for Journals by Title or ISSN
for Articles by Keywords

Publisher: John Wiley and Sons   (Total: 1577 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

We no longer collect new content from this publisher because the publisher has forbidden systematic access to its RSS feeds.
Journal Cover BJU International
  [SJR: 2.009]   [H-I: 116]   [38 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  [1577 journals]
  • Management of metastatic prostate cancer in the elderly: identifying
           fitness for chemotherapy in the post STAMPEDE world
    • Authors: A Thompson; M J Beresford, P Sarmah, E R Jefferies
      Abstract: The relative proportion of>75 is expected to double over the next 25 years and older men are more likely to be diagnosed with advanced disease. Meta-analysis of the eagerly awaited CHAARTED, STAMPEDE and GETUG15 trials have shown that men with newly diagnosed hormone sensitive metastatic prostate cancer (mPCa) who were treated with docetaxel in addition to ADT, showed a 9% absolute overall survival benefit at 4 years1. As such, European Association of Urology (EAU) guidelines recommend that newly diagnosed mPCa should be treated with castration plus docetaxel chemotherapy ‘provided the patient is fit enough’. However, this assessment of fitness for chemotherapy remains a clinical stumbling block.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-19T05:00:20.583005-05:
      DOI: 10.1111/bju.13990
  • Journal information
    • PubDate: 2017-08-17T03:57:19.399541-05:
      DOI: 10.1111/bju.13642
  • An important counseling tool for urologists managing patients with
           neurogenic detrusor overactivity
    • Authors: Elodi Dielubanza; Sandip Vasavada
      PubDate: 2017-08-17T03:57:14.474643-05:
      DOI: 10.1111/bju.13898
  • Multi-Parametric Magnetic Resonance Imaging (mpMRI) Identifies Significant
           Apical Prostate Cancers
    • Authors: Alexander P. Kenigsberg; Tsutomu Tamada, Andrew B. Rosenkrantz, Elton Llukani, Fang-Ming Deng, Jonathan Melamed, Ming Zhou, Herbert Lepor
      Abstract: ObjectiveTo determine if multiparametric MRI (mpMRI) identifies significant apical disease, thereby informing decisions regarding preservation of the membranous urethra.Materials and MethodsMen undergoing radical prostatectomy between January 2012 and June 2016 who underwent a 12-core transrectal-ultrasound guided systematic biopsy, preoperative 3-T MRI, and sectioning of the prostate specimen with tumor foci mapping were extracted from a single surgeon's prospective longitudinal outcomes database. Apical systematic biopsy vs. mpMRI lesion were compared for predicting aggressive tumor in the prostatic apex defined as Prostate Cancer Grade Group>1.ResultsOf the 100 men who met eligibility criteria, 43 (43%) exhibited aggressive prostate cancer in the distal 5mm of the apex. A Likert score> 2 in the apical one-third of the prostate was found to be more reliable than any cancer found on apical systematic biopsy at detecting aggressive cancer in the apex. On multivariate regression that included Likert score in the apex, age, PSA, prostate size, and presence of any cancer on apical biopsy, only Likert score (p=.005) and PSA (p=.025) were significant and independent predictors of aggressive cancer in the distal apex.ConclusionMRI is superior to systematic biopsy at identifying aggressive prostate cancer within the distal prostatic apex and may be useful for planning the extent of apical preservation during prostatectomy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:30:30.19329-05:0
      DOI: 10.1111/bju.13987
  • Female Urethral Injuries Associated with Pelvic Fracture: A Systematic
           Review of the Literature
    • Authors: Devin N. Patel; Cynthia S. Fok, George D. Webster, Jennifer T. Anger
      Abstract: ObjectivesTo systematically review the literature of female urethral injuries associated with pelvic fracture and determine optimal management of this rare injury.Materials and MethodsUsing Meta-analysis Of Observational Studies in Epidemiology criteria, we searched Cochrane, Pubmed and OVID databases for all articles available before June 30, 2016 using the terms “female pelvic fracture urethroplasty,” “female urethral distraction,” “female pelvic fracture urethral injury,” “female pelvic fracture urethra girls.” Two reviewers (CF, DP) independently reviewed the titles, abstracts, and articles in duplicate.ResultsWe identified 162 individual articles from the databases. Fifty-one articles met our criteria for full review. There were 158 female patients with urethral trauma. Of these injuries, 83 (53%) were managed with immediate repair, with 17/83 (20%) via primary alignment and 66/83 (80%) via anastomotic repair. The remaining 75/158 (47%) were managed with delayed repair. Rates of urethral stenosis and fistula were highest after primary alignment. Urethral integrity appears to be similar following both primary anastomosis and delayed repair; however, patients experienced significantly more incontinence and vaginal stenosis following delayed repair. Those patients who underwent delayed urethral repair were more likely to undergo more extensive reconstructive surgery than those who underwent primary repair.ConclusionsThe optimal management of female urethral distraction defects is based on very low quality literature. Based on our review of the available literature, primary anastomotic repair of a female urethral distraction defect via a vaginal approach as soon as the patient is hemodynamically stable appears optimal.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:30:20.661599-05:
      DOI: 10.1111/bju.13989
  • Controlled release of IGF1 enhances urethral sphincter function and
           histological structure in the treatment of female stress urinary
           incontinence in a rodent model
    • Authors: Hao Yan; Liren Zhong, Yaodong Jiang, Jian Yang, Junhong Deng, Shicheng Wei, Emmanuel Opara, Anthony Atala, Xiangming Mao, Margot Damaser, Yuanyuan Zhang
      Abstract: ObjectivesStress urinary incontinence (SUI) diminishes the quality of life of millions, particularly women who have delivered vaginally, which can injure the urethral sphincter. Despite several well-established treatments for SUI, growth factor therapy might provide an alternative to promote urethral sphincter repair. The goal of this study was to determine the effects of controlled release of IGF1 from alginate-poly-L-ornithine-gelatin microbeads (IGF1-A-PLO-G microbeads) on sphincter tissue regeneration in a rat model of SUI.Materials and MethodsForty-four female SD rats were randomized into 4 groups: vaginal distension followed by periurethral injection of IGF1-A-PLO-G beads (VD+IGF1 microbeads): 1x104 beads/1 ml normal saline; VD+empty microbeads; VD+saline; or sham VD+saline (sham).ResultsUrethral function (leak point pressure, LPP) was significantly decreased 1 week after VD+saline (23.9 ± 1.3 cmH2O) or VD+empty microbeads (21.7 ± 0.8 cmH2O) compared to the sham group (44.4 ± 3.4 cmH2O; p
      PubDate: 2017-08-14T06:25:36.99069-05:0
      DOI: 10.1111/bju.13985
  • Chipping away at the body politic one study at a time: the case for more
           “unprofessional” online content
    • Authors: Christopher E. Bayne; Benjamin J. Davies
      Abstract: Koo et al's recent paper[1] on unprofessional online content among US urology residency graduates has received attention in the lay press and social media outlets. The paper has an Altmetric Attention score of 341[2]—good for the fifth-most online-cited paper the BJUI has ever published. Seventeen news outlets have reported the study, including MSN, Medscape, and US News & World Report.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-14T06:25:29.267848-05:
      DOI: 10.1111/bju.13986
  • Microvascular and lymphovascular tumor invasion are associated with poor
           prognosis and metastatic spread in renal cell carcinoma: A validation
           study in clinical practice
    • Authors: Jens Bedke; Johannes Heide, Silvia Ribback, Steffen Rausch, Michela Martino, Marcus Scharpf, Andrea Haitel, Uwe Zimmermann, Maik Pechoel, Hussam Alkhayyat, Shahrokh F. Shariat, Frank Dombrowski, Arnulf Stenzl, Martin Burchardt, Tobias Klatte, Nils Kroeger
      Abstract: ObjectiveTo validate microvascular (MVI) and lymphovascular (LVI) invasion as a prognostic factor in renal cell carcinoma patients (pts.)Materials and MethodsData of patients with RCC who underwent radical or nephron sparing surgery were prospectively collected from three academic centers. The occurrence of MVI and LVI was determined with standard staining protocols by experienced pathologists at the time of diagnosis. The association of MVI and LVI with clinicopathological data, metastatic spread and cancer-specific survival (CSS) was evaluated with Fisher's exact tests, binary logistic regression analyses and univariable and multivariable Cox proportional hazard regression models.ResultsMVI was present in 201 of 747 (26.9%) pts. and was associated with advanced TNM stages, high Fuhrman grades and sarcomatoid features (each p
      PubDate: 2017-08-13T04:35:19.351396-05:
      DOI: 10.1111/bju.13984
  • Focal irreversible electroporation as primary treatment for localized
           prostate cancer
    • Authors: Willemien van den Bos; Matthijs J. Scheltema, Amila R. Siriwardana, Anton M.F. Kalsbeek, James E. Thompson, Francis Ting, Maret Böhm, Anne-Maree Haynes, Ron Shnier, Warick Delprado, Phillip D. Stricker
      Abstract: ObjectivesTo determine the safety, quality of life (QoL) and short-term oncological outcomes of primary focal IRE for the treatment of localized prostate cancer. To identify potential risk factors for oncological failure.Patients and methodsPatients that met both the consensus guidelines on patient criteria and selection methods for primary focal therapy were eligible for analysis. Focal IRE was performed for organ-confined clinically significant PCa, being high-volume Gleason sum score 6 (ISUP grade 1) or any Gleason sum score 7 (ISUP grade 2-3). Oncologic, adverse event and QoL outcome data with a minimum of 6 months follow-up were analysed. Patient characteristics and peri-operative treatment parameters were compared for patients with and without oncological failure on follow-up biopsy. Wilcoxon's Signed Rank Test, Wilcoxon's Rank Sum Test and Chi-square test were used to assess statistically significant differences in paired continuous, unpaired continuous and categorical variables respectively.ResultsA total of 63 patients met all eligibility criteria and were included for final analysis. No high-grade adverse events occurred. Quality of life questionnaire analysis demonstrated no significant change in physical (p=0.81), mental (p=0.48), bowel (p=0.25) and both urinary QoL domains (p=0.41 and p=0.25); there was a mild decrease in the sexual QoL domain (median score 66 at baseline vs 54 at 6 months, p=0.0003). Compared to baseline PSA, a decline of 70% (1.8, IQR 0.96-4.8) was seen between 6-12 months. A narrow safety margin (p=0.047) and system errors (p=0.010) were identified as potential early risk factors for in-field oncological failure. In-field and whole-gland oncological control on follow-up biopsies was 84% (38/45) and 76% (34/45); this increased to 97% (38/39) and 87% (34/39) when patients treated with a narrow safety margin and system errors were excluded.ConclusionOur data supports the safety and feasibility of focal IRE as a primary treatment for localized PCa with effective short-term oncological control in carefully selected men.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-10T14:30:30.66946-05:0
      DOI: 10.1111/bju.13983
  • Evaluation of a needle disinfectant technique to reduce infection-related
           hospitalization following transrectal prostate biopsy
    • Authors: Gregory B. Auffenberg; Ji Qi, Yuqing Gao, David C. Miller, Zaojun Ye, Andrew Brachulis, Susan Linsell, Tejal N. Gandhi, David Kraklau, James E. Montie, Khurshid R. Ghani,
      Abstract: ObjectivesTo determine whether a needle disinfectant technique during transrectal prostate biopsy is associated with lower rates of infection-related hospitalization.Subjects and MethodsWe conducted a retrospective analysis of all transrectal prostate biopsies performed across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 through March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalizations based on whether or not a needle disinfectant technique was utilized. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalizations within 30 days of biopsy. Generalized estimating equation (GEE) models were fit to adjust for potential confounders.ResultsDuring the evaluated period, 17,954 biopsies were performed with 5,321 (29.6%) including a disinfectant technique. The observed rate of infection-related hospitalization was lower when a disinfectant technique was utilized at biopsy (0.60% vs. 0.90% without disinfectant technique, p=0.04). After accounting for differences between groups the adjusted hospitalization rate in the disinfectant group was 0.85% (vs. 1.12%), (adjusted OR 0.76, 95% CI 0.50 -1.15, p= 0.19).ConclusionsIn this observational analysis, hospitalizations for infectious complications were less common when the procedure included a needle disinfection technique. However, after adjusting for potential confounders the impact of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimize infectious complications.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-10T11:20:20.074208-05:
      DOI: 10.1111/bju.13982
  • Cyclic AMP-Dependent Post-Translational Modification of Neuronal Nitric
           Oxide Synthase Neuroprotects Penile Erection in Rats
    • Authors: Serkan Karakus; Biljana Musicki, Justin D. La Favor, Arthur L. Burnett
      Abstract: ObjectivesTo evaluate nNOS phosphorylation, nNOS uncoupling, and oxidative stress in the penis and major pelvic ganglia (MPG), before and after the administration of the cAMP-dependent protein kinase A (PKA) agonist colforsin in a rat model of bilateral cavernous nerve injury (BCNI) which mimics nerve injury following prostatectomy.Materials and MethodsAdult male Sprague–Dawley rats were divided into BCNI and sham groups. Each group included 2 subgroups: vehicle and colforsin (0.1 mg/kg/day i.p.). After 3 days, erectile function (intracavernosal pressure) was measured and penes and MPG were collected for molecular analyses of phospho(P)-nNOS (Ser-1412 and Ser-847), total nNOS, nNOS uncoupling, binding of neuronal nitric oxide synthase (PIN) to nNOS, gp91phox subunit of NADPH oxidase, active caspase 3, PKA catalytic subunit alpha (PKA-Cα) (by Western blot) and oxidative stress (hydrogen peroxide [H2O2] and superoxide by Western blot and microdialysis method).ResultsErectile function was decreased 3 days after BCNI and normalized by colforsin. nNOS phosphorylation on both positive (Ser-1412) and negative (Ser-847) regulatory sites, and nNOS uncoupling, were increased after BCNI in the penis and MPG and normalized by colforsin. Hydrogen peroxide and total ROS productions were increased in the penis after BCNI and normalized by colforsin. Protein expression of gp91phox was increased in the MPG after BCNI and was normalized by colforsin treatment. Binding of PIN to nNOS was increased in the penis after BCNI and was normalized by colforsin treatment. Protein expression of active Caspase 3 was increased in the MPG after BCNI and was normalized by colforsin treatment. Protein expression of PKA-Cα was decreased in the penis after BCNI and normalized by colforsin.ConclusionCollectively, BCNI impairs nNOS function in the penis and MPG by mechanisms involving its phosphorylation and uncoupling in association with increased oxidative stress, resulting in erectile dysfunction. PKA activation by colforsin reverses these molecular changes and preserves penile erection in the face of BCNI.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-07T02:55:27.390659-05:
      DOI: 10.1111/bju.13981
  • Serous-lined, stapled pouch wall plication: initial results of a simple
           and quick novel continence mechanism in troubleshooting secondary to
           continent cutaneous urinary diversion
    • Authors: Hubertus Riedmiller; Arkadius Kocot, Charis Kalogirou
      Abstract: ObjectivesTo report a novel and straightforward technique of a secondary continent outlet for continent cutaneous urinary diversion (CCUD) reservoirs without the need for further bowel resection, reducing operation time and hospitalization.Patients And MethodsFrom 2015 to 2017, 6 patients with unreconstructable, incontinent outlets (out of a total pool of n=595 CCUD patients) have undergone the technique described here at our department. It relies on the Mitrofanoff principle, using a stapled full-thickness pouch wall plication, which creates a flap-valve continence mechanism.ResultsAll patients enjoyed full continence with ease of CIC in the postoperative period and on follow-up to a mean of 12,4 months (7-18 months). No major complications were encountered in all patients and the average capacity of the reservoirs was not compromised by the procedure (540 ml preoperatively vs. 500 ml in further follow-up).ConclusionIn revisional surgery for secondary CCUD incontinence - especially if the patient has already lost a significant amount of bowel or has previously undergone radiation therapy – the technique described here represents a safe and effective alternative to restore continence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-04T10:10:20.033634-05:
      DOI: 10.1111/bju.13979
  • Comparison between the detected and undetected lesions by template-guided
           transperineal saturation prostate biopsy
    • Authors: Zhipeng Mai; Yu Xiao, Weigang Yan, Yi Zhoua, Zhien Zhou, Zhiyong Liang, Zhigang Ji, Hanzhong Li
      Abstract: ObjectiveTo compare the characteristics of detected and undetected lesions by template-guided transperineal saturation prostate biopsy and evaluate the potential impact of undetected lesions.Materials and MethodsThis study evaluated the characteristics of lesions in radical prostatectomy (RP) specimens, compared the differences between detected and undetected lesions by systematic transperineal ultrasound guided 11-region biopsy in tumour volume, Gleason score, surgical margin, spatial location and clinical significance, and assessed the potential impact of undetected clinical significant lesions.ResultsThe median number of biopsy cores was 24. Sixty-four percent of the clinically significant lesions (170/264) were detected. There were significant differences between the detected and undetected lesions in tumour volume, Gleason score and clinical significance. The inconsistency of lesion position between biopsy and RP specimens in the anterior and posterior zones and the left and right sides were 3.4% (7/203) and 5.4% (11/203), respectively. Of the 129 patients, 13 (10.1%) had undetected clinically significant lesions in the biopsy lying on the same side but in a different zone from the detected clinically significant lesions, whereas 23 (17.8%) cases had undetected clinically significant lesions in the biopsy lying on the opposite side from the detected clinically significant lesions.ConclusionsTemplate-guided transperineal saturation prostate biopsy could detect about two-thirds of clinically significant lesions. Most of the undetected ones were those with small tumour volume. Approximately 20-30% of patients had undetected clinically significant lesions in a different lobe or quadrant comparing with the detected ones in the biopsy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-03T13:55:18.580125-05:
      DOI: 10.1111/bju.13977
  • Intradetrusor onabotulinumtoxinA injections for refractory neurogenic
           detrusor overactivity incontinence: Do we need urodynamic investigation
           for outcome assessment'
    • Authors: Miriam Koschorke; Lorenz Leitner, Helen Sadri, Stephanie C. Knüpfer, Ulrich Mehnert, Thomas M. Kessler
