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Journal Cover BJU International
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1589 journals]
  • Utility of early transperineal template-guided prostate biopsy for risk
           stratification in men undergoing active surveillance for prostate cancer
    • Authors: James Voss; Raj Pal, Shaista Ahmed, Magnus Hannah, Adil Jaulim, Thomas Walton
      Abstract: ObjectiveTo assess the accuracy and utility of routine multiparametric MRI (mp-MRI) and transperineal template-guided prostate biopsy (TPB) following enrolment on to active surveillance.Patients and MethodsFrom April 2012 to December 2016 consecutive men from our single institution diagnosed with low or intermediate risk prostate cancer on TRUS biopsy were offered further staging with early mp-MRI and TPB within 12 months of diagnosis. Data was collected prospectively. Eligibility criteria comprised: age ≤77 years; Gleason score ≤3+4; clinical stage T1-T2; PSA ≤15 ng/ml;
      PubDate: 2017-12-14T00:55:36.397253-05:
      DOI: 10.1111/bju.14100
  • MRI cognitive fusion biopsy – is near enough good enough'
    • Authors: Niranjan J Sathianathen; Daniel Christidis, Badrinath R Konety, Nathan L Lawrentschuk
      Abstract: The evidence supporting the use of MRI-fusion biopsies over blind, systematic methods is mounting quickly and has subsequently led to several institutions embracing this new technique and technology. However, questions still remain whether there is difference between the modes of fusion - cognitive, software-based and in-bore - in terms of cancer detection. While it appears intuitive that software and in-bore approaches would be more accurate than cognitive targeting, many studies have failed to demonstrate a significant difference. This could at least partly be explained by the phenomenon of MRI images underestimating the size of lesions and thus the ultra-precise targeting benefits provided by software and in-bore methods may be superfluous.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-13T18:17:17.549748-05:
      DOI: 10.1111/bju.14103
  • Familial risks in urolithiasis in the population of sweden
    • Authors: Kari Hemminki; Otto Hemminki, Asta Försti, Kristina Sundquist, Jan Sundquist, Xinjun Li
      Abstract: ObjectivesTo assess detailed familial risks for medically diagnosed urolithiasis (UL, urinary tract stone disease) based on nationwide hospital and population records.Subjects/patients and methodsSubjects were identified from the Swedish Multigeneration Register in which 211,718 UL patients. Standardized incidence ratios (SIRs) were calculated by comparison to individuals without a family history of UL.ResultsThe highest familial SIRs were invariably found for the same (concordant) type of UL: 2.18 for kidney, 2.20 for ureter and 1.93 for bladder. SIRs increased from 1.84, when one parent was affected, to 3.54 when both parents were affected, which was a multiplicative interaction. The SIR was 1.79 when one sibling was affected but it increased to 24.91 when two siblings were affected. Such excessive risks (5.2% of familial cases) are likely explained by high-penetrant genes. Low SIR of 1.29 between spouses suggested minor contribution by shared environmental factors on the familial risk.ConclusionsThe results point to underlying genetic causes for the observed familial clustering and establish the genetic landscape of UL. Family histories should be taken in UL diagnostics and prevention could follow guidelines recommended for recurrent UL.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-13T02:00:43.920616-05:
      DOI: 10.1111/bju.14096
  • Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review
           and meta-analysis of comparative studies
    • Authors: Tuo Deng; Bing Liu, Xiaolu Duan, Chao Cai, Zhijian Zhao, Wei Zhu, Junhong Fan, Wenqi Wu, Guohua Zeng
      Abstract: ObjectiveTo explore the efficacy and detailed strategies of antibiotic prophylaxis in ureteroscopic lithotripsy (URL) through a systematic review and meta-analysis.Materials and MethodsA systematic literature search using Pubmed, Embase, Medline, Cochrane Library, CBM, CNKI and VIP databases was performed to obtain comparative studies on the efficacy of different antibiotic prophylaxis strategies in URL for preventing postoperative infections. The last search was conducted on June 25, 2017. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess efficacies of varied strategies of prophylactic antibiotics.Results11 studies containing 4591 patients were included in this systematic review and meta-analysis. No significant difference was found in the risk of postoperative febrile urinary tract infections (fUTIs) between groups with and without prophylactic antibiotics (OR = 0.82, 95%CI: 0.40-1.67, P = 0.59). Patients receiving a single dose of preoperative antibiotics shared a significant lower risk of pyuria (OR = 0.42, 95%CI: 0.25-0.69, P = 0.0007) and bacteriuria (OR = 0.25, 95%CI: 0.11-0.58, P = 0.001). Intravenous antibiotic was not superior to single oral use in reducing fUTI (OR = 1.00, 95%CI: 0.26-3.88, P = 1.00).ConclusionWe concluded that preoperative antibiotic prophylaxis could not lower the risk of postoperative fUTI, but a single dose could reduce the incidence of pyuria or bacteriuria. Oral single dose of preventive antibiotics is preferred because of its cost-effectiveness. Efficacies of different types of antibiotics and other strategies could not be achieved in our meta-analysis. RCTs with larger sample size and more rigorous study design are needed for a valid conclusion.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-12T09:12:22.562901-05:
      DOI: 10.1111/bju.14101
  • Male Circumcision for the Prevention of HIV Acquisition: A Meta-Analysis
    • Authors: Sanjeev C Sharma; Nicholas Raison, Shamim Khan, Majid Shabbir, Prokar Dasgupta, Kamran Ahmed
      Abstract: ObjectivesTo assess male circumcision for the prevention of HIV acquisition in heterosexual and homosexual men using all available data. Previous meta-analyses suggest that circumcision is effective at reducing the risk of HIV acquisition amongst heterosexual men but the effect amongst homosexual males remains under debate.Subjects and MethodsA systematic literature review was conducted searching for studies that assessed male circumcision as a method to prevent HIV acquisition in homosexual and/or heterosexual males. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials. gov were searched in March 2017. Random effects model was employed to calculate a pooled relative risk (RR) and its associated 95% confidence interval (CI).ResultsIn total 49 studies were included in this meta-analysis. The overall pooled RR for both homosexual and heterosexual males was 0.58, 95% CI 0.48 to 0.70 suggesting that circumcision is associated with a reduction in HIV risk. Circumcision was found to be protective for both homosexual and heterosexual males (RR: 0.80, 95% CI 0.69 to 0.92 and 0.28, 95% CI 0.14 to 0.59 respectively). Heterosexual males have a greater relative risk reduction (72% compared to 20% for homosexual men). Significant heterogeneity between the studies was present (Chi2 = 1378.34, df = 48; I2 = 97%).ConclusionThis meta-analysis demonstrates that male circumcision is effective at reducing HIV risk for both heterosexual and homosexual males.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-12T09:06:13.828511-05:
      DOI: 10.1111/bju.14102
  • Hospital Volume and Outcomes of Robot-Assisted Partial Nephrectomy
    • Authors: Leilei Xia; Jose E. Pulido, Raju R. Chelluri, Marshall C. Strother, Benjamin L. Taylor, Jay D. Raman, Thomas J. Guzzo
      Abstract: ObjectiveTo evaluate the impact of hospital volume on outcomes of robot-assisted partial nephrectomy (RAPN).Materials and MethodsPatients with renal cell carcinoma who underwent RAPN between 2010 and 2013 were identified in the National Cancer Database. Hospital yearly RAPN volume was categorized into five groups by most closely sorting patients into five groups of equal size (quintiles): very low, low, medium, high, and very high. Outcomes included 30-day mortality, 90-day mortality, open conversion, prolonged length of stay (PLOS,>3 days), 30-day readmission, and positive surgical margin (PSM) rates. Unadjusted analyses and multivariable logistic regressions were used to compare outcomes. Sensitivity analyses with hospital volume considered as a continuous variable were also performed.ResultsA total of 18,724 RAPN cases were included. Hospital volume quintiles were: very low volume, 1-7 cases (n=3,693); low volume, 8-14 cases (n=3,719); medium volume, 15-23 cases (n=3,833); high volume, 24-43 cases (n=3,649); very high volume, ≥ 44 cases (n=3,830). There was no significant difference in 30-day or 90-day mortality between five groups. Multivariable logistic regressions (references: very low volume) showed that higher hospital volume was associated with lower odds of conversion (low [OR=0.88, P=0.377]; medium [OR=0.60, P=0.001]; high [OR=0.57, P
      PubDate: 2017-12-12T09:03:21.140716-05:
      DOI: 10.1111/bju.14099
  • Incorporating Prostate Health Index Density, MRI, and Prior Negative
           Biopsy Status to Improve the Detection of Clinically Significant Prostate
    • Authors: Sasha C. Druskin; Jeffrey J. Tosoian, Allen Young, Sarah Collica, Arnav Srivastava, Kamyar Ghabili, Katarzyna J. Macura, Ballentine H Carter, Alan W. Partin, Lori J. Sokoll, Ashley E. Ross, Christian P. Pavlovich
      Abstract: ObjectivesTo determine the performance of Prostate Health Index (PHI) density (PHID) combined with MRI and prior negative biopsy (PNB) status for the diagnosis of clinically-significant prostate cancer (PCa).Patients & MethodsPatients without a prior diagnosis of PCa, with elevated PSA and a normal digital rectal exam who had PHI testing prospectively prior to prostate biopsy were included. PHID was calculated retrospectively using prostate volume derived from transrectal ultrasound at biopsy. Univariable and multivariable logistic regression modeling, along with receiver operating characteristic analysis, was used to determine the ability of serum biomarkers to predict clinically-significant cancer (defined as either GG≥2 disease or GG1 PCa detected in>2 cores or>50% of any one core) on biopsy. Age, PNB status and PIRADS score were incorporated into the regression models.ResultsOf the 241 men who qualified for the study, 91 (37.8%) had clinically-significant cancer on biopsy. The median PHID was 0.74 (IQR 0.44-1.24); it was 1.18 (IQR 0.77-1.83) and 0.55 (IQR 0.38-0.89) in those with and without clinically-significant PCa on biopsy, respectively (p
      PubDate: 2017-12-12T08:58:52.945307-05:
      DOI: 10.1111/bju.14098
  • Therapeutic Effects of Endoscopic Ablation in Hunner Type Interstitial
           Cystitis Patients
    • Authors: Kwang Jin Ko; Hyunwoo Chung, Yoon Seok Suh, Sin Woo Lee, Tae Heon Kim, Kyu-Sung Lee
      Abstract: ObjectivesTo investigate the efficacy of endoscopic ablation of Hunner lesions (HLs) in patients with interstitial cystitis (IC) and to find predictors of early recurrence of HLs.Materials and MethodsA prospective study was performed for Hunner type IC who underwent transurethral ablation. We repeated endoscopic ablation when symptoms and HLs recurred during the follow-up period. The primary endpoint was recurrence-free time. Secondary endpoints were a change of number of frequency, nocturia, and urgency episodes and changes in visual analogue scale for pain and other symptom indices at follow-up visits.ResultsA total of 72 patients were analyzed. The median follow-up period was 29.5 (range, 12.0-50.0) months. After primary ablation treatment, HLs recurred in 75.0% (54/72) of subjects, and the median recurrence-free time was 12.0 ± 1.6 months. Among the 54 patients with recurrence, 50 underwent a second ablation treatment. HLs occurred in 44.0% (22/50) of individuals after the second operation, and the median recurrence-free time was 18.0 ± 5.1 months. Lower maximal cystometric capacity (odds ratio 1.01, 95% CI 1.001-1.013) was the predictive factor for early recurrence. There were significant improvements in the visual analogue scale for pain, O'Leary-Sant interstitial cystitis symptom index and problem index, pelvic pain and urgency/frequency patient symptom scale after treatment (all, p
      PubDate: 2017-12-12T08:52:36.342034-05:
      DOI: 10.1111/bju.14097
  • The effects of recreational ketamine cystitis on urinary tract
           reconstruction – a surgical challenge
    • Authors: Néha Sihra; Jeremy Ockrim, Dan Wood
      Abstract: ObjectivesTo identify the rate of post-operative complications in patients who require surgical reconstruction for ketamine-induced urinary tract dysfunction and to identify any predictors for poor post-operative outcome with subsequent management strategies.Materials and methodsA retrospective review of data collected between 2007 and 2017 was performed. Evaluation included CT urogram, cystoscopy and biopsy. Indications and outcomes for surgical intervention were assessed.Results44 patients were identified. 68% were male and mean age at presentation was 31 years (range 23-55). All bladder biopsies confirmed an eosinophilic inflammatory infiltrate. A significant proportion of patients (81.8%) were found to have reduced cystoscopic bladder capacity of
      PubDate: 2017-12-12T03:05:52.199081-05:
      DOI: 10.1111/bju.14094
  • Targeted versus systematic robot-assisted transperineal MRI-TRUS fusion
           prostate biopsy
    • Authors: J Mischinger; S Kaufmann, G I Russo, N Harland, S Rausch, B Amend, M Scharpf, L Loewe, T Todenhoefer, M Notohamiprodjo, K Nikolaou, A Stenzl, J Bedke, S Kruck
      Abstract: ObjectivesTo evaluate the performance of transperineal robot-assisted (RA) targeted (TB) and systematic (SB) prostate biopsy in the primary and repeat biopsy setting.Patients and MethodsPatients were admitted to RA biopsy between 2014-2016. Prior to RA-TB, multiparametric (mp) Magnetic Resonance Imaging (MRI) was performed. Prostate lesions were scored (Prostate Imaging, Reporting and Data System Version 2) and used for RA-TB planning. In addition, RA-SB was performed. Available, whole-gland pathology was analyzed.Results130 patients were biopsy-naive whereas 72 had previous negative transrectal ultrasound (TRUS)-biopsy. In total 202 patients had suspicious mpMRI lesions. Clinically significant (cs) prostate cancer (PC) was found in 85% of all PC cases (n=123). Total and cs PC detection for RA-TB vs. RA-SB were 77% vs. 84% and 80% vs. 82% (n.s.), respectively. RA-TB demonstrated a better sampling performance compared to RA-SB (26.4% vs 13.9%; p
      PubDate: 2017-12-06T11:58:08.78624-05:0
      DOI: 10.1111/bju.14089
  • Consensus statements on the management of metastatic prostate cancer from
           the Hong Kong Urological Association and Hong Kong Society of Uro-Oncology
    • Authors: Darren Ming-Chun Poon; Chi-Kwok Chan, Tim-Wai Chan, Foon-Yiu Cheung, Philip Wai-Kay Kwong, Eric Ka-Chai Lee, Angus Kwong-Chuen Leung, Simon Yiu-Lam Leung, Wai-Kit Ma, Hing-Shing So, Po-Chor Tam, Lap-Yin Ho
      Abstract: ObjectivesTo establish a set of consensus statements to facilitate physician management strategies for patients with metastatic prostate cancer (mPC) in Hong Kong.Materials and methodsA local expert consensus was organised jointly by the two main professional organisations representing prostate cancer specialists in Hong Kong. A total of 12 experts were included in the consensus panel. Six of the most crucial and relevant areas of debate regarding the management of mPC were identified. With the use of a modified Delphi method, several panel meetings were held for the members to discuss their clinical experience and the published literature regarding the areas of debate. At the final meeting, each drafted statement was voted on by every member based on its practicability of recommendation in the locality.ResultsAfter the panel voting, a total of 45 consensus statements regarding the management of mPC were ultimately accepted and established.ConclusionThe consensus statements were primarily derived from the latest clinical evidence and major overseas guidelines, with the consideration of local clinical experience and practicability. These are considered applicable recommendations for Hong Kong physicians for the management of mPC patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:53:21.089297-05:
      DOI: 10.1111/bju.14091
  • β3-adrenoceptor agonists inhibit carbachol-evoked Ca2+ oscillations
           in murine detrusor myocytes
    • Authors: Caoimhin S. Griffin; Eamonn Bradley, Mark A. Hollywood, Noel G. McHale, Keith D. Thornbury, Gerard P. Sergeant
      Abstract: ObjectiveTo test if carbachol-evoked Ca2+ oscillations in freshly isolated murine detrusor myocytes were affected by β3-adrenoceptor modulators.Material & MethodsIsometric tension recordings were made from strips of murine detrusor and intracellular Ca2+ measurements were made from isolated detrusor myocytes using confocal microscopy. Transcriptional expression of β-AR sub-types in detrusor strips and isolated detrusor myocytes was assessed using RT-PCR and real-time quantitative PCR. Immunocytochemistry experiments, using a β3-AR selective antibody, was performed to confirm that β3-ARs were present on detrusor myocytes.ResultsRT-PCR and real-time quantitative PCR experiments revealed that β1, β2 & β3-AR were expressed in murine detrusor, but that β3-ARs were the most abundant sub-type. The selective β3-AR agonist BRL37344 reduced the amplitude of carbachol-induced contractions of detrusor smooth muscle. These responses were unaffected by addition of the BK channel blocker, iberiotoxin. BRL37344 also reduced the amplitude of carbachol-induced Ca2+ oscillations in freshly isolated murine detrusor myocytes. This effect was mimicked by CL316,243, another β3-AR agonist and inhibited by the β3-AR antagonist, L748,337, but not by propranolol an antagonist of β1 and β2-ARs. BRL37344 did not affect caffeine-evoked Ca2+ transients or L-type Ca2+ current in isolated detrusor myocytes.ConclusionInhibition of cholinergic-mediated contractions of the detrusor by β3-AR agonists is associated with a reduction in Ca2+ oscillations in detrusor myocytes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:53:17.069224-05:
      DOI: 10.1111/bju.14090
  • Clinical Pathway improves Implementation of Evidence-based Strategies for
           the management of Androgen Deprivation Therapy–induced side effects in
           Prostate Cancer Patients
    • Authors: Renée Bultijnck; Inge Van de Caveye, Elke Rammant, Sofie Everaert, Nicolaas Lumen, Karel Decaestecker, Valérie Fonteyne, Benedicte Deforche, Piet Ost
      Abstract: ObjectivesTo assess the effects of a prostate cancer (PCa) clinical pathway on the implementation of evidence-based strategies for the management of ADT-induced side effects.Subjects/patients and methodsA clinical pathway was introduced at hospital-level in 2015. The pathway consists out of evidence-based strategies for the management of ADT-induced side effects. All PCa patients receiving ADT for>6 months were eligible to enter the clinical pathway. Data of recommended evidence-based strategies were retrospectively extracted from electronic health records of all eligible patients in the year before (2014) and the year of implementation of the pathway (2015). Descriptive statistics were used for patient characteristics. The Chi-square test (or Fisher exact test) and Mann-Whitney U test were used to compare results between the control group and intervention group.ResultsIn total, 126 patients were included in the control group and 132 patients in the intervention group. Baseline patient characteristics were well balanced. After implementation of the pathway, metabolic, bone and cardiac risk assessment screenings were more frequently applied in the intervention group (metabolic 46% vs 4%, bone 58% vs 10%, and cardiac 61% vs 16%, p
      PubDate: 2017-12-01T02:40:31.112335-05:
      DOI: 10.1111/bju.14086
  • First experience in the UK of treating women with recurrent urinary tract
           infections with the bacterial vaccine Uromune®
    • Authors: Bob Yang; Stephen Foley
      Abstract: ObjectivesTo determine the effectiveness of Uromune® in preventing recurrent urinary tract infections (UTIs) in women.Patients and MethodsA total of 77 women with microbiology-proven recurrent UTIs were given Uromune sublingual vaccine for a period of 3 months. Time to first UTI recurrence since treatment and adverse events were prospectively recorded in a follow-up period of up to 12 months.ResultsOf the 77 women, 75 completed the treatment. Of the 75 women who completed treatment, 59 (78%) had no subsequent UTIs in the follow-up period. Prior to treatment, all women had experienced a minimum of three or more episodes of UTI during the preceding 12 months. Proportionally, the majority of recurrences occurred in postmenopausal women. One patient had to stop treatment because of an adverse event (rash over face and neck).ConclusionThis prospective study suggests that Uromune is safe and effective at preventing UTIs in women. Further research is required in larger groups of patients for longer treatment times. An international double-blind randomized control trial comparing Uromune with placebo is currently underway.
