Practices RSS : Gourt

The Optimal Application of Prostate-Specific Antigen (PSA) Velocity to Predict High-Risk Disease.

The Optimal Application of Prostate-Specific Antigen (PSA) Velocity to Predict High-Risk Disease. Eur Urol. 2008 Nov;54(5):978-979 Authors: Loeb S, Kettermann A, Ferrucci L, Landis P, Metter EJ, Carter BH PMID: 19884959 [PubMed - as supplied by publisher]

A New Multimodality Technique Accurately Maps the Primary Lymphatic Landing Sites of the Bladder.

Related Articles A New Multimodality Technique Accurately Maps the Primary Lymphatic Landing Sites of the Bladder. Eur Urol. 2009 Oct 23; Authors: Roth B, Wissmeyer MP, Zehnder P, Birkhäuser FD, Thalmann GN, Krause TM, Studer UE BACKGROUND: Pathoanatomic studies have failed to map accurately the primary lymphatic landing sites of the urinary bladder. OBJECTIVE: To use single-photon emission computed tomography (SPECT) combined with computed tomography (CT) plus intraoperative gamma probe verification to map the primary lymphatic landing sites of the bladder. DESIGN, SETTING, AND PARTICIPANTS: Clinical trial of 60 consecutive cystectomy patients at a single centre. INTERVENTION: Flexible cystoscopy-guided injection of technetium nanocolloid into one of six non-tumour-bearing sites of the bladder for preoperative detection of radioactive lymph nodes (LNs) with SPECT/CT followed by intraoperative verification with a gamma probe. Backup extended pelvic LN dissection (PLND) for ex vivo detection of missed LNs. MEASUREMENTS: Three-dimensional projection of each LN site. RESULTS AND LIMITATIONS: A median of 4 (range: 1-14) radioactive LNs were detected per site and patient. Ninety-two percent of all LNs were found distal and caudal to where the ureter crosses the common iliac arteries. Eight percent were found proximal to the uretero-iliac crossing, none without simultaneous detection of additional radioactive LNs within the endopelvic region. Extended PLND resected 92% of all primary lymphatic landing sites; limited PLND resected only 52%. A few LNs may have been missed despite preoperative SPECT/CT, intraoperative gamma probe verification, and extended backup PLND. CONCLUSIONS: Multimodality SPECT/CT plus intraoperative gamma probe show the template of the bladder's primary lymphatic landing sites to be larger than is often thought. PLND limited to the ventral portion of the external iliac vessels and obturator fossa removes only about 50% of all primary lymphatic landing sites, whereas extended PLND along the major pelvic vessels, including the internal iliac, external iliac, obturator, and common iliac region up to the uretero-iliac crossing, removes about 90%. TRIAL REGISTRATION: ClinicalTrials.gov, ISRCTN39379749. PMID: 19879039 [PubMed - as supplied by publisher]

Editorial comment on: a review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate.

Related Articles Editorial comment on: a review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009 Jun;55(6):1357 Authors: Rassweiler J PMID: 19361917 [PubMed - indexed for MEDLINE]

A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate.

A review of the recent evidence (2006-2008) for 532-nm photoselective laser vaporisation and holmium laser enucleation of the prostate. Eur Urol. 2009 Jun;55(6):1345-57 Authors: Naspro R, Bachmann A, Gilling P, Kuntz R, Madersbacher S, Montorsi F, Reich O, Stief C, Vavassori I CONTEXT: Holmium laser enucleation of the prostate (HoLEP) and 532-nm laser vaporisation of the prostate (with potassium titanyl phosphate [KTP] or lithium borate [LBO]) are promising alternatives to transurethral resection of the prostate (TURP) and open prostatectomy (OP). OBJECTIVE: To assess safety, efficacy, and durability by analysing the most recent evidence of both techniques, aiming to identify advantages, pitfalls, and unresolved issues. EVIDENCE ACQUISITION: A Medline search of recently published data (2006-2008) regarding both techniques over the last 2 yr (January 2006 to September 2008) was performed using evidence obtained from randomised trials (level of evidence: 1b), well-designed controlled studies without randomisation (level of evidence: 2a), individual cohort studies (level of evidence: 2b), individual case control studies (level of evidence: 3), and case series (level of evidence: 4). EVIDENCE SYNTHESIS: In the last 2 yr, several case-control and cohort studies have demonstrated reproducibility, safety, and efficacy of HoLEP and 80-W KTP laser vaporisation. Four randomised controlled trials (RCTs) were available for HoLEP, two compared with TURP and two compared with OP, with follow-up >24 mo. Results confirmed general efficacy and durability of HoLEP, as compared with both standard techniques. Only two RCTs were available comparing KTP laser vaporisation with TURP with short-term follow-up, and only one RCT was available comparing KTP laser vaporisation with OP. The results confirmed the overall low perioperative morbidity of KTP laser vaporisation, although efficacy was comparable to TURP in the short term, despite a higher reoperation rate. CONCLUSIONS: Although they are at different points of maturation, KTP or LBO laser vaporisation and HoLEP are promising alternatives to both TURP and OP. Sufficient data proves HoLEP's durability for most prostate sizes at long-term follow-up; KTP laser vaporisation needs further evaluation to define the reoperation rate. Increasing the number of quality prospective RCTs with adequate follow-up is mandatory to tailor each technique to the right patient. PMID: 19361906 [PubMed - indexed for MEDLINE]

Will the global economic downturn affect prostate cancer care? Pelvic lymphadenectomy as an example.

Related Articles Will the global economic downturn affect prostate cancer care? Pelvic lymphadenectomy as an example. Eur Urol. 2009 Jun;55(6):1266-8 Authors: Moul JW PMID: 19349110 [PubMed - indexed for MEDLINE]

Nondestructive testing in urologic oncology.

Related Articles Nondestructive testing in urologic oncology. Eur Urol. 2009 Jun;55(6):1289-91; discussion 1291-2 Authors: Egawa S PMID: 19342153 [PubMed - indexed for MEDLINE]

Photodynamic diagnosis using 5-aminolevulinic acid for the detection of positive surgical margins during radical prostatectomy in patients with carcinoma of the prostate: a multicentre, prospective, phase 2 trial of a diagnostic procedure.