      Abstract: ObjectiveTo evaluate if urinary continence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed.Patients and MethodsA consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) incontinence were prospectively evaluated. Patients underwent UDI prior and 6 weeks after onabotulinumtoxinA injections. Primary outcome was the prevalence of maximum storage detrusor pressure>40 cmH2O in continent patients 6 weeks after treatment. Secondary outcomes were treatment effects on other clinical and video-urodynamic parameters.Results6 weeks after intradetrusor onabotulinumtoxinA injections, 98 (66%) of the 148 patients with NDO incontinence became continent. Of these patients, 18 (18%, confidence interval 12-27%) had a maximum storage detrusor pressure>40cmH2O. Gender, underlying neurological disorder and high storage detrusor pressures prior to treatment seem to increase the risk for poor urodynamic outcomes.ConclusionsUrinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, since high intravesical pressures threatening the upper urinary tract might be missed in a relevant percentage of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-03T13:50:19.076503-05:
      DOI: 10.1111/bju.13976
  • Comparison between target MRI in-gantry and cognitive target transperineal
           or transrectal guided prostate biopsies for PIRADS 3-5 MRI lesions
    • Authors: A J Yaxley; J W Yaxley, I Thangasamy, E Ballard, M Pokorny
      Abstract: ObjectiveTo compare the detection rates of prostate cancer in men with PIRADS 3-5 abnormalities on 3T mpMRI using in-bore MRI guided biopsy (MRGB) compared to cognitively directed transperineal biopsy (cTP) and transrectal (cTRUS).MethodsThis is a retrospective single centre study of consecutive men attending the private practice clinic of an experienced urologist performing MRGB and an experienced urologist performing cTP and cTRUS biopsy techniques for PIRADS 3-5 lesions identified on 3T mpMRI. SPSS version 22 was used for statistical analysis.ResultsThere were 595 target mpMRI lesions from 482 men with PIRADS 3-5 regions of interest during 483 episodes of biopsy. The abnormal mpMRI target lesion was biopsied using the MRGB method for 298 biopsies, cTP method for 248 and by cTRUS for 49 biopsies. There was no significant difference in prostate cancer (CaP) detection between biopsy method in PIRADS 3 (48.9%, 40.0%, 44.4%), PIRADS 4 (73.2%, 81.0%, 85.0%) or PIRADS 5 (95.2, 92.0%, 95.0%) lesions. There was no significant difference in significant CaP detection between biopsy method in PIRADS 3 (42.2%, 30.0%, 33.3%), PIRADS 4 (66.8%, 66.0%, 80.0%) or PIRADS 5 (90.5%, 89.8%, 90.0%) lesions. There was no difference in CaP or significant CaP based on lesion location or size between the methods.ConclusionWe found no significant difference in the ability to detect CaP or significant CaP using targeted MRGB, cTP, cTRUS methods. Identification of an abnormal area on mpMRI appears more important in increasing the detection of prostate cancer than the technique used to biopsy an MRI abnormality.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:20:30.611533-05:
      DOI: 10.1111/bju.13971
  • Large institutional variations in androgen deprivation therapy utilization
           with definitive radiotherapy in a population-based cohort of men with
           intermediate- and high-risk prostate cancer
    • Authors: Wee Loon Ong; Farshad Foroudi, Sue Evans, Jeremy Millar
      Abstract: ObjectiveTo evaluate the pattern of androgen deprivation therapy (ADT) utilization with definitive radiotherapy (RT) in men with prostate cancer (CaP) in a population-based study in AustraliaPatients and methodsThis is a prospective cohort of men with intermediate and high-risk CaP captured in the population-based Prostate Cancer Outcome Registry Victoria (PCOR-Vic) treated with definitive prostate RT between January 2010 and December 2015. The primary outcome of interest is ADT utilization. Chi-squared test for trend was used to evaluate temporal trend in ADT utilization over the study period. Multivariate logistic regressions were used to evaluate the effect of patient-, tumour-, treatment-factors, and treatment institutions (public/ private and metropolitan/ regional) on the likelihood of ADT utilization.Results1806 men were included in the study – 199 (11%) favourable NCCN intermediate risk (i.e. only one intermediate risk feature, primary Gleason grade 3, and
      PubDate: 2017-07-27T07:15:48.16045-05:0
      DOI: 10.1111/bju.13969
  • Impact of warm ischemia time on postoperative renal function after partial
           nephrectomy for clinical T1 renal cell carcinoma: a propensity score
           matched study
    • Authors: Hakmin Lee; Byung Do Song, Seok-Soo Byun, Sang Eun Lee, Sung Kyu Hong
      Abstract: ObjectivesTo preserve renal function, partial nephrectomy (PN) is recommended to patients with small renal masses. However, controversy still exists as to whether prolonged ischemia time adversely affects the incidence of chronic kidney disease (CKD) after PN. We analyzed the effect of prolonged warm ischemia time (WIT) on long-term renal function following PN.Materials and MethodsWe reviewed data from 1,816 patients who underwent PN for clinical T1 renal tumor. The propensity scores for prolonged WIT were calculated with shorter WIT group (< 30 minutes) matched to longer WIT group (≥ 30 minutes) in 1:2 ratio. Multivariate analysis was performed to determine independent predictors for occurrence of postoperative CKD [eGFR (estimated glomerular filtration rate < 60 mL/min/1.732] and major renal function deterioration (MRFD) (decrease of eGFR ≥ 25% postoperatively).ResultsAfter propensity score matching, there was no significant difference in CKD-free survival between the two WIT groups (p = 0.787). Furthermore, longer WIT did not show any significant associations with postoperative CKD-free survival (HR 1.002, 95% CI 0.989 – 1.015, p = 0.765) and MRFD-free survival (HR 1.014, 95% CI 1.000 – 1.028, p = 0.055). From further subgroup analyses using more detailed cut-off of WIT (≤20, 21-30, 31-40, 41-50, ≥50 minutes) and status of preoperative CKD, no significant differences were noted in CKD and MRFD-free survival among the subgroups (all p value> 0.05).ConclusionsProlonged WIT was not associated with increased incidence of CKD and MRFD after PN.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:15:28.818591-05:
      DOI: 10.1111/bju.13968
  • Ventral-Onlay Buccal Mucosa Graft Substitution Urethroplasty for Urethral
           Stricture in Females
    • Authors: Bashir. M. B. Mukhtar; Marco Spilotros, Sachin Malde, Tamsin J. Greenwell
      Abstract: ObjectiveTo present our outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating female urethral stricture (FUS).Patients and MethodsA review of a prospectively collected database of 22 consecutive women (median age 50 years, range 34-72) with urethral stricture having VOBMGSU since June 2012 and a minimum follow up of 6 months (median 21.5, range 6-51).Data was analysed for stricture recurrence, change in median peak free flow rate (Qmax) and median post-void residuals (PVR). Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test.ResultsFreedom from stricture recurrence was achieved in 21/22 (95.5%) women. Median Qmax significantly improved from 7 ml/s (range 3.5-11) to 18 ml/s (range 5-37) (p < 0.05). Median PVR significantly reduced from 100mls (range 0-300) to 15 mls (range 0-150) (p < 0.05). Short and longer-term complication rates were low. One patient developed mild de novo stress urinary incontinence, which settled with conservative measures by 6 months.ConclusionsEarly and medium term results indicate that VOBMGSU is an excellent treatment for female urethral stricture that can avoid the need for repeat procedures regularly required after traditional endoscopic management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:15:23.403119-05:
      DOI: 10.1111/bju.13970
  • Trifecta outcomes of robot-assisted partial nephrectomy in solitary
           kidney: A Vattikuti Collective Quality Initiative (VCQI) database analysis
    • Authors: Sohrab Arora; Ronney Abaza, James M. Adshead, Rajesh K. Ahlawat, Benjamin J. Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A. Moon, T B Yuvaraja, Umberto Capitanio, Alessandro Larcher, Francesco Porpiglia, James R. Porter, Alexander Mottrie, Mahendra Bhandari, Craig Rogers
      Abstract: ObjectivesTo analyze the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database.Patients and MethodsA total of 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centers in nine 9 countries. Out of these patients, 74 underwent RAPN in solitary kidney between 2007 and 2016. A retrospective analysis of the functional and oncological outcomes was performed. Trifecta was defined as a warm ischemia time of less than 20 minutes, negative surgical margins, and no complications intraoperatively or within 3 months of follow up.ResultsAll 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) minutes. Early unclamping was used in 11 (14.9%) cases, while zero ischemia was used in 12 (16.2%) cases. Trifecta outcomes were achieved in 38/66 (57.6%) of the patients. Median (IQR) ischemia time was 15.5 (8.75-20.0) minutes for the entire cohort. Overall complication rate was 24.1% and the rate of Clavien-Dindo ≤2 complications was 16.3%. Positive surgical margins were present in four cases (5.4%). Median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at three months was 7.0 ml/min/1.72m2 (11.01%).ConclusionOur findings suggest that RAPN is a safe and effective treatment option for select renal tumors in solitary kidneys in terms of a trifecta of negative surgical margins, warm ischemia time less than 20 minutes, and low operative and perioperative morbidity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:10:31.028689-05:
      DOI: 10.1111/bju.13967
  • Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) 5-Point Likert
           Scoring System Evaluated by The Result of MRI/Ultrasonography Image-fusion
           Targeted Biopsy of The Prostate
    • Authors: Toshitaka Shin; Thomas B. Smyth, Osamu Ukimura, Nariman Ahmadi, Andre Luis Castro Abreu, Chisato Ohe, Masakatsu Oishi, Hiromitsu Mimata, Inderbir S. Gill
      Abstract: ObjectiveTo evaluate the accuracy of MRI based Likert scoring system in detection of clinically significant prostate cancer (CSPC) using MRI/Ultrasonography (US) image-fusion targeted biopsy (FTB) as a reference standard.Patients and MethodsWe retrospectively reviewed 1218 MRI-lesions in 629 patients who underwent subsequent MRI/US FTB between 10/2012 and 8/2015. 3-Tesla MRI was independently reported by 1 of 8 radiologists with varying levels of experience and scored on a 5-point Likert scale. All of lesions with Likert 1-5 were prospectively defined as targets for MRI/US FTB. CSPC was defined as Gleason score ≥7.ResultsMedian patient age was 64 years, PSA level was 6.97ng/ml and estimated prostate volume was 52.2ml. Of 1218 lesions, 48% (n=581) were rated as Likert 1-2, 35% (n=428) were Likert 3 and 17% (n=209) were Likert 4-5. According to the Likert system of grading from 1 to 5, overall cancer detection rate were 12%, 13%, 22%, 50%, 59%, and CSPC detection rate were 4%, 4%, 12%, 33%, 48%, respectively. Grading of a 5-point scale showed strong positive correlation with overall cancer detection rate (r=0.949, p=0.05) and CSPC detection rate (r=0.944, p=0.05). In comparison between the more experienced radiologists for MRI-prostate and less experienced radiologists, statistical differences were noted in overall cancer detection rate (63% vs 35%, p=0.001) and CSPC detection rate (47% vs 29%, p=0.027) in Likert 4-5 lesions.ConclusionsThe detection rates of overall cancer and CSPC strongly correlated with a 5-point grading of the Likert scale. Among the radiologists with different levels of experience, there were significant differences in these cancer detection rates.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-27T07:10:24.750424-05:
      DOI: 10.1111/bju.13972
  • Transumbilical laparoendoscopic single-site radical prostatectomy and
           cystectomy with the aid of transurethral port: a feasibility study
    • Authors: Jian Su; Qingyi Zhu, Lin Yuan, Yang Zhang, Qingling Zhang, Yunfei Wei
      Abstract: ObjectiveOur aim was to describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site radical prostatectomy (LESS-RP) and cystectomy (LESS-RC) in a single institution.Materials and MethodsBetween December 2014 and March 2016, 114 cases were performed LESS-RP and LESS-RC, including LESS-RP (n=68), LESS-RC with cutaneous ureterostomy (LESS-RC/CU) (n=38) and LESS-RC with orthotopic ileal neobladder (LESS-RC/OIN) (n=8). Access was achieved via a single-port with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port (“Zhu's port”) was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The perioperative and postoperative data were collected and analyzed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects.ResultsAll the procedures were completed successfully. No conversion into conventional laparoscopic surgery was necessary. For LESS-RP, the average operative time was 152 min. Estimated blood loss was 117 ml. Mean hospital stay was 16.4 days after surgery. For LESS-RC/CU and LESS-RC/OIN, the average operative time was 215 min and 328 min, estimated blood loss was 175ml and 252ml, and mean hospital stay was 9.4 days and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intraoperative complications were occurred in two patients (1.75%), and postoperative complications in nine cases (7.89%). 14 out of 68 (20.6%) patients who underwent LESS-RP encountered positive surgical margins. Follow-up ranged from 10-30.6 months. In prostate cancer, good urinary control was observed in 35.3%,97.1% and 100% of the patients at 1 month, 6 months and 12 months after the operation.Biochemical recurrence(BCR) was observed in 11.8% patients. In bladder cancer, two patients had local recurrence and two patients had distant metastasis.ConclusionLESS-RP and LESS-RC are feasible and safe with the aid of transurethral port. Operating through the transurethral port might overcome the challenges posed by the single port laparoscopic approach.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-22T04:06:54.9371-05:00
      DOI: 10.1111/bju.13965
  • Implementation rates of uro-oncology multi-disciplinary meeting decisions
    • Authors: Ned Kinnear; Riley Smith, Derek B Hennessey, Damien Bolton, Shomik Sengupta
      Abstract: ObjectivesTo assess implementation rates of the consensus plans made at the uro-oncology multidisciplinary meeting (MDM) of an Australian tertiary centre, and analyse obstacles to implementation.MethodsA retrospective review was performed of all patients discussed at the uro-oncology MDM at our institution between 1 January to 30 June 2015.Rates of referral for MDM discussion following a new histological diagnosis of malignancy, categorised by tumour type, were assessed.Patient records were interrogated to confirm MDM plan implementation, with the outcomes examined being completion of MDM plan within 3 months and factors preventing implementation.ResultsDuring the enrolment period, from 291 uro-oncological procedures 240 yielded malignant histology, of which 160 (67%) were discussed at the MDM.Overall, 202 patients, including 32 females, were discussed at the uro-oncology MDM.MDM consensus plans were implemented in 184 (91.1%) patients.Reasons for deviation from the MDM plan included delay in care, patient deterioration or comorbidities, patient preference, consultant decision, loss to follow up and change in patient scenario due to additional new information.ConclusionThe MDM is increasingly important in the care of uro-oncology patients, with about two-thirds of new diagnoses currently captured.There appear to be few barriers to the implementation of consensus plans, with nearly all patients undergoing the recommended management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-18T02:57:51.205491-05:
      DOI: 10.1111/bju.13892
  • Chronic spinal cord injury causes up-regulation of serotonin (5-HT) 2A and
           2C receptors in lumbosacral cord motoneurons
    • Authors: Nailong Cao; Jianshu Ni, Xiaohu Wang, Hongjian Tu, Baojun Gu, Jiemin Si, Gang Wu, Karl-Erik Andersson
      Abstract: ObjectivesTo explore if the mechanism of the voiding dysfunction caused by spinal cord injury in rats can be improved by intravenous administration of the 5-HT2A/2C receptor agonist,
      DOI , and discuss whether it can be ascribed to serotonin 2A and 2C receptor up-regulation in lumbosacral cord motoneurons.Materials and MethodsFemale Sprague-Dawley rats were used, which were divided into two groups (Spinal cord injury group VS Normal control group). Under urethane anesthesia, cystometry was performed to examine the variation of urodynamic parameters before and after successive intrathecal administration of various doses of
      DOI into the lumbosacral cord. Additionally, the changes of serotonin 2A and 2C receptors in the lumbosacral cord were investigated by immunohistochemical staining and Western blot.ResultsCompared to controls, spinal cord injured rats had higher bladder capacity and post-void residual urine volume, and lower voiding efficiency. After spinal cord injury,
      DOI improved voiding efficiency likely via affecting external urethral sphincter activity. Immunohistochemical staining and Western blot analysis showed that serotonin 2A and 2C receptors were up-regulated in lumbosacral cord motoneurons.ConclusionIn rats with spinal cord injury,
      DOI can improve voiding efficiency, and this may be due to serotonin 2A and 2C receptor up-regulation in lumbosacral cord motoneurons controlling external urethral sphincter activity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T11:50:29.562316-05:
  • Baseline and Longitudinal Plasma Caveolin-1 Level as a Biomarker in Active
           Surveillance for Early Stage Prostate Cancer
    • Authors: Spyridon P. Basourakos; John W. Davis, Brian F. Chapin, John F. Ward, Curtis A. Pettaway, Louis L. Pisters, Neema Navai, Mary F. Achim, Xuemei Wang, Hsiang-Chun Chen, Seungtaek Choi, Deborah Kuban, Patricia Troncoso, Sam Hanash, Timothy C. Thompson, Jeri Kim
      Abstract: ObjectivesTo evaluate the role of caveolin-1 as a predictor of disease reclassification in men with early prostate cancer undergoing active surveillance.Patients and MethodsWe analyzed archived plasma samples prospectively collected from men with early prostate cancer in a single-institution active surveillance study. Of 825 patients enrolled, 542 had 1 or more years of follow-up. Baseline and longitudinal plasma caveolin-1 levels were measured using an enzyme-linked immunosorbent assay. Tumor volume or Gleason grade increases were criteria for disease reclassification. Logistic regression analyses assessed associations between clinicopathologic characteristics and reclassification risk.ResultsIn 542 patients, 480 (88.6%) had stage cT1c disease, 542 (100.0%) had a median prostate-specific antigen level of 4.1 ng/mL, and 531 (98.0%) had a median Cancer of the Prostate Risk Assessment score of 1. In all, 473 (87.3%) had a Gleason score of 3+3. After a median of 3.1 years’ follow-up, disease was reclassified in 163 (30.1%). Baseline caveolin-1 levels were 2.2±8.5 ng/mL (mean) and 0.2 ng/mL (range, 0–85.5 ng/mL) (median). In univariate analysis, baseline caveolin-1 was a significant predictor for risk of disease reclassification (OR, 1.82, 95% CI 1.24–2.65, p=0.002); in multivariate analysis, with adjustments for age, tumor length, group risk stratification, and number of positive cores, reclassification risk associated with caveolin-1 remained significant (OR 1.91, 95% CI 1.28–2.84, p=0.001).ConclusionBaseline plasma caveolin-1 level was an independent predictor of disease classification. New methods for refining active surveillance and intervention may result.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T11:50:27.165897-05:
      DOI: 10.1111/bju.13963
  • Erectile Function after Stereotactic Body Radiotherapy for Localized
           Prostate Cancer
    • Authors: Robert T. Dess; Holly E. Hartman, Nima Aghdam, William C. Jackson, Payal D. Soni, Ahmed E Abugharib, Simeng Suy, Neil B. Desai, Zachary S. Zumsteg, Rohit Mehra, Todd M. Morgan, Felix Y. Feng, Daniel A. Hamstra, Matthew J. Schipper, Sean P. Collins, Daniel E. Spratt
