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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: 1, SJR: 0.655, h-index: 70)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 20, SJR: 0.439, h-index: 32)
J. of Molecular Recognition     Hybrid Journal   (Followers: 1, SJR: 0.986, h-index: 56)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 17, 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: 1)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.314, h-index: 23)
J. of Muscle Foods     Hybrid Journal   (Followers: 3)
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: 7, 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: 2, 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: 20, SJR: 2.541, h-index: 83)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 13, SJR: 1.246, h-index: 96)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 14, 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: 15, SJR: 0.662, h-index: 42)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.596, h-index: 53)
J. of Personality     Hybrid Journal   (Followers: 11, 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: 199, SJR: 1.206, h-index: 102)
J. of Philosophy of Education     Hybrid Journal   (Followers: 6, SJR: 0.491, h-index: 17)
J. of Phycology     Hybrid Journal   (Followers: 5, 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   (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: 165, 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: 13, 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: 37, 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: 6, SJR: 1.961, h-index: 36)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, 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: 8, 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: 9, 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: 12, SJR: 1.511, h-index: 18)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 2)
J. of Supreme Court History     Hybrid Journal   (Followers: 6)
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: 12, SJR: 1.673, h-index: 138)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 154, 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: 2)
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: 20, 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
   Journal TOC RSS feeds Export to Zotero [193 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  [1603 journals]   [SJR: 1.381]   [H-I: 96]
  • 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
    • 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
  • Extended Pelvic Lymph Node Dissection in Prostate Cancer Patients
           Previously Treated With Surgery for Lower Urinary Tract Symptoms
    • Authors: Nicola Fossati; Daniel D Sjoberg, Umberto Capitanio, Giorgio Gandaglia, Alessandro Larcher, Alessandro Nini, Vincenzo Mirone, Andrew J Vickers, Francesco Montorsi, Alberto Briganti
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the effect of previous prostate surgery performed for lower urinary tract symptoms (LUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer, testing two widely used LNI predictive models. Subject / Patients and Methods From 1990 to 2012, we collected data on 4734 prostate cancer patients treated with radical prostatectomy and extended pelvic lymph node dissection. Of these, 4453 (94%) had no prior prostate surgery (“naïve patients”), while 286 (6%) had previously undergone surgery for LUTS. Two LNI prediction models based on patients treated with extended pelvic lymph node dissection were evaluated using the area under the receiver operating characteristics (ROC) curve, the calibration plot method, and decision curve analyses. Results The rate of LNI was 12%, while the median number of lymph nodes removed was 15 in both groups (p=0.9). The two tested nomograms provided more accurate prediction in naïve patients relative to patients previously treated with prostate surgery for LUTS (AUC: 82% and 81% vs. 68% and 71%, p=0.01 and p=0.04 respectively). In naïve patients the surgeon would have missed one LNI for every 53 and 34 avoided ePLND using the Briganti and Godoy nomograms, respectively; in patients previously treated with surgery for LUTS, a LNI would have been missed in 13 and 21 patients not undergoing ePLND. Conclusion The accuracy and the clinical net‐benefit of LNI prediction tools decrease importantly in patients with prior prostate surgery for LUTS. These models should be avoided in such patients, who should instead be subject to routine pelvic lymph node dissection.
      PubDate: 2014-08-28T06:27:09.595269-05:
      DOI: 10.1111/bju.12912
  • 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
  • Extraprostatic Extension of Prostatic Carcinoma: Is its Proximity to
           Surgical margin or Gleason Score Important?
    • Authors: Ruta Gupta; Rachel O'Connell, Anne‐Maree Haynes, Phillip D Stricker, Wade Barrett, Jennifer J Turner, Warick Delprado, Lisa G Horvath, James G Kench
      Pages: n/a - n/a
      Abstract: Objective To examine the association between histopathological factors of extraprostatic cancer and outcome. Materials and methods Patients with EPE without positive margins, seminal vesicle or lymph node involvement were analyzed from a consecutive radical prostatectomy cohort of 1136 (2002‐2006) for: 1) measurement of distance of EPE from the margin; 2) Gleason score of the EPE; 3) extent of EPE. Log‐rank, Kaplan‐Meier, Cox regression analyses were performed. Results This study includes 194 pT3a, pN0, R0 cases with a median follow up of 5.4 years with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with Gleason score >8 in the extraprostatic portion showed increased incidence of BCR compared to those with Gleason scores of 8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.
      PubDate: 2014-08-19T19:45:44.389508-05:
      DOI: 10.1111/bju.12911
  • Preventable mortality after common urological surgery: failing to
    • 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
  • The social media revolution is changing the conference experience:
           analytics and trends from eight international meetings
    • Authors: Sarah E. Wilkinson; Marnique Y. Basto, Greta Perovic, Nathan Lawrentschuk, Declan G. Murphy
      Pages: n/a - n/a
      Abstract: Objective To analyse the use of Twitter at urology conferences to enhance the social media conference experience. Materials and methods We prospectively registered the hashtags of eight international urology conferences taking place in 2013, using the social media metrics website, In addition, we prospectively registered the hashtag for the European Association of Urology Annual Meeting for three consecutive years (2012‐14) to analyse the trend in the use of Twitter at a particular meeting. Metrics including number of tweets, number of participants, tweet traffic per day, and overall digital impressions were captured for five days prior to each conference, the conference itself, and the following two days. We also measured corresponding social media activity at a very large non‐urology meeting (the American Society of Clinical Oncology) for comparative purposes. Results Twitter activity was noted at all eight conferences in 2013. In total, 12,363 tweets were sent generating over 14 million impressions. The number of participants tweeting at each meeting varied from 80 (#SIU2013) to 573 (#AUA13). Overall, the American Urological Association meeting (#AUA13) generated the most Twitter activity with over 8.6 million impressions and a total of 4,663 tweets over the peri‐conference period. It also had the highest number of impressions and tweets per day over this period – 717 thousand and 389 respectively. The EAU Annual Meeting 2013 (#EAU13) generated 1.74 million impressions from a total of 1,762 tweets from 236 participants. Regarding trends in Twitter use, there was a very sharp rise in Twitter activity at the EAU Annual Meeting between 2012‐2014. Over this three‐year period, the number of participants increasing almost ten‐fold, leading to an increase in the number of tweets from 347 to almost 6,000. At #EAU14, digital impressions reached 7.35 million with 5,903 tweets sent by 797 participants. Conclusions Urological conferences, to a varying extent, have adopted social media as a means of amplifying the conference experience to a wider audience, generating international engagement and global reach. Twitter is a very powerful tool that amplifies the content of scientific meetings, and conference organisers should put in place strategies to capitalise on this.
      PubDate: 2014-08-18T01:56:02.342987-05:
      DOI: 10.1111/bju.12910
  • Clinical performance of Prostate Health Index (PHI) for prediction of
           prostate cancer in obese men: data from a multicenter European prospective
           study, PROMEtheuS project
    • Authors: Alberto Abrate; Massimo Lazzeri, Giovanni Lughezzani, Nicolòmaria Buffi, Vittorio Bini, Alexander Haese, Alexandre Taille, Thomas McNicholas, Joan Palou Redorta, Giulio M. Gadda, Giuliana Lista, Ella Kinzikeeva, Nicola Fossati, Alessandro Larcher, Paolo Dell'Oglio, Francesco Mistretta, Massimo Freschi, Giorgio Guazzoni
      Pages: n/a - n/a
      Abstract: Objectives To test [‐2]proPSA (p2PSA), p2PSA/fPSA (%p2PSA) and Prostate Health Index (PHI) accuracy in predicting prostate cancer (PCa) in obese men and to test whether PHI is more accurate than PSA in predicting PCa in obese patients. Patients and Methods The analysis consisted of a nested case‐control study from the PRO‐psa Multicentric European Study (PROMEtheuS) project. The study is registered at http://www.controlled‐ The primary outcome was to test sensitivity, specificity and accuracy (clinical validity) of serum p2PSA, %p2PSA and PHI, in determining PCa at prostate biopsy in obese men (BMI ≥ 30 kg/m2), compared to tPSA, fPSA and %fPSA. The number of avoidable prostate biopsies (clinical utility) was also assessed. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis. Results Over 965 subjects, 383 (39.7%) were normal‐weight (BMI < 25 kg/m2), 440 (45.6%) were overweight (BMI 25‐29.9 kg/m2) and 142 (14.7%) were obese (BMI ≥ 30 kg/m2). Among obese patients, PCa was found in 65 subjects (45.8%), with a higher percentage of GS ≥7 diseases (67.7%). PSA, p2PSA, %p2PSA and PHI were significantly higher, and %fPSA significantly lower in patients with PCa (p
      PubDate: 2014-08-18T01:55:54.780163-05:
      DOI: 10.1111/bju.12907
  • Individual Patient Data from Registrational Trials of Silodosin in the
           Treatment of Non‐neurogenic Male Lower Urinary Tract Symptoms
           Associated with Benign Prostatic Enlargement: Subgroup Analyses of
           Efficacy and Safety Data
    • Authors: Giacomo Novara; Christopher R. Chapple, Francesco Montorsi
      Pages: n/a - n/a
      Abstract: Objective To evaluate efficacy and safety of silodosin in a pooled analysis of individual patient data from three registrational RCTs comparing silodosin and placebo in patients with lower urinary tract symptoms (LUTS). Patients and methods A pooled analysis of 1494 patients from three 12‐week, multicentre, double‐blind, placebo‐controlled phase III RCTs was performed. Efficacy and safety data were assessed across patients with different baseline characteristics. Statistical analyses were performed with SAS software v.9.3. Results Silodosin was significantly more effective than placebo in improving all IPSS‐related parameters, and Qmax (p
      PubDate: 2014-08-18T01:55:46.326916-05:
      DOI: 10.1111/bju.12906
  • 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
  • Role of multiparametric magnetic resonance imaging (MRI) in focal therapy
           for prostate cancer: a Delphi consensus project
    • Authors: Berrend G. Muller; Willemien Bos, Maurizio Brausi, Francois Cornud, Paolo Gontero, Alexander Kirkham, Peter A. Pinto, Thomas J. Polascik, Ardeshir R. Rastinehad, Theo M. Reijke, Jean J. Rosette, Osamu Ukimura, Arnauld Villers, Jochen Walz, Hessel Wijkstra, Michael Marberger
      Pages: n/a - n/a
      Abstract: Objective To define the role of multiparametric MRI (mpMRI) for treatment planning, guidance and follow‐up in focal therapy for prostate cancer based on a multidisciplinary Delphi consensus project. Materials and Methods An online consensus process based on a questionnaire was circulated according to the Delphi method. Discussion points were identified by literature research and were sent to the panel via an online questionnaire in three rounds. A face‐to‐face consensus meeting followed the three rounds of questions that were sent to a 48‐participant expert panel consisting of urologists, radiologists and engineers. Participants were presented with the results of the previous rounds. Conclusions formulated from the results of the questionnaire were discussed in the final face‐to‐face meeting. Results Consensus was reached in 41% of all key items. Patients selected for focal therapy should have biopsy‐proven prostate cancer. Biopsies should ideally be performed after mpMRI of the prostate. Standardization of imaging protocols is essential and mpMRIs should be read by an experienced radiologist. In the follow‐up after focal therapy, mpMRI should be performed after 6 months, followed by a yearly mpMRI. mpMRI findings should be confirmed by targeted biopsies before re‐treatment. No consensus was reached on whether mpMRI could replace transperineal template saturation biopsies to exclude significant lesions outside the target lesion. Conclusions Consensus was reached on a number of areas related to the conduct, interpretation and reporting of mpMRI for use in treatment planning, guidance and follow‐up of focal therapy for prostate cancer. Future studies, comparing mpMRI with transperineal saturation mapping biopsies, will confirm the importance of mpMRI for a variety of purposes in focal therapy for prostate cancer.
      PubDate: 2014-08-16T12:23:16.480748-05:
      DOI: 10.1111/bju.12548
  • Impact of comorbidity on health‐related quality of life after
           prostate cancer treatment: combined analysis of two prospective cohort
    • 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
  • Vesico‐ureteric reflux (VUR) management and screening patterns: are
           paediatric urologists following the 2010 American Urological Association
           (AUA) guidelines?
    • Authors: Peter L. Sunaryo; Gina M. Cambareri, Dock G. Winston, Moneer K. Hanna, Jeffrey A. Stock
      Pages: n/a - n/a
      Abstract: Objective To evaluate the current practice patterns of vesico‐ureteric reflux (VUR) management and screening among paediatric urologists and their relationship with the current American Urological Association (AUA) guidelines in managing and treating VUR. Subjects and Methods A 17‐question survey was sent out to 476 paediatric urologists who are members of the Society for Pediatric Urology (SPU). In all, 133 respondents answered the survey and results were included for all questions. Results Paediatric urologists who were surveyed were consistent with the 2010 AUA guidelines in the initial evaluation of children with VUR, continuous antibiotic prophylaxis for the child aged < or >1 year, and follow‐up evaluation in children with VUR. Most paediatric urologists do not obtain a serum creatinine on initial screening of children with VUR. The new guidelines address screening of siblings of patients with VUR and most paediatric urologists were consistent with these recommendations. Almost one third of responders screened all neonates diagnosed with prenatal hydronephrosis regardless of clinical history or findings on imaging despite the recommendations of the new guidelines. Conclusion We conclude that based on our present sample, most paediatric urologists follow the 2010 AUA guidelines on VUR management.
      PubDate: 2014-08-16T12:22:46.893294-05:
      DOI: 10.1111/bju.12588
  • Testicular‐sparing surgery for bilateral or monorchide testicular
           tumours: a multicenter study of long‐term oncological and functional
    • 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
    • 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
    • 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
  • Candidate selection for quadrant‐based focal ablation through a
           combination of diffusion‐weighted magnetic resonance imaging and
           prostate biopsy
    • Authors: Yoh Matsuoka; Noboru Numao, Kazutaka Saito, Hiroshi Tanaka, Jiro Kumagai, Soichiro Yoshida, Junichiro Ishioka, Fumitaka Koga, Hitoshi Masuda, Satoru Kawakami, Yasuhisa Fujii, Kazunori Kihara
      Abstract: Objectives ● To identify prostatic quadrants that could be preserved without intervention, using diffusion‐weighted magnetic resonance imaging (DWI) and extended core biopsy, as a step toward implementation of quadrant‐based focal ablation with potential preservation of erectile and ejaculatory functions, based on comparisons with unilateral hemigland ablation. Patients and Methods ● We conducted a prebiopsy DWI study including 648 quadrants in 162 men who underwent 14‐core biopsy including anterior sampling and radical prostatectomy for localized cancer. ● Imaging and pathology were analyzed on a quadrant basis. Each quadrant was assessed through four‐core sampling. Predictive performance of DWI and biopsy regarding quadrant status was analyzed. Results ● On radical prostatectomy specimens, 170 anterior (52.5%) and 172 posterior quadrants (53.1%) harbored significant cancer (SC). ● Negative predictive values of DWI, biopsy, and their combination for SC were 79.7%, 70.6%, and 91.1%, respectively, in anterior quadrants, and 78.5%, 81.3%, and 91.7%, respectively, in posterior quadrants. ● DWI incrementally improved the negative predictive values of biopsy in anterior (p
      PubDate: 2014-08-14T04:08:45.348039-05:
      DOI: 10.1111/bju.12901
  • 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
  • Hypoalbuminemia is Associated with Mortality in Patients Undergoing
           Cytoreductive Nephrectomy
    • Authors: Anthony T. Corcoran; Samuel D. Kaffenberger, Peter E. Clark, John Walton, Elizabeth Handorf, Zack Piotrowski, Jeffery J. Tomaszewski, Serge Ginzburg, Reza Mehrazin, Elizabeth Plimack, David Y.T. Chen, Marc C. Smaldone, Robert G. Uzzo, Todd M. Morgan, Alexander Kutikov
      Abstract: Objective ● To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). Patients and Methods ● A multi‐institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993‐2012. ● Nutritional markers evaluated were: body mass index
      PubDate: 2014-08-14T04:07:54.615522-05:
      DOI: 10.1111/bju.12897
  • Real‐time in vivo periprostatic nerve tracking using multiphoton
           microscopy in a rat survival surgery model: a promising pre‐clinical
           study for enhanced nerve‐sparing surgery
    • Authors: Matthieu Durand; Manu Jain, Amit Aggarwal, Brian D. Robinson, Abhishek Srivastava, Rebecca Smith, Prasanna Sooriakumaran, Joyce Loeffler, Chris Pumill, Jean Amiel, Daniel Chevallier, Sushmita Mukherjee, Ashutosh K. Tewari
      Abstract: Objectives To assess the ability of MPM to visualize, differentiate and track periprostatic nerves in an in vivo rat model, mimicking real‐time imaging in humans during RP. To investigate the tissue toxicity and the reproducibility of in vivo MPM on prostatic glands in the rat after imaging and final histological correlation study. Patients and methods In vivo prostatic rat imaging was carried out using a custom‐built bench‐top MPM system generating real‐time 3D histologic images, after performing survival surgery consisting of mini‐laparotomies under xylazine/ketamine anesthesia exteriorizing the right prostatic lobe. The acquisition time and the depth of anesthesia were adjusted for collecting multiple images in order to track the periprostatic nerves in real‐time. The rats were then monitored for 15 days before undergoing a new set of imaging under similar settings. After sacrificing the rats, their prostates were submitted for routine histology and correlation studies. Results In vivo MPM images distinguished periprostatic nerves within the capsule and the prostatic glands from fresh unprocessed prostatic tissue without the use of exogenous contrast agents nor biopsy sample Real time nerve tracking outlining the prostate was feasible and acquisition was not disturbed by motion artifacts No serious adverse event was reported during rat monitoring; no tissue damage due to laser was seen on the imaged lobe compared to the contralateral lobe (control) allowing comparison of their corresponding histology. Conclusions For the first time, we have demonstrated that in vivo tracking of periprostatic nerves using MPM is feasible in rat models. Development of a multiphoton endoscope for intraoperative use in humans is currently in progress and must be assessed.
      PubDate: 2014-08-14T04:07:45.559747-05:
      DOI: 10.1111/bju.12903
  • The conservative management of renal trauma: a literature review and
           practical clinical guideline from Australia and New Zealand
    • Authors: McCombie SP; Thyer I, Corcoran NM, Rowling C, Dyer J, Le Roux A, Kuan M, Wallace DMA, Hayne D
      Abstract: Although the conservative management of renal trauma has gained in popularity since the middle of the last century, there remains a lack of specific guidance as to what this conservative approach should entail. The literature on the conservative management of renal trauma is reviewed within the framework of the American Association for the Surgery of Trauma (AAST) kidney injury severity scale. The decision on when to initiate conservative management is examined within the modern context of ureteric stenting, percutaneous drainage, and embolisation. Additionally, grade four injuries and intra‐operative consults are examined separately in view of the difficulties these groups cause in making appropriate treatment decisions. Graded recommendations are made by a multi‐disciplinary panel consisting of urologists, radiologists, and infectious disease physicians. Recommendations are made regarding several key topics including: imaging, inpatient monitoring, thromboprophylaxis, bed rest, antibiotics, discharge criteria, return to activity, and follow‐up. These recommendations have undergone formal review and debate at the Western Australian USANZ 2013 state conference, and were presented at the USANZ 2014 annual scientific meeting. It is hoped that these recommendations may help standardise the conservative management of renal trauma, as well as stimulate further debate and research.
      PubDate: 2014-08-14T04:02:12.838424-05:
      DOI: 10.1111/bju.12902
  • Survival disparities between Māori and non‐Māori men with
           prostate cancer in New Zealand
    • Authors: Zuzana Obertová; Nina Scott, Charis Brown, Alistair Stewart, Ross Lawrenson
      Abstract: Objective To examine temporal trends and current survival differences between Māori and non‐Māori men with prostate cancer in New Zealand. Subjects/patients and methods A cohort of 37,529 men aged 40+ years diagnosed with prostate cancer between 1996 and 2010 was identified from the New Zealand Cancer Registry and followed until 25 May 2011. Cause of death was obtained from the Mortality Collection by data linkage. Survival for Māori compared with non‐Māori men was estimated using the Kaplan‐Meier method, and Cox proportional hazard regression models, adjusted for age, year of diagnosis, socioeconomic deprivation and rural/urban residence. Results The probability of surviving was significantly lower for Māori compared with non‐Māori men at one, five and 10 years post‐diagnosis. Māori men were more likely to die of any cause (adjusted hazard ratio (HR), 1.84 [95% CI, 1.72, 1.97]) and of prostate cancer (adjusted HR, 1.94 [95% CI, 1.76, 2.14]). The adjusted HR of prostate cancer death for Māori men diagnosed with regional extent was 2.62‐fold [95% CI; 1.60, 4.31]) compared with non‐Māori men. The survival gap between Māori and non‐Māori men has not changed throughout the study period. Conclusion Significantly poorer survival was observed for Māori men compared with non‐Māori, particularly when diagnosed with regional prostate cancer. Despite improvements in survival for all men diagnosed after 2000, the survival gap between Māori and non‐Māori men has not been reduced with time. Differences in prostate cancer detection and management, partly driven by higher socio‐economic deprivation in Māori men, were identified as the most likely contributors to ethnic survival disparities in New Zealand.
