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Journal Cover BJU International
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   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1583 journals]
  • Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive
           prostate cancer amenable to lesion ablative therapy
    • Authors: Aurélie De Bruycker; Bieke Lambert, Tom Claeys, Louke Delrue, Chamberlain Mbah, Gert De Meerleer, Geert Villeirs, Filip De Vos, Kathia De Man, Karel Decaestecker, Valérie Fonteyne, Nicolaas Lumen, Filip Ameye, Ignace Billiet, Steven Joniau, Friedl Vanhaverbeke, Wim Duthoy, Piet Ost
      Abstract: ObjectivesTo describe the anatomical patterns of PCa recurrence following primary therapy and investigate if patients with low-volume disease have a better prognosis as compared to their counterparts.Material and methodsPatients eligible for a F18-choline PET-CT were entered in a prospective cohort study. Eligible patients had an asymptomatic biochemical recurrence following primary PCa treatment and testosterone levels>50 ng/ml. The number of lesions were counted per scan. Patients with an isolated local recurrence or with up to 3 metastases (+/- local recurrence) were considered “low-volume” and patients with>3 metastases as high-volume. Descriptive statistics were used to report recurrences. Cox-regression analysis investigated the influence of prognostic variables on the time to developing castration resistant PCa (CRPC).ResultsIn 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed) (11%), viscera (4%) or a combination of any of the previous (37%). In total, 153 patients (74%) had a low-volume recurrence and 55 patients (26%) had a high-volume recurrence. The 3-year CRPC-free survival for the whole cohort was 79% (95% CI: 43 – 55%) and 88% for low-volume recurrences and 50% for high-volume recurrences, respectively (p
      PubDate: 2017-06-24T06:07:34.178756-05:
      DOI: 10.1111/bju.13938
  • Impact of Preoperative Calculation of Nephron Volume Loss on Future of
           Partial Nephrectomy Techniques; Planning a Strategic Roadmap for Improving
           Functional Preservation and Securing Oncological Safety
    • Authors: Koon Ho Rha; Ali Abdel Raheem, Sung Yul Park, Kwang Hyun Kim, Hyung Joon Kim, Kyo Chul Koo, Young Deuk Choi, Byung Ha Jung, Sang Kon Lee, Won Ki Lee, Jayram Krishnan, Tae Young Shin, Jin-Seon Cho
      Abstract: ObjectivesTo assess the correlation of resected and ischaemised volume (RAIV), which is preoperatively calculated volume of nephron loss (VNL), with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset.Subjects and MethodsWe identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robotic PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were utilised to identify the associations between various time points of PRF and RAIV as a continuous variable.ResultsMean RAIV was 24.2 ± 29.2 cm3. Mean preoperative eGFR and eGFRs at postoperative day 1, 6 months and 3 years follow-up was 91.0 and 76.8, 80.2 and 87.7 ml/min per 1.73 m2, respectively. In multivariable linear regression analysis, the amount of changes in PRF in long-term follow-up were significantly correlated with RAIV (β = 0.261, β = 0.165, β = 0.260 at postoperative day 1, 6 months and 3 years follow-up, respectively). This study has the limitation of its retrospective nature.ConclusionPreoperatively calculated RAIV significantly correlates with the amount of changes in PRF during long-term follow-up. RAIV could lead our research to the level of prediction of the amount of PRF decline. RAIV provides appropriate evidence to explain the technical advantages of emerging techniques.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-20T13:24:15.375778-05:
      DOI: 10.1111/bju.13937
  • Development of a Patient and Institutional-Based Model for Estimation of
           Operative Times for Robot-Assisted Radical Cystectomy: Results from the
           International Robotic Cystectomy Consortium
    • Authors: Ahmed A. Hussein; Paul R. May, Youssef E. Ahmed, Matthias Saar, Carl J Wijburg, Lee Richstone, Andrew Wagner, Timothy Wilson, Bertram Yuh, Joan Palou Redorta, Prokar Dasgupta, Omar Kawa, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini, Franco Gaboardi, Giovannalberto Pini, Francis Schanne, Alexandre Mottrie, Koon-ho Rha, Ashok Hemal, Michael Stockle, John Kelly, Wei Shen Tan, Thomas J. Maatman, Vassilis Poulakis, Jihad Kaouk, Abdullah Erdem Canda, Mevlana Derya Balbay, Peter Wiklund, Khurshid A. Guru
      Abstract: ObjectivesTo design a methodology to predict operative times for robot-assisted radical cystectomy (RARC) based on variation in institutional, patient and disease characteristic to help in operating room scheduling and quality control.MethodsThe model included preoperative variables and therefore can be used for prediction of surgical times: institutional volume, age, gender, BMI, ASA Score, history of prior surgery and radiation, clinical stage, neoadjuvant chemotherapy, type, technique of diversion and the extent of lymph node dissection. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with surgical time. The data was split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated recursively on the resultant data sets until the permutation tests showed no significant association with operative time.Results2134 procedures were included. The variable most strongly associated with surgical time was type of diversion (ileal conduits – 70 minutes shorter, p66 RARCs) was important (higher volume—55 minutes shorter, p
      PubDate: 2017-06-16T03:55:24.991016-05:
      DOI: 10.1111/bju.13934
  • Impact of diagnostic ureteroscopy on intra-vesical recurrence in patients
           undergoing radical nephroureterectomy for upper tract urothelial cancer: A
           systematic review and meta-analysis
    • Authors: Michele Marchioni; Giulia Primiceri, Luca Cindolo, Lance Hampton, Mayer B Grob, Georgi Guruli, Luigi Schips, Shahrokh F. Shariat, Riccardo Autorino
      Abstract: PurposeTo analyze the association between the use of diagnostic ureteroscopy (URS) and development of intra-vesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for high risk upper tract urothelial cancer.MethodsA systematic review of the published data was performed up to December 2016 using multiple search engines to identify eligible studies. A formal meta-analysis was conducted for studies comparing patients who underwent URS before RNU to those with did not. HRs with their 95% CIs from each study were used to calculate pooled HRs. Pooled estimates were calculated using a fixed-effects or random-effects model according to heterogeneity. Statistical analyses were performed using RevMan, version 5.ResultsSeven studies were included in the systematic review, but only six of were deemed fully eligible for meta-analysis. Among the 2,382 patients included in the meta-analysis, 765 underwent diagnostic URS prior to RNU. All examined studies were retrospective, and the majority examined Asian populations. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS, respectively. At pooled analysis, a statistically significant association was found between occurrence of URS prior to RNU and IVR (HR=1.56; 95% CI 1.33 to 1.88; p < 0.001). There was not heterogeneity in the observed outcomes according to the I2 statistic of 2% (p = 0.40).ConclusionsWithin the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU. Further research is this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-16T03:55:19.83854-05:0
      DOI: 10.1111/bju.13935
  • Journal information
    • PubDate: 2017-06-15T22:18:38.542293-05:
      DOI: 10.1111/bju.13640
  • Safety and effectiveness of collagenase clostridium histolyticum (CCH)
           (Xiapex®) in the treatment of Peyronie's Disease using a new modified
           shortened protocol
    • Authors: Amr Abdel Raheem; Marco Capece, Odunayo Kalejaiye, Tarek Abdel-Raheem, Marco Falcone, Mark Johnson, Oliver George Ralph, Giulio Garaffa, Andrew Nim Christopher, David John Ralph
      Abstract: ObjectivesTo evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH) (Xiapex®, Xiaflex®) in the treatment of Peyronie's disease (PD) using a new modified treatment protocol which aims at reducing the number of injections needed and reducing patient visits, thus reducing the cost and duration of treatment.Patients and MethodsA prospective study of 53 patients with PD who had treatment with CCH at a single center using a new modified protocol. The angle of curvature assessment after an intra-cavernosal injection of PGE1, IIEF and Peyronie's disease questionnaires (PDQ) were performed at baseline and at week 12 (4 weeks after the last injection). The global assessment of PD questionnaire was performed at week 12. Under a penile block of 10ml of plain lignocaine 1%, a total of 3 intra-lesional injections of CCH (0.9mg) were given at 4 weekly intervals using a new modified injection technique.In between injections patients used a combination of home modelling, stretching and a vacuum device on a daily basis in order to mechanically stretch the plaque. Investigator modelling was not performed.ResultsThe mean penile curvature at baseline was 54° (30 - 90°). Of the 53 patients in the study, 51 patients (96.2%) had an improvement in the angel of curvature with a mean value of 17.36° (0°- 40°) or 31.4% from baseline (0 - 57%) after 3 CCH injections. The end mean curvature was 36.9° (12 °- 75°; p
      PubDate: 2017-06-14T01:55:18.503188-05:
      DOI: 10.1111/bju.13932
  • Mild heating and reduction of bladder spontaneous contractions
    • Authors: Darryl G Kitney; Rita I Jabr, Bahareh Vahabi, Christopher H Fry
      Abstract: ObjectivesTo measure the effect of external heating on bladder wall contractile function, histological structure and expression of proteins related to tissue protection and apoptosis.Material and methodsIn vitro preparations of bladder wall and ex vivo perfused pig bladders were heated from 37°C to 42, 46 and 50°C for 15 minutes. Isolated preparations were heated by radiant energy and perfused bladders by altering perfusate temperature. Spontaneous contractions or pressure variations were recorded, as well as responses to the muscarinic agonist carbachol or motor nerve excitation in vitro during heating. Tissue histology in control and after heating was analysed using H&E staining and DAPI nuclear labelling. The effects of heating on protein expression levels of i) heat shock proteins HSP27-pSer82 and inducible-HSP70 and ii) caspase-3 and its downstream DNA-repair substrate, PARP were measured.ResultsHeating to 42°C reduced spontaneous contractions or pressure variations by about 70%, effects were fully reversible. There were no effects on carbachol or nerve-mediated responses. Tissue histology was unaffected by heating and expression of heat-shock proteins as well as caspase-3 and PARP were also unaltered. A TRPV1 antagonist had no effect on the reduction of spontaneous activity. Heating to 46°C had a similar effect on spontaneous activity and also reduced the carbachol contracture. Urothelial structure was damaged, caspase-3 levels were increased and inducible-HSP70 levels declined. At 50°C evoked contractions were abolished, the urothelium was absent and heat-shock proteins and PARP expression was reduced with raised caspase-3 expression.ConclusionsHeating to 42°C caused a profound, reversible and reproducible attenuation of spontaneous activity with no tissue damage and no initiation of apoptosis pathways. Higher temperatures caused tissue damage and activation of apoptotic mechanisms. Mild heating offers a novel approach to reduce bladder spontaneous activity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T14:25:19.136486-05:
