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J. of Medical Virology     Hybrid Journal   (Followers: 8, SJR: 1.058, h-index: 89)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 5, SJR: 3.008, h-index: 75)
J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 29, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 39, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 5, SJR: 0.267, h-index: 25)
J. of Neurochemistry     Hybrid Journal   (Followers: 1, SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 6, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 3, SJR: 0.761, h-index: 43)
J. of Neuroscience Research     Hybrid Journal   (Followers: 9, SJR: 1.423, h-index: 120)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 3)
J. of Nursing Management     Hybrid Journal   (Followers: 20, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 5, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 21, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 16, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 4, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 34, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 17, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 18, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 11, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 20, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 6, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 132, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 10, SJR: 0.687, h-index: 20)
J. of Phycology     Hybrid Journal   (Followers: 7, SJR: 1.148, h-index: 84)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 9, SJR: 0.64, h-index: 48)
J. of Phytopathology     Hybrid Journal   (Followers: 4, SJR: 0.503, h-index: 37)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 2.189, h-index: 81)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 5, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 13, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 16, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 36, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 110, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 24, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 10, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 19, SJR: 2.115, h-index: 82)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.44, h-index: 31)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 65, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 5)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 2, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 24, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 12, SJR: 1.105, h-index: 69)
J. of Regional Science     Hybrid Journal   (Followers: 10, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 6, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 20, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 4, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 21, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 4, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 11, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 7, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 12, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 11, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 14, SJR: 1.117, h-index: 51)
J. of Social Issues     Hybrid Journal   (Followers: 19, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 17, SJR: 0.156, h-index: 15)
J. of Sociolinguistics     Hybrid Journal   (Followers: 19, SJR: 1.11, h-index: 21)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 3, SJR: 0.209, h-index: 4)
J. of Supreme Court History     Hybrid Journal   (Followers: 10)
J. of Surgical Oncology     Hybrid Journal   (Followers: 3, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 5, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 26, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 34, SJR: 2.112, h-index: 151)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 20, SJR: 1.072, h-index: 61)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 102)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 12, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 4, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 4, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 3, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 32, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 16, SJR: 1.59, h-index: 49)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 28, SJR: 7.863, h-index: 82)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 20, SJR: 1.435, h-index: 51)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 20, SJR: 0.846, h-index: 88)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.451, h-index: 32)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 10)
J. of the World Aquaculture Society     Hybrid Journal   (Followers: 12, SJR: 0.477, h-index: 38)
J. of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 48, SJR: 2.56, h-index: 108)
J. of Time Series Analysis     Hybrid Journal   (Followers: 6, SJR: 1.361, h-index: 34)
J. of Tissue Engineering and Regenerative Medicine     Hybrid Journal   (Followers: 6, SJR: 1.074, h-index: 35)
J. of Traumatic Stress     Hybrid Journal   (Followers: 13, SJR: 1.63, h-index: 82)

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Journal Cover BJU International
  [SJR: 1.812]   [H-I: 104]   [53 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  [1598 journals]
  • The role of targeted prophylactic antimicrobial therapy prior to
           transrectal ultrasound (TRUS) guided prostate biopsy in reducing infection
           rates: a systematic review
    • Authors: A Cussans; B K Somani, A Basarab, T Dudderidge
      Abstract: Objective To compare the incidence of infective complications following transrectal ultrasound‐guided (TRUS) biopsy with either empirical fluoroquinolone or culture‐based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance in men undergoing prostate biopsy. Materials and methods A systematic review of the literature was performed following PRISMA guidelines. We included studies of patients undergoing TRUS biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of pre‐procedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of fluoroquinolone resistance was recorded as a secondary outcome measure. Studies with no control group were excluded. Results From 125 studies screened, 9 studies (4571 patients) met the inclusion criteria [1‐9]. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America [1‐4, 8, 9]. The remaining were undertaken in Spain [5], Turkey [6] and Columbia [7]. Within these studies, 2484 (54.3%) patients received empirical fluoroquinolone prophylaxis whilst 2087 (45.7%) patients had pre‐biopsy rectal swabs and targeted antibiotics. Mean fluoroquinolone resistance was 22.8%. Post biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55%, 2.21%) compared with groups receiving targeted antibiotics (0.72%, 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Conclusion Our systematic review suggests that targeted prophylactic antimicrobial therapy prior to TRUS guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-28T04:37:12.35668-05:0
      DOI: 10.1111/bju.13402
  • Urology technical and non‐technical skills development: the emerging
           role of simulation
    • Authors: Prem Rashid; Troy R.J. Gianduzzo
      Abstract: Objective To review the emerging role of technical and non‐technical simulation in urological education and training. Method A review was conducted to examine the current role of simulation in urology training. A PUBMED search of the terms ‘urology training’, ‘urology simulation’ and ‘urology education’ revealed 11 504 titles. Three hundred and fifty‐seven abstracts were identified as English language, peer reviewed papers pertaining to the role of simulation in urology and related topics. Key papers were used to explore themes. Some cross‐referenced papers were also included. Results There is an ongoing need to ensure that training time is efficiently utilised while ensuring that optimal technical and non‐technical skills are achieved. Changing working conditions and the need to minimise patient harm by inadvertent errors must be taken into account. Simulation models for specific technical aspects have been the mainstay of graduated step‐wise low and high fidelity training. Whole scenario environments as well as non‐technical aspects can be slowly incorporated into the curriculum. Doing so should also help define what have been challenging competencies to teach and evaluate. Dedicated time, resources and trainer up‐skilling are important. Concurrent studies are needed to help evaluate the effectiveness of introducing step‐wise simulation for technical and non‐technical competencies. Conclusion Simulation based learning remains the best avenue of progressing surgical education. Technical and non‐technical simulation could be used in the selection process. There are good economic, logistic and safety reasons to pursue the process of ongoing development of simulation co‐curricula. While the role of simulation is assured, its progress will depend on a structured program that takes advantage of what can be delivered via this medium. Overall, simulation can be developed further for urological training programs to encompass technical and non‐technical skill development at all stages, including recertification.
      PubDate: 2015-12-23T03:02:46.325043-05:
      DOI: 10.1111/bju.13259
  • Health resource use following robot‐assisted surgery versus open and
           conventional laparoscopic techniques in oncology: Analysis of English
           secondary care data for radical prostatectomy and partial nephrectomy
    • Authors: D Hughes; C Camp, J O'Hara, J Adshead
      Abstract: Objectives To evaluate post‐operative health resource utilisation and secondary care costs of radical prostatectomy and partial nephrectomy in English NHS hospitals, via a comparison of robot‐assisted, conventional laparoscopic, and open surgical approaches. Patients and methods We retrospectively analysed the secondary care records of 23,735 patients receiving radical prostatectomy who underwent robot‐assisted surgery (RARP, n=8,016) or laparoscopic surgery (LRP, n=6,776) or open surgery (ORP, n=8,943). We further analysed 2,173 patients receiving partial nephrectomy who underwent robot‐assisted surgery (RAPN, n=365) or laparoscopic surgery (LPN, n=792) or open surgery (OPN, n=1,016). Post‐operative inpatient admissions, hospital bed‐days and excess bed‐days, and outpatient appointments at 360 and 1,080 days post‐intervention were reviewed. Results Patients receiving RARP required significantly fewer inpatient admissions, hospital bed‐days, and excess bed‐days at 360 and 1,080 days, compared with ORP patients. Patients receiving ORP record a significantly higher number of outpatient appointments at 1,080 days. Corresponding total costs are significantly lower for RARP patients at 360 days (£1,679 versus £2,031 for ORP, P
      PubDate: 2015-12-22T21:31:38.172148-05:
      DOI: 10.1111/bju.13401
  • Will chemotherapy change the management of prostate cancer?
    • Authors: Clare Gilson; Matthew R Sydes, Simon Chowdhury
      Abstract: Systemic therapy for metastatic prostate cancer has radically changed in the last 10 years with the introduction of several novel agents that have shown significant improvements in progression free and overall survival (see table 1). These have largely been studied in metastatic castrate‐refractory prostate cancer (mCRPC) and have prolonged survival but in each case by less than 6 months1. The treatment of these men has not significantly changed since Huggins and Hodges first demonstrated the effects of castration and androgen deprivation remains the mainstay of systemic treatment. However the latest breakthrough in the treatment of metastatic disease is the introduction of a relatively old drug, docetaxel chemotherapy, earlier in the disease for hormone sensitive patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-22T21:26:03.389567-05:
      DOI: 10.1111/bju.13400
  • Extreme Obesity Does Not Predict Poor Cancer Outcomes Following Surgery
           for Renal Cell Cancer
    • Authors: Michael L. Blute; Kristin Zorn, Matthew Grimes, Fangfang Shi, Tracy M. Downs, David F. Jarrard, Sara L. Best, Kyle Richards, Stephen Y. Nakada, E. Jason Abel
      Abstract: Objective To evaluate if extreme obesity (BMI ≥ 40) is associated with perioperative outcomes, overall survival (OS), cancer‐specific survival (CSS), or recurrence‐free survival (RFS) after surgical treatment for RCC. Patients and Methods After IRB approval, an institutional database identified patients treated surgically between January 2000 and December 2014 with pathologic diagnosis of RCC. Comprehensive clinical and pathologic data were reviewed. Kaplan‐Meier analyses were used to estimate OS, RFS, and CSS. Univariate and multivariate Cox proportional hazards analysis was used to evaluate for associations with OS, CSS and RFS in patients with extreme obesity among other known predictive variables. Results A total 100 (11.9%) patients were identified with BMI ≥ 40 and 743 (88.1%) with BMI
      PubDate: 2015-12-22T12:36:04.554495-05:
      DOI: 10.1111/bju.13381
  • The impact of Frailty on complications in patients undergoing common
           urologic procedures; a study from the American College of Surgeons
           National Surgical Quality Improvement Database
    • Authors: Anne M Suskind; Louise C Walter, Chengshi Jin, John Boscardin, Saunak Sen, Matthew R Cooperberg, Emily Finlayson
      Abstract: Objectives To evaluate the association of frailty, a measure of diminished physiologic reserve, with both major and minor surgical complications among patients undergoing urologic surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) from 2007 to 2013, we identified all urologic cases that appeared more than 1000 times in the dataset among patients age 40 and older. Frailty was measured using the NSQIP Frailty Index (FI), a validated measure that includes 11 impairments such as decreased functional status and impaired sensorium. We created multivariable logistic regression models using the NSQIP Frailty Index to assess major and minor complications after surgery. Results We identified 95,108 urologic cases representing 21 urologic procedures. The average frequency of complications per individual was 11.7%, with the most common complications being hospital readmission (6.2%), blood transfusion (4.6%), and urinary tract infection (3.1%). Major and minor complications increased with increasing NSQIP‐FI. Frailty remained strongly associated with complications after adjustment for year, age, race, smoking status, and method of anesthesia [adjusted OR 1.74 (95% CI 1.64, 1.85) NSQIP‐FI 0.18+]. Increasing NSQIP‐FI was associated with increasing frequency of complications within age groups (by decade) up to age 81 and across most procedures. Conclusion Frailty strongly correlates with risk of post‐operative complications among patients undergoing urologic surgery. This finding is true within most age groups and across most urologic procedures. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-21T08:19:56.08969-05:0
      DOI: 10.1111/bju.13399
  • A survey of patient expectations regarding sexual function following
           radical prostatectomy
    • Authors: Serkan Deveci; Geoffrey T. Gotto, Byron Alex, Keith O'Brien, John P. Mulhall
      Abstract: Introduction Clinical experience suggests that some radical prostatectomy (RP) patients have unrealistic expectations with regard to their long‐term sexual function. This study was undertaken to assess the understanding of patients who had previously undergone RP with regard to their postoperative sexual function. Methods Patients presenting within 3 months of their RP (open and robotic) were questioned regarding the sexual function information that they had received pre‐operatively. Patients were questioned about erectile function, postoperative ejaculatory status, orgasm and postoperative penile morphology changes. Statistical analyses were performed to assess for differences between patients who underwent open versus robotic RP. Results 336 consecutive patients (from 9 surgeons) with a mean age of 64±11 years had the survey instrument administered (216 underwent open and 120 underwent robotic RP). No significant differences existed in patient age or comorbidity profiles between the two groups. Only 38% of men had an accurate recollection of their nerve sparing status. The mean (SD) elapsed time post‐RP at the time of postoperative assessment was 3 (2) months. Robotic RP patients expected shorter EF recovery time (6 vs 12 months, p=0.02), a higher likelihood of recovery back to baseline erectile function (75 vs. 50%, p=0.01), and lower potential need for ICI (4 vs. 20%, p=0.01). Almost half of all patients were unaware that they were rendered anejaculatory by their surgery. None of the robotic RP patients and only 10% of open RP patients recalled being informed of the potential for penile length loss (p
      PubDate: 2015-12-21T06:13:22.962391-05:
      DOI: 10.1111/bju.13398
  • A prospective multicentric international study on the surgical outcomes
           and patients’ satisfaction rates of the ‘sliding’
           technique for end‐stage Peyronie's disease with severe shortening of
           the penis and erectile dysfunction
    • Authors: Luigi Rolle; Marco Falcone, Carlo Ceruti, Massimiliano Timpano, Omid Sedigh, David J. Ralph, Franklin Kuehhas, Marco Oderda, Mirko Preto, Mattia Sibona, Arianna Gillo, Giulio Garaffa, Paolo Gontero, Bruno Frea
      Abstract: Objectives To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the ‘sliding’ technique (ST). Patients and Methods From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end‐stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Questions 2 and 3, and the Peyronie's disease questionnaire (PDQ) were completed preoperatively by all patients. At the follow‐up visits (at 3, 6 and 12 months), the IIEF, the SEP Questions 2 and 3, the PDQ, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were completed. The outcome analysis was focused on penile length restoration, and intra‐ and postoperative complications classified according the Clavien–Dindo Classification. Results The mean (range) follow‐up was 37 (9–60) months. A malleable penile prosthesis (PP) was implanted in seven patients, while an inflatable three‐pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen‐fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II) and PP infection requiring the removal of the device (7%) (Grade III). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5–4) cm and no patient reported recurrence of the curvature. Conclusions The present series suggests that, in the hands of experienced high‐volume surgeons, penile length restoration with the use of the ST represents an effective option for end‐stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow‐up will be required to fully establish the efficacy of this procedure.
      PubDate: 2015-12-21T00:33:15.625017-05:
      DOI: 10.1111/bju.13371
  • 68Ga‐PSMA has high detection rate of prostate cancer recurrence
           outside the prostatic fossa in patients being considered for salvage
           radiation treatment
    • Authors: Pim J. van Leeuwen; Phillip Stricker, George Hruby, Andrew Kneebone, Francis Ting, Ben Thompson, Quoc Nguyen, Bao Ho, Louise Emmett
      Abstract: Objectives To examine the detection rates of 68Ga‐PSMA‐PET/CT in patients with biochemical recurrence (BCR) after radical prostatectomy (RP), and also the impact on their management. Materials and methods 300 consecutive PC patients who underwent 68Ga‐PSMA‐PET/CT between February and July 2015 were prospectively included in the ProCan‐I Database. For this analysis, men were included with BCR (PSA ≥0.05ng/ml) after RP, PSA
      PubDate: 2015-12-18T13:02:37.336972-05:
      DOI: 10.1111/bju.13397
  • Clostridium Histolyticum Collagenase – Is this revolutionary medical
           treatment for Peyronie's disease'
    • Authors: C Poullis; M Shabbir, I Eardley, J Mulhall, S Minhas
      Abstract: Peyronie's disease was described by Francois de la Peyronie in 1743, a battlefield surgeon and Commander of the Medical Corps of Louis XIV. The prevalence in the general population varies from 0.39‐3.4%, but increases to 7.1% in patients between 50‐69 years of age, with a reported prevalence rate of 20.3% in men with diabetes. The disease has two distinct clinical phases; the acute and stable or chronic phases. The acute phase is characterised by painful erections with increasing penile deformity usually lasting between 3‐12 months. The chronic phase is usually pain‐free and characterised by stabilisation of the plaque and penile deformity. The aetio‐pathogenesis of the disease remains largely unknown with local trauma, genetic and vascular factors being implicated. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-18T12:51:49.335433-05:
      DOI: 10.1111/bju.13396
  • Defining the Publication Source of High Quality Evidence in Urology: An
           Analysis of EvidenceUpdates
    • Authors: Vikram M. Narayan; Kristin Chrouser, R. Brian Haynes, Rick Parrish, Philipp Dahm
      Abstract: Objectives To determine the publication sources of Urology articles within EvidenceUpdates, a second‐order peer review system of the medical literature designed to identify high quality articles to support up‐to‐date and evidence‐based clinical decisions. Materials and Methods Using administrator‐level access, all EvidenceUpdates citations from 2003 to 2014 were downloaded from the topics Surgery‐Urology and Oncology‐Genitourinary. Data fields accessed included PUBMED unique reference identifier, study title, abstract, journal and date of publication, as well as clinical relevance and newsworthiness ratings as determined by discipline‐specific physician raters. The citations were then coded by clinical topic (oncology, voiding dysfunction, ED/infertility, infection/inflammation, stones/endourology/laparoscopy, trauma/reconstruction, transplant, or other), journal category (general medical journal, oncology journal, urology journal, non‐urology specialty journal, Cochrane review, or other), and study design (randomized controlled trial, systematic review, observational study, or other). Articles that were perceived to be misclassified and/or of no direct interest to urologists were excluded. Descriptive statistics using proportions and 95% confidence intervals as well as means and standard deviations were used to characterize the overall data cohort and to analyze trends over time. Results We identified 731 unique citations classified under either Surgery‐Urology or Oncology‐Genitourinary for analysis after exclusions. Between 2005 and 2014, the most common topics were oncology (48.6%, 355 articles) and voiding dysfunction (21.8%, 159 articles). Within the topic of oncology, prostate cancer contributed over half the studies (54.6%; n=194). The most common study types were randomized controlled trials (42.3%, 309 articles) and systematic reviews (39.6%, 290 articles). Systematic reviews had a nearly four‐fold relative increase within less than a decade. The largest proportion of studies relevant to urology were published in general oncology journals (20.0%; n=146), followed by the Cochrane Library (19.3%, n=141) and general medical journals (17.2%; n=126). Urology‐specific journals contributed to only approximately one‐tenth of EvidenceUpdates alerts (9.4%; n=69), with the highest contribution occurring during the 2013/2014 period. With respect to clinical relevance and newsworthiness scores (each graded on scales of 1‐7), urology journals scored the highest in clinical relevance 5.9 ±0.75 and general medical journals scored highest for newsworthiness at 5.3 ± 0.94. On average, randomized controlled trials scored highest both for clinical relevance and newsworthiness with mean scores of 5.71 ± 0.81 and 5.22 ± 0.91, respectively. Conclusions A large number of high quality, clinically relevant, and newsworthy peer‐reviewed urology publications are published outside of traditional urology journals. This requires urologists to implement well‐defined strategies to stay abreast of current best evidence. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-14T09:43:31.305408-05:
      DOI: 10.1111/bju.13392
  • Conservative Management of Staghorn Calculi: A Single Centre Experience
    • Authors: P G Deutsch; K Subramonian
      Abstract: Objective To evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function. Patients and Methods Twenty‐two patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included. Patients were reviewed yearly with symptom assessment, urine culture and measurement of eGFR. Results The presentations to urology were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections (18%). The reasons for conservative management in the cohort were co‐morbidities (59%), patient choice (36%) or poor access/anatomy (5%). Results for the whole cohort showed rates of recurrent urinary tract infections (50%), progressive renal failure (14%), disease specific mortality (9%), dialysis dependence (9%) and hospital attendances due to stone‐related morbidity (27%). Comparison of outcome measures between the unilateral and bilateral staghorn stones showed statistically significant differences in disease specific mortality (0 vs. 40%) and morbidity (12% and 80%) in favour of the unilateral group. Although there was a decreased incidence in urinary tract infection (41% vs. 80%), renal deterioration (6% vs. 40%) and dialysis requirement (6% vs. 20%) in the unilateral group, these findings were not statistically significant. Conclusions From the results we have concluded that conservative management of staghorn calculi is perhaps not as unsafe as previously thought. Careful patient selection, to include unilateral asymptomatic stones with minimal infection and thorough counselling to the risks of conservative management could make it a suitable option for specific patient groups. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-14T09:41:16.256484-05:
      DOI: 10.1111/bju.13393
  • Dynamic Sentinel Lymph Node Biopsy for Penile Cancer: A Comparison between
           One and Two‐day Protocols
    • Authors: Panagiotis Dimopoulos; Panagiotis Christopoulos, Sam Shilito, Zara Gall, Brian Murby, David Ashworth, Ben Taylor, Bernadette Carrington, Jonathan Shanks, Noel Clarke, Vijay Ramani, Nigel Parr, Maurice Lau, Vijay Sangar
      Abstract: Objective To determine the outcome of clinically negative node (cN0) patients with penile cancer undergoing Dynamic Sentinel Node Biopsy (DSNB), comparing the results of a one and two day protocol that can be used as a minimal invasive procedure for staging of penile cancer. Material and Methods This is a retrospective analysis of 151 cN0 patients who underwent DSNB from 2008‐2013 for newly diagnosed penile cancer. Data were analyzed per groin and separated into groups according to the protocol followed. The comparison of the two protocols involved the number of nodes excised, gamma counts, false negative rate and complication rate (Clavien‐Dindo grading system (CD)). Results 280 groins from 151 patients underwent DSNB following a negative USS±FNAC (Ultrasound ± Fine Needle Aspiration Cytology). One‐day protocol was performed in 65 groins and two‐day protocol in 215. A statistically significant higher number of nodes were harvested with the one‐day protocol (1.92/groin) compared to the two‐day protocol (1.60/groin). The false negative rates were 0%, 6.8% and 5.1%. for one day and two day protocols, and overall respectively. Morbidity of the DSNB was 21.4% for all groins and 26.2% and 20.1% for one day and two day protocols respectively. The majority of the complications were of CD grade 1‐2. Conclusions and Patient Summary DSNB is safe for staging penile cancer patients. There is a trend towards a one day protocol having a lower false negative rate than a two day protocol, albeit at the expense of a slightly higher complication rate. This article is protected by copyright. All rights reserved.
