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Publisher: John Wiley and Sons   (Total: 1610 journals)

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J. of Marriage and Family     Hybrid Journal   (Followers: 19, SJR: 3.241, h-index: 98)
J. of Mass Spectrometry     Hybrid Journal   (Followers: 24, SJR: 1.207, h-index: 92)
J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 26)
J. of Medical Primatology     Hybrid Journal   (Followers: 2, SJR: 0.527, h-index: 30)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 1.058, h-index: 89)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 3.008, h-index: 75)
J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 27, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 26, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.267, h-index: 25)
J. of Muscle Foods     Hybrid Journal   (Followers: 3, SJR: 0.274, h-index: 24)
J. of Neurochemistry     Hybrid Journal   (Followers: 1, SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 5, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 2, SJR: 0.761, h-index: 43)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.423, h-index: 120)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 3)
J. of Nursing Management     Hybrid Journal   (Followers: 19, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 5, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 19, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 14, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 4, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 32, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 15, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 120, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 10, SJR: 0.687, h-index: 20)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 1.148, h-index: 84)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.64, h-index: 48)
J. of Phytopathology     Hybrid Journal   (Followers: 3, SJR: 0.503, h-index: 37)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 2.189, h-index: 81)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 13, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 31, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 122, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 24, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 17, SJR: 2.115, h-index: 82)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.44, h-index: 31)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 51, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 4)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 3, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 22, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.105, h-index: 69)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 10, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 18, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 6, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 11, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 9, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 7, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 9, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 12, SJR: 1.117, h-index: 51)
J. of Social Issues     Hybrid Journal   (Followers: 18, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.156, h-index: 15)
J. of Sociolinguistics     Hybrid Journal   (Followers: 16, SJR: 1.11, h-index: 21)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 4, SJR: 0.209, h-index: 4)
J. of Supreme Court History     Hybrid Journal   (Followers: 8)
J. of Surgical Oncology     Hybrid Journal   (Followers: 2, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 25, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 22, SJR: 2.112, h-index: 151)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 75, SJR: 1.745, h-index: 83)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 1.072, h-index: 61)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 8)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 10, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 4, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 3, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 3, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 32, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 13, SJR: 1.59, h-index: 49)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 27, SJR: 7.863, h-index: 82)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 17, SJR: 1.435, h-index: 51)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [64 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  [1610 journals]
  • Retrograde transport of radiolabelled botulinum neurotoxin type a (bont/a)
           to the central nervous system following intradetrusor injection in rats
    • Authors: Dionysia Papagiannopoulou; Lina Vardouli, Fotios Dimitriadis, Apostolos Apostolidis
      Abstract: Objectives to investigate the potential distribution of radiolabelled BoNT/A in the central nervous system (CNS) after bladder injection in normal rats, by using the gamma emitting radionuclide technetium‐99m (99mTc). Materials and Methods BoNT/A was radiolabelled by pre‐treatment with 2‐iminothiolane and incubation with 99mTc‐gluconate. The labelled toxin 99mTc‐BoNT/A was purified by size‐exclusion high‐performance liquid chromatography. Twenty‐four female Wistar rats were evenly injected in the bladder wall with either 99mTc‐ΒοΝΤ/Α (n=12) or free 99mTc (n=12). Four rats from each group were sacrificed at 1, 3 and 6 hours post injection, respectively. The bladder, L6‐S1 spinal cord (SC) segment and L6‐S1 dorsal root ganglia (DRG) were harvested and their radioactivity counted in a gamma scintillation detector. Results were calculated as % Injected Dose (I.D.) per gram tissue. The paired t‐test was used for comparison of means of 99mTc‐ΒοΝΤ/Α radioactivity versus free 99mTc in the tissues of interest. Results Radiolabelled BoNT/A had high radiochemical stability of 70% after 24h. Gradual accumulation of 99mTc‐ΒοΝΤ/Α was seen in the DRG up to 6h post injection (p=0.04 and p=0.029 compared to 1h and 3h respectively), while no accumulation was detected for free 99mTc. Consequently, 99mTc‐ΒοΝΤ/Α radioactivity in the DRG was higher than free 99mTc radioactivity (3.18±0.67%I.D./g vs 0.19±0.10% I.D./g., p=0.002 6h post injection). Values for 99mTc‐ΒοΝΤ/Α radioactivity in the SC were higher compared to free 99mTc but not significantly. The bladder retained higher dosages of 99mTc‐ΒοΝΤ/Α compared to free 99mTc at all time‐points. Conclusions Significant accumulation of the radiolabelled toxin in the lumbosacral DRG together with a less significant uptake in the respective SC segment as opposed to free radioactivity provide first evidence of BoNT/A's retrograde transport to the CNS following bladder injection in rats. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T14:57:47.157613-05:
      DOI: 10.1111/bju.13163
       
  • Responder and health‐related quality of life analyses in men with
           lower urinary tract symptoms treated with a fixed‐dose combination
           
    • Authors: Marcus J. Drake; Roman Sokol, Karin Coyne, Zalmai Hakimi, Jameel Nazir, Julie Dorey, Monique Klaver, Klaudia Traudtner, Isaac Odeyemi, Matthias Oelke, Philip Kerrebroeck,
      Abstract: Objective To evaluate the effect of a fixed–dose combination (FDC) of solifenacin and an oral controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS) on health–related quality of life (HRQoL) in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Patients and methods Men with moderate‐to‐severe storage symptoms and voiding symptoms were treated for 12 weeks with FDC of solifenacin 6 mg or 9 mg plus TOCAS (0.4 mg), TOCAS monotherapy (0.4 mg) or placebo in a randomised, double‐blind study (NEPTUNE). The co‐primary endpoints were Total Urgency Frequency Score (TUFS) and total International Prostate Symptom Score (IPSS). HRQoL was assessed by several secondary endpoints: IPSS QoL index, overactive bladder questionnaire (OAB‐q), and Patient Global Impression (PGI) scale. The correlation between symptom improvement (TUFS) and HRQoL was assessed by Spearman rank correlation coefficients. Single and double responder analyses, using subjective and objective measures, were also performed. Results In the responder analyses, men treated with FDC of solifenacin 6 mg plus TOCAS consistently demonstrated significantly improved outcomes compared with placebo (8/8 responder analyses performed) and TOCAS (6/8 responder analyses performed). There was a significant correlation (p
      PubDate: 2015-04-24T01:31:11.738056-05:
      DOI: 10.1111/bju.13162
       
  • Bone Scan Index predicts outcome in patients with metastatic hormone
           sensitive prostate cancer
    • Authors: Mads Hvid Poulsen; Janne Rasmussen, Lars Edenbrandt, Poul Flemming Høilund‐Carlsen, Oke Gerke, Allan Johansen, Lars Lund
      Abstract: Objective To evaluate the Bone Scan Index (BSI) for prediction of castration resistance and prostate cancer specific survival. In a retrospective material, we used a novel computer‐assisted software for automated detection/quantification of bone metastases by BSI. Prostate cancer patients are M‐staged by whole‐body bone scintigraphy (WBS) and categorized as M0 or M1. Within the M1 group, there is a wide range of clinical outcomes. The BSI was introduced a decade ago providing quantification of bone metastases by estimating the percentage of bone involvement. Being too time consuming, it never gained widespread clinical use. Subjects & methods A total of 88 patients with prostate cancer awaiting initiation of androgen deprivation due to metastases were included. WBS was performed using a two‐headed gamma camera. BSI was obtained using the automated platform EXINI bone (EXINI Diagnostics AB, Lund, Sweden). In Cox proportional hazard models, time to castration resistant prostate cancer (CRPC) and prostate cancer specific survival were modelled as the dependent variables, whereas PSA, Gleason score and BSI were used as explanatory factors. For Kaplan‐Meier estimates, BSI groups were dichotomously split into: BSI
      PubDate: 2015-04-24T01:21:34.977608-05:
      DOI: 10.1111/bju.13160
       
  • Risk factors for mesh erosion after female pelvic floor reconstructive
           surgery: a systematic review and meta‐analysis
    • Authors: Tuo Deng; Banghua Liao, Deyi Luo, Hong Shen, Kunjie Wang
      Abstract: Objectives To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and Methods A systematic literature search of the Pubmed, Embase, Cochrane Library, CBM, CNKI and VIP databases was performed to identify the studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratio (OR) with 95% confidence interval (CI) was calculated to assess the strength of associations between the factors and mesh erosion. Results A total of 25 studies containing 7084 patients were included in our systematic review and meta‐analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in elder age vs. younger age (OR = 0.96, 95% CI: 0.94‐0.98), more parities vs. less parities (OR = 1.27, 95% CI: 1.07‐1.51), the presence of premenopausal / estrogen replacement therapy (ERT) (OR = 1.36, 95% CI: 1.03‐1.79), diabetes mellitus (OR = 1.87, 95% CI: 1.35‐2.57), smoking (OR = 2.35, 95% CI: 1.80‐3.08), concomitant pelvic organ prolapse (POP) surgery (OR = 0.37, 95% CI: 0.16‐0.84), concomitant hysterectomy (OR = 1.46, 95% CI: 1.03‐2.07), preservation of uterus at surgery (OR = 0.22, 95% CI: 0.08‐0.63), and senior surgeons operation vs. junior surgeons operation (OR = 0.42, 95% CI: 0.30‐0.58). Conclusion Our study indicated that younger age, more parities, premenopausal / ERT, diabetes mellitus, smoking, concomitant hysterectomy, and junior surgeons operation were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of uterus may be the potential protective factors for mesh erosion. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:18:18.897774-05:
      DOI: 10.1111/bju.13158
       
  • Online and Social Media Presence of Australian and New Zealand Urologists
    • Authors: Nicholas Davies; Declan G Murphy, Simon Rij, Henry H Woo, Nathan Lawrentschuk
      Abstract: Objective To assess the online and social media presence of all practising Australian and New Zealand urologists. Materials and Methods In July 2014, all active members of the Urological Society of Australia and New Zealand (USANZ) were identified. A comprehensive search of Google and each social media platform (Facebook, Twitter, LinkedIn and YouTube) was undertaken for each urologist to identify any private websites or social media profiles. Results Of the 435 urologists currently practising in Australia and New Zealand, 305 (70.1%) have an easily identifiable social media account. LinkedIn (51.3%) is the most commonly utilised form of social media followed by Twitter (33.3%) and private Facebook (30.1%) accounts. Approximately half (49.8%) have a private business website. The average number of social media accounts per urologist is 1.42 and sixteen urologists (3.7%) have an account with all searched social media platforms. Over half of those with a Twitter account (55.9%) follow a dedicated urology journal club and have a median of 12 ‘followers (range 1‐2862)’. Social media users had a median of two ‘tweets’ on Twitter (range 0‐8717), two LinkedIn posts (range 1‐45) and one YouTube video (range 1‐14). Conclusion This study represents a unique dataset not relying on selection or recall bias but using data freely available to public and colleagues to gauge social media presence of urologists. The majority of Australian and New Zealand urologists have a readily identifiable online and social media presence, with widespread and consistent use across both countries. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:17:59.824133-05:
      DOI: 10.1111/bju.13159
       
  • Physical activity as a risk factor for prostate cancer diagnosis: a
           prospective biopsy cohort analysis
    • Authors: Cosimo De Nunzio; Fabrizio Presicce, Riccardo Lombardo, Fabiana Cancrini, Stefano Petta, Alberto Trucchi, Mauro Gacci, Luca Cindolo, Andrea Tubaro
      Abstract: Objectives To assess the association between physical activity, evaluated by the Physical activity scale for elderly (PASE) questionnaire, and prostate cancer (PC) risk in a consecutive series of men undergoing prostate biopsy. Materials and Methods From 2011 onwards, a consecutive men undergoing 12‐core prostate biopsy were enrolled into a prospective database. Indications for a prostatic biopsy were a PSA value ≥ 4 ng/ml and/or a positive digital rectal examination (DRE). Body mass index (BMI) and waist circumferences were measured before the biopsy. Fasting blood samples were collected before biopsy and tested for: total PSA, glucose, HDL, trygliceridemia levels. Blood pressure was recorded. Metabolic syndrome (MetS) was defined according to the Adult Treatment panel III. PASE questionnaire was collected before the biopsy. Results 286 patients were enrolled with a median age and PSA of 68 (IQR 62/74) years and 6.1 ng/ml (IQR 5/8.8) respectively. Median BMI was26.4 kg/m2 (IQR: 24.6/29); median waist circumference was 102 cm (IQR: 97/108) and 75 patients (26%) presented a Metabolic syndrome. One‐hundred and six patients (37%) had prostate cancer on biopsy. Patients with PC presented an higher PSA (6.7 ng/ml, IQR: 5/10 vs 5.6 ng/ml, IQR: 4.8/8; p= 0.007) and a lower LogPASE score (2.03 (1.82/2.18) vs 2.10 (1.92/2.29); p=0.005). On multivariate analysis, in addition to well‐recognized risk factors such as age, PSA, prostate volume, LogPASE score was an independent risk factor for prostate cancer diagnosis (OR: 0.146, 95%CI: 0.037 ‐ 0.577; p= 0.006). Log PASE was also an independent predictor of high‐grade cancer (OR: 0.07, 95% CI: 0.006‐0.764; p= 0.029). Conclusion In our single centre study, an increased physical activity evaluated by the PASE questionnaire is associated with a reduced risk of PC and of high‐grade prostate cancer on biopsy. Further studies should clarify the molecular pathways behind this association. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:01:43.162692-05:
      DOI: 10.1111/bju.13157
       
  • “Percutaneous Nephrolithotomy in the Super Obese (BMI
           ≥ 50):Overcoming the Challenges.”
    • Authors: Mohamed Keheila; David Leavitt, Riccardo Galli, Piruz Motamedinia, Nithin Theckumparampil, Micheal Siev, David Hoenig, Arthur Smith, Zeph Okeke
      Abstract: Objective To analyze our experience, outcomes and lessons learned with percutaneous nephrolithotomy (PCNL) in the super obese (body mass index ≥ 50 kg/m2). Materials and Methods In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m2. Patient demographics, perioperative outcomes and complications were determined. Additionally, a number of special PCNL considerations in the super obese that can maximize safe outcomes are outlined. Results Twenty‐one PCNLs performed on 17 super obese patients were identified. Mean patient age was 54.8 years. Mean body mass index (BMI) was 57.2 kg/m2. Mean stone area was 1037 mm2. Full staghorn stones were appreciated in 6 patients and partial staghorns in 4 patients. Mean operative time was 106 minutes and mean hemoglobin drop was 1.2 g/dl. Overall stone free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese including using extra‐long nephroscopes and graspers, using custom cut extra long access sheaths with suture “tails” secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. Conclusion With appropriate perioperative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance is comparable to that of prior reported PCNL series in the morbidly obese, and is achievable with few complications. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-18T02:21:57.017131-05:
      DOI: 10.1111/bju.13155
       
  • Long‐term outcomes of high risk bladder cancer screening cohort
    • Authors: Nathan Starke; Nirmish Singla, Ahmed Haddad, Yair Lotan
      Abstract: Purpose To evaluate long‐term outcomes of patients at high risk of bladder cancer (BC) who participated in a BC screening trial. Materials and methods High‐risk patients based on age ≥50 years, ≥10 pack‐years smoking, and/or ≥15 years environmental exposure enrolled in one‐time screening trial using NMP‐22 assay (3/2006‐11/2007) at Dallas VA hospital. Subsequent detection of smoking related malignancies (Bladder, lung and renal cell carcinoma) was determined through Jan 31, 2014. Multivariable regression analysis was used to determine factors associated with BC diagnosis and survival. Results Cohort included 925 subjects: 886 patients (95.8%) were smokers and 613 (66.3%) had hazardous occupational exposure. At initial screen, 57 patients had positive NMP22 test and 2 had BC. Another 9 (1.0%) patients were diagnosed with BC during median follow‐up of 78.4 months. All BCs were non‐invasive (Ta); low grade (n=7) and high grade (n=4). RCC and lung cancer were diagnosed in 10 (1.1%) and 18 (1.9%) patients, respectively. 134 patients died including 3 from RCC and 12 from lung cancer, but none from BC. Factors associated with worse overall survival on MVA: lung cancer (HR 5.06, p60 pack years smoking history (HR 4.51, p=0.037). Conclusion At 6.5 years of follow‐up, no patients in this high‐risk cohort developed muscle invasive BC. Lung cancer, hematuria and >60 pack years smoking history are independent predictors of mortality. Other cause mortality is an important consideration in patients undergoing BC screening. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-18T02:15:59.419168-05:
      DOI: 10.1111/bju.13154
       
  • Prostatic arterial embolization for the treatment of LUTS due to benign
           prostatic hyperplasia:A comparative study of medium and large size
           prostates
    • Authors: Maoqiang Wang; Liping Guo, Feng Duan, Kai Yuan, Guodong Zhang, Kai Li, Jieyu Yan, Yan Wang, Haiyan Kang
      Abstract: Objectives To compare the outcomes of prostatic arterial embolization (PAE) in treating large prostates (>80 mL) in comparison with medium‐sized prostates (50‐80 mL), largely to determine whether size may affect the outcome of PAE. Patients and methods A total of 115 patients (mean, 71.5 years) diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) that was refractory to medical treatment underwent PAE. Group A (n=64) included patients with a mean prostate volume of 129 mL; group B (n=51) included patients with a mean prostate volume of 64 mL. PAE was performed using 100‐μm particles. Follow‐up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post‐void residual volume (PVR), the international index of erectile function short form (IIEF‐5), prostatic specific antigen (PSA) and prostate volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter. Results There were no significant differences in baseline IPSS, QoL, Qmax, PVR, PSA, or IIEF‐5, between groups. Technical success rate was 93.8% in group A and 96.8% in group B (P=0.7). A total of 101 patients (55 patients in group A and 46 patients in group B) had completed the follow‐up with a mean of 17 months (range 12–33 months). Compared with the baseline, there were significant improvements in IPSS, QoL, Qmax, PV, and PVR in both groups after PAE. The outcomes in group A were significantly better (group A vs group B mean±SD) regarding IPSS (‐14±6.5 vs ‐10.5±5.5), Qmax (6.0±1.5 vs 4.5±1.0), PVR (‐80.0±25.0 vs ‐60.0±20.0), PV (‐54.5±18.0 [‐42.3%] vs ‐18.5±5.0 [‐28.9%]), and QoL (‐3.0±1.5 vs ‐2.0±1.0) with P values
      PubDate: 2015-04-07T11:22:03.642318-05:
      DOI: 10.1111/bju.13147
       
