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For common prenatal abnormality, continuous antibiotics unnecessary in many cases

MedicalNewsToday - 13 hours 50 min ago
Up to 5 percent of all prenatal ultrasounds uncover antenatal hydronephrosis, or enlarged kidneys, the most commonly detected prenatal abnormality in the United States.
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Genetic screening helps predict which children with kidney disease will respond to standard therapy

MedicalNewsToday - Mon, 2014-07-28 03:00
A genetic screening test may help predict which patients with one of the most common childhood kidney diseases will respond to standard therapies.
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Reducing dialysis patients' need for multiple medications

MedicalNewsToday - Mon, 2014-07-28 03:00
A medication called ferric citrate may reduce dialysis patients' need to take multiple drugs that treat complications related to kidney disease.
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Long-term Phase 3 study results for Zerenex™ (ferric citrate) published

MedicalNewsToday - Mon, 2014-07-28 02:00
Data demonstrate the drug candidate's potential to become the first phosphate binder to increase iron stores while reducing the need for IV iron and erythropoiesis-stimulating agents in end-stage...
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Ancestral exposures to pesticide linked to 3 generations of disease

MedicalNewsToday - Mon, 2014-07-28 02:00
Washington State University researchers say ancestral exposures to the pesticide methoxychlor may lead to adult onset kidney disease, ovarian disease and obesity in future generations.
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The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Systematic Review

Abstract Context

Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).

Objective

To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.

Evidence acquisition

Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.

Evidence synthesis

Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.

Conclusions

Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.

Patient summary

The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed.

Take Home Message

Current evidence suggests that extended lymphadenectomy might be superior to lesser degrees of dissection in terms of oncologic outcomes with comparable perioperative morbidity. High-quality data from randomized clinical trials are needed to draw a firm conclusion.

Keywords: Bladder neoplasms, Radical cystectomy, Lymphadenectomy, Lymph node dissection, Standard, extended, or superextended dissection, Oncologic outcomes.

Footnotes

a Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands

b Department of Urology, Tampere University Hospital, Tampere, Finland

c Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain

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

e Department of Urology, University of Florida, Gainesville, FL, USA

f Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA

g Department of Pathology, Groupe Hospitalier Pitié—Salpêtrière, Paris, France

h Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK

i 3rd Medical Department/LBI-ACR VIEnna—LBCTO and ACR-ITR VIEnna, Kaiser Franz Josef Spital, Vienna, Austria

j Department of Urology, Eberhard-Karls University, Tübingen, Germany

k Department of Urology, Foch Hospital, Suresnes, France

l Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain

m Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden

Corresponding author. Radboud University Medical Centre, Department of Urology, Geert Grooteplein Zuid 10 (659), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Tel. +31 24 361 37 35; Fax: +31 24 354 10 31.

Article information

PII: S0302-2838(14)00491-6
DOI: 10.1016/j.eururo.2014.05.031
© 2014 European Association of Urology, Published by Elsevier B.V.

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Function lost in spinal cord injury restored by gene inhibitor, salmon fibrin

MedicalNewsToday - Sat, 2014-07-26 02:00
A therapy combining salmon fibrin injections into the spinal cord and injections of a gene inhibitor into the brain restored voluntary motor function impaired by spinal cord injury, scientists at UC...
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Long-term Safety and Efficacy of Single-tablet Combinations of Solifenacin and Tamsulosin Oral Controlled Absorption System in Men with Storage and Voiding Lower Urinary Tract Symptoms: Results from the NEPTUNE Study and NEPTUNE II Open-label Extension

Abstract Background

Short-term trials have demonstrated the efficacy and safety of combination therapy using antimuscarinics and α-blockers in men with lower urinary tract symptoms (LUTS). The Study of Solifenacin Succinate and Tamsulosin Hydrochloride OCAS (oral controlled absorption system) in Males with Lower Urinary Tract Symptoms (NEPTUNE) II is the first long-term study using solifenacin (Soli) and the oral controlled absorption system formulation of tamsulosin (TOCAS).

Objective

To evaluate long-term (up to 52 wk) safety and efficacy of flexible dosing of two fixed-dose combinations (FDC) of Soli plus TOCAS in men with moderate to severe storage symptoms and voiding symptoms.

Design, setting, and participants

Patients with both storage and voiding LUTS, maximum urinary flow rate of 4.0–12.0 ml/s, prostate size <75 ml, and postvoid residuals ≤150 ml, who completed the 12-wk, double-blind NEPTUNE study could continue in the 40-wk, open-label NEPTUNE II study.

Intervention

FDC of Soli 6 mg plus TOCAS 0.4 mg, or Soli 9 mg plus TOCAS 0.4 mg; patients could switch between doses in NEPTUNE II.

Outcome measurements and statistical analysis

Safety and efficacy data from NEPTUNE and NEPTUNE II were combined to cover a 52-wk period. Primary efficacy end points were total International Prostate Symptom Score (IPSS) and total urgency and frequency score (TUFS); secondary end points included IPSS storage and voiding subscores, micturition diary variables, and quality of life parameters.

