<?xml version="1.0" encoding="utf-8" ?>
<rss version="2.0">

            <channel>
                <title>European Urology - Articles in press</title>
                <link>http://www.europeanurology.com</link>
                <description>European Urology RSS feed of the articles currently in press. AIMS AND SCOPE Elsevier is the publisher of European Urology, the official journal of the European Association of Urology. European Urology publishes peer-reviewed original articles and topical reviews on a wide range of urological problems. Topics such as oncology, impotence, infertility, pediatrics, lithiasis and endourology, as well as recent advances in techniques, instrumentation, surgery and pediatric urology provide readers with a complete guide to international developments in urology. Published monthly, European Urology is an important journal for all clinicians and researchers in this field. All members of the EAU receive the journal as a benefit of their membership. For more information on the European Association of Urology, please go to: http://www.uroweb.org Supplements to European Urology are published under the title European Urology Supplements (ISSN 1569-9056). All subscribers to European Urology automatically receive this publication. You can also visit the EAU-EBU Update Series (ISSN 1871-2592). </description>
                <language>en-US</language>
                <copyright>© 2013 Published by Elsevier Inc. All rights reserved.</copyright>
                
                <item>
                    <title><![CDATA[The Role of Radical Prostatectomy and Lymph Node Dissection in Lymph Node–Positive Prostate Cancer: A Systematic Review of the Literature]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00500-9/abstract</link>
                    <description><![CDATA[Context:Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined.Objective:To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach using local radiotherapy and/or androgen-deprivation therapy (ADT), in LN-positive PCa.Evidence acquisition:A systematic Medline search for studies reporting on treatment regimens and outcomes in patients with LN-positive PCa undergoing RP between 1993 and 2012 was performed.Evidence synthesis:RP can improve progression-free and overall survival in LN-positive PCa, although there is a lack of high-level evidence. Therefore, the former practice of aborting surgery in the presence of positive nodes might no longer be supported by current evidence, especially in those patients with a limited LN tumor burden. Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum, in which the internal and the common iliac nodes represent critical landmarks in the metastatic distribution. Sophisticated imaging technologies are still under investigation to improve the prediction of LN-positive PCa. Nonetheless, extended PLND including the common iliac arteries should be offered to intermediate- and high-risk patients to improve nodal staging with a possible benefit in prostate-specific antigen progression-free survival by removing significant metastatic load. Adjuvant ADT has the potential to improve overall survival after RP; the therapeutic role of a trimodal approach with adjuvant local radiotherapy awaits further elucidation. Age is a critical parameter for survival because cancer-specific mortality exceeds overall mortality in younger patients (Our understanding of radical prostatectomy in lymph node–positive prostate cancer needs a conceptual change from a palliative option to an effective instrument for significant improvement of long-term survival.]]></description>
                    <pubDate>Thu, 23 May 2013 06:55:01 GMT</pubDate>
                    <guid>S0302-2838(13)00500-9</guid>
                </item>
            
                <item>
                    <title><![CDATA[Cancer-specific Survival After Metastasis Following Primary Radical Prostatectomy Compared with Radiation Therapy in Prostate Cancer Patients: Results of a Population-based, Propensity Score–Matched Analysis]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00489-2/abstract</link>
                    <description><![CDATA[Background:Data regarding the difference in the clinical course from metastasis to prostate cancer–specific mortality (PCSM) following radical prostatectomy (RP) compared with radiation therapy (RT) are lacking.Objective:To examine the association between primary treatment modality and prostate cancer–specific survival (PCSS) after metastasis.Design, setting, and participants:We used the Surveillance Epidemiology and End Results–Medicare linked database from 1994 to 2007 for patients diagnosed with localized prostate cancer (PCa). We used cancer stage and Gleason score to stratify patients into low and intermediate–high risks.Intervention:Radical prostatectomy or radiation therapy.Outcome measurements and statistical analysis:Our outcome is time from onset of metastases to PCSM. Propensity score matching and Cox regression were used to analyze the PCSM hazard for the RP group compared with the RT group.Results and limitations:Our study consisted of 66 492 men diagnosed with PCa, 51 337 men receiving RT, and 15 155 men undergoing RP within 1 yr of cancer diagnosis. During the study period, 2802 men were diagnosed as having metastatic disease. A total of 916 men with metastases were included in the propensity-matched cohort; of these men, 186 died from PCa. During the follow-up, for the low-risk patients, the adjusted PCSS after metastasis was 86.2% and 79.3% in the RP and RT groups, respectively; for the intermediate–high-risk patients, the PCSS after metastasis was 76.3% and 63.3% in the RP and RT groups, respectively. The hazard ratios estimating the risk of PCSM between the RP and RT groups were 0.68 (95% confidence interval [CI], 0.38–1.22) and 0.51 (95% CI, 0.36–0.73) for the low- and intermediate–high-risk groups, respectively. Because of the nature of observational studies, the results may be affected by residual confounders and treatment indication.Conclusions:Following the development of metastases, men who received primary RP have a longer PCSS than men who received primary RT. Our results may have implications for the timing and nature of local PCa treatment.Men who underwent radical prostatectomy as the primary treatment for prostate cancer have a better prognosis than men who received radiation therapy after the development of metastasis. This finding may have implications for the timing and nature of local prostate cancer treatment.]]></description>
                    <pubDate>Wed, 22 May 2013 04:05:01 GMT</pubDate>
                    <guid>S0302-2838(13)00489-2</guid>
                </item>
            