      Abstract: ObjectiveTo elucidate the functional erection rate following prostate stereotactic body radiotherapy (SBRT) and to develop a comprehensive prognostic model of outcomes following treatment.Patients and MethodsBetween 2008 and 2013, 373 consecutive men with localized prostate cancer were treated with SBRT at a single academic institution as part of a prospective clinical trial or prospective registry. Prospective longitudinal patient-reported quality of life (HRQOL) was collected using the Expanded Prostate Cancer Index Composite (EPIC-26). Functional erections were strictly defined as “firm enough for intercourse” per EPIC-26. Detailed comorbidity data were also collected. Logistic regression models were utilized to predict 24 month and 60 month functional erection rates. Observed erection rates post-SBRT were compared with other radiation modalities (external beam radiotherapy (EBRT) and brachytherapy) using prospectively validated models.ResultsMedian follow up was 56 months (interquartile-range 37-73); response rate at two years was 84%. For those with functional erections at baseline, 57% and 45% retained function at 24 and 60 months, respectively. On multivariable analysis (MVA) for 24-month erectile function, significant variables included higher baseline sexual HRQOL (adjust odds ratio (AOR) 1.55 per 10 points [95%CI 1.37-1.74], p
      PubDate: 2017-07-15T11:45:50.081915-05:
      DOI: 10.1111/bju.13962
  • Comparison of Perioperative and Functional Outcomes of Robotic Partial
           Nephrectomy for cT1a versus cT1b Renal Masses
    • Authors: Christopher R. Reynolds; Joan C. Delto, David Paulucci, Corey Weinstein, Ketan Badani, Daniel Eun, Ronney Abaza, James Porter, Akshay Bhandari, Ashok Hemal
      Abstract: ObjectivesTo compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy in a large multi-institutional study.Patients and MethodsThe present retrospective IRB approved multi-institutional study utilized a prospectively maintained database to identify patients undergoing robotic partial nephrectomy by 6 surgeons for a solitary cT1a (n=1307) or cT1b (n=377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and median follow-up of 12.2 months were compared in univariable and multivariable regression analyses adjusting for surgeon performing the procedure and date of surgery.ResultsIn univariable analysis, cT1b masses were associated with longer operative time (190.0 vs. 159.0 minutes, p
      PubDate: 2017-07-15T02:20:25.127366-05:
      DOI: 10.1111/bju.13960
  • Sleep disorders in patients with Erectile Dysfunction
    • Authors: O. Kalejaiye; Amr Abdel Raheem, A. Moubasher, M. Capece, S. McNeillis, A. Muneer, N Christopher, G. Garaffa, D. Ralph
      Abstract: ObjectivesTo assess the prevalence of OSA in men presenting with ED at a single centre.Subjects and methodsAll men attending a specialised andrology outpatient department with a new diagnosis of erectile dysfunction were included in this prospective study. All patients completed 3 questionnaires: International Index of Erectile Function (IIEF) and 2 sleep questionnaires. The sleep questionnaires used were the ‘OSA screening’ questionnaire and the Insomnia severity index’. Their ED management was subsequently undertaken in keeping with local and European guidelines. OSA diagnosis was made based on a score of 3 or more on the OSA screening questionnaire and those patients were referred for specialist management.ResultsBetween February and September 2016, one hundred and twenty-nine men completed the study questionnaires. An OSA score ≥ 3 on the OSA screening questionnaire was found in 55% (n=71) of the patients indicating a need for specialist sleep referral. Men who scored ≥ 3 on the OSA questionnaire were significantly older (61.4yrs vs. 46.5yrs; p
      PubDate: 2017-07-15T02:05:23.65621-05:0
      DOI: 10.1111/bju.13961
  • Chitosan Membranes application on the Prostatic Neurovascular Bundles
           following Robot-assisted Radical Prostatectomy: a phase II study
    • Authors: F. Porpiglia; R. Bertolo, C. Fiori, M. Manfredi, S. De Cillis, S. Geuna
      Abstract: ObjectiveTo evaluate the feasibility and the safety of the application of chitosan membranes on the neuro-vascular bundles after nerve-sparing Robot-Assisted Radical Prostatectomy (RARP). The secondary aim of the study was to report preliminary data and more particularly potency recovery data.Materials and MethodsSingle-center, single-arm prospective study. Enrolment from July 2015 to September 2016 of all patients with localized prostate cancer scheduled for RARP with IIEF-5 score> 17 after San Luigi Gonzaga Hospital Ethics Committee (Orbassano) approval (80/2015) and patient's acceptance. All patients underwent nerve-sparing RARP with application of Chitosan Membranes on the neuro-vascular bundles.Demographics, peri-operative, postoperative data and complications were evaluated. Potency recovery data were particularly evaluated. Specifically for the purpose of the study, any referred sign/symptom of local allergy/intolerance to the chitosan membranes was recorded and evaluated.ResultsHundred-forty patients underwent nerve-sparing RARP with chitosan membranes application on the neuro-vascular bundles. The application was easy in almost all the cases and did not compromise the safety of the procedure. None of the patients reported signs of intolerance/allergy attributable to the membranes.ConclusionIn our experience chitosan membranes application on the neuro-vascular bundles after nerve-sparing RARP was feasible and safe, without compromising the length, the difficulty and the complications rate of the “standard” procedure. No patients experienced signs of intolerance/allergy attributable to the membranes. Potency recovery data were encouraging. Comparative cohort would have added value to the study. The present paper was performed pre-CE mark achievement.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-15T02:00:26.536451-05:
      DOI: 10.1111/bju.13959
  • The new generation super-mini percutaneous nephrolithotomy (SMP) system: a
           step-by-step guide
    • Authors: Guohua Zeng; Wei Zhu, Yang Liu, Junhong Fan, Zhijian Zhao, Chao Cai
      Abstract: ObjectiveTo present our novel miniaturized endoscopic system and describe a step-by-step guide for successful implementation of the super-mini percutaneous nephrolithotomy (SMP).MethodsThe new-generation SMP endoscopic system consists of (i) a 40,000-pixel super-mini nephroscope with an 8.0 F outer diameter and 7.5 F inner diameter dismountable sheath (ii) and a newly designed irrigation-suction sheath available in either 12 F or 14 F.The irrigation-suction sheath is a two-layered metal structure. The key feature of the irrigation-suction sheath is to allow irrigation and suction respectively (the inflow through the space between the two layers of the sheath, the outflow through the central lumen of the sheath). This property could improve irrigation and stone clearance despite reduced instrument dimension.A total of 59 patients with renal stones underwent new-generation SMP between April 2016 and December 2016. The percutaneous tract dilatation was carried out to 14 F. Lithotripsy was performed using either holmium laser or pneumatic lithotripter. Stone fragments were sucked out by vacuum suctioning through the sheath. A nephrostomy tube or Double-J stent was placed only if clinically indicated. Low-dose CT was performed to assess the stone-free status on the morning after the procedure.ResultsThe mean stone burden was 2.4 cm. 9 of the 59 patients had diabetes, and 5 had hypertension.SMP was completed successfully in all patients with a mean operative duration of 32.9 min and a mean 13g/L hemoglobin decrease. The stone-free rate was 91.5%.Complications occurred in 5.1% of the patients, all of them were Clavien I (minor fever managed by antipyretic therapy), no transfusions were needed.ConclusionThe new-generation SMP system is safe, feasible, and efficient for managing renal calculi less than 3 cm with advantages of a small percutaneous tract, less blood loss, high efficacy for stone clearance, improved visual field, short operative time and ease of operating.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-10T08:46:47.450704-05:
      DOI: 10.1111/bju.13955
  • First-line vascular endothelial growth factor inhibitors for metastatic
           renal cell carcinoma and the impact of new agents entering the treatment
    • Authors: Rohit Jain; Saby George
      Abstract: Clinical trials assessing the safety and efficacy of new therapies versus standard of care (SOC) for advanced RCC (aRCC), which includes locally advanced and metastatic RCC (mRCC), are ongoing. The current first-line standards of care for the treatment of aRCC with clear cell histology are the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) sunitinib and pazopanib[1,2].This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-08T02:55:52.200801-05:
      DOI: 10.1111/bju.13954
  • Urological Complications: Learning from the Past and preparing for the
    • Authors: Nick Simson; Thomas Stonier, Ben J Challacombe
      Abstract: Historically, the medical profession has been poor at discussing adverse events. A defensive, closed culture existed for many years, culminating in wide scale loss of public trust. Numerous NHS scandals have emerged, uncovering a culture with little transparency. Thankfully, via lessons from the aviation industry, we have made great strides in the way we discuss and learn from complications, but there remains room for improvement. Classification of complications via the Clavien-Dindo system has allowed surgeons to compare themselves to others more accurately. Public reporting of surgical outcomes via BAUS aims to improve results in accordance with the well-known aphorism “the more we are watched, the better we behave”. Complication sessions at urological meetings are commonplace, and video recording of minimally invasive surgery has allowed us to capture surgical complications like never before. Clearly though, there is a long way to go. Public reporting certainly has its faults. Patient outcomes may be related to the wider multidisciplinary team rather than surgical proficiency alone, and there is ongoing debate regarding which outcomes to measure, and around individual surgeons’ case mix. In an era of social media, we must also learn to keep apace with new ways of sharing information. In openly discussing complications however, we have never been better.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T12:42:56.460981-05:
      DOI: 10.1111/bju.13948
  • Long-term oncological outcomes and toxicity in 597 men ≤60 years of age
           at time of low dose rate brachytherapy for localised prostate cancer
    • Authors: Stephen E.M. Langley; Ricardo Soares, Jennifer Uribe, Santiago Uribe-Lewis, Julian Money-Kyrle, Carla Perna, Sara Khaksar, Robert Laing
      Abstract: ObjectivesTo report oncological and functional outcomes of men treated with low dose rate (LDR) prostate brachytherapy who were 60 years old or younger at time of treatment.Patients and methodsOf 3,262 patients treated with LDR brachytherapy at our centre up to June 2016, we retrospectively identified 597 patients ≤60 years at treatment with at least three years post-implant follow-up and four PSA measurements of which one was the baseline. Overall disease-specific and relapse-free survival were analysed together with prospectively collected physician reported adverse events and patient reported symptom scores.ResultsMedian (range) age was 57 (44-60) years, median follow-up 8.9 (1.5-17.2) years and median PSA follow-up 5.9 (0.8-15) years. Low, intermediate and high-risk disease represented 53%, 37% and 10% of cases. Ten years post-implant overall and prostate cancer-specific survival were 98% and 99% for low-risk, 99% and 100% for intermediate and 93% and 95% for high-risk disease respectively. Ten years post-implant relapse free survival using the nadir plus 2 definition was 95%, 90% and 87% for low, intermediate and high-risk disease respectively. Urinary stricture was the most common genitourinary event observed in 19 (3.2%) patients. Preserved erectile function five years post-implant was observed in 75% of patients who were potent prior to treatment.ConclusionLDR brachytherapy is an efficacious treatment with long-term control of prostate cancer in men ≤60 years at time of treatment. It was associated with low rates of treatment related toxicity and can be considered a first line treatment for prostate cancer in this patient group.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:40:18.035476-05:
      DOI: 10.1111/bju.13946
  • Robotic Radical Perineal Cystectomy And Extended Pelvic Lymphadenectomy:
           Initial Investigation Using A Purpose-Built Single-Port Robotic System
    • Authors: Matthew J. Maurice; Jeremy Reese, Jihad H. Kaouk
      Abstract: ObjectivesTo assess the feasibility of perineal radical cystoprostatectomy using the latest generation purpose-built single-port robotic surgical system.Materials and methodsIn two male cadavers, the da Vinci SP1098 Surgical System was used to perform radical cystoprostatectomy and bilateral extended pelvic lymphadenectomy. New features in this model include enhanced high-definition three-dimensional optics, improved instrument maneuverability, and a real-time instrument tracking and guideance system. The surgery was accomplished through a 3-cm perineal incision via a novel robotic single-port system, which accomodates three double-jointed articulating robotic instruments, an articulating camera, and an accessory laparoscopic instrument. The primary outcomes were technical feasibility, intraoperative complications, and total robotic operative time.ResultsThe cases were completed successfully without conversion. There were no accidental punctures or lacerations. The robotic operative times were 197 and 202 minutes.ConclusionsIn this preclinical model, robotic radical perineal cystoprostatectomy and extended pelvic lympadenectomy was feasible using the SP1098 robotic platform. Further investigation is needed to assess the feasibility of urinary diversion using this novel approach and new technology.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:31:45.801258-05:
      DOI: 10.1111/bju.13947
  • Comparative Assessment of Efficacy of OnabotulinumtoxinA and Oral
           Therapies (Anticholinergics and Mirabegron) for Overactive Bladder: A
           Systematic Review and Network Meta-analysis
    • Authors: Marcus J Drake; Victor W Nitti, David A Ginsberg, Benjamin M Brucker, Zsolt Hepp, Rachael McCool, Julie M Glanville, Kelly Fleetwood, Daniel James, Christopher R Chapple
      Abstract: ObjectivesTo compare the efficacy of onabotulinumtoxinA, mirabegron, and anticholinergics in adults with idiopathic overactive bladder (OAB) using network meta-analysis (NMA).Subjects and MethodsInformation sources were searched for randomized blinded controlled trials, of at least 2 weeks duration, comparing any dose of onabotulinumtoxinA, eligible oral/transdermal anticholinergics, or mirabegron, with each other or placebo, in adults with OAB. Bayesian random-effects models were used to synthesize the results at week 12: NMA for responder analyses and network meta-regression (NMR) for change from baseline analyses. The NMR was used to adjust for differences in baseline severity between studies. Sensitivity analysis, excluding studies considered to be at a high risk of methodological bias, was conducted.Results56 randomized trials were included in the networks. For each outcome, results are reported for all licensed treatment doses. For each NMR, results are based on patients with an average number of episodes of the outcome at baseline. After 12 weeks, all treatments are more efficacious than placebo. Patients who received onabotulinumtoxinA (100U) had, on average, the greatest reductions in urinary incontinence episodes (UIE), urgency, and micturition frequency, and the highest odds of achieving decreases of 100% and ≥50% in the daily number of UIE. When comparing onabotulinumtoxinA with other pharmacotherapies, mean differences favoured onabotulinumtoxinA 100U over all comparators for UIE and urgency (credible intervals excluded zero) and all but two of the comparators for micturition frequency. OnabotulinumtoxinA 100U was also associated with higher odds of achieving a 100% and ≥50% decrease in daily UIE than most other licensed treatments in the network. The exclusion of studies with a high risk of bias had little impact on the conclusions.ConclusionThe results indicate that, after 12 weeks, onabotulinumtoxinA 100U provides greater relief of OAB symptoms compared with most other licensed doses of other pharmacotherapies in the network.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-03T02:25:33.545841-05:
      DOI: 10.1111/bju.13945
  • Delays in the diagnosis and initial treatment of bladder cancer in Western
    • Authors: Steve P. McCombie; Haider K. Bangash, Melvyn Kuan, Isaac Thyer, Fran Lee, Dickon Hayne
      Abstract: ObjectivesTo quantify and examine the aetiology of delays in the diagnosis and initial treatment of patients with bladder cancer in Western Australia.Subjects and MethodsAll attendances at a one-stop haematuria clinic at a public tertiary-level hospital in Western Australia between May 2008 and April 2014 were reviewed retrospectively. All patients diagnosed with a bladder tumour over this period were identified. These patients and their GPs were contacted retrospectively and invited to participate in telephone interviews, with additional data collected from clinical records as required. Waiting times to presentation, referral, assessment, and initial treatment were established for patients who presented with visible haematuria.ResultsOf 1365 attendances, 151 patients were diagnosed with a bladder tumour and 100 of these were both suitable and agreed to participate in the study. For patients with visible haematuria the median waiting time from initial bleeding to surgery was 69.5 days (range 9 - 1165). This was comprised of a median (range) pre-referral waiting time of 12 days (0 - 1137), assessment waiting time of 12.5 days (0 - 207), and treatment waiting time of 20 days (1 - 69). Reasons for prolonged waiting times included poor public awareness, patient fear and anxiety, delayed and non-referral from primary care, administrative delays, and resource limitations.ConclusionMany patients experience significant delay in the diagnosis and treatment of their bladder cancer in Western Australia, and this data likely reflects national trends. This concerning data warrants consideration of how delays can be reduced in order to improve outcomes for these patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-29T07:40:29.789705-05:
      DOI: 10.1111/bju.13939
  • Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive
           prostate cancer amenable to lesion ablative therapy
    • Authors: Aurélie De Bruycker; Bieke Lambert, Tom Claeys, Louke Delrue, Chamberlain Mbah, Gert De Meerleer, Geert Villeirs, Filip De Vos, Kathia De Man, Karel Decaestecker, Valérie Fonteyne, Nicolaas Lumen, Filip Ameye, Ignace Billiet, Steven Joniau, Friedl Vanhaverbeke, Wim Duthoy, Piet Ost
      Abstract: ObjectivesTo describe the anatomical patterns of PCa recurrence following primary therapy and investigate if patients with low-volume disease have a better prognosis as compared to their counterparts.Material and methodsPatients eligible for a F18-choline PET-CT were entered in a prospective cohort study. Eligible patients had an asymptomatic biochemical recurrence following primary PCa treatment and testosterone levels>50 ng/ml. The number of lesions were counted per scan. Patients with an isolated local recurrence or with up to 3 metastases (+/- local recurrence) were considered “low-volume” and patients with>3 metastases as high-volume. Descriptive statistics were used to report recurrences. Cox-regression analysis investigated the influence of prognostic variables on the time to developing castration resistant PCa (CRPC).ResultsIn 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed) (11%), viscera (4%) or a combination of any of the previous (37%). In total, 153 patients (74%) had a low-volume recurrence and 55 patients (26%) had a high-volume recurrence. The 3-year CRPC-free survival for the whole cohort was 79% (95% CI: 43 – 55%) and 88% for low-volume recurrences and 50% for high-volume recurrences, respectively (p
