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Publisher: John Wiley and Sons   (Total: 1604 journals)

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J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 2, SJR: 0.378, h-index: 23)
J. of Medical Primatology     Hybrid Journal   (Followers: 1, SJR: 0.473, h-index: 28)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 0.936, h-index: 82)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 2.003, h-index: 72)
J. of Microscopy     Hybrid Journal   (Followers: 2, SJR: 0.655, h-index: 70)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 22, SJR: 0.439, h-index: 32)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 0.986, h-index: 56)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 22, SJR: 2.196, h-index: 55)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.602, h-index: 44)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.314, h-index: 23)
J. of Muscle Foods     Hybrid Journal   (Followers: 4)
J. of Neurochemistry     Hybrid Journal   (SJR: 1.754, h-index: 162)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 4, SJR: 1.038, h-index: 75)
J. of Neuroimaging     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 39)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.218, h-index: 113)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 2)
J. of Nursing Management     Hybrid Journal   (Followers: 18, SJR: 1.028, h-index: 34)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 3, SJR: 0.903, h-index: 45)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 18, SJR: 0.499, h-index: 37)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 13, SJR: 0.371, h-index: 30)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.632, h-index: 51)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 2, SJR: 0.729, h-index: 51)
J. of Organizational Behavior     Hybrid Journal   (Followers: 25, SJR: 2.541, h-index: 83)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 14, SJR: 1.246, h-index: 96)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 15, SJR: 0.439, h-index: 46)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 3.025, h-index: 122)
J. of Peptide Science     Hybrid Journal   (Followers: 16, SJR: 0.662, h-index: 42)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.596, h-index: 53)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 1.803, h-index: 75)
J. of Petroleum Geology     Hybrid Journal   (Followers: 4, SJR: 0.471, h-index: 22)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 231, SJR: 1.206, h-index: 102)
J. of Philosophy of Education     Hybrid Journal   (Followers: 7, SJR: 0.491, h-index: 17)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 0.864, h-index: 77)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.603, h-index: 45)
J. of Phytopathology     Hybrid Journal   (Followers: 2, SJR: 0.513, h-index: 33)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 1.435, h-index: 73)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.732, h-index: 44)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 14, SJR: 1.297, h-index: 43)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 5, SJR: 0.684, h-index: 8)
J. of Political Philosophy     Hybrid Journal   (Followers: 29, SJR: 1.774, h-index: 26)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 183, SJR: 1.281, h-index: 98)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 0.932, h-index: 87)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.142, h-index: 2)
J. of Product Innovation Management     Hybrid Journal   (Followers: 14, SJR: 2.157, h-index: 72)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.358, h-index: 28)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 50, SJR: 0.473, h-index: 35)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 1)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.294, h-index: 5)
J. of Public Economic Theory     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 8)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.546, h-index: 38)
J. of Quaternary Science     Hybrid Journal   (Followers: 23, SJR: 1.543, h-index: 59)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 10, SJR: 1.138, h-index: 62)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 9, SJR: 1.961, h-index: 36)
J. of Religious Ethics     Hybrid Journal   (Followers: 4, SJR: 0.189, h-index: 8)
J. of Religious History     Hybrid Journal   (Followers: 17, SJR: 0.133, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.32, h-index: 11)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.81, h-index: 19)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 11, SJR: 2.998, h-index: 62)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.349, h-index: 8)
J. of Research on Adolescence     Hybrid Journal   (Followers: 4, SJR: 1.634, h-index: 47)
J. of Risk & Insurance     Hybrid Journal   (Followers: 9, SJR: 1.138, h-index: 32)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 0.79, h-index: 47)
J. of Sensory Studies     Hybrid Journal   (Followers: 2, SJR: 0.65, h-index: 27)
J. of Separation Science     Hybrid Journal   (Followers: 7, SJR: 1.092, h-index: 55)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.006, h-index: 57)
J. of Sleep Research     Hybrid Journal   (Followers: 10, SJR: 1.05, h-index: 67)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.737, h-index: 39)
J. of Small Business Management     Hybrid Journal   (Followers: 10, SJR: 0.988, h-index: 42)
J. of Social Issues     Hybrid Journal   (Followers: 16, SJR: 1.532, h-index: 63)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.118, h-index: 3)
J. of Sociolinguistics     Hybrid Journal   (Followers: 13, SJR: 1.511, h-index: 18)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 2)
J. of Supreme Court History     Hybrid Journal   (Followers: 7)
J. of Surgical Oncology     Hybrid Journal   (Followers: 1, SJR: 1.024, h-index: 69)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.933, h-index: 19)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.601, h-index: 29)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.36, h-index: 23)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 22, SJR: 1.167, h-index: 119)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 19, SJR: 1.673, h-index: 138)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 181, SJR: 1.555, h-index: 74)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 0.817, h-index: 56)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 4)
J. of the CardioMetabolic Syndrome     Hybrid Journal  
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 9, SJR: 1.211, h-index: 51)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 2, SJR: 0.535, h-index: 35)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 1, SJR: 0.46, h-index: 13)
J. of the Institute of Brewing     Free   (SJR: 0.528, h-index: 25)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 2, SJR: 0.935, h-index: 40)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 29, SJR: 1.128, h-index: 25)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 9, SJR: 1.258, h-index: 44)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 20, SJR: 5.518, h-index: 75)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 13, SJR: 0.877, h-index: 47)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 21, SJR: 0.781, h-index: 80)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.521, h-index: 30)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)

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Journal Cover BJU International
   [218 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
     Published by John Wiley and Sons Homepage  [1604 journals]   [SJR: 1.381]   [H-I: 96]
  • Robotic versus Non‐Robotic Instruments in Spatially Constrained
           Operative Workspaces – A Pre‐Clinical Randomised Crossover
           Study
    • Authors: Thomas P Cundy; Hani J Marcus, Archie Hughes‐Hallett, Thomas MacKinnon, Azad S Najmaldin, Guang‐Zhong Yang, Ara Darzi
      Pages: n/a - n/a
      Abstract: Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within 3 different cylindrical workspace sizes. Three pairs of instruments were compared; 3mm non‐robotic mini‐laparoscopy instruments, 5mm robotic instruments and 8mm robotic instruments. Workspace diameters were 4cm, 6cm and 8cm, with volumes of 50cm3, 113cm3 and 201cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. Overall median task performance scores for 3mm, 5mm and 8mm instruments were 421, 398 and 402 respectively (P = 0.12). Task scores were highest (best) for 3mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for 4cm, 6cm and 8cm diameter workspaces being 388, 415 and 420 respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with robotic instruments. Conclusion Smaller workspaces limit performance of robotic and non‐robotic instruments. In operative workspaces smaller than 200cm3, 3mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace restricted anatomical areas.
      PubDate: 2014-11-10T04:34:38.167304-05:
      DOI: 10.1111/bju.12987
       
  • A Novel Interface for the Telementoring of Robotic Surgery
    • Authors: Daniel H. Shin; Leonard Dalag, Raed A. Azhar, Michael Santomauro, Raj Satkunasivam, Charles Metcalfe, Matthew Dunn, Andre Berger, Hooman Djaladat, Mike Nguyen, Mihir M. Desai, Monish Aron, Inderbir S. Gill, Andrew J. Hung
      Pages: n/a - n/a
      Abstract: Objectives To prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (ConnectTM) for the da Vinci robot. Materials and Methods Robotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using ConnectTM. While viewing 2D, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using 2‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. Mentoring interface was rated using a multi‐factorial Likert‐based survey. Mann‐Whitney and T‐tests determined statistical difference. Results We enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative parameters of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (p>0.05). Mentors preferred remote over in‐room telestration (p=0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases utilizing wired (versus wireless) connections had lower latency and better data transfer (p=0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting ConnectTM, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions. Conclusion In a tightly controlled environment, the ConnectTM interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread utilization of this technology.
      PubDate: 2014-11-10T04:34:23.819349-05:
      DOI: 10.1111/bju.12985
       
  • Prediction of Cancer‐Specific Survival After Radical Cystectomy in
           pT4a Urothelial Carcinoma of the Bladder – Development of a Tool for
           Clinical Decision‐making
    • Authors: Atiqullah Aziz; Shahrokh F. Shariat, Florian Roghmann, Sabine Brookman‐May, Christian G. Stief, Michael Rink, Felix K. Chun, Margit Fisch, Vladimir Novotny, Michael Froehner, Manfred P. Wirth, Marco J. Schnabel, Hans‐Martin Fritsche, Maximilian Burger, Armin Pycha, Antonin Brisuda, Marko Babjuk, Stefan Vallo, Axel Haferkamp, Jan Roigas, Joachim Noldus, Regina Stredele, Björn Volkmer, Patrick J. Bastian, Evanguelos Xylinas, Matthias May
      Pages: n/a - n/a
      Abstract: Objective To externally validate May et al.'s pT4a‐specific risk model for cancer‐specific survival (CSS) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data of 856 pT4a patients after RC for UCB at 21 centres in Europe and North‐America was assessed. May et al.'s risk model including female gender, presence of positive LVI and lack of AC administration as adverse predictors for CSS was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver operating characteristics derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinico‐pathological parameters on CSS. Decision curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5‐year‐CSS after RC was 34% in our cohort. May et al.'s risk model predicted individual 5‐year‐CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (HR1.45), lymphovascular invasion (HR1.37), lymph node metastases (HR2.54), positive soft tissue surgical margin (HR1.39), neoadjuvant (HR2.24) and lack of adjuvant chemotherapy (HR1.67, all p
      PubDate: 2014-11-10T04:34:16.110634-05:
      DOI: 10.1111/bju.12984
       
  • Comparative efficacy and safety of various treatment procedures for lower
           pole renal calculi: a systematic review and network meta‐analysis
    • Authors: Shaun Wen Huey Lee; Nathorn Chaiyakunapruk, Huey Yi Chong, Men Long Liong
      Pages: n/a - n/a
      Abstract: Objective To compare the effectiveness of various treatments used for lower pole renal calculi Methods We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as ClinicalTrials.gov for reports up to April 1, 2014. Search was supplemented with abstract reports from various urology conferences. All randomised, blinded clinical studies including patients treated for lower pole renal calculi
      PubDate: 2014-11-10T04:34:08.778002-05:
      DOI: 10.1111/bju.12983
       
  • Temporary Implantable Nitinol Device (TIND®): a novel, minimally
           invasive treatment for relief of lower urinary tract symptoms (LUTS)
           related to benign prostatic hyperplasia: feasibility, safety and
           functional results at one year follow‐up
    • Authors: F. Porpiglia; C. Fiori, R. Bertolo, D. Garrou, G. Cattaneo, D. Amparore
      Pages: n/a - n/a
      Abstract: Objectives To report the first clinical experience with Temporary Implantable Nitinol Device (TIND ‐ Meditate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and Methods Thirty two patients with LUTS were enrolled in this prospective study that was approved by institutional Ethics Committee. Inclusion criteria were: age >50 years, IPSS scores of ≥10, urinary peak flow (Qmax) < 12 ml/sec, prostate volume < 50 cc. TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to Clavien system), functional results and quality of life (QoL) were evaluated. Follow‐up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. Student t, ANOVA and Kruskall Wallis tests, simple and multiple linear regression models were used in the statistical analysis. Results Patients’ age was 69.4 years, prostate volume (+standard deviation‐s.d.), IPSS score (interquartile range – i.r.), QoL (i.r.) and Qmax (+s.d.) were 29.5 (+7.4) cc, 19 (14‐23), 3 (3‐4), and 7.6 (+2.2) ml/sec respectively. All the implantations were successfully concluded with no intraoperative complications recorded. Mean operative time (+s.d.) was 5.8 (+2.5) min and median postoperative stay (i.r.) was 1 (1‐2) day. All but one devices (96%) were removed 5 days after the implantation, in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (1, 3.1%), transient incontinence due to device displacement (1, 3.1%) prostatic abscess (1, 3.1%) and urinary tract infection (1, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. Statistically significant differences were observed in the IPSS scores, QoL and Qmax when comparing pre‐ and postoperative results at every time point. After 12 months, IPSS score, QoL and Qmax were 9 (7‐13), 1 (1‐2) and 12 (+4.7) ml/sec respectively. Mean variations with respect to baseline conditions at the same time points were ‐45% in terms of IPSS score and +67% in terms of Qmax. During follow up period, required medical therapy or surgical procedures for BPH. Conclusion TIND implantation is a feasible and safe minimally‐invasive option for the treatment of BPH‐related LUTS. The functional results are encouraging and the treatment significantly improved patient quality of life. Further studies are required to assess durability of TIND results and to optimize the indications of such a procedure.
      PubDate: 2014-11-10T04:33:03.90969-05:0
      DOI: 10.1111/bju.12982
       
  • Long‐Term Outcomes of Robot‐Assisted Radical Prostatectomy:
           Where Do We Stand?
    • Authors: Francesco Montorsi; Giorgio Gandaglia, Alberto Briganti
      Pages: n/a - n/a
      PubDate: 2014-11-10T04:32:52.898566-05:
      DOI: 10.1111/bju.12981
       
  • Patterns of Surveillance Imaging After Nephrectomy in the Medicare
           Population
    • Authors: Michael A. Feuerstein; Coral L. Atoria, Laura C. Pinheiro, William C. Huang, Paul Russo, Elena B. Elkin
      Pages: n/a - n/a
      Abstract: Objectives To characterize patterns of imaging surveillance after nephrectomy in a population‐based cohort of older kidney cancer patients. Patients and Methods Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, we identified patients ≥66 years of age who had partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009. Primary outcomes were chest (X‐ray or CT) and abdominal (CT, MRI or ultrasound) imaging in Medicare claims from 4 to 36 months after surgery. We estimated the frequency of imaging in three time periods (post‐operative months 4‐12, 13‐24, 25‐36), stratified by tumor stage. Repeated‐measures logistic regression was used to identify patient and disease characteristics associated with imaging. Results Rates of chest imaging were 65‐80%, with chest X‐ray surpassing CT in each time period. Rates of abdominal imaging were 58‐76%, and cross‐sectional imaging was more common than ultrasound in each time period. Use of cross‐sectional chest and abdominal imaging increased over time while chest X‐ray decreased (p
      PubDate: 2014-11-10T04:32:44.623618-05:
      DOI: 10.1111/bju.12980
       
  • Mechanisms of ATP release ‐ future therapeutic targets?
    • Authors: Karl‐Erik Andersson
      Pages: n/a - n/a
      PubDate: 2014-11-10T04:32:35.676686-05:
      DOI: 10.1111/bju.12979
       
  • Review: The use of sling versus sphincter in post‐prostatectomy
           urinary incontinence
    • Authors: Van Bruwaene Siska; Van der Aa Frank, De Ridder Dirk
      Pages: n/a - n/a
      Abstract: Up till now the artificial urinary sphincter (AUS) was the so‐called gold standard in post‐prostatectomy incontinence. However, male slings have gained much popularity in recent years due to the ease in surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
      PubDate: 2014-11-10T04:32:25.692326-05:
      DOI: 10.1111/bju.12976
       
  • Renal Function is the same regardless of clamp technique 6 months after
           Robot‐assisted Partial Nephrectomy: Analysis of Off‐Clamp,
           Selective Arterial Clamp and Main Artery Clamp with minimum of 1 year
           follow‐up
    • Authors: Christos Komninos; Tae Young Shin, Patrick Tuliao, Woong Kyu Han, Byung Ha Chung, Young Deuk Choi, Koon Ho Rha
      Abstract: Objectives To compare the renal functional outcomes in patients with more than one year of follow‐up who underwent robotic partial nephrectomy (RPN) with several clamping techniques. Material and methods Perioperative data of 23 (off‐clamp‐group 1), 25 (selective clamp‐group 2) and 114 (main artery clamp‐group 3) patients who underwent RPN, were retrospectively analyzed. The main outcome parameters were the postoperative serum creatinine, eGFR and its percentage change, which were collected at periodic intervals during the first 12 months and annually thereafter, in addition to the late eGFR. Only patients with more than 1 year of follow‐up were included in the analysis. Results Baseline characteristics of groups 2 and 3 were similar, while patients in group 1 had smaller size and lower complexity tumors. Median follow‐up was 45 (group 1), 20 (group 2) and 47 (group 3) months, respectively. Median clamping time was 24.8 minutes in the main artery and 18 minutes in selective artery group, respectively. Group 2 had greater median blood loss volume (100 vs. 500 vs. 200 ml, p
      PubDate: 2014-11-06T04:20:35.083893-05:
      DOI: 10.1111/bju.12975
       
  • Development Of A Standardised Training Curriculum For Robotic Surgery: A
           Consensus Statement From An International Multidisciplinary Group Of
           Experts
    • Authors: Kamran Ahmed; Reenam Khan, Alexandre Mottrie, Catherine Lovegrove, Ronny Abaza, Rajesh Ahlawat, Thomas Ahlering, Goran Ahlgren, Walter Artibani, Eric Barret, Xavier Cathelineau, Ben Challacombe, Patrick Coloby, Jacques Hubert, M Shamim Khan, Maurice Stephan Michel, Francesco Montorsi, Declan Murphy, Joan Palou, Vipul Patel, Pierre‐Thierry Piechaud, Hendrik Van Poppel, Pascal Rischmann, Rafael Sanchez‐Salas, Stefan Siemer, Michael Stoeckle, Jens Uwe Stolzenburg, Jean Etienne Terrier, Joachin Thueroff, Christophe Vaessen Christophe, Henk G Van Der Poel, Ben Van Cleynenbreugel, Alessandro Volpe, Christian Wagner, Peter Wiklund, Timothy Wilson, Manfred Wirth, Jörn Witt, Prokar Dasgupta
      Abstract: Objectives To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. Materials and Methods An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during ERUS (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. Following content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme.. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. Results 150 minutes (19 pages) of the focus group discussion was transcribed (21316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter‐rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. Conclusion This group proposes a multi‐step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the OR.
      PubDate: 2014-10-31T01:49:32.367066-05:
      DOI: 10.1111/bju.12974
       
  • HIV‐related stone disease – a potential new paradigm'
    • Authors: Arumainayagam N; Gresty H, Shamsuddin A, Garvey L, DasGupta R
      PubDate: 2014-10-27T06:27:46.817659-05:
      DOI: 10.1111/bju.12971
       
  • Incidence of urethral stricture after bipolar transurethral resection of
           the prostate using TURis: results from a randomised trial
    • Authors: Kazumasa Komura; Teruo Inamoto, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Koichiro Minami, Rintaro Oide, Hirofumi Uehara, Kiyoshi Takahara, Hajime Hirano, Hayahito Nomi, Satoshi Kiyama, Toshikazu Watsuji, Haruhito Azuma
      Abstract: Objectives To assess whether bipolar transurethral resection of the prostate (B‐TURP) using the TURis® system has a similar level of efficacy and safety to that of the traditional monopolar transurethral resection of the prostate (M‐TURP), and to evaluate the impact of the TURis system on postoperative urethral stricture rates over a 36‐month follow‐up period. Patients and Methods A total of 136 patients with benign prostatic obstruction were randomised to undergo either B‐TURP using the TURis system or conventional M‐TURP, and were regularly followed for 36 months after surgery. The primary endpoint was safety, which included the long‐term complication rates of postoperative urethral stricture. The secondary endpoint was the follow‐up measurement of efficacy. Results In peri‐operative findings, no patient in either treatment group presented with transurethral resection syndrome, and the decline in levels of haemoglobin and hematocrit were similar. The mean operation time was significantly extended in the TURis treatment group compared with the M‐TURP group (79.5 vs 68.6 min; P = 0.032) and postoperative clot retention was more likely to be seen after M‐TURP (P = 0.044). Similar efficacy findings were maintained throughout 36 months, but a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M‐TURP vs 19.0% in TURis; P = 0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume ≤ 70 mL (3.8% in M‐TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M‐TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M‐TURP; P = 0.012). Furthermore, the mean operation time for TURis was significantly longer than for M‐TURP for the subgroup of patients with a prostate volume > 70 mL (99.6 vs 77.2 min; P = 0.011), but not for the subgroup of patients with a prostate volume ≤ 70 mL. Conclusion The TURis system seems to be as efficacious and safe as conventional M‐TURP except that there was a higher incidence of urethral stricture in patients with larger preoperative prostate volumes.
      PubDate: 2014-10-24T01:55:28.518382-05:
      DOI: 10.1111/bju.12831
       
  • Is there an antiandrogen withdrawal syndrome with enzalutamide'
    • Authors: Alejo Rodriguez‐Vida; Diletta Bianchini, Mieke Van Hemelrijck, Simon Hughes, Zafar Malik, Thomas Powles, Amit Bahl, Sarah Rudman, Heather Payne, Johann Bono, Simon Chowdhury
      Abstract: Objective To examine prostate‐specific antigen (PSA) levels after enzalutamide discontinuation to assess whether an antiandrogen withdrawal syndrome (AAWS) exists with enzalutamide. Methods We retrospectively identified 30 consecutive patients with metastatic prostate cancer who were treated with enzalutamide after docetaxel. Post‐discontinuation PSA results were available for all patients and were determined at 2‐weekly intervals until starting further anticancer systemic therapy. PSA withdrawal response was defined as a PSA decline by ≥50% from the last on‐treatment PSA, with a confirmed decrease ≥3 weeks later. Patient characteristics were evaluated in relation to the AAWS using univariate logistic regression analysis. Results The median (range) patient age was 70.5 (56–86) years and the median (range) follow‐up was 9.0 (0.5–16) months. The most common metastatic sites were the bone (86.7%) and lymph nodes (66.7%). Most patients (70%) had previously received abiraterone and 12 patients (40%) had also received cabazitaxel. The median (range) treatment duration with enzalutamide was 3.68 (1.12–21.39) months. PSA levels after enzalutamide withdrawal were monitored for a median (range) time of 35 (10–120) days. Only one patient (3.3%) had a confirmed PSA response ≥50% after enzalutamide discontinuation. One patient (3.3%) had a confirmed PSA response of between 30 and 50% and another patient (3.3%) had an unconfirmed PSA response of between 30 and 50%. The median overall survival was 15.5 months (95% CI 8.1–24.7). None of the factors analysed in the univariate analysis were significant predictors of PSA decline after enzalutamide discontinuation. Conclusions This retrospective study provides the first evidence that enzalutamide may have an AAWS in a minority of patients with metastatic castration‐resistant prostate cancer. Further studies are needed to confirm the existence of an enzalutamide AAWS and to assess its relevance in prostate cancer management.
      PubDate: 2014-10-24T01:35:20.799166-05:
      DOI: 10.1111/bju.12826
       
  • Cytotoxic chemotherapy in the contemporary management of metastatic
           castration‐resistant prostate cancer (mCRPC)
    • Authors: Guru Sonpavde; Christopher G. Wang, Matthew D. Galsky, William K. Oh, Andrew J. Armstrong
      Abstract: For several years, docetaxel was the only treatment shown to improve survival of patients with metastatic castration‐resistant prostate cancer (mCRPC). There are now several novel agents available, although chemotherapy with docetaxel and cabazitaxel continues to play an important role. However, the increasing number of available agents will inevitably affect the timing of chemotherapy and therefore it may be important to offer this approach before declining performance status renders patients ineligible for chemotherapy. Patient selection is also important to optimise treatment benefit. The role of predictive biomarkers has assumed greater importance due to the development of multiple agents and resistance to available agents. In addition, the optimal sequence of treatments remains undefined and requires further study in order to maximize long‐term outcomes. We provide an overview of the clinical data supporting the role of chemotherapy in the treatment of mCRPC and the emerging role in metastatic castration‐sensitive prostate cancer. We review the key issues in the management of patients including selection of patients for chemotherapy, when to start chemotherapy, and how best to sequence treatments to maximise outcomes. In addition, we briefly summarise the promising new chemotherapeutic agents in development in the context of emerging therapies.
      PubDate: 2014-10-23T21:58:29.773493-05:
      DOI: 10.1111/bju.12867
       
  • Medium‐term oncological outcomes for extended vs saturation biopsy
           and transrectal vs transperineal biopsy in active surveillance for
           prostate cancer
    • Authors: James E. Thompson; Andrew Hayen, Adam Landau, Anne‐Maree Haynes, Arveen Kalapara, Joseph Ischia, Jayne Matthews, Mark Frydenberg, Phillip D. Stricker
      Abstract: Objective To assess, in men undergoing active surveillance (AS) for low‐risk prostate cancer, whether saturation or transperineal biopsy altered oncological outcomes, compared with standard transrectal biopsy. Patients and Methods Retrospective analysis of prospectively collected data from two cohorts with localised prostate cancer (1998–2012) undergoing AS. Prostate cancer‐specific, metastasis‐free and treatment‐free survival, unfavourable disease and significant cancer at radical prostatectomy (RP) were compared for standard (12 core, median 16), and transrectal vs transperineal biopsy, using multivariate analysis. Results In all, 650 men were included in the analysis with a median (mean) follow‐up of 55 (67) months. Prostate cancer‐specific, metastasis‐free and biochemical recurrence‐free survival were 100%, 100% and 99% respectively. Radical treatment‐free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). On Kaplan–Meier analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (log‐rank P = 0.01). On multivariate Cox proportional hazards analysis, saturation biopsy (hazard ratio 1.68, P < 0.01) but not transperineal approach (P = 0.89) was associated with increased objective biopsy progression requiring treatment. On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (odds ratio 0.42, P = 0.03) but saturation biopsy did not alter the likelihood (P = 0.25). Neither transperineal nor saturation biopsy altered the likelihood of significant vs insignificant cancer at RP (P = 0.19 and P = 0.41, respectively). Conclusions AS achieved satisfactory oncological outcomes. Saturation biopsy increased progression to treatment on AS; longer follow‐up is needed to determine if this represents beneficial earlier detection of significant disease or over‐treatment. Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.
      PubDate: 2014-10-23T21:29:37.142058-05:
      DOI: 10.1111/bju.12858
       