                <item>
                    <title><![CDATA[The Role of Robot-assisted Radical Prostatectomy and Pelvic Lymph Node Dissection in the Management of High-risk Prostate Cancer: A Systematic Review]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00492-2/abstract</link>
                    <description><![CDATA[Context:The role of robot-assisted radical prostatectomy (RARP) for men with high-risk (HR) prostate cancer (PCa) has not been well studied.Objective:To evaluate the indications for surgical treatment, technical aspects such as nerve sparing (NS) and lymph node dissection (LND), and perioperative outcomes of men with HR PCa treated with RARP.Evidence acquisition:A systematic expert review of the literature was performed in October 2012, searching the Medline, Web of Science, and Scopus databases. Studies with a precise HR definition, robotic focus, and reporting of perioperative and pathologic outcomes were included.Evidence synthesis:A total of 12 papers (1360 patients) evaluating RARP in HR PCa were retrieved. Most studies (67%) used the D’Amico classification for defining HR. Biopsy Gleason grade 8–10 was the most frequent HR identifier (61%). Length of follow-up ranged from 9.7 to 37.7 mo. Incidence of NS varied, although when performed did not appear to compromise oncologic outcomes. Extended LND (ELND) revealed positive nodes in up to a third of patients. The rate of symptomatic lymphocele after ELND was 3%. Overall mean operative time was 168 min, estimated blood loss was 189 ml, length of hospital stay was 3.2 d, and catheterization time was 7.8 d. The 12-mo continence rates using a no-pad definition ranged from 51% to 95% with potency recovery ranging from 52% to 60%. The rate of organ-confined disease was 35%, and the positive margin rate was 35%. Three-year biochemical recurrence–free survival ranged from 45% to 86%.Conclusions:Although the use of RARP for HR PCa has been relatively limited, it appears safe and effective for select patients. Short-term results are similar to the literature on open radical prostatectomy. Variability exists for NS and the template of LND, although ELND improves staging and removes a higher number of metastatic nodes. Further study is required to assess long-term outcomes.Robotic prostatectomy appears to be safe and effective for selected high-risk prostate cancer patients. Short-term results are similar to open radical prostatectomy. Extended node dissection improves staging and removes a higher number of metastatic nodes. Further follow-up is required to assess long-term outcomes.]]></description>
                    <pubDate>Sun, 19 May 2013 03:46:06 GMT</pubDate>
                    <guid>S0302-2838(13)00492-2</guid>
                </item>
            
                <item>
                    <title><![CDATA[Reply from Authors re: Rodolfo Montironi, Antonio Lopez-Beltran, Liang Cheng, Francesco Montorsi, Marina Scarpelli. Central Prostate Pathology Review: Should It Be Mandatory? Eur Urol. In press. DOI:10.1016/j.eururo.2013.04.002]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00494-6/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Sun, 19 May 2013 03:46:04 GMT</pubDate>
                    <guid>S0302-2838(13)00494-6</guid>
                </item>
            
                <item>
                    <title><![CDATA[The Mutational Landscape of Prostate Cancer]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00495-8/abstract</link>
                    <description><![CDATA[Context:Prostate cancer (PCa) is a clinically heterogeneous disease with marked variability in patient outcomes. Molecular characterization has revealed striking mutational heterogeneity that may underlie the variable clinical course of the disease.Objective:In this review, we discuss the common genomic alterations that form the molecular basis of PCa, their functional significance, and the potential to translate this knowledge into patient care.Evidence acquisition:We reviewed the relevant literature, with a particular focus on recent studies on somatic alterations in PCa.Evidence synthesis:Advances in sequencing technology have resulted in an explosion of data regarding the mutational events underlying the development and progression of PCa. Heterogeneity is the norm; few abnormalities in specific genes are highly recurrent, but alterations in certain signaling pathways do predominate. These alterations include those in pathways known to affect tumorigenesis in a wide spectrum of tissues, such as the phosphoinositide 3-kinase/phosphatase and tensin homolog/Akt pathway, cell cycle regulation, and chromatin regulation. Alterations more specific to PCa are also observed, particularly gene fusions of ETS transcription factors and alterations in androgen signaling. Mounting data suggest that PCa can be subdivided based on a molecular profile of genetic alterations.Conclusions:Major advances have been made in cataloging the genomic alterations in PCa and understanding the molecular mechanisms underlying the disease. These findings raise the possibility that PCa could soon transition from being a poorly understood, heterogeneous disease with a variable clinical course to being a collection of homogenous subtypes identifiable by molecular criteria, associated with distinct risk profiles, and perhaps amenable to specific management strategies or targeted therapies.Prostate cancer is a clinically heterogeneous disease with marked variability in patient outcomes. Molecular characterization has revealed striking mutational heterogeneity that may underlie the variable clinical course of the disease and that may provide improved risk stratification and novel therapeutic targets.]]></description>
                    <pubDate>Sun, 19 May 2013 03:45:01 GMT</pubDate>
                    <guid>S0302-2838(13)00495-8</guid>
                </item>
            
