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Journal Cover BJU International
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   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1589 journals]
  • Health-related quality of life outcomes from a contemporary prostate
           cancer registry in a large diverse population
    • Authors: Gary W. Chien; Jeff M. Slezak, Teresa N. Harrison, Howard Jung, Joy S. Gelfond, Chengyi Zhang, Edward Wu, Richard Contreras, Ronald K. Loo, Steven J. Jacobsen
      Abstract: ObjectiveTo assess the health-related quality of life (HRQoL) of patients with prostate cancer up to 24 months after treatment in a contemporary large diverse population.Patients and MethodsPatients with newly diagnosed prostate cancer from March 2011 to January 2014 in our healthcare system were included. The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire was administered before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment up to November 2014 for all methods of treatment. The Kruskall–Wallis test was used to compare the distribution of each EPIC-26 domain score at each time point, and mixed models were used to assess the overall scores over the period after treatment.ResultsIn all, 5 727 patients were included. There were data for 3 422, 2 329, 2 017, 1 922, 1 772, 1 260, and 837 patients before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment, respectively. At 1 month, bowel scores were the lowest for patients that had had radiation therapy, and urinary irritative symptoms were the lowest for those who had had brachytherapy. There were sexual function declines for all the treatment methods, with surgery having the steepest decline; open radical prostatectomy (ORP) had a greater decline than robot-assisted laparoscopic prostatectomy (RALP). Patients who underwent RALP had a better return of sexual function, approaching that of brachytherapy and radiation therapy at 24 months. Urinary incontinence (UI) also declined the most in surgical patients, with RALP patients improving slightly more than ORP patients at 12–24 months.ConclusionsPatients' HRQoL after prostate cancer treatment varies by treatment method. Notably, sexual function recovers most for RALP patients. UI remains worse at 24 months after surgery, compared to other methods of prostate cancer treatment.
      PubDate: 2017-04-19T23:48:02.468433-05:
      DOI: 10.1111/bju.13843
  • Association between Type 2 diabetes, curative treatment and survival in
           men with intermediate and high risk localised prostate cancer
    • Authors: Danielle Crawley; Hans Garmo, Sarah Rudman, Pär Stattin, Björn Zethelius, Lars Holmberg, Jan Adolfsson, Mieke Van Hemelrijck
      Abstract: ObjectiveTo investigate if curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM), as little is known about if a diagnosis of T2DM influences receipt of curative treatment in men with localised PCa.Subjects/Patients and methodsData from Prostate Cancer database Sweden (PCBaSe) from men with T2DM and PCa (n=2,210) was used to compare with those with PCa only (n=23,071). All men had intermediate (T1-2, Gleason score 7 and/or PSA 10-20 ng/ml) or high risk (T3 and/or Gleason score 8-10 and/or PSA 20—50 ng/ml) localised PCa diagnosed between 1st January 2006 and 31st December 2014. Multivariate logistic regression was used to calculate odds ratios for receiving curative treatment in men with and without T2DM. Overall survival, up to 8 years of follow-up, was calculated for men with T2DM only and for men with T2DM and PCa.ResultsMen with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR: 0.78, 95%CI: 0.69-0.87). The 8 year overall survival was 79% and 33% respectively for men with T2DM and high risk PCa who did and did not receive curative treatment.ConclusionsMen with T2DM were less likely to receive curative treatment for localised intermediate and high risk PCa. Men with T2DM and high risk PCa who received curative treatment had substantially higher survival than those who did not. Some of the survival differences represent a selection bias of the healthiest patients to receive curative treatment. Clinicians need to interpret such data carefully and ensure that individual patients with T2DM and PCa are not under nor over treated unnecessarily.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:54.356936-05:
      DOI: 10.1111/bju.13880
  • Newsworthiness versus scientific impact: are the most highly cited urology
           papers the most widely disseminated in the media?
    • Authors: E M O'Connor; G J Nason, F O'Kelly, R P Manecksha, S Loeb
      Abstract: BackgroundDiscordance exists between scientific impact and media attention. Altmetrics are non-traditional measures of impact which are composite scores that include social media and traditional media sharing of an article.ObjectiveTo assess whether a correlation exists between newsworthiness (Altmetric score) and the scientific impact markers such as citation analysis, impact factors and levels of evidence.Materials and MethodsThe top 5 most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (scientific impact group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (media impact group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores.ResultsIn the scientific impact group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8, There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% CI 0.16-0.52, p
      PubDate: 2017-04-18T07:05:51.009867-05:
      DOI: 10.1111/bju.13881
  • Efficacy and safety of combinations of mirabegron and solifenacin compared
           with monotherapy and placebo in patients with overactive bladder (SYNERGY
    • Authors: Sender Herschorn; Christopher R Chapple, Paul Abrams, Salvador Arlandis, David Mitcheson, Kyu-Sung Lee, Arwin Ridder, Matthias Stoelzel, Asha Paireddy, Rob Maanen, Dudley Robinson
      Abstract: Overactive bladder (OAB) syndrome is characterized by urinary urgency, with or without urgency urinary incontinence, usually accompanied by increased daytime frequency and nocturia, in the absence of urinary tract infection (UTI) or other obvious pathology [1]. Urgency urinary incontinence is present in approximately one-third of cases [2], but is not a prerequisite. However, of all the OAB symptoms, it has the greatest impact on quality of life (QoL) [3, 4], and is associated with significantly lower productivity and higher healthcare resource utilization [5].This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:46.432278-05:
      DOI: 10.1111/bju.13882
  • Evaluation of Gender-Based Disparities from Initial Hematuria Presentation
           to Upper Tract Urothelial Carcinoma Diagnosis: Analysis of a Nationwide
           Insurance Claims Database
    • Authors: Meera R. Chappidi; Max Kates, Jeffrey J. Tosoian, Michael H. Johnson, Noah M. Hahn, Trinity J. Bivalacqua, Phillip M. Pierorazio
      Abstract: ObjectiveTo investigate the duration from initial hematuria presentation to upper tract urothelial carcinoma (UTUC) diagnosis and the effect of gender on this duration.Patients and MethodsPatients with hematuria claims in the year prior to UTUC diagnosis were identified in the MarketScan database (2010-2014). Delayed diagnosis was defined as >90 days from hematuria presentation to UTUC diagnosis. Multivariable Poisson regression models were used to determine factors associated with delayed UTUC diagnosis.ResultsAmong 1326 UTUC patients, 469(35.4%) experienced delayed diagnosis. Men (n=866) had a longer median interval from hematuria to diagnosis than women (60 vs. 49 days, p=0.04). In the multivariable model, male gender (RR=1.13 95%CI[0.95-1.34]) was not associated with delayed diagnosis while UTI (RR=1.52 95%CI[1.32-1.76]), nephrolithiasis (RR=1.23 95%CI[1.06-1.44]), new (RR=1.37 95%CI[1.12-1.66]), and recurrent prostate-related (RR=1.61 95%CI[1.23, 2.10]) diagnoses were. For men presenting to non-urologists, UTI (RR=1.44, 95%CI[1.22-1.71]), nephrolithiasis (RR=1.25 95%CI[1.05-1.49]), new (RR=1.41, 95%CI[1.12-1.78]) and recurrent (RR=1.94, 95%CI[1.45-2.58]) prostate-related diagnoses were associated with delayed diagnosis. However, for men presenting to urologists, nephrolithiasis (RR=1.08 95%CI[0.78-1.49]), new (RR=1.15, 95%CI[0.79-1.68]) and recurrent (RR=1.17, 95%CI[0.69-1.97]) prostate-related diagnoses were not associated while UTI (RR=1.74, 95% CI[1.31-2.31]) diagnosis was still associated with delayed diagnosis.ConclusionA UTUC diagnosis was made >90 days after hematuria presentation in approximately 1/3 of patients. Men experienced a longer median interval from hematuria to UTUC diagnosis compared to women, but male gender was not an independent predictor of delayed diagnosis. Benign diagnoses during hematuria work-up are strongly associated with delayed diagnosis, especially among patients initially seen by non-urologists. Future interventions should focus on development of non-invasive techniques to improve clinical risk stratification of patients presenting with hematuria and to educate practitioners, especially non-urologists, on the importance of a thoughtful hematuria evaluation and common mimickers of UTUC to help improve delays in diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:00:53.022152-05:
      DOI: 10.1111/bju.13878
  • Journal information
    • PubDate: 2017-04-09T23:47:33.077484-05:
      DOI: 10.1111/bju.13865
  • Reliability of negative multiparametric MRI of the prostate: can we avoid
           the biopsy? Not yet!
    • Authors: Mark Frydenberg
      PubDate: 2017-04-09T23:47:32.620565-05:
      DOI: 10.1111/bju.13787
  • Unprofessional content on Facebook accounts of US urology residency
    • Authors: Kevin Koo; Zita Ficko, E. Ann Gormley
      Abstract: ObjectiveTo characterize unprofessional content on public Facebook accounts of contemporary US urology residency graduates.MethodsFacebook was queried with the names of all urologists who graduated from US urology residency programmes in 2015 to identify publicly accessible profiles. Profiles were assessed for unprofessional or potentially objectionable content using a prospectively designed rubric, based on professionalism guidelines by the American Urological Association, the American Medical Association, and the Accreditation Council for Graduate Medical Education. Content authorship (self vs other) was determined, and profiles were reviewed for self-identification as a urologist.ResultsOf 281 graduates, 223 (79%) were men and 267 (95%) held MD degrees. A total of 201 graduates (72%) had publicly identifiable Facebook profiles. Of these, 80 profiles (40%) included unprofessional or potentially objectionable content, including 27 profiles (13%) reflecting explicitly unprofessional behaviour, such as depictions of intoxication, uncensored profanity, unlawful behaviour, and confidential patient information. When unprofessional content was found, the content was self-authored in 82% of categories. Among 85 graduates (42%) who self-identified as a urologist on social media, nearly half contained concerning content. No differences in content were found between men and women, MD and DO degree-holders, or those who did or did not identify as a urologist (all P > 0.05).ConclusionThe majority of recent residency graduates had publicly accessible Facebook profiles, and a substantial proportion contained self-authored unprofessional content. Of those identifying as urologists on Facebook, approximately half violated published professionalism guidelines. Greater awareness of trainees’ online identities is needed.
      PubDate: 2017-04-09T23:20:27.723421-05:
      DOI: 10.1111/bju.13846
  • The BCG + Mitomycin trial for high risk non-muscle-invasive bladder
           cancer: Progress report and lessons learned
    • Authors: Dickon Hayne; Martin Stockler, Steve P. McCombie, Nicola Lawrence, Andrew Martin, Shomik Sengupta, Ian D. Davis
      Abstract: The BCG + Mitomycin trial (ACTRN12613000513718; ClinicalTrials. gov NCT02948543; ANZUP 1301) is an ongoing randomised phase III trial aiming to compare the efficacy and safety of the addition of intravesical Mitomycin chemotherapy to standard intravesical BCG in patients with resected, high-risk non-muscle-invasive bladder cancer (NMIBC) [1]. Our meta-analysis suggested reduced rates of recurrence (relative risk (RR) 0.75; 95% CI 0.61 to 0.92, p
      PubDate: 2017-04-09T07:05:28.657137-05:
      DOI: 10.1111/bju.13873
  • Understanding Pain and Coping in Women with Interstitial Cystitis/Bladder
           Pain Syndrome (IC/BPS)
    • Authors: L. Katz; D. A. Tripp, L. K. Carr, R. Mayer, R. M. Moldwin, J. C. Nickel
      Abstract: ObjectivesTo examine a self-regulation and coping model for IC/BPS that may help us understand the pain experience of chronic IC/BPS patients.Materials and MethodsThe model tested illness perceptions, illness-focused coping, emotional regulation, mental health and disability in stepwise method using factor analysis and structural equation modeling. Step 1 explored the underlying constructs. Step 2 confirmed the measurement models to determine the structure/composition of the main constructs. Step 3 evaluated the model fit and specified pathways in the proposed IC-Self Regulation Model.ResultsFemale patients with urologist diagnosed IC/BPS were recruited and diagnosed across tertiary care centres in North America (n=217). The data was collected through self-report questionnaires. An IC/BPS self-regulatory model was supported. Physical disability was worsened by patient's negative perception of their illness, attempts to cope using illness-focused coping and poorer emotional regulation. Mental health was supported by perceptions that individuals could do something about their illness, using wellness-focused behavioural strategies, and adaptive emotion regulation.ConclusionsThe results clarify the complex and unique process of self-regulation in women suffering from IC/BPS, implicating cognitive and coping targets, and highlighting emotional regulation. This knowledge will help clinicians understand and manage these patients’ distress and disability.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-07T02:25:56.864266-05:
      DOI: 10.1111/bju.13874
  • Prostate specific membrane antigen (PSMA) from diagnostic to therapeutic
           target: radionuclide therapy comes of age in prostate cancer
    • Authors: John A. Violet; Michael S. Hofman
      Abstract: Without doubt, molecular imaging using PET/CT directed against prostate specific membrane antigen (PSMA) has generated much interest for its impressive accuracy in detecting prostate cancer, particularly for biochemical recurrence[1]. PSMA expression is up regulated in advanced prostate cancer, including metastatic castration resistant prostate cancer (mCRPC), and provides a novel therapeutic target for radionuclide therapy directed towards PSMA-avid disease.Radionuclide therapy relies on the identification of a suitable tumour associated ‘target’ and an appropriate ‘vehicle’ that can bind to this with high selectivity and specificity to allow delivery of a therapeutic radionuclide.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-05T15:57:55.201155-05:
      DOI: 10.1111/bju.13871
  • Long-Term Sexual Health Outcomes in Men with Classic Bladder Exstrophy
    • Authors: Timothy S Baumgartner; Kathy M Lue, Pokket Sirisreetreerux, Sarita Metzger, Ross G Everett, Sunil S Reddy, Ezekiel Young, Uzoma A Anele, Cameron E Alexander, Nilay M Gandhi, Heather N Di Carlo, John P Gearhart
      Abstract: ObjectivesTo identify the long-term sexual health outcomes and relationships in men born with classic bladder exstrophy (CBE).Materials And MethodsA prospectively-maintained institutional database comprised of 1248 patients with exstrophy-epispadias was utilized. Male patients 18 years or older with CBE were included. A 42-question survey was designed utilizing a combination of demographic information and previously validated questionnaires.ResultsA total of 215 men inclusion criteria, of which 113 (53%) completed the questionnaire. The mean age of the participants was 32 years. Ninety-six (85%) of the respondents had been sexually active in their lifetime, of which only 66 (58%) were moderately to very satisfied with their sex life. The average Sexual Health Inventory for Men score was 19.8. The Penile Perception Score revealed all aspects of assessment scored an average between very dissatisfied and satisfied.Thirty-two respondents (28%) had attempted to obtain pregnancy with their partner. Twenty-three (20%) were successful in achieving pregnancy, while 31 (27%) reported a confirmed fertility problem. 31 (27%) reported having a semen analysis or post-ejaculatory urinalysis. Of the samples collected, only 4 individuals reported azoospermia.ConclusionCBE patients have many of the same sexual and relationship successes and concerns as the general population. This is invaluable data to provide to both the parents of boys with CBE, as it is to the patients themselves as they transition to adulthood.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T17:50:32.965824-05:
      DOI: 10.1111/bju.13866
  • Long-Term Third Party Assessment Of Results After Continent Cutaneous
           Diversion With Lundiana Pouch
    • Authors: Fredrik Liedberg; Sigurdur Gudjonsson, Abai Xu, Pär-Ola Bendahl, Thomas Davidsson, Wiking Månsson
      Abstract: ObjectivesTo investigate functional outcomes and complications at long-term follow-up after continent cutaneous diversion with Lundiana pouch.Subjects and methodsComplications, reoperations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files.ResultsA complication Clavien grade 3 or higher including unscheduled readmissions occurred in 45/193 patients (23%) within 90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one reoperation, and uretero-intestinal stricture was the most prevalent cause in 28 (15%) of those subjects. Reoperations were more prevalent in patients operated during the first half of the study period than during the second half (2000−2007) (62% vs 47%; p=0.03), and they were also more frequent in patients with surgery for benign causes than in patients with surgery for malignancy (60% vs 51%; p=0.04). Continence was achieved in 172/188 patients (91%). Sixteen percent of all patients required revisional surgery of the outlet to remain continent with an easily catheterizable pouch or to address stomal stenosis. The mean decrease in eGFR was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 ml/min/1.73m2; p
      PubDate: 2017-03-29T00:16:34.206233-05:
      DOI: 10.1111/bju.13863
  • Prostate cancer, family history, and eligibility for active surveillance:
           A systematic review of the literature
    • Authors: J.M Telang; B.R Lane, M.L Cher, D.C Miller, J.M Dupree
      Abstract: BackgroundActive surveillance is an increasingly prevalent treatment choice for low-grade prostate cancer. The eligibility criteria for active surveillance are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for active surveillance treatment.ObjectiveTo determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance.MethodsPubMed searches of “family history and prostate cancer”, “family history and prostate cancer progression” and “factors of prostate cancer progression” were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis.ResultsReview of six publications suggests that family history does not increase the risk of prostate cancer progression. Six studies found that family history does not increase the risk of prostate cancer progression, while one study found that family history increases the risk of prostate cancer progression only in African Americans.ConclusionA family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for active surveillance. Further studies are needed to better understand the relationship between race, family history, and eligibility for active surveillance.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:39.847593-05:
      DOI: 10.1111/bju.13862
  • Cost-effectiveness of a new urinary biomarker-based risk score compared to
           standard of care in prostate cancer diagnostics – a decision analytical
    • Authors: Siebren Dijkstra; Tim M. Govers, Rianne J. Hendriks, Jack A. Schalken, Wim Van Criekinge, Leander Van Neste, Janneke P.C. Grutters, J.P. Michiel Sedelaar, Inge M. van Oort
      Abstract: ObjectiveTo assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx) to identify patients for transrectal ultrasound-guided biopsy (TRUSGB) and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUSGB.Materials and methodsA decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test versus SOC in men with a PSA >3 ng/ml. Transition probabilities, utilities and costs were derived from literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions.ResultsA diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade PCa resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses demonstrated that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUSGB only slightly influenced the outcome of the model.ConclusionBased on the currently available evidence, the reduction of overdiagnosis and overtreatment due to the use of the SelectMDx test in men with PSA>3 ng/ml may lead to a reduction in total costs per patient and a gain in QALYs.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:28.001061-05:
      DOI: 10.1111/bju.13861
  • Cytoreductive therapy in the era of targeted therapies: a review
    • Authors: Nisha Pindoria; Nicholas Raison, Gideon Blecher, Rick Catterwell, Prokar Dasgupta
      Abstract: In the pre-targeted therapy era, palliative cytoreductive nephrectomy combined with cytokine immunotherapy was the standard treatment protocol for the management of metastatic renal cell carcinoma. The introduction of targeted therapies has improved response rates, median survival and overall prognosis when compared to immunotherapy. The role of cytoreductive nephrectomy in providing an independent survival advantage when used alongside immunotherapy has been demonstrated by two randomised controlled trials. However, with the new shift in improved treatment outcomes from cytokine immunotherapy to targeted therapies, the continuing role of cytoreductive nephrectomy as a viable surgical treatment modality remains controversial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:15:28.239992-05:
      DOI: 10.1111/bju.13860
  • Transperineal prostate biopsy – tips for analgesia
    • Authors: Shannon McGrath; Daniel Christidis, Emma Clarebrough, Rahul Ingle, Marlon Perera, Damien Bolton, Nathan Lawrentschuk
      Abstract: The modern transperineal prostate biopsy (TPB) technique was first described in 1983(1). Since its introduction, TPB has become favorable over transrectal ultrasound prostate biopsy (TRUS-PB) approach due to higher cancer detection rates particularly in the anterior and transition zones, lower rates of sepsis, and decreased risk of rectal bleeding(2). Using a standardized template for prostate biopsy – sampling of the prostate is improved with TP prostate biopsy when compared to transrectal-guided biopsy(2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:10:29.617742-05:
      DOI: 10.1111/bju.13859
  • Predictive value of the 2014 International Society of Urological Pathology
           grading system for prostate cancer in radical prostatectomy patients with
           long-term follow up