      PubDate: 2015-12-08T03:04:15.799613-05:
      DOI: 10.1111/bju.13389
  • Level of evidence, sponsorship, conflict of interest policy and commercial
           impact of PubMed‐listed clinical urolithiasis‐related trials
           in 2014
    • Authors: Martin Schoenthaler; Arkadiusz Miernik, Konrad Wilhelm, Daniel Schlager, Dominik Stefan Schoeb, Fabian Adams, Philipp Dahm, Simon Hein
      Abstract: Objective To evaluate published trials on urolithiasis regarding level of evidence, type of sponsorship and declared conflicts of interest and to elucidate potential conflicts of interest. Materials and Methods We performed a systematic PubMed® literature search using a predefined Boolean search term to identify PubMed®‐listed clinical research studies on urolithiasis in 2014 (4th quarter). All authors screened the results for eligibility criteria and two independent reviewers evaluated and performed data extraction of predefined endpoints including level of evidence, declaration of conflict of interest and sponsorship/ funding (as indicated in the published print version), and commercial impact. Results A total of 110 clinical trials in urolithiasis listed in PubMed® met the inclusion criteria. Overall, levels of evidence 1, 2, 3, and 4 were found in 15%, 14%, 21%, and 51% respectively. Ninety % of publications indicated conflicts of interest, 93% of which declared no existing conflict of interest. Sponsorship was indicated in 36% of publications, 55% of which stated public funding, 33% institutional funding, 10% industrial funding, and 2% both public and industrial funding. Eleven percent of the published trials were rated to bear a high commercial impact. Conclusions The current study provides evidence of increasing levels of evidence for published clinical trials on urolithiasis in 2014 (as compared to earlier data). Ninety percent of publications indicated conflicts of interest, whereas sponsoring of studies was declared only by one third. A considerable number of trials involved issues of high commercial impact. Recently established legal programs and voluntary acts on self‐reporting of financial relationships will enhance transparency in the future. However, increased public funding will be needed to further promote the quality of trials on urolithiasis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-30T05:02:32.57322-05:0
      DOI: 10.1111/bju.13387
  • Guideline of Guidelines: follow‐up after nephrectomy for renal cell
    • Authors: Timothy J Williamson; John R Pearson, Joseph Ischia, Damien M Bolton, Nathan Lawrentschuk
      Abstract: AIM; To review and compare the international guidelines and surveillance protocols for post‐nephrectomy renal cell carcinoma (RCC) METHOD; PubMed database searches were conducted according to the PRISMA statement in order to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. RESULTS; 17 articles were reviewed with 3 urological endorsed guidelines, 3 oncological and 11 proposed strategies. Guidelines and strategies varied significantly in relation to follow‐up, specifically the frequency and timing of radiological imaging. CONCLUSION; Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics. KEY WORDS; Kidney Neoplasms, Nephrectomy, Guideline, Recurrence, Outcomes This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-30T05:02:19.502851-05:
      DOI: 10.1111/bju.13384
  • Nephron‐sparing surgery across a nation – outcomes from the
           British Association of Urological Surgeons 2012 national partial
           nephrectomy audit
    • Authors: Archie Fernando; Sarah Fowler, Tim O'Brien,
      Abstract: Objective To determine the scope and outcomes of nephron‐sparing surgery (NSS) across the UK and in so doing set a realistic benchmark and identify fresh contemporary challenges in NSS . Patients and methods In 2012 reporting of outcomes of all types of nephrectomy became mandatory in the UK. 148 surgeons in 86 centres prospectively entered data on 6042 nephrectomies undertaken in 2012. This study is a retrospective analysis of the NSS procedures in the dataset. Results 1044 NSS procedures. Median surgical volume 4 per consultant (1‐39) and 8 per centre (1‐59). 36 surgeons and 10 centres reported on only 1 NSS. Indications: elective ≤4.5cm 59%; elective >4.5cms 10%; relative 7%; imperative 12%; and VHL 1%; unknown 11%. Median tumour size 3.4cm (0.8‐30). Technique: Minimally invasive surgery (MIS) 42%, open 58%. Conversions 4%. Histology: Malignant 80%; benign 18%; unknown 2%. Risk factors for benign histology: age
      PubDate: 2015-11-18T05:17:37.156372-05:
      DOI: 10.1111/bju.13353
  • Trends of the risk of second primary cancer among bladder cancer
           survivors: a population‐based cohort of 10,047 patients
    • Abstract: Objectives To determine whether the risk of second primary cancer (SPC) among patients with bladder cancer (BCa) has changed over past years. Materials and methods Data from ten French population‐based cancer registries were used to establish a cohort of 10,047 patients diagnosed with a first invasive (T1 or greater) BCa between 1989 and 2004 and followed up until 2007. A SPC was defined as the first primary cancer occurring at least two months after a BCa diagnosis. Standardized incidence ratios (SIRs) of metachronous SPC were calculated. Multivariate Poisson regression models were used to assess the direct effect of the year of BCa diagnosis on the risk of SPC. Results The risk of new malignancy among BCa survivors was 60% higher than the general population (SIR=1.60, 95% CI 1.51–1.68). Male patients presented a high risk of SPC of the lung (SIR=3.12), head and neck (SIR=2.19) and prostate (SIR=1.54). In multivariate analyses adjusted on gender, age at diagnosis and follow‐up, a significant increase of the risk of second cancer of the lung was observed over calendar year of BCa diagnosis (p for linear trend .010), with a SIR increasing by 3.7% for each year (95% CI 0.9%‐6.6%). However, no particular trend was observed regarding the risk of second cancer of the head and neck (p=.596) or the prostate (p=.518). Conclusions As the risk of SPC of the lung increased between 1989 and 2004, this study contributes more evidence to support promotion of tobacco‐cessation interventions among BCa patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T10:35:02.659784-05:
      DOI: 10.1111/bju.13351
  • Clinical significance of preoperative C‐reactive protein and
           squamous cell carcinoma antigen levels in penile squamous cell carcinoma
    • Abstract: Objective The association between pre‐treatment levels of C‐reactive protein (CRP) and squamous cell carcinoma antigen (SCC‐Ag) has not been clarified. Therefore, we evaluated the relevance of CRP and SCC‐Ag levels in relation to clinicopathologic factors and prognosis in penile cancer. Patients and Methods A total of 124 Chinese penile squamous cell cancer patients treated between November 2007 and October 2014 were analyzed retrospectively. Receiver operating characteristic curves were used to identify the combination of markers with the best sensitivity and specificity for prognosis prediction. Statistical data analysis was performed using a nonparametric method, and survival analysis was performed using the log rank test and Cox proportional hazard model. Results Levels of CRP ≥4.5 mg/L and SCC‐Ag ≥1.4 ng/ml were both significantly associated with lymph node metastasis laterality (χ2 trend test, P=0.041), extranodal extension (χ2 trend test, P
      PubDate: 2015-11-17T07:36:53.684623-05:
      DOI: 10.1111/bju.13379
  • Multiphoton microscopy for rapid histopathological evaluation of kidney
    • Authors: Manu Jain; Brian D. Robinson, Amit Aggarwal, Maria M. Shevchuk, Douglas S. Scherr, Sushmita Mukherjee
      Abstract: Objective To explore the potential of multiphoton microscopy (MPM) for rapid evaluation and triaging of ex vivo kidney tissue. MPM is an optical imaging technique that relies on intrinsic tissue emission to generate histological‐resolution images from fresh (unfixed and unstained) tissue. Since MPM does not require any tissue processing which is necessary for conventional histopathology, it can provide a rapid histo‐morphological feedback in real‐time, while preserving the tissue in its native state for future ancillary studies. Materials and methods Fresh neoplastic and non‐neoplastic tissues from nephrectomy specimens (n=40) were imaged with MPM and later submitted for routine histopathology. Results On MPM, normal kidney architecture was evident and clearly distinguishable from tumor. Forty malignant tumors [Clear Cell RCC (CCRCC) =20, Papillary RCC (PRCC) =10, Chromophobe RCC (ChRCC) and Papillary Urothelial Carcinoma (PUC) =5 each, as diagnosed by H&E) were imaged and subtyped as non‐papillary and papillary based on their architecture. Non‐papillary tumors were further classified based on their unique cytoplasmic signatures. CCRCC had a predominant population of cells with fat droplets in cytoplasm. ChRCC had cells with non‐fatty/homogeneous cytoplasm and distinct intra‐cytoplasmic granules. PRCC had single‐cell‐lined papillae with often abundant histiocytes in their core whereas PUC had multi‐layered urothelium‐lined papillae. The diagnostic accuracy of tumor subtyping by two independent uropathologists was 95%. Conclusion MPM can reliably differentiate neoplastic from non‐neoplastic kidney tissue and subtype kidney tumors in fresh, unprocessed tissue. Thus, it might be useful as a rapid real‐time diagnostic tool for the evaluation of kidney biopsies, and surgical margins in partial nephrectomies, to improve overall patient management. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T07:36:46.036512-05:
      DOI: 10.1111/bju.13377
  • Adherent perinephric fat at minimally invasive partial nephrectomy is
           associated with adverse perioperative outcomes and malignant renal
    • Authors: Neil J. Kocher; Sudhir Kunchala, Christopher Reynolds, Erik Lehman, Sarah Nie, Jay D. Raman
      Abstract: Objectives To predict adherent perinephric fat (APF) at minimally invasive partial nephrectomy (MIPN), the Mayo Adhesive Probability (MAP) score was developed as a pre‐operative model. We review a contemporary MIPN cohort to determine the impact of MAP score and APF on MIPN outcomes. Patients and Methods 245 patients undergoing MIPN were included. The presence of APF was determined through keywords in operative notes, and radiographic data were obtained from preoperative cross‐sectional imaging. Posterior fat thickness (PFT) was measured between the renal capsule and the posterior abdominal wall at the level of the renal vein. Perinephric stranding was graded on a 0‐3 severity scale. Results 123 men and 122 women with a median age of 55 years, BMI of 31.7, tumor size of 2.7 cm, and nephrometry score of 6 were included. Median posterior fat thickness was 1.79 cm and MAP score was 2.63. 26 patients (10.6%) had evidence of APF at time of renal surgery. Factors predictive of APF included increasing age (P=0.001), male gender (P=0.045), perinephric stranding (P=0.002), PFT (P
      PubDate: 2015-11-17T07:36:27.399025-05:
      DOI: 10.1111/bju.13378
  • Trends in utilization, perioperative outcomes and costs for
           nephroureterectomies in the management of upper tract urothelial carcinoma
           (UTUC): a 10‐year population‐based analysis
    • Abstract: Objective To perform a population‐based study to evaluate contemporary utilization trends, morbidity and costs associated with nephroureterectomies (NU). Contemporary data for NU are largely derived from single academic institution series describing the experience of high‐volume surgeons. It is unclear if the same favorable results occur on a national level. Patients and Methods Using the Premier Hospital Database, we captured patients undergoing a NU with diagnoses of renal pelvis or ureteral neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90‐day postoperative complications, operating‐room‐time (OT), prolonged length‐of‐stay (pLOS) and direct hospital costs among open, laparoscopic (LNU) and robotic (RNU) approaches. Results After applying sampling and propensity weights we derived a final study cohort of 17,254 ONU, 13,317 LNU and 3,774 RNU for UTUC in the US between 2004 and 2013. During that period, minimally invasive NU (miNU) increased from 36%‐to‐54% while the total number of NUs decreased by nearly 20%. No differences were noted in perioperative outcomes between three surgical approaches, including when the analysis was restricted to highest‐volume hospitals and highest‐volume surgeons. OT was longer for LNU and RNU (p
      PubDate: 2015-11-17T07:25:56.490419-05:
      DOI: 10.1111/bju.13375
  • Comparison of oncological and health related quality of life (HRQOL)
           outcomes between open (ORP) and robotic‐assisted radical
           prostatectomy (RARP) for localized prostate cancer – findings from
           the population‐based Victorian Prostate Cancer Registry (PCR)
    • Authors: Wee Loon Ong; Sue M Evans, Tim Spelman, Paul A Kearns, Declan G Murphy, Jeremy L Millar
      Abstract: Objective To compare the short‐term oncological and HRQOL outcomes between open (ORP) and robotic‐assisted (RARP) radical prostatectomy in the population‐based Victorian Prostate Cancer Registry (PCR). Patients and Methods This is a prospective cohort of prostate cancer patients who had RP (1117 ORP and 885 RARP) between January 2009 and June 2012. The oncological outcomes of interest were: positive surgical margin (PSM) and biochemical recurrence (BCR) (defined as post‐operative PSA >0.2ng/ml). The HRQOL outcomes were: sexual and urinary bother, assessed using the Expanded Prostate Cancer Index Composite (EPIC) at 1‐ and 2‐year post‐diagnosis. Student T‐test or Mann‐Whitney U‐test were used for univariate comparison of continuous variables, and Pearson's chi‐squared test for categorical variables. Bonferonni correction was applied to account for multiple testing, with threshold for significance of P
      PubDate: 2015-11-17T07:21:44.340177-05:
      DOI: 10.1111/bju.13380
  • Outcomes of Unselected Patients with Metastatic Clear‐Cell Renal
           Cell Carcinoma Treated with Front‐Line Pazopanib Therapy Followed by
           Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitors
           (VEGFR‐TKI) or Mammalian Target of Rapamycin Inhibitors (mTORi): A
           Single Institution Experience
    • Authors: Marc R. Matrana; Tharakeswara Bathala, Matthew T Campbell, Cihan Duran, Aditya Shetty, Purnima Teegavarapu, Sarathi Kalra, Lianchun Xiao, Bradley Atkinson, Paul Corn, Eric Jonasch, Nizar M. Tannir
      Abstract: Background Data regarding unselected patients with metastatic clear‐cell renal cell carcinoma (ccRCC) treated with first‐line pazopanib are limited. Patients and Methods We reviewed records of patients with metastatic ccRCC treated with first‐line pazopanib during 11/09‐11/12. Cox models were fitted to evaluate the association of progression‐free survival (PFS) and overall survival (OS) with patient co‐variables. Results Eighty‐eight patients were identified; 74 were evaluable for response: 2 (3%) had complete response, 27 (36%) had partial response, 36 (49%) had stable disease, and 9 (12%) had progressive disease. Median PFS was 13.7 months (95% CI: 8.7 – 18.3). PFS was correlated with Karnofsky performance score < 80 (HR = 3.26, p < 0.0001) and serum lactate dehydrogenase >1.5 ULN (HR = 3.25, p = 0.0135). Median OS was 29.1 months (95% CI: 20.2 – NA). OS was correlated with brain metastasis (HR = 2.55, p = 0.0089), neutrophilia (HR = 1.179, p = 0.0178), and anemia (HR = 3.51, p = 0.0001). No treatment‐related deaths occurred. Fifty‐three patients received second‐line therapy (VEGFR‐TKI [22], mTORi [22], others [9]); median PFS was 8.6 months (95% CI: 3.3 – 25.7) with VEGFR‐TKI and 5 months (95% CI: 3.5 – 15.2) with mTORi, p = 0.41; median OS was 19.9 months (95% CI: 12.9 – NA) and 14.2 months (95% CI: 8.1 – NA), from initiation of second‐line VEGFR‐TKI or mTORi, respectively, p = 0.37. Conclusions In this retrospective study, first‐line pazopanib confirmed its efficacy in metastatic ccRCC. Trends for longer PFS and OS were observed with VEGFR‐TKI than mTORi after first‐line pazopanib. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T07:21:32.514225-05:
      DOI: 10.1111/bju.13374
  • The urological recommendations from the NICE Guideline Suspected Cancer:
           Recognition & Referral June 2015
    • Authors: Edward R. Jefferies; Simon F. Brewster,
      Abstract: NICE have recently published an updated guideline for secondary care cancer referrals (Suspected cancer: recognition and referral NG12 (1)) which updates the CG27 (2005) Referral guidelines for suspected cancer (2). There have been some significant changes to the urgent (two week) referral guidance for urological cancer (see Table 1), especially with regard to the management of haematuria. On behalf of the BAUS Section of Oncology we have summarised their findings salient to our urological practice. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T01:02:58.586513-05:
      DOI: 10.1111/bju.13355
  • Pioglitazone and Bladder Cancer
    • Authors: Hannah Warren; Nicholas Raison, Prokar Dasgupta
      Abstract: Last month, Lewis et al published the results of a large, 10 year observational cohort study on the association between the anti‐diabetic drug pioglitazone, and bladder cancer and 10 additional cancers [1]. The study recruited 193,099 diabetic patients over 40 years of age from electronic health records of the Kaiser Permanente Northern California (KPNC) diabetes registry. Use of pioglitazone and other anti‐diabetic medications was collected from prescription records. The KPNC cancer registry was used to identify site specific cancer diagnoses. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T00:52:41.27974-05:0
      DOI: 10.1111/bju.13352
  • Extent of Renal Vein Invasion Influences Prognosis in Patients with Renal
           Cell Carcinoma
    • Authors: Mark W. Ball; Michael A. Gorin, Kelly T. Harris, Kevin M. Curtiss, George J. Netto, Christian P. Pavlovich, Phillip M. Pierorazio, Mohamad E. Allaf
      Abstract: Objective To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma. Patients Methods Patients undergoing extirpative surgery for RCC at our institution from 2003‐2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40). Kaplan‐Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence‐free survival (RFS) and cancer‐specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models. Results At a median follow‐up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0.03, p = 0.009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2.3, 95% confidence interval [CI] 1.1‐4.4, p = 0.03) and CSS (HR 3.5, 95%CI 1.3‐9.9, p = 0.02) compared to segmental RVI. Sub‐stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared to the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counseling and future staging guidelines. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T00:46:55.787952-05:
      DOI: 10.1111/bju.13349
  • A prospective multicentric international study on the surgical outcomes
           and patients’ satisfaction rates of the “Sliding
           Technique” for end‐stage Peyronie's disease with severe
           shortening of the penis and erectile dysfunction
    • Authors: Yvonne Chan; Patrick Fisher, Derya Tilki, Christopher P. Evans
      Abstract: Objective Urethral recurrence (UR) after radical cystectomy is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of recurrence, management of the remnant urethra, and treatment of recurrence become critical questions. To summarize the current literature on the diagnosis and management of urethral recurrence after radical cystectomy. Patients and Methods A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after radical cystectomy. The search terms used included urethral recurrence, cystectomy or cystoprostatectomy. Selected studies provided information on the type of urinary diversion performed, the incidence of recurrence, and the time to recurrence. Results Incidence of UR after radical cystectomy ranges from 1‐8% with most recurrences occurring within the first two years after surgery. Increased risk of UR is associated with involvement of the prostate, tumor multifocality, bladder neck involvement, and cutaneous diversion. Median overall survival after urethral recurrence ranges from 6‐54 months and 5‐year disease specific survival after UR is reported between 0‐83%. Conclusion Urethral recurrence remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate to high risk recurrence to enable early detection of non‐invasive disease, which may be amenable to conservative therapy prior to urethrectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-11T02:18:58.356987-05:
      DOI: 10.1111/bju.13370
  • Open label study evaluating outpatient urethral sphincter injections of
           onabotulinumtoxinA to treat women with urinary retention due to a primary
           disorder of sphincter relaxation (Fowler's syndrome)
    • Authors: Jalesh N. Panicker; Jai H. Seth, Shahid Khan, Gwen Gonzales, Collette Haslam, Thomas M. Kessler, Clare J. Fowler