                <item>
                    <title><![CDATA[Chronic Administration of Anticholinergics in Rats Induces a Shift from Muscarinic to Purinergic Transmission in the Bladder Wall]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00497-1/abstract</link>
                    <description><![CDATA[Background:First-line pharmacotherapy for overactive bladder consists of anticholinergics. However, patient compliance is exceptionally low, which may be due to progressive loss of effectiveness.Objective:To decipher the involved molecular mechanisms and to evaluate the effects of chronic systemic administration of anticholinergics on bladder function and on muscarinic and purinergic receptors expression in rats.Design, setting, and participants:Female Wistar rats were implanted with an osmotic pump that chronically administered vehicle (Vehc), 0.36 mg/kg per day oxybutynin (Oxyc), or 0.19 mg/kg per day fesoterodine (Fesoc) for 28 d.Interventions:For cystometry experiments, a small catheter was implanted in the bladder.Outcome measurements and statistical analysis:Urologic phenotype was evaluated by the analysis of the micturition pattern and urodynamics. Expression of muscarinic and purinergic receptors was assessed by Western blot analysis of detrusor membrane protein. Functional responses to carbachol and adenosine triphosphate (ATP) were evaluated using muscle-strip contractility experiments.Results and limitations:The number of voided spots was transiently decreased in Oxyc rats. In Oxyc rats, the effect of an acute high dose of oxybutynin (1 mg/kg intraperitoneally [IP]) on the intermicturition interval was abolished. Expression experiments revealed a decrease of muscarinic acetylcholine receptors M2 (mAChR2) and M3 (mAChR3), whereas the purinergic receptor P2X, ligand-gated ion channel, 1 (P2X1) was enhanced in Oxyc and Fesoc rats compared to Vehc rats. In concordance with the modification of the expression pattern in Oxyc rats, the force generated by carbachol and ATP in muscle-strip contractility experiments was, respectively, lower and higher. Urodynamics revealed that the effects of systemic administration of the purinergic blocker pyridoxalphosphate-6-azophenyl-2’,4’-disulphonic acid (50 mg/kg IP) were enhanced in Oxyc rats. As rat bladder physiology is different from that of humans, it is difficult to directly extrapolate our findings to human patients.Conclusions:Chronic administration of anticholinergics in rats induces receptor loss of efficiency and a shift from muscarinic to purinergic transmission.Chronic administration of anticholinergics in rats induces loss of drug efficiency. This is caused by downregulation of muscarinic transmission and a shift to the purinergic system.]]></description>
                    <pubDate>Sat, 18 May 2013 03:45:04 GMT</pubDate>
                    <guid>S0302-2838(13)00497-1</guid>
                </item>
            
                <item>
                    <title><![CDATA[Maintenance Bacillus Calmette-Guérin Treatment of Non–Muscle-invasive Bladder Cancer: A Critical Evaluation of the Evidence]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00493-4/abstract</link>
                    <description><![CDATA[Context:Despite the effectiveness of bacillus Calmette-Guérin (BCG) therapy in non–muscle-invasive bladder cancer (NIMBC) to delay recurrence and disease progression, the evidence supporting maintenance treatment and its optimal duration.Objective:The purposes of this paper are to critically review the evidence supporting the use of maintenance BCG after an initial series of induction instillations and to illustrate the factors contributing to current dilemmas in establishing the optimal duration of BCG treatment.Evidence acquisition:The following terms were used in Medline database searches for original articles published before February 1, 2013: bladder cancer, urothelial cancer, bacillus Calmette-Guérin, maintenance, and induction. All randomized controlled trials and meta-analyses, including those based on indirect comparisons, were evaluated.Evidence synthesis:Seven randomized studies compared induction BCG plus maintenance to induction alone, with or without retreatment with BCG on recurrence. All but one of these studies were underpowered and the largest study used a broad, composite end point: worsening-free survival. Seven meta-analyses have been conducted, three of which included data from observational cohort studies. They demonstrated the benefit of maintenance BCG to reduce disease recurrence and delay progression compared to various control groups; however, the analyses were based on suboptimal data. Although there is new evidence that 1 yr of maintenance BCG is sufficient treatment in intermediate-risk patients, the optimal duration of BCG maintenance remains unknown. A new randomized trial is proposed, which includes induction BCG with retreatment on recurrence as a control arm, to study this question.Conclusions:The optimal duration of BCG treatment in patients with NMIBC remains unknown and should be the subject of further studies. We recommend that in addition to 3 yr of maintenance BCG, guideline panels also include 1 yr of therapy and induction BCG with retreatment on recurrence as a possible treatment options for patients with NMIBC, albeit with a lower level of evidence and grade of recommendation.Based on a critical analysis of the available evidence, the optimal duration of bacillus Calmette-Guérin treatment in patients with non–muscle-invasive bladder cancer remains unknown and should be the subject of further studies.]]></description>
                    <pubDate>Sat, 18 May 2013 03:45:02 GMT</pubDate>
                    <guid>S0302-2838(13)00493-4</guid>
                </item>
            
