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European Urology Focus

H Abraham Chiang, Philip J Cheng, Jacqueline M Speed, Jill Steinberg, Peter A Najjar, Graeme S Steele, Quoc-Dien Trinh, Jairam R Eswara, Steven L Chang, Adam S Kibel, Matthias F Stopfkuchen-Evans, Mark A Preston
BACKGROUND: Novel venous thromboembolism (VTE) prophylaxis programs, including postdischarge pharmacologic prophylaxis, have been associated with decreased VTE rates. Such practices have not been widely adopted in managing radical cystectomy (RC) patients. OBJECTIVE: To evaluate the effect of a perioperative VTE prophylaxis program on VTE rates after RC. DESIGN, SETTING, AND PARTICIPANTS: Single-institution, nonrandomized, pre- and post-intervention analysis of 319 patients undergoing RC at Brigham and Women's Hospital between July 2011 and April 2017...
September 15, 2018: European Urology Focus
Abraham Morgentaler
Current methods for diagnosing testosterone deficiency are inadequate. It is time to rethink how we determine who is a candidate for treatment, with a goal of helping our patients. Free testosterone appears more accurate than total testosterone.
September 14, 2018: European Urology Focus
Amelia Pietropaolo, Jane Hendry, Rena Kyriakides, Robert Geraghty, Patrick Jones, Omar Aboumarzouk, Bhaskar K Somani
BACKGROUND: Elective treatment of ureteric stones is needed after emergency drainage of urosepsis. OBJECTIVE: We wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). DESIGN, SETTING, AND PARTICIPANTS: Data of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012-December 2016) were prospectively collected...
September 12, 2018: European Urology Focus
Laurent Derré, Ilaria Lucca, Valérie Cesson, Massimo Valerio, Yannick Cerantola, Rodolfo Burruni, Urs Fritschi, Dalila Gharbi, Martine Bobst, Anne-Sophie Legris, Florence Dartiguenave, Patrice Jichlinski, Denise Nardelli-Haefliger
Towards the development of vaccines against urinary tract infections (UTI), we determined the ability of intramuscular (i.m.) immunization to result in antigen-specific antibodies in urine. As a model antigen/vaccine, levels of total and vaccine-specific antibodies were determined in urine as a spin-out study of a phase 1 trial. Non-muscle-invasive bladder cancer (NMIBC) patients at different risks of progression, undergoing intravesical bacillus Calmette-Guérin (BCG) immunotherapy or not, received an adjuvanted recombinant protein vaccine that resulted in high titers of vaccine-specific serum immunoglobulin G (IgG) in all patients, regardless of the risk group...
September 12, 2018: European Urology Focus
Laura Bukavina, Jon C Tilburt, Badrinath Konety, Nilay D Shah, Cary P Gross, James B Yu, Frederick Schumacher, Alexander Kutikov, Marc C Smaldone, Simon P Kim
BACKGROUND: Magnetic resonance imaging (MRI) of the prostate and fusion biopsy have been advanced to improve the detection of clinically significant prostate cancer (PCa). Yet, frequency of their use and contemporary attitudes among radiation oncologists (ROs) and urologists (UROs) remain largely unknown. OBJECTIVE: We performed a national survey of UROs and ROs to assess the perceived attitudes towards and frequency of prostate MRI and fusion biopsy. DESIGN, SETTING, AND PARTICIPANTS: We conducted a national survey of 915 ROs and 940 UROs about prostate MRI and fusion biopsy in 2017...
September 12, 2018: European Urology Focus
Luca Boeri, Andrea Gallioli, Elisa De Lorenzis, Matteo Fontana, Franco Palmisano, Gianluca Sampogna, Stefano Paolo Zanetti, Vito Lorusso, Ilaria Sabatini, Irene Fulgheri, Giorgio Malagò, Roberto Brambilla, Mauro Campoleoni, Giancarlo Albo, Fabrizio Longo, Andrea Salonia, Emanuele Montanari
BACKGROUND: The impact of surgical experience on radiation exposure (RE) during endourological procedures has been poorly investigated. OBJECTIVE: To assess the impact of surgical experience on fluoroscopy time (FT) and RE during retrograde intrarenal surgery (RIRS). DESIGN, SETTING, AND PARTICIPANTS: The study included 140 patients who underwent RIRS performed either by a senior surgeon (expertise of >100 RIRSs) (group A) or by two junior residents (expertise of <15 RIRSs) (group B) between January 2016 and May 2018...
