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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  [1616 journals]
  • Future of robotic surgery in urology
    • Authors: Jens J Rassweiler; Riccardo Autorino, Jan Klein, Alex Mottrie, Ali Serdar Goezen, Jens-Uwe Stolzenburg, Koon H Rha, Marc Schurr, Jihad Kaouk, Vipul Patel, Prokar Dasgupta, Evangelos Liatsikos
      Abstract: ObjectivesTo provide a comprehensive overview of the current status and future perspectives in the field of robotic systems for urologic surgery.Materials and MethodsA non-systematic literature review was performed by using PubMed / Medline search electronic engines. Existing patents for robotic devices were researched using the Google search machine. Findings were critically analyzed also by taking into account personal experience of the authors.ResultsRelevant patents of the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming on the stage. They can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using 3D-HD-videotechnology and three arms mounted on separate carts. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5 mm instruments with six degrees of freedom. REVO-I consists of an open console and a four-arm arrangement on one cart; first experimental with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the OR-table. Clinical trials of SP 1098-platform using da Vinci Xi for console-based single-port surgery were reported in 2015. SPORT robot has been tested in animal experiments for single port-surgery. SURGIBOT represent a bedside solution for single-port surgery providing flexible tube-guided instruments. Avicenna Roboflex has been developed for robotic flexible ureteroscopy with promising early clinical results.ConclusionsSeveral console-based robots for laparoscopic multi- and single-port surgery are expected to come to the market within the next five years. Future developments in the field of robotic surgery are likely to focus on the specific features of robotic arms, instruments, console, and video technology. The high technical standards of four da Vinci generations have set a high bar for upcoming devices. Ultimately, the implementation of these upcoming systems will depend on their actual clinical applicability and costs. How these technical developments will facilitate surgeons and whether their use will translate into better outcomes for our patients remains to be determined.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-20T09:30:40.232352-05:
      DOI: 10.1111/bju.13851
  • Urinary Continence Recovery after Radical
           Prostatectomy—Anatomic/Reconstructive and Nerve Sparing Techniques to
           Improve Outcomes
    • Authors: Christian P. Pavlovich; Bernardo Rocco, Sasha C. Druskin, John W. Davis
      Abstract: In an editorial board moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomic preservation and reconstruction steps that improve continence. Drs. Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a “clinically significant” difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr. Pavlovich's team demonstrates how clinically relevant differences in patient reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr. Davis demonstrates further reproducibility of technique.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-20T09:30:30.450548-05:
      DOI: 10.1111/bju.13852
  • Journal information
    • PubDate: 2017-03-20T08:03:11.170829-05:
      DOI: 10.1111/bju.13637
  • When joy turns to anxiety: parental experience with counselling after
           prenatal diagnosis of congenital anomaly
    • Authors: Nathalie R. Webb
      PubDate: 2017-03-20T08:03:07.41963-05:0
      DOI: 10.1111/bju.13738
  • Size is no barrier: robot-assisted partial nephrectomy in patients with a
           high body mass index
    • Authors: Benjamin Namdarian; Akshaya Rajangam, Benjamin Challacombe
      PubDate: 2017-03-20T08:03:07.2188-05:00
      DOI: 10.1111/bju.13736
  • Establishing the pathways and indications for performing isotope bone
           scans in newly diagnosed intermediate risk localised prostate cancer –
           results from a large contemporaneous cohort
    • Authors: Gokul Vignesh KandaSwamy; Adam Bennett, Krishna Narahari, Owen Hughes, John Rees, Howard Kynaston
      Abstract: ObjectiveTo establish the pattern of isotope bone scan (BS) positivity in a large contemporaneous cohort of newly diagnosed localised prostate cancer (PCa) patients and compare with the European Association of Urology (EAU) guidelines.BackgroundImaging guidelines and clinical practice of using BS to stage newly diagnosed patients with intermediate risk (IR) localised PCa are not uniform in the literature.Patients and methodsAll newly diagnosed PCa patients were discussed in a specialist multidisciplinary team (sMDT) meeting and were prospectively entered in a database. Patients were categorised based on D'Amico classification. All intermediate and high risk (HR) patients had pelvic MRI and BS unless contraindicated. The BS positivity in each group was analysed and negative predictive value (NPV) calculated. A cohort of 2720 patients between 2002 and 2015 were retrospectively analysed.ResultsOut of 976 patients in D'Amico IR category, 99 patients had primary Gleason pattern 4. Only 1 of the 99 patients had a positive BS and no positive BS was seen in patients with Gleason primary pattern 3 in the IR category. On subgroup analysis, based on PSA and Gleason grade alone, the BS positivity rate in patients with PSA
      PubDate: 2017-03-20T03:00:31.218763-05:
      DOI: 10.1111/bju.13850
  • Multiple sclerosis and nephrolithiasis: a matched-case comparative study
    • Authors: Vishnu Ganesan; Wen Min Chen, Rajat Jain, Shubha De, Manoj Monga
      Abstract: ObjectiveTo compare stone composition and serum/urine biochemistries in stone formers with multiple sclerosis (MS) against stone formers without MS and to examine the association between mobility, methods of bladder emptying, and stone formation.Patients and MethodsIn this retrospective case-control study, we identified patients diagnosed with MS and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to two controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index, and sex. For the second part of this study, matched controls (MS patients without a history of stones) were identified in a 1:1 ratio in a similar fashion. Results of 24-h urine biochemistry studies, stone compositions, serum laboratory measures, medications, history of stone surgeries, mobility, and method of bladder emptying were collected.ResultsIn all, 587 patients were identified who had both MS and a history of stone disease. Of these, 118 patients had a stone composition available. When compared to matched controls, patients with MS were significantly more likely to have calcium phosphate stones (42% vs 15%, P < 0.001) and struvite stones (8% vs 3%, P = 0.03) and less likely to have calcium oxalate monohydrate stones (39% vs 64%, P < 0.001). Among those patients with a composition available, those with MS were more likely to have undergone a percutaneous nephrolithotomy (PCNL; 25% vs 12%, P = 0.005) or a cystolithopaxy (16% vs 3%, P < 0.001) compared to their matched controls. In all, 61 patients had a complete 24-h urinary stone panel. There were no significant differences in urinary pH, volume, creatinine, calcium, citrate, oxalate, sodium, and uric acid as well as rates of hypocitraturia, hyperoxaluria, hypercalciuria, and hyperuricosuria among patients with MS. Use of intermittent straight catheterisation [ISC; odds ratio (OR) 3.50, 95% confidence interval (CI) 1.89–6.47]; P < 0.001] or an indwelling catheter (OR 9.78, 95% CI 4.81–19.88; P < 0.001) for bladder emptying was significantly associated with stone disease. There was no association between level of mobility and stone disease (P = 0.10).ConclusionsSimilar to findings seen in patients with spinal cord injuries, patients with MS have a high incidence of calcium phosphate stones and struvite stones when compared with matched controls. Additionally, they were more likely to undergo PCNL. The method of bladder management appears to be a risk factor in the development of stone disease. These findings suggest the importance of prompt treatment of urinary tract infections in this population and delay the use of ISC, suprapubic tube, or an indwelling Foley, when possible.
      PubDate: 2017-03-17T05:07:37.970755-05:
      DOI: 10.1111/bju.13820
  • cAMP-Dependent Regulation of RhoA/Rho-kinase Attenuates Detrusor
           Overactivity in a Novel Mouse Experimental Model
    • Authors: William Akakpo; Biljana Musicki, Arthur L. Burnett
      Abstract: ObjectivesTo investigate detrusor function and cAMP activation as a possible target for detrusor overactivity in an experimental model lacking a key denitrosylation enzyme, S-nitrosoglutathione reductase (GSNOR).Materials and MethodsGSNOR-deficient (GSNOR-/-) (n=30) and wild-type (WT) mice (n=26) were treated for 7 days with the cAMP activator, colforsin (1mg/kg), or vehicle intraperitoneally. Cystometric studies or molecular analyses of bladder specimens were performed. Bladder function indices and expression levels of proteins that regulate detrusor relaxation (nitric oxide synthase pathway) or contraction (RhoA/Rho-kinase pathway) and oxidative stress were assessed. Student t-test and one-way ANOVA were used.ResultsGSNOR-/- mice showed a significant increase (P
      PubDate: 2017-03-16T23:10:34.828248-05:
      DOI: 10.1111/bju.13847
  • Surgical outcomes of percutaneous nephrolithotomy (PCNL) in 3,402 patients
           and results of stone analysis in 1,559 patients from a single centre in
    • Authors: S. A. H Rizvi; M Hussain, S H Askari, M Lal, M N Zafar
      Abstract: ObjectiveTo report our experience of a series of PCNL from a single centre over the last 18 years in terms of patients and stone characteristics, indications, stone clearance and complications and chemical analysis of stones in a subgroup.Patients and MethodsWe retrospectively analysed the outcomes of PCNL in 3,402 adult patients who underwent the procedure between 1997 and 2014 from a prospectively maintained database. Data analysis included patients’ age, sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone free status at one-month follow-up. The tabulation of outcome in relation to complications and success has been divided into two eras 1997-2005 and 2006-2014 to study the differences.ResultsOf the 3,402 patients, 2,501 (73.5%) were males and 901 (26.5%) were females with M:F ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% patients whereas 72.5% were non- staghorn calculi. Intra-corporeal energy sources used for stone fragmentation included ultrasound in 917 (26.9%), Pneumatic Lithoclast 1,820 (53.5%), Holmium Laser 141 (4.1%) and Lithoclast master in 524 (15.4%) patients. Majority (97.4%) had 18-22 F nephrostomy tube after the procedure whereas 69 (2.03%) had tube-less PCNL. Volume of the irrigation fluid used ranged from 7 liters to 37 liters with mean of 28.4 liters. The stone free rate after PCNL in first era was 78% versus 83.2% in second era as assessed by combination of Ultrasound scan and plain X-ray KUB. The complications in first era was higher 21.3% as compared to 10.3% in second era and was statistically significant. Stone analysis showed 41% pure and 58% mixed stones. Majority were comprised of calcium oxalate.ConclusionsThis is the largest series of PCNL reported from any single centre in Pakistan. Stone disease has high prevalence and is associated with infective and obstructive complications including renal failure. PCNL as treatment modality offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource constrained healthcare system.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-16T23:10:31.206978-05:
      DOI: 10.1111/bju.13848
  • Aetiology and management of earlier vs later biochemical recurrence after
           retropubic radical prostatectomy
    • Authors: Elton Llukani; Herbert Lepor
      Abstract: ObjectivesTo examine the characteristics and management of earlier (within 5 years) vs later (after 5 years) biochemical recurrence (BCR) after radical prostatectomy (RP).Materials and MethodsBetween October 2000 and October 2009, 1597 men underwent open retropubic RP. BCRs were managed using salvage radiation therapy (SRT), androgen deprivation therapy (ADT) or active surveillance (AS). BCR-free survival was assessed using Kaplan–Meier analysis. Factors predicting earlier or later BCR and BCR after SRT were assessed using logistic regression andCox proportional hazard models, respectively.ResultsThe probabilities of developing BCR within 5 years and 10 years were 12.3% (95% confidence interval [CI] 10.7–13.9) and 18.4% (95% CI 16.2–20.6), respectively. On multivariate analysis, prostate-specific antigen doubling time, positive surgical margins and pathological Gleason score significantly differentiated earlier from later BCR. Overall, 74.5, 12.7 and 12.7% of men developing BCR underwent SRT, ADT or AS, respectively. A significantly greater proportion of men in the earlier BCR group underwent SRT (80.8 vs 59%) and ADT (14.6 vs 8.2%), and a significantly greater proportion of men in the later BCR group underwent AS (32.8 vs 4.6%; P
      PubDate: 2017-03-14T23:05:45.600015-05:
      DOI: 10.1111/bju.13816
  • Comprehensive assessment of renal tumor complexity in a large percutaneous
           cryoablation cohort
    • Authors: Bimal Bhindi; R. Houston Thompson, Ross J. Mason, Mustafa M. Haddad, Jennifer R. Geske, A. Nicholas Kurup, James D. Hannon, Stephen A. Boorjian, Bradley C. Leibovich, Thomas D. Atwell, Grant D. Schmit
      Abstract: ObjectiveTo evaluate the association between renal tumor complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA).Patients and methodsPatients with renal tumors treated with PCA were identified using our prospectively-maintained ablation registry (2003-2015). Salvage procedures and inherited tumor syndromes were excluded. The associations between R.E.N.A.L. Nephrometry Score (NS) and risk of complications, renal function impairment, local failure, and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models.ResultsThe cohort included 618 tumors treated during 580 procedures in 565 patients. Median follow-up was 34 months (IQR 14,66). Complications (any grade) during a procedure (n[total]=87, 15%) were more frequent with higher NS (Score 4-6: 10%; 7-9: 14%; 10-12: 36%;p
      PubDate: 2017-03-13T02:00:31.508192-05:
      DOI: 10.1111/bju.13841
  • Modified retroperitoneal lymph node dissection for postchemotherapy
           residual tumor: a long term update
    • Authors: Jane S. Cho; Hristos Z. Kaimakliotis, K. Clint Cary, Timothy A. Masterson, Stephen Beck, Richard Foster
      Abstract: ObjectivesTo update previously reported outcomes of modified template postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in appropriately selected patients with metastatic non-seminomatous germ cell tumor (NSGCT). Our previous report was criticized for short follow-up. Herein, we provide a long-term update on this cohort.Materials and MethodsOne hundred patients with normal serum markers after cisplatin-based chemotherapy and residual retroperitoneal tumor underwent modified PC-RPLND between 1991 and 2004. Using a prospectively managed institutional testicular cancer database, long-term follow-up was obtained.ResultsAs previously reported, 43 patients underwent a right modified template, 18 patients underwent a left full modified template, and 39 patients underwent a left modified template. The updated long-term median follow-up for the entire cohort is 125 months. Seven patients developed recurrent disease with a median time to recurrence of 11 months (Range 6-102 months), and one patient died of recurrent disease in the chest 4 years following surgery. All recurrences were outside the boundaries of a full bilateral template RPLND with the most common location of recurrence being the chest. The 5 and 10-year recurrence-free survival were 93% and 92% respectively. The overall survival at 10 years was 99%.ConclusionsIn appropriately selected patients with low volume disease before and after chemotherapy, a modified template has durable long-term efficacy without risk of in-field recurrences at a median follow-up of 125 months.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-13T02:00:27.516872-05:
      DOI: 10.1111/bju.13844
  • High concordance of findings obtained from in-gantry transgluteal MRI- and
           TRUS-guided biopsy as compared to prostatectomy specimens
    • Authors: Stefan Steurer; Sebastian Dwertmann Rico, Ronald Simon, Sarah Minner, Maria Christina Tsourlakis, Till Krech, Christina Koop, Markus Graefen, Hans Heinzer, Meike Adam, Hartwig Huland, Thorsten Schlomm, Guido Sauter, Agron Lumiani
      Abstract: ObjectivesTo determine the utility of our transgluteal MRI-guided prostate biopsy approach.Patients and Methods960 biopsy series taken within the period of one year were evaluated including 301 MRI-guided and 659 TRUS-guided biopsies.ResultsThe positivity rate and the fraction of high-grade cancers were significantly higher in MRI-guided than in TRUS biopsies. 65.4% of 301 MRI-guided and 57.2% of 659 TRUS biopsies contained cancer (p=0.0157). A Gleason 3+3=6 was seen in 16.8% of 197 MRI-guided and 36.1% of 377 TRUS biopsies (p
      PubDate: 2017-03-13T01:55:26.828315-05:
      DOI: 10.1111/bju.13840
  • Stereotactic ablative body radiotherapy for inoperable primary kidney
           cancer: a prospective clinical trial
    • Authors: Shankar Siva; Daniel Pham, Tomas Kron, Mathias Bressel, Jacqueline Lam, Teng Han Tan, Brent Chesson, Mark Shaw, Sarat Chander, Suki Gill, Nicholas R. Brook, Nathan Lawrentschuck, Declan G. Murphy, Farshad Foroudi
      Abstract: ObjectiveTo assess the feasibility and safety of stereotactic ablative body radiotherapy (SABR) for renal cell carcinoma (RCC) in patients unsuitable for surgery. Secondary objectives were to assess oncological and functional outcomes.Materials and MethodsThis was a prospective interventional clinical trial with institutional ethics board approval. Inoperable patients were enrolled, after multidisciplinary consensus, for intervention with informed consent. Tumour response was defined using Response Evaluation Criteria In Solid Tumors v1.1. Toxicities were recorded using Common Terminology Criteria for Adverse Events v4.0. Time-to-event outcomes were described using the Kaplan–Meier method, and associations of baseline variables with tumour shrinkage was assessed using linear regression. Patients received either single fraction of 26 Gy or three fractions of 14 Gy, dependent on tumour size.ResultsOf 37 patients (median age 78 years), 62% had T1b, 35% had T1a and 3% had T2a disease. One patient presented with bilateral primaries. Histology was confirmed in 92%. In total, 33 patients and 34 kidneys received all prescribed SABR fractions (89% feasibility). The median follow-up was 24 months. Treatment-related grade 1–2 toxicities occurred in 26 patients (78%) and grade 3 toxicity in one patient (3%). No grade 4–5 toxicities were recorded and six patients (18%) reported no toxicity. Freedom from local progression, distant progression and overall survival rates at 2 years were 100%, 89% and 92%, respectively. The mean baseline glomerular filtration rate was 55 mL/min, which decreased to 44 mL/min at 1 and 2 years (P < 0.001). Neutrophil:lymphocyte ratio correlated to % change in tumour size at 1 year, r2 = 0.45 (P < 0.001).ConclusionThe study results show that SABR for primary RCC was feasible and well tolerated. We observed encouraging cancer control, functional preservation and early survival outcomes in an inoperable cohort. Baseline neutrophil:lymphocyte ratio may be predictive of immune-mediated response and warrants further investigation.
