Subjects -> MEDICAL SCIENCES (Total: 8821 journals)
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UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)                     

Showing 1 - 159 of 159 Journals sorted alphabetically
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access  
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 4)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 42)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 38)
Andrologia     Hybrid Journal   (Followers: 2)
Andrology     Hybrid Journal   (Followers: 4)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 7)
Andrology-Open Access     Open Access  
Annales d'Urologie     Full-text available via subscription  
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access  
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
BANTAO Journal     Open Access  
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 34)
BJUI Compass     Open Access   (Followers: 2)
BMC Nephrology     Open Access   (Followers: 11)
BMC Urology     Open Access   (Followers: 14)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 8)
Canadian Urological Association Journal     Open Access   (Followers: 2)
Cancer Urology     Open Access   (Followers: 2)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 9)
Case Reports in Urology     Open Access   (Followers: 12)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 4)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 22)
Clinical Kidney Journal     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Clinical Nephrology and Urology Science     Open Access   (Followers: 6)
Clinical Queries: Nephrology     Hybrid Journal   (Followers: 1)
Cuadernos de Cirugía     Open Access   (Followers: 3)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 10)
Current Opinion in Urology     Hybrid Journal   (Followers: 12)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 1)
Diabetic Nephropathy     Open Access   (Followers: 1)
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Full-text available via subscription   (Followers: 33)
European Urology Focus     Hybrid Journal   (Followers: 5)
European Urology Oncology     Hybrid Journal   (Followers: 1)
European Urology Open Science     Open Access   (Followers: 10)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Herald Urology     Open Access   (Followers: 2)
Hong Kong Journal of Nephrology     Open Access   (Followers: 3)
Human Andrology     Partially Free   (Followers: 2)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 12)
International Urology and Nephrology     Hybrid Journal   (Followers: 7)
Jornal Brasileiro de Nefrologia     Open Access  
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 2)
Journal of Clinical Urology     Hybrid Journal   (Followers: 14)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 4)
Journal of Nephrology Research     Open Access   (Followers: 3)
Journal of Pediatric Nephrology     Open Access   (Followers: 5)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 12)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 1)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 31)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Translational Neurosciences     Open Access  
Journal of Urology     Full-text available via subscription   (Followers: 46)
Journal of Urology & Nephrology     Open Access   (Followers: 2)
Kidney Disease and Transplantation     Open Access   (Followers: 4)
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 46)
Kidney International Reports     Open Access   (Followers: 3)
Kidney Medicine     Open Access  
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access   (Followers: 1)
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 22)
Nature Reviews Urology     Full-text available via subscription   (Followers: 13)
Nefrología (English Edition)     Open Access  
Nefrología (Madrid)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 13)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 27)
Nephron     Hybrid Journal   (Followers: 4)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 4)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 5)
Open Journal of Urology     Open Access   (Followers: 6)
Open Urology & Nephrology Journal     Open Access  
Pediatric Urology Case Reports     Open Access   (Followers: 7)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 6)
Renal Failure     Open Access   (Followers: 12)
Renal Replacement Therapy     Open Access   (Followers: 4)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access   (Followers: 1)
Revista Urologia Colombiana     Open Access  
Saudi Journal of Kidney Diseases and Transplantation     Open Access   (Followers: 2)
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 7)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 8)
Therapeutic Advances in Urology     Open Access   (Followers: 4)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Ukrainian Journal of Nephrology and Dialysis     Open Access   (Followers: 1)
Uro-News     Hybrid Journal   (Followers: 1)
Urolithiasis     Hybrid Journal   (Followers: 2)
Urologia Internationalis     Full-text available via subscription   (Followers: 2)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 4)
Urologic Nursing     Full-text available via subscription   (Followers: 4)
Urologic Radiology     Hybrid Journal  
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urologie Scan     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 33)
Urology Annals     Open Access   (Followers: 4)
Urology Case Reports     Open Access   (Followers: 3)
Urology Practice     Full-text available via subscription   (Followers: 2)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access   (Followers: 1)
World Journal of Nephrology and Urology     Open Access   (Followers: 15)
World Journal of Urology     Hybrid Journal   (Followers: 11)


Similar Journals
Journal Cover
European Urology Focus
Journal Prestige (SJR): 0.663
Citation Impact (citeScore): 1
Number of Followers: 5  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2405-4569
Published by Elsevier Homepage  [3305 journals]
  • Surgery for Male Stress Incontinence: Which Technique and When'
    • Abstract: Publication date: Available online 5 April 2019Source: European Urology FocusAuthor(s): Barbara Hermans, Frank Van der Aa
  • Carcinoma In Situ of the Urinary Bladder: A Systematic Review of Current
           Knowledge Regarding Detection, Treatment, and Outcomes
    • Abstract: Publication date: Available online 23 March 2019Source: European Urology FocusAuthor(s): José Daniel Subiela, Oscar Rodríguez Faba, Félix Guerrero Ramos, Helena Vila Reyes, Francesca Pisano, Alberto Breda, Joan Palou ContextCarcinoma in situ (CIS) of the bladder is defined as a high-grade flat lesion confined to the mucosa. Intravesical treatment with bacillus Calmette–Guérin (BCG) is commonly used to reduce the risk of recurrence and progression; however, CIS of the bladder exhibits a heterogeneous clinical behavior and a significant proportion of patients do not show a primary response.ObjectiveTo evaluate the available evidence concerning diagnosis, treatment strategies, follow-up, prognosis, and oncological outcomes in patients with CIS of the bladder.Evidence acquisitionA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted using the databases PubMed/MEDLINE and Embase. We included randomized controlled trials, systematic reviews, meta-analyses, and observational studies. Outcomes of interest were: (1) diagnostic strategies, (2) first- and second-line treatments, (3) follow-up strategies, and (4) prognosis and oncological outcomes.Evidence synthesisOverall 62 articles met the inclusion criteria. Most articles concerned retrospective studies and presented mixed data with other non–muscle-invasive bladder cancer categories. The evidence shows that new optical imaging modalities significantly increase the detection rate of CIS. BCG immunotherapy remains the first-line therapy in patients with CIS of the bladder; however, after treatment, adequate follow-up is necessary. Clinicopathological factors remain the main indicators of response to BCG, recurrence, and progression.ConclusionsNew optical imaging modalities are superior to white light cystoscopy in the detection of CIS of the bladder. There are no robust data that justify consideration of other agents as an alternative to BCG immunotherapy. Despite efforts to identify relevant biomarkers, clinicopathological factors remain the most important prognostic factors.Patient summaryNew optical techniques have improved the detection of carcinoma in situ (CIS) of the bladder. Bladder preservation using bacillus Calmette-Guérin immunotherapy remains the cornerstone of the treatment of CIS of the bladder.
  • Rare Genitourinary Malignancies: Current Status and Future Directions of
    • Abstract: Publication date: Available online 23 March 2019Source: European Urology FocusAuthor(s): Bradley A. McGregor, Guru P. Sonpavde Treatment options for rare genitourinary malignancies, including adrenocortical carcinoma, bladder/upper tract cancers of variant histology, penile squamous cell carcinoma, and chemotherapy-refractory germ cell tumors, are limited, often with a poor response to systemic therapy. Given preclinical data and efficacy across multiple malignancies, immunotherapy has been and continues to be explored in this challenging setting. In this report, we explore the data for immunotherapy in these tumors and highlight ongoing clinical trials. International collaborations and innovative trials will be critical to advancing treatment for these rare tumors.Patient summaryIn this report, we explore the data for immunotherapy in rare genitourinary malignancies and highlight ongoing clinical trials. International collaborations and innovative trials will be critical to advancing treatment for these rare tumors.
  • Tumor Enucleation is Appropriate During Partial Nephrectomy: Against
    • Abstract: Publication date: Available online 22 March 2019Source: European Urology FocusAuthor(s): Matvey Tsivian, Vignesh T. Packiam, R. Houston Thompson
  • Outcomes of Prostate-specific Antigen-based Prostate Cancer Screening
           Among Men Using Nonsteroidal Anti-inflammatory Drugs
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Teemu Johannes Murtola, Arla M. Vettenranta, Kirsi Talala, Kimmo Taari, Ulf-Håkan Stenman, Teuvo L.J. Tammela, Anssi Auvinen BackgroundThe Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC), the largest component of the European Randomized Study of Screening for Prostate Cancer (ERSPC), showed a smaller, nonsignificant reduction in prostate cancer–specific mortality by systematic prostate-specific antigen (PSA)-based screening compared with the overall ERSPC results. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and also PSA elevations due to intraprostatic inflammation.ObjectiveTo explore whether NSAID usage modifies the effects of PSA-based screening on prostate cancer incidence and mortality.Design, setting, and participantsA cohort of 78 165 men from the FinRSPC were linked to a comprehensive national prescription database to obtain information on NSAID reimbursements prior to screening.Outcome measurements and statistical analysisProstate cancer risk and mortality were compared between the FinRSPC screening arm and the control arm among NSAID users and nonusers using an age-adjusted Cox regression model.Results and limitationsScreening increased the detection of Gleason 6 (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.47–1.72 and HR 1.39, 95% CI 1.26–1.54) and localized prostate tumors (HR 1.25, 95% CI 1.18–1.32 and HR 1.11, 95% CI 1.03–1.20) more among baseline NSAID nonusers than among users, respectively (p for interaction
  • Peri-prostatic Fat Volume Measurement as a Predictive Tool for Castration
           Resistance in Advanced Prostate Cancer
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Mark Salji, Jane Hendry, Amit Patel, Imran Ahmad, Colin Nixon, Hing Y. Leung BackgroundObesity and aggressive prostate cancer (PC) may be linked, but how local peri-prostatic fat relates to tumour response following androgen deprivation therapy (ADT) is unknown.ObjectiveTo test if peri-prostatic fat volume (PPFV) predicts tumour response to ADT.Design, setting, and participantsWe performed a retrospective study on consecutive patients receiving primary ADT. From staging pelvic magnetic resonance imaging scans, the PPFV was quantified with OsirixX 6.5 imaging software. Statistical (univariate and multivariate) analysis were performed using R Version 3.2.1.Results and limitationsOf 224 consecutive patients, 61 with advanced (≥T3 or N1 or M1) disease had (3-mm high resolution axial sections) pelvic magnetic resonance imaging scan before ADT. Median age = 75 yr; median PPFV = 24.8 cm3 (range, 7.4–139.4 cm3). PPFV was significantly higher in patients who developed castration resistant prostate cancer (CRPC; n = 31), with a median of 37.9 cm3 compared with 16.1 cm3 (p
  • Near-infrared Fluorescence Imaging with Indocyanine Green in
           Robot-assisted Partial Nephrectomy: Pooled Analysis of Comparative Studies
    • Abstract: Publication date: Available online 21 March 2019Source: European Urology FocusAuthor(s): Alessandro Veccia, Alessandro Antonelli, Lance J. Hampton, Francesco Greco, Sisto Perdonà, Estevão Lima, Ashok K. Hemal, Ithaar Derweesh, Francesco Porpiglia, Riccardo Autorino ContextThe use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN).ObjectiveTo perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF).Evidence acquisitionA systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software.Evidence synthesisSix comparative studies were identified. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No significant difference was identified between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular filtration rate (eGFR) values in the NIRF-RAPN group at short-term (1–3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26 ml/min; 95% confidence interval [CI]: 6.46, 12.06; p 
  • The Harms of Overdiagnosis and Overtreatment in Patients with Small Renal
           Masses: A Mini-review
    • Abstract: Publication date: Available online 21 March 2019Source: European Urology FocusAuthor(s): Ericka M. Sohlberg, Thomas J. Metzner, John T. Leppert Overdiagnosis and overtreatment refer to the detection and treatment of conditions that would not ultimately affect an individual’s health. With increasing detection of small renal masses there is growing awareness of the overdiagnosis and overtreatment of these tumors, supported by studies showing that 15–30% of nephrectomy specimens are pathologically benign, and that many small renal cell carcinomas are indolent. The harms of overdiagnosis and overtreatment are numerous, including psychosocial stressors and renal morbidity, in addition to unnecessary surgical complications. A greater understanding of the potential harms of overdiagnosis and overtreatment is crucial as clinicians focus on optimizing patient selection for renal mass biopsy, active surveillance protocols, and minimally invasive surgery.Patient summaryIn this mini-review we discuss the issues of overdiagnosis and overtreatment in patients with kidney cancer. We enumerate the risks of overdiagnosis and overtreatment, and examine the next steps towards preventing these harms.
