To determine whether the addition of four paramedian peripheral and four lateral peripheral cores improves the cancer detection
rate (CDR) of the extended 10-core biopsy scheme and which patients benefit most from such additional samples.
Methods
One thousand and ninety-one consecutive patients scheduled for first ultrasound-guided transrectal prostate biopsy prospectively
underwent a 18-core biopsy scheme, including the traditional sextant (6-core), 4 lateral peripheral (10-core), 4 paramedian
peripheral (14-core) and additional 4 lateral peripheral cores (18-core).
Results
The CDR of the 6-, 10-, 14- and 18-core schemes was 33.1, 39.2, 41.6 and 41.8 %, respectively; the difference between the
10- and 6-core scheme reached significance (p < 0.005), whereas that between the 18- or 14- and the 10-core scheme did not. The percentage of tumors diagnosed on the sole
basis of the 14-core scheme was significantly greater in patients with low PSA (≤7.2 vs. >7.2 ng/ml: 12.1 vs. 1.8 %; p < 0.0001), large prostate volume (≥50 vs. <50 cc: 3.4 vs. 9.1 %; p = 0.011) and particularly low PSA density (<0.15 vs. ≥0.15: 15.9 vs. 1 %; p < 0.0001). The 18-core scheme did not provide diagnostic advantages in any patients’ population.
Conclusions
The addition of 4 lateral peripheral samples did not increase the CDR of the 10-core biopsy scheme. The addition of four paramedian
peripheral samples was beneficial only in patients with PSA density <0.15, in whom the 10-core scheme would have miss almost
16 % of tumors. Since more than half of our patients had low (<0.15) PSA density, these findings seem to be of great clinical
relevance.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0989-8
Authors
Luigi Cormio, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
Vincenzo Scattoni, Department of Urology, Scientific Institute H San Raffaele, University Vita-Salute, Milan, Italy
Fabrizio Lorusso, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
Antonia Perrone, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
Giuseppe Di Fino, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
Oscar Selvaggio, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
Francesca Sanguedolce, Pathology Unit, Department of Surgical Sciences, University of Foggia, Foggia, Italy
Pantaleo Bufo, Pathology Unit, Department of Surgical Sciences, University of Foggia, Foggia, Italy
Francesco Montorsi, Department of Urology, Scientific Institute H San Raffaele, University Vita-Salute, Milan, Italy
Giuseppe Carrieri, Department of Urology and Renal Transplantation, University of Foggia, via Pinto 1, 71110 Foggia, Italy
To investigate the outcome between the primary and secondary hypospadias with severe chordee in older patients by the transverse
preputial island flap (TPIF).
Materials and methods
We retrospectively analyzed 53 hypospadias patients who were performed with TPIF for urethroplasty, including 25 primary hypospadias
(Group 1) and 28 secondary hypospadias (Group 2). The mean age in Group 1 was 12.12 ± 10.709 and 18.64 ± 8.727 in Group 2
(P = 0.0181). The mean follow-up time was 38.7 months (22–60 months).
Results
All of the foreskin flaps survived after the operation without necrosis. The overall complication rate was 24 % in Group 1
and 53.57 % in Group 2 (P = 0.0280). All the patients were also divided into two cohorts according to their ages in surgery. In the 0–10-yr cohort,
there was a significant difference in the overall complication rate between the primary and secondary groups (P = 0.0173). But in the cases who were over 11 year old, there was no significant difference in the overall complications between
two groups (P = 0.1603). Also no significant difference was found in the mean length of the urethral defect between two groups (P = 0.8312).
Conclusion
The Duckett technique is an optional choice for some older Chinese patients undergoing primary operations, but it has a higher
complication rate in those who have undergone previous failed urethroplasties. The unsatisfactory results found in the reoperative
group were supposed to be linked to the older age, the lack of subcutaneous flap coverage and local scar tissue, but not to
the length of the urethral defect.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0990-2
Authors
Da-chao Zheng, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Hao Wang, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Mu-jun Lu, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Qi Chen, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Yan-bo Chen, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Xiao-min Ren, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Hai-jun Yao, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Ming-xi Xu, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Ke Zhang, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Zhi-kang Cai, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
Zhong Wang, Department of Urology, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011 People’s Republic of China
To determine retrospectively the perioperative management and outcome of transurethral prostate/bladder surgery (TURP, TURB)
and transrectal prostate biopsy in hemophiliacs.
Methods
Thirty-seven hemophilic patients underwent TURP (12 patients), TURB (13 patients), or transrectal prostate biopsy (12 patients)
with proactive hemostaseological management (i.e., factor supply, close meshed hemostaseological analysis). Thirty-seven non-hemophiliac
patients served as matched pairs who matched for age, gender, accompanying diseases, and the type of surgical procedure. The
resulting pairs were analyzed for duration of surgery, hospital stay, and complications.
Results
Average TURP length in hemophiliacs was 77.92 min, in the matched pairs group TURP 67.08 min (p = 0.487). Mean TURB length in hemophiliacs was 43.46 min versus 35.38 min in controls (p = 0.678). More important, the length of hospital stay was significant longer in the hemophiliacs undergoing TURP compared
to non-hemophiliac control group (12.08 days vs. 5.83 days; p < 0.001). In TURB patients, similar results were found (11.15 days hemophiliacs vs. 6.15 controls; p = 0.018). Regarding complications (bleeding, hemorrhage, readmission), no significant difference between the groups was obtained.
Conclusion
Urological interventions in hemophiliac patients with factor supply have the same risk for postoperative complications as
in non-hemophiliacs. The only significant difference between hemophiliacs and non-hemophiliacs was the length of hospital
stay.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0988-9
Authors
Sebastian Rogenhofer, Department of Urologie, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Stefan Hauser, Department of Urologie, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Anne Breuer, Department of Urologie, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Guido Fechner, Department of Urologie, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Stefan C. Mueller, Department of Urologie, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Johannes Oldenburg, Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Georg Goldmann, Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery
(RIRS) for 10–20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications.
Patients and methods
A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual
fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group.
Results
Success rates were 66.5, 91.4, and 87 % for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7 %, respectively;
p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9 %, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused.
Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s,
and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively).
Conclusions
For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment
rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure,
hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.
In this study, we evaluate the outcomes of salvage cryotherapy for locally recurrent prostate cancer within the COLD (cryo
online data) Registry. Furthermore, we assess the results of salvage cryotherapy (with intermediate follow-up) stratified
by pre-treatment prostate-specific antigen (PSA) levels to determine which patients may best be suited for treatment.
Methods
The COLD registry was developed as a prospective, centrally collected database among patients undergoing salvage cryoablation
for locally recurrent prostate cancer following primary prostate radiotherapy with curative intent. Of the patients undergoing
salvage cryotherapy (without neoadjuvant hormonal ablative therapy), complete medical records were available in 156 patients,
with their mean follow-up being 3.8 years (0.9–12.7 years). The treatment outcomes of salvage cryotherapy were assessed using
the Phoenix definition (nadir PSA + 2 ng/ml) of biochemical failure.
Results
Of our entire study population, the biochemical disease-free survival (bDFS) rates at 1, 2, and 3 years were 89.0, 73.7, and
66.7 %, respectively. Stratification of our patients into two subgroups is based on their pre-treatment total serum PSA values
<5 and ≥5 ng/ml, and bDFS rates at 3 years for these two subgroups were 78.3 and 52.9 %, respectively. A Kaplan–Meier analysis
of bDFS stratified by these same pre-treatment PSA values revealed that the subset of patients with a PSA ≥ 5 ng/ml had statistically
significant poorer bDFS rates (P = 0.01).
Conclusions
Salvage prostate cryotherapy is a potentially curative local salvage therapy. The importance of early referral when patients
have a pre-treatment PSA < 5 ng/ml is essential to optimize treatment outcomes.
Content Type Journal Article
Category Topic Paper
Pages 1-5
DOI 10.1007/s00345-012-0982-2
Authors
Philippe E. Spiess, Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Office 12538, Tampa, FL 33612, USA
David A. Levy, Department of Regional Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Louis L. Pisters, Department of Urologic Oncology, Anderson Cancer Center, Houston, TX, USA
Vladimir Mouraviev, Department of Urology, University of Cincinnati, Cincinnati, OH, USA
J. Stephen Jones, Department of Regional Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
To explore the dose response to onabotulinumtoxinA 50, 100, and 200 U in patients with spinal cord injury (SCI) with urinary
incontinence (UI) due to neurogenic detrusor overactivity (NDO).
Methods
Patients (N = 73) with SCI (level T1 or lower) with NDO and UI (≥14 UI episodes/week) received 30 intradetrusor injections of onabotulinumtoxinA
(50 U [n = 19], 100 U [n = 21], or 200 U [n = 17]) or placebo (n = 16) via cystoscopy, avoiding the trigone. Changes from baseline in UI episodes/week, volume voided/micturition, maximum
cystometric capacity, and maximum detrusor pressure (MDP) during first involuntary detrusor contraction (IDC) were evaluated.
Adverse events (AEs) were assessed.
Results
A significant linear dose response for UI episodes/week was identified at weeks 18, 30, 36, 42, and 54 (P < 0.05) with a similar trend (P = 0.092) at week 6 (primary time point). A significant linear dose response was observed in volume/void at all post-treatment
time points up to week 54 (P < 0.05) and in MDP during first IDC at week 6 (P = 0.034). The proportion of patients who achieved continence at week 6 was highest in the 200 U group. Duration of effect
was longest with the 200 U dose, compared with other treatment groups. The AEs were comparable across groups; urinary tract
infection was the most common AE across all treatment groups.
Conclusions
In this exploratory dose–response study of SCI patients with UI due to NDO, onabotulinumtoxinA 200 U was the most effective
dose. The AE profile was comparable across all groups.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0984-0
Authors
Apostolos Apostolidis, 2nd Department of Urology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloníki, Greece
Catherine Thompson, Allergan, Ltd., Marlow, Buckinghamshire, UK
In male patients, the pudendal block was applied only in rare cases as a therapy of neuralgia of the pudendal nerve. We compared
pudendal nerve block (NPB) and combined spinal-epidural anesthesia (CSE) in order to perform a pain-free high-dose-rate (HDR)
brachytherapy in a former pilot study in 2010. Regarding this background, in the present study, we only performed the bilateral
perineal infiltration of the pudendal nerve.
Methods
In 25 patients (71.8 ± 4.18 years) suffering from a high-risk prostate carcinoma, we performed the HDR-brachytherapy with
the NPB. The perioperative compatibility, the subjective feeling (German school marks principle 1–6), subjective pain (VAS
1–10) and the early postoperative course (mobility, complications) were examined.
Results
All patients preferred the NPB. There was no change of anesthesia form necessary. The expense time of NPB was 10.68 ± 2.34 min.
The hollow needles (mean 24, range 13–27) for the HDR-brachytherapy remained on average 79.92 ± 12.41 min. During and postoperative,
pain feeling was between 1.4 ± 1.08 and 1.08 ± 1.00. A transurethral 22 French Foley catheter was left in place for 6 h. All
patients felt the bladder catheter as annoying, but they considered postoperative mobility as more important as complete lack
of pain. The subjective feeling was described as 2.28 ± 0.74. Any side effects or complications did not appear.
