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Publisher: John Wiley and Sons   (Total: 1594 journals)

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Journal of Medical Imaging and Radiation Oncology     Hybrid Journal   (2 followers)
Journal of Medical Primatology     Hybrid Journal   (1 follower)
Journal of Medical Radiation Sciences     Open Access   (2 followers)
Journal of Medical Virology     Hybrid Journal   (6 followers)
Journal of Metamorphic Geology     Hybrid Journal   (6 followers)
Journal of Microscopy     Hybrid Journal   (2 followers)
Journal of Midwifery & Women's Health     Hybrid Journal   (17 followers)
Journal of Molecular Recognition     Hybrid Journal  
Journal of Money, Credit and Banking     Hybrid Journal   (17 followers)
Journal of Morphology     Hybrid Journal   (3 followers)
Journal of Multi-Criteria Decision Analysis     Hybrid Journal   (1 follower)
Journal of Multicultural Counseling and Development     Hybrid Journal   (1 follower)
Journal of Muscle Foods     Hybrid Journal   (3 followers)
Journal of Neurochemistry     Hybrid Journal  
Journal of Neuroendocrinology     Hybrid Journal   (4 followers)
Journal of Neuroimaging     Hybrid Journal   (1 follower)
Journal of Neuroscience Research     Hybrid Journal   (6 followers)
Journal of Nursing and Healthcare of Chronic Illne Ss: An International Interdisciplinary Journal     Hybrid Journal   (2 followers)
Journal of Nursing Management     Hybrid Journal   (15 followers)
Journal of Nursing Scholarship     Hybrid Journal   (2 followers)
Journal of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (16 followers)
Journal of Obstetrics and Gynaecology Research     Hybrid Journal   (12 followers)
Journal of Oral Pathology & Medicine     Hybrid Journal   (2 followers)
Journal of Oral Rehabilitation     Hybrid Journal   (2 followers)
Journal of Organizational Behavior     Hybrid Journal   (17 followers)
Journal of Orthopaedic Research     Hybrid Journal   (13 followers)
Journal of Paediatrics and Child Health     Hybrid Journal   (12 followers)
Journal of Pathology     Hybrid Journal   (6 followers)
Journal of Peptide Science     Hybrid Journal   (14 followers)
Journal of Periodontal Research     Hybrid Journal  
Journal of Personality     Hybrid Journal   (8 followers)
Journal of Petroleum Geology     Hybrid Journal   (4 followers)
Journal of Pharmaceutical Sciences     Hybrid Journal   (124 followers)
Journal of Philosophy of Education     Hybrid Journal   (5 followers)
Journal of Phycology     Hybrid Journal   (5 followers)
Journal of Physical Organic Chemistry     Hybrid Journal   (7 followers)
Journal of Phytopathology     Hybrid Journal   (2 followers)
Journal of Pineal Research     Hybrid Journal  
Journal of Plant Nutrition and Soil Science     Hybrid Journal   (3 followers)
Journal of Policy Analysis and Management     Hybrid Journal   (12 followers)
Journal of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (5 followers)
Journal of Political Philosophy     Hybrid Journal   (29 followers)
Journal of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (116 followers)
Journal of Polymer Science Part B: Polymer Physics     Hybrid Journal   (21 followers)
Journal of Polymer Science Part C : Polymer Letters     Hybrid Journal   (5 followers)
Journal of Popular Music Studies     Hybrid Journal   (8 followers)
Journal of Product Innovation Management     Hybrid Journal   (11 followers)
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Journal of Public Economic Theory     Hybrid Journal   (4 followers)
Journal of Public Health Dentistry     Hybrid Journal   (1 follower)
Journal of Quaternary Science     Hybrid Journal   (23 followers)
Journal of Raman Spectroscopy     Hybrid Journal   (9 followers)
Journal of Rapid Methods and Automation In Microbiology     Hybrid Journal   (2 followers)
Journal of Regional Science     Hybrid Journal   (6 followers)
Journal of Religious Ethics     Hybrid Journal   (4 followers)
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Journal of Software Maintenance and Evolution: Research and Practice     Hybrid Journal   (2 followers)
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Journal of Surgical Oncology     Hybrid Journal   (1 follower)
Journal of Synthetic Lubrication     Hybrid Journal  
Journal of Systematics Evolution     Open Access   (4 followers)
Journal of Texture Studies     Hybrid Journal   (2 followers)
Journal of the American Association of Nurse Practitioners     Partially Free   (3 followers)
Journal of the American Ceramic Society     Hybrid Journal   (20 followers)
Journal of the American Geriatrics Society     Hybrid Journal   (8 followers)
Journal of the American Society for Information Science and Technology     Hybrid Journal   (104 followers)
Journal of the American Water Resources Association     Hybrid Journal   (18 followers)
Journal of the CardioMetabolic Syndrome     Hybrid Journal  
Journal of the European Academy of Dermatology and Venereology     Hybrid Journal   (3 followers)
Journal of the Experimental Analysis of Behavior     Hybrid Journal  
Journal of the History of the Behavioral Sciences     Hybrid Journal   (1 follower)
Journal of the Institute of Brewing     Free  
Journal of the Peripheral Nervous System     Hybrid Journal   (2 followers)
Journal of the Royal Anthropological Institute     Hybrid Journal   (28 followers)
Journal of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (9 followers)
Journal of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (18 followers)
Journal of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (13 followers)
Journal of the Science of Food and Agriculture     Hybrid Journal   (20 followers)
Journal of the Society for Information Display     Hybrid Journal   (1 follower)
Journal of the Society for the Anthropology of Europe     Hybrid Journal   (8 followers)
Journal of the World Aquaculture Society     Hybrid Journal   (12 followers)

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BJU International    [115 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  [1594 journals]   [SJR: 1.381]   [H-I: 96]
  • Limited ability of existing nomograms to predict outcomes in men
           undergoing active surveillance for prostate cancer
    • Abstract: Objective To assess the ability of current nomograms to predict disease progression at repeat biopsy or at delayed radical prostatectomy (RP) in a prospectively accrued cohort of patients managed by active surveillance (AS). Materials and Methods A total of 273 patients meeting low‐risk criteria who were managed by AS and who underwent multiple biopsies and/or delayed RP were included in the study. The Kattan (base, medium and full), Steyerberg, Nakanishi and Chun nomograms were used to calculate the likelihood of indolent disease (‘nomogram probability’) as well as to predict ‘biopsy progression’ by grade or volume, ‘surgical progression’ by grade or stage, or ‘any progression’ on repeat biopsy or surgery. We evaluated the associations between each nomogram probability and each progression outcome using logistic regression with (area under the receiver‐operating characteristic curve (AUC) values and decision curve analysis. Results The nomogram probabilities of indolent disease were lower in patients with biopsy progression (P < 0.01) and any progression on repeat biopsy or surgical pathology (P < 0.05). In regression analyses, nomograms showed a modest ability to predict biopsy progression, adjusted for total number of biopsies (AUC range 0.52–0.67) and any progression (AUC range 0.52–0.70). Decision curve analyses showed that all the nomograms, except for the Kattan base model, have similar value in predicting biopsy progression and any progression. Nomogram probabilities were not associated with surgical progression in a subgroup of 58 men who underwent delayed RP. Conclusions Existing nomograms have only modest accuracy in predicting the outcomes of patients undergoing AS. Improvements to existing nomograms should be made before they are implemented in clinical practice and used to select patients for AS.
       
  • Prognostic value of microRNA expression pattern in upper tract urothelial
           carcinoma
    • Abstract: Objective To examine the microRNA (miRNA) expression pattern in tumour samples from patients with progressing and non‐progressing upper tract urothelial carcinoma (UTUC) in order to identify putative miRNAs that may be used as prognostic markers. Patients and Methods We conducted a multicentre, retrospective study of formalin‐fixed paraffin‐embedded tissue samples from 150 patients with UTUC who had undergone radical nephroureterectomy. Global miRNA expression patterns were analysed in 18 selected samples from patients with UTUC using TaqMan arrays. The differential expression of five key miRNAs was validated by quantitative polymerase chain reaction in an independent cohort of 132 samples from patients with UTUC. Models to predict tumour progression and cancer‐specific survival that included miRNA expression patterns were developed by Cox regression analysis. Results Twenty‐six miRNAs were found to be aberrantly expressed between samples from patients with progressing and non‐progressing UTUC and five of these were selected for subsequent studies. The regression analysis identified tumour stage and miR‐31 and miR‐149 expression as independently associated with tumour progression and tumour stage and miR‐149 expression as independently associated with cancer‐specific survival. The risk scores derived from these miRNA models were able to discriminate two groups with a highly significantly different probability of tumour progression (hazard ratio [HR] 4.78; P < 0.001) and death (HR 276; P = 0.004). Conclusions There is a differential miRNA expression pattern between patients with progressing and non‐progressing UTUC. The identification of new miRNAs associated with a high probability of tumour recurrence and cancer‐specific survival in patients with UTUC and their combination in a robust, easy‐to‐use and reliable algorithm may help tailor treatment and surveillance strategies in these patients.
       
  • MicroRNA and urothelial cell carcinoma
    •  
  • A critical appraisal of complications of percutaneous nephrolithotomy in
           paediatric patients using adult instruments
    • Abstract: Objective To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24–30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES‐Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group. Results The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2–17) years. The mean (range) stone burden was 376.68 ± 265.23 (150–2400) mm2. The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone‐free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013–1.065, odds ratio = 1.04; P = 0.038). Conclusions Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter‐observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure.
       
  • Microsurgical denervation of rat spermatic cord: safety and efficacy data
    • Abstract: Objective To describe a microsurgical technique for denervation of the spermatic cord and use of multiphoton microscopy (MPM) laser to identify and ablate residual nerves after microsurgical denervation. To evaluate structural and functional changes in the rat testis and vas deferens after denervation. Materials and Methods Nine Sprague‐Dawley rats were divided into three experimental groups: sham, microsurgical denervation of the spermatic cord (MDSC), and MDSC immediately followed by laser ablation with MPM. At 2 months after surgery, we assessed testicular volume, functional circulation of the testicular artery with Doppler, patency of the vas deferens, and histology of the testis and vas deferens. Results There was a significant decrease in the median number of nerves remaining around the vas deferens with MDSC alone (3.5 nerves) or MDSC with MPM (1.5 nerves) compared with sham rats (15.5 nerves) (P = 0.003). Although, MDSC with MPM resulted in the fewest remaining nerves, this result was similar to MDSC alone (P = 0.29). No deleterious effects on spermatogenesis or vas patency were seen in the experimental groups when compared with the sham rats. Conclusion A microsurgical approach can be used to effectively and safely denervate the rat spermatic cord with minimal changes to structure and function of the testis and vas deferens. MPM can be used as an adjunct to identify and ablate residual nerves after MDSC.
       
  • Long‐term follow‐up of sacral neuromodulation for lower
           urinary tract dysfunction
    • Abstract: Objective To report our long‐term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re‐interventions and degree of success. Patients and Methods This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. Results The mean duration of follow‐up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re‐intervention. The re‐intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow‐up. Conclusions SNM appears effective in the long‐term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re‐intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re‐intervention rates will improve.
       
