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Journal Cover BJU International
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   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  [1612 journals]
  • Improving clinical prognostic stratification models for men with prostate
           cancer: a practical step closer to more individualised care without added
    • Authors: Vincent J Gnanapragasam; Anne Y Warren
      Abstract: Risk stratification remains the cornerstone in deciding management for men with non-metastatic prostate cancer. Current risk stratification systems however have barely changed in two decades and have shown significant shortcomings with regards intra and inter-group heterogeneity in disease behaviour and therapy outcomes. A number of sophisticated and expensive molecular tests have been developed and more are being investigated to address this gap. However, new thinking on how to better use existing pathological information and refining clinical risk models may already offer significant incremental benefits in improving prognostic prediction without additional costs or resourcing. In this comment we highlight some recent research which may help inform this issue.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-22T02:40:59.868421-05:
      DOI: 10.1111/bju.13721
  • Long-term outcome of the adjustable transobturator male system (ATOMS):
           results of a European multicentre study
    • Authors: Alexander Friedl; Sandra Mühlstädt, Roman Zachoval, Alessandro Giammò, Danijel Kivaranovic, Maximilian Rom, Paolo Fornara, Clemens Brössner
      Abstract: ObjectiveTo evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS®, Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting.Patients and MethodsIn all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (
      PubDate: 2016-11-21T01:18:16.69795-05:0
      DOI: 10.1111/bju.13684
  • Low-dose desmopressin combined with serum sodium monitoring can prevent
           clinically significant hyponatraemia in patients treated for nocturia
    • Authors: Kristian Vinter Juul; Anders Malmberg, Egbert der Meulen, Johan Vande Walle, Jens Peter Nørgaard
      Abstract: ObjectiveTo explore risk factors for desmopressin-induced hyponatraemia and evaluate the impact of a serum sodium monitoring plan.Subjects and methodsThis was a meta-analysis of data from three clinical trials of desmopressin in nocturia. Participants received placebo or desmopressin orally disintegrating tablet ([ODT], 10–100 μg). Incidence of serum sodium
      PubDate: 2016-11-15T10:15:38.146759-05:
      DOI: 10.1111/bju.13718
  • Introduction of robotically-assisted radical cystectomy within an
           established enhanced recovery programme
    • Authors: Catherine Miller; Nicholas J Campain, Rachel Dbeis, Mark Daugherty, Nicholas Batchelor, Elizabeth Waine, John S McGrath
      Abstract: ObjectivesIn recent years, there has been rapid adoption of robotically-assisted surgery (RAS) for the treatment of pelvic urological cancers. This is particularly true for radical prostatectomy (RP) where robotically-assisted laparoscopic prostatectomy (RALP) has become the predominant surgical approach across England. Despite this, less than 15% of patients undergoing radical cystectomy (RC) in England in 2014 underwent a robotically-assisted radical cystectomy (RARC). However, as expertise in RAS spreads, an increasing number of cancer centres are now adopting this approach for patients undergoing RC. The current paper describes the implementation phase of a robotically-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS).Patients and Methods114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 (ileal conduit (n= 97) and orthotopic neobladder (n=17)). Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied. All patients were managed on the Exeter Enhanced Recovery Pathway (ERP) in a unit where embedded ER practice was already established. Data were collected prospectively on the national cystectomy registry - the British Association of Urological Surgeons (BAUS) Complex Operations Dataset.ResultsRARC was technically feasible in all but one case. Mean operative time period was 3-5 hours with an overall transfusion rate of 8.8%. Higher-grade complications (Clavien-Dindo grade III-IV) were seen in 18.4% of patients with a 30-day mortality of 0.9%. Median LOS following RARC was 7 days (range 3-68) with a re-admission rate of 18.4%.ConclusionsThe current series demonstrates that RARC can be safely implemented in a unit experienced in RAS. Case-selection in this setting is not deemed necessary. There are benefits in terms of lower transfusion rates and reduced LOS. The side-effect profile appears to differ from that of ORC and, despite the fact that complication rates are equivalent, ‘technical’ complications are over-represented in the RAS group. As such, they should improve with experience, recognition and modification of surgical technique. ERPs can be safely applied to all patients undergoing RARC to maximize the benefits of minimally-invasive surgery.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-15T01:31:46.730564-05:
      DOI: 10.1111/bju.13702
  • Guideline of Guidelines Priapism
    • Authors: Asif Muneer; David Ralph
      Abstract: Priapism is defined as a prolonged penile erection lasting for more than 4 hours in the absence of sexual stimulation and remains despite orgasm. Current priapism guidelines for priapism have been published following a comprehensive literature review and expert consensus by the American Urological Association (AUA) and by an evidence review according to the Oxford Centre for Evidence based medicine by the European Association of Urology (EAU). Although there are both local and regional guidelines available throughout the UK, these tend to be adaptations of guidelines from larger urology organisations and there are currently no guidelines from the British Association of Urological Surgeons (BAUS).This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-14T10:05:26.472748-05:
      DOI: 10.1111/bju.13717
  • Prostatic Urethral Lift (PUL) vs Transurethral Resection of the Prostate
           (TURP): 2 Year Results of the BPH6 Prospective, Multi-Center, Randomised
    • Authors: C Gratzke; N Barber, M Speakman, R Berges, U Wetterauer, D Greene, K-D Sievert, C Chapple, J Sonksen
      Abstract: ObjectivesTo compare Prostatic Urethral Lift (PUL) to Transurethral Resection of the Prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.Subjects/patients and methods80 patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) enrolled in a prospective, randomised, controlled, non-blinded study conducted at 10 European centers. The BPH6 responder endpoint assessed symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation, and safety. Additional evaluations of patient perspective, quality of life, and sleep were prospectively collected, analyzed, and presented here for the first time.ResultsSignificant improvements in International prostate symptom score (IPSS), IPSS quality of life (QoL), BPH Impact Index (BPH II), and peak flow rate were observed in both arms through the 2 year follow up. TURP IPSS and peak flow change were superior to PUL. IPSS QoL and BPH II improvements were not statistically different. PUL resulted in superior quality of recovery, ejaculatory function preservation, and performance on the composite BPH6 index. Ejaculatory function bother scores did not demonstrate statistically significant change in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep starting at the 6 month interval and continuing to the end of the study. Over the two year follow up, 6 PUL subjects (13.6%) and 2 TURP subjects (5.7%) underwent secondary treatment for return of LUTS. Most patients perceived LUTS improvement and would recommend their treatment procedure to a friend.ConclusionPUL was compared to TURP in a randomised, controlled study which further characterized both modalities so that care providers and patients can better understand the net benefit when selecting a treatment option.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-14T01:45:33.882162-05:
      DOI: 10.1111/bju.13714
  • Value of 111In-PSMA-radioguided surgery for salvage lymphadenectomy in
           recurrent prostate cancer: correlation with histopathology and clinical
    • Authors: Isabel Rauscher; Charlotte Düwel, Martina Wirtz, Margret Schottelius, Hans-Jürgen Wester, Kristina Schwamborn, Bernhard Haller, Markus Schwaiger, Jürgen E. Gschwend, Matthias Eiber, Tobias Maurer
      Abstract: ObjectivesTo evaluate the use of 111In-labeled PSMA-I&T based radioguided surgery (111In-PSMA-RGS) for salvage surgery in recurrent prostate cancer (PC) using comparison of intraoperative γ-probe measurements to histopathological results of dissected specimens. Furthermore, the success of 111In-PSMA-RGS was determined by postoperative prostate-specific antigen (PSA) responses, PC-specific treatment-free survival as well as postoperative complication rates.Patients and MethodsIn this study, 31 consecutive patients with localized recurrent PC undergoing salvage surgery with PSMA-targeted RGS using an 111In-labeled PSMA ligand were retrospectively included from April 2014 to July 2015. Preoperative median PSA was 1.3 (IQR: 0.57-2.53ng/ml, range: 0.2–13.9ng/ml). Results of ex vivo radioactivity rating (positive vs. negative) of resected tissue specimens were compared to findings of postoperative histological analysis. Best PSA response without additional treatment was determined following 111In-PSMA-RGS and salvage-surgery related postoperative complications and PC-specific additional treatments were recorded.ResultsIn 30/31 patients, 111In-PSMA-RGS allowed intraoperative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. By 111In-PSMA-RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer-free, 4 were false negative and 6 false positive compared to histological evaluation. Follow-up information was available for 30/31 patients. PSA decline >50% and >90% was observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to
      PubDate: 2016-11-10T13:10:30.161807-05:
      DOI: 10.1111/bju.13713
  • Risk Stratification – a Tool to predict the Course of Active
           Surveillance for Localized Prostate Cancer?
    • Authors: Jan Herden; Axel Heidenreich, Lothar Weissbach
      Abstract: ObjectiveTo investigate a cohort of patients under active surveillance (AS) for localized prostate cancer (PCa) concerning possible differences in discontinuation rates, subsequent therapies, reasons for intervention, and pathologic findings after deferred surgery depending on stratification in very low-, low-, and intermediate/high-risk PCa.Patients and MethodsHAROW is a non-interventional, observational, outcomes research study on the management of localized PCa in the community setting. Fourhundred sixtyeight (468) Patients were prospectively enrolled in the HAROW study, with a mean Follow-up of 28.5 months. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6-months intervals.ResultsOf 468 AS patients, 244 qualified for the very low-, 142 for the low- and 82 for the intermediate/high-risk group. Onehundred twelve (112) patients discontinued AS. Discontinuation rates were 25.4% in very low-, 21.1% in low- and 24.4% in intermediate/high-risk groups (p=0.633). Main reasons for intervention were biopsy upgrade and/or PSA elevation in the very low- and in the low-risk groups; and patient preference in the intermediate/high-risk group (p
      PubDate: 2016-11-10T13:10:24.543681-05:
      DOI: 10.1111/bju.13715
  • Utility of Patient-Specific Silicone Renal Models for Planning and
           Rehearsal of Complex Tumor Resections Prior to Robotic-Assisted
           Laparoscopic Partial Nephrectomy
    • Authors: Friedrich-Carl Rundstedt; Jason M. Scovell, Smriti Agrawal, Jacques Zaneveld, Richard E. Link
      Abstract: ObjectiveSurgical planning for robotic partial nephrectomy (RALPN) depends on preoperative imaging and interpretation of spatial relationships between tumor and renal anatomy. We describe our experience using patient specific tissue-like kidney models created with advanced 3D printing technology for preoperative planning and surgical rehearsal prior to RALPN .Patients and MethodsA feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D print models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction we generated pre-surgical models out of a silicone-based material. All surgical rehearsals were performed using the Davinci™ robotic system prior to the actual procedure. To determine construct validity, we compared resection times between the model and actual tumor in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumor volume resected for each model and patient tumor.ResultsWe generated patient-specific models for 10 patients with complex tumor anatomy. Nephrometry scores were between 7 and 11 with an average maximal tumor diameter of 40.6 mm. Resection times between model and patient (6:58 min vs. 8:22 min, p=0.16) and tumor volumes between computer model, excised model, and excised tumor (38.88 mm3 vs. 38.50 mm3 vs. 41.79 mm3, p=0.98) were not significantly different.ConclusionsWe have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals and improve surgical training.
      PubDate: 2016-11-10T13:05:31.513813-05:
      DOI: 10.1111/bju.13712
  • Competency Based Training in Robotic Surgery: Benchmark Scores for Virtual
           Reality Robotic Simulation
    • Authors: N Raison; K Ahmed, N Fossati, N Buffi, A Mottrie, P Dasgupta, H der Poel
      Abstract: ObjectivesTo develop benchmark scores of competency for use within a competency-based virtual reality (VR) robotic training curriculum.Subjects and MethodsThis longitudinal, observational study analysed results from 9 EAU hands-on-training courses in VR simulation. 223 participants ranging from novice to expert robotic surgeons completed 1565 exercises. Competency was set at 75% of the mean expert score. Benchmark scores for all general performances metrics generated by the simulator were calculated. Assessment exercises were selected by expert consensus and through learning curve analysis. Three basic skill and two advanced skill exercises were identified.ResultsBenchmark scores based on expert performance offered viable targets for novice and intermediate trainees in robotic surgery. Novice participants met the competency standards for most basic skill exercises however advanced exercises were significantly more challenging. Intermediate participants performed better across the seven metrics but still fell short of the benchmark standard in the more difficult exercises.ConclusionBenchmark scores derived from expert performances offer relevant and challenging scores for trainees to achieve during VR simulation training. Objective feedback allows both participants and trainers to monitor educational progress and ensures that training remains effective. Furthermore, the well-defined goals set through benchmarking offer clear targets for trainees and enable training to move to a more efficient competency based curriculum.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:25.305904-05:
      DOI: 10.1111/bju.13710
  • Multicentre evaluation of target and systematic biopsies using Magnetic
           Resonance and Ultrasound Image-Fusion guided Transperineal Prostate Biopsy
           in patients with a previous negative biopsy
    • Authors: N L Hansen; C Kesch, T Barrett, B Koo, J P Radtke, D Bonekamp, HP Schlemmer, A Y Warren, K Wieczorek, M Hohenfellner, C Kastner, B Hadaschik
      Abstract: ObjectivesTo evaluate the detection rates of targeted and systematic biopsies in magnetic resonance (MRI) and transrectal ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal US guided biopsies in two high-volume centres.Patients and methodsTwo centre, prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided target and systematic saturation biopsy from 2012 to 2015. MRI was reported according to PIRADS Version 1. Detection of Gleason score (GS) 7-10 cancer (PCa) on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.ResultsMedian PSA was 9.0 (IQR 6.7-13.4) ng/ml. PIRADS 3-5 MRI lesions were reported in 343 (70%) patients. GS 7-10 PCa was detected in 149 (31%). PPV for detecting GS 7-10 PCa was 0.20 (±0.07) for PIRADS 3, 0.32 (±0.09) for PIRADS 4, and 0.70 (±0.08) for PIRADS 5. NPV of PIRADS 1-2 was 0.92 (±0.04) for GS 7-10 and 0.99 (±0.02) for GS ≥ 4+3 cancer. Systematic biopsies alone found 125/138 (91%) GS 7-10 cancers. In patients with suspicious lesions (PIRADS 4-5) on MRI, systematic biopsies would not have detected 12/113 significant PCa (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PIRADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of GS 7-10, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA-density improved the AUC of PIRADS from 0.822 to 0.846.ConclusionIn patients with high probability MRI lesions, the highest detection rates of GS 7-10 cancer still required combined targeted and systematic MRI/TRUS image-fusion, however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA-density and a negative MRI read by experienced radiologists.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-10T12:45:23.079047-05:
      DOI: 10.1111/bju.13711
  • 11C-acetate PET/CT imaging for detection of recurrent disease following
           radical prostatectomy or radiotherapy in patients with prostate cancer
    • Authors: L. Esch; M. Fahlbusch, P. Albers, H. Hautzel, V. Müller-Mattheis
      Abstract: ObjectivesTo evaluate the effectiveness of CT-matched 11C-acetate PET (AC-PET) in prostate cancer patients with PSA relapse following radical prostatectomy (RP) or radiotherapy (RT) in a prospective study.Subjects and MethodsIn 103 relapsing patients after RP (n=97) or RT (n=6) AC-PET images and CT scans were obtained. In PET positive patients with localized recurrence detected lesions were resected and histologically verified or -after local RT- followed-up by PSA testing. Patients with distant disease on AC-PET were treated with androgen deprivation/chemotherapy.Results42/103 patients were PET positive with PSA levels
      PubDate: 2016-11-08T20:43:51.427501-05:
      DOI: 10.1111/bju.13706
  • Robotic Partial Nephrectomy: Continued Refinement of Outcomes Beyond the
           Initial Learning Curve
    • Authors: David J. Paulucci; Ronney Abaza, Daniel D. Eun, Ashok K. Hemal, Ketan K. Badani
      Abstract: ObjectivesTo evaluate trends in perioperative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robotic partial nephrectomy (RPN) among multiple surgeons.Patients and MethodsA multi-institutional database was used to evaluate trends in patient demographics (age, gender, comorbidities, etc.), tumor characteristics (size, complexity, etc.) and perioperative outcomes (warm ischemia time, operative time, complications, estimated blood loss, trifecta achievement, etc.) in consecutive cases 50-300 (n=960) from 2008 to 2016 among four experienced surgeons. Trends in outcomes were assessed using multivariable regression models adjusted for demographic and tumor-specific variables. Outcomes between cases 50-99 and 250-300 were compared.ResultsRPN was increasingly performed in patients with larger tumors (β=0.001, p=.048), hypertension (OR=1.003, p=.008) diabetes (OR=1.003, p=.025) and prior abdominal surgery (OR=1.003, p=.006). Surgeon experience was associated with more trifecta achievement (OR=1.006, p
      PubDate: 2016-11-08T07:55:20.432284-05:
      DOI: 10.1111/bju.13709
  • Management and Outcomes of Patients with Renal Medullary Carcinoma: A
           Multi-Center Collaborative Study
    • Authors: Amishi Y. Shah; Jose A. Karam, Gabriel G. Malouf, Priya Rao, Zita D. Lim, Eric Jonasch, Lianchun Xiao, Jianjun Gao, Ulka N. Vaishampayan, Daniel Y. Heng, Elizabeth R. Plimack, Elizabeth A. Guancial, Chunkit Fung, Stefanie R. Lowas, Pheroze Tamboli, Kanishka Sircar, Surena F. Matin, W. Kimryn Rathmell, Christopher G. Wood, Nizar M. Tannir
      Abstract: ObjectiveTo describe the management strategies and outcomes of patients with renal medullary carcinoma (RMC) and characterize predictors of overall survival (OS).Patients and MethodsRMC is a rare and aggressive malignancy that afflicts young patients with sickle cell trait; there are limited data on management to date. This is a study of patients with RMC who were treated during 2000-2015 at eight academic institutions in North America and France. The Kaplan-Meier method was used to estimate OS, measured from initial RMC diagnosis to date of death. Cox regression analysis was used to determine predictors of OS.ResultsFifty-two patients (37 males) were identified. Median age at diagnosis was 28 years (range 9-48). Forty-nine patients (94%) had stage III/IV. Median OS for all patients was 13.0 months. Thirty-eight patients (75%) had nephrectomy. Patients who underwent nephrectomy had superior OS compared to patients who were treated with systemic therapy only (median OS 16.4 vs. 7.0 months, p=0.0004). Forty-five patients received chemotherapy and 13 (29%) had an objective response; 28 patients received targeted therapies, with 8-week median therapy duration and no objective responses. Only seven patients (13%) survived longer than two years.ConclusionsRMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but less than 20% of patients survive longer than two years, underscoring the need to develop more effective therapy for this rare tumor. In this study, nephrectomy was associated with improved OS.This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-08T07:50:20.077445-05:
      DOI: 10.1111/bju.13705
  • 3-year data of the AdVanceXP male sling: results of a prospective
           multicenter study
    • Authors: Ricarda M. Bauer; Markus T. Grabbert, Benedikt Klehr, Peter Gebhartl, Christian Gozzi, Roland Homberg, Florian May, Peter Rehder, Christian G. Stief, Alexander Kretschmer
      Abstract: ObjectivesIn recent years, several studies showed the effectiveness and safety of the AdVance sling for the treatment of male stress urinary incontinence (SUI). In 2010 the second generation of Advance, the AdVance XP was introduced with several changes of the sling design and with a new needle shape. Aim of the study was to evaluate the efficacy and safety of the AdVance XP sling in male SUI after radical prostatectomy in a prospective multicenter study.MethodsIn total 115 patients were included. Patients with urine nocturnal incontinence, previous incontinence surgery, previous radiotherapy and coaptive zone 50%. All others were classified as failures. Significance analysis was performed with Wilcoxon-test.ResultsMean preoperative urine loss in the 24h pad-test was 272.0 g (median 272.0 g).After a follow-up of 3 months (n= 114) 64.9% of the patients were cured and 31.6% improved. Mean urine loss decreased significantly to 34.9 g (p
      PubDate: 2016-11-08T07:40:19.803593-05:
      DOI: 10.1111/bju.13704
  • A prospective and randomized trial comparing fluoroscopic, total
           ultrasonographic, and combined guidance for renal access in
           mini-percutaneous nephrolithotomy
    • Authors: Wei Zhu; Jiasheng Li, Jian Yuan, Yongda Liu, Shaw P Wan, Guanzhao Liu, Wenzhong Chen, Wenqi Wu, Jintai Luo, Dongliang Zhong, Defeng Qi, Ming Lei, Wen Zhong, Ze Zhang, Zhaohui He, Zhijian Zhao, Suilin Lu, Yuji Wu, Guohua Zeng
      Abstract: ObjectiveTo compare the safety and efficacy of fluoroscopic, total ultrasonographic, and combined ultrasonographic and fluoroscopic guidance for percutaneous renal access in mini-percutaneous nephrolithotomy (mini-PCNL).Materials And MethodsThe present study was conducted between July 2014 and May 2015 as a prospective randomized trial at the First Affiliated Hospital of Guangzhou Medical University. 450 consecutive patients with renal stones larger than 2 cm were randomized to undergo fluoroscopy-, total ultrasonography-, or combined-guided mini-PCNL (150 patients for each group). The primary endpoints were the stone-free rate (SFR) and blood loss (hemoglobin decrease during the operation and transfusion rate). Secondary endpoints included access failure rate, operative time, and complications. S.T.O.N.E. score was used to document the complexity of the renal stones. The study was registered at (NCT02266381).ResultsThe three groups had similar baseline characteristics. With S.T.O.N.E. scores of 5-6 or 9-13, the SFRs were comparable between the three groups. For S.T.O.N.E. scores of 7-8, fluoroscopic guidance and combined guidance achieved significantly better SFR than total ultrasonographic guidance (one-session SFR 85.1% vs. 88.5% vs. 66.7%, p=0.006; overall SFR at three months postoperatively 89.4% vs. 90.2% vs. 69.8%, p=0.002). Multiple-tracts mini-PCNL was used more frequently in the fluoroscopy-guided and combined-guided group than total ultrasonography-guided group (20.7% vs. 17.1% vs. 9.5%, p=0.028). The mean total radiation exposure time was significantly greater for fluoroscopic guidance than for combined guidance (47.5 vs. 17.9 seconds, p
      PubDate: 2016-11-08T07:35:33.42226-05:0
      DOI: 10.1111/bju.13703
  • Contemporary minimally invasive surgery for adrenal masses: It's not all
           about (Pure) laparoscopy
    • Authors: Nicola Pavan; Ithaar Derweesh, Jens Rassweiler, Benjamin Challacombe, Homayoun Zargar, James Porter, Evangelos Liatsikos, Jihad Kaouk, Francesco Porpiglia, Riccardo Autorino
      Abstract: A quarter of century has elapsed since the first described laparoscopic adrenalectomy (LA), and since then, minimally invasive surgery for the management of adrenal masses has come a long way: indications have expanded, techniques have evolved, and data have matured.Ball et al recently reported an evidence-based systematic review on the use of minimally invasive adrenalectomy as part of the International Consultation on Urological Diseases and European Association of Urology consultation [1]. Notably, the authors included 52 comparative studies in their analysis, published up to 2014, and they provided the following recommendations: laparoscopy should be first line therapy for benign adrenal masses (Grade B), and pheochromocytoma (Grade B), whereas it should be regarded as feasible option for select adrenocortical carcinoma cases (those without adjacent organ involvement) (Grade C).This article is protected by copyright. All rights reserved.
