4019 articles - 08.09.10
1: Nat Rev Urol. 2010 Sep;7(9):487-93.
Strope SA, Andriole GL.
Washington University School of Medicine, Barnes-Jewish Hospital, Siteman Cancer Center, 4960 Children's Place, Campus Box 8242, St Louis, MO 63110, USA.
With the publication of the long-term results of two randomized screening trials and updates to screening guidelines from many organizations, the past 2 years have been eventful in the field of prostate cancer screening. Both the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial-which failed to identify a benefit of screening in a community setting-and the European Randomized Study of Screening for Prostate Cancer-which showed a modest benefit to screening in a clinical trial setting-have sought to address the role of screening in reducing mortality from prostate cancer. Epidemiologic evidence supports the role of PSA screening in the stage and grade migration of prostate cancer, but to date the evidence for its role in changing mortality patterns is more equivocal. As a result, little support exists at present among urologic and cancer prevention organizations for population-based PSA screening. Particularly in the USA, where PSA screening has been relatively widespread, reductions in prostate-cancer-specific mortality are likely to be in part related to improvements in treatment, rather than solely to PSA screening. The substantial risk of overdiagnosis and overtreatment of latent prostate cancer means that methods to increase the specificity of prostate cancer screening, and particularly its ability to identify high-risk disease, are essential. Strategies such as the use of 5alpha-reductase inhibitors in high-risk patients, and the continued development of urinary and genetic markers hold promise in this regard.
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PMID: 20818326 [PubMed - in process]2: J Urol. 2010 Aug 19; [Epub ahead of print]
Routh JC, McGee SM, Ashley RA, Reinberg Y, Vandersteen DR.
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota.
PURPOSE: Prognostic information is limited on children with congenital anterior urethral valves or a diverticulum. We reviewed the literature and examined our clinical database to identify clinical features predicting a poor renal outcome, defined as azotemia, renal failure or death. MATERIALS AND METHODS: We reviewed 97 English language studies of patients 18 years old or younger. Seven patients from our institutions were also included in analysis. After data abstraction we used multivariate models to define factors associated with outcomes of interest. RESULTS: We identified 239 male patients with anterior urethral valves, of whom 139 had adequate data available for study inclusion. Of these patients 108 (78%) had normal renal function after treatment. On bivariate analysis vesicoureteral reflux (OR 22.4, p <0.0001), pretreatment azotemia (OR 17.1, p <0.0001), urinary tract infection (OR 3.3, p = 0.006), hydronephrosis (OR 10.0, p = 0.0004) and bladder trabeculation (OR 7.3, p = 0.01) were associated with renal failure or death while treatment method (p = 0.9), obstruction type (valve vs diverticulum, p = 0.4) and valve location (p = 0.6) were not. After adjusting for other factors only pretreatment azotemia (p = 0.0005) and vesicoureteral reflux (p = 0.01) remained associated with renal failure and/or death with a trend toward significance for urinary tract infection (p = 0.06). When all 3 factors were present, the odds of a poor renal outcome increased 25-fold (p = 0.005). CONCLUSIONS: Congenital anterior urethral obstruction in children has a generally good prognosis but may occasionally result in a poor renal outcome. The combination of pretreatment azotemia, vesicoureteral reflux and urinary tract infection is highly predictive of a poor renal outcome. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20728183 [PubMed - as supplied by publisher]3: J Urol. 2010 Aug 19; [Epub ahead of print]
McQuiston L, Macneily A, Liu D, Mickelson J, Yerkes E, Chaviano A, Roth D, Stoltz RS, Herz DB, Maizels M.
Department of Surgery (Pediatric Surgery) Dartmouth-Hitchcock Medical Center/Children's Hospital at Dartmouth, Lebanon, New Hampshire.
