical stage ≥T2c. Patients underwent RARP with pelvic lymph node dissection, between 2003 and 2012, in one center. Only 1.6% (13/810) of patients received any adjuvant treatment. Favorable pathologic outcome was defined as specimen‐confined (SC) disease (pT2‐T3a, node negative, and negative surgical margins) at RARP‐specimen. Logistic regression models were used to test the relationship among all available predicators and harboring SC PCa. A logistic regression coefficient‐based nomogram was constructed and internally validated using 200 bootstrap resamples. Kaplan‐Meier method estimated biochemical recurrence (BCR) ‐free and cancer‐specific mortality (CSM) free survival rates, after stratification according to pathological disease status. Results Overall, 55.2% patients harbored SC disease at RARP. At multivariable analysis, PSA level, clinical stage, primary/secondary Gleason scores, and maximum percent tumor quartiles were all independent predictors of SC PCa (all P
      PubDate: 2014-11-21T05:17:07.922969-05:
      DOI: 10.1111/bju.12998
       
  • Significance of lymphovascular invasion in organ‐confined,
           node‐negative urothelial cancer of the bladder: data from the
           prospective p53‐MVAC trial
    • Authors: Friedrich‐Carl Rundstedt; Douglas A. Mata, Susan Groshen, John P. Stein, Donald G. Skinner, Walter M. Stadler, Richard J. Cote, Oleksandr N. Kryvenko, Guilherme Godoy, Seth P. Lerner
      Abstract: Objectives • To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ‐confined, node‐negative urothelial cancer of the bladder (UCB) in a post‐hoc analysis of a prospective clinical trial. • To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumors exhibited LVI. Patients and Methods • Surgical and tumor factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1‐T2 N0 UCB in the p53‐MVAC trial (SWOG 4B951/NCT00005047). • The presence or absence of LVI was determined by pathologic examination of transurethral resection or RC specimens. • Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results • Among 499 patients with a median follow‐up of 4.9 years, a subset of 102 (20%) had LVI‐positive tumors. Of these, 34 patients had pT1 and 68 had pT2 disease. • LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 (95% confidence interval [CI]: 1.15 to 2.77; number of events [EV] = 95; p = 0.01) and with OS with a HR of 2.02 (95% CI: 1.31 to 3.11; EV = 98; p = 0.001) after adjustment for pathologic stage. • Among 27 patients with LVI‐positive tumors who were randomized to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70; 95% CI: 0.16 to 3.17; EV = 7; p = 0.65) or with OS (HR: 0.45; 95% CI: 0.11 to 1.83; EV = 9; p = 0.26). Conclusions • Our post‐hoc analysis of the p53‐MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1‐T2N0 disease. • The analysis did not demonstrate a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not ruled out.
      PubDate: 2014-11-21T05:16:59.328858-05:
      DOI: 10.1111/bju.12997
       
  • Evolving role of Positron Emission Tomography (PET) in Urological
           Malignancy
    • Authors: Sebastian Mafeld; Nikhil Vasdev, Amit Patel, Tamir Ali, Timothy Lane, Gregory Boustead, Andrew C Thorpe, James M Adshead, Philip Haslam
      Abstract: We present a review on the increasing indications for the use of Positron emission tomography (PET) in uro‐oncology. In our review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
      PubDate: 2014-11-20T01:52:40.17733-05:0
      DOI: 10.1111/bju.12988
       
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • Authors: Silke Walleser Autiero; Hallas N, Betts C, Ockrim JL,
      Abstract: Objective To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. Patients and Methods The cost‐effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the NHS in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT‐A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10 year time horizon for all treatment options with the exception of PTNS, which has a time horizon of five years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios. Direct medical resources included are: device and drug acquisition costs, pre‐procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. Results At five years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT‐A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT‐A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost‐effective. Conclusion In the management of patients with idiopathic OAB wet, the results of this cost‐utility analysis favors SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT‐A over a 10 year period.
      PubDate: 2014-11-19T02:20:15.629369-05:
      DOI: 10.1111/bju.12972
       
  • A phase I study of TRC105 anti‐CD105 (endoglin) antibody in
           metastatic castration‐resistant prostate cancer
    • Authors: Fatima H. Karzai; Andrea B. Apolo, Liang Cao, Ravi A. Madan, David E. Adelberg, Howard Parnes, David G. McLeod, Nancy Harold, Cody Peer, Yunkai Yu, Yusuke Tomita, Min‐Jung Lee, Sunmin Lee, Jane B. Trepel, James L. Gulley, William D. Figg, William L. Dahut
      Abstract: Objective ● TRC105 is a chimeric IgG1 monoclonal antibody that binds endoglin (CD105). ● This phase I open‐label study evaluated the safety, pharmacokinetics, and pharmacodynamics of TRC105 in patients with metastatic castration‐resistant prostate cancer (mCRPC). Patients and Methods ● Patients with mCRPC received escalating doses of intravenous TRC105 until unacceptable toxicity or disease progression, up to a predetermined dose level using a standard 3+3 phase I design. Results ● Twenty patients were treated and the top dose level studied of 20 mg/kg every two weeks was the maximum tolerated dose. ● Common adverse effects included infusion‐related reaction (90%), low grade headache (67%), anemia (48%), epistaxis (43%), and fever (43%). ● Ten patients had stable disease on study and eight patients had PSA declines. ● Significant plasma CD105 reduction was observed at the higher dose levels. In an exploratory analysis, vascular endothelial growth factor (VEGF) was increased after treatment with TRC105 and VEGF levels were associated with CD105 reduction. Conclusion ● TRC105 was tolerated at 20 mg/kg every other week with a safety profile distinct from that of VEGF inhibitors. ● There was a significant induction of plasma VEGF associated with CD105 reduction, suggesting anti‐angiogenic activity of TRC105. ● An exploratory analysis revealed a tentative correlation between the reduction of CD105 and a decrease in PSA velocity, suggestive of potential activity of TRC105 in the CRPC patients. The data from this exploratory analysis suggests rising VEGF is a possible compensatory mechanism for TRC105 induced anti‐angiogenic activity.
      PubDate: 2014-11-19T02:20:07.482584-05:
      DOI: 10.1111/bju.12986
       
  • Targeted Microbubbles: A Novel Application for Treatment of Kidney Stones
    • Authors: Krishna Ramaswamy; Vanessa Marx, Daniel Laser, Thomas Kenny, Thomas Chi, Michael Bailey, Matthew Sorensen, Robert Grubbs, Marshall Stoller
      Abstract: Kidney stone disease is endemic. Extracorporeal shock wave lithotripsy (EWL) was the first major technologic breakthrough where focused shock waves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine' The logical progression was to manufacture these powerful microbubbles ex‐vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: 1) bisphosphonates attach to hydroxyapatite crystals with high affinity; and 2) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to preemptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging modalities – especially useful in high risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine.
      PubDate: 2014-11-17T05:26:08.747119-05:
      DOI: 10.1111/bju.12996
       
  • The Swedish National Penile Cancer Register: Incidence, Tumour
           Characteristics, Management and Survival
    • Authors: Peter Kirrander; Amir Sherif, Bengt Friedrich, Mats Lambe, Ulf Håkansson,
      Abstract: Objectives ● To assess penile cancer incidence, stage distribution, adherence to guidelines, and prognostic factors in a population‐based setting. Patients and Methods ● The population‐based Swedish National Penile Cancer Register (NPECR) contains detailed information on tumour characteristics and management patterns. ● A total of 1678 men with primary squamous cell carcinoma of the penis identified in the NPECR between 2000 and 2012 were included in the study.  Results ● The mean age‐adjusted incidence of penile cancer was 2.1/100,000 men, remaining virtually unchanged during the study period. ● At diagnosis, 14% and 2% were clinically N+ and M+, respectively. ● Most patients were staged pTis (34%), pT2 (19%), or pT1 (18%), whereas stage was unavailable in 18%. ● Organ‐preserving treatment was used in 71% of Tis−T1 tumours. In cN0 and ≥pT1G2 patients, 50% underwent lymph node staging, while 74% of cN1−3 patients underwent lymph node dissection. ● The overall 5‐year relative survival was 82%. Men aged ≥40 years and those with pT2−3, G2−3 and N+ tumours had worse outcome. Conclusion ● The incidence of penile cancer in Sweden is stable. ● Most men presented with localised disease, and the proportion of non‐invasive tumours was high. During the period under study, adherence to guidelines was suboptimal. ● The overall 5‐year relative survival was 82%. Older age, increasing tumour stage and grade, and increasing lymph node stage were associated with poorer survival.
      PubDate: 2014-11-14T05:47:52.132398-05:
      DOI: 10.1111/bju.12993
       
  • Mucinous Tubular and Spindle Cell Carcinoma (MTSCC) of the Kidney: A
           Retrospective Detailed Study of Radiologic, Pathologic and Clinical
           Outcomes
    • Authors: Patrick A. Kenney; Raghunandan Vikram, Srinivasa R. Prasad, Pheroze Tamboli, Surena F. Matin, Christopher G. Wood, Jose A. Karam
      Abstract: Objective To characterize the clinical, radiologic and histologic features of Mucinous Tubular and Spindle Cell Carcinoma (MTSCC), as well as oncologic outcomes. Patients and methods This is a single institution retrospective analysis of all MTSCC patients from 2002‐2011. Patients were excluded if MTSCC could not be confirmed on pathology re‐review (n=4). Clinical characteristics, pathology, imaging, and outcomes were reviewed for the 19 included patients. Results Median age at diagnosis was 59 years (range 17‐71) with a female predominance (78.9%). On contrast enhanced CT scan, MTSCC enhanced less than the cortex during the corticomedullary phase. Mean tumor attenuation was 36 HU (range 24‐48), 67 HU (range 41‐133), 89 HU (range 49‐152), and 76 HU (range 52‐106) in the precontrast, corticomedullary, nephrographic and excretory phases, respectively. Sixteen patients were treated with partial (N=5) or radical nephrectomy (N=11) for pT1(62.5%), pT2(31.3%), and pT3a disease(6.3%). One patient had active surveillance. Of 3 patients(13.0%) managed with energy ablation, there was one recurrence that was treated with salvage surgery. One patient(5.3%) had metastatic disease at diagnosis and died of disease 64.7 months later. A patient with a pT2bN0M0 MTSCC with sarcomatoid dedifferentiation developed bone metastases 9.5 months after diagnosis and was alive at 19.0 months. The remainder were free of recurrence or progression. Conclusion MTSCC is a rare RCC variant. In this largest series to date, MTSCC presented at a broad range of ages and displayed a female predilection. Imaging and pathologic features of MTSCC display some overlap with papillary RCC. MTSCC is associated with excellent outcomes overall, but is not universally indolent.
      PubDate: 2014-11-14T05:47:44.545789-05:
      DOI: 10.1111/bju.12992
       
  • Robotic versus Non‐Robotic Instruments in Spatially Constrained
           Operative Workspaces – A Pre‐Clinical Randomised Crossover
           Study
    • Authors: Thomas P Cundy; Hani J Marcus, Archie Hughes‐Hallett, Thomas MacKinnon, Azad S Najmaldin, Guang‐Zhong Yang, Ara Darzi
      Pages: n/a - n/a
      Abstract: Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within 3 different cylindrical workspace sizes. Three pairs of instruments were compared; 3mm non‐robotic mini‐laparoscopy instruments, 5mm robotic instruments and 8mm robotic instruments. Workspace diameters were 4cm, 6cm and 8cm, with volumes of 50cm3, 113cm3 and 201cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. Overall median task performance scores for 3mm, 5mm and 8mm instruments were 421, 398 and 402 respectively (P = 0.12). Task scores were highest (best) for 3mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for 4cm, 6cm and 8cm diameter workspaces being 388, 415 and 420 respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with robotic instruments. Conclusion Smaller workspaces limit performance of robotic and non‐robotic instruments. In operative workspaces smaller than 200cm3, 3mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace restricted anatomical areas.
      PubDate: 2014-11-10T04:34:38.167304-05:
      DOI: 10.1111/bju.12987
       
  • A Novel Interface for the Telementoring of Robotic Surgery
    • Authors: Daniel H. Shin; Leonard Dalag, Raed A. Azhar, Michael Santomauro, Raj Satkunasivam, Charles Metcalfe, Matthew Dunn, Andre Berger, Hooman Djaladat, Mike Nguyen, Mihir M. Desai, Monish Aron, Inderbir S. Gill, Andrew J. Hung
      Pages: n/a - n/a
      Abstract: Objectives To prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (ConnectTM) for the da Vinci robot. Materials and Methods Robotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using ConnectTM. While viewing 2D, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using 2‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. Mentoring interface was rated using a multi‐factorial Likert‐based survey. Mann‐Whitney and T‐tests determined statistical difference. Results We enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative parameters of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (p>0.05). Mentors preferred remote over in‐room telestration (p=0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases utilizing wired (versus wireless) connections had lower latency and better data transfer (p=0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting ConnectTM, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions. Conclusion In a tightly controlled environment, the ConnectTM interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread utilization of this technology.
      PubDate: 2014-11-10T04:34:23.819349-05:
      DOI: 10.1111/bju.12985
       
  • Prediction of Cancer‐Specific Survival After Radical Cystectomy in
           pT4a Urothelial Carcinoma of the Bladder – Development of a Tool for
           Clinical Decision‐making
    • Authors: Atiqullah Aziz; Shahrokh F. Shariat, Florian Roghmann, Sabine Brookman‐May, Christian G. Stief, Michael Rink, Felix K. Chun, Margit Fisch, Vladimir Novotny, Michael Froehner, Manfred P. Wirth, Marco J. Schnabel, Hans‐Martin Fritsche, Maximilian Burger, Armin Pycha, Antonin Brisuda, Marko Babjuk, Stefan Vallo, Axel Haferkamp, Jan Roigas, Joachim Noldus, Regina Stredele, Björn Volkmer, Patrick J. Bastian, Evanguelos Xylinas, Matthias May
      Pages: n/a - n/a
      Abstract: Objective To externally validate May et al.'s pT4a‐specific risk model for cancer‐specific survival (CSS) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data of 856 pT4a patients after RC for UCB at 21 centres in Europe and North‐America was assessed. May et al.'s risk model including female gender, presence of positive LVI and lack of AC administration as adverse predictors for CSS was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver operating characteristics derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinico‐pathological parameters on CSS. Decision curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5‐year‐CSS after RC was 34% in our cohort. May et al.'s risk model predicted individual 5‐year‐CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (HR1.45), lymphovascular invasion (HR1.37), lymph node metastases (HR2.54), positive soft tissue surgical margin (HR1.39), neoadjuvant (HR2.24) and lack of adjuvant chemotherapy (HR1.67, all p
      PubDate: 2014-11-10T04:34:16.110634-05:
      DOI: 10.1111/bju.12984
       
  • Comparative efficacy and safety of various treatment procedures for lower
           pole renal calculi: a systematic review and network meta‐analysis
    • Authors: Shaun Wen Huey Lee; Nathorn Chaiyakunapruk, Huey Yi Chong, Men Long Liong
      Pages: n/a - n/a
      Abstract: Objective To compare the effectiveness of various treatments used for lower pole renal calculi Methods We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as ClinicalTrials.gov for reports up to April 1, 2014. Search was supplemented with abstract reports from various urology conferences. All randomised, blinded clinical studies including patients treated for lower pole renal calculi
      PubDate: 2014-11-10T04:34:08.778002-05:
      DOI: 10.1111/bju.12983
       
  • Temporary Implantable Nitinol Device (TIND®): a novel, minimally
           invasive treatment for relief of lower urinary tract symptoms (LUTS)
           related to benign prostatic hyperplasia: feasibility, safety and
           functional results at one year follow‐up
    • Authors: F. Porpiglia; C. Fiori, R. Bertolo, D. Garrou, G. Cattaneo, D. Amparore
      Pages: n/a - n/a
      Abstract: Objectives To report the first clinical experience with Temporary Implantable Nitinol Device (TIND ‐ Meditate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and Methods Thirty two patients with LUTS were enrolled in this prospective study that was approved by institutional Ethics Committee. Inclusion criteria were: age >50 years, IPSS scores of ≥10, urinary peak flow (Qmax) < 12 ml/sec, prostate volume < 50 cc. TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to Clavien system), functional results and quality of life (QoL) were evaluated. Follow‐up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. Student t, ANOVA and Kruskall Wallis tests, simple and multiple linear regression models were used in the statistical analysis. Results Patients’ age was 69.4 years, prostate volume (+standard deviation‐s.d.), IPSS score (interquartile range – i.r.), QoL (i.r.) and Qmax (+s.d.) were 29.5 (+7.4) cc, 19 (14‐23), 3 (3‐4), and 7.6 (+2.2) ml/sec respectively. All the implantations were successfully concluded with no intraoperative complications recorded. Mean operative time (+s.d.) was 5.8 (+2.5) min and median postoperative stay (i.r.) was 1 (1‐2) day. All but one devices (96%) were removed 5 days after the implantation, in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (1, 3.1%), transient incontinence due to device displacement (1, 3.1%) prostatic abscess (1, 3.1%) and urinary tract infection (1, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. Statistically significant differences were observed in the IPSS scores, QoL and Qmax when comparing pre‐ and postoperative results at every time point. After 12 months, IPSS score, QoL and Qmax were 9 (7‐13), 1 (1‐2) and 12 (+4.7) ml/sec respectively. Mean variations with respect to baseline conditions at the same time points were ‐45% in terms of IPSS score and +67% in terms of Qmax. During follow up period, required medical therapy or surgical procedures for BPH. Conclusion TIND implantation is a feasible and safe minimally‐invasive option for the treatment of BPH‐related LUTS. The functional results are encouraging and the treatment significantly improved patient quality of life. Further studies are required to assess durability of TIND results and to optimize the indications of such a procedure.
      PubDate: 2014-11-10T04:33:03.90969-05:0
      DOI: 10.1111/bju.12982
       