      PubDate: 2016-11-01T07:25:27.3936-05:00
      DOI: 10.1111/bju.13701
  • Radio-guided sentinel lymph node detection and lymph node mapping in
           invasive urinary bladder cancer—a prospective clinical study
    • Authors: F. Aljabery; I. Shabo, Hans Olson, Oliver Gimm, Staffan Jahnson
      Abstract: ObjectivesWe investigated the possibility to detect sentinel nodes in patients with urinary bladder cancer (UBC) intra-operatively and whether the histopathological status of the identified sentinel nodes reflected that of the lymphatic field.Patients and methodsWe studied 103 patients with UBC pathological stage T1-T4 who were treated with cystectomy and pelvic lymph node (LN) dissection during 2005–2011 at the Department of Urology, Linköping University Hospital. Radioactive tracer Nanocoll 70 MBq (megabequerel) and blue dye were injected in the bladder wall around the primary tumour prior to surgery. Sentinel nodes were detected ex vivo during the operation with a hand-hold Geiger probe (Neoprobe Gamma Detection System). All lymph nodes were formalin-fixed, sectioned three times, mounted on slides and stained with hematoxylin-eosin. An experienced uropathologist (HO) evaluated the slides.ResultsThe mean age of the patients was 69 years, and 80 (77%) were male. Pathological staging was T1-12 (12%), T2-20 (19%), T3-48 (47%) and T4-23 (22%). A mean number of 31 nodes per patient were examined (range 7–68), totaling 3,253 nodes. LN metastases were found in 41 (40%) patients. Sentinel nodes were detected in 80% (83 of 103) of the patients. Sensitivity and specificity for detecting metastatic disease by SNB varied between LN stations with an average value of 67% and 90%, respectively. Lymph node metastatic density had a significant prognostic impact; a value of 8% or more was significantly related to shorter survival. Lympho-vascular invasion occurred in 65% (n=67) of patients and was significantly associated with shorter cancer-specific survival (p
      PubDate: 2016-10-31T08:11:17.005542-05:
      DOI: 10.1111/bju.13700
  • Diagnosis and long-term outcome of renal cysts after laparoscopic partial
           nephrectomy in children
    • Authors: C. Esposito; M. Escolino, B. Troncoso Solar, R. Iacona, R. Esposito, A. Settimi, I. Mushtaq
      Abstract: ObjectivesTo document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions post-LPN.Materials and MethodsWe reviewed the US imaging reports performed during follow-up in 125 children (77 girls, 48 boys - average age 3.2 years) underwent LPN in 2 centers of pediatric surgery in the period 2005-2015.ResultsTransperitoneal approach was adopted in 83 cases while retroperitoneoscopy in 42 cases. The average follow-up was 4.2 years. At US, an avascular cyst related to the operative site was found after 61/ 125 procedures (48.8%). As for their appearance, 53/61 cysts were simple and anechoic and 8/61 appeared septated. The average diameter of the cysts was 3.3 x 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after mean 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size and only 5/61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 cases (83.6%) while they were associated with urinary infections and abdominal pain in the remaining 10 patients. None of them required a re-intervention.ConclusionsThe US finding of a simple cyst at the operative site after LPN is a common event during follow-up, with an incidence of about 50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There is no correlation between cysts formation and type of surgical technique adopted. As there is no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodical US controls.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-25T09:50:24.564409-05:
      DOI: 10.1111/bju.13698
  • Urinary collecting system invasion is associated with poor survival in
           clear cell renal cell carcinoma patients
    • Authors: George C. Bailey; Stephen A. Boorjian, Matthew J. Ziegelmann, Mary E. Westerman, Christine M. Lohse, Bradley C. Leibovich, John C. Cheville, R. Houston Thompson
      Abstract: ObjectivesTo evaluate the prognostic significance of urinary collecting system invasion in a large series of clear cell renal cell carcinoma patients.MaterialsPatients with clear cell renal cell carcinoma treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urologic pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan-Meier method and associations of collecting system invasion with death from renal cell carcinoma were evaluated using Cox models.ResultsOf the 859 patients with clear cell renal cell carcinoma, 58 (6.8%) demonstrated collecting system invasion. At last follow-up, 310 patients had died from renal cell carcinoma at a median of 1.8 years following surgery. Median follow-up for patients alive at last follow-up was 8.2 years. Estimated cancer-specific survival at 10 years following surgery for patients with collecting system invasion was 17%, compared with 60% for patients without collecting system invasion (p
      PubDate: 2016-10-20T10:35:23.991745-05:
      DOI: 10.1111/bju.13669
  • Additive effects of the Rho Kinase Inhibitor Y-27632 and vardenafil on
           relaxation of corpus cavernosum tissue of patients with erectile
           dysfunction and clinical phosphodiesterase type 5 inhibitor failure
    • Authors: Pieter Uvin; Maarten Albersen, Ine Bollen, Maarten Falter, Emmanuel Weyne, Loes Linsen, Hanna Tinel, Peter Sandner, Trinity J Bivalacqua, Dirk JMK De Ridder, Frank Van der Aa, Bert Brône, Koenraad Van Renterghem
      Abstract: ObjectivesTo evaluate the expression of the Rho/Rho associated protein kinase (ROCK) pathway in corpus cavernosum of patients with severe erectile dysfunction (ED) compared to healthy human corpus cavernosum, and to test the functional effects of two Rho Kinase Inhibitors (RKI) on erectile tissue of patients with severe ED, not responding to phosphodiesterase type 5 inhibitors (PDE5-i).Patients and methodsHuman corpus cavernosum samples were obtained after consent from individuals undergoing penile prosthesis implantation (n = 7 for organ bath experiments, n = 17 for qPCR). Potent control subjects (n = 5) underwent penile needle biopsy. qPCR was performed for the expression of RhoA and ROCK subtypes 1 and 2. Immunohistochemistry staining against ROCK and α smooth muscle actin (αSMA) was performed on corpus cavernosum of an ED patient. Tissue strips were precontracted with phenylepinephrine and incubated with 1μM of the PDE5-i vardenafil or with DMSO (control). Subsequently, increasing concentrations of the RKIs azaindole or Y-27632 were added and relaxation of tissue was quantified.ResultsThe expression of ROCK1 was unchanged (p > 0.05), while ROCK2 (p < 0.05) was significantly upregulated in ED patients, compared to controls. ROCK 1 and 2 protein colocalized with αSMA, confirming the presence of this kinase in cavernous smooth muscle cells and/or myofibroblasts. After incubation with DMSO, 10μM azaindole and 10μM Y-27632 relaxed precontracted tissues with 49.5 ± 7.42% (p = 0.1470 when compared to vehicle) and 85.9 ± 10.3% (p = 0.0016 when compared to vehicle), respectively. Additive effects on relaxation of human corpus cavernosum were seen after preincubation with 1μM vardenafil.ConclusionThe RKI Y-27632 causes a significant relaxation of corpus cavernosum in tissue strips of patients with severe erectile dysfunction. The additive effect of vardenafil and Y-27632 demonstrate that a combined inhibition of Rho-kinase and phosphodiesterase type 5 could be a promising orally administered treatment for severe ED.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-20T09:05:22.792984-05:
      DOI: 10.1111/bju.13691
  • Clinical Risk Stratification in Patients with Surgically Resectable
           Micropapillary Bladder Cancer
    • Authors: Mario I. Fernández; Stephen B. Williams, Daniel L. Willis, Rebecca S. Slack, Rian J. Dickstein, Sahil Parikh, Edmund Chiong, Arlene O. Siefker-Radtke, Charles C. Guo, Bogdan A. Czerniak, David J. McConkey, Jay B. Shah, Louis L. Pisters, H.Barton Grossman, Colin P. N. Dinney, Ashish M. Kamat
      Abstract: ObjectiveTo analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data.Patients and MethodsA review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree analysis was performed to identify risk groups for survival.ResultsFor the entire cohort, estimated 5-year overall and disease-specific survival rates were 52% and 58%, respectively. Classification and regression tree analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumor-associated hydronephrosis. Five-year disease-specific survival for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (p
      PubDate: 2016-10-18T03:25:20.605334-05:
      DOI: 10.1111/bju.13689
  • Quality of life outcomes from the PATCH trial evaluating LHRH agonists
           versus transdermal oestradiol for androgen suppression in advanced
           prostate cancer
    • Authors: Duncan C Gilbert; Trinh Duong, Howard G Kynaston, Abdulla A Alhasso, Fay H Cafferty, Stuart D Rosen, Subramanian Kanaga-Sundaram, Sanjay Dixit, Marc Laniado, Sanjeev Madaan, Gerald Collins, Alvan Pope, Andrew Welland, Matthew Nankivell, Richard Wassersug, Mahesh KB Parmar, Ruth E Langley, Paul D Abel
      Abstract: ObjectivesTo compare quality of life (QoL) outcomes at 6 months between men with advanced prostate cancer (PCa) receiving either transdermal oestradiol (tE2) or LHRH agonists (LHRHa) for androgen deprivation therapy (ADT).Patients and methodsMen with locally advanced or metastatic PCa participating in an ongoing randomised, multi-centre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via 3 or 4 transcutaneous patches containing 100mcg of oestradiol/24 hours. LHRHa was administered as per local practice. Patients completed questionnaires based on EORTC QLQ-C30 with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.Results727 men were enrolled between August 2007 and 5 October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median age 74 years (interquartile range [IQR] 68-79), median PSA 44 ng/ml (IQR 19-119), and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than LHRHa (mean difference +4.2, 95% CI 1.2 to 7.1, p=0.006), less fatigue and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to tE2 arm.ConclusionPatients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynecomastia. The ongoing trial will evaluate clinical efficacy, and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:20:21.109965-05:
      DOI: 10.1111/bju.13687
  • Factors associated with Regional Recurrence Following Lymphadenectomy for
           Penile Squamous Cell Carcinoma
    • Authors: Jay P. Reddy; Curtis A. Pettaway, Lawrence B. Levy, Lance C. Pagliaro, Pheroze Tamboli, Priya Rao, Isuru Jayaratna, Karen E. Hoffman
      Abstract: ObjectiveTo identify factors associated with regional recurrence (RR) following lymphadenectomy for penile cancer in order to determine which patients might benefit from adjuvant therapy.Materials/MethodsMen who underwent lymphadenectomy for penile squamous cell carcinoma from 1977-2014 were identified from an institutional database. Kaplan-Meier curves estimated recurrence-free survival (RFS) calculated from the date of lymphadenectomy. Cox regression models evaluated the association between RFS and patient and tumor characteristics.Results182 men who underwent lymphadenectomy for penile cancer were identified. Median patient age was 62 years and median follow-up was 4.2 years. 34 men experienced RR following lymphadenectomy, of which 24 developed isolated RR without distant metastasis. Median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathologic nodal stage, pathologic inguinal laterality, pelvic nodal involvement, lymph node density >5.2%, >3 pathologically-involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (p3 pathologically involved lymph nodes (AHR 3.78, 95% CI: 2.12-6.65; p
      PubDate: 2016-10-18T03:15:20.146557-05:
      DOI: 10.1111/bju.13686
  • Efficacy of knowledge and competence-based training of non-physicians in
           the provision of Early Infant Circumcision (EIC) using the Mogen clamp in
           Rakai, Uganda
    • Authors: E.Nelson Kankaka; G. Kigozi, D. Kayiwa, N. Kighoma, F. Makumbi, T. Murungi, D. Nabukalu, R. Nampijja, S. Watya, D. Namuguzi, F. Nalugoda, G. Nakigozi, D. Sserwadda, M. Wawer, R.H. Gray
      Abstract: Early infant circumcision (EIC) is the most common neonatal surgical procedure in males.1 It has also been incorporated as a component in combination HIV prevention in 14 of Sub-Saharan African countries with high HIV prevalence and low circumcision coverage.2,3 EIC has advantages over adult circumcision due to lower adverse events, no risk of early resumption of sex and potentially lower cost4–6. Sub-Saharan African countries have low physician coverage, but comparatively higher coverage of non-physicians who could facilitate roll out of circumcision for HIV prevention. The major concern has been safety of the procedure and complications can be mitigated by adequate training using a structured curriculum7–11with a didactic and supervised practicum, step-by-step checklists and immediate feedback from mentors. Anatomic models have also been shown to enhance trainee-learning.12–15This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-18T03:05:51.922449-05:
      DOI: 10.1111/bju.13685
  • Long-term utility of adjuvant hormonal and radiation therapy for patients
           with seminal vesicle invasion at radical prostatectomy
    • Authors: Marco Moschini; Vidit Sharma, Giorgio Gandaglia, Paolo Dell'Oglio, Nicola Fossati, Emanuele Zaffuto, Francesco Montorsi, Alberto Briganti, R. Jeffrey Karnes
      Abstract: IntroductionThe literature is conflicting on the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer (PCa) demonstrating seminal vesicle invasion (pT3b; SVI).MethodsPatients with SVI during RP and pelvic lymph node dissection at two major referral centers from 1986-2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were performed to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence, cancer specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients.ResultsOverall, 3,279 patients with SVI were included with a median follow up of 148 months. Considering the whole SVI population, 1,387 (42%) received no adjuvant therapy, 1,179 (36%) received aHT, 461 (14.1%) received aRT while 252 (7.7%) received both aHT and aRT, respectively. 10 year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all p
      PubDate: 2016-10-18T02:30:24.135404-05:
      DOI: 10.1111/bju.13683
  • Application of shear wave elastography to estimate the stiffness of the
           male striated urethral sphincter during voluntary contractions
    • Authors: Ryan E. Stafford; Rafeef Aljuraifani, François Hug, Paul W. Hodges
      Abstract: ObjectivesTo investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter during voluntary activation using shear wave elastography; to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. striated urethral sphincter); and to determine the relationship between muscle stiffness and contraction intensity.Subjects and methodsTen healthy men participated. A linear ultrasound transducer was placed mid-sagittal on the perineum adjacent to a pair of electromyography electrodes that recorded non-specific pelvic floor muscle activity. Stiffness in the area expected to contain the striated urethral sphincter was estimated via ultrasound shear wave elastography at rest and during voluntary pelvic floor muscles contractions to 5%, 10% and 15% maximum. Still image frames were exported for each repetition and analysed with software that detected increases in stiffness above 150% of the resting stiffness.ResultsPelvic floor muscle contraction elicited an increase in stiffness above threshold within the region expected to contain the striated sphincter for all participants and contraction intensities. The mean(SD) ventral-dorsal distance between the centre of the stiffness area and region of maximal motion of the mid-urethra (caused by striated urethral sphincter contraction) was 5.6(1.8), 6.2(0.8), and 5.8(0.7) mm for 5%, 10% and 15% MVC respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities(5% vs. 10%; P
      PubDate: 2016-10-18T02:25:26.528424-05:
      DOI: 10.1111/bju.13688
  • The management of non-visualisation following dynamic sentinel lymph node
           biopsy for squamous cell carcinoma of the penis
    • Authors: Varun Sahdev; Maarten Albersen, Michelle Christodoulidou, Arie Parnham, Peter Malone, Raj Nigam, Jamshed Bomanji, Asif Muneer
      Abstract: ObjectivesTo review the management and clinical outcomes of uni- or bilateral non-visualization of inguinal lymph nodes following dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0). An additional objective was to develop an algorithm for the management of patients in which non-visualisation occurs.Patients and MethodsThis is a retrospective observational study over a period of 4 years comprising 166 patients with penile squamous cell carcinoma undergoing DSNB and followed up for a minimum of 6 months. All cases diagnosed with uni- or bilateral non-visualisation of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes following non-visualisation and the oncological outcomes including local and regional recurrence rates were documented.ResultsOut of 166 consecutive patients undergoing DSNB, 20 (12%) patients had unilateral non-visualisation following injection of intradermal 99mTc. Of these 20 patients, 7 underwent repeat DSNB at a later date with 6 having successful visualisation. One patient had persistent non-visualisation and proceeded to a superficial modified inguinal lymphadenectomy (SML). None of these patients experienced recurrence at follow-up. A further seven patients underwent modified SML with on table frozen section analysis of the lymph node packet; none of these patients were found to have micrometastatic disease in the inguinal lymph nodes although one patient developed metastatic inguinal node disease at a later date. Six patients elected to undergo clinical surveillance and have remained disease free.ConclusionPatients with impalpable inguinal lymph nodes undergoing DSNB with ≥ T1G2 disease should ideally have bilateral visualisation of the sentinel lymph nodes reflecting the drainage pattern from the primary tumour. In this series, 12% of patients were found to have unilateral non-visualisation following DSNB. Patients offered a repeat DSNB at a later date, were successful in localising the sentinel node in 86% of cases. Patients with favourable histological parameters can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that a SML may be carried out if there is repeated non-visualisation. Larger cohorts are required in order to validate this proposed algorithm.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:20:25.768838-05:
      DOI: 10.1111/bju.13680
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared to salvage radiation therapy in patients with pN1 prostate cancer
           treated with radical prostatectomy
    • Authors: Derya Tilki; Felix Preisser, Pierre Tennstedt, Patrick Tober, Philipp Mandel, Thorsten Schlomm, Thomas Steuber, Hartwig Huland, Schwarz Rudolf, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Abstract: ObjectiveTo analyze the comparative effectiveness of no treatment or salvage radiation therapy at biochemical recurrence (NT/sRT) versus adjuvant radiation therapy (aRT) in LN positive patients after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN positive prostate cancer (PCa) at RP with or without additional radiation treatment from 2005 to 2013 were retrospectively analyzed. Cox regressions addressed factors influencing biochemical recurrence (BCR) and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsMedian follow-up for the entire patient group was 33.8 months. Four-year BCR-free and metastasis-free survival rates were 43.3% and 86.6% for all patients, respectively. In multivariate analysis, NT/sRT (n=505) was an independent risk factor for BCR and metastasis compared to patients with aRT (n=213). The superiority of aRT was confirmed after propensity score-matching. Four-year metastasis-free survival in the matched cohort was 82.5% versus 91.8% for the NT/sRT and aRT groups, respectively (p=0.02). Early sRT (pre-RT PSA ≤0.5 ng/ml) compared to sRT at PSA >0.5 ng/ml was significantly associated with decreased risk of metastasis.ConclusionLN positive patients who received aRT had a significantly better oncological outcome compared to patients with NT/sRT independent of tumor characteristics. Patients with early sRT showed higher rates of response and better metastasis-free survival than patients with pre-RT PSA >0.5 ng/ml.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:15:35.748361-05:
      DOI: 10.1111/bju.13679
  • Impact of Suboptimal Neoadjuvant Chemotherapy on Perioperative Outcomes
           and Survival After Robot-Assisted Radical Cystectomy: A Multicenter
           Multinational Study
    • Authors: Nobuyuki Hinata; Ahmed Aly Hussein, Saby George, Donald L. Trump, Ellis G. Levine, Kawa Omar, Prokar Dasgupta, Muhammad Shamim Khan, Abolfazl Hosseini, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo evaluate the effect of suboptimal dosing on the outcomes of patients who received neoadjuvant chemotherapy (NAC) and robot-assisted radical cystectomy (RARC).Patients and MethodsWe retrospectively reviewed 336 consecutive patients with urothelial carcinoma of the bladder who were treated with NAC and RARC at three academic institutions. Outcomes were compared between 3 groups: patients who received optimal NAC; patients who received suboptimal NAC; and those who did not receive NAC. To adjust for potential baseline differences between the three groups, propensity-score-based matching was performed. The suboptimal dose group was defined as those who received fewer than three cycles of cisplatin-based chemotherapy, received decreased dosage, or one's not treated with cisplatin. Primary outcomes analyzed were recurrence-free survival (RFS) and overall survival (OS). Secondary outcomes were perioperative complications and readmissions after RARC.ResultsWithin the cohort after propensity-score matching, 69 patients received optimal dose NAC, 41 received suboptimal NAC and 69 did not receive NAC. Complication rates and readmission rates between the 3 groups did not differ significantly. On multivariable analysis, suboptimal dosing and no NAC were independent predictors of worse RFS (HR: 2.5, 95%CI: 1.2-5.7, p=0.01 and HR 2.4, 95%CI 1.28-5.16, p=0.01) and worse OS (HR 4.5, 95%CI 1.6-15.0, p
      PubDate: 2016-10-15T08:15:34.670061-05:
      DOI: 10.1111/bju.13678
  • Prostate Health Index (phi) Improves Multivariable Risk Prediction of
