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J. of Medical Primatology     Hybrid Journal   (Followers: 1, SJR: 0.473, h-index: 28)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 0.936, h-index: 82)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 2.003, h-index: 72)
J. of Microscopy     Hybrid Journal   (Followers: 2, SJR: 0.655, h-index: 70)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 20, SJR: 0.439, h-index: 32)
J. of Molecular Recognition     Hybrid Journal   (SJR: 0.986, h-index: 56)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 17, SJR: 2.196, h-index: 55)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.602, h-index: 44)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 1)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.314, h-index: 23)
J. of Muscle Foods     Hybrid Journal   (Followers: 2)
J. of Neurochemistry     Hybrid Journal   (SJR: 1.754, h-index: 162)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 4, SJR: 1.038, h-index: 75)
J. of Neuroimaging     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 39)
J. of Neuroscience Research     Hybrid Journal   (Followers: 6, SJR: 1.218, h-index: 113)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 2)
J. of Nursing Management     Hybrid Journal   (Followers: 17, SJR: 1.028, h-index: 34)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 2, SJR: 0.903, h-index: 45)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 19, SJR: 0.499, h-index: 37)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 12, SJR: 0.371, h-index: 30)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 2, SJR: 0.632, h-index: 51)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 2, SJR: 0.729, h-index: 51)
J. of Organizational Behavior     Hybrid Journal   (Followers: 18, SJR: 2.541, h-index: 83)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 12, SJR: 1.246, h-index: 96)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 15, SJR: 0.439, h-index: 46)
J. of Pathology     Hybrid Journal   (Followers: 7, SJR: 3.025, h-index: 122)
J. of Peptide Science     Hybrid Journal   (Followers: 14, SJR: 0.662, h-index: 42)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.596, h-index: 53)
J. of Personality     Hybrid Journal   (Followers: 11, SJR: 1.803, h-index: 75)
J. of Petroleum Geology     Hybrid Journal   (Followers: 4, SJR: 0.471, h-index: 22)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 176, SJR: 1.206, h-index: 102)
J. of Philosophy of Education     Hybrid Journal   (Followers: 5, SJR: 0.491, h-index: 17)
J. of Phycology     Hybrid Journal   (Followers: 5, SJR: 0.864, h-index: 77)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.603, h-index: 45)
J. of Phytopathology     Hybrid Journal   (Followers: 2, SJR: 0.513, h-index: 33)
J. of Pineal Research     Hybrid Journal   (SJR: 1.435, h-index: 73)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.732, h-index: 44)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 13, SJR: 1.297, h-index: 43)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 5, SJR: 0.684, h-index: 8)
J. of Political Philosophy     Hybrid Journal   (Followers: 29, SJR: 1.774, h-index: 26)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 148, SJR: 1.281, h-index: 98)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 0.932, h-index: 87)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.142, h-index: 2)
J. of Product Innovation Management     Hybrid Journal   (Followers: 11, SJR: 2.157, h-index: 72)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.358, h-index: 28)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 32, SJR: 0.473, h-index: 35)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 1)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.294, h-index: 5)
J. of Public Economic Theory     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 8)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.546, h-index: 38)
J. of Quaternary Science     Hybrid Journal   (Followers: 23, SJR: 1.543, h-index: 59)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 9, SJR: 1.138, h-index: 62)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 6, SJR: 1.961, h-index: 36)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.189, h-index: 8)
J. of Religious History     Hybrid Journal   (Followers: 18, SJR: 0.133, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.32, h-index: 11)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.81, h-index: 19)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 9, SJR: 2.998, h-index: 62)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.349, h-index: 8)
J. of Research on Adolescence     Hybrid Journal   (Followers: 4, SJR: 1.634, h-index: 47)
J. of Risk & Insurance     Hybrid Journal   (Followers: 8, SJR: 1.138, h-index: 32)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 0.79, h-index: 47)
J. of Sensory Studies     Hybrid Journal   (Followers: 2, SJR: 0.65, h-index: 27)
J. of Separation Science     Hybrid Journal   (Followers: 6, SJR: 1.092, h-index: 55)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.006, h-index: 57)
J. of Sleep Research     Hybrid Journal   (Followers: 8, SJR: 1.05, h-index: 67)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.737, h-index: 39)
J. of Small Business Management     Hybrid Journal   (Followers: 9, SJR: 0.988, h-index: 42)
J. of Social Issues     Hybrid Journal   (Followers: 16, SJR: 1.532, h-index: 63)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.118, h-index: 3)
J. of Sociolinguistics     Hybrid Journal   (Followers: 12, SJR: 1.511, h-index: 18)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 2)
J. of Supreme Court History     Hybrid Journal   (Followers: 6)
J. of Surgical Oncology     Hybrid Journal   (Followers: 1, SJR: 1.024, h-index: 69)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.933, h-index: 19)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.601, h-index: 29)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.36, h-index: 23)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 20, SJR: 1.167, h-index: 119)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 12, SJR: 1.673, h-index: 138)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 134, SJR: 1.555, h-index: 74)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 0.817, h-index: 56)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 1)
J. of the CardioMetabolic Syndrome     Hybrid Journal  
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 9, SJR: 1.211, h-index: 51)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (SJR: 0.535, h-index: 35)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 1, SJR: 0.46, h-index: 13)
J. of the Institute of Brewing     Free   (SJR: 0.528, h-index: 25)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 2, SJR: 0.935, h-index: 40)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 29, SJR: 1.128, h-index: 25)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 9, SJR: 1.258, h-index: 44)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 18, SJR: 5.518, h-index: 75)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 13, SJR: 0.877, h-index: 47)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 20, SJR: 0.781, h-index: 80)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.521, h-index: 30)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)
J. of the World Aquaculture Society     Hybrid Journal   (Followers: 13, SJR: 0.446, h-index: 36)

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Journal Cover BJU International
   [167 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
     Published by John Wiley and Sons Homepage  [1602 journals]   [SJR: 1.381]   [H-I: 96]
  • Long term follow‐up of a multicentre randomised controlled trial
           comparing TVT, PelvicolTM and autologous fascial slings for the treatment
           of stress urinary incontinence in women
    • Authors: Zainab A. Khan; Arjun Nambiar, Roland Morley, Christopher R. Chapple, Simon J. Emery, Malcolm G. Lucas
      Pages: n/a - n/a
      Abstract: Objective To compare the long‐term outcomes of TVT, autologous fascial slings (AFS) and PelvicolTM in the management of female SUI. Subjects/ Methods and Materials A multicenter randomised controlled trial carried out in 4 UK centers from 2001‐2006 involving 201 women requiring primary surgery for SUI. Women were randomly assigned to receive TVT, AFS or PelvicolTM. Primary outcome was surgical success defined as “women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up”. Secondary outcomes included completely ‘dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and Euro‐QoL scores. Results 162 (80.6%) women were available for follow‐up with a median duration of 10‐years (6.6‐12.6 years). ‘Success’ rates for TVT, AFS and PelvicolTM were 73%, 75.4% and 58% respectively. Comparing the 12‐month and 10‐year ‘success’ rates, deterioration from 93% to 73% (p=
      PubDate: 2014-06-24T09:20:37.864159-05:
      DOI: 10.1111/bju.12851
  • The Impact of Robotic Surgery on the Surgical Management of Prostate
           Cancer in the United States
    • Authors: Steven L Chang; Adam S Kibel, James D Brooks, Benjamin I Chung
      Pages: n/a - n/a
      Abstract: Objective To describe the surgeon characteristics associated with RARP adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods A retrospective cohort study with a weighted sample size of 489,369 men who underwent non‐RARP (i.e., open or laparoscopic radical prostatectomy [RP]) or RARP in the United States from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing>50% of annual RP with the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High‐volume surgeons, defined as performing>24 RP annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (OR: 2.4; 95% CI: 1.7‐3.4), intermediate‐ (200‐399 beds; OR: 5.96; 95% CI: 1.3‐26.5) and large‐sized hospitals (≥400 beds; OR: 6.1; 95% CI: 1.4‐25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR: 3.3; 95% CI: 1.7 to 6.4). RARP adoption was generally associated with increased RP volume, greatest for high‐volume surgeons and least for low‐volume surgeons (
      PubDate: 2014-06-23T11:02:57.08684-05:0
      DOI: 10.1111/bju.12850
  • Incidence of Needle Tract Seeding Following Prostate Biopsy for Suspected
           Cancer ‐ review of the literature
    • Authors: D Volanis; DE Neal, AY Warren, VJ Gnanapragasam
      Pages: n/a - n/a
      Abstract: With the widespread clinical use of PSA, biopsy of the prostate has become one of the most commonly performed urological procedures. In general it is well tolerated although there is some morbidity and risk of infection. In recent years, there have been increasing concerns that prostate biopsy may lead to tumour seeding along the needle tract. The aim of the present paper is to review the evidence on the prevalence of tumour seeding after prostate biopsy and to define the risk of this event in the context of current clinical practice. A Pubmed literature search was conducted in January 2014 according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) statement. Literature was examined with emphasis on the incidence of seeding, clinical presentation and on risk factors including type of needle used, transrectal versus transperineal approach as well as tumour grade and stage. Twenty‐six publications were identified reporting needle tract seeding post prostate biopsy. In total, the number of patients with needle tract seeding reported in literature is 42. In the majority of cases seeding was reported after transperineal biopsy of the prostate, while 9 cases occurred following transrectal biopsy. Based on the reviewed series the incidence of seeding appears much less than 1%. The increase in the number of biopsies and cores taken at each biopsy over the years has not resulted in an increase in the reported cases of seeding. In conclusion, seeding along the needle track is rare complication after prostate biopsy. Its actual incidence is presently difficult to quantify. It is reasonable to advice appropriate counselling and take measure to reduce this event where possible; however, we do not advocate avoidance of biopsies as the benefits of appropriate cancer diagnosis and management outweigh any potential risks from seeding.
      PubDate: 2014-06-23T11:00:15.396041-05:
      DOI: 10.1111/bju.12849
  • The Impact of Urinary Incontinence on Quality of Life in a
           real‐world population of women aged 45‐60 years: Results from
           a survey in France, Germany, the UK and the USA
    • Authors: Paul Abrams; Andrew P Smith, Nikki Cotterill
      Pages: n/a - n/a
      Abstract: Objective To develop a clear understanding of the relationship between severity of urinary incontinence (UI) and quality of life (QoL) and mental well‐being in a population of women of working age with the requisite demands of a busy, active life. Subjects and Methods A survey of women with UI, aged between 45 and 60 years, was conducted via the internet in the UK, France, Germany and the USA between September 1 and 30, 2013. Validated outcome measures were used to assess symptoms and the impact of UI on activities of daily life, QoL, and mental well‐being: The International Consultation on Incontinence Modular Questionnaire Short Form; (ICIQ‐UI Short Form) The ICIQ‐Lower Urinary Tract Symptoms Quality of Life; (ICIQ‐LUTSqol) The Warwick‐Edinburgh Mental Well‐being Scale; (WEMWBS) The relationships between UI, QoL and mental well‐being were analysed using analyses of variance and regression. Results The survey was completed by a total of 1203 women with UI with an average age of 52.7 years. Based upon responses to the ICIQ‐UI Short Form regarding the amount of urine that leaks, respondents were categorized as having light (n=1023, 87%), medium (n=134, 11%), or severe UI (n=20, 2%). Mean scores on the ICIQ‐UI Short Form increased with severity (light UI 7.9 ± 3.4, medium UI 13.8 ± 2.9, and severe UI 18.3 ± 3.9), as did the impact on QoL, assessed using the ICIQ‐LUTSqol, (light 30.6 ± 7.3, medium 41.0 ± 11.2, and severe 56.9 ± 17.6). Mental well‐being decreased with severity of UI, mean scores on the WEMWBS were: light 48.3 ± 10.1, medium 44.5 ± 9.5, and severe 39.9 ± 16.2. Conclusion In women with urinary incontinence aged 45‐60 years, UI symptoms directly affect QoL, which subsequently impacts negatively on mental well‐being.