Conclusions
Bilateral NPB is a safe and effective analgesic option in HDR-brachytherapy and can replace CSE. It offers the advantage of
almost no impaired mobility of the patient and can be performed by the urologist himself. Using transrectal ultrasound guidance,
the method can be learned quickly.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0987-x
Authors
Marcus Schenck, Department of Urology and Urooncology, University of Essen Medical School, Hufelandstraße 55, 45122 Essen, Germany
Catarina Schenck, Practice Clinic Anesthesiology, Essen, Germany
Herbert Rübben, Department of Urology and Urooncology, University of Essen Medical School, Hufelandstraße 55, 45122 Essen, Germany
Martin Stuschke, Department of Radiooncology, University of Essen Medical School, Essen, Germany
Tim Schneider, PURR, Practice Clinic Urology Rhein-Ruhr, Mülheim, Germany
Andreas Eisenhardt, PURR, Practice Clinic Urology Rhein-Ruhr, Mülheim, Germany
Roberto Rossi, Department of Urology and Urooncology, University of Essen Medical School, Hufelandstraße 55, 45122 Essen, Germany
Kidney retransplantation is the best treatment option for transplanted patients returning to dialysis. The aim of this study
was to explore the effect of removal of a failed graft on the outcome of a subsequent transplant.
Methods
We identified 140 patients who underwent retransplantation at our institution. Retrospective comparison was performed between
patients undergoing kidney retransplantation with (group A, n = 28) and without (group B, n = 112) preliminary nephrectomy. Graft and patient survival were calculated by the Kaplan–Meier method.
Results
After a mean follow-up of 64.5 months, patients survival was comparable between the two groups (group A = 68.6 vs. group B = 63.5 months;
p = 0.6). Mean graft survival was 65.5 versus 56.0 months in group A and B, respectively (p = 0.14). Surgical complications after retransplantation were significantly higher in group A compared to group B (57.1 vs.
19.6 %; p = 0.0002). There was no significant difference between the two groups in the panel reactive antibody level at the time of
retransplantation (group A = 20 % vs. group B = 32 %; p = 0.22). The acute rejection rate was 35.7 % in group A and 25 % in group B (p = 0.36). The risk of delayed graft function was not significantly increased in group A (p = 0.63). Finally, 2 years after retransplantation, patients who had not undergone nephrectomy had lower serum creatinine
concentrations (1.3 vs. 1.7 mg/dl; p = 0.01) and higher estimated GFR (77.9 vs. 59.3 ml/min/1.73 m2; p = 0.02).
Conclusion
Our experience shows that there is no advantage in performing allograft nephrectomy before retransplantation, and that this
procedure does not seem to significantly influence the survival of a subsequent graft.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0986-y
Authors
Giuseppe Lucarelli, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Antonio Vavallo, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Carlo Bettocchi, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Vincenzo Losappio, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
Loreto Gesualdo, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
Giuseppe Grandaliano, Nephrology, Dialysis and Transplantation Unit, Department of Biomedical Sciences, University of Foggia, Foggia, Italy
Francesco Paolo Selvaggi, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Michele Battaglia, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Pasquale Ditonno, Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
To evaluate the long-term functional results and complications of an orthotopic ileal neobladder, defined as perugia ileal
neobladder (PIN), in a group of patients with bladder cancer who underwent radical cystectomy (RC).
Methods
Between 1993 and 2009, 237 consecutive patients who underwent RC for non-metastatic bladder cancer and orthotopic ileal neobladder
reconstruction were enrolled. The neobladder was created using a modified Camey-II technique and consisted of a detubularized
ileal loop of 45 cm using a vertical “Y” shape. Complications (<90 days) were reviewed and staged according to Clavien–Dindo
classification and evaluated at long-term follow-up. Standard monitoring for cancer recurrence (computerized tomography, bone
scan), cystourethrography, urodynamics and frequency/volume charts were performed during follow-up.
Results
The median follow-up was 64 months, and the 5-year overall survival rate was 64 %. Early complications were mostly grade I
and II; grade III and IV complications were observed in 27 patients. Perioperative mortality rate was 1.6 %. The most frequent
late complications were neobladder–ureteral reflux, urolithiasis and urethral anastomotic stricture. Daytime and nighttime
urinary continence were 93.5 and 83.9 %, respectively. All patients were able to completely empty neobladders. Twenty patients
were followed up for at least 10 years and presented satisfactory functional results.
Conclusions
Surgical morbidity of RC and orthotopic neobladder was significant; however, the rate of grade III–IV complications was low.
The long-term functional results of the PIN were interesting, confirming that appropriate patients’ selection, adequate surgical
technique, accurate patients’ counseling and follow-up are essential.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0985-z
Authors
Massimo Porena, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
Luigi Mearini, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
Alessandro Zucchi, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
Michele Del Zingaro, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
Ettore Mearini, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
Antonella Giannantoni, Urology Department, University of Perugia, Sant’Andrea delle Fratte, 06100 Perugia, Italy
To evaluate the effect of vardenafil on renal function after renal ischemia–reperfusion (IR) injury (IRI) in a rat model.
Materials and methods
Seventy-one Wistar rats were divided into 7 groups including (1) a vehicle-treated group, (2) a vehicle pretreated-IR group,
(3–6) vardenafil pretreated-IR groups in doses of 0.02, 0.2, 2 and 20 μg/kg, respectively, (7) a group of IR followed by treatment
with 2 μg/kg of vardenafil. Vardenafil or vehicle solution was administered one hour before unilateral nephrectomy and the
induction of 45 min of ischemia on the contralateral kidney by clamping of renal pedicle. Four hours of reperfusion were allowed
after renal ischemia. Studied parameters were serum creatinine, fractional excretion of sodium (FENa), and histological evaluation
of renal specimens. In addition, renal tissue cGMP levels, ERK1/2 phosphorylation as well as renal function by renal scintigraphy
were also evaluated.
Results
Administration of vardenafil before the induction of ischemia resulted in a significant reduction in creatinine and FENa levels
as well as in less histological lesions observed in treated kidneys in comparison with the vehicle-treated group. The underlying
mechanism of cytoprotection was cGMP depended and involved the phosphorylation of ERK proteins. Renal scintigraphy confirmed
that PDE5 inhibition attenuates renal IRI.
Conclusions
Vardenafil attenuates renal IRI. Based on similar results from relevant studies on other PDE-5 inhibitors in renal and cardiac
IRI, it can be assumed that all PDE-5 inhibitors share a common mechanism of cytoprotection.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0980-4
Authors
Iason Kyriazis, Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece
George C. Kagadis, Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
Panagiotis Kallidonis, Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece
Ioannis Georgiopoulos, Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece
Antonia Marazioti, Laboratory of Molecular Pharmacology, Department of Pharmacy, University of Patras, Patras, Greece
Aikaterini Geronasiou, Department of Anatomy, University of Patras, Patras, Greece
Despοina Liourdi, Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece
George Loudos, Department of Medical Instruments, TEI Athens, Athens, Greece
Vasilios Schinas, Department of Biochemistry, University Hopsital of Rion, Patras, Greece
Dimitris Apostolopoulos, Department of Nuclear Medicine, University of Patras, Patras, Greece
Helen Papadaki, Department of Anatomy, University of Patras, Patras, Greece
Christodoulos Flordellis, Department of Pharmacology, Medical School, University of Patras, Patras, Greece
George C. Nikiforidis, Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
Andreas Papapetropoulos, Laboratory of Molecular Pharmacology, Department of Pharmacy, University of Patras, Patras, Greece
Evangelos Ν. Liatsikos, Department of Urology, University of Patras Medical School, Rion, 26 500 Patras, Greece
A second transurethral resection of the bladder (TURB) is recommended for high-grade bladder cancer (BC) yet yields negative
results in over half of the cases. Aim of this study was to identify prognostic indicators of a positive second TURB or the
need for a subsequent cystectomy.
Materials and methods
The study cohort consisted of 101 patients with high-risk BC (T1G2-3, TaG3, Carcinoma in situ) who underwent second TURB after complete first resection. Age, gender, stage, grade, carcinoma in situ (Cis), tumour number, size, localization, surgeon experience and bladder wash cytology before the second TURB were considered as
potential prognostic factors of positive histology at second TURB or the need for subsequent cystectomy.
Results
The mean follow-up period was 23.8 months. The study cohort was comprised of 82 males and 17 females. Cytology on bladder
wash urine was performed in 85/101 patients and in 39 was negative; 55.5 % of second TURB specimens were negative. The rate
of upstaging to ≥T2 was 4.9 %. Cis (OR 8.4; 95 % CI 1.3–54.2; p = 0.03) and positive cytology (OR 6.8; 95 % CI 2.3–19.9; p = <0.01) were independent prognostic factors of a residual tumour in the second TURB. Cytology also correlated with clinical
need for cystectomy in the follow-up (HR 6.5; 95 % CI 1.3–30.5; p = 0.02).
Conclusions
CIS and positive cytology prior to second TURB increased the risk of a positive second TURB specimen. A positive cytology
also increases the risk of the subsequent need for cystectomy.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0975-1
Authors
M. Lodde, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
R. Mayr, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
T. Martini, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
E. Comploj, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
S. Palermo, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
E. Trenti, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
E. Hanspeter, Department of Pathology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
H. M. Fritsche, Department of Urology, University of Regensburg, Caritas-Krankenhaus St. Josef Univers Landshuter Str. 65, 93059 Regensburg, Germany
C. Mian, Department of Pathology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
A. Pycha, Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy
Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects
functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess
urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical
prostatectomy (RARP).
Methods
Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension
on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function,
estimated blood loss (EBL), operative time, and positive surgical margins (PSM).
Results
In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and
higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month
urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate
(PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and
continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM.
Conclusions
While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on
the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral
versus non-/unilateral nerve-sparing also improves urinary function recovery.
Content Type Journal Article
Category Original Article
Pages 1-7
DOI 10.1007/s00345-012-0973-3
Authors
Keith J. Kowalczyk, Department of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, Washington, DC 20007, USA
Andy C. Huang, Department of Urology, Tapei City Hospital-Renai Branch, Tapei, Taiwan
Nathanael D. Hevelone, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women’s/Faulkner Hospital, Boston, MA, USA
Stuart R. Lipsitz, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women’s/Faulkner Hospital, Boston, MA, USA
Hua-yin Yu, Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
John H. Lynch, Department of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, Washington, DC 20007, USA
Jim C. Hu, Department of Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
Micropapillary (MP) bladder cancer is a rare variant of urothelial carcinoma (UC) which has been associated with an aggressive
natural history. We sought to report the outcomes of patients with MP bladder cancer treated with radical cystectomy (RC)
and compare survival to patients with pure UC of the bladder.
Methods
We identified 73 patients with MP bladder cancer and 748 patients with pure UC who underwent RC at our institution with median
postoperative follow-up of 9.6 years. MP patients were stage-matched 1:2 to patients with pure UC. Survival was estimated
using the Kaplan–Meier method and compared with the log-rank test.
Results
MP cancers were associated with a high rate of adverse pathologic features, as 48/73 patients (66 %) had pT3/4 tumors and
37 (50 %) had pN+ disease. Ten-year cancer-specific survival in MP patients was 31 %, compared with 53 % in the overall cohort
with pure UC (p = 0.001). When patients with MP bladder cancer were then stage-matched to those with pure UC, no significant differences
between the groups were noted with regard to 10-year local recurrence-free survival (62 vs. 69 %; p = 0.87), distant metastasis-free survival (44 vs. 56 %; p = 0.54), or cancer-specific survival (31 vs. 40 %; p = 0.41).