           Aggressive Prostate Cancer
    • Authors: Stacy Loeb; Sanghyuk S. Shin, Dennis L. Broyles, John T. Wei, Martin Sanda, George Klee, Alan W. Partin, Lori Sokoll, Daniel W. Chan, Chris H. Bangma, Ron H. N. van Schaik, Kevin M. Slawin, Leonard S. Marks, William J. Catalona
      Abstract: ObjectiveTo examine the use of the Prostate Health Index (phi)* as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicenter US study.Materials and MethodsThe study population included 728 men with PSA levels of 2-10 ng/mL and negative digital rectal examination enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of phi improves the performance of currently available risk calculators (PCPT and ERSPC). We also designed and internally validated a new phi-based multivariable predictive model, and created a nomogram.ResultsOf 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. Phi predicted the risk of aggressive prostate cancer across the spectrum of values. Adding phi significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, prior biopsy, prostate volume, PSA, and phi with an AUC of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision curve analysis.ConclusionUsing phi as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-15T08:05:52.721224-05:
      DOI: 10.1111/bju.13676
  • The Robotic Approach Improves Surgical Outcomes in Obese Patients
           Undergoing Partial Nephrectomy
    • Authors: Ercan Malkoc; Matthew J. Maurice, Onder Kara, Daniel Ramirez, Ryan J. Nelson, Peter A. Caputo, Pascal Mouracade, Robert Stein, Jihad H. Kaouk
      Abstract: ObjectivesTo assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses.Patients and MethodsUsing our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m2) with small renal masses (
      PubDate: 2016-10-04T01:50:11.55434-05:0
      DOI: 10.1111/bju.13675
  • Outcomes of advanced urothelial carcinoma patients following
           discontinuation of Programmed Death (PD)-1 or PD-Ligand (L)-1 inhibitors
    • Authors: G Sonpavde; G R Pond, S Mullane, A A Ramirez, N J Vogelzang, A Necchi, T Powles, J Bellmunt
      Abstract: ObjectiveTo study the subsequent therapy and disease outcomes of patients with advanced urothelial carcinoma (UC) following discontinuation of programmed death-1 (PD-1) or PD-Ligand (L)1 inhibitors.Patients and methodsWe performed a retrospective analysis to examine outcomes and systemic therapy administration following PD-1/PD-L1 inhibitor therapy in patients with advanced UC. Data were collected from institutions including demographics and therapy administered. Univariable Cox regression analyses examined clinical factors potentially associated with overall survival (OS) following PD-1/PD-L1 inhibitors.ResultsData from 62 patients was available from 4 institutions with capture of subsequent therapy and outcomes following checkpoint inhibitor immunotherapy. The median age was 65.5 years and 51 (82.3%) were male. The median duration of PD-1/PD-L1 inhibitors available from 55 patients was 64 days (range 7-669). Of these, 22 (35.5%) patients received post-PD1/PD-L1 inhibitor therapy with a variety of different chemotherapy regimens (n=16), chemobiologic combination (n=1), biologic agents (n=4) and immunotherapy (n=1). The median time from last PD1/PD-L1 inhibitor therapy to subsequent therapy was 58 days (range 14-242). The median OS of all patients following completion of PD-1/PD-L1 inhibitors was 149 days (95% CI: 75-359). Among those who received some post-PD1/PD-L1 inhibitor therapy, median OS was 182 days (95% CI: 121-372), and the median time to progression was 124 days (95% CI: 61-273) when examining from start of post-PD1/PD-L1 therapy. Among these 22 patients, the only significant baseline prognostic factor associated with OS was performance status.ConclusionsIn this dataset, 35.5% of patients with advanced UC received systemic therapy following salvage therapy with PD1/PD-L1 inhibitors. Outcomes with subsequent therapy appear similar to those historically observed in patients who had not received prior PD1/PD-L1 inhibitors. Further study of patients receiving post-PD1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-04T01:40:58.140777-05:
      DOI: 10.1111/bju.13674
  • Virtue male sling for post-prostatectomy stress incontinence: a
           prospective evaluation and mid-term outcomes
    • Authors: Matteo Ferro; Danilo Bottero, Carolina D'Elia, Deliu Victor Matei, Antonio Cioffi, Gabriele Cozzi, Alessandro Serino, Giovanni Cordima, Roberto Bianchi, Piero Giacomo Incarbone, Antonio Brescia, Gennaro Musi, Ferdinando Fusco, Serena Detti, Vincenzo Mirone, Ottavio de Cobelli
      Abstract: ObjectivesTo evaluate the efficacy and safety of the Virtue Male sling in a cohort of patients affected by post prostatectomy stress urinary incontinence (SUI).MethodsAll consecutive patients treated with Virtue® male sling at our Institution in year 2012 were included in our prospective, non randomized study.Patients were evaluated preoperatively and at 1, 3, 6, 12, 24 and 36 months after surgery with 24-hour pad weight test, ICI-Q short form questionnaire, Urinary Symptom Profile questionnaire, bladder diary, uroflowmetry and Patient Global Impression of Improvement and Patient Global Impression of Severity Questionnaire.ResultsMen age was 65.5 years. 72.4% of patients complained a pre operative mild incontinence (1-2 PPD), whereas 9 patients used 3-5 pads/day. 17 complications occurred in 29 patients (58.6%) and all were grade I.At 12 months follow up patients showed a significant improvement in 24 h PAD test (128.6 VS 2.5), pads per day used (2 VS 0), ICI Q SF score (14.3 VS 0.9), USP SUI score (4 VS 0) and outcomes remains stable at 36 months.At last follow up, PGI I questionnaire showed a median score of 1 (very much better).ConclusionsVirtue® Male Sling is an effective treatment option for low to moderate post-prostatectomy incontinence.This article is protected by copyright. All rights reserved.
      PubDate: 2016-10-03T08:20:29.821855-05:
      DOI: 10.1111/bju.13672
  • A Randomized Controlled Trial Evaluating Renal Protective Effects of
           Selenium ACE, Verapamil and Losartan against Extracorporeal Shock Waves
           Lithotripsy Induced Renal Injury
    • Authors: Ahmed R. EL-Nahas; Mohamed M. Elsaadany, Diaa-Eldin Taha, Ahmed M. Elshal, Mohamed Abo El-Ghar, Amani M. Ismail, Essam A. Elsawy, Hazem H. Saleh, Ehab W. Wafa, Amira Awadalla, Tamer S. Barakat, Khaled Z Sheir
      Abstract: ObjectiveTo evaluate the protective effects of Selenium-ACE, Verapamil and losartan against SWL induced renal injury.Patients and methodsA randomized controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (300mg/L) were excluded. SWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomized into one of 4 groups using sealed closed envelops. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 hours and 1 week post-SWL. The primary outcome was the differences between albuminuria and uNGAL. Dynamic contrast enhanced MRI (DCE-MRI) was performed before SWL, 2-4 hours and 1 week post-SWL to compare changes in renal perfusion.ResultsOut of 329 patients assessed for eligibility, final analysis was performed for 160 patients (40 in each group). Losartan was the only medications that showed significantly lower levels of albuminuria after one week (P
      PubDate: 2016-09-30T05:35:42.135099-05:
      DOI: 10.1111/bju.13667
  • Parents’ Perceptions of Counselling Following Prenatal Diagnosis of
    • Authors: Sarah Marokakis; Nadine A Kasparian, Sean E Kennedy
      Abstract: ObjectivesTo explore parents’ experiences of counselling after prenatal diagnosis of congenital anomalies of the kidney and urinary tract.Materials and MethodsParents of a child born between September 2012 and March 2015 with posterior urethral valves (PUV) or multicystic dysplastic kidney (MCDK) completed a semi-structured telephone interview, demographic survey, and the Depression, Anxiety and Stress Scales (DASS21). Qualitative data were analysed thematically using NVivo10 software.ResultsSeventeen parents (PUV n=8; MCDK n=9) participated (response rate: 40%), and most were offered counselling during pregnancy (14/17). Parents described feelings of shock, fear and uncertainty following diagnosis, and desired early information on all aspects of their child's condition. Most participants were satisfied with the information received; however, unmet information needs relating to treatment and prognosis were identified, particularly amongst fathers and parents in the PUV group. Some parents felt relieved after counselling (12/17); however, emotional distress often persisted long after diagnosis. Parents described a need for written and web-based information resources, specialised psychological services, and parent support groups.ConclusionWhile parents valued counselling, many continued to report unmet informational and psychological needs. Early counselling addressing topics important to parents and provision of additional resources and support services may improve parents’ adjustment to their baby's diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:47.230139-05:
      DOI: 10.1111/bju.13668
  • When to perform preoperative chest computed tomography for renal cancer
    • Authors: Alessandro Larcher; Paolo Dell'Oglio, Nicola Fossati, Alessandro Nini, Fabio Muttin, Nazareno Suardi, Francesco De Cobelli, Andrea Salonia, Alberto Briganti, Xu Zhang, Francesco Montorsi, Roberto Bertini, Umberto Capitanio
      Abstract: ObjectivesTo provide objective criteria for preoperative staging chest computed tomography [CCT] in patients diagnosed with renal cell carcinoma [RCC], since, in absence of established indications, the decision for preoperative CCT remains subjective.Patients and Methods1,946 patients elected for surgical treatment of RCC and collected in a prospective institutional database were assessed. The outcome of the study was presence of pulmonary metastases at staging CCT. A multivariable logistic regression model predicting positive CCT was fitted. Predictors consisted of preoperative clinical tumour [cT] and nodal [cN] stage, presence of systemic symptoms and platelets/haemoglobin ratio.ResultsThe rate of positive CCT was 6% (n=119). At multivariable logistic regression, ≥cT1b, cN1, systemic symptoms and haemoglobin/platelets ratio were all associated with higher risk of positive CCT (all p1%, a negative CCT is spared in 37% of the population and a positive CCT is missed in 0.2% of the population only.ConclusionsThe proposed strategy estimates the risk of positive CCT at RCC staging with optimal accuracy and resulted statistically and clinically relevant. The current findings support a recommendation for CCT in patients with ≥cT1b, cN1, systemic symptoms or anaemia and thrombocythemia. Conversely, in patients with cT1a, cN0 without systemic symptoms, anaemia and thrombocythemia, CCT can be omitted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-29T09:20:43.908394-05:
      DOI: 10.1111/bju.13670
  • Transgenic Animal Model for Studying the Mechanism of Obesity‐Associated
           Stress Urinary Incontinence
    • Authors: Lin Wang; Guiting Lin, Yung‐Chin Lee, Amanda B. Reed‐Maldonado, Melissa T Sanford, Guifang Wang, Huixi Li, Lia Banie, Zhengcheng Xin, Tom F. Lue
      Abstract: PurposeTo study and compare the function and structure of the urethral sphincter in female Zucker lean and Zucker fatty (ZF) rats and to assess viability of ZF fats as a model for female obesity‐associated stress urinary incontinence (OA‐SUI).Materials and MethodsTwelve16‐week‐old female Zucker Lean (ZUC‐Leprfa 186) (ZL) rats and twelve16‐week‐old female Zucker Fatty (ZUC‐Leprfa 185) (ZF) rats were grouped into two groups: ZL arm and ZF arm. Intraperitoneal insulin tolerance testing was carried out before functional study. Metabolic cages, conscious cystometry, and leak point pressure (LPP) were conducted. Urethral tissues were harvested for immunofluorescence staining to check intramyocellular lipid (IMCL) and sphincter muscle (smooth muscle and striated muscle) composition.ResultsThe ZF rats demonstrated insulin resistance, increased voiding frequency, and decreased LPP compared to ZL rats (p
      PubDate: 2016-09-21T04:24:31.647568-05:
      DOI: 10.1111/bju.13661
  • Phenotypic diversity of circulating tumour cells in patients with
           metastatic castration‐resistant prostate cancer
    • Authors: Andrew S. McDaniel; Roberta Ferraldeschi, Rachel Krupa, Mark Landers, Ryon Graf, Jessica Louw, Adam Jendrisak, Natalee Bales, Dena Marrinucci, Zafeiris Zafeiriou, Penelope Flohr, Spyridon Sideris, Mateus Crespo, Ines Figueiredo, Joaquin Mateo, Johann S. de Bono, Ryan Dittamore, Scott A. Tomlins, Gerhardt Attard
      Abstract: ObjectivesTo utilize a non‐biased assay of circulating tumour cells (CTCs) in prostate cancer (PCa) patients in order to identify non‐traditional CTC phenotypes potentially excluded by conventional detection methods reliant upon antigen and/or sized based enrichment.Patients and Methods41 metastatic castration resistant prostate cancer (mCRPC) patients and 20 healthy volunteers were analysed on the Epic CTC Platform, via high throughput imaging of DAPI expression and CD45/cytokeratin (CK) immunofluorescence (IF) in all circulating nucleated cells plated on glass slides. IF for androgen receptor [AR] expression, and FISH for PTEN and ERG confirmed PCa origin of CTCs.ResultsTraditional (t) CTCs (CD45‐/CK+/morphologically distinct) were identified in 100% mCRPC patients. Using the above markers, we identified non‐traditional CTCs in mCRPC patients, including CK‐ and apoptotic CTCs. Small CTCs (≤WBC size) were identified in 98% of mCRPC patients. Total, traditional and non‐traditional CTCs were significantly increased in deceased vs. living patients at 18 months; however only non‐traditional CTCs associated with overall survival. Traditional and total CTC counts by the Epic platform in the mCRPC cohort were also significantly correlated with CTC counts by the CellSearch system.ConclusionsHeterogeneous non‐traditional CTC populations that may be missed by other approaches are frequent in mCRPC; characterization of non‐traditional CTCs may provide additional prognostic or predictive information.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-18T21:36:19.742643-05:
      DOI: 10.1111/bju.13631
  • Risk of Hospitalization Following Primary Treatment for Prostate Cancer
    • Authors: Stephen B. Williams; Zhigang Duan, Karim Chamie, Karen E. Hoffman, Benjamin D. Smith, Jim C. Hu, Jay B. Shah, John W. Davis, Sharon H. Giordano
      Abstract: ObjectiveTo compare the risk of hospitalization and associated costs in patients following treatment for prostate cancer.Patients and MethodsWe identified 29,571 patients age 66–75 years without significant comorbidity from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database who were diagnosed with localized prostate cancer between 2004 and 2009. We compared the rates of all cause and toxicity‐related hospitalization that occurred within 1 year following initiation of definitive therapy. We used multivariable logistic regression analysis to identify determinants associated with hospitalization.ResultsMen who underwent surgery rather than radiotherapy had lower odds of being hospitalized for any cause following therapy (OR 0.80: 95% CI, 0.74–0.87). Patients who underwent surgery rather than radiotherapy had higher odds of being hospitalized for treatment‐related complications (OR 1.15: 95% CI, 1.03–1.29). However, men who underwent external beam radiotherapy/IMRT (OR 0.84: 95% CI, 0.72‐0.99) had 16% lower odds of hospitalization from treatment‐related complications than patients undergoing surgery. Using propensity score weighted analyses, there was no significant difference in the odds of hospitalization from treatment‐related complications for men who underwent surgery versus radiotherapy (OR 1.06: 95% CI, 0.92–1.21). Patients hospitalized for treatment‐related complications following radiotherapy were costlier than patients who underwent surgery (Mean $18,381 vs. $13,203, p
      PubDate: 2016-09-16T00:18:44.30954-05:0
      DOI: 10.1111/bju.13647
  • Long term outcome of high dose rate (HDR) brachytherapy for intermediate
           and high risk prostate cancer with a median follow up of 10 years
    • Authors: J W Yaxley; K Lah, J P Yaxley, R A Gardiner, H Samaratunga, J MacKean
      Abstract: ObjectiveTo evaluate the long term outcome of high dose rate brachytherapy (HDR) for patients with intermediate and high risk prostate cancerSubjects, Patients and MethodsWe retrospectively analysed the prospective longitudinal cohort data base of a single surgeon series of 507 consecutive patients treated with external beam radiotherapy and a high dose rate prostate brachytherapy boost (HDR) between August 2000 and December 2009. The risk factors are based on the D'Amico classification. We measured the incidence of biochemical freedom of recurrent prostate cancer (bNED) based on the Phoenix definition of failure (nadir + 2). We also reviewed the incidence of urethral stricture in this cohort.ResultsWith a minimum follow up of 6 years and a median follow up of 10.3 years, the bNED for intermediate and high risk disease is 93.3 and 74.2% at 5 years respectively and 86.9% and 56.1% at 10 years. Patients with only 1 intermediate risk factor had a 10 year bNED of 94%, whereas patients with all 3 high risk factors had a 10 year bNED of 39.5%. The overall urethral stricture rate was 13.6%. Prior to 2005 the urethral stricture rate was 28.9% and after January 2005 was 4.2%. For the 271 men with a minimum follow up of 10 years the actual 10 year prostate cancer specific survival is 90.8% and actual overall survival is 86.7%.ConclusionsHigh dose rate prostatic brachytherapy remains an appropriate treatment option for patients with intermediate or high risk prostate cancer features, who are considered not suitable for, or wish to avoid a radical prostatectomy. From December 2004, prevention strategies decreased the risk of post brachytherapy urethral strictures.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:47:32.745397-05:
      DOI: 10.1111/bju.13659
  • Prospective study comparing Videoendoscopic radical Inguinal Lymph node
           dissection (VEILND) with Open radical inguinal lymphnode dissection
           (OILND) for penile cancer over an 8 year period
    • Authors: Vivekanandan Kumar; Krishna K Sethia
      Abstract: ObjectivesTo compare the complications and oncological outcomes between Video Endoscopic Inguinal Lymph node Dissection (VEILND) and Open Inguinal Lymph node Dissection (OILND) in men with carcinoma of the penis.Patients and methodsA prospectively collected institutional database was used to determine the outcomes in 42 consecutive patients undergoing inguinal lymph node dissection between 2008 and 2015 in a centre for treating penile cancer. Before 2013 all procedures involved open surgery. Since 2013 we have performed VEILND on all patients in need of ILND. The wound related, non‐wound related complications, length of stay and oncological safety between OILND and VEILND groups were compared. The mean duration of follow up was 71months for OILND and 16 months for the VEILND groups.ResultsIn the study period 42 patients underwent 68 inguinal node dissections (open 35, video‐assisted 33). The patients demographics, primary stage and grade, indications were comparable in both the groups. There were no intraoperative complications in either group. The wound complication rate was significantly lower in VEILND group at 6% compared to 68% in the OILND group. Lymphocele rates were similar in both the groups (27 and 20%). The VEILND group showed better or same lymph node yield, mean number of positive lymph nodes and lymph node density confirming oncological safety. There were no groin recurrence in either group of patients. VEILND patients had significant reduced length of stay by 4.9 days (p=0.0001).ConclusionVEILND is an oncologically safe procedure with considerably low morbidity and reduced length of stay at a mean follow‐up of 16 months (Range: 4‐35 months).This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-15T09:40:25.561228-05:
      DOI: 10.1111/bju.13660
  • Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair
           – demonstration of technique and matched‐pair analysis
    • Authors: Jens J. Rassweiler; Jan Klein, Alexandra Tschada, Ali Serdar Gözen
      Abstract: ObjectivesTo present technique and long‐term results of retroperitoneal laparoscopic partial nephrectomy (LPN) focussing on the impact of an ergonomic platform.Patients and MethodsBetween January 2000 and May 2016, 287 patients (193 male, 94 female) underwent LPN by four surgeons. Median age was 59 (19‐85) years. Mean tumour size was 3.1 (1‐9) cm. Mean PADUA‐score was 7.3 (6‐12). Access was retroperitoneal in 235 (82%) cases. Since October 2010, we used ETHOSTM‐chair during excision of the tumour in 130 (45.3%) patients. 51 (17.7%) tumours were excised without ischemia and 226 (78.7%) tumours under warm ischemia with clamping of renal artery using an enucleo‐resection technique. We suture the resection bed and perform renorrhaphy using a barbed‐suture pre‐loaded with absorbable LAPRA‐TYTM‐clip. The impact of ETHOS‐chair was examined using a matched‐pair analysis (66 ETHOS vs. 67 Non‐ETHOS‐chair).ResultsMedian operating time was 146 (60‐325) minutes. Median estimated blood loss was 99 (10 ‐ 3000) cc, mean warm ischemia time was 17.1 (7‐47) minutes. Histology showed 240 (83.6%) renal cell carcinomas and 46 (15.9%) benign tumours. Cumulative overall disease‐free survival rate after a median follow‐up of 84 (3‐155) months was 100 % for 203 pT1 renal cell tumours, local recurrence was observed in one patient (0.4%), who was managed by radical nephrectomy. There were two conversions (0.7%) to open surgery respectively to hand‐assisted laparoscopy. Perirenal hematoma was observed in 13 (4.5%) patients. 20 (6.9%) patients required transfusions (2‐11 units). We observed 5 urine leaks (1.7%) requiring prolonged drainage. Median hospital stay was 5 (3‐24) days. Three patients developed a‐v‐fistulas successfully occluded by super‐selective embolization (1.0%). Use of ETHOSTM‐chair resulted in shorter OR‐time (134.7 vs. 168.5 min., p = 0.04) including warm ischemia time (13.1 vs. 15.9 min., p=0.01) less complications (15% vs. 29.8%, p = 0.02). Limitation of the analysis is the fact that it is not prospective randomized trial.ConclusionsLPN is technically difficult but oncologic effective. Standardization and simplification of endoscopic suturing using ETHOS‐chair significantly improved the outcome of the surgical procedure.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T22:01:01.305238-05:
      DOI: 10.1111/bju.13627
  • Perioperative and short‐term outcomes after Retzius‐sparing
