To determine the 5-year oncologic outcome of Endoscopic Extraperitoneal Radical Prostatectomy (EERPE) from a medium volume centre thereby providing much needed data on the oncologic outcomes from the United Kingdom.

From January 2006 to January 2012, 575 patients underwent EERPE for localized prostate cancer by a single surgeon who had completed a modular training programme. Follow-up was standard as per local hospital policy and data collected in our prospective database. A retrospective review on patient demographics, PSA, pathological T stages, Gleason scores, margin status and biochemical recurrence data was performed. Biochemical recurrence was defined by a PSA level >0.2ng/ml.

Mean patient age was 62-years (range = 40.3 - 76.5), mean follow-up was 30 months (range =12 – 72). Median operative time 135min (IQR= 120-170), median blood loss 200mls (IQR=100-250mls). 135/575 (23.5%) had positive surgical margins (PSM). PSM rate for pT2 disease was 66/406 (16.3%) and for pT3 disease 68/168 (40.5%). Overall BCR-free survival at 5-years was 81.5%. Multivariate Cox analysis showed that positive surgical margin, Gleason score, D'Amico risk category and pT stage were independent predictors of biochemical recurrence-free survival.

This assessment of oncologic results of EERPE, which includes the surgical learning curve, demonstrates that the adoption of EERPE after mentored fellowship training translates into mid-term oncologic outcomes in line with retropubic/transperitoneal laparoscopic approaches and with large volume centres worldwide which have pioneered LRP. This study shows that EERPE in a medium volume 2^nd generation laparoscopic centre produces results with good 5-year oncologic outcome, comparable to other major series, for patients in the United Kingdom.

To evaluate the Prostate Imaging Reporting and Data System (PIRADS) in multiparametric MRI (mp-MRI) based on single cores and single core histology. To calculate positive and negative predictive values of different modalities of mp-MRI.

We performed MRI-targeted TRUS-guided perineal prostate biopsies on 50 patients (mean age 66, mean PSA 9.9 ng/ml) with suspicion for prostate cancer. The biopsy trajectories of every core taken were documented in three dimensions in a 3D-prostate model. Every core was evaluated separately for prostate cancer and the performed biopsy trajectories were projected on mp-MRI images. PIRADS scores of 1177 cores were then assessed by a histology-blinded uro-radiologists in T2w, DCE, DWI and spectroscopy.

The PIRADS score was significantly higher in cores positive for cancer as compared to negative cores. There was significant correlation between the PIRADS score and histopathology in every modality. ROC analysis showed excellent specificity for T2 (90% peripheral zone / 97% transition zone) and DWI (98%/97%) images regardless of the prostate region observed. These numbers decreased for DCE (80%/93%) and MRS (76%/83%). All modalities demonstrate NPVs of 99% if a threshold of 2 (for T2, DCE, and MRS) or 3 (for DWI) is used. However PPVs were low.

Our results show that PIRADS scoring is feasible for clinical routine and allows standardized reporting. PIRADS can be used as a decision support system for targeting of suspicious lesions. mp-MRI has a high negative predictive value for prostate cancer and, thus, might be a valuable tool in the initial diagnostic work-up.

To present a series of 15 laparoscopic and robotic Mitrofanoff and Yang-Monti vesicostomies in an adult population, in order to assess the feasibility and safety of these minimally invasive approaches.

From 2009 to 2012, fifteen patients underwent laparoscopic (N=11) or robotic (N=4) construction of vesicostomy by a single surgeon (DR): Mitrofanoff appendicovesicostomy (N=11) or double Yang-Monti ileal conduit (N=4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (N=11) and urethral dysfunction (N=4). The patients were evaluated postoperatively by means of a cystography. Quality of life (QoL) was evaluated by means of an internally developed questionnaire.

All surgeries were successfully completed with no conversions. Operative time was always less than 5 hours. Mean blood loss was 150 cc. Mean follow-up was 22 months. Early postoperative complications included: deep retro-vesical abscess (N=2) and upper urinary tract infections (N=4). One patient had perioperative cardiac failure. Late postoperative complications included: stomal stenosis (N=2), persistent low-pressure bladder incontinence (N=1), recurrent infections (N=1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients demonstrated complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 87% of our patients (N=13) do not regret the surgery.

While a longer follow-up is needed to assess the durability of our results, this series demonstrates that the laparoscopic and robotic approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

To investigate suburothelial inflammation and urothelial dysfunction that occurs with ketamine-related cystitis (KC) and interstitial cystitis/bladder pain syndrome (IC/BPS).

Bladder tissues from 16 patients with KC, 17 with IC/BPS, and 10 controls were analysed. Immunofluorescence (IF) staining of the junction protein E-cadherin, tryptase (to assess mast cell activation) and TUNEL (to assess urothelial apoptosis ) were performed. The fluorescence intensity of E-cadherin was measured by Image J method. The percentages of activated mast cells and apoptotic cells were calculated as positive cells per area unit (4 μm2).

The mean age was 25.0 ± 3.8, 41.3 ± 13.7, and 50.5 ± 9.6 years in KC, IC/BPS and controls patients, respectively (p < 0.05). The distributions of E-cadherin in KC (10.1 ± 11.2) and IC/BPS (25.1 ± 16.3) tissues were significantly reduced compared to controls (42.4 ± 16.7) (both p < 0.05). The number of activated mast cell measured by tryptase signals in KC (6.5 ± 3.7) and IC/BPS (4.6 ± 3.0) were significantly increased compared to controls (1.3 ± 1.12) (both p < 0.05). TUNEL staining revealed a significant increase of apoptotic cells in KC (4.4 ± 2.5) and IC/BPS (2.4 ± 1.7) tissues compared to control tissues (0.1 ± 0.3) (both p < 0.05). KC tissues had significantly decreased expression of E-cadherin (p = 0.024) and significantly increased numbers of apoptotic cells (p = 0.02) than in IC/BPS tissues. Increased numbers of apoptotic cells and decreased expression of E-cadherin significantly correlated with maximal bladder capacity in the overall patient samples (p < 0.05).

KC and IC/BPS tissues both showed defective junction protein, increased suburothelial inflammation and increased urothelial cell apoptosis. Decreased expression of E-cadherin and increased apoptosis were more severe in KC than in IC/BPS bladder tissues. These findings were associated with the clinical symptoms of KC and IC/BPS.

To conduct a meta-analysis of the literature on the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) compared with laparoscopic partial nephrectomy (LPN).

An electronic database search of MEDLINE, EMBASE, google scholar, and the Cochrane library was performed up to January 8, 2013. All studies comparing RAPN with LPN were included. The outcome measures were the demographic parameters and the perioperative results, including operative time, warm ischemia time, blood loss, length of hospital stay, conversion rates, positive margin, and complications. A meta-analysis of the results was conducted.

A total of 766 patients were included, 425 patients in the RAPN group and 341 patients in the LPN group. There was no significant difference between the two groups in any of the demographic parameters (age: p=0.89; sex: p=0.31; malignant pathology: p=0.54; tumor size: p=0.99; or tumor laterality: p=0.06). There was no difference between the two groups regarding operative times (p=0.75), estimated blood loss (p=0.75), conversion rates (p=0.52), positive margins (p= 0.61), complications (p=0.27), or length of hospital stay (p=0.27), except that the RAPN group had significantly shorter warm ischemia time than the LPN group (p =0.01; WMD: -3.65; 95% CI, -6.46 to -0.83).

This meta-analysis shows that RAPN provides equivalent perioperative outcomes to those of LPN with the advantage of a significantly shorter warm ischemia time.

To assess fistula recurrence rate and quality of life after repair as well as the impact on continence and erection in patients with recto-anastomotic fistula after radical prostatectomy. Even in the more recent publications the number of cases for recto-urinary fistulas after radical prostatectomy is relatively small. Success rates at fistula closure are good; however data regarding functional outcome and quality of life is more restricted.

Retrospective study of patients treated for recto-urethral fistulas after radical prostatectomy between 1993 and 2008. All 17 patients were assessed for fistula recurrence in 2007 and received a standardized non-validated questionnaire to assess quality of life in 2011; furthermore, a patient's chart review was performed.

Surgical technique: fistula closure was abdominal in ten patients, perineal in 5 and combined abdominal and perineal in two, some with tissue interposition.

In 2007, follow-up was available for 14 patients, 1 was deceased, 2 lost to follow-up. Mean follow-up was 73.3 months, mean patient age 63 years. In 2 patients, rectal injury during the initial surgery was reported; another 3 had undergone adjuvant radiation therapy (18%). In 2011, another 2 patients were deceased; mean follow-up was 99.5 months (range, 44-184). A strong improvement in Qol as compared to before surgery was found in 58% of patients, a slight improvement in 8%, no change in quality of life in 25%. 67% are very satisfied with the surgery, 33% are satisfied.

Perineal or abdominal fistula repair yields excellent success rates and high patient satisfaction. However, urinary incontinence can be found in a number of patients postoperatively, requiring further treatment.

To clarify the role of phosphodiesterase-5 inhibitors (PDE5i) in post-prostatectomy penile rehabilitation (PPPR) To compare nightly and on-demand use of PDE5i after nerve-sparing minimally-invasive radical prostatectomy (RP)

Single-institution, double-blind, randomized controlled trial of nightly versus on-demand 50mg sildenafil citrate after nerve-sparing minimally-invasive RP 100 pre-operatively potent men (age < 65, IIEF-EF scores ≥ 26) who underwent nerve-sparing surgery Randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose 6 tablets/month) for 12 months, followed by a 1-month washout period Validated measures of erectile function (IIEF-EF and EPIC) were compared between treatment groups over the entire 13-month time course using multivariable mixed linear regression models

Treatment groups well-matched pre-operatively (mean age 54.3 vs. 54.6, baseline IIEF-EF 29.4 vs. 29.3, for nightly compared to on-demand sildenafil groups respectively) No significant differences were found in erectile function between treatments (nightly sildenafil vs. on-demand sildenafil) at any single post-prostatectomy timepoint, after adjusting for potential confounding factors When evaluated over all timepoints simultaneously, no statistically significant effects of treatment group (nightly sildenafil vs. on-demand sildenafil) were found on recovery of potency assessed by absolute IIEF-EF values (p=0.765), percentage of men returning to an IIEF-EF > 21 (p=0.830), or IIEF-EF recovery to a percentage of baseline value (p=0.778) When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessments of potency (including EPIC item 59, response erections "firm enough for intercourse"), attempted intercourse frequency, or confidence

Erectile recovery up to one year post-prostatectomy does not differ between previously potent men who use sildenafil nightly compared to on-demand This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally-invasive RP

• To identify differences between ablative and extirpative minimally invasive techniques represented by laparoscopic guided cryoablation (LC) and robotic partial nephrectomy (RPN) respectively in treating small renal tumours in different aspects including safety, peri-operative morbidity and early oncological outcomes.

• Between June 2008 and April 2012 we have treated 56 patients with LC (group 1) and more recently we have performed RPN using the Da Vinci robotic platform; from October 2010 to April 2012 (group 2) 47 patients were treated using this approach.

• Intra-operative, post-operative and oncological outcomes were collected prospectively, analysed and compared for both groups.

• Median age was 69 and 60 for group 1 and 2 respectively (P<0.05), while no significant difference was identified in disease stage, there was a significant difference in tumour size, the larger tumours being treated in group 2.

• Mean operative time was 146 min and 159 min for group 1 and 2 (P = 0.0941), whilst mean blood loss in the 1st group was 47 ml in comparison to 94 ml in group 2 (P =0.2505). Median hospital stay was the same for both groups (1 night) and he average warm ischemia time was 23 min in the 2nd group.

• Marginal change in pre and 6 weeks post-operative renal function was recorded (the mean post-operative increase in serum creatinine was 5.4 mmol/l in Group 1 and 9.2 mmol/l for group 2).

• 2/47 (4.3%) patients of group 2 were converted to laparoscopic radical nephrectomy due to difficulty in controlling bleeding during hilar dissection. Only two cases (3.6%) had recurrence in the cryotherapy group, both were treated with re-cryoablation. 5.4% from group 1 and 4.3% from group 2 had Clavien grade I post-operative complication, only one patient was recorded as Clavien grade II from group 2, while 1.8% and 4.3% of patients had Clavien III-b in group 1 and 2 respectively.

• Our data confirms that LC is a successful, minimally invasive and safe treatment option for the management of small renal tumours, however, the apparent similar characteristics of RPN suggest that an increasing proportion of patients, whatever their age or medical co-morbidities, may be reasonably offered a robotic assisted extirpative procedure with the likely benefit of a lower risk of local recurrence and the need for retreatment.

To assess safety and efficacy of tadalafil once daily on lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia (BPH-LUTS) in men without erectile dysfunction (ED).

To compare these with effects in men with ED.

Following a 4-week washout period and 4-week placebo run-in period, 1,089 men without ED (n=338) and with ED (n=751) were randomly assigned to placebo or tadalafil 5 mg once daily for 12 weeks in 3 global clinical studies with similar designs.

In the pooled dataset, post-hoc analyses of covariance assessed BPH-LUTS impact/severity using the International Prostate Symptom Score (IPSS), BPH Impact Index (BII), and IPSS Quality of Life (IPSS-QoL).

Safety was assessed using treatment-emergent adverse events.

Treatment-by-ED-status interaction assessed efficacy differences between yes/no-ED subgroups.

Men without ED were similar in BPH-LUTS severity/previous therapy to men with ED.

Tadalafil significantly reduced BPH-LUTS from baseline versus placebo in men without ED (IPSS –5.4 vs –3.3, p<0.01; IPSS voiding subscore –3.5 vs –2.0, p<0.01; IPSS storage subscore –1.9 vs –1.3, p<0.05).

Tadalafil also significantly improved quality of life from baseline versus placebo in men without ED (IPSS-QoL –1.0 vs –0.7, BII –1.4 vs –1.0; both p<0.05).

Between-ED-subgroup interactions were not statistically significant (all p>0.68).

Tadalafil was safe and well tolerated.

Tadalafil 5 mg once daily improved BPH-LUTS in men without ED with a similar magnitude as that observed in men with ED.

The adverse event profile in men without ED was consistent with that observed in men with ED.

To assess the prognostic significance of positive surgical margins (PSM) after minimally invasive radical prostatectomy (MIRP) in interaction with other established prognosis factors.

After institutional review board approval, we retrospectively analyzed data prospectively collected from 1998 to 2010 for 4628 consecutive patients with clinically localised prostate cancer who underwent MIRP. Biochemical recurrence (BCR) was defined by prostate-specific antigen (PSA) greater than 0.2 ng/ml. The impact of PSM on BCR was evaluated using multivariable Cox proportional hazards regression. Estimates of BCR-free survival were generated with the Kaplan-Meier method and compared among groups with the log-rank test.

