Urology News Feeds

Manuka honey could stave off catheter-associated UTIs

MedicalNewsToday - Tue, 09/27/2016 - 10:00
Manuka honey shows promise for tackling catheter-associated urinary tract infections, after a study found it halted the formation of bacterial biofilms.
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Roller coasters could help pass kidney stones

MedicalNewsToday - Tue, 09/27/2016 - 02:00
Using a 3-D-printed kidney model, researchers found riding on the Big Thunder Mountain Railroad at Walt Disney World could help pass small kidney stones.
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'Teashirt' gene links autism and kidney problems, new study finds

MedicalNewsToday - Tue, 09/27/2016 - 02:00
A gene dubbed the 'Teashirt' by its discoverers has been identified as a link between children with kidney problems and autism, in a new study which has implications for how doctors working on both...
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Hybrid Transvaginal NOTES Nephrectomy: Post-Operative Sexual Outcomes. a Three Center Matched Study

Urology (Gold Journal) In Press - Tue, 09/27/2016 - 00:00
To evaluate our experience in patients undergoing hybrid transvaginal NOTES nephrectomy and evaluate the sexual functions in the post-operative period.
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Contemporary Trends in the Inpatient Management of Fournier's Gangrene: Predictors of Length of Stay and Mortality Based on Population-Based Sample

Urology (Gold Journal) In Press - Tue, 09/27/2016 - 00:00
To describe clinical management of Fournier's gangrene, and to characterize predictive factors associated with inpatient mortality and extended hospital stay.
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Better Defining The Spectrum Of Adult Hypospadias: Examining The Effect Of Childhood Surgery On Adult Presentation

Urology (Gold Journal) In Press - Tue, 09/27/2016 - 00:00
To describe the spectrum of adult presentations with hypospadias-related complications and examine the effect of childhood surgical repair on these adult presentations.
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Churukanti GR, Kim A, Rich DD, Schuyler KG, Lavien GD, Stein DM, Siddiqui MM. Role of Ultrasonography for Testicular Injuries in Penetrating Scrotal Trauma. Urology. 2016 Apr 28. pii: S0090-4295(16)30126-1. doi: 10.1016/j.urology.2016.04.025

Urology (Gold Journal) In Press - Tue, 09/27/2016 - 00:00
We read your article with interest and would congratulate you for defining the role of ultrasonography for testicular injuries in penetrating scrotal trauma. Very few studies have been done on this subject as per literature. We have certain queries regarding your article.
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Properties of the four kallikrein panel outside the diagnostic grey zone: meta-analysis of patients with positive digital rectal exam or prostate-specific antigen 10 ng / mL and above

The four-kallikrein panel, commercially available as the 4Kscore™, is a reflex test for prostate cancer early detection that has been extensively validated in multiple international cohorts. It has been suggested that use of such reflex tests be limited to those with PSA less than 10 ng/mL and negative DRE. We aimed to determine the value of the panel in men outside this “diagnostic grey zone”.
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A randomized study of intra-operative autologous retropubic urethral sling on urinary control after robotic-assisted radical prostatectomy

We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic-assisted radical prostatectomy (RARP) improved recovery of continence.
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The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis

Questions still remain regarding the durability and longevity of flexible ureteroscopes (URS). The objective of this manuscript is to estimate potential economic benefits of the single use flexible digital URS compared to our recent experience with reusable flexible digital URS using cost benefit analysis.
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PTEN Loss in Gleason Score 3+4=7 Prostate Biopsies is Associated with Non-Organ Confined Disease at Radical Prostatectomy

Men with intermediate risk prostate cancer have widely variable outcomes, with some suggesting that active surveillance or less invasive therapies (brachytherapy or focal therapy) may be appropriate for some men with Gleason Score 3+4=7 disease. Molecular markers may help further distinguish prostate cancers with aggressive behavior. Here, we tested whether loss of the PTEN tumor suppressor in 3+4=7 tumor biopsies is associated with adverse pathology at prostatectomy.
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Re: Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy

Footnotes

a Department of Urology, Lille University, Lille, France

b Englander Institute for Precision Medicine, Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA

Corresponding author. Department of Urology, Lille University, CHRU F-59000 Lille, France.

Article information

PII: S0302-2838(16)30639-X
DOI: 10.1016/j.eururo.2016.09.017
© 2016 European Association of Urology, Published by Elsevier B.V.

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Solifenacin in Children and Adolescents with Overactive Bladder: Results of a Phase 3 Randomised Clinical Trial

Abstract Background

Solifenacin, an effective, well-tolerated treatment for adult overactive bladder (OAB) symptoms, has not been evaluated in placebo-controlled paediatric clinical trials.

Objectives

To evaluate the efficacy and safety of once-daily oral solifenacin suspension in OAB patients aged 5–<12 yr (children) and 12–<18 yr (adolescents).

Design, setting, and participants

The study involved a 4-wk urotherapy run-in followed by 1:1 randomisation to 12-wk double-blind solifenacin or placebo treatment alongside urotherapy.