PURPOSE: Computer enhanced visual learning is a new method to train residents to perform surgery using components and provide them with access to a personalized surgical feedback archive using the Internet. At the parent institution in Chicago we have already noted that this method is effective to train residents to perform orchiopexy. To assess whether this new methodology to enhance resident surgical instruction is generalizable we performed a prospective, multi-institutional clinical trial. MATERIALS AND METHODS: We prospectively compared ratings of resident skills in performing pediatric orchiopexy at 4 institutions as novices to computer enhanced visual learning curriculum (study group) vs those at the single institution accustomed to that curriculum (control group). All urology residents and attending physicians accessed the computer enhanced visual learning curriculum. After each case was completed the attending urologist rated resident performance of each step and provided feedback on weaknesses for the resident to remediate at the next case. The learning score was calculated for each case as the sum of the ratings x case difficulty. Scores on the first case and the best case were compared between the study and control groups by resident and institution. RESULTS: The study group included 6 attending physicians and 36 residents (99 orchiopexies). The control group included 8 attending physicians and 21 residents (108 orchiopexies). Between the study and control groups we noted no significant differences in average resident postgraduate year (2.9 vs 2.7), number of procedures per resident (3.9 vs 4.9), frequency with which residents viewed computer enhanced visual learning preoperatively (63% vs 74%) or attending physician provision of feedback (63% vs 88%) (each p not significant). Similarly of residents who completed more than 1 surgery there was no significant difference in the percent who showed an improved learning score in the study vs the control group (86% vs 79%) or in the magnitude of average improvement (10.5 vs 13.4) (each p not significant). CONCLUSIONS: The institutional groups did not differ in training resident skills using computer enhanced visual learning for pediatric orchiopexy. Thus, the program provides a consistent learning experience and is generalizable across institutions. We believe that this tool will change the practice of how training programs educate residents by enhancing learning by a checklist approach and a computer platform to archive feedback and remediation. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20728179 [PubMed - as supplied by publisher]4: J Urol. 2010 Aug 19; [Epub ahead of print]
Hsieh MH, Madden-Fuentes RJ, Bayne A, Munch E, Wildenfels P, Alexander SJ, Gonzales ET Jr, Cisek LJ, Jones EA, Roth DR.
Department of Urology, Stanford University School of Medicine (MHH).
PURPOSE: Parental decision making in children with vesicoureteral reflux has potentially become more complex with the evolution of ethnic diversity in the United States, the Internet, the publication of contradictory clinical data and the emergence of minimally invasive surgery. We performed a cross-sectional study of parental management for pediatric vesicoureteral reflux. MATERIALS AND METHODS: We administered a 26-item questionnaire to parents of children with vesicoureteral reflux seen at Texas Children's Hospital urology offices or undergoing antireflux surgery at that institution. Univariate and multivariate analysis was done on patient disease characteristics, demographics, predicted reflux duration, surgery success rate, antibiotic cessation, complication risk, financial considerations, urologist recommendations, Internet information, friend recommendations, and postoperative voiding cystourethrography, renal ultrasound and recovery. RESULTS: Enrolled in the study were 15 boys and 49 girls with a mean age of 3.5 years and a mean reflux grade of 2.8. Of the cases 37 were bilateral. Parents chose endoscopic treatment in 38 children, open ureteroneocystostomy in 9, antibiotic prophylaxis in 14 and observation without antibiotics in 3. Univariate analysis suggested that Hispanic parents rated ultrasound and financial considerations as more important than white parents (p <0.05). Multivariate analysis revealed that differences seen on univariate analysis may have been due to an association between race and income. Finally, 93.6% of parents rated urologist opinion as very or extremely important. CONCLUSIONS: Data indicate that the parents of our patients highly value the opinion of the pediatric urologist when choosing treatment for their children with vesicoureteral reflux. Despite social changes the physician-parental relationship remains critical. Differences in parental decision making may be linked to associations between race and income. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20728107 [PubMed - as supplied by publisher]5: J Urol. 2010 Aug 18; [Epub ahead of print]
Castagnetti M, El-Ghoneimi A.
Section of Pediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy.
PURPOSE: We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature. MATERIALS AND METHODS: We reviewed studies published between 1990 and December 2009, searching for "hypospadias" in MEDLINE(R)/PubMed(R), EMBASE(R), Web of Science(R) and the Cochrane Library. RESULTS: The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series). Based on the literature, curvature should be addressed stepwise starting with ventral dissection that extends underneath the urethral plate (urethral plate mobilization). Contrary to former practice, urethral plate division seems to have more of a role if significant curvature persists. Dorsal plication seems sufficient to correct only minor degrees of curvature, while a minority of cases require ventral lengthening. No urethroplasty techniques appear to be definitively superior. After urethral plate division a staged urethroplasty has lower complication rates but a second operation is required, which might otherwise be avoided in approximately 70% of cases. CONCLUSIONS: The present systematic review shows the weak evidence backing current management of primary severe hypospadias. We even lack a clear-cut definition of severe hypospadias and associated curvature. Hence, while we developed general recommendations for treatment based on our review of available evidence, we emphasize the need to establish shared criteria for accurate preoperative or introperative patient stratification, and to define objective outcome measures and followup intervals for data reporting to make comparison of surgical approaches reliable. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20727541 [PubMed - as supplied by publisher]6: J Urol. 2010 Aug 17; [Epub ahead of print]
Zilberman DE, Lipkin ME, de la Rosette JJ, Ferrandino MN, Mamoulakis C, Laguna MP, Preminger GM.
Comprehensive Kidney Stone Center, Division of Urology, Duke University Medical Center, Durham, North Carolina.