The median follow-up was 55 mo. On multivariable analysis, PSM was independent prognostic factor for recurrence (adjusted hazard ratio: 2.14 for positive vs negative margins; 95% confidence interval [CI], 1.86-2.45; p < 0.001). Other independent predictors for BCR were preoperative PSA, date of surgery, pT stage, Gleason score and lymph node involvement (all p < 0.001). The 5-yr BCR-free probability was 80.6% (95% CI, 79-82.2) for negative margins vs 51% (95% CI, 47-55) for positive margins (log rank p < 0.001). pT2 and pT3a positive margins patients had similar prognosis as pT3a and pT3b negative margins, respectively (log rank p ≥ 0.05).

PSM after MIRP is associated with 2.14-fold increased risk of BCR. In pT2 and pT3a population, PSM could be considered as a pathological upstaging.

To evaluate the safety and efficacy of solo ultrasound-guided percutaneous nephrolithotomy (PCNL).

From May 2007 to July 2012, 24-Fr-tract PCNL was applied in 705 cases (679 patients; 26 with bilateral stones).

Caliceal puncture and dilation were performed under solo ultrasound (US)-guidance in all cases.

The procedure was evaluated for access success, post-procedural hospitalization duration, complications (modified Clavien system), stone clearance, and the need for auxiliary maneuvers.

The mean operative time was 66 ± 25 min, with a mean post-procedural hospitalization time of 3.98 ± 1.34 days.

The patients experienced a mean hemoglobin level decrease of 2.24 ± 2.02 g/d; the overall stone-free rate, 4 weeks after surgery, was 92.6% in patients with a single calculus, and 82.9% in patients with staghorn or multiple calculi.

Auxiliary treatments, including shock wave lithotripsy in 52, re-PCNL in 41, and ureteroscopy in 18 patients, were performed 1 week after the primary procedure in 111 (15.7%) cases, for residual stones over 4 mm in size.

The sensitivities of intraoperative US-guidance and flexible nephroscopy for detecting significant residual stones and clinically insignificant residual fragments were 95.3% and 89.1%, respectively.

There were 94 grade 1 (13.3%), 17 grade 2 (2.4%), and 2 grade 3 (0.3%) complications; however, grade 4 or 5 complications were not encountered.

Total US-guided PCNL is safe and convenient.

It may be performed without any major complications and with the advantage of preventing radiation hazards and damage to adjacent organs.

To compare the effectiveness of robot-assisted and standard laparoscopic prostatectomy.

A care pathway was described

Systematic literature review based on a search of Medline, Medline in Process, Embase, Biosis, Science Citation Index, Cochrane Controlled Trials Register, Current Controlled Trials, Clinical Trials, WHO International Clinical Trials Registry and NIH Reporter, the HTA databases, the Database of Abstracts of Reviews of Effects, and relevant conference abstracts up to 31^st October 2010). Additionally, reference lists were scanned, an expert panel consulted, and websites of manufacturers, professional organisations, and regulatory bodies were checked.

We selected randomised controlled trials (RCT) and non-randomised comparative studies published after 1^st January 1995 including men with localised prostate cancer undergoing robotic or laparoscopic prostatectomy compared against the other procedure or against open prostatectomy. Studies where at least 90% of included men had clinical tumour stages T1 to T2 and which reported at least one of our specified outcomes were eligible for inclusion.

A mixed treatment comparison meta-analysis was performed to generate comparative statistics on specified outcomes.

We included data from 19,064 men across one RCT and 57 non-randomised comparative reports.

Robotic prostatectomy had lower risk of major intra-operative harms such as organ injury [0.4 % robotic versus 2.9% laparoscopic, odds ratio (95% credible interval) 0.16 (0.03 to 0.76)], and lower rate of a surgical margin positive for cancer [17.6% robotic versus 23.6% laparoscopic, odds ratio (95% credible interval) 0.69 (0.51 to 0.96)]. There was no evidence of a difference in the proportion of men with urinary incontinence at 12 months [odds ratio (95% credible interval) 0.55 (0.09 to 2.84)]. There were insufficient data on sexual dysfunction.

Surgeon learning rates for the procedures did not differ although data were limited.

Men undergoing robotic prostatectomy appear to have reduced surgical morbidity, and a lower risk of a positive surgical margin which may reduce rates of cancer recurrence and need for further treatment. Considerable uncertainty surrounds these results.

We found no evidence that men undergoing robotic prostatectomy are disadvantaged in terms of early outcomes.

We were unable to determine longer term relative effectiveness.

20-40% of renal cell carcinoma (RCC) patients will develop recurrence after surgery with curative intention, which will develop within the first five years after primary surgery in most cases, but also later (up to 45 years) in the follow-up (FU) in approximately 6-10% of patients. Time and pattern of metastasis show strong individual variations, and knowledge about those patients who are at risk for recurrence at different time-points would allow for an individualized aftercare and potentially also for initiation of early salvage treatment. Furthermore, the prognostic influence of time to recurrence (TTR) on cancer-specific survival (CSS) after disease recurrence is currently controversially discussed.

In this study, we evaluated the prognostic impact of TTR on CSS after recurrence in RCC patients undergoing radical nephrectomy or nephron sparing surgery. Differences in clinical and histopathological criteria between patients with early and late recurrence were evaluated as well. The study shows that, besides age, gender, tumour histology, and pT stage, also TTR is a significant predictor of CSS after recurrence in RCC patients who undergo primary surgery with curative intention. The earlier in the postsurgical FU recurrent disease occurs, the more reduced is survival after recurrence. Vice versa, the prognosis of patients in case of recurrence is improved with every day a patient stays disease-free after surgery up to four years from surgery, but not beyond this time-period.

Advanced age, male gender, advanced tumour diameter and stage, lymphovascular invasion, Fuhrman grade 3-4, and pN+ stage are more frequent in patients with early recurrence, which might provide the possibility of risk adapted aftercare. These data might be useful for implementation as risk stratification tool in clinical trials to avoid bias, i.e., to allow for equal representation of early and late recurrence patients in treatment arms.

To assess the prognostic impact of time to recurrence (TTR) on cancer-specific survival (CSS) after recurrence in renal cell carcinoma (RCC) patients undergoing radical nephrectomy or nephron sparing surgery.

To analyze differences in clinical and histopathological criteria between patients with early and late recurrence.

Of 13,107 RCC patients from an international multicentre database, 1,712 patients developed recurrence in the follow-up (FU) (median 50.1 months; IQR 25-106).

1,402 patients had recurrence within five years (Group A) and 310 patients beyond this time-period (Group B).

Differences in clinical and histopathological parameters between patients with early and late recurrence were analyzed.

The influence of TTR and further parameters on CSS after recurrence was assessed by Cox regression analysis.

Male gender, advanced age, tumour diameter and stage, Fuhrman grade 3-4, lymphovascular invasion (LVI), and pN+ stage were significantly more frequent in patients with early recurrence, who had a significantly reduced 3-year CSS of 30% compared to Group B (41%; p=0.001).

Age, gender, tumour histology, pT stage, and continuous TTR (HR: 0.99, p=0.006; monthly interval) independently predicted CSS.

By inclusion of dichotomized TTR in the multivariable model, a significant influence of this parameter on CSS was present until 48 months after surgery, but not beyond this time-period.

Advanced age, male gender, larger tumour diameters, LVI, Fuhrman grade 3-4, pN+ stage, and advanced tumour stages are associated with early recurrence.

Up to four years from surgery, a shorter TTR independently predicts a reduced CSS after recurrence.

To evaluate predictors of understaging in patients with presumed non-muscle invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumor (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT.

We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease following TURBT who underwent RC at our institution from April 2000 to July 2011. 60 of these cT1 patients had undergone a restaging TURBT prior to RC. The primary outcome measure was pathological staging of T2 or greater disease at the time of RC.

134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumor (OR 0.43, 95% CI 0.25-0.76, p = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71 – 1.00, p = 0.05) were independent risk factors for understaging.

Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumor and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.

To investigate the effect of Human Papillomavirus (HPV) and Chlamydia trachomatis (Ct) co-infection on sperm concentration, motility and morphology, in a large cohort of young heterosexual male patients with chronic prostatitis-related symptoms.

Patients with chronic prostatitis-related symptoms, attending the same Sexually Transmitted Diseases (STD) Centre from January 2005 and December 2010, were consecutively enrolled in this cross-sectional study. All patients underwent clinical and instrumental examination, microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibodies evaluation for Ct, specific tests for HPV and semen parameter analysis. The semen parameters analysed were: volume, pH, sperm concentration, motility and morphology. Subjects were subdivided in two groups: Group A – patients with singular Ct infection and Group B - patients with Ct and HPV co-infection. The main outcome measurement was the effect of Ct and HPV co-infection on semen parameters.

1,003 out of 3,050 screened patients were enrolled (32.9%). 716 (71.3%) patients were allocated to group A, and 287 (28.7%) to group B. Statistically significant differences were reported in terms of percent motile sperm (df=1001; t=11.85; p<0.001) and percent of normal morphological forms (df=1001; t=7.18; p<0.001), while no differences were reported between the two groups in terms of semen volume or pH. According to WHO cut-off normal parameters (WHO 2010), 364 (50.8%) men in group A and 192 (66.8%) men in group B were considered sub-fertile (OR=1.95; 95% CI 1.46-2.60; p<0.0001). No correlation between HPV genotype, mucosal IgA type and semen parameters was found.

In a population of prostatitis-related symptoms due to Ct infection, co-infection with HPV has a significant role in decreasing male fertility parameters, in particular with regards to sperm motility and morphology.

To determine if female partners of patients with penile cancer had more cervical lesions and neoplasia than to be expected from population based data.

We included all consecutive patients with primary penile carcinoma in the period 2004-2010. ● Results of the Dutch cervical cancer screening were used to consider (pre)malignant cervical lesions in female partners of patients with penile cancer.

In total, 206 women were included. ● Gyneacological information was avaliable in 195 women: Normal smears were seen in 129 partners, ten smears were abnormal (5.1%, 95%CI 2.5-9.2). ● PAP 2 was found in five, PAP 3a in two, PAP 3b in two women and PAP 4 in one woman. ● Colposcopy in two women with PAP 3b showed CIN 3 in both. ● This prevalence was not different from baseline results in the general Dutch population.

Female partners of patients with penile cancer did not show more premalignant cervical lesions than in the general population.

To systematically review the range of methods of assessment of elasticity in the prostate to investigate its use as a biomarker for prostate cancer.

A systematic review of the electronic database PubMed was performed up to December 2012. All relevant studies assessing the use of elasticity as a biomarker for prostate cancer were included except those not studying human prostates or reporting a sensitivity, specificity or quantitative elasticity value.

There has been a lot of interest in the use of elasticity in the detection of prostate cancer and there have been many publications using a variety of methods of detection. The most common method of assessment is an imaging method, called sonoelastography. Further imaging methods include ultrasound, 3-D ultrasound and MR elastography. These modalities are reviewed for sensitivity and specificity. The other method of assessment is the mechanical method. These use quantitative elasticity values to differentiate benign from malignant areas of the prostate. This method of assessment has shown that the elasticity changes for differing Gleason grades and T stages of disease within the prostate. Quantitative elasticity values offer the potential of using “cut-off” elasticity values under which the prostate is benign.

Tissue elasticity has great potential as a diagnostic and prognostic biomarker for prostate cancer and can be assessed using a variety of methods. Currently transrectal sonoelastography has the most evidence supporting its use in clinical practice.

To determine the quality of transurethral resection of bladder tumour (TURBT) in the UK. To evaluate the utility of a novel ‘snapshot’ methodology in carrying out national audits.

Every consultant Urologist in the UK was asked to contribute details of their first patient with a new bladder cancer treated with TURBT after midnight of 31st January 2010. Responses were received from 192 consultants.

The median time from referral to first Urology appointment was 11 days (range 0-161 days), and the median time from first appointment to TURBT was 27 days (range 1-588 days). 12 (6.3%) patients underwent photodynamic diagnosis (PDD) assisted TURBT and 119 patients (61%) received a dose of Mitomycin C after TURBT. The rate of major complications was low, with 5 incidences (2.6%) of bladder perforation. There was no record of muscle present in resected specimens in 40 cases (20.8%) and resection was considered incomplete in 26 cases (13.5%). 31 patients (16.1%) underwent early re-resection with residual tumour or CIS detected in 17 cases, although no tumour was upstaged. Of the 37 patients classified with intermediate risk non muscle invasive bladder cancer (NMIBC), there were 9 recurrences (24.3%) at 3 months, and 13 recurrences (35.1%) at 1 year. Newly presenting muscle invasive bladder cancer (MIBC) managed with currently available treatments has a high mortality rate of 33.3% at 1 year.

The quality of TURBT in the UK is high. Areas for improvement include the timeliness of diagnosis and treatment, and improved care of patients with intermediate risk NMIBC and MIBC. The snapshot methodology is promising but widening participation is a priority.

To study if UroVysion kit, a multicolor fluorescence in situ hybridization (FISH) detecting the copy number of chromosomes 3, 7, 9p21, and 17, may predict patient outcome in NMIBC.

Totally 118 bladder washing solutions were prospectively collected from patients who underwent TURBT (median age: 50.5, male/female: 91/27, tumor grade 1/2/3: 18/52/42, stage pTis/Ta/T1: 8/62/42) from 2007 to 2010, analyzed by UroVysion to detect the copy number of chromosomes 3, 7, 9p21, and 17. Variant fraction, sum of non-modal copy number fraction of each chromosome, and % deletion of 9p21, fraction of null or one copy number of 9p21 locus was defined abnormal when percentage of each fraction was 16%, and 12% or more, respectively. Maffezzini risk criteria were also analyzed in our cohorts.

Recurrence and disease progression were found in 57 (48.3%), and 12 (10.1%) cases, respectively with a median follow-up of 35.7 months. Multivariate analysis demonstrated that % 9p21 loss (>12%) were an independent prognostic factor for recurrence (p<0.0001, OR: 3.24, 95% CI: 1.85-5.62). As for disease progression, tumor grade, positive urine cytology, concurrent CIS, and mean VF (>16%) were significant prognostic factors in univariate analysis. In multivariate analysis, mean VF (>16%) turned out to be a prognostic factor for disease progression (p=0.0476, OR: 6.07, 95% CI: 1.02-57.45).