      DOI: 10.1111/bju.13933
  • A critical appraisal of the application of propensity score methods in the
           urology literature
    • Authors: Madhur Nayan; Robert J. Hamilton, David N. Juurlink, Antonio Finelli, Girish S. Kulkarni, Peter C. Austin
      Abstract: ObjectivesTo determine whether studies that used propensity score (PS) methods in the urology literature provided sufficient detail to allow scientific reproducibility and whether appropriate statistical tests were used to obtain valid measures of effect.Materials and MethodsWe searched OVID Medline and the Science Citation Index from inception to November 2016 to identify studies that used PS methods from 5 general urology journals. From each included article, we extracted pertinent information related to the PS methodology such as estimation of the PS, whether balance diagnostics were performed, and the statistical analysis performed.ResultsWe identified 114 articles for inclusion. Matching on the PS was the most common method used (62 studies, 54.4%). Of all studies, 103 (90.4%) described which covariates were used to estimate the PS; however, only 24 provided justification for the selected covariates. Although the majority of studies (70.2%) performed some sort of diagnostic evaluation to assess balance, few studies (24.6%) used appropriate methods for balance assessment. Only 4 (6.4%) studies that used PS matching provided sufficient detail to replicate the matching strategy. Finally, the majority (77.4%) of studies that used PS matching explicitly used inappropriate statistical methods to estimate the effect of an exposure on an outcome.ConclusionsPropensity score methods are poorly described and implemented in the urology literature. We provide recommendations for improvement to allow scientific reproducibility and obtain valid measures of effect from their use.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-13T02:50:23.347117-05:
      DOI: 10.1111/bju.13930
  • Centralisation of radical cystectomies for bladder cancer in England, a
           decade on from the ‘Improving Outcomes Guidance’: The case for super
    • Authors: Mehran Afshar; Henry Goodfellow, Francesca Jackson-Spence, Felicity Evison, John Parkin, Richard T Bryan, Helen Parsons, Nicholas D James, Prashant Patel
      Abstract: ObjectiveTo analyse the impact of centralisation of radical cystectomy provision for bladder cancer in England, on post-operative mortality, length of stay, complications and re-intervention rate, from implementation of centralisation from 2002, until 2014. In 2002, UK policymakers introduced the Improving Outcomes Guidance (IOG) for urological cancers after a global cancer surgery commission identified substantial shortcomings in provision of care of radical cystectomies. One key recommendation was centralisation of cystectomies to high output centres. No study has yet robustly analysed the changes since IOG, to assess a national healthcare system which has mature data on such institutional transformation.MethodsRadical Cystectomies performed for bladder cancer in England between 2003/2004 and 2013/2014 were analysed from Hospital Episode Statistics (HES) data. Outcomes including 30-day, 90-day, and one-year all-cause post-operative mortality, median length of stay, complications and re-interventions were calculated. Multivariable statistical analysis was undertaken to describe the relationship between each surgeon and the providers’ annual case volume and mortality.Results15,292 cystectomies were identified. Percentage of cystectomies performed in discordance with IOG reduced from 65.0% to 12.4%, corresponding with improvement in 30-day mortality from 2.7% to 1.5% (p=0.0235). Procedures adhering to IOG had superior 30-day mortality (2.9% vs. 2.1%; p=0.0029) to those which did not, and superior one-year mortality (25.6% vs. 21.5%; p
      PubDate: 2017-06-08T09:15:37.410012-05:
      DOI: 10.1111/bju.13929
  • Anti-VEGF treatment decreases bladder pain in cyclophosphamide cystitis
           – a MAPP Research Network Animal Model Study
    • Authors: H Henry Lai; Baixin Shen, Pooja Vijairania, Zhang Xiaowei, Sherri K. Vogt, Robert W. Gereau
      Abstract: ObjectiveTo investigate whether treatment with anti-VEGF (vascular endothelial growth factor) neutralizing antibodies can reduce pain and voiding dysfunction in the cyclophosphamide (CYP) cystitis model of bladder pain in mice.Materials and MethodsAdult female mice received anti-VEGF neutralizing antibodies (10 mg/kg intraperitoneal B20-4.1.1 VEGF mAb) or saline (control) pre-treatment, followed by CYP (150 mg/kg intraperitoneal) to induce acute cystitis. Pelvic nociceptive responses were assessed by applying von Frey filaments to the pelvic area. Spontaneous micturition was assessed using the void spot assay.ResultsSystemic anti-VEGF neutralizing antibodies treatment significantly reduced the pelvic nociceptive response to CYP cystitis compared to control (saline). In the anti-VEGF pre-treatment group, there was a significant increase in pelvic hypersensitivity measured by the area under the curve (AUC) with von Frey filaments at 5 hours post-CYP (p=0.0035). However by 48 and 96 hours post-CYP, the pelvic hypersensitivity have reduced by 54% and 47% respectively compared to the 5 hours post-CYP time point, and were no longer significantly different from the baseline (p=0.22 and 0.17 respectively). There was no difference in urinary frequency and mean voided volume between the two pre-treatment groups.ConclusionSystemic blockade of VEGF signaling with anti-VEGF neutralizing antibodies was effective in reducing pelvic/bladder pain in the CYP cystitis model of bladder pain. Our data support the further investigation of the use of anti-VEGF antibodies to manage bladder pain or visceral pain.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T10:35:20.785549-05:
      DOI: 10.1111/bju.13924
  • Testing Radical prostatectomy in men with prostate cancer and
           oligoMetastases to the bone: a randomised controlled feasibility trial
    • Authors: Prasanna Sooriakumaran
      Abstract: Prostate cancer is the commonest cancer and the second most frequent cause of cancer death in Western men1. Men presenting with metastatic disease have a median survival of only 42.1 months2 and current standard-of-care consists of initial androgen deprivation therapy (ADT) followed by chemotherapy and novel agents once the cancer no longer responds to ADT. The burden on the health care setting of treating men with metastatic prostate cancer is vast and a recent study estimated costs of USD20,000 per man3.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:30:34.635193-05:
      DOI: 10.1111/bju.13925
  • Natural History of ‘Second’ Biochemical Failure Following Salvage
           Radiation Therapy for Prostate Cancer: A Multi-Institution Study
    • Authors: Vasu Tumati; William C. Jackson, Ahmed E. Abugharib, Ganesh Raj, Claus Roehrborn, Yair Lotan, Kevin Courtney, Aditya Bagrodia, Jeffrey C. Gahan, Zachary S. Zumsteg, Michael R. Folkert, Aaron M. Laine, Raquibul Hannan, Daniel E. Spratt, Neil B. Desai
      Abstract: ObjectivesTo describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) following prostatectomy.Subjects/Patients and MethodsFollowing SRT at two institutions from 1986-2013, 286 patients developed second BCR, defined as two rises in PSA of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses.ResultsAt a median 6.1 years following second BCR, rates of DM, CRPC, PCSS, and OS were 41%, 27%, 83%, and 73%, respectively. On multivariable analysis, interval to second BCR
      PubDate: 2017-06-05T04:28:40.46275-05:0
      DOI: 10.1111/bju.13926
  • The Pregnant Urologist
    • Authors: Susan Jane Hall; Simon Williams
      Abstract: The latest statistics show that females constitute 15% of UK Urology consultants and 30% of Urology trainees. This number is set to rise with females accounting for 60% of recent medical school intakes (1). Having young female trainees will result in a larger number of trainees working during pregnancy. Furthermore Urology as a specialty involves potential risks to the developing foetus and mother from both ionising radiation in theatre and from exposure to the potentially harmful 5 α reductase inhibitors, Povidone-iodine surgical scrub, cytotoxic chemicals such as Mitomycin, along with long working hours and on call duties.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-05T04:25:12.738456-05:
      DOI: 10.1111/bju.13927
  • Role of serum steroid hormones in women with stress urinary incontinence:
           a case–control study
    • Authors: Barbara Bodner-Adler; Klaus Bodner, Oliver Kimberger, Ksenia Halpern, Malte Rieken, Heinz Koelbl, Wolfgang Umek
      Abstract: ObjectivesTo investigate the potential relationship between endogenous sex steroids and presence of stress urinary incontinence (SUI).Patients and MethodsA total of 47 peri- and postmenopausal women with SUI were matched 1:1 with 47 continent women based on age, menopausal status, body mass index (BMI) and parity. Blood samples were drawn from all the women for assessment of oestradiol (E2), follicle-stimulating hormone, luteinizing hormone, testosterone, androstendion (AEON), dehydroepiandrosterone sulphate and sex hormone-binding globulin with an electrochemiluminescence immunoassay.ResultsWomen with SUI had significantly lower serum levels of E2 (8.49 ± 7.47 vs 13.09 ± 13.80; P = 0.048) and AEON (0.59 ± 0.41 vs 1.20 ± 0.87; P = 0.033) compared with controls. This difference in E2 levels remained significant after controlling for age, menopausal age, years from menopause, BMI, parity, testosterone and AEON. In addition, hypertension and history of hysterectomy were observed significantly more frequently in the SUI group (P < 0.001). There was no significant association between hormone levels and degree of SUI (P> 0.05).ConclusionThe results of the present study indicate that a low E2 level might have a negative impact on the lower urinary tract and continence mechanism and a low E2 level is a possible risk factor for SUI in women.