  • What is the Role of Surgery in Bladder Pain Syndrome'
    • Abstract: Publication date: Available online 20 March 2019Source: European Urology FocusAuthor(s): Alison P. Downey, Nadir I. Osman
  • Time for an Integrated Global Strategy to Decrease Deaths from Prostate
    • Abstract: Publication date: Available online 18 March 2019Source: European Urology FocusAuthor(s): Christopher J. Sweeney
  • Sexual Dysfunction and Bother Due to Erectile Dysfunction in the Healthy
           Elderly Male Population: Prevalence from a Systematic Review
    • Abstract: Publication date: Available online 14 March 2019Source: European Urology FocusAuthor(s): Maud J.M. Geerkens, Hoda H.M. Al-Itejawi, Jakko A. Nieuwenhuijzen, Eric J.M. Meuleman, Birgit I. Lissenberg-Witte, R.J.A. van Moorselaar, André N. Vis ContextTherapies initiated by urologists, medical as well as surgical, may cause adverse effects in different sexual domains. Sexual domains that are often affected are sexual interest, sexual activity, and erectile functioning. As many elderly men undergo these therapies, it is important to know the prevalence of sexual dysfunction (SD) in these domains and its impact in the healthy elderly male population. This may help healthcare providers counsel their patients properly on possible adverse effects.ObjectiveTo review the prevalence of sexual functioning and SD in the domains of sexual desire, sexual activity, and erectile dysfunction (ED) and its impact (bother and medical use), stratified by age.Evidence acquisitionThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies investigating the prevalence of SD, stratified by age, were eligible. Studies investigating bother due to ED, and studies evaluating medical use or use of medical professional healthcare providers in association with SD were eligible.Evidence synthesisA total of 76 articles were eligible for a full systematic review. Lack of sexual desire was reported to vary between 12% and 51.6% for men aged ≥60 yr, 20% and 65.9% for men aged ≥70 yr, and 40% and 82.4% for men aged ≥80 yr. The percentages of men bothered by ED were as follows: 14.3–70% for men aged ≥60 yr, 6.7–48% for men aged ≥70 yr, and 38% for men aged ≥80 yr. A substantial number of men (50.3–92%) find a normal sex life important as they age and remain sexually active. Only a minority of elderly men seek help from healthcare professionals or use medication for SD.ConclusionsThe prevalence of SD in the healthy male population, reflected by a loss of sexual desire and sexual activity, increases only slightly with age. Bother due to ED is relatively low and there is an association with age. Still, a large number of men in the middle-aged and elderly groups regard sexuality as an important aspect of life. While considering a surgical or medical therapy that could have an impact on sexual functioning, sexually related outcomes should be set against current sexual functioning and a probable decline of sexual functioning due to ageing.Patient summaryWhile counselling elderly patients for sexual dysfunction when starting a treatment that could have an influence on sexual functioning, one should consider current sexual functioning and its importance for the individual.
  • Standardized Magnetic Resonance Imaging Reporting Using the Prostate
           Cancer Radiological Estimation of Change in Sequential Evaluation Criteria
           and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with
           Transperineal Saturation Biopsy to Select Men on Active Surveillance
    • Abstract: Publication date: Available online 13 March 2019Source: European Urology FocusAuthor(s): Svenja Dieffenbacher, Joanne Nyarangi-Dix, Francesco Giganti, David Bonekamp, Claudia Kesch, Maya B. Müller-Wolf, Viktoria Schütz, Claudia Gasch, Gencay Hatiboglu, Marcus Hauffe, Albrecht Stenzinger, Stefan Duensing, Heinz-Peter Schlemmer, Caroline M. Moore, Markus Hohenfellner, Jan Philipp Radtke BackgroundContemporary selection criteria for men with prostate cancer (PC) suitable for active surveillance (AS) are unsatisfactory, leading to high disqualification rates based on tumor misclassification. Conventional biopsy protocols are based on standard 12-core transrectal ultrasound (TRUS) biopsy.ObjectiveTo assess the value of magnetic resonance imaging (MRI)/TRUS fusion biopsy over 4-yr follow-up in men on AS for low-risk PC.Design, setting, and participantsBetween 2010 and 2018, a total of 273 men were included. Of them, 157 men with initial 12-core TRUS biopsy and 116 with initial MRI/TRUS fusion biopsy were followed by systematic and targeted transperineal MRI/TRUS fusion biopsies based on Prostate Cancer Research International Active Surveillance criteria. MRI from follow-up MRI/TRUS fusion biopsy was assessed using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system.Outcome measurements and statistical analysisAS-disqualification rates for patients on AS initially diagnosed by either 12-core TRUS biopsy or by MRI/TRUS fusion biopsy were compared using Kaplan–Meier estimates, log-rank tests, and regression analyses. We also analyzed the influence of negative primary MRI and PRECISE scoring to predict AS disqualification using Kaplan–Meier estimates, log-rank tests, and receiver operating characteristic (ROC) curve analysis.Results and limitationsOf men diagnosed by 12-core TRUS biopsy, 59% were disqualified from AS based on the results of subsequent MRI/TRUS fusion biopsy. In the initial MRI fusion biopsy cohort, upgrading occurred significantly less frequently (19%, p 
  • The Role of PD-L1 Testing in Advanced Genitourinary Malignancies
    • Abstract: Publication date: Available online 11 March 2019Source: European Urology FocusAuthor(s): Andrew W. Hahn, Deepika Sirohi, Neeraj Agarwal
  • Clinical Comparison of Holmium Laser Enucleation of the Prostate and
           Bipolar Transurethral Enucleation of the Prostate in Patients Under Either
           Anticoagulation or Antiplatelet Therapy
    • Abstract: Publication date: Available online 11 March 2019Source: European Urology FocusAuthor(s): Luca Boeri, Paolo Capogrosso, Eugenio Ventimiglia, Matteo Fontana, Gianluca Sampogna, Stefano Paolo Zanetti, Edoardo Pozzi, Rani Zuabi, Nicolò Schifano, Francesco Chierigo, Fabrizio Longo, Franco Gadda, Paolo Guido Dell’Orto, Vincenzo Scattoni, Francesco Montorsi, Emanuele Montanari, Andrea Salonia BackgroundA significant number of patients who require surgery for benign prostatic hyperplasia are under either anticoagulation (AC) or antiplatelet (AP) therapy.ObjectiveTo assess the efficacy and morbidity of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) in patients who required AC/AP therapy.Design, setting, and participantsThis study included 296 (67.6%) and 142 (32.4%) patients who underwent HoLEP and B-TUEP, respectively. The AC/AP group included patients whose AP therapy was not interrupted pre-, peri-, and/or postoperatively, and patients who underwent perioperative AC therapy bridging with low-molecular-weight heparin.InterventionHoLEP and B-TUEP.Outcome measurements and statistical analysisWe tested the hypothesis that AC/AP therapy had a limited impact on the efficacy of HoLEP and B-TUEP. To adjust for potential baseline confounders, propensity-score matching was performed. Clinical characteristics were compared among groups using the Kruskal-Wallis or chi-square test. Logistic regression analyses tested the association between clinical variables and the odds of Clavien-Dindo ≥2 complications after surgery.Results and limitationsOverall, 28 (9.5%) and 46 (15.5%) patients in the HoLEP group and 15 (10.5%) and 24 (16.9%) men in the B-TUEP group had AC and AP therapy, respectively (p = 0.9). HoLEP patients under either AC or AP therapy deserved longer catheter maintenance and a longer hospital stay (HS) than those without AC/AP therapy (all p ≤ 0.01). Operative time, rates of postoperative complications, and 2-mo International Prostate Symptoms Score (IPSS) were similar between patients with and without AC/CP. Among B-TUEP patients, HS was longer (p = 0.03) and the rate of complications was higher (p 
  • Mental Illness and Bladder Cancer Patients: The Time for Assertive
           Intervention Is Now
    • Abstract: Publication date: Available online 9 March 2019Source: European Urology FocusAuthor(s): Zachary Klaassen, Soum D. Lokeshwar, Amy Lowery-Allison, Christopher J.D. Wallis
  • Defining the Tumor Microenvironment of Penile Cancer by Means of the
           Cancer Immunogram
    • Abstract: Publication date: Available online 9 March 2019Source: European Urology FocusAuthor(s): Hielke-Martijn de Vries, Sarah R. Ottenhof, Simon Horenblas, Michiel S. van der Heijden, Ekaterina S. Jordanova Current chemotherapeutic treatment for advanced penile squamous cell carcinoma has substantial side effects and no randomized data to support an overall survival benefit. Immunotherapy with checkpoint blockade is currently being tested in penile cancer patients in clinical trials. The high PD-L1 expression and CD8+ T-cell infiltration in penile cancer represent a promising prospect for immunotherapy response in the treatment of locally advanced disease. For efficacious immunotherapy treatment, a better understanding of the tumor microenvironment (TME) is critical. Here we use the structure revealed by cancer immunograms to define current knowledge of the penile cancer TME as a backbone for future research.Patient summaryAdvanced penile cancer has a poor prognosis with a need for more effective therapy. In this manuscript we describe the potential of immunotherapy as a new treatment modality in penile cancer.
  • Late-onset Hypogonadism and Testosterone Therapy – A Summary of
           Guidelines from the American Urological Association and the European
           Association of Urology
    • Abstract: Publication date: Available online 8 March 2019Source: European Urology FocusAuthor(s): Mikkel Fode, Andrea Salonia, Suks Minhas, Arthur L. Burnett, Alan W. Shindel Men with low serum testosterone and symptoms of androgen deficiency may be diagnosed with testosterone deficiency. This condition is associated with metabolic syndrome and cardiovascular disease. The benefits (eg, improvement in sexual function) and risks (eg, prostate cancer and cardiovascular disease) of testosterone therapy are controversial. The American Urological Association and European Association of Urology guidelines on testosterone therapy differ on several points of management, likely reflecting the ambiguities surrounding testosterone therapy in practice. This paper summarizes both guidelines with a focus on the differences between the two sets of guidelines.Patient summaryThe benefits and risks of testosterone therapy are controversial, as reflected in the European Association of Urology and American Urological Association guidelines that differ on several points of management.
  • Patient-reported Outcome Measures in Metastatic Urinary Cancers
    • Abstract: Publication date: Available online 8 March 2019Source: European Urology FocusAuthor(s): Cristiane Decat Bergerot, Paulo Gustavo Bergerot, Errol J. Philip, Sumanta Kumar Pal Patient-reported outcome measures (PROMs) have widely been used to assess treatment-related symptoms in clinical trials and provide insight into the patients’ perspective during treatment. This mini-review sought to outline the benefits of measuring patient-reported outcomes, describe the most common measures used in recent pivotal studies in metastatic urinary cancers, and summarize the main findings published in the last 2 yr. In general, European Organization for Research and Treatment Cancer QLQC30 and Functional Assessment of Cancer Therapy were the most common PROMs used in these trials. PROMs provided important information concerning patients’ quality of life and symptom burden during treatment, including insight into how these drugs may be tolerated in real-world clinical circumstances; however, many still do not assess patients' social and emotional experiences. Based on this mini-review, the combination of a symptomatic toxicity scale and validated quality of life measure represents a reliable strategy to assess patient perspectives during treatment.Patient summaryIn this mini-review on patient-reported outcomes measures (PROMs), we explored data from recent pivotal studies in metastatic urinary cancer. We found that all recent clinical trials in metastatic urinary cancers assessed patient-reported outcomes, primarily through the use of quality of life measures. We recommend the use of both a symptomatic toxicity scale and a quality of life scale to evaluate PROMs.