Results

In all, 1066 men completed NEPTUNE and received one dose or more of study medication in NEPTUNE II. Treatment-emergent adverse events were reported in 499 (46.8%) patients who participated in NEPTUNE II; most were mild or moderate. Urinary retention occurred in 13 of 1208 (1.1%) patients receiving one or more FDCs in NEPTUNE and/or NEPTUNE II; 8 (0.7%) required catheterisation (acute urinary retention [AUR]). Reductions in total IPSS and TUFS during NEPTUNE were maintained for up to 52 wk of FDC treatment, with mean reductions of 9.0 (standard deviation [SD]: 5.7) and 10.1 (SD: 9.2), respectively, from baseline to end of treatment. Clinically relevant improvements were also observed for secondary efficacy end points.

Conclusions

Long-term treatment with FDC Soli plus TOCAS was well tolerated and efficacious in men with storage and voiding LUTS, with a low incidence of AUR.

Patient summary

Treatment with solifenacin plus tamsulosin in a fixed-dose combination tablet was well tolerated by men with lower urinary tract symptoms. Improvements in symptoms were achieved after 4 wk of treatment, with further improvements at week 16 maintained for up to 52 wk throughout the study.

Take Home Message

In men with moderate to severe storage symptoms and voiding symptoms, fixed-dose combination treatment with solifenacin plus tamsulosin for up to 52 wk was well tolerated, with a low incidence of urinary retention. Efficacy improvements during the NEPTUNE study were maintained throughout NEPTUNE II.

Keywords: α-Adrenergic blocker, Benign prostatic hyperplasia, Clinical trial, Lower urinary tract symptoms, Muscarinic antagonist, Phase 3, Solifenacin, Tamsulosin OCAS.

Footnotes

a University of Bristol and Bristol Urological Institute, Bristol, UK

b Royal Hallamshire Hospital and Sheffield Hallam University, Sheffield, UK

c Private Urological Care Centre, Piaristicka, Trencin, Slovakia

d Hannover Medical School, Hannover, Germany

e Astellas Pharma Global Development, Leiden, The Netherlands

f Maastricht University Medical Centre, Maastricht, The Netherlands

Corresponding author. University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK. Tel. +44 0117 3235145.

Article information

PII: S0302-2838(14)00653-8
DOI: 10.1016/j.eururo.2014.07.013
© 2014 European Association of Urology, Published by Elsevier B.V.

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Long-term Follow-up After Tissue-engineered Buccal Mucosa Urethroplasty

Footnotes

a Department of Urology, Royal Hallamshire Hospital, Sheffield, UK

b Kroto Research Institute, University of Sheffield, Sheffield, UK

Corresponding author. Department of Urology, H Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S102JF, UK.

Article information

PII: S0302-2838(14)00647-2
DOI: 10.1016/j.eururo.2014.07.007
© 2014 Published by Elsevier B.V.

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Re: Walter Artibani, Vincenzo Ficarra, Ben J. Challacombe, et al. EAU Policy on Live Surgery Events. Eur Urol 2014;66:87–97

Refers to article:

EAU Policy on Live Surgery Events

Walter Artibani, Vincenzo Ficarra, Ben J. Challacombe, Clement-Claude Abbou, Jens Bedke, Rafael Boscolo-Berto, Maurizio Brausi, Jean J.M.C.H. de la Rosette, Serdar Deger, Louis Denis, Giorgio Guazzoni, Bertrand Guillonneau, John P.F.A. Heesakkers, Didier Jacqmin, Thomas Knoll, Luis Martínez-Piñeiro, Francesco Montorsi, Alexander Mottrie, Pierre-Thierry Piechaud, Abhay Rane, Jens Rassweiler, Arnulf Stenzl, Jeroen Van Moorselaar, Roland F. Van Velthoven, Hendrik van Poppel, Manfred Wirth, Per-Anders Abrahamsson and Keith F. Parsons

Accepted 19 January 2014

July 2014 (Vol. 66, Issue 1, pages 87 - 97)

Footnotes

Department of Urology, Karolinska University Hospital, Stockholm, Sweden

Corresponding author. Department of Urology, Institutionssekr, Institutionen för MMK, Karolinska Universitetssjukhuset, 171 76 Stockholm, Sweden. Tel. +46 8 517 728 54; Fax: +46 8 517 735 99.

Article information

PII: S0302-2838(14)00649-6
DOI: 10.1016/j.eururo.2014.07.009
© 2014 European Association of Urology, Published by Elsevier B.V.

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Unnecessary repeat biopsies for prostate cancer may be eliminated by new accurate epigenetic test

MedicalNewsToday - Thu, 2014-07-24 02:00
More than one million prostate biopsies are performed each year in the U.S. alone, including many repeat biopsies for fear of cancer missed.
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