Intervention

Solifenacin paediatric equivalent doses (PEDs) of adult doses: 2.5 mg, 5 mg, 7.5 mg, and 10 mg. The starting dose was PED 5 mg; all patients were titrated to an optimum dose at 3-wk intervals over 9 wk, resulting in ≥3 wk at the optimum dose before end of treatment (EoT).

Outcome measurements and statistics

Superiority of solifenacin versus placebo in change from baseline to EoT for mean volume voided/micturition (MVV, primary endpoint); daytime maximum volume voided/micturition (DMaxVV); incontinence episodes (mean/24 h); mean number of incontinence-free days or nights/7 d; micturition frequency; and Micturition frequency adjusted for baseline total voided volume (VTB) as an exploratory parameter). Efficacy parameters were analysed using analysis of covariance. Safety parameters (treatment-emergent adverse events, serious adverse events, laboratory variables, vital signs, electrocardiogram, postvoid residual volume) are summarised using descriptive statistics.

Results and limitations

In children, solifenacin was superior to placebo in terms of the change from baseline to EoT for MVV (solifenacin-placebo difference 12.1 ml, 95% confidence interval [CI] 0.2–24.0; p = 0.046), DMaxVV (difference in adjusted mean change from baseline for solifenacin–placebo 31.9 ml, 95% CI 4.3–59.5; p = 0.024), VTB-adjusted micturition frequency (p = 0.028). Other endpoints were not significantly different. Solifenacin was well tolerated. For adolescents, it was not possible to draw firm efficacy conclusions because of the low numbers recruited.

Conclusions

Once-daily solifenacin oral suspension in children with OAB was superior to placebo for MVV (primary efficacy endpoint) and was well tolerated.

Patient summary

In this 12-wk study, a once-daily oral suspension of solifenacin in children aged 5–<12 yr with overactive bladder was superior to placebo in increasing mean volume voided/micturition, the primary efficacy variable in the study. Solifenacin was well tolerated, with a low incidence of dry mouth and constipation.

This study is registered at ClinicalTrials.gov as NCT01565707.

Take Home Message

A once-daily oral suspension of solifenacin in children aged 5–<12 yr with overactive bladder was superior to placebo for the primary efficacy endpoint of mean volume voided/micturition. Solifenacin was well tolerated, with low incidence of dry mouth and constipation.

Keywords: Adolescents, Children, Incontinence, Overactive bladder, Solifenacin.

Footnotes

a Astellas Pharma Europe BV, Leiden, The Netherlands

b CHU de Québec, Division of Urology, Québec, Canada

c Aarhus University Hospital, Department of Paediatrics, Aarhus, Denmark

Corresponding author. Medical Science – Urology/Nephrology, Astellas Pharma Europe BV, P.O. Box 344, Sylviusweg 62, Leiden, The Netherlands. Tel. +31 71 5454012.

Present address: 246 Victoria Avenue, Hull, HU53DZ UK.

Joint senior authors.

Article information

PII: S0302-2838(16)30573-5
DOI: 10.1016/j.eururo.2016.08.061
© 2016 European Association of Urology, Published by Elsevier B.V.

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Re: Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, et al. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder...

Refers to article:

Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel

Thomas Seisen, Benoit Peyronnet, Jose Luis Dominguez-Escrig, Harman M. Bruins, Cathy Yuhong Yuan, Marko Babjuk, Andreas Böhle, Maximilian Burger, Eva M. Compérat, Nigel C. Cowan, Eero Kaasinen, Joan Palou, Bas W.G. van Rhijn, Richard J. Sylvester, Richard Zigeuner, Shahrokh F. Shariat and Morgan Rouprêt

Accepted 11 July 2016

Footnotes

a Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

b Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Corresponding author. Department of Urology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung, Kaohsiung, Taiwan. Tel. +886 7 7317123; Fax: +886 7 7317123.

Article information

PII: S0302-2838(16)30663-7
DOI: 10.1016/j.eururo.2016.09.028
© 2016 Published by Elsevier B.V.

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Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Abstract Context

Several noninvasive tests have been developed for diagnosing bladder outlet obstruction (BOO) in men to avoid the burden and morbidity associated with invasive urodynamics. The diagnostic accuracy of these tests, however, remains uncertain.

Objective

To systematically review available evidence regarding the diagnostic accuracy of noninvasive tests in diagnosing BOO in men with lower urinary tract symptoms (LUTS) using a pressure-flow study as the reference standard.

Evidence acquisition

The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central, Google Scholar, and WHO International Clinical Trials Registry Platform Search Portal databases were searched up to May 18, 2016. All studies reporting diagnostic accuracy for noninvasive tests for BOO or detrusor underactivity in men with LUTS compared to pressure-flow studies were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the QUADAS-2 tool.