  • Primary Squamous Cell Carcinoma of the Male Proximal Urethra: Outcomes
           from a Single Centre
    • Abstract: Publication date: Available online 7 March 2019Source: European Urology FocusAuthor(s): Fabio Castiglione, Hussain M. Alnajjar, Michelle Christodoulidou, Maarten Albersen, Arie Parnham, Alex Freeman, Charles Jameson, Anita Mitra, Raj Nigam, Peter Malone, Asif Muneer, on behalf of the Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists BackgroundPrimary squamous cell carcinoma (SCC) of the male proximal urethra is an aggressive and rare urogenital malignancy.ObjectiveTo review the surgical management and outcomes for male proximal urethral SCCs within a single centre and to suggest an algorithm for the surgical management of these rare tumours.Design, setting, and participantsThis was a retrospective study of patients undergoing surgery for male proximal urethral SCC within a single tertiary academic centre managing rare genital tumours. Ten patients with a histological diagnosis of proximal urethral SCC were identified from an institutional database over a period of 10 yr with a median follow-up of 22.5 mo (standard deviation ± 25.77 mo).Outcome measurements and statistical analysisPathological staging, surgical treatment, and neoadjuvant and adjuvant treatment were recorded. Complications according to the Clavien-Dindo classification and overall survival rates were recorded. Kaplan-Meier curves were used for overall survival.Results and limitationsA total of 10 patients were identified of whom eight underwent panurethrectomy and radical prostatectomy. Radical inguinal lymphadenectomy was performed in five patients, which confirmed bilateral metastatic disease. Perioperative complications were reported in six patients (Clavien I and II). Within 6 mo of surgery, 90% of patients developed distant metastatic disease. Nine patients died of urethra cancer during the follow-up. One patient is still on follow-up. The median overall follow-up was 13.92 mo (range: 5–91 mo). At 5 yr, cancer-specific/overall survival was 10%. A limitation of this study is the retrospective design, which is unavoidable for such a rare disease.ConclusionsRadical surgery allows local disease control, but despite neo/adjuvant treatment, proximal urethral SCC is associated with poor survival outcomes and progression to distant metastatic disease within 6 mo.Patient summaryProximal urethral squamous cell carcinoma is a rare cancer in men which is often detected late. Patients often present with problems such as voiding, urethral bleeding, or a palpable mass. Aggressive surgery allows local control, but despite this the overall survival is poor. Adjuvant and neoadjuvant radiochemotherapy can improve survival. Multicentric randomised trials are needed to identify the correct treatment modality.
  • Midterm Health-related Quality of Life After Radical Cystectomy: A
           Propensity Score–matched Analysis
    • Abstract: Publication date: Available online 7 March 2019Source: European Urology FocusAuthor(s): Alexander Kretschmer, Tobias Grimm, Alexander Buchner, Friedrich Jokisch, Brigitte Ziegelmüller, Jozefina Casuscelli, Gerald Schulz, Christian G. Stief, Alexander Karl BackgroundRadical cystectomy (RC) and urinary diversion affect various dimensions of patents’ health-related quality of life (HRQOL). Knowledge regarding patient-reported HRQOL following RC is mainly based on retrospective findings of cross-sectional studies.ObjectiveTo provide data from a large prospective propensity score–matched cohort with a systematic follow-up of up to 2 yr.Design, setting, and participantsA total of 134 consecutive patients who underwent RC and ileal conduit (IC) or orthotopic ileal neobladder (ONB) urinary diversion in a tertiary care centre were prospectively enrolled, and a propensity score matching analysis based on American Society of Anesthesiologists score, age, and tumour stage was performed. Exclusion criteria encompassed age
  • Modelling Study with an Interactive Model Assessing the Cost-effectiveness
           of 68Ga Prostate-specific Membrane Antigen Positron Emission
           Tomography/Computed Tomography and Nano Magnetic Resonance Imaging for the
           Detection of Pelvic Lymph Node Metastases in Patients with Primary
           Prostate Cancer
    • Abstract: Publication date: Available online 28 February 2019Source: European Urology FocusAuthor(s): Mirre Scholte, Jelle O. Barentsz, J.P. Michiel Sedelaar, Martin Gotthardt, Janneke P.C. Grutters, Maroeska M. Rovers BackgroundOutcomes of extended pelvic lymph node dissection (ePLND) show that only 16% of prostate cancer (PCa) patients harbour lymph node (LN) metastases. Ga-68 prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and nano magnetic resonance imaging (nano-MRI) might be noninvasive alternatives for ePLND; however, it remains uncertain whether they are cost-effective.ObjectiveTo develop an interactive model to determine the cost-effectiveness of 68Ga PSMA PET/CT and nano-MRI as compared with ePLND for the detection of pelvic LN metastases in patients with intermediate- to high-risk PCa.Design, setting, and participantsDecision tree with state transition model for men with intermediate- to high-risk PCa. Input data was derived from systematic literature searches.Outcome measurements and statistical analysisQuality-adjusted life years (QALYs) and healthcare costs were modelled over lifetime. Sensitivity analyses were used to assess uncertainty.Results and limitationsAssuming 100% sensitivity of ePLND, no QALY loss after ePLND, and no treatment improvement due to imaging, the PSMA PET/CT and nano-MRI strategies seem to be less expensive per patient (€3047 and €2738, respectively) and result in loss of QALYs (0.07 and 0.03, respectively) compared with the ePLND strategy. PSMA PET/CT and nano-MRI are both cost saving and more effective when ePLND has a sensitivity of ≤60% and ≤84%, ePLND results in a QALY loss of 0.060 and 0.024 over lifetime, or the imaging techniques reduce recurrences by 26% and 8%, respectively.ConclusionsPSMA PET/CT and nano-MRI seem to be cost-effective compared with ePLND since they save cost, but at the possible expense of a small QALY loss. Our interactive model provides insight into the influence of important model parameters on the cost effectiveness of 68Ga PSMA PET/CT and nano-MRI, and the opportunity for updating the cost effectiveness when new evidence becomes available.Patient summaryWe developed an interactive model that can be used in shared decision making regarding the use of extended pelvic lymph node dissection, 68Ga prostate-specific membrane antigen positron emission tomography/computed tomography, or nano magnetic resonance imaging for lymph node staging in individual patients with intermediate- to high-risk prostate cancer. Owing to remaining uncertainty, we cannot yet give advice about the use of these techniques.
  • State of the Future: Translational Approaches in Renal Cell Carcinoma in
           the Immunotherapy Era
    • Abstract: Publication date: Available online 28 February 2019Source: European Urology FocusAuthor(s): Ziad Bakouny, Ronan Flippot, David A. Braun, Aly-Khan A. Lalani, Toni K. Choueiri The emergence of immune checkpoint inhibitors as treatment options for metastatic renal cell carcinoma (RCC) has significantly improved outcomes for patients, but also posed new challenges for researchers. Only a subset of patients respond to these therapies, and some who initially respond ultimately develop therapeutic resistance. In this brief report, we review and discuss the importance of novel technological advances for immunotherapy translational research in RCC. In particular, we highlight the potential of single-cell sequencing methods and novel PD-L1 tracer-based imaging modalities for biomarker discovery, as well as ex vivo tumor spheroids for the creation of tumor “immunograms”.Patient summaryImmunotherapy, which leverages a patient’s immune system to target tumors, is effective for a substantial number of patients with metastatic kidney cancer. We review novel technologies that may help in understanding why some patients do not respond to these treatments, with the goals of eventually being able to identify which patients will respond to therapy and developing strategies to overcome therapeutic resistance.
  • The role and timing of cytoreductive nephrectomy in the immunotherapy era
    • Abstract: Publication date: Available online 26 February 2019Source: European Urology FocusAuthor(s): Emily C.L. Wong, Anil KapoorTake Home MessagesThe role and timing of cytoreductive nephrectomy in the immunotherapy era require further investigation. Extrapolation of data from the cytokine era that demonstrated an overall survival benefit of cytoreductive nephrectomy suggest that similar results might emerge from future trials using immunotherapy agents.
  • Adding Colour to the Grey Zone of Advanced Prostate Cancer
    • Abstract: Publication date: Available online 26 February 2019Source: European Urology FocusAuthor(s): Declan G. Murphy, Anwar R. Padhani, Piet Ost
  • Revisiting Intermittent Therapy in Metastatic Prostate Cancer: Can Less Be
           More in the “New World Order”'
    • Abstract: Publication date: Available online 23 February 2019Source: European Urology FocusAuthor(s): Jeffrey Shevach, Matthew R. Sydes, Maha Hussain ContextAndrogen deprivation therapy (ADT) is the standard of care for men with metastatic hormone-sensitive prostate cancer (HSPC) and a potential treatment option in those with prostate-specific antigen relapse after local therapy. Based on promising biological and preclinical data, several clinical trials compared the efficacy of intermittent androgen deprivation (IAD) versus continuous androgen deprivation (CAD) with the objective of delaying disease progression and improving survival and quality of life (QoL).ObjectiveThe objective of this review is to revisit the concept of IAD in the “new world order” and reconsider whether it has a potential clinical role in an era where we have seen unprecedented progress in the management of patients with metastatic HSPC.Evidence acquisitionMEDLINE, Embase, and the Cochrane Library databases were searched for randomized controlled trials comparing IAD and CAD therapies. References of retrieved articles were also searched. Articles with at least 100 randomized patients, which were published in 2008 or later and had data on overall survival or QoL outcomes, were included.Evidence synthesisThe evidence to date cannot exclude inferiority of IAD compared with CAD with respect to survival outcomes. The hazard ratios in metastatic disease indicate less favorable survival with IAD. No superiority trial conclusively favored IAD or CAD. Two trials demonstrated noninferiority of IAD, although the noninferiority margins (NIMs) are clinically concerning. Another trial could not exclude noninferiority. A modest but temporary QoL and symptom benefit generally favoring IAD was observed.ConclusionsIAD has not conclusively demonstrated an impact on disease progression or survival, and has only modest effects on QoL and symptoms measured in the short term. As such, it is not the standard of care, particularly in the era where we have seen unprecedented survival impact with combination ADT + docetaxel or abiraterone +prednisone. IAD may need to be reassessed in the context of current therapies, ideally driven by biological rationale, with the goal of minimizing physical and financial toxicities with appropriately designed informative clinical trials.Patient summaryIn this report, we looked at two hormone therapy approaches for prostate cancer that is still sensitive to castration: one with treatment breaks and one without. Patients may tolerate therapy with breaks more easily, but this effect is not sustained and is not associated with better longevity. The best longevity is seen in patients who receive newer hormone therapies or chemotherapy in addition to continuous hormone therapy. Whether these newer therapies would be as effective if given intermittently is an important but unanswered question.