  • Long‐term functional outcomes after artificial urinary sphincter
           implantation in men with stress urinary incontinence
    • Authors: Priscilla Léon; Emmanuel Chartier‐Kastler, Morgan Rouprêt, Vanina Ambrogi, Pierre Mozer, Véronique Phé
      Abstract: Objective To evaluate long‐term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery. Patients and Methods Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow‐up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision. Results In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64–72) years. The median (IQR) duration of follow‐up was 15 (8.25–19.75) years. At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow‐up, in intention‐to‐treat analysis, 77.2% of patients were continent. Conclusion In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
      PubDate: 2014-10-23T21:23:19.129545-05:
      DOI: 10.1111/bju.12848
       
  • Hypogonadal symptoms in young men are associated with a serum total
           testosterone threshold of 400ng/dL
    • Authors: Jason M. Scovell; Ranjith Ramasamy, Nathan Wilken, Jason R. Kovac, Larry I. Lipshultz
      Abstract: Objective To investigate the association between hypogonadal symptoms and total serum testosterone levels in young men (
      PubDate: 2014-10-23T05:29:53.449331-05:
      DOI: 10.1111/bju.12970
       
  • Cigarette smoking during external beam radiation therapy for prostate
           cancer is associated with an increased risk of prostate
           cancer‐specific mortality and treatment‐related toxicity
    • Authors: Emily Steinberger; Marisa Kollmeier, Sean McBride, Caroline Novak, Xin Pei, Michael J. Zelefsky
      Abstract: Purpose To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy (EBRT) for clinically localized prostate cancer is associated with increased treatment‐related toxicity or disease progression. Methods Of 2,358 patients receiving EBRT for prostate cancer 1988‐2005, 2,156 had chart‐recorded smoking histories. Patients were classified as never smokers, current smokers, former smokers, and current smoking unknown. Variables considered included quantity of tobacco use in pack‐years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. Median EBRT dose was 8100 Gy and median follow‐up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Current smoking significantly increased the risks of both prostate‐specific antigen relapse (hazard ratio [HR] = 1.4, P = 0.02) and distant metastases (HR = 2.37, P
      PubDate: 2014-10-23T05:29:27.843636-05:
      DOI: 10.1111/bju.12969
       
  • Early adopters or laggards' Attitudes toward and use of social media
           among urologists
    • Authors: Michael Fuoco; Michael J. Leveridge
      Abstract: Objective To understand the attitudes and practices of urologists regarding social media use. Social media services have become ubiquitous, but their role in the context of medical practice is underappreciated. Subjects and Methods A survey was sent to all active members of the Canadian Urological Association by e‐mail and surface mail. Likert scales were used to assess engagement in social media, as well as attitudes toward physician responsibilities, privacy concerns and patient interaction online. Results Of 504 surveys delivered, 229 were completed (45.4%). Urologists reported frequent or daily personal and professional social media use in 26% and 8% of cases, respectively. There were no differences between paper (n = 103) or online (n = 126; P > 0.05) submissions. Among frequent social media users, YouTube™ (86%), Facebook™ (76%), and Twitter™ (41%) were most commonly used; 12% post content or links frequently to these sites. The most common perceived roles of social media in health care were for inter‐professional communication (67%) or as a simple information repository (59%); online patient interaction was endorsed by 14% of urologists. Fewer than 19% had read published guidelines for online patient interaction, and ≤64% were unaware of their existence. In all, 94.6% agreed that physicians need to exercise caution personal social media posting, although 57% felt that medical regulatory bodies should ‘stay out of [their] personal social media activities’, especially those in practice 20 years (P = 0.02). Conclusion Practicing urologists engage infrequently in social media activities, and are almost universal in avoiding social media for professional use. Most feel that social media is best kept to exchanges between colleagues. Emerging data suggest an increasing involvement is likely in the continuing professional development space.
      PubDate: 2014-10-23T04:04:31.725549-05:
      DOI: 10.1111/bju.12855
       
  • The emerging use of Twitter by urological journals
    • Authors: Gregory J. Nason; Fardod O'Kelly, Michael E. Kelly, Nigel Phelan, Rustom P. Manecksha, Nathan Lawrentschuk, Declan G. Murphy
      Abstract: Objective To assess the emerging use of Twitter by urological journals. Methods A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on Twitter.com. Each journal website was accessed for links to social media (SoMe). The number of ‘tweets’, followers and age of profile was determined. To evaluate the content, over a 6‐month period (November 2013 to April 2014), all tweets were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. Results In all, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean (range) number of tweets and followers was 557 (19–1809) and 1845 (82–3692), respectively. The mean (range) age of the twitter profiles was 952 (314–1758) days with an average 0.88 tweets/day. A Twitter profile was associated with a higher mean impact factor of the journal (mean [sd] 3.588 [3.05] vs 1.78 [0.99], P = 0.013). Over a 6‐month period, November 2013 to April 2014, the median (range) number of tweets per profile was 82 (2–415) and the median (range) number of articles linked to tweets was 73 (0–336). Of these 710 articles, 152 were Level 1 evidence‐based articles, 101 Level 2, 278 Level 3 and 179 Level 4. The median (range) Klout score was 47 (19–58). The Klout scores of major journals did not exactly mirror their impact factors. Conclusion SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user‐friendly platform. Recently, many of the leading urological journals have used Twitter to highlight significant articles of interest to readers.
      PubDate: 2014-10-23T03:28:09.556108-05:
      DOI: 10.1111/bju.12840
       
  • Ejaculatory dysfunction after treatment for lower urinary tract symptoms:
           retrograde ejaculation or retrograde thinking'
    • Authors: Paul Sturch; Henry H. Woo, Tom McNicholas, Gordon Muir
      PubDate: 2014-10-23T01:27:52.526145-05:
      DOI: 10.1111/bju.12868
       
  • Robotic management of genitourinary injuries from obstetric and
           
    • Authors: Paul T. Gellhaus; Akshay Bhandari, M. Francesca Monn, Thomas A. Gardner, Prashanth Kanagarajah, Christopher E. Reilly, Elton Llukani, Ziho Lee, Daniel D. Eun, Hani Rashid, Jean V. Joseph, Ahmed E. Ghazi, Guan Wu, Ronald S. Boris
      Abstract: Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high‐volume institutions between 2002 and 2013 that had a robot‐assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1–297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re‐implants (11 with ipsilateral psoas hitch) and 15 uretero‐ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1–63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1–26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow‐up of the entire cohort was 16.6 (1–63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.
      PubDate: 2014-10-23T01:00:10.321729-05:
      DOI: 10.1111/bju.12785
       
  • Evaluation of functional outcomes after laparoscopic partial nephrectomy
           using renal scintigraphy: clamped vs clampless technique
    • Authors: Francesco Porpiglia; Riccardo Bertolo, Daniele Amparore, Valerio Podio, Tiziana Angusti, Andrea Veltri, Cristian Fiori
      Abstract: Objectives To examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy (LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN. Patients and Methods Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time (WIT): group A, conventional LPN and group B, clampless‐LPN (WIT = 0 min). Demographic and peri‐operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi‐squared and Student's t‐tests were carried out and regression analysis was performed. Results Group A was found to be similar to group B in all variables measured except for WIT and blood loss (P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney. Conclusions In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function.
      PubDate: 2014-10-22T22:36:10.60907-05:0
      DOI: 10.1111/bju.12834
       
  • Incidence of needle‐tract seeding following prostate biopsy for
           suspected cancer: a review of the literature
    • Authors: Dimitrios Volanis; David E. Neal, Anne Y. Warren, Vincent J. Gnanapragasam
      Abstract: With the widespread clinical use of prostate‐specific antigen (PSA), biopsy of the prostate has become one of the most commonly performed urological procedures. In general it is well tolerated, although there is some morbidity and risk of infection. In recent years, there have been increasing concerns that prostate biopsy may lead to tumour seeding along the needle tract. The aim of the present paper was to review the evidence on the prevalence of tumour seeding after prostate biopsy and to define the risk of this event in the context of current clinical practice. A PubMed literature search was conducted in January 2014 according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) statement. Literature was examined with emphasis on the incidence of seeding, clinical presentation and on risk factors including type of needle used, transrectal vs transperineal approach, as well as tumour grade and stage. In all, 26 publications were identified reporting needle‐tract seeding after prostate biopsy. In all, 42 patients with needle‐tract seeding were identified. In most cases, seeding was reported after transperineal biopsy of the prostate, while nine cases occurred after transrectal biopsy. Based on the reviewed series the incidence of seeding appears to be
      PubDate: 2014-10-22T22:27:15.686689-05:
      DOI: 10.1111/bju.12849
       
  • Contemporary practice and technique‐related outcomes for radical
           prostatectomy in the UK: a report of national outcomes
    • Authors: Alexander Laird; Sarah Fowler, Daniel W. Good, Grant D. Stewart, Vaikuntam Srinivasan, Declan Cahill, Simon F. Brewster, S. Alan McNeill,
      Abstract: Objective To determine current radical prostatectomy (RP) practice in the UK and compare surgical outcomes between techniques. Patients and Methods All RPs performed between 1 January 2011 and 31 December 2011 in the UK with data entered into the British Association of Urological Surgeons (BAUS) database, were identified for analysis. Overall surgical outcomes were assessed and subgroup analyses of these outcomes, based on operative technique [open RP (ORP), laparoscopic RP (LRP) and robot‐assisted laparoscopic RP (RALP)], were made. Continuous variables were compared using the Mann–Whitney U‐test and categorical variables using the Pearson chi‐squared test. Univariate and multivariate binary regression analyses were performed to assess the effect of patient, surgeon and technique‐related variables on surgical outcomes. Results During the study period 2163 RPs were performed by 115 consultants with a median (range) of 11 (1–154) cases/consultant. Most RPs were performed laparoscopically (ORP 25.8%, LRP 54.6%, RALP 19.6%) and those performing minimally invasive techniques are more likely to have a higher annual case volume with 50 cases/year. Most patients were classified as having intermediate‐ or high‐risk disease preoperatively (1596 patients, 82.5%) and this increased to 97.2% (1649) on postoperative risk stratification. The overall intraoperative complication rate was 14.2% and was significantly greater for LRP (17.8%) vs ORP (8.2%) and RALP (12.4%), (P < 0.001). In all, 71% of patients had an estimated blood loss (EBL) of 500, > 1000 and >2000 mL EBL compared with the other techniques (P < 0.001). The postoperative complication rate was 10.7% overall, with a significantly greater postoperative complication rate in the LRP group (LRP 14.6%, ORP 8.8% and RALP 10.3% respectively, P = 0.007). Positive surgical margin (PSM) rates were 17.5% for pT2 disease and 42.3% for pT3 disease. The PSM rate was significantly lower in the RALP patients compared with the ORP patients for those with pT2 disease (P = 0.025), while there was no difference between ORP and LRP (ORP 21.7%, LRP 18.1% and RALP 13.0%). There was no significant difference in the PSM rate in pT3 disease between surgical techniques. Conclusion Most RPs in the UK are performed using minimally invasive techniques, which offer reduced blood loss and transfusion rates compared with ORP. The operation time, complication rate, PSM rates, and association with higher volume practice support RALP as the minimally invasive technique of choice, which could have implications for regions without access to such services. The disparity in outcomes between this national study and high‐volume single centres, most probably reflects the low median national case volume, and combined with the positive effect of high case volume on multivariate analysis of surgical outcomes and PSM rates, strengthens the argument for centralisation of services.
      PubDate: 2014-10-22T22:21:52.371956-05:
      DOI: 10.1111/bju.12866
       
  • Long‐term follow‐up of a multicentre randomised controlled
           trial comparing tension‐free vaginal tape, xenograft and autologous
           fascial slings for the treatment of stress urinary incontinence in women
    • Authors: Zainab A. Khan; Arjun Nambiar, Roland Morley, Christopher R. Chapple, Simon J. Emery, Malcolm G. Lucas
      Abstract: Objective To compare the long‐term outcomes of a tension‐free vaginal tape (TVT; Gynecare™, Somerville, NJ, USA), autologous fascial sling (AFS) and xenograft sling (porcine dermis, Pelvicol™; Bard, Murray Hill, NJ, USA) in the management of female stress urinary incontinence (SUI). Patients and Methods A multicentre randomised controlled trial carried out in four UK centres from 2001 to 2006 involving 201 women requiring primary surgery for SUI. The women were randomly assigned to receive TVT, AFS or Pelvicol. The primary outcome was surgical success defined as ‘women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up’. The secondary outcomes included ‘completely dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL EQ‐5D questionnaire scores. Results In all, 162 (80.6%) women were available for follow‐up with a median (range) duration of 10 (6.6–12.6) years. ‘Success’ rates for TVT, AFS and Pelvicol were 73%, 75.4% and 58%, respectively. Comparing the 1‐ and 10‐year ‘success’ rates, there was deterioration from 93% to 73% (P < 0.05) in the TVT arm and 90% to 75.4% (P < 0.05) in the AFS arm; ‘dry’ rates were 31.7%, 50.8% and 15.7%, respectively. Overall, the ‘dry’ rates favoured AFS when compared with Pelvicol (P < 0.001) and TVT (P = 0.036). The re‐operation rate for persistent SUI was 3.2% (two patients) in the TVT arm, 13.1% (five) in the Pelvicol arm, while none of the patients in the AFS arm required further intervention. Conclusions Our study indicates there is not enough evidence to suggest a difference in long‐term success rates between AFS and TVT. However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT.
      PubDate: 2014-10-22T21:52:05.646649-05:
      DOI: 10.1111/bju.12851
       
  • Role of emergency ureteroscopy in the management of ureteric stones:
           analysis of 394 cases
    • Authors: Kamran Zargar‐Shoshtari; William Anderson, Michael Rice
      Abstract: Objective To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. Methods We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. Results A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re‐presented, for pain (76%), bleeding (10%) or infection (14%). Conclusion We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
      PubDate: 2014-10-22T20:34:28.086976-05:
      DOI: 10.1111/bju.12841
       
  • Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging
           reporting and data system (PI‐RADS) scoring in a transperineal
           prostate biopsy setting
    • Authors: Alistair D.R. Grey; Manik S. Chana, Rick Popert, Konrad Wolfe, Sidath H. Liyanage, Peter L. Acher
      Abstract: Objectives To determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard. Patients and Methods The study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2‐ and diffusion‐weighted images, 1.5 Tesla scanner, 8‐channel body coil). A specialist uro‐radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI‐RADS) scores on a Likert‐type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24–40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length ≥6 mm. Results A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (n = 103); primary biopsy (n = 83); and active surveillance (n = 15). Patients' mean (±sd) age, prostate‐specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI‐RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87–99) and a specificity of 60% (95% CI 51–68) at this threshold. Receiver–operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82–0.92). The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7% Conclusion We found that PI‐RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision‐making process for prostate biopsy.
      PubDate: 2014-10-22T20:33:59.638291-05:
      DOI: 10.1111/bju.12862
       
  • Ureteric stents vs percutaneous nephrostomy for initial urinary drainage
           in children with obstructive anuria and acute renal failure due to
           ureteric calculi: a prospective, randomised study
    • Authors: Mohammed S. ElSheemy; Ahmed M. Shouman, Ahmed I. Shoukry, Ahmed ElShenoufy, Waseem Aboulela, Kareem Daw, Ahmed A. Hussein, Hany A. Morsi, Hesham Badawy
      Abstract: Objectives To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria (OCA) and post‐renal acute renal failure (ARF) due to bilateral ureteric calculi, to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. Patients and Methods A series of 90 children aged ≤12 years presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric Hospital in this randomised comparative study. Patients with grade 0–1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non‐blinded, block randomisation, sealed envelope method) into PCN‐tube or bilateral JJ‐stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8–6 F JJ stents or 6–8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. Results All presented patients completed the study with intention‐to‐treat analysis. There was no significant difference between the PCN‐tube and JJ‐stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN‐tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ‐stent group. The degree of hydronephrosis significantly affected the operative time for PCN‐tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN‐tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN‐tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). Conclusion We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ‐stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN‐tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure.
      PubDate: 2014-10-20T22:13:18.799669-05:
      DOI: 10.1111/bju.12768
       
  • Lack of association of joint hypermobility with urinary incontinence
           subtypes and pelvic organ prolapse
    • Authors: Alex Derpapas; Rufus Cartwright, Purnima Upadhyaya, Alka A. Bhide, Alex G. Digesu, Vik Khullar
      Abstract: Objective To test the hypothesis that joint hypermobility (JHM) is associated with specific urinary incontinence (UI) subtypes and uterovaginal prolapse. Patients and Methods In all, 270 women scheduled to undergo urodynamic investigations were invited to self‐complete a validated five‐item JHM questionnaire. Women underwent history taking, symptoms assessing via the King's Health Questionnaire and clinical examination using the Pelvic Organ Prolapse Quantification system. Associations between JHM and pelvic floor disorders in univariate and multivariate ordinal regression were reported using odds ratios (ORs) and 95% confidence intervals (CIs). Results The prevalence of JHM was 31.1%. JHM had a negative association with age (OR 0.98/year, P = 0.04). There was no association between JHM and either urodynamic (P = 0.41), or symptomatic stress UI (P = 0.48). Nor was there association with detrusor overactivity or symptomatic urgency UI. Multivariate ordinal regression of JHM with maximum prolapse stage, adjusting for age, showed a significant relationship (OR 1.26/stage, 95% CI 1.06–1.46, P < 0.05). Conclusion Although JHM is highly prevalent amongst women with lower urinary tract symptoms (LUTS), there is no strong association of JHM with any UI subtype. There is a trend towards higher prolapse staging in women with JHM, which becomes significant only after adjustment for the confounding negative association between age and JHM.
      PubDate: 2014-10-20T22:06:56.951793-05:
      DOI: 10.1111/bju.12823
       
  • Safety and diagnostic accuracy of percutaneous biopsy in upper tract
           urothelial carcinoma
    • Authors: Steven Y. Huang; Kamran Ahrar, Sanjay Gupta, Michael J. Wallace, Joe E. Ensor, Savitri Krishnamurthy, Surena F. Matin
      Abstract: Objective To assess the diagnostic accuracy and safety of percutaneous biopsy for upper tract urothelial carcinoma (UTUC). Patients and Methods From 2002 to 2013, 26 upper tract lesions in 24 patients (20 men; median [range] age 67.8 [51.7–85.9] years) were percutaneously biopsied. Analysis was separated based on lesion appearance: (i) mass infiltrating renal parenchyma, (ii) filling defect in the collecting system, (iii) urothelial wall thickening. We tracked immediate complications and tract seeding on follow‐up imaging. Results Of the 26 upper tract lesions, 15 (58%) were masses infiltrating the renal parenchyma (mean [range] size 5.4 [1.1–14.0] cm), six (23%) were urothelial wall thickenings (mean [range] size 0.8 [0.4–1.1] cm), and five (19%) were filling defects within the renal pelvis or calyx (mean [range] size 2.7 [1.0–4.6] cm). Definitive diagnosis of UTUC was made by biopsy in 22 of 26 lesions (85%). Biopsy characterised 14 of 15 infiltrative masses and five of five filling defects; biopsy characterised three of six cases of urothelial wall thickening. CT follow‐up was available for 19 patients (73%) at a median (range) of 13.6 (1.0–98.9) months. Three patients (11%) developed recurrence in the nephrectomy bed at 5.6, 9.7, and 29.0 months after biopsy; none were attributed to tract seeding after independent review, because recurrence was remote from the biopsy site. Conclusion Percutaneous biopsy is effective for diagnosis of UTUC, providing tissue diagnosis in 85% of cases. While case reports cite a risk of tract seeding, no cases of recurrence were definitely attributable to percutaneous biopsy. Thus, for upper tract urothelial lesions, which are not amenable to endoscopic biopsy, percutaneous biopsy is a safe and effective technique.
      PubDate: 2014-10-20T22:05:10.22679-05:0
      DOI: 10.1111/bju.12824
       
  • Metabolic syndrome‐like components and prostate cancer risk: results
           from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study
           
    • Authors: Katharine N. Sourbeer; Lauren E. Howard, Gerald L. Andriole, Daniel M. Moreira, Ramiro Castro‐Santamaria, Stephen J. Freedland, Adriana C. Vidal
      Abstract: Objective To evaluate the relationship between number of metabolic syndrome (MetS)‐like components and prostate cancer diagnosis in a group of men where nearly all biopsies were taken independent of prostate‐specific antigen (PSA) level, thus minimising any confounding from how the various MetS‐like components may influence PSA levels. Subjects/Patients and Methods We analysed data from 6426 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study with at least one on‐study biopsy. REDUCE compared dutasteride vs placebo on prostate cancer risk among men with an elevated PSA level and negative pre‐study biopsy and included two on‐study biopsies regardless of PSA level at 2 and 4 years. Available data for MetS‐like components included data on diabetes, hypertension, hypercholesterolaemia, and body mass index. The association between number of these MetS‐like components and prostate cancer risk and low‐grade (Gleason sum 7) vs no prostate cancer was evaluated using logistic regression. Results In all, 2171 men (34%) had one MetS‐like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS‐like components had lower PSA levels (P = 0.029). One vs no MetS‐like components was protective for overall prostate cancer (P = 0.041) and low‐grade prostate cancer (P = 0.010). Two (P = 0.69) or three to four (P = 0.15) MetS‐like components were not significantly related to prostate cancer. While one MetS‐like component was unrelated to high‐grade prostate cancer (P = 0.97), two (P = 0.059) or three to four MetS‐like components (P = 0.02) were associated with increased high‐grade prostate cancer risk, although only the latter was significant. Conclusion When biopsies are largely PSA level independent, men with an initial elevated PSA level and a previous negative biopsy, and multiple MetS‐like components were at an increased risk of high‐grade prostate cancer, suggesting the link between MetS‐like components and high‐grade prostate cancer is unrelated to a lowered PSA level.
      PubDate: 2014-10-20T20:59:27.037151-05:
      DOI: 10.1111/bju.12843
       
  • Testosterone therapy and cancer risk
    • Authors: Michael L. Eisenberg; Shufeng Li, Paul Betts, Danielle Herder, Dolores J. Lamb, Larry I. Lipshultz
      Abstract: Objective To determine if testosterone therapy (TT) status modifies a man's risk of cancer. Patients and Methods The Urology clinic hormone database was queried for all men with a serum testosterone level and charts examined to determine TT status. Patient records were linked to the Texas Cancer Registry to determine the incidence of cancer. Men accrued time at risk from the date of initiating TT or the first office visit for men not on TT. Standardised incidence rates and time to event analysis were performed. Results In all, 247 men were on TT and 211 did not use testosterone. In all, 47 men developed cancer, 27 (12.8%) were not on TT and 20 (8.1%) on TT. There was no significant difference in the risk of cancer incidence based on TT (hazard ratio [HR] 1.0, 95% confidence interval [CI] 0.57–1.9; P = 1.8). There was no difference in prostate cancer risk based on TT status (HR 1.2, 95% CI 0.54–2.50). Conclusion There was no change in cancer risk overall, or prostate cancer risk specifically, for men aged >40 years using long‐term TT.
      PubDate: 2014-10-20T05:08:08.566885-05:
      DOI: 10.1111/bju.12756
       
  • The scientific basis for the use of biomaterials in stress urinary
           incontinence (SUI) and pelvic organ prolapse (POP)
    • Authors: Marc Colaco; Jayadev Mettu, Gopal Badlani
      Abstract: Objectives To review the scientific and clinical literature to assess the basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pelvic floor diseases (PFDS), such as SUI and POP, are common and vexing disorders. While synthetic mesh‐based repairs have long been considered an option for PFD treatment, and their efficacy established in randomised clinical trials, safety of its use has recently been called into question. Materials and Methods Using the PubMed, MEDLINE and Medical Subject Headings (MeSH) databases, we performed a critical review of English‐language publications that contained the following keywords: ‘pelvic organ prolapse’, ‘stress urinary incontinence’, ‘mesh’, ‘biomaterial’, ‘collagen’, ‘elastin’ and ‘extracellular matrix’. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review. Results We found that many of the potential causes of PFDs are due to altered metabolism of patient extracellular matrix (specifically collagen, elastin, and their respective enzymes) and as such, repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. However, mesh use is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu. Conclusion While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision‐making process.
      PubDate: 2014-10-20T03:48:27.406083-05:
      DOI: 10.1111/bju.12819
       