      PubDate: 2014-08-14T04:02:04.988083-05:
      DOI: 10.1111/bju.12900
  • Prostate cancer mortality outcomes and patterns of primary treatment for
           Aboriginal men in New South Wales, Australia
    • Authors: Jennifer C Rodger; Rajah Supramaniam, Alison J Gibberd, David P Smith, Bruce K Armstrong, Anthony Dillon, Dianne L O'Connell
      Abstract: Objective To compare prostate cancer mortality for Aboriginal and non‐Aboriginal men and to describe prostate cancer treatments received by Aboriginal men. Subjects and methods We analysed cancer registry records for all men diagnosed with prostate cancer in New South Wales (NSW) in 2001‐2007 linked to hospital inpatient episodes and deaths. More detailed information on androgen deprivation therapy and radiotherapy was obtained from medical records for 87 NSW Aboriginal men diagnosed in 2000‐2011. The main outcomes were primary treatment for, and death from, prostate cancer. Analysis included Cox proportional hazards regression and logistic regression. Results There were 259 Aboriginal men among 35214 prostate cancer cases diagnosed in 2001‐2007. Age and spread of disease at diagnosis were similar for Aboriginal and non‐Aboriginal men. Prostate cancer mortality 5 years after diagnosis was higher for Aboriginal men (17.5%, 95% Confidence Interval (CI):12.4‐23.3) than non‐Aboriginal men (11.4%, 95% CI:11.0‐11.8). Aboriginal men were 49% more likely to die of prostate cancer (Hazard Ratio 1.49, 95% CI:1.07‐1.99) after adjusting for differences in demographic factors, stage at diagnosis, health access and comorbidities. Aboriginal men were less likely to have a prostatectomy for localised or regional cancer than non‐Aboriginal men (adjusted Odds Ratio 0.60 95% CI:0.40‐0.91). Of 87 Aboriginal men with full staging and treatment information 60% were diagnosed with localised disease. Of these 38% had a prostatectomy (+/‐ radiotherapy), 29% had radiotherapy only and 33% had neither. Conclusion More research is required to explain differences in treatment and mortality for Aboriginal men with prostate cancer compared to non‐Aboriginal men. In the meantime, ongoing monitoring and efforts are needed to ensure Aboriginal men have equitable access to best care.
      PubDate: 2014-08-14T04:01:56.567746-05:
      DOI: 10.1111/bju.12899
  • Robot‐assisted laparoscopic ureteric reimplantation: extravesical
    • Authors: Pankaj P. Dangle; Anup Shah, Mohan S. Gundeti
      Abstract: Objectives To describe our standardised approach to performing robot‐assisted extravesical ureteric reimplantation. Patients and Methods A total of 29 children, with high grade (III–V) vesico‐ureteric reflux (VUR) underwent robot‐assisted extravesical ureteric reimplantation between September 2010 and September 2013. Follow‐up renal ultrasonography was performed at 1 month and 3 months and a voiding cysto‐urethrogram (VCUG) was obtained at 4 months to assess VUR resolution. Results The mean (range) patient age at the time of surgery was 5.38 (3.0–10.0) years. Postoperative VCUG showed complete resolution of VUR in 32/40 ureters (80%). Of the remaining refluxing ureters, downgrading of VUR on VCUG was shown in 7/8 ureters (87.5%). The mean (range) length of hospital stay was 1.8 (1–3) days. Conclusions In conclusion, robot‐assisted extravesical ureteric reimplantation is technically feasible with acceptable resolution of VUR.
      PubDate: 2014-08-14T02:48:18.509033-05:
      DOI: 10.1111/bju.12813
  • Health‐related quality of life from a prospective randomised
           clinical trial of robot‐assisted laparoscopic vs open radical
    • 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
  • Early unclamping technique during robot‐assisted laparoscopic
           partial nephrectomy can minimise warm ischaemia without increasing
    • Authors: Benoit Peyronnet; Hervé Baumert, Romain Mathieu, Alexandra Masson‐Lecomte, Yohann Grassano, Mathieu Roumiguié, Walid Massoud, Vincent Abd El Fattah, Franck Bruyère, Stéphane Droupy, Alexandre Taille, Nicolas Doumerc, Jean‐Christophe Bernhard, Christophe Vaessen, Morgan Rouprêt, Karim Bensalah
      Abstract: Objective To compare perioperative outcomes of early unclamping (EUC) vs standard unclamping (SUC) during robot‐assisted partial nephrectomy (RAPN), as early unclamping of the renal pedicle has been reported to decrease warm ischaemia time (WIT) during laparoscopic PN. Patients and Methods A retrospective multi‐institutional study was conducted at eight French academic centres between 2009 and 2013. Patients who underwent RAPN for a renal mass were included in the study. Patients without vascular clamping or for whom the decision to perform a radical nephrectomy was taken before unclamping were excluded. Perioperative outcomes were compared using the chi‐squared and Fisher's exact tests for discrete variables and the Mann–Whitney test for continuous variables. Predictors of WIT and estimated blood loss (EBL) were assessed using multiple linear regression analysis. Results In all, there were 430 patients: 222 in the EUC group and 208 in the SUC group. Tumours were larger (35.8 vs 32.3 mm, P = 0.02) and more complex (R.E.N.A.L. nephrometry score 6.9 vs 6.1, P < 0.001) in the EUC group but surgeons were more experienced (>50 procedures 12.2% vs 1.4%, P < 0.001). The mean WIT was shorter (16.7 vs 22.3 min, P < 0.001) and EBL was higher (369.5 vs 240 mL, P = 0.001) in the EUC group with no significant difference in complications or transfusion rates. The results remained the same when analysing subgroups of complex renal tumours (R.E.N.A.L. nephrometry score ≥7) or RAPN performed by less experienced surgeons (
      PubDate: 2014-08-13T09:41:01.133506-05:
      DOI: 10.1111/bju.12766
  • 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
  • Propensity‐score matched analysis comparing robot‐assisted
           with laparoscopic partial nephrectomy
    • Authors: Zhenjie Wu; Mingmin Li, Shangqing Song, Huamao Ye, Qing Yang, Bing Liu, Chen Cai, Bo Yang, Liang Xiao, Qi Chen, Chen Lü, Xu Gao, Chuanliang Xu, Xiaofeng Gao, Jianguo Hou, Linhui Wang, Yinghao Sun
      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.
      PubDate: 2014-08-13T09:17:27.862438-05:
      DOI: 10.1111/bju.12774
  • Differences in 24‐h urine composition between nephrolithiasis
           patients with and without diabetes mellitus
    • Authors: Christopher Hartman; Justin I. Friedlander, Daniel M. Moreira, Sammy E. Elsamra, Arthur D. Smith, Zeph Okeke
      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.
      PubDate: 2014-08-13T09:16:35.2424-05:00
      DOI: 10.1111/bju.12807
  • External validation of the Briganti nomogram to estimate the probability
           of specimen‐confined disease in patients with high‐risk
           prostate cancer
    • Authors: Mathieu Roumiguié; Jean‐Baptiste Beauval, Thomas Filleron, Thibaut Benoit, Pascal Rischmann, Alexandre Taille, Laurent Salomon, Michel Soulié, Bernard Malavaud, Guillaume Ploussard
      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.
      PubDate: 2014-08-13T08:44:24.400723-05:
      DOI: 10.1111/bju.12763
  • Is radical nephrectomy a legitimate therapeutic option in patients with
           renal masses amenable to nephron‐sparing surgery'
    • Authors: Jeffrey J. Tomaszewski; Marc C. Smaldone, Robert G. Uzzo, Alexander Kutikov
      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.
      PubDate: 2014-08-13T08:39:14.002305-05:
      DOI: 10.1111/bju.12696
  • Combined injection of three different lineages of
           early‐differentiating human amniotic fluid‐derived cells
           restores urethral sphincter function in urinary incontinence
    • Authors: So Young Chun; Joon Beom Kwon, Seon Yeong Chae, Jong Kil Lee, Jae‐sung Bae, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Jeong Ok Lim, James J Yoo, Wun‐Jae Kim, Bup Wan Kim, Tae Gyun Kwon
      Abstract: Objective To investigate whether a triple combination of early‐differentiated cells derived from human amniotic fluid stem cells (hAFSCs) would show synergistic effects in urethral sphincter regeneration. Materials and Methods We early‐differentiated hAFSCs into muscle, neuron and endothelial progenitor cells and then injected them into the urethral sphincter region of pudendal neurectomized ICR mice, as single‐cell, double‐cell or triple‐cell combinations. Urodynamic studies and histological, immunohistochemical and molecular analyses were performed. Results Urodynamic study showed significantly improved leak point pressure in the triple‐cell‐combination group compared with the single‐cell‐ or double‐cell‐combination groups. These functional results were confirmed by histological and immunohistochemical analyses, as evidenced by the formation of new striated muscle fibres and neuromuscular junctions at the cell injection site. Molecular analysis showed higher target marker expression in the retrieved urethral tissue of the triple‐cell‐combination group. The injection of early‐differentiated hAFSCs suppressed in vivo host CD8 lymphocyte aggregations and did not form teratoma. The nanoparticle‐labelled early‐differentiated hAFSCs could be tracked in vivo with optical imaging for up to 14 days after injection. Conclusion Our novel concept of triple‐combined early‐differentiated cell therapy for the damaged sphincter may provide a viable option for incontinence treatment.
      PubDate: 2014-08-13T08:37:46.861095-05:
      DOI: 10.1111/bju.12815
  • Outcomes of men with an elevated prostate‐specific antigen (PSA)
           level as their sole preoperative intermediate‐ or high‐risk
    • Authors: Farzana A. Faisal; Debasish Sundi, Phillip M. Pierorazio, Mark W. Ball, Elizabeth B. Humphreys, Misop Han, Jonathan I. Epstein, Alan W. Partin, H. Ballentine Carter, Trinity J. Bivalacqua, Edward M. Schaeffer, Ashley E. Ross
      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.
      PubDate: 2014-08-13T08:32:08.058701-05:
      DOI: 10.1111/bju.12771
  • Development and internal validation of a nomogram for predicting
           stone‐free status after flexible ureteroscopy for renal stones
    • Authors: Hiroki Ito; Kentaro Sakamaki, Takashi Kawahara, Hideyuki Terao, Kengo Yasuda, Shinnosuke Kuroda, Masahiro Yao, Yoshinobu Kubota, Junichi Matsuzaki
      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.
      PubDate: 2014-08-13T08:29:40.746532-05:
      DOI: 10.1111/bju.12775
  • Silencing histone deacetylase 2 using small hairpin RNA induces regression
           of fibrotic plaque in a rat model of Peyronie's disease
    • Authors: Ki‐Dong Kwon; Min Ji Choi, Jin‐Mi Park, Kang‐Moon Song, Mi‐Hye Kwon, Dulguun Batbold, Guo Nan Yin, Woo Jean Kim, Ji‐Kan Ryu, Jun‐Kyu Suh
      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.
      PubDate: 2014-08-13T08:21:28.9626-05:00
      DOI: 10.1111/bju.12812
  • Diagnostic performance and safety of a three‐dimensional
           14‐core systematic biopsy method
    • Authors: Hideki Takeshita; Satoru Kawakami, Noboru Numao, Mizuaki Sakura, Manabu Tatokoro, Shinya Yamamoto, Toshiki Kijima, Yoshinobu Komai, Kazutaka Saito, Fumitaka Koga, Yasuhisa Fujii, Iwao Fukui, Kazunori Kihara
      Abstract: Objective To investigate the diagnostic performance and safety of a three‐dimensional 14‐core biopsy (3D14PBx) method, which is a combination of the transrectal six‐core and transperineal eight‐core biopsy methods. Patients and Methods Between December 2005 and August 2010, 1103 men underwent 3D14PBx at our institutions and were analysed prospectively. Biopsy criteria included a PSA level of 2.5–20 ng/mL or abnormal digital rectal examination (DRE) findings, or both. The primary endpoint of the study was diagnostic performance and the secondary endpoint was safety. We applied recursive partitioning to the entire study cohort to delineate the unique contribution of each sampling site to overall and clinically significant cancer detection. Results Prostate cancer was detected in 503 of the 1103 patients (45.6%). Age, family history of prostate cancer, DRE, PSA, percentage of free PSA and prostate volume were associated with the positive biopsy results significantly and independently. Of the 503 cancers detected, 39 (7.8%) were clinically locally advanced (≥cT3a), 348 (69%) had a biopsy Gleason score (GS) of ≥7, and 463 (92%) met the definition of biopsy‐based significant cancer. Recursive partitioning analysis showed that each sampling site contributed uniquely to both the overall and the biopsy‐based significant cancer detection rate of the 3D14PBx method. The overall cancer‐positive rate of each sampling site ranged from 14.5% in the transrectal far lateral base to 22.8% in the transrectal far lateral apex. As of August 2010, 210 patients (42%) had undergone radical prostatectomy, of whom 55 (26%) were found to have pathologically non‐organ‐confined disease, 174 (83%) had prostatectomy GS ≥7 and 185 (88%) met the definition of prostatectomy‐based significant cancer. Conclusions This is the first prospective analysis of the diagnostic performance of an extended biopsy method, which is a simplified version of the somewhat redundant super‐extended three‐dimensional 26‐core biopsy. As expected, each sampling site uniquely contributed not only to overall cancer detection, but also to significant cancer detection. 3D14PBx is a feasible systematic biopsy method in men with PSA
      PubDate: 2014-08-13T08:17:37.750112-05:
      DOI: 10.1111/bju.12772
  • Clinical role of pathological downgrading after radical prostatectomy in
           patients with biopsy confirmed Gleason score 3 + 4 prostate cancer
    • Authors: Tatsuo Gondo; Bing Ying Poon, Kazuhiro Matsumoto, Melanie Bernstein, Daniel D. Sjoberg, James A. Eastham
      Abstract: Objective To identify preoperative factors predicting Gleason score downgrading after radical prostatectomy (RP) in patients with biopsy Gleason score 3+4 prostate cancer and to determine if prediction of downgrading can identify potential candidates for active surveillance (AS). Patients and Methods We identified 1317 patients with biopsy Gleason score 3+4 prostate cancers who underwent RP at the Memorial Sloan‐Kettering Cancer Center between 2005 and 2013. Several preoperative and biopsy characteristics were evaluated by forward selection regression, and selected predictors of downgrading were analysed by multivariable logistic regression. Decision curve analysis was used to evaluate the clinical utility of the multivariate model. Results Gleason score was downgraded after RP in 115 patients (9%). We developed a multivariable model using age, prostate‐specific antigen density, percentage of positive cores with Gleason pattern 4 cancer out of all cores taken, and maximum percentage of cancer involvement within a positive core with Gleason pattern 4 cancer. The area under the curve for this model was 0.75 after 10‐fold cross validation. However, decision curve analysis revealed that the model was not clinically helpful in identifying patients who will downgrade at RP for the purpose of reassigning them to AS. Conclusion While patients with pathological Gleason score 3 + 3 with tertiary Gleason pattern ≤4 at RP in patients with biopsy Gleason score 3 + 4 prostate cancer may be potential candidates for AS, decision curve analysis showed limited utility of our model to identify such men. Future study is needed to identify new predictors to help identify potential candidates for AS among patients with biopsy confirmed Gleason score 3 + 4 prostate cancer.
      PubDate: 2014-08-13T08:11:06.864243-05:
      DOI: 10.1111/bju.12769
  • Evolution of shockwave lithotripsy (SWL) technique: a 25‐year single
           centre experience of >5000 patients
    • Authors: Jitendra Jagtap; Shashikant Mishra, Amit Bhattu, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai
      Abstract: Objective To assess the impact of various treatment optimisation strategies in shockwave lithotripsy (SWL) used at a single centre over the last 25 years. Patients and Methods In all, 5017 patients treated between 1989 and 2013 were reviewed and divided into groups A, B, C and D for the treatment periods of 1989–1994 (1561 patients), 1995–2000 (1741), 2001–2006 (1039) and 2007–2013 (676), respectively. The Sonolith 3000 (A and B) and Dornier compact delta lithotripters (C and D) were used. Refinements included frequent re‐localisation, limiting maximum shocks and booster therapy in group B and Hounsfield unit estimation, power ramping and improved coupling in group D. Parameters reviewed were annual SWL utilisation, stone and treatment data, retreatment, auxiliary procedures, complications and stone‐free rate (SFR). Results The SFR with Dornier compact delta was significantly higher than that of the Sonolith 3000 (P < 0.001). The SFR improved significantly from 77.58%, 81.28%, 82.58% to 88.02% in groups A, B, C, and D, respectively (P < 0.001). There was a concomitant decrease in repeat SWL (re‐treatment rate: A, 48.7%; B, 33.4%; C, 15.8%; and D, 10.1%; P < 0.001) and complication rates (A, 8%; B, 6.4%; C, 4.9%; and D, 1.6%; P < 0.001). This led to a rise in the efficiency quotient (EQ) in groups A–D from 50.41, 58.94, 68.78 to 77.06 (P < 0.001).The auxiliary procedure rates were similar in all groups (P = 0.62). Conclusion In conclusion, improvement in the EQ together with a concomitant decrease in complication rate can be achieved with optimum patient selection and use of various treatment optimising strategies.
      PubDate: 2014-08-11T06:13:56.586457-05:
      DOI: 10.1111/bju.12808
  • Factors influencing disease progression of prostate cancer under active
           surveillance: a McGill University Health Center cohort
    • Authors: Ghassan A. Barayan; Fadi Brimo, Louis R. Bégin, James A. Hanley, Zhihui Liu, Wassim Kassouf, Armen G. Aprikian, Simon Tanguay
      Abstract: Objective To evaluate the clinical and pathological factors influencing the risk of disease progression in a cohort of patients with low–intermediate risk prostate cancer under active surveillance (AS). Patients and Methods We studied 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favourable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least one repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3–6 months for prostate‐specific antigen (PSA) measurement and physical examination. Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least one core, and a predominant Gleason pattern of 4. Results For the 155 patients, the mean (sd) age at diagnosis was 67 (7) years; the median (interquartile range) follow‐up was 5.4 (3.6–9.5) years. Of these, 67, 25, six, and two patients had two, three, four, and five repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score of 3+4, while the remaining 144 (93%) patients had a Gleason score of ≤6. In all, 50 (32.3%) patients had disease progression on repeat biopsies, with a median progression‐free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5‐year overall survival rate was 100%. Having a PSA density (PSAD) of >0.15 ng/mL/mL, >1 positive core, and Gleason score >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P < 0.05), while a maximum percentage of cancer in any core of >10% showed a trend toward significance for a higher progression rate (P = 0.054). On multivariate analysis, only the presence of a PSAD of >0.15 ng/mL/mL remained significant for a higher progression rate (P < 0.05). Of the 155 patients, five (3.2%) subsequently received radiotherapy, 13 (8.4%) received hormonal therapy, and 13 (8.4%) underwent radical prostatectomy. Conclusion AS is a suitable management option for patients with clinically low‐risk prostate cancer. A PSAD of >0.15 ng/mL/mL is an important predictor for disease progression.
      PubDate: 2014-08-11T06:12:23.87027-05:0
      DOI: 10.1111/bju.12754
  • Perioperative and renal functional outcomes of elective
           robot‐assisted partial nephrectomy (RAPN) for renal tumours with
           high surgical complexity
    • Authors: Alessandro Volpe; Diletta Garrou, Daniele Amparore, Geert De Naeyer, Francesco Porpiglia, Vincenzo Ficarra, Alexandre Mottrie
      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.