Photodynamic diagnosis using 5-aminolevulinic acid for the detection of positive surgical margins during radical prostatectomy in patients with carcinoma of the prostate: a multicentre, prospective, phase 2 trial of a diagnostic procedure. Eur Urol. 2009 Jun;55(6):1281-8 Authors: Adam C, Salomon G, Walther S, Zaak D, Khoder W, Becker A, Reich O, Blana A, Ganzer R, Denzinger S, Popken G, Sroka R, Knüchel-Clarke R, Köllermann J, Sauter G, Hartmann A, Bertz S, Graefen M, Huland H, Wieland W, Stief CG BACKGROUND: Surgical margin status after radical prostatectomy (RP) is a significant risk factor for tumour recurrence. It is an intriguing concept to find a fluorescence marker for photodynamic diagnosis (PDD) to make tumour margins visible during surgery. OBJECTIVE: To investigate the feasibility of identification of positive surgical margins (PSM) during open retropubic or endoscopic extraperitoneal RP by 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) to enhance surgical radicality. DESIGN, SETTING, AND PARTICIPANTS: Thirty-nine patients (Gleason score 6-10, prostate-specific antigen [PSA] 2.3-120 ng/ml) received 20 mg/kg of body weight of 5-ALA orally and underwent RP (24 endoscopic extraperitoneal, 15 open retropubic). MEASUREMENTS: A PDD-suitable laparoscopy optic (Karl-Storz GmbH, Tuttlingen, Germany) with a yellow long-pass filter was coupled to a fibre-optic light cord with an excitation light source (380-420 nm, D-Light, Karl-Storz GmbH, Tuttlingen, Germany) for fluorescence excitation of PpIX and to a PDD-suitable camera for video and photo documentation by the AIDA DVD system (Karl-Storz GmbH, Tuttlingen, Germany). RESULTS AND LIMITATIONS: There were more false-negative cases in the open group (four vs two) than in the endoscopic group but more false-positive cases in the endoscopic group (two vs none) than in the open group. The overall sensitivity and specificity were 56% and 91.6%, respectively. The sensitivity of the endoscopic cases was much higher (75% vs 38%) than for the open cases, while the specificity was higher for the open group (88.2% vs 100%). CONCLUSIONS: PDD with 5-ALA-induced PpIX during RP might be a feasible and effective method for reducing the rate of PSM. The technique seems to be more practicable during endoscopic RP rather than open RP. Further clinical studies with higher patient volumes and further development of the technique seem justified. TRIAL REGISTRATION: EudraCT: 2005-004406-93. PMID: 19328622 [PubMed - indexed for MEDLINE]

Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

Related Articles Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009 Jun;55(6):1457-8 Authors: Apostolidis A PMID: 19304373 [PubMed - indexed for MEDLINE]

Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

Related Articles Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009 Jun;55(6):1456-7 Authors: Costantini E, Lazzeri M PMID: 19304371 [PubMed - indexed for MEDLINE]

Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009 Jun;55(6):1450-5 Authors: Liapis A, Bakas P, Creatsas G BACKGROUND: Data about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited. OBJECTIVE: Assessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP. DESIGN, SETTING, AND PARTICIPANTS: Thirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center. MEASUREMENTS: Preoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2-3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6 mo (range: 12-28 mo). RESULTS AND LIMITATIONS: Overall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients' answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured. CONCLUSIONS: The TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures. PMID: 19304370 [PubMed - indexed for MEDLINE]

Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

Editorial comment on: Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Eur Urol. 2009 Jun;55(6):1455-6 Authors: De Ridder D PMID: 19304369 [PubMed - indexed for MEDLINE]

Intermittent androgen deprivation therapy: conventional wisdom versus evidence.

Related Articles Intermittent androgen deprivation therapy: conventional wisdom versus evidence. Eur Urol. 2009 Jun;55(6):1278-80 Authors: Tombal B PMID: 19303201 [PubMed - indexed for MEDLINE]

Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.

Related Articles Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol. 2009 Jun;55(6):1407 Authors: Patel HR PMID: 19299074 [PubMed - indexed for MEDLINE]

Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.

Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol. 2009 Jun;55(6):1397-407 Authors: Kamihira O, Hattori R, Yamaguchi A, Kawa G, Ogawa O, Habuchi T, Kawauchi A, Uozumi J, Yokoi S, Tsujihata M, Hasui Y, Miyakoda K, Tada H, Ono Y, Naito S BACKGROUND: Laparoscopic nephroureterectomy (LNUx) is prevalent in Japan and throughout the world, but long-term outcome data remain limited. OBJECTIVE: To understand the present state of LNUx in Japan, we conducted a multicenter analysis of clinical outcome and long-term cancer control for patients who underwent the procedure. DESIGN, SETTING, AND PARTICIPANTS: Between January 1995 and December 2005, 1003 patients with urothelial cancer in the upper urinary tract were treated with LNUx at 51 institutions in Japan, and patient data were collected retrospectively. MEASUREMENTS: Patient profiles were gathered and analyzed for survival, intravesical recurrence, and risk factors influencing them. RESULTS AND LIMITATIONS: Median operative time was 320 min. Median bleeding volume was 232 ml. Complications occurred in 93 cases (9.3%) intraoperatively and in 107 cases (10.7%) postoperatively. Overall survival rate was 70% at 5 yr. Grade 3, pT3 or pT4, multifocal tumor, lymph-node metastasis, and previous or coexistent bladder tumor were independent risk factors for overall survival. Intravesical recurrence rate was 43% at 5 yr. Intravesical recurrence occurred more frequently in males, in patients with multifocal tumors, in patients with previous or coexistent bladder tumors, and in patients who underwent the hand-assisted approach. CONCLUSIONS: Our report represents the largest multicenter analysis of LNUx reported to date. Male sex and the use of the hand-assisted approach were shown for the first time to be risk factors for recurrence-free survival and intravesical recurrence. To further analyze the effectiveness of LNUx, a long-term outcome comparison with risk stratification must be made between LNUx and open nephroureterectomy. PMID: 19299072 [PubMed - indexed for MEDLINE]

Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.

Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol. 2009 Jun;55(6):1408 Authors: Autorino R, Falsaperla M PMID: 19299070 [PubMed - indexed for MEDLINE]

Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.

Editorial comment on: Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol. 2009 Jun;55(6):1409 Authors: Touijer K PMID: 19299068 [PubMed - indexed for MEDLINE]

Pelvic lymph node dissection in prostate cancer.

Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009 Jun;55(6):1251-65 Authors: Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE CONTEXT: Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. OBJECTIVE: To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. EVIDENCE ACQUISITION: A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focussing on the role of PLND in PCa staging and outcome were reviewed and discussed by all of the contributing authors. EVIDENCE SYNTHESIS: Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; ie, removal of obturator, external iliac, hypogastric with or without presacral and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; ie, removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harbouring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (<8%). The outcome for patients with positive nodes is not necessarily poor. Indeed, patients with low-volume nodal metastases experience excellent survival rates, regardless of adjuvant treatment. But despite few retrospective studies reporting an association between PLND and PCa progression and survival, the exact impact of PLND on patient outcomes has not yet been clearly proven because of the lack of prospective randomised trials. CONCLUSIONS: On the basis of current data, we suggest that if a PLND is indicated, then it should be extended. Conversely, in view of the low rate of LNI among patients with low-risk PCa, a staging ePLND might be spared in this patient category. Whether this approach is also safe from oncologic perspectives is still unknown. Patients with low-volume nodal metastases have a good long-term prognosis; to what extent this prognosis is the result of a positive impact of PLND on PCa outcomes is still to be determined. PMID: 19297079 [PubMed - indexed for MEDLINE]

Editorial comment on: Insignificant prostate cancer and active surveillance: from definition to clinical implications.

Related Articles Editorial comment on: Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009 Jun;55(6):1331-2 Authors: Albertson PC PMID: 19286304 [PubMed - indexed for MEDLINE]

Editorial comment on: Insignificant prostate cancer and active surveillance: from definition to clinical implications.

Related Articles Editorial comment on: Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009 Jun;55(6):1331 Authors: Aus G PMID: 19286303 [PubMed - indexed for MEDLINE]

Insignificant prostate cancer and active surveillance: from definition to clinical implications.

Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009 Jun;55(6):1321-30 Authors: Bastian PJ, Carter BH, Bjartell A, Seitz M, Stanislaus P, Montorsi F, Stief CG, Schröder F CONTEXT: Due to early detection strategies, prostate cancer is diagnosed early in its natural history. It remains unclear whether all patients diagnosed with prostate cancer warrant radical treatment or may benefit from delayed intervention following active surveillance. OBJECTIVE: A systematic review of active surveillance protocols to investigate the inclusion criteria for active surveillance and the outcome of treatment. EVIDENCE ACQUISITION: Medline was searched using the following terms: prostate cancer, active surveillance and expectant management for dates up to October 2008. Further studies were chosen on the basis of manual searches of reference lists and review papers. EVIDENCE SYNTHESIS: Numerous studies on active surveillance were identified. The recent inclusion criteria of the studies are rather similar. Keeping the short follow-up of all studies in mind, the majority of men stay on active surveillance, and the percentage of patients receiving active treatment is as high as 35% of all patients. Once a patients requires active treatment, most patients still present with curable prostate cancer. Furthermore, only few deaths due to prostate cancer have occurred. CONCLUSIONS: Active surveillance is an alternative option to immediate treatment of men with presumed insignificant prostate cancer. It seems that criteria used to identify men with low-risk prostate cancer are rather similar, and immediate treatment of men meeting these criteria may result in an unnecessary number of treatments in these highly selected patients. Data from randomised trials comparing active surveillance and active treatment will provide additional insight into outcome and follow-up strategies. PMID: 19286302 [PubMed - indexed for MEDLINE]

Lack of KRAS and BRAF mutation in renal cell carcinoma.

Related Articles Lack of KRAS and BRAF mutation in renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1490-1 Authors: Gattenlöhner S, Etschmann B, Riedmiller H, Müller-Hermelink HK PMID: 19282104 [PubMed - indexed for MEDLINE]

Intermittent androgen deprivation for locally advanced and metastatic prostate cancer: results from a randomised phase 3 study of the South European Uroncological Group.

Intermittent androgen deprivation for locally advanced and metastatic prostate cancer: results from a randomised phase 3 study of the South European Uroncological Group. Eur Urol. 2009 Jun;55(6):1269-77 Authors: Calais da Silva FE, Bono AV, Whelan P, Brausi M, Marques Queimadelos A, Martin JA, Kirkali Z, Calais da Silva FM, Robertson C BACKGROUND: Few randomised studies have compared intermittent hormonal therapy (IHT) with continuous therapy for the treatment of advanced prostate cancer (PCa). OBJECTIVE: To determine whether intermittent therapy is associated with a shorter time to progression. DESIGN, SETTING, AND PARTICIPANTS: 766 patients with locally advanced or metastatic PCa received a 3-mo induction treatment. The 626 patients whose prostate-specific antigen (PSA) level decreased to <4 ng/ml or to 80% below the initial value were randomised. INTERVENTION: Patients received cyproterone acetate (CPA) 200mg for 2 wk and then monthly depot injections of a luteinising hormone-releasing hormone (LHRH) analogue plus 200mg of CPA daily during induction. Patients randomised to the intermittent arm ceased treatment, while those randomised to the continuous arm received 200mg of CPA daily plus an LHRH analogue. MEASUREMENTS: Primary outcome measurement was time to subjective or objective progression. Secondary outcomes were survival and quality of life (QoL). Time off therapy in the intermittent arm was also recorded. RESULTS AND LIMITATIONS: 127 patients from the intermittent arm and 107 patients from the continuous arm progressed, with a hazard ratio (HR) of 0.81 (95% confidence interval [CI]: 0.63-1.05, p=0.11). There was no difference in survival, with an HR of 0.99 (95% CI: 0.80-1.23) and 170 deaths in the intermittent arm and 169 deaths in the continuous arm. The greater number of cancer deaths in the intermittent treatment arm (106 vs 84) was balanced by a greater number of cardiovascular deaths in the continuous arm (52 vs 41). Side-effects were more pronounced in the continuous arm. Men treated with intermittent therapy reported better sexual function. Median time off therapy for the intermittent patients was 52 wk (95% CI: 39.4-65.7). CONCLUSIONS: IHT should be considered for use in routine practice because it is associated with no reduction in survival, no clinically meaningful impairment in QoL, better sexual activity, and considerable economic benefit to the individual and the community. PMID: 19249153 [PubMed - indexed for MEDLINE]

Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status.

Related Articles Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol. 2009 Jun;55(6):1385 Authors: Klingler HC PMID: 19243887 [PubMed - indexed for MEDLINE]

Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status.

Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol. 2009 Jun;55(6):1377-83 Authors: Porpiglia F, Fiori C, Grande S, Morra I, Scarpa RM BACKGROUND: Continence after laparoscopic radical prostatectomy is critical to patients and to surgeons. In this setting, the management of deep venous complex (DVC) without involvement of the sphincter fibres could be an important step of the procedure. OBJECTIVE: To evaluate the effects of a personal selective suture of the plexus (selective ligature of the deep venous complex [SLDVC]) on continence, blood loss, and surgical margin status during laparoscopic radical prostatectomy (LRP). DESIGN, SETTING, AND PARTICIPANTS: We planned a prospective randomised study. Sixty consecutive patients with clinically localised prostate cancer were involved in the study and were divided into two groups: group A (30 patients) underwent LRP with extraperitoneoscopic approach with standard management of DVC; group B (30 patients) underwent LRP with SLDVC. INTERVENTION: In group A, a standard ligature of DVC was performed (ligature and subsequent section); in group B, a selective ligature of DVC after its section was performed. MEASUREMENTS: Continence was evaluated during follow-up visits at catheter removal, and after 1, 3, 6, and 12 mo, perioperative variables and pathologic features of specimens were recorded. RESULTS AND LIMITATIONS: The two groups were comparable in terms of age, body mass index (BMI), prostate-specific antigen (PSA) values, and Gleason score at biopsy. No differences were found between the two groups in terms of operative times, blood loss, catheterisation time, and postoperative stay or histologic status. As far as continence rate is concerned, a significant difference was recorded between the groups (53% in group A vs 80% in group B) after 3 mo. CONCLUSIONS: This selective ligature of the DVC after its section can contribute to early recovery of continence. Our data suggest that SLDVC compromises neither the safety of the procedure nor its oncologic effectiveness. PMID: 19243886 [PubMed - indexed for MEDLINE]

Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status.

Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol. 2009 Jun;55(6):1384-5 Authors: Naspro R PMID: 19243885 [PubMed - indexed for MEDLINE]

Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status.

Editorial comment on: Selective versus standard ligature of the deep venous complex during laparoscopic radical prostatectomy: effects on continence, blood loss, and margin status. Eur Urol. 2009 Jun;55(6):1383-4 Authors: Mottrie A PMID: 19243884 [PubMed - indexed for MEDLINE]

Editorial comment on: Vaccine therapy in patients with renal cell carcinoma.

Related Articles Editorial comment on: Vaccine therapy in patients with renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1342-3 Authors: Bellmunt J, Ribas A PMID: 19201525 [PubMed - indexed for MEDLINE]

Editorial comment on: Vaccine therapy in patients with renal cell carcinoma.

Related Articles Editorial comment on: Vaccine therapy in patients with renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1343-4 Authors: Clark PE PMID: 19201523 [PubMed - indexed for MEDLINE]

Vaccine therapy in patients with renal cell carcinoma.

Vaccine therapy in patients with renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1333-42 Authors: Van Poppel H, Joniau S, Van Gool SW CONTEXT: Renal cell carcinoma (RCC) is one of the most immunoresponsive cancers in humans. Although immunotherapy is currently much less used than in the past, it remains an important option that warrants further exploration. OBJECTIVE: To examine the current status of vaccine therapy for RCC and to provide information on relevant clinical studies. EVIDENCE ACQUISITION: We reviewed recent literature on Medline (2003-2008, using the keywords renal cell carcinoma, cancer vaccines, active immunotherapy, and dendritic cells). Subsequent references were identified from reference list of retrieved articles. Quality assessment included prospective phase 1-3 trials and critical evaluations with low numbers of patients. EVIDENCE SYNTHESIS: Therapeutic vaccines can be divided in autologous tumour cell-based vaccines, genetically modified tumour cell-based and dendritic cell (DC)-based vaccines, and peptide-based vaccines. To date, only two randomised, adjuvant, phase 3 studies investigating RCC vaccines have been published. Autologous tumour cell vaccine (Reniale) improved the 5-yr progression-free survival (PFS) for high-risk nonmetastatic RCC patients at all tumour stages when administered after nephrectomy. The benefit was clearer in the T3 group. A per-protocol analysis revealed a statistically significant PFS and overall survival (OS) in favour of the vaccine. Autologous tumour-derived heat shock protein peptide complex (HSPPC-96; vitespen) could not significantly improve recurrence-free survival in RCC patients at high risk for recurrence after nephrectomy, but did so in intermediate risk patients. DC vaccination in metastatic RCC (mRCC) patients is safe and can induce antigen-specific immune response and obtain tumour regression in a subset of patients. CONCLUSIONS: RCC vaccines have much less toxicity than other current therapies and remain an important area for further research. Reniale has shown significant benefit as an adjuvant RCC vaccine. Vitespen seems promising as an adjuvant treatment in earlier stage disease. A possible area of research is the use of RCC vaccines with immune-enhancing or antiangiogenic agents in the adjuvant setting. PMID: 19201522 [PubMed - indexed for MEDLINE]

Editorial comment on: Bladder tumor infiltrating mature dendritic cells and macrophages as predictors of response to bacillus Calmette-Guérin immunotherapy.

Related Articles Editorial comment on: Bladder tumor infiltrating mature dendritic cells and macrophages as predictors of response to bacillus Calmette-Guérin immunotherapy. Eur Urol. 2009 Jun;55(6):1395-6 Authors: de Reijke TM PMID: 19193488 [PubMed - indexed for MEDLINE]

Bladder tumor infiltrating mature dendritic cells and macrophages as predictors of response to bacillus Calmette-Guérin immunotherapy.

