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Re: Evaluation of a Novel Single-use Flexible Ureteroscope

Footnotes

a Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France

b Pierre et Marie Curie University, Paris, France

c Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

Corresponding author. Department of Urology, Tenon Hospital, Pierre et Marie Curie University, Assistance-Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France.

Article information

PII: S0302-2838(17)30105-7
DOI: 10.1016/j.eururo.2017.02.016
© 2017 European Association of Urology, Published by Elsevier B.V.

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Re: A Pilot Study to Evaluate the Role of Magnetic Resonance Imaging for Prostate Cancer Screening in the General Population

Footnotes

Department of Urology, University of California at Los Angeles, Los Angeles, CA, USA

Corresponding author. Department of Urology, University of California at Los Angeles, 300 Stein Plaza, Los Angeles, CA 90024, USA.

Article information

PII: S0302-2838(17)30101-X
DOI: 10.1016/j.eururo.2017.02.012
© 2017 European Association of Urology, Published by Elsevier B.V.

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Re: Decreased Overall and Bladder Cancer-specific Mortality with Adjuvant Chemotherapy After Radical Cystectomy: Multivariable Competing Risk Analysis

Footnotes

a Department of Urology, Klinikum St. Elisabeth, Straubing, Germany

b Department of Urology, Klinikum Neuruppin, Neuruppin, Germany

c Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany

d Janssen Research and Development, Los Angeles, CA, USA

Corresponding author. Department of Urology, Ludwig-Maximilians University Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.

Article information

PII: S0302-2838(17)30107-0
DOI: 10.1016/j.eururo.2017.02.018
© 2017 European Association of Urology, Published by Elsevier B.V.

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Investigating Genomic Aberrations of the Androgen Receptor: Moving Closer to More Precise Prostate Cancer Care?

Refers to article:

Comprehensive Profiling of the Androgen Receptor in Liquid Biopsies from Castration-resistant Prostate Cancer Reveals Novel Intra-AR Structural Variation and Splice Variant Expression Patterns

Bram De Laere, Pieter-Jan van Dam, Tom Whitington, Markus Mayrhofer, Emanuela Henao Diaz, Gert Van den Eynden, Jean Vandebroek, Jurgen Del-Favero, Steven Van Laere, Luc Dirix, Henrik Grönberg and Johan Lindberg

Accepted 3 January 2017

Footnotes

The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK

Corresponding author. Division of Clinical Studies, The Institute of Cancer Research, Drug Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel. +44 208 7224028; fax: +44 208 6427979.

Article information

PII: S0302-2838(17)30094-5
DOI: 10.1016/j.eururo.2017.02.005
© 2017 European Association of Urology, Published by Elsevier B.V.

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Vessel-sparing Radiotherapy for Localized Prostate Cancer to Preserve Erectile Function: A Single-arm Phase 2 Trial

Abstract Background

Erectile dysfunction remains the most common side effect from radical treatment of localized prostate cancer. We hypothesized that the use of vessel-sparing radiotherapy, analogous to the functional anatomy approach of nerve-sparing radical prostatectomy (RP), would improve erectile function preservation while maintaining tumor control for men with localized prostate cancer.

Objective

To determine erectile function rates after vessel-sparing radiotherapy.

Design, setting, and participants

Men with localized prostate cancer were enrolled in a phase 2 single-arm trial (NCT02958787) at a single academic center.

Intervention

Patients received vessel-sparing radiotherapy utilizing a planning MRI and MRI-angiogram to delineate and avoid the erectile vasculature.

Outcome measurements and statistical analysis

Both physician- and patient-reported inventories were used to capture erectile function at baseline and at 2 and 5 yr after treatment. Validated model-based comparisons were performed to compare vessel-sparing results to nerve-sparing RP and conventional radiotherapy.