  • Comparing long‐term outcomes between primary versus progressive
           muscle invasive bladder cancer after radical cystectomy
    • Authors: Marco Moschini; Vidit Sharma, Paolo Dell'oglio, Vito Cucchiara, Giorgio Gandaglia, Francesco Cantiello, Fabio Zattoni, Federico Pellucchi, Alberto Briganti, Rocco Damiano, Francesco Montorsi, Andrea Salonia, Renzo Colombo
      Abstract: Objective To assess the impact of primary or progressive status on recurrence‐free survival (RFS), cancer specific mortality (CSM) and overall mortality (OM) after radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). Patients and Methods Overall, 768 consecutive patients underwent RC due to MIBC at our institution between 2000 and 2012. Primary MIBC was defined as no previous history of BCa and progressive was defined as recorded previous treated non‐MIBC that had progressed to MIBC. The median follow‐up was 85 (60‐109) months. Univariate and multivariate Cox regression models were used to compare RFS, CSM, and OM between these two cohorts. Results Overall, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive MIBC. There were no differences between the two groups in terms of demographics, pathological and perioperative complications (all p>0.1). The 10‐year rates of RFS, CSM, and OM for primary vs. progressive status were 43% vs. 36% (p=0.01), 43% vs. 37% (p=0.01), and 35% vs 28% (p=0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of RFS (HR: 1.47, 95%CI: 1.12‐1.79, p=0.03) (Table 2), CSM (HR: 1.42, 95%CI: 1.07‐1.89, p=0.01) (Table 2), and OM (HR: 1.42, 95%CI: 1.13‐1.65, p=0.02). Conclusions Among patients treated with RC due to MIBC, progressive status is associated with a higher CSM, OM and recurrence rate after RC. Our study thus provides an impetus to improve risk sub‐stratification when bladder cancer is still at the NMIBC stage, be it through new biomarkers or improved imaging, as a subset of NMIBC are likely to benefit from early RC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-07T11:11:16.864512-05:
      DOI: 10.1111/bju.13146
       
  • Over the horizon ‐ future innovations in global urology
    • Authors: Nicholas J Campain; Ruaraidh P MacDonagh, Kien Alfred Mteta, John S McGrath,
      Abstract: In the previous two commentary articles we have discussed some of the issues surrounding global urology, with a focus on sub‐Saharan Africa where the burden of urological disease is greatest. Coupled with low levels of infrastructure, funding and resources, the urological training environment is complex, with most urological care being provided by non‐specialists. Accepting the challenges of working in this environment, we look ahead to potential developments and innovations to improve global urological care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-04T02:46:11.848675-05:
      DOI: 10.1111/bju.13145
       
  • Improving Multivariable Prostate Cancer Risk Assessment Using The Prostate
           Health Index
    • Authors: Robert W Foley; Laura Gorman, Neda Sharifi, Keefe Murphy, Helen Moore, Alexandra V Tuzova, Antoinette S Perry, T Brendan Murphy, Dara J Lundon, R William G Watson
      Abstract: Objectives To analyse the clinical utility of a prediction model incorporating both clinical information as well as a novel biomarker in order to inform the decision for prostate biopsy in an Irish cohort. Patients and Methods Serum isolated from 250 men from three tertiary referral centres with pre‐biopsy blood draws was analysed for total PSA, free PSA and p2PSA. From this, the phi score was calculated (phi=(p2PSA/fPSA)*√tPSA). Their clinical information was used to derive their risk according to the Prostate Cancer Prevention Trial risk model (PCPT). Two clinical prediction models were created via multivariable regression consisting of age, family history, abnormality on digital rectal exam, prior negative biopsy and either PSA or phi score respectively. Calibration plots, receiver‐operating characteristic (ROC) curves as well as decision curves were generated to assess the performance of the three models. Results The PSA model and phi model were both highly calibrated in this cohort, with the phi model demonstrating the best correlation between predicted probabilities and actual outcome. The areas under the ROC curve for the phi model, PSA model and PCPT were 0.77, 0.71 & 0.69 respectively for the prediction of PCa and 0.79, 0.72 & 0.72 for the prediction of high grade PCa. Decision curve analysis demonstrated a superior net benefit of the phi model over both the PSA model and PCPT in the diagnosis of PCa and high grade PCa over the entire range of risk probabilities. Conclusion A logical and standardised approach to the use of clinical risk factors can allow for more accurate risk stratification of men under investigation for PCa. The measurement of p2PSA and the integration of this biomarker into a clinical prediction model can further increase the accuracy of risk stratification, helping to better inform the decision for prostate biopsy in a referral population. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-03T08:23:58.385061-05:
      DOI: 10.1111/bju.13143
       
  • Enzalutamide: Targeting the androgen signalling pathway in metastatic
           castration‐resistant prostate cancer
    • Authors: Jack Schalken; John M. Fitzpatrick
      Abstract: Context Significant progress has been made in the understanding of the underlying cancer biology of castration‐resistant prostate cancer (CRPC) with the androgen receptor (AR) signalling pathway remaining implicated throughout the prostate cancer disease continuum. Reactivation of the AR signalling pathway is considered to be a key driver of CRPC progression and, as such, the AR is a logical target for therapy in CRPC. Objective To understand the importance of AR signalling in the treatment of patients with metastatic CRPC (mCRPC) and to discuss the clinical benefits associated with inhibition of the AR signalling pathway. Evidence Acquisition A search was conducted to identify articles relating to the role of AR signalling in CRPC and therapies that inhibit the AR signalling pathway. Evidence Synthesis Current understanding of prostate cancer has identified the AR signalling pathway as a logical target for the treatment of CRPC. Available therapies that inhibit the AR signalling pathway include AR blockers, androgen biosynthesis inhibitors and AR signalling inhibitors. Enzalutamide, the first approved AR signalling inhibitor, has a novel mode of action targeting AR signalling at three key stages. The direct mode of action of enzalutamide has been shown to translate into clinical responses in patients with mCRPC. Conclusions The targeting of the AR signalling pathway in patients with mCRPC results in numerous clinical benefits. As the number of treatment options increase, more trials evaluating the sequencing and combination of treatments are required. Patient Summary This review highlights the continued importance of targeting a key driver in the progression of CRPC, AR signalling, and the clinical benefits associated with inhibition of the AR signalling pathway in the treatment of patients with CRPC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T10:08:00.172758-05:
      DOI: 10.1111/bju.13123
       
  • Clinical Significance of Peripheral Zone Thickness in Men with Lower
           Urinary Tract Symptom/Benign Prostatic Hyperplasia
    • Authors: Jong Kyou Kwon; Jang Hee Han, Ho Chul Choi, Dong Hyuk Kang, Joo Yong Lee, Jae Heon Kim, Cheol Kyu Oh, Young Deuk Choi, Kang Su Cho
      Abstract: Objective To evaluate the clinical impact of peripheral zone thickness (PZT), based on presumed circle area ratio (PCAR) theory, on urinary symptoms in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) as a novel prostate parameter. Patients And Methods Medical records were obtained from a prospective database of first‐visit men with LUTS/BPH. Age, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), maximum flow rate (Qmax), and post‐void residual (PVR) were assessed. Total prostate volume (TPV), transition zone volume (TZV), and transition zone index (TZI), and PZT were measured from transrectal ultrasonography. Reliability analysis was also performed. Results A total of 1009 patients were enrolled for the analysis. Mean PZT was 11.10 ± 2.50 mm, and patients were classified into 3 groups; PZT < 9.5 mm, 9.5 mm ≤ PZT
      PubDate: 2015-03-23T07:45:37.655271-05:
      DOI: 10.1111/bju.13130
       
  • Characterisation of the contractile dynamics of the resting ex vivo
           urinary bladder of the pig
    • Authors: R G Lentle; G W Reynolds, P W M Janssen, C M Hulls, Q M King, J P Chambers
      Abstract: Objectives To characterise the area and movements of ongoing spontaneous localised contractions in the resting porcine urinary bladder and relate these to ambient intravesical pressure (pves) in order to further our understanding of their genesis and role in accommodating incoming urine Materials and methods We used image analysis to quantify the areas and movements of discrete propagating patches of contraction (PPCs) on the anterior, anterolateral and posterior surfaces of the urinary bladders of 6 pigs maintained ex vivo with small incremental increases in volume. We then correlated the magnitude of pves and cyclic changes in pves with parameters derived from spatiotemporal maps. Results Contractile movements in the resting bladder consisted only of PPCs that covered around 1/5th of the surface of the bladder, commenced at various sites and were of around 6 s duration. They propagated at around 6 mm/s mainly across the anterior and lateral surface of the bladder by various, sometimes circular, routes in a quasi‐stable rhythm, and did not traverse the trigone. The frequencies of these rhythms were low (3.15 cpm) and broadly similar to those of cyclic changes in pves (3.55 cpm). Each PPC was associated with a region of stretching (positive strain rate) and these events occurred in a background of more constant strain. The amplitudes of cycles in pves and the areas undergoing PPCs increased following a sudden increase in pves but the frequency of cycles of pves and of origin of PPCs did not change. Peaks in pves cycles occurred when PPCs were traversing the upper half of the bladder, which was more compliant. The velocity of propagation of PPCs was similar to that of transverse propagation of action potentials in bladder myocytes and significantly greater than that reported in interstitial cells. The size of PPCs, their frequency and their rate of propagation were not affected by intra‐arterial dosage with tetrodotoxin or lidocaine. Conclusions The origin and duration of PPCs influence both pves and cyclic variation in pves. Hence, propagating rather than stationary areas of contraction may contribute to overall tone and to variation in pves. Spatiotemporal mapping of PPCs may contribute to our understanding of the generation of tone and the basis of clinical entities such as overactive bladder, painful bladder syndrome and detrusor overactivity. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:45:30.620902-05:
      DOI: 10.1111/bju.13132
       
  • Radical treatment of localised prostate cancer in the elderly
    • Authors: Wouter Everaerts; Simon Van Rij, Fairleigh Reeves, Anthony Costello
      Abstract: Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man above 70 should undergo a health assessment using a validated tool prior to making treatment decisions. Fit elderly males with intermediate or high‐risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention prior to treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a ‘bifecta’ of oncological control and continence is appropriate as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of less than ten years. Primary ADT is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly‐specific research is needed to guide prostate cancer care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:35:23.801485-05:
      DOI: 10.1111/bju.13128
       
  • Envisioning an IDEAL Future for Urological Innovation
    • Authors: Philipp Dahm
      Abstract: Urologists take pride in standing at the forefront of cutting‐edge innovation and being among the first to embrace new procedures and technologies. In fact, when talking to urology residency applicants, access to advanced technology is among the most frequently cited motivating factors for their career choice. This innovative spirit has allowed urologists to harness acoustic waves to treat nephrolithiasis, made us leaders in the use of miniaturized endoscopic equipment and pioneers in the application of robotic‐assisted, laparoscopic surgery. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:59:58.911988-05:
      DOI: 10.1111/bju.13129
       
  • Novel anticoagulants and antiplatelet agents; a guide for the urologist
    • Authors: G Ellis; A J Camm, S N Datta
      Abstract: Novel Oral Anti‐Coagulants (NOACs) are increasingly being used in clinical practice and are set to almost entirely replace the Vitamin K agonists, such as warfarin, in the near future. Similarly, new antiplatelet agents are now regularly used in place of older agents such as aspirin and clopidogrel. In an aging population, with an increasing burden of complex comorbidities, urologists will frequently encounter patients who will be using such agents. Some background knowledge, and an understanding, of these drugs and the issues that surround their usage is essential. This article will provide readers with an understanding of these new drugs, including their mechanisms of action, the up‐to‐date evidence justifying their recent introduction into clinical practice and the appropriate interval for stopping them prior to surgery. It will also consider the risks of peri‐operative bleeding with regard to patients taking these drugs and the risks of venous thromboembolism in those in whom they are stopped. Strategies to manage anticoagulant‐associated bleeding are discussed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:57:56.040672-05:
      DOI: 10.1111/bju.13131
       
  • Multicenter prospective evaluation of the learning curve of the holmium
           laser enucleation of the prostate (HoLEP)
    • Authors: Grégoire Robert; Jean‐Nicolas Cornu, Marc Fourmarier, Saussine Christian, Aurélien Descazeaud, Abdel Rahmène Azzouzi, Eric Vicaut, Bertrand Lukacs
      Abstract: Objectives To describe the step‐by‐step learning curve of Holmium Laser Enucleation (HoLEP) surgical technique. Patients and methods A prospective, multicentrer observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy, never having performed HoLEP were included. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation, within less than 90 minutes, without any conversion to standard TURP, with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Results Of nine centers, three abandoned the procedure before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time longer than 90 minutes (n=51), followed by conversion to TURP (n=14), incomplete morcellation (n=8), significant stress (n=9), or difficulty (n=14) during procedure. Ignoring operating time, 64% of procedures were successful and four out of five centers did 4 consecutive successful cases. Of the five centers who completed the study, four chose to continue HoLEP. Conclusion Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the operation. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:22:57.144723-05:
      DOI: 10.1111/bju.13124
       
  • Impact of stage migration and practice changes on high risk prostate
           cancer: results from patients treated with radical prostatectomy over the
           last two decades
    • Authors: N. Fossati; N. M. Passoni, M. Moschini, G. Gandaglia, A. Larcher, M. Freschi, G. Guazzoni, D. D. Sjoberg, A. J. Vickers, F. Montorsi, A. Briganti
      Abstract: Background Phenotype of prostate cancer at diagnosis has changed through the years. We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high‐risk prostate cancer patients. Patients and methods We evaluated 1,033 clinically high‐risk patients, defined as the presence of at least one of the following risk factors: pre‐operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year‐per‐year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes. Results We observed a decrease over time in the proportion of high‐risk patients with a pre‐operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5‐year: 0.90; 95% CI: 0.84–0.96; p=0.01) and distant metastasis (HR per 5‐year: 0.91; 95% CI: 0.83–0.99; p=0.039), after adjusting for age, pre‐operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score. Conclusions In this single center study, an increased diagnosis of localized and less extensive high‐grade prostate cancer was observed over the last two decades. High‐risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high‐risk prostate cancer among contemporary patients are needed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:22:50.622373-05:
      DOI: 10.1111/bju.13125
       
  • A Comparative Analysis of Robotic versus Laparoscopic Retroperitoneal
           Lymph Node Dissection for Testicular Cancer
    • Authors: Kelly T. Harris; Michael A. Gorin, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf
      Abstract: Objective To compare the safety and perioperative outcomes of robotic versus laparoscopic retroperitoneal lymph node dissection (RPLND). Patients and Methods Our institutional review board approved retrospective testicular cancer registry was queried for patients who underwent a primary unilateral robotic (R‐RPLND) or laparoscopic (L‐RPLND) RPLND by a single surgeon for a stage I testicular nonseminomatous germ cell tumor. Groups were compared for differences in baseline and outcomes variables. Results Between July 2006 and July 2014, a total of 16 R‐RPLND and 21 L‐RPLND cases were performed by a single surgeon. Intra‐ and perioperative outcomes including operative time, estimated blood loss, lymph node yield, complicate rate and ejaculatory status were similar between groups (all p > 0.1). Conclusions As an early checkpoint, R‐RPLND appears comparable to the laparoscopic approach in terms of safety and perioperative outcomes. It remains unclear if R‐RPLND offers any tangible benefits over standard laparoscopy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:06:48.805506-05:
      DOI: 10.1111/bju.13121
       
  • Contrast Enhanced Ultrasound Parametric Imaging for the detection of
           Prostate Cancer
    • Authors: AW Postema; PJA Frinking, M Smeenge, TM De Reijke, JJMCH De la Rosette, F Tranquart, H Wijkstra
      Abstract: Objective To investigate the value of Dynamic Contrast Enhanced‐Ultrasound (DCE‐US) and software‐generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores. Patients and methods For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE‐US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software that extracts perfusion parameters that differentiate benign from malignant tissue form DCE‐US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity NPV, and PPV on the per‐prostate level. Results Based on DCE‐US, 470/651 (72.2%) of biopsy locations appeared benign resulting in 40 false negatives (8.5%) regarding clinically significant tumour only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false negatives (5.6%). In the per‐prostate clinical analysis, DCE‐US classified 38/82 prostates as benign, missing 8 diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing 3 diagnoses. Sensitivity, specificity, PPV and NPV were 73%, 58%, 50% and 79% for DCE‐US alone and 91%, 56%, 57% and 90% with parametric maps, respectively. Conclusion DCE‐US interpretation with parametric maps allows good prediction of biopsy outcome. A two‐thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:46:50.891522-05:
      DOI: 10.1111/bju.13116
       