      PubDate: 2017-05-29T05:35:25.979913-05:
      DOI: 10.1111/bju.13902
  • Initial multicentre experience of 68Gallium-PSMA PET/CT guided
           robot-assisted salvage lymphadenectomy: acceptable safety profile but
           oncological benefit appears limited
    • Authors: Amila Siriwardana; James Thompson, Pim J. van Leeuwen, Shaela Doig, Anton Kalsbeek, Louise Emmett, Warick Delprado, David Wong, Hemamali Samaratunga, Anne-Maree Haynes, Geoff Coughlin, Phillip Stricker
      Abstract: ObjectivesTo evaluate the safety and short-term oncological outcomes for 68Ga-PSMA PET/CT directed robot-assisted salvage node dissection (RASND) for prostate cancer oligometastatic nodal recurrence.Materials and MethodsBetween February 2014 and April 2016, 35 patients across two centres underwent RASND for 68Ga-PSMA PET/CT detected oligometastatic nodal recurrence. RASND was performed by targeted pelvic dissection, unilateral extended pelvic template or bilateral extended pelvic template dissection, depending on previous pelvic treatment and extent/location of nodal disease. Complications were reported by the Clavien-Dindo classification system. Definitions of prostate-specific antigen (PSA) treatment response (TR) to RASND were defined as 6-week PSA
      PubDate: 2017-05-26T06:50:22.670802-05:
      DOI: 10.1111/bju.13919
  • Estimating the effect of immortal-time bias in urologic research: a case
           example of testosterone-replacement therapy
    • Authors: Christopher J.D. Wallis; Refik Saskin, Steven A. Narod, Calvin Law, Girish S. Kulkarni, Arun Seth, Robert K. Nam
      Abstract: ObjectiveTo quantify the effect of immortal-time bias in an observational study examining the effect of cumulative testosterone exposure on mortality.Subjects and MethodsWe used a population-based matched cohort study of men aged 66 and older newly treated with testosterone replacement therapy and matched-controls from 2007-2012 in Ontario, Canada to quantify the effects of immortal-time bias. We used generalized estimating equations to determine the association between cumulative testosterone replacement therapy exposure and mortality. Results produced by models using time-fixed and time-varying exposures were compared. Further, we undertook a systematic review of PubMed to identify studies addressing immortal-time bias or time-varying exposures in the urologic literature and qualitative summated these.ResultsAmong 10,311 TRT-exposed men and 28,029 controls, the use of a time-varying exposure resulted in the attenuation of treatment effects compared with an analysis which did not account for immortal-time bias. While both analyses showed a decreased risk of death for patients in the highest tertile of TRT exposure, the effect was overestimated when using a time-fixed analysis (aHR 0.56, 95% CI 0.52-0.61) when compared to a time-varying analysis (aHR 0.67, 95% CI 0.62-0.73). Of the 1241 studies employing survival analysis identified in the literature, nine manuscripts met criteria for inclusion. Of these, 5 employed time-varying analytic methodology. Each of these was a large, population-based retrospective cohort study assessing potential harms of pharmacologic agents.ConclusionsWhere exposures vary over time, a time-varying exposure is necessary to draw meaningful conclusions. Failure to employ a time-varying analysis will result in overestimation of a beneficial effect. However, time-varying exposures are uncommonly utilized among manuscripts published in prominent urologic journals.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-26T06:46:13.681787-05:
      DOI: 10.1111/bju.13918
  • Renal functional outcomes in patients undergoing percutaneous cryoablation
           or partial nephrectomy for a solitary renal mass
    • Authors: Ross J. Mason; Thomas D. Atwell, Christine Lohse, Bimal Bhindi, Adam Weisbrod, Stephen A. Boorjian, Bradley C. Leibovich, Grant D. Schmit, R. Houston Thompson
      Abstract: ObjectivesTo compare renal functional changes after percutaneous cryoablation (CA) or partial nephrectomy (PN).Patients and MethodsPatients who underwent CA or PN for a solitary renal mass at a single institution were identified (2003-2013). Estimated glomerular filtration rates (eGFR) were calculated at baseline, discharge, and 3 months follow-up using the Chronic Kidney Disease Epidemiology Collaboration equation. Changes in renal function were compared between groups using 1:1 propensity score (PS) matching, adjustment for PS quintile, and inverse probability weighting (IPW).ResultsThere were 2,040 procedures available for the PS analyses, including 448 CA and 1,592 PN. After PS adjustments, there were no significant differences in baseline clinical features between CA and PN patients. In the PS matched analysis, the changes in eGFR from baseline to discharge for CA and PN patients were -3.1 and -1.1 ml/min/1.73m2 (p=0.038) with percent changes of -4.5% and 0% (p=0.006). From baseline to 3-month follow-up, the absolute changes in eGFR for CA and PN patients were -4.3 and -2.1 ml/min/1.73m2 (p=0.008) and the percent changes were -6.1% and -2.4% (p=0.005). Similar results were obtained after adjusting for PS quintiles and in the IPW analysis. Importantly, the rate of CKD stage progression at 3-months follow-up was similar between groups (21% versus 18%).ConclusionsOur results confirm that both CA and PN have a minor impact on renal function. While we observed a statistically greater decline in eGFR after CA compared with PN, both approaches result in excellent preservation of renal function.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-26T06:46:12.554036-05:
      DOI: 10.1111/bju.13917
  • Impact of Body Mass Index on Robotic Radical Cystectomy with
           Intra-Corporeal Urinary Diversion
    • Authors: Nariman Ahmadi; Thomas G. Clifford, Gus Miranda, Jie Cai, Monish Aron, Mihir M. Desai, Inderbir S. Gill
      Abstract: ObjectivesTo determine the impact of body mass index (BMI) on peri-operative and oncological outcomes following robotic radical cystectomy (RRC) with intra-corporeal urinary diversion (ICUD).Subjects and MethodsA total of 216 patients undergoing RRC, extended lymphadenectomy and ICUD (07/2010-12/2015) were categorized into four BMI groups according to the 2004 World Health Organization (WHO) obesity classification:
      PubDate: 2017-05-22T12:31:14.496647-05:
      DOI: 10.1111/bju.13916
  • Evaluating an educational intervention to alleviate distress amongst men
           with newly diagnosed prostate cancer and their partners
    • Authors: Lindsay Hedden; Richard Wassersug, Sarah Mahovlich, Phil Pollock, Monita Sundar, Robert H. Bell, Larry Goldenberg, Celestia S. Higano
      Abstract: ObjectiveTo determine whether an education session alleviates distress for both patients with prostate cancer and their partners; and whether their partner's attendance at the session; and disease, treatment, and sociodemographic characteristics affect changes in distress levels.Patients, Subjects and MethodsWe identified men with untreated prostate cancer at the Vancouver Prostate Centre between February 2015 and March 2016 who agreed to attend our education session. The session consisted of a didactic presentation covering the biology of prostate cancer, treatment options, and side-effects, followed by a private joint session with a urologist and radiation oncologist. We assessed distress using the Distress Thermometer (DT) and compared pre- and post-session distress, and change in distress between patients and partners using matched and unmatched t-tests, respectively. We also assessed pre-session anxiety using the seven-item Generalised Anxiety Disorder measure, and decisional certainty using the Decisional Conflict Scale.ResultsIn all, 71 patients and 48 partners participated in the study. Attending the session led to a significant reduction in the median DT score for patients (4.0–3.0, P < 0.01) and partners (5.0–4.0, P = 0.02). Partners reported higher distress both before and after the session (4.9 vs 3.8, P = 0.03 pre-session and 4.2 vs 3.2, P = 0.03 post-session). The presence of a partner at the session did not affect patients’ pre- or post-session distress or the success of the session at alleviating distress. Sociodemographic and clinical characteristics had little effect on distress levels.ConclusionsAn interdisciplinary education session is equally effective at alleviating distress for both patients with prostate cancer and their female partners.