                <item>
                    <title><![CDATA[OnabotulinumtoxinA for Idiopathic Overactive Bladder Symptoms: Many Answers but More Questions]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00498-3/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Sat, 18 May 2013 03:45:01 GMT</pubDate>
                    <guid>S0302-2838(13)00498-3</guid>
                </item>
            
                <item>
                    <title><![CDATA[Management of Biochemical Recurrence After Primary Treatment of Prostate Cancer: A Systematic Review of the Literature]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00491-0/abstract</link>
                    <description><![CDATA[Context:Despite excellent cancer control with the treatment of localized prostate cancer (PCa), some men will experience a recurrence of disease. The optimal management of recurrent disease remains uncertain.Objective:To systematically review recent literature regarding management of biochemical recurrence after primary treatment for localized PCa.Evidence acquisition:A comprehensive systematic review of the literature was performed from 2000 to 2012 to identify articles pertaining to management after recurrent PCa. Search terms included prostate cancer recurrence, salvage therapy, radiorecurrent prostate cancer, post HIFU, post cryoablation, postradiation, and postprostatectomy salvage. Studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and required to provide a comprehensive description of primary and secondary treatments along with outcomes.Evidence synthesis:The data from 32 original publications were reviewed. The most common option for local salvage therapy after radical prostatectomy (RP) was radiation. Options for local salvage therapy after primary radiation included RP, brachytherapy, and cryotherapy. Different definitions of recurrence and risk profiles among patients make comparative assessment among salvage treatment modalities difficult. Triggers for intervention and factors predicting response to salvage therapy vary.Conclusions:Radiation therapy (RT) after RP can provide durable prostate-specific antigen (PSA) responses in a sizeable percentage of men, especially when given early (ie, PSA Radiation therapy (RT) after radical prostatectomy can provide durable prostate-specific antigen responses in a sizeable percentage of men, especially when given early. The role of salvage after RT is less clear. More randomized studies would enhance the literature in this field.]]></description>
                    <pubDate>Fri, 17 May 2013 04:06:56 GMT</pubDate>
                    <guid>S0302-2838(13)00491-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Incidence of Prostate Cancer After Termination of Screening in a Population-based Randomised Screening Trial]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00490-9/abstract</link>
                    <description><![CDATA[Background:In a previous publication from the Göteborg randomised screening trial from 2010, biennial prostate-specific antigen (PSA) screening for men ≤69 yr of age was shown to lower prostate cancer (PCa) mortality by 44%. The evidence of the optimal age to stop screening, however, is limited.Objective:To examine the risk of PCa after the discontinuation of screening.Design, setting, and participants:In December 1994, 20 000 men in Göteborg, Sweden, between the ages of 50 and 65 yr were randomised to a screening arm (invited biennially to PSA testing) and a control arm (not invited). At the upper age limit (average: 69 yr), a total of 13 423 men (6449 and 6974 in the screening and control arms, respectively) were still alive without PCa. The incidence of PCa hereafter was established by matching with the Western Swedish Cancer Register. Participants were followed until a diagnosis of PCa, death, or final follow-up on June 30, 2012, or for a maximum of 12 yr after the last invitation.Outcome measurements and statistical analysis:Incidence rates and disease-free survival were calculated with life table models and Kaplan-Meier estimates. A competing risk model was also applied.Results and limitations:Postscreening, 173 cases of PCa were diagnosed in the screening arm (median follow-up: 4.8 yr) and 371 in the control arm (median follow-up: 4.9 yr). Up to 9 yr postscreening, all risk groups were more commonly diagnosed in the control arm, but after 9 yr the rates in the screening arm caught up, other than those for the low-risk group. PCa mortality also caught up after 9 yr.Conclusions:Nine years after the termination of PSA testing, the incidence of potentially lethal cancers equals that of nonscreened men. Considering the high PCa mortality rate in men >80 yr of age, a general age of 70 yr to discontinue screening might be too low. Instead, a flexible age to discontinue based on individual risk stratification should be recommended.Discontinuation of prostate cancer screening at 70 yr of age may be too early, at least in healthy men. Instead, the age to discontinue screening should be flexible based on risk stratification and life expectancy.]]></description>
                    <pubDate>Fri, 17 May 2013 04:05:34 GMT</pubDate>
                    <guid>S0302-2838(13)00490-9</guid>
                </item>
            