      Abstract: Objectives To assess the efficacy, defined as improvement of flow rates by more than 50%, improvement in residual volume and scores on the IPSS questionnaire, and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile and specific findings in the urethral sphincter EMG (Fowler's Syndrome). Patients and methods In this open label pilot institutional review board approved study, ten women) with a primary disorder of urethral sphincter relaxation (elevated urethral pressure profile (UPP), sphincter volume and abnormal EMG) presenting with obstructed voiding (n=5) or in complete urinary retention (n=5) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS questionnaire, and urinary flow and post‐void residual volume were measured. After 2% lidocaine injection, 100U of onabotulinumtoxintypeA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at week 1, 4 and 10 post‐treatment and assessed using the IPSS questionnaire, urinary flow rate and post‐void residual volume. The UPP was repeated at week 4. Results The mean patient age was 40 years (range 25‐65), and mean symptom scores on the IPSS questionnaire improved from 25.6 to 14.1, and mean bother score reduced from 6.1 to 3.5 at week 10. As compared to a baseline mean flow rate of 8.12 mls/sec in the women who could void, the flow rate improved to 15.8 mls/sec at week 10. Four out of five women in complete retention could void spontaneously, with a mean flow rate of 14.3 mls/sec at week 10. The mean post‐void residual volume decreased from 260 mls to 89 mls. The mean static UPP improved from 113 to 90 cmH20 at baseline. No serious side effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress incontinence. Seven out of the ten women opted to return for repeat injections. Conclusion This pilot study demonstrates an improvement in patient‐reported lower urinary tract symptoms, and objective parameters such as flow rate, post‐void residual volume and UPP, ten weeks following urethral sphincter injections of onabotulinumtoxinA. No serious side effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-08T03:59:25.436673-05:
      DOI: 10.1111/bju.13342
  • The impact of re‐TUR on clinical outcomes in a large
           multi‐centre cohort of T1‐HG/G3 patients treated with BCG
    • Abstract: Objectives To determine if a re‐TUR in the presence or absence of muscle at the first TUR in T1‐high grade (HG)/G3 bladder cancer patients makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). Methods In a large retrospective multi‐centre cohort of 2451 T1‐HG/G3 patients initially treated with BCG, 935 (38%) had a re‐TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in 4 groups: group 1 (no muscle, no re‐TUR), group 2 (no muscle, re‐TUR), group 3 (muscle, no re‐TUR) and group 4 (muscle, re‐TUR). Clinical outcomes were compared across the 4 groups. Results Re‐TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary specimen. Adjusting for the most important prognostic factors, re‐TUR in the absence of muscle had a borderline significant effect on time to recurrence (HR = 0.67, p = 0.08), progression (HR = 0.46, p = 0.06), CSS (HR = 0.31; p = 0.07) and OS (HR = 0.48, p = 0.05). Re‐TUR in the presence of muscle in the primary specimen did not improve the outcome for any of the endpoints. Conclusions Our retrospective analysis suggests that re‐TUR may not be necessary in T1‐HG/G3 patients if muscle is present in the specimen of the primary TUR. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-06T23:59:46.262344-05:
      DOI: 10.1111/bju.13354
  • Advances in Advanced Prostate Cancer – The Continuing Journey
    • Authors: Heather Payne; Reena Davda, Robert Jones, Simon Crabb, Janis Troup, Simon Hughes
      Abstract: Prior to 2004, the uro‐oncology community viewed the management of advanced or metastatic prostate cancer with an air of resigned nihilism. Now, the range of therapeutic options available is the subject of ongoing debate and the British Uro‐oncology Group (BUG) is collating oncologist opinions on the future management of castration‐sensitive disease. Historically, treatment for metastatic prostate cancer was limited to androgen deprivation therapy (ADT) with the aims of delaying disease progression and palliating symptoms. Patients invariably progressed, developing castration‐resistant disease with limited effective therapeutic options. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-04T21:56:38.001681-05:
      DOI: 10.1111/bju.13350
  • Outcome of Living Donor Renal Transplantation in Children with Lower
           Urinary Tract Dysfunction: A Comparative Retrospective Study
    • Abstract: Objectives To compare outcome of renal transplantation (RTx) in children with end stage renal disease (ESRD) due to lower urinary tract dysfunction (LUTD) versus other causes. Patients and methods Database of children < 18 years old who underwent RTx from May 2008 through April 2012 was reviewed. Patients were divided into Group A (LUTD = 29 children) and Group B (other causes of ESRD = 74 children). RTx was performed after achieving low intravesical pressure (< 30 cmH2O) with adequate bladder capacity and drainage. Both groups were compared using student t, Mann‐Whitney, Chi‐square or Exact tests. Graft survival rates (GSR) were evaluated by Kaplan‐Meier curves and Log‐rank test. Results Mean age was 5.05 ± 12.4 (2.2‐18) years. Causes of LUTD were PUV (41.4%), VUR (37.9%), neurogenic bladder (10.3%), Prune Belly Syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration, or donor type. In Group A, 25/29 (86.2%) patients underwent ≥ 1 surgery to optimize UT for allograft. Pre‐transplant nephrectomy was performed in 15/29 (51.7%), PUV ablation in 9/29 (31%) and ileocystoplasty in 4/29 (13.7%) patients. Mean follow‐up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between both groups at different points of follow‐up. GSR at end of study was 93.1% and 91.1% in groups A and B, respectively (p = 1). According to Kaplan‐Meier survival curves, there was no significant difference in GSR between both groups using the Log‐rank test (p = 0.503). No graft was lost due to urological complications. In Group B, 1 child died due to septicemia. UTI was 24% and 12% in Groups A and B, respectively albeit not significant. No significant difference was found between both groups as regard the incidence of post‐transplantation hydronephrosis. Out of 22 patients with hydronephrosis following transplantation, 3 patients were complicated by UTI. Injection of bulking agents was required in 2 patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. Conclusion Acceptable graft function, survival and UTI rates can be achieved in children with ESRD due to LUTD. Thorough assessment and optimization of LUT together with close follow‐up are keys for successful RTx. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-02T10:40:27.300731-05:
      DOI: 10.1111/bju.13347
  • Gleason pattern 4, Active Surveillance No More
    • Authors: Niranjan J. Sathianathen; Declan G. Murphy, Roderick C. N. Bergh, Nathan Lawrentschuk
      Abstract: To reduce overtreatment of indolent prostate cancer (PCa), urologists have embraced active surveillance (AS) as a management strategy for low‐risk PCa. However, patterns‐of‐care studies are now demonstrating that AS is also being utilized for patients with intermediate‐risk disease. A contemporary Australian study of 980 men reported that 8.9% of intermediate‐risk men were placed on AS of which 53.8% had Gleason score (GS) 3+4 PCa and 10.4% with 4+3 disease[1]. The most recent update from the CaPSURE database also reflected this trend in AS. However, questions remain about the safety of this practice, particularly as the majority of AS protocols worldwide exclude men with GS4 cancers unless their life expectancy is limited. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T23:51:53.834352-05:
      DOI: 10.1111/bju.13333
  • Microscopic hematuria at time of diagnosis is associated with lower
           disease stage in patients with newly diagnosed bladder cancer
    • Authors: Daniel Ramirez; Amit Gupta, Daniel Canter, Brian Harrow, Ryan W. Dobbs, Victor Kucherov, Edward Mueller, Necole Streeper, Matthew A. Uhlman, Robert S. Svatek, Edward M. Messing, Yair Lotan
      Abstract: Objectives To determine whether the severity of hematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer. Subjects/Patients And Methods We conducted a multi‐institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of hematuria, demographic information, clinical and social history, imaging and pathology. The association of hematuria severity with incident tumor stage and grade was evaluated using logistic regression. Results Patients diagnosed with bladder cancer presented with gross hematuria (n=1083, 78.3%), microscopic hematuria (n=189, 13.7%) or without hematuria (n=112, 8.1%). High‐grade disease was found in 64% and 57.1% of patients presenting with gross and microscopic hematuria, respectively and severity of hematuria was not associated with higher grade disease. Stage of disease at for patients presenting with microscopic hematuria was Ta/CIS (68.8%), T1 (19.6%) and ≥T2 (11.6%). Stage of disease at for patients presenting with gross hematuria was Ta/CIS (55.9%), T1 (19.6%) and ≥T2 (17.9%). On multivariate analyses, gross hematuria was independently associated with ≥T2 disease at diagnosis (OR: 1.69, 95%CI 1.05 – 2.71, p = 0.03). Conclusions Among patients with newly diagnosed bladder cancer, presentation with gross hematuria is associated with a more advanced pathologic stage. Earlier detection of disease, before development of gross hematuria, could influence survival in patients with bladder cancer. Type of hematuria at presentation does not impact grade of disease. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T23:51:33.376411-05:
      DOI: 10.1111/bju.13345
  • The Urologist's role in Multidisciplinary Management of Placenta Percreta
    • Authors: Briony L. Norris; Wouter Everaerts, Elske Posma, Declan G. Murphy, Mark P. Umstad, Anthony J. Costello, C. David Wrede, Jamie Kearsley
      Abstract: Objectives To evaluate urological interventions in patients with placental adhesive disorders in our collaborative experience at a tertiary referral centre. Patients and Methods We performed a retrospective analysis of a prospectively collected data set, consisting of all women that presented with placental adhesive disorders at the Royal Women's Hospital from August 2009 to September 2013. Patients who required urological intervention were identified and perioperative details were retrieved. Results Of the 49 women that presented with placental adhesive disorders, 36 of them (73.5%) underwent urological interventions. The patients were divided into three groups: planned hysterectomy (n=37), planned conservative management (n=5) and undiagnosed placenta percreta (n=7). In the planned hysterectomy group, 29 patients underwent preoperative cystoscopy and ureteric catheter placement. In 10 patients (34%), the placenta partially invaded the bladder and/or ureter, requiring urological repair. In the conservative management group, four underwent preoperative cystoscopy and ureteric catheter placement and one case required closure of a cystotomy. Of the seven patients with undiagnosed percreta, two were noted to have bladder involvement requiring repair at the time of Caesarean hysterectomy. Conclusion Patients with placental adhesive disorders frequently require urological intervention to prevent or repair injury to the urinary tract. These cases are best managed in specialist centres with multidisciplinary expertise including urologists and interventional radiologists. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T02:05:25.144965-05:
      DOI: 10.1111/bju.13332
  • A prediction model for early biochemical failure after radical
           prostatectomy based on the CAPRA‐S score and the presence of
           secondary circulating prostate cells
    • Authors: Nigel P. Murray; Socrates Aedo, Eduardo Reyes, Nelson Orellana, Cynthia Fuentealba, Omar Jacob
      Abstract: Objective To establish a prediction model for early biochemical failure based on the CAPRA‐S score and secondary circulating prostate cells. Patients and Methods A prospective single center study of men who underwent radical prostatectomy as monotherapy for prostate cancer. Clinical‐pathological findings were used to calculate the CAPRA‐S score. 90 days after surgery blood was taken for CPC detection, mononuclear cells were obtained using differential gel centrifugation, and CPCs identified using immunocytochemistry. A CPC was defined as a cell expressing PSA but not CD45. The CPC test was defined as positive or negative. Patients were followed up for up to 5 years, biochemical failure was defined as a PSA >0.2ng/ml. The validity of the CAPRA‐S score was calibrated using partial validation, and Cox proportional hazard regression to build three models, CAPRA‐S, CPC and combined models. Results 321 men participated, mean age 65.5 years, after 5 years of follow up the biochemcial free survival was 98.55%. The model using CAPRA‐S showed a HR of 7.66, that of CPC 34.52 and the combined model showed a HR of 2.60 for CAPRA‐S and 22.5 for CPC. Using the combined model, 23% of men changed from low risk to high risk or vice versa. Conclusion The incorporation of CPC detection significantly increased the discrimination in establishing the probability of biochemcial failure, high risk CAPRA‐S patients who are negative for CPCs have a much better prognosis. The addition of CPC detection gives clinically significant information of who may be eligible for adjuvant therapy. Methods and Patients A single center prospective observational study of men following radical prostatectomy for prostate cancer. CAPRA‐S scores were obtained from the surgical specimen analysis; secondary CPCs were detected using inmunocytochemistry three months post surgery, a positive sample contained ≥1 PSA (+) CD45 (‐) staining cell/blood sample and BF was defined as a serum total PSA >0.20ng/ml. Five year BF was determined using Cox regression analysis for models using the CAPRA‐S, CPC, and combined data, they were compared using a decision analysis curve (DAC), Harrell's C concordance test and predicted versus observed survival using Kaplan‐Meier curves. Results 321 men, mean age 65.5yrs participated, in whom 193 (60%) had secondary CPCs detected. After 5 years of follow up the predicted biochemical free survival was 98.6%. For the DAC, the combined CAPRA‐S/CPC model was superior to both single variable models with a Harrell's C score of 0.86. Using the combined model 23.7% of men changed risk group. Discussion The incorporation of CPC detection into the CAPRA‐S score improved significantly its prognostic value, it identified a low risk CAPRA‐S sub‐group with intermediate risk and a high risk CAPRA‐S subgroup with low risk. The incorporation of CPC detection into the CAPRA‐s score provides clinically important information on possible treatment decisions. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-28T00:40:38.904101-05:
      DOI: 10.1111/bju.13367
  • The prevalence of metabolic syndrome and its components amongst men with
           and without clinical benign prostatic hyperplasia: a large,
           cross‐sectional, UK epidemiological study
    • Authors: Julia R. DiBello; Chris Ioannou, Jonathan Rees, Ben Challacombe, Joe Maskell, Nurul Choudhury, Christof Kastner, Mike Kirby
      Abstract: Objectives To compare the prevalence of (1) the metabolic syndrome and (2) the components of the metabolic syndrome in men aged 50 years and older with and without clinical benign prostate hyperplasia (BPH). Subjects and methods This was a cross‐sectional study using the UK Clinical Practice Research Database (CPRD). Men were selected from the UK CPRD that were ≥50 years of age and still registered as of 31st December 2011. Cohort 1 included men with clinical BPH, and cohort 2 men without clinical BPH that were matched 1:1 to those in cohort 1 by general practice, year of birth and prior years of available history (1 to
      PubDate: 2015-10-26T21:28:56.213779-05:
      DOI: 10.1111/bju.13334
  • Symptom burden and information needs in prostate cancer survivors: A case
           for tailored long‐term survivorship care
    • Abstract: Objectives To determine the relationship between long‐term prostate cancer survivors’ symptom burden and information needs. Subjects/patients and methods We used population‐based data from the Michigan Prostate Cancer Survivor Study (n=2,499). We examined unadjusted differences in long‐term information needs according to symptom burden and performed multivariable logistic regression to examine symptom burden and information needs adjusting for patient characteristics. Results High symptom burden was reported across all domains (sexual 44.4%, urinary 14.4%, vitality 12.7%, bowel 8.4%, emotional 7.6%) with over half of respondents (56%) reporting they needed more information. Top information needs involved recurrence, relationships, and long‐term effects. Prostate cancer survivors with high symptom burden more often searched for information regardless of domain (p
      PubDate: 2015-10-26T00:22:15.381119-05:
      DOI: 10.1111/bju.13329
  • Variation of Serum Prostate‐Specific Antigen in Men with Prostate
           Cancer Managed with Active Surveillance
    • Authors: Behfar Ehdaie; Bing Ying Poon, Daniel D. Sjoberg, Pedro Recabal, Vincent Laudone, Karim Touijer, James Eastham, Peter T. Scardino
      Abstract: Objective To describe fluctuations in PSA levels in men managed with AS to determine if a single PSA increase is a consistent measure to trigger intervention. Patients And Methods We evaluated data on 541 men on AS from 1995 through 2011. PSA variation was described by studying the Kaplan‐Meier probability of patients’ PSA levels reaching 4 or 7 ng/mL, going below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan‐Meier probability of a PSA change followed by an equal or greater change in the opposite direction. Results We analyzed data on 541 AS patients with a median of 8 PSA measurements (IQR, 6‐12) on AS for a median of 4 years (IQR, 2‐6). The 5‐year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% CI, 35%‐46%) and the 5‐year estimate of subsequently falling below this threshold was 90% (95% CI, 82%‐95%). The 5 year estimate of a PSA direction change was 95% (95% CI, 93‐97%) overall and 56% (95% CI, 51%‐61%) for PSA direction changes of ≥1 ng/mL. Conclusions We observed a high probability of variability in PSA levels for men on AS. The probability of changes in PSA, defined by an increase to specified thresholds or a rise >1ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time. Therefore, a single change in PSA level is not a reliable endpoint for men on AS. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-26T00:01:02.62584-05:0
      DOI: 10.1111/bju.13328
  • Prediction of renal mass aggressiveness using clinical and radiographic
           features: A global, multicenter prospective study
    • Authors: Shay Golan; Scott Eggener, Svetozar Subotic, Eric Barret, Luigi Cormio, Seiji Naito, Ahmet Tefekli, M. Pilar Laguna Pes
      Abstract: Objective To examine the ability of preoperative clinical characteristics to predict histological features of RMs. Materials And Methods Data from consecutive patients with clinical stage I RMs treated surgically between 2010‐2011 in the CROES Renal Mass Registry were collected. Based on surgical histology, tumors were categorized as benign, low aggressiveness cancer, and high aggressiveness cancer. Multivariate logistic regression was used to estimate the probability of the histological group by clinical and radiographic features in the entire cohort and a subcohort of cT1a tumors. The performance of the models was studied by calibration, Nagelkerke's R2, and discrimination (ROC area under the curve). A p
      PubDate: 2015-10-25T23:49:00.14641-05:0
      DOI: 10.1111/bju.13331
  • Surgimesh M‐SLING® Transobturator and Prepubic Four Arm
           Urethral Sling for Post‐Prostatectomy Stress Urinary Incontinence:
           Clinical Prospective Assessment at 24 months
    • Authors: B. Le Portz; O. Haillot, M. Brouziyne, C. Saussine
      Abstract: Objective To assess the tolerance and midterm clinical outcomes regarding the treatment of post‐prostatectomy male incontinence (PPI) with a new four arm mesh sling. Material and Methods This is a French multicentre prospective study for the treatment of PPI, which included 93 patients, subjected to radical prostatectomy at least a year before sling implantation. Data was collected preoperatively, and patients were followed at 3, 12 and 24 months post operatively. Objective outcome parameters included number of pads per day, 24h pad‐test, maximum urinary flow rate (Qmax) and urinary retention. We further analysed the Urinary Symptom Profile (USP®) score, the degree of erectile dysfunction, the patients’ satisfaction level, post‐operative pain, and procedure complications. Catheterisation and hospitalisation periods were also registered. Patients were considered cured if no protection was used and/or daily pad weight
      PubDate: 2015-10-24T09:17:15.032654-05:
      DOI: 10.1111/bju.13368
  • Trends in stage‐specific incidence of prostate cancer in Norway,
           1980‐2010: A population‐based study