      PubDate: 2017-03-10T21:50:29.648383-05:
      DOI: 10.1111/bju.13811
  • Assessing the relative influence of hospital and surgeon volume on
           short-term mortality after radical cystectomy
    • Authors: Nikhil Waingankar; Katherine Mallin, Marc Smaldone, Brian L. Egleston, Andrew Higgins, David P. Winchester, Robert G. Uzzo, Alexander Kutikov
      Abstract: ObjectivesTo assess the relationship between surgeon (SV) and hospital volume (HV) on mortality after radical cystectomy (RC).Patients and MethodsWe queried the National Cancer Database (NCDB) for adult patients undergoing RC between 2010 and 2013. We calculated average volume for each surgeon and hospital. Using propensity-scored weights for combined volume groups with a proportional hazards regression model, we compared the associations between HV and SV with 90-day survival after RC.ResultsA total of 19 346 RCs were performed at 927 hospitals by 2 927 surgeons in the period 2010–2013. The median (interquartile range) HV and SV were 12.3 (5.0–35.5) and 4.3 (1.3–12.3) cases, respectively. For HV, 90-day unadjusted mortality was 8.5% in centres with 30 cases/year (95% CI 5.0–6.2). For SV, 90-day mortality was 8.1% for surgeons with 30 cases/year (95% CI 2.8–5.2; all P < 0.05). The 30-day mortality rate was lowest for the combined HV–SV groups with HV>30, ranging from 1.6% to 2.1%.ConclusionsIn hospitals reporting to the NCDB, volume was associated with improved mortality after RC. These associations appear to be driven by hospital- rather than surgeon-level effects. An elevated SV had a beneficial effect on mortality at the highest-volume hospitals. These findings inform efforts to regionalize complex surgical care and improve quality at community and safety net hospitals.
      PubDate: 2017-03-10T10:42:38.668074-05:
      DOI: 10.1111/bju.13804
  • Long-term follow-up of treatment of erectile dysfunction after radical
           prostatectomy using nerve grafts and end-to-side somatic-autonomic
           neurorraphy: a new technique
    • Authors: José Carlos Souza Trindade; Fausto Viterbo, André Petean Trindade, Wagner José Fávaro, José Carlos Souza Trindade-Filho
      Abstract: ObjectiveTo study a novel penile reinnervation technique using four sural nerve grafts and end-to-side neurorraphies connecting bilaterally the femoral nerve and the cavernous corpus and the femoral nerve and the dorsal penile nerves.Patients and MethodsTen patients (mean [± sd; range] age 60.3 [± 4.8; 54–68] years), who had undergone radical prostatectomy (RP) at least 2 years previously, underwent penile reinnervation in the present study. Four patients had undergone radiotherapy after RP. All patients reported satisfactory sexual activity prior to RP. The surgery involved bridging of the femoral nerve to the dorsal nerve of the penis and the inner part of the corpus cavernosum with sural nerve grafts and end-to-side neurorraphies. Patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire and pharmaco-penile Doppler ultrasonography (PPDU) preoperatively and at 6, 12 and 18 months postoperatively, and using a Clinical Evolution of Erectile Function (CEEF) questionnaire, administered after 36 months.ResultsThe IIEF scores showed improvements with regard to erectile dysfunction (ED), satisfaction with intercourse and general satisfaction. Evaluation of PPDU velocities did not reveal any difference between the right and left sides or among the different time points. The introduction of nerve grafts neither caused fibrosis of the corpus cavernosum, nor reduced penile vascular flow. CEEF results showed that sexual intercourse began after a mean of 13.7 months with frequency of sexual intercourse varying from once daily to once monthly. Acute complications were minimal. The study was limited by the small number of cases.ConclusionsA total of 60% of patients were able to achieve full penetration, on average, 13 months after reinnervation surgery. Patients previously submitted to radiotherapy had slower return of erectile function. We conclude that penile reinnervation surgery is a viable technique, with effective results, and could offer a new treatment method for ED after RP.
      PubDate: 2017-03-10T10:28:21.978421-05:
      DOI: 10.1111/bju.13772
  • Salvage high-intensity focused ultrasound (HIFU) for locally recurrent
           prostate cancer after failed radiation therapy: Multi-institutional
           analysis of 418 patients
    • Authors: Sebastien Crouzet; Andreas Blana, Francois J. Murat, Gilles Pasticier, Stephen C. W. Brown, Giario N. Conti, Roman Ganzer, Olivier Chapet, Albert Gelet, Christian G. Chaussy, Cary N. Robertson, Stefan Thuroff, John F. Ward
      Abstract: ObjectiveTo report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database.Patients and MethodsThis retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the ‘Phoenix’ definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan–Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported.ResultsIn all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4–10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group.ConclusionS-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of>80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure
      PubDate: 2017-03-10T10:26:27.731056-05:
      DOI: 10.1111/bju.13766
  • Novel use of Twitter to disseminate and evaluate adherence to clinical
           guidelines by the European Association of Urology
    • Authors: Stacy Loeb; Morgan Roupret, Inge Van Oort, James N'dow, Marc Gurp, Jarka Bloemberg, Julie Darraugh, Maria J. Ribal
      PubDate: 2017-03-10T10:25:08.107661-05:
      DOI: 10.1111/bju.13802
  • Calculating life expectancy to inform prostate cancer screening and
           treatment decisions
    • Authors: Scott R. Hawken; Gregory B. Auffenberg, David C. Miller, Brian R. Lane, Michael L. Cher, Firas Abdollah, Hyunsoon Cho, Khurshid R. Ghani,
      PubDate: 2017-03-10T10:15:09.291713-05:
      DOI: 10.1111/bju.13812
  • Sentinel node biopsy for prostate cancer: report from a consensus panel
    • Authors: Henk G. Poel; Esther M. Wit, Cenk Acar, Nynke S. Berg, Fijs W. B. Leeuwen, Renato A. Valdes Olmos, Alexander Winter, Friedhelm Wawroschek, Fredrik Liedberg, Steven Maclennan, Thomas Lam,
      Abstract: ObjectiveTo explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer through a consensus panel of experts.MethodsA two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the research and development project/University of California, Los Angeles Appropriateness Methodology on 150 statements in nine domains. The disagreement index based on the interpercentile range, adjusted for symmetry score, was used to assess consensus and non-consensus among panel members.ResultsConsensus was obtained on 91 of 150 statements (61%). The main outcomes were: (1) the results from an extended lymph node dissection (eLND) are still considered the ‘gold standard’, and sentinel node (SN) detection should be combined with eLND, at least in patients with intermediate- and high-risk prostate cancer; (2) the role of SN detection in low-risk prostate cancer is unclear; and (3) future studies should contain oncological endpoints as number of positive nodes outside the eLND template, false-negative and false-positive SN procedures, and recurrence-free survival. A high rate of consensus was obtained regarding outcome measures of future clinical trials on SNB (89%). Consensus on tracer technology was only obtained in 47% of statements, reflecting a need for further research and standardization in this area. The low-level evidence in the available literature and the composition of mainly SNB users in the panel constitute the major limitations of the study.ConclusionsConsensus on a majority of elementary statements on SN detection in prostate cancer was obtained.; therefore, the results from this consensus report will provide a basis for the design of further studies in the field. A group of experts identified evidence and knowledge gaps on SN detection in prostate cancer and its application in daily practice. Information from the consensus statements can be used to direct further studies.
      PubDate: 2017-03-08T21:53:54.917083-05:
      DOI: 10.1111/bju.13810
  • ‘Risk-stratification based on magnetic resonance imaging and
           prostate-specific antigen density may reduce unnecessary follow-up biopsy
           procedures in men on active surveillance for low-risk prostate cancer’
    • Authors: Arnout R. Alberts; Monique J. Roobol, Frank-Jan H. Drost, Geert J. van Leenders, Leonard P. Bokhorst, Chris H. Bangma, Ivo G. Schoots
      Abstract: ObjectivesTo assess the value of risk-stratification based on magnetic resonance imaging (MRI) and prostate-specific antigen (PSA) density in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer (PCa) in men on active surveillance.Materials and MethodsA total of 210 men on active surveillance with GS 3+3 PCa received a first MRI and if indicated (PI-RADS ≥3) targeted biopsy (TBx) using MRI-TRUS fusion. The MRI was performed 3 months after diagnosis (group A: n=97), at confirmatory biopsy (group B: n=39) or at surveillance biopsy after ≥1 repeat TRUS-guided systematic biopsies (TRUS-Bx) (group C: n=74). The primary outcome was upgrading to Gleason score (GS) ≥3+4 PCa based on MRI ± TBx in group A, B and C. Biopsy outcomes were stratified for the overall PI-RADS score and PSA density to identify a subgroup of men in whom a biopsy could have been avoided since no GS upgrading was detected.ResultsA total of 134/210 (64%) men had a positive MRI and a total of 51/210 (24%) men showed GS upgrading based on MRI-TBx. The percentage of GS upgrading based on MRI-TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively group A, B and C. Additional GS upgrading detected by TRUS-Bx occurred in 3/39 (8%) men in group B and 1/17 (6%) men who received TRUS-Bx in group C. No GS upgrading was detected by MRI-TBx in men with PI-RADS 3 and PSA density
      PubDate: 2017-03-07T14:25:24.792744-05:
      DOI: 10.1111/bju.13836
  • Identification of Novel Non-invasive Biomarkers of Urinary Chronic Pelvic
           Pain Syndrome (UCPPS): Findings from the Multidisciplinary Approach to the
           Study of Chronic Pelvic Pain (MAPP) Research Network
    • Authors: A Dagher; A Curatolo, M Sachdev, A J Stephens, C Mullins, J R Landis, A van Bokhoven, A El-Hayek, J Froehlich, A C Briscoe, R Roy, J Yang,  M A Pontari, D Zurakowski, R S Lee, M A Moses,
      Abstract: ObjectiveTo date, no definitive, broadly accepted biomarkers for UCPPS have been identified. The present study examines a series of candidate markers for UCPPS selected based on proposed involvement in underlying biological processes and is intended to provide new insights into pathophysiology and suggest targets for expanded clinical and mechanistic studies.MethodsBaseline urine samples from MAPP Research Network study participants with UCPPS (n=259), positive controls (PC) (chronic pain without pelvic pain, n=107), and healthy controls (HC) (n=125) were analyzed for the presence of proteins suggested in the literature to be associated with UCPPS. MMP-2 (Matrix Metalloproteinase-2), MMP-9, MMP-9/NGAL complex (Neutrophil gelatinase-associated lipocalin, also known as Lipocalin-2), VEGF (Vascular Endothelial Growth Factor), VEGF-R1 (VEGF Receptor 1) and NGAL were assayed and quantitated using mono-specific ELISAs for each protein. Log-transformed concentration (pg/mL or ng/mL) and concentration normalized to total protein (pg/μg) were comparedamong UCPPS, PC, and HC participants within sex using the Student's t-test, with p-values adjusted for multiple comparisons. Multivariable logistic regression and ROC curves assessed biomarkers’ utility in distinguishing UCPPS and control participants. Associations of protein with symptom severity were assessed by linear regression.ResultsSignificantly higher normalized concentrations (pg/μg) of VEGF, VEGF-R1, and MMP-9 in males and VEGF concentration (pg/mL) in females were associated with UCPPS versus HC. These proteins provided only marginal discrimination between UCPPS participants and HC. In UCCPS males, pain severity was significantly positively associated with concentrations of MMP-9 and MMP-9/NGAL complex and urinary severity with MMP-9, MMP-9/NGAL complex, and VEGF-R1. In UCPPS females, pain and urinary symptom severity were associated with increased normalized concentrations of MMP-9/NGAL complex, while pain severity alone was associated with increased normalized concentrations of VEGF and urinary severity alone was associated with increased normalized concentrations of MMP-2. Pain severity in UCPPS females was significantly positively associated with concentrations of all biomarkers except NGAL and urinary severity with all concentrations except VEGF-R1.ConclusionAltered levels of MMP-9, MMP-9/NGAL complex and VEGF-R1 in males, and all biomarkers in females, were associated with clinical symptoms of UCPPS. None of the evaluated candidate markers usefully discriminated UCPPS patients from controls. Elevated VEGF, MMP-9 and VEGF-R1 in males and VEGF in females may provide potential new insights into the pathophysiology of UCPPS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-06T09:10:37.738221-05:
      DOI: 10.1111/bju.13832
  • Focal Salvage HIFU in radiorecurrent prostate cancer
    • Authors: A Kanthabalan; M Peters, M Van Vulpen, N McCartan, R G Hindley, A Emara, M C. Moore, M Arya, M Emberton, H U Ahmed
      Abstract: ObjectiveTo assess short to medium term cancer control rates and side effects of focal salvage High Intensity Focused Ultrasound (HIFU).Materials and methodsA retrospective registry analysis identified 150 men who underwent focal salvage HIFU (Sonablate 500) (November 2006-August 2015). Metastatic disease was excluded using the nodal assessment on the pelvic MRI, a radioisotope bone scan and PET imaging (choline-FDG-PET or Choline PET-CT). In our current clinical practice, metastatic disease must be ruled out by both Choline PET and bone scan. Localisation of cancer was by multi-parametric prostate MRI (T2W, diffusion-weighting, dynamic contrast enhancement) with systematic or template prostate mapping biopsies.Primary outcome was a composite failure incorporating biochemical failure (BF) and/or positive localised or distant imaging and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer specific death. Secondary outcome was BF using the Phoenix-ASTRO definition (nadir+2ng/ml). We used Kaplan-Meier analysis and Cox-proportional hazards regression to quantify the effect of the determinants on the endpoints.ResultsMean age at focal salvage therapy was 69.8 years (SD 6.1) and median PSA pre-focal salvage treatment was 5.5 ng/ml [IQR 3.6-7.9). Median follow-up was 35 months (IQR 22-52). Patients were classified as low 2.7% (4/150), intermediate 39.3% (59/150) and high-risk disease 41.3% (62/150) according to D'Amico classification, prior to focal salvage HIFU.Composite failure occurred in 61% (91/150) and BF occurred in 51.3% (77/150). The Kaplan-Meier composite endpoint free survival (CEFS) at 3 years was 40% (95% CI 31-50) for the entire group. Kaplan-Meier estimates of CEFS were 100%, 49% and 24% at 3 years in low, intermediate and high D'Amico risk groups pre-salvage, respectively. The Kaplan-Meier biochemical disease free survival (BDFS) at 3 years was 48% (95% CI 39-59) for the entire group. Kaplan-Meier estimates of BDFS was 100%, 61% and 32% at 3 years in low, intermediate and high D'Amico risk groups pre-salvage, respectively. Complications included urine infection (11.3%; 17/150), bladder neck stricture (8%; 12/150), recto-urethral fistula after 1 HIFU procedure (2%; 3/150) and osteitis pubis (0.7%; 1/150).ConclusionFocal salvage HIFU confers a relatively low complication and side-effect rate. Composite endpoint free survival and biochemical control in the short to medium term is reasonable, especially in this relatively high risk cohort but still on the lower end compared to current whole gland salvage therapies. Focal salvage therapy may offer disease control in high risk men whilst minimising additional treatment morbidities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:00:30.207199-05:
      DOI: 10.1111/bju.13831
  • First-line non-cytotoxic therapy in chemotherapy-naive patients with
           metastatic castration-resistant prostate cancer: a systematic review of 10
           randomised clinical trials
    • Authors: Michiel H.F. Poorthuis; Robin W.M. Vernooij, R. Jeroen A. Moorselaar, Theo M. Reijke
      Abstract: The aim of this study is to systematically evaluate all available treatment options in chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC). We systematically searched PubMed, EMBASE, and the Cochrane libraries up to 1 March 2016 for peer-reviewed publications on randomised clinical trials (RCTs). RCTs were included if progression-free survival (PFS), overall survival (OS), quality of life (QoL), or adverse events (AEs) were quantitatively evaluated. We assessed the risk of bias with the Cochrane Collaboration's tool and graded the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's approach. We included 25 articles, reporting on 10 unique RCTs describing seven different comparisons. In one RCT, a prolonged OS and PFS (high quality) were found with abiraterone and prednisone compared to placebo plus prednisone. In one RCT, a prolonged OS and PFS (high quality) were found with enzalutamide compared to placebo. In two RCTs, a prolonged OS (high and moderate quality) was found with 223radium compared to placebo, but its effect on PFS is unknown. In three RCTs, a prolonged OS (moderate quality) was found with sipuleucel-T compared to placebo, but no prolonged PFS (low quality). In one RCT a prolonged PFS (high quality) was found with orteronel compared to placebo, but no prolonged OS (moderate quality). In one RCT, a prolonged OS (moderate quality) was found with bicalutamide compared to placebo, but its effect on PFS is unknown. In one RCT, a prolonged PFS (high quality) was found with enzalutamide compared to bicalutamide, but its effect on OS is unknown. The best evidence was found for abiraterone and enzalutamide for effective prolongation of OS and PFS to treat chemotherapy-naive patients with mCRPC. However, taking both QoL and AEs into consideration, other treatment modalities could be considered for individual patients.