                <item>
                    <title><![CDATA[Robot-assisted Laparoscopic Mitrofanoff Appendicovesicostomy Technique and Outcomes of Extravesical and Intravesical Approaches]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00473-9/abstract</link>
                    <description><![CDATA[Background:With growing experience in pediatric robotic surgery, select centers are now performing robot-assisted, laparoscopic Mitrofanoff appendicovesicostomy (RALMA).Objective:We present our technique and outcomes of RALMA with or without enterocystoplasties and compare stomal outcomes between two different approaches of the appendicovesical anastomosis: an extravesical (EV) anterior bladder approach and an intravesical (IV) posterior bladder approach.Design, setting, and participants:Data from 18 children who have undergone RALMA since 2008 were retrospectively reviewed. RALMA was performed by one surgeon in an academic setting.Surgical procedure:The appendix was anastomosed on the posterior wall of the bladder intravesically when concomitant enterocystoplasty was done. Otherwise, the appendix was anastomosed extravesically on the anterior wall of the bladder.Outcome measurements and statistical analysis:The primary outcome measured was the overall continence rate. Secondary outcomes included the overall complication rate and stomal complications.Results and limitations:The entire cohort included 18 patients (10 IV, 8 EV). The mean overall operative time was 494.1 min. The mean overall length of hospitalization was 5.2 d. There were five immediate, postoperative complications (all Clavien grade 1): three postoperative ilea, one stomal site infection, and one clogged suprapubic catheter. Median follow-up was 24.2 mo. The overall stomal continence rate was 94.4%. One patient from the IV group required dextranomer/hyaluronic acid copolymer for stomal incontinence. Among the eight patients in the EV cohort, there was one stomal complication of stomal stenosis (Clavien grade 1). Among the 10 patients in the IV cohort, there were two stomal complications requiring revisions (both Clavien grade 3): parastomal hernia and stomal stenosis. Limitations of the study include retrospective design, small number of patients, and lack of direct comparison of approaches given the nature of the surgery.Conclusions:Our updated outcomes of RALMA with or without enterocystoplasty continue to be encouraging, with a 94.4% continence rate. We believe that anterior EV reimplantation is a feasible option in isolated RALMA.We present our robot-assisted laparoscopic technique for Mitrofanoff appendicovesicostomy in children and describe an alternative anterior extravesical approach to the traditional posterior intravesical appendicovesical anastomosis. Results demonstrate that this approach is feasible and safe and does not compromise stomal outcomes.]]></description>
                    <pubDate>Thu, 16 May 2013 03:45:03 GMT</pubDate>
                    <guid>S0302-2838(13)00473-9</guid>
                </item>
            
                <item>
                    <title><![CDATA[Castration-resistant Prostate Cancer: Where We Stand in 2013 and What Urologists Should Know]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00487-9/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Wed, 15 May 2013 04:06:02 GMT</pubDate>
                    <guid>S0302-2838(13)00487-9</guid>
                </item>
            
                <item>
                    <title><![CDATA[Re: Caroline E. Weibull, Sandra Eloranta, Daniel Altman, Anna L.V. Johansson, Mats Lambe. Childbearing and the Risk of Bladder Cancer: A Nationwide Population-based Cohort Study. Eur Urol 2013;63:733–8]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00485-5/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Wed, 15 May 2013 04:05:44 GMT</pubDate>
                    <guid>S0302-2838(13)00485-5</guid>
                </item>
            
                <item>
                    <title><![CDATA[Prospective Randomized Evaluation of Risk-adapted Prostate-specific Antigen Screening in Young Men: The PROBASE Trial]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00488-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Wed, 15 May 2013 04:05:08 GMT</pubDate>
                    <guid>S0302-2838(13)00488-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Waiting for Global Access to Urologic Care]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00482-X/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 14 May 2013 03:39:41 GMT</pubDate>
                    <guid>S0302-2838(13)00482-X</guid>
                </item>
            