September 12, 2018: European Urology Focus
Justin William Collins, Paolo Dell'Oglio, Andrew J Hung, Nicholas R Brook
We discuss the differences in cognitive (thinking) and other non-technical skills (NTS) in robotic surgery training compared to other approaches to surgery. Recognition of the importance of NTS and cognitive training will aid the development of robotic surgery curricula.
September 11, 2018: European Urology Focus
Jun Wang, Mierxiati Abudurexiti, Ning Shao, Yu Wei, Yao Zhu, Ding-Wei Ye
BACKGROUND: Accumulated evidence suggests that metastatic prostate cancer (mPCa) with a low prostate-specific antigen (PSA) level may be a unique entity. However, its clinical features and prognosis have not been fully evaluated. OBJECTIVE: To investigate the clinical features of low-PSA mPCa and the impact of low PSA level on overall survival (OS) and PCa-specific mortality (PCSM) of mPCa. DESIGN, SETTING, AND PARTICIPANTS: A total of 8479 mPCa patients were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015)...
September 11, 2018: European Urology Focus
David Shin, Tejash Shah, Hossein Sadeghi-Nejad
Xiaflex or collagenase Clostridium histolyticum intralesional injections are safe and effective as first-line treatment for Peyronie's disease.
September 10, 2018: European Urology Focus
Charles C Peyton, E Jason Abel, Juan Chipollini, David C Boulware, Mounsif Azizi, Jose A Karam, Vitaly Margulis, Viraj A Master, Surena F Matin, Jay D Raman, Wade J Sexton, Christopher G Wood, Philippe E Spiess
BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). OBJECTIVE: To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). DESIGN, SETTING, AND PARTICIPANTS: Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions...
September 8, 2018: European Urology Focus
Premal Patel, Nicholas Hauser
When choosing a management strategy for a patient with Peyronie's disease (PD), it is critical to consider the phase of the disease, penile plaque characteristics, degree of curvature, associated deformities, stretched penile length, and baseline erectile function. Equally important is an understanding of the patient's goals and expectations. Treatment cost and duration may also be vital considerations for the patient. In this case, the degree of curvature and large calcified plaque make treatment with intralesional injection of collagenase Clostridium histolyticum unlikely to result in a functionally straight erection despite 6-7 mo of therapy...
September 8, 2018: European Urology Focus
Molly E DeWitt-Foy, J Curtis Nickel, Daniel A Shoskes
Chronic prostatitis/chronic pelvic pain syndrome represents a wide range of clinical phenotypes and has traditionally been a diagnosis of exclusion with few proven remedies. Our structured, simplified approach to evaluation and management of this complex condition results in improved patient outcomes.
September 8, 2018: European Urology Focus
Henk G van der Poel, Nikos Grivas, Fijs van Leeuwen
The intraoperative use of fluorescent tracers and matching cameras can empower urologists' ability to recognize critical anatomical and functional features. Indocyanine green is the most extensively used near-infrared fluorescent tracer. It has been widely applied due to its ability to illuminate vascular and lymphatic anatomies. A plurality of fluorescence cameras are available allowing the connection of this technology with many surgical approaches, including robotic surgery. Although large comparative validation studies are lacking, numerous studies support the role of fluorescence guidance in urology...
September 6, 2018: European Urology Focus
Tim O'Brien
Although there is level 1 evidence for the use of intravesical chemotherapy after the transurethral resection of bladder tumour, the decision to apply it needs to be individualised. "What benefit will the patient derive from it?"