      PubDate: 2017-02-28T23:00:28.530582-05:
      DOI: 10.1111/bju.13764
  • Surgical histopathology for suspected oncocytoma on renal mass biopsy: a
           systematic review and meta-analysis
    • Authors: Hiten D. Patel; Sasha C. Druskin, Steven P. Rowe, Phillip M. Pierorazio, Michael A. Gorin, Mohamad E. Allaf
      Abstract: To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.
      PubDate: 2017-02-27T21:50:31.352849-05:
      DOI: 10.1111/bju.13763
  • Robot-assisted partial prostatectomy for anterior prostate cancer: a
           step-by-step guide
    • Authors: Arnauld Villers; Vincent Flamand, Rodríguez-Carlin Arquímedes, Philippe Puech, Georges-Pascal Haber, Mihir M. Desai, Sebastien Crouzet, Adil Ouzzane, Inderbir S. Gill
      Abstract: ObjectiveTo describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC).Patients and MethodsAfter Institutional Review Board approval, over an 8-year period (2008–2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low–intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively.ResultsThe RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien–Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence.ConclusionPZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.
      PubDate: 2017-02-26T22:33:33.813834-05:
      DOI: 10.1111/bju.13785
  • Anatomical patterns of recurrence following biochemical relapse after
    • Authors: William C. Jackson; Neil B. Desai, Ahmed E. Abugharib, Vasu Tumati, Robert T. Dess, Jae Y. Lee, Shuang G. Zhao, Moaaz Soliman, Michael Folkert, Aaron Laine, Raquibul Hannan, Zachary S. Zumsteg, Howard Sandler, Daniel A. Hamstra, Jeffrey S. Montgomery, David C. Miller, Mike A. Kozminski, Brent K. Hollenbeck, Jason W. Hearn, Ganesh Palapattu, Scott A. Tomlins, Rohit Mehra, Todd M. Morgan, Felix Y. Feng, Daniel E. Spratt
      Abstract: ObjectivesTo characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT).Patients and MethodsA multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months.ResultsThe median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively.ConclusionsWe demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
      PubDate: 2017-02-26T22:30:35.404518-05:
      DOI: 10.1111/bju.13792
  • Prostate cancer screening practices in a large, integrated health system:
    • Authors: Anita D. Misra-Hebert; Bo Hu, Eric A. Klein, Andrew Stephenson, Glen B. Taksler, Michael W. Kattan, Michael B. Rothberg
      Abstract: ObjectivesTo assess prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men, and to assess primary provider variation associated with prostate cancer screening.Patients and MethodsOur study population included 160 211 men aged ≥40 years with at least one visit to a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 to December 2014. Yearly rates of screening PSA testing by primary care providers (PCPs), rates of re-screening, and rates of prostate biopsies were assessed.ResultsAnnual PSA-screening testing declined from 2007 to 2014 in all age groups, as did biennial and quadrennial screening. Yearly rates declined for men aged ≥70 years, from 22.8% to 8.9%; ages 50–69 years, from 39.2% to 20%; and ages 40–49 years, from 11% to 4.6%. Overall rates were lower for African-American (A-A) men vs non-A-A men; for men with a family history of prostate cancer, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA testing did not substantially change after the USPSTF recommendations. While the number of men screened and rates of follow-up prostate cancer screening declined in 2011–2014 compared to 2007–2010, similar re-screening rates were noted for men aged 45–75 years with initial PSA levels of 75 years with initial PSA levels of
      PubDate: 2017-02-26T22:30:30.114483-05:
      DOI: 10.1111/bju.13793
  • Positive outcomes with first onabotulinumtoxinA treatment persist in the
           long term with repeat treatments in patients with neurogenic detrusor
    • Authors: Pierre Denys; Roger Dmochowski, Philip Aliotta, David Castro-Diaz, Bertil Blok, Karen Ethans, Tamer Aboushwareb, Andrew Magyar, Michael Kennelly
      Abstract: ObjectiveTo examine whether response to first treatment with onabotulinumtoxinA is predictive of long-term treatment outcome in patients with neurogenic detrusor overactivity (NDO).Patients and MethodsPatients with NDO who were enrolled in a 3-year extension study (after a 52-week phase III study) received onabotulinumtoxinA ‘as needed’, based on fulfilment of prespecified retreatment criteria. This post hoc analysis included patients who received only the 200-U dose during the phase III and extension studies. Data on mean percent reduction from baseline in urinary incontinence (UI) episodes at week 6 after the first treatment were analysed, and the patients were stratified into three response groups:
      PubDate: 2017-02-26T22:30:27.059661-05:
      DOI: 10.1111/bju.13795
  • Prevalence of kidney stones in China: an ultrasonography based
           cross-sectional study
    • Authors: Guohua Zeng; Zanlin Mai, Shujie Xia, Zhiping Wang, Keqin Zhang, Li Wang, Yongfu Long, Jinxiang Ma, Yi Li, Show P. Wan, Wenqi Wu, Yongda Liu, Zelin Cui, Zhijian Zhao, Jing Qin, Tao Zeng, Yang Liu, Xiaolu Duan, Xin Mai, Zhou Yang, Zhenzhen Kong, Tao Zhang, Chao Cai, Yi Shao, Zhongjin Yue, Shujing Li, Jiandong Ding, Shan Tang, Zhangqun Ye
      Abstract: ObjectivesTo investigate the prevalence and associated factors of kidney stones among adults in China.Subjects and methodsA nationwide cross-sectional survey was conducted among persons aged 18 and older across China from May 2013 to July 2014. Participants underwent urinary tract ultrasonographic examinations, questionnaires, and provided blood and urine samples to analyze. Kidney stones were defined as particles in size of 4 mm or greater. Prevalence was defined as the proportion of participants with kidney stone and binary logistic regression was used to estimate the associated factors.ResultsA total of 12570 individuals (45.2% men) with an average age of 48.8±15.3 (18-96) years were selected and invited to participate in the study. And 9310 (40.7% men) individuals completed the investigation, with a response rate of 74.1%. The prevalence of kidney stones was 6.4% (95% confidence interval (CI):5.9, 6.9), and the age- and sex-adjusted prevalence was 5.8% (95% CI: 5.3, 6.3; 6.5% in men and 5.1% in women). Binary logistic regression analysis showed that male, rural residents, age, family history of urinary stones, concurrent with diabetes mellitus and hyperuricemia, increased consumption of meat, and excessive sweating were all statistical significantly associated with increased risk of kidney stones. By contrast, consumed more tea, legume, and fermented vinegar were statistical significantly associated with decreased risk of kidney stones formationConclusionKidney stones are common disease among Chinese adults and about one in seventeen adults are affected currently. Some Chinese dietary habits may lower risk of kidney stones formation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-25T00:15:32.671939-05:
      DOI: 10.1111/bju.13828
  • Cannabinoids for treating neurogenic lower urinary tract dysfunction in
           patients with multiple sclerosis: a systematic review and meta-analysis
    • Authors: Nadim Abo Youssef; Marc P. Schneider, Livio Mordasini, Benjamin V. Ineichen, Lucas M. Bachmann, Emmanuel Chartier-Kastler, Jalesh N. Panicker, Thomas M. Kessler
      Abstract: ObjectivesTo review systematically all the available evidence on efficacy and safety of cannabinoids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS).Patients and MethodsThe review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of the Cochrane register, Embase, Medline, Scopus (last search on 11 November 2016).ResultsAfter screening 8 469 articles, we included two randomized controlled trials and one open-label study, in which a total of 426 patients were enrolled. Cannabinoids relevantly decreased the number of incontinence episodes in all three studies. Pooling data showed the mean difference in incontinence episodes per 24 h to be −0.35 (95% confidence interval −0.46 to −0.24). Mild adverse events were frequent (38–100%), but only two patients (0.7%) reported a serious adverse event.ConclusionsPreliminary data imply that cannabinoids might be an effective and safe treatment option for NLUTD in patients with MS; however, the evidence base is poor and more high-quality, well-designed and adequately powered and sampled studies are urgently needed to reach definitive conclusions.
      PubDate: 2017-02-23T03:35:28.25606-05:0
      DOI: 10.1111/bju.13759
  • Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis
    • Authors: Amihay Nevo; Roy Mano, Jack Baniel, David A. Lifshitz
      Abstract: ObjectivesTo evaluate the association between stent dwelling time and sepsis after ureteroscopy, and identify risk factors for sepsis in this setting.Patients and MethodsThe prospectively collected database of a single institution was queried for all patients who underwent ureteroscopy for stone extraction between 2010 and 2016. Demographic, clinical, preoperative and operative data were collected. The primary study endpoint was sepsis within 48 h of ureteroscopy. Logistic regressions were performed to identify predictors of post-ureteroscopy sepsis in the ureteroscopy cohort and specifically in patients with prior stent insertion.ResultsBetween October 2010 and April 2016, 1 256 patients underwent ureteroscopy for stone extraction. Risk factors for sepsis included prior stent placement, female gender and Charlson comorbidity index. A total of 601 patients had a ureteric stent inserted before the operation and were included in the study cohort, in which the median age was 56 years, 90 patients were women (30%), and 97 patients were treated for positive preoperative urine cultures (16.1%). Postoperative sepsis, 3 months were 1, 4.9, 5.5 and 9.2%, respectively. On multivariate analysis, stent dwelling time, stent insertion because of sepsis, and female gender were significantly associated with post-ureteroscopy sepsis in patients with prior stent placement.ConclusionsPatients who undergo ureteroscopy after ureteric stent insertion have a higher risk of postoperative sepsis. Prolonged stent dwelling time, sepsis as an indication for stent insertion, and female gender are independent risk factors. Stent placement should be considered cautiously, and if inserted, ureteroscopy should be performed within 1 month.
      PubDate: 2017-02-22T21:06:49.939037-05:
      DOI: 10.1111/bju.13796
  • Outcome predictors of radical cystectomy in patients with cT4 prostate
           cancer: A multi-institutional study of 62 patients
    • Authors: Martin Spahn; Alessandro Morlacco, Silvan Boxler, Steven Joniau, Alberto Briganti, Francesco Montorsi, Paolo Gontero, Pia Bader, Detlef Frohneberg, Hein Poppel, R. Jeffrey Karnes,
      Abstract: ObjectivesTo identify which patients with macroscopic bladder infiltrating T4 prostate cancer (PCa) might have favorable outcomes when treated with radical cystectomy (RC)Materials and methodsWe evaluated 62 patients with cT4cN0-1cM0 PCa treated with RC and pelvic lymph node dissection between 1972-2011. In addition to descriptive statistics, the Kaplan-Meier method and log-rank tests were used to depict survival rates. Uni- and multivariate Cox regression analysis tested the association between predictors and progression-free, PCa-specific-, and overall survival.ResultsOf the 62 patients, 19 (30.6%) did not have clinical progression during follow-up, 2 (3.2%) had local recurrence, and 32 (51.6%) had hematogenous and 9 (14.5%) combined pelvic and distant metastasis. Fourty (64.5%) patients died, 34 (54.8%) of PCa and 6 (9.7%) of other causes. Median survival of the 19 patients who were metastasis-free at last follow-up was 86 months (range 1-314 mos), 8/19 had a follow-up of more than 5 years, and 5 survived metastasis-free for more than 15 years. Patients without seminal vesicle invasion (SVI) had the best outcomes, with an estimated 10-year PCa-specific survival of 75% compared to 24% for patients with SVI.ConclusionRC can be an appropriate treatment for local control and part of a multimodality approach for cT4-PCa. Although recurrences can be probable, it does not necessarily translate into cancer-specific death. Men without SVI had a 75% 10-year PCa-specific survival. Although SVI is not as favorable, there can be good local control but these patients are at higher risk of progression and may need more aggressive systemic treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T23:45:21.686034-05:
      DOI: 10.1111/bju.13818
  • Systematic review of the oncological and functional outcomes of pelvic
           organ-preserving cystectomy compared with standard radical cystectomy in
           women who undergo curative surgery and orthotopic neobladder substitution
           for bladder cancer
    • Authors: Erik Veskimäe; Yann Neuzillet, Mathieu Rouanne, Steven MacLennan, Thomas B. L Lam, Yuhong Yuan, Eva Compérat, Nigel C Cowan, Georgios Gakis, Antoine G van der Heijden, Maria J Ribal, J. Alfred Witjes, Thierry Lebrét
      Abstract: ContextPelvic-organ preserving radical cystectomy (POPRC) for female patients may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy (RC).ObjectiveTo determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer (BCa).Evidence acquisitionMedline, Embase, Cochrane controlled trials databases and clinicaltrial. gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard radical cystectomy and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival at>2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment.Evidence synthesisThe searches yielded 11,941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86%) having resumed sexual activity within 6 months post-operatively, with median patients’ sexual satisfaction scores 88.5% ranging from 80% to 100%. Survival outcomes were reported in 7 studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 yr, cancer-specific survival (CSS) was 70-100% and overall survival (OS) 65-100%. 11 studies reported continence outcomes. Overall daytime and nighttime continence was 58-100% and 42-100%, respectively. Overall self-catheterization rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, narrative synthesis was made. The overall risk of bias was high across all studies.ConclusionFor well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC in terms of oncological outcomes whilst improving sexual and urinary function outcomes. However, in women undergoing cystectomy, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative settingThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:50:23.099561-05:
      DOI: 10.1111/bju.13819
  • PCNL Access by Urologist or Interventional Radiologist: Practice and
           Outcomes in the United Kingdom
    • Authors: James N Armitage; John Withington, Sarah Fowler, William JG Finch, Neil A Burgess, Stuart O Irving, Jonathan Glass, Oliver J Wiseman
      Abstract: Introduction and ObjectiveObtaining percutaneous access to the renal collecting system is fundamental to safe and effective percutaneous nephrolithotomy (PCNL). Practice varies between countries, hospitals and individual surgeons as to whether access is obtained by a urologist or an interventional radiologist (IR). We compared outcomes of urologist versus IR tracts in the contemporary UK setting.Patients and MethodsData submitted to the British Association of Urological Surgeons (BAUS) PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts and perceived and actual difficulty of access. Post-operative outcomes, including stone free rates, lengths of stay and complications including transfusion rates were also compared.ResultsOverall, percutaneous renal access was undertaken by an IR in 3,453 of 5,211 procedures (66.3%); this rate appeared stable over the entire study period, for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group.IRs performed more multiple tract access than urologists (6.8% vs 5.1%, p=0.02), but similar rates of supracostal punctures (8.2% vs 9.2%, p=0.23). IRs used ultrasound more commonly than urologists to guide access (56.6% vs. 21.7%, p=0.0001). There were no significant differences in complication rates, lengths of stay or stone free rates.ConclusionsOur findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedureThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:50:21.887242-05:
      DOI: 10.1111/bju.13817
  • Long-Term Results Of Ileal Ureteric Replacement – A 25 Years Single
           Centre Experience
    • Authors: Arkadius kocot; charis kalogirou, daniel vergho, hubertus riedmiller
      Abstract: ObjectivesTo report the long-term outcome of ileal ureteric replacement (IUR) in complex reconstruction of the urinary tract.Patients And MethodsFrom 1991 to 2016, IUR was performed in 157 patients with structural or functional ureteric loss. In 52 patients, bilateral IUR became necessary. Implantation sites where either the native urinary bladder (n=79) or intestinal reservoirs (n=78). In the latter group, the technique was used at the time of primary urinary diversion (n=34), in a secondary approach (n=29) and in undiversion or conversion procedures (n=15). Anti-refluxive implantation was performed in 37 patients. In 8 patients the ileal ureter was implanted into the cutis as an ileal conduit. All patients were followed prospectively according to a standardized protocol.ResultsThe mean follow-up was 54.1 months. In 114 patients with dilation of the upper urinary tract before surgery a significant improvement of the dilation was proven in 98 patients. Serum creatinine levels decreased or remained stable in 147 of 157 patients. Reflux was present in all cases without and in six cases with an anti-reflux mechanism. In six patients, operative revision became necessary because of severe metabolic acidosis, mucus obstruction or stenosis of the ileal ureter.ConclusionTo our knowledge, this is the world's largest single-center series of IUR reported to date. Long-term follow-up confirms that this approach is a safe and reliable solution even under complex circumstances. Anti-refluxive implantation is recommended in intestinal reservoirs, whereas reflux prevention seems to be of minor importance when the native bladder is chosen as site of implantationThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T22:40:54.77201-05:0
      DOI: 10.1111/bju.13825
  • Morphometric Analysis of Prostate Zonal Anatomy using Magnetic Resonance
           Imaging (MRI): The Impact on Age-related Changes in Japanese and American
    • Authors: Toru Matsugasumi; Atsuko Fujihara, So Ushijima, Motohiro Kanazawa, Yasuhiro Yamada, Takumi Shiraishi, Fumiya Hongo, Kazumi Kamoi, Koji Okihara, Andre Luis de Castro Abreu, Masakatsu Oishi, Toshitaka Shin, Suzanne Palmer, Inderbir S. Gill, Osamu Ukimura
      Abstract: ObjectivesMagnetic resonance imaging (MRI) can be used to reliably evaluate prostate zonal anatomy. Objectives of this study was to evaluate the impact of morphometric MRI analysis of the prostate zonal anatomy on aging, prostatic hypertrophy, and lower urinary tract symptoms in patients from Japan and the USA.Subjects and MethodsA retrospective analysis of 307 men, including Japanese (n=156) and American (n=151) patients, who consecutively underwent 3-Tesla MRI and International Prostate Symptom Score (IPSS) due to elevated PSA. Using Synapse-Vincent (Fujifilm), the prostatic zones were segmented in each axial step-section of T2-w-MRI to reconstruct a 3D-model of the prostate to calculate the zonal-volumes (whole-gland prostate [Pr-vol], transition zone [TZ-vol], and peripheral zone [PZ-vol]), the presumed circle area ratio [PCAR], and PZ thickness. Bivariate associations were quantified with the Spearman rank correlation coefficient.ResultsThe American men presented a greater Pr-vol (49ml vs. 42ml, p=0.003) and TZ-vol (26ml vs. 20ml, p
      PubDate: 2017-02-20T21:50:24.291801-05:
      DOI: 10.1111/bju.13823
  • Robot-Assisted Approach to W Configuration Urinary Diversion:A
           Step-by-Step Technique
    • Authors: Ahmed A. Hussein; Youssef E. Ahmed, Justen D. Kozlowski, Paul May, John Nyquist, Sandra Sexton, Leslie Curtin, James O. Peabody, Hassan Abol-Enein, Khurshid A. Guru
      Abstract: IntroductionTo describe a detailed step-by-step approach of our technique to robot-assisted intracorporeal “W” orthotopic ileal neobladder (ICNB).MethodsFive patients underwent robot-assisted radical cystectomy (RARC), extended pelvic lymph node dissection (ePLND) and ICNB. ICNB was divided into 6 key steps to facilitate and enable a detailed analysis and auditing of the technique. No conversion to open surgery was required. Timing for each step was noted. All patients had at least 3 months of follow up.ResultsMean age was 57 years. Mean overall console and diversion times were 357 and 193 minutes, respectively. None of the patients had any evidence of residual disease following RARC. Four of five patients experienced complications; 3 developed fevers due to urinary tract infection (one required readmission), and 1 patient developed myocardial infarction and required coronary angiography and stenting. Looking at the timing for the individual steps, bowel detubularization and construction of posterior plate were consistently the longest among the key steps (average 46 minutes, 13% of the overall operative time), followed by uretero-ileal anastomosis (37 minutes, 10%), neobladder-urethral anastomosis (23 minutes, 6%) and identification and fixation of the bowel (26 minutes, 7%).ConclusionWe described our step-by-step technique and initial perioperative outcomes of our first five intracorporeal neobladders with “W” configurationThis article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T21:50:22.068827-05:
      DOI: 10.1111/bju.13824
  • Anatomical study of renal arterial vasculature and its potential impact on
           partial nephrectomy
    • Authors: Veronica Macchi; Alessandro Crestani, Andrea Porzionato, Maria Martina Sfriso, Aldo Morra, Marta Rossanese, Giacomo Novara, Raffaele De Caro, Vincenzo Ficarra
      Abstract: ObjectivesTo validate Graves’ classification of the intrarenal arteries and to verify the absence of collateral arterial blood supply between different renal segments, in order to maximize peri-operative and functional outcomes of partial nephrectomy.Materials and MethodsThe study was performed on 15 normal kidneys sampled from eight unembalmed cadavers. Kidneys with the surrounding perirenal fat tissue were removed en bloc with the abdominal segment of the aorta. The renal artery was injected with acrylic and radiopaque resins, with the specimen suspended in water. CT examination of the injected kidneys was performed to analyse the branches located deeply. After imaging acquisition, the specimens were treated with sodium hydroxide for removal of the parenchyma to obtain vascular casts.ResultsTen casts (66.6%) showed the classic subdivision of the main artery into single posterior and anterior branches. With regard to the distribution of the segmental or second-order arteries, only two casts (13%) showed a pattern similar to that described by Graves, characterized by four segmental (second-order) branches coming from the anterior renal artery (apical, superior, middle and inferior). In the remaining 13 kidneys (87%) a different arterial vascular network was detected. In 10 casts (80%) a single renal segment was vascularized by two or more different branches coming from an artery leading to another segment (multiple vascularization). Multiple vascularization was observed in three (20%) apical segments, five (33%) superior segments, six (40%) middle segments, seven (47%) inferior segments and two (13%) posterior segments.ConclusionsThis study shows that in the human kidneys the arterial vasculature is frequently different from that described by Graves. Moreover, in a significant percentage of cases, a single renal segment receives two or more branches that originate from an artery leading to another segment.