      PubDate: 2014-08-11T06:10:27.742509-05:
      DOI: 10.1111/bju.12751
  • Sexual function and health‐related quality of life in women with
           classic bladder exstrophy
    • Authors: Rebecca Deans; Lih‐Mei Liao, Dan Wood, Christopher Woodhouse, Sarah M. Creighton
      Abstract: Objective To investigate sexual function and quality of life in adolescent and adult women with classic bladder exstrophy (BE). Materials and Methods A two‐part observational cross‐sectional study with a questionnaire arm and a retrospective case review arm was performed. The study was undertaken in a centre providing a tertiary referral gynaecology and urology service. Outcomes were sexual function and quality‐of‐life scores. Results A total of 44 patients with BE were identified from departmental databases and included in the study, of whom 28 (64%) completed postal questionnaires. Sexual function scores and quality‐of‐life visual analogue scales were significantly poorer compared with normative data. Conclusions Bladder exstrophy has a detrimental psychological impact on women. In future, methodical multidisciplinary paediatric follow‐up research will help to identify predictors of better and worse adolescent and adult outcomes. Development and evaluation of cost‐effective psychological interventions to target specific problems is also warranted.
      PubDate: 2014-08-11T06:10:13.126621-05:
      DOI: 10.1111/bju.12811
  • International index of erectile function erectile function domain vs the
           sexually health inventory for men: methodological challenges in the
           radical prostatectomy population
    • Authors: Eduardo P. Miranda; John P. Mulhall
      Pages: n/a - n/a
      PubDate: 2014-08-11T06:09:46.991473-05:
      DOI: 10.1111/bju.12806
  • Laparoendoscopic single‐site (LESS) robot‐assisted partial
           nephrectomy (RAPN) reduces postoperative wound pain without a rise in
           complication rates
    • Authors: Tae Young Shin; Sey Kiat Lim, Christos Komninos, Dong Wook Kim, Woong Kyu Han, Sung Jun Hong, Byung Ha Jung, Koon Ho Rha
      Pages: n/a - n/a
      Abstract: Objective To compare long‐term functional outcomes and pain scale scores of patients who underwent laparoendoscopic single‐site (LESS)‐ robot‐assisted partial nephrectomy (RAPN) to those who underwent conventional RAPN (C‐RAPN), as LESS surgery is increasingly being adopted by urologists worldwide to reduce morbidities and scarring associated with surgical interventions. Patients and Methods In all, 167 consecutive patients who had RAPN were identified from our Institutional Review Board‐approved computerised database between October 2006 to July 2012. Patients were stratified into two groups: 80 patients who underwent C‐RAPN and 79 who underwent LESS‐RAPN. Results The LESS‐RAPN group had a longer warm ischaemia time [WIT, mean (sd) 26.5 (10.5) vs 19.8 (13.1) min; P = 0.001] and total operation time [TOT, mean (sd) 210.3 (83.4) vs 183.1 (76.1) min; P = 0.033] when compared with the C‐RAPN group. While, the LESS‐RAPN group and C‐RAPN group were not significantly different for the number of patients with negative surgical margins [77 (96.2%) vs 73 (91.4%); P = 0.194), absolute change in postoperative renal function [mean (sd) −6.5 (16.7)% vs −7.6 (16.7)%; P = 0.738) and postoperative complications rate [12 (15.0%) vs 10 (12.6%); P = 0.279). Furthermore, the LESS‐RAPN group had lower visual analogue pain scale (VAPS) scores at discharge [mean (sd) 2.1 (1.3) vs 1.7 (1.0); P = 0.048]. Conclusions Despite a significantly longer WIT and TOT, the functional outcomes of LESS‐RAPN were comparable to those of C‐RAPN for tumours of similar mean sizes and complexities, without any detriments in oncological and complications outcomes. On discharge, patients who underwent LESS‐RAPN also reported lower pain levels as one of the advantages of minimally invasive surgery. With the development of instrumentation specifically designed for single‐site surgery, LESS could be more easily conducted in patients who are interested in improved quality of life outcomes.
      PubDate: 2014-08-11T06:09:35.924992-05:
      DOI: 10.1111/bju.12783
  • Real‐time transrectal ultrasonography‐guided hands‐free
           technique for focal cryoablation of the prostate
    • Authors: Andre Luis Castro Abreu; Duke Bahn, Sameer Chopra, Scott Leslie, Toru Matsugasumi, Inderbir S. Gill, Osamu Ukimura
      Pages: n/a - n/a
      Abstract: Objectives To describe, step‐by‐step, our hands‐free technique for focal cryoablation of prostate cancer. Materials and Methods After detailed discussion of its limitations and benefits, consent was obtained to perform focal cryoablation in patients with biopsy‐proven unilateral low‐ to intermediate‐risk prostate cancer. The procedure was performed transperineally, using a hands‐free technique (without an external grid template) under real‐time bi‐plane transrectal ultrasonography (TRUS) guidance, using an argon/helium‐gas‐based third generation cryoablation system. Follow‐up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy. Results The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands‐free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands‐free bi‐plane TRUS probe manipulation to facilitate real‐time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real‐time TRUS monitoring of ice‐ball size, control of the energy delivered and the use of a warming urethral catheter. Conclusion We have described step‐by‐step the focal cryoablation of prostate cancer using a hands‐free technique. This technique facilitates the effective delivery of cryoprobes and the intra‐operative real‐time quick manipulation of the TRUS probe.
      PubDate: 2014-08-11T06:09:31.661608-05:
      DOI: 10.1111/bju.12795
  • Laparoscopic radical prostatectomy for high‐risk prostate cancer
    • Authors: Antonina Di Benedetto; Ricardo Soares, Zach Dovey, Simon Bott, Roy G. McGregor, Christopher G. Eden
      Pages: n/a - n/a
      Abstract: Objective To investigate the results of performing laparoscopic radical prostatectomy (LRP) in patients with high‐risk prostate cancer (HRPC): PSA level of ≥20 ng/mL ± biopsy Gleason ≥8 ± clinical T stage ≥2c. Patients and Methods Of a total of 1975 patients having LRP during a 159‐month period from 2000 to 2013, 446 (22.6%) had HRPC; all patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning. The median (range) patient age was 64.0 (36–79) years; body mass index 27.0 (18–43) kg/m2; PSA level 8.1 (0.1–93) ng/mL and biopsy Gleason 8 (6–10). All patients had a pelvic lymphadenectomy, which was done using an extended template after April 2008 (53.3%). Neurovascular bundle (NVB) preservation was done in 41.5% (bilateral 26.3%; unilateral 15.2%) of patients; an incremental or partial nerve‐sparing technique was used in 99 of the 302 (32.8%) NVBs preserved. Results The median (range) gland weight was 58.5 (20–161) g; operating time 180 (92–330) min; blood loss 200 (10–1400) mL; postoperative hospitalisation 3.0 (2–7) nights; catheterisation time 14 (2–35) days; complication rate 7.6%; lymph node (LN) count 16 (2–51); LN positivity 16.2%; LN involvement 2 (1–8); positive surgical margin (PSM) rate 26.0%; up‐grading 2.5%; down‐grading 4.3%; up‐staging from T1/2 to T3, 24.7%; down‐staging from T3 to T1/2, 6.1%. No cases were converted to open surgery and three patients were transfused (0.7%) after surgery. At a mean (range) follow‐up of 24.9 (3–120) months, 79.2% of patients were free of biochemical recurrence, 91.8% were continent and 64.4% of previously potent non‐diabetic men aged
      PubDate: 2014-08-11T06:09:03.402184-05:
      DOI: 10.1111/bju.12797
  • Prostate cancer incidence on cystoprostatectomy specimens is directly
           linked to age: results from a multicentre study
    • Authors: Géraldine Pignot; Laurent Salomon, Cédric Lebacle, Yann Neuzillet, Pierre Lunardi, Pascal Rischmann, Marc Zerbib, Cecile Champy, Morgan Roupret, Benoit Peyronnet, Gregory Verhoest, Thibault Murez, Herve Quintens, Stéphane Larré, Nadine Houédé, Eva Compérat, Michel Soulié, Christian Pfister
      Pages: n/a - n/a
      Abstract: Objective To assess the incidence and age‐related histopathological characteristics of incidentally diagnosed prostate cancer from specimens obtained via radical cystoprostatectomy (RCP) for muscle‐invasive bladder cancer. Patients and Methods A retrospective review of the histopathological features of 2424 male patients who underwent a RCP for bladder cancer was done at eight centres between January 1996 and June 2012. No patient had preoperative suspicion of prostate cancer. Statistical analyses were performed in different age‐related groups. Results Overall, prostate cancer was diagnosed in 518 men (21.4%). Incidences varied significantly according to age (5.2% in those aged 75 years, P < 0.001). Most of the prostate cancers were considered as ‘non‐aggressive’, that is to say organ‐confined (≤pT2) and well‐differentiated (Gleason score
      PubDate: 2014-08-11T06:08:49.844346-05:
      DOI: 10.1111/bju.12803
  • Preferences in the management of high‐risk prostate cancer among
           urologists in Europe: results of a web‐based survey
    • Authors: Cristian I. Surcel; Prasanna Sooriakumaran, Alberto Briganti, Pieter J.L. De Visschere, Jurgen J. Fütterer, Pirus Ghadjar, Hendrik Isbarn, Piet Ost, Guillaume Ploussard, Roderick C.N. Bergh, Inge M. Oort, Ofer Yossepowitch, J.P. Michiel Sedelaar, Gianluca Giannarini,
      Pages: n/a - n/a
      Abstract: Objective To explore preferences in the management of patients with newly diagnosed high‐risk prostate cancer (PCa) among urologists in Europe through a web‐based survey. Materials and Methods A web‐based survey was conducted between 15 August and 15 September 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29‐item multiple‐choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high‐risk PCa was e‐mailed to all urologists included in the mailing list of EAU members. Europe was divided into four geographical regions: Central‐Eastern Europe (CEE), Northern Europe (NE), Southern Europe (SE) and Western Europe (WE). Descriptive statistics were used. Differences among sample segments were obtained from a z‐test compared with the total sample. Results Of the 12 850 invited EAU members, 585 urologists practising in Europe completed the survey. High‐risk PCa was defined as serum PSA ≥20 ng/mL or clinical stage ≥ T3 or biopsy Gleason score ≥ 8 by 67% of responders, without significant geographical variations. The preferred single‐imaging examinations for staging were bone scan (74%, 81% in WE and 70% in SE; P = 0.02 for both), magnetic resonance imaging (53%, 72% in WE and 40% in SE; P = 0.02 and P = 0.01, respectively) and computed tomography (45%, 60% in SE and 23% in WE; P = 0.01 for both). Pre‐treatment predictive tools were routinely used by 62% of the urologists, without significant geographical variations. The preferred treatment was radical prostatectomy as the initial step of a multiple‐treatment approach (60%, 40% in NE and 70% in CEE; P = 0.02 and P < 0.01, respectively), followed by external beam radiation therapy with androgen deprivation therapy (29%, 45% in NE and 20% in CEE; P = 0.01 and P = 0.02, respectively), and radical prostatectomy as monotherapy (4%, 7% in WE; P = 0.04). When surgery was performed, the open retropubic approach was the most popular (58%, 74% in CEE, 37% in NE; P < 0.01 for both). Pelvic lymph node dissection was performed by 96% of urologists, equally split between a standard and extended template. There was no consensus on the definition of disease recurrence after primary treatment, and much heterogeneity in the administration of adjuvant and salvage treatments. Conclusion With the limitation of a low response rate, the present study is the first survey evaluating preferences in the management of high‐risk PCa among urologists in Europe. Although the definition of high‐risk PCa was fairly uniform, wide variations in patterns of primary and adjuvant/salvage treatments were observed. These differences might translate into variations in quality of care with a possible impact on ultimate oncological outcome.
      PubDate: 2014-08-11T06:08:24.32607-05:0
      DOI: 10.1111/bju.12796
  • 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
    • Authors: Siobhan Sutcliffe; Graham A. Colditz, Melody S. Goodman, Ratna Pakpahan, Joel Vetter, Timothy J. Ness, Gerald L. Andriole, H. Henry Lai
      Pages: n/a - n/a
      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.
      PubDate: 2014-08-11T06:07:42.980252-05:
      DOI: 10.1111/bju.12778
  • Nanotechnology applications in urology: a review
    • Authors: Michael Maddox; James Liu, Sree Harsha Mandava, Cameron Callaghan, Vijay John, Benjamin R. Lee
      Pages: n/a - n/a
      Abstract: The objectives of this review are to discuss the current literature and summarise some of the promising areas with which nanotechnology may improve urological care. A Medline literature search was performed to elucidate all relevant studies of nanotechnology with specific attention to its application in urology. Urological applications of nanotechnology include its use in medical imaging, gene therapy, drug delivery, and photothermal ablation of tumours. In vitro and animal studies have shown initial encouraging results. Further study of nanotechnology for urological applications is warranted to bridge the gap between preclinical studies and translation into clinical practice, but nanomedicine has shown significant potential to improve urological patient care.
      PubDate: 2014-08-11T06:06:36.566175-05:
      DOI: 10.1111/bju.12782
  • Effect of a genomic classifier test on clinical practice decisions for
           patients with high‐risk prostate cancer after surgery
    • Authors: Ketan K. Badani; Darby J. Thompson, Gordon Brown, Daniel Holmes, Naveen Kella, David Albala, Amar Singh, Christine Buerki, Elai Davicioni, John Hornberger
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the impact of a genomic classifier (GC) test for predicting metastasis risk after radical prostatectomy (RP) on urologists' decision‐making about adjuvant treatment of patients with high‐risk prostate cancer. Subjects and Methods Patient case history was extracted from the medical records of each of the 145 patients with pT3 disease or positive surgical margins (PSMs) after RP treated by six high‐volume urologists, from five community practices. GC results were available for 122 (84%) of these patients. US board‐certified urologists (n = 107) were invited to provide adjuvant treatment recommendations for 10 cases randomly drawn from the pool of patient case histories. For each case, the study participants were asked to make an adjuvant therapy recommendation without (clinical variables only) and with knowledge of the GC test results. Recommendations were made without knowledge of other participants' responses and the presentation of case histories was randomised to minimise recall bias. Results A total of 110 patient case histories were available for review by the study participants. The median patient age was 62 years, 71% of patients had pT3 disease and 63% had PSMs. The median (range) 5‐year predicted probability of metastasis by the GC test for the cohort was 3.9 (1–33)% and the GC test classified 72% of patients as having low risk for metastasis. A total of 51 urologists consented to the study and provided 530 adjuvant treatment recommendations without, and 530 with knowledge of the GC test results. Study participants performed a mean of 130 RPs/year and 55% were from community‐based practices. Without GC test result knowledge, observation was recommended for 57% (n = 303), adjuvant radiation therapy (ART) for 36% (n = 193) and other treatments for 7% (n = 34) of patients. Overall, 31% (95% CI: 27–35%) of treatment recommendations changed with knowledge of the GC test results. Of the ART recommendations without GC test result knowledge, 40% (n = 77) changed to observation (95% CI: 33–47%) with this knowledge. Of patients recommended for observation, 13% (n = 38 [95% CI: 9–17%]) were changed to ART with knowledge of the GC test result. Patients with low risk disease according to the GC test were recommended for observation 81% of the time (n = 276), while of those with high risk, 65% were recommended for treatment (n = 118; P < 0.001). Treatment intensity was strongly correlated with the GC‐predicted probability of metastasis (P < 0.001) and the GC test was the dominant risk factor driving decisions in multivariable analysis (odds ratio 8.6, 95% CI: 5.3–14.3%; P < 0.001). Conclusions Knowledge of GC test results had a direct effect on treatment strategies after surgery. Recommendations for observation increased by 20% for patients assessed by the GC test to be at low risk of metastasis, whereas recommendations for treatment increased by 16% for patients at high risk of metastasis. These results suggest that the implementation of genomic testing in clinical practice may lead to significant changes in adjuvant therapy decision‐making for high‐risk prostate cancer.
      PubDate: 2014-08-11T06:05:38.116516-05:
      DOI: 10.1111/bju.12789
  • γEpithelial Na+ Channel and the Acid‐Sensing Ion Channel 1
           expression in the urothelium of patients with neurogenic detrusor
    • Authors: C. Traini; G. Del Popolo, M. Lazzeri, K. Mazzaferro, F. Nelli, L. Calosi, M.G. Vannucchi
      Abstract: Objective To investigate the expression of two types of cation channels such as the γEpithelial Na+ Channel (γENaC) and the Acid‐Sensing Ion Channel1 (ASIC1) in the urothelium of controls and in patients affected by neurogenic detrusor overactivity (NDO). In parallel, the urodynamic parameters were collected and correlated to the immunohistochemical (IHC) results. Subjects and Methods Four controls and 12 patients with a clinical diagnosis of NDO and suprasacral spinal cord lesion underwent to urodynamic measurements and cystoscopy. Cold cup biopsies were frozen and processed for immunohistochemistry and western blots. Spearman's correlation coefficient between morphological and urodynamic data was applied. One‐way ANOVA followed by Newman–Keuls multiple comparison post‐hoc test was applied for western blot results. Results In the controls, γENaC and ASIC1 were expressed in the urothelium with differences in their cell distribution and intensity. In NDO patients, both markers showed consistent changes either in cell distribution and labeling intensity compared to controls. A significant correlation between the higher intensity of the γENaC expression in urothelium of NDO patients and the lower values of bladder compliance was detected. Conclusion The present findings show important changes in the expression of γENaC and ASIC1 in NDO human urothelium. Of note, while the changes in γENaC might impair the mechanosensory function of urothelium, the increase of the ASIC1 might represent an attempt to compensate excess in local sensitivity.
      PubDate: 2014-08-11T06:02:42.495484-05:
      DOI: 10.1111/bju.12896
  • Cardiopulmonary Reserve as Determined by Cardiopulmonary Exercise Testing
           Correlates with Length of Stay and Predicts Complications following
           Radical Cystectomy
    • Authors: Stephen Tolchard; Johanna Angell, Mark Pyke, Simon Lewis, Nicholas Dodds, Alia Darweish, Paul White, David Gillatt
      Abstract: Objective To investigate whether poor pre‐operative cardiopulmonary reserve and comorbid state dictate high risk status and can predict complications in patients undergoing radical cystectomy. Subjects and Methods 105 consecutive patients with transitional cell carcinoma (stage T1‐T3) undergoing robotic (n=38) or open (n=67) radical cystectomy in a single UK centre underwent pre‐operative cardiopulmonary exercise testing (CPET). Outcome measures and statistical analysis Prospective primary outcome variables were all cause complications and post‐operative length of stay (LOS). Binary logistic regression analysis identified potential predictive factor(s) and the predictive accuracy of CPET for all cause complications was examined using receiver operator characteristic (ROC) curve analysis. Correlations analysis employed Spearman's Rank Correlation and group comparison, the Mann Whitney U‐test and Fishers exact test. Any relationships were confirmed using the Mantel‐Haenszel Common Odds Ratio Estimate, Kaplan‐Meier analysis and the Chi‐squared test. Results AT was negatively (r = ‐·206, p = ·035), and VE/VCO2 positively (r = ·324, p = ·001) correlated with complications and LOS. Logistic regression analysis identified low AT (50% of patients presenting for radical cystectomy had significant heart failure, whereas pre‐operatively only very few (2%) had this diagnosis. Analysis using the Mann Whitney test showed that VE/VCO2≥33 was the most significant determinant of LOS (p = ·004). Kaplan‐Meier analysis showed that patients in this group had an additional median stay of 4 days (p = ·008). Finally, patients with an ASA grade of 3 and those on long‐term β‐blocker therapy were found to be at particular risk of MI and death following radical cystectomy with Odds ratios of 4.0 (p = ·042, 95% CI [1·05 – 15·24]) and 6.3 (p = ·008, [1·60 – 24·84]). Conclusion Patients with poor cardiopulmonary reserve and hypertension are at higher risk of post‐operative complications and have increased LOS following radical cystectomy. Heart failure is known to be a significant determinant of peri‐operative death and is significantly under diagnosed in this patient group.
