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Journal Cover BJU International
  [SJR: 2.009]   [H-I: 116]   [35 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  [1605 journals]
  • Late surgical correction of hypospadias increases the risk of
           complications: a 501 consecutive patients series
    • Authors: Sarah Garnier; Olivier Maillet, Barbara Cereda, Margot Ollivier, Clement Jeandel, Sylvie Broussous, Christophe Lopez, Francoise Paris, Pascal Philibert, Cyril Amouroux, Claire Jeandel, Amandine Coffy, Laura Gaspari, Jean Pierre Daures, Charles Sultan, Nicolas Kalfa
      Abstract: ObjectivesTo evaluate the outcome of hypospadias surgery according to age and to determine if some complications are age-related.Patients and methodsThis retrospective study was based on 722 hypospadiac boys undergoing primary repair. 501 had a urethroplasty and were included. Not only complications requiring an additional procedure were included (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) but also healing troubles, infections, hematomas and detrusor-sphincter dyssynergy. Logistic regression analysis was performed.ResultsHypospadias was anterior in 63.1%, mid-penile in 20.5%, posterior in 8.4% and scrotal in 7.9%. The median age was 4 years(1-16y). The overall rate of re-intervention and complication was 22.8% and 36.2% respectively. Age above 2 years was a significant predictor of complications (p=0.002, OR:1.98 IC 95% [1.26;3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy between 24-36 months (12,5% vs 3,6%, p=0.01) and healing problems beyond 13 years old (1,5% vs 28,5%, p= 0.06).ConclusionDelayed surgery may be detrimental for patients. Factors related to age may influence the rate of complications. Above 2 years, urethral surgery may interfere with the normal toilet-training process. During puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be prudent to continue to advocate for early surgery in patients with disorders of sex development.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-13T02:51:17.709314-05:
      DOI: 10.1111/bju.13771
       
  • Prognostic Value of Tissue Based Biomarker Signature in Clear Cell Renal
           Cell Carcinoma
    • Authors: Ahmed Q. Haddad; Jun-Hang Luo, Laura-Maria Krabbe, Oussama Darwish, Bishoy Gayed, Ramy Youssef, Payal Kapur, Dinesh Rakheja, Yair Lotan, Arthur Sagalowsky, Vitaly Margulis
      Abstract: ObjectiveTo improve risk stratification for recurrence prognostication in localized clear cell renal cell carcinoma (ccRCC) patients.Patients and Methods367 patients with non-metastatic ccRCC were included. The cohort was divided into a training and validation set. Using tissue microarrays, immunostaining was performed for 24 biomarkers representative of key pathways in ccRCC. Using LASSO Cox regression, we identified several markers which were used to construct a risk classifier for risk of disease recurrence.ResultsMedian follow-up was 63.5 months (IQR 24.0- 85.3 months). Five out of 24 markers were selected by LASSO Cox regression for the risk classifier: N-cadherin, E-cadherin, Ki67, cyclin D1 and phosphorylated eukaryotic initiation factor 4E binding protein-1 (p-4EB1). Patients were classified as either low, intermediate or high risk of disease recurrence by tertiles of risk score. 5-year recurrence free survival (RFS) was 93.8%, 87.7% and 70% for patients with low, intermediate and high risk score, respectively (p
      PubDate: 2017-01-11T11:09:04.516556-05:
      DOI: 10.1111/bju.13776
       
  • Development of a Voided Urine Assay for Detecting Prostate Cancer
           Noninvasively: A Pilot Study
    • Authors: Edouard J. Trabulsi; Sushil K. Tripathi, Leonard Gomella, Charalambos Solomides, Eric Wickstrom, Mathew L. Thakur
      Abstract: ObjectiveTo validate a hypothesis that prostate cancer (PCa) can be detected noninvasively by a simple and reliable assay by targeting genomic VPAC receptors expressed on malignant PCa cells shed in voided urine.Materials and MethodsVPAC receptors were targeted with a specific biomolecule, TP4303, developed in our laboratory. With an IRB “exempt” approval of use of de-identified discarded samples, an aliquot of urine collected as a standard of care, from patients presenting to the urology clinic, (N=207, M= 176, F= 31, 21 years or older) was cytospun. The cells were fixed and treated with TP4303 and 4, 6 Dimidino-2-phenylindole, Dihydrochloride (DAPI). The cells were then observed under a microscope and cells with TP4303 orange fluorescence around the blue (DAPI) nucleus were considered malignant and those only with blue nucleus were regarded as normal. VPAC presence was validated using receptor blocking assay and cell malignancy was confirmed by PCa gene profile examination.ResultsThe urine specimens were labeled only with gender and presenting diagnosis, with no personal health identifiers or other clinical data. The assay detected VPAC positive cells in 98.6% of the patients having a PCa diagnosis, (N=141), and none (0%) of the males with benign prostatic hyperplasia (BPH) (N=10). Of the 56 “normal” patients, 62.5% (N=35, M=10, F=25) were negative for VPAC cells; 19.6% (N=11, M=11, F=0) had VPAC positive cells; and 17.8% (N=10, M=4, F=6) were uninterpretable due to excessive crystals in the urine. Although data are limited, the sensitivity of the assay was 99.3% with confidence interval of 96.1%-100% and the specificity was 100% with confidence interval of 69.2%-100%. Receptor blocking assay and FACS analyses demonstrated the presence of VPAC receptors and gene profiling examinations confirmed that the cells expressing VPAC receptors were malignant PCa cells.ConclusionThese preliminary data are highly encouraging and warrant further evaluation of the assay to serve as a simple and reliable tool to detect PCa noninvasively.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:40:28.490622-05:
      DOI: 10.1111/bju.13775
       
  • TANGO – a screening tool to identify comorbidities on the causal
           pathway of Nocturia
    • Authors: W F Bower; G E Rose, C F Ervin, J Goldin, D M Whishaw, F Khan
      Abstract: ObjectivesTo develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia.MethodsVariables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the short form screening tool.Subjects/PatientsThe tool was administered to 252 individuals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected was subjected to descriptive analysis; criteria were applied to reduce number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the individual's Aetiology of Nocturia to Guide Outcomes.ResultsThe demographic characteristics of the sample are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long Form to the screening Short Form is presented. The resultant short form patient-completed nocturia screening tool is reported.ConclusionsA novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:30:27.766759-05:
      DOI: 10.1111/bju.13774
       
  • Quantifying severe urinary complications after radical prostatectomy: the
           development and validation of a surgical performance indicator using
           hospital administrative data
    • Authors: A Sujenthiran; SC Charman, M Parry, J Nossiter, A Aggarwal, P Dasgupta, H Payne, NW Clarke, P Cathcart, J van der Meulen
      Abstract: ObjectivesTo develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within two years after radical prostatectomy (RP) identified in hospital administrative data.Patients and MethodsMen who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding-framework based on procedure codes was developed to identify severe urinary complications which were grouped into “stricture”, “incontinence” and “other”. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression to estimate adjusted odds ratios (OR) for patient and surgical characteristics.Results17,299 men were included, 2,695 (15.6%) experienced at least one severe urinary complication within two years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds(OR comparing lowest with highest quintile: 1.45; 95%CI, 1.26-1.67) and those with prolonged length of hospital stay (OR 1.54, 95% CI, 1.40-1.69) and were less common in men who had robotic surgery (OR 0.65, 95% CI, 0.58-0.74).ConclusionThese results demonstrate severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment modalities and for service evaluation comparing performance of prostate cancer surgery providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-11T08:25:33.719822-05:
      DOI: 10.1111/bju.13770
       
  • Salvage high-intensity focused ultrasound (HIFU) for locally recurrent
           prostate cancer after failed radiation therapy: Multi-institutional
           analysis of 418 patients
    • Authors: Sebastien Crouzet; Andreas Blana, Francois J. Murat, Gilles Pasticier, Stephen C.W. Brown, Giario N. Conti, Roman Ganzer, Olivier Chapet, Albert Gelet, Christian G. Chaussy, Cary N. Robertson, Stefan Thuroff, John F. Ward
      Abstract: ObjectiveTo report the oncological outcome of Salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer (PCa) following External Beam Radiotherapy (EBRT) from a multicenter database.Materials and MethodsThis retrospective study comprises patients from 9 centers with local recurrent disease following EBRT treated with S-HIFU from 1995 to 2009. Biochemical free survival rates (BFSR) was based on the “Phoenix” definition (nadir+2). Secondary end points included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall, tumor specific and metastasis free survival. Adverse events and quality of life status are reported.ResultsA total of 418 patients with a mean follow-up of 3.5±2.5 years were included. The average age was 68.6±5.8 years. The average PSA pre S-HIFU was 6.8±7.8ng/ml. The median PSA nadir after S-HIFU was 0.19ng/ml. The overall, cancer specific and metastasis free survival rate at 7 years were 72%, 82% and 81%, respectively. At 5 years the BFSR was 58%, 51% and 36% for pre EBRT low-, intermediate- and high-risk patients, respectively. The 5 years BFSR was 67%, 42% and 22% for pre S-HIFU PSA ≤4, 4 to 10 and ≥10ng/ml respectively.Complication rates decreased after the introduction of specific post-radiation treatment parameters: incontinence (grade II or III) from 32% to 19% (p=0.002); bladder outlet obstruction (BOO) or stenosis from 30% to 15% (p=0.003); urethro-rectal fistula decreased from 9% to 0.6% (p
      PubDate: 2017-01-07T02:30:27.700329-05:
      DOI: 10.1111/bju.13766
       
  • First-line non-cytotoxic therapy in chemotherapy-naive patients with
           metastatic castration-resistant prostate cancer: a systematic review of
           ten randomised clinical trials
    • Authors: Michiel H.F. Poorthuis; Robin W.M. Vernooij, R. Jeroen A. van Moorselaar, Theo M. de Reijke
      Abstract: ObjectiveTo systematically evaluate all available treatment options in chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC).MethodsWe systematically searched PubMed, EMBASE, and the Cochrane libraries up to March 1, 2016 for peer-reviewed publications on randomised clinical trials (RCTs). RCTs were included if progression-free survival (PFS), overall survival (OS), quality of life (QoL), or adverse events (AEs) were quantitatively evaluated. We assessed the risk of bias (RoB) with the Cochrane Collaboration's tool and graded the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's approach.ResultsWe included 25 articles, reporting on ten unique RCTs describing seven different comparisons. In one RCT, a prolonged OS and PFS (high quality) were found with abiraterone and prednisone compared to placebo plus prednisone. In one RCT, a prolonged OS and PFS (high quality) were found with enzalutamide compared to placebo. In two RCTs, a prolonged OS (high and moderate quality) was found with 223radium compared to placebo, but its effect on PFS is unknown. In three RCTs, a prolonged OS (moderate quality) was found with sipuleucel-T compared to placebo, but no prolonged PFS (low quality). In one RCT a prolonged PFS (high quality) was found with orteronel compared to placebo, but no prolonged OS (moderate quality). In one RCT, a prolonged OS (moderate quality) was found with bicalutamide compared to placebo, but its effect on PFS is unknown. In one study, a prolonged PFS (high quality) was found with enzalutamide compared to bicalutamide, but its effect on OS is unknown.ConclusionsThe best evidence was found for abiraterone and enzalutamide for effective prolongation of PFS and OS to treat chemotherapy-naive mCRPC patients. However, taking both QoL and AEs into consideration, other treatment modalities could be considered for individual patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T22:50:22.24634-05:0
      DOI: 10.1111/bju.13764
       
  • Surgical Histopathology for Suspected Oncocytoma on Renal Mass Biopsy: a
           Systematic Review and Meta-Analysis
    • Authors: Hiten D. Patel; Sasha C. Druskin, Steven P. Rowe, Phillip M. Pierorazio, Michael A. Gorin, Mohamad E. Allaf
      Abstract: ObjectiveTo estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology.Materials and MethodsA systematic review of MEDLINE, Embase, and the Cochrane databases (1997-July 1, 2016) was conducted to quantify all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma.In addition, institutional data was assessed to identify additional cases.Concordance with surgical histopathology (positive predictive value) was evaluated for patients undergoing surgery by performing a meta-analysis.ResultsA total of 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery.One additional study from identified 2 neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis.Surgical pathology showed oncocytoma (64.6%), chromophobe RCC (12.5%), other RCC (12.5%), hybrid oncocytic/chromphobe tumor (6.3%), and other benign lesions (4.2%).Positive predictive value of oncocytoma on RMB was 67% (95% confidence interval 34% to 94%) with significant heterogeneity between studies (I2=71.8%, p
      PubDate: 2017-01-06T02:20:35.942551-05:
      DOI: 10.1111/bju.13763
       
  • Guideline of Guidelines – Non-Muscle Invasive Bladder Cancer
    • Authors: Solomon L. Woldu; Aditya Bagrodia, Yair Lotan
      Abstract: Non-muscle invasive bladder cancer (NMIBC) represents the vast majority of bladder cancer diagnoses, however this definition represents a spectrum of disease with a variable clinical course notable for significant risk of recurrence and potential for progression. Management involves risk-adapted strategies of cystoscopic surveillance and intravesical therapy with a goal of bladder preservation when safe to do so. Multiple organizational guidelines exist to help practitioners manage this complicated disease process, however adherence to management principles amongt practicing urologists is reportedly low. We review four major organizational guidelines on NMIBC: American Urological Association (AUA) / Society of Urologic Oncology (SUO), European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and National Institute for Health and Care Excellence (NICE).This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T02:15:25.021899-05:
      DOI: 10.1111/bju.13760
       
  • Prostate health index density improves detection of clinically-significant
           prostate cancer
    • Authors: Jeffrey J. Tosoian; Sasha C. Druskin, Darian Andreas, Patrick Mullane, Meera Chappidi, Sarah Joo, Kamyar Ghabili, Mufaddal Mamawala, Joseph Agostino, Ballentine H Carter, Alan W. Partin, Lori J. Sokoll, Ashley E. Ross
      Abstract: ObjectivesTo explore the utility of prostate health index (PHI) density for detection of clinically-significant prostate cancer (PCa) in a contemporary cohort of men presenting for diagnostic workup of PCa.Patients & MethodsThe study cohort included patients with elevated PSA (>2 ng/ml) and negative digital rectal examination who underwent PHI testing and prostate biopsy at our institution in 2015. Serum markers were prospectively measured per standard clinical pathway. PHI was calculated as [([-2]proPSA/free PSA) x (PSA)½], and density calculations were performed using prostate volume as determined on transrectal ultrasound. Logistic regression was used to assess the ability of serum markers to predict clinically-significant PCa, defined as any Gleason score ≥7 cancer or Gleason score 6 cancer in >2 cores or >50% of any positive core.ResultsOf 118 men with PHI testing who underwent biopsy, 47 (39.8%) were found to have clinically-significant PCa on biopsy. The median PHI density was 0.70 (IQR 0.43-1.21); it was 0.53 (IQR 0.36-0.75) in men with negative biopsy or clinically-insignificant PCa and 1.21 (IQR 0.74-1.88) in men with clinically-significant PCa (p
      PubDate: 2017-01-06T02:15:22.821258-05:
      DOI: 10.1111/bju.13762
       
  • Cannabinoids for treating neurogenic lower urinary tract dysfunction in
           patients with multiple sclerosis: a systematic review and meta-analysis
    • Authors: Nadim Abo Youssef; Marc P. Schneider, Livio Mordasini, Benjamin. V. Ineichen, Lucas M. Bachmann, Emmanuel Chartier-Kastler, Jalesh N. Panicker, Thomas M. Kessler
      Abstract: ObjectivesTo systematically review all available evidence on efficacy and safety of cannabinoids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS).Patients and methodsThe review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus (last search on 11 November 2016).ResultsAfter screening 8469 articles, two randomized controlled trials and one open label study enrolling a total of 426 patients, were included. Cannabinoids relevantly decreased incontinence episodes in all three studies. Pooling data showed mean difference in incontinence episodes per 24 hours to be -0.35 (95% confidence interval -0.46 to -0.24). Mild adverse events were frequent (38-100%), but only two patients (0.7%) reported a serious adverse event.ConclusionsPreliminary data imply, that cannabinoids might be an effective and safe treatment option for NULTD in patients with MS. However, evidence base is poor and more high-quality, well-designed, adequately powered and sampled studies are urgently needed to reach definitive conclusions.This article is protected by copyright. All rights reserved.
      PubDate: 2017-01-06T02:05:28.086953-05:
      DOI: 10.1111/bju.13759
       
  • Journal information
    • PubDate: 2016-12-21T05:13:37.337669-05:
      DOI: 10.1111/bju.13634
       
  • Thank you to our Reviewers 2016
    • PubDate: 2016-12-21T05:13:35.15777-05:0
      DOI: 10.1111/bju.13730
       
  • Safety and early effectiveness of robotic partial nephrectomy for large
           angiomyolipomas
    • Authors: Shay Golan; Scott Johnson, Matthew Maurice, Jihad Kaouk, Weil Lai, Benjamin Lee, Steve Kheyfets, Chandru Sundaram, David Cahn, Robert Uzzo, Arieh Shalhav
      Abstract: ObjectivesTo evaluate a multicenter series of robotic assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).Materials and methodsBetween 2005-2016, 40 patients with large or symptomatic AMLs underwent RAPN at 5 academic centers in the United States. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analyzed. Surgical outcomes were compared between patients who underwent selective arterial embolization (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.ResultsMedian tumor diameter was 7.2 cm (interquartile range [IQR]: 5–8.5 cm), and the median nephrometry score was 9 (IQR: 7-10). Six patients (15%) had a history of tuberous sclerosis, and 11 (28%) had previously undergone SAE. Median operative time and median warm ischemia time were 207 minutes (IQR: 180-231) and 22.5 minutes (IQR: 16-28), respectively. Non-clamping technique was applied in 8 (20%) patients. Median blood loss was 200 ml (IQR: 100-245), and 4 patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and 7 postoperative complications occurred in 6 patients (15%). During a median follow-up time of 8 months (IQR: 1-15), none of the patients developed AML-related symptoms. The median eGFR preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before surgery and those who did not.ConclusionsRAPN appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with favorable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-18T03:35:22.511374-05:
      DOI: 10.1111/bju.13747
       
  • Early surgical outcomes and oncological results of robotic assisted
           partial nephrectomy: A multi-centre study
    • Authors: R Veeratterapillay; S Addla, C Jelley, J Bailie, D Rix, S Bromage, N Oakley, R Weston, N Soomro
      Abstract: ObjectiveTo describe a multi-centre experience of robotic assisted partial nephrectomy (RAPN) in Northern England with focus on early surgical outcomes and oncological results.Patients and methodsAll consecutive patients undergoing RAPN at four tertiary referral centres in Northern England in the period 2012-2015 were included for analysis. RAPN was performed via a trans-peritoneal approach using standardised technique. Prospective data collection was performed to capture preoperative characteristics (including the R.E.N.A.L. nephrometry score), peri-operative parameters, and post-operative data including renal function. Correlations between warm ischaemic time (WIT), positive margin rate, complication rates, R.E.N.A.L. nephrometry scores and learning curve were assessed by univariate and multivariate analyses.Results250 patients (mean age 58.1±13 years, mean BMI 27.3±7 kg/m2) were included with a median follow-up of 12 months (3-36). The mean tumour size was 30.6±10mm, mean RENAL nephrometry score was 6.1±2 and 55% of tumours were left sided. Mean operative console time was 141±38 min, warm ischaemic time 16.7±8 min and estimated blood loss 205±245 mLs. There were 5 conversions (2%) to open/radical nephrectomy. The overall complication rate was 16.4% (Clavien I 1.6%, Clavien II 8.8%, Clavien III 6%, Clavien IV/V 0%). Pathologically, 82.4% of tumours were malignant and the overall positive margin rate was 7.3%. The mean preoperative and immediate post-operative eGFR were 92.8±27 and 80.8±27 ml/min/1.73m2 respectively(p=0.001). 66%of patients remained in the same CKD category postoperatively and none of the patients required dialysis during the study period. ‘Trifecta’ (defined as WIT
      PubDate: 2016-12-18T03:30:24.842382-05:
      DOI: 10.1111/bju.13743
       