Conclusion
MP cancers are associated with a higher rate of locally advanced disease. However, when matched to patients with pure UC,
patients with MP tumors did not have increased local/distant recurrence or adverse cancer-specific survival following RC.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0976-0
Authors
Jeffrey K. Wang, Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Stephen A. Boorjian, Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
John C. Cheville, Department of Pathology, Mayo Clinic, Rochester, MN, USA
Simon P. Kim, Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Robert F. Tarrell, Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA
Prabin Thapa, Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA
Igor Frank, Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
To retrospectively analyze the clinical outcome of patients with hepatic metastases from renal cell carcinoma who were treated
with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT).
Methods
Ten patients (7 men and 3 women; median age 72 ± 7.9 years) with a total number of 16 hepatic metastases from histologically
proven renal cell carcinoma were treated with CT-HDRBT after discussing the case in an interdisciplinary tumor conference.
All patients had underwent nephrectomy before CT-HDRBT. Three patients had extrahepatic manifestations (2 lung and 1 bone).
Six patients had received immunotherapy or targeted therapy before CT-HDRBT. Follow-up included gadoxetic acid (Gd-EOB-DTPA)
enhanced MRI two times within 6–8 weeks and after that every 3 months after treatment to evaluate treatment efficacy.
Results
Mean follow-up time was 21.6 ± 13.7 months. One patient developed local and systemic (pulmonary and osseous) progression after
10.8 months which was treated with targeted therapy and died 20.3 months after CT-HDRBT. None of the remaining nine patients
developed local progression or died during the follow-up period. Five patients developed systemic progression (3 pulmonary,
1 osseous and 1 locally at the site of nephrectomy) after an average of 19.7 ± 5.5 months.
Conclusions
CT-HDRBT is a viable alternative to hepatic resection of liver metastases from renal cell carcinoma in selected patients.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0981-3
Authors
Dominik Geisel, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Federico Collettini, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Timm Denecke, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Christian Grieser, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Anne Flörcken, Department of Hematology and Oncology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Peter Wust, Department of Radiation Oncology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Bernd Hamm, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Bernhard Gebauer, Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and
many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic
hematuria the risk of having bladder cancer can be predicted with high accuracy. Toward this end, we analyzed risk factors
in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.
Methods
Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria
were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were
recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors
associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses.
The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.
Results
Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7 %) had bladder cancer. Increasing age (OR = 1.03,
p < 0.0001), smoking history (OR = 3.72, p < 0.0001), gross hematuria (OR = 1.71, p = 0.002), and positive cytology (OR = 14.71, p < 0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1 % accuracy for predicting
the presence of bladder cancer.
Conclusions
Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed
a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0979-x
Authors
Eugene K. Cha, Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY 10065, USA
Lenuta-Ancuta Tirsar, Department of Urology, EuromedClinic, Fürth, and Urologie24, Nürnberg, Germany
Christian Schwentner, Department of Urology, University of Tübingen, Tübingen, Germany
Joerg Hennenlotter, Department of Urology, University of Tübingen, Tübingen, Germany
Paul J. Christos, Division of Biostatistics and Epidemiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
Arnulf Stenzl, Department of Urology, University of Tübingen, Tübingen, Germany
Christine Mian, Department of Pathology, General Hospital of Bolzano, Bolzano, Italy
Thomas Martini, Department of Urology, General Hospital of Bolzano, Bolzano, Italy
Armin Pycha, Department of Urology, General Hospital of Bolzano, Bolzano, Italy
Shahrokh F. Shariat, Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY 10065, USA
Bernd J. Schmitz-Dräger, Department of Urology, EuromedClinic, Fürth, and Urologie24, Nürnberg, Germany
To investigate the clinical implication of legumain, an asparaginyl endopeptidase that is highly expressed in several types
of cancer, expression in prostate cancer.
Methods
Legumain expression in prostate cancer cell lines was determined by real-time reverse transcriptase PCR and Western blot.
Furthermore, legumain expression in 88 prostatectomy specimens was evaluated by immunohistochemistry. The association between
legumain expression and clinicopathological factors was analyzed.
Results
Legumain expression was confirmed at the mRNA and protein levels in all the cells. Although all the cancer tissues were positive
for legumain, 2 staining patterns were observed in the cytoplasm: diffuse cytoplasmic and vesicular positivity. The rates
of Gleason score ≥8, extracapsular extension, and perineural invasion in the group with vesicular staining were significantly
higher than those in the diffuse cytoplasmic group (p < 0.05). The maximum size of the tumor with vesicular staining was significantly greater than that of the tumor with diffuse
cytoplasmic staining (p = 0.0302). The 5-year biochemical recurrence-free rate in the patients with vesicular legumain staining was 53.2 %; this
rate was significantly lower than that (78.8 %) in the patients with diffuse cytoplasmic staining (p = 0.0269).
Conclusions
Tumors that showed a vesicular staining pattern of legumain had the potential of being highly invasive and aggressive in patients
with prostate cancer who were treated with radical prostatectomy. This suggests that legumain might contribute to the invasiveness
and aggressiveness of prostate cancer.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0977-z
Authors
Yoshio Ohno, Department of Urology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
Jun Nakashima, Department of Urology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
Miki Izumi, Department of Diagnostic Pathology, Tokyo Medical University, Tokyo, Japan
Makoto Ohori, Department of Urology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
Takeshi Hashimoto, Department of Urology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
Masaaki Tachibana, Department of Urology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney
stones.
Methods
Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected
retrospectively by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics,
stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication
rates between prone- and supine PCNL.
Results
One hundred seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole
(single stone: 53.6 %; multiple stones: 46.4 %). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple
lower pole stones were treated with supine PCNL (5.8 vs. 23.1 %; p = 0.0001, and 25 vs. 81.5 %; p = 0.0001, respectively, for prone- and supine PCNL). One-month SFR was 88.9 %; an auxiliary procedure was needed in 6 patients;
the 3-month SFR was 90.2 %. There were 9 post-operative major complications (7.7 %). No differences were observed in terms
of 1- and 3-month SFRs (90.4 vs. 87.7 %; p = 0.64; 92.3 vs. 89.2 %; p = 0.4) and complication rates (7.6 vs. 7.7 %; p = 0.83) when comparing prone- versus supine PCNL, respectively.
Conclusions
The results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, regardless the
position used. Supine PCNL was more frequently offered in case of patients at higher ASA score and in case of multiple lower
pole stones.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0941-y
Authors
Francesco Sanguedolce, Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, C/Cartagena 340-350, 08026 Barcelona, Spain
Alberto Breda, Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, C/Cartagena 340-350, 08026 Barcelona, Spain
Felix Millan, Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, C/Cartagena 340-350, 08026 Barcelona, Spain
Marianne Brehmer, Department of Urology, Karolinska University Hospital, Stockholm, Sweden
Thomas Knoll, Department of Urology, Klinikum Sindelfingen, University of Tübingen, Tübingen, Germany
Evangelos Liatsikos, Department of Urology, Patras University, Patras, Greece
Palle Osther, Department of Urology, Frederica Hospital, University of Southern Denmark, Fredericia, Denmark
Olivier Traxer, Department of Urology, Tenon Hospital, 6th University of Paris, Paris, France
Cesare Scoffone, Department of Urology, Cottolengo Hospital, Turin, Italy
Open surgery (ONU) is still considered to be the gold standard approach for nephroureterectomy (NU); however, with the introduction
of laparoscopic surgery, minimally invasive techniques have been applied to surgical therapy of upper urinary tract tumours
(UUT-UC) and they are gaining adepts. However, several concerns still exist about the safety of laparoscopic nephroureterectomy
(LNU) in the treatment of UUT-UC, and different authors suggest that, although it could be equivalent to open surgery, this
equivalence is not accomplished in all UUT-UC, suggesting that more advanced disease should undergo open surgery. More controversial
still is the application of robotic surgery (RALNU) or really novel minimally invasive techniques, such as laparoendoscopic
single-site surgery (LESSNU), for the treatment of UUT-UC. Although all these techniques seem feasible, their influence on
oncologic results is still a matter of concern.
Methodology
We present a review on the oncologic outcomes of minimally invasive laparoscopic techniques in the treatment of UUT-UC. We
focus our analysis on oncologic outcomes and we also analyze the different techniques proposed for the treatment of the distal
ureter during minimally invasive surgery for UUT-UC. In the absence of prospective randomized studies with large patient samples,
we must base our conclusions on retrospective studies and longer follow-up.
Conclusion
Given the evidence accumulated so far, LNU has proven to be equivalent or non-inferior, in terms of recurrence-free survival
(RFS) and cancer-specific survival (CSS) to ONU. Nevertheless, comparative studies are needed with longer follow-up before
determining the equivalence of LNU in advanced tumours.
Content Type Journal Article
Category Topic paper
Pages 1-15
DOI 10.1007/s00345-012-0968-0
Authors
Maria J. Ribal, Uro-Oncology Unit, Urology Department, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
J. Huguet, Uro-Oncology Unit, Urology Department, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
A. Alcaraz, Uro-Oncology Unit, Urology Department, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
First analysis of immune cell infiltration in stage pT1 urothelial bladder carcinoma: CD3 positivity as a prognostic marker for cancer-specific survival
Content Type Journal Article
Category Letter to Editor
Pages 1-3
DOI 10.1007/s00345-012-0974-2
Authors
Wolfgang Otto, Caritas St. Josef Medical Centre, Department of Urology, Regensburg University, Landshuterstraße 65, 93053 Regensburg, Germany
Stefan Denzinger, Caritas St. Josef Medical Centre, Department of Urology, Regensburg University, Landshuterstraße 65, 93053 Regensburg, Germany
Wolf F. Wieland, Caritas St. Josef Medical Centre, Department of Urology, Regensburg University, Landshuterstraße 65, 93053 Regensburg, Germany
Arndt Hartmann, Institute of Pathology, University of Erlangen, Erlangen, Germany
To evaluate sex as a possible prognostic factor in bladder cancer patients treated with transurethral resection (TURBT) and
radio- (RT) or radiochemotherapy (RCT).
Methods
Kaplan–Meier analyses and multiple Cox proportional hazards regression analyses were performed to analyze sex as a possible
prognostic factor on the overall (OS) and cancer-specific (CSS) survival of 386 male and 105 female patients who underwent
TURBT and RCT or RT with curative intent between 1982 and 2007.
Results
After a follow-up of 5 years, female sex demonstrated a hazard ratio (HR) of 1.79 (95 % CI 1.24–2.57) for OS; for CSS, the
HR was 2.4 (95 % CI 1.52–3.80). Sex was an adverse prognosticator of both OS and CSS independent from age at diagnosis, cT
stage, grading, concurrent cis, LVI, focality, therapy response, resection status and therapy mode. Kaplan–Meier analysis
showed significantly reduced OS of women compared with men, with a median survival of 2.3 years for female patients and 5.1 years
for male patients (p = 0.045, log-rank test). The estimated median CSS was 7.1 years for female patients and 12.7 years for male patients (p = 0.11, log-rank test).
Conclusions
Female sex is an independent prognostic factor for reduced OS and CSS in bladder cancer patients treated by TURBT and RT or
RCT. These data are in agreement with those reported for OS after radical cystectomy in muscle-invasive bladder cancers. Therefore,
further studies are strongly warranted to obtain more information about molecular differences regarding sex-specific carcinogenesis
in bladder cancer and about possible therapeutic considerations.