      PubDate: 2014-06-23T10:46:06.733353-05:
      DOI: 10.1111/bju.12852
  • Long‐term functional outcomes after artificial urinary sphincter
           (AMS 800®) implantation in men with stress urinary incontinence
    • Authors: Priscilla Léon; Emmanuel Chartier‐Kastler, Morgan Rouprêt, Vanina Ambrogi, Pierre Mozer, Véronique Phé
      Pages: n/a - n/a
      Abstract: Objective To evaluate long‐term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery. Material and methods Men who had undergone placement of an AMS 800® between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision. Results Fifty‐seven consecutive patients were included (median age 69 years; IQR: 64–72). Median duration of follow‐up was 15 years (IQR: 8.25–19.75). At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. Explantation of an AUS was done in nine men because of erosion (n=7) and infection (n=2). Survival rates, without AUS explantation, were 87, 87, 80, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59, 28, 15, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow‐up, in intention‐to‐treat analysis, 77.2% of patients were continent. Conclusion In the long term (>10 years) the AMS 800® can offer a high rate of continence to men suffering from SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
      PubDate: 2014-06-23T10:43:53.88639-05:0
      DOI: 10.1111/bju.12848
  • Laparoendoscopic Single‐Site Robotic Partial Nephrectomy Reduces
           Postoperative Wound Pain Without Rise of Complications rates
    • Authors: Tae Young Shin; Sey Kiat Lim, Christos Komninos, Dong Wook Kim, Woong Kyu Han, Sung Jun Hong, Byung Ha Jung, Koon Ho Rha
      Pages: n/a - n/a
      Abstract: Objectives To reduce morbidities and scarring associated with surgical interventions, laparoendoscopic single‐site (LESS) surgery has been introduced and is increasingly being adopted by urologists worldwide. In the present study, we compared long term functional outcomes and pain scale of patients who underwent LESS‐RPN to those who underwent conventional RPN (C‐RPN). Patients And Methods A total of 167 consecutive patients who had RPN were identified from our institutional review board approved computerized database between October 2006 to July 2012. Patients were stratified into two groups: 80 patients underwent C‐RPN and 79 patients underwent LESS‐RPN. Results The LESS‐RPN group had a longer mean warm ischemia time (26.5±10.5 min vs 19.8 ± 13.1 min; p = 0.001), total operation time (210.3 ± 83.4 min vs 183.1 ± 76.1 min; p = 0.033) when compared to the C‐RPN group. However, the LESS‐RPN group and C‐RPN group did not have significant differences in number of patients with negative for surgical margin (77(96.2%) vs 73 (91.4%); p = 0.194), absolute change of postoperative renal function (‐6.5±16.7% vs ‐7.6±16.7%; p = 0.738) and postoperative complication rate (12(15.0%) vs 10 (12.6%); p = 0.279). Furthermore, the LESS‐RPN group has lower visual analog pain scale (VAPS) at discharge (2.1 ± 1.3 vs 1.7 ± 1.0; p = 0.048). Conclusions Despite significantly longer WIT and TOT, the functional outcome of LESS‐RPN is comparable to that of C‐RPN with similar mean tumor sizes and complexity without any disadvantages of oncologic and complications outcome. On discharge, Patients who underwent LESS‐RPN also have lower pain level as one of advantages of minimally invasive surgery. With the development of instrumentation specifically designed for single‐site surgery, LESS‐RPN could be more easily applied to patients who are interested in improved quality of life.
      PubDate: 2014-06-23T10:33:25.852267-05:
      DOI: 10.1111/bju.12783
  • Clinical significance of prognosis of the neutrophil‐lymphocyte
           ratio and erythrocyte sedimentation rate in patients undergoing radical
           nephroureterectomy for upper urinary tract urothelial carcinoma
    • Authors: Hyun Hwan Sung; Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han‐Yong Choi, Hyun Moo Lee
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil‐lymphocyte ratio (NLR) as prognostic factors in patients underwent radical nephroureterectomy for upper tract urothelial cancer (UTUC). Materials and Methods A total of 410 patients were retrospectively reviewed. Elevated NLR was defined as ≥2.5. Normal ESR was ranged as 0‐22 and 0‐27 in men and women, retrospectively. Patients were divided into 3 groups: those with ESR and NLR in normal range (group 0, n = 168), elevations in either ESR or NLR (group I, n = 169), and elevations in both ESR and NLR (group II, n = 73). Results Median age was 64 years with follow‐up duration of 40.2 months. The 35.6% and 41.2% of patients had elevated NLR and ESR, respectively. Group II was associated with advanced tumor status including size, grade, stage, lymph node, and margin (P
      PubDate: 2014-06-20T06:55:18.207524-05:
      DOI: 10.1111/bju.12846
  • Docetaxel rechallenge in patients with metastatic
           castration‐resistant prostate cancer
    • Authors: S. Oudard; G. Kramer, O. Caffo, L. Creppy, Y. Loriot, S. Hansen, M. Holmberg, F. Rolland, J.P. Machiels, M. Krainer
      Pages: n/a - n/a
      Abstract: Objective To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration‐resistant prostate cancer (mCRPC) relapsing after an initial good response to first‐line doxetaxel. Patients and Methods We retrospectively reviewed the records of consecutive mCRPC patients with a good response to first‐line docetaxel (serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression). We analyzed the impact of management at relapse (docetaxel rechallenge or non‐taxane‐based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyze potential predictors of a favourable outcome. Results We identified 270 good responders to first‐line docetaxel. Median progression‐free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non‐taxane‐based therapy. There was no significant difference in median OS (18.2 [95%CI, 16.1‐22.0] and 16.8 [95%CI 13.4‐21.5] months, respectively, p=0.35). However, a good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, p6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI>6 months predicted longer OS. Haemoglobin (6 months but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.
      PubDate: 2014-06-20T06:55:15.024234-05:
      DOI: 10.1111/bju.12845
  • A Rare 8q24 SNP Predisposes North American Men to Prostate Cancer and
           Possibly More Aggressive Disease
    • Authors: Boris Grin; Stacy Loeb, Kim Roehl, Phillip R. Cooper, William J. Catalona, Brian T. Helfand
      Pages: n/a - n/a
      Abstract: Objective To assess the frequency of a novel prostate cancer‐associated single nucleotide polymorphism (SNP), rs188140481, in a North American population and to evaluate the clinical significance of this variant including annotated prostatectomy pathology. Subjects and Methods We examined the frequency of the minor allele at rs188140481 in 4,299 North American men including 1,979 PC cases and 2,320 healthy volunteers. We compared the clinico‐pathologic features of PC between carriers and non‐carriers of the SNP. Results The rs188140481[A] SNP was present in 1.6% of the cohort; it was significantly more likely to be carried by men with PC than healthy controls (OR 3.14; 95% CI 1.85‐5.35). After adjusting for age and PSA carriers were found 6.73‐fold (95% CI 1.69‐26.76) more likely to develop PC than non‐carriers. Age at diagnosis, frequency of a positive family history of PC, and biochemical recurrence rates were similar between SNP carriers and non‐carriers. Patients with the SNP had a proportionately higher frequency of stage ≥T2c disease (29.5% vs. 20.1%; p = 0.13), Gleason ≥8 tumors (13.3% vs. 6.5%; p = 0.10), and extracapsular extension (28.9% vs. 18.8%; p = 0.12) compared to non‐carriers. Conclusions rs188140481[A] is a rare SNP that confers greater risk of PC compared to SNPs identified by genome‐wide association studies. Because of its low frequency, larger studies are needed to validate the prognostic significance of this locus, and associations with adverse pathology.
      PubDate: 2014-06-20T06:51:36.081638-05:
      DOI: 10.1111/bju.12847
  • Preservation of the saphenous vein during laparoendoscopic
           single‐site inguinal lymphadenectomy: comparison with the
           conventional laparoscopic technique
    • Authors: Jun‐Bin Yuan; Min‐Feng Chen, Lin Qi, Yuan Li, Yang‐Le Li, Cheng Chen, Jin‐bo Chen, Xiong‐Bing Zu, Long‐Fei Liu
      Pages: n/a - n/a
      Abstract: Objective • To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single‐site inguinal lymphadenectomy (LESSIL) compared with conventional endoscopic inguinal lymphadenectomy (CEIL) on inguinal nodes management. Patients and Methods • Between February and July 2013, total 12 male patients with squamous cell carcinoma of the penis (SCCP) who underwent penectomy were involved in our study. • All 12 patients underwent bilateral inguinal lymphadenectomy (LESSIL or CEIL in different sides) with preservation of the saphenous vein. • Both LESSIL and CEIL removed all lymphatic tissue in the boundaries of adductor longus muscle (medially), the sartorius muscle (laterally), 2cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply). • All of the operations were performed by one experienced surgeon. Results • All 24 procedures (12 LESSIL and 12 CEIL) were completed successfully without conversion to open surgery. • For LESSIL and CEIL groups, the operation time (min) was 94.6 ± 14.8 vs. 90.8 ± 10.6 (P =0.145). • No significant differences in the incidence of postoperative complications (skin‐related problems, hecatomb, lower extremity edema, lymphatic complications rate and overall complication rate) were noted between the two groups (P>0.05). • There was no lower extremity edema happened in any limbs of the two groups. • No significant differences were observed in both lymph node clearance rate and detection rate of histologically positive lymph nodes (P>0.05). • However, the postoperative patient's satisfaction with scar appearance and cosmetic results of the LESSIL group (75%) was significantly better than those of the CEIL group (25%) (P =0.039). Conclusion • This preliminary study suggests that both LESSIL and CEIL are safe and feasible procedures for inguinal lymphadenectomy. • Preservation of the saphenous vein during LESSIL/CEIL can effectively reduce the incidence of posteroperative lower extremity edema. Moreover, • LESSIL seems to provide superior cosmetic results than CEIL.
      PubDate: 2014-06-20T06:34:05.130288-05:
      DOI: 10.1111/bju.12838
  • The role of functional polymorphisms in immune response genes as
           biomarkers of BCG Immunotherapy outcome in bladder cancer: Establishment
           of a predictive profile in a Southern Europe population
    • Authors: Luís Lima; Daniela Oliveira, José A Ferreira, Ana Tavares, Ricardo Cruz, Rui Medeiros, Lúcio Santos
      Pages: n/a - n/a
      Abstract: Objective To evaluate the predictive value of genetic polymorphisms in the context of BCG immunotherapy outcome and create a predictive profile that may allow discriminating the risk of recurrence. Material and Methods In a dataset of 204 patients treated with BCG, we evaluate 42 genetic polymorphisms in 38 genes involved in the BCG mechanism of action, using Sequenom MassARRAY technology. Stepwise multivariate Cox Regression was used for data mining. Results In agreement with previous studies we observed that gender, age, tumor multiplicity and treatment scheme were associated with BCG failure. Using stepwise multivariate Cox Regression analysis we propose the first predictive profile of BCG immunotherapy outcome and a risk score based on polymorphisms in immune system molecules (SNPs in TNFA‐1031T/C (rs1799964), IL2RA rs2104286 T/C, IL17A‐197G/A (rs2275913), IL17RA‐809A/G (rs4819554), IL18R1 rs3771171 T/C, ICAM1 K469E (rs5498), FASL‐844T/C (rs763110) and TRAILR1‐397T/G (rs79037040) in association with clinicopathological variables. This risk score allows the categorization of patients into risk groups: patients within the Low Risk group have a 90% chance of successful treatment, whereas patients in the High Risk group present 75% chance of recurrence after BCG treatment. Conclusion We have established the first predictive score of BCG immunotherapy outcome combining clinicopathological characteristics and a panel of genetic polymorphisms. Further studies using an independent cohort are warranted. Moreover, the inclusion of other biomarkers may help to improve the proposed model.
      PubDate: 2014-06-16T06:55:32.29252-05:0
      DOI: 10.1111/bju.12844
  • Metabolic syndrome‐like components and prostate cancer risk: Results
           from the REDUCE Study
    • Authors: Katharine N. Sourbeer; Lauren E. Howard, Gerald L. Andriole, Daniel M. Moreira, Ramiro Castro‐Santamaria, Stephen J. Freedland, Adriana C. Vidal
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between number of metabolic syndrome (MetS)‐like components and prostate cancer (PC) diagnosis in a group of men where nearly all biopsies were performed independent of PSA, thus minimizing any confounding from how the various MetS‐like components may influence PSA levels. Subjects/Patients and Methods We analyzed data from 6,426 men in REDUCE with at least one on‐study biopsy. REDUCE compared dutasteride vs. placebo on PC risk among men with an elevated PSA and negative pre‐study biopsy and included two on‐study biopsies regardless of PSA at two and four years. Available data for MetS‐like components included data on diabetes, hypertension, hypercholesterolemia, and body mass index (BMI). The association between number of these MetS‐like components and PC risk and low‐grade (Gleason7) vs. no PC was evaluated using logistic regression. Results 2,171 men (34%) had one MetS‐like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS‐like components had lower PSAs (p=0.029). One vs. no MetS‐like components was protective for overall PC (p=0.041) and low‐grade PC (p=0.010). Two (p=0.69) or three to four (p=0.15) MetS‐like components were not significantly related to PC. While one MetS‐like component was unrelated to high‐grade (p=0.97), two (p=0.059) or three to four MetS‐like components (p=0.02) were associated with increased high‐grade risk, though only the latter was significant. Conclusion When biopsies are largely PSA‐independent, men with an elevated PSA and a previous negative biopsy and multiple MetS‐like components were at an increased risk of high‐grade PC, suggesting the link between MetS‐like and high‐grade PC is unrelated to lowered PSA.