Evidence synthesis

The search yielded 2774 potentially relevant reports. After screening titles and abstracts, 53 reports were retrieved for full-text screening, of which 42 (recruiting a total of 4444 patients) were eligible. Overall, the results were predominantly based on findings from nonrandomised experimental studies and, within the limits of such study designs, the quality of evidence was typically moderate across the literature. Differences in noninvasive test threshold values and variations in the urodynamic definition of BOO between studies limited the comparability of the data. Detrusor wall thickness (median sensitivity 82%, specificity 92%), near-infrared spectroscopy (median sensitivity 85%, specificity 87%), and the penile cuff test (median sensitivity 88%, specificity 75%) were all found to have high sensitivity and specificity in diagnosing BOO. Uroflowmetry with a maximum flow rate of <10 ml/s was reported to have lower median sensitivity and specificity of 68% and 70%, respectively. Intravesical prostatic protrusion of >10 mm was reported to have similar diagnostic accuracy, with median sensitivity of 68% and specificity of 75%.

Conclusions

According to the literature, a number of noninvasive tests have high sensitivity and specificity in diagnosing BOO in men. However, although the majority of studies have a low overall risk of bias, the available evidence is limited by heterogeneity. While several tests have shown promising results regarding noninvasive assessment of BOO, invasive urodynamics remain the gold standard.

Patient summary

Urodynamics is an accurate but potentially uncomfortable test for patients in diagnosing bladder problems such as obstruction. We performed a thorough and comprehensive review of the literature to determine if there were less uncomfortable but equally effective alternatives to urodynamics for diagnosing bladder problems. We found that some simple tests appear to be promising, although they are not as accurate. Further research is needed before these tests are routinely used in place of urodynamics.

Take Home Message

A number of noninvasive tests for diagnosing bladder outlet obstruction (BOO) in men with lower urinary tract symptoms have been studied and have been found to have high sensitivity and specificity but high heterogeneity. Despite these promising results for noninvasive assessment of BOO, a pressure-flow study remains the gold standard test.

Keywords: Bladder outlet obstruction (BOO), Men, Lower urinary tract symptoms, Diagnosis, Urodynamics, Noninvasive, Systematic review.

Footnotes

a Department of Urology, Guy's and St Thomas’ NHS Foundation Trust, London, UK

b Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK

c Department of Urology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany

d Academic Urology Unit, University of Aberdeen, Aberdeen, UK

e Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

f Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany

g Department of Urology, University Hospital Bonn, Bonn, Germany

h School of Clinical Sciences, University of Bristol, Bristol, UK

i Department of Urology, University of Florence, AOUC – Careggi Hospital, Florence, Italy

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

k Department of Urology, Kaiser Franz Josef Spital, Vienna, Austria

l Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece

m Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

n Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

Corresponding author. Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 6–8 Feidiou, 41221 Larissa, Greece. Tel. +30 24 10555296; Fax: +30 24 13501562.

Article information

PII: S0302-2838(16)30661-3
DOI: 10.1016/j.eururo.2016.09.026
© 2016 European Association of Urology, Published by Elsevier B.V.

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Researchers take a new step towards non-antibiotic bladder infection therapies

MedicalNewsToday - Mon, 09/26/2016 - 08:00
A cross-border team of scientists has gained fresh insight into the development of bladder infections, also known as cystitis.
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UTI testing technology cuts screening time to four hours

MedicalNewsToday - Mon, 09/26/2016 - 02:00
Researchers using DNA sequencing to profile antibiotic resistance in infection have achieved a turnaround time from 'sample to answer' of less than four hours for urinary tract infections (UTIs).
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Delayed Obstruction with Asymptomatic Loss of Renal Function after Dextranomer/Hyaluronic Acid Copolymer (Deflux) Injection for Vesicoureteral Reflux: a Close Look at a Disturbing Outcome

Urology (Gold Journal) In Press - Mon, 09/26/2016 - 00:00
Dextranomer/hyaluronic acid copolymer (Deflux) first received FDA approval in 2001 for endoscopic injection in children with grade II-IV vesicoureteral reflux (VUR). As experience has grown, Deflux has been used more liberally with encouraging results. We report three cases where Deflux was used in off-label fashion, resulting in delayed ureteral obstruction and loss of renal function (range 18-52 months post-operatively). We now place increased emphasis on the need for long-term follow-up after Deflux in both routine and complex cases, particularly in situations of off-label use.
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Functional Effects of Bulbospongiosus Muscle Sparing on Ejaculatory Function and Post-void Dribbling after Bulbar Urethroplasty

Bulbar urethroplasty outcomes studies have shown low, but significant, rates of post- void dribbling (PVD) and ejaculatory dysfunction. The bulbospongiosus muscle is involved with expulsion of seminal fluid and urine from the bulbar urethra, and thus we hypothesized that performing urethroplasty utilizing a technique that does not split the muscle may result in better post-operative patient reported ejaculatory function (EF) and less PVD.
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Pediatric Renal Angiomyolipomas in Tuberous Sclerosis Complex

Tuberous Sclerosis Complex (TSC) is a genetic disorder characterized by the growth of hamartomas in multiple organs. Up to 80% of TSC patients will have at least one angiomyolipoma (AML) in their lifetime. In this study we aim to describe the incidence and natural history of AMLs in a pediatric TSC population, and analyze tumor growth to determine optimal renal imaging intervals in an effort to improve counseling, follow-up and treatment.
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