  • Validation of the bladder control self‐assessment questionnaire
           (B‐SAQ) in men
    • Abstract: Objective To validate the Bladder Control Self‐Assessment Questionnaire (B‐SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men. Patients and Methods This was a prospective, single‐centre study including 211 patients in a urology outpatient setting. All patients completed the B‐SAQ and Kings Health Questionnaire (KHQ) before consultation, and the consulting urologist made an independent assessment of LUTS and the need for treatment. The psychometric properties of the B‐SAQ were analysed. Results A total of 98% of respondents completed all items correctly in
       
  • Clinical role of pathological downgrading after radical prostatectomy in
           patients with biopsy‐proven Gleason score 3+4 prostate cancer
    • Abstract: Objective ● To identify preoperative factors predicting Gleason score downgrading after radical prostatectomy in patients with biopsy Gleason score 3+4 prostate cancer. ● To determine if prediction of downgrading can identify potential candidates for active surveillance. Patients and Methods ● We identified 1317 patients with biopsy Gleason score 3+4 prostate cancer who underwent radical prostatectomy at Memorial Sloan‐Kettering Cancer Center between 2005 and 2013. ● Several preoperative and biopsy characteristics were evaluated by forward selection regression, and selected predictors of downgrading were analyzed by multivariable logistic regression. ● Decision curve analysis was performed to evaluate the clinical utility of the multivariate model. Results ● Gleason score was downgraded after radical prostatectomy in 115 patients (9%). ● We developed a multivariable model using age, prostate specific antigen density, percent of positive cores with Gleason 4 cancer out of all cores taken, and maximum percent of cancer involvement within a positive core with Gleason 4 cancer. ● The area under the curve for this model was 0.75 after ten‐fold cross validation. ● However, decision curve analysis revealed that the model was not clinically helpful in identifying patients who will downgrade at radical prostatectomy for the purpose of reassigning them to active surveillance. Conclusion ● While patients with pathology Gleason score 3+3 with tertiary Gleason pattern 4 or lower at radical prostatectomy in patients with biopsy Gleason score 3+4 prostate cancer may be potential candidates for active surveillance, decision curve analysis showed limited utility of our model to identify such men. ● Future study is needed to identify new predictors to help identify potential candidates for active surveillance among patients with biopsy‐proven Gleason score 3+4 prostate cancer.
       
  • Percutaneous nephrolithotomy in England: practice and outcomes described
           in the Hospital Episode Statistics database
    • Abstract: Objective To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals. Patients and Methods We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals. Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in‐hospital mortality within 30 days of surgery. Results A total of 5750 index PCNL procedures were performed in 165 hospitals. During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis. There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention. There were 13 (0.2%) in‐hospital deaths within 30 days of surgery. Conclusions Haemorrhage and infection represent relatively common and potentially severe complications of PCNL. Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery. Complications of PCNL may be under‐reported in the HES database and need to be corroborated using other data sources.
       
  • Complications and outcomes of salvage robot‐assisted radical
           prostatectomy: a single‐institution experience
    • Abstract: Objective To determine the peri‐operative outcomes of men undergoing salvage robot‐assisted prostatectomy (RARP) and to examine the complications, functional consequences and need for additional treatments after salvage RARP. Patients and Methods At total of 51 consecutive patients underwent salvage RARP after previous failed local therapy. Biochemical recurrence (BCR) was defined as two postoperative PSA measurements ≥0.2 ng/mL. Complications at any time postoperatively were recorded prospectively using a modified Clavien system. The Kaplan–Meier method was used for survival estimation, and regression models were used to identify the predictors of BCR or progression‐free survival (PFS) and complications. Results The median age at salvage RARP was 68 years and a median of 68 months had elapsed from the time of primary treatment. The median follow‐up was 36 months. The median operation duration was 179 min with a median estimated blood loss of 175 mL. In all, 50% of patients had pathological stage 3 disease and positive surgical margins were found in 31% of patients. The estimated 3‐year BCR‐free or PFS was 57%. The overall complication rate was 47%, with a 35% major complication rate (Grade III–V). Potency was maintained in 23% of preoperatively potent patients and 45% of all patients regained urinary control. No clinical variables were predictive of major complications, but all patients with postoperative bladder neck contracture were incontinent. A higher PSA level and extracapsular extension were significantly associated with BCR or progression (P < 0.01). Conclusions Salvage RARP provides oncological control with potential avoidance of systemic non‐curative therapy. Complication, incontinence and erectile dysfunction rates are significant but frequently correctable. This reinforces the need for proper patient counselling and selection.
       
  • Robot‐assisted partial nephrectomy (RAPN) for completely endophytic
           renal masses: a single institution experience
    • Abstract: Objective To analyse the outcomes of robot‐assisted partial nephrectomy (RAPN) for completely endophytic renal tumours. Patients and Methods Medical records of patients who had undergone RAPN for a completely endophytic (i.e. 3 points for the ‘E’ domain of the R.E.N.A.L. nephrometry score) enhancing renal mass at our Centre from 2006 to 2012 were retrieved from our prospectively maintained RAPN database and used for this analysis. Demographics, surgical and early postoperative outcomes were compared with those of patients with exophytic masses (i.e. 1 point for the ‘E’ domain) and those of patients with mesophytic masses (i.e. 2 points for the ‘E’ domain). Results In all, 65 patients (mean age 56 years; mean body mass index 29.4 kg/m2; mean Charlson comorbidity index 3.2) were included in the study group, accounting for 16.7% of RAPN cases over the study period. The main surgical outcomes were: mean operative time 175 min, mean estimated blood loss 225 mL, and mean warm ischaemia time 21.7 min. Pathology showed a malignant histology in 48 cases (74%), mostly clear cell renal cell carcinoma. Two positive margins (3%) were found. Patients with a completely endophytic mass had smaller tumours on preoperative imaging (mean 2.6 vs 3.3 for mesophytic vs 3.7 cm for exophytic; P < 0.001), and higher overall R.E.N.A.L. score (mean 8.7 vs 7.6 vs 6.4; P < 0.001). There was a lower rate of unclamped cases in the endophytic group (3.1% vs 4.8% vs 18%; P < 0.001). There were no differences in intraoperative complications, length of hospital stay, positive margin rate, postoperative change in estimated glomerular filtration rate, given a similar length of follow‐up (mean 12.6 vs 15.7 vs 14.5 months; P = 0.3). Conclusion RAPN for completely intraparenchymal renal tumours can be safely and effectively performed in centres with significant robotic expertise, with surgical outcomes resembling those obtained in the general RAPN population.
       
  • Assessing the anatomical characteristics of renal masses has a limited
           effect on the prediction of pathological outcomes in solid, enhancing,
           small renal masses: results using the PADUA classification system
    • Abstract: Objective To evaluate whether assessing the anatomical characteristics of renal masses increases the accuracy of prediction of tumour pathology in small renal masses (SRMs). Patients and Methods We retrospectively reviewed 1129 consecutive patients who underwent extirpative surgeries for a clinical T1 renal mass, for which the preoperative aspects and dimensions used for an anatomical (PADUA) classification were available. Multivariate logistic regression analyses of demographic and anatomical characteristics were performed. Nomograms to predict malignancy and high grade pathology were constructed using a basic model (age, sex and tumour size), and an extended model (anatomical characteristics incorporated into the basic model), and the area under the curve (AUC) between models was compared. Results Age, sex and tumour size were significantly associated with malignancy and high grade pathology in the T1 and T1a category (except sex for high grade pathology in T1a tumours). Exophytic rate (T1 and T1a) and renal sinus or urinary collecting system involvement (only T1a) were also significant predictors of high grade pathology. Nomograms using the extended model for malignancy showed an insignificant AUC increase compared with those using the basic model (T1, from 0.771 to 0.780, P = 0.149, and T1a, from 0.803 to 0.819, P = 0.055). For high grade pathology, the extended model achieved a significant AUC increase (from 0.595 to 0.643, P = 0.014) in the T1a category, but the AUC for both T1 and T1a tumours showed merely modest competence (0.654 and 0.643, respectively). Conclusion Age, sex and tumour size are the primary predictors of tumour pathology of SRMs, and incorporating other anatomical characteristics has only a limited positive effect on the accuracy of prediction of pathological outcomes.
       
  • Five‐year outcomes after iodine‐125 seed brachytherapy for
           low‐risk prostate cancer at three cancer centres in the UK
    • Abstract: Objective To report the outcomes of >1000 men with low‐risk prostate cancer treated with low‐dose‐rate (LDR) brachytherapy at three large UK cancer centres. Patients and Methods A total of 1038 patients with low‐risk prostate cancer (prostate‐specific antigen [PSA] ≤10 ng/mL, Gleason score 6, ≤T2b disease) were treated with LDR iodine 125 (I‐125) brachytherapy between 2002 and 2007. Patients were treated at three UK centres. PSA and clinical follow‐up was performed at each centre. Biochemical recurrence‐free survival was reported for the cohort. Results The median (range) PSA follow‐up for the whole group was 5 years (4 months to 9 years). A total of 79 patients had biochemical failure, defined by a rise in PSA level: 16 patients fulfilled the ASTRO definition of biochemical failure, 25 patients fulfilled the Phoenix definition and 38 patients fulfilled both definitions. The 5‐year biochemical relapse‐free survival (bRFS) rate was 94.1% by the ASTRO definition and 94.2% by the Phoenix definition. The absence of neoadjuvant hormone therapy was predictive of inferior biochemical control as defined by the Phoenix definition (P = 0.033). Conclusions Our prospective multicentre series showed excellent bRFS with LDR I‐125 brachytherapy for patients with low‐risk prostate cancer. Further work is necessary to define the role of neoadjuvant androgen deprivation therapy in combination with brachytherapy.
       
  • Prognostic value of preoperative multiparametric magnetic resonance
           imaging (MRI) for predicting biochemical recurrence after radical
           prostatectomy
    • Abstract: Objective To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP). Patients and Methods We reviewed the clinical records of patients who underwent either standard RP or laparoscopic RP between January 2005 and December 2009 at our institution. Patients who received radiotherapy or androgen deprivation therapy before surgery were excluded. A total of 314 patients met the study inclusion criteria. Cox proportional hazard regression models were used for analyses. In accordance with the criteria in the established guidelines, a radiologist scored the probability of the presence of prostate cancer using a five‐point scale of diagnostic confidence level. The highest confidence level of any pulse sequence was considered as the evaluation result. Results MRI positivity was significantly associated with a high clinical stage (cT ≥ 2; P = 0.039), a high positive biopsy core rate (≥0.2; P < 0.001), a high biopsy Gleason score ([GS] ≥8; P < 0.001) and a high pathological GS (≥8; P = 0.005). Univariate analysis and multivariate analysis showed that MRI positivity was a prognostic indicator in the analysis that included only preoperative variables and also in the analysis including preoperative and pathological variables. Conclusion Multiparametric MRI positivity can independently predict biochemical recurrence after RP.
       