      PubDate: 2014-06-16T06:39:34.601555-05:
      DOI: 10.1111/bju.12843
  • Validation of the Greenlighttm Simulator and Development of a Training
           Curriculum for Photoselective Vaporisation of the Prostate
    • Authors: Abdullatif Aydin; Gordon H Muir, Manuela E Graziano, Mohammed Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: n/a - n/a
      Abstract: Objectives To assess face, content and construct validity and feasibility and acceptability of the GreenLightTM Simulator, and to establish learning curves and develop an evidence‐based training curriculum. Subjects and Methods This prospective, observational and comparative study, recruited novice (n=25), intermediate (n=14) and expert‐level urologists (n=7) from the United Kingdom and Europe at the 28th EAU Annual Meeting, 2013. A group of novices (n=12) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (n=13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporization time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Results Construct validity was demonstrated in two of five training modules (p=0.038; p=0.018) and in a considerable number of case metrics (p=0.034). Learning curves were observed in all five training modules (p
      PubDate: 2014-06-16T06:39:12.65915-05:0
      DOI: 10.1111/bju.12842
  • The Role of Emergency Ureteroscopy in the Management of Ureteric Stones:
           Analysis of 394 Cases
    • Authors: Kamran Zargar‐Shoshtari; William Anderson, Matthieu Bordenave, Michael Rice
      Pages: n/a - n/a
      Abstract: Objective To analyze the outcomes of emergency Ureteroscopy (eURS) cases performed in Auckland City Hospital (ACH) Method Retrospective review of all eURS cases in ACH from 1st of January 2010 to the 31st of December 2011. Data on patients, stones and procedures were collected and analysed. Failure was defined as fragments larger than 3mm or need for repeat procedure. Results 499 ureteroscopies were identified and 394 (79%) were eURS. The mean age was 48 years (SD 16, range 13‐88). 83% of eURS cases were American Association of Anaesthesia Score of (ASA) 1 or 2. 25% of stones were larger than 9 mm with a mean size of 8 mm (SD 4mm). 285 (72%) of procedures were successful. These patients were younger (47 vs. 51), were more likely to have ASA score of 1 (103 vs. 26), had smaller stones (7 vs. 9 mm) and were more likely to have distal stones (p
      PubDate: 2014-06-13T05:26:37.515735-05:
      DOI: 10.1111/bju.12841
  • The emerging use of Twitter by urological journals
    • Authors: Nason GJ; O'Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, Murphy DG
      Pages: n/a - n/a
      Abstract: Objective To assess the emerging use of Twitter by urological journals. Methods A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on . Each journal website was accessed for links to SoMe. The number of tweets, followers and age of profile was determined. To evaluate the content, over a six month period (November 2013 –April 2014), all ‘tweets’ were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. Results In total, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean number of tweets and followers was 557 (range 19‐1809) and 1845 (range 82‐3692), respectively. The mean age of the twitter profiles was 952 days (range 314‐1758 days) with an average of 0.88 tweets per day. A Twitter profile was associated with a higher mean impact factor of the journal (3.588 +/‐ 3.05 vs 1.78 +/‐ 0.99, p=0.013). Over a six month period, November 2013 to April 2014, the median number of tweets per profile was 82 (range 2‐415), the median number of articles linked to tweets was 73 (range 0‐336). Of these 710 articles, 152 were level 1 evidence based articles, 101 level 2, 278 level 3 and 179 level 4. The median Klout score was 47 (range 19‐58). The Klout scores of major journals did not exactly mirror their impact factors. Conclusion SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user‐friendly platform. Recently, many of the leading urological journals have utilized Twitter to highlight significant articles of interest to readers.
      PubDate: 2014-06-13T05:26:23.729533-05:
      DOI: 10.1111/bju.12840
  • A new one layer epididymovasostomy technique
    • Authors: Alayman Hussein
      Pages: n/a - n/a
      Abstract: Objectives description and evaluation of the outcome of a new epididymovasostomy technique. Design Clinical article Setting University IVF center and hospital. Patients Nine cases of obstructive azoospermia. Intervention: A new microsurgical epididymovasostomy technique was applied, bilaterally, to all patients. The principles of the new technique is to open a small window in the tunica of the epididymis and make an opening in the underneath epididymal tubule and keep it opened by fixing the edges of the epididymal opening to the edge of the epididymal tunica with four 10/0 Nylon sutures. The abdominal cut end of the vas is then anastomosed to the epididymal opening by suturing the epididymal tubule, fixed to its tunica in one layer, to the full thickness vas. Main Outcome Measure: finding sperm in the ejaculate. Results Sperm was found in the ejaculate in 6 out of 9 cases after our new, one layer, epididymovasostomy technique. Operative time was 176±23 minutes. Conclusion Our new, one layer, epididymovasostomy technique is a simple alternative method of epididymovasostomy with a reasonable outcome. More cases and follow up are needed to compare it with the conventional epididymovasostomy.
      PubDate: 2014-06-13T05:26:09.73153-05:0
      DOI: 10.1111/bju.12839
  • Preoperative serum cholesterol is an independent prognostic factor for
           patients with renal cell carcinoma (RCC)
    • Authors: Michela Martino; Carmen V. Leitner, Christoph Seemann, Sebastian L. Hofbauer, Ilaria Lucca, Andrea Haitel, Shahrokh F. Shariat, Tobias Klatte
      Pages: n/a - n/a
      Abstract: Objective To assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC), as increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers. Patients and Methods We analysed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. Preoperative total cholesterol levels were determined in serum using colorimetric analysis (CHOD‐PAP method). The association with cancer‐specific survival (CSS) was assessed with Cox models. Discrimination was quantified with the C‐index. The median follow‐up was 52 months. Results The median (interquartile range) serum cholesterol was 195 (166–232) mg/dL. Decreasing serum cholesterol was associated with more advanced T, N and M stages (P < 0.001), higher grades (P = 0.001) and presence of tumour necrosis (P = 0.002). Continuously coded cholesterol was associated with CSS in both univariable (hazard ratio [HR] 0.87, P < 0.001) and multivariable analyses (HR 0.93, P = 0.001). The discrimination of a multivariable base model increased significantly from 88.3% to 89.2% following inclusion of cholesterol (P = 0.006). In patients with clinically localised disease (T1–3N0/+M0), cholesterol remained associated with CSS in multivariable analysis (HR 0.90, P = 0.002) and increased the discrimination from 74.6% to 76.9% (P = 0.002). Conclusions Preoperative serum cholesterol is an independent prognostic factor for patients with RCC, with lower levels being associated with worse survival. Its use increases the discrimination of established prognostic factors. As cholesterol is a broadly available routine marker, its use may provide a meaningful adjunct in clinical practice. The biological rationale underlying this association remains to be clarified.
      PubDate: 2014-06-12T02:03:04.73289-05:0
      DOI: 10.1111/bju.12767
  • Exploring the Evidence For Early Unclamping During Robotic Partial
           Nephrectomy: Is It Worth The Time And Effort'
    • Authors: Oliver Cawley; Alexandrina Roman, Matthew Brown, Ben Challacombe
      PubDate: 2014-06-10T04:36:43.436353-05:
      DOI: 10.1111/bju.12836
  • Evaluation of functional outcomes following laparoscopic partial
           nephrectomy by using renal scintigraphy: “clamped” versus
    • Authors: F. Porpiglia; R. Bertolo, D. Amparore, V. Podio, T. Angusti, A. Veltri, C. Fiori
      Abstract: Objective To examine differences in postoperative renal functional outcomes comparing clampless versus conventional Laparoscopic Partial Nephrectomy (LPN) by using renal scintigraphy. To identify predictors of poorer postoperative renal functional outcomes following clampless LPN. Patients and Methods From September 2010 to September 2012, eighty‐seven patients with renal mass suitable for LPN were prospectively enrolled and underwent LPN. From September 2010 till September 2011 LPN with renal artery clamping was performed; from September 2011 till September 2012 clampless LPN (no clamping of renal artery) was performed Clampless patients were unselected and consecutive, and performed at the end of surgeon's learning curve. Patients were divided into 2 Groups according to Warm Ischaemia Time (WIT): Group A, conventional‐LPN, and Group B, clampless‐LPN (WIT = 0 min). Demographic and perioperative data were collected and analysed; functional outcomes were evaluated by biochemical markers and renal scintigraphy, at baseline and at third month postoperatively: percentage of loss of renal function evaluated by renal scintigraphy parameters was calculated. T‐ and Chi‐square tests and Regression analysis were performed. P‐value < 0.05 was considered as statistically significant. Results Group A was completely comparable to Group B except for WIT (0 in all Group B cases) and blood losses (p
      PubDate: 2014-06-10T04:36:36.744728-05:
      DOI: 10.1111/bju.12834
  • Preventable Mortality Following Common Urologic Surgery: Failing to
    • Authors: Jesse D. Sammon; Daniel Pucheril, Firas Abdollah, Briony Varda, Akshay Sood, Naeem Bhojani, Steven L. Chang, Simon P. Kim, Nedim Ruhotina, Marianne Schmid, Maxine Sun, Adam S. Kibel, Mani Menon, Marcus E. Semel, Quoc‐Dien Trinh
      Abstract: Objective To assess in‐hospital mortality in patients undergoing many commonly performed urologic surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in failure to rescue (FTR) rates, e.g. death following a complication that was potentially recognizable/preventable. Patients and Methods Discharges of all patients undergoing urologic surgery between 1998 and 2010 were extracted from the Nationwide Inpatient Sample (NIS) and assessed for overall and FTR mortality. Admission trends were assessed with linear regression. Logistic regression models fitted with generalized estimating equations were used to estimate the impact of primary predictors on over‐all and FTR mortality and changes in mortality rates. Results Between 1998 and 2010, an estimated 7,725,736 urologic surgeries requiring hospitalization were performed in the U.S.; admissions for urologic surgery decreased 0.63% per year (p=0.008). Odds of overall mortality decreased slightly (OR: 0.990, 95%CI (0.988‐0.993)), yet the odds of mortality attributable to FTR increased 5% every year (OR: 1.050, 95%CI (1.038‐1.062)). Patient age, race, Charlson Comorbidity Index, public insurance status, as well as urban hospital location were independent predictors of FTR mortality (p
      PubDate: 2014-06-10T04:36:30.710775-05:
      DOI: 10.1111/bju.12833
  • Higher Incidence of Urethral Stricture after Bipolar Transurethral
           Resection of the Prostate Using TURis' – Results from a
           Randomized Trial
    • Authors: Kazumasa Komura; Teruo Inamoto, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Koichiro Minami, Rintaro Oide, Hirofumi Uehara, Kiyoshi Takahara, Hajime Hirano, Hayahito Nomi, Satoshi Kiyama, Toshikazu Watsuji, Haruhito Azuma
      Abstract: Objective To assess whether bipolar transurethral resection of the prostate (B‐TURP) using the TURis system demonstrates a comparable level of efficacy and safety with the traditional monopolar transurethral resection (M‐TURP), and to evaluate the impact of the TURis sytem on postoperative urethral stricture (US) over a 36 month follow‐up period. Subjects/patients and methods 136 patients having benign prostatic obstruction (BPO) were randomized to undergo either B‐TURP using the TURis system or the conventional M‐TURP, and regularly followed for 36 months post‐surgery. The primary end point was safety, which included the long term complication rates of postoperative US. The secondary end point was the follow‐up measurement of efficacy. Results In perioperative findings, no patient in either treatment group presented with TUR syndrome, and the decline in levels of hemoglobin and hematocrit were comparable. The mean operation time was significantly extended in the TURis treatment group compared with M‐TURP (79.5 and 68.6 min for TURis and M‐TURP, respectively; p = 0.032) and postoperative clot retention was more likely to be seen following M‐TURP (p = 0.044). Comparable efficacy findings were maintained throughout 36 months, however a significant difference in postoperative US rates between groups was detected (6.6% in M‐TURP vs 19.0% in TURis: p = 0.022). When stratifying patients according to a prostate volume (PV) of 70 ml, there was no significant difference between the two treatment groups in relation to the occurrence of US in patients with PV < 70 ml (3.8% in M‐TURP vs 3.8% in TURis) whereas the TURis treatment resulted in a statistically higher US rate compared with M‐TURP in patients with PV > 70 ml (20% in TURis vs 2.2% in M‐TURP, p = 0.012). Furthermore, the mean operation time using TURis was significantly longer than M‐TURP for the subgroup of PV > 70 ml (99.6 min in TURis vs 77.2 min in M‐TURP, p = 0.011), but not for the subgroup of PV < 70 ml. Conclusion The TURis system seems to be as efficacious and safe as the conventional M‐TURP except for a higher incidence of US seen in patients having larger preoperative prostate volumes.
