Urology News

Journal of Endourology , Vol. 0, No. 0.

According to a study published in the February 8 issue of JAMA, cefpodoxime, an antibiotic used as a short-term therapy in women with uncomplicated bladder infection (cystitis), failed to meet criteria for non-inferiority in comparison to ciprofloxacin. There have been concerns that ciprofloxacin, classed as a fluoroquinolone antibiotic, is overused, resulting in an increase in resistance rates...

A protein kinase known as ROCK1 can exacerbate an important process called fission in the mitochondria, the power plants of cells, leading to diabetic kidney disease, said researchers from Baylor College of Medicine in a report that appears online in the journal Cell Metabolism. (ROCK1 stands for (Rho-associated coiled-coil containing protein kinase 1...

Man may not live by bread alone, but cancer in animals appears less resilient, judging by a study that found chemotherapy drugs work better when combined with cycles of short, severe fasting. Even fasting on its own effectively treated a majority of cancers tested in animals, including cancers from human cells...

Two outcomes-based measures from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were recently endorsed by the National Quality Forum (NQF)...

Objective: To develop a noninvasive and real-time dual-wavelengths optic system to detect testicular torsion in an animal model. Diagnosis of testicular torsion is challenging in emergency conditions and frequently ends with surgical exploration. Materials and Methods: In this study, 9 male 8-month-old Wistar albino rats weighing an average of 400 g were used. A transverse incision on the upper scrotum was done and the right testis was torsed with a 720° medial rotation. The other testis of each rat was used as the control or sham group. In the sham group, the testicle was moved out of the body but no torsion was applied before repositioning into the scrotum. Transmission of continuous-wave light through all testes at wavelengths of 660 nm and 940 nm were measured. Results: The ratio of the average intensities of the transmitted light of both wavelengths—660 nm to 940 nm—was used as a parameter to diagnose testis torsion. The ratios were significantly different (P = .001) between the torsion group and control group. Conclusion: Our noninvasive technique measuring attenuation of dual wavelengths in transmission geometry across the testis has the ability to distinguish between the testis with and without torsion on the basis of a threshold value of the ratio.

Journal of Endourology , Vol. 0, No. 0.

Journal of Endourology , Vol. 0, No. 0.

Journal of Endourology , Vol. 0, No. 0.

Journal of Endourology , Vol. 0, No. 0.

Background:Evidence supporting the widespread use of GreenLight High Performance System (HPS) 120-W photoselective vaporization of the prostate (PVP) is lacking.Objective:To assess the noninferiority of PVP compared with transurethral resection of the prostate (TURP) on urinary symptoms and the superiority of PVP over TURP on length of hospital stay.Design, setting, and participants:A multicenter randomized controlled trial was conducted.Intervention:Patients underwent monopolar TURP or PVP with the GreenLight HPS 120-W laser.Measurements:International Prostate Symptom Score (IPSS), Euro-QOL questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual Function Questionnaire, sexual satisfaction, and adverse events were collected at 1, 3, 6, and 12 mo. The two groups were compared using the 95% confidence interval (CI) of median difference for testing noninferiority of the IPSS at 12 mo and the student t test for testing the difference in length of hospital stay.Results and limitations:A total of 139 patients (70 vs 69 men in each group) were randomized. Median IPSS scores at 12-mo follow-up were 5 (interquartile range [IQR]: 3–8) for TURP versus 6 (IQR: 3–9) for PVP, and the 95% CI of the difference of the median was equal to −2 to 3. Because the upper limit of the 95% CI was >2 (the noninferiority margin), the hypothesis of noninferiority could not be considered demonstrated. Median length of stay was significantly shorter in the PVP group than in the TURP group, with a median of 1 (IQR: 1–2) versus 2.5 (IQR: 2–3.5), respectively (p < 0.0001). Uroflowmetry parameters and complications were comparable in both groups. Sexual outcomes were slightly better in the PVP group without reaching statistical significance.Conclusions:The present study failed to demonstrate the noninferiority of 120-W GreenLight PVP versus TURP on prostate symptoms at 1 yr but showed that PVP was associated with a shorter length of stay in the hospital.Trial registration:NCT01043588.Photoselective vaporization of the prostate by GreenLight 120-W laser provides results comparable with transurethral resection of the prostate, with a reduced hospital stay.

Background:Two botulinum toxins A have been evaluated for the treatment of refractory neurogenic detrusor overactivity (NDO) in humans: Dysport (abobotulinumtoxinA) and Botox (onabotulinumtoxinA). However, these two distinct commercialized products have different potency units and so are not interchangeable.Objective:Assessment of the dose response and determination of minimal effective dose (MED) for Dysport and Botox in spinal cord–injured (SCI) rats with NDO.Design, setting, and participants:Female, adult, Sprague-Dawley rats (n = 98) underwent T8-T9 spinal cord transection. Nineteen days after spinal cord injury, rats received intradetrusor injections (25 μl injected, eight sites) of vehicle (V); Dysport 2, 5, 7.5, 10, and 12.5 U; and Botox 0.8, 2, 5, 7.5, and 10 U. Two days after injection, continuous cystometry was performed in conscious rats.Measurements:Voiding contractions (VC) were assessed by duration of VC, intercontraction interval, voided volume, maximal pressure, pressure threshold change, and intravesical baseline pressure (BP), while nonvoiding contractions (NVC) were evaluated by amplitude, frequency, and volume threshold to elicit NVC. MEDs for Dysport and Botox were determined by analysis of variance step-down trend test.Results and limitations:MEDs for Dysport and Botox were 10 U and 7.5 U, respectively. Regarding VC, only BP significantly decreased after 10 U Dysport and 7.5 U Botox compared to V (from 3.7 ± 0.6 to 1.5 ± 0.1 and 1.4 ± 0.3 mm Hg, respectively; p This is the first preclinical dose-ranging study with Dysport and Botox under standardized conditions showing similar inhibiting effects on neurogenic detrusor overactivity, albeit at different minimal effective doses. It highlights the importance of distinguishing each preparation for predicted outcomes and doses to be used.

