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   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1605 journals]
  • 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
  • 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.Materials and MethodsIn this retrospective case-control study, we identified patients diagnosed with multiple sclerosis and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to 2 controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index (BMI), 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-hour urine biochemistry studies, stone compositions, serum labs, medications, history of stone surgeries, mobility, and method of bladder emptying were collected.ResultsA total of 587 patients were identified who had both multiple sclerosis 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 PCNL (25% vs 12%, p = 0.005) or a cystolithopaxy (16% vs. 3%, p < 0.001) compared to their matched controls. 61 patients had a complete 24-hour 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 catheterization (OR, 3.50 [95% CI, 1.89-6.47]; P = < 0.001) or an indwelling catheter (OR, 9.78 [95% CI, 4.81-19.88]; P =
      PubDate: 2017-02-20T22:55:20.718436-05:
      DOI: 10.1111/bju.13820
  • 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
  • Etiology and Management of Earlier versus Later Biochemical Recurrence
           Following Retropubic Radical Prostatectomy
    • Authors: Elton Llukani; Herbert Lepor
      Abstract: Approximately 100,000 radical prostatectomies (RP) are performed annually in the US with the intent to cure clinically localized prostate cancer. Oncological control following RP is assessed by monitoring serum PSA levels. By consensus, a PSA exceeding 0.2 ng/mL is considered the threshold for a biochemical recurrence (BCR) following RP (3). BCR often predates radiographic and clinical evidence of disease recurrence by many years (4-6).This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:45:31.837558-05:
      DOI: 10.1111/bju.13816
  • 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
  • Journal information
    • PubDate: 2017-02-16T23:51:59.554671-05:
      DOI: 10.1111/bju.13636
  • 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
  • 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,
      Abstract: Current guidelines for prostate cancer (PCa) consider life expectancy (LE) an important factor when making screening and treatment decisions. For patients with LE
      PubDate: 2017-02-15T16:25:24.360712-05:
      DOI: 10.1111/bju.13812
  • Assessing the Relative Influence of Hospital and Surgeon Volume on
           Short-Term Mortality following Radical Cystectomy
    • Authors: Nikhil Waingankar; Katherine Mallin, Marc Smaldone, Brian L. Egleston, Andrew Higgins, David P. Winchester, Robert Uzzo, Alexander Kutikov
      Abstract: ObjectivesTo assess the relationship between surgeon and hospital volume on mortality following radical cystectomy (RC).Patients and MethodsWe queried the National Cancer Database (NCDB) for adult patients undergoing RC from 2010-2013. We calculated average volume for each surgeon (SV) and hospital (HV). Using propensity-scored weights for combined volume groups with a proportional hazards regression model, we compared association between HV and SV on 90-day survival following RC.Results19,346 RC were performed at 927 hospitals by 2,927 surgeons from 2010 - 2013. Median HV and SV were 12.3 (IQR 5.0-35.5) and 4.3 (IQR 1.3-12.3) cases, respectively. For HV, 90 day unadjusted mortality was 8.5% in centers 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 p30, ranging from 1.6% to 2.1%.ConclusionsIn hospitals reporting to the NCDB, volume is associated with improved mortality after RC. These associations appear to be driven by hospital rather than surgeon-level effects. Increased SV provides 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.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-13T12:20:27.070027-05:
      DOI: 10.1111/bju.13804
  • Stereotactic Ablative Body Radiotherapy for Inoperable Primary Kidney
           Cancer: A Prospective Clinical Trial
    • Authors: Shankar Siva; Daniel Pham, Tomas Kron, Mathias Bressel, Jacqueline Lam, Tan Teng Han, 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 RCC in patients unsuitable for surgery. Secondary objectives were to assess oncologic 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 and informed consent. Tumor response was defined using RECIST 1.1 criteria. Toxicities were recorded using CTCAE v4.0. Time-to-event outcomes were described using Kaplan-Meier method and associations of baseline variables with tumor shrinkage was assessed using linear regression. Patients received either single fraction of 26Gy or three fractions of 14Gy dependent on tumour size.ResultsOf 37 patients (median age of 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 n=26 (78%), grade 3 toxicity in n=1 (3%). No grade 4-5 toxicities were recorded and n=6 (18%) reported no toxicity. Freedom from local progression, distant progression and overall survival at 2 years were 100%, 89% and 92%, respectively. The mean baseline GFR was 55 mL/min, which decreased to 44 mL/min at 1 and 2 years (p < 0.001). Neutrophil to lymphocyte (N/L) ratio was correlated to % change in tumor size at 1-year, r2=0.45, p
      PubDate: 2017-02-10T23:00:25.749276-05:
      DOI: 10.1111/bju.13811
  • Sentinel node biopsy for prostate cancer: report from a consensus panel
    • Authors: Henk G. Poel; Esther M. Wit, Cenk Acar, Nynke S. van den Berg, Fijs W.B. van 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 by 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 RAND/University of California, Los Angeles Appropriateness Methodology on 150 statements in 9 domains. The disagreement index based on the interpercentile range-adjusted for symmetry score was used to assess consensus and non-consensus among panel membersResultsConsensus was obtained on 91 of 150 (61%) statements. Main outcomes were: 1. The results from an extended lymph node dissection (eLND) are still considered the gold standard and SN detection should be combined with eLND at least in intermediate and high risk prostate cancer patients; 2. The role of SN detection in low risk prostate cancer is unclear; 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 SN users in the panel constitute the major limitations of the study.ConclusionConsensus 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.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-10T22:55:27.998259-05:
      DOI: 10.1111/bju.13810
  • 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
  • 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
  • Novel Use of Twitter to Disseminate and Evaluate Adherence with Clinical
           Guidelines by the European Association of Urology
    • Authors: Stacy Loeb; Morgan Roupret, Inge Van Oort, James N'dow, Marc Van Gurp, Jarka Bloemberg, Julie A. Darraugh, Maria Ribal
      Abstract: The European Association of Urology was the first scientific association to systematically convert the clinical guidelines into social media posts for dissemination through twitter. Posts were classified using the hashtag #eauguidelines and each post was
      PubDate: 2017-02-07T10:00:25.760097-05:
      DOI: 10.1111/bju.13802
  • Ureteral 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 following 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– 2016. Demographic, clinical, preoperative, and operative data were collected. Primary study endpoint was sepsis within 48 hours of ureteroscopy. Logistic regressions were performed to identify predictors of post-ureteroscopy sepsis in the ureteroscopy cohort in specifically in patients with prior stent insertionResultsBetween October 2010 and April 2016, 1256 patients underwent ureteroscopy for stone extraction. Risk factors for sepsis included prior stent placement, female gender and Charlson comorbidity index. 601 patients had ureteral stent inserted before the operation and were included in the study cohort, in which Median age was 56 years, 90 patients were female (30%), and 97 patients were treated for positive preoperative urine cultures (16.1%). Postoperative sepsis, within 48 hours from surgery, occurred in eight (1.2%) of non-stented patients and in 28 patients (4.7%) with prior stent insertion. Sepsis rates after stent dwelling times of 1, 2, 3 and >3 months were 1%, 4.9%, 5.5% and 9.2%, respectively. On multivariate analysis stent dwelling time, stent insertion due to sepsis, and female gender were significantly associated with post-ureteroscopy sepsis in patient with prior stent placementConclusionsPatients who undergo ureteroscopy after ureteral 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 a month.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-01T00:40:30.156864-05:
      DOI: 10.1111/bju.13796
  • Positive outcomes with first onabotulinumtoxinA treatment persist
           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 neurogenic detrusor overactivity (NDO) patients.Patients and MethodsNDO patients in a 3-year extension study (following a 52-week phase 3 study) received onabotulinumtoxinA ‘as needed’ based on fulfilment of prespecified retreatment criteria. This post-hoc analysis included patients who received only the 200U dose during the phase 3 and extension studies. Data were analysed by mean percent reduction from baseline in urinary incontinence (UI) episodes at week 6 after the first treatment and stratified into 3 response groups:
      PubDate: 2017-01-31T02:21:13.845639-05:
      DOI: 10.1111/bju.13795
  • 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 (PCa) 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 PCa screening.Patients and MethodsOur study population included 160, 211 men age >= 40 with at least 1 visit in 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 through December 2014. Yearly rates of screening PSA testing by primary care provider (PCP), rates of rescreening 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 >= age 70, from 22.8% to 8.9%, ages 50-69, from 39.2% to 20% and ages 40-49, from 11% to 4.6%. Overall rates were lower for African American men vs. non-African American men; for men with a family history of PCa, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA did not substantially change following the USPSTF recommendations. While the number of men screened and rates of follow-up PCa screening declined in 2011-2014 compared to 2007-2010, similar rescreening rates were noted for men age 45-75 with initial PSA levels < 1ng/ml or 1-3 ng/ml in both the earlier and later cohorts. For men age > 75 with initial PSA level < 3 ng/ml screened in both cohorts, follow-up screening rates were similar. Rates of prostate biopsy declined for men >=age 70 in 2014 compared to 2007. For men who had PSA screening, rates of first prostate biopsy increased in later years for African American men and men with a family history of PCa.ConclusionsPCa screening declined from 2007 to 2014 even in higher risk groups and follow-up screening rates were not related to previous PSA level. However, rates of first prostate biopsy for men who had a PSA were higher for men with increased risk for PCa in later years. Variation in PSA testing was noted among PCPs. Future work should further explore sources of variation in screening practices and implementation of risk-based strategies for PCa screening in primary care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-31T02:21:00.851319-05:
      DOI: 10.1111/bju.13793
  • Anatomic Patterns of Recurrence Following Biochemical Relapse after
    • Authors: William C. Jackson; Neil 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 characterize the frequency and detailed anatomic sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT).Materials/MethodsA multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotropic (lymph nodes only), osteotropic (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 post-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 128 of 574 men (22%) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotropic, osteotropic, and multifocal, respectively. The tropic 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
      PubDate: 2017-01-31T02:15:34.25486-05:0
      DOI: 10.1111/bju.13792
  • 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: ObjectivesPrevious epidemiological studies have suggested a cross-sectional association between nocturia and depressive symptoms. The purpose of this study was to evaluate the association between nocturia and the incidence of depressive symptoms.Participants and methodsOf 1127 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 void 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 males (HR, 2.51; 95% CI, 1.27–4.97; P = 0.008) but not in females (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.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-27T14:45:31.318337-05:
      DOI: 10.1111/bju.13791
  • Science Made Simple: “Biomarker Classification, Validation, and What to
           Look for in 2017 and Beyond
    • Authors: John W. Davis
      Abstract: The Translational Science section of the BJUI is very selective and focused on bringing our readers high quality work that has potential to impact practice. A very common submission includes methods utilizing retrospective design, small to moderate sample size, biomarker expression at the immunohistochemistry stage, and prognostic classification. These papers are probably better off in biomarker-focused journals.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-24T07:01:39.957467-05:
      DOI: 10.1111/bju.13790
  • Anatomic study of renal arterial vasculature and its potential implication
           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: Background and objectivesA detailed understanding of surgical anatomy is an essential requisite to maximize perioperative and functional outcomes of partial nephrectomy. The objectives of this study were 1) to validate the Graves classification and 2) to verify the real absence of collateral arterial blood-supply between different renal segments.Material and methodsThe study was performed on 15 normal kidneys sampled from 8 un-embalmed 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. A computed tomography examination of the injected kidneys was performed in order to analyse the branches located deeply. After the imaging acquisition, the specimens were treated with sodium hydroxide for removal of the parenchyma to obtain the vascular casts.ResultsTen casts (66.6%) showed the classical subdivision of the main artery in a single posterior and anterior branch. Concerning the distribution of the segmental or second order arteries, only 2 (13%) casts showed a pattern similar to that described by Graves characterized by 4 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 (80%) casts a single renal segment resulted vascularised by two or more different branches coming from an artery destined to another segment (multiple vascularisation). In details, multiple vascularisation was observed in 3 (20%) apical segments, in 5 (33%) superior segments, in 6 (40%) middle segments, in 7 (47%) inferior segments, and in 2 (13%) posterior segments.ConclusionsThis study demonstrates that in the human kidneys the arterial vasculature is frequently different from the classical Graves description. Moreover, in a significant percentage of cases, a single renal segment receives two or more branches coming from an artery destined to another segment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-24T06:55:41.019246-05:
      DOI: 10.1111/bju.13788
  • Detection of Prostate Cancer Using Magnetic Resonance
           Imaging/Ultrasonography Fusion Targeted Biopsy in African-American Men
    • Authors: Toshitaka Shin; Thomas B. Smyth, Osamu Ukimura, Nariman Ahmadi, Andre Luis de 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 (mp-MRI) with real-time trans-rectal ultrasonography (US).Patients and MethodsWe retrospectively analyzed 661 patients (117 A-A and 544 Caucasian) who underwent pre-biopsy mp-MRI and the following MRI/US fusion biopsy (UroStation, Koelis) (10/2012 - 8/2015). The mp-MRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPCa) was defined as biopsy Gleason score ≥7.ResultsAfter controlling for age, prostate-specific antigen (PSA) level and prostate volume, there were no significant differences between A-A and Caucasian men in detection rate of overall cancer (35.0% vs 34.2%, p=0.9) and CSPCa (18.8% vs 21.7%, p=0.3) with targeted biopsy. There were no significant differences between 2 races in the location of dominant lesions on MRI, and in the proportion of 5-point Likert scoring. In A-A men, targeted biopsy from the grade 4-5 lesions outperformed random biopsy in detection rate of overall cancer (70.6% vs 37.2%, p=0.003) and CSPCa (52.9% vs 12.4%, p
      PubDate: 2017-01-23T04:10:38.239902-05:
      DOI: 10.1111/bju.13786
  • Robot-assisted Partial Prostatectomy for Anterior Cancer: a step-by-step
    • Authors: Arnauld Villers; Vincent Flamand, Rodriguez Arquimedes, Philippe Puech, Georges-Pascal Haber, Mihir M Desai, Sebastien Crouzet, Adil Ouzzane, Inderbir S Gill
      Abstract: ObjectivesTo describe a step-by-step guide for isolated MRI-detected anterior prostate cancer (APC).Patients and MethodsFollowing IRB approval, over an 8-year period, (2008-2015) 17 consenting patients were enrolled in a prospective, single-arm, single-center, IDEAL phase 2a study. Inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to transperitoneal robot-assited radical prostatectomy procedure. Three steps of dissection were identified in this following order: 1-retrograde apical after dorsal venous plexus division, transition zone (TZ) enucleation and distal peripheral zone (PZ) sectioning. 2-antegrade at bladder neck (BN) after anterior BN sectioning, TZ enucleation upto verumontanum, and 3-lateral dissections including anterolateral PZ sectioning without incision of endopelvic fascias. We reported the incidence of perioperative complications. Robotic completion of prostatectomy in 4 cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 yr, respectively.ResultsRobotic surgery comprised en-bloc excision of the anterior part of the prostate comprising of the AFMS, bladder neck, prostate adenoma (TZ and median lobe) along with proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra and anterior BN. Posterolateral parts of PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. Bladder opening was sutured to anterior sphincteric urethra wall and PZ lateral edges. Technique was feasible in all cases with no conversion to open procedure. Perioperative complications were only grade 2. Robotic completion of prostatectomy was feasible in the 4 cases with cancer recurrence.ConclusionPeripheral zone prostate sparing partial prostatectomy for isolated anterior cancer was feasible and safe and represents an option for highly-selected men with anterior cancers as an alternative to other focal ablative therapy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-23T04:10:34.98688-05:0