    • Authors: Judith Grogan; Ruta Gupta, Kate L Mahon, Phillip D Stricker, Anne-Maree Haynes, Warick Delprado, Jennifer Turner, Lisa G Horvath, James G Kench
      Abstract: ObjectiveTo assess the relationship between the ISUP 2014 grading system, biochemical relapse (BCR) and clinical relapse (CLR) following radical prostatectomy, to determine whether the 2014 ISUP grading system is a better predictor of survival compared to the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.Patients and methods635 radical prostatectomy cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow up (median 15.25 years, 0.3-26 years) were obtained. Log rank, Kaplan Meier, Cox regression and Harrell's concordance c-indices analyses were performed.ResultsAt a median follow up of 15 years, 276 (44%) of patients had BCR and 41 (7%) had clinical relapse. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 (9%) patients respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared to the 1992 Gleason system. Grade Group (HR: 4.9, p
      PubDate: 2017-03-28T10:05:35.933541-05:
      DOI: 10.1111/bju.13857
  • Cut-points for PSA doubling time in men with non-metastatic
           castration-resistant prostate cancer
    • Authors: Lauren E. Howard; Daniel Moreira, Amanda De Hoedt, William J. Aronson, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Martha K. Terris, Stephen J. Freedland
      Abstract: ObjectivesTo examine whether PSADT correlates with metastases, all-cause mortality (ACM), and prostate cancer-specific mortality (PCSM) and identify PSADT cut-points that can be used clinically for risk stratification in men with M0 CRPC.Materials and MethodsWe collected data on 441 men with M0 CRPC in 2000-2015 at five Veterans Affairs hospitals. Cox models were used to test the association between log-transformed PSADT and development of metastasis, ACM, and PCSM. To identify cut-points, we categorized PSADT into groups of every 3 months and then combined groups with similar hazard ratios.ResultsMedian follow-up was 28.3 months (IQR: 14.7-49.1). As a continuous variable, PSADT was associated with metastases, ACM, and PCSM (HR 1.40-1.68, all p
      PubDate: 2017-03-28T10:05:28.849829-05:
      DOI: 10.1111/bju.13856
  • Safety and efficacy of 2-weekly cabazitaxel in metastatic
           castration-resistant prostate cancer
    • Authors: A. Clément-Zhao; M. Auvray, H. Aboudagga, F. Blanc-Durand, A. Angelergues, Y. A. Vano, F. Mercier, N. El Awadly, B. Verret, C. Thibault, S. Oudard
      Abstract: ObjectivesTo evaluate the safety and efficacy of a 2-weekly cabazitaxel schedule in metastatic castration-resistant prostate cancer (mCRPC) patients.Materials and methodsFrom October 2013 to February 2016, 43 mCRPC patients were treated with cabazitaxel (16 mg/m2 on days 1 and 15 of a 4-week cycle) with G-CSF support. The safety profile and efficacy (prostate-specific antigen [PSA] response; biological, clinical or radiological progression-free survival [PFS] and overall survival [OS]) were analyzed.ResultsAll patients had received prior docetaxel and 79.1% abiraterone acetate. At inclusion, 46.5% were aged >70 years and 27.9% were ECOG-PS ≥2. Six patients stopped treatment because of toxicity. Grade ≥3 toxicities were: asthenia 16.3%; neutropenia 11.6%; thrombocytopenia 9.3%; diarrhoea 7%, anaemia 4.7%, febrile neutropenia 4.7% and haematuria 2.3%. 52.4% achieved a ≥30% PSA response, 40.5% had a ≥50% PSA response. Median OS was 15.2 months.ConclusionThis prospective pilot study suggests that cabazitaxel 16 mg/m² given bi-weekly has a manageable toxicity profile in docetaxel and abiraterone acetate pretreated mCRPC patients. A prospective phase III trial versus the standard cabazitaxel regimen is planned to confirm these results.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:01:23.141582-05:
      DOI: 10.1111/bju.13855
  • A core outcome set for localised prostate cancer effectiveness trials
    • Authors: Steven MacLennan; Paula R Williamson, Hanneke Bekema, Marion Campbell, Craig Ramsay, James N'Dow, Sara MacLennan, Luke Vale, Philipp Dahm, Nicolas Mottet, Thomas Lam, , Paul Abel, Hashim U. Ahmed, Gary Akehurst, Robert Almquist, Karl Beck, David Budd, Steven Canfield, James Catto, Philip Cornford, William Cross, Alexander Ewen, Judith Grant, Rakesh Heer, David Hurst, Rob Jones, Roger Kockelbergh, Andrew Mackie, Graham MacDonald, Alan McNeill, Malcolm Mason, Sam McClinton, Duncan McLaren, Hugh Mostafid, Ian Pearce, Linda Pennet, Justine Royle, Hans Schreuder, Grant D. Stewart, Henk van der Poel, Kevin Wardlaw, Thomas Wiegel
      Abstract: ObjectiveTo develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer.BackgroundMany treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials.Subjects and methodsA list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients.ResultsThe final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere.ConclusionWe have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T09:40:37.702254-05:
      DOI: 10.1111/bju.13854
  • 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
      Abstract: ObjectivesTo provide a comprehensive overview of the current status and future perspectives in the field of robotic systems for urologic surgery.Materials and MethodsA non-systematic literature review was performed by using PubMed / Medline search electronic engines. Existing patents for robotic devices were researched using the Google search machine. Findings were critically analyzed also by taking into account personal experience of the authors.ResultsRelevant patents of the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming on the stage. They 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 3D-HD-videotechnology and three arms mounted on separate carts. 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. REVO-I consists of an open console and a four-arm arrangement on one cart; first experimental with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the OR-table. Clinical trials of SP 1098-platform using da Vinci Xi for console-based single-port surgery were reported in 2015. SPORT robot has been tested in animal experiments for single port-surgery. SURGIBOT represent a bedside solution for single-port surgery providing flexible tube-guided instruments. 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 the market within the next five 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 actual clinical applicability and costs. How these technical developments will facilitate surgeons and whether their use will translate into better outcomes for our patients remains to be determined.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-20T09:30:40.232352-05:
      DOI: 10.1111/bju.13851
  • Urinary Continence Recovery after Radical
           Prostatectomy—Anatomic/Reconstructive and Nerve Sparing Techniques to
           Improve Outcomes
    • Authors: Christian P. Pavlovich; Bernardo Rocco, Sasha C. Druskin, John W. Davis
      Abstract: In an editorial board moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomic preservation and reconstruction steps that improve continence. Drs. Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a “clinically significant” difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr. Pavlovich's team demonstrates how clinically relevant differences in patient reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr. Davis demonstrates further reproducibility of technique.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-20T09:30:30.450548-05:
      DOI: 10.1111/bju.13852
  • Establishing the pathways and indications for performing isotope bone
           scans in newly diagnosed intermediate risk localised prostate cancer –
           results from a large contemporaneous cohort
    • Authors: Gokul Vignesh KandaSwamy; Adam Bennett, Krishna Narahari, Owen Hughes, John Rees, Howard Kynaston
      Abstract: ObjectiveTo establish the pattern of isotope bone scan (BS) positivity in a large contemporaneous cohort of newly diagnosed localised prostate cancer (PCa) patients and compare with the European Association of Urology (EAU) guidelines.BackgroundImaging guidelines and clinical practice of using BS to stage newly diagnosed patients with intermediate risk (IR) localised PCa are not uniform in the literature.Patients and methodsAll newly diagnosed PCa patients were discussed in a specialist multidisciplinary team (sMDT) meeting and were prospectively entered in a database. Patients were categorised based on D'Amico classification. All intermediate and high risk (HR) patients had pelvic MRI and BS unless contraindicated. The BS positivity in each group was analysed and negative predictive value (NPV) calculated. A cohort of 2720 patients between 2002 and 2015 were retrospectively analysed.ResultsOut of 976 patients in D'Amico IR category, 99 patients had primary Gleason pattern 4. Only 1 of the 99 patients had a positive BS and no positive BS was seen in patients with Gleason primary pattern 3 in the IR category. On subgroup analysis, based on PSA and Gleason grade alone, the BS positivity rate in patients with PSA
      PubDate: 2017-03-20T03:00:31.218763-05:
      DOI: 10.1111/bju.13850
  • Multiple sclerosis and nephrolithiasis: a matched-case comparative study
    • Authors: Vishnu Ganesan; Wen Min Chen, Rajat Jain, Shubha De, Manoj Monga
      Abstract: ObjectiveTo compare stone composition and serum/urine biochemistries in stone formers with multiple sclerosis (MS) against stone formers without MS and to examine the association between mobility, methods of bladder emptying, and stone formation.Patients and MethodsIn this retrospective case-control study, we identified patients diagnosed with MS and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to two controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index, and sex. For the second part of this study, matched controls (MS patients without a history of stones) were identified in a 1:1 ratio in a similar fashion. Results of 24-h urine biochemistry studies, stone compositions, serum laboratory measures, medications, history of stone surgeries, mobility, and method of bladder emptying were collected.ResultsIn all, 587 patients were identified who had both MS and a history of stone disease. Of these, 118 patients had a stone composition available. When compared to matched controls, patients with MS were significantly more likely to have calcium phosphate stones (42% vs 15%, P < 0.001) and struvite stones (8% vs 3%, P = 0.03) and less likely to have calcium oxalate monohydrate stones (39% vs 64%, P < 0.001). Among those patients with a composition available, those with MS were more likely to have undergone a percutaneous nephrolithotomy (PCNL; 25% vs 12%, P = 0.005) or a cystolithopaxy (16% vs 3%, P < 0.001) compared to their matched controls. In all, 61 patients had a complete 24-h urinary stone panel. There were no significant differences in urinary pH, volume, creatinine, calcium, citrate, oxalate, sodium, and uric acid as well as rates of hypocitraturia, hyperoxaluria, hypercalciuria, and hyperuricosuria among patients with MS. Use of intermittent straight catheterisation [ISC; odds ratio (OR) 3.50, 95% confidence interval (CI) 1.89–6.47]; P < 0.001] or an indwelling catheter (OR 9.78, 95% CI 4.81–19.88; P < 0.001) for bladder emptying was significantly associated with stone disease. There was no association between level of mobility and stone disease (P = 0.10).ConclusionsSimilar to findings seen in patients with spinal cord injuries, patients with MS have a high incidence of calcium phosphate stones and struvite stones when compared with matched controls. Additionally, they were more likely to undergo PCNL. The method of bladder management appears to be a risk factor in the development of stone disease. These findings suggest the importance of prompt treatment of urinary tract infections in this population and delay the use of ISC, suprapubic tube, or an indwelling Foley, when possible.
      PubDate: 2017-03-17T05:07:37.970755-05:
      DOI: 10.1111/bju.13820
  • cAMP-Dependent Regulation of RhoA/Rho-kinase Attenuates Detrusor
           Overactivity in a Novel Mouse Experimental Model
    • Authors: William Akakpo; Biljana Musicki, Arthur L. Burnett
      Abstract: ObjectivesTo investigate detrusor function and cAMP activation as a possible target for detrusor overactivity in an experimental model lacking a key denitrosylation enzyme, S-nitrosoglutathione reductase (GSNOR).Materials and MethodsGSNOR-deficient (GSNOR-/-) (n=30) and wild-type (WT) mice (n=26) were treated for 7 days with the cAMP activator, colforsin (1mg/kg), or vehicle intraperitoneally. Cystometric studies or molecular analyses of bladder specimens were performed. Bladder function indices and expression levels of proteins that regulate detrusor relaxation (nitric oxide synthase pathway) or contraction (RhoA/Rho-kinase pathway) and oxidative stress were assessed. Student t-test and one-way ANOVA were used.ResultsGSNOR-/- mice showed a significant increase (P
      PubDate: 2017-03-16T23:10:34.828248-05:
      DOI: 10.1111/bju.13847
  • Surgical outcomes of percutaneous nephrolithotomy (PCNL) in 3,402 patients
           and results of stone analysis in 1,559 patients from a single centre in
    • Authors: S. A. H Rizvi; M Hussain, S H Askari, M Lal, M N Zafar
      Abstract: ObjectiveTo report our experience of a series of PCNL from a single centre over the last 18 years in terms of patients and stone characteristics, indications, stone clearance and complications and chemical analysis of stones in a subgroup.Patients and MethodsWe retrospectively analysed the outcomes of PCNL in 3,402 adult patients who underwent the procedure between 1997 and 2014 from a prospectively maintained database. Data analysis included patients’ age, sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone free status at one-month follow-up. The tabulation of outcome in relation to complications and success has been divided into two eras 1997-2005 and 2006-2014 to study the differences.ResultsOf the 3,402 patients, 2,501 (73.5%) were males and 901 (26.5%) were females with M:F ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% patients whereas 72.5% were non- staghorn calculi. Intra-corporeal energy sources used for stone fragmentation included ultrasound in 917 (26.9%), Pneumatic Lithoclast 1,820 (53.5%), Holmium Laser 141 (4.1%) and Lithoclast master in 524 (15.4%) patients. Majority (97.4%) had 18-22 F nephrostomy tube after the procedure whereas 69 (2.03%) had tube-less PCNL. Volume of the irrigation fluid used ranged from 7 liters to 37 liters with mean of 28.4 liters. The stone free rate after PCNL in first era was 78% versus 83.2% in second era as assessed by combination of Ultrasound scan and plain X-ray KUB. The complications in first era was higher 21.3% as compared to 10.3% in second era and was statistically significant. Stone analysis showed 41% pure and 58% mixed stones. Majority were comprised of calcium oxalate.ConclusionsThis is the largest series of PCNL reported from any single centre in Pakistan. Stone disease has high prevalence and is associated with infective and obstructive complications including renal failure. PCNL as treatment modality offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource constrained healthcare system.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-16T23:10:31.206978-05:
      DOI: 10.1111/bju.13848
  • Aetiology and management of earlier vs later biochemical recurrence after
           retropubic radical prostatectomy
    • Authors: Elton Llukani; Herbert Lepor
      Abstract: ObjectivesTo examine the characteristics and management of earlier (within 5 years) vs later (after 5 years) biochemical recurrence (BCR) after radical prostatectomy (RP).Materials and MethodsBetween October 2000 and October 2009, 1597 men underwent open retropubic RP. BCRs were managed using salvage radiation therapy (SRT), androgen deprivation therapy (ADT) or active surveillance (AS). BCR-free survival was assessed using Kaplan–Meier analysis. Factors predicting earlier or later BCR and BCR after SRT were assessed using logistic regression andCox proportional hazard models, respectively.ResultsThe probabilities of developing BCR within 5 years and 10 years were 12.3% (95% confidence interval [CI] 10.7–13.9) and 18.4% (95% CI 16.2–20.6), respectively. On multivariate analysis, prostate-specific antigen doubling time, positive surgical margins and pathological Gleason score significantly differentiated earlier from later BCR. Overall, 74.5, 12.7 and 12.7% of men developing BCR underwent SRT, ADT or AS, respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8 vs 59%) and ADT (14.6 vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8 vs 4.6%; P
      PubDate: 2017-03-14T23:05:45.600015-05:
      DOI: 10.1111/bju.13816
  • Comprehensive assessment of renal tumor complexity in a large percutaneous
           cryoablation cohort
    • Authors: Bimal Bhindi; R. Houston Thompson, Ross J. Mason, Mustafa M. Haddad, Jennifer R. Geske, A. Nicholas Kurup, James D. Hannon, Stephen A. Boorjian, Bradley C. Leibovich, Thomas D. Atwell, Grant D. Schmit
      Abstract: ObjectiveTo evaluate the association between renal tumor complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA).Patients and methodsPatients with renal tumors treated with PCA were identified using our prospectively-maintained ablation registry (2003-2015). Salvage procedures and inherited tumor syndromes were excluded. The associations between R.E.N.A.L. Nephrometry Score (NS) and risk of complications, renal function impairment, local failure, and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models.ResultsThe cohort included 618 tumors treated during 580 procedures in 565 patients. Median follow-up was 34 months (IQR 14,66). Complications (any grade) during a procedure (n[total]=87, 15%) were more frequent with higher NS (Score 4-6: 10%; 7-9: 14%; 10-12: 36%;p
      PubDate: 2017-03-13T02:00:31.508192-05:
      DOI: 10.1111/bju.13841
  • Modified retroperitoneal lymph node dissection for postchemotherapy
           residual tumor: a long term update
    • Authors: Jane S. Cho; Hristos Z. Kaimakliotis, K. Clint Cary, Timothy A. Masterson, Stephen Beck, Richard Foster
      Abstract: ObjectivesTo update previously reported outcomes of modified template postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in appropriately selected patients with metastatic non-seminomatous germ cell tumor (NSGCT). Our previous report was criticized for short follow-up. Herein, we provide a long-term update on this cohort.Materials and MethodsOne hundred patients with normal serum markers after cisplatin-based chemotherapy and residual retroperitoneal tumor underwent modified PC-RPLND between 1991 and 2004. Using a prospectively managed institutional testicular cancer database, long-term follow-up was obtained.ResultsAs previously reported, 43 patients underwent a right modified template, 18 patients underwent a left full modified template, and 39 patients underwent a left modified template. The updated long-term median follow-up for the entire cohort is 125 months. Seven patients developed recurrent disease with a median time to recurrence of 11 months (Range 6-102 months), and one patient died of recurrent disease in the chest 4 years following surgery. All recurrences were outside the boundaries of a full bilateral template RPLND with the most common location of recurrence being the chest. The 5 and 10-year recurrence-free survival were 93% and 92% respectively. The overall survival at 10 years was 99%.ConclusionsIn appropriately selected patients with low volume disease before and after chemotherapy, a modified template has durable long-term efficacy without risk of in-field recurrences at a median follow-up of 125 months.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-13T02:00:27.516872-05:
      DOI: 10.1111/bju.13844
  • High concordance of findings obtained from in-gantry transgluteal MRI- and
           TRUS-guided biopsy as compared to prostatectomy specimens
    • Authors: Stefan Steurer; Sebastian Dwertmann Rico, Ronald Simon, Sarah Minner, Maria Christina Tsourlakis, Till Krech, Christina Koop, Markus Graefen, Hans Heinzer, Meike Adam, Hartwig Huland, Thorsten Schlomm, Guido Sauter, Agron Lumiani
      Abstract: ObjectivesTo determine the utility of our transgluteal MRI-guided prostate biopsy approach.Patients and Methods960 biopsy series taken within the period of one year were evaluated including 301 MRI-guided and 659 TRUS-guided biopsies.ResultsThe positivity rate and the fraction of high-grade cancers were significantly higher in MRI-guided than in TRUS biopsies. 65.4% of 301 MRI-guided and 57.2% of 659 TRUS biopsies contained cancer (p=0.0157). A Gleason 3+3=6 was seen in 16.8% of 197 MRI-guided and 36.1% of 377 TRUS biopsies (p
      PubDate: 2017-03-13T01:55:26.828315-05:
      DOI: 10.1111/bju.13840
  • Stereotactic ablative body radiotherapy for inoperable primary kidney
           cancer: a prospective clinical trial
    • Authors: Shankar Siva; Daniel Pham, Tomas Kron, Mathias Bressel, Jacqueline Lam, Teng Han Tan, Brent Chesson, Mark Shaw, Sarat Chander, Suki Gill, Nicholas R. Brook, Nathan Lawrentschuck, Declan G. Murphy, Farshad Foroudi
      Abstract: ObjectiveTo assess the feasibility and safety of stereotactic ablative body radiotherapy (SABR) for renal cell carcinoma (RCC) in patients unsuitable for surgery. Secondary objectives were to assess oncological and functional outcomes.Materials and MethodsThis was a prospective interventional clinical trial with institutional ethics board approval. Inoperable patients were enrolled, after multidisciplinary consensus, for intervention with informed consent. Tumour response was defined using Response Evaluation Criteria In Solid Tumors v1.1. Toxicities were recorded using Common Terminology Criteria for Adverse Events v4.0. Time-to-event outcomes were described using the Kaplan–Meier method, and associations of baseline variables with tumour shrinkage was assessed using linear regression. Patients received either single fraction of 26 Gy or three fractions of 14 Gy, dependent on tumour size.ResultsOf 37 patients (median age 78 years), 62% had T1b, 35% had T1a and 3% had T2a disease. One patient presented with bilateral primaries. Histology was confirmed in 92%. In total, 33 patients and 34 kidneys received all prescribed SABR fractions (89% feasibility). The median follow-up was 24 months. Treatment-related grade 1–2 toxicities occurred in 26 patients (78%) and grade 3 toxicity in one patient (3%). No grade 4–5 toxicities were recorded and six patients (18%) reported no toxicity. Freedom from local progression, distant progression and overall survival rates at 2 years were 100%, 89% and 92%, respectively. The mean baseline glomerular filtration rate was 55 mL/min, which decreased to 44 mL/min at 1 and 2 years (P < 0.001). Neutrophil:lymphocyte ratio correlated to % change in tumour size at 1 year, r2 = 0.45 (P < 0.001).ConclusionThe study results show that SABR for primary RCC was feasible and well tolerated. We observed encouraging cancer control, functional preservation and early survival outcomes in an inoperable cohort. Baseline neutrophil:lymphocyte ratio may be predictive of immune-mediated response and warrants further investigation.