      PubDate: 2014-06-09T05:58:54.397324-05:
      DOI: 10.1111/bju.12831
  • Circumcision and prostate cancer: a population‐based
           case‐control study in Montréal, Canada
    • Authors: Andrea R. Spence; Marie‐Claude Rousseau, Pierre I. Karakiewicz, Marie‐Élise Parent
      Abstract: Objectives To investigate the possible association between circumcision and prostate cancer risk, to examine whether age at circumcision influences prostate cancer risk, and to determine whether race modifies the circumcision–prostate cancer relationship. Subjects and Methods PROtEuS (Prostate Cancer and Environment Study), a population‐based case‐control study set amongst the mainly French‐speaking population in Montréal, Canada, was used to address study objectives. The study included 1590 pathologically confirmed prostate cancer cases diagnosed in a Montréal French hospital between 2005 and 2009, and 1618 population controls ascertained from the French electoral list, frequency‐matched to cases by age. In‐person interviews elicited information on sociodemographic, lifestyle and environmental factors. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between circumcision, age at circumcision and prostate cancer risk, adjusting for age, ancestry, family history of prostate cancer, prostate cancer screening history, education, and history of sexually transmitted infections. Results Circumcised men had a slightly lower risk, albeit not statistically significant, of developing prostate cancer than uncircumcised men (OR 0.89, 95% CI 0.76–1.04). Circumcision was found to be protective in men circumcised aged ≥36 years (OR 0.55, 95% CI 0.30–0.98). A weaker protective effect was seen among men circumcised within 1 year of birth (OR 0.86, 95% CI 0.72–1.04). The strongest protective effect of circumcision was recorded in Black men (OR 0.40, 95% CI 0.19–0.86, P‐value for interaction 0.02) but no association was found with other ancestral groups. Conclusion Our findings provide novel evidence for a protective effect of circumcision against prostate cancer development, especially in those circumcised aged ≥36 years; although circumcision before the age of 1 year may also confer protection. Circumcision appeared to be protective only among Black men, a group that has the highest rate of disease. Further research into the differences in effect of circumcision on prostate cancer risk by ancestry is warranted, as is the influence of age at circumcision.
      PubDate: 2014-05-28T04:06:59.040222-05:
      DOI: 10.1111/bju.12741
  • Spine metastases in prostate cancer: comparison of
           technetium‐99m‐MDP whole‐body bone scintigraphy,
           [18F]choline positron emission tomography(PET)/computed tomography (CT)
           and [18F]NaF PET/CT
    • Authors: Mads H. Poulsen; Henrik Petersen, Poul F. Høilund‐Carlsen, Jørn S. Jakobsen, Oke Gerke, Jens Karstoft, Signe I. Steffansen, Steen Walter
      Abstract: Objective To compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole‐body bone scintigraphy (WBS) with technetium‐99m‐MDP, [18F]‐sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [18F]‐fluoromethylcholine (FCH) PET/CT. Patients and Methods The study entry criteria were biopsy‐proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion‐based analysis. The primary target variable was bone lesion (malignant/benign) and the ‘gold standard’ was MRI. Results A total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non‐malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; NaF‐PET/CT: 93, 54, 82, 78 and 81%; and FCH‐PET/CT: 85, 91, 95, 75 and 87%, respectively. Conclusions We found that FCH‐PET/CT and NaF‐PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone‐naïve prostate cancer.
      PubDate: 2014-05-22T04:07:08.17632-05:0
      DOI: 10.1111/bju.12599
  • Using patient‐reported outcomes to assess and improve prostate
           cancer brachytherapy
    • Authors: James A. Talcott; Judith Manola, Ronald C. Chen, Jack A. Clark, Irving Kaplan, Anthony V. D'Amico, Anthony L. Zietman
      Abstract: Objective To describe a successful quality improvement process that arose from unexpected differences in control groups' short‐term patient‐reported outcomes (PROs) within a comparative effectiveness study of a prostate brachytherapy technique intended to reduce urinary morbidity. Patients and Methods Patients planning prostate brachytherapy at one of three institutions were enrolled in a prospective cohort study. Patients were surveyed using a validated instrument to assess treatment‐related toxicity before treatment and at pre‐specified intervals. Unexpectedly, urinary PROs were worse in one of two standard brachytherapy technique control populations (US‐BT1 and US‐BT2). Therefore, we collaboratively reviewed treatment procedures, identified a discrepancy in technique, made a corrective modification, and evaluated the change. Results The patient groups were demographically and clinically similar. In the first preliminary analysis, US‐BT2 patients reported significantly more short‐term post‐treatment urinary symptoms than US‐BT1 patients. The study's treating physicians reviewed the US‐BT1 and US‐BT2 treatment protocols and found that they differed in whether they used an indwelling urinary catheter. After adopting the US‐BT1 approach, short‐term urinary morbidity in US‐BT2 patients decreased significantly. Brachytherapy procedures were otherwise unchanged. Conclusion Many procedures in cancer treatments are not evaluated, resulting in practice variation and suboptimal outcomes. Patients, the primary medical consumers, provide little direct input in evaluations of their care. We used PROs, a sensitive and valid measure of treatment‐related toxicity, for quality assessment and quality improvement (QA/QI) of prostate brachytherapy. This serendipitous patient‐centred QA/QI process may be a useful model for empirically evaluating complex cancer treatment procedures and for screening for substandard care.
      PubDate: 2014-05-22T03:56:37.297826-05:
      DOI: 10.1111/bju.12464
  • Extent of lymph node dissection at nephrectomy affects
           cancer‐specific survival and metastatic progression in specific
           sub‐categories of patients with renal cell carcinoma (RCC)
    • Authors: Umberto Capitanio; Nazareno Suardi, Rayan Matloob, Marco Roscigno, Firas Abdollah, Ettore Di Trapani, Marco Moschini, Andrea Gallina, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Roberto Bertini
      Abstract: Objective To test whether the number of lymph nodes removed affects cancer‐specific survival (CSS) or metastatic progression‐free survival (MPFS) in different renal cell carcinoma (RCC) scenarios. Methods We used Cox regression analyses to analyse the effect of the number of lymph nodes removed on CSS and MPFS in 1983 patients with RCC treated with nephrectomy. To adjust for possible clinical and surgical selection bias, analyses were further adjusted for number of positive nodes, presence of metastases, age, performance status, T stage, tumour size and grade. Results The prevalence of lymph node invasion was 6.1%. The mean follow‐up period was 83.3 months. Multivariable analyses showed that the number of nodes removed had an independent, protective effect on CSS in patients with pT2a–pT2b or pT3c–pT4 RCC (hazard ratio [HR] 0.91, P = 0.008 and HR 0.89, P < 0.001, respectively), in patients with bulky tumours (tumour size >10 cm, HR 0.97, P = 0.03) or when sarcomatoid features were found (HR 0.81, P = 0.006). The removal of each additional lymph node was associated with a 3–19% increase in CSS. When considering MPFS as an endpoint, the number of nodes removed had an independent, protective effect in the same patient categories. Conclusions When clinically indicated, the number of nodes removed affects CSS and MPFS in specific sub‐categories of patients with RCC.
      PubDate: 2014-05-22T03:43:07.745286-05:
      DOI: 10.1111/bju.12508
  • Adjuvant Radiotherapy for Lymph‐node Positive Prostate Cancer
    • Authors: Finn E. Eyben; Kalevi Kairemo, Timo Kiljunen, Timo Joensuu
      PubDate: 2014-05-22T03:29:51.277867-05:
      DOI: 10.1111/bju.12659
  • Current status of magnetic resonance imaging (MRI) and ultrasonography
           fusion software platforms for guidance of prostate biopsies
    • Authors: Jennifer K. Logan; Soroush Rais‐Bahrami, Baris Turkbey, Andrew Gomella, Hayet Amalou, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto
      Abstract: Prostate MRI is currently the best diagnostic imaging method for detecting PCa. Magnetic resonance imaging (MRI)/ultrasonography (US) fusion allows the sensitivity and specificity of MRI to be combined with the real‐time capabilities of transrectal ultrasonography (TRUS). Multiple approaches and techniques exist for MRI/US fusion and include direct ‘in bore’ MRI biopsies, cognitive fusion, and MRI/US fusion via software‐based image coregistration platforms.
      PubDate: 2014-05-22T03:21:06.826097-05:
      DOI: 10.1111/bju.12593
  • The changing face of urinary continence surgery in England: a perspective
           from the Hospital Episode Statistics database
    • Authors: John Withington; Sadaf Hirji, Arun Sahai
      Abstract: Objective To quantify changes in surgical practice in the treatment of stress urinary incontinence (SUI), urge urinary incontinence (UUI) and post‐prostatectomy stress incontinence (PPI) in England, using the Hospital Episode Statistics (HES) database. Patients and Methods We used public domain information from the HES database, an administrative dataset recording all hospital admissions and procedures in England, to find evidence of change in the use of various surgical procedures for urinary incontinence from 2000 to 2012. Results For the treatment of SUI, a general increase in the use of synthetic mid‐urethral tapes, such as tension‐free vaginal tape (TVTO) and transobturator tape (TOT), was observed, while there was a significant decrease in colposuspension procedures over the same period. The number of procedures to remove TVT and TOT has also increased in recent years. In the treatment of overactive bladder and UUI, there has been a significant increase in the use of botulinum toxin A and neuromodulation in recent years. This coincided with a steady decline in the recorded use of clam ileocystoplasty. A steady increase was observed in the insertion of artificial urinary sphincter (AUS) devices in men, related to PPI. Conclusions Mid‐urethral synthetic tapes now represent the mainstream treatment of SUI in women, but tape‐related complications have led to an increase in procedures to remove these devices. The uptake of botulinum toxin A and sacral neuromodulation has led to fewer clam ileocystoplasty procedures being performed. The steady increase in insertions of AUSs in men is unsurprising and reflects the widespread uptake of radical prostatectomy in recent years. There are limitations to results sourced from the HES database, with potential inaccuracy of coding; however, these data support the trends observed by experts in this field.
      PubDate: 2014-05-22T03:16:52.448775-05:
      DOI: 10.1111/bju.12650
  • Postoperative statin use and risk of biochemical recurrence following
           radical prostatectomy: results from the Shared Equal Access Regional
           Cancer Hospital (SEARCH) database
    • Authors: Emma H. Allott; Lauren E. Howard, Matthew R. Cooperberg, Christopher J. Kane, William J. Aronson, Martha K. Terris, Christopher L. Amling, Stephen J. Freedland
      Abstract: Objective To investigate the effect of statin use after radical prostatectomy (RP) on biochemical recurrence (BCR) in patients with prostate cancer who never received statins before RP. Patients and Methods We conducted a retrospective analysis of 1146 RP patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Multivariable Cox proportional hazards analyses were used to examine differences in risk of BCR between post‐RP statin users vs nonusers. To account for varying start dates and duration of statin use during follow‐up, post‐RP statin use was treated as a time‐dependent variable. In a secondary analysis, models were stratified by race to examine the association of post‐RP statin use with BCR among black and non‐black men. Results After adjusting for clinical and pathological characteristics, post‐RP statin use was significantly associated with 36% reduced risk of BCR (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.47–0.87; P = 0.004). Post‐RP statin use remained associated with reduced risk of BCR after adjusting for preoperative serum cholesterol levels. In secondary analysis, after stratification by race, this protective association was significant in non‐black (HR 0.49, 95% CI 0.32–0.75; P = 0.001) but not black men (HR 0.82, 95% CI 0.53–1.28; P = 0.384). Conclusion In this retrospective cohort of men undergoing RP, post‐RP statin use was significantly associated with reduced risk of BCR. Whether the association between post‐RP statin use and BCR differs by race requires further study. Given these findings, coupled with other studies suggesting that statins may reduce risk of advanced prostate cancer, randomised controlled trials are warranted to formally test the hypothesis that statins slow prostate cancer progression.
      PubDate: 2014-05-08T03:22:35.890122-05:
      DOI: 10.1111/bju.12720
  • Low free testosterone levels predict disease reclassification in men with
           prostate cancer undergoing active surveillance
    • Authors: Ignacio F. San Francisco; Pablo A. Rojas, William C. DeWolf, Abraham Morgentaler
      Abstract: Objective To determine whether total testosterone and free testosterone levels predict disease reclassification in a cohort of men with prostate cancer (PCa) on active surveillance (AS). Patients and Methods Total testosterone and free testosterone concentrations were determined at the time the men began the AS protocol. Statistical analysis was performed using Student's t‐test and a chi‐squared test to compare groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were obtained using univariate logistic regression. Receiver–operator characteristic curves were generated to determine the investigated testosterone thresholds. Kaplan–Meier curves were used to estimate time to disease reclassification. A Cox proportional hazard regression model was used for multivariate analysis. Results A total of 154 men were included in the AS cohort, of whom 54 (35%) progressed to active treatment. Men who had disease reclassification had significantly lower free testosterone levels than those who were not reclassified (0.75 vs 1.02 ng/dL, P = 0.03). Men with free testosterone levels
      PubDate: 2014-05-04T21:48:04.430901-05:
      DOI: 10.1111/bju.12682
  • Fluctuation in prostate cancer gene 3 (PCA3) score in men undergoing first
           or repeat prostate biopsies
    • Authors: Stefano De Luca; Roberto Passera, Susanna Cappia, Enrico Bollito, Donato Franco Randone, Angela Milillo, Mauro Papotti, Francesco Porpiglia
      Abstract: Objective To evaluate the variability in prostate cancer gene 3 (PCA3) score over time in men with elevated serum prostate‐specific antigen (PSA) levels who are undergoing first or repeat prostate biopsy. Patients and Methods A total of 360 men from two Italian institutions who had undergone at least two PCA3 assessments were selected. Of these, 97.5% were scheduled for first or repeat prostate biopsy because of elevated PSA level and/or positive digital rectal examination (DRE). We compared the PCA3 scores in men with a negative biopsy (normal parenchyma, benign prostatic hyperplasia [BPH], chronic prostatitis, high‐grade prostate intraepithelial neoplasia [HG‐PIN]) with those in men with a positive biopsy. We evaluated PCA3 repeated measures biological variability and its possible association with basic patient characteristics (age, family history of prostate cancer, DRE, prostate volume, BPH, prostatitis and HG‐PIN). Three different thresholds were used to evaluate the possible changes in risk class: the standard threshold (a PCA3 score of 35), a US Food and Drug Administation‐approved PCA3 threshold of 25 and a threshold selected based on our previous research which was a PCA3 score of 50. Results The PCA3 scores varied significantly (P < 0.001) when comparing men with a negative biopsy with those with a positive biopsy (median [range] PCA3 score: 25 [2–276] vs 43 [7–331]). There was no significant difference in PCA3 scores in men with chronic prostatitis and HG‐PIN compared with other men with negative biopsies. The median (range) time between the two PCA3 assessments was 16.2 (3–53.7) months. No association was found between PCA3 repeated measures modifications and age, family history of prostate cancer, DRE, BPH, prostatitis, HG‐PIN and use of 5‐α‐reductase inhibitors. The variability of PCA3 scores on repeated measures confirmed the risk class for about 80% of patients; of the remaining 20% of patients, the risk class was upgraded in two thirds and downgraded in one third. Conclusion PCA3 score can be considered a stable marker over time in most cases but there is a group of men among whom there is clinically notable risk class change. Further investigation is required to determine the genesis of this phenomenon.