      DOI: 10.1111/bju.13785
  • Chromogranin A and neurone-specific enolase variations during the first
           three months of abiraterone therapy predict outcomes in patients with
           metastatic castration-resistant prostate cancer
    • Authors: Liancheng Fan; Yanqing Wang, Chi Chenfei, Jiahua Pan, Xun Shangguan, Zhixiang Xin, Jianian Hu, Zhou Lixin, Baijun Dong, Wei Xue
      Abstract: ObjectiveTo determine the prognostic factors of circulating chromogranin A (CgA) and neurone-specific enolase (NSE) variations during the first 3 months of abiraterone Acetate (AA) treatment in metastatic castration-resistant prostate cancer (mCRPC) patients.Patients and MethodsThe serum levels of CgA, NSE were measured at baseline and after 3 months of AA treatments in 40 mCRPC patients. Outcome measures were PSA 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 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.ConclusionIn our study, we observed that CgA and NSE elevation during the first 3 months of AA treatment and elevated baseline CgA and NSE levels were independent prognostic factors in OS, rPFS and PSA-PFS in mCRPC treated with AA. It is suggested that serial CgA and NSE evaluation would help clinicians in distinguishing the mCRPC patients who would obtain the best survival benefit from AA treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-20T13:15:35.582152-05:
      DOI: 10.1111/bju.13781
  • 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 Sig24 for identifying prostate cancer patients at risk of developing metastases or experiencing PCSM following radical prostatectomy.Subjects 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 pathologic Gleason scores (GS) 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 an increased risk of developing metastasis (HR: 3.78, 95% CI: 1.96-7.29, p < 0.001) or experiencing PCSM (HR: 6.54, 95% CI: 2.16-19.83, p < 0.001).ConclusionsThe findings of this study demonstrate the applicability of Sig24 for the prognosis of metastasis or PCSM following radical prostatectomy. Future studies investigating the combination of Sig24 with available prognostic tests may provide new approaches to improve risk stratification for patients with prostate cancer.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-20T12:15:26.939082-05:
      DOI: 10.1111/bju.13779
  • Dishevelled segment polarity protein 3 (DVL3): a novel and easily
           applicable recurrence predictor in localized prostate adenocarcinoma
    • Authors: Pil-Jong Kim; Ji Y. Park, Hong-Gee Kim, Yong Mee Cho, Heounjeong Go
      Abstract: ObjectiveTo identify new biomarkers for the biochemical recurrence (BCR) of prostate adenocarcinoma.Patients and MethodsClinical information of 500 prostate adenocarcinoma patients 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 analyzed according to the Gleason grade groups reflecting BCR. The results obtained from the analysis using TCGA dataset were confirmed by immunohistochemistry analyses of the confirmation cohort composed of 395 localized prostate adenocarcinoma patients.ResultsTCGA discovery set was subgrouped into lower-risk and higher-risk groups for recurrence-free survival (RFS) (P
      PubDate: 2017-01-20T12:15:24.136255-05:
      DOI: 10.1111/bju.13783
  • Weighing the Evidence from Surgical Trials
    • Authors: Quoc-Dien Trinh; Alexander P. Cole, Prokar Dasgupta
      Abstract: With growing calls to improve value in health care, the assessment of surgical outcomes has moved to the spotlight. Public awareness of medical errors has spurred initiatives like the ProPublica “Surgeon Scorecard” to measure and report complications (h t t p s : //projects. propublica. org/surgeons/). High-tech and expensive innovations such as robot-assisted surgery must be measured against traditional approaches.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-20T12:05:24.689716-05:
      DOI: 10.1111/bju.13778
  • Long-term follow-up for treatment of erectile dysfunction post-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: Radical prostatectomy (RP) for prostate cancer treatment, although effective, can lead to severe erectile dysfunction. This study describes a new technique, which aims to reestablish the nerve stimulus in penile erection by two sural nerve graft bridges bilaterally, using the end to side neurorraphy. The first bridge is between femoral nerve and dorsal nerve of penis and the second, is between the femoral nerve and the interior of the corpus cavernosum. In this neurorraphy the endings of the newly formed fibres, generated by the femoral nerve, release acetylcholine inside the cavernous bodies, beginning the erection mechanism.ObjectiveTo study a novel penile reinnervation technique between the femoral nerve with the corpus cavernosum and dorsal penile nerves via sural nerve grafts by end-to-side neurorraphies.Patients and MethodsTen patients with a mean age of 60.3 ± 4.8 years (54 – 68) who had undergone RP at least two years previously were submitted to penile reinnervation. Four patients had undergone radiotherapy following 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, Pharmacopenile Doppler Ultrassonography (PPDU) pre-operative and with 6, 12 and 18 months post-operative, and by a clinical evolution of erectile function (CEEF) questionnaire during 36 months.ResultsIIEF presented improvements for erectile dysfunction, satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between right and left sides or between the allocated time periods. The introduction of nerve grafts neither cause fibrosis of the corpus cavernosum, nor reduced penile vascular flow. Regarding CEEF, sexual intercourse began after 13.7 months on average, with frequency of sexual intercourse (SI) varying from once daily to once monthly. Acute complications were minimal. This study was limited by the number of cases.ConclusionsSixty percent of cases achieved full penetration, on average, thirteen months after reinnervation surgery. One may observe that patients previously submitted to radiotherapy presented slower recuperation of erectile function. One may conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer itself as a new treatment modality for erectile dysfunction following radical prostatectomy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-17T02:38:01.49067-05:0
      DOI: 10.1111/bju.13772
  • Late surgical correction of hypospadias increases the risk of
           complications: a 501 consecutive patients series
    • 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 outcome of hypospadias surgery according to age and to determine if some complications are age-related.Patients and methodsThis retrospective study was based on 722 hypospadiac boys undergoing primary repair. 501 had a urethroplasty and were included. Not only complications requiring an additional procedure were included (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) but also healing troubles, infections, hematomas 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%. The median age was 4 years(1-16y). The overall rate of re-intervention and complication was 22.8% and 36.2% respectively. Age above 2 years was a significant predictor of complications (p=0.002, OR:1.98 IC 95% [1.26;3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy between 24-36 months (12,5% vs 3,6%, p=0.01) and healing problems beyond 13 years old (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. Above 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 for early surgery in patients with disorders of sex development.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-13T02:51:17.709314-05:
      DOI: 10.1111/bju.13771
  • 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 localized clear cell renal cell carcinoma (ccRCC) patients.Patients and Methods367 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 LASSO Cox regression, we identified several markers which were used to construct a risk classifier for risk of disease recurrence.ResultsMedian follow-up was 63.5 months (IQR 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-4EB1). Patients were classified as either low, intermediate or high risk of disease recurrence by tertiles of risk score. 5-year recurrence free survival (RFS) was 93.8%, 87.7% and 70% for patients with low, intermediate and high risk score, respectively (p
      PubDate: 2017-01-11T11:09:04.516556-05:
      DOI: 10.1111/bju.13776
  • Development of a Voided Urine Assay for Detecting Prostate Cancer
           Noninvasively: 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 (PCa) can be detected noninvasively by a simple and reliable assay by targeting genomic VPAC receptors expressed on malignant PCa cells shed in voided urine.Materials and MethodsVPAC receptors were targeted with a specific biomolecule, TP4303, developed in our laboratory. With an IRB “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, (N=207, M= 176, F= 31, 21 years or older) was cytospun. The cells were fixed and treated with TP4303 and 4, 6 Dimidino-2-phenylindole, Dihydrochloride (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 blue nucleus were regarded as normal. VPAC presence was validated using receptor blocking assay and cell malignancy was confirmed by PCa gene profile examination.ResultsThe urine specimens were labeled 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 patients having a PCa diagnosis, (N=141), and none (0%) of the males with benign prostatic hyperplasia (BPH) (N=10). Of the 56 “normal” patients, 62.5% (N=35, M=10, F=25) were negative for VPAC cells; 19.6% (N=11, M=11, F=0) had VPAC positive cells; and 17.8% (N=10, M=4, F=6) were uninterpretable due to excessive crystals in the urine. Although data are limited, the sensitivity of the assay was 99.3% with confidence interval of 96.1%-100% and the specificity was 100% with confidence interval of 69.2%-100%. Receptor blocking assay and FACS analyses demonstrated the presence of VPAC receptors and gene profiling examinations confirmed that the cells expressing VPAC receptors were malignant PCa cells.ConclusionThese preliminary data are highly encouraging and warrant further evaluation of the assay to serve as a simple and reliable tool to detect PCa noninvasively.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:40:28.490622-05:
      DOI: 10.1111/bju.13775
  • TANGO – a screening tool to identify comorbidities on the causal
           pathway of Nocturia
    • Authors: W F Bower; G E Rose, C F Ervin, J Goldin, D M Whishaw, F 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 screening tool.Subjects/PatientsThe 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 was subjected to descriptive analysis; criteria were applied to reduce 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 screening Short Form is presented. The resultant short form 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.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:30:27.766759-05:
      DOI: 10.1111/bju.13774
  • Quantifying severe urinary complications after radical prostatectomy: the
           development and validation of a surgical performance indicator using
           hospital administrative data
    • Authors: A Sujenthiran; SC Charman, M Parry, J Nossiter, A Aggarwal, P Dasgupta, H Payne, NW Clarke, P Cathcart, J van der Meulen
      Abstract: ObjectivesTo develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within two years after 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 to estimate adjusted odds ratios (OR) for patient and surgical characteristics.Results17,299 men were included, 2,695 (15.6%) experienced at least one severe urinary complication within two 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%CI, 1.26-1.67) and those with prolonged length of hospital stay (OR 1.54, 95% CI, 1.40-1.69) and were less common in men who had robotic surgery (OR 0.65, 95% CI, 0.58-0.74).ConclusionThese results demonstrate 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 modalities and for service evaluation comparing performance of prostate cancer surgery providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:25:33.719822-05:
      DOI: 10.1111/bju.13770
  • 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 (PCa) following External Beam Radiotherapy (EBRT) from a multicenter database.Materials and MethodsThis retrospective study comprises patients from 9 centers with local recurrent disease following EBRT treated with S-HIFU from 1995 to 2009. Biochemical free survival rates (BFSR) was based on the “Phoenix” definition (nadir+2). Secondary end points included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall, tumor specific and metastasis free survival. Adverse events and quality of life status are reported.ResultsA total of 418 patients with a mean follow-up of 3.5±2.5 years were included. The average age was 68.6±5.8 years. The average PSA pre S-HIFU was 6.8±7.8ng/ml. The median PSA nadir after S-HIFU was 0.19ng/ml. The overall, cancer specific and metastasis free survival rate at 7 years were 72%, 82% and 81%, respectively. At 5 years the BFSR was 58%, 51% and 36% for pre EBRT low-, intermediate- and high-risk patients, respectively. The 5 years BFSR was 67%, 42% and 22% for pre S-HIFU PSA ≤4, 4 to 10 and ≥10ng/ml respectively.Complication rates decreased after the introduction of specific post-radiation treatment parameters: incontinence (grade II or III) from 32% to 19% (p=0.002); bladder outlet obstruction (BOO) or stenosis from 30% to 15% (p=0.003); urethro-rectal fistula decreased from 9% to 0.6% (p
      PubDate: 2017-01-07T02:30:27.700329-05:
      DOI: 10.1111/bju.13766
  • First-line non-cytotoxic therapy in chemotherapy-naive patients with
           metastatic castration-resistant prostate cancer: a systematic review of
           ten randomised clinical trials
    • Authors: Michiel H.F. Poorthuis; Robin W.M. Vernooij, R. Jeroen A. van Moorselaar, Theo M. de Reijke
      Abstract: ObjectiveTo systematically evaluate all available treatment options in chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC).MethodsWe systematically searched PubMed, EMBASE, and the Cochrane libraries up to March 1, 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 (RoB) with the Cochrane Collaboration's tool and graded the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's approach.ResultsWe included 25 articles, reporting on ten 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 study, a prolonged PFS (high quality) was found with enzalutamide compared to bicalutamide, but its effect on OS is unknown.ConclusionsThe best evidence was found for abiraterone and enzalutamide for effective prolongation of PFS and OS to treat chemotherapy-naive mCRPC patients. However, taking both QoL and AEs into consideration, other treatment modalities could be considered for individual patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T22:50:22.24634-05:0
      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: ObjectiveTo estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology.Materials and MethodsA systematic review of MEDLINE, Embase, and the Cochrane databases (1997-July 1, 2016) was conducted to quantify 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) was evaluated for patients undergoing surgery by performing a meta-analysis.ResultsA total of 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 from identified 2 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 RCC (12.5%), other RCC (12.5%), hybrid oncocytic/chromphobe tumor (6.3%), and other benign lesions (4.2%).Positive predictive value of oncocytoma on RMB was 67% (95% confidence interval 34% to 94%) with significant heterogeneity between studies (I2=71.8%, p
      PubDate: 2017-01-06T02:20:35.942551-05:
      DOI: 10.1111/bju.13763
  • 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, Ballentine H Carter, Alan W. Partin, Lori J. Sokoll, Ashley E. Ross
      Abstract: ObjectivesTo explore the utility of prostate health index (PHI) density for detection of clinically-significant prostate cancer (PCa) in a contemporary cohort of men presenting for diagnostic workup of PCa.Patients & MethodsThe study cohort included patients with elevated 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) x (PSA)½], and density calculations were performed using prostate volume as determined on transrectal ultrasound. 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 PHI density was 0.70 (IQR 0.43-1.21); it was 0.53 (IQR 0.36-0.75) in men with negative biopsy or clinically-insignificant PCa and 1.21 (IQR 0.74-1.88) in men with clinically-significant PCa (p
      PubDate: 2017-01-06T02:15:22.821258-05:
      DOI: 10.1111/bju.13762
  • Cannabinoids for treating neurogenic lower urinary tract dysfunction in
           patients with multiple sclerosis: a systematic review and meta-analysis
    • Authors: Nadim Abo Youssef; Marc P. Schneider, Livio Mordasini, Benjamin. V. Ineichen, Lucas M. Bachmann, Emmanuel Chartier-Kastler, Jalesh N. Panicker, Thomas M. Kessler
      Abstract: ObjectivesTo systematically review all available evidence on efficacy and safety of cannabinoids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS).Patients and methodsThe review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus (last search on 11 November 2016).ResultsAfter screening 8469 articles, two randomized controlled trials and one open label study enrolling a total of 426 patients, were included. Cannabinoids relevantly decreased incontinence episodes in all three studies. Pooling data showed mean difference in incontinence episodes per 24 hours to be -0.35 (95% confidence interval -0.46 to -0.24). Mild adverse events were frequent (38-100%), but only two patients (0.7%) reported a serious adverse event.ConclusionsPreliminary data imply, that cannabinoids might be an effective and safe treatment option for NULTD in patients with MS. However, evidence base is poor and more high-quality, well-designed, adequately powered and sampled studies are urgently needed to reach definitive conclusions.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T02:05:28.086953-05:
      DOI: 10.1111/bju.13759
  • London welcomes the European Association of Urology (EAU)
    • Authors: Christopher R. Chapple
      Pages: 359 - 359
      PubDate: 2017-02-16T23:51:55.561509-05:
      DOI: 10.1111/bju.13797
  • Rethinking cancer surveillance with shared-care models and survivorship
           plans: the time is now!