  • Benefit in regionalisation of care for patients treated with radical
           cystectomy: a nationwide inpatient sample analysis
    • Abstract: Objective To quantify in absolute terms the potential benefit of regionalisation of care from low‐ to high‐volume hospitals. Patients and Methods Patients with a primary diagnosis of bladder cancer treated with radical cystectomy (RC) were identified within the Nationwide Inpatient Sample, a retrospective observational population‐based cohort of the USA, between 1998 and 2009. Intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in‐hospital mortality rates represented the outcomes of interest. Potentially avoidable outcomes were calculated by subtracting predicted rates (i.e. estimated outcomes if care was delivered at a high‐volume hospital) from observed rates (i.e. actual observed outcomes after care delivered at a low‐volume hospital). Multivariable logistic regression models and number needed to treat were generated. Results Patients treated at high‐volume hospitals had lower odds of complications during hospitalisation than those treated in low‐volume hospitals. Potentially avoidable intraoperative complications, postoperative complications, blood transfusions, prolonged hospitalisation, and in‐hospital mortality rates were 0.6, 7.4, 2.8, 9.4, and 2.0%, respectively. This corresponds to a number needed to redirect from low‐ to high‐volume hospitals in order to avoid one adverse event of 166, 14, 36, 11 and 50, respectively. Conclusion This is the first report to quantify the potential benefit of regionalisation of RC for muscle‐invasive bladder cancer to high‐volume hospitals.
       
  • Prospective comparison of quality‐of‐life outcomes between
           ileal conduit urinary diversion and orthotopic neobladder reconstruction
           after radical cystectomy: a statistical model
    • Abstract: Objective To conduct a prospective comparison of quality‐of‐life (QoL) outcomes in patients who underwent ileal conduit (IC) urinary diversion with those who underwent orthotopic neobladder (ONB) reconstruction after radical cystectomy for invasive bladder cancers. Patients and Methods Between January 2007 and December 2012, 227 patients underwent radical cystectomy and either IC urinary diversion or ONB (sigmoid or ileal) reconstruction. Contraindications for ON were impaired renal function (serum creatinine >2 mg/dL), chronic inflammatory bowel disease, previous bowel resection and tumour involvement at the bladder neck/prostatic urethra. Patients who did not have these contraindications chose to undergo either IC or ONB reconstruction, after impartial counselling. Baseline characteristics, including demographic profile, body mass index, comorbidities, histopathology of the cystoprostatectomy (with lymph nodes) specimen, pathological tumour stage, postoperative complications, adjuvant therapy and relapse, were recorded and compared. The European Organization for Research and Treatment of Cancer QoL questionnaire C30 version 3 was used to analyse QoL before surgery and 6, 12 and 18 months after surgery. Results Of the 227 patients, 28 patients in the IC group and 35 in the ONB group were excluded. The final analysis included 80 patients in the IC and 84 in the ONB group. None of the baseline characteristics were significantly different between the groups, except for age, but none of the baseline QoL variables were found to be correlated with age. In the preoperative phase, there were no significant differences in any of the QoL domains between the IC or the ONB groups. At 6, 12 and 18 months in the postoperative period, physical functioning (P < 0.001, P < 0.001 and P = 0.001, respectively), role functioning (P = 0.01, P = 0.01 and P = 0.003, respectively), social functioning (P = 0.01, P = 0.01 and P = 0.01, respectively) and global health status/QoL (P < 0.001, P < 0.001 and P = 0.002, respectively) were better in patients in the ONB group than in those in the IC group and the differences were significant. The financial burden related to bladder cancer treatment was significantly lower in the ONB group than in the IC group at 6, 12 and 18 months of follow‐up (P = 0.05, P = 0.05 and P = 0.005, respectively) Conclusions ONB is better than IC in terms of physical functioning, role functioning, social functioning, global health status/QoL and financial expenditure. ONB reconstruction provides better QoL outcomes than does IC urinary diversion.
       
  • Implementation of the Exeter Enhanced Recovery Programme for patients
           undergoing radical cystectomy
    • Abstract: Objectives To describe our experience with the implementation and refinement of an enhanced recovery programme (ERP) for radical cystectomy (RC) and urinary diversion. To assess the impact on length of stay (LOS), complication and readmission rates. Patients and Methods In all, 165 consecutive patients undergoing open RC (ORC) and urinary diversion between January 2008 and April 2013 were entered into an ERP. A retrospective case note review was undertaken. Outcomes recorded included LOS, time to mobilisation, complication rates within the first 30 days (Clavien‐Dindo classification) and readmissions. Results All patients were successfully entered into the ERP. As enhanced recovery principles became embedded in the unit, LOS reduced from a mean of 14 days over the initial year of the ERP to a mean of 9.2 days. The complication rate was 6.6% for Clavien ≥3, and 43.5% for Clavien ≤2. The 30‐day mortality rate was 1.2%. The 30‐day readmission rate was 13.9%. In the most contemporary subset of 52 patients: the median time after ORC to sit out of bed, mobilise and open bowels was day 1, 2 and 6, respectively. Conclusions The ERP described for patients undergoing ORC appears to be safe. Benefits include early feeding, mobilisation and hospital discharge. The ERP will continue to develop with the incorporation of advancing evidence and technology, in particular the introduction of robot‐assisted RC.
       
  • Cryoablation for locally advanced clinical stage T3 prostate cancer: a
           report from the Cryo‐On‐Line Database (COLD) Registry
    • Abstract: Objective To assess the oncological and functional outcomes of primary prostate cryoablation for men with clinical stage T3 (cT3) prostate cancer, as although radical prostatectomy (RP) or external beam radiotherapy (EBRT) are the standard treatments for locally advanced cT3 prostate cancer some patients opt for nonextirpative prostate cryoablation instead. Patients and Methods The Cryo‐On‐Line Database (COLD) Registry was queried to identify patients with cT3 prostate cancer treated with whole‐gland cryoablation (366 patients). We assessed biochemical disease‐free survival (bDFS) using the Phoenix definition and determined reported rates of urinary incontinence and retention, sexual activity, and rectourethral fistulisation after treatment. Patients were subsequently assessed according to whether they were administered neoadjuvant androgen‐deprivation therapy or not (ADT; 115 patients, 31.4%). Results For the entire cohort, the 36‐ and 60‐month bDFS rates were 65.3% and 51.9%, respectively. Patients who received neoadjuvant ADT had statistically nonsignificantly higher 36‐ and 60‐month bDFS rates (68.0% and 55.4%, respectively) than patients who did not receive neoadjuvant ADT (55.3% and 36.9%, respectively). The after treatment urinary incontinence rate was 2.6%; urinary retention rate, 6.0%; sexual activity rate, 30.4%; and rectourethral fistulisation rate, 1.1%. Conclusions Cryoablation for patients with cT3 prostate cancer leads to less favourable bDFS than that after RP or RT for the same group of men. The after treatment rectourethral fistulisation rates for patients with cT3 disease are higher than in those with organ‐confined prostate cancer treated with cryoablation; however, urinary dysfunction and sexual activity rates are similar for men with cT3 to those reported from this same registry in men with cT2 disease. The addition of neoadjuvant ADT (though not studied prospectively here) should be strongly considered if a patient with cT3 prostate cancer is to be treated with cryoablation.
       
  • Outcomes of surgical treatment of Peyronie's disease
    • Abstract: The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer‐reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non‐systematic review included ‘Peyronie's disease’, ‘outcomes’, ‘complications’, ‘erectile dysfunction or ED’, ‘patient expectation’, and ‘patient satisfaction’; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty‐one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non‐surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug‐resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long‐term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence‐based selection of the surgical approach.
       
  • How are we doing with percutaneous nephrolithotomy (PCNL) in England'
    •  
  • Efficacy and complications of intravesical BCG in immunocompromised
           patients
    •  
  • Daily phosphodiesterase type 5 inhibitor therapy: a new treatment option
           for prostatitis/prostatodynia'
    •  
  • Total urgency and frequency score as a measure of urgency and frequency in
           overactive bladder and storage lower urinary tract symptoms
    • Abstract: The term lower urinary tract symptoms (LUTS) encompasses a range of urinary symptoms, including storage symptoms (e.g. overactive bladder [OAB]) as well as voiding and post‐micturition symptoms. Although treatment of male LUTS tends to focus on voiding symptoms, patients typically find storage symptoms the most bothersome. The core storage symptom is urgency, which drives the other main storage symptoms of increased daytime frequency, nocturia and incontinence. Although several validated questionnaires have been widely used to study urgency, few measure the two important storage parameters, urgency and frequency, in a single assessment. The total urgency and frequency score (TUFS) is a new validated tool that captures both variables and is derived from the Patient Perception of Intensity of Urgency Scale, which has been validated in patients with OAB and LUTS. The TUFS was first validated in OAB in the phase IIa BLOSSOM study, which was designed to assess the efficacy and safety of mirabegron, a β3‐adrenoceptor agonist, in 260 patients. The responsiveness of the TUFS to treatment has been confirmed in a further three large‐scale randomized controlled trials of solifenacin in patients with OAB or LUTS. Changes in TUFS from baseline to end of treatment were consistent with changes in micturition diary variables in all four studies. Furthermore, the TUFS was significantly correlated with several health‐related quality‐of‐life variables in the phase III NEPTUNE study. Thus, the TUFS appears to be useful for assessing improvements in major storage symptoms (urgency and frequency) in clinical trials.
       
  • Flying high as a kite
    •  
  • Cryosurgery for clinical T3 prostate cancer
    •  
  • Enhanced recovery programmes: an important step towards going lean in
           healthcare
    •  
  • Life is good with orthotopic bladder substitutes!
    •  
  • Standardising and structuring of robotic surgery curricula: validation and
           integration of non‐technical skills is required
    •  
  • Metabolic atrophy and 3‐T 1H‐magnetic resonance spectroscopy
           correlation after radiation therapy for prostate cancer
    • Abstract: Objective To correlate 3‐T magnetic resonance spectroscopic imaging (MRSI) with prostate‐specific antigen (PSA) levels in patients with prostate cancer treated with external beam radiation therapy to assess the potential advantages of MRSI. Materials and Methods A total of 50 patients (age range 65–83 years) underwent PSA and MRSI surveillance before and at 3, 6, 12, 18 and 24 months after radiotherapy. Results Of the 50 patients examined, 13 patients completely responded to therapy showing metabolic atrophy (MA), defined as a choline‐plus‐creatine/citrate (CC/C) ratio 0.8). Three of those patients with recurrence had a biochemical relapse at 18 months and the other two at 24 months. Two of the 50 patients did not respond to the treatment, showing persistent disease from the 3rd month (CC/C ratio >0.8); one patient had biochemical relapse at 6 and the other at 12 months. Conclusions MRSI was shown to have a greater potential than PSA level in monitoring patients after radiotherapy, because it anticipates PSA nadir, and biochemical relapse in particular.
       