      PubDate: 2017-05-17T22:25:31.277127-05:
      DOI: 10.1111/bju.13885
  • The contemporary role of ureterolysis in Retroperitoneal Fibrosis RPF) -
           treatment of last resort or first intent' An analysis of 50 cases
    • Authors: Tim O'Brien; Archie Fernando
      Abstract: ObjectiveTo determine the outcomes of open ureterolysis in a contemporary cohort of patients presenting with ureteric obstruction secondary to retroperitoneal fibrosis (RPF).Patients and methodsProspective analysis of 50 patients undergoing open ureterolysis and omental wrap between January 2012 and January 2016 in a single centre managed by a multi-disciplinary RPF team. Minimum follow up of 1 year. Indications were: nephrostomy-dependent drainage (n=5); stent failure as evidenced by persistent hydronephrosis (n=20); severe stent symptoms (n=22); and patient choice/pre-emptive (n=3). Outcome measures were stent-free rate; change in renal function post-ureterolysis; operative parameters (operative time, blood loss, complications, length of stay); and need for further intervention.Results48/50 (96%) patients stent free at 3 months and 47/50 (94%) stent free at 12 months. Median change in GFR by indication at one year was: overall +6% (IQR -4 to +22; p
      PubDate: 2017-05-14T05:02:31.13567-05:0
      DOI: 10.1111/bju.13915
  • Additional benefit of using a risk based selection for prostate biopsy: an
           analysis of biopsy complications in the Rotterdam section of the European
           Randomized Study of Screening for Prostate Cancer (ERSPC)
    • Authors: Peter K.F. Chiu; Arnout R. Alberts, Lionne D.F. Venderbos, Chris H. Bangma, Monique J. Roobol
      Abstract: ObjectiveTo investigate biopsy complications and hospital admissions that could be reduced by the use of ERSPC risk calculators (RC).Materials and MethodsAll biopsies in the Rotterdam section of the ERSPC from 1993 to 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC RC3 and RC4 were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC3/4 probability cut-offs for prostate cancer(PCa) risk of ≥12.5% and high grade PCa(HGPCa) risk ≥3%, we assessed the the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these cut-offs.Results10747 biopsies with complete questionnaires were included. A total of 7294(67.9%) complications, 3.9% (424/10747) post-biopsy fever, and 0.9%(92/10747) hospital admissions were recorded. Fever rate has been static over the years, but hospital admissions had tripled from 0.6%(1993-1996) to 2.1%(2009-2015). Among 7704 biopsies which fit the criteria of RC3 or 4, 35.8%(2757/7704) biopsies, 37.4%(1972/5268) complications, 39.4%(128/325) fever, and 42.3%(30/71) admissions could have been avoided by using one of the RCs. More complications could have been avoided in the case of RC4 or more recent biopsies(2009-2015). 35.9% of the total cost of biopsies and complication treatment could be saved.ConclusionA significant proportion of biopsy complications, hospital admissions, and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only, and this effect was most prominent in more recent biopsies and in men with repeated biopsies or screening.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-12T10:50:59.825424-05:
      DOI: 10.1111/bju.13913
  • Prognostic Utility of Biopsy-Derived Cell Cycle Progression Score in
           Patients with NCCN Low-Risk Prostate Cancer Undergoing Radical
           Prostatectomy: Implications for Treatment Guidance
    • Authors: Jeffrey T. Tosoian; Meera R. Chappidi, Jay T. Bishoff, Stephen J. Freedland, Julia Reid, Michael Brawer, Steven Stone, Thorsten Schlomm, Ashley E. Ross
      Abstract: ObjectivesTo determine the prognostic utility of the Cell Cycle Progression (CCP) score in men with National Comprehensive Cancer Network (NCCN) low-risk prostate cancer who underwent radical prostatectomy (RP).Patients and MethodsPatients who underwent RP for Gleason score ≤6 prostate cancer at three institutions (Martini Clinic [MC], Durham Veterans Affairs Medical Center [DVA], and Intermountain Healthcare [IHC]) were identified. The CCP score was obtained from diagnostic (DVA, IHC) or simulated biopsies (MC). Primary outcome was biochemical recurrence (BCR, PSA≥0.2 ng/ml) after RP. Prognostic utility of the CCP score was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models in the subset of men meeting NCCN low-risk criteria and the overall cohort.ResultsAmong the 236 patients identified, 80% (188/236) met NCCN low-risk criteria. Five-year BCR-free survival for the low (1) CCP score groups was 89.2%, 80.4%, 64.7%, respectively, in the low-risk cohort (p=0.03), and 85.9%, 79.1%, 63.1%, respectively, in the overall cohort (p=0.041). In multivariable models adjusting for clinical and pathological variables with the CAPRA score, the CCP score was an independent predictor of BCR in the low-risk (HR=1.77 per unit score, 95%CI [1.21, 2.58], p=0.003) and overall cohorts (HR=1.41 per unit score, 95%CI [1.02, 1.96], p=0.039).ConclusionIn a cohort of NCCN low-risk patients, the CCP score improved clinical risk stratification of patients at increased risk of BCR, which suggests the CCP score could improve the assessment of candidacy for active surveillance and guide optimal treatment selection in these patients with otherwise similar clinical parameters.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-08T10:50:25.202304-05:
      DOI: 10.1111/bju.13911
  • Association of Human Development Index with global bladder, kidney,
           prostate and testis cancer incidence and mortality
    • Authors: Alyssa K. Greiman; James S. Rosoff, Sandip M. Prasad
      Abstract: ObjectivesTo describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development.Materials and MethodsWe obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI).ResultsAge-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5–2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R2 = 0.78), prostate (regression coefficient −1.56, R2 = 0.85), kidney (regression coefficient −1.34, R2 = 0.74), and bladder cancer (regression coefficient −1.01, R2 = 0.80).ConclusionWhile incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes.
      PubDate: 2017-05-08T06:50:27.303028-05:
      DOI: 10.1111/bju.13875
  • Tweet this: how advocacy for breast and prostate cancers stacks up on
           social media
    • Authors: Stacy Loeb; Brian Stork, Heather T. Gold, Natasha K. Stout, Danil V. Makarov, Christopher Weight, Hendrik Borgmann
      Abstract: Despite the large burden of disease for both breast and prostate cancer, breast cancer receives substantially more federal funding and little is known about the extent to which advocacy in social media differs between them. We aimed to perform a comprehensive comparison of Twitter activity related to prostate and breast cancer over the past 5 years (1/11-1/16) using the Symplur Signals analytics platform. Overall there were 2,518,250 tweets from 800,833 users about breast cancer and 389,696 tweets from 106,507 users about prostate cancer over the 5-year period between 2012-2017 demonstrating a 7-fold higher activity for breast cancer. For both cancers, twitter activity grew steadily over time, but the estimated reach of tweets was 9-fold higher for breast cancer. The types of key influencers to the discussion differed between the two cancers, and by the hashtag used (#breastcancer or #bcsm, and #prostatecancer or #pcsm). The mean number of tweets during October breast cancer awareness month (166,896 tweets/month) was 16 times higher than the combined total of prostate cancer tweets during awareness months of September and November (“Movember”) (10,159 tweets/month). Considering the potential utility of social media to increase cancer-related knowledge, public awareness and education, our findings suggest a role for greater advocacy on Twitter by the prostate cancer community.This article is protected by copyright. All rights reserved.
      PubDate: 2017-05-04T10:46:03.945787-05:
      DOI: 10.1111/bju.13908
  • Does the training of fellows affect perioperative outcomes of robotic
           partial nephrectomy'
    • Authors: Zine-Eddine Khene; Benoit Peyronnet, Elise Bosquet, Benjamin Pradère, Corentin Robert, Tarek Fardoun, Solène-Florence Kammerer-Jacquet, Grégory Verhoest, Nathalie Rioux-Leclercq, Romain Mathieu, Karim Bensalah
      Abstract: ObjectiveTo evaluate the impact of fellows’ involvement on robot-assisted partial nephrectomy (RAPN) perioperative outcomes.Materials and methodsWe analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) or fellow operating under the supervision of the expert surgeon (fellow group). Perioperative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows’ involvement on perioperative and postoperative outcomes. Trifecta and MIC scores were used to assess quality of surgery in both expert and fellow groups. Trifecta was defined as a combination of warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications. MIC score was defined as negative surgical margins, ischemia time under 20 min, and absence of complications grade 3 or higher.ResultsFellows were involved in a total of 89 procedures (41%). Patients’ characteristics were comparable in both groups. Operative time (OT) and warm ischemia time (WIT) were longer in the fellow group (180 vs. 120 min, p
      PubDate: 2017-05-02T11:10:31.579918-05:
      DOI: 10.1111/bju.13901
  • Reduced Estimated Glomerular Filtration Rate (eGFR
    • Authors: Michael L. Blute; Victor Kucherov, Timothy J. Rushmer, Shivashankar Damodaran, Fangfang Shi, E. Jason Abel, David F. Jarrard, Kyle A. Richards, Edward M. Messing, Tracy M. Downs
      Abstract: IntroductionTo evaluate if moderate CKD (eGFR
      PubDate: 2017-05-02T11:10:27.395938-05:
      DOI: 10.1111/bju.13904
  • Unification of favorable intermediate, unfavorable intermediate, and very
           high risk-stratification criteria for prostate cancer
    • Authors: Zachary S. Zumsteg; Michael J. Zelefsky, Kaitlin M. Woo, Daniel E. Spratt, Marisa A. Kollmeier, Sean McBride, Xin Pei, Howard M. Sandler, Zhigang Zhang
      Abstract: ObjectiveTo improve on the existing risk-stratification systems.Patients and MethodsThis was a retrospective investigation including 2248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into favorable and unfavorable groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into standard and very high-risk groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavorable intermediate risk (UIR) had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P
      PubDate: 2017-05-02T11:08:41.9696-05:00
      DOI: 10.1111/bju.13903
  • Clinical and patient reported outcomes of SPARE - a randomised feasibility
           study of selective bladder preservation versus radical cystectomy
    • Authors: R A Huddart; A Birtle, L Maynard, M Beresford, J Blazeby, J Donovan, JD Kelly, T Kirkbank, D B McLaren, G Mead, C Moynihan, R Persad, C Scrase, R Lewis, E Hall