  • Prognostic DNA Methylation Biomarkers in High-risk Non–muscle-invasive
           Bladder Cancer: A Systematic Review to Identify Loci for Prospective
    • Abstract: Publication date: Available online 23 February 2019Source: European Urology FocusAuthor(s): Pratik M.S. Gurung, Abigail R. Barnett, Jayne S. Wilson, John Hudson, Douglas G. Ward, Edward M. Messing, Richard T. Bryan ContextHigh-risk non–muscle-invasive bladder cancer (HR-NMIBC) represents over 30% of all incident urothelial bladder cancers (BCs); patients are at risk of progression, and 20–30% will die from BC within 5 yr. Current guidelines recommend induction and maintenance of intravesical bacillus Calmette-Guérin (BCG) or upfront radical cystectomy for highest-risk disease, treatments with markedly different morbidity, mortality, and patient burden. There are no validated biomarkers to facilitate such treatment decisions. Alterations in DNA methylation are commonplace in BC; hence, measurable changes in DNA methylation represent an opportunity for the discovery of such biomarkers.ObjectiveTo systematically assess the evidence regarding DNA methylation markers as prognosticators for HR-NMIBC.Evidence acquisitionStandard systematic review methods were employed with searches undertaken in MEDLINE, EMBASE, and PubMed up to January 2019. Studies that included patients with HR-NMIBC and investigated the utility of DNA methylation biomarkers as prognostic tools were included.Evidence synthesisOf 63 prognostic biomarker studies identified, 21 met the protocol-driven inclusion criteria and were directly relevant to HR-NMIBC patient outcomes: tumour recurrence (TR), tumour progression (TP), disease-specific survival (DSS), and overall survival (OS). These studies described 140 methylation markers; of these, the most promising were cadherin-13 (CDH13; hazard ratios [HRs]: 5.1 for TR, 6.6 for TP, 3.8–8.0 for OS), protocadherins (PCDHs; HRs: 4.7 for TR, 2.5 for TP, 3.0–4.8 for OS), Runt domain transcription factor 3 (RUNX3; HR: 5.1 for TP), Homeobox 9 (HOXA9; HR: 1.9 for TR), Islet-1 (ISL1; HRs: 1.7 for TR, 3.3 for TP), and PAX6 (HR: 2.2 for TR).ConclusionsThis systematic review identifies a number of potentially useful prognostic methylation markers for HR-NMIBC. These loci (CDH13, PCDHs, RUNX3, HOXA9, ISL1, and PAX6) should be validated in prospective studies in order to translate benefit to patients.Patient summaryEarly bladder cancer represents a more complex spectrum of disease than can be assessed by conventional methods Emerging studies on molecular markers will improve our understanding of this disease, and may enable more precise and personalised treatment.
  • Oligometastatic Prostate Cancer Should Be Studied and Treated Differently
           to High-volume Disease. Con: The Underlying Biology is the Same, so They
           Should Not Be Treated Differently
    • Abstract: Publication date: Available online 23 February 2019Source: European Urology FocusAuthor(s): Nicholas D. James
  • Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old:
           Analysis of the REnal SURGery in Elderly (RESURGE) Group
    • Abstract: Publication date: Available online 22 February 2019Source: European Urology FocusAuthor(s): Ahmet Bindayi, Riccardo Autorino, Umberto Capitanio, Nicola Pavan, Maria Carmen Mir, Alessandro Antonelli, Toshio Takagi, Riccardo Bertolo, Tobias Maurer, Koon Ho Rha, Jean−Alexandre Long, Bo Yang, Luigi Schips, Estevão Lima, Alberto Breda, Estefania Linares, Antonio Celia, Cosimo De Nunzio, Ryan Dobbs, Sunil Patel BackgroundPartial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes.ObjectiveTo evaluate quality and functional outcomes of PN in patients>75 yr using trifecta as a composite outcome of surgical quality.Design, setting, and participantsMulticenter retrospective analysis of 653 patients aged>75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group).InterventionPN.Outcome measurements and statistical analysisPrimary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes.Results and limitationsWe analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p 
  • Germline DNA-repair Gene Mutations and Efficacy of Abiraterone or
           Enzalutamide in Patients with Metastatic Castration-resistant Prostate
    • Abstract: Publication date: Available online 21 February 2019Source: European Urology FocusAuthor(s): Ning Shao, Yao Zhu, Ding Wei Ye
  • Tumor Enucleation Is Appropriate During Partial Nephrectomy
    • Abstract: Publication date: Available online 21 February 2019Source: European Urology FocusAuthor(s): Andrea Minervini, Marco CariniTake Home MessagesTumor enucleation is oncologically safe and has the potential to meet the essential requirements for conservative surgery: (1) to widen the indications to tumors with unfavorable nephrometry; (2) to be well suited for minimally invasive surgery; and (3) to maximize the volume of parenchyma preserved.
  • Disparities in Bladder Cancer Treatment and Survival Amongst Elderly
           Patients with a Pre-existing Mental Illness
    • Abstract: Publication date: Available online 21 February 2019Source: European Urology FocusAuthor(s): Niranjan J. Sathianathen, Yunhua Fan, Stephanie L. Jarosek, Isha Konety, Christopher J. Weight, Sophia Vinogradov, Badrinath R. Konety BackgroundPre-existing mental illness is known to adversely impact cancer care and outcomes, but this is yet to be assessed in the bladder cancer setting.ObjectiveTo characterize the patterns of care and survival of elderly patients with a pre-existing mental illness diagnosed with bladder cancer.Design, setting, and participantsWe conducted a retrospective analysis of patients enrolled in Surveillance, Epidemiology, and End Results (SEER)-Medicare. A population-based sample was considered. Elderly patients (≥68 yr old) with localized bladder cancer from 2004 to 2011 were stratified by the presence of a pre-existing mental illness at the time of cancer diagnosis: severe mental illness (consisting of bipolar disorder, schizophrenia, and other psychotic disorders), anxiety, and/or depression.Outcome measurements and statistical analysisWe performed multivariable logistic regression analyses to compare the stage of presentation and receipt of guideline-concordant therapies (radical cystectomy for muscle-invasive disease). Survival between patients with a pre-existing mental disorder and those without were compared using Kaplan–Meier analyses with log-rank tests.Results and limitationsOf 66 476 cases included for analysis, 6.7% (n = 4468) had a pre-existing mental health disorder at the time of cancer diagnosis. These patients were significantly more likely to present with muscle-invasive disease than those with no psychiatric diagnosis (23.0% vs 19.4%, p–
  • Partial Versus Radical Nephrectomy for the Clinical T1a Renal Mass
    • Abstract: Publication date: Available online 15 February 2019Source: European Urology FocusAuthor(s): Boris Gershman, Bradley C. Leibovich, Simon P. Kim
  • Should Low-intensity Extracorporeal Shockwave Therapy Be the First-line
           Erectile Dysfunction Treatment for Nonresponders to Phosphodiesterase Type
           5 Inhibition'
    • Abstract: Publication date: Available online 15 February 2019Source: European Urology FocusAuthor(s): Premal Patel, Mikkel Fode, Tom Lue, Ranjith Ramasamy
  • Retzius-sparing Robot-assisted Laparoscopic Radical Prostatectomy: An
           International Survey on Surgical Details and Worldwide Diffusion
    • Abstract: Publication date: Available online 15 February 2019Source: European Urology FocusAuthor(s): Antonio Galfano, Silvia Secco, Aldo Massimo Bocciardi, Alexandre Mottrie
  • Defining a “High Volume” Radical Cystectomy Hospital: Where Do
           We Draw the Line'
    • Abstract: Publication date: Available online 14 February 2019Source: European Urology FocusAuthor(s): Sohrab Arora, Jacob Keeley, Amit Patel, Sriram V. Eleswarapu, Chandler Bronkema, Shaheen Alanee, Mani Menon BackgroundCentralization of radical cystectomy (RC) to “high volume” centers can lead to decreased morbidity but also limits access to care. In the context of centralization, there is a need to systematically define the hospital volume cutoffs for this procedure.ObjectiveTo systematically examine the effect of hospital volume on inpatient complications of RC for bladder cancer and to define a threshold to minimize RC morbidity.Design, setting, and participantsThis was a retrospective analysis of data for 6790 adults undergoing RC for nonmetastatic bladder cancer during 2008–2011 from the National Inpatient Sample (weighted population estimate of 33 249 RCs in the USA during this period).InterventionRC.Outcome measurements and statistical analysisOverall and major complications were defined according to International Classification of Diseases (9th revision) diagnosis and procedure codes. To define the relationship between hospital volume and morbidity, logistic regression analyses within a generalized estimating equation framework with restricted cubic splines were used.Results and limitationsThe inpatient complication rate was 4769/6790 (70.2%), of which 1572/6790 (23.2%) were major complications. Restricted cubic spline analysis revealed a significant inverse nonlinear association between hospital volume and complications. The odds of complications decreased with increasing volume, with a plateau at 50–55 cases/yr for any complications (p = 0.024) and 45–50 cases/yr for major complications (p = 0.007).ConclusionsThe relationship between hospital volume and RC morbidity is nonlinear, with a plateau for the complication rate at 50–55 cases/yr. Restricting RC to centers with such high thresholds will restrict access to care. There is a need to identify and publish best practices from high-volume centers in quality improvement initiatives to improve morbidity at low-volume centers.Patient summaryThere is a nonlinear relationship between the annual number of radical cystectomy procedures performed at a hospital and the inpatient complication rate. Complications decrease with increasing hospital volume and reach a plateau at 50–55 cases per year, beyond which the incremental benefit of increasing volume is minimal.
  • Essential Research Priorities in Renal Cancer: A Modified Delphi Consensus
    • Abstract: Publication date: Available online 14 February 2019Source: European Urology FocusAuthor(s): Sabrina H. Rossi, Christopher Blick, Catherine Handforth, Janet E. Brown, Grant D. Stewart, on behalf of the Renal Cancer Gap Analysis Collaborative BackgroundIdentification of clear and focused research priorities is crucial to drive research forward.ObjectiveTo identify research priorities in renal cell carcinoma (RCC) through a multidisciplinary collaboration between clinicians, researchers, and patients.Design, setting, and participantsIn phase I, 44 RCC experts provided 24 literature reviews within their field, summarising research gaps (RGs). Three expert discussion meetings and patient interviews were performed, and 39 potential RGs were identified. In phase II, experts (N = 82) scored these gaps on a nine-point scale (1–3: not important; 4–6: important; 7–9: critical) through a multistep Delphi process involving three online surveys and two further consensus meetings. The surveys aimed to reach a consensus, defined as ≥70% agreement by experts.Outcome measurements and statistical analysisThree iterations of the Delphi survey were performed. The results obtained after the third Delphi survey were distributed amongst the RCC experts and patient representatives for final feedback.Results and limitationsIn the first Delphi survey, the response rate was 56% (46/82), increasing to 67% (55/82) and 71% (58/82) in the second and third iterations, respectively. Survey respondents included 45.7% urologists, 37.0% oncologists, 8.7% radiologists, and 8.6% other specialists (pathologists, health economists, geneticist, and scientists). The process resulted in the identification of 14 crucial RGs, across a broad range of RCC themes. Key themes included further research into systemic therapies for RCC and management strategies that maximise quality of life, especially in patient groups that are “difficult to treat” and have rarer RCC subtypes. Two crucial RGs relate to biomarkers and novel imaging approaches for both localised and metastatic disease, to enable prognostic risk stratification and individualise patient management. Study participants were from a UK and European setting; therefore, we acknowledge that the RGs identified represent European priorities.ConclusionsThese RGs will facilitate international collaboration towards a concerted attempt to improve patients’ survival and quality of life.Patient summaryWe formed a collaboration between researchers, clinicians, and patients to identify research priorities in kidney cancer. We identified 14 priorities that will improve patient outcomes by focusing on research efforts.