      PubDate: 2017-06-24T06:07:34.178756-05:
      DOI: 10.1111/bju.13938
  • Impact of Preoperative Calculation of Nephron Volume Loss on Future of
           Partial Nephrectomy Techniques; Planning a Strategic Roadmap for Improving
           Functional Preservation and Securing Oncological Safety
    • Authors: Koon Ho Rha; Ali Abdel Raheem, Sung Yul Park, Kwang Hyun Kim, Hyung Joon Kim, Kyo Chul Koo, Young Deuk Choi, Byung Ha Jung, Sang Kon Lee, Won Ki Lee, Jayram Krishnan, Tae Young Shin, Jin-Seon Cho
      Abstract: ObjectivesTo assess the correlation of resected and ischaemised volume (RAIV), which is preoperatively calculated volume of nephron loss (VNL), with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset.Subjects and MethodsWe identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robotic PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were utilised to identify the associations between various time points of PRF and RAIV as a continuous variable.ResultsMean RAIV was 24.2 ± 29.2 cm3. Mean preoperative eGFR and eGFRs at postoperative day 1, 6 months and 3 years follow-up was 91.0 and 76.8, 80.2 and 87.7 ml/min per 1.73 m2, respectively. In multivariable linear regression analysis, the amount of changes in PRF in long-term follow-up were significantly correlated with RAIV (β = 0.261, β = 0.165, β = 0.260 at postoperative day 1, 6 months and 3 years follow-up, respectively). This study has the limitation of its retrospective nature.ConclusionPreoperatively calculated RAIV significantly correlates with the amount of changes in PRF during long-term follow-up. RAIV could lead our research to the level of prediction of the amount of PRF decline. RAIV provides appropriate evidence to explain the technical advantages of emerging techniques.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-20T13:24:15.375778-05:
      DOI: 10.1111/bju.13937
  • Development of a Patient and Institutional-Based Model for Estimation of
           Operative Times for Robot-Assisted Radical Cystectomy: Results from the
           International Robotic Cystectomy Consortium
    • Authors: Ahmed A. Hussein; Paul R. May, Youssef E. Ahmed, Matthias Saar, Carl J Wijburg, Lee Richstone, Andrew Wagner, Timothy Wilson, Bertram Yuh, Joan Palou Redorta, Prokar Dasgupta, Omar Kawa, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini, Franco Gaboardi, Giovannalberto Pini, Francis Schanne, Alexandre Mottrie, Koon-ho Rha, Ashok Hemal, Michael Stockle, John Kelly, Wei Shen Tan, Thomas J. Maatman, Vassilis Poulakis, Jihad Kaouk, Abdullah Erdem Canda, Mevlana Derya Balbay, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo design a methodology to predict operative times for robot-assisted radical cystectomy (RARC) based on variation in institutional, patient and disease characteristic to help in operating room scheduling and quality control.MethodsThe model included preoperative variables and therefore can be used for prediction of surgical times: institutional volume, age, gender, BMI, ASA Score, history of prior surgery and radiation, clinical stage, neoadjuvant chemotherapy, type, technique of diversion and the extent of lymph node dissection. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with surgical time. The data was split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated recursively on the resultant data sets until the permutation tests showed no significant association with operative time.Results2134 procedures were included. The variable most strongly associated with surgical time was type of diversion (ileal conduits – 70 minutes shorter, p66 RARCs) was important (higher volume—55 minutes shorter, p
      PubDate: 2017-06-16T03:55:24.991016-05:
      DOI: 10.1111/bju.13934
  • Impact of diagnostic ureteroscopy on intra-vesical recurrence in patients
           undergoing radical nephroureterectomy for upper tract urothelial cancer: A
           systematic review and meta-analysis
    • Authors: Michele Marchioni; Giulia Primiceri, Luca Cindolo, Lance Hampton, Mayer B Grob, Georgi Guruli, Luigi Schips, Shahrokh F. Shariat, Riccardo Autorino
      Abstract: PurposeTo analyze the association between the use of diagnostic ureteroscopy (URS) and development of intra-vesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for high risk upper tract urothelial cancer.MethodsA systematic review of the published data was performed up to December 2016 using multiple search engines to identify eligible studies. A formal meta-analysis was conducted for studies comparing patients who underwent URS before RNU to those with did not. HRs with their 95% CIs from each study were used to calculate pooled HRs. Pooled estimates were calculated using a fixed-effects or random-effects model according to heterogeneity. Statistical analyses were performed using RevMan, version 5.ResultsSeven studies were included in the systematic review, but only six of were deemed fully eligible for meta-analysis. Among the 2,382 patients included in the meta-analysis, 765 underwent diagnostic URS prior to RNU. All examined studies were retrospective, and the majority examined Asian populations. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS, respectively. At pooled analysis, a statistically significant association was found between occurrence of URS prior to RNU and IVR (HR=1.56; 95% CI 1.33 to 1.88; p < 0.001). There was not heterogeneity in the observed outcomes according to the I2 statistic of 2% (p = 0.40).ConclusionsWithin the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU. Further research is this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-16T03:55:19.83854-05:0
      DOI: 10.1111/bju.13935
  • Safety and effectiveness of collagenase clostridium histolyticum (CCH)
           (Xiapex®) in the treatment of Peyronie's Disease using a new modified
           shortened protocol
    • Authors: Amr Abdel Raheem; Marco Capece, Odunayo Kalejaiye, Tarek Abdel-Raheem, Marco Falcone, Mark Johnson, Oliver George Ralph, Giulio Garaffa, Andrew Nim Christopher, David John Ralph
      Abstract: ObjectivesTo evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH) (Xiapex®, Xiaflex®) in the treatment of Peyronie's disease (PD) using a new modified treatment protocol which aims at reducing the number of injections needed and reducing patient visits, thus reducing the cost and duration of treatment.Patients and MethodsA prospective study of 53 patients with PD who had treatment with CCH at a single center using a new modified protocol. The angle of curvature assessment after an intra-cavernosal injection of PGE1, IIEF and Peyronie's disease questionnaires (PDQ) were performed at baseline and at week 12 (4 weeks after the last injection). The global assessment of PD questionnaire was performed at week 12. Under a penile block of 10ml of plain lignocaine 1%, a total of 3 intra-lesional injections of CCH (0.9mg) were given at 4 weekly intervals using a new modified injection technique.In between injections patients used a combination of home modelling, stretching and a vacuum device on a daily basis in order to mechanically stretch the plaque. Investigator modelling was not performed.ResultsThe mean penile curvature at baseline was 54° (30 - 90°). Of the 53 patients in the study, 51 patients (96.2%) had an improvement in the angel of curvature with a mean value of 17.36° (0°- 40°) or 31.4% from baseline (0 - 57%) after 3 CCH injections. The end mean curvature was 36.9° (12 °- 75°; p
      PubDate: 2017-06-14T01:55:18.503188-05:
      DOI: 10.1111/bju.13932
  • Mild heating and reduction of bladder spontaneous contractions
    • Authors: Darryl G Kitney; Rita I Jabr, Bahareh Vahabi, Christopher H Fry
      Abstract: ObjectivesTo measure the effect of external heating on bladder wall contractile function, histological structure and expression of proteins related to tissue protection and apoptosis.Material and methodsIn vitro preparations of bladder wall and ex vivo perfused pig bladders were heated from 37°C to 42, 46 and 50°C for 15 minutes. Isolated preparations were heated by radiant energy and perfused bladders by altering perfusate temperature. Spontaneous contractions or pressure variations were recorded, as well as responses to the muscarinic agonist carbachol or motor nerve excitation in vitro during heating. Tissue histology in control and after heating was analysed using H&E staining and DAPI nuclear labelling. The effects of heating on protein expression levels of i) heat shock proteins HSP27-pSer82 and inducible-HSP70 and ii) caspase-3 and its downstream DNA-repair substrate, PARP were measured.ResultsHeating to 42°C reduced spontaneous contractions or pressure variations by about 70%, effects were fully reversible. There were no effects on carbachol or nerve-mediated responses. Tissue histology was unaffected by heating and expression of heat-shock proteins as well as caspase-3 and PARP were also unaltered. A TRPV1 antagonist had no effect on the reduction of spontaneous activity. Heating to 46°C had a similar effect on spontaneous activity and also reduced the carbachol contracture. Urothelial structure was damaged, caspase-3 levels were increased and inducible-HSP70 levels declined. At 50°C evoked contractions were abolished, the urothelium was absent and heat-shock proteins and PARP expression was reduced with raised caspase-3 expression.ConclusionsHeating to 42°C caused a profound, reversible and reproducible attenuation of spontaneous activity with no tissue damage and no initiation of apoptosis pathways. Higher temperatures caused tissue damage and activation of apoptotic mechanisms. Mild heating offers a novel approach to reduce bladder spontaneous activity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T14:25:19.136486-05:
      DOI: 10.1111/bju.13933
  • A critical appraisal of the application of propensity score methods in the
           urology literature
    • Authors: Madhur Nayan; Robert J. Hamilton, David N. Juurlink, Antonio Finelli, Girish S. Kulkarni, Peter C. Austin
      Abstract: ObjectivesTo determine whether studies that used propensity score (PS) methods in the urology literature provided sufficient detail to allow scientific reproducibility and whether appropriate statistical tests were used to obtain valid measures of effect.Materials and MethodsWe searched OVID Medline and the Science Citation Index from inception to November 2016 to identify studies that used PS methods from 5 general urology journals. From each included article, we extracted pertinent information related to the PS methodology such as estimation of the PS, whether balance diagnostics were performed, and the statistical analysis performed.ResultsWe identified 114 articles for inclusion. Matching on the PS was the most common method used (62 studies, 54.4%). Of all studies, 103 (90.4%) described which covariates were used to estimate the PS; however, only 24 provided justification for the selected covariates. Although the majority of studies (70.2%) performed some sort of diagnostic evaluation to assess balance, few studies (24.6%) used appropriate methods for balance assessment. Only 4 (6.4%) studies that used PS matching provided sufficient detail to replicate the matching strategy. Finally, the majority (77.4%) of studies that used PS matching explicitly used inappropriate statistical methods to estimate the effect of an exposure on an outcome.ConclusionsPropensity score methods are poorly described and implemented in the urology literature. We provide recommendations for improvement to allow scientific reproducibility and obtain valid measures of effect from their use.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T02:50:23.347117-05:
      DOI: 10.1111/bju.13930
  • Centralisation of radical cystectomies for bladder cancer in England, a
           decade on from the ‘Improving Outcomes Guidance’: The case for super
    • Authors: Mehran Afshar; Henry Goodfellow, Francesca Jackson-Spence, Felicity Evison, John Parkin, Richard T Bryan, Helen Parsons, Nicholas D James, Prashant Patel
      Abstract: ObjectiveTo analyse the impact of centralisation of radical cystectomy provision for bladder cancer in England, on post-operative mortality, length of stay, complications and re-intervention rate, from implementation of centralisation from 2002, until 2014. In 2002, UK policymakers introduced the Improving Outcomes Guidance (IOG) for urological cancers after a global cancer surgery commission identified substantial shortcomings in provision of care of radical cystectomies. One key recommendation was centralisation of cystectomies to high output centres. No study has yet robustly analysed the changes since IOG, to assess a national healthcare system which has mature data on such institutional transformation.MethodsRadical Cystectomies performed for bladder cancer in England between 2003/2004 and 2013/2014 were analysed from Hospital Episode Statistics (HES) data. Outcomes including 30-day, 90-day, and one-year all-cause post-operative mortality, median length of stay, complications and re-interventions were calculated. Multivariable statistical analysis was undertaken to describe the relationship between each surgeon and the providers’ annual case volume and mortality.Results15,292 cystectomies were identified. Percentage of cystectomies performed in discordance with IOG reduced from 65.0% to 12.4%, corresponding with improvement in 30-day mortality from 2.7% to 1.5% (p=0.0235). Procedures adhering to IOG had superior 30-day mortality (2.9% vs. 2.1%; p=0.0029) to those which did not, and superior one-year mortality (25.6% vs. 21.5%; p
      PubDate: 2017-06-08T09:15:37.410012-05:
      DOI: 10.1111/bju.13929
  • Anti-VEGF treatment decreases bladder pain in cyclophosphamide cystitis
           – a MAPP Research Network Animal Model Study
    • Authors: H Henry Lai; Baixin Shen, Pooja Vijairania, Zhang Xiaowei, Sherri K. Vogt, Robert W. Gereau
      Abstract: ObjectiveTo investigate whether treatment with anti-VEGF (vascular endothelial growth factor) neutralizing antibodies can reduce pain and voiding dysfunction in the cyclophosphamide (CYP) cystitis model of bladder pain in mice.Materials and MethodsAdult female mice received anti-VEGF neutralizing antibodies (10 mg/kg intraperitoneal B20-4.1.1 VEGF mAb) or saline (control) pre-treatment, followed by CYP (150 mg/kg intraperitoneal) to induce acute cystitis. Pelvic nociceptive responses were assessed by applying von Frey filaments to the pelvic area. Spontaneous micturition was assessed using the void spot assay.ResultsSystemic anti-VEGF neutralizing antibodies treatment significantly reduced the pelvic nociceptive response to CYP cystitis compared to control (saline). In the anti-VEGF pre-treatment group, there was a significant increase in pelvic hypersensitivity measured by the area under the curve (AUC) with von Frey filaments at 5 hours post-CYP (p=0.0035). However by 48 and 96 hours post-CYP, the pelvic hypersensitivity have reduced by 54% and 47% respectively compared to the 5 hours post-CYP time point, and were no longer significantly different from the baseline (p=0.22 and 0.17 respectively). There was no difference in urinary frequency and mean voided volume between the two pre-treatment groups.ConclusionSystemic blockade of VEGF signaling with anti-VEGF neutralizing antibodies was effective in reducing pelvic/bladder pain in the CYP cystitis model of bladder pain. Our data support the further investigation of the use of anti-VEGF antibodies to manage bladder pain or visceral pain.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T10:35:20.785549-05:
      DOI: 10.1111/bju.13924
  • Testing Radical prostatectomy in men with prostate cancer and
           oligoMetastases to the bone: a randomised controlled feasibility trial
    • Authors: Prasanna Sooriakumaran
      Abstract: Prostate cancer is the commonest cancer and the second most frequent cause of cancer death in Western men1. Men presenting with metastatic disease have a median survival of only 42.1 months2 and current standard-of-care consists of initial androgen deprivation therapy (ADT) followed by chemotherapy and novel agents once the cancer no longer responds to ADT. The burden on the health care setting of treating men with metastatic prostate cancer is vast and a recent study estimated costs of USD20,000 per man3.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:30:34.635193-05:
      DOI: 10.1111/bju.13925
  • Natural History of ‘Second’ Biochemical Failure Following Salvage
           Radiation Therapy for Prostate Cancer: A Multi-Institution Study
    • Authors: Vasu Tumati; William C. Jackson, Ahmed E. Abugharib, Ganesh Raj, Claus Roehrborn, Yair Lotan, Kevin Courtney, Aditya Bagrodia, Jeffrey C. Gahan, Zachary S. Zumsteg, Michael R. Folkert, Aaron M. Laine, Raquibul Hannan, Daniel E. Spratt, Neil B. Desai
      Abstract: ObjectivesTo describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) following prostatectomy.Subjects/Patients and MethodsFollowing SRT at two institutions from 1986-2013, 286 patients developed second BCR, defined as two rises in PSA of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses.ResultsAt a median 6.1 years following second BCR, rates of DM, CRPC, PCSS, and OS were 41%, 27%, 83%, and 73%, respectively. On multivariable analysis, interval to second BCR
      PubDate: 2017-06-05T04:28:40.46275-05:0
      DOI: 10.1111/bju.13926
  • The Pregnant Urologist
    • Authors: Susan Jane Hall; Simon Williams
      Abstract: The latest statistics show that females constitute 15% of UK Urology consultants and 30% of Urology trainees. This number is set to rise with females accounting for 60% of recent medical school intakes (1). Having young female trainees will result in a larger number of trainees working during pregnancy. Furthermore Urology as a specialty involves potential risks to the developing foetus and mother from both ionising radiation in theatre and from exposure to the potentially harmful 5 α reductase inhibitors, Povidone-iodine surgical scrub, cytotoxic chemicals such as Mitomycin, along with long working hours and on call duties.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:25:12.738456-05:
      DOI: 10.1111/bju.13927
  • Role of serum steroid hormones in women with stress urinary incontinence:
           a case–control study
    • Authors: Barbara Bodner-Adler; Klaus Bodner, Oliver Kimberger, Ksenia Halpern, Malte Rieken, Heinz Koelbl, Wolfgang Umek
      Abstract: ObjectivesTo investigate the potential relationship between endogenous sex steroids and presence of stress urinary incontinence (SUI).Patients and MethodsA total of 47 peri- and postmenopausal women with SUI were matched 1:1 with 47 continent women based on age, menopausal status, body mass index (BMI) and parity. Blood samples were drawn from all the women for assessment of oestradiol (E2), follicle-stimulating hormone, luteinizing hormone, testosterone, androstendion (AEON), dehydroepiandrosterone sulphate and sex hormone-binding globulin with an electrochemiluminescence immunoassay.ResultsWomen with SUI had significantly lower serum levels of E2 (8.49 ± 7.47 vs 13.09 ± 13.80; P = 0.048) and AEON (0.59 ± 0.41 vs 1.20 ± 0.87; P = 0.033) compared with controls. This difference in E2 levels remained significant after controlling for age, menopausal age, years from menopause, BMI, parity, testosterone and AEON. In addition, hypertension and history of hysterectomy were observed significantly more frequently in the SUI group (P < 0.001). There was no significant association between hormone levels and degree of SUI (P> 0.05).ConclusionThe results of the present study indicate that a low E2 level might have a negative impact on the lower urinary tract and continence mechanism and a low E2 level is a possible risk factor for SUI in women.