  • A new one‐layer epididymovasostomy technique
    • Authors: Alayman Hussein
      Abstract: Objectives To describe and evaluate the outcomes of a new epididymovasostomy technique. Patients and Methods Nine patients with obstructive azoospermia were treated at the Minia University Hospital using a new microsurgical bilateral epididymovasostomy technique. The technique involved the opening of a small window in the tunica of the epididymis, making an opening in the underneath epididymal tubule and keeping it open by fixing the edges of the epididymal opening to the edge of the epididymal tunica with four 10/0 nylon sutures. The abdominal cut end of the vas deferens was then anastomosed to the epididymal opening by suturing the epididymal tubule, fixed to its tunica in one layer, to the full thickness vas deferens. The main outcome measure was finding sperm in the ejaculate. Results Sperm was found in the ejaculate in six out of nine patients after our new, one‐layer, epididymovasostomy technique. Mean ± sd operating time was 176 ± 23 min. Conclusions This new, one‐layer, epididymovasostomy technique provides a simple alternative method of epididymovasostomy, with reasonable outcomes. More cases and follow‐up are needed to make meaningful comparisons with conventional epididymovasostomy.
      PubDate: 2014-10-20T02:58:45.271142-05:
      DOI: 10.1111/bju.12839
       
  • Long‐term efficacy of polydimethylsiloxane (Macroplastique®)
           injection for Mitrofanoff leakage after continent urinary diversion
           surgery
    • Authors: Antoine Kass‐iliyya; Tina G. Rashid, Isabella Citron, Charlotte Foley, Rizwan Hamid, Tamsin J. Greenwell, P. Julian R. Shah, Jeremy L. Ockrim
      Abstract: Objective To assess the long‐term efficacy of polydimethylsiloxane (Macroplastique®) injection (MPI) in the treatment of Mitrofanoff leakage secondary to valve incompetence. Patients and Methods Between 1995 and 2012, the records of 24 consecutive patients who underwent MPI for Mitrofanoff urinary leakage after continent cutaneous urinary diversion (CCUD) surgery were examined. All patients had a valve deemed of sufficient length (>2 cm) to attempt Macroplastique coaptation. Treatment outcomes were divided into three categories based on physician assessment: success (dry), partial success (>50% reduction in incontinence pads) and failure. Success rates were assessed according to the type of reservoir and conduit channel. Results The mean (range) follow‐up was 30 (6–96) months. One patient had initial difficulty catheterising, and subsequently required major revision surgery. In all, 12 patients (50%) failed the treatment and subsequently underwent operative revision to the channel. Three patients (12.5%) achieved complete success; one patient had an appendix channel through native bladder and the remaining two had Monti channels through colon. Nine patients (37.5%) had partial success; success rates were higher with appendix channels (four of six) and colonic reservoirs (six of seven) when compared with Monti channels (eight of 18, 44%) and ileal reservoirs (zero of two). Five of the nine patients with partial success eventually required further surgical revision for deteriorating continence at a mean (range) of 41 (14–96) months, whilst the other four have maintained sufficient continence with MPI alone. Conclusion Macroplastique bulking cured only 12.5% patients, but leakage was substantially improved in a further 37.5% allowing major surgery to be avoided or postponed in one half of the cohort. Appendix Mitrofanoffs do better than the Monti Mitrofanoff, with channels through colonic segments generally doing better than those through ileal bladders. MPI should be considered as a less invasive alternative to avoid or delay major reconstructive surgery.
      PubDate: 2014-10-20T02:44:23.811316-05:
      DOI: 10.1111/bju.12817
       
  • Obesity is associated with higher risk of prostate cancer detection in a
           biopsy population in Korea
    • Authors: Juhyun Park; Sung Yong Cho, Seung Bae Lee, Hwancheol Son, Hyeon Jeong
      Abstract: Objective To evaluate the impact of obesity on prostate cancer detection, as measured by the body mass index (BMI) in a Korean biopsy population. Patients and Methods We retrospectively reviewed the records of 1213 men who underwent transrectal ultrasonography‐guided prostate biopsy at our institution. Biopsy outcomes were analysed with respect to various variables, including patient age, prostate‐specific antigen (PSA), prostate volume, digital rectal examination (DRE) findings and obesity, defined as BMI ≥25 kg/m2, an Asian BMI category. Results Among 1213 men, 408 (33.6%) were obese and 344 (28.4%) had a positive biopsy. Obese men were younger (65.5 vs 67.1 years, P = 0.003), had a larger prostate (49.2 vs 42.9 mL, P < 0.001) and were less likely to have any abnormality on DRE (8.1 vs 15.9% P < 0.001) than non‐obese men. In the multivariate analysis, obesity was significantly associated with a higher risk of prostate cancer detection in men undergoing biopsy (odds ratio [OR] = 1.446, P = 0.024). In addition, obesity was significantly associated with a higher rate of biopsy‐detected high grade (Gleason score ≥4 + 3) disease, and this association remained after multivariate adjustment (OR = 1.498, P = 0.039). Conclusions Obese men were younger, had a larger prostate, and had less tendency to have an abnormality on DRE than non‐obese men. Obesity was associated with a higher risk of prostate cancer detection as an independent factor, including high grade prostate cancer in a Korean biopsy population.
      PubDate: 2014-10-20T01:44:24.857765-05:
      DOI: 10.1111/bju.12600
       
  • A novel prognostic model for patients with sarcomatoid renal cell
           carcinoma
    • Authors: Ben Y. Zhang; R. Houston Thompson, Christine M. Lohse, Bradley C. Leibovich, Stephen A. Boorjian, John C. Cheville, Brian A. Costello
      Abstract: Objective To demonstrate sarcomatoid differentiation is an independent prognostic feature for patients with grade 4 renal cell carcinoma (RCC) with or without distant metastases. To identify independent predictors of survival, evaluate the correlation between the amount of sarcomatoid differentiation and cancer‐specific survival (CSS), and to design a multivariate prognostic model for patients with sarcomatoid RCC. Patients and Methods We used the Mayo Clinic Nephrectomy Registry to identify 204 post‐nephrectomy patients with sarcomatoid‐variant RCC, as well as 207 patients with unilateral grade 4 RCC without sarcomatoid features for comparison. All slides were reviewed by one pathologist. CSS was estimated using the Kaplan–Meier method. The associations of clinical and pathological features with death from RCC were evaluated using Cox proportional hazards regression models. Results For all patients with grade 4 RCC, the presence of sarcomatoid differentiation was associated with a 58% increased risk of death from RCC (P < 0.001). For patients with grade 4 non‐metastatic (M0) RCC, the presence of sarcomatoid differentiation was associated with an 82% increased risk of death from RCC (P < 0.001). For patients with sarcomatoid RCC, the 2009 primary tumour classifications, presence of regional lymph nodes and distant metastases, coagulative tumour necrosis, and the amount of sarcomatoid differentiation were each significantly associated with death from RCC in a multivariate setting. After adjusting for other prognostic variables, each 10% increase in the amount of sarcomatoid differentiation was associated with a 6% increased risk of death from RCC (P = 0.028). Patients whose tumours contained ≥30% (median amount) sarcomatoid differentiation were 52% more likely to die from RCC compared with patients whose tumours contained
      PubDate: 2014-10-19T20:51:30.253909-05:
      DOI: 10.1111/bju.12781
       
  • International multicenter psychometric evaluation of patient reported
           outcome data for the treatment of Peyronie's disease
    • Authors: Kueronya V; Miernik A, Stupar S, Kojovic V, Hatzichristodoulou G, Egydio PH, Tosev G, Falcone M, De Luca F, Mulalic D, Djordjevic M, Schoenthaler M, Fahr C, Kuehhas FE
      Abstract: Objective To compare patient reported outcomes of the the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant following surgical correction of the penile curvature. Materials and Methods A retrospective review was performed regarding men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment‐related patient reported outcomes and satisfaction were evaluated with a non‐validated questionnaire. Results The average response rate to the questionnaire was 70,9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 individuals, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD (range 2.1‐3.2 cm), preoperatively. Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range, 0.4‐1.2cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by loss of length. Conclusions Penile length loss due to PD affects the majority of patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.
      PubDate: 2014-10-18T05:03:04.761042-05:
      DOI: 10.1111/bju.12968
       
  • Risk of Acute Myocardial Infarction after Androgen Deprivation Therapy for
           Prostate Cancer in the Chinese Population
    • Authors: Jeremy Yuen Chun Teoh; Samson Yun Sang Chan, Peter Ka Fung Chiu, Darren Ming Chun Poon, Ho Yuen Cheung, Simon See Ming Hou, Chi‐Fai Ng
      Abstract: Objective ‐ To investigate the risk of acute myocardial infarction (AMI) after androgen deprivation therapy (ADT) for prostate cancer in the Chinese population. Methods ‐ All Chinese prostate cancer patients who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from year 2000 to 2009 were retrospectively reviewed. ‐ We compared the risk of AMI in the patients who were given further ADT (ADT group) with those who were not given any ADT (non‐ADT group). ‐ Potential risk factors of AMI including age, diabetes mellitus, hypertension, hyperlipidemia, history of stroke, ischemic heart disease, ECOG performance status and duration of ADT were reviewed. ‐ The risk of AMI after ADT was first analyzed with Kaplan‐Meier method, followed by Cox regression analyses including the potential risk factors mentioned. Results ‐ A total of 452 patients were included, consisting of 200 patients in the non‐ADT group and 252 patients in the ADT group. ‐ The mean age was 68.2+5.9 years in the non‐ADT group and 69.5+6.5 years in the ADT group, and the difference was statistically significant (P = 0.031). ‐ There was no significant difference in their pre‐existing medical conditions and ECOG performance status. ‐ The ADT group was associated with an increased risk of AMI when compared to the non‐ADT group (P = 0.004) upon Kaplan‐Meier analysis. ‐ Upon multivariate Cox regression analysis, hyperlipidemia, poor ECOG performance status and the use of ADT were the only three significant factors that were associated with increased risk of developing new AMI. Conclusions ‐ There was increased risk of AMI after ADT for prostate cancer in the Chinese population. ‐ Hyperlipidemia and poor ECOG performance status were also significant risk factors for developing AMI. ‐ The risk of AMI should be considered while deciding on ADT, especially in patients with history of hyperlipidemia and relatively poor ECOG performance status. Prostate cancer, androgen deprivation therapy, myocardial infarction, Asian population
      PubDate: 2014-10-18T05:03:00.315896-05:
      DOI: 10.1111/bju.12967
       
  • DGKK Variants and hypospadias in Han Chinese: association and
           meta‐analysis
    • Authors: Qichao Ma; Yunman Tang, Houwei Lin, Maosheng Xu, Guofeng Xu, Xiaoliang Fang, Jianhua Chen, Zhijian Song, Zhiqiang Li, Yongyong Shi, Hongquan Geng
      Abstract: Objective To investigate whether diacylglycerol kinase kappa (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population, as has been suggested by previous publications. Patients and Methods A case‐control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias cases were further divided into mild, moderate and severe subgroups for analysis. Results Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias (ORs>1, 0.050.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta‐analysis on six SNPs, using combined data from our results and those of previous studies of different races (including 1966 cases and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs>1, p1, p
      PubDate: 2014-10-18T05:02:58.216041-05:
      DOI: 10.1111/bju.12965
       
  • Adverse Effects of Androgen Deprivation Therapy in Prostate Cancer and
           Their Management
    • Authors: H. Rhee; J.H. Gunter, P. Heathcote, K. Ho, P. Stricker, N.M. Corcoran, C.C. Nelson
      Abstract: Objective To provide an up‐to‐date summary of current literature on the management of adverse effects of androgen deprivation therapy (ADT). Subjects All men suffering from prostate cancer who are treated with androgen deprivation therapy. Methods All relevant medical literature from 2005 to 2014 and older relevant papers were reviewed to formulate this article. Recent health advisory statements from the Australian government, societies and advocacy groups have been incorporated to the document. Results There are numerous adverse effects of ADT that require pro‐active prevention and treatment. Ranging from cardiovascular disease, diabetes and osteoporosis to depression, cognitive decline and sexual dysfunction, the range of adverse effects is wide. Baseline assessment, monitoring, prevention and consultation from a multidisciplinary team are important in minimizing the harm from ADT. Conclusions This review provides series of practical recommendations to assist with managing adverse effects of ADT.
      PubDate: 2014-10-18T05:02:55.734203-05:
      DOI: 10.1111/bju.12964
       
  • A Prognostic Model for Survival after Palliative Urinary Diversion for
           Malignant Ureteral Obstruction: A Prospective Study of 208 Patients
    • Authors: Maurício D. Cordeiro; Rafael F. Coelho, Daher C. Chade, Rodrigo R. Pessoa, Mateus S. Chaib, José R. Colombo Júnior, Marcos F. Dall'Oglio, José Pontes‐Júnior, Giuliano B. Guglielmetti, Miguel Srougi
      Abstract: Objective To identify factors associated with survival after palliative urinary diversion for patients with malignant ureteral obstruction (MUO) and create a risk‐stratification model for treatment decisions. Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteral stenting or percutaneous nephrostomy (PCN) between January 1, 2009 and November 1, 2011 in 2 tertiary‐care university hospitals, with a minimum 6‐month follow‐up. Inclusion criteria were age >18 years and MUO confirmed by CT, ultrasonography or MRI. Outcome measurements and statistical analysis Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan‐Meier survival estimates at 1, 6 and 12 months and log‐rank tests. Results Median survival was 144 days (range 0–1,084 days) for the 208 patients included after UD (n=58 uretral stenting, n=150 PCN); 164 patients died, 44 (21.2%) during hospitalization. Overall survival did not differ by UD type (p=0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These 2 risk factors were used to divide patients into 3 groups by survival type: favorable (no factors), intermediate (1 factor) and unfavorable (2 factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favorable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavorable group (p
      PubDate: 2014-10-18T05:02:52.417999-05:
      DOI: 10.1111/bju.12963
       
  • Hypothermic Machine Perfusion Improves Doppler Ultrasound Resistive
           Indices and Long‐term Allograft Function Following Renal
           Transplantation: A Single Center Analysis
    • Authors: Marie S. Dion; Thomas B. McGregor, Vivian C. McAlister, Patrick P.W. Luke, Alp Sener
      Abstract: Objectives To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys may improve long‐term renal allograft function compared to static cold storage (CS). Methods We evaluated whether graft doppler ultrasound resistive indices improved with HMP compared to CS preservation and examined whether these improvements were predictive of long term graft function. 30 kidney transplants (15 pairs) were examined. One of the kidney pair was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n=15). Doppler ultrasound was done on days 1 and 7 after transplantation and resistive indices were evaluated. Estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. Results Despite longer cold‐ischemic times, kidneys maintained with HMP had lower resistive indices (p = 0.005) with correspondingly higher eGFR throughout follow‐up. Subgroup analysis showed that the HMP induced improvement in post‐operative eGFR is largest in kidneys obtained from donors after cardiac death (DCD), even at 2 years after transplantation (p=0.008). Conclusions HMP of transplant kidneys appears to improve vascular resistance after transplantation and positively impacts long‐term allograft function compared to CS in the DCD recipient population.
      PubDate: 2014-10-18T05:02:50.132278-05:
      DOI: 10.1111/bju.12960
       
  • Complications after artificial urinary sphincter implantation in patients
           with or without prior radiotherapy
    • Authors: Emmanuel Ravier; Hakim Fassi‐Fehri, Sébastien Crouzet, Albert Gelet, Nadia Abid, Xavier Martin
      Abstract: Objective To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy (RT). Patients and Methods Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurological and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and those lost to follow‐up. In all, 122 patients were included in the study, 61 with prior RT and 61 without prior RT. All patients underwent the same surgical technique by two different surgeons. All AUS were implanted with a bulbar urethral cuff position. The mean (range) follow‐up was 37.25 (1–126) months. Results In the patients without prior RT and those with prior RT, revision rates were 32.8% vs 29.5%, respectively (P = 0.59). The median time to first revision was 11.7 months. Early complications were similar in the two groups (4.9% vs 6.5%, P = 1). Erosion rates were not significantly different (4.9% vs 13.1%, P = 0.13). However, infection and explantation were more prevalent in patients with prior RT [two (3.2%) vs 10 (16.3%), P = 0.018 and three (4.9%) vs 12 (19.6%), P = 0.016, respectively]. Finally, continence rates were not significantly different [75.4% (without prior RT) vs 63.9% (with prior RT), P = 0.23]. Conclusion AUS is the ‘gold standard’ treatment of male urinary incontinence after re‐education failure in patients with or without prior RT. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior RT.
      PubDate: 2014-10-18T04:56:40.590983-05:
      DOI: 10.1111/bju.12777
       
  • NICE Guidelines on Prostate Cancer Active Surveillance: Is UK Practice
           Leading the World'
    • Authors: Edward H. Streeter; Simon F. Brewster,
      PubDate: 2014-10-18T04:56:38.701141-05:
      DOI: 10.1111/bju.12752
       
  • Multiparametric magnetic resonance imaging (MRI) and subsequent
           MRI/ultrasonography fusion‐guided biopsy increase the detection of
           anteriorly located prostate cancers
    • Authors: Dmitry Volkin; Baris Turkbey, Anthony N. Hoang, Soroush Rais‐Bahrami, Nitin Yerram, Annerleim Walton‐Diaz, Jeffrey W. Nix, Bradford J. Wood, Peter L. Choyke, Peter A. Pinto
      Abstract: Objective To describe the detection rate of anteriorly located prostate cancer (PCa) with the addition of magnetic resonance imaging (MRI)/ultrasonography (US) fusion‐guided biopsy (FGB) to the standard transrectal ultrasonography (TRUS)‐guided biopsy. Patients and Methods All patients, regardless of their biopsy history, who were referred for clinical suspicion of PCa (i.e elevated prostate‐specific antigen (PSA) level and abnormal digital rectal examination) underwent 3T multiparametric‐MRI (mpMRI) screening; and those with suspicious lesions in the anterior region of the prostate were identified. Patients then received a FGB of all suspicious lesions in addition to a systematic 12‐core extended sextant TRUS‐guided biopsy. We conducted a lesion‐based analysis comparing cancer detection rates of anterior targets using FGB vs systematic cores taken from the same anatomic sextant within the prostate. Lengths of cancer in the most involved core were also compared between the two biopsy techniques used. Patients with only anterior targets were analysed separately. Results Of 499 patients undergoing FGB, 162 had a total of 241 anterior lesions. The mean age, PSA level and prostate volume in this group were 62 years, 12.7 ng/dL, and 57 mL, respectively. In total, PCa was diagnosed in 121 anterior lesions (50.2%) identified on mpMRI. Sixty‐two (25.7%) of these anterior lesions were documented as positive for cancer on systematic 12‐core TRUS‐guided biopsy cores, while 97 (40.2%) were positive on the targeted FGB cores (P = 0.001). In lesions that were positive on both FGB and TRUS biopsy, the most involved core was 112% longer on FGB (3.7 vs 1.6 mm, P ≤ 0.01). Forty‐two patients had only anterior lesions on mpMRI; of these, 24 (57.1%) were found to have cancer on the FGB + TRUS biopsy platform. Six patients were positive on FGB only and 13 were positive on both biopsy techniques; however, 7/13 patients were upgraded to a higher Gleason score after FGB. All five patients positive on TRUS biopsy only were candidates for active surveillance. Conclusion The results showed that FGB detects significantly more anteriorly located PCa than does TRUS‐guided biopsy alone and it may serve as an effective tool for the subset of patients with such tumours.
      PubDate: 2014-10-18T04:52:43.801795-05:
      DOI: 10.1111/bju.12670
       
  • Primary invasive carcinoma associated with penoscrotal extramammary
           Paget's disease: a clinicopathological analysis of 56 cases
    • Authors: Bo Dai; Yun‐Yi Kong, Kun Chang, Yuan‐Yuan Qu, Ding‐Wei Ye, Shi‐Lin Zhang, Hai‐Liang Zhang
      Abstract: Objectives To investigate the clinicopathological features, therapeutic strategies, and prognostic factors of patients with penoscrotal invasive extramammary Paget's disease (EMPD). Patients and Methods We retrospectively collected clinical, pathological, and follow‐up data of 56 men with invasive penoscrotal EMPD. Histopathological features of the primary skin lesion including tumour size, surgical margin status, depth of invasion and lymphovascular invasion were examined. Results The median age was 67 years and median longest diameter of lesion was 5 cm. All patients were treated with wide surgical excision and 22 patients with clinically positive regional lymph nodes underwent therapeutic regional lymph node dissection. At the end of the study, 44.6% of patients developed distant metastasis and 39.3% of patients had died from disease. Univariate analysis showed that patients with one of the following poor prognostic factors: depth of invasion of lower dermis or deeper, presence of lymphovascular invasion and regional lymph node metastasis at diagnosis, had significantly shorter cancer‐specific survival time. Multivariate analysis found that depth of invasion was the only independent prognostic factor. Conclusion The prognosis of invasive EMPD is significantly associated with depth of invasion, lymphovascular invasion and regional lymph node status. More aggressive therapy and more rigorous follow‐up should be recommended for patients with these poor prognostic factors.
      PubDate: 2014-10-17T03:35:41.115569-05:
      DOI: 10.1111/bju.12776
       
  • Burden of male lower urinary tract symptoms (LUTS) suggestive of benign
           prostatic hyperplasia (BPH) – focus on the UK
    • Authors: Mark Speakman; Roger Kirby, Scott Doyle, Chris Ioannou
      Abstract: Key Messages Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45–49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.
      PubDate: 2014-10-16T21:59:07.742372-05:
      DOI: 10.1111/bju.12745
       
  • Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer
           surgery: a UK national audit
    • Authors: Simon Pridgeon; Paula Allchorne, Bruce Turner, John Peters, James Green
      Abstract: Objectives To evaluate the use of post‐discharge venous thromboembolism (VTE) prophylaxis in UK pelvic cancer centres consistent with national guidelines. Methods Data was collected from healthcare professionals from 64 UK pelvic cancer centres. Results After radical cystectomy (RC), all cancer centres routinely use low‐molecular‐weight heparin (LMWH) in the perioperative period. After RC 67% of cancer centres use post‐discharge LMWH routinely. After radical prostatectomy (RP), 98% of units use perioperative LMWH VTE prophylaxis routinely. After RP, 61% of hospitals always use post‐discharge LMWH. In all, 27% of all UK cancer centres reported deaths or serious VTE complications from urological pelvic cancer surgery in the last 2 years. Conclusions The National Institute for Health and Care Excellence (NICE) issued explicit guidance of VTE prophylaxis after pelvic and abdominal cancer surgery. Conversion of national guidance into local policy is ≈60% for UK pelvic cancer centres. A lack of good quality evidence is cited as a reason for not adhering to NICE guidance.
      PubDate: 2014-10-16T21:47:26.181798-05:
      DOI: 10.1111/bju.12693
       
  • Endophytic Tumours Do Not Constitute a Barrier to Robotic Partial
           Nephrectomy
    • Authors: Christos Komninos; Patrick Tuliao, Koon Ho Rha
      PubDate: 2014-10-16T21:44:13.281908-05:
      DOI: 10.1111/bju.12625
       
  • Penile cancer: organ‐sparing techniques
    • Authors: Paul K. Hegarty; Ian Eardley, Axel Heidenreich, W. Scott McDougal, Suks Minhas, Philippe E. Spiess, Nick Watkin, Simon Horenblas
      Abstract: To compare the oncological safety of treating patients with penile cancer with conservative techniques developed to preserve function, cosmesis and psychological well‐being with more radical ablative strategies. We conducted an extensive review of the literature of penile‐preserving and ablative techniques and report on the oncological as well as functional outcomes. There were no randomised studies comparing penile‐preserving and ablative techniques. Most studies consisted of retrospective cohorts. The quality of evidence was level 3 at best. Cancer‐specific survival is similar in penile‐preserving and ablative approaches for low‐stage disease. Penile preservation is better for functional and cosmetic outcomes and should be offered as a primary treatment method in men with low‐stage penile cancer.
      PubDate: 2014-10-16T21:31:06.810939-05:
      DOI: 10.1111/bju.12338
       
  • Clinical utility of 18F‐fluorocholine PET‐CT in biochemical
           relapse of prostate cancer after radical treatment. Results of a
           multicentre study
    • Authors: Sonia Rodado‐Marina; Mónica Coronado‐Poggio, Ana María García‐Vicente, Jose Ramón García‐Garzón, Aurora Crespo Jara, Antonio Maldonado‐Suárez, Antonio Rodríguez‐Fernández
      Abstract: Objective This study evaluated the usefulness of 18F‐fluorocholine PET/CT in restaging patients with a history of prostate adenocarcinoma who faced biochemical relapse after early radical treatment, and correlated the technique's disease detection rate with a set of variables and clinical and pathological parameters. Material and methods This was a retrospective multicentre study which included 374 patients referred for choline PET/CT who had biochemical relapse. In the end, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow‐up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline PET/CT with qualitative (T, N, early prostatectomy vs. other treatments, hormone therapy concomitant to choline PET/CT) and quantitative (age, Gleason score, PSA levels at diagnosis, PSA nadir, PSA on the day of the choline PET/CT or trigger PSA and PSADT) variables. We analysed whether there were independent predictive factors associated with the positive PET/CT result. All statistical tests were considered two‐sided and significant values where p
      PubDate: 2014-10-13T03:05:53.634252-05:
      DOI: 10.1111/bju.12953
       
  • Renal cell cancer histologic subtype distribution differs by race and sex
    • Authors: Loren Lipworth; Alicia K. Morgans, Todd L. Edwards, Daniel A Barocas, Sam S. Chang, S. Duke Herrell, David F. Penson, Matthew J. Resnick, Joseph A. Smith, Peter E. Clark
      Abstract: Objectives To examine racial differences in the distribution of histologic subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype. Materials and methods Tumors from 1,532 consecutive RCC patients who underwent nephrectomy at Vanderbilt University Medical Center (1998‐2012) were classified as clear cell, papillary, chromophobe, and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between race, sex, age, ESRD and body mass index at diagnosis (BMI, kg/m2) according to histologic subtype. Results The RCC subtype distribution was significantly different among blacks compared with whites (p
      PubDate: 2014-10-13T03:05:08.999603-05:
      DOI: 10.1111/bju.12950
       