PURPOSE: Traditionally the placement of a nephrostomy tube at the conclusion of percutaneous nephrolithotomy is considered the standard of care. However, the need for nephrostomy tube placement has been questioned by numerous authors. We evaluated the literature regarding tubeless percutaneous nephrolithotomy, and determined potential candidates for tubeless percutaneous nephrolithotomy and whether this procedure can be considered the new standard of care for complex stone removal. MATERIALS AND METHODS: A MEDLINE(R) search was conducted between May 1997 and January 2010 to detect studies reporting tubeless percutaneous nephrolithotomy. "Nephrolithiasis," "percutaneous nephrolithotomy," "tubeless" and "lithotripsy" were used as medical subject headings (MeSH) key words. Additional citations were identified by reviewing the reference lists of the included articles. All relevant articles were reviewed for indications, outcomes and complications. RESULTS: The data obtained from 50 reports document comparable complication rates between tubeless and standard percutaneous nephrolithotomy. Tubeless percutaneous nephrolithotomy demonstrated advantages such as less pain, less debilitation, less costs and a shorter hospital stay. Mean stone-free rates for tubeless percutaneous nephrolithotomy were as high as 89%. CONCLUSIONS: Tubeless percutaneous nephrolithotomy appears to be safe and efficacious in uneventful procedures, in children, in obese patients, in simultaneous bilateral procedures, in supracostal access and in renal units with coexisting anatomical anomalies. Nephrostomy tube placement should still be considered in certain cases such as those with more than 2 nephrostomy access tracts, those necessitating a second look and those with intraoperative complications such as significant bleeding or collecting system perforation. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20723920 [PubMed - as supplied by publisher]7: BMC Urol. 2010 Aug 19;10(1):14 [Epub ahead of print]
Cardozo L, Khullar V, El-Tahtawy A, Guan Z, Malhotra B, Staskin D.
ABSTRACT: BACKGROUND: Fesoterodine is an antimuscarinic for the treatment of overactive bladder, a syndrome of urgency, with or without urgency urinary incontinence (UUI), usually with increased daytime frequency and nocturia. Our objective was to develop predictive models to describe the dose response of fesoterodine. METHODS: Data from subjects enrolled in double-blind, placebo-controlled phase II and III trials were used for developing longitudinal dose-response models. RESULTS: The models predicted that clinically significant and near-maximum treatment effects would be seen within 3 to 4 weeks after treatment initiation. For a typical patient with 11 micturitions per 24 hours at baseline, predicted change was -1.2, -1.7, and -2.2 micturitions for placebo and fesoterodine 4 mg and 8 mg, respectively. For a typical patient with 2 UUI episodes per 24 hours at baseline, predicted change was -1.05, -1.26, and -1.43 UUI episodes for placebo and fesoterodine 4 mg and 8 mg, respectively. Increase in mean voided volume was estimated at 9.7 mL for placebo, with an additional 14.2 mL and 28.4 mL for fesoterodine 4 mg and 8 mg, respectively. CONCLUSIONS: A consistent dose response for fesoterodine was demonstrated for bladder diary endpoints in subjects with overactive bladder, a result that supports the greater efficacy seen with fesoterodine 8 mg in post hoc analyses of clinical trial data. The dose-response models can be used to predict outcomes for doses not studied or for patient subgroups underrepresented in clinical trials. Trial Registration: The phase III trials used in this analysis have been registered at ClinicalTrials.gov (NCT00220363 and NCT00138723).
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PMID: 20723260 [PubMed - as supplied by publisher]8: Prostate. 2010 Aug 5; [Epub ahead of print]
Liu H, Wang B, Han C.
State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China.
BACKGROUND: Genome-wide and replication association studies (GWAs) have identified multiple loci at which common variants modestly influence the risk of developing prostate cancer (PCa). To enhance the power to identify loci associated with PCa, we constructed a meta-analysis of GWAs on PCa. METHODS: Articles evaluating the effects of genome-wide SNPs on PCa were identified by searching the PubMed database. After extraction of relevant data, main and subgroup meta-analyses were performed to assess the effects of relevant SNPs on PCa. RESULTS: 21 eligible articles containing 71 subgroups were included in this meta-analysis. Significant associations were found between 31 SNPs and PCa. They were rs445114, rs620861, rs983085, rs1016343, rs1447295, rs1859962, rs2660753, rs2710646, rs2735839, rs3760511, rs4242382, rs4430796, rs4962416, rs5945572, rs5945619, rs6470494, rs6501455, rs6983267, rs6983561, rs7000448, rs7214479, rs7501939, rs7920517, rs7931342, rs9364554, rs9623117, rs10090154, rs10486567, rs10896449, rs10993994, and rs16901979. The weighted odds ratios for above SNPs ranged between 0.64 and 1.88 (all P < 0.05). Subgroup analysis further indicated that the significant associations of some SNPs existed only in specific ancestry population (P < 10(-5)). CONCLUSIONS: The current meta-analysis demonstrated the moderate effects of above 31 SNPs on PCa and 14 independent PCa risk loci were identified. Prostate (c) 2010 Wiley-Liss, Inc.