  • Updates on the Management of Rare Genitourinary Malignancies: Where Do We
    • Abstract: Publication date: Available online 14 February 2019Source: European Urology FocusAuthor(s): Philippe E. Spiess
  • Biological Evolution of Castration-resistant Prostate Cancer
    • Abstract: Publication date: Available online 14 February 2019Source: European Urology FocusAuthor(s): Alastair Davies, Vincenza Conteduca, Amina Zoubeidi, Himisha Beltran ContextRecent studies focused on the molecular characterization of metastatic prostate cancer have identified genomic subsets and emerging resistance patterns. Detection of these alterations in patients has potential implications for therapy selection and prognostication.ObjectiveThe primary objective is to review the current landscape of clinical and molecular biomarkers in advanced prostate cancer and understand how they may reflect underlying tumor biology. We also discuss how these features may potentially impact earlier stages of the disease.Evidence acquisitionA literature search was performed of recent clinical biomarker/genomic studies focused on advanced metastatic prostate cancer as well as relevant preclinical studies investigating how these alterations influence therapy response or resistance.Evidence synthesisMetastatic castration-resistant prostate cancer is commonly driven by androgen receptor signaling even after progression on potent hormonal agents, but other alterations may also be present or emerge during therapy resistance such as DNA repair gene aberrations or combined loss of tumor suppressor genes. Biological implications of these changes are context dependent, which may affect their detection and interpretation.ConclusionsMolecular changes occur during prostate cancer progression and treatment resistance. Detection of genomic alterations has potential to influence therapy choice. Additional studies are warranted to elucidate the evolution of these changes and their impact in earlier stages of the disease.Patient summaryWe review the biology of advanced prostate cancer, and highlight opportunities and challenges for using biological or molecular assays to help guide individualized treatment decisions for patients.
  • Are Slings Still the Gold Standard for Female Stress Urinary
           Incontinence' Con: Artificial Urinary Sphincter for Female
    • Abstract: Publication date: Available online 13 February 2019Source: European Urology FocusAuthor(s): Emmanuel Chartier-Kastler, Christine Reus
  • Overview of Systemic Therapy Augmenting Management of High-risk Localized
           Prostate Cancer
    • Abstract: Publication date: Available online 8 February 2019Source: European Urology FocusAuthor(s): Cécile Vicier, Felix Y. Feng, Karim Fizazi
  • Radiological Response Heterogeneity Is of Prognostic Significance in
           Metastatic Renal Cell Carcinoma Treated with Vascular Endothelial Growth
           Factor-targeted Therapy
    • Abstract: Publication date: Available online 6 February 2019Source: European Urology FocusAuthor(s): Peter E. Hall, Scott T.C. Shepherd, Janet Brown, James Larkin, Robert Jones, Christy Ralph, Robert Hawkins, Simon Chowdhury, Ekaterini Boleti, Amit Bahl, Kate Fife, Andrew Webb, Simon J. Crabb, Thomas Geldart, Robert Hill, Joanna Dunlop, Duncan McLaren, Charlotte Ackerman, Akhila Wimalasingham, Luis Beltran BackgroundResponse evaluation criteria in solid tumours (RECIST) is widely used to assess tumour response but is limited by not considering disease site or radiological heterogeneity (RH).ObjectiveTo determine whether RH or disease site has prognostic significance in patients with metastatic clear-cell renal cell carcinoma (ccRCC).Design, setting, and participantsA retrospective analysis was conducted of a second-line phase II study in patients with metastatic ccRCC (NCT00942877), evaluating 138 patients with 458 baseline lesions.InterventionThe phase II trial assessed vascular endothelial growth factor-targeted therapy ± Src inhibition.Outcome measurements and statistical analysisRH at week 8 was assessed within individual patients with two or more lesions to predict overall survival (OS) using Kaplan-Meier method and Cox regression model. We defined a high heterogeneous response as occurring when one or more lesion underwent a ≥10% reduction and one or more lesion underwent a ≥10% increase in size. Disease progression was defined by RECIST 1.1 criteria.Results and limitationsIn patients with a complete/partial response or stable disease by RECIST 1.1 and two or more lesions at week 8, those with a high heterogeneous response had a shorter OS compared to those with a homogeneous response (hazard ratio [HR] 2.01; 95% confidence interval [CI]: 1.39–2.92; p 20% increase in sum of target lesion diameters only (HR 2.12; 95% CI: 1.43–3.14; p 
  • Male Slings for Postprostatectomy Incontinence: A Systematic Review and
    • Abstract: Publication date: Available online 2 February 2019Source: European Urology FocusAuthor(s): Kathrin Meisterhofer, Sereina Herzog, Karin A. Strini, Luca Sebastianelli, Ricarda Bauer, Orietta Dalpiaz ContextMale slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model.ObjectiveTo evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence.Evidence acquisitionThis systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords “incontinence,” “prostatectomy,” and “male sling/system” was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients’ quality of life.Evidence synthesisThe literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45–0.56, I2 = 82%). Subjective cure was achieved in 33–94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51–0.71, I2 = 88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings.ConclusionsBoth fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed.Patient summaryFixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
  • Prostate Cancer Survival Estimates by the General Public Using
           Unrestricted Internet Searches and Online Nomograms
    • Abstract: Publication date: Available online 2 February 2019Source: European Urology FocusAuthor(s): Justin P. Campagna, Lee Baumgarten, Lucas P. Labine, Isaac Palma, Jacob A. Albersheim, Niranjan Sathianathen, Christopher J. Weight BackgroundPatient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information.ObjectiveTo evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram.Design, setting, and participantsAdults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient’s 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram.Outcome measurements and statistical analysisParticipants’ answers were compared to a “reference” estimate and a “ballpark” estimate of ±10 percentage points of the “reference” value.Results and limitationsA total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8–19.2%) were within the “ballpark” estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8–31.3%) correctly used the nomogram and 51% (95% CI 42.6–59.6%) estimated within the “ballpark” when using the nomogram.ConclusionsUse of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information.Patient summaryThe general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports.
  • Evidence Synthesis to Accelerate and Improve the Evaluation of Therapies
           for Metastatic Hormone-sensitive Prostate Cancer
    • Abstract: Publication date: Available online 1 February 2019Source: European Urology FocusAuthor(s): Jayne F. Tierney, Claire L. Vale, Wendy R. Parelukar, Larysa Rydzewska, Susan Halabi There are many ongoing randomised trials of promising therapies for metastatic hormone-sensitive prostate cancer (mHSPC), but standard systematic reviews may not synthesise these in a timely or reliable way. We demonstrate how a novel approach to evidence synthesis is being used to speed up and improve treatment evaluations for mHSPC. This more prospective, dynamic, and collaborative approach to systematic reviews of both trial results and individual participant data (IPD) is helping in establishing quickly and reliably which treatments are most effective and for which men. However, mHSPC is a complex disease and trials can be lengthy. Thus, parallel efforts will synthesise further IPD to identify early surrogate endpoints for overall survival and prognostic factors, to reduce the duration and improve the design of future trials. The STOPCAP M1 repository of IPD will be made available to other researchers for tackling new questions that might arise. The associated global, collaborative forum will aid strategic and harmonised development of the next generation of mHSPC trials (STOPCAP M1; summaryWe report how a worldwide research effort will review results and anonymised data from advanced prostate cancer trials in new and different ways. We will work out, as quickly as possible, which advanced prostate cancer treatments are best and for which men. We will also find which measures of prostate cancer control and which cancer and patient characteristics can be used to shorten and improve trials of newer treatments. Finally, we describe how the data will help answer new questions about advanced prostate cancer and its treatments.
  • Immediate Placement of a Penile Prosthesis as First-line Treatment for the
           Management of Ischaemic Priapism
    • Abstract: Publication date: Available online 26 January 2019Source: European Urology FocusAuthor(s): Asif Muneer, David J. Ralph
  • Association Between Preoperative Magnetic Resonance Imaging–based
           Urethral Parameters and Continence Recovery Following Robot-assisted
           Radical Prostatectomy
    • Abstract: Publication date: Available online 25 January 2019Source: European Urology FocusAuthor(s): Lawrence H.C. Kim, Amit Patel, Netty Kinsella, Mansour T.A. Sharabiani, Derfel Ap Dafydd, Declan Cahill BackgroundStudies demonstrated the significance of membranous urethral length (MUL) as a predictor of continence following robot-assisted radical prostatectomy (RARP). There are other magnetic resonance imaging (MRI) parameters that might be linked to continence outcome.ObjectiveTo evaluate the association between preoperative urethral parameters on MRI and continence outcome, to estimate the risk of incontinence using different cut-off values, and to assess interobserver variability in measuring urethral parameters.Design, setting, and participantsPatients with localised prostate cancer who underwent RARP were retrospectively reviewed. Baseline patient characteristics, perioperative, and pathological outcomes were assessed. Continence was defined as no pad or a safety pad with
  • Should the Care of Penile Cancer be Confined to Centralized Centers of
    • Abstract: Publication date: Available online 23 January 2019Source: European Urology FocusAuthor(s): Mohamed H. Kamel
  • Outcomes of European Basic Laparoscopic Urological Skills (EBLUS)
           Examinations: Results from European School of Urology (ESU) and EAU
           Section of Uro-Technology (ESUT) over 6 Years (2013–2018)
    • Abstract: Publication date: Available online 17 January 2019Source: European Urology FocusAuthor(s): Bhaskar K. Somani, Ben Van Cleynenbreugel, Ali-Serdar Gözen, Andreas Skolarikos, Christian Wagner, John Beatty, Sas Barmoshe, Jose Maria Gaya Sopena, Theodoros Kalogeropoulos, Oscar Rodriguez Faba, Rafael Salas Sanchez, Marek Schmidt, Giampaolo Siena, Giovannalberto Pini, Joan Palou, Robert Geraghty, Domenico Veneziano BackgroundThe European School of Urology (ESU) and EAU Section of Uro-Technology (ESUT) started hands-on-training (HOT) sessions in 2007 along with structured European Basic Laparoscopic Urological Skills (EBLUS) examinations in 2013. EBLUS includes an online theoretical course, HOT by expert tutors on a set of dry-lab exercises, and finally a standardised examination for skill assessment and certification.ObjectiveTo analyse the results and predictors of success from the EBLUS examinations that were conducted during the European Urology Residents Education Programme (EUREP) and other international and national dedicated ESU events.Design, setting, and participantsESU has been delivering EBLUS courses and examinations over the past 6 yr (2013–2018) in more than 40 countries worldwide. Trainees were asked about their laparoscopic background (procedures assisted/performed) and about the availability of HOT or simulator/box trainer in their facility. Apart from the online theoretical course, 4 HOT tasks [(1) peg transfer, (2) pattern cutting, (3) single knot tying, and (4) clip and cut] with its quality assessment of depth perception, bimanual dexterity, and efficiency were a part of the assessment and were considered critical to pass the EBLUS examination.Results and limitationsA total of 875 EBLUS examinations were delivered (EUREP, n = 385; other ESU events, n = 490), with complete data available for 533 (61%) participants among which 295 (55%) passed the examinations. Pass rate increased on a yearly basis from 35% to 70% (p 
  • Are Slings Still the Gold Standard for Female Stress Urinary
    • Abstract: Publication date: Available online 14 January 2019Source: European Urology FocusAuthor(s): John Heesakkers
  • What Is Oligometastatic Prostate Cancer'
    • Abstract: Publication date: Available online 12 January 2019Source: European Urology FocusAuthor(s): Michael Fraser, Bridget Koontz, Urban Emmenegger, Gert De Meerleer, Vincent Khoo, Felix Feng, Niall M. Corcoran, Christopher M. Hovens, Phuoc T. Tran, Piet Ost, Paul C. Boutros, on behalf of the GAP6 Consortium Advanced prostate cancer patients can present with both widely metastatic or oligometastatic disease. Accumulating clinical evidence suggests that patients with oligometastatic disease have improved clinical responses from metastasis-directed therapy. This suggests that tumours that give rise to the oligometastatic state are distinct biologically and genetically from those that induce widely metastatic lesions. Detailed genomic analysis of the oligometastatic state will identify the molecular events that distinguish localised from metastatic disease, defining the molecular signatures of curability. The GAP6 consortium is well poised to address this question.Patient summaryIn this report, we have reviewed the evidence that prostate cancer patients with only a small number of distant tumour deposits have cancers that are driven by genetic and biological changes, which are distinct from those tumours that readily spread to many distant sites. So far, the evidence is not clear cut; however, in-depth studies to answer this question are underway.