      PubDate: 2017-02-20T21:16:08.102661-05:
      DOI: 10.1111/bju.13788
  • Biomarker classification, validation, and what to look for in 2017 and
    • Authors: John W. Davis
      PubDate: 2017-02-20T21:15:25.273369-05:
      DOI: 10.1111/bju.13790
  • Chromogranin A and neurone-specific enolase variations during the first 3
           months of abiraterone therapy predict outcomes in patients with metastatic
           castration-resistant prostate cancer
    • Authors: Liancheng Fan; Yanqing Wang, Chenfei Chi, Jiahua Pan, Shangguan Xun, Zhixiang Xin, Jianian Hu, Lixin Zhou, Baijun Dong, Wei Xue
      Abstract: ObjectiveTo determine the prognostic utility of serum chromogranin A (CgA) and neurone-specific enolase (NSE) variations during the first 3 months of abiraterone acetate (AA) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC).Patients and MethodsThe serum levels of CgA, NSE were measured at baseline and after 3 months of AA treatment in 40 patients with mCRPC. Outcome measures were prostate-specific antigen progression-free survival (PSA-PFS), radiographic PFS (rPFS), and overall survival (OS).ResultsCgA levels were not correlated with NSE levels (P = 0.296). In multivariate analysis the combination of CgA and NSE (≥1 marker positive vs both markers negative) and the combination of CgA and NSE elevation during the first 3 months of AA treatment (≥1 marker positive vs both markers negative) remained significant predictors of OS, rPFS, and PSA-PFS.ConclusionWe found that CgA and NSE elevation during the first 3 months of AA treatment and elevated baseline CgA and NSE levels were independent prognostic factors for OS, rPFS and PSA-PFS in patients with mCRPC treated with AA. This suggests that serial CgA and NSE evaluation may help clinicians in distinguishing patients with mCRPC who would obtain the best survival benefit from AA treatment.
      PubDate: 2017-02-19T22:10:27.372213-05:
      DOI: 10.1111/bju.13781
  • Nocturia increases the incidence of depressive symptoms: a longitudinal
           study of the HEIJO-KYO cohort
    • Authors: Kenji Obayashi; Keigo Saeki, Hiromitsu Negoro, Norio Kurumatani
      Abstract: ObjectivesTo evaluate the association between nocturia and the incidence of depressive symptoms.Participants and MethodsOf 1 127 participants in the HEIJO-KYO population-based cohort, 866 elderly individuals (mean age 71.5 years) without depressive symptoms at baseline were followed for a median period of 23 months. Nocturnal voiding frequency was logged using a standardized urination diary and nocturia was defined as a frequency of ≥2 voids per night. Depressive symptoms were assessed using the Geriatric Depression Scale.ResultsDuring the follow-up period, 75 participants reported the development of depressive symptoms (score ≥6). The nocturia group (n = 239) exhibited a significantly higher hazard ratio (HR) for incident depressive symptoms than the non-nocturia group (n = 627) in the Cox proportional hazard model, which was adjusted for age, gender, alcohol consumption, day length and presence of hypertension and chronic kidney disease (HR 1.69, 95% confidence interval [CI] 1.05–2.72; P = 0.032]. The significance remained after adjustment for sleep disturbances (HR 1.68, 95% CI 1.02–2.75; P = 0.040). Analysis stratified by gender showed that the association between nocturia and the incidence of depressive symptoms was significant in men (HR 2.51, 95% CI 1.27–4.97; P = 0.008) but not in women (HR 1.12, 95% CI 0.53–2.44; P = 0.74).ConclusionsNocturia is significantly associated with a higher incidence of depressive symptoms in the general elderly population, and gender differences may underlie this association.
      PubDate: 2017-02-17T23:35:30.598407-05:
      DOI: 10.1111/bju.13791
  • Development of a voided urine assay for detecting prostate cancer
           non-invasively: a pilot study
    • Authors: Edouard J. Trabulsi; Sushil K. Tripathi, Leonard Gomella, Charalambos Solomides, Eric Wickstrom, Mathew L. Thakur
      Abstract: ObjectiveTo validate a hypothesis that prostate cancer can be detected non-invasively by a simple and reliable assay by targeting genomic VPAC receptors expressed on malignant prostate cancer cells shed in voided urine.Patients/Subjects and MethodsVPAC receptors were targeted with a specific biomolecule, TP4303, developed in our laboratory. With an Institutional Review Board exempt approval of use of de-identified discarded samples, an aliquot of urine collected as a standard of care, from patients presenting to the urology clinic (207 patients, 176 men and 31 women, aged ≥21 years) was cytospun. The cells were fixed and treated with TP4303 and 4,6-diamidino-2-phenylindole (DAPI). The cells were then observed under a microscope and cells with TP4303 orange fluorescence around the blue (DAPI) nucleus were considered ‘malignant’ and those only with a blue nucleus were regarded as ‘normal’. VPAC presence was validated using receptor blocking assay and cell malignancy was confirmed by prostate cancer gene profile examination.ResultsThe urine specimens were labelled only with gender and presenting diagnosis, with no personal health identifiers or other clinical data. The assay detected VPAC positive cells in 98.6% of the men with a prostate cancer diagnosis (141), and none of the 10 men with benign prostatic hyperplasia. Of the 56 ‘normal’ patients, 62.5% (35 patients, 10 men and 25 women) were negative for VPAC cells; 19.6% (11, 11 men and no women) had VPAC positive cells; and 17.8% (10, four men and six women) were uninterpretable due to excessive crystals in the urine. Although data are limited, the sensitivity of the assay was 99.3% with a confidence interval (CI) of 96.1–100% and the specificity was 100% with a CI of 69.2–100%. Receptor blocking assay and fluorescence-activated cell sorting (FACS) analyses demonstrated the presence of VPAC receptors and gene profiling examinations confirmed that the cells expressing VPAC receptors were malignant prostate cancer cells.ConclusionThese preliminary data are highly encouraging and warrant further evaluation of the assay to serve as a simple and reliable tool to detect prostate cancer non-invasively.
      PubDate: 2017-02-16T21:30:40.606646-05:
      DOI: 10.1111/bju.13775
  • A Multiparametric Magnetic Resonance Imaging Based Risk Model to Determine
           the Risk of Significant Prostate Cancer prior to biopsy
    • Authors: Pim J van Leeuwen; Andrew Hayen, James E Thompson, Daniel Moses, Ron Shnier, Maret Böhm, Magdaline Abuodha, Anne-Maree Haynes, Francis Ting, Jelle Barentsz, Monique Roobol, Justin Vass, Krishan Rasiah, Warick Delprado, Phillip D Stricker
      Abstract: ObjectivesTo develop and externally validate a predictive model for detection of significant prostate cancer (PC).Subjects and MethodsDevelopment of the model was based on prospective cohort including 393 men who underwent mpMRI prior to biopsy. External validity of the model was then examined retrospectively in 198 men from a separate institution whom underwent a mpMRI followed by biopsy for abnormal PSA/DRE. A model was developed with age, PSA, DRE, prostate volume, previous biopsy and PIRADS score as predictors for significant PC (Gleason 7 with>5% grade 4, ≥ 20% cores positive or ≥ 7mm of PC in any core). Probability was studied via logistic regression. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling.Results393 men had complete data. A total of 149 patients (37.9%) had significant PC. While the variable model had good accuracy in predicting significant PC (AUC of 0.80), the advanced model (incorporating mpMRI) had significant higher AUC of 0.88 (p
      PubDate: 2017-02-16T12:45:59.047265-05:
      DOI: 10.1111/bju.13814
  • Detection of prostate cancer using magnetic resonance
           imaging/ultrasonography image-fusion targeted biopsy in African-American
    • Authors: Toshitaka Shin; Thomas B. Smyth, Osamu Ukimura, Nariman Ahmadi, Andre Luis Castro Abreu, Masakatsu Oishi, Hiromitsu Mimata, Inderbir S. Gill
      Abstract: ObjectiveTo assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US).Patients and MethodsWe retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7.ResultsAfter controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4–5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively.ConclusionsOur key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.
      PubDate: 2017-02-15T23:50:30.291003-05:
      DOI: 10.1111/bju.13786
  • TANGO - a screening tool to identify comorbidities on the causal pathway
           of nocturia
    • Authors: Wendy F. Bower; Georgie E. Rose, Claire F. Ervin, Jeremy Goldin, David M. Whishaw, Fary Khan
      Abstract: ObjectivesTo develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia.MethodsVariables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the Short-Form (SF) screening tool. The tool was administered to 252 individuals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected were subjected to descriptive analysis; criteria were applied to reduce the number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the individual's Aetiology of Nocturia to Guide Outcomes.ResultsThe demographic characteristics of the sample are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long-Form to the SF is presented. The resultant TANGO-SF patient-completed nocturia screening tool is reported.ConclusionsA novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.
      PubDate: 2017-02-12T23:31:30.952781-05:
      DOI: 10.1111/bju.13774
  • Evaluation of a 24-gene signature for prognosis of metastatic events and
           prostate cancer-specific mortality
    • Authors: Kathryn L. Pellegrini; Martin G. Sanda, Dattatraya Patil, Qi Long, María Santiago-Jiménez, Mandeep Takhar, Nicholas Erho, Kasra Yousefi, Elai Davicioni, Eric A. Klein, Robert B. Jenkins, R. Jeffrey Karnes, Carlos S. Moreno
      Abstract: ObjectivesTo determine the prognostic potential of a 24-gene signature, Sig24, for identifying patients with prostate cancer who are at risk of developing metastases or of prostate cancer-specific mortality (PCSM) after radical prostatectomy (RP).Patients and MethodsSig24 scores were calculated from previously collected gene expression microarray data from the Cleveland Clinic and Mayo Clinic (I and II). The performance of Sig24 was determined using time-dependent c-index analysis, Cox proportional hazards regression and Kaplan–Meier survival analysis.ResultsHigher Sig24 scores were significantly associated with higher pathological Gleason scores in all three cohorts. Analysis of the Mayo Clinic II cohort, which included time-to-event information, indicated that patients with high Sig24 scores also had a higher risk of developing metastasis (hazard ratio [HR] 3.78, 95% confidence interval [CI]: 1.96–7.29; P < 0.001) or of PCSM (HR 6.54, 95% CI: 2.16–19.83; P < 0.001).ConclusionsThe findings of the present study show the applicability of Sig24 for the prognosis of metastasis or PCSM after RP. Future studies investigating the combination of Sig24 with available prognostic tests may provide new approaches to improve risk stratification for patients with prostate cancer.
      PubDate: 2017-02-11T02:40:29.314774-05:
      DOI: 10.1111/bju.13779
  • Dishevelled segment polarity protein 3 (DVL3): a novel and easily
           applicable recurrence predictor in localised prostate adenocarcinoma
    • Authors: Pil-Jong Kim; Ji Y. Park, Hong-Gee Kim, Yong Mee Cho, Heounjeong Go
      Abstract: ObjectiveTo identify new biomarkers for biochemical recurrence (BCR) of prostate adenocarcinoma.Patients and MethodsClinical information of 500 patients with prostate adenocarcinoma and their 152 RNA-sequencing and protein-array data from The Cancer Genome Atlas (TCGA) were separated into a discovery set and a validation set. Each dataset was analysed according to the Gleason grade groups reflecting BCR. The results obtained from the analysis using TCGA dataset were confirmed by immunohistochemistry analyses of a confirmation cohort composed of 395 patients with localised prostate adenocarcinoma.ResultsTCGA discovery set was subgrouped into lower- and higher-risk groups for recurrence-free survival (RFS) (P < 0.001). Cyclin B1 (CCNB1), dishevelled segment polarity protein 3 (DVL3), paxillin (PXN), RAF1, transferrin, X-ray repair cross complementing 5 (XRCC5) and BIM had lower expression in the lower-risk group than that in the higher-risk group (all, P < 0.05). In TCGA validation set, CCNB1, DVL3, transferrin, XRCC5 and BIM were also differently expressed between the two groups. Immunohistochemically, DVL3 positivity was associated with high prostate-specific antigen (PSA) levels, resection margin involvement, and BCR (all, P < 0.05). A high Gleason score indicated a marginal relationship (P = 0.055). BIM positivity was related to high PSA levels, lymphovascular invasion, and BCR (all, P < 0.05). Both DVL3 positivity (P = 0.010) and BIM positivity (P = 0.024) were associated with shorter RFS, but statistical significance was lost when the multivariate Cox regression model included all patients. In the lower-risk group, the multivariate Cox model confirmed that DVL3 was an independent predictor for poor RFS (hazard ratio 1.80, P = 0.040), and the concordance index (C-index) was 0.805.ConclusionsDVL3 and BIM were expressed in patients with a higher risk of BCR. DVL3 may be a novel and easily applicable recurrence predictor of localised prostate adenocarcinoma.