           robot‐assisted radical prostatectomy stratified by gland size
    • Authors: Glen D.R Santok; Ali Abdel Raheem, Lawrence H. C. Kim, Kidon Chang, Trenton G. H. Lum, Byung H. Chung, Young D. Choi, Koon H. Rha
      Abstract: Objectiveo investigate the impact of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius sparing robot assisted laparoscopic prostatectomy (RS‐RALP).Materials and MethodsThis is a retrospective analysis of 294 patients with organ‐confined prostate cancer (PCa) treated with RS‐RALP in a high volume center from November 2012 to February 2015. Patients were divided into three groups based on their TRUS volume as follows: group 1, (n=231, 60cc). Perioperative, oncological, and continence outcomes were compared between the three groups.ResultsThe median prostate volumes for each group were; 26.1cc (22‐ 40 31), 45.9cc (41‐50) and 70cc (68‐85). Blood loss was higher in group 3 compared to group 2 and group 1; 475cc (312‐575), 200cc (150‐400) and 250cc (150‐400), respectively (p=0.001) Intraoperative transfusion rate was higher in group 3 patients (p=0.004) while complication rate did not differ (p=0.05). Console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; 100±35minutes, 92±34.4minutes and 93±24.8 minutes, respectively (p=0.70). BCR and continence rate did not differ between the three groups (p=0.89, p=0.25, respectively).ConclusionRS‐RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostate. We therefore recommend for surgeons to start at smaller sized prostate in the commencement of application of RS‐RALP technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T21:50:41.077391-05:
      DOI: 10.1111/bju.13632
  • Quality of life and pain relief in men with metastatic
           castration‐resistant prostate cancer on cabazitaxel: the
           non‐interventional QoLiTime study
    • Authors: Ralf‐Dieter Hofheinz; Carsten Lange, Thorsten Ecke, Susanne Kloss, Burkhard Linsse, Christine Windemuth‐Kieselbach, Peter Hammerer, Salah‐Eddin Al‐Batran
      Abstract: ObjectiveTo examine health‐related quality of life in men with metastatic castration‐resistant prostate cancer on cabazitaxel.Patients and methodsMen with metastatic castration‐resistant prostate cancer receiving cabazitaxel (25 mg/m², every 3 weeks) and 10 mg/day oral prednis(ol)one were enrolled (2011–2014) in the non‐interventional prospective QoLiTime study. Primary outcome was change in quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30 item) with respect to PSA response after 4 cycles of cabazitaxel. Secondary outcomes included occurrence of adverse events.ResultsOf 527 men, 348 received 4 cycles of cabazitaxel and 266 had sufficient PSA measurements. After 4 cycles, 92 (34.6%) men had a PSA decrease ≥50% (responders). Quality of life remained stable throughout the study (P=0.62). Change in quality of life did not differ between responders and non‐responders (P=0.69). Change in PSA and global health status between baseline and 4 cycles showed an inversely proportional relationship (correlation coefficient –0.14; 95% CI –0.26 to –0.01; P=0.03), with increasing PSA corresponding to lower health status. Responders showed no change in physical functioning versus baseline (–1.75, P=0.12); non‐responders showed a reduction versus baseline (–7.00, P
      PubDate: 2016-09-12T10:30:33.313897-05:
      DOI: 10.1111/bju.13658
  • Is a negative mpMRI really able to rule out significant prostate
           cancer': The real life experience
    • Authors: Nicolas Branger; Thomas Maubon, Miriam Traumann, Jeanne Thomassin‐Piana, Nicolas Brandone, Sébastien Taix, Julien Touzlian, Serge Brunelle, Geraldine Pignot, Naji Salem, Gwenaelle Gravis, Jochen Walz
      Abstract: ObjectivesTo evaluate the histopathological results after radical prostatectomy in patients that had a normal preoperative mpMRI in order to see if they had significant or insignificant disease. Moreover we evaluated the influence of the expertise of the radiologist on the results.Materials and methodsWe retrospectively included patients who underwent radical prostatectomy in our center and who had a preoperative negative mpMRI. The MRIs were considered negative when no suspicious lesion was seen or when the PI‐RADS V1 score was less than 7. We used pTNM stage and Gleason score on pathology reports, and whole mount sections to calculate tumor volume.ResultsWe identified 101 patients from 2009 to 2015. Final pathology showed that 16.9% had an extraprostatic extension (EEP), 13.8% had primary Gleason pattern 4 (4+3 and up), 47.5% had secondary Gleason pattern 4 or 5, 55.9% and 20.6% had a main tumor volume ≥ 0.5mL and ≥ 2mL respectively. When limiting the analysis to expert reading only, the numbers improved: only one patient (3.4%) had an EEP (p
      PubDate: 2016-09-12T10:30:32.058433-05:
      DOI: 10.1111/bju.13657
  • A novel infusion‐drainage device to assess lower urinary tract
           function in neuro‐imaging
    • Authors: Lorenz Leitner; Matthias Walter, Behnaz Jarrahi, Johann Wanek, Jörg Diefenbacher, Lars Michels, Martina D. Liechti, Spyros S. Kollias, Thomas M. Kessler, Ulrich Mehnert
      Abstract: ObjectiveTo evaluate the applicability and precision of a novel infusion‐drainage device (IDD) for standardised filling paradigms in neuro‐urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) (dys)function.Subjects/patients and methodsThe IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorised slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterisation, the bladder was pre‐filled until a persistent desire to void was reported from each subject. The scan paradigm comprised of automated, repetitive bladder filling and withdrawal of 100 mL body warm (37° C) saline interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping 12.ResultsVolume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flowrates and volumes. MR compatibility was demonstrated with a small decrease in signal‐to‐noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans and a decrease of 1.76% for time‐variant SNR. Automated, repetitive bladder filling elicited robust (p=0.05, family‐wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level dependent (BOLD) signal changes in such areas.ConclusionWe were able to develop a magnetic resonance (MR) compatible and MR synchronised IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in congruence to the applied stimuli. The IDD is commercially available, portable, and multi‐configurable. Such a device may help to improve precision and standardization of LUT tasks in neuroimaging studies on supraspinal LUT control, and may therefore facilitate multi‐site studies and comparability between different LUT investigations in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-12T10:15:29.51283-05:0
      DOI: 10.1111/bju.13655
  • PADUA and RENAL nephrometry scores correlates with perioperative outcomes
           after robot‐assisted partial nephrectomy: analysis of the Vattikuti
           Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database
    • Authors: Riccardo Schiavina; Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A. Moon, Francesco Porpiglia, Benjamin J. Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
      Abstract: ObjectivesTo evaluate and compare the correlations between PADUA and RENAL scores and perioperative outcomes and postoperative complications in a multicenter, international series of patients undergoing Robot‐assisted partial nephrectomy (RAPN) for masses suspicious of RCC.Patients and methodsWe retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international Centers that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI‐RUS) database. All patients underwent pre‐operative computed tomography or magnetic resonance imaging to define the clinical stage and anatomic characteristics of the tumors. PADUA and RENAL scores were retrospectively assessed in each Center. Univariate and multivariate analyses were performed to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumor size, PADUA and RENAL complexity group categories and warm ischemia time >20 minutes, urinary calyceal system closure and grade of postoperative complications.ResultsOverall, 277 patients have been evaluated. The median tumor size was 33.0 millimeters (22.0‐43.0). The median PADUA and RENAL score were 8 and 7 respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low, intermediate or high‐complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low, intermediate or high‐complexity group according to RENAL score, respectively. Both nephrometric tools significantly correlated with perioperative outcomes at univariate and multivariate analyses..ConclusionA precise stratification of patients before partial nephrectomy is recommended, allowing to balance the potential threats and benefits of nephron‐sparing surgery. In our analysis, both PADUA and RENAL were significantly associated with prolonged WIT and high‐grade postoperative complications after RAPN.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-11T00:00:24.276066-05:
      DOI: 10.1111/bju.13628
  • Serum levels of enclomiphene and zuclomiphene in hypogonadal men on
           long‐term clomiphene citrate treatment
    • Authors: Sevann Helo; Joseph Mahon, Joseph Ellen, Ron Wiehle, Gregory Fontenot, Kuang Hsu, Paul Feustel, Charles Welliver, Andrew McCullough
      Abstract: ObjectivesTo determine the relative concentrations of enclomiphene (ENC) and zuclomiphene (ZUC) isomers in hypogonadal men (HM) on long‐term clomiphene citrate (CC) therapy. To determine whether patient age, body mass index, or duration of therapy were predictive of relative concentrations of ENC and ZUC.Patients and MethodsMen already on CC 25 mg daily therapy for secondary hypogonadism for a minimum of six weeks were recruited to have their ENC and ZUC levels assessed. Total testosterone (T), free testosterone, estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH) prior to initiation of and while on CC therapy were recorded for all patients. Patient demographics including age, body mass index, and medical comorbidites were recorded. Serum samples were obtained at the time of enrollment to determine ENC and ZUC concentrations.ResultsA total of 15 men were enrolled from June 2015 to August 2015. Median patient age was 36 (range 22‐70) years, median body mass index 32.0 (range 21.1‐40.3)kg/m2, and median duration of treatment 25.9 (range 1.7‐86.6) months. Baseline median total T, estradiol, and LH were 205.0 ng/dL, 17.0 pg/mL, and 4.0 mlU/mL, respectively. Post‐treatment median total T, estradiol, and LH increased to 488.0 ng/dL 34.0 pg/mL, and 6.1 mIU/mL, respectively (all p
      PubDate: 2016-09-11T00:00:21.328709-05:
      DOI: 10.1111/bju.13625
  • Diagnostic accuracy of CT urography and visual assessment during
           ureterorenoscopy in upper tract urothelial carcinoma
    • Authors: Alexandra Grahn; Miden Melle‐Hannah, Camilla Malm, Fredrik Jäderling, Eva Radecka, Mats Beckman, Marianne Brehmer
      Abstract: Upper tract urothelial carcinoma (UTUC) is a rare condition, although the annual incidence is increasing, possibly as a result of improved diagnostic performance and higher survival rates in patients with bladder cancer. Research data and technical development achieved in the last decades have led to a shift in the guidelines of European Association of Urology (EAU) and American Urological Association for diagnosis and treatment of UTUC. Computed tomography urography (CTU) has become the imaging of choice for investigation.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T07:36:46.28093-05:0
      DOI: 10.1111/bju.13652
  • The landscape of systematic reviews in urology (1998 through 2015): An
           assessment of methodologic quality
    • Authors: Julia L. Han; Shreyas Gandhi, Crystal G. Bockoven, Vikram Narayan, Philipp Dahm
      Abstract: Sir Archie Cochrane is credited with the recognition that few clinical questions in health care are appropriately addressed by consulting the results of a single study alone; instead, we should perform systematic reviews to summarize the entire body of evidence—ideally, high‐quality evidence—in order to inform patient decision‐making and health policy. His contributions provided the impetus for the founding of the Cochrane Collaboration and for the development of transparent, rigorous methods for systematic reviews. Over the last two decades, such reviews have gained increasing importance with regard to their perceived role in informing evidence‐based clinical practice. They tend to be frequently cited in the literature and thus can raise a journal's impact factor. The number of systematic reviews published in the urology literature has clearly increased.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T04:21:15.537585-05:
      DOI: 10.1111/bju.13653
  • A Qualitative Study on Decision‐Making by Prostate Cancer Physicians
           during Active Surveillance
    • Authors: Stacy Loeb; Caitlin Curnyn, Angela Fagerlin, R. Scott Braithwaite, Mark D. Schwartz, Herbert Lepor, H. Ballentine Carter, Erica Sedlander
      Abstract: ObjectiveTo explore and identify factors that influence physicians’ decisions while monitoring prostate cancer patients on active surveillance.Subjects and methodsA purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the US. We conducted 24 in‐depth interviews from July‐December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software was used for organization and further analysis.ResultsEight key themes emerged to explain variation in active surveillance monitoring: 1) physician comfort with active surveillance, 2) protocol selection, 3) beliefs about the utility and quality of testing, 4) years of experience and exposure to AS during training, 5) concerns about inflicting “harm”, 6) patient characteristics, 7) patient preferences, and 8) financial incentives.ConclusionThese qualitative data reveal which factors influence physicians that manage patients on AS. There is tension between providing standardized care while also considering individual patients’ needs and health status. Additional education on active surveillance is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:59.225621-05:
      DOI: 10.1111/bju.13651
  • Pathologic Analysis of the Prostatic Anterior Fat Pad at the time of
           Radical Prostatectomy: Insights from a Prospective Series
    • Authors: Mark W. Ball; Kelly T. Harris, Zeyad Schwen, Jeffrey K Mullins, Misop Han, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein
      Abstract: ObjectiveTo assess factors associated with lymphatic drainage and lymph node metastasis to the prostatic anterior fat pad (PAFP) in men with prostate cancer and the utility of routine PAFP analysis at the time of radical prostatectomy (RP).MethodsOur institution began to prospectively collect PAFP tissue in 2010. The PAFP was removed at the time of RP and sent as a pathologic specimen separate from the pelvic LNs and prostate. Consecutive RPs performed at our institution in which the PAFP was removed were reviewed to determine the rate of LNs in the PAFP, the rate of metastatic LNs in the PAFP, and the association of metastatic PAFP LN with clinical and pathologic features. The impact on biochemical recurrence was assessed with a Cox's proportional hazard model.ResultsIn total, 2,413 AFP specimens were available for analysis. LNs were found in the AFP in 255(10.6%) cases and metastatic LNs to the PAFP were found in 14 (0.6%) cases. Metastatic PAFP LNs were associated with anterior tumors in 11 (78.6%) cases (p = 0.01), and were present only in pre‐operative D'Amico intermediate‐ (n=6, 42.8%) and high‐ (n=8, 57.1%) risk patients (p < 0.001). Metastatic PAFP LNs were associated with extraprostatic disease in 13 (92.8%) of cases, though concomitant pelvic LN involvement was present in only 4 (28.6%) cases. With a mean follow up of 1.5 years, 3 (21.4%) patients with metastatic PAFP LN experienced BCR. Positive LN involvement in either the pelvic LN or PAFP had worse BCR than LN negative patients (p < 0.0001); however, there was no difference in BCR between patients with positive pelvic LN and positive PAFP LN (p=0.5).ConclusionMetastatic PAFP LNs are rare and always occur in the presence of other adverse pathologic features. The routine pathologic analysis of PAFP as a separate specimen, especially in low‐risk disease, may not be warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-09T02:50:57.770637-05:
      DOI: 10.1111/bju.13654
  • Lesion volume predicts prostate cancer risk and aggressiveness: validation
           of its value alone and matched with PIRADS score
    • Authors: Eugenio Martorana; Giacomo Maria Pirola, Michele Scialpi, Salvatore Micali, Andrea Iseppi, Luca Reggiani Bonetti, Shaniko Kaleci, Pietro Torricelli, Giampaolo Bianchi
      Abstract: ObjectiveTo demonstrate the association between MRI estimated lesion volume (LV), PCa detection and tumour clinical significance evaluating this variable alone and matched with PI‐RADSv2 score.Patients and methodsWe retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal MRI/US fusion targeted biopsy (Tp MRI/US FTB) between January 2014 and February 2016 using Biopsee® system. Suspicious lesions (SL) were bordered using a “region of interest” and the system calculated prostate volume and LV. Patients were divided in groups considering LV (< 0.5 ml, 0.5 ‐ 1 ml, > 1 ml) and PI‐RADS score (1‐5). We considered as clinically significant PCa (sPCa) all cancers with GS ≥ 3 + 4 as suggested by PI‐RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t test. MRI LV volume and HTV concordance was verified using a Bland‐Altman plot. Chi‐square test, logistic and ordinal regression model were used to evaluate difference in frequencies. The selected level of statistical significance was ≤ 0.05.ResultsThe LV and PI‐RADS score were associated both with PCa detection (p < 0.00001 and p= 0.00012) and with sPCa detection (p< 0.00001 and p= 0.00808). When the two variables were matched, LV increased the risk within each PI‐RADS group. PCa detection became 1.4 times higher for LV 0.5 ‐ 1 ml and 1.8 times higher for LV > 1 ml; sPCa detection increased 2.6 times for LV 0.5 ‐ 1 ml and 4 times for LV > 1ml. There was positive correlation between MRI LV and HTV (r = 0,9876, p < 0.001). Finally, Bland‐Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations are its monocentric and retrospective design and the limited casistic.ConclusionsThis study demonstrates that PIRADS score and the LV, independently and matched, are associated with PCa detection and with tumour clinical significance.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T13:50:20.096471-05:
      DOI: 10.1111/bju.13649
  • The influence of prostate‐specific antigen density on positive and
           negative predictive values of multiparametric magnetic resonance imaging
    • Authors: Nienke L. Hansen; Tristan Barrett, Brendan Koo, Andrew Doble, Vincent Gnanapragasam, Anne Warren, Christof Kastner, Ola Bratt
      Abstract: ObjectivesTo evaluate the influence of PSA‐D on positive (PPV) and negative (NPV) predictive values of mpMRI to detect GS ≥7 cancer in a repeat biopsy setting.Patients and methodsRetrospective study of 514 men with previous prostate biopsy showing no or GS 6 cancer. All had mpMRI, graded 1‐5 on a Likert scale for cancer suspicion, and subsequent targeted and 24‐core systematic image‐fusion guided transperineal biopsy in 2013‐2015. NPVs and PPVs of mpMRIs for detecting GS ≥7 cancer were calculated (±95% confidence intervals) for PSA‐D ≤0.1, 0.1‐0.2, ≤0.2 and >0.2 ng/ml/cm3, and compared by Chi‐square test for linear trend.ResultsGS ≥7 cancer was detected in 31% of the men. NPV of Likert 1‐2 mpMRI was 0.91 (±0.04) with PSA‐D ≤0.2 and 0.71 (±0.16) with >0.2 (p=0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with PSA‐D ≤0.2 and 0.44 (±0.19) with >0.2 (p=0.002). PSA‐D also significantly affected the PPV of Likert 4‐5 mpMRI lesions: the PPV was 0.47 (±0.08) with PSA‐D ≤0.2 and 0.66 (±0.10) with >0.2 (p=0.0001).ConclusionIn a repeat biopsy setting, PSA‐D ≤0.2 is associated with low detection of GS ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with high PSA‐D, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if PSA‐D is low.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-08T12:50:27.269121-05:
      DOI: 10.1111/bju.13619
  • Safety, reliability and accuracy of small renal tumor biopsies: Results of
           a multi‐institution registry
    • Authors: Patrick O. Richard; Michael A. S. Jewett, Simon Tanguay, Olli Saarela, Zhihui Amy Liu, Frédéric Pouliot, Anil Kapoor, Ricardo Rendon, Antonio Finelli
      Abstract: ObjectiveTo validate the safety, accuracy and reliability of RTB and its role in decreasing unnecessary treatment in a multi‐institution review.Materials and methodsThis was a multi‐institution retrospective study of patients who underwent RTB to characterize a SRM between 2011 and May 2015. Subjects were identified using the prospectively maintained Canadian Kidney Cancer information system (CKCis). Diagnostic and concordance rates were presented using proportions whereas factors associated with a diagnostic RTB were identified using a logistic regression model.ResultsOf the 373 biopsied SRMs, the initial biopsy was diagnostic in 87% of cases. Of the 47 nondiagnostic biopsies, 15 had a repeat biopsy of which, 80% were diagnostic. Therefore, when both were combined, a diagnosis was obtained in 91% of SRMs. Of these, 18% were benign. Size was the only factor found to be associated with achieving a diagnostic biopsy. RTB histology and nuclear grade (high or low) were found to be highly concordant with surgical pathology (86% and 81%, respectively). Of the discordant tumors (n=16), all were upgraded from low to high grade on surgical pathology. Adverse events were rare (
      PubDate: 2016-09-07T03:40:22.747368-05:
      DOI: 10.1111/bju.13630
  • Randomised trial of early infant circumcision performed by clinical
           officers and registered nurse midwives using the Mogen clamp in Rakai,
    • Authors: Edward N. Kankaka; Teddy Murungi, Godfrey Kigozi, Frederick Makumbi, Dorean Nabukalu, Stephen Watya, Nehemiah Kighoma, Resty Nampijja, Daniel Kayiwa, Fred Nalugoda, David Serwadda, Maria Wawer, Ronald H. Gray
      Abstract: ObjectivesTo assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda.Subjects and MethodsWe conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with # NCT02596282. In all, 501 healthy neonates aged 1–28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed‐up at 1, 7 and 28 days.ResultsIn all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow‐up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs.ConclusionsEIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.