      PubDate: 2014-08-11T06:02:34.259856-05:
      DOI: 10.1111/bju.12895
  • The Genetic Diversity of Cystinuria in a UK Population of Patients
    • Authors: Kathie A Wong; Rachael Mein, Mark Wass, Frances Flinter, Caroline Pardy, Matthew Bultitude, Kay Thomas
      Abstract: Objectives To examine the genetic mutations in the first UK cohort of patients with cystinuria with preliminary genotype/phenotype correlation Patients and Methods DNA sequencing and MLPA were used to identify the mutations in 74 patients in a specialist cystinuria clinic in the UK. Patients with type A cystinuria were classified into two groups: group M patients had at least one missense mutation. Group N patients had two alleles of all other types of mutations including frameshift, splice site, nonsense, deletions and duplications. The levels of urinary dibasic amino acids, age of presentation of disease, number of stone episodes and interventions were compared between patients in the two groups using Mann‐Whitney U test. Results 41 patients had type A cystinuria including one patient with a variant of unknown significance. 23 patients had type B cystinuria, including 6 patients with variants of unknown significance. One patient had 3 sequence variants in SLC7A9 however 2 are of unknown significance. Three patients had type AB cystinuria. Three had a single mutation in SLC7A9. No identified mutations were found in three patients in either gene. There were a total of 88 mutations in SLC3A1 and 55 mutations in SLC7A9. There were 23 pathogenic mutations identified in our UK cohort of patients not previously reported in literature. In patients with type A cystinuria, the presence of a missense mutation correlated to lower levels of urinary lysine (611.9mM/MC SE22.65 vs 752.3mM/MC SE46.39, p=0.0171), arginine (194.8mM/MC SE24.83 vs 397.7mM/MC SE15.32, p=0.0008) and ornithine (109.2mM/MC SE7.403 vs 146.6mM/MC SE12.7, p=0.0211). There was no difference in the levels of urinary cystine (182.1mM/MC SE8.89 vs 207.2mM/MC SE19.23, p=0.2343). Conclusions We have characterised the genetic diversity of cystinuria in a UK population including 23 pathogenic mutations not previously described in literature. Patients with at least one missense mutation in SLC3A1 had significantly lower levels of lysine, arginine, ornithine but not cystine than patients with all other combinations of mutations.
      PubDate: 2014-08-11T06:02:24.342261-05:
      DOI: 10.1111/bju.12894
  • Oncologic outcomes after partial versus radical nephrectomy in renal cell
           carcinomas smaller than 7 cm with presumed renal sinus fat invasion on
           preoperative imaging
    • Authors: Kyo Chul Koo; Jong Chan Kim, Kang Su Cho, Young Deuk Choi, Sung Joon Hong, Seung Choul Yang, Won Sik Ham
      Abstract: Objectives To compare oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal tumors ≤7 cm which preoperative imaging reveals potential renal sinus fat invasion (cT3a), as RN is preferred for these tumors due to concerns regarding high tumor stage. Materials and Methods Among 1,137 nephrectomies performed for renal tumors ≤7 cm from January 2005 to August 2012, 401 solitary cT3a renal cell carcinomas (RCCs) without metastases were analyzed. Classification as cT3a included only renal sinus fat invasion, as there were no tumors with suspected perinephric fat invasion. Multivariate models were used to evaluate predictors of recurrence‐free survival (RFS) and cancer‐specific survival (CSS). Results There were 34 RCCs (8.5%) with unexpected perinephric fat invasion, but only 77 RCCs (19.2%) were staged as pT3a. During the median follow‐up of 43.0 months, recurrence occurred in seven (6.7%) PN cases and 25 (8.4%) RN cases. Six recurred PN cases had positive surgical margins (PSMs). The two cohorts showed equal oncologic outcomes with respect to 5‐year RFS and CSS. Multivariate analyses revealed PSM, pathologic T stage, sarcomatoid dedifferentiation, and type of surgery as significant predictors of recurrence. Older age, pathologic T stage, and sarcomatoid dedifferentiation were significant predictors of cancer‐specific mortality. Conclusions Renal tumors ≤7 cm with presumed renal sinus fat invasion were mostly pT1. PN conferred equivalent oncologic outcomes to RN. If clear surgical margins can be obtained, PN should be considered for these tumors, as patients may benefit from renal function preservation.
      PubDate: 2014-08-07T07:05:28.499173-05:
      DOI: 10.1111/bju.12893
  • Defining the Learning Curve for multi‐parametric MRI of the prostate
           using MRI‐TRUS fusion guided transperineal prostate biopsies as a
           validation tool
    • Authors: Gabriele Gaziev; Karan Wadhwa, Tristan Barrett, Brendan C. Koo, Ferdia A. Gallagher, Eva Serrao, Julia Frey, Jonas Seidenader, Lina Carmona, Anne Warren, Vincent Gnanapragasam, Andrew Doble, Christof Kastner
      Abstract: Objectives To determine the accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) during the learning curve of radiologists using MRI targeted, transrectal ultrasound guided transperineal fusion biopsy (MTTP) for validation. Material And Methods Prospective data on 340 men who underwent mpMRI (T2 weighted and DW‐MRI) followed by MTTP prostate biopsy, was collected according to Ginsburg and STARD standards. MRI were reported by two experienced radiologists and scored on a Likert scale. Biopsies were performed by consultant urologists blinded to the MRI result and men had both targeted and systematic sector biopsies which were reviewed by a dedicated uropathologist. The cohorts were divided into groups representing five consecutive time intervals in the study. Sensitivity and specificity of positive MRI reports, Prostate cancer (CaP) detection by positive MRI, distribution of significant Gleason score and negative MRI with false negative for CaP were calculated. Data were sequentially analyzed and the learning curve was determined by comparing the first and last group. Results We detected a positive mpMRI in 64 patients from group A (91%) and 52 patients from group E (74%). CaP detection rate on mpMRI increased from 42% (27/64) in group A to 81% (42/52) in group E (p value
      PubDate: 2014-08-07T07:05:26.40246-05:0
      DOI: 10.1111/bju.12892
  • An evaluation of the ‘weekend effect’ in patients admitted
           with metastatic prostate cancer
    • Authors: Marianne Schmid; Khurshid R. Ghani, Toni K. Choueiri, Akshay Sood, Victor Kapoor, Firas Abdollah, Felix K. Chun, Jeffrey J. Leow, Kola Olugbade, Jesse D. Sammon, Mani Menon, Adam S. Kibel, Margit Fisch, Paul L. Nguyen, Quoc‐Dien Trinh
      Abstract: Objectives To investigate whether mortality is increased for patients with metastatic prostate cancer (mCaP) admitted over the weekend. Patients and methods Using the Nationwide Inpatient Sample (NIS) between 1998‐2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in‐hospital mortality, complications, utilization of imaging and procedures were assessed. Adjusted logistic regression models examined associations of mortality and complications. Results A weighted sample of 534,011 patients with mCaP was identified, including 81.7% weekday and 18.3% weekend admissions. Of these, 8.6% died following a weekday vs. 10.9% after a weekend admission (p
      PubDate: 2014-08-07T07:05:24.857614-05:
      DOI: 10.1111/bju.12891
  • Perioperative Outcomes of Cytoreductive Nephrectomy in the UK in 2012
    • Authors: Jackson BL; Fowler S, Williams ST,
      Abstract: Objectives To define the perioperative morbidity and 30‐day mortality of cytoreductive nephrectomy (CN) using the BAUS nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in the United Kingdom. Patients & Methods All nephrectomies recorded in the database in 2012 were analysed, and cytoreductive cases identified. Outcome measures were: blood loss greater than 1000mls, transfusion requirement, intra‐ and post‐operative complications assessed by Clavien‐Dindo score, and 30‐day mortality (including failure‐to‐rescue rate). Univariate and multivariate logistic regression analysis was used to assess predictors of adverse outcomes. Results 279 cases were undertaken by 141 surgeons in 90 centres. WHO Performance Status was 0 or 1 in 72.4% (n = 202). Open nephrectomy was performed in 59% (n = 163), with the remainder laparoscopic. Conversion rate for laparoscopy was 14% (n=16). 40 patients underwent pre‐operative tyrosine‐kinase inhibitor treatment. No significant differences in outcome were observed for this group. 30‐day mortality was 1.79%. Intraoperative complications occurred in 11.9%, post‐operative complications in 20.8%. Complications of Clavien‐Dindo grade III or above occurred in 8%. Blood loss of greater than one litre occurred in 15.4% of cases and 24.1% of patients required a perioperative transfusion. Tumour size >10cm was an independent risk factor for blood loss >1 litre (p=0.021) and intraoperative complications (p=0.021). The number of metastatic sites was an independent predictor of blood loss >1 litre (p=0.001) and transfusion requirement (p=0.026). Performance status of two or more was also independently associated with intraoperative complication risk (p=0.021). Conclusions CN in contemporary UK practice appears to have excellent perioperative outcomes overall. Risk factors for adverse perioperative outcomes include tumour size over 10cm, number of metastatic sites and PS ≥ 2. The balance of risk and benefit for CN should be carefully considered for patients with poor performance status or extensive metastases.
      PubDate: 2014-08-07T07:05:22.897188-05:
      DOI: 10.1111/bju.12890
  • Number of positive pre‐operative biopsy cores is a predictor of
           positive surgical margins in small prostates after robot‐assisted
           radical prostatectomy
    • Authors: Patrick H. Tuliao; Kyo Chul Koo, Christos Komninos, Chien Hsiang Chang, Young Deuk Choi, Byung Ha Chung, Sung Joon Hong, Koon Ho Rha
      Abstract: Objective To determine the impact of prostate size on positive surgical margin (PSM) rates after RARP and the pre‐operative factors associated with PSM. Materials And Methods A total of 1,229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had trans‐urethral resection of the prostate, neo‐adjuvant therapy, clinically‐advanced cancer, and the first 200 performed cases, to reduce the effect of learning curve. Included were 815 patients who were then divided into three groups: 45 g (group3). Multivariate analysis determined predictors of PSM and BCR. Results Console time and blood loss increased with increasing prostate size. There were more high‐grade tumors in group one (group1 vs. group2 and group3, 33.9% vs. 25.1 and 25.6%, p=0.003 and p=0.005). PSM were increased in 20 ng/dl, Gleason score >7, T3 tumor, and >3 positive biopsy cores. In group one, pre‐operative stage T3 (OR=3.94, p=0.020) and >3 positive biopsy core (OR=2.52, p=0.043) were predictive of PSM while a PSA >20ng/dl predicted the occurrence of BCR (OR=5.34, p=0.021). No pre‐operative factors predicted PSM or BCR for groups two and three. Conclusion A pre‐operative biopsy with >3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA >20 ng/dl is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer post‐operative follow‐up.
      PubDate: 2014-08-07T07:05:21.294877-05:
      DOI: 10.1111/bju.12888
  • Minimum five‐year follow‐up of 1,138 consecutive laparoscopic
           radical prostatectomies
    • Authors: Ricardo Soares; Antonina Di Benedetto, Zach Dovey, Simon Bott, Roy G. McGregor, Christopher G. Eden
      Abstract: Objectives To investigate the long‐term outcomes of laparoscopic radical prostatectomy (LRP). Methods A total of 1,138 patients underwent LRP during a 163 month period from 2000‐2008 of which 51.5%, 30.3% and 18.2% were in d'Amico's low‐, intermediate‐ and high‐risk groups [d'Amico, 1998], respectively. All intermediate‐ and high‐risk patients were staged by pre‐operative MRI or CT and isotope bone scanning and had a pelvic lymph node dissection (PLND), which was extended after April 2008. Median patient age (with range) = 62 (40‐78) yr; BMI = 26 (19‐44) kg/m2; PSA = 7.0 (1‐50) ng/ml and Gleason = 6 (6‐10). NVB preservation was done in 55.3% (bilateral = 45.5%; unilateral = 9.8%) of patients. Results Median gland weight = 52 (14‐214) g; operating time = 177 (78‐600) minutes; PLND in 299 (26.3%) of which 54 (18.0%) were extended; blood loss = 200 (10‐1300) ml; post‐op. Hospital stay = 3 (2‐14) nights; catheterization time = 14 (1‐35) days; complication rate = 5.2%; node count = 12 (4‐26); lymph node positivity = 0.8%; node involvement = 2 (1‐2); margin positivity = 13.9%; up‐grading = 29.3%; down‐grading = 5.3%; up‐staging from T1/2 to T3 = 11.4%; down‐staging from T3 to T2 = 37.1%. One case (0.09%) was converted to open surgery and 6 patients were transfused (0.5%). At a mean follow‐up of 88.6 (60‐120) months 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously‐potent non‐diabetic men
      PubDate: 2014-08-07T07:05:19.53146-05:0
      DOI: 10.1111/bju.12887
  • Identification of Binding Sites for C‐terminal proGRP‐derived
           peptides in Renal Cell Carcinoma: A Potential Target for Future Therapy
    • Authors: Joseph Ischia; Oneel Patel, Kapil Sethi, Marianne S. Nordlund, Damien Bolton, Arthur Shulkes, Graham S. Baldwin
      Abstract: Objective To determine the expression and biology of the neuroendocrine growth factor gastrin‐releasing peptide (GRP) and other proGRP‐derived peptides in renal cancer. Materials and methods Receptor binding studies, ELISA and radioimmunoassay were used to quantitate the presence of proGRP‐derived peptide receptors and their ligands in renal cancer cell lines and human renal cancers. Biological activity of proGRP peptides was confirmed with proliferation, migration, and ERK1/2 activation assays in vitro. In vivo, ACHN renal cancer xenografts were treated with proGRP‐derived peptides to assess tumour size and necrosis. HIF1α and VEGF expression was investigated with western blotting and ELISA respectively to determine the possible contribution of the proGRP peptides to tumour viability. Results In ACHN cells that express both proGRP‐ and GRP‐receptors, the expression of proGRP binding sites was 80 fold greater than the GRP‐receptor (GRPR). C‐terminal proGRP‐derived peptides stimulated the activation of ERK1/2, but with a different time course to GRP, consistent with the suggestion that these peptides may have unique cellular functions. Both GRP and proGRP47‐68 stimulated proliferation and migration of ACHN cells in vitro, but only GRP reduced the extent of tumor necrosis in ACHN xenografts. GRP, but not proGRP47‐68, was able to induce HIF1α and VEGF expression in ACHN cells. This may account in part for the reduction in necrosis following GRP treatment. C‐terminal proGRP‐derived peptides were present in all three renal cancer cell lines and a panel of human renal cancers, but mature amidated GRP was absent. Conclusion C‐terminal proGRP peptides are more abundant in renal cancers and their cell lines than the more extensively studied amidated peptide, GRP. These results suggest that C‐terminal proGRP‐derived peptides may be a better target for novel renal cancer treatments.
      PubDate: 2014-08-04T06:36:37.562427-05:
      DOI: 10.1111/bju.12886
  • Early urinary continence recovery after robot‐assisted radical
           prostatectomy in older Australian men
    • Authors: Marnique Y. Basto; Chinni Vidyasagar, Luc Marvelde, Helen Freeborn, Emma Birch, Adam Landau, Declan G. Murphy, Daniel Moon
      Pages: n/a - n/a
      Abstract: Objective To compare the recovery of urinary continence (UC) after robot‐assisted radical prostatectomy (RARP) in men aged ≥70 and
      PubDate: 2014-07-31T06:16:12.995082-05:
      DOI: 10.1111/bju.12800
  • Prevalence of ciprofloxacin‐resistant Enterobacteriaceae in the
           intestinal flora of patients undergoing trans‐rectal prostate biopsy
           in Norwich, UK
    • Authors: Marcelino Yazbek Hanna; Catherine Tremlett, Gurvir Josan, Ali Eltom, Robert Mills, Mark Rochester, David M Livermore
      Abstract: Objective To determine the efficacy of fluoroquinolone prophylaxis in patients undergoing trans‐rectal ultrasound scan (TRUS)‐guided biopsy of the prostate in the Norwich population, and its correlation with ciprofloxacin resistance in the faecal flora. We also aimed to determine the usefulness of a pre‐biopsy rectal screen for resistant bacteria in these patients. Patients and methods The incidence and microbiology of sepsis after TRUS‐guided prostate biopsies between 2007 and 2011 was audited retrospectively. Subsequently, in 2012, a prospective study was performed, collecting the same data but also culturing rectal swabs from all patients undergoing TRUS biopsy, with a post‐biopsy follow‐up period of 6 months. All patients were given prophylactic oral ciprofloxacin, as per Trust policy (750 mg 1 hour pre‐biopsy, followed by 250 mg q12h for 3 subsequent days). Results Between 2007 and 2011, 3600 patients underwent TRUS biopsy. Among these, 11 (0.3%) were admitted to hospital for post‐biopsy related sepsis but only 4 (0.1%) had ciprofloxacin‐resistant Escherichia coli confirmed from blood cultures: three had ciprofloxacin‐susceptible Enterobacteriaceae, and four had no ciprofloxacin susceptibility data. In 2012, 10 (3.7%) of 267 patients sampled pre‐biopsy had ciprofloxacin‐resistant E. coli recovered on rectal swab culture but none of these men presented with post‐biopsy sepsis; during the 6‐month follow‐up period, seven patients were diagnosed with urinary tract infections. Conclusion Ciprofloxacin‐resistant Enterobacteriaceae remains rare in the intestinal flora of the Norwich TRUS population, meaning that the drug remains adequate as prophylaxis. Pre‐biopsy rectal swabs may be useful for individual departments to periodically assess their own populations and to ensure their antibiotic policy remains valid. In populations where resistance is known to be highly prevalent, pre‐biopsy rectal swabs can help guide addition of further antibiotics to prevent post‐biopsy septicaemia.
      PubDate: 2014-07-31T01:32:42.242676-05:
      DOI: 10.1111/bju.12865
  • Teaching laparoscopic radical prostatectomy during the primary surgeon's
           early learning curve – analysis of our first 207 cases
    • Authors: Serge Luke; Warick Delprado, Mark Louie‐Johnsun
      Pages: n/a - n/a
      Abstract: Objective To assess the feasibility of introducing laparoscopic radical prostatectomy (LRP) training during the primary surgeon's early learning curve in a regional Australian centre. Patients and methods From a prospective single surgeon database perioperative, oncological and functional outcome data was collected from the first 207 consecutive patients who underwent LRP immediately after a 12‐month LRP Fellowship in a high‐volume centre by the primary surgeon (M.L.J.). A training case was defined as the successful completion of at least two of 10 steps by a training Fellow. Perioperative and oncological outcomes were compared in training and non‐training cohorts and overall learning curve was assessed by comparing consecutive 50‐patient cohorts. Results In all, 31% of cases were training cases with a median (range) of 7 (2–10) steps of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 min; P < 0.001). There was no statistically significant difference in perioperative outcomes of length of stay (2.7 vs 2.6 days), transfusion rates (3.1% vs 2.1%), major complication (Clavien >3a) rates (1.6% vs 2.1%) or positive surgical margins (PSMs: pT2 2.8% vs 15.3% and pT3 52.0% vs 45.1%) between training and non‐training groups, respectively. Overall, there were two open conversions (1.0%). Conclusion Despite the challenging learning curve, LRP training can be commenced safely with a stepwise modular approach, even when the primary surgeon is in their early learning curve. Perioperative outcomes including PSMs and major complications were unaffected by trainee involvement.
      PubDate: 2014-07-30T06:20:22.59273-05:0
      DOI: 10.1111/bju.12799
  • Urodynamic testing: physiological background, setting‐up,
           calibration and artefacts
    • Authors: Orit Raz; Vincent Tse, Lewis Chan
      Pages: n/a - n/a
      Abstract: Urodynamics (UDS) is an interactive diagnostic study of lower urinary tract function. It is composed of several tests that can be used to obtain functional information about urine storage and expulsion. Its main goal is to reproduce the patients' symptoms and determine their cause. The present article is a review of the physiological concepts behind UDS, and explains the various normal and abnormal forces and parameters that are measured and used during the tests to assist the physician in making a diagnosis. It outlines the importance and methods of the calibration of UDS equipment to optimise diagnostic accuracy and reliability, which would have a crucial impact over the treatment's decision, and consequently the patient's outcome.