      PubDate: 2017-02-10T04:25:27.362946-05:
      DOI: 10.1111/bju.13783
  • Prognostic value of tissue-based biomarker signature in clear cell renal
           cell carcinoma
    • Authors: Ahmed Q. Haddad; Jun-Hang Luo, Laura-Maria Krabbe, Oussama Darwish, Bishoy Gayed, Ramy Youssef, Payal Kapur, Dinesh Rakheja, Yair Lotan, Arthur Sagalowsky, Vitaly Margulis
      Abstract: ObjectiveTo improve risk stratification for recurrence prognostication in patients with localised clear cell renal cell carcinoma (ccRCC).Patients and MethodsIn all, 367 patients with non-metastatic ccRCC were included. The cohort was divided into a training and validation set. Using tissue microarrays, immunostaining was performed for 24 biomarkers representative of key pathways in ccRCC. Using Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression, we identified several markers that were used to construct a risk classifier for risk of disease recurrence.ResultsThe median (interquartile range) follow-up was 63.5 (24.0–85.3) months. Five out of 24 markers were selected by LASSO Cox regression for the risk classifier: N-cadherin, E-cadherin, Ki67, cyclin D1 and phosphorylated eukaryotic initiation factor 4E binding protein-1 (p-4EBP1). Patients were classified as either low, intermediate or high risk of disease recurrence by tertiles of risk score. The 5-year recurrence-free survival (RFS) was 93.8%, 87.7% and 70% for patients with low-, intermediate- and high-risk scores, respectively (P < 0.001). Patients with a high marker score had worse RFS on multivariate analysis adjusted for age, gender, race and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score (hazard ratio 3.66, 95% confidence interval 1.58–8.49, P = 0.003 for high vs low marker score in the overall cohort). The five-marker classifier increased the concordance index of the clinical model in both the training and validation sets.ConclusionWe developed a five-marker-based prognostic tool that can effectively classify patients with ccRCC according to risk of disease recurrence after surgery. This tool, if prospectively validated, could provide individualised risk estimation for patients with ccRCC.
      PubDate: 2017-02-09T10:51:21.906331-05:
      DOI: 10.1111/bju.13776
  • Detection and oncological effect of circulating tumour cells in patients
           with variant urothelial carcinoma histology treated with radical
    • Authors: Armin Soave; Sabine Riethdorf, Roland Dahlem, Sarah Minner, Lars Weisbach, Oliver Engel, Margit Fisch, Klaus Pantel, Michael Rink
      Abstract: ObjectivesTo investigate for the presence of circulating tumour cells (CTC) in patients with variant urothelial carcinoma of the bladder (UCB) histology treated with radical cystectomy (RC), and to determine their impact on oncological outcomes.Patients and methodsWe prospectively collected data of 188 patients with UCB treated with RC without neoadjuvant chemotherapy. Pathological specimens were meticulously reviewed for pure and variant UCB histology. Preoperatively collected blood samples (7.5 mL) were analysed for CTC using the CellSearch® system (Janssen, Raritan, NJ, USA).ResultsVariant UCB histology was found in 47 patients (25.0%), most frequently of squamous cell differentiation (16.5%). CTC were present in 30 patients (21.3%) and 12 patients (25.5%) with pure and variant UCB histology, respectively. At a median follow-up of 25 months, the presence of CTC and non-squamous cell differentiation were associated with reduced recurrence-free survival (RFS) and cancer-specific survival (pairwise P ≤ 0.016). Patients without CTC had better RFS, independent of UCB histology, than patients with CTC with any UCB histology (pairwise P < 0.05). In multivariable analyses, the presence of CTC, but not variant UCB histology, was an independent predictor for disease recurrence [hazard ratio (HR) 3.45; P < 0.001] and cancer-specific mortality (HR 2.62; P = 0.002).ConclusionCTC are detectable in about a quarter of patients with pure or variant UCB histology before RC, and represent an independent predictor for outcomes, when adjusting for histological subtype. In addition, our prospective data confirm the unfavourable influence of non-squamous cell-differentiated UCB on outcomes.
      PubDate: 2017-02-09T10:51:18.743203-05:
      DOI: 10.1111/bju.13782
  • Quantifying severe urinary complications after radical prostatectomy: the
           development and validation of a surgical performance indicator using
           hospital administrative data
    • Authors: Arunan Sujenthiran; Susan C. Charman, Matthew Parry, Julie Nossiter, Ajay Aggarwal, Prokar Dasgupta, Heather Payne, Noel W. Clarke, Paul Cathcart, Jan Meulen
      Abstract: ObjectivesTo develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data.Patients and MethodsMen who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into ‘stricture’, ‘incontinence’ and ‘other’. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan–Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics.ResultsA total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26–1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40–1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58–0.74).ConclusionThese results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.
      PubDate: 2017-02-08T21:55:35.025636-05:
      DOI: 10.1111/bju.13770
  • Changes in penile length after radical prostatectomy: investigation of the
           underlying anatomical mechanism
    • Authors: Yoshifumi Kadono; Kazuaki Machioka, Kazufumi Nakashima, Masashi Iijima, Kazuyoshi Shigehara, Takahiro Nohara, Kazutaka Narimoto, Kouji Izumi, Yasuhide Kitagawa, Hiroyuki Konaka, Toshifumi Gabata, Atsushi Mizokami
      Abstract: ObjectiveTo measure changes in penile length (PL) over time before and after radical prostatectomy (RP), and to investigate the underlying mechanisms for these changes.Patients and MethodsThe stretched PL (SPL) of 102 patients was measured before, 10 days after, and at 1, 3, 6, 9, 12, 18 and 24 months after RP. The perpendicular distance from the distal end of the membranous urethra to the midline of the pelvic outlet was measured on mid-sagittal magnetic resonance imaging (MRI) slice at three time points: preoperatively; 10 days after RP; and 12 months after RP. Pre- and postoperative SPLs were compared using paired Student's t-test. Predictors of PL shortening at 10 days and at 12 months after RP were evaluated on univariate and multivariate analyses.ResultsThe SPL was shortest 10 days after RP (mean PL shortening from preoperative level: 19.9 mm), and gradually recovered thereafter. SPL at 12 months after RP was not significantly different from preoperative SPL. On MRI examination, the distal end of membranous urethra was found to have moved proximally (mean proximal displacement: 3.9 mm) at 10 days after RP, and to have returned to the preoperative position at 12 months after RP. On univariate analysis, only the volume of the removed prostate was a predictor of SPL change at 10 days after surgery; on multivariate analysis, the association was not statistically significant. No predictor of SPL change was found at 12 months after RP.ConclusionThe SPL was shortest at 10 days after RP and gradually recovered thereafter in the present study. Anatomically, the glans and corpus spongiosum surrounding the urethra are an integral structure, and the proximal urethra is drawn into the pelvis during urethrovesical anastomosis. This is the first report showing that slight vertical repositioning of the membranous urethra after RP causes changes in SPL over time. These results can help inform patients about changes in penile appearance after RP.
      PubDate: 2017-02-08T21:55:30.446179-05:
      DOI: 10.1111/bju.13777
  • Prostate Health Index density improves detection of clinically significant
           prostate cancer
    • Authors: Jeffrey J. Tosoian; Sasha C. Druskin, Darian Andreas, Patrick Mullane, Meera Chappidi, Sarah Joo, Kamyar Ghabili, Mufaddal Mamawala, Joseph Agostino, Herbert B. Carter, Alan W. Partin, Lori J. Sokoll, Ashley E. Ross
      Abstract: ObjectivesTo explore the utility of Prostate Health Index (PHI) density for the detection of clinically significant prostate cancer (PCa) in a contemporary cohort of men presenting for diagnostic evaluation of PCa.Patients and MethodsThe study cohort included patients with elevated prostate-specific antigen (PSA;>2 ng/mL) and negative digital rectal examination who underwent PHI testing and prostate biopsy at our institution in 2015. Serum markers were prospectively measured per standard clinical pathway. PHI was calculated as ([{−2}proPSA/free PSA] × [PSA]½), and density calculations were performed using prostate volume as determined by transrectal ultrasonography. Logistic regression was used to assess the ability of serum markers to predict clinically significant PCa, defined as any Gleason score ≥7 cancer or Gleason score 6 cancer in>2 cores or>50% of any positive core.ResultsOf 118 men with PHI testing who underwent biopsy, 47 (39.8%) were found to have clinically significant PCa on biopsy. The median (interquartile range [IQR]) PHI density was 0.70 (0.43–1.21), and was 0.53 (0.36–0.75) in men with negative biopsy or clinically insignificant PCa and 1.21 (0.74–1.88) in men with clinically significant PCa (P < 0.001). Clinically significant PCa was detected in 3.6% of men in the first quartile of PHI density (1.21 (P < 0.001). Using a threshold of 0.43, PHI density was 97.9% sensitive and 38.0% specific for clinically significant PCa, and 100% sensitive for Gleason score ≥7 disease. Compared with PSA (area under the curve [AUC] 0.52), PSA density (AUC 0.70), %free PSA (AUC 0.75), the product of %free PSA and prostate volume (AUC 0.79), and PHI (AUC 0.76), PHI density had the highest discriminative ability for clinically significant PCa (AUC 0.84).ConclusionsBased on the present prospective single-centre experience, PHI density could be used to avoid 38% of unnecessary biopsies, while failing to detect only 2% of clinically significant cancers.
      PubDate: 2017-02-06T09:46:36.304117-05:
      DOI: 10.1111/bju.13762
  • Weighing the evidence from surgical trials
    • Authors: Quoc-Dien Trinh; Alexander P. Cole, Prokar Dasgupta
      PubDate: 2017-02-06T09:46:27.667989-05:
      DOI: 10.1111/bju.13778
  • Late surgical correction of hypospadias increases the risk of
           complications: a series of 501 consecutive patients
    • Authors: Sarah Garnier; Olivier Maillet, Barbara Cereda, Margot Ollivier, Clement Jeandel, Sylvie Broussous, Christophe Lopez, Francoise Paris, Pascal Philibert, Cyril Amouroux, Claire Jeandel, Amandine Coffy, Laura Gaspari, Jean Pierre Daures, Charles Sultan, Nicolas Kalfa
      Abstract: ObjectivesTo evaluate the outcomes of hypospadias surgery according to age and to determine if some complications are age-related.Patients and MethodsThis retrospective study was based on 722 boys with hypospadias undergoing primary repair. A total of 501 boys underwent urethroplasty and were included in the study. Complications requiring an additional procedure (stenosis, fistula, dehiscence, relapse of curvature, urethrocele) were included in the analysis, as well as healing problems, infections, haematomas and detrusor-sphincter dyssynergy. Logistic regression analysis was performed.ResultsHypospadias was anterior in 63.1%, mid-penile in 20.5%, posterior in 8.4% and scrotal in 7.9% of the boys. The median (range) age was 4 (1–16) years. The overall rates of re-intervention and complications were 22.8% and 36.2%, respectively. Age>2 years was a significant predictor of complications (P = 0.002, odds ratio 1.98 [95% confidence interval 1.26–3.13]). Some periods of time appeared to be associated with a specific complication: dyssynergy was more common between the ages of 24 and 36 months (12.5 vs 3.6%; P = 0.01) and healing problemswere more common in boys aged>13 years (1.5 vs 28.5%; P = 0.06).ConclusionDelayed surgery may be detrimental for patients. Factors related to age may influence the rate of complications. After the age of 2 years, urethral surgery may interfere with the normal toilet-training process. During puberty, endogenous testosterone may alter healing. Even if no specific data exist for severe hypospadias, it may be prudent to continue to advocate early surgery in patients with disorders of sex development.
      PubDate: 2017-02-01T08:11:12.477421-05:
      DOI: 10.1111/bju.13771
  • Efficacy and safety of tadalafil 5 mg once daily in the treatment of lower
           urinary tract symptoms associated with benign prostatic hyperplasia in men
           aged ≥75 years: integrated analyses of pooled data from multinational,
           randomized, placebo-controlled clinical studies
    • Authors: Matthias Oelke; Adrian Wagg, Yasushi Takita, Hartwig Büttner, Lars Viktrup
      Abstract: ObjectiveTo assess efficacy and safety of tadalafil in men aged ≥75 years with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and additional safety in men aged ≥75 years with erectile dysfunction (ED).Patients and MethodsWe conducted an integrated analysis of 12 phase II–III randomized, double-blind and/or open-label extension studies to evaluate short-term (12–26 weeks) efficacy and short- and longer-term (42–52 weeks) safety in men aged
      PubDate: 2017-01-22T21:30:31.879734-05:
      DOI: 10.1111/bju.13744
  • Importance and outcome relevance of central pathology review in
           prostatectomy specimens: data from the SAKK 09/10 randomized trial on
           prostate cancer
    • Authors: Pirus Ghadjar; Stefanie Hayoz, Vera Genitsch, Daniel R. Zwahlen, Tobias Hölscher, Philipp Gut, Matthias Guckenberger, Guido Hildebrandt, Arndt-Christian Müller, Paul M. Putora, Alexandros Papachristofilou, Lukas Stalder, Christine Biaggi-Rudolf, Marcin Sumila, Helmut Kranzbühler, Yousef Najafi, Piet Ost, Ngwa C. Azinwi, Christiane Reuter, Stephan Bodis, Kaouthar Khanfir, Volker Budach, Daniel M. Aebersold, George N. Thalmann,
      Abstract: ObjectiveTo conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in changes in histopathological prognostic factors, such as Gleason score.Patients and MethodsA total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated.ResultsThere was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (3–38) mm. A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma (odds ratio [OR] 2.04 [95% CI 1.30, 3.20]; P = 0.002), resection margin status (OR 0.36 [95% CI 0.18, 0.72]; P = 0.004) and Gleason score (OR 1.55 [95% CI 1.00, 2.42]; P = 0.05) remained associated with rapid progression after salvage RT after backward selection.ConclusionThe results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
      PubDate: 2017-01-19T01:20:23.817352-05:
      DOI: 10.1111/bju.13742
  • Early surgical outcomes and oncological results of robot-assisted partial
           nephrectomy: a multicentre study
    • Authors: Rajan Veeratterapillay; Sanjai K. Addla, Clare Jelley, John Bailie, David Rix, Steve Bromage, Neil Oakley, Robin Weston, Naeem A. Soomro
      Abstract: ObjectiveTo describe a multicentre experience of robot-assisted partial nephrectomy (RAPN) in northern England, with focus on early surgical outcomes and oncological results.Patients and MethodsAll consecutive patients undergoing RAPN at four tertiary referral centres in northern England in the period 2012–2015 were included for analysis. RAPN was performed via a transperitoneal approach using a standardized technique. Prospective data collection was performed to capture preoperative characteristics (including R.E.N.A.L. nephrometry score), and peri-operative and postoperative data, including renal function. Correlations between warm ischaemia time (WIT), positive surgical margin (PSM) rate, complication rates, R.E.N.A.L. nephrometry scores and learning curve were assessed using univariate and multivariate analyses.ResultsA total of 250 patients (mean age 58.1 ± 13 years, mean ± sd body mass index 27.3 ± 7 kg/m2) were included, with a median (range) follow-up of 12 (3–36) months. The mean ± sd tumour size was 30.6 ± 10 mm, mean R.E.N.A.L. nephrometry score was 6.1 ± 2 and 55% of tumours were left-sided. Mean ± sd operating console time was 141 ± 38 min, WIT 16.7 ± 8 min and estimated blood loss 205 ± 145 mL. There were five conversions (2%) to open/radical nephrectomy. The overall complication rate was 16.4% (Clavien I, 1.6%; Clavien II, 8.8%; Clavien III, 6%; Clavien IV/V; 0%). Pathologically, 82.4% of tumours were malignant and the overall PSM rate was 7.3%. The mean ± sd preoperative and immediate postoperative estimated glomerular filtration rates were 92.8 ± 27 and 80.8 ± 27 mL/min/1.73 m2, respectively (P = 0.001). In all, 66% of patients remained in the same chronic kidney disease category postoperatively, and none of the patients required dialysis during the study period. ‘Trifecta’ (defined as WIT < 25 min, negative surgical margin status and no peri-operative complications) was achieved in 68.4% of patients overall, but improved with surgeon experience. PSM status and long WIT were significantly associated with early learning curve.ConclusionThis is the largest multicentre RAPN study in the UK. Initial results show that RAPN is safe and can be performed with minimal morbidity. Early oncological outcomes and renal function preservation data are encouraging.
      PubDate: 2017-01-18T08:56:41.6601-05:00
      DOI: 10.1111/bju.13743
  • Development, validation and clinical application of Pelvic Lymphadenectomy
           Assessment and Completion Evaluation: intraoperative assessment of lymph
           node dissection after robot-assisted radical cystectomy for bladder cancer
    • Authors: Ahmed A. Hussein; Nobuyuki Hinata, Shiva Dibaj, Paul R. May, Justen D. Kozlowski, Hassan Abol-Enein, Ronney Abaza, Daniel Eun, Mohamed S. Khan, James L. Mohler, Piyush Agarwal, Kamal Pohar, Richard Sarle, Ronald Boris, Sridhar S. Mane, Alan Hutson, Khurshid A. Guru
      Abstract: ObjectivesTo develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC).Patients, Subjects and MethodsA panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into three zones. In all, 21 de-identified videos of bilateral robot-assisted PLNDs were assessed by the 11 experts using PLACE to determine inter-rater reliability. Lymph node (LN) clearance was defined as the proportion of cleared LNs from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE).ResultsA significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431–545). There was a significant positive correlation between LN clearance and LN count (R2 = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group.ConclusionsPelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC.