  • Pharmacological characterization of the relaxation induced by the soluble
           guanylate cyclase activator, BAY 60‐2770 in rabbit corpus cavernosum
           
    • Authors: Camila Stefani Estancial; Renata Lopes Rodrigues, Gilberto De Nucci, Edson Antunes, Fabiola Zakia Mónica
      Abstract: Objective To characterize the relaxation induced by the soluble guanylate cyclase (sGC) activator, BAY 60‐2770 in rabbit corpus cavernosum. Material and Methods Penis from male New Zealand rabbits were removed and fours strips of corpus cavernosum (CC) were obtained. Concentration‐response curves to BAY 60‐2770 were carried out in the absence and presence of inhibitors of nitric oxide synthase, L‐NAME (100 μM), sGC, ODQ (10 μM) and phosphodiestarase type 5, tadalafil (0.1 μM). The potency (pEC50) and maximal response (Emax) values were determined. Second, electrical‐field stimulation (EFS)‐induced contraction or relaxation was realized in the absence and presence of BAY 60‐2770 (0.1 or 1 μM) alone or in combination of ODQ (10 μM). In the case of EFS‐induced relaxation two protocols were realized: 1) ODQ (10 μM) was first incubated for 20 min and then BAY 60‐2770 (1 μM) was added for another 20 min (ODQ + BAY 60‐2770). In different CC strips, BAY 60‐2770 was incubated for 20 min followed by another 20 min with ODQ (BAY 60‐2770 + ODQ). The intracellular levels of cyclic guanosine monophosphate (cGMP) were also determined. Results BAY 60‐2770 potently relaxed rabbit CC with pEC50 and Emax values of 7.58 ± 0.19 and 81 ± 4%, respectively. The inhibitors ODQ (n=7) or tadalafil (n=7) produced 4.2‐ and 6.3‐leftward shifts, respectively in BAY 60‐2770‐induced relaxation without interfering on the Emax values. The intracellular levels of cGMP were augmented after stimulation with BAY 60‐2770 (1 μM) alone, whereas its co‐incubation with ODQ produced even higher levels of cGMP. The EFS‐induced contraction was reduced in the presence of BAY 60‐2770 (1 μM) and this inhibition was even greater when BAY 60‐2770 was co‐incubated with ODQ. The nitrergic stimulation induced CC relaxation, which was abolished in the presence of ODQ. BAY 60‐2770 alone increased the amplitude of relaxation. Co‐incubation of ODQ and BAY 60‐2770 did not alter the relaxation in comparison with ODQ alone. Interestingly, when BAY 60‐2770 was incubated prior to ODQ, EFS‐induced relaxation was partly restored in comparison with ODQ alone or ODQ + BAY 60‐2770. Conclusions Considering that the relaxation induced by the sGC activator, BAY 60‐2770 was increased after sGC oxidation and unaltered in the absence of nitric oxide, these class of substances are advantageous over sGC stimulators or PDE5 inhibitors for the treatment in those patients with erectile dysfunction and high endothelial damage. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-26T01:31:46.85697-05:0
      DOI: 10.1111/bju.13105
       
  • Guideline of Guidelines: Prostate Cancer Imaging
    • Authors: Daniel A Wollin; Danil V Makarov
      Abstract: In the era before the widespread adoption of PSA screening for prostate cancer, most incident cases were already advanced stage. Because treatment options such as surgery or radiation are thought mainly to benefit patients with localized disease, prostate cancer imaging was necessary prior to treatment of almost all patients. In the PSA era, however, over 90% of incident cases are localized, making the need for routine imaging with CT, MRI, or bone scan obsolete [1]. Numerous studies show a relatively low rate of positive staging imaging in low‐ and intermediate‐ risk patients. Recognizing these trends, several professional societies issued prostate cancer imaging guidelines in the mid‐1990s in an effort to curb the overuse of imaging. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-26T01:25:53.933476-05:
      DOI: 10.1111/bju.13104
       
  • Diagnosis and treatment of chronic bacterial prostatitis and chronic
           prostatitis/chronic pelvic pain syndrome: a consensus guideline
    • Authors: Jon Rees; Mark Abrahams, Andrew Doble, Alison Cooper,
      Abstract: Objectives To improve awareness and recognition of these conditions among non‐specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non‐specialist and specialist settings. To promote efficient referral of care between non‐specialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and Methods The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high‐quality, published evidence was lacking. Results CBP and CP/CPPS can present with a wide range of clinical manifestations. The 4 main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS ‐ voiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first‐line treatment include antibiotics, alpha‐adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics such as quinolones should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, GPs, cognitive behavioural therapists/psychologists, sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. Conclusion Chronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom‐based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-24T09:43:14.900182-05:
      DOI: 10.1111/bju.13101
       
  • Internet‐based treatment of stress urinary incontinence: 1‐
           and 2 years results of a randomised controlled trial with focus on pelvic
           floor muscle training
    • Authors: M Sjöström; G Umefjord, H Stenlund, P Carlbring, G Andersson, E Samuelsson
      Abstract: Objectives To evaluate the long‐term effects of two non‐face‐to‐face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods Randomised controlled trial with online recruitment of 250 community‐dwelling women aged 18‐70 years with SUI ≥1/week. Diagnosis based on validated self‐assessed questionnaires, 2‐day bladder diary, and telephone interview with a urotherapist. Consecutive computer‐generated block‐randomisation with allocation by an independent administrator to 3 months of treatment with either an Internet‐based treatment programme (n=124) or a programme sent by post (n=126). Both interventions focused mainly on PFMT; the Internet group received continuous e‐mail support from a urotherapist, whereas the postal group trained on their own. Follow‐up was performed after 1 and 2 years via self‐assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form, ICIQ‐UI SF) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptoms Quality of Life, ICIQ‐LUTSqol). Secondary outcomes were the Patient's Global Impression of Improvement, health‐specific quality of life (EQ‐Visual Analogue Scale), use of incontinence aids, and satisfaction with treatment. There was no face‐to‐face contact with the participants at any time. Analysis was based on intention‐to‐treat. Results We lost 32.4% (81/250) of participants to follow‐up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (p0.8) for symptoms and condition‐specific quality of life after 1 and 2 years, respectively. No significant differences were found between the groups. The mean changes (SD) in symptom score were 3.7 (3.3) for Internet and 3.2 (3.4) for postal (p=0.47) after 1 year, and 3.6 (3.5) for Internet and 3.4 (3.3) for postal (p=0.79) after 2 years. The mean changes (SD) of condition‐specific quality of life were 5.5 (6.5) for Internet and 4.7 for postal (6.5) (p=0.55) after 1 year, and 6.4 (6.0) for Internet and 4.8 (7.6) for postal (p=0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (Internet 31.9% (28/88), postal 33.8% (27/80) p=0.82), but after 2 years significantly more participants in the Internet group reported this level of improvement (39.2% (29/74) vs. 23.8% (19/80), p=0.03). Health‐specific quality of life improved significantly in the Internet group after 2 years (mean change EQ‐VAS 3.8 (11.4), p=0.005). We found no other significant improvements in this measure. One year after treatment, 69.8% (60/86) of participants in the Internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non‐face‐to‐face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition‐specific quality of life 1 and 2 years after treatment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-14T02:47:40.598066-05:
      DOI: 10.1111/bju.13091
       
  • Telemetric monitoring of bladder function in female Göttingen
           minipigs
    • Authors: Nadine D Huppertz; Ruth Kirschner‐Hermanns, Rene H Tolba, Joachim O Grosse
      Abstract: Objectives To generate real‐time radio‐telemetric urodynamic reference data of maximum detrusor pressure (Pdet max), maximum flowrate (Qmax) and estimated grade of infravesical obstruction as well as for duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translational aspects of the use of Göttingen minipigs for urological research. Material and Methods In five female Göttingen minipigs, a telemetric transmitter was implanted and 24 h measurements in metabolic cages were performed. Through operator based analysis, synchronized real‐time radio‐telemetric cystometric data with flowmetric data and video sequences were used to determine voiding detrusor contractions (VC) and non‐voiding detrusor contractions (NVC). Furthermore data from telemetric natural filling cystometry from free‐moving and restricted maintenance were compared for potential difference. Results Median maximum detrusor pressure (Pdet max) of VC's was 120.6 cm H2O (21.0‐ 370.0 cm H2O) (median [range]) and, therefore, significantly different from Pdet max of NVC's (64.60 cm H2O [20.4 to 280.6 cmH2O]). Intra‐individual comparison of minipig data revealed great differences in voiding contractions. Effects of limited moving on VC's were analyzed and showed significantly higher Pdet max and lower DOC than in free‐moving maintenance. Conclusion The presented data can be used for the development of telecystometric implanted minipig models ‐ to investigate changes of detrusor function like under‐ or overactivity and might serve as model for bladder changes occurring with iatrogenic bladder outlet obstruction (BOO) or different therapeutical options for overactive bladder (OAB). Radio‐telemetric real‐time natural filling and voiding cystometries are feasible, reproducible in not anesthetized minipigs of free or limited moving and can give new insights in understanding circadian behaviour, physiological and pathological bladder function. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:44:32.04063-05:0
      DOI: 10.1111/bju.13089
       
  • Outcomes of Robotic‐Assisted Laparoscopic Upper Urinary Tract
           Reconstruction: 250 Consecutive Patients
    • Authors: Tracy Marien; Marc Bjurlin, Blake Wynia, Matthew Bilbily, Gaurav Rao, Lee C. Zhao, Ojas Shah, Michael D. Stifelman
      Abstract: Objective To evaluate our long‐term outcomes of robotic assisted laparoscopic (RAL) upper urinary tract (UUT) reconstruction. Materials and Methods Data from 250 consecutive patients undergoing RAL UUT reconstruction including pyeloplasty with or without stone extraction, ureterolysis, ureteroureterostomy, ureterocalicostomy, ureteropyelostomy, ureteral reimplantation and buccal mucosa graft ureteroplasty was collected at a tertiary referral center between March 2003 and December 2013. The primary outcomes were symptomatic and radiographic improvement of obstruction and complication rate. The mean follow‐up was 17.1 months. Results Radiographic and symptomatic success rates ranged from 85% to 100% for each procedure with a 98% radiographic success rate and 97% symptomatic success rate for the entire series. There were a total of 34 complications; none greater than Clavien grade 3. Conclusion RAL UUT can be performed with few complications, with durable long‐term success, and is a reasonable alternative to the open procedure in experienced robotic surgeons. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:41:13.170724-05:
      DOI: 10.1111/bju.13086
       
  • A review of detrusor overactivity and the overactive bladder after radical
           prostate cancer treatment
    • Authors: N Thiruchelvam; F Cruz, M Kirby, A Tubaro, C Chapple, K D Sievert
      Abstract: There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians and increasingly patients are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency, and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology, and options for treatment of OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pre‐treatment urinary symptoms and carefully evaluate post‐treatment symptoms. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T10:16:11.054799-05:
      DOI: 10.1111/bju.13078
       
  • Final Quality of Life and Safety Data for patients with mCRPC treated with
           Cabazitaxel in the UK Early Access Programme (NCT01254279)
    • Authors: A Bahl; S Masson, Z Malik, AJ Birtle, S Sundar, RJ Jones, ND James, MD Mason, S Kumar, D Bottomley, A Lydon, S Chowdhury, J Wylie, JS Bono
      Abstract: Background Cabazitaxel is a novel taxoid developed to overcome resistance to other taxanes. The 2010 TROPIC trial demonstrated improved survival for cabazitaxel compared with mitoxantrone in metastatic castration resistant prostate cancer (mCRPC) after previous docetaxel chemotherapy. However, concerns regarding safety (particularly neutropenic and cardiac complications) remained and quality of life (QOL) was not assessed. Objective The UK Early Access Programme (EAP) was part of an international phase IIIb/IV trial set up to facilitate access to cabazitaxel and to record detailed safety data. In the UK a specific amendment enabled formal QOL evaluation. Design, Setting and Participants 112 patients participated at 12 UK Cancer Centres. All had mCRPC with disease progression during or after docetaxel. Intervention Patients received cabazitaxel 25mg/m2 every 3 weeks with prednisolone 10mg daily for up to 10 cycles. Safety assessments were performed prior to each cycle and QOL recorded at alternate cycles using the EQ5D‐3L questionnaire and visual analogue scale (VAS). Outcome measures and statistical analysis Safety profile was compiled following completion of the EAP and QOL measures analysed to record trends. No formal statistical analysis was carried out. Results and Limitations The incidences of neutropenic sepsis (6.3%), grade 3 and 4 diarrhoea (4.5%) and grade 3 and 4 cardiac toxicity (0%) were low. Neutropenic sepsis episodes though low occurred only in patients who did not receive prophylactic G‐CSF. There were trends to improved VAS and EQ5D‐3L pain scores during treatment. Conclusions The UK EAP experience indicates that cabazitaxel may improve QOL in mCRPC and represents an advance and useful addition to the armamentarium of treatment for patients whose disease has progressed during or after docetaxel. In view of the potential toxicity, careful patient selection is important. Patient Summary We recorded detailed information about side effects and quality of life in 112 patients with advanced prostate cancer receiving cabazitaxel chemotherapy. We found that side effects were less severe than expected and, importantly, many patients’ quality of life and pain symptoms improved during treatment.
      PubDate: 2015-01-30T03:59:19.676623-05:
      DOI: 10.1111/bju.13069
       
  • Post‐operative Radiation Therapy for Patients at High‐risk of
           Recurrence after Radical Prostatectomy: Does Timing Matter'
    • Authors: Charles C. Hsu; Alan T. Paciorek, Matthew R. Cooperberg, Mack Roach, I‐Chow J. Hsu, Peter R. Carroll
      Abstract: Objective To evaluate among prostatectomy patients at high‐risk of recurrence whether the timing of post‐operative radiation therapy (adjuvant, early salvage with detectable post‐prostatectomy PSA, or “late” salvage with PSA>1.0) significantly is associated with overall, prostate‐cancer specific or metastasis‐free survival, in a longitudinal cohort. Patients and Methods Of 6176 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor(CaPSURE), 305 patients with high‐risk pathologic features(margin positivity, Gleason Score(pGS) 8‐10, or pT3‐T4) who underwent post‐operative radiation were examined, either in the adjuvant(≤6 months from surgery with undetectable PSA, N=76) or salvage setting(>6 months after surgery or pre‐radiation PSA>0.1, N=229). Early (PSA≤1.0, N=180) or late salvage radiation(PSA>1.0, N=49) was based on post‐prostatectomy, pre‐radiation PSA. Multivariable Cox regression examined associations with all‐cause mortality and prostate cancer‐specific mortality or metastases(PCSMM). Results After a median of 74 months from prostatectomy, 65 men died(with 37 events of PCSMM). Adjuvant and salvage radiation patients had comparable high‐risk features. Compared to adjuvant, salvage radiation(early or late) had an increased association with all‐cause mortality(hazard ratio[HR] 2.7, p=0.018) and with PCSM(HR 4.0, p=0.015). PCSM‐free survival differed by further stratification of timing, with 10‐year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage radiation, respectively(P=0.026). For PCSM‐ and overall‐survival, compared to adjuvant RT, late salvage RT had statistically significantly increased risk, however early salvage RT did not. Conclusion This analysis suggests that patients who underwent early salvage radiation with PSA1.0 is associated with worse clinical outcomes.
      PubDate: 2015-01-20T02:13:04.133915-05:
      DOI: 10.1111/bju.13043
       
  • The accuracy of Magnetic Resonance Imaging (MRI) in predicting the
           invasion of the tunica albuginea and the urethra during the primary
           staging of Penile Cancer
    • Authors: Vishwanath Hanchanale; Lehana Yeo, Nawraj Subedi, Jonathan Smith, Tze Wah, Patricia Harnden, Selina Bhattarai, Sameer Chilka, Ian Eardley
      Abstract: Objectives Penile preserving surgery is increasingly offered to men with localised penile cancer and surgical margins of less than 10 mm appear to offer excellent oncological control. Invasion of the tunica albuginea (TA) and the urethra are important factors in determining the feasibility of such surgery. We assessed the accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile Cancer. Methods One hundred and four consecutive patients with clinical T1‐T3 penile cancer had a penile MRI as a part of local staging protocol. An artificial erection was induced by injecting alprostadil (prostaglandin E1). Four men with poor quality MRI images were excluded from the study. The preoperative MRI was compared to final histology to assess its accuracy in predicting the invasion of the tunica albuginea and urethral invasion. Results Data of one hunded patients who underwent penile MRI prior to definitive surgery for invasive penile carcinoma was available for analysis. The mean age was 65 years and number of patients with pathological stage T1, T2 and T3 were 32, 52 and 16 respectively. The sensitivity and specificity of MRI in predicting the invasion of tunica albuginea and urethra were 82.1%, 73.6% and 62.5%, 82.1% respectively. There were no MRI related complications. Conclusions This study shows that penile MRI is an accurate imaging modality in assessing the tunica albuginea invasion but is less sensitive in assessing urethral invasion. These results support the use of MRI in the local staging of penile cancer.
      PubDate: 2015-01-20T02:12:46.112717-05:
      DOI: 10.1111/bju.13041
       
  • Guideline of guidelines: A Review of Urologic Trauma Guidelines
    • Authors: Darren J. Bryk; Lee C. Zhao
      Abstract: Objective To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). Materials and Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low‐grade injuries. The major difference is for high‐grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommends initial conservative management in hemodynamically stable patients. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies as well as clinical principles and expert opinions. Large‐scale prospective studies can improve the quality of evidence, and direct more effective evaluation and management of urologic trauma.
      PubDate: 2015-01-20T02:12:38.105022-05:
      DOI: 10.1111/bju.13040
       