      PubDate: 2016-09-06T00:50:47.727872-05:
      DOI: 10.1111/bju.13589
  • Prostate cancer outcomes for men who present with symptoms at diagnosis
    • Authors: Kerri R. Beckmann; Michael E. O'Callaghan, Rasa Ruseckaite, Ned Kinnear, Caroline Miller, Sue Evans, David M. Roder, Kim Moretti,
      Abstract: ObjectiveTo compare clinical features, treatments and outcomes in men with non‐metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate specific antigen (PSA).Patients and methodsThis study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi‐institutional clinical registry covering both the public and private sectors. Participants included all non‐metastatic cases from 1998‐2013 referred for urinary/prostatic symptoms or elevated PSA. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa survival, metastatic‐free survival and disease‐free survival) were compared using multivariate Cox proportional hazards and competing risk regression.ResultsOur analytic cohort consisted of 4841 men with localised PCa. Symptomatic men had lower risk disease (IR= 0.70, CI 0.61‐0.81 for high vs low risk), fewer radical prostatectomies (IR=0.64 CI 0.56‐0.75) and less radiotherapy (IR=0.86, CI 0.77‐0.96) than men presenting with elevated PSA. All‐cause mortality (HR=1.31, CI 1.16‐1.47), disease‐specific mortality (HR=1.42, CI 1.13‐1.77) and risk of metastases (HR=1.36, CI 1.13‐1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics. However, risk of disease progression did not differ (HR=0.90, CI 0.74‐1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR=3.4, CI 1.3‐8.8), those over 70 years (HR=1.4, CI 1.0‐1.8), private patients (HR=2.1, CI 1.3‐3.3), those diagnosed via biopsy (HR=1.3, CI 1.0‐1.7) and those diagnosed before 2006 (HR=1.6, CI 1.1.2‐1.7).ConclusionOur results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post‐treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2016-09-03T22:20:28.085435-05:
      DOI: 10.1111/bju.13622
  • Value of 3‐T multiparametric magnetic resonance imaging and targeted
           biopsy for improved risk stratification in patients considered for active
    • Authors: Rodrigo R. Pessoa; Publio C. Viana, Romulo L. Mattedi, Giuliano B. Guglielmetti, Mauricio D. Cordeiro, Rafael F. Coelho, William C. Nahas, Miguel Srougi
      Abstract: ObjectiveTo evaluate the role of multiparametric magnetic resonance imaging (mpMRI) of the prostate and transrectal guided biopsy (TRUS‐Bx) with visual estimation in early risk stratification of patients on active surveillance.Patients and methodspatients with low‐risk, low‐grade, localized prostate cancer (PCa) were prospectively enrolled and submitted to a 3T 16‐channel cardiac surface coil mpMRI of the prostate and confirmatory biopsy (CB), which included a standard biopsy (SB) and visual estimation‐guided TRUS‐Bx. Cancer‐suspicious regions (CSRs) were defined using Prostate Imaging Reporting and Data System (PI‐RADS) scores. Reclassification occurred if CB confirmed the presence of a Gleason score ≥7, greater than three positive fragments, or ≥50% involvement of any core. The performance of mpMRI for the prediction of CB results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, PSA, PSA density (PSAd), number of positive cores in the initial biopsy, and mpMRI grade on CB reclassification. Our report is consistent with START guidelines.Resultsa total of 105 patients were available for analysis in the study. From this cohort, 42 (40%) had PI‐RADS 1, 2, or 3 lesions and 63 (60%) had only grade 4 or 5 lesions. Overall, 87 patients underwent visual estimation TRUS‐Bx. Reclassification among patients with PI‐RADS 1, 2, 3, 4, and 5 was 0%, 23.1%, 9.1%, 74.5%, and 100%, respectively. Overall, mpMRI sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for disease reclassification were 92.5%, 76%, 81%, and 90.5%, respectively. In the multivariate analysis, only PSAd and mpMRI remained significant for reclassification (p
      PubDate: 2016-09-03T22:20:25.78864-05:0
      DOI: 10.1111/bju.13624
  • Metastatic Potential to Regional Lymph Nodes with Gleason Score ≤7
           including Tertiary Pattern 5 at Radical Prostatectomy
    • Authors: Mairo L. Diolombi; Jonathan I. Epstein
      Abstract: Objectives To determine the risk of pelvic LN metastases at radical prostatectomy (RP) with GS ≤7: 3+3=6 (GG1); 3+4=7 (GG2); 3+4=7 (GG2) with tertiary pattern 5 (T5); 4+3=7 (GG3); 4+3=7 (GG3) with T5 using the 2014 Modified Gleason grading system and the novel Grade Group (GG) system.Materials and Methods We searched our RP database between 2005 and 2014 for cases of GS ≤7 with simultaneous pelvic LN dissection (PLND). Since 2005, we have graded all glomeruloid and cribriform cancer as Gleason pattern 4 and graded mucinous adenocarcinoma based on the underlying architectural pattern consistent with the 2014 Modified Gleason grading system. All RPs were embedded in entirety, including the PLND. A total of 7442 cases were identified, of which 73 had at least 1 positive LN (+LN).Results The incidence of regional LN metastases at RP for 3+3=6 (GG1); 3+4=7 (GG2); 3+4=7 (GG2) with T5; 4+3=7 (GG3); 4+3=7 (GG3) with T5 were 0%, 0.6%, 0.4%, 4.3% and 6.3% respectively. There was a statistically significant difference in risk of +LN at RP between the Grade Groups as defined by the novel Grade Group system. There was no statistically significant difference in risk of +LN at RP for men with 3+4 (GG2) vs. 3+4 (GG2) with T5 and for men with 4+3 (GG3) vs. 4+3 (GG3) with T5. Non‐pelvic LN involvement was identified in 0.2% of all RPs. Two patients with Gleason score 3+4=7 with
      PubDate: 2016-09-02T22:40:24.93675-05:0
      DOI: 10.1111/bju.13623
  • Surgical quality of minimally invasive adrenalectomy for adrenocortical
           carcinoma: a contemporary analysis using the national cancer data base
    • Authors: Matthew J. Maurice; Matthew J. Bream, Simon P. Kim, Robert Abouassaly
      Abstract: ObjectivesTo compare quality outcomes between open (OA) and minimally invasive (MIA) adrenalectomy for adrenocortical carcinoma.Patients and MethodsIn the National Cancer Data Base, we identified 481 patients with non‐metastatic adrenocortical carcinoma who underwent adrenalectomy from 2010‐2013. OA and MIA were compared on positive‐surgical‐margin and lymphadenectomy rates (primary outcomes) and lymph node yield, length of stay, readmission, and overall survival (secondary outcomes). Using the intention‐to‐treat principle, minimally‐invasive‐converted‐to‐open cases were considered MIA. Logistic regression analysis was used to identify predictors of positive margins and lymphadenectomy. Associations between approach and the outcomes were further assessed by stage and tumor size.ResultsOverall, 161 patients (33.5%) underwent MIA. MIA was used more commonly in older, comorbid patients; for smaller, localized tumors; and at lower‐volume centers. In the intention‐to‐treat analysis, MIA independently predicted positive margins (OR 2.0, 95%CI 1.1‐3.6, p=.03) and no lymphadenectomy (OR 0.1, 95%CI 0.03‐0.6, p=.01). On subgroup analysis, the association between MIA and positive margins only held true for pT3 disease (48.7% vs. 26.7%, p=.01). A higher rate of margin positivity was observed for tumors ≥10 cm managed with MIA vs. OA, but this difference was not significant (28.2% vs. 18.5%, p=.16). Likewise, the association between MIA and no lymphadenectomy was only observed for male patients, tumors ≥10 cm, and cN0 disease. After excluding minimally‐invasive‐converted‐to‐open cases, the difference in margin positivity was less pronounced and non‐significant (OR 1.8, 95%CI 0.9‐3.4, p=.08). MIA was associated with significantly shorter median length of stay (3 vs. 6 days, p
      PubDate: 2016-09-01T00:15:23.627576-05:
      DOI: 10.1111/bju.13618
  • Renal fossa recurrence following nephrectomy for renal cell carcinoma:
           prognostic features and oncologic outcomes
    • Authors: Sarah P. Psutka; Mark Heidenreich, Stephen A. Boorjian, George C. Bailey, John C. Cheville, Suzanne B. Stewart‐Merrill, Christine M. Lohse, Thomas D. Atwell, Brian A. Costello, Bradley C. Leibovich, R. Houston Thompson
      Abstract: ObjectiveTo describe clinicopathologic features associated with increased risk of renal fossa recurrences (RFR) following radical nephrectomy (RN) and to describe prognostic features associated with cancer‐specific survival (CSS) among patients with RFR treated with primarily locally‐directed therapy, systemically directed therapy, or expectant management.Patients And MethodsRecords of 2502 patients treated with RN for unilateral, sporadic, localized RCC between 1970 and 2006 were reviewed. CSS following RFR was estimated using the Kaplan‐Meier method. Associations with the development of RFR and CSS following RFR were evaluated using Cox proportional hazards regression models.ResultsA total of 33 (1.3%) patients developed isolated RFR (iRFR) and 30 (1.2%) patients developed RFR in the setting of synchronous metastases following RN (study cohort, N=63). Median follow‐up for the series was 9.0 years after RN and 6.0 years following RFR diagnosis. On multivariable analysis, advanced pathologic stage (pT2: HR 4.36, p=0.004; pT3/4: HR 4.39, p=0.003) and coagulative necrosis (HR 2.71, p=0.006) were independently associated with increased risk of iRFR. The median time to recurrence was 1.5 years post‐nephrectomy among the 33 patients with iRFR, and 1.4 years among all patients. Overall, median CSS was 2.5 years after iRFR diagnosis, 1.3 years after RFR in the setting of synchronous metastases, and 2.2 years overall. Following primary locally directed therapy (surgery, ablation, or radiation), systemic therapy, or expectant management, the 3‐year CSS rates among patients with iRFR were 63%, 50%, and 13% (p=0.001) and were 64%, 50%, and 28% (p=0.006) among all patients,respectively. On multivariable analysis, when compared to observation, locally directed therapies were associated with a significantly decreased risk of death from RCC (HR 0.26, p
      PubDate: 2016-08-31T22:25:24.890225-05:
      DOI: 10.1111/bju.13620
  • Selective Arterial Clamping Does Not Improve Outcomes in Robotic Partial
           Nephrectomy; A Propensity Score Analysis Of Patients Without Impaired
           Renal Function
    • Authors: David J. Paulucci; Daniel C. Rosen, John P. Sfakianos, Michael J. Whalen, Ronney Abaza, Daniel D. Eun, Louis S. Krane, Ashok K. Hemal, Ketan K. Badani
      Abstract: ObjectivesTo assess the benefit of selective arterial clamping (SAC) as an alternative to main renal artery clamping (MAC) during robotic partial nephrectomy (RPN) in patients without underlying chronic kidney disease.Subjects/Patients and MethodsOur study cohort comprised 665 patients without impaired renal function undergoing MAC (n=589) and SAC (n=76) RPN respectively from four medical institutions from 2008‐2015. We compared complication rates, positive surgical margin (PSM) rates, and perioperative and intermediate term renal functional outcome between 132 MAC and 66 SAC patients after 2 to 1 nearest neighbor propensity score matching for age, sex, BMI, R.E.N.A.L. Nephrometry score, tumor size, baseline eGFR, ASA, Charlson Comorbidity Index (CCI), and warm ischemia time (WIT).ResultsIn propensity matched patients, PSM (5.7% vs. 3.0%, p=.407) and complications (13.8% vs. 10.6%, p=.727) did not differ for MAC vs. SAC. Incidence of acute kidney injury in MAC vs. SAC (25.0% vs. 32.0%, p=.315) within the first 30 days was similar. At median follow‐up of 7.5 months, the percentage reduction in eGFR (‐9.3% vs. ‐10.4%, p=.518) and progression to CKD ≥ Stage 3 (7.2% vs. 8.5%, p=.792) showed no difference.ConclusionsOur study findings show no difference in PSM, complications, nor intermediate term renal functional outcomes in patients with unimpaired renal function with SAC compared to MAC. When expected WIT is low, routine utilization of SAC may not be necessary. Further studies will need to determine the role of SAC in solitary kidney patients or in patients with significantly impaired renal function.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-31T22:20:24.904237-05:
      DOI: 10.1111/bju.13614
  • Management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary
           adverse events (UAEs) from radiotherapy for prostate cancer
    • Authors: Erik N. Mayer; Jonathan D. Tward, Mitchell Bassett, Sara M. Lenherr, James M. Hotaling, William O. Brant, William T. Lowrance, Jeremy B. Myers
      Abstract: ObjectiveTo describe the management of grade 4 Radiation Therapy Oncology Group (RTOG) urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). We hypothesized grade 4 UAEs often require complex surgical management and subject patients to significant morbidity.MethodsA single‐center retrospective review, over a 6‐year period (2010‐2015), identified men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined modality therapy (radical prostatectomy (RP) followed by external beam radiotherapy (EBRT), EBRT + low‐dose brachytherapy (LDR), EBRT + high‐dose brachytherapy (HDR), or other combinations of RT) or single modality RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto‐urethral fistula) or bladder (contraction, necrosis, fistula, ureteral stricture, or hemorrhage).ResultsWe identified 73 men with a mean age of 73 years. Forty‐four (60%) had combined modality therapy, consisting of RP + EBRT (19), high dose rate brachytherapy (HDR) + EBRT (19), low dose rate brachytherapy (LDR) + EBRT (5), and other combined modality RT (2). Twenty‐nine (40%) patients had single modality therapy consisting of EBRT (4), HDR (11), LDR (12), or proton beam (2). UAEs were isolated to the bladder in 6 (8%), the outlet in 52 (71%), and both in 15 (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion in 23 (32%). Reconstruction included: ureteral (4), recto‐urethral fistula repair (2), and posterior urethroplasty (13), of which 14/16 (88%) surgeries with follow‐up >90 days were successful.ConclusionsAlthough the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their morbidity is significant, and approximately one third of patients with these high‐grade complications require urinary diversion. Conversely only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-30T02:10:44.94212-05:0
      DOI: 10.1111/bju.13607
  • Risk Prediction Tool for Grade Reclassification in Favorable‐Risk
           Men on Active Surveillance
    • Authors: Mufaddal M. Mamawala; Karthik Rao, Patricia Landis, Jonathan I. Epstein, Bruce J. Trock, Jeffrey J. Tosoian, Kenneth J. Pienta, H. Ballentine Carter
      Abstract: ObjectiveTo create a nomogram for men on active surveillance (AS) for prediction of grade reclassification (GR) above Gleason score 6 (Grade group >2) at surveillance biopsy.Materials and MethodsFrom a cohort of men enrolled in an AS program, a multivariable model was used to identify clinical and pathologic parameters predictive of GR. Nomogram performance was assessed using receiver operating characteristic curves, calibration and decision curve analysis.ResultsOf 1374 men, 254 (18.50%) were reclassified to Gleason 7 or higher on surveillance prostate biopsy. Variables predictive of GR were earlier year of diagnosis (≤2004 vs. ≥2005; odds ratio [OR] = 2.16, P = < 0.0001), older age (OR = 1.05, P = 0.0004), higher prostate specific antigen density [PSAD] (OR = 1.19 [per 0.1 unit increase], P = 0.04), bilateral disease (OR = 2.86, P = < 0.0001), risk strata (low‐risk vs. very‐low‐risk, OR=1.79, P = 0.0009) and total number of biopsies without GR (OR = 0.68, P = < 0.0001). On internal validation, a nomogram created using the multivariable model demonstrated an area under the curve of 0.757 (95% CI = 0.730, 0.797) for predicting GR at the time of next surveillance biopsy.ConclusionThe nomogram described is currently being used at each return visit to assess the need for a surveillance biopsy, and could increase retention in AS.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-29T11:40:23.026279-05:
      DOI: 10.1111/bju.13608
  • The actual lowering effect of metabolic syndrome on serum
           prostate‐specific antigen levels is partly concealed by enlarged
           prostate: results from a large‐scale population‐based study
    • Authors: Sicong Zhao; Ming Xia, Jianchun Tang, Yong Yan
      Abstract: ObjectivesTo clarify the actual lowering effect of metabolic syndrome (MetS) on serum prostate‐specific antigen (PSA) levels in a Chinese‐screened population.Materials and MethodsA total of 45,540 ostensibly healthy men aged 55‐69 years of old who underwent routine health check‐ups at Beijing Shijitan Hospital from 2008 to 2015 were included in this study. All subjects underwent detailed clinical evaluations. PSA mass density was calculated (serum PSA level × plasma volume ÷ prostate volume) for simultaneously adjusting plasma volume and prostate volume. According to the modified NCEP‐ATP III criteria, subjects were dichotomized by the presence of MetS, and the differences in PSA density and PSA mass density were compared between groups. Linear regression analysis was used to evaluate the effect of MetS on serum PSA levels.ResultsWhen larger prostate volume in men with MetS was adjusted, both the PSA density and PSA mass density in subjects with MetS were significantly lower than that in subjects without MetS, and the estimated difference in mean serum PSA level between subjects with and without MetS was greater than that before prostate volume was adjusted. In multivariate regression model, the presence of MetS was independently associated with an 11.3% decline in serum PSA levels compared with subjects without MetS. In addition, the increasing number of positive MetS components was significantly and linearly associated with the declining in serum PSA levels.ConclusionThe actual lowering effect of MetS on serum PSA levels was partly concealed by the enlarged prostate in men with MetS, and the presence of MetS was independently associated with lower serum PSA levels. Urologists need to be aware of the effect of MetS on serum PSA levels and discuss this subject with their patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-28T21:45:25.745517-05:
      DOI: 10.1111/bju.13621
  • Oncologic outcomes and complication rates after laparoscopic‐assisted
           cryoablation: a EuRECA multi‐institutional study
    • Authors: Tommy K. Nielsen; Brunolf W. Lagerveld, Francis Keeley, Giovanni Lughezzani, Seshadri Sriprasad, Neil J. Barber, Lars U. Hansen, Nicole M. Buffi, Giorgio Guazzoni, Johan A. Zee, Mohamed Ismail, Khaled Farrag, Amr M. Emara, Lars Lund, Øyvind Østraat, Michael Borre
      Abstract: ObjectiveTo assess complication rates and intermediate oncologic outcomes of laparoscopic‐assisted cryoablation (LCA) in patients with small renal masses (SRM).Patients and MethodsA retrospective review of 808 patients treated with LCA for T1a renal masses from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien‐Dindo classification. Kaplan‐Meier analyses were used to estimate 5 and 10‐year disease‐free survival (DFS) and overall survival (OS).ResultsMedian age was 67 years (IQR: 58‐74). Median tumour size was 25mm (IQR: 19‐30). The transperitoneal approach was used in 77.7% of the patients. Median postoperative hospital stay was two days. A total of 514 patients with a biopsy‐confirmed RCC were available for survival analyses. Median follow‐up time for the RCC‐cohort was 36 months (IQR: 14‐56). A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5/10‐year DFS was 90.4%/80.0% and 5/10‐year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥ 3) in 26 patients (3.2%). An ASA score of three was associated with an increased risk of overall complications (OR: 2.85; 95%CI: 1.32‐6.20; p=0.005).ConclusionsThis large series of LCA demonstrates satisfactory long‐term oncologic outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-26T03:00:33.501699-05:
      DOI: 10.1111/bju.13615
  • Prostate size, nocturia, and the digital rectal exam: a cohort study of
           30,500 men
    • Authors: Benjamin V. Stone; Jonathan Shoag, Joshua A. Halpern, Sameer Mittal, Patrick Lewicki, David M. Golombos, Dina Bedretdinova, Bilal Chughtai, Christopher E. Barbieri, Richard K. Lee
      Abstract: ObjectivesTo evaluate the utility of the digital rectal exam (DRE) in estimating prostate size and the association of DRE with nocturia in a population‐based cohort.Subjects and MethodsWe identified all men randomized to the screening arm of the PLCO trial for whom DRE results were available. Subjects were excluded with history of prostate surgery or incident prostate cancer. Prostate posterior surface area was derived from DRE sagittal and transverse estimates. Relationships between prostate posterior surface area, transrectal ultrasound (TRUS), PSA, and nocturia were analyzed using intraclass correlation coefficient (ICC), Spearman's rank correlation, and multivariable logistic regression.Results30,500 men met inclusion criteria, with 103,275 screening visits containing paired DRE and PSA data. DRE posterior surface area estimates had an ICC of 0.547 (95% CI 0.541‐0.554) and were significantly yet modestly correlated with increased prostate‐specific antigen (rs=0.18, p
      PubDate: 2016-08-23T21:45:32.692036-05:
      DOI: 10.1111/bju.13613
  • COX‐2 Inhibition for Prostate Cancer Chemoprevention: Double‐Blind
           Randomized Study of Pre‐Prostatectomy Celecoxib or Placebo
    • Authors: Jason F. Flamiatos; Tomasz M. Beer, Julie N. Graff, Kristine M. Eilers, Wei Tian, Harman S. Sekhon, Mark Garzotto
      Abstract: ObjectiveTo evaluate the biologic effects of selective cyclooxygenase‐2 inhibition on prostate tissue in men undergoing prostatectomy.Materials and MethodsPatients with localized prostate cancer were randomized to receive either celecoxib 400 mg twice daily or placebo for four weeks prior to prostatectomy. Specimens were analyzed for levels of apoptosis, prostaglandins, and androgen receptor. Effects on serum prostate‐specific antigen (PSA) and post‐operative opioid use were also measured.ResultsTwenty‐eight of 44 anticipated patients enrolled and completed treatment. One patient on the celecoxib arm had a myocardial infarction post‐operatively. For this reason, and safety concerns in other studies, enrollment was halted. The apoptosis index in tumor cells was 0.29% (95% CI: 0.11‐0.47%) versus 0.39% (95% CI: 0.00‐0.84%) in the celecoxib and placebo arms, respectively (p=0.68). The apoptosis index in benign cells was 0.18% (95% CI: 0.03‐0.32%) versus 0.13% (95% CI: 0.00‐0.28%) in the celecoxib and placebo arms, respectively (p=0.67). PGE2 and androgen receptor levels were similar in cancer and benign tissues when comparing the two arms. Median baseline PSA was 6.0ng/ml and 6.2ng/ml for the celecoxib and placebo groups, respectively, and did not significantly change after celecoxib treatment. There was no difference in post‐operative opiate usage between arms.ConclusionCelecoxib had no effect on apoptosis, prostaglandins or androgen receptor levels in cancerous or benign prostate tissues. These findings coupled with drug safety concerns should serve to limit interest in these selective drugs as chemopreventive agents.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-23T21:45:27.390728-05:
      DOI: 10.1111/bju.13612
  • Evolution of the Robotic Orthotopic Ileal Neobladder Formation: A Step by
           Step Update to The USC Technique
    • Authors: Sameer Chopra; Andre Luis de Castro Abreu, Andre K. Berger, Shuchi Sehgal, Inderbir Gill, Monish Aron, Mihir M. Desai
      Abstract: ObjectiveTo describe, step‐by‐step, our updated, time‐efficient technique for intracorporeal neobladder formation.Patients and MethodsThere are five main surgical steps to forming the intracorporeal orthotopic ileal neobladder: isolation of the small bowel intestine; small bowel anastomosis; bowel detubularization and suture of the posterior wall of the neobladder; neobladder‐urethral anastomosis and folding the pouch; and ureteral‐chimney anastomosis. Improvements have been made during these steps to improve time efficiency without compromising neobladder formation.ResultsA total of 65 cm of small intestinal bowel is removed for neobladder formation. Our technical improvements have demonstrated an improvement in operative time from 450 minutes to 360 minutes.ConclusionWe describe an updated step‐by‐step technique to our institution's robotic intracorporeal orthotopic ileal neobladder formation using a time‐efficient technique.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-30T09:10:30.423817-05:
      DOI: 10.1111/bju.13611
  • The ProCare Trial: a phase II randomised controlled trial of shared care
           for follow‐up of men with prostate cancer
    • Authors: Jon D Emery; Michael Jefford, Madeleine King, Dickon Hayne, Andrew Martin, Juanita Doorey, Amelia Hyatt, Emily Habgood, Tee Lim, Cynthia Hawks, Marie Pirotta, Lyndal Trevena, Penelope Schofield
      Abstract: ObjectivesTo test the feasibility and efficacy of a multifaceted model of shared care for men after completion of treatment for prostate cancer.Patients and MethodsMen who had completed treatment for low to moderate risk prostate cancer within the previous eight weeks were eligible. Participants were randomised to usual care or shared care. Shared care entailed substituting two hospital visits with three visits in primary care, a survivorship care plan, recall and reminders, and screening for distress and unmet needs. Outcome measures included psychological distress, prostate cancer‐specific quality of life (PCSQoL), satisfaction and preferences for care and health care resource use.Results88 men were randomised (Shared Care n=45; Usual Care n=43). There were no clinically important or statistically significant differences between groups on distress, PCSQoL, or satisfaction with care. At the end of the trial men in the intervention group were significantly more likely to prefer a shared care model to hospital follow‐up than those in the control group Intervention 63% vs Control 24% p=0.0007). There was high compliance with PSA monitoring in both groups. The shared care model was cheaper than usual care (Shared care AUS$1,411; Usual Care AUS$1,728; difference AUS$323 (plausible range AUS$91‐554)).ConclusionWell‐structured shared care for men with low to moderate risk prostate cancer is feasible and appears to produce clinically comparable outcomes to standard care at lower cost.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:35:29.712123-05:
      DOI: 10.1111/bju.13593
  • Routinely reported ‘equivocal’ lymphovascular invasion in
           prostatectomy specimens is associated with adverse outcomes
    • Authors: Elena Galiabovitch; Christopher M. Hovens, Justin S. Peters, Anthony J. Costello, Shane Battye, Sam Norden, Andrew Ryan, Niall M. Corcoran
      Abstract: ObjectiveTo evaluate the significance of routinely reported ‘equivocal’ lymphovascular invasion in prostatectomy specimens of patients with clinically localised prostate cancer.Materials and MethodsProspectively collected data from men who underwent prostatectomy for clinically localised prostate cancer were retrospectively reviewed. Rates of adverse pathological features and biochemical recurrence were compared between tumours positive, negative or ‘equivocal’ for lymphovascular invasion. Multivariable Cox regression analysis was performed to identify independent predictors of biochemical recurrence.ResultsIn 1310 consecutive cases, lymphovascular invasion was present definitively in 82 (6.3%) and equivocally in 43 (3.3%). Similar to definitive lymphovascular invasion, ‘equivocal’ lymphovascular invasion was significantly associated with other adverse pathological features, including advanced stage, higher Gleason grade, and surgical margin positivity. Biochemical recurrence occurred more frequently in patients with tumours ‘equivocal’ (61%) or positive for lymphovascular invasion (71%) than in negative patients (14.7%). In addition, patients with both definitive and equivocal lymphovascular invasion had a significantly shorter biochemical recurrence‐free survival compared to negative patients. Multivariable Cox regression analysis indicated that the presence of either definitive or ‘equivocal’ lymphovascular invasion were independent predictors of disease recurrence (HR 3.32, 95%CIs 2.3‐4.8, p
      PubDate: 2016-07-19T01:35:27.28618-05:0
      DOI: 10.1111/bju.13594
  • Comparison of spinal cord contusion and transection: functional and
           histological changes in the rat urinary bladder
    • Authors: Benjamin N. Breyer; Thomas M. Fandel, Amjad Alwaal, E. Charles Osterberg, Alan W. Shindel, Guiting Lin, Emil A. Tanagho, Tom F. Lue
      Abstract: ObjectiveTo compare the effect of complete transection (tSCI) and contusion injury (cSCI) on bladder function and bladder wall structure in rats.Materials and Methods30 female Sprague‐Dawley rats were randomly divided into three equal groups: uninjured controls, cSCI, and tSCI. The cSCI group underwent spinal cord contusion, while the tSCI group underwent complete spinal cord transection. 24‐hour metabolic cage measurement and conscious cystometry were performed at 6 weeks post‐injury.ResultsConscious cystometry analysis showed that cSCI and tSCI groups had significantly larger bladder capacities than the control group. The cSCI group had significantly more non‐voiding detrusor contractions than the tSCI group. Both injury groups displayed more non‐voiding contractions compared to the control group. Mean threshold pressure was significantly higher in the tSCI group than in control and cSCI groups. The number of voids in the tSCI group was less compared to the control group. Metabolic cage analysis showed that the tSCI group had larger maximum voiding volume as compared to control and cSCI. VAChT/smooth muscle immunoreactivity was higher in control than in cSCI or tSCI rats. The area of calcitonin gene‐related peptide (CGRP) staining was lower in tSCI as compared to control or cSCI.ConclusionsSpinal cord transection and contusion produce different bladder phenotypes in rat models of SCI. Functional data suggest that the tSCI group has obstructive high‐pressure voiding pattern, while the cSCI group has more uninhibited detrusor contractions.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:31:07.895521-05:
      DOI: 10.1111/bju.13591
  • Liquid biopsy: ready to guide therapy in advanced prostate cancer?
    • Authors: Miriam Hegemann; Arnulf Stenzl, Jens Bedke, Kim Nguyen Chi, Peter Colin Black, Tilman Todenhöfer
      Abstract: The identification of molecular markers associated with response to specific therapy is a key step for the implementation of personalized treatment strategies in patients with metastatic prostate cancer (PC). Only in a low proportion of patients, biopsies of metastatic tissue are performed. Circulating tumor cells (CTC), cell free‐DNA (cfDNA) and RNA offer the potential for non‐invasive characterization of disease and molecular stratification of patients. Furthermore, a “liquid biopsy” approach permits longitudinal assessments, allowing sequential monitoring of response and progression and the potential to alter therapy based on observed molecular changes. In PC, CTC enumeration using the CellSearch© platform correlates with survival. Recent studies on the presence of androgen receptor variants in CTC have shown that the such molecular characterization of CTC provides a potential for identifying patients with resistance to agents that inhibit the androgen signaling axis, such as abiraterone and enzalutamide. New developments in CTC isolation, as well as in‐vitro and in‐vivo analysis of CTC will further promote the use of CTC as a tool for retrieving molecular information from advanced tumors in order to identify mechanisms of therapy resistance. In addition to CTC, nucleic acids such as RNA and cell free DNA (cfDNA) released by tumor cells into the peripheral blood contains important information on transcriptomic and genomic alterations in the tumors. Initial studies have shown that genomic alterations of the androgen receptor and other genes detected in CTC or cfDNA of patients with castration resistant prostate cancer (CRPC) correlate with treatment outcomes to enzalutamide and abiraterone. Due to recent developments in high throughput analysis techniques, it is likely that CTC, cfDNA and RNA will be an important component of personalized treatment strategies in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-19T01:25:58.470194-05:
      DOI: 10.1111/bju.13586
  • Raised pre‐operative INR identifies patients at high risk of
           peri‐operative death after simultaneous renal and cardiac surgery for
           tumours involving the peri‐diaphragmatic inferior vena cava (IVC) and
           right atrium
    • Authors: Tim O'Brien; Archie Fernando, Kay Thomas, Mieke Van Hemelrijck, Craig Bailey, Conal Austin
      Abstract: BackgroundThe ability to predict and therefore avoid surgery in those patients likely to die from simultaneous renal and cardiac surgery for urological tumours involving the peri‐diaphragmatic vena cava and right atrium would be valuable.ObjectiveTo identify pre‐operative factors that predict thirty‐day mortality (TDM) in patients undergoing this type of surgery.Design setting and participantsRetrospective review of peri‐operative outcomes in patients managed between December 2007 and January 2016 by a single team.Outcome measurements and statistical analysisRelationships with outcome analysed using Fisher's Exact and Mann Whitney U tests.Results and Limitations46 patients of whom 41/46 (89%) underwent surgery.20 males; 21 females. Median age 65 yrs (range 17‐95). 37 renal cell cancer, 1 adrenal cancer, 2 primitive neuroectodermal tumours and 1 leiomyosarcoma.Overall TDM 3/41 patients (7%). INR, age and eGFR correlated significantly with TDM.Mortality if INR >1.5, 3/5 (60%) compared to 0/36 (0%) if INR 1.5 and age >70 years 3/3 (100%)INR correlated with serious complications (≥Clavien 3) (INR>1.5: 5/5 (100%) vs INR
      PubDate: 2016-07-19T01:25:44.444591-05:
      DOI: 10.1111/bju.13587
  • A 22‐year Restrospective Study: Educational Update and New Referral
           Pattern of Age at Orchidopexy
    • Authors: Yi Wei; Sheng‐de Wu, Yang‐ca Wang, Tao Lin, Da‐wei He, Xu‐liang Li, Jun‐hong Liu, Xing Liu, Yi Hua, Peng Lu, De‐ying Zhang, Sheng Wen, Guang‐hui Wei
      Abstract: ObjectivesResearch suggesting progressive deterioration in an undescended testis (UDT) has led to the reduction in the target age for orchidopexy to 6‐12 months of age. However, it is still unknown whether changing targets have altered practice. The objective was to determine the current age at orchidopexy in China and whether changing targets have altered practice.Materials and MethodsThe demographics of orchidopexies performed in Children's Hospital of Chongqing Medical University between 1993 and 2014 were reviewed. Survey of general publics’ cognition of undescended testes and survey of primary healthcare practitioners’ current opinion on age at orchidopexy and referral patterns were performed.ResultsA total of 3784 orchidopexies were performed over 22 years. The median age at orchidopexy fell between 1993 to 2014. There was an initial drop in the age for orchidopexy between 2000‐2010(3 years old)compared with the median age between 1993‐2000(4 years old).(P
      PubDate: 2016-07-19T01:25:35.090771-05:
      DOI: 10.1111/bju.13588
  • Journal information
    • First page: 842
      PubDate: 2016-11-15T00:03:08.936726-05:
      DOI: 10.1111/bju.13305
  • The Prostate Testing for Cancer and Treatment (ProtecT) study: what have
           we learnt'
    • Authors: Freddie C. Hamdy
      First page: 843
      PubDate: 2016-11-15T00:03:02.513936-05:
      DOI: 10.1111/bju.13699
  • ‘Killing two birds with one stone’: patient-reported quality-of-life
           outcomes from the Prostate Testing for Cancer and Treatment (ProtecT)
    • Authors: Mark D. Tyson; David F. Penson
      First page: 844
      PubDate: 2016-11-15T00:03:10.063893-05:
      DOI: 10.1111/bju.13673
  • What is behind the flare phenomenon'
    • Authors: Elizabeth R. Kessler
      First page: 845
      PubDate: 2016-11-15T00:03:04.39098-05:0
      DOI: 10.1111/bju.13554
  • Light reflectance spectroscopy is one more emerging technique with the
           potential to adjust excision limits during radical prostatectomy
    • Authors: Thomas Bessede; Ash Tewari
      First page: 846
      PubDate: 2016-11-15T00:03:10.422432-05:
      DOI: 10.1111/bju.13560
  • Single nucleotide polymorphisms of the vascular endothelial growth factor
           receptor – a promising biomarker in metastatic renal cell carcinoma
    • Authors: Solomon L. Woldu; Vitaly Margulis
      First page: 847
      PubDate: 2016-11-15T00:03:02.399365-05:
      DOI: 10.1111/bju.13617
  • Open partial nephrectomy is still alive
    • Authors: Alessandro Crestani; Marta Rossanese, Gianluca Giannarini
      First page: 848
      PubDate: 2016-11-15T00:03:02.978637-05:
      DOI: 10.1111/bju.13650
  • Interpretation of conventional survival analysis and competing-risk
           analysis: an example of hypertension and prostate cancer
    • Authors: Christel Häggström; Pär Stattin, Tanja Stocks, Hans Garmo, Lars Holmberg, Mieke Hemelrijck
      First page: 850
      PubDate: 2016-04-24T21:31:00.225439-05:
      DOI: 10.1111/bju.13494
  • If the robot is there, why not use it' Why we should use the robot for
           laparoscopic nephrectomy
    • Authors: Wayne Lam; Mollika Chakravorty, Ben Challacombe
      First page: 852
      PubDate: 2016-05-29T21:55:26.622065-05:
      DOI: 10.1111/bju.13509
  • The Role of Biobanking in Urology: A Review
    • Authors: Heather J. Chalfin; Elizabeth Fabian, Leslie Mangold, David B. Yeater, Kenneth J. Pienta, Alan W. Partin
      First page: 864
      Abstract: In the current era of individualized medicine, a biorepository of human samples is essential to support clinical and translational research. There have been limited efforts in this arena within the field of urology, as costs, logistical, and ethical issues represent significant deterrents to biobanking. The Johns Hopkins Brady Urological Institute (JHBUI) Biorepository was founded in 1994 as a resource to facilitate discovery. Since its inception, the biorepository has enabled numerous research endeavors including pivotal trials leading to the regulatory approval of four diagnostic tests for prostate cancer. In this review, we discuss the current state of biobanking within urology, outline the specific ethical and financial challenges of biobanking as well as solutions, and describe the operations of a successful urologic biorepository.This article is protected by copyright. All rights reserved.
