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Este mes en... World Journal of Urology

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Este mes en... World Journal of Urology:

  • Prostate cancer detection rates in different biopsy schemes. Which cores for which patients?

    Abstract
    Purpose  
    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
  • The varied presentations of dhat syndrome

    The varied presentations of dhat syndrome

    • Content Type Journal Article
    • Category Letter to the Editor
    • Pages 1-1
    • DOI 10.1007/s00345-012-0992-0
    • Authors
      • S. Prakash, All India Institute of Medical Sciences, New Delhi, India
  • A comparative study of the use of a transverse preputial island flap (the Duckett technique) to treat primary and secondary hypospadias in older Chinese patients with severe chordee

    Abstract
    Objective  
    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
  • Urological surgery in patients with hemorrhagic bleeding disorders Hemophilia A, Hemophilia B, von Willebrand disease: a retrospective study with matched pairs analysis

    Abstract
    Purpose  
    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
  • Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones

    Abstract
    Objectives  
    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.

    • Content Type Journal Article
    • Category Original Article
    • Pages 1-6
    • DOI 10.1007/s00345-012-0991-1
    • Authors
      • Berkan Resorlu, Ankara, Turkey
      • Ali Unsal, Ankara, Turkey
      • Tevfik Ziypak, Ankara, Turkey
      • Akif Diri, Ankara, Turkey
      • Gokhan Atis, Ankara, Turkey
      • Selcuk Guven, Ankara, Turkey
      • Ahmet Ali Sancaktutar, Ankara, Turkey
      • Abdulkadir Tepeler, Ankara, Turkey
      • Omer Faruk Bozkurt, Ankara, Turkey
      • Derya Oztuna, Ankara, Turkey
  • Outcomes of salvage prostate cryotherapy stratified by pre-treatment PSA: update from the COLD registry

    Abstract
    Objectives  
    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
  • An exploratory, placebo-controlled, dose–response study of the efficacy and safety of onabotulinumtoxinA in spinal cord injury patients with urinary incontinence due to neurogenic detrusor overactivity

    Abstract
    Purpose  
    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
      • Xiaohong Yan, Allergan Inc., Irvine, CA, USA
      • Sherif Mourad, Ain Shams University, Cairo, Egypt
  • Pudendal nerve block in HDR-brachytherapy patients: do we really need general or regional anesthesia?

    Abstract
    Purpose  
    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
  • Impact of transplant nephrectomy on retransplantation: a single-center retrospective study

    Abstract
    Purpose  
    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
  • Perugia ileal neobladder: functional results and complications

    Abstract
    Purpose  
    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
  • PDE5 inhibition against acute renal ischemia reperfusion injury in rats: does vardenafil offer protection?

    Abstract
    Purpose  
    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
  • Positive urine cytology and carcinoma in situ prior to second transurethral resection of the bladder correlate with positive second resection histology and the need for subsequent cystectomy

    Abstract
    Objective  
    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
  • Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery

    Abstract
    Objectives  
    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
  • Outcomes following radical cystectomy for micropapillary bladder cancer versus pure urothelial carcinoma: a matched cohort analysis

    Abstract
    Purpose  
    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
  • Treatment for liver metastasis from renal cell carcinoma with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT): a case series

    Abstract
    Purpose  
    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
  • Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer

    Abstract
    Purpose  
    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
  • Association of legumain expression pattern with prostate cancer invasiveness and aggressiveness

    Abstract
    Objectives  
    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
  • Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience

    Abstract
    Purpose  
    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
  • Oncologic outcomes obtained after laparoscopic, robotic and/or single port nephroureterectomy for upper urinary tract tumours

    Abstract
    Introduction  
    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

    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
  • Female sex is an independent risk factor for reduced overall survival in bladder cancer patients treated by transurethral resection and radio- or radiochemotherapy

    Abstract
    Purpose  
    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
  • Serum testosterone plays an important role in the metastatic ability of castration resistant prostate cancer

    Abstract
    Purpose  
    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
  • Shock wave lithotripsy versus ureteroscopy for ureteral calculi: a prospective assessment of patient-reported outcomes

    Abstract
    Objective  
    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
  • Clinical usefulness of ultrasound assessment of detrusor wall thickness in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury: urodynamics made easy?

    Abstract
    Purpose  
    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
  • Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from The Global PCNL Study from The Clinical Research Office Endourology Society

    Abstract
    Purpose  
    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
  • High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment

    Abstract
    Purpose  
    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
  • The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database

    Abstract
    Objectives  
    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
  • Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy

    Abstract
    Purpose  
    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
  • Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: the results from a multi-institutional French cohort

    Abstract
    Objectives  
    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
  • Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter

    Abstract
    Purpose  
    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
  • Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study

    Abstract
    Background  
    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
  • Neoadjuvant targeted therapy in a primary metastasized renal cell cancer patient leads to down-staging of inferior vena cava thrombus (IVC) enabling a cardiopulmonary bypass-free tumor nephrectomy: a case report

    Abstract
    Background  
    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
  • Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study

    Abstract
    Objectives  
    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
  • Oncologic outcomes obtained after neoadjuvant and adjuvant chemotherapy for the treatment of urothelial carcinomas of the upper urinary tract: a review

    Abstract
    Introduction  
    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
  • Genetic polymorphisms on 8q24.1 and 4p16.3 are not linked with urothelial carcinoma of the bladder in contrast to their association with aggressive upper urinary tract tumours

    Abstract
    Purpose  
    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
  • Systematic review and meta-analysis of randomized controlled trials evaluating silodosin in the treatment of non-neurogenic male lower urinary tract symptoms suggestive of benign prostatic enlargement

    Abstract
    Purpose  
    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
  • Re-irradiation for salvage of prostate cancer failures after primary radiotherapy

    Abstract
    Purpose  
    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

    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
  • Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience

    Abstract
    Introduction  
    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
  • Disease-free survival as a surrogate for overall survival in upper tract urothelial carcinoma

    Abstract
    Objectives  
    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
      • Wassim Kassouf, McGill University, Montreal, QC, Canada
      • 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
  • Influence of endourological devices on 3D reconstruction image quality using the Uro Dyna-CT

    Abstract
    Purpose  
    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
  • TVT versus TOT, 2-year prospective randomized study

    Abstract
    Purpose  
    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
  • Upper urinary tract instillations in the treatment of urothelial carcinomas: a review of technical constraints and outcomes

    Abstract
    Objectives  
    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
  • Macroscopic and microsurgical varicocelectomy: what’s the intraoperative difference?

    Abstract
    Purpose  
    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
  • The Urological Dyna-CT: ex vivo feasibility study of interventional cross-sectional imaging in the endourological operation room

    Abstract
    Background  
    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
  • Hormone therapy for radiorecurrent prostate cancer

    Abstract
    Background  
    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
  • Significance of ADC value for detection and characterization of urothelial carcinoma of upper urinary tract using diffusion-weighted MRI

    Abstract
    Purpose  
    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
  • Predictive tools for clinical decision-making and counseling of patients with upper tract urothelial carcinoma

    Abstract
    Background  
    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
  • Distinct patterns and behaviour of urothelial carcinoma with respect to anatomical location: how molecular biomarkers can augment clinico-pathological predictors in upper urinary tract tumours

    Abstract
    Purpose  
    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
  • Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinoma

    Abstract
    Purpose  
    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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