September 6, 2018: European Urology Focus
J Kellogg Parsons, Peter A Pinto, Christian P Pavlovich, Edward Uchio, Hyung L Kim, Mikel N Nguyen, James L Gulley, Christina Jamieson, Paul Hsu, Margarita Wojtowicz, Howard Parnes, Jeffrey Schlom, William L Dahut, Ravi A Madan, Renee N Donahue, H-H Sherry Chow
The Immunotherapy to Prevent Progression on Active Surveillance Study is the first trial of immunotherapy for localized prostate cancer. We randomized active surveillance patients to PSA-TRICOM (PROSTVAC) or placebo for 5mo. Final results will be available in 2019.
September 6, 2018: European Urology Focus
Robert S Svatek, Cathy Tangen, Scott Delacroix, William Lowrance, Seth P Lerner
The S1602 Intergroup trial is a randomized phase III clinical trial that aims to test two important hypotheses: (1) priming with intradermal bacillus Calmette-Guérin (BCG) vaccine prior to standard intravesical BCG improves response to BCG in terms of recurrence-free survival and (2) Tokyo-172 BCG strain is non-inferior to TICE BCG in terms of time to high-grade recurrence. The study was approved by the Cancer Therapy Evaluation Program of the National Cancer Institute and activated in spring 2017. Here, we provide a synopsis of the study background, design, and update of the clinical trial...
September 6, 2018: European Urology Focus
Nannan Thirumavalavan, Jason M Scovell, Richard E Link, Dolores J Lamb, Larry I Lipshultz
Patients undergoing solid organ transplantation have experienced increased graft survival rates over the past several decades. With increased longevity making fatherhood a viable option, many patients desire to pursue this path. However, many patients and practitioners are likely unaware of the feasibility and safety for a man on a transplant immunosuppression regimen to safely pursue fatherhood. In this review, we discuss effects of organ transplantation and post-transplantation treatment on male hormones, fertility, and the risk to potential offspring...
September 4, 2018: European Urology Focus
Katriina J Peltola, Petri Bono, Robert Hugh Jones, Egils Vjaters, Pirjo Nykänen, Annamari Vuorela, Riikka Oksala, Pasi Pohjanjousi, Mika V J Mustonen, Karim Fizazi, Christophe Massard
BACKGROUND: Most prostate cancer patients develop castration-resistant prostate cancer (CRPC) after androgen deprivation therapy treatment. CRPC growth is mediated mostly by androgen receptor signalling driven by primary androgens synthesised largely by the CYP17A1 enzyme. OBJECTIVE: To evaluate the safety profile and dose-limiting toxicities of ODM-204. DESIGN, SETTING, AND PARTICIPANTS: In this open, uncontrolled, nonrandomised, multicentre, tolerability and pharmacokinetic first-in-man phase I dose escalation study, patients with metastatic CRPC were randomised to receive ODM-204 in sequential cohorts of five dose levels (ie, 50, 100, 200, 300, and 500mg twice daily) concomitantly with prednisone...
September 4, 2018: European Urology Focus
Ramnath Subramaniam
The use of robot-assisted surgery (RAS) by paediatric urologists is increasing. This mini review looks at the current status of RAS in paediatric urology. The challenges involved in RAS use in children are reviewed, as well as the indications for and feasibility of procedures performed and, where possible, outcomes with RAS. PATIENT SUMMARY: The current status of robot-assisted surgery (RAS) in paediatric urology, together with the challenges in using RAS for children is outlined in this mini review...
September 4, 2018: European Urology Focus
William B Tabayoyong, Ashish M Kamat, Michael A O'Donnell, James M McKiernan, Mohamed D Ray-Zack, Joan Palou, Maurizio Brausi, Peter C Black, Stephen B Williams
CONTEXT: Current guidelines remain ill-defined regarding the optimal intravesical chemotherapy type and regimen for the treatment of non-muscle-invasive bladder cancer (NMIBC). Although maintenance therapy is a standard part of bacillus Calmette-Guerin (BCG) therapy, its role in the context of chemotherapy remains debatable. OBJECTIVE: We reviewed the literature regarding the utilization of intravesical maintenance chemotherapy in the treatment of NMIBC to determine its impact on recurrence, progression, and survival...
September 3, 2018: European Urology Focus
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