      PubDate: 2017-03-10T21:50:29.648383-05:
      DOI: 10.1111/bju.13811
  • Assessing the relative influence of hospital and surgeon volume on
           short-term mortality after radical cystectomy
    • Authors: Nikhil Waingankar; Katherine Mallin, Marc Smaldone, Brian L. Egleston, Andrew Higgins, David P. Winchester, Robert G. Uzzo, Alexander Kutikov
      Abstract: ObjectivesTo assess the relationship between surgeon (SV) and hospital volume (HV) on mortality after radical cystectomy (RC).Patients and MethodsWe queried the National Cancer Database (NCDB) for adult patients undergoing RC between 2010 and 2013. We calculated average volume for each surgeon and hospital. Using propensity-scored weights for combined volume groups with a proportional hazards regression model, we compared the associations between HV and SV with 90-day survival after RC.ResultsA total of 19 346 RCs were performed at 927 hospitals by 2 927 surgeons in the period 2010–2013. The median (interquartile range) HV and SV were 12.3 (5.0–35.5) and 4.3 (1.3–12.3) cases, respectively. For HV, 90-day unadjusted mortality was 8.5% in centres with 30 cases/year (95% CI 5.0–6.2). For SV, 90-day mortality was 8.1% for surgeons with 30 cases/year (95% CI 2.8–5.2; all P < 0.05). The 30-day mortality rate was lowest for the combined HV–SV groups with HV>30, ranging from 1.6% to 2.1%.ConclusionsIn hospitals reporting to the NCDB, volume was associated with improved mortality after RC. These associations appear to be driven by hospital- rather than surgeon-level effects. An elevated SV had a beneficial effect on mortality at the highest-volume hospitals. These findings inform efforts to regionalize complex surgical care and improve quality at community and safety net hospitals.
      PubDate: 2017-03-10T10:42:38.668074-05:
      DOI: 10.1111/bju.13804
  • Long-term follow-up of treatment of erectile dysfunction after radical
           prostatectomy using nerve grafts and end-to-side somatic-autonomic
           neurorraphy: a new technique
    • Authors: José Carlos Souza Trindade; Fausto Viterbo, André Petean Trindade, Wagner José Fávaro, José Carlos Souza Trindade-Filho
      Abstract: ObjectiveTo study a novel penile reinnervation technique using four sural nerve grafts and end-to-side neurorraphies connecting bilaterally the femoral nerve and the cavernous corpus and the femoral nerve and the dorsal penile nerves.Patients and MethodsTen patients (mean [± sd; range] age 60.3 [± 4.8; 54–68] years), who had undergone radical prostatectomy (RP) at least 2 years previously, underwent penile reinnervation in the present study. Four patients had undergone radiotherapy after RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire and pharmaco-penile Doppler ultrasonography (PPDU) preoperatively and at 6, 12 and 18 months postoperatively, and using a Clinical Evolution of Erectile Function (CEEF) questionnaire, administered after 36 months.ResultsThe IIEF scores showed improvements with regard to erectile dysfunction (ED), satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between the right and left sides or among the different time points. The introduction of nerve grafts neither caused fibrosis of the corpus cavernosum, nor reduced penile vascular flow. CEEF results showed that sexual intercourse began after a mean of 13.7 months with frequency of sexual intercourse varying from once daily to once monthly. Acute complications were minimal. The study was limited by the small number of cases.ConclusionsA total of 60% of patients were able to achieve full penetration, on average, 13 months after reinnervation surgery. Patients previously submitted to radiotherapy had slower return of erectile function. We conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer a new treatment method for ED after RP.
      PubDate: 2017-03-10T10:28:21.978421-05:
      DOI: 10.1111/bju.13772
  • Salvage high-intensity focused ultrasound (HIFU) for locally recurrent
           prostate cancer after failed radiation therapy: Multi-institutional
           analysis of 418 patients
    • Authors: Sebastien Crouzet; Andreas Blana, Francois J. Murat, Gilles Pasticier, Stephen C. W. Brown, Giario N. Conti, Roman Ganzer, Olivier Chapet, Albert Gelet, Christian G. Chaussy, Cary N. Robertson, Stefan Thuroff, John F. Ward
      Abstract: ObjectiveTo report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database.Patients and MethodsThis retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the ‘Phoenix’ definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan–Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported.ResultsIn all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4–10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group.ConclusionS-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of>80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure
      PubDate: 2017-03-10T10:26:27.731056-05:
      DOI: 10.1111/bju.13766
  • Novel use of Twitter to disseminate and evaluate adherence to clinical
           guidelines by the European Association of Urology
    • Authors: Stacy Loeb; Morgan Roupret, Inge Van Oort, James N'dow, Marc Gurp, Jarka Bloemberg, Julie Darraugh, Maria J. Ribal
      PubDate: 2017-03-10T10:25:08.107661-05:
      DOI: 10.1111/bju.13802
  • Calculating life expectancy to inform prostate cancer screening and
           treatment decisions
    • Authors: Scott R. Hawken; Gregory B. Auffenberg, David C. Miller, Brian R. Lane, Michael L. Cher, Firas Abdollah, Hyunsoon Cho, Khurshid R. Ghani,
      PubDate: 2017-03-10T10:15:09.291713-05:
      DOI: 10.1111/bju.13812
  • Sentinel node biopsy for prostate cancer: report from a consensus panel
    • Authors: Henk G. Poel; Esther M. Wit, Cenk Acar, Nynke S. Berg, Fijs W. B. Leeuwen, Renato A. Valdes Olmos, Alexander Winter, Friedhelm Wawroschek, Fredrik Liedberg, Steven Maclennan, Thomas Lam,
      Abstract: ObjectiveTo explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer through a consensus panel of experts.MethodsA two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the research and development project/University of California, Los Angeles Appropriateness Methodology on 150 statements in nine domains. The disagreement index based on the interpercentile range, adjusted for symmetry score, was used to assess consensus and non-consensus among panel members.ResultsConsensus was obtained on 91 of 150 statements (61%). The main outcomes were: (1) the results from an extended lymph node dissection (eLND) are still considered the ‘gold standard’, and sentinel node (SN) detection should be combined with eLND, at least in patients with intermediate- and high-risk prostate cancer; (2) the role of SN detection in low-risk prostate cancer is unclear; and (3) future studies should contain oncological endpoints as number of positive nodes outside the eLND template, false-negative and false-positive SN procedures, and recurrence-free survival. A high rate of consensus was obtained regarding outcome measures of future clinical trials on SNB (89%). Consensus on tracer technology was only obtained in 47% of statements, reflecting a need for further research and standardization in this area. The low-level evidence in the available literature and the composition of mainly SNB users in the panel constitute the major limitations of the study.ConclusionsConsensus on a majority of elementary statements on SN detection in prostate cancer was obtained.; therefore, the results from this consensus report will provide a basis for the design of further studies in the field. A group of experts identified evidence and knowledge gaps on SN detection in prostate cancer and its application in daily practice. Information from the consensus statements can be used to direct further studies.
      PubDate: 2017-03-08T21:53:54.917083-05:
      DOI: 10.1111/bju.13810
  • ‘Risk-stratification based on magnetic resonance imaging and
           prostate-specific antigen density may reduce unnecessary follow-up biopsy
           procedures in men on active surveillance for low-risk prostate cancer’
    • Authors: Arnout R. Alberts; Monique J. Roobol, Frank-Jan H. Drost, Geert J. van Leenders, Leonard P. Bokhorst, Chris H. Bangma, Ivo G. Schoots
      Abstract: ObjectivesTo assess the value of risk-stratification based on magnetic resonance imaging (MRI) and prostate-specific antigen (PSA) density in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer (PCa) in men on active surveillance.Materials and MethodsA total of 210 men on active surveillance with GS 3+3 PCa received a first MRI and if indicated (PI-RADS ≥3) targeted biopsy (TBx) using MRI-TRUS fusion. The MRI was performed 3 months after diagnosis (group A: n=97), at confirmatory biopsy (group B: n=39) or at surveillance biopsy after ≥1 repeat TRUS-guided systematic biopsies (TRUS-Bx) (group C: n=74). The primary outcome was upgrading to Gleason score (GS) ≥3+4 PCa based on MRI ± TBx in group A, B and C. Biopsy outcomes were stratified for the overall PI-RADS score and PSA density to identify a subgroup of men in whom a biopsy could have been avoided since no GS upgrading was detected.ResultsA total of 134/210 (64%) men had a positive MRI and a total of 51/210 (24%) men showed GS upgrading based on MRI-TBx. The percentage of GS upgrading based on MRI-TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively group A, B and C. Additional GS upgrading detected by TRUS-Bx occurred in 3/39 (8%) men in group B and 1/17 (6%) men who received TRUS-Bx in group C. No GS upgrading was detected by MRI-TBx in men with PI-RADS 3 and PSA density
      PubDate: 2017-03-07T14:25:24.792744-05:
      DOI: 10.1111/bju.13836
  • Identification of Novel Non-invasive Biomarkers of Urinary Chronic Pelvic
           Pain Syndrome (UCPPS): Findings from the Multidisciplinary Approach to the
           Study of Chronic Pelvic Pain (MAPP) Research Network
    • Authors: A Dagher; A Curatolo, M Sachdev, A J Stephens, C Mullins, J R Landis, A van Bokhoven, A El-Hayek, J Froehlich, A C Briscoe, R Roy, J Yang,  M A Pontari, D Zurakowski, R S Lee, M A Moses,
      Abstract: ObjectiveTo date, no definitive, broadly accepted biomarkers for UCPPS have been identified. The present study examines a series of candidate markers for UCPPS selected based on proposed involvement in underlying biological processes and is intended to provide new insights into pathophysiology and suggest targets for expanded clinical and mechanistic studies.MethodsBaseline urine samples from MAPP Research Network study participants with UCPPS (n=259), positive controls (PC) (chronic pain without pelvic pain, n=107), and healthy controls (HC) (n=125) were analyzed for the presence of proteins suggested in the literature to be associated with UCPPS. MMP-2 (Matrix Metalloproteinase-2), MMP-9, MMP-9/NGAL complex (Neutrophil gelatinase-associated lipocalin, also known as Lipocalin-2), VEGF (Vascular Endothelial Growth Factor), VEGF-R1 (VEGF Receptor 1) and NGAL were assayed and quantitated using mono-specific ELISAs for each protein. Log-transformed concentration (pg/mL or ng/mL) and concentration normalized to total protein (pg/μg) were comparedamong UCPPS, PC, and HC participants within sex using the Student's t-test, with p-values adjusted for multiple comparisons. Multivariable logistic regression and ROC curves assessed biomarkers’ utility in distinguishing UCPPS and control participants. Associations of protein with symptom severity were assessed by linear regression.ResultsSignificantly higher normalized concentrations (pg/μg) of VEGF, VEGF-R1, and MMP-9 in males and VEGF concentration (pg/mL) in females were associated with UCPPS versus HC. These proteins provided only marginal discrimination between UCPPS participants and HC. In UCCPS males, pain severity was significantly positively associated with concentrations of MMP-9 and MMP-9/NGAL complex and urinary severity with MMP-9, MMP-9/NGAL complex, and VEGF-R1. In UCPPS females, pain and urinary symptom severity were associated with increased normalized concentrations of MMP-9/NGAL complex, while pain severity alone was associated with increased normalized concentrations of VEGF and urinary severity alone was associated with increased normalized concentrations of MMP-2. Pain severity in UCPPS females was significantly positively associated with concentrations of all biomarkers except NGAL and urinary severity with all concentrations except VEGF-R1.ConclusionAltered levels of MMP-9, MMP-9/NGAL complex and VEGF-R1 in males, and all biomarkers in females, were associated with clinical symptoms of UCPPS. None of the evaluated candidate markers usefully discriminated UCPPS patients from controls. Elevated VEGF, MMP-9 and VEGF-R1 in males and VEGF in females may provide potential new insights into the pathophysiology of UCPPS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-06T09:10:37.738221-05:
      DOI: 10.1111/bju.13832
  • Focal Salvage HIFU in radiorecurrent prostate cancer
    • Authors: A Kanthabalan; M Peters, M Van Vulpen, N McCartan, R G Hindley, A Emara, M C. Moore, M Arya, M Emberton, H U Ahmed
      Abstract: ObjectiveTo assess short to medium term cancer control rates and side effects of focal salvage High Intensity Focused Ultrasound (HIFU).Materials and methodsA retrospective registry analysis identified 150 men who underwent focal salvage HIFU (Sonablate 500) (November 2006-August 2015). Metastatic disease was excluded using the nodal assessment on the pelvic MRI, a radioisotope bone scan and PET imaging (choline-FDG-PET or Choline PET-CT). In our current clinical practice, metastatic disease must be ruled out by both Choline PET and bone scan. Localisation of cancer was by multi-parametric prostate MRI (T2W, diffusion-weighting, dynamic contrast enhancement) with systematic or template prostate mapping biopsies.Primary outcome was a composite failure incorporating biochemical failure (BF) and/or positive localised or distant imaging and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer specific death. Secondary outcome was BF using the Phoenix-ASTRO definition (nadir+2ng/ml). We used Kaplan-Meier analysis and Cox-proportional hazards regression to quantify the effect of the determinants on the endpoints.ResultsMean age at focal salvage therapy was 69.8 years (SD 6.1) and median PSA pre-focal salvage treatment was 5.5 ng/ml [IQR 3.6-7.9). Median follow-up was 35 months (IQR 22-52). Patients were classified as low 2.7% (4/150), intermediate 39.3% (59/150) and high-risk disease 41.3% (62/150) according to D'Amico classification, prior to focal salvage HIFU.Composite failure occurred in 61% (91/150) and BF occurred in 51.3% (77/150). The Kaplan-Meier composite endpoint free survival (CEFS) at 3 years was 40% (95% CI 31-50) for the entire group. Kaplan-Meier estimates of CEFS were 100%, 49% and 24% at 3 years in low, intermediate and high D'Amico risk groups pre-salvage, respectively. The Kaplan-Meier biochemical disease free survival (BDFS) at 3 years was 48% (95% CI 39-59) for the entire group. Kaplan-Meier estimates of BDFS was 100%, 61% and 32% at 3 years in low, intermediate and high D'Amico risk groups pre-salvage, respectively. Complications included urine infection (11.3%; 17/150), bladder neck stricture (8%; 12/150), recto-urethral fistula after 1 HIFU procedure (2%; 3/150) and osteitis pubis (0.7%; 1/150).ConclusionFocal salvage HIFU confers a relatively low complication and side-effect rate. Composite endpoint free survival and biochemical control in the short to medium term is reasonable, especially in this relatively high risk cohort but still on the lower end compared to current whole gland salvage therapies. Focal salvage therapy may offer disease control in high risk men whilst minimising additional treatment morbidities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:00:30.207199-05:
      DOI: 10.1111/bju.13831
  • First-line non-cytotoxic therapy in chemotherapy-naive patients with
           metastatic castration-resistant prostate cancer: a systematic review of 10
           randomised clinical trials
    • Authors: Michiel H.F. Poorthuis; Robin W.M. Vernooij, R. Jeroen A. Moorselaar, Theo M. Reijke
      Abstract: The aim of this study is to systematically evaluate all available treatment options in chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC). We systematically searched PubMed, EMBASE, and the Cochrane libraries up to 1 March 2016 for peer-reviewed publications on randomised clinical trials (RCTs). RCTs were included if progression-free survival (PFS), overall survival (OS), quality of life (QoL), or adverse events (AEs) were quantitatively evaluated. We assessed the risk of bias with the Cochrane Collaboration's tool and graded the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's approach. We included 25 articles, reporting on 10 unique RCTs describing seven different comparisons. In one RCT, a prolonged OS and PFS (high quality) were found with abiraterone and prednisone compared to placebo plus prednisone. In one RCT, a prolonged OS and PFS (high quality) were found with enzalutamide compared to placebo. In two RCTs, a prolonged OS (high and moderate quality) was found with 223radium compared to placebo, but its effect on PFS is unknown. In three RCTs, a prolonged OS (moderate quality) was found with sipuleucel-T compared to placebo, but no prolonged PFS (low quality). In one RCT a prolonged PFS (high quality) was found with orteronel compared to placebo, but no prolonged OS (moderate quality). In one RCT, a prolonged OS (moderate quality) was found with bicalutamide compared to placebo, but its effect on PFS is unknown. In one RCT, a prolonged PFS (high quality) was found with enzalutamide compared to bicalutamide, but its effect on OS is unknown. The best evidence was found for abiraterone and enzalutamide for effective prolongation of OS and PFS to treat chemotherapy-naive patients with mCRPC. However, taking both QoL and AEs into consideration, other treatment modalities could be considered for individual patients.