  • Patient reported “ever had” and “current” long
           term physical symptoms following prostate cancer treatments
    • Authors: Anna T Gavin; Frances J Drummond, Conan Donnelly, Eamonn O'Leary, Linda Sharp, Heather R Kinnear
      Abstract: Objective To document prostate cancer patient reported ‘ever experienced’ and ‘current’ prevalence of disease specific physical symptoms stratified by primary treatment received. Patients 3,348 prostate cancer survivors 2‐15 years post diagnosis. Methods Cross‐sectional, postal survey of 6,559 survivors diagnosed 2‐15 years ago with primary, invasive PCa (ICD10‐C61) identified via national, population based cancer registries in Northern Ireland and Republic of Ireland. Questions included symptoms at diagnosis, primary treatments and physical symptoms (impotence/urinary incontinence/bowel problems/breast changes/loss of libido/hot flashes/fatigue) experienced ‘ever’ and at questionnaire completion (“current”). Symptom proportions were weighted by age, country and time since diagnosis. Bonferroni corrections were applied for multiple comparisons. Results Adjusted response rate 54%; 75% reported at least one ‘current’ physical symptom (‘ever’:90%), with 29% reporting at least three. Prevalence varied by treatment; overall 57% reported current impotence; this was highest following radical prostatectomy (RP)76% followed by external beam radiotherapy with concurrent hormone therapy (HT); 64%. Urinary incontinence (overall ‘current’ 16%) was highest following RP (‘current'28%, ‘ever'70%). While 42% of brachytherapy patients reported no ‘current’ symptoms; 43% reported ‘current’ impotence and 8% ‘current’ incontinence. ‘Current’ hot flashes (41%), breast changes (18%) and fatigue (28%) were reported more often by patients on HT. Conclusion Symptoms following prostate cancer are common, often multiple, persist long‐term and vary by treatment. They represent a significant health burden. An estimated 1.6% of men over 45 is a prostate cancer survivor currently experiencing an adverse physical symptom. Recognition and treatment of physical symptoms should be prioritised in patient follow‐up. This information should facilitate men and clinicians when deciding about treatment as differences in survival between radical treatments is minimal.
      PubDate: 2015-01-18T23:02:52.137378-05:
      DOI: 10.1111/bju.13036
       
  • Knowledge, Attitudes and Beliefs towards Management of Men with Locally
           Advanced Prostate Cancer following Radical Prostatectomy: An Australian
           Survey of Urologists
    • Authors: Bernadette (Bea) Brown; Jane Young, Andrew B Kneebone, Andrew J Brooks, Amanda Dominello, Mary Haines
      Abstract: Objective To investigate Australian urologists’ knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline‐recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methods A nationwide mailed and web‐based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results 157 surveys were included in the analysis (45% response rate). Just over half of respondents (57%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists’ attitudes and beliefs towards the specific recommendation for post‐operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = .520, p
      PubDate: 2015-01-14T03:53:29.770426-05:
      DOI: 10.1111/bju.13037
       
  • Association between number of prostate biopsies and patient‐reported
           functional outcomes after radical prostatectomy: implications for active
           surveillance protocols
    • Abstract: Objectives To evaluate whether the number of preoperative prostate biopsies affects functional outcomes after radical prostatectomy (RP). Methods We identified men treated with RP at our institution between 2008 and 2011. At 6 and 12 months post‐operatively, patients completed questionnaires assessing erectile and urinary function. Men with preoperative incontinence or erectile dysfunction or who did not complete the questionnaire were excluded. Primary outcomes were urinary and erectile function at 12 months postoperatively. We used logistic regression to estimate the impact of number of prostate biopsies on functional outcomes after adjusting for demographic and clinical factors. Results We identified 2,712 men treated with RP between 2008 and 2011. Most men (80%) had 1 preoperative prostate biopsy, 16% had 2, and 4% had at least 3. On adjusted analysis, erectile function at 12 months was not significantly different for men with 2 (OR 1.25; 95% CI 0.90, 1.75) or 3 or more (OR 1.52; 95% CI 0.84, 2.78) biopsies, compared to those with 1. Similarly, urinary function at 12 months was not significantly different for men with 2 (0.84, 95% CI 0.64, 1.10) or 3 or more (0.99, 95% CI 0.60, 1.61) biopsies compared to those with 1. Conclusions We did not find evidence that more preoperative prostate biopsies adversely affected erectile or urinary function at 12 months following RP. This article is protected by copyright. All rights reserved.
       
  • Wound dehiscence in a sample of 1,776 cystectomies – identification
           of predictors and implications for outcomes
    • Abstract: Objective To investigate the incidence and predictors of wound dehiscence in patients undergoing cystectomy. Materials and Methods 1776 patient records with Current Procedural Terminology (CPT) codes for radical cystectomy were extracted from the American College of Surgeons National Quality Improvement Program (ACS‐NSQIP) between 2005 and 2012. Stratification was made on the basis of the occurrence of postoperative wound dehiscence, defined as loss of integrity of fascial closure. Descriptive and logistic regression models were performed to identify predictors of postoperative wound dehiscence. The implications of wound dehiscence on peri‐ and postoperative outcomes such as complications, mortality, prolonged length of stay (pLOS >11 days) and prolonged operative time (pOT > 411 minutes), were assessed. Results Of 1776 patients analyzed, 57 (3.2%) had a documented wound dehiscence. In multivariable analyses, COPD (OR: 2.0, 95% CI: 1.0‐4.0, p=0.03) and high BMI (OR: 2.3, 95% CI: 1.3‐4.4, p=0.008) were significant predictors of wound dehiscence. While female gender had significantly lower proportions of wound dehiscence, multivariable analyses did not confirm this (OR: 0.4, 95% CI: 0.4‐1.4, p=0.75). Conclusions Our study is the first to identify predictors of wound dehiscence following radical cystectomy in a large, contemporary multi‐institutional cohort. Identifying patients at risk for postoperative wound complications may guide the use preventative measures at the time of surgery. This article is protected by copyright. All rights reserved.
       
  • Oncologic control associated with surgical resection of isolated
           retroperitoneal lymph node recurrence from renal cell carcinoma
    • Abstract: Objective To evaluate the outcome of patients following surgical resection of isolated retroperitoneal lymph node (RPLN) recurrence of renal cell carcinoma (RCC) using a multicenter international cohort. Materials And Methods Fifty patients were identified who underwent resection of isolated RPLN recurrence of RCC at four institutions following nephrectomy for pTanyNanyM0 disease. Progression‐free (PFS) and cancer‐specific survival (CSS) were estimated using the Kaplan‐Meier method. Cox proportional hazards regression models were utilized to assess the association of clinicopathological characteristics with disease progression. Results Median age at resection was 57.0 years (IQR 50.0‐62.5). Median time to RPLN recurrence following nephrectomy was 12.6 months (IQR 6.9‐39.5), with no significant difference in median time to RPLN recurrence noted between patients with N+ disease at nephrectomy (10.7 months (IQR 6.5‐24.6)) and patients with Nx/pN0 disease at nephrectomy (13.7 months (IQR 8.7‐44.2)) (p=0.66). Median size of the RPLN recurrence prior to resection was 2.6 cm (IQR 1.9‐5). The most common site for RPLN recurrence was within the interaortocaval region (34%). Median follow‐up after RPLN resection for patients alive at last follow‐up was 28.0 months (IQR 13.7, 51.2). During follow‐up, 26 patients developed RCC recurrence, at a median of 9.9 (IQR 4.0‐18.5) months after RPLN resection. Of those who developed a secondary recurrence, disease was again isolated to the retroperitoneum in 7 patients. Eleven patients subsequently died, including 10 who died of disease. Median PFS after RPLN resection was 19.5 months, with a 3‐ and 5‐year PFS of 40.5% and 35.4%, respectively. We moreover found that RPLN recurrence ≤ 12 months after nephrectomy was associated with a significantly inferior median PFS (12.3 months) compared to RPLN recurrence > 12 months following nephrectomy (47.6 months; p=0.003). Moreover, on multivariate analysis, a shorter time to recurrence remained associated with a significantly increased risk for subsequent disease progression (HR 3.51; p=0.005). Conclusion Surgical resection of isolated RPLN recurrence from RCC may result in durable cancer control in appropriately selected patients. Recurrence ≤ 12 months following nephrectomy was associated with a significantly increased risk of progression following resection, underscoring the importance of this variable for risk stratification. Thus, we recommend that, in the setting of isolated RPLN recurrence of RCC (in patients without precluding comorbidities), careful consideration with the patients and medical oncology colleagues be undertaken regarding the relative and individualized benefits of surgical resection, systemic therapy, and surveillance. This article is protected by copyright. All rights reserved.
       
  • Corrigendum
    •  
  • Validation of the GreenLight™ Simulator and development of a
           training curriculum for photoselective vaporisation of the prostate
    • Abstract: Objectives To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence‐based training curriculum. Subjects and Methods This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert‐level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Results Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence‐based training curriculum, to help trainees acquire transferable skills, was produced using the results. Conclusion This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency.
       
  • ATP release from freshly isolated guinea‐pig bladder urothelial
           cells: a quantification and study of the mechanisms involved
    • Abstract: Objectives To quantify the amount of ATP released from freshly isolated bladder urothelial cells, study its control by intracellular and extracellular calcium and identify the pathways responsible for its release. Materials and Methods Urothelial cells were isolated from male guinea‐pig urinary bladders and stimulated to release ATP by imposition of drag forces by repeated pipetting. ATP was measured using a luciferin‐luciferase assay and the effects of modifying internal and external calcium concentration and blockers of potential release pathways studied. Results Freshly isolated guinea‐pig urothelial cells released ATP at a mean (sem) rate of 1.9 (0.1) pmoles/mm2 cell membrane, corresponding to about 700 pmoles/g of tissue, and about half [49 (6)%, n = 9) of the available cell ATP. This release was reduced to a mean (sem) of 0.46 (0.08) pmoles/mm2 (160 pmoles/g) with 1.8 mm external calcium, and was increased about two‐fold by increasing intracellular calcium. The release from umbrella cells was not significantly different from a mixed intermediate and basal cell population, suggesting that all three groups of cells release a similar amount of ATP per unit area. ATP release was reduced by ≈50% by agents that block pannexin and connexin hemichannels. It is suggested that the remainder may involve vesicular release. Conclusions A significant fraction of cellular ATP is released from isolated urothelial cells by imposing drag forces that cause minimal loss of cell viability. This release involves multiple release pathways, including hemichannels and vesicular release.
       
  • Am I normal' A systematic review and construction of nomograms for
           flaccid and erect penis length and circumference in up to 15 521 men
           
    • Abstract: Objective To systematically review and create nomograms of flaccid and erect penile size measurements. Methods Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample. Exclusion criteria: samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (sd) and simulation of 20 000 observations from the normal distribution to generate nomograms of penis size. Results Nomograms for flaccid pendulous [n = 10 704, mean (sd) 9.16 (1.57) cm] and stretched length [n = 14 160, mean (sd) 13.24 (1.89) cm], erect length [n = 692, mean (sd) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (sd) 9.31 (0.90) cm], and erect circumference [n = 381, mean (sd) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. Limitations: relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length. Conclusions Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.
       
  • Long‐term follow‐up of a multicentre randomised controlled
           trial comparing tension‐free vaginal tape, xenograft and autologous
           fascial slings for the treatment of stress urinary incontinence in women
    • Abstract: Objective To compare the long‐term outcomes of a tension‐free vaginal tape (TVT; Gynecare™, Somerville, NJ, USA), autologous fascial sling (AFS) and xenograft sling (porcine dermis, Pelvicol™; Bard, Murray Hill, NJ, USA) in the management of female stress urinary incontinence (SUI). Patients and Methods A multicentre randomised controlled trial carried out in four UK centres from 2001 to 2006 involving 201 women requiring primary surgery for SUI. The women were randomly assigned to receive TVT, AFS or Pelvicol. The primary outcome was surgical success defined as ‘women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up’. The secondary outcomes included ‘completely dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL EQ‐5D questionnaire scores. Results In all, 162 (80.6%) women were available for follow‐up with a median (range) duration of 10 (6.6–12.6) years. ‘Success’ rates for TVT, AFS and Pelvicol were 73%, 75.4% and 58%, respectively. Comparing the 1‐ and 10‐year ‘success’ rates, there was deterioration from 93% to 73% (P < 0.05) in the TVT arm and 90% to 75.4% (P < 0.05) in the AFS arm; ‘dry’ rates were 31.7%, 50.8% and 15.7%, respectively. Overall, the ‘dry’ rates favoured AFS when compared with Pelvicol (P < 0.001) and TVT (P = 0.036). The re‐operation rate for persistent SUI was 3.2% (two patients) in the TVT arm, 13.1% (five) in the Pelvicol arm, while none of the patients in the AFS arm required further intervention. Conclusions Our study indicates there is not enough evidence to suggest a difference in long‐term success rates between AFS and TVT. However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT.
       
  • Long‐term functional outcomes after artificial urinary sphincter
           implantation in men with stress urinary incontinence
    • Abstract: Objective To evaluate long‐term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery. Patients and Methods Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow‐up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision. Results In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64–72) years. The median (IQR) duration of follow‐up was 15 (8.25–19.75) years. At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow‐up, in intention‐to‐treat analysis, 77.2% of patients were continent. Conclusion In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
       
  • Exploring associations between lower urinary tract symptoms (LUTS) and
           gastrointestinal (GI) problems in women: a study in women with urological
           and GI problems vs a control population
    • Abstract: Objectives To study the prevalence of self‐reported lower urinary tract symptoms (LUTS) in women consulting a Gastroenterology clinic with complaints of functional constipation (FC), fecal incontinence (FI) or both, compared with a female control population. Also, to study the influence of FC, FI, or both on self‐reported LUTS in women attending a Urology clinic. Patients and Methods We present a retrospective study of data collected through a validated self‐administered bladder and bowel symptom questionnaire in a tertiary referral hospital from three different female populations: 104 controls, 159 gastroenterological patients and 410 urological patients. Based on the reported bowel symptoms, patients were classified as having FC, FI, a combination of both, or, no FC or FI. LUTS were compared between the control population and the gastroenterological patients, and between urological patients with and without concomitant gastroenterological complaints. Results were corrected for possible confounders through logistic regression analysis. Results The prevalence of LUTS in the control population was similar to large population‐based studies. Nocturia was significantly more prevalent in gastroenterological patients with FI compared with the control population [odds ratio (OR) 9.1]. Female gastroenterological patients with FC more often reported straining to void (OR 10.3), intermittency (OR 5.5), need to immediately re‐void (OR 3.7) and feeling of incomplete emptying (OR 10.5) compared with the control population. In urological patients, urgency (94%) and urgency urinary incontinence (UUI, 54% of UI) were reported more often by patients with FI than by patients without gastroenterological complaints (58% and 30% of UI respectively), whereas intermittency (OR 3.6), need to immediately re‐void (OR 2.2) and feeling of incomplete emptying (OR 2.2) were reported more often by patients with FC than by patients without gastroenterological complaints. Conclusion As LUTS are reported significantly more often by female gastroenterological patients than by a control population, and as there is a difference in self‐reported LUTS between female urological patients with different concomitant gastroenterological complaints, we suggest that general practitioners, gastroenterologists and urologists should always include the assessment of symptoms of the other pelvic organ system in their patient evaluation. The clinical correlations between bowel symptoms and LUTS may be explained by underlying neurological mechanisms.
       
  • Role of emergency ureteroscopy in the management of ureteric stones:
           analysis of 394 cases
    • Abstract: Objective To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. Methods We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. Results A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re‐presented, for pain (76%), bleeding (10%) or infection (14%). Conclusion We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
       
  • Long‐term analysis of oncological outcomes after laparoscopic
           radical cystectomy in Europe: results from a multicentre study by the
           European Association of Urology (EAU) section of Uro‐technology
    • Abstract: Objective To report long‐term outcomes of laparoscopic radical cystectomy (LRC) in a multicentre European cohort, and explore feasibility and safety of LRC. Patients and Methods This study was coordinated by European Association of Urology (EAU)‐section of Uro‐technology (ESUT) with nine centres enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analysed. Descriptive statistics were used to explore peri‐ and postoperative characteristics of th ecohort. Kaplan–Meier curves were constructed to evaluate recurrence‐free survival (RFS), cancer‐specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, lymph node (LN) involvement and surgical margin status. Results Minor complications (Clavien I–II) occurred in 39% and major (IIIa–IVb) in 17%. In all, 10 (2%) postoperative deaths were recorded. The median (interquartile, IQR) LN retrieval was 14 (9–17) and positive surgical margins were detected in 29 (5.8%) patients. The median (mean, IQR) follow‐up was 50 (60, 19–90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5 years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, LN involvement and margin status (log‐rank P < 0.001). On multivariate Cox analysis, T stage and LN involvement (both P < 0.001) were significant predictors of RFS, CSS and OS. Positive margins were significant predictors of RFS (P = 0.016) and CSS (P = 0.043). Conclusions In this European LRC multicentre study, the largest to date, long‐term RFS, CSS and OS rates after LRC appear comparable to those reported in current open RC series. Further randomised controlled trials are necessary to assess the global impact of LRC.
       