Bladder tumor infiltrating mature dendritic cells and macrophages as predictors of response to bacillus Calmette-Guérin immunotherapy. Eur Urol. 2009 Jun;55(6):1386-95 Authors: Ayari C, LaRue H, Hovington H, Decobert M, Harel F, Bergeron A, Têtu B, Lacombe L, Fradet Y BACKGROUND: The clinical significance of tumor-infiltrating dendritic cells (TIDCs) and tumor-associated macrophages (TAMs) as markers of immune response has been reported for many cancers. OBJECTIVE: To measure tumor infiltration by CD83(+) dendritic cells (DCs) and CD68(+) macrophages in non-muscle-invasive urothelial cancer (NMIUC) prior to bacillus Calmette-Guérin (BCG) immunotherapy and to evaluate their significance in the response to immunotherapy. DESIGN, SETTING, AND PARTICIPANTS: Patients with NMIUC at high risk of recurrence and progression were recruited for a study on markers of the response to BCG. INTERVENTION: Patients were treated by transurethral resection followed by maintenance BCG. MEASUREMENTS: Immunohistochemical staining with anti-CD83 and anti-CD68 monoclonal antibodies on 53 and 46 NMIUC tumors, respectively, prior to BCG treatment. A scoring index was calculated based on the average density of positive cells within the papillary axis, the stroma, lymphoid aggregates, and infiltration into tumors. RESULTS AND LIMITATIONS: CD83(+) TIDCs were observed mostly within lymphoid aggregates. Multivariate Cox regression analysis showed that maintenance BCG (more than one maintenance cycle) was highly effective in patients with a low level of CD83(+) TIDCs at time of resection (hazard ratio [HR]: 0.035; p=0.002) but showed reduced efficacy in patients with a high level of CD83(+) TIDCs (HR: 0.87; p=0.810). A high level of infiltration by CD83(+) TIDCs slightly decreased the risk of recurrence in patients treated with one or no maintenance BCG cycle (HR: 0.4; p=0.117). In the same population, a strong infiltration of CD68(+) TAMs was associated with an increased risk of recurrence (HR: 3.8; p=0.013). CONCLUSIONS: These results suggest that patients with a high level of infiltration by CD83(+) TIDCs or CD68(+) TAMs do not respond as well to BCG immunotherapy. If confirmed in larger cohorts, the pretreatment level of infiltration by these cells may be useful to influence the choice of treatment strategy. PMID: 19193487 [PubMed - indexed for MEDLINE]

Case study of the month. Complete histologic remission after sunitinib neoadjuvant therapy in T3b renal cell carcinoma.

Related Articles Case study of the month. Complete histologic remission after sunitinib neoadjuvant therapy in T3b renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1477-80 Authors: Robert G, Gabbay G, Bram R, Wallerand H, Deminière C, Cornelis F, Bernhard JC, Ravaud A, Ballanger P The authors present the first case report of complete histologic remission after neoadjuvant sunitinib treatment on primary renal tumour and vena cava thrombus. A 78-yr-old woman with an Eastern Cooperative Oncology Group (ECOG) score of 0 presented with a T3b renal tumour. She refused surgical treatment but agreed to percutaneous biopsy and medical treatment. A Fuhrman III renal cell carcinoma was histologically confirmed on percutaneous biopsy, and sunitinib treatment was administered over 6 mo. A significant objective response was observed for tumour size and thrombus. The patient finally accepted surgical treatment. Pathologic examination concluded with a complete response of primary tumour and thrombus. PMID: 19150171 [PubMed - indexed for MEDLINE]

Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up.

Related Articles Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009 Jun;55(6):1358-66 Authors: Murphy DG, Kerger M, Crowe H, Peters JS, Costello AJ BACKGROUND: Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer. OBJECTIVE: We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit. DESIGN, SETTING AND PARTICIPANTS: From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases. SURGICAL PROCEDURE: A six port transperitoneal approach using a 4-arm da Vinci system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up. MEASUREMENTS: Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) > or =0.2 ng/mL) is used as a surrogate for cancer control. RESULTS AND LIMITATIONS: The mean age+/-standard deviation (SD) was 60.2+/-6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3-9.6) ng/mL. The mean operating time+/-SD was 186+/-49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR=15-30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score > or =21) who underwent nerve-sparing RALP, 62% were potent at 12 months. CONCLUSIONS: The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes. PMID: 19147274 [PubMed - indexed for MEDLINE]

Editorial comment on: Observation should be considered as an alternative in management of renal masses in older and comorbid patients.

Related Articles Editorial comment on: Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol. 2009 Jun;55(6):1428-9 Authors: Volpe A PMID: 19147272 [PubMed - indexed for MEDLINE]

Editorial comment on: Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up.

Editorial comment on: Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009 Jun;55(6):1367 Authors: Cestari A, Guazzoni G PMID: 19147271 [PubMed - indexed for MEDLINE]

Editorial comment on: Observation should be considered as an alternative in management of renal masses in older and comorbid patients.

Related Articles Editorial comment on: Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol. 2009 Jun;55(6):1427-8 Authors: Remzi M PMID: 19147268 [PubMed - indexed for MEDLINE]

Observation should be considered as an alternative in management of renal masses in older and comorbid patients.

Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol. 2009 Jun;55(6):1419-27 Authors: Beisland C, Hjelle KM, Reisaeter LA, Bostad L BACKGROUND: Renal masses diagnosed in older and comorbid patients represent a challenge with regard to treatment. OBJECTIVE: To evaluate clinical outcome and tumor progression in patients with renal masses managed by observation due to age and comorbidity. DESIGN, SETTING, AND PARTICIPANTS: The medical records of 63 consecutive patients with renal masses primarily managed by observation during 2002-2007 were reviewed retrospectively and analyzed. The mean age for all patients at diagnosis was 76.6 yr, and 59% were male. Mean tumor size was 4.3 cm in diameter at diagnosis. Of these, 30% had Eastern Cooperative Oncology Group performance status (PS) of 2 or 3, 78% were American Society of Anesthesiologists (ASA) class 3, and the patients had a mean of 2.8 other medical conditions. MEASUREMENTS: Registration of age, ASA class, PS, comorbid conditions, computed tomography scans, primary tumor size, tumor growth rate, pathology parameters, observation time, survival time. RESULTS AND LIMITATIONS: Five-year overall survival (OS) and cancer-specific survival (CSS) rates were 42.8% and 93.3%, respectively. For tumors < or =4.0 cm in size, 5-yr CSS was 100%. Nine patients received delayed radical treatment, none of whom had later progression of the disease. In 18 patients histopathologic diagnosis of the renal masses were available, and in 15 patients (83%) renal cell carcinoma (RCC) was verified. The annual growth rate was <1cm/yr in 85.4% of the cases. In tumors < or =4.0 cm, only 1 of 27 tumors (3.7%) grew faster than 1cm/yr. CONCLUSIONS: Management of renal masses by observation among older and comorbid patients seems to give acceptable results with regard to OS and CSS rates after 5 yr. The risk of disease progression is significantly higher in patients with larger sized renal masses (>4 cm). Thus, selection for observation in this group has to be stricter than in a group of patients with smaller sized renal masses (< or =4.0 cm). PMID: 19147267 [PubMed - indexed for MEDLINE]

Is metastasectomy for urothelial carcinoma worthwhile?