Content Type Journal Article
Category Topic paper
Pages 1-6
DOI 10.1007/s00345-012-0971-5
Authors
Bastian Keck, Department of Urology, University Hospital Erlangen, Universitätsstraße 12, 91052 Erlangen, Germany
Oliver J. Ott, Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
Lothar Häberle, Clinical Cancer Registry, Tumor Center of the University Erlangen, Erlangen, Germany
Frank Kunath, Department of Urology, University Hospital Erlangen, Universitätsstraße 12, 91052 Erlangen, Germany
Christian Weiss, Department of Radiotherapy and Oncology, University Frankfurt am Main, Frankfurt am Main, Germany
Claus Rödel, Department of Radiotherapy and Oncology, University Frankfurt am Main, Frankfurt am Main, Germany
Rolf Sauer, Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
Rainer Fietkau, Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
Bernd Wullich, Department of Urology, University Hospital Erlangen, Universitätsstraße 12, 91052 Erlangen, Germany
Frens S. Krause, Department of Urology, AKH, General Hospital, Linz, Austria
Prostate cells are dependent on androgens for growth and proliferation. Androgen deprivation therapy is the recommended treatment
for advanced/metastatic prostate cancer. Under this therapy, prostate cancer will inevitably progress to castration resistant
prostate cancer (CRPC). Despite putative castration resistance, testosterone might still play a crucial role in the progression
of CRPC. The goal of this study was to determine the role of testosterone in the formation of metastases of CRPC in both in
vitro and in vivo settings.
Methods
In vitro, the effect of testosterone and the non-aromatizable androgen methyltrienolone on migration, invasion and proliferation
of a castration-resistant prostate cancer rat cell line (Dunning R3327-MATLyLu) was assessed using a transwell assay and a
sulforhodamine B assay and immunohistochemical detection of ki67. Androgen receptor status was determined using Western blot.
In vivo, Copenhagen rats were divided in four groups (males, females, castrated males and females with testosterone suppletion)
and inoculated with MATLyLu cells. Tumor size was assessed daily.
Results
Testosterone increased cell migration and invasion in a concentration-dependent manner in vitro. Testosterone did not affect
in vitro cell proliferation. No difference was shown between the effect of testosterone and methyltrienolone. In vivo, in
groups with higher levels of circulating testosterone, more rats had (micro)metastases compared with groups with low levels
of testosterone. No effect was observed on primary tumor size/growth.
Conclusions
Despite assumed castration resistance, progression of prostate cancer is still influenced by androgens. Therefore, continuous
suppression of serum testosterone in patients who show disease progression during castration therapy is still warranted.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0972-4
Authors
Tim M. van der Sluis, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Irene V. Bijnsdorp, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
John J. L. Jacobs, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Eric J. H. Meuleman, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Lawrence Rozendaal, Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
Albert A. Geldof, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
R. Jeroen A. van Moorselaar, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
André N. Vis, Department of Urology, VU University Medical Center, Room 4F027, PO Box 7057, 1007 MB Amsterdam, The Netherlands
To compare patient-reported outcomes (PROs) with objective outcomes after shock wave lithotripsy (SWL) and ureteroscopic surgery
(URS) for ureteral calculi (UC).
Methods
We prospectively evaluated 160 consecutive patients who underwent SWL (n = 65) or URS (n = 95) for a single radiopaque UC ranging from 4 to 15 mm. For patients who underwent URS, a 6-Fr double-J stent was routinely
placed for 2 weeks after surgery. To examine PRO, we used a self-administered nonvalidated questionnaire evaluating overall
satisfaction and PRO in four domains (pain, hematuria, voiding symptom, and time to return to routine activity) and willingness
to undergo the treatment procedure again. Propensity-score matching analysis was performed to adjust for potential confounding
by discrepancy of pretreatment parameters between groups. Stone-free rates (SFRs) and complications were also compared.
Results
SFRs after the first, second, and third sessions of SWL were 61.5, 81.0, and 93.5 %, respectively. SFR after URS was 100 %,
which was significantly better than SFRs for third-session SWL (p = 0.023). Complications were comparable. By propensity-score matching analysis, overall satisfaction was similar between
groups, whereas PRO for voiding symptom and time to return to routine activity were significantly better in the SWL group
(all p < 0.05). The two groups were not different in willingness to undergo the same procedure again.
Conclusions
Despite significantly higher SFR after URS for UC, overall patient satisfaction was comparable after SWL and URS, meanwhile
PRO of the SWL group was better than URS for voiding symptom and time to return to routine activity. In addition of objective
treatment outcomes, PROs should be considered in counseling treatment methods for UC.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0966-2
Authors
Jinsung Park, Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
Dong Wook Shin, Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
Jae Hoon Chung, Department of Urology, Hanyang University Guri Hospital, 249-1 Gyomun-dong, Guri, 471-701 Korea
Seung Wook Lee, Department of Urology, Hanyang University Guri Hospital, 249-1 Gyomun-dong, Guri, 471-701 Korea
To evaluate the clinical usefulness of sonographic measurement of detrusor wall thickness (DWT) for the prediction of risk
factors in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI).
Methods
In a prospective study, 60 consecutive patients with NLUTD due to SCI presenting for routine urodynamic assessment at a specialized
SCI center underwent additional measurement of DWT at varying bladder volumes. Results of urodynamic testing were classified
into favorable and unfavorable. DWT at maximum capacity was used to calculate a possible cutoff value for favorable urodynamic
results.
Results
Urodynamic results were favorable in 48 patients and unfavorable in 12 patients. A DWT of 0.97 mm or less can safely (sensitivity
91.7 %, specificity 63.0 %) be used as a cutoff point for the absence of risk factors for renal damage.
Conclusion
According to our results, DWT may be useful as an additional risk assessment for renal damage in patients with NLUTD due to
SCI. However, as other parameters required for bladder management, especially detrusor overactivity, cannot be evaluated by
this technique, it cannot replace urodynamic testing.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0970-6
Authors
Jürgen Pannek, Department of Neuro-Urology, Swiss Paraplegic Center, Guido A. Zäch Strasse 1, 6207 Nottwil, Switzerland
Peter Bartel, Department of Neuro-Urology, Swiss Paraplegic Center, Guido A. Zäch Strasse 1, 6207 Nottwil, Switzerland
Konrad Göcking, Department of Neuro-Urology, Swiss Paraplegic Center, Guido A. Zäch Strasse 1, 6207 Nottwil, Switzerland
Angela Frotzler, Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL).
Methods
The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients
treated with PCNL over a 1-year period at 96 participating centers worldwide. This report focuses on the 3,968 patients who
received a NT of known size. Preoperative, surgical procedure and outcome data were analyzed according to NT size, dividing
patients into two groups, namely small-bore (SB; nephrostomy size ≤ 18 Fr) and large-bore (LB; nephrostomy size > 18 Fr) NT.
Results
Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/dL; P < 0.001), overall complications (15.8 vs. 21.4 %; P < 0.001) and a trend toward a lower rate of fever (9.1 vs. 10.7 %). Patients receiving a LB NT conversely had a statistically,
though not clinically significant, longer postoperative hospital stay (4.4 vs. 4.2 days; P = 0.027). There were no differences in urinary leakage (0.9 vs. 1.3 %, P = 0.215) or stone-free rates (79.5 vs. 78.1 %, P = 0.281) between the two groups.
Conclusions
LB NTs seem to reduce bleeding and overall complication rate. These findings would suggest that if a NT has to be placed,
it should better be a LB one.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0969-z
Authors
Luigi Cormio, Department of Urology, University of Foggia, Foggia, Italy
Glenn Preminger, Department of Urology, Duke University Medical Center, Durham, NC, USA
Christian Saussine, Department of Urology, University of Strasbourg, Strasbourg, France
Niels Peter Buchholz, Department of Urology, Barts & The London NHS Trust, London, UK
Xiaochun Zhang, Department of Urology, Peking University First Hospital, Beijing, China
Helena Walfridsson, Department of Urology, University Hospital, Orebro, Sweden
Andreas J. Gross, Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
Jean de la Rosette, Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ Amsterdam Z-O, The Netherlands
Despite standard treatment with transurethral resection (TUR) and adjuvant bacillus Calmette–Guérin (BCG), many high-risk
bladder cancers (HRBCs) recur and some progress. Based on a review of the literature, we aimed to establish the optimal current
approach for the early diagnosis and management of HRBC.
Methods
A MEDLINE® search was conducted to identify the published literature relating to early identification and treatment for non-muscle-invasive
bladder cancer. Particular attention was paid to factors such as quality of TUR, importance of second TUR, substaging, and
CIS. In addition, studies on urinary markers, photodynamic diagnosis, predictive clinical and molecular factors for recurrence
and progression after BCG, and best management practice were analysed.
Results and conclusions
Good quality of TUR and the implementation of photodynamic diagnosis in selected cases provide a more accurate diagnosis and
reduce the risk of residual tumour in HRBC. Although insufficient evidence is available to warrant the use of new urinary
molecular markers in isolation, their use in conjunction with cytology and cystoscopy may improve early diagnosis and follow-up.
BCG plus maintenance for at least 1 year remains the standard adjuvant treatment for HRBC. Moreover, there is enough evidence
to consider the implementation of new specific risk tables for patients treated with BCG. In HRBC patients with poor prognostic
factors after TUR, early cystectomy should be considered.
Content Type Journal Article
Category Invited Review
Pages 1-8
DOI 10.1007/s00345-012-0967-1
Authors
Oscar Rodriguez Faba, Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, C/Cartagena, 340-350, 08025 Barcelona, Spain
Joan Palou, Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, C/Cartagena, 340-350, 08025 Barcelona, Spain
Alberto Breda, Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, C/Cartagena, 340-350, 08025 Barcelona, Spain
H. Villavicencio, Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, C/Cartagena, 340-350, 08025 Barcelona, Spain
According to the current upper urinary tract urothelial carcinomas (UTUC) guidelines, ureteroscopic evaluation (URS) is recommended
to improve diagnostic accuracy and obtain a grade (by biopsy or cytology). However, URS may delay radical surgery [e.g., nephroureterectomy
(RNU)]. The objective of this study was to evaluate the influence of URS implementation before RNU on patient survival.
Methods
A French multicentre retrospective study including 512 patients with nonmetastatic UTUC was conducted between 1995 and 2011.
Achievement of ureteroscopy (URS), treatment time (time between imaging diagnosis and RNU), tumour location, pT–pN stage,
grade, lymphovascular invasion (LVI) and the presence of invaded surgical margins (R+) were evaluated as prognostic factors
for survival using univariate and multivariate Cox regression analyses. Cancer-specific survival (CSS), recurrence-free survival
(RFS) and metastasis-free survival (MFS) were calculated using the Kaplan–Meier method.
Results
A total of 170 patients underwent ureteroscopy prior to RNU (URS+ group), and 342 did not undergo URS (URS−). The median treatment
time was significantly longer in the URS+ group (79.5 vs. 44.5 days, p = 0.04). Ureteroscopic evaluation was correlated with ureteral location and lower stage and tumour grade (p = 0.022, 0.005, 0.03, respectively). Tumour stage, LVI+ and R+ status were independently associated with CSS (p = 0.024, 0.049 and 0.006, respectively). The 5-year CSS, RFS and MFS did not differ between the two groups (p = 0.23, 0.89 and 0.35, respectively). These results were confirmed for muscle-invasive (MI) UTUC (p = 0.21, 0.44 and 0.67 for CSS, RFS and MFS, respectively).
Conclusions
Despite the increased time to radical surgery, diagnostic ureteroscopy can be systematically performed for the appraisal of
UTUC to refine the therapeutic strategy without significantly affecting oncological outcomes, even for MI lesions.