      PubDate: 2014-04-29T21:20:41.492948-05:
      DOI: 10.1111/bju.12654
  • Role of fluorodeoxyglucose positron emission tomography (FDG
           PET)‐computed tomography (CT) in the staging of bladder cancer
    • Authors: Henry Goodfellow; Zaid Viney, Paul Hughes, Sheila Rankin, Giles Rottenberg, Simon Hughes, Felicity Evison, Prokar Dasgupta, Timothy O'Brien, Muhammad Shamim Khan
      Abstract: Objective To determine whether to use 18F‐fluorodeoxyglucose positron emission tomography (FDG PET) scans in the preoperative staging of bladder cancer (BC). Patients and Methods In all, 233 patients with muscle‐invasive BC (MIBC) or high‐risk non‐MIBC being considered for radical cystectomy (RC) between 2005 and 2011 had FDG‐PET and computed tomography (CT) of the chest, abdomen and pelvis to assess for pelvic lymph node (LN) involvement or distant metastases. Sensitivity and specificity for detecting pelvic LN involvement was determined by comparing the results of the scans to the histopathology reports in patients undergoing RC. These parameters for distant metastases were determined from biopsy results or follow‐up imaging. In patients who did not undergo RC, follow‐up imaging was used to evaluate the sensitivity and specificity. Patients were excluded from analysis if they either had neoadjuvant chemotherapy or had
      PubDate: 2014-04-16T22:25:30.670511-05:
      DOI: 10.1111/bju.12608
  • Active surveillance for renal angiomyolipoma: outcomes and factors
           predictive of delayed intervention
    • Authors: Idir Ouzaid; Riccardo Autorino, Richard Fatica, Brian R. Herts, Gordon McLennan, Erick M. Remer, Georges‐Pascal Haber
      Abstract: Objective To present the outcomes of active surveillance (AS) for renal angiomyolipomas (AMLs) and to assess the clinical features predicting delayed intervention of this treatment option. Patients and Methods We retrospectively reviewed the outcomes of patients diagnosed with AMLs on computed tomography (CT) who were managed with AS at our institution. The AS protocol consisted of 6‐ and 12‐month, then annual follow‐up visits, each one including a physical examination and CT imaging. Discontinuation of AS was defined as the need or decision for an active procedure during the follow‐up period. Causes of delayed intervention, as well as the type of active treatment (AT), were recorded. Clinical features at presentation of patients failing AS were compared with those who remained under AS at the time of the last follow‐up. Predictive factors of delayed intervention were analysed using univariate and multivariate Cox regression models. Results Overall, 130 patients were included in the analysis, of whom 102 (78.5%) were incidentally diagnosed, while 15 (11.5%) and 13 patients (10%) presented with flank pain and haematuria, respectively. After a mean (sd) follow‐up of 49 (40) months, 17 patients (13%) discontinued AS and underwent AT. Patients who underwent delayed intervention were more likely to present with a higher body mass index, larger tumours and symptomatic disease. Angioembolization represented the first‐line AT after AS (64.7%), whereas partial nephrectomy was adopted in 29.4% of patients. On the univariate analysis, risk factors for delayed intervention included tumour size ≥4 cm, symptoms at diagnosis, and history of concomitant or contralateral kidney disease. On the multivariate analysis, only tumour size and symptoms remained independently associated with discontinuation of AS. Conclusions Tumour size and symptoms at initial presentation were highly predictive of discontinuation of AS in the management of AMLs. Selective angioembolization was the first‐line option used for AT after AS was discontinued.
      PubDate: 2014-04-16T22:25:27.792138-05:
      DOI: 10.1111/bju.12604
  • Role of urinary cations in the aetiology of bladder symptoms and
           interstitial cystitis
    • Authors: C. Lowell Parsons; Timothy Shaw, Zoltan Berecz, Yongxuan Su, Paul Zupkas, Sulabha Argade
      Abstract: Objectives To identify and characterise urinary cationic metabolites, defined as toxic factors, in patients with interstitial cystitis (IC) and in control subjects. To evaluate the cytotoxicity of the urinary cationic metabolite fraction of patients with IC vs control subjects and of individual metabolites in cultured urothelial cells. Subjects and Methods Cationic fractions (CFs) were isolated from the urine specimens of 62 patients with IC and 33 control subjects by solid‐phase extraction. CF metabolites were profiled using C18 reverse‐phase high performance liquid chromatography (RP‐HPLC) with UV detection, quantified by area‐under‐the‐peaks using known standards, and normalized to creatinine. RP‐HPLC and liquid chromatography (LC)‐mass spectrometry (MS)/tandem MS (MS/MS) were used to identify major CF peaks. HTB‐4 urothelial cells were used to determine the cytotoxicity of CFs and of individual metabolites with and without Tamm–Horsfall protein (THP). Results RP‐HPLC analysis showed that metabolite quantity was twofold higher in patients with IC compared with control subjects. The mean (sem) for control subjects vs patients was 3.1 (0.2) vs 6.3 (0.5) mAU*min/μg creatinine (P < 0.001). LC‐MS identified 20 metabolites. Patients with IC had higher levels of modified nucleosides, amino acids and tryptophan derivatives compared with control subjects. The CF cytotoxicity was higher for patients with IC compared with control subjects. The mean (sem) for control subjects vs patients was −2.3 (2.0)% vs 36.7 (2.7)% (P < 0.001). A total of 17 individual metabolites were tested for their cytotoxicity. Cytotoxicity data for major metabolites were all significant (P < 0.001): 1‐methyladenosine (51%), 5‐methylcytidine (36%), 1‐methyl guanine (31%), N4‐acetylcytidine (24%), N7‐methylguanosine (20%) and L‐Tryptophan (16%). These metabolites were responsible for higher toxicity in patients with IC. The toxicity of all metabolites was significantly lower in the presence of control THP (P < 0.001). Conclusions Major urinary cationic metabolites were characterised and found to be present in higher amounts in patients with IC compared with control subjects. The cytotoxicity of cationic metabolites in patients with IC was significantly higher than in control subjects, and control THP effectively lowered the cytotoxicity of these metabolites. These data provide new insights into toxic factor composition as well as a framework in which to develop new therapeutic strategies to sequester their harmful activity, which may help relieve the bladder symptoms associated with IC.
      PubDate: 2014-04-16T22:25:25.708897-05:
      DOI: 10.1111/bju.12603
  • Muscle‐invasive bladder cancer: evaluating treatment and survival in
           the National Cancer Data Base
    • Authors: Angela B. Smith; Allison M. Deal, Michael E. Woods, Eric M. Wallen, Raj S. Pruthi, Ronald C. Chen, Matthew I. Milowsky, Matthew E. Nielsen
      Abstract: Objective To evaluate the association between patterns of care and patient survival for the treatment of muscle‐invasive bladder cancer (MIBC) using a large, national database. Patients and Methods We identified a cohort of 36 469 patients with MIBC (stage II) from 1998 to 2010 from the National Cancer Data Base. Patients were stratified into four treatment groups: radical cystectomy, chemo‐radiation, other therapy, or no treatment. Overall survival (OS) among the groups was evaluated using Kaplan–Meier analysis and the log rank test. A multivariable Cox proportional hazards model was fit to evaluate the association between treatment groups and OS. Results In all, 27% of patients received radical cystectomy, 10% chemo‐radiation, 61% other therapy and 2% no treatment. Unadjusted Kaplan–Meier analysis showed significant differences by treatment group, with cystectomy having the greatest median OS (48 months) followed by chemo‐radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, the OS for cystectomy was similar to that for chemo‐radiation (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.98, 1.12), but superior to other therapy (HR 1.42; 95% CI 1.35, 1.48), and no treatment (HR 2.40; 95% CI 2.12, 2.72). The OS time for chemo‐radiation was superior to other therapy and no treatment. Conclusions Radical cystectomy and chemo‐radiation are significantly underused despite a substantial survival benefit compared with other therapies or no treatment. Future studies are needed to optimise care delivery and improve outcomes for patients with MIBC.
      PubDate: 2014-04-16T22:25:18.778664-05:
      DOI: 10.1111/bju.12601
  • Is intermittent androgen‐deprivation therapy beneficial for patients
           with advanced prostate cancer'
    • Authors: Johannes M. Wolff; Per‐Anders Abrahamsson, Jacques Irani, Fernando Calais da Silva
      Abstract: Use of intermittent androgen‐deprivation therapy (IADT) in patients with prostate cancer has been evaluated in several studies, in an attempt to delay the development of castration resistance and reduce side‐effects associated with ADT. However it is still not clear whether survival is adversely affected in patients treated with IADT. In this review, we explore the available data in an attempt to identify the most suitable candidate patients for IADT, and discuss factors that may inform appropriate patient stratification. ADT is first‐line treatment for advanced/metastatic prostate cancer and is also recommended for use with definitive radiotherapy for high‐risk localised prostate cancer. The changes in hormone levels induced by ADT can lead to short‐ and long‐term side‐effects which, although treatable in most cases, can significantly reduce the tolerability of ADT treatment. IADT has been investigated in several phase II and phase III studies in patients with locally advanced or metastatic prostate cancer, in an attempt to delay time to tumour progression and reduce the side‐effect burden of ADT. In selected patient groups IADT is no less effective than continuous ADT, ameliorating the impact of ADT‐related side‐effects, and, to a degree, their impact on patient health‐related quality of life (HRQL). Further comparative study is required, particularly in relation to HRQL and long‐term complications associated with ADT.
      PubDate: 2014-04-16T06:00:59.947449-05:
      DOI: 10.1111/bju.12626
  • ‘Measurement for Improvement Not Judgement’ – the Case
           of Percutaneous Nephrolithotomy
    • Authors: John Withington; James Armitage, William Finch, Ben Hughes, Jonathan M. Glass, Oliver J. Wiseman, Stuart O. Irving, Neill A. Burgess
      Pages: n/a - n/a
      PubDate: 2014-04-16T05:44:49.451476-05:
      DOI: 10.1111/bju.12660
  • Hemi salvage high‐intensity focused ultrasound (HIFU) in unilateral
           radiorecurrent prostate cancer: a prospective two‐centre study
    • Authors: Eduard Baco; Albert Gelet, Sébastien Crouzet, Erik Rud, Olivier Rouvière, Hélène Tonoli‐Catez, Viktor Berge, Jean‐Yves Chapelon, Heidi B. Eggesbø
      Pages: n/a - n/a
      Abstract: Objective To report the oncological and functional outcomes of hemi salvage high‐intensity focused ultrasound (HSH) in patients with unilateral radiorecurrent prostate cancer. Patients and Methods Between 2009 and 2012, 48 patients were prospectively enrolled in two European centres. Inclusion criteria were biochemical recurrence (BCR) after primary radiotherapy (RT), positive magnetic resonance imaging and ≥1 positive biopsy in only one lobe. BCR was defined using Phoenix criteria (a rise by ≥2 ng/mL above the nadir prostate specific antigen [PSA] level). The following schemes and criteria for functional outcomes were used: Ingelman‐Sundberg score using International Continence Society (ICS) questionnaire (A and B), International prostate symptom score (IPSS), International Index of Erectile Function‐5 (IIEF‐5) points, the European Organisation for the Research and Treatment of Cancer (EORTC) quality of life questionnaires (QLQ C‐30). HSH was performed under spinal or general anaesthesia using the Ablatherm® Integrated Imaging device. Patients with obstructive voiding symptoms at the time of treatment underwent an endoscopic bladder neck resection or incision during the same anaesthesia to prevent the risk of postoperative obstruction. Results After HSH the mean (sd) PSA nadir was 0.69 (0.83) ng/mL at a median (interquartile range) follow‐up of 16.3 (10.5–24.5) months. Disease progression occurred in 16/48 (33%). Of these, four had local recurrence in the untreated lobe and four bilaterally, six developed metastases, and two had rising PSA levels without local recurrence or radiological confirmed metastasis. Progression‐free survival rates at 12, 18, and 24 months were 83%, 64%, and 52%. Severe incontinence occurred in four of the 48 patients (8%), eight (17%) required one pad a day, and 36/48 (75%) were pad‐free. The ICS questionnaire showed a mean (sd) deterioration from 0.7 (2.0) to 2.3 (4.5) for scores A and 0.6 (1.4) to 1.6 (3.0) for B. The mean (sd) IPSS and erectile function (IIEF‐5) scores decreased from a mean (sd) of 7.01 (5.6) to 8.6 (5.1) and from 11.2 (8.6) to 7.0 (5.8), respectively. The mean (sd) EORTC QLC‐30 scores before and after HSH were 35.7 (8.6) vs 36.8 (8.6). Conclusion HSH is a feasible therapeutic option in patients with unilateral radiorecurrent prostate cancer, which offers limited urinary and rectal morbidity, and preserves health‐related quality of life.