      PubDate: 2017-05-29T05:35:25.979913-05:
      DOI: 10.1111/bju.13902
  • Initial multicentre experience of 68Gallium-PSMA PET/CT guided
           robot-assisted salvage lymphadenectomy: acceptable safety profile but
           oncological benefit appears limited
    • Authors: Amila Siriwardana; James Thompson, Pim J. van Leeuwen, Shaela Doig, Anton Kalsbeek, Louise Emmett, Warick Delprado, David Wong, Hemamali Samaratunga, Anne-Maree Haynes, Geoff Coughlin, Phillip Stricker
      Abstract: ObjectivesTo evaluate the safety and short-term oncological outcomes for 68Ga-PSMA PET/CT directed robot-assisted salvage node dissection (RASND) for prostate cancer oligometastatic nodal recurrence.Materials and MethodsBetween February 2014 and April 2016, 35 patients across two centres underwent RASND for 68Ga-PSMA PET/CT detected oligometastatic nodal recurrence. RASND was performed by targeted pelvic dissection, unilateral extended pelvic template or bilateral extended pelvic template dissection, depending on previous pelvic treatment and extent/location of nodal disease. Complications were reported by the Clavien-Dindo classification system. Definitions of prostate-specific antigen (PSA) treatment response (TR) to RASND were defined as 6-week PSA
      PubDate: 2017-05-26T06:50:22.670802-05:
      DOI: 10.1111/bju.13919
  • Estimating the effect of immortal-time bias in urologic research: a case
           example of testosterone-replacement therapy
    • Authors: Christopher J.D. Wallis; Refik Saskin, Steven A. Narod, Calvin Law, Girish S. Kulkarni, Arun Seth, Robert K. Nam
      Abstract: ObjectiveTo quantify the effect of immortal-time bias in an observational study examining the effect of cumulative testosterone exposure on mortality.Subjects and MethodsWe used a population-based matched cohort study of men aged 66 and older newly treated with testosterone replacement therapy and matched-controls from 2007-2012 in Ontario, Canada to quantify the effects of immortal-time bias. We used generalized estimating equations to determine the association between cumulative testosterone replacement therapy exposure and mortality. Results produced by models using time-fixed and time-varying exposures were compared. Further, we undertook a systematic review of PubMed to identify studies addressing immortal-time bias or time-varying exposures in the urologic literature and qualitative summated these.ResultsAmong 10,311 TRT-exposed men and 28,029 controls, the use of a time-varying exposure resulted in the attenuation of treatment effects compared with an analysis which did not account for immortal-time bias. While both analyses showed a decreased risk of death for patients in the highest tertile of TRT exposure, the effect was overestimated when using a time-fixed analysis (aHR 0.56, 95% CI 0.52-0.61) when compared to a time-varying analysis (aHR 0.67, 95% CI 0.62-0.73). Of the 1241 studies employing survival analysis identified in the literature, nine manuscripts met criteria for inclusion. Of these, 5 employed time-varying analytic methodology. Each of these was a large, population-based retrospective cohort study assessing potential harms of pharmacologic agents.ConclusionsWhere exposures vary over time, a time-varying exposure is necessary to draw meaningful conclusions. Failure to employ a time-varying analysis will result in overestimation of a beneficial effect. However, time-varying exposures are uncommonly utilized among manuscripts published in prominent urologic journals.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-26T06:46:13.681787-05:
      DOI: 10.1111/bju.13918
  • Renal functional outcomes in patients undergoing percutaneous cryoablation
           or partial nephrectomy for a solitary renal mass
    • Authors: Ross J. Mason; Thomas D. Atwell, Christine Lohse, Bimal Bhindi, Adam Weisbrod, Stephen A. Boorjian, Bradley C. Leibovich, Grant D. Schmit, R. Houston Thompson
      Abstract: ObjectivesTo compare renal functional changes after percutaneous cryoablation (CA) or partial nephrectomy (PN).Patients and MethodsPatients who underwent CA or PN for a solitary renal mass at a single institution were identified (2003-2013). Estimated glomerular filtration rates (eGFR) were calculated at baseline, discharge, and 3 months follow-up using the Chronic Kidney Disease Epidemiology Collaboration equation. Changes in renal function were compared between groups using 1:1 propensity score (PS) matching, adjustment for PS quintile, and inverse probability weighting (IPW).ResultsThere were 2,040 procedures available for the PS analyses, including 448 CA and 1,592 PN. After PS adjustments, there were no significant differences in baseline clinical features between CA and PN patients. In the PS matched analysis, the changes in eGFR from baseline to discharge for CA and PN patients were -3.1 and -1.1 ml/min/1.73m2 (p=0.038) with percent changes of -4.5% and 0% (p=0.006). From baseline to 3-month follow-up, the absolute changes in eGFR for CA and PN patients were -4.3 and -2.1 ml/min/1.73m2 (p=0.008) and the percent changes were -6.1% and -2.4% (p=0.005). Similar results were obtained after adjusting for PS quintiles and in the IPW analysis. Importantly, the rate of CKD stage progression at 3-months follow-up was similar between groups (21% versus 18%).ConclusionsOur results confirm that both CA and PN have a minor impact on renal function. While we observed a statistically greater decline in eGFR after CA compared with PN, both approaches result in excellent preservation of renal function.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-26T06:46:12.554036-05:
      DOI: 10.1111/bju.13917
  • Impact of Body Mass Index on Robotic Radical Cystectomy with
           Intra-Corporeal Urinary Diversion
    • Authors: Nariman Ahmadi; Thomas G. Clifford, Gus Miranda, Jie Cai, Monish Aron, Mihir M. Desai, Inderbir S. Gill
      Abstract: ObjectivesTo determine the impact of body mass index (BMI) on peri-operative and oncological outcomes following robotic radical cystectomy (RRC) with intra-corporeal urinary diversion (ICUD).Subjects and MethodsA total of 216 patients undergoing RRC, extended lymphadenectomy and ICUD (07/2010-12/2015) were categorized into four BMI groups according to the 2004 World Health Organization (WHO) obesity classification:
      PubDate: 2017-05-22T12:31:14.496647-05:
      DOI: 10.1111/bju.13916
  • Evaluating an educational intervention to alleviate distress amongst men
           with newly diagnosed prostate cancer and their partners
    • Authors: Lindsay Hedden; Richard Wassersug, Sarah Mahovlich, Phil Pollock, Monita Sundar, Robert H. Bell, Larry Goldenberg, Celestia S. Higano
      Abstract: ObjectiveTo determine whether an education session alleviates distress for both patients with prostate cancer and their partners; and whether their partner's attendance at the session; and disease, treatment, and sociodemographic characteristics affect changes in distress levels.Patients, Subjects and MethodsWe identified men with untreated prostate cancer at the Vancouver Prostate Centre between February 2015 and March 2016 who agreed to attend our education session. The session consisted of a didactic presentation covering the biology of prostate cancer, treatment options, and side-effects, followed by a private joint session with a urologist and radiation oncologist. We assessed distress using the Distress Thermometer (DT) and compared pre- and post-session distress, and change in distress between patients and partners using matched and unmatched t-tests, respectively. We also assessed pre-session anxiety using the seven-item Generalised Anxiety Disorder measure, and decisional certainty using the Decisional Conflict Scale.ResultsIn all, 71 patients and 48 partners participated in the study. Attending the session led to a significant reduction in the median DT score for patients (4.0–3.0, P < 0.01) and partners (5.0–4.0, P = 0.02). Partners reported higher distress both before and after the session (4.9 vs 3.8, P = 0.03 pre-session and 4.2 vs 3.2, P = 0.03 post-session). The presence of a partner at the session did not affect patients’ pre- or post-session distress or the success of the session at alleviating distress. Sociodemographic and clinical characteristics had little effect on distress levels.ConclusionsAn interdisciplinary education session is equally effective at alleviating distress for both patients with prostate cancer and their female partners.
      PubDate: 2017-05-17T22:25:31.277127-05:
      DOI: 10.1111/bju.13885
  • The contemporary role of ureterolysis in Retroperitoneal Fibrosis RPF) -
           treatment of last resort or first intent' An analysis of 50 cases
    • Authors: Tim O'Brien; Archie Fernando
      Abstract: ObjectiveTo determine the outcomes of open ureterolysis in a contemporary cohort of patients presenting with ureteric obstruction secondary to retroperitoneal fibrosis (RPF).Patients and methodsProspective analysis of 50 patients undergoing open ureterolysis and omental wrap between January 2012 and January 2016 in a single centre managed by a multi-disciplinary RPF team. Minimum follow up of 1 year. Indications were: nephrostomy-dependent drainage (n=5); stent failure as evidenced by persistent hydronephrosis (n=20); severe stent symptoms (n=22); and patient choice/pre-emptive (n=3). Outcome measures were stent-free rate; change in renal function post-ureterolysis; operative parameters (operative time, blood loss, complications, length of stay); and need for further intervention.Results48/50 (96%) patients stent free at 3 months and 47/50 (94%) stent free at 12 months. Median change in GFR by indication at one year was: overall +6% (IQR -4 to +22; p
      PubDate: 2017-05-14T05:02:31.13567-05:0
      DOI: 10.1111/bju.13915
  • Additional benefit of using a risk based selection for prostate biopsy: an
           analysis of biopsy complications in the Rotterdam section of the European
           Randomized Study of Screening for Prostate Cancer (ERSPC)
    • Authors: Peter K.F. Chiu; Arnout R. Alberts, Lionne D.F. Venderbos, Chris H. Bangma, Monique J. Roobol
      Abstract: ObjectiveTo investigate biopsy complications and hospital admissions that could be reduced by the use of ERSPC risk calculators (RC).Materials and MethodsAll biopsies in the Rotterdam section of the ERSPC from 1993 to 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC RC3 and RC4 were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC3/4 probability cut-offs for prostate cancer(PCa) risk of ≥12.5% and high grade PCa(HGPCa) risk ≥3%, we assessed the the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these cut-offs.Results10747 biopsies with complete questionnaires were included. A total of 7294(67.9%) complications, 3.9% (424/10747) post-biopsy fever, and 0.9%(92/10747) hospital admissions were recorded. Fever rate has been static over the years, but hospital admissions had tripled from 0.6%(1993-1996) to 2.1%(2009-2015). Among 7704 biopsies which fit the criteria of RC3 or 4, 35.8%(2757/7704) biopsies, 37.4%(1972/5268) complications, 39.4%(128/325) fever, and 42.3%(30/71) admissions could have been avoided by using one of the RCs. More complications could have been avoided in the case of RC4 or more recent biopsies(2009-2015). 35.9% of the total cost of biopsies and complication treatment could be saved.ConclusionA significant proportion of biopsy complications, hospital admissions, and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only, and this effect was most prominent in more recent biopsies and in men with repeated biopsies or screening.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-12T10:50:59.825424-05:
      DOI: 10.1111/bju.13913
  • Prognostic Utility of Biopsy-Derived Cell Cycle Progression Score in
           Patients with NCCN Low-Risk Prostate Cancer Undergoing Radical
           Prostatectomy: Implications for Treatment Guidance
    • Authors: Jeffrey T. Tosoian; Meera R. Chappidi, Jay T. Bishoff, Stephen J. Freedland, Julia Reid, Michael Brawer, Steven Stone, Thorsten Schlomm, Ashley E. Ross
      Abstract: ObjectivesTo determine the prognostic utility of the Cell Cycle Progression (CCP) score in men with National Comprehensive Cancer Network (NCCN) low-risk prostate cancer who underwent radical prostatectomy (RP).Patients and MethodsPatients who underwent RP for Gleason score ≤6 prostate cancer at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA], and Intermountain Healthcare [IHC]) were identified. The CCP score was obtained from diagnostic (DVA, IHC) or simulated biopsies (MC). Primary outcome was biochemical recurrence (BCR, PSA≥0.2 ng/ml) after RP. Prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and the overall cohort.ResultsAmong the 236 patients identified, 80% (188/236) met NCCN low-risk criteria. Five-year BCR-free survival for the low (1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (p=0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (p=0.041). In multivariable models adjusting for clinical and pathological variables with the CAPRA score, the CCP score was an independent predictor of BCR in the low-risk (HR=1.77 per unit score, 95%CI [1.21, 2.58], p=0.003) and overall cohorts (HR=1.41 per unit score, 95%CI [1.02, 1.96], p=0.039).ConclusionIn a cohort of NCCN low-risk patients, the CCP score improved clinical risk stratification of patients at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimal treatment selection in these patients with otherwise similar clinical parameters.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-08T10:50:25.202304-05:
      DOI: 10.1111/bju.13911
  • Association of Human Development Index with global bladder, kidney,
           prostate and testis cancer incidence and mortality
    • Authors: Alyssa K. Greiman; James S. Rosoff, Sandip M. Prasad
      Abstract: ObjectivesTo describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development.Materials and MethodsWe obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI).ResultsAge-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5–2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R2 = 0.78), prostate (regression coefficient −1.56, R2 = 0.85), kidney (regression coefficient −1.34, R2 = 0.74), and bladder cancer (regression coefficient −1.01, R2 = 0.80).ConclusionWhile incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes.