    • Authors: Matthew T. Gettman
      Pages: 360 - 361
      PubDate: 2017-02-16T23:51:57.048655-05:
      DOI: 10.1111/bju.13629
  • Ultrasonography vs computed tomography for stone size
    • Authors: Daron Smith; Uday Patel
      Pages: 361 - 362
      PubDate: 2017-02-16T23:51:59.44189-05:0
      DOI: 10.1111/bju.13735
  • Laparoscopic renal mass cryoablation: an operation in search of an
    • Authors: Daniel C. Parker; Brian W. Cross
      Pages: 363 - 364
      PubDate: 2017-02-16T23:51:57.248316-05:
      DOI: 10.1111/bju.13692
  • Nephrometry scoring systems: valuable research tools, but can they be
           applied in daily clinical practice?
    • Authors: Matthew A. Meissner; Jose A. Karam
      Pages: 364 - 365
      PubDate: 2017-02-16T23:52:01.058929-05:
      DOI: 10.1111/bju.13716
  • Guideline of Guidelines – Non-Muscle Invasive Bladder Cancer
    • Authors: Solomon L. Woldu; Aditya Bagrodia, Yair Lotan
      First page: 371
      Abstract: Non-muscle invasive bladder cancer (NMIBC) represents the vast majority of bladder cancer diagnoses, however this definition represents a spectrum of disease with a variable clinical course notable for significant risk of recurrence and potential for progression. Management involves risk-adapted strategies of cystoscopic surveillance and intravesical therapy with a goal of bladder preservation when safe to do so. Multiple organizational guidelines exist to help practitioners manage this complicated disease process, however adherence to management principles amongt practicing urologists is reportedly low. We review four major organizational guidelines on NMIBC: American Urological Association (AUA) / Society of Urologic Oncology (SUO), European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and National Institute for Health and Care Excellence (NICE).This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T02:15:25.021899-05:
      DOI: 10.1111/bju.13760
  • Safety and early effectiveness of robotic partial nephrectomy for large
    • Authors: Shay Golan; Scott Johnson, Matthew Maurice, Jihad Kaouk, Weil Lai, Benjamin Lee, Steve Kheyfets, Chandru Sundaram, David Cahn, Robert Uzzo, Arieh Shalhav
      Abstract: ObjectivesTo evaluate a multicenter series of robotic assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).Materials and methodsBetween 2005-2016, 40 patients with large or symptomatic AMLs underwent RAPN at 5 academic centers in the United States. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analyzed. Surgical outcomes were compared between patients who underwent selective arterial embolization (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.ResultsMedian tumor diameter was 7.2 cm (interquartile range [IQR]: 5–8.5 cm), and the median nephrometry score was 9 (IQR: 7-10). Six patients (15%) had a history of tuberous sclerosis, and 11 (28%) had previously undergone SAE. Median operative time and median warm ischemia time were 207 minutes (IQR: 180-231) and 22.5 minutes (IQR: 16-28), respectively. Non-clamping technique was applied in 8 (20%) patients. Median blood loss was 200 ml (IQR: 100-245), and 4 patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and 7 postoperative complications occurred in 6 patients (15%). During a median follow-up time of 8 months (IQR: 1-15), none of the patients developed AML-related symptoms. The median eGFR preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before surgery and those who did not.ConclusionsRAPN appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with favorable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-18T03:35:22.511374-05:
      DOI: 10.1111/bju.13747
  • Early surgical outcomes and oncological results of robotic assisted
           partial nephrectomy: A multi-centre study
    • Authors: R Veeratterapillay; S Addla, C Jelley, J Bailie, D Rix, S Bromage, N Oakley, R Weston, N Soomro
      Abstract: ObjectiveTo describe a multi-centre experience of robotic 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 trans-peritoneal approach using standardised technique. Prospective data collection was performed to capture preoperative characteristics (including the R.E.N.A.L. nephrometry score), peri-operative parameters, and post-operative data including renal function. Correlations between warm ischaemic time (WIT), positive margin rate, complication rates, R.E.N.A.L. nephrometry scores and learning curve were assessed by univariate and multivariate analyses.Results250 patients (mean age 58.1±13 years, mean BMI 27.3±7 kg/m2) were included with a median follow-up of 12 months (3-36). The mean tumour size was 30.6±10mm, mean RENAL nephrometry score was 6.1±2 and 55% of tumours were left sided. Mean operative console time was 141±38 min, warm ischaemic time 16.7±8 min and estimated blood loss 205±245 mLs. There were 5 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 positive margin rate was 7.3%. The mean preoperative and immediate post-operative eGFR were 92.8±27 and 80.8±27 ml/min/1.73m2 respectively(p=0.001). 66%of patients remained in the same CKD category postoperatively and none of the patients required dialysis during the study period. ‘Trifecta’ (defined as WIT
      PubDate: 2016-12-18T03:30:24.842382-05:
      DOI: 10.1111/bju.13743
  • Efficacy and Safety of Tadalafil 5mg Once Daily in the Treatment of Lower
           Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia
           (LUTS/BPH) in Men Aged 75 years or Older: Integrated Analyses of Pooled
           Data From Multinational, Randomised, 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 ≥75 years with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and additional safety in men ≥75 years with erectile dysfunction (ED).Subjects and MethodsIntegrated analysis of 12 Phase II-III randomised, 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
      PubDate: 2016-12-18T03:30:22.854186-05:
      DOI: 10.1111/bju.13744
  • Development, Validation and Clinical Application of Pelvic Lymphadenectomy
           Assessment and Completion Evaluation (PLACE): Intraoperative Assessment of
           Lymph Node Dissection after Robot-Assisted Radical Cystectomy for Bladder
    • Authors: Ahmed A. Hussein; Nobuyuki Hinata, Shiva Dibaj, Paul R. May, Justen D. Kozlowski, Hassan Abol-Enein, Ronney Abaza, Daniel Eun, Shamim Khan, James L. Mohler, Piyush Agrawal, 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).MethodsA panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into 3 zones. Twenty-one de-identified videos of bilateral robot-assisted PLND were assessed by the 11 experts using PLACE to determine inter-rater reliability (IRR). Lymph node clearance was defined as the proportion of cleared lymph nodes from all PLACE zones. We investigated the correlation between lymph node clearance and lymph node count. Then, we compared the lymph node 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 21 bilateral PLND videos. Median (interquartile range) for lymph node clearance was 468 (431-545). There was a significant positive correlation between lymph node clearance and lymph node count (R2=0.70, p
      PubDate: 2016-12-17T17:20:25.472623-05:
      DOI: 10.1111/bju.13748
  • 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, Martin P. 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: ObjectivesTo 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 shifts of histopathological prognostic factors such as the Gleason Score.Patients and MethodsA total of 350 patients were randomized and specimens of 279 (80%) of the patients were centrally reviewed by a dedicated genitourinary pathologist.The Gleason Score, tumor classification and resection margin status were reassessed and compared with the local pathology reports. Agreement was assessed using contingency tables and Cohen's Kappa. Additionally, the association between other histopathological features (e.g. largest diameter of carcinoma) with rapid biochemical progression (up to 6 months after salvage RT) was investigated.ResultsThere was good concordance between central pathology review and local pathologists for seminal vesicle invasion [pT3b: 91%; k=0.95 (95% CI 0.89, 1.00)], for extraprostatic extension [pT3a/b: 94%; k=0.82 (95% CI 0.75, 0.89)], and for positive surgical margin status [87%; k=0.7 (95% CI 0.62, 0.79)]. Agreement was lower for Gleason score [78%; k=0.61 (95% CI 0.52, 0.70)]. The median largest diameter of carcinoma was 16 mm (range, 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% Confidence interval (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 reveal concordant results for seminal vesicle invasion, extraprostatic extension, positive surgical margin but lower agreement for Gleason Score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-17T17:20:22.803705-05:
      DOI: 10.1111/bju.13742
  • Robotic Salvage Retroperitoneal and Pelvic Lymph Node Dissection for
           “Node-only” Recurrent Prostate Cancer: Technique and Initial Series
    • Authors: Andre Luis Castro Abreu; Carlos E. S. Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir S. Gill
      Abstract: ObjectivesTo describe the technique of robotic high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer.Materials and MethodsTen patients underwent robotic sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by carbon-11 acetate PET/CT imaging. Our anatomic 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 4 prospectively-assigned anatomic zones.ResultsMedian operative time was 4.8 hours, blood loss 100 ml and hospital stay 1 day. No patient had intra-operative complication, open conversion or blood transfusion. Three patients had spontaneously-resolving Clavien II post-operative complications. Mean number of nodes excised per patient was 83 (41-132) and mean number of positive nodes per patient was 23 (0-109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomic levels I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, median PSA decreased by 83% at 2 months follow-up.ConclusionThe initial series of robotic sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robotic technical details for an anatomic lymphadenectomy template up to the renal vessels is presented. Longer follow-up is necessary to assess oncologic outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:50:34.123546-05:
      DOI: 10.1111/bju.13741
  • Clinical impact of 68Ga-PSMA PET/CT in prostate cancer patients with
           rising PSA after treatment with curative intent: preliminary analysis of a
           multidisciplinary approach
    • Authors: S Albisinni; C Artigas, F Aoun, I Biaou, J Grosman, T Gil, E Hawaux, K Limani, F Otte, A Peltier, S Sideris, N Sirtaine, P Flamen, R Velthoven
      Abstract: BackgroundTo assess the impact of 68Ga-(HBED-CC)-PSMA (Prostate Specific Membrane Antigen) PET/CT in the clinical management of PCa patients with rising PSA after treatment with curative intent. 68Ga-PSMA PET/CT scan is a novel molecular imaging technique in the field of prostate cancer (PCa).Methods131 consecutive patients were referred to our center for a 68Ga-PSMA PET/CT in the setting of recurring prostate cancer. 11/131(8%) presented persistent PSA after radical prostatectomy, while 120/131 (92%) were referred for biochemical recurrence after surgery, radiotherapy or both. Images where performed 1 hour post-injection of 2MBq/Kg of 68Ga-(HBED-CC)-PSMA ligand. All exams were interpreted by two experienced nuclear medicine specialists. With the results of the exam, a multidisciplinary oncology committee (MOC) reported on the treatment strategy. A positive impact in clinical management was considered if the exam determined a modification in the treatment strategy compared to MOC decision prior to PSMA.ResultsAll patients completed the exam with no adverse reactions. Median PSA at the time of the exam was 2.2ng/ml (range 0.72-6.7). Overall, 68Ga-PSMA PET/CT detected at least one lesion suspicious of PCa in 98/131 (75%) patients. An impact in management was found in 99/131patients (76%).Main modifications included continuing surveillance (withholding hormonal therapy), hormonal manipulations, stereotaxic radiotherapy, salvage radiotherapy, salvage node dissection or salvage local treatment (prostatectomy, HIFU).ConclusionOur preliminary experience suggests that performing 68Ga-PSMA PET/CT in PCa patients with rising PSA after treatment with curative intent can be clinically useful as it changes the treatment strategy in a significant percentage of patients. However, larger prospective trials are needed to validate our findings.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:45:26.46431-05:0
      DOI: 10.1111/bju.13739
  • 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, U. 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 d 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 mo of treatment including ≥4 mo of therapy at their highest tolerated dose. Secondary endpoints included progression-free survival (PFS) and safety.ResultsEighty-three 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. ORR was 44.4% (n = 8/18; 95% CI: 21.5–69.2) and 17.9% (n = 12/67; 95% CI: 9.6–29.2) in the mITT and ITT populations, respectively. Median PFS was 7.4 mo (95% CI: 6.0‒11.7) (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 above 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.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:45:25.219934-05:
      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 EPE at time of surgery, using commonly available pre-operative markers.Materials and MethodsA consecutive sample of 753 men treated by radical prostatectomy at University Health Network, between 2009 and 2015, was used to develop the nomogram. The validation cohort consisted of 311 men treated by radical prostatectomy at Ottawa Hospital Research Institute, between 1992 and 2014. Study outcome was presence of ipsilateral extraprostatic extension. The association between predictors considered and extraprostatic extension was tested using univariate and multivariate logistic regression analyses. Nomogram predictive accuracy was determined using area under the receiver operating characteristic curve.ResultsThe overall rate of extraprostatic extension was 19.8% of all lobes in the developmental cohort and 28.9% in the validation cohort. Significant parameters in the models were age, prostate-specific antigen, and ipsilateral Gleason Score, percent cores positive, and highest core involvement (all p
      PubDate: 2016-12-08T16:00:28.055651-05:
      DOI: 10.1111/bju.13733
  • ProtecTion from overtreatment – does a randomised trial finally answer
           the key question in localised prostate cancer'
    • Authors: Luke L. Wang; Christopher J.D. Wallis, Niranjan Sathianathen, Nathan Lawrentschuk, Declan G. Murphy, Robert Nam, Daniel Moon
      Abstract: For the first time we now have a randomised trial comparing active monitoring, surgery and radiation therapy for the management of localised prostate cancer and the investigators are to be congratulated on this highly anticipated landmark study – the Prostate testing for cancer and Treatment (ProtecT) trial[1]. Comparing 545 patients randomised to active monitoring, 553 to radical prostatectomy, and 545 to radiotherapy, at a median follow-up of 10 years the study reports no significant difference in prostate-cancer specific or overall survival amongst the three groups[1].This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-08T16:00:21.353881-05:
      DOI: 10.1111/bju.13734
  • 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
      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
  • 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 der 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. Participants received placebo or desmopressin orally disintegrating tablet ([ODT], 10–100 μg). Incidence of serum sodium
      PubDate: 2016-11-15T10:15:38.146759-05:
      DOI: 10.1111/bju.13718
  • Introduction of robotically-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: ObjectivesIn recent years, there has been rapid adoption of robotically-assisted surgery (RAS) for the treatment of pelvic urological cancers. This is particularly true for radical prostatectomy (RP) where robotically-assisted laparoscopic prostatectomy (RALP) has become the predominant surgical approach across England. Despite this, less than 15% of patients undergoing radical cystectomy (RC) in England in 2014 underwent a robotically-assisted radical cystectomy (RARC). However, as expertise in RAS spreads, an increasing number of cancer centres are now adopting this approach for patients undergoing RC. The current paper describes the implementation phase of a robotically-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS).Patients and Methods114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 (ileal conduit (n= 97) and orthotopic neobladder (n=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 ER 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. Mean operative time period was 3-5 hours with an overall transfusion rate of 8.8%. Higher-grade complications (Clavien-Dindo grade III-IV) were seen in 18.4% of patients with a 30-day mortality of 0.9%. Median LOS following RARC was 7 days (range 3-68) with a re-admission rate of 18.4%.ConclusionsThe current series demonstrates that RARC can be safely implemented in a unit experienced in 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 ORC and, despite the fact that complication rates are 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 maximize the benefits of minimally-invasive surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-15T01:31:46.730564-05:
      DOI: 10.1111/bju.13702
  • Prostatic Urethral Lift (PUL) vs Transurethral Resection of the Prostate
           (TURP): 2 Year Results of the BPH6 Prospective, Multi-Center, Randomised
    • Authors: C Gratzke; N Barber, M Speakman, R Berges, U Wetterauer, D Greene, K-D Sievert, C Chapple, J Sonksen
      Abstract: ObjectivesTo compare Prostatic Urethral Lift (PUL) to Transurethral Resection of the Prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.Subjects/patients and methods80 patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) enrolled in a prospective, randomised, controlled, non-blinded study conducted at 10 European centers. 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, analyzed, and presented here for the first time.ResultsSignificant improvements in International prostate symptom score (IPSS), IPSS quality of life (QoL), BPH Impact Index (BPH II), and peak flow rate were observed in both arms through the 2 year follow up. TURP IPSS and peak flow change were superior to PUL. IPSS QoL and BPH II improvements were not statistically different. PUL resulted in superior quality of recovery, ejaculatory function preservation, and performance on the composite BPH6 index. Ejaculatory function bother scores did not demonstrate statistically significant change in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep starting at the 6 month interval and continuing to the end of the study. Over the two year follow up, 6 PUL subjects (13.6%) and 2 TURP subjects (5.7%) underwent secondary treatment for return of LUTS. Most patients perceived LUTS improvement and would recommend their treatment procedure to a friend.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.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-14T01:45:33.882162-05:
      DOI: 10.1111/bju.13714
  • Value of 111In-PSMA-radioguided surgery for salvage lymphadenectomy in
           recurrent prostate cancer: correlation with histopathology and clinical
    • Authors: Isabel Rauscher; Charlotte Düwel, Martina Wirtz, Margret Schottelius, Hans-Jürgen Wester, Kristina Schwamborn, Bernhard Haller, Markus Schwaiger, Jürgen E. Gschwend, Matthias Eiber, Tobias Maurer
      Abstract: ObjectivesTo evaluate the use of 111In-labeled PSMA-I&T based radioguided surgery (111In-PSMA-RGS) for salvage surgery in recurrent prostate cancer (PC) using comparison of intraoperative γ-probe measurements to histopathological results of dissected specimens. Furthermore, the success of 111In-PSMA-RGS was determined by postoperative prostate-specific antigen (PSA) responses, PC-specific treatment-free survival as well as postoperative complication rates.Patients and MethodsIn this study, 31 consecutive patients with localized recurrent PC undergoing salvage surgery with PSMA-targeted RGS using an 111In-labeled PSMA ligand were retrospectively included from April 2014 to July 2015. Preoperative median PSA was 1.3 (IQR: 0.57-2.53ng/ml, range: 0.2–13.9ng/ml). Results of ex vivo radioactivity rating (positive vs. negative) of resected tissue specimens were compared to findings of postoperative histological analysis. Best PSA response without additional treatment was determined following 111In-PSMA-RGS and salvage-surgery related postoperative complications and PC-specific additional treatments were recorded.ResultsIn 30/31 patients, 111In-PSMA-RGS allowed intraoperative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. By 111In-PSMA-RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer-free, 4 were false negative and 6 false positive compared to histological evaluation. Follow-up information was available for 30/31 patients. PSA decline >50% and >90% was observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to
      PubDate: 2016-11-10T13:10:30.161807-05:
      DOI: 10.1111/bju.13713
  • Risk Stratification – a Tool to predict the Course of Active
           Surveillance for Localized Prostate Cancer?