  • The impact of robotic surgery on the surgical management of prostate
           cancer in the USA
    • Abstract: Objective To describe the surgeon characteristics associated with robot‐assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods A retrospective cohort study with a weighted sample size of 489 369 men who underwent non‐RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High‐volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7–3.4), intermediate‐ (200–399 beds; OR 5.96, 95% CI 1.3–26.5) and large‐sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4–25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7–6.4). RARP adoption was generally associated with increased RP volume, greatest for high‐volume surgeons and least for low‐volume surgeons (
       
  • Renal function is the same 6 months after robot‐assisted partial
           nephrectomy regardless of clamp technique: analysis of outcomes for
           off‐clamp, selective arterial clamp and main artery clamp
           techniques, with a minimum follow‐up of 1 year
    • Abstract: Objective To compare the renal functional outcomes, with >1 year of follow‐up, of patients who underwent robot‐assisted partial nephrectomy (RAPN) performed with different clamping techniques. Patients and Methods The peri‐operative data of patients undergoing RAPN performed with different clamping techniques were retrospectively analysed (group 1: off‐clamp, n = 23; group 2: selective clamp, n = 25; group 3: main artery clamp, n = 114). The main outcome measures were postoperative serum creatinine level, estimated glomerular filtration rate (eGFR) and percentage change in eGFR, the data for which were collected at periodic intervals during the first 12 months and annually thereafter, in addition to late eGFR value. Only patients with >1 year of follow‐up were included in the analysis. Results The baseline characteristics of groups 2 and 3 were similar, while patients in group 1 had smaller sized tumours and lower tumour complexity. The median follow‐up periods were 45 (group 1), 20 (group 2) and 47 (group 3) months. The median clamping times were 24.8 min in the main artery clamp and 18 min in the selective artery clamp groups. Group 2 had greater median blood loss volume (100 vs 500 vs 200 mL for groups 1, 2 and 3, respectively; P < 0.01) and a longer length of hospital stay (3 vs 4 vs 3 days for groups 1, 2 and 3, respectively; P = 0.02). No significant differences were found among the groups with regard to transfusion rates, positive surgical margin rates, complications, recurrence or mortality rates. Groups 1 and 2 had significantly less deterioration of postoperative renal function during the first 3 months after surgery (P = 0.04; percent change in eGFR −1.5, −2 and −8% for groups 1, 2 and 3, respectively), but this beneficial outcome was not observed after 6 months or for the latest eGFR measurement (P = 0.48; latest percent change in eGFR −3, −6 and −3.5% for groups 1, 2 and 3, respectively). In regression analysis, baseline eGFR, type of clamp procedure and tumour complexity score were predictive of normal renal function 7 days after surgery, while only baseline eGFR and age could predict it 1 year postoperatively. Conclusions Off‐clamp and selective artery clamp techniques result in superior short‐term renal functional outcomes compared with the main artery clamp approach; however, after the 6th postoperative month, there were no significant differences regarding the functional outcome among the above surgical techniques, as long as the warm ischaemia time was 20–30 min.
       
  • Clinical performance of serum isoform [‐2]proPSA (p2PSA), and its
           derivatives %p2PSA and the Prostate Health Index, in men aged <60
           years: results from a multicentric European study
    • Abstract: Objectives To test the hypothesis that [‐2]proPSA (p2PSA) and its derivatives are more accurate than total prostate‐specific antigen (tPSA), free prostate‐specific antigen (fPSA) and fPSA as percentage of tPSA (%fPSA) in detecting prostate cancer (PCa) in men aged
       
  • Stratification of patients with intermediate‐risk prostate cancer
    • Abstract: Objective To identify an appropriate risk stratification system for intermediate‐risk prostate cancer (PCa). Patients and Methods We reviewed the data on 1559 patients who were treated with radical prostatectomy (RP) at our institution between 2005 and 2013 and classified them according to National Comprehensive Cancer Network (NCCN) risk groups. For our analyses, intermediate‐risk PCa was designated as unfavourable intermediate‐risk PCa if it met at least one of the following two criteria: biopsy Gleason score 4 + 3 and/or presence of ≥2 intermediate‐risk criteria. All other men with intermediate‐risk PCa were designated as having favourable intermediate‐risk disease. Postoperative outcomes, including biochemical recurrence (BCR)‐free survival, were calculated and compared using the log‐rank test and Cox proportional hazards model. Results In multivariable analysis, biopsy Gleason score 4 + 3 and multiple (≥2) intermediate‐risk criteria were observed to be independent predictors of BCR risk among men in the intermediate‐risk group undergoing RP. The favourable intermediate‐risk group had a significantly higher 5‐year BCR‐free survival compared with the unfavourable intermediate‐risk group (87.5 vs 66.5%; P < 0.001). The unfavourable intermediate‐risk group had significantly higher 5‐year BCR‐free survival than the high‐risk group (66.5 vs 47.9%; P < 0.001) while the favourable intermediate‐risk group had significantly lower 5‐year BCR‐free survival than the low‐risk group (87.5 vs 93.5%; P = 0.002). Conclusions A marked heterogeneity exists in the biochemical outcomes of contemporary patients with intermediate‐risk PCa who undergo definitive RP. According to biopsy Gleason score and number of intermediate‐risk criteria present, the intermediate‐risk group should be sub‐divided into those with favourable and unfavourable intermediate‐risk disease.
       
  • Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and
           the risk of end‐stage renal disease (ESRD)
    • Abstract: Objective To assess whether radical nephrectomy (RN) compared with partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) is associated with greater risk of end‐stage renal disease (ESRD). Patients and Methods We performed a population‐based, retrospective cohort study using linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed RCC diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment choice. The primary outcome was ESRD. Secondary outcomes included overall mortality, myocardial infarction, and new‐onset chronic kidney disease (CKD). A modern cohort of patients (2003–2010) was analysed separately. Results We included 11 937 patients, of whom 2107 (18%) underwent PN. The median follow‐up was 57 months. In the full cohort, type of surgery was not associated with the rate of ESRD, whereas PN was associated with a decreased likelihood of ESRD compared with RN in the modern cohort using a multivariable proportional hazards model [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.25–0.75) or propensity score modelling (HR 0.48, 95% CI 0.27–0.82). PN was also associated with a lower risk of new‐onset CKD (HR 0.48, 95% CI 0.41–0.57). Conclusions Although it is well‐known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with less ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC.
       
  • Transrectal ultrasonography (TRUS)‐guided pelvic plexus block to
           reduce pain during prostate biopsy: a randomised controlled trial
    • Abstract: Objective To assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasonography(TRUS)‐guided prostate biopsy, compared with the conventional periprostatic nerve block (PNB). Patients and Methods A prospective, double‐blind observational study was conducted with patients being randomised into three groups. Group‐1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 mL 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 mL 2% lignocaine injection bilaterally. Group‐2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group‐3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on a visual analogue scale (VAS) at two time points: VAS‐1: during biopsy procedure and VAS‐2: 30 min after the procedure. Results The mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among the three groups. The mean pain score during biopsy was significantly less in the PPB group [mean (range) sore of 2.91 (2–4)] compared with the PNB group [mean (range) score of 4 (3–5)], and both these groups were superior to the no nerve block group [mean score of 5.4 (3–7)]. There was no significant difference between the mean pain scores, 30 min after the procedure among the three groups with the mean (range) scores being 2.75 (2–4), 2.83 (2–4) and 2.85 (2–4), respectively. Conclusion PPB is superior to conventional periprostatic nerve block (PNB) for pain control during TRUS‐guided biopsy and both are in turn superior to no nerve block.
       
  • Medium‐term oncological outcomes for extended vs saturation biopsy
           and transrectal vs transperineal biopsy in active surveillance for
           prostate cancer
    • Abstract: Objective To assess, in men undergoing active surveillance (AS) for low‐risk prostate cancer, whether saturation or transperineal biopsy altered oncological outcomes, compared with standard transrectal biopsy. Patients and Methods Retrospective analysis of prospectively collected data from two cohorts with localised prostate cancer (1998–2012) undergoing AS. Prostate cancer‐specific, metastasis‐free and treatment‐free survival, unfavourable disease and significant cancer at radical prostatectomy (RP) were compared for standard (12 core, median 16), and transrectal vs transperineal biopsy, using multivariate analysis. Results In all, 650 men were included in the analysis with a median (mean) follow‐up of 55 (67) months. Prostate cancer‐specific, metastasis‐free and biochemical recurrence‐free survival were 100%, 100% and 99% respectively. Radical treatment‐free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). On Kaplan–Meier analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (log‐rank P = 0.01). On multivariate Cox proportional hazards analysis, saturation biopsy (hazard ratio 1.68, P < 0.01) but not transperineal approach (P = 0.89) was associated with increased objective biopsy progression requiring treatment. On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (odds ratio 0.42, P = 0.03) but saturation biopsy did not alter the likelihood (P = 0.25). Neither transperineal nor saturation biopsy altered the likelihood of significant vs insignificant cancer at RP (P = 0.19 and P = 0.41, respectively). Conclusions AS achieved satisfactory oncological outcomes. Saturation biopsy increased progression to treatment on AS; longer follow‐up is needed to determine if this represents beneficial earlier detection of significant disease or over‐treatment. Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.
       
  • Clinical utility of 18F‐fluorocholine positron‐emission
           tomography/computed tomography (PET/CT) in biochemical relapse of prostate
           cancer after radical treatment: results of a multicentre study
    • Abstract: Objective To evaluate 18F‐fluorocholine positron‐emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. Patients and Methods This was a retrospective multicentre study that included 374 patients referred for choline‐PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow‐up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline‐PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline‐PET/CT] and quantitative [age, Gleason score, prostate‐specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline‐PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. Results Choline‐PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow‐up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow‐up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline‐PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of
       
  • Ureteroscopy for stone disease in the paediatric population: a systematic
           review
    • Abstract: The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English‐language articles reporting on a minimum of 50 patients aged ≤18 years treated with URS for stone disease were included. Two reviewers independently extracted the data from each study. A total of 14 studies (1718 procedures) were reported in patients with a mean (range) age of 7.8 (0.25–18.0) years. The mean (range) stone burden was 9.8 (1–30) mm and the mean (range) stone‐free rate (SFR) 87.5 (58–100)% with initial therapeutic URS. The majority of these stones were in the ureter (n = 1427, 83.4%). There were 180 (10.5%) Clavien I–III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorized into those that included children with either a mean age 6 years. (10 studies, 1377 procedures). A higher failure rate (4.4 vs 1.7%) and a higher complication rate (24.0 vs 7.1%) were observed in children whose mean age was
       
  • To clamp or not to clamp in robotic partial nephrectomy'
    •  
  • When normal is not enough
    •  
  • Nomogram to predict the benefit from salvage systemic therapy for advanced
           urothelial carcinoma
    •  
  • The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer
           Trials Group – a new co‐operative cancer trials group in
           genitourinary oncology
    •  
  • The scientific basis for the use of biomaterials in stress urinary
           incontinence (SUI) and pelvic organ prolapse (POP)
    • Abstract: Objectives To review the scientific and clinical literature to assess the basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pelvic floor diseases (PFDS), such as SUI and POP, are common and vexing disorders. While synthetic mesh‐based repairs have long been considered an option for PFD treatment, and their efficacy established in randomised clinical trials, safety of its use has recently been called into question. Materials and Methods Using the PubMed, MEDLINE and Medical Subject Headings (MeSH) databases, we performed a critical review of English‐language publications that contained the following keywords: ‘pelvic organ prolapse’, ‘stress urinary incontinence’, ‘mesh’, ‘biomaterial’, ‘collagen’, ‘elastin’ and ‘extracellular matrix’. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review. Results We found that many of the potential causes of PFDs are due to altered metabolism of patient extracellular matrix (specifically collagen, elastin, and their respective enzymes) and as such, repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. However, mesh use is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu. Conclusion While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision‐making process.
       
  • Mechanisms of ATP release – future therapeutic targets'
    •  
  • Choline‐positron emission tomography/CT in patients with relapsing
           prostate cancer: to be performed with therapeutic consequences only
    •  
  • A tribute to Dr. William D. Steers, 1955–2015
    •  
  • Learning from The Lancet
    •  
  • Sexual function and stress level of male partners of infertile couples
           during fertile period
    • Abstract: Objectives To evaluate the sexual function and stress level during timed intercourse (TI) of male partners of infertile couples. Patients and Methods The study included 236 male partners of couples with more than 1 year of infertility who sought medical care or an evaluation of couple infertility. Besides infertility evaluation, all participants were asked to complete the International Index of Erectile Function (IIEF) ‐5 for evaluation of sexual function and stresses related to infertility and timed intercourse were measured using ten‐division VAS questionnaires. Results Stress levels regarding sexual function were higher during fertile than infertile periods in109 of the 236 (46.2%) male partners, with 122 (51.7%) reporting no difference in stress during fertile and non‐fertile periods. Mean VAS score of sexual relationship stress was significantly higher during fertile than non‐fertile periods (3.4 ±2.6 vs. 2.1±2.2, p < 0.001). Of the 236 men, 21 (8.9%) reported more than mild to moderate ED (IIEF‐5 score≤16) and 99 (42%) reported mild ED (IIEF‐5 score 17‐21). Conclusion This is the first report showing quantitatively that male partners of infertile couples experience significantly higher TI related stresses during fertile than during non‐fertile period. Sexual dysfunction is also common in male partners of infertile couple. Medical personnel dealing with infertile couples should be aware of these potential problems in male partners and provide appropriate counseling. This article is protected by copyright. All rights reserved.
       
  • Laparoscopic extended pelvic lymph node dissection as validation of the
           performance of [11C]‐acetate‐PET/CT in detection of lymph node
           metastasis in intermediate and high‐risk prostate cancer
    • Abstract:  Objectives To evaluate the accuracy of the radiopharmaceutical [11C]‐acetate combined with positron emission tomography/computer tomography (acetate‐PET/CT) in lymph node staging in newly diagnosed prostate cancer (PCa) cases. A second aim was to evaluate the potential discriminative properties of acetate‐PET/CT in clinical routine. Patients and methods In a prospective comparative study, from July 2010 to June 2013, 53 men with newly histologically diagnosed intermediate or high risk PCa underwent acetate‐PET/CT investigation at one regional center prior to laparoscopic extended pelvic lymph node dissection (ePLND) at one referral center. The sensitivity, specificity and accuracy of acetate‐PET/CT were calculated. Comparisons were made between true positive and false negative PET/CT cases to identify differences in the clinical parameters: PSA, Gleason status, lymph metastasis burden and size, calculated risk of lymph node involvement, and curative treatment decisions. Results 26 patients had surgically/histologically proven lymph node metastasis (LN+). Acetate‐PET/CT was true positive in 10 patients, false positive in 1 patient, false negative in 16 patients and true negative in 26 cases. The individual sensitivity was 38%, specificity 96% and accuracy 68%. The PET/CT‐positive nodes (N+) cases had significantly more involved nodes (mean 7,9 vs. 2,4, p
       
  • Comparison of Survival Rates in Stage 1 Renal Cell Carcinoma Between
           Partial Nephrectomy and Radical Nephrectomy Patients According to Age
           Distribution: A Propensity Score Matching Study
    • Abstract: Objective To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for Stage 1 renal cell carcinoma (RCC) according to age distribution. The survival advantage of PN vs. RN in RCC patients has been unclear owing to conflicting data. Methods We studied 952 Stage 1 RCC patients who underwent either PN or RN. Patients were divided into 3 groups according to age: Group 1 (≤54 years), Group 2 (55–64 years), and Group 3 (≥65 years). Patient variables including age, BMI, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumor size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR) were adjusted using 1:1 propensity score matching between PN and RN. Results Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared to Groups 2 and 3. Postoperative eGFR dropped by 11–13% in PN patients and by 34–36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5‐year OS: PN 96%, RN 81%, p = 0.0430); however, there was no significant difference in Group 1 (5‐year OS: PN 100%, RN 93%, p = 0.3021) or Group 2 (5‐year OS: PN 94%, RN 87%, p = 0.3577). Conclusions Only the oldest group of patients showed significantly better OS owing to PN compared to RN; however, we still recommend PN in young patients. This article is protected by copyright. All rights reserved.
       
  • Iodinated contrast reactions – ending the myth of contrast allergic
           reactions to iodinated contrast agents in Urological Practice
    • Abstract: Iodinated contrast agents (ICA) are an essential part of the urologist's everyday practice, allowing enhanced imaging of the urinary tract. Contrast is administered directly into the urinary tract during retrograde pyelograms, JJ stent insertion, ureterorenoscopy, urethrography and cystography. Contrast can also be administered intravenously, for example during CT urogram studies in the investigation of haematuria. Increasingly, patients are labelled as having a contrast “allergy” when in fact this is a misnomer as it is not a true allergy. This article is protected by copyright. All rights reserved.
       
  • Assessing the impact of mass media public health campaigns:‘Be Clear
           on Cancer: Blood in Pee’ a case in point
    • Abstract: Objectives To assess the impact of Public Health England's recent ‘Be clear on cancer: Blood in the pee’ mass media campaign on suspected cancer referral burden and new cancer diagnosis. Methods A retrospective cohort study design was used; for two distinct time periods, August 2012 to May 2013 and August 2013 to May 2014, all referrals deemed to be at risk of urological cancer by the referring primary health care physician to Imperial College NHS Healthcare Trust were screened. Data points collected were: age and sex, whether the referral was for visible haematuria, non‐visible haematuria or other suspected urological cancer. In addition to referral data, hospital episode data for all new renal cell, and upper and lower tract transitional cell carcinoma, as well as testicular and prostate cancer diagnoses for the same time periods were obtained. Results Over the campaign period and the subsequent three months, the number of haematuria referrals increased by 92% (p=0.013) when compared to the same period a year earlier. This increase in referrals was not associated with a significant corresponding rise in cancer diagnosis; instead changes of 26.8% (p=0.56) and ‐3.3% (p=0.84) were seen in renal and transitional cell carcinomas respectively. Conclusion This study has demonstrated that the ‘Be clear on cancer: Blood in pee’ mass media campaign significantly increased the number of new suspected cancer referrals, but no significant change in the diagnosis of target cancers across a large catchment. Mass media campaigns are expensive; require significant planning and appropriate implementation and while the findings of this study do not challenge their fundamental objective, more work needs to be done to understand why no significant change in target cancers were observed. Further consideration should also be given to the increased referral burden that results from these campaigns such that pre‐emptive strategies, including educational and process mapping, across primary and secondary care can be implemented. This article is protected by copyright. All rights reserved.
       