      PubDate: 2017-11-23T22:50:26.438179-05:
      DOI: 10.1111/bju.14067
  • Journal information
    • PubDate: 2017-11-23T01:44:22.379535-05:
      DOI: 10.1111/bju.13645
  • Considerations in fertility preservation in cases of genital trauma
    • Authors: B Z Starmer; A Baird, M A Lucky
      Abstract: ObjectiveTo perform a review of the literature to assess the options of preserving fertility in patients with fertility threatening testicular injuries and their efficacy to help guide surgeons who encounter these patients in the future.MethodsMedline, EMBASE and Cochrane library databases were searched using the keywords treatment, therapy, management, scrotal trauma / injury, testicular trauma / injury / amputation, fertility and fertility preservation Inclusion criteria: studies reporting the fertility preserving techniques with a history of testicular trauma with loss of one, both or nearly all testicular parenchymal tissueResultsTwo cases of testicular sperm extraction, eight cases of testicular replantation, and one case of cryopreservation after injury were identified. Presence of viable sperm post-surgery was found in 5/11 patients. Common reasons for failure of replantation were prolonged ischaemic time and extensive crush injury to the vascular supply of the testis. 2/2 cases of TESE and the single cryopreservation case obtained viable spermConclusionScrotal trauma with threat to fertility is rare. It is important that urologists should consider fertility in any situation where complete or a large amount of testicular tissue loss is at risk of occurring and offer fertility preservation options as locally available.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-22T04:15:19.521205-05:
      DOI: 10.1111/bju.14084
  • Improving the efficacy of proteasome inhibitors in the treatment of renal
           cell carcinoma by combination with the HIV-protease inhibitors lopinavir
           or nelfinavir
    • Authors: Dominik Abt; Andrej Besse, Lenka Sedlarikova, Marianne Kraus, Juergen Bader, Tobias Silzle, Martina Vodinska, Ondrej Slaby, Hans-Peter Schmid, Daniel Stephan Engeler, Christoph Driessen, Lenka Besse
      Abstract: ObjectivesTo assess the potential of second-generation proteasome inhibition by carfilzomib and its combination with the HIV-protease inhibitors (HIV-PIs) lopinavir and nelfinavir in vitro for improved treatment of clear cell renal cell cancer (ccRCC).Materials and methodsCytotoxicity, reactive oxygen species (ROS) production and unfolded protein response (UPR) activation of proteasome inhibitors, HIV-PIs and their combination was assessed in 3 cell lines and primary cells derived from 3 ccRCC tumors by MTS assay, flow cytometry, quantitative PCR and western blot, respectively. Proteasome activity was determined by activity based probes. Flow cytometry was used to assess apoptosis by Annexin V/PI assay and ABCB1 activity by Mitotracker Green FM efflux assay.ResultsLopinavir and nelfinavir significantly increased the cytotoxic effect of carfilzomib in all cell lines and primary cells. ABCB1 efflux pump inhibition, induction of ROS production and UPR pre-activation by lopinavir were identified as underlying mechanisms of this strong synergistic effect. Combination treatment led to unresolved protein stress, increased activation of pro-apoptotic UPR pathway and significant increase of apoptosis.ConclusionThe combination of the proteasome inhibitor carfilzomib and the HIV-PIs lopinavir and nelfinavir has a strong synergistic cytotoxic activity against ccRCC in vitro at therapeutically relevant drug concentrations. This effect is most likely explained by synergistic UPR triggering and ABCB1-modulation caused by HIV-PIs. Our findings suggest that combined treatment of second-generation proteasome inhibitors and HIV-PIs should be investigated in patients with metastatic RCC within a clinical trial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-21T17:50:32.21457-05:0
      DOI: 10.1111/bju.14083
  • Urological Dysfunction in Young Women: An inheritance of Childhood'
    • Authors: Elisabetta Costantini; Ester Illiano, Konstantinos Giannitsas, Marco Prestipino, Antonio Luigi Pastore, Antonio Carbone, Giovanni Palleschi, Raffaele Balsamo, Franca Natale, Donata Villari, Vittorio Bini, Serena Maruccia, Maria-Teresa Filocamo, Alessandro Zucchi
      Abstract: ObjectiveTo investigate the correlation of a history of lower urinary tract symptomatology during childhood to lower urinary tract dysfunction in young adult women.Subjects/patients and methodsThis was a multicenter, prospective, case-control study conducted from April 2013 to November 2015. The trial was registered in ClinicalTrials. gov (NCT02185287). Three-hundred women, 18 to 40 years old, participated. Cases were women attending urogynecology clinics for various lower urinary tract complaints and controls were recruited from a healthy population. Exclusion criteria were designed to avoid common causes of lower urinary tract dysfunction and symptoms and included diabetes mellitus, neurological disease and pelvic inflammatory disease. All women completed a self-administered 77-item questionnaire exploring childhood urological and bowel history, as well as current urological, bowel and sexual symptoms. Statistical analysis was performed using Chi-squared and Fisher's exact tests to compare categorical variables. Multivariate logistic regression models were fit for the prediction of the adult outcomes, incorporating as explanatory variables all those that showed a significant p-value in bivariate analysis. P-value
      PubDate: 2017-11-21T01:30:21.303243-05:
      DOI: 10.1111/bju.14081
  • Florence Robotic Intracorporeal Neobladder (FloRIN). A new reconfiguration
           strategy developed following the IDEAL guidelines
    • Authors: Andrea Minervini; Davide Vanacore, Gianni Vittori, Martina Milanesi, Agostino Tuccio, Giampaolo Siena, Riccardo Campi, Andrea Mari, Andrea Gavazzi, Marco Carini
      Abstract: ObjectiveTo describe our step-by-step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, according to the IDEAL Collaboration guidelines.Patients and methodsFloRIN neobladder was performed after the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro-ileal anastomosis creating an asymmetrical U shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an L; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero-enteral “orthotopic” bilateral anastomosis. The idealization and development of FloRIN followed IDEAL guidelines recommended stages: Phase 1 (simulation) consisted in the neobladder robotic configuration on silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardization in ten consecutive robotic approaches. Phase 2a and 2b included urodynamics and imaging assessment of patients treated.ResultsFrom February 2016 to September 2017 FloRIN was performed in 18 patients. Comparing the first 3 (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartiles) reconstruction operating time was 260 (220-340) vs 160 (150-210) min, respectively. Postoperative surgical complications occurred in 4/18 (22.1%) patients, including one surgical Clavien 3 and three Clavien 1, postoperative medical Clavien 2 occured in 3/18 (16.7%) patients. The urodynamic examination (available in 9 [50%] patients) showed median (interquartiles) reservoir cystometric capacity, compliance, and post-void residual of 240 (220-267) mL, 18 (12.5-19.8) ml/cmH2O, and 0 (0-50) mL, respectively. Ultrasound showed no Grade ≥2 vesicoureteral reflux.ConclusionWe described the FloRIN neobladder, showing its technical feasibility with acceptable time efficiency. The first cases studied showed good reservoirs capacity, low pressure with no reflux, and complete voiding.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-15T10:46:05.764311-05:
      DOI: 10.1111/bju.14077
  • Defining a Hba1c Value That Predicts Increased Risk Of Penile Implant
    • Authors: Mohamad Habous; Raanan Tal, Tarek Soliman, Alaa Tealab, Mohammed Nassar, Zenhom Mekawi, Saad Mahmoud, Osama Abdelwahab, Mohamed Elkhouly, Hatem Kamr, Abdallah Remeah, Saleh Binsaleh, David Ralph, John Mulhall
      Abstract: ObjectivesTo explore the association between HbA1C level and penile implant infection rates and to define a cut-off value that predicted implant infection.Patients and MethodsA multi center prospective study included all patients undergoing penile implant surgery between 2009-15. Preoperative, perioperative and postoperative management were identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. HbA1c levels were analyzed as a continuous variable and sequential analysis was conducted utilizing 0.5% increments to define a cut-off level predicting implant infection. Multivariable analysis was performed with the following factors entered the model: Diabetes, HbA1C level, patient age, implant type, vascular risk factor number, presence of Peyronie's disease (PD), BMI and surgeon volume. A ROC curve was generated to define the optimal HbA1C cut-off for infection prediction.Results902 implant procedures were performed over this period of time. The mean age was 56.6 years. The mean HbA1c level was 8.0, with 81% of men having a HbA1c>6%. 685 (76%) implants were malleable, and 217 (24%) were inflatable devices. 302 (33.5%) patients had also a diagnosis of PD. Overall infection rate was 8.9% (80/902 subjects). Patients who had implant infection had significantly higher mean HbA1c levels, 9.5% vs 7.8% (p
      PubDate: 2017-11-10T02:35:44.354953-05:
      DOI: 10.1111/bju.14076
  • The NeuroSAFE Approach to Nerve Sparing in Robotic Assisted Radical
           Prostatectomy in a British Setting – A Prospective Observational
           Comparative Study
    • Authors: George Mirmilstein; Bhavan Rai, Olayinka Gbolahan, Vinaya Srirangam, Ashish Narula, Samita Agarwal, Tim Lane, Nikhil Vasdev, Jim Adshead
      Abstract: ObjectivesTo evaluate the NeuroSAFE technique in a British setting in men undergoing RALP.Patients and MethodsWe retrospectively analysed our prospectively maintained database of patients who underwent RALP between Nov 2008 and Feb 2017. We examined preoperative pathological and functional parameters, intra-operative nerve sparing, post-operative histology as well as functional and oncological follow-up. We compared those who had a NeuroSAFE approach and those who had nerve sparing without NeuroSAFE. We also compared all the RALPs before and after the introduction of NeuroSAFE. Statistical analysis was done using the two tailed T-test and Chi-Squared analysis.ResultsThis single surgeon series included 417 RALPs including 120 NeuroSAFEs. The NeuroSAFE cohort had a greater proportion of D'Amico high risk disease (30.8% vs 9.6%, p
      PubDate: 2017-11-10T02:35:30.61457-05:0
      DOI: 10.1111/bju.14078
  • The implications of baseline bone health assessment at initiation of
           androgen deprivation therapy for prostate cancer
    • Authors: Peter S. Kirk; Tudor Borza, Vahakn B. Shahinian, Megan E.V. Caram, Danil V. Makarov, Jeremy B. Shelton, John T. Leppert, Ryan M. Blake, Jennifer A. Davis, Brent K. Hollenbeck, Anne Sales, Ted A. Skolarus
      Abstract: ObjectivesTo assess bone density testing (BDT) use among prostate cancer survivors receiving ADT, and downstream implications for osteoporosis and fracture diagnoses as well as pharmacologic osteoporosis treatment in a national integrated delivery system.MethodsWe identified 17,017 men with prostate cancer who received any ADT between 2005 and 2014 using Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3-year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacologic treatment.ResultsWe found a minority of patients received BDT (n=2,502, 15%), however the rate of testing increased to over 20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher-risk prostate cancer (both p
      PubDate: 2017-11-10T02:30:23.371821-05:
      DOI: 10.1111/bju.14075
  • First North American validation and head-to-head comparison of four
           preoperative nomograms for prediction of lymph node invasion before
           radical prostatectomy
    • Authors: Marco Bandini; Michele Marchioni, Raisa S. Pompe, Zhe Tian, Giorgio Gandaglia, Nicola Fossati, Firas Abdollah, Markus Graefen, Francesco Montorsi, Fred Saad, Shahrokh F. Shariat, Alberto Briganti, Pierre I. Karakiewicz
      Abstract: ObjectivesTo perform a head-to-head comparison of four nomograms, namely the Cagiannos, the 2012-Briganti, the Godoy and the online-Memorial Sloan Kettering Cancer Center (MSKCC), for prediction of lymph node invasion (LNI) in a North American population.Materials & Methods19,775 clinically localized prostate cancer (PCa) patients underwent radical prostatectomy and pelvic lymph node dissection (PLND) were identified within the Surveillance Epidemiology and End Results (SEER) database. All four nomograms were tested with Heagerty's concordance index (C-index), calibration plots and decision curves analyses (DCA). Moreover, we examined specific nomogram derived cut-offs to compare the number of avoided PLNDs and missed LNI positive cases.ResultsAll nomograms demonstrated highly comparable C-index value: the Cagiannos (78.6%), the Godoy (78.2%), the 2012-Briganti (79.8%) and the MSKCC (79.9%). The Cagiannos nomogram showed the best calibration, followed by the 2012-Briganti, the Godoy and the online-MSKCC. In DCA, the 2012-Briganti and the Cagiannos in that order provided the best results followed by the Godoy and the online-MSKCC models. For each nomogram, the cut-off associated with ≤10% missed LNI cases avoided 8,693 (46.6%), 8,652 (46.4%), 8,461 (45.4%) and 8,590 (46.1%) PLNDs for respectively the Cagiannos (2.6% cut-off), the online-MSKCC (4.3% cut-off), the Godoy (3.6% cut-off) and the 2012-Briganti (4.6% cut-off) nomograms.ConclusionThe Cagiannos and the 2012-Briganti nomograms exhibited the best calibrations and DCA results. Conversely, C-index values and ability to avoid unnecessary PLND were virtually the same for all four examined nomograms.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-10T02:25:20.066888-05:
      DOI: 10.1111/bju.14074
  • Sporadic Primary Hyperparathyroidism and Stone Disease: a Comprehensive
           Metabolic Evaluation Before and After Parathyroidectomy
    • Authors: Giovanni S. Marchini; Kauy V. M. Faria, Fábio C. M. Torricelli, Manoj Monga, Miguel Srougi, William C. Nahas, Eduardo Mazzucchi
      Abstract: Objectivesto characterize the stone risk and the impact of parathyroidectomy on the metabolic profile of patients with primary hyperparathyroidism (PHPT) and urolithiasis.Subjects and MethodsWe analyzed the prospectively collected charts of patients treated at our stone clinic from Jan/2001-Jan/2016 searching for patients with PHPT and urolithiasis. Imaging evaluation of the kidneys, bones and parathyroid glands were assessed. We analyzed the demographic data, serum and urinary parameters before and after parathyroidectomy. Statistical analysis included paired T/Fisher/Spearman/ANOVA tests. Significance was set at p
      PubDate: 2017-11-10T02:20:55.952054-05:
      DOI: 10.1111/bju.14072
  • Intracorporeal robotic assisted radical cystectomy together with an
           enhanced recovery programme improves postoperative outcomes by aggregating
           marginal gains
    • Authors: Wei Shen Tan; Mae-Yen Tan, Benjamin W Lamb, Ashwin Sridhar, Anna Mohammed, Hilary Baker, Senthil Nathan, Timothy Briggs, Melanie Tan, John D Kelly
      Abstract: ObjectiveTo assess the cumulative effect of an enhanced recovery after surgery (ERAS) pathway and a minimally invasive RARC with intracorporeal urinary diversion (iRARC) in comparison to open radical cystectomy (ORC) on hospital length of stay (LOS) and perioperative outcomes.Materials & methodsBetween Feb 2009 and Oct 2017, 304 radical cystectomy cases were performed at a single institution (54 ORC, 250 RARC). Data were prospectively collected. We identified 45 consecutive ORC cases performed without ERAS before the commencement of the RARC programme (Cohort A), 50 consecutive iRARC cases performed without ERAS (Cohort B) and 40 iRARC cases with ERAS (Cohort C). Primary outcome measure was hospital LOS while secondary outcome measures included perioperative 90-day complications and readmission rates. Complications were accessed using the Clavian-Dindo classification.ResultsPatients in all cohorts were evenly match in age, sex, body mass index (BMI), neoadjuvant treatment, tumour stage, lymph node yield, previous pelvic radiotherapy and surgery, perioperative anaemia as well as physiological state. iRARC with ERAS patients had a significantly higher ASA (III-IV) and were more likely to receive neobladder reconstruction. Median hospital LOS were shorter in iRARC with ERAS (7 days, IQR: 6-10) compared to iRARC without ERAS (11, 8-15) and ORC (17 (14-21). In a propensity score-matched cohort of iRARC patients, patients with ERAS has a significantly lower 90-day readmission rates. Additionally, implementing ERAS in an iRARC cohort resulted in a significantly lower 90-day all (p
      PubDate: 2017-11-10T02:20:20.66114-05:0
      DOI: 10.1111/bju.14073
  • Surgical management of Azoospermia – Can the NHS England Clinical
           Commissioning Policy reduce geographical inequality of services'
    • Authors: Majid Shabbir; Chitranjan J Shukla, Gareth Brown, Trevor John Dorkin, Marc Lucky, Richard Pearcy, Rowland Rees, Duncan Summerton, Asif Muneer
      Abstract: Developments in assisted reproductive techniques (ART) have transformed the management of male factor infertility and the advent of intracytoplasmic sperm injection (ICSI) in 1993 was a landmark in the management of the infertile male. While this has been an undoubted success, it has led to a shift away from understanding and correcting the potential reversible causes of male factor infertility, to one that simply overcomes it with assisted reproductive techniques (ART). The aetiology of male infertility can broadly be divided into impaired spermatogenesis, or impaired sperm transport within the genital tract. The most challenging of these is male infertility due to azoospermia, which affects approximately 10-15% of infertile men (2.7million men in Europe).This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-03T10:30:50.180774-05:
      DOI: 10.1111/bju.14068
  • The impact of the global BCG shortage on treatment patterns:
           population-based data
    • Authors: Marlon Perera; Nathan Papa, Daniel Christidis, Shannon McGrath, Todd Manning, Matthew Roberts, Damien Bolton, Nathan Lawrentschuk, Shomik Sengupta
      Abstract: An international shortage of Intravesical Bacillus Calmette-Guérin (BCG) therapy has considerably affected clinical practice patterns for non-muscle invasive bladder cancer. We aimed to review the trends of BCG therapy in Australia between April 2006 and 2016 using Pharmaceutical Benefits Australia data. A sudden, global drop in October/November 2014 and a precipitous fall for the CIS indication in June/July 2012 was identified. After restoration of supply, BCG prescriptions for primary and relapsing TCC rebounded to a higher level than prior to the first shock. For carcinoma in-situ (CIS) the number of prescriptions did not rebound and are currently close to zero.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-26T10:45:22.678854-05:
      DOI: 10.1111/bju.14065
  • Strategies for success: A multi-institutional study on robotic partial
           nephrectomy for complex renal lesions
    • Authors: D B Hennessey; G Wei, D Moon, N Kinnear, D M Bolton, N Lawrentschuk, Y K Chan
      Abstract: ObjectiveDue to their size, location and proximity to the hilum, some complex renal tumours may preclude a minimally invasive approach to nephron sparing surgery. We describe our technique, illustrated with images and videos, of robotic partial nephrectomy for challenging renal tumours.Patients and MethodsA study of 249 patients who underwent robotic partial nephrectomy (RPN) in multiple institutions was performed. Patients were identified using prospective RPN databases. A complex renal lesion was defined as a RENAL nephrometry score ≥10. Data was presented as median (interquartile range) and differences between groups were examined.Results31 (12.4%) RPN were performed for complex renal tumours. Median age was 57 (50.5 – 70.5) years. 21 (67.7%) were male, 10 (32.3%) were female. American Society of Anesthesiologists score was 2 (2 - 3). Median operative time was 200 (50 – 265) min, median warm ischaemia time was 23 (18.5 – 29) min, and median blood loss was 200 (50 – 265) ml. There were no intraoperative complications. 2 (6.4%) patients had post-operative complications. 1 (3.2%) patient had a positive margin. Length of stay was 3.5 (3 – 5) days. Median follow up was 12.5 (7 – 24) months. There were no recurrences. RPN did result in statistically significant changes in renal function 3 months post RPN compared to preoperative renal function, p=0.0001.ConclusionRPN is a safe approach for select patients with complex renal tumours and may facilitate tumour resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-26T10:40:36.615081-05:
      DOI: 10.1111/bju.14059
  • Identifying the candidate for super extended staging pelvic lymph node
           dissection among patients with high-risk prostate cancer
    • Authors: Giorgio Gandaglia; Emanuele Zaffuto, Nicola Fossati, Marco Bandini, Nazareno Suardi, Elio Mazzone, Paolo Dell'Oglio, Armando Stabile, Massimo Freschi, Francesco Montorsi, Alberto Briganti
      Abstract: ObjectivesTo assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) and to identify those who would benefit from the removal of the common iliac and presacral nodes.Patients and methods471 high-risk PCa patients treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve.ResultsThe median preoperative LNI risk was 25.5%. The median number of nodes removed was 23 and 171 (36.3%) patients had LNI. Overall, 61 (13.0%) and 28 (5.9%) patients had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P
      PubDate: 2017-10-24T01:05:19.134249-05:
      DOI: 10.1111/bju.14066
  • Associations of Specific Postoperative Complications with Costs after
           Radical Cystectomy
    • Authors: Matthew Mossanen; Ross E. Krasnow, Stuart R Lipsitz, Mark A. Preston, Adam S. Kibel, Albert Ha, John L. Gore, Angela B. Smith, Jeffrey J. Leow, Quoc D. Trinh, Steven L. Chang
      Abstract: BackgroundRadical cystectomy (RC) is a morbid surgery plagued by complications. Expenditures attributed to specific complications after RC is not well characterized. We sought to quantify the financial impact of complications after RC and their associations with respective 90-day costs.MethodsWe used the Premier Hospital Database to identify 9,137 RC patients (weighted population of 57,553) from 360 hospitals between 2003-2013. Complications were categorized according to Agency for Healthcare Research and Quality Clinical Classifications. Patients with and without complications were compared and multivariable analysis was performed.ResultsAn index complication increased costs by $9,262 [95% CI 8300-10,223] and a readmission complication increased costs by $20,697 [95%CI 18,735-22,660]. The four most costly index complications (descending order) were venous thromboembolism (VTE), infection, wound and soft tissue event, and pulmonary (p 3 units, and teaching hospitals were associated with higher costs (p
      PubDate: 2017-10-24T00:40:20.942188-05:
      DOI: 10.1111/bju.14064
  • Oxidative stress and its possible relation to lower urinary tract
           functional pathology
    • Authors: K-E Andersson
      Abstract: Oxidative stress is considered to reflect an imbalance between the systemic manifestation of reactive oxygen and nitrogen species (RONS) and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. RONS are not only harmful agents that cause oxidative damage in pathologies, they also have important roles as regulatory agents in a range of biological phenomena. They are normally generated as by-products of oxygen metabolism; however, environmental stressors (i.e., UV, ionizing radiations, pollutants, heavy metal, and xenobiotics) contribute to greatly increase RONS production. Several antioxidants have been exploited in recent years for their actual or supposed beneficial effect against oxidative stress, but so far, none has been approved for any indication because they have not met the criteria of efficacy for drug approval. The present review discusses the concept of oxidative stress, how to measure it, how to prevent it, and its occurrence in different organ systems with special reference to the lower urinary tract.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-24T00:40:18.906698-05:
      DOI: 10.1111/bju.14063
  • Early Discharge and Post-Discharge Outcomes in Patients Undergoing Radical
           Cystectomy for Bladder Cancer
    • Authors: Leilei Xia; Benjamin L. Taylor, Andrew D. Newton, Aseem Malhotra, Jose E. Pulido, Marshall C. Strother, Thomas J. Guzzo
      Abstract: ObjectiveTo assess whether discharging patients early after radical cystectomy (RC) is associated with increased risk of readmissions and post-discharge complications.Materials and MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients who underwent an elective RC from 2012 to 2015. Patients were stratified into two groups: those with hospital length of stay (LOS) of 4-5 days (early-discharge) and those with LOS of 6-9 days (routine-discharge). We used multivariable logistic regressions to assess the impact of early-discharge on 30-day readmission and post-discharge complication rates. Sensitivity analyses and subgroup analyses were performed to validate the robustness of our primary analyses.ResultsA total of 3,311 patients were included. Unadjusted outcomes comparison showed no difference in readmission rate (21.6% vs. 23.0%) or post-discharge complication rate (17.7% vs. 19.6%) between early-discharge and routine-discharge groups. Multivariable logistic regression also showed early discharge was not associated with increased odds of readmission (OR=1.00, 95%CI=0.82-1.22, P=1.000) or post-discharge complication (OR=0.95, 95%CI=0.77-1.17, P=0.616). Two-step sensitivity analyses (excluding patients with LOS of 8-9 days followed by patients with any pre-discharge adverse event) validated the robustness of our primary analyses. Subgroup analyses also showed similar results in all subgroups except the subgroup of patients with age ≥ 85 years.ConclusionsEarly discharge after RC was not associated with readmissions or post-discharge complications. Future prospective studies, with defined perioperative care pathways, are needed to identify potential components that may enable hospitals to discharge patients early without compromising post-discharge outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-24T00:35:30.974541-05:
      DOI: 10.1111/bju.14058
  • Laparoscopic and robotic-assisted versus open radical prostatectomy for
           the treatment of localised prostate cancer: a Cochrane systematic review
    • Authors: Dragan Ilic; Sue M Evans, Christie Ann Allan, Jae Hung Jung, Declan Murphy, Mark Frydenberg
      Abstract: To determine the effects of laparoscopic radical prostatectomy (LRP), or robotic-assisted radical prostatectomy (RARP), compared to open radical prostatectomy (ORP) in men with localised prostate cancer.We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings with no restrictions on the language of publication or publication status, up until 9 June 2017. We included all randomised or pseudo-randomised controlled trials with a direct comparison of LRP and RARP to ORP. 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. We performed statistical analyses using a random-effects model and assessed the quality of the evidence (QoE) according to GRADE. The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions.We included two unique studies with 446 randomised participants with clinically localised prostate cancer. All available outcome data were short-term (up to 3 months). We found no study that addressed the outcome of prostate cancer-specific survival. Based on one trial, RARP likely results in little to no difference in urinary quality of life (mean difference [MD] -1.30, 95% confidence interval [CI] -4.65 to 2.05; moderate QoE) and sexual quality of life (MD 3.90, 95% CI -1.84 to 9.64; moderate QoE). No study addressed the outcomes of biochemical recurrence-free survival or overall survival. Based on one trial, RARP may result in little to no difference in overall surgical complications (risk ratio [RR] 0.41, 95% CI 0.16 to 1.04; low QoE) or serious postoperative complications (RR 0.16, 95% CI 0.02 to 1.32; low QoE). Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at one day (MD -1.05, 95% CI -1.42 to -0.68; low QoE) and up to one week (MD -0.78, 95% CI -1.40 to -0.17; low QoE). Based on one study, RARP likely results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI -0.32 to 0.34; moderate QoE). Based on one study, RARP likely reduces the length of hospital stay (MD -1.72, 95% CI -2.19 to -1.25; moderate QoE). Based on two studies, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI 0.12 to 0.46; low QoE). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1000 men (95% CI 78 fewer to 48 fewer).There is no evidence to inform the comparative effectiveness of LRP or RARP compared to ORP for oncological outcomes. Urinary and sexual quality of life appears similar. Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-24T00:35:21.397198-05:
      DOI: 10.1111/bju.14062
  • A prospective randomised placebo-controlled study of the impact of
           dutasteride/tamsulosin combination therapy on sexual function domains in
           sexually active men with lower urinary tract symptoms (LUTS) secondary to
           benign prostatic hyperplasia (BPH)
    • Authors: Claus G. Roehrborn; Michael J. Manyak, Juan Manuel Palacios-Moreno, Timothy H. Wilson, Erik PM. Roos, Javier Cambronero Santos, Dimitrios Karanastasis, Janet Plastino, Francois Giuliano, Raymond C. Rosen
      Abstract: ObjectiveTo prospectively assess the impact of the fixed-dose combination of the 5-alpha reductase inhibitor (5ARI), dutasteride 0.5 mg and the alpha-1 blocker, tamsulosin 0.4 mg (DUT-TAM FDC) therapy on sexual function domain scores in sexually active males with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), using the Men's Sexual Health Questionnaire (MSHQ).Patients and methodsThis European and Australian double-blind, placebo-controlled, parallel-group study was conducted at 51 centres. Inclusion criteria: age ≥50 years, International Prostate Symptom Score ≥12, prostate volume ≥30 cc, prostate-specific antigen 1.5–10 ng/mL. Patients were randomised 1:1 to DUT-TAM FDC therapy or placebo for 12 months. The change from baseline to Month 12 on the total MSHQ (primary endpoint) and MSHQ erection, ejaculation and satisfaction domains (secondary outcome) was assessed, using a mixed model repeated measures analysis. Safety was evaluated.ResultsThe intention-to-treat population included 489 patients (243 DUT-TAM FDC therapy; 246 placebo). A significant decrease (worsening) was observed with DUT-TAM FDC therapy versus placebo on the total MSHQ score (–8.7 vs −0.7; standard error [SE]: 0.81, 0.78; P
      PubDate: 2017-10-16T17:40:55.355755-05:
      DOI: 10.1111/bju.14057
  • National cohort study comparing severe medium-term urinary complications
           following radical prostatectomy: robot-assisted versus laparoscopic versus
           retropubic open radical prostatectomy
    • Authors: A Sujenthiran; J Nossiter, M Parry, SC Charman, A Aggarwal, H Payne, P Dasgupta, NW Clarke, J van der Meulen, P Cathcart
      Abstract: ObjectivesDespite the rapid adoption of robot-assisted radical prostatectomy (RARP), there is little evidence about the occurrence of medium-term urinary complications with this type of surgery compared to laparoscopic (LRP) or retropubic open radical prostatectomy (ORP).The aim of this study was to evaluate the occurrence of severe urinary complications within two years of surgery in men undergoing RARP, LRP or ORP.Patients and MethodsPopulation-based cohort study of men who underwent RARP (n=4,947), LRP (n= 5,479), or ORP (n=6,873) between 2008 and 2012 in the English National Health Service (NHS) using national cancer registry records linked to Hospital Episodes Statistics – an administrative database of admissions to NHS hospitals. We identified the occurrence of any severe urinary or severe stricture-related complication within two years of surgery using a validated tool. Multi-level regression modelling was used to determine the association between the type of surgery and occurrence of complications with adjustment for patient and surgical factors.ResultsMen undergoing RARP were least likely to experience any urinary complication (10.5%) or a stricture-related complication (3.3%) compared to those who had LRP (15.8% any or 5.7% stricture-related) or ORP (19.1% any or 6.9% stricture-related). The impact of the type of surgery on the occurrence of any urinary or stricture-related complications remained statistically significant with adjustment for patient and surgical factors (p < 0.01).ConclusionMen who underwent RARP have the lowest risk of developing severe urinary complications within two years of surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-15T09:50:26.13837-05:0
      DOI: 10.1111/bju.14054
  • Incidentally detected testicular lesions <10 mm in diameter: can
           orchidectomy be avoided'
    • Authors: Glenda Scandura; Clare Verrill, Andrew Protheroe, Johnson Joseph, Wendy Ansell, Anju Sahdev, Jonathan Shamash, Daniel M Berney
      Abstract: ObjectiveTo investigate the pathology of excised testicular lesions
      PubDate: 2017-10-15T09:50:23.468367-05:
      DOI: 10.1111/bju.14056
  • Utilization and Quality Outcomes of cT1a, cT1b and cT2a Partial
           Nephrectomy: Analysis of the National Cancer Database
    • Authors: Katherine Fero; Zachary A. Hamilton, Ahmet Bindayi, James D. Murphy, Ithaar H. Derweesh
      Abstract: ObjectiveTo describe utilization and compare quality outcomes of partial nephrectomy (PN) for cT1a, cT1b and cT2a renal mass using a large national database.MethodsRetrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a/cT1b/T2a renal cell carcinoma between 2004-2013. We examined utilization of PN over time and quality indicators [positive surgical margin (PSM) and 30-day postoperative readmission rates (30Day-Readmit)]. Multivariable analysis was utilized to elucidate predictors for outcome comparisons.Results43,749 patients underwent PN for cT1a, cT1b and cT2a renal mass (34,796 cT1a; 8,040 cT1b; 913 cT2a). Proportion undergoing PN increased from 30.8% in 2004 to 56.7% in 2013 (p
      PubDate: 2017-10-15T09:50:21.3199-05:00
      DOI: 10.1111/bju.14055
  • Impact of ureteroscopy before radical nephroureterectomy for upper tract
           urothelial carcinomas on oncologic outcomes: a meta-analysis
    • Authors: Run-Qi Guo; Peng Hong, Geng-Yan Xiong, Zhang Lei, Dong Fang, Xue-Song Li, Kai Zhang, Li-Qun Zhou
      Abstract: ObjectivesTo investigate whether ureteroscopy (URS) before radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUC) has an impact on oncologic outcomes.Materials and MethodsWe performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta-analysis on survival outcomes.ResultsOur meta-analysis included eight eligible studies containing 3,975 patients. The results were as follows: cancer-specific survival (CSS) (Hazard Ratio (HR) = 0.76, 95% CI: 0.59 - 0.99, P = 0.04), overall survival (OS) (HR = 0.76, 95% CI: 0.48 - 1.21, P = 0.24), recurrence-free survival (RFS) (HR = 0.89, 95% CI: 0.69 - 1.14, P = 0.37), metastasis-free survival (MFS) (HR = 1.06, 95% CI: 0.82 - 1.36, P = 0.66), and intravesical recurrence-free survival (IRFS) (HR = 1.51, 95% CI: 1.29 - 1.77, P < 0.00001). Excluding the previous bladder tumour history, the results of IRFS were HR = 1.81, 95% CI: 1.53-2.13, and P < 0.00001.ConclusionsThis meta-analysis indicated that URS before RNU did not have a negative impact on CSS, OS, RFS, or MFS in UTUC patients. However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU. Further studies are needed to assess the effects of post-URS intravesical chemotherapy on intravesical recurrence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-15T09:45:20.811552-05:
      DOI: 10.1111/bju.14053
  • Multicentre evaluation of Magnetic Resonance Imaging supported
           transperineal prostate biopsy in biopsy-naïve men with suspicion of
           prostate cancer
    • Authors: N. L Hansen; T Barrett, C Kesch, L Pepdjonovic, D Bonekamp, R O'Sullivan, F Distler, A Warren, C Samel, B Hadaschik, J Grummet, C Kastner
      Abstract: ObjectivesTo analyse the detection rates of primary MRI-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres.Patients and MethodsMulticentre, prospective outcome study of 807 consecutive biopsy-naïve patients having undergone MRI-guided transperineal prostate biopsy as the first diagnostic intervention between 10/2012 and 05/2016. MRI was reported following PI-RADS criteria. 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score (GS) 7-10 cancer in targeted and overall biopsy. Predictive values were calculated for different PI-RADS and PSA density (PSA-D) groups.ResultsCancer was detected in 68% and GS 7-10 in 49% of patients. Negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSA-D ≤0.1 ng/ml/cm3 for GS7-10 was 0.91 (±0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of GS 7-10 was significantly higher at 71% versus 59% and 61% with either approach alone (p=0.000). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (p>0.05). Limitations include variability of mpMRI reading and Gleason grading.ConclusionMRI-based transperineal biopsy performed at high volume, tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of GS 7-10 cancer. Prostate biopsies may not be needed for men with low PSA-D and a non-suspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-11T02:05:24.359062-05:
      DOI: 10.1111/bju.14049
  • Multiple growth periods predict unfavorable pathology in patients with
           small renal masses
    • Authors: Alex Jang; Hiten D. Patel, Mark Riffon, Michael A. Gorin, Alice Semerjian, Michael H. Johnson, Mohamad E. Allaf, Phillip M. Pierorazio
      Abstract: ObjectiveTo use the number of positive growth periods as a characterization of the growth of small renal masses in order to determine potential predictors of malignancy.Patients and MethodsPatients who underwent axial imaging at multiple time points prior to surgical resection for a small renal mass were queried. Patients were categorized based on their pathologic tumor grade and stage: favorable (benign, chromophobe, and low-grade pT1-2 RCC) vs. unfavorable (high-grade of any stage and low-grade pT3-4 RCC). A positive growth period was counted each time the difference in greatest tumor diameters between two images was positive. Cochran-Armitage trend test and Somers’ D association was used to determine if the number of positive growth periods was correlated with unfavorable pathology.ResultsOf the 124 patients, 86 (69.4%) had favorable pathology and 38 (30.6%) had unfavorable pathology. Those who had favorable pathology were younger than those who had unfavorable pathology (median [IQR]=61.0 [52.2-66.0] vs 68.5 [61.5-77.0], p
      PubDate: 2017-10-09T03:35:15.702995-05:
      DOI: 10.1111/bju.14051
  • STAMPEDE-ing Towards Androgen Biosynthesis Inhibition for Treatment of
           High-Risk Hormone-Naïve Prostate Cancer: Changing the LATITUDE
    • Authors: Zachary Klaassen; Declan G. Murphy
      Abstract: Since Dr. Huggins’ 1941 Nobel prize winning finding that androgen deprivation therapy (ADT) effectively controls metastatic prostate cancer (PCa), 70 years passed before CHAARTED [1] and STAMPEDE [2] demonstrated that adding docetaxel to ADT prolongs survival in men with metastatic PCa. The de novo metastatic PCa global incidence is striking: 3% in the US, 6% across Europe, 4-10% in Latin America, and 60% in Asia-Pacific [3]. Historically, ADT has been standard of care, however most men progress to metastatic castration-resistant prostate cancer (mCRPC).This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-09T03:31:36.150201-05:
      DOI: 10.1111/bju.14050
  • The impact of bladder cancer on health-related quality of life
    • Authors: Angela B. Smith; Byron Jaeger, Laura C. Pinheiro, Lloyd J. Edwards, Hung-Jui Tan, Matthew E. Nielsen, Bryce B. Reeve
      Abstract: ObjectivesTo identify HRQOL changes before to after diagnosis in older adults with bladder cancer and to compare their changes to non-cancer controls.Patients and MethodsData from the Surveillance, Epidemiology, and End Results registries were linked with Medicare Health Outcomes Survey (MHOS) data. Medicare beneficiaries>= 65 years from 1998-2013 who were diagnosed with bladder cancer between baseline and follow-up MHOS were matched with non-cancer controls using propensity scores. Linear mixed models were used to estimate predictors of HRQOL changes.ResultsAfter matching, 535 bladder cancer patients (458 non-invasive and 77 invasive) and 2770 non-cancer controls were identified. Both non-invasive and invasive cases (respectively) reported significant declines in HRQOL over time when compared to controls: Physical Component Summary (-2 and -5.3 vs. -0.4), Bodily Pain (-1.9 and -3.6 vs. -0.7), Role Physical (-2.7 and -4.7 vs. -0.7), General Health (-2.4 and -6.1 vs. 0), Vitality (-1.2 and -3.5 vs. -0.1) and Social Functioning (-2.1 and -5.7 vs. -0.8). All scores range from 0 to 100. When stratified by time since diagnosis, HRQOL improved over 1 year for some domains (Role Physical) but remained lower across most domains.ConclusionsAfter diagnosis, bladder cancer patients experienced significant declines in physical, mental, and social HRQOL relative to controls. Decrements were most pronounced among individuals with invasive disease. Identifying methods to better understand and address HRQOL decrements among bladder cancer patients is needed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-08T23:05:27.0035-05:00
      DOI: 10.1111/bju.14047
  • Cost-analysis of open radical cystectomy versus robot-assisted radical
    • Authors: S. S. Bansal; T. Dogra, P. Weston Smith, S. Amran, I. Auluck, M. S. Bhambra, M. S. Sura, E. Rowe, A. Koupparis
      Abstract: ObjectivesTo perform a cost analysis comparing the cost of robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC) in a UK tertiary referral centre and to identify the key cost drivers.MethodsData on hospital stay, operative duration, transfusion rate and volume and complication rate were obtained from a prospectively updated institutional database for patients undergoing RARC or ORC. A cost decision tree model was created. Sensitivity analysis was performed to find key drivers of overall cost and to find breakeven points with ORC. Monte Carlo analysis was performed to quantify the variability in the dataset.ResultsOne RARC procedure costs £12,449.87, or £12,106.12 if the robot was donated via charitable funds. In comparison, one ORC procedure costs £10,474.54. RARC is 18.9% more expensive than ORC. The key cost drivers were operative duration, hospital length of stay and the number of cases performed per annum.ConclusionHigh ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-06T06:05:24.33649-05:0
      DOI: 10.1111/bju.14044
  • Intraductal carcinoma of the prostate can evade androgen-deprivation, with
           emergence of castrate tolerant cells
    • Authors: Laura H. Porter; Kohei Hashimoto, Mitchell G. Lawrence, Carmel Pezaro, David Clouston, Hong Wang, Melissa Papargiris, Heather Thorne, Jason Li, , Andrew Ryan, Sam Norden, Daniel Moon, Damien M. Bolton, Shomik Sengupta, Mark Frydenberg, Declan G. Murphy, Gail P. Risbridger, Renea A. Taylor
      Abstract: ObjectivesTo determine the relevance of intraductal carcinoma of the prostate (IDC-P) in advanced prostate cancer, we first examined whether IDC-P was originally present in patients who later developed advanced prostate cancer and then used patient-derived xenografts (PDXs) to investigate the response of IDC-P to androgen deprivation therapy (ADT).Materials and methodsWe conducted a retrospective pathology review of IDC-P in primary prostate biopsy or surgery specimens from 38 men who subsequently developed advanced prostate cancer. Overall survival was calculated using the Kaplan-Meier method. To demonstrate the response of IDC-P to ADT, we established PDXs from seven men with familial and/or high-risk sporadic prostate cancer. After castration and testosterone restoration of host mice, we measured the volume and proliferation of IDC-P within PDX grafts.ResultsIDC-P was a prominent feature in the primary prostate specimens, present in 63% of specimens and often co-existing with poorly-differentiated adenocarcinoma. Overall survival was similar in patients with or without IDC-P. In the PDXs from all seven patients, IDC-P was identified and present at a similar volume to adenocarcinoma. Residual IDC-P lesions persisted after host castration and, similar to castrate-tolerant adenocarcinoma, testosterone restoration led to tumour regeneration.ConclusionIDC-P is prevalent in aggressive prostate cancer and contains cells that can withstand androgen deprivation. Thus, IDC-P appears functionally relevant in advanced prostate cancer. The presence of IDC-P may be a trigger to develop innovative clinical management plans.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-04T13:55:21.865115-05:
      DOI: 10.1111/bju.14043
  • Survival Outcomes for Patients with Localized Upper-Tract Urothelial
           Carcinoma Managed with Non-Definitive Treatment
    • Authors: Jamil S. Syed; Kevin A. Nguyen, Alfredo Suarez-Sarmiento, Katelyn Johnson, Michael S. Leapman, Jay D. Raman, Brian Shuch
      Abstract: ObjectiveTo investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non-definitive therapy, which currently remains unknown.Subjects/Patients and MethodsWe utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localized, histologically confirmed kidney/renal pelvis and ureteral urothelial carcinoma. Survival analysis using the Kaplan Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer specific mortality (CSM).ResultsWe identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age: 81 vs. 71, p
      PubDate: 2017-10-03T10:35:20.606288-05:
      DOI: 10.1111/bju.14042
  • Prognostic value of urinary PCA3 during active surveillance of low-risk
           prostate cancer in patients receiving 5α-reductase inhibitors
    • Authors: Vincent Fradet; Paul Toren, Molière Nguile-Makao, Michele Lodde, Jérome Lévesque, Caroline Léger, André Caron, Alain Bergeron, Tal Ben-Zvi, Louis Lacombe, Frédéric Pouliot, Rabi Tiguert, Thierry Dujardin, Yves Fradet
      Abstract: ObjectivesTo determine the clinical performance of the urinary PCA3 test to predict the risk of Gleason grade re-classification among men receiving a 5α-reductase inhibitor during active surveillance for prostate cancer.Patients and MethodsPatients with low-risk prostate cancer were enrolled in a prospective Phase II study of active surveillance complemented with prescription of a 5ARI. Repeat biopsy was performed within the first year and annually according to physician and patient preference. Ninety patients had urine collected after digital rectal examination of the prostate before the first repeat biopsy. The PCA3 test was performed in a blinded manner at a central laboratory.ResultsUsing a PCA3 score cut-off of 35, we observed a significant difference (p=0.0002) in the risk of being diagnosed with Gleason ≥ 7 cancer during a median of 7 years of follow-up. Adjusted cox regression and Kaplan-Meier analyses also demonstrated a significantly higher risk of upgrading to Gleason ≥ 7 during follow-up for those with a higher PCA3 score.ConclusionThe urinary PCA3 test predicted Gleason grade re-classification among patients receiving a 5α-reductase inhibitor during active surveillance for low risk prostate cancer.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T10:30:26.871031-05:
      DOI: 10.1111/bju.14041
  • The BURST Research Collaborative: an alternative research model for
           carrying out large scale multi-centre Urological studies
    • Authors: Veeru Kasivisvanathan; Hashim Ahmed, Sophia Cashman, Ben Challacombe, Mark Emberton, Chuanyu Gao, Benjamin W Lamb, Arjun Nambiar, Robert Pickard, Taimur T Shah, Daron Smith
      Abstract: Veeru Kasivisvanathan's research is funded from the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Taimur Shah would like to acknowledge funding from the St Peter's Trust for clinical research and has received support for conference attendance and speaker fees from Astellas, Ferring and Galil Medical. Mark Emberton is a National Institute for Health Research Senior Investigator (2015-) and receives research support from the UCLH/UCL NIHR Biomedical Research Centre.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T09:00:31.147527-05:
      DOI: 10.1111/bju.14040
  • Surgical Management of Penile Carcinoma in Situ: Results from an
           International Collaborative Study and Review of the Literature
    • Authors: Juan Chipollini; Sylvia Yan, Sarah R. Ottenhof, Yao Zhu, Désirée Draeger, Adam S. Baumgarten, Dominic H. Tang, Chris Protzel, Ding-wei Ye, Oliver W. Hakenberg, Simon Horenblas, Nicholas A. Watkin, Philippe E. Spiess
      Abstract: ObjectivesTo evaluate recurrence after penile sparing surgery (PSS) in the management of carcinoma-in-situ (CIS) of the penis in a large multicenter cohort of patients.Patients and MethodsWe identified consecutive patients from 5 major, academic centers treated from June 1986 to November 2014 who underwent PSS for pathologically proven penile CIS. Primary outcome was local recurrence free survival (RFS) and estimated using the Kaplan-Meier method.ResultsA total of 205 patients were identified. Treatment modalities included circumcision, glansectomy, wide local excision, laser therapy and total glans resurfacing. Over a median follow-up of 40 months (interquartile range [IQR]: 26-65.6), there were 48 local recurrences with 45.8% occurring in the first year and 81.3% occurring by year 5. Majority of recurrences were observed in the laser group (58.3%). Median time to local recurrence was 15.9 months (5.66-26.14). The 1, 2, and 5-yr RFS were 88.4, 85.6, and 75%, respectively; and the median RFS was 106.5 months (80.2-132.2).ConclusionsAmong patients with penile CIS selected for surgical management, durable responses at intermediate to long-term follow-up were noted. For those with glandular CIS, glans resurfacing offered the best outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-03T09:00:23.615856-05:
      DOI: 10.1111/bju.14037
  • Testing the external validity of EORTC 30904 comparing overall survival
           after radical nephrectomy vs nephron sparing surgery in contemporary North
           American patients with renal cell cancer
    • Authors: Sohrab Arora; Nicolas Landenberg, Philipp Gild, Akshay Sood, Deepansh Dalela, Quoc-Dien Trinh, Mani Menon, Craig Rogers, Firas Abdollah
      Abstract: EORTC 30904 reported that for solitary renal mass
      PubDate: 2017-10-03T08:55:20.426087-05:
      DOI: 10.1111/bju.14039
  • The accuracy of patients’ perceptions of the risks associated with
           localized prostate cancer treatments
    • Authors: Marie-Anne van Stam; Henk G. van der Poel, Jochem R.N. van der Voort van Zyp, Corinne N. Tillier, Simon Horenblas, Neil K. Aaronson, J.L.H. Ruud Bosch
      Abstract: ObjectivesTo assess localized prostate cancer (PC) patients’ understanding of the differences in outcomes and risks of radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS), and to identify correlates of misperceptions.Patients And MethodsWe used baseline data (questionnaires completed after treatment information was provided but prior to treatment) of 426 newly diagnosed localized PC patients who participated (87% response rate) in a prospective, longitudinal, multicenter study. Patients’ pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature. We used univariate and multivariate linear regression to identify correlates of misperceptions.ResultsApproximately two-third (68%, n=211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT. More than half of the patients did not comprehend that RP patients are at greater risk for incontinence (65%, n=202) and erectile dysfunction (61%, n=190), and less at risk for bowel problems (53%, n=211) compared to RT patients. Many patients overestimated the risk of requiring definitive treatment following AS (45%, n=157), and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n=333). Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with better understanding of the risks (p
      PubDate: 2017-09-28T07:55:20.487391-05:
      DOI: 10.1111/bju.14034
  • The Outcomes of Inflatable Penile Prosthesis Insertion in 247 Patients
           Completing Female to Male Gender Reassignment Surgery
    • Authors: M. Falcone; G. Garaffa, A. Gillo, D. Dente, A.N. Christopher, D.J. Ralph
      Abstract: ObjectivesTo assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria (GD).Subject/patients and methodsWe conducted a retrospective single center analysis of 247 consecutive patients. The recruitment time was between January 2001 and October 2015. A total of 328 inflatable PP were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently the cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long-term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non-validated questionnaires. The data was analyzed with non-parametric tests, a multivariate logistic regression analysis, and a Kaplan-Meier survival curve.ResultsThe average follow-up was 20 months. 88% of patients were satisfied with the result although only 77% used their device for sexual intercourse. The overall 5-year device survival was 78% with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only the type of phalloplasty significantly affected the infection risk (p = 0.013).ConclusionsPenile prosthesis implantation into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-23T03:45:21.215177-05:
      DOI: 10.1111/bju.14027
  • A Novel Tool for Predicting Extracapsular Extension During Graded Partial