Content Type Journal Article
Category Topic Paper
Pages 1-8
DOI 10.1007/s00345-012-0959-1
Authors
Laurent Nison, Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037 Lille, France
Morgan Rouprêt, Department of Urology, Université Paris 6, CHU Pitié Salpétrière, AP-HP, Paris, France
Grégory Bozzini, Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037 Lille, France
Adil Ouzzane, Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037 Lille, France
François Audenet, Department of Urology, Université Paris 6, CHU Pitié Salpétrière, AP-HP, Paris, France
Géraldine Pignot, Department of Urology, Université Paris 5, Hôpital Cochin, AP-HP, Paris, France
Alain Ruffion, Department of Urology, CHU Lyon-Sud, Lyon, France
Jean-Nicolas Cornu, Department of Urology, Hôpital Tenon, AP-HP, Paris, France
Sophie Hurel, Department of Urology, Hôpital Côte de Nacre, CHU Caen, Caen, France
Antoine Valeri, Department of Urology, Hôpital de la Cavale Blanche, CHU Brest, Brest, France
Mathieu Roumiguie, Department of Urology, Hôpital de Rangueil, CHU Toulouse, Toulouse, France
Thomas Polguer, Department of Urology, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
Nicolas Hoarau, Department of Urology, CHU Angers, Angers, France
Olivier Mérigot de Treigny, Department of Urology, Hôpital de Rangueil, CHU Toulouse, Toulouse, France
Evanguelos Xylinas, Department of Urology, Hôpital Henri Mondor, AP-HP, Creteil, France
Alexandre Matte, Department of Urology, Hôpital Le Bocage, CHU Dijon, Dijon, France
Stéphane Droupy, Department of Urology, Hôpital Carémeau, CHU Nimes, Nimes, France
Pierre Olivier Fais, Department of Urology, Hôpital Nord, AP-HM, Marseille, France
Aurélien Descazeaud, Department of Urology, Hôpital Dupuytren, CHU Limoges, Limoges, France
Pierre Colin, Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037 Lille, France
MD for the French Collaborative National Database on UUT-UC
There is a lack of studies comparing shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive
percutaneous nephrolithotomy (MIP) in renal stone treatment. This study compared treatment outcome, stone-free rate (SFR)
and stone-free survival (SFS) with regard to stone size and localization.
Methods
This analysis included 482 first-time-treated patients in the period 2001–2007. Detailed clinical information, stone analysis
and metabolic evaluation were evaluated retrospectively. Outcome, SFR and SFS were analyzed with regard to size (<1 vs. ≥1 cm)
and localization (lower vs. non-lower pole).
Results
Higher SFRs in lower and non-lower pole stones ≥1 cm were confirmed for RIRS and MIP (p < 0.0001). A regression model confirmed a higher risk of non-lower pole stone persistence for SWL versus RIRS (OR: 2.27,
p = 0.034, SWL vs. MIP (OR: 3.23, p = 0.009) and larger stone burden ≥1 versus <1 cm (OR: 2.43, p = 0.006). In accordance, a higher risk of residual stones was found in the lower pole for SWL versus RIRS (OR: 2.67, p = 0.009), SWL versus MIP (OR: 4.75, p < 0.0001) and stones ≥1 cm versus <1 cm (OR: 3.02, p = 0.0006). In RIRS and MIP patients, more complications, stenting, prolonged disability, need/duration of hospitalization
and analgesia were noticed (p < 0.05). Overall SFS increased from SWL, RIRS, to MIP (p < 0.001). SWL showed lower SFS for non-lower pole (p = 0.006) and lower pole stones (p = 0.007).
Conclusions
RIRS and MIP were shown to have higher stone-free rates and SFS compared to SWL. The price for better outcome was higher,
considering tolerable complication rates. Despite larger preoperative stone burden, MIP achieved high and long-term treatment
success.
Content Type Journal Article
Category Original Article
Pages 1-7
DOI 10.1007/s00345-012-0962-6
Authors
Stephan Kruck, Department of Urology, University of Tuebingen, Tübingen, Germany
Aristoteles G. Anastasiadis, Department of Urology, University of Rostock, Rostock, Germany
Thomas R. W. Herrmann, Department of Urology, Hannover Medical School, Hannover, Germany
Ute Walcher, Department of Urology, General Hospital Hall i.T., Milser Straße 10–12, 6060 Hall in Tirol, Austria
Mohamed F. Abdelhafez, Department of Urology, University of Tuebingen, Tübingen, Germany
André P. Nicklas, Department of Urology, General Hospital Hall i.T., Milser Straße 10–12, 6060 Hall in Tirol, Austria
Lillian Hölzle, Department of Urology, University of Tuebingen, Tübingen, Germany
David Schilling, Department of Urology, University of Tuebingen, Tübingen, Germany
Jens Bedke, Department of Urology, University of Tuebingen, Tübingen, Germany
Arnulf Stenzl, Department of Urology, University of Tuebingen, Tübingen, Germany
Udo Nagele, Department of Urology, General Hospital Hall i.T., Milser Straße 10–12, 6060 Hall in Tirol, Austria
Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma
(UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to
the clinicopathological features.
Materials and methods
A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for
non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate
analyses were conducted to identify factors associated with survival.
Results
Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only
with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and
the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate
analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group
(69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor
of MFS (p = 0.01) but not CSS (p = 0.86).
Conclusion
Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal
tumours appear to have a worse prognosis than ureteral tumours.
Content Type Journal Article
Category Topic Paper
Pages 1-9
DOI 10.1007/s00345-012-0964-4
Authors
G. Bozzini, Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France
L. Nison, Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France
P. Colin, Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France
A. Ouzzane, Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France
D. R. Yates, Academic Department of Urology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
F. Audenet, Academic Department of Urology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
G. Pignot, Academic Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, René Descartes University, Paris, France
A. Arvin-Berod, Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble, France
O. Merigot, Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France
L. Guy, Academic Department of Urology, CHRU Clermont-Ferrand, University of Clermont-Ferrand, Clermont-Ferrand, France
J. Irani, Academic Department of Urology, Centre Hospitalier Universitaire of Poitiers, Poitiers, France
F. Saint, Academic Department of Urology, CHRU Amiens, University of Amiens, Amiens, France
S. Gardic, Academic Department of Urology, CHRU Limoges, University of Limoges, Limoges, France
P. Gres, Academic Department of Urology, CHRU Nîmes, University of Nîmes, Nimes, France
F. Rozet, Academic Department of Urology, Institut Mutualiste Montsouris, Paris, France
Y. Neuzillet, Academic Department of Urology, Academic Hospital of Foch, Suresnes, France
A. Ruffion, Academic Department of Urology, CHRU Lyon Sud, University of Lyon, Lyon, France
M. Roupret, Academic Department of Urology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval
ureter and our initial experience with this method in 4 patients.
Methods
From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade
single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and
Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway
between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly
to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail
ureteral stent assembly was implanted in 3 of the 4 patients.
Results
All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The
mean operating time was 105 min (range, 90–135 min). The mean blood loss was 18 mL (range, 5–50 mL). None of the patients
required blood transfusion. The double-pigtail ureteral stent was removed 4–6 weeks postoperatively. The mean postoperative
hospital stay was 7.3 days (range, 6–9 days). No intraoperative or postoperative complications occurred. At a mean follow-up
of 10 months, excellent improvement in the ureteral obstruction was observed.
Conclusions
We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that
this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed
to confirm its benefits.
Content Type Journal Article
Category Original Article
Pages 1-7
DOI 10.1007/s00345-012-0965-3
Authors
Ning Kang, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Jun-hui Zhang, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Yi-nong Niu, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Jian-wen Wang, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Xi-quan Tian, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Yan Yong, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Nian-zeng Xing, Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020 China
Microbial ureteral stent colonisation (MUSC) is one leading risk factor for complications associated with ureteral stent placement.
As MUSC remains frequently undetected by standard urine cultures, its definitive diagnosis depends on microbiological investigation
of the stent. However, a standard reference laboratory technique for studying MUSC is still lacking.
Materials and methods
A total of 271 ureteral stents removed from 199 consecutive patients were investigated. Urine samples were obtained prior
to device removal. Stents were divided into four parts. Each part was separately processed by the microbiology laboratory
within 6 h. Ureteral stents were randomly allocated to roll-plate or sonication, respectively, and analysed using standard
microbiological techniques. Demographic and clinical data were prospectively collected using a standard case-report form.
Results
Overall, roll-plate showed a higher detection rate of MUSC compared with sonication (35 vs. 28 %, p < 0.05) and urine culture (35 vs. 8 %, p < 0.05). No inferiority of Maki’s technique was observed even when stents were stratified according to indwelling time below or above
30 days. Compared with roll-plate, sonication commonly failed to detect Enterococcus spp., coagulase-negative staphylococci (CoNS) and Enterobacteriaceae. In addition, sonication required more hands-on time, more equipment and higher training than roll-plate in the laboratory.
Conclusions
This prospective randomised study demonstrates the superiority of Maki’s roll-plate technique over sonication in the diagnosis
of MUSC and that urine culture is less sensitive than both methods. The higher detection rate, simplicity and cost-effectiveness
render roll-plate the methodology of choice for routine clinical investigation as well as basic laboratory research.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0963-5
Authors
G. Bonkat, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
O. Braissant, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
M. Rieken, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
G. Müller, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
R. Frei, Clinical Microbiology Laboratory, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
Andre van der Merwe, Department of Urology, Faculty of Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg, 7505 South Africa
F. P. Siegel, Department of Urology, University Hospital Mannheim, Ruprecht-Karls University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
T. C. Gasser, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
S. Wyler, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
A. Bachmann, Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
A. F. Widmer, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
We report on a 62-year-old gentleman presenting at our urological department with an advanced renal cell cancer of the right
kidney (10 cm in diameter), with an extensive caval vein thrombus (level IV) and bilateral pulmonary metastases. Another suspicious
lesion at the left hemithorax was radiologically described.
Method
A presurgical, neoadjuvant systemic therapy with sunitinib, a tyrosine kinase inhibitor, was initiated for 4 cycles in total
(50 mg/day; 4 weeks on/2 weeks off). The cytoreductive nephrectomy was performed following the fourth cycle of sunitinib and
after a 14-day break. Transesophageal echocardiography was used for intraoperative monitoring of the caval vein thrombus.
Systemic treatment with sunitinib was continued 4 weeks after surgery.
Results
A significant reduction in tumor size, metastatic sites and down-staging of IVC from level IV to level III according to Novick
classification was achieved.
Conclusion
Significant down-staging of the tumor caval vein thrombus which initially reached the right atrium enabled us to perform surgery
limited to the abdominal cavity without extracorporeal circulation nor hypothermia.
Content Type Journal Article
Category Original Article
Pages 1-4
DOI 10.1007/s00345-012-0955-5
Authors
Inga Peters, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Michael Winkler, Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
Björn Jüttner, Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
Omke E. Teebken, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
T. R. Herrmann, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Christoph von Klot, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Mario Kramer, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Angela Reichelt, Institute for Radiology, Hannover Medical School, Hannover, Germany
Mahmoud Abbas, Department of Pathology, Hannover Medical School, Hannover, Germany
Markus A. Kuczyk, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Axel S. Merseburger, Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
To identify predictive factors and assess the impact on oncological outcomes of intravesical recurrence after radical nephroureterectomy
(RNU) in upper tract urothelial carcinoma (UTUC).
Methods
Using a national multicentric retrospective dataset, we identified all patients with UTUC who underwent a RNU between 1995
and 2010 (n = 482). Intravesical recurrence was tested as a prognostic factor for survival through univariable and multivariable Cox
regression analysis.