  • Long‐Term Outcomes of Robot‐Assisted Radical Prostatectomy:
           Where Do We Stand?
    • Authors: Francesco Montorsi; Giorgio Gandaglia, Alberto Briganti
      Pages: n/a - n/a
      PubDate: 2014-11-10T04:32:52.898566-05:
      DOI: 10.1111/bju.12981
       
  • Patterns of Surveillance Imaging After Nephrectomy in the Medicare
           Population
    • Authors: Michael A. Feuerstein; Coral L. Atoria, Laura C. Pinheiro, William C. Huang, Paul Russo, Elena B. Elkin
      Pages: n/a - n/a
      Abstract: Objectives To characterize patterns of imaging surveillance after nephrectomy in a population‐based cohort of older kidney cancer patients. Patients and Methods Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, we identified patients ≥66 years of age who had partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009. Primary outcomes were chest (X‐ray or CT) and abdominal (CT, MRI or ultrasound) imaging in Medicare claims from 4 to 36 months after surgery. We estimated the frequency of imaging in three time periods (post‐operative months 4‐12, 13‐24, 25‐36), stratified by tumor stage. Repeated‐measures logistic regression was used to identify patient and disease characteristics associated with imaging. Results Rates of chest imaging were 65‐80%, with chest X‐ray surpassing CT in each time period. Rates of abdominal imaging were 58‐76%, and cross‐sectional imaging was more common than ultrasound in each time period. Use of cross‐sectional chest and abdominal imaging increased over time while chest X‐ray decreased (p
      PubDate: 2014-11-10T04:32:44.623618-05:
      DOI: 10.1111/bju.12980
       
  • Mechanisms of ATP release ‐ future therapeutic targets?
    • Authors: Karl‐Erik Andersson
      Pages: n/a - n/a
      PubDate: 2014-11-10T04:32:35.676686-05:
      DOI: 10.1111/bju.12979
       
  • Review: The use of sling versus sphincter in post‐prostatectomy
           urinary incontinence
    • Authors: Van Bruwaene Siska; Van der Aa Frank, De Ridder Dirk
      Pages: n/a - n/a
      Abstract: Up till now the artificial urinary sphincter (AUS) was the so‐called gold standard in post‐prostatectomy incontinence. However, male slings have gained much popularity in recent years due to the ease in surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
      PubDate: 2014-11-10T04:32:25.692326-05:
      DOI: 10.1111/bju.12976
       
  • Renal Function is the same regardless of clamp technique 6 months after
           Robot‐assisted Partial Nephrectomy: Analysis of Off‐Clamp,
           Selective Arterial Clamp and Main Artery Clamp with minimum of 1 year
           follow‐up
    • Authors: Christos Komninos; Tae Young Shin, Patrick Tuliao, Woong Kyu Han, Byung Ha Chung, Young Deuk Choi, Koon Ho Rha
      Abstract: Objectives To compare the renal functional outcomes in patients with more than one year of follow‐up who underwent robotic partial nephrectomy (RPN) with several clamping techniques. Material and methods Perioperative data of 23 (off‐clamp‐group 1), 25 (selective clamp‐group 2) and 114 (main artery clamp‐group 3) patients who underwent RPN, were retrospectively analyzed. The main outcome parameters were the postoperative serum creatinine, eGFR and its percentage change, which were collected at periodic intervals during the first 12 months and annually thereafter, in addition to the late eGFR. Only patients with more than 1 year of follow‐up were included in the analysis. Results Baseline characteristics of groups 2 and 3 were similar, while patients in group 1 had smaller size and lower complexity tumors. Median follow‐up was 45 (group 1), 20 (group 2) and 47 (group 3) months, respectively. Median clamping time was 24.8 minutes in the main artery and 18 minutes in selective artery group, respectively. Group 2 had greater median blood loss volume (100 vs. 500 vs. 200 ml, p
      PubDate: 2014-11-06T04:20:35.083893-05:
      DOI: 10.1111/bju.12975
       
  • Incidence of urethral stricture after bipolar transurethral resection of
           the prostate using TURis: results from a randomised trial
    • Authors: Kazumasa Komura; Teruo Inamoto, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Koichiro Minami, Rintaro Oide, Hirofumi Uehara, Kiyoshi Takahara, Hajime Hirano, Hayahito Nomi, Satoshi Kiyama, Toshikazu Watsuji, Haruhito Azuma
      Abstract: Objectives To assess whether bipolar transurethral resection of the prostate (B‐TURP) using the TURis® system has a similar level of efficacy and safety to that of the traditional monopolar transurethral resection of the prostate (M‐TURP), and to evaluate the impact of the TURis system on postoperative urethral stricture rates over a 36‐month follow‐up period. Patients and Methods A total of 136 patients with benign prostatic obstruction were randomised to undergo either B‐TURP using the TURis system or conventional M‐TURP, and were regularly followed for 36 months after surgery. The primary endpoint was safety, which included the long‐term complication rates of postoperative urethral stricture. The secondary endpoint was the follow‐up measurement of efficacy. Results In peri‐operative findings, no patient in either treatment group presented with transurethral resection syndrome, and the decline in levels of haemoglobin and hematocrit were similar. The mean operation time was significantly extended in the TURis treatment group compared with the M‐TURP group (79.5 vs 68.6 min; P = 0.032) and postoperative clot retention was more likely to be seen after M‐TURP (P = 0.044). Similar efficacy findings were maintained throughout 36 months, but a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M‐TURP vs 19.0% in TURis; P = 0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume ≤ 70 mL (3.8% in M‐TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M‐TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M‐TURP; P = 0.012). Furthermore, the mean operation time for TURis was significantly longer than for M‐TURP for the subgroup of patients with a prostate volume > 70 mL (99.6 vs 77.2 min; P = 0.011), but not for the subgroup of patients with a prostate volume ≤ 70 mL. Conclusion The TURis system seems to be as efficacious and safe as conventional M‐TURP except that there was a higher incidence of urethral stricture in patients with larger preoperative prostate volumes.
      PubDate: 2014-10-24T01:55:28.518382-05:
      DOI: 10.1111/bju.12831
       
  • Is there an antiandrogen withdrawal syndrome with enzalutamide'
    • Authors: Alejo Rodriguez‐Vida; Diletta Bianchini, Mieke Van Hemelrijck, Simon Hughes, Zafar Malik, Thomas Powles, Amit Bahl, Sarah Rudman, Heather Payne, Johann Bono, Simon Chowdhury
      Abstract: Objective To examine prostate‐specific antigen (PSA) levels after enzalutamide discontinuation to assess whether an antiandrogen withdrawal syndrome (AAWS) exists with enzalutamide. Methods We retrospectively identified 30 consecutive patients with metastatic prostate cancer who were treated with enzalutamide after docetaxel. Post‐discontinuation PSA results were available for all patients and were determined at 2‐weekly intervals until starting further anticancer systemic therapy. PSA withdrawal response was defined as a PSA decline by ≥50% from the last on‐treatment PSA, with a confirmed decrease ≥3 weeks later. Patient characteristics were evaluated in relation to the AAWS using univariate logistic regression analysis. Results The median (range) patient age was 70.5 (56–86) years and the median (range) follow‐up was 9.0 (0.5–16) months. The most common metastatic sites were the bone (86.7%) and lymph nodes (66.7%). Most patients (70%) had previously received abiraterone and 12 patients (40%) had also received cabazitaxel. The median (range) treatment duration with enzalutamide was 3.68 (1.12–21.39) months. PSA levels after enzalutamide withdrawal were monitored for a median (range) time of 35 (10–120) days. Only one patient (3.3%) had a confirmed PSA response ≥50% after enzalutamide discontinuation. One patient (3.3%) had a confirmed PSA response of between 30 and 50% and another patient (3.3%) had an unconfirmed PSA response of between 30 and 50%. The median overall survival was 15.5 months (95% CI 8.1–24.7). None of the factors analysed in the univariate analysis were significant predictors of PSA decline after enzalutamide discontinuation. Conclusions This retrospective study provides the first evidence that enzalutamide may have an AAWS in a minority of patients with metastatic castration‐resistant prostate cancer. Further studies are needed to confirm the existence of an enzalutamide AAWS and to assess its relevance in prostate cancer management.
      PubDate: 2014-10-24T01:35:20.799166-05:
      DOI: 10.1111/bju.12826
       
  • Cytotoxic chemotherapy in the contemporary management of metastatic
           castration‐resistant prostate cancer (mCRPC)
    • Authors: Guru Sonpavde; Christopher G. Wang, Matthew D. Galsky, William K. Oh, Andrew J. Armstrong
      Abstract: For several years, docetaxel was the only treatment shown to improve survival of patients with metastatic castration‐resistant prostate cancer (mCRPC). There are now several novel agents available, although chemotherapy with docetaxel and cabazitaxel continues to play an important role. However, the increasing number of available agents will inevitably affect the timing of chemotherapy and therefore it may be important to offer this approach before declining performance status renders patients ineligible for chemotherapy. Patient selection is also important to optimise treatment benefit. The role of predictive biomarkers has assumed greater importance due to the development of multiple agents and resistance to available agents. In addition, the optimal sequence of treatments remains undefined and requires further study in order to maximize long‐term outcomes. We provide an overview of the clinical data supporting the role of chemotherapy in the treatment of mCRPC and the emerging role in metastatic castration‐sensitive prostate cancer. We review the key issues in the management of patients including selection of patients for chemotherapy, when to start chemotherapy, and how best to sequence treatments to maximise outcomes. In addition, we briefly summarise the promising new chemotherapeutic agents in development in the context of emerging therapies.
      PubDate: 2014-10-23T21:58:29.773493-05:
      DOI: 10.1111/bju.12867
       
  • Medium‐term oncological outcomes for extended vs saturation biopsy
           and transrectal vs transperineal biopsy in active surveillance for
           prostate cancer
    • Authors: James E. Thompson; Andrew Hayen, Adam Landau, Anne‐Maree Haynes, Arveen Kalapara, Joseph Ischia, Jayne Matthews, Mark Frydenberg, Phillip D. Stricker
      Abstract: Objective To assess, in men undergoing active surveillance (AS) for low‐risk prostate cancer, whether saturation or transperineal biopsy altered oncological outcomes, compared with standard transrectal biopsy. Patients and Methods Retrospective analysis of prospectively collected data from two cohorts with localised prostate cancer (1998–2012) undergoing AS. Prostate cancer‐specific, metastasis‐free and treatment‐free survival, unfavourable disease and significant cancer at radical prostatectomy (RP) were compared for standard (12 core, median 16), and transrectal vs transperineal biopsy, using multivariate analysis. Results In all, 650 men were included in the analysis with a median (mean) follow‐up of 55 (67) months. Prostate cancer‐specific, metastasis‐free and biochemical recurrence‐free survival were 100%, 100% and 99% respectively. Radical treatment‐free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). On Kaplan–Meier analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (log‐rank P = 0.01). On multivariate Cox proportional hazards analysis, saturation biopsy (hazard ratio 1.68, P < 0.01) but not transperineal approach (P = 0.89) was associated with increased objective biopsy progression requiring treatment. On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (odds ratio 0.42, P = 0.03) but saturation biopsy did not alter the likelihood (P = 0.25). Neither transperineal nor saturation biopsy altered the likelihood of significant vs insignificant cancer at RP (P = 0.19 and P = 0.41, respectively). Conclusions AS achieved satisfactory oncological outcomes. Saturation biopsy increased progression to treatment on AS; longer follow‐up is needed to determine if this represents beneficial earlier detection of significant disease or over‐treatment. Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.
      PubDate: 2014-10-23T21:29:37.142058-05:
      DOI: 10.1111/bju.12858
       
  • Long‐term functional outcomes after artificial urinary sphincter
           implantation in men with stress urinary incontinence
    • Authors: Priscilla Léon; Emmanuel Chartier‐Kastler, Morgan Rouprêt, Vanina Ambrogi, Pierre Mozer, Véronique Phé
      Abstract: Objective To evaluate long‐term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery. Patients and Methods Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow‐up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision. Results In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64–72) years. The median (IQR) duration of follow‐up was 15 (8.25–19.75) years. At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow‐up, in intention‐to‐treat analysis, 77.2% of patients were continent. Conclusion In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
      PubDate: 2014-10-23T21:23:19.129545-05:
      DOI: 10.1111/bju.12848
       
  • Early adopters or laggards' Attitudes toward and use of social media
           among urologists
    • Authors: Michael Fuoco; Michael J. Leveridge
      Abstract: Objective To understand the attitudes and practices of urologists regarding social media use. Social media services have become ubiquitous, but their role in the context of medical practice is underappreciated. Subjects and Methods A survey was sent to all active members of the Canadian Urological Association by e‐mail and surface mail. Likert scales were used to assess engagement in social media, as well as attitudes toward physician responsibilities, privacy concerns and patient interaction online. Results Of 504 surveys delivered, 229 were completed (45.4%). Urologists reported frequent or daily personal and professional social media use in 26% and 8% of cases, respectively. There were no differences between paper (n = 103) or online (n = 126; P > 0.05) submissions. Among frequent social media users, YouTube™ (86%), Facebook™ (76%), and Twitter™ (41%) were most commonly used; 12% post content or links frequently to these sites. The most common perceived roles of social media in health care were for inter‐professional communication (67%) or as a simple information repository (59%); online patient interaction was endorsed by 14% of urologists. Fewer than 19% had read published guidelines for online patient interaction, and ≤64% were unaware of their existence. In all, 94.6% agreed that physicians need to exercise caution personal social media posting, although 57% felt that medical regulatory bodies should ‘stay out of [their] personal social media activities’, especially those in practice 20 years (P = 0.02). Conclusion Practicing urologists engage infrequently in social media activities, and are almost universal in avoiding social media for professional use. Most feel that social media is best kept to exchanges between colleagues. Emerging data suggest an increasing involvement is likely in the continuing professional development space.
      PubDate: 2014-10-23T04:04:31.725549-05:
      DOI: 10.1111/bju.12855
       
  • The emerging use of Twitter by urological journals
    • Authors: Gregory J. Nason; Fardod O'Kelly, Michael E. Kelly, Nigel Phelan, Rustom P. Manecksha, Nathan Lawrentschuk, Declan G. Murphy
      Abstract: Objective To assess the emerging use of Twitter by urological journals. Methods A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on Twitter.com. Each journal website was accessed for links to social media (SoMe). The number of ‘tweets’, followers and age of profile was determined. To evaluate the content, over a 6‐month period (November 2013 to April 2014), all tweets were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. Results In all, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean (range) number of tweets and followers was 557 (19–1809) and 1845 (82–3692), respectively. The mean (range) age of the twitter profiles was 952 (314–1758) days with an average 0.88 tweets/day. A Twitter profile was associated with a higher mean impact factor of the journal (mean [sd] 3.588 [3.05] vs 1.78 [0.99], P = 0.013). Over a 6‐month period, November 2013 to April 2014, the median (range) number of tweets per profile was 82 (2–415) and the median (range) number of articles linked to tweets was 73 (0–336). Of these 710 articles, 152 were Level 1 evidence‐based articles, 101 Level 2, 278 Level 3 and 179 Level 4. The median (range) Klout score was 47 (19–58). The Klout scores of major journals did not exactly mirror their impact factors. Conclusion SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user‐friendly platform. Recently, many of the leading urological journals have used Twitter to highlight significant articles of interest to readers.
      PubDate: 2014-10-23T03:28:09.556108-05:
      DOI: 10.1111/bju.12840
       
  • Ejaculatory dysfunction after treatment for lower urinary tract symptoms:
           retrograde ejaculation or retrograde thinking'
    • Authors: Paul Sturch; Henry H. Woo, Tom McNicholas, Gordon Muir
      PubDate: 2014-10-23T01:27:52.526145-05:
      DOI: 10.1111/bju.12868
       