  • Perioperative Outcomes of 6042 Nephrectomies in 2012:
           Surgeon‐reported results in the United Kingdom from the BAUS
           Nephrectomy Database
    • Abstract: Objective ● To present the perioperative outcomes from the BAUS nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in England. Patients and Methods ● All nephrectomies performed in the year 2012 and recorded in the database were analysed. These were divided into simple nephrectomy (SN), partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). ● The estimated capture rate for nephrectomy was 80%. ● The outcomes measured were 30‐day mortality (30‐DM), Clavien‐Dindo complications ≥ Grade III, intraoperative blood transfusion, conversion to open and length of stay. Results ● The overall 30‐DM was 0.55% (SN 0.53%; PN 0.10%; RN 0.52%; NU 1.27%) ● Clavien‐Dindo complications ≥ Grade III were recorded in 3.9% of nephrectomies (SN 4.3%; PN 5.4%; RN 3.1%; NU 4.5%) ● Intraoperative blood transfusion was required in 8.4% of nephrectomies (SN 5.2%; PN 3.4%; RN 11.1%; NU 8.3%) ● Conversion to open was carried out in 5.5% of minimally invasive nephrectomies (SN 6.1%; PN 4.0% ; RN 5.5% ; NU 5.6%) ●Open nephrectomy patients remained in hospital for a median of 6 days (SN 7; PN 5; RN 7; NU 8) which was higher than the median 4 day stay (SN 3; PN 4; RN 4; NU 5) with minimally invasive surgery. Conclusions ● Nephrectomy in 2012 was a safe procedure with morbidity and mortality rates comparable to or less than published series. ●The collection of surgeon specific data should be iterative with further refinement of data categories, support for the collection process and independent validation of results.
       
  • Hyaluronan‐mediated motility receptor (RHAMM) immunohistochemical
           expression and androgen deprivation in normal peritumoral, hyperplasic and
           neoplastic prostate tissue
    • Abstract: Objectives To evaluate hyaluronan‐mediated motility receptor (RHAMM) expression in normal, hyperplasic and neoplastic prostate tissue after various types and durations of androgen‐deprivation therapy (ADT). Clinical and oncological data from men with localised prostate adenocarcinoma were also assessed and compared with RHAMM expression data. Patients and Methods Data from 367 men who underwent histological evaluation of the prostate were retrospectively evaluated under six conditions: (i) benign prostatic hyperplasia (BPH), (ii) BPH treated with finasteride, (iii) prostate cancer without ADT, (iv) prostate cancer treated with neoadjuvant ADT before prostatectomy (cyproterone 200 mg/day), (v) castration‐resistant prostate cancer (CRPC), and (vi) normal peritumoral prostate tissue. Tissue microarrays were constructed and 1354 cores were evaluated for immunohistochemical RHAMM expression. Results There was no RHAMM expression in any tissue from normal patients or those with BPH or prostate cancer without ADT. There was RHAMM expression in 39.4% of prostate cancer tissues treated with ADT and in 46.2% of CRPC samples (P = 0.001). There was a significant increase in RHAMM expression with increased ADT duration in group 4, with a marked increase in RHAMM expression after 6–12 months of ADT (P = 0.04). No prognostic or clinical factors related to prostate cancer were associated with RHAMM expression. Conclusions RHAMM expression in prostate cancer is directly associated with ADT. Significant RHAMM expression occurs as early as after 1 month of ADT and progressively increases with ADT duration. When prostate cancer becomes CRPC, RHAMM expression is higher. RHAMM expression was not associated with prostate cancer prognostic factors. RHAMM overexpression may contribute to the development of hormonal resistance in prostate cancer.
       
  • Ureteral stents versus percutaneous nephrostomy for initial urinary
           drainage in children with obstructive anuria and acute renal failure due
           to ureteral calculi: a prospective, randomized study
    • Abstract: Objectives • To compare percutaneous nephrostomy (PCN) versus double J ureteric stent (JJ) as an initial urinary drainage in children with obstructive calcular anuria (OCA) and post‐renal acute renal failure (ARF) due to bilateral ureteric calculi to identify the selection criteria for the initial urinary drainage method that will improve the urinary drainage, decrease the complications and facilitate the subsequent definitive clearance of stones. • As this comparison is lacking in literature. Patients and methods • A series of 90 children ≤12 years old presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric hospital in this randomized comparative study. • Patients with grade 0‐1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication to both methods of drainage. • Stable patients (or patients stabilized by dialysis) were randomized (non‐blinded, block randomization, closed envelope method) into PCN or bilateral JJ (45 patients for each group). • Initial urinary drainage was performed under general anesthesia and fluoroscopic guidance. We used 4.8‐6Fr JJ or 6‐8Fr PCN. • Primary outcome was the safety and efficacy of both groups in the recovery of renal functions. Both groups were compared in the operative and imaging times, complications, and period for return to normal serum creatinine. Secondary outcome included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome inside each group. Results • All presented patients completed the study with intention‐to‐treat analysis. • There was no significant difference between PCN and JJ in the operative and imaging times, period to return to normal creatinine and failure of insertion. The complications were significantly more with PCN group. • The stone size (> 2cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in JJ group. • The degree of hydronephrosis affected significantly the operative time for PCN insertion. Grade two hydronephrosis was associated with all cases of insertion failure in PCN group. • The total number of the needed subsequent interventions to clear stones was significantly higher with PCN group especially in patients with bilateral stones prepared for chemolytic dissolution (alkalinization) or shockwave lithotripsy (ESWL). Conclusion • We recommend the use of JJ as an initial urinary drainage in stones prepared for chemolytic dissolution or ESWL as this will lower the total number of the needed subsequent interventions to clear stones. This is also true for stones prepared for ureteroscopy, as JJ insertion will facilitate subsequent ureteroscopy due to previous ureteric stenting. • Mild hydronephrosis will prolong the operative time for PCN insertion and may increase the incidence of insertion failure. • We recommend the use of PCN if the stone size is > 2 cm as there was a more risk of possible iatrogenic ureteric injury during stenting alongside these large ureteric stones in addition to prolongation of operative time with increased incidence of failure.
       
  • Preoperative serum cholesterol is an independent prognostic factor for
           patients with renal cell carcinoma
    • Abstract: Objective • Increasing evidence suggests that alterations in the lipid profile are associated with the development, progression and prognosis of various cancers. • The purpose of this study was to assess the prognostic role of preoperative serum cholesterol in patients with renal cell carcinoma (RCC). Patients and Methods • We analyzed 867 patients, who underwent radical or partial nephrectomy for RCC between 2002 and 2012. • Total cholesterol levels were determined in preoperative serum using the CHOD‐PAP method. • The association with cancer‐specific survival (CSS) was assessed with Cox models. • Discrimination was quantified with the C‐index. • The median follow‐up was 52 months. Results • The median serum cholesterol was 195 mg/dl (IQR 166‐232). • Decreasing serum cholesterol was associated with more advanced T, N and M stages (P
       
  • Evaluation of urinary prostate cancer antigen‐3 (PCA3) and
           TMPRSS2‐ERG score changes when starting androgen‐deprivation
           therapy with triptorelin 6‐month formulation in patients with
           locally advanced and metastatic prostate cancer
    • Abstract: Objective To assess prostate cancer antigen‐3 (PCA3) and TMPRSS2‐ERG scores in patients with advanced and metastatic prostate cancer at baseline and after 6 months of treatment with triptorelin 22.5 mg, and analyse these scores in patient‐groups defined by different disease characteristics. Patients and Methods The Triptocare study was a prospective, open‐label, multicentre, single‐arm, Phase III study of triptorelin 22.5 mg in men with locally advanced or metastatic prostate cancer, who were naïve to androgen‐deprivation therapy (ADT). The primary objective was to model the urinary PCA3 change at 6 months, according to baseline variables. Other outcome measures included urinary PCA3 and TMPRSS2‐ERG scores and statuses, and serum testosterone and prostate‐specific antigen (PSA) levels at baseline and at 1, 3 and 6 months after initiation of ADT. Safety was assessed by recording adverse events and changes in laboratory parameters. Results The intent‐to‐treat population comprised 322 patients; 39 (12.1%) had non‐assessable PCA3 scores at baseline, and 109/322 (33.9%), 215/313 (68.7%) and 232/298 (77.9%) had non‐assessable PCA3 scores at 1, 3 and 6 months, respectively. Baseline Gleason score was the only variable associated with non‐assessability of PCA3 score at 6 months (P = 0.017) – the hazard of having a non‐assessable PCA3 score at 6 months was 1.824‐fold higher (95% confidence interval 1.186–2.805) in patients with a Gleason score ≥8 vs those with a Gleason score ≤6. The median PCA3 scores at baseline were significantly higher in patients aged ≥65 years vs those aged 90% of patients achieved castrate levels of testosterone (
       
  • Impact of the International Continence Society report on the
           standardisation of terminology in nocturia on the quality of reports on
           nocturia and nocturnal polyuria: a systematic review
    • Abstract: Objectives To systematically review and evaluate the impact of the ICS‐2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and NP. In 2002, the International Continence Society (ICS) defined nocturnal polyuria (NP) as a NP index (nocturnal urine volume/total 24‐h urine volume) exceeding 0.2‐0.33, depending on age. Materials and Methods In April 2013 the Pubmed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativity. Quality scores of items were compared between studies published before and after the ICS‐2002 report. Results The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, IQR 4‐6) but low for external validity. Following publication of the ICS‐2002 report, external validity showed a significant change from 1 (IQR 1‐2) to 2 (1‐2.5, p=0.019). Nocturia remained undefined in 12 studies. Nineteen different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n=11) of studies before and 66% (n=27) after the ICS‐2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies, respectively, after the ICS‐2002 report. Conclusion The ICS‐2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voidings between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
       
  • Factors Influencing Disease Progression of Prostate Cancer under Active
           Surveillance: A McGill University Health Center Cohort
    • Abstract: Objective To evaluate clinical and pathological factors that influence the risk for disease progression in a cohort of patients with low‐intermediate risk prostate cancer (PCa) under active surveillance (AS). Patients and Methods We studied a total of 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favorable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least 1 repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3–6 months for prostate‐specific antigen (PSA) measurement and physical examination (PE). Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least 1 core, and a predominant Gleason pattern of 4. Results For the 155 patients, the mean age (SD) at diagnosis was 67 (7) years; median follow‐up was 5.4 years (interquartile range [IQR], 3.6–9.5 years). Of these, 67 patients, 25 patients, 6 patients, and 2 patients had 2, 3, 4, and 5 repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score (GS) of 3+4, while the remaining 144 (93%) patients had a GS of ≤6. A total of 50 (32.3%) patients showed disease progression on repeat biopsies, with a median progression‐free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5‐year overall survival rate was 100%. Having a PSA density (PSAd) of >0.15, >1 positive core, and GS >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P10% showed a trend toward significance for a higher progression rate (P=0.054). On multivariate analysis, only the presence of PSAd >0.15 remained significant for a higher progression rate (P0.15 ng/ml/cc is an important predictor for disease progression.
       
  • Testosterone Therapy and Cancer Risk
    • Abstract: Objective To determine if testosterone therapy status modifies a man's risk of cancer. Patients and Methods Urology clinic hormone database queried for all men with a serum testosterone level and charts examined to determine testosterone supplementation status. Linked patient records to the Texas Cancer Registry to determine the incidence of cancer. Men accrued time at risk from the date initiating TT or the first office visit for men not on TT. Standardized incidence rates and time to event analysis performed Results 247 were on testosterone therapy and 211 did not use testosterone. 47 men developed cancer–27 (12.8%) of the men not on TT and 20 (8.1%) of the men on TT. No significant difference in the risk of cancer incidence based on TT (HR 1.0, 95% CI 0.57 – 1.9, p=1.8). No difference in prostate cancer risk based on TT status (HR 1.2, 95% CI 0.54‐2.5). Conclusion No change in cancer risk overall, or prostate cancer risk, specifically, for men over 40 utilizing long term testosterone therapy.
       