  • Immediate Placement of Penile Prosthesis for the Management of Ischemic
           Priapism as First-line Treatment
    • Abstract: Publication date: Available online 11 January 2019Source: European Urology FocusAuthor(s): Faysal A. Yafi, Wayne J.G. Hellstrom
  • Considerations When Treating Patients with Good-risk Germ Cell Tumors
    • Abstract: Publication date: Available online 11 January 2019Source: European Urology FocusAuthor(s): Aditya Bagrodia, Costantine Albany, Clint Cary
  • Patient-reported Outcomes in Metastatic Castration-sensitive Prostate
           Cancer in the Adjuvant Setting
    • Abstract: Publication date: Available online 3 January 2019Source: European Urology FocusAuthor(s): Alicia K. Morgans, Martin R. Stockler We review the importance of quality of life (QOL) data from patient-reported outcome measures (PROMs) among men treated with androgen deprivation therapy (ADT) for metastatic castration-sensitive prostate cancer (mCSPC) or localized prostate cancer treated with adjuvant therapy. This information is important for patients as they make treatment choices and for regulatory agencies approving drug therapies. Studies of treatments for mCSPC suggest that the improvements in survival associated with more intensive systemic treatment are accompanied by improvements in QOL. ADT prolongs survival among men with intermediate- or high-risk localized disease in combination with radiation, but the optimal duration is still being defined. For men with biochemical recurrence, starting ADT earlier rather than later had minimal adverse effects on QOL but may not prolong survival. We conclude that rigorous assessment of QOL with validated PROMs must be a priority for clinical trials of novel and more intensive approaches to treatment with ADT.Patient summaryData on quality of life that are collected using patient-reported outcome measures are important for patients with prostate cancer as they make treatment choices and for regulatory agencies approving drug therapies.
  • Contemporary Trends in the Incidence of Metastatic Prostate Cancer Among
           US Men: Results from Nationwide Analyses
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Deepansh Dalela, Maxine Sun, Mireya Diaz, Patrick Karabon, Thomas Seisen, Quoc-Dien Trinh, Mani Menon, Firas Abdollah Studies have noted contrasting findings with regard to the contemporary incidence of metastatic prostate cancer (PCa) in the USA, especially in light of the United States Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA) screening in recent years. We used data from the 18 population- based tumor registries of the Surveillance, Epidemiology and End Results (SEER) 2004–2013 database to study trends in the incidence of metastatic PCa among men stratified by age and race. Joinpoint regression analyses were performed to identify time points associated with any statistically significant change in incidence. Overall, there was a significant increase in incidence between 2009 and 2013 (annual percentage change [APC] 3.10%; p 
  • Risk of Upgrading and Upstaging Among 10 000 Patients with Gleason 3 + 4
           Favorable Intermediate-risk Prostate Cancer
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): David D. Yang, Brandon A. Mahal, Vinayak Muralidhar, Michelle D. Nezolosky, Marie E. Vastola, Shelby A. Labe, Ninjin Boldbaatar, Martin T. King, Neil E. Martin, Peter F. Orio, Clair J. Beard, Karen E. Hoffman, Quoc-Dien Trinh, Daniel E. Spratt, Felix Y. Feng, Paul L. Nguyen BackgroundIt is unknown whether active surveillance can be safely offered to patients with Gleason 3 + 4 favorable intermediate-risk (FIR) prostate cancer.ObjectiveTo examine the incidence and predictors of upgrading and upstaging among patients with Gleason 3 + 4 FIR disease.Design, setting, and participantsThe study involved 10 089 patients in the National Cancer Database diagnosed from 2010 to 2012 with Gleason 3 + 4 disease, prostate-specific antigen (PSA)
  • Incorporation of Urinary Prostate Cancer Antigen 3 and TMPRSS2:ERG into
           Prostate Cancer Prevention Trial Risk Calculator
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Donna P. Ankerst, Martin Goros, Scott A. Tomlins, Dattatraya Patil, Ziding Feng, John T. Wei, Martin G. Sanda, Jonathan Gelfond, Ian M. Thompson, Robin J. Leach, Michael A. Liss BackgroundThe Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) is a commonly used risk tool for predicting the outcome on biopsy based on the established risk factors.ObjectiveTo determine whether incorporation of the novel urinary markers prostate cancer antigen 3 (PCA3) and TMPRSS2:ERG (T2:ERG) into the PCPTRC improves its discrimination, accuracy, and clinical net benefit.Design, setting, and participantsSince PCA3 and T2:ERG were not measured as part of the PCPTRC, a Bayesian modeling approach was used to combine data where the markers were measured in a Michigan cohort with the PCPTRC as prior probabilities to form an updated PCPTRC. This update was compared to the existing PCPTRC on an independent Early Detection Research Network cohort in terms of discrimination, calibration, and decision curve analysis.Results and limitationsAmong the 1225 Michigan biopsies, 57.7%, 24.0%, and 18.3% were negative, with low- and high-grade (Gleason grade ≥ 7) prostate cancer, respectively. Evaluated on the Early Detection Research Network validation set comprising 854 biopsies, areas under the curve (95% confidence interval) for predicting high-grade cancer in the 854 biopsies comprising the validation set were 70.0% (66.0–74.0%), 76.4% (72.8–80.0%), and 77.1% (73.6–80.6%) for the PCPTRC alone, with PCA3 added, and PCA3 and T2:ERG added, respectively. Net benefit was improved for the updated PCPTRC, while calibration was not. Limitations are that the updated PCPTRC is based on two different cohorts, the PCPT and Michigan, and that 20% of the validation set came from the Michigan center. More validation is required; hence, the updated risk tool is posted online.ConclusionsIncorporation of PCA3 into the PCPTRC improved validation on an independent cohort, whereas T2:ERG offered negligible utility in addition to PCA3.Patient summaryAfter passing external validation, prostate cancer antigen 3 has been added to the online Prostate Cancer Prevention Trial Risk Calculator for use by patients in deciding whether to proceed to biopsy. TMPRSS2:ERG did not improve prediction on the external validation set, but is included for further validation.
  • Antimicrobial Stewardship: What We All Just Need to Know
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Magnus J. Grabe, Fredrik Resman ContextMicrobial resistance to antibiotics is increasing while antimicrobials are limited. Responsible use is necessary.ObjectiveDescribe the present acquisitions of antimicrobial stewardship programmes (ASPs) in general and in urology.Evidence synthesisWell-designed ASPs have an impact on reducing treatment duration, shortening intravenous treatment in favour of oral targeted therapy, and reducing the total antibiotic prescription. Moreover, the hospital length of stay can potentially be reduced without hazard for the patient.ConclusionsIt is recommended to set up an ASP for education and feedback as standard in urological practice. The exact design of the ASP should be tailored to regional prerequisites.
  • The Role of Human Papilloma Virus in Penile Cancer Prevention and New
           Therapeutic Agents
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Boris Schlenker, Peter Schneede Penile cancer remains an aggressive disease with poor prognosis in advanced stages. Another specific problem of any rare disease is that the population is not aware of prevention strategies and higher chances for curation by early diagnosis. In penile carcinogenesis, two major pathways are known. Besides a non-human papilloma virus (HPV)-related pathway (mainly caused by phimosis and chronic inflammation), up to 50% of penile carcinomas are HPV-related (HPV high-risk types). Prophylactic HPV vaccination has proven its efficacy against cervical cancer; its B-cell-mediated immunity against HPV capsid proteins provides probably lifelong protection against specific HPV subtypes covered by the vaccine. Therefore, a consequent HPV vaccination program for children of both sexes might dramatically reduce the incidence of not only cervical cancer but also partially prevent penile cancer.However, for the treatment of already existing intracellular HPV infections, an antigen-specific T-cell immunity is necessary. Appropriate therapeutic HPV vaccines are under investigation. This article gives an overview about different levels of prevention of the HPV-related penile cancer.
  • Vaccine Development for Urinary Tract Infections: Where Do We Stand'
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Giuseppe Magistro, Christian G. Stief Urinary tract infections (UTIs) are among the most common bacterial infections. Its management has become increasingly challenging due to antimicrobial resistance. The four mainstays to tackle this crisis rely on the development of new antibiotic agents, the introduction of preventive and alternative antimicrobial strategies, the concept of antimicrobial stewardship, and effective hygiene measures. One of the most effective approaches to prevent UTIs is the design of a potent vaccine. OM-89 is a lyophilised preparation of membrane proteins from 18 different uropathogenic Escherichia coli strains. The safety and efficacy of this immunoactive agent is well documented; therefore, it is recommended for the prophylaxis of UTI according to the current European Association of Urology guidelines on urological infections. In terms of a true vaccine designed to target specifically pathogenic bacteria, no substance is currently available. ExPEC4V, a novel tetravalent bioconjugate vaccine against extraintestinal pathogenic E. coli, was evaluated for safety, immunogenicity, and clinical efficacy in a randomised, single-blinded, placebo-controlled phase 1b trial. The vaccine was well tolerated and elicited a robust antibody response in patients suffering from recurrent UTIs. Although the first clinical data suggested a reduced incidence of UTIs after vaccination, especially for higher bacterial loads, further randomised controlled trials are necessary to determine its true clinical benefit.
  • The Urinary Tract Microbiome: The Answer to All Our Open Questions'
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Giuseppe Magistro, Christian G. Stief ContextThe dogma of a sterile urinary tract persisted for over a century. With the advances in new high-throughput sequencing technologies and modified culture protocols for microbiome research, we have discovered a variable microbial spectrum in the urinary tract. Its relevance for health and disease is now under investigation.ObjectiveTo present the latest insights into the role of the urinary tract microbiome in functional disorders.Evidence acquisitionMedline, PubMed, the Cochrane database, and Embase were screened for randomised controlled trials, clinical trials, and reviews on the urinary tract microbiome.Evidence synthesisThe urinary tract is not sterile. Every individual harbours a complex microbial network in the urinary tract that is exposed to internal and external factors. Any imbalance in this network is likely to contribute to the development of lower urinary tract symptoms. Functional disorders such as interstitial cystitis, urinary urge incontinence, and chronic prostatitis/chronic pelvic pain syndrome, none of which include a bacterial origin for diagnosis, show features of an altered microbiome with specific dominating urotypes in contrast to urine from asymptomatic healthy individuals. The growing insights into the impact of the urinary microbiome on these entities may help in gaining a deeper understanding of the condition and may provide guidance for optimised management.ConclusionsThe urinary tract is not sterile. The discovery of the urinary microbiome suggests that any imbalance may have a relevant role in the development of symptoms in functional disorders.Patient summaryThe urinary tract is naturally colonised with a specific microbial spectrum for which impairment may cause bothersome symptoms.
  • Management of Urethritis: Is It Still the Time for Empirical Antibiotic
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Riccardo Bartoletti, Florian M.E. Wagenlehner, Truls Erik Bjerklund Johansen, Bela Köves, Tommaso Cai, Zafer Tandogdu, Gernot Bonkat ContextUrethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection.ObjectiveThe aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation.Evidence acquisitionA literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report.Evidence synthesisEmpirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens’ microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis “modern view” also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated.ConclusionsThe treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses.Patient summaryUrethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.