  • Efficacy and Safety of Tadalafil 5mg Once Daily in the Treatment of Lower
           Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia
           (LUTS/BPH) in Men Aged 75 years or Older: Integrated Analyses of Pooled
           Data From Multinational, Randomised, Placebo-controlled Clinical Studies
    • Authors: Matthias Oelke; Adrian Wagg, Yasushi Takita, Hartwig Büttner, Lars Viktrup
      Abstract: ObjectiveTo assess efficacy and safety of tadalafil in men ≥75 years with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and additional safety in men ≥75 years with erectile dysfunction (ED).Subjects and MethodsIntegrated analysis of 12 Phase II-III randomised, double-blind and/or open-label extension studies to evaluate short-term (12-26 weeks) efficacy and short- and longer-term (42-52 weeks) safety in men
      PubDate: 2016-12-18T03:30:22.854186-05:
      DOI: 10.1111/bju.13744
       
  • Development, Validation and Clinical Application of Pelvic Lymphadenectomy
           Assessment and Completion Evaluation (PLACE): Intraoperative Assessment of
           Lymph Node Dissection after Robot-Assisted Radical Cystectomy for Bladder
           Cancer
    • Authors: Ahmed A. Hussein; Nobuyuki Hinata, Shiva Dibaj, Paul R. May, Justen D. Kozlowski, Hassan Abol-Enein, Ronney Abaza, Daniel Eun, Shamim Khan, James L. Mohler, Piyush Agrawal, Kamal Pohar, Richard Sarle, Ronald Boris, Sridhar S. Mane, Alan Hutson, Khurshid A. Guru
      Abstract: ObjectivesTo develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC).MethodsA panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into 3 zones. Twenty-one de-identified videos of bilateral robot-assisted PLND were assessed by the 11 experts using PLACE to determine inter-rater reliability (IRR). Lymph node clearance was defined as the proportion of cleared lymph nodes from all PLACE zones. We investigated the correlation between lymph node clearance and lymph node count. Then, we compared the lymph node count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE).ResultsA significant reliability was achieved for all PLACE zones among the 11 raters for 21 bilateral PLND videos. Median (interquartile range) for lymph node clearance was 468 (431-545). There was a significant positive correlation between lymph node clearance and lymph node count (R2=0.70, p
      PubDate: 2016-12-17T17:20:25.472623-05:
      DOI: 10.1111/bju.13748
       
  • Importance and outcome relevance of central pathology review in
           prostatectomy specimens: data from the SAKK 09/10 randomized trial on
           prostate cancer
    • Authors: Pirus Ghadjar; Stefanie Hayoz, Vera Genitsch, Daniel R. Zwahlen, Tobias Hölscher, Philipp Gut, Matthias Guckenberger, Guido Hildebrandt, Arndt-Christian Müller, Martin P. Putora, Alexandros Papachristofilou, Lukas Stalder, Christine Biaggi-Rudolf, Marcin Sumila, Helmut Kranzbühler, Yousef Najafi, Piet Ost, Ngwa C. Azinwi, Christiane Reuter, Stephan Bodis, Kaouthar Khanfir, Volker Budach, Daniel M. Aebersold, George N. Thalmann,
      Abstract: ObjectivesTo conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in shifts of histopathological prognostic factors such as the Gleason Score.Patients and MethodsA total of 350 patients were randomized and specimens of 279 (80%) of the patients were centrally reviewed by a dedicated genitourinary pathologist.The Gleason Score, tumor classification and resection margin status were reassessed and compared with the local pathology reports. Agreement was assessed using contingency tables and Cohen's Kappa. Additionally, the association between other histopathological features (e.g. largest diameter of carcinoma) with rapid biochemical progression (up to 6 months after salvage RT) was investigated.ResultsThere was good concordance between central pathology review and local pathologists for seminal vesicle invasion [pT3b: 91%; k=0.95 (95% CI 0.89, 1.00)], for extraprostatic extension [pT3a/b: 94%; k=0.82 (95% CI 0.75, 0.89)], and for positive surgical margin status [87%; k=0.7 (95% CI 0.62, 0.79)]. Agreement was lower for Gleason score [78%; k=0.61 (95% CI 0.52, 0.70)]. The median largest diameter of carcinoma was 16 mm (range, 3–38 mm). A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma [odds ratio (OR): 2.04 (95% Confidence interval (CI): 1.30, 3.20); p = 0.002], resection margin status [OR: 0.36 (95% CI: 0.18, 0.72); p = 0.004] and Gleason score [OR: 1.55 (95% CI: 1.00, 2.42); p = 0.05] remained associated with rapid progression after salvage RT after backward selection.ConclusionThe results of the central pathology analyses reveal concordant results for seminal vesicle invasion, extraprostatic extension, positive surgical margin but lower agreement for Gleason Score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-17T17:20:22.803705-05:
      DOI: 10.1111/bju.13742
       
  • Robotic Salvage Retroperitoneal and Pelvic Lymph Node Dissection for
           “Node-only” Recurrent Prostate Cancer: Technique and Initial Series
    • Authors: Andre Luis Castro Abreu; Carlos E. S. Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir S. Gill
      Abstract: ObjectivesTo describe the technique of robotic high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer.Materials and MethodsTen patients underwent robotic sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by carbon-11 acetate PET/CT imaging. Our anatomic template extends from bilateral renal artery/vein cranially up to Cloquet's node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees; RPLND precedes PLND. Meticulous node-mapping assessed nodes at 4 prospectively-assigned anatomic zones.ResultsMedian operative time was 4.8 hours, blood loss 100 ml and hospital stay 1 day. No patient had intra-operative complication, open conversion or blood transfusion. Three patients had spontaneously-resolving Clavien II post-operative complications. Mean number of nodes excised per patient was 83 (41-132) and mean number of positive nodes per patient was 23 (0-109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomic levels I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, median PSA decreased by 83% at 2 months follow-up.ConclusionThe initial series of robotic sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robotic technical details for an anatomic lymphadenectomy template up to the renal vessels is presented. Longer follow-up is necessary to assess oncologic outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:50:34.123546-05:
      DOI: 10.1111/bju.13741
       
  • Clinical impact of 68Ga-PSMA PET/CT in prostate cancer patients with
           rising PSA after treatment with curative intent: preliminary analysis of a
           multidisciplinary approach
    • Authors: S Albisinni; C Artigas, F Aoun, I Biaou, J Grosman, T Gil, E Hawaux, K Limani, F Otte, A Peltier, S Sideris, N Sirtaine, P Flamen, R Velthoven
      Abstract: BackgroundTo assess the impact of 68Ga-(HBED-CC)-PSMA (Prostate Specific Membrane Antigen) PET/CT in the clinical management of PCa patients with rising PSA after treatment with curative intent. 68Ga-PSMA PET/CT scan is a novel molecular imaging technique in the field of prostate cancer (PCa).Methods131 consecutive patients were referred to our center for a 68Ga-PSMA PET/CT in the setting of recurring prostate cancer. 11/131(8%) presented persistent PSA after radical prostatectomy, while 120/131 (92%) were referred for biochemical recurrence after surgery, radiotherapy or both. Images where performed 1 hour post-injection of 2MBq/Kg of 68Ga-(HBED-CC)-PSMA ligand. All exams were interpreted by two experienced nuclear medicine specialists. With the results of the exam, a multidisciplinary oncology committee (MOC) reported on the treatment strategy. A positive impact in clinical management was considered if the exam determined a modification in the treatment strategy compared to MOC decision prior to PSMA.ResultsAll patients completed the exam with no adverse reactions. Median PSA at the time of the exam was 2.2ng/ml (range 0.72-6.7). Overall, 68Ga-PSMA PET/CT detected at least one lesion suspicious of PCa in 98/131 (75%) patients. An impact in management was found in 99/131patients (76%).Main modifications included continuing surveillance (withholding hormonal therapy), hormonal manipulations, stereotaxic radiotherapy, salvage radiotherapy, salvage node dissection or salvage local treatment (prostatectomy, HIFU).ConclusionOur preliminary experience suggests that performing 68Ga-PSMA PET/CT in PCa patients with rising PSA after treatment with curative intent can be clinically useful as it changes the treatment strategy in a significant percentage of patients. However, larger prospective trials are needed to validate our findings.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:45:26.46431-05:0
      DOI: 10.1111/bju.13739
       
  • Sorafenib dose escalation in treatment-naïve patients with metastatic
           renal cell carcinoma: a non-randomised, open-label, Phase 2b study
    • Authors: Martin E. Gore; Robert J. Jones, Alain Ravaud, Markus Kuczyk, Tomasz Demkow, Alessandra Bearz, JoAnn Shapiro, U. Phillip Strauss, Camillo Porta
      Abstract: ObjectiveTo assess the efficacy and safety of sorafenib dose escalation in metastatic renal cell carcinoma (mRCC).Patients and MethodsIntra-patient dose escalation may enhance the clinical benefit of targeted anticancer agents in metastatic disease. In this non-randomised, open-label, Phase 2b study, treatment-naïve patients with mRCC were initially treated with the standard oral sorafenib dose (400 mg twice daily [BID]). Two dose escalations were planned, each 200 mg BID after 28 d at the prior level. Dose reductions, interruptions, or delayed escalations were used to manage adverse events (AEs). The primary endpoint was objective response rate (ORR) in the modified intent-to-treat (mITT) population, which comprised patients with ≥6 mo of treatment including ≥4 mo of therapy at their highest tolerated dose. Secondary endpoints included progression-free survival (PFS) and safety.ResultsEighty-three patients received sorafenib. The dose received for the longest duration was 400, 600, and 800 mg BID in 48.2%, 15.7%, and 24.1% of patients, respectively. ORR was 44.4% (n = 8/18; 95% CI: 21.5–69.2) and 17.9% (n = 12/67; 95% CI: 9.6–29.2) in the mITT and ITT populations, respectively. Median PFS was 7.4 mo (95% CI: 6.0‒11.7) (ITT). The most-common AEs of any grade were hand–foot skin reaction (66.3%) and diarrhoea (63.9%).ConclusionSorafenib demonstrated clinical benefit in treatment-naïve patients with mRCC. However, relatively few patients could sustain doses above 400 mg BID. There was evidence that, where tolerated, escalation from the standard sorafenib dose may have enhanced clinical benefit. However, this study does not support dose escalation for most patients with treatment-naïve mRCC. Alternative protocols for sorafenib dose escalation could be explored.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-15T22:45:25.219934-05:
      DOI: 10.1111/bju.13740
       
  • Development and External Validation of a Biopsy-Derived Nomogram to
           Predict Risk of Ipsilateral Extraprostatic Extension
    • Authors: Rashid Sayyid; Nathan Perlis, Ardalanejaz Ahmad, Andrew Evans, Ants Toi, Michael Horrigan, Antonio Finelli, Alexandre Zlotta, Girish Kulkarni, Robert Hamilton, Christopher Morash, Neil Fleshner
      Abstract: ObjectivesTo develop and externally validate a nomogram that predicts risk of side-specific EPE at time of surgery, using commonly available pre-operative markers.Materials and MethodsA consecutive sample of 753 men treated by radical prostatectomy at University Health Network, between 2009 and 2015, was used to develop the nomogram. The validation cohort consisted of 311 men treated by radical prostatectomy at Ottawa Hospital Research Institute, between 1992 and 2014. Study outcome was presence of ipsilateral extraprostatic extension. The association between predictors considered and extraprostatic extension was tested using univariate and multivariate logistic regression analyses. Nomogram predictive accuracy was determined using area under the receiver operating characteristic curve.ResultsThe overall rate of extraprostatic extension was 19.8% of all lobes in the developmental cohort and 28.9% in the validation cohort. Significant parameters in the models were age, prostate-specific antigen, and ipsilateral Gleason Score, percent cores positive, and highest core involvement (all p
      PubDate: 2016-12-08T16:00:28.055651-05:
      DOI: 10.1111/bju.13733
       
  • ProtecTion from overtreatment – does a randomised trial finally answer
           the key question in localised prostate cancer'
    • Authors: Luke L. Wang; Christopher J.D. Wallis, Niranjan Sathianathen, Nathan Lawrentschuk, Declan G. Murphy, Robert Nam, Daniel Moon
      Abstract: For the first time we now have a randomised trial comparing active monitoring, surgery and radiation therapy for the management of localised prostate cancer and the investigators are to be congratulated on this highly anticipated landmark study – the Prostate testing for cancer and Treatment (ProtecT) trial[1]. Comparing 545 patients randomised to active monitoring, 553 to radical prostatectomy, and 545 to radiotherapy, at a median follow-up of 10 years the study reports no significant difference in prostate-cancer specific or overall survival amongst the three groups[1].This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-08T16:00:21.353881-05:
      DOI: 10.1111/bju.13734
       
  • Urologists of tomorrow—the case for educational intervention
    • Authors: Vincenzo Ficarra; Vincenzo Mirone, Prokar Dasgupta
      Abstract: In recent decades, urology has gained a relevance that is independent of general surgery. This progress comes as a consequence of the high prevalence of urologic diseases and their enormous social and economic impacts, as well as significant innovations in the technologies and medical therapies used to treat urologic conditions. Briefly, it is estimated that 3–5% of consultations in general practice are for urologic conditions [1]. Prostate cancer is the most common cancer for males, while bladder and kidney/pelvis cancers represent the sixth and the eighth most common tumors in US in both sexes (www.seer.cancer.gov).This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-05T00:36:39.242381-05:
      DOI: 10.1111/bju.13732
       
  • A qualitative perspectival review of the Australian and New Zealand
           Urology Education and Training program
    • Authors: Prem Rashid
      Abstract: IntroductionThe Australian and New Zealand (ANZ) urology training program was assessed via a prospective, qualitative review to explore the challenges facing the delivery of high quality urological training now and into the future.AimTo report the reflective considerations and opinions of leaders in the ANZ urological surgical training program.MethodsEthics approved semi-structured, template-based, qualitative interview techniques were employed to evaluate key aspects of the current urology training program. Those interviewed were senior office bearers and management staff involved in the Surgical, Education and Training (SET) Program. Interviews were recorded and transcribed for analysis. Grounded theory was used with thematic analysis to assess the data. The initial impression of the data was used to identify critical codes and themes, which were then developed and abstracted to bring together global concepts.ResultsTwenty-four extracted themes are outlined in this paper. The recent evolution of urology training was documented, as the pathway into training has changed several times over the years. The changes in the program have opinion leaders concerned that the ‘pendulum has swung too far.’ Surgical teachers will only truly develop if appropriate resources are allocated. This can be achieved by making up-skilling courses accessible, relevant and ultimately, a part of the accreditation of training posts. Management of underperforming trainees is challenging and continues to occupy a significant and disproportionate allocation of resources. Early constructive intervention is very important to avoid unnecessary escalation of complex issues and the resultant inter-personal consequences.ConclusionsThe ANZ/RACS SET Urology Program began like many of the other surgical specialties, from humble beginnings. It is now a mature program, but there remain areas needing improvement. The workload of supervisors and office bearers has been increasing and the management of underperforming trainees takes time and resources away from progress in educational development. Progressive steps can be instituted to improve supervisor up-skilling and structural changes can be made to ensure that office bearers can continue to undertake their valuable work without undue pressure and stress. Some of this will involve separating innovation in education and training from day-to-day trainee management.This article is protected by copyright. All rights reserved.
      PubDate: 2016-12-05T00:32:43.281395-05:
      DOI: 10.1111/bju.13731
       
  • Improving clinical prognostic stratification models for men with prostate
           cancer: a practical step closer to more individualised care without added
           costs
    • Authors: Vincent J Gnanapragasam; Anne Y Warren
      Abstract: Risk stratification remains the cornerstone in deciding management for men with non-metastatic prostate cancer. Current risk stratification systems however have barely changed in two decades and have shown significant shortcomings with regards intra and inter-group heterogeneity in disease behaviour and therapy outcomes. A number of sophisticated and expensive molecular tests have been developed and more are being investigated to address this gap. However, new thinking on how to better use existing pathological information and refining clinical risk models may already offer significant incremental benefits in improving prognostic prediction without additional costs or resourcing. In this comment we highlight some recent research which may help inform this issue.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-22T02:40:59.868421-05:
      DOI: 10.1111/bju.13721
       
  • Long-term outcome of the adjustable transobturator male system (ATOMS):
           results of a European multicentre study
    • Authors: Alexander Friedl; Sandra Mühlstädt, Roman Zachoval, Alessandro Giammò, Danijel Kivaranovic, Maximilian Rom, Paolo Fornara, Clemens Brössner
      Abstract: ObjectiveTo evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS®, Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting.Patients and MethodsIn all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (
      PubDate: 2016-11-21T01:18:16.69795-05:0
      DOI: 10.1111/bju.13684
       
  • Low-dose desmopressin combined with serum sodium monitoring can prevent
           clinically significant hyponatraemia in patients treated for nocturia
    • Authors: Kristian Vinter Juul; Anders Malmberg, Egbert der Meulen, Johan Vande Walle, Jens Peter Nørgaard
      Abstract: ObjectiveTo explore risk factors for desmopressin-induced hyponatraemia and evaluate the impact of a serum sodium monitoring plan.Subjects and methodsThis was a meta-analysis of data from three clinical trials of desmopressin in nocturia. Participants received placebo or desmopressin orally disintegrating tablet ([ODT], 10–100 μg). Incidence of serum sodium
      PubDate: 2016-11-15T10:15:38.146759-05:
      DOI: 10.1111/bju.13718
       
  • Introduction of robotically-assisted radical cystectomy within an
           established enhanced recovery programme
    • Authors: Catherine Miller; Nicholas J Campain, Rachel Dbeis, Mark Daugherty, Nicholas Batchelor, Elizabeth Waine, John S McGrath
      Abstract: ObjectivesIn recent years, there has been rapid adoption of robotically-assisted surgery (RAS) for the treatment of pelvic urological cancers. This is particularly true for radical prostatectomy (RP) where robotically-assisted laparoscopic prostatectomy (RALP) has become the predominant surgical approach across England. Despite this, less than 15% of patients undergoing radical cystectomy (RC) in England in 2014 underwent a robotically-assisted radical cystectomy (RARC). However, as expertise in RAS spreads, an increasing number of cancer centres are now adopting this approach for patients undergoing RC. The current paper describes the implementation phase of a robotically-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS).Patients and Methods114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 (ileal conduit (n= 97) and orthotopic neobladder (n=17)). Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied. All patients were managed on the Exeter Enhanced Recovery Pathway (ERP) in a unit where embedded ER practice was already established. Data were collected prospectively on the national cystectomy registry - the British Association of Urological Surgeons (BAUS) Complex Operations Dataset.ResultsRARC was technically feasible in all but one case. Mean operative time period was 3-5 hours with an overall transfusion rate of 8.8%. Higher-grade complications (Clavien-Dindo grade III-IV) were seen in 18.4% of patients with a 30-day mortality of 0.9%. Median LOS following RARC was 7 days (range 3-68) with a re-admission rate of 18.4%.ConclusionsThe current series demonstrates that RARC can be safely implemented in a unit experienced in RAS. Case-selection in this setting is not deemed necessary. There are benefits in terms of lower transfusion rates and reduced LOS. The side-effect profile appears to differ from that of ORC and, despite the fact that complication rates are equivalent, ‘technical’ complications are over-represented in the RAS group. As such, they should improve with experience, recognition and modification of surgical technique. ERPs can be safely applied to all patients undergoing RARC to maximize the benefits of minimally-invasive surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-15T01:31:46.730564-05:
      DOI: 10.1111/bju.13702
       