      PubDate: 2017-01-18T08:10:24.24055-05:0
      DOI: 10.1111/bju.13748
  • Robotic salvage retroperitoneal and pelvic lymph node dissection for
           ‘node-only’ recurrent prostate cancer: technique and initial series
    • Authors: Andre Abreu; Carlos Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir Gill
      Abstract: ObjectivesTo describe the technique of robot-assisted high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer.Patients and MethodsIn all, 10 patients underwent robot-assisted sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by 11C-acetate positron emission tomography/computed tomography imaging. Our anatomical template extends from bilateral renal artery/vein cranially up to Cloquet's node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees; RPLND precedes PLND. Meticulous node-mapping assessed nodes at four prospectively assigned anatomical zones.ResultsThe median operative time was 4.8 h, estimated blood loss 100 mL and hospital stay 1 day. No patient had an intraoperative complication, open conversion or blood transfusion. Three patients had spontaneously resolving Clavien–Dindo grade II postoperative complications. The mean (range) number of nodes excised per patient was 83 (41–132) and mean (range) number of positive nodes per patient was 23 (0–109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomical level I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, the median PSA level had decreased by 83% at the 2-month follow-up.ConclusionThe initial series of robot-assisted sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robot-assisted technical details for an anatomical LND template up to the renal vessels are presented. Longer follow-up is necessary to assess oncological outcomes.
      PubDate: 2017-01-14T08:01:11.419146-05:
      DOI: 10.1111/bju.13741
  • Safety and early effectiveness of robot-assisted partial nephrectomy for
           large angiomyolipomas
    • Authors: Shay Golan; Scott C. Johnson, Matthew J. Maurice, Jihad H. Kaouk, Weil R. Lai, Benjamin R. Lee, Steven V. Kheyfets, Chandru P. Sundaram, David B. Cahn, Robert G. Uzzo, Arieh L. Shalhav
      Abstract: ObjectiveTo evaluate a multicentre series of robot-assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).Patients and MethodsBetween 2005 and 2016, 40 patients with large or symptomatic AMLs underwent RAPN at five academic centres in the USA. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analysed. Surgical outcomes were compared between patients who underwent selective arterial embolisation (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.ResultsThe median (interquartile range [IQR]) tumour diameter was 7.2 (5–8.5) cm, and the median (IQR) nephrometry score was 9 (7–10). Six patients (15%) had a history of tuberous sclerosis and 11 (28%) had previously undergone SAE. The median (IQR) operative time and warm ischaemia time was 207 (180–231) and 22.5 (16–28) min, respectively. A non-clamping technique was used in eight (20%) patients. The median (IQR) estimated blood loss was 200 (100–245) mL, and four patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and seven postoperative complications occurred in six patients (15%). During a median (IQR) follow-up of 8 (1–15) months, none of the patients developed AML-related symptoms. The median estimated glomerular filtration rate preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before RAPN and those who did not.ConclusionsRobot-assisted partial nephrectomy appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with a favourable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.
      PubDate: 2017-01-12T22:20:24.505929-05:
      DOI: 10.1111/bju.13747
  • Sorafenib dose escalation in treatment-naïve patients with metastatic
           renal cell carcinoma: a non-randomised, open-label, Phase 2b study
    • Authors: Martin E. Gore; Robert J. Jones, Alain Ravaud, Markus Kuczyk, Tomasz Demkow, Alessandra Bearz, JoAnn Shapiro, Uwe Phillip Strauss, Camillo Porta
      Abstract: ObjectiveTo assess the efficacy and safety of sorafenib dose escalation in metastatic renal cell carcinoma (mRCC).Patients and MethodsIntra-patient dose escalation may enhance the clinical benefit of targeted anticancer agents in metastatic disease. In this non-randomised, open-label, Phase 2b study, treatment-naïve patients with mRCC were initially treated with the standard oral sorafenib dose [400 mg twice daily (BID)]. Two dose escalations were planned, each 200 mg BID after 28 days at the prior level. Dose reductions, interruptions, or delayed escalations were used to manage adverse events (AEs). The primary endpoint was objective response rate (ORR) in the modified intent-to-treat (mITT) population, which comprised patients with ≥6 months of treatment including ≥4 months of therapy at their highest tolerated dose. Secondary endpoints included progression-free survival (PFS) and safety.ResultsIn all, 83 patients received sorafenib. The dose received for the longest duration was 400, 600, and 800 mg BID in 48.2%, 15.7%, and 24.1% of patients, respectively. The ORR was 44.4% [n = 8/18; 95% confidence interval (CI) 21.5–69.2] and 17.9% (n = 12/67; 95% CI 9.6–29.2) in the mITT and ITT populations, respectively. The median (95% CI) PFS was 7.4 (6.0–11.7) months (ITT). The most common AEs of any grade were hand–foot skin reaction (66.3%) and diarrhoea (63.9%).ConclusionSorafenib demonstrated clinical benefit in treatment-naïve patients with mRCC. However, relatively few patients could sustain doses of>400 mg BID. There was evidence that, where tolerated, escalation from the standard sorafenib dose may have enhanced clinical benefit. However, this study does not support dose escalation for most patients with treatment-naïve mRCC. Alternative protocols for sorafenib dose escalation could be explored.
      PubDate: 2017-01-09T10:20:28.421181-05:
      DOI: 10.1111/bju.13740
  • Development and external validation of a biopsy-derived nomogram to
           predict risk of ipsilateral extraprostatic extension
    • Authors: Rashid Sayyid; Nathan Perlis, Ardalanejaz Ahmad, Andrew Evans, Ants Toi, Michael Horrigan, Antonio Finelli, Alexandre Zlotta, Girish Kulkarni, Robert Hamilton, Christopher Morash, Neil Fleshner
      Abstract: ObjectivesTo develop and externally validate a nomogram that predicts risk of side-specific extraprostatic extension (EPE) at time of surgery, using commonly available preoperative markers.Materials and MethodsA consecutive sample of 753 men treated by radical prostatectomy (RP) at the University Health Network, Toronto, between 2009 and 2015, was used to develop the nomogram. The validation cohort consisted of 311 men treated by RP at Ottawa Hospital Research Institute, between 1992 and 2014. The study outcome was presence of ipsilateral EPE. The association between predictors considered and EPE was tested using univariate and multivariate logistic regression analyses. The predictive accuracy of the nomogram was determined using the area under the receiver-operating characteristic curve.ResultsThe overall rate of EPE was 19.8% of all lobes in the developmental cohort and 28.9% in the validation cohort. Significant variables in the models were age, prostate-specific antigen and ipsilateral Gleason score, percentage of positive cores and highest core involvement (all P < 0.05). The nomogram predicting risk of EPE had a predictive accuracy of 0.74 in the external validation cohort.ConclusionWe developed and externally validated a nomogram that predicts the risk of ipsilateral EPE based on commonly used preoperative markers. This nomogram may be used to assist surgical decision-making prior to RP.
      PubDate: 2017-01-06T05:00:32.614376-05:
      DOI: 10.1111/bju.13733
  • Clinical impact of 68Ga-prostate-specific membrane antigen (PSMA) positron
           emission tomography/computed tomography (PET/CT) in patients with prostate
           cancer with rising prostate-specific antigen after treatment with curative
           intent: preliminary analysis of a multidisciplinary approach
    • Authors: Simone Albisinni; Carlos Artigas, Fouad Aoun, Ibrahim Biaou, Julien Grosman, Thierry Gil, Eric Hawaux, Ksenija Limani, Francois-Xavier Otte, Alexandre Peltier, Spyridon Sideris, Nicolas Sirtaine, Patrick Flamen, Roland Velthoven
      Abstract: ObjectiveTo assess the impact of a novel molecular imaging technique, 68Ga-(HBED-CC)-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), in the clinical management of patients with prostate cancer with rising prostate-specific antigen (PSA) after treatment with curative intent.Patients and MethodsIn all, 131 consecutive patients were referred to our centre for a 68Ga-PSMA PET/CT in the setting of recurring prostate cancer. Of these patients, 11/131(8%) presented with persistent PSA after radical prostatectomy, while 120/131 (92%) were referred for biochemical recurrence after surgery, radiotherapy or both. The images where taken 1 h after injection of 2 MBq/kg of the 68Ga-(HBED-CC)-PSMA ligand. All examinations were interpreted by two experienced nuclear medicine specialists. Using the results of the examination, a multidisciplinary oncology committee (MOC) reported on the treatment strategy. A positive impact on clinical management was considered if the examination determined a modification in the treatment strategy compared to the MOC decision before PSMA imaging.ResultsAll patients completed the examination with no adverse reactions. The median (interquartile range) PSA level at the time of the examination was 2.2 (0.72–6.7) ng/mL. Overall, 68Ga-PSMA PET/CT detected at least one lesion suspicious for prostate cancer in 98/131 (75%) patients. There was an impact on subsequent management in 99/131 patients (76%). The main modifications included continuing surveillance (withholding hormonal therapy), hormonal manipulations, stereotaxic radiotherapy, salvage radiotherapy, salvage node dissection or salvage local treatment (prostatectomy, high-intensity focussed ultrasound).ConclusionOur preliminary experience suggests that performing 68Ga-PSMA PET/CT in patients with prostate cancer with rising PSA after treatment with curative intent can be clinically useful as it changes the treatment strategy in a significant proportion of patients. However, larger prospective trials are needed to validate our present findings.
      PubDate: 2017-01-04T02:30:22.415062-05:
      DOI: 10.1111/bju.13739
  • ‘ProtecTion’ from overtreatment: does a randomized trial finally
           answer the key question in localized prostate cancer'
    • Authors: Luke L. Wang; Christopher J.D. Wallis, Niranjan Sathianathen, Nathan Lawrentschuk, Declan G. Murphy, Robert Nam, Daniel Moon
      PubDate: 2017-01-04T02:25:47.066685-05:
      DOI: 10.1111/bju.13734
  • The BJUI's clinical trials initiative
    • Authors: John W. Davis; Graeme MacLennan
      Pages: 503 - 503
      PubDate: 2017-03-20T08:03:08.318305-05:
      DOI: 10.1111/bju.13837
  • Video endoscopic inguinal lymphadenectomy (VEIL): is a new standard ready
           to be accepted?
    • Authors: Marcos Tobias-Machado
      Pages: 504 - 505
      PubDate: 2017-03-20T08:03:04.999061-05:
      DOI: 10.1111/bju.13723
  • Is minimally invasive inguinal node dissection the way forward?
    • Authors: Nick Watkin
      Pages: 505 - 506
      PubDate: 2017-03-20T08:03:07.892541-05:
      DOI: 10.1111/bju.13761
  • An end to the phenomenon of ‘upgrading’ in early prostate
    • Authors: Mark Emberton
      Pages: 506 - 507
      PubDate: 2017-03-20T08:03:04.240417-05:
      DOI: 10.1111/bju.13671
  • Renal tumour biopsy: let's talk about it
    • Authors: Haider Rahbar; Craig Rogers
      Pages: 507 - 508
      PubDate: 2017-03-20T08:03:07.802039-05:
      DOI: 10.1111/bju.13696
  • Renal access during percutaneous nephrolithotomy: increasing value of
           ultrasonographic guidance for a safer and successful procedure
    • Authors: Kemal Sarica
      Pages: 509 - 510
      PubDate: 2017-03-20T08:03:07.326311-05:
      DOI: 10.1111/bju.13746
  • Touching the future: three-dimensional printing facilitates preoperative
           planning, realistic simulation and enhanced precision in robot-assisted
           laparoscopic partial nephrectomy
    • Authors: Nicolò Luyk; Benjamin Namdarian, Benjamin Challacombe
      Pages: 510 - 512
      PubDate: 2017-03-20T08:03:11.255534-05:
      DOI: 10.1111/bju.13800
  • Prostatic urethral lift vs transurethral resection of the prostate: 2-year
           results of the BPH6 prospective, multicentre, randomized study
    • Authors: Christian Gratzke; Neil Barber, Mark J. Speakman, Richard Berges, Ulrich Wetterauer, Damien Greene, Karl-Dietrich Sievert, Christopher R. Chapple, Jacob M. Patterson, Lasse Fahrenkrug, Martin Schoenthaler, Jens Sonksen
      Abstract: ObjectivesTo compare prostatic urethral lift (PUL) with transurethral resection of the prostate (TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception.Patients and MethodsA total of 80 patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia (BPH) were enrolled in a prospective, randomized, controlled, non-blinded study conducted at 10 European centres. 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, analysed and presented for the first time.ResultsSignificant improvements in International Prostate Symptom Score (IPSS), IPSS quality of life (QoL), BPH Impact Index (BPHII), and maximum urinary flow rate (Qmax) were observed in both arms throughout the 2-year follow up. Change in IPSS and Qmax in the TURP arm were superior to the PUL arm. Improvements in IPSS QoL and BPHII score were not statistically different between the study arms. PUL resulted in superior quality of recovery, ejaculatory function preservation and performance on the composite BPH6 index. Ejaculatory function bother scores did not change significantly in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep.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.
      PubDate: 2016-12-21T21:38:56.04767-05:0
      DOI: 10.1111/bju.13714
  • Management of non-visualization 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 during dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0), and to develop an algorithm for the management of patients in which non-visualization 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-visualization of sentinel nodes in this cohort were identified from a penile cancer database. The management of the inguinal lymph nodes after non-visualization and the oncological outcomes including local and regional recurrence rates were documented.ResultsOut of 166 consecutive patients undergoing DSNB, 20 patients (12%) had unilateral non-visualization after injection of intradermal 99mTc. Of these 20 patients, seven underwent repeat DSNB at a later date, with six having successful visualization. One patient had persistent non-visualization 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 ≥G2 T1 disease should ideally have bilateral visualization of the sentinel lymph nodes, reflecting the drainage pattern from the primary tumour. In the present series, 12% of patients were found to have unilateral non-visualization after DSNB. Among patients offered a repeat DSNB at a later date, localizing the sentinel node was successful in 86% of cases. Patients with favourable histological characteristics can be placed on clinical surveillance. Those with high-risk disease can be offered a repeat DSNB procedure on the proviso that SML may be carried out if there is repeated non-visualization. Larger cohorts are required to validate this proposed algorithm.
      PubDate: 2016-12-21T21:38:48.939727-05:
      DOI: 10.1111/bju.13680
  • Introduction of robot-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: ObjectivesTo describe the implementation phase of a robot-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS).Patients and MethodsIn all, 114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 [ileal conduit (97 patients) and orthotopic neobladder (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 enhanced recovery 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. The mean operating time was 3–5 h with an overall transfusion rate of 8.8%. There were higher-grade complications (Clavien–Dindo grade III–IV) in 18.4% of patients, with a 30-day mortality rate of 0.9%. The median (range) LOS after RARC was 7 (3–68) days, with a re-admission rate of 18.4%.ConclusionsThe present series shows that RARC can be safely implemented in a unit experienced in robot-assisted surgery (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 open RC, and despite the fact that complication rate is 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 maximise the benefits of minimally invasive surgery.
      PubDate: 2016-12-21T01:00:23.567809-05:
      DOI: 10.1111/bju.13702
  • Multicentre evaluation of targeted and systematic biopsies using magnetic
           resonance and ultrasound image-fusion guided transperineal prostate biopsy
           in patients with a previous negative biopsy
    • Authors: Nienke L. Hansen; Claudia Kesch, Tristan Barrett, Brendan Koo, Jan P. Radtke, David Bonekamp, Heinz-Peter Schlemmer, Anne Y. Warren, Kathrin Wieczorek, Markus Hohenfellner, Christof Kastner, Boris Hadaschik
      Abstract: ObjectivesTo evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres.Patients and MethodsA two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7–10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.ResultsThe median (interquartile range) PSA level was 9.0 (6.7–13.4) ng/mL. PI-RADS 3–5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7–10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7–10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1–2 was 0.92 (±0.04) for Gleason score 7–10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7–10 cancers. In patients with suspicious lesions (PI-RADS 4–5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7–10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846.ConclusionIn patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7–10 cancer still required combined targeted and systematic MRI/US 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 mpMRI read by experienced radiologists.
      PubDate: 2016-12-21T00:35:27.781165-05:
      DOI: 10.1111/bju.13711
  • Utility of patient-specific silicone renal models for planning and
           rehearsal of complex tumour resections prior to robot-assisted
           laparoscopic partial nephrectomy
    • Authors: Friedrich-Carl Rundstedt; Jason M. Scovell, Smriti Agrawal, Jacques Zaneveld, Richard E. Link
      Abstract: ObjectiveTo describe our experience using patient-specific tissue-like kidney models created with advanced three-dimensional (3D)-printing technology for preoperative planning and surgical rehearsal prior to robot-assisted laparoscopic partial nephrectomy (RALPN).Patients and MethodsA feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D-print kidney models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction, we generated pre-surgical models using a silicone-based material. All surgical rehearsals were performed using the da Vinci® robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) before the actual procedure. To determine construct validity, we compared resection times between the model and actual tumour in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumour volume resected for each model and patient tumour.ResultsWe generated patient-specific models for 10 patients with complex tumour anatomy. R.E.N.A.L. nephrometry scores were between 7 and 11, with a mean maximal tumour diameter of 40.6 mm. The mean resection times between model and patient (6:58 vs 8:22 min, P = 0.162) and tumour volumes between the computer model, excised model, and excised tumour (38.88 vs 38.50 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: 2016-12-10T09:35:48.392388-05:
      DOI: 10.1111/bju.13712
  • 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 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. Patients received placebo or desmopressin orally disintegrating tablet (ODT; 10–100 μg). The incidence of serum sodium
      PubDate: 2016-12-10T09:35:25.473078-05:
      DOI: 10.1111/bju.13718
  • Competency based training in robotic surgery: benchmark scores for virtual
           reality robotic simulation
    • Authors: Nicholas Raison; Kamran Ahmed, Nicola Fossati, Nicolò Buffi, Alexandre Mottrie, Prokar Dasgupta, Henk Van 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 nine European Association of Urology hands-on-training courses in VR simulation. In all, 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 performance 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 did not achieve 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.