  • Robotic management of genitourinary injuries from obstetric and
           
    • Authors: Paul T. Gellhaus; Akshay Bhandari, M. Francesca Monn, Thomas A. Gardner, Prashanth Kanagarajah, Christopher E. Reilly, Elton Llukani, Ziho Lee, Daniel D. Eun, Hani Rashid, Jean V. Joseph, Ahmed E. Ghazi, Guan Wu, Ronald S. Boris
      Abstract: Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high‐volume institutions between 2002 and 2013 that had a robot‐assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1–297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re‐implants (11 with ipsilateral psoas hitch) and 15 uretero‐ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1–63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1–26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow‐up of the entire cohort was 16.6 (1–63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.
      PubDate: 2014-10-23T01:00:10.321729-05:
      DOI: 10.1111/bju.12785
       
  • Evaluation of functional outcomes after laparoscopic partial nephrectomy
           using renal scintigraphy: clamped vs clampless technique
    • Authors: Francesco Porpiglia; Riccardo Bertolo, Daniele Amparore, Valerio Podio, Tiziana Angusti, Andrea Veltri, Cristian Fiori
      Abstract: Objectives To examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy (LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN. Patients and Methods Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time (WIT): group A, conventional LPN and group B, clampless‐LPN (WIT = 0 min). Demographic and peri‐operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi‐squared and Student's t‐tests were carried out and regression analysis was performed. Results Group A was found to be similar to group B in all variables measured except for WIT and blood loss (P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney. Conclusions In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function.
      PubDate: 2014-10-22T22:36:10.60907-05:0
      DOI: 10.1111/bju.12834
       
  • Incidence of needle‐tract seeding following prostate biopsy for
           suspected cancer: a review of the literature
    • Authors: Dimitrios Volanis; David E. Neal, Anne Y. Warren, Vincent J. Gnanapragasam
      Abstract: With the widespread clinical use of prostate‐specific antigen (PSA), biopsy of the prostate has become one of the most commonly performed urological procedures. In general it is well tolerated, although there is some morbidity and risk of infection. In recent years, there have been increasing concerns that prostate biopsy may lead to tumour seeding along the needle tract. The aim of the present paper was to review the evidence on the prevalence of tumour seeding after prostate biopsy and to define the risk of this event in the context of current clinical practice. A PubMed literature search was conducted in January 2014 according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) statement. Literature was examined with emphasis on the incidence of seeding, clinical presentation and on risk factors including type of needle used, transrectal vs transperineal approach, as well as tumour grade and stage. In all, 26 publications were identified reporting needle‐tract seeding after prostate biopsy. In all, 42 patients with needle‐tract seeding were identified. In most cases, seeding was reported after transperineal biopsy of the prostate, while nine cases occurred after transrectal biopsy. Based on the reviewed series the incidence of seeding appears to be
      PubDate: 2014-10-22T22:27:15.686689-05:
      DOI: 10.1111/bju.12849
       
  • Contemporary practice and technique‐related outcomes for radical
           prostatectomy in the UK: a report of national outcomes
    • Authors: Alexander Laird; Sarah Fowler, Daniel W. Good, Grant D. Stewart, Vaikuntam Srinivasan, Declan Cahill, Simon F. Brewster, S. Alan McNeill,
      Abstract: Objective To determine current radical prostatectomy (RP) practice in the UK and compare surgical outcomes between techniques. Patients and Methods All RPs performed between 1 January 2011 and 31 December 2011 in the UK with data entered into the British Association of Urological Surgeons (BAUS) database, were identified for analysis. Overall surgical outcomes were assessed and subgroup analyses of these outcomes, based on operative technique [open RP (ORP), laparoscopic RP (LRP) and robot‐assisted laparoscopic RP (RALP)], were made. Continuous variables were compared using the Mann–Whitney U‐test and categorical variables using the Pearson chi‐squared test. Univariate and multivariate binary regression analyses were performed to assess the effect of patient, surgeon and technique‐related variables on surgical outcomes. Results During the study period 2163 RPs were performed by 115 consultants with a median (range) of 11 (1–154) cases/consultant. Most RPs were performed laparoscopically (ORP 25.8%, LRP 54.6%, RALP 19.6%) and those performing minimally invasive techniques are more likely to have a higher annual case volume with 50 cases/year. Most patients were classified as having intermediate‐ or high‐risk disease preoperatively (1596 patients, 82.5%) and this increased to 97.2% (1649) on postoperative risk stratification. The overall intraoperative complication rate was 14.2% and was significantly greater for LRP (17.8%) vs ORP (8.2%) and RALP (12.4%), (P < 0.001). In all, 71% of patients had an estimated blood loss (EBL) of 500, > 1000 and >2000 mL EBL compared with the other techniques (P < 0.001). The postoperative complication rate was 10.7% overall, with a significantly greater postoperative complication rate in the LRP group (LRP 14.6%, ORP 8.8% and RALP 10.3% respectively, P = 0.007). Positive surgical margin (PSM) rates were 17.5% for pT2 disease and 42.3% for pT3 disease. The PSM rate was significantly lower in the RALP patients compared with the ORP patients for those with pT2 disease (P = 0.025), while there was no difference between ORP and LRP (ORP 21.7%, LRP 18.1% and RALP 13.0%). There was no significant difference in the PSM rate in pT3 disease between surgical techniques. Conclusion Most RPs in the UK are performed using minimally invasive techniques, which offer reduced blood loss and transfusion rates compared with ORP. The operation time, complication rate, PSM rates, and association with higher volume practice support RALP as the minimally invasive technique of choice, which could have implications for regions without access to such services. The disparity in outcomes between this national study and high‐volume single centres, most probably reflects the low median national case volume, and combined with the positive effect of high case volume on multivariate analysis of surgical outcomes and PSM rates, strengthens the argument for centralisation of services.
      PubDate: 2014-10-22T22:21:52.371956-05:
      DOI: 10.1111/bju.12866
       
  • Long‐term follow‐up of a multicentre randomised controlled
           trial comparing tension‐free vaginal tape, xenograft and autologous
           fascial slings for the treatment of stress urinary incontinence in women
    • Authors: Zainab A. Khan; Arjun Nambiar, Roland Morley, Christopher R. Chapple, Simon J. Emery, Malcolm G. Lucas
      Abstract: Objective To compare the long‐term outcomes of a tension‐free vaginal tape (TVT; Gynecare™, Somerville, NJ, USA), autologous fascial sling (AFS) and xenograft sling (porcine dermis, Pelvicol™; Bard, Murray Hill, NJ, USA) in the management of female stress urinary incontinence (SUI). Patients and Methods A multicentre randomised controlled trial carried out in four UK centres from 2001 to 2006 involving 201 women requiring primary surgery for SUI. The women were randomly assigned to receive TVT, AFS or Pelvicol. The primary outcome was surgical success defined as ‘women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up’. The secondary outcomes included ‘completely dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL EQ‐5D questionnaire scores. Results In all, 162 (80.6%) women were available for follow‐up with a median (range) duration of 10 (6.6–12.6) years. ‘Success’ rates for TVT, AFS and Pelvicol were 73%, 75.4% and 58%, respectively. Comparing the 1‐ and 10‐year ‘success’ rates, there was deterioration from 93% to 73% (P < 0.05) in the TVT arm and 90% to 75.4% (P < 0.05) in the AFS arm; ‘dry’ rates were 31.7%, 50.8% and 15.7%, respectively. Overall, the ‘dry’ rates favoured AFS when compared with Pelvicol (P < 0.001) and TVT (P = 0.036). The re‐operation rate for persistent SUI was 3.2% (two patients) in the TVT arm, 13.1% (five) in the Pelvicol arm, while none of the patients in the AFS arm required further intervention. Conclusions Our study indicates there is not enough evidence to suggest a difference in long‐term success rates between AFS and TVT. However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT.
      PubDate: 2014-10-22T21:52:05.646649-05:
      DOI: 10.1111/bju.12851
       
  • Role of emergency ureteroscopy in the management of ureteric stones:
           analysis of 394 cases
    • Authors: Kamran Zargar‐Shoshtari; William Anderson, Michael Rice
      Abstract: Objective To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. Methods We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. Results A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re‐presented, for pain (76%), bleeding (10%) or infection (14%). Conclusion We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
      PubDate: 2014-10-22T20:34:28.086976-05:
      DOI: 10.1111/bju.12841
       
  • Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging
           reporting and data system (PI‐RADS) scoring in a transperineal
           prostate biopsy setting
    • Authors: Alistair D.R. Grey; Manik S. Chana, Rick Popert, Konrad Wolfe, Sidath H. Liyanage, Peter L. Acher
      Abstract: Objectives To determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard. Patients and Methods The study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2‐ and diffusion‐weighted images, 1.5 Tesla scanner, 8‐channel body coil). A specialist uro‐radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI‐RADS) scores on a Likert‐type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24–40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length ≥6 mm. Results A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (n = 103); primary biopsy (n = 83); and active surveillance (n = 15). Patients' mean (±sd) age, prostate‐specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI‐RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87–99) and a specificity of 60% (95% CI 51–68) at this threshold. Receiver–operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82–0.92). The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7% Conclusion We found that PI‐RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision‐making process for prostate biopsy.
      PubDate: 2014-10-22T20:33:59.638291-05:
      DOI: 10.1111/bju.12862
       
  • Ureteric stents vs percutaneous nephrostomy for initial urinary drainage
           in children with obstructive anuria and acute renal failure due to
           ureteric calculi: a prospective, randomised study
    • Authors: Mohammed S. ElSheemy; Ahmed M. Shouman, Ahmed I. Shoukry, Ahmed ElShenoufy, Waseem Aboulela, Kareem Daw, Ahmed A. Hussein, Hany A. Morsi, Hesham Badawy
      Abstract: Objectives To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method 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 urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. Patients and Methods A series of 90 children aged ≤12 years 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 randomised comparative study. Patients with grade 0–1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non‐blinded, block randomisation, sealed envelope method) into PCN‐tube or bilateral JJ‐stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8–6 F JJ stents or 6–8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. Results All presented patients completed the study with intention‐to‐treat analysis. There was no significant difference between the PCN‐tube and JJ‐stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN‐tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ‐stent group. The degree of hydronephrosis significantly affected the operative time for PCN‐tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN‐tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN‐tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). Conclusion We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ‐stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN‐tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure.
      PubDate: 2014-10-20T22:13:18.799669-05:
      DOI: 10.1111/bju.12768
       
  • Lack of association of joint hypermobility with urinary incontinence
           subtypes and pelvic organ prolapse
    • Authors: Alex Derpapas; Rufus Cartwright, Purnima Upadhyaya, Alka A. Bhide, Alex G. Digesu, Vik Khullar
      Abstract: Objective To test the hypothesis that joint hypermobility (JHM) is associated with specific urinary incontinence (UI) subtypes and uterovaginal prolapse. Patients and Methods In all, 270 women scheduled to undergo urodynamic investigations were invited to self‐complete a validated five‐item JHM questionnaire. Women underwent history taking, symptoms assessing via the King's Health Questionnaire and clinical examination using the Pelvic Organ Prolapse Quantification system. Associations between JHM and pelvic floor disorders in univariate and multivariate ordinal regression were reported using odds ratios (ORs) and 95% confidence intervals (CIs). Results The prevalence of JHM was 31.1%. JHM had a negative association with age (OR 0.98/year, P = 0.04). There was no association between JHM and either urodynamic (P = 0.41), or symptomatic stress UI (P = 0.48). Nor was there association with detrusor overactivity or symptomatic urgency UI. Multivariate ordinal regression of JHM with maximum prolapse stage, adjusting for age, showed a significant relationship (OR 1.26/stage, 95% CI 1.06–1.46, P < 0.05). Conclusion Although JHM is highly prevalent amongst women with lower urinary tract symptoms (LUTS), there is no strong association of JHM with any UI subtype. There is a trend towards higher prolapse staging in women with JHM, which becomes significant only after adjustment for the confounding negative association between age and JHM.
      PubDate: 2014-10-20T22:06:56.951793-05:
      DOI: 10.1111/bju.12823
       
  • Safety and diagnostic accuracy of percutaneous biopsy in upper tract
           urothelial carcinoma
    • Authors: Steven Y. Huang; Kamran Ahrar, Sanjay Gupta, Michael J. Wallace, Joe E. Ensor, Savitri Krishnamurthy, Surena F. Matin
      Abstract: Objective To assess the diagnostic accuracy and safety of percutaneous biopsy for upper tract urothelial carcinoma (UTUC). Patients and Methods From 2002 to 2013, 26 upper tract lesions in 24 patients (20 men; median [range] age 67.8 [51.7–85.9] years) were percutaneously biopsied. Analysis was separated based on lesion appearance: (i) mass infiltrating renal parenchyma, (ii) filling defect in the collecting system, (iii) urothelial wall thickening. We tracked immediate complications and tract seeding on follow‐up imaging. Results Of the 26 upper tract lesions, 15 (58%) were masses infiltrating the renal parenchyma (mean [range] size 5.4 [1.1–14.0] cm), six (23%) were urothelial wall thickenings (mean [range] size 0.8 [0.4–1.1] cm), and five (19%) were filling defects within the renal pelvis or calyx (mean [range] size 2.7 [1.0–4.6] cm). Definitive diagnosis of UTUC was made by biopsy in 22 of 26 lesions (85%). Biopsy characterised 14 of 15 infiltrative masses and five of five filling defects; biopsy characterised three of six cases of urothelial wall thickening. CT follow‐up was available for 19 patients (73%) at a median (range) of 13.6 (1.0–98.9) months. Three patients (11%) developed recurrence in the nephrectomy bed at 5.6, 9.7, and 29.0 months after biopsy; none were attributed to tract seeding after independent review, because recurrence was remote from the biopsy site. Conclusion Percutaneous biopsy is effective for diagnosis of UTUC, providing tissue diagnosis in 85% of cases. While case reports cite a risk of tract seeding, no cases of recurrence were definitely attributable to percutaneous biopsy. Thus, for upper tract urothelial lesions, which are not amenable to endoscopic biopsy, percutaneous biopsy is a safe and effective technique.
      PubDate: 2014-10-20T22:05:10.22679-05:0
      DOI: 10.1111/bju.12824
       
  • Metabolic syndrome‐like components and prostate cancer risk: results
           from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study
           
    • Authors: Katharine N. Sourbeer; Lauren E. Howard, Gerald L. Andriole, Daniel M. Moreira, Ramiro Castro‐Santamaria, Stephen J. Freedland, Adriana C. Vidal
      Abstract: Objective To evaluate the relationship between number of metabolic syndrome (MetS)‐like components and prostate cancer diagnosis in a group of men where nearly all biopsies were taken independent of prostate‐specific antigen (PSA) level, thus minimising any confounding from how the various MetS‐like components may influence PSA levels. Subjects/Patients and Methods We analysed data from 6426 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study with at least one on‐study biopsy. REDUCE compared dutasteride vs placebo on prostate cancer risk among men with an elevated PSA level and negative pre‐study biopsy and included two on‐study biopsies regardless of PSA level at 2 and 4 years. Available data for MetS‐like components included data on diabetes, hypertension, hypercholesterolaemia, and body mass index. The association between number of these MetS‐like components and prostate cancer risk and low‐grade (Gleason sum 7) vs no prostate cancer was evaluated using logistic regression. Results In all, 2171 men (34%) had one MetS‐like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS‐like components had lower PSA levels (P = 0.029). One vs no MetS‐like components was protective for overall prostate cancer (P = 0.041) and low‐grade prostate cancer (P = 0.010). Two (P = 0.69) or three to four (P = 0.15) MetS‐like components were not significantly related to prostate cancer. While one MetS‐like component was unrelated to high‐grade prostate cancer (P = 0.97), two (P = 0.059) or three to four MetS‐like components (P = 0.02) were associated with increased high‐grade prostate cancer risk, although only the latter was significant. Conclusion When biopsies are largely PSA level independent, men with an initial elevated PSA level and a previous negative biopsy, and multiple MetS‐like components were at an increased risk of high‐grade prostate cancer, suggesting the link between MetS‐like components and high‐grade prostate cancer is unrelated to a lowered PSA level.
      PubDate: 2014-10-20T20:59:27.037151-05:
      DOI: 10.1111/bju.12843
       
  • Testosterone therapy and cancer risk
    • Authors: Michael L. Eisenberg; Shufeng Li, Paul Betts, Danielle Herder, Dolores J. Lamb, Larry I. Lipshultz
      Abstract: Objective To determine if testosterone therapy (TT) status modifies a man's risk of cancer. Patients and Methods The Urology clinic hormone database was queried for all men with a serum testosterone level and charts examined to determine TT status. Patient records were linked to the Texas Cancer Registry to determine the incidence of cancer. Men accrued time at risk from the date of initiating TT or the first office visit for men not on TT. Standardised incidence rates and time to event analysis were performed. Results In all, 247 men were on TT and 211 did not use testosterone. In all, 47 men developed cancer, 27 (12.8%) were not on TT and 20 (8.1%) on TT. There was no significant difference in the risk of cancer incidence based on TT (hazard ratio [HR] 1.0, 95% confidence interval [CI] 0.57–1.9; P = 1.8). There was no difference in prostate cancer risk based on TT status (HR 1.2, 95% CI 0.54–2.50). Conclusion There was no change in cancer risk overall, or prostate cancer risk specifically, for men aged >40 years using long‐term TT.
      PubDate: 2014-10-20T05:08:08.566885-05:
      DOI: 10.1111/bju.12756
       