  • The dose‐dependent effect of androgen deprivation therapy for
           localized prostate cancer on adverse cardiac events
    • Abstract: Objectives To investigate the dose‐dependent effect of androgen deprivation therapy (ADT) on adverse cardiac events in elderly men with non‐metastatic prostate cancer (PCa) stratified according to life expectancy (LE). Patients and methods 50,384 men diagnosed with localized PCa between 1992 and 2007 were identified within the SEER registry areas. We compared those who did receive ADT vs. those who did not within 2 years of PCa diagnosis, calculated as monthly equivalent doses of Gonadotropin‐releasing hormone (GnRH) agonists (
       
  • Low testosterone level is an independent risk factor for high‐grade
           prostate cancer detection via biopsy
    • Abstract: Objectives To investigate the relationship between low testosterone level and prostate cancer detection risk in a biopsy population. Patients and Methods A total of 681 men who underwent initial 12‐core transrectal prostate biopsy at our institution were included in this retrospective study. Patients were divided into groups with low (< 300 ng/dL) and normal testosterone levels (≥ 300 ng/dL). Clinical and pathological data were analyzed. Results Among 681 men, 86 men (12.6%) showed low testosterone level, 143 (32.7%) had a positive biopsy, and 99 (14.5%) were revealed to have high‐grade prostate cancer. Mean age, prostate‐specific antigen (PSA), PSA density (PSAD), body mass index (BMI), the numbers of abnormal digital rectal examination (DRE) findings and diabetes mellitus (DM) history were significantly different between the low and normal testosterone groups. A low testosterone level was significantly associated with a higher risk of detection of overall prostate cancer than a normal testosterone level in univariate analysis (odds ratio [OR] = 2.545, P = 0.001), but not in multivariate analysis adjusting for parameters such as age, PSA, prostate volume, BMI, abnormal DRE findings and DM (OR = 1.583, P = 0.277). Meanwhile, the low testosterone level was significantly related with a higher rate of high‐grade prostate cancer compared to the normal testosterone level in univariate (OR = 3.324, P < 0.001) and multivariate analysis adjusting for other parameters (OR = 2.138, P = 0.035). Conclusions Low testosterone level is an independent risk factor for high‐grade prostate cancer detection via biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out. This article is protected by copyright. All rights reserved.
       
  • Transcutaneous Interferential Electrical Stimulation for Management of
           Non‐neuropathic Underactive Bladder in Children: A Randomized
           Clinical Trial
    • Abstract: Objectives To assess the efficacy of transcutaneous interferential (IF) electrical stimulation and urotherapy in the management of non‐neuropathic underactive bladder (UB) in children with voiding dysfunction (VD). Patients and methods A total of 36 children with UB without neuropathic disease (15 boys, 21 girls; mean age 8.9±2.6) were enrolled and then randomly allocated to two equal treatment groups comprising IF and control groups. The control group underwent only standard urotherapy comprising diet, hydration, scheduled voiding, toilet training and pelvic floor and abdominal muscles relaxation. Children in the IF group, likewise underwent standard urotherapy and also received IF electrical stimulation. Children in both groups underwent a 15‐ course treatment program two times per week. A complete voiding and bowel habit diary was filled out by parents before, after treatment and one year later. Bladder ultrasound and uroflowmetry/EMG were performed before, at the end of treatment courses and at one year follow‐up. Results The mean number of voiding episodes before treatment was 2.6±1 and 2.7±0.76 times/day in IF and control groups, respectively which significantly increased after IF therapy in IF group, compared with only standard urotherapy in control group (6.3±1.4 times/day vs. 4.7±1.3 times/day, P < 0.002). The mean bladder capacity prior to treatment was 424±123 and 463±121ml in control and IF groups, respectively. This finding decreased significantly one year after the treatment in IF group compared to controls (227±86 vs.344±127 ml, P < 0.01). Maximum urine flow increased and voiding time decreased significantly in IF group compared with controls at the end of treatment sessions and one year later (P < 0.05). All children had abnormal flow curve at the beginning of the study. Flow curve became normal in 14/18 (77%) of children in IF group and 6/18 (33%) in control group, respectively at the end of follow up (P
       
  • Disease reclassification risk with stringent criteria and frequent
           monitoring in men with favorable‐risk prostate cancer undergoing
           active surveillance
    • Abstract: Objective To determine the frequency of disease reclassification and to identify clinicopathologic variables associated with it in patients with favorable‐risk prostate cancer undergoing active surveillance. Patients and Methods We assessed 191 men selected by what may be the most stringent criteria used in active surveillance studies yet conducted who enrolled in a prospective cohort active surveillance trial. Clinicopathologic characteristics were analyzed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score (GS) 3+3 (
       
  • Long‐Term Response to Renal Ischemia in the Human Kidney After
           Partial Nephrectomy – Results from a Prospective Clinical Trial
    • Abstract: Objective To assess the one‐year renal functional changes in patients undergoing partial nephrectomy with intraoperative renal biopsies. Subjects and Methods 40 patients with a single renal mass deemed fit for a partial nephrectomy were recruited prospectively between January 2009 and October 2010. We performed renal biopsies of normal renal parenchyma and collected serum markers before, during, and after surgically induced renal clamp ischemia during the partial nephrectomy. We then followed patients clinically with interval serum creatinine and physical exam. Results Perioperative data in 40 patients showed a transient increase in creatinine which did not correlate with ischemia time. Renal ultra‐structural changes were generally mild and the mitochondrial swelling which as noted, resolved at the post‐perfusion biopsy. 37 patients had one‐year follow‐up data. Creatinine (Cr) at one year increased by 0.121 mg/dl, which represents 12.99% decrease in renal function from baseline (preop Cr= 0.823mg/dl, eGFR=93.9). The only factors predicting creatinine change on multivariate analysis were patient age, race and ischemia type with cold ischemia associated with increased creatinine. Importantly, the duration of ischemia did not show any significant correlation with renal function change, either as a continuous variable (p=0.452) or as a categorical variable (p = 0.792). Conclusions Out data suggest that limited ischemia is generally well‐tolerated in the setting of partial nephrectomy and does not directly correspond to long‐term renal functional decline. For surgeons performing partial nephrectomy, the kidney can be safely clamped to ensure optimal oncologic outcomes. This article is protected by copyright. All rights reserved.
       
  • Guidelines of Guidelines: Urinary Incontinence
    • Abstract: Objective to review key guidelines on the management of urinary incontinence in order to guide clinical management in a practical way. Materials and methods guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialized guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research & Evaluation II (AGREE) Instrument was used to evaluate the quality of these guidelines. Results there is general agreement between the groups on the recommended initial workup and the use of conservative therapies for first line treatment, with limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures, however generally the mid‐urethral sling is recommended for uncomplicated stress urinary incontinence, with different recommendations on the approach as well as the comparability to other treatments, such as the autologous fascial sling. Conclusion this Guideline of Guidelines provides a summary of the salient similarities and differences between prominent groups on the management of urinary incontinence. This article is protected by copyright. All rights reserved.
       
  • Variability of Inter‐observer Agreement on Feasibility of Partial
           Nephrectomy Before and After Neoadjuvant Axitinib for Locally Advanced
           RCC: Independent Analysis from a Phase II Trial
    • Abstract: Objective To evaluate how many patients could have undergone PN instead of RN before and after neoadjuvant axitinib therapy, as assessed by 5 independent urologic oncologists, and to study the variability of inter‐observer agreement. Patients and Methods Pre‐ and post systemic treatment CT scans from 22 patients with ccRCC in a phase II neoadjuvant axitinib trial were reviewed by 5 independent urologic oncologists. RENAL score and Kappa statistics were calculated. Results Median RENAL score changed from 11 pre‐treatment to 10 post‐treatment, p=0.0017. Five tumors with moderate‐complexity pre‐treatment remained moderate‐complexity post‐treatment. Of 17 tumors with high‐complexity pre‐treatment, 3 became moderate‐complexity post‐treatment. Overall kappa statistic was 0.611. Moderate‐complexity kappa was 0.611 vs. high‐complexity kappa of 0.428. Pre‐treatment kappa was 0.550 vs. post‐treatment of 0.609. After treatment with axitinib, all 5 reviewers agreed that only 5 patients required RN (instead of 8 pre‐treatment) and that 10 patients could now undergo PN (instead of 3 pre‐treatment). The odds of PN feasibility were 22.8‐times higher after treatment with axitinib. Conclusions There is considerable variability in inter‐observer agreement on the feasibility of PN in patients treated with neoadjuvant targeted therapy. Although more patients were candidates for PN after neoadjuvant therapy, it remains difficult to identify these patients a priori. This article is protected by copyright. All rights reserved.
       
  • Technique for Office‐Based, Ultrasound‐Guided Percutaneous
           Biopsy of Renal Cortical Neoplasms Using a Novel Transducer for
           Facilitated Ultrasound Targeting
    • Abstract: Objectives ‐ To help clarify which small renal cortical neoplasms (RCNs) require surgery through the use of office‐based, ultrasound‐guided percutaneous renal biopsy ‐ We report our preliminary experience performing biopsies of small RCNs using a novel transducer forfacilitated ultrasound targeting Patients and Methods ‐ Biopsies were done using a facilitated ultrasound targeting technology which incorporates a needle guide and onscreen beam‐steered technology to permit highly precise needle deployment ‐ Patient and tumor characteristics, procedure time, complications, and biopsy efficacy were documented ‐ Wong‐Baker pain levels were obtained before, during, and one hour after the procedure Results ‐ Seven patients underwent biopsy, six for RCNs and one for medical renal disease ‐ The mean patient age was 68.5 years (range 54‐79), and mean tumor diameter was 2.55 cm (range 2.0‐2.9) ‐ Mean pain levels before, during, and 1 hour after the procedure were 0, 1.6, and 0.5, respectively ‐ There were no intra‐ or post‐procedural complications ‐ Biopsy results were diagnostic in 5 of the 6 RCN cases and in the single case of medical renal disease Conclusions ‐ Our preliminary experience demonstrates that office‐based percutaneous renal biopsy with this technique is safe and effective ‐ An international multi‐center study is planned to confirm these preliminary results
       
  • Immunocytochemical detection of ERG expression in exfoliated urinary cells
           identifies patients with prostate cancer with high specificity
    • Abstract: Objectives To evaluate immunocytochemical detection of ERG protein in exfoliated cells as a means of identifying patients with prostate cancer (CaP) prior to prostate biopsy. Patients and methods 30 mls of post‐ digital rectal examination (DRE) urine was collected from 158 patients with an elevated age‐specific PSA and/or an abnormal DRE who underwent prostate biopsy. In all cases, exfoliated urinary cells from half of the sample underwent immunocytochemical assessment for ERG protein expression. Exfoliated cells in the remaining half underwent assessment of TMPRSS2:ERG status using either nested reverse‐transcriptase‐PCR (151 cases) or fluorescence in‐situ hybridisation (FISH, 8 cases). Corresponding tissue samples were evaluated using FISH to determine chromosomal gene fusion tissue status, and immunohistochemistry (IHC) to determine ERG protein expression. Results were correlated with clinico‐pathological variables. Results The sensitivity and specificity of urinary ERG immunocytochemistry (ICC) for CaP was 22.7% and 100% respectively. ERG ICC correlated with advanced tumour grade, stage and higher serum PSA. In comparison urine TMPRSS2:ERG transcript analysis had 27% sensitivity and 98% specificity for CaP. On tissue IHC, ERG staining was highly specific for CaP. 52% of cancers harboured foci of ERG staining. However, only 46% of cancers which demonstrated ERG overexpression were positive on urine ICC. ERG ICC demonstrated strong concordance with urinary RT‐PCR and FISH, and tissue IHC and FISH. Conclusion This is the first study to demonstrate that cytological gene fusion detection using ICC is feasible and identifies patients with adverse disease parameters. ERG ICC was highly specific but this technique was less sensitive than RT‐PCR.
       
  • A novel FISH‐based definition of BCG failure to enhance recruitment
           into clinical trials of intravesical therapies
    • Abstract: Objectives To present a (molecular) definition of BCG failure which incorporates fluorescence in situ hybridization (FISH) testing to predict BCG failure before it becomes clinically evident. This will help in trial designs for patients with non‐muscle invasive bladder cancer (NMIBC) who fail BCG and thus lack an adequate control arm other than radical cystectomy. Patients and Methods We used data from 143 patients were followed prospectively for 2 years during intravesical BCG therapy during which time FISH assays were collected and correlated to clinical outcomes. Results Of the 95 patients with no evidence of tumor at 3‐month cystoscopy, 23 developed tumor recurrence, and 17 developed disease progression by 2 years. Patients with a positive FISH at both 6‐weeks and 3‐months were more likely to develop tumor recurrence (17/37, 46% and 16/28, 57%, respectively) compared to patients with a negative FISH (6/58, 10% and 3/39, 8%, respectively) (both: p
       
  • Robot Assisted Intracorporeal Pyramid Neo‐bladder
    • Abstract: Objective To describe the a robotic assisted intracorporeal Pyramid neo‐bladder (NB) reconstruction technique and report operative and peri‐operative metrics, post‐operative upper tract imaging, neo‐bladder functional outcomes and oncological outcomes. Patients and methods A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0‐78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration. Results Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UTI) (n=4), ileus (n=4), diarrhoea and vomiting (n=3), post‐operative collection (n=2), and blocked stent (n=1). Late postoperative complications include UTI (n=7), NB stone (n=2), voiding hem‐o‐loc (n=2), NB leak (n=2), diarrhoea and vomiting (n=1), uretero‐ileal stricture (n=1), vitamin B12 deficiency (n=1) and port site hernia (n=1). There was no evidence of hydronephrosis in 18 patients with a median follow‐up of 21.5 months. At 24 months, recurrence free survival was 86% and overall survival was 100%. Nineteen patients and 13 patients report 6 month day time and night time continence respectively. Conclusions The pyramid NB is technically feasible using a robotic platform and provides satisfactory functional outcomes at median of 21.5 months. This article is protected by copyright. All rights reserved.
       
  • Prognosis of patients with metastatic renal cell carcinoma and pancreatic
           metastases
    • Abstract: Objectives To identify the clinical outcomes of mRCC patients with PM treated with either pazopanib or sunitinib and assess whether PM is an independent prognostic variable in the current therapeutic environment. Patients and Methods Retrospective review of mRCC patients in an outpatient clinic was done from January 2006 to November 2011. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Comparison of baseline characteristics was done using chi² and t‐test and Overall Survival (OS) and Cancer‐Specific Survival (CSS) was estimated using Kaplan‐Meier methods. Predictors of OS were analyzed using Cox regression. Results A total of 228 patients were reviewed of which 44 (19.3%) had metastases to the pancreas and 184 (81.7%) had metastasis to sites other than the pancreas. The distribution of baseline characteristics was equal in both groups with the exception of a higher incidence of prior nephrectomy, diabetes and number of metastatic sites in the pancreatic metastasis group. 4 patients had isolated metastases to the pancreas, however, the majority of patients (68%) with pancreatic metastases had at least three different organ sites of metastases, as compared to 29% in patients without pancreatic metastases (p0.05), excluding pancreas. Median OS was 39 months (95% confidence interval [CI], 24‐57, HR=0.66, 95% CI = 0.42‐0.94, p=0.02) for patients with pancreatic metastases, compared to 26 months (95% CI, 21‐31) for patients without pancreatic metastases (p‐value
       
  • Prostate Biopsy Decisions: One Size Fits All Approach with Total PSA is
           Out and a Multivariable Approach with the Prostate Health Index is In
    • Abstract: The days of using one PSA threshold to trigger a biopsy for all men are over, and the field has moved toward a more individualized approach to prostate biopsy decisions taking into account each patient's specific set of risk factors. Foley et al. provide compelling evidence supporting the use of the Prostate Health Index (phi) as part of this multivariable approach to prostate biopsy decisions.[1] There is now a large body of evidence showing that phi is more specific for prostate cancer than total PSA and percent free PSA, as was concluded in a 2014 systematic review.[2] This article is protected by copyright. All rights reserved.
       