           Nerve Sparing in Radical Prostatectomy
    • Authors: Vipul Patel; Marco Sandri, Angelica Anna Chiara Grasso, Elisa De Lorenzis, Franco Palmisano, Giancarlo Albo, Rafael Ferreira Coelho, Alexander Mottrie, Harvey Tadzia, Darian Kameh, Hariharan Palayapalayam, Peter Wiklund, Silvano Bosari, Stefano Puliatti, Paola Zuccolotto, Giampaolo Bianchi, Bernardo Rocco
      Abstract: ObjectivesTo create a statistical tool for the estimation of extra-capsular extension (ECE) level of prostate cancer and determine the nerve sparing (NS) approach that can be safely performed during radical prostatectomy (RP).Patients And MethodsA total of 11,794 lobes, from 6,360 patients who underwent robot¬ assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width greater than 1, 2, 3, and 4mm. A five¬ zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view a patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount and the areas identified by the decision rule.ResultsOut of 6,360 patients, 1,803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1,351 lobes (11.4%) and extended beyond the capsule for more than 1, 2, 3, and 4mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (IR 1.00 - 2.00). The 5 logistic models showed good predictive performance; the area under the ROC curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width greater than 1, 2, 3, and 4mm, respectively.ConclusionThis novel tool predict with a good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at can supports surgeons in patient counselling and preoperative planning.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-22T04:55:24.969042-05:
      DOI: 10.1111/bju.14026
  • Role of estrogen receptor alpha and beta in bladder tissue in patients
           with clinical diagnosis of benign prostatic hyperplasia
    • Authors: R. Bhattar; S. S. Yadav, V. Tomar, A. Mittal, G. Gangkak, J. Mehta
      Abstract: ObjectiveTo study the differential expression of estrogen receptor (ER) subtypes in human urinary bladder tissue using immunohistochemistry (IHC) methods and explores their correlation with various measures of LUTS.MethodsIn this prospective case control study, case group (group A) comprised of 34 patients having bothersome LUTS underwent transurethral resection of prostate (TURP). 19 age matched otherwise normal patients who underwent cystoscopy as an investigation for microscopic hematuria were categorized in control group (group B). Cystoscopy and bladder biopsy was done in both groups. IHC evaluation of biopsy specimens were done for ER subtypes (ERα and ERβ) and for Ki 67 in semiquantitative fashion. Correlations of receptors with various measures of BPH/LUTS were also assessed.Results: There was statistical significant expression of ERα (both epithelial and stromas cells) in case group as comparison to control group however ERβ expression was not significant between both groups. Ki 67 expression was also more significant in case group. When we compare clinical parameters with receptor status, IPSS, PVR and prostate size were significantly associated with epithelial and stromal ERα. However ERβ was associated only with PVR.ConclusionWe found significant correlation between bladder ER levels (specifically ERα) and various clinical measures of BPH. So we conclude that ERα is the key mediator that could be responsible for various clinical measures of BPH/LUTS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-21T01:55:45.833859-05:
      DOI: 10.1111/bju.14022
  • The impact of lymph node dissection and positive lymph nodes on cancer
           specific mortality in contemporary pT2-3 non-metastatic renal cell
           carcinoma treated with radical nephrectomy
    • Authors: Michele Marchioni; Marco Bandini, Raisa S. Pompe, Tristan Martel, Zhe Tian, Shahrokh F. Shariat, Anil Kapoor, Luca Cindolo, Alberto Briganti, Luigi Schips, Umberto Capitanio, Pierre I. Karakiewicz
      Abstract: ObjectiveTo assess the effect of lymph node dissection (LND), number of removed nodes (NRN) and number of positive nodes (NPN) on cancer specific mortality (CSM), in contemporary vs. historical patients, with pT2-3NanyM0 renal cell carcinoma (RCC) treated with radical nephrectomy (RN).MethodsWithin the SEER database (2001-2013), we identified patients with non-metastatic pT2-3 Nany RCC who underwent RN with or without LND. Kaplan–Meier analyses and multivariable Cox regression models with propensity score weighting for inverse probability of treatment were used.ResultsOf 25,357 patients, 24.8% underwent lymph node dissection (2001-2007: 3,167 patients vs. 2008-2013: 3,133 patients). Median NRN was 3 (IQR 1-7). Positive nodes were identified in 17.1%: 9.3% of pT2 and 21.6% of pT3 patients, who underwent LND. Median NPN was 2 (IQR 1-2). In multivariable models, LND did not decrease CSM (HR 1.29, p
      PubDate: 2017-09-20T11:00:19.819862-05:
      DOI: 10.1111/bju.14024
  • Drugs for metabolic conditions and prostate cancer death in men on GnRH
    • Authors: Cecilia Bosco; Chloe Wong, Hans Garmo, Danielle Crawley, Lars Holmberg, , Niklas Hammar, Jan Adolfsson, Pär Stattin, Mieke Van Hemelrijck
      Abstract: BackgroundIt is unclear whether metabolic syndrome and its related drugs is affecting treatment response in men with prostate cancer (PCa) on Gonadotropin releasing Hormone (GnRH) agonists. We aimed to evaluate whether drugs for metabolic conditions influence PCa-specific mortality in men starting GnRH agonists.MethodsWe selected all men receiving GnRH agonists as primary treatment in PCBaSe Sweden (n=9,267). Use of drugs for metabolic conditions (i.e. anti-diabetes, anti-dyslipidaemia, and anti-hypertension) in relation to all cause, cardiovascular disease (CVD), and PCa-specific death was studied using multivariate Cox proportional hazard and Fine and Gray competing regression models.Results6,322 (68%) men used at least one drug for a metabolic condition at GnRH agonist initiation: 46% on antihypertensive drugs only, 32% on drugs for dyslipidaemia and hypertension and about 10% on drugs for more than two metabolic conditions. Cox models indicated a weak increased risk of PCa death in men who are on drugs for hypertension only (HR: 1.12 (95%CI: 1.03-1.23)) or drugs for hyperglycaemia (HR: 1.19 (95%CI: 1.06-1.35)) at GnRH agonist initiation. However, upon taking into account competing risk from CVD death, none of the drugs for metabolic conditions were associated with an increased risk of PCa death.ConclusionWe did not find evidence for a better or worse response to GnRH agonists in men with PCa who were also on drugs for hypertension, dyslipidaemia, or hyperglycaemia.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T10:55:35.695292-05:
      DOI: 10.1111/bju.14023
  • Real World Uptake, Safety Profile and Outcomes of Docetaxel in Newly
           Diagnosed Metastatic Prostate Cancer
    • Authors: Robert Rulach; Stephen McKay, Sam Neilson, Lillian White, Jan Wallace, Ross Carruthers, Carolynn Lamb, Almudena Cascales, Husam Marashi, Hilary Glen, Balaji Venugopal, Azmat Sadoyze, Norma Sidek, J. Martin Russell, Abdulla Alhasso, David Dodds, Jennifer Laskey, Robert J. Jones, Nicholas MacLeod
      Abstract: ObjectivesTo investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial.Subjects/patients and MethodsPatients in the West of Scotland Cancer Network (WoSCAN) with newly diagnosed mPC were identified from the regional multidisciplinary team (MDT) meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression and overall survival were compared between those patients who received docetaxel and androgen deprivation therapy (ADT), or ADT alone using survival analysis.ResultsOut of 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (HR 2.03, 95% CI (1.27, 3.25), log-rank test, p= 0.002) and had an increased risk of death (HR 5.88, 95% CI 2.52, 13.72, log-rank p=0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine times greater if chemotherapy was started within three weeks of ADT initiation (95% CI (1.22,77.72) p= 0.032).ConclusionDocetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started 3 weeks or more after androgen deprivation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T10:00:19.156196-05:
      DOI: 10.1111/bju.14025
  • Adjuvant chemotherapy after radical nephroureterectomy does not improve
           survival in patients with upper tract urothelial carcinoma: a joint study
           of the EAU-Young Academic Urologists and the Upper Tract Urothelial
           Carcinoma Collaboration
    • Authors: Andrea Necchi; Salvatore Lo Vullo, Luigi Mariani, Marco Moschini, Kees Hendricksen, Michael Rink, Roman Sosnowski, Jakub Dobruch, Jay D. Raman, Christopher G. Wood, Vitaly Margulis, Morgan Roupret, Alberto Briganti, Francesco Montorsi, Evanguelos Xylinas, Shahrokh F. Shariat,
      Abstract: ObjectiveTo analyze the outcomes of adjuvant chemotherapy versus observation in a multicenter cohort of patients with upper tract urothelial carcinoma (UTUC). The benefit from adjuvant chemotherapy after radical nephroureterectomy (RNU) is debated in these patients.Patients and MethodsData from 15 centers was collected, totalling 1,544 patients, treated between 2000 and 2015. Criteria for patient selection included pT2-4N0/x stage, or lymph node-positive disease, and prior RNU. The standardized differences (SD) approach was used to compare subgroup characteristics. Overall survival (OS) was the primary endpoint. The propensity scores (PS) techniques included 1:1 PS matching as primary analysis, added to the inverse probability of treatment weighting (IPTW) as secondary analysis. The latter was also performed with the inclusion of the covariates, i.e. with “doubly robust” estimation (DREP). Six-month landmark analysis was done to exclude early events.ResultsA total of 312 patients received adjuvant chemotherapy and 1,232 observation. Despite differences between the two groups, SD was generally
      PubDate: 2017-09-20T09:35:34.172702-05:
      DOI: 10.1111/bju.14020
  • Quality of life following brachytherapy or bilateral nerve sparing robotic
           prostatectomy for prostate cancer: a prospective cohort
    • Authors: Pierre Blanchard; John W. Davis, Steven J. Frank, Jeri Kim, Curtis A. Pettaway, Thomas J. Pugh, Louis L. Pisters, John F. Ward, Seungtaek Choi, Brian F. Chapin, Karen Hoffman, Neema Navai, Mary Achim, Sean E. McGuire, Surena F. Matin, Quynh Nguyen, Usama Mahmood, William J. Graber, Hsiang-Chun Chen, Xuemei Wang, Deborah A. Kuban
      Abstract: BackgroundQuality of life (QoL) has become an important issue in cancer care. Better data on QoL after prostate cancer treatment could help patients make an informed decision regarding the treatment of their choice.MethodsPathologically proven, non-metastatic, T1-T3bN0 prostate cancer patients were included in this prospective non-randomized study if they were to receive curative intent treatment. Sample size was at least 181 patients per cohort/treatment type. Quality of life (QoL) was recorded at baseline and each follow-up using the Expanded Prostate Cancer Index Composite (EPIC-50) instrument. The minimal clinically important difference was defined as half of the standard deviation of the baseline score for each domain. A mixed effect models was used to compare the different treatments. We here report on the brachytherapy and the bilateral nerve sparing robotic prostatectomy cohorts. Hormonotherapy was not allowed.ResultsFrom November 2007 to January 2013, 181 patients were included in the brachytherapy and 210 in the robotic prostatectomy group respectively. Among the surgical patients, 178 had bilateral nerve- sparing and were included in this analysis. Response rate to EPIC questionnaires were higher in the brachytherapy compared to the prostatectomy arm, with 82% vs. 57% at two years post treatment and 55% vs 45% at four years. In the mixed model, surgical patients had better QoL regarding urinary irritation/obstruction or bother and bowel function, and lower QoL regarding sexual function and urinary incontinence. Results were confirmed in a propensity score matched model. Patient satisfaction was significantly higher among brachytherapy patients at 1, 2 and 3 years post treatment.ConclusionThis prospective non randomized study demonstrates long-term differences in QoL domains after bilateral nerve- sparing robotic prostatectomy or brachytherapy. Difference in patient satisfaction should be further explored. These results can be used to counsel patients in the decision-making process.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-20T09:35:19.222199-05:
      DOI: 10.1111/bju.14021
  • Increased Accuracy of a novel mRNA-based Urine Test for Bladder Cancer
    • Authors: Renate Pichler; Josef Fritz, Gennadi Tulchiner, Gerald Klinglmair, Afschin Soleiman, Wolfgang Horninger, Helmut Klocker, Isabel Heidegger
      Abstract: ObjectivesTo evaluate the diagnostic accuracy of the Xpert Bladder Cancer (BC) Monitor, compared to cystoscopy and cytology in the oncological follow-up of non-muscle invasive bladder cancer (NMIBC).Material and Methods140 patients with a previous history of NMIBC undergoing routine surveillance at our department were enrolled prospectively (ISRCTN study registry number 37210907). Urine cytology was evaluated according to the Paris classification system. In addition, urinary specimens were analyzed using the Xpert BC Monitor, which measures five target mRNAs (ABL1, CRH, IGF2, UPK1B, ANXA10) using real-time-PCR. Descriptive analysis, diagnostic accuracy including sensitivities, specificities, predictive values [positive (PPV) and negative (NPV)], receiver operating characteristic (ROC) curves, and area under the curve (AUC) were calculated.ResultsThe overall sensitivity (0.84) and NPV (0.93) of the Xpert BC Monitor were significantly superior to that of bladder washing cytology (0.33 and 0.76, p
      PubDate: 2017-09-20T09:25:20.206997-05:
      DOI: 10.1111/bju.14019
  • Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic
    • Authors: Giancarlo Marra; Ettore Dalmasso, Marco Angello, Stefania Munegato, Andrea Bosio, Omidreza Sedigh, Luigi Biancone, Paolo Gontero
      Abstract: BackgroundThe majority of kidney transplants are performed in recipients (RTR) over 50; simultaneously their life expectancy is improving. The increasing age and number of RTR is likely to be paralleled by an increase of prostate cancer (PCa) incidence. However, little is known on the optimal management of these patients who represent a therapeutic challenge due to medical and anatomical graft-related issues.MethodsAMED, Medline and Embase were searched until November 17th, 2016 adhering to the PRISMA guidelines and the AMSTAR checklist to investigate oncological and functional outcomes of PCa treatment in RTR. Type of immunosuppression and peri-operative antibiotic use/protocols were also assessed. The search was implemented manually. Exclusion criteria were absence of full texts or absence of information allowing to differentiate oncological and/or functional outcomes of each therapeutic approach used.ResultsWe included 241 men from 27 retrospective studies published between 1991 and 2016; 7 were case-control and 20 were case series. We also considered 9 case reports, published between 1999 and 2016. Follow up ranged from 1 to 120 months. PCa was organ-confined and with Gleason Score ≤6 in 75.2% and 60.4%. Surgery was the most frequent treatment (n=186) with Cancer specific (CSS) and overall survival (OS) being 96,8% and 96,8%, respectively. Functional outcomes including continence and erectile function and complications were less frequently reported and generally comparable to standard RP.Other treatment modalities included radiotherapy ± androgen deprivation therapy (n=34; OS 88.2%; CSS 88.2%), androgen deprivation therapy alone (n=14; OS 42.9%; CSS 64.3%), brachytherapy (n=11: OS and CSS 100%), watchful waiting (n=4) and active surveillance (n=1). Overall no treatment-related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Limitations include low quality of the studies (LE III n=7; IV n=20), absence of standardized methods to report functional outcomes and complications and inconsistency in immunosuppression and antibiotics administration reports.ConclusionsOutcomes of PCa treatment in RTR are encouraging and do not seem inferior to those of non-RTR. RP was the most assessed approach whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High quality studies are needed as the level of evidence is low and results should be interpreted with caution.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-18T03:16:00.254898-05:
      DOI: 10.1111/bju.14018
  • Systematic Review and Network Meta-Analysis on the Relative Efficacy of
           Osteoporotic Medications: Men with Prostate Cancer on Continuous Androgen
           Deprivation Therapy to Reduce Risk of Fragility Fractures
    • Authors: Yeesha Poon; Petros Pechlivanoglou, Shabbir M H Alibhai, David Naimark, Jeffrey S Hoch, Emmanuel Papadimitropoulos, Mary-Ellen Hogan, Murray Krahn
      Abstract: BackgroundAndrogen deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for fractures. This analysis evaluated the relative effectiveness of osteoporosis treatments using BMD as a surrogate endpoint for fragility fractures in men on continuous ADT.MethodWe included randomized controlled trials studying bisphosphonates, denosumab, toremifene, and raloxifene in patients with non-metastatic prostate cancer on ADT for review. Primary outcomes included percentage change in BMD from baseline at total hip, lumbar spine and femoral neck sites. We also recorded incidence rates of any fractures. Network meta-analysis was done to evaluate change in BMD.ResultsOut of 270 identified articles, 13 RCTs were included for analysis. The largest BMD improvement compared to placebo at 12 months for total hip site was: raloxifene 3.70% (95% credible interval [CrI], 1.48-5.92%), lumbar spine: zoledronic acid 6.96% (CrI:-5.34-8.52%) and femoral neck: risedronate 6.77% (CrI:-6.87-20.27%). Two studies reported fractures as outcome measure. Toremifene and denosumab studies reported improved incidence of new vertebral fracture outcome vs placebo (2.5% vs 4.9%; p