  • &rft.title=European+Urology+Focus&rft.issn=2405-4569&">Update on Strategies to Reduce Infectious Complications After Prostate
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Adrian Pilatz, Rajan Veeratterapillay, Bela Köves, Tommaso Cai, Riccardo Bartoletti, Florian Wagenlehner, Franck Bruyère, Suzanne Geerlings, Gernot Bonkat, Benjamin Pradere ContextProstate biopsy is one of the most performed procedures in urology. As a diagnostic procedure it should be of low risk. However, morbidity following prostate biopsy is common due to infectious complications.ObjectiveTo describe how to reduce infectious complications following prostate biopsy. We report on antibiotic and technical interventions to reduce infectious complications.Evidence acquisitionThe data presented are based on a narrative review. Search in PubMed and Medline was performed until May 2018 with a focus on randomised controlled trials and meta-analyses. Articles were reviewed for data on symptomatic infections, hospitalisation, and adverse events.Evidence synthesisAntibiotic prophylaxis is the standard of care. However, the duration of antibiotic preemptive treatment is still under debate. The use of augmented antibiotic prophylaxis as well as targeted antibiotic prophylaxis might be of potential value, but evidence is currently limited. Moreover, no antibiotic class was shown to be clearly superior to another. The evaluation of the technical aspects during prostate biopsy reveals that rectal preparation with povidone-iodine is clearly effective to reduce infectious complications. Transperineal biopsy has a potential benefit to reduce infectious complications, but powerful randomised controlled studies are missing. Finally, the number of biopsy cores, the application of periprostatic nerve block, or the use of a cleansing enema has no impact on prostate biopsy in terms of infectious complications.ConclusionsThe available data only suggest that rectal preparation with povidone-iodine as well as antibiotic prophylaxis is of significant advantage to reduce infectious complications following prostate biopsy. The augmented and targeted antibiotic prophylaxis shows some potential, but need further validation.Patient summaryIn this review we evaluate the best management strategy to prevent infectious complications following prostate biopsy. We show that antibiotic prophylaxis is essential for prostate biopsy and that rectal preparation with povidone-iodine is mandatory.
  • Current Evidence on Nonantibiotic Prevention of Recurrent Urinary Tract
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Jennifer Kranz, Stefanie Schmidt, Laila Schneidewind
  • Asymptomatic Bacteriuria is Harmless and Even Protective: Don’t Treat if
           You Don’t Have a Very Specific Reason
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Björn Wullt, Fredrik Sundén, Magnus Grabe
  • Asymptomatic Bacteriuria: To Treat or Not To Treat. Pro Treatment
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Béla Köves
  • Novel Antibiotics in the Treatment of Urinary Tract Infections
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Kurt G. Naber, Florian M.E. Wagenlehner
  • Management of Urosepsis in 2018
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Gernot Bonkat, Tomasso Cai, Rajan Veeratterapillay, Franck Bruyère, Riccardo Bartoletti, Adrian Pilatz, Béla Köves, Suzanne E. Geerlings, Benjamin Pradere, Robert Pickard, Florian M.E. Wagenlehner Despite optimal treatment, urosepsis has still high morbidity and mortality rates. An updated definition and classification system for sepsis have recently been introduced. Management of urosepsis comprises four major aspects: (1) early diagnosis, (2) early empiric intravenous antimicrobial treatment, (3) identification and control of complicating factors, and (4) specific sepsis therapy. The quick sequential organ failure assessment is replacing the systemic inflammatory response syndrome scoring for rapid identification of patients with urosepsis.Patient summaryUrosepsis is a serious, life-threatening complication of infections originating from the urinary tract. As urosepsis has a very high mortality rate, it is important that is quickly spotted and that appropriate treatment is swiftly begun. Imaging of urinary tract disorders has been shown to be useful in decreasing mortality from urosepsis, and in the future microbiology techniques may also prove useful. Given the severity of urosepsis and the associated risks, large efforts need to be made to prevent high-risk infections in hospitals with appropriate prevention measures, such as the early removal of catheters used whenever possible.
  • &rft.title=European+Urology+Focus&rft.issn=2405-4569&">Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Molly E. DeWitt-Foy, J. Curtis Nickel, Daniel A. Shoskes
  • Urological Infections: “The Time for Change is Now”
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Giuseppe Magistro
  • Leveraging the Full Potential of Clinical Registries
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): Alexander P. Cole, David F. Friedlander, Quoc-Dien Trinh
  • Caveolin-1 Expression in Upper Tract Urothelial Carcinoma
    • Abstract: Publication date: January 2019Source: European Urology Focus, Volume 5, Issue 1Author(s): David D’Andrea, Marco Moschini, Beat Foerster, Mohammad Abufaraj, Vitaly Margulis, Jose Karam, Yair Lotan, Jay Raman, Romain Mathieu, Morgan Rouprêt, Pierre I. Karakiewicz, Alberto Briganti, Andrea Haitel, Sharhrokh F. Shariat BackgroundImprovement in postoperative risk stratification of upper tract urothelial carcinoma (UTUC) is required to better predict outcomes and counsel patients on adjuvant treatment.ObjectiveTo validate the association between caveolin-1 and oncological outcomes in patients treated with radical nephroureterectomy (RNU) for UTUC.Design, setting, and participantsCaveolin-1 expression was evaluated via immunochemistry on a tissue microarray from 621 patients. Caveolin-1 was considered overexpressed when at least 50% of the tumor cells stained positive. The median follow-up in this retrospective study was 35 mo (interquartile range 16–65).InterventionRadical nephroureterectomy.Outcome measurements and statistical analysisUnivariate and multivariable Cox proportional hazards regression models were used to assess the association between caveolin-1 expression and recurrence and cancer-specific mortality (CSM).Results and limitationsCaveolin-1 was overexpressed in 150 patients (24%). Overexpression was associated with higher pathological stage (p 
  • Impact of Age on Perioperative Outcomes at Radical Prostatectomy: A
           Population-Based Study
    • Abstract: Publication date: Available online 26 December 2018Source: European Urology FocusAuthor(s): Felix Preisser, Elio Mazzone, Sebastiano Nazzani, Sophie Knipper, Zhe Tian, Philipp Mandel, Raisa Pompe, Fred Saad, Francesco Montorsi, Shahrokh F. Shariat, Hartwig Huland, Markus Graefen, Derya Tilki, Pierre I. Karakiewicz BackgroundRadical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications.ObjectiveWe tested the relationship between RP early postoperative outcomes and age within a population-based data repository.Design, setting, and participantsWithin the National Inpatient Sample database (2008–2013), we identified patients who underwent robotically assisted or open RP.Outcome measurements and statistical analysisMultivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications.Results and limitationsOverall, 68 780 patients underwent RP with a median age of 62 yr (interquartile range: 57–67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p 
  • Health Care Delivery for Metastatic Hormone-sensitive Prostate Cancer
           Across the Globe
    • Abstract: Publication date: Available online 23 December 2018Source: European Urology FocusAuthor(s): Annika Herlemann, Samuel L. Washington, Matthew R. Cooperberg Prostate cancer remains a leading cause of cancer-related death in men. Concurrently, the incidence of metastatic hormone-sensitive prostate cancer (mHSPC) at diagnosis has significantly risen as a result, in part, of recent advances in imaging. Given the increased utilization of prostate-specific membrane antigen–targeted positron emission tomography imaging and other modalities with improved accuracy in the detection of cancer, combined with changes in screening and other secular trends, more men get diagnosed at an oligometastatic stage in which timely treatment may improve survival. However, the optimal timing of initiation and the specific sequence of systemic agents are not yet clearly defined. Worldwide, both urologists and oncologists may primarily direct the medical management of mHSPC. This collaboration potentially invites differing treatment recommendations dependent upon the treating physician’s medical specialty. Ideally, a shared decision-making approach incorporating multidisciplinary tumor board discussions and personalized analysis will provide personalized treatment recommendations to optimize the benefit for mHSPC patients. Here, we conducted a concise review and evaluation of existing literature, and provide one perspective on health care delivery for mHSPC worldwide.Patient summaryGiven the improvement in imaging techniques and changes in screening practices, the incidence of metastatic hormone-sensitive prostate cancer will likely continue to rise. An early, multimodal treatment approach involving a multidisciplinary team is critical to delivering the best care to this patient population.
  • The Changing Face of Artificial Urinary Sphincter Use in France: The
           Future is Female
    • Abstract: Publication date: Available online 23 December 2018Source: European Urology FocusAuthor(s): Benoit Peyronnet, Juliette Hascoet, Lucie-Marie Scailteux, Xavier Gamé, Jean-Nicolas Cornu
  • Clinical Trials of Metastatic Castration-sensitive Prostate Cancer: Recent
           Progress and New Horizons
    • Abstract: Publication date: Available online 14 December 2018Source: European Urology FocusAuthor(s): Anis A. Hamid, Michael J. Morris, Ian D. Davis
  • Health Technology Assessment and Health Care Utilisation in the Management
           of Early Prostate Cancer
    • Abstract: Publication date: Available online 11 December 2018Source: European Urology FocusAuthor(s): Richard De Abreu Lourenco, Scott Williams Health technology assessment (HTA) is a key tool used to allocate health care funding. A critical aspect of HTA is the performance of economic evaluations that compare the costs and outcomes for competing therapies; these typically rely on data from clinical trials. For early prostate cancer, this represents a challenge, as long-term survival and quality-of-life effects—key outcomes in such evaluations—may require a decade or more of follow-up. Thus, identification of early or intermediate measures of benefit is critical. Systematic reviews of economic evaluations in prostate cancer show that understanding the links between intermediate and final outcomes is important for confidence in assessments of what represents value for money. This highlights the importance of efforts to identify and validate intermediate clinical endpoints for use in determining clinical benefit, and hence value for money, in early prostate cancer.Patient summaryAs the costs of providing care rise, the challenge is to ensure that we achieve value for money. In this brief review, we note the importance of clinical trial data in understanding what represents value for money and we highlight current efforts to identify measures that can be used to make decisions on treatment funding sooner.
  • The Biology of Oligometastatic Prostate Cancer: A Different Beast than
           Polymetastatic Prostate Cancer
    • Abstract: Publication date: Available online 4 December 2018Source: European Urology FocusAuthor(s): Michael Jonathan Kucharczyk, Gwenaelle Gravis, Tamim Niazi
  • PTEN Loss but Not ERG Expression in Diagnostic Biopsies Is Associated with
           Increased Risk of Progression and Adverse Surgical Findings in Men with
           Prostate Cancer on Active Surveillance
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Utku Lokman, Andrew M. Erickson, Hanna Vasarainen, Antti S. Rannikko, Tuomas Mirtti BackgroundActive surveillance (AS) is an option for men with low-risk prostate cancer (PCa). PTEN and ERG have been considered as potential biomarkers of PCa progression and survival.ObjectiveTo study the role of ERG and PTEN status in the Prostate Cancer Research International: Active Surveillance (PRIAS) trial diagnostic biopsies (DBxs) in predicting surveillance discontinuation and adverse surgical findings in subsequent radical prostatectomy (RP).Design, setting, and participantsA total of 231 patients were recruited to the PRIAS between 2007 and 2013 in Helsinki. DBx tissue for immunohistochemistry (IHC) was available from 190 patients. Tissue microarrays (TMAs) were constructed from 57 specimens of subsequent RPs. DBxs containing grade group (GG) 1 PCa and RP TMA sections were stained with ERG and PTEN antibodies, and scored as either negative or positive.Outcome measurements and statistical analysesOutcomes were followed up by biopsy GG upgrade (GG ≥ 2) and protocol-based treatment change, as well as adverse findings in RP (GG ≥ 3 or pathological stage ≥ 3). Clinical variables and biomarker status in DBx were correlated in Cox regression analysis and cumulative survival in Kaplan–Meier analysis, and finally, Gray’s competing risk analysis was performed and nonprotocol-based discontinuation was considered as a competing event.Results and limitationsIn both uni- and multivariate Cox regression analyses, only the number of positive cores in the DBx, the number of rebiopsy sessions, and PTEN status at diagnosis were significantly associated with rebiopsy GG upgrade, treatment change, and adverse histopathology in RP. In Kaplan–Meier analysis, PTEN loss was associated with a shorter time to GG upgrade and treatment change. Patients with PTEN loss had a higher probability for protocol-based discontinuation but not for competing risk factors compared with patients with intact PTEN. Biopsy ERG status was concordant with RP TMA ERG status, while PTEN was not. Limitations include a retrospective analysis of prospective cohort data.ConclusionsPTEN status at diagnosis is a potential biomarker for identifying patients with PCa on AS with a high risk for progression or adverse findings on subsequent RP.Patient summaryA simple diagnostic biopsy-based analysis of PTEN status may help identify patients with high risk for prostate cancer progression.