  • Metastases to the Kidney: A Comprehensive Analysis of 151 Patients from a
           Tertiary Referral Center
    • Abstract: Purpose Metastases to the kidney are a rare entity, historically described in autopsy studies. The primary aim of this study was to describe the presentation, treatment, and outcomes of patients with metastatic tumors to the kidney treated at a tertiary referral center. Patients and Methods We retrospectively identified 151 patients diagnosed with a primary non‐renal malignancy with renal metastasis. Clinical, radiographic and pathologic characteristics were assessed. Overall survival (OS) was calculated using Kaplan‐Meier methods. Results Median patient age was 56.7 years. The most common presenting symptoms were flank pain (30%), hematuria (16%) and weight loss (12%). Most primary cancers were carcinomas (80.8%). The most common primary tumor sites were lung (43.7%), colorectal (10.6%), ENT (6%), breast (5.3%), soft tissue (5.3%), and thyroid (5.3%). Renal metastases were typically solitary (77.5%). Concordance between radiologist and clinician imaging assessment was 54.0%. Three ablations and 48 nephrectomies were performed. For non‐surgical patients, renal metastasis diagnosis was made with FNA or biopsy. Median OS from primary tumor diagnosis was 3.08 years and median OS from time of metastatic diagnosis was 1.13 years. For patients treated with surgery, median OS from primary tumor diagnosis was 4.81 years, and OS from metastatic diagnosis was 2.24 years. Conclusions Metastases to the kidney are a rare entity. Survival appears to be longer in patients who are candidates for, and are treated with surgery. Surgical intervention in carefully selected patients with oligometastatic disease and good performance status should be considered. A multi‐disciplinary approach with input from urologists, oncologists, radiologists, and pathologists is needed to achieve the most optimal outcomes for this specific patient population. This article is protected by copyright. All rights reserved.
       
  • Clinical characteristics and quality‐of‐life in patients
           surviving a decade of prostate cancer with bone metastases
    • Abstract: Objective To describe characteristics and quality‐of‐life (QOL) and to define factors associated with long‐term survival in a subgroup of prostate cancer patients with M1b disease. Methods and patients The study was based on 915 patients from a prospective randomised multicentre trial (no.5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade (TAB). Long‐term survival was defined as patients having an overall survival >10 year, and logistic regression models were constructed to identity clinical predictors of survival. QOL during follow‐up was assessed using EROTC‐30 ratings. . Results Forty (4.4%) of the 915 men survived longer than 10 years. Factors significantly associated with increased likelihood of surviving more than ten years in the univariate analyses were: absence of cancer‐related pain; performance status < 2; negligible analgesic consumption; T‐category 1‐2; PSA
       
  • The Relationship Between Lymph Node Ratio and Cancer‐Specific
           Survival in a Contemporary Series of Patients with Penile Cancer and Lymph
           Node Metastases
    • Abstract: Objective ‐ To evaluate the association between lymph node ratio (LNR) and cancer‐specific survival (CSS) in a population of patients with penile cancer and lymph node metastases (LNM). Patients And Methods ‐ We evaluated 81 patients with pathologically‐determined LNM who were surgically treated at our Institution between 2000 and 2012. ‐ LNR was considered both as a continuously‐coded and as a categorically‐coded variable. The minimum p‐value approach was used to determine the most significant LNR cut‐off value. ‐The Kaplan‐Meier method was used to determine CSS rates. Univariable and multivariable Cox regression models were fitted to test the predictors of CSS. Results ‐ The median number of positive and removed lymph nodes were 2 (IQR: 1‐4) and 22 (IQR: 13‐30), respectively. Median LNR was 10.3% (IQR: 6.3 ‐16.6) and the most significant LNR cut‐off value was 22%. Median follow‐up was 26 months (IQR: 16‐62). ‐ Overall, 5‐year CSS rate was 50.5%. After stratification according to LNR, 5‐year CSS rates were 65.2 vs. 9.6% in patients with LNR < vs. ≥ 22%, respectively (p
       
  • Transurethral intraprostatic injection of botulinum neurotoxin type A for
           the treatment of chronic prostatitis/chronic pelvic pain syndrome: results
           of a prospective pilot double‐blind and randomized
           placebo‐controlled study
    • Abstract: Objective To evaluate the effect of botulinum neurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Materials and Methods Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4–6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT‐A or normal saline in a prospective pilot double‐blind randomized study. The patients' NIH‐CPSI total and subscale scores, American Urological Association (AUA)‐symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups. Results A total of 60 consecutive patients were randomized to a BoNT‐A (treatment) or normal saline (placebo) group. In the treatment group at the 1‐, 3‐ and 6‐month evaluation the NIH‐CPSI total and subscale scores, and the AUA‐SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA‐SS and frequencies of nocturnal urination were not significant at 1‐month follow‐up, repeated‐measure analysis showed significant improvement in each of these values over the entire follow‐up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow‐up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively. Conclusions Transurethral intraprostatic BoNT‐A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.
       
  • Is it safe to insert a testicular prosthesis at the time of radical
           orchidectomy for testis cancer: an audit of 904 men undergoing radical
           orchidectomy
    • Abstract: Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 to July 2005 and November 2007 to November 2009 were included. Data on postoperative complications, length of stay (LOS), re‐admission rate and return to theatre rate were collected. Results In all, 904 men [median (range) age 35 (14–88) years], underwent a radical orchidectomy during the study period and 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (P < 0.001), with a median age of 33 vs 37 years. There was no significant difference between the groups for LOS (P = 0.387), hospital re‐admission rates (P = 0.539) or return to theatre rate (P = 0.999). In all, 33/885 patients were readmitted ≤30 days of orchidectomy, with one of 236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30‐day hospital re‐admission (odds ratio 1.032, P = 0.016). Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re‐admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
       
  • 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.
       
  • Argument for prostate cancer screening in populations of
           African‐Caribbean origin
    • Abstract: The high prevalence, incidence and mortality rates of prostate cancer in Tobago would appear to strongly indicate that screening of this population would be justified and could positively impact on mortality. We consider our approach to be consonant with the recommendations of the EAU (Heidenreich A et al, 2013) and the findings of Hugosson et al, 2014)
       
  • Nephroureterectomy surgery in the United Kingdom in 2012: British
           Association of Urological Surgeons (BAUS) Registry data
    • Abstract: Objective Descriptive report of registry data obtained by BAUS in relation to nephroureterectomy (NU) surgery in the UK performed between January 1st and December 31st 2012. Subjects/Patients and methods Registry data entered by each individual surgeon's team (self‐reported) on all 6042 nephrectomy surgeries reported to BAUS during 2012 were analysed to identify all NU surgery. Parameters for analysis included demographics, indication, type of surgery, histopathology and complications (Clavien system) of surgery. Data did not include tumour location or multiplicity, pre‐operative diagnostic evaluation or details of minimally‐invasive surgery (MIS) undertaken. Prior to analysis for this report a central process of “data‐cleansing” was undertaken by a BAUS group in order to address any discrepancy between the listed surgery and the pre‐operative indication. Results In total 863 NU surgeries were included, performed by 220 consultant surgeons in 119 centres, and the median number of NU per surgeon and unit was 3 and 6 respectively (ranges 1‐20 and 1‐29). The most common age group was 71‐80 years (40%), majority were male (64%), and haematuria was the most common presentation (74%). Dominant pathology was upper tract urothelial cancer (89%, 735), with final stage ≥pT2 in 47% (367), and grade was 1, 2 or 3 in 6% (38), 36% (228) and 58% (362) respectively. Operative technique included MIS in 85% (720) and total reported operative complication rate (any Clavien) was 15% (128), of which Clavien ≥3 was reported in 4% (36), and peri‐operative death was reported in 9 patients (1%). Advantages in favour of MIS included reduced length of stay in hospital (median 5 v 8 days), reduced major blood loss (3 v 14%) and reduced transfusion requirement (6 v 24%). Seventy‐six cases (8%) were excluded from analysis based on benign pathology leading to reassignment to “simple nephrectomy” category. Conclusion NU is currently a low‐volume operation (median 3 cases per year) within the remit of the nephrectomy surgeon, but is a safe procedure with a relatively low complication rate. The majority of NU surgery is now performed with laparoscopic assistance, with advantages including reduced major blood loss, reduced transfusion requirement and shorter hospital stay.
       
  • Number of positive pre‐operative biopsy cores is a predictor of
           positive surgical margins in small prostates after robot‐assisted
           radical prostatectomy
    • Abstract: Objective To determine the impact of prostate size on positive surgical margin (PSM) rates after RARP and the pre‐operative factors associated with PSM. Materials And Methods A total of 1,229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had trans‐urethral resection of the prostate, neo‐adjuvant therapy, clinically‐advanced cancer, and the first 200 performed cases, to reduce the effect of learning curve. Included were 815 patients who were then divided into three groups: 45 g (group3). Multivariate analysis determined predictors of PSM and BCR. Results Console time and blood loss increased with increasing prostate size. There were more high‐grade tumors in group one (group1 vs. group2 and group3, 33.9% vs. 25.1 and 25.6%, p=0.003 and p=0.005). PSM were increased in 20 ng/dl, Gleason score >7, T3 tumor, and >3 positive biopsy cores. In group one, pre‐operative stage T3 (OR=3.94, p=0.020) and >3 positive biopsy core (OR=2.52, p=0.043) were predictive of PSM while a PSA >20ng/dl predicted the occurrence of BCR (OR=5.34, p=0.021). No pre‐operative factors predicted PSM or BCR for groups two and three. Conclusion A pre‐operative biopsy with >3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA >20 ng/dl is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer post‐operative follow‐up.
       
  • γEpithelial Na+ Channel and the Acid‐Sensing Ion Channel 1
           expression in the urothelium of patients with neurogenic detrusor
           overactivity
    • Abstract: Objective To investigate the expression of two types of cation channels such as the γEpithelial Na+ Channel (γENaC) and the Acid‐Sensing Ion Channel1 (ASIC1) in the urothelium of controls and in patients affected by neurogenic detrusor overactivity (NDO). In parallel, the urodynamic parameters were collected and correlated to the immunohistochemical (IHC) results. Subjects and Methods Four controls and 12 patients with a clinical diagnosis of NDO and suprasacral spinal cord lesion underwent to urodynamic measurements and cystoscopy. Cold cup biopsies were frozen and processed for immunohistochemistry and western blots. Spearman's correlation coefficient between morphological and urodynamic data was applied. One‐way ANOVA followed by Newman–Keuls multiple comparison post‐hoc test was applied for western blot results. Results In the controls, γENaC and ASIC1 were expressed in the urothelium with differences in their cell distribution and intensity. In NDO patients, both markers showed consistent changes either in cell distribution and labeling intensity compared to controls. A significant correlation between the higher intensity of the γENaC expression in urothelium of NDO patients and the lower values of bladder compliance was detected. Conclusion The present findings show important changes in the expression of γENaC and ASIC1 in NDO human urothelium. Of note, while the changes in γENaC might impair the mechanosensory function of urothelium, the increase of the ASIC1 might represent an attempt to compensate excess in local sensitivity.
       
  • An evaluation of the ‘weekend effect’ in patients admitted
           with metastatic prostate cancer
    • Abstract: Objectives To investigate whether mortality is increased for patients with metastatic prostate cancer (mCaP) admitted over the weekend. Patients and methods Using the Nationwide Inpatient Sample (NIS) between 1998‐2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in‐hospital mortality, complications, utilization of imaging and procedures were assessed. Adjusted logistic regression models examined associations of mortality and complications. Results A weighted sample of 534,011 patients with mCaP was identified, including 81.7% weekday and 18.3% weekend admissions. Of these, 8.6% died following a weekday vs. 10.9% after a weekend admission (p
       
  • Salvage micro‐dissection testicular sperm extraction; Outcome in men
           with Non obstructive azoospermia with previous failed sperm retrievals
    • Abstract: Objective To assess the outcome of m‐TESEas a salvage treatment in men withnon‐obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or TESA. Materials and Methods A total of 58 men with NOA underwent micro‐dissection testicular sperm extraction. All patients had previously undergone either single/multiple TESE or TESA with no sperm found. All patients underwent an m‐TESE using a standard technique. Serum follicle‐stimulating hormone, Testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent pre‐operative genetic screening.One patient was found to havean AZFc micro‐deletion and 5 werediagnosed with Kleinfelter's syndrome. Results The mean age of patients was39.0 years (range 26‐57).Spermatozoa were successfully retrieved in 27men by m‐TESE (46.5%).The mean FSH level was 19.4 (range 1.6‐ 58.5). There was no correlation in age (retrieved 38.1, not retrieved 39.7 p=0.38) FSH levels (Mean FSH retrieved 21.4, not retrieved 17.7p=0.3) and the ability to find sperm by m‐TESE. However, there was a significant difference with respect to testosterone and sperm retrieval (Mean testosterone retrieved 14.99, not retrieved 11.39 p
       
  • Sunitinib‐induced hypertension, neutropenia and thrombocytopenia as
           predictors of good prognosis in metastatic renal cell carcinoma patients
    • Abstract: Objectives To evaluate the clinical significance of hypertension, neutropenia and thrombocytopenia as possible new biomarkers of sunitinib efficacy in non‐trial metastatic renal cell carcinoma (mRCC) patients. Materials and methods 181 consecutive mRCC patients were treated with sunitinib. Thirty‐nine (22%) patients received sunitinib 50 mg/day 4 weeks on/ 2 weeks off, 80 patients (44%) 37.5 mg/day continuously and 62 (34%) 25 mg/day continuously as their starting dose. Treatment‐induced adverse events (AE) and their impact on outcome were analysed on multiple sunitinib doses. Results During sunitinib treatment 60 patients (33%) developed ≥grade 2 hypertension, 88 (49%) ≥grade 2 neutropenia and 135 (75%) ≥grade 1 thrombocytopenia. These AEs were associated significantly with longer progression‐free survival (PFS; 15.7 vs. 6.7; 14.6 vs. 6.9; 10.4 vs. 4.2 months, respectively; P
       
  • Prognostic Factors Influencing Survival from Regionally Advanced Squamous
           Cell Carcinoma of the Penis After Preoperative Chemotherapy
    • Abstract: Objective To describe both clinical and pathologic response rates, survival, and predictors of survival when utilizing contemporary peri‐operative chemotherapy and surgical resection for patients with regionally advanced squamous cell carcinoma of the penis. Materials & Methods Retrospective review of all patients diagnosed with squamous cell carcinoma of the penis and regional lymph node metastases that were treated with chemotherapy with the intent to undergo lymphadenectomy. Clinical and pathologic responses were reported. Recurrence‐free and overall survival was estimated using Kaplan‐Meier analysis. Cox proportional hazards regression was used to assess factors for survival. Results Sixty‐one patients were identified, of which 54 (90%) received chemotherapy with paclitaxel/ifosfamide/cisplatin. Thirty‐nine patients (65%) exhibited either a partial (PR) or complete response (CR) to chemotherapy. Five‐year survival varied significantly (p=0.045‐0.001) among patients achieving a CR/PR (50%), stable disease (25%), and progression (7.7%). Ten patients (16.4%) were rendered pN0 with combined therapy. Twenty patients (33%) were alive and disease free at a median follow‐up of 67 months, while 32 (52%) died of disease. Long‐term survival was associated with response to chemotherapy and favorable pathologic findings post resection. Conclusion Contemporary chemotherapy resulted in clinically significant responses among patients with regionally advanced penile cancer. Approximately 50% of such patients with an objective response to chemotherapy who undergo consolidative lymphadenectomy will remain alive at 5 years.
       
  • A Systematic Review of Experience of 180W XPS GreenLight Laser
           Vaporization of the Prostate in 1640 men
    • Abstract: Aim To systematically review the literature regarding clinical outcomes of 180W XPS GreenLight laser (GL) vaporization for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications in the field of 180 Watt GreenLight Laser (GL) vaporization for the treatment of LUTS due to BPH were identified by a literature search. It was searched for peer reviewed original articles in English language. Search items were: 180W lithium triborate laser or 180W greenlight laser or 180 watt lithium triborate laser or 180 watt greenlight laser or XPS greenlight laser. 30 papers published between 2012 and 2014 matched this search. Out of this collective 10 papers were identified dealing with consecutive cohorts of patients treated with the 180W XPS GreenLight® laser. Results Ten papers included a total experience of 1640 patients. The only RCT in this field compares 180W XPS with transurethral resection of the Prostate (TURP). Functional outcomes and prostate volume reduction following GL vaporization were similar to TURP. Catheterization time and hospital stay were shorter in patients undergoing 180W XPS GL‐vaporization (41 and 66 hours vs 60 and 97 hours respectively). Four papers compared the 180W XPS system to former GL devices demonstrating increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180W XPS GreenLight laser offers shorter operation times than the former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
       
  • HIV‐related stone disease – a potential new paradigm'
    •  
  • Renal cell cancer histologic subtype distribution differs by race and sex
    • Abstract: Objectives To examine racial differences in the distribution of histologic subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype. Materials and methods Tumors from 1,532 consecutive RCC patients who underwent nephrectomy at Vanderbilt University Medical Center (1998‐2012) were classified as clear cell, papillary, chromophobe, and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between race, sex, age, ESRD and body mass index at diagnosis (BMI, kg/m2) according to histologic subtype. Results The RCC subtype distribution was significantly different among blacks compared with whites (p
       
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Abstract: Objective ● At USC, the submission of lymphadenectomy specimens changed from en bloc to 13 separate anatomically defined packets in May 2002. ● We update our previous analysis of the clinical and pathological impact of this change in methodology, and determine whether lymph node (LN) packeting resulted in any change in oncologic outcomes. Patients and Methods ● 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection (LND) for cTxN0M0 bladder cancer between 01/1996 and 12/2007 were identified, ● Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results ● Pathologic tumor stage distribution and proportion of LN‐positive patients (group 1: 82 (22%) vs. group 2: 99 (21%); p=0.80) were similar: the median number of total LNs identified increased significantly (group 1: 32 (range: 10‐97), group 2: 65 (range: 10‐179); p
       
  • Applications of Three‐Dimensional Printing Technology in Urologic
           Practice
    • Abstract: A rapid expansion in the medical applications of three‐dimensional (3D) printing technology has been observed in recent years. This technology is capable of manufacturing low‐cost and customizable surgical devices, 3D models for use in pre‐operative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost‐effective tool in urologic practice, few studies are available that clearly demonstrate the clinical benefit of 3D printed materials. Nevertheless, 3D printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D printing technology on the future of urologic practice. This article is protected by copyright. All rights reserved.
       