      PubDate: 2017-09-18T02:45:19.355662-05:
      DOI: 10.1111/bju.14015
  • First-line therapy with dacomitinib, an orally available pan-HER tyrosine
           kinase inhibitor, for locally-advanced or metastatic penile squamous cell
           carcinoma: results of an open label, single-arm, single-center, phase 2
    • Authors: A. Necchi; S. Lo Vullo, F. Perrone, D. Raggi, P. Giannatempo, G. Calareso, N. Nicolai, L. Piva, D. Biasoni, M. Catanzaro, T. Torelli, S. Stagni, E. Togliardi, M. Colecchia, A. Busico, A. Gloghini, A. Testi, L. Mariani, R. Salvioni
      Abstract: ObjectiveTo harness the frontline therapy in advanced penile squamous cell carcinoma (PSCC), for which chemotherapy exerts moderate activity but poor efficacy. Dacomitinib is an irreversible, pan-epidermal growth factor receptor (HER) inhibitor.Patients and MethodsIn a phase 2 study (NCT01728233), patients received dacomitinib 45 mg/day, orally, continuously. Inclusion criteria were SCC histology, clinical stage N2-3 or M1 (TNM 2009), and no prior chemotherapy administration. The primary endpoint was the objective response-rate (ORR, according to RECIST v1.1). Stopping rules based on the Bayesian posterior probability (PP) to demonstrate that the ORR exceeded 20% were set.ResultsFrom June 2013 to October 2016, 28 patients were treated. Eight (28.6%) had visceral metastases, 14 (50%) had pelvic and 17 (60.7%) clinically-involved bilateral lymph nodes. One complete and eight partial responses were obtained (ORR: 32.1%, 80% credibility interval 21.0-43.0%). The median follow-up duration was 19.8 months (IQR: 6.3-25.7); 12-month progression-free survival was 26.2% (95%CI: 13.2-51.9); 12-month overall survival (OS) was 54.9% (95%CI: 36.4-82.8). The median OS of locally-advanced patients was 20 months (IQR: 11.1-not reached). The Bayesian PP of exceeding the 20% ORR target was 92.3%. Grade 3 adverse events (skin rash) were seen in 3 patients (10.7%). Tissue samples from 25 patients were analyzed. Only two patients had HR-HPV-positive tumor. EGFR amplification was found in 4 patients (equally responders and non responders) and it was confirmed in all post-dacomitinib samples. TERT mutations (60%) were found in responders only, PI3K/mTOR pathway gene mutations in 42.9% responders versus 8.3% non responders.ConclusionDacomitinib was active and well tolerated in patients with advanced PSCC and may represent an option when combination chemotherapy cannot be administered. Mutations in downstream effectors of EGFR signaling in relation to dacomitinib activity deserve further studies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-16T10:20:31.444962-05:
      DOI: 10.1111/bju.14013
  • Guideline of Guidelines – Asymptomatic Microscopic Haematuria
    • Authors: Brian J. Linder; Edward J. Bass, Hugh Mostafid, Stephen A. Boorjian
      Abstract: ObjectiveTo review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH).MethodsThis is a review of the haematuria guidelines from 1.) American Urological Association (AUA), 2.) consensus statement from the Canadian Urological Association, Canadian Urologic Oncology Group, and Bladder Cancer Canada, 3.) American College of Physicians (ACP), 4.) Joint Consensus Statement of the Renal Association (RA) and British Association of Urological Surgeons (BAUS), and 5.) National Institute for Clinical Excellence (NICE).ResultsAll guidelines reviewed recommend evaluation for AMH, in absence of potential benign aetiologies, with the work up including cystoscopy and upper urinary tract imaging. Existing guidelines vary in the definition of AMH (role of urine dipstick versus urine microscopy), age threshold for recommending evaluation, and the optimal imaging modality (computed tomography versus ultrasound). Of the reviewed guidelines, none recommend use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation.ConclusionsSignificant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, this entity represents a valuable future research opportunity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-16T10:20:22.592585-05:
      DOI: 10.1111/bju.14016
  • Prospective comparison of transperineal MRI/ultrasound-fusion biopsy and
           transrectal systematic biopsy in biopsy-naïve patients
    • Authors: Angelika Borkowetz; Boris Hadaschik, Ivan Platzek, Marieta Toma, Georgi Torsev, Theresa Renner, Roman Herout, Martin Baunacke, Michael Laniado, Gustavo Baretton, Jan Philipp Radtke, Claudia Kesch, Markus Hohenfellner, Michael Froehner, Heinz-Peter Schlemmer, Manfred Wirth, Stefan Zastrow
      Abstract: ObjectivesTo evaluate the value of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasound-fusion biopsy (fusPbx) to conventional transrectal systematic biopsy (sysPbx) in biopsy-naïve patients.Patients and MethodsThis multicentre, prospective trial investigated biopsy-naïve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa defined as Gleason pattern four or five. Here, we present our analysis after a study period of two years.ResultsThe study included 214 patients. Median number of targeted and systematic cores was six (range 2-15) and 12 (range 6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs. 43%; p=0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (p=0.296). The missing rate of significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs. 38% vs. 35%, p
      PubDate: 2017-09-16T10:15:20.850023-05:
      DOI: 10.1111/bju.14017
  • Robotic Kidney Transplantation: Comparison of the First 40 Cases of Open
           vs Robotic Transplantations by a Single Surgeon
    • Authors: Volkan Tuğcu; Nevzat Can Şener, Selçuk Şahin, Abdullah Hızır Yavuzsan, Fatih Gökhan Akbay, Süheyla Apaydın
      Abstract: ObjectiveTo compare the outcomes of the first 40 cases who underwent robotic kidney transplantation (RKT) with those of the first 40 cases who underwent open kidney transplantation (KT) in the Dr. Sadi Konuk Training Hospital.Material and MethodsBetween January 2016 and February 2017, we prospectively collected the data of the first 40 RKT cases (RKT group) and compared them with those of the first 40 open KT cases (OKT group). Comparisons were made using One-way ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi-square or Fisher Exact test for categorical variables.ResultsThere were 40 patients in the RKT group and 40 in the OKT group. Below are some statistics of the RKT group: mean operative time - 265.375±46.63 minutes; console time - 180.25±35.26 minutes; total ischemia time - 96.7±30.02 minutes, rewarming time - 54.70±17.80 minutes, and estimated blood loss - 182.25±55.26 ml. Some of the statistics taken from the OKT group are as follows: operative time - 250.25±41 minutes (p=0.129), total ischemia time - 71.79±8.55 minutes (p
      PubDate: 2017-09-16T10:10:23.444459-05:
      DOI: 10.1111/bju.14014
  • Perioperative Allogeneic Blood Transfusion Does Not Adversely Impact
           Oncological Outcomes After Radical Cystectomy for Urinary Bladder Cancer
           – a Propensity Score-weighted European Multicenter Study
    • Authors: Malte W. Vetterlein; Philipp Gild, Luis A. Kluth, Thomas Seisen, Michael Gierth, Hans-Martin Fritsche, Maximilian Burger, Chris Protzel, Oliver W. Hakenberg, Nicolas von Landenberg, Florian Roghmann, Joachim Noldus, Philipp Nuhn, Armin Pycha, Michael Rink, Felix K.-H. Chun, Matthias May, Margit Fisch, Atiqullah Aziz
      Abstract: ObjectivesTo evaluate the effect of perioperative blood transfusion (PBT) on recurrence-free survival (RFS), overall survival (OS), cancer-specific mortality (CSM), and other-cause mortality (OCM) in patients undergoing radical cystectomy (RC), utilizing a contemporary European multicenter cohort.Patients and MethodsThe PROspective MulticEnTer RadIcal Cystectomy Series (PROMETRICS) includes data on 679 patients who underwent RC at 18 European tertiary care centers in 2011. The association between PBT and oncological survival outcomes was assessed using Kaplan-Meier, Cox regression, and competing-risks analyses. Imbalances in clinicopathological features between patients receiving PBT vs. not were mitigated using conventional multivariable adjusting as well as inverse probability of treatment weighting (IPTW).ResultsOverall, 611 patients had complete information on PBT, and 315 (51.6%) received PBT. The two groups (PBT vs. no PBT) differed significantly with respect to most clinicopathological features including perioperative blood loss (median: 1000ml; IQR: 600-1500ml vs. median: 500ml; IQR: 400-800ml; P
      PubDate: 2017-09-14T03:12:05.268533-05:
      DOI: 10.1111/bju.14012
  • Association between Metabolic Syndrome and intravesical prostatic
           protrusion in benign prostatic enlargement patients with lower urinary
           tract symptoms (MIPS Study)
    • Authors: G I Russo; F. Regis, P. Spatafora, J. Frizzi, D. Urzì, S. Cimino, S. Serni, M. Carini, M. Gacci, G. Morgia
      Abstract: ObjectiveTo investigate the association between metabolic syndrome (MetS) and morphological features of benign prostatic enlargement (BPE), including total prostate volume (TPV), transitional zone volume (TZV) and intra vesical prostatic protrusion (IPP).Patients and MethodsFrom January 2015 to January 2017, 224 consecutive men older than 50 years presenting with lower urinary tract symptoms (LUTS) suggestive of BPE were recruited in this multicentre cross-sectional study. MetS was defined according to international diabetes federation criteria. Multivariate linear and logistic regression models were performed to verify factors associated with IPP, TZV and TPV.ResultsPatients with MetS showed significantly increase of IPP (p
      PubDate: 2017-09-05T02:40:25.145645-05:
      DOI: 10.1111/bju.14007
  • Time on androgen deprivation therapy and adaptations to exercise:
           secondary analysis from a 12-month randomized controlled trial in men with
           prostate cancer
    • Authors: Dennis R. Taaffe; Laurien M. Buffart, Robert U. Newton, Nigel Spry, James Denham, David Joseph, David Lamb, Suzanne K. Chambers, Daniel A. Galvão
      Abstract: ObjectivesTo explore if duration of prior exposure to androgen deprivation therapy (ADT) in men with prostate cancer (PCa) undertaking a yearlong exercise program moderates the exercise response on body composition and muscle performance. In addition, we explored the moderator effect of baseline testosterone, time since ADT, and baseline value of the outcome.Patients and MethodsIn a multicenter randomized controlled trial, 100 patients previously treated for either 6 months (short-term) or 18 months (long-term) ADT in combination with radiotherapy as part of the TROG 03.04 RADAR trial were randomized to 6 months supervised exercise followed by a 6-month home-based maintenance program, or to printed physical activity educational material for 12 months across 13 university-affiliated exercise clinics in Australia and New Zealand. Patients were long-term PCa survivors with a mean age of 71.7 ± 6.4 years, and were assessed for lower extremity performance (repeated chair rise) with a subset (n=57) undergoing additional measures for upper- and lower-body muscle strength and body composition [lean mass, fat mass, appendicular skeletal muscle (ASM)] by dual X-ray absorptiometry. Data were analysed using generalized estimating equations (GEE).ResultsTime on ADT significantly moderated the exercise effects on chair rise (βinteraction= -1.3s, 95% CI= -2.6; 0.0), whole body lean (βinteraction= 1194g, 95% CI= 234; 2153) and ASM (βinteraction= 562g, 95% CI= 49; 1075) mass, and approached significance for fat mass (βinteraction= -1107g, 95% CI= -2346; 132), with larger benefits for men previously on long-term ADT. At 6 months, the intervention effects on chair rise time -1.5 s (95% CI -2.5 to -0.5), whole body lean 824 g (95% CI 8 to 1640), ASM 709 g (95% CI 260 to 1158), and fat -1377 g (95% CI -2156 to -598) mass were significant for men previously on long-term ADT, but not for men on short-term ADT. At 12 months, intervention effects for men on long-term ADT remained significant for the chair rise with improved performance (-2.0 s, 95% CI -3.0 to -1.0) and increased ASM (537 g, 95% CI 153 to 921). Time on ADT did not moderate the exercise effects on muscle strength nor did time since ADT cessation moderate any intervention effects. Similarly, testosterone and baseline values of the outcome had negligible moderator effects.ConclusionsPCa patients previously treated long-term with ADT respond more favourably to exercise in terms of lower body muscle performance and body composition (lean and fat mass, and ASM) than those with short-term ADT exposure. As a result, men who were formerly on long-term androgen suppression regimens should be especially prescribed exercise medicine interventions to alleviate residual treatment-related adverse effects.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-05T02:30:27.619669-05:
      DOI: 10.1111/bju.14008
  • Prospective Randomized Non-Inferiority Trial of Pelvic Drain Placement
           Versus No Pelvic Drain Placement after Robot-Assisted Radical
    • Authors: Avinash Chenam; Bertram Yuh, Ali Zhumkhawala, Nora Ruel, William Chu, Clayton Lau, Kevin Chan, Timothy Wilson, Jonathan Yamzon
      Abstract: ObjectivesTo determine if eliminating the prophylactic placement of a pelvic drain (PD) after robot-assisted radical prostatectomy (RARP) affects the incidence of early (90-day) postoperative adverse events.Materials and MethodsIn this parallel-group, blinded, non-inferiority trial, we randomized patients planning to undergo RARP to one of two arms: no drain placement (ND) or PD placement. Patients with demonstrable intra-operative leakage upon bladder irrigation were excluded. Randomization sequence was determined a-priori using a computer algorithm, and included a stratified design with respect to low vs. intermediate/high D'Amico risk classifications. Surgeons remained blinded to the randomization arm until final eligibility was verified at the end of the RARP. The primary endpoint was overall incidence of 90-day complications which, based on our standard treatment using PD retrospectively, was estimated at 13%. The non-inferiority margin was set at 10%, and the planned sample size was 312. An interim analysis was planned and conducted when 1/3 of the planned accrual and follow-up was completed, to rule out futility if the delta margin was in excess of 0.1389.ResultsFrom 2012 to 2016, 189 patients were accrued to the study, with 92 patients allocated to the ND group and 97 patients allocated to the PD group. Due to lower than expected accrual rates, accrual to the study was halted by regulatory entities, and we did not reach the intended accrual goal. ND and PD groups were comparable in median PSA (6.3 vs 5.8 respectively, p=0.5), clinical stage (p=0.8), D'Amico risk classification (p=0.4), median lymph nodes dissected (17 vs 18, p=0.2) and proportion of patients receiving an extended pelvic lymph node dissection (70.7% vs 79.4% respectively, p=0.3). Incidence of 90-day overall and major (Clavien ≥ III) complications in the ND group (17.4% and 5.4%, respectively) was not inferior to the PD group (26.8% and 5.2%, respectively; p=0.0008 and p=0.007 for difference of proportions
      PubDate: 2017-09-05T02:25:34.489532-05:
      DOI: 10.1111/bju.14010
  • Effects of Thiazolidinedione in Patients with Active Bladder Cancer
    • Authors: Roger Li; Michael J. Metcalfe, J.E. Ferguson 3rd, Sharada Mokkapati, Graciela M. Nogueras González, Colin P. Dinney, Neema Navai, David J. McConkey, Sunil K. Sahai, Ashish M. Kamat
      Abstract: ObjectiveTo examine the influence of perioperative thiazolidinedione (TZD) on cancer-specific outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma (UC).Design, Setting, and ParticipantsA retrospective cohort of 173 diabetic patients undergoing RC from 2005 to 2010 was identified. Of those, 53 were on TZD treatment at the time of surgery, with 33 patients taking pioglitazone. Baseline clincopathologic characteristics, as well as cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were compared between the patients on and off of TZD at the time of RC. In subgroup analysis, outcomes in patients specifically taking pioglitazone at the time of surgery were compared to those not on TZD.ResultsBaseline clinicopathologic characteristics were similar between patients on and off of TZD treatment at the time of RC. Overall, the median CSS rate was not reached in either group (p=0.7). The estimated 5-year CSS was 67.8% in the non-TZD group and 66.3% in the TZD group. On multivariate analysis incorporating patient age, pathologic T staging, and adjuvant chemotherapy, TZD use was found not to be a significant predictor for CSS (HR 1.20; 95% CI, 0.66-2.17, p=0.5). Additionally, recurrence free survival (RFS) (p=0.3) and OS (p=0.2) were also similar between the two groups without adjusting for other variables. Comparison between patients taking pioglitazone vs. patients not taking TZD yielded similar CSS (p=0.2), RFS (p=0.5), and OS (p=0.2).ConclusionsCSS, as well as RFS and OS after RC were not compromised in patients on TZD therapy at the time of RC. Additional investigation is warranted in non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) patients undergoing bladder sparing procedures to assess the safety of using TZD in the setting of active UC.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-05T02:25:33.093526-05:
      DOI: 10.1111/bju.14009
  • Analysis of Survival for Patients with Chronic Kidney Disease Primarily
           Related to Renal Cancer Surgery
    • Authors: Jitao Wu; Chalairat Suk-Ouichai, Wen Dong, Elvis Caraballo Antonio, Ithaar H. Derweesh, Brian R. Lane, Sevag Demirjian, Jianbo Li, Steven C. Campbell
      Abstract: ObjectivesTo evaluate predictors of long-term survival for patients with chronic kidney disease primarily due to surgery (CKD-S). Patients with CKD-S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort.Patients and MethodsFrom 1997-2008, 4,246 patients underwent RCS at our center. Median follow-up was 9.4 years (IQR=7.3-11.0). New baseline GFR was defined as highest GFR between nadir and 6 weeks after surgery. We retrospectively evaluated 3 cohorts: no-CKD (new baseline GFR≥60ml/min/1.73m2); CKD-S (new baseline GFR