  • A Phase II, Randomized, Double‐blind, Placebo‐Controlled Trial
           of Methylphenidate for Reduction of Fatigue in Prostate Cancer Patients
           Receiving LHRH‐Agonist Therapy
    • Abstract: Objectives To investigate whether methylphenidate could alleviate fatigue, as measured by the Functional Assessment of Cancer Therapy: Fatigue subscale (FACT‐F), in men with PCa treated with an LHRH agonist for a minimum of 6 months. To assess changes in global fatigue and QoL as measured by the Bruera Global Fatigue Severity Scale (BFS) and the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36), respectively. Materials and Methods We performed a single center, randomized, double‐blind, placebo‐controlled trial with the goal to recruit 128 participants. Men treated with an LHRH agonist for PCa were screened between February 2008 and June 2012 for fatigue at our outpatient clinics using the BFS. Participants were randomized to receive either 10mg daily of methylphenidate or a placebo. Change of fatigue levels and in SF‐36 scores between both groups were compared using linear regression adjusted for baseline scores. Results The study was closed prematurely due to poor accrual. Of the 790 subjects screened, 24 men were randomized to methylphenidate or placebo (12 per group). After 10 weeks, the improvement in fatigue was greater in the methylphenidate arm than in placebo [+7.7(7.7) vs. +1.4(7.6)]; p=0.022). The within‐group analysis demonstrated a significant improvement of fatigue in the methylphenidate arm (p=0.008) but not in the placebo arm (p=0.82). The use of methylphenidate also resulted in a significantly greater improvement in QoL as measured by the physical and mental component score than placebo (p=0.04 for both component scores). Conclusion Our findings support the benefit of methylphenidate on fatigue and QoL among men with LHRH‐induced fatigue. Clinicians should be aware of its benefit and should consider discussing these findings with their fatigued patients.
       
  • Early unclamping technique during robotically‐assisted
           laparoscopic partial nephrectomy can minimize warm ischemia without
           increasing morbidity
    • Abstract: Purpose Early unclamping of the renal pedicle has been reported to decrease WIT during laparoscopic PN. Our objective was to compare peri‐operative outcomes of early unclamping (EU) versus standard unclamping (SU) during robotically assisted partial nephrectomy (RPN). Patients and methods A retrospective multi‐institutional study was conducted at eight French academic centres between 2009 and 2013. Patients who underwent RPN for a renal mass were included in the study. Patients without vascular clamping or for whom the decision to perform a radical nephrectomy was taken before unclamping were excluded. Peri‐operative outcomes were compared using χ2 test and Fisher exact tests for discrete variables and Mann‐Whitney test for continuous variables. Predictors of WIT and estimated blood loss (EBL) were assessed using multiple linear regression analysis. Results There were 430 patients: 222 in the EU group and 208 in the SU group. Tumors were larger (35.8 vs. 32.3 mm, p= 0.02) and more complex (RENAL Score: 6.9 vs. 6.1, p50 procedures: 12.2% vs. 1.4%, p
       
  • NICE Guidelines on Prostate Cancer Active Surveillance: Is UK practice
           leading the World'
    •  
  • External validation of the Briganti nomogram to estimate the probability
           of specimen confined disease in patients with high‐risk prostate
           cancer
    • Abstract: OBJECTIVE To establish an external validation of the updated nomogram from Briganti et al, which provides estimates of the probability of specimen‐confined disease from age, PSA, clinical stage, and biopsy Gleason score in preoperatively defined high risk PCa. PATIENTS AND METHODS 523 high‐risk PCa patients as defined by d'Amico classification undergoing RP and bilateral lymph node dissection in two academic centres between 1990 and 2013. Specimen‐confined (SC) disease was defined as pT2–pT3a node‐negative PCa with negative surgical margins. The Receiver Operating Characteristic (ROC) curve was obtained to quantify the overall accuracy (Area Under the Curve, AUC) of the model to predict SC disease. Calibration curve was then constructed to illustrate the relationship between the risk‐estimates obtained by the model (X‐axis) and the observed proportion of SC disease (y‐axis). Kaplan‐Meier method was used for biochemical recurrence‐free survival (BCR) assessment. RESULTS Median age and PSA level were 64 years and 21 ng/ml. Definition of high risk PCa was based on PSA level only in 38.3% of cases, a biopsy Gleason score >7 in 34.5% of cases, a clinical stage >T2b in 6.9% of cases, or a combination of these 2 or 3 factors in 20.3% of cases. Positive surgical margins were observed in 43.6% with a rate of 14.8% in pT2 cancers, lymph node metastasis in 12.1% patients. pT stage was pT0:0.9%, pT2:28.9%, pT3a:37.5%, and pT3b‐4:32.7%. Overall, 44.4% of PCa had (n=232) SC disease. PSA, and cT were independently predictive for SC disease. The 2‐, 5‐, and 8‐year BCR free recurrence was significantly improved in specimen‐confined disease as compared with not organ‐confined disease (respectively 80.87% [73.67; 86.29] vs 37.55% [30.64; 44.44]; 63.53% [52.37; 72.74] vs 26.93% [19.97; 34.36]; 55.08 % [41.49; 66.74] vs 19.52% [12.50; 27.70]; p
       
  • Prognosis of patients with pelvic lymph node (LN) metastasis after radical
           prostatectomy: Value of extranodal extension and size of the largest LN
           metastasis
    • Abstract: Objective To assess the prognostic role of extranodal extension (ENE) and the size of the largest lymph node (LN) metastasis in predicting early biochemical relapse (eBCR) in patients with LN metastasis after radical prostatectomy (RP). Patients and Methods We evaluated BCR‐free survival in men with LN metastases after RP and pelvic LN dissection performed in six high‐volume centres. Multivariable Cox regression tested the role of ENE and diameter of largest LN metastasis in predicting eBCR after adjusting for clinicopathological variables. We compared the discrimination of multivariable models including ENE, the size of largest LN metastasis and the number of positive LNs. Results Overall, 484 patients were included. The median (interquartile range, IQR) follow‐up was 16.1 (6–27.5) months. The median (IQR) number of removed LNs was 10 (4–14), and the median (IQR) number of positive LNs was 1 (1–2). ENE was present in 280 (58%) patients, and 211 (44%) had their largest metastasis >10 mm. Patients with ENE and/or largest metastasis of >10 mm had significantly worse eBCR‐free survival (all P < 0.01). On multivariable analysis, number of positive LNs (≤2 vs >2) and the diameter of LN metastasis (≤10 vs >10 mm), but not ENE, were significant predictors of eBCR (all P < 0.003). ENE and diameter of LN metastasis increased the area under the curve of a baseline multivariable model (0.663) by 0.016 points. Conclusions The diameter of the largest LN metastasis and the number of positive LNs are independent predictors of eBCR. Considered together, ENE and the diameter of the largest LN metastasis have less discrimination than the number of positive LNs.
       
  • Nephron‐sparing management vs radical nephroureterectomy for
           low‐ or moderate‐grade, low‐stage upper tract urothelial
           carcinoma
    • Abstract: Objective To compare overall and cancer‐specific outcomes between patients with upper tract urothelial carcinoma (UTUC) managed with either radical nephroureterectomy (RNU) or nephron‐sparing measures (NSM) using a large population‐based dataset. Patients and Methods Using Surveillance, Epidemiology, and End Results (SEER) data, patients diagnosed with low‐ or moderate‐grade, localised non‐invasive UTUC were stratified into two groups: those treated with RNU or NSM (observation, endoscopic ablation, or segmental ureterectomy). Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) rates were determined using cumulative incidence estimators. Adjusting for clinical and pathological characteristics, the associations between surgical type, all‐cause mortality and CSM were tested using Cox regressions and Fine and Gray regressions, respectively. Results Of 1227 patients [mean (sd) age 70.2 (11.00) years, 63.2% male] meeting inclusion criteria, 907 (73.9%) and 320 (26.1%) patients underwent RNU and NSM for low‐ or moderate‐grade, low‐stage UTUC from 1992 to 2008. Patients undergoing NSM were older (mean age 71.6 vs 69.7 years, P < 0.01) with a greater proportion of well‐differentiated tumours (26.3% vs 18.0%, P = 0.001). While there were differences in OCM between the groups (P < 0.01), CSM trends were equivalent. After adjustment, RNU treatment was associated with improved non‐cancer cause survival [hazard ratio (HR) 0.78, confidence interval [CI] 0.64–0.94) while no association with CSM was demonstrable (HR 0.89, CI 0.63–1.26). Conclusions Patients with low‐ or moderate‐grade, low‐stage UTUC managed through NSM are older and are more likely to die of other causes, but they have similar CSM rates to those patients managed with RNU. These data may be useful when counselling patients with UTUC with significant competing comorbidities.
       
  • Indications, results and safety profile of transperineal sector biopsies
           (TPSB) of the prostate: a single centre experience of 634 cases
    • Abstract: Objective To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. Patients and Methods A retrospective review of a single‐centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24–38 cores using a ‘sector plan’. Procedures were carried out under general anaesthetic in most patients. Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low‐risk disease diagnosed based on a 12‐core TRB (307). Results Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors. As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL). Of men with Gleason 3+3 disease on TRB, 29% were upgraded and went on to have radical treatment. Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per‐urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. Conclusions TPSB of the prostate has a role in defining disease previously missed or under‐diagnosed by TRB. The procedure has low morbidity.
       
  • Incidence and predictors of understaging in patients with clinical T1
           urothelial carcinoma undergoing radical cystectomy
    • Abstract: Objective To evaluate predictors of understaging in patients with presumed non‐muscle‐invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. Patients and Methods We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011. In all, 60 of these cT1 patients had undergone a restaging TURBT before RC. The primary outcome measure was pathological staging of ≥T2 disease at the time of RC. Results In all, 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25–0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, P = 0.05) were independent risk factors for understaging. Conclusions Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.
       
  • Perioperative and renal functional outcomes of elective
           robot‐assisted partial nephrectomy for renal tumors with high
           surgical complexity
    • Abstract: Objective To evaluate the perioperative, postoperative and functional outcomes of robot‐assisted partial nephrectomy (RAPN) for renal tumors with high surgical complexity at a large volume centre. Patients and Methods Perioperative and functional outcomes of RAPNs for renal tumors with a PADUA score ≥10 performed at our institution between September 2006 and December 2012 were collected in a prospectively maintained database and analysed. Surgical complications were graded according to the Clavien‐Dindo classification. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at the third postoperative day and 3‐6 months after surgery. Results Forty‐four RAPN for renal tumors with PADUA score ≥10 were included in the analysis. Twenty‐three tumors (52.3%) were cT1b. Median operative time, estimated blood loss and warm ischemia time were 120 minutes (IQR 94‐132, range 60‐230), 150 ml (IQR 80‐200, range 25‐1200) and 16 minutes (IQR 13.8‐18, range 5‐35), respectively. Two intraoperative complications occurred (4.5%): one inferior vena caval injury and one bleeding from the renal bed, which were both managed robotically. Postoperative complications were observed in 10 cases (22.7%), of whom 4 (9.1%) were high Clavien grade, including two bleedings that required percutaneous embolization, one urinoma that resolved with ureteral stenting and one bowel occlusion managed with laparoscopic adhesiolysis. Two patients (4.5%) had positive surgical margins and were followed expectantly with no radiological recurrence at an average follow‐up of 23 months. Mean serum creatinine levels were significantly increased after surgery (121.1 vs. 89.3 μmol/L; p=0.001), but decreased over time, without significant differences with the preoperative values at 6 months follow‐up (96.4 vs. 89.3 μmol/L; p=0.09). The same trend was observed for eGFR. Conclusion In experienced hands RAPN for renal tumors with PADUA score ≥10 is feasible with short warm ischemia time, acceptable major complication rate and good long‐term renal functional outcomes. A slightly higher risk of positive surgical margins can be expected due to the high surgical complexity of these lesions. The robotic technology allows a safe expansion of the indications of minimally invasive partial nephrectomy to anatomically very challenging renal lesions in referral centres.
       