      PubDate: 2014-04-16T05:44:20.072827-05:
      DOI: 10.1111/bju.12545
  • In vitro fragmentation efficiency of holmium:
           yttrium‐aluminum‐garnet (YAG) laser lithotripsy – a
           comprehensive study encompassing different frequencies, pulse energies,
           total power levels and laser fibre diameters
    • Authors: Peter Kronenberg; Olivier Traxer
      Pages: n/a - n/a
      Abstract: Objective To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high‐ with low‐frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. Materials and Methods An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2–1.2 J pulse energies, 5–40 Hz frequencies, 4–20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. Results Low frequency‐high pulse energy (LoFr‐HiPE) settings were (up to six times) more efficient than high frequency‐low pulse energy (HiFr‐LoPE) at the same power levels (P < 0.001), as they produced deeper (P < 0.01) and wider (P < 0.001) fissures. There were linear correlations between pulse energy and fragmentation volume, fissure width, and fissure depth (all P < 0.001). Total power did not correlate with fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). Conclusions At the same total power level, LoFr‐HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time‐consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability.
      PubDate: 2014-04-16T03:55:29.785349-05:
      DOI: 10.1111/bju.12567
  • Evaluation of urinary prostate cancer antigen‐3 (PCA3) and
           TMPRSS2‐ERG score changes when starting androgen‐deprivation
           therapy with triptorelin 6‐month formulation in patients with
           locally advanced and metastatic prostate cancer
    • Authors: Luis Martínez‐Piñeiro; Jack A. Schalken, Patrick Cabri, Pascal Maisonobe, Alexandre Taille,
      Pages: n/a - n/a
      Abstract: Objective To assess prostate cancer antigen‐3 (PCA3) and TMPRSS2‐ERG scores in patients with advanced and metastatic prostate cancer at baseline and after 6 months of treatment with triptorelin 22.5 mg, and analyse these scores in patient‐groups defined by different disease characteristics. Patients and Methods The Triptocare study was a prospective, open‐label, multicentre, single‐arm, Phase III study of triptorelin 22.5 mg in men with locally advanced or metastatic prostate cancer, who were naïve to androgen‐deprivation therapy (ADT). The primary objective was to model the urinary PCA3 change at 6 months, according to baseline variables. Other outcome measures included urinary PCA3 and TMPRSS2‐ERG scores and statuses, and serum testosterone and prostate‐specific antigen (PSA) levels at baseline and at 1, 3 and 6 months after initiation of ADT. Safety was assessed by recording adverse events and changes in laboratory parameters. Results The intent‐to‐treat population comprised 322 patients; 39 (12.1%) had non‐assessable PCA3 scores at baseline, and 109/322 (33.9%), 215/313 (68.7%) and 232/298 (77.9%) had non‐assessable PCA3 scores at 1, 3 and 6 months, respectively. Baseline Gleason score was the only variable associated with non‐assessability of PCA3 score at 6 months (P = 0.017) – the hazard of having a non‐assessable PCA3 score at 6 months was 1.824‐fold higher (95% confidence interval 1.186–2.805) in patients with a Gleason score ≥8 vs those with a Gleason score ≤6. The median PCA3 scores at baseline were significantly higher in patients aged ≥65 years vs those aged 90% of patients achieved castrate levels of testosterone (
      PubDate: 2014-04-04T09:02:24.995055-05:
      DOI: 10.1111/bju.12542
  • Research vibrations
    • Authors: Dirk De Ridder; Prokar Dasgupta
      Pages: 1 - 1
      PubDate: 2014-06-25T03:14:05.092952-05:
      DOI: 10.1111/bju.12809
  • Penile vibratory stimulation: a novel approach for penile rehabilitation
           after nerve‐sparing radical prostatectomy
    • Authors: Amr Abdel Raheem; David Ralph
      Pages: 2 - 3
      PubDate: 2014-06-25T03:14:09.092985-05:
      DOI: 10.1111/bju.12526
  • Is zero sepsis alone enough to justify transperineal prostate biopsy'
    • Authors: Declan G. Murphy; Mahesha Weerakoon, Jeremy Grummet
      Pages: 3 - 4
      PubDate: 2014-06-25T03:14:02.718029-05:
      DOI: 10.1111/bju.12390
  • Radical prostatectomy at young age
    • Authors: Manfred P. Wirth; Michael Froehner
      Pages: 4 - 5
      PubDate: 2014-06-25T03:14:04.488949-05:
      DOI: 10.1111/bju.12409
  • High hospital volume reduces mortality after cystectomy
    • Authors: Giorgio Gandaglia; Pierre I. Karakiewicz, Quoc‐Dien Trinh, Maxine Sun
      Pages: 5 - 6
      PubDate: 2014-06-25T03:14:04.333467-05:
      DOI: 10.1111/bju.12780
  • Robot‐assisted nephrouretectomy: is LESS more'
    • Authors: Homayoun Zargar; Jihad H. Kaouk
      Pages: 7 - 8
      PubDate: 2014-06-25T03:14:09.230141-05:
      DOI: 10.1111/bju.12418
  • Magic bullet in management of Peyronie's Disease
    • Authors: Paul K. Hegarty
      Pages: 7 - 7
      PubDate: 2014-06-25T03:13:59.336131-05:
      DOI: 10.1111/bju.12722
  • Engaging responsibly with social media: The British Journal of Urology
           International (BJUI) guidelines
    • Authors: Declan G. Murphy; Stacy Loeb, Marnique Y. Basto, Benjamin Challacombe, Quoc‐Dien Trinh, Mike Leveridge, Todd Morgan, Prokar Dasgupta, Matthew Bultitude
      Pages: 9 - 11
      PubDate: 2014-06-25T03:14:06.425729-05:
      DOI: 10.1111/bju.12788
  • The Challenges of Managing Urological Malignancy in the Elderly
    • Authors: Yasmin Abu‐Ghanem; Jugdeep K. Dhesi, Benjamin J. Challacombe
      Pages: 12 - 15
      PubDate: 2014-06-25T03:14:09.368899-05:
      DOI: 10.1111/bju.12617
  • Minimally invasive treatment of Peyronie's disease: evidence‐based
    • Authors: Gerald H. Jordan; Culley C. Carson, Larry I. Lipshultz
      Pages: 16 - 24
      Abstract: Peyronie's disease (PD) is often physically and psychologically devastating for patients, and the goal of treatment is to improve symptoms and sexual function without adding treatment‐related morbidity. The potential for treatment‐related morbidity after more invasive interventions, e.g. surgery, creates a need for effective minimally invasive treatments. We critically examined the available literature using levels of evidence to determine the reported support for each treatment. Most available minimally invasive treatments lack critical support for effectiveness due to the absence of randomised, placebo‐controlled trials (RCTs) or non‐significant results after RCTs. Iontophoresis, oral therapies (vitamin E, potassium para‐aminobenzoate, tamoxifen, carnitine, and colchicine), extracorporeal shockwave therapy, and intralesional injection with verapamil or nicardipine have shown mixed or negative results. Treatments that have decreased penile curvature deformity in Level 1 or Level 2 evidence‐based, placebo‐controlled studies include intralesional injection with interferon α‐2b or collagenase clostridium histolyticum.
      PubDate: 2014-06-25T03:14:00.915927-05:
      DOI: 10.1111/bju.12634
  • Management of advanced primary urethral carcinomas
    • Authors: Farshid Dayyani; Karen Hoffman, Patricia Eifel, Charles Guo, Raghu Vikram, Lance C. Pagliaro, Curtis Pettaway
      First page: 25
      Abstract: Primary urethral carcinoma (PUC) is a rare malignancy accounting for T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus‐related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi‐institutional studies are needed to better define the optimal treatment approach for this disease entity.
      PubDate: 2014-05-22T03:54:15.758337-05:
      DOI: 10.1111/bju.12630
  • Indications, results and safety profile of transperineal sector biopsies
           (TPSB) of the prostate: a single centre experience of 634 cases
    • Authors: Lona Vyas; Peter Acher, Janette Kinsella, Ben Challacombe, Richard T.M. Chang, Paul Sturch, Declan Cahill, Ashish Chandra, Richard Popert
      Pages: 32 - 37
      Abstract: Objective To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. Patients and Methods A retrospective review of a single‐centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24–38 cores using a ‘sector plan’. Procedures were carried out under general anaesthetic in most patients. Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low‐risk disease diagnosed based on a 12‐core TRB (307). Results Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors. As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL). Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment. Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per‐urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. Conclusions TPSB of the prostate has a role in defining disease previously missed or under‐diagnosed by TRB. The procedure has low morbidity.
      PubDate: 2014-04-03T11:07:18.888531-05:
      DOI: 10.1111/bju.12282
  • Association of hospital volume with conditional 90‐day mortality
           after cystectomy: an analysis of the National Cancer Data Base
    • Authors: Matthew E. Nielsen; Katherine Mallin, Mark A. Weaver, Bryan Palis, Andrew Stewart, David P. Winchester, Matthew I. Milowsky
      First page: 46
      Abstract: Objective To examine the association of hospital volume and 90‐day mortality after cystectomy, conditional on survival for 30 days. Patients and Methods The National Cancer Data Base was used to evaluate 30‐ and 90‐day mortality for 35 055 patients who underwent cystectomy for bladder cancer at one of 1118 hospitals. Patient data were aggregated into hospital volume categories based on the mean annual number of procedures (low‐volume hospital:
      PubDate: 2014-05-22T03:21:03.891126-05:
      DOI: 10.1111/bju.12566
  • Impact of smoking status and cumulative exposure on intravesical
           recurrence of upper tract urothelial carcinoma after radical
    • Authors: Evanguelos Xylinas; Luis A. Kluth, Malte Rieken, Richard K. Lee, Maya Elghouayel, Vicenzo Ficarra, Vitaly Margulis, Yair Lotan, Morgan Rouprêt, Juan I. Martinez‐Salamanca, Kazumasa Matsumoto, Christian Seitz, Pierre I. Karakiewicz, Marc Zerbib, Douglas S. Scherr, Shahrokh F. Shariat,
      Pages: 56 - 61
      Abstract: Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods In all, 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes smoked per day (cpd), duration, and time from cessation. The cumulative smoking exposure was categorised as light‐short‐term (≤19 cpd and ≤19.9 years), moderate (all combinations except light‐short‐term and heavy‐long‐term), and heavy‐long‐term (≥20 cpd and ≥20 years). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR. Results In all, 190 patients (36%) never smoked; 205 (40%) and 125 (24%) were former and current smokers, respectively. Among smokers, 42 (8%), 185 (36%), and 102 (20%) patients were light‐short‐term, moderate, and heavy‐long‐term smokers, respectively. Within a median follow‐up of 37 months, 152 patients (29%) had IVR. Actuarial IVR‐free‐survival estimates (standard error) at 2, 5, and 10 years were 72 (2)%, 58 (3)%, and 51 (4)%, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 cpd), smoking duration (≥20 years), and heavy‐long‐term smoking were associated with higher risk of IVR (all P ≤ 0.01). Patients who quit smoking ≥10 years before RNU had better IVR outcomes than current smokers and those patients who quit smoking 10 years before RNU seems to mitigate these detrimental effects.