Results
Overall, intravesical recurrence occurred in 169 patients (35 %) with a median age of 69.2 years (IQR: 60–76) and after a
median follow-up of 39.5 months (IQR: 25–60). Actuarial intravesical recurrence-free survival estimates at 2 and 5 years after
RNU were 72 and 45 %, respectively. On univariable analyses, previous history of bladder tumor, tumor multifocality, laparoscopic
approach, pathological T-stage, presence of concomitant CIS and lymphovascular invasion were all associated with intravesical
recurrence. On multivariable analysis, previous history of bladder cancer, tumor multifocality and laparoscopic approach remained
independent predictors of intravesical recurrence. Existence of intravesical recurrence was not correlated with worst oncological
outcomes in terms of disease recurrence (p = 0.075) and cancer-specific mortality (p = 0.06).
Conclusions
In the current study, intravesical recurrence occurred in 35 % of patients with UTUC after RNU. Previous history of bladder
cancer, tumor multifocality, concomitant CIS and laparoscopic approach were independent predictors of intravesical recurrence.
These findings are in line with recent published data and should be considered carefully to provide a definitive surveillance
protocol regarding management of urothelial carcinomas regardless of the location of urothelial carcinomas in the whole urinary
tract.
Content Type Journal Article
Category Topic paper
Pages 1-8
DOI 10.1007/s00345-012-0957-3
Authors
Evanguelos Xylinas, Department of Urology and Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
Pierre Colin, Academic Department of Urology, CHU Lille, Univ Lille Nord de France, 59000 Lille, France
François Audenet, Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Véronique Phe, Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Luc Cormier, Academic Department of Urology, CHRU Dijon, University of Dijon, Dijon, France
Olivier Cussenot, Academic Department of Urology of Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Alain Houlgatte, Department of Urology, Val de Grâce Military Hospital, Paris, France
Gilles Karsenty, Academic Department of Urology, CHU Marseille, University of Marseille, Marseille, France
Franck Bruyère, Academic Department of Urology, CHRU Tours, University of Tours, Tours, France
Thomas Polguer, Academic Department of Urology, CHRU Clermont Ferrand, University of Clermont Ferrand, Clermont Ferrand, France
Alain Ruffion, Academic Department of Urology, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon, France
Antoine Valeri, Academic Department of Urology, CHRU Brest, University of Brest, Brest, France
François Rozet, Department of Urology, Institut Mutualiste Montsouris, Paris, France
Jean-Alexandre Long, Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble, France
Marc Zerbib, Department of Urology and Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
Morgan Rouprêt, Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Nephroureterectomy with excision of a bladder cuff is the gold standard in the treatment of upper urinary tract carcinomas
(UTUC). But especially for patients suffering from advanced tumor stages, life expectancy has not improved over the years
with local recurrence or distant metastases being the main reasons for treatment failure. Chemotherapy in an adjuvant or neoadjuvant
setting seems therefore to be a promising approach.
Methods
The literature of the last 20 years was searched using Medline. Articles were chosen by using the given abstracts. Only articles
written in English and not older than 20 years were considered.
Results
Most information concerning chemotherapy of urothelial carcinomas is gained from studies comprising patients suffering from
lower urinary tract carcinomas. The combination of methotrexate, adriamycin, vinblastine and cisplatin as well as the combination
of gemcitabine and cisplatin are the most used chemotherapy regimens in advanced UCC and have shown beneficial results. The
summarized data of studies for UTUC contained no level one information. Down staging effects as well as prolongation of survival
have been shown for some patients treated with neoadjuvant chemotherapy, but because of the small study groups and the retrospective
design, no definite conclusions can be drawn from these results. In addition, there exists an uncertainty for preoperative
staging. Results for adjuvant chemotherapy are lacking.
Conclusion
No definite recommendations for peri-operative chemotherapy in UTUC can be derived from the current literature. Current therapy
is largely based on extrapolation from the bladder cancer literature. Prospective studies dedicated to UTUC are needed.
Content Type Journal Article
Category Topic paper
Pages 1-6
DOI 10.1007/s00345-012-0960-8
Authors
Jan Cordier, Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
Guru Sonpavde, Urologic Medical Oncology, UAB Comprehensive Cancer Center, Birmingham, AL, USA
Christian G. Stief, Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
Derya Tilki, Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
Bladder urothelial carcinoma (bladder-UC) displays distinct genotypic differences compared to upper tract UC (UTUC). We recently
reported specific 8q24 SNP variants confer susceptibility to UTUC and aggressive disease features. Herein, we evaluate a bladder-UC
cohort to see whether similar polymorphisms are linked similarly same way with disease risk and aggressiveness.
Methods
231 bladder-UC patients and 261 benign controls were matched for gender, age, ethnicity and smoking habits. We retrospectively
retrieved information on tumour stage, grade, size, multiplicity, carcinoma in situ and tumour number. DNA was extracted from
paraffin-embedded primary bladder-UC samples and blood of benign controls. Genotyping of rs9642880[T] (8q24.1) and rs798766[T]
(4p16.3) was performed using commercially available Taqman® assays and the ABI™ 7000 Sequence Detector.
Results
Using a case–control analysis, bladder-UC risk was increased in individuals carrying the T/T genotype of rs9642880 [OR = 1.72
(95 % CI 1.1–2.8); p = 0.028] and rs798766 [OR = 1.84 (95 % CI 0.9–2.3); p = 0.01]. When analysing parameters of bladder-UC aggressiveness, the T/T genotypes for rs9642880 and rs798766 were not found
to be associated with either grade [OR = 0.89 (95 % CI 0.52–1.32; p = 0.68) and OR = 0.95 (95 % CI 0.58–1.48; p = 0.61), respectively] or pathological stage [OR = 0.79 (95 % CI 0.42–1.48; p = 0.46) and OR = 0.90 (95 % CI 0.49–1.61; p = 0.72), respectively]. SNP variability of rs9642880[T] and rs798766[T] is associated with an increased risk of bladder-UC
but we did not find an association with disease aggressiveness as we did previously for UTUC.
Conclusions
This is further evidence of the distinct genetic differences that exist between bladder-UC and UTUC, and it is not possible
to extrapolate results of genetic studies between these two urothelial disease entities.
Content Type Journal Article
Category Topic paper
Pages 1-7
DOI 10.1007/s00345-012-0954-6
Authors
David R. Yates, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Morgan Rouprêt, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Sarah J. Drouin, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Marie Audouin, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Géraldine Cancel-Tassin, CeRePP Group, EA3104, Tenon Hospital, Paris, France
Eva Comperat, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Marc-Olivier Bitker, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Olivier Cussenot, Academic Department of Urology and Pathology of la Pitié-Salpêtrière, Tenon Hospital, Groupe Hospitalo-Universitaire Est, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) reporting the efficacy and safety of
silodosin in the treatment of non-neurogenic male LUTS suggestive of benign prostatic enlargement.
Patients and methods
A systematic review searching multiple dataset for the term “silodosin”. A meta-analysis was conducted using Review Manager
software (Cochrane Collaboration, Oxford, UK).
Results
Our systematic search retrieved four studies summarizing the data of five RCTs. Silodosin was more effective than placebo
with regard to mean change in all the parameters related to the IPSS and Qmax (all p values <0.0003). Adverse events (AE), abnormal ejaculation (AEj), and withdrawal due to AE were all more common with silodosin
(all p values <0.001). The prevalence of dizziness and adverse events other than AEj was similar with silodosin and placebo. Silodosin
was more effective than tamsulosin 0.2 mg with regard to some IPSS-related parameters and Qmax (p ≤ 0.05). Silodosin and tamsulosin 0.4 mg were similarly effective in all the efficacy analyses. AEj was less common with
tamsulosin 0.2 and 0.4 mg (p values <0.00001); adverse events other than AEj were more common with tamsulosin 0.2 and 0.4 mg (p values ≤0.05).
Conclusions
Silodosin was significantly more effective than placebo and tamsulosin 0.2 mg in improving symptoms and as effective as tamsulosin
0.4 mg. With regard to adverse events, AEj was more common with silodosin. All the adverse events other than AEj were significantly
more common with tamsulosin 0.2 and 0.4 mg and as frequent with silodosin and placebo.
Content Type Journal Article
Category Original Article
Pages 1-12
DOI 10.1007/s00345-012-0944-8
Authors
Giacomo Novara, Department of Oncological, Surgical, and Gastroenterological Sciences, Urology Clinic, University of Padua, Via Giustiniani 2, 35100 Padua, Italy
Andrea Tubaro, Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
Roberto Sanseverino, Ospedale Umberto I, Salerno, Italy
Sebastiano Spatafora, Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy
Walter Artibani, University of Verona, Verona, Italy
Filiberto Zattoni, Department of Oncological, Surgical, and Gastroenterological Sciences, Urology Clinic, University of Padua, Via Giustiniani 2, 35100 Padua, Italy
Francesco Montorsi, Urologic Research Institute, Vita Salute San Raffaele University, Milan, Italy
Christopher R. Chapple, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
To review the literature on use of radiation as a salvage option after local-only failure following initial treatment with
radiation.
Methods
PubMed was searched from inception to June 2012 using terms designed to include relevant articles on salvage radiation as
a treatment for local-only failures after radiation.
Results
Eighteen separate studies were found which demonstrated widely different patient populations, treatment methods, follow-up
periods, and reporting. Only one phase II prospective study was found with no randomized controlled trials. Biochemical disease-free
survival (bDFS) at four to 5 years ranged from 20 to 75 %. Patient selection may have influenced these varying rates since
some studies with lower bDFS had higher risk populations. Factors associated with improved bDFS included post-treatment prostate-specific
antigen (PSA) nadir of <0.5 ng/mL, pre-salvage PSA <6, Gleason score ≤7, and PSA doubling time (PSADT) >10 months. Overall
survival ranged from 54 to 94 %, and disease-specific survival ranged from 74 to 100 %. The crude rate of grade 3–4 genitourinary
toxicities among all studies was 13 % (range 0–47 %), and the crude rate of grade 3–4 gastrointestinal toxicities was 5 %
(range 0–20 %). Incontinence rates were low among reviewed studies at 4 % (range 0–29 %).
Conclusions
Brachytherapy represents a reasonable salvage option for patients with local recurrence after initial radiotherapy for prostate
cancer. However, rates of toxicities, as in other salvage treatments, can be fairly high, and the likelihood of death from
prostate recurrence variable. Prospective studies are needed to better define the efficacy and toxicity of this treatment
modality.
Content Type Journal Article
Category Topic paper
Pages 1-7
DOI 10.1007/s00345-012-0953-7
Authors
Stephen J. Ramey, Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, MSC 318, 169 Ashley Avenue, Charleston, SC 29425, USA
David T. Marshall, Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, MSC 318, 169 Ashley Avenue, Charleston, SC 29425, USA
Urothelial carcinomas of the upper urinary tract are now recognised as a true and distinct entity from bladder cancer and belong fully to the broad spectrum of onco-urologic neoplasms
Content Type Journal Article
Category Topic paper
Pages 1-3
DOI 10.1007/s00345-012-0958-2
Authors
Morgan Rouprêt, Academic Department of Urology of Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, Hopital Pitié, University Paris 6, 47-83 bvd de l’Hôpital, 75013 Paris, France
Pierre Colin, Academic Department of Urology, CHRU Lille, University Lille Nord de France, Lille, France
Through evolution in technology, endoscopic treatment has gained popularity for the treatment of upper tract urothelial carcinoma
(ENDO-UTUC).