      PubDate: 2017-05-08T06:50:27.303028-05:
      DOI: 10.1111/bju.13875
  • Tweet this: how advocacy for breast and prostate cancers stacks up on
           social media
    • Authors: Stacy Loeb; Brian Stork, Heather T. Gold, Natasha K. Stout, Danil V. Makarov, Christopher Weight, Hendrik Borgmann
      Abstract: Despite the large burden of disease for both breast and prostate cancer, breast cancer receives substantially more federal funding and little is known about the extent to which advocacy in social media differs between them. We aimed to perform a comprehensive comparison of Twitter activity related to prostate and breast cancer over the past 5 years (1/11-1/16) using the Symplur Signals analytics platform. Overall there were 2,518,250 tweets from 800,833 users about breast cancer and 389,696 tweets from 106,507 users about prostate cancer over the 5-year period between 2012-2017 demonstrating a 7-fold higher activity for breast cancer. For both cancers, twitter activity grew steadily over time, but the estimated reach of tweets was 9-fold higher for breast cancer. The types of key influencers to the discussion differed between the two cancers, and by the hashtag used (#breastcancer or #bcsm, and #prostatecancer or #pcsm). The mean number of tweets during October breast cancer awareness month (166,896 tweets/month) was 16 times higher than the combined total of prostate cancer tweets during awareness months of September and November (“Movember”) (10,159 tweets/month). Considering the potential utility of social media to increase cancer-related knowledge, public awareness and education, our findings suggest a role for greater advocacy on Twitter by the prostate cancer community.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-04T10:46:03.945787-05:
      DOI: 10.1111/bju.13908
  • Does the training of fellows affect perioperative outcomes of robotic
           partial nephrectomy'
    • Authors: Zine-Eddine Khene; Benoit Peyronnet, Elise Bosquet, Benjamin Pradère, Corentin Robert, Tarek Fardoun, Solène-Florence Kammerer-Jacquet, Grégory Verhoest, Nathalie Rioux-Leclercq, Romain Mathieu, Karim Bensalah
      Abstract: ObjectiveTo evaluate the impact of fellows’ involvement on robot-assisted partial nephrectomy (RAPN) perioperative outcomes.Materials and methodsWe analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) or fellow operating under the supervision of the expert surgeon (fellow group). Perioperative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows’ involvement on perioperative and postoperative outcomes. Trifecta and MIC scores were used to assess quality of surgery in both expert and fellow groups. Trifecta was defined as a combination of warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications. MIC score was defined as negative surgical margins, ischemia time under 20 min, and absence of complications grade 3 or higher.ResultsFellows were involved in a total of 89 procedures (41%). Patients’ characteristics were comparable in both groups. Operative time (OT) and warm ischemia time (WIT) were longer in the fellow group (180 vs. 120 min, p
      PubDate: 2017-05-02T11:10:31.579918-05:
      DOI: 10.1111/bju.13901
  • Reduced Estimated Glomerular Filtration Rate (eGFR
    • Authors: Michael L. Blute; Victor Kucherov, Timothy J. Rushmer, Shivashankar Damodaran, Fangfang Shi, E. Jason Abel, David F. Jarrard, Kyle A. Richards, Edward M. Messing, Tracy M. Downs
      Abstract: IntroductionTo evaluate if moderate CKD (eGFR
      PubDate: 2017-05-02T11:10:27.395938-05:
      DOI: 10.1111/bju.13904
  • Unification of favorable intermediate, unfavorable intermediate, and very
           high risk-stratification criteria for prostate cancer
    • Authors: Zachary S. Zumsteg; Michael J. Zelefsky, Kaitlin M. Woo, Daniel E. Spratt, Marisa A. Kollmeier, Sean McBride, Xin Pei, Howard M. Sandler, Zhigang Zhang
      Abstract: ObjectiveTo improve on the existing risk-stratification systems.Patients and MethodsThis was a retrospective investigation including 2248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into favorable and unfavorable groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into standard and very high-risk groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavorable intermediate risk (UIR) had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P
      PubDate: 2017-05-02T11:08:41.9696-05:00
      DOI: 10.1111/bju.13903
  • Clinical and patient reported outcomes of SPARE - a randomised feasibility
           study of selective bladder preservation versus radical cystectomy
    • Authors: R A Huddart; A Birtle, L Maynard, M Beresford, J Blazeby, J Donovan, JD Kelly, T Kirkbank, D B McLaren, G Mead, C Moynihan, R Persad, C Scrase, R Lewis, E Hall
      Abstract: ObjectivesTo test the feasibility of a randomised trial in muscle invasive bladder cancer (MIBC) and compare outcomes in patients who receive neoadjuvant chemotherapy followed by radical cystectomy or selective bladder preservation, where definitive treatment (cystectomy or radiotherapy) is determined by response to chemotherapy.Patients and methodsSPARE is a multicentre randomised controlled trial comparing radical cystectomy and selective bladder preservation in patients with MIBC staged T2-3 N0 M0, fit for both treatment strategies and receiving three cycles of neoadjuvant chemotherapy.Patients were randomised between radical cystectomy and selective bladder preservation prior to a cystoscopy after cycle three of neoadjuvant chemotherapy. Patients with ≤T1 residual tumour received a fourth cycle of neoadjuvant chemotherapy in both groups, followed by radical radiotherapy in the selective bladder preservation group and radical cystectomy in in the radical cystectomy group; non-responders in both groups proceeded immediately to radical cystectomy following cycle three.Feasibility study primary endpoints were accrual rate and compliance with assigned treatment strategy. The phase III trial was designed to demonstrate non-inferiority of selective bladder preservation in terms of overall survival in patients whose tumours responded to neoadjuvant chemotherapy. Secondary endpoints included patient reported quality of life, clinician assessed toxicity, loco-regional recurrence free survival and rate of salvage cystectomy after bladder preservation.ResultsTrial recruitment was challenging and below the predefined target with 45 patients recruited in 30 months (25 radical cystectomy; 20 selective bladder preservation). Non-compliance with assigned treatment strategy was frequent, 6/25 patients (24%) randomised to radical cystectomy received radiotherapy.Long term bladder preservation rate was 11/15 (73%) in those who received radiotherapy per protocol. Overall survival was not significantly different between groups.ConclusionsRandomising MIBC patients between radical cystectomy and selective bladder preservation based on response to neoadjuvant chemotherapy was not feasible in the UK health system. Strong clinician and patient preferences for treatments impacted willingness to undergo randomisation and acceptance of treatment allocation. Due to the small number of participants, firm conclusions about disease and toxicity outcomes cannot be drawn.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-28T11:27:35.034547-05:
      DOI: 10.1111/bju.13900
  • Trends in the surgical management of Stage 1 Renal Cell Carcinoma:
           findings from a population-based study
    • Authors: V White; D J T Marco, D Bolton, I D Davis, M Jefford, D Hill, H M Prince, J L Millar, I M Winship, M Coory, G G Giles
      Abstract: ObjectivesTo determine whether use of nephron sparing surgery (NSS) for treatment of stage 1 renal cell carcinomas changed between 2009 and end 2013 in Australia.Patients and MethodsAll adult cases of renal cell carcinoma diagnosed in 2009, 2012, and 2013 were identified through the population-based Victorian Cancer Registry.For each identified patient, trained data-abstractors attended treating hospitals or clinician rooms to extract tumour and treatment data through medical record review.Multivariable logistic regression analyses examined significance of change in use of NSS over time, after adjusting for potential confounders.ResultsA total of 1836 patients with renal cell carcinoma were identified. Of these, the proportion of cases with stage 1 tumours was 64% in 2009, 66% in 2012, and 69% in 2013.For T1a tumours, the proportion of patients residing in metropolitan areas receiving NSS increased from 43% in 2009 to 58% in 2012 (P
      PubDate: 2017-04-28T00:35:27.678514-05:
      DOI: 10.1111/bju.13889
  • ESUT educational video on fluoroscopic guided puncture in PCNL: All
           techniques step by step
    • Authors: Iason Kyriazis; Evangelos Liatsikos, Odysseas Sopilidis, Panagiotis Kallidonis, Andreas Skolarikos,
      Abstract: ObjectiveKidney puncture during percutaneous nephrolithotomy (PCNL) is regarded as one of the most demanding aspects of the procedure and only a minority of urologists perform this step without assistance by a radiologist. Currently a wide variation of fluoroscopic guided techniques is available in clinical practice. In this work we describe the most common fluoroscopic guided access techniques in a step-by-step manner aiming to assist on the standardization of their technique and terminology.MethodsA high quality animation video was created for each of the respective fluoroscopic techniques focusing into the parallel projection of external surgical maneuvers and their effect in the 3 dimensional space of the kidney.ResultsFour predominant fluoroscopic guided percutaneous access techniques are available each with different advantages and limitations. Monoplanar access is employed when a stable-single axis fluoroscopic generator is available and is mostly based on surgeons’ experience. Biplanar access employs a second fluoroscopy axis to access puncture's depth. Bull's eye technique follows a coaxial to fluoroscopy puncture path and is associated with the shorter learning curve at the cost of increased hand radiation exposure. Hybrid and conventional triangulate techniques use target projection by two fluoroscopic planes to define the exact localization of target in space and access it through a third puncture site.ConclusionsFluoroscopic guidance during PCNL puncture is a very efficient method of access establishment. Percutaneous surgeon should be familiar with all available variations of fluoroscopic approach in order to be ready to adopt puncture on any given scenario.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:52:17.863354-05:
      DOI: 10.1111/bju.13894
  • Optimal outcome achievement in partial nephrectomy for T1 renal masses: A
           contemporary analysis of open and robotic cases
    • Authors: Matthew J. Maurice; Daniel Ramirez, Önder Kara, Ercan Malkoç, Ryan J. Nelson, Khaled Fareed, Robert J. Stein, Amr F. Fergany, Jihad H. Kaouk
      Abstract: ObjectivesTo compare optimal outcome achievement between open and robotic partial nephrectomy.Patients and methodsUsing our institutional partial nephrectomy database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys from 2011-2015. Tetrafecta, which was defined as negative surgical margins, freedom from perioperative complications, ≥80% renal functional preservation, and no chronic kidney disease upstaging, was chosen as the composite optimal outcome. Factors associated with Tetrafecta achievement were assessed by multivariable logistic regression with adjustment for age, gender, race, Charlson score, body mass index, chronic kidney disease, tumor size, tumor complexity, and approach.ResultsOverall Tetrafecta achievement was 38%. Negative margins, freedom from complications, and optimal functional preservation was achieved in 97.1%, 73.6%, and 54.2% of cases, respectively. For T1a masses, Tetrafecta achievement was similar between approaches (p=0.97), but for T1b masses, the robotic approach achieved significantly higher Tetrafecta rates (43.0% vs. 21.3%, p
      PubDate: 2017-04-24T07:52:04.266542-05:
      DOI: 10.1111/bju.13888
  • The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]):
           Recruitment Feasibility and Baseline Demographics of a Randomized Trial of
           Diet in Men on Active Surveillance for Prostate Cancer
    • Authors: J. Kellogg Parsons; John P. Pierce, James Mohler, Electra Paskett, Sin-Ho Jung, Michael J. Morris, Eric Small, Olwen Hahn, Peter Humphrey, John Taylor, James Marshall
      Abstract: ObjectiveTo assess the feasibility of performing national, randomized trials of dietary interventions for localized prostate cancer.MethodsThe Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) is a phase 3 clinical trial testing the efficacy of a high-vegetable diet to prevent progression in prostate cancer patients on active surveillance. Participants were randomized to a validated diet counseling intervention or a control condition. Chi-Square and Kruskal Wallis analyses were used to assess between-group differences at baseline.ResultsFrom 2011 to 2015, 478 (103%) of a targeted 464 patients were randomized at 91 study sites. At baseline, mean (SD) age was 64 (6) years and PSA 4.9 (2.1) ng/mL. Fifty-six (12%) participants were African-American, 17 (4%) Hispanic/Latino, and 16 (3%) Asian-American. There were no significant between-group differences for age (p-value = 0.98), race/ethnicity (p-value = 0.52), geographic region (p-value = 0.60), time since prostate cancer diagnosis (p-value = 0.85), PSA (p-value = 0.96), clinical stage (T1c or T2a, p-value = 0.27), or Gleason sum (Gleason 6 or 3+4 = 7, p-value = 0.76). In a pre-planned analysis, the baseline prostate biopsy samples of the first 50 patients underwent central pathology review to confirm eligibility, with an expectation that
      PubDate: 2017-04-24T07:52:02.968606-05:
      DOI: 10.1111/bju.13890
  • Patient Reported Outcome (PRO) questionnaires for men who have radical
           surgery for prostate cancer: a conceptual review of existing instruments
    • Authors: Evangelia Protopapa; Jan der Meulen, Caroline M. Moore, Sarah C. Smith
      Abstract: ObjectivesTo critically review conceptual frameworks for available patient reported outcome (PRO) questionnaires in men having radical prostatectomy; psychometrically evaluate each questionnaire; identify whether each is appropriate for use at the level of the individual patient.Materials and MethodsWe searched PubMed, the Reports and Publications database of the University of Oxford Patient Reported Outcomes Measurement Group and the website of the International Consortium for Health Outcomes Measurement (ICHOM) for psychometric reviews of prostate cancer specific PRO questionnaires. From these we identified relevant questionnaires and critically appraised the conceptual content, guided by the Wilson and Cleary framework and psychometric properties, using well established criteria.ResultsSearches found four reviews and one recommendation paper. We identified seven prostate cancer specific PROs (EPIC-26, EPIC-50, UCLA-PCI, FACT-P, QLQ-PR25, and PC-QoL and STAR). Six out of seven measures purported to measure health related quality of life, but items focused strongly on urinary and sexual symptoms/functioning. The remaining questionnaire (STAR) claimed to assess functional recovery after radical prostatectomy. The psychometric evidence for these questionnaires was incomplete and variable in quality; none had evidence that they were appropriate for use with individual patients.ConclusionSeveral questionnaires provide the basis of measures of urinary and/or sexual symptoms/functioning. Further work should explore other aspects of health related quality of life that are important for men having radical prostatectomy. Further psychometric work is also needed to determine whether they can be used at the individual level.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:51:49.802545-05:
      DOI: 10.1111/bju.13896
  • Impact of preoperative risk on metastatic progression and cancer specific
           death in patients with adverse pathology at radical prostatectomy
    • Authors: Katharina Boehm; Sami-Ramzi Leyh-Bannurah, Clemens Rosenbaum, Laurenz S. Brandi, Lars Budäus, Markus Graefen, Hartwig Huland, Axel Haferkamp, Derya Tilki
      Abstract: ObjectiveTo evaluate the impact of preoperative risk category on metastatic disease (MetD) and prostate cancer mortality (CSM) in prostate cancer (PCa) patients with adverse pathology at radical prostatectomy (RP).Patients and MethodsThe records of 6943 patients who underwent radical prostatectomy (RP) in a European tertiary-center were analysed. Biochemical recurrence (BCR), MetD and CSM were assessed for patients with adverse pathology at RP and stratified according to preoperative low- vs. intermediate/high-risk PCa. Kaplan-Meier-, cumulative incidence, cox-regression and competing risk regression analyses were performed.ResultsIn patients with extracapsular extension MetD-rate was 1.6% vs. 8% (p
      PubDate: 2017-04-24T07:36:26.150675-05:
      DOI: 10.1111/bju.13887
  • Future of robotic surgery in urology
    • Authors: Jens J. Rassweiler; Riccardo Autorino, Jan Klein, Alex Mottrie, Ali Serdar Goezen, Jens-Uwe Stolzenburg, Koon H. Rha, Marc Schurr, Jihad Kaouk, Vipul Patel, Prokar Dasgupta, Evangelos Liatsikos
      Abstract: ObjectivesTo provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives.Materials and MethodsA non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors.ResultsThe relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results.ConclusionsSeveral console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the next 5 years. Future developments in the field of robotic surgery are likely to focus on the specific features of robotic arms, instruments, console, and video technology. The high technical standards of four da Vinci generations have set a high bar for upcoming devices. Ultimately, the implementation of these upcoming systems will depend on their clinical applicability and costs. How these technical developments will facilitate surgery and whether their use will translate into better outcomes for our patients remains to be determined.
      PubDate: 2017-04-22T01:10:58.21899-05:0
      DOI: 10.1111/bju.13851
  • Health-related quality of life outcomes from a contemporary prostate
           cancer registry in a large diverse population
    • Authors: Gary W. Chien; Jeff M. Slezak, Teresa N. Harrison, Howard Jung, Joy S. Gelfond, Chengyi Zheng, Edward Wu, Richard Contreras, Ronald K. Loo, Steven J. Jacobsen
      Abstract: ObjectiveTo assess the health-related quality of life (HRQoL) of patients with prostate cancer up to 24 months after treatment in a contemporary large diverse population.Patients and MethodsPatients with newly diagnosed prostate cancer from March 2011 to January 2014 in our healthcare system were included. The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire was administered before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment up to November 2014 for all methods of treatment. The Kruskall–Wallis test was used to compare the distribution of each EPIC-26 domain score at each time point, and mixed models were used to assess the overall scores over the period after treatment.ResultsIn all, 5 727 patients were included. There were data for 3 422, 2 329, 2 017, 1 922, 1 772, 1 260, and 837 patients before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment, respectively. At 1 month, bowel scores were the lowest for patients that had had radiation therapy, and urinary irritative symptoms were the lowest for those who had had brachytherapy. There were sexual function declines for all the treatment methods, with surgery having the steepest decline; open radical prostatectomy (ORP) had a greater decline than robot-assisted laparoscopic prostatectomy (RALP). Patients who underwent RALP had a better return of sexual function, approaching that of brachytherapy and radiation therapy at 24 months. Urinary incontinence (UI) also declined the most in surgical patients, with RALP patients improving slightly more than ORP patients at 12–24 months.ConclusionsPatients' HRQoL after prostate cancer treatment varies by treatment method. Notably, sexual function recovers most for RALP patients. UI remains worse at 24 months after surgery, compared to other methods of prostate cancer treatment.
      PubDate: 2017-04-19T23:48:02.468433-05:
      DOI: 10.1111/bju.13843
  • Long-term third-party assessment of results after continent cutaneous
           diversion with Lundiana pouch
    • Authors: Fredrik Liedberg; Sigurdur Gudjonsson, Abai Xu, Pär-Ola Bendahl, Thomas Davidsson, Wiking Månsson
      Abstract: ObjectivesTo investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch.Patients and MethodsComplications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files.ResultsA complication of Clavien–Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000–2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/188 patients (91%). In all, 16% of all patients required revisional surgery of the outlet to remain continent with an easily catheterisable pouch or to address stomal stenosis. The mean decrease in estimated glomerular filtration rate was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 mL/min/1.73 m2; P < 0.006). A disinterested third-party assessment revealed 10 postoperative complications, 17 re-operations during follow-up, and seven occasions of hospitalisation due to pyelonephritis (included in data above) not recorded at the primary data review.ConclusionsThe Lundiana pouch is associated with a high risk of re-operation, although the functional results are good. Independent review by a third party increased the validity of the outcome data.