A multicolor-FISH analysis using commercially available kit could be a powerful molecular marker not only for diagnosis, but also for predicting patient prognosis in patients with NMIBC.

To analyze the proteomic profile of seminal plasma in search for proteins and post-genomic pathways associated with sperm DNA fragmentation.

A cross-sectional study including 89 subjects from a human reproduction service was carried out. All semen samples were assessed for sperm DNA fragmentation using the Comet assay. Results from 60 sperm were analyzed by the Komet 6.0.1 software. Olive Tail Moment variable was used to form the Low and High sperm DNA fragmentation groups. Seminal plasma proteins from these groups were pooled and used for proteomics analysis (2D nanoUPLC-ESI-MS^E). Quantitative data were used for functional enrichment studies.

Seventy-two proteins were identified or quantified in seminal plasma. Of these, nine were differentially expressed in the Low group and twenty-one in the High group. Forty-two proteins were conserved between these groups. Functional enrichment analysis indicates that sperm DNA fragmentation is related to functions such as lipoprotein particle remodeling and regulation, fatty acid binding and immune response. Proteins found exclusively in the Low group may be involved in correcting spermatogenesis and/or improving sperm function. Proteins in the High group were associated with increased innate immune response, sperm motility and/or maturation and inhibition of mitochondrial apoptosis.

Protein expression and post-genomic pathways of seminal plasma differ according to the rate of sperm DNA integrity.

To investigate the association of ED with commonly used medications including antihypertensive, psychoactive medications, and pain and anti-inflammatory medications.

The Boston Area Community Health (BACH) Survey used a multistage stratified design to recruit a random sample of 2,301 men age 30-79. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Prescription medication use, captured using a combination of drug inventory and self-report with a prompt by indication, included in this analysis were antihypertensive agents (AHT), psychoactive medications, and pain and anti-inflammatory medications. Logistic regression was used to estimate odds ratios of the association of medication use and ED and adjust for potential confounders including age, comorbid conditions, and sociodemographic and lifestyle factors.

Multivariable analyses show benzodiazepines (adjusted OR=2.34, 95%CI: 1.03, 5.31) and tricyclic antidepressants (adjusted OR=3.35, 95%CI:1.09, 10.27) were associated with ED, while no association was observed for SSNRI/SNRIs and atypical antipsychotics. AHT use, whether in monotherapy or in conjunction with other AHTs, and pain or anti-inflammatory medications were not associated with ED after accounting for confounding factors.

Results of the BACH study suggest adverse effects of some psychoactive medications (benzodiazepines and tricyclic antidepressants). No evidence of an association of AHT or pain and anti-inflammatory medication with ED was observed.

We enrolled 241 BC patients and 199 controls. Genomic DNA samples were extracted from peripheral blood and polymorphisms were analysed by the High Resolution Melting analysis and by the Real-Time polymerase chain reaction using TaqMan fluorescent probes.

Out of the six evaluated polymorphisms of MMPs and TIMPs, only one was found to be associated with BC risk. Significant difference was noted for MMP1 (rs1799750) 2G/1G+1G/1G genotype (OR, 0.62; 95% CI, 0.39-0.98; P=0.042). Additionally, joint effect of this genotype on BC risk among ever smokes (OR, 0.51; 95% CI, 0.28-0.89; P=0.019), but not in never smokers was observed. The combined genotype MMP2 -1306C/T (rs243865) allele T with MMP9 -1562C/T (rs3918242) allele T was found to increase BC risk (OR, 2.00; 95% CI, 1.10-3.62; P=0.022).

Our results suggest that genetic variations in five polymorphisms of MMPs and TIMPs are not associated with a high risk of BC. Only MMP1 polymorphism may be related to the risk of BC, notably in ever-smokers. Our study suggests that the effects of polymorphisms of MMPs and TIMPs on BC risk deserve further investigation.

To evaluate side effects, erectile function and capability to preserve adjacent tissues of bilateral focal prostate ablation using low energy direct current (LEDC) in a canine model.

Twelve male Beagle dogs underwent bilateral focal prostate ablation using the NanoKnife™ LEDC system. Three 19G monopolar electrodes were transperineally placed on each side of the prostate under transrectal ultrasonographic (TRUS) guidance using a triangular probe array. Intra- and postoperative side effects were recorded. Erectile function was evaluated at baseline and 4-5 and 26-27 days postoperatively. The animals were terminated at 7(n=6) and 30 days (n=6) for gross and microscopic evaluation of the prostate and adjacent organs.

Median prostate volume on TRUS was 12.1mL (range 8.9-17.2). The electrodes were placed at a median distances of 0.55-0.66cm from the capsule, urethra and rectum. All procedures were completed successfully and recovery was uneventful. There were no episodes of urinary retention. All animals were able to achieve erections postoperatively. Pathological analyses revealed inflammatory changes in the ablation zone at 7 days and replacement by fibrosis at 30 days. On microscopic examination no histological injury to the capsule, urethra, rectal wall or nervous structures was identified.

In this study, bilateral focal prostate ablation using LEDC was safe and had a favorable side-effects profile limited to transient minor events. LEDC ablation effectively spared adjacent structures as well as physiological functions in all animals.

What is already known about the subject: Imaging is now playing an increasingly important role in the detection and localisation of prostate cancer. Multi-parametric (mp) MRI in particular has shown promise as an accurate method for determining the focality of tumours, and has potential to inform the conduct of novel minimally-invasive, tissue-preserving (‘focal’) treatments, such that high precision may be achieved when treating a therapeutic target. However, reliably utilising this information has been technically challenging, as most minimally-invasive technologies are delivered using an ultrasound guidance platform. As a consequence, current forms of focal therapy within trials have typically used relatively large regions, such as a lobe or quadrant, as the therapeutic target. This often results in large discrepancies between the tumour and target volumes, potentially leading to under-treatment at the margins.

To evaluate the feasibility in using a computer-assisted, deformable image registration software to enable three-dimensional, mpMRI-derived information on tumour location and extent to inform the planning and conduct of focal high-intensity focused ultrasound (HIFU) therapy.

A nested pilot study of 26 consecutive men with a visible discrete focus on mpMRI, correlating with positive histology on transperineal template mapping biopsy, who underwent focal HIFU (Sonablate 500®) within a prospective, ethics committee approved multi-centre trial (‘INDEX’).

Non-rigid image registration software developed in our institution was used to transfer data on the location and limits of the index lesion as defined by mpMRI.

Manual contouring of the prostate capsule and histologically-confirmed MR-visible lesion was performed pre-operatively by a urologist and uro-radiologist.

A deformable patient-specific computer model, which captures the location of the target lesion, was automatically generated for each patient and registered to a 3D TRUS volume using a small number (10-20) of manually-defined capsule points.

During the focal HIFU, the urologist could add additional sonications following image-registration if it was felt that the original treatment plan did not cover the lesion sufficiently with a margin

Prostate capsule and lesion contouring was achieved in under 5 minutes pre-operatively. The mean time taken to register images was 6 minutes (range 3 – 16).

Additional treatment sonications were added in 13 of 26 cases leading to a mean additional treatment time of 45 secs (range 9 - 90).

Non-rigid MR-US registration is feasible, efficient and can locate lesions on ultrasound.

The process has potential for improved accuracy of focal treatments, and improved diagnostic sampling strategies for prostate cancer.

Further work on whether deformable MR-US registration impacts on efficacy is required.

To analyze predictive factors of postoperative complications after robotic assisted laparoscopic partial nephrectomy (RALPN).

Data from 240 patients who underwent RALPN between 2009 and 2011 at 6 French centres were retrospectively reviewed. Clinical (age, BMI, ASA and Charlson score, anticoagulant treatment), tumoral (size, R.E.N.A.L Nephrometry score) and operative (surgeon experience, blood loss, opening of the collecting system, operative time) parameters were considered. Postoperative complications were classified according to the Clavien system. Univariate and multivariate regression models were used to assess the impact of these variables on the occurrence of global and major complications.

Median age was 61 years (26-83). Tumours were of low complexity in 62% of cases. Median operative time, blood loss and warm ischemia time were 161 min (45-425), 100 ml (0-2500) and 20 min (0-59), respectively. Postoperative complications occurred in 79 (33%) patients. Complications were ≥ grade 3 in 25 (10%) patients and were mostly hemorrhagic. In multivariate analysis, surgeon's experience (HR 2.14 [1.07 - 4.27], p = 0.03) and blood loss (HR: 1.002 [1.001 - 1.003], p = 0.0002) were independent predictors of overall complications. When considering major complications, opening of the collecting system was the only factor that was significant (OR: 2.99 [1.2-7.26], p =0.02). Nephrometry RENAL score was not associated with post-operative complications.

In our experience, RALPN is associated with a 30% risk of postoperative complications. Surgeon's experience, blood loss and opening of the collecting system were the three predictors of postoperative complications.

To determine patterns of management and surveillance imaging for stage I testicular cancer amongst Australian medical oncologists in Australia during 2010.

The survey comprised 14 questions about management strategy and surveillance imaging for all patients with stage I testicular cancer treated over the previous 12 months.

52 medical oncologists documented the management for an estimated 470 patients.

For seminoma, management was surveillance in 33%, radiotherapy in 5%, and adjuvant carboplatin in 62%.

For non-seminoma, management was surveillance in 73%, adjuvant chemotherapy in 23%, and retro-peritoneal lymph node dissection in 4%.

Frequency of surveillance imaging was highly variable, and ≥ 10 CT scans were used by 38% of clinicians for seminoma and 46% of clinicians for non-seminoma.

We found considerable variation in management. The infrequent use of surveillance and frequent use of carboplatin for seminoma differs from international guidelines.

Radiation exposure from CT imaging should be reduced through standardised follow-up protocols, and possibly by alternate imaging modalities if validated in appropriate studies.

To evaluate prostate cancer diagnosis rates and survival outcomes in patients receiving unrelated (non-prostate) urologic care as compared to patients receiving non-urologic care.

We conducted a population based study using the Surveillance Epidemiology and End Results (SEER) database to identify men who underwent surgical treatment of RCC (18,188) and CRC (45,093) from 1992 to 2008. Using SEER*stat software to estimate standardized incidence ratios (SIRs), we investigated rates of prostate cancer diagnosis in RCC and CRC patients. Adjusting for patient age, race, and year of diagnosis on multivariate analysis, Cox and Fine & Gray proportional hazards regressions were used to evaluate overall and disease specific survival endpoints.

Expected incidence of prostate cancer was higher in both RCC and CRC patients (SIR=1.36[1.27–1.46] vs. 1.06[1.02-1.11]). Adjusted prostate cancer SIRs were 30% higher (p<0.001) in patients with RCC. Overall (HR=1.13, p<0.001) and primary cancer (sHR=1.17, p<0.001) adjusted mortalities were higher in patients with RCC with no significant difference in prostate cancer-specific mortality (sHR=0.827, p=0.391).

Rates of prostate cancer diagnosis were higher in patients with RCC (a cohort with unrelated urologic cancer care) vs. CRC. Despite higher overall mortality in RCC patients, prostate cancer specific survival was similar in both groups. Opportunities may exist to better target prostate cancer screening in patients who receive non-prostate related urologic care. Furthermore, urologists should not feel obligated to perform PSA-screening for all patients receiving non-prostate related urologic care.

Radical cystectomy and conduit formation is curative but is associated with significant postoperative morbidity and mortality.

Our aim was to determine the relationship of preoperatively measured cardiopulmonary function, to the development of postoperative complications and hospital length of stay in a cohort of patients undergoing radical cystectomy.

Consecutive patients planned to have radical cystectomy underwent cardiopulmonary exercise testing (CPET) to a standardised protocol.

The results of the CPET were blinded from the clinicians involved in the care of the patients.

Patients were prospectively monitored for the primary outcome of postoperative complications, as defined by a validated classification (Clavien-Dindo).

Secondary outcome included hospital length of stay and mortality.

82 patients underwent CPET prior to radical cystectomy. 8 patients did not subsequently undergo radical surgery and a further 5 patients did not exercise sufficiently to allow for appropriate determination of the cardiopulmonary variables of interest.

There was a significant difference in hospital length of stay between those patients who had a major perioperative complication (Clavien score >3) to those that did not (16 vs 30 p<0.0001 HR 3.6 95% CI 2.1-6.3).

The anaerobic threshold remained as the only significant independent predictor variable for the presence or absence of major postoperative complications (OR 0.74; 95% CI 0.57-0.97. p=0.03).

When the optimal predictive value of anaerobic threshold of 12ml/min/kg was used as a fitness marker, there was a significant relationship between fitness and length of hospital stay (Median Hospital LOS: Unfit 22 vs fit 16 days HR 0.47 95% CI 0.28 - 0.80 p=0.006)

Impaired preoperative cardiopulmonary reserve was related to major morbidity, prolonged hospital stay and increased use of critical care resource after radical cystectomy.

This has important health and economic implications for risk assessment, rationalization of postoperative resource and the potential for therapeutic preoperative intervention with exercise therapy.

To determine the characteristics of patients with germ cell cancer and bone metastases.

The case records of patients with known germ cell tumours (GCTs) within the Anglian Germ Cell Cancer Group database between January 2005 to March 2011 were reviewed retrospectively. Data were collected for histopathology, presence of bone metastases at diagnosis or relapse, site of bone metastases and imaging modality used to confirm bone metastases, treatment received, response to treatment and overall survival. We present here the largest unselected cohort of bone metastases in germ cell tumour patients.

A total of 2,550 cases of GCT were reviewed and bone involvement was noted in 19 cases. The primary site was either testicular (13/19), mediastinal (1/19) or unknown (5/19). The majority of cases were of non-seminomatous GCT (11/19, 58%) and only 3 cases of seminomatous GCT (3/19, 16%) with 5 cases in which diagnosis was based on clinical history and significantly raised germ cell tumour markers (5/19, 26%). In all of these 5 cases beta human chorionic gonadotropin was raised and in 3/5 cases alpha-fetoprotein was raised in keeping with non-seminomatous GCT. Bone metastases were found at diagnosis (0.51%, 13/2550) or at relapse (0.24%, 6/2550). The sites of bone metastases were the vertebrae (15/19, 79%), pelvis (3/19, 16%), ribs (3/19, 16%) and femur (2/19, 11%). Ten patients (53%) had solitary, and 9 patients (47%) had multiple, sites of bone metastases. In patients presenting with bone metastases at diagnosis compared to relapse, the mortality rate was 23% (3/13) and 50% respectively (3/6). After receiving one line of chemotherapy, 9 patients (47%) remained in remission not requiring further treatment, 6 (32%) required further chemotherapy due to subsequent relapse, 3 (16%) died after first-line chemotherapy and one was lost to follow-up. At the time of data collection and based on the last clinic follow-up, 6 patients (32%) had died with a median follow-up [interquartile range] of 11.5 months [4.3, 24.8] and 10 (53%) remained alive with a median follow-up of 26 months [13.5, 48]. Three patients were lost to follow-up. Of the known patients alive, 8 (42%) remained in remission and 2 (11%) had recurrent disease requiring further treatment.