      PubDate: 2016-08-29T11:35:32.01481-05:0
      DOI: 10.1111/bju.13606
  • Patient-reported outcomes in the ProtecT randomized trial of clinically
           localized prostate cancer treatments: study design, and baseline urinary,
           bowel and sexual function and quality of life
    • Authors: Athene Lane; Chris Metcalfe, Grace J. Young, Tim J. Peters, Jane Blazeby, Kerry N. L. Avery, Daniel Dedman, Liz Down, Malcolm D. Mason, David E. Neal, Freddie C. Hamdy, Jenny L. Donovan,
      First page: 869
      Abstract: ObjectivesTo present the baseline patient-reported outcome measures (PROMs) in the Prostate Testing for Cancer and Treatment (ProtecT) randomized trial comparing active monitoring, radical prostatectomy and external-beam conformal radiotherapy for localized prostate cancer and to compare results with other populations.Materials and MethodsA total of 1643 randomized men, aged 50–69 years and diagnosed with clinically localized disease identified by prostate-specific antigen (PSA) testing, in nine UK cities in the period 1999–2009 were included. Validated PROMs for disease-specific (urinary, bowel and sexual function) and condition-specific impact on quality of life (Expanded Prostate Index Composite [EPIC], 2005 onwards; International Consultation on Incontinence Questionnaire-Urinary Incontinence [ICIQ-UI], 2001 onwards; the International Continence Society short-form male survey [ICSmaleSF]; anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), generic mental and physical health (12-item short-form health survey [SF-12]; EuroQol quality-of-life survey, the EQ-5D-3L) were assessed at prostate biopsy clinics before randomization. Descriptive statistics are presented by treatment allocation and by men's age at biopsy and PSA testing time points for selected measures.ResultsA total of 1438 participants completed biopsy questionnaires (88%) and 77–88% of these were analysed for individual PROMs. Fewer than 1% of participants were using pads daily (5/754). Storage lower urinary tract symptoms were frequent (e.g. nocturia 22%, 312/1423). Bowel symptoms were rare, except for loose stools (16%, 118/754). One third of participants reported erectile dysfunction (241/735) and for 16% (118/731) this was a moderate or large problem. Depression was infrequent (80/1399, 6%) but 20% of participants (278/1403) reported anxiety. Sexual function and bother were markedly worse in older men (65–70 years), whilst urinary bother and physical health were somewhat worse than in younger men (49–54 years, all P < 0.001). Bowel health, urinary function and depression were unaltered by age, whilst mental health and anxiety were better in older men (P < 0.001). Only minor differences existed in mental or physical health, anxiety and depression between PSA testing and biopsy assessments.ConclusionThe ProtecT trial baseline PROMs response rates were high. Symptom frequencies and generic quality of life were similar to those observed in populations screened for prostate cancer and control subjects without cancer.
      PubDate: 2016-08-17T02:23:27.812655-05:
      DOI: 10.1111/bju.13582
  • Co-introduction of a steroid with docetaxel chemotherapy for metastatic
           castration-resistant prostate cancer affects PSA flare
    • Authors: Masaki Shiota; Akira Yokomizo, Ario Takeuchi, Keijiro Kiyoshima, Junichi Inokuchi, Katsunori Tatsugami, Ken-ichiro Shiga, Hirofumi Koga, Akito Yamaguchi, Seiji Naito, Masatoshi Eto
      First page: 880
      Abstract: ObjectiveTo investigate the potential relationship of steroid usage with prostate-specific antigen (PSA) flare as well as the prognostic impact of PSA flare, which is known to occur in 10–20% of patients with metastatic castration-resistant prostate cancer during docetaxel chemotherapy.Patients and MethodsThis study included 71 patients with metastatic castration-resistant prostate cancer treated by docetaxel chemotherapy with co-introduction of a steroid. PSA flare was defined as a transient PSA increase followed by a PSA decrease.ResultsPSA flare was recognized in 7.0–23.9% of patients according to the definition used. Intriguingly, men with steroid intake before the initiation of docetaxel chemotherapy experienced significantly fewer PSA flares. The progression-free survival rate in men with PSA flare was equivalent to that of PSA responders, but significantly better than men with PSA failure.ConclusionsOur results suggest that de novo steroid co-introduction with docetaxel chemotherapy induces the PSA flare phenomenon. This novel finding may account for the mechanism of PSA flare as well as being valuable for distinguishing PSA elevation attributable to PSA flare from that attributable to PSA failure.
      PubDate: 2016-04-06T23:36:26.370859-05:
      DOI: 10.1111/bju.13483
  • Detecting positive surgical margins: utilisation of light-reflectance
           spectroscopy on ex vivo prostate specimens
    • Authors: Aaron H. Lay; Xinlong Wang, Monica S. C. Morgan, Payal Kapur, Hanli Liu, Claus G. Roehrborn, Jeffrey A. Cadeddu
      First page: 885
      Abstract: ObjectiveTo assess the efficacy of light-reflectance spectroscopy (LRS) to detect positive surgical margins (PSMs) on ex vivo radical prostatectomy (RP) specimens.Materials and MethodsA prospective evaluation of ex vivo RP specimens using LRS was performed at a single institution from June 2013 to September 2014. LRS measurements were performed on selected sites on the prostate capsule, marked with ink, and correlated with pathological analysis. Significant features on LRS curves differentiating malignant tissue from benign tissue were determined using a forward sequential selection algorithm. A logistic regression model was built and randomised cross-validation was performed. The sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC) for LRS predicting PSM were calculated.ResultsIn all, 50 RP specimens were evaluated using LRS. The LRS sensitivity for Gleason score ≥7 PSMs was 91.3%, specificity 92.8%, accuracy 92.5%, PPV 73.2%, NPV 99.4%, and the AUC was 0.960. The LRS sensitivity for Gleason score ≥6 PSMs was 65.5%, specificity 88.1%, accuracy 83.3%, PPV 66.2%, NPV 90.7%, and the AUC was 0.858.ConclusionsLRS can reliably detect PSMs for Gleason score ≥7 prostate cancer in ex vivo RP specimens.
      PubDate: 2016-05-20T04:01:54.465028-05:
      DOI: 10.1111/bju.13503
  • Validation of VEGFR1 rs9582036 as predictive biomarker in metastatic
           clear-cell renal cell carcinoma patients treated with sunitinib
    • Authors: Benoit Beuselinck; Johnny Jean-Baptiste, Patrick Schöffski, Gabrielle Couchy, Clément Meiller, Frederic Rolland, Yves Allory, Steven Joniau, Virginie Verkarre, Reza Elaidi, Evelyne Lerut, Tania Roskams, Jean-Jacques Patard, Stephane Oudard, Arnaud Méjean, Diether Lambrechts, Jessica Zucman-Rossi
      First page: 890
      Abstract: ObjectivesTo validate vascular endothelial growth factor receptor-1 (VEGFR1) single nucleotide polymorphism (SNP) rs9582036 as a potential predictive biomarker in metastatic clear-cell renal cell carcinoma (m-ccRCC) patients treated with sunitinib.Materials and Methodsm-ccRCC patients receiving sunitinib as first-line targeted therapy were included. We assessed response rate (RR), progression-free survival (PFS), overall survival (OS), and clinical and biochemical parameters associated with outcome. We genotyped five VEGFR1 SNPs: rs9582036, rs7993418, rs9554320, rs9554316 and rs9513070. Association with outcome was studied by univariate analysis and by multivariate Cox regression. Additionally, we updated survival data of our discovery cohort as described previously.ResultsSixty-nine patients were included in the validation cohort. rs9582036 CC-carriers had a poorer PFS (8 vs 12 months, P = 0.02) and OS (11 vs 27 months, P = 0.003) compared to AC/AA-carriers. rs7993418 CC-carriers had a poorer OS (8 vs 24 months, P = 0.004) compared to TC/TT-carriers. rs9554320 AA-carriers had a poorer RR (0% vs 53%, P = 0.009), PFS (5 vs 12 months, P = 0.003) and OS (10 vs 25 months, P = 0.004) compared to AC/CC-carriers. When pooling patients from the discovery cohort, as described previously (n = 88), and the validation cohort, in the total series of 157 patients, rs9582036 CC-carriers had a poorer RR (8% vs 49%, P = 0.004), PFS (8 vs 14 months, P = 0.003) and OS (13 vs 30 months, P = 0.0004) compared to AC/AA-carriers. Unfavorable prognostic markers at start of sunitinib were well balanced between rs9582036 CC- and AC/AA-carriers.ConclusionVEGFR1 rs9582036 is a candidate predictive biomarker in m-ccRCC-patients treated with sunitinib.
      PubDate: 2016-08-12T02:55:54.163181-05:
      DOI: 10.1111/bju.13585
  • Impact of tumour size on prognosis of upper urinary tract urothelial
           carcinoma after radical nephroureterectomy: a multi-institutional analysis
           of 795 cases
    • Authors: Yan Shibing; Liu Liangren, Wei Qiang, Liao Hong, Song Turun, Lei Junhao, Yang Lu, Yuan Zhengyong, Jiang Yonghao, Fu Guangqing, Li Yunxiang, Cao Dehong
      First page: 902
      Abstract: ObjectiveTo evaluate the prognostic impact of tumour size on survival outcomes in upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).Patients and MethodsData on 795 patients treated with RNU for UTUC from seven centres were retrospectively analysed with focus on tumour size. Clinicopathological features and relevant prognostic factors were compared between patients with tumours ≤3.0 cm and those with tumours >3.0 cm in size. The primary endpoints were cancer-specific survival (CSS), disease recurrence-free survival (RFS) and overall survival (OS).ResultsAt a median follow-up of 32 months, 313 (39.4%) patients died from UTUC, 321 (40.4%) developed cancer recurrence, and 359 (45.1%) died from all causes. Tumour size >3.0 cm was associated with unfavourable clinicopathlogical features. Kaplan–Meier analysis showed that tumour size was significantly correlated with worse CSS, RFS and OS (all P < 0.001). Multivariate analysis showed that tumour size was an independent predictor of CSS (hazard ratio [HR] 2.296; P < 0.001), RFS (HR 2.193; P < 0.001) and OS (HR 2.417; P < 0.001).ConclusionsTumour size >3.0 cm was a significant predictor of CSS, RFS and OS after RNU for patients with UTUC. Further studies are warranted before tumour size is included in risk prediction tools.
      PubDate: 2016-03-27T21:15:42.933608-05:
      DOI: 10.1111/bju.13463
  • Prostate-specific antigen patterns in US and European populations:
           comparison of six diverse cohorts
    • Authors: Andrew J. Simpkin; Jenny L. Donovan, Kate Tilling, J. Athene Lane, Richard M. Martin, Peter C. Albertsen, Anna Bill-Axelson, H. Ballentine Carter, J. L. H Ruud Bosch, Luigi Ferrucci, Freddie C. Hamdy, Lars Holmberg, E. Jeffrey Metter, David E. Neal, Christopher C. Parker, Chris Metcalfe
      First page: 911
      Abstract: ObjectiveTo determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa).Subjects and MethodsWe analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations.ResultsThe annual percentage PSA change of 4–5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3–2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations.ConclusionWe found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
      PubDate: 2016-02-29T06:56:27.377917-05:
      DOI: 10.1111/bju.13422
  • Risk of prostate cancer-specific death in men with baseline metabolic
           aberrations treated with androgen deprivation therapy for biochemical
    • Authors: Sarah M. Rudman; Kathryn P. Gray, Julie L. Batista, Michael J. Pitt, Edward L. Giovannucci, Peter G. Harper, Massimo Loda, Lorelei A. Mucci, Christopher J. Sweeney
      First page: 919
      Abstract: ObjectivesTo investigate the associations of host metabolic factors and metabolic syndrome on prostate cancer-specific death (PCSD) and overall survival (OS) in patients treated with androgen deprivation therapy (ADT) for biochemically recurrent disease.Patients and MethodsThe analysis included 273 patients with prostate cancer treated with ADT for rising prostate-specific antigen level after surgery or radiotherapy. Patients were assessed for the presence of diabetes, hypertension, dyslipidaemia and obesity before commencing ADT, and Adult Treatment Panel III criteria were used to assess the presence of the composite diagnosis of metabolic syndrome. A competing risks regression model was used to assess associations of time to PCSD with the metabolic conditions, while a multivariable Cox regression model was used to assess associations of OS with metabolic syndrome and metabolic conditions.ResultsDuring a median follow-up of 11.6 years, 157 patients (58%) died, of whom 58 (21%) died from prostate cancer. At the start of ADT the median (range) patient age was 74 (46–92) years and the median PSA level was 3.0 ng/mL. Metabolic syndrome was observed in 31% of patients; hypertension (68%) and dyslipidaemia (47%) were the most common metabolic conditions. No association of PCSD and metabolic syndrome status was observed. Patients with hypertension tended to have a higher cumulative incidence of PCSD than those without hypertension (sub-distribution hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.89, 2.84; P = 0.11) although the difference was not statistically significant. Patients with metabolic syndrome had an increased risk of death from all causes (HR 1.56, 95% CI 1.07, 2.29; P = 0.02) when compared with patients without metabolic syndrome, as did patients with hypertension (HR 1.72, 95% CI 1.18, 2.49; P = 0.004).ConclusionsNo association of PCSD and metabolic syndrome was observed in this cohort of men receiving ADT for biochemically recurrent prostate cancer. Metabolic syndrome was associated with an increased risk of death from all causes and a similar effect was also observed for patients with prostate cancer with hypertension alone.
      PubDate: 2016-03-08T02:07:10.938437-05:
      DOI: 10.1111/bju.13428
  • Change in platelet count as a prognostic indicator for response to primary
           tyrosine kinase inhibitor therapy in metastatic renal cell carcinoma
    • Authors: Zachary Hamilton; Hak J. Lee, Juan Jimenez, Brian R. Lane, Song Wang, Alp T. Beksac, Kyle Gillis, Amy Alagh, Conrad Tobert, James M. Randall, Christopher J. Kane, Frederick Millard, Steven C. Campbell, Ithaar H. Derweesh
      First page: 927
      Abstract: ObjectiveTo evaluate change in platelet count as an indicator of response to primary tyrosine kinase inhibitor (TKI) therapy for metastatic renal cell carcinoma (mRCC).Patients and MethodsWe conducted a multicentre retrospective analysis of patients with mRCC undergoing primary TKI therapy from May 2005 to August 2014. Change in platelet count was defined as post-treatment platelet count after the first cycle of treatment minus the pretreatment platelet count. Response Evaluation Criteria in Solid Tumours were used to define partial response (PR), stable disease (SD) and progressive disease (PD). Analysis was conducted between subgroups with stable/increased (+ΔPlt) and decreased (–ΔPlt) counts. The primary outcome was overall survival (OS), determined using Kaplan–Meier analysis. Multivariable analysis was conducted for risk factors associated with PD.ResultsA total of 115 patients with mRCC were analysed, of whom 19 (16.6%) had a +ΔPlt and 96 (83%) a –ΔPlt. More patients with a +ΔPlt had a Karnofsky score 2 metastatic sites (78.9 vs 51%; P = 0.041). More patients with +ΔPlt than with –ΔPlt had PD (89.4 vs 19.1%; P < 0.001) and more of those with –ΔPlt than with +ΔPlt had SD/PR (80.9 vs 10.6%; P < 0.001). Multivariable analysis showed that +ΔPlt (odds ratio [OR] 5.36, P < 0.001), Karnofsky score < 80 (OR 2.96, P = 0.002) and >2 metastatic sites at presentation (OR 1.87, P = 0.013) were risk factors for PD. Kaplan–Meier analysis showed a lower 5-year OS in patients with +ΔPlt than in those with –ΔPlt (23 vs 53%; P < 0.0001). +ΔPlt had a sensitivity of 48.6%, a specificity of 97.4%, a positive predictive value of 89.5% and a negative predictive value of 80.9% for PD.ConclusionsPatients with a –ΔPlt were more likely to respond to TKI therapy and had longer OS. +ΔPlt above baseline had a high specificity for PD after primary TKI. Further investigation is required to determine the utility of ΔPlt.
      PubDate: 2016-05-11T22:40:26.484689-05:
      DOI: 10.1111/bju.13490
  • Active surveillance for low-risk non-muscle-invasive bladder cancer:
           mid-term results from the Bladder cancer Italian Active Surveillance
           (BIAS) project
    • Authors: Rodolfo Hurle; Luisa Pasini, Massimo Lazzeri, Piergiuseppe Colombo, NicolòMaria Buffi, Giovanni Lughezzani, Paolo Casale, Emanuela Morenghi, Roberto Peschechera, Silvia Zandegiacomo, Alessio Benetti, Alberto Saita, Pasquale Cardone, Giorgio Guazzoni
      First page: 935
      Abstract: ObjectiveTo report the oncological safety and the risk of progression for patients with non-muscle-invasive bladder cancer (NMIBC) included in an active surveillance (AS) programme after the diagnosis of recurrence.Patients and methodsThis is a prospective study enrolling patients with history of pathologically confirmed low grade pTa–pT1a NMIBC and diagnosed with a tumour recurrence. Inclusion criteria consisted of negative urine cytology, presence of ≤5 lesions with a diameter of ≤10 mm, absence of carcinoma in situ (CIS) or persistent gross haematuria. The primary outcome of interest was adherence to AS. Need to proceed with treatment was defined as progression in number/dimension/positive cytology/symptoms (gross haematuria persistent) or any further intervention (resection or electro-fulguration). Finally, we assessed the up-grading and up-staging when transurethral resection of bladder tumour was performed.ResultsThe study population consisted of 55 patients with a previous diagnosis of NMIBC (70 AS events) prospectively recruited since 2008. The mean patient age was 69.8 years. The median follow-up was 53 months. The median time patients remained under AS was 12.5 months. There was disease progression in 28 patients (51%). No patient progressed to muscle-invasive disease. In all, 15 patients (27.3%) had an increase in the number and/or size of the tumour, nine (16.4%) had haematuria, and four (7.3%) had a positive cytology. Only five (9%) patients in the whole series progressed to a high-grade tumour (Grade 3) or presented with associated CIS. The overall adherence to the follow-up schedule was 95%.ConclusionOur data show that an AS protocol for NMIBC could be a reasonable option in a select group of patients with small, recurrent cancers.