      PubDate: 2016-12-09T07:28:17.39687-05:0
      DOI: 10.1111/bju.13710
  • Management and outcomes of patients with renal medullary carcinoma: a
           multicentre 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 characterise 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 in 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.ResultsIn all, 52 patients (37 males) were identified. The median (range) age at diagnosis was 28 (9–48) years and 49 patients (94%) had stage III/IV. The median OS for all patients was 13.0 months and 38 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 < 0.001). In all, 45 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 for>24 months.ConclusionsRMC carries a poor prognosis. Chemotherapy provides palliation and remains the mainstay of therapy, but 24 months, underscoring the need to develop more effective therapy for this rare tumour. In this study, nephrectomy was associated with improved OS.
      PubDate: 2016-12-09T07:26:05.928032-05:
      DOI: 10.1111/bju.13705
  • 11C-acetate positron-emission tomography/computed tomography imaging for
           detection of recurrent disease after radical prostatectomy or radiotherapy
           in patients with prostate cancer
    • Authors: Lukas Hendrik Esch; Melanie Fahlbusch, Peter Albers, Hubertus Hautzel, Volker Müller-Mattheis
      Abstract: ObjectivesTo evaluate, in a prospective study, the effectiveness of computed tomography (CT)-matched 11C-acetate (AC) positron-emission tomography (PET) in patients with prostate cancer (PCa) who had prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or radiotherapy (RT).Patients and MethodsIn 103 relapsing patients after RP (n = 97) or RT (n = 6) AC-PET images and CT scans were obtained. In patients with AC-PET-positive results with localized PCa 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.ResultsOf 103 patients, 42 were AC-PET-positive. PSA levels were
      PubDate: 2016-12-05T03:17:27.745394-05:
      DOI: 10.1111/bju.13706
  • Value of 111In-prostate-specific membrane antigen (PSMA)-radioguided
           surgery for salvage lymphadenectomy in recurrent prostate cancer:
           correlation with histopathology and clinical follow-up
    • Authors: Isabel Rauscher; Charlotte Düwel, Martina Wirtz, Margret Schottelius, Hans-Jürgen Wester, Kristina Schwamborn, Bernhard Haller, Markus Schwaiger, Jürgen E. Gschwend, Matthias Eiber, Tobias Maurer
      Abstract: ObjectivesTo evaluate the use of 111In-labelled prostate-specific membrane antigen (PSMA)-I&T-based radioguided surgery (111In-PSMA-RGS) for salvage surgery in recurrent prostate cancer (PCa) using comparison of intra-operative gamma probe measurements with histopathological results of dissected specimens. In addition, to determine the success of 111In-PSMA-RGS with regard to postoperative prostate-specific antigen (PSA) responses, PCa-specific treatment-free survival rates and postoperative complication rates.Patients and MethodsA total of 31 consecutive patients with localized recurrent PCa undergoing salvage surgery with PSMA-targeted radioguided surgery using a 111In-labelled PSMA ligand between April 2014 and July 2015 were retrospectively included in this study. The preoperative (interquartile range; range) median PSA level was 1.3 (0.57–2.53 ng/mL; 0.2–13.9 ng/mL). Results of ex vivo radioactivity rating (positive vs negative) of resected tissue specimens were compared with findings of postoperative histological analysis. Best PSA response without additional treatment was determined after 111In-PSMA-RGS, and salvage-surgery-related postoperative complications and PCa-specific additional treatments were recorded.ResultsIn 30/31 patients, 111In-PSMA-RGS allowed intra-operative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. According to 111In-PSMA-RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer-free, four were false-negative and six were false-positive compared with histological evaluation. Follow-up information was available for 30/31 patients. PSA declines of>50% and>90% were observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to
      PubDate: 2016-12-04T21:46:14.838242-05:
      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 undergoing active surveillance (AS) for localized prostate cancer (PCa) with regard to possible differences in discontinuation rates, subsequent therapies, reasons for intervention and pathological findings after deferred surgery after patient stratification into very-low-risk, low-risk and intermediate-/high-risk PCa groups.Patients and MethodsThe HAROW study was a non-interventional, observational, outcomes research study on the management of localized PCa in the community setting. A total of 468 patients were prospectively enrolled in the HAROW study, with a mean follow-up of 28.5 months. Treating urologists reported clinical variables, information on therapy and clinical course of disease at 6-month intervals.ResultsOf 468 patients under AS, 244 were stratified into very-low-risk, 142 into low-risk and 82 into intermediate-/high-risk groups. Of these patients, 112 discontinued AS. Discontinuation rates were 25.4% in the very-low-risk, 21.1% in the low-risk and 24.4% in the intermediate-/high-risk groups (P = 0.633). The main reasons for intervention were biopsy upgrade and/or prostate-specific antigen elevation in the very-low- and low-risk groups, and patient preference in the intermediate-/high-risk group (P < 0.05). No significant differences were found regarding subsequent therapies and pathological findings after deferred surgery.ConclusionOur results show no differences in the outcome of risk-stratified patients in the specified risk groups managed with AS, while switching to an invasive treatment on the patient′s request was more frequent in the intermediate-/high-risk group.
      PubDate: 2016-12-04T21:46:04.83282-05:0
      DOI: 10.1111/bju.13715
  • Radio-guided sentinel lymph node detection and lymph node mapping in
           invasive urinary bladder cancer: a prospective clinical study
    • Authors: Firas Aljabery; Ivan Shabo, Hans Olsson, Oliver Gimm, Staffan Jahnson
      Abstract: ObjectivesTo investigate the possibility of detecting sentinel lymph nodes (SNs) in patients with urinary bladder cancer (BCa) intra-operatively and whether the histopathological status of the identified SNs reflected that of the lymphatic field.Patients and MethodsWe studied 103 patients with BCa 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 and blue dye were injected into the bladder wall around the primary tumour before surgery. SNs were detected ex vivo during the operation with a handheld Geiger probe (Gamma Detection System; Neoprobe Corp., Dublin, OH, USA). All LNs were formalin-fixed, sectioned three times, mounted on slides and stained with haematoxylin and eosin. An experienced uropathologist 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 (range) number of 31 (7–68) nodes per patient were examined, totalling 3 253 nodes. LN metastases were found in 41 patients (40%). SNs were detected in 83 of the 103 patients (80%). Sensitivity and specificity for detecting metastatic disease by SN biopsy (SNB) varied between LN stations, with average values of 67% and 90%, respectively. LN metastatic density (LNMD) had a significant prognostic impact; a value of ≥8% was significantly related to shorter survival. Lymphovascular invasion (LVI) occurred in 65% of patients (n = 67) and was significantly associated with shorter cancer-specific survival (P < 0.001).ConclusionWe conclude that SNB is not a reliable technique for peri-operative localization of LN metastases during cystectomy for BCa; however, LNMD has a significant prognostic value in BCa and may be useful in the clinical context and in BCa oncological and surgical research. LVI was also found to be a prognostic factor.
      PubDate: 2016-12-04T21:41:45.510744-05:
      DOI: 10.1111/bju.13700
  • 36-month data for the AdVance XP® male sling: results of a
           prospective multicentre 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: ObjectivesTo evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence (SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape.Patients and MethodsIn all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of 50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test.ResultsThe mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g (P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g (P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred.ConclusionThe AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months.
      PubDate: 2016-12-02T03:31:12.714689-05:
      DOI: 10.1111/bju.13704
  • A prospective and randomised 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 guidance (FG), total ultrasonographic guidance (USG), and combined ultrasonographic and fluoroscopic guidance (CG) for percutaneous renal access in mini-percutaneous nephrolithotomy (mini-PCNL).Patients and methodsThe present study was conducted between July 2014 and May 2015 as a prospective randomised trial at the First Affiliated Hospital of Guangzhou Medical University. In all, 450 consecutive patients with renal stones of>2 cm were randomised to undergo FG, USG, or CG mini-PCNL (150 patients for each group). The primary endpoints were the stone-free rate (SFR) and blood loss (haemoglobin decrease during the operation and transfusion rate). Secondary endpoints included access failure rate, operating 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, FG and CG achieved significantly better SFRs than USG (one-session SFR 85.1% vs 88.5% vs 66.7%, P = 0.006; overall SFR at 3 months postoperatively 89.4% vs 90.2% vs 69.8%, P = 0.002). Multiple-tracts mini-PCNL was used more frequently in the FG and CG groups than in the USG group (20.7% vs 17.1% vs 9.5%, P = 0.028). The mean total radiation exposure time was significantly greater for FG than for CG (47.5 vs 17.9 s, P < 0.001). The USG had zero radiation exposure. There was no significant difference in the haemoglobin decrease, transfusion rate, access failure rate, operating time, nephrostomy drainage time, and hospital stay among the groups. The overall operative complication rates using the Clavien–Dindo grading system were similar between the groups.ConclusionsMini-PCNL under USG is as safe and effective as FG or CG in the treatment of simple kidney stones (S.T.O.N.E. scores 5–6) but with no radiation exposure. FG or CG is more effective for patients with S.T.O.N.E. scores of 7–8, where multiple percutaneous tracts may be necessary.
      PubDate: 2016-11-28T10:10:30.109538-05:
      DOI: 10.1111/bju.13703
  • Robot-assisted 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 peri-operative outcomes of 250 consecutive cases beyond the initial learning curve (LC) of robot-assisted partial nephrectomy (RAPN) among multiple surgeons.Patients and MethodsA multi-institutional database was used to evaluate trends in patient demographics (e.g. age, gender, comorbidities), tumour characteristics (e.g. size, complexity) and peri-operative outcomes (e.g. warm ischaemia time [WIT], operating time, complications, estimated blood loss [EBL], trifecta achievement) 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 tumour-specific variables. Outcomes for cases 50–99 were compared with those for cases 250–300.ResultsIn the study period RAPN was increasingly performed in patients with larger tumours (β = 0.001, P = 0.048), hypertension (odds ratio [OR] 1.003; P = 0.008) diabetes (OR 1.003; P = 0.025) and previous abdominal surgery (OR 1.003; P = 0.006). Surgeon experience was associated with more trifecta achievement (OR 1.006; P < 0.001), shorter WIT (β = −0.036, P < 0.001), less EBL (β = −0.154, P = 0.009), fewer blood transfusions (OR 0.989, P = 0.024) and a reduced length of hospital stay (β = −0.002, P = 0.002), but not with operating time (P = 0.243), complications (P = 0.587) or surgical margin status (P = 0.102). Tumour size and WIT in cases 50–99 vs 250–300 were 2.7 vs 3.2 cm (P = 0.001) and 21.4 vs 16.2 min (P < 0.001), respectively.ConclusionRefinement of RAPN outcomes, concomitant with the treatment of a patient population with larger tumours and more comorbidities, occurs after the initial LC is reached. Although RAPN can consistently be performed safely with acceptable outcomes after a small number of cases, improvement in trifecta achievement, WIT, EBL, blood transfusions and a shorter hospitalization continues to occur up to 300 procedures.
      PubDate: 2016-11-28T10:10:27.62575-05:0
      DOI: 10.1111/bju.13709
  • Prostate Health Index 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. 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 multicentre US study.Materials and MethodsThe study population included 728 men, with prostate-specific antigen (PSA) levels of 2–10 ng/mL and a 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 (the Prostate Cancer Prevention Trial [PCPT] and European Randomised Study of Screening for Prostate Cancer [ERSPC] risk calculators). 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. The 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, previous biopsy, prostate volume, PSA and PHI, with an area under the curve 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.
      PubDate: 2016-11-22T06:43:30.305596-05:
      DOI: 10.1111/bju.13676
  • Adjuvant radiation therapy is associated with better oncological outcome
           compared with 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, Rudolf Schwarz, Cordula Petersen, Markus Graefen, Sascha Ahyai
      Abstract: ObjectiveTo analyse the comparative effectiveness of no treatment (NT) or salvage radiation therapy (sRT) at biochemical recurrence (BCR) vs adjuvant radiation therapy (aRT) in patients with lymph node (LN)-positive prostate cancer (PCa) after radical prostatectomy (RP).Patients and MethodsA total of 773 patients with LN-positive PCa at RP, with or without additional radiation therapy (RT), in the period 2005–2013, were retrospectively analysed. Cox regression analysis was used to assess factors influencing BCR and metastasis-free survival (MFS). Propensity score-matched analyses were performed.ResultsThe median follow-up for the entire patient group was 33.8 months. Four-year BCR-free and MFS rates were 43.3% and 86.6%, respectively, for all patients. In multivariate analysis, NT/sRT (n = 505) was an independent risk factor for BCR and metastasis compared with aRT (n = 213). The superiority of aRT was confirmed after propensity score matching. The 4-year MFS in the matched cohort was 82.5% vs 91.8% for the NT/sRT and aRT groups, respectively (P = 0.02). Early sRT (pre-RT prostate-specific antigen [PSA] ≤0.5 ng/mL) compared with sRT at PSA>0.5 ng/mL was significantly associated with a lower risk of metastasis.ConclusionPatients with LN-positive PCa who received aRT had a significantly better oncological outcome than patients with NT/sRT, independent of tumour characteristics. Patients with early sRT had higher rates of response and better MFS than patients with pre-RT PSA>0.5 ng/mL.
      PubDate: 2016-11-21T01:30:28.001707-05:
      DOI: 10.1111/bju.13679
  • 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
  • Diagnosis and long-term outcome of renal cysts after laparoscopic partial
           nephrectomy in children
    • Authors: Ciro Esposito; Maria Escolino, Bernardita Troncoso Solar, Roberta Iacona, Rosanna Esposito, Alessandro Settimi, Imran Mushtaq
      Abstract: ObjectiveTo document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions following LPN.Patients and MethodsWe reviewed the ultrasonography (US) imaging reports performed during the follow-up of 125 children (77 girls, 48 boys; mean age 3.2 years) who underwent LPN in two centres of paediatric surgery in the period 2005–2015.ResultsA transperitoneal approach was adopted in 83 children and a retroperitoneal approach in 42. The mean 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 eight of the 61 cysts appeared septated. The mean diameter of the cysts was 3.3 × 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after a mean of 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size, and only five of the 61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 children (83.6%), while they were associated with urinary tract infections (UTIs) and abdominal pain in the remaining 10; none required a re-intervention.ConclusionsThe US finding of a simple cyst at the operative site after LPN is common during follow-up, with an incidence of ~50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There was no correlation between cyst formation and type of surgical technique adopted. As there was no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodic US evaluations.
      PubDate: 2016-11-14T21:45:26.9796-05:00
      DOI: 10.1111/bju.13698
  • Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting
           treatments in addition to chemotherapy in patients with metastatic
           castrate-refractory prostate cancer: results from the TRAPEZE trial
           (ISRCTN 12808747)
    • Authors: Lazaros Andronis; Ilias Goranitis, Sarah Pirrie, Ann Pope, Darren Barton, Stuart Collins, Adam Daunton, Duncan McLaren, Joe M. O'Sullivan, Chris Parker, Emilio Porfiri, John Staffurth, Andrew Stanley, James Wylie, Sharon Beesley, Alison Birtle, Janet E. Brown, Prabir Chakraborti, Syed A. Hussain, J. Martin Russell, Lucinda J. Billingham, Nicholas D. James
      Pages: 522 - 529
      Abstract: ObjectiveTo evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).Patients and methodsData on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.ResultsThe per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.ConclusionsThe addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
      PubDate: 2016-07-10T21:35:43.310527-05:
      DOI: 10.1111/bju.13549
  • Prospective study comparing video-endoscopic radical inguinal lymph node
           dissection (VEILND) with open radical ILND (OILND) for penile cancer over
           an 8-year period
    • Authors: Vivekanandan Kumar; K. Krishna Sethia
      Pages: 530 - 534
      Abstract: ObjectiveTo compare the complications and oncological outcomes between video-endoscopic inguinal lymph node dissection (VEILND) and open ILND (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 ILND between 2008 and 2015 in a centre for treating penile cancer. Before 2013 all procedures were OILNDs. Since 2013 we have performed VEILND on all patients in need of ILND. The wound-related and non-wound-related complications, length of stay, and oncological safety between OILND and VEILND groups were compared. The mean duration of follow-up was 71 months for OILND and 16 months for the VEILND groups.ResultsIn the study period 42 patients underwent 68 ILNDs (OILND 35, VEILND 33). The patients’ demographics, primary stage and grade, and indications were comparable in both groups. There were no intraoperative complications in either group. The wound complication rate was significantly lower in the VEILND group at 6% compared to 68% in the OILND group. Lymphocoele rates were similar in both the groups (27% and 20%). The VEILND group had a better or the same lymph node yield, mean number of positive lymph nodes, and lymph node density confirming oncological safety. There were no groin recurrences in either group of patients. VEILND significantly reduced the mean length of stay by 4.8 days (P < 0.001).ConclusionVEILND is an oncologically safe procedure with considerably low morbidity and reduced length of stay, at a mean (range) follow-up of 16 (4–35) months.