Results and limitations

From 2001 to 2009, 135 men underwent vessel-sparing radiotherapy. After a planned interim analysis, the trial was stopped after meeting the primary endpoint. The median follow-up was 8.7 yr, with a ≥94% response rate to all inventories at each time point. At 5 yr, 88% of patients were sexually active with or without the use of sexual aids. The 2-yr erectile function rates were significantly improved with vessel-sparing radiotherapy (78%, 95% confidence interval [CI] 71–85%) compared to modeled rates for convention radiotherapy (42%, 95% CI 38-45%; p < 0.001) or nerve-sparing prostatectomy (24%, 95% CI 22–27%; p < 0.001). At 2 yr after treatment, 87% of baseline-potent men retained erections suitable for intercourse. The 5- and 10-yr rates of biochemical relapse–free survival were 99.3% and 89.9%, and at 5 yr the biochemical failures were limited to the National Comprehensive Cancer Network high-risk group. The single-arm design is a limitation.

Conclusions

Vessel-sparing radiotherapy appears to more effectively preserve erectile function when compared to historical series and model-predicted outcomes following nerve-sparing RP or conventional radiotherapy, with maintenance of tumor control. This approach warrants independent validation.

Patient summary

In this interim analysis we looked at using a novel approach to spare critical erectile structures to preserve erectile function after prostate cancer radiotherapy. We found that almost 90% of patients at 5 yr after treatment remained sexually active, significantly higher than previous studies with surgery or radiotherapy.

Take Home Message

Vessel-sparing radiotherapy for men with localized prostate cancer using a novel magnetic resonance imaging–based approach to spare erectile vasculature resulted in 88% maintenance of sexual activity at 5 yr after treatment, 87% retention of erections suitable for intercourse at 2 yr after treatment, and maintenance of tumor control.

Keywords: Erectile dysfunction, Prostate cancer, Radiotherapy, Vessel-sparing radiation.

Footnotes

a Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

b Department of Urology, Providence Cancer Center, Southfield, MI, USA

c Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

d Department of Radiation Oncology, Providence Cancer Center, Southfield, MI, USA

Corresponding author. Department of Radiation Oncology, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. Tel. +1 248 8493321; Fax: +1 248 8498448.

These authors contributed equally to this work.

Article information

PII: S0302-2838(17)30096-9
DOI: 10.1016/j.eururo.2017.02.007
© 2017 European Association of Urology, Published by Elsevier B.V.

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Editorial Comment

Although it is perhaps a forgotten entity, percussion has been shown to facilitate the passage of stone fragments (reference 13 in article). These authors report a novel percussion machine that creates vibrations to “shake up” stone fragments to improve passage. Similar in concept but using different technology, ultrasonic propulsion has been described to use focused ultrasound to move stones to facilitate passage and potentially relieve obstruction (reference 17 in article).1
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A 10-Year Retrospective Review of Nephrolithiasis in the Navy and Navy Pilots

Little is known about the incidence of nephrolithiasis in the U.S. Navy, and Navy pilots must be kidney stone-free and are often referred for treatment of small asymptomatic stones. The primary objectives of this study were to determine the incidence of nephrolithiasis, CT scans performed, proportion undergoing treatment, and incidence of stone-related mishaps of Navy pilots compared with other Navy personnel.
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Clinical outcome following a low-suspicion multiparametric prostate MRI or benign MRI-guided biopsy to detect prostate cancer: A follow-up study in men with prior negative transrectal ultrasound-guided biopsies

To assess the future risk of detecting significant prostate cancer following either a low-suspicion MRI or suspicious MRI with benign MRI-guided biopsies in men with prior negative systematic biopsies.
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Reply

Urology (Gold Journal) In Press - Tue, 02/21/2017 - 00:00
Let me begin by thanking the author for the thoughtful points laid out in the editorial comment. We are in agreement that computerized tomography (CT) is not the only modality available for imaging stones in the urinary tract, and a comparison of CT to other imaging modalities is beyond the intended scope of the current study. However, the superiority of CT imaging specifically for definitive diagnosis of ureteral stones and determination of stone size cannot be disputed. Kanno et al1 evaluated the efficacy of ultrasound (US) for the detection of renal stones and found that CT had a sensitivity of 100%, whereas US was only 70%.
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Editorial Comment