  • Targeted local therapy in oligometastatic prostate cancer: a promising
           potential opportunity after failed primary treatment
    • Authors: Fairleigh Reeves; Declan Murphy, Christopher Evans, Patrick Bowden, Anthony Costello
      PubDate: 2014-10-13T02:39:55.11755-05:0
      DOI: 10.1111/bju.12957
       
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Authors: Pascal Zehnder; Felix Moltzahn, Anirban P. Mitra, Jie Cai, Gus Miranda, Eila C. Skinner, Inderbir S. Gill, Siamak Daneshmand
      Abstract: Objective ● At USC, the submission of lymphadenectomy specimens changed from en bloc to 13 separate anatomically defined packets in May 2002. ● We update our previous analysis of the clinical and pathological impact of this change in methodology, and determine whether lymph node (LN) packeting resulted in any change in oncologic outcomes. Patients and Methods ● 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection (LND) for cTxN0M0 bladder cancer between 01/1996 and 12/2007 were identified, ● Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results ● Pathologic tumor stage distribution and proportion of LN‐positive patients (group 1: 82 (22%) vs. group 2: 99 (21%); p=0.80) were similar: the median number of total LNs identified increased significantly (group 1: 32 (range: 10‐97), group 2: 65 (range: 10‐179); p
      PubDate: 2014-10-13T02:39:46.404403-05:
      DOI: 10.1111/bju.12956
       
  • A Systematic Review of Experience of 180W XPS GreenLight Laser
           Vaporization of the Prostate in 1640 men
    • Authors: C. Brunken; C. Seitz, H.H. Woo
      Abstract: Aim To systematically review the literature regarding clinical outcomes of 180W XPS GreenLight laser (GL) vaporization for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications in the field of 180 Watt GreenLight Laser (GL) vaporization for the treatment of LUTS due to BPH were identified by a literature search. It was searched for peer reviewed original articles in English language. Search items were: 180W lithium triborate laser or 180W greenlight laser or 180 watt lithium triborate laser or 180 watt greenlight laser or XPS greenlight laser. 30 papers published between 2012 and 2014 matched this search. Out of this collective 10 papers were identified dealing with consecutive cohorts of patients treated with the 180W XPS GreenLight® laser. Results Ten papers included a total experience of 1640 patients. The only RCT in this field compares 180W XPS with transurethral resection of the Prostate (TURP). Functional outcomes and prostate volume reduction following GL vaporization were similar to TURP. Catheterization time and hospital stay were shorter in patients undergoing 180W XPS GL‐vaporization (41 and 66 hours vs 60 and 97 hours respectively). Four papers compared the 180W XPS system to former GL devices demonstrating increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180W XPS GreenLight laser offers shorter operation times than the former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
      PubDate: 2014-10-13T02:39:37.992433-05:
      DOI: 10.1111/bju.12955
       
  • ATP release from freshly isolated guinea‐pig bladder urothelial
           cells: a quantification and study of the mechanisms involved
    • Authors: L M McLatchie; C H Fry
      Abstract: Objectives To quantify the amount of ATP released from freshly isolated bladder urothelial cells, study its control by intracellular and extracellular calcium and identify the pathways responsible for its release. Materials and methods Urothelial cells were isolated from male guinea‐pig urinary bladders and stimulated to release ATP by imposition of drag forces by repeated pippetting. ATP was measured using a luciferin‐luciferase assay and the effects of modifying internal and external calcium concentration and blockers of potential release pathways studied. Results Freshly isolated guinea‐pig urothelial cells released ATP at a mean rate of 1.9±0.1 pmoles.mm‐2 cell membrane, corresponding to about 700 pmoles/g of tissue, and about half (49±6 %, n=9) of available cell ATP. This release was reduced to 0.46±0.08 pmoles.mm‐2 (160 pmoles/g) with 1.8 mM external calcium, and was increased approximately 2‐fold by increasing intracellular calcium. The release from umbrella cells was not significantly different from a mixed intermediate and basal cell population, suggesting that all three groups of cells release a similar amount of ATP per unit area. ATP release was reduced by about 50% by agents which block pannexin and connexin hemichannels. It is suggested that the remainder may involve vesicular release. Conclusions A significant fraction of cellular ATP is released from isolated urothelial cells by imposing drag forces that cause minimal loss of cell viability. This release involves multiple release pathways, including hemichannels and vesicular release.
      PubDate: 2014-10-13T02:39:29.838007-05:
      DOI: 10.1111/bju.12954
       
  • Pelvic Recurrence Following Radical Cystectomy: A Call to Arms
    • Authors: Stephen B. Williams; Ashish M. Kamat, Donald L. Lamm
      PubDate: 2014-10-13T02:39:06.217065-05:
      DOI: 10.1111/bju.12952
       
  • Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the
           Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of
           a Prospective Pilot Double‐Blind and Randomized
           Placebo‐Controlled study
    • Authors: Siavash Falahatkar; Elaheh Shahab, Keivan Gholamjani Moghaddam, Ehsan Kazemnezhad
      Abstract: Objective To evaluate the effect of botulinumneurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Materials and Methods From November 2011 to January 2013, 60 men aged ≥18 years with CP/CPPS, NIH‐CPSI symptom scale score≥10 and pain subscale score≥8, and refractory to 4 to 6 weeks medical therapy underwent transurethral intraprostatic injection of BoNT‐A or normal saline (NS) in a prospective pilot double‐blind randomized study. NIH‐CPSI total and subscale scores, AUA‐SS, VAS and (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and 1,3 and 6 months after injection and also were compared between two groups. Results 60 consecutive patients were randomized as BoNT‐A or placebo group. In BoNT‐A group at 1, 3 and 6‐month evaluation compared to baseline values, NIH‐CPSI total and subscale scores, AUA‐SS, VAS and QoL scores along with frequencies of diurnal and nocturnal urinations had significantly improved (p
      PubDate: 2014-10-13T02:38:58.431961-05:
      DOI: 10.1111/bju.12951
       
  • Safety and clinical outcomes of patients treated with abiraterone acetate
           after docetaxel: results of the Italian Named Patient Programme
    • Authors: Orazio Caffo; Ugo De Giorgi, Lucia Fratino, Giovanni Lo Re, Umberto Basso, Alessandro D'Angelo, Maddalena Donini, Francesco Verderame, Raffaele Ratta, Giuseppe Procopio, Enrico Campadelli, Francesco Massari, Donatello Gasparro, Sveva Macrini, Caterina Messina, Monica Giordano, Daniele Alesini, Fable Zustovich, Anna P. Fraccon, Giovanni Vicario, Vincenza Conteduca, Francesca Maines, Enzo Galligioni
      Abstract: Objective To assess the safety and efficacy of abiraterone acetate (AA) in patients with metastatic castration‐resistant prostate cancer (mCRPC) treated in a compassionate named patient programme (NPP). Patients and Methods We retrospectively reviewed the clinical records of patients with mCRPC treated with AA at the standard daily oral dose of 1000 mg plus prednisone 10 mg/day in 19 Italian hospitals. Results We assessed 265 patients with mCRPC treated with AA. The most frequent (>1%) grade 3–4 toxicities were anaemia (4.2%), fatigue (4.2%), and bone pain (1.5%). The median progression‐free survival was 7 months; median overall survival was 17 months after starting AA, and 35 months after the first docetaxel administration. Our study reproduced the clinical outcomes reported in the AA pivotal trial, including those relating to special populations such as the elderly, patients with a poor performance status, symptomatic patients, and patients with visceral metastases. Conclusions Our data show the safety and activity of AA when administered outside clinical trials, and confirm the findings of the post‐docetaxel pivotal trial in the patients as a whole population and in special populations of specific interest.
      PubDate: 2014-10-08T22:44:42.432427-05:
      DOI: 10.1111/bju.12857
       
  • Three‐dimensional navigation system integrating
           position‐tracking technology with movable tablet display for
           percutaneous targeting
    • Authors: Arnaud Marien; Andre Luis De Castro Abreu, Mihir Desai, Raed A. Azhar, Sameer Chopra, Sunao Shoji, Toru Matsugasumi, Masahiko Nakamoto, Inderbir S. Gill, Osamu Ukimura
      Abstract: Objectives To assess the feasibility of a novel percutaneous navigation system (Translucent™ Medical) that integrates position‐tracking technology with a movable tablet display. Materials and Methods Total 18 fiducial markers (CIVCO Medical), which served as the target centers for the virtual tumors (target‐fiducials), were implanted in the prostate and kidney of fresh cadaver, followed by a pre‐operative CT for 3D models reconstruction of the surgical regions, which were registered on the body intra‐operatively. The position of movable tablet's display can be selected to obtain the best recognition of the interior anatomy. The system navigated puncture needle (with position‐tracking‐sensor attached) with a color‐coded, predictive puncture‐line. When the operator punctured the target‐fiducial, another fiducial, serving as the center of the ablative treatment (treatment‐fiducial), was placed. A post‐operative CT was acquired to assess the digitized distance (as the real distance) between the target‐ and treatment‐fiducials to evaluate the accuracy of the procedure. Results The movable tablet display (with position‐tracking‐sensor attached) facilitated the surgeon to recognize the 3D anatomy of the internal organs with overlaid puncture line of puncture needle with position‐tracking‐sensor attached. The mean (virtual) distance from the needle tip to the target, (calculated with the computer workstation), was 2.5 mm. In an analysis of each digitalized axial component, the errors were significantly greater along the z‐axis (p
      PubDate: 2014-10-07T22:56:06.378767-05:
      DOI: 10.1111/bju.12948
       
  • Long‐Term Analysis of Oncologic Outcomes After Laparoscopic Radical
           Cystectomy in Europe: Results from a Multicentric Study of
           Eau‐Section of Uro‐Technology
    • Authors: Simone Albisinni; Jens Rassweiler, Clement‐Claude Abbou, Xavier Cathelineau, Piotr Chlosta, Laurent Fossion, Franco Gaboardi, Peter Rimington, Laurent Salomon, Rafael Sanchez‐Salas, Jens‐Uwe Stolzenburg, Dogu Teber, Roland Velthoven
      Abstract: Objective To report long‐term outcomes of laparoscopic radical cystectomy (LRC) in a multi‐centric European cohort, and explore feasibility and safety of the procedure. Patients and Methods This study was coordinated by EAU‐section of Uro‐technology (ESUT) with nine centers enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analyzed. Descriptive statistics were used to explore peri‐ and post‐operative characteristics of the cohort. Kaplan‐Meier curves were constructed to evaluate recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, node involvement and surgical margin status. Results Minor complications (Clavien I‐II) occurred in 39% and major (IIIa‐IVb) in 17%. 10 (2%) post‐operative deaths were recorded. Median lymph node retrieval was 14 (IQR 9‐17) and positive surgical margins were detected in 29 (5.8%) patients. Median follow‐up was 50 months (mean 60, IQR 19‐90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, node involvement and margin status (log‐rank p
      PubDate: 2014-10-07T22:55:55.992849-05:
      DOI: 10.1111/bju.12947
       
  • Prognostic Factors Influencing Survival from Regionally Advanced Squamous
           Cell Carcinoma of the Penis After Preoperative Chemotherapy
    • Authors: Rian J. Dickstein; Mark F. Munsell, Lance C. Pagliaro, Curtis A. Pettaway
      Abstract: Objective To describe both clinical and pathologic response rates, survival, and predictors of survival when utilizing contemporary peri‐operative chemotherapy and surgical resection for patients with regionally advanced squamous cell carcinoma of the penis. Materials & Methods Retrospective review of all patients diagnosed with squamous cell carcinoma of the penis and regional lymph node metastases that were treated with chemotherapy with the intent to undergo lymphadenectomy. Clinical and pathologic responses were reported. Recurrence‐free and overall survival was estimated using Kaplan‐Meier analysis. Cox proportional hazards regression was used to assess factors for survival. Results Sixty‐one patients were identified, of which 54 (90%) received chemotherapy with paclitaxel/ifosfamide/cisplatin. Thirty‐nine patients (65%) exhibited either a partial (PR) or complete response (CR) to chemotherapy. Five‐year survival varied significantly (p=0.045‐0.001) among patients achieving a CR/PR (50%), stable disease (25%), and progression (7.7%). Ten patients (16.4%) were rendered pN0 with combined therapy. Twenty patients (33%) were alive and disease free at a median follow‐up of 67 months, while 32 (52%) died of disease. Long‐term survival was associated with response to chemotherapy and favorable pathologic findings post resection. Conclusion Contemporary chemotherapy resulted in clinically significant responses among patients with regionally advanced penile cancer. Approximately 50% of such patients with an objective response to chemotherapy who undergo consolidative lymphadenectomy will remain alive at 5 years.
      PubDate: 2014-10-07T22:55:46.012981-05:
      DOI: 10.1111/bju.12946
       
  • Changing trends in the aetiology and management of male urethral stricture
           disease in China: an observational descriptive study from 13 centres
    • Authors: Yue‐Min Xu; Lu‐Jie Song, Kun‐Jie Wang, Jian Lin, Guang Sun, Zhong‐Jin Yue, Hai Jiang, Yu‐Xi Shan, Shao‐Xing Zhu, Yu‐Jie Wang, Zhi‐ming Liu, Zhen‐Hua Li, Zhong‐Hua Liu, Qing‐Ke Chen, Min‐Kai Xie
      Abstract: Objective To determine whether there were any changes in the aetiology and management of urethral strictures in China. Patients and Methods The data from 4764 male patients with urethral stricture disease who underwent treatment at 13 medical centres in China between 2005 and 2010 were retrospectively collected. The databases were analysed for the possible causes, site and treatment techniques for the urethral stricture, as well as for changes in the urethral stricture aetiology and management. Results The most common cause of urethral strictures was trauma, which occurred in 2466 patients (51.76%). The second most common cause was iatrogenic injures, which occurred in 1643 patients (34.49%). The most common techniques to treat urethral strictures were endourological surgery (1740, 36.52%), anastomotic urethroplasty (1498, 31.44%) and substitution urethroplasty (1039, 21.81%). A comparison between the first three years and the last three years showed that the constituent ratio of endourological surgery decreased from 54% to 32.75%, whereas the constituent ratios of anastomotic urethroplasty and substitution urethroplasty increased from 26.73% and 19.18% to 39.93% and 27.32%, respectively (P<0.05). Conclusions During recent years, there has been an increase in the incidence of urethral strictures caused by trauma and iatrogenic injury. Endourological urethral surgery rates decreased significantly, and open urethroplasty rates increased significantly during the latter three years analysed.
      PubDate: 2014-10-07T22:55:39.625686-05:
      DOI: 10.1111/bju.12945
       
  • Short‐term pretreatment with a dual 5α‐reductase
           inhibitor before bipolar transurethral resection of the prostate
           (B‐TURP): evaluation of prostate vascularity and decreased surgical
           blood loss in large prostate
    • Authors: G.M. Busetto; R. Giovannone, G. Antonini, A. Rossi, F. Del Giudice, S. Tricarico, G. Ragonesi, V. Gentile, E. De Berardinis
      Abstract: Introduction dual 5α‐reductase inhibitor (5‐ARI), dutasteride, blocks the convertion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume, PSA, while increasing urinary flow rate. Bipolar transurethral resection of the prostate (B‐TURP) represents an improvement of the traditional TURP with almost the same efficacy and outcomes while the incidence of side‐effects is lower. Assuming that dutasteride has an action on prostatic vascularisation and assuming B‐TURP as a standard procedure for patients affected by BPH, we hypothesized that a short‐term pretreatment with dutasteride (0.5 mg daily for 8 weeks) can reduce intraoperative bleeding. Materials & Methods A total of 259 patients have been enrolled and randomized in Group A receiving placebo and Group B receiving dutasteride. In particular we evaluated blood parameters (haemoglobin and hematocrit) and prostate vascularity with vascular endothelial growth factor (VEGF) and microvascular density (MVD) using CD34. Statistical analysis was carried out using two‐sided tests, with p values < 0.05 denoting statistical significance. Continuous variables are reported as mean ± standard deviation and compared between groups using Student's t test. Analysis of Covariance was applied to assess the significance of variation in hemoglobin and hematocrit levels. Results total testosterone, DHT, PSA and prostate volume were evaluated and with the exception of DHT and PSA there was no statistically significant difference between the two groups. When comparing changes in hemoglobin and haematocrit between the Group A and Group B, before and after the B‐TURP, there is a statistically significant difference only when in the case of a large prostate ≥ 50 mL (ΔHb 3.86 vs. 2.05 and ΔHt 4.98 vs. 2.64 respectively). Evaluating MVD and VEGF index in prostates < 50 mL there is no significant difference while in large prostate the difference become statistically significant. Conclusions dutasteride is able to reduce operative and peri‐operative bleeding in patients submitted to B‐TURP only if a large prostate (≥ 50 mL) is being treated. Our findings are confirmed by hemoglobin and hematocrit values reported before and after the surgery and by the count of VEGF and CD34.
      PubDate: 2014-10-07T06:24:47.682111-05:
      DOI: 10.1111/bju.12917
       
  • Effects of bariatric surgery on untreated Lower Urinary Tract Symptoms: a
           prospective multicentre cohort study
    • Authors: Serge Luke; Ben Addison, Katherine Broughton, Jonathan Masters, Richard Stubbs, Andrew Kennedy‐Smith
      Abstract: OBJECTIVE To evaluate the effects of bariatric surgery on Lower Urinary Tract Symptoms in a prospective cohort study. MATERIALS AND METHODS Patients undergoing bariatric surgery were recruited into the study. Assessment was done using International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and PSA levels were recorded, insulin resistance was quantified using Homeostasis Model Assessment method (HOMA‐IR). Patients were assessed prior to; 6‐8 weeks post; and 1 year post surgery. Weight loss, change in BMI, total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method. Linear regression analysis was performed with total symptoms score change at one year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA‐IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables. RESULTS 86 patients were recruited, 82% completed at least one follow up after surgery. There was significant weight loss and reduction of BMI after surgery (p
      PubDate: 2014-09-29T07:12:29.842953-05:
      DOI: 10.1111/bju.12943
       
  • A rare 8q24 single nucleotide polymorphism (SNP) predisposes North
           American men to prostate cancer and possibly more aggressive disease
    • Authors: Boris Grin; Stacy Loeb, Kim Roehl, Phillip R. Cooper, William J. Catalona, Brian T. Helfand
      Abstract: Objective To assess the frequency of a novel prostate cancer‐associated single nucleotide polymorphism (SNP), rs188140481, in a North American population and to evaluate the clinical significance of this variant including annotated prostatectomy pathology. Patients/Subjects and Methods We examined the frequency of the minor allele at rs188140481 in 4299 North American men including 1979 men with prostate cancer and 2320 healthy volunteers. We compared the clinicopathological features of prostate cancer between carriers and non‐carriers of the SNP. Results The rs188140481[A] SNP was present in 1.6% of the cohort; it was significantly more likely to be carried by men with prostate cancer than healthy controls (odds ratio 3.14; 95% confidence interval [CI] 1.85–5.35). After adjusting for age and PSA levels, carriers were found to be 6.73‐fold (95% CI 1.69–26.76) more likely to develop prostate cancer than non‐carriers. Age at diagnosis, frequency of a positive family history of prostate cancer, and biochemical recurrence rates were similar between SNP carriers and non‐carriers. Patients with the SNP had a proportionately higher frequency of stage ≥T2c disease (29.5% vs 20.1%; P = 0.13), Gleason ≥8 tumours (13.3% vs 6.5%; P = 0.10), and extracapsular extension (28.9% vs 18.8%; P = 0.12) compared with non‐carriers. Conclusions rs188140481[A] is a rare SNP that confers greater risk of prostate cancer compared with SNPs identified by genome‐wide association studies. Because of its low frequency, larger studies are needed to validate the prognostic significance of this locus, and associations with adverse pathology.
      PubDate: 2014-09-25T20:37:14.532946-05:
      DOI: 10.1111/bju.12847
       
  • Sunitinib‐induced hypertension, neutropenia and thrombocytopenia as
           predictors of good prognosis in metastatic renal cell carcinoma patients
    • Authors: Juhana Rautiola; Frede Donskov, Katriina Peltola, Heikki Joensuu, Petri Bono
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the clinical significance of hypertension, neutropenia and thrombocytopenia as possible new biomarkers of sunitinib efficacy in non‐trial metastatic renal cell carcinoma (mRCC) patients. Materials and methods 181 consecutive mRCC patients were treated with sunitinib. Thirty‐nine (22%) patients received sunitinib 50 mg/day 4 weeks on/ 2 weeks off, 80 patients (44%) 37.5 mg/day continuously and 62 (34%) 25 mg/day continuously as their starting dose. Treatment‐induced adverse events (AE) and their impact on outcome were analysed on multiple sunitinib doses. Results During sunitinib treatment 60 patients (33%) developed ≥grade 2 hypertension, 88 (49%) ≥grade 2 neutropenia and 135 (75%) ≥grade 1 thrombocytopenia. These AEs were associated significantly with longer progression‐free survival (PFS; 15.7 vs. 6.7; 14.6 vs. 6.9; 10.4 vs. 4.2 months, respectively; P
      PubDate: 2014-09-23T06:54:36.400177-05:
      DOI: 10.1111/bju.12940
       
  • In patients with a previous negative prostate biopsy and a suspicious
           lesion on MRI, is a 12‐core biopsy still necessary in addition to a
           targeted biopsy?
    • Authors: Simpa S. Salami; Eran Ben‐Levi, Oksana Yaskiv, Laura Ryniker, Baris Turkbey, Louis R. Kavoussi, Robert Villani, Ardeshir R. Rastinehad
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the performance of multiparametric MRI (MP‐MRI) in predicting CaP on repeat biopsy; and to compare the cancer detection rates (CDR) of MRI/TRUS fusion‐guided biopsy with standard 12‐core biopsy in men with at least one previous negative biopsy. Materials and Methods We prospectively enrolled men with elevated or rising PSA and/or abnormal DRE into our MRI/TRUS fusion‐guided prostate biopsy trial. Participants underwent a 3T MP‐MRI with an endorectal coil. Three radiologists graded all suspicious lesions on a 5‐point Likert scale. MRI/TRUS fusion‐guided biopsies of suspicious prostate lesions and standard TRUS‐guided 12‐core biopsies were performed. Analysis of 140 eligible men with at least one previous negative biopsy was performed. We calculated CDR and estimated area under curves (AUCs) of MP‐MRI in predicting any and clinically significant CaP. Results The overall CDR was 65.0% (91/140). Higher level of suspicion on MP‐MRI was significantly associated with prostate cancer detection (p< 0.001) with an AUC of 0.744 compared with 0.653 and 0.680 for PSA and PSA density respectively. The CDRs of MRI/TRUS fusion‐guided and standard 12‐core biopsy modalities were 52.1% (73/140) and 48.6% (68/140) respectively (p = 0.435). However, fusion biopsy was more likely to detect clinically significant CaP when compared with the 12‐core modality (47.9% vs. 30.7%; p < 0.001). Of the cancers missed by 12‐core, 20.9% (19/91) were clinically significant. Most cancers missed by 12‐core (69.6%) were located in the anterior fibromuscular stroma and central gland. Using a Fusion biopsy only approach in men with an MRI suspicion score of ≥ 4 would have missed only 3.5% of clinically significant CaP. Conclusions MP‐MRI and subsequent MRI/TRUS fusion‐guided biopsy platform may improve detection of clinically significant CaP in men with previous negative biopsies. Addition of a 12‐core biopsy may be needed to avoid missing some clinically significant CaP.
      PubDate: 2014-09-23T06:54:29.313112-05:
      DOI: 10.1111/bju.12938
       
  • Trans‐Pacific Variation in Outcomes for Men Treated With Primary
           Androgen Deprivation Therapy for Prostate Cancer
    • Authors: Matthew R. Cooperberg; Shiro Hinotsu, Mikio Namiki, Peter R. Carroll, Hideyuki Akaza
      Abstract: Objectives To compare directly survival outcomes of primary androgen deprivation therapy (PADT) in Japan, where this treatment is endorsed by guidelines, with outcomes in the U.S., where it is not. Patients and Methods Data were compared between men receiving PADT in the US CaPSURE registry and the Japanese J‐CaP database. Competing risks regression was used to assess prostate cancer‐specific mortality (CSM), adjusting for age, Japan Cancer of the Prostate Risk Assessment (J‐CAPRA) score, diagnosis year, and treatment type (combined androgen blockade [CAB] vs. castration monotherapy), comorbidity, and practice type. Results Men on PADT in J‐CaP (N=13,880) were older than those in CaPSURE (N=1633), and had higher‐risk disease (mean J‐CAPRA score 3.8 vs. 2.1, p
      PubDate: 2014-09-19T06:04:50.871524-05:
      DOI: 10.1111/bju.12937
       