Background:Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns.Objective:To assess the relation of biopsy and RP grade in the largest study to date.Design, setting, and participants:A total of 7643 totally embedded RP and corresponding needle biopsies (2004–2010) were analyzed according to the updated Gleason system.Interventions:All patients underwent prostate biopsy prior to RP.Measurements:The relation of upgrading or downgrading to patient and cancer characteristics was compared using the chi-square test, Student t test, and multivariable logistic regression.Results and limitations:A total of 36.3% of cases were upgraded from a needle biopsy GS 5–6 to a higher grade at RP (11.2% with GS 6 plus tertiary). Half of the cases had matching GS 3 + 4 = 7 at biopsy and RP with an approximately equal number of cases downgraded and upgraded at RP. With biopsy GS 4 + 3 = 7, RP GS was almost equally 3 + 4 = 7 and 4 + 3 = 7. Biopsy GS 8 led to an almost equal distribution between RP GS 4 + 3 = 7, 8, and 9–10. A total of 58% of the cases had matching GS 9–10 at biopsy and RP. In multivariable analysis, increasing age (p < 0.0001), increasing serum prostate-specific antigen level (p < 0.0001), decreasing RP weight (p < 0.0001), and increasing maximum percentage cancer/core (p < 0.0001) predicted the upgrade from biopsy GS 5–6 to higher at RP. Despite factoring in multiple variables including the number of positive cores and the maximum percentage of cancer per core, the concordance indexes were not sufficiently high to justify the use of nomograms for predicting upgrading and downgrading for the individual patient.Conclusions:Almost 20% of RP cases have tertiary patterns. A needle biopsy can sample a tertiary higher Gleason pattern in the RP, which is then not recorded in the standard GS reporting, resulting in an apparent overgrading on the needle biopsy.Use of the modified Gleason score (GS) system considering radical prostatectomy (RP) tertiary grade patterns, age, prostate-specific antigen, prostate weight, and maximum percentage cancer/core predicts upgrade from biopsy GS 6 to higher at RP.

Background:The extent of lymphadenectomy needed to optimize oncologic outcomes after radical cystectomy (RC) for patients with regionally advanced bladder cancer (BCa) is unclear.Objective:Evaluate the effect of the location of lymph node metastasis on recurrence-free survival (RFS) and cancer-specific survival (CSS) for patients undergoing RC with a mapping pelvic lymph node dissection (PLND).Design, setting, and participants:A study of 591 patients undergoing RC with mapping PLND was completed between 2000 and 2010. Median follow-up was 30 mo.Intervention:RC with mapping PLND.Measurements:We evaluated the impact of lymph node involvement by location on disease outcomes using the 2010 TNM staging system. Survival estimates were described using Kaplan-Meier methods. Gender, age, pathologic stage, histology, number of positive nodes, node density, use of perioperative chemotherapy, and grade were evaluated as predictors of RFS and CSS using multivariate Cox proportional hazard regression.Results and limitations:Overall, 114 patients (19%) had lymph node involvement, and 42 patients (7%) had pN3 disease. On multivariate analysis, the number of positive lymph nodes (one or two or more) was significantly associated with increased risk of cancer-specific death (hazard ratio [HR]: 1.9 [95% confidence interval (CI), 1.04–3.46], p = 0.036; versus HR: 4.3 [95% CI, 2.25–8.34], p < 0.0005). Positive lymph node location was not an independent predictor of RFS or CSS. Five-year RFS for pN3 patients undergoing RC with PLND was 25% (95% CI, 22–54). This finding was not statistically different from our pN1 and pN2 patients (38% [95% CI, 22–54] and 35% [95% CI, 11–60], respectively). This study is limited by the lack of prospective randomization and a control group.Conclusions:The outcome for patients with involved common iliac lymph nodes was similar to the outcome for patients with primary nodal basin disease. These data support inclusion of the common iliac lymph nodes (pN3) in the nodal staging system for BCa. Lymph node location was not an independent predictor of outcome, whereas the number of positive lymph nodes was an independent predictor of worse oncologic outcome (pN1, pN2). Further refinements of the TNM system to provide improved prognostication are warranted.Bladder cancer patients with resected pN3 disease experience outcomes similar to those of patients with nodal disease limited to the true pelvis. Inclusion of the common iliac lymph nodes in the nodal staging system for bladder cancer improves prognostication; however, further refinements are warranted.

Treatment with three relatively new "targeted" cancer drugs has been linked to a slightly elevated chance of fatal side effects, according to a new analysis led by scientists at Dana-Farber Cancer Institute. They added that the risk remains low, but should be taken into account by physicians and patients. The incidence of fatal complications was 1...