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PMID: 20690139 [PubMed - as supplied by publisher]9: J Urol. 2010 Sep;184(3):842-50.
Neto AS, Tobias-Machado M, Wroclawski ML, Fonseca FL, Teixeira GK, Amarante RD, Wroclawski ER, Del Giglio A.
Urologic Oncology Division, Department of Urology, ABC Medicine School, Santo Andre, Sao Paulo, Brazil.
PURPOSE: HER-2/neu has been linked to the clinical progression of hormone independent prostate cancer. We performed a meta-analysis to investigate the prognostic impact of HER-2/neu over expression in patients with prostate adenocarcinoma, and its correlation with other pathological and clinical variables. MATERIALS AND METHODS: We searched the MEDLINE, Embase, CancerLit and ASCO abstract databases for published studies of HER-2/neu protein expression in primary prostate cancer tissue with a median followup of greater than 2 years and data on survival in patients with and without HER-2/neu over expression. We separately analyzed studies reporting HER-2/neu soluble receptor levels in patients with prostate cancer. RESULTS: We included 38 articles with a total of 5,976 patients. The overall RR of death in those with HER-2/neu over expression in the primary tumor was 1.63 (95% CI 1.47-1.82, p <0.0001). In the presence of over expression the recurrence RR was 1.87 (95% CI 1.59-2.21, p <0.0001). High HER-2/neu extracellular domain levels also correlated with death (RR 2.01, 95% CI 1.21-3.35, p = 0.007) and recurrence (RR 1.74, 95% CI 1.41-2.15, p <0.0001). CONCLUSIONS: There is a consistent association of HER-2/neu over expression and Gleason less than 7 with a higher RR of death and recurrence in patients with prostate cancer. Further clinical trials should test the hypothesis that HER-2/neu is a marker of a clinically worse outcome in patients with prostate cancer and a potential target for therapy. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20663525 [PubMed - in process]10: J Urol. 2010 Sep;184(3):1134-44. Epub 2010 Jul 21.
Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M.
Guidelines Department, American Urological Association, 1000 Corporate Blvd., Linthicum, Maryland 21090, USA.
PURPOSE: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit. MATERIALS AND METHODS: The Panel searched the MEDLINE(R) database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children with vesicoureteral reflux and a defined care program that permitted identification of cohort specific clinical outcomes. The reporting of meta-analysis of observational studies elaborated by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group was followed. The extracted data were analyzed and formulated into evidence-based recommendations. RESULTS: A total of 2,028 articles were reviewed and data were extracted from 131 articles. Data from 17,972 patients were included in this analysis. This systematic meta-analysis identified increasing frequency of urinary tract infection, increasing grade of vesicoureteral reflux and presence of bladder and bowel dysfunction as unique risk factors for renal cortical scarring. The efficacy of continuous antibiotic prophylaxis could not be established with current data. However, its purported lack of efficacy, as reported in selected prospective clinical trials, also is unproven owing to significant limitations in these studies. Reflux resolution and endoscopic surgical success rates are dependent upon bladder and bowel dysfunction. The Panel then structured guidelines for clinical vesicoureteral reflux management based on the goals of minimizing the risk of acute infection and renal injury, while minimizing the morbidity of testing and management. These guidelines are specific to children based on age as well as the presence of bladder and bowel dysfunction. Recommendations for long-term followup based on risk level are also included. CONCLUSIONS: Using a structured, formal meta-analytic technique with rigorous data selection, conditioning and quality assessment, we attempted to structure clinically relevant guidelines for managing vesicoureteral reflux in children. The lack of robust prospective randomized controlled trials limits the strength of these guidelines but they can serve to provide a framework for practice and set boundaries for safe and effective practice. As new data emerge, these guidelines will necessarily evolve. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20650499 [PubMed - in process]11: J Urol. 2010 Sep;184(3):1145-51. Epub 2010 Jul 21.
Skoog SJ, Peters CA, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M.
Guidelines Department, American Urological Association, 1000 Corporate Blvd., Linthicum, Maryland 21090, USA.