  • Association between metabolic syndrome and severity of lower urinary tract
           symptoms: observational study in a 4,666 European men cohort
    • Authors: Pourya Pashootan; Guillaume Ploussard, Arnaud Cocaul, Armaury De Gouvello, François Desgrandchamps
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between metabolic syndrome (MS) and the frequency and severity of lower urinary tract symptoms (LUTS) Patients and Methods 4,666 male patients from 55 to 100 years old consulting a general practitioner (GP) on a 12‐days period in December 2009 have been included into an observational study. LUTS were defined according to the I‐PSS score and metabolic syndrome with the NECP/ATP III definition. We studied the correlation between MS and its individual component, and the severity of LUTS (I‐PSS and treatment for LUTS). Analyses were adjusted on BMI, age, and PSA level. Results MS was reported in 51.5 % of the patients and 47% were treated for LUTS. There was a significant link between MS and treated LUTS (p
      PubDate: 2014-09-17T04:13:12.936292-05:
      DOI: 10.1111/bju.12931
       
  • An investigation into the relationship between Statins and Cancer using
           population‐based data
    • Authors: Jennifer C Melvin; Hans Garmo, Rhian Daniel, Thurkaa Shanmugalingam, Pär Stattin, Christel Häggström, Sarah Rudman, Lars Holmberg, Mieke Van Hemelrijck
      Pages: n/a - n/a
      Abstract: Background Results to date for the association between use of statins and prostate cancer (PCa) death in observational studies are inconsistent. We investigated the application of causal inference methods, which aim to address observational data as if they were from a randomised clinical trial (RCT). Material and Methods We examined the association between statins and PCa‐death in 14,926 men in PCBaSe Sweden. We used inverse probability weighted (IPW) estimation of marginal structural models (MSM), as well incorporating truncated IPW in the presence of time‐dependent confounders (TDC) (e.g., disease severity), affected by the exposure. Results The baseline adjusted odds ratio (OR) was 0.62 (95%CI: 0.51‐0.75), which compared risk of PCa‐death between men on statins and men not on statins. The calculated IPW for the MSM were highly variable, with the smallest weight at 0.0019 and the largest at 13,574, resulting in an OR of 0.89 (95%CI: 0.69‐1.14). Truncating the weights improved variability, reducing the largest weight to 13.16. The truncated MSM OR was 0.86 (95%CI: 0.81‐0.91). Conclusion An association of statins and risk of PCa‐death could not be reliably discerned, due to lack of data on essential confounders, namely serum cholesterol levels and disease severity. No observational studies on statin‐use to date present information on serum cholesterol levels and disease severity in one setting, highlighting the need for careful interpretation of investigations into drugs in relation to diseases other than their intended purpose in observational settings.
      PubDate: 2014-09-16T04:27:00.887158-05:
      DOI: 10.1111/bju.12935
       
  • Diagnostic value of biparametric magnetic resonance imaging (MRI) as an
           adjunct to prostate‐specific antigen (PSA)‐based detection of
           prostate cancer in men without prior biopsies
    • Authors: Soroush Rais‐Bahrami; M. Minhaj Siddiqui, Srinivas Vourganti, Baris Turkbey, Ardeshir R. Rastinehad, Lambros Stamatakis, Hong Truong, Annerleim Walton‐Diaz, Anthony N. Hoang, Jeffrey W. Nix, Maria J. Merino, Bradford J. Wood, Richard M. Simon, Peter L. Choyke, Peter A. Pinto
      Pages: n/a - n/a
      Abstract: Objectives To determine the diagnostic yield of analysing biparametric (T2‐ and diffusion‐weighted) magnetic resonance imaging (B‐MRI) for prostate cancer detection compared with standard digital rectal examination (DRE) and prostate‐specific antigen (PSA)‐based screening. Patients and Methods Review of patients who were enrolled in a trial to undergo multiparametric‐prostate (MP)‐MRI and MR/ultrasound fusion‐guided prostate biopsy at our institution identified 143 men who underwent MP‐MRI in addition to standard DRE and PSA‐based prostate cancer screening before any prostate biopsy. Patient demographics, DRE staging, PSA level, PSA density (PSAD), and B‐MRI findings were assessed for association with prostate cancer detection on biopsy. Results Men with detected prostate cancer tended to be older, with a higher PSA level, higher PSAD, and more screen‐positive lesions (SPL) on B‐MRI. B‐MRI performed well for the detection of prostate cancer with an area under the curve (AUC) of 0.80 (compared with 0.66 and 0.74 for PSA level and PSAD, respectively). We derived combined PSA and MRI‐based formulas for detection of prostate cancer with optimised thresholds. (i) for PSA and B‐MRI: PSA level + 6 x (the number of SPL) > 14 and (ii) for PSAD and B‐MRI: 14 × (PSAD) + (the number of SPL) >4.25. AUC for equations 1 and 2 were 0.83 and 0.87 and overall accuracy of prostate cancer detection was 79% in both models. Conclusions The number of lesions positive on B‐MRI outperforms PSA alone in detection of prostate cancer. Furthermore, this imaging criteria coupled as an adjunct with PSA level and PSAD, provides even more accuracy in detecting clinically significant prostate cancer.
      PubDate: 2014-09-15T04:54:55.847952-05:
      DOI: 10.1111/bju.12639
       
  • Effective Non‐Technical Skills are Imperative to Robot Assisted
           Surgery
    • Authors: Oliver Brunckhorst; Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: n/a - n/a
      PubDate: 2014-09-15T02:26:11.067214-05:
      DOI: 10.1111/bju.12934
       
  • Trifecta and Optimal Peri‐operative outcomes of Robotic and
           Laparoscopic Partial Nephrectomy In Surgical Treatment Of Small Renal
           Masses: A Multi‐Institutional Study
    • Authors: Homayoun Zargar; M. Allaf, Sam Bhayani, Michael Stifelman, Craig Rogers, Mark Ball, Jeffrey Larson, Susan Marshall, Ramesh Kumar, Jihad Kaouk
      Pages: n/a - n/a
      Abstract: Objective To compare the perioperative outcomes of RPN with LPN performed for SRMs, in a large multi‐institutional series. To define a new composite outcome measure, termed “ optimal outcome” for the RPN group. Patients and Methods Retrospective review of 2392 consecutive cases of RPN and LPN performed in 5 high volume centres from 2004 to mid 2013. We limited our study to SRMs and cases performed by surgeons with significant expertise with the technique. The Trifecta was defined as negative surgical margin, zero perioperative complications and warm ischemia ≤ 25. The “optimal outcome” was defined as achievement of Trifecta with addition of 90% eGFR preservation and no CKD stage upgrading. Univariable and multivariable analysis were performed to identify factors predicting Trifecta and “optimal outcome” achievement. Results Total of 1185 RPN and 646 LPN met our inclusion criteria. Patients in the RPN group were older and had higher median CCI and higher RENAL scores. The RPN group had lower warm ischemia time (18 vs. 26), overall complication rate (16.2 vs. 25.9%), and PSM (3.2% vs. 9.7%). A significantly higher Trifecta rate was observed for RPN (70% vs. 33%). The rate of achievement of “optimal outcome” for RPN group was 38.5%. Conclusions In this large multi‐institutional series RPN was superior to LPN in terms of peri‐operative surgical outcomes measured by Trifecta. Patients in the RPN group had better outcomes for all three components of Trifecta compared to their LPN counterparts. Our more strict definition for “optimal outcome” might be a better tool for assessing peri‐operative and functional outcomes after minimally invasive partial nephrectomy. This tool needs to be externally validated.
      PubDate: 2014-09-15T02:25:58.183976-05:
      DOI: 10.1111/bju.12933
       
  • Salvage micro‐dissection testicular sperm extraction; Outcome in men
           with Non obstructive azoospermia with previous failed sperm retrievals
    • Authors: J. S. Kalsi; P. Shah, Y. Thum, A. Muneer, D. J. Ralph, S. Minhas
      Pages: n/a - n/a
      Abstract: Objective To assess the outcome of m‐TESEas a salvage treatment in men withnon‐obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or TESA. Materials and Methods A total of 58 men with NOA underwent micro‐dissection testicular sperm extraction. All patients had previously undergone either single/multiple TESE or TESA with no sperm found. All patients underwent an m‐TESE using a standard technique. Serum follicle‐stimulating hormone, Testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent pre‐operative genetic screening.One patient was found to havean AZFc micro‐deletion and 5 werediagnosed with Kleinfelter's syndrome. Results The mean age of patients was39.0 years (range 26‐57).Spermatozoa were successfully retrieved in 27men by m‐TESE (46.5%).The mean FSH level was 19.4 (range 1.6‐ 58.5). There was no correlation in age (retrieved 38.1, not retrieved 39.7 p=0.38) FSH levels (Mean FSH retrieved 21.4, not retrieved 17.7p=0.3) and the ability to find sperm by m‐TESE. However, there was a significant difference with respect to testosterone and sperm retrieval (Mean testosterone retrieved 14.99, not retrieved 11.39 p
      PubDate: 2014-09-15T02:25:49.619319-05:
      DOI: 10.1111/bju.12932
       
  • Ureteroscopy for stone disease in the paediatric population – A
           systematic review
    • Authors: Ishii H; Griffin S, Somani BK
      Abstract: Objectives To look at the role of ureteroscopy for treatment of paediatric stone disease. Materials and Methods We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English language articles reporting on a minimum of 50 patients ≤18 years treated with ureteroscopy for stone disease were included. Two reviewers independently extracted the data from each study. Results A total of 14 studies (1718 procedures) were reported with a mean age of 7.8 years (0.25‐18 years). The mean stone burden was 9.8mm (1‐30mm) with a stone free rate (SFR) of 87.5% (58‐100%) with initial therapeutic ureteroscopy. Majority of these stones were in the ureter (n=1427, 83.4%). There were 180 (10.5%) clavien I‐III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorised into children below and above a mean age of 6 years. Four studies (341 procedures) and 10 studies (1377 procedures) respectively were reported in studies with children below and above mean age of 6 years. A higher failure rate (4.4% versus1.7%) and a higher complication rate (24% versus 7.1%) were observed in children with a mean age under the age of 6 years. Conclusion Ureteroscopy for paediatric stone disease is a relatively safe procedure with a reasonably good stone free rate, however there seems to be a higher failure rate and complication in children less than 6 years of age.
      PubDate: 2014-09-09T06:56:26.67629-05:0
      DOI: 10.1111/bju.12927
       
  • Proportion of tadalafil‐treated patients with clinically meaningful
           improvement in lower urinary tract symptoms associated with benign
           prostatic hyperplasia – integrated data from 1499 study participants
           
    • Authors: J. Curtis Nickel; Gerald B. Brock, Sender Herschorn, Ruth Dickson, Carsten Henneges, Lars Viktrup
      Abstract: Objectives •  To evaluate the proportion of patients achieving clinically meaningful improvement of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH‐LUTS) with tadalafil using two definitions of response. Patients and Methods •  Post‐hoc integrated analysis of four placebo‐controlled studies in men (≥45 years old; International Prostate Symptom Score [IPSS] ≥13; Qmax ≥4 to ≤15 mL/sec) with BPH‐LUTS randomized to tadalafil 5mg (N=752) or placebo (N=747) for 12 weeks following a 4‐week placebo run‐in. •  Responders were defined as having a total IPSS improvement of ≥3 points or ≥25% from randomization to endpoint (Week 12). •  Response status was calculated per patient, and relative benefit and odds ratios (95% CI) of tadalafil versus placebo was calculated using a logistic Generalized Mixed Model for Repeated Measures. Results •  Tadalafil 5mg once daily resulted in a significantly greater proportion of: 1. Patients achieving ≥3‐point IPSS improvement: 71.1% and 56.0% for tadalafil and placebo patients, respectively (odds ratio [95% CI]: 1.9 (1.5, 2.4); p
      PubDate: 2014-09-05T03:41:04.511326-05:
      DOI: 10.1111/bju.12926
       
  • ANZUP – a new co‐operative cancer trials group in
           genito‐urinary oncology
    • Authors: Shomik Sengupta; Peter Grimison, Dickon Hayne, Scott Williams, Suzanne Chambers, Paul Souza, Martin Stockler, Margaret McJannett, Guy Toner, Ian D. Davis
      Abstract: Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; and is unremunerated deputy‐chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd. Peter Grimison reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Germ Cell Subcommittee of the ANZUP Cancer Trials Group Ltd. Dickon Hayne reports grants from Cancer Australia, during the conduct of the study; and is unremunerated chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd. Scott Williams is unremunerated chair of the prostate cancer subcommittee the ANZUP Cancer Trials Group Ltd. Suzanne Chambers is unremunerated chair of the Quality of Life and Supportive Care Subcommittee of the ANZUP Cancer Trials Group Ltd. Paul DeSouza is unremunerated Chair of the Translational and Correlative Research Subcommittee of the ANZUP Cancer Trials Group Ltd. Martin Stockler reports reports grants from Cancer Australia, during the conduct of the study; Margaret McJannett is an employee of the ANZUP Cancer Trials Group Ltd. Guy Toner reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Deputy‐Chair of the Board of ANZUP Cancer Trials Group Ltd Ian Davis reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Board of ANZUP Cancer Trials Group Ltd
      PubDate: 2014-09-05T03:40:53.932513-05:
      DOI: 10.1111/bju.12925
       
  • Radiation exposure to a pregnant urological surgeon – what is
           safe'
    • Authors: AM Birnie; SR Keoghane
      PubDate: 2014-09-05T03:40:44.726156-05:
      DOI: 10.1111/bju.12923
       
  • Nomogram to predict the benefit from salvage systemic therapy for advanced
           urothelial carcinoma
    • Authors: Guru Sonpavde; Gregory R. Pond, Ronan Fougeray, Joaquim Bellmunt
      PubDate: 2014-09-05T03:40:35.972012-05:
      DOI: 10.1111/bju.12922
       
  • Retrograde ureteric stent insertion in the management of infected
           obstructed kidneys
    • Authors: Stephanie Flukes; Dickon Hayne, Melvyn Kuan, Michael Wallace, Kevin McMillan, Nicholas John Rukin
      Pages: n/a - n/a
      Abstract: Objectives To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosis secondary to ureteric calculi. Patients and methods Prospective analysis of all patients over 15 month period admitted with an infected obstructed kidneys secondary to ureteric calculi. Inclusion criteria were based on clinical evidence of systemic inflammatory response syndrome (SIRS) and radiological evidence of obstructing ureteric calculi. Outcome measures included success of procedure, admission to intensive care unit (ICU), length of hospital stay, morbidity, and all‐cause mortality during hospital admission. Results 52 patients included. Success of retrograde ureteric stenting was 98%. Seventeen per cent of patients required an ICU admission, with a post ureteric instrumentation ICU admissions rate of 6%. Mean white cell count and serum creatinine improved significantly post‐procedure. Major complication rate included septic shock 6%, but there were no episodes of major haemorrhage and no deaths. Conclusion Retrograde ureteric stenting is safe and effective in infected obstructed kidneys. Results are comparable to percutaneous nephrostomy tube insertion. Post instrumentation ICU admissions occur in 6% of retrograde stentings.
      PubDate: 2014-09-01T02:36:22.216154-05:
      DOI: 10.1111/bju.12918
       
  • Is it Safe to Insert a Testicular Prosthesis at the Time of Radical
           Orchidectomy for Testis Cancer – an Audit of 904 Men Undergoing
           Radical Orchidectomy
    • Authors: R Robinson; CD Tait, NW Clarke, VAC Ramani
      Pages: n/a - n/a
      Abstract: Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 – July 2005 and November 2007 – November 2009 were included. Data on post‐operative complications, length of stay (LOS), re‐admission rate and return to theatre rate was collected. Results 904 men (median age of 35 years, range 14 ‐ 88), underwent a radical orchidectomy during the study period. 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (p=0.0003), median age of 33 vs 37 years respectively. There was no significant difference between the 2 groups in LOS (p=0.387), hospital re‐admission rates (p=0.539) or return to theatre rate (p=>0.999). 33/885 patients were readmitted within 30 days of orchidectomy, with 1/236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30‐day hospital re‐admission (OR 1.032, p=0.016). Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re‐admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is a safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
      PubDate: 2014-08-28T06:28:15.212835-05:
      DOI: 10.1111/bju.12920
       
  • Is continent cutaneous urinary diversion a suitable alternative to
           orthotopic bladder substitute and ileal conduit after cystectomy?
    • Authors: Bashir Al Hussein Al Awamlh; Lily C. Wang, Daniel P. Nguyen, Malte Rieken, Richard K. Lee, Daniel J. Lee, Thomas Flynn, James Chrystal, Shahrokh F. Shariat, Douglas S. Scherr
      Pages: n/a - n/a
      Abstract: Objective ● To evaluate functional outcomes of continent cutaneous urinary diversion (CCUD) after cystectomy. ● To compare diversion‐related complications and long‐term renal function in a contemporary cohort of patients undergoing urinary diversion with CCUD, orthotopic bladder substitute (OBS) and ileal conduit (IC). Patients and Methods ● 322 patients underwent cystectomy and CCUD, OBS or IC from January 2002 to June 2013. CCUD was performed using either a modified Indiana pouch or an appendiceal stoma. ● For patients with CCUD, continence status and time intervals between clean intermittent catheterisations at last follow‐up were recorded. ● For all three diversion types, diversion‐related complications and renal function outcome as determined by the estimated glomerular filtration rate (eGFR) at baseline and at different time intervals after surgery were evaluated. ● Multivariate regression analysis was used to evaluate the association of diversion type, baseline variables and diversion‐related complications with renal function over time. Results ● Of all 322 patients, 73 (23%) received CCUD, 79 (25%) received OBS, and 170 (53%) received IC. ● After a median follow‐up of 36 months, the continence rate for patients with CCUD was 89%. Sixty‐four (88%) patients with CCUD were able to catheterise every 4‐8 hours and 5 (7%) were able to catheterise every 8‐10 hours. ● After a median follow‐up of 35 months, rates of diversion‐related complications were similar among patients who underwent CCUD, OBS or IC. ● Patients who received IC had poorer renal function preoperatively than those who received CCUD or OBS. However, at one year after surgery and thereafter, the three groups had comparable renal function. ● On multivariate analysis, the type of urinary diversion was not associated with decline in renal function. However, patient age at surgery, diabetes mellitus, baseline eGFR, postoperative non obstructive hydronephrosis and uretero‐enteric stricture were associated with decline in renal function. Conclusions ● CCUD is associated with excellent functional outcomes. ● Rates of diversion‐related complications and renal function outcomes are comparable with those from OBS and IC. ● CCUD should be considered a valid alternative for patients who undergo cystectomy and require urinary diversion.
      PubDate: 2014-08-28T06:28:07.711336-05:
      DOI: 10.1111/bju.12919
       
  • Oncologic Outcomes of Cryosurgery as Primary Treatment in T3 Prostate
           Cancer: Experience of a Single Center
    • Authors: Zhi Guo; Tongguo Si, Xueling Yang, Yan Xu
      Pages: n/a - n/a
      Abstract: Objective To access the oncologic outcomes and to determine prognostic factors for overall survival (OS), cancer‐specific survival (CSS), and biochemical progression‐free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer (PCa). Methods Between 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan‐Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. Results cT3a was detected in 60% (45/75) of patients, and cT3b was detected in 40% (30/75) of cases. The five‐year OS, CSS, and BPFS rates were 85.3, 92.0, and 48%, respectively. There was a significant difference when comparing the pT3a to pT3b groups for 5‐year OS (88.9 vs. 80%, P=0.02) and BPFS (55.6 vs. 36.7%, P=0.01), but there was no difference in CSS (93.3 vs. 90%, P=0.63). Stage, Gleason score, and nadir PSA were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. Conclusions Cryosurgery could offer good 5‐year OS, CSS, and BPFS rates for cT3 PCa, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.
      PubDate: 2014-08-28T06:27:27.692528-05:
      DOI: 10.1111/bju.12914
       
  • Pathologic Factors Associated with Survival Benefit From Adjuvant
           Chemotherapy: A Population‐Based Study of Bladder Cancer
    • Authors: Christopher M. Booth; D. Robert Siemens, Xuejiao Wei, Yingwei Peng, David M. Berman, William J. Mackillop
      Pages: n/a - n/a
      Abstract: Objective To evaluate whether pathologic factors are associated with differential effect of ACT. Patients and Methods In this population‐based retrospective cohort study we linked electronic records of treatment and surgical pathology to the Ontario Cancer Registry. The study population included all patients with MIBC undergoing cystectomy in Ontario 1994‐2008. Factors associated with overall (OS) and cancer‐specific survival (CSS) were evaluated using Cox proportional hazards. We tested for interaction between the following variables and ACT effect‐size: N stage, margin status, T stage, and lymphovascular invasion (LVI). Results The study population included 2802 patients; 19% were treated with ACT. Interaction terms with ACT for OS/CSS are: N stage (p
      PubDate: 2014-08-28T06:27:18.862634-05:
      DOI: 10.1111/bju.12913
       
  • The impact of robotic surgery on the surgical management of prostate
           cancer in the USA
    • Authors: Steven L. Chang; Adam S. Kibel, James D. Brooks, Benjamin I. Chung
      Pages: n/a - n/a
      Abstract: Objective To describe the surgeon characteristics associated with robot‐assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods A retrospective cohort study with a weighted sample size of 489 369 men who underwent non‐RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High‐volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7–3.4), intermediate‐ (200–399 beds; OR 5.96, 95% CI 1.3–26.5) and large‐sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4–25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7–6.4). RARP adoption was generally associated with increased RP volume, greatest for high‐volume surgeons and least for low‐volume surgeons (
      PubDate: 2014-08-26T00:52:13.437319-05:
      DOI: 10.1111/bju.12850
       
  • Evidence of increased centrally enhanced bladder compliance with ageing in
           a mouse model
    • Authors: Phillip P. Smith; Anthony DeAngelis, Richard Simon
      Pages: n/a - n/a
      Abstract: Objective To test the hypothesis that ageing is associated with increasing neurogenic enhancement of bladder filling compliance. Materials and Methods Female B6 mice (aged 2, 12, 22 and 26 months) underwent cystometry while alive and immediately after death. Bladder compliance was calculated from pressure‐time data. Pressure data were transformed using Fast Fourier Transform to obtain power spectra of bladder pressure variations attributable to contractile activity during filling in both alive and dead mice. A cut‐off frequency (CF) was determined for each mouse, above which any power content would be primarily neurogenic. Compliance and power spectra results were compared among age groups, and correlations sought. Results A reversible loss of bladder compliance and non‐voiding contractile (NVC) activity followed abolition of voiding reflexes in female colony mice in all age groups. Bladder filling compliance increased with age in urethane‐anaesthetised and post‐mortem conditions, and more so in the former. Power below the CF did not significantly vary with age. Neurogenic power increased with age, and significantly correlated with compliance. Conclusions An increase in neurogenic power during filling accompanies increased centrally mediated compliance enhancement with age. A bladder control model in which brain processes related to micturition may compensate for age‐associated changes; thereby preserving voiding function is suggested. Urinary dysfunction could be viewed as the result of homeostatic failure rather than strictly end‐organ pathology.
      PubDate: 2014-08-19T21:12:31.675268-05:
      DOI: 10.1111/bju.12669
       
  • Preventable mortality after common urological surgery: failing to
           rescue?
    • Authors: Jesse D. Sammon; Daniel Pucheril, Firas Abdollah, Briony Varda, Akshay Sood, Naeem Bhojani, Steven L. Chang, Simon P. Kim, Nedim Ruhotina, Marianne Schmid, Maxine Sun, Adam S. Kibel, Mani Menon, Marcus E. Semel, Quoc‐Dien Trinh
      Pages: n/a - n/a
      Abstract: Objective To assess in‐hospital mortality in patients undergoing many commonly performed urological surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in ‘failure to rescue’ (FTR) rates, e.g. death after a complication that was potentially recognisable/preventable. Patients and Methods Discharges of all patients undergoing urological surgery between 1998 and 2010 were extracted from the Nationwide Inpatient Sample and assessed for overall and FTR mortality. Admission trends were assessed with linear regression. Logistic regression models fitted with generalised estimating equations were used to estimate the impact of primary predictors on over‐all and FTR mortality and changes in mortality rates. Results Between 1998 and 2010, an estimated 7 725 736 urological surgeries requiring hospitalisation were performed in the USA; admissions for urological surgery decreased 0.63% per year (P = 0.008). Odds of overall mortality decreased slightly (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.988–0.993), yet the odds of mortality attributable to FTR increased 5% every year (OR 1.050, 95% CI 1.038–1.062). Patient age, race, Charlson Comorbidity Index, public insurance status, as well as urban hospital location were independent predictors of FTR mortality (P < 0.001). Conclusion A shift from inpatient to outpatient surgery for commonly performed urological procedures has coincided with increasing rates of FTR mortality. Older, sicker, minority group patients and those with public insurance were more likely to die after a potentially recognisable/preventable complication. These strata of high‐risk individuals represent ideal targets for process improvement initiatives.
      PubDate: 2014-08-19T01:02:04.688454-05:
      DOI: 10.1111/bju.12833
       
  • Augmented‐reality‐based skills training for
           robot‐assisted urethrovesical anastomosis: a
           multi‐institutional randomised controlled trial
    • Authors: Ashirwad Chowriappa; Syed Johar Raza, Anees Fazili, Erinn Field, Chelsea Malito, Dinesh Samarasekera, Yi Shi, Kamran Ahmed, Gregory Wilding, Jihad Kaouk, Daniel D. Eun, Ahmed Ghazi, James O. Peabody, Thenkurussi Kesavadas, James L. Mohler, Khurshid A. Guru
      Pages: n/a - n/a
      Abstract: Objective To validate robot‐assisted surgery skills acquisition using an augmented reality (AR)‐based module for urethrovesical anastomosis (UVA). Methods Participants at three institutions were randomised to a Hands‐on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank‐sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross‐over group). Results A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. Conclusion Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.
      PubDate: 2014-08-16T12:49:29.97563-05:0
      DOI: 10.1111/bju.12704
       