      PubDate: 2014-07-30T06:20:19.680962-05:
      DOI: 10.1111/bju.12633
  • Uro‐oncology multidisciplinary meetings at an Australian tertiary
           referral centre – impact on clinical decision‐making and
           implications for patient inclusion
    • Authors: Kenny Rao; Kiran Manya, Arun Azad, Nathan Lawrentschuk, Damien Bolton, Ian D. Davis, Shomik Sengupta
      Pages: n/a - n/a
      Abstract: Objectives To analyse the impact of the uro‐oncology multidisciplinary meeting (MDM) at an Australian tertiary centre on patient management decisions, and to develop criteria for patient inclusion in MDMs. Methods Over a 3‐month period, all cases presented at our weekly uro‐oncology MDM were prospectively assessed, by asking the presenting clinician to state their provisional management plans and comparing this with the subsequent consensus decision. The impact of the MDM was graded as high if there was a major change in the management plan or if a plan was developed where there was none. Results Over the study period, 120 discussions about 107 patients were recorded. Prostate, urothelial, kidney and testis cancer represented 46 (38.3%), 36 (30%), 26 (21.6%) and 12 (10%) of the discussions, respectively. The MDM made high impact changes to the original plan in 32 (26.7%) cases. High impact changes were nearly twice as likely to occur in patients with metastatic disease as in those without metastases (P < 0.05). Primary cross referral between disciplines occurred in 40 (33.3%) cases, including 66.7% of testicular and 42% of bladder cancers but only 26% of prostate and 19% of kidney cancers (P < 0.02). Conclusions The uro‐oncology MDM alters management plans in about one‐quarter of cases. Additionally, MDMs also serve other purposes, such as cross‐referral or consideration for clinical trials. Patients should be discussed in MDMs if multimodal therapy may be required, clinical trial eligibility is being considered or if metastasis or recurrence is noted.
      PubDate: 2014-07-29T05:11:54.124115-05:
      DOI: 10.1111/bju.12764
  • A Valsalva leak‐point pressure of >100 cmH2O is associated
           with greater success in AdVance™ sling placement for the treatment
           of post‐prostatectomy urinary incontinence
    • Authors: Jon Barnard; Simon Rij, Andre M. Westenberg
      Pages: n/a - n/a
      Abstract: Objectives To determine if there is a Valsalva leak‐point pressure (VLPP) threshold that predicts for retro‐urethral transobturator sling (RTS) success in men with post‐prostatectomy urinary incontinence (UI). Patients and Methods The preoperative urodynamic parameters of all patients undergoing RTS (AdVance™) sling surgery over the last 5 years were analysed and compared with the postoperative outcomes. The sling was defined as having been successful if the patient no longer had to wear pads or merely used a pad to provide a sense of security. Results In all, 46 men with a mean (range) age of 65 (45–83) years, underwent AdVance™ sling surgery. 10 men had undergone holmium laser enucleation of the prostate, one a transurethral resection of the prostate and 35 radical prostatectomy. 11 men had a VLPP of ≤100 cmH2O. Of these 11 men, three had no, or minimal, improvement in their leakage and all three required a secondary procedure (artificial urinary sphincter, AUS). In the 35 men with a VLPP of >100cmH2O there were three failures. One of these was successfully salvaged with a repeat sling, another with an AUS and one with ProACT™ balloons. The hazard ratio (HR) for failure with a VLPP of ≤100 cmH20 compared with a VLPP of >100 cmH2O was 4 (95% confidence interval 0.68–23.7). Conclusion A VLPP of >100 cmH2O has a high degree of predictability for success for AdVance™ sling placement for men with post‐prostatectomy UI.
      PubDate: 2014-07-28T10:35:29.229486-05:
      DOI: 10.1111/bju.12791
  • Anxiety in the management of localised prostate cancer by active
    • Authors: Jake Anderson; Susan Burney, Joanne E. Brooker, Lina A. Ricciardelli, Jane M. Fletcher, Prassannah Satasivam, Mark Frydenberg
      Pages: n/a - n/a
      Abstract: Objectives To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health‐related quality of life (HRQL). Patients and Methods In all, 260 men with prostate cancer on AS were invited to complete psychological measures including the Hospital and Anxiety Depression Scale; the State‐Trait Anxiety Inventory‐Trait Scale; the Memorial Anxiety Scale for Prostate Cancer; and the Functional Assessment of Cancer Therapy Scale‐Prostate. Overall, 86 men with a mean (sd, range) age of 65.7 (5.4, 51–75) years returned data, yielding a response rate of 33%. Outcome measures were standardised psychological measures. Pearson's correlations were used to examine bivariate relationships, while regression analyses were used to describe predictors of dependent variables. Results When compared with the findings of prior research, the men in our cohort had normal levels of general anxiety and illness‐specific anxiety and high prostate cancer‐related HRQL. Age, trait anxiety and fear of recurrence (FoR) were significant predictors of prostate cancer‐related HRQL; trait anxiety and FoR were significant predictors of total HRQL. Results should be interpreted in context of sample characteristics and the correlational design of the study. Conclusions Participants reported low levels of anxiety and high HRQL. Trait anxiety and FoR were significant predictors of both prostate cancer‐related and total HRQL. The administration of a short trait‐anxiety screening tool may help identify men with clinically significant levels of anxiety and those at risk of reduced HRQL.
      PubDate: 2014-07-28T10:35:25.675102-05:
      DOI: 10.1111/bju.12765
  • Should we routinely stent after ureteropyeloscopy?
    • Authors: Darren Foreman; Sophie Plagakis, Andrew T. Fuller
      Pages: n/a - n/a
      Abstract: Arguments ‘for’ and ‘against’ ureteric stenting after ureteropyeloscopy are discussed. An individualised approach balancing renal function preservation, irritative lower urinary tract symptoms and emergent return to theatre needs to be adopted while being mindful of healthcare spending.
      PubDate: 2014-07-28T10:35:23.237388-05:
      DOI: 10.1111/bju.12708
  • Multidisciplinary urological engagement in translational renal cancer
    • Authors: Grant D. Stewart; David J. Harrison, Charles Swanton, Rebecca Lewis, Judith Bliss, James Larkin, David L. Nicol,
      Pages: n/a - n/a
      PubDate: 2014-07-28T05:14:38.627125-05:
      DOI: 10.1111/bju.12697
  • Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk
           of End Stage Renal Disease
    • Authors: Stanley A. Yap; Antonio Finelli, David R Urbach, George A Tomlinson, Shabbir M.H. Alibhai
      Pages: n/a - n/a
      Abstract: Objective To assess whether radical nephrectomy (RN) compared to partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) is associated with greater risk of end‐stage renal disease (ESRD). Subjects and Methods We performed a population‐based, retrospective cohort study using linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed RCC diagnosed between 1995 and 2010. Cox proportional hazards (PH), propensity score, and competing risks models were used to assess the impact of treatment choice. The primary outcome was ESRD. Secondary outcomes included overall mortality, myocardial infarction, and new‐onset CKD. A modern cohort of patients (2003‐2010) was analyzed separately. Results We included a total of 11,937 patients, of whom 2,107 (18%) underwent PN. Median follow‐up was 57 months. In the full cohort, type of surgery was not associated with the rate of ESRD, whereas PN was associated with a decreased likelihood of ESRD compared to RN in the modern cohort using a multivariable PH model (HR 0.44, CI 0.25‐0.75) or propensity score modeling (HR 0.48, 0.27‐0.82). PN was also associated with a lower risk of new‐onset CKD (HR 0.48, CI 0.41‐0.57). Conclusions Although it is well‐known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with less ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC.
      PubDate: 2014-07-27T23:17:13.748353-05:
      DOI: 10.1111/bju.12883
  • The impact of androgen‐deprivation therapy (ADT) on the risk of
           cardiovascular (CV) events in patients with non‐metastatic prostate
           cancer: a population‐based study
    • Authors: Giorgio Gandaglia; Maxine Sun, Ioana Popa, Jonas Schiffmann, Firas Abdollah, Quoc‐Dien Trinh, Fred Saad, Markus Graefen, Alberto Briganti, Francesco Montorsi, Pierre I. Karakiewicz
      Pages: n/a - n/a
      Abstract: Objective To examine and quantify the contemporary association between androgen‐deprivation therapy (ADT) and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large USA contemporary cohort of patients with prostate cancer. Patients and Methods In all, 140 474 patients diagnosed with non‐metastatic prostate cancer between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity score methodology. The 10‐year CAD, AMI, and SCD rates were estimated. Competing‐risks regression analyses tested the association between the type of ADT (GnRH agonists vs bilateral orchidectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow‐up. Results Overall, the 10‐year rates of CAD, AMI, and SCD were 25.9%, 15.6%, and 15.8%, respectively. After stratification according to ADT status (ADT‐naïve vs GnRH agonists vs bilateral orchidectomy), the CAD rates were 25.1% vs 26.9% vs 23.2%, the AMI rates were 14.8% vs 16.6% vs 14.8%, and the SCD rates were 14.2% vs 17.7% vs 16.4%, respectively. In competing‐risks multivariable regression analyses, the administration of GnRH agonists (all P < 0.001), but not bilateral orchidectomy (all P ≥ 0.7), was associated with higher risk of CAD, AMI, and SCD. Conclusions The administration of GnRH agonists, but not orchidectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non‐metastatic prostate cancer. Alternative forms of ADT should be considered in patients at higher risk of CV events.
      PubDate: 2014-07-27T02:35:12.373142-05:
      DOI: 10.1111/bju.12732
  • Balancing cardiovascular (CV) and cancer death among patients with small
           renal masses: modification by CV risk
    • Authors: Hiten D. Patel; Max Kates, Phillip M. Pierorazio, Mohamad E. Allaf
      Pages: n/a - n/a
      Abstract: Objective To assess modification of comparative cancer survival by cardiovascular (CV) risk and treatment strategy among older patients with small renal masses (SRMs). Patients and Methods Patients with localised T1a renal cell carcinoma were identified in the Surveillance, Epidemiology and End Results‐Medicare database (1995–2007). Patients were stratified by CV risk, using major atherosclerotic CV comorbidities identified by the Framingham Heart Study, to compare overall (OS), cancer‐specific (CSS), and CV‐specific survival (CVSS) for those who deferred therapy (DT) to those undergoing either partial (PN) or radical nephrectomy (RN). Cox proportional hazards and Fine and Gray competing risks regression adjusted for demographics, comorbidities, and tumour size were performed. Results In all, 754 (10.5%) patients had DT, 1849 (25.8%) patients underwent PN, and 4574 (63.7%) patients underwent RN. Patients at high CV risk who had DT had the greatest CV‐to‐cancer mortality rate ratio (2.89), and CV risk was generally associated with worse OS and CVSS. Patients in the high CV risk strata had no difference in CSS between treatment strategies [DT vs PN: hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.25–1.41; DT vs RN: HR 0.81, 95%CI 0.46–1.43)], while there was a 2–4 fold CSS benefit for surgery in the low CV risk strata. Conclusions Cancer survival was comparable across treatment strategies for older patients with SRMs with high risk CV disease. Greater attention to CV comorbidity as it relates to competing risks of death and life expectancy may be deserved in selecting patients appropriate for active surveillance because patients at low CV risk might benefit from surgery.
      PubDate: 2014-07-27T02:34:05.516875-05:
      DOI: 10.1111/bju.12719
  • Can factors affecting complication rates for ureteric
           re‐implantation be predicted? Use of the modified Clavien
           classification system in a paediatric population
    • Authors: Evren Suer; Cihat Ozcan, Murat Mermerkaya, Mehmet Ilker Gokce, Omer Gulpinar, Onur Telli, Tarkan Soygur, Berk Burgu
      Pages: n/a - n/a
      Abstract: Objective To determine preoperative predictive factors of postoperative complications of ureteric re‐implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. Patients and Methods In all, 383 children who underwent ureteric re‐implantation for vesico‐ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re‐implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. Results In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow‐up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3–4 hydronephrosis, obstructing megaureters, a tailoring‐tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring‐tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications. Conclusion Ureteric re‐implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring‐tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.
      PubDate: 2014-07-27T02:33:57.035118-05:
      DOI: 10.1111/bju.12746
  • Critical analysis of phase II and III randomised control trials (RCTs)
           evaluating efficacy and tolerability of a β3‐adrenoceptor
           agonist (Mirabegron) for overactive bladder (OAB)
    • Authors: Marta Rossanese; Giacomo Novara, Ben Challacombe, Alessandro Iannetti, Prokar Dasgupta, Vincenzo Ficarra
      Abstract: To critically analyse available phase II and III randomised control trials (RCTs) reporting clinical data about the efficacy and tolerability of Mirabegron (a β3‐adrenoceptor agonist) in the treatment of overactive bladder (OAB) syndrome. A review of the literature was performed in September 2013 using the MEDLINE database. A ‘free text’ protocol was used for the search strategy using ‘overactive bladder’ and ‘Mirabegron’ as keywords. Subsequently, the searches were pooled and limited to phase II and III RCTs. Two phase II and five phase III RCTs were selected and analysed. The available phase II studies showed the efficacy and tolerability of different doses of Mirabegron compared with placebo. Moreover, a dose‐ranging study showed that 50 mg once daily should be considered the most promising dose for clinical use. The 12‐week phase III studies confirmed the effectiveness of Mirabegron to significantly reduce the mean number of incontinence episodes/24 h and the mean number of micturitions/24 h compared with placebo. A post hoc analysis confirmed that favourable results with Mirabegron were reported both in patients with OAB who were antimuscarinic naïve and in those who had discontinued prior antimuscarinic therapy. Moreover, a phase III trial showed the safety and tolerability of 12‐month treatment of Mirabegron. Discontinuation due to adverse events was low both using the 50 and 100 mg dose of Mirabegron. Mirabegron is the first of a new class of drugs for the treatment of OAB able to influence non‐voiding activity and produce an increased storage capacity and inter‐void interval. Recently published phase II and III RCTs have shown that the β3‐adrenoceptor‐selective agonist, Mirabegron, is an effective and safe drug for the symptomatic treatment of OAB syndrome. Mirabegron represents a valid medical option both for patients with OAB who are antimuscarinic naïve, as well as in those where antimuscarinics are ineffective or not tolerated.
      PubDate: 2014-07-27T02:33:54.240671-05:
      DOI: 10.1111/bju.12730
  • Does cumulative prostate cancer length in prostate biopsies improve
           prediction of clinically insignificant cancer at radical prostatectomy in
           patients eligible for active surveillance?
    • Authors: Derrick J Chen; Sara M Falzarano, Jesse K McKenney, Chris G Przybycin, Jordan P Reynolds, Andres Roma, J. Stephen Jones, A. Stephenson, Eric Klein, Cristina Magi‐Galluzzi
      Pages: n/a - n/a
      Abstract: Objectives To evaluate if cumulative cancer length on prostate needle biopsy (Bx) divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer (IC) on radical prostatectomy (RP) in patients with prostate cancer (PCA) eligible for active surveillance (AS). Materials and Methods Patients diagnosed with PCA on extended (≥10 cores) Bx with initial prostate‐specific antigen (iPSA)
      PubDate: 2014-07-25T02:45:39.759057-05:
      DOI: 10.1111/bju.12880
  • Disease‐specific death and metastasis do not occur in patients with
           Gleason score ≤6 on radical prostatectomy
    • Authors: Charlotte F. Kweldam; Mark F Wildhagen, Chris H. Bangma, Geert J.L.H. Leenders
      Pages: n/a - n/a
      Abstract: Objectives To assess the lymph node metastasis‐free survival, distant metastasis‐free survival and disease‐specific survival in men with Gleason score ≤6 prostate cancer on radical prostatectomy. Patients and methods We included 1101 consecutive radical prostatectomy patients operated between March 1985 to July 2013 at a single institution. The outcome variables were metastasis‐free survival and disease‐specific survival. The postoperative survival was estimated by the Kaplan‐Meier method. Results The Gleason score distribution of the study population (n=1101) was Gleason score ≤6 (n=449, 41%), Gleason score 3+4=7 (n=436, 40%), Gleason score 4+3=7 (n=99, 9%) and Gleason score 8‐10 (n=117, 11%). The median post‐operative follow‐up was 100 months (IQR 48‐150). During follow‐up 197 men (18%) died of whom 42 (3.8%) from prostate cancer related causes. A total of 19/1101 patients (1.7%) had documented lymph node metastasis at time of operation: 0 in Gleason score ≤6, 7 in Gleason score 3+4=7 (1.6%), 6 in Gleason score 4+3=7 (6.1%) and 6 in Gleason score 8‐10 (5.1%). Distant metastasis occurred in 56/1101 patients (5.1%): 0 in Gleason score ≤6, 23 in Gleason score 3+4=7 (5.3%), 17 in Gleason score 4+3=7 (17%) and 16 in Gleason score 8‐10 (14%). Disease‐specific death, stratified per Gleason score group was: 0 in ≤6, 16 (3.7%) in 3+4=7, 16 (16%) in 4+3=7 and 10 (8.5%) in 8‐10. Conclusion No metastasis or disease‐specific death were observed in men with Gleason score ≤6 prostate cancer on radical prostatectomy, demonstrating the negligible potential to metastasize in this large subgroup of prostate cancer patients.
      PubDate: 2014-07-25T02:45:37.743413-05:
      DOI: 10.1111/bju.12879
  • The treatment of Penile Carcinoma‐In‐Situ within a UK
           supra‐regional network
    • Authors: M Lucky; K Murthy, B Rogers, S Jones, M Lau, V Sangar, NJ Parr
      Pages: n/a - n/a
      Abstract: Objectives To review outcomes of the treatment of carcinoma in situ of the penis at a large supra‐regional penile cancer network, where centralisation has permitted greater experience with treatment outcomes, and suggest treatment strategies. Materials and Methods The network penile cancer database which details presentation, treatment and complications was analysed from 2003‐10, identifying patients with CIS, with minimum follow up of 2 years, looking at treatments administered and outcomes. Results Fifty‐seven patients with mean age 61yr (range:34‐91yr) were identified. Eighteen were treated by circumcision (CIRC) only, 20 by CIRC and local excision (LE) and 19 by CIRC and 5‐flurouracil (5FU). Mean follow up was 3.5yr (2‐8). Of those treated by CIRC none subsequently developed CIS on the glans. For those who underwent CIRC+LE, 5/20 developed recurrence requiring further treatment. Of those treated by CIRC+5FU, 14/19 (73.7%) completely responded (CR). Of incomplete responders (IR, n=5), 2 showed focal invasive malignancy at repeat biopsy. One IR underwent glansectomy and 4 grafting. No CR relapsed. Complications of 5FU included significant inflammatory response in 7 (36.8%), with 2 requiring hospital admission and 1 neo‐phimosis (5.3%). Conclusion This study suggests that patients undergoing circumcision for isolated CIS and complete responders to 5FU may require only short term follow up, as recurrence is unlikely, whereas longer follow up is required for all other patients. However numbers in this study are small and larger studies are needed to support this. Incomplete response to 5FU dictates immediate re‐biopsy as it carries a significant chance of previously undetected invasive disease.
      PubDate: 2014-07-25T02:45:36.077884-05:
      DOI: 10.1111/bju.12878
  • The changing reality of urothelial bladder cancer: should
           non‐squamous variant histology be managed as a distinct clinical
    • Authors: M. Francesca Monn; Hristos Z Kaimakliotis, K Clint Cary, Richard Bihrle, Jose A Pedrosa, Timothy A Masterson, Richard S Foster, Thomas A Gardner, Liang Cheng, Michael O Koch
      Pages: n/a - n/a
      Abstract: Objectives To assess the effect of non‐squamous variant histology on survival in muscle invasive urothelial bladder cancer. Materials and Methods A cohort of 411 radical cystectomy cases performed with curative intent for muscle invasive primary urothelial carcinoma (UC) was identified between 2008 and June 2013. Survival analysis was evaluated using Kaplan‐Meier methodology comparing NV+SQD histology to non‐SQD variant histology (non‐SQD variants). Multivariable cox proportional hazards regression assessed all‐cause and disease specific mortality. Results Of the 411 cystectomy cases, 77 (19%) were non‐SQD variant histology. Median OS for non‐SQD variant histology was 28 months, whereas the NV+SQD group had not reached median OS at 74 months (log rank test p
      PubDate: 2014-07-25T02:45:33.414347-05:
      DOI: 10.1111/bju.12877
  • Transient receptor potential channel modulators as pharmacological
           treatments for lower urinary tract symptoms: myth or reality?