  • The scientific basis for the use of biomaterials in stress urinary
           incontinence (SUI) and pelvic organ prolapse (POP)
    • Authors: Marc Colaco; Jayadev Mettu, Gopal Badlani
      Abstract: Objectives To review the scientific and clinical literature to assess the basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pelvic floor diseases (PFDS), such as SUI and POP, are common and vexing disorders. While synthetic mesh‐based repairs have long been considered an option for PFD treatment, and their efficacy established in randomised clinical trials, safety of its use has recently been called into question. Materials and Methods Using the PubMed, MEDLINE and Medical Subject Headings (MeSH) databases, we performed a critical review of English‐language publications that contained the following keywords: ‘pelvic organ prolapse’, ‘stress urinary incontinence’, ‘mesh’, ‘biomaterial’, ‘collagen’, ‘elastin’ and ‘extracellular matrix’. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review. Results We found that many of the potential causes of PFDs are due to altered metabolism of patient extracellular matrix (specifically collagen, elastin, and their respective enzymes) and as such, repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. However, mesh use is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu. Conclusion While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision‐making process.
      PubDate: 2014-10-20T03:48:27.406083-05:
      DOI: 10.1111/bju.12819
       
  • A new one‐layer epididymovasostomy technique
    • Authors: Alayman Hussein
      Abstract: Objectives To describe and evaluate the outcomes of a new epididymovasostomy technique. Patients and Methods Nine patients with obstructive azoospermia were treated at the Minia University Hospital using a new microsurgical bilateral epididymovasostomy technique. The technique involved the opening of a small window in the tunica of the epididymis, making an opening in the underneath epididymal tubule and keeping it open by fixing the edges of the epididymal opening to the edge of the epididymal tunica with four 10/0 nylon sutures. The abdominal cut end of the vas deferens was then anastomosed to the epididymal opening by suturing the epididymal tubule, fixed to its tunica in one layer, to the full thickness vas deferens. The main outcome measure was finding sperm in the ejaculate. Results Sperm was found in the ejaculate in six out of nine patients after our new, one‐layer, epididymovasostomy technique. Mean ± sd operating time was 176 ± 23 min. Conclusions This new, one‐layer, epididymovasostomy technique provides a simple alternative method of epididymovasostomy, with reasonable outcomes. More cases and follow‐up are needed to make meaningful comparisons with conventional epididymovasostomy.
      PubDate: 2014-10-20T02:58:45.271142-05:
      DOI: 10.1111/bju.12839
       
  • Long‐term efficacy of polydimethylsiloxane (Macroplastique®)
           injection for Mitrofanoff leakage after continent urinary diversion
           surgery
    • Authors: Antoine Kass‐iliyya; Tina G. Rashid, Isabella Citron, Charlotte Foley, Rizwan Hamid, Tamsin J. Greenwell, P. Julian R. Shah, Jeremy L. Ockrim
      Abstract: Objective To assess the long‐term efficacy of polydimethylsiloxane (Macroplastique®) injection (MPI) in the treatment of Mitrofanoff leakage secondary to valve incompetence. Patients and Methods Between 1995 and 2012, the records of 24 consecutive patients who underwent MPI for Mitrofanoff urinary leakage after continent cutaneous urinary diversion (CCUD) surgery were examined. All patients had a valve deemed of sufficient length (>2 cm) to attempt Macroplastique coaptation. Treatment outcomes were divided into three categories based on physician assessment: success (dry), partial success (>50% reduction in incontinence pads) and failure. Success rates were assessed according to the type of reservoir and conduit channel. Results The mean (range) follow‐up was 30 (6–96) months. One patient had initial difficulty catheterising, and subsequently required major revision surgery. In all, 12 patients (50%) failed the treatment and subsequently underwent operative revision to the channel. Three patients (12.5%) achieved complete success; one patient had an appendix channel through native bladder and the remaining two had Monti channels through colon. Nine patients (37.5%) had partial success; success rates were higher with appendix channels (four of six) and colonic reservoirs (six of seven) when compared with Monti channels (eight of 18, 44%) and ileal reservoirs (zero of two). Five of the nine patients with partial success eventually required further surgical revision for deteriorating continence at a mean (range) of 41 (14–96) months, whilst the other four have maintained sufficient continence with MPI alone. Conclusion Macroplastique bulking cured only 12.5% patients, but leakage was substantially improved in a further 37.5% allowing major surgery to be avoided or postponed in one half of the cohort. Appendix Mitrofanoffs do better than the Monti Mitrofanoff, with channels through colonic segments generally doing better than those through ileal bladders. MPI should be considered as a less invasive alternative to avoid or delay major reconstructive surgery.
      PubDate: 2014-10-20T02:44:23.811316-05:
      DOI: 10.1111/bju.12817
       
  • A novel prognostic model for patients with sarcomatoid renal cell
           carcinoma
    • Authors: Ben Y. Zhang; R. Houston Thompson, Christine M. Lohse, Bradley C. Leibovich, Stephen A. Boorjian, John C. Cheville, Brian A. Costello
      Abstract: Objective 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 (CSS), 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 one pathologist. CSS was estimated using the Kaplan–Meier method. The associations of clinical and pathological 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 < 0.001). For patients with grade 4 non‐metastatic (M0) RCC, the presence of sarcomatoid differentiation was associated with an 82% increased risk of death from RCC (P < 0.001). For patients with sarcomatoid RCC, the 2009 primary tumour classifications, presence of regional lymph nodes and distant metastases, coagulative tumour necrosis, and the amount of sarcomatoid differentiation were each significantly associated with death from RCC in a multivariate setting. After adjusting for other prognostic variables, each 10% increase in the amount of sarcomatoid differentiation was associated with a 6% increased risk of death from RCC (P = 0.028). Patients whose tumours contained ≥30% (median amount) sarcomatoid differentiation were 52% more likely to die from RCC compared with patients whose tumours contained
      PubDate: 2014-10-19T20:51:30.253909-05:
      DOI: 10.1111/bju.12781
       
  • Complications after artificial urinary sphincter implantation in patients
           with or without prior radiotherapy
    • Authors: Emmanuel Ravier; Hakim Fassi‐Fehri, Sébastien Crouzet, Albert Gelet, Nadia Abid, Xavier Martin
      Abstract: Objective To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy (RT). Patients and Methods Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurological and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and those lost to follow‐up. In all, 122 patients were included in the study, 61 with prior RT and 61 without prior RT. All patients underwent the same surgical technique by two different surgeons. All AUS were implanted with a bulbar urethral cuff position. The mean (range) follow‐up was 37.25 (1–126) months. Results In the patients without prior RT and those with prior RT, revision rates were 32.8% vs 29.5%, respectively (P = 0.59). The 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). However, infection and explantation were more prevalent in patients with prior RT [two (3.2%) vs 10 (16.3%), P = 0.018 and three (4.9%) vs 12 (19.6%), P = 0.016, respectively]. Finally, continence rates were not significantly different [75.4% (without prior RT) vs 63.9% (with prior RT), P = 0.23]. Conclusion AUS is the ‘gold standard’ treatment of male urinary incontinence after re‐education failure in patients with or without prior RT. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior RT.
      PubDate: 2014-10-18T04:56:40.590983-05:
      DOI: 10.1111/bju.12777
       
  • Burden of male lower urinary tract symptoms (LUTS) suggestive of benign
           prostatic hyperplasia (BPH) – focus on the UK
    • Authors: Mark Speakman; Roger Kirby, Scott Doyle, Chris Ioannou
      Abstract: Key Messages Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45–49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.
      PubDate: 2014-10-16T21:59:07.742372-05:
      DOI: 10.1111/bju.12745
       
  • Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer
           surgery: a UK national audit
    • Authors: Simon Pridgeon; Paula Allchorne, Bruce Turner, John Peters, James Green
      Abstract: Objectives To evaluate the use of post‐discharge venous thromboembolism (VTE) prophylaxis in UK pelvic cancer centres consistent with national guidelines. Methods Data was collected from healthcare professionals from 64 UK pelvic cancer centres. Results After radical cystectomy (RC), all cancer centres routinely use low‐molecular‐weight heparin (LMWH) in the perioperative period. After RC 67% of cancer centres use post‐discharge LMWH routinely. After radical prostatectomy (RP), 98% of units use perioperative LMWH VTE prophylaxis routinely. After RP, 61% of hospitals always use post‐discharge LMWH. In all, 27% of all UK cancer centres reported deaths or serious VTE complications from urological pelvic cancer surgery in the last 2 years. Conclusions The National Institute for Health and Care Excellence (NICE) issued explicit guidance of VTE prophylaxis after pelvic and abdominal cancer surgery. Conversion of national guidance into local policy is ≈60% for UK pelvic cancer centres. A lack of good quality evidence is cited as a reason for not adhering to NICE guidance.
      PubDate: 2014-10-16T21:47:26.181798-05:
      DOI: 10.1111/bju.12693
       
  • Targeted local therapy in oligometastatic prostate cancer: a promising
           potential opportunity after failed primary treatment
    • Authors: Fairleigh Reeves; Declan Murphy, Christopher Evans, Patrick Bowden, Anthony Costello
      PubDate: 2014-10-13T02:39:55.11755-05:0
      DOI: 10.1111/bju.12957
       
  • Safety and clinical outcomes of patients treated with abiraterone acetate
           after docetaxel: results of the Italian Named Patient Programme
    • Authors: Orazio Caffo; Ugo De Giorgi, Lucia Fratino, Giovanni Lo Re, Umberto Basso, Alessandro D'Angelo, Maddalena Donini, Francesco Verderame, Raffaele Ratta, Giuseppe Procopio, Enrico Campadelli, Francesco Massari, Donatello Gasparro, Sveva Macrini, Caterina Messina, Monica Giordano, Daniele Alesini, Fable Zustovich, Anna P. Fraccon, Giovanni Vicario, Vincenza Conteduca, Francesca Maines, Enzo Galligioni
      Abstract: Objective To assess the safety and efficacy of abiraterone acetate (AA) in patients with metastatic castration‐resistant prostate cancer (mCRPC) treated in a compassionate named patient programme (NPP). Patients and Methods We retrospectively reviewed the clinical records of patients with mCRPC treated with AA at the standard daily oral dose of 1000 mg plus prednisone 10 mg/day in 19 Italian hospitals. Results We assessed 265 patients with mCRPC treated with AA. The most frequent (>1%) grade 3–4 toxicities were anaemia (4.2%), fatigue (4.2%), and bone pain (1.5%). The median progression‐free survival was 7 months; median overall survival was 17 months after starting AA, and 35 months after the first docetaxel administration. Our study reproduced the clinical outcomes reported in the AA pivotal trial, including those relating to special populations such as the elderly, patients with a poor performance status, symptomatic patients, and patients with visceral metastases. Conclusions Our data show the safety and activity of AA when administered outside clinical trials, and confirm the findings of the post‐docetaxel pivotal trial in the patients as a whole population and in special populations of specific interest.
      PubDate: 2014-10-08T22:44:42.432427-05:
      DOI: 10.1111/bju.12857
       
  • Long‐Term Analysis of Oncologic Outcomes After Laparoscopic Radical
           Cystectomy in Europe: Results from a Multicentric Study of
           Eau‐Section of Uro‐Technology
    • Authors: Simone Albisinni; Jens Rassweiler, Clement‐Claude Abbou, Xavier Cathelineau, Piotr Chlosta, Laurent Fossion, Franco Gaboardi, Peter Rimington, Laurent Salomon, Rafael Sanchez‐Salas, Jens‐Uwe Stolzenburg, Dogu Teber, Roland Velthoven
      Abstract: Objective To report long‐term outcomes of laparoscopic radical cystectomy (LRC) in a multi‐centric European cohort, and explore feasibility and safety of the procedure. Patients and Methods This study was coordinated by EAU‐section of Uro‐technology (ESUT) with nine centers enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analyzed. Descriptive statistics were used to explore peri‐ and post‐operative characteristics of the cohort. Kaplan‐Meier curves were constructed to evaluate recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, node involvement and surgical margin status. Results Minor complications (Clavien I‐II) occurred in 39% and major (IIIa‐IVb) in 17%. 10 (2%) post‐operative deaths were recorded. Median lymph node retrieval was 14 (IQR 9‐17) and positive surgical margins were detected in 29 (5.8%) patients. Median follow‐up was 50 months (mean 60, IQR 19‐90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, node involvement and margin status (log‐rank p
      PubDate: 2014-10-07T22:55:55.992849-05:
      DOI: 10.1111/bju.12947
       
  • Effects of bariatric surgery on untreated Lower Urinary Tract Symptoms: a
           prospective multicentre cohort study
    • Authors: Serge Luke; Ben Addison, Katherine Broughton, Jonathan Masters, Richard Stubbs, Andrew Kennedy‐Smith
      Abstract: OBJECTIVE To evaluate the effects of bariatric surgery on Lower Urinary Tract Symptoms in a prospective cohort study. MATERIALS AND METHODS Patients undergoing bariatric surgery were recruited into the study. Assessment was done using International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and PSA levels were recorded, insulin resistance was quantified using Homeostasis Model Assessment method (HOMA‐IR). Patients were assessed prior to; 6‐8 weeks post; and 1 year post surgery. Weight loss, change in BMI, total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method. Linear regression analysis was performed with total symptoms score change at one year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA‐IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables. RESULTS 86 patients were recruited, 82% completed at least one follow up after surgery. There was significant weight loss and reduction of BMI after surgery (p
      PubDate: 2014-09-29T07:12:29.842953-05:
      DOI: 10.1111/bju.12943
       
  • Association between metabolic syndrome and severity of lower urinary tract
           symptoms: observational study in a 4,666 European men cohort
    • Authors: Pourya Pashootan; Guillaume Ploussard, Arnaud Cocaul, Armaury De Gouvello, François Desgrandchamps
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between metabolic syndrome (MS) and the frequency and severity of lower urinary tract symptoms (LUTS) Patients and Methods 4,666 male patients from 55 to 100 years old consulting a general practitioner (GP) on a 12‐days period in December 2009 have been included into an observational study. LUTS were defined according to the I‐PSS score and metabolic syndrome with the NECP/ATP III definition. We studied the correlation between MS and its individual component, and the severity of LUTS (I‐PSS and treatment for LUTS). Analyses were adjusted on BMI, age, and PSA level. Results MS was reported in 51.5 % of the patients and 47% were treated for LUTS. There was a significant link between MS and treated LUTS (p
      PubDate: 2014-09-17T04:13:12.936292-05:
      DOI: 10.1111/bju.12931
       
  • Diagnostic value of biparametric magnetic resonance imaging (MRI) as an
           adjunct to prostate‐specific antigen (PSA)‐based detection of
           prostate cancer in men without prior biopsies
    • Authors: Soroush Rais‐Bahrami; M. Minhaj Siddiqui, Srinivas Vourganti, Baris Turkbey, Ardeshir R. Rastinehad, Lambros Stamatakis, Hong Truong, Annerleim Walton‐Diaz, Anthony N. Hoang, Jeffrey W. Nix, Maria J. Merino, Bradford J. Wood, Richard M. Simon, Peter L. Choyke, Peter A. Pinto
      Pages: n/a - n/a
      Abstract: Objectives To determine the diagnostic yield of analysing biparametric (T2‐ and diffusion‐weighted) magnetic resonance imaging (B‐MRI) for prostate cancer detection compared with standard digital rectal examination (DRE) and prostate‐specific antigen (PSA)‐based screening. Patients and Methods Review of patients who were enrolled in a trial to undergo multiparametric‐prostate (MP)‐MRI and MR/ultrasound fusion‐guided prostate biopsy at our institution identified 143 men who underwent MP‐MRI in addition to standard DRE and PSA‐based prostate cancer screening before any prostate biopsy. Patient demographics, DRE staging, PSA level, PSA density (PSAD), and B‐MRI findings were assessed for association with prostate cancer detection on biopsy. Results Men with detected prostate cancer tended to be older, with a higher PSA level, higher PSAD, and more screen‐positive lesions (SPL) on B‐MRI. B‐MRI performed well for the detection of prostate cancer with an area under the curve (AUC) of 0.80 (compared with 0.66 and 0.74 for PSA level and PSAD, respectively). We derived combined PSA and MRI‐based formulas for detection of prostate cancer with optimised thresholds. (i) for PSA and B‐MRI: PSA level + 6 x (the number of SPL) > 14 and (ii) for PSAD and B‐MRI: 14 × (PSAD) + (the number of SPL) >4.25. AUC for equations 1 and 2 were 0.83 and 0.87 and overall accuracy of prostate cancer detection was 79% in both models. Conclusions The number of lesions positive on B‐MRI outperforms PSA alone in detection of prostate cancer. Furthermore, this imaging criteria coupled as an adjunct with PSA level and PSAD, provides even more accuracy in detecting clinically significant prostate cancer.
      PubDate: 2014-09-15T04:54:55.847952-05:
      DOI: 10.1111/bju.12639
       