                <item>
                    <title><![CDATA[Reply from Authors re: Bernard H. Bochner. Oncologic Outcomes Achieved by Radical Cystectomy. Eur Urol. In press. DOI:10.1016/j.eururo.2013.03.037]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00474-0/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 14 May 2013 03:39:28 GMT</pubDate>
                    <guid>S0302-2838(13)00474-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Reprogramming Stromal Cells from the Urinary Tract and Prostate: A Trip to Pluripotency and Back?]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00484-3/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 14 May 2013 03:38:41 GMT</pubDate>
                    <guid>S0302-2838(13)00484-3</guid>
                </item>
            
                <item>
                    <title><![CDATA[Toxicities Following Treatment with Bisphosphonates and Receptor Activator of Nuclear Factor-κB Ligand Inhibitors in Patients with Advanced Prostate Cancer]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00481-8/abstract</link>
                    <description><![CDATA[Context:Advanced prostate cancer (PCa) is associated with skeletal complications, both as a result of bone metastases and because of fractures associated with fragility due to androgen-deprivation therapy (ADT). Osteoclast inhibitors are commonly used to reduce skeletal complications but are associated with a number of potential adverse events.Objective:To review clinical trials of osteoclast inhibitors in advanced PCa, to discuss the adverse event profile of these agents, and to discuss strategies to address specific adverse events.Evidence acquisition:PubMed was searched for reports of clinical trials of osteoclast inhibitors in advanced PCa. As zoledronic acid and denosumab are used most commonly in this disease, these trials were the focus. The literature was reviewed to identify key publications addressing the prevention and management of adverse events associated with these drugs.Evidence synthesis:The major findings of the trials and the adverse events are discussed. Prevention and management of common adverse events are addressed.Conclusions:Zoledronic acid prevents loss of bone mineral density associated with ADT and delays skeletal-related events in metastatic castration-resistant PCa (mCRPC). Denosumab reduces the incidence of fragility fractures associated with ADT, delays the onset of bone metastases in nonmetastatic castration-resistant disease, and is superior to zoledronic acid in the prevention of skeletal complications in mCRPC. Adverse events associated with both agents include osteonecrosis of the jaw and hypocalcemia. Hypocalcemia is more common with denosumab. Zoledronic acid requires dose modifications for renal insufficiency, is contraindicated in severe renal insufficiency, and has been associated with deterioration of renal function. Appropriate patient selection with close attention to dental health, supplementation with calcium and vitamin D, and monitoring of laboratory values are effective strategies to minimize the impact of adverse events associated with osteoclast inhibitors in advanced PCa.This systematic review of the literature examines the adverse events associated with osteoclast inhibitors in advanced prostate cancer.]]></description>
                    <pubDate>Tue, 14 May 2013 03:37:05 GMT</pubDate>
                    <guid>S0302-2838(13)00481-8</guid>
                </item>
            
                <item>
                    <title><![CDATA[The Robotic Approach Does Not Change the Current Paradigms of Pelvic Lymph Node Dissection for Prostate Cancer]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00483-1/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Tue, 14 May 2013 03:35:03 GMT</pubDate>
                    <guid>S0302-2838(13)00483-1</guid>
                </item>
            
                <item>
                    <title><![CDATA[Future Direction in Pharmacotherapy for Non-neurogenic Male Lower Urinary Tract Symptoms]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00465-X/abstract</link>
                    <description><![CDATA[Background:The pathophysiology of male lower urinary tract symptoms (LUTS) is highly complex and multifactorial. The shift in perception that LUTS are not sex or organ specific has not been followed by significant innovations regarding the available drug classes.Objective:To review pathophysiologic mechanisms and clinical and experimental data related to the development of new pharmacologic treatments for male LUTS.Evidence acquisition:The PubMed database was used to identify articles describing experimental and clinical studies of pathophysiologic mechanisms contributing to male LUTS and, supported by them, new pharmacotherapies with clinical or experimental evidence in the field.Evidence synthesis:Several pathologic processes (eg, androgen signaling, inflammation, and metabolic factors) and targets (eg, the urothelium, prostate, interstitial cells, detrusor, neurotransmitters, neuromodulators, and receptors) have been implicated in male LUTS. Some newly introduced drugs, such as phosphodiesterase type 5 inhibitors and β3-adrenergic agonists, have just started broad use in clinical practice. Drugs with potential benefit, such as vitamin D3 receptor analogs, gonadotropin-releasing hormone antagonists, cannabinoids, and drugs injected into the prostate, have been evaluated in experimental studies and have progressed to clinical trials. However, safety and efficacy data for these drugs are still scarce. Some compounds with interesting profiles have only been tested in experimental settings (eg, transient receptor potential channel blockers, Rho-kinase inhibitors, purinergic receptor blockers, and endothelin-converting enzyme inhibitors).Conclusions:New pathophysiologic mechanisms of male LUTS are described that lead to the continuous development of new pharmacotherapies. To date, few drugs have been added to the current armamentarium, and several are in various phases of clinical or experimental investigation.The pathophysiology of male lower urinary tract symptoms (LUTS) is highly complex and multifactorial. Based on different mechanisms and targets, new pharmacotherapies have been developed. Exciting novel therapies based on new disease mechanisms of action are under development for male LUTS.]]></description>
                    <pubDate>Wed, 08 May 2013 04:05:46 GMT</pubDate>
                    <guid>S0302-2838(13)00465-X</guid>
                </item>
            