      PubDate: 2016-06-13T21:30:28.357332-05:
      DOI: 10.1111/bju.13536
  • Predicting complications in partial nephrectomy for T1a tumours: does
           approach matter'
    • Authors: Daniel Ramirez; Matthew J. Maurice, Peter A. Caputo, Ryan J. Nelson, Önder Kara, Ercan Malkoç, Jihad H. Kaouk
      First page: 940
      Abstract: ObjectivesTo assess differences in complications after robot-assisted (RAPN) and open partial nephrectomy (OPN) among experienced surgeons.Patients and MethodsWe identified patients in our institutional review board-approved, prospectively maintained database who underwent OPN or RAPN for management of unifocal, T1a renal tumours at our institution between January 2011 and August 2015. The primary outcome measure was the rate of 30-day overall postoperative complications. Baseline patient factors, tumour characteristics and peri-operative factors, including approach, were evaluated to assess the risk of complications.ResultsPatients who underwent OPN were found to have a higher rate of overall complications (30.3% vs 18.2%; P = 0.038), with wound complications accounting for the majority of these events (11.8% vs 1.8%; P < 0.001). Multivariable logistic regression analysis showed the open approach to be an independent predictor of overall complications (odds ratio 1.58, 95% confidence interval 1.03–2.43; P = 0.035). Major limitations of the study include its retrospective design and potential lack of generalizability.ConclusionsThe open surgical approach predicts a higher rate of overall complications after partial nephrectomy for unifocal, T1a renal tumours. For experienced surgeons, the morbidity associated with nephron-sparing surgery may be incrementally improved using the robot-assisted approach.
      PubDate: 2016-08-11T07:15:42.113658-05:
      DOI: 10.1111/bju.13583
  • Comparison of robot-assisted and open partial nephrectomy for completely
           endophytic renal tumours: a single centre experience
    • Authors: Onder Kara; Matthew J. Maurice, Ercan Malkoc, Daniel Ramirez, Ryan J. Nelson, Peter A. Caputo, Robert J. Stein, Jihad H. Kaouk
      First page: 946
      Abstract: ObjectiveTo compare outcomes between robot-assisted partial nephrectomy (RAPN) and open PN (OPN) for completely endophytic renal tumours.Patients and MethodsWe retrospectively reviewed 1 230 consecutive cases, consisting of 823 RAPNs and 407 OPNs, performed for renal mass at a single academic tertiary centre between 2011 and 2016. Of these, data on 87 RAPN and 56 OPN cases for completely endophytic renal tumours were analysed. Patient and tumour characteristics, operative, postoperative, functional, and oncological outcomes were compared between groups.ResultsApart from a higher prevalence of solitary kidney among OPN cases (RAPN, 5.7% vs OPN, 21.4%; P = 0.005), demographic characteristics were similar between the groups. There were no statistically significant differences in tumour size (P = 0.07), tumour stage (P = 0.3), margin status (P = 0.48), malignant tumour subtypes (P = 0.51), and grades (P = 0.61) between the groups. Also, there were no statistically significant differences among the groups for warm ischaemia time (P = 0.15), cold ischaemia time (P = 0.28), and intraoperative (P = 0.75) or postoperative (Clavien–Dindo Grade I–V, P = 0.08; Clavien–Dindo Grade III–V, P = 0.85) complication rates. The patients in the RAPN group had a shorter length of stay (P < 0.001), less estimated blood loss (P < 0.001), and lower intraoperative transfusion rates (0% vs 7.1%, P = 0.02). No local recurrences occurred during a median (interquartile range) follow-up of 15.2 (7–27.2) and 18.1 (8.2–30.9) months in the RAPN and OPN groups, respectively. There was no difference in estimated glomerular filtration rate preservation rates between groups for the early (P = 0.26) and latest (P = 0.22) functional follow-up.ConclusionFor completely endophytic renal tumours, both OPN and RAPN have excellent outcomes when performed by experienced surgeons at a high-volume centre. For skilled robotic surgeons, RAPN is a safe and effective alternative to OPN with the advantages of shorter length of stay and less blood loss.
      PubDate: 2016-08-01T00:10:41.645792-05:
      DOI: 10.1111/bju.13572
  • Robot-assisted vs open adrenalectomy: evaluation of cost-effectiveness and
           peri-operative outcome
    • Authors: Kai Alexander Probst; Carsten-Henning Ohlmann, Matthias Saar, Stefan Siemer, Michael Stöeckle, Martin Janssen
      First page: 952
      Abstract: ObjectivesTo compare robot-assisted laparoscopic adrenalectomy (RALA) and open adrenalectomy (OA) with regard to intra-operative complications, peri-operative outcome and cost effectiveness.Subjects and MethodsFunctional and statistical data from patients who underwent OA or RALA between 2001 and 2015 were prospectively recorded including intra- and postoperative outcomes. Data on per-day costs from current census reports (€540/day and €1 145/day for normal and intermediate care [IMC]) were also used to evaluate treatment costs. Additional costs for RALA were assumed at €2288 as reported in the current literature. Patients were matched by American Society of Anesthesiologists score, age, side of surgery and gender for comparison of OA and RALA. A total of 28 matched pairs were analysed with regard to patient characteristics, peri-operative outcomes and cost-effectiveness. Statistical significance of outcome variables was determined using Student's t-test and Pearson's chi-squared test.ResultsAs a result of the matching process, patient groups did not differ in their main characteristics. Length of hospital stay was shorter for RALA than for OA (11.1 ± 4.8 vs 6.8 ± 1.2 days; P < 0.01) as was IMC treatment (2.3 ± 1.7 vs 1.2 ± 0.4 days; P < 0.01). The mean operating time was longer for RALA (128.5 ± 46.5 vs 102.2 ± 44.5 min; P = 0.03), but the last 10 RALA procedures (mean: 97.1 ± 35.2 min) were similar to OA. The rate of complications was similar in the two groups. Estimated costs were €8 627.5 for OA and €7 334 for RALA.ConclusionsThe study showed that RALA was safe and cost-effective compared with OA. Increasing experience leads to similar operating times, putting high-volume centres at an advantage.
      PubDate: 2016-06-10T01:11:46.152834-05:
      DOI: 10.1111/bju.13529
  • Comparative testing of reliability and audit utility of ordinal objective
           calculus complexity scores. Can we make an informed choice yet'
    • Authors: Jiten Jaipuria; Manav Suryavanshi, Tridib K. Sen
      First page: 958
      Abstract: ObjectivesTo assess reliability of Guy's, Seoul National University renal stone (S‐RESC) and S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL) and assess utility in discriminating outcomes [Stone free rate (SFR), complications, need for multiple PCNL sessions and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution‐specific instrumentation.Patients and methodsProspectively maintained database of 2 tertiary institutions was analysed (606 cases). Institutes differed in instrumentation while overall surgical team comprised – two trainees (experience 1000 cases). Scores were assigned and reassigned after 4 months by one trainee and expert surgeon. Interrater and test‐retest agreement were analysed by Cohen's kappa and Intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison.ResultsDespite some areas of inconsistencies, individually all scores had excellent interrater and test‐retest concordance. On multivariable analyses while the experience of the surgeon and surgical approach characteristics (such as access tract location, amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently independently associated with all outcomes. S‐RESC score had a superior association with SFR, the need for multiple PCNL sessions and auxiliary procedures.ConclusionIndividually all scoring systems performed well. On cross comparison, S‐RESC score consistently emerged more superiorly associated with all outcomes signifying the importance of the distributional complexity of calculus (which also indirectly amalgamates influence of stone number, size, and anatomic location) in discriminating outcomes. Our study proves the utility of scores in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training and objective assessment of surgical technique modifications.This article is protected by copyright. All rights reserved.
      PubDate: 2016-07-22T06:55:43.623573-05:
      DOI: 10.1111/bju.13597
  • Treatment patterns, testicular loss and disparities in inpatient surgical
           management of testicular torsion in boys: a population-based study
    • Authors: Akshay Sood; Hanhan Li, Kristina D. Suson, Kaustav Majumder, Mai Sedki, Firas Abdollah, Jesse D. Sammon, Ariella Friedman, Björn Löppenberg, Yegappan Lakshmanan, Quoc-Dien Trinh, Jack S. Elder
      First page: 969
      Abstract: ObjectivesTo examine temporal trends in inpatient testicular torsion (TT) treatment and testicular loss (TL), and to identify risk factors for TL using a large nationally representative paediatric cohort, stratified to established high prevalence TT cohorts (neonatal TT [NTT]; age
      PubDate: 2016-07-19T22:25:25.66396-05:0
      DOI: 10.1111/bju.13557
  • What is the outcome of paediatric gastrocystoplasty when the patients
           reach adulthood'
    • Authors: Romain Boissier; Eugenie Di Crocco, Alice Faure, Geraldine Hery, Véronique Delaporte, Eric Lechevallier, Pierre D. E. Mouriquand, Jean-Michel Guys, Gilles Karsenty
      First page: 980
      Abstract: ObjectiveTo document the long-term outcomes of paediatric augmentation gastrocystoplasty (AGC) in terms of preservation of renal function and maintenance of dryness, and to analyse the rate of complications.Patients and methodsThe medical records of children who had undergone AGC between 1992 and 2000 (minimum time interval of 15 years) were reviewed retrospectively. The following data were collected: age at surgery, the cause of bladder dysfunction, functioning of the AGC, any complications, and the long-term outcome of the patients. All of the patients were re-contacted by telephone.ResultsA total of 11 AGCs were carried out between 1992 and 2000, at a median (range) age of 11 (6.5–14) years. The diagnosis of patients undergoing AGC included myelomeningocele (four), bladder exstrophy (four), posterior urethral valves (one), irradiated bladder (one), and Prune Belly syndrome (one). The median [interquartile range (IQR)] follow-up was 17 (15–19.5) years. Renal function was preserved or improved in seven of the 11 patients and nine patients were dry after AGC. Seven of the 11 patients reported symptoms linked to haematuria-dysuria syndrome, which was resistant to treatment in one case and requiring excision of the gastric patch. Three of the 11 patients developed a tumour on the gastric graft after a median (range) delay of 20 (11–22) years after the initial procedure. All had gastric adenocarcinoma of which two were metastatic at the time of diagnosis requiring pelvectomy with pelvic lymph node dissection and adjuvant chemotherapy. Seven of the 11 patients underwent excision of the gastric patch after a median (IQR) time of 11 (8.5–20.5) years.ConclusionsOur long-term data confirmed that most patients undergoing AGC had preservation of their renal function and were continent. However, long-term, AGC was associated with a significant risk of malignant transformation and a high rate of surgical re-intervention involving removal of the gastric patch. These results question the use of this technique for bladder augmentation, irrespective of the indication. We highlight the importance of strict endoscopic follow-up of all patients already having undergone an AGC and the need to inform and educated patients about tumour-related symptoms.
      PubDate: 2016-07-24T22:45:32.084838-05:
      DOI: 10.1111/bju.13558
  • Characterising the safety of clomiphene citrate in male patients through
           prostate-specific antigen, haematocrit, and testosterone levels
    • Authors: Jason C. Chandrapal; Spencer Nielson, Darshan P. Patel, Chong Zhang, Angela P. Presson, William O. Brant, Jeremy B. Myers, James M. Hotaling
      First page: 994
      Abstract: ObjectiveTo determine the safety profile of clomiphene citrate (CC) in men being treated for hypogonadism or infertility by measuring prostate-specific antigen (PSA), haematocrit (Hct), and testosterone levels.Patients and MethodsWe identified patients presenting to our institution who were placed on CC, 50 mg every day or every other day, for male infertility and/or symptomatic hypoandrogenism between September 2013 and April 2016. Patients with documented exogenous testosterone, human chorionic gonadotrophin, or anastrozole use within 2 weeks of baseline evaluations were excluded. Our primary outcomes were the effects of CC on PSA, Hct, and total testosterone levels evaluated at the 3, 6, 9, or 12 months of follow-up. Outcomes were averaged within patients across visits and summarised by mean, median, range, standard deviation (SD) and the 95% confidence interval (CI) for the mean.ResultsA total of 77 patients had recorded PSA, Hct, and/or testosterone values. The mean (SD, range) age and body mass index was 34 (6, 22–51) years and 31 (6, 22–52) kg/m2, respectively. The mean (SD) follow-up was 358 (29) days. Within this group, CC concentration was changed in 24 patients (31%) and was discontinued in 24 patients (31%). The median (range) duration of CC therapy before discontinuation was 127 (44–161) days. The use of CC significantly raised both mean total and bioavailable testosterone levels by 200 ng/dL and 126 ng/dL, respectively (P < 0.001). This increase in testosterone had significant clinical effects with improvements in Androgen Deficiency in Aging Male questionnaire scores (P < 0.01) but not Sexual Health Inventory for Men scores. CC had no effect on mean PSA (1 ng/dL, 95% CI 0.8–1.1) or Hct (49%, 95% CI 41–53) levels, which were within normal ranges.ConclusionsAs more men are placed on CC for infertility or hypogonadism, characterising the safety effect profile becomes important. Our study found that CC significantly increased testosterone levels without changing PSA or Hct values. Because the biochemical response to CC can vary, we suggest scheduling laboratory evaluation at regular intervals; however, ordering routine assessment of PSA and Hct may not be necessary.
      PubDate: 2016-06-24T03:32:04.343729-05:
      DOI: 10.1111/bju.13546
  • Prevalence and characteristics of adverse drug reactions at admission to
           hospital: a prospective observational study
    • Authors: Sze Ling Chan; Xiaohui Ang, Levana L. Sani, Hong Yen Ng, Michael D. Winther, Jian Jun Liu, Liam R. Brunham, Alexandre Chan
      Pages: 1636 - 1646
      Abstract: AimsAdverse drug reactions (ADRs) contribute to poorer patient outcomes and additional burden to the healthcare system. However, data on the true burden, relevant types and drugs causing ADRs are lacking. The aim of this study was to determine the prevalence of ADR-related hospitalization in the general adult population in Singapore and to investigate their characteristics.MethodsWe prospectively recruited 1000 adult patients with unplanned admission to a large tertiary-care hospital. Two independent reviewers evaluated all suspected ADRs for causality, type, severity and avoidability. The prevalence of ADR-related hospitalization was calculated based on ‘definite’ and ‘probable’ ADRs. Logistic regression was used to evaluate predictors for having an ADR at admission.ResultsThe prevalence of all ADRs at admission was 12.4% (95% CI: 10.5–14.6%) and ADRs causing admission was 8.1% (95% CI: 6.5–10.0%). The most common ADRs were gastrointestinal-related. The most common drug category causing ADRs were cardiovascular drugs. Patients with ADRs had a longer length of stay than those who did not (median 4 vs. 3 days, P = 1.70 × 10−3). About 30% of ADRs at admission were caused by at least one drug with a clinical annotation in the Pharmacogenomics KnowledgeBase (PharmGKB), suggesting that some of these ADRs may have been predicted by pharmacogenetic testing.ConclusionsWe have quantified the burden and characteristics of clinically impactful ADRs in the Singaporean general adult population. Our results will provide vital information for efforts in reducing ADRs through targeted vigilance, patient education and pharmacogenomics in Singapore.
      PubDate: 2016-09-19T22:00:24.361762-05:
      DOI: 10.1111/bcp.13081
  • Determinants of angiotensin-converting enzyme inhibitor (ACEI) intolerance
           and angioedema in the UK Clinical Practice Research Datalink
    • Authors: Seyed Hamidreza Mahmoudpour; Ekaterina Vitalievna Baranova, Patrick C. Souverein, Folkert W. Asselbergs, Anthonius Boer, Anke Hilse Maitland-van der Zee,
      Pages: 1647 - 1659
      Abstract: AimThe aim of the present study was to describe the occurrence and determinants of angiotensin-converting enzyme (ACE) inhibitor (ACEI) intolerance and angioedema (AE) among patients initiating ACEI therapy in a real-world primary care population.MethodsTwo nested case–control studies were conducted in a cohort of 276 977 patients aged ≥45 years initiating ACEIs from 2007 to 2014 in the UK Clinical Practice Research Datalink (CPRD). Cases of AE occurring for the first time during ACEI therapy (n = 416) were matched with AE-free controls (n = 4335) on the duration of ACEI treatment. Documented switches to angiotensin-II receptor blockers in the prescription records were used to identify ACEI-intolerance cases (n = 24 709), and these were matched with continuous ACEI users (n = 84 238) on the duration of ACEI therapy. Conditional logistic regression was used to assess the associations of demographic factors, comorbidities and comedication with AE and ACEI intolerance.ResultsAE during ACEI therapy was associated with age over 65 years [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.07, 1.73], history of allergy (OR 1.53, 95% CI 1.19, 1.96), use of calcium channel blockers (OR 1.57, 95% CI 1.23; 2.01), use of antihistamines (OR 21.25, 95% CI 16.44, 27.46) and use of systemic corticosteroids (OR 4.52, 95% CI 3.26, 6.27). ACEI intolerance was significantly associated with more comorbidities and comedication compared with AE, including allergy (OR 2.02, 95% CI 1.96, 2.09), use of antiasthmatic drugs (OR 1.51, 95% CI 1.42, 1.61) and use of antihistamines (OR 1.53, 95% CI 1.43, 1.63).ConclusionsAmong ACEI users developing AE or ACEI intolerance, several comorbidities and comedication classes were significantly more prevalent compared with ACEI users not developing these adverse reactions.
      PubDate: 2016-10-04T00:05:43.948847-05:
      DOI: 10.1111/bcp.13090
  • Do pharmacist-led medication reviews in hospitals help reduce hospital
           readmissions? A systematic review and meta-analysis
    • Authors: Pierre Renaudin; Laurent Boyer, Marie-Anne Esteve, Pierre Bertault-Peres, Pascal Auquier, Stéphane Honore
      Pages: 1660 - 1673
      Abstract: AimsThe aim of this meta-analysis is to examine the impact of in-hospital pharmacist-led medication reviews in paediatric and adult patients.MethodsRelevant studies were identified from the Medline and Cochrane Library databases. Studies were included if they met the following criteria (without any language or date restrictions): design: randomized controlled trial; intervention: in-hospital pharmacist-led medication review (experimental group) vs. usual care (control group); participants: paediatric or adult population. The primary outcome was all-cause readmissions and/or emergency department (ED) visits at different time points. The secondary outcomes were all-cause readmissions, all-cause ED visits, drug-related readmissions, mortality, length of hospital stay, adherence and quality of life. We calculated the relative risk (RR) or mean differences (MD) with 95% confidence intervals (CIs) for each study. We used fixed and/or random effects models. Heterogeneity was assessed using the I2 statistic.ResultsWe systematically reviewed 19 randomized controlled trials (4805 participants). The readmission rates did not differ between the experimental group and the control group (RR = 0.97, 95% CI 0.89; 1.05, p = 0.470). The secondary outcomes did not differ between the two groups, except for in drug-related readmissions, which were lower in the experimental group (RR = 0.25, 95% CI 0.14; 0.45, p 
      PubDate: 2016-09-29T21:00:48.39559-05:0
      DOI: 10.1111/bcp.13085
  • Impact of statin therapy on plasma leptin concentrations: a systematic
           review and meta-analysis of randomized placebo-controlled trials
    • Authors: Amirhossein Sahebkar; Renato Giua, Claudio Pedone
      Pages: 1674 - 1684
      Abstract: ObjectivesThe effects of statins on insulin sensitivity, metabolic homeostasis and adipokines in humans are controversial. Several studies have investigated the impact of statin therapy on plasma leptin concentrations but the results have been inconsistent. The aim of the present study was to conduct a systematic review and meta-analysis of available evidence to calculate the effect size of statin therapy in changing serum leptin concentrations.MethodsA systematic search in PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases was performed to identify randomized placebo-controlled trials investigating the effect of statins on plasma leptin concentrations. A random-effects model and generic inverse variance method were used for meta-analysis. Sensitivity analysis, risk-of-bias evaluation and publication bias assessment were carried out using standard methods. Random-effects meta-regression was used to evaluate the impact of treatment duration on the estimated effect size.ResultsSix trials, with a total of 425 subjects, met the eligibility criteria. Overall, statin therapy had no significant effect on leptin levels (weighted mean difference −0.32 ng ml–1, 95% confidence nterval: −2.94, 2.30, P = 0.813). This effect was robust in the sensitivity analysis and in subgroup analyses of trials with
      PubDate: 2016-10-04T00:00:04.318703-05:
      DOI: 10.1111/bcp.13086
  • Amiloride treatment and increased risk of pressure ulcers in hospitalized
    • Authors: Matthieu Roustit; Céline Genty, Marion Lepelley, Sophie Blaise, Bérengère Fromy, Jean-Luc Cracowski, Jean-Luc Bosson
      Pages: 1685 - 1687
      PubDate: 2016-09-18T18:20:29.521029-05:
      DOI: 10.1111/bcp.13084
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