    • Authors: Yves Deruyver; Thomas Voets, Dirk De Ridder, Wouter Everaerts
      Pages: n/a - n/a
      Abstract: Transient Receptor Potential (TRP) channels belong to the most intensely pursued drug targets of the last decade. These ion channels are considered promising targets for the treatment of pain, hypersensitivity disorders and lower urinary tract symptoms (LUTS). The aim of this review is to discuss to which extent TRP channels have lived up to their promise as new pharmacological targets in the lower urinary tract and to outline the challenges that lie ahead. TRPV1 agonists have proven their efficacy in the treatment of neurogenic detrusor overactivity albeit at the expense of prolonged adverse effects as pelvic burning pain, sensory urgency, and hematuria. TRPV1 antagonists have been very successful in preclinical studies to treat pain and detrusor overactivity. However, clinical trials with the first generation TRPV1 antagonists were terminated early due to hyperthermia, a serious, on‐target, side effect. TRPV4, TRPA1 and TRPM8 have important sensory functions in the lower urinary tract. Antagonists of these channels have shown their potential in pre‐clinical studies of lower urinary tract dysfunction and are awaiting clinical validation.
      PubDate: 2014-07-25T02:45:31.872001-05:
      DOI: 10.1111/bju.12876
  • Full immersion simulation – validation of a distributed simulation
           environment for technical and non‐technical skills training in
    • Authors: James Brewin; Jessica Tang, Prokar Dasgupta, Muhammad S Khan, Kamran Ahmed, Fernando Bello, Roger Kneebone, Peter Jaye
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the face, content and construct validity of the Distributed Simulation (DS) environment for non‐technical skills training and for endourology technical skills training. To evaluate the educational impact of DS for urology training. Subjects and Methods Distributed Simulation offers a portable, low cost simulated operating room environment (OR) that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with ten experienced and ten trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real time and blinded video analysis and validated performance metrics. Non‐parametric statistical methods were used to compare differences between groups. Results The DS environment demonstrated face, content and construct validity for both non‐technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was demonstrated. Further studies are needed to evaluate the effect of simulated OR training on real OR performance. Conclusions This study has demonstrated the validity of the DS environment for non‐technical, as well as technical skills training. DS‐based simulation appears to be a valuable addition to traditional classroom based simulation training.
      PubDate: 2014-07-23T03:12:12.703922-05:
      DOI: 10.1111/bju.12875
  • Upper Limit of Cancer Extent on Biopsy Defining Very Low Risk Prostate
    • Authors: Ola Bratt; Yasin Folkvaljon, Stacy Loeb, Laurence Klotz, Lars Egevad, Pär Stattin
      Pages: n/a - n/a
      Abstract: Objective To investigate how much Gleason pattern 3 cancer the prostate biopsy specimens may contain without an increased risk of undetected more aggressive cancer, compared with the risk for cancers fulfilling the National Comprehensive Cancer Network (NCCN) criteria for very low risk prostate cancer. Subjects and Methods We identified 1,286 men aged < 70 years in the National Prostate Cancer Register of Sweden who underwent primary radical prostatectomy for stage T1c or T2 prostate cancer with Gleason pattern ≤ 3 only, prostate‐specific antigen < 10 ng/mL and PSA density < 0.15 ng/ml/cc. The association between the extent of cancer in the biopsies (the number and proportion of positive cores and the total cancer length in the cores in mm) and the likelihood of Gleason pattern 4‐5 in the prostatectomy specimen was analysed with logistic regression. Results Overall, 438 (34%) of the 1,286 men had Gleason pattern 4‐5 in the prostatectomy specimen. Increasing number and proportion of positive biopsy cores as well as increasing biopsy cancer length were both significantly associated with increased risk of upgrading at radical prostatectomy in univariable analysis, but in multivariable analysis only biopsy cancer length remained significant. The 684 men with stage T1c and < 8 mm cancer had similar risk of upgrading regardless of whether the number of positive biopsy cores was 1‐2 or 3‐4 (28% versus 27% risk); upgrading was more common among the remaining men (40%, p < 0.01). Conclusions Men younger than 70 years with stage T1c prostate cancer and 3‐4 biopsy cores with Gleason pattern 3 are not more likely to have undetected Gleason pattern 4‐5 cancer than men with 1‐2 cores with cancer, provided that the total biopsy cancer length is < 8 mm. We propose that the definition of very low risk prostate cancer is widened accordingly.
      PubDate: 2014-07-23T03:12:02.90863-05:0
      DOI: 10.1111/bju.12874
  • USANZ: The ‘Timing of androgen deprivation therapy in incurable
           prostate cancer’ protocol (TOAD) – where are we now?
           Synopsis of the Victorian Cooperative Oncology Group PR 01‐03 and
           TransTasman Radiation Oncology Group 03.06 clinical trial
    • Authors: Gillian M Duchesne; Henry H Woo
      Pages: n/a - n/a
      Abstract: Objectives To outline the development of the TOAD (Timing of Androgen Deprivation) protocol, a collaborative randomised clinical trial under the auspices of the Cancer Council Victoria, the Trans Tasman Radiation Oncology Group, and the Urological Society of Australia and New Zealand, which opened to recruitment in 2004 Patients and Methods The principal hypothesis for the trial was that the early introduction of ADT (experimental arm) at the time when curative therapies are no longer considered an option, would improve overall survival for these patients, whilst maintaining an acceptable quality of life; compared to waiting for disease progression or the development of symptoms (control arm). An increase in overall survival at five years of 10% was judged to be clinically worthwhile. Results Recruitment was slow, with fewer than half of the protocol requirement of 750 patients eventually accrued, but nonetheless it is considered that the trial will still contribute a major source of evidence in this area. The study closed to follow‐up at the end of 2013, with data analysis commencing mid‐2014, and with the primary publication anticipated to be submitted by the end of 2014. Conclusions The question of timing of androgen deprivation still remains relevant in the current era of newer and more varied treatment modalities. Even with the advent of novel chemotherapy and the biological agents which are undergoing investigation for progressively earlier disease stages, the dilemma of when to commence palliative treatment in an asymptomatic patient will remain, unless or until these agents are shown to increase overall survival. The TOAD trial will contribute to answering at least in part, some of these questions.
      PubDate: 2014-07-22T01:32:52.608015-05:
      DOI: 10.1111/bju.12864
  • Transrectal Ultrasound Guided Pelvic Plexus Block to reduce pain during
           prostate biopsy: a randomized controlled trial
    • Authors: Tarun Jindal; Subhabrata Mukherjee, Rajan Kumar Sinha, Mir Reza Kamal, Nabankur Ghosh, Barun Saha, Nilanjan Mitra, Pramod Kumar Sharma, Soumendra Nath Mandal, Dilip Karmakar
      Pages: n/a - n/a
      Abstract: Objective To assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasound (TRUS) guided prostate biopsy, in comparison with the conventional periprostatic nerve block (PNB). Materials and Methods A prospective, double blinded observational study was conducted with the patients being randomized into three groups. Group‐1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 ml of 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 ml of 2% lignocaine injection bilaterally. Group‐2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group‐3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on visual analogue scale (VAS) at two time points ‐ VAS‐1: during biopsy procedure and VAS ‐2: 30 minutes after the procedure. Results Mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among these three groups. The mean pain score during the biopsy was significantly less in PPB group (mean score of 2.91, range 2‐4), compared to PNB group (mean score of 4, range 3‐5), and both these groups were superior to no nerve block group (mean score of 5.4, range 3‐7). There was no significant difference between the mean pain scores, 30 minutes after the procedure, among the three groups with the mean score being 2.75 (range 2‐4), 2.83 (range 2‐4) and 2.85 (range 2‐4), respectively. Conclusion Pelvic plexus block (PPB) is superior to conventional periprostatic nerve block (PNB) in term of pain control during TRUS biopsy and both are in turn superior to no nerve block.
      PubDate: 2014-07-21T06:06:52.445826-05:
      DOI: 10.1111/bju.12872
  • Comparison of MR‐US fusion‐guided prostate biopsies obtained
           from axial and sagittal approaches
    • Authors: Cheng William Hong; Soroush Rais‐Bahrami, Annerleim Walton‐Diaz, Nabeel Shakir, Daniel Su, Arvin K. George, Maria J. Merino, Baris Turkbey, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto
      Pages: n/a - n/a
      Abstract: Objectives  •To compare cancer detection rates and concordance between MR‐US fusion‐guided prostate biopsy cores obtained from axial and sagittal approaches. Patients and Methods  •Institutional records of MR‐US fusion‐guided biopsy were reviewed.  •Detection rates for all cancers, Gleason ≥3+4 cancers, and Gleason ≥4+3 cancers were computed.  •Agreement between axial and sagittal cores for cancer detection, and frequency where one upgraded the other was computed on a per‐target and per‐patient basis. Results  •893 encounters from 791 subjects that underwent MR‐US fusion‐guided biopsy in 2007–2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis.  •Mean age and PSA at each encounter was 61.8 years and 9.7ng/ml (median=6.45ng/ml).  •Detection rates for all cancers, ≥3+4 cancers, and ≥4+3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores.  •Per‐target agreement was 88.6%, 93.0%, and 96.5% respectively. On a per‐target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores respectively.  •Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under‐characterization of cancer in 4.7% or 5.2% of patients respectively. Conclusion  •Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target.  •Discordance between axial and sagittal cores is greatest in intermediate‐risk scenarios, where obtaining multiple cores may improve tissue characterization.
      PubDate: 2014-07-21T06:06:51.723904-05:
      DOI: 10.1111/bju.12871
  • The effect of hypogonadism and testosterone‐enhancing therapy on
           alkaline phosphatase and bone mineral density
    • Authors: Ali A. Dabaja; Campbell F. Bryson, Peter N. Schlegel, Darius A. Paduch
      Pages: n/a - n/a
      Abstract: Objective To evaluate the relationship of testosterone (T) enhancing therapy on alkaline phosphatase (AP) in relation to bone mineral density (BMD) in hypogonadal men. Patients and Methods Retrospective review of 140 men with T
      PubDate: 2014-07-21T06:06:49.966025-05:
      DOI: 10.1111/bju.12870
  • Argument for prostate cancer screening in populations of
           African‐Caribbean origin
    • Authors: AL Patrick; CH Bunker, JB Nelson, R Dhir, VW Wheeler, JM Zmuda, J‐R Richard, AC Belle, LH Kuller
      Pages: n/a - n/a
      Abstract: The high prevalence, incidence and mortality rates of prostate cancer in Tobago would appear to strongly indicate that screening of this population would be justified and could positively impact on mortality. We consider our approach to be consonant with the recommendations of the EAU (Heidenreich A et al, 2013) and the findings of Hugosson et al, 2014)
      PubDate: 2014-07-21T06:06:48.856194-05:
      DOI: 10.1111/bju.12869
  • Ejaculatory Dysfunction After Treatment for Lower Urinary Tract Symptoms:
           Retrograde Ejaculation or Retrograde Thinking?
    • Authors: Paul Sturch; Henry H Woo, Tom McNicholas, Gordon Muir
      Pages: n/a - n/a
      PubDate: 2014-07-21T06:06:46.40263-05:0
      DOI: 10.1111/bju.12868
  • Cytotoxic chemotherapy in the contemporary management of metastatic
           prostate cancer
    • Authors: Guru Sonpavde; Christopher G. Wang, Matthew D. Galsky, William K. Oh, Andrew J. Armstrong
      Pages: n/a - n/a
      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 optimize 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 maximize outcomes. In addition, we briefly summarize the promising new chemotherapeutic agents in development in the context of emerging therapies.
      PubDate: 2014-07-21T06:05:18.845022-05:
      DOI: 10.1111/bju.12867
  • Contemporary practice and technique related outcomes for radical
           prostatectomy in the United Kingdom: a report of national outcomes
    • Authors: A. Laird; S. Fowler, D.W. Good, G.D. Stewart, V. Srinivasan, D. Cahill, S.F. Brewster, S.A. McNeill,
      Pages: n/a - n/a
      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 01 January 2011 and 31 December 2011 in the UK with data entered into the BAUS database were identified for analysis. • Overall surgical outcomes were assessed and subgroup analysis of these outcomes, based on operative technique (open, laparoscopic and robot assisted laparoscopic), 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 radical prostatectomies were performed by 115 consultants with a median of 11 (1‐154) cases per 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 50cases/year. • The majority of cases were classified as intermediate or high risk disease pre‐operatively (1596 cases [82.5%]) and this increased to 97.2% (1649 patients) on post‐operative risk stratification. • Overall intra‐operative complication rate was 14.2% and was significantly greater in LRP (17.8%) compared to the ORP (8.2%) and RALP (12.4%), p500ml, >1000ml and >2000ml EBL compared to other techniques (p
      PubDate: 2014-07-21T06:05:17.355135-05:
      DOI: 10.1111/bju.12866
  • The diagnostic accuracy of MRI PI‐RADS scoring in a transperineal
           prostate biopsy setting
    • Authors: Grey ADR; Chana MS, Popert R, Wolfe K, Liyanage SH, Acher PL
      Pages: n/a - n/a
      Abstract: Objectives ● To determine the sensitivity, specificity of multiparametric MRI (mp‐MRI) for significant prostate cancer with transperineal sector biopsy (TPB) as the reference standard. Patients and Methods ● Consecutive men who presented for TPSB between July 2012 and November 2013 following mp‐MRI (T2 and diffusion‐weighted images, 1.5 Tesla scanner, 8‐channel body coil) were included. ● A specialist uro‐radiologist, blinded to clinical details, assigned qualitative PI‐RADS (Prostate Imaging Reporting and Data System) scores on a Likert scale of 1 to 5 denoting the likelihood of significant prostate cancer with 1‐highly unlikely, 3‐equivocal, and 5‐highly likely. ● Transperineal sector biopsies 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 ≥6mm.    Results ● Two hundred and one patients went on to analysis. Indications were: prior negative transrectal biopsy with continued suspicion of prostate cancer (103); primary biopsy (83); and active surveillance (15). Mean(±sd) age, PSA and prostate volumes were 65(±7) years, 12.8(±12.4)ng/mL and 62(±36)cm3 respectively. ● Overall, biopsies were benign, clinically insignificant and clinically significant in 124(62%), 20(10%) and 57(28%) men respectively. 2 of 88 men with PI‐RADS score 1 or 2 had significant prostate cancer giving sensitivity (95% confidence intervals) 97%(87 to 99) and specificity 60%(51 to 68) at this threshold. ● ROC analysis gave an area under the curve (95% confidence intervals) of 0.89 (0.82 to 0.92). ● The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7% Conclusion ● PI‐RADS scoring performs well as a predictor for biopsy outcome and may be used in the decision making process for prostate biopsy.
      PubDate: 2014-07-16T01:46:03.752969-05:
      DOI: 10.1111/bju.12862
  • Co‐administration of TRPV4 and TRPV1 antagonists potentiate the
           effect of each drug in a rat model of cystitis
    • Authors: A. Charrua; CD. Cruz, K. Jansen, B. Rozenberg, J Heesakkers, F Cruz
      Pages: n/a - n/a
      Abstract: Objective To investigate TRPV4 expression in bladder afferents. To study the effect of TRPV4 and TRPV1 antagonists, alone and in combination, in bladder hyperactivity and pain induced by cystitis. Material and Methods TRPV4 expression in bladder afferents was analyzed by immunohistochemistry in L6 dorsal root ganglia (DRG), labelled by fluorogold injected in the urinary bladder. TRPV4 and TRPV1 co‐expression was also investigated in L6 DRG neurons of control and in animals with lipopolysaccharide‐induced cystitis. The effect of TRPV4 antagonist RN1734 and TRPV1 antagonist SB366791 on bladder hyperactivity and pain induced by cystitis was assessed by cystometry and visceral pain behaviour tests, respectively. Results TRPV4 is expressed in sensory neurons that innervate the urinary bladder. TRPV4 positive bladder afferents represent a different population than the TRPV1 expressing bladder afferents, since their co‐localization was minimal in control and inflamed animals. While low doses of RN1734 and SB366791 (176.7 ng/kg and 143.9 ng/kg, respectively) had no effect on bladder activity, the co‐administration of the two totally reversed bladder hyperactivity induced by lipopolysaccharide. In these same doses, the antagonists partially reversed bladder pain behaviour induced by cystitis. Conclusions TRPV4 and TRPV1 are present in different bladder afferent populations. The synergistic activity of antagonists for these receptors in very low doses may offer the opportunity to treat lower urinary tract symptoms while minimizing the potential side‐effects of each drug.
      PubDate: 2014-07-16T01:45:50.375862-05:
      DOI: 10.1111/bju.12861
  • Trans‐perineal prostate biopsy: template‐guided or
    • Authors: Philip E Dundee; Jeremy Grummet, Declan G Murphy
      Pages: n/a - n/a
      Abstract: There is growing interest in the use of trans‐perineal template biopsy for the diagnosis of prostate cancer. This is principally due to the reduced sepsis rate and improved diagnostic accuracy when compared with transrectal prostate biopsy. However, the need for a brachytherapy stepper and template are limiting factors. Here we discuss trans‐perineal biopsy using a free‐hand approach.
      PubDate: 2014-07-07T04:36:08.775835-05:
      DOI: 10.1111/bju.12860
  • Medium‐term oncologic outcomes for extended versus saturation biopsy
           and transrectal versus 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
      Pages: n/a - n/a
      Abstract: Purpose • In AS for low risk PCa, we assessed whether saturation or transperineal biopsy altered medium‐term oncologic outcomes compared with standard transrectal biopsy. Materials and methods • Retrospective analysis of prospectively collected data from two cohorts with localised PCa (1998‐2012) undergoing AS. • PCa‐specific, metastasis‐free and treatment‐free survival, unfavourable disease and significant cancer at RP were compared for standard (6‐12 core, median 10) versus saturation (>12 core, median 16), and transrectal versus transperineal biopsy, using multivariate analysis. Results • 650 men analysed; Median (mean) follow‐up of 55 (67) months. • PCa‐specific, metastasis‐free and BCR‐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 KM analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (Log Rank x2=5.87, p=0.01). On multivariate PH analysis, saturation biopsy (HR=1.68, p
      PubDate: 2014-07-02T08:40:24.479792-05:
      DOI: 10.1111/bju.12858
  • Safety and Clinical Outcomes of Patients Treated with Abiraterone Acetate
           After Docetaxel: Results of the Italian Named Patient Programme
    • Authors: O. Caffo; U. De Giorgi, L. Fratino, G. Lo Re, U. Basso, A. D′Angelo, M. Donini, F. Verderame, R. Ratta, G. Procopio, E. Campadelli, F. Massari, D. Gasparro, S. Macrini, C. Messina, M. Giordano, D. Alesini, F. Zustovich, A.P. Fraccon, G. Vicario, V. Conteduca, F. Maines, E. Galligioni
      Pages: n/a - n/a
      Abstract: Objective To assess the safety and efficacy of abiraterone acetate (AA) in patients with mCRPC treated in a compassionate named patient programme (NPP). Patients and methods We retrospectively reviewed the clinical records of mCRPC patients treated with AA at the standard daily oral dose of 1,000 mg plus prednisone 10 mg/day in 19 Italian hospitals. Results We assessed 265 mCRPC patients treated with AA. The most frequent (>1%) grade 3‐4 toxicities were anemia (4.2%), fatigue (4.2%), and bone pain (1.5%). Median progression‐free survival was seven months; median overall survival was 17 months after starting AA, and 35 months after the first docetaxel administration. Our study reproduced the clinical outcomes observed 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: 2014-07-02T08:40:23.066167-05:
      DOI: 10.1111/bju.12857
  • Early Adopters or Laggards? Attitudes Toward and Use of Social Media
           Among Urologists
    • Authors: Michael Fuoco; Michael J Leveridge
      Pages: n/a - n/a
      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. Materials and Methods A survey was sent to all active members of the Canadian Urological Association by email 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. 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. 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: 2014-07-01T05:43:52.089464-05:
      DOI: 10.1111/bju.12855
  • Long term follow‐up of a multicentre randomised controlled trial
           comparing TVT, PelvicolTM 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
      Pages: n/a - n/a
      Abstract: Objective To compare the long‐term outcomes of TVT, autologous fascial slings (AFS) and PelvicolTM in the management of female SUI. Subjects/ Methods and Materials A multicenter randomised controlled trial carried out in 4 UK centers from 2001‐2006 involving 201 women requiring primary surgery for SUI. Women were randomly assigned to receive TVT, AFS or PelvicolTM. Primary outcome was surgical success defined as “women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up”. Secondary outcomes included completely ‘dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and Euro‐QoL scores. Results 162 (80.6%) women were available for follow‐up with a median duration of 10‐years (6.6‐12.6 years). ‘Success’ rates for TVT, AFS and PelvicolTM were 73%, 75.4% and 58% respectively. Comparing the 12‐month and 10‐year ‘success’ rates, deterioration from 93% to 73% (p=
      PubDate: 2014-06-24T09:20:37.864159-05:
      DOI: 10.1111/bju.12851
  • Incidence of Needle Tract Seeding Following Prostate Biopsy for Suspected
           Cancer ‐ review of the literature
    • Authors: D Volanis; DE Neal, AY Warren, VJ Gnanapragasam
      Pages: n/a - n/a
      Abstract: With the widespread clinical use of 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 is 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 versus transperineal approach as well as tumour grade and stage. Twenty‐six publications were identified reporting needle tract seeding post prostate biopsy. In total, the number of patients with needle tract seeding reported in literature is 42. In the majority of cases seeding was reported after transperineal biopsy of the prostate, while 9 cases occurred following transrectal biopsy. Based on the reviewed series the incidence of seeding appears much less than 1%. The increase in the number of biopsies and cores taken at each biopsy over the years has not resulted in an increase in the reported cases of seeding. In conclusion, seeding along the needle track is rare complication after prostate biopsy. Its actual incidence is presently difficult to quantify. It is reasonable to advice appropriate counselling and take measure to reduce this event where possible; however, we do not advocate avoidance of biopsies as the benefits of appropriate cancer diagnosis and management outweigh any potential risks from seeding.