      PubDate: 2017-08-21T04:51:21.956367-05:
      DOI: 10.1111/bju.13994
  • Does robot-assisted radical prostatectomy benefit prostate cancer patients
           with bone oligometastases'
    • Authors: Won Sik Jang; Myung Soo Kim, Won Sik Jeong, Ki Don Chang, Kang Su Cho, Won Sik Ham, Koon Ho Rha, Sung Joon Hong, Young Deuk Choi
      Abstract: ObjectiveTo investigate perioperative and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in oligometastatic prostate cancer (PCa).Patients and MethodsWe retrospectively reviewed the records of 79 oligometastatic PCa patients treated with RARP or ADT between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated perioperative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models.ResultsRARP-treated patients showed comparable postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than those of ADT-treated patients. PFS and CSS were improved in RARP-treated, compared with ADT-treated, patients (median PFS: 75 vs. 28 months, p = 0.008; median CSS: not reached vs. 40 months, p = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR] = 0.388, p = 0.003; CSS: HR = 0.264, p = 0.004).ConclusionsWe demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. However, our study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa. Therefore, to confirm our findings, large, prospective, multicenter studies are required.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-21T04:45:40.115888-05:
      DOI: 10.1111/bju.13992
  • A more extended lymph node dissection template at radical prostatectomy
           detects metastases in the common iliac region and in the fossa of Marcille
    • Authors: Lydia Maderthaner; Marc A. Furrer, Urs E. Studer, Fiona C. Burkhard, George N. Thalmann, Daniel P. Nguyen
      Abstract: ObjectivesTo assess the effect of adding lymph nodes (LN) located along the common iliac vessels and in the fossa of Marcille to the extended pelvic lymph node dissection (PLND) template at radical prostatectomy (RP).Patients and MethodsAt a referral center, RP and PLND were undergone by 485 patients from 2000 to 2008 (historical cohort: classical extended PLND template) and 268 patients from 2010 to 2015 (contemporary cohort: extended PLND template including LN located along the common iliac vessels and in the fossa of Marcille). Descriptive analyses compared baseline, pathologic, complication and functional data between the two cohorts. A logistic regression model assessed the template's effect on probability of detecting LN metastases.ResultsAmong 80 pN+ patients in the historical cohort, sole location of metastasis was external iliac/obturator fossa in 23 (29%), and internal iliac in 18 (23%), while 39 (49%) had metastases in both locations. Among 72 pN+ patients in the contemporary cohort, sole location of metastasis was external iliac/obturator fossa in 17 (24%), internal iliac in 24 (33%), and common iliac in 1 (1%), while 30 (42%) had metastases in>1 location (including fossa of Marcille in 5 patients). Among all 46 patients in the contemporary cohort with ≤2 metastases, 3 had one or both metastases in the common iliac region or the fossa of Marcille.Adjusted probability of detecting LN metastases was higher, but not significantly so, in the contemporary cohort. There were no differences between the two cohorts in complication and functional outcomes.ConclusionA more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications. However, the overall probability of detecting LN metastases was not significantly higher.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-21T04:45:27.174282-05:
      DOI: 10.1111/bju.13993
  • Management of metastatic prostate cancer in the elderly: identifying
           fitness for chemotherapy in the post STAMPEDE world
    • Authors: A Thompson; M J Beresford, P Sarmah, E R Jefferies
      Abstract: The relative proportion of>75 is expected to double over the next 25 years and older men are more likely to be diagnosed with advanced disease. Meta-analysis of the eagerly awaited CHAARTED, STAMPEDE and GETUG15 trials have shown that men with newly diagnosed hormone sensitive metastatic prostate cancer (mPCa) who were treated with docetaxel in addition to ADT, showed a 9% absolute overall survival benefit at 4 years1. As such, European Association of Urology (EAU) guidelines recommend that newly diagnosed mPCa should be treated with castration plus docetaxel chemotherapy ‘provided the patient is fit enough’. However, this assessment of fitness for chemotherapy remains a clinical stumbling block.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-19T05:00:20.583005-05:
      DOI: 10.1111/bju.13990
  • Female Urethral Injuries Associated with Pelvic Fracture: A Systematic
           Review of the Literature
    • Authors: Devin N. Patel; Cynthia S. Fok, George D. Webster, Jennifer T. Anger
      Abstract: ObjectivesTo systematically review the literature of female urethral injuries associated with pelvic fracture and determine optimal management of this rare injury.Materials and MethodsUsing Meta-analysis Of Observational Studies in Epidemiology criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female pelvic fracture urethroplasty,” “female urethral distraction,” “female pelvic fracture urethral injury,” “female pelvic fracture urethra girls.” Two reviewers (CF, DP) independently reviewed the titles, abstracts, and articles in duplicate.ResultsWe identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review. There were 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair, with 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair.ConclusionsThe optimal management of female urethral distraction defects is based on very low quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is hemodynamically stable appears optimal.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:30:20.661599-05:
      DOI: 10.1111/bju.13989
  • Controlled release of IGF1 enhances urethral sphincter function and
           histological structure in the treatment of female stress urinary
           incontinence in a rodent model
    • Authors: Hao Yan; Liren Zhong, Yaodong Jiang, Jian Yang, Junhong Deng, Shicheng Wei, Emmanuel Opara, Anthony Atala, Xiangming Mao, Margot Damaser, Yuanyuan Zhang
      Abstract: ObjectivesStress urinary incontinence (SUI) diminishes the quality of life of millions, particularly women who have delivered vaginally, which can injure the urethral sphincter. Despite several well-established treatments for SUI, growth factor therapy might provide an alternative to promote urethral sphincter repair. The goal of this study was to determine the effects of controlled release of IGF1 from alginate-poly-L-ornithine-gelatin microbeads (IGF1-A-PLO-G microbeads) on sphincter tissue regeneration in a rat model of SUI.Materials and MethodsForty-four female SD rats were randomized into 4 groups: vaginal distension followed by periurethral injection of IGF1-A-PLO-G beads (VD+IGF1 microbeads): 1x104 beads/1 ml normal saline; VD+empty microbeads; VD+saline; or sham VD+saline (sham).ResultsUrethral function (leak point pressure, LPP) was significantly decreased 1 week after VD+saline (23.9 ± 1.3 cmH2O) or VD+empty microbeads (21.7 ± 0.8 cmH2O) compared to the sham group (44.4 ± 3.4 cmH2O; p
      PubDate: 2017-08-14T06:25:36.99069-05:0
      DOI: 10.1111/bju.13985
  • Microvascular and lymphovascular tumor invasion are associated with poor
           prognosis and metastatic spread in renal cell carcinoma: A validation
           study in clinical practice
    • Authors: Jens Bedke; Johannes Heide, Silvia Ribback, Steffen Rausch, Michela Martino, Marcus Scharpf, Andrea Haitel, Uwe Zimmermann, Maik Pechoel, Hussam Alkhayyat, Shahrokh F. Shariat, Frank Dombrowski, Arnulf Stenzl, Martin Burchardt, Tobias Klatte, Nils Kroeger
      Abstract: ObjectiveTo validate microvascular (MVI) and lymphovascular (LVI) invasion as a prognostic factor in renal cell carcinoma patients (pts.)Materials and MethodsData of patients with RCC who underwent radical or nephron sparing surgery were prospectively collected from three academic centers. The occurrence of MVI and LVI was determined with standard staining protocols by experienced pathologists at the time of diagnosis. The association of MVI and LVI with clinicopathological data, metastatic spread and cancer-specific survival (CSS) was evaluated with Fisher's exact tests, binary logistic regression analyses and univariable and multivariable Cox proportional hazard regression models.ResultsMVI was present in 201 of 747 (26.9%) pts. and was associated with advanced TNM stages, high Fuhrman grades and sarcomatoid features (each p
      PubDate: 2017-08-13T04:35:19.351396-05:
      DOI: 10.1111/bju.13984
  • Cyclic AMP-Dependent Post-Translational Modification of Neuronal Nitric
           Oxide Synthase Neuroprotects Penile Erection in Rats
    • Authors: Serkan Karakus; Biljana Musicki, Justin D. La Favor, Arthur L. Burnett
      Abstract: ObjectivesTo evaluate nNOS phosphorylation, nNOS uncoupling, and oxidative stress in the penis and major pelvic ganglia (MPG), before and after the administration of the cAMP-dependent protein kinase A (PKA) agonist colforsin in a rat model of bilateral cavernous nerve injury (BCNI) which mimics nerve injury following prostatectomy.Materials and MethodsAdult male Sprague–Dawley rats were divided into BCNI and sham groups. Each group included 2 subgroups: vehicle and colforsin (0.1 mg/kg/day i.p.). After 3 days, erectile function (intracavernosal pressure) was measured and penes and MPG were collected for molecular analyses of phospho(P)-nNOS (Ser-1412 and Ser-847), total nNOS, nNOS uncoupling, binding of neuronal nitric oxide synthase (PIN) to nNOS, gp91phox subunit of NADPH oxidase, active caspase 3, PKA catalytic subunit alpha (PKA-Cα) (by Western blot) and oxidative stress (hydrogen peroxide [H2O2] and superoxide by Western blot and microdialysis method).ResultsErectile function was decreased 3 days after BCNI and normalized by colforsin. nNOS phosphorylation on both positive (Ser-1412) and negative (Ser-847) regulatory sites, and nNOS uncoupling, were increased after BCNI in the penis and MPG and normalized by colforsin. Hydrogen peroxide and total ROS productions were increased in the penis after BCNI and normalized by colforsin. Protein expression of gp91phox was increased in the MPG after BCNI and was normalized by colforsin treatment. Binding of PIN to nNOS was increased in the penis after BCNI and was normalized by colforsin treatment. Protein expression of active Caspase 3 was increased in the MPG after BCNI and was normalized by colforsin treatment. Protein expression of PKA-Cα was decreased in the penis after BCNI and normalized by colforsin.ConclusionCollectively, BCNI impairs nNOS function in the penis and MPG by mechanisms involving its phosphorylation and uncoupling in association with increased oxidative stress, resulting in erectile dysfunction. PKA activation by colforsin reverses these molecular changes and preserves penile erection in the face of BCNI.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-07T02:55:27.390659-05:
      DOI: 10.1111/bju.13981
  • Serous-lined, stapled pouch wall plication: initial results of a simple
           and quick novel continence mechanism in troubleshooting secondary to
           continent cutaneous urinary diversion
    • Authors: Hubertus Riedmiller; Arkadius Kocot, Charis Kalogirou
      Abstract: ObjectivesTo report a novel and straightforward technique of a secondary continent outlet for continent cutaneous urinary diversion (CCUD) reservoirs without the need for further bowel resection, reducing operation time and hospitalization.Patients And MethodsFrom 2015 to 2017, 6 patients with unreconstructable, incontinent outlets (out of a total pool of n=595 CCUD patients) have undergone the technique described here at our department. It relies on the Mitrofanoff principle, using a stapled full-thickness pouch wall plication, which creates a flap-valve continence mechanism.ResultsAll patients enjoyed full continence with ease of CIC in the postoperative period and on follow-up to a mean of 12,4 months (7-18 months). No major complications were encountered in all patients and the average capacity of the reservoirs was not compromised by the procedure (540 ml preoperatively vs. 500 ml in further follow-up).ConclusionIn revisional surgery for secondary CCUD incontinence - especially if the patient has already lost a significant amount of bowel or has previously undergone radiation therapy – the technique described here represents a safe and effective alternative to restore continence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-04T10:10:20.033634-05:
      DOI: 10.1111/bju.13979
  • Intradetrusor onabotulinumtoxinA injections for refractory neurogenic
           detrusor overactivity incontinence: Do we need urodynamic investigation
           for outcome assessment'
    • Authors: Miriam Koschorke; Lorenz Leitner, Helen Sadri, Stephanie C. Knüpfer, Ulrich Mehnert, Thomas M. Kessler
      Abstract: ObjectiveTo evaluate if urinary continence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed.Patients and MethodsA consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) incontinence were prospectively evaluated. Patients underwent UDI prior and 6 weeks after onabotulinumtoxinA injections. Primary outcome was the prevalence of maximum storage detrusor pressure>40 cmH2O in continent patients 6 weeks after treatment. Secondary outcomes were treatment effects on other clinical and video-urodynamic parameters.Results6 weeks after intradetrusor onabotulinumtoxinA injections, 98 (66%) of the 148 patients with NDO incontinence became continent. Of these patients, 18 (18%, confidence interval 12-27%) had a maximum storage detrusor pressure>40cmH2O. Gender, underlying neurological disorder and high storage detrusor pressures prior to treatment seem to increase the risk for poor urodynamic outcomes.ConclusionsUrinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, since high intravesical pressures threatening the upper urinary tract might be missed in a relevant percentage of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-03T13:50:19.076503-05:
      DOI: 10.1111/bju.13976
  • NICE guidance and the BJUI
    • Authors: Prokar Dasgupta
      Pages: 743 - 743
      PubDate: 2017-11-23T01:44:26.256906-05:
      DOI: 10.1111/bju.14069
  • Potential new strategies for the treatment of renal medullary carcinoma
    • Authors: Paul Russo
      Pages: 744 - 744
      PubDate: 2017-11-23T01:44:28.27819-05:0
      DOI: 10.1111/bju.13758
  • Prostate cancer biomarkers: new scenarios in the multi-parametric magnetic
           resonance imaging era
    • Authors: Francesco Porpiglia; Stefano De Luca
      Pages: 745 - 746
      PubDate: 2017-11-23T01:44:26.058367-05:
      DOI: 10.1111/bju.13803
  • Novel risk stratification nomograms for counseling patients on the need
           for prostate biopsy
    • Authors: Marc A. Bjurlin; Samir S. Taneja
      Pages: 746 - 747
      PubDate: 2017-11-23T01:44:25.932381-05:
      DOI: 10.1111/bju.13912
  • Human development and its impact on genitourinary cancers
    • Authors: Mieke Hemelrijck
      Pages: 747 - 748
      PubDate: 2017-11-23T01:44:23.861645-05:
      DOI: 10.1111/bju.13914
  • First-line vascular endothelial growth factor inhibitors for advanced
           renal cell carcinoma and the impact of new agents entering the treatment
    • Authors: Rohit Jain; Saby George
      Pages: 749 - 751
      PubDate: 2017-07-30T21:31:45.530342-05:
      DOI: 10.1111/bju.13954
  • Bladder cancer: diagnosis and management of bladder cancer
    • Pages: 755 - 765
      PubDate: 2017-11-23T01:44:23.941247-05:
      DOI: 10.1111/bju.14045
  • A multiparametric magnetic resonance imaging-based risk model to determine
           the risk of significant prostate cancer prior to biopsy
    • Authors: Pim J. Leeuwen; Andrew Hayen, James E. Thompson, Daniel Moses, Ron Shnier, Maret Böhm, Magdaline Abuodha, Anne-Maree Haynes, Francis Ting, Jelle Barentsz, Monique Roobol, Justin Vass, Krishan Rasiah, Warick Delprado, Phillip D. Stricker
      Pages: 774 - 781
      Abstract: ObjectiveTo develop and externally validate a predictive model for detection of significant prostate cancer.Patients and MethodsDevelopment of the model was based on a prospective cohort including 393 men who underwent multiparametric magnetic resonance imaging (mpMRI) before biopsy. External validity of the model was then examined retrospectively in 198 men from a separate institution whom underwent mpMRI followed by biopsy for abnormal prostate-specific antigen (PSA) level or digital rectal examination (DRE). A model was developed with age, PSA level, DRE, prostate volume, previous biopsy, and Prostate Imaging Reporting and Data System (PIRADS) score, as predictors for significant prostate cancer (Gleason 7 with>5% grade 4, ≥20% cores positive or ≥7 mm of cancer in any core). Probability was studied via logistic regression. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling.ResultsIn all, 393 men had complete data and 149 (37.9%) had significant prostate cancer. While the variable model had good accuracy in predicting significant prostate cancer, area under the curve (AUC) of 0.80, the advanced model (incorporating mpMRI) had a significantly higher AUC of 0.88 (P < 0.001). The model was well calibrated in internal and external validation. Decision analysis showed that use of the advanced model in practice would improve biopsy outcome predictions. Clinical application of the model would reduce 28% of biopsies, whilst missing 2.6% significant prostate cancer.ConclusionsIndividualised risk assessment of significant prostate cancer using a predictive model that incorporates mpMRI PIRADS score and clinical data allows a considerable reduction in unnecessary biopsies and reduction of the risk of over-detection of insignificant prostate cancer at the cost of a very small increase in the number of significant cancers missed.