      PubDate: 2017-02-28T23:00:28.530582-05:
      DOI: 10.1111/bju.13764
  • Surgical histopathology for suspected oncocytoma on renal mass biopsy: a
           systematic review and meta-analysis
    • Authors: Hiten D. Patel; Sasha C. Druskin, Steven P. Rowe, Phillip M. Pierorazio, Michael A. Gorin, Mohamad E. Allaf
      Abstract: To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.
      PubDate: 2017-02-27T21:50:31.352849-05:
      DOI: 10.1111/bju.13763
  • Robot-assisted partial prostatectomy for anterior prostate cancer: a
           step-by-step guide
    • Authors: Arnauld Villers; Vincent Flamand, Rodríguez-Carlin Arquímedes, Philippe Puech, Georges-Pascal Haber, Mihir M. Desai, Sebastien Crouzet, Adil Ouzzane, Inderbir S. Gill
      Abstract: ObjectiveTo describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC).Patients and MethodsAfter Institutional Review Board approval, over an 8-year period (2008–2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low–intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively.ResultsThe RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien–Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence.ConclusionPZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.
      PubDate: 2017-02-26T22:33:33.813834-05:
      DOI: 10.1111/bju.13785
  • Anatomical patterns of recurrence following biochemical relapse after
    • Authors: William C. Jackson; Neil B. Desai, Ahmed E. Abugharib, Vasu Tumati, Robert T. Dess, Jae Y. Lee, Shuang G. Zhao, Moaaz Soliman, Michael Folkert, Aaron Laine, Raquibul Hannan, Zachary S. Zumsteg, Howard Sandler, Daniel A. Hamstra, Jeffrey S. Montgomery, David C. Miller, Mike A. Kozminski, Brent K. Hollenbeck, Jason W. Hearn, Ganesh Palapattu, Scott A. Tomlins, Rohit Mehra, Todd M. Morgan, Felix Y. Feng, Daniel E. Spratt
      Abstract: ObjectivesTo characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT).Patients and MethodsA multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months.ResultsThe median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively.ConclusionsWe demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
      PubDate: 2017-02-26T22:30:35.404518-05:
      DOI: 10.1111/bju.13792
  • Prostate cancer screening practices in a large, integrated health system:
    • Authors: Anita D. Misra-Hebert; Bo Hu, Eric A. Klein, Andrew Stephenson, Glen B. Taksler, Michael W. Kattan, Michael B. Rothberg
      Abstract: ObjectivesTo assess prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men, and to assess primary provider variation associated with prostate cancer screening.Patients and MethodsOur study population included 160 211 men aged ≥40 years with at least one visit to a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 to December 2014. Yearly rates of screening PSA testing by primary care providers (PCPs), rates of re-screening, and rates of prostate biopsies were assessed.ResultsAnnual PSA-screening testing declined from 2007 to 2014 in all age groups, as did biennial and quadrennial screening. Yearly rates declined for men aged ≥70 years, from 22.8% to 8.9%; ages 50–69 years, from 39.2% to 20%; and ages 40–49 years, from 11% to 4.6%. Overall rates were lower for African-American (A-A) men vs non-A-A men; for men with a family history of prostate cancer, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA testing did not substantially change after the USPSTF recommendations. While the number of men screened and rates of follow-up prostate cancer screening declined in 2011–2014 compared to 2007–2010, similar re-screening rates were noted for men aged 45–75 years with initial PSA levels of 75 years with initial PSA levels of
      PubDate: 2017-02-26T22:30:30.114483-05:
      DOI: 10.1111/bju.13793
  • Positive outcomes with first onabotulinumtoxinA treatment persist in the
           long term with repeat treatments in patients with neurogenic detrusor
    • Authors: Pierre Denys; Roger Dmochowski, Philip Aliotta, David Castro-Diaz, Bertil Blok, Karen Ethans, Tamer Aboushwareb, Andrew Magyar, Michael Kennelly
      Abstract: ObjectiveTo examine whether response to first treatment with onabotulinumtoxinA is predictive of long-term treatment outcome in patients with neurogenic detrusor overactivity (NDO).Patients and MethodsPatients with NDO who were enrolled in a 3-year extension study (after a 52-week phase III study) received onabotulinumtoxinA ‘as needed’, based on fulfilment of prespecified retreatment criteria. This post hoc analysis included patients who received only the 200-U dose during the phase III and extension studies. Data on mean percent reduction from baseline in urinary incontinence (UI) episodes at week 6 after the first treatment were analysed, and the patients were stratified into three response groups:
      PubDate: 2017-02-26T22:30:27.059661-05:
      DOI: 10.1111/bju.13795
  • Prevalence of kidney stones in China: an ultrasonography based
           cross-sectional study
    • Authors: Guohua Zeng; Zanlin Mai, Shujie Xia, Zhiping Wang, Keqin Zhang, Li Wang, Yongfu Long, Jinxiang Ma, Yi Li, Show P. Wan, Wenqi Wu, Yongda Liu, Zelin Cui, Zhijian Zhao, Jing Qin, Tao Zeng, Yang Liu, Xiaolu Duan, Xin Mai, Zhou Yang, Zhenzhen Kong, Tao Zhang, Chao Cai, Yi Shao, Zhongjin Yue, Shujing Li, Jiandong Ding, Shan Tang, Zhangqun Ye
      Abstract: ObjectivesTo investigate the prevalence and associated factors of kidney stones among adults in China.Subjects and methodsA nationwide cross-sectional survey was conducted among persons aged 18 and older across China from May 2013 to July 2014. Participants underwent urinary tract ultrasonographic examinations, questionnaires, and provided blood and urine samples to analyze. Kidney stones were defined as particles in size of 4 mm or greater. Prevalence was defined as the proportion of participants with kidney stone and binary logistic regression was used to estimate the associated factors.ResultsA total of 12570 individuals (45.2% men) with an average age of 48.8±15.3 (18-96) years were selected and invited to participate in the study. And 9310 (40.7% men) individuals completed the investigation, with a response rate of 74.1%. The prevalence of kidney stones was 6.4% (95% confidence interval (CI):5.9, 6.9), and the age- and sex-adjusted prevalence was 5.8% (95% CI: 5.3, 6.3; 6.5% in men and 5.1% in women). Binary logistic regression analysis showed that male, rural residents, age, family history of urinary stones, concurrent with diabetes mellitus and hyperuricemia, increased consumption of meat, and excessive sweating were all statistical significantly associated with increased risk of kidney stones. By contrast, consumed more tea, legume, and fermented vinegar were statistical significantly associated with decreased risk of kidney stones formationConclusionKidney stones are common disease among Chinese adults and about one in seventeen adults are affected currently. Some Chinese dietary habits may lower risk of kidney stones formation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-25T00:15:32.671939-05:
      DOI: 10.1111/bju.13828
  • Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis
    • Authors: Amihay Nevo; Roy Mano, Jack Baniel, David A. Lifshitz
      Abstract: ObjectivesTo evaluate the association between stent dwelling time and sepsis after ureteroscopy, and identify risk factors for sepsis in this setting.Patients and MethodsThe prospectively collected database of a single institution was queried for all patients who underwent ureteroscopy for stone extraction between 2010 and 2016. Demographic, clinical, preoperative and operative data were collected. The primary study endpoint was sepsis within 48 h of ureteroscopy. Logistic regressions were performed to identify predictors of post-ureteroscopy sepsis in the ureteroscopy cohort and specifically in patients with prior stent insertion.ResultsBetween October 2010 and April 2016, 1 256 patients underwent ureteroscopy for stone extraction. Risk factors for sepsis included prior stent placement, female gender and Charlson comorbidity index. A total of 601 patients had a ureteric stent inserted before the operation and were included in the study cohort, in which the median age was 56 years, 90 patients were women (30%), and 97 patients were treated for positive preoperative urine cultures (16.1%). Postoperative sepsis, 3 months were 1, 4.9, 5.5 and 9.2%, respectively. On multivariate analysis, stent dwelling time, stent insertion because of sepsis, and female gender were significantly associated with post-ureteroscopy sepsis in patients with prior stent placement.ConclusionsPatients who undergo ureteroscopy after ureteric stent insertion have a higher risk of postoperative sepsis. Prolonged stent dwelling time, sepsis as an indication for stent insertion, and female gender are independent risk factors. Stent placement should be considered cautiously, and if inserted, ureteroscopy should be performed within 1 month.
      PubDate: 2017-02-22T21:06:49.939037-05:
      DOI: 10.1111/bju.13796
  • Outcome predictors of radical cystectomy in patients with cT4 prostate
           cancer: A multi-institutional study of 62 patients
    • Authors: Martin Spahn; Alessandro Morlacco, Silvan Boxler, Steven Joniau, Alberto Briganti, Francesco Montorsi, Paolo Gontero, Pia Bader, Detlef Frohneberg, Hein Poppel, R. Jeffrey Karnes,
      Abstract: ObjectivesTo identify which patients with macroscopic bladder infiltrating T4 prostate cancer (PCa) might have favorable outcomes when treated with radical cystectomy (RC)Materials and methodsWe evaluated 62 patients with cT4cN0-1cM0 PCa treated with RC and pelvic lymph node dissection between 1972-2011. In addition to descriptive statistics, the Kaplan-Meier method and log-rank tests were used to depict survival rates. Uni- and multivariate Cox regression analysis tested the association between predictors and progression-free, PCa-specific-, and overall survival.ResultsOf the 62 patients, 19 (30.6%) did not have clinical progression during follow-up, 2 (3.2%) had local recurrence, and 32 (51.6%) had hematogenous and 9 (14.5%) combined pelvic and distant metastasis. Fourty (64.5%) patients died, 34 (54.8%) of PCa and 6 (9.7%) of other causes. Median survival of the 19 patients who were metastasis-free at last follow-up was 86 months (range 1-314 mos), 8/19 had a follow-up of more than 5 years, and 5 survived metastasis-free for more than 15 years. Patients without seminal vesicle invasion (SVI) had the best outcomes, with an estimated 10-year PCa-specific survival of 75% compared to 24% for patients with SVI.ConclusionRC can be an appropriate treatment for local control and part of a multimodality approach for cT4-PCa. Although recurrences can be probable, it does not necessarily translate into cancer-specific death. Men without SVI had a 75% 10-year PCa-specific survival. Although SVI is not as favorable, there can be good local control but these patients are at higher risk of progression and may need more aggressive systemic treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T23:45:21.686034-05:
      DOI: 10.1111/bju.13818
  • Systematic review of the oncological and functional outcomes of pelvic
           organ-preserving cystectomy compared with standard radical cystectomy in
           women who undergo curative surgery and orthotopic neobladder substitution
           for bladder cancer
    • Authors: Erik Veskimäe; Yann Neuzillet, Mathieu Rouanne, Steven MacLennan, Thomas B. L Lam, Yuhong Yuan, Eva Compérat, Nigel C Cowan, Georgios Gakis, Antoine G van der Heijden, Maria J Ribal, J. Alfred Witjes, Thierry Lebrét
      Abstract: ContextPelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).ObjectiveTo determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa).Evidence acquisitionMedline, Embase, Cochrane controlled trials databases and clinicaltrial. gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at>2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment.Evidence synthesisThe searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86%) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5% ranging from 80% to 100%. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100% and overall survival (OS) 65-100%. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100% and 42-100%, respectively. Overall self-catheterization rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies.ConclusionFor well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative settingThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:50:23.099561-05:
      DOI: 10.1111/bju.13819
  • PCNL Access by Urologist or Interventional Radiologist: Practice and
           Outcomes in the United Kingdom
    • Authors: James N Armitage; John Withington, Sarah Fowler, William JG Finch, Neil A Burgess, Stuart O Irving, Jonathan Glass, Oliver J Wiseman
      Abstract: Introduction and ObjectiveObtaining percutaneous access to the renal collecting system is fundamental to safe and effective percutaneous nephrolithotomy (PCNL). Practice varies between countries, hospitals and individual surgeons as to whether access is obtained by a urologist or an interventional radiologist (IR). We compared outcomes of urologist versus IR tracts in the contemporary UK setting.Patients and MethodsData submitted to the British Association of Urological Surgeons (BAUS) PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts and perceived and actual difficulty of access. Post-operative outcomes, including stone free rates, lengths of stay and complications including transfusion rates were also compared.ResultsOverall, percutaneous renal access was undertaken by an IR in 3,453 of 5,211 procedures (66.3%); this rate appeared stable over the entire study period, for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group.IRs performed more multiple tract access than urologists (6.8% vs 5.1%, p=0.02), but similar rates of supracostal punctures (8.2% vs 9.2%, p=0.23). IRs used ultrasound more commonly than urologists to guide access (56.6% vs. 21.7%, p=0.0001). There were no significant differences in complication rates, lengths of stay or stone free rates.ConclusionsOur findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedureThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:50:21.887242-05:
      DOI: 10.1111/bju.13817
  • Long-Term Results Of Ileal Ureteric Replacement – A 25 Years Single
           Centre Experience
    • Authors: Arkadius kocot; charis kalogirou, daniel vergho, hubertus riedmiller
      Abstract: ObjectivesTo report the long-term outcome of ileal ureteric replacement (IUR) in complex reconstruction of the urinary tract.Patients And MethodsFrom 1991 to 2016, IUR was performed in 157 patients with structural or functional ureteric loss. In 52 patients, bilateral IUR became necessary. Implantation sites where either the native urinary bladder (n=79) or intestinal reservoirs (n=78). In the latter group, the technique was used at the time of primary urinary diversion (n=34), in a secondary approach (n=29) and in undiversion or conversion procedures (n=15). Anti-refluxive implantation was performed in 37 patients. In 8 patients the ileal ureter was implanted into the cutis as an ileal conduit. All patients were followed prospectively according to a standardized protocol.ResultsThe mean follow-up was 54.1 months. In 114 patients with dilation of the upper urinary tract before surgery a significant improvement of the dilation was proven in 98 patients. Serum creatinine levels decreased or remained stable in 147 of 157 patients. Reflux was present in all cases without and in six cases with an anti-reflux mechanism. In six patients, operative revision became necessary because of severe metabolic acidosis, mucus obstruction or stenosis of the ileal ureter.ConclusionTo our knowledge, this is the world's largest single-center series of IUR reported to date. Long-term follow-up confirms that this approach is a safe and reliable solution even under complex circumstances. Anti-refluxive implantation is recommended in intestinal reservoirs, whereas reflux prevention seems to be of minor importance when the native bladder is chosen as site of implantationThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:40:54.77201-05:0
      DOI: 10.1111/bju.13825
  • Morphometric Analysis of Prostate Zonal Anatomy using Magnetic Resonance
           Imaging (MRI): The Impact on Age-related Changes in Japanese and American
    • Authors: Toru Matsugasumi; Atsuko Fujihara, So Ushijima, Motohiro Kanazawa, Yasuhiro Yamada, Takumi Shiraishi, Fumiya Hongo, Kazumi Kamoi, Koji Okihara, Andre Luis de Castro Abreu, Masakatsu Oishi, Toshitaka Shin, Suzanne Palmer, Inderbir S. Gill, Osamu Ukimura
      Abstract: ObjectivesMagnetic resonance imaging (MRI) can be used to reliably evaluate prostate zonal anatomy. Objectives of this study was to evaluate the impact of morphometric MRI analysis of the prostate zonal anatomy on aging, prostatic hypertrophy, and lower urinary tract symptoms in patients from Japan and the USA.Subjects and MethodsA retrospective analysis of 307 men, including Japanese (n=156) and American (n=151) patients, who consecutively underwent 3-Tesla MRI and International Prostate Symptom Score (IPSS) due to elevated PSA. Using Synapse-Vincent (Fujifilm), the prostatic zones were segmented in each axial step-section of T2-w-MRI to reconstruct a 3D-model of the prostate to calculate the zonal-volumes (whole-gland prostate [Pr-vol], transition zone [TZ-vol], and peripheral zone [PZ-vol]), the presumed circle area ratio [PCAR], and PZ thickness. Bivariate associations were quantified with the Spearman rank correlation coefficient.ResultsThe American men presented a greater Pr-vol (49ml vs. 42ml, p=0.003) and TZ-vol (26ml vs. 20ml, p
      PubDate: 2017-02-20T21:50:24.291801-05:
      DOI: 10.1111/bju.13823
  • Robot-Assisted Approach to W Configuration Urinary Diversion:A
           Step-by-Step Technique
    • Authors: Ahmed A. Hussein; Youssef E. Ahmed, Justen D. Kozlowski, Paul May, John Nyquist, Sandra Sexton, Leslie Curtin, James O. Peabody, Hassan Abol-Enein, Khurshid A. Guru
      Abstract: IntroductionTo describe a detailed step-by-step approach of our technique to robot-assisted intracorporeal “W” orthotopic ileal neobladder (ICNB).MethodsFive patients underwent robot-assisted radical cystectomy (RARC), extended pelvic lymph node dissection (ePLND) and ICNB. ICNB was divided into 6 key steps to facilitate and enable a detailed analysis and auditing of the technique. No conversion to open surgery was required. Timing for each step was noted. All patients had at least 3 months of follow up.ResultsMean age was 57 years. Mean overall console and diversion times were 357 and 193 minutes, respectively. None of the patients had any evidence of residual disease following RARC. Four of five patients experienced complications; 3 developed fevers due to urinary tract infection (one required readmission), and 1 patient developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularization and construction of posterior plate were consistently the longest among the key steps (average 46 minutes, 13% of the overall operative time), followed by uretero-ileal anastomosis (37 minutes, 10%), neobladder-urethral anastomosis (23 minutes, 6%) and identification and fixation of the bowel (26 minutes, 7%).ConclusionWe described our step-by-step technique and initial perioperative outcomes of our first five intracorporeal neobladders with “W” configurationThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T21:50:22.068827-05:
      DOI: 10.1111/bju.13824
  • Anatomical study of renal arterial vasculature and its potential impact on
           partial nephrectomy
    • Authors: Veronica Macchi; Alessandro Crestani, Andrea Porzionato, Maria Martina Sfriso, Aldo Morra, Marta Rossanese, Giacomo Novara, Raffaele De Caro, Vincenzo Ficarra
      Abstract: ObjectivesTo validate Graves’ classification of the intrarenal arteries and to verify the absence of collateral arterial blood supply between different renal segments, in order to maximize peri-operative and functional outcomes of partial nephrectomy.Materials and MethodsThe study was performed on 15 normal kidneys sampled from eight unembalmed cadavers. Kidneys with the surrounding perirenal fat tissue were removed en bloc with the abdominal segment of the aorta. The renal artery was injected with acrylic and radiopaque resins, with the specimen suspended in water. CT examination of the injected kidneys was performed to analyse the branches located deeply. After imaging acquisition, the specimens were treated with sodium hydroxide for removal of the parenchyma to obtain vascular casts.ResultsTen casts (66.6%) showed the classic subdivision of the main artery into single posterior and anterior branches. With regard to the distribution of the segmental or second-order arteries, only two casts (13%) showed a pattern similar to that described by Graves, characterized by four segmental (second-order) branches coming from the anterior renal artery (apical, superior, middle and inferior). In the remaining 13 kidneys (87%) a different arterial vascular network was detected. In 10 casts (80%) a single renal segment was vascularized by two or more different branches coming from an artery leading to another segment (multiple vascularization). Multiple vascularization was observed in three (20%) apical segments, five (33%) superior segments, six (40%) middle segments, seven (47%) inferior segments and two (13%) posterior segments.ConclusionsThis study shows that in the human kidneys the arterial vasculature is frequently different from that described by Graves. Moreover, in a significant percentage of cases, a single renal segment receives two or more branches that originate from an artery leading to another segment.