PURPOSE: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to screening of siblings and offspring of index patients with vesicoureteral reflux and infants with prenatal hydronephrosis. From this evidence clinical practice guidelines are developed to manage the clinical scenarios insofar as the data permit. MATERIALS AND METHODS: The Panel searched the MEDLINE(R) database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children, clearly stating the number of children undergoing screening for vesicoureteral reflux. Vesicoureteral reflux should have been diagnosed with a cystogram and renal outcomes assessed by nuclear scintigraphy. The screening articles were extracted into data tables developed to evaluate epidemiological factors, patient and renal outcomes, and results of treatment. The reporting of meta-analysis of observational studies elaborated by the MOOSE group was followed. The extracted data were analyzed and formulated into evidence-based recommendations regarding the screening of siblings and offspring in index cases with vesicoureteral reflux and infants with prenatal hydronephrosis. RESULTS: In screened populations the prevalence of vesicoureteral reflux is 27.4% in siblings and 35.7% in offspring. Prevalence decreases at a rate of 1 screened person every 3 months of age. The prevalence is the same in males and females. Bilateral reflux prevalence is similar to unilateral reflux. Grade I-II reflux is estimated to be present in 16.7% and grade III-V reflux in 9.8% of screened patients. The estimate for renal cortical abnormalities overall is 19.3%, with 27.8% having renal damage in cohorts of symptomatic and asymptomatic children combined. In asymptomatic siblings only the rate of renal damage is 14.4%. There are presently no randomized, controlled trials of treated vs untreated screened siblings with vesicoureteral reflux to evaluate health outcomes as spontaneous resolution, decreased rates of urinary infection, pyelonephritis or renal scarring. In screened populations with prenatal hydronephrosis the prevalence of vesicoureteral reflux is 16.2%. Reflux in the contralateral nondilated kidney accounted for a mean of 25.2% of detected cases for a mean prevalence of 4.1%. In patients with a normal postnatal renal ultrasound the prevalence of reflux is 17%. The prenatal anteroposterior renal pelvic diameter was not predictive of reflux prevalence. A diameter of 4 mm is associated with a 10% to 20% prevalence of vesicoureteral reflux. The prevalence of reflux is statistically significantly greater in females (23%) than males (16%) (p=0.022). Reflux grade distribution is approximately a third each for grades I-II, III and IV-V. The estimate of renal damage in screened infants without infection is 21.8%. When stratified by reflux grade renal damage was estimated to be present in 6.2% grade I-III and 47.9% grade IV-V (p <0.0001). The risk of urinary tract infection in patients with and without prenatal hydronephrosis and vesicoureteral reflux could not be determined. The incidence of reported urinary tract infection in patients with reflux was 4.2%. CONCLUSIONS: The meta-analysis provided meaningful information regarding screening for vesicoureteral reflux. However, the lack of randomized clinical trials for screened patients to assess clinical health outcomes has made evidence-based guideline recommendations difficult. Consequently, screening guidelines are based on present practice, risk assessment, meta-analysis results and Panel consensus. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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PMID: 20650494 [PubMed - in process]12: Urology. 2010 Jun 18; [Epub ahead of print]
Abouassaly R, Alibhai SM, Shah N, Timilshina N, Fleshner N, Finelli A.
Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
OBJECTIVES: To review the surgical management of upper tract urothelial carcinoma (UTUC) on a population level. UTUC accounts for 5% of urothelial malignancies, making it less amenable to single-center reporting. Complete nephroureterectomy is the standard of care, and increasing evidence has shown that a suboptimal surgical technique is associated with an adverse prognosis. METHODS: We obtained information for all patients diagnosed with UTUC (n = 830) and those treated surgically (n = 680) in the province of Ontario, Canada from the Ontario Cancer Registry from 1995 to 2004. Demographic, treatment, and vital status information was obtained for all patients, and pathology reports were available for 422 patients. The primary outcome was overall survival. The secondary outcomes included measures of surgical quality (ie, number of lymph nodes sampled, ureteral length excised, surgical margin status, and 30-day mortality) and disease-specific survival. RESULTS: The unadjusted 5-year overall survival rate was 57.2%, with a median survival of 72.5 months. For those treated surgically, the 30-day mortality rate was 1.8%, and the positive surgical margin rate was 8.5%. Lymph nodes were identified in only 27% of the specimens, with a median yield of 1 (range 1-15). An estimated 25.8% of patients might have undergone incomplete ureteral resection at the time of nephroureterectomy. CONCLUSIONS: UTUC is a lethal malignancy, with nearly one half the patients dying within 5 years. Furthermore, lymphadenectomy was rarely performed and approximately one fourth of patients might have undergone incomplete ureterectomy. The published outcomes from "centers of excellence" do not appear to reflect the surgical quality seen on a population level for this rare, but significant, malignancy. Copyright (c) 2010 Elsevier Inc. All rights reserved.
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PMID: 20646743 [PubMed - as supplied by publisher]13: J Urol. 2010 Sep;184(3):859-64.
Hellenthal NJ, Underwood W, Penetrante R, Litwin A, Zhang S, Wilding GE, Teh BT, Kim HL.
Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA.