  • Massive renal size is not a contraindication to a laparoscopic approach
           for bilateral native nephrectomies in autosomal dominant polycystic kidney
           disease (ADPKD)
    • Authors: Eric S. Wisenbaugh; Mark D. Tyson, Erik P. Castle, Mitchell R. Humphreys, Paul E. Andrews
      Pages: n/a - n/a
      Abstract: Objective To determine if massive renal size should be a contraindication for attempting a laparoscopic approach to bilateral native nephrectomies in patients with autosomal dominant polycystic kidney disease (ADPKD). Patients and Methods We retrospectively reviewed all laparoscopic bilateral nephrectomies performed for ADPKD at our institution from 1 January 2000 to 31 December 2012. We stratified patients by kidney weight (with or without at least one kidney weighing >2500 g) and compared perioperative data, complications, and status of kidney allografts. Additionally, the subset of patients with at least one kidney weighing >3500 g was compared with the rest of the cohort. Results We identified 68 patients; mean (range) individual kidney weight was 1984 (197–5042) g. In all, 24 patients had at least one kidney weighing >2500 g, yet patients in this group were not significantly different from the rest of the cohort for complications, estimated blood loss, transfusion rate, or duration of hospitalisation. For those who underwent simultaneous renal allotransplantation, native kidney size was not associated with graft outcomes. Additionally, of the six patients with at least one kidney weighing >3500 g, only one required a blood transfusion, and the group had no intraoperative or postoperative Clavien grade ≥3 complications. None of the cohort required conversion to open surgery. Conclusion Massive size of polycystic kidneys is not a contraindication to attempting a laparoscopic approach to bilateral nephrectomies in an experienced, high‐volume centre.
      PubDate: 2014-08-16T12:41:42.786571-05:
      DOI: 10.1111/bju.12821
       
  • Metabolic syndrome and benign prostatic enlargement: a systematic review
           and meta‐analysis
    • Authors: Mauro Gacci; Giovanni Corona, Linda Vignozzi, Matteo Salvi, Sergio Serni, Cosimo De Nunzio, Andrea Tubaro, Matthias Oelke, Marco Carini, Mario Maggi
      Pages: n/a - n/a
      Abstract: Objective To summarise and meta‐analyse current literature on metabolic syndrome (MetS) and benign prostatic enlargement (BPE), focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, prostate‐specific antigen and urinary symptoms, as evidence suggests an association between MetS and lower urinary tract symptoms (LUTS) due to BPE. Methods An extensive PubMed and Scopus search was performed including the following keywords: ‘metabolic syndrome’, ‘diabetes’, ‘hypertension’, ‘obesity’ and ‘dyslipidaemia’ combined with ‘lower urinary tract symptoms’, ‘benign prostatic enlargement’, ‘benign prostatic hyperplasia’ and ‘prostate’. Results Of the retrieved articles, 82 were selected for detailed evaluation, and eight were included in this review. The eight studies enrolled 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification. Patients with MetS had significantly higher total prostate volume when compared with those without MetS (+1.8 mL, 95% confidence interval [CI] 0.74–2.87; P < 0.001). Conversely, there were no differences between patients with or without MetS for International Prostate Symptom Score total or LUTS subdomain scores. Meta‐regression analysis showed that differences in total prostate volume were significantly higher in older (adjusted r = 0.09; P = 0.02), obese patients (adjusted r = 0.26; P < 0.005) and low serum high‐density lipoprotein cholesterol concentrations (adjusted r = −0.33; P < 0.001). Conclusions Our results underline the exacerbating role of MetS‐induced metabolic derangements in the development of BPE. Obese, dyslipidaemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement.
      PubDate: 2014-08-16T12:26:19.776098-05:
      DOI: 10.1111/bju.12728
       
  • Impact of comorbidity on health‐related quality of life after
           prostate cancer treatment: combined analysis of two prospective cohort
           studies
    • Authors: Bryce B. Reeve; Ronald C. Chen, Dominic T. Moore, Allison M. Deal, Deborah S. Usinger, Jessica C. Lyons, James A. Talcott
      Pages: n/a - n/a
      Abstract: Objective To improve and individualise estimates of treatment outcomes for men diagnosed with prostate cancer, we examined the impact of baseline comorbidity on health‐related quality of life (HRQL) outcomes in an analysis of two pooled, prospective cohort studies. Patients and Methods We studied 697 patients from three academic hospitals who received radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT). Measures of patient‐reported bowel, urinary, and sexual symptoms along with physical and mental health were prospectively collected before treatment and 3, 12, 24, and 36 months after treatment. We assessed baseline comorbidity by the validated Index of Co‐Existent Disease (ICED), abstracted from medical records. Regression mixed‐models were built for each treatment group and HRQL outcome controlling for baseline age, education, marital status, risk group and patient‐reported general health. Results About 71% of patients had one or more comorbid conditions at baseline. After adjusting for covariates, we found baseline comorbidity was independently associated with poorer sexual function after BT (P = 0.04) and RP (P = 0.03) but not EBRT (P = 0.35). Physical health was significantly worse for men receiving BT with more comorbidities (P = 0.02). Baseline comorbid conditions were not associated with urinary incontinence or bowel functioning. Conclusions Comorbidity at baseline is significantly associated with poorer sexual function after prostate BT or RP. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments.
      PubDate: 2014-08-16T12:23:02.846656-05:
      DOI: 10.1111/bju.12723
       
  • Testicular‐sparing surgery for bilateral or monorchide testicular
           tumours: a multicenter study of long‐term oncological and functional
           results
    • Authors: Ludovic Ferretti; Paul Sargos, Marine Gross‐Goupil, Vincent Izard, Hervé Wallerand, Eric Huyghe, Jean‐Marc Rigot, Xavier Durand, Gerard Benoit, Jean‐Marie Ferriere, Stéphane Droupy
      Pages: n/a - n/a
      Abstract: Objective To review long‐term oncological and functional outcomes of testicular‐sparing surgery (TSS) in men presenting with bilateral or monorchide testicular tumours at one of five reference centres for testicular neoplasm and infertility. Patients and Methods We review 25 cases of bilateral synchrone and metachrone testicular tumours treated in five academic centres between 1984 and 2013. Clinical, biological, ultrasonography and pathological tumour findings, overall survival (OS) times, local or metastatic recurrence, pre‐ and postoperative hormonal profile, paternity and the need for androgen substitution were assessed. Results Eleven patients with a bilateral synchrone tumour and 14 patients with a testicular tumour on a solitary testicle underwent a tumorectomy. The mean (sem) patient age was 31.9 (1.04) years, total testosterone level was 4.5 (0.57) ng.mL and tumour size was 11.66 (1.49) mm. Tumour types were as follows: 11 seminoma, nine non‐seminomatous or mixed germ cell tumours, four Leydig tumours, and one hamartoma. Frozen‐section examination was performed in 14 patients, and matched the final pathological analysis in 11 patients. There was an OS rate of 100% and three patients (12%) presented with a local recurrence after a mean follow‐up of 42.7 months. Radical orchiectomy was performed for six patients. No patient with a preserved testicle required androgen therapy; the mean postoperative total testosterone level was 4.0 ng/mL. No patient remained fertile after radiation therapy. Conclusions TSS for bilateral testicular tumour is safe and effective in selected patients, and should be considered to avoid definitive androgen therapy. Adjuvant radiotherapy remains poorly described in the literature, leading to adjuvant treatment heterogeneity for testicular tumours.
      PubDate: 2014-08-16T12:14:40.811551-05:
      DOI: 10.1111/bju.12549
       
  • Preservation of the saphenous vein during laparoendoscopic
           single‐site inguinal lymphadenectomy: comparison with the
           conventional laparoscopic technique
    • Authors: Jun‐Bin Yuan; Min‐Feng Chen, Lin Qi, Yuan Li, Yang‐Le Li, Cheng Chen, Jin‐bo Chen, Xiong‐Bing Zu, Long‐Fei Liu
      Pages: n/a - n/a
      Abstract: Objective To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single‐site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes. Patients and Methods A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein. All lymphatic tissue in the boundaries of the adductor longus muscle (medially), the sartorius muscle (laterally), 2 cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply) was removed in both surgical techniques. All 24 procedures were performed by one experienced surgeon. Results All 24 procedures (12 LESS and 12 conventional endoscopic inguinal lymphadenectomies) were completed successfully without conversion to open surgery. For LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy groups, the mean ± sd operating time was 94.6 ± 14.8 min and 90.8 ± 10.6 min, respectively (P = 0.145). No significant differences in the incidence of postoperative complications (skin‐related problems, hecatomb, lower extremity oedema, lymphatic complications and overall complications) were noted between the two groups (P > 0.05). No lower extremity oedema occurred in any limbs of the two groups. No significant differences were observed in either lymph node clearance rate or detection rate of histologically positive lymph nodes (P > 0.05). The patient satisfaction rate with scar appearance and cosmetic results was significantly better in the LESS inguinal lymphadenectomy group than in the conventional endoscopic inguinal lymphadenectomy group of (75 vs 25%; P = 0.039). Conclusions This preliminary study suggests that both LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESS inguinal lymphadenectomy/conventional endoscopic inguinal lymphadenectomy can effectively reduce the incidence of postoperative lower extremity oedema. LESS inguinal lymphadenectomy seems to provide better cosmetic results than conventional endoscopic inguinal lymphadenectomy.
      PubDate: 2014-08-16T11:40:46.75214-05:0
      DOI: 10.1111/bju.12838
       
  • Oncological predictive value of the 2004 World Health Organisation grading
           classification in primary T1 non‐muscle‐invasive bladder
           cancer. A step forward or back?
    • Authors: Federico Pellucchi; Massimo Freschi, Marco Moschini, Lorenzo Rocchini, Carmen Maccagnano, Suardi Nazareno, Franco Bergamaschi, Francesco Montorsi, Renzo Colombo
      Pages: n/a - n/a
      Abstract: Objective To compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer. Patients and Methods We retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro‐pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non‐muscle‐invasive bladder cancer at second TUR received bacille Calmette‐Guérin. Follow‐up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence‐free survival (RFS) and progression‐free survival (PFS) rates were performed using the Kaplan–Meier method with the log‐rank test. Results G2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow‐up period was 31.1 (19; 1–93) months. The 5‐year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5‐year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001). Conclusion The results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.
      PubDate: 2014-08-16T11:40:31.260509-05:
      DOI: 10.1111/bju.12666
       
  • Progression and treatment of incident lower urinary tract symptoms (LUTS)
           among men in the California Men's Health Study
    • Authors: Lauren P. Wallner; Jeff M. Slezak, Ronald K. Loo, Virginia P. Quinn, Stephen K. Van Den Eeden, Steven J. Jacobsen
      Pages: n/a - n/a
      Abstract: Objectives To characterise the progression and treatment of lower urinary tract symptoms (LUTS) among men aged 45–69 years in the California Men's Health Study. Patients and Methods A total of 39 222 men, aged 45–69 years, enrolled in the Southern California Kaiser Permanente Health Plan were surveyed in 2002–2003 and again in 2006–2007. Those men who completed both surveys who did not have a diagnosis of benign prostatic hyperplasia (BPH) and were not on medication for LUTS at baseline were included in the study (N = 19 505). Among the men with no or mild symptoms at baseline, the incidence of moderate/severe LUTS (American Urological Association Symptom Index [AUASI] score ≥8) and odds of progression to severe LUTS (AUASI score ≥20) was estimated during 4 years of follow‐up. Results Of the 9640 men who reported no/mild LUTS at baseline, 3993 (41%) reported moderate/severe symptoms at follow‐up and experienced a 4‐point change in AUASI score on average. Of these men, 351 (8.8%) had received a pharmacological treatment, eight (0.2%) had undergone a minimally invasive or surgical procedure and 3634 (91.0%) had no treatment recorded. Men who progressed to severe symptoms (AUASI score ≥20; n = 165) were more likely to be on medication for BPH (odds ratio [OR] 8.09, 95% confidence interval [CI] 5.77–11.35), have a BPH diagnosis (OR 4.74, 95% CI 3.40–6.61) or have seen a urologist (OR 2.49, 95% CI 1.81–3.43) when compared with men who did not progress to severe symptoms (AUASI score
      PubDate: 2014-08-16T11:39:12.989692-05:
      DOI: 10.1111/bju.12810
       
  • Risk factors of hospital readmission after radical cystectomy and urinary
           diversion: analysis of a large contemporary series
    • Authors: Ahmed M. Harraz; Yasser Osman, Samer El‐Halwagy, Mahmoud Laymon, Ahmed Mosbah, Hassan Abol‐Enein, Atalla A. Shaaban
      Pages: n/a - n/a
      Abstract: Objectives To determine the incidence, risk factors and causes of hospital readmission in a large series of patients who underwent radical cystectomy (RC) and urinary diversion. Patients and Methods We retrospectively analysed the data of 1000 patients who underwent RC and urinary diversion between January 2004 and September 2009 in our tertiary referral centre. Patients stayed in hospital for 21 and 11 days for orthotopic and ileal conduit diversions, respectively. The primary outcome was the development of a complication requiring hospital readmission at ≤3 months (early) and >3 months (late). Causes of hospital readmissions were categorised according to frequency of readmissions. Predictors were determined using univariate and multivariate logistic regression models. Results In all, 895 patients were analysed excluding 105 patients because of perioperative mortality and loss to follow‐up. Early and late readmissions occurred in 8.6% and 11% patients, respectively. The commonest causes of first readmission were upper urinary tract obstruction (UUO, 13%) and pyelonephritis (12.4%) followed by intestinal obstruction (11.9%) and metabolic acidosis (11.3%). The development of postoperative high‐grade complications (odds ratio [OR] 1.955; 95% confidence interval [CI] 1.254–3.046; P = 0.003) and orthotopic bladder substitution (OR 1.585; 95% CI 1.095–2.295; P = 0.015) were independent predictors for overall hospital readmission after RC. Postoperative high‐grade complications (OR 2.488; 95% CI 1.391–4.450; P = 0.002), orthotopic bladder substitution (OR 2.492; 95% CI 1.423–4.364; P = 0.001) and prolonged hospital stay (OR 1.964; 95% CI:1.166–3.308; P = 0.011) were independent predictors for early readmission while hypertension (OR 1.670; 95% CI 1.007–2.769; P = 0.047) was an independent predictor for late readmission. Conclusion Hospital readmissions are a significant problem after RC. In the present study, UUO, pyelonephritis, metabolic acidosis and intestinal obstruction were the main causes of readmission. Orthotopic bladder substitution and development of postoperative high‐grade complications were significant predictors for overall readmission.
      PubDate: 2014-08-16T11:38:59.268976-05:
      DOI: 10.1111/bju.12830
       
  • Bladder reconstruction using scaffold‐less autologous smooth muscle
           cell sheet engineering: early histological outcomes for autoaugmentation
           cystoplasty
    • Authors: Saman S. Talab; Abdol‐Mohammad Kajbafzadeh, Azadeh Elmi, Ali Tourchi, Shabnam Sabetkish, Nastaran Sabetkish, Maryam Monajemzadeh
      Pages: n/a - n/a
      Abstract: Objective To investigate the feasibility of a new approach for cystoplasty using autologous smooth muscle cell (SMC) sheet and scaffold‐less bladder tissue engineering with the main focus on histological outcomes in a rabbit model. Materials and Methods In all, 24 rabbits were randomly divided into two groups. In the experimental group, SMCs were obtained from the bladder muscular layer, labelled with PKH‐26, and seeded on temperature‐responsive culture dishes. Contiguous cell sheets were noninvasively harvested by reducing the temperature and triple‐layer cell‐dense tissues were constructed. After partial detrusorectomy, the engineered tissue was transplanted onto the urothelial diverticulum. The control group underwent partial detrusorectomy followed by peritoneal fat coverage. At 2, 4, and 12 weeks the rabbits were humanely killed and haematoxylin and eosin, Masson's trichrome, cluster of differentiation 34 (CD34), CD31, CD3, CD68, α‐smooth muscle actin (α‐SMA), picrosirius red, and pentachrome staining were used to evaluate bladder reconstruction. Results At 2 weeks after SMC‐sheet grafting, PKH‐26 labelled SMCs were evident in the muscular layer. At 4 weeks, 79.1% of the cells in the muscular layer were PKH‐positive cells. The portion of the muscular layer increased in the experimental group during the follow‐up and was similar to normal bladder tissue after 12 weeks. α‐SMA staining showed well organised muscle at 4 and 12 weeks. CD34+ endothelial progenitor cells and CD31+ microvessels increased continuously and peaked 4 and 12 weeks after grafting, respectively. Conclusion In the present study, we show that autologous SMC‐sheet grafting has the potential for reliable bladder reconstruction and is technically feasible with a favourable evolution over the 12 weeks following implantation. Our findings could pave the way toward future bladder tissue engineering using the SMC‐sheet technique.
      PubDate: 2014-08-16T11:18:33.744255-05:
      DOI: 10.1111/bju.12685
       
  • Repeated biopsies in patients with prostate cancer on active surveillance:
           clinical implications of interobserver variation in histopathological
           assessment
    • Authors: Frederik B. Thomsen; Niels Marcussen, Kasper D. Berg, Ib J. Christensen, Ben Vainer, Peter Iversen, Klaus Brasso
      Pages: n/a - n/a
      Abstract: Objective To investigate the clinical implications of interobserver variation in the assessment of re‐biopsies obtained during active surveillance (AS) of prostate cancer. Patients and Methods In all, 107 patients with low‐risk prostate cancer with 93 diagnostic biopsy sets and 109 re‐biopsy sets were included. The International Society of Urological Pathology 2005 Gleason scoring system was used for the histopathological assessment of all biopsies. Three different definitions of histopathological progression were applied. Unweighted and linear weighted Kappa (κ) statistics were used to compare the interobserver agreement. Results The overall Gleason score agreement was 68.8% with a weighted κ of 0.670. The interobserver agreement was 79.6% for meeting the AS selection criteria. According to the three progression definitions applied, overall agreement was between 80.7% and 89.0% with weighted κ values of 0.746–0.791. Treatment recommendations would have changed in up to 10.1% (95% confidence interval 5.4–17.7%) of the 109 re‐biopsy sets. Conclusion Kappa statistics showed strong agreement between the histological evaluations. However, up to 10% of patients on AS would receive a different treatment recommendation depending upon which histopathological evaluation of re‐biopsies was used for treatment planning.
      PubDate: 2014-08-16T11:18:20.138744-05:
      DOI: 10.1111/bju.12820
       
  • Indications for intervention during active surveillance of prostate
           cancer: a comparison of the Johns Hopkins and Prostate Cancer Research
           International Active Surveillance (PRIAS) protocols
    • Authors: Max Kates; Jeffrey J. Tosoian, Bruce J. Trock, Zhaoyong Feng, H. Ballentine Carter, Alan W. Partin
      Pages: n/a - n/a
      Abstract: Objective To analyse how patients enrolled in our biopsy based surveillance programme would fare under the Prostate Cancer Research International Active Surveillance (PRIAS) protocol, which uses PSA kinetics. Patients and Methods Since 1995, 1125 men with very‐low‐risk prostate cancer have enrolled in the AS programme at the Johns Hopkins Hospital (JHH), which is based on monitoring with annual biopsy. The PRIAS protocol uses a combination of periodic biopsies (in years 1, 4, and 7) and prostate‐specific antigen doubling time (PSADT) to trigger intervention. Patients enrolled in the JHH AS programme were retrospectively reviewed to evaluate how the use of the PRIAS protocol would alter the timing and use of curative intervention. Results Over a median of 2.1 years of follow up, 38% of men in the JHH AS programme had biopsy reclassification. Of those, 62% were detected at biopsy intervals corresponding to the PRIAS criteria, while 16% were detected between scheduled PRIAS biopsies, resulting in a median delay in detection of 1.9 years. Of the 202 men with >5 years of follow‐up, 11% in the JHH programme were found to have biopsy reclassification after it would have been identified in the PRIAS protocol, resulting in a median delay of 4.7 years to reclassification. In all, 12% of patients who would have undergone immediate intervention under PRIAS due to abnormal PSA kinetics would never have undergone reclassification on the JHH protocol and thus would not have undergone definitive intervention. Conclusions There are clear differences between PSA kinetics‐based AS programmes and biopsy based programmes. Further studies should address whether and how the differences in timing of intervention impact subsequent disease progression and prostate cancer mortality.
      PubDate: 2014-08-16T11:16:57.893064-05:
      DOI: 10.1111/bju.12828
       
  • The impact of urinary incontinence on health‐related quality of life
           (HRQoL) in a real‐world population of women aged 45–60 years:
           results from a survey in France, Germany, the UK and the USA
    • Authors: Paul Abrams; Andrew P. Smith, Nikki Cotterill
      Pages: n/a - n/a
      Abstract: Objective To develop a clear understanding of the relationship between severity of urinary incontinence (UI) and health‐related quality of life (HRQoL) and mental well‐being in a population of women of working age with the requisite demands of a busy, active life. Subjects and Methods A survey of women with UI, aged between 45 and 60 years, was conducted via the internet in the UK, France, Germany and USA between 1 and 30 September 2013. Validated outcome measures were used to assess symptoms and the impact of UI on activities of daily life, HRQoL, and mental well‐being: The International Consultation on Incontinence Modular Questionnaire Short Form; (ICIQ‐UI Short Form); the ICIQ‐Lower Urinary Tract Symptoms Quality of Life; (ICIQ‐LUTSqol); the Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS). The relationships between UI, HRQoL and mental well‐being were analysed using analyses of variance and regression. Results The survey was completed by 1203 women with UI with an average age of 52.7 years. Based upon responses to the ICIQ‐UI Short Form about the amount of urine that leaks, respondents were categorised as having light (n = 1023, 87%), medium (n = 134, 11%), or severe UI (n = 20, 2%). The scores on the ICIQ‐UI Short Form increased with severity [mean (sd) scores: light UI 7.9 (3.4), medium UI 13.8 (2.9), and severe UI 18.3 (3.9)], as did the impact on HRQoL, assessed using the ICIQ‐LUTSqol [mean (sd) scores: light UI 30.6 (7.3), medium UI 41.0 (11.2), and severe UI 56.9 (17.6)]. Mental well‐being decreased with severity of UI, the mean (se) WEMWBS scores were: light UI 48.3 (10.1), medium UI 44.5 (9.5), and severe UI 39.9 (16.2). Conclusion In women with UI, aged 45–60 years, UI symptoms directly affect HRQoL, which subsequently impacts negatively on mental well‐being.
      PubDate: 2014-08-16T11:16:44.125414-05:
      DOI: 10.1111/bju.12852
       
  • Robot‐assisted retroperitoneal lymph node dissection: technique and
           initial case series of 18 patients
    • Authors: Scott M. Cheney; Paul E. Andrews, Bradley C. Leibovich, Erik P. Castle
      Pages: n/a - n/a
      Abstract: Objective To evaluate outcomes of the first 18 patients treated with robot‐assisted retroperitoneal lymph node dissection (RA‐RPLND) for non‐seminomatous germ cell tumours (NSGCT) and paratesticular rhabdomyosarcoma (RMS) at our institution. Patients and Methods Between March 2008 and May 2013, 17 patients underwent RA‐RPLND for NSGCT and one for paratesticular RMS. Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), and length of stay (LOS). Perioperative outcomes were compared between patients receiving primary RA‐RPLND vs post‐chemotherapy RA‐RPLND. Medium‐term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. Results RA‐RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs. For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow‐up of 22 (1–58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve‐sparing approach. Patients receiving primary RA‐RPLND had shorter operative times compared with those post‐chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs, P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). Conclusion This initial selected case series of RA‐RPLND shows that the procedure is safe, reproducible, and feasible for stage I–IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.
      PubDate: 2014-08-16T11:13:51.559788-05:
      DOI: 10.1111/bju.12804
       
  • Association of Androgen Deprivation Therapy with Excess
           Cardiac‐Specific Mortality in Men with Prostate Cancer
    • Authors: David R. Ziehr; Ming‐Hui Chen, Danjie Zhang, Michelle H. Braccioforte, Brian J. Moran, Brandon A. Mahal, Andrew S. Hyatt, Shehzad S. Basaria, Clair J. Beard, Joshua A. Beckman, Toni K. Choueiri, Anthony V. D'Amico, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L Nguyen
      Abstract: Objectives To determine if androgen deprivation therapy (ADT) is associated with excess cardiac‐specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI). Subjects/patients and methods Five thousand seventy‐seven men (median age, 69.5 years) with cT1c‐T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. Fine and Gray's competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity. Results After a median follow‐up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at five years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39‐1.78; P=0.64; n=2653) or in men with diabetes mellitus, hypertension, or hypercholesterolemia (2.09% vs 1.97%, AHR, 1.33; 95% CI, 0.70‐2.53; P=0.39; n=2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01‐10.64; P=0.048; n=256). In this subgroup, the five‐year cumulative incidence of CSM was 7.01% (95% CI 2.82‐13.82%) for ADT vs 2.01% (95% CI 0.38‐6.45%) for no ADT. Conclusion ADT was associated with a five percent absolute excess risk of CSM at five years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
      PubDate: 2014-08-15T01:55:07.623913-05:
      DOI: 10.1111/bju.12905
       