      PubDate: 2016-10-11T03:05:54.895596-05:
      DOI: 10.1111/bju.13660
  • Value of 3-Tesla 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
      Pages: 535 - 542
      Abstract: ObjectiveTo evaluate the role of multiparametric magnetic resonance imaging (mpMRI) of the prostate and transrectal ultrasonography guided biopsy (TRUS-Bx) with visual estimation in early risk stratification of patients with prostate cancer on active surveillance (AS).Patients and MethodsPatients with low-risk, low-grade, localised prostate cancer were prospectively enrolled and submitted to a 3-T 16-channel cardiac surface coil mpMRI of the prostate and confirmatory biopsy (CBx), which included a standard biopsy (SBx) and visual estimation-guided TRUS-Bx. Cancer-suspicious regions were defined using Prostate Imaging Reporting and Data System (PI-RADS) scores. Reclassification occurred if CBx 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 CBx results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, prostate-specific antigen (PSA) level, PSA density (PSAD), number of positive cores in the initial biopsy, and mpMRI grade on CBx reclassification. Our report is consistent with the Standards of Reporting for MRI-targeted Biopsy Studies (START) guidelines.ResultsIn all, 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, and negative predictive value 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 < 0.05). In the cross-tabulation, SBx would have missed 15 significant cases detected by targeted biopsy, but SBx did detect five cases of significant cancer not detected by targeted biopsy alone.ConclusionMultiparametric magnetic resonance imaging is a significant tool for predicting cancer severity reclassification on CBx among AS candidates. The reclassification rate on CBx is particularly high in the group of patients who have PI-RADS grades 4 or 5 lesions. Despite the usefulness of visual-guided biopsy, it still remains highly recommended to retrieve standard fragments during CBx in order to avoid missing significant tumours.
      PubDate: 2016-09-03T22:20:25.78864-05:0
      DOI: 10.1111/bju.13624
  • Safety, reliability and accuracy of small renal tumour biopsies: results
           from 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
      Pages: 543 - 549
      Abstract: ObjectiveTo validate, in a multi-institution review, the safety, accuracy and reliability of renal tumour biopsy (RTB) and its role in decreasing unnecessary treatment.Materials and MethodsWe conducted a multi-institution retrospective study of patients who underwent RTB to characterize a small renal mass (SRM) between 2011 and May 2015. Patients were identified using the prospectively maintained Canadian Kidney Cancer information system. 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 non-diagnostic biopsies, 15 had a repeat biopsy of which, 80% were diagnostic. When both were combined, therefore, 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 tumours (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
  • Comparison of prostate cancer survival in Germany and the USA: can
           differences be attributed to differences in stage distributions?
    • Authors: Alexander Winter; Eunice Sirri, Lina Jansen, Friedhelm Wawroschek, Joachim Kieschke, Felipe A. Castro, Agne Krilaviciute, Bernd Holleczek, Katharina Emrich, Annika Waldmann, Hermann Brenner,
      Pages: 550 - 559
      Abstract: ObjectivesTo better understand the influence of prostate-specific antigen (PSA) screening and other health system determinants on prognosis of prostate cancer, up-to-date relative survival (RS), stage distributions, and trends in survival and incidence in Germany were evaluated and compared with the United States of America (USA).Patients and MethodsIncidence and mortality rates for Germany and the USA for the period 1999–2010 were obtained from the Centre for Cancer Registry Data at the Robert Koch Institute and the USA Surveillance Epidemiology and End Results (SEER) database. For analyses on stage and survival, data from 12 population-based cancer registries in Germany and from the SEER-13 database were analysed. Patients (aged ≥ 15 years) diagnosed with prostate cancer (1997–2010) and mortality follow-up to December 2010 were included. The 5- and 10-year RS and survival trends (2002–2010) were calculated using standard and model-based period analysis.ResultsBetween 1999 and 2010, prostate cancer incidence decreased in the USA but increased in Germany. Nevertheless, incidence remained higher in the USA throughout the study period (99.8 vs 76.0 per 100,000 in 2010). The proportion of localised disease significantly increased from 51.9% (1998–2000) to 69.6% (2007–2010) in Germany and from 80.5% (1998–2000) to 82.6% (2007–2010) in the USA. Mortality slightly decreased in both countries (1999–2010). Overall, 5- and 10-year RS was lower in Germany (93.3%; 90.7%) than in the USA (99.4%; 99.6%) but comparable after adjustment for stage. The same patterns were seen in age-specific analyses. Improvements seen in prostate cancer survival between 2002–2004 and 2008–2010 (5-year RS: 87.4% and 91.2%; +3.8% units) in Germany disappeared after adjustment for stage (P = 0.8).ConclusionThe survival increase in Germany and the survival advantage in the USA might be explained by differences in incidence and stage distributions over time and across countries. Effects of early detection or a lead-time bias due to the more widespread utilisation and earlier introduction of PSA testing in the USA are likely to explain the observed patterns.
      PubDate: 2016-06-20T22:15:29.288835-05:
      DOI: 10.1111/bju.13537
  • Estimating the risks and benefits of active surveillance protocols for
           prostate cancer: a microsimulation study
    • Authors: Tiago M. Carvalho; Eveline A.M. Heijnsdijk, Harry J. Koning
      Pages: 560 - 566
      Abstract: ObjectiveTo estimate the increase in prostate cancer mortality (PCM) and the reduction in overtreatment resulting from different active surveillance (AS) protocols, compared with treating men immediately.Patients and MethodsWe used a microsimulation model (MISCAN-Prostate), with the natural history of prostate cancer based on European Randomized Study of Screening for Prostate Cancer data. We estimated the probabilities of referral to radical treatment while on AS, depending on disease stage, using data from the Johns Hopkins AS cohort. We sampled 10 million men, representative of the US population, and projected the effects of applying AS protocols that differed by time between biopsies and compared these with the effects of treating men immediately.ResultsWe found that AS with yearly follow-up biopsies for men with low-risk prostate cancer (≤ T2a stage and Gleason 6) increases the probability of PCM to 2.6% (1% increase) and reduces overtreatment from 2.5 to 2.1% (18.4% reduction). With biopsies every 3 years after the first year, PCM increases by 2.3% and overtreatment reduces from 2.5 to 1.9% (30.3% reduction). The inclusion of men in the intermediate-risk group (> T2a stage or Gleason 3+4) in AS protocols increases PCM by 2.7% and reduces overtreatment from 2.5 to 2.0% (23.1% reduction). These results may not apply to African-American men.ConclusionsOffering AS to men with low-risk prostate cancer is relatively safe. Increasing the biopsy interval from yearly to up to every 3 years after the first year will significantly reduce overtreatment among men in the low-risk group, with limited PCM risk.
      PubDate: 2016-06-26T21:45:25.52178-05:0
      DOI: 10.1111/bju.13542
  • 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
      Pages: 567 - 572
      Abstract: ObjectiveTo evaluate the significance of routinely reported ‘equivocal’ lymphovascular invasion (LVI) in prostatectomy specimens of patients with clinically localized prostate cancer.Materials and MethodsProspectively collected data from men who underwent prostatectomy for clinically localized prostate cancer were retrospectively reviewed. Rates of adverse pathological features and biochemical recurrence (BCR) were compared between tumours positive, negative or ‘equivocal’ for LVI. Multivariable Cox regression analysis was performed to identify independent predictors of BCR.ResultsOf 1 310 consecutive cases, LVI was present definitively in 82 (6.3%) and equivocally in 43 (3.3%) cases. Similar to definitive LVI, equivocal LVI was significantly associated with other adverse pathological features, including advanced stage, higher Gleason grade and positive surgical margins. BCR occurred more frequently in patients with tumours that were equivocal (61%) or positive for LVI (71%) than in patients with negative results (14.7%). In addition, patients with both definitive and equivocal LVI had a significantly shorter BCR-free survival time compared with those with negative LVI. Multivariable Cox regression analysis indicated that the presence of either definitive or equivocal LVI were independent predictors of disease recurrence (hazard ratio [HR] 3.32, 95% confidence interval [CI] 2.3–4.8; P
      PubDate: 2016-08-31T22:20:29.2681-05:00
      DOI: 10.1111/bju.13594
  • Outcomes in patients with advanced urothelial carcinoma after
           discontinuation of programmed death (PD)-1 or PD ligand 1 inhibitor
    • Authors: Guru Sonpavde; Gregory R. Pond, Stephanie Mullane, Ana A. Ramirez, Nicholas J. Vogelzang, Andrea Necchi, Thomas Powles, Joaquim Bellmunt
      Pages: 579 - 584
      Abstract: ObjectiveTo study the subsequent therapy and disease outcomes of patients with advanced urothelial carcinoma (UC) after discontinuation of programmed death-1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors.Patients and MethodsWe performed a retrospective analysis to examine outcomes and systemic therapy administration after PD-1/PD-L1 inhibitor therapy in patients with advanced UC. Data on demographics and therapy administered were collected from the institutions involved in the study. Univariable Cox regression analyses were performed to examine the clinical factors potentially associated with overall survival (OS) after PD-1/PD-L1 inhibitor therapy.ResultsData from 62 patients were available from four institutions, with capture of subsequent therapy and outcomes after checkpoint inhibitor immunotherapy. The median patient age was 65.5 years and 51 patients (82.3%) were male. The median (range) duration of PD-1/PD-L1 inhibitor therapy in 55 patients for whom these data were available was 64 (7–669) days. Of these, 22 patients (35.5%) received post-PD-1/PD-L1 inhibitor therapy through a variety of different chemotherapy regimens (n = 16), chemobiological combination (n = 1), biological agents (n = 4) and immunotherapy (n = 1). The median (range) time from last PD-1/PD-L1 inhibitor therapy to subsequent therapy was 58 (14–242) days. The median OS of all patients after completion of PD-1/PD-L1 inhibitor therapy was 149 days (95% confidence interval [CI]: 75–359). Among those who received some post-PD-1/PD-L1 inhibitor therapy, the median OS was 182 days (95% CI: 121–372), and the median time to progression was 124 days (95% CI: 61–273) from the start of post-PD-1/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 after salvage therapy with PD-1/PD-L1 inhibitors. Outcomes after subsequent therapy appear similar to those historically observed in patients who had not received prior PD-1/PD-L1 inhibitor therapy. Further study of patients receiving post-PD-1/PD-L1 inhibitor therapy is warranted to identify factors associated with outcomes and potentially synergistic sequences.
      PubDate: 2016-10-26T11:10:26.558152-05:
      DOI: 10.1111/bju.13674
  • Urinary collecting system invasion is associated with poor survival in
           patients with clear-cell renal cell carcinoma
    • 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
      Pages: 585 - 590
      Abstract: ObjectivesTo evaluate the prognostic significance of urinary collecting system invasion (UCSI) in a large series of patients with clear-cell renal cell carcinoma (RCC).Materials and MethodsPatients with clear-cell RCC treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urological pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan–Meier method, and associations of UCSI with death from RCC were evaluated using Cox models.ResultsOf the 859 patients with clear-cell RCC, 58 (6.8%) had UCSI. At last follow-up, 310 patients had died from RCC at a median of 1.8 years after surgery. The median follow-up for patients alive at last follow-up was 8.2 years. The estimated cancer-specific survival at 10 years after surgery for patients with UCSI was 17%, compared with 60% for patients without UCSI (P < 0.001). In a multivariable model, UCSI remained independently associated with an increased risk of death from RCC (hazard ratio 1.5; P = 0.018). Further, among patients with pT3 RCC, those with USCI had survival outcomes similar to those of patients with pT4 RCC.ConclusionsCollecting system invasion is associated with poor prognosis among patients with clear-cell RCC. If validated, consideration should be given to including UCSI in future staging systems.
      PubDate: 2016-10-20T10:35:23.991745-05:
      DOI: 10.1111/bju.13669
  • Factors associated with regional recurrence after lymph node dissection
           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
      Pages: 591 - 597
      Abstract: ObjectiveTo identify factors associated with regional recurrence after lymph node dissection (LND) for squamous cell carcinoma (SCC) to determine which patients might benefit from adjuvant therapy.Patients and MethodsMen who underwent LND for penile SCC from 1977 to 2014 were identified from an institutional database. Kaplan–Meier curves estimated recurrence-free survival (RFS) calculated from the date of LND. Cox regression models evaluated the association between RFS and patient and tumour characteristics.ResultsIn all, 182 men who underwent LND for penile SCC were identified. The median patient age was 62 years and the median follow-up was 4.2 years. After LND 34 men had regional recurrence, of which 24 developed isolated regional recurrences without distant metastasis. The median RFS was 5.7 months, and the 3-year RFS rate was 70%. On univariate analysis, lymphovascular invasion, clinical and pathological nodal stage, pathological inguinal laterality, pelvic nodal involvement, lymph node density ≥5.2%, ≥3 pathologically involved lymph nodes, and extranodal extension (ENE) were associated with worse RFS (all P < 0.05). On multivariate analysis, clinical N3 disease [adjusted hazard ratio (AHR)] 3.53, 95% confidence interval (CI) 1.68–7.45; P = 0.001), ≥3 pathologically involved lymph nodes (AHR 3.78, 95% CI 2.12–6.65; P < 0.001), and ENE (AHR 3.32, 95% CI 1.93–5.76; P < 0.001) were associated with worse RFS. The 3-year RFS for patients with cN0, cN1, cN2, and cN3 disease was 91.7%, 64.5%, 54.7%, and 38.3%, respectively. For men with ≥3 involved nodes, the 3-year RFS was 17% vs 82.4% in men with
      PubDate: 2016-11-08T02:29:21.252496-05:
      DOI: 10.1111/bju.13686
  • Impact of suboptimal neoadjuvant chemotherapy on peri-operative outcomes
           and survival after robot-assisted radical cystectomy: a multicentre
           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
      Pages: 605 - 611
      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 among three 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
      PubDate: 2016-11-18T02:20:29.839414-05:
      DOI: 10.1111/bju.13678
  • 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
      Pages: 619 - 625
      Abstract: ObjectivesTo investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter (SUS) during voluntary activation using shear-wave elastography (SWE); to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. SUS); and to determine the relationship between muscle stiffness and contraction intensity.Subjects and MethodsIn all, 10 healthy men participated. A linear ultrasound (US) 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 SUS was estimated via US SWE 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 SUS 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 SUS contraction) was 5.6 (1.8), 6.2 (0.8), and 5.8 (0.7) mm for 5%, 10% and 15% maximal voluntary contraction, respectively. Greater pelvic floor muscle contraction intensity resulted in a concomitant increase in stiffness, which differed between contraction intensities (5% vs 10%, P < 0.001; 5% vs 15%, P < 0.001; 10% vs 15%, P = 0.003).ConclusionVoluntary contraction of the pelvic floor muscles in men is associated with an area of stiffness increase measured with SWE, which concurs with the expected location of the SUS. The increase in stiffness occurred in association with an increase in perineal surface electromyography activity, providing evidence that stiffness amplitude relates to general pelvic floor muscle contraction intensity. Future applications of SWE may include investigations of patient populations in which dysfunction of the SUS is thought to play an important role, or investigation of the effect of rehabilitation programmes that target this muscle.
      PubDate: 2016-11-11T00:25:30.741888-05:
      DOI: 10.1111/bju.13688
  • Efficacy of knowledge and competence-based training of non-physicians in
           the provision of early infant male circumcision using the Mogen clamp in
           Rakai, Uganda
    • Authors: Edward Nelson Kankaka; Godfrey Kigozi, Daniel Kayiwa, Nehemiah Kighoma, Frederick Makumbi, Teddy Murungi, Dorean Nabukalu, Resty Nampijja, Stephen Watya, Daniel Namuguzi, Fred Nalugoda, Gertrude Nakigozi, David Serwadda, Maria Wawer, Ronald H. Gray
      Pages: 631 - 637
      Abstract: ObjectiveTo assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum.Subjects and MethodsTraining in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events.ResultsDespite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10–47) min for the COs, and 15 (10–50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity.ConclusionCompetence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
      PubDate: 2016-11-11T00:25:40.801658-05:
      DOI: 10.1111/bju.13685
  • The landscape of systematic reviews in urology (1998 to 2015): an
           assessment of methodological quality
    • Authors: Julia L. Han; Shreyas Gandhi, Crystal G. Bockoven, Vikram M. Narayan, Philipp Dahm
      Pages: 638 - 649
      Abstract: ObjectivesTo assess the quality of published systematic reviews in the urology literature (an extension of our previously reported work), as high-quality systematic reviews play a paramount role in informing evidence-based clinical practice.Materials and MethodsOur focus was on systematic reviews in the urology literature that incorporated questions of prevention and therapy. To identify such reviews published during a 36-month period (2013–2015), we systematically searched PubMed and hand-searched the table of contents of four major urology journals. Two reviewers independently assessed the methodological quality of those reviews, using the 11-point ‘Assessment of Multiple Systematic Reviews’ (AMSTAR) instrument. We performed protocol-driven analyses of the data from our present study's 36-month period alone, as well as in aggregate with the data from our previously reported work's study periods (2009–2012 and 1998–2008).ResultsIn our literature search of the 36-month period (2013–2015), we initially identified 490 possibly relevant reviews, of which 125 met our inclusion criteria. The most common topic of reviews for the 2013–2015 period was oncology (51.2%; n = 64), followed by voiding dysfunction (21.6%; n = 27). The mean [standard deviation (SD)] AMSTAR score in the 2013–2015 period (n = 125) was 4.8 (2.4); 2009–2012 (n = 113), 5.4 (2.3); and 1998–2008 (n = 57), 4.8 (2.0) (P = 0.127). In the 2013–2015 period, the mean (SD) AMSTAR score for the BJU International (n = 25) was 5.6 (2.9); for The Journal of Urology (n = 20), 5.1 (2.6); for European Urology (n = 60), 4.5 (2.2); and for Urology (n = 20), 4.4 (2.2) (P = 0.106).ConclusionsThe number of systematic reviews published in the urology literature has exponentially increased, year by year, but their methodological quality has stagnated. To enhance the validity and impact of systematic reviews, all authors and editors must apply established methodological standards.
      PubDate: 2016-10-17T00:11:12.874066-05:
      DOI: 10.1111/bju.13653
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