PURPOSE: Sunitinib is an approved treatment for metastatic renal cell carcinoma. We performed a prospective clinical trial to evaluate the safety and clinical response to sunitinib administered before nephrectomy in patients with localized or metastatic clear cell renal cell carcinoma. MATERIALS AND METHODS: Patients with biopsy proven clear cell renal cell carcinoma were enrolled in the study and treated with 37.5 mg sunitinib malate daily for 3 months before nephrectomy. The primary end point was safety. RESULTS: In an 18-month period 20 patients were enrolled. The most common toxicities were gastrointestinal symptoms and hematological effects. Grade 3 toxicity developed in 6 patients (30%). No surgical complications were attributable to sunitinib treatment. Of the 20 patients 17 (85%) experienced reduced tumor diameter (mean change -11.8%, range -27% to 11%) and cross-sectional area (mean change -27.9%, range -43% to 23%). Enhancement on contrast enhanced computerized tomography decreased in 15 patients (mean HU change -22%, range -74% to 29%). After tumor reduction 8 patients with cT1b disease underwent laparoscopic partial nephrectomy. Surgical parameters, such as blood loss, transfusion rate, operative time and complications, were similar to those in patients who underwent surgery during the study period and were not enrolled in the trial. CONCLUSIONS: Preoperative treatment with sunitinib is safe. Sunitinib decreased the size of primary renal cell carcinoma in 17 of 20 patients. Future trials can be considered to evaluate neoadjuvant sunitinib to maximize nephron sparing and decrease the recurrence of high risk, localized renal cell carcinoma. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
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PMID: 20643461 [PubMed - in process]14: J Urol. 2010 Sep;184(3):901-6.
Craig BM, Gilbert SM, Herndon JB, Vogel B, Quinn GP.
Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida 33612-9416, USA. benjamin.craig@moffitt.org
PURPOSE: On June 7, 2000 President Clinton issued an executive memorandum directing Medicare payment for routine patient care in qualifying clinical trials. We estimated the proportion of older patients with prostate cancer who were examined as part of a qualifying clinical trial, and the association between participation and patient characteristics. MATERIALS AND METHODS: We performed an observational study using the Surveillance, Epidemiology and End Results Medicare database to determine participation in qualifying clinical trials in a sample of 37,216 men 66 years old or older who were enrolled in Medicare and diagnosed with prostate cancer between September 2000 and December 2002. RESULTS: Within 3 years of diagnosis 211 men (0.567%) received routine patient care in a qualifying clinical trial. These participants were more likely to be younger than 70 years (OR 1.687, 95% CI 1.27-2.24) and less likely to be less educated and reside in low income, metropolitan neighborhoods. White men were more likely to participate in clinical trials than nonwhite men but this association was not statistically significant (OR 1.426, CI 0.97-2.09). Participation varied significantly by registry site (0% to 1.2%) but not by tumor grade or stage, or prostate specific antigen status. CONCLUSIONS: Few older patients with prostate cancer participated in qualifying trials between 2000 and 2002. Those who participated were not representative of the general population of older patients with prostate cancer. Greater efforts are required to expand trial enrollment and decrease disparities in research participation. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Research Support, N.I.H., Extramural
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20643449&dopt=ExternalLink
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PMID: 20643449 [PubMed - in process]15: J Urol. 2010 Sep;184(3):879-82.
Johannes JR, Nelson E, Bibbo M, Bagley DH.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
PURPOSE: Fluorescence in situ hybridization is gaining popularity for transitional cell carcinoma screening. We determined the accuracy of fluorescence in situ hybridization for identifying upper tract transitional cell carcinoma. MATERIALS AND METHODS: A retrospective review of our upper tract transitional cell carcinoma database from 2005 to 2008 identified 35 patients with upper tract transitional cell carcinoma who submitted voided urine specimens for fluorescence in situ hybridization at commercial laboratory during a routine office visit. Each patient was evaluated endoscopically in the operating room within 3 months of sampling. Suspicious lesions were biopsied and treated. Transitional cell carcinoma in the lower or upper tract was proved by direct visualization, positive biopsy or upper tract cytology read as positive or highly suspicious for malignancy. RESULTS: Of the patients 35 satisfied study inclusion criteria. A total of 67 fluorescence in situ hybridization specimens were submitted. Upper tract transitional cell carcinoma was identified on 51 operative evaluations, of which 23 showed concurrent bladder tumor. For all encounters the sensitivity of fluorescence in situ hybridization was 56% and specificity was 80%. Sensitivity for low and high grade lesions was 68% and 67%, respectively. Only upper tract tumors were noted in 28 patients, in whom there were 2 false-positive and 13 false-negative voided fluorescence in situ hybridization results. In these cases sensitivity was 54% and specificity was 78% compared to the 18% sensitivity and 100% specificity of bladder cytology. Sensitivity for low and high grade upper tract transitional cell carcinoma was 60% and 50%, respectively. CONCLUSIONS: Voided fluorescence in situ hybridization has become an adjunct for bladder transitional cell carcinoma surveillance. However, it has limited value for upper tract tumor surveillance. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20643443&dopt=ExternalLink
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PMID: 20643443 [PubMed - in process]16: J Urol. 2010 Aug;184(2):702-7. Epub 2010 Jun 19.