      PubDate: 2017-03-31T23:30:35.314404-05:
      DOI: 10.1111/bju.13814
  • Prostate Health Index density improves detection of clinically significant
           prostate cancer
    • Authors: Jeffrey J. Tosoian; Sasha C. Druskin, Darian Andreas, Patrick Mullane, Meera Chappidi, Sarah Joo, Kamyar Ghabili, Mufaddal Mamawala, Joseph Agostino, Herbert B. Carter, Alan W. Partin, Lori J. Sokoll, Ashley E. Ross
      Pages: 793 - 798
      Abstract: ObjectivesTo explore the utility of Prostate Health Index (PHI) density for the detection of clinically significant prostate cancer (PCa) in a contemporary cohort of men presenting for diagnostic evaluation of PCa.Patients and MethodsThe study cohort included patients with elevated prostate-specific antigen (PSA;>2 ng/mL) and negative digital rectal examination who underwent PHI testing and prostate biopsy at our institution in 2015. Serum markers were prospectively measured per standard clinical pathway. PHI was calculated as ([{−2}proPSA/free PSA] × [PSA]½), and density calculations were performed using prostate volume as determined by transrectal ultrasonography. Logistic regression was used to assess the ability of serum markers to predict clinically significant PCa, defined as any Gleason score ≥7 cancer or Gleason score 6 cancer in>2 cores or>50% of any positive core.ResultsOf 118 men with PHI testing who underwent biopsy, 47 (39.8%) were found to have clinically significant PCa on biopsy. The median (interquartile range [IQR]) PHI density was 0.70 (0.43–1.21), and was 0.53 (0.36–0.75) in men with negative biopsy or clinically insignificant PCa and 1.21 (0.74–1.88) in men with clinically significant PCa (P < 0.001). Clinically significant PCa was detected in 3.6% of men in the first quartile of PHI density (1.21 (P < 0.001). Using a threshold of 0.43, PHI density was 97.9% sensitive and 38.0% specific for clinically significant PCa, and 100% sensitive for Gleason score ≥7 disease. Compared with PSA (area under the curve [AUC] 0.52), PSA density (AUC 0.70), %free PSA (AUC 0.75), the product of %free PSA and prostate volume (AUC 0.79), and PHI (AUC 0.76), PHI density had the highest discriminative ability for clinically significant PCa (AUC 0.84).ConclusionsBased on the present prospective single-centre experience, PHI density could be used to avoid 38% of unnecessary biopsies, while failing to detect only 2% of clinically significant cancers.
      PubDate: 2017-02-06T09:46:36.304117-05:
      DOI: 10.1111/bju.13762
  • Association of Human Development Index with global bladder, kidney,
           prostate and testis cancer incidence and mortality
    • Authors: Alyssa K. Greiman; James S. Rosoff, Sandip M. Prasad
      Pages: 799 - 807
      Abstract: ObjectivesTo describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development.Materials and MethodsWe obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI).ResultsAge-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5–2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R2 = 0.78), prostate (regression coefficient −1.56, R2 = 0.85), kidney (regression coefficient −1.34, R2 = 0.74), and bladder cancer (regression coefficient −1.01, R2 = 0.80).ConclusionWhile incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes.
      PubDate: 2017-05-08T06:50:27.303028-05:
      DOI: 10.1111/bju.13875
  • Prognostic utility of biopsy-derived cell cycle progression score in
           patients with National Comprehensive Cancer Network low-risk prostate
           cancer undergoing radical prostatectomy: implications for treatment
    • Authors: Jeffrey J. Tosoian; Meera R. Chappidi, Jay T. Bishoff, Stephen J. Freedland, Julia Reid, Michael Brawer, Steven Stone, Thorsten Schlomm, Ashley E. Ross
      Pages: 808 - 814
      Abstract: ObjectivesTo determine the prognostic utility of the cell cycle progression (CCP) score in men with National Comprehensive Cancer Network (NCCN)-defined low-risk prostate cancer (PCa) undergoing radical prostatectomy (RP).Patients and MethodsMen who underwent RP for Gleason score ≤6 PCa at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA] and Intermountain Healthcare [IH]) were identified. The CCP score was obtained from diagnostic (DVA, IH) or simulated biopsies (MC). The primary outcome was biochemical recurrence (BCR; prostate-specific antigen ≥0.2 ng/mL) after RP. The prognostic utility of the CCP score was assessed using Kaplan–Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and in the overall cohort.ResultsAmong the 236 men identified, 80% (188/236) met the NCCN low-risk criteria. Five-year BCR-free survival for the low (1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (P = 0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (P = 0.041). In multivariable models adjusting for clinical and pathological variables with the Cancer of the Prostate Risk Assessment (CAPRA) score, the CCP score was an independent predictor of BCR in the low-risk (hazard ratio [HR] 1.77 per unit score, 95% confidence interval [CI] 1.21, 2.58; P = 0.003) and overall cohorts (HR 1.41 per unit score, 95% CI 1.02, 1.96; P = 0.039).ConclusionIn a cohort of men with NCCN-defined low-risk PCa, the CCP score improved clinical risk stratification of men who were at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimum treatment selection in these patients with otherwise similar clinical characteristics.
      PubDate: 2017-06-11T23:05:23.743477-05:
      DOI: 10.1111/bju.13911
  • Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive
           prostate cancer amenable to lesion ablative therapy
    • Authors: Aurélie De Bruycker; Bieke Lambert, Tom Claeys, Louke Delrue, Chamberlain Mbah, Gert De Meerleer, Geert Villeirs, Filip De Vos, Kathia De Man, Karel Decaestecker, Valérie Fonteyne, Nicolaas Lumen, Filip Ameye, Ignace Billiet, Steven Joniau, Friedl Vanhaverbeke, Wim Duthoy, Piet Ost
      Pages: 815 - 821
      Abstract: ObjectivesTo describe the anatomical patterns of prostate cancer (PCa) recurrence after primary therapy and to investigate if patients with low-volume disease have a better prognosis as compared with their counterparts.Materials and MethodsPatients eligible for an 18-F choline positron-emission tomography (PET)-computed tomography (CT) were enrolled in a prospective cohort study. Eligible patients had asymptomatic biochemical recurrence after primary PCa treatment and testosterone levels>50 ng/mL. The number of lesions was counted per scan. Patients with isolated local recurrence (LR) or with ≤3 metastases (with or without LR) were considered to have low-volume disease and patients with>3 metastases to have high-volume disease. Descriptive statistics were used to report recurrences. Cox regression analysis was used to investigate the influence of prognostic variables on the time to developing castration-resistant PCa (CRPC).ResultsIn 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed; 11%), viscera (4%), or a combination of any of the previous (37%). In total, 153 patients (74%) had low-volume recurrence and 55 patients (26%) had high-volume recurrence. The 3-year CRPC-free survival rate for the whole cohort was 79% (95% confidence interval 43–55), 88% for low-volume recurrences and 50% for high-volume recurrences (P 
      PubDate: 2017-07-16T22:15:22.491795-05:
      DOI: 10.1111/bju.13938
  • Future of robotic surgery in urology
    • Authors: Jens J. Rassweiler; Riccardo Autorino, Jan Klein, Alex Mottrie, Ali Serdar Goezen, Jens-Uwe Stolzenburg, Koon H. Rha, Marc Schurr, Jihad Kaouk, Vipul Patel, Prokar Dasgupta, Evangelos Liatsikos
      Pages: 822 - 841
      Abstract: ObjectivesTo provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives.Materials and MethodsA non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors.ResultsThe relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results.ConclusionsSeveral console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the next 5 years. Future developments in the field of robotic surgery are likely to focus on the specific features of robotic arms, instruments, console, and video technology. The high technical standards of four da Vinci generations have set a high bar for upcoming devices. Ultimately, the implementation of these upcoming systems will depend on their clinical applicability and costs. How these technical developments will facilitate surgery and whether their use will translate into better outcomes for our patients remains to be determined.
      PubDate: 2017-04-22T01:10:58.21899-05:0
      DOI: 10.1111/bju.13851
  • Comparison of perioperative and functional outcomes of robotic partial
           nephrectomy for cT1a vs cT1b renal masses
    • Authors: Christopher R. Reynolds; Joan C. Delto, David J. Paulucci, Corey Weinstein, Ketan Badani, Daniel Eun, Ronney Abaza, James Porter, Akshay Bhandari, Ashok K. Hemal
      Pages: 842 - 847
      Abstract: ObjectiveTo compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy (RPN) in a large multi-institutional studyPatients and MethodsThe present retrospective Institutional Review Board-approved multi-institutional study utilised a prospectively maintained database to identify patients undergoing RPN by six surgeons for a solitary cT1a (n = 1 307) or cT1b (n = 377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and at a median follow-up of 12.2 months were compared in univariable and multivariable regression analyses adjusting for surgeon performing the procedure and date of surgery.ResultsIn univariable analysis, cT1b masses were associated with longer operative time (190.0 vs 159.0 min, P < 0.001), longer warm ischaemia time (18.8 vs 15.0 min, P < 0.001), higher estimated blood loss (150.0 vs 100.0 mL, P < 0.001), more intraoperative complications (5.6% vs 2.4%, P = 0.034), and more surgical postoperative complications (10.1% vs 5.7%, P =0.002). Results were similar in multivariable analysis with additional findings including more overall postoperative complications (odds ratio 1.55, P = 0.015) and longer length of stay (P < 0.001) associated with cT1b masses. There were no differences in the risk of progression of chronic kidney disease stage at 12.2 months, positive surgical margins, or major postoperative complications.ConclusionsAlthough our study shows a longer operative time, longer warm ischemia time, and higher complication rate for patients undergoing RPN for cT1b renal masses, the magnitude of these differences is small. RPN should be considered for cT1b lesions when anatomical and spatial location allow for a feasible procedure.
      PubDate: 2017-08-11T05:11:08.631322-05:
      DOI: 10.1111/bju.13960
  • Sleep disorders in patients with erectile dysfunction
    • Authors: Odunayo Kalejaiye; Amr Abdel Raheem, Amr Moubasher, Marco Capece, Sara McNeillis, Asif Muneer, Andrew N. Christopher, Giulio Garaffa, David J. Ralph
      Pages: 855 - 860
      Abstract: ObjectiveTo assess the prevalence of obstructive sleep apnoea (OSA) in men presenting with erectile dysfunction (ED) at a single centre.Patients and MethodsAll men attending a specialised andrology outpatient department with a new diagnosis of ED were included in this prospective study. All patients completed three questionnaires: the International Index of Erectile Function (IIEF) and two sleep questionnaires [the Obstructive Sleep Apnoea Screening questionnaire and the Insomnia Severity Index (ISI)]. Their ED management was subsequently undertaken in accordance with local and European guidelines. An OSA diagnosis was made based on a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire and those patients were referred for specialist management.ResultsBetween February and September 2016, 129 patients with ED completed the study questionnaires. In all, 71 patients (55%) had a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire, indicating a need for specialist sleep referral. Men who scored ≥3 on the Obstructive Sleep Apnoea Screening questionnaire were significantly older (61.4 vs 46.5 years; P < 0.001) and had a significantly higher body mass index (29.4 vs 26.7 kg/m2; P < 0.001) when compared to the control group (OSA score of
      PubDate: 2017-08-08T06:25:22.302826-05:
      DOI: 10.1111/bju.13961
  • Critical appraisal of the application of propensity score methods in the
           urology literature
    • Authors: Madhur Nayan; Robert J. Hamilton, David N. Juurlink, Antonio Finelli, Girish S. Kulkarni, Peter C. Austin
      Pages: 873 - 880
      Abstract: ObjectivesTo determine whether studies that used propensity score (PS) methods in the urology literature provide sufficient detail to allow scientific reproducibility and whether appropriate statistical tests were used to obtain valid measures of effect.Materials and MethodsWe searched OVID Medline and the Science Citation Index from inception to November 2016 to identify studies that used PS methods in five general urology journals. From each included article, we extracted pertinent information related to the PS methodology, such as estimation of the PS, whether balance diagnostics were performed, and the statistical analysis performed.ResultsWe identified 114 articles for inclusion. Matching on the PS was the most common method used (62 studies, 54.4%). Of all studies, 103 (90.4%) described which covariates were used to estimate the PS; however, only 24 provided justification for the selected covariates. Although the majority of studies (70.2%) performed some sort of diagnostic evaluation to assess balance, few studies (24.6%) used appropriate methods for balance assessment. Only four (6.4%) studies that used PS matching provided sufficient detail to replicate the matching strategy. Finally, the majority (77.4%) of studies that used PS matching explicitly used inappropriate statistical methods to estimate the effect of an exposure on an outcome.ConclusionsIn the urology literature PS methods were poorly described and implemented. We provide recommendations for improvement to allow scientific reproducibility and obtain valid measures of effect from their use.
      PubDate: 2017-07-07T23:31:02.137809-05:
      DOI: 10.1111/bju.13930
  • Robotic radical perineal cystectomy and extended pelvic lymphadenectomy:
           initial investigation using a purpose-built single-port robotic system
    • Authors: Matthew J. Maurice; Jihad H. Kaouk
      Pages: 881 - 884
      Abstract: ObjectivesTo assess the feasibility of radical perineal cystoprostatectomy using the latest generation purpose-built single-port robotic surgical system.Materials and MethodsIn two male cadavers the da Vinci® SP1098 Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform radical perineal cystoprostatectomy and bilateral extended pelvic lymph node dissection (ePLND). New features in this model include enhanced high-definition three-dimensional optics, improved instrument manoeuvrability, and a real-time instrument tracking and guidance system. The surgery was accomplished through a 3-cm perineal incision via a novel robotic single-port system, which accommodates three double-jointed articulating robotic instruments, an articulating camera, and an accessory laparoscopic instrument. The primary outcomes were technical feasibility, intraoperative complications, and total robotic operative time.ResultsThe cases were completed successfully without conversion. There were no accidental punctures or lacerations. The robotic operative times were 197 and 202 min.ConclusionsIn this preclinical model, robotic radical perineal cystoprostatectomy and ePLND was feasible using the SP1098 robotic platform. Further investigation is needed to assess the feasibility of urinary diversion using this novel approach and new technology.
      PubDate: 2017-08-08T23:17:21.590709-05:
      DOI: 10.1111/bju.13947
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