Although bone disease in germ cell cancer is rare, awareness of this condition is important and there is a need for prospective evaluation of patient characteristics, treatment approaches and survival outcome in this group of patients.

To test the sensitivity, specificity and accuracy of serum p2PSA, %p2PSA and PHI, in men with a family history of prostate cancer (PCa) undergoing prostatic biopsy for suspected PCa. To evaluate the potential reduction of unnecessary biopsies and the characteristics of potentially missed cases of PCa that would result from using serum p2PSA, %p2PSA and PHI.

The analysis consisted of a nested case-control study from the PRO-psa Multicentric European Study (PROMEtheusS) project. All patients had a PCa affected first degree relative (father, brother, son). Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis.

Of the 1026 patients enrolled in the PROMEtheuS cohort, 158 (15.4%) had a PCa affected first-degree relative. p2PSA, %p2PSA and PHI values were significantly higher (p<0.0001), and %fPSA values significantly lower (p<0.0001) in the 71 patients with PCa (44.9%) compared to patients without PCa. Univariable accuracy analysis showed %p2PSA (AUC: 0.733) and PHI (AUC: 0.733) to be the most accurate predictors of PCa at biopsy, significantly outperforming tPSA (AUC: 0.549), fPSA (AUC: 0.489) and %fPSA (AUC: 0.600) (p≤0.001). For %p2PSA a cut-off of 1.66 showed the best balance between sensitivity and specificity (70.4 and 70.1%; 95%C.I: 58.4-80.7 and 59.4-79.5 respectively). A PHI cut-off of 40 showed the best balance between sensitivity and specificity (respectively 64.8 and 71.3%; 95%C.I 52.5-75.8 and 60.6-80.5). At 90% sensitivity, the cut-off of %p2PSA and PHI were respectively 1.20 and 25.5 with a specificity of 37.9 and 25.5%. At a %p2PSA cut-off of 1.20 a total of 39 (24.8%) biopsies could have been avoided, but 2 cancers with a Gleason score of 7 would have been missed. At a PHI cut-off of 25.5 a total of 27 (17.2%) biopsies could have been avoided and 2 (3.8%) cancers with a Gleason score of 7 would have been missed.

In multivariable logistic regression models, %p2PSA and PHI achieved independent predictor status and significantly increased the accuracy of multivariable models including PSA and prostate volume by 8.7 and 10% respectively (p ≤0.001). p2PSA, %p2PSA and PHI were directly correlated with Gleason Score (rho: 0.247, p=0.038; rho: 0.366, p=0.002; rho: 0.464, p<0.001, respectively).

%p2PSA and PHI are more accurate than tPSA, fPSA and %fPSA in predicting PCa in men with a family history of PCa Consideration of %p2PSA and PHI results in the avoidance of several unnecessary biopsies. p2PSA, %p2PSA and PHI correlate with cancer aggressiveness.

To evaluate the safety, tolerability and effectiveness of outpatient (office-based) local anaesthetic laser ablation (OLA) of Non-muscle Invasive Bladder Cancer (NMIBC) in an elderly population with and without photodynamic diagnosis (PDD). To compare the cost-effectiveness of outpatient laser ablation of NMIBC with inpatient cystodiathermy (IC).

Prospective cohort study of patients with NMIBC treated with outpatient local anaesthetic laser ablation (OLA) by one consultant surgeon between March 2008 - July 2011 A subgroup of patients had PDD prior to laser ablation. Safety and effectiveness determined by complications (time 0, 3/7, 3/12), patient tolerability (visual analogue score) and recurrence rates Long-term costs and cost effectiveness of OLA and IC of NMIBC were evaluated using Markov modelling

74 OLA procedures (44 white light, 30 PDD) on 54 patients. Mean age 77 (Range 52-95). Over 50% had >3 co-morbidities. Previous tumour histology ranged from G1pTa to T3. One patient had haematuria for one week which settled spontaneously and did not require hospital admission. There were no other complications. The procedure was well tolerated with pain scores of 0-2/10. Additional lesions seen in 21% of patients with PDD that were not seen with white light. At three months, the percentage of patients who had recurrence for OLA with white light and OLA with PDD were 10.6% and 4.3% respectively. At one year, 65.1% and 46.9% of patients had recurrence. Cost of OLA is much lower than IC (£538 vs £1474), even with the addition of PDD (£912 vs £1844). Over the course of a patient's lifetime, OLA was more clinically effective than IC (0.147 QALY, SD 0.059 QALY) and less costly (£2576.42, SD £7293.07)At a Cost-Effectiveness Threshold (CET) of 30,000 £/QALY as set by NICE, there is an 82% probability that OLA is cost-effective

This first report on the safety and tolerability of outpatient laser ablation of NMIBC and the feasibility of PDD as an adjunct The first study to demonstrate the long term cost-effectiveness of OLA of NMIBC Results support the use of OLA for the treatment of NMIBC especially in the elderly

To evaluate oncologic outcome trends over the last three decades in patients following radical cystectomy (RC) and extended pelvic lymph node dissection (LND)

Retrospective analysis of the University of Southern California (USC) cystectomy cohort of patients (n=1488) operated with intent to cure from 1980-2005 for biopsy proven muscle-invasive urothelial bladder cancer To focus on outcomes of unexpected (cN0M0) node-positive patients, the USC subset was extended with unexpected node-positive patients from the University of Berne (UB) (combined subgroup n=521) Patients were grouped and compared according to decade of surgery (1980-1989/1990-1999/≥2000) Survival probabilities were calculated with Kaplan-Meier plots, Logrank tests compared outcomes according to decade of surgery, followed by multivariable verification

Ten year recurrence-free survival was 78-80% in patients with organ confined, node-negative disease, 53-60% in patients with extravesical, yet node-negative disease and approximately 30% in node-positive patients Although the number of patients receiving systemic chemotherapy increased, no survival improvement was noted in either the entire USC cohort, or in the combined node-positive USC-UB cohort In contrast, patient age at surgery increased progressively, suggesting a relative survival benefit

Radical surgery remains the mainstay of therapy for muscle-invasive bladder cancer Yet, our study reveals predictable outcomes but no survival improvement in patients undergoing RC over the last three decades Any future survival improvements are likely to result from more effective systemic treatments and/or earlier detection of the disease

To illustrate the underlying variability in perioperative mortality following RC by analyzing failure-to-rescue (FTR) rates, i.e. deaths after complications.

Patients undergoing RC for non-metastatic BCa were identified using the Nationwide Inpatient Sample, between 1999-2009, resulting in a weighted estimate of 79972 patients. FTR was assessed according to patient and hospital characteristics, as well as complication type. Generalized linear regression analyses were performed.

Overall, 26740 patients had a complication, corresponding to a FTR rate of 5.5%. Septicemia (odds ratio [OR]: 13.41, P<0.001), cardiac (OR: 3.97, P<0.001), wound (OR: 2.12, P<0.001), genitourinary (OR: 1.62, P=0.045) and hematological (OR: 1.78, P=0.008) complications were associated with FTR. Older age (OR: 1.05, P<0.001), increasing comorbidities (OR: 1.33, P<0.001), Medicare (OR: 1.52, P=0.016), and Medicaid insurance status (OR: 2.10, P=0.029) were associated with higher odds of FTR. Conversely, increasing hospital volume (OR: 0.992, P=0.014) reduced the odds of FTR.

Whereas both patient and hospital characteristics are accountable for increased odds of FTR, the occurrence of septicemia and cardiac complications were the most strongly correlated with higher risk of in-hospital mortality when complication(s) occur.

To determine renal function and cardiovascular outcomes following living donor nephrectomy (LDN). Living donor kidney transplantation has become established as the treatment of choice for end stage renal failure. Benefits to the recipient have to be balanced against peri-operative and long term health risks to the donor.

The UK Transplant Registry (UKTR) was used to identify 4,586 living donors who had donated a kidney for transplantation in the UK between 2001 and 2008.

The mean GFR fell from 103 ml/min/1.73 m² pre donation to 58 ml/min/1.73 m² one year post donation. One year post donation 60% of donors had a GFR below 60 ml/min/1.73 m². A post donation GFR below 60 ml/min/1.73m² was associated with older age, females, lower pre donation GFR, white ethnicity, earlier donation period, nonrelated donor type and BMI > 25. Over a two year period following LDN we observed an overall mortality rate of 0.39%, cardiovascular death in a single patient (mortality rate of 0.02%) and a major cardio-vascular event rate of 0.44%.

In this study we demonstrate that mild renal dysfunction is common following LDN, however due to the short duration of follow up we are unable to comment on whether this subsequently leads to an increased risk of developing of cardio-vascular disease.

To investigate causes of death in a UK cohort of prostate cancer patients.

We examined causes of death in a UK cohort of 50,066 men with prostate cancer diagnosed between 1997 and 2006 reported to the Thames Cancer Registry (TCR) and followed up to the end of 2007. The underlying cause of death was taken from the death certificate. Uptake of PSA screening was low in the UK during the period studied. We examined the relationship between cause of death and patient characteristics at diagnosis including age, cancer stage, and treatment (within six months of diagnosis).

20,181 deaths occurred during the period 49·8% recorded as being due to prostate cancer, 17·8% to cardiovascular disease, 11·6% to other cancers, and 20·7% to other causes. Irrespective of age, cancer stage, or treatment within six months of diagnosis, prostate cancer was an important cause of death ranging from 31·6% to 74·3% of all deaths in different subgroups.

For men with prostate cancer diagnosed in a setting where uptake of PSA screening is low, our findings challenge the belief that prostate cancer is not an important cause of death.

• We studied 1000 consecutive patients concurrently treated by either LRP or RRP between 2001 and 2005.
• LRPs were performed by a single surgeon and RRP by four surgeons.
• Primary outcomes were BCR and SRT. Survival analysis included relevant clinical and pathological variables.

• Of 844 included patients, 244 underwent LRP and 600 RRP.
• Clinical and pathological characteristics were similar in both groups. Most patients had Gleason 6 tumours (68%) and pT2 disease (86%). The median follow-up was 6.1 years and median time to recurrence 3.4 years.
• Overall, BCR occurred in 14% of patients: 13.1% after LRP and 14.7% after RRP.
• SRT was performed in 10.7% of patients both after LRP and RRP. In uni- and multivariate Cox regression models, surgical technique was not a significant predictor of BCR or SRT.

• Our results suggest that in high-volume centres, LRP provides equivalent oncological control to RRP.

• The data of 133 consecutive patients who underwent robot-assisted RP by a single surgeon (V.R.P.) were prospectively collected.
• Degree of nerve sparing (NS) was graded intraoperatively by the surgeon independently at either side as complete, partial or none.
• A pathologist who was ‘blinded’ to the surgeon's classification measured the following parameters at the posterolateral aspect of the apex, base and mid prostate at either side of the RP specimen: length, width and area of neural tissue, number of nerves per high-power field and number of total slides containing neural tissue.
• Measurements were correlated to the surgeon's intraoperative perception.

• All measurements correlated significantly with surgeon's intent of NS at all locations (P = 0.001).
• Among them, the cross-sectional area had the highest correlation coefficient (–0.550 at apex, –0.604 at mid prostate and –0.606 at the base).

• The cross-sectional area of nerve tissue showed the highest correlation with surgeon's intent of NS at all locations.
• Having a standardised method of assessing and reporting residual nerve tissue allows the surgeon to objectively evaluate the quality of nerve preservation and to compare the progress of his NS technique over time.

• A prospective analysis of technical and radiological outcomes was undertaken after treatment of 171 consecutive tumours in 147 patients.
• Oncological efficacy in a subset of 125 tumours in 104 patients with >6 months' radiological follow-up and a further subset of 62 patients with solitary, biopsy-proven renal carcinoma was also analysed.
• Factors influencing technical success, as determined by imaging follow-up, and complication rates were statistically analysed using a statistics software package and logistic regression analyses.

• No variables were found to predict subtotal treatment, although gender (P = 0.08), tumour size of >4 cm (P = 0.09) and central location of tumour (P = 0.07) approached significance.
• Upper pole location was the single variable that was found to predict complications (P = 0.006).
• Among the 104 patients (125 tumours), radiologically assessed at ≥6 months and with a mean radiological follow-up of 20.1 months, we found a single case of unexpected late local recurrence.

• Percutaneous image-guided cryoablation, at a mean of 20.1 months' follow-up, appears to provide a safe and effective treatment option with a low complication rate.
• Anteriorly sited tumours should not be considered a contraindication for percutaneous image-guided cryoablation.

• A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010.
• LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis.

• Overall, 551 patients were included and were divided into two groups: those without LVI (LVI−), n = 388 and those with LVI (LVI+), n = 163.
• LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P < 0.001).
• The 5-year CSS and MFS rates were significantly worse in the LVI+ group than in LVI− group (52.2 vs 84.5%, P < 0.001 and 43.8 vs 82.7%, P < 0.001, respectively).
• In multivariate analysis, LVI+ status was an independent prognostic factor for CSS and MFS (P = 0.04 and P < 0.001). These findings were confirmed for the pN0/x patient subgroup (n = 504, P < 0.001).
• In the pN0/x patient subgroup, we described a prognostic tool for MFS based on independent factors that permitted us to stratify patients into groups of high, intermediate or low risk of metastasis relapse.

• The presence of LVI was a strong predictor of a poor outcome for UTUC.
• When a lymphadenectomy has not been achieved, the report of LVI status is crucial to identfiy those patients at higher risk for metastatic relapse.

• A total of 59 patients with complete radiographic, clinical and follow-up information were included for analysis.
• Technetium Tc 99m (⁹⁹Tc^m)-diethylene-triamine-penta-acetic acid (DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually.
• All cross-sectional images were reviewed by a single radiologist and a DAP score was assigned.

• The median decline in total GFR after PN was 13% at a median follow-up of 12 months (from 86.8 to 76.2 mL/min per 1.73 m², P < 0.001).
• The median GFR of the operated kidney showed a significant decrease peri-operatively (42.4 to 27.1 mL/min per 1.73 m², P < 0.001). The function of the contralateral kidney showed a significant increase (43.5 to 48.8 mL/min per 1.73 m², P < 0.001).
• On multivariate analysis, preoperative total GFR, ischaemia time and DAP sum score were independent predictors of absolute functional decline of the affected kidney (all P < 0.001), while only preoperative total GFR and DAP sum score were significantly associated with the total absolute GFR reduction (all P < 0.001).