    • Authors: Jan Herden; Axel Heidenreich, Lothar Weissbach
      Abstract: ObjectiveTo investigate a cohort of patients under active surveillance (AS) for localized prostate cancer (PCa) concerning possible differences in discontinuation rates, subsequent therapies, reasons for intervention, and pathologic findings after deferred surgery depending on stratification in very low-, low-, and intermediate/high-risk PCa.Patients and MethodsHAROW is a non-interventional, observational, outcomes research study on the management of localized PCa in the community setting. Fourhundred sixtyeight (468) Patients were prospectively enrolled in the HAROW study, with a mean Follow-up of 28.5 months. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6-months intervals.ResultsOf 468 AS patients, 244 qualified for the very low-, 142 for the low- and 82 for the intermediate/high-risk group. Onehundred twelve (112) patients discontinued AS. Discontinuation rates were 25.4% in very low-, 21.1% in low- and 24.4% in intermediate/high-risk groups (p=0.633). Main reasons for intervention were biopsy upgrade and/or PSA elevation in the very low- and in the low-risk groups; and patient preference in the intermediate/high-risk group (p
      PubDate: 2016-11-10T13:10:24.543681-05:
      DOI: 10.1111/bju.13715
  • Utility of Patient-Specific Silicone Renal Models for Planning and
           Rehearsal of Complex Tumor Resections Prior to Robotic-Assisted
           Laparoscopic Partial Nephrectomy
    • Authors: Friedrich-Carl Rundstedt; Jason M. Scovell, Smriti Agrawal, Jacques Zaneveld, Richard E. Link
      Abstract: ObjectiveSurgical planning for robotic partial nephrectomy (RALPN) depends on preoperative imaging and interpretation of spatial relationships between tumor and renal anatomy. We describe our experience using patient specific tissue-like kidney models created with advanced 3D printing technology for preoperative planning and surgical rehearsal prior to RALPN .Patients and MethodsA feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D print models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction we generated pre-surgical models out of a silicone-based material. All surgical rehearsals were performed using the Davinci™ robotic system prior to the actual procedure. To determine construct validity, we compared resection times between the model and actual tumor in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumor volume resected for each model and patient tumor.ResultsWe generated patient-specific models for 10 patients with complex tumor anatomy. Nephrometry scores were between 7 and 11 with an average maximal tumor diameter of 40.6 mm. Resection times between model and patient (6:58 min vs. 8:22 min, p=0.16) and tumor volumes between computer model, excised model, and excised tumor (38.88 mm3 vs. 38.50 mm3 vs. 41.79 mm3, p=0.98) were not significantly different.ConclusionsWe have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals and improve surgical training.
      PubDate: 2016-11-10T13:05:31.513813-05:
      DOI: 10.1111/bju.13712
  • Competency Based Training in Robotic Surgery: Benchmark Scores for Virtual
           Reality Robotic Simulation
    • Authors: N Raison; K Ahmed, N Fossati, N Buffi, A Mottrie, P Dasgupta, H 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 9 EAU hands-on-training courses in VR simulation. 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 performances 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 fell short of 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.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:25.305904-05:
      DOI: 10.1111/bju.13710
  • Multicentre evaluation of target and systematic biopsies using Magnetic
           Resonance and Ultrasound Image-Fusion guided Transperineal Prostate Biopsy
           in patients with a previous negative biopsy
    • Authors: N L Hansen; C Kesch, T Barrett, B Koo, J P Radtke, D Bonekamp, HP Schlemmer, A Y Warren, K Wieczorek, M Hohenfellner, C Kastner, B Hadaschik
      Abstract: ObjectivesTo evaluate the detection rates of targeted and systematic biopsies in magnetic resonance (MRI) and transrectal ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal US guided biopsies in two high-volume centres.Patients and methodsTwo centre, prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided target and systematic saturation biopsy from 2012 to 2015. MRI was reported according to PIRADS Version 1. Detection of Gleason score (GS) 7-10 cancer (PCa) on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.ResultsMedian PSA was 9.0 (IQR 6.7-13.4) ng/ml. PIRADS 3-5 MRI lesions were reported in 343 (70%) patients. GS 7-10 PCa was detected in 149 (31%). PPV for detecting GS 7-10 PCa was 0.20 (±0.07) for PIRADS 3, 0.32 (±0.09) for PIRADS 4, and 0.70 (±0.08) for PIRADS 5. NPV of PIRADS 1-2 was 0.92 (±0.04) for GS 7-10 and 0.99 (±0.02) for GS ≥ 4+3 cancer. Systematic biopsies alone found 125/138 (91%) GS 7-10 cancers. In patients with suspicious lesions (PIRADS 4-5) on MRI, systematic biopsies would not have detected 12/113 significant PCa (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PIRADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of GS 7-10, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA-density improved the AUC of PIRADS from 0.822 to 0.846.ConclusionIn patients with high probability MRI lesions, the highest detection rates of GS 7-10 cancer still required combined targeted and systematic MRI/TRUS 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 MRI read by experienced radiologists.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:23.079047-05:
      DOI: 10.1111/bju.13711
  • 11C-acetate PET/CT imaging for detection of recurrent disease following
           radical prostatectomy or radiotherapy in patients with prostate cancer
    • Authors: L. Esch; M. Fahlbusch, P. Albers, H. Hautzel, V. Müller-Mattheis
      Abstract: ObjectivesTo evaluate the effectiveness of CT-matched 11C-acetate PET (AC-PET) in prostate cancer patients with PSA relapse following radical prostatectomy (RP) or radiotherapy (RT) in a prospective study.Subjects and MethodsIn 103 relapsing patients after RP (n=97) or RT (n=6) AC-PET images and CT scans were obtained. In PET positive patients with localized 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.Results42/103 patients were PET positive with PSA levels
      PubDate: 2016-11-08T20:43:51.427501-05:
      DOI: 10.1111/bju.13706
  • Robotic 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
      Abstract: ObjectivesTo evaluate trends in perioperative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robotic partial nephrectomy (RPN) among multiple surgeons.Patients and MethodsA multi-institutional database was used to evaluate trends in patient demographics (age, gender, comorbidities, etc.), tumor characteristics (size, complexity, etc.) and perioperative outcomes (warm ischemia time, operative time, complications, estimated blood loss, trifecta achievement, etc.) 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 tumor-specific variables. Outcomes between cases 50-99 and 250-300 were compared.ResultsRPN was increasingly performed in patients with larger tumors (β=0.001, p=.048), hypertension (OR=1.003, p=.008) diabetes (OR=1.003, p=.025) and prior abdominal surgery (OR=1.003, p=.006). Surgeon experience was associated with more trifecta achievement (OR=1.006, p
      PubDate: 2016-11-08T07:55:20.432284-05:
      DOI: 10.1111/bju.13709
  • Management and Outcomes of Patients with Renal Medullary Carcinoma: A
           Multi-Center 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 characterize 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 during 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.ResultsFifty-two patients (37 males) were identified. Median age at diagnosis was 28 years (range 9-48). Forty-nine patients (94%) had stage III/IV. Median OS for all patients was 13.0 months. Thirty-eight 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=0.0004). Forty-five 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 longer than two years.ConclusionsRMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but less than 20% of patients survive longer than two years, underscoring the need to develop more effective therapy for this rare tumor. In this study, nephrectomy was associated with improved OS.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-08T07:50:20.077445-05:
      DOI: 10.1111/bju.13705
  • 3-year data of the AdVanceXP male sling: results of a prospective
           multicenter study
    • Authors: Ricarda M. Bauer; Markus T. Grabbert, Benedikt Klehr, Peter Gebhartl, Christian Gozzi, Roland Homberg, Florian May, Peter Rehder, Christian G. Stief, Alexander Kretschmer
      Abstract: ObjectivesIn recent years, several studies showed the effectiveness and safety of the AdVance sling for the treatment of male stress urinary incontinence (SUI). In 2010 the second generation of Advance, the AdVance XP was introduced with several changes of the sling design and with a new needle shape. Aim of the study was to evaluate the efficacy and safety of the AdVance XP sling in male SUI after radical prostatectomy in a prospective multicenter study.MethodsIn total 115 patients were included. Patients with urine nocturnal incontinence, previous incontinence surgery, previous radiotherapy and coaptive zone 50%. All others were classified as failures. Significance analysis was performed with Wilcoxon-test.ResultsMean preoperative urine loss in the 24h pad-test was 272.0 g (median 272.0 g).After a follow-up of 3 months (n= 114) 64.9% of the patients were cured and 31.6% improved. Mean urine loss decreased significantly to 34.9 g (p
      PubDate: 2016-11-08T07:40:19.803593-05:
      DOI: 10.1111/bju.13704
  • A prospective and randomized trial comparing fluoroscopic, total
           ultrasonographic, and combined guidance for renal access in
           mini-percutaneous nephrolithotomy
    • Authors: Wei Zhu; Jiasheng Li, Jian Yuan, Yongda Liu, Shaw P Wan, Guanzhao Liu, Wenzhong Chen, Wenqi Wu, Jintai Luo, Dongliang Zhong, Defeng Qi, Ming Lei, Wen Zhong, Ze Zhang, Zhaohui He, Zhijian Zhao, Suilin Lu, Yuji Wu, Guohua Zeng
      Abstract: ObjectiveTo compare the safety and efficacy of fluoroscopic, total ultrasonographic, and combined ultrasonographic and fluoroscopic guidance for percutaneous renal access in mini-percutaneous nephrolithotomy (mini-PCNL).Materials And MethodsThe present study was conducted between July 2014 and May 2015 as a prospective randomized trial at the First Affiliated Hospital of Guangzhou Medical University. 450 consecutive patients with renal stones larger than 2 cm were randomized to undergo fluoroscopy-, total ultrasonography-, or combined-guided mini-PCNL (150 patients for each group). The primary endpoints were the stone-free rate (SFR) and blood loss (hemoglobin decrease during the operation and transfusion rate). Secondary endpoints included access failure rate, operative time, and complications. S.T.O.N.E. score was used to document the complexity of the renal stones. The study was registered at (NCT02266381).ResultsThe three groups had similar baseline characteristics. With S.T.O.N.E. scores of 5-6 or 9-13, the SFRs were comparable between the three groups. For S.T.O.N.E. scores of 7-8, fluoroscopic guidance and combined guidance achieved significantly better SFR than total ultrasonographic guidance (one-session SFR 85.1% vs. 88.5% vs. 66.7%, p=0.006; overall SFR at three months postoperatively 89.4% vs. 90.2% vs. 69.8%, p=0.002). Multiple-tracts mini-PCNL was used more frequently in the fluoroscopy-guided and combined-guided group than total ultrasonography-guided group (20.7% vs. 17.1% vs. 9.5%, p=0.028). The mean total radiation exposure time was significantly greater for fluoroscopic guidance than for combined guidance (47.5 vs. 17.9 seconds, p
      PubDate: 2016-11-08T07:35:33.42226-05:0
      DOI: 10.1111/bju.13703
  • Radio-guided sentinel lymph node detection and lymph node mapping in
           invasive urinary bladder cancer—a prospective clinical study
    • Authors: F. Aljabery; I. Shabo, Hans Olson, Oliver Gimm, Staffan Jahnson
      Abstract: ObjectivesWe investigated the possibility to detect sentinel nodes in patients with urinary bladder cancer (UBC) intra-operatively and whether the histopathological status of the identified sentinel nodes reflected that of the lymphatic field.Patients and methodsWe studied 103 patients with UBC pathological stage T1-T4 who were treated with cystectomy and pelvic lymph node (LN) dissection during 2005–2011 at the Department of Urology, Linköping University Hospital. Radioactive tracer Nanocoll 70 MBq (megabequerel) and blue dye were injected in the bladder wall around the primary tumour prior to surgery. Sentinel nodes were detected ex vivo during the operation with a hand-hold Geiger probe (Neoprobe Gamma Detection System). All lymph nodes were formalin-fixed, sectioned three times, mounted on slides and stained with hematoxylin-eosin. An experienced uropathologist (HO) evaluated the slides.ResultsThe mean age of the patients was 69 years, and 80 (77%) were male. Pathological staging was T1-12 (12%), T2-20 (19%), T3-48 (47%) and T4-23 (22%). A mean number of 31 nodes per patient were examined (range 7–68), totaling 3,253 nodes. LN metastases were found in 41 (40%) patients. Sentinel nodes were detected in 80% (83 of 103) of the patients. Sensitivity and specificity for detecting metastatic disease by SNB varied between LN stations with an average value of 67% and 90%, respectively. Lymph node metastatic density had a significant prognostic impact; a value of 8% or more was significantly related to shorter survival. Lympho-vascular invasion occurred in 65% (n=67) of patients and was significantly associated with shorter cancer-specific survival (p
      PubDate: 2016-10-31T08:11:17.005542-05:
      DOI: 10.1111/bju.13700
  • Diagnosis and long-term outcome of renal cysts after laparoscopic partial
           nephrectomy in children
    • Authors: C. Esposito; M. Escolino, B. Troncoso Solar, R. Iacona, R. Esposito, A. Settimi, I. Mushtaq
      Abstract: ObjectivesTo document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions post-LPN.Materials and MethodsWe reviewed the US imaging reports performed during follow-up in 125 children (77 girls, 48 boys - average age 3.2 years) underwent LPN in 2 centers of pediatric surgery in the period 2005-2015.ResultsTransperitoneal approach was adopted in 83 cases while retroperitoneoscopy in 42 cases. The average 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 8/61 appeared septated. The average diameter of the cysts was 3.3 x 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after mean 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size and only 5/61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 cases (83.6%) while they were associated with urinary infections and abdominal pain in the remaining 10 patients. None of them required a re-intervention.ConclusionsThe US finding of a simple cyst at the operative site after LPN is a common event during follow-up, with an incidence of about 50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There is no correlation between cysts formation and type of surgical technique adopted. As there is no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodical US controls.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-25T09:50:24.564409-05:
      DOI: 10.1111/bju.13698
  • Urinary collecting system invasion is associated with poor survival in
           clear cell renal cell carcinoma patients
    • Authors: George C. Bailey; Stephen A. Boorjian, Matthew J. Ziegelmann, Mary E. Westerman, Christine M. Lohse, Bradley C. Leibovich, John C. Cheville, R. Houston Thompson
      Abstract: ObjectivesTo evaluate the prognostic significance of urinary collecting system invasion in a large series of clear cell renal cell carcinoma patients.MaterialsPatients with clear cell renal cell carcinoma treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urologic pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan-Meier method and associations of collecting system invasion with death from renal cell carcinoma were evaluated using Cox models.ResultsOf the 859 patients with clear cell renal cell carcinoma, 58 (6.8%) demonstrated collecting system invasion. At last follow-up, 310 patients had died from renal cell carcinoma at a median of 1.8 years following surgery. Median follow-up for patients alive at last follow-up was 8.2 years. Estimated cancer-specific survival at 10 years following surgery for patients with collecting system invasion was 17%, compared with 60% for patients without collecting system invasion (p