  • Guideline of Guidelines Priapism
    • Authors: Asif Muneer; David Ralph
      Abstract: Priapism is defined as a prolonged penile erection lasting for more than 4 hours in the absence of sexual stimulation and remains despite orgasm. Current priapism guidelines for priapism have been published following a comprehensive literature review and expert consensus by the American Urological Association (AUA) and by an evidence review according to the Oxford Centre for Evidence based medicine by the European Association of Urology (EAU). Although there are both local and regional guidelines available throughout the UK, these tend to be adaptations of guidelines from larger urology organisations and there are currently no guidelines from the British Association of Urological Surgeons (BAUS).This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-14T10:05:26.472748-05:
      DOI: 10.1111/bju.13717
       
  • Prostatic Urethral Lift (PUL) vs Transurethral Resection of the Prostate
           (TURP): 2 Year Results of the BPH6 Prospective, Multi-Center, Randomised
           Study
    • Authors: C Gratzke; N Barber, M Speakman, R Berges, U Wetterauer, D Greene, K-D Sievert, C Chapple, J Sonksen
      Abstract: ObjectivesTo compare Prostatic Urethral Lift (PUL) to Transurethral Resection of the Prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.Subjects/patients and methods80 patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) enrolled in a prospective, randomised, controlled, non-blinded study conducted at 10 European centers. The BPH6 responder endpoint assessed symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation, and safety. Additional evaluations of patient perspective, quality of life, and sleep were prospectively collected, analyzed, and presented here for the first time.ResultsSignificant improvements in International prostate symptom score (IPSS), IPSS quality of life (QoL), BPH Impact Index (BPH II), and peak flow rate were observed in both arms through the 2 year follow up. TURP IPSS and peak flow change were superior to PUL. IPSS QoL and BPH II improvements were not statistically different. PUL resulted in superior quality of recovery, ejaculatory function preservation, and performance on the composite BPH6 index. Ejaculatory function bother scores did not demonstrate statistically significant change in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep starting at the 6 month interval and continuing to the end of the study. Over the two year follow up, 6 PUL subjects (13.6%) and 2 TURP subjects (5.7%) underwent secondary treatment for return of LUTS. Most patients perceived LUTS improvement and would recommend their treatment procedure to a friend.ConclusionPUL was compared to TURP in a randomised, controlled study which further characterized both modalities so that care providers and patients can better understand the net benefit when selecting a treatment option.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-14T01:45:33.882162-05:
      DOI: 10.1111/bju.13714
       
  • Value of 111In-PSMA-radioguided surgery for salvage lymphadenectomy in
           recurrent prostate cancer: correlation with histopathology and clinical
           follow-up
    • Authors: Isabel Rauscher; Charlotte Düwel, Martina Wirtz, Margret Schottelius, Hans-Jürgen Wester, Kristina Schwamborn, Bernhard Haller, Markus Schwaiger, Jürgen E. Gschwend, Matthias Eiber, Tobias Maurer
      Abstract: ObjectivesTo evaluate the use of 111In-labeled PSMA-I&T based radioguided surgery (111In-PSMA-RGS) for salvage surgery in recurrent prostate cancer (PC) using comparison of intraoperative γ-probe measurements to histopathological results of dissected specimens. Furthermore, the success of 111In-PSMA-RGS was determined by postoperative prostate-specific antigen (PSA) responses, PC-specific treatment-free survival as well as postoperative complication rates.Patients and MethodsIn this study, 31 consecutive patients with localized recurrent PC undergoing salvage surgery with PSMA-targeted RGS using an 111In-labeled PSMA ligand were retrospectively included from April 2014 to July 2015. Preoperative median PSA was 1.3 (IQR: 0.57-2.53ng/ml, range: 0.2–13.9ng/ml). Results of ex vivo radioactivity rating (positive vs. negative) of resected tissue specimens were compared to findings of postoperative histological analysis. Best PSA response without additional treatment was determined following 111In-PSMA-RGS and salvage-surgery related postoperative complications and PC-specific additional treatments were recorded.ResultsIn 30/31 patients, 111In-PSMA-RGS allowed intraoperative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. By 111In-PSMA-RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer-free, 4 were false negative and 6 false positive compared to histological evaluation. Follow-up information was available for 30/31 patients. PSA decline >50% and >90% was observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to
      PubDate: 2016-11-10T13:10:30.161807-05:
      DOI: 10.1111/bju.13713
       
  • Risk Stratification – a Tool to predict the Course of Active
           Surveillance for Localized Prostate Cancer?
    • Authors: Jan Herden; Axel Heidenreich, Lothar Weissbach
      Abstract: ObjectiveTo investigate a cohort of patients under active surveillance (AS) for localized prostate cancer (PCa) concerning possible differences in discontinuation rates, subsequent therapies, reasons for intervention, and pathologic findings after deferred surgery depending on stratification in very low-, low-, and intermediate/high-risk PCa.Patients and MethodsHAROW is a non-interventional, observational, outcomes research study on the management of localized PCa in the community setting. Fourhundred sixtyeight (468) Patients were prospectively enrolled in the HAROW study, with a mean Follow-up of 28.5 months. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6-months intervals.ResultsOf 468 AS patients, 244 qualified for the very low-, 142 for the low- and 82 for the intermediate/high-risk group. Onehundred twelve (112) patients discontinued AS. Discontinuation rates were 25.4% in very low-, 21.1% in low- and 24.4% in intermediate/high-risk groups (p=0.633). Main reasons for intervention were biopsy upgrade and/or PSA elevation in the very low- and in the low-risk groups; and patient preference in the intermediate/high-risk group (p
      PubDate: 2016-11-10T13:10:24.543681-05:
      DOI: 10.1111/bju.13715
       
  • Utility of Patient-Specific Silicone Renal Models for Planning and
           Rehearsal of Complex Tumor Resections Prior to Robotic-Assisted
           Laparoscopic Partial Nephrectomy
    • Authors: Friedrich-Carl Rundstedt; Jason M. Scovell, Smriti Agrawal, Jacques Zaneveld, Richard E. Link
      Abstract: ObjectiveSurgical planning for robotic partial nephrectomy (RALPN) depends on preoperative imaging and interpretation of spatial relationships between tumor and renal anatomy. We describe our experience using patient specific tissue-like kidney models created with advanced 3D printing technology for preoperative planning and surgical rehearsal prior to RALPN .Patients and MethodsA feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D print models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction we generated pre-surgical models out of a silicone-based material. All surgical rehearsals were performed using the Davinci™ robotic system prior to the actual procedure. To determine construct validity, we compared resection times between the model and actual tumor in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumor volume resected for each model and patient tumor.ResultsWe generated patient-specific models for 10 patients with complex tumor anatomy. Nephrometry scores were between 7 and 11 with an average maximal tumor diameter of 40.6 mm. Resection times between model and patient (6:58 min vs. 8:22 min, p=0.16) and tumor volumes between computer model, excised model, and excised tumor (38.88 mm3 vs. 38.50 mm3 vs. 41.79 mm3, p=0.98) were not significantly different.ConclusionsWe have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals and improve surgical training.
      PubDate: 2016-11-10T13:05:31.513813-05:
      DOI: 10.1111/bju.13712
       
  • Competency Based Training in Robotic Surgery: Benchmark Scores for Virtual
           Reality Robotic Simulation
    • Authors: N Raison; K Ahmed, N Fossati, N Buffi, A Mottrie, P Dasgupta, H der Poel
      Abstract: ObjectivesTo develop benchmark scores of competency for use within a competency-based virtual reality (VR) robotic training curriculum.Subjects and MethodsThis longitudinal, observational study analysed results from 9 EAU hands-on-training courses in VR simulation. 223 participants ranging from novice to expert robotic surgeons completed 1565 exercises. Competency was set at 75% of the mean expert score. Benchmark scores for all general performances metrics generated by the simulator were calculated. Assessment exercises were selected by expert consensus and through learning curve analysis. Three basic skill and two advanced skill exercises were identified.ResultsBenchmark scores based on expert performance offered viable targets for novice and intermediate trainees in robotic surgery. Novice participants met the competency standards for most basic skill exercises however advanced exercises were significantly more challenging. Intermediate participants performed better across the seven metrics but still fell short of the benchmark standard in the more difficult exercises.ConclusionBenchmark scores derived from expert performances offer relevant and challenging scores for trainees to achieve during VR simulation training. Objective feedback allows both participants and trainers to monitor educational progress and ensures that training remains effective. Furthermore, the well-defined goals set through benchmarking offer clear targets for trainees and enable training to move to a more efficient competency based curriculum.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:25.305904-05:
      DOI: 10.1111/bju.13710
       
  • Multicentre evaluation of target and systematic biopsies using Magnetic
           Resonance and Ultrasound Image-Fusion guided Transperineal Prostate Biopsy
           in patients with a previous negative biopsy
    • Authors: N L Hansen; C Kesch, T Barrett, B Koo, J P Radtke, D Bonekamp, HP Schlemmer, A Y Warren, K Wieczorek, M Hohenfellner, C Kastner, B Hadaschik
      Abstract: ObjectivesTo evaluate the detection rates of targeted and systematic biopsies in magnetic resonance (MRI) and transrectal ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal US guided biopsies in two high-volume centres.Patients and methodsTwo centre, prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided target and systematic saturation biopsy from 2012 to 2015. MRI was reported according to PIRADS Version 1. Detection of Gleason score (GS) 7-10 cancer (PCa) on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.ResultsMedian PSA was 9.0 (IQR 6.7-13.4) ng/ml. PIRADS 3-5 MRI lesions were reported in 343 (70%) patients. GS 7-10 PCa was detected in 149 (31%). PPV for detecting GS 7-10 PCa was 0.20 (±0.07) for PIRADS 3, 0.32 (±0.09) for PIRADS 4, and 0.70 (±0.08) for PIRADS 5. NPV of PIRADS 1-2 was 0.92 (±0.04) for GS 7-10 and 0.99 (±0.02) for GS ≥ 4+3 cancer. Systematic biopsies alone found 125/138 (91%) GS 7-10 cancers. In patients with suspicious lesions (PIRADS 4-5) on MRI, systematic biopsies would not have detected 12/113 significant PCa (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PIRADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of GS 7-10, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA-density improved the AUC of PIRADS from 0.822 to 0.846.ConclusionIn patients with high probability MRI lesions, the highest detection rates of GS 7-10 cancer still required combined targeted and systematic MRI/TRUS image-fusion, however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA-density and a negative MRI read by experienced radiologists.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:23.079047-05:
      DOI: 10.1111/bju.13711
       
  • 11C-acetate PET/CT imaging for detection of recurrent disease following
           radical prostatectomy or radiotherapy in patients with prostate cancer
    • Authors: L. Esch; M. Fahlbusch, P. Albers, H. Hautzel, V. Müller-Mattheis
      Abstract: ObjectivesTo evaluate the effectiveness of CT-matched 11C-acetate PET (AC-PET) in prostate cancer patients with PSA relapse following radical prostatectomy (RP) or radiotherapy (RT) in a prospective study.Subjects and MethodsIn 103 relapsing patients after RP (n=97) or RT (n=6) AC-PET images and CT scans were obtained. In PET positive patients with localized recurrence detected lesions were resected and histologically verified or -after local RT- followed-up by PSA testing. Patients with distant disease on AC-PET were treated with androgen deprivation/chemotherapy.Results42/103 patients were PET positive with PSA levels
      PubDate: 2016-11-08T20:43:51.427501-05:
      DOI: 10.1111/bju.13706
       
  • Robotic Partial Nephrectomy: Continued Refinement of Outcomes Beyond the
           Initial Learning Curve
    • Authors: David J. Paulucci; Ronney Abaza, Daniel D. Eun, Ashok K. Hemal, Ketan K. Badani
      Abstract: ObjectivesTo evaluate trends in perioperative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robotic partial nephrectomy (RPN) among multiple surgeons.Patients and MethodsA multi-institutional database was used to evaluate trends in patient demographics (age, gender, comorbidities, etc.), tumor characteristics (size, complexity, etc.) and perioperative outcomes (warm ischemia time, operative time, complications, estimated blood loss, trifecta achievement, etc.) in consecutive cases 50-300 (n=960) from 2008 to 2016 among four experienced surgeons. Trends in outcomes were assessed using multivariable regression models adjusted for demographic and tumor-specific variables. Outcomes between cases 50-99 and 250-300 were compared.ResultsRPN was increasingly performed in patients with larger tumors (β=0.001, p=.048), hypertension (OR=1.003, p=.008) diabetes (OR=1.003, p=.025) and prior abdominal surgery (OR=1.003, p=.006). Surgeon experience was associated with more trifecta achievement (OR=1.006, p
      PubDate: 2016-11-08T07:55:20.432284-05:
      DOI: 10.1111/bju.13709
       
  • Management and Outcomes of Patients with Renal Medullary Carcinoma: A
           Multi-Center Collaborative Study
    • Authors: Amishi Y. Shah; Jose A. Karam, Gabriel G. Malouf, Priya Rao, Zita D. Lim, Eric Jonasch, Lianchun Xiao, Jianjun Gao, Ulka N. Vaishampayan, Daniel Y. Heng, Elizabeth R. Plimack, Elizabeth A. Guancial, Chunkit Fung, Stefanie R. Lowas, Pheroze Tamboli, Kanishka Sircar, Surena F. Matin, W. Kimryn Rathmell, Christopher G. Wood, Nizar M. Tannir
      Abstract: ObjectiveTo describe the management strategies and outcomes of patients with renal medullary carcinoma (RMC) and characterize predictors of overall survival (OS).Patients and MethodsRMC is a rare and aggressive malignancy that afflicts young patients with sickle cell trait; there are limited data on management to date. This is a study of patients with RMC who were treated during 2000-2015 at eight academic institutions in North America and France. The Kaplan-Meier method was used to estimate OS, measured from initial RMC diagnosis to date of death. Cox regression analysis was used to determine predictors of OS.ResultsFifty-two patients (37 males) were identified. Median age at diagnosis was 28 years (range 9-48). Forty-nine patients (94%) had stage III/IV. Median OS for all patients was 13.0 months. Thirty-eight patients (75%) had nephrectomy. Patients who underwent nephrectomy had superior OS compared to patients who were treated with systemic therapy only (median OS 16.4 vs. 7.0 months, p=0.0004). Forty-five patients received chemotherapy and 13 (29%) had an objective response; 28 patients received targeted therapies, with 8-week median therapy duration and no objective responses. Only seven patients (13%) survived longer than two years.ConclusionsRMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but less than 20% of patients survive longer than two years, underscoring the need to develop more effective therapy for this rare tumor. In this study, nephrectomy was associated with improved OS.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-08T07:50:20.077445-05:
      DOI: 10.1111/bju.13705
       
  • 3-year data of the AdVanceXP male sling: results of a prospective
           multicenter study
    • Authors: Ricarda M. Bauer; Markus T. Grabbert, Benedikt Klehr, Peter Gebhartl, Christian Gozzi, Roland Homberg, Florian May, Peter Rehder, Christian G. Stief, Alexander Kretschmer
      Abstract: ObjectivesIn recent years, several studies showed the effectiveness and safety of the AdVance sling for the treatment of male stress urinary incontinence (SUI). In 2010 the second generation of Advance, the AdVance XP was introduced with several changes of the sling design and with a new needle shape. Aim of the study was to evaluate the efficacy and safety of the AdVance XP sling in male SUI after radical prostatectomy in a prospective multicenter study.MethodsIn total 115 patients were included. Patients with urine nocturnal incontinence, previous incontinence surgery, previous radiotherapy and coaptive zone 50%. All others were classified as failures. Significance analysis was performed with Wilcoxon-test.ResultsMean preoperative urine loss in the 24h pad-test was 272.0 g (median 272.0 g).After a follow-up of 3 months (n= 114) 64.9% of the patients were cured and 31.6% improved. Mean urine loss decreased significantly to 34.9 g (p
      PubDate: 2016-11-08T07:40:19.803593-05:
      DOI: 10.1111/bju.13704
       
  • A prospective and randomized trial comparing fluoroscopic, total
           ultrasonographic, and combined guidance for renal access in
           mini-percutaneous nephrolithotomy
    • Authors: Wei Zhu; Jiasheng Li, Jian Yuan, Yongda Liu, Shaw P Wan, Guanzhao Liu, Wenzhong Chen, Wenqi Wu, Jintai Luo, Dongliang Zhong, Defeng Qi, Ming Lei, Wen Zhong, Ze Zhang, Zhaohui He, Zhijian Zhao, Suilin Lu, Yuji Wu, Guohua Zeng
      Abstract: ObjectiveTo compare the safety and efficacy of fluoroscopic, total ultrasonographic, and combined ultrasonographic and fluoroscopic guidance for percutaneous renal access in mini-percutaneous nephrolithotomy (mini-PCNL).Materials And MethodsThe present study was conducted between July 2014 and May 2015 as a prospective randomized trial at the First Affiliated Hospital of Guangzhou Medical University. 450 consecutive patients with renal stones larger than 2 cm were randomized to undergo fluoroscopy-, total ultrasonography-, or combined-guided mini-PCNL (150 patients for each group). The primary endpoints were the stone-free rate (SFR) and blood loss (hemoglobin decrease during the operation and transfusion rate). Secondary endpoints included access failure rate, operative time, and complications. S.T.O.N.E. score was used to document the complexity of the renal stones. The study was registered at http://clinicaltrials.gov/ (NCT02266381).ResultsThe three groups had similar baseline characteristics. With S.T.O.N.E. scores of 5-6 or 9-13, the SFRs were comparable between the three groups. For S.T.O.N.E. scores of 7-8, fluoroscopic guidance and combined guidance achieved significantly better SFR than total ultrasonographic guidance (one-session SFR 85.1% vs. 88.5% vs. 66.7%, p=0.006; overall SFR at three months postoperatively 89.4% vs. 90.2% vs. 69.8%, p=0.002). Multiple-tracts mini-PCNL was used more frequently in the fluoroscopy-guided and combined-guided group than total ultrasonography-guided group (20.7% vs. 17.1% vs. 9.5%, p=0.028). The mean total radiation exposure time was significantly greater for fluoroscopic guidance than for combined guidance (47.5 vs. 17.9 seconds, p
      PubDate: 2016-11-08T07:35:33.42226-05:0
      DOI: 10.1111/bju.13703
       
  • Contemporary minimally invasive surgery for adrenal masses: It's not all
           about (Pure) laparoscopy
    • Authors: Nicola Pavan; Ithaar Derweesh, Jens Rassweiler, Benjamin Challacombe, Homayoun Zargar, James Porter, Evangelos Liatsikos, Jihad Kaouk, Francesco Porpiglia, Riccardo Autorino
      Abstract: A quarter of century has elapsed since the first described laparoscopic adrenalectomy (LA), and since then, minimally invasive surgery for the management of adrenal masses has come a long way: indications have expanded, techniques have evolved, and data have matured.Ball et al recently reported an evidence-based systematic review on the use of minimally invasive adrenalectomy as part of the International Consultation on Urological Diseases and European Association of Urology consultation [1]. Notably, the authors included 52 comparative studies in their analysis, published up to 2014, and they provided the following recommendations: laparoscopy should be first line therapy for benign adrenal masses (Grade B), and pheochromocytoma (Grade B), whereas it should be regarded as feasible option for select adrenocortical carcinoma cases (those without adjacent organ involvement) (Grade C).This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-01T07:25:27.3936-05:00
      DOI: 10.1111/bju.13701
       