      Abstract: ObjectivesTo test the feasibility of a randomised trial in muscle invasive bladder cancer (MIBC) and compare outcomes in patients who receive neoadjuvant chemotherapy followed by radical cystectomy or selective bladder preservation, where definitive treatment (cystectomy or radiotherapy) is determined by response to chemotherapy.Patients and methodsSPARE is a multicentre randomised controlled trial comparing radical cystectomy and selective bladder preservation in patients with MIBC staged T2-3 N0 M0, fit for both treatment strategies and receiving three cycles of neoadjuvant chemotherapy.Patients were randomised between radical cystectomy and selective bladder preservation prior to a cystoscopy after cycle three of neoadjuvant chemotherapy. Patients with ≤T1 residual tumour received a fourth cycle of neoadjuvant chemotherapy in both groups, followed by radical radiotherapy in the selective bladder preservation group and radical cystectomy in in the radical cystectomy group; non-responders in both groups proceeded immediately to radical cystectomy following cycle three.Feasibility study primary endpoints were accrual rate and compliance with assigned treatment strategy. The phase III trial was designed to demonstrate non-inferiority of selective bladder preservation in terms of overall survival in patients whose tumours responded to neoadjuvant chemotherapy. Secondary endpoints included patient reported quality of life, clinician assessed toxicity, loco-regional recurrence free survival and rate of salvage cystectomy after bladder preservation.ResultsTrial recruitment was challenging and below the predefined target with 45 patients recruited in 30 months (25 radical cystectomy; 20 selective bladder preservation). Non-compliance with assigned treatment strategy was frequent, 6/25 patients (24%) randomised to radical cystectomy received radiotherapy.Long term bladder preservation rate was 11/15 (73%) in those who received radiotherapy per protocol. Overall survival was not significantly different between groups.ConclusionsRandomising MIBC patients between radical cystectomy and selective bladder preservation based on response to neoadjuvant chemotherapy was not feasible in the UK health system. Strong clinician and patient preferences for treatments impacted willingness to undergo randomisation and acceptance of treatment allocation. Due to the small number of participants, firm conclusions about disease and toxicity outcomes cannot be drawn.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-28T11:27:35.034547-05:
      DOI: 10.1111/bju.13900
  • Trends in the surgical management of Stage 1 Renal Cell Carcinoma:
           findings from a population-based study
    • Authors: V White; D J T Marco, D Bolton, I D Davis, M Jefford, D Hill, H M Prince, J L Millar, I M Winship, M Coory, G G Giles
      Abstract: ObjectivesTo determine whether use of nephron sparing surgery (NSS) for treatment of stage 1 renal cell carcinomas changed between 2009 and end 2013 in Australia.Patients and MethodsAll adult cases of renal cell carcinoma diagnosed in 2009, 2012, and 2013 were identified through the population-based Victorian Cancer Registry.For each identified patient, trained data-abstractors attended treating hospitals or clinician rooms to extract tumour and treatment data through medical record review.Multivariable logistic regression analyses examined significance of change in use of NSS over time, after adjusting for potential confounders.ResultsA total of 1836 patients with renal cell carcinoma were identified. Of these, the proportion of cases with stage 1 tumours was 64% in 2009, 66% in 2012, and 69% in 2013.For T1a tumours, the proportion of patients residing in metropolitan areas receiving NSS increased from 43% in 2009 to 58% in 2012 (P
      PubDate: 2017-04-28T00:35:27.678514-05:
      DOI: 10.1111/bju.13889
  • Who is at risk of death from nephrectomy' An analysis of thirty-day
           mortality after 21 380 nephrectomies in 3 years of the British Association
           of Urological Surgeons (BAUS) National Nephrectomy Audit
    • Authors: Archie Fernando; Sarah Fowler, Mieke Van Hemelrijck, Tim O'Brien,
      Abstract: ObjectiveTo ascertain contemporary overall and differential thirty-day mortality (TDM) rates after all types of nephrectomy in the UK, and to identify potential new risk factors for death.Patients and MethodsWe conducted a retrospective analysis of the 110 deaths that occurred within 30 days of surgery out of the total of 21 380 nephrectomies performed, and calculated the odds ratio (OR) and 95% confidence interval (CI) for TDM based on peri-operative characteristics.ResultsThe overall TDM rate was 110/21380 (0.5%). The TDM rates after radical, partial, simple nephrectomy and nephro-ureterectomy were 0.6% (63/11057), 0.1% (4/3931), 0.4% (11/2819) and 0.9% (28/3091), respectively. TDM increased with age, stage, estimated blood loss (EBL), operating time and performance status. EBL of 1–2 L was associated with a greater risk of TDM than EBL of 2–5 L (OR 1.38; 95% CI 1.03–2.24). Conversion from minimally invasive surgery was associated with higher risk than non-conversion (OR 2.53; 95% CI 1.14–4.51. Curative surgery was safer than cytoreductive surgery (OR 0.31; 95% CI 0.18–0.54). There was an association between surgical volume and TDM.ConclusionsThis study provides contemporary insights into the true risks of all types of nephrectomy. The TDM rate after nephrectomy in the UK appears acceptably low at 0.5%. Established risk factors were confirmed and the following novel risk factors were identified: modest EBL (1–2 L) and conversion from minimally invasive surgery.
      PubDate: 2017-04-24T23:06:15.328868-05:
      DOI: 10.1111/bju.13842
  • Robot-assisted versus open radical prostatectomy: the day after
    • Authors: Vincenzo Ficarra; Giacomo Novara, Prokar Dasgupta
      Abstract: Contrary to the available systematic reviews of non-randomized comparative studies, the recent Australian RCT demonstrated that robot-assisted (RARP) and retropubic radical prostatectomy (RRP) yield similar functional outcomes at 12 weeks follow-up. Conversely, the same trial confirmed that RARP has been associated with lower estimated blood loss (EBL), better pain control and equivalent complication rate in comparison with RRP. The
      Authors discussed some critical aspects influencing the interpretation of the results of the Royal Brisbane & Women's Hospital (RBWH) trial and the implications for patients, urologists and health system providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:52:30.860797-05:
      DOI: 10.1111/bju.13891
  • ESUT educational video on fluoroscopic guided puncture in PCNL: All
           techniques step by step
    • Authors: Iason Kyriazis; Evangelos Liatsikos, Odysseas Sopilidis, Panagiotis Kallidonis, Andreas Skolarikos,
      Abstract: ObjectiveKidney puncture during percutaneous nephrolithotomy (PCNL) is regarded as one of the most demanding aspects of the procedure and only a minority of urologists perform this step without assistance by a radiologist. Currently a wide variation of fluoroscopic guided techniques is available in clinical practice. In this work we describe the most common fluoroscopic guided access techniques in a step-by-step manner aiming to assist on the standardization of their technique and terminology.MethodsA high quality animation video was created for each of the respective fluoroscopic techniques focusing into the parallel projection of external surgical maneuvers and their effect in the 3 dimensional space of the kidney.ResultsFour predominant fluoroscopic guided percutaneous access techniques are available each with different advantages and limitations. Monoplanar access is employed when a stable-single axis fluoroscopic generator is available and is mostly based on surgeons’ experience. Biplanar access employs a second fluoroscopy axis to access puncture's depth. Bull's eye technique follows a coaxial to fluoroscopy puncture path and is associated with the shorter learning curve at the cost of increased hand radiation exposure. Hybrid and conventional triangulate techniques use target projection by two fluoroscopic planes to define the exact localization of target in space and access it through a third puncture site.ConclusionsFluoroscopic guidance during PCNL puncture is a very efficient method of access establishment. Percutaneous surgeon should be familiar with all available variations of fluoroscopic approach in order to be ready to adopt puncture on any given scenario.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:52:17.863354-05:
      DOI: 10.1111/bju.13894
  • Optimal outcome achievement in partial nephrectomy for T1 renal masses: A
           contemporary analysis of open and robotic cases
    • Authors: Matthew J. Maurice; Daniel Ramirez, Önder Kara, Ercan Malkoç, Ryan J. Nelson, Khaled Fareed, Robert J. Stein, Amr F. Fergany, Jihad H. Kaouk
      Abstract: ObjectivesTo compare optimal outcome achievement between open and robotic partial nephrectomy.Patients and methodsUsing our institutional partial nephrectomy database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys from 2011-2015. Tetrafecta, which was defined as negative surgical margins, freedom from perioperative complications, ≥80% renal functional preservation, and no chronic kidney disease upstaging, was chosen as the composite optimal outcome. Factors associated with Tetrafecta achievement were assessed by multivariable logistic regression with adjustment for age, gender, race, Charlson score, body mass index, chronic kidney disease, tumor size, tumor complexity, and approach.ResultsOverall Tetrafecta achievement was 38%. Negative margins, freedom from complications, and optimal functional preservation was achieved in 97.1%, 73.6%, and 54.2% of cases, respectively. For T1a masses, Tetrafecta achievement was similar between approaches (p=0.97), but for T1b masses, the robotic approach achieved significantly higher Tetrafecta rates (43.0% vs. 21.3%, p
      PubDate: 2017-04-24T07:52:04.266542-05:
      DOI: 10.1111/bju.13888
  • The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]):
           Recruitment Feasibility and Baseline Demographics of a Randomized Trial of
           Diet in Men on Active Surveillance for Prostate Cancer
    • Authors: J. Kellogg Parsons; John P. Pierce, James Mohler, Electra Paskett, Sin-Ho Jung, Michael J. Morris, Eric Small, Olwen Hahn, Peter Humphrey, John Taylor, James Marshall
      Abstract: ObjectiveTo assess the feasibility of performing national, randomized trials of dietary interventions for localized prostate cancer.MethodsThe Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) is a phase 3 clinical trial testing the efficacy of a high-vegetable diet to prevent progression in prostate cancer patients on active surveillance. Participants were randomized to a validated diet counseling intervention or a control condition. Chi-Square and Kruskal Wallis analyses were used to assess between-group differences at baseline.ResultsFrom 2011 to 2015, 478 (103%) of a targeted 464 patients were randomized at 91 study sites. At baseline, mean (SD) age was 64 (6) years and PSA 4.9 (2.1) ng/mL. Fifty-six (12%) participants were African-American, 17 (4%) Hispanic/Latino, and 16 (3%) Asian-American. There were no significant between-group differences for age (p-value = 0.98), race/ethnicity (p-value = 0.52), geographic region (p-value = 0.60), time since prostate cancer diagnosis (p-value = 0.85), PSA (p-value = 0.96), clinical stage (T1c or T2a, p-value = 0.27), or Gleason sum (Gleason 6 or 3+4 = 7, p-value = 0.76). In a pre-planned analysis, the baseline prostate biopsy samples of the first 50 patients underwent central pathology review to confirm eligibility, with an expectation that
      PubDate: 2017-04-24T07:52:02.968606-05:
      DOI: 10.1111/bju.13890
  • Patient Reported Outcome (PRO) questionnaires for men who have radical
           surgery for prostate cancer: a conceptual review of existing instruments
    • Authors: Evangelia Protopapa; Jan der Meulen, Caroline M. Moore, Sarah C. Smith