      PubDate: 2014-06-25T03:14:06.792028-05:
      DOI: 10.1111/bju.12400
  • Occult lymph node metastases in patients with carcinoma invading bladder
           muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after
           cystectomy alone
    • Authors: Laura S. Mertens; Richard P. Meijer, Wim Meinhardt, Henk G. Poel, Axel Bex, J. Martijn Kerst, Michiel S. Heijden, Andries M. Bergman, Simon Horenblas, Bas W.G. Rhijn
      Pages: 67 - 74
      Abstract: Objective To investigate the effect of neoadjuvant chemotherapy (NAC) on the incidence of lymph node (LN) metastases in clinically node‐negative (cN0) patients with carcinoma invading the bladder muscle (MIBC). Patients and Methods Between 1990 and 2012, 828 consecutive patients underwent radical cystectomy (RC) with extended pelvic LN dissection (ePLND), of whom 441 had cT2–4N0M0 stage disease. A total of 83 patients received NAC then underwent RC and 358 patients underwent RC only. The ePLND template and the indication for NAC remained the same during the study period. The incidence of occult LN metastases was compared between the groups. Unadjusted and adjusted odds ratios (ORs) were calculated to investigate the influence of NAC, cT stage, gender and the preoperative staging technique used (computed tomography [CT] or positron emission tomography/CT) on the occurrence of LN metastases. Overall survival (OS) and disease‐specific survival were analysed using the Kaplan–Meier method. Results Patients in the NAC group more often had locally advanced MIBC than patients in the non‐NAC group (cT3–4: 88.0 vs 30.2%). In the NAC group, 19.3% of patients had LN metastases vs 28.5% of the patients in the non‐NAC group (P = 0.099). In the patients with cT3–4 disease, the occurrence of LN metastases was significantly lower in the NAC group than in the non‐NAC group (21.9 vs 40.7%, respectively, P = 0.002). In multivariable analysis, adjusting for cT stage, gender and staging method, NAC was independently associated with a lower likelihood of LN metastases (OR: 0.41, 95% CI 0.21–0.79; P = 0.008). Among the patients with cT3–4 disease, the median OS was significantly longer in the NAC group than in the non‐NAC group (68.0 vs 23.0 months, P = 0.047) Conclusion These data suggest that, along with a downstaging effect on the primary bladder tumour, NAC is associated with a lower incidence of occult LN metastases at the time of RC.
      PubDate: 2014-01-17T07:14:23.879318-05:
      DOI: 10.1111/bju.12447
  • The prognostic significance of perineural invasion and race in men
           considering active surveillance
    • Authors: Joshua A. Cohn; Pankaj P. Dangle, Chihsiung E. Wang, Charles B. Brendler, Kristian R. Novakovic, Michael S. McGuire, Brian T. Helfand
      Pages: 75 - 80
      Abstract: Objective To determine the importance of perineural invasion (PNI) on diagnostic biopsy in men enrolled in active surveillance (AS). Patients and Methods Eligibility criteria for AS included clinical stage ≤ T2a and Gleason score ≤6, ≤3 cores positive, maximum single core involvement
      PubDate: 2014-01-22T07:09:40.393319-05:
      DOI: 10.1111/bju.12463
  • Prognostic impact of baseline serum C‐reactive protein in patients
           with metastatic renal cell carcinoma (RCC) treated with sunitinib
    • Authors: Benoit Beuselinck; Yann‐Alexandre Vano, Stéphane Oudard, Pascal Wolter, Robert De Smet, Lore Depoorter, Corine Teghom, Alexandra Karadimou, Jessica Zucman‐Rossi, Philip R. Debruyne, Hendrik Van Poppel, Steven Joniau, Evelyne Lerut, Michiel Strijbos, Herlinde Dumez, Robert Paridaens, Ben Van Calster, Patrick Schöffski
      Pages: 81 - 89
      Abstract: Objective To evaluate the impact of baseline serum C‐reactive protein (CRP) level on outcome in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib. Patients and Methods We reviewed the charts of patients with mRCC who started sunitinib as a first targeted treatment between 2005 and 2012 in three hospitals in Belgium and France. Collected data included known prognostic factors for mRCC, anatomical location of metastatic sites, response rate (RR), progression‐free survival (PFS) and overall survival (OS). Results A total of 200 eligible patients were identified by retrospective chart review. The median PFS and OS were 12 and 20 months, respectively. We observed a clear impact of baseline CRP levels on outcome: the median PFS was 25 months in the group with baseline CRP ≤5 mg/L and 8 months in the group with baseline CRP>5 mg/L (hazard ratio [HR] 2.48, 95% CI 1.74–3.59). The median OS in each group was 50 vs 12 months, respectively (HR 3.17, 2.20–4.68). In the group with baseline CRP ≤5 mg/L, 61% of patients experienced a partial response compared with 32% of patients in the group with baseline CRP>5 mg/L (difference = 29%, 95% CI 15–42). When adding baseline CRP (with a log transformation) to the six variables of the International Metastatic RCC Database Consortium (IMDC) model in a multivariable Cox regression model, baseline CRP was independently associated with poor PFS (HR for each doubling in CRP level: 1.14, 95% CI 1.03–1.26; P = 0.01) and OS (HR: 1.29, 95% CI 1.16–1.43; P < 0.001). Adding baseline CRP to the model increased the c‐statistic of PFS at 5 years from 0.63 (0.59–0.68) to 0.69 (0.65–0.73), and the c‐statistic of OS at 5 years from 0.65 (0.60–0.69) to 0.70 (0.66–0.74). Patients with elevated baseline CRP levels had a poor prognosis independent of the IMDC risk group, whereas patients with a low baseline CRP in the IMDC favourable risk group had a very good outcome. Conclusion Baseline serum CRP level is a strong independent variable linked with RR, PFS and OS in patients with mRCC treated with sunitinib.
      PubDate: 2014-01-15T05:54:18.792325-05:
      DOI: 10.1111/bju.12494
  • Efficacy of robot‐assisted radical cystectomy (RARC) in advanced
           bladder cancer: results from the International Radical Cystectomy
           Consortium (IRCC)
    • Authors: Ali Al‐Daghmin; Eric C. Kauffman, Yi Shi, Ketan Badani, M. Derya Balbay, Erdem Canda, Prokar Dasgupta, Reza Ghavamian, Robert Grubb, Ashok Hemal, Jihad Kaouk, Adam S. Kibel, Thomas Maatman, Mani Menon, Alex Mottrie, Kenneth Nepple, John G. Pattaras, James O. Peabody, Vassilis Poulakis, Raj Pruthi, Juan Palou Redorta, Koon‐Ho Rha, Lee Richstone, Francis Schanne, Douglas S. Scherr, Stefan Siemer, Michael Stöckle, Eric M. Wallen, Alon Weizer, Peter Wiklund, Timothy Wilson, Gregory Wilding, Michael Woods, Khurshid A. Guru
      First page: 98
      Abstract: Objective To characterise the surgical feasibility and outcomes of robot‐assisted radical cystectomy (RARC) for pathological T4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. Results In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350 mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30‐ and 90‐day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90‐day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3–5 complications, 90‐day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. Conclusions RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.
      PubDate: 2014-05-22T03:21:05.278921-05:
      DOI: 10.1111/bju.12569
  • Urinary saturation: casual or causal risk factor in urolithiasis'
    • Authors: Allen L. Rodgers
      Pages: 104 - 110
      Abstract: Objective To assess (i) the extent to which urinary supersaturation (SS) has successfully discriminated between stone formers and healthy individuals (N), (ii) whether absolute SS has diagnostic worth and (iii) whether high SS is the fundamental cause of stone formation per se. Materials and Methods Google Scholar was used to identify studies in which urinary compositional data had been determined. In those cases where SS values were not given, or where other risk indices had been reported, they were (re‐)calculated. Collected data were termed ‘global’ but were then ‘filtered’ according to stone type and protocols used for SS calculations. SS distribution plots for calcium oxalate, brushite and uric acid were constructed. Data were statistically analysed using the unpaired t‐test and Mann–Whitney test. Results In all, 47 studies yielded 123 SS values for healthy individuals and 122 values for stone formers. The mean and median SS values were significantly greater in stone formers compared with healthy individuals in all but one of the comparisons. Wide variations in SS occurred for healthy individuals and stone formers. The two groups could not be separated. Conclusions Absolute SS has no diagnostic worth. It is impossible to quantify the meaning of a ‘high’ SS value. Urines cannot be identified as originating from healthy individuals or stone formers based on their SS. SS should be determined in clinical and research settings for relative comparisons during the assessment of treatment efficacies. This study provides a compelling argument for SS being a casual factor rather than a causal one.
      PubDate: 2014-01-22T07:10:45.072311-05:
      DOI: 10.1111/bju.12481
  • Penile vibratory stimulation in the recovery of urinary continence and
           erectile function after nerve‐sparing radical prostatectomy: a
           randomized, controlled trial
    • Authors: Mikkel Fode; Michael Borre, Dana A. Ohl, Jonas Lichtbach, Jens Sønksen
      Pages: 111 - 117
      Abstract: Objective To examine the effect of penile vibratory stimulation (PVS) in the preservation and restoration of erectile function and urinary continence in conjunction with nerve‐sparing radical prostatectomy (RP). Patients and Methods The present study was conducted between July 2010 and March 2013 as a randomized prospective trial at two university hospitals. Eligible participants were continent men with an International Index of Erectile Function‐5 (IIEF‐5) score of at least 18, scheduled to undergo nerve‐sparing RP. Patients were randomized to a PVS group or a control group. Patients in the PVS group were instructed in using a PVS device (FERTI CARE® vibrator). Stimulation was performed at the frenulum once daily by the patients in their own homes for at least 1 week before surgery. After catheter removal, daily PVS was re‐initiated for a period of 6 weeks. Participants were evaluated at 3, 6 and 12 months after surgery with the IIEF‐5 questionnaire and questions regarding urinary bother. Patients using up to one pad daily for security reasons only were considered continent. The study was registered at (NCT01067261). Results Data from 68 patients were available for analyses (30 patients randomized to PVS and 38 patients randomized to the control group). The IIEF‐5 score was highest in the PVS group at all time points after surgery with a median score of 18 vs 7.5 in the control group at 12 months (P = 0.09), but the difference only reached borderline significance. At 12 months, 16/30 (53%) patients in the PVS group had reached an IIEF‐5 score of at least 18, while this was the case for 12/38 (32%) patients in the control group (P = 0.07). There were no significant differences in the proportions of continent patients between groups at 3, 6 or 12 months. At 12 months 90% of the PVS patients were continent, while 94.7% of the control patients were continent (P = 0.46). Conclusion The present study did not document a significant effect of PVS. However, the method proved to be acceptable for most patients and there was a trend towards better erectile function with PVS. More studies are needed to explore this possible effect further.
      PubDate: 2014-01-22T07:11:24.292159-05:
      DOI: 10.1111/bju.12501
  • A case‐control study: are urological procedures risk factors for the
           development of infective endocarditis'
    • Authors: Amar R. Mohee; Robert West, Wazir Baig, Ian Eardley, Jonathan A.T. Sandoe
      Pages: 118 - 124
      Abstract: Objective To evaluate the association between urological procedures and the development of infective endocarditis (IE), as there are case‐reports linking urological procedures to IE but evidence of a causal relationship is lacking and no major guidelines advise prophylaxis to prevent development of IE during transurethral urological procedures. No case‐control study has been undertaken to examine the relationship between urological procedures and the development of IE. Patients and Methods Retrospective evaluation of the IE database at our institution. The population consisted of patients diagnosed with enterococcal, staphylococcal, Streptococcus bovis‐group and oral streptococcal IE over a 10‐year period. Possible risk factors for the development of IE, including urological procedures were collected. A case‐control design was used and univariable and multivariable analyses were carried out. Missing data was accounted for using the multiple imputations method. Results We included 384 patients with IE. There was a statistical association between the development of enterococcal IE and preceding urological procedures (odds ratio 8.21, 95% confidence interval 3.54–19.05, P < 0.05). Increasing age and being an intravenous drug user were also associated with enterococcal IE. Haemodialysis and the presence of an intracardiac device were associated with the development of coagulase‐negative staphyloccal IE. Conclusion This is the first study to show a statistical association between urological procedures and the development of IE. The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemias.
      PubDate: 2014-03-05T11:50:35.422962-05:
      DOI: 10.1111/bju.12550
  • Long‐acting testosterone injections for treatment of testosterone
           deficiency after brachytherapy for prostate cancer
    • Authors: Felipe G. Balbontin; Sergio A. Moreno, Enrique Bley, Rodrigo Chacon, Andres Silva, Abraham Morgentaler
      First page: 125
      Abstract: Objective To evaluate the clinical and biochemical effects of long‐acting testosterone undecanoate injections in men with prostate cancer treated with brachytherapy, as the use of testosterone therapy (TTh) in men with prostate cancer is highly controversial, with limited published safety data, particularly after brachytherapy treatment. Patients and Methods In all, 20 men treated with brachytherapy for prostate cancer received TTh for symptoms of testosterone deficiency from February 2005 to August 2013. Symptoms of testosterone deficiency included low libido, erectile dysfunction, and fatigue. The mode of TTh was long‐acting testosterone undecanoate injections in all cases. Sexual function was assessed by Sexual Health Inventory for Men (SHIM) questionnaire. Serum PSA and testosterone concentrations were recorded monthly for 3 months, then every 3 months for the first year, every 6 months for the second year, and annually then after. Results The mean (range) age was 62 (49–74) years and the mean (range) serum PSA level at the time of prostate cancer diagnosis was 6.2 (2–11.5) ng/mL. The Gleason score was 2 + 3 in one patient, 3 + 3 in 15 patients, 3 + 4 in three patients and 4 + 4 in one patient. In all, 15 men were stage T1c and five were T2a. The mean (range) baseline total testosterone concentration was 343 (200–592) ng/dL, and 6.9 (2.1–9.7) ng/dL for free testosterone. The mean SHIM scores improved with treatment from 16.1 at baseline to 22.1 with TTh (P = 0.002). There was a decrease in mean PSA level from baseline of 0.7 ng/mL before initiation of TTh to 0.1 ng/mL at last follow‐up (P < 0.001), with a median (range) follow‐up of 31 (12–48) months. There were no cases of prostate cancer progression or recurrence. Conclusions With a median of 31‐months follow‐up, long‐acting testosterone injections in men with prostate cancer treated with brachytherapy produced significant clinical benefits. There were no cases of rising serum PSA, prostate cancer progression or recurrence.