  • Radio-guided sentinel lymph node detection and lymph node mapping in
           invasive urinary bladder cancer—a prospective clinical study
    • Authors: F. Aljabery; I. Shabo, Hans Olson, Oliver Gimm, Staffan Jahnson
      Abstract: ObjectivesWe investigated the possibility to detect sentinel nodes in patients with urinary bladder cancer (UBC) intra-operatively and whether the histopathological status of the identified sentinel nodes reflected that of the lymphatic field.Patients and methodsWe studied 103 patients with UBC pathological stage T1-T4 who were treated with cystectomy and pelvic lymph node (LN) dissection during 2005–2011 at the Department of Urology, Linköping University Hospital. Radioactive tracer Nanocoll 70 MBq (megabequerel) and blue dye were injected in the bladder wall around the primary tumour prior to surgery. Sentinel nodes were detected ex vivo during the operation with a hand-hold Geiger probe (Neoprobe Gamma Detection System). All lymph nodes were formalin-fixed, sectioned three times, mounted on slides and stained with hematoxylin-eosin. An experienced uropathologist (HO) evaluated the slides.ResultsThe mean age of the patients was 69 years, and 80 (77%) were male. Pathological staging was T1-12 (12%), T2-20 (19%), T3-48 (47%) and T4-23 (22%). A mean number of 31 nodes per patient were examined (range 7–68), totaling 3,253 nodes. LN metastases were found in 41 (40%) patients. Sentinel nodes were detected in 80% (83 of 103) of the patients. Sensitivity and specificity for detecting metastatic disease by SNB varied between LN stations with an average value of 67% and 90%, respectively. Lymph node metastatic density had a significant prognostic impact; a value of 8% or more was significantly related to shorter survival. Lympho-vascular invasion occurred in 65% (n=67) of patients and was significantly associated with shorter cancer-specific survival (p
      PubDate: 2016-10-31T08:11:17.005542-05:
      DOI: 10.1111/bju.13700
       
  • Diagnosis and long-term outcome of renal cysts after laparoscopic partial
           nephrectomy in children
    • Authors: C. Esposito; M. Escolino, B. Troncoso Solar, R. Iacona, R. Esposito, A. Settimi, I. Mushtaq
      Abstract: ObjectivesTo document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions post-LPN.Materials and MethodsWe reviewed the US imaging reports performed during follow-up in 125 children (77 girls, 48 boys - average age 3.2 years) underwent LPN in 2 centers of pediatric surgery in the period 2005-2015.ResultsTransperitoneal approach was adopted in 83 cases while retroperitoneoscopy in 42 cases. The average follow-up was 4.2 years. At US, an avascular cyst related to the operative site was found after 61/ 125 procedures (48.8%). As for their appearance, 53/61 cysts were simple and anechoic and 8/61 appeared septated. The average diameter of the cysts was 3.3 x 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after mean 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size and only 5/61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 cases (83.6%) while they were associated with urinary infections and abdominal pain in the remaining 10 patients. None of them required a re-intervention.ConclusionsThe US finding of a simple cyst at the operative site after LPN is a common event during follow-up, with an incidence of about 50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There is no correlation between cysts formation and type of surgical technique adopted. As there is no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodical US controls.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-25T09:50:24.564409-05:
      DOI: 10.1111/bju.13698
       
  • Urinary collecting system invasion is associated with poor survival in
           clear cell renal cell carcinoma patients
    • Authors: George C. Bailey; Stephen A. Boorjian, Matthew J. Ziegelmann, Mary E. Westerman, Christine M. Lohse, Bradley C. Leibovich, John C. Cheville, R. Houston Thompson
      Abstract: ObjectivesTo evaluate the prognostic significance of urinary collecting system invasion in a large series of clear cell renal cell carcinoma patients.MaterialsPatients with clear cell renal cell carcinoma treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urologic pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan-Meier method and associations of collecting system invasion with death from renal cell carcinoma were evaluated using Cox models.ResultsOf the 859 patients with clear cell renal cell carcinoma, 58 (6.8%) demonstrated collecting system invasion. At last follow-up, 310 patients had died from renal cell carcinoma at a median of 1.8 years following surgery. Median follow-up for patients alive at last follow-up was 8.2 years. Estimated cancer-specific survival at 10 years following surgery for patients with collecting system invasion was 17%, compared with 60% for patients without collecting system invasion (p
      PubDate: 2016-10-20T10:35:23.991745-05:
      DOI: 10.1111/bju.13669
       
  • Additive effects of the Rho Kinase Inhibitor Y-27632 and vardenafil on
           relaxation of corpus cavernosum tissue of patients with erectile
           dysfunction and clinical phosphodiesterase type 5 inhibitor failure
    • Authors: Pieter Uvin; Maarten Albersen, Ine Bollen, Maarten Falter, Emmanuel Weyne, Loes Linsen, Hanna Tinel, Peter Sandner, Trinity J Bivalacqua, Dirk JMK De Ridder, Frank Van der Aa, Bert Brône, Koenraad Van Renterghem
      Abstract: ObjectivesTo evaluate the expression of the Rho/Rho associated protein kinase (ROCK) pathway in corpus cavernosum of patients with severe erectile dysfunction (ED) compared to healthy human corpus cavernosum, and to test the functional effects of two Rho Kinase Inhibitors (RKI) on erectile tissue of patients with severe ED, not responding to phosphodiesterase type 5 inhibitors (PDE5-i).Patients and methodsHuman corpus cavernosum samples were obtained after consent from individuals undergoing penile prosthesis implantation (n = 7 for organ bath experiments, n = 17 for qPCR). Potent control subjects (n = 5) underwent penile needle biopsy. qPCR was performed for the expression of RhoA and ROCK subtypes 1 and 2. Immunohistochemistry staining against ROCK and α smooth muscle actin (αSMA) was performed on corpus cavernosum of an ED patient. Tissue strips were precontracted with phenylepinephrine and incubated with 1μM of the PDE5-i vardenafil or with DMSO (control). Subsequently, increasing concentrations of the RKIs azaindole or Y-27632 were added and relaxation of tissue was quantified.ResultsThe expression of ROCK1 was unchanged (p > 0.05), while ROCK2 (p < 0.05) was significantly upregulated in ED patients, compared to controls. ROCK 1 and 2 protein colocalized with αSMA, confirming the presence of this kinase in cavernous smooth muscle cells and/or myofibroblasts. After incubation with DMSO, 10μM azaindole and 10μM Y-27632 relaxed precontracted tissues with 49.5 ± 7.42% (p = 0.1470 when compared to vehicle) and 85.9 ± 10.3% (p = 0.0016 when compared to vehicle), respectively. Additive effects on relaxation of human corpus cavernosum were seen after preincubation with 1μM vardenafil.ConclusionThe RKI Y-27632 causes a significant relaxation of corpus cavernosum in tissue strips of patients with severe erectile dysfunction. The additive effect of vardenafil and Y-27632 demonstrate that a combined inhibition of Rho-kinase and phosphodiesterase type 5 could be a promising orally administered treatment for severe ED.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-20T09:05:22.792984-05:
      DOI: 10.1111/bju.13691
       
  • Clinical Risk Stratification in Patients with Surgically Resectable
           Micropapillary Bladder Cancer
    • Authors: Mario I. Fernández; Stephen B. Williams, Daniel L. Willis, Rebecca S. Slack, Rian J. Dickstein, Sahil Parikh, Edmund Chiong, Arlene O. Siefker-Radtke, Charles C. Guo, Bogdan A. Czerniak, David J. McConkey, Jay B. Shah, Louis L. Pisters, H.Barton Grossman, Colin P. N. Dinney, Ashish M. Kamat
      Abstract: ObjectiveTo analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data.Patients and MethodsA review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree analysis was performed to identify risk groups for survival.ResultsFor the entire cohort, estimated 5-year overall and disease-specific survival rates were 52% and 58%, respectively. Classification and regression tree analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumor-associated hydronephrosis. Five-year disease-specific survival for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (p
      PubDate: 2016-10-18T03:25:20.605334-05:
      DOI: 10.1111/bju.13689
       
  • Quality of life outcomes from the PATCH trial evaluating LHRH agonists
           versus transdermal oestradiol for androgen suppression in advanced
           prostate cancer
    • Authors: Duncan C Gilbert; Trinh Duong, Howard G Kynaston, Abdulla A Alhasso, Fay H Cafferty, Stuart D Rosen, Subramanian Kanaga-Sundaram, Sanjay Dixit, Marc Laniado, Sanjeev Madaan, Gerald Collins, Alvan Pope, Andrew Welland, Matthew Nankivell, Richard Wassersug, Mahesh KB Parmar, Ruth E Langley, Paul D Abel
      Abstract: ObjectivesTo compare quality of life (QoL) outcomes at 6 months between men with advanced prostate cancer (PCa) receiving either transdermal oestradiol (tE2) or LHRH agonists (LHRHa) for androgen deprivation therapy (ADT).Patients and methodsMen with locally advanced or metastatic PCa participating in an ongoing randomised, multi-centre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via 3 or 4 transcutaneous patches containing 100mcg of oestradiol/24 hours. LHRHa was administered as per local practice. Patients completed questionnaires based on EORTC QLQ-C30 with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.Results727 men were enrolled between August 2007 and 5 October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median age 74 years (interquartile range [IQR] 68-79), median PSA 44 ng/ml (IQR 19-119), and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than LHRHa (mean difference +4.2, 95% CI 1.2 to 7.1, p=0.006), less fatigue and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to tE2 arm.ConclusionPatients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynecomastia. The ongoing trial will evaluate clinical efficacy, and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:20:21.109965-05:
      DOI: 10.1111/bju.13687
       
  • Factors associated with Regional Recurrence Following Lymphadenectomy for
           Penile Squamous Cell Carcinoma
    • Authors: Jay P. Reddy; Curtis A. Pettaway, Lawrence B. Levy, Lance C. Pagliaro, Pheroze Tamboli, Priya Rao, Isuru Jayaratna, Karen E. Hoffman
      Abstract: ObjectiveTo identify factors associated with regional recurrence (RR) following lymphadenectomy for penile cancer in order to determine which patients might benefit from adjuvant therapy.Materials/MethodsMen who underwent lymphadenectomy for penile squamous cell carcinoma from 1977-2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of lymphadenectomy. Cox regression models evaluated the association between RFS and patient and tumor characteristics.Results182 men who underwent lymphadenectomy for penile cancer were identified. Median patient age was 62 years and median follow-up was 4.2 years. 34 men experienced RR following lymphadenectomy, of which 24 developed isolated RR without distant metastasis. Median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathologic nodal stage, pathologic inguinal laterality, pelvic nodal involvement, lymph node density >5.2%, >3 pathologically-involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (p3 pathologically involved lymph nodes (AHR 3.78, 95% CI: 2.12-6.65; p
      PubDate: 2016-10-18T03:15:20.146557-05:
      DOI: 10.1111/bju.13686
       
  • Efficacy of knowledge and competence-based training of non-physicians in
           the provision of Early Infant Circumcision (EIC) using the Mogen clamp in
           Rakai, Uganda
    • Authors: E.Nelson Kankaka; G. Kigozi, D. Kayiwa, N. Kighoma, F. Makumbi, T. Murungi, D. Nabukalu, R. Nampijja, S. Watya, D. Namuguzi, F. Nalugoda, G. Nakigozi, D. Sserwadda, M. Wawer, R.H. Gray
      Abstract: Early infant circumcision (EIC) is the most common neonatal surgical procedure in males.1 It has also been incorporated as a component in combination HIV prevention in 14 of Sub-Saharan African countries with high HIV prevalence and low circumcision coverage.2,3 EIC has advantages over adult circumcision due to lower adverse events, no risk of early resumption of sex and potentially lower cost4–6. Sub-Saharan African countries have low physician coverage, but comparatively higher coverage of non-physicians who could facilitate roll out of circumcision for HIV prevention. The major concern has been safety of the procedure and complications can be mitigated by adequate training using a structured curriculum7–11with a didactic and supervised practicum, step-by-step checklists and immediate feedback from mentors. Anatomic models have also been shown to enhance trainee-learning.12–15This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:05:51.922449-05:
      DOI: 10.1111/bju.13685
       
  • Long-term utility of adjuvant hormonal and radiation therapy for patients
           with seminal vesicle invasion at radical prostatectomy
    • Authors: Marco Moschini; Vidit Sharma, Giorgio Gandaglia, Paolo Dell'Oglio, Nicola Fossati, Emanuele Zaffuto, Francesco Montorsi, Alberto Briganti, R. Jeffrey Karnes
      Abstract: IntroductionThe literature is conflicting on the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer (PCa) demonstrating seminal vesicle invasion (pT3b; SVI).MethodsPatients with SVI during RP and pelvic lymph node dissection at two major referral centers from 1986-2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were performed to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence, cancer specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients.ResultsOverall, 3,279 patients with SVI were included with a median follow up of 148 months. Considering the whole SVI population, 1,387 (42%) received no adjuvant therapy, 1,179 (36%) received aHT, 461 (14.1%) received aRT while 252 (7.7%) received both aHT and aRT, respectively. 10 year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all p
      PubDate: 2016-10-18T02:30:24.135404-05:
      DOI: 10.1111/bju.13683
       
  • Application of shear wave elastography to estimate the stiffness of the
           male striated urethral sphincter during voluntary contractions
    • Authors: Ryan E. Stafford; Rafeef Aljuraifani, François Hug, Paul W. Hodges
      Abstract: ObjectivesTo investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter during voluntary activation using shear wave elastography; to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. striated urethral sphincter); and to determine the relationship between muscle stiffness and contraction intensity.Subjects and methodsTen healthy men participated. A linear ultrasound transducer was placed mid-sagittal on the perineum adjacent to a pair of electromyography electrodes that recorded non-specific pelvic floor muscle activity. Stiffness in the area expected to contain the striated urethral sphincter was estimated via ultrasound shear wave elastography at rest and during voluntary pelvic floor muscles contractions to 5%, 10% and 15% maximum. Still image frames were exported for each repetition and analysed with software that detected increases in stiffness above 150% of the resting stiffness.ResultsPelvic floor muscle contraction elicited an increase in stiffness above threshold within the region expected to contain the striated sphincter for all participants and contraction intensities. The mean(SD) ventral-dorsal distance between the centre of the stiffness area and region of maximal motion of the mid-urethra (caused by striated urethral sphincter contraction) was 5.6(1.8), 6.2(0.8), and 5.8(0.7) mm for 5%, 10% and 15% MVC respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities(5% vs. 10%; P
      PubDate: 2016-10-18T02:25:26.528424-05:
      DOI: 10.1111/bju.13688
       
  • The management of non-visualisation following dynamic sentinel lymph node
           biopsy for squamous cell carcinoma of the penis
    • Authors: Varun Sahdev; Maarten Albersen, Michelle Christodoulidou, Arie Parnham, Peter Malone, Raj Nigam, Jamshed Bomanji, Asif Muneer
      Abstract: ObjectivesTo review the management and clinical outcomes of uni- or bilateral non-visualization of inguinal lymph nodes following dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0). An additional objective was to develop an algorithm for the management of patients in which non-visualisation occurs.Patients and MethodsThis is a retrospective observational study over a period of 4 years comprising 166 patients with penile squamous cell carcinoma undergoing DSNB and followed up for a minimum of 6 months. All cases diagnosed with uni- or bilateral non-visualisation of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes following non-visualisation and the oncological outcomes including local and regional recurrence rates were documented.ResultsOut of 166 consecutive patients undergoing DSNB, 20 (12%) patients had unilateral non-visualisation following injection of intradermal 99mTc. Of these 20 patients, 7 underwent repeat DSNB at a later date with 6 having successful visualisation. One patient had persistent non-visualisation and proceeded to a superficial modified inguinal lymphadenectomy (SML). None of these patients experienced recurrence at follow-up. A further seven patients underwent modified SML with on table frozen section analysis of the lymph node packet; none of these patients were found to have micrometastatic disease in the inguinal lymph nodes although one patient developed metastatic inguinal node disease at a later date. Six patients elected to undergo clinical surveillance and have remained disease free.ConclusionPatients with impalpable inguinal lymph nodes undergoing DSNB with ≥ T1G2 disease should ideally have bilateral visualisation of the sentinel lymph nodes reflecting the drainage pattern from the primary tumour. In this series, 12% of patients were found to have unilateral non-visualisation following DSNB. Patients offered a repeat DSNB at a later date, were successful in localising the sentinel node in 86% of cases. Patients with favourable histological parameters can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that a SML may be carried out if there is repeated non-visualisation. Larger cohorts are required in order to validate this proposed algorithm.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:20:25.768838-05:
      DOI: 10.1111/bju.13680
       
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared to salvage radiation therapy in patients with pN1 prostate cancer
           treated with radical prostatectomy
    • Authors: Derya Tilki; Felix Preisser, Pierre Tennstedt, Patrick Tober, Philipp Mandel, Thorsten Schlomm, Thomas Steuber, Hartwig Huland, Schwarz Rudolf, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Abstract: ObjectiveTo analyze the comparative effectiveness of no treatment or salvage radiation therapy at biochemical recurrence (NT/sRT) versus adjuvant radiation therapy (aRT) in LN positive patients after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN positive prostate cancer (PCa) at RP with or without additional radiation treatment from 2005 to 2013 were retrospectively analyzed. Cox regressions addressed factors influencing biochemical recurrence (BCR) and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsMedian follow-up for the entire patient group was 33.8 months. Four-year BCR-free and metastasis-free survival rates were 43.3% and 86.6% for all patients, respectively. In multivariate analysis, NT/sRT (n=505) was an independent risk factor for BCR and metastasis compared to patients with aRT (n=213). The superiority of aRT was confirmed after propensity score-matching. Four-year metastasis-free survival in the matched cohort was 82.5% versus 91.8% for the NT/sRT and aRT groups, respectively (p=0.02). Early sRT (pre-RT PSA ≤0.5 ng/ml) compared to sRT at PSA >0.5 ng/ml was significantly associated with decreased risk of metastasis.ConclusionLN positive patients who received aRT had a significantly better oncological outcome compared to patients with NT/sRT independent of tumor characteristics. Patients with early sRT showed higher rates of response and better metastasis-free survival than patients with pre-RT PSA >0.5 ng/ml.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:15:35.748361-05:
      DOI: 10.1111/bju.13679
       
  • Impact of Suboptimal Neoadjuvant Chemotherapy on Perioperative Outcomes
           and Survival After Robot-Assisted Radical Cystectomy: A Multicenter
           Multinational Study
    • Authors: Nobuyuki Hinata; Ahmed Aly Hussein, Saby George, Donald L. Trump, Ellis G. Levine, Kawa Omar, Prokar Dasgupta, Muhammad Shamim Khan, Abolfazl Hosseini, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo evaluate the effect of suboptimal dosing on the outcomes of patients who received neoadjuvant chemotherapy (NAC) and robot-assisted radical cystectomy (RARC).Patients and MethodsWe retrospectively reviewed 336 consecutive patients with urothelial carcinoma of the bladder who were treated with NAC and RARC at three academic institutions. Outcomes were compared between 3 groups: patients who received optimal NAC; patients who received suboptimal NAC; and those who did not receive NAC. To adjust for potential baseline differences between the three groups, propensity-score-based matching was performed. The suboptimal dose group was defined as those who received fewer than three cycles of cisplatin-based chemotherapy, received decreased dosage, or one's not treated with cisplatin. Primary outcomes analyzed were recurrence-free survival (RFS) and overall survival (OS). Secondary outcomes were perioperative complications and readmissions after RARC.ResultsWithin the cohort after propensity-score matching, 69 patients received optimal dose NAC, 41 received suboptimal NAC and 69 did not receive NAC. Complication rates and readmission rates between the 3 groups did not differ significantly. On multivariable analysis, suboptimal dosing and no NAC were independent predictors of worse RFS (HR: 2.5, 95%CI: 1.2-5.7, p=0.01 and HR 2.4, 95%CI 1.28-5.16, p=0.01) and worse OS (HR 4.5, 95%CI 1.6-15.0, p
      PubDate: 2016-10-15T08:15:34.670061-05:
      DOI: 10.1111/bju.13678
       