    • Abstract: Objectives To estimate changes in the stage distribution of prostate cancer during the time period where opportunistic PSA‐testing was introduced. Subjects and methods Cancer stage, age and year of diagnosis were obtained for all men over the age of 50 diagnosed with prostate cancer in Norway during the period 1980‐2010. Three calendar‐time periods (1980‐1989, 1990‐2000, and 2001‐2010) and three age groups (50‐65, 66‐74, and 75+) were defined. Birth cohorts were categorized into four intervals: 1941. We used Poisson regressions to conduct both a time period and cohort‐based analysis of trends in the incidence of localised, regional and distant cancer for each combination of age groups and calendar‐time periods or birth cohorts, respectively. Additionally, we explored the effect of cohorts on the stage‐specific incidence graphically with a Poisson regression using 5‐year age groups, and by estimating cumulative incidence rates for each birth cohort. Results The annual incidence of localised cancers among men aged 50‐65 and 66‐74 rose from 41.4 and 255.2 per 100,000, respectively, before the introduction of PSA‐testing to 137.9 and 418.7 in 2001‐2010 afterwards, corresponding to 3.3 (CI: 3.1; 3.5) and 1.6 (CI: 1.6; 1.7) fold increases. The incidence of regional cancers increased by a factor seven among men aged
      PubDate: 2015-10-24T09:16:12.379626-05:
      DOI: 10.1111/bju.13364
  • Risk of thromboembolic disease in men with prostate cancer undergoing
           androgen deprivation
    • Abstract: Objectives To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT) while accounting for known TED risk factors. Materials and Methods TED risk was assessed for 42,263 PCa men on ADT compared to a matched, PCa‐free cohort of 190,930 men. Associations between ADT and deep venous thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models. Previous PCa‐related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy, were accounted for. Results Between 1997‐2013, 11,242 PCa men received anti‐androgen (AA) monotherapy, 26,959 gonadotropin‐releasing hormone (GnRH) agonists, 1,091 combined androgen blockade, and 3,789 underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men were at increased TED risk versus the comparison cohort, HR: 1.67 (95% CI: 1.40‐1.98) and 1.61 (95% CI: 1.15‐2.28), respectively. Men on AA monotherapy were at decreased risk, HR for DVT: 0.49 (95% CI: 0.33‐0.74). TED risk was highest among those who switched from AA to GnRH agonists, PE HR: 2.55 (95% CI: 1.76‐3.70). This increased from 2.52 (95% CI: 1.54‐4.12) in year one, to 4.05 (95% CI: 2.51‐6.55) in year two. Conclusion TED incidence among men on ADT increased with the duration of therapy and risk was highest for those who switched regimen, thus implicating roles for disease progression as well as ADT in propagating TED risk. Nonetheless, these findings support that only men with a relevant indication should receive systemic ADT. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-24T03:40:05.814888-05:
      DOI: 10.1111/bju.13360
  • Oral enclomiphene citrate raises testosterone and preserves sperm counts
           in obese hypogonadal men, unlike topical testosterone: restoration instead
           of replacement
    • Authors: Edward D. Kim; Andrew McCullough, Jed Kaminetsky
      Abstract: Objectives To determine the effects of daily oral doses of enclomiphene citrate compared with topical testosterone gel treatment on serum total testosterone (TT), luteinising hormone (LH), follicle‐stimulating hormone (FSH), and sperm counts in men with secondary hypogonadism. Patients and Methods Two parallel randomised, double‐blind, double‐dummy, placebo‐controlled, multicentre, phase III studies were undertaken to evaluate two doses of enclomiphene citrate vs testosterone gel (AndroGel®1.62%) on TT, LH, FSH, and sperm counts in overweight men aged 18–60 years with secondary hypogonadism. Men were screened and enrolled in the trials (ZA‐304 and ZA‐305). All enrolled men had early morning serum TT levels in the low or low normal range (≤300 ng/dL; ≤10.4 nmol/L) and had low or normal LH (
      PubDate: 2015-10-23T10:45:44.140562-05:
      DOI: 10.1111/bju.13337
  • Repeat transurethral resection for non‐muscle‐invasive bladder
           cancer: a contemporary series
    • Authors: Rasha Gendy; Warick Delprado, Phillip Brenner, Andrew Brooks, Graham Coombes, Paul Cozzi, Peter Nash, Manish I. Patel
      Abstract: Objectives To evaluate the depth of transurethral resections of bladder tumour (TURBT), residual cancer rates and up‐staging rates in a contemporary Australian series. Materials and Methods Specimen reports from a single, major reporting pathology centre, servicing a group of urological oncologists in Sydney were obtained for TURBTs performed between October 2008 and February 2013. We examined the depth of TURBT, rates of repeat‐TURBT (re‐TUR) and residual cancer rates at the 3–6 month check cystoscopy. Results One thousand and two hundred and nine transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in 151 (39.7%) of 380 high‐risk specimens (high grade Ta, T1). Of the 380 high‐risk non‐muscle‐invasive tumours, 85 (22.4%) proceeded to re‐TUR. Of the 48 T1 specimens and 37 Ta high grade specimens that proceeded to re‐TUR, 7 (14.6%) and 1 (2.7%) respectively were upstaged to muscle‐invasive disease. Rates of residual disease/early recurrence at 3–6 months was significantly better for those with re‐TUR compared to those without 56.8% vs 82.5% (P < 0.001) for Ta high grade and 39.6% vs 84% (P = 0.028) for T1 tumours respectively. Conclusion Re‐TUR rates in high‐risk non‐muscle‐invasive bladder cancer are low. However in a contemporary series, the upstaging rates are low, but residual cancer rates high, supporting the need for re‐TUR in this population.
      PubDate: 2015-10-21T01:44:11.715345-05:
      DOI: 10.1111/bju.13265
  • Trends in incidence and survival for upper tract urothelial cancer (UTUC)
           in the state of Victoria – Australia
    • Authors: Richard Woodford; Weranja Ranasinghe, Hau Choong Aw, Shomik Sengupta, Raj Persad
      Abstract: Objective To investigate the incidence and mortality trends of upper tract urothelial cancers (UTUC) in Victoria over the last decade. Patients and Methods Age‐adjusted incidence and mortality rates were calculated for UTUC. These were identified using data from the Victorian Cancer Registry from 2001 until 2011 based on histological diagnoses. Age at diagnosis, sex and demographical location were compared. Results The age‐standardised incidence of UTUC remained stable from 2001 to 2011. There were 278 deaths from UTUC over this period with an overall 5‐year survival rate of 32%. There was no significant difference in survival between 2001–06 and 2007–11 (30% vs 36%, respectively). Lower age at diagnosis was associated with a significant improvement in survival (P = 0.01). Sex and geographical location appeared to have no effect on survival. Conclusion The 5‐year survival rates for UTUC in Victoria are poor, particularly in comparison to worldwide data. In contrast to worldwide trends, the incidence of UTUC appears to be stable. No significant improvement in 5‐year survival rates over the short study period was identified. These findings highlight the difficulties in managing this rare yet deadly malignancy.
      PubDate: 2015-10-21T01:43:27.540925-05:
      DOI: 10.1111/bju.13232
  • Incidence and risk factors of venous thromboembolism after pelvic
           uro‐oncologic surgery – a single center experience
    • Authors: Emily C. Chen; Nathan Papa, Nathan Lawrentschuk, Damien Bolton, Shomik Sengupta
      Abstract: Objective To determine the incidence and assess risk factors for the development of VTE among patients undergoing major pelvic surgery for prostate and bladder cancer in an Australian tertiary referral center. Patients and Methods Consecutive patients undergoing major pelvic uro‐oncologic surgery, namely radical cystectomy and radical prostatectomy over a five‐year period (2009–2013) were identified. Patient variables and types of thromboprophylaxis (pharmacological and/or mechanical) used in this patient cohort were collected for analyses as predictive factors. Results The overall incidence of VTE was 1.8%. Patients undergoing radical cystectomy were more likely to suffer a VTE event compared to patients having radical prostatectomy. In this cohort, the risk factors for VTE include, prolonged operative time of greater than 4 hours (h), lymph node dissection (LND) and patients requiring blood transfusions. Conclusion Patients undergoing major pelvic uro‐oncologic surgery have an approximately 1.8% risk of developing VTE. Risk factors identified in this study should be used to guide the use of early and prolonged thromboprophylaxis.
      PubDate: 2015-10-21T01:43:06.684409-05:
      DOI: 10.1111/bju.13238
  • Men with a negative real‐time MRI/ultrasound‐fusion guided
           targeted biopsy but prostate cancer detection on TRUS‐guided random
           biopsy – what are the reasons for targeted biopsy failure'
    • Abstract: Objective To examine the value of additional TRUS‐guided random biopsy (RB) in patients with negative MRI/Ultrasound‐fusion guided targeted biopsy (TB) and to identify possible reasons for TB failure. Patients and Methods Subgroup analysis of 61 men with prostate cancer (PCa) detection by 10‐core RB but negative TB in a cohort of 408 men with suspicious multiparemetric MRI (mpMRI) between January 2012 and January 2015. Consensus re‐reading of mpMRI (using both PI‐RADS version 1 and version 2) of each suspicious lesion blinded to the biopsy results, followed by an un‐blinded anatomic correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. Definition of clinically significant PCa according to Epstein criteria and stratification into risk groups according to the EAU guideline. Results RB detected significant PCa in 64% (39/61) and intermediate/high risk PCa in 57% (35/61). The initial reading of mpMRI identified 90 suspicious lesions (PI‐RADS ≥3) in the cohort. Blinded consensus re‐reading of the mpMRI led to PI‐RADS score downgrading of 45 (50%) lesions and upgrading of 13 (14%) lesions. Thus negative TB could be explained by a false high initial PI‐RADS score for 32 (34%) lesions and sampling of the target lesion by RB in the corresponding anatomic site for 36 of 90 lesions (40%) in 35 of 61 (57%) patients. Sampling the target lesion by RB was most likely for lesions with PI‐RADS scores 4/5 and a Gleason score ≥7. 70 PCa lesions (67% Gleason score 6) in 44 (72%) patients were sampled from prostatic sites with no abnormalities on mpMRI. Conclusion In case of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated by positive sampling of the target lesion by the additional RB and the second reason for TB failure was a false high initial PI‐RADS score. The challenges of both MRI diagnostics and prostate lesion sampling are evident in our collective and support the integration of RB into the TB workflow. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-20T23:52:40.040317-05:
      DOI: 10.1111/bju.13327
  • Immunotherapy for Bladder Cancer: Rediscovering an Old Friend
    • Abstract: The history of bladder cancer treatment is intimately linked with the use of immunotherapy. In 1990 intravesical bacillus Calmette‐Guerin (BCG) to treat non‐muscle invasive bladder cancer (NMIBC) became the first approved cancer immunotherapy. Early in the twentieth century, Albert Calmette and Camille Guerin, developed the eponymous BCG vaccine from a strain of Mycobacterium bovis found on the udder of an infected cow. Although it was successfully developed as a tuberculosis vaccine, BCG was ineffective as a therapy in the majority of cancers (1). This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-20T23:52:11.397044-05:
      DOI: 10.1111/bju.13330
  • Abstracts of “The 38th Annual Scientific Meeting of Indonesian
           Urological Association”
    • PubDate: 2015-10-20T08:16:09.614743-05:
      DOI: 10.1111/bju.13359
  • Aquablation ‐ Image Guided Robotically‐Assisted Waterjet
           Ablation of the Prostate: Initial Clinical Experience
    • Authors: Peter Gilling; Rana Reuther, Arman Kahokehr, Mark Fraundorfer
      Abstract: Introduction This first‐in‐man study was designed to demonstrate the safety and feasibility of Aquablation. This is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam®) for the targeted and heat‐free removal of prostatic tissue in men suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Patients and Methods A prospective, non‐randomized, single‐center trial in men between the ages of 50 – 80 years of age with moderate‐to‐severe LUTS was conducted. Under real‐time image‐based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat‐free resection of the prostate using a high‐velocity saline stream. Patients were evaluated at one, three, and six months. Results Fifteen patients were treated with Aquablation under general anaesthesia. The mean age was 73 years (range of 59 to 86 years) and a mean prostate size of 54 ml (range of 27 to 85 ml). A significant median lobe was present in 6 of the 15 subjects. The mean International Prostate Symptom Score (IPSS) was 23 and peak urinary flow rate (Qmax) was 8.4 ml/s at baseline. The mean procedural time was 48 minutes with a mean Aquablation treatment time of 8 minutes. All procedures were technically successful with no serious or unexpected adverse events. All but one patient had removal of catheter on day one, and the majority of patients were discharged on the first postoperative day. No patient required a blood transfusion, and post‐operative sodium changes were negligible. No serious 30 day adverse events occurred. One patient underwent a second Aquablation treatment within ninety days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P
      PubDate: 2015-10-19T02:44:45.85447-05:0
      DOI: 10.1111/bju.13358
  • Indoor cold exposure and nocturia: a cross‐sectional analysis of the
           HEIJO‐KYO study
    • Authors: Keigo Saeki; Kenji Obayashi, Norio Kurumatani
      Abstract: Objectives To investigate the association between indoor cold exposure and the prevalence of nocturia among elderly, we conducted the present study. Subjects and methods Temperature in the living room and bedroom of 1065 home dwelling elderly volunteers (≥60 years) was measured for 48 h. Nocturia (≥2 voids per night) and nocturnal urine production were determined using an urination diary and nocturnal urine collection, respectively. Results The mean age of participants was 71.9±7.1 (standard deviation) years, and the prevalence of nocturia was 30.8%. A 1°C decrease in daytime indoor temperature was associated with higher odds ratio (OR) for nocturia (1.064, 95% confidence interval (CI) 1.016–1.114, p = 0.008), independent of outdoor temperature and other potential confounders such as basic characteristics (age, gender, body mass index, alcohol intake, smoking), comorbidities (diabetes, renal dysfunction), medications (calcium channel blocker, diuretics, sleeping pills), socioeconomic status (education, household income), nighttime dipping of ambulatory blood pressure, daytime physical activity, objectively measured sleep efficiency, and urinary melatonin excretion. The association stayed significant after adjustment for nocturnal urine production rate (OR 1.084, 95% CI 1.032–1.138, p = 0.001). Conclusions Indoor cold exposure during daytime was independently associated with nocturia among elderly participants. The mechanism is explained by cold‐induced detrusor over activity. The prevalence of nocturia could be reduced by modification of the indoor thermal environment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-19T02:23:42.060006-05:
      DOI: 10.1111/bju.13325
  • Population‐based assessment of cancer specific mortality after local
           tumour ablation or observation for kidney cancer: a competing risks
    • Authors: Alessandro Larcher; Vincent Trudeau, Maxine Sun, Katharina Boehm, Malek Meskawi, Zhe Tian, Nicola Fossati, Paolo Dell'Oglio, Umberto Capitanio, Alberto Briganti, Shahrokh F. Shariat, Francesco Montorsi, Pierre I. Karakiewicz
      Abstract: Objectives To examine the potential difference in cancer specific mortality that could distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer using competing risks regression. Patients and methods The study focused on 1860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results‐Medicare database. Propensity‐score matching was used. Cancer specific mortality (CSM) represented the study outcome. Multivariable competing risks regression analyses adjusting for other‐cause mortality as well as patient (including comorbidities) and tumour characteristics were fitted. Results Overall, fewer patients had LTA vs. OBS (30% vs. 70%; n=553 vs. n=1307). Compared to OBS patients, LTA patients were younger (median age 77 vs. 78 years; p
      PubDate: 2015-10-16T10:22:37.842208-05:
      DOI: 10.1111/bju.13326
  • Urethral atrophy after implantation of an artificial urinary sphincter:
           fact or fiction'
    • Authors: Simon Bugeja; Stella L. Ivaz, Anastasia Frost, Daniela E. Andrich, Anthony R. Mundy
      Abstract: Objectives To investigate the concept of urethral ‘atrophy’ which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (AUS); and to investigate the specific cause of the malfunction of the AUS in these patients and address their management. Patients and methods Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their AUS (AMS800™) explored for malfunction and replaced with a new device composed of exactly the same size components, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. Mean follow‐up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation including measurement of the Valsalva leak point pressure (VLPP) and the retrograde cuff occlusive pressure (RCOP). After explantation of the AUS in patients without any apparent abnormality of the device at the time of replacement the pressure generated by the explanted pressure regulating balloon (PRB) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum. Results In 31 of the 50 (62%) undergoing exploration a specific cause for the malfunction of their AUS was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low VLPP and RCOP. A typical ‘waisted’ or ‘hour‐glass’ appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the 6 patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted PRBs, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted AUS with a new device with the same size cuff and PRB in 14 of these 19 patients was successful in 12 (85.7%). Conclusion These results and other theoretical considerations suggest that recurrent incontinence, years after initially successful implantation of an AUS is because of material failure of the PRB, probably due to age, and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing or implanting a PRB with a higher pressure range or implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-12T21:24:16.681728-05:
      DOI: 10.1111/bju.13324
  • Is there a place for cytoreduction in metastatic prostate cancer'
    • Authors: Fairleigh Reeves; Anthony J. Costello
      Abstract: Cytoreductive treatment in metastatic prostate cancer (mPCa) primarily refers to local control of the primary tumour by radical prostatectomy (RP) or radiotherapy. However, extirpative treatment of limited metastatic disease by stereotactic body radiotherapy (SBRT) or surgical resection may further reduce or even possibly eliminate disease burden. This comment piece explores the theory and evidence for RP in the setting of mPCa. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-10T02:26:08.822078-05:
      DOI: 10.1111/bju.13323
  • Robotic Partial Nephrectomy with Intracorporeal Renal Hypothermia Using
           Ice Slush: Step‐by‐step Technique and matched comparison to
           warm ischemia
    • Authors: Daniel Ramirez; Peter Caputo, Jayram Krishnan, Homayoun Zargar, Jihad H. Kaouk
      Abstract: Objectives Renal hypothermia protects against effects of ischemia and permits longer pedicle clamp times during robotic partial nephrectomy (RPN). Our objective is to outline our step‐by‐step technique for intracorporeal renal cooling during RPN. Patients and materials Patient selection was performed during preoperative clinic visit. Inclusion criteria included cases where warm ischemia was estimated to be > 30 minutes during pre‐operative assessment as determined by patients with complex renal masses. Special equipment required for this procedure include an Ecolab Hush Slush machine (Microtek Medical Inc., Columbus, MS) a Mon‐a‐therm needle thermocouple device (Covidien, Mansfield, MA), and 6 modified 20 mL syringes. Patients are arranged in 60 degree modified flank position with the operative table flexed slightly at the level of the anterior superior iliac spine (ASIS). For introduction of temperature probe and ice slush, an additional 12mm trocar is placed along the mid‐axillary line beneath the costal margin. Modified 10/20 cc syringes are prefilled with ice slush for instillation via accessary trocar. Perioperative and 6 month functional outcomes were compared to a cohort of patients who underwent RPN with warm ischemia in a 2:1 matched fashion. Matching was performed based on preoperative eGFR, ischemia time and RENAL score. Results Strategies for successful intracorporeal renal cooling include: (1) placement of accessory port directly over the kidney. (2) Uniform ice consistency and modified syringes. (3) Sequential clamping of renal artery and vein. (4) Protection of the neighboring intestine with a laparoscopic sponge. (5) Complete mobilization of the kidney. Kidney temperature is monitored via needle thermocoupler device while core body temperature is concurrently monitored via esophageal probe in real time. Renal function was assessed by measuring serum creatinine, eGFR and MAG‐3 renal scan perioperatively and at 6‐month follow up. In the separate matched analysis, cold ischemia during RPN was found to be associated with a 12.9% improvement in preservation of postoperative eGFR. No difference was seen in either group at 6 month follow up. Conclusions RPN with intracorporeal renal hypothermia using ice slush is technically feasible and may improve post‐operative renal function in the short‐term. Our technique for intracorporeal hypotheramia is cost‐effective, simple and highly reproducible. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-05T05:22:46.996978-05:
      DOI: 10.1111/bju.13346
  • Diagnosing secondary hypogonadism: important consequences for fertility
           and reversibility
    • Authors: John Dean; Mario Maggi, Bert-Jan Boer, Wayne Hellstrom, Mohit Khera, Edward D Kim, Andrew McCullough, Frederick Wu, Michael Zitzmann
      Abstract: Hypogonadism (HG, testicular failure in men) has become a controversial and much misunderstood condition. Many men perceive testosterone as a panacea for the ills of ageing and “Low-T clinics” have sprung up to meet their demands, even though testosterone is often not the answer. In light of the unprecedented rise in testosterone prescriptions in recent years, particularly amongst middle-aged men, the US Food and Drug Administration (FDA) issued a Safety Communication in May 2015 intended to restrict the use of testosterone. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-11T09:16:28.472415-05:
      DOI: 10.1111/bju.13316
  • Training in minimally invasive surgery in urology EAU‐ICUD
    • Authors: Henk der Poel; Willem Brinkman, Ben Cleynenbreugel, Panagiotis Kallidonis, Jens-Uwe Stolzenburg, Evangelos Liatsikos, Kamran Ahmed, Oliver Brunckhorst, Mohammed Shamim Khan, Minh Do, Roman Ganzer, Declan G Murphy, Simon Van Rij, Philip E Dundee, Prokar Dasgupta
      Abstract: Objectives To describe the progress in training for minimal invasive surgery (MIS) in urology Methods A group of experts in the field provided input to come to recommendations for MIS training. A literature search was done on MIS training in general and specific for urological procedures. Results A literature search showed the rapidly developing options for e‐learning, box and virtual training and suggested that box training is a relatively cheap and effective means of improving laparoscopic skills. Development of non‐technical skills is an integral part of surgical skills training and should be included in training curricula. The application of modular training of surgical procedures showed more rapid skills acquiring. Training curricula for minimal invasive surgery in urology are being developed in both US and Europe. Conclusion Training in MIS has shifted from “see‐one‐do‐one‐teach‐one” to a structured learning from e‐learning to skills lab and modular training settings. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-09T11:32:39.096762-05:
      DOI: 10.1111/bju.13320
  • Pathologic gleason 8‐10: do all men do poorly' results from the
           search database
    • Authors: Sean Fischer; Daniel Lin, Ross M. Simon, Lauren Howard, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Matt R. Cooperberg, Stephen J. Freedland, Adriana C. Vidal
      Abstract: Objective To determine whether there are subsets of men with pathologic high‐grade disease (Gleason 8‐10) who have particularly high or low 2‐year BCR risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathologic features such as surgical margins (SM), extracapsular extension (ECE) and seminal vesicle invasion (SVI). Methods We identified 459 patients treated with RP with pathologic Gleason 8‐10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics – Group 1: men with negative surgical margins and no extracapsular extension (‐SM/‐ECE), Group 2 (+SM/‐ECE), Group 3 (‐SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with SVI (+SVI). Cox proportional hazards models and the log‐rank test were used to compare BCR among the groups. Results At 2‐years post‐RP, pathological group was significantly correlated with BCR (log‐rank, p
      PubDate: 2015-09-09T05:17:39.519598-05:
      DOI: 10.1111/bju.13319
  • In parallel comparative evaluation between multiparametric mri, pca3 and
           phi in predicting pathologically confirmed significant prostate cancer in
           men eligible for active surveillance
    • Authors: F Porpiglia; F Cantiello, S De Luca, M Manfredi, A Veltri, F Russo, A Sottile, R Damiano
      Abstract: Objective To assess the performance capabilities of multiparametric Magnetic Resonance Imaging (mpMRI), Prostate Health Index (PHI) and Prostate Cancer Antigen 3 gene (PCA3) in predicting the presence of pathologically confirmed significant Prostate Cancer (PCSPCa), according to the European Randomized Study of Screening Prostate Cancer (ERSPC) definition, in a same cohort of patients who underwent Radical Prostatectomy (RP) but eligible for Active Surveillance (AS). Materials and Methods An observational retrospective study was performed in 120 prostate cancer (PCa) patients treated with robot‐assisted RP but eligible for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements, respectively. In addition, all patients underwent preoperatively and after 6‐8 weeks from biopsy to mpMRI with a 1.5T scanner using a 4‐5 channel phase array coil combined with an endorectal coin. mpMRI images were assessed and diagrams depicting prostate sextants were used to designate regions of abnormalities within the prostate. Findings in the prostate were assigned to one of five categories according Prostate Imaging‐Reporting and Data System guidelines (PI‐RADS) and considered positive for PCa if final PI‐RADS was >3 and negative if ≤3. Results A pathologically confirmed reclassification was observed in 55 patients (45.8%). mpMRI demonstrated a good specificity and negative predictive value (0.61 and 0.73, respectively) for ruling out a PCSPCa compared with PHI and PCA3. On multivariate analyses and after one thousand bootstrapping resampling, the inclusion of both PHI and mpMRI significantly increased the accuracy of the base model in predicting PCSPCa. Particularly, to predict PCSPCa, the base model had an AUC of 0.71 which significantly increased by 4% with the addition of PHI (AUC=0.75; p
      PubDate: 2015-09-09T05:14:15.916936-05:
      DOI: 10.1111/bju.13318
  • To Clamp or Not to Clamp' Long‐Term Functional Outcomes for
           Elective Off‐Clamp Laparoscopic Partial Nephrectomy
    • Authors: Paras H. Shah; Arvin K. George, Daniel M. Moreira, Manaf Alom, Zhamshid Okhunov, Simpa Salami, Nikhil Waingankar, Michael J. Schwartz, Manish A. Vira, Lee Richstone, Louis R. Kavoussi
      Abstract: Objective To evaluate whether elective off‐clamp laparoscopic partial nephrectomy affords long‐term renal functional benefit compared to the on‐clamp approach. Subjects/Patients and Methods This is a retrospective review of patients who underwent elective laparoscopic partial nephrectomy between 2006 and 2011. Patients were followed longitudinally for up to 5 years. 315 patients with radiographic evidence of a solitary renal mass and normal‐appearing contralateral kidney underwent elective laparoscopic partial nephrectomy; 209 were performed on‐clamp versus 106 off‐clamp. One patient who required conversion from laparoscopic to open partial nephrectomy was excluded from the study. Additionally, 4 patients in the on‐clamp cohort who underwent subsequent radical nephrectomy for local‐regional recurrence were excluded from longitudinal functional evaluation after their procedure. The primary objective was to evaluate differences in postoperative estimated glomerular filtration rate between hilar clamping groups. Subgroup analyses were performed for patients with clamp times >30 minutes and those with baseline renal insufficiency (estimated glomerular filtration rate 0.05). Univariable and multivariable analyses did not demonstrate significant differences in postoperative estimated glomerular filtration rate between both groups among all‐comers, those with clamp times >30 min, and patients w/ baseline renal insufficiency. Risk of chronic kidney disease was not diminished by the off‐clamp approach with up to 5 years of follow‐up. Conclusions Progressive recovery of renal function after hilar clamping in the elective setting eclipses short‐term functional benefit achieved with off‐clamp laparoscopic partial nephrectomy by 6 months; no significant difference in estimated glomerular filtration rate or percent incidence of chronic kidney disease exists between on‐clamp and off‐clamp cohorts with up to 5‐year follow‐up. As such, eliminating transient ischemia during elective laparoscopic partial nephrectomy does not confer clinical benefit. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-08T07:40:24.281247-05:
      DOI: 10.1111/bju.13309
  • A Positive Family History as risk factor for Prostate Cancer in a
           Population‐based Study with organized PSA‐Screening: Results
           of the Swiss ERSPC (Aarau)
    • Abstract: Objective To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA‐screening in a population‐based study. Patients and Methods The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA‐tests every 4 years. Men reporting first‐degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA‐triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan‐Meier and Cox regression analyses were used. Results Of 4,932 attendees with a median age of 60.9 (IQR 57.6‐65.1) years, 334 (6.8%) reported a positive FH. Median follow‐up duration was 11.6 years (IQR 10.3‐13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2‐2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02‐1.06), baseline PSA (HR 1.13 95% CI 1.12‐1.14), and FH (HR 1.6, CI 1.24‐2.14) were independent predictors for overall PCa incidence (p
      PubDate: 2015-08-31T10:22:04.258927-05:
      DOI: 10.1111/bju.13310
  • Comparison of the efficacy and safety of 2 mg and 4 mg tolterodine
           combined with an α‐blocker in men with lower urinary tract
           symptoms and overactive bladder: A randomised controlled trial
    • Abstract: Objective To evaluate the efficacy and safety of low‐dose (2 mg) tolterodine extended release (ER) with an α‐blocker versus standard‐dose (4 mg) tolterodine ER with an α‐blocker for the treatment of men with residual storage symptoms after α‐blocker monotherapy. Patients and Methods This was a 12‐week, single‐blind, randomised, parallel‐group, non‐inferiority trial that included men with residual storage symptoms despite receiving at least 4 weeks of α‐blocker treatment. Inclusion criteria were total International Prostate Symptom Score (IPSS) ≥12, IPSS‐quality of life item score ≥3, and ≥8 micturitions and ≥2 urgency episodes per 24 hours. The primary outcome was change in the total IPSS score from baseline. Bladder diary variables, patient‐reported outcomes, and safety were also assessed. Results Patients were randomly assigned to addition of either 2 mg tolterodine ER (n=47) or 4 mg tolterodine ER (n=48) to α‐blocker therapy for 12 weeks. Patients in both treatment groups demonstrated significant improvement in total IPSS score (‐5.5 and ‐6.3, respectively), micturition per 24 hours (‐1.3 and ‐1.7, respectively), and nocturia per night (‐0.4 and ‐0.4, respectively). Changes in IPSS, bladder diary variables, and patient‐reported outcomes were not significantly different between the treatment groups. All interventions were well tolerated by patients. Conclusions These results suggest that 12 weeks of low‐dose tolterodine ER add‐on therapy is comparable to standard‐dose tolterodine ER add‐on therapy in terms of efficacy and safety for patients experiencing residual storage symptoms after receiving α‐blocker monotherapy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:28:22.599679-05:
      DOI: 10.1111/bju.13267
  • Budget impact of incorporating one instillation of hexaminolevulinate
           hydrochloride blue‐ light cystoscopy in trans‐urethral bladder
           tumour resection for non‐muscle invasive bladder cancer patients in
    • Abstract: Objectives To explore the cost impact on Swedish healthcare of incorporating one instillation of hexaminolevulinate hydrochloride (HAL) blue light cystoscopy into the transurethral resection of bladder tumours (TURBT) in patients with suspected new or recurrent non‐muscle invasive bladder cancer (NMIBC). Materials and Methods A decision tree model was built based on European Association of Urology guidelines for the treatment and management of NMIBC. Input data was compiled from two recent studies comparing recurrence rates of bladder cancer in patients undergoing TURBT with the current standard of care (SOC) of white light cystoscopy, or with the SOC and HAL blue light cystoscopy. Using this published data with clinical cost data for surgical and outpatient procedures and pharmaceutical costs the model reported on clinical and economic differences associated with the two treatment options. Results This model demonstrates the significant clinical benefits likely to be observed through the incorporation of HAL blue light cystoscopy for TURBT in terms of reductions in recurrences of bladder cancer. Analysis of economic outputs of the model found that the use of one instillation of HAL for TURBT in all Swedish NMIBC patients is likely to be cost neutral or cost saving over 5 years relative to the current SOC of white light cystoscopy. Conclusions The results of this analysis provide additional health economic rationale for the incorporation of a single instillation of HAL blue light cystoscopy for TURBT in the treatment of NMIBC patients in Sweden. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:19:09.098462-05:
      DOI: 10.1111/bju.13261
  • Prostate Biopsy Decisions: One Size Fits All Approach with Total PSA is
           Out and a Multivariable Approach with the Prostate Health Index is In
    • Authors: Stacy Loeb
      Abstract: The days of using one PSA threshold to trigger a biopsy for all men are over, and the field has moved toward a more individualized approach to prostate biopsy decisions taking into account each patient's specific set of risk factors. Foley et al. provide compelling evidence supporting the use of the Prostate Health Index (phi) as part of this multivariable approach to prostate biopsy decisions.[1] There is now a large body of evidence showing that phi is more specific for prostate cancer than total PSA and percent free PSA, as was concluded in a 2014 systematic review.[2] This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:24:59.659737-05:
      DOI: 10.1111/bju.13195
  • Knowledge, Attitudes and Beliefs towards Management of Men with Locally
           Advanced Prostate Cancer following Radical Prostatectomy: An Australian
           Survey of Urologists
    • Authors: Bernadette (Bea) Brown; Jane Young, Andrew B Kneebone, Andrew J Brooks, Amanda Dominello, Mary Haines
      Abstract: Objective To investigate Australian urologists’ knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline‐recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methods A nationwide mailed and web‐based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results 157 surveys were included in the analysis (45% response rate). Just over half of respondents (57%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists’ attitudes and beliefs towards the specific recommendation for post‐operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = .520, p
      PubDate: 2015-01-14T03:53:29.770426-05:
      DOI: 10.1111/bju.13037
  • Admissions to hospital due to fracture in England in prostate cancer
           patients treated with Androgen Deprivation Therapy (ADT) – do we
           have to worry about the hormones'
    • Abstract: Objective To investigate the relationship effect of androgen deprivation therapy (ADT) and fracture in men in the UK. Patients and Methods Using the Hospital Episodes Statistics (HES) database for years 2004 to 2008 that contains all the information about NHS and NHS‐funded hospital admissions in England ‐ 8,902 patients were found to have had prostate cancer and an admission to hospital with a fracture in 2004 to 2008. Of these 3,372 (37.8%) were flagged as being treated with ADT, whilst there were 5,530 (62.2%) admissions in the non ADT group (table 1). There were a total number of 228,852 admissions in the background population. Results The risk of a fracture requiring hospitalisation increases from 1.12 to 1.41 per 100 person years when a man is treated with ADT with prostate cancer than without – an absolute increase of only 0.29 per 100 person years. When compared to the background population, there is an increase from 0.58 per 100 person years in the background population to 1.41 – a relative rate ratio increase of 2.4 (p
  • The ERSPC Risk Calculators Significantly Outperform The PCPT 2.0 In The
           Prediction Of Prostate Cancer; A Multi‐Institutional Study
    • Abstract: Introduction To analyse the performance of the Prostate Cancer Prevention Trial Risk Calculator (PCPT‐RC) and two iterations of the European Randomised Study of Screening for Prostate Cancer Risk Calculator (ERSPC‐RC), one of which incorporates prostate volume and another which incorporates prostate volume and the Prostate Health Index (ERSPC‐PHI) in a referral population. Methods The risk of prostate cancer (PCa) and significant PCa (Gleason ≥7) in 2,001 patients from 6 tertiary referral centres was calculated according to the PCPT‐RC and ERSPC‐RC formulae. The calculators’ predictions were analysed using the area under the receiver operating characteristics curve (AUC), calibration plots, Hosmer‐Lemeshow test for goodness of fit and decision curve analysis. In a subset of 222 patients for whom the Prostate Health Index (PHI) score was available, each patient's risk was calculated as per the ERSPC‐RC and ERSPC‐PHI risk calculator. Results The ERSPC‐RC outperformed the PCPT‐RC in the prediction of PCa, with an AUC of 0.71 compared to 0.64 and also outperformed the PCPT‐RC in the prediction of significant PCa (p
  • The impact of the 2005 International Society of Urological Pathology
           consensus guidelines on Gleason grading – a matched pair analysis
    • Abstract: Objectives To investigate whether the International Society of Urological Pathology (ISUP) 2005 revision of the Gleason grading system has influenced the risk of biochemical recurrence (BR) after radical prostatectomy (RP), as the new guideline implies that some prostate cancers (PCa) previously graded as Gleason score (GS) 6 (3+3) are now considered as GS 7 (3+4). Patients and methods A matched pair analysis was conducted. Two‐hundred‐and‐fifteen patients with GS 6 or GS 7 (3+4) PCa on biopsies who underwent RP prior to December 31st, 2005 (pre‐ISUP group), were matched 1:1 by biopsy GS, clinical tumour category, PSA, and margin status to patients undergoing RP between January 1st, 2008 and December 31st, 2011 (post‐ISUP group). Patients were followed until BR defined as PSA ≥0.2 ng/ml. Risk of BR was analysed in a competing risk model. Results Median follow‐up was 9.5 years in the pre‐ISUP group and 4.8 years in the post‐ISUP group. The 5‐year cumulative incidences of BR were 34.0% and 13.9% (p
  • Diffusion‐weighted Imaging (DWI) Predicts Upgrading of Gleason Score
           in Biopsy‐proven Low‐grade Prostate Cancers
    • Abstract: Objective To analyze whether diffusion‐weighted imaging (DWI) predicts Gleason score (GS) upgrading in biopsy‐proven low‐grade prostate cancers. Patients and Methods A total of 132 patients who have biopsy‐proven low‐grade (GS< 7) prostate cancers, 3T DWI, and surgical confirmation were retrospectively included. Clinical [prostate‐specific antigen, greatest percentage of biopsy core, and percentage of positive core number] and DWI parameters [minimum apparent diffusion coefficient (ADCmin) and mean ADC (ADCmean)] were evaluated. ADCmin was measured using a region‐of‐interest of 5‐10 mm2 at the area of lowest ADC value within a cancer, while ADCmean was measured using a region‐of‐interest covering more than half of a cancer by two independent, blinded readers, respectively. Logistic regression and receiver operating‐characteristic curve analyses were performed. Results The rate of GS upgrading was 46.1% (61/132). In both univariate and multivariate analyses, ADCmin and ADCmean were persistently significant for predicting GS upgrading (p< 0.05), whereas clinical parameters were not (p> 0.05). In both readers, the area of under curve (AUC) of ADCmin was significantly greater than that of ADCmean (AUCs of reader 1, 0.760 versus 0.711, p< 0.001; AUCs of reader 2, 0.752 versus 0.714, p= 0.003). Conclusion DWI may predict GS upgrading of biopsy‐proven low‐grade prostate cancers. The use of cancer ADCmin may allow better performance than ADCmean. This article is protected by copyright. All rights reserved.