  • The impact of robotic surgery on the surgical management of prostate
           cancer in the USA
    • Authors: Steven L. Chang; Adam S. Kibel, James D. Brooks, Benjamin I. Chung
      Pages: n/a - n/a
      Abstract: Objective To describe the surgeon characteristics associated with robot‐assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods A retrospective cohort study with a weighted sample size of 489 369 men who underwent non‐RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High‐volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7–3.4), intermediate‐ (200–399 beds; OR 5.96, 95% CI 1.3–26.5) and large‐sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4–25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7–6.4). RARP adoption was generally associated with increased RP volume, greatest for high‐volume surgeons and least for low‐volume surgeons (
      PubDate: 2014-08-26T00:52:13.437319-05:
      DOI: 10.1111/bju.12850
       
  • Evidence of increased centrally enhanced bladder compliance with ageing in
           a mouse model
    • Authors: Phillip P. Smith; Anthony DeAngelis, Richard Simon
      Pages: n/a - n/a
      Abstract: Objective To test the hypothesis that ageing is associated with increasing neurogenic enhancement of bladder filling compliance. Materials and Methods Female B6 mice (aged 2, 12, 22 and 26 months) underwent cystometry while alive and immediately after death. Bladder compliance was calculated from pressure‐time data. Pressure data were transformed using Fast Fourier Transform to obtain power spectra of bladder pressure variations attributable to contractile activity during filling in both alive and dead mice. A cut‐off frequency (CF) was determined for each mouse, above which any power content would be primarily neurogenic. Compliance and power spectra results were compared among age groups, and correlations sought. Results A reversible loss of bladder compliance and non‐voiding contractile (NVC) activity followed abolition of voiding reflexes in female colony mice in all age groups. Bladder filling compliance increased with age in urethane‐anaesthetised and post‐mortem conditions, and more so in the former. Power below the CF did not significantly vary with age. Neurogenic power increased with age, and significantly correlated with compliance. Conclusions An increase in neurogenic power during filling accompanies increased centrally mediated compliance enhancement with age. A bladder control model in which brain processes related to micturition may compensate for age‐associated changes; thereby preserving voiding function is suggested. Urinary dysfunction could be viewed as the result of homeostatic failure rather than strictly end‐organ pathology.
      PubDate: 2014-08-19T21:12:31.675268-05:
      DOI: 10.1111/bju.12669
       
  • Preventable mortality after common urological surgery: failing to
           rescue?
    • Authors: Jesse D. Sammon; Daniel Pucheril, Firas Abdollah, Briony Varda, Akshay Sood, Naeem Bhojani, Steven L. Chang, Simon P. Kim, Nedim Ruhotina, Marianne Schmid, Maxine Sun, Adam S. Kibel, Mani Menon, Marcus E. Semel, Quoc‐Dien Trinh
      Pages: n/a - n/a
      Abstract: Objective To assess in‐hospital mortality in patients undergoing many commonly performed urological surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in ‘failure to rescue’ (FTR) rates, e.g. death after a complication that was potentially recognisable/preventable. Patients and Methods Discharges of all patients undergoing urological surgery between 1998 and 2010 were extracted from the Nationwide Inpatient Sample and assessed for overall and FTR mortality. Admission trends were assessed with linear regression. Logistic regression models fitted with generalised estimating equations were used to estimate the impact of primary predictors on over‐all and FTR mortality and changes in mortality rates. Results Between 1998 and 2010, an estimated 7 725 736 urological surgeries requiring hospitalisation were performed in the USA; admissions for urological surgery decreased 0.63% per year (P = 0.008). Odds of overall mortality decreased slightly (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.988–0.993), yet the odds of mortality attributable to FTR increased 5% every year (OR 1.050, 95% CI 1.038–1.062). Patient age, race, Charlson Comorbidity Index, public insurance status, as well as urban hospital location were independent predictors of FTR mortality (P < 0.001). Conclusion A shift from inpatient to outpatient surgery for commonly performed urological procedures has coincided with increasing rates of FTR mortality. Older, sicker, minority group patients and those with public insurance were more likely to die after a potentially recognisable/preventable complication. These strata of high‐risk individuals represent ideal targets for process improvement initiatives.
      PubDate: 2014-08-19T01:02:04.688454-05:
      DOI: 10.1111/bju.12833
       
  • Augmented‐reality‐based skills training for
           robot‐assisted urethrovesical anastomosis: a
           multi‐institutional randomised controlled trial
    • Authors: Ashirwad Chowriappa; Syed Johar Raza, Anees Fazili, Erinn Field, Chelsea Malito, Dinesh Samarasekera, Yi Shi, Kamran Ahmed, Gregory Wilding, Jihad Kaouk, Daniel D. Eun, Ahmed Ghazi, James O. Peabody, Thenkurussi Kesavadas, James L. Mohler, Khurshid A. Guru
      Pages: n/a - n/a
      Abstract: Objective To validate robot‐assisted surgery skills acquisition using an augmented reality (AR)‐based module for urethrovesical anastomosis (UVA). Methods Participants at three institutions were randomised to a Hands‐on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank‐sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross‐over group). Results A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. Conclusion Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.
      PubDate: 2014-08-16T12:49:29.97563-05:0
      DOI: 10.1111/bju.12704
       
  • Massive renal size is not a contraindication to a laparoscopic approach
           for bilateral native nephrectomies in autosomal dominant polycystic kidney
           disease (ADPKD)
    • Authors: Eric S. Wisenbaugh; Mark D. Tyson, Erik P. Castle, Mitchell R. Humphreys, Paul E. Andrews
      Pages: n/a - n/a
      Abstract: Objective To determine if massive renal size should be a contraindication for attempting a laparoscopic approach to bilateral native nephrectomies in patients with autosomal dominant polycystic kidney disease (ADPKD). Patients and Methods We retrospectively reviewed all laparoscopic bilateral nephrectomies performed for ADPKD at our institution from 1 January 2000 to 31 December 2012. We stratified patients by kidney weight (with or without at least one kidney weighing >2500 g) and compared perioperative data, complications, and status of kidney allografts. Additionally, the subset of patients with at least one kidney weighing >3500 g was compared with the rest of the cohort. Results We identified 68 patients; mean (range) individual kidney weight was 1984 (197–5042) g. In all, 24 patients had at least one kidney weighing >2500 g, yet patients in this group were not significantly different from the rest of the cohort for complications, estimated blood loss, transfusion rate, or duration of hospitalisation. For those who underwent simultaneous renal allotransplantation, native kidney size was not associated with graft outcomes. Additionally, of the six patients with at least one kidney weighing >3500 g, only one required a blood transfusion, and the group had no intraoperative or postoperative Clavien grade ≥3 complications. None of the cohort required conversion to open surgery. Conclusion Massive size of polycystic kidneys is not a contraindication to attempting a laparoscopic approach to bilateral nephrectomies in an experienced, high‐volume centre.
      PubDate: 2014-08-16T12:41:42.786571-05:
      DOI: 10.1111/bju.12821
       
  • Oncological predictive value of the 2004 World Health Organisation grading
           classification in primary T1 non‐muscle‐invasive bladder
           cancer. A step forward or back?
    • Authors: Federico Pellucchi; Massimo Freschi, Marco Moschini, Lorenzo Rocchini, Carmen Maccagnano, Suardi Nazareno, Franco Bergamaschi, Francesco Montorsi, Renzo Colombo
      Pages: n/a - n/a
      Abstract: Objective To compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer. Patients and Methods We retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro‐pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non‐muscle‐invasive bladder cancer at second TUR received bacille Calmette‐Guérin. Follow‐up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence‐free survival (RFS) and progression‐free survival (PFS) rates were performed using the Kaplan–Meier method with the log‐rank test. Results G2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow‐up period was 31.1 (19; 1–93) months. The 5‐year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5‐year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001). Conclusion The results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.
      PubDate: 2014-08-16T11:40:31.260509-05:
      DOI: 10.1111/bju.12666
       
  • Indications for intervention during active surveillance of prostate
           cancer: a comparison of the Johns Hopkins and Prostate Cancer Research
           International Active Surveillance (PRIAS) protocols
    • Authors: Max Kates; Jeffrey J. Tosoian, Bruce J. Trock, Zhaoyong Feng, H. Ballentine Carter, Alan W. Partin
      Pages: n/a - n/a
      Abstract: Objective To analyse how patients enrolled in our biopsy based surveillance programme would fare under the Prostate Cancer Research International Active Surveillance (PRIAS) protocol, which uses PSA kinetics. Patients and Methods Since 1995, 1125 men with very‐low‐risk prostate cancer have enrolled in the AS programme at the Johns Hopkins Hospital (JHH), which is based on monitoring with annual biopsy. The PRIAS protocol uses a combination of periodic biopsies (in years 1, 4, and 7) and prostate‐specific antigen doubling time (PSADT) to trigger intervention. Patients enrolled in the JHH AS programme were retrospectively reviewed to evaluate how the use of the PRIAS protocol would alter the timing and use of curative intervention. Results Over a median of 2.1 years of follow up, 38% of men in the JHH AS programme had biopsy reclassification. Of those, 62% were detected at biopsy intervals corresponding to the PRIAS criteria, while 16% were detected between scheduled PRIAS biopsies, resulting in a median delay in detection of 1.9 years. Of the 202 men with >5 years of follow‐up, 11% in the JHH programme were found to have biopsy reclassification after it would have been identified in the PRIAS protocol, resulting in a median delay of 4.7 years to reclassification. In all, 12% of patients who would have undergone immediate intervention under PRIAS due to abnormal PSA kinetics would never have undergone reclassification on the JHH protocol and thus would not have undergone definitive intervention. Conclusions There are clear differences between PSA kinetics‐based AS programmes and biopsy based programmes. Further studies should address whether and how the differences in timing of intervention impact subsequent disease progression and prostate cancer mortality.
      PubDate: 2014-08-16T11:16:57.893064-05:
      DOI: 10.1111/bju.12828
       
  • Association of Androgen Deprivation Therapy with Excess
           Cardiac‐Specific Mortality in Men with Prostate Cancer
    • Authors: David R. Ziehr; Ming‐Hui Chen, Danjie Zhang, Michelle H. Braccioforte, Brian J. Moran, Brandon A. Mahal, Andrew S. Hyatt, Shehzad S. Basaria, Clair J. Beard, Joshua A. Beckman, Toni K. Choueiri, Anthony V. D'Amico, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L Nguyen
      Abstract: Objectives To determine if androgen deprivation therapy (ADT) is associated with excess cardiac‐specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI). Subjects/patients and methods Five thousand seventy‐seven men (median age, 69.5 years) with cT1c‐T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. Fine and Gray's competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity. Results After a median follow‐up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at five years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39‐1.78; P=0.64; n=2653) or in men with diabetes mellitus, hypertension, or hypercholesterolemia (2.09% vs 1.97%, AHR, 1.33; 95% CI, 0.70‐2.53; P=0.39; n=2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01‐10.64; P=0.048; n=256). In this subgroup, the five‐year cumulative incidence of CSM was 7.01% (95% CI 2.82‐13.82%) for ADT vs 2.01% (95% CI 0.38‐6.45%) for no ADT. Conclusion ADT was associated with a five percent absolute excess risk of CSM at five years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
      PubDate: 2014-08-15T01:55:07.623913-05:
      DOI: 10.1111/bju.12905
       
  • Exploring associations between LUTS and GI problems in women: a study in
           women with urological and GI problems versus a control population
    • Authors: M. Wyndaele; B.Y. De Winter, P.A. Pelckmans, S. De Wachter, M. Van Outryve, J.J. Wyndaele
      Abstract: Objectives First, to study the prevalence of self‐reported LUTS in women consulting a Gastroenterology clinic with complaints of functional constipation (FC), fecal incontinence (FI) or both, compared to a female control population. Secondly, to study the influence of FC, FI, or both on self‐reported LUTS in women attending a Urology clinic. Patients and methods We present a retrospective study of data collected through a validated self‐administered bladder and bowel symptom questionnaire in a tertiary referral hospital from three different female populations: 104 controls, 159 gastroenterological patients and 410 urological patients. Based on the reported bowel symptoms, patients were classified as having FC, FI, a combination of both, or, no FC or FI. LUTS were compared between the control population and the gastroenterological patients, and between urological patients with and without concomitant gastroenterological complaints. Results were corrected for possible confounders through logistic regression analysis. Results The prevalence of LUTS in the control population was comparable to large population‐based studies. Nocturia was significantly more prevalent in gastroenterological patients with FI compared to the control population (OR 9.1). Female gastroenterological patients with FC more often reported straining to void (OR 10.3), intermittency (OR 5.5), need to immediately revoid (OR 3.7) and feeling of incomplete emptying (OR 10.5) compared to the control population. In urological patients, urgency (94%) and UUI (54% of UI) were reported more often by patients with FI than by patients without gastroenterological complaints (58% and 30% of UI respectively), whereas intermittency (OR 3.6), need to immediately revoid (OR 2.2) and feeling of incomplete emptying (OR 2.2) were reported more often by patients with FC than by patients without gastroenterological complaints. Conclusion As LUTS are reported significantly more often by female gastroenterological patients than by a control population, and as there is a difference in self‐reported LUTS between female urological patients with different concomitant gastroenterological complaints, we suggest that general practitioners, gastroenterologists and urologists should always include the assessment of symptoms of the other pelvic organ system in their patient evaluation. The clinical correlations between bowel and LUT symptoms may be explained by underlying neurological mechanisms.
      PubDate: 2014-08-15T01:55:00.74-05:00
      DOI: 10.1111/bju.12904
       
  • Baseline characteristics predict risk of progression and response to
           combined medical therapy for benign prostatic hyperplasia (BPH)
    • Authors: Michael A. Kozminski; John T. Wei, Jason Nelson, David M. Kent
      Abstract: Objective To better risk stratify patients, using baseline characteristics, to help optimise decision‐making for men with moderate‐to‐severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. Patients and Methods After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre‐treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. Results In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post‐void residual urine volume, serum prostate‐specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Conclusions Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient‐specific benefits against possible risks of adverse effects for a given patient.
      PubDate: 2014-08-13T09:41:17.979521-05:
      DOI: 10.1111/bju.12802
       
  • Pelvic recurrence after radical cystectomy: a call to arms
    •  
  • Cardiopulmonary reserve as determined by cardiopulmonary exercise testing
           correlates with length of stay and predicts complications after radical
           cystectomy
    • Abstract: Objective To investigate whether poor preoperative cardiopulmonary reserve and comorbid state dictate high‐risk status and can predict complications in patients undergoing radical cystectomy (RC). Patients and Methods In all, 105 consecutive patients with transitional cell carcinoma (TCC; stage T1–T3) undergoing robot‐assisted (38 patients) or open (67) RC in a single UK centre underwent preoperative cardiopulmonary exercise testing (CPET). Prospective primary outcome variables were all‐cause complications and postoperative length of stay (LOS). Binary logistic regression analysis identified potential predictive factor(s) and the predictive accuracy of CPET for all‐cause complications was examined using receiver operator characteristic (ROC) curve analysis. Correlations analysis employed Spearman's rank correlation and group comparison, the Mann–Whitney U‐test and Fisher's exact test. Any relationships were confirmed using the Mantel–Haenszel common odds ratio estimate, Kaplan–Meier analysis and the chi‐squared test. Results The anaerobic threshold (AT) was negatively (r = −206, P = 0.035), and the ventilatory equivalent for carbon dioxide (VE/VCO2) positively (r = 0.324, P = 0.001) correlated with complications and LOS. Logistic regression analysis identified low AT (50% of patients presenting for RC had significant heart failure, whereas preoperatively only very few (2%) had this diagnosis. Analysis using the Mann–Whitney test showed that a VE/VCO2 ≥33 was the most significant determinant of LOS (P = 0.004). Kaplan–Meier analysis showed that patients in this group had an additional median LOS of 4 days (P = 0.008). Finally, patients with an American Society of Anesthesiologists grade of 3 (ASA 3) and those on long‐term β‐blocker therapy were found to be at particular risk of myocardial infarction (MI) and death after RC with odds ratios of 4.0 (95% CI 1.05–15.2; P = 0.042) and 6.3 (95% CI 1.60–24.8; P = 0.008). Conclusion Patients with poor cardiopulmonary reserve and hypertension are at higher risk of postoperative complications and have increased LOS after RC. Heart failure is known to be a significant determinant of perioperative death and is significantly under diagnosed in this patient group.
       