• Preoperative renal function status and DAP score of renal tumours are the primary determinants of long-term functional outcomes after PN, but renal ischaemia damage to the operated kidney after PN is possibly masked by functional compensation of the contralateral healthy kidney if only overall renal function is assessed.

• Between 1988 and 2006, within the Surveillance, Epidemiology, and End Results database, patients with T2 N0–2 M0–1 RCC treated with a nephrectomy were abstracted.
• Tumour size was evaluated according to several thresholds: ≥8, ≥9, ≥10, ≥11, and ≥12 cm. Kaplan–Meier and life tables for cancer-specific mortality (CSM) were computed.
• Several Cox regression modes were fitted for prediction of CSM, using different thresholds.
• The predictive accuracy of various thresholds was compared using the area under the curve and methods of calibration.

• In all, 4963 patients were identified. Kaplan–Meier analyses showed statistically significant CSM-free survival differences between all examined thresholds.
• In multivariable Cox-regression models, all tested tumour size thresholds emerged as independent predictors of CSM.
• Of all thresholds, the values of 9 (0.55) and 11 cm (0.55) achieved the highest discrimination in univariable analysis, followed by 10 (0.539), 12 (0.539), and 8 cm (0.531).
• When the thresholds were combined with all other variables, the 11 cm (0.688) achieved the highest discrimination.

• The discriminant properties of all examined thresholds showed very similar discriminant properties, which brings into questioning whether a dichotomization of pT2 tumours is really necessary.

• Analysis of annual hospitalisation data using Australian Institute of Health and Welfare (AIHW) datasets showed an increase in CIS from 2001 onwards.
• To determine whether the increase seen with AIHW data represented a true increase in the rates offices, patient level data was examined using the Centre for Health record linkage (CHeReL) datasets.

• CHeReL linked data of 13 790 males and 5902 females, calculated the average incidence of CIS to be 20.9 per 100 000 and 6.5 per 100 000 respectively in those aged > 50 years, showing a rapid increase in the rates of CIS from 2001.
• There was an 11% (P = 0.04) and 14% (P = 0.02) annual increase in incidence of CIS in men and women and these rates increased with age.

• National data (AIHW) substantially underestimate the incidence of CIS in the Australian population.
• Patient level data suggest CIS rates are rapidly increasing in Australia despite high treatment rates.
• Closer surveillance and awareness of these high rates warrants further study and we recommend that CIS be considered a reportable disease.

• A decision-analytic model was used to compare the costs of PVP and TURP.
• Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals.
• The probability of re-intervention was obtained from secondary literature sources.
• Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions.

• In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] –12 187 to 14 516) more costly per patient than TURP.
• The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention.
• Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ –684, 95% CrI –8319 to 5796 and AU$ –100, 95% CrI –13 026 to 13 678, respectively). However, CrIs were wide for all analyses.

• In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs.
• However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.

• To present the template-guided transperineal prostate biopsy (TPB) outcomes for patients of two urologists from a single institution.

• We conducted a prospective study of 409 consecutive men who underwent TPB between December 2006 and June 2008 in a tertiary referral centre using a standardized 14-region technique.
• The procedure was performed as day surgery under general anaesthesia with fluoroquinolone antibiotic cover.
• Follow-up took place within 2 weeks, during which time men were interviewed using a standardized template.
• Results were compared with those of the Australian national prostate biopsy audits performed by the Urological Society of Australia and New Zealand (USANZ).

• Indications for biopsy included elevated prostate-specific antigen (PSA) level (75%), with a median PSA level of 6.5 ng/mL, abnormal digital rectal examination (8%) and active surveillance (AS) re-staging (18%).
• The mean patient age was 63 years and two-thirds of patients were undergoing their first biopsy.
• A positive biopsy was found in 232 men, 74% of whom had a Gleason score of ≥7. The overall cancer detection rate was 56.7% (USANZ 2005 national audit = 56.5%). Stratified between those having their first TPB or a repeat procedure (after a previous negative biopsy), the detection rates were 64.4 and 35.6%, respectively. Significantly higher detection rates were found in prostates <50 mL in volume than in larger prostates (65.2 vs 38.3%, respectively, P < 0.001).
• Haematuria was the most common side effect (51.7%). Others included dysuria (16.4%), acute urinary retention (4.2%) and fever (3.2%). One patient (0.2%) had septicaemia requiring i.v. antibiotics.
• Repeat biopsy was not associated with increased complication rates.

• TPB is a safe and efficacious technique, with a cancer detection rate of 56.7% in the present series, and a low incidence of major side effects. Stratified by prostate volume, the detection rate of TPB was higher in smaller glands.
• Given the relatively low rate of serious complications, clinicians could consider increasing the number of TPB biopsy cores in larger prostates as a strategy to improve cancer detection within this group. Conversely, in patients on AS programmes, a staging TPB may be a superior approach for patients undergoing repeat biopsy so as to minimize their risk of serious infection.

• Bilateral percutaneous access was established in 28 porcine renal units. At the end of the procedure, a type 1 absorbable fish origin collagen powder, a human fibrinogen- and thrombin-coated sponge or a cross-linked gelatin granule/topical thrombin matrix were randomly placed on the nephrostomy tracts. Four nephrostomy accesses were left intact and served as controls. No percutaneous tube, ureteric stent or bladder catheter was left in place postoperatively.
• Computed tomography urography on postoperative days 1, 15, 30 and 40 was used to access renal drainage.
• On postoperative day 40, all animals were killed and both kidneys from each animal were harvested for histological evaluation.

• Evidence of risk for drainage occlusion after sealant application was found.
• The use of haemostatic sealants was associated with significant histological lesions in the renal parenchyma, regardless of which sealant was used.
• No sealant was identified as superior to the others.
• Nephrostomy tracts that were left without sealant application (control group) were associated with no morbidity and fewer histopathological changes.

• Based on these experimental results, the safety of the application of haemostatic sealants in tubeless PCNL should be reassessed, focusing not only on the potential of such materials to occlude urinary drainage but also on their effect on renal histology.
• Further investigation is considered necessary.

• To assess the feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma.

• Nine patients were treated by a pure laparoscopic approach for local recurrence of a renal tumour between 2005 and 2011 by a single surgeon (HB), following an initial open radical nephrectomy for the primary tumour.
• Clinical and histopathological data were collected prospectively and analysed retrospectively.
• Seven patients were treated by a transperitoneal approach and two patients had a retroperitoneal approach.

• Relapse occurred within a mean time of 83 months (7–168) following nephrectomy. Recurrent tumour size varied from 2.5 to 4.5 cm. All surgeries were performed laparoscopically without need for conversion.
• Mean operative duration was 144 min (40–240), mean estimated blood loss was 430 mL (50–1300) and mean hospital stay was 4.5 days (3–6). Three patients had Clavien grade I intraoperative complications. Late complications were noted in two patients (Clavien I and IIIb).
• Pathology confirmed clear cell carcinoma in all patients with an absence of sarcomatoid features and negative surgical margins.
• Three patients had neoadjuvant treatment and two patients had adjuvant treatment. In all, 67% of patients were disease free with a mean follow-up period of 3 years.

• Surgical removal of isolated local recurrence remains the only possibility of cure in patients with renal cell carcinoma.
• We demonstrated that the laparoscopic approach is a safe and feasible alternative treatment option for selected cases with low morbidity and satisfactory oncological outcomes.

• To assess the efficacy and tolerability of everolimus in advanced urothelial carcimoma (UC).

• The present study comprised a single-arm, non-randomized study in which all patients received everolimus 10 mg orally once daily continuously (one cycle = 4 weeks).
• In total, 45 patients with metastatic UC progressing after one to four cytotoxic agents were enrolled between February 2009 and November 2010 at the Memorial Sloan-Kettering Cancer Center.
• The primary endpoints were 2-month progression-free survival (PFS) and the safety of everolimus, with the secondary endpoint being the response rate.
• A Simon minimax two-stage design tested the null hypothesis that the true two month PFS rate was ≤50%, as opposed to the alternative hypothesis of ≥70%.

• The most common grade 3/4 toxicities were fatigue, infection, anaemia, lymphopaenia, hyperglycaemia and hypophosphataemia.
• There were two partial responses in nodal metastases, with one patient achieving a 94% decrease in target lesions and remaining on drug at 26 months.
• An additional 12 patients exhibited minor tumour regression.
• There were 23 of 45 (51%) patients who were progression-free at 2 months with a median (95% CI) PFS of 2.6 (1.8–3.5) months and a median (95% CI) overall survival of 8.3 (5.5–12.1) months.
• No clear association was observed between mammalian target of rapamycin pathway marker expression and 2-month PFS.

• Although everolimus did not meet its primary endpoint, one partial response, one near-complete response and twelve minor regressions were observed.
• Everolimus possesses meaningful anti-tumour activity in a subset of patients with advanced UC.
• Studies aiming to define the genetic basis of everolimus activity in individual responders are ongoing.

• To report long-term outcomes of men ≤60 years treated with brachytherapy (BT) for low- and intermediate-risk prostate cancer.

• Of 1655 patients treated with BT for clinically localized prostate cancer between January 1998 and May 2008 at Memorial Sloan-Kettering Cancer Center, 236 patients with National Comprehensive Cancer Network low- (n = 178) or intermediate-risk (n = 58) prostate cancer were ≤60 years old with a 3-year minimum follow-up, and represent the subjects of this report.
• Brachytherapy was given either as monotherapy (n = 169) or with external beam radiation therapy (EBRT; n = 67). Forty-four patients (19%) received neoadjuvant cytoreductive hormone therapy. The ‘nadir+2’ definition was used for prostate-specific antigen (PSA) recurrence.
• Common Terminology Criteria for Acute Events (CTCAE) v 3.0 was used to grade genitourinary (GU) and gastrointestinal (GI) toxicity. Potency was defined as the ability to obtain an erection suitable for intercourse or an International Index of Erectile Function score ≥ 22.
• The Kaplan–Meier method and Cox regression were used for statistical analysis. The median follow-up was 83 months.

• The 8-year PSA relapse-free survival (RFS), cancer-specific and overall survival rates for the entire cohort were 96, 99 and 96%, respectively.
• For patients with low-risk disease, the 8-year PSA RFS rate was 97% and for intermediate-risk patients it was 94% (P = 0.34).
• There was no difference in PSA RFS between BT alone and combined therapy (P = 0.17). Late grade ≥ 2 GU and GI toxicity was 14 and 3%, respectively.
• Of 150 patients potent before treatment, 76 (51%) were potent at last follow-up, with 50/76 (66%) using no medication.
• There was no significant difference in post-treatment potency between BT alone and BT with EBRT (P = 0.74).

• Brachytherapy provides patients aged ≤ 60 years with low- and intermediate-risk prostate cancer with excellent outcomes and has a low risk of significant long-term GU or GI morbidity.
• Erectile function is preserved in >50% of patients and the majority do not require erectile dysfunction medication.

• Our analysis included 205 patients on active surveillance, each of whom had had at least two surveillance biopsies.
• We used the Cox proportional hazard regression model to analyse the association between different risk factors and progression-free survival over successive biopsies. This multivariate model was then used to develop a nomogram.
• Discrimination and calibration of the nomogram were internally validated using 200 bootstrap resamplings.

• The median follow-up of patients free of progression was 4.6 years. A total of 58 (28%) patients experienced progression.
• Factors significantly associated with progression were: overall number of positive cores in the diagnostic and first surveillance biopsies, race and prostate-specific antigen density.
• The bootstrapping concordance index of the nomogram including these variables was 81%.
• The nomogram tended to underestimate the probability of progression but it identified fairly accurately the distinct groups of patients at low, intermediate and high risk of progression.

• In the development cohort, the nomogram was able to separate patients with respect to their risk of biopsy progression.
• Since accurate risk stratification is essential to optimize patient care, this tool, if external validation confirms its performance, may prove useful for both the counselling and management of patients with low-volume, Gleason 6 prostate cancer.

• Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 1995 to 2007 was used to identify 577 men with LN metastases discovered during RP and absence of distant metastases, of which 177 underwent ART ≤1 year of RP.
• Propensity score models were used to compare overall mortality and prostate cancer-specific mortality (PCSM) for men that did and those that did not receive ART.

• Men in both groups received adjuvant androgen-deprivation therapy at similar rates after propensity weighting adjustments (33.6% vs 33.7%, P = 0.977).
• ART was not associated with differences in overall (5.09 vs 3.77 events per 100 person-years, P = 0.153) or PCSM (2.89 vs 1.31, P = 0.090) relative to men who did not receive ART.

• ART after RP in men with LN-positive prostate cancer was not associated with improved overall or disease-specific survival, in contrast to previous single-centre studies.
• Prospective randomised studies are needed to assess the effectiveness of ART in this patient population.

• Bacillus Calmette-Guérin (BCG) immunotherapy is currently the most effective treatment of non-muscle invasive bladder cancer and one of the most successful applications of immunotherapy to the treatment of cancer.
• This review summarises the history and development of BCG as a modern cancer treatment, appraises current optimal application of BCG immunotherapy in bladder cancer, discusses promising new therapies closely related to BCG, and briefly explores the possibility that BCG or related treatments may have an application in other urological malignancies.
• BCG is a nonspecific stimulant to the reticuloendothelial system and induces a local inflammatory response with the infiltration of granulocytes followed by macrophages and lymphocytes, particularly helper T cells.
• The initial BCG controlled trial showed a statistically significant reduction in tumour recurrence and found the advantage increased with duration of follow-up. Similar results were reported in much higher risk patients in an independent concurrent study. Follow-up suggested that a single 6-week course of intravesical BCG provided long-term protection (up to 10 years) from tumour recurrence and even reduced disease progression.
• While induction BCG (six weekly instillations) reduced recurrence, progression and mortality at 10 years, this advantage was lost by 15 years, and patients remained at high risk for progression without the use of maintenance BCG.
• In a meta-analysis by the Cochrane group, induction BCG was found to be markedly superior to mitomycin C in high-risk patients but not in low-risk patients. Additionally, the National Comprehensive Cancer Network guidelines lists the use of intravesical BCG as preferred therapy, citing Category 1 data for high-grade Ta, all T1, and any Tis tumours.
• Maintenance BCG therapy may be the most important advance in BCG treatment of bladder cancer since the initial introduction. The risk of tumour recurrence and disease progression is life-long in most patients, but the immune stimulation induced by BCG wanes with time.
• Logarithmic dose reduction of BCG in patients with increasing side-effects will typically prevent escalation of toxicity.
• Simple dose reduction, appropriate antibiotics, and understanding treatment contraindications have greatly increased the safety of BCG. The 3-week maintenance schedule for 3 years has been evaluated in randomised clinical trials and appears to be the current optimal treatment.
• With the success achieved in bladder cancer and the relative safety and economy of BCG, consideration should be given to further research for its effectiveness in other genitourinary malignancies.