  • Testosterone Modulates Endothelial Progenitor Cells in Rat Corpus
    • Abstract: Objectives To investigate the effects of testosterone on cavernosal endothelial progenitor cells (EPCs) in a castrated rat model. Methods Forty‐five male Sprague–Dawley rats (12 weeks old) were divided into control, surgical castration, and castration with testosterone replacement groups. The rats were castrated under ketamine anesthesia, and testosterone was administered by daily subcutaneous injection of 3 mg/kg testosterone propionate. The corpus cavernosum was obtained after perfusion with 10 mL saline via the abdominal aorta 4 weeks later. The expression of EPC‐specific markers [CD34, Flk1, and vascular endothelial (VE)‐cadherin] was evaluated by flow cytometry analysis and immunofluorescence staining. Results CD34+/Flk1+ and CD34+/VE‐cadherin+ cells were detected in the cavernosal sinusoidal endothelial space. Flow cytometry analysis showed that CD34 and Flk1 double positive cells (EPCs) made up about 3.79% of the corpus cavernosum in normal rats. The percentage of EPC marker positive cells decreased significantly in the castration group (2.8%; p
  • The incidence and sequela of lymphocele formation after
           robot‐assisted extended pelvic lymph node dissection
    • Abstract: Objective To reveal an accurate incidence of lymphocele formation and its sequela following robot‐assisted radical prostatectomy and extended lymph node dissection (eLND) in a contemporary prostate cancer cohort. Patients and Method Consecutive patients who underwent radical prostatectomy and eLND with robot‐assistance and had a minimum follow‐up of 3 months were included. All surgeries were performed by one surgeon through a transperitoneal approach, with patients uniformly receiving low molecular weight heparin. Patients were followed with serial ultrasound imagings based on a predetermined schedule for lymphocele surveillance. Incidence and sequela of lymphoceles were retrospectively assessed. Results A total of 521 patients were analyzed. Follow‐up after surgery was 33.5 ± 22.8 months. Lymphocele developed in 9% and became symptomatic in 2.5%. All except one were detected on 1st month imaging; however, 76% regressed at 3‐month ultrasound. If lymphocele persisted at 3 months, 64% developed symptoms associated with infection and required drainage. Having diabetes mellitus was significantly associated with a higher risk of developing infected lymphocele. Other symptoms related to lymphocele were rare. Comparisons of patient characteristics between patients with and without lymphoceles did not demonstrate any significant prognostic indicators to predict the occurrence of lymphocele in neither univariate nor multivariate analysis in the present cohort. Conclusion The incidence of symptomatic lymphocele after robot‐assisted transperitoneal radical prostatectomy and eLND is rare. Obtaining an US imaging at 3 months after surgery seems feasible. Once a lymphocele is detected on 3 monthly US, discussing percutaneous external drainage with the patient appears to be wise, since it may prevent the development of symptomatic lymphocele in 2/3 of the patients. This article is protected by copyright. All rights reserved.
  • Ambulatory Movements, Team Dynamics and Interactions during
           Robot‐Assisted Surgery
    • Abstract: Objective To analyze ambulatory movements and team dynamics during robot‐assisted surgery (RAS), and investigate whether congestion of the physical space associated with RA technology led to workflow challenges, or predisposed to errors and adverse events. Methods With IRB approval, we retrospectively reviewed 10 recorded RA radical prostatectomies in a single operating room (OR). OR was divided into 8 zones, and all movement were tracked and described in terms of start and end zones, duration, personnel, and purpose. Movement were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). Results Mean operative time was 166 minutes, of which ambulation constituted 27 minutes (16%). A total of 2,896 ambulatory movements were identified (mean=290 ambulatory movements/procedure). Most of movements were procedure‐related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR (Figure 1); the heaviest traffic was between the Circulating Nurse Zone, Transit Zone and Supply‐1 Zone.Fifty percent of ambulatory movements were found to be avoidable. Conclusion More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence‐based OR layout that enhances access, workflow and patient safety. This article is protected by copyright. All rights reserved.
  • Risk of prostate cancer specific death in men with baseline metabolic
           aberrations treated with androgen deprivation therapy for biochemical
    • Abstract: Objectives To investigate the association of host metabolic factors and the metabolic syndrome on prostate cancer specific death (PCSD) and overall survival (OS) in patients treated with androgen deprivation therapy (ADT) for biochemically recurrent disease. Patients and Methods The analysis included 273 prostate cancer patients treated with ADT for rising PSA after surgery or radiotherapy. Patients were assessed for the presence of diabetes, hypertension, dyslipidaemia, and obesity prior to the commencement of ADT and using ATPIII criteria for the presence of the composite diagnosis of metabolic syndrome (MS). Competing risks regression model assessed associations of time to PCSD with the metabolic conditions, while multivariable Cox regression model assessed associations of OS with MS and metabolic conditions. Results During a median follow‐up of 11.6 years, 157 (58%) patients died, of which 58 (21%) died of prostate cancer. At the start of ADT the median age was 74 (range=46, 92) years, the median PSA was 3.0 ng/mL. MS were observed in 31% patients; hypertension (68%) and dyslipidaemia (47%) were the most common metabolic conditions. No association of PCSD and MS status was observed. Patients with hypertension tended to have a higher cumulative incidence of PCSD compared to those without hypertension (sub‐distribution hazards ratio HR=1.59 (95%CI 0.89, 2.84; p‐value=0·11) though not statistically significant. Patients with MS had an increased risk of death from all causes (HR=1.56, 95%CI: 1.07, 2.29; p=0.02) when compared with patients without MS; as did patients with hypertension (HR=1·72, 95% CI: 1·18‐2·49; p=0·004). Conclusions No association of prostate cancer specific death and metabolic syndrome was observed in this cohort of men receiving ADT for biochemically recurrent prostate cancer. Patients with MS were associated with an increased risk of death from all causes and a similar effect was also observed for prostate cancer patients with hypertension alone. This article is protected by copyright. All rights reserved.
  • Radiographic Size of Retroperitoneal Lymph Nodes Predicts Pathologic Nodal
           Involvement for Patients with Renal Cell Carcinoma: Development of a Risk
           Prediction Model
    • Abstract: Objectives To evaluate the ability of clinical and radiographic features to predict lymph node (pN1) disease among patients with renal cell carcinoma (RCC) undergoing nephrectomy, and to develop a preoperative risk prediction model. Patients and Methods 220 patients with preoperative computed tomography (CT) scans available for review underwent radical nephrectomy with lymph node dissection (LND) from 2000‐2010. Radiographic features were assessed by one genitourinary radiologist blinded to pN status. Associations of features with pN1 disease were evaluated using logistic regression to develop predictive models. Model performance was assessed using AUC and decision curve analysis. Results Median lymph node yield was 10 (IQR 5‐18). Fifty‐five (25%) patients had pN1 disease at nephrectomy. On univariable analysis, maximum lymph node (LN) short axis diameter (OR 1.17; p
  • Prostate specific antigen patterns in US and European populations:
           comparison of six diverse cohorts
    • Abstract: Objective To determine whether there are differences in prostate specific antigen (PSA) at diagnosis or changes in PSA between US and European populations of men with and without prostate cancer. Subjects and methods Repeated measures of PSA from six clinically and geographically diverse patient cohorts: two cohorts of men with PSA‐detected prostate cancer, two cohorts with clinically‐detected prostate cancer and two cohorts of men without prostate cancer. Using multilevel models, average PSA at diagnosis and PSA change over time were compared between populations. Results Annual percentage PSA change of 4‐5% was similar between men without cancer and men with PSA‐detected cancer. PSA at diagnosis was 1.7ng/ml lower in a US cohort of PSA‐detected men (95% CI 1.3‐2.0ng/ml), compared to a PSA‐detected UK cohort, but there was no evidence for a different rate of PSA change between these populations. Conclusion PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without prostate cancer. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies. This article is protected by copyright. All rights reserved.
  • Accurately Determining Patients Who Underwent Robot‐Assisted
           Surgery: Limitations Of Administrative Databases
    • Abstract: The comparative effectiveness of open vs. robot‐assisted radical prostatectomy for prostate cancer remains a controversial debate in urology. Its evaluation has largely relied on observational studies using administrative claims. In this report, we compare the accuracy of ICD‐9 procedure codes vs. an itemized charge description methodology before and after the introduction of an ICD‐9 code specifically identifying RARP in October 2008. We find that prior to 2008, charge description and ICD‐9 procedures codes were poorly correlated, whereas after 2008, they were highly correlated. These findings call for a cautious interpretation of comparative effectiveness studies of ORP vs. RARP relying on ICD‐9 procedures codes, particularly before October 2008. This article is protected by copyright. All rights reserved.
  • Predictive Value of Negative 3T Multiparametric Prostate MRI on 12 Core
           Biopsy Results
    • Abstract: Objectives To evaluate the cancer detection rates (CDR) for men undergoing 12 core systematic prostate biopsy with negative prebiopsy mpMRI (NegMR). Materials & Methods Clinical data from consecutive men undergoing prostate biopsy with prebiopsy 3T mpMRI from December 2011 to August 2014 were reviewed from an IRB approved prospective database. Prebiopsy mpMRI was read by a single radiologist and men with NegMR prior to biopsy were identified for this analysis. Clinical features, CDR, and NPV rates were summarized. Results Seventy five men underwent SPB with a NegMRI during the study period. For the entire cohort, men with no prior biopsy, men with prior negative biopsy, and men enrolled in active surveillance protocols, overall CDR was 18.7%, 13.8%, 8.0% and 38.1%, respectively, and detection of Gleason sum ≥ 7 (GS≥7) cancer was 1.3%, 0%, 4.0% and 0%, respectively. The NPV for all cancers was 81.3%, 86.2%, 92.0%, and 61.9%, and for GS≥7 cancer was 98.7%, 100%, 96.0% and 100%, respectively. Conclusions Negative prebiopsy mpMRI confers an overall NPV of 82% on 12 core biopsy for all cancer and 98% for GS≥7. Based upon biopsy indication, these findings assist in prebiopsy risk stratification for detection of high risk disease and may provide guidance in the decision to pursue biopsy. This article is protected by copyright. All rights reserved.
  • Phase II study of dual phosphoinositol‐3‐kinase (PI3K) and
           mammalian target of rapamycin (mTOR) inhibitor BEZ235 in patients with
           locally advanced or metastatic transitional cell carcinoma (TCC)
    • Abstract: Background Excessive activation of the PI3K/Akt/mTOR pathway is frequently observed in transitional cell carcinoma (TCC) due to a loss of PTEN and/or activating mutation of PIK3CA. Allosteric mTOR inhibition by everolimus resulted in modest efficacy in advanced TCC. In different TCC cell lines, it has been shown that PI3K inhibition enhanced the efficacy of mTOR inhibitors with a synergistic effect observed mainly in cells with PI3K/Akt/mTOR pathway alterations. Objectives To assess in a multicenter phase II trial the safety and efficacy of BEZ235, an oral pan‐class I PI3K and mTOR complex1/2 inhibitor, in locally advanced or metastatic TCC after failure of platinum‐based therapy. Patients and methods Patients with locally advanced or metastatic TCC progressing after platinum therapy were prospectively stratified by PI3K/Akt/mTOR pathway alterations, defined as PTEN loss and PIK3CA mutation. All received BEZ235 until progressive disease (PD) or unacceptable toxicity. The primary endpoint was the progression free survival (PFS) rate at 16 weeks. This study was, however, closed prematurely due to BEZ235 being withdrawn from further development. Results Twenty patients (18 without and two with PI3K/Akt/mTOR alterations) were enrolled and received BEZ235. One partial response (5%) and two cases of stable disease (10%) were observed, all in patients without PI3K/mTOR pathway alterations. The PFS rate at 8 and 16 weeks was 15% and 10%, respectively; the median PFS was 62 days (95% confidence interval (CI) 53 ‐ 110 days; range 38 ‐ 588 days) and the median OS was 127 days (95% CI 58 ‐ 309 days; range 41 ‐ 734 days). Among the 90% of patients who presented with any grade drug‐related adverse events, 50% presented with grade 3 ‐ 4 adverse events including stomatitis (15%), fatigue (5%), nausea (5%), diarrhea (5%), renal failure (5%), cutaneous rash (5%), hepatotoxicity (5%) and hypertension (5%), Conclusions BEZ235 showed modest clinical activity and an unfavorable toxicity in patients with advanced and pretreated TCC. However, a minority of patients presented clinical benefit, suggesting that a complete blockade of the PI3K/ mTOR axis could improve outcome in some specific patients. Furthermore, this study showed that molecular stratification of patients for personalized medicine before treatment is feasible. This article is protected by copyright. All rights reserved.
  • A prospective study of the short‐term quality of life outcomes of
           patients undergoing transperineal prostate biopsy
    • Abstract: A prospective, observational study to investigate whether transperineal prostate biopsy (TPbx) results in patient‐reported quality of life changes from baseline in the first three‐months after the procedure. Patients and methods Consenting patients completed the Expanded Prostate cancer Index Composite (EPIC‐26), the Sexual Health Inventory for Men (SHIM), the International Prostate Symptom Score (IPSS), the Generalised Anxiety Disorder (GAD‐7), the Patient Health Questionnaire (PHQ‐9) and a global question about willingness to have a repeat TPbx in a years’ time. The instruments were scored using published scoring methods. Wilcoxon signed ranks tests and Mann‐Whitney U tests were used to investigate statistically significant differences. Clinically significant differences were also investigated defined by published minimal important differences for the EPIC and changes in established categorical groups for the other instruments. Results Fifty‐three participants consented to participate and completed the baseline questionnaire in addition to at least one of the 1‐ or 3‐month follow‐up questionnaires. We found that most patients having a TPbx had no clinically significant change in quality of life in the first three months following the procedure. However, 24% exhibited clinically worse urinary function and 18% had worse sexual function at one‐month. At three‐months, 3% of patients had clinically worse urinary function and 25% continued to have worse sexual function compared with baseline. Patients who were subsequently diagnosed with cancer on the basis of the results of the TPbx exhibited statistically significantly reduced quality of life for the EPIC urinary scales and reduced improvements in scores on the psychological scales at one‐month follow‐up compared with those who were not diagnosed with cancer. Conclusions Most patients having a TPbx had no clinically significant change in quality of life in the first three months following the procedure. However, patients should be advised that a quarter may have clinically worse urinary function and nearly 20% have clinically worse sexual function in the first month and that sexual function deficits may continue up to three‐months. The results of this study provide a resource that the clinician can use when discussing TPbx with patients. This article is protected by copyright. All rights reserved.