  • Exploring associations between LUTS and GI problems in women: a study in
           women with urological and GI problems versus a control population
    • Authors: M. Wyndaele; B.Y. De Winter, P.A. Pelckmans, S. De Wachter, M. Van Outryve, J.J. Wyndaele
      Abstract: Objectives First, to study the prevalence of self‐reported LUTS in women consulting a Gastroenterology clinic with complaints of functional constipation (FC), fecal incontinence (FI) or both, compared to a female control population. Secondly, to study the influence of FC, FI, or both on self‐reported LUTS in women attending a Urology clinic. Patients and methods We present a retrospective study of data collected through a validated self‐administered bladder and bowel symptom questionnaire in a tertiary referral hospital from three different female populations: 104 controls, 159 gastroenterological patients and 410 urological patients. Based on the reported bowel symptoms, patients were classified as having FC, FI, a combination of both, or, no FC or FI. LUTS were compared between the control population and the gastroenterological patients, and between urological patients with and without concomitant gastroenterological complaints. Results were corrected for possible confounders through logistic regression analysis. Results The prevalence of LUTS in the control population was comparable to large population‐based studies. Nocturia was significantly more prevalent in gastroenterological patients with FI compared to the control population (OR 9.1). Female gastroenterological patients with FC more often reported straining to void (OR 10.3), intermittency (OR 5.5), need to immediately revoid (OR 3.7) and feeling of incomplete emptying (OR 10.5) compared to the control population. In urological patients, urgency (94%) and UUI (54% of UI) were reported more often by patients with FI than by patients without gastroenterological complaints (58% and 30% of UI respectively), whereas intermittency (OR 3.6), need to immediately revoid (OR 2.2) and feeling of incomplete emptying (OR 2.2) were reported more often by patients with FC than by patients without gastroenterological complaints. Conclusion As LUTS are reported significantly more often by female gastroenterological patients than by a control population, and as there is a difference in self‐reported LUTS between female urological patients with different concomitant gastroenterological complaints, we suggest that general practitioners, gastroenterologists and urologists should always include the assessment of symptoms of the other pelvic organ system in their patient evaluation. The clinical correlations between bowel and LUT symptoms may be explained by underlying neurological mechanisms.
      PubDate: 2014-08-15T01:55:00.74-05:00
      DOI: 10.1111/bju.12904
       
  • Enzalutamide in European and North American men participating in the
           AFFIRM trial
    • Authors: Axel S. Merseburger; Howard I. Scher, Joaquim Bellmunt, Kurt Miller, Peter F.A. Mulders, Arnulf Stenzl, Cora N. Sternberg, Karim Fizazi, Mohammad Hirmand, Billy Franks, Gabriel P. Haas, Johann de Bono, Ronald de Wit
      Abstract: Objective ● To explore any differences in efficacy and safety outcomes between European (EU) (n = 684) and North American (NA) (n = 395) patients in the AFFIRM trial (NCT00974311). Patients and Methods ● Phase III, double‐blind, placebo‐controlled, multinational AFFIRM trial in men with metastatic castration‐resistant prostate cancer (mCRPC) after docetaxel. ● Participants were randomly assigned in a 2:1 ratio to receive oral enzalutamide 160 mg/day or placebo. ● The primary end point was overall survival (OS) in a post hoc analysis. Results ● Enzalutamide significantly improved OS compared with placebo in both EU and NA patients. The median OS in EU patients was longer than NA patients in both treatment groups. However, the relative treatment effect, expressed as hazard ratio and 95% confidence interval, was similar in both regions: 0.64 (0.50, 0.82) for EU and 0.63 (0.47, 0.83) for NA. Significant improvements in other end points further confirmed the benefit of enzalutamide over placebo in patients from both regions. ● The tolerability profile of enzalutamide was comparable between EU and NA patients, with fatigue and nausea the most common adverse events. Four EU patients (4/461 enzalutamide‐treated, 0.87%) and one NA patient (1/263 enzalutamide‐treated, 0.38%) experienced seizures. ● The difference in median OS was related in part to the timing of development of CRPC and baseline demographics on study entry. Conclusion ● This post hoc exploratory analysis of the AFFIRM trial demonstrated a consistent OS benefit for enzalutamide in men with mCRPC who had previously progressed on docetaxel in both NA‐ and EU‐treated patients, although the median OS was higher in EU relative to NA patients. Efficacy benefits were consistent across end points, with a comparable safety profile in both regions.
      PubDate: 2014-08-14T04:08:05.911492-05:
      DOI: 10.1111/bju.12898
       
  • Health‐related quality of life from a prospective randomised
           clinical trial of robot‐assisted laparoscopic vs open radical
           cystectomy
    • Authors: Jamie C. Messer; Sanoj Punnen, John Fitzgerald, Robert Svatek, Dipen J. Parekh
      Abstract: Objective To compare health‐related quality‐of‐life (HRQoL) outcomes for robot‐assisted laparoscopic radical cystectomy (RARC) with those of traditional open radical cystectomy (ORC) in a prospective randomised fashion. Patients and Methods This was a prospective randomised clinical trial evaluating the HRQoL for ORC vs RARC in consecutive patients from July 2009 to June 2011. We administered the Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index questionnaire, validated to assess HRQoL, preoperatively and then at 3, 6, 9 and 12 months postoperatively. Scores for each domain and total scores were compared in terms of deviation from preoperative values for both the RARC and the ORC cohorts. Multivariate linear regression was used to assess the association between the type of radical cystectomy and HRQoL. Results At the time of the study, 47 patients had met the inclusion criteria, with 40 patients being randomised for analysis. The cohorts consisted of 20 patients undergoing ORC and 20 undergoing RARC, who were balanced with respect to baseline demographic and clinical features. Univariate analysis showed a return to baseline scores at 3 months postoperatively in all measured domains with no statistically significant difference among the various domains between the RARC and the ORC cohorts. Multivariate analysis showed no difference in HRQoL between the two approaches in any of the various domains, with the exception of a slightly higher physical well‐being score in the RARC group at 6 months. Conclusions There were no significant differences in the HRQoL outcomes between ORC and RARC, with a return of quality of life scores to baseline scores 3 months after radical cystectomy in both cohorts.
      PubDate: 2014-08-13T09:43:12.395242-05:
      DOI: 10.1111/bju.12818
       
  • Exploring the evidence for early unclamping during robot‐assisted
           partial nephrectomy: is it worth the time and effort'
    • Authors: Oliver Cawley; Alexandrina Roman, Matthew Brown, Ben Challacombe
      PubDate: 2014-08-13T09:41:33.083937-05:
      DOI: 10.1111/bju.12836
       
  • Baseline characteristics predict risk of progression and response to
           combined medical therapy for benign prostatic hyperplasia (BPH)
    • Authors: Michael A. Kozminski; John T. Wei, Jason Nelson, David M. Kent
      Abstract: Objective To better risk stratify patients, using baseline characteristics, to help optimise decision‐making for men with moderate‐to‐severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. Patients and Methods After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre‐treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. Results In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post‐void residual urine volume, serum prostate‐specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Conclusions Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient‐specific benefits against possible risks of adverse effects for a given patient.
      PubDate: 2014-08-13T09:41:17.979521-05:
      DOI: 10.1111/bju.12802
       
  • Lymphatic drainage in renal cell carcinoma: back to the basics
    • Authors: Riaz J. Karmali; Hiroo Suami, Christopher G. Wood, Jose A. Karam
      Abstract: Lymphatic drainage in renal cell carcinoma (RCC) is unpredictable, however, basic patterns can be observed in cadaveric and sentinel lymph node mapping studies in patients with RCC. The existence of peripheral lymphovenous communications at the level of the renal vein has been shown in mammals but remains unknown in humans. The sentinel lymph node biopsy technique can be safely applied to map lymphatic drainage patterns in patients with RCC. Further standardisation of sentinel node biopsy techniques is required to improve the clinical significance of mapping studies. Understanding lymphatic drainage in RCC may lead to an evidence‐based consensus on the surgical management of retroperitoneal lymph nodes.
      PubDate: 2014-08-13T09:36:00.030566-05:
      DOI: 10.1111/bju.12814
       
  • The Wallstent: long‐term follow‐up of metal stent placement
           for the treatment of benign ureteroileal anastomotic strictures after
           Bricker urinary diversion
    • Abstract: Objective To evaluate the long‐term follow‐up (primary and secondary patency) of metal stent placement in benign ureteroileal anastomotic strictures after Bricker urinary diversion and to compare the failed treatment group with the group of successfully treated patients to search for predisposing factors of stent failure. Patients and Methods For patients treated since 1989 for benign ureteroileal strictures after Bricker urinary diversion with end‐to‐side anastomosis, we retrospectively collected data on clinical history, stent placement, auxiliary measures and patency rates from a prospectively kept database. Results In all, 49 patients (mean age 64 years) underwent 56 metal stent procedures. Placement of the stent was possible in all patients. Stent patency without auxiliary treatment remained adequate in 23 cases (primary patency of 41.1%, mean follow‐up 37.7 months). A secondary treatment was successfully performed in 11 patients who had stent obstruction, mostly caused by hyperplastic reaction, encrustation, or migration of the stent. The secondary patency rate was 60.7% (mean follow‐up 55.8 months), comparable with patency rates of 36–100% described in literature with mostly small patient groups and much shorter follow‐up periods. Conclusion To the best of our knowledge we report the largest series of metal stenting in benign ureteroileal anastomotic strictures with the longest follow‐up. We show that placement of a metal stent can lead to a permanent de‐obstruction in approximately six out of 10 patients with preservation of renal function.
       
  • Perioperative and renal functional outcomes of elective
           robot‐assisted partial nephrectomy (RAPN) for renal tumours with
           high surgical complexity
    • Abstract: Objective To evaluate the perioperative, postoperative and functional outcomes of robot‐assisted partial nephrectomy (RAPN) for renal tumours with high surgical complexity at a large volume centre. Patients and Methods Perioperative and functional outcomes of RAPNs for renal tumours with a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of ≥10 performed at our institution between September 2006 and December 2012 were collected in a prospectively maintained database and analysed. Surgical complications were graded according to the Clavien‐Dindo classification. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at the third postoperative day and 3–6 months after RAPN. Results In all, 44 RAPNs for renal tumours with PADUA scores of ≥10 were included in the analysis; 23 tumours (52.3%) were cT1b. The median (interquartile range; range) operative time, estimated blood loss and warm ischaemia time (WIT) were 120 (94, 132; 60–230) min, 150 (80, 200; 25–1200) mL and 16 (13.8, 18; 5–35) min, respectively. Two intraoperative complications occurred (4.5%): one inferior vena caval injury and one bleed from the renal bed, which were both managed robotically. There were postoperative complications in 10 patients (22.7%), of whom four (9.1%) were high Clavien grade, including two bleeds that required percutaneous embolisation, one urinoma that resolved with ureteric stenting and one bowel occlusion managed with laparoscopic adhesiolysis. Two patients (4.5%) had positive surgical margins (PSMs) and were followed expectantly with no radiological recurrence at a mean follow‐up of 23 months. The mean serum creatinine levels were significantly increased after surgery (121.1 vs 89.3 μmol/L; P = 0.001), but decreased over time, with no significant differences from the preoperative values at the 6‐month follow‐up (96.4 vs 89.3 μmol/L; P = 0.09). The same trend was seen for eGFR. Conclusion In experienced hands RAPN for renal tumours with a PADUA score of ≥10 is feasible with short WIT, acceptable major complication rate and good long‐term renal functional outcomes. A slightly higher risk of PSMs can be expected due to the high surgical complexity of these lesions. The robotic technology allows a safe expansion of the indications of minimally invasive PN to anatomically very challenging renal lesions in referral centres.
       
  • Subtyping of renal cortical neoplasms in fine needle aspiration biopsies
           using a decision tree based on genomic alterations detected by
           fluorescence in situ hybridization
    • Abstract: Objectives To improve the overall accuracy of diagnosis in needle biopsies of renal masses, especially small renal masses (SRMs), using fluorescence in situ hybridization (FISH), and to develop a renal cortical neoplasm classification decision tree based on genomic alterations detected by FISH. Patients and Methods Ex vivo fine needle aspiration biopsies of 122 resected renal cortical neoplasms were subjected to FISH using a series of seven‐probe sets to assess gain or loss of 10 chromosomes and rearrangement of the 11q13 locus. Using specimen (nephrectomy)‐histology as the ‘gold standard’, a genomic aberration‐based decision tree was generated to classify specimens. The diagnostic potential of the decision tree was assessed by comparing the FISH‐based classification and biopsy histology with specimen histology. Results Of the 114 biopsies diagnostic by either method, a higher diagnostic yield was achieved by FISH (92 and 96%) than histology alone (82 and 84%) in the 65 biopsies from SRMs (
       
  • Predicting ease of perinephric fat dissection at time of open partial
           nephrectomy using preoperative fat density characteristics
    • Abstract: Objective To predict the ease of perinephric fat surgical dissection at the time of open partial nephrectomy (OPN) using perinepheric fat density characteristics as measured on preoperative computed tomography (CT). Patients and Methods In all, 41 consecutive OPN patients with available preoperative imaging and prospectively collected dissection difficulty assessment were identified. Using a scoring system that was adopted for the purposes of this study, the genitourinary surgeon quantified the difficulty of the perinephric fat dissection on the surface of the renal capsule at the time of surgery. On axial CT slice centred on the renal hilum, we measured the quantity and density of perinephric fat whose absorption coefficient was between –190 to –30 Hounsfield units. Correlation between perinephric fat surface density (PnFSD) as noted on preoperative imaging and as observed by the surgeon at time of surgery were correlated in a completely ‘double‐blinded’ fashion. Density comparisons between fat dissection difficulties were made using an anova. Associations between covariates and perinephric fat density were evaluated by univariate and multivariate logistic regression analyses. Receiver‐operating characteristic (ROC) curves for six different predictive models were created to visualise the predictive enhancement of PnFSD. Results PnFSD was positively correlated with total surgical duration (Pearson's correlation coefficient 0.314, P = 0.04). PnFSD significantly correlated with gender (P = 0.001) and difficulty of perinephric fat surgical dissection (P < 0.001) scores. The mean (sd) PnFSD for a dissection that was not difficult (n = 19) was 5598.32 (1367.77) surface density pixel unit (SDPU), and for a difficult dissection (n = 22) was 10272.23 (3804.67) SDPU. Univariate analysis showed gender (P = 0.002), and PnFSD were predictive of the presence of ‘sticky’ perinephric fat. A multivariate analysis model showed that PnFSD was the only variable that remained an independent predictor of perinephric fat dissection difficulty (P = 0.01). Of the six ROC models assessed, only PnFSD had a significant capability to predict the difficulty of the perinephric fat dissection due to the presence of highly adherent ‘sticky’ fat, with an area under the curve of 0.87 (P < 0.001). Conclusion Accurate preoperative assessment of perinephric fat density constitutes a strong indicator of perioperative fat dissection difficulty. Perinephric fat densities can be practically obtained from preoperative CT to identify ‘sticky’ fat, which may help determine the anticipated ease of surgical dissection, which can guide education, preoperative surgical planning, and potentially the surgical approach offered to patients.
       
  • The Cancer of the Prostate Risk Assessment (CAPRA) score predicts
           biochemical recurrence in intermediate‐risk prostate cancer treated
           with external beam radiotherapy (EBRT) dose escalation or low‐dose
           rate (LDR) brachytherapy
    • Abstract: Objective To study the prognostic value of the University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) after various doses of external beam radiotherapy (EBRT) and/or permanent seed low‐dose rate (LDR) prostate brachytherapy (PB). Patients and Methods We retrospectively analysed 345 patients with intermediate‐risk prostate cancer, with PSA levels of 10–20 ng/mL and/or Gleason 7 including 244 EBRT patients (70.2–79.2 Gy) and 101 patients treated with LDR PB. The minimum follow‐up was 3 years. No patient received primary androgen‐deprivation therapy. bF was defined according to the Phoenix definition. Cox regression analysis was used to estimate the differences between CAPRA groups. Results The overall bF rate was 13% (45/345). The CAPRA score, as a continuous variable, was statistically significant in multivariate analysis for predicting bF (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.10–1.72, P = 0.006). There was a trend for a lower bF rate in patients treated with LDR PB when compared with those treated by EBRT ≤ 74 Gy (HR 0.234, 95% CI 0.05–1.03, P = 0.055) in multivariate analysis. In the subgroup of patients with a CAPRA score of 3–5, CAPRA remained predictive of bF as a continuous variable (HR 1.51, 95% CI 1.01–2.27, P = 0.047) in multivariate analysis. Conclusion The CAPRA score is useful for predicting biochemical recurrence in patients treated for intermediate‐risk prostate cancer with EBRT or LDR PB. It could help in treatment decisions.
       
  • Metabolic atrophy and 3‐T 1H‐magnetic resonance spectroscopy
           correlation after radiation therapy for prostate cancer
    • Abstract: Objective To correlate 3‐T magnetic resonance spectroscopic imaging (MRSI) with prostate‐specific antigen (PSA) levels in patients with prostate cancer treated with external beam radiation therapy to assess the potential advantages of MRSI. Materials and Methods A total of 50 patients (age range 65–83 years) underwent PSA and MRSI surveillance before and at 3, 6, 12, 18 and 24 months after radiotherapy. Results Of the 50 patients examined, 13 patients completely responded to therapy showing metabolic atrophy (MA), defined as a choline‐plus‐creatine/citrate (CC/C) ratio 0.8). Three of those patients with recurrence had a biochemical relapse at 18 months and the other two at 24 months. Two of the 50 patients did not respond to the treatment, showing persistent disease from the 3rd month (CC/C ratio >0.8); one patient had biochemical relapse at 6 and the other at 12 months. Conclusions MRSI was shown to have a greater potential than PSA level in monitoring patients after radiotherapy, because it anticipates PSA nadir, and biochemical relapse in particular.
       
  • Bladder cancer incidence and mortality in patients treated with radiation
           for uterine cancer
    • Abstract: Objective To estimate the effect of radiation therapy (RT) administered for uterine cancer (UtC) on bladder cancer (BC) incidence, tumour characteristics at presentation, and mortality. Patients and Methods In this retrospective cohort study, records of 56 681 patients diagnosed with UtC as their first primary malignancy during 1980–2005 were obtained from the Surveillance, Epidemiology and End‐Results (SEER) database. Follow‐up for incident BC ended on 31 December 2008. Occurrences of BC diagnoses and BC deaths in patients with UtC managed with or without RT were summarised with counts and person‐time incidence rates (counts divided by person‐years of observation). Age adjustment of rates was performed by direct standardisation. Incident BC cases were described in terms of histological types, grades and stages. Results With a mean follow‐up of 15 years, BC was diagnosed in 146 (0.93%) of 15 726 patients with UtC managed with RT, and in 197 (0.48%) of 40 955 patients with UtC managed without RT, with an age‐adjusted rate ratio of 2.0 (95% confidence interval [CI] 1.6–2.5). Fatal BC occurred in 39 (0.25%) and 36 (0.09%) of patients with UtC managed with vs without RT, respectively, with an age‐adjusted rate ratio of 2.9 (95% CI 1.8–4.6). Incident BC cases diagnosed in patients with UtC managed with vs without RT had similar distributions of histological types, grades, and stages. Conclusions Use of RT for UtC is associated with increased BC incidence and mortality later in life. Heightened awareness should help identify women with new voiding symptoms or haematuria, all of which should be fully evaluated.
       
  • Impact of renal surgery for cortical neoplasms on lipid metabolism
    • Abstract: Objective To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease (CKD). Patients and Methods We conducted a two‐centre retrospective analysis of 905 patients (mean age 57.5 years, mean follow‐up 78 months), who underwent RN (n = 610) or PN (n = 295) between July 1987 and June 2007. Demographics, preoperative and postoperative hyperlipidaemia were recorded. De novo hyperlipidaemia was defined as that ocurring ≥6 months after surgery in cases where laboratory values met National Cholesterol Education Program Adult Treatment Panel III definitions. The Kaplan–Meier method was used to assess freedom from de novo hyperlipidaemia. Multivariable analysis was conducted to determine the risk factors for de novo hyperlipidaemia. Results There were no significant differences with respect to demographics, preoperative glomerular filtration rate (GFR)
       
  • Urothelial carcinoma involving the prostate: the association of revised
           tumour stage and coexistent bladder cancer with survival after radical
           cystectomy
    • Abstract: Objective To evaluate survival among patients with urothelial carcinoma (UC) within the prostate in order to assess the impact of depth of tumour invasion as well as the importance of a concurrent bladder tumour. Patients and Methods We identified 201 patients who underwent radical cystectomy (RC) between 1980 and 2006 and were found to have UC involving the prostate. All specimens were re‐reviewed by a genitourinary pathologist. Survival was estimated using the Kaplan–Meier method and compared with the log‐rank test. Cox hazard regression models tested the association of clinicopathological variables with outcome. Results In all, 93 patients had pTis disease in the prostate, 43 had pT2 tumours, and 66 patients were pT4a. The median follow‐up was 10.5 years. The 5‐year cancer‐specific survival for patients with pTis, pT2, and pT4a prostate UC was 73%, 57%, and 21% respectively (P < 0.001). On multivariable analysis, higher prostate tumour stage (hazard ratio [HR] 2.09; P = 0.01), positive lymph node status (HR 2.09; P = 0.002), and concurrent ≥pT3 bladder cancer (HR 4.16; P < 0.001) were significantly associated with an increased risk of death from UC. Conclusions Among patients with prostatic UC involvement, depth of tumour invasion was significantly associated with cancer‐specific mortality, validating the staging reclassification. Concurrent locally advanced bladder cancer also negatively impacted survival, suggesting the potential prognostic value of reporting a secondary tumour stage in such cases.
       
  • Histone deacetylase inhibition: a new target for Peyronie's disease'
    •  
  • Management of stent symptoms: what a pain!
    •  
  • Spine metastases in prostate cancer: comparison of
           technetium‐99m‐MDP whole‐body bone scintigraphy,
           [18F]choline positron emission tomography(PET)/computed tomography (CT)
           and [18F]NaF PET/CT
    • Abstract: Objective To compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole‐body bone scintigraphy (WBS) with technetium‐99m‐MDP, [18F]‐sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [18F]‐fluoromethylcholine (FCH) PET/CT. Patients and Methods The study entry criteria were biopsy‐proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion‐based analysis. The primary target variable was bone lesion (malignant/benign) and the ‘gold standard’ was MRI. Results A total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non‐malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; NaF‐PET/CT: 93, 54, 82, 78 and 81%; and FCH‐PET/CT: 85, 91, 95, 75 and 87%, respectively. Conclusions We found that FCH‐PET/CT and NaF‐PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone‐naïve prostate cancer.
       
  • Oncological outcomes after robot‐assisted radical prostatectomy:
           long‐term follow‐up in 4803 patients
    • Abstract: Objective To evaluate oncological outcomes in patients undergoing robot‐assisted radical prostatectomy (RARP) at a high‐volume tertiary centre with focus on biochemical recurrence (BCR); previous studies on oncological outcomes for patients undergoing RARP for prostate cancer are limited to small series. Patients and Methods In all, 5152 consecutive patients underwent RARP from 2001 to 2010; 4803 patients comprised the study cohort after exclusions. BCR was defined as a serum prostate‐specific antigen (PSA) level of ≥0.2 ng/mL with a confirmatory value. BCR‐free survival (BCRFS), metastasis‐free survival (MFS) and cancer‐specific survival (CSS) were estimated using the Kaplan–Meier method and Cox hazards regression models were generated. Results The mean preoperative PSA level was 6.1 ng/mL, pathological Gleason grade and stage were ≥7 in 68% and ≥pT3 in 34% of patients. There was BCR in 470 patients (9.8%), 31 patients developed metastatic disease (0.7%) and 13 patients died from prostate cancer (0.3%) during a mean (range) follow‐up of 34.6 (1–116.7) months. Actuarial 8‐year BCRFS, MFS and CSS were 81%, 98.5% and 99.1%, respectively. In patients with node‐positive disease, actuarial 5‐year BCRFS, MFS, and CSS were 26%, 82%, and 97%. For organ‐confined disease, predictors of BCR included pathology Gleason grade (primary Gleason 5 vs 3, hazard ratio [HR] 5.52, P = 0.018; Gleason 4 vs 3, HR 1.97, P = 0.001), preoperative PSA level (10–20 vs ≤10 ng/mL, HR 2.38, P = 0.001), and surgical margin status (positive vs negative, HR 3.84, P < 0.001) Conclusions RARP appears to confer effective long‐term biochemical control. To our knowledge, this is the largest report of oncological outcomes in a RARP series to date.
       
  • Surgical Science – everything is not what it seems
    •  
  • Bone metastases in prostate cancer: which scan'
    •  
  • Robotic and conventional open radical cystectomy lead to similar
           postoperative health‐related quality of life
    •  
  • Complex tumours, partial nephrectomy and functional outcomes
    •  
  • Development and internal validation of a nomogram for predicting
           stone‐free status after flexible ureteroscopy for renal stones
    • Abstract: Objective To develop and internally validate a preoperative nomogram for predicting stone‐free status (SF) after flexible ureteroscopy (fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. Patients and Methods We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. Results Five independent predictors of SF after fURS were identified: stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of >50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. Conclusion The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease.
       