      PubDate: 2017-02-20T21:16:08.102661-05:
      DOI: 10.1111/bju.13788
  • Biomarker classification, validation, and what to look for in 2017 and
    • Authors: John W. Davis
      PubDate: 2017-02-20T21:15:25.273369-05:
      DOI: 10.1111/bju.13790
  • Chromogranin A and neurone-specific enolase variations during the first 3
           months of abiraterone therapy predict outcomes in patients with metastatic
           castration-resistant prostate cancer
    • Authors: Liancheng Fan; Yanqing Wang, Chenfei Chi, Jiahua Pan, Shangguan Xun, Zhixiang Xin, Jianian Hu, Lixin Zhou, Baijun Dong, Wei Xue
      Abstract: ObjectiveTo determine the prognostic utility of serum chromogranin A (CgA) and neurone-specific enolase (NSE) variations during the first 3 months of abiraterone acetate (AA) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC).Patients and MethodsThe serum levels of CgA, NSE were measured at baseline and after 3 months of AA treatment in 40 patients with mCRPC. Outcome measures were prostate-specific antigen progression-free survival (PSA-PFS), radiographic PFS (rPFS), and overall survival (OS).ResultsCgA levels were not correlated with NSE levels (P = 0.296). In multivariate analysis the combination of CgA and NSE (≥1 marker positive vs both markers negative) and the combination of CgA and NSE elevation during the first 3 months of AA treatment (≥1 marker positive vs both markers negative) remained significant predictors of OS, rPFS, and PSA-PFS.ConclusionWe found that CgA and NSE elevation during the first 3 months of AA treatment and elevated baseline CgA and NSE levels were independent prognostic factors for OS, rPFS and PSA-PFS in patients with mCRPC treated with AA. This suggests that serial CgA and NSE evaluation may help clinicians in distinguishing patients with mCRPC who would obtain the best survival benefit from AA treatment.
      PubDate: 2017-02-19T22:10:27.372213-05:
      DOI: 10.1111/bju.13781
  • Nocturia increases the incidence of depressive symptoms: a longitudinal
           study of the HEIJO-KYO cohort
    • Authors: Kenji Obayashi; Keigo Saeki, Hiromitsu Negoro, Norio Kurumatani
      Abstract: ObjectivesTo evaluate the association between nocturia and the incidence of depressive symptoms.Participants and MethodsOf 1 127 participants in the HEIJO-KYO population-based cohort, 866 elderly individuals (mean age 71.5 years) without depressive symptoms at baseline were followed for a median period of 23 months. Nocturnal voiding frequency was logged using a standardized urination diary and nocturia was defined as a frequency of ≥2 voids per night. Depressive symptoms were assessed using the Geriatric Depression Scale.ResultsDuring the follow-up period, 75 participants reported the development of depressive symptoms (score ≥6). The nocturia group (n = 239) exhibited a significantly higher hazard ratio (HR) for incident depressive symptoms than the non-nocturia group (n = 627) in the Cox proportional hazard model, which was adjusted for age, gender, alcohol consumption, day length and presence of hypertension and chronic kidney disease (HR 1.69, 95% confidence interval [CI] 1.05–2.72; P = 0.032]. The significance remained after adjustment for sleep disturbances (HR 1.68, 95% CI 1.02–2.75; P = 0.040). Analysis stratified by gender showed that the association between nocturia and the incidence of depressive symptoms was significant in men (HR 2.51, 95% CI 1.27–4.97; P = 0.008) but not in women (HR 1.12, 95% CI 0.53–2.44; P = 0.74).ConclusionsNocturia is significantly associated with a higher incidence of depressive symptoms in the general elderly population, and gender differences may underlie this association.
      PubDate: 2017-02-17T23:35:30.598407-05:
      DOI: 10.1111/bju.13791
  • Development of a voided urine assay for detecting prostate cancer
           non-invasively: a pilot study
    • Authors: Edouard J. Trabulsi; Sushil K. Tripathi, Leonard Gomella, Charalambos Solomides, Eric Wickstrom, Mathew L. Thakur
      Abstract: ObjectiveTo validate a hypothesis that prostate cancer can be detected non-invasively by a simple and reliable assay by targeting genomic VPAC receptors expressed on malignant prostate cancer cells shed in voided urine.Patients/Subjects and MethodsVPAC receptors were targeted with a specific biomolecule, TP4303, developed in our laboratory. With an Institutional Review Board exempt approval of use of de-identified discarded samples, an aliquot of urine collected as a standard of care, from patients presenting to the urology clinic (207 patients, 176 men and 31 women, aged ≥21 years) was cytospun. The cells were fixed and treated with TP4303 and 4,6-diamidino-2-phenylindole (DAPI). The cells were then observed under a microscope and cells with TP4303 orange fluorescence around the blue (DAPI) nucleus were considered ‘malignant’ and those only with a blue nucleus were regarded as ‘normal’. VPAC presence was validated using receptor blocking assay and cell malignancy was confirmed by prostate cancer gene profile examination.ResultsThe urine specimens were labelled only with gender and presenting diagnosis, with no personal health identifiers or other clinical data. The assay detected VPAC positive cells in 98.6% of the men with a prostate cancer diagnosis (141), and none of the 10 men with benign prostatic hyperplasia. Of the 56 ‘normal’ patients, 62.5% (35 patients, 10 men and 25 women) were negative for VPAC cells; 19.6% (11, 11 men and no women) had VPAC positive cells; and 17.8% (10, four men and six women) were uninterpretable due to excessive crystals in the urine. Although data are limited, the sensitivity of the assay was 99.3% with a confidence interval (CI) of 96.1–100% and the specificity was 100% with a CI of 69.2–100%. Receptor blocking assay and fluorescence-activated cell sorting (FACS) analyses demonstrated the presence of VPAC receptors and gene profiling examinations confirmed that the cells expressing VPAC receptors were malignant prostate cancer cells.ConclusionThese preliminary data are highly encouraging and warrant further evaluation of the assay to serve as a simple and reliable tool to detect prostate cancer non-invasively.
      PubDate: 2017-02-16T21:30:40.606646-05:
      DOI: 10.1111/bju.13775
  • A Multiparametric Magnetic Resonance Imaging Based Risk Model to Determine
           the Risk of Significant Prostate Cancer prior to biopsy
    • Authors: Pim J van 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
      Abstract: ObjectivesTo develop and externally validate a predictive model for detection of significant prostate cancer (PC).Subjects and MethodsDevelopment of the model was based on prospective cohort including 393 men who underwent mpMRI prior to biopsy. External validity of the model was then examined retrospectively in 198 men from a separate institution whom underwent a mpMRI followed by biopsy for abnormal PSA/DRE. A model was developed with age, PSA, DRE, prostate volume, previous biopsy and PIRADS score as predictors for significant PC (Gleason 7 with>5% grade 4, ≥ 20% cores positive or ≥ 7mm of PC in any core). Probability was studied via logistic regression. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling.Results393 men had complete data. A total of 149 patients (37.9%) had significant PC. While the variable model had good accuracy in predicting significant PC (AUC of 0.80), the advanced model (incorporating mpMRI) had significant higher AUC of 0.88 (p
      PubDate: 2017-02-16T12:45:59.047265-05:
      DOI: 10.1111/bju.13814
  • Detection of prostate cancer using magnetic resonance
           imaging/ultrasonography image-fusion targeted biopsy in African-American
    • Authors: Toshitaka Shin; Thomas B. Smyth, Osamu Ukimura, Nariman Ahmadi, Andre Luis Castro Abreu, Masakatsu Oishi, Hiromitsu Mimata, Inderbir S. Gill
      Abstract: ObjectiveTo assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US).Patients and MethodsWe retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7.ResultsAfter controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4–5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively.ConclusionsOur key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.
      PubDate: 2017-02-15T23:50:30.291003-05:
      DOI: 10.1111/bju.13786
  • TANGO - a screening tool to identify comorbidities on the causal pathway
           of nocturia
    • Authors: Wendy F. Bower; Georgie E. Rose, Claire F. Ervin, Jeremy Goldin, David M. Whishaw, Fary Khan
      Abstract: ObjectivesTo develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia.MethodsVariables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the Short-Form (SF) screening tool. The tool was administered to 252 individuals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected were subjected to descriptive analysis; criteria were applied to reduce the number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the individual's Aetiology of Nocturia to Guide Outcomes.ResultsThe demographic characteristics of the sample are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long-Form to the SF is presented. The resultant TANGO-SF patient-completed nocturia screening tool is reported.ConclusionsA novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.
      PubDate: 2017-02-12T23:31:30.952781-05:
      DOI: 10.1111/bju.13774
  • Evaluation of a 24-gene signature for prognosis of metastatic events and
           prostate cancer-specific mortality
    • Authors: Kathryn L. Pellegrini; Martin G. Sanda, Dattatraya Patil, Qi Long, María Santiago-Jiménez, Mandeep Takhar, Nicholas Erho, Kasra Yousefi, Elai Davicioni, Eric A. Klein, Robert B. Jenkins, R. Jeffrey Karnes, Carlos S. Moreno
      Abstract: ObjectivesTo determine the prognostic potential of a 24-gene signature, Sig24, for identifying patients with prostate cancer who are at risk of developing metastases or of prostate cancer-specific mortality (PCSM) after radical prostatectomy (RP).Patients and MethodsSig24 scores were calculated from previously collected gene expression microarray data from the Cleveland Clinic and Mayo Clinic (I and II). The performance of Sig24 was determined using time-dependent c-index analysis, Cox proportional hazards regression and Kaplan–Meier survival analysis.ResultsHigher Sig24 scores were significantly associated with higher pathological Gleason scores in all three cohorts. Analysis of the Mayo Clinic II cohort, which included time-to-event information, indicated that patients with high Sig24 scores also had a higher risk of developing metastasis (hazard ratio [HR] 3.78, 95% confidence interval [CI]: 1.96–7.29; P < 0.001) or of PCSM (HR 6.54, 95% CI: 2.16–19.83; P < 0.001).ConclusionsThe findings of the present study show the applicability of Sig24 for the prognosis of metastasis or PCSM after RP. Future studies investigating the combination of Sig24 with available prognostic tests may provide new approaches to improve risk stratification for patients with prostate cancer.
      PubDate: 2017-02-11T02:40:29.314774-05:
      DOI: 10.1111/bju.13779
  • Dishevelled segment polarity protein 3 (DVL3): a novel and easily
           applicable recurrence predictor in localised prostate adenocarcinoma
    • Authors: Pil-Jong Kim; Ji Y. Park, Hong-Gee Kim, Yong Mee Cho, Heounjeong Go
      Abstract: ObjectiveTo identify new biomarkers for biochemical recurrence (BCR) of prostate adenocarcinoma.Patients and MethodsClinical information of 500 patients with prostate adenocarcinoma and their 152 RNA-sequencing and protein-array data from The Cancer Genome Atlas (TCGA) were separated into a discovery set and a validation set. Each dataset was analysed according to the Gleason grade groups reflecting BCR. The results obtained from the analysis using TCGA dataset were confirmed by immunohistochemistry analyses of a confirmation cohort composed of 395 patients with localised prostate adenocarcinoma.ResultsTCGA discovery set was subgrouped into lower- and higher-risk groups for recurrence-free survival (RFS) (P < 0.001). Cyclin B1 (CCNB1), dishevelled segment polarity protein 3 (DVL3), paxillin (PXN), RAF1, transferrin, X-ray repair cross complementing 5 (XRCC5) and BIM had lower expression in the lower-risk group than that in the higher-risk group (all, P < 0.05). In TCGA validation set, CCNB1, DVL3, transferrin, XRCC5 and BIM were also differently expressed between the two groups. Immunohistochemically, DVL3 positivity was associated with high prostate-specific antigen (PSA) levels, resection margin involvement, and BCR (all, P < 0.05). A high Gleason score indicated a marginal relationship (P = 0.055). BIM positivity was related to high PSA levels, lymphovascular invasion, and BCR (all, P < 0.05). Both DVL3 positivity (P = 0.010) and BIM positivity (P = 0.024) were associated with shorter RFS, but statistical significance was lost when the multivariate Cox regression model included all patients. In the lower-risk group, the multivariate Cox model confirmed that DVL3 was an independent predictor for poor RFS (hazard ratio 1.80, P = 0.040), and the concordance index (C-index) was 0.805.ConclusionsDVL3 and BIM were expressed in patients with a higher risk of BCR. DVL3 may be a novel and easily applicable recurrence predictor of localised prostate adenocarcinoma.