Related Articles Is metastasectomy for urothelial carcinoma worthwhile? Eur Urol. 2009 Jun;55(6):1300-1 Authors: Herr HW PMID: 19124189 [PubMed - indexed for MEDLINE]

Editorial comment on: Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve.

Related Articles Editorial comment on: Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009 Jun;55(6):1468 Authors: Naspro R PMID: 19111384 [PubMed - indexed for MEDLINE]

Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve.

Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009 Jun;55(6):1459-67 Authors: Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, Coremans G, Deprest J BACKGROUND: Limited prospective data on the anatomic and functional outcome after laparoscopic sacrocolpopexy (LSC) are available in the literature. OBJECTIVE: To describe the medium-term anatomic and functional outcome of LSC. DESIGN, SETTING, AND PARTICIPANTS: Prospective consecutive series of 132 women with vaginal vault prolapse undergoing LSC between 2001 and 2006, which was after our learning curve. Patients with urodynamically proven stress incontinence (SI) underwent a concomitant tension-free vaginal tape (TVT) procedure. INTERVENTION: Patients underwent LSC with a polypropylene implant. MEASUREMENTS: Principal outcome measures were anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification (POPQ) system and subjective cure and impact on quality of life measured by a standardised interview and, since its introduction in 2004, by a prolapse-specific quality-of-life questionnaire (P-QOL). RESULTS AND LIMITATIONS: At a mean follow-up of 12.5 mo, the anatomic cure rate for the apex was 98%. Anatomic failures elsewhere were mainly at the posterior compartment (18%). Subjective prolapse cure rate was 91.7%, and no patients required reoperation for recurrent prolapse. Symptoms of preoperative SI, urge incontinence, or constipation were cured in 43%, 46%, and 42% of patients, respectively. The rate of de novo SI was 7.3%. De novo constipation developed in 5% and de novo dyspareunia developed in 19%. Patients' quality of life improved significantly. Erosions occurred in 4.5%, all within 1 yr. A limitation of the study is that the quality-of-life assessment score became available halfway through the study, limiting the number of preoperative observations (n=36). CONCLUSIONS: We demonstrated that LSC results in good anatomic outcome and subjective cure of prolapse symptoms at medium term. The posterior compartment was most vulnerable for recurrence. PMID: 19111382 [PubMed - indexed for MEDLINE]

Editorial comment on: Medium-term anatomic and function results of laparoscopic sacrocolpopexy beyond the learning curve.

Editorial comment on: Medium-term anatomic and function results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009 Jun;55(6):1467-8 Authors: Haverkorn R, Lemack GE PMID: 19111381 [PubMed - indexed for MEDLINE]

Editorial comment on: Surgical treatment of Peyronie's disease by plaque incision and grafting with buccal mucosa.

Related Articles Editorial comment on: Surgical treatment of Peyronie's disease by plaque incision and grafting with buccal mucosa. Eur Urol. 2009 Jun;55(6):1475-6 Authors: Levine LA PMID: 19084326 [PubMed - indexed for MEDLINE]

Surgical treatment of Peyronie's disease by plaque incision and grafting with buccal mucosa.

Surgical treatment of Peyronie's disease by plaque incision and grafting with buccal mucosa. Eur Urol. 2009 Jun;55(6):1469-75 Authors: Cormio L, Zucchi A, Lorusso F, Selvaggio O, Fioretti F, Porena M, Carrieri G BACKGROUND: Plaque incision and tunical grafting is widely used to correct penile curvatures secondary to Peyronie's disease (PD), but there is no consensus on the ideal graft to be used. OBJECTIVE: To evaluate the efficacy, safety, and reproducibility of plaque incision and buccal mucosa grafting (BMG) in the correction of severe penile curvatures secondary to PD. DESIGN, SETTING, AND PARTICIPANTS: Fifteen patients reporting normal erections and stable curvature (>12-mo duration) entered this prospective study carried out at two university hospitals. INTERVENTION: All patients underwent plaque incision and BMG. MEASUREMENTS: Preoperative evaluation included the International Index of Erectile Function (IIEF-5) and penile duplex ultrasounds with measurement of curvature and length of affected side. Follow-up visits were scheduled at 1, 3, 6, and 12 mo postoperatively, then yearly. Three-mo postoperative evaluation included IIEF-5, patient and partner satisfaction, and intracavernous injection test with evaluation of penile rigidity, straightness, and length; patient and partner satisfaction was recorded at all subsequent visits. RESULTS AND LIMITATIONS: Mean patient age was 56.3 yr and mean penile curvature 72 degrees ; five patients had a two-sided curvature with mean second curvature of 37 degrees . There were no complications. All patients resumed unassisted intercourse 1 mo after surgery. Three-mo postoperative evaluation showed 100% penile straightening, 1.8-cm mean increase in length of affected side, no curvature recurrence or de novo erectile dysfunction, 1.6 mean increase in IIEF-5 score, and patient and partner satisfaction of 93.3% and 100%, respectively. Although results remained stable at subsequent follow-up (mean 13.1 mo), a greater number of patients and longer follow-up are needed before drawing any definite conclusions. CONCLUSIONS: BMG provided excellent short-term results, probably because its prompt revascularisation, suggested by the fast return of spontaneous erections, prevented shrinkage, which is the main cause of graft failure. It also proved to be safe and reproducible, thus representing a valuable treatment option for PD. PMID: 19084325 [PubMed - indexed for MEDLINE]

Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05).

Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05). Eur Urol. 2009 Jun;55(6):1293-9 Authors: Lehmann J, Suttmann H, Albers P, Volkmer B, Gschwend JE, Fechner G, Spahn M, Heidenreich A, Odenthal A, Seif C, Nürnberg N, Wülfing C, Greb C, Kälble T, Grimm MO, Fieseler CF, Krege S, Retz M, Schulte-Baukloh H, Gerber M, Hack M, Kamradt J, Stöckle M BACKGROUND: Recent publications suggest a benefit from surgical removal of urothelial carcinoma metastases (UCM) for a subgroup of patients. OBJECTIVE: We report the combined experience and outcome of patients undergoing resection of UCM gained at 15 uro-oncologic centers in Germany. DESIGN, SETTING, AND PARTICIPANTS: Retrospective survey of 44 patients with distant UCM of the bladder or upper urinary tract who underwent complete resection of all detectable metastases in 15 different German uro-oncological centers between 1991 and 2008. INTERVENTION: Resected metastatic sites were the following: retroperitoneal lymph nodes (56.8%), distant lymph nodes (11.3%), lung (18.2%), bone (4.5%), adrenal gland (2.3%), brain (2.3%), small intestine (2.3%), and skin (2.3%). Systemic chemotherapy was administered in 35 of 44 patients (79.5%) before and/or after UCM surgery. MEASUREMENTS: Overall, cancer-specific and progression-free survival from time of diagnosis and metastasectomy of UCM. RESULTS AND LIMITATIONS: Median survival from initial diagnosis of UCM and subsequent resection was as follows: overall survival, 35 mo and 27 mo; cancer-specific survival, 38 mo and 34 mo; and progression-free survival, 19 mo and 15 mo. Overall 5-yr survival from metastasectomy for the entire cohort was 28%. Seventeen patients were still alive without progression at a median follow-up of 8 mo. Seven patients without disease progression survived for >2 yr and remained free from tumor progression at a median follow-up of 63 mo. No significant prognostic factors could be determined due to the limited patient number. CONCLUSIONS: Long-term cancer control and possible cure can be achieved in a subgroup of patients following surgical removal of UCM. Metastasectomy in patients with disseminated UCM remains investigational and should only be offered to those with limited disease as a combined-modality approach with systemic chemotherapy. PMID: 19058907 [PubMed - indexed for MEDLINE]

Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment.

Related Articles Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment. Eur Urol. 2009 Jun;55(6):1440-8 Authors: Roosen A, Datta SN, Chowdhury RA, Patel PM, Kalsi V, Elneil S, Dasgupta P, Kessler TM, Khan S, Panicker J, Fry CH, Brandner S, Fowler CJ, Apostolidis A BACKGROUND: An increasing body of evidence suggests a possible role of suburothelial myofibroblasts (MFs) in bladder mechanosensation and in the pathophysiology of detrusor overactivity (DO). OBJECTIVE: To determine whether markers of MFs, including gap junction protein connexin43 (Cx43) and c-kit have altered immunohistochemical expression in the suburothelium of patients with neurogenic DO (NDO) or idiopathic DO (IDO) and whether this is affected by successful treatment of DO with botulinum neurotoxin type A (BoNTA). DESIGN, SETTING, AND PARTICIPANTS: Patients with NDO (n=10) or IDO (n=11) were treated in a single-centre, open-label study of intradetrusor BoNTA injections. Control tissue was obtained from 10 patients undergoing pelvic-floor repair procedures who had no overactive bladder (OAB) symptoms. This study is registered with ClinicalTrials.gov, number NCT00662064. INTERVENTIONS: Bladder biopsies performed with flexible cystoscopes were obtained from control subjects and from NDO and IDO patients before BoNTA treatment and at 4 wk and 16 wk after treatment. They were studied with quantitative immunofluorescence using antibodies to connexin 43 (Cx43), vimentin, and c-kit. MEASUREMENTS: Differences in Cx43, vimentin, and c-kit immunoreactivity between control subjects and NDO or IDO patients (primary outcomes). Changes in NDO or IDO, Cx43 immunoreactivity, and c-kit immunoreactivity after BoNTA treatment (secondary outcomes). RESULTS AND LIMITATIONS: Cx43 immunoreactivity was increased in both IDO and NDO patients compared to controls, but remained unchanged after BoNTA treatment. C-kit immunoreactivity was similar in NDO/IDO patients and controls and remained unchanged after BoNTA treatment. CONCLUSIONS: Increased gap junction formation in the suburothelium has been demonstrated in biopsies from humans with DO. It is hypothesised that this change could have a significant role in the pathogenesis of the detrusor abnormality. Successful treatment of NDO or IDO does not appear to be associated with changes in the expression of Cx43 or c-kit on suburothelial MFs. PMID: 19054608 [PubMed - indexed for MEDLINE]

Editorial comment on: Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment.

Editorial comment on: Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment. Eur Urol. 2009 Jun;55(6):1448-9 Authors: Gratzke C, Hedlund P PMID: 19054607 [PubMed - indexed for MEDLINE]

Critical evaluation of the prostate from cystoprostatectomies for bladder cancer: insights from a complete sampling with the whole mount technique.

Related Articles Critical evaluation of the prostate from cystoprostatectomies for bladder cancer: insights from a complete sampling with the whole mount technique. Eur Urol. 2009 Jun;55(6):1305-9 Authors: Montironi R, Cheng L, Mazzucchelli R, Scarpelli M, Kirkali Z, Montorsi F, Lopez-Beltran A PMID: 18995951 [PubMed - indexed for MEDLINE]

Can tyrosine kinase inhibitors be discontinued in patients with metastatic renal cell carcinoma and a complete response to treatment? A multicentre, retrospective analysis.

Related Articles Can tyrosine kinase inhibitors be discontinued in patients with metastatic renal cell carcinoma and a complete response to treatment? A multicentre, retrospective analysis. Eur Urol. 2009 Jun;55(6):1430-8 Authors: Johannsen M, Flörcken A, Bex A, Roigas J, Cosentino M, Ficarra V, Kloeters C, Rief M, Rogalla P, Miller K, Grünwald V BACKGROUND: Discontinuation of treatment with tyrosine kinase inhibitors (TKIs) and readministration in case of recurrence could improve quality of life (QoL) and reduce treatment costs for patients with metastatic renal cell carcinoma (mRCC) in which a complete remission (CR) is achieved by medical treatment alone or with additional resection of residual metastases. OBJECTIVE: To evaluate whether TKIs can be discontinued in these selected patients with mRCC. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of medical records and imaging studies was performed on all patients with mRCC treated with TKIs (n=266) in five institutions. Patients with a CR under TKI treatment alone or with additional metastasectomy of residual disease following a partial response (PR), in which TKIs were discontinued, were included in the analysis. Outcome criteria analysed were time to recurrence of previous metastases, occurrence of new metastases, symptomatic progression, improvement of adverse events, and response to reexposure to TKIs. INTERVENTIONS: Sunitinib 50mg/day for 4 wk on and 2 wk off, sorafenib 800mg/day. MEASUREMENTS: Response according to Response Evaluation Criteria in Solid Tumours (RECIST). RESULTS AND LIMITATIONS: We identified 12 cases: 5 CRs with sunitinib, 1 CR with sorafenib, and 6 surgical CRs with sunitinib followed by residual metastasectomy. Side-effects subsided in all patients off treatment. At a median follow-up of 8.5 mo (range: 4-25) from TKI discontinuation, 7 of 12 patients remained without recurrence and 5 had recurrent disease, with new metastases in 3 cases. Median time to progression was 6 mo (range: 3-8). Readministration of TKI was effective in all cases. The study is limited by small numbers and retrospective design. CONCLUSIONS: Discontinuation of TKI in patients with mRCC and CR carries the risk of progression with new metastases and potential complications. Further investigation in a larger cohort of patients is warranted before such an approach can be regarded as safe. PMID: 18950936 [PubMed - indexed for MEDLINE]

Editorial comment on: Can tyrosine kinase inhibitors be discontinued in patients with metastatic renal cell carcinoma and a complete response to treatment? A multicentre, retrospective analysis.