                <item>
                    <title><![CDATA[Computerized Quantification and Planimetry of Prostatic Capsular Nerves in Relation to Adjacent Prostate Cancer Foci]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00466-1/abstract</link>
                    <description><![CDATA[Background:Perineural invasion is discussed as a significant route of extraprostatic extension in prostate cancer (PCa). Recent in vitro studies suggested a complex mechanism of neuroepithelial interaction.Objective:The present study was intended to investigate whether the concept of neuroepithelial interaction can be supported by a quantitative analysis and planimetry of capsular nerves in relation to adjacent PCa foci.Design, setting, and participants:Whole-mount sections of the prostate were created from patients undergoing non–nerve-sparing laparoscopic radical prostatectomy. For each prostate, adjacent sections were created and stained both to identify capsular nerves (S100) and to localize cancer foci (hematoxylin and eosin).Outcome measurements and statistical analysis:Computerized quantification and planimetry of capsular nerves (ImageJ software) were performed after applying a digital grid to define 12 capsular sectors. For statistical analyses, mixed linear models were calculated using the SAS 9.3 software package.Results and limitations:Specimens of 33 prostates were investigated. A total of 1957 capsular nerves and a total capsular nerve surface area of 26.44 mm2 were measured. The major proportion was found in the dorsolateral (DL) region (p Overall capsular nerve count and nerve surface area are significantly increased in the presence of adjacent prostate cancer foci. The present study supports former findings suggesting that tumor foci may lead to complex neuroepithelial interactions resulting in prostate cancer–induced nerve growth.]]></description>
                    <pubDate>Wed, 08 May 2013 04:05:05 GMT</pubDate>
                    <guid>S0302-2838(13)00466-1</guid>
                </item>
            
                <item>
                    <title><![CDATA[A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00375-8/abstract</link>
                    <description><![CDATA[Context:Due to the complexity and challenging nature of radical prostatectomy (RP), it is likely that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as by the hospital.Objective:To review systematically the association between hospital and surgeon volume and perioperative, oncologic, and functional outcomes after RP.Evidence acquisition:A systematic review of the literature was performed, searching PubMed, Embase, and Scopus databases for original and review articles between January 1, 1995, and December 31, 2011. Inclusion and exclusion criteria comprised RP, hospital and/or surgeon volume reported as a predictor variable, a measurable end point, and a description of multiple hospitals or surgeons.Evidence synthesis:Overall 45 publications fulfilled the inclusion criteria, where most data originated from retrospective institutional or population-based cohorts. Studies generally focused on hospital or surgeon volume separately. Although most of these analyses corroborated the impact of increasing volume with better outcomes, some failed to find any significant effect. Studies also differed with respect to the proposed volume cut-off for improved outcomes, as well as the statistical means of evaluating the volume–outcome relationship. Five studies simultaneously compared hospital and surgeon volume, where results suggest that the importance of either hospital or surgeon volume largely depends on the end point of interest.Conclusions:Undeniable evidence suggests that increasing volume improves outcomes. Although it would seem reasonable to refer RP patients to high-volume centers, such regionalization may not be entirely practical. As such, the implications of such a shift in practice have yet to be fully determined and warrant further exploration.Undeniable evidence suggests that increasing surgical volume improves outcomes. Although it would seem reasonable to refer radical prostatectomy patients to high-volume centers, such regionalization may not be entirely practical.]]></description>
                    <pubDate>Wed, 08 May 2013 03:45:02 GMT</pubDate>
                    <guid>S0302-2838(13)00375-8</guid>
                </item>
            