      Abstract: ObjectivesTo critically review conceptual frameworks for available patient reported outcome (PRO) questionnaires in men having radical prostatectomy; psychometrically evaluate each questionnaire; identify whether each is appropriate for use at the level of the individual patient.Materials and MethodsWe searched PubMed, the Reports and Publications database of the University of Oxford Patient Reported Outcomes Measurement Group and the website of the International Consortium for Health Outcomes Measurement (ICHOM) for psychometric reviews of prostate cancer specific PRO questionnaires. From these we identified relevant questionnaires and critically appraised the conceptual content, guided by the Wilson and Cleary framework and psychometric properties, using well established criteria.ResultsSearches found four reviews and one recommendation paper. We identified seven prostate cancer specific PROs (EPIC-26, EPIC-50, UCLA-PCI, FACT-P, QLQ-PR25, and PC-QoL and STAR). Six out of seven measures purported to measure health related quality of life, but items focused strongly on urinary and sexual symptoms/functioning. The remaining questionnaire (STAR) claimed to assess functional recovery after radical prostatectomy. The psychometric evidence for these questionnaires was incomplete and variable in quality; none had evidence that they were appropriate for use with individual patients.ConclusionSeveral questionnaires provide the basis of measures of urinary and/or sexual symptoms/functioning. Further work should explore other aspects of health related quality of life that are important for men having radical prostatectomy. Further psychometric work is also needed to determine whether they can be used at the individual level.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T07:51:49.802545-05:
      DOI: 10.1111/bju.13896
  • Impact of preoperative risk on metastatic progression and cancer specific
           death in patients with adverse pathology at radical prostatectomy
    • Authors: Katharina Boehm; Sami-Ramzi Leyh-Bannurah, Clemens Rosenbaum, Laurenz S. Brandi, Lars Budäus, Markus Graefen, Hartwig Huland, Axel Haferkamp, Derya Tilki
      Abstract: ObjectiveTo evaluate the impact of preoperative risk category on metastatic disease (MetD) and prostate cancer mortality (CSM) in prostate cancer (PCa) patients with adverse pathology at radical prostatectomy (RP).Patients and MethodsThe records of 6943 patients who underwent radical prostatectomy (RP) in a European tertiary-center were analysed. Biochemical recurrence (BCR), MetD and CSM were assessed for patients with adverse pathology at RP and stratified according to preoperative low- vs. intermediate/high-risk PCa. Kaplan-Meier-, cumulative incidence, cox-regression and competing risk regression analyses were performed.ResultsIn patients with extracapsular extension MetD-rate was 1.6% vs. 8% (p
      PubDate: 2017-04-24T07:36:26.150675-05:
      DOI: 10.1111/bju.13887
  • Profiling microRNA from nephrectomy and biopsy specimens: predictors of
           progression and survival in clear cell renal cell carcinoma
    • Authors: Casey G. Kowalik; Drew A. Palmer, Travis B. Sullivan, Patrick A. Teebagy, John M. Dugan, John A. Libertino, Eric J. Burks, David Canes, Kimberly M. Rieger-Christ
      Abstract: ObjectiveTo identify miRNA characteristic of metastatic clear cell renal cell carcinoma (ccRCC) and those indicative of cancer specific survival in nephrectomy and biopsy specimens. We also sought to determine if a miRNA panel could differentiate benign from ccRCC tissue.Materials and MethodsRNA was isolated from nephrectomy and kidney biopsy specimens (n=156; n=46 respectively). Samples were grouped: benign, non-progressive and progressive ccRCC. MiRNA were profiled by microarray and validated by qRT-PCR. Biomarker signatures were developed to predict cancer status in nephrectomy and biopsy specimens. Cancer specific survival was examined using Kaplan-Meier and Cox proportional hazards analyses.ResultsMicroarray analysis revealed 20 differentially expressed miRNA comparing non-progressive with progressive tumors. A biomarker signature validated in nephrectomy specimens had a sensitivity of 86.7% and a specificity of 92.9% for differentiating benign and ccRCC. A second signature differentiated non-progressive versus progressive ccRCC with a sensitivity of 93.8% and a specificity of 83.3%. These biomarkers also discriminated cancer status in biopsy specimens. Levels of miR-10a-5p, -10b-5p, and -223-3p were associated with cancer specific survival.ConclusionThis study identified miRNA differentially expressed in ccRCC samples; as well as those correlating with cancer specific survival. Biomarkers identified in this study have the potential to identify patients who are likely to have progressive ccRCC, and although preliminary, these results may aid in differentiating aggressive and indolent ccRCC based on biopsy specimens.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:44.453137-05:
      DOI: 10.1111/bju.13886
  • Prevalence and risk factors of symptomatic urinary tract infection after
           endoscopic incision for the treatment of ureterocele in children
    • Authors: Kimihiko Moriya; Michiko Nakamura, Yoko Nishimura, Yukiko Kanno, Takeya Kitta, Masafumi Kon, Nobuo Shinohara
      Abstract: ObjectiveTo clarify the impact of endoscopic incision for ureterocele as an initial procedure, retrospective chart review was performed focusing on the prevalence and risk factors of symptomatic urinary tract infection after endoscopic incision.Materials and methodsAmong children with ureterocele who were managed between September 1994 and April 2016, patients who were observed conservatively without additional surgical management after endoscopic incision were included in this study. Type of ureterocele was divided into intravesical and ectopic. Symptomatic urinary tract infection was defined as either recurrent non-febrile or febrile urinary tract infection. Statistical analysis was performed using the Cox proportional Hazard model or Kaplan-Meier Curve with log-rank test for evaluation of the prevalence and risk factors.ResultsThirty-six patients met the inclusion criteria. Median age at endoscopic incision was 8.9 months. Eleven children had symptomatic urinary tract infections (febrile in 9 and recurrent non-febrile in 2) during median follow-up of 75.5 months. Initial symptomatic urinary tract infection in each child occurred within 25 months after endoscopic incision. Symptomatic urinary tract infection-free rate after endoscopic incision was 65.6%. The risk factors for symptomatic urinary tract infection were female gender, duplex system, ectopic ureterocele, and unchanged hydronephrosis after EI.ConclusionsThe current study demonstrated the critical period and risk factors for symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele. These results suggest that when conservative management is indicated after endoscopic incision, patients, especially those with risk factors, should be followed carefully at least for 25 months after endoscopic incision for symptomatic urinary tract infection.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:29.917069-05:
      DOI: 10.1111/bju.13884
  • Health-related quality of life outcomes from a contemporary prostate
           cancer registry in a large diverse population
    • Authors: Gary W. Chien; Jeff M. Slezak, Teresa N. Harrison, Howard Jung, Joy S. Gelfond, Chengyi Zhang, Edward Wu, Richard Contreras, Ronald K. Loo, Steven J. Jacobsen
      Abstract: ObjectiveTo assess the health-related quality of life (HRQoL) of patients with prostate cancer up to 24 months after treatment in a contemporary large diverse population.Patients and MethodsPatients with newly diagnosed prostate cancer from March 2011 to January 2014 in our healthcare system were included. The Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire was administered before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment up to November 2014 for all methods of treatment. The Kruskall–Wallis test was used to compare the distribution of each EPIC-26 domain score at each time point, and mixed models were used to assess the overall scores over the period after treatment.ResultsIn all, 5 727 patients were included. There were data for 3 422, 2 329, 2 017, 1 922, 1 772, 1 260, and 837 patients before treatment, and at 1, 3, 6, 12, 18, and 24 months after treatment, respectively. At 1 month, bowel scores were the lowest for patients that had had radiation therapy, and urinary irritative symptoms were the lowest for those who had had brachytherapy. There were sexual function declines for all the treatment methods, with surgery having the steepest decline; open radical prostatectomy (ORP) had a greater decline than robot-assisted laparoscopic prostatectomy (RALP). Patients who underwent RALP had a better return of sexual function, approaching that of brachytherapy and radiation therapy at 24 months. Urinary incontinence (UI) also declined the most in surgical patients, with RALP patients improving slightly more than ORP patients at 12–24 months.ConclusionsPatients' HRQoL after prostate cancer treatment varies by treatment method. Notably, sexual function recovers most for RALP patients. UI remains worse at 24 months after surgery, compared to other methods of prostate cancer treatment.
      PubDate: 2017-04-19T23:48:02.468433-05:
      DOI: 10.1111/bju.13843
  • Association between Type 2 diabetes, curative treatment and survival in
           men with intermediate and high risk localised prostate cancer
    • Authors: Danielle Crawley; Hans Garmo, Sarah Rudman, Pär Stattin, Björn Zethelius, Lars Holmberg, Jan Adolfsson, Mieke Van Hemelrijck
      Abstract: ObjectiveTo investigate if curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM), as little is known about if a diagnosis of T2DM influences receipt of curative treatment in men with localised PCa.Subjects/Patients and methodsData from Prostate Cancer database Sweden (PCBaSe) from men with T2DM and PCa (n=2,210) was used to compare with those with PCa only (n=23,071). All men had intermediate (T1-2, Gleason score 7 and/or PSA 10-20 ng/ml) or high risk (T3 and/or Gleason score 8-10 and/or PSA 20—50 ng/ml) localised PCa diagnosed between 1st January 2006 and 31st December 2014. Multivariate logistic regression was used to calculate odds ratios for receiving curative treatment in men with and without T2DM. Overall survival, up to 8 years of follow-up, was calculated for men with T2DM only and for men with T2DM and PCa.ResultsMen with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR: 0.78, 95%CI: 0.69-0.87). The 8 year overall survival was 79% and 33% respectively for men with T2DM and high risk PCa who did and did not receive curative treatment.ConclusionsMen with T2DM were less likely to receive curative treatment for localised intermediate and high risk PCa. Men with T2DM and high risk PCa who received curative treatment had substantially higher survival than those who did not. Some of the survival differences represent a selection bias of the healthiest patients to receive curative treatment. Clinicians need to interpret such data carefully and ensure that individual patients with T2DM and PCa are not under nor over treated unnecessarily.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:54.356936-05:
      DOI: 10.1111/bju.13880
  • Newsworthiness versus scientific impact: are the most highly cited urology
           papers the most widely disseminated in the media?