      PubDate: 2016-10-20T10:35:23.991745-05:
      DOI: 10.1111/bju.13669
  • 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
      Abstract: ObjectiveTo analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data.Patients and MethodsA review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree analysis was performed to identify risk groups for survival.ResultsFor the entire cohort, estimated 5-year overall and disease-specific survival rates were 52% and 58%, respectively. Classification and regression tree analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumor-associated hydronephrosis. Five-year disease-specific survival for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (p
      PubDate: 2016-10-18T03:25:20.605334-05:
      DOI: 10.1111/bju.13689
  • Quality of life outcomes from the PATCH trial evaluating LHRH 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 KB Parmar, Ruth E Langley, Paul D Abel
      Abstract: ObjectivesTo compare quality of life (QoL) outcomes at 6 months between men with advanced prostate cancer (PCa) receiving either transdermal oestradiol (tE2) or LHRH agonists (LHRHa) for androgen deprivation therapy (ADT).Patients and methodsMen with locally advanced or metastatic PCa participating in an ongoing randomised, multi-centre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via 3 or 4 transcutaneous patches containing 100mcg of oestradiol/24 hours. LHRHa was administered as per local practice. Patients completed questionnaires based on EORTC QLQ-C30 with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.Results727 men were enrolled between August 2007 and 5 October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median age 74 years (interquartile range [IQR] 68-79), median PSA 44 ng/ml (IQR 19-119), and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than LHRHa (mean difference +4.2, 95% CI 1.2 to 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 gynecomastia (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 tE2 arm.ConclusionPatients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynecomastia. The ongoing trial will evaluate clinical efficacy, and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:20:21.109965-05:
      DOI: 10.1111/bju.13687
  • Factors associated with Regional Recurrence Following Lymphadenectomy for
           Penile Squamous Cell Carcinoma
    • Authors: Jay P. Reddy; Curtis A. Pettaway, Lawrence B. Levy, Lance C. Pagliaro, Pheroze Tamboli, Priya Rao, Isuru Jayaratna, Karen E. Hoffman
      Abstract: ObjectiveTo identify factors associated with regional recurrence (RR) following lymphadenectomy for penile cancer in order to determine which patients might benefit from adjuvant therapy.Materials/MethodsMen who underwent lymphadenectomy for penile squamous cell carcinoma from 1977-2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of lymphadenectomy. Cox regression models evaluated the association between RFS and patient and tumor characteristics.Results182 men who underwent lymphadenectomy for penile cancer were identified. Median patient age was 62 years and median follow-up was 4.2 years. 34 men experienced RR following lymphadenectomy, of which 24 developed isolated RR without distant metastasis. Median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathologic nodal stage, pathologic inguinal laterality, pelvic nodal involvement, lymph node density >5.2%, >3 pathologically-involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (p3 pathologically involved lymph nodes (AHR 3.78, 95% CI: 2.12-6.65; p
      PubDate: 2016-10-18T03:15:20.146557-05:
      DOI: 10.1111/bju.13686
  • Efficacy of knowledge and competence-based training of non-physicians in
           the provision of Early Infant Circumcision (EIC) using the Mogen clamp in
           Rakai, Uganda
    • Authors: E.Nelson Kankaka; G. Kigozi, D. Kayiwa, N. Kighoma, F. Makumbi, T. Murungi, D. Nabukalu, R. Nampijja, S. Watya, D. Namuguzi, F. Nalugoda, G. Nakigozi, D. Sserwadda, M. Wawer, R.H. Gray
      Abstract: Early infant circumcision (EIC) is the most common neonatal surgical procedure in males.1 It has also been incorporated as a component in combination HIV prevention in 14 of Sub-Saharan African countries with high HIV prevalence and low circumcision coverage.2,3 EIC has advantages over adult circumcision due to lower adverse events, no risk of early resumption of sex and potentially lower cost4–6. Sub-Saharan African countries have low physician coverage, but comparatively higher coverage of non-physicians who could facilitate roll out of circumcision for HIV prevention. The major concern has been safety of the procedure and complications can be mitigated by adequate training using a structured curriculum7–11with a didactic and supervised practicum, step-by-step checklists and immediate feedback from mentors. Anatomic models have also been shown to enhance trainee-learning.12–15This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:05:51.922449-05:
      DOI: 10.1111/bju.13685
  • Long-term utility of adjuvant hormonal and radiation therapy for patients
           with seminal vesicle invasion at radical prostatectomy
    • Authors: Marco Moschini; Vidit Sharma, Giorgio Gandaglia, Paolo Dell'Oglio, Nicola Fossati, Emanuele Zaffuto, Francesco Montorsi, Alberto Briganti, R. Jeffrey Karnes
      Abstract: IntroductionThe literature is conflicting on the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer (PCa) demonstrating seminal vesicle invasion (pT3b; SVI).MethodsPatients with SVI during RP and pelvic lymph node dissection at two major referral centers from 1986-2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were performed to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence, cancer specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients.ResultsOverall, 3,279 patients with SVI were included with a median follow up of 148 months. Considering the whole SVI population, 1,387 (42%) received no adjuvant therapy, 1,179 (36%) received aHT, 461 (14.1%) received aRT while 252 (7.7%) received both aHT and aRT, respectively. 10 year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all p
      PubDate: 2016-10-18T02:30:24.135404-05:
      DOI: 10.1111/bju.13683
  • Application of shear wave elastography to estimate the stiffness of the
           male striated urethral sphincter during voluntary contractions
    • Authors: Ryan E. Stafford; Rafeef Aljuraifani, François Hug, Paul W. Hodges
      Abstract: ObjectivesTo investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter during voluntary activation using shear wave elastography; to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. striated urethral sphincter); and to determine the relationship between muscle stiffness and contraction intensity.Subjects and methodsTen healthy men participated. A linear ultrasound transducer was placed mid-sagittal on the perineum adjacent to a pair of electromyography electrodes that recorded non-specific pelvic floor muscle activity. Stiffness in the area expected to contain the striated urethral sphincter was estimated via ultrasound shear wave elastography at rest and during voluntary pelvic floor muscles contractions to 5%, 10% and 15% maximum. Still image frames were exported for each repetition and analysed with software that detected increases in stiffness above 150% of the resting stiffness.ResultsPelvic floor muscle contraction elicited an increase in stiffness above threshold within the region expected to contain the striated sphincter for all participants and contraction intensities. The mean(SD) ventral-dorsal distance between the centre of the stiffness area and region of maximal motion of the mid-urethra (caused by striated urethral sphincter contraction) was 5.6(1.8), 6.2(0.8), and 5.8(0.7) mm for 5%, 10% and 15% MVC respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities(5% vs. 10%; P
      PubDate: 2016-10-18T02:25:26.528424-05:
      DOI: 10.1111/bju.13688
  • The management of non-visualisation following dynamic sentinel lymph node
           biopsy for squamous cell carcinoma of the penis
    • Authors: Varun Sahdev; Maarten Albersen, Michelle Christodoulidou, Arie Parnham, Peter Malone, Raj Nigam, Jamshed Bomanji, Asif Muneer
      Abstract: ObjectivesTo review the management and clinical outcomes of uni- or bilateral non-visualization of inguinal lymph nodes following dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0). An additional objective was to develop an algorithm for the management of patients in which non-visualisation occurs.Patients and MethodsThis is a retrospective observational study over a period of 4 years comprising 166 patients with penile squamous cell carcinoma undergoing DSNB and followed up for a minimum of 6 months. All cases diagnosed with uni- or bilateral non-visualisation of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes following non-visualisation and the oncological outcomes including local and regional recurrence rates were documented.ResultsOut of 166 consecutive patients undergoing DSNB, 20 (12%) patients had unilateral non-visualisation following injection of intradermal 99mTc. Of these 20 patients, 7 underwent repeat DSNB at a later date with 6 having successful visualisation. One patient had persistent non-visualisation and proceeded to a superficial modified inguinal lymphadenectomy (SML). None of these patients experienced recurrence at follow-up. A further seven patients underwent modified SML with on table frozen section analysis of the lymph node packet; none of these patients were found to have micrometastatic disease in the inguinal lymph nodes although one patient developed metastatic inguinal node disease at a later date. Six patients elected to undergo clinical surveillance and have remained disease free.ConclusionPatients with impalpable inguinal lymph nodes undergoing DSNB with ≥ T1G2 disease should ideally have bilateral visualisation of the sentinel lymph nodes reflecting the drainage pattern from the primary tumour. In this series, 12% of patients were found to have unilateral non-visualisation following DSNB. Patients offered a repeat DSNB at a later date, were successful in localising the sentinel node in 86% of cases. Patients with favourable histological parameters can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that a SML may be carried out if there is repeated non-visualisation. Larger cohorts are required in order to validate this proposed algorithm.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:20:25.768838-05:
      DOI: 10.1111/bju.13680
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared to 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, Schwarz Rudolf, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Abstract: ObjectiveTo analyze the comparative effectiveness of no treatment or salvage radiation therapy at biochemical recurrence (NT/sRT) versus adjuvant radiation therapy (aRT) in LN positive patients after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN positive prostate cancer (PCa) at RP with or without additional radiation treatment from 2005 to 2013 were retrospectively analyzed. Cox regressions addressed factors influencing biochemical recurrence (BCR) and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsMedian follow-up for the entire patient group was 33.8 months. Four-year BCR-free and metastasis-free survival rates were 43.3% and 86.6% for all patients, respectively. In multivariate analysis, NT/sRT (n=505) was an independent risk factor for BCR and metastasis compared to patients with aRT (n=213). The superiority of aRT was confirmed after propensity score-matching. Four-year metastasis-free survival in the matched cohort was 82.5% versus 91.8% for the NT/sRT and aRT groups, respectively (p=0.02). Early sRT (pre-RT PSA ≤0.5 ng/ml) compared to sRT at PSA >0.5 ng/ml was significantly associated with decreased risk of metastasis.ConclusionLN positive patients who received aRT had a significantly better oncological outcome compared to patients with NT/sRT independent of tumor characteristics. Patients with early sRT showed higher rates of response and better metastasis-free survival than patients with pre-RT PSA >0.5 ng/ml.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:15:35.748361-05:
      DOI: 10.1111/bju.13679
  • Impact of Suboptimal Neoadjuvant Chemotherapy on Perioperative Outcomes
           and Survival After Robot-Assisted Radical Cystectomy: A Multicenter
           Multinational Study
    • Authors: Nobuyuki Hinata; Ahmed Aly Hussein, Saby George, Donald L. Trump, Ellis G. Levine, Kawa Omar, Prokar Dasgupta, Muhammad Shamim Khan, Abolfazl Hosseini, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo evaluate the effect of suboptimal dosing on the outcomes of patients who received neoadjuvant chemotherapy (NAC) and robot-assisted radical cystectomy (RARC).Patients and MethodsWe retrospectively reviewed 336 consecutive patients with urothelial carcinoma of the bladder who were treated with NAC and RARC at three academic institutions. Outcomes were compared between 3 groups: patients who received optimal NAC; patients who received suboptimal NAC; and those who did not receive NAC. To adjust for potential baseline differences between the three groups, propensity-score-based matching was performed. The suboptimal dose group was defined as those who received fewer than three cycles of cisplatin-based chemotherapy, received decreased dosage, or one's not treated with cisplatin. Primary outcomes analyzed were recurrence-free survival (RFS) and overall survival (OS). Secondary outcomes were perioperative complications and readmissions after RARC.ResultsWithin the cohort after propensity-score matching, 69 patients received optimal dose NAC, 41 received suboptimal NAC and 69 did not receive NAC. Complication rates and readmission rates between the 3 groups did not differ significantly. On multivariable analysis, suboptimal dosing and no NAC were independent predictors of worse RFS (HR: 2.5, 95%CI: 1.2-5.7, p=0.01 and HR 2.4, 95%CI 1.28-5.16, p=0.01) and worse OS (HR 4.5, 95%CI 1.6-15.0, p
      PubDate: 2016-10-15T08:15:34.670061-05:
      DOI: 10.1111/bju.13678
  • Prostate Health Index (phi) Improves Multivariable Risk Prediction of
           Aggressive Prostate Cancer
    • Authors: Stacy Loeb; Sanghyuk S. Shin, Dennis L. Broyles, John T. Wei, Martin Sanda, George Klee, Alan W. Partin, Lori Sokoll, Daniel W. Chan, Chris H. Bangma, Ron H. N. van Schaik, Kevin M. Slawin, Leonard S. Marks, William J. Catalona
      Abstract: ObjectiveTo examine the use of the Prostate Health Index (phi)* as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicenter US study.Materials and MethodsThe study population included 728 men with PSA levels of 2-10 ng/mL and negative digital rectal examination enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of phi improves the performance of currently available risk calculators (PCPT and ERSPC). We also designed and internally validated a new phi-based multivariable predictive model, and created a nomogram.ResultsOf 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. Phi predicted the risk of aggressive prostate cancer across the spectrum of values. Adding phi significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, prior biopsy, prostate volume, PSA, and phi with an AUC of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision curve analysis.ConclusionUsing phi as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:05:52.721224-05:
      DOI: 10.1111/bju.13676
  • Outcomes of advanced urothelial carcinoma patients following
           discontinuation of Programmed Death (PD)-1 or PD-Ligand (L)-1 inhibitors
    • Authors: G Sonpavde; G R Pond, S Mullane, A A Ramirez, N J Vogelzang, A Necchi, T Powles, J Bellmunt