  • Brachytherapy for prostate cancer: feasible but oncological equivalence
           unproven
    •  
  • Oncological outcomes of cryosurgery as primary treatment in T3 prostate
           cancer: experience of a single centre
    • Abstract: Objective To assess the oncological outcomes and determine prognostic factors for overall survival (OS), cancer‐specific survival (CSS), and biochemical progression‐free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer. Patients and Methods Between 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan–Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. Results Clinical stage T3a (cT3a) was detected in 60% (45/75) of patients and cT3b detected in 40% (30/75). The 5‐year OS, CSS, and BPFS rates were 85.3%, 92.0%, and 48%, respectively. There was a significant difference when comparing the pT3a with the pT3b group for 5‐year OS (88.9% vs 80%, P = 0.02) and BPFS (55.6% vs 36.7%, P = 0.01), but there was no difference in CSS (93.3% vs 90%, P = 0.63). Stage, Gleason score, and nadir prostate‐specific antigen (PSA) were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. Conclusions Cryosurgery can offer good 5‐year OS, CSS, and BPFS rates for cT3 prostate cancer, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.
       
  • Extended pelvic lymph node dissection in patients with prostate cancer
           previously treated with surgery for lower urinary tract symptoms
    • Abstract: Objectives To evaluate the effect of previous prostate surgery performed for lower urinary tract symptoms (LUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer, testing two widely used LNI predictive models. Patients and Methods From 1990 to 2012, we collected data on 4734 patients with prostate cancer treated with radical prostatectomy and extended pelvic LN dissection (ePLND). Of these, 4453 (94%) had no prior prostate surgery (‘naïve patients’), while 286 (6%) had previously undergone surgery for LUTS. Two LNI prediction models based on patients treated with ePLND were evaluated using the receiver operating characteristic‐derived area under the curve (AUC), the calibration plot method, and decision‐curve analyses. Results The rate of LNI was 12%, while the median number of LNs removed was 15 in both groups (P = 0.9). The two tested nomograms provided more accurate prediction in naïve patients than for those previously treated with prostate surgery for LUTS (AUC: 82% and 81% vs 68% and 71%, P = 0.01 and P = 0.04, respectively). In naïve patients the surgeon would have missed one LNI for every 53 and 34 avoided ePLND using the Briganti and Godoy nomograms, respectively; in patients previously treated with surgery for LUTS, a LNI would have been missed in 13 and 21 patients not undergoing ePLND. Conclusion The accuracy and the clinical net‐benefit of LNI prediction tools decrease significantly in patients with prior prostate surgery for LUTS. These models should be avoided in such patients, who should undergo routine ePLND.
       
  • Transient receptor potential channel modulators as pharmacological
           treatments for lower urinary tract symptoms (LUTS): myth or reality'
    • Abstract: Transient receptor potential (TRP) channels belong to the most intensely pursued drug targets of the last decade. These ion channels are considered promising targets for the treatment of pain, hypersensitivity disorders and lower urinary tract symptoms (LUTS). The aim of the present review is to discuss to what extent TRP channels have adhered to their promise as new pharmacological targets in the lower urinary tract (LUT) and to outline the challenges that lie ahead. TRP vanilloid 1 (TRPV1) agonists have proven their efficacy in the treatment of neurogenic detrusor overactivity (DO), albeit at the expense of prolonged adverse effects as pelvic ‘burning’ pain, sensory urgency and haematuria. TRPV1 antagonists have been very successful in preclinical studies to treat pain and DO. However, clinical trials with the first generation TRPV1 antagonists were terminated early due to hyperthermia, a serious, on‐target, side‐effect. TRP vanilloid 4 (TRPV4), TRP ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) have important sensory functions in the LUT. Antagonists of these channels have shown their potential in pre‐clinical studies of LUT dysfunction and are awaiting clinical validation.
       
  • Radiation exposure to a pregnant urological surgeon – what is
           safe'
    •  
  • Ureteroscopy for stone disease in the paediatric population: a systematic
           review
    • Abstract: The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English‐language articles reporting on a minimum of 50 patients aged ≤18 years treated with URS for stone disease were included. Two reviewers independently extracted the data from each study. A total of 14 studies (1718 procedures) were reported in patients with a mean (range) age of 7.8 (0.25–18.0) years. The mean (range) stone burden was 9.8 (1–30) mm and the mean (range) stone‐free rate (SFR) 87.5 (58–100)% with initial therapeutic URS. The majority of these stones were in the ureter (n = 1427, 83.4%). There were 180 (10.5%) Clavien I–III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorized into those that included children with either a mean age 6 years. (10 studies, 1377 procedures). A higher failure rate (4.4 vs 1.7%) and a higher complication rate (24.0 vs 7.1%) were observed in children whose mean age was
       
  • Clinical utility of 18F‐fluorocholine positron‐emission
           tomography/computed tomography (PET/CT) in biochemical relapse of prostate
           cancer after radical treatment: results of a multicentre study
    • Abstract: Objective To evaluate 18F‐fluorocholine positron‐emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. Patients and Methods This was a retrospective multicentre study that included 374 patients referred for choline‐PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow‐up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline‐PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline‐PET/CT] and quantitative [age, Gleason score, prostate‐specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline‐PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. Results Choline‐PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow‐up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow‐up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline‐PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of
       
  • A lot of questions (and a few answers…) in retroperitoneal fibrosis
    •  
  • The effect of hypogonadism and testosterone‐enhancing therapy on
           alkaline phosphatase and bone mineral density
    • Abstract: Objective To evaluate the relationship of testosterone‐enhancing therapy on alkaline phosphatase (AP) in relation to bone mineral density (BMD) in hypogonadal men. Patients and Methods Retrospective review of 140 men with testosterone levels of
       
  • Short‐term pretreatment with a dual 5α‐reductase
           inhibitor before bipolar transurethral resection of the prostate
           (B‐TURP): evaluation of prostate vascularity and decreased surgical
           blood loss in large prostates
    • Abstract: Objective To investigate if short‐term treatment with dutasteride (8 weeks) before bipolar transurethral resection of the prostate (B‐TURP) can reduce intraoperative bleeding, as dutasteride a dual 5α‐reductase inhibitor (5‐ARI) blocks the conversion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume and prostate‐specific antigen (PSA) levels, while increasing urinary flow rate. Patients and Methods In all, 259 patients were enrolled and randomised to two groups: Group A, receiving placebo and Group B, receiving dutasteride (0.5 mg daily for 8 weeks). Blood samples were taken before and after B‐TURP for serum chemistry evaluation. In particular we evaluated blood parameters associated with blood loss [haemoglobin (Hb) and haematocrit (Ht)] and prostate vascularity [vascular endothelial growth factor (VEGF) immunoreactivity and microvessel density (MVD) using cluster of differentiation 34 (CD34) immunoreactivity]. Results Total testosterone, DHT, PSA level and prostate volume were evaluated and with the exception of DHT and PSA level there was no statistically significant differences between the groups. When comparing changes in Hb and Ht between Group A and Group B before and after B‐TURP, there was a statistically significant difference only in patients with large prostates of ≥50 mL (ΔHb 3.86 vs 2.05 g/dL and ΔHt 4.98 vs 2.64%, in Groups A and B, respectively). There was no significant difference in MVD and VEGF index in prostates of
       
  • Transrectal ultrasonography (TRUS)‐guided pelvic plexus block to
           reduce pain during prostate biopsy: a randomised controlled trial
    • Abstract: Objective To assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasonography(TRUS)‐guided prostate biopsy, compared with the conventional periprostatic nerve block (PNB). Patients and Methods A prospective, double‐blind observational study was conducted with patients being randomised into three groups. Group‐1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 mL 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 mL 2% lignocaine injection bilaterally. Group‐2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group‐3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on a visual analogue scale (VAS) at two time points: VAS‐1: during biopsy procedure and VAS‐2: 30 min after the procedure. Results The mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among the three groups. The mean pain score during biopsy was significantly less in the PPB group [mean (range) sore of 2.91 (2–4)] compared with the PNB group [mean (range) score of 4 (3–5)], and both these groups were superior to the no nerve block group [mean score of 5.4 (3–7)]. There was no significant difference between the mean pain scores, 30 min after the procedure among the three groups with the mean (range) scores being 2.75 (2–4), 2.83 (2–4) and 2.85 (2–4), respectively. Conclusion PPB is superior to conventional periprostatic nerve block (PNB) for pain control during TRUS‐guided biopsy and both are in turn superior to no nerve block.
       
  • Nomogram to predict the benefit from salvage systemic therapy for advanced
           urothelial carcinoma
    •  
  • Risk stratification for bladder recurrence of upper urinary tract
           urothelial carcinoma after radical nephroureterectomy
    • Abstract: Objectives To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU). Patients and Methods We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c‐index) focusing on predictive accuracy and decision‐curve analysis, which indicate whether a model is appropriate for decision‐making and determining subsequent patient prognosis. Results The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c‐index: 0.60 and 0.62). According to the decision‐curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low‐, intermediate‐ and high‐risk groups, respectively. Conclusions We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk‐stratified surveillance protocol.
       
  • The accuracy of Magnetic Resonance Imaging (MRI) in predicting the
           invasion of the tunica albuginea and the urethra during the primary
           staging of Penile Cancer
    • Abstract: Objectives Penile preserving surgery is increasingly offered to men with localised penile cancer and surgical margins of less than 10 mm appear to offer excellent oncological control. Invasion of the tunica albuginea (TA) and the urethra are important factors in determining the feasibility of such surgery. We assessed the accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile Cancer. Methods One hundred and four consecutive patients with clinical T1‐T3 penile cancer had a penile MRI as a part of local staging protocol. An artificial erection was induced by injecting alprostadil (prostaglandin E1). Four men with poor quality MRI images were excluded from the study. The preoperative MRI was compared to final histology to assess its accuracy in predicting the invasion of the tunica albuginea and urethral invasion. Results Data of one hunded patients who underwent penile MRI prior to definitive surgery for invasive penile carcinoma was available for analysis. The mean age was 65 years and number of patients with pathological stage T1, T2 and T3 were 32, 52 and 16 respectively. The sensitivity and specificity of MRI in predicting the invasion of tunica albuginea and urethra were 82.1%, 73.6% and 62.5%, 82.1% respectively. There were no MRI related complications. Conclusions This study shows that penile MRI is an accurate imaging modality in assessing the tunica albuginea invasion but is less sensitive in assessing urethral invasion. These results support the use of MRI in the local staging of penile cancer.
       
  • External urethral sphincter electromyography in asymptomatic women and the
           influence of the menstrual cycle
    • Abstract: Objective To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. Subjects and methods Healthy female volunteers aged 20‐40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaire, pregnancy test, urine dipstick, urinary free flow and post void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index greater than 35, incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode, in the early follicular phase and the mid‐luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. Results One hundred and nineteen women enquired about the research and following screening, 18 females were eligible to enter the study phase. Complete results were obtained in 15 women. Thirty EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in 8 (53%) of the female volunteers. Three had CRDs and DBs in both early follicular and midluteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the midluteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. Conclusions CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
       
  • Post‐operative Radiation Therapy for Patients at High‐risk of
           Recurrence after Radical Prostatectomy: Does Timing Matter'
    • Abstract: Objective To evaluate among prostatectomy patients at high‐risk of recurrence whether the timing of post‐operative radiation therapy (adjuvant, early salvage with detectable post‐prostatectomy PSA, or “late” salvage with PSA>1.0) significantly is associated with overall, prostate‐cancer specific or metastasis‐free survival, in a longitudinal cohort. Patients and Methods Of 6176 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor(CaPSURE), 305 patients with high‐risk pathologic features(margin positivity, Gleason Score(pGS) 8‐10, or pT3‐T4) who underwent post‐operative radiation were examined, either in the adjuvant(≤6 months from surgery with undetectable PSA, N=76) or salvage setting(>6 months after surgery or pre‐radiation PSA>0.1, N=229). Early (PSA≤1.0, N=180) or late salvage radiation(PSA>1.0, N=49) was based on post‐prostatectomy, pre‐radiation PSA. Multivariable Cox regression examined associations with all‐cause mortality and prostate cancer‐specific mortality or metastases(PCSMM). Results After a median of 74 months from prostatectomy, 65 men died(with 37 events of PCSMM). Adjuvant and salvage radiation patients had comparable high‐risk features. Compared to adjuvant, salvage radiation(early or late) had an increased association with all‐cause mortality(hazard ratio[HR] 2.7, p=0.018) and with PCSM(HR 4.0, p=0.015). PCSM‐free survival differed by further stratification of timing, with 10‐year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage radiation, respectively(P=0.026). For PCSM‐ and overall‐survival, compared to adjuvant RT, late salvage RT had statistically significantly increased risk, however early salvage RT did not. Conclusion This analysis suggests that patients who underwent early salvage radiation with PSA1.0 is associated with worse clinical outcomes.
       
  • Novel method of full‐thickness bladder closure with an endoscopic
           suturing machine: a survival study in a porcine model
    • Abstract: Objective To assess the feasibility of a pure endoscopic closure method for vesical perforations using fully absorbable material. Materials and Methods A pilot experimental study was performed in eight anaesthetized female pigs. Four 10‐mm and four 20‐mm endoscopic full thickness cystotomies were created. An endoscopic suturing machine (RD‐180®; LSI Solutions, Victor, NY, USA) was deployed through the working channel of a cystoscope and used to close the incisions with absorbable sutures. Immediate assessment of the quality of the closure was obtained by distending the bladder with saline solution stained with methylene blue under laparoscopic control. After 3 weeks of follow‐up, a necropsy examination was performed to check for signs of peritonitis and wound dehiscence and to assess the quality of healing. Results The experiment was completed in all eight pigs without complications. The median procedure time was 10 ± 4.3 min. The immediate bladder distention test did not show any methylene blue leakage. The postoperative period was uneventful. The post mortem examination after 3 weeks revealed complete healing of the bladder wall incisions with no signs of infection, wound dehiscence or adhesions in the peritoneal cavity of any of the pigs. Conclusion This study describes a successful novel method for endoscopic closure of bladder perforations. The technique was easy, reproducible and safe. Nevertheless, further experimental investigation should be carried out before clinical application of this method.
       
  • Holmium laser enucleation (HoLEP) and photoselective vaporisation of the
           prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and
           chronic urinary retention
    • Abstract: Objectives To evaluate short‐term outcomes of holmium laser enucleation of the prostate (HoLEP) and photoselective vaporisation of the prostate (PVP) in patients with benign prostatic hyperplasia (BPH) and chronic urinary retention (CUR). Patients and Methods A retrospective chart review was performed of all patients with CUR who underwent HoLEP or PVP at our institution over a 3‐year period. CUR was defined as a persistent post‐void residual urine volume (PVR) of >300 mL or refractory urinary retention requiring catheterisation. Results We identified 72 patients with CUR who underwent HoLEP and 31 who underwent PVP. Preoperative parameters including median catheterisation duration (3 vs 5 months, P = 0.71), American Urological Association Symptom Index score (AUASI; 18 vs 21, P = 0.24), and PVR (555 vs 473 mL, P = 0.096) were similar between the HoLEP and PVP groups. The HoLEP group had a larger prostate volume (88.5 vs 49 mL, P < 0.001) and higher PSA concentration (4.5 vs 2.4 ng/mL, P = 0.001). At median 6‐month follow‐up, 71 (99%) HoLEP patients and 23 (74%) PVP patients were catheter‐free (P < 0.001). Of the voiding patients, postoperative AUASI (3 vs 4, P = 0.06), maximum urinary flow rate (23 vs 18 mL/s, P = 0.28) and PVR (56.5 vs 54 mL, P = 1.0) were improved in both groups. Conclusions Both HoLEP and PVP are effective at improving urinary parameters in men with CUR. Despite larger prostate volumes, HoLEP had a 99% successful deobstruction rate, thus rendering patients catheter‐free.
       
  • Changing USA national trends for adrenalectomy: the influence of surgeon
           and technique
    • Abstract: Objective To explain differences over time between operative approach and surgeon type for adrenal surgery in the USA. Patients and methods A retrospective cohort analysis was performed on all patients undergoing adrenalectomy between 2002 and 2011 using the Nationwide Inpatient Sample. Patients undergoing concurrent nephrectomy were excluded. Surgeon specialty was only available for 2003–2009. Descriptive analyses and multivariable logistic regression models were used to assess variables associated with minimally invasive surgery (MIS) and urologist‐performed procedures. Results In all, 58 948 adrenalectomies were identified. A MIS approach was used in 20% of these operations. There was a 4% increase in MIS throughout the study period (P < 0.001). Cases performed at teaching hospitals were more likely to be MIS (odds ratio [OR] 1.47, P < 0.001). We were able to identify surgical specialty in 23 746 cases, of which 60% were performed by urologists. Cases performed in the Midwest compared with Northeast were at increased adjusted odds of being performed by urologists (OR 1.38, P = 0.11). Despite most cases being performed by urologists, adrenalectomy by urologists showed a 15% annual decrease over the analysed period (P < 0.001). Conclusions The use of a MIS technique to perform adrenalectomy is increasing at a slower rate compared with most other surgical extirpative procedures. Further investigation to explain the decreased performance of adrenalectomy by urologists is warranted.
       