      PubDate: 2017-02-10T04:25:27.362946-05:
      DOI: 10.1111/bju.13783
  • Prognostic value of tissue-based biomarker signature in clear cell renal
           cell carcinoma
    • Authors: Ahmed Q. Haddad; Jun-Hang Luo, Laura-Maria Krabbe, Oussama Darwish, Bishoy Gayed, Ramy Youssef, Payal Kapur, Dinesh Rakheja, Yair Lotan, Arthur Sagalowsky, Vitaly Margulis
      Abstract: ObjectiveTo improve risk stratification for recurrence prognostication in patients with localised clear cell renal cell carcinoma (ccRCC).Patients and MethodsIn all, 367 patients with non-metastatic ccRCC were included. The cohort was divided into a training and validation set. Using tissue microarrays, immunostaining was performed for 24 biomarkers representative of key pathways in ccRCC. Using Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression, we identified several markers that were used to construct a risk classifier for risk of disease recurrence.ResultsThe median (interquartile range) follow-up was 63.5 (24.0–85.3) months. Five out of 24 markers were selected by LASSO Cox regression for the risk classifier: N-cadherin, E-cadherin, Ki67, cyclin D1 and phosphorylated eukaryotic initiation factor 4E binding protein-1 (p-4EBP1). Patients were classified as either low, intermediate or high risk of disease recurrence by tertiles of risk score. The 5-year recurrence-free survival (RFS) was 93.8%, 87.7% and 70% for patients with low-, intermediate- and high-risk scores, respectively (P < 0.001). Patients with a high marker score had worse RFS on multivariate analysis adjusted for age, gender, race and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score (hazard ratio 3.66, 95% confidence interval 1.58–8.49, P = 0.003 for high vs low marker score in the overall cohort). The five-marker classifier increased the concordance index of the clinical model in both the training and validation sets.ConclusionWe developed a five-marker-based prognostic tool that can effectively classify patients with ccRCC according to risk of disease recurrence after surgery. This tool, if prospectively validated, could provide individualised risk estimation for patients with ccRCC.
      PubDate: 2017-02-09T10:51:21.906331-05:
      DOI: 10.1111/bju.13776
  • Detection and oncological effect of circulating tumour cells in patients
           with variant urothelial carcinoma histology treated with radical
    • Authors: Armin Soave; Sabine Riethdorf, Roland Dahlem, Sarah Minner, Lars Weisbach, Oliver Engel, Margit Fisch, Klaus Pantel, Michael Rink
      Abstract: ObjectivesTo investigate for the presence of circulating tumour cells (CTC) in patients with variant urothelial carcinoma of the bladder (UCB) histology treated with radical cystectomy (RC), and to determine their impact on oncological outcomes.Patients and methodsWe prospectively collected data of 188 patients with UCB treated with RC without neoadjuvant chemotherapy. Pathological specimens were meticulously reviewed for pure and variant UCB histology. Preoperatively collected blood samples (7.5 mL) were analysed for CTC using the CellSearch® system (Janssen, Raritan, NJ, USA).ResultsVariant UCB histology was found in 47 patients (25.0%), most frequently of squamous cell differentiation (16.5%). CTC were present in 30 patients (21.3%) and 12 patients (25.5%) with pure and variant UCB histology, respectively. At a median follow-up of 25 months, the presence of CTC and non-squamous cell differentiation were associated with reduced recurrence-free survival (RFS) and cancer-specific survival (pairwise P ≤ 0.016). Patients without CTC had better RFS, independent of UCB histology, than patients with CTC with any UCB histology (pairwise P < 0.05). In multivariable analyses, the presence of CTC, but not variant UCB histology, was an independent predictor for disease recurrence [hazard ratio (HR) 3.45; P < 0.001] and cancer-specific mortality (HR 2.62; P = 0.002).ConclusionCTC are detectable in about a quarter of patients with pure or variant UCB histology before RC, and represent an independent predictor for outcomes, when adjusting for histological subtype. In addition, our prospective data confirm the unfavourable influence of non-squamous cell-differentiated UCB on outcomes.
      PubDate: 2017-02-09T10:51:18.743203-05:
      DOI: 10.1111/bju.13782
  • Quantifying severe urinary complications after radical prostatectomy: the
           development and validation of a surgical performance indicator using
           hospital administrative data
    • Authors: Arunan Sujenthiran; Susan C. Charman, Matthew Parry, Julie Nossiter, Ajay Aggarwal, Prokar Dasgupta, Heather Payne, Noel W. Clarke, Paul Cathcart, Jan Meulen
      Abstract: ObjectivesTo develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data.Patients and MethodsMen who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into ‘stricture’, ‘incontinence’ and ‘other’. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan–Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics.ResultsA total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26–1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40–1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58–0.74).ConclusionThese results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.
      PubDate: 2017-02-08T21:55:35.025636-05:
      DOI: 10.1111/bju.13770
  • Changes in penile length after radical prostatectomy: investigation of the
           underlying anatomical mechanism
    • Authors: Yoshifumi Kadono; Kazuaki Machioka, Kazufumi Nakashima, Masashi Iijima, Kazuyoshi Shigehara, Takahiro Nohara, Kazutaka Narimoto, Kouji Izumi, Yasuhide Kitagawa, Hiroyuki Konaka, Toshifumi Gabata, Atsushi Mizokami
      Abstract: ObjectiveTo measure changes in penile length (PL) over time before and after radical prostatectomy (RP), and to investigate the underlying mechanisms for these changes.Patients and MethodsThe stretched PL (SPL) of 102 patients was measured before, 10 days after, and at 1, 3, 6, 9, 12, 18 and 24 months after RP. The perpendicular distance from the distal end of the membranous urethra to the midline of the pelvic outlet was measured on mid-sagittal magnetic resonance imaging (MRI) slice at three time points: preoperatively; 10 days after RP; and 12 months after RP. Pre- and postoperative SPLs were compared using paired Student's t-test. Predictors of PL shortening at 10 days and at 12 months after RP were evaluated on univariate and multivariate analyses.ResultsThe SPL was shortest 10 days after RP (mean PL shortening from preoperative level: 19.9 mm), and gradually recovered thereafter. SPL at 12 months after RP was not significantly different from preoperative SPL. On MRI examination, the distal end of membranous urethra was found to have moved proximally (mean proximal displacement: 3.9 mm) at 10 days after RP, and to have returned to the preoperative position at 12 months after RP. On univariate analysis, only the volume of the removed prostate was a predictor of SPL change at 10 days after surgery; on multivariate analysis, the association was not statistically significant. No predictor of SPL change was found at 12 months after RP.ConclusionThe SPL was shortest at 10 days after RP and gradually recovered thereafter in the present study. Anatomically, the glans and corpus spongiosum surrounding the urethra are an integral structure, and the proximal urethra is drawn into the pelvis during urethrovesical anastomosis. This is the first report showing that slight vertical repositioning of the membranous urethra after RP causes changes in SPL over time. These results can help inform patients about changes in penile appearance after RP.
      PubDate: 2017-02-08T21:55:30.446179-05:
      DOI: 10.1111/bju.13777
  • 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
      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
  • Weighing the evidence from surgical trials
    • Authors: Quoc-Dien Trinh; Alexander P. Cole, Prokar Dasgupta
      PubDate: 2017-02-06T09:46:27.667989-05:
      DOI: 10.1111/bju.13778
  • Late surgical correction of hypospadias increases the risk of
           complications: a series of 501 consecutive patients
    • Authors: Sarah Garnier; Olivier Maillet, Barbara Cereda, Margot Ollivier, Clement Jeandel, Sylvie Broussous, Christophe Lopez, Francoise Paris, Pascal Philibert, Cyril Amouroux, Claire Jeandel, Amandine Coffy, Laura Gaspari, Jean Pierre Daures, Charles Sultan, Nicolas Kalfa
      Abstract: ObjectivesTo evaluate the outcomes of hypospadias surgery according to age and to determine if some complications are age-related.Patients and MethodsThis retrospective study was based on 722 boys with hypospadias undergoing primary repair. A total of 501 boys underwent urethroplasty and were included in the study. Complications requiring an additional procedure (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) were included in the analysis, as well as healing problems, infections, haematomas and detrusor-sphincter dyssynergy. Logistic regression analysis was performed.ResultsHypospadias was anterior in 63.1%, mid-penile in 20.5%, posterior in 8.4% and scrotal in 7.9% of the boys. The median (range) age was 4 (1–16) years. The overall rates of re-intervention and complications were 22.8% and 36.2%, respectively. Age>2 years was a significant predictor of complications (P = 0.002, odds ratio 1.98 [95% confidence interval 1.26–3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy was more common between the ages of 24 and 36 months (12.5 vs 3.6%; P = 0.01) and healing problemswere more common in boys aged>13 years (1.5 vs 28.5%; P = 0.06).ConclusionDelayed surgery may be detrimental for patients. Factors related to age may influence the rate of complications. After the age of 2 years, urethral surgery may interfere with the normal toilet-training process. During puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be prudent to continue to advocate early surgery in patients with disorders of sex development.
      PubDate: 2017-02-01T08:11:12.477421-05:
      DOI: 10.1111/bju.13771
  • Efficacy and safety of tadalafil 5 mg once daily in the treatment of lower
           urinary tract symptoms associated with benign prostatic hyperplasia in men
           aged ≥75 years: integrated analyses of pooled data from multinational,
           randomized, placebo-controlled clinical studies
    • Authors: Matthias Oelke; Adrian Wagg, Yasushi Takita, Hartwig Büttner, Lars Viktrup
      Abstract: ObjectiveTo assess efficacy and safety of tadalafil in men aged ≥75 years with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and additional safety in men aged ≥75 years with erectile dysfunction (ED).Patients and MethodsWe conducted an integrated analysis of 12 phase II–III randomized, double-blind and/or open-label extension studies to evaluate short-term (12–26 weeks) efficacy and short- and longer-term (42–52 weeks) safety in men aged
      PubDate: 2017-01-22T21:30:31.879734-05:
      DOI: 10.1111/bju.13744
  • Importance and outcome relevance of central pathology review in
           prostatectomy specimens: data from the SAKK 09/10 randomized trial on
           prostate cancer
    • Authors: Pirus Ghadjar; Stefanie Hayoz, Vera Genitsch, Daniel R. Zwahlen, Tobias Hölscher, Philipp Gut, Matthias Guckenberger, Guido Hildebrandt, Arndt-Christian Müller, Paul M. Putora, Alexandros Papachristofilou, Lukas Stalder, Christine Biaggi-Rudolf, Marcin Sumila, Helmut Kranzbühler, Yousef Najafi, Piet Ost, Ngwa C. Azinwi, Christiane Reuter, Stephan Bodis, Kaouthar Khanfir, Volker Budach, Daniel M. Aebersold, George N. Thalmann,
      Abstract: ObjectiveTo conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in changes in histopathological prognostic factors, such as Gleason score.Patients and MethodsA total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated.ResultsThere was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (3–38) mm. A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma (odds ratio [OR] 2.04 [95% CI 1.30, 3.20]; P = 0.002), resection margin status (OR 0.36 [95% CI 0.18, 0.72]; P = 0.004) and Gleason score (OR 1.55 [95% CI 1.00, 2.42]; P = 0.05) remained associated with rapid progression after salvage RT after backward selection.ConclusionThe results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
      PubDate: 2017-01-19T01:20:23.817352-05:
      DOI: 10.1111/bju.13742
  • Early surgical outcomes and oncological results of robot-assisted partial
           nephrectomy: a multicentre study
    • Authors: Rajan Veeratterapillay; Sanjai K. Addla, Clare Jelley, John Bailie, David Rix, Steve Bromage, Neil Oakley, Robin Weston, Naeem A. Soomro
      Abstract: ObjectiveTo describe a multicentre experience of robot-assisted partial nephrectomy (RAPN) in northern England, with focus on early surgical outcomes and oncological results.Patients and MethodsAll consecutive patients undergoing RAPN at four tertiary referral centres in northern England in the period 2012–2015 were included for analysis. RAPN was performed via a transperitoneal approach using a standardized technique. Prospective data collection was performed to capture preoperative characteristics (including R.E.N.A.L. nephrometry score), and peri-operative and postoperative data, including renal function. Correlations between warm ischaemia time (WIT), positive surgical margin (PSM) rate, complication rates, R.E.N.A.L. nephrometry scores and learning curve were assessed using univariate and multivariate analyses.ResultsA total of 250 patients (mean age 58.1 ± 13 years, mean ± sd body mass index 27.3 ± 7 kg/m2) were included, with a median (range) follow-up of 12 (3–36) months. The mean ± sd tumour size was 30.6 ± 10 mm, mean R.E.N.A.L. nephrometry score was 6.1 ± 2 and 55% of tumours were left-sided. Mean ± sd operating console time was 141 ± 38 min, WIT 16.7 ± 8 min and estimated blood loss 205 ± 145 mL. There were five conversions (2%) to open/radical nephrectomy. The overall complication rate was 16.4% (Clavien I, 1.6%; Clavien II, 8.8%; Clavien III, 6%; Clavien IV/V; 0%). Pathologically, 82.4% of tumours were malignant and the overall PSM rate was 7.3%. The mean ± sd preoperative and immediate postoperative estimated glomerular filtration rates were 92.8 ± 27 and 80.8 ± 27 mL/min/1.73 m2, respectively (P = 0.001). In all, 66% of patients remained in the same chronic kidney disease category postoperatively, and none of the patients required dialysis during the study period. ‘Trifecta’ (defined as WIT < 25 min, negative surgical margin status and no peri-operative complications) was achieved in 68.4% of patients overall, but improved with surgeon experience. PSM status and long WIT were significantly associated with early learning curve.ConclusionThis is the largest multicentre RAPN study in the UK. Initial results show that RAPN is safe and can be performed with minimal morbidity. Early oncological outcomes and renal function preservation data are encouraging.
      PubDate: 2017-01-18T08:56:41.6601-05:00
      DOI: 10.1111/bju.13743
  • Development, validation and clinical application of Pelvic Lymphadenectomy
           Assessment and Completion Evaluation: intraoperative assessment of lymph
           node dissection after robot-assisted radical cystectomy for bladder cancer
    • Authors: Ahmed A. Hussein; Nobuyuki Hinata, Shiva Dibaj, Paul R. May, Justen D. Kozlowski, Hassan Abol-Enein, Ronney Abaza, Daniel Eun, Mohamed S. Khan, James L. Mohler, Piyush Agarwal, Kamal Pohar, Richard Sarle, Ronald Boris, Sridhar S. Mane, Alan Hutson, Khurshid A. Guru
      Abstract: ObjectivesTo develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC).Patients, Subjects and MethodsA panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into three zones. In all, 21 de-identified videos of bilateral robot-assisted PLNDs were assessed by the 11 experts using PLACE to determine inter-rater reliability. Lymph node (LN) clearance was defined as the proportion of cleared LNs from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE).ResultsA significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431–545). There was a significant positive correlation between LN clearance and LN count (R2 = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group.ConclusionsPelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC.
      PubDate: 2017-01-18T08:10:24.24055-05:0
      DOI: 10.1111/bju.13748
  • Robotic salvage retroperitoneal and pelvic lymph node dissection for
           ‘node-only’ recurrent prostate cancer: technique and initial series
    • Authors: Andre Abreu; Carlos Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir Gill
      Abstract: ObjectivesTo describe the technique of robot-assisted high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer.Patients and MethodsIn all, 10 patients underwent robot-assisted sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by 11C-acetate positron emission tomography/computed tomography imaging. Our anatomical template extends from bilateral renal artery/vein cranially up to Cloquet's node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees; RPLND precedes PLND. Meticulous node-mapping assessed nodes at four prospectively assigned anatomical zones.ResultsThe median operative time was 4.8 h, estimated blood loss 100 mL and hospital stay 1 day. No patient had an intraoperative complication, open conversion or blood transfusion. Three patients had spontaneously resolving Clavien–Dindo grade II postoperative complications. The mean (range) number of nodes excised per patient was 83 (41–132) and mean (range) number of positive nodes per patient was 23 (0–109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomical level I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, the median PSA level had decreased by 83% at the 2-month follow-up.ConclusionThe initial series of robot-assisted sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robot-assisted technical details for an anatomical LND template up to the renal vessels are presented. Longer follow-up is necessary to assess oncological outcomes.
      PubDate: 2017-01-14T08:01:11.419146-05:
      DOI: 10.1111/bju.13741
  • Safety and early effectiveness of robot-assisted partial nephrectomy for
           large angiomyolipomas
    • Authors: Shay Golan; Scott C. Johnson, Matthew J. Maurice, Jihad H. Kaouk, Weil R. Lai, Benjamin R. Lee, Steven V. Kheyfets, Chandru P. Sundaram, David B. Cahn, Robert G. Uzzo, Arieh L. Shalhav
      Abstract: ObjectiveTo evaluate a multicentre series of robot-assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).Patients and MethodsBetween 2005 and 2016, 40 patients with large or symptomatic AMLs underwent RAPN at five academic centres in the USA. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analysed. Surgical outcomes were compared between patients who underwent selective arterial embolisation (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.ResultsThe median (interquartile range [IQR]) tumour diameter was 7.2 (5–8.5) cm, and the median (IQR) nephrometry score was 9 (7–10). Six patients (15%) had a history of tuberous sclerosis and 11 (28%) had previously undergone SAE. The median (IQR) operative time and warm ischaemia time was 207 (180–231) and 22.5 (16–28) min, respectively. A non-clamping technique was used in eight (20%) patients. The median (IQR) estimated blood loss was 200 (100–245) mL, and four patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and seven postoperative complications occurred in six patients (15%). During a median (IQR) follow-up of 8 (1–15) months, none of the patients developed AML-related symptoms. The median estimated glomerular filtration rate preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before RAPN and those who did not.ConclusionsRobot-assisted partial nephrectomy appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with a favourable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.