  • The Impact of Surgeon Volume on the Morbidity and Costs of Radical
           Cystectomy in the United States: A Contemporary Population‐Based
           Analysis
    • Abstract: Objective To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity as well as the economic burden of bladder cancer in the United States. Methods We captured all patients who underwent a RC (ICD‐9 code 57.71) from 2003 to 2010, using a nationwide hospital discharge database. Patient, hospital, and surgical characteristics were evaluated. Annual volume of RC for surgeons was divided into quintiles. Multivariable regression models were developed adjusting for clustering and survey weighting to evaluate the outcomes including 90‐day major complications (Clavien 3‐5) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis. Results The weighted cohort included 49,792 RC patients with an overall 90‐day major complication rate of 16.2%. Compared to surgeons performing one RC annually, surgeons performing ≥7 RC each year had a 45% decreased odds of major complications (OR: 0.55, p
       
  • Prostate Tumor Volumes: Agreement Between MRI and Histology Using Novel
           Co‐registration Software
    • Abstract: Objective To evaluate the agreement in volumes of prostate tumors determined on multiparametric MRI (mpMRI) and histologic assessment, using detailed software‐assisted co‐registration. Materials and Methods 37 patients who underwent 3T mpMRI (T2WI, DWI/ADC, DCE) were included. A radiologist traced the borders of suspicious lesions on T2WI and ADC and assigned a suspicion score (SS) from 2‐5; a uro‐pathologist traced borders of tumors on histopathologic photographs. Software was used to co‐register MRI and 3D digital reconstructions of RP specimens and compute imaging and histopathologic volumes. Agreement in volumes between MRI and histology was assessed using Bland‐Altman plots and stratified by tumor characteristics. Results Among 50 tumors, mean difference and 95% limits of agreement on MRI relative to histology were ‐32% (‐128% to +65%) on T2WI and ‐47% (‐143% to +49%) on ADC. For all tumor subsets, volume under‐estimation was more marked on ADC maps (mean difference ranging from ‐57% to ‐16%) than T2WI (mean difference ranging from ‐45% to +2%). 95% limits of agreement were wide for all comparisons, with lower 95% limit ranging between ‐77% and ‐143% across assessments. Volume under‐estimation was more marked for tumors with Gleason score ≥7 or MRI SS 4 or 5. Conclusion Volume estimates of PCa using MRI tended to substantially under‐estimate histopathologic volumes, with wide variability in extent of under‐estimation across cases. These findings have implications for efforts to use MRI to guide risk assessment.
       
  • Predictors of preoperative delays prior to radical cystectomy for bladder
           cancer in Quebec, Canada: a population‐based study
    • Abstract: Objectives To characterize and measure different components of preoperative delays experienced by bladder cancer patients before radical cystectomy in the province of Quebec, Canada and to identify predictors of long wait times. Methods We conducted a retrospective cohort study using data of patients who underwent radical cystectomy for bladder cancer from 2000 to 2009 in Quebec. The cohort was obtained with the linkage of two health provincial databases: the RAMQ database (data on medical services dispensed to Quebec residents), and the ISQ database (demographic data on births and deaths). For the entire cohort, we determined several components of delay from first medical visit related to bladder cancer symptoms until radical cystectomy. Predictors of long delays were analysed using logistic regression. Results We analyzed a total of 2778 patients who met inclusion criteria. Median urologist referral delay was 32 days. Median delays between first urologist visit and radical cystectomy and from TURBT to surgery were 90 days and 46 days, respectively. Median overall delay was 116 days. All components of delay progressively increased from the decade of 1990 to the 2000's. Male sex was a protective factor for several components of delay, which suggests that gender‐related variations may exist in the continuum of care for bladder cancer (OR= 0.67, 95%CI: 0.50‐0.89 for overall delay). Patient's age and gender were associated with delayed urologist referral, delayed time to TURBT, and long overall wait time. Factors related to the health system were associated with long cystoscopy delays. Conclusion Median preoperative delays among patients with bladder cancer have been increasing and remain unacceptably long. Patient's age, gender, and type of hospital facility were associated with long wait times.
       
  • Salvage Surgery After Energy Ablation For Renal Masses
    • Abstract: Objectives ● To evaluate the feasibility, safety, pathologic, radiologic and functional outcomes of salvage surgery after prior renal mass ablation therapy. Patients and Methods ● After IRB approval, we reviewed our renal tumor database, and described characteristics and outcomes of patients who experienced a local recurrence after energy ablation for renal masses, and underwent salvage surgical therapy. Results ● Fourteen patients fit the inclusion criteria. Median age was 65 years (IQR 59‐77), with median Charlson Comorbidity Index of 2 (IQR 0.75‐3.00). Three patients had solitary kidney. Seven patients received their ablation therapies at an outside institution. Ten patients previously underwent percutaneous RFA, 3 percutaneous cryoablation, and 1 laparoscopic cryoablation. Median nephrometry score at time of surgery was 7 (IQR 5‐9). Time from ablation to surgery was 26.5 months (IQR 16.3‐39.3). ● Eleven patients underwent partial nephrectomy, and 3 underwent planned radical nephrectomy. Median surgery time was 203 minutes (IQR 177‐265). Median length of stay was 5.5 days. There was 1 microscopic positive surgical margin. Median tumor size at final pathology was 3.1 cm. Thirteen patients had RCC and 1 had no tumor present. Nine were pT1a, 1 pT1b, 2 pT3a, and 1 pT3b. ● There were 4 Clavien grade 3 complications in 4 patients. ● Median preoperative eGFR and eGFR at last follow‐up were 66 and 66 mL/min/1.73 m2. ● There were no deaths at median follow‐up of 26.5 months (IQR 10.5‐49.5). Conclusions ● Patients with prior renal ablation therapy can be salvaged with partial or radical nephrectomy with good intermediate‐term outcomes. ● These procedures may be associated with a high rate of adverse events. ● Longer follow‐up is necessary.
       
  • Impact of Renal Surgery for Cortical Neoplasms on Lipid Metabolism
    • Abstract: Objective To examine incidence of and risk factors for development of hyperlipidemia (HL) in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as HL is a major source of morbidity in chronic kidney disease (CKD). Patients and Methods Two‐center retrospective analysis of 905 patients (mean age 57.5 years, mean follow‐up 78 months) who underwent RN (610) or PN (295) from 7/1987‐6/2007. Demographics, preoperative and postoperative HL were recorded. De novo HL was defined ≥6 months after surgery with laboratory values meeting National Cholesterol Education Program ATP III definitions. Kaplan‐Meier method was used to assess freedom from de novo HL. Multivariable analysis (MVA) was conducted to elucidate risk factors for de novo HL. Results There were no significant differences with respect to demographics, preoperative GFR
       
  • Can Factors Affecting Complication Rates for Ureteral Reimplantation be
           Predicted' Use of Clavien Classification System in Pediatric
           Population
    • Abstract: Clavien classification (CC) of postoperative complications is widely used in surgical procedures. We aimed to determine predictive factors on postoperative complications of ureteral reimplantation (UR) in children by utilizing this standardized system. MATERİALS AND METHODS We reached the date of 383children who underwent UR for vesicoureteral reflux (VUR) and obstructing megaureters (OM) between 2002 and 2011.Intravesical and extravesical URs were performed in 338 and 45 patients, respectively. Complications were evaluated according to the CC systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS A total of 247 females and 136 males were studied. Mean patient age was 46 ± 25 months and the mean follow‐up period was 49,4±27,8 months. Mean hospitalization time was 4,7 ±1,6days. Complications were occurred in 76(19,8%) of patients.Of these complications 34(8,8%) was clavien grade 1, 22(5,7%) was clavien grade 2 and 20(5,2%) was clavien grade 3. The SFU grade3‐4 hydronephrosis, OM, tailoring‐tapering and folding procedure, refractory VD and duplex system were statistically significant on univariate analysis.Prior injection history, paraureteral diverticula, stenting, gender,age, operation technique(intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory VD, tailoring‐tapering procedure, diameter >9mm and duplex system reached statistical significance. CONCLUSİON UR still remains as a valid option for treatment of certain VUR patients. Refractory VD, tailoring‐tapering procedure, diameter >9mm and associated duplex systems are the outstanding predictive factors for postoperative complication. Use of standardized complication grading systems should be encouraged to determine the valid complication rates between series.
       
  • Twitter Response to the United States Preventive Services Task Force
           Recommendations against Screening with Prostate Specific Antigen
    • Abstract: Objective To examine public and media response to the United States Preventive Services Task Force's (USPSTF) draft (October 2011) and finalized (May 2012) recommendations against prostate‐specific antigen (PSA) testing using Twitter, a popular social network with over 200 million active users. Materials and Methods We used a mixed methods design to analyze posts on Twitter, called “tweets.” Using the search term “prostate cancer,” we archived tweets in the 24 hour periods following the release of the USPSTF draft and finalized recommendations. We recorded tweet rate per hour and developed a coding system to assess type of user and sentiment expressed in tweets and linked articles. Results After the draft and finalized recommendations, 2042 and 5357 tweets focused on the USPSTF report, respectively. Tweet rate nearly doubled within two hours of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro‐screening during both periods. In contrast, anti‐screening articles were tweeted more frequently in both draft and finalized study periods. From the draft to the finalized recommendations, the proportion of anti‐screening tweets and anti‐screening article links increased (p= 0.03 and p
       
  • Burden of male lower urinary tract symptoms (LUTS) suggestive of benign
           prostatic hyperplasia (BPH) – focus on the UK
    • Abstract: Objectives To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK Patients and Methods Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013 Data were extracted and the quality of the studies was assessed for inclusion UK data were reported; in the absence of UK data, European and US data were provided Results In total, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014 The papers show that LUTS are common in the UK – affecting about 3% of men aged 45–49 years, rising to >30% in men aged 85 years and older European and US studies have demonstrated the major impact of LUTS on quality of life of the patient and their partner LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial Conclusion LUTS associated with BPH is a highly impactful condition which is often undertreated LUTS/BPH have a major impact on men, their families, health services and society Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms
       
  • Genetic polymorphisms modify bladder cancer recurrence and survival in a
           USA population‐based prognostic study
    • Abstract: Objective To identify genetic variants that modify bladder cancer prognosis focusing on genes involved in major biological carcinogenesis processes (apoptosis, proliferation, DNA repair, hormone regulation, immune surveillance, and cellular metabolism), as nearly half of patients with bladder cancer experience recurrences reliable predictors of this recurrent phenotype are needed to guide surveillance and treatment. Patients and methods We analysed variant genotypes hypothesised to modify these processes in 563 patients with urothelial‐cell carcinoma enrolled in a population‐based study of incident bladder cancer conducted in New Hampshire, USA. After diagnosis, patients were followed over time to ascertain recurrence and survival status, making this one of the first population‐based studies with detailed prognosis data. Cox proportional hazards regression was used to assess the relationship between single nucleotide polymorphisms (SNPs) and prognosis endpoints. Results Patients with aldehyde dehydrogenase 2 (ALDH2) variants had a shorter time to first recurrence (adjusted non‐invasive hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.29–2.78). There was longer survival among patients with non‐invasive tumours associated with DNA repair X‐ray repair cross‐complementing protein 4 (XRCC4) heterozygous genotype compared with wild‐type (adjusted HR 0.53, 95% CI 0.38–0.74). Time to recurrence was shorter for patients who had a variant allele in vascular cellular adhesion molecule 1 (VCAM1) and were treated with immunotherapy (P interaction < 0.001). Conclusions Our analysis suggests candidate prognostic SNPs that could guide personalised bladder cancer surveillance and treatment.
       