  • Complications following artificial urinary sphincter placement after
           radical prostatectomy and radiotherapy: A meta‐analysis
    • Abstract: Objective To conduct a systematic review and meta‐analysis of AUS placement following radical prostatectomy (RP) and radiotherapy (EBRT). Materials and methods A systematic database search was conducted using keywords, according to PRISMA guidelines. Published series of AUS insertion were retrieved, according to the inclusion criteria. The Newcastle‐Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software. Results There were 1886 patients available for analysis of surgical revision outcomes, and 949 for persistent urinary incontinence outcomes from 15 and 11 studies respectively. The mean age (SD) was 66.9 ± 1.4 years and the number of patients per study was 126.6 ± 41.7. Average follow up was 36.7 ± 3.9 months (range, 18 – 68). Artificial urinary sphincter revision was higher in RP + EBRT versus RP alone, with a random effects risk ratio of 1.56 (95% Confidence Interval [CI] 1.02 – 2.72; p
       
  • Foxp3 expression serves as an early chronic inflammation marker of
           squamous cell differentiation and aggressive pathology of urothelial
           carcinomas in neurological patients
    • Abstract: Objective To establish whether the expression of Foxp3 provides specific diagnostic information about neurological patients with urothelial carcinoma of the bladder (UCB). Materials/methods UCB tissue samples from neurological patients were retrieved and compared to control samples. The expression of Foxp3 was analysed via immunohistochemistry of micro‐array tissue sections. The correlation between Foxp3 expression, histological parameters and tumour stage was assessed. Results Overall, 20 UCB tissue samples and 20 others without UCB from neurological patients, and 46 UCB tissue samples from non‐neurological patients were analysed. The distribution of pT of UCB in the neurological patients was as follows: 1 pTa low grade(5%), 3 pTa high grade(15%), 3 pT1(15%), 1 pT2(5%), 7 pT3(35%) and 5 pT4(25%). Squamous cell differentiation was observed in 9 UCB samples (45%). Foxp3 expression was detected in tumour tissues, including 1 pTa high grade, 1 pT1, 1 pT2, 5 pT3 and 5 pT4 tumours. Foxp3 was expressed in 11/13 muscle‐invasive tumours. All tumours displaying squamous cell differentiation expressed Foxp3. Foxp3 was not expressed in the pT3 tumours that displayed sarcomatoid and micropapillary properties. Among the bladder samples without UCB from neurological patients, no expression of Foxp3 was observed. Among the UCB samples from the non‐neurological patients, only 7 cases displayed squamous cell differentiation. All tumours that displayed squamous cell differentiation expressed Foxp3, including 1 pTa high grade, 4 pT3 and 2 pT4 tumours. Other tumours displaying urothelial differentiation did not express Foxp3. The expression of Foxp3 correlated to squamous cell differentiation in neurological(p=0.004) and non‐neurological UCB tissue(p
       
  • An assessment of the physical impact of complex surgical tasks on surgeon
           errors and discomfort: a comparison between robot‐assisted,
           laparoscopic and open approaches
    • Abstract: Objectives To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot‐assisted. Subjects and Methods Six urological surgeons made an in vitro simulated vesico‐urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot‐assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self‐reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. Results The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot‐assisted approach (anova, P < 0.005). The number of errors and the level of self‐reported discomfort were highest for the laparoscopic approach (anova, P < 0.005). Limitations of the present study include the small sample size and variation in prior surgical experience of the participants. Conclusions In an in vitro model of anastomosis surgery, robot‐assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.
       
  • Review of appendiceal onlay flap in the management of complex ureteric
           strictures in six patients
    • Abstract: Objectives To evaluate appendiceal onlay flap ureteroplasty for repairing complex right proximal and mid‐ureteric strictures. Patients and Methods Between August 2006 and August 2012 four women and two men (mean age 34.2 years) underwent right laparoscopic appendiceal onlay flap ureteroplasty. The mean stricture length was 2.5 cm. Stricture formation was secondary to impacted ureteric stones in three patients and failed pyeloplasty for congenital pelvi‐ureteric junction obstruction in the remaining three. Each patient had ipsilateral flank pain before surgery. Results The mean operating time, estimated blood loss and hospital stay were 244 min, 175 mL and 3.2 days, respectively. No intra‐ or peri‐operative complications were noted. The objective success rate was 100% (all patients had radiographic and/or endoscopic resolution of their ureteric strictures). The subjective success rate was 66%, (two patients developed recurrent discomfort, which upon exploration was found to be attributable to fibrosis away from the appendiceal onlay graft, where the gonadal vessels crossed the ureter). Both patients with recurrent pain underwent laparoscopic ureterolysis and bladder advancement flap proximal to the appendiceal onlay, which markedly improved one patient's pain but the other patient continued to have discomfort, ultimately resulting in a laparoscopic nephroureterectomy. Conclusions Appendiceal onlay ureteroplasty is a viable treatment option for patients with complex right proximal and mid‐ureteric strictures, while minimising the potential morbidity of appendiceal and ileal interposition.
       
  • Can supervised exercise prevent treatment toxicity in patients with
           prostate cancer initiating androgen‐deprivation therapy: a
           randomised controlled trial
    • Abstract: Objective To determine if supervised exercise minimises treatment toxicity in patients with prostate cancer initiating androgen‐deprivation therapy (ADT). This is the first study to date that has investigated the potential role of exercise in preventing ADT toxicity rather than recovering from established toxicities. Patients and Methods Sixty‐three men scheduled to receive ADT were randomly assigned to a 3‐month supervised exercise programme involving aerobic and resistance exercise sessions commenced within 10 days of their first ADT injection (32 men) or usual care (31 men). The primary outcome was body composition (lean and fat mass). Other study outcomes included bone mineral density, physical function, blood biomarkers of chronic disease risk and bone turnover, general and prostate cancer‐specific quality of life, fatigue and psychological distress. Outcomes were compared between groups using analysis of covariance adjusted for baseline values. Results Compared to usual care, a 3‐month exercise programme preserved appendicular lean mass (P = 0.019) and prevented gains in whole body fat mass, trunk fat mass and percentage fat with group differences of −1.4 kg (P = 0.001), −0.9 kg (P = 0.008) and −1.3% (P < 0.001), respectively. Significant between‐group differences were also seen favouring the exercise group for cardiovascular fitness (peak oxygen consumption 1.1 mL/kg/min, P = 0.004), muscular strength (4.0–25.9 kg, P ≤ 0.026), lower body function (–1.1 s, P < 0.001), total cholesterol: high‐density lipoprotein‐cholesterol ratio (–0.52, P = 0.028), sexual function (15.2, P = 0.028), fatigue (3.1, P = 0.042), psychological distress (–2.2, P = 0.045), social functioning (3.8, P = 0.015) and mental health (3.6–3.8, P ≤ 0.022). There were no significant group differences for any other outcomes. Conclusion Commencing a supervised exercise programme involving aerobic and resistance exercise when initiating ADT significantly reduced treatment toxicity, while improving social functioning and mental health. Concurrent prescription of supervised exercise when initiating ADT is therefore advised to minimise morbidity associated with severe hypogonadism.
       
  • 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.
       
  • Gleason inflation 1998–2011: a registry study of 97 168 men
    • Abstract: Objectives To study long‐term trends in Gleason grading in a nationwide population and to assess the impact of the International Society of Urological Pathology (ISUP) revision in 2005 of the Gleason system on grading practices, as in recent years there has been a shift upwards in Gleason grading of prostate cancer. Patients and Methods All newly diagnosed prostate cancers in Sweden are reported to the National Prostate Cancer Register (NPCR). In 97 168 men with a primary diagnosis of prostate cancer on needle biopsy from 1998 to 2011, Gleason score, clinical T stage (cT) and serum levels of prostate‐specific antigen (s‐PSA) at diagnosis were analysed. Results Gleason score, cT stage and s‐PSA were reported to the NPCR in 97%, 99% and 99% of cases. Before and after 2005, Gleason score 7–10 was diagnosed in 52% and 57%, respectively (P < 0.001). After standardisation for cT stage and s‐PSA with 1998 as baseline these tumours increased from 59% to 72%. Among low‐risk tumours (stage cT1and s‐PSA 4–10 ng/mL) Gleason score 7–10 increased from 16% in 1998 to 40% in 2011 (P trend < 0.001), mean 19% and 33% before and after 2005 (P < 0.001). Among high‐risk tumours (stage T3 and s‐PSA 20–50 ng/mL) Gleason score 7–10 increased from 65% in 1998 to 94% in 2011 (P trend < 0.001), mean 78% and 90% before and after 2005 (P < 0.001). A Gleason score of 2–5 was reported in 27% in 1998 and 1% in 2011. Gleason score 5 decreased sharply after 2005 and Gleason score 2–4 was almost abandoned. Conclusions There has been a gradual shift towards higher Gleason grading, which started before 2005 but became more evident after the ISUP 2005 revision. Among low‐stage tumours reporting of Gleason score 7–10 was more than doubled during the study period. When corrected for stage migration upgrading is considerable over recent decades. This has clinical consequences for therapy decisions such as eligibility for active surveillance. Grading systems need to be as stable as possible to enable comparisons over time and to facilitate the interpretation of the prognostic impact of grade.
       
  • Variation in performance of candidate surgical quality measures for
           muscle‐invasive bladder cancer by hospital type
    • Abstract: Objective To test the association between hospital type and performance of candidate quality measures for treatment of muscle‐invasive bladder cancer (MIBC) using a large national tumour registry. Proposed quality measures include receipt of neoadjuvant chemotherapy, timely treatment, adequate lymph node dissection, and continent urinary diversion. Patients and Methods Using the National Cancer Database, patients with stage ≥II urothelial carcinoma treated with radical cystectomy (RC) from 2003 to 2010 were identified. Hospitals were grouped by type and annual RC volume: community, comprehensive low volume (CLV), comprehensive high volume (CHV), academic low volume (ALV), and academic high volume (AHV) groups. Logistic regression models were used to test the association between hospital group and performance of quality measures, adjusting for year, demographic, and clinical/pathological characteristics; generalised estimating equations were fitted to the models to adjust for clustering at the hospital level. Results In all, 23 279 patients underwent RC at community (12.4%), comprehensive (CLV 38%, CHV 5%), and academic (ALV 17%, AHV 28%) hospitals. While only 0.8% (175) of patients met all four quality criteria, 61% of patients treated at AHV hospitals met two or more quality metric indicators compared with ALV (45%), CHV (44%), CLV (38%), and community (37%) hospitals (P < 0.001). After adjustment, patients were more likely to receive two or more quality measures when treated at AHV (odds ratio [OR] 2.4, confidence interval [CI] 2.0–2.9), ALV (OR 1.3, CI 1.1–1.6), and CHV (OR 1.3, CI 1.03–1.7) hospitals compared with community hospitals. Conclusions Patients undergoing RC at AHV hospitals were more likely to meet quality criteria. However, performance remains low across hospital types, highlighting the opportunity to improve quality of care for MIBC.
       
  • Laparoendoscopic single‐site (LESS) vs laparoscopic
           living‐donor nephrectomy: a systematic review and
           meta‐analysis
    • Abstract: The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site (LESS) living‐donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria. Weighted mean differences (WMDs) were used to measure continuous variables and odds ratios (ORs) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time (WMD 15.06 min, 95% confidence interval [CI] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time (WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN (WMD −22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN (OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar (WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge (WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN (WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate (OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups (WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN, with a lower analgesic requirement. However, it is more technically challenging than LLDN, as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.
       
  • Increase of Framingham risk score is associated with severity of Lower
           urinary tract symptoms
    • Abstract: Objective To determine the relationship between LUTS/BPH and 10‐year risk of CVD assessed by the Framingham Cardiovascular Risk score in a cohort of patients without previous episodes of stroke and/or acute myocardial infarction. Patients and Methods Between September 2010 to September 2014, 336 consecutive patients with BPH related LUTS were prospectively enrolled. The general 10‐year cardiovascular disease Framingham risk score, expressed as a percent and assessing the risk of atherosclerotic cardiovascular disease (CVD) events was calculated for each patients. Respectively, individuals with low risk had 10% or less CVD risk at 10 years, with intermediate risk 10‐20%, and with high risk 20% or more. Logistic regression analyses were carried out to identify variables for predicting Framingham risk score ≥ 10% and moderate‐severe LUTS (IPSS≥ 8) adjusted for confounding factors. Results As category of Framingham risk score increased, we observed higher IPSS (18.0 vs. 18.50 vs. 19.0; p
       
  • Sexually transmitted infections, benign prostatic hyperplasia and lower
           urinary tract symptom‐related outcomes: Results from the Prostate,
           Lung, Colorectal, and Ovarian Cancer Screening Trial
    • Abstract: Objectives The exact pathogenesis of benign prostatic hyperplasia (BPH) and related lower urinary tract symptoms (LUTS) remains unclear; however evidence supports a role of inflammation. One possible source of prostatic inflammation is sexually transmitted infections (STIs), which have been found to be positively related to LUTS in some mostly small case‐control studies or cross‐sectional surveys. The objective of our analysis is to examine whether a history of STIs or positive STI serology is associated with prevalent and incident BPH/LUTS‐related outcomes in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Methods Self‐reported history of STIs (gonorrhea, syphilis) was ascertained at baseline, and serological evidence of STIs (Chlamydia trachomatis, Trichomonas vaginalis, HPV‐16, HPV‐18, HSV‐2, HHV‐8, and CMV) was detected in baseline serum specimens. We used data collected on the baseline questionnaire, as well as results from the baseline PSA test and digital rectal exam (DRE), to define prevalent BPH/LUTS‐related outcomes as evidence of LUTS (self‐reported diagnosis of an enlarged prostate/BPH, BPH surgery, or nocturia (waking ≥2 times/night to urinate)) and evidence of prostate enlargement (PSA>1.4 ng/mL or prostate volume ≥30 cc) in men without prostate cancer. We created a similar definition of incident BPH using data from the follow‐up questionnaire completed 5‐13 years after enrollment (self‐reported diagnosis of an enlarged prostate/BPH or nocturia), data on finasteride use during follow‐up, and results from the follow‐up PSA tests and DREs. We used Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) in our cross‐sectional analysis of self‐reported (n=32,900) and serologically‐detected STIs (n=1,143) with prevalent BPH/LUTS, and risk ratios in our prospective analysis of self‐reported STIs with incident BPH/LUTS (n=5,226). Results Generally null results were observed for a self‐reported history of STIs and positive STI serologies with prevalent and incident BPH/LUTS‐related outcomes, with the possible exception of T. vaginalis infection. This STI was positively associated with prevalent nocturia (PR 1.36, 95% confidence interval (CI): 1.18‐1.65), prevalent large prostate volume (PR 1.21 95% CI 1.02‐1.43), and any prevalent BPH/LUTS (PR 1.32 95% CI 1.09‐1.61); too few men had information on both STI serologies and incident BPH/LUTS to investigate associations between T. vaginalis infection and incident BPH/LUTS‐related outcomes. Conclusions Our findings do not support associations of several known STIs with BPH/LUTS‐related outcomes, although T. vaginalis infection may warrant further study.
       
  • Intermediate Analysis of A Phase Ii Trial Assessing Gemcitabine and
           Cisplatin in Locoregional or Metastatic Penile Squamous Cell Carcinoma
    • Abstract: Objective Patients with squamous cell carcinoma of the penis and unresected loco‐regional lymph nodes and/or distant metastases have a poor prognostic with no standard of chemotherapy. We performed a phase II study evaluating the association of gemcitabine and cisplatin in this population. Patients and method Eligible patients had histological confirmed squamous cell carcinoma of the penis with unresected locoregional lymph nodes and/or distant metastases at initial diagnosis or at relapse, and measurable disease as defined by RECIST criteria. Patients were treated with the association of gemcitabine 1250 mg/m2 on day 1 over 30 minutes and cisplatin 50 mg/m2 on day 1 over 1 hour, every two weeks. Primary endpoint was the objective response rate; secondary endpoints were time to progression (TTP) and overall survival (OS). Results Twenty five patients were included in the first step of the study between February 2004 and January 2010 and received a median of 5 cycles. For ITT population, 2 patients (95%CI = [0.98 ;26.0]) presented an objective response. Thirteen patients had stable disease (52% 95%CI = [35.5‐76.8]). Median TTP is estimated at 5.48 months (95%CI = [2.40 ;11.73]). After a median follow up of 26.97 months (95%CI = [17.77 ; Not reached]), nine patients were still alive. OS median and 2 years OS rates are respectively estimated at 14.98 months (95%CI = [ 9.76 ;32.9]) and 39.32% (95%CI = [19.15 ; 59.03]). Eleven patients had a SAE (44%) within 24% were relied to chemotherapy. Conclusion The every two weeks administration of the combination of gemcitabine and cisplatin showed non‐significant responses in patients with unresected loco‐regional or metastatic penile squamous cell carcinoma. Despite manageable side effects, this combination cannot be recommended as a standard of care due to disappointing response rates observed in this negative study. Further regimens should be explored to improve the overall survival of these patients with poor prognosis.
       