      PubDate: 2017-01-12T22:20:24.505929-05:
      DOI: 10.1111/bju.13747
  • Sorafenib dose escalation in treatment-naïve patients with metastatic
           renal cell carcinoma: a non-randomised, open-label, Phase 2b study
    • Authors: Martin E. Gore; Robert J. Jones, Alain Ravaud, Markus Kuczyk, Tomasz Demkow, Alessandra Bearz, JoAnn Shapiro, Uwe Phillip Strauss, Camillo Porta
      Abstract: ObjectiveTo assess the efficacy and safety of sorafenib dose escalation in metastatic renal cell carcinoma (mRCC).Patients and MethodsIntra-patient dose escalation may enhance the clinical benefit of targeted anticancer agents in metastatic disease. In this non-randomised, open-label, Phase 2b study, treatment-naïve patients with mRCC were initially treated with the standard oral sorafenib dose [400 mg twice daily (BID)]. Two dose escalations were planned, each 200 mg BID after 28 days at the prior level. Dose reductions, interruptions, or delayed escalations were used to manage adverse events (AEs). The primary endpoint was objective response rate (ORR) in the modified intent-to-treat (mITT) population, which comprised patients with ≥6 months of treatment including ≥4 months of therapy at their highest tolerated dose. Secondary endpoints included progression-free survival (PFS) and safety.ResultsIn all, 83 patients received sorafenib. The dose received for the longest duration was 400, 600, and 800 mg BID in 48.2%, 15.7%, and 24.1% of patients, respectively. The ORR was 44.4% [n = 8/18; 95% confidence interval (CI) 21.5–69.2] and 17.9% (n = 12/67; 95% CI 9.6–29.2) in the mITT and ITT populations, respectively. The median (95% CI) PFS was 7.4 (6.0–11.7) months (ITT). The most common AEs of any grade were hand–foot skin reaction (66.3%) and diarrhoea (63.9%).ConclusionSorafenib demonstrated clinical benefit in treatment-naïve patients with mRCC. However, relatively few patients could sustain doses of>400 mg BID. There was evidence that, where tolerated, escalation from the standard sorafenib dose may have enhanced clinical benefit. However, this study does not support dose escalation for most patients with treatment-naïve mRCC. Alternative protocols for sorafenib dose escalation could be explored.
      PubDate: 2017-01-09T10:20:28.421181-05:
      DOI: 10.1111/bju.13740
  • Development and external validation of a biopsy-derived nomogram to
           predict risk of ipsilateral extraprostatic extension
    • Authors: Rashid Sayyid; Nathan Perlis, Ardalanejaz Ahmad, Andrew Evans, Ants Toi, Michael Horrigan, Antonio Finelli, Alexandre Zlotta, Girish Kulkarni, Robert Hamilton, Christopher Morash, Neil Fleshner
      Abstract: ObjectivesTo develop and externally validate a nomogram that predicts risk of side-specific extraprostatic extension (EPE) at time of surgery, using commonly available preoperative markers.Materials and MethodsA consecutive sample of 753 men treated by radical prostatectomy (RP) at the University Health Network, Toronto, between 2009 and 2015, was used to develop the nomogram. The validation cohort consisted of 311 men treated by RP at Ottawa Hospital Research Institute, between 1992 and 2014. The study outcome was presence of ipsilateral EPE. The association between predictors considered and EPE was tested using univariate and multivariate logistic regression analyses. The predictive accuracy of the nomogram was determined using the area under the receiver-operating characteristic curve.ResultsThe overall rate of EPE was 19.8% of all lobes in the developmental cohort and 28.9% in the validation cohort. Significant variables in the models were age, prostate-specific antigen and ipsilateral Gleason score, percentage of positive cores and highest core involvement (all P < 0.05). The nomogram predicting risk of EPE had a predictive accuracy of 0.74 in the external validation cohort.ConclusionWe developed and externally validated a nomogram that predicts the risk of ipsilateral EPE based on commonly used preoperative markers. This nomogram may be used to assist surgical decision-making prior to RP.
      PubDate: 2017-01-06T05:00:32.614376-05:
      DOI: 10.1111/bju.13733
  • Clinical impact of 68Ga-prostate-specific membrane antigen (PSMA) positron
           emission tomography/computed tomography (PET/CT) in patients with prostate
           cancer with rising prostate-specific antigen after treatment with curative
           intent: preliminary analysis of a multidisciplinary approach
    • Authors: Simone Albisinni; Carlos Artigas, Fouad Aoun, Ibrahim Biaou, Julien Grosman, Thierry Gil, Eric Hawaux, Ksenija Limani, Francois-Xavier Otte, Alexandre Peltier, Spyridon Sideris, Nicolas Sirtaine, Patrick Flamen, Roland Velthoven
      Abstract: ObjectiveTo assess the impact of a novel molecular imaging technique, 68Ga-(HBED-CC)-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), in the clinical management of patients with prostate cancer with rising prostate-specific antigen (PSA) after treatment with curative intent.Patients and MethodsIn all, 131 consecutive patients were referred to our centre for a 68Ga-PSMA PET/CT in the setting of recurring prostate cancer. Of these patients, 11/131(8%) presented with persistent PSA after radical prostatectomy, while 120/131 (92%) were referred for biochemical recurrence after surgery, radiotherapy or both. The images where taken 1 h after injection of 2 MBq/kg of the 68Ga-(HBED-CC)-PSMA ligand. All examinations were interpreted by two experienced nuclear medicine specialists. Using the results of the examination, a multidisciplinary oncology committee (MOC) reported on the treatment strategy. A positive impact on clinical management was considered if the examination determined a modification in the treatment strategy compared to the MOC decision before PSMA imaging.ResultsAll patients completed the examination with no adverse reactions. The median (interquartile range) PSA level at the time of the examination was 2.2 (0.72–6.7) ng/mL. Overall, 68Ga-PSMA PET/CT detected at least one lesion suspicious for prostate cancer in 98/131 (75%) patients. There was an impact on subsequent management in 99/131 patients (76%). The main modifications included continuing surveillance (withholding hormonal therapy), hormonal manipulations, stereotaxic radiotherapy, salvage radiotherapy, salvage node dissection or salvage local treatment (prostatectomy, high-intensity focussed ultrasound).ConclusionOur preliminary experience suggests that performing 68Ga-PSMA PET/CT in patients with prostate cancer with rising PSA after treatment with curative intent can be clinically useful as it changes the treatment strategy in a significant proportion of patients. However, larger prospective trials are needed to validate our present findings.
      PubDate: 2017-01-04T02:30:22.415062-05:
      DOI: 10.1111/bju.13739
  • The British are coming!
    • Authors: Manoj Monga
      Pages: 651 - 651
      PubDate: 2017-04-09T23:47:25.862574-05:
      DOI: 10.1111/bju.13868
  • Is there a role for pure clinical prediction models in prostate cancer in
           the contemporary era?
    • Authors: Giorgio Gandaglia; Nicola Fossati, Paolo Dell'Oglio, Francesco Montorsi, Alberto Briganti
      Pages: 652 - 653
      PubDate: 2017-04-09T23:47:31.347299-05:
      DOI: 10.1111/bju.13833
  • Oestrogen redux: will transdermal delivery rebalance the
           risk–benefit equation?
    • Authors: Paul F. Schellhammer
      Pages: 653 - 654
      PubDate: 2017-04-09T23:47:29.446268-05:
      DOI: 10.1111/bju.13737
  • The BPH6 study raises the bar on how we should conduct BPH surgical trials
    • Authors: Henry H. Woo
      Pages: 654 - 655
      PubDate: 2017-04-09T23:47:30.91622-05:0
      DOI: 10.1111/bju.13815
  • Considerations about the adjustable transobturator male system (ATOMS®)
           device… is it really all so easy?
    • Authors: Christian Gozzi
      Pages: 655 - 656
      PubDate: 2017-04-09T23:47:28.972367-05:
      DOI: 10.1111/bju.13830
  • Do micropapillary patients benefit from chemotherapy?
    • Authors: Nicolas Landenberg; Jacqueline M. Speed, Quoc-Dien Trinh
      Pages: 656 - 658
      PubDate: 2017-04-09T23:47:26.815938-05:
      DOI: 10.1111/bju.13780
  • Prostatic urethral lift vs transurethral resection of the prostate: 2-year
           results of the BPH6 prospective, multicentre, randomized study
    • Authors: Christian Gratzke; Neil Barber, Mark J. Speakman, Richard Berges, Ulrich Wetterauer, Damien Greene, Karl-Dietrich Sievert, Christopher R. Chapple, Jacob M. Patterson, Lasse Fahrenkrug, Martin Schoenthaler, Jens Sonksen
      Abstract: ObjectivesTo compare prostatic urethral lift (PUL) with transurethral resection of the prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.Patients and MethodsA total of 80 patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia (BPH) were enrolled in a prospective, randomized, controlled, non-blinded study conducted at 10 European centres. The BPH6 responder endpoint assessed symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation and safety. Additional evaluations of patient perspective, quality of life and sleep were prospectively collected, analysed and presented for the first time.ResultsSignificant improvements in International Prostate Symptom Score (IPSS), IPSS quality of life (QoL), BPH Impact Index (BPHII), and maximum urinary flow rate (Qmax) were observed in both arms throughout the 2-year follow up. Change in IPSS and Qmax in the TURP arm were superior to the PUL arm. Improvements in IPSS QoL and BPHII score were not statistically different between the study arms. PUL resulted in superior quality of recovery, ejaculatory function preservation and performance on the composite BPH6 index. Ejaculatory function bother scores did not change significantly in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep.ConclusionPUL was compared to TURP in a randomised, controlled study which further characterized both modalities so that care providers and patients can better understand the net benefit when selecting a treatment option.
      PubDate: 2016-12-21T21:38:56.04767-05:0
      DOI: 10.1111/bju.13714
  • Introduction of robot-assisted radical cystectomy within an established
           enhanced recovery programme
    • Authors: Catherine Miller; Nicholas J. Campain, Rachel Dbeis, Mark Daugherty, Nicholas Batchelor, Elizabeth Waine, John S. McGrath
      Abstract: ObjectivesTo describe the implementation phase of a robot-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS).Patients and MethodsIn all, 114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 [ileal conduit (97 patients) and orthotopic neobladder (17)]. Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied. All patients were managed on the Exeter Enhanced Recovery Pathway (ERP) in a unit where embedded enhanced recovery practice was already established. Data were collected prospectively on the national cystectomy registry – the British Association of Urological Surgeons (BAUS) Complex Operations Dataset.ResultsRARC was technically feasible in all but one case. The mean operating time was 3–5 h with an overall transfusion rate of 8.8%. There were higher-grade complications (Clavien–Dindo grade III–IV) in 18.4% of patients, with a 30-day mortality rate of 0.9%. The median (range) LOS after RARC was 7 (3–68) days, with a re-admission rate of 18.4%.ConclusionsThe present series shows that RARC can be safely implemented in a unit experienced in robot-assisted surgery (RAS). Case-selection in this setting is not deemed necessary. There are benefits in terms of lower transfusion rates and reduced LOS. The side-effect profile appears to differ from that of open RC, and despite the fact that complication rate is equivalent; ‘technical’ complications are over-represented in the RAS group. As such, they should improve with experience, recognition, and modification of surgical technique. ERPs can be safely applied to all patients undergoing RARC to maximise the benefits of minimally invasive surgery.
      PubDate: 2016-12-21T01:00:23.567809-05:
      DOI: 10.1111/bju.13702
  • Multicentre evaluation of targeted and systematic biopsies using magnetic
           resonance and ultrasound image-fusion guided transperineal prostate biopsy
           in patients with a previous negative biopsy
    • Authors: Nienke L. Hansen; Claudia Kesch, Tristan Barrett, Brendan Koo, Jan P. Radtke, David Bonekamp, Heinz-Peter Schlemmer, Anne Y. Warren, Kathrin Wieczorek, Markus Hohenfellner, Christof Kastner, Boris Hadaschik
      Abstract: ObjectivesTo evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres.Patients and MethodsA two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7–10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.ResultsThe median (interquartile range) PSA level was 9.0 (6.7–13.4) ng/mL. PI-RADS 3–5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7–10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7–10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1–2 was 0.92 (±0.04) for Gleason score 7–10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7–10 cancers. In patients with suspicious lesions (PI-RADS 4–5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7–10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846.ConclusionIn patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7–10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.
      PubDate: 2016-12-21T00:35:27.781165-05:
      DOI: 10.1111/bju.13711
  • Low-dose desmopressin combined with serum sodium monitoring can prevent
           clinically significant hyponatraemia in patients treated for nocturia
    • Authors: Kristian Vinter Juul; Anders Malmberg, Egbert Meulen, Johan Vande Walle, Jens Peter Nørgaard
      Abstract: ObjectiveTo explore risk factors for desmopressin-induced hyponatraemia and evaluate the impact of a serum sodium monitoring plan.Subjects and MethodsThis was a meta-analysis of data from three clinical trials of desmopressin in nocturia. Patients received placebo or desmopressin orally disintegrating tablet (ODT; 10–100 μg). The incidence of serum sodium
      PubDate: 2016-12-10T09:35:25.473078-05:
      DOI: 10.1111/bju.13718
  • Competency based training in robotic surgery: benchmark scores for virtual
           reality robotic simulation
    • Authors: Nicholas Raison; Kamran Ahmed, Nicola Fossati, Nicolò Buffi, Alexandre Mottrie, Prokar Dasgupta, Henk Van Der Poel
      Abstract: ObjectivesTo develop benchmark scores of competency for use within a competency based virtual reality (VR) robotic training curriculum.Subjects and MethodsThis longitudinal, observational study analysed results from nine European Association of Urology hands-on-training courses in VR simulation. In all, 223 participants ranging from novice to expert robotic surgeons completed 1565 exercises. Competency was set at 75% of the mean expert score. Benchmark scores for all general performance metrics generated by the simulator were calculated. Assessment exercises were selected by expert consensus and through learning-curve analysis. Three basic skill and two advanced skill exercises were identified.ResultsBenchmark scores based on expert performance offered viable targets for novice and intermediate trainees in robotic surgery. Novice participants met the competency standards for most basic skill exercises; however, advanced exercises were significantly more challenging. Intermediate participants performed better across the seven metrics but still did not achieve the benchmark standard in the more difficult exercises.ConclusionBenchmark scores derived from expert performances offer relevant and challenging scores for trainees to achieve during VR simulation training. Objective feedback allows both participants and trainers to monitor educational progress and ensures that training remains effective. Furthermore, the well-defined goals set through benchmarking offer clear targets for trainees and enable training to move to a more efficient competency based curriculum.
      PubDate: 2016-12-09T07:28:17.39687-05:0
      DOI: 10.1111/bju.13710
  • Management and outcomes of patients with renal medullary carcinoma: a
           multicentre collaborative study
    • Authors: Amishi Y. Shah; Jose A. Karam, Gabriel G. Malouf, Priya Rao, Zita D. Lim, Eric Jonasch, Lianchun Xiao, Jianjun Gao, Ulka N. Vaishampayan, Daniel Y. Heng, Elizabeth R. Plimack, Elizabeth A. Guancial, Chunkit Fung, Stefanie R. Lowas, Pheroze Tamboli, Kanishka Sircar, Surena F. Matin, W. Kimryn Rathmell, Christopher G. Wood, Nizar M. Tannir
      Abstract: ObjectiveTo describe the management strategies and outcomes of patients with renal medullary carcinoma (RMC) and characterise predictors of overall survival (OS).Patients and MethodsRMC is a rare and aggressive malignancy that afflicts young patients with sickle cell trait; there are limited data on management to date. This is a study of patients with RMC who were treated in 2000–2015 at eight academic institutions in North America and France. The Kaplan–Meier method was used to estimate OS, measured from initial RMC diagnosis to date of death. Cox regression analysis was used to determine predictors of OS.ResultsIn all, 52 patients (37 males) were identified. The median (range) age at diagnosis was 28 (9–48) years and 49 patients (94%) had stage III/IV. The median OS for all patients was 13.0 months and 38 patients (75%) had nephrectomy. Patients who underwent nephrectomy had superior OS compared to patients who were treated with systemic therapy only (median OS 16.4 vs 7.0 months, P < 0.001). In all, 45 patients received chemotherapy and 13 (29%) had an objective response; 28 patients received targeted therapies, with 8-week median therapy duration and no objective responses. Only seven patients (13%) survived for>24 months.ConclusionsRMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but 24 months, underscoring the need to develop more effective therapy for this rare tumour. In this study, nephrectomy was associated with improved OS.
      PubDate: 2016-12-09T07:26:05.928032-05:
      DOI: 10.1111/bju.13705
  • 11C-acetate positron-emission tomography/computed tomography imaging for
           detection of recurrent disease after radical prostatectomy or radiotherapy
           in patients with prostate cancer
    • Authors: Lukas Hendrik Esch; Melanie Fahlbusch, Peter Albers, Hubertus Hautzel, Volker Müller-Mattheis
      Abstract: ObjectivesTo evaluate, in a prospective study, the effectiveness of computed tomography (CT)-matched 11C-acetate (AC) positron-emission tomography (PET) in patients with prostate cancer (PCa) who had prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or radiotherapy (RT).Patients and MethodsIn 103 relapsing patients after RP (n = 97) or RT (n = 6) AC-PET images and CT scans were obtained. In patients with AC-PET-positive results with localized PCa recurrence, detected lesions were resected and histologically verified or, after local RT, followed-up by PSA testing. Patients with distant disease on AC-PET were treated with androgen deprivation/chemotherapy.ResultsOf 103 patients, 42 were AC-PET-positive. PSA levels were
      PubDate: 2016-12-05T03:17:27.745394-05:
      DOI: 10.1111/bju.13706
  • Quality-of-life outcomes from the Prostate Adenocarcinoma: TransCutaneous
           Hormones (PATCH) trial evaluating luteinising hormone-releasing hormone
           agonists versus transdermal oestradiol for androgen suppression in
           advanced prostate cancer
    • Authors: Duncan C. Gilbert; Trinh Duong, Howard G. Kynaston, Abdulla A. Alhasso, Fay H. Cafferty, Stuart D. Rosen, Subramanian Kanaga-Sundaram, Sanjay Dixit, Marc Laniado, Sanjeev Madaan, Gerald Collins, Alvan Pope, Andrew Welland, Matthew Nankivell, Richard Wassersug, Mahesh K. B. Parmar, Ruth E. Langley, Paul D. Abel
      Pages: 667 - 675
      Abstract: ObjectivesTo compare quality-of-life (QoL) outcomes at 6 months between men with advanced prostate cancer receiving either transdermal oestradiol (tE2) or luteinising hormone-releasing hormone agonists (LHRHa) for androgen-deprivation therapy (ADT).Patients and methodsMen with locally advanced or metastatic prostate cancer participating in an ongoing randomised, multicentre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via three or four transcutaneous patches containing oestradiol 100 μg/24 h. LHRHa was administered as per local practice. Patients completed questionnaires based on the European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core (EORTC QLQ-C30) with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.ResultsIn all, 727 men were enrolled between August 2007 and October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median (interquartile range) age of 74 (68–79) years and PSA level of 44 (19–119) ng/mL, and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than those on LHRHa (mean difference +4.2, 95% confidence interval 1.2–7.1; P = 0.006), less fatigue, and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynaecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to the tE2 arm.ConclusionPatients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynaecomastia. The ongoing trial will evaluate clinical efficacy and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.