  • Prevalence of the HOXB13 G84E mutation in Danish men treated by radical
           prostatectomy and correlations with prostate cancer risk and
    • Abstract: Objective To determine the prevalence of the HOXB13 G84E mutation (rs138213197) in Danish men with/without prostate cancer (PC) and to investigate possible correlations between HOXB13 mutation status and clinicopathological parameters associated with tumor aggressiveness. Materials and methods Case‐control study including 995 men with PC (cases) who underwent radical prostatectomy (RP) between 1997 and 2011 at the Department of Urology, Aarhus University Hospital, Denmark. As controls, we used 1622 healthy male controls with normal prostate specific antigen (PSA) level. Results The HOXB13 G84E mutation was identified in 0.49% of controls and in 2.51% of PC cases. The mutation was associated with a 5.12‐fold increased relative risk of PC (95% confidence interval [CI]=2.26‐13.38; p=13×10‐6). Furthermore, carriers of the risk allele were significantly more likely to have a higher PSA level at diagnosis (mean 19.9 vs. 13.6 ng/ml; p=0.032), pathological Gleason score ≥7 (83.3% vs. 60.9%; p =0.032), and positive surgical margins (56.0% vs. 28.5%; p=0.006) than non‐carriers. Risk allele carriers were also more likely to have aggressive disease (54.2% vs. 28.6%; p=0.011), as defined by preoperative PSA ≥20 ng/ml, pathological Gleason score ≥ (4+3) and/or presence of regional/distant disease. At 70 months mean follow‐up, we found no significant association between HOXB13 mutation status and biochemical recurrence in this RP cohort. Conclusion This is the first study to investigate the HOXB13 G84E mutation in Danish males. The mutation was detected in 0.49% of controls and in 2.51% of cases, and was associated with 5.12‐fold increased relative risk of being diagnosed with PC. In our RP cohort, HOXB13 mutation carriers were more likely to develop aggressive PC. Further studies are needed to assess the potential of HOXB13 for future targeted screening approaches. This article is protected by copyright. All rights reserved.
  • Plasma fibrinogen level: An independent prognostic factor for
           disease‐free survival and cancer‐specific survival in patients
           with localized renal cell carcinoma
    • Abstract: Objectives To investigate the impact of perioperative plasma fibrinogen level as a biomarker of oncological outcome in localized renal cell carcinoma (RCC). Methods We consecutively identified 601 localized RCC patients who underwent curative surgery at a single institution. Subsequent disease recurrence and cancer‐specific survival were assessed using the Kaplan–Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, multivariate analysis was performed for these outcomes. Results Using the defined cut‐off level of preoperative plasma fibrinogen ≥420 mg/dL as elevated, we found 56 patients (9.3%) with an elevated plasma fibrinogen level preoperatively. In Kaplan–Meier analysis, there was a significant difference in disease‐free and cancer‐specific survival rates between patients with and without preoperative plasma fibrinogen levels ≥420 mg/dL. Multivariate analysis showed that elevated preoperative plasma fibrinogen level was an independent predictor of subsequent disease recurrence and cancer‐specific mortality. In a subgroup analysis of the elevated preoperative plasma fibrinogen level group, postoperative normalization of plasma fibrinogen level was significantly associated with cancer‐specific survival, showing that patients with non‐normalized plasma fibrinogen levels tended to have a higher incidence of cancer‐specific mortality after surgery. Conclusion Patients with elevated preoperative plasma fibrinogen levels could be significantly predicted to have subsequent tumor metastasis and cancer‐specific mortality, while there was a significant difference in cancer‐specific survival between patients in the normalized and non‐normalized postoperative plasma fibrinogen groups. While these are hypothesis generating results, plasma fibrinogen levels may be a useful biomarker, due to its low cost and ease of assessment. This article is protected by copyright. All rights reserved.
  • Endogenous and exogenous testosterone and the risk of prostate cancer and
           increased prostate specific antigen (PSA): a meta‐analysis
    • Abstract: Objective To review and quantify the association between endogenous and exogenous testosterone and prostate specific antigen (PSA) and prostate cancer. Methods Literature searches were performed following the PRISMA guidelines. Prospective cohort studies that reported data on the associations between endogenous testosterone and prostate cancer, and placebo controlled randomised trials of testosterone replacement therapy (TRT) that reported data on PSA and/or prostate cancer cases were retained. Meta‐analyses were performed using random‐effects models with tests for publication bias and heterogeneity. Results Twenty estimates were included in a meta‐analysis which produced a summary relative risk of prostate cancer for an increase of 5 nmol/L of testosterone of 0.99 (95% CI (0.96, 1.02)) without heterogeneity (I² = 0%). Based on 26 trials, the overall difference in PSA levels following onset of use of TRT was 0.10 ng/mL (‐0.28, 0.48). Results were similar when conducting heterogeneity analyses by mode of administration, region, age at baseline, baseline testosterone, trial duration, type of patients and type of testosterone replacement therapy. The summary relative risk of prostate cancer as an adverse effect from 11 TRT trials was 0.87 (0.30; 2.50). Results were consistent across studies. Conclusions Prostate cancer appears to be unrelated to endogenous testosterone levels. Testosterone replacement therapy for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. The current data are reassuring although some care is essential until multiple studies with longer follow‐up are available. This article is protected by copyright. All rights reserved.
  • Percutaneous Nephrolithotomy for Staghorn Stones: A Randomized Trial
           Comparing High Power Holmium Laser versus Ultrasonic Lithotripsy
    • Abstract: Objective To compare high power holmium Laser lithotripsy (HP‐HLL) and ultrasonic lithotripsy (US‐L) in disintegration of staghorn stones during percutaneous nephrolithotomy (PNL). Patients and Methods A non‐inferiority randomized controlled trial was conducted between August 2011 and September 2014. Inclusion criteria were patients’ age >18 years who had complete staghorn stones (branching to the three major calyces) without contraindications to PNL. Eligible patients were randomized between 2 groups (HP‐HLL and US‐L). A Standard PNL in prone position was performed for all patients. The only difference between treatment groups was method of stone disintegration. In the first group, Laser power of 40‐60 Watt (2 Joules, 20‐30 Hertz) was used to pulverize the staghorn stone into very small fragments that can pass through the Amplatz sheath with the irrigation fluid. Ultrasonic lithotripsy with suction of the fragments was used in the second group. The primary outcome (stone‐free rate) was evaluated with non‐contrast CT after 3 months. Secondary outcomes; complication, blood transfusion, operative time and haemoglobin deficit were compared. Outcome assessor was blinded to the treatment arm. Results The study included 70 patients (35 in each group). The base line characters (age, sex, BMI, side, stone volume and density) and operative technique (number, size of tracts and need for second PNL session) were comparable for both groups. Operative time was significantly shorter in US‐L (130+34 versus 148.7+35 minutes, P=0.028). Mean hemoglobin deficit was significantly more with US‐L (1.7+0.9 versus 1.3+0.6, P=0.037). The differences in blood transfusion (17% in US‐L versus 11% for HP‐HLL) and the complication rates (34% US‐L versus 23% HP‐HLL) were not significant (P=0.495 and 0.290 respectively). The stone‐free rates at 3 months were comparable (60% for US‐L and 66% for HPL‐L, P=0.621). Conclusions Compared with US‐L for intracorporeal lithotripsy of staghorn stone during PNL, HP‐HLL showed comparable safety and efficacy with lower hemoglobin deficit but longer operative time. This article is protected by copyright. All rights reserved.
  • MicroRNA‐30a as a prognostic factor in Urothelial Carcinoma of
           Bladder inhibits cellular malignancy by antagonizing Notch1
    • Abstract: Objective To explore the relation between miR‐30a and Notch1 and to evaluate the potential prognostic role of miR‐30a in invasive urothelial carcinoma of bladder (UCB). Patients and methods Fifty invasive urothelial carcinoma of bladder (UCB) tissue specimens, along with the adjacent bladder tissue specimens were obtained and clinical parameters of the fifty patients were analyzed. Bioinformatics analysis was performed and microRNA‐30a (miRNA‐30a/ miR‐30a) was selected as a potential miRNA targeting Notch1 and luciferase assay was performed to verify the binding site between miR‐30a and Notch1. Quantitative real‐time PCR (qRT‐PCR) was conducted to assess the RNA expressions of miR‐30a and Notch1, while western blotting and immunohistochemical staining were carried out to assess the protein expression of Notch1. Finally, cell proliferation, cell cycle, cell migration and invasion assays were conducted to evaluate the cellular effects of miR‐30a and Notch1 on UCB cell lines T24 and 5637. Results MiR‐30a was downregulated in tumour tissues when compared with adjacent bladder tissues (P
  • Phase II Trial of Docetaxel, Bevacizumab, Lenalidomide, and Prednisone in
           Patients With Metastatic Castration‐Resistant Prostate Cancer
    • Abstract: Objective To determine the safety and clinical efficacy of two anti‐angiogenic agents, bevacizumab and lenalidomide, with docetaxel and prednisone. Preclinical data have demonstrated the importance of angiogenesis in prostate cancer, but previous clinical trials using angiogenesis inhibitors in combination with docetaxel have not established clinical benefit. The use of multiple anti‐angiogenic therapies together may suppress resistance mechanisms and optimize this therapeutic strategy. Subjects and Methods Eligible patients with metastatic castration‐resistant prostate cancer enrolled in this open label, phase II study of lenalidomide with bevacizumab (15 mg/kg), docetaxel (75 mg/m2) and prednisone (10mg daily). Docetaxel and bevacizumab were administered on day 1 of a 3‐week treatment cycle. To establish safety, lenalidomide dosing in this combination was escalated in a conventional 3+3 design (15, 20 and 25mg daily for two weeks followed by one week off). Patients received supportive measures including prophylactic pegfilgrastim and enoxaparin. The primary objectives were safety and clinical efficacy. Results Sixty‐three patients enrolled in this trial. Toxicities were manageable with most common adverse events being hematologic ascertained by weekly blood counts. Twenty‐nine patients (46%) had grade 4 neutropenia, 20 (32%) had grade 3 anemia and 7 (11%) had grade 3 thrombocytopenia. Despite frequent neutropenia, serious infections were rare. Other common non‐hematologic grade 3 adverse events include fatigue (10%) and diarrhea (10%). Grade 2 adverse events in >10% of patients included anorexia, weight loss, constipation, osteonecrosis of the jaw, rash and dyspnea. Of 61 evaluable patients, 57 (93%), 55(90%), and 33(54%) had PSA declines >30%, >50%, and >90% respectively. Twenty‐four of 29 patients (86%) had a confirmed radiographic partial response. The median time to progression and overall survival were 18.2 and 24.6 months, respectively. Conclusion With appropriate supportive measures, combination angiogenesis inhibition can be safely administered and potentially provide clinical benefit. This hypothesis generating data would require randomized trials to confirm these findings. This article is protected by copyright. All rights reserved.
  • Hypospadias Repair with Onlay Preputial Graft: A 25‐year experience
           with long‐term follow‐up
    • Abstract: Objective To evaluate the long‐term outcomes of hypospadias repair utilizing an onlay preputial graft. Material and Methods Patient records from 1989‐2013 were retrospectively reviewed. A single surgeon performed all cases and surgical technique was the same for all patients. Results There were 62 patients in the cohort and average follow‐up was 47.4 (range 1‐185) months. The meatal location was separated into distal (1 patient), midshaft (19) and proximal (42). A total of 22 (35.5%) patients experienced complications. There were three main types of complications, including meatal stenosis in 3 (4.8%), stricture in 3 (4.8%) and fistula in 21 (33.9%). The average timing of presentation with a complication after surgery was 24.9 (range 1‐127) months. 54.5% of the patients with complications presented 12 months or more after the initial surgery and 31.8% of the patients with complications presented 3 or more years from the surgical date. On univariable analysis age at the time of surgery, length of the graft, presence of chordee or meatal location (proximal or midshaft) did not predict a complication. The width of the graft was associated with a complication, with each 1 mm increase in width decreasing the odds of a complication by 56%. On multivariable analysis width remained statistically significant (OR 0.44, 95%CI 0.230‐0.840, p=0.013) for predicting a complication. Conclusion Hypospadias repair with onlay preputial graft is an option for single stage repair, especially in cases of proximal hypospadias or where the urethral plate width and/or the glanular groove is insufficient for other types of repair. Compared to flaps, the use of grafts may decrease the risk of penile torsion and prevent less bulk around the urethra, improving skin and glans closure. This article is protected by copyright. All rights reserved.
  • Complications after prostate biopsies in men on active surveillance and
           its effect on receiving further biopsies in the Prostate cancer Research
           International: Active Surveillance (PRIAS) study
    • Abstract: Objective To study the risk of serial prostate biopsies on complications in men on active surveillance and determine the effect of complications on receiving further biopsies. Materials and methods In the global Prostate cancer Research International: Active Surveillance (PRIAS) study men are prospectively followed on active surveillance and repeat prostate biopsies are scheduled 1, 4, and 7 years after the diagnostic biopsy, or once yearly if PSA‐doubling time (PSA‐DT) is
  • Multicenter outcomes of robotic partial nephrectomy after major open
           abdominal surgery
    • Abstract: Objective To evaluate the outcomes of RPN after major prior abdominal surgery (PAS) using a large multicenter database. Methods We identified 1686 RPN from five academic centers between 2006 and 2014. A total of 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared to the 1470 patients who had no major PAS. The Chi squared test and Mann Whitney U test were used for categorical and continuous variables, respectively. Results There was no statistically significant difference in Charlson comorbidity index, tumor size, RENAL score or pre‐operative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index (BMI) were higher in patients with PAS. The prior abdominal surgery group had a higher EBL but this did not lead to a higher transfusion rate. A retroperitoneal approach was utilized more often in patients with major PAS (11.2% vs. 5.4%), although this group did not have a higher percentage of posterior tumors (38.8% vs. 43.3%, p =0.286) Operative time, warm ischemia time, length of stay, positive surgical margin, percent change in eGFR and perioperative complications were not significantly different between the two groups. Conclusions Robotic partial nephrectomy in patients with major PAS is safe and feasible with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach. This article is protected by copyright. All rights reserved.
  • Do stones still kill' An analysis of death from stone disease 1999 to
           2013 in England and Wales
    • Abstract: Objective To analyse the trends in the number of deaths attributable to urolithiasis in England and Wales over the past 15 years (1999‐2003). Introduction Urolithiasis has an estimated lifetime risk of 12% in males and 6% in females. It is not perceived as a life‐threatening pathology. Admissions with urinary calculi contribute to 0.5% of all inpatient hospital stays. The number of deaths attributable to stone disease has yet to be identified and presented. Methods Office of National Statistics Data relating to causes of death from urolithiasis, coded as ICD‐10 N20‐N23, was collated and analysed for the 15 year period from 1999‐2013 in England and Wales. This data is sub‐categorised into anatomical location of calculi, age and gender. Results A total of 1954 deaths were attributed to urolithiasis from 1999‐2013 (mean 130.3 deaths/year). Of which, 141 were attributed to ureteric stones (mean 9.4 deaths/year). Calculi of the kidney and ureter accounted for 91% of all deaths secondary to urolithiasis; lower urinary tract (bladder or urethra) calculi contributed to only 7.9% of deaths. Data revealed an overall increasing trend in mortality from urolithiasis over this 15 year period with an increase of 3.8 deaths/year based on a linear trend (R2 0.65). Overall, the number of deaths in females was significantly higher than in males, (ratio 1.5:1, P
  • Enhancer of zeste homolog 2 (EZH2) promotes tumour cell migration and
           invasion via epigenetic repression of E‐cadherin in renal cell
    • Abstract: Objective To investigate the molecular mechanism and clinical significance for an oncogenic role of enhancer of zeste homolog 2 (EZH2) in renal cell carcinoma (RCC). Materials and Methods Immunohistochemistry analyses of EZH2, histone H3 trimethyl Lys27 (H3K27me3) and E‐cadherin were performed in tumour tissue samples from 257 patients with RCC. Regulatory effects of EZH2 on E‐cadherin expression were examined by quantitative real‐time polymerase chain reaction, Western blot, chromatin immunoprecipitation assay and immunohistochemical staining. Migration and invasion assays were performed in RCC cell lines. Tumour xenograft experiments with RCC cells were carried out in nude mice. Results EZH2 promoted migration and invasion in RCC cell lines. Silencing EZH2 with short‐hairpin EZH2 (shEZH2) or 3‐deazaneplanocin A (DZNep) inhibited migration and invasion (P < 0.001), up‐regulated the expression of E‐cadherin in vitro, inhibited tumour growth, and prolonged survival in vivo (P = 0.022). EZH2 expression accompanied with E‐cadherin repression was associated with advanced disease stage (P = 0.004) and poor overall (P < 0.001) and disease‐free survival (P < 0.001). Conclusion EZH2 may contribute to RCC progression and is a potential therapeutic target for advanced RCC.
  • Rates of self‐reported ‘burnout’ and causative factors
           amongst urologists in Ireland and the UK: a comparative
           cross‐sectional study
    • Abstract: Objectives To determine the incidence of ‘burnout’ among UK and Irish urological consultants and non‐consultant hospital doctors (NCHDs). The second objective was to identify possible causative factors and to investigate the impact of various vocational stressors that urologists face in their day‐to‐day work and to establish whether these correlate with burnout. The third objective was to develop a new questionnaire to complement the Maslach Burnout Inventory (MBI), more specific to urologists as distinct from other surgical/medical specialties, and to use this in addition to the MBI to determine if there is a requirement to develop effective preventative measures for stress in the work place, and develop targeted remedial measures when individuals are affected by burnout. Subjects and methods A joint collaboration was carried out between the Irish Society of Urology (ISU) and the British Association of Urological Surgeons (BAUS). Anonymous voluntary questionnaires were sent to all current registered members of both governing bodies. The questionnaire comprised two parts: the first part encompassed sociodemographic data collection and identifying potential risk factors for burnout, and the second used the MBI to objectively assess for workplace burnout. To evaluate differences in burnout, 2 × 2 contingency tables and Fischer's exact probability tests were used. Results In all, 575 urologists responded to the online survey out of a total of 1380 invites, yielding a 42% response rate. All respondents were aged
  • Differential effects of isomers of clomiphene citrate on reproductive
           tissues in male mice
    • Abstract: Objectives To determine, in a chronic dosing study, the oral toxicity potential of the test substances, enclomiphene citrate (ENC) and zuclomiphene citrate (ZUC), when administered to male mice by oral gavage. Materials and Methods Mice were divided into five treatment groups. Group I, placebo; Group II, 40 mg/kg body weight/day ENC; Group III, 4 mg/kg/day ENC; Group IV, 40 mg/kg/day ZUC; Group V, 4 mg/kg/day ZUC. Serum samples and tissues were obtained from each mouse for analysis and body weights were measured. Results In this chronic dosing study in mice, profound effects on Leydig cells, epididymis, seminal vesicles, and kidneys were seen, as well as effects on serum testosterone, follicle‐stimulating hormone and luteinising hormone levels that were associated with ZUC treatment only. Treatment with the isolated enclomiphene isomer had positive effects on testosterone production and no effects on testicular histology. Conclusions The present study suggests that an unopposed high dose of zuclomiphene can have pernicious effects on male mammalian reproductive organs. The deleterious effects seen when administering ZUC in male mice, justifies the case for a monoisomeric preparation and the development of ENC for clinical use in human males to increase serum levels of testosterone and maintain sperm counts.