      PubDate: 2014-05-02T03:19:24.215829-05:
      DOI: 10.1111/bju.12668
  • Preserving sexual function after robotic radical prostatectomy: avoiding
           thermal energy near nerves
    • Authors: Thomas E. Ahlering; Douglas W. Skarecky
      Pages: 131 - 132
      PubDate: 2014-06-25T03:13:58.299191-05:
      DOI: 10.1111/bju.12663
  • Oxalate at physiological urine concentrations induces oxidative injury in
           renal epithelial cells: effect of α‐tocopherol and ascorbic
    • Authors: Vijayalakshmi Thamilselvan; Mani Menon, Sivagnanam Thamilselvan
      Pages: 140 - 150
      Abstract: Objectives To test our hypothesis that physiological levels of urinary oxalate induce oxidative renal cell injury, as studies to date have shown that oxalate causes oxidative injury only at supra‐physiological levels. To study the combined effect of α‐tocopherol and ascorbic acid against oxalate‐induced oxidative injury, as oxalate‐induced oxidative cell injury is known to promote initial attachment of calcium oxalate crystals to injured renal tubules and subsequent development of kidney stones. Materials and Methods Cultures of normal (antioxidant‐undepleted) and antioxidant‐depleted LLC‐PK1 cells were exposed to oxalate at human physiological urine concentrations. After exposure, markers of oxidative stress and cell injury were measured in the cells and media, respectively. In addition, we also evaluated the combined effects of α‐tocopherol and ascorbic acid on oxalate‐induced oxidative cell injury. Results Exposure of renal cells to oxalate at urinary physiological levels increased the oxidative cell injury as assessed by increased lactate dehydrogenase (LDH) leakage and increased lipid hydroperoxide in the renal cells; however, this effect was not seen until 24 h after oxalate exposure, at which point the injury was milder. On the other hand, when cellular reduced glutathione (GSH) and catalase were depleted in renal epithelial cells with pharmacological inhibitors, the physiological levels of urinary oxalate caused significant oxidative cell injury at 24 h, and remarkably, when additional endogenous antioxidants were depleted, the oxalate at the upper limit of normal 24 h urine caused a significant amount of cell injury in a shorter period of time, which was comparable to that seen in cells exposed to higher levels of oxalate. Exposure of LLC‐PK1 cells to oxalate resulted in increased levels of H2O2 and lipid hydroperoxide, correlating with increased release of cell injury markers, including LDH, alkaline phosphate, and γ‐glutamyl transpeptidase from renal tubular epithelial cells. Oxalate exposure decreased the activity and protein expression of superoxide dismutase and glutathione peroxidase in a time‐dependent manner. LLC‐PK1 cells treated with oxalate and either α‐tocopherol or ascorbic acid alone exhibited a significant decrease in oxidative cell injury and restored endogenous renal antioxidants towards normal levels, and interestingly, combined treatment with α‐tocopherol and ascorbic was more efficient at preventing oxalate‐induced toxicity than treatment with either agent alone. Conclusion To our knowledge this is the first study to show that oxalate alone at human physiological urine concentrations (in the absence of calcium oxalate crystal formation), induced oxidative renal injury in renal epithelial cells when endogenous antioxidants are depleted. Our data further suggests that a combination of α‐tocopherol and ascorbic acid may be more effective than each individual agent in reducing oxalate‐induced oxidative renal injury and subsequent calcium oxalate crystal deposition in recurrent stone formers.
      PubDate: 2014-06-25T03:14:00.226634-05:
      DOI: 10.1111/bju.12642
  • Live surgical education: a perspective from the surgeons who perform it
    • Authors: Shahid A.A. Khan; Richard T.M. Chang, Kamran Ahmed, Thomas Knoll, Roland Velthoven, Ben Challacombe, Prokar Dasgupta, Abhay Rane
      Pages: 151 - 158
      Abstract: Objective To evaluate the experience and views regarding live surgical broadcasts (LSB) among European urologists attending the European Association of Urology Robotic Urology Society (ERUS) congress in September 2012. Materials and Methods An anonymous survey was distributed via email inviting the participants of the ERUS congress with experience of LSB to share their opinions about LSB. The outcomes measured included; personal experience of LSB, levels of anxiety faced and the perceived surgical quality. The impact of factors, such as communication/team‐working, travel fatigue and lack of specific equipment were also evaluated. Results In all, 106 surgeons responded with 98 (92.5%) reporting personal experience of LSB; 6.5% respondents noted ‘significant anxiety’ increasing to 19.4% when performing surgery away from home (P < 0.001). Surgical quality was perceived as ‘slightly worse’ and ‘significantly worse’ by 16.1% and 2.2%, which deteriorated further to 23.9% and 3.3% respectively in a ‘foreign’ environment (P = 0.005). In all, 10.9% of surgeons ‘always’ brought their own surgical team compared with 37% relying on their host institution; 2.4% raised significant concerns with their team and 18.8% encountered significantly more technical difficulties. Lack of specific equipment (10.3%), language difficulties (6.2%) and jet lag (7.3%) were other significant factors reported. In all, 75% of surgeons perceived the audience wanted a slick demonstration; however, 52.2% and 42.4% respectively also reported the audience wished the surgeon to struggle or manage a complication during a LSB. Conclusions A small proportion of surgeons had significantly heightened anxiety levels and lower perceived performance during LSB, which in a ‘foreign’ environment seemed to affect a greater proportion of surgeons. Various factors appear to impact surgical performance raising concerns about the appropriateness of unregulated LSB as a teaching method. To mitigate these concerns, surgeons' performing live surgery feel that the operation needs to be well planned using appropriate equipment; with many considering bringing their own team or operating from home on a video link.
      PubDate: 2014-02-19T08:09:39.387992-05:
      DOI: 10.1111/bju.12283
  • Functional and oncological outcomes of patients aged <50 years treated
           with radical prostatectomy for localised prostate cancer in a European
    • Authors: Andreas Becker; Pierre Tennstedt, Jens Hansen, Quoc‐Dien Trinh, Luis Kluth, Nabil Atassi, Thorsten Schlomm, Georg Salomon, Alexander Haese, Lars Budaeus, Uwe Michl, Hans Heinzer, Hartwig Huland, Markus Graefen, Thomas Steuber
      Pages: 38 - 45
      Abstract: Objective To address the biochemical and functional outcomes after radical prostatectomy (RP) of men aged
      PubDate: 2013-12-02T11:41:34.671356-05:
      DOI: 10.1111/bju.12407
  • Bladder outlet obstruction (BOO) in men with castration‐resistant
           prostate cancer
    • Authors: Maximilian Rom; Matthias Waldert, Georg Schatzl, Natalia Swietek, Shahrokh F. Shariat, Tobias Klatte
      Pages: 62 - 66
      Abstract: Objective To evaluate the frequency of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in patients with castration‐resistant prostate cancer (CRPC) and lower urinary tract symptoms (LUTS). Patients and Methods Our prospective urodynamics database was queried. Inclusion criteria were CRPC and an International Prostate Symptom Score (IPSS) ≥ 20. Exclusion criteria were previous local therapy to the prostate gland, known urethral stricture disease, and a neurological component of LUTS. Twenty‐one patients were identified. Urodynamic findings were analysed and compared with those of a matched cohort of 42 patients with benign prostatic enlargement (BPE). Results The median age of patients in the CRPC group was 74 years, and the median prostate‐specific antigen (PSA) level at the time of the urodynamic study was 90 ng/mL. According to the BOO index, three patients (14%) were obstructed, three were equivocally obstructed (14%) and 15 were unobstructed. DO was seen in 12 patients (57%). Compared with the BPE group, patients with CRPC had lower cystometric bladder capacities (P = 0.003), were less likely to have BOO (14 vs 43%, P = 0.009) and more likely to have DO (57 vs 29%, P = 0.028). Conclusions This study generates the hypothesis that only a minority of CRPC patients with LUTS have BOO, and that more than half of patients have DO. LUTS in CRPC may therefore be seldom attributable to BOO, but are, at least in part, related to DO and reduced cystometric capacity. A urodynamic investigation may be necessary before palliative transurethral resection of the prostate to select appropriate candidates. Larger prospective studies are needed to confirm our findings.
      PubDate: 2013-12-02T11:42:44.232789-05:
      DOI: 10.1111/bju.12438
  • Laparoendoscopic single‐site (LESS) robot‐assisted
           nephroureterectomy: comparison with conventional multiport technique in
           the management of upper urinary tract urothelial carcinoma
    • Authors: Sey Kiat Lim; Tae‐Young Shin, Kwang Hyun Kim, Woong Kyu Han, Byung Ha Chung, Sung Joon Hong, Young Deuk Choi, Koon Ho Rha
      Pages: 90 - 97
      Abstract: Objective To compare the peri‐operative, pathological and oncological outcomes of laparoendoscopic single‐site (LESS) robot‐assisted nephroureterectomy (LESS‐RALNU) with those of multiport robot‐asssisted nephroureterectomy (M‐RALNU). Patients and Methods A total of 38 patients with upper urinary tract urothelial carcinoma underwent LESS‐RALNU (n = 17) or M‐RALNU (n = 21) by a single surgeon at a tertiary institution. Data were obtained from a prospectively maintained database. Results Patients' demographics and tumour characteristics were similar between the M‐RALNU and LESS‐RALNU groups. The mean follow‐up was 48.4 months for M‐RALNU and 30.9 months for LESS‐RALNU (P = 0). The mean operating time, estimated blood loss and length of hospitalization for M‐RALNU and LESS‐RALNU were 251 min, 192 mL, 6.5 days and 247 min, 376 mL and 5.4 days, respectively (P > 0.05). Overall, there were no significant differences in complication rates, although three patients in the LESS‐RALNU group required blood transfusion, whereas no patient in the M‐RALNU group did (P = 0.081). The proportion of patients with bladder recurrence, local recurrence and distant metastases was similar between the two groups. There were no significant differences in the recurrence‐free survival, cancer‐specific survival and overall survival rates between the two groups. Conclusions Although the oncological and peri‐operative outcomes of patients who underwent LESS‐RALNU compared well with those who underwent M‐RALNU and with series of other surgical approaches, LESS‐RALNU might result in greater intra‐operative blood loss. We suggest careful selection of patient for this technique.
      PubDate: 2013-10-31T06:56:44.775044-05:
      DOI: 10.1111/bju.12356
  • Electrocautery‐induced cavernous nerve injury in rats that mimics
           radical prostatectomy in humans
    • Authors: Lu‐Jie Song; Jian‐Qiang Zhu, Min‐Kai Xie, Yong‐Chuan Wang, Hong‐Bin Li, Zhi‐Qiang Cui, Hong‐Kai Lu, Yue‐Min Xu
      Pages: 133 - 139
      Abstract: Objective To investigate the early and delayed effects of cavernous nerve electrocautery injury (CNEI) in a rat model, with the expectation that this model could be used to test rehabilitation therapies for erectile dysfunction (ED) after radical prostatectomy (RP). Materials and Methods In all, 30 male Sprague‐Dawley rats were randomly divided equally into two groups (15 per group). The control group received CNs exposure surgery only and the experimental group received bilateral CNEI. At 1, 4 and 16 weeks after surgery (five rats at each time point), the ratio of maximal intracavernosal pressure (ICP) to mean arterial pressure (MAP) was measured in the two groups. Neurofilament expression in the dorsal penile nerves was assessed by immunofluorescent staining and Masson's trichrome staining was used to assess the smooth muscle to collagen ratio in both groups. Results At the 1‐week follow‐up, the mean ICP/MAP was significantly lower in the CNEI group compared with the control group, at 9.94% vs 70.06% (P < 0.05). The mean ICP/MAP in the CNEI group was substantially increased at the 4‐ (35.97%) and 16‐week (37.11%) follow‐ups compared with the 1‐week follow‐up (P < 0.05). At all three follow‐up time points, the CNEI group had significantly decreased neurofilament staining compared with the control group (P < 0.05). Also, neurofilament expressions in the CNEI group at both 4 and 16 weeks were significantly higher than that at 1 week (P < 0.05), but there was no difference between 4 and 16 weeks (P> 0.05). The smooth muscle to collagen ratio in the CNEI group was significantly lower than in the control group at the 4‐ and 16‐week follow‐ups (P < 0.05), and the ratio at 16 weeks was further reduced compared with that at 4 weeks (P < 0.05). Conclusions In the CNEI rat model, we found the damaging effects of CNEI were accompanied by a decline in ICP, reduced numbers of nerve fibres in the dorsal penile nerve, and exacerbated fibrosis in the corpus cavernosum. This may provide a basis for studying potential preventative measures or treatment strategies to ameliorate ED caused by CNEI during RP.
      PubDate: 2013-10-31T06:56:41.367227-05:
      DOI: 10.1111/bju.12348
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