      PubDate: 2016-11-12T06:55:24.546685-05:
      DOI: 10.1111/bju.13687
  • Prediction of pathological stage based on clinical stage, serum
           prostate-specific antigen, and biopsy Gleason score: Partin Tables in the
           contemporary era
    • Authors: Jeffrey J. Tosoian; Meera Chappidi, Zhaoyong Feng, Elizabeth B. Humphreys, Misop Han, Christian P. Pavlovich, Jonathan I. Epstein, Alan W. Partin, Bruce J. Trock
      Pages: 676 - 683
      Abstract: ObjectiveTo update the Partin Tables for prediction of pathological stage in the contemporary setting and examine trends in patients treated with radical prostatectomy (RP) over the past three decades.Patients and MethodsFrom January 2010 to October 2015, 4459 men meeting inclusion criteria underwent RP and pelvic lymphadenectomy for histologically confirmed prostate cancer at the Johns Hopkins Hospital. Preoperative clinical stage, serum prostate-specific antigen (PSA) level, and biopsy Gleason score (i.e. prognostic Grade Group) were used in a polychotomous logistic regression model to predict the probability of pathological outcomes categorised as: organ-confined (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+). Preoperative characteristics and pathological findings in men treated with RP since 1983 were collected and clinical-pathological trends were described.ResultsThe median (range) age at surgery was 60 (34–77) years and the median (range) PSA level was 4.9 (0.1–125.0) ng/mL. The observed probabilities of pathological outcomes were: OC disease in 74%, EPE in 20%, SV+ in 4%, and LN+ in 2%. The probability of EPE increased substantially when biopsy Gleason score increased from 6 (Grade Group 1, GG1) to 3 + 4 (GG2), with smaller increases for higher grades. The probability of LN+ was substantially higher for biopsy Gleason score 9–10 (GG5) as compared to lower Gleason scores. Area under the receiver operating characteristic curves for binary logistic models predicting EPE, SV+, and LN+ vs OC were 0.724, 0.856, and 0.918, respectively. The proportion of men treated with biopsy Gleason score ≤6 cancer (GG1) was 47%, representing a substantial decrease from 63% in the previous cohort and 77% in 2000–2005. The proportion of men with OC cancer has remained similar during that time, equalling 73–74% overall. The proportions of men with SV+ (4.1% from 3.4%) and LN+ (2.3% from 1.4%) increased relative to the preceding era for the first time since the Partin Tables were introduced in 1993.ConclusionsThe Partin Tables remain a straightforward and accurate approach for projecting pathological outcomes based on readily available clinical data. Acknowledging these data are derived from a tertiary care referral centre, the proportion of men with OC disease has remained stable since 2000, despite a substantial decline in the proportion of men with biopsy Gleason score 6 (GG1). This is consistent with the notion that many men with Gleason score 6 (GG1) disease were over treated in previous eras.
      PubDate: 2016-07-29T04:05:26.970406-05:
      DOI: 10.1111/bju.13573
  • Clinical risk stratification in patients with surgically resectable
           micropapillary bladder cancer
    • Authors: Mario I. Fernández; Stephen B. Williams, Daniel L. Willis, Rebecca S. Slack, Rian J. Dickstein, Sahil Parikh, Edmund Chiong, Arlene O. Siefker-Radtke, Charles C. Guo, Bogdan A. Czerniak, David J. McConkey, Jay B. Shah, Louis L. Pisters, H. Barton Grossman, Colin P. N. Dinney, Ashish M. Kamat
      Pages: 684 - 691
      Abstract: ObjectiveTo analyse survival in patients with clinically localised, surgically resectable micropapillary bladder cancer (MPBC) undergoing radical cystectomy (RC) with and without neoadjuvant chemotherapy (NAC) and develop risk strata based on outcome data.Patients and MethodsA review of our database identified 103 patients with surgically resectable (≤cT4acN0 cM0) MPBC who underwent RC. Survival estimates were calculated using Kaplan–Meier method and compared using log-rank tests. Classification and regression tree (CART) analysis was performed to identify risk groups for survival.ResultsFor the entire cohort, estimated 5-year overall survival and disease-specific survival (DSS) rates were 52% and 58%, respectively. CART analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumour-associated hydronephrosis. The 5-year DSS for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (P < 0.001). Patients down-staged at RC
      PubDate: 2016-11-11T00:25:23.011808-05:
      DOI: 10.1111/bju.13689
  • Primary Gleason pattern upgrading in contemporary patients with D'Amico
           low-risk prostate cancer: implications for future biomarkers and imaging
    • Authors: Sami-Ramzi Leyh-Bannurah; Hiba Abou-Haidar, Paolo Dell'Oglio, Jonas Schiffmann, Zhe Tian, Hans Heinzer, Hartwig Huland, Markus Graefen, Lars Budäus, Pierre I. Karakiewicz
      Pages: 692 - 699
      Abstract: ObjectiveTo retrospectively assess the rate of high-grade primary Gleason upgrading (HGPGU) to primary Gleason pattern 4 or 5 in a contemporary cohort of patients with D'Amico low-risk prostate cancer including those who fulfilled Prostate Cancer Research International Active Surveillance (PRIAS) criteria, and to develop a tool for HGPGU prediction. HGPGU is a contraindication in most active surveillance (AS) and focal therapy protocols.Patients and MethodsIn all, 10 616 patients with localised prostate cancer were treated at a high-volume European tertiary care centre from 2010 to 2015 with radical prostatectomy. Analyses were restricted to 1 819 patients with D'Amico low-risk prostate cancer (17.1%) with prostate-specific antigen (PSA) levels of
      PubDate: 2016-08-05T04:14:03.008311-05:
      DOI: 10.1111/bju.13570
  • Management of Radiation Therapy Oncology Group grade 4 urinary adverse
           events after radiotherapy for prostate cancer
    • Authors: Erik N. Mayer; Jonathan D. Tward, Mitchell Bassett, Sara M. Lenherr, James M. Hotaling, William O. Brant, William T. Lowrance, Jeremy B. Myers
      Pages: 700 - 708
      Abstract: ObjectiveTo describe the management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa).MethodsWe conducted a single-centre retrospective review, over a 6-year period (2010–2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [RP] followed by external beam radiotherapy [EBRT], EBRT + low-dose-rate [LDR] brachytherapy, EBRT + high-dose-rate [HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs.ResultsWe identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT (n = 19), HDR brachytherapy + EBRT (n = 19), LDR brachytherapy + EBRT (n = 5), and other combined RT (n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT (n = 4), HDR brachytherapy (n = 11), LDR brachytherapy (n = 12), or proton beam therapy (n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (UD) in 23 men (32%). Reconstruction included: ureteric (n = 4), recto-urethral fistula repair (n = 2), and posterior urethroplasty (n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful.ConclusionsAlthough the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.
      PubDate: 2016-08-30T02:10:44.94212-05:0
      DOI: 10.1111/bju.13607
  • Cyclooxygenase-2 (COX-2) inhibition for prostate cancer chemoprevention:
           double-blind randomised study of pre-prostatectomy celecoxib or placebo
    • Authors: Jason F. Flamiatos; Tomasz M. Beer, Julie N. Graff, Kristine M. Eilers, Wei Tian, Harman S. Sekhon, Mark Garzotto
      Pages: 709 - 716
      Abstract: ObjectiveTo evaluate the biological effects of selective cyclooxygenase-2 inhibition on prostate tissue in patients undergoing radical prostatectomy (RP).Patients and MethodsPatients with localised prostate cancer were randomised to receive either celecoxib 400 mg twice daily or placebo for 4 weeks before RP. Specimens were analysed for levels of apoptosis, prostaglandins, and androgen receptor (AR). Effects on serum prostate-specific antigen (PSA) and postoperative opioid use were also measured.ResultsIn all, 28 of 44 anticipated patients enrolled and completed treatment. One patient in the celecoxib arm had a myocardial infarction postoperatively. For this reason, and safety concerns in other studies, enrolment was halted. The apoptosis index (AI) in tumour cells was 0.29% [95% confidence interval (CI) 0.11–0.47%] vs 0.39% (95% CI 0.00–0.84%) in the celecoxib and placebo arms, respectively (P = 0.68). The AI in benign cells was 0.18% (95% CI 0.03–0.32%) vs 0.13% (95% CI 0.00–0.28%) in the celecoxib and placebo arms, respectively (P = 0.67). Prostaglandin E2 and AR levels were similar in cancerous and benign tissues when comparing the two arms. The median baseline PSA level was 6.0 and 6.2 ng/mL for the celecoxib and placebo groups, respectively, and did not significantly change after celecoxib treatment. There was no difference in postoperative opiate usage between arms.ConclusionCelecoxib had no effect on apoptosis, prostaglandins or AR levels in cancerous or benign prostate tissues. These findings coupled with drug safety concerns should serve to limit interest in these selective drugs as chemopreventive agents.
      PubDate: 2016-08-23T21:45:27.390728-05:
      DOI: 10.1111/bju.13612
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared with salvage radiation therapy in patients with pN1 prostate
           cancer treated with radical prostatectomy
    • Authors: Derya Tilki; Felix Preisser, Pierre Tennstedt, Patrick Tober, Philipp Mandel, Thorsten Schlomm, Thomas Steuber, Hartwig Huland, Rudolf Schwarz, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Pages: 717 - 723
      Abstract: ObjectiveTo analyse the comparative effectiveness of no treatment (NT) or salvage radiation therapy (sRT) at biochemical recurrence (BCR) vs adjuvant radiation therapy (aRT) in patients with lymph node (LN)-positive prostate cancer (PCa) after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN-positive PCa at RP, with or without additional radiation therapy (RT), in the period 2005–2013, were retrospectively analysed. Cox regression analysis was used to assess factors influencing BCR and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsThe median follow-up for the entire patient group was 33.8 months. Four-year BCR-free and MFS rates were 43.3% and 86.6%, respectively, for all patients. In multivariate analysis, NT/sRT (n = 505) was an independent risk factor for BCR and metastasis compared with aRT (n = 213). The superiority of aRT was confirmed after propensity score matching. The 4-year MFS in the matched cohort was 82.5% vs 91.8% for the NT/sRT and aRT groups, respectively (P = 0.02). Early sRT (pre-RT prostate-specific antigen [PSA] ≤0.5 ng/mL) compared with sRT at PSA >0.5 ng/mL was significantly associated with a lower risk of metastasis.ConclusionPatients with LN-positive PCa who received aRT had a significantly better oncological outcome than patients with NT/sRT, independent of tumour characteristics. Patients with early sRT had higher rates of response and better MFS than patients with pre-RT PSA >0.5 ng/mL.
      PubDate: 2016-11-21T01:30:28.001707-05:
      DOI: 10.1111/bju.13679
  • The influence of prostate-specific antigen density on positive and
           negative predictive values of multiparametric magnetic resonance imaging
    • Authors: Nienke L. Hansen; Tristan Barrett, Brendan Koo, Andrew Doble, Vincent Gnanapragasam, Anne Warren, Christof Kastner, Ola Bratt
      Pages: 724 - 730
      Abstract: ObjectivesTo evaluate the influence of prostate-specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting.Patients and MethodsRetrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1–5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013–2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1–0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi-square test for linear trend.ResultsGleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1–2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4–5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001).ConclusionIn a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.
      PubDate: 2016-09-08T12:50:27.269121-05:
      DOI: 10.1111/bju.13619
  • Quality of life and pain relief in men with metastatic
           castration-resistant prostate cancer on cabazitaxel: the
           non-interventional ‘QoLiTime’ study
    • Authors: Ralf-Dieter Hofheinz; Carsten Lange, Thorsten Ecke, Susanne Kloss, Burkhard Linsse, Christine Windemuth-Kieselbach, Peter Hammerer, Salah-Eddin Al-Batran
      Pages: 731 - 740
      Abstract: ObjectiveTo examine health-related quality of life (QoL) in men with metastatic castration-resistant prostate cancer (mCRPC) on cabazitaxel.Patients and MethodsMen with mCRPC receiving cabazitaxel (25 mg/m², every 3 weeks) and 10 mg/day oral prednis(ol)one were enrolled (2011–2014) in the non-interventional prospective ‘QoLiTime’ study. Primary outcome was change in QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item) with respect to prostate-specific antigen (PSA) response after four cycles of cabazitaxel. Secondary outcomes included occurrence of adverse events (AEs).ResultsOf 527 men, 348 received four cycles of cabazitaxel and 266 had the necessary PSA level measurements. After four cycles, 92 (34.6%) men had a PSA level decrease ≥50% (responders). QoL remained stable throughout the study (P = 0.62). Change in QoL did not differ between responders and non-responders (P = 0.69). Change in PSA level and global health status between baseline and four cycles showed an inversely proportional relationship (correlation coefficient –0.14; 95% confidence interval –0.26 to –0.01; P = 0.03), with increasing PSA level corresponding to lower health status. Responders showed no change in physical functioning vs baseline (–1.75, P = 0.12); non-responders showed a reduction vs baseline (–7.00, P < 0.001) and responders (P = 0.05). Responders showed an improvement in pain vs baseline (–7.61, P = 0.05) and vs non-responders (P = 0.01). AEs occurred in 292 patients (55.4%), most commonly anaemia (16.5%), fatigue (12.3%) and diarrhoea (11.8%). Neutropenia and febrile neutropenia were reported in 3.8% and 3.6% of patients, respectively.ConclusionProstate-specific antigen level response was associated with stable physical functioning and improvement in pain. Symptom increases were seen in areas typical of chemotoxicity, but QoL was maintained.
      PubDate: 2016-09-30T04:06:50.505605-05:
      DOI: 10.1111/bju.13658
  • Robot-assisted partial nephrectomy: continued refinement of outcomes
           beyond the initial learning curve
    • Authors: David J. Paulucci; Ronney Abaza, Daniel D. Eun, Ashok K. Hemal, Ketan K. Badani
      Pages: 748 - 754
      Abstract: ObjectivesTo evaluate trends in peri-operative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robot-assisted partial nephrectomy (RAPN) among multiple surgeons.Patients and MethodsA multi-institutional database was used to evaluate trends in patient demographics (e.g. age, gender, comorbidities), tumour characteristics (e.g. size, complexity) and peri-operative outcomes (e.g. warm ischaemia time [WIT], operating time, complications, estimated blood loss [EBL], trifecta achievement) in consecutive cases 50–300 (n = 960) from 2008 to 2016 among four experienced surgeons. Trends in outcomes were assessed using multivariable regression models adjusted for demographic and tumour-specific variables. Outcomes for cases 50–99 were compared with those for cases 250–300.ResultsIn the study period RAPN was increasingly performed in patients with larger tumours (β = 0.001, P = 0.048), hypertension (odds ratio [OR] 1.003; P = 0.008) diabetes (OR 1.003; P = 0.025) and previous abdominal surgery (OR 1.003; P = 0.006). Surgeon experience was associated with more trifecta achievement (OR 1.006; P < 0.001), shorter WIT (β = −0.036, P < 0.001), less EBL (β = −0.154, P = 0.009), fewer blood transfusions (OR 0.989, P = 0.024) and a reduced length of hospital stay (β = −0.002, P = 0.002), but not with operating time (P = 0.243), complications (P = 0.587) or surgical margin status (P = 0.102). Tumour size and WIT in cases 50–99 vs 250–300 were 2.7 vs 3.2 cm (P = 0.001) and 21.4 vs 16.2 min (P < 0.001), respectively.ConclusionRefinement of RAPN outcomes, concomitant with the treatment of a patient population with larger tumours and more comorbidities, occurs after the initial LC is reached. Although RAPN can consistently be performed safely with acceptable outcomes after a small number of cases, improvement in trifecta achievement, WIT, EBL, blood transfusions and a shorter hospitalization continues to occur up to 300 procedures.
      PubDate: 2016-11-28T10:10:27.62575-05:0
      DOI: 10.1111/bju.13709
  • Diagnosis and long-term outcome of renal cysts after laparoscopic partial
           nephrectomy in children
    • Authors: Ciro Esposito; Maria Escolino, Bernardita Troncoso Solar, Roberta Iacona, Rosanna Esposito, Alessandro Settimi, Imran Mushtaq
      Pages: 761 - 766
      Abstract: ObjectiveTo document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions following LPN.Patients and MethodsWe reviewed the ultrasonography (US) imaging reports performed during the follow-up of 125 children (77 girls, 48 boys; mean age 3.2 years) who underwent LPN in two centres of paediatric surgery in the period 2005–2015.ResultsA transperitoneal approach was adopted in 83 children and a retroperitoneal approach in 42. The mean follow-up was 4.2 years. At US, an avascular cyst related to the operative site was found after 61/125 procedures (48.8%). As for their appearance, 53/61 cysts were simple and anechoic, and eight of the 61 cysts appeared septated. The mean diameter of the cysts was 3.3 × 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after a mean of 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size, and only five of the 61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 children (83.6%), while they were associated with urinary tract infections (UTIs) and abdominal pain in the remaining 10; none required a re-intervention.ConclusionsThe US finding of a simple cyst at the operative site after LPN is common during follow-up, with an incidence of ~50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There was no correlation between cyst formation and type of surgical technique adopted. As there was no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodic US evaluations.
      PubDate: 2016-11-14T21:45:26.9796-05:00
      DOI: 10.1111/bju.13698
  • Long-term outcome of the adjustable transobturator male system (ATOMS):
           results of a European multicentre study
    • Authors: Alexander Friedl; Sandra Mühlstädt, Roman Zachoval, Alessandro Giammò, Danijel Kivaranovic, Maximilian Rom, Paolo Fornara, Clemens Brössner
      Pages: 785 - 792
      Abstract: ObjectiveTo evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS®, Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting.Patients and MethodsIn all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (
      PubDate: 2016-11-21T01:18:16.69795-05:0
      DOI: 10.1111/bju.13684
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