  • Prostate Health Index (phi) Improves Multivariable Risk Prediction of
           Aggressive Prostate Cancer
    • Authors: Stacy Loeb; Sanghyuk S. Shin, Dennis L. Broyles, John T. Wei, Martin Sanda, George Klee, Alan W. Partin, Lori Sokoll, Daniel W. Chan, Chris H. Bangma, Ron H. N. van Schaik, Kevin M. Slawin, Leonard S. Marks, William J. Catalona
      Abstract: ObjectiveTo examine the use of the Prostate Health Index (phi)* as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicenter US study.Materials and MethodsThe study population included 728 men with PSA levels of 2-10 ng/mL and negative digital rectal examination enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of phi improves the performance of currently available risk calculators (PCPT and ERSPC). We also designed and internally validated a new phi-based multivariable predictive model, and created a nomogram.ResultsOf 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. Phi predicted the risk of aggressive prostate cancer across the spectrum of values. Adding phi significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, prior biopsy, prostate volume, PSA, and phi with an AUC of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision curve analysis.ConclusionUsing phi as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:05:52.721224-05:
      DOI: 10.1111/bju.13676
       
  • The Robotic Approach Improves Surgical Outcomes in Obese Patients
           Undergoing Partial Nephrectomy
    • Authors: Ercan Malkoc; Matthew J. Maurice, Onder Kara, Daniel Ramirez, Ryan J. Nelson, Peter A. Caputo, Pascal Mouracade, Robert Stein, Jihad H. Kaouk
      Abstract: ObjectivesTo assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses.Patients and MethodsUsing our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m2) with small renal masses (
      PubDate: 2016-10-04T01:50:11.55434-05:0
      DOI: 10.1111/bju.13675
       
  • Outcomes of advanced urothelial carcinoma patients following
           discontinuation of Programmed Death (PD)-1 or PD-Ligand (L)-1 inhibitors
    • Authors: G Sonpavde; G R Pond, S Mullane, A A Ramirez, N J Vogelzang, A Necchi, T Powles, J Bellmunt
      Abstract: ObjectiveTo study the subsequent therapy and disease outcomes of patients with advanced urothelial carcinoma (UC) following discontinuation of programmed death-1 (PD-1) or PD-Ligand (L)1 inhibitors.Patients and methodsWe performed a retrospective analysis to examine outcomes and systemic therapy administration following PD-1/PD-L1 inhibitor therapy in patients with advanced UC. Data were collected from institutions including demographics and therapy administered. Univariable Cox regression analyses examined clinical factors potentially associated with overall survival (OS) following PD-1/PD-L1 inhibitors.ResultsData from 62 patients was available from 4 institutions with capture of subsequent therapy and outcomes following checkpoint inhibitor immunotherapy. The median age was 65.5 years and 51 (82.3%) were male. The median duration of PD-1/PD-L1 inhibitors available from 55 patients was 64 days (range 7-669). Of these, 22 (35.5%) patients received post-PD1/PD-L1 inhibitor therapy with a variety of different chemotherapy regimens (n=16), chemobiologic combination (n=1), biologic agents (n=4) and immunotherapy (n=1). The median time from last PD1/PD-L1 inhibitor therapy to subsequent therapy was 58 days (range 14-242). The median OS of all patients following completion of PD-1/PD-L1 inhibitors was 149 days (95% CI: 75-359). Among those who received some post-PD1/PD-L1 inhibitor therapy, median OS was 182 days (95% CI: 121-372), and the median time to progression was 124 days (95% CI: 61-273) when examining from start of post-PD1/PD-L1 therapy. Among these 22 patients, the only significant baseline prognostic factor associated with OS was performance status.ConclusionsIn this dataset, 35.5% of patients with advanced UC received systemic therapy following salvage therapy with PD1/PD-L1 inhibitors. Outcomes with subsequent therapy appear similar to those historically observed in patients who had not received prior PD1/PD-L1 inhibitors. Further study of patients receiving post-PD1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-04T01:40:58.140777-05:
      DOI: 10.1111/bju.13674
       
  • Virtue male sling for post-prostatectomy stress incontinence: a
           prospective evaluation and mid-term outcomes
    • Authors: Matteo Ferro; Danilo Bottero, Carolina D'Elia, Deliu Victor Matei, Antonio Cioffi, Gabriele Cozzi, Alessandro Serino, Giovanni Cordima, Roberto Bianchi, Piero Giacomo Incarbone, Antonio Brescia, Gennaro Musi, Ferdinando Fusco, Serena Detti, Vincenzo Mirone, Ottavio de Cobelli
      Abstract: ObjectivesTo evaluate the efficacy and safety of the Virtue Male sling in a cohort of patients affected by post prostatectomy stress urinary incontinence (SUI).MethodsAll consecutive patients treated with Virtue® male sling at our Institution in year 2012 were included in our prospective, non randomized study.Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery with 24-hour pad weight test, ICI-Q short form questionnaire, Urinary Symptom Profile questionnaire, bladder diary, uroflowmetry and Patient Global Impression of Improvement and Patient Global Impression of Severity Questionnaire.ResultsMen age was 65.5 years. 72.4% of patients complained a pre operative mild incontinence (1-2 PPD), whereas 9 patients used 3-5 pads/day. 17 complications occurred in 29 patients (58.6%) and all were grade I.At 12 months follow up patients showed a significant improvement in 24 h PAD test (128.6 VS 2.5), pads per day used (2 VS 0), ICI Q SF score (14.3 VS 0.9), USP SUI score (4 VS 0) and outcomes remains stable at 36 months.At last follow up, PGI I questionnaire showed a median score of 1 (very much better).ConclusionsVirtue® Male Sling is an effective treatment option for low to moderate post-prostatectomy incontinence.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-03T08:20:29.821855-05:
      DOI: 10.1111/bju.13672
       
  • A Randomized Controlled Trial Evaluating Renal Protective Effects of
           Selenium ACE, Verapamil and Losartan against Extracorporeal Shock Waves
           Lithotripsy Induced Renal Injury
    • Authors: Ahmed R. EL-Nahas; Mohamed M. Elsaadany, Diaa-Eldin Taha, Ahmed M. Elshal, Mohamed Abo El-Ghar, Amani M. Ismail, Essam A. Elsawy, Hazem H. Saleh, Ehab W. Wafa, Amira Awadalla, Tamer S. Barakat, Khaled Z Sheir
      Abstract: ObjectiveTo evaluate the protective effects of Selenium-ACE, Verapamil and losartan against SWL induced renal injury.Patients and methodsA randomized controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (300mg/L) were excluded. SWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomized into one of 4 groups using sealed closed envelops. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 hours and 1 week post-SWL. The primary outcome was the differences between albuminuria and uNGAL. Dynamic contrast enhanced MRI (DCE-MRI) was performed before SWL, 2-4 hours and 1 week post-SWL to compare changes in renal perfusion.ResultsOut of 329 patients assessed for eligibility, final analysis was performed for 160 patients (40 in each group). Losartan was the only medications that showed significantly lower levels of albuminuria after one week (P
      PubDate: 2016-09-30T05:35:42.135099-05:
      DOI: 10.1111/bju.13667
       
  • Parents’ Perceptions of Counselling Following Prenatal Diagnosis of
           
    • Authors: Sarah Marokakis; Nadine A Kasparian, Sean E Kennedy
      Abstract: ObjectivesTo explore parents’ experiences of counselling after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.Materials and MethodsParents of a child born between September 2012 and March 2015 with posterior urethral valves (PUV) or multicystic dysplastic kidney (MCDK) completed a semi-structured telephone interview, demographic survey, and the Depression, Anxiety and Stress Scales (DASS21). Qualitative data were analysed thematically using NVivo10 software.ResultsSeventeen parents (PUV n=8; MCDK n=9) participated (response rate: 40%), and most were offered counselling during pregnancy (14/17). Parents described feelings of shock, fear and uncertainty following diagnosis, and desired early information on all aspects of their child's condition. Most participants were satisfied with the information received; however, unmet information needs relating to treatment and prognosis were identified, particularly amongst fathers and parents in the PUV group. Some parents felt relieved after counselling (12/17); however, emotional distress often persisted long after diagnosis. Parents described a need for written and web-based information resources, specialised psychological services, and parent support groups.ConclusionWhile parents valued counselling, many continued to report unmet informational and psychological needs. Early counselling addressing topics important to parents and provision of additional resources and support services may improve parents’ adjustment to their baby's diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:47.230139-05:
      DOI: 10.1111/bju.13668
       
  • When to perform preoperative chest computed tomography for renal cancer
           staging
    • Authors: Alessandro Larcher; Paolo Dell'Oglio, Nicola Fossati, Alessandro Nini, Fabio Muttin, Nazareno Suardi, Francesco De Cobelli, Andrea Salonia, Alberto Briganti, Xu Zhang, Francesco Montorsi, Roberto Bertini, Umberto Capitanio
      Abstract: ObjectivesTo provide objective criteria for preoperative staging chest computed tomography [CCT] in patients diagnosed with renal cell carcinoma [RCC], since, in absence of established indications, the decision for preoperative CCT remains subjective.Patients and Methods1,946 patients elected for surgical treatment of RCC and collected in a prospective institutional database were assessed. The outcome of the study was presence of pulmonary metastases at staging CCT. A multivariable logistic regression model predicting positive CCT was fitted. Predictors consisted of preoperative clinical tumour [cT] and nodal [cN] stage, presence of systemic symptoms and platelets/haemoglobin ratio.ResultsThe rate of positive CCT was 6% (n=119). At multivariable logistic regression, ≥cT1b, cN1, systemic symptoms and haemoglobin/platelets ratio were all associated with higher risk of positive CCT (all p1%, a negative CCT is spared in 37% of the population and a positive CCT is missed in 0.2% of the population only.ConclusionsThe proposed strategy estimates the risk of positive CCT at RCC staging with optimal accuracy and resulted statistically and clinically relevant. The current findings support a recommendation for CCT in patients with ≥cT1b, cN1, systemic symptoms or anaemia and thrombocythemia. Conversely, in patients with cT1a, cN0 without systemic symptoms, anaemia and thrombocythemia, CCT can be omitted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:43.908394-05:
      DOI: 10.1111/bju.13670
       
  • Transgenic Animal Model for Studying the Mechanism of Obesity‐Associated
           Stress Urinary Incontinence
    • Authors: Lin Wang; Guiting Lin, Yung‐Chin Lee, Amanda B. Reed‐Maldonado, Melissa T Sanford, Guifang Wang, Huixi Li, Lia Banie, Zhengcheng Xin, Tom F. Lue
      Abstract: PurposeTo study and compare the function and structure of the urethral sphincter in female Zucker lean and Zucker fatty (ZF) rats and to assess viability of ZF fats as a model for female obesity‐associated stress urinary incontinence (OA‐SUI).Materials and MethodsTwelve16‐week‐old female Zucker Lean (ZUC‐Leprfa 186) (ZL) rats and twelve16‐week‐old female Zucker Fatty (ZUC‐Leprfa 185) (ZF) rats were grouped into two groups: ZL arm and ZF arm. Intraperitoneal insulin tolerance testing was carried out before functional study. Metabolic cages, conscious cystometry, and leak point pressure (LPP) were conducted. Urethral tissues were harvested for immunofluorescence staining to check intramyocellular lipid (IMCL) and sphincter muscle (smooth muscle and striated muscle) composition.ResultsThe ZF rats demonstrated insulin resistance, increased voiding frequency, and decreased LPP compared to ZL rats (p
      PubDate: 2016-09-21T04:24:31.647568-05:
      DOI: 10.1111/bju.13661
       
  • Phenotypic diversity of circulating tumour cells in patients with
           metastatic castration‐resistant prostate cancer
    • Authors: Andrew S. McDaniel; Roberta Ferraldeschi, Rachel Krupa, Mark Landers, Ryon Graf, Jessica Louw, Adam Jendrisak, Natalee Bales, Dena Marrinucci, Zafeiris Zafeiriou, Penelope Flohr, Spyridon Sideris, Mateus Crespo, Ines Figueiredo, Joaquin Mateo, Johann S. de Bono, Ryan Dittamore, Scott A. Tomlins, Gerhardt Attard
      Abstract: ObjectivesTo utilize a non‐biased assay of circulating tumour cells (CTCs) in prostate cancer (PCa) patients in order to identify non‐traditional CTC phenotypes potentially excluded by conventional detection methods reliant upon antigen and/or sized based enrichment.Patients and Methods41 metastatic castration resistant prostate cancer (mCRPC) patients and 20 healthy volunteers were analysed on the Epic CTC Platform, via high throughput imaging of DAPI expression and CD45/cytokeratin (CK) immunofluorescence (IF) in all circulating nucleated cells plated on glass slides. IF for androgen receptor [AR] expression, and FISH for PTEN and ERG confirmed PCa origin of CTCs.ResultsTraditional (t) CTCs (CD45‐/CK+/morphologically distinct) were identified in 100% mCRPC patients. Using the above markers, we identified non‐traditional CTCs in mCRPC patients, including CK‐ and apoptotic CTCs. Small CTCs (≤WBC size) were identified in 98% of mCRPC patients. Total, traditional and non‐traditional CTCs were significantly increased in deceased vs. living patients at 18 months; however only non‐traditional CTCs associated with overall survival. Traditional and total CTC counts by the Epic platform in the mCRPC cohort were also significantly correlated with CTC counts by the CellSearch system.ConclusionsHeterogeneous non‐traditional CTC populations that may be missed by other approaches are frequent in mCRPC; characterization of non‐traditional CTCs may provide additional prognostic or predictive information.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-18T21:36:19.742643-05:
      DOI: 10.1111/bju.13631
       
  • Risk of Hospitalization Following Primary Treatment for Prostate Cancer
    • Authors: Stephen B. Williams; Zhigang Duan, Karim Chamie, Karen E. Hoffman, Benjamin D. Smith, Jim C. Hu, Jay B. Shah, John W. Davis, Sharon H. Giordano
      Abstract: ObjectiveTo compare the risk of hospitalization and associated costs in patients following treatment for prostate cancer.Patients and MethodsWe identified 29,571 patients age 66–75 years without significant comorbidity from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database who were diagnosed with localized prostate cancer between 2004 and 2009. We compared the rates of all cause and toxicity‐related hospitalization that occurred within 1 year following initiation of definitive therapy. We used multivariable logistic regression analysis to identify determinants associated with hospitalization.ResultsMen who underwent surgery rather than radiotherapy had lower odds of being hospitalized for any cause following therapy (OR 0.80: 95% CI, 0.74–0.87). Patients who underwent surgery rather than radiotherapy had higher odds of being hospitalized for treatment‐related complications (OR 1.15: 95% CI, 1.03–1.29). However, men who underwent external beam radiotherapy/IMRT (OR 0.84: 95% CI, 0.72‐0.99) had 16% lower odds of hospitalization from treatment‐related complications than patients undergoing surgery. Using propensity score weighted analyses, there was no significant difference in the odds of hospitalization from treatment‐related complications for men who underwent surgery versus radiotherapy (OR 1.06: 95% CI, 0.92–1.21). Patients hospitalized for treatment‐related complications following radiotherapy were costlier than patients who underwent surgery (Mean $18,381 vs. $13,203, p
      PubDate: 2016-09-16T00:18:44.30954-05:0
      DOI: 10.1111/bju.13647
       
  • Long term outcome of high dose rate (HDR) brachytherapy for intermediate
           and high risk prostate cancer with a median follow up of 10 years
    • Authors: J W Yaxley; K Lah, J P Yaxley, R A Gardiner, H Samaratunga, J MacKean
      Abstract: ObjectiveTo evaluate the long term outcome of high dose rate brachytherapy (HDR) for patients with intermediate and high risk prostate cancerSubjects, Patients and MethodsWe retrospectively analysed the prospective longitudinal cohort data base of a single surgeon series of 507 consecutive patients treated with external beam radiotherapy and a high dose rate prostate brachytherapy boost (HDR) between August 2000 and December 2009. The risk factors are based on the D'Amico classification. We measured the incidence of biochemical freedom of recurrent prostate cancer (bNED) based on the Phoenix definition of failure (nadir + 2). We also reviewed the incidence of urethral stricture in this cohort.ResultsWith a minimum follow up of 6 years and a median follow up of 10.3 years, the bNED for intermediate and high risk disease is 93.3 and 74.2% at 5 years respectively and 86.9% and 56.1% at 10 years. Patients with only 1 intermediate risk factor had a 10 year bNED of 94%, whereas patients with all 3 high risk factors had a 10 year bNED of 39.5%. The overall urethral stricture rate was 13.6%. Prior to 2005 the urethral stricture rate was 28.9% and after January 2005 was 4.2%. For the 271 men with a minimum follow up of 10 years the actual 10 year prostate cancer specific survival is 90.8% and actual overall survival is 86.7%.ConclusionsHigh dose rate prostatic brachytherapy remains an appropriate treatment option for patients with intermediate or high risk prostate cancer features, who are considered not suitable for, or wish to avoid a radical prostatectomy. From December 2004, prevention strategies decreased the risk of post brachytherapy urethral strictures.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:47:32.745397-05:
      DOI: 10.1111/bju.13659
       
  • Prospective study comparing Videoendoscopic radical Inguinal Lymph node
           dissection (VEILND) with Open radical inguinal lymphnode dissection
           (OILND) for penile cancer over an 8 year period
    • Authors: Vivekanandan Kumar; Krishna K Sethia
      Abstract: ObjectivesTo compare the complications and oncological outcomes between Video Endoscopic Inguinal Lymph node Dissection (VEILND) and Open Inguinal Lymph node Dissection (OILND) in men with carcinoma of the penis.Patients and methodsA prospectively collected institutional database was used to determine the outcomes in 42 consecutive patients undergoing inguinal lymph node dissection between 2008 and 2015 in a centre for treating penile cancer. Before 2013 all procedures involved open surgery. Since 2013 we have performed VEILND on all patients in need of ILND. The wound related, non‐wound related complications, length of stay and oncological safety between OILND and VEILND groups were compared. The mean duration of follow up was 71months for OILND and 16 months for the VEILND groups.ResultsIn the study period 42 patients underwent 68 inguinal node dissections (open 35, video‐assisted 33). The patients demographics, primary stage and grade, indications were comparable in both the groups. There were no intraoperative complications in either group. The wound complication rate was significantly lower in VEILND group at 6% compared to 68% in the OILND group. Lymphocele rates were similar in both the groups (27 and 20%). The VEILND group showed better or same lymph node yield, mean number of positive lymph nodes and lymph node density confirming oncological safety. There were no groin recurrence in either group of patients. VEILND patients had significant reduced length of stay by 4.9 days (p=0.0001).ConclusionVEILND is an oncologically safe procedure with considerably low morbidity and reduced length of stay at a mean follow‐up of 16 months (Range: 4‐35 months).This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:40:25.561228-05:
      DOI: 10.1111/bju.13660
       
  • Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair
           – demonstration of technique and matched‐pair analysis
    • Authors: Jens J. Rassweiler; Jan Klein, Alexandra Tschada, Ali Serdar Gözen
      Abstract: ObjectivesTo present technique and long‐term results of retroperitoneal laparoscopic partial nephrectomy (LPN) focussing on the impact of an ergonomic platform.Patients and MethodsBetween January 2000 and May 2016, 287 patients (193 male, 94 female) underwent LPN by four surgeons. Median age was 59 (19‐85) years. Mean tumour size was 3.1 (1‐9) cm. Mean PADUA‐score was 7.3 (6‐12). Access was retroperitoneal in 235 (82%) cases. Since October 2010, we used ETHOSTM‐chair during excision of the tumour in 130 (45.3%) patients. 51 (17.7%) tumours were excised without ischemia and 226 (78.7%) tumours under warm ischemia with clamping of renal artery using an enucleo‐resection technique. We suture the resection bed and perform renorrhaphy using a barbed‐suture pre‐loaded with absorbable LAPRA‐TYTM‐clip. The impact of ETHOS‐chair was examined using a matched‐pair analysis (66 ETHOS vs. 67 Non‐ETHOS‐chair).ResultsMedian operating time was 146 (60‐325) minutes. Median estimated blood loss was 99 (10 ‐ 3000) cc, mean warm ischemia time was 17.1 (7‐47) minutes. Histology showed 240 (83.6%) renal cell carcinomas and 46 (15.9%) benign tumours. Cumulative overall disease‐free survival rate after a median follow‐up of 84 (3‐155) months was 100 % for 203 pT1 renal cell tumours, local recurrence was observed in one patient (0.4%), who was managed by radical nephrectomy. There were two conversions (0.7%) to open surgery respectively to hand‐assisted laparoscopy. Perirenal hematoma was observed in 13 (4.5%) patients. 20 (6.9%) patients required transfusions (2‐11 units). We observed 5 urine leaks (1.7%) requiring prolonged drainage. Median hospital stay was 5 (3‐24) days. Three patients developed a‐v‐fistulas successfully occluded by super‐selective embolization (1.0%). Use of ETHOSTM‐chair resulted in shorter OR‐time (134.7 vs. 168.5 min., p = 0.04) including warm ischemia time (13.1 vs. 15.9 min., p=0.01) less complications (15% vs. 29.8%, p = 0.02). Limitation of the analysis is the fact that it is not prospective randomized trial.ConclusionsLPN is technically difficult but oncologic effective. Standardization and simplification of endoscopic suturing using ETHOS‐chair significantly improved the outcome of the surgical procedure.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T22:01:01.305238-05:
      DOI: 10.1111/bju.13627
       
  • Quality of life and pain relief in men with metastatic
           castration‐resistant prostate cancer on cabazitaxel: the
           non‐interventional QoLiTime study
    • Authors: Ralf‐Dieter Hofheinz; Carsten Lange, Thorsten Ecke, Susanne Kloss, Burkhard Linsse, Christine Windemuth‐Kieselbach, Peter Hammerer, Salah‐Eddin Al‐Batran
      Abstract: ObjectiveTo examine health‐related quality of life in men with metastatic castration‐resistant prostate cancer on cabazitaxel.Patients and methodsMen with metastatic castration‐resistant prostate cancer receiving cabazitaxel (25 mg/m², every 3 weeks) and 10 mg/day oral prednis(ol)one were enrolled (2011–2014) in the non‐interventional prospective QoLiTime study. Primary outcome was change in quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30 item) with respect to PSA response after 4 cycles of cabazitaxel. Secondary outcomes included occurrence of adverse events.ResultsOf 527 men, 348 received 4 cycles of cabazitaxel and 266 had sufficient PSA measurements. After 4 cycles, 92 (34.6%) men had a PSA decrease ≥50% (responders). Quality of life remained stable throughout the study (P=0.62). Change in quality of life did not differ between responders and non‐responders (P=0.69). Change in PSA and global health status between baseline and 4 cycles showed an inversely proportional relationship (correlation coefficient –0.14; 95% CI –0.26 to –0.01; P=0.03), with increasing PSA corresponding to lower health status. Responders showed no change in physical functioning versus baseline (–1.75, P=0.12); non‐responders showed a reduction versus baseline (–7.00, P
      PubDate: 2016-09-12T10:30:33.313897-05:
      DOI: 10.1111/bju.13658
       
  • Is a negative mpMRI really able to rule out significant prostate
           cancer': The real life experience
    • Authors: Nicolas Branger; Thomas Maubon, Miriam Traumann, Jeanne Thomassin‐Piana, Nicolas Brandone, Sébastien Taix, Julien Touzlian, Serge Brunelle, Geraldine Pignot, Naji Salem, Gwenaelle Gravis, Jochen Walz
      Abstract: ObjectivesTo evaluate the histopathological results after radical prostatectomy in patients that had a normal preoperative mpMRI in order to see if they had significant or insignificant disease. Moreover we evaluated the influence of the expertise of the radiologist on the results.Materials and methodsWe retrospectively included patients who underwent radical prostatectomy in our center and who had a preoperative negative mpMRI. The MRIs were considered negative when no suspicious lesion was seen or when the PI‐RADS V1 score was less than 7. We used pTNM stage and Gleason score on pathology reports, and whole mount sections to calculate tumor volume.ResultsWe identified 101 patients from 2009 to 2015. Final pathology showed that 16.9% had an extraprostatic extension (EEP), 13.8% had primary Gleason pattern 4 (4+3 and up), 47.5% had secondary Gleason pattern 4 or 5, 55.9% and 20.6% had a main tumor volume ≥ 0.5mL and ≥ 2mL respectively. When limiting the analysis to expert reading only, the numbers improved: only one patient (3.4%) had an EEP (p
      PubDate: 2016-09-12T10:30:32.058433-05:
      DOI: 10.1111/bju.13657
       
  • A novel infusion‐drainage device to assess lower urinary tract
           function in neuro‐imaging
    • Authors: Lorenz Leitner; Matthias Walter, Behnaz Jarrahi, Johann Wanek, Jörg Diefenbacher, Lars Michels, Martina D. Liechti, Spyros S. Kollias, Thomas M. Kessler, Ulrich Mehnert
      Abstract: ObjectiveTo evaluate the applicability and precision of a novel infusion‐drainage device (IDD) for standardised filling paradigms in neuro‐urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) (dys)function.Subjects/patients and methodsThe IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorised slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterisation, the bladder was pre‐filled until a persistent desire to void was reported from each subject. The scan paradigm comprised of automated, repetitive bladder filling and withdrawal of 100 mL body warm (37° C) saline interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping 12.ResultsVolume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flowrates and volumes. MR compatibility was demonstrated with a small decrease in signal‐to‐noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans and a decrease of 1.76% for time‐variant SNR. Automated, repetitive bladder filling elicited robust (p=0.05, family‐wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level dependent (BOLD) signal changes in such areas.ConclusionWe were able to develop a magnetic resonance (MR) compatible and MR synchronised IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in congruence to the applied stimuli. The IDD is commercially available, portable, and multi‐configurable. Such a device may help to improve precision and standardization of LUT tasks in neuroimaging studies on supraspinal LUT control, and may therefore facilitate multi‐site studies and comparability between different LUT investigations in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T10:15:29.51283-05:0
      DOI: 10.1111/bju.13655
       
  • PADUA and RENAL nephrometry scores correlates with perioperative outcomes
           after robot‐assisted partial nephrectomy: analysis of the Vattikuti
           Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database
           
    • Authors: Riccardo Schiavina; Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A. Moon, Francesco Porpiglia, Benjamin J. Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
      Abstract: ObjectivesTo evaluate and compare the correlations between PADUA and RENAL scores and perioperative outcomes and postoperative complications in a multicenter, international series of patients undergoing Robot‐assisted partial nephrectomy (RAPN) for masses suspicious of RCC.Patients and methodsWe retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international Centers that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database. All patients underwent pre‐operative computed tomography or magnetic resonance imaging to define the clinical stage and anatomic characteristics of the tumors. PADUA and RENAL scores were retrospectively assessed in each Center. Univariate and multivariate analyses were performed to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumor size, PADUA and RENAL complexity group categories and warm ischemia time >20 minutes, urinary calyceal system closure and grade of postoperative complications.ResultsOverall, 277 patients have been evaluated. The median tumor size was 33.0 millimeters (22.0‐43.0). The median PADUA and RENAL score were 8 and 7 respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low, intermediate or high‐complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low, intermediate or high‐complexity group according to RENAL score, respectively. Both nephrometric tools significantly correlated with perioperative outcomes at univariate and multivariate analyses..ConclusionA precise stratification of patients before partial nephrectomy is recommended, allowing to balance the potential threats and benefits of nephron‐sparing surgery. In our analysis, both PADUA and RENAL were significantly associated with prolonged WIT and high‐grade postoperative complications after RAPN.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-11T00:00:24.276066-05:
      DOI: 10.1111/bju.13628
       
  • Diagnostic accuracy of CT urography and visual assessment during
           ureterorenoscopy in upper tract urothelial carcinoma
    • Authors: Alexandra Grahn; Miden Melle‐Hannah, Camilla Malm, Fredrik Jäderling, Eva Radecka, Mats Beckman, Marianne Brehmer
      Abstract: Upper tract urothelial carcinoma (UTUC) is a rare condition, although the annual incidence is increasing, possibly as a result of improved diagnostic performance and higher survival rates in patients with bladder cancer. Research data and technical development achieved in the last decades have led to a shift in the guidelines of European Association of Urology (EAU) and American Urological Association for diagnosis and treatment of UTUC. Computed tomography urography (CTU) has become the imaging of choice for investigation.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T07:36:46.28093-05:0
      DOI: 10.1111/bju.13652
       
  • The landscape of systematic reviews in urology (1998 through 2015): An
           assessment of methodologic quality
    • Authors: Julia L. Han; Shreyas Gandhi, Crystal G. Bockoven, Vikram Narayan, Philipp Dahm
      Abstract: Sir Archie Cochrane is credited with the recognition that few clinical questions in health care are appropriately addressed by consulting the results of a single study alone; instead, we should perform systematic reviews to summarize the entire body of evidence—ideally, high‐quality evidence—in order to inform patient decision‐making and health policy. His contributions provided the impetus for the founding of the Cochrane Collaboration and for the development of transparent, rigorous methods for systematic reviews. Over the last two decades, such reviews have gained increasing importance with regard to their perceived role in informing evidence‐based clinical practice. They tend to be frequently cited in the literature and thus can raise a journal's impact factor. The number of systematic reviews published in the urology literature has clearly increased.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T04:21:15.537585-05:
      DOI: 10.1111/bju.13653
       
  • A Qualitative Study on Decision‐Making by Prostate Cancer Physicians
           during Active Surveillance
    • Authors: Stacy Loeb; Caitlin Curnyn, Angela Fagerlin, R. Scott Braithwaite, Mark D. Schwartz, Herbert Lepor, H. Ballentine Carter, Erica Sedlander
      Abstract: ObjectiveTo explore and identify factors that influence physicians’ decisions while monitoring prostate cancer patients on active surveillance.Subjects and methodsA purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the US. We conducted 24 in‐depth interviews from July‐December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software was used for organization and further analysis.ResultsEight key themes emerged to explain variation in active surveillance monitoring: 1) physician comfort with active surveillance, 2) protocol selection, 3) beliefs about the utility and quality of testing, 4) years of experience and exposure to AS during training, 5) concerns about inflicting “harm”, 6) patient characteristics, 7) patient preferences, and 8) financial incentives.ConclusionThese qualitative data reveal which factors influence physicians that manage patients on AS. There is tension between providing standardized care while also considering individual patients’ needs and health status. Additional education on active surveillance is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:59.225621-05:
      DOI: 10.1111/bju.13651
       
  • Pathologic Analysis of the Prostatic Anterior Fat Pad at the time of
           Radical Prostatectomy: Insights from a Prospective Series
    • Authors: Mark W. Ball; Kelly T. Harris, Zeyad Schwen, Jeffrey K Mullins, Misop Han, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein
      Abstract: ObjectiveTo assess factors associated with lymphatic drainage and lymph node metastasis to the prostatic anterior fat pad (PAFP) in men with prostate cancer and the utility of routine PAFP analysis at the time of radical prostatectomy (RP).MethodsOur institution began to prospectively collect PAFP tissue in 2010. The PAFP was removed at the time of RP and sent as a pathologic specimen separate from the pelvic LNs and prostate. Consecutive RPs performed at our institution in which the PAFP was removed were reviewed to determine the rate of LNs in the PAFP, the rate of metastatic LNs in the PAFP, and the association of metastatic PAFP LN with clinical and pathologic features. The impact on biochemical recurrence was assessed with a Cox's proportional hazard model.ResultsIn total, 2,413 AFP specimens were available for analysis. LNs were found in the AFP in 255(10.6%) cases and metastatic LNs to the PAFP were found in 14 (0.6%) cases. Metastatic PAFP LNs were associated with anterior tumors in 11 (78.6%) cases (p = 0.01), and were present only in pre‐operative D'Amico intermediate‐ (n=6, 42.8%) and high‐ (n=8, 57.1%) risk patients (p < 0.001). Metastatic PAFP LNs were associated with extraprostatic disease in 13 (92.8%) of cases, though concomitant pelvic LN involvement was present in only 4 (28.6%) cases. With a mean follow up of 1.5 years, 3 (21.4%) patients with metastatic PAFP LN experienced BCR. Positive LN involvement in either the pelvic LN or PAFP had worse BCR than LN negative patients (p < 0.0001); however, there was no difference in BCR between patients with positive pelvic LN and positive PAFP LN (p=0.5).ConclusionMetastatic PAFP LNs are rare and always occur in the presence of other adverse pathologic features. The routine pathologic analysis of PAFP as a separate specimen, especially in low‐risk disease, may not be warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:57.770637-05:
      DOI: 10.1111/bju.13654
       
  • Lesion volume predicts prostate cancer risk and aggressiveness: validation
           of its value alone and matched with PIRADS score
    • Authors: Eugenio Martorana; Giacomo Maria Pirola, Michele Scialpi, Salvatore Micali, Andrea Iseppi, Luca Reggiani Bonetti, Shaniko Kaleci, Pietro Torricelli, Giampaolo Bianchi
      Abstract: ObjectiveTo demonstrate the association between MRI estimated lesion volume (LV), PCa detection and tumour clinical significance evaluating this variable alone and matched with PI‐RADSv2 score.Patients and methodsWe retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal MRI/US fusion targeted biopsy (Tp MRI/US FTB) between January 2014 and February 2016 using Biopsee® system. Suspicious lesions (SL) were bordered using a “region of interest” and the system calculated prostate volume and LV. Patients were divided in groups considering LV (< 0.5 ml, 0.5 ‐ 1 ml, > 1 ml) and PI‐RADS score (1‐5). We considered as clinically significant PCa (sPCa) all cancers with GS ≥ 3 + 4 as suggested by PI‐RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t test. MRI LV volume and HTV concordance was verified using a Bland‐Altman plot. Chi‐square test, logistic and ordinal regression model were used to evaluate difference in frequencies. The selected level of statistical significance was ≤ 0.05.ResultsThe LV and PI‐RADS score were associated both with PCa detection (p < 0.00001 and p= 0.00012) and with sPCa detection (p< 0.00001 and p= 0.00808). When the two variables were matched, LV increased the risk within each PI‐RADS group. PCa detection became 1.4 times higher for LV 0.5 ‐ 1 ml and 1.8 times higher for LV > 1 ml; sPCa detection increased 2.6 times for LV 0.5 ‐ 1 ml and 4 times for LV > 1ml. There was positive correlation between MRI LV and HTV (r = 0,9876, p < 0.001). Finally, Bland‐Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations are its monocentric and retrospective design and the limited casistic.ConclusionsThis study demonstrates that PIRADS score and the LV, independently and matched, are associated with PCa detection and with tumour clinical significance.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T13:50:20.096471-05:
      DOI: 10.1111/bju.13649
       
  • The influence of prostate‐specific antigen density on positive and
           negative predictive values of multiparametric magnetic resonance imaging
           
    • Authors: Nienke L. Hansen; Tristan Barrett, Brendan Koo, Andrew Doble, Vincent Gnanapragasam, Anne Warren, Christof Kastner, Ola Bratt
      Abstract: ObjectivesTo evaluate the influence of PSA‐D on positive (PPV) and negative (NPV) predictive values of mpMRI to detect GS ≥7 cancer in a repeat biopsy setting.Patients and methodsRetrospective study of 514 men with previous prostate biopsy showing no or GS 6 cancer. All had mpMRI, graded 1‐5 on a Likert scale for cancer suspicion, and subsequent targeted and 24‐core systematic image‐fusion guided transperineal biopsy in 2013‐2015. NPVs and PPVs of mpMRIs for detecting GS ≥7 cancer were calculated (±95% confidence intervals) for PSA‐D ≤0.1, 0.1‐0.2, ≤0.2 and >0.2 ng/ml/cm3, and compared by Chi‐square test for linear trend.ResultsGS ≥7 cancer was detected in 31% of the men. NPV of Likert 1‐2 mpMRI was 0.91 (±0.04) with PSA‐D ≤0.2 and 0.71 (±0.16) with >0.2 (p=0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with PSA‐D ≤0.2 and 0.44 (±0.19) with >0.2 (p=0.002). PSA‐D also significantly affected the PPV of Likert 4‐5 mpMRI lesions: the PPV was 0.47 (±0.08) with PSA‐D ≤0.2 and 0.66 (±0.10) with >0.2 (p=0.0001).ConclusionIn a repeat biopsy setting, PSA‐D ≤0.2 is associated with low detection of GS ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with high PSA‐D, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if PSA‐D is low.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T12:50:27.269121-05:
      DOI: 10.1111/bju.13619
       
  • Safety, reliability and accuracy of small renal tumor biopsies: Results of
           a multi‐institution registry
    • Authors: Patrick O. Richard; Michael A. S. Jewett, Simon Tanguay, Olli Saarela, Zhihui Amy Liu, Frédéric Pouliot, Anil Kapoor, Ricardo Rendon, Antonio Finelli
      Abstract: ObjectiveTo validate the safety, accuracy and reliability of RTB and its role in decreasing unnecessary treatment in a multi‐institution review.Materials and methodsThis was a multi‐institution retrospective study of patients who underwent RTB to characterize a SRM between 2011 and May 2015. Subjects were identified using the prospectively maintained Canadian Kidney Cancer information system (CKCis). Diagnostic and concordance rates were presented using proportions whereas factors associated with a diagnostic RTB were identified using a logistic regression model.ResultsOf the 373 biopsied SRMs, the initial biopsy was diagnostic in 87% of cases. Of the 47 nondiagnostic biopsies, 15 had a repeat biopsy of which, 80% were diagnostic. Therefore, when both were combined, a diagnosis was obtained in 91% of SRMs. Of these, 18% were benign. Size was the only factor found to be associated with achieving a diagnostic biopsy. RTB histology and nuclear grade (high or low) were found to be highly concordant with surgical pathology (86% and 81%, respectively). Of the discordant tumors (n=16), all were upgraded from low to high grade on surgical pathology. Adverse events were rare (
      PubDate: 2016-09-07T03:40:22.747368-05:
      DOI: 10.1111/bju.13630
       
  • Infographics
    • Authors: Prokar Dasgupta
      Pages: 1 - 1
      PubDate: 2016-12-21T05:13:33.892863-05:
      DOI: 10.1111/bju.13729
       
  • Laparoscopic adrenalectomy: the ‘gold standard’ when performed
           appropriately
    • Authors: Tadashi Matsuda
      Pages: 2 - 3
      PubDate: 2016-12-21T05:13:36.920144-05:
      DOI: 10.1111/bju.13707
       
  • Circulating biomarkers of neuroendocrine prostate cancer: an unmet
           challenge
    • Authors: Pasquale Rescigno; Daniel Nava Rodrigues, Johann S. Bono
      Pages: 3 - 4
      PubDate: 2016-12-21T05:13:38.835932-05:
      DOI: 10.1111/bju.13550
       
  • Quality improvement in cystectomy care with enhanced recovery (QUICCER)
           study
    • Authors: George N. Thalmann
      Pages: 4 - 5
      PubDate: 2016-12-21T05:13:38.933836-05:
      DOI: 10.1111/bju.13553
       