                <item>
                    <title><![CDATA[A Prospective Patient-centred Evaluation of Urethroplasty for Anterior Urethral Stricture Using a Validated Patient-reported Outcome Measure]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00422-3/abstract</link>
                    <description><![CDATA[Background:Studies of interventions for urethral stricture have inferred patient benefit from clinician-driven outcomes or questionnaires lacking scientifically robust evidence of their measurement properties for men with this disease.Objective:To evaluate urethral reconstruction from the patients’ perspective using a validated patient-reported outcome measure (PROM).Design, setting, and participants:Forty-six men with anterior urethral stricture at four UK urology centres completed the PROM before (baseline) and 2 yr after urethroplasty.Intervention:A psychometrically robust PROM for men with urethral stricture disease.Outcome measurements and statistical analysis:Lower urinary tract symptoms (LUTS), health status, and treatment satisfaction were measured, and paired t and Wilcoxon matched-pairs tests were used for comparative analysis.Results and limitations:Thirty-eight men underwent urethroplasty for bulbar stricture and eight for penile stricture. The median (range) follow-up was 25 (20–30) mo. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) improved from a median of 12 at baseline to 4 at 2 yr (mean [95% confidence interval (CI)] of differences 6.6 [4.2–9.1], p < 0.0001). A total of 33 men (72%) felt their urinary symptoms interfered less with their overall quality of life, 8 (17%) reported no change, and 5 (11%) were worse 2 yr after urethroplasty. Overall, 40 men (87%) remained “satisfied” or “very satisfied” with the outcome of their operation. Health status visual analogue scale scores (100 = best imaginable health, 0 = worst) 2 yr after urethroplasty improved from a mean of 69 at baseline to 79 (mean [95% CI] of differences 10 [2–18], p = 0.018). Health state index scores (1 = full health, 0 = dead) improved from 0.79 at baseline to 0.89 at 2 yr (mean [95% CI] of differences 0.10 [0.02–0.18), p = 0.012]).Conclusions:This is the first study to prospectively evaluate urethral reconstruction using a validated PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.Standardisation of outcome reporting is a vital next step in comparative effectiveness research of competing interventions for urethral stricture disease and operative techniques for urethral reconstruction. The Urethral Stricture Surgery patient-reported outcome measure is fit for this purpose and should be part of that standard.]]></description>
                    <pubDate>Mon, 06 May 2013 12:45:31 GMT</pubDate>
                    <guid>S0302-2838(13)00422-3</guid>
                </item>
            
                <item>
                    <title><![CDATA[Predictive Value of Four Kallikrein Markers for Pathologically Insignificant Compared With Aggressive Prostate Cancer in Radical Prostatectomy Specimens: Results From the European Randomized Study of Screening for Prostate Cancer Section Rotterdam]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00457-0/abstract</link>
                    <description><![CDATA[Background:Treatment decisions can be difficult in men with low-risk prostate cancer (PCa).Objective:To evaluate the ability of a panel of four kallikrein markers in blood—total prostate-specific antigen (PSA), free PSA, intact PSA, and kallikrein-related peptidase 2—to distinguish between pathologically insignificant and aggressive disease on pathologic examination of radical prostatectomy (RP) specimens as well as to calculate the number of avoidable surgeries.Design, setting, and participants:The cohort comprised 392 screened men participating in rounds 1 and 2 of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer. Patients were diagnosed with PCa because of an elevated PSA ≥3.0 ng/ml and were treated with RP between 1994 and 2004.Outcome measurements and statistical analysis:We calculated the accuracy (area under the curve [AUC]) of statistical models to predict pathologically aggressive PCa (pT3–T4, extracapsular extension, tumor volume >0.5 cm3, or any Gleason grade ≥4) based on clinical predictors (age, stage, PSA, biopsy findings) with and without levels of four kallikrein markers in blood.Results and limitations:A total of 261 patients (67%) had significant disease on pathologic evaluation of the RP specimen. While the clinical model had good accuracy in predicting aggressive disease, reflected in a corrected AUC of 0.81, the four kallikrein markers enhanced the base model, with an AUC of 0.84 (p < 0.0005). The model retained its ability in patients with low-risk and very-low-risk disease and in comparison with the Steyerberg nomogram, a published prediction model. Clinical application of the model incorporating the kallikrein markers would reduce rates of surgery by 135 of 1000 patients overall and 110 of 334 patients with pathologically insignificant disease. A limitation of the present study is that clinicians may be hesitant to make recommendations against active treatment on the basis of a statistical model.Conclusions:Our study provided proof of principle that predictions based on levels of four kallikrein markers in blood distinguish between pathologically insignificant and aggressive disease after RP with good accuracy. In the future, clinical use of the model could potentially reduce rates of immediate unnecessary active treatment.Predictions based on levels of four kallikrein markers in blood—total prostate-specific antigen (PSA), free PSA, intact PSA, and kallikrein-related peptidase 2—can accurately distinguish between pathologically insignificant and aggressive disease after radical prostatectomy. Clinical use of the model could reduce rates of unnecessary surgery.]]></description>
                    <pubDate>Mon, 06 May 2013 12:45:24 GMT</pubDate>
                    <guid>S0302-2838(13)00457-0</guid>
                </item>
            
                <item>
                    <title><![CDATA[Robotic-assisted Partial Nephrectomy: Excellent Intermediate Results for Those Who Follow Up]]></title>
                    <link>http://www.europeanurology.com/article/S0302-2838(13)00458-2/abstract</link>
                    <description><![CDATA[]]></description>
                    <pubDate>Mon, 06 May 2013 12:45:20 GMT</pubDate>
                    <guid>S0302-2838(13)00458-2</guid>
                </item>
            
            </channel>
       
</rss>