  • Outcomes of men with an elevated prostate‐specific antigen (PSA)
           level as their sole preoperative intermediate‐ or high‐risk
           feature
    • Abstract: Objective To investigate the post‐prostatectomy and long‐term outcomes of men presenting with an elevated pretreatment prostate‐specific antigen (PSA) level (>10 ng/mL), but otherwise low‐risk features (biopsy Gleason score ≤6 and clinical stage ≤T2a). Patients and Methods PSA‐incongruent intermediate‐risk (PII) cases were defined as those patients with preoperative PSA >10 and ≤20 ng/mL but otherwise low‐risk features, and PSA‐incongruent high‐risk (PIH) cases were defined as men with PSA >20 ng/mL but otherwise low‐risk features. Our institutional radical prostatectomy database (1992–2012) was queried and the results were stratified into D’Amico low‐, intermediate‐ and high risk, PSA‐incongruent intermediate‐risk and PSA‐incongruent high‐risk cases. Prostate cancer (PCa) features and outcomes were evaluated using appropriate comparative tests. Multivariable analyses were adjusted for age, race and year of surgery. Results Of the total cohort of 17 608 men, 1132 (6.4%) had PII‐risk disease and 183 (1.0%) had PIH‐risk disease. Compared with the low‐risk group, the odds of upgrading at radical prostatectomy (RP) were 2.20 (95% CI 1.93–2.52; P < 0.001) for the PII group and 3.58 (95% CI 2.64–4.85; P < 0.001) for the PIH group, the odds of extraprostatic disease at RP were 2.35 (95% CI 2.05–2.68; P < 0.001) for the PII group and 6.68 (95% CI 4.89–9.15; P < 0.001) for the PIH group, and the odds of positive surgical margins were 1.97 (95% CI 1.67–2.33; P < 0.001) for the PII group and 3.54 (95% CI 2.50–4.95, P < 0.001) for the PIH group. Compared with low‐risk disease, PII‐risk disease was associated with a 2.85‐, 2.99‐ and 3.32‐fold greater risk of biochemical recurrence (BCR), metastasis and PCa‐specific mortality, respectively, and PIH‐risk disease was associated with a 5.32‐, 6.14‐ and 7.07‐fold greater risk of BCR, metastasis and PCa‐specific mortality, respectively (P ≤ 0.001 for all comparisons). For the PII group, the higher risks of positive surgical margins, upgrading, upstaging and BCR were dependent on PSA density (PSAD): men in the PII group who had a PSAD 10 and ≤20 ng/mL with a PSAD ≥0.15 ng/mL/g, but otherwise low‐risk PCa, are at greater risk of adverse pathological and oncological outcomes and may be inappropriate candidates for active surveillance. These men are at greater risk of having anterior tumours that are undersampled at biopsy, so if treatment is deferred, ancillary testing such as anterior zone sampling or magnetic resonance imaging should be strongly encouraged. Men with elevated PSA levels >10 and ≤20 ng/mL but low PSAD have outcomes similar to those in the low‐risk group, and consideration of surveillance is appropriate in these cases.
       
  • Is radical nephrectomy a legitimate therapeutic option in patients with
           renal masses amenable to nephron‐sparing surgery'
    • Abstract: The decision to perform a radical nephrectomy (RN) or a partial nephrectomy (PN), not unlike most decisions in clinical practice, ultimately hinges on the balance of risk. Do the higher risks of a more complex surgery (PN) justify the theoretical benefits of kidney tissue preservation' Data suggest that for patients with an anatomically complex renal mass and a normal contralateral kidney, for whom additional surgical intensity may be risky, such as the elderly and comorbid, RN presents a robust treatment option. Nevertheless, PN, especially for small and anatomically simple renal masses in young patients without comorbidities should remain the surgical reference standard, as preservation of renal tissue can serve as an ‘insurance policy’ not only against future renal functional decline, but also against the possibility of tumour development in the contralateral kidney. In the present review, we outline the ongoing debate between the role of RN and PN in treatment of the enhancing renal mass.
       
  • External validation of the Briganti nomogram to estimate the probability
           of specimen‐confined disease in patients with high‐risk
           prostate cancer
    • Abstract: Objective To establish an external validation of the updated nomogram from Briganti et al., which provides estimates of the probability of specimen‐confined disease using the variables age, prostate‐specific antigen (PSA), clinical stage and biopsy Gleason score in preoperatively defined high‐risk prostate cancer (PCa). Patients and Methods The study included 523 patients with high‐risk PCa, as defined by d'Amico classification, undergoing radical prostatectomy (RP) and bilateral lymph node dissection in one of two academic centres between 1990 and 2013. Specimen‐confined disease was defined as pT2–pT3a node‐negative PCa with negative surgical margins. The receiver–operator characteristic (ROC) curve was obtained to quantify the overall accuracy (area under the curve [AUC]) of the model in predicting specimen‐confined disease. A calibration curve was then constructed to illustrate the relationship between the risk estimates obtained by the model (x‐axis) and the observed proportion of specimen‐confined disease (y‐axis). The Kaplan–Meier method was used to assess biochemical recurrence (BCR)‐free survival. Results Patients' median age and PSA level were 64 years and 21 ng/mL, respectively. The definition of high‐risk PCa was based on PSA level only in 38.3%, a biopsy Gleason score >7 in 34.5%, a clinical stage >T2b in 6.9%, or a combination of these two or three factors in 20.3% of patients. Positive surgical margins were observed in 43.6%, with a rate of 14.8% in pT2 cancers and lymph node metastasis in 12.1% of patients. pT stage was pT0 in 0.9%, pT2 in 28.9%, pT3a in 37.5% and pT3b–4 in 32.7% of patients. Overall, 44.4% of patients (N = 232) had specimen‐confined disease. PSA and cT stage were independently predictive of specimen‐confined disease. The median (range) 2‐, 5‐, and 8‐year BCR‐free survival rates were significantly higher in specimen‐confined disease as compared with non‐specimen‐confined disease: 80.87 (73.67–86.29) vs 37.55 (30.64–44.44)%, 63.53 (52.37–72.74) vs 26.93 (19.97–34.36)% and 55.08 (41.49–66.74) vs 19.52 (12.50–27.70)%, respectively (P < 0.001). The ROC curve analysis showed relevant accuracy of the model (AUC 0.6470, 95% CI 0.60–0.69) although the calibration plot suggested that, for risks ranging from 0.3 to 0.5, the odds of extracapsular extension were underestimated. Conclusions This external validation of the Briganti nomogram shows relevant accuracy, although the relative imprecision for intermediate risk may limit its clinical relevance. Our follow‐up findings confirm the large proportion of specimen‐confined PCa with good oncological outcomes in this heterogeneous subgroup of patients with high‐risk PCa.
       
  • Differences in 24‐h urine composition between nephrolithiasis
           patients with and without diabetes mellitus
    • Abstract: Objectives To examine the differences in 24‐h urine composition between nephrolithiasis patients with and without diabetes mellitus (DM) in a large cohort of stone‐formers and to examine differences in stone composition between patients with and without DM. Patients and Methods A retrospective review of 1117 patients with nephrolithiasis and a 24‐h urine analysis was completed. Univariable analysis of 24‐h urine profiles and multivariable linear regression models were performed, comparing patients with and without DM. A subanalysis of patients with stone analysis data available was performed, comparing the stone composition of patients with and without DM. Results Of the 1117 patients who comprised the study population, 181 (16%) had DM and 936 (84%) did not have DM at the time of urine analysis. Univariable analysis showed significantly higher total urine volume, citrate, uric acid (UA), sodium, potassium, sulphate, oxalate, chloride, and supersaturation (SS) of UA in individuals with DM (all P < 0.05). However, patients with DM had significantly lower SS of calcium phosphate and pH (all P < 0.05). Multivariable analysis showed that patients with DM had significantly lower urinary pH and SS of calcium phosphate, but significantly greater citrate, UA, sulphate, oxalate, chloride, SSUA, SS of calcium oxalate, and volume than patients without DM (all P < 0.05). Patients with DM had a significantly greater proportion of UA in their stones than patients without DM (50.2% vs 13.5%, P < 0.001). Conclusions DM was associated with multiple differences on 24‐h urine analysis compared with those without DM, including significantly higher UA and oxalate, and lower pH. Control of urinary UA and pH, as well as limiting intake of dietary oxalate may reduce stone formation in patients with DM.
       
  • Propensity‐score matched analysis comparing robot‐assisted
           with laparoscopic partial nephrectomy
    • Abstract: Objectives To compare the peri‐operative and early renal functional outcomes of robot‐assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for kidney tumours. Materials and Methods A total of 237 patients fulfilling the selection criteria were included, of whom 146 and 91 patients were treated with LPN and RAPN, respectively. To adjust for potential baseline confounders, propensity‐score matching was performed. A favourable outcome was defined as a warm ischaemia time (WIT) of ≤20 min, negative surgical margins, no surgical conversion, no Clavien ≥3 complications and no postoperative chronic kidney disease (CKD) upstaging. Descriptive statistics and multivariable logistic regression analyses were performed before and after propensity‐score matching. Results Within the propensity‐score‐matched cohort, the RAPN group was associated with significantly lower estimated blood loss (EBL; 156 vs 198 mL, mean difference [MD] = −42; P = 0.025), a shorter WIT (22.8 vs 31 min, MD = −8.2; P < 0.001) and a higher proportion of malignant lesions (88.4 vs 67.5%; odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.2–5.67; P = 0.023). With regard to early renal functional outcomes, the mean last estimated glomerular filtration rate was 95.8 and 89.4 mL/min per 1.73 m2 (MD = 6.4; P = 0.01), with a mean ± sd percentage change of −4.8 ± 17.9 and −12.2 ± 16.6 (MD = 7.4; P = 0.018) in the RAPN and LPN groups, respectively. The intra‐operative complication rate was significantly lower in the RAPN group (1.3 vs 11.7%; OR 0.1, 95% CI 0.01–0.81; P = 0.018). On multivariable analysis, surgical approach (RAPN vs LPN, OR 5.457, 95% CI 2.075–14.346; P = 0.001), Charlson Comorbidity Index (OR 0.223; 95% CI 0.062–0.811; P = 0.023), diameter‐axial‐polar score (OR 0.488, 95% CI 0.329–0.723; P < 0.001) and preoperative CKD stage (OR 3.189, 95% CI 1.204–8.446; P = 0.020) were found to be independent predictors of obtaining a favourable outcome. Conclusions After adjusting for potential treatment selection biases, RAPN was found to be superior to LPN for peri‐operative outcomes (EBL, WIT and intra‐operative complications) and early renal functional preservation.
       
  • Targeted Microbubbles: A Novel Application for Treatment of Kidney Stones
    • Abstract: Kidney stone disease is endemic. Extracorporeal shock wave lithotripsy (EWL) was the first major technologic breakthrough where focused shock waves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine' The logical progression was to manufacture these powerful microbubbles ex‐vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: 1) bisphosphonates attach to hydroxyapatite crystals with high affinity; and 2) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to preemptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging modalities – especially useful in high risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine.
       
  • A phase I study of TRC105 anti‐CD105 (endoglin) antibody in
           metastatic castration‐resistant prostate cancer
    • Abstract: Objective ● TRC105 is a chimeric IgG1 monoclonal antibody that binds endoglin (CD105). ● This phase I open‐label study evaluated the safety, pharmacokinetics, and pharmacodynamics of TRC105 in patients with metastatic castration‐resistant prostate cancer (mCRPC). Patients and Methods ● Patients with mCRPC received escalating doses of intravenous TRC105 until unacceptable toxicity or disease progression, up to a predetermined dose level using a standard 3+3 phase I design. Results ● Twenty patients were treated and the top dose level studied of 20 mg/kg every two weeks was the maximum tolerated dose. ● Common adverse effects included infusion‐related reaction (90%), low grade headache (67%), anemia (48%), epistaxis (43%), and fever (43%). ● Ten patients had stable disease on study and eight patients had PSA declines. ● Significant plasma CD105 reduction was observed at the higher dose levels. In an exploratory analysis, vascular endothelial growth factor (VEGF) was increased after treatment with TRC105 and VEGF levels were associated with CD105 reduction. Conclusion ● TRC105 was tolerated at 20 mg/kg every other week with a safety profile distinct from that of VEGF inhibitors. ● There was a significant induction of plasma VEGF associated with CD105 reduction, suggesting anti‐angiogenic activity of TRC105. ● An exploratory analysis revealed a tentative correlation between the reduction of CD105 and a decrease in PSA velocity, suggestive of potential activity of TRC105 in the CRPC patients. The data from this exploratory analysis suggests rising VEGF is a possible compensatory mechanism for TRC105 induced anti‐angiogenic activity.
       
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • Abstract: Objective To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. Patients and Methods The cost‐effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the NHS in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT‐A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10 year time horizon for all treatment options with the exception of PTNS, which has a time horizon of five years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios. Direct medical resources included are: device and drug acquisition costs, pre‐procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. Results At five years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT‐A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT‐A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost‐effective. Conclusion In the management of patients with idiopathic OAB wet, the results of this cost‐utility analysis favors SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT‐A over a 10 year period.
       
  • Evolving role of Positron Emission Tomography (PET) in Urological
           Malignancy
    • Abstract: We present a review on the increasing indications for the use of Positron emission tomography (PET) in uro‐oncology. In our review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
       
  • Significance of lymphovascular invasion in organ‐confined,
           node‐negative urothelial cancer of the bladder: data from the
           prospective p53‐MVAC trial
    • Abstract: Objectives • To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ‐confined, node‐negative urothelial cancer of the bladder (UCB) in a post‐hoc analysis of a prospective clinical trial. • To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumors exhibited LVI. Patients and Methods • Surgical and tumor factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1‐T2 N0 UCB in the p53‐MVAC trial (SWOG 4B951/NCT00005047). • The presence or absence of LVI was determined by pathologic examination of transurethral resection or RC specimens. • Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results • Among 499 patients with a median follow‐up of 4.9 years, a subset of 102 (20%) had LVI‐positive tumors. Of these, 34 patients had pT1 and 68 had pT2 disease. • LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 (95% confidence interval [CI]: 1.15 to 2.77; number of events [EV] = 95; p = 0.01) and with OS with a HR of 2.02 (95% CI: 1.31 to 3.11; EV = 98; p = 0.001) after adjustment for pathologic stage. • Among 27 patients with LVI‐positive tumors who were randomized to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70; 95% CI: 0.16 to 3.17; EV = 7; p = 0.65) or with OS (HR: 0.45; 95% CI: 0.11 to 1.83; EV = 9; p = 0.26). Conclusions • Our post‐hoc analysis of the p53‐MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1‐T2N0 disease. • The analysis did not demonstrate a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not ruled out.
       
  • Predicting Pathologic Outcomes in Patients Undergoing Robot‐Assisted
           Radical Prostatectomy for High Risk Prostate Cancer: A Preoperative
           Nomogram
    • Abstract: Objective To identify which high‐risk PCa patients may harbor favorable pathologic outcomes at surgery. Materials and Methods We evaluated 810 patients with high‐risk PCa, defined as having ≥1 of the following: PSA >20 ng/ml, Gleason score ≥8, clinical stage ≥T2c. Patients underwent RARP with pelvic lymph node dissection, between 2003 and 2012, in one center. Only 1.6% (13/810) of patients received any adjuvant treatment. Favorable pathologic outcome was defined as specimen‐confined (SC) disease (pT2‐T3a, node negative, and negative surgical margins) at RARP‐specimen. Logistic regression models were used to test the relationship among all available predicators and harboring SC PCa. A logistic regression coefficient‐based nomogram was constructed and internally validated using 200 bootstrap resamples. Kaplan‐Meier method estimated biochemical recurrence (BCR) ‐free and cancer‐specific mortality (CSM) free survival rates, after stratification according to pathological disease status. Results Overall, 55.2% patients harbored SC disease at RARP. At multivariable analysis, PSA level, clinical stage, primary/secondary Gleason scores, and maximum percent tumor quartiles were all independent predictors of SC PCa (all P
       
  • Urological chronic pelvic pain syndrome symptom flares: characterisation
           of the full range of flares at two sites in the Multidisciplinary Approach
           to the Study of Chronic Pelvic Pain (MAPP) Research Network
    • Abstract: Objectives To describe the full range of symptom exacerbations defined by people with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome as ‘flares’, and to investigate their associated healthcare utilization and bother at two sites of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Epidemiology and Phenotyping study. Subjects and Methods Participants completed a flare survey that asked them: 1) whether they had ever had flares (‘symptoms that are much worse than usual’) that lasted 1 h and 1 day; and 2) for each duration of flare, to report: their average length and frequency; their typical levels of urological and pelvic pain symptoms; and their levels of healthcare utilization and bother. We compared participants' responses to their non‐flare MAPP values and by duration of flare using generalized linear mixed models. Results Of 85 participants, 76 (89.4%) completed the flare survey, 72 (94.7%) of whom reported experiencing flares. Flares varied widely in terms of their duration (seconds to months), frequency (several times per day to once per year or less), and intensity and type of symptoms (e.g. pelvic pain vs urological symptoms). Flares of all durations were associated with greater pelvic pain, urological symptoms, disruption to participants' activities and bother, with increasing severity of each of these factors as the duration of flares increased. Days‐long flares were also associated with greater healthcare utilization. In addition to duration, symptoms (pelvic pain, in particular) were also significant determinants of flare‐related bother. Conclusions Our findings suggest that flares are common and associated with greater symptoms, healthcare utilization, disruption and bother. Our findings also show the characteristics of flares most bothersome to patients (i.e. increased pelvic pain and duration), and thus of greatest importance to consider in future research on flare prevention and treatment.
       
  • Silencing histone deacetylase 2 using small hairpin RNA induces regression
           of fibrotic plaque in a rat model of Peyronie's disease
    • Abstract: Objectives To examine the therapeutic effect of adenovirus encoding histone deacetylase 2 (HDAC2) small hairpin RNA (Ad‐HDAC2 shRNA) in a rat model of Peyronie's disease (PD) and to determine the mechanisms by which HDAC2 knockdown ameliorates fibrotic responses in primary fibroblasts derived from human PD plaque. Materials and Methods Rats were distributed into four groups (n = 6 per group): age‐matched controls without treatment; rats in which PD has been induced (PD rats) without treatment; PD rats receiving a single injection of control adenovirus encoding scrambled small hairpin RNA (Ad‐shRNA) (day 15; 1 × 108 pfu/0.1 mL phosphate‐buffered saline [PBS]); and PD rats receiving a single injection of Ad‐HDAC2 shRNA (day 15; 1 × 108 pfu/0.1 mL PBS) into the lesion. PD‐like plaque was induced by repeated intratunical injections of 100 μL each of human fibrin and thrombin solutions on days 0 and 5. On day 30, the penis was harvested for histological examination. Fibroblasts isolated from human PD plaque were pretreated with HDAC2 small interfering (si)RNA (100 pmoL) and then stimulated with transforming growth factor (TGF)‐β1 (10 ng/mL) to determine hydroxyproline levels, procollagen mRNA, apoptosis and protein expression of poly(ADP‐ribose) polymerase 1 (PARP1) and cyclin D1. Results We observed that Ad‐HDAC2 shRNA decreased inflammatory cell infiltration, reduced transnuclear expression of phospho‐Smad3 and regressed fibrotic plaque of the tunica albuginea in PD rats in vivo. siRNA‐mediated silencing of HDAC2 significantly decreased the TGF‐β1‐induced transdifferentiation of fibroblasts into myofibroblasts and collagen production, and induced apoptosis by downregulating the expression of PARP1, and decreased the expression of cyclin D1 (a positive cell‐cycle regulator) in primary cultured fibroblasts derived from human PD plaque in vitro. Conclusion Specific inhibition of HDAC2 with RNA interference may represent a novel targeted therapy for PD.
       
  • Effect of partial bladder outlet obstruction and reversal on rabbit
           bladder physiology and biochemistry: duration of recovery period and
           severity of function
    • Abstract: Objectives To use a rabbit model of partial bladder outlet obstruction (BOO) to investigate the point at which obstructive bladder dysfunction becomes irreversible. Methods Partial BOO was induced in New Zealand White rabbits. It was then reversed and the rabbits were allowed to recover for 4, 8 or 12 weeks. Both at the time of reversal and at the end of the study, the rabbits were grouped according to bladder decompensation level (mild, intermediate or severe) based on bladder mass (weight). Results A strong correlation was observed between the production and distribution of collagen and the reduction of smooth muscle contractile function. We found that only in the bladders that were severely decompensated at the time of reversal did collagen levels not decrease. Conclusion The data show that recovery of function after reversal of partial BOO is directly related primarily to collagen levels at the time of reversal.
       
  • Bimanual examination of the retrieved specimen and regional hypothermia
           during robot‐assisted radical prostatectomy: a novel technique for
           reducing positive surgical margin and achieving pelvic cooling
    • Abstract: Objective To describe a novel method of achieving pelvic hypothermia during robot‐assisted radical prostatectomy (RARP) and a modification of technique allowing immediate organ retrieval for intraoperative examination and targeted frozen‐section biopsies. Patients and Methods Intracorporeal cooling and extraction (ICE) consists of a modification of the standard RARP technique with the use of the GelPOINT™ (Applied Medical, Rancho Santa Margarita, CA, USA), a hand access platform, which allows for delivery of ice‐slush and rapid specimen extraction without compromising pneumoperitoneum. Results The ICE technique reproducibly achieves a temperature of 15 °C in the pelvic cavity with no obvious body temperature change. Adopting this technique during RARP, there was an absolute risk reduction by 26.6% in positive surgical margin rate in patients with pT3a disease when compared with similar patients undergoing conventional RARP (P = 0.04). Conclusions The ICE technique eliminates the potential handicap of decreased tactile sensation for oncological margins, especially in the high‐risk patients. This technique allows the surgeon to immediately examine the surgical specimen after resection, and with the aid of frozen‐section pathology determine if further resection is required. A prospective trial is underway in our centre to evaluate the effects of this novel technique on postoperative outcomes.
       
  • Corrigendum
    •  
  • Mucinous Tubular and Spindle Cell Carcinoma (MTSCC) of the Kidney: A
           Retrospective Detailed Study of Radiologic, Pathologic and Clinical
           Outcomes
    • Abstract: Objective To characterize the clinical, radiologic and histologic features of Mucinous Tubular and Spindle Cell Carcinoma (MTSCC), as well as oncologic outcomes. Patients and methods This is a single institution retrospective analysis of all MTSCC patients from 2002‐2011. Patients were excluded if MTSCC could not be confirmed on pathology re‐review (n=4). Clinical characteristics, pathology, imaging, and outcomes were reviewed for the 19 included patients. Results Median age at diagnosis was 59 years (range 17‐71) with a female predominance (78.9%). On contrast enhanced CT scan, MTSCC enhanced less than the cortex during the corticomedullary phase. Mean tumor attenuation was 36 HU (range 24‐48), 67 HU (range 41‐133), 89 HU (range 49‐152), and 76 HU (range 52‐106) in the precontrast, corticomedullary, nephrographic and excretory phases, respectively. Sixteen patients were treated with partial (N=5) or radical nephrectomy (N=11) for pT1(62.5%), pT2(31.3%), and pT3a disease(6.3%). One patient had active surveillance. Of 3 patients(13.0%) managed with energy ablation, there was one recurrence that was treated with salvage surgery. One patient(5.3%) had metastatic disease at diagnosis and died of disease 64.7 months later. A patient with a pT2bN0M0 MTSCC with sarcomatoid dedifferentiation developed bone metastases 9.5 months after diagnosis and was alive at 19.0 months. The remainder were free of recurrence or progression. Conclusion MTSCC is a rare RCC variant. In this largest series to date, MTSCC presented at a broad range of ages and displayed a female predilection. Imaging and pathologic features of MTSCC display some overlap with papillary RCC. MTSCC is associated with excellent outcomes overall, but is not universally indolent.
       
  • The Swedish National Penile Cancer Register: Incidence, Tumour
           Characteristics, Management and Survival
    • Abstract: Objectives ● To assess penile cancer incidence, stage distribution, adherence to guidelines, and prognostic factors in a population‐based setting. Patients and Methods ● The population‐based Swedish National Penile Cancer Register (NPECR) contains detailed information on tumour characteristics and management patterns. ● A total of 1678 men with primary squamous cell carcinoma of the penis identified in the NPECR between 2000 and 2012 were included in the study.  Results ● The mean age‐adjusted incidence of penile cancer was 2.1/100,000 men, remaining virtually unchanged during the study period. ● At diagnosis, 14% and 2% were clinically N+ and M+, respectively. ● Most patients were staged pTis (34%), pT2 (19%), or pT1 (18%), whereas stage was unavailable in 18%. ● Organ‐preserving treatment was used in 71% of Tis−T1 tumours. In cN0 and ≥pT1G2 patients, 50% underwent lymph node staging, while 74% of cN1−3 patients underwent lymph node dissection. ● The overall 5‐year relative survival was 82%. Men aged ≥40 years and those with pT2−3, G2−3 and N+ tumours had worse outcome. Conclusion ● The incidence of penile cancer in Sweden is stable. ● Most men presented with localised disease, and the proportion of non‐invasive tumours was high. During the period under study, adherence to guidelines was suboptimal. ● The overall 5‐year relative survival was 82%. Older age, increasing tumour stage and grade, and increasing lymph node stage were associated with poorer survival.
       
 
 
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