  • Small-cell Carcinomas of the Urinary Bladder and Prostate: TERT Promoter
           Mutation Status Differentiates Sites of Malignancy and Provides Evidence
           of Common Clonality Between Small-cell Carcinoma of the Urinary Bladder
           and Urothelial Carcinoma
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): David S. Priemer, Mingsheng Wang, Shaobo Zhang, Antonio Lopez-Beltran, Erik Kouba, Rodolfo Montironi, Darrell D. Davidson, Gregory T. MacLennan, Lisha Wang, Adeboye O. Osunkoya, Youping Deng, Robert E. Emerson, Liang Cheng BackgroundSmall-cell carcinoma (SCC) of the urinary bladder frequently appears alongside urothelial carcinoma, suggesting common clonality. TERT promoter mutations have been recently implicated in urothelial carcinogenesis.ObjectiveTo investigate the degree to which TERT promoter mutations are involved in SCC of the urinary bladder, the linked tumorigenesis between urothelial carcinoma and SCC of the urinary bladder, and the molecular distinctions between SCC of the urinary bladder and of the prostate.Design, setting, and participantsWe investigated TERT promoter mutations in 53 cases of SCC of the urinary bladder and in 26 cases of SCC of the prostate using laboratory-based studies of tissue samples and clinical data.Outcome measurements and statistical analysisWe measured the frequency of TERT promoter mutations in SCCs of the urinary bladder and prostate, and concordance of the mutation status between concurrent urinary bladder SCC and urothelial carcinoma.Results and limitationsTERT promoter mutations were detected in 29/53 (55%) cases of urinary bladder and 0/26 (0%) cases of prostate SCC. Of 25 cases with concurrent urinary bladder SCC and non–small-cell components, all cases harbored identical TERT promoter mutation status in both phenotypes.ConclusionsTERT promoter mutations are found in more than half of urinary bladder SCCs. Mutation status is also identical in urothelial carcinoma and SCC components of concomitant malignancies, providing evidence of a common clonality. TERT promoter mutation status can differentiate SCC of the urinary bladder from prostate SCC, suggesting potential diagnostic use.Patient summarySmall-cell carcinoma of the urinary bladder shares a common clonal origin with conventional urothelial carcinoma and may arise from a heterogeneous subclone. TERT promoter mutations may have utility as a differential biomarker for determining the primary site of a genitourinary small-cell carcinoma.
  • Comparative Perioperative Outcomes in Septuagenarians and Octogenarians
           Undergoing Radical Cystectomy for Bladder Cancer—Do Outcomes Differ'
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Tyler D. Haden, Megan C. Prunty, Alexander B. Jones, Chelsea B. Deroche, Katie S. Murray, Naveen Pokala BackgroundTreatment choice for muscle invasive bladder cancer continues to be radical cystectomy. However, radical cystectomy carries a relatively high risk of morbidity and mortality compared with other urological procedures.ObjectiveTo compare surgical complications following radical cystectomy in septuagenarians and octogenarians.Design, setting, and participantsThe National Surgical Quality Improvement Program database (2009–2013) was used to identify patients who were 70 yr and older and underwent radical cystectomy.Outcome measurements and statistical analysisThe data were analyzed for demographics and comorbidities, and compared for complications, including pulmonary, thromboembolic, wound, and cardiac complications. Patients who were 70–79 yr of age were compared with those 80 yr and older. Univariate and multivariate analyses were completed.Results and limitationsA total of 1710 patients aged ≥70 yr met our inclusion criteria. Of them, 28.8% (n = 493) were 80 yr and older, while 71.2% (n = 1217) were between 70 and 79 yr old. Operative time (338.4 vs 307.2 min, p = 0.0001) and the length of stay (11.9 vs 10.4 d, p = 0.0016) were higher in the octogenarian group. The intra- and postoperative transfusion rates, reoperative rates, wound dehiscence rates, and pneumonia, sepsis, and myocardial infarction rates were similar between the two groups. The wound infection rate (7.3% vs 4.1%, p = 0.01) was higher in the septuagenarians and mortality rate (4.3% vs 2.3%, p = 0.04) was higher in the octogenarian group.ConclusionsRadical cystectomy can safely be performed in octogenarians without increased cardiac, pulmonary, and thromboembolic complications when compared with septuagenarians. These patients need to be counseled that the mortality rate is slightly higher compared with that in septuagenarians. Chronological age alone should not be used to decide on offering radical cystectomy.Patient summaryWe looked at complications following radical cystectomy in patients aged 80 yr and older. We found that there was no significant difference for wound, cardiac, or pulmonary complications, but there was an increased risk of mortality in this age group.
  • Treatment Patterns and Survival Outcomes for Patients with Small Cell
           Carcinoma of the Bladder
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Benjamin W. Fischer-Valuck, Yuan James Rao, Lauren E. Henke, Soumon Rudra, Caressa Hui, Brian C. Baumann, Hiram A. Gay, Jeff M. Michalski BackgroundSmall cell carcinoma of the bladder (SCCaB) is a rare tumor without a standard treatment algorithm. Treatment patterns and survival outcomes from the National Cancer Database (NCDB) may provide insight into optimal treatment strategies.ObjectiveTo investigate the relationship between overall survival (OS) and treatment strategy.Design, setting, and participantsThis was an observational study of treatment-naïve patients who received treatment from 2004 to 2013. Patients with cT1–4aN0M0 SCCaB were identified from the NCDB, a hospital-based tumor registry that captures>70% of incident cancer cases in the USA.InterventionTreatment strategies included local therapy alone, chemotherapy (CT), radiation therapy (RT), chemoradiation therapy (CRT), radical cystectomy (RC), and RC plus chemotherapy (RC + C).Outcome measurements and statistical analysisOS was analyzed as a function of treatment modality adjusting for patient, demographic, and tumor-related factors. The Kaplan-Meier survival method, and the log-rank test and Cox regression were used for univariable and multivariable analyses.Results and limitationsWe identified 856 patients with median follow-up of 18.3 mo. The median OS for the entire cohort was 20.7 mo (95% confidence interval [CI] 18.3–23.2) and estimated 3-yr and 5-yr OS were 37.5% and 28.2%, respectively. The most common treatment modality was CT (225 patients; 26.3%) followed by CRT (203 patients; 23.7%) and RC + C (201 patients; 23.5%). The median OS was 18.4 mo (95% CI 15.2–21.5) for CT, 34.1 mo (95% CI 22.5–45.8) for CRT, and 32.4 mo (95% CI 20.8–44.1) for RC + C. OS did not significantly differ between CRT and RC + C (p = 0.42). On multivariable analysis, the best OS was associated with CRT (hazard ratio [HR] 0.41, 95% CI 0.32–0.53; p 
  • Distinct Lipidomic Landscapes Associated with Clinical Stages of
           Urothelial Cancer of the Bladder
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Danthasinghe Waduge Badrajee Piyarathna, Thekkelnaycke M. Rajendiran, Vasanta Putluri, Venkatrao Vantaku, Tanu Soni, Friedrich-Carl von Rundstedt, Sri Ramya Donepudi, Feng Jin, Suman Maity, Chandrashekar R. Ambati, Jianrong Dong, Daniel Gödde, Stephan Roth, Stephan Störkel, Stephan Degener, George Michailidis, Seth P. Lerner, Subramaniam Pennathur, Yair Lotan, Cristian Coarfa BackgroundThe first global lipidomic profiles associated with urothelial cancer of the bladder (UCB) and its clinical stages associated with progression were identified.ObjectiveTo identify lipidomic signatures associated with survival and different clinical stages of UCB.Design, setting, and participantsPathologically confirmed 165 bladder-derived tissues (126 UCB, 39 benign adjacent or normal bladder tissues). UCB tissues included Ta (n = 16), T1 (n = 30), T2 (n = 43), T3 (n = 27), and T4 (n = 9); lymphovascular invasion (LVI) positive (n = 52) and negative (n = 69); and lymph node status N0 (n = 28), N1 (n = 11), N2 (n = 9), N3 (n = 3), and Nx (n = 75).Results and limitationsUCB tissues have higher levels of phospholipids and fatty acids, and reduced levels of triglycerides compared with benign tissues. A total of 59 genes associated with altered lipids in UCB strongly correlate with patient survival in an UCB public dataset. Within UCB, there was a progressive decrease in the levels of phosphatidylserine (PS), phosphatidylethanolamines (PEs), and phosphocholines, whereas an increase in the levels of diacylglycerols (DGs) with tumor stage. Transcript and protein expression of phosphatidylserine synthase 1, which converts DGs to PSs, decreased progressively with tumor stage. Levels of DGs and lyso-PEs were significantly elevated in tumors with LVI and lymph node involvement, respectively. Lack of carcinoma in situ and treatment information is the limitation of our study.ConclusionsTo date, this is the first study describing the global lipidomic profiles associated with UCB and identifies lipids associated with tumor stages, LVI, and lymph node status. Our data suggest that triglycerides serve as the primary energy source in UCB, while phospholipid alterations could affect membrane structure and/or signaling associated with tumor progression.Patient summaryLipidomic alterations identified in this study set the stage for characterization of pathways associated with these altered lipids that, in turn, could inform the development of first-of-its-kind lipid-based noninvasive biomarkers and novel therapeutic targets for aggressive urothelial cancer of the bladder.
  • Gender-specific Differences in Recurrence of Non–muscle-invasive Bladder
           Cancer: A Systematic Review and Meta-analysis
    • Abstract: Publication date: December 2018Source: European Urology Focus, Volume 4, Issue 6Author(s): Annemarie Uhlig, Arne Strauss, Ali Seif Amir Hosseini, Joachim Lotz, Lutz Trojan, Marianne Schmid, Johannes Uhlig ContextThe incidence of urothelial carcinoma of the bladder (UCB) is lower in women; however, women tend to present with more advanced disease. To date, there is no quantitative synthesis of studies reporting gender-specific outcomes in non–muscle-invasive UCB.ObjectiveTo conduct a meta-analysis evaluating gender-specific differences in recurrence of non–muscle-invasive urinary bladder cancer (NMIBC).Evidence acquisitionAn unrestricted systematic literature search of the MEDLINE, EMBASE, and Cochrane libraries was conducted. Studies evaluating the impact of gender on disease recurrence after local treatment of NMIBC using multivariable Cox proportional hazard models were included. Random effect meta-analysis, subgroup analyses, meta-influence, and cumulative meta-analyses were conducted. Publication bias was assessed via a funnel plot and Eggeŕs test.Evidence synthesisOf 609 studies screened, 27 comprising 23 754 patients were included. Random effect meta-analyses indicated women at increased risk for UCB recurrence compared with men (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.01–1.23, p = 0.03). Subgroup analyses yielded estimates between HR = 0.99 and HR = 1.68. Gender-specific differences in UCB recurrence were most pronounced in studies administering exclusively bacillus Calmette-Guerin (BCG; HR = 1.64, 95% CI: 1.13–2.39, p = 0.01), especially in a long-term treatment regimen (HR = 1.68, 95% CI: 1.32–2.15, p 
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