  • Risk factors for mesh erosion after female pelvic floor reconstructive
           surgery: a systematic review and meta‐analysis
    • Abstract: Objectives To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and Methods A systematic literature search of the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Chinese Science and Technology Periodical (VIP) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of associations between the factors and mesh erosion. Results In all, 25 studies containing 7 084 patients were included in our systematic review and meta‐analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients (OR 0.96, 95% CI 0.94–0.98), more parities vs less parities (OR 1.27, 95% CI 1.07–1.51), the presence of premenopausal/oestrogen replacement therapy (ERT) (OR 1.36, 95% CI 1.03–1.79), diabetes mellitus (OR 1.87, 95% CI 1.35–2.57), smoking (OR 2.35, 95% CI 1.80–3.08), concomitant pelvic organ prolapse (POP) surgery (OR 0.37, 95% CI 0.16–0.84), concomitant hysterectomy (OR 1.46, 95% CI 1.03–2.07), preservation of the uterus at surgery (OR 0.22, 95% CI 0.08–0.63), and surgery performed by senior vs junior surgeons (OR 0.42, 95% CI 0.30–0.58). Conclusion Our study indicates that younger age, more parities, premenopausal/ERT, diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.
  • Percutaneous nephrolithotomy in super obese patients (body mass index
           ≥ 50 kg/m2): overcoming the challenges
    • Abstract: Objective To analyse our experience with and the outcomes and lessons learned from percutaneous nephrolithotomy (PCNL) in the super obese (body mass index [BMI] ≥50 kg/m2). Patients and Methods In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m2. Patient demographics, peri‐operative outcomes and complications were determined. Additionally, we identified a number of special PCNL considerations in the super obese that can maximize safe outcomes. Results A total of 21 PCNL procedures performed on 17 super obese patients were identified. The mean patient age was 54.8 years, the mean BMI was 57.2 kg/m2 and the mean stone area was 1 037 mm2. Full staghorn stones were observed in six patients and partial staghorns in four patients. The mean operating time was 106 min and the mean haemoglobin decrease was 1.2 g/dL. The overall stone‐free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese, including using extra‐long nephroscopes and graspers, using custom‐cut extra long access sheaths with suture ‘tails’ secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. Conclusion With appropriate peri‐operative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance was similar to that reported in previous PCNL series in the morbidly obese, and is achievable with few complications.
  • Clinical significance of peripheral zone thickness in men with lower
           urinary tract symptoms/benign prostatic hyperplasia
    • Abstract: Objective To evaluate the clinical impact of prostate peripheral zone thickness (PZT), based on presumed circle area ratio (PCAR) theory, on urinary symptoms in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) as a novel prostate parameter. Patients and methods Medical records were obtained from a prospective database of first‐visit men with LUTS/BPH. Age, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), maximum urinary flow rate (Qmax), and post‐void residual urine volume (PVR) were assessed. Total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI), and PZT were measured by transrectal ultrasonography. Reliability analysis was also performed. Results In all, 1009 patients were enrolled for the analysis. The mean (sd) PZT was 11.10 (2.50) mm, and patients were classified into three groups PZT thickness groups; PZT
  • Swedish National Penile Cancer Register: incidence, tumour
           characteristics, management and survival
    • Abstract: Objectives To assess penile cancer incidence, stage distribution, adherence to guidelines and prognostic factors in a population‐based setting. Patients and Methods The population‐based Swedish National Penile Cancer Register (NPECR) contains detailed information on tumour characteristics and management patterns. A total of 1 678 men with primary squamous cell carcinoma of the penis identified in the NPECR between 2000 and 2012 were included in the study. Results The mean age‐adjusted incidence of penile cancer was 2.1/100 000 men, remaining virtually unchanged during the study period. At diagnosis, 14 and 2% of the men had clinical N+ and M+ disease, respectively. Most men were staged pTis (34%), pT2 (19%), or pT1 (18%), while stage information was unavailable for 18% of the men. Organ‐preserving treatment was used in 71% of Tis–T1 tumours. Of men with cN0 and ≥pT1G2 disease, 50% underwent lymph node staging, while 74% of men with cN1–3 disease underwent lymph node dissection. The overall 5‐year relative survival rate was 82%. Men aged ≥40 years and those with pT2–3, G2–3 and N+ tumours had worse outcomes. Conclusions The incidence of penile cancer in Sweden is stable. Most men presented with localized disease, and the proportion of non‐invasive tumours was high. During the period under study, adherence to guidelines was suboptimum. The overall 5‐year relative survival rate was 82%. Older age, increasing tumour stage and grade, and increasing lymph node stage were associated with poorer survival.
  • Patterns of surveillance imaging after nephrectomy in the Medicare
    • Abstract: Objectives To characterize patterns of imaging surveillance after nephrectomy in a population‐based cohort of older patients with kidney cancer. Patients and Methods Using the Surveillance, Epidemiology and End Results (SEER)‐Medicare database, we identified patients aged ≥66 years who underwent partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009. Primary outcomes were chest imaging (X‐ray or computed tomography [CT]) and abdominal imaging (CT, MRI or ultrasonography) in Medicare claims from 4 to 36 months after surgery. We estimated the frequency of imaging in three time periods (postoperative months 4–12, 13–24, 25–36), stratified by tumour stage. Repeated‐measures logistic regression was used to identify the patient and disease characteristics associated with imaging. Results Rates of chest imaging were 65–80%, with chest X‐ray surpassing CT in each time period. Rates of abdominal imaging were 58–76%, and cross‐sectional imaging was more common than ultrasonography in each time period. Use of cross‐sectional chest and abdominal imaging increased over time, while the use of chest X‐ray decreased (P < 0.01). Ultrasonography use remained stable for patients with T1 and T2 disease, but the rate of use decreased in patients with T3 disease (P < 0.05). Rates of chest and abdominal imaging increased with tumour stage (P < 0.001). Conclusions Patterns of imaging suggest possible overuse in patients at low risk of recurrence and underuse in those at greater risk. New surveillance imaging guidelines may reduce unwarranted variability and promote risk‐based, cost‐effective management after nephrectomy.
  • Prediction of cancer‐specific survival after radical cystectomy in
           pT4a urothelial carcinoma of the bladder: development of a tool for
           clinical decision‐making
    • Abstract: Objective To externally validate the pT4a‐specific risk model for cancer‐specific survival (CSS) proposed by May et al. (Urol Oncol 2013; 31: 1141–1147) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North‐America were assessed. The risk model proposed by May et al., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver‐operating characteristic‐derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision‐curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5‐year‐CSS after RC was 34% in our cohort. The risk model devised by May et al. predicted individual 5‐year‐CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P < 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision‐curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. Conclusions The risk model devised by May et al. was validated with moderate discrimination and was outperformed by our newly developed pT4a‐specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB.
  • A prognostic model for survival after palliative urinary diversion for
           malignant ureteric obstruction: a prospective study of 208 patients
    • Abstract: Objective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk‐stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6‐month follow‐up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan–Meier survival estimates at 1, 6 and 12 months, and log‐rank tests. Results The median (range) survival was 144 (0–1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
  • Renal cell cancer histological subtype distribution differs by race and
    • Abstract: Objectives To examine racial differences in the distribution of histological subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype. Materials and Methods Tumours from 1532 consecutive patients with RCC who underwent nephrectomy at Vanderbilt University Medical Center (1998–2012) were classified as clear‐cell, papillary, chromophobe and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between race, sex, age, end‐stage renal disease (ESRD) and body mass index at diagnosis according to histological subtype. Results The RCC subtype distribution was significantly different in black people from that in white people (P < 0.001), with a substantially higher proportion of patients with papillary RCC among black people than white people (35.7 vs 13.8%). In multivariate analyses, compared with clear‐cell RCC, people with papillary RCC were significantly more likely to be black (OR 4.15; 95% CI 2.64–6.52) and less likely to be female (OR 0.60; 95% CI 0.43–0.83). People with chromophobe RCC were significantly more likely to be female (OR 2.32; 95% CI 1.44–3.74). Both people with papillary RCC (OR 6.26; 95% CI 2.75–14.24) and those with chromophobe RCC (OR 7.07; 95% CI 2.13–23.46) were strongly and significantly more likely to have ESRD, compared with those with clear‐cell RCC. Conclusion We observed marked racial differences in the proportional subtype distribution of RCCs diagnosed at a large tertiary care academic centre. To our knowledge, no previous study has examined racial differences in the distribution of RCC histologies while adjusting for ESRD, which was the factor most strongly associated with papillary and chromophobe RCC compared with clear‐cell RCC.
  • Is it safe to insert a testicular prosthesis at the time of radical
           orchidectomy for testis cancer: an audit of 904 men undergoing radical
    • Abstract: Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 to July 2005 and November 2007 to November 2009 were included. Data on postoperative complications, length of stay (LOS), re‐admission rate and return to theatre rate were collected. Results In all, 904 men [median (range) age 35 (14–88) years], underwent a radical orchidectomy during the study period and 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (P < 0.001), with a median age of 33 vs 37 years. There was no significant difference between the groups for LOS (P = 0.387), hospital re‐admission rates (P = 0.539) or return to theatre rate (P = 0.999). In all, 33/885 patients were readmitted ≤30 days of orchidectomy, with one of 236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30‐day hospital re‐admission (odds ratio 1.032, P = 0.016). Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re‐admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
  • Radical cystectomy with super‐extended lymphadenectomy: impact of
           separate vs en bloc lymph node submission on analysis and outcomes
    • Abstract: Objective To update our previous analysis of the clinical and pathological impact of the change in the submission of lymphadenectomy specimens from en bloc to 13 separate anatomically defined packets, which took place at the University of Southern California in May 2002, and to determine whether lymph node (LN) packeting resulted in any change in oncological outcomes. Patients and Methods A total of 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection for cTxN0M0 bladder cancer between January 1996 and December 2007 were identified. Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results The pathological tumour stage distribution and the proportion of LN‐positive patients (group 1: 82 patients [22%] versus group 2: 99 patients [21%]; P = 0.80) were similar between the two groups: the median [range] number of total LNs identified increased significantly (group 1: 32 [10–97] versus group 2: 65 [10–179]; P < 0.001). LN density decreased (group 1, 11% versus group 2, 4%; P = 0.005). The median [range] number of positive LNs removed was similar (group 1: 0 [0–30] versus group 2: 0 [0–97]; P = 0.87). No nodal stage shift was observed. The 5‐year overall survival (group 1: 58% versus group 2: 59%; P = 0.65) and recurrence‐free survival rates (group 1: 68% versus group 2: 70%; P = 0.57) were similar. Conclusions The incidence of patients with positive LNs remained unchanged, regardless of how the LN specimen was submitted. Submitting 13 separate nodal packets significantly increased the total LN yield, but did not result in a significant increase in the number of positive LNs or a consecutive nodal stage shift and did not affect oncological outcomes. Based on these results LN density is not an accurate prognosticator.
  • Positive surgical margins in radical prostatectomy patients do not predict
           long‐term oncological outcomes: results from the Shared Equal Access
           Regional Cancer Hospital (SEARCH) cohort
    • Abstract: Objective To assess the impact of positive surgical margins (PSMs) on long‐term outcomes after radical prostatectomy (RP), including metastasis, castrate‐resistant prostate cancer (CRPC), and prostate cancer‐specific mortality (PCSM). Patients and Methods Retrospective study of 4 051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate‐specific antigen (PSA) level. Results The median (interquartile range) follow‐up was 6.6 (3.2–10.6) years and 1 127 patients had >10 years of follow‐up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1 600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P  0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high‐risk features, PSMs alone may not be an indication for adjuvant radiotherapy.
  • Guideline of guidelines: a review of urological trauma guidelines
    • Abstract: Objective To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital). Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA), and renal trauma guidelines from the Société Internationale d'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low‐grade injuries. The major difference is for haemodynamically stable patients who have high‐grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies, as well as clinical principles and expert opinions. Multi‐institutional collaborative research can improve the quality of evidence and direct more effective evaluation and management of urological trauma.
  • DaPeCa‐1: diagnostic accuracy of sentinel lymph node biopsy in 222
           patients with penile cancer at four tertiary referral centres – a
           national study from Denmark
    • Abstract: Objectives To estimate the diagnostic accuracy of sentinel lymph node biopsy (SNB) in patients with penile cancer and assess SNB complications in a national multicentre setting. Patients and methods Retrospectively data were collected from records in four university centres by one medical doctor covering all SNBs performed in Denmark between 1 January 2000 and 31 December 2010. Patients had either impalpable lymph nodes (LNs) in one or both groins, or had a palpable inguinal mass from which aspiration cytology failed to reveal malignancy. Patients were injected with nanocolloid technetium and had a scintigram recorded before the SNB. The primary endpoint was LN recurrence on follow‐up. The secondary endpoint was complications after SNB. Diagnostic accuracy was computed. Results In all, 409 groins in 222 patients were examined by SNB. The median (interquartile range) follow‐up of patients who survived was 6.6 (5–10) years. Of 343 negative groins, eight were false negatives. The sensitivity was 89.2% (95% confidence interval 79.8–95.2%) per groin. Interestingly, four of 67 T1G1 patients had a positive SNB. In all, 28 of 222 (13%) patients had complications of Clavien‐Dindo grade I–IIIa. Conclusion Penile cancer SNB with a close follow‐up stages LN involvement reliably and has few complications in a national multicentre setting. Inguinal LN dissection was avoided in 76% of patients.
  • Enzalutamide: targeting the androgen signalling pathway in metastatic
           castration‐resistant prostate cancer
    • Abstract: Significant progress has been made in the understanding of the underlying cancer biology of castration‐resistant prostate cancer (CRPC) with the androgen receptor (AR) signalling pathway remaining implicated throughout the prostate cancer disease continuum. Reactivation of the AR signalling pathway is considered to be a key driver of CRPC progression and, as such, the AR is a logical target for therapy in CRPC. The objective of this review was to understand the importance of AR signalling in the treatment of patients with metastatic CRPC (mCRPC) and to discuss the clinical benefits associated with inhibition of the AR signalling pathway. A search was conducted to identify articles relating to the role of AR signalling in CRPC and therapies that inhibit the AR signalling pathway. Current understanding of prostate cancer has identified the AR signalling pathway as a logical target for the treatment of CRPC. Available therapies that inhibit the AR signalling pathway include AR blockers, androgen biosynthesis inhibitors, and AR signalling inhibitors. Enzalutamide, the first approved AR signalling inhibitor, has a novel mode of action targeting AR signalling at three key stages. The direct mode of action of enzalutamide has been shown to translate into clinical responses in patients with mCRPC. In conclusion, the targeting of the AR signalling pathway in patients with mCRPC results in numerous clinical benefits. As the number of treatment options increase, more trials evaluating the sequencing and combination of treatments are required. This review highlights the continued importance of targeting a key driver in the progression of CRPC, AR signalling, and the clinical benefits associated with inhibition of the AR signalling pathway in the treatment of patients with CRPC.
  • Table of Contents
  • Editorial Board
  • Issue Information
  • Importance of fundamental science as the cornerstone for translational
  • Penis cancer management: insight into the future
  • Should we worry about positive surgical margins in prostate cancer'
  • Should we start with low‐dose anti‐cholinergics when
           α‐blockers alone fail to control mixed lower urinary tract
           symptoms in men'
  • When two and two don't make four
  • The diminishing returns of robotic diffusion: complications after
           robot‐assisted radical prostatectomy
  • Observations on transatlantic renal cell cancer surgery outcomes
  • Ninety‐Day Postoperative Mortality after Robot‐assisted
           Laparoscopic Prostatectomy and Retropubic Radical Prostatectomy.
           Nation‐wide population‐based study
    • Abstract: Objective To assess 90‐day postoperative mortality after Robot assisted laparoscopic Radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) by use of nationwide population‐based registry data. Patients and methods Cohort study in the National Prostate Cancer Register (NPCR) of Sweden of 22 344 men with prostate cancer in clinical local stage T1‐T3, PSA
  • Validation of a bone scan positivity risk table in non‐metastatic
           castration‐resistant prostate cancer
    • Abstract: Objectives We have previously developed a risk table to predict the probability of a positive bone scan among men with non‐metastatic castrate resistant prostate cancer (M0 CRPC). Herein, we tested its external validity of this risk table in a separate cohort. Patients and Methods We retrospectively analyzed 429 bone scans of 281 CRPC patients with no known prior metastases treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision curve analysis were used to assess the performance of our prior model to predict a positive scan in the current data. Results A total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log‐transformed PSA (HR 2.13, 95%CI 1.71‐2.66, p
  • Erectile dysfunction (ED) and lower urinary tract symptoms associated with
           benign prostatic hyperplasia (LUTS/BPH) combined responders to tadalafil
           after 12‐weeks of treatment
    • Abstract: Objective To analyze the proportion of men taking tadalafil 5mg once‐daily who reach a combined improvement (henceforth known as a combined responder) in symptoms of both erectile dysfunction (ED) and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Materials and Methods Data from men aged ≥45 years randomized to tadalafil 5mg once‐daily or placebo enrolled in one of four randomized, placebo‐controlled LUTS/BPH clinical trials were analyzed (N=927). A novel classification of combined responders to ED and LUTS/BPH treatment (“combined responder”) was defined, based on published criteria for improvement in both the Erectile Function domain of the International Index of Erectile Function (IIEF‐EF) scale and the total International Prostate Symptom Score (IPSS). Descriptive analyses assessed the covariate distribution by responder status. Un‐adjusted and adjusted logistic regressions provided odds ratios (ORs, 95% confidence interval) comparing combined responders to all others (partial and non‐responders). Results Among men randomized to tadalafil 5mg, 40.5% were combined responders (N=189). Among placebo randomized men, 18.3% were combined responders (N=84). Combined responders, in the total population, had the highest baseline IPSS and lowest baseline IIEF‐EF scores, corresponding to the highest level of dysfunction. The majority of men were ≤65 years of age, white, non‐obese, non‐smokers, and regular alcohol consumers. Only treatment, baseline IPSS, baseline IIEF‐EF, obesity, and psychoactive medication use were significantly associated with responder status (p≤0.05). Tadalafil‐treated men had 2.8 times significantly increased adjusted‐odds of being combined responders vs. non‐responders (p
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