    • Authors: E M O'Connor; G J Nason, F O'Kelly, R P Manecksha, S Loeb
      Abstract: BackgroundDiscordance exists between scientific impact and media attention. Altmetrics are non-traditional measures of impact which are composite scores that include social media and traditional media sharing of an article.ObjectiveTo assess whether a correlation exists between newsworthiness (Altmetric score) and the scientific impact markers such as citation analysis, impact factors and levels of evidence.Materials and MethodsThe top 5 most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (scientific impact group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (media impact group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores.ResultsIn the scientific impact group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8, There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% CI 0.16-0.52, p
      PubDate: 2017-04-18T07:05:51.009867-05:
      DOI: 10.1111/bju.13881
  • Efficacy and safety of combinations of mirabegron and solifenacin compared
           with monotherapy and placebo in patients with overactive bladder (SYNERGY
    • Authors: Sender Herschorn; Christopher R Chapple, Paul Abrams, Salvador Arlandis, David Mitcheson, Kyu-Sung Lee, Arwin Ridder, Matthias Stoelzel, Asha Paireddy, Rob Maanen, Dudley Robinson
      Abstract: Overactive bladder (OAB) syndrome is characterized by urinary urgency, with or without urgency urinary incontinence, usually accompanied by increased daytime frequency and nocturia, in the absence of urinary tract infection (UTI) or other obvious pathology [1]. Urgency urinary incontinence is present in approximately one-third of cases [2], but is not a prerequisite. However, of all the OAB symptoms, it has the greatest impact on quality of life (QoL) [3, 4], and is associated with significantly lower productivity and higher healthcare resource utilization [5].This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:05:46.432278-05:
      DOI: 10.1111/bju.13882
  • Evaluation of Gender-Based Disparities from Initial Hematuria Presentation
           to Upper Tract Urothelial Carcinoma Diagnosis: Analysis of a Nationwide
           Insurance Claims Database
    • Authors: Meera R. Chappidi; Max Kates, Jeffrey J. Tosoian, Michael H. Johnson, Noah M. Hahn, Trinity J. Bivalacqua, Phillip M. Pierorazio
      Abstract: ObjectiveTo investigate the duration from initial hematuria presentation to upper tract urothelial carcinoma (UTUC) diagnosis and the effect of gender on this duration.Patients and MethodsPatients with hematuria claims in the year prior to UTUC diagnosis were identified in the MarketScan database (2010-2014). Delayed diagnosis was defined as >90 days from hematuria presentation to UTUC diagnosis. Multivariable Poisson regression models were used to determine factors associated with delayed UTUC diagnosis.ResultsAmong 1326 UTUC patients, 469(35.4%) experienced delayed diagnosis. Men (n=866) had a longer median interval from hematuria to diagnosis than women (60 vs. 49 days, p=0.04). In the multivariable model, male gender (RR=1.13 95%CI[0.95-1.34]) was not associated with delayed diagnosis while UTI (RR=1.52 95%CI[1.32-1.76]), nephrolithiasis (RR=1.23 95%CI[1.06-1.44]), new (RR=1.37 95%CI[1.12-1.66]), and recurrent prostate-related (RR=1.61 95%CI[1.23, 2.10]) diagnoses were. For men presenting to non-urologists, UTI (RR=1.44, 95%CI[1.22-1.71]), nephrolithiasis (RR=1.25 95%CI[1.05-1.49]), new (RR=1.41, 95%CI[1.12-1.78]) and recurrent (RR=1.94, 95%CI[1.45-2.58]) prostate-related diagnoses were associated with delayed diagnosis. However, for men presenting to urologists, nephrolithiasis (RR=1.08 95%CI[0.78-1.49]), new (RR=1.15, 95%CI[0.79-1.68]) and recurrent (RR=1.17, 95%CI[0.69-1.97]) prostate-related diagnoses were not associated while UTI (RR=1.74, 95% CI[1.31-2.31]) diagnosis was still associated with delayed diagnosis.ConclusionA UTUC diagnosis was made >90 days after hematuria presentation in approximately 1/3 of patients. Men experienced a longer median interval from hematuria to UTUC diagnosis compared to women, but male gender was not an independent predictor of delayed diagnosis. Benign diagnoses during hematuria work-up are strongly associated with delayed diagnosis, especially among patients initially seen by non-urologists. Future interventions should focus on development of non-invasive techniques to improve clinical risk stratification of patients presenting with hematuria and to educate practitioners, especially non-urologists, on the importance of a thoughtful hematuria evaluation and common mimickers of UTUC to help improve delays in diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-18T07:00:53.022152-05:
      DOI: 10.1111/bju.13878
  • Understanding Pain and Coping in Women with Interstitial Cystitis/Bladder
           Pain Syndrome (IC/BPS)
    • Authors: L. Katz; D. A. Tripp, L. K. Carr, R. Mayer, R. M. Moldwin, J. C. Nickel
      Abstract: ObjectivesTo examine a self-regulation and coping model for IC/BPS that may help us understand the pain experience of chronic IC/BPS patients.Materials and MethodsThe model tested illness perceptions, illness-focused coping, emotional regulation, mental health and disability in stepwise method using factor analysis and structural equation modeling. Step 1 explored the underlying constructs. Step 2 confirmed the measurement models to determine the structure/composition of the main constructs. Step 3 evaluated the model fit and specified pathways in the proposed IC-Self Regulation Model.ResultsFemale patients with urologist diagnosed IC/BPS were recruited and diagnosed across tertiary care centres in North America (n=217). The data was collected through self-report questionnaires. An IC/BPS self-regulatory model was supported. Physical disability was worsened by patient's negative perception of their illness, attempts to cope using illness-focused coping and poorer emotional regulation. Mental health was supported by perceptions that individuals could do something about their illness, using wellness-focused behavioural strategies, and adaptive emotion regulation.ConclusionsThe results clarify the complex and unique process of self-regulation in women suffering from IC/BPS, implicating cognitive and coping targets, and highlighting emotional regulation. This knowledge will help clinicians understand and manage these patients’ distress and disability.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-07T02:25:56.864266-05:
      DOI: 10.1111/bju.13874
  • Long-Term Sexual Health Outcomes in Men with Classic Bladder Exstrophy
    • Authors: Timothy S Baumgartner; Kathy M Lue, Pokket Sirisreetreerux, Sarita Metzger, Ross G Everett, Sunil S Reddy, Ezekiel Young, Uzoma A Anele, Cameron E Alexander, Nilay M Gandhi, Heather N Di Carlo, John P Gearhart
      Abstract: ObjectivesTo identify the long-term sexual health outcomes and relationships in men born with classic bladder exstrophy (CBE).Materials And MethodsA prospectively-maintained institutional database comprised of 1248 patients with exstrophy-epispadias was utilized. Male patients 18 years or older with CBE were included. A 42-question survey was designed utilizing a combination of demographic information and previously validated questionnaires.ResultsA total of 215 men inclusion criteria, of which 113 (53%) completed the questionnaire. The mean age of the participants was 32 years. Ninety-six (85%) of the respondents had been sexually active in their lifetime, of which only 66 (58%) were moderately to very satisfied with their sex life. The average Sexual Health Inventory for Men score was 19.8. The Penile Perception Score revealed all aspects of assessment scored an average between very dissatisfied and satisfied.Thirty-two respondents (28%) had attempted to obtain pregnancy with their partner. Twenty-three (20%) were successful in achieving pregnancy, while 31 (27%) reported a confirmed fertility problem. 31 (27%) reported having a semen analysis or post-ejaculatory urinalysis. Of the samples collected, only 4 individuals reported azoospermia.ConclusionCBE patients have many of the same sexual and relationship successes and concerns as the general population. This is invaluable data to provide to both the parents of boys with CBE, as it is to the patients themselves as they transition to adulthood.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T17:50:32.965824-05:
      DOI: 10.1111/bju.13866
  • Long-Term Third Party Assessment Of Results After Continent Cutaneous
           Diversion With Lundiana Pouch
    • Authors: Fredrik Liedberg; Sigurdur Gudjonsson, Abai Xu, Pär-Ola Bendahl, Thomas Davidsson, Wiking Månsson
      Abstract: ObjectivesTo investigate functional outcomes and complications at long-term follow-up after continent cutaneous diversion with Lundiana pouch.Subjects and methodsComplications, reoperations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files.ResultsA complication Clavien grade 3 or higher including unscheduled readmissions occurred in 45/193 patients (23%) within 90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one reoperation, and uretero-intestinal stricture was the most prevalent cause in 28 (15%) of those subjects. Reoperations were more prevalent in patients operated during the first half of the study period than during the second half (2000−2007) (62% vs 47%; p=0.03), and they were also more frequent in patients with surgery for benign causes than in patients with surgery for malignancy (60% vs 51%; p=0.04). Continence was achieved in 172/188 patients (91%). Sixteen percent of all patients required revisional surgery of the outlet to remain continent with an easily catheterizable pouch or to address stomal stenosis. The mean decrease in eGFR was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 ml/min/1.73m2; p
      PubDate: 2017-03-29T00:16:34.206233-05:
      DOI: 10.1111/bju.13863
  • Prostate cancer, family history, and eligibility for active surveillance:
           A systematic review of the literature
    • Authors: J.M Telang; B.R Lane, M.L Cher, D.C Miller, J.M Dupree
      Abstract: BackgroundActive surveillance is an increasingly prevalent treatment choice for low-grade prostate cancer. The eligibility criteria for active surveillance are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for active surveillance treatment.ObjectiveTo determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance.MethodsPubMed searches of “family history and prostate cancer”, “family history and prostate cancer progression” and “factors of prostate cancer progression” were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis.ResultsReview of six publications suggests that family history does not increase the risk of prostate cancer progression. Six studies found that family history does not increase the risk of prostate cancer progression, while one study found that family history increases the risk of prostate cancer progression only in African Americans.ConclusionA family history of prostate cancer does not appear to increase a patient's risk of having more aggressive prostate cancer and is therefore unlikely to be an important factor in determining eligibility for active surveillance. Further studies are needed to better understand the relationship between race, family history, and eligibility for active surveillance.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:39.847593-05:
      DOI: 10.1111/bju.13862
  • Cost-effectiveness of a new urinary biomarker-based risk score compared to
           standard of care in prostate cancer diagnostics – a decision analytical
    • Authors: Siebren Dijkstra; Tim M. Govers, Rianne J. Hendriks, Jack A. Schalken, Wim Van Criekinge, Leander Van Neste, Janneke P.C. Grutters, J.P. Michiel Sedelaar, Inge M. van Oort
      Abstract: ObjectiveTo assess the cost-effectiveness of a new urinary biomarker-based risk score (SelectMDx) to identify patients for transrectal ultrasound-guided biopsy (TRUSGB) and to compare this with the current standard of care (SOC), using only prostate-specific antigen (PSA) to select for TRUSGB.Materials and methodsA decision tree and Markov model were developed to evaluate the cost-effectiveness of SelectMDx as a reflex test versus SOC in men with a PSA >3 ng/ml. Transition probabilities, utilities and costs were derived from literature and expert opinion. Cost-effectiveness was expressed in quality-adjusted life years (QALYs) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions.ResultsA diagnostic strategy including SelectMDx with a cut-off chosen at a sensitivity of 95.7% for high-grade PCa resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses demonstrated that the disutility assigned to active surveillance had a high impact on the QALYs gained and the disutility attributed to TRUSGB only slightly influenced the outcome of the model.ConclusionBased on the currently available evidence, the reduction of overdiagnosis and overtreatment due to the use of the SelectMDx test in men with PSA>3 ng/ml may lead to a reduction in total costs per patient and a gain in QALYs.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-29T00:05:28.001061-05:
      DOI: 10.1111/bju.13861
  • Cytoreductive therapy in the era of targeted therapies: a review
    • Authors: Nisha Pindoria; Nicholas Raison, Gideon Blecher, Rick Catterwell, Prokar Dasgupta
      Abstract: In the pre-targeted therapy era, palliative cytoreductive nephrectomy combined with cytokine immunotherapy was the standard treatment protocol for the management of metastatic renal cell carcinoma. The introduction of targeted therapies has improved response rates, median survival and overall prognosis when compared to immunotherapy. The role of cytoreductive nephrectomy in providing an independent survival advantage when used alongside immunotherapy has been demonstrated by two randomised controlled trials. However, with the new shift in improved treatment outcomes from cytokine immunotherapy to targeted therapies, the continuing role of cytoreductive nephrectomy as a viable surgical treatment modality remains controversial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:15:28.239992-05:
      DOI: 10.1111/bju.13860
  • Transperineal prostate biopsy – tips for analgesia
    • Authors: Shannon McGrath; Daniel Christidis, Emma Clarebrough, Rahul Ingle, Marlon Perera, Damien Bolton, Nathan Lawrentschuk
      Abstract: The modern transperineal prostate biopsy (TPB) technique was first described in 1983(1). Since its introduction, TPB has become favorable over transrectal ultrasound prostate biopsy (TRUS-PB) approach due to higher cancer detection rates particularly in the anterior and transition zones, lower rates of sepsis, and decreased risk of rectal bleeding(2). Using a standardized template for prostate biopsy – sampling of the prostate is improved with TP prostate biopsy when compared to transrectal-guided biopsy(2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:10:29.617742-05:
      DOI: 10.1111/bju.13859
  • Predictive value of the 2014 International Society of Urological Pathology
           grading system for prostate cancer in radical prostatectomy patients with
           long-term follow up
    • Authors: Judith Grogan; Ruta Gupta, Kate L Mahon, Phillip D Stricker, Anne-Maree Haynes, Warick Delprado, Jennifer Turner, Lisa G Horvath, James G Kench
      Abstract: ObjectiveTo assess the relationship between the ISUP 2014 grading system, biochemical relapse (BCR) and clinical relapse (CLR) following radical prostatectomy, to determine whether the 2014 ISUP grading system is a better predictor of survival compared to the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.Patients and methods635 radical prostatectomy cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow up (median 15.25 years, 0.3-26 years) were obtained. Log rank, Kaplan Meier, Cox regression and Harrell's concordance c-indices analyses were performed.ResultsAt a median follow up of 15 years, 276 (44%) of patients had BCR and 41 (7%) had clinical relapse. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 (9%) patients respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared to the 1992 Gleason system. Grade Group (HR: 4.9, p
      PubDate: 2017-03-28T10:05:35.933541-05:
      DOI: 10.1111/bju.13857
  • Cut-points for PSA doubling time in men with non-metastatic
           castration-resistant prostate cancer
    • Authors: Lauren E. Howard; Daniel Moreira, Amanda De Hoedt, William J. Aronson, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Martha K. Terris, Stephen J. Freedland
      Abstract: ObjectivesTo examine whether PSADT correlates with metastases, all-cause mortality (ACM), and prostate cancer-specific mortality (PCSM) and identify PSADT cut-points that can be used clinically for risk stratification in men with M0 CRPC.Materials and MethodsWe collected data on 441 men with M0 CRPC in 2000-2015 at five Veterans Affairs hospitals. Cox models were used to test the association between log-transformed PSADT and development of metastasis, ACM, and PCSM. To identify cut-points, we categorized PSADT into groups of every 3 months and then combined groups with similar hazard ratios.ResultsMedian follow-up was 28.3 months (IQR: 14.7-49.1). As a continuous variable, PSADT was associated with metastases, ACM, and PCSM (HR 1.40-1.68, all p
      PubDate: 2017-03-28T10:05:28.849829-05:
      DOI: 10.1111/bju.13856
  • Safety and efficacy of 2-weekly cabazitaxel in metastatic
           castration-resistant prostate cancer
    • Authors: A. Clément-Zhao; M. Auvray, H. Aboudagga, F. Blanc-Durand, A. Angelergues, Y. A. Vano, F. Mercier, N. El Awadly, B. Verret, C. Thibault, S. Oudard
      Abstract: ObjectivesTo evaluate the safety and efficacy of a 2-weekly cabazitaxel schedule in metastatic castration-resistant prostate cancer (mCRPC) patients.Materials and methodsFrom October 2013 to February 2016, 43 mCRPC patients were treated with cabazitaxel (16 mg/m2 on days 1 and 15 of a 4-week cycle) with G-CSF support. The safety profile and efficacy (prostate-specific antigen [PSA] response; biological, clinical or radiological progression-free survival [PFS] and overall survival [OS]) were analyzed.ResultsAll patients had received prior docetaxel and 79.1% abiraterone acetate. At inclusion, 46.5% were aged >70 years and 27.9% were ECOG-PS ≥2. Six patients stopped treatment because of toxicity. Grade ≥3 toxicities were: asthenia 16.3%; neutropenia 11.6%; thrombocytopenia 9.3%; diarrhoea 7%, anaemia 4.7%, febrile neutropenia 4.7% and haematuria 2.3%. 52.4% achieved a ≥30% PSA response, 40.5% had a ≥50% PSA response. Median OS was 15.2 months.ConclusionThis prospective pilot study suggests that cabazitaxel 16 mg/m² given bi-weekly has a manageable toxicity profile in docetaxel and abiraterone acetate pretreated mCRPC patients. A prospective phase III trial versus the standard cabazitaxel regimen is planned to confirm these results.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:01:23.141582-05:
      DOI: 10.1111/bju.13855
  • A core outcome set for localised prostate cancer effectiveness trials
    • Authors: Steven MacLennan; Paula R Williamson, Hanneke Bekema, Marion Campbell, Craig Ramsay, James N'Dow, Sara MacLennan, Luke Vale, Philipp Dahm, Nicolas Mottet, Thomas Lam, , Paul Abel, Hashim U. Ahmed, Gary Akehurst, Robert Almquist, Karl Beck, David Budd, Steven Canfield, James Catto, Philip Cornford, William Cross, Alexander Ewen, Judith Grant, Rakesh Heer, David Hurst, Rob Jones, Roger Kockelbergh, Andrew Mackie, Graham MacDonald, Alan McNeill, Malcolm Mason, Sam McClinton, Duncan McLaren, Hugh Mostafid, Ian Pearce, Linda Pennet, Justine Royle, Hans Schreuder, Grant D. Stewart, Henk van der Poel, Kevin Wardlaw, Thomas Wiegel
      Abstract: ObjectiveTo develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer.BackgroundMany treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials.Subjects and methodsA list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients.ResultsThe final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere.ConclusionWe have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T09:40:37.702254-05:
      DOI: 10.1111/bju.13854
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Biomarkers in chronic pelvic pain syndrome: did we find the Holy
    • Authors: Thomas M. Kessler
      Pages: 1 - 1
      PubDate: 2017-06-15T22:18:41.435304-05:
      DOI: 10.1111/bju.13922
  • Biomarkers for urological chronic pelvic pain: is there light at the end
           of the tunnel'
    • Authors: J. Curtis Nickel
      Pages: 2 - 3
      PubDate: 2017-06-15T22:18:39.075736-05:
      DOI: 10.1111/bju.13907
  • Shift from protocol-based to personalized medicine in active surveillance:
           beginning of a new era
    • Authors: Stacy Loeb
      Pages: 3 - 4
      PubDate: 2017-06-15T22:18:41.828932-05:
      DOI: 10.1111/bju.13677
  • Active surveillance in prostate cancer: new efforts, new voices, new hope
    • Authors: Spyridon P. Basourakos; Karen Hoffman, Jeri Kim
      Pages: 4 - 5
      PubDate: 2017-06-15T22:18:37.814622-05:
      DOI: 10.1111/bju.13722
  • Prostate-specific membrane antigen radioguided surgery: a promising
    • Authors: Nicolas Geurts; Alastair D. Lamb, Nathan Lawrentschuk, Declan G. Murphy
      Pages: 5 - 6
      PubDate: 2017-06-15T22:18:38.450835-05:
      DOI: 10.1111/bju.13838
  • Pre-stenting and the risk of postoperative sepsis: a shorter dwell time is
    • Authors: Daron Smith
      Pages: 7 - 8
      PubDate: 2017-06-15T22:18:39.963565-05:
      DOI: 10.1111/bju.13876
  • 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
      Pages: 76 - 82
      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
  • 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
      Pages: 83 - 91
      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
  • Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis
    • Authors: Amihay Nevo; Roy Mano, Jack Baniel, David A. Lifshitz
      Pages: 117 - 122
      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
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