Urology (Gold Journal) In Press - Tue, 02/21/2017 - 00:00
The authors present a retrospective review of computerized tomography (CT) scans in 150 patients with ureteral stones to demonstrate the clinical relevance of coronal measurements of stone size for predicting stone passage. This work highlights 2 important and clinically relevant aspects of urinary stone disease management: accurate stone size measurement and medical expulsion. What makes these 2 topics particularly confusing is the heterogeneous nature of the literature surrounding each. Diagnostic imaging for kidney stones is a shifting landscape.
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Researchers make breakthrough in fight against superbug

MedicalNewsToday - Mon, 02/20/2017 - 02:00
Researchers at Queen's University Belfast have discovered why a lethal superbug is so resistant to the last line antibiotic meaning potential treatments could now be developed to fight the killer...
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Prevalence of Renal Angiomyolipomas and Spontaneous Bleeding Related to Angiomyolipmas in Tuberous Sclerosis Complex Patients in France and Norway - a Questionnaire Study

Urology (Gold Journal) In Press - Mon, 02/20/2017 - 00:00
To estimate the prevalence of renal angiomyolipomas (AMLs) and AML-related bleedings among patients with Tuberous Sclerosis Complex (TSC) and to gather information about associated treatments.
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Compensatory Structural and Functional Adaptation after Nephrectomy in Obese Patients According to Waist Circumference

Urology (Gold Journal) In Press - Mon, 02/20/2017 - 00:00
To investigate whether the postnephrectomy renal adaptation mechanism, focused on functional hyperfiltration as well as structural hypertrophy, was affected by abdominal obesity.
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Patterns of Pelvic Lymph Node Dissection at The Time of Radical Prostatectomy for Low-Risk Men

Urology (Gold Journal) In Press - Mon, 02/20/2017 - 00:00
To examine nationwide patterns of lymph node dissection (LND) in men with D'Amico low-risk prostate cancer, including the rate of detected lymph node metastasis and factors associated with the decision to perform LND. Existing guidelines recommend against LND at the time of radical prostatectomy (RP) in low-risk men, yet this is still a common practice.
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Gender Differences in Publication Productivity among Academic Urologists in the United States

Urology (Gold Journal) In Press - Mon, 02/20/2017 - 00:00
To describe the publication productivity of academic urologists in the United States by gender.
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Vaginectomy and Buccal Mucosa Vaginoplasty as Local Therapy for Pediatric Vaginal Rhabdomyosarcoma

Urology (Gold Journal) In Press - Mon, 02/20/2017 - 00:00
We report a case of vaginal rhabdomyosarcoma where vaginectomy with buccal mucosa vaginoplasty was performed with the goal of sparing radiation therapy to the young pelvis.The patient presented at 30 months with an exophytic vaginal mass, found to be botryoid RMS. After receiving neoadjuvant VAC chemotherapy with good response, she underwent surgery. It was performed using an anterior sagittal approach on the prone position, which allowed for a safe circumferential dissection of the vagina all the way to the cervix and en bloc resection.
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This Month in Adult Urology

From the earliest descriptions of medical procedures, management of lower urinary tract symptoms (LUTS) from benign prostate enlargement has been an area of controversy. This issue of The Journal of Urology® includes articles on the significant advances in the treatment of LUTS which have been made as well as a variety of available options. There are many ways to eliminate obstructing prostate tissue and which is best depends on a number of factors, including equipment availability, and surgeon preference and experience.
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Re: Sexual Activity and Function in the Year after an Acute Myocardial Infarction among Younger Women and Men in the United States and Spain

S. T. Lindau, E. Abramsohn, H. Bueno, G. D’Onofrio, J. H. Lichtman, N. P. Lorenze, R. M. Sanghani, E. S. Spatz, J. A. Spertus, K. M. Strait, K. Wroblewski, S. Zhou and H. M. Krumholz
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