  • The RAZOR (randomized open vs robotic cystectomy) trial: study design and
           trial update
    • Abstract: The purpose of the RAZOR (randomized open vs robotic cystectomy) study is to compare open radical cystectomy (ORC) vs robot‐assisted RC (RARC), pelvic lymph node dissection (PLND) and urinary diversion for oncological outcomes, complications and health‐related quality of life (HRQL) measures with a primary endpoint of 2‐year progression‐free survival (PFS). RAZOR is a multi‐institutional, randomized, non‐inferior, phase III trial that will enrol at least 320 patients with T1–T4, N0–N1, M0 bladder cancer with ≈160 patients in both the RARC and ORC arms at 15 participating institutions. Data will be collected prospectively at each institution for cancer outcomes, complications of surgery and HRQL measures, and then submitted to trial data management services Cancer Research and Biostatistics (CRAB) for final analyses. To date, 306 patients have been randomized and accrual to the RAZOR trial is expected to conclude in 2014. In this study, we report the RAZOR trial experimental design, objectives, data safety, and monitoring, and accrual update. The RAZOR trial is a landmark study in urological oncology, randomizing T1–T4, N0–N1, M0 patients with bladder cancer to ORC vs RARC, PLND and urinary diversion. RAZOR is a multi‐institutional, non‐inferiority trial evaluating cancer outcomes, surgical complications and HRQL measures of ORC vs RARC with a primary endpoint of 2‐year PFS. Full data from the RAZOR trial are not expected until 2016–2017.
       
  • Social media makes global urology meetings truly global
    •  
  • How active should active surveillance be'
    •  
  • Conventional laparoscopic surgery: more pain, no gain!
    •  
  • Opening the flood gates: holmium laser enucleation is superior to
           photoselective vaporization of the prostate for the treatment of chronic
           urinary retention
    •  
  • Malignant medication' Testosterone and cancer
    •  
  • ‘Measurement for Improvement Not Judgement’ – the Case
           of Percutaneous Nephrolithotomy
    •  
  • Proton Therapy Websites: Information Anarchy Creates Confusion
    •  
  • Avoiding obsolescence in advanced prostate cancer management: a guide for
           urologists
    • Abstract: Prostate cancer is one of the most common cancers diagnosed in men in the USA and 20–30% of men treated for localised prostate cancer will fail therapy and develop advanced prostate cancer. More drugs have been approved for the treatment of advanced prostate cancer in the past 3 years than in the past three decades, and each drug has its own mechanism of action and, often, unique monitoring requirements. As the treatment landscape for men with advanced prostate cancer is undergoing significant expansion, the roles of both oncologists and urologists are shifting, and the decision for the urologist to treat vs refer requires early assessment to identify which patients are candidates for these novel treatments and the monitoring of patients for tolerability, response, and potential side‐effects. Given these rapid changes, the authors of this review met in January 2013 and again in April 2013 to discuss the current challenges facing urologists in adopting these new treatments into their own practices. Here, we provide a brief overview of advanced prostate cancer medical therapies approved in the past decade, the necessary monitoring procedures and early detection methods needed to safely and effectively manage patients receiving these therapies, and our recommendations for applying these new therapies within different models of urology practice, such that urologists can remain an integral component of their patient's care once he has transitioned into advanced prostate cancer
       
  • A novel urodynamic model for lower urinary tract assessment in awake rats
    • Abstract: Objectives To develop a urodynamic model incorporating external urethral sphincter (EUS) electromyography (EMG) in awake rats. Materials and methods Bladder catheters and EUS EMG electrodes were implanted in female Sprague Dawley rats. Assessments were performed in awake, lightly restrained animals on postoperative day 12‐14. Measurements were repeated in the same animal on day 16 under urethane anesthesia. Urodynamics and EUS EMG were performed simultaneously. In addition, serum creatinine and bladder histology was assessed. Results No significant differences in urodynamic parameters were found between bladder catheter only versus bladder catheter and EUS EMG electrode groups. Urethane anesthesia evoked prominent changes in both urodynamic parameters and EUS EMG. Serum creatinine was within the normal limits in all animals. Bladder weight and bladder wall thickness were significantly increased in both the bladder catheter only and the bladder catheter and EUS EMG group compared to controls. Conclusions Our novel urodynamic model allows repetitive measurements of both bladder and EUS function at different time points in the same animal under fully awake conditions and opens promising avenues to investigate LUTD in a translational approach.
       
  • Central obesity is predictive of persistent storage LUTS after surgery for
           Benign Prostatic Enlargement: results of a multicenter prospective study
    • Abstract: Objective Central obesity can be associated with the development of benign prostatic enlargement (BPE) and with the worsening of lower urinary tract symptoms (LUTS). The aim of our study was to evaluate the impact of components of Metabolic Syndrome (MetS) on urinary outcomes after surgical therapy for severe LUTS due to BPE. Materials and Methods A multicenter prospective study was conducted including 378 consecutive men surgically treated for large BPE with simple open prostatectomy (OP) or transurethral resection of the prostate (TURP), between January 2012 and October 2013. LUTS were measured by the International Prostate Symptom Score (IPSS), immediately before surgery and 6 to 12 months postoperatively. MetS was defined according the US National Cholesterol Education Program‐Adult Treatment Panel III. Results The improvement of total and storage IPSS postoperatively was related to diastolic blood pressure and waist circumference (WC). WC>102 cm was associated with a higher risk of an incomplete recovery of both total IPSS (OR: 0.343, p=0.001) and storage IPSS (OR: 0.208, p
       
  • Patient reported “ever had” and “current” long
           term physical symptoms following prostate cancer treatments
    • Abstract: Objective To document prostate cancer patient reported ‘ever experienced’ and ‘current’ prevalence of disease specific physical symptoms stratified by primary treatment received. Patients 3,348 prostate cancer survivors 2‐15 years post diagnosis. Methods Cross‐sectional, postal survey of 6,559 survivors diagnosed 2‐15 years ago with primary, invasive PCa (ICD10‐C61) identified via national, population based cancer registries in Northern Ireland and Republic of Ireland. Questions included symptoms at diagnosis, primary treatments and physical symptoms (impotence/urinary incontinence/bowel problems/breast changes/loss of libido/hot flashes/fatigue) experienced ‘ever’ and at questionnaire completion (“current”). Symptom proportions were weighted by age, country and time since diagnosis. Bonferroni corrections were applied for multiple comparisons. Results Adjusted response rate 54%; 75% reported at least one ‘current’ physical symptom (‘ever’:90%), with 29% reporting at least three. Prevalence varied by treatment; overall 57% reported current impotence; this was highest following radical prostatectomy (RP)76% followed by external beam radiotherapy with concurrent hormone therapy (HT); 64%. Urinary incontinence (overall ‘current’ 16%) was highest following RP (‘current'28%, ‘ever'70%). While 42% of brachytherapy patients reported no ‘current’ symptoms; 43% reported ‘current’ impotence and 8% ‘current’ incontinence. ‘Current’ hot flashes (41%), breast changes (18%) and fatigue (28%) were reported more often by patients on HT. Conclusion Symptoms following prostate cancer are common, often multiple, persist long‐term and vary by treatment. They represent a significant health burden. An estimated 1.6% of men over 45 is a prostate cancer survivor currently experiencing an adverse physical symptom. Recognition and treatment of physical symptoms should be prioritised in patient follow‐up. This information should facilitate men and clinicians when deciding about treatment as differences in survival between radical treatments is minimal.
       
  • The current use of Active Surveillance in an Australian cohort of men: a
           pattern of care analysis from the Victorian Prostate Cancer Registry
    • Abstract: Objectives To ascertain the treatment trends and patterns of care, for men with prostate cancer (PC) on Active Surveillance (AS) in Victoria, Australia. Material and Methods De‐identified data was obtained for 6424 men from the PCR. Men included in this study were diagnosed with prostate cancer from 2008 to August 2012 with a minimum of 12‐month follow‐up. Patients were stratified using the NCCN risk grouping system and those who were not actively treated were identified. Data was acquired to describe the trends and uptake of AS according to public vs. private hospital sector, and regional vs. metropolitan regions. Results A total of 1603/ 6424 (24.9%) of men received no treatment with curative intent at 12 months follow‐ up. This cohort included patients in whom the chosen management plan was AS (980/1603, 61.1%), watchful waiting (WW‐ 341/1603, 21.3%), or no management plan (282/1603, 17.6%) was recorded. From this, 980/6424(15.3%) of patients were recorded as being on AS across all NCCN categories at 12 months after diagnosis. This includes 653/1816 (35.9%) of very low and low‐risk men, and 251/2820 (8.9%) of intermediate‐risk men. Of our patients on AS, 169/980 (17.2%) progressed onto active treatment after 12 months. This was radical prostatectomy in 116 (68.6%), with 32 (18.9%) undergoing external beam radiation therapy (EBRT), 12 (7.1%) undergoing brachytherapy (BT) and 9 (5.3%) undergoing androgen deprivation therapy (ADT). Overall, 629/979 (64.2%) of AS patients were notified from a private hospital, with 350/979 (35.7%) of patients notified from a public hospital (1 patient unclassified). Of these, 202/652 (30.9%) of AS patients with very low/ low risk were managed in the public sector, vs. 450/652 (69%) of very low/ low risk AS patients being managed in the private sector. In our cohort, patients with very low and low risk disease, managed in a private hospital, were more likely to be on AS (p=0.005). AS patients in the private sector were also observed to have a median age 2.8 years younger (65.6 vs. 68.4, p
       
  • Guideline of guidelines: A Review of Urologic Trauma Guidelines
    • Abstract: Objective To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). Materials and Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low‐grade injuries. The major difference is for high‐grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommends initial conservative management in hemodynamically stable patients. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies as well as clinical principles and expert opinions. Large‐scale prospective studies can improve the quality of evidence, and direct more effective evaluation and management of urologic trauma.
       
  • Management of sexual dysfunction due to central nervous system disorders:
           A systematic review
    • Abstract: Objective To systematically review the management of sexual dysfunction (SD) due to central nervous system disorders. Methods The review was done according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Studies were identified independently by two reviewers using electronic searches of MEDLINE and OVID (from January 2004 to August 2014) and hand searches of reference lists and review articles. Results In patients with central nervous system disorders, neuro‐urological assessment is recommended for both genders before starting any treatment for SD. For men, blood sexual hormones evaluation is the main investigation performed prior to phosphodiesterase type 5 inhibitors (PDE5Is) treatment, whereas there is no consensus on routine laboratory tests for women. PDE5Is are the first‐line medical treatment for men, with the most robust data derived from patients with spinal cord lesion assessed by validated questionnaires, mainly the International Index of Erectile Function‐15. There is no effective medical treatment for SD in women. Sacral neuromodulation for lower urinary tract dysfunction may improve SD in both genders. Conclusions Although SD is a major burden for patients with central nervous system disorders, high‐evidence level studies are rare and only available for PDE5Is treating erectile dysfunction. Well‐designed prospective studies are urgently needed for both genders.
       
  • Causes of death in men with localised prostate cancer: a nationwide,
           population‐based study
    • Abstract: Objective To detail the distribution of causes of death for localised prostate cancer (PCa). Patients and Methods PCBase Sweden links the Swedish National Prostate Cancer Register (NPCR) with other nation‐wide population‐based healthcare registers. We selected all 57,187 men diagnosed with localised PCa between 1997‐2009 and their 114,374 age‐ and county‐matched PCa‐free control men. Mortality was calculated using competing risk regression analyses, taking into account PCa risk category, age, and Charlson comorbidity index (CCI). Results In men with low risk PCa, all‐cause mortality was lower compared to corresponding PCa‐free men: 10‐year all‐cause mortality was 18% for men diagnosed at age 70 with CCI=0 and 21% among corresponding controls. 31% of these cases died of CVD compared to 37% of their controls. For men with low‐risk PCa, 10‐year PCa‐mortality was 0.4%, 1%, and 3% when diagnosed at age 50, 60, and 70, respectively. PCa was the third most common cause of death (18%), after CVD (31%) and other cancers (30%). In contrast, PCa was the most common cause of death in men with intermediate and high‐risk localised PCa. Conclusions Men with low‐risk PCa had lower all‐cause mortality than PCa‐free men due to lower cardiovascular mortality, driven by early detection selection. However, for men with intermediate or high‐risk disease, PCa death was substantial, irrespective of CCI, and this was even more pronounced for those diagnosed at age 50 or 60.
       
  • Knowledge, Attitudes and Beliefs towards Management of Men with Locally
           Advanced Prostate Cancer following Radical Prostatectomy: An Australian
           Survey of Urologists
    • Abstract: Objective To investigate Australian urologists’ knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline‐recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methods A nationwide mailed and web‐based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results 157 surveys were included in the analysis (45% response rate). Just over half of respondents (57%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists’ attitudes and beliefs towards the specific recommendation for post‐operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = .520, p
       
  • Efficacy and safety of a fixed‐dose combination of dutasteride and
           tamsulosin treatment (Duodart™) compared with watchful waiting with
           initiation of tamsulosin therapy if symptoms do not improve, both provided
           with lifestyle advice, in the management of treatment‐naïve men
           with moderately symptomatic benign prostatic hyperplasia: 2‐Year
           CONDUCT study results
    • Abstract: Objective To investigate whether a fixed‐dose combination of 0.5 mg dutasteride and 0.4 mg tamsulosin (FDC) is more effective than watchful waiting with protocol‐defined initiation of tamsulosin therapy if symptoms did not improve (WW‐All) in treatment‐naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. Patients and methods This was a multicentre, randomised, open‐label, parallel‐group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8–19, prostate volume ≥30 cc and total serum PSA ≥1.5 ng/ml. Patients were randomised to FDC (n = 369) or WW‐All (n = 373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. Results The change in IPSS at 24 months was significantly greater for FDC than WW‐All (–5.4 vs. –3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW‐All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were observed in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. Conclusion FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, caused rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.
       
  • Utilization of pre‐operative imaging for muscle‐invasive
           bladder cancer: a population‐based study
    • Abstract: Objective To test the hypotheses that: a) use of pre‐operative imaging for muscle‐invasive bladder cancer (MIBC) conforms to practice guidelines; b) pre‐operative imaging, through more accurate staging is associated with improved outcomes. Materials & Methods In this population‐based cohort study, records of treatment were linked to the Ontario Cancer Registry to identify all patients with MIBC treated with cystectomy from 1994‐2008. Utilization of chest, abdomen‐pelvis and bone imaging were evaluated. Trends were evaluated over time. Logistic regression was used to analyze factors associated with utilization. Cox model analyses were used to explore associations between imaging and survival. Results 2802 patients with MIBC underwent cystectomy during 1994‐2008. Over the three 5‐year study periods, an increase in the proportion of patients having pre‐operative: chest x‐ray(CXR)(55%,64%,63%,p
       
  • Effect of Surgical Approach on Erectile Function Recovery following
           Bilateral Nerve‐Sparing Radical Prostatectomy: An Evaluation
           Utilizing Data from a Randomized, Double‐Blind, Double‐Dummy
           Multicenter Trial of Tadalafil versus Placebo
    • Abstract: Objectives To report pre‐specified and exploratory results on the effect of different surgical approaches on erectile function (EF) after nerve‐sparing radical prostatectomy (nsRP) obtained from the multicenter, randomized, double‐blind, double‐dummy REACTT trial of tadalafil (once a day [OaD] or on‐demand [pro‐re‐nata, PRN]) versus placebo. Patients and Methods Patients
       
  • Transperineal biopsy prostate cancer detection in first biopsy and
           post‐negative TRUS biopsy settings: The Victorian Transperineal
           Biopsy Collaboration experience
    • Abstract: Objectives To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate Patients and Methods VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy following previous negative TRUS biopsy, between September 2009 and September 2013 in the VTBC database were included in this study. Data for each patient was collected prospectively (except for TPB prior to 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group Univariate and multivariate analyses were performed to identify factors predictive of cancer detection on TPB Results 160 patients were included in the study, of these 57 patients had TPB as first biopsy while 103 had TPB as repeat biopsy after previous negative TRUS biopsies The median patient age at TPB was 63, with the repeat biopsy patients having higher median serum PSA level (5.8ng/ml for first biopsy, and 9.6ng/ml for repeat biopsy) and larger prostate volumes (40cc for first biopsy, and 51cc for repeat biopsy) Cancer was detected in 53% of first biopsy patients and 36% of repeat biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as Gleason score of 7 or higher, or more than 3 positive cores of Gleason 6 75% of cancers detected in repeat biopsies involved the anterior region (based on the Ginsburg Study Group's recommended biopsy map), while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancer detected in first biopsies were confined exclusively within the anterior region Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive of cancer detection in first biopsies Conclusions TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant cancer TPB provides excellent sampling of the anterior region of the prostate, which is often under‐sampled using the TRUS approach, and should be considered an option for all men in whom a prostate biopsy is indicated.
       
 
 
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