• Twelve female Yorkshire pigs had bilateral cutaneous ureterostomies placed laparoscopically with identical duration of pneumoperitoneum for all cases.
• An experimental group (n = 9) underwent induced unilateral renal ischaemia with left hilar clamping of timed duration (15, 30, 60 min) and a control group (n = 3) had no induced renal ischaemia.
• Urine was collected and analysed from each RU to assess creatinine and NGAL concentration preoperatively and at multiple postoperative time points. Serum was collected and analysed daily for creatinine and NGAL levels.
• Statistical comparisons were made using the rank-sum and sign-rank tests.

• Three pigs were excluded because of intra-operative and postoperative complications.
• In the RUs that experienced renal ischaemia (n = 7),the median urine volume was lower (P = 0.04) at 6, 12, 24 and 48 h and the median NGAL concentration was higher (P = 0.04) at 12 and 48 h compared with the RUs of control pigs that experienced no renal ischaemia (n = 2).
• When comparing the ischaemic (left) RU of the pigs in the experimental group with their contralateral non-ischaemic (right) RU, ischaemic RUs had a lower median cumulative urine volume at 6, 12, 24 and 48 h (P = 0.05) and a higher median NGAL concentration at 12, 24 and 48 h (P < 0.05).
• At 48 h, no significant increase was found in serum NGAL in pigs in the experimental group compared with controls (P = 0.2).
• Creatinine clearance (CC) was lower in ischaemic RUs compared with non-ischaemic RUs 1 day after surgery (P = 0.04) with decreasing CC as the duration of ischaemia increased.

• We have developed a promising novel small-scale pilot surgical model that allowed the evaluation of bilateral RU function separately during and after unilateral renal ischaemia.
• The induction of unilateral renal ischaemia corresponds with physiological changes in both the ischaemic and contralateral RU.
• AKI as measured by increases in NGAL and decreased renal function as measured by decreases in CC, are specific to the RU exposed to ischaemia.

• We retrospectively analysed and compared the morbidity, and the peri-operative and functional outcomes of patients aged 50–59, 60–69, 70–79 and ≥80 years. Complications at 30 days were stratified using the Clavien system.
• Functional outcomes were assessed using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max), post-void residual urine volume (PVR) and urinary continence.

• A total of 311 patients underwent HoLEP for obstructive voiding symptoms from August 2007 to June 2011, of whom 22 patients were aged 50–59 years, 91 were aged 60–69 years, 153 were aged 70–79 years, and 45 were aged ≥80 years.
• The overall morbidity rates were similar among the age groups (20, 24.4, 21.6 and 22.1% for groups 1, 2, 3 and 4, respectively), as were the incidence of significant complications (Clavien grade ≥ III), change in serum haemoglobin level, and length of hospital stay.
• Patients ≥80 years did have a longer catheterization time (3.4 days) than patients aged 50–59 years (1.68 days).
• By 1 year there were no significant differences in urinary continence, IPSS, Q_max, or PVR among the age groups.

• Overall morbidity, hospital stay, and 1-year functional outcomes of HoLEP were similar among all age groups.
• This study shows that HoLEP is a safe and effective treatment for benign prostatic hyperplasia regardless of age.

• Peripheral blood from 77 patients with RCC and 40 healthy controls was evaluated by flow cytometry using monoclonal antibodies against CD4, CD25, FoxP3, CD45RA, CD45RO, CD152, CD184, CD279, CD3, CD16, CD56, CD161, CD158a, CD4, CD26, CD30, CD183 and CD184.
• A concomitant evaluation of 38 molecules was conducted in patients’ serum using a multiplex biometric ELISA-based immunoassay.

• The number of NK cells CD3⁻/CD16⁺, CD3⁻/CD16⁺/CD161⁺ (NK) and CD3⁻/CD16⁺/CD161⁺/CD158a⁺ (NK- Kir 2+) was greater in the patients with RCC (P < 0.05); and the number of Treg cells CD4⁺/CD25^high+/FOXP3⁺ and the subset CD4⁺/CD25^high+/FOXP3⁺/CD45RA⁺ (naïve) and CD45R0⁺(memory) cells, were greater in the patients with RCC (P < 0.001).
• An increase in the following was observed in the serum of patients with RCC compared with healthy controls: interleukin (IL)-4, IL-6, IL-8, IL-10, G-CSF, CXCL10, CXCL11, hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF). According to Ingenuity Pathway Analysis (IPA), CXCL10, IL-6, IL-8, epidermal growth factor (EGF), HGF and VEGF were associated with a network that controls cellular movement, tissue development and cellular growth.
• Kaplan–Meier analysis for disease-free survival showed that high numbers of CD4⁺/CD25^high+/FOXP3⁺/CD45RA⁺ (Treg naïve) and low numbers of CD3⁻/CD16⁺/CD161⁺/CD158a⁺ (NK-Kir+) cells predict short disease-free survival in patients with RCC.

• Concomitant evaluation of Treg (CD4⁺/CD25^high+/FOXP3⁺ and CD4⁺/CD25^high+/FOXP3⁺/CD45RA⁺) and of six soluble factors (IL-6, IL-8 ,VEGF, CXCL10, CXCL11, EGF, HGF) might be a surrogate marker of host immunity in patients with RCC.

• In all, 403 consecutive patients with clinically localised (T1–3N0M0) ccRCC treated by radical or partial nephrectomy were enrolled.
• Preoperative serum levels of hs-CRP were evaluated as both a continuous and categorical variables.
• Associations with clinical (age, gender) and pathological variables (T classification, grade, tumour necrosis) were assessed with the chi-square and Kruskal–Wallis tests.
• Univariable and multivariable Cox proportional hazards models were fitted. The prognostic accuracy (PA) was assessed with Harrell's C-index.

• The mean hs-CRP level was 1.32 mg/dL. The hs-CRP levels were associated with T classification (P = 0.05), high-grade disease (P < 0.001) and tumour necrosis (P = 0.003).
• After a median follow-up of 43 months, 41 patients (10.1%) had developed disease recurrence. With each unit increase in hs-CRP levels, the risk of recurrence increased by 10% (hazard ratio 1.10, P = 0.015).
• The thresholds of 0.5 and 0.75 mg/dL showed the best discrimination for stratification of patients according to the probability of recurrence.
• These categorically coded hs-CRP levels were identified as independent prognostic factors in multivariable analyses (P < 0.001) and led to a significant increase in the PA of a multivariable base model containing the variables of the ‘Stage, Size, Grade and Necrosis’ (SSIGN) score.

• This study validates preoperative serum hs-CRP levels as independent prognostic factor after surgery for localised ccRCC.
• Hs-CRP may be included in standard prognostic modelling after surgery and may guide surveillance and inclusion in adjuvant clinical trials.

• Observational study of 6489 men with localised prostate cancer treated with RP at six different hospitals in Denmark between 1995 and 2011.
• Survival was described using Kaplan–Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files.
• Cumulative incidence of death, any cause and prostate cancer-specific, was described using Nelson–Aalen estimates.
• Risk for prostate cancer death was analysed in a Cox multivariate regression model using the covariates: age, cT-category, PSA level and biopsy Gleason score.

• The median follow-up was 4 years. During follow-up, 328 patients died, 109 (33.2%) from prostate cancer and 219 (66.8%) from other causes. Six patients (0.09%) died ≤30 days of RP.
• In multivariate analysis, cT-category was a predictor of prostate cancer death (P < 0.001). Compared with T1 disease, both cT2c (hazard ratio [HR] 2.2) and cT3 (HR 7.2) significantly increased the risk of prostate cancer death. For every doubling of PSA level the risk of prostate cancer death was increased by 34.8% (P < 0.001). Biopsy Gleason score 4 + 3 and ≥8 were associated with an increased risk of prostate cancer death compared with biopsy Gleason score ≤ 6 of 2.3 and 2.7 (P = 0.003), respectively.
• The cumulative hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2–17.7) and 6.6% (95% CI 4.9–8.2) respectively.

• We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer.
• The main limitation of the study was the relatively short follow-up.
• Interestingly, our national results are comparable to high-volume, single institution, single surgeon series.

• SRP was performed on 206 men with BCR after RT at a tertiary care institution between 1998 and 2011. Post-RT biopsy and SRP specimens were reviewed by a genitourinary pathologist.

• SVI was detected in 65 (32%) of 206 patients. No difference was found between EBRT alone (65% vs 63%) and BT (29% vs 31%) with or without EBRT in patients with SVI. Men with SVI had higher rates of cT3 disease (20% vs 8%) and Gleason score ≥ 8 at SRP (52% vs 21%).
• BCR-free survival at 5 years was 18% and 56% in patients with and without SVI (hazard ratio 2.85, 95% confidence interval 1.87–4.36, P < 0.001), yet the rate of local recurrence was low (11%).
• Prostate cancer was identified in nine of 18 patients who underwent SV biopsy and was the only location of prostate cancer in two patients.

• SVI is a prognostic indicator for BCR after SRP, but local recurrence in patients with SVI after SRP remains low.
• We recommend SV biopsy to improve staging and cancer detection in men with BCR after radiotherapy.

• Urological and renal functional outcomes of TURP performed in RT recipients for treatment of lower urinary tract obstruction attributable to BPH were prospectively assessed in a series of 32 consecutive patients with follow-up of ≥48 months.
• Maximum urinary flow rate (Q_max) at uroflowmetry, International Prostate Symptom Score (IPSS), post-void residual urine volume (PVR), haemoglobin and serum creatinine (sCr) levels were recorded before TURP and 1, 6, 24 and 48 months after the procedure. The trends in these variables after TURP were evaluated.
• Early and delayed complications were assessed and graded according to the Clavien classification system.

• TURP was performed at a mean of 6 months after RT.
• No intraoperative complications occurred. Seven postoperative complications were observed (21.9%): two Clavien grade II and five Clavien grade IIIa.
• Q_max, IPSS and PVR improved significantly after surgery and the improvement was maintained until 48 months. No patient required a repeat TURP during follow-up.
• SCr levels significantly decreased 1 and 6 months after TURP and did not significantly increase at long-term follow-up.

• TURP for lower urinary tract obstruction attributable to BPH in RT recipients is safe and effective since it improves urinary flow, bladder emptying and related urinary symptoms.
• TURP allows an early significant improvement of graft function that is maintained at a follow-up of 48 months.

• To evaluate the feasibility and safety of the novel prototype sewing device EndoSew^® in placing an extracorporeal resorbable running suture for ileal conduits.

• We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew^® running suture.
• The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew^® only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14.
• Secondary endpoints were the time requirements and complications ≤30 days after surgery.

• A complete EndoSew^® running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure.
• In three patients, two additional single freehand stitches were needed to anchor the thread and to seal tiny leaks. Consequently, all suture lines in 6/10 patients were watertight with EndoSew^® suturing alone and in 10/10 patients after additional freehand stitches.
• The median (range) sewing time was 5.5 (3–10) min and the median (range) suture length was 4.5 (2–5.5) cm.
• There were no suture-related complications.

• The EndoSew^® procedure is both feasible and safe.
• After additional freehand stitches in four patients all sutures were watertight.
• With further technical refinements, EndoSew^® has the potential to facilitate the intracorporeal construction of urinary diversions.

• To assess the consistency of reporting on positive surgical margins (PSMs) and associated prognostic variables after radical prostatectomy (RP) in the current literature
• To provide a standardized methodology for quantifying the characteristics and the prognostic impact of PSMs after RP.

• We conducted a review of articles that assessed the prognostic value of characteristics of PSMs after RP. The articles were identified using a MEDLINE search.
• The methodology and quality of the reporting of PSMs were analysed according to six criteria defined according to the guidelines of the College of American Pathologists and the International Society of Uropathologists.
• Forty-four studies, involving ≥100 patients and published from January 2005 to the present, were reviewed.

• Each of the 44 studies was assessed for their reporting of the six defined PSM criteria, as well as for the significance of PSM characteristics on biochemical recurrence (BCR).
• The definition of a PSM was the only criterion that was consistently reported.
• All studies were deficient in defining and reporting one or more of the PSM criteria. Major inconsistencies were observed in the reporting of PSM site and length, and the presence of intraprostatic incision.
• The many conflicting reports gave little insight into the true significance of particular PSM-associated variables on BCR.

• There is a lack of consistency in the reporting on and prognostic significance of PSMs and PSM-associated prognostic variables.
• We hypothesize that these conflicting results are partly attributable to a lack of use of a standardized reporting methodology for PSMs. Implementation of a previously reported standardized scoring system for PSMs may help eliminate these inconsistencies in the future.

• SRP was performed between 1998 and 2011 on 198 patients.
• All patients underwent a PRB. PRB and SRP specimens were evaluated by a genitourinary pathologist. Patients had external-beam RT alone (EBRT; 71%) or brachytherapy with or without EBRT (29%).

• Of the men undergoing SRP, 26 (14%) were clinical stage ≥T3, with 13% of PRBs with Gleason score ≥8.
• Cancer was unilateral in 120 (61%) biopsies, with contralateral or bilateral prostate cancer at SRP in 49%. In the SRP specimen, cancer was multifocal in 57%.
• Cancer was upgraded at SRP in 58% of men, with 20% having an increase in primary Gleason grade.
• The accuracy of PRB varied by region from 62% to 76%, with undetected cancers ranging from 12% to 26% and most likely to occur at the mid-gland.

• Radiation-recurrent prostate cancers were often multifocal, and biopsy missed up to 20% of tumours.
• More than half of the cancers were upgraded at SRP, and many that were unilateral on PRB were bilateral at SRP.

• The National Electronic Injury Surveillance System, a dataset validated to provide a probability sample of patients who present to emergency departments (EDs) in the USA with injuries, was analysed to characterize zip-related genital injuries occurring between 2002 and 2010.
• A total of 523 cases were analysed to obtain national estimates.

• Between 2002 and 2010, an estimated 17 616 patients presented to US EDs with trouser zip injuries to the genitals.
• The penis was almost always the only genital organ involved.
• Zip injuries represented nearly one-fifth of all penile injuries.
• Amongst adults, zips were the most frequent cause of penile injuries.
• Annual zip-related genital injury incidence remained stable over the study period.