Methods
A total of 20 patients with ENDO-UTUC were compared to 178 treated by radical nephroureterectomy (RNU) for a pTa-1 UTUC, and
a systematic review was performed.
Results
Mean age for ENDO-UTUC was 71.9 ± 16.0 years, and tumor features were favorable (90 % papillary, 14 low grade, 11 pTa). All
ENDO-UTUC were performed ureteroscopically. Mean follow-up was 20.4 ± 30 months. The 5-year overall survival (OS) rate was
45 %. Local (LR) and bladder recurrence (BR) was 25 and 15 %. Time to definitive treatment was longer, ASA higher, LR rates
higher, OS lower for ENDO-UTUC (all p < 0.001), but no difference was recorded for BR (p = 0.056) and cancer-specific survival (CSS) (p = 0.364). Postoperative kidney function (KF) was better in the ENDO-UTUC (p = 0.048), though preoperative KF showed no difference. The maximal level of evidence was 3b, patients were highly selected,
numbers of patients were low, and ASA scores high. OS was rather low and CSS high. LR rate was high (61 %) and BR rate moderate
(39 %) for ureteroscopic and 36 and 28 %, respectively, for percutaneous approach.
Conclusions
LR for ENDO-UTUC is high. In high-grade UTUC, oncological outcome is worse. RNU is associated with a significant loss of KF,
but LR is rare. ENDO-UTUC is reserved for selected cases if elective. In imperative cases, it has to be balanced between KF,
morbidity of the procedure, risk of operation and tumor control. ENDO-UTUC is not necessarily underused in Austria, because
of lack in evidence, but 41 % of all RNU were performed in pTa/pTis/pT1 lesions.
Content Type Journal Article
Category Topic paper
Pages 1-8
DOI 10.1007/s00345-012-0948-4
Authors
Harun Fajkovic, Department of Urology, Landesklinikum St. Poelten, St. Poelten, Austria
Tobias Klatte, Department of Urology, Medical University of Vienna, Vienna, Austria
Udo Nagele, Department of Urology, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Austria
Michael Dunzinger, Department of Urology, Landeskrankenhaus Vöcklabruck, Vöcklabruck, Austria
Richard Zigeuner, Department of Urology, Medical University of Graz, Graz, Austria
Wilhelm Hübner, Department of Urology, Landesklinikum Korneuburg, Wiener Ring 3-5, 2100 Korneuburg, Austria
Mesut Remzi, Department of Urology, Landesklinikum Korneuburg, Wiener Ring 3-5, 2100 Korneuburg, Austria
The primary endpoint in trials of perioperative systemic therapy for urothelial carcinoma is 5-year overall survival (OS).
A shorter-term endpoint could significantly speed the translation of advances into practice. We hypothesized that disease-free
survival (DFS) could be a surrogate endpoint for OS in upper tract urothelial carcinoma (UTUC) patients treated with radical
nephroureterectomy (RNU).
Patients and methods
The study included 2,492 patients treated with RNU with curative intent for UTUC.
Results
2/3-year DFS estimates were 78/73 %, and the 5-year OS estimate was 64 %. The overall agreements between 2- and 3-year DFS
with 5-year OS were 85 and 87 %, respectively. Agreements were similar when analyzed in subgroups stratified by pathological
stages, lymph node status, and adjuvant chemotherapy. The kappa statistic was 0.59 (95 % CI 0.55–0.63) for 2-year DFS/5-year
OS and 0.64 (95 % CI 0.61–0.68) for 3-year DFS/5-year OS, indicating moderate reliability. The hazard ratio for DFS as a time-dependent
variable for predicting OS was 11.5 (95 % CI 9.1–14.4), indicating a strong relationship between DFS and OS.
Conclusions
In patients treated with RNU for UTUC, DFS and OS are highly correlated, regardless of tumor stage and adjuvant chemotherapy.
While significant differences in DFS, assessed at 2 and 3 years, are highly likely to persist in OS at 5 years, marginal DFS
advantages may not translate into OS benefit. External validation is necessary before accepting DFS as an appropriate surrogate
endpoint for clinical trials investigating advanced UTUC patients.
Content Type Journal Article
Category Topic Paper
Pages 1-7
DOI 10.1007/s00345-012-0939-5
Authors
Harun Fajkovic, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
Eugene K. Cha, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
Evanguelos Xylinas, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
Michael Rink, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
Armin Pycha, General Hospital of Bolzano, Bolzano, Italy
Christian Seitz, General Hospital of Bolzano, Bolzano, Italy
Christian Bolenz, Mannheim Medical Center, University of Heidelberg, Heidelberg, Germany
Allison Dunning, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
Giacomo Novara, University of Padua, Padua, Italy
Quoc-Dien Trinh, University of Montreal, Montreal, QC, Canada
Pierre I. Karakiewicz, University of Montreal, Montreal, QC, Canada
Vitaly Margulis, University of Texas Southwestern Medical Center, Dallas, TX, USA
Jay D. Raman, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
Thomas J. Walton, Nottingham City Hospital, Nottingham, UK
Shiro Baba, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
Joaquin Carballido, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
Wolfgang Otto, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
Francesco Montorsi, Vita-Salute University, Milan, Italy
Yair Lotan, University of Texas Southwestern Medical Center, Dallas, TX, USA
Hans-Martin Fritsche, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
Karim Bensalah, CHU Pontchaillou, Rennes, France
Richard Zigeuner, Medical University of Graz, Graz, Austria
Douglas S. Scherr, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
Guru Sonpavde, Texas Oncology, Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
Morgan Roupret, Pitié-Salpêtrière Hospital, APHP, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Shahrokh F. Shariat, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Starr 900, New York, NY 10065, USA
The urological Dyna-CT (Uro Dyna-CT) was established in clinical use for classical imaging as well as for interventional surgery.
To evaluate whether irradiation artefacts may occur during interventional surgery, we analysed the impact of different instruments
on 3D reconstruction in the Uro Dyna-CT.
Materials and methods
Ten different endourological instruments [ureterorenoscope (URS)-fibrescope, percutaneous nephrolithotomy (PCNL) working sheath]
and accessory equipments such as ureteral catheter, guide wires and stents (DJ, MJ) were introduced in a porcine renal pelvis
either retrograde via the ureter or transparenchymally. Subsequently, digital fluoroscopy, standard X-ray and an Uro Dyna-CT
were performed. Three colleagues evaluated the image quality independent from each other.
Results
There were basically no limitations regarding image quality in digital fluoroscopy and standard X-ray. In the Uro Dyna-CT,
only with the URS fiberscope and the PCNL working sheath, small artefacts and irradiations were detected, whereas ureteric
catheter with and without wire, as well as the hydrophilic guide wire, showed no artefacts at all. The remaining material
demonstrated minimal artefacts, which did not affect the image quality.
Conclusions
The Uro Dyna-CT can be used for all interventional endourological procedures using the common armamentarium and instruments
without significant limitation of image quality. There are only minor limitations according a PCNL working sheath and the
rigid URS. These instruments should be removed out of the examination field before performing the computed tomography and
be replaced afterwards by using a safety wire.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0917-y
Authors
M.-C. Rassweiler, UMM Urology Mannheim, University of Heidelberg, Mannheim, Germany
M. Ritter, UMM Urology Mannheim, University of Heidelberg, Mannheim, Germany
M.-S. Michel, UMM Urology Mannheim, University of Heidelberg, Mannheim, Germany
A. Häcker, UMM Urology Mannheim, University of Heidelberg, Mannheim, Germany
To evaluate in a comprehensive way TVT in comparison with TOT, the results of a single-center RCT are presented. Many studies
addressed efficacy and safety of TVT and TOT.
Methods
Women included were adults having predominant SUI with positive stress test. They were randomized to get either TVT (Gynecare®) or TOT (Aris®). All women were seen 1 week, 3, 6, 12, 18, and 24 months.
Results
Seventy-one women completed 2-year follow-up. Median age was 47 (range 33–60 years). Mean ± SD BMI in TVT group was 34 ± 5
while in TOT group was 32 ± 5 kg/m2. POP of any degree was seen in 50 % (35 women). At 1 year, pad test–negative women were 31 and 29 for TVT and TOT, respectively.
At 2 years, figures became 28 in TVT group and 27 in TOT. At 1 year, UDI 6 and IIQ 7 decreased by 78.5 and 81 % for TVT and
by 69 % and 75 % for TOT group. At 2 year, comparable percentages were 73 and 79 % for TVT and 69 and 82 % for TOT. Fifteen
unique patients had adverse events, 10 of them had TOT.
Conclusions
Both tapes have similar efficacy, regarding cure of incontinence. TVT is more effective, albeit insignificantly, than TOT
at 2 years. However, serious adverse events were more frequent with TVT, yet TOT has more unique adverse events.
Content Type Journal Article
Category Original Article
Pages 1-5
DOI 10.1007/s00345-012-0956-4
Authors
Bassem S. Wadie, Voiding Dysfunction and Incontinence Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
Ahmed S. Elhefnawy, Voiding Dysfunction and Incontinence Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
The role of topical upper urinary tract instillation as adjuvant treatment after conservative management of urothelial carcinomas
remains unclear. The aim of this article was to review available techniques and protocols proposed to treat urothelial carcinomas
of the upper tract (UTUC).
Methods
Evidence acquisition on UTUC topical instillations was performed by a Medline search using combinations of the following key
words: urothelial carcinomas; upper urinary tract; renal pelvis; ureter; adjuvant therapy; recurrence; bacillus Calmette-Guérin
(BCG); mitomycin C. A total of 36 publications were included in analysis.
Results
Different approaches have been reported for instillation of the upper tract (UT): percutaneous nephrostomy, retrograde catheterisation
and vesico-ureteral reflux. Currently, BCG and mitomycin C are the most commonly agents used for topical treatment of UTUC.
A role for BCG in the management of UT carcinoma in situ (CIS) has been demonstrated in retrospective studies, although a
definitive efficacy of adjuvant topical therapy after endoscopic resection of Ta/T1 tumours has not yet been proven. No individual
study has shown a statistical improvement in survival and recurrence rates.
Conclusion
Currently BCG instillation should be considered as first-line treatment for UT CIS managed conservatively in carefully selected
patients. The place for adjuvant topical instillation after ablation of Ta/T1 tumours is less evident and should be evaluated
on an individual basis.
Content Type Journal Article
Category Topic paper
Pages 1-8
DOI 10.1007/s00345-012-0949-3
Authors
François Audenet, Academic Department of Urology of Georges Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes, University Paris V, Paris, France
Olivier Traxer, Academic Department of Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Karim Bensalah, Academic Department of Urology of Rennes Pontchaillou, Rennes, France
Morgan Rouprêt, Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Many authors reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele. However,
the difference in intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic
cord has not been critically discussed.
Methods
Between August 2010 and February 2011, 32 men with 42 sides’ grade 2–3 varicocele were enrolled in this study. One surgeon
firstly mimicked the modified open varicocelectomy by identifying, isolating, and marking the presumed internal spermatic
veins, lymphatics, and arteries. Another surgeon then checked the same spermatic cord using operating microscope to investigate
the number of missed veins, to be ligated lymphatics and arteries in the “imitative” open varicocelectomy.