  • Face, content, construct and concurrent validity of dry laboratory
           exercises for robotic training using a global assessment tool
    • Abstract: Objectives To evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content, construct and concurrent validities. To evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance. Materials and Methods Participants were prospectively categorized into two groups: robotic novice (no cases as primary surgeon) and robotic expert (≥30 cases). Participants completed three virtual reality (VR) exercises using the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA), as well as corresponding dry lab versions of each exercise (Mimic Technologies, Seattle, WA, USA) on the da Vinci Surgical System. Simulator performance was assessed by metrics measured on the simulator. Dry lab performance was blindly video‐evaluated by expert review using the six‐metric GEARS tool. Participants completed a post‐study questionnaire (to evaluate face and content validity). A Wilcoxon non‐parametric test was used to compare performance between groups (construct validity) and Spearman's correlation coefficient was used to assess simulation to dry lab performance (concurrent validity). Results The mean number of robotic cases experienced for novices was 0 and for experts the mean (range) was 200 (30–2000) cases. Expert surgeons found the dry lab exercises both ‘realistic’ (median [range] score 8 [4–10] out of 10) and ‘very useful’ for training of residents (median [range] score 9 [5–10] out of 10). Overall, expert surgeons completed all dry lab tasks more efficiently (P < 0.001) and effectively (GEARS total score P < 0.001) than novices. In addition, experts outperformed novices in each individual GEARS metric (P < 0.001). Finally, in comparing dry lab with simulator performance, there was a moderate correlation overall (r = 0.54, P < 0.001). Most simulator metrics correlated moderately to strongly with corresponding GEARS metrics (r = 0.54, P < 0.001). Conclusions The robotic dry lab exercises in the present study have face, content, construct and concurrent validity with the corresponding VR tasks. Until now, the assessment of dry lab exercises has been limited to basic metrics (i.e. time to completion and error avoidance). For the first time, we have shown it is feasibile to apply a global assessment tool (GEARS) to dry lab training.
       
  • Does prostate HistoScanning™ play a role in detecting prostate
           cancer in routine clinical practice' Results from three independent
           studies
    • Abstract: Objectives To evaluate the ability of prostate HistoScanning™ (PHS; Advanced Medical Diagnostics, Waterloo, Belgium) to detect, characterize and locally stage prostate cancer, by comparing it with transrectal ultrasonography (TRUS)‐guided prostate biopsies, transperineal template prostate biopsies (TTBs) and whole‐mount radical prostatectomy specimens. Subjects and Methods Study 1. We recruited 24 patients awaiting standard 12‐core TRUS‐guided biopsies of the prostate to undergo PHS immediately beforehand. We compared PHS with the TRUS‐guided biopsy results in terms of their ability to detect cancer within the whole prostate and to localize it to the correct side and to the correct region of the prostate. Lesions that were suspicious on PHS were biopsied separately. Study 2. We recruited 57 patients awaiting TTB to have PHS beforehand. We compared PHS with the TTB pathology results in terms of their ability to detect prostate cancer within the whole gland and to localize it to the correct side and to the correct sextant of the prostate. Study 3. We recruited 24 patients awaiting radical prostatectomy for localized prostate cancer to undergo preoperative PHS. We compared PHS with standardized pathological analysis of the whole‐mount prostatectomy specimens in terms of their measurement of total tumour volume within the prostate, tumour volume within prostate sextants and volume of index lesions identified by PHS. Results The PHS‐targeted biopsies had an overall cancer detection rate of 38.1%, compared with 62.5% with standard TRUS‐guided biopsies. The sensitivity and specificity of PHS for localizing tumour to the correct prostate sextant, compared with standard TRUS‐guided biopsies, were 100 and 5.9%, respectively. The PHS‐targeted biopsies had an overall cancer detection rate of 13.4% compared with 54.4% for standard TTB. PHS had a sensitivity and specificity for cancer detection in the posterior gland of 100 and 13%, respectively, and for the anterior gland, 6 and 82%, respectively. We found no correlation between total tumour volume estimates from PHS and radical prostatectomy pathology (Pearson correlation coefficient −0.096). Sensitivity and specificity of PHS for detecting tumour foci ≥0.2 mL in volume were 63 and 53%. Conclusions These three independent studies in 105 patients suggest that PHS does not reliably identify and characterize prostate cancer in the routine clinical setting.
       
  • Phase III, randomised, double‐blind, placebo‐controlled study
           of the β3‐adrenoceptor agonist mirabegron, 50 mg once
           daily, in Japanese patients with overactive bladder
    • Abstract: Objective To evaluate the efficacy and safety of the β3‐adrenoceptor agonist mirabegron, in a Japanese population with overactive bladder (OAB). Patients and Methods This randomised, double‐blind, placebo‐controlled phase III study enrolled adult patients experiencing OAB symptoms for ≥24 weeks. Patients with ≥ 8 micturitions/24 h and ≥1 urgency episode/24 h or ≥1 urgency incontinence episode/24 h were randomised to once‐daily placebo, mirabegron 50 mg or tolterodine 4 mg (as an active comparator, without testing for non‐inferiority of efficacy and safety) for 12 weeks. The primary endpoint was the change in the mean number of micturitions/24 h from baseline to final assessment. Secondary endpoints included micturition variables related to urgency and/or incontinence and quality‐of‐life domain scores on the King's Health Questionnaire. Safety assessments included adverse events (AEs), post‐void residual urine volume, laboratory variables, vital signs and 12‐lead electrocardiogram. Results A total of 1139 patients were randomised to receive placebo (n = 381), mirabegron 50 mg (n = 380) or tolterodine 4 mg (n = 378). Demographic and baseline characteristics were similar among the treatment groups. At final assessment, mirabegron was significantly superior to placebo in terms of mean [sd] change from baseline in number of micturitions/24 h (–1.67 [2.212] vs ‐0.86 [2.354]; P < 0.001) and mean [sd] change from baseline in number of urgency episodes/24 h (–1.85 [2.555] vs –1.37 [3.191]; P = 0.025), incontinence episodes/24 h (–1.12 [1.475] vs –0.66 [1.861]; P = 0.003), urgency incontinence episodes/24 h (–1.01 [1.338] vs –0.60 [1.745]; P = 0.008), and volume voided/micturition (24.300 [35.4767] vs 9.715 [29.0864] mL; P < 0.001). The incidence of AEs in the mirabegron group was similar to that in the placebo group. Most AEs were mild and none were severe. Conclusions Mirabegron 50 mg once daily is an effective treatment for OAB symptoms, with a low occurrence of side effects in a Japanese population.
       
  • Use of advanced treatment technologies among men at low risk of dying from
           prostate cancer
    •  
  • A clinical evaluation of a sensor to detect blockage due to crystalline
           biofilm formation on indwelling urinary catheters
    • Abstract: Objective To test the performance and acceptability of an early warning sensor to predict encrustation and blockage of long‐term indwelling urinary catheters. Patients and Methods In all, 17 long‐term indwelling catheter users, 15 ‘blockers’ and two ‘non‐blockers’ (controls) were recruited; 11 participants were followed prospectively until catheter change, three withdrew early and three did not start. Two sensors were placed in series between the catheter and the urine bag at catheter change. The sensor nearest the bag was changed at the same time as the bag change (weekly); the sensor nearest the catheter remained in situ for the duration of the catheter's life. Bacteriology and pH determinations were performed on urine samples at each bag, sensor and catheter change. The colour of the sensors was recorded daily. On removal, each sensor and the catheter were examined for visible evidence of encrustation and blockage. Participants were asked to keep a daily diary to record colour change and any other relevant observations and to complete a psychosocial impact of assistive devices tool at the end of the study. Participants and carers/healthcare professionals (when involved in urine bag or catheter change) were asked to complete a questionnaire about the sensor. Results Urease‐producing bacteria were isolated from seven of the 14 patients (including early withdrawals; P. mirabilis in four, Morganella or Providencia in three). In six of the seven patients the sensors turned blue‐black; two of these were early withdrawals, two went to planned catheter change (one of these was recruited as a ‘non‐blocker’) and three had catheter blockage. The number of days of catheterisation before blockage was 22, 23 and 25 days, and the sensor changed colour within 24–48 h after insertion. The urine mean (range) pH of the sensors that turned blue‐black was 7.6 (5.5–9.0) and of the sensors that remained yellow 6.1 (5.1–7.5). The sensor was generally well‐received and was positive in the psychosocial assessment. Conclusions The sensor is a useful indicator of urine pH and of the conditions that lead to catheter blockage. It may be particularly useful for new indwelling catheter users. To be a universally acceptable predictor of catheter blockage, the time from sensor colour change to blockage needs to be reduced.
       
  • Subclassification of upper urinary tract urothelial carcinoma by the
           neutrophil‐to‐lymphocyte ratio (NLR) improves prediction of
           oncological outcome
    • Abstract: Objective To examine the potential role of the neutrophil‐to‐lymphocyte ratio (NLR) for subclassification of localised upper urinary tract urothelial carcinoma (UUT‐UC). Patients and Methods From 2004 to 2010, 234 patients with localised UUT‐UC underwent radical nephroureterectomy (RNU). NLRs were only obtained under afebrile conditions before RNU. Patients that underwent neoadjuvant or adjuvant chemotherapy were excluded. The prognostic impact of the NLR was assessed using the log‐rank test and multivariate analyses. Results Only advanced pathological stage (>T2) and a NLR of >3 were independently associated with metastasis (P < 0.001 and P = 0.02, respectively) and cancer‐specific mortality (P = 0.002 and P = 0.006, respectively). The use of a NLR of >3 further identified a poor prognostic group, especially in patients with T3 UUT‐UC for metastasis‐free survival and cancer‐specific survival (log‐rank test, both P < 0.001). Conclusions For localised UUT‐UC, pathological stage and preoperative NLR independently predict systemic recurrence and cancer‐specific death after RNU. Using the NLR for subclassification of T3 UUT‐UC seems to further identify a poor prognostic group and may help with clinical decisions about treatment intervention in clinical practice.
       