• Zip-related genital injuries affect both paediatric and adult cohorts.
• Practitioners should be familiar with various zip-detachment strategies for these populations.

• We included 207 patients, who underwent treatment with botulinum toxin type A for non-neurogenic OAB from January 2009 to June 2012 at our institution, in a prospective database that recorded details of their presentation, treatment and outcomes.
• In December 2009, our institution switched from using onabotulinumtoxinA to using abobotulinumtoxinA.

• Results from the onabotulinumtoxinA cohort (n = 101) and the abobotulinumtoxinA cohort (n = 106) were compared.
• Similar reductions in daytime frequency, nocturia and incontinence episodes were observed after treatment, with no difference in duration of effect.
• The abobotulinumtoxinA cohort had almost twice the rate of symptomatic urinary retention (23 vs 42%) requiring intermittent self-catheterisation (ISC).

• AbobotulinumtoxinA use was complicated by a significantly higher risk of requiring ISC.
• The study suggests that these two toxins are not interchangeable at the doses used.

• Retrospectively analysed 109 whole-mounted and entirely submitted radical prostatectomy specimens with prostate cancer.
• All tumours in each prostate were outlined on whole-mount slides and digitally scanned to produce tumour maps. Tumour map images were exported to three-dimensional (3D) slicer software (http://www.slicer.org) to develop a 3D-prostate cancer model.
• In all, 20 transrectal biopsy schemes involving two to 40 cores and two to six anteriorly directed biopsy (ADBx) cores (including transition zone, TZ) were simulated, as well as models with various biopsy cutting lengths.
• Detection rates for tumours of different volumes were determined for the various biopsy simulation schemes.

• In 109 prostates, 800 tumours were detected, 90 with a TV of ≥0.5 mL (mean TV 0.24 mL).
• Detection rate for tumours with a TV of ≥0.5 mL plateaued at 77% (69/90) using a 12-core (3 × 4) scheme, standard 17-mm biopsy cutting length without ADBx cores. In all, 20 of 21 (95%) tumours with a TV of ≥0.5 mL not detected by this scheme originated in the anterior peripheral zone or TZ.
• Increasing the biopsy cutting length and depth/number of ADBx cores improved the detection rate for tumours with a TVof ≥0.5 mL in the 12-core scheme.
• Using a 22-mm cutting length and a 12-core scheme with additional volume-adjusted ADBx cores, 100% of ≥0.5 mL tumours in prostates ≤ 50 mL in volume and 94.7% of ≥0.5 mL tumours in prostates > 50 mL in volume were detected.

• Our 3D-prostate cancer model analysis suggests that nearly all prostate cancers with a TV of ≥0.5 mL can be detected by 14–18 transrectal needle-biopsy cores.
• Using longer biopsy cutting lengths and increasing the depth and number of ADBx cores (including TZ) according to prostate volume are necessary as well.

• Previous studies showed no survival benefit with respect to performing lymph node dissection (LND) at nephrectomy, whereas a recent population-based analysis suggested otherwise, although the latter relied on imputation. To reconcile the findings of that study by critically evaluating the handling of missing data.

• Study participants comprised patients diagnosed with non-metastatic renal cell carcinoma (RCC) of all stages who underwent LND at nephrectomy (n = 10 596).
• Multivariable Cox regression models were performed to predict cancer-specific mortality (CSM), where the primary variable of interest was the extent of LND.
• To examine differences in approaches with respect to handling missing data, separate analyses were performed: (i) imputed population; (ii) exclusion of patients with missing data; and (iii) inclusion of patients with missing data as a sub-category.

• Overall, 2916 (28%) patients had missing tumour grade.
• In multivariable analyses, our findings showed that increasing the extent of LND was associated with a significant protective effect on CSM in patients with pN1 after imputation (hazard ratio [HR], 0.82; P = 0.04).
• By contrast, the extent of LND was no longer significantly associated with a lower risk of CSM after excluding patients with a missing tumour grade (HR, 0.83; P = 0.1) or when including patients with missing tumour grade as a sub-category (HR, 0.82; P = 0.05).

• The findings of the present study failed to corroborate the association of a survival benefit with increasing extent of LND at nephrectomy.
• The different methodologies employed to account for missing data may introduce important biases.
• Such considerations are non-negligible with respect to the interpretation of results for investigators who rely on administrative cohorts.

• To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) using a true bipolar system, for the first time in an international multicentre double-blind randomized controlled trial focusing on the overall sexual function quantified with the International Index of Erectile Function Questionnaire (IIEF-15). Other baseline/perioperative parameters potentially influencing erectile function (EF) after TURP were secondarily investigated.

• From July 2006 to June 2009, consecutive TURP candidates with benign prostatic obstruction were prospectively recruited in four academic urological centres, randomized 1:1 into M-TURP/B-TURP arms and followed up at 6 weeks, 6 and 12 months after surgery. In all, 295 eligible patients were enrolled.
• Overall sexual function was quantified using self-administered IIEF-15 at baseline and at each subsequent visit.
• Total IIEF/domain scores were calculated and EF score classified erectile dysfunction severity. Differences in erectile dysfunction severity at each visit compared with baseline (EF evolution), classified patients into ‘improved’, ‘stable’ or ‘deteriorated’.
• Pre-postoperative IIEF/domain scores and differences in the distribution of EF evolution were compared between arms throughout follow-up.

• In all, 279 patients received the allocated intervention; 218/279 patients (78.1%) provided complete IIEF-15 data at baseline and were considered in sexual function analysis. Complete IIEF-15 data were available from 193/218 (88.5%), 186/218 (85.3%) and 179/218 (82.1%) patients at 6 weeks, 6 months and 12 months, respectively.
• Sexual function did not differ significantly between arms during follow-up (scores: IIEF, P = 0.750; EF, P = 0.636; orgasmic function, P = 0.868; sexual desire, P = 0.735; intercourse satisfaction, P = 0.917; overall satisfaction, P = 0.927).
• Resection type was not a predictor of any sexual function changes observed.
• Distribution of EF evolution did not differ between arms at any time (M-TURP vs B-TURP at 12 months: improved, 23/87 [26.4%] vs 18/92 [19.6%]; stable, 53/87 [60.9%] vs 56/92 [60.8%]; deteriorated, 11/87 [12.7%] vs 18/92 [19.6%]; P = 0.323).

• There were no differences between M-TURP/B-TURP in any aspect of sexual function.

• A systematic review of the literature was performed to identify studies comparing LPN and RPN.
• Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected.
• Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected.
• A meta-analysis using random effect model was performed.
• A further Bland–Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques.

• Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN).
• There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] –12.01 to 104.26).
• Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI –15.22 to 3.70).
• Also, LOS (P = 0.22, 95% CI –0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI –0.05 to 0.06).

• Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient.
• Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.

• To present a comparative analysis of peri-operative outcomes for >200 cases of conventional laparoscopic donor nephrectomy (LDN) and laparoendoscopic single site donor nephrectomy (LESS-DN).

• From 2006 to 2011, 213 donor nephrectomies were performed by two surgeons (R.E.L and W.A.M.) at a tertiary transplant centre. The approach changed from conventional LDN to LESS-DN over the course of the series.
• The two approaches were compared retrospectively and evaluated for differences in peri-operative outcomes.
• Statistical significance was assessed using Student's t-test and chi-squared analysis.

• A total of 111 patients underwent LDN and 102 patients underwent LESS-DN.
• Total operating time was significantly longer in the LESS-DN group (206.1 vs 181.9 min, P < 0.001), but LESS-DN resulted in less intra-operative blood loss (61.5 mL vs 85.9 mL, P < 0.001) and shorter warm ischaemia times (4.4 vs 5.0 min, P = 0.01).
• There were no significant differences in analgesic requirements, subjective pain scores, length of hospital stay, postoperative graft function, or donor's postoperative glomerular filtration rate between the two approaches.
• Complication rates were low regardless of the approach, and there were no major complications (>grade II) in the LESS-DN group.

• In experienced hands, LESS-DN results in peri-operative outcomes similar to those of conventional LDN without compromising donor safety, while providing a desirable cosmetic result.
• For surgeons familiar with LDN, transitioning to the LESS approach using this technique appears to have a relatively short learning curve.

• All patients with a primary or secondary diagnosis of kidney or ureteric calculus between 1999 and 2009 in the US Nationwide Inpatient Sample were extracted and weighted.
• Temporal trend analyses were used to determine trends in gender, race and age presentation, as well as utilization rates of interventions.
• Temporal trends were quantified using the estimated annual percent change (EAPC) using least squares linear regression analysis.

• Overall, 2 109 455 patients were hospitalized with upper urinary tract calculi over the 11-year period. The majority of admissions were for ureteric calculi (63.4%).
• Admissions for renal calculus increased by 12.1% during the study period (EAPC + 0.92%, P = 0.039, 95% CI: 0.17–1.66), whilst discharges for ureteric calculus remained stable.
• A significant increase (25.4%) in hospitalizations for women was found (EAPC + 2.21%, P < 0.001, 95% CI: 1.40–3.03); by 2006, more women than men were admitted to hospital (95 953 vs. 94 556, respectively).
• There were significant increases in hospitalization for black, Hispanic and older patients.
• Significant changes in the use of all studied interventions were found except for ureteroscopy, extracorporeal shockwave lithotripsy and nephrectomy.

• In this nationally representative sample of inpatient discharges, significant increases were found in admissions for renal compared with ureteric calculi, and for black, Hispanic and older patients.
• With regard to surgical intervention, the largest increase was found in the use of procedures for kidney calculi.
• Women now comprise the majority in the inpatient management of stone disease.

• To evaluate whether older age in men with low-risk prostate cancer increases the risk of prostate cancer-specific mortality (PCSM) when non-curative approaches are selected as initial management.

• The study cohort consisted of 27 969 men, with a median age of 67 years, with prostate-specific antigen (PSA)-detected, low-risk prostate cancer (clinical category T1c, Gleason score ≤6, and PSA ≤10) identified by the Surveillance, Epidemiology and End Results programme between 2004 and 2007.
• Fine and Gray's competing risk regression analysis was used to evaluate whether management with non-curative vs curative therapy was associated with an increased risk of PCSM after adjusting for PSA level, age at diagnosis and year of diagnosis.

• After a median follow-up of 2.75 years, 1121 men died, 60 (5.4%) from prostate cancer.
• Both older age (adjusted hazard ratio [AHR] 1.05; 95% confidence interval (CI) 1.02–1.08; P < 0.001) and non-curative treatment (AHR 3.34; 95% CI 1.97–5.67; P < 0.001) were significantly associated with an increased risk of PCSM.
• Men > the median age experienced increased estimates of PCSM when treated with non-curative as opposed to curative intent (P < 0.001); this finding was not seen in men ≤ the median age (P = 0.17).

• Pending prospective validation, our study suggests that non-curative approaches for older men with ‘low-risk’ prostate cancer result in an increased risk of PCSM, suggesting the need for alternative approaches to exclude occult, high grade prostate cancer in these men.

• Robotic surgical skills were prospectively assessed in 49 participating surgeons who were classified as follows: ‘novice/trainee’: urology residents, previous experience <30 cases (n = 38) and ‘experts’: faculty surgeons, previous experience ≥30 cases (n = 11).
• Three standardized, validated training methods were used: (i) structured inanimate tasks; (ii) virtual reality exercises on the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA); and (iii) a standardized robotic surgical task in a live porcine model with performance graded by the Global Evaluative Assessment of Robotic Skills (GEARS) tool.
• A Kruskal–Wallis test was used to evaluate performance differences between novices and experts (construct validity).
• Spearman's correlation coefficient (ρ) was used to measure the association of performance across inanimate, simulation and in vivo methods (cross-method validity).

• Novice and expert surgeons had previously performed a median (range) of 0 (0–20) and 300 (30–2000) robotic cases, respectively (P < 0.001).
• Construct validity: experts consistently outperformed residents with all three methods (P < 0.001).
• Cross-method validity: overall performance of inanimate tasks significantly correlated with virtual reality robotic performance (ρ = −0.7, P < 0.001) and in vivo robotic performance based on GEARS (ρ = −0.8, P < 0.0001).
• Virtual reality performance and in vivo tissue performance were also found to be strongly correlated (ρ = 0.6, P < 0.001).

• We propose the novel concept of cross-method validity, which may provide a method of evaluating the relative value of various forms of skills education and assessment.
• We externally confirmed the construct validity of each featured training tool.

• We review the literature regarding existing explanations for the MRP and look to other systems of physiological regulation that might provide a model for the conceptualization of the MRP.

• Our approach differs from traditional explanations in that it emphasizes the possible roles of various peripheral, rather than central, feedback (afferent) systems that affect peripheral autonomic functioning and response.
• Yet our approach is consistent with other peripheral regulatory feedback systems controlling autonomic response related to such processes as heart rate, respiration, and gut motility.

• Although direct empirical research supporting our approach is lacking, sufficient evidence exists to support the idea that such processes are not only possible but likely with respect to the male refractory period. We suggest several lines of research that might provide empirical support for this approach.

• We extracted from our prostate cancer database all consecutive patients with a minimum follow-up of 5 years after RARP. Biochemical failure was defined as a confirmed PSA concentration of >0.2 ng/mL.
• All patients alive at the last follow-up were evaluated for functional outcomes using the Expanded Prostate Cancer Index Composite (EPIC) and Sexual Health Inventory for Men (SHIM) questionnaires.
• Oncological and functional outcomes were reported according to the SCP system. Specifically, patients were classified as using no pad (C0), using one pad for security (C1), and using ≥1 pad (C2) (not including the prior definition).
• Patients potent (SHIM score of >17) without any aids were classified as P0 category; patients potent (SHIM score of >17) with use of phosphodiesterase type 5 inhibitorsas P1; and patients with erectile dysfunction (SHIM score of <17) as P2 category. Patients who did not undergo a nerve-sparing technique, who were not potent preoperatively, who were not interested in erections, or who did not have sexual partners were classified as Px category.

• The 3-, 5- and 7-year biochemical recurrence-free survival rates were 96.3%; 89.6% and 88.3%, respectively.
• At follow-up, 146 (79.8%) were fully continent (C0), 20 (10.9%) still used a safety pad (C1) and 17 (9.3%) were incontinent using ≥1 pad (C2).
• Excluding Px patients, 52 patients (47.3%) were classified as P0; 41 patients (37.3%) were classified as P1 and 17 patients (15.5%) were P2.
• In patients preoperatively continent and potent, who received a nerve-sparing technique and did not require any adjuvant therapy, oncological and functional success was attained by 77 (80.2%) patients.
• In the subgroup of 67 patients not evaluable for potency recovery (Px), oncological and continence outcomes were attained in 46 patients (68.7%).