Results
There were significant differences in the average number of internal spermatic arteries (1.67 vs. 0.91), internal spermatic
veins (6.45 vs. 4.31), and lymphatics (2.93 vs. 1.17) between microscopic and macroscopic procedure (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, an average of 2.14 ± 1.26 internal spermatic veins was missed; among them, 1.63 ± 1.32
internal spermatic veins adherent to the preserved testicular artery were overlooked. The number of 0.69 ± 0.84 lymphatics
and 0.74 ± 0.74 arteries were to be ligated in “macroscopic varicocelectomy.” A number of 1.07 ± 1.11 lymphatics were neither
identified nor ligated. In addition, in 2 cases, the vasal vessels of the vas deferens were to be ligated at macroscopic procedure.
Conclusions
Microsurgical varicocelectomy could preserve more internal spermatic arteries and lymphatic and ligate more veins which may
interpret the superiority of microsurgical varicocele repair.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0950-x
Authors
Xiaopeng Liu, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Hao Zhang, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Xingxing Ruan, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Hengjun Xiao, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Wentao Huang, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Liaoyuan Li, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Xin Gao, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Yan Zhang, Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630 China
Imaging of the urinary tract and its surrounding tissue still remains challenging, since standard imaging in the urological
operation room consists of fluoroscopy and plain X-rays. The combination of a ceiling-mounted X-ray system and a new urological
intervention table now allows cross-sectional imaging and 3D reconstruction to be performed in the endourological operation
room (Urological Dyna-CT).
Materials and methods
The imaging quality of the Artis Zee Ceiling (Siemens Medical Solutions, Erlangen, Germany) was assessed using slice images
of an ex vivo pig kidney model prepared with artificial stones (plaster of Paris). We compared the image quality of three
different examination protocols with this model. 3D reconstruction quality was illustrated by means of retrograde filling
of one pig`s urinary tract with a diluted contrast medium. Results: Interventional stone detection and localization is possible
with a 5 s low-dose Urological Dyna-CT. Detailed imaging of the collecting system by retrograde pyelography is possible with
a high image quality.
Conclusion
The combination of an Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) with our newly developed urological intervention table we call the
Urological Dyna-CT. In addition to such standard procedures as fluoroscopy or plain X-rays, cross-sectional imaging and 3D
reconstruction of the urinary tract are possible and provide fast and excellent urological imaging.
Content Type Journal Article
Category Original Article
Pages 1-4
DOI 10.1007/s00345-012-0951-9
Authors
M. S. Michel, Department of Urology, Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
M. Ritter, Department of Urology, Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
H. Wertz, Department of Radiation Therapy and Radio oncology, Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
S. Schönberg, Institute of Clinical Radiology and Nuclear Medicine, Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
A. Häcker, Department of Urology, Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
G. Weisser, Institute of Clinical Radiology and Nuclear Medicine, Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
The management of patients who relapse after radical radiotherapy is a challenging problem for the multidisciplinary team.
This group of men may have been considered ineligible or chosen not to be treated with an initial surgical approach as a result
of high-risk features or significant comorbid conditions. It is important not to miss the opportunity for definitive local
salvage therapies at this stage, and eligible patients should undergo careful restaging to determine their suitability for
these approaches. For those men not suitable for local treatment, androgen deprivation therapy (ADT) remains an option.
Methods
Literature review of the evidence relating to the management of hormone therapy for radiorecurrent prostate cancer.
Results
Results from retrospective studies have shown that not all men with biochemical relapse will experience distant metastasis
or a reduction in survival due to prostate cancer progression. Therefore, the timing of ADT commencement remains controversial.
However, it would seem appropriate to offer immediate therapy to men with advanced disease or unfavourable prostate-specific
antigen (PSA) kinetics at relapse. Patients with more favourable risk factors and PSA kinetics may be considered for watchful
waiting and deferred ADT to avoid or delay the associated toxicities. Patients with non-metastatic disease can be given the
option of castration-based therapy or an antiandrogen such as bicalutamide which may have potential advantages in maintenance
of sexual function, physical capacity and bone mineral density but at the expense of an increase in gynaecomastia and mastalgia.
Recent data suggest the burden of toxicity from ADT may be reduced by the use of intermittent hormone therapy without compromising
survival in this group of patients with radiorecurrence.
Conclusions
Hormone therapy remains an option for men with radiorecurrent prostate cancer.
Content Type Journal Article
Category Topic paper
Pages 1-6
DOI 10.1007/s00345-012-0952-8
Authors
H. Payne, Department of Clinical Oncology, University College Hospital London, First Floor Central 250 Euston Road, London, NW1 2PG UK
A. Khan, Department of Clinical Oncology, University College Hospital London, First Floor Central 250 Euston Road, London, NW1 2PG UK
S. Chowdhury, Department of Clinical Oncology, University College Hospital London, First Floor Central 250 Euston Road, London, NW1 2PG UK
R. Davda, Department of Clinical Oncology, University College Hospital London, First Floor Central 250 Euston Road, London, NW1 2PG UK
To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics
of upper urinary tract urothelial carcinomas (UTUCs).
Materials and methods
We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with
apparent diffusion coefficient (ADC) maps calculated between b = 0 and b = 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most
restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours
were compared with that of normal renal parenchyma using an unpaired Student’s t test. Association between ADC values and histological features was tested using non-parametric tests.
Results
Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small
tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (p = 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (p < 0.001). No statistical association was found between ADC values and pathological features (location, p = 0.35; grade, p = 0.98; muscle-invasive disease, p = 0.76 and locally advanced stage, p = 0.57).
Conclusion
DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding
healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need
further investigations in a large prospective multi-institutional study.
Content Type Journal Article
Category Topic paper
Pages 1-7
DOI 10.1007/s00345-012-0945-7
Authors
A. Sufana Iancu, Department of Nephro-urological Radiology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, 1, Rue Michel Polonovski, 59037 Lille, France
P. Colin, Department of Urology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, Lille, France
P. Puech, Department of Nephro-urological Radiology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, 1, Rue Michel Polonovski, 59037 Lille, France
A. Villers, Department of Urology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, Lille, France
A. Ouzzane, Department of Urology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, Lille, France
J. C. Fantoni, Department of Urology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, Lille, France
X. Leroy, Department of Pathology, Biology and Pathology Center, CHRU Lille, Université Lille Nord de France, Lille, France
L. Lemaitre, Department of Nephro-urological Radiology, Claude Huriez Hospital, CHRU Lille, Université Lille Nord de France, 1, Rue Michel Polonovski, 59037 Lille, France
Upper tract urothelial carcinoma (UTUC) is a rare disease with a highly heterogeneous biologic behavior. Accurate individualized
prediction of the behavior of UTUC could help guide personalized clinical decision-making regarding optimal therapy.
Methods
A MEDLINE literature search was performed on UTUC predictive tools. We recorded input variables, prediction form, number of
patients used to develop the prediction tools, outcomes being predicted, prediction tool-specific features, predictive accuracy,
and whether internal or external validations were performed. Each prediction tool was classified according to the clinical
disease state it addressed and the outcome it predicted.
Results
The literature search generated five published tools for UTUC staging and prognostication. None of these prediction tools
have undergone external validation yet. Two tools focused on the clinical decision-making regarding conservative management
versus radical nephroureterectomy (RNU), lymphadenectomy versus not, and neoadjuvant systemic therapy versus not. Three tools
focused on the prognosis after RNU, thereby helping in the decision-making regarding adjuvant systemic chemotherapy.
Conclusions
Management of UTUC is challenging, and there are no high-level data to guide physicians and patients. Prognostic tools relying
on data from large cohorts of patients are currently the best source of information for evidence-based management of UTUC
patients.
Content Type Journal Article
Category Topic Paper
Pages 1-6
DOI 10.1007/s00345-012-0947-5
Authors
Evanguelos Xylinas, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, USA
Luis Kluth, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, USA
Sibani Mangal, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, USA
Morgan Roupret, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, USA
Pierre I. Karakiewicz, Department of Urology, University of Montreal Health Center, Montreal, Canada
Shahrokh F. Shariat, Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, USA
Upper urinary tract urothelial carcinoma (UTUC) shares many similarities with bladder-UC, but there is strong evidence on
a clinical, aetiological, epidemiological and genetic level that key differences exist. In this review, we aim to highlight
how UTUC differs from bladder-UC and report on the utility of molecular markers in the diagnosis and management of UTUC.
Materials and methods
A systematic literature search was conducted using the Medline and Embase databases and specific keyword combinations: ‘urothelial
carcinoma’, ‘bladder cancer’, ‘transitional cell carcinoma’, ‘upper tract’, ‘upper urinary tract’, ‘genetics’, ‘prognosis’
and ‘biomarkers’.
Results
UTUC has specific acquired (e.g. Balkans nephropathy, phenacetin abuse) and genetic hereditary non-polyposis colorectal cancer
risk factors compared with bladder-UC. In general, the molecular biology of UC is broadly similar, irrespective of location
in the urinary tract. However, there are distinct genetic (microsatellite instability) and epigenetic (hypermethylation) differences
between some UTUC and bladder-UC. Clinical-pathological variables (e.g. hydronephrosis, tumour architecture, tumour location,
stage and grade) have independent predictive power in UTUC, but tissue and urinary biomarkers can improve the clinical prediction
of recurrence, invasion and survival in UTUC, though the evidence level is weak.
Conclusions
UTUC shares many similarities with bladder-UC, but there is strong evidence that they should be considered as distinct urothelial
entities. Prospective multi-institutional studies investigating molecular markers are urgently needed to augment clinic-pathological
predictors in UTUC.
Content Type Journal Article
Category Topic paper
Pages 1-9
DOI 10.1007/s00345-012-0946-6
Authors
David R. Yates, The Academic Department of Urology, Royal Hallamshire Hospital, Glossop Rd, Sheffield, UK
James W. F. Catto, The Academic Department of Urology, Royal Hallamshire Hospital, Glossop Rd, Sheffield, UK
Preoperative elevation of markers of systemic inflammation is associated with a poor outcome in several cancers. The purpose
of this study was to evaluate the prognostic significance of preoperative systemic inflammatory markers in patients with non-metastatic
upper urinary tract cancer (UUTC).
Methods
The records of 84 patients with non-metastatic UUTC who had undergone nephroureterectomy were reviewed, and the associations
between preoperative clinical variables and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses.
Results
Clinical tumor stage, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly associated with RFS in univariate
analysis. Multivariate analysis showed that clinical T stage (hazard ratio [HR], 3.009; 95 % confidence interval [CI], 1.149–9.321;
p = 0.024) and neutrophil count (HR, 3.521; 95 % CI, 1.423–9.108; p = 0.007) were independent predictors of RFS. The 3-year RFS in patients with a neutrophil count <4,000/μL was significantly
higher than that in patients with a neutrophil count ≥4,000/μL (82.9 vs. 51.0 %, p = 0.004). Based on clinical T stage (T2 or less vs. T3 or greater) and neutrophil count (<4,000 vs. ≥4,000/μL), patients
were stratified into 3 groups: low, intermediate, and high risk groups. RFS rates were significantly different between the
3 groups (p = 0.0005).
Conclusions
Preoperative neutrophil count was an independent predictor of RFS in patients with non-metastatic UUTC. Stratification of
patients based on neutrophil count and clinical T stage may be valuable for preoperative patient counseling and identifying
patients with poor prognosis who may be candidates for neoadjuvant chemotherapy.
Content Type Journal Article
Category Original Article
Pages 1-6
DOI 10.1007/s00345-012-0942-x
Authors
Takeshi Hashimoto, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
Yoshio Ohno, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
Jun Nakashima, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
Tatsuo Gondo, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
Makoto Ohori, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
Masaaki Tachibana, Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
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