      Abstract: ObjectiveTo study the subsequent therapy and disease outcomes of patients with advanced urothelial carcinoma (UC) following discontinuation of programmed death-1 (PD-1) or PD-Ligand (L)1 inhibitors.Patients and methodsWe performed a retrospective analysis to examine outcomes and systemic therapy administration following PD-1/PD-L1 inhibitor therapy in patients with advanced UC. Data were collected from institutions including demographics and therapy administered. Univariable Cox regression analyses examined clinical factors potentially associated with overall survival (OS) following PD-1/PD-L1 inhibitors.ResultsData from 62 patients was available from 4 institutions with capture of subsequent therapy and outcomes following checkpoint inhibitor immunotherapy. The median age was 65.5 years and 51 (82.3%) were male. The median duration of PD-1/PD-L1 inhibitors available from 55 patients was 64 days (range 7-669). Of these, 22 (35.5%) patients received post-PD1/PD-L1 inhibitor therapy with a variety of different chemotherapy regimens (n=16), chemobiologic combination (n=1), biologic agents (n=4) and immunotherapy (n=1). The median time from last PD1/PD-L1 inhibitor therapy to subsequent therapy was 58 days (range 14-242). The median OS of all patients following completion of PD-1/PD-L1 inhibitors was 149 days (95% CI: 75-359). Among those who received some post-PD1/PD-L1 inhibitor therapy, median OS was 182 days (95% CI: 121-372), and the median time to progression was 124 days (95% CI: 61-273) when examining from start of post-PD1/PD-L1 therapy. Among these 22 patients, the only significant baseline prognostic factor associated with OS was performance status.ConclusionsIn this dataset, 35.5% of patients with advanced UC received systemic therapy following salvage therapy with PD1/PD-L1 inhibitors. Outcomes with subsequent therapy appear similar to those historically observed in patients who had not received prior PD1/PD-L1 inhibitors. Further study of patients receiving post-PD1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-04T01:40:58.140777-05:
      DOI: 10.1111/bju.13674
  • Qualitative study on decision-making by prostate cancer physicians during
           active surveillance
    • Authors: Stacy Loeb; Caitlin Curnyn, Angela Fagerlin, Ronald Scott Braithwaite, Mark D. Schwartz, Herbert Lepor, Herbert Ballentine Carter, Erica Sedlander
      Abstract: ObjectiveTo explore and identify factors that influence physicians’ decisions while monitoring patients with prostate cancer on active surveillance (AS).Subjects and MethodsA purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the USA. We conducted 24 in-depth interviews from July to December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software were used for organization and further analysis.ResultsEight key themes emerged to explain variation in AS monitoring: (i) physician comfort with AS; (ii) protocol selection; (iii) beliefs about the utility and quality of testing; (iv) years of experience and exposure to AS during training; (v) concerns about inflicting ‘harm’; (vi) patient characteristics; (vii) patient preferences; and (viii) financial incentives.ConclusionThese qualitative data reveal which factors influence physicians who manage patients on AS. There is tension between providing standardized care while also considering individual patients’ needs and health status. Additional education on AS is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.
      PubDate: 2016-10-02T05:20:41.186095-05:
      DOI: 10.1111/bju.13651
  • Parents’ Perceptions of Counselling Following Prenatal Diagnosis of
    • Authors: Sarah Marokakis; Nadine A Kasparian, Sean E Kennedy
      Abstract: ObjectivesTo explore parents’ experiences of counselling after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.Materials and MethodsParents of a child born between September 2012 and March 2015 with posterior urethral valves (PUV) or multicystic dysplastic kidney (MCDK) completed a semi-structured telephone interview, demographic survey, and the Depression, Anxiety and Stress Scales (DASS21). Qualitative data were analysed thematically using NVivo10 software.ResultsSeventeen parents (PUV n=8; MCDK n=9) participated (response rate: 40%), and most were offered counselling during pregnancy (14/17). Parents described feelings of shock, fear and uncertainty following diagnosis, and desired early information on all aspects of their child's condition. Most participants were satisfied with the information received; however, unmet information needs relating to treatment and prognosis were identified, particularly amongst fathers and parents in the PUV group. Some parents felt relieved after counselling (12/17); however, emotional distress often persisted long after diagnosis. Parents described a need for written and web-based information resources, specialised psychological services, and parent support groups.ConclusionWhile parents valued counselling, many continued to report unmet informational and psychological needs. Early counselling addressing topics important to parents and provision of additional resources and support services may improve parents’ adjustment to their baby's diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:47.230139-05:
      DOI: 10.1111/bju.13668
  • When to perform preoperative chest computed tomography for renal cancer
    • Authors: Alessandro Larcher; Paolo Dell'Oglio, Nicola Fossati, Alessandro Nini, Fabio Muttin, Nazareno Suardi, Francesco De Cobelli, Andrea Salonia, Alberto Briganti, Xu Zhang, Francesco Montorsi, Roberto Bertini, Umberto Capitanio
      Abstract: ObjectivesTo provide objective criteria for preoperative staging chest computed tomography [CCT] in patients diagnosed with renal cell carcinoma [RCC], since, in absence of established indications, the decision for preoperative CCT remains subjective.Patients and Methods1,946 patients elected for surgical treatment of RCC and collected in a prospective institutional database were assessed. The outcome of the study was presence of pulmonary metastases at staging CCT. A multivariable logistic regression model predicting positive CCT was fitted. Predictors consisted of preoperative clinical tumour [cT] and nodal [cN] stage, presence of systemic symptoms and platelets/haemoglobin ratio.ResultsThe rate of positive CCT was 6% (n=119). At multivariable logistic regression, ≥cT1b, cN1, systemic symptoms and haemoglobin/platelets ratio were all associated with higher risk of positive CCT (all p1%, a negative CCT is spared in 37% of the population and a positive CCT is missed in 0.2% of the population only.ConclusionsThe proposed strategy estimates the risk of positive CCT at RCC staging with optimal accuracy and resulted statistically and clinically relevant. The current findings support a recommendation for CCT in patients with ≥cT1b, cN1, systemic symptoms or anaemia and thrombocythemia. Conversely, in patients with cT1a, cN0 without systemic symptoms, anaemia and thrombocythemia, CCT can be omitted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:43.908394-05:
      DOI: 10.1111/bju.13670
  • Long term outcome of high dose rate (HDR) brachytherapy for intermediate
           and high risk prostate cancer with a median follow up of 10 years
    • Authors: J W Yaxley; K Lah, J P Yaxley, R A Gardiner, H Samaratunga, J MacKean
      Abstract: ObjectiveTo evaluate the long term outcome of high dose rate brachytherapy (HDR) for patients with intermediate and high risk prostate cancerSubjects, Patients and MethodsWe retrospectively analysed the prospective longitudinal cohort data base of a single surgeon series of 507 consecutive patients treated with external beam radiotherapy and a high dose rate prostate brachytherapy boost (HDR) between August 2000 and December 2009. The risk factors are based on the D'Amico classification. We measured the incidence of biochemical freedom of recurrent prostate cancer (bNED) based on the Phoenix definition of failure (nadir + 2). We also reviewed the incidence of urethral stricture in this cohort.ResultsWith a minimum follow up of 6 years and a median follow up of 10.3 years, the bNED for intermediate and high risk disease is 93.3 and 74.2% at 5 years respectively and 86.9% and 56.1% at 10 years. Patients with only 1 intermediate risk factor had a 10 year bNED of 94%, whereas patients with all 3 high risk factors had a 10 year bNED of 39.5%. The overall urethral stricture rate was 13.6%. Prior to 2005 the urethral stricture rate was 28.9% and after January 2005 was 4.2%. For the 271 men with a minimum follow up of 10 years the actual 10 year prostate cancer specific survival is 90.8% and actual overall survival is 86.7%.ConclusionsHigh dose rate prostatic brachytherapy remains an appropriate treatment option for patients with intermediate or high risk prostate cancer features, who are considered not suitable for, or wish to avoid a radical prostatectomy. From December 2004, prevention strategies decreased the risk of post brachytherapy urethral strictures.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:47:32.745397-05:
      DOI: 10.1111/bju.13659
  • Prospective study comparing Videoendoscopic radical Inguinal Lymph node
           dissection (VEILND) with Open radical inguinal lymphnode dissection
           (OILND) for penile cancer over an 8 year period
    • Authors: Vivekanandan Kumar; Krishna K Sethia
      Abstract: ObjectivesTo compare the complications and oncological outcomes between Video Endoscopic Inguinal Lymph node Dissection (VEILND) and Open Inguinal Lymph node Dissection (OILND) in men with carcinoma of the penis.Patients and methodsA prospectively collected institutional database was used to determine the outcomes in 42 consecutive patients undergoing inguinal lymph node dissection between 2008 and 2015 in a centre for treating penile cancer. Before 2013 all procedures involved open surgery. Since 2013 we have performed VEILND on all patients in need of ILND. The wound related, non‐wound related complications, length of stay and oncological safety between OILND and VEILND groups were compared. The mean duration of follow up was 71months for OILND and 16 months for the VEILND groups.ResultsIn the study period 42 patients underwent 68 inguinal node dissections (open 35, video‐assisted 33). The patients demographics, primary stage and grade, indications were comparable in both the groups. There were no intraoperative complications in either group. The wound complication rate was significantly lower in VEILND group at 6% compared to 68% in the OILND group. Lymphocele rates were similar in both the groups (27 and 20%). The VEILND group showed better or same lymph node yield, mean number of positive lymph nodes and lymph node density confirming oncological safety. There were no groin recurrence in either group of patients. VEILND patients had significant reduced length of stay by 4.9 days (p=0.0001).ConclusionVEILND is an oncologically safe procedure with considerably low morbidity and reduced length of stay at a mean follow‐up of 16 months (Range: 4‐35 months).This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:40:25.561228-05:
      DOI: 10.1111/bju.13660
  • The landscape of systematic reviews in urology (1998 through 2015): An
           assessment of methodologic quality
    • Authors: Julia L. Han; Shreyas Gandhi, Crystal G. Bockoven, Vikram Narayan, Philipp Dahm
      Abstract: Sir Archie Cochrane is credited with the recognition that few clinical questions in health care are appropriately addressed by consulting the results of a single study alone; instead, we should perform systematic reviews to summarize the entire body of evidence—ideally, high‐quality evidence—in order to inform patient decision‐making and health policy. His contributions provided the impetus for the founding of the Cochrane Collaboration and for the development of transparent, rigorous methods for systematic reviews. Over the last two decades, such reviews have gained increasing importance with regard to their perceived role in informing evidence‐based clinical practice. They tend to be frequently cited in the literature and thus can raise a journal's impact factor. The number of systematic reviews published in the urology literature has clearly increased.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T04:21:15.537585-05:
      DOI: 10.1111/bju.13653
  • Lesion volume predicts prostate cancer risk and aggressiveness: validation
           of its value alone and matched with PIRADS score
    • Authors: Eugenio Martorana; Giacomo Maria Pirola, Michele Scialpi, Salvatore Micali, Andrea Iseppi, Luca Reggiani Bonetti, Shaniko Kaleci, Pietro Torricelli, Giampaolo Bianchi
      Abstract: ObjectiveTo demonstrate the association between MRI estimated lesion volume (LV), PCa detection and tumour clinical significance evaluating this variable alone and matched with PI‐RADSv2 score.Patients and methodsWe retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal MRI/US fusion targeted biopsy (Tp MRI/US FTB) between January 2014 and February 2016 using Biopsee® system. Suspicious lesions (SL) were bordered using a “region of interest” and the system calculated prostate volume and LV. Patients were divided in groups considering LV (< 0.5 ml, 0.5 ‐ 1 ml, > 1 ml) and PI‐RADS score (1‐5). We considered as clinically significant PCa (sPCa) all cancers with GS ≥ 3 + 4 as suggested by PI‐RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t test. MRI LV volume and HTV concordance was verified using a Bland‐Altman plot. Chi‐square test, logistic and ordinal regression model were used to evaluate difference in frequencies. The selected level of statistical significance was ≤ 0.05.ResultsThe LV and PI‐RADS score were associated both with PCa detection (p < 0.00001 and p= 0.00012) and with sPCa detection (p< 0.00001 and p= 0.00808). When the two variables were matched, LV increased the risk within each PI‐RADS group. PCa detection became 1.4 times higher for LV 0.5 ‐ 1 ml and 1.8 times higher for LV > 1 ml; sPCa detection increased 2.6 times for LV 0.5 ‐ 1 ml and 4 times for LV > 1ml. There was positive correlation between MRI LV and HTV (r = 0,9876, p < 0.001). Finally, Bland‐Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations are its monocentric and retrospective design and the limited casistic.ConclusionsThis study demonstrates that PIRADS score and the LV, independently and matched, are associated with PCa detection and with tumour clinical significance.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T13:50:20.096471-05:
      DOI: 10.1111/bju.13649
  • Improving clinical prognostic stratification models for men with prostate
           cancer: a practical step closer to more individualised care without added
    • Authors: Vincent J Gnanapragasam; Anne Y Warren
      First page: 366
      Abstract: Risk stratification remains the cornerstone in deciding management for men with non-metastatic prostate cancer. Current risk stratification systems however have barely changed in two decades and have shown significant shortcomings with regards intra and inter-group heterogeneity in disease behaviour and therapy outcomes. A number of sophisticated and expensive molecular tests have been developed and more are being investigated to address this gap. However, new thinking on how to better use existing pathological information and refining clinical risk models may already offer significant incremental benefits in improving prognostic prediction without additional costs or resourcing. In this comment we highlight some recent research which may help inform this issue.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-22T02:40:59.868421-05:
      DOI: 10.1111/bju.13721
  • Urologists of tomorrow—the case for educational intervention
    • Authors: Vincenzo Ficarra; Vincenzo Mirone, Prokar Dasgupta
      First page: 368
      Abstract: In recent decades, urology has gained a relevance that is independent of general surgery. This progress comes as a consequence of the high prevalence of urologic diseases and their enormous social and economic impacts, as well as significant innovations in the technologies and medical therapies used to treat urologic conditions. Briefly, it is estimated that 3–5% of consultations in general practice are for urologic conditions [1]. Prostate cancer is the most common cancer for males, while bladder and kidney/pelvis cancers represent the sixth and the eighth most common tumors in US in both sexes ( article is protected by copyright. All rights reserved.