Editorial comment on: Can tyrosine kinase inhibitors be discontinued in patients with metastatic renal cell carcinoma and a complete response to treatment? A multicentre, retrospective analysis. Eur Urol. 2009 Jun;55(6):1439 Authors: Bamias A PMID: 18950935 [PubMed - indexed for MEDLINE]

Is simple enucleation a minimal partial nephrectomy responding to the EAU guidelines' recommendations?

Related Articles Is simple enucleation a minimal partial nephrectomy responding to the EAU guidelines' recommendations? Eur Urol. 2009 Jun;55(6):1315-8 Authors: Ficarra V, Galfano A, Cavalleri S PMID: 18801609 [PubMed - indexed for MEDLINE]

Chemotherapy for prostate cancer in senior adults: are we treating the elderly or the frail?

Related Articles Chemotherapy for prostate cancer in senior adults: are we treating the elderly or the frail? Eur Urol. 2009 Jun;55(6):1310-2 Authors: Bellmunt J PMID: 18778888 [PubMed - indexed for MEDLINE]

Should we perform imaging-guided lymph node dissection in patients with lymphatic recurrence of prostate cancer after radical prostatectomy?

Related Articles Should we perform imaging-guided lymph node dissection in patients with lymphatic recurrence of prostate cancer after radical prostatectomy? Eur Urol. 2009 Jun;55(6):1302-4 Authors: Martorana G, Schiavina R, Franceschelli A PMID: 18707806 [PubMed - indexed for MEDLINE]

Editorial comment on: Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer.

Related Articles Editorial comment on: Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer. Eur Urol. 2009 Jun;55(6):1375-6 Authors: Rosenthal MA PMID: 18706756 [PubMed - indexed for MEDLINE]

Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer.

Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer. Eur Urol. 2009 Jun;55(6):1368-75 Authors: Italiano A, Ortholan C, Oudard S, Pouessel D, Gravis G, Beuzeboc P, Bompas E, Fléchon A, Joly F, Ferrero JM, Fizazi K BACKGROUND: There are no data on the patterns of care and outcome of very elderly patients with castration-resistant prostate cancer (CRPC) treated with docetaxel. OBJECTIVE: To assess the routine use of first-line docetaxel-based chemotherapy in CRPC patients aged >75 yr. DESIGN, SETTING, AND PARTICIPANTS: We reviewed the clinical files of 175 patients aged > or =75 yr with CRPC treated with first-line docetaxel in nine French tertiary care cancer centres from 2000 to 2007. MEASUREMENTS: Response rate, survival, and adverse events (AE). RESULTS AND LIMITATIONS: Median age was 78 yr. Ninety-five patients (54%) received a standard 3-wk regimen (SR), and 80 patients (46%) received an adapted regimen (AR) delivered on a weekly schedule with various times for rest periods. Patients treated with an AR were older (>80 yr) and had poorer performance status (PS; > or =2) than patients treated with the SR. The prostate-specific antigen (PSA) response rates were not significantly different between the standard and adapted treatment groups (71% vs 68%, p=0.79). The median progression-free survival (PFS) was 7.4 mo. The median overall survival (OS) was 15 mo. The incidence of grade 3 or 4 AEs was 46% and was correlated with poor PS and the presence of visceral disease but not with the regimen. Early discontinuation of treatment because of toxicity occurred more frequently in the AR group than in the SR group (30% vs 8.4%, p=0.0005). In multivariate analysis, only PS and the presence of visceral disease were predictors of OS. CONCLUSIONS: Docetaxel is active and feasible in elderly patients with good PS. The optimal treatment of frail patients with CRPC remains to be established. Geriatric tools should be used to more accurately detect elderly CRPC patients who are unfit for chemotherapy. Age by itself should not be used as a criterion to deny patients with CRPC a potentially effective chemotherapy. PMID: 18706755 [PubMed - indexed for MEDLINE]

Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma.

Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma. Eur Urol. 2009 Jun;55(6):1410-8 Authors: Minervini A, di Cristofano C, Lapini A, Marchi M, Lanzi F, Giubilei G, Tosi N, Tuccio A, Mancini M, della Rocca C, Serni S, Bevilacqua G, Carini M BACKGROUND: The oncologic safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor and on the possibility of obtaining negative surgical margins (SMs). OBJECTIVE: To investigate the PS and SMs after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SMs. The risk of PS invasion related to other clinical and pathologic variables was also evaluated. DESIGN, SETTING, AND PARTICIPANTS: Between September 2006 and December 2007, data were gathered prospectively from 187 consecutive patients who had kidney surgery. Overall, 90 consecutive patients who had TE for RCC were eligible for the study. All specimens were evaluated using an image analyzer by a dedicated uropathologist. INTERVENTION: TE was done by blunt dissection using the natural cleavage plane between the tumor and the normal parenchyma. MEASUREMENTS: PS, SM, and routinely available clinical and pathologic variables were recorded. RESULTS AND LIMITATIONS: In 60 RCC tumors (67%) the PS was intact and free from invasion (PS-) while in 30 (33%) there were signs of penetration within its layers, with or without invasion beyond it. Indeed, 26.6% had PS that had been penetrated on the parenchymal side and 6.6% had penetration on the perirenal fat tissue side. The odds of having PS penetration increased significantly with an increase in clinical tumor size. PS penetration was also significantly associated with pathologic tumor dimensions and grade. In all cases the SMs were negative after TE. The present patients, followed for >2 yr, will enable us to correlate the risk of local recurrence with PS status. CONCLUSIONS: The risk of PS penetration is associated with clinical and pathologic tumor dimensions and grade. If there is PS invasion into normal parenchyma, the presence of a thin layer of tissue allows for negative SM even if a TE is performed. PMID: 18692300 [PubMed - indexed for MEDLINE]