      PubDate: 2014-06-23T11:00:15.396041-05:
      DOI: 10.1111/bju.12849
  • Long‐term functional outcomes after artificial urinary sphincter
           (AMS 800®) implantation in men with stress urinary incontinence
    • Authors: Priscilla Léon; Emmanuel Chartier‐Kastler, Morgan Rouprêt, Vanina Ambrogi, Pierre Mozer, Véronique Phé
      Pages: n/a - n/a
      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. Material and methods Men who had undergone placement of an 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 Fifty‐seven consecutive patients were included (median age 69 years; IQR: 64–72). Median duration of follow‐up was 15 years (IQR: 8.25–19.75). At the end of follow‐up, 25 patients (43.8%) still had their primary AUS. Explantation of an AUS was done in nine men because of erosion (n=7) and infection (n=2). 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 suffering from SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
      PubDate: 2014-06-23T10:43:53.88639-05:0
      DOI: 10.1111/bju.12848
  • Guideline of Guidelines
    • Authors: Prokar Dasgupta
      Pages: 315 - 315
      PubDate: 2014-08-25T22:26:17.939376-05:
      DOI: 10.1111/bju.12882
  • Neutrophil‐to‐lymphocyte ratio as a prognostic factor in upper
           tract urothelial cancer
    • Authors: Moben Mirza
      Pages: 316 - 317
      PubDate: 2014-08-25T22:26:21.965219-05:
      DOI: 10.1111/bju.12513
  • Should centralized histopathological review in penile cancer be the global
           standard? A call for the international adoption of penile specialist
    • Authors: Catherine M. Corbishley
      Pages: 317 - 318
      PubDate: 2014-08-25T22:26:21.009528-05:
      DOI: 10.1111/bju.12596
  • Perioperative aspirin: To give or not to give?
    • Authors: Akshay Sood; Quoc‐Dien Trinh
      Pages: 318 - 319
      PubDate: 2014-08-25T22:26:15.14631-05:0
      DOI: 10.1111/bju.12525
  • Novel commercially available genomic tests for prostate cancer: a roadmap
           to understanding their clinical impact
    • Authors: John W. Davis
      Pages: 320 - 322
      PubDate: 2014-07-14T08:11:48.27416-05:0
      DOI: 10.1111/bju.12695
  • Guideline of guidelines: prostate cancer screening
    • Authors: Stacy Loeb
      Pages: 323 - 325
      PubDate: 2014-08-25T22:26:14.564704-05:
      DOI: 10.1111/bju.12854
  • Totally intracorporeal robot‐assisted radical cystectomy: optimizing
           total outcomes
    • Authors: Justin W. Collins; N. Peter Wiklund
      Pages: 326 - 333
      Abstract: We performed a systematic literature review to assess the current status of a totally intracorporeal robot‐assisted radical cystectomy (RARC) approach. The current ‘gold standard’ for radical cystectomy remains open radical cystectomy. RARC has lagged behind robot‐assisted prostatectomy in terms of adoption and perceived patient benefit, but there are indications that this is now changing. There have been several recently published large series of RARC, both with extracorporeal and with intracorporeal urinary diversions. The present review focuses on the totally intracorporeal approach. Radical cystectomy is complex surgery with several important outcome measures, including oncological and functional outcomes, complication rates, patient recovery and cost implications. We aim to answer the question of whether there are advantages to a totally intracorporeal robotic approach or whether we are simply making an already complex procedure more challenging with an associated increase in complication rates. We review the current status of both oncological and functional outcomes of totally intracorporeal RARC compared with standard RARC with extraperitoneal urinary diversion and with open radical cystectomy, and assess the associated short‐ and long‐term complication rates. We also review aspects in training and research that have affected the uptake of RARC. Additionally we evaluate how current technology is contributing to the future development of this surgical technique.
      PubDate: 2014-03-05T11:50:39.184862-05:
      DOI: 10.1111/bju.12558
  • Should centralized histopathological review in penile cancer be the global
    • Authors: Vincent Tang; Laurence Clarke, Zara Gall, Jonathan H. Shanks, Daisuke Nonaka, Nigel J. Parr, P. Anthony Elliott, Noel W. Clarke, Vijay Ramani, Maurice W. Lau, Vijay K. Sangar
      Pages: 340 - 343
      Abstract: Objective To assess the role of centralized pathological review in penile cancer management. Materials and Methods Newly diagnosed squamous cell carcinomas (SCC) of the penis, including squamous cell carcinoma in situ (CIS), from biopsy specimens were referred from 15 centres to the regional supra‐network multidisciplinary team (Sn‐MDT) between 1 January 2008 and 30 March 2011. Biopsy histology reports and slides from the respective referring hospitals were reviewed by the Sn‐MDT pathologists. The biopsy specimens’ histological type, grade and stage reported by the Sn‐MDT pathologist were compared with those given in the referring hospital pathology report, as well as with definitive surgery histology. Any changes in histological diagnosis were sub‐divided into critical changes (i.e. those that could alter management) and non‐critical changes (i.e. those that would not affect management). Results A total of 155 cases of squamous cell carcinoma or CIS of the penis were referred from 15 different centres in North‐West England. After review by the Sn‐MDT, the histological diagnosis was changed in 31% of cases and this difference was statistically significant. A total of 60.4% of the changes were deemed to be critical changes that resulted in a significant change in management. When comparing the biopsy histology reported by the Sn‐MDT with the final histology from the definitive surgical specimens, a good correlation was generally found. Conclusions In the present study a significant proportion of penile cancer histology reports were revised after review by the Sn‐MDT. Many of these changes altered patient management. The present study shows that accurate pathological diagnosis plays a crucial role in determining the correct treatment and maximizing the potential for good clinical outcomes in penile cancer. In the case of histopathology, centralization has increased exposure to penile cancer and thereby increased diagnostic accuracy, and should therefore be considered the ‘gold standard’.
      PubDate: 2014-01-15T05:50:26.323236-05:
      DOI: 10.1111/bju.12449
  • Impact of androgen suppression and zoledronic acid on bone mineral density
           and fractures in the Trans‐Tasman Radiation Oncology Group (TROG)
           03.04 Randomised Androgen Deprivation and Radiotherapy (RADAR) randomized
           controlled trial for locally advanced prostate cancer
    • Authors: James W. Denham; Michael Nowitz, David Joseph, Gillian Duchesne, Nigel A. Spry, David S. Lamb, John Matthews, Sandra Turner, Chris Atkinson, Keen‐Hun Tai, Nirdosh Kumar Gogna, Lizbeth Kenny, Terry Diamond, Richard Smart, David Rowan, Pablo Moscato, Renato Vimieiro, Richard Woodfield, Kevin Lynch, Brett Delahunt, Judy Murray, Cate D'Este, Patrick McElduff, Allison Steigler, Allison Kautto, Jean Ball
      Pages: 344 - 353
      Abstract: Objective To study the influence of adjuvant androgen suppression and bisphosphonates on incident vertebral and non‐spinal fracture rates and bone mineral density (BMD) in men with locally advanced prostate cancer. Patients and Methods Between 2003 and 2007, 1071 men with locally advanced prostate cancer were randomly allocated, using a 2 × 2 trial design, to 6 months i.m. leuprorelin (androgen suppression [AS]) before radiotherapy alone ± 12 months additional leuprorelin ± 18 months zoledronic acid (ZdA), commencing at randomization. The main endpoint was incident thoraco‐lumbar vertebral fractures, which were assessed radiographically at randomization and at 3 years, then reassessed by centralized review. Subsidiary endpoints included incident non‐spinal fractures, which were documented throughout follow‐up, and BMD, which was measured in 222 subjects at baseline, 2 years and 4 years. Results Incident vertebral fractures at 3 years were observed in 132 subjects. Their occurrence was not increased by 18 months’ AS, nor reduced by ZdA. Incident non‐spinal fractures occurred in 72 subjects and were significantly related to AS duration but not to ZdA. Osteopenia and osteoporosis prevalence rates at baseline were 23.4 and 1.4%, respectively, at the hip. Treatment for 6 and 18 months with AS caused significant reductions in hip BMD at 2 and 4 years (P < 0.01) and ZdA prevented these losses at both time points. Conclusion In an AS‐naïve population, 18 months of ZdA treatment prevented the sustained BMD losses caused by 18 months of AS treatment; however, the study power was insufficient to show that AS duration or ZdA influenced vertebral fracture rates.
      PubDate: 2014-02-11T00:48:17.872815-05:
      DOI: 10.1111/bju.12497
  • Reflex fluorescence in situ hybridization assay for suspicious urinary
           cytology in patients with bladder cancer with negative surveillance
    • Authors: Philip H. Kim; Ranjit Sukhu, Billy H. Cordon, John P. Sfakianos, Daniel D. Sjoberg, A. Ari Hakimi, Guido Dalbagni, Oscar Lin, Harry W. Herr
      Pages: 354 - 359
      Abstract: Objective To assess the ability of reflex UroVysion fluorescence in situ hybridization (FISH) testing to predict recurrence and progression in patients with non‐muscle‐invasive bladder cancer (NMIBC) with suspicious cytology but negative cystoscopy. Patients and Methods Patients under NMIBC surveillance were followed with office cystoscopy and urinary cytology every 3–6 months. Between March 2007 and February 2012, 500 consecutive patients with suspicious cytology underwent reflex FISH analysis. Clinical and pathological data were reviewed retrospectively. Predictors for recurrence, progression and findings on subsequent cystoscopy (within 2–6 months after FISH) were evaluated using univariate and multivariate Cox regression. Results In all, 243 patients with suspicious cytology also had negative surveillance cystoscopy. Positive FISH was a significant predictor of recurrence (hazard ratio [HR] = 2.35, 95% confidence interval [CI]: 1.42–3.90, P = 0.001) in multivariate analysis and for progression (HR = 3.01, 95% CI: 1.10–8.21, P = 0.03) in univariate analysis, compared with negative FISH. However, positive FISH was not significantly associated with evidence of tumour on subsequent surveillance cystoscopy compared with negative FISH (odds ratio = 0.8, 95% CI: 0.26–2.74, P = 1). Conclusions Positive FISH predicts recurrence and progression in patients under NMIBC surveillance with suspicious cytology but negative cystoscopy. However, there was no association between the FISH result and tumour recurrence in the immediate follow‐up period. Reflex FISH testing for suspicious cytology might have limited ability to modify surveillance strategies in NMIBC.
      PubDate: 2014-02-14T09:27:12.981298-05:
      DOI: 10.1111/bju.12516
  • Comparison of high‐dose (86.4 Gy) IMRT vs combined
           brachytherapy plus IMRT for intermediate‐risk prostate cancer
    • Authors: Daniel E. Spratt; Zachary S. Zumsteg, Pirus Ghadjar, Marisa A. Kollmeier, Xin Pei, Gilad Cohen, William Polkinghorn, Yoshiya Yamada, Michael J. Zelefsky
      Pages: 360 - 367
      Abstract: Objective To compare tumour control and toxicity outcomes with the use of high‐dose intensity‐modulated radiation therapy (IMRT) alone or brachytherapy combined with IMRT (combo‐RT) for patients with intermediate‐risk prostate cancer. Patients and Methods Between 1997 and 2010, 870 consecutive patients with intermediate‐risk prostate cancer were treated at our institution with either 86.4 Gy of IMRT alone (n = 470) or combo‐RT consisting of brachytherapy combined with 50.4 Gy of IMRT (n = 400). Brachytherapy consisted of low‐dose‐rate permanent interstitial implantation in 260 patients and high‐dose‐rate temporary implantation in 140 patients. The median (range) follow‐up for the entire cohort was 5.3 (1–14) years. Results For IMRT alone vs combo‐RT, 7‐year actuarial prostate‐specific antigen (PSA)‐relapse‐free survival (PSA‐RFS) rates were 81.4 vs 92.0% (P < 0.001), and distant metastases‐free survival (DMFS) rates were 93.0 vs 97.2% (P = 0.04), respectively. Multivariate analysis showed that combo‐RT was associated with better PSA‐RFS (hazard ratio [HR], 0.40 [95% confidence interval, 0.24–0.66], P < 0.001), and better DMFS (HR, 0.41 [0.18–0.92], P = 0.03). A higher incidence of acute genitourinary (GU) grade 2 (35.8 vs 18.9%; P < 0.01) and acute GU grade 3 (2.3 vs 0.4%; P = 0.03) toxicities occurred in the combo‐RT group than in the IMRT‐alone group. Most acute toxicity resolved. Late toxicity outcomes were similar between the treatment groups. The 7‐year actuarial late toxicity rates for grade 2 gastrointestinal (GI) toxicity were 4.6 vs 4.1% (P = 0.89), for grade 3 GI toxicity 0.4 vs 1.4% (P = 0.36), for grade 2 GU toxicity 19.4 vs 21.2% (P = 0.14), and grade 3 GU toxicity 3.1 vs 1.4% (P = 0.74) for the IMRT vs the combo‐RT group, respectively. Conclusions Enhanced dose escalation using combo‐RT was associated with superior PSA‐RFS and DMFS outcomes for patients with intermediate‐risk prostate cancer compared with high‐dose IMRT alone at a dose of 86.4 Gy. While acute GU toxicities were more prevalent in the combo‐RT group, the incidence of late GI and GU toxicities was similar between the treatment groups.
      PubDate: 2014-01-22T07:11:32.858037-05:
      DOI: 10.1111/bju.12514
  • The impact of perioperative blood transfusion on survival after
           nephrectomy for non‐metastatic renal cell carcinoma (RCC)
    • Authors: Brian J. Linder; R. Houston Thompson, Bradley C. Leibovich, John C. Cheville, Christine M. Lohse, Dennis A. Gastineau, Stephen A. Boorjian
      Pages: 368 - 374
      Abstract: Objective To evaluate the association of perioperative blood transfusion (PBT) with survival after nephrectomy. Patients and Methods We identified 2318 patients who underwent partial or radical nephrectomy at Mayo Clinic between 1990 and 2006. PBT was defined as transfusion of allogenic red blood cells during surgery or postoperative hospitalisation. Survival was estimated using the Kaplan–Meier method and compared with the log‐rank test. Cox proportional hazards regression models were used to evaluate the association of PBT with outcome. Results In all, 498 patients (21%) received a PBT. The median (interquartile range) number of units transfused was 3 (2, 5). Patients receiving a PBT were significantly older at surgery (P < 0.001), more likely to be female (P < 0.001), with more frequent symptomatic presentation (P < 0.001), worse Eastern Cooperative Oncology Group performance status (P < 0.001), and more frequent adverse pathological features, such as high nuclear grade (P < 0.001), locally‐advanced tumour stage (P < 0.001) and lymph node invasion (P < 0.001). The median follow‐up was 9.1 years. Receipt of a PBT was associated with adverse 5‐year cancer‐specific (68% vs 92%; P < 0.001) and overall (56% vs 82%; P < 0.001) survival. On multivariate analyses, PBT remained associated with higher risk of death from any cause (hazard ratio [HR] 1.23; P = 0.02). Among patients who received a PBT, an increasing number of units transfused was independently associated with increased all‐cause mortality (HR 1.08; P = 0.001). Conclusion PBT is associated with a significantly increased risk of mortality after nephrectomy. While external validation is needed, continued efforts to minimise the use of blood products in these patients are warranted.
      PubDate: 2014-01-29T05:05:35.298499-05:
      DOI: 10.1111/bju.12535
  • Evolution of the Southampton Enhanced Recovery Programme for radical
           cystectomy and the aggregation of marginal gains
    • Authors: Julian Smith; Zhao Wu Meng, Richard Lockyer, Tim Dudderidge, John McGrath, Matthew Hayes, Brian Birch
      Pages: 375 - 383
      Abstract: Objective To describe and assess the evolution of an enhanced recovery programme (ERP) for open radical cystectomy. Patients and Methods We introduced a mentored ERP for radical cystectomy in January 2011. The programme underwent service evaluation and multiple changes in August 2012 that we define as marginal gains. We present a retrospective review of 133 consecutive patients undergoing open radical cystectomy, grouped according to the three stages of the ERP from October 2008 to April 2013: (1) non‐ERP group (October 2008 to December 2010): n = 69; (2) ERP‐1 group (January 2011 to July 2012): n = 37; and (3) ERP‐2 group (August 2012 to April 2013): n = 27. Primary outcomes were length of hospital stay (LOS), readmission, morbidity at 90 days using the Clavien classification system and mortality. Secondary outcomes were time to flatus, ileus rates, re‐operation rates and oncological outcomes. Results There were no differences in patient demographics among any of the groups for: age, gender, BMI, American Society of Anesthesiologists score and the use of neoadjuvant chemotherapy. There were no differences in readmission, morbidity and mortality rates. The overall 90‐day mortality was six patients (4.5%). There were significant differences in ileus rates between the non‐ERP, the ERP‐1 and the ERP‐2 groups: 44.9% (31 patients), 29.7% (11 patients) and 14.8% (four patients), respectively (P = 0.017). There was a significant difference in the presence of pathological lymphadenopathy in the ERP‐2 group: non‐ERP group, 10.1%; ERP‐1 group, 16.2%; and ERP‐2 group, 44.4%; P = 0.002. There was also a difference in the mean (sd) lymph node yield in ERP‐2: non‐ERP group, 8.4 (5.4) nodes; ERP‐1, 8.2 (6.4) nodes; and ERP‐2, 16.7 (5.4) nodes (P < 0.001). The median (range) LOS was 14 (7–91) days, 10 (6–55) days and 7 (3–99) days in the non‐ERP, ERP‐1 and ERP‐2 groups, respectively (P < 0.001). Conclusions Auditing an already successful ERP and implementing a number of marginal gains has led to a significant decrease in the median LOS for radical cystectomy. The LOS for open radical cystectomy at University Hospital Southampton has halved. In the second phase of our ERP, our median LOS is 7 days.
      PubDate: 2014-07-27T01:41:59.973519-05:
      DOI: 10.1111/bju.12644
  • Sepsis and ‘superbugs’: should we favour the transperineal
           over the transrectal approach for prostate biopsy?
    • Authors: Jeremy P. Grummet; Mahesha Weerakoon, Sean Huang, Nathan Lawrentschuk, Mark Frydenberg, Daniel A. Moon, Mary O'Reilly, Declan Murphy
      Pages: 384 - 388
      Abstract: Objective To determine the rate of hospital re‐admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)‐guided biopsy for patients undergoing repeat prostate biopsy. Patients and Methods Pooled prospective databases on TP biopsy from multiple centres in Melbourne were queried for rates of re‐admission for infection. A literature review of PubMed and Embase was also conducted using the search terms: ‘prostate biopsy, fever, infection, sepsis, septicaemia and complications’. Results In all, 245 TP biopsies were performed (111 at Alfred Health, 92 at Epworth Healthcare, 38 at Peter MacCallum Cancer Centre, and four at other institutions). The rate of hospital re‐admission for infection was zero. The literature review showed that the rate of sepsis after TRUS biopsy appears to be rising with increasing rates of multi‐resistant bacteria found in rectal flora, and is as high as 5%. However, the rate of sepsis from published series of TP biopsy approached zero. Conclusions Both local and international data suggest a negligible rate of sepsis with TP biopsy. This compares to a concerning rise in the rate of sepsis after TRUS biopsy due to the increasing prevalence of multi‐resistant bacteria in rectal flora. Although TRUS biopsy is convenient, cheap and quick to perform, we think that TP biopsy should now be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.