  • Adverse Pathology and Undetectable Ultrasensitive Prostate‐Specific
           
    • Abstract: Objectives To determine if men with adverse pathology but undetectable ultrasensitive (
       
  • Positive Surgical Margins in Radical Prostatectomy Patients Do Not Predict
           Long‐term Oncological Outcomes: Results from SEARCH
    • Abstract: Purpose To assess the impact of positive surgical margins (PSMs) on long‐term outcomes after radical prostatectomy (RP), including metastasis, castrate‐resistant prostate cancer (CRPC), and prostate cancer‐specific mortality (PCSM). Materials and Methods Retrospective study of 4,051 men in SEARCH treated by RP from 1988‐2013. Proportional hazard models were used to estimate hazard ratios of PSMs in predicting BCR, CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and pre‐operative PSA. Results Median follow‐up was 6.6 years (IQR 3.2‐10.6) and 1,127 patients had over 10 years of follow‐up. During this time, 302 (32%) men experienced BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died of PC. There were 1600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all p≤0.001). After adjusting for demographic and pathological characteristics, margins were associated with increased risk of only BCR (HR 1.98, p0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA, and when patients who underwent adjuvant therapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high‐risk features, PSMs alone may not be an indication for adjuvant treatment. This article is protected by copyright. All rights reserved.
       
  • Diacylglycerol kinase κ (DGKK) variants and hypospadias in Han
           Chinese: association and meta‐analysis
    • Abstract: Objective To investigate whether diacylglycerol kinase κ (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population as has been suggested by previous publications. Patients Subjects and Methods A case‐control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias patients were further divided into mild, moderate and severe subgroups for analysis. Results Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias [odds ratios (ORs) > 1, P = 0.05 to P < 0.1), whereas no significant relationship was seen with the severe cases (ORs >1, P > 0.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta‐analysis on six SNPs, using combined data from our present results and those of previous studies of different races (including 1966 patients and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs >1, P < 0.05), and rs1934179 was significantly associated with severe hypospadias (OR > 1, P < 0.05). Conclusions DGKK gene variants do not appear to play a major role in hypospadias susceptibility in the Chinese Han population. Our meta‐analysis supports the hypothesis that DGKK is a common risk gene for hypospadias, particularly in cases of mild or moderate hypospadias in Caucasian populations.
       
  • Hypothermic machine perfusion improves Doppler ultrasonography resistive
           indices and long‐term allograft function after renal
           transplantation: a single‐centre analysis
    • Abstract: Objectives To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long‐term renal allograft function compared with static cold storage (CS). Methods We evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long‐term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n = 15). Doppler ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. Results Despite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow‐up. Subgroup analysis showed that the HMP‐induced improvement in postoperative eGFR was greatest in kidneys obtained from donation after cardiac death (DCD), even at 2 years after transplantation (P = 0.008). Conclusions HMP of transplant kidneys appears to improve vascular resistance after transplantation and has a positive impact on long‐term allograft function compared with CS in the population of recipients of DCD kidneys.
       
  • A prognostic model for survival after palliative urinary diversion for
           malignant ureteric obstruction: a prospective study of 208 patients
    • Abstract: Objective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk‐stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6‐month follow‐up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan–Meier survival estimates at 1, 6 and 12 months, and log‐rank tests. Results The median (range) survival was 144 (0–1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
       
  • Review: The use of sling versus sphincter in post‐prostatectomy
           urinary incontinence
    • Abstract: Up till now the artificial urinary sphincter (AUS) was the so‐called gold standard in post‐prostatectomy incontinence. However, male slings have gained much popularity in recent years due to the ease in surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
       
  • Actions of cyclic 3'5’‐adenosine monophosphate (cAMP) on
           calcium sensitisation in human detrusor smooth muscle contraction
    • Abstract: Objectives To clarify the effect of cyclic adenosine monophosphate (cAMP) on the Ca2+‐sensitised smooth muscle contraction in human detrusor, as well as the role of novel exchange protein directly activated by cAMP (Epac) in cAMP‐mediated relaxation. Materials and Methods All experimental protocols to record isometric tension force were performed using α‐toxin‐permeabilized human detrusor smooth muscle strips. The mechanisms of cAMP‐mediated suppression of Ca2+ sensitisation activated by 10 μM carbachol (CCh) and 100 μM guanosine‐5’‐triphosphate (GTP) were studied using a selective rho kinase (ROK) inhibitor, Y‐27632, and a selective protein kinase C (PKC) inhibitor, GF‐109203X. The relaxation mechanisms were further probed using a selective protein kinase A (PKA) activator, 6‐Bnz‐cAMP, and selective Epac activator, 8‐pCPT‐2’‐O‐Me‐cAMP. Results CCh‐induced Ca2+ sensitisation was inhibited by cAMP in a concentration‐dependent manner. GF109203X (10 μM) but not Y‐27632 (10 μM) significantly enhanced the relaxation effect induced by cAMP (100 μM). 6‐Bnz‐cAMP (100 μM) predominantly decreased the tension force in comparison with 8‐pCPT‐2’‐O‐Me‐cAMP (100 μM). Conclusions We demonstrated that cAMP predominantly inhibited the ROK pathway but not the PKC pathway. The PKA‐dependent pathway is dominant, while Epac plays a minor role in human DSM Ca2+ sensitisation. This article is protected by copyright. All rights reserved.
       
  • The efficacy of irinotecan, paclitaxel, and oxaliplatin (IPO) in relapsed
           germ cell tumors with high dose chemotherapy as consolidation‐ a
           non‐cisplatin‐ based induction approach
    • Abstract: Objectives To determine the outcome of an expanded cohort of patients with relapsed germ cell tumors (GCT) treated with a salvage chemotherapy regimen consisting of irinotecan, paclitaxel and oxaliplatin (IPO) and assess the role of IPO as an alternative to standard cisplatin‐based chemotherapy regimens in this setting. Patients and methods The results of 72 consecutive patients were reviewed retrospectively. IPO was used either as a second‐line treatment (n=29), of which 20 patients subsequently received high‐dose chemotherapy (HDCT), or third‐line (n=43), of which 32 patients proceeded to HDCT. Results The 2‐year PFS and 3‐year OS rates for the whole cohort were 30.2% (95%CI 17.3‐40.5%) and 33.4% (95%CI: 20.1‐43.8 %) respectively. CR was achieved in 3%, m‐ve PR in 41%, m+ve PR in 18%, SD in 17% and PD in 20%. In the second‐line setting, the 2‐year PFS rate was 43.5% (95%CI: 21.7‐60.8%) and 3‐year OS 49.1% (95%CI: 24.2‐65.1%). In the third‐line setting, the 2‐year PFS rate was 21.0% (95%CI 9.5‐35.4%) and the 3‐year OS rate was 23.9% (95%CI 11.7‐38.2).According to the current international prognostic factor study group criteria for first relapse for the high and very high risk group the 2 year PFS rates were 50% and 30% respectively. There were 2 treatment related deaths from IPO, and 4 from HDCT. Grade 3 or 4 toxicities included neutropenia (35%), thrombocytopenia (18%), infection (15%), diarrhea (11%) and lethargy (8%).  Conclusions IPO offers an effective, well‐tolerated, non‐nephrotoxic alternative to cisplatin‐based salvage regimens for patients with relapsed GCT. It appears particularly useful in high risk patients and for those in whom cisplatin is ineffective or contra‐indicated.
       
  • Transperineal template‐guided prostate biopsy: 10 years of
           experience
    • Abstract: Objective • To assess the efficacy and safety of transperineal template‐guided prostate biopsy. Materials and Methods • From December 2003 to December 2013, a total of 3007 patients (30‐91 years old, mean age 69.1) who met the inclusion criteria underwent 11‐region transrectal ultrasound‐guided transperineal template prostate biopsy. • The inclusion criteria included a prostate‐specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 ng/ml (range 0.2‐100 ng/ml). • The prostate cancer detection rate and prostate biopsy adverse effects, as well as prostate cancer spatial distribution were analyzed. Results • A mean of 19.3 cores (range 11 to 44) were obtained for each biopsy, and more cores were obtained in larger prostates than in smaller ones. • One to four cores were collected from each region. Prostate cancer was detected in 1067 of the 3007 patients (35.5%). The prostate cancer detection rates in groups with PSA levels of 0‐4.0 ng/ml, 4.1‐10.0 ng/ml, 10.1‐20.0 ng/ml, 20.1‐50.0 ng/ml, and 50.1‐100.0 ng/ml were 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), 56.0% (232/414), and 92.0% (241/262), respectively. • The mean positives for cancer in regions 1‐10 and region 11 (the apical region) were 46.7% vs. 52.0% (P=0.014). • Regarding adverse effects, 47.0% of the patients reported hematuria, 6.1% developed hemospermia, 1.9% required short‐term catheterization after biopsy because of acute urinary retention, and 0.03% (one patient) developed urosepsis. Conclusions • Transrectal ultrasound‐guided transperineal template prostate biopsy is safe and accurate. • The current study suggests that prostate carcinoma foci are more frequently localized in the apical region.
       
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • Abstract: Objectives •  To review emerging trends in prostate cancer (PC) literature with a focus on the marketing and implementation of new technologies, and the use of PC terms Methods •  Literature search of MEDLINE for external‐beam radiotherapy, prostatectomy, deferred intervention and focal therapy articles pertaining to PC •  Observational trends of PC literature relating to the marketing of new technologies and the use of standardised language Results •  PC literature has proliferated across all treatment modalities, particularly in the research of new technologies (robot‐assisted prostatectomy, image‐guided radiotherapy and focal therapy) •  Marketing and implementation of new technologies has occurred in some instances before effectiveness and adverse effects have been determined •  Inconsistent use of terminology exists in the PC literature Conclusion •  There is an ever‐present need for editors and researchers to maintain integrity and relevance in PC research •  We advocate a standardised language in PC and inclusion of active surveillance and robot‐assisted prostatectomy as MeSH indexing to reflect current trends and needs in PC research
       
  • Patterns of Surveillance Imaging After Nephrectomy in the Medicare
           Population
    • Abstract: Objectives To characterize patterns of imaging surveillance after nephrectomy in a population‐based cohort of older kidney cancer patients. Patients and Methods Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, we identified patients ≥66 years of age who had partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009. Primary outcomes were chest (X‐ray or CT) and abdominal (CT, MRI or ultrasound) imaging in Medicare claims from 4 to 36 months after surgery. We estimated the frequency of imaging in three time periods (post‐operative months 4‐12, 13‐24, 25‐36), stratified by tumor stage. Repeated‐measures logistic regression was used to identify patient and disease characteristics associated with imaging. Results Rates of chest imaging were 65‐80%, with chest X‐ray surpassing CT in each time period. Rates of abdominal imaging were 58‐76%, and cross‐sectional imaging was more common than ultrasound in each time period. Use of cross‐sectional chest and abdominal imaging increased over time while chest X‐ray decreased (p
       
  • Prediction of Cancer‐Specific Survival After Radical Cystectomy in
           pT4a Urothelial Carcinoma of the Bladder – Development of a Tool for
           Clinical Decision‐making
    • Abstract: Objective To externally validate May et al.'s pT4a‐specific risk model for cancer‐specific survival (CSS) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data of 856 pT4a patients after RC for UCB at 21 centres in Europe and North‐America was assessed. May et al.'s risk model including female gender, presence of positive LVI and lack of AC administration as adverse predictors for CSS was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver operating characteristics derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinico‐pathological parameters on CSS. Decision curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5‐year‐CSS after RC was 34% in our cohort. May et al.'s risk model predicted individual 5‐year‐CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (HR1.45), lymphovascular invasion (HR1.37), lymph node metastases (HR2.54), positive soft tissue surgical margin (HR1.39), neoadjuvant (HR2.24) and lack of adjuvant chemotherapy (HR1.67, all p
       
  • A phase I study of TRC105 anti‐CD105 (endoglin) antibody in
           metastatic castration‐resistant prostate cancer
    • Abstract: Objective ● TRC105 is a chimeric IgG1 monoclonal antibody that binds endoglin (CD105). ● This phase I open‐label study evaluated the safety, pharmacokinetics, and pharmacodynamics of TRC105 in patients with metastatic castration‐resistant prostate cancer (mCRPC). Patients and Methods ● Patients with mCRPC received escalating doses of intravenous TRC105 until unacceptable toxicity or disease progression, up to a predetermined dose level using a standard 3+3 phase I design. Results ● Twenty patients were treated and the top dose level studied of 20 mg/kg every two weeks was the maximum tolerated dose. ● Common adverse effects included infusion‐related reaction (90%), low grade headache (67%), anemia (48%), epistaxis (43%), and fever (43%). ● Ten patients had stable disease on study and eight patients had PSA declines. ● Significant plasma CD105 reduction was observed at the higher dose levels. In an exploratory analysis, vascular endothelial growth factor (VEGF) was increased after treatment with TRC105 and VEGF levels were associated with CD105 reduction. Conclusion ● TRC105 was tolerated at 20 mg/kg every other week with a safety profile distinct from that of VEGF inhibitors. ● There was a significant induction of plasma VEGF associated with CD105 reduction, suggesting anti‐angiogenic activity of TRC105. ● An exploratory analysis revealed a tentative correlation between the reduction of CD105 and a decrease in PSA velocity, suggestive of potential activity of TRC105 in the CRPC patients. The data from this exploratory analysis suggests rising VEGF is a possible compensatory mechanism for TRC105 induced anti‐angiogenic activity.
       
  • Evolving role of Positron Emission Tomography (PET) in Urological
           Malignancy
    • Abstract: We present a review on the increasing indications for the use of Positron emission tomography (PET) in uro‐oncology. In our review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
       
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • Abstract: Objective To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. Patients and Methods The cost‐effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the NHS in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT‐A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10 year time horizon for all treatment options with the exception of PTNS, which has a time horizon of five years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios. Direct medical resources included are: device and drug acquisition costs, pre‐procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. Results At five years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT‐A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT‐A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost‐effective. Conclusion In the management of patients with idiopathic OAB wet, the results of this cost‐utility analysis favors SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT‐A over a 10 year period.
       
  • Population‐based study of long‐term functional outcomes after
           prostate cancer treatment
    • Abstract: Objective To evaluate long‐term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow‐up of 12 years (IQR 11‐13). Patients and methods In this nationwide, population‐based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1‐2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤70 years at diagnosis. 1,000 prostate cancer‐free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self‐reported questionnaire. Results Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83‐2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73‐3.49]) compared to control men. Multi‐modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76‐7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93‐5.37] for urinary incontinence. Conclusion The proportion of men who suffer long‐term impact on functional outcomes after prostate cancer treatment was substantial. This article is protected by copyright. All rights reserved.
       
  • Global surgery ‐ How much of the burden is urological'
    • Abstract: An estimated two billion people worldwide lack access to any surgical care (1) and surgical conditions account for 11 ‐ 30% of the global burden of disease (2). Delivery of surgical, and therefore, urological care is a pre‐requisite for a functioning healthcare system and vital to achieve the new post‐MDG (Millennium Development Goals) aim of ‘universal health coverage’(3). This article is protected by copyright. All rights reserved.
       
  • Robotic radical cystectomy with intracorporeal urinary diversion: Impact
           on an established enhanced recovery protocol
    • Abstract: Objectives To assess the impact of the introduction of robotic‐assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP). To examine the effect on mortality and morbidity rates, transfusion rates and length of stay Patients and Methods Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction was obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was peri‐operative outcomes including transfusion rate, complication rates, 30d and 90d mortality rates and hospital stay. Results The demographics of the comparative groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade. A significant reduction in transfusion rate was observed in the RARC versus the open groups (p
       
  • Could a dye offer a cheap and simple approach to detect bladder cancer
           using white‐light cystoscopy'
    • Abstract: One of the main problems following an initial diagnosis and treatment for bladder cancer is the very high level of recurrence, in up to 80% of patients and progression to more invasive types of cancer in as many as 45% (1). This necessitates a high level of patient monitoring, the most in any area of cancer care, which is both very expensive and not always reliable. The majority of this screening uses white light cystoscopy, in which a cystoscope or fibre‐optic light tube with a camera at one end, is introduced into the bladder and the lining of the bladder examined using normal white light. This techniques relies on the surgeon spotting changes in the lining of the bladder, which given its large surface area and folded nature is often difficult, particularly when the lesions are small such as papillary bladder tumours or flat such as the highly aggressive carcinoma in situ (CIS). This article is protected by copyright. All rights reserved.
       
  • Current challenges to urological training in sub‐Saharan Africa
    • Abstract: There is not a perfect model for overseas support, but it is clear that any intervention must be well planned, be responsive to local needs and ideally offer the opportunity for ongoing longitudinal support and training. Assessment and follow up of outcomes, whilst difficult, is essential to further improving global Urological care. It is the surgical community in low income countries that will ultimately enforce change but overseas urological input from organisations can offer significant expertise to enhance training. This article is protected by copyright. All rights reserved.
       
  • Long‐term results of a prospective randomised trial assessing the
           impact of readaptation of the dorsolateral peritoneal layer following
           extended pelvic lymph node dissection and cystectomy
    • Abstract: Objective To evaluate the long term oncological and functional outcomes after readaptation of the dorsolateral peritoneal layer following pelvic lymph node dissection (PLND) and cystectomy . Patients and Methods A randomised, single‐center, single‐blinded, two‐arm trial was conducted on 200 consecutive cystectomy patients who underwent PLND and cystectomy for bladder cancer (
       
 
 
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