Peters KM, Girdler B, Turzewski C, Trock G, Feber K, Nantau W, Bush B, Gonzalez J, Kass E, de Benito J, Diokno A.
Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA.
PURPOSE: Restoring bladder and bowel function in spina bifida by creation of a skin-central nervous system-bladder reflex arc via lumbar to sacral nerve rerouting has a reported success rate of 87% in China. We report 1-year results of the first North American trial on nerve rerouting. MATERIALS AND METHODS: Nine subjects were enrolled in the study. Intradural lumbar to sacral nerve rerouting was performed. Subjects underwent urodynamic testing with stimulation of the cutaneous dermatome and careful neurological followup. Adverse events were closely monitored along with changes in bowel and bladder function. RESULTS: At 1 year 7 patients (78%) had a reproducible increase in bladder pressure with stimulation of the dermatome. Two patients were able to stop catheterization and all safely stopped antimuscarinics. No patient achieved complete urinary continence. The majority of subjects reported improved bowel function. One patient was continent of stool at baseline and 4 were continent at 1 year. Of the patients 89% had variable weakness of lower extremity muscle groups at 1 month. One child had persistent foot drop and the remainder returned to baseline by 12 months. CONCLUSIONS: At 1 year a novel reflex arc with stimulation of the appropriate dermatome was seen in the majority of subjects. Improvements in voiding and bowel function were noted. Lower extremity weakness was mostly self-limited, except in 1 subject with a persistent foot drop. More patients and longer followup are needed to assess the risk/benefit ratio of this novel procedure. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Clinical Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20639040&dopt=ExternalLink
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PMID: 20639040 [PubMed - indexed for MEDLINE]17: J Urol. 2010 Aug;184(2):648-53. Epub 2010 Jun 19.
MacDonald SL, Canfield SE, Fesperman SF, Dahm P.
Department of Urology, Albert Einstein College of Medicine, New York, New York, USA.
PURPOSE: Well done systematic reviews provide the highest quality evidence for clinical questions of therapeutic effectiveness. We assessed the methodological quality of systematic reviews in the urological literature. MATERIALS AND METHODS: We systematically investigated all systematic reviews published in 4 major urological journals from 1998 to 2008. Studies were identified using a predefined search strategy in PubMed and confirmed by a hand search of journal tables of contents. A validated 11-point instrument to assess the methodological quality of systematic reviews was applied by 2 independent reviewers after a pilot testing phase. Disagreements were discussed and resolved by consensus. RESULTS: The systematic literature search identified 217 individual systematic reviews, of which 57 ultimately met study eligibility criteria. Ten (17.5%), 20 (35.1%) and 27 (47.4%) systematic reviews were published in 1998 to 2001, 2002 to 2005 and 2006 to 2008, respectively. Using the measurement tool to assess systematic reviews the mean +/- SD score was 4.8 +/- 2.0 points. Fewer than half of all systematic reviews performed a systematic literature search that included at least 2 databases (49.1%) or unpublished studies (31.6%), or provided a list of included and excluded studies (45.6%). Of the systematic reviews 63.2% assessed and documented the methodological quality of included studies. Systematic reviews with The Cochrane Collaboration authorship affiliation had a higher mean score than those with no such reported affiliation (6.5 +/- 1.2 vs 4.4 +/- 1.9 points, p <0.001). CONCLUSIONS: Results suggest that an increasing number of systematic reviews are published in the urological literature. However, many systematic reviews fail to meet established methodological standards, raising concerns about validity. Increased efforts are indicated to promote quality standards for performing systematic reviews among the authors and readership of the urological literature. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20639030&dopt=ExternalLink
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PMID: 20639030 [PubMed - indexed for MEDLINE]18: J Urol. 2010 Aug;184(2):598-603. Epub 2010 Jun 19.
Burgio KL, Goode PS, Richter HE, Markland AD, Johnson TM 2nd, Redden DT.
Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Birmingham, Alabama and Atlanta, Georgia, USA. kburgio@aging.uab.edu
PURPOSE: We tested whether individualized drug therapy enhanced with behavioral training would result in better outcomes than individualized drug therapy alone. MATERIALS AND METHODS: Participants were community dwelling women with urge predominant incontinence. Using a randomized clinical trial design women were randomized to 8 weeks (4 visits) of drug therapy alone (32) or drug therapy plus behavioral training (32). Drug therapy was individually titrated, extended release oxybutynin with proactive management of side effects. Behavioral training included pelvic floor muscle training and urge suppression techniques. The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks (with followup at 6 and 12 months). Secondary outcomes included patient satisfaction, global perception of improvement, Urogenital Distress Inventory and Incontinence Impact Questionnaire. RESULTS: In intent to treat analysis frequency of incontinence was reduced a mean of 88.5% in the drug alone group and 78.3% in the combined therapy group (p = 0.16). Outcomes were not significantly different between the groups in the analysis of completers (91.5% vs 86.2%, p = 0.34), or in either analysis at 6 or 12 months. The groups also did not differ significantly on secondary outcomes at any point. Participants in the drug alone group tended to be taking higher doses of oxybutynin at 8 weeks but the final dose did not differ significantly between the groups. Based on a conditional power calculation the trial was stopped early for futility. CONCLUSIONS: When drug therapy is implemented with frequent individualized dose titration, daily bladder diaries and careful management of side effects, initiating concurrent behavioral training does not enhance outcomes for urge incontinence in women. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Comparative Study Randomized Controlled Trial Research Support, U.S. Gov't, Non-P.H.S.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20639023&dopt=ExternalLink
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PMID: 20639023 [PubMed - indexed for MEDLINE]19: Urology. 2010 Jul 12; [Epub ahead of print]
Jiang DK, Ren WH, Yao L, Wang WZ, Peng B, Yu L.
State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China.
OBJECTIVES: To perform a meta-analysis to explore a more robust estimate of the effect of the TP53 Arg72Pro polymorphism on bladder cancer risk. Studies investigating the association between TP53 Arg72Pro polymorphism and bladder cancer risk have reported conflicting results. METHODS: All eligible studies were searched in PubMed. The quality of the studies was evaluated according to a predefined scale. Crude odds ratios, with the 95% confidence intervals, were assessed for the association using fixed- and random-effects models. RESULTS: We identified 10 case-control studies involving 3549 subjects for the present meta-analysis. Overall, no evidence of an association was observed between the TP53 genotypes and bladder cancer susceptibility when all the studies were pooled into the meta-analysis. However, a significantly decreased risk of bladder cancer was associated with TP53 genotypes for Arg/Arg versus Pro/Pro (odds ratio 0.74, 95% confidence interval 0.55-0.99) and Arg/Arg plus Arg/Pro versus Pro/Pro (odds ratio 0.77, 95% confidence interval 0.59-1.00) in Asians. In contrast, no effect of this polymorphism on bladder cancer in whites, Africans, or other population was observed when only high-quality scored studies were considered. CONCLUSIONS: The results of the present meta-analysis suggest that the TP53 Arg72 allele is a protective factor and that the Pro/Pro genotype might increase the susceptibility to bladder cancer in Asians. The conflicting findings among studies might have resulted from variations in the allele frequencies among the different races, as well as the methodologic quality of the studies. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20630574&dopt=ExternalLink
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PMID: 20630574 [PubMed - as supplied by publisher]20: J Urol. 2010 Aug;184(2):539-45. Epub 2010 Jun 17.
Zhu Y, Zhang HL, Yao XD, Zhang SL, Dai B, Shen YJ, Ye DW.
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
PURPOSE: Optimal management for penile cancer in patients with clinically negative lymph nodes is still under debate. We developed and evaluated a nomogram to stratify patients who are suitable candidates for further treatment. MATERIALS AND METHODS: This study included 110 men with penile cancer and clinically negative lymph nodes from 1990 to 2008. All patients underwent primary tumor resection and regional lymphadenectomy. We retrospectively reviewed medical records and tumor slides. Statistical analysis was done in R with library rms. RESULTS: The lymph node metastasis rate in the entire cohort was 23.6%. The final model, presented as a nomogram, included T stage, grade, lymphovascular invasion and p53 expression. Only lymphovascular invasion showed independent prognostic value on multivariate analysis (p = 0.024). The model also showed good calibration (bootstrap corrected concordance index 0.79). To determine the clinical usefulness of the nomogram we compared it with the European Association of Urology risk classification using decision curve analysis. At a 10% probability threshold our nomogram led to 1 positive result per 100 patients without an increase in the number of false-positive results. At this probability threshold the model also decreased 13 unnecessary interventions per 100 patients without missing more metastatic disease. CONCLUSIONS: We generated a nomogram in patients with clinically node negative penile cancer based on readily available pathological factors. The clinical usefulness of the nomogram was evidenced by decision curve analysis. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20620414&dopt=ExternalLink
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PMID: 20620414 [PubMed - indexed for MEDLINE]