      PubDate: 2016-12-05T00:36:39.242381-05:
      DOI: 10.1111/bju.13732
  • ProCare Trial: a phase II randomized controlled trial of shared care for
           follow-up of men with prostate cancer
    • Authors: Jon D. Emery; Michael Jefford, Madeleine King, Dickon Hayne, Andrew Martin, Juanita Doorey, Amelia Hyatt, Emily Habgood, Tee Lim, Cynthia Hawks, Marie Pirotta, Lyndal Trevena, Penelope Schofield
      Pages: 381 - 389
      Abstract: ObjectivesTo test the feasibility and efficacy of a multifaceted model of shared care for men after completion of treatment for prostate cancer.Patients and MethodsMen who had completed treatment for low- to moderate-risk prostate cancer within the previous 8 weeks were eligible. Participants were randomized to usual care or shared care. Shared care entailed substituting two hospital visits with three visits in primary care, a survivorship care plan, recall and reminders, and screening for distress and unmet needs. Outcome measures included psychological distress, prostate cancer-specific quality of life, satisfaction and preferences for care and healthcare resource use.ResultsA total of 88 men were randomized (shared care n = 45; usual care n = 43). There were no clinically important or statistically significant differences between groups with regard to distress, prostate cancer-specific quality of life or satisfaction with care. At the end of the trial, men in the intervention group were significantly more likely to prefer a shared care model to hospital follow-up than those in the control group (intervention 63% vs control 24%; P
      PubDate: 2016-08-29T11:35:27.394043-05:
      DOI: 10.1111/bju.13593
  • Oncological outcomes and complication rates after laparoscopic-assisted
           cryoablation: a European Registry for Renal Cryoablation (EuRECA)
           multi-institutional study
    • Authors: Tommy K. Nielsen; Brunolf W. Lagerveld, Francis Keeley, Giovanni Lughezzani, Seshadri Sriprasad, Neil J. Barber, Lars U. Hansen, Nicole M. Buffi, Giorgio Guazzoni, Johan A. Zee, Mohamed Ismail, Khaled Farrag, Amr M. Emara, Lars Lund, Øyvind Østraat, Michael Borre
      Pages: 390 - 395
      Abstract: ObjectiveTo assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs).Patients and MethodsA retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien–Dindo classification. Kaplan–Meier analyses were used to estimate 5- and 10-year disease-free survival (DFS) and overall survival (OS).ResultsThe median [interquartile (IQR)] age was 67 (58–74) years. The median (IQR) tumour size was 25 (19–30) mm. The transperitoneal approach was used in 77.7% of the patients. The median postoperative hospital stay was 2 days. In all, 514 patients with a biopsy-confirmed renal cell carcinoma (RCC) were available for survival analyses. The median (IQR) follow-up for the RCC-cohort was 36 (14–56) months. A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5-/10-year DFS was 90.4%/80.0% and 5-/10-year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥III) in 26 patients (3.2%). An American Society of Anesthesiologists score of 3 was associated with an increased risk of overall complications (odds ratio 2.85, 95% confidence interval 1.32–6.20; P = 0.005).ConclusionsThis large series of LCA demonstrates satisfactory long-term oncological outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.
      PubDate: 2016-08-26T03:00:33.501699-05:
      DOI: 10.1111/bju.13615
  • Patient–physician communication and health-related quality of life of
           patients with localised prostate cancer undergoing radical prostatectomy
           – a longitudinal multilevel analysis
    • Authors: Nicole Ernstmann; Lothar Weissbach, Jan Herden, Nicola Winter, Lena Ansmann
      Pages: 396 - 405
      Abstract: ObjectivesTo examine whether patient–physician communication is associated with health-related quality of life (HRQoL) in a sample of patients with localised prostate cancer undergoing radical prostatectomy (RP).Patients and methodsHAROW (Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) is a prospective, observational study designed to collect data of the different treatment options for newly diagnosed patients with localised prostate cancer under real-life conditions. At 6-months intervals, clinical data (D'Amico risk categories, Charlson comorbidity index), aspects of patient–provider communication (standardised psychosocial-care instrument for patients’ assessment of communication; Cologne Patient Questionnaire), and HRQoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) were assessed. Data were analysed by longitudinal multilevel analysis.ResultsCompleted questionnaires for 1772 patients undergoing a RP were analysed over a 3-year follow-up period. Patients rated the patient-provider communication generally high with slight variations over the course of treatment (3.2–3.8). The HRQoL of the patients varied substantial over time and between the reported subscales (global HRQoL 71.1–77.2; physical functioning 89.1–92.1; role functioning 81.0–88.1; emotional functioning 74.4–84.0; cognitive functioning 84.3–87.7; social functioning (77.7–84.0). The longitudinal multilevel models showed significant associations between patient–provider communication in terms of devotion, support and shared decision-making, and functional aspects of HRQoL.ConclusionPatient–provider communication is a valuable resource to support patients with prostate cancer coping with the disease and to improve their HRQoL. Future interventions should be designed especially for urologists to enhance their awareness for the importance of communication and the relationship with their patients with prostate cancer for treatment outcomes.
      PubDate: 2016-04-22T09:31:01.423661-05:
      DOI: 10.1111/bju.13495
  • Toxicity and efficacy of salvage carbon 11-choline positron emission
           tomography/computed tomography-guided radiation therapy in patients with
           lymph node recurrence of prostate cancer
    • Authors: Andrei Fodor; Genoveffa Berardi, Claudio Fiorino, Maria Picchio, Elena Busnardo, Margarita Kirienko, Elena Incerti, Italo Dell'Oca, Cesare Cozzarini, Paola Mangili, Marcella Pasetti, Riccardo Calandrino, Luigi Gianolli, Nadia G Di Muzio
      Pages: 406 - 413
      Abstract: ObjectiveTo report the 3-year toxicity and outcomes of carbon 11 (11C)-choline-positron emission tomography (PET)/computed tomography (CT)-guided radiotherapy (RT), delivered via helical tomotherapy (HTT; Tomotherapy® Hi-Art II® Treatment System, Accuray Inc., Sunnyvale, CA, USA) after lymph node (LN) relapses in patients with prostate cancer.Patients and MethodsFrom January 2005 to March 2013, 81 patients with biochemical recurrence after surgery, with or without adjuvant/salvage RT or radical RT, and with evidence of LN 11C-choline-PET/CT pathological uptake, underwent HTT (median [range] prostate-specific antigen level 2.59 [0.61–187] ng/mL). Of the 81 patients, 72 were treated at the pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-choline-PET/CT. Nine patients were treated without simultaneous integrated boost (50–65.5 Gy, 25–30 fr).ResultsWith a median (range) follow-up of 36 (9–116) months, 91.4% of the patients had a PSA reduction 3 months after HTT. The 3-year overall, local relapse-free and clinical relapse-free survival rates were 80.0, 89.8 and 61.8%, respectively. The 3-year actuarial incidences of ≥grade 2 rectal and ≥grade 2 genitourinary toxicity were 6.6% (±2.9%) and 26.3% (±5.5%), respectively. A PSA nadir of ≥0.26 ng/mL (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7–7.7; P = 0.001), extrapelvic 11C-choline-PET/CT-positive LN location (HR 2.4, 95% CI 0.9–6.4; P = 0.07), RT previous to HTT (HR 2.7; 95% CI 1.07–6.9, P = 0.04) and number of positive LNs (HR 1.13, 95% CI 1.04–1.22; P = 0.003) were the main predictors of clinical relapse after HTT.Conclusions11C-choline-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of prostate cancer in previously treated patients.
      PubDate: 2016-05-24T02:40:35.961914-05:
      DOI: 10.1111/bju.13510
  • Magnetic resonance microscopy may enable distinction between normal
           histomorphological features and prostate cancer in the resected prostate
    • Authors: Matthieu Durand; Manu Jain, Brian Robinson, Eric Aronowitz, Youssef El Douahy, Robert Leung, Douglas S. Scherr, Amelia Ng, Dominique Donzeau, Jean Amiel, Pascal Spincemaille, Arnauld Villers, Douglas J. Ballon
      Pages: 414 - 423
      Abstract: ObjectivesTo determine imaging protocol parameters for characterization of prostate tissue at histological length scales.Material and MethodsRapid acquisition with relaxation enhancement, spin echo and gradient echo fast low angle shot data were acquired using ex vivo 3-Tesla or 7-Tesla magnetic field strengths from fresh prostatectomy specimens (n = 15) obtained from either organ donor or patients with prostate cancer (PCa). To achieve the closest correspondence between histopathological components and magnetic resonance imaging (MRI) results, in terms of resolution and sectioning planes, multiple high-resolution imaging protocols (ranging from a few minutes to overnight) were tested. Ductograms were generated as part of image post-processing. Specimens were subsequently submitted for histopathological evaluation.ResultsA total of seven imaging protocols were tested. Ex vivo 7-Tesla MRI identified normal components of prostate glands, including ducts, blood vessels, concretions and stroma at a spatial resolution of 60 × 60 × 60 μm3 to 107 × 107 × 500 μm3. Malignant glands and nests of tumour cells identified at 60 × 60 × 90 μm3 were highly similar to low-magnification (×2) histopathology. Ductograms enhanced the differentiation between benign and malignant glands. The results of the present study were encouraging, and further work is warranted with a larger sample size.ConclusionWe showed that critical histopathological features of the prostate gland can be identified with high-resolution ex vivo MRI examination and this offers promise that MRI microscopy of PCa will ultimately be possible in vivo.
      PubDate: 2016-06-01T22:55:39.085473-05:
      DOI: 10.1111/bju.13523
  • Raised preoperative international normalised ratio (INR) identifies
           patients at high risk of perioperative death after simultaneous renal and
           cardiac surgery for tumours involving the peri-diaphragmatic inferior vena
           cava and right atrium
    • Authors: Tim O'Brien; Archie Fernando, Kay Thomas, Mieke Van Hemelrijck, Craig Bailey, Conal Austin
      Pages: 424 - 429
      Abstract: ObjectiveTo identify preoperative factors that predict 30-day mortality in patients undergoing simultaneous cardiac and renal surgery for urological tumours involving the peri-diaphragmatic vena cava and right atrium- The ability to predict mortality and therefore avoid surgery in those patients likely to die would be valuable.Patients and MethodsWe retrospectively reviewed perioperative outcomes in patients managed between December 2007 and January 2016 by a single team. The relationships of outcome measurements were analysed using Fisher's exact and Mann–Whitney U-tests.ResultsOf the 46 patients identified, 41 (89%) underwent surgery (20 males and 21 females). The median (range) age was 65 (17–95) years. Histology confirmed 37 renal cell cancers, one adrenal cancer, two primitive neuroectodermal tumours, and one leiomyosarcoma. The overall 30-day mortality rate was 7% (three of 41 patients). The international normalised ratio (INR), age, and estimated glomerular filtration rate (eGFR) correlated significantly with 30-day mortality. The mortality rate was high in patients with an INR ≥1.5 and
      PubDate: 2016-08-29T11:35:24.802185-05:
      DOI: 10.1111/bju.13587
  • Selective arterial clamping does not improve outcomes in robot-assisted
           partial nephrectomy: a propensity-score analysis of patients without
           impaired renal function
    • Authors: David J. Paulucci; Daniel C. Rosen, John P. Sfakianos, Michael J. Whalen, Ronney Abaza, Daniel D. Eun, Louis S. Krane, Ashok K. Hemal, Ketan K. Badani
      Pages: 430 - 435
      Abstract: ObjectivesTo assess the benefit of selective arterial clamping (SAC) as an alternative to main renal artery clamping (MAC) during robot-assisted partial nephrectomy (RAPN) in patients without underlying chronic kidney disease (CKD).Patients and MethodsOur study cohort comprised 665 patients without impaired renal function undergoing MAC (n = 589) or SAC (n = 76) during RAPN from four medical institutions in the period 2008–2015. We compared complication rates, positive surgical margin (PSM) rates, and peri-operative and intermediate-term renal functional outcome between 132 patients undergoing MAC and 66 undergoing SAC after 2-to-1 nearest-neighbour propensity-score matching for age, sex, body mass index, RENAL nephrometry score, tumour size, baseline estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI) and warm ischaemia time (WIT).ResultsIn propensity-score-matched patients, PSM (5.7 vs 3.0%; P = 0.407) and complication rates (13.8 vs 10.6%; P = 0.727) did not differ between the MAC and SAC groups. The incidence of acute kidney injury for MAC vs SAC (25.0 vs 32.0%; P = 0.315) within the first 30 days was similar. At a median follow-up of 7.5 months, the percentage reduction in eGFR (−9.3 vs −10.4%; P = 0.518) and progression to CKD ≥ stage 3 (7.2 vs 8.5%; P = 0.792) showed no difference.ConclusionsOur study findings show no difference in PSM rates, complication rates or intermediate-term renal functional outcomes between patients with unimpaired renal function who underwent SAC vs those who underwent MAC. When expected WIT is low, the routine use of SAC may not be necessary. Further studies will need to determine the role of SAC in patients with a solitary kidney or with significantly impaired renal function.