      PubDate: 2014-02-19T08:09:45.030098-05:
      DOI: 10.1111/bju.12536
  • Role of fluorodeoxyglucose positron emission tomography (FDG
           PET)‐computed tomography (CT) in the staging of bladder cancer
    • Authors: Henry Goodfellow; Zaid Viney, Paul Hughes, Sheila Rankin, Giles Rottenberg, Simon Hughes, Felicity Evison, Prokar Dasgupta, Timothy O'Brien, Muhammad Shamim Khan
      Pages: 389 - 395
      Abstract: Objective To determine whether to use 18F‐fluorodeoxyglucose positron emission tomography (FDG PET) scans in the preoperative staging of bladder cancer (BC). Patients and Methods In all, 233 patients with muscle‐invasive BC (MIBC) or high‐risk non‐MIBC being considered for radical cystectomy (RC) between 2005 and 2011 had FDG‐PET and computed tomography (CT) of the chest, abdomen and pelvis to assess for pelvic lymph node (LN) involvement or distant metastases. Sensitivity and specificity for detecting pelvic LN involvement was determined by comparing the results of the scans to the histopathology reports in patients undergoing RC. These parameters for distant metastases were determined from biopsy results or follow‐up imaging. In patients who did not undergo RC, follow‐up imaging was used to evaluate the sensitivity and specificity. Patients were excluded from analysis if they either had neoadjuvant chemotherapy or had
      PubDate: 2014-04-16T22:25:30.670511-05:
      DOI: 10.1111/bju.12608
  • Open and robot‐assisted radical retropubic prostatectomy in men
           receiving ongoing low‐dose aspirin medication: revisiting an old
    • Authors: Sami‐Ramzi Leyh‐Bannurah; Jens Hansen, Hendrik Isbarn, Thomas Steuber, Pierre Tennstedt, Uwe Michl, Thorsten Schlomm, Alexander Haese, Hans Heinzer, Hartwig Huland, Markus Graefen, Lars Budäus
      Pages: 396 - 403
      Abstract: Objective To assess blood loss, transfusion rates and 90‐day complication rates in patients receiving ongoing 100 mg/day aspirin medication and undergoing open radical prostatectomy (RP) or robot‐assisted RP (RARP). Patients and Methods Between February 2010 and August 2011, 2061 open RPs and 400 RARPs were performed. All patients received low‐molecular‐weight heparin for thrombembolism prophylaxis. Aspirin intake during surgery was recorded in 137 patients (5.5%). Descriptive statistics and multivariable analyses after propensity‐score matching for balancing potential differences in patients with and without aspirin medication were used to assess the risk of blood loss above the median in patients undergoing open RP or RARP. Results The median blood loss in the open RP cohort with and without aspirin medication was 750 and 700 mL, respectively, and in the RARP cohort it was 200 and 150 mL, respectively. Within the same cohorts, transfusions were administered in 21 and 8% and 0 and 1% of patients, respectively. The 90‐day complication rates in patients with ongoing aspirin medication were 5.8, 4.4, 7.3 and 0% for Clavien grades I, II, III and IV complications, respectively. In multivariable analyses and after propensity‐score matching, prostate volume (odds ratio 1.03; 95% CI 1.02–1.04; P < 0.01) but not ongoing aspirin medication achieved independent predictor status for the risk of blood loss above the median. Conclusions Major surgery such as open RP and RARP can be safely performed in patients with ongoing aspirin medication without greater blood loss. Higher 90‐day complication rates were not detected in such patients. Differences in transfusion rates between the groups receiving and not receiving ongoing aspirin medication may be explained by a higher proportion of patients with coronary artery disease in the group receiving ongoing aspirin mediciation. This comorbidity may result in a higher peri‐operative threshold for allogenic blood transfusion.
      PubDate: 2014-07-15T06:05:27.764307-05:
      DOI: 10.1111/bju.12504
  • Does body mass index impact the outcomes of tubeless percutaneous
    • Authors: Nicholas J. Kuntz; Andreas Neisius, Gastón M. Astroza, Matvey Tsivian, Muhammad W. Iqbal, Ramy Youssef, Michael N. Ferrandino, Glenn M. Preminger, Michael E. Lipkin
      Pages: 404 - 411
      Abstract: Objective To evaluate whether body mass index (BMI) has an impact on the outcomes of tubeless percutaneous nephrolithotomy (PCNL). Patients and Methods We retrospectively reviewed patients who underwent tubeless PCNL at our institution from 2006 to 2011. Specifically, stone‐free rates, complications, and hospital length of stay (LOS) were assessed. Patients were divided into four groups based on BMI:
      PubDate: 2014-02-20T17:24:37.368739-05:
      DOI: 10.1111/bju.12538
  • Active surveillance for renal angiomyolipoma: outcomes and factors
           predictive of delayed intervention
    • Authors: Idir Ouzaid; Riccardo Autorino, Richard Fatica, Brian R. Herts, Gordon McLennan, Erick M. Remer, Georges‐Pascal Haber
      Pages: 412 - 417
      Abstract: Objective To present the outcomes of active surveillance (AS) for renal angiomyolipomas (AMLs) and to assess the clinical features predicting delayed intervention of this treatment option. Patients and Methods We retrospectively reviewed the outcomes of patients diagnosed with AMLs on computed tomography (CT) who were managed with AS at our institution. The AS protocol consisted of 6‐ and 12‐month, then annual follow‐up visits, each one including a physical examination and CT imaging. Discontinuation of AS was defined as the need or decision for an active procedure during the follow‐up period. Causes of delayed intervention, as well as the type of active treatment (AT), were recorded. Clinical features at presentation of patients failing AS were compared with those who remained under AS at the time of the last follow‐up. Predictive factors of delayed intervention were analysed using univariate and multivariate Cox regression models. Results Overall, 130 patients were included in the analysis, of whom 102 (78.5%) were incidentally diagnosed, while 15 (11.5%) and 13 patients (10%) presented with flank pain and haematuria, respectively. After a mean (sd) follow‐up of 49 (40) months, 17 patients (13%) discontinued AS and underwent AT. Patients who underwent delayed intervention were more likely to present with a higher body mass index, larger tumours and symptomatic disease. Angioembolization represented the first‐line AT after AS (64.7%), whereas partial nephrectomy was adopted in 29.4% of patients. On the univariate analysis, risk factors for delayed intervention included tumour size ≥4 cm, symptoms at diagnosis, and history of concomitant or contralateral kidney disease. On the multivariate analysis, only tumour size and symptoms remained independently associated with discontinuation of AS. Conclusions Tumour size and symptoms at initial presentation were highly predictive of discontinuation of AS in the management of AMLs. Selective angioembolization was the first‐line option used for AT after AS was discontinued.
      PubDate: 2014-04-16T22:25:27.792138-05:
      DOI: 10.1111/bju.12604
  • Superiority of fesoterodine 8 mg vs 4 mg in reducing urgency
           urinary incontinence episodes in patients with overactive bladder: results
           of the randomised, double‐blind, placebo‐controlled EIGHT
    • Authors: Christopher Chapple; Tim Schneider, François Haab, Franklin Sun, Laurence Whelan, David Scholfield, Erika Dragon, Erin Mangan
      Pages: 418 - 426
      Abstract: Objective To assess the superiority of fesoterodine 8 mg vs 4 mg for improvement in urgency urinary incontinence (UUI) episodes and other diary variables, diary‐dry rate (proportion of patients with >0 UUI episodes on baseline diary and 0 UUI episodes on post‐baseline diary), and improvements in measures of symptom bother, health‐related quality of life (HRQL), and other patient‐reported outcomes (PROs). Patients and Methods This was a 12‐week, randomised, double‐blind, placebo‐controlled, multinational trial of men and women aged ≥18 years with overactive bladder (OAB) symptoms including UUI ( ID NCT01302067). Patients were randomised (2:2:1) to receive fesoterodine 8 mg, fesoterodine 4 mg, or placebo once daily; those randomised to fesoterodine 8 mg started with fesoterodine 4 mg once daily for 1 week, then 8 mg once daily for the remaining 11 weeks. Patients completed bladder diaries at baseline and weeks 4 and 12 and the Patient Perception of Bladder Condition (PPBC), Urgency Perception Scale (UPS), and Overactive Bladder Questionnaire (OAB‐q) at baseline and week 12. The primary endpoint was change from baseline to week 12 in UUI episodes per 24 h. Results At week 12, patients receiving fesoterodine 8 mg (779 patients) had significantly greater reductions from baseline in UUI episodes, micturitions, and urgency episodes than patients receiving fesoterodine 4 mg (790) or placebo (386); diary‐dry rate was significantly higher in the fesoterodine 8‐mg group vs the fesoterodine 4‐mg and placebo groups (all P < 0.05). At week 12, patients receiving fesoterodine 8 mg also had significantly greater improvements in scores on the PPBC, UPS, and all OAB‐q scales and domains than patients receiving fesoterodine 4 mg or placebo (all P < 0.01). Patients receiving fesoterodine 4 mg had significantly greater improvements in UUI episodes, urgency episodes, and micturitions; significantly higher diary‐dry rates; and significantly greater improvement in PPBC scores and OAB‐q scores than patients receiving placebo (all P < 0.05). Dry mouth was the most commonly reported adverse event (AE) in the fesoterodine groups (placebo group, 3.4%; fesoterodine 4‐mg group, 12.9%; fesoterodine 8‐mg group, 26.1%); most cases were mild or moderate in all treatment groups. Rates of serious AEs and discontinuations due to AEs were low in all groups. Conclusions In a 12‐week, prospectively designed, superiority trial, fesoterodine 8 mg showed statistically significantly superior efficacy vs fesoterodine 4 mg and placebo, as measured by reductions in UUI episodes and other diary variables, diary‐dry dry rate, and improvements in measures of symptom bother, HRQL, and other PROs; clear evidence of dose‐dependent efficacy is unique to fesoterodine among antimuscarinics and other oral agents for the treatment of OAB. Fesoterodine 4 mg was significantly more effective than placebo on all outcomes except for improvements in UPS scores. These data support the benefit of having two doses of fesoterodine in clinical practice, with the recommended starting dose of 4 mg for all patients and the fesoterodine 8‐mg dose available for patients who require a higher dose to achieve optimal symptom relief.
      PubDate: 2014-07-01T09:38:25.503788-05:
      DOI: 10.1111/bju.12678
  • A pooled analysis of individual patient data from registrational trials of
           silodosin in the treatment of non‐neurogenic male lower urinary
           tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)
    • Authors: Giacomo Novara; Christopher R. Chapple, Francesco Montorsi
      Pages: 427 - 433
      Abstract: Objective To evaluate the efficacy and safety of silodosin in a pooled analysis based on individual patients data from three randomised controlled trials (RCTs) comparing silodosin and placebo. Patients and methods A pooled analysis of 1494 patients from three 12‐week, similarly designed, parallel‐group, multicentre, randomised, double‐blind, placebo‐controlled phase III RCTs (SI04009, SI04010, KMD3213‐IT‐CL 0215) was performed. Differences from placebo for the mean change from baseline to the end of treatment for the International Prostate Symptom Score (IPSS) and uroflowmetry data were tested using an analysis of covariance model. Results At study end, in the intention‐to‐treat population, silodosin was significantly more effective than placebo in improving IPSS total score (adjusted means differences [AMD] 2.7; P < 0.001). Silodosin was significantly more effective than placebo in improving storage, voiding, and quality‐of‐life‐item subscores (all P < 0.001). Similarly, silodosin was more effective than placebo in improving maximum urinary flow rate (Qmax; AMD 0.8; P = 0.002). The most frequently reported adverse event (AE) was ejaculatory dysfunction, reported in 186 (22%) patients in the silodosin group and six (0.9%) in the placebo group (odds ratio 28.14; P < 0.001). Dizziness and orthostatic hypotension rates were similar in silodosin and placebo groups. Conclusions Silodosin is an effective treatment for male lower urinary tract symptoms suggestive of benign prostatic hyperplasia. The drug is able to improve total IPSS, all IPSS‐related parameters, and Qmax at uroflowmetry. Ejaculatory dysfunction is the main treatment‐related AE, whereas prevalence of cardiovascular AEs was similar to placebo.
      PubDate: 2014-03-13T09:38:57.650652-05:
      DOI: 10.1111/bju.12712
  • Interstitial cells in the urinary tract, where are they and what do they
    • Authors: Christopher H. Fry
      Pages: 434 - 435
      PubDate: 2014-08-25T22:26:21.161075-05:
      DOI: 10.1111/bju.12731
  • Voltage‐operated Ca2+ currents and Ca2+‐activated Cl–
           currents in single interstitial cells of the guinea‐pig prostate
    • Authors: Richard J. Lang; Mary A. Tonta, Hiromichi Takano, Hikaru Hashitani
      Pages: 436 - 446
      Abstract: Objective To investigate the expression of ‘T‐type’ and ‘L‐type’ voltage‐operated Ca2+ channels in single interstitial cells of the guinea‐pig prostate. Material and Methods Whole‐cell and perforated patch‐clamp techniques were applied to prostatic interstitial cells (PICs) dispersed using collagenase. Results In contrast to prostatic myocytes, PICs under voltage clamp and filled with K+ (130 mm) were distinguished by the absence of a voltage‐operated transient outward K+ current or spike discharge upon membrane depolarisation when under current clamp. Depolarisation of Cs+‐filled PICs evoked an inward current at potentials positive to −60 mV, which peaked in amplitude near 0 mV. This inward current increased when Ba2+ (5 mm) replaced the external Ca2+ (1.5 mm) and displayed a variable sensitivity to the inhibitory actions of conditioning depolarisations to −40 mV applied before the test depolarisation or to 1 μm nifedipine, the ‘L‐type’ Ca2+ channel blocker. A residual inward current recorded in nifedipine was blocked by 10 μm Ni2+. Cs+‐filled PICs also displayed a slowly inactivating outward current that was little affected by nifedipine, reduced by the Cl– channel blocker, niflumic acid (10 μm) and blocked by Ba2+ or a conditioning depolarisation. Conclusion PICs express both a small ‘T‐type’ Ca2+ channel current (ICa) and a large ‘L‐type’ ICa. Ca2+ influx through ‘T‐type’ ICa was an essential trigger for the activation of a Ca2+‐activated Cl–‐selective current. The dependence of PIC Ca2+ signalling on ‘T‐type’ and ‘L‐type’ ICa is unique compared with other interstitial cells of the urogenital tract and may well be pharmaceutically exploitable.
      PubDate: 2014-08-25T22:26:15.285057-05:
      DOI: 10.1111/bju.12656
  • Tissue engineering of diseased bladder using a collagen scaffold in a
           bladder exstrophy model
    • Authors: Luc A.J. Roelofs; Barbara B.M. Kortmann, Egbert Oosterwijk, Alex J. Eggink, Dorien M. Tiemessen, A. Jane Crevels, Rene M.H. Wijnen, Willeke F. Daamen, Toin H. Kuppevelt, Paul J. Geutjes, Wout F.J. Feitz
      Pages: 447 - 457
      Abstract: Objective To compare the regenerative capacity of diseased bladder in a large animal model of bladder exstrophy with regeneration in healthy bladder using a highly porous collagen scaffold. Materials and Methods Highly porous bovine type I collagen scaffolds with a diameter of 32 mm were prepared. In 12 fetal sheep a bladder exstrophy was surgically created at 79 days’ gestation. Lambs were born at full term (140 days’ gestation). After 1 week the bladder lesion was reconstructed and augmented with a collagen scaffold (group 1). In nine normal newborn lambs the bladder was augmented with a collagen scaffold 1 week after birth (group 2). Functional (video‐urodynamics) and histological evaluation was performed at 1 and 6 months after surgery. Results The survival rate was 58% in group 1 and 100% in group 2. Cystograms were normal in all lambs, besides low‐grade reflux in both groups. Urodynamics showed comparable capacity between both groups and a trend to lower compliance in group 1. Histological evaluation at 1 month revealed a non‐confluent urothelial layer, an immature submucosa, and initial ingrowth of smooth muscle cells. At 6 months both groups showed normal urothelial lining, standard extracellular matrix development, and smooth muscle cell ingrowth. Conclusions Bladder tissue regeneration with a collagen scaffold in a diseased bladder model and in healthy bladder resulted in comparable functional and histological outcome, with a good quality of regenerated tissue involving all tissue layers. Improvements may still be needed for larger augmentations or more severely diseased bladders.
      PubDate: 2014-08-25T22:26:16.901393-05:
      DOI: 10.1111/bju.12591
  • Astaxanthin modulates osteopontin and transforming growth factor β1
           expression levels in a rat model of nephrolithiasis: a comparison with
           citrate administration
    • Authors: Manju Alex; M.V. Sauganth Paul, M. Abhilash, Varghese V. Mathews, T.V. Anilkumar, R. Harikumaran Nair
      Pages: 458 - 466
      Abstract: Objectives To evaluate the effect of astaxanthin on renal angiotensin‐I converting enzyme (ACE) levels, osteopontin (OPN) and transforming growth factor β1 (TGF‐β1) expressions and the extent of crystal deposition in experimentally induced calcium oxalate kidney stone disease in a male Wistar rat model. To compare the efficacy of astaxanthin treatment with a currently used treatment strategy (citrate administration) for kidney stones. Materials and Methods The expression of OPN was assessed by immunohistochemistry. One step reverse transcriptase polymerase chain reaction followed by densitometry was used to assess renal OPN and TGF‐β1 levels. Renal ACE levels were quantified by an enzyme‐linked immunosorbent assay method. Crystal deposition in kidney was analysed by scanning electron microscopic (SEM)‐energy‐dispersive X‐ray (EDX). Results The renal ACE levels and the expression of OPN and TGF‐β1 were upregulated in the nephrolithiasis‐induced rats. Astaxanthin treatment reduced renal ACE levels and the expression OPN and TGF‐β1. SEM‐EDX analysis showed that crystal deposition was reduced in the astaxanthin‐treated nephrolithiatic group. Astaxanthin treatment was more effective than citrate administration in the regulation of renal ACE levels, OPN and TGF‐β1 expressions. Conclusions Astaxanthin administration reduced renal calcium oxalate crystal deposition possibly by modulating the renal renin‐angiotensin system (RAS), which reduced the expression of OPN and TGF‐β1 levels. Astaxanthin administration was more effective than citrate treatment in reducing crystal deposition and down‐regulating the expression of OPN and TGF‐β1.
      PubDate: 2014-02-19T08:09:48.05216-05:0
      DOI: 10.1111/bju.12537
  • Validation of pretreatment neutrophil–lymphocyte ratio as a
           prognostic factor in a European cohort of patients with upper tract
           urothelial carcinoma
    • Authors: Orietta Dalpiaz; Georg C. Ehrlich, Sebastian Mannweiler, Jessica M.Martín Hernández, Armin Gerger, Tatjana Stojakovic, Karl Pummer, Richard Zigeuner, Martin Pichler, Georg C. Hutterer
      Pages: 334 - 339
      Abstract: Objective To investigate the potential prognostic significance of the neutrophil–lymphocyte ratio (NLR) in a large European cohort of patients with upper urinary tract urothelial cell carcinoma (UUT‐UCC). Patients and Methods We retrospectively evaluated data from 202 consecutive patients with non‐metastatic upper urinary tract urothelial cell carcinoma (UUT‐UCC), who underwent surgery between 1990 and 2012 at a single tertiary academic centre. Patients' cancer‐specific survival (CSS) and overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of the NLR, multivariate proportional Cox regression models were applied for both endpoints. Results A higher NLR was significantly associated with shorter CSS (P = 0.002, log‐rank test), as well as with shorter OS (P < 0.001, log‐rank test). Multivariate analysis identified a high NLR as an independent prognostic factor for patients' CSS (hazard ratio 2.72, 95% CI 1.25–5.93, P = 0.012), and OS (hazard ratio 2.48, 95% CI 1.31–4.70, P = 0.005). Conclusions In the present cohort, patients with a high preoperative NLR had higher cancer‐specific and overall mortality after radical surgery for UUT‐UCC, compared with those with a low preoperative NLR. This easily identifiable laboratory measure should be considered as an additional prognostic factor in UUT‐UCC in future.
      PubDate: 2013-11-27T05:51:41.808659-05:
      DOI: 10.1111/bju.12441
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