  • Prevalence of dyslipidaemia in patients with renal cell carcinoma: a
           case‐control study in China
    • Abstract: Objective To examine the prevalence of dyslipidaemia in patients with renal cell carcinoma (RCC) in a Chinese population. Patients and Methods In all, 550 histologically confirmed RCC cases and 570 controls, matched for age and sex were included. Total cholesterol, triglyceride, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) were assessed before treatment using standard techniques. The lipid profiles were defined as ‘normal’, ‘borderline high’, ‘high’ and ‘low’ according to Chinese Guidelines on Adult Dyslipidaemia. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression in both unadjusted and adjusted models. Results Abnormal LDL elevation was common in RCC cases compared with controls (P < 0.001). Results for total cholesterol, triglyceride and HDL levels between groups were insignificant. The OR for RCC for high levels of LDL (≥160 mg/dL) compared with those with a normal LDL profile was 4.675 (95% CI 1.900–11.500). After adjustment for age, gender, body mass index, smoking status, hypertension, diabetes, total cholesterol and triglyceride, the coexistence of high levels of LDL and RCC was large and statistically significant (OR 8.955, 95% CI 3.371–23.786). There was a significant coexistence of RCC for participants with high LDL levels when subgroups of cases with clear cell subtypes and advanced T stages were compared with controls. Conclusion Abnormal LDL elevation was prevalent in Chinese patients with RCC. The results remain to be evaluated in prospective cohorts.
       
  • Neoadjuvant chemotherapy for bladder cancer does not increase risk of
           perioperative morbidity
    • Abstract: Objective To determine whether neoadjuvant chemotherapy (NAC) is a predictor of postoperative complications, length of stay (LOS), or operating time after radical cystectomy (RC) for bladder cancer. Patients and Methods A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed to identify patients receiving NAC before RC from 2005 to 2011. Bivariable and multivariable analyses were used to determine whether NAC was associated with 30‐day perioperative outcomes, e.g. complications, LOS, and operating time. Results Of the 878 patients who underwent RC for bladder cancer in our study, 78 (8.9%) received NAC. Excluding those patients who were ineligible for NAC due to renal insufficiency, 78/642 (12.1%) received NAC. In all, 457 of the 878 patients (52.1%) undergoing RC had at least one complication ≤30 days of RC, including 43 of 78 patients (55.1%) who received NAC and 414 of 800 patients (51.8%) who did not (P = 0.58). On multivariable logistic regression, NAC was not a predictor of complications (P = 0.87), re‐operation (P = 0.16), wound infection (P = 0.32), or wound dehiscence (P = 0.32). Using multiple linear regression, NAC was not a predictor of increased operating time (P = 0.24), and patients undergoing NAC had a decreased LOS (P = 0.02). Conclusions Our study is the first large multi‐institutional analysis specifically comparing complications after RC with and without NAC. Using a nationally validated, prospectively maintained database specifically designed to measure perioperative outcomes, we found no increase in perioperative complications or surgical morbidity with NAC. Considering these findings and the well‐established overall survival benefit over surgery alone, efforts are needed to improve the uptake of NAC.
       
  • The Cancer of the Prostate Risk Assessment (CAPRA) score predicts
           biochemical recurrence in intermediate‐risk prostate cancer treated
           with external beam radiotherapy (EBRT) dose escalation or low‐dose
           rate (LDR) brachytherapy
    • Abstract: Objective To study the prognostic value of the University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) after various doses of external beam radiotherapy (EBRT) and/or permanent seed low‐dose rate (LDR) prostate brachytherapy (PB). Patients and Methods We retrospectively analysed 345 patients with intermediate‐risk prostate cancer, with PSA levels of 10–20 ng/mL and/or Gleason 7 including 244 EBRT patients (70.2–79.2 Gy) and 101 patients treated with LDR PB. The minimum follow‐up was 3 years. No patient received primary androgen‐deprivation therapy. bF was defined according to the Phoenix definition. Cox regression analysis was used to estimate the differences between CAPRA groups. Results The overall bF rate was 13% (45/345). The CAPRA score, as a continuous variable, was statistically significant in multivariate analysis for predicting bF (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.10–1.72, P = 0.006). There was a trend for a lower bF rate in patients treated with LDR PB when compared with those treated by EBRT ≤ 74 Gy (HR 0.234, 95% CI 0.05–1.03, P = 0.055) in multivariate analysis. In the subgroup of patients with a CAPRA score of 3–5, CAPRA remained predictive of bF as a continuous variable (HR 1.51, 95% CI 1.01–2.27, P = 0.047) in multivariate analysis. Conclusion The CAPRA score is useful for predicting biochemical recurrence in patients treated for intermediate‐risk prostate cancer with EBRT or LDR PB. It could help in treatment decisions.
       
  • A case‐control study: are urological procedures risk factors for the
           development of infective endocarditis'
    • Abstract: Objective To evaluate the association between urological procedures and the development of infective endocarditis (IE), as there are case‐reports linking urological procedures to IE but evidence of a causal relationship is lacking and no major guidelines advise prophylaxis to prevent development of IE during transurethral urological procedures. No case‐control study has been undertaken to examine the relationship between urological procedures and the development of IE. Patients and Methods Retrospective evaluation of the IE database at our institution. The population consisted of patients diagnosed with enterococcal, staphylococcal, Streptococcus bovis‐group and oral streptococcal IE over a 10‐year period. Possible risk factors for the development of IE, including urological procedures were collected. A case‐control design was used and univariable and multivariable analyses were carried out. Missing data was accounted for using the multiple imputations method. Results We included 384 patients with IE. There was a statistical association between the development of enterococcal IE and preceding urological procedures (odds ratio 8.21, 95% confidence interval 3.54–19.05, P < 0.05). Increasing age and being an intravenous drug user were also associated with enterococcal IE. Haemodialysis and the presence of an intracardiac device were associated with the development of coagulase‐negative staphyloccal IE. Conclusion This is the first study to show a statistical association between urological procedures and the development of IE. The bacteraemia leading to IE may be a result of the urological procedures or a consequence of the underlying urological pathology causing recurrent subclinical bacteraemias.
       
  • Impact of the type of ureteroileal anastomosis on renal function measured
           by diuretic scintigraphy: long‐term results of a prospective
           randomized study
    • Abstract: Objective To determine the long‐term effects of the direct refluxing‐type ureteroileal anastomosis technique with those of an antireflux technique on individual renal units, using diuretic scintigraphy in a prospectively randomized study. Patients and Methods Between 2002 and 2006, a prospective randomized study was conducted on 102 patients undergoing radical cystectomy and urinary diversion. In every patient, both ureters were randomized to be implanted using a direct refluxing technique or an antireflux, serous‐lined extramural tunnel (SLET) technique. Renal function (RF) was evaluated using 99mTc‐MAG‐3 diuretic scintigraphy. The serial changes in corrected glomerular filtration rate (cGFR) for each technique and for each side were compared. Results Over a median follow‐up of 6 years, the patients in both the direct refluxing and the SLET technique groups were found to have a significant reduction in mean (sd) cGFR between baseline and last follow‐up: cGFR decreased from 59.4 (12.4) to 45.6 (15.3) mL/min (P < 0.001) and from 54.3 (11.2) to 46.3 (12.8) mL/min (P = 0.002), respectively. Five patients (4.9%) in the SLET group developed obstruction (four left‐sided and one right‐sided) compared with one (0.9%) in the direct refluxing group (right‐sided). The onset of obstruction was noted 1–7 months after radical cystectomy. There was no significant difference between the groups in reductions in cGFR across the timepoints. Comparison of the two techniques according to the side of ureter implantation showed that the direct refluxing technique trended towards better functional outcomes on the left side. Conclusions There was no observed difference in the RF of individual renal units between the SLET and the direct refluxing groups in the long term. The need to incorporate an antireflux technique should be questioned and tailored according to the surgeon's experience and confidence.
       
  • Totally intracorporeal robot‐assisted radical cystectomy: optimizing
           total outcomes
    • Abstract: We performed a systematic literature review to assess the current status of a totally intracorporeal robot‐assisted radical cystectomy (RARC) approach. The current ‘gold standard’ for radical cystectomy remains open radical cystectomy. RARC has lagged behind robot‐assisted prostatectomy in terms of adoption and perceived patient benefit, but there are indications that this is now changing. There have been several recently published large series of RARC, both with extracorporeal and with intracorporeal urinary diversions. The present review focuses on the totally intracorporeal approach. Radical cystectomy is complex surgery with several important outcome measures, including oncological and functional outcomes, complication rates, patient recovery and cost implications. We aim to answer the question of whether there are advantages to a totally intracorporeal robotic approach or whether we are simply making an already complex procedure more challenging with an associated increase in complication rates. We review the current status of both oncological and functional outcomes of totally intracorporeal RARC compared with standard RARC with extraperitoneal urinary diversion and with open radical cystectomy, and assess the associated short‐ and long‐term complication rates. We also review aspects in training and research that have affected the uptake of RARC. Additionally we evaluate how current technology is contributing to the future development of this surgical technique.
       
  • Prevalence of the HOXB13 G84E prostate cancer risk allele in men
           treated with radical prostatectomy
    • Abstract: Objective To determine the prevalence and clinical correlates of the G84E mutation in the homeobox transcription factor, or HOXB13, gene using DNA samples from 9559 men with prostate cancer undergoing radical prostatectomy. Patients and Methods DNA samples from men treated with radical prostatectomy at the University of Michigan and John Hopkins University were genotyped for G84E and this was confirmed by Sanger sequencing. The frequency and distribution of this allele was determined according to specific patient characteristics (family history, age at diagnosis, pathological Gleason grade and stage). Results Of 9559 patients, 128 (1.3%) were heterozygous carriers of G84E. Patients who possessed the variant were more likely to have a family history of prostate cancer than those who did not (46.0 vs 35.4%; P = 0.006). G84E carriers were also more likely to be diagnosed at a younger age than non‐carriers (55.2 years vs 58.1 years; P < 0.001). No difference in the proportion of patients diagnosed with high grade or advanced stage tumours according to carrier status was observed. Conclusions In the present study, carriers of the rare G84E variant in HOXB13 were both younger at the time of diagnosis and more likely to have a family history of prostate cancer compared with homozygotes for the wild‐type allele. No significant differences in allele frequency were detected according to selected clinical characteristics of prostate cancer. Further investigation is required to evaluate the role of HOXB13 in prostate carcinogenesis.
       
  • A Pooled Analysis of Individual Patient Data from Registrational Trials of
           Silodosin in the Treatment of Non‐neurogenic Male Lower Urinary
           Tract Symptoms Suggestive of Benign Prostatic Enlargement
    • Abstract: Objective To evaluate efficacy and safety of silodosin in a pooled analysis based on individual patients data from 3 randomized controlled trials (RCTs) comparing silodosin and placebo Patients and methods A pooled analysis of 1494 patients from three 12‐week, similarly designed, parallel‐group, multicenter, randomized, double‐blind, placebo controlled phase 3 RCTs (SI04009, SI04010, KMD3213‐IT‐CL 0215) was performed. Differences from placebo for the mean change from baseline to the end of treatment for the IPSS and uroflowmetry data were tested using ANCOVA model. A 2‐sided p
       
 
 
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