      PubDate: 2017-04-19T02:21:33.022064-05:
      DOI: 10.1111/bju.13863
  • Establishing the pathways and indications for performing isotope bone
           scans in newly diagnosed intermediate-risk localised prostate cancer –
           results from a large contemporaneous cohort
    • Authors: Gokul V. KandaSwamy; Adam Bennett, Krishna Narahari, Owen Hughes, John Rees, Howard Kynaston
      Abstract: ObjectiveTo establish the pattern of isotope bone scan (BS) positivity in a large contemporaneous cohort of patients with newly diagnosed localised prostate cancer and compare with the European Association of Urology (EAU) guidelines, as imaging guidelines and clinical practice for using BS to stage newly diagnosed patients with intermediate-risk localised prostate cancer are not uniform in the literature.Patients and MethodsAll patients with newly diagnosed prostate cancer were discussed in a specialist multidisciplinary team meeting and were prospectively entered in a database. Patients were categorised based on D'Amico classification. All intermediate- and high-risk patients had pelvic magnetic resonance imaging and BS unless contraindicated. The BS positivity in each group was analysed and the negative predictive value (NPV) calculated. A cohort of 2720 patients between 2002 and 2015 was retrospectively analysed.ResultsOf 976 patients in the D'Amico intermediate-risk category, 99 had primary Gleason pattern 4. Only one of the 99 patients had a positive BS and there were no positive BS in patients with Gleason primary pattern 3 in the intermediate-risk category. On subgroup analysis, based on prostate-specific antigen (PSA) level and Gleason grade alone, the BS-positivity rate in patients with a PSA level of
      PubDate: 2017-04-19T02:21:30.61825-05:0
      DOI: 10.1111/bju.13850
  • Association between Type 2 diabetes, curative treatment and survival in
           men with intermediate and high risk localised prostate cancer
    • Authors: Danielle Crawley; Hans Garmo, Sarah Rudman, Pär Stattin, Björn Zethelius, Lars Holmberg, Jan Adolfsson, Mieke Van Hemelrijck
      Abstract: ObjectiveTo investigate if curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM), as little is known about if a diagnosis of T2DM influences receipt of curative treatment in men with localised PCa.Subjects/Patients and methodsData from Prostate Cancer database Sweden (PCBaSe) from men with T2DM and PCa (n=2,210) was used to compare with those with PCa only (n=23,071). All men had intermediate (T1-2, Gleason score 7 and/or PSA 10-20 ng/ml) or high risk (T3 and/or Gleason score 8-10 and/or PSA 20—50 ng/ml) localised PCa diagnosed between 1st January 2006 and 31st December 2014. Multivariate logistic regression was used to calculate odds ratios for receiving curative treatment in men with and without T2DM. Overall survival, up to 8 years of follow-up, was calculated for men with T2DM only and for men with T2DM and PCa.ResultsMen with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR: 0.78, 95%CI: 0.69-0.87). The 8 year overall survival was 79% and 33% respectively for men with T2DM and high risk PCa who did and did not receive curative treatment.ConclusionsMen with T2DM were less likely to receive curative treatment for localised intermediate and high risk PCa. Men with T2DM and high risk PCa who received curative treatment had substantially higher survival than those who did not. Some of the survival differences represent a selection bias of the healthiest patients to receive curative treatment. Clinicians need to interpret such data carefully and ensure that individual patients with T2DM and PCa are not under nor over treated unnecessarily.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:54.356936-05:
      DOI: 10.1111/bju.13880
  • Newsworthiness versus scientific impact: are the most highly cited urology
           papers the most widely disseminated in the media?
    • Authors: E M O'Connor; G J Nason, F O'Kelly, R P Manecksha, S Loeb
      Abstract: BackgroundDiscordance exists between scientific impact and media attention. Altmetrics are non-traditional measures of impact which are composite scores that include social media and traditional media sharing of an article.ObjectiveTo assess whether a correlation exists between newsworthiness (Altmetric score) and the scientific impact markers such as citation analysis, impact factors and levels of evidence.Materials and MethodsThe top 5 most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (scientific impact group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (media impact group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores.ResultsIn the scientific impact group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8, There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% CI 0.16-0.52, p
      PubDate: 2017-04-18T07:05:51.009867-05:
      DOI: 10.1111/bju.13881
  • Efficacy and safety of combinations of mirabegron and solifenacin compared
           with monotherapy and placebo in patients with overactive bladder (SYNERGY
    • Authors: Sender Herschorn; Christopher R Chapple, Paul Abrams, Salvador Arlandis, David Mitcheson, Kyu-Sung Lee, Arwin Ridder, Matthias Stoelzel, Asha Paireddy, Rob Maanen, Dudley Robinson
      Abstract: Overactive bladder (OAB) syndrome is characterized by urinary urgency, with or without urgency urinary incontinence, usually accompanied by increased daytime frequency and nocturia, in the absence of urinary tract infection (UTI) or other obvious pathology [1]. Urgency urinary incontinence is present in approximately one-third of cases [2], but is not a prerequisite. However, of all the OAB symptoms, it has the greatest impact on quality of life (QoL) [3, 4], and is associated with significantly lower productivity and higher healthcare resource utilization [5].This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:46.432278-05:
      DOI: 10.1111/bju.13882
  • Evaluation of Gender-Based Disparities from Initial Hematuria Presentation
           to Upper Tract Urothelial Carcinoma Diagnosis: Analysis of a Nationwide
           Insurance Claims Database
    • Authors: Meera R. Chappidi; Max Kates, Jeffrey J. Tosoian, Michael H. Johnson, Noah M. Hahn, Trinity J. Bivalacqua, Phillip M. Pierorazio
      Abstract: ObjectiveTo investigate the duration from initial hematuria presentation to upper tract urothelial carcinoma (UTUC) diagnosis and the effect of gender on this duration.Patients and MethodsPatients with hematuria claims in the year prior to UTUC diagnosis were identified in the MarketScan database (2010-2014). Delayed diagnosis was defined as >90 days from hematuria presentation to UTUC diagnosis. Multivariable Poisson regression models were used to determine factors associated with delayed UTUC diagnosis.ResultsAmong 1326 UTUC patients, 469(35.4%) experienced delayed diagnosis. Men (n=866) had a longer median interval from hematuria to diagnosis than women (60 vs. 49 days, p=0.04). In the multivariable model, male gender (RR=1.13 95%CI[0.95-1.34]) was not associated with delayed diagnosis while UTI (RR=1.52 95%CI[1.32-1.76]), nephrolithiasis (RR=1.23 95%CI[1.06-1.44]), new (RR=1.37 95%CI[1.12-1.66]), and recurrent prostate-related (RR=1.61 95%CI[1.23, 2.10]) diagnoses were. For men presenting to non-urologists, UTI (RR=1.44, 95%CI[1.22-1.71]), nephrolithiasis (RR=1.25 95%CI[1.05-1.49]), new (RR=1.41, 95%CI[1.12-1.78]) and recurrent (RR=1.94, 95%CI[1.45-2.58]) prostate-related diagnoses were associated with delayed diagnosis. However, for men presenting to urologists, nephrolithiasis (RR=1.08 95%CI[0.78-1.49]), new (RR=1.15, 95%CI[0.79-1.68]) and recurrent (RR=1.17, 95%CI[0.69-1.97]) prostate-related diagnoses were not associated while UTI (RR=1.74, 95% CI[1.31-2.31]) diagnosis was still associated with delayed diagnosis.ConclusionA UTUC diagnosis was made >90 days after hematuria presentation in approximately 1/3 of patients. Men experienced a longer median interval from hematuria to UTUC diagnosis compared to women, but male gender was not an independent predictor of delayed diagnosis. Benign diagnoses during hematuria work-up are strongly associated with delayed diagnosis, especially among patients initially seen by non-urologists. Future interventions should focus on development of non-invasive techniques to improve clinical risk stratification of patients presenting with hematuria and to educate practitioners, especially non-urologists, on the importance of a thoughtful hematuria evaluation and common mimickers of UTUC to help improve delays in diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:00:53.022152-05:
      DOI: 10.1111/bju.13878
  • Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and
           results of stone analysis in 1559 patients
    • Authors: Syed Adibul Hasan Rizvi; Manzoor Hussain, Syed Hassan Askari, Altaf Hashmi, Murli Lal, Mirza Naqi Zafar
      Abstract: ObjectiveTo report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup.Patients and MethodsWe retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients’ age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997–2005 and 2006–2014, to study the differences.ResultsOf the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast® master in 524 (15.4%). In the majority of patients (97.4%) a 18–22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate.ConclusionsThis is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.
      PubDate: 2017-04-17T02:26:12.615865-05:
      DOI: 10.1111/bju.13848
  • Risk-stratification based on magnetic resonance imaging and
           prostate-specific antigen density may reduce unnecessary follow-up biopsy
           procedures in men on active surveillance for low-risk prostate cancer
    • Authors: Arnout R. Alberts; Monique J. Roobol, Frank-Jan H. Drost, Geert J. Leenders, Leonard P. Bokhorst, Chris H. Bangma, Ivo G. Schoots
      Abstract: ObjectivesTo assess the value of risk-stratification based on magnetic resonance imaging (MRI) and prostate-specific antigen density (PSA-D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS).Patients and MethodsIn all, 210 men on AS with Gleason score 3 + 3 prostate cancer received a first MRI and if indicated [Prostate Imaging Reporting and Data System (PI-RADS) score ≥3] targeted biopsy (TBx) using MRI-transrectal ultrasonography (TRUS) fusion. The MRI was performed 3 months after diagnosis (group A: n = 97), at confirmatory biopsy (group B: n = 39) or at surveillance biopsy after one or more repeat TRUS-guided systematic biopsies (TRUS-Bx) (group C: n = 74). The primary outcome was upgrading to Gleason score ≥3 + 4 prostate cancer based on MRI ± TBx in groups A, B and C. Biopsy outcomes were stratified for the overall PI-RADS score and PSA-D to identify a subgroup of men in whom a biopsy could have been avoided as no Gleason score upgrading was detected.ResultsIn all, 134/210 (64%) men had a positive MRI and 51/210 (24%) men had Gleason score upgrading based on MRI-TBx. The percentage of Gleason score upgrading based on MRI-TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively groups A, B and C. Additional Gleason score upgrading detected by TRUS-Bx occurred in 8% (3/39) of men in group B and 6% (1/17) of men who received TRUS-Bx in group C. No Gleason score upgrading was detected by MRI-TBx in men with a PI-RADS score of 3 and a PSA-D of
      PubDate: 2017-04-04T01:50:27.420436-05:
      DOI: 10.1111/bju.13836
  • Prostate cancer, family history, and eligibility for active surveillance:
           A systematic review of the literature
    • Authors: J.M Telang; B.R Lane, M.L Cher, D.C Miller, J.M Dupree
      Abstract: BackgroundActive surveillance is an increasingly prevalent treatment choice for low-grade prostate cancer. The eligibility criteria for active surveillance are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for active surveillance treatment.ObjectiveTo determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance.MethodsPubMed searches of “family history and prostate cancer”, “family history and prostate cancer progression” and “factors of prostate cancer progression” were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis.ResultsReview of six publications suggests that family history does not increase the risk of prostate cancer progression. Six studies found that family history does not increase the risk of prostate cancer progression, while one study found that family history increases the risk of prostate cancer progression only in African Americans.ConclusionA family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for active surveillance. Further studies are needed to better understand the relationship between race, family history, and eligibility for active surveillance.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:39.847593-05:
      DOI: 10.1111/bju.13862
  • Cost-effectiveness of a new urinary biomarker-based risk score compared to
           standard of care in prostate cancer diagnostics – a decision analytical
    • Authors: Siebren Dijkstra; Tim M. Govers, Rianne J. Hendriks, Jack A. Schalken, Wim Van Criekinge, Leander Van Neste, Janneke P.C. Grutters, J.P. Michiel Sedelaar, Inge M. van Oort
      Abstract: ObjectiveTo assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx) to identify patients for transrectal ultrasound-guided biopsy (TRUSGB) and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUSGB.Materials and methodsA decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test versus SOC in men with a PSA >3 ng/ml. Transition probabilities, utilities and costs were derived from literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions.ResultsA diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade PCa resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses demonstrated that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUSGB only slightly influenced the outcome of the model.ConclusionBased on the currently available evidence, the reduction of overdiagnosis and overtreatment due to the use of the SelectMDx test in men with PSA>3 ng/ml may lead to a reduction in total costs per patient and a gain in QALYs.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:28.001061-05:
      DOI: 10.1111/bju.13861
  • Predictive value of the 2014 International Society of Urological Pathology
           grading system for prostate cancer in radical prostatectomy patients with
           long-term follow up
    • Authors: Judith Grogan; Ruta Gupta, Kate L Mahon, Phillip D Stricker, Anne-Maree Haynes, Warick Delprado, Jennifer Turner, Lisa G Horvath, James G Kench
      Abstract: ObjectiveTo assess the relationship between the ISUP 2014 grading system, biochemical relapse (BCR) and clinical relapse (CLR) following radical prostatectomy, to determine whether the 2014 ISUP grading system is a better predictor of survival compared to the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.Patients and methods635 radical prostatectomy cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow up (median 15.25 years, 0.3-26 years) were obtained. Log rank, Kaplan Meier, Cox regression and Harrell's concordance c-indices analyses were performed.ResultsAt a median follow up of 15 years, 276 (44%) of patients had BCR and 41 (7%) had clinical relapse. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 (9%) patients respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared to the 1992 Gleason system. Grade Group (HR: 4.9, p
      PubDate: 2017-03-28T10:05:35.933541-05:
      DOI: 10.1111/bju.13857
  • Cut-points for PSA doubling time in men with non-metastatic
           castration-resistant prostate cancer
    • Authors: Lauren E. Howard; Daniel Moreira, Amanda De Hoedt, William J. Aronson, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Martha K. Terris, Stephen J. Freedland
      Abstract: ObjectivesTo examine whether PSADT correlates with metastases, all-cause mortality (ACM), and prostate cancer-specific mortality (PCSM) and identify PSADT cut-points that can be used clinically for risk stratification in men with M0 CRPC.Materials and MethodsWe collected data on 441 men with M0 CRPC in 2000-2015 at five Veterans Affairs hospitals. Cox models were used to test the association between log-transformed PSADT and development of metastasis, ACM, and PCSM. To identify cut-points, we categorized PSADT into groups of every 3 months and then combined groups with similar hazard ratios.ResultsMedian follow-up was 28.3 months (IQR: 14.7-49.1). As a continuous variable, PSADT was associated with metastases, ACM, and PCSM (HR 1.40-1.68, all p
      PubDate: 2017-03-28T10:05:28.849829-05:
      DOI: 10.1111/bju.13856
  • Safety and efficacy of 2-weekly cabazitaxel in metastatic
           castration-resistant prostate cancer
    • Authors: A. Clément-Zhao; M. Auvray, H. Aboudagga, F. Blanc-Durand, A. Angelergues, Y. A. Vano, F. Mercier, N. El Awadly, B. Verret, C. Thibault, S. Oudard
      Abstract: ObjectivesTo evaluate the safety and efficacy of a 2-weekly cabazitaxel schedule in metastatic castration-resistant prostate cancer (mCRPC) patients.Materials and methodsFrom October 2013 to February 2016, 43 mCRPC patients were treated with cabazitaxel (16 mg/m2 on days 1 and 15 of a 4-week cycle) with G-CSF support. The safety profile and efficacy (prostate-specific antigen [PSA] response; biological, clinical or radiological progression-free survival [PFS] and overall survival [OS]) were analyzed.ResultsAll patients had received prior docetaxel and 79.1% abiraterone acetate. At inclusion, 46.5% were aged >70 years and 27.9% were ECOG-PS ≥2. Six patients stopped treatment because of toxicity. Grade ≥3 toxicities were: asthenia 16.3%; neutropenia 11.6%; thrombocytopenia 9.3%; diarrhoea 7%, anaemia 4.7%, febrile neutropenia 4.7% and haematuria 2.3%. 52.4% achieved a ≥30% PSA response, 40.5% had a ≥50% PSA response. Median OS was 15.2 months.ConclusionThis prospective pilot study suggests that cabazitaxel 16 mg/m² given bi-weekly has a manageable toxicity profile in docetaxel and abiraterone acetate pretreated mCRPC patients. A prospective phase III trial versus the standard cabazitaxel regimen is planned to confirm these results.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:01:23.141582-05:
      DOI: 10.1111/bju.13855
  • A core outcome set for localised prostate cancer effectiveness trials
    • Authors: Steven MacLennan; Paula R Williamson, Hanneke Bekema, Marion Campbell, Craig Ramsay, James N'Dow, Sara MacLennan, Luke Vale, Philipp Dahm, Nicolas Mottet, Thomas Lam, , Paul Abel, Hashim U. Ahmed, Gary Akehurst, Robert Almquist, Karl Beck, David Budd, Steven Canfield, James Catto, Philip Cornford, William Cross, Alexander Ewen, Judith Grant, Rakesh Heer, David Hurst, Rob Jones, Roger Kockelbergh, Andrew Mackie, Graham MacDonald, Alan McNeill, Malcolm Mason, Sam McClinton, Duncan McLaren, Hugh Mostafid, Ian Pearce, Linda Pennet, Justine Royle, Hans Schreuder, Grant D. Stewart, Henk van der Poel, Kevin Wardlaw, Thomas Wiegel
      Abstract: ObjectiveTo develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer.BackgroundMany treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials.Subjects and methodsA list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients.ResultsThe final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere.ConclusionWe have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T09:40:37.702254-05:
      DOI: 10.1111/bju.13854
  • Sexuality in men with exstrophy
    • Authors: Christopher R.J. Woodhouse
      Pages: 301 - 301
      PubDate: 2017-08-17T03:57:16.77779-05:0
      DOI: 10.1111/bju.13893
  • Positive messages for bladder cancer management in negative sentinel lymph
           node study
    • Authors: Tim Dudderidge
      Pages: 302 - 303
      PubDate: 2017-08-17T03:57:18.142635-05:
      DOI: 10.1111/bju.13745
  • Is choline-based PET imaging still relevant in recurrent prostate
    • Authors: Nathan Lawrentschuk; Julia M. Corfield, Andrew Scott
      Pages: 303 - 304
      PubDate: 2017-08-17T03:57:16.877666-05:
      DOI: 10.1111/bju.13813
  • Salvage lymph node dissection: if yes, robotics'
    • Authors: Nazareno Suardi; Francesco Montorsi
      Pages: 304 - 305
      PubDate: 2017-08-17T03:57:14.394697-05:
      DOI: 10.1111/bju.13789
  • The utility of microRNAs as biomarkers in predicting progression and
           survival in patients with clear-cell renal cell carcinoma
    • Authors: Firas G. Petros; Christopher J.D. Wallis
      Pages: 305 - 307
      PubDate: 2017-08-17T03:57:17.695331-05:
      DOI: 10.1111/bju.13931
  • Robot-assisted versus open radical prostatectomy: the day after
    • Authors: Vincenzo Ficarra; Giacomo Novara, Prokar Dasgupta
      First page: 308
      Abstract: Contrary to the available systematic reviews of non-randomized comparative studies, the recent Australian RCT demonstrated that robot-assisted (RARP) and retropubic radical prostatectomy (RRP) yield similar functional outcomes at 12 weeks follow-up. Conversely, the same trial confirmed that RARP has been associated with lower estimated blood loss (EBL), better pain control and equivalent complication rate in comparison with RRP. The
      Authors discussed some critical aspects influencing the interpretation of the results of the Royal Brisbane & Women's Hospital (RBWH) trial and the implications for patients, urologists and health system providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:52:30.860797-05:
      DOI: 10.1111/bju.13891
  • Prostate specific membrane antigen (PSMA) from diagnostic to therapeutic
           target: radionuclide therapy comes of age in prostate cancer
    • Authors: John A. Violet; Michael S. Hofman
      First page: 310
      Abstract: Without doubt, molecular imaging using PET/CT directed against prostate specific membrane antigen (PSMA) has generated much interest for its impressive accuracy in detecting prostate cancer, particularly for biochemical recurrence[1]. PSMA expression is up regulated in advanced prostate cancer, including metastatic castration resistant prostate cancer (mCRPC), and provides a novel therapeutic target for radionuclide therapy directed towards PSMA-avid disease.Radionuclide therapy relies on the identification of a suitable tumour associated ‘target’ and an appropriate ‘vehicle’ that can bind to this with high selectivity and specificity to allow delivery of a therapeutic radionuclide.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-05T15:57:55.201155-05:
      DOI: 10.1111/bju.13871
  • Cytoreductive therapy in the era of targeted therapies: a review
    • Authors: Nisha Pindoria; Nicholas Raison, Gideon Blecher, Rick Catterwell, Prokar Dasgupta
      First page: 320
      Abstract: In the pre-targeted therapy era, palliative cytoreductive nephrectomy combined with cytokine immunotherapy was the standard treatment protocol for the management of metastatic renal cell carcinoma. The introduction of targeted therapies has improved response rates, median survival and overall prognosis when compared to immunotherapy. The role of cytoreductive nephrectomy in providing an independent survival advantage when used alongside immunotherapy has been demonstrated by two randomised controlled trials. However, with the new shift in improved treatment outcomes from cytokine immunotherapy to targeted therapies, the continuing role of cytoreductive nephrectomy as a viable surgical treatment modality remains controversial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:15:28.239992-05:
      DOI: 10.1111/bju.13860
  • Dishevelled segment polarity protein 3 (DVL3): a novel and easily
           applicable recurrence predictor in localised prostate adenocarcinoma
    • Authors: Pil-Jong Kim; Ji Y. Park, Hong-Gee Kim, Yong Mee Cho, Heounjeong Go
      Pages: 343 - 350
      Abstract: ObjectiveTo identify new biomarkers for biochemical recurrence (BCR) of prostate adenocarcinoma.Patients and MethodsClinical information of 500 patients with prostate adenocarcinoma and their 152 RNA-sequencing and protein-array data from The Cancer Genome Atlas (TCGA) were separated into a discovery set and a validation set. Each dataset was analysed according to the Gleason grade groups reflecting BCR. The results obtained from the analysis using TCGA dataset were confirmed by immunohistochemistry analyses of a confirmation cohort composed of 395 patients with localised prostate adenocarcinoma.ResultsTCGA discovery set was subgrouped into lower- and higher-risk groups for recurrence-free survival (RFS) (P < 0.001). Cyclin B1 (CCNB1), dishevelled segment polarity protein 3 (DVL3), paxillin (PXN), RAF1, transferrin, X-ray repair cross complementing 5 (XRCC5) and BIM had lower expression in the lower-risk group than that in the higher-risk group (all, P < 0.05). In TCGA validation set, CCNB1, DVL3, transferrin, XRCC5 and BIM were also differently expressed between the two groups. Immunohistochemically, DVL3 positivity was associated with high prostate-specific antigen (PSA) levels, resection margin involvement, and BCR (all, P < 0.05). A high Gleason score indicated a marginal relationship (P = 0.055). BIM positivity was related to high PSA levels, lymphovascular invasion, and BCR (all, P < 0.05). Both DVL3 positivity (P = 0.010) and BIM positivity (P = 0.024) were associated with shorter RFS, but statistical significance was lost when the multivariate Cox regression model included all patients. In the lower-risk group, the multivariate Cox model confirmed that DVL3 was an independent predictor for poor RFS (hazard ratio 1.80, P = 0.040), and the concordance index (C-index) was 0.805.ConclusionsDVL3 and BIM were expressed in patients with a higher risk of BCR. DVL3 may be a novel and easily applicable recurrence predictor of localised prostate adenocarcinoma.