  • Prognostic value of prostate biopsy grade: forever a product of sampling
    • Authors: Jeffrey J. Tosoian; Jonathan I. Epstein
      Pages: 5 - 7
      PubDate: 2016-12-21T05:13:38.4018-05:00
      DOI: 10.1111/bju.13508
       
  • Getting personal with prostate cancer: DNA-repair defects and olaparib in
           metastatic prostate cancer
    • Authors: Nicholas Raison; Oussama Elhage, Prokar Dasgupta
      Pages: 8 - 9
      PubDate: 2016-06-09T05:58:24.850933-05:
      DOI: 10.1111/bju.13522
       
  • Prostate Imaging Reporting and Data System score of four or more: active
           surveillance no more
    • Authors: Marlon Perera; Nikolas Katelaris, Declan G Murphy, Shannon McGrath, Nathan Lawrentschuk
      Pages: 9 - 12
      PubDate: 2016-07-22T11:51:10.081968-05:
      DOI: 10.1111/bju.13562
       
  • International Consultation on Urological Diseases and European Association
           of Urology International Consultation on Minimally Invasive Surgery in
           Urology: laparoscopic and robotic adrenalectomy
    • Authors: Mark W. Ball; Ashok K. Hemal, Mohamad E. Allaf
      Pages: 13 - 21
      Abstract: The aim of this study was to provide an evidence-based systematic review of the use of laparoscopic and robotic adrenalectomy in the treatment of adrenal disease as part of the International Consultation on Urological Diseases and European Association of Urology consultation on Minimally Invasive Surgery in Urology. A systematic literature search (January 2004 to January 2014) was conducted to identify comparative studies assessing the safety and efficacy of minimally invasive adrenal surgery. Subtopics including the role of minimally invasive surgery for pheochromocytoma, adrenocortical carcinoma (ACC) and large adrenal tumours were examined. Additionally, the role of transperitoneal and retroperitoneal approaches, as well as laparoendoscopic single-site (LESS) and robotic adrenalectomy were reviewed. The major findings are presented in an evidence-based fashion. Large retrospective and prospective data were analysed and a set of recommendations provided by the committee was produced. Laparoscopic surgery should be considered the first-line therapy for benign adrenal masses requiring surgical resection and for patients with pheochromocytoma. While a laparoscopic approach may be feasible for selected cases of ACC without adjacent organ involvement, an open surgical approach remains the ‘gold standard’. Large adrenal tumours without preoperative or intra-operative suspicion of ACC may be safely resected via a laparoscopic approach. Both transperitoneal and retroperitoneal approaches to laparoscopic adrenalectomy are safe. The approach should be chosen based on surgeon training and experience. LESS and robotic adrenalectomy should be considered as alternatives to laparoscopic adrenalectomy but require further study.
      PubDate: 2016-08-19T23:15:33.932461-05:
      DOI: 10.1111/bju.13592
       
  • The potential role of unregulated autonomous bladder micromotions in
           urinary storage and voiding dysfunction; overactive bladder and detrusor
           underactivity
    • Authors: Marcus J. Drake; Anthony Kanai, Dominika A. Bijos, Youko Ikeda, Irina Zabbarova, Bahareh Vahabi, Christopher H. Fry
      Pages: 22 - 29
      Abstract: The isolated bladder shows autonomous micromotions, which increase with bladder distension, generate sensory nerve activity, and are altered in models of urinary dysfunction. Intravesical pressure resulting from autonomous activity putatively reflects three key variables; the extent of micromotion initiation, distances over which micromotions propagate, and overall bladder tone. In vivo, these variables are subordinate to the efferent drive of the central nervous system. In the micturition cycle storage phase, efferent inhibition keeps autonomous activity generally at a low level, where it may signal ‘state of fullness’, whilst maintaining compliance. In the voiding phase, mass efferent excitation elicits generalised contraction (global motility initiation). In lower urinary tract dysfunction, efferent control of the bladder can be impaired, for example due to peripheral ‘patchy’ denervation. In this case, loss of efferent inhibition may enable unregulated micromotility, and afferent stimulation, predisposing to urinary urgency. If denervation is relatively slight, the detrimental impact on voiding may be low, as the adjacent innervated areas may be able to initiate micromotility synchronous with the efferent nerve drive, so that even denervated areas can contribute to the voiding contraction. This would become increasingly inefficient the more severe the denervation, such that ability of triggered micromotility to propagate sufficiently to engage the denervated areas in voiding declines, so the voiding contraction increasingly develops the characteristics of underactivity. In summary, reduced peripheral coverage by the dual efferent innervation (inhibitory and excitatory) impairs regulation of micromotility initiation and propagation, potentially allowing emergence of overactive bladder and, with progression, detrusor underactivity.
      PubDate: 2016-08-23T03:30:30.653911-05:
      DOI: 10.1111/bju.13598
       
  • Chromogranin A and neurone-specific enolase serum levels as predictors of
           treatment outcome in patients with metastatic castration-resistant
           prostate cancer undergoing abiraterone therapy
    • Authors: Matthias M. Heck; Markus A. Thaler, Sebastian C. Schmid, Anna-Katharina Seitz, Robert Tauber, Hubert Kübler, Tobias Maurer, Mark Thalgott, Georgios Hatzichristodoulou, Michael Höppner, Roman Nawroth, Peter B. Luppa, Jürgen E. Gschwend, Margitta Retz
      Pages: 30 - 37
      Abstract: ObjectiveTo determine the impact of elevated neuroendocrine serum markers on treatment outcome in patients with metastatic castration-resistant prostate cancer (mCRPC) undergoing treatment with abiraterone in a post-chemotherapy setting.Patients and MethodChromogranin A (CGa) and neurone-specific enolase (NSE) were determined in serum drawn before treatment with abiraterone from 45 patients with mCRPC. Outcome measures were overall survival (OS), prostate-specific antigen (PSA) response defined by a PSA level decline of ≥50%, PSA progression-free survival (PSA-PFS), and clinical or radiographic PFS.ResultsThe CGa and NSE serum levels did not correlate (P = 0.6). Patients were stratified in to low- (nine patients), intermediate- (18) or high-risk (18) groups according to elevation of none, one, or both neuroendocrine markers, respectively. The risk groups correlated with decreasing median OS (median OS not reached vs 15.3 vs 6.6 months; P < 0.001), decreasing median clinical or radiographic PFS (8.3 vs 4.4 vs 2.7 months; P = 0.001) and decreasing median PSA-PFS (12.0 vs 3.2 vs 2.7 months; P = 0.012). In multivariate Cox regression analysis the combination of CGa and NSE (≥1 marker positive vs both markers negative) remained significant predictors of OS, clinical or radiographic PFS, and PSA-PFS. We did not observe a correlation with PSA response (63% vs 35% vs 31%; P = 0.2).ConclusionChromogranin A and NSE did not predict PSA response in patients with mCRPC treated with abiraterone. However, we observed a correlation with shorter PSA-PFS, clinical or radiographic PFS, and OS. This might be due to an elevated risk of developing resistance under abiraterone treatment related to neuroendocrine differentiation.
      PubDate: 2016-04-27T21:55:42.917976-05:
      DOI: 10.1111/bju.13493
       
  • Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER)
           study
    • Authors: Janet E. Baack Kukreja; Maureen Kiernan, Bethany Schempp, Aisha Siebert, Adriana Hontar, Benjamin Nelson, James Dolan, Katia Noyes, Ann Dozier, Ahmed Ghazi, Hani H. Rashid, Guan Wu, Edward M. Messing
      Pages: 38 - 49
      Abstract: ObjectivesTo determine if patients managed with a cystectomy enhanced recovery pathway (CERP) have improved quality of care after radical cystectomy (RC), as defined by a decrease in length of hospital stay (LOS) without an increase in complications or readmissions compared with those not managed with CERP.Subjects and MethodsThe Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study was a non-randomized quasi-experimental study. Data were collected between June 2011 and April 2015. The CERP was implemented in July 2013. The primary endpoint was LOS. Secondary endpoints were quality scores, complications and readmissions. Multivariable regression was performed. Propensity score matching was carried out to further simulate randomized clinical trial conditions. A CERP quality composite score was created and evaluated with regard to adherence to CERP elements.ResultsThe study included 79 patients managed with CERP and 121 who were not managed with CERP. After matching, there were 75 patients in the non-CERP group. The LOS was significantly different between the groups: the median LOS was 5 and 8 days for the CERP and non-CERP group, respectively (P < 0.001). Multivariable linear regression showed that any complication was the most significant predictor of total LOS at 90 days after RC. The higher the quality composite score the shorter the LOS (P < 0.001). There was no association between CERP and a greater number of complications or readmissions.ConclusionsAudited quality measures in the CERP are associated with a reduction in LOS with no increase in readmissions or complications. The CERP is important for the future improvement of peri-operative care for RC and provides an opportunity to improve the quality of care provided.
      PubDate: 2016-06-03T10:05:30.848432-05:
      DOI: 10.1111/bju.13521
       
  • Accuracy of prostate biopsies for predicting Gleason score in radical
           prostatectomy specimens: nationwide trends 2000–2012
    • Authors: Daniela Danneman; Linda Drevin, Brett Delahunt, Hemamali Samaratunga, David Robinson, Ola Bratt, Stacy Loeb, Pär Stattin, Lars Egevad
      Pages: 50 - 56
      Abstract: ObjectivesTo investigate how well the Gleason score in diagnostic needle biopsies predicted the Gleason score in a subsequent radical prostatectomy (RP) specimen before and after the 2005 International Society of Urological Pathology (ISUP) revision of Gleason grading, and if the recently proposed ISUP grades 1–5 (corresponding to Gleason scores 6, 3 + 4, 4 + 3, 8 and 9–10) better predict the RP grade.Patients and MethodsAll prostate cancers diagnosed in Sweden are reported to the National Prostate Cancer Register (NPCR). We analysed the Gleason scores and ISUP grades from the diagnostic biopsies and the RP specimens in 15 598 men in the NPCR who: were diagnosed between 2000 and 2012 with clinical stage T1–2 M0/X prostate cancer on needle biopsy; were aged ≤70 years; had serum PSA concentration of
      PubDate: 2016-03-24T04:00:38.170904-05:
      DOI: 10.1111/bju.13458
       
  • Diffusion-weighted imaging predicts upgrading of Gleason score in
           biopsy-proven low grade prostate cancers
    • Authors: Sung Yoon Park; Young Taik Oh, Dae Chul Jung, Nam Hoon Cho, Young Deuk Choi, Koon Ho Rha, Sung Joon Hong
      Pages: 57 - 66
      Abstract: ObjectiveTo analyse whether diffusion-weighted imaging (DWI) predicts Gleason score (GS) upgrading in biopsy-proven low grade prostate cancer (PCa).Patients and MethodsA total of 132 patients who had biopsy-proven low grade (GS < 7) PCa, 3T DWI results, and surgical confirmation were retrospectively included in the study. Clinical variables (prostate-specific antigen, greatest percentage of cancer in a biopsy core and percentage of positive cores) and DWI variables (minimum apparent diffusion coefficient [ADCmin] and mean ADC [ADCmean]) were evaluated. ADCmin was measured, by two independent, blinded readers, using a region of interest (ROI) of 5–10 mm2 at the area of lowest ADC value within a cancer, while ADCmean was measured using an ROI covering more than half of a cancer. Logistic regression and receiver-operating characteristic curve analyses were performed.ResultsThe rate of GS upgrading was 46.1% (61/132). In both univariate and multivariate analyses, ADCmin and ADCmean were persistently significant for predicting GS upgrading (P < 0.05), whereas clinical variables were not (P > 0.05). In both readers’ results, the area under the curve (AUC) of ADCmin was significantly greater than that of ADCmean (reader 1: AUC 0.760 vs 0.711; P < 0.001; reader 2: AUC 0.752 vs 0.714; P = 0.003).ConclusionOur results showed that DWI may predict GS upgrading of biopsy-proven low grade PCa. The variable ADCmin in PCa may perform better than ADCmean.
      PubDate: 2016-02-24T23:17:58.236985-05:
      DOI: 10.1111/bju.13436
       
  • Initial experience of an algorithm-based protocol for the community
           follow-up of men with prostate cancer
    • Authors: Philip P. Goodall; Jessica Little, Eleanor Robinson, Ian Trimble, Owen J. Cole, Thomas J. Walton
      Pages: 67 - 73
      Abstract: ObjectiveTo evaluate the implementation of a novel algorithm-based discharge programme for the community follow-up of men with prostate cancer.Patients and MethodsMen with prostate cancer considered suitable for discharge were identified from consultant-led and clinical nurse-specialist telephone clinics at Nottingham University Hospitals National Health Service Trust. Patients were discharged on to one of four discharge pathways: watchful waiting, androgen-deprivation therapy (ADT), post-prostatectomy, and post-radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care after breach of pre-defined prostate-specific antigen (PSA) level threshold criteria. Reasons for non-compliance, re-referral, and cause of death were determined for all discharged men.ResultsIn all, 573 men were discharged across all four pathways; 169 on the watchful-waiting pathway, 229 on the ADT pathway, 95 on the post-prostatectomy pathway, and 80 on the post-radiotherapy pathway. All patients had ≥12 months of follow-up. In all, 48 of 54 (88.9%) men were re-referred promptly after a PSA-threshold breach. Of the remaining six patients there were three refusals, one unrelated death before referral, and two late referrals at 4 months. Three patients were lost to follow-up due to database non-registration and were subsequently recalled, none of whom had a PSA-threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression, while one was due to a likely progressive PSA non-secreting tumour.ConclusionInitial results suggest the algorithm-based protocol is a viable, effective, and oncologically safe method for the controlled discharge of men from secondary to primary care. Longer-term follow-up, patient satisfaction and cost-effectiveness data are required to assess the true impact of the initiative.
      PubDate: 2016-03-12T03:31:24.481606-05:
      DOI: 10.1111/bju.13446
       
  • Factors predicting progression to castrate-resistant prostate cancer in
           patients with advanced prostate cancer receiving long-term
           androgen-deprivation therapy
    • Authors: Alexandre Taille; Luis Martínez-Piñeiro, Patrick Cabri, Aude Houchard, Jack Schalken,
      Pages: 74 - 81
      Abstract: ObjectivesTo assess time to progression to castrate-resistant prostate cancer (CRPC) and factors influencing longer-term outcomes in patients receiving androgen-deprivation therapy (ADT) in an extension to the Triptocare study (NCT01020448). This is pertinent as the Triptocare study did not show that urinary prostate cancer antigen-3 (PCA3) score was a reliable marker of cancer stage in advanced prostate cancer and was not useful for assessing response 6 months after initiation of ADT with triptorelin 22.5 mg.Patients and MethodsAn international, multicentre, non-interventional, observational, longitudinal, prospective study involving patients from the Triptocare study. CRPC status of patients was collected for up to 3 years from ADT initiation. Patient treatment and assessments were at the investigator's discretion. Co-primary endpoints were rate of CRPC at 3 years after initiating ADT and the median time to CRPC. An exploratory endpoint was the association of Triptocare baseline variables (including TMPRSS2-ERG and PCA3 scores) and PCA3 score at Triptocare last value available with CRPC onset.ResultsOf the 325 patients in the Triptocare study safety population, 180 patients were enrolled in the Triptocare LT study (102 received continuous and 78 received intermittent ADT). CRPC rates at 3 years were 24/102 (23.5%) and 6/78 (7.7%) patients in the continuous and intermittent ADT groups, respectively. The median time to CRPC was not reached for either group. PCA3 score status at baseline was the only variable associated with a higher risk of progression to CRPC in both the intermittent and continuous ADT groups; compared with a baseline PCA3 score of ≥35, a PCA3 score below the level of quantification had a hazard ratio (HR) of 20.04 ([95% confidence interval (CI) 2.71–148.34] and a HR of 9.44 [95% CI 2.39–37.27], respectively). Baseline metastatic disease and testosterone level were additionally associated with progression to CRPC in the continuous ADT population (HR 5.20, 95% CI 1.68–16.06 and HR 0.995, 95% CI 0.991–0.999, respectively).ConclusionIn men with locally advanced or metastatic prostate cancer, a PCA3 score of ≥35 at the time of initiating ADT may predict a lower risk of developing CRPC in the following 3 years.
      PubDate: 2016-03-23T04:10:41.410278-05:
      DOI: 10.1111/bju.13455
       
  • Pre-biopsy 3-Tesla MRI and targeted biopsy of the index prostate cancer:
           correlation with robot-assisted radical prostatectomy
    • Authors: Uday Patel; Prokar Dasgupta, Ben Challacombe, Declan Cahill, Christian Brown, Roshnee Patel, Roger Kirby
      Pages: 82 - 90
      Abstract: ObjectiveTo study whether pre-biopsy 3-Tesla prostate magnetic resonance imaging (MRI) with targeted biopsy allows accurate anatomical and oncological characterization of the index prostate tumour, and whether this translates into improved positive surgical margin (PSM) rates after radical prostatectomy.Patients and MethodsWe conducted a retrospective analysis of all men (n = 201) who underwent robot-assisted radical prostatectomy (RARP) between July 2012 and July 2014. Patients were divided into a study group (n = 63) who had undergone pre-biopsy 3-Tesla MRI, followed by visual targeted and systematic prostate biopsy, and a control group (n = 138) who had undergone systematic biopsy alone. The two groups were well matched regarding patient and cancer characteristics. The primary study objective was to assess the accuracy of pre-biopsy MRI for localizing the index tumour. Secondary study objectives were to assess the accuracy of MRI in assessing the maximum tumour diameter (MTD) of the index tumour focus and accuracy of the targeted biopsy in determining the Gleason score and primary Gleason grade of the index tumour focus and whether PSMs were improved after RARP. The reference standard was whole-gland pathology of the resected prostate gland. Continuous variables and proportions were compared using the t-test and Mann–Whitney test or contingency tables, respectively. Pearson's correlation coefficient and Bland–Altman plots were used to compare measurement of MTD.ResultsThe MRI accurately located the index tumour focus in 73% of patients. Accuracies, stratified according to use of the Prostate Imaging Reporting and Data System (PI-RADS) categories 5, 4 and 3, were 94, 75 and 60% respectively. Accuracies stratified according to MTD of ≤0.7, ≤1 and >1 cm were 50, 57 and 79%, respectively. There was a positive linear correlation between MRI and histological MTD (r = 0.42, 95% confidence interval [CI] 0.16–0.63; P = 0.002), but MRI generally underestimated the MTD: the mean MRI-measured MTD was 1.51 cm (95% CI 1.29–1.72) vs a mean pathological MTD of 2.15 cm (95% CI 1.86–2.43). Targeted biopsy identified 37% more cancer per core than non-targeted biopsy. The mean maximum core length was 8.9 mm (95% CI 7.8–10) vs 6.5 mm (95% CI 5.8–7.2) for the study vs the control group (P = 0.0002; non-paired t-test). Gleason scoring was significantly more predictive after targeted biopsies, with unchanged scores in 40/63 men (63%) vs 62/138 men (45%) in the study and control groups, respectively (P = 0.001; Fisher's test). The odds of Gleason upgrading were 2.5 times greater (P = 0.028) in the control group. The primary Gleason grade was not significantly different in the two groups [45/63 men (71%) vs 91/138 men (66%); study vs control group respectively (P = 0.51, Fisher's test)]. Overall PSMs were nonsignificantly lower in the study group (15.8 vs 18.8%; P = 0.84, Fisher's test); and the MRI location of the index tumour focus correlated with the site of PSM in 70% of men in the study group.ConclusionsPre-biopsy MRI can accurately identify the index prostate tumour, especially in those with higher PI-RADS grades and tumour diameter. Targeted biopsy of this focus retrieves significantly more cancerous tissue per core, and is more accurate regarding Gleason scores, but not primary Gleason grade. MRI underestimated the MTD, and PSMs were not significantly improved in the present study.
      PubDate: 2016-06-03T10:05:33.998399-05:
      DOI: 10.1111/bju.13525
       