      PubDate: 2016-08-31T22:20:24.904237-05:
      DOI: 10.1111/bju.13614
  • Surgical quality of minimally invasive adrenalectomy for adrenocortical
           carcinoma: a contemporary analysis using the National Cancer Database
    • Authors: Matthew J. Maurice; Matthew J. Bream, Simon P. Kim, Robert Abouassaly
      Pages: 436 - 443
      Abstract: ObjectivesTo compare quality outcomes between open (OA) and minimally invasive (MIA) adrenalectomy for adrenocortical carcinoma (ACC).Patients and MethodsIn the National Cancer Database, we identified 481 patients with non-metastatic ACC who underwent adrenalectomy from 2010 to 2013. OA and MIA were compared on positive surgical margin (PSM) and lymph node dissection (LND) rates (primary outcomes), and lymph node yield, length of stay (LOS), readmission, and overall survival (secondary outcomes). Using the intention-to-treat principle, minimally-invasive-converted-to-open cases were considered MIA. Logistic regression analysis was used to identify predictors of PSMs and LND. Associations between approach and the outcomes were further assessed by stage and tumour size.ResultsOverall, 161 patients (33.5%) underwent MIA. MIA was used more commonly in older, comorbid patients; for smaller, localised tumours; and at lower-volume centres. In the intention-to-treat analysis, MIA independently predicted PSMs [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1–3.6; P = 0.03) and no LND (OR 0.1, 95% CI 0.03–0.6; P = 0.01). On subgroup analysis, the association between MIA and PSMs only held true for pT3 disease (48.7% vs 26.7%, P = 0.01). A higher PSM rate was seen for tumours of ≥10 cm managed with MIA vs OA, but this difference was not significant (28.2% vs 18.5%, P = 0.16). Likewise, the association between MIA and no LND was only observed for male patients, tumours ≥10 cm, and cN0 disease. After excluding minimally-invasive-converted-to-open cases, the difference in PSM was less pronounced and non-significant (OR 1.8, 95% CI 0.9–3.4; P = 0.08). MIA was associated with significantly shorter median LOS (3 vs 6 days, P < 0.01) and non-significantly decreased readmissions (4.4% vs 8.8%, P = 0.08) compared to OA without any difference in lymph node yield or overall survival.ConclusionFor organ-confined disease, MIA offers comparable surgical quality to OA, while expediting inpatient recovery. OA is associated with superior outcomes for locally advanced disease.
      PubDate: 2016-09-01T00:15:23.627576-05:
      DOI: 10.1111/bju.13618
  • Pathological analysis of the prostatic anterior fat pad at radical
           prostatectomy: insights from a prospective series
    • Authors: Mark W. Ball; Kelly T. Harris, Zeyad R. Schwen, Jeffrey K. Mullins, Misop Han, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein
      Pages: 444 - 448
      Abstract: ObjectiveTo assess factors associated with lymphatic drainage and lymph node (LN) metastasis to the prostatic anterior fat pad (PAFP) in men with prostate cancer and the utility of routine PAFP analysis at the time of radical prostatectomy (RP).Patients and MethodsOur institution began to prospectively collect PAFP tissue in 2010. The PAFP was removed at the time of RP and sent as a pathological specimen separate from the pelvic LNs and prostate. Consecutive RPs performed at our institution in which the PAFP was removed were reviewed to determine the rate of LNs in the PAFP, the rate of metastatic LNs in the PAFP, and the association of metastatic PAFP LN with clinical and pathological features. The impact on biochemical recurrence (BCR) was assessed with a Cox's proportional hazard model.ResultsIn all, 2 413 PAFP specimens were available for analysis. LNs were found in the PAFP in 255 (10.6%) cases and metastatic LNs in the PAFPs were found in 14 (0.6%) cases. Metastatic PAFP LNs were associated with anterior tumours in 11 of the 14 cases (P = 0.01), and were present only in preoperative D'Amico intermediate- (six of 14) and high- (eight of 14) risk patients (P < 0.001). Metastatic PAFP LNs were associated with extraprostatic disease in 13 of the 14 cases, although concomitant pelvic LN involvement was present in only four of the 14 cases. With a mean follow-up of 1.5 years, three of the 14 patients with metastatic PAFP LN developed BCR. Positive LN involvement in either the pelvic LN or PAFP had worse BCR than LN-negative patients (P < 0.001); however, there was no difference in BCR between patients with positive pelvic LN and positive PAFP LN (P = 0.5).ConclusionMetastatic PAFP LNs are rare and always occur in the presence of other adverse pathological features. The routine pathological analysis of PAFP as a separate specimen, especially in low-risk disease, may not be warranted.
      PubDate: 2016-09-30T09:16:19.089724-05:
      DOI: 10.1111/bju.13654
  • Is a negative mpMRI really able to rule out significant prostate
           cancer': The real life experience
    • Authors: Nicolas Branger; Thomas Maubon, Miriam Traumann, Jeanne Thomassin‐Piana, Nicolas Brandone, Sébastien Taix, Julien Touzlian, Serge Brunelle, Geraldine Pignot, Naji Salem, Gwenaelle Gravis, Jochen Walz
      First page: 449
      Abstract: ObjectivesTo evaluate the histopathological results after radical prostatectomy in patients that had a normal preoperative mpMRI in order to see if they had significant or insignificant disease. Moreover we evaluated the influence of the expertise of the radiologist on the results.Materials and methodsWe retrospectively included patients who underwent radical prostatectomy in our center and who had a preoperative negative mpMRI. The MRIs were considered negative when no suspicious lesion was seen or when the PI‐RADS V1 score was less than 7. We used pTNM stage and Gleason score on pathology reports, and whole mount sections to calculate tumor volume.ResultsWe identified 101 patients from 2009 to 2015. Final pathology showed that 16.9% had an extraprostatic extension (EEP), 13.8% had primary Gleason pattern 4 (4+3 and up), 47.5% had secondary Gleason pattern 4 or 5, 55.9% and 20.6% had a main tumor volume ≥ 0.5mL and ≥ 2mL respectively. When limiting the analysis to expert reading only, the numbers improved: only one patient (3.4%) had an EEP (p
      PubDate: 2016-09-12T10:30:32.058433-05:
      DOI: 10.1111/bju.13657
  • PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative
           outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti
           Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database
    • Authors: Riccardo Schiavina; Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A. Moon, Francesco Porpiglia, Benjamin J. Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
      Pages: 456 - 463
      Abstract: ObjectivesTo evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC).Patients and MethodsWe retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international centres that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed in each centre. Univariate and multivariate analyses were used to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories and warm ischaemia time (WIT) of >20 min, urinary calyceal system closure, and grade of postoperative complications.ResultsOverall, 277 patients were evaluated. The median (interquartile range) tumour size was 33.0 (22.0–43.0) mm. The median PADUA and R.E.N.A.L. scores were eight and seven, respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low-, intermediate- or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low-, intermediate- or high-complexity group according to R.E.N.A.L. score, respectively. Both nephrometry tools significantly correlated with perioperative outcomes at univariate and multivariate analyses.ConclusionA precise stratification of patients before PN is recommended to consider both the potential threats and benefits of nephron-sparing surgery. In our present analysis, both PADUA and R.E.N.A.L. were significantly associated with predicting prolonged WIT and high-grade postoperative complications after RAPN.
      PubDate: 2016-09-11T00:00:24.276066-05:
      DOI: 10.1111/bju.13628
  • Accuracy of ultrasonography for renal stone detection and size
           determination: is it good enough for management decisions?
    • Authors: Vishnu Ganesan; Shubha De, Daniel Greene, Fabio Cesar Miranda Torricelli, Manoj Monga
      Pages: 464 - 469
      Abstract: ObjectivesTo determine the sensitivity and specificity of ultrasonography (US) for detecting renal calculi and to assess the accuracy of US for determining the size of calculi and how this can affect counselling decisions.Materials and MethodsWe retrospectively identified all patients at our institution with a diagnosis of nephrolithiasis who underwent US followed by non-contrast computed tomography (CT) within 60 days. Data on patient characteristics, stone size (maximum axial diameter) and stone location were collected. The sensitivity, specificity and size accuracy of US was determined using CT as the standard.ResultsA total of 552 US and CT examinations met the inclusion criteria. Overall, the sensitivity and specificity of US was 54 and 91%, respectively. There was a significant association between sensitivity of US and stone size (P < 0.001), but not with stone location (P = 0.58). US significantly overestimated the size of stones in the 0–10 mm range (P < 0.001). Assuming patients with stones 0–4 mm in size will be selected for observation and those with stones ≥5 mm could be counselled on the alternative of intervention, we found that in 14% (54/384) of cases where CT would suggest observation, US would lead to a recommendation for intervention. By contrast, when CT results would suggest intervention as management, US would suggest observation in 39% (65/168) of cases. An average of 22% (119/552) of patients could be inappropriately counselled. Stones classified as 5–10 mm according to US had the highest probability (43% [41/96]) of having their management recommendation changed when CT was performed. The use of plain abdominal film of kidney, ureter and bladder and US increases sensitivity (78%), but 37% (13/35) of patients may still be counselled inappropriately to undergo observation.ConclusionsUsing US to guide clinical decision-making for residual or asymptomatic calculi is limited by low sensitivity and inability to size the stone accurately. As a result, one in five patients may be inappropriately counselled when using US alone.
      PubDate: 2016-08-17T20:45:23.282666-05:
      DOI: 10.1111/bju.13605
  • Preliminary experience using a tunica vaginalis flap as the dorsal
           component of Bracka's urethroplasty
    • Authors: Luke Harper; Jean-Luc Michel, Frederique Sauvat
      Pages: 470 - 473
      Abstract: ObjectiveTo evaluate clinical use of a tunica vaginalis flap as the dorsal component of a two-stage urethroplasty in boys with cripple hypospadias.Patients and MethodsWe performed the first stage of a Bracka two-stage urethroplasty, using a tunica vaginalis flap as the dorsal component in six boys with cripple hypospadias. We analysed their clinical characteristics and the results of this technique.ResultsThe mean (range) age of the boys was 57 (34–120) months. The mean (range) number of previous procedures the boys had undergone was 4 (3–5). At the 6-month follow-up, all the boys presented significant fibrosis of the dorsal graft rendering it unusable for tubularisation.ConclusionsExposure to the external environment seems to induce retraction and fibrosis of the tunica vaginalis. We believe one should be very cautious about using tunica vaginalis as the dorsal component of a two-stage urethroplasty, as significant fibrosis might well render the flap unusable.
      PubDate: 2016-08-17T20:40:33.224145-05:
      DOI: 10.1111/bju.13604
  • Virtue male sling for post-prostatectomy stress incontinence: a
           prospective evaluation and mid-term outcomes
    • Authors: Matteo Ferro; Danilo Bottero, Carolina D'Elia, Deliu Victor Matei, Antonio Cioffi, Gabriele Cozzi, Alessandro Serino, Giovanni Cordima, Roberto Bianchi, Piero Giacomo Incarbone, Antonio Brescia, Gennaro Musi, Ferdinando Fusco, Serena Detti, Vincenzo Mirone, Ottavio de Cobelli
      First page: 482
      Abstract: ObjectivesTo evaluate the efficacy and safety of the Virtue Male sling in a cohort of patients affected by post prostatectomy stress urinary incontinence (SUI).MethodsAll consecutive patients treated with Virtue® male sling at our Institution in year 2012 were included in our prospective, non randomized study.Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery with 24-hour pad weight test, ICI-Q short form questionnaire, Urinary Symptom Profile questionnaire, bladder diary, uroflowmetry and Patient Global Impression of Improvement and Patient Global Impression of Severity Questionnaire.ResultsMen age was 65.5 years. 72.4% of patients complained a pre operative mild incontinence (1-2 PPD), whereas 9 patients used 3-5 pads/day. 17 complications occurred in 29 patients (58.6%) and all were grade I.At 12 months follow up patients showed a significant improvement in 24 h PAD test (128.6 VS 2.5), pads per day used (2 VS 0), ICI Q SF score (14.3 VS 0.9), USP SUI score (4 VS 0) and outcomes remains stable at 36 months.At last follow up, PGI I questionnaire showed a median score of 1 (very much better).ConclusionsVirtue® Male Sling is an effective treatment option for low to moderate post-prostatectomy incontinence.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-03T08:20:29.821855-05:
      DOI: 10.1111/bju.13672
  • Germline genetic variation in JAK2 as a prognostic marker in
           castration-resistant prostate cancer
    • Authors: Ben Y. Zhang; Shaun M. Riska, Douglas W. Mahoney, Brian A. Costello, Rhea Kohli, Jorge F. Quevedo, James R. Cerhan, Manish Kohli
      Pages: 489 - 495
      Abstract: ObjectivesTo evaluate the prognostic significance of germline variation in candidate genes in patients with castration-resistant prostate cancer (CRPC).MethodsGermline DNA was extracted from peripheral blood mononuclear cells of patients with CRPC enrolled in a clinically annotated registry. Fourteen candidate genes implicated in either initiation or progression of prostate cancer were tagged using single nucleotide polymorphisms (SNPs) from HapMap with a minor allele frequency of >5%. The primary endpoint was overall survival (OS), defined as time from development of CRPC to death. Principal component analysis was used for gene levels tests of significance. For SNP-level results the per allele hazard ratios (HRs) and 95% confidence intervals (CIs) under the additive allele model were estimated using Cox regression, adjusted for age at CRPC and Gleason score (GS).ResultsA total of 240 patients with CRPC were genotyped (14 genes; 84 SNPs). The median (range) age of the cohort was 69 (43–93) years. The GS distribution was 55% with GS ≥8, 32% with GS = 7 and 13% with GS
      PubDate: 2016-08-06T03:50:36.528021-05:
      DOI: 10.1111/bju.13584
  • A qualitative perspectival review of the Australian and New Zealand
           Urology Education and Training program
    • Authors: Prem Rashid
      First page: 496
      Abstract: IntroductionThe Australian and New Zealand (ANZ) urology training program was assessed via a prospective, qualitative review to explore the challenges facing the delivery of high quality urological training now and into the future.AimTo report the reflective considerations and opinions of leaders in the ANZ urological surgical training program.MethodsEthics approved semi-structured, template-based, qualitative interview techniques were employed to evaluate key aspects of the current urology training program. Those interviewed were senior office bearers and management staff involved in the Surgical, Education and Training (SET) Program. Interviews were recorded and transcribed for analysis. Grounded theory was used with thematic analysis to assess the data. The initial impression of the data was used to identify critical codes and themes, which were then developed and abstracted to bring together global concepts.ResultsTwenty-four extracted themes are outlined in this paper. The recent evolution of urology training was documented, as the pathway into training has changed several times over the years. The changes in the program have opinion leaders concerned that the ‘pendulum has swung too far.’ Surgical teachers will only truly develop if appropriate resources are allocated. This can be achieved by making up-skilling courses accessible, relevant and ultimately, a part of the accreditation of training posts. Management of underperforming trainees is challenging and continues to occupy a significant and disproportionate allocation of resources. Early constructive intervention is very important to avoid unnecessary escalation of complex issues and the resultant inter-personal consequences.ConclusionsThe ANZ/RACS SET Urology Program began like many of the other surgical specialties, from humble beginnings. It is now a mature program, but there remain areas needing improvement. The workload of supervisors and office bearers has been increasing and the management of underperforming trainees takes time and resources away from progress in educational development. Progressive steps can be instituted to improve supervisor up-skilling and structural changes can be made to ensure that office bearers can continue to undertake their valuable work without undue pressure and stress. Some of this will involve separating innovation in education and training from day-to-day trainee management.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-05T00:32:43.281395-05:
      DOI: 10.1111/bju.13731
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