      PubDate: 2017-02-10T04:25:27.362946-05:
      DOI: 10.1111/bju.13783
  • Anatomical patterns of recurrence following biochemical relapse after
    • Authors: William C. Jackson; Neil B. Desai, Ahmed E. Abugharib, Vasu Tumati, Robert T. Dess, Jae Y. Lee, Shuang G. Zhao, Moaaz Soliman, Michael Folkert, Aaron Laine, Raquibul Hannan, Zachary S. Zumsteg, Howard Sandler, Daniel A. Hamstra, Jeffrey S. Montgomery, David C. Miller, Mike A. Kozminski, Brent K. Hollenbeck, Jason W. Hearn, Ganesh Palapattu, Scott A. Tomlins, Rohit Mehra, Todd M. Morgan, Felix Y. Feng, Daniel E. Spratt
      Pages: 351 - 357
      Abstract: ObjectivesTo characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT).Patients and MethodsA multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months.ResultsThe median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively.ConclusionsWe demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
      PubDate: 2017-02-26T22:30:35.404518-05:
      DOI: 10.1111/bju.13792
  • Who is at risk of death from nephrectomy' An analysis of thirty-day
           mortality after 21 380 nephrectomies in 3 years of the British Association
           of Urological Surgeons (BAUS) National Nephrectomy Audit
    • Authors: Archie Fernando; Sarah Fowler, Mieke Van Hemelrijck, Tim O'Brien,
      First page: 358
      Abstract: ObjectiveTo ascertain contemporary overall and differential thirty-day mortality (TDM) rates after all types of nephrectomy in the UK, and to identify potential new risk factors for death.Patients and MethodsWe conducted a retrospective analysis of the 110 deaths that occurred within 30 days of surgery out of the total of 21 380 nephrectomies performed, and calculated the odds ratio (OR) and 95% confidence interval (CI) for TDM based on peri-operative characteristics.ResultsThe overall TDM rate was 110/21380 (0.5%). The TDM rates after radical, partial, simple nephrectomy and nephro-ureterectomy were 0.6% (63/11057), 0.1% (4/3931), 0.4% (11/2819) and 0.9% (28/3091), respectively. TDM increased with age, stage, estimated blood loss (EBL), operating time and performance status. EBL of 1–2 L was associated with a greater risk of TDM than EBL of 2–5 L (OR 1.38; 95% CI 1.03–2.24). Conversion from minimally invasive surgery was associated with higher risk than non-conversion (OR 2.53; 95% CI 1.14–4.51. Curative surgery was safer than cytoreductive surgery (OR 0.31; 95% CI 0.18–0.54). There was an association between surgical volume and TDM.ConclusionsThis study provides contemporary insights into the true risks of all types of nephrectomy. The TDM rate after nephrectomy in the UK appears acceptably low at 0.5%. Established risk factors were confirmed and the following novel risk factors were identified: modest EBL (1–2 L) and conversion from minimally invasive surgery.
      PubDate: 2017-04-24T23:06:15.328868-05:
      DOI: 10.1111/bju.13842
  • High concordance of findings obtained from transgluteal magnetic resonance
           imaging - and transrectal ultrasonography-guided biopsy as compared with
           prostatectomy specimens
    • Authors: Stefan Steurer; Sebastian Dwertmann Rico, Ronald Simon, Sarah Minner, Maria Christina Tsourlakis, Till Krech, Christina Koop, Markus Graefen, Hans Heinzer, Meike Adam, Hartwig Huland, Thorsten Schlomm, Guido Sauter, Agron Lumiani
      Pages: 365 - 376
      Abstract: ObjectivesTo determine the utility of our transgluteal magnetic resonance imaging (MRI)-guided prostate biopsy approach.Patients and MethodsA total of 960 biopsy series, taken within the period of 1 year, were evaluated, including 301 MRI-guided and 659 transrectal ultrasonography (TRUS)-guided biopsies.ResultsThe positivity rate and proportion of high grade cancers were significantly higher in MRI-guided than in TRUS-guided biopsies. Of 301 MRI-guided biopsies, 65.4% contained cancer while 57.2% of 659 TRUS biopsies contained cancer (P = 0.016). Gleason grade 3 + 3 = 6 disease was observed in 16.8% of 197 MRI-guided and in 36.1% of 377 TRUS-guided biopsies (P < 0.001). There was also a markedly higher quantity of cancer tissue in MRI-guided biopsies. In all cancers, the mean cancer surface area was 64.8 ± 51.6 mm2 in MRI-guided biopsies as compared with 23.0 ± 31.4 mm2 in non-MRI-guided biopsies (P < 0.001). With respect to the tissue quantity, superiority of MRI-guided biopsy was highest in Gleason grade 3 + 3 = 6 cancers (20.9 ± 27.9 vs 5.1 ± 10.2 mm2; P < 0.001) and in Gleason grade 3 + 4 = 7 cancers (59.7 ± 38.0 vs 17.7 ± 18.4 mm2; P < 0.001). Comparison of biopsy Gleason grades with findings in prostatectomy specimens was possible in 80 patients with MRI-guided and in 170 patients with non-MRI-guided biopsies. This comparison showed a very high but almost identical concordance of TRUS- and MRI-guided biopsies with the prostatectomy specimen findings. With both approaches, undetected high-risk cancers were present in ~10% of patients with low-risk biopsy results. A significant difference was observed, however, in the proportion of patients who had clinically insignificant cancers and who underwent surgery. The proportion of patients with Gleason grade 3 + 3 = 6 carcinoma in their prostatectomy specimen was 11.2% in the post-TRUS biopsy cohort, but only 2.5% in the post-MRI biopsy cohort (P = 0.021).ConclusionMRI-guided transgluteal prostate biopsy has a high detection rate for high-risk carcinomas, while the risk of detecting clinically insignificant carcinomas appears to be reduced. This may by itself lead to a reduction of unnecessary prostatectomies. Overtreatment may be further avoided by better applicability of molecular testing to MRI-guided biopsies because of the excessive amount of tissue available for analysis, especially in patients with potential low-risk carcinomas.
      PubDate: 2017-04-11T22:06:07.712714-05:
      DOI: 10.1111/bju.13840
  • Robotic salvage retroperitoneal and pelvic lymph node dissection for
           ‘node-only’ recurrent prostate cancer: technique and initial series
    • Authors: Andre Abreu; Carlos Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir Gill
      Pages: 401 - 408
      Abstract: ObjectivesTo describe the technique of robot-assisted high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer.Patients and MethodsIn all, 10 patients underwent robot-assisted sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by 11C-acetate positron emission tomography/computed tomography imaging. Our anatomical 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 four prospectively assigned anatomical zones.ResultsThe median operative time was 4.8 h, estimated blood loss 100 mL and hospital stay 1 day. No patient had an intraoperative complication, open conversion or blood transfusion. Three patients had spontaneously resolving Clavien–Dindo grade II postoperative complications. The mean (range) number of nodes excised per patient was 83 (41–132) and mean (range) number of positive nodes per patient was 23 (0–109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomical level I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, the median PSA level had decreased by 83% at the 2-month follow-up.ConclusionThe initial series of robot-assisted sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robot-assisted technical details for an anatomical LND template up to the renal vessels are presented. Longer follow-up is necessary to assess oncological outcomes.
      PubDate: 2017-01-14T08:01:11.419146-05:
      DOI: 10.1111/bju.13741
  • Prevalence and risk factors of symptomatic urinary tract infection after
           endoscopic incision for the treatment of ureterocele in children
    • Authors: Kimihiko Moriya; Michiko Nakamura, Yoko Nishimura, Yukiko Kanno, Takeya Kitta, Masafumi Kon, Nobuo Shinohara
      First page: 409
      Abstract: ObjectiveTo clarify the impact of endoscopic incision for ureterocele as an initial procedure, retrospective chart review was performed focusing on the prevalence and risk factors of symptomatic urinary tract infection after endoscopic incision.Materials and methodsAmong children with ureterocele who were managed between September 1994 and April 2016, patients who were observed conservatively without additional surgical management after endoscopic incision were included in this study. Type of ureterocele was divided into intravesical and ectopic. Symptomatic urinary tract infection was defined as either recurrent non-febrile or febrile urinary tract infection. Statistical analysis was performed using the Cox proportional Hazard model or Kaplan-Meier Curve with log-rank test for evaluation of the prevalence and risk factors.ResultsThirty-six patients met the inclusion criteria. Median age at endoscopic incision was 8.9 months. Eleven children had symptomatic urinary tract infections (febrile in 9 and recurrent non-febrile in 2) during median follow-up of 75.5 months. Initial symptomatic urinary tract infection in each child occurred within 25 months after endoscopic incision. Symptomatic urinary tract infection-free rate after endoscopic incision was 65.6%. The risk factors for symptomatic urinary tract infection were female gender, duplex system, ectopic ureterocele, and unchanged hydronephrosis after EI.ConclusionsThe current study demonstrated the critical period and risk factors for symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele. These results suggest that when conservative management is indicated after endoscopic incision, patients, especially those with risk factors, should be followed carefully at least for 25 months after endoscopic incision for symptomatic urinary tract infection.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:29.917069-05:
      DOI: 10.1111/bju.13884
  • Long-Term Sexual Health Outcomes in Men with Classic Bladder Exstrophy
    • Authors: Timothy S Baumgartner; Kathy M Lue, Pokket Sirisreetreerux, Sarita Metzger, Ross G Everett, Sunil S Reddy, Ezekiel Young, Uzoma A Anele, Cameron E Alexander, Nilay M Gandhi, Heather N Di Carlo, John P Gearhart
      First page: 422
      Abstract: ObjectivesTo identify the long-term sexual health outcomes and relationships in men born with classic bladder exstrophy (CBE).Materials And MethodsA prospectively-maintained institutional database comprised of 1248 patients with exstrophy-epispadias was utilized. Male patients 18 years or older with CBE were included. A 42-question survey was designed utilizing a combination of demographic information and previously validated questionnaires.ResultsA total of 215 men inclusion criteria, of which 113 (53%) completed the questionnaire. The mean age of the participants was 32 years. Ninety-six (85%) of the respondents had been sexually active in their lifetime, of which only 66 (58%) were moderately to very satisfied with their sex life. The average Sexual Health Inventory for Men score was 19.8. The Penile Perception Score revealed all aspects of assessment scored an average between very dissatisfied and satisfied.Thirty-two respondents (28%) had attempted to obtain pregnancy with their partner. Twenty-three (20%) were successful in achieving pregnancy, while 31 (27%) reported a confirmed fertility problem. 31 (27%) reported having a semen analysis or post-ejaculatory urinalysis. Of the samples collected, only 4 individuals reported azoospermia.ConclusionCBE patients have many of the same sexual and relationship successes and concerns as the general population. This is invaluable data to provide to both the parents of boys with CBE, as it is to the patients themselves as they transition to adulthood.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T17:50:32.965824-05:
      DOI: 10.1111/bju.13866
  • Profiling microRNA from nephrectomy and biopsy specimens: predictors of
           progression and survival in clear cell renal cell carcinoma
    • Authors: Casey G. Kowalik; Drew A. Palmer, Travis B. Sullivan, Patrick A. Teebagy, John M. Dugan, John A. Libertino, Eric J. Burks, David Canes, Kimberly M. Rieger-Christ
      First page: 428
      Abstract: ObjectiveTo identify miRNA characteristic of metastatic clear cell renal cell carcinoma (ccRCC) and those indicative of cancer specific survival in nephrectomy and biopsy specimens. We also sought to determine if a miRNA panel could differentiate benign from ccRCC tissue.Materials and MethodsRNA was isolated from nephrectomy and kidney biopsy specimens (n=156; n=46 respectively). Samples were grouped: benign, non-progressive and progressive ccRCC. MiRNA were profiled by microarray and validated by qRT-PCR. Biomarker signatures were developed to predict cancer status in nephrectomy and biopsy specimens. Cancer specific survival was examined using Kaplan-Meier and Cox proportional hazards analyses.ResultsMicroarray analysis revealed 20 differentially expressed miRNA comparing non-progressive with progressive tumors. A biomarker signature validated in nephrectomy specimens had a sensitivity of 86.7% and a specificity of 92.9% for differentiating benign and ccRCC. A second signature differentiated non-progressive versus progressive ccRCC with a sensitivity of 93.8% and a specificity of 83.3%. These biomarkers also discriminated cancer status in biopsy specimens. Levels of miR-10a-5p, -10b-5p, and -223-3p were associated with cancer specific survival.ConclusionThis study identified miRNA differentially expressed in ccRCC samples; as well as those correlating with cancer specific survival. Biomarkers identified in this study have the potential to identify patients who are likely to have progressive ccRCC, and although preliminary, these results may aid in differentiating aggressive and indolent ccRCC based on biopsy specimens.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:44.453137-05:
      DOI: 10.1111/bju.13886
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
Home (Search)
Subjects A-Z
Publishers A-Z
Your IP address:
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016