  • Contemporary retroperitoneal lymph node dissection (RPLND) for testis
           cancer in the UK – a national study
    • Authors: Hannah Wells; Matthew C. Hayes, Tim O'Brien, Sarah Fowler
      Pages: 91 - 99
      Abstract: ObjectivesTo undertake a comprehensive prospective national study of the outcomes of retroperitoneal lymph node dissection (RPLND) for testis cancer over a 1-year period in the UK.Patients and MethodsData were submitted online using the British Association of Urological Surgeons Section of Oncology Data and Audit System. All new patients undergoing RPLND for testis cancer between March 2012 and February 2013 were studied prospectively. Data were analysed using Tableau software and case ascertainment compared with Hospital Episode Statistics data.ResultsIn all, 162 men underwent RPLND by 20 surgeons in 17 centres. The mean (range) case volume per centre was 9 (2–32) and the median (range) case volume per surgeon was 6 (1–30). Indications included: residual mass after chemotherapy (73%), primary treatment (6%), relapse (14%), and salvage (7%). The median time to surgery after chemotherapy was 8–12 weeks (12 weeks) and 91% of procedures utilised open surgery. The median operating time was 3–4 h (6 h). Nerve sparing was performed in 67% of patients (19% bilateral, 48% unilateral). The dissection was template in 81% and lumpectomy in 16%; 25% required additional intraoperative procedures including 11% synchronous planned nephrectomy. In all, 157/160 (98%) of recorded RPLND operations were completed. One was terminated due to bleeding and in two the mass could not be removed. There were no deaths within 30 days of surgery. In all, 75% of the men did not require a blood transfusion, 15% required 1–2 units and 10% received >2 units. There were postoperative complications in 10% of the men (Clavien–Dindo Grade I, seven men; Grade II, seven; and Grade III, one). The mean (range) length of stay was 5.5 (1–59) days. Histology showed necrosis in 22%; teratoma differentiated in 42%; and residual cancer in 36%.ConclusionsThis prospective collaborative national study describes for the first time the surgical outcomes after RPLND across the UK. The quality of RPLND in the UK appears high. The study can act as a benchmark for this type of surgery across the world.
      PubDate: 2016-07-30T02:00:27.158471-05:
      DOI: 10.1111/bju.13569
       
  • The contemporary landscape of occupational bladder cancer within the
           United Kingdom: a meta-analysis of risks over the last 80 years
    • Authors: Marcus G. Cumberbatch; Ben Windsor-Shellard, James W. F. Catto
      Pages: 100 - 109
      Abstract: ObjectiveTo profile the contemporary risks of occupational bladder in the UK, as this is a common malignancy that arises through occupational carcinogen exposure.Materials and methodsA systematic review using PubMed, Medline, Embase and Web of Science was performed in March 2016. We selected reports of British workers in which bladder cancer or occupation were the main focus, with sufficient cases or with confidence intervals (CIs). We used the most recent data in populations with multiple reports. We combined odds ratios and risk ratios (RRs) to provide pooled RRs of incidence and disease-specific mortality (DSM). We tested for heterogeneity and publication bias. We extracted bladder cancer mortality from Office of National Statistics death certificates. We compered across regions and with our meta-analysis.ResultsWe identified 25 articles reporting risks in 702 941 persons. Meta-analysis revealed significantly increased incidence for 12/37 and DSM for five of 37 occupational classes. Three classes had reduced bladder cancer risks. The greatest risk of bladder cancer incidence occurred in chemical process (RR 1.87, 95% CI 1.50–2.34), rubber (RR 1.82, 95% CI 1.4–2.38), and dye workers (RR 1.8, 95% CI 1.07–3.04). The greatest risk of DSM occurred in electrical (RR 1.49, 95% CI 1.19–1.87) and chemical process workers (RR 1.35, 95% CI 1.09–1.68). Bladder cancer mortality was higher in the North of England, probably reflecting smoking patterns and certain industries. Limitations include the lack of sufficient robust data, missing occupational tasks, and no adjustment for smoking.ConclusionOccupational bladder cancer occurs in many workplaces and the risks for incidence and DSM may differ. Regional differences may reflect changes in industry and smoking patterns. Relatively little is known about bladder cancer within British industry, suggesting official data underestimate the disease.
      PubDate: 2016-07-26T09:00:23.762067-05:
      DOI: 10.1111/bju.13561
       
  • The impact of the United States Preventive Services Task Force (USPTSTF)
           recommendations against prostate-specific antigen (PSA) testing on PSA
           testing in Australia
    • Authors: Homayoun Zargar; Roderick Bergh, Daniel Moon, Nathan Lawrentschuk, Anthony Costello, Declan Murphy
      Pages: 110 - 115
      Abstract: ObjectiveTo assess the impact of the United States Preventive Services Task Force (USPTSTF) recommendations on prostate-specific antigen (PSA) testing, prostate biopsy, and prostatectomy in Australian men based on the available Medicare data.Patients and MethodsEvents were identified using Medicare item numbers for PSA testing (66655, 66659), prostate biopsy (37219), prostatectomy (37210), and prostatectomy with lymph node dissection (37211). The occurrences of each procedure was queried per 100 000 capita for consecutive financial years over the period 2000–2015. For each item number, reports were also generated for all Australian States. For PSA testing the data was stratified into three age groups of 45–54, 55–64, and 65–74 years. For assessing the rate of prostatectomy the capita rate values for two item numbers of prostatectomy (37210) and prostatectomy with lymph node dissection (37211) were combined.ResultsSteady declines in per capita incidences of all five item numbers assessed were seen for the three consecutive financial years (2013–2015) since the publication of the USPTSTF recommendation statement. These declines were seen across all Australian States. When examining the rate of PSA testing for the three age brackets 45–54, 55–64, and 65–74 years, similar trends were identified.ConclusionsSince the introduction of the USPTSTF recommendation statement there has been a steady nationwide decline in per capita incidences of PSA testing, prostate biopsy, and prostatectomy based on the Australian Medicare data. Whether these declines are in the right direction toward reduction in over-diagnosis and overtreatment of clinically insignificant prostate cancer or stage migration toward more locally advanced disease due to lost opportunity in diagnosing and treating early clinically significant prostate cancer will remain to be seen.
      PubDate: 2016-08-22T23:05:26.871649-05:
      DOI: 10.1111/bju.13602
       
  • Renal fossa recurrence following nephrectomy for renal cell carcinoma:
           prognostic features and oncologic outcomes
    • Authors: Sarah P. Psutka; Mark Heidenreich, Stephen A. Boorjian, George C. Bailey, John C. Cheville, Suzanne B. Stewart‐Merrill, Christine M. Lohse, Thomas D. Atwell, Brian A. Costello, Bradley C. Leibovich, R. Houston Thompson
      First page: 116
      Abstract: ObjectiveTo describe clinicopathologic features associated with increased risk of renal fossa recurrences (RFR) following radical nephrectomy (RN) and to describe prognostic features associated with cancer‐specific survival (CSS) among patients with RFR treated with primarily locally‐directed therapy, systemically directed therapy, or expectant management.Patients And MethodsRecords of 2502 patients treated with RN for unilateral, sporadic, localized RCC between 1970 and 2006 were reviewed. CSS following RFR was estimated using the Kaplan‐Meier method. Associations with the development of RFR and CSS following RFR were evaluated using Cox proportional hazards regression models.ResultsA total of 33 (1.3%) patients developed isolated RFR (iRFR) and 30 (1.2%) patients developed RFR in the setting of synchronous metastases following RN (study cohort, N=63). Median follow‐up for the series was 9.0 years after RN and 6.0 years following RFR diagnosis. On multivariable analysis, advanced pathologic stage (pT2: HR 4.36, p=0.004; pT3/4: HR 4.39, p=0.003) and coagulative necrosis (HR 2.71, p=0.006) were independently associated with increased risk of iRFR. The median time to recurrence was 1.5 years post‐nephrectomy among the 33 patients with iRFR, and 1.4 years among all patients. Overall, median CSS was 2.5 years after iRFR diagnosis, 1.3 years after RFR in the setting of synchronous metastases, and 2.2 years overall. Following primary locally directed therapy (surgery, ablation, or radiation), systemic therapy, or expectant management, the 3‐year CSS rates among patients with iRFR were 63%, 50%, and 13% (p=0.001) and were 64%, 50%, and 28% (p=0.006) among all patients,respectively. On multivariable analysis, when compared to observation, locally directed therapies were associated with a significantly decreased risk of death from RCC (HR 0.26, p
      PubDate: 2016-08-31T22:25:24.890225-05:
      DOI: 10.1111/bju.13620
       
  • Robot-assisted partial cystectomy: perioperative outcomes and early
           oncological efficacy
    • Authors: David M. Golombos; Padraic O'Malley, Patrick Lewicki, Benjamin V. Stone, Douglas S. Scherr
      Pages: 128 - 134
      Abstract: ObjectiveTo report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach.Patients and MethodsWe retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan–Meier method.ResultsThe median (interquartile range) patient age was 75 (65–81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively.ConclusionRAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.
      PubDate: 2016-06-15T00:05:34.677575-05:
      DOI: 10.1111/bju.13535
       
  • Perioperative and short‐term outcomes after Retzius‐sparing
           robot‐assisted radical prostatectomy stratified by gland size
    • Authors: Glen D.R Santok; Ali Abdel Raheem, Lawrence H. C. Kim, Kidon Chang, Trenton G. H. Lum, Byung H. Chung, Young D. Choi, Koon H. Rha
      First page: 135
      Abstract: Objectiveo investigate the impact of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius sparing robot assisted laparoscopic prostatectomy (RS‐RALP).Materials and MethodsThis is a retrospective analysis of 294 patients with organ‐confined prostate cancer (PCa) treated with RS‐RALP in a high volume center from November 2012 to February 2015. Patients were divided into three groups based on their TRUS volume as follows: group 1, (n=231, 60cc). Perioperative, oncological, and continence outcomes were compared between the three groups.ResultsThe median prostate volumes for each group were; 26.1cc (22‐ 40 31), 45.9cc (41‐50) and 70cc (68‐85). Blood loss was higher in group 3 compared to group 2 and group 1; 475cc (312‐575), 200cc (150‐400) and 250cc (150‐400), respectively (p=0.001) Intraoperative transfusion rate was higher in group 3 patients (p=0.004) while complication rate did not differ (p=0.05). Console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; 100±35minutes, 92±34.4minutes and 93±24.8 minutes, respectively (p=0.70). BCR and continence rate did not differ between the three groups (p=0.89, p=0.25, respectively).ConclusionRS‐RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostate. We therefore recommend for surgeons to start at smaller sized prostate in the commencement of application of RS‐RALP technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T21:50:41.077391-05:
      DOI: 10.1111/bju.13632
       
  • Results of a randomized, double-blind, active-controlled clinical trial
           with propiverine extended release 30 mg in patients with overactive
           bladder
    • Authors: Jing Leng; Limin Liao, Ben Wan, Chuanjun Du, Wei Li, Keji Xie, Zhoujun Shen, Zhuoqun Xu, Shiliang Wu, Zujun Fang, Lulin Ma, Shaomei Han, Cornelia Feustel, Yong Yang, Helmut Madersbacher
      Pages: 148 - 157
      Abstract: ObjectiveTo compare the efficacy and safety of the 30 mg extended release (ER) formulation of propiverine hydrochloride with the 4 mg ER formulation of tolterodine tartrate in patients with overactive bladder (OAB) in a non-inferiority trial.Patients and MethodsEligible patients, aged 18–75 years and with symptoms of OAB, were enrolled in this multicentre, randomized, double-blind, parallel-group, active-controlled study. After a 2-week screening period, patients were randomized at a 1:1 ratio to receive either propiverine ER 30 mg or tolterodine ER 4 mg daily during the 8-week treatment period. Efficacy was assessed using a 3-day voiding diary and patient's self-reported assessment of treatment effect. Safety assessment included recording of adverse events, laboratory test results, measurement of post-void residual urine and electrocardiograms.ResultsA total of 324 patients (244 female and 80 male) were included in the study. Both active treatments improved the variables included in the voiding diary and in the patient's self-reported assessment. The change from baseline in the number of voidings per 24 h was significantly greater in the propiverine ER 30 mg group compared with the tolterodine ER 4 mg group after 8 weeks of treatment (full analysis set [FAS] −4.6 ± 4.1 vs −3.8 ± 5.1; P = 0.005). Significant improvements were also observed for the change of urgency incontinence episodes after 2 weeks (P = 0.026) and 8 weeks (P = 0.028) of treatment when comparing propiverine ER 30 mg with tolterodine ER 4 mg. Both treatments were well tolerated, with a similar frequency of adverse drug reactions in both the propiverine ER 30 mg and tolterodine ER 4 mg groups (FAS 40.7 vs 39.5%; P = 0.8). More patients treated with tolterodine ER 4 mg discontinued the treatment because of adverse drug reactions compared with propiverine ER 30 mg (7.4 vs 3.1%).ConclusionsPropiverine ER 30 mg was confirmed to be an effective and well-tolerated treatment option for patients with OAB symptoms. This first head-to-head study showed non-inferiority of propiverine ER 30 mg compared with tolterodine ER 4 mg.
      PubDate: 2016-05-13T03:45:45.284904-05:
      DOI: 10.1111/bju.13500
       
  • Urethral diverticulectomy with Martius labial fat pad interposition
           improves symptom resolution and reduces recurrence
    • Authors: Sachin Malde; Néha Sihra, Sahar Naaseri, Marco Spilotros, Eskinder Solomon, Mahreen Pakzad, Rizwan Hamid, Jeremy L. Ockrim, Tamsin J. Greenwell
      Pages: 158 - 163
      Abstract: ObjectiveTo assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition.Patients and MethodsWe reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes.ResultsIn all, 70 women with a mean (range) age of 46.5 (24–77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%).ConclusionsThe commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.
      PubDate: 2016-08-17T02:23:34.558405-05:
      DOI: 10.1111/bju.13579
       
  • Randomised trial of early infant circumcision performed by clinical
           officers and registered nurse midwives using the Mogen clamp in Rakai,
           Uganda
    • Authors: Edward N. Kankaka; Teddy Murungi, Godfrey Kigozi, Frederick Makumbi, Dorean Nabukalu, Stephen Watya, Nehemiah Kighoma, Resty Nampijja, Daniel Kayiwa, Fred Nalugoda, David Serwadda, Maria Wawer, Ronald H. Gray
      First page: 164
      Abstract: ObjectivesTo assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda.Subjects and MethodsWe conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with clinicaltrials.gov # NCT02596282. In all, 501 healthy neonates aged 1–28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed‐up at 1, 7 and 28 days.ResultsIn all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow‐up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs.ConclusionsEIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.
      PubDate: 2016-09-06T00:50:47.727872-05:
      DOI: 10.1111/bju.13589
       
  • Serum levels of enclomiphene and zuclomiphene in hypogonadal men on
           long‐term clomiphene citrate treatment
    • Authors: Sevann Helo; Joseph Mahon, Joseph Ellen, Ron Wiehle, Gregory Fontenot, Kuang Hsu, Paul Feustel, Charles Welliver, Andrew McCullough
      First page: 171
      Abstract: ObjectivesTo determine the relative concentrations of enclomiphene (ENC) and zuclomiphene (ZUC) isomers in hypogonadal men (HM) on long‐term clomiphene citrate (CC) therapy. To determine whether patient age, body mass index, or duration of therapy were predictive of relative concentrations of ENC and ZUC.Patients and MethodsMen already on CC 25 mg daily therapy for secondary hypogonadism for a minimum of six weeks were recruited to have their ENC and ZUC levels assessed. Total testosterone (T), free testosterone, estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH) prior to initiation of and while on CC therapy were recorded for all patients. Patient demographics including age, body mass index, and medical comorbidites were recorded. Serum samples were obtained at the time of enrollment to determine ENC and ZUC concentrations.ResultsA total of 15 men were enrolled from June 2015 to August 2015. Median patient age was 36 (range 22‐70) years, median body mass index 32.0 (range 21.1‐40.3)kg/m2, and median duration of treatment 25.9 (range 1.7‐86.6) months. Baseline median total T, estradiol, and LH were 205.0 ng/dL, 17.0 pg/mL, and 4.0 mlU/mL, respectively. Post‐treatment median total T, estradiol, and LH increased to 488.0 ng/dL 34.0 pg/mL, and 6.1 mIU/mL, respectively (all p
      PubDate: 2016-09-11T00:00:21.328709-05:
      DOI: 10.1111/bju.13625
       
  • The origins of urinary stone disease: upstream mineral formations initiate
           downstream Randall's plaque
    • Authors: Ryan S. Hsi; Krishna Ramaswamy, Sunita P. Ho, Marshall L. Stoller
      Pages: 177 - 184
      Abstract: ObjectivesTo describe a new hypothesis for the initial events leading to urinary stones. A biomechanical perspective on Randall's plaque formation through form and function relationships is applied to functional units within the kidney, we have termed the ‘medullo-papillary complex’ – a dynamic relationship between intratubular and interstitial mineral aggregates.MethodsA complete MEDLINE search was performed to examine the existing literature on the anatomical and physiological relationships in the renal medulla and papilla. Sectioned human renal medulla with papilla from radical nephrectomy specimens were imaged using a high resolution micro X-ray computed tomography. The location, distribution, and density of mineral aggregates within the medullo-papillary complex were identified.ResultsMineral aggregates were seen proximally in all specimens within the outer medulla of the medullary complex and were intratubular. Distal interstitial mineralisation at the papillary tip corresponding to Randall's plaque was not seen until a threshold of proximal mineralisation was observed. Mineral density measurements suggest varied chemical compositions between the proximal intratubular (330 mg/cm3) and distal interstitial (270 mg/cm3) deposits. A review of the literature revealed distinct anatomical compartments and gradients across the medullo-papillary complex that supports the empirical observations that proximal mineralisation triggers distal Randall's plaque formation.ConclusionThe early stone event is initiated by intratubular mineralisation of the renal medullary tissue leading to the interstitial mineralisation that is observed as Randall's plaque. We base this novel hypothesis on a multiscale biomechanics perspective involving form and function relationships, and empirical observations. Additional studies are needed to validate this hypothesis.
      PubDate: 2016-07-14T21:55:41.947843-05:
      DOI: 10.1111/bju.13555
       
  • Evolution of the Robotic Orthotopic Ileal Neobladder Formation: A Step by
           Step Update to The USC Technique
    • Authors: Sameer Chopra; Andre Luis de Castro Abreu, Andre K. Berger, Shuchi Sehgal, Inderbir Gill, Monish Aron, Mihir M. Desai
      First page: 185
      Abstract: ObjectiveTo describe, step‐by‐step, our updated, time‐efficient technique for intracorporeal neobladder formation.Patients and MethodsThere are five main surgical steps to forming the intracorporeal orthotopic ileal neobladder: isolation of the small bowel intestine; small bowel anastomosis; bowel detubularization and suture of the posterior wall of the neobladder; neobladder‐urethral anastomosis and folding the pouch; and ureteral‐chimney anastomosis. Improvements have been made during these steps to improve time efficiency without compromising neobladder formation.ResultsA total of 65 cm of small intestinal bowel is removed for neobladder formation. Our technical improvements have demonstrated an improvement in operative time from 450 minutes to 360 minutes.ConclusionWe describe an updated step‐by‐step technique to our institution's robotic intracorporeal orthotopic ileal neobladder formation using a time‐efficient technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-30T09:10:30.423817-05:
      DOI: 10.1111/bju.13611
       
 
 
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