• Oncological and functional success was attained in a high percentage of patients who underwent RARP at ≥5 years follow-up.
• Interestingly, this study confirmed that excellent oncological and functional outcomes can be obtained in the ‘best’ category of patients, i.e. those preoperatively continent and potent and with tumour characteristics suitable for a nerve-sparing technique.

• To investigate the psychological needs of patients diagnosed with testicular cancer.

• We identified 1192 eligible men diagnosed with non-seminomatous testicular cancer, treated according to the bi-national cancer-care programmes SWENOTECA I–IV between 1981 and 2004.
• Using a study-specific questionnaire we asked the survivors if they had experienced some kind of crisis attributable to their cancer diagnosis. We also asked if they were and, if not, if they wish they had been offered information about crisis and stress reactions and professional counselling.

• We obtained information from 974/1192 (82%) testicular cancer survivors diagnosed at a mean of 11 years before follow-up.
• Sixty-three percent reported that they had experienced a crisis owing to their diagnosis. For most men (76%) the crisis was at its worst at the time of diagnosis and treatment.
• Between 1981 and 2004, 145 men (15%) reported that they received information about common stress and crisis reactions and 348 (36%) reported that they were offered counselling.
• Of the men not informed about stress and crisis reactions and not offered counselling, 353/514 (69%) and 251/403 (62%), respectively, wish they had been. The percentage who reported that they wish that they had been informed or offered counselling did not differ significantly depending on civil status, age at diagnosis or stage of disease.

• The vast majority of Swedish testicular cancer survivors reported that they experienced a crisis because of their cancer diagnosis.
• Moreover, regardless of stage of disease, most men reported a need for psychological support at the time of diagnosis and treatment that was not satisfactorily met by the healthcare provision.

• To assess the accuracy and generalizability of the pre- and postoperative Karakiewicz nomograms for predicting cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC).

• This retrospective study included 3231 patients from European and US centres, who were treated by radical or partial nephrectomy for RCC between 1992 and 2010.
• Prognostic scores for each patient were calculated and the primary endpoint was CSS.
• Discriminating ability was assessed by Harrell's c-index for censored data. The ‘validation by calibration’ method proposed by Van Houwelingen was used for checking the calibration of covariate effects. Calibration was graphically explored.

• Local and systemic symptoms were present in 23.2% and 9.1% of the patients, respectively.
• The median follow-up (FU) was 49 months. At the last FU, 408 cancer-related deaths were recorded, Kaplan–Meier estimates of CSS (with 95% confidence intervals [CIs]) at 5 and 10 years were 0.86 (0.84–0.87) and 0.77 (0.75–0.80), respectively.
• Both nomograms discriminated well. Stratified c-indices for CSS were 0.784 (95% CI 0.753–0.814) for the preoperative nomogram, and 0.842 (95% CI 0.816–0.867) for the postoperative one, with a significant difference between the two values (P < 0.001).
• The covariate-based predictions on our data for both nomograms were valid. The calibration plots showed no relevant departures from ideal predictions.

• The results suggest that the postoperative Karakiewicz nomogram discriminates substantially better than the preoperative one.
• These nomogram-based predictions may be used as benchmark data for pretreatment and postoperative decision-making in patients at various stages of RCC.

• To evaluate the diffusion of nephron-sparing modalities (NSM) for the treatment of renal neoplasms in the USA over the last decade and to identify the factors associated with renal procedure selection.

• The Nationwide Inpatient Sample was utlized to identify patients undergoing cryo/radiofrequency ablation (C/RFA), radical nephrectomy (RN) and partial nephrectomy (PN) from 1998 to 2008.
• Annual trends in procedure prevalence were determined.
• Multivariate analyses were performed to query the influence of age, race, sex and comorbid disease on surgery selection.

• We identified 443 853 procedures performed during the study period: 25 599 C/RFA, 79 568 PN and 338 687 RN.
• The prevalence per 100 000 hospital admissions in 1998 was 3.7 for C/RFA, nine for PN and 87.1 for RN. All procedures increased over the study period, by 1.05, 3.1 and 2.2/100 000 admissions per year, respectively (all P < 0.001).
• Diabetes, urban, teaching and large capacity hospitals were associated with NSM (either C/RFA or PN) compared to RN (all P ≤ 0.011). Age ≥70 years, female, hypertension, diabetes, chronic kidney disease (CKD) and region outside the Northeast favoured C/RFA over PN (all P ≤ 0.026).
• Compared to those without CKD, patients with CKD had an almost twofold higher probability of undergoing RN than NSM (odds ratio, 1.88; 95% confidence interval, 1.7–2.1). Despite increasing NSM utilization over the study period, most patients with CKD still received RN.

• Although the prevalence of NSM is increasing, RN is more common.
• The low utilization of NSM in patients with pre-existing CKD warrants further investigation.

• We used national databases to collect the data: incidence, stage and survival data from the National Cancer Data Repository (NCDR) and British Association of Urological Surgeons (BAUS) audit database; mortality data from the Office for National Statistics (ONS); and treatment method data from the Hospital Episodes Statistics (HES).

• The incidence of UTUC is increasing (from 1985 to 2009 it increased by 38% in men and 77% in women). It affects mainly those aged >60 years, and diagnoses are increasingly made in those aged >80 years. Diagnoses at advanced stage have increased from 45 to 80%.
• Mortality has risen faster than incidence; the overall 5-year survival rate has dropped from 60 to 48%. Survival is worst in stage IV disease and in patients aged ≥80 years; when analysed by age or stage group, survival rates are unchanged.
• Nephroureterectomy has increased by 75%, but endoscopic treatment, which only became available part way through the study period, now accounts for 11% of surgical interventions for UTUC, mainly in stage I disease and in the elderly.

• Despite sharing its risk factors with bladder cancer, current incidence and mortality trends for UTUC contrast with those in bladder cancer. Increasing use of cross-sectional imaging may explain some of the identified increased incidence. Higher incidence specifically in people >80 years, together with stage migration to more advanced cancers, are likely to have caused at least some of the observed increased mortality.
• Further study is required to answer the questions of whether there are other hitherto unidentified aetiological or prognostic factors; whether less aggressive treatment of UTUCs in the elderly is always justified; and whether the rising frequency of minimally invasive treatment means suboptimum oncological management.

• To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU).

• Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered.
• The main demographic data and perioperative outcomes were analysed.

• The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m², and of whom 29.7% had undergone previous abdominal/pelvic surgery.
• The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL.
• A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases.
• Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2).
• The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients.
• At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months.

• This study reports the largest multi-institutional experience of LESS-NU to date.
• Peri-operative outcomes mirror those of published standard laparoscopy series.
• Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.

• To address the role of the androgen receptor (AR) on mRNA and protein levels in prepuces of boys with and without hypospadias.

• Data from 40 foreskin specimens of consecutive circumcised boys (20 with vs 20 without hypospadias) were enrolled in this prospective study. After surgery, samples were fixed in formaldehyde and frozen in liquid nitrogen. Total RNA was isolated from frozen tissue and transcribed to complementary DNA.
• The amount of AR mRNA was measured by quantitative real-time polymerase chain reaction and Western Blot and standardised, automated immunohistochemistry were used to assess AR protein levels.

• The mean age at time of surgery was 61.8 and 30.9 months in boys without and with hypospadias, respectively.
• There was penile, coronal and sine hypospadias in seven (35%), nine (45%), and four (20%) boys, respectively.
• AR mRNA was significantly elevated in the prepuces of boys with hypospadias compared with boys without hypospadias, at a mean (sd) of 28.33 (5.39) vs 15.31 (1.85) (P = 0.013).
• Furthermore, the amount of AR protein was higher in boys with, compared with boys without hypospadias, at a mean (sd) of 133.25 (6.17) vs 100 (4.45) (P = 0.014).

• Different AR mRNA expression and protein levels seem to be an indication of an AR signalling defect as a cause in boys with hypospadias.
• Decreased AR DNA binding and functional capability may result in a compensatory up-regulation of both AR mRNA and protein.
• Further studies are necessary to perform structural analysis of the AR and to corroborate these preliminary findings.

• To assess the prognostic variables predicting the risk of biochemical progression-free survival (bPFS) after salvage prostate whole-gland cryotherapy using the Phoenix definition of bPFS.

• A total of 132 patients underwent prostate whole-gland salvage cryotherapy with curative intent. No patient underwent neoadjuvant/adjuvant hormonal ablative therapy, and all had extended post-salvage prostate-specific antigen (PSA) follow-up data.
• Cox univariate and multivariate logistic regression analyses of potential predictors of bPFS were conducted.
• Kaplan–Meier analyses of bPFS was also performed.

• At a mean (range) follow-up of 4.3 (0.9–12.7) years, the median (range) post-cryotherapy nadir PSA achieved was 0.17 (0–33.9) ng/mL.
• On multivariate analysis, predictors of bPFS were nadir PSA post-cryotherapy and pre-salvage biopsy Gleason score (P < 0.001 and 0.009, respectively).
• Risk stratification groups (low, intermediate and high) were developed based on the presence of zero, one or two adverse risk factors, the risk factors being either a nadir PSA >2.5 ng/mL or biopsy Gleason score ≥7, with the Kaplan–Meier bPFS curves of these risk groups being significantly different (P = 0.02 and <0.001, respectively).

• Post-salvage nadir PSA and pre-salvage biopsy Gleason score are important predictors of outcome in this patient cohort.
• Low-, intermediate- and high-risk groups can be determined based on these variables and can define patients best suited for prostate cryotherapy.

• To analyse the expression of five bladder cancer-associated urinary proteins and investigate if expression is related to the malignant phenotype of the tumour.
• To explore the possible prognostic value of these proteins.

• Urine samples, 16 from patients with bladder cancer and 26 from controls, were used in Western Blotting experiments.
• Tissue microarrays with bladder tissue from 344 patients diagnosed with bladder cancer between 1984 and 2005 was used in immunohistochemistry experiments.
• The proteins apolipoprotein E (APOE), fibrinogen β chain precursor (FGB), leucine-rich α2-glycoprotein (LRG1), polymerase (RNA) I polypeptide E (POLR1E), α1-antitrypsin (SERPINA1) and topoisomerase 2A (TOP2A) were probed with antibodies validated by the Human Protein Atlas.

• Increased expressions of APOE, FGB and POLR1E were correlated with increased tumour stage (P < 0.001).
• Expression of SERPINA1 in Ta and T1 tumours was found to increase the risk of tumour progression (hazard ratio 2.57, 95% confidence interval 1.13–5.87; P = 0.025)

• All proteins previously detected in urine from patients with bladder cancer were also expressed in bladder cancer tissue.
• The expression of APOE, FGB and POLR1E increased with stage and they are potential diagnostic markers.
• SERPINA1 was identified as a prognostic marker candidate.

• In the open-label UK Study Assessing Flexible-dose Fesoterodine in Adults trial, patients aged ≥18 years with self-reported OAB symptoms for ≥3 months, a mean of at least eight micturitions per 24 h and three or more urgency episodes per 24 h on a 3-day bladder diary at baseline, and at least moderate bladder-related problems reported on the Patient Perception of Bladder Condition (PPBC) at baseline, were treated with fesoterodine for 12 weeks.
• All patients received fesoterodine 4 mg once daily for the first 4 weeks, at which time they could choose to increase the dose to 8 mg once daily, based on a discussion of treatment efficacy and tolerability with the investigator, or they could remain on fesoterodine 4 mg for the remaining 8 weeks.
• The 12-week treatment period was followed by a 4-week follow-up period of no fesoterodine treatment.
• Patients completed 3-day bladder diaries and the PPBC at baseline, week 4, end of treatment (week 12) and end of the follow-up period (week 16); the King's Health Questionnaire at baseline, end of treatment (week 12) and end of the follow-up period (week 16); and the Benefit, Satisfaction and Willingness to Continue questionnaire at week 12.

• After 12 weeks of fesoterodine treatment, patients had clinically meaningful improvements in bladder diary variables and King's Health Questionnaire domains; 79% (254/322) of patients reported an improvement on the PPBC.
• After 4 weeks of no treatment, most patients deteriorated back to week 4 levels or worse on all bladder diary and patient-reported outcomes.
• Patients who expressed a benefit from fesoterodine treatment, satisfaction with their treatment or a willingness to continue treatment showed greater improvement from baseline to week 12 and greater deterioration from week 12 to week 16 than patients who did not respond positively on the Benefit, Satisfaction and Willingness to Continue questionnaire.
• Both men and women showed a meaningful deterioration in bladder diary variables and patient-reported outcomes at week 16; baseline symptom severity, age and week 4 dose escalation status did not appear to affect outcome deterioration at week 16.

• At 4 weeks after fesoterodine was discontinued, patients showed an increase in the frequency of OAB symptoms, an increase in the severity of bladder-related problems and a reduction in health-related quality of life.
• Many patients with OAB who respond to antimuscarinics may require treatment for more than 12 weeks because symptoms recur as early as 4 weeks after the cessation of therapy.

• To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.

• We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007.
• The eGFR was calculated at baseline and at 3–6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations).

• The median (interquartile range) eGFR decreased by 18.2 (8–12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m², which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m², which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3–pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001).
• None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m² (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m² (P = 0.04) were associated with better overall survival in univariable analyses.

• In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU.
• Renal function did not affect cancer-specific outcomes after RNU.

• Retrospective study with a Dutch insurance company database (containing PSA test claims) and a large district hospital-laboratory database (containing PSA-test results).
• The difference in primary PSA-testing rate as well as follow-up testing before and after the ERSPC was tested using the chi-square test with statistical significance at P < 0.05.

• Decline in PSA tests 4 months after ERSPC publication, especially for men aged ≥60 years.
• Primary testing as well as follow-up testing decreased, both for PSA levels of <4 ng/mL as well as for PSA levels of 4–10 ng/mL.
• Follow-up testing after a PSA level result of >10 ng/mL moderately increased (P = 0.171).
• Referral to a urologist after a PSA level result of >4 ng/mL decreased slightly after the ERSPC publication (P = 0.044).

• After the ERSPC publication primary PSA testing as well as follow-up testing decreased.
• Follow-up testing seemed not to be adequate after an abnormal PSA result. The reasons for this remain unclear.

• A total of 864 consecutive patients, comprising 553 (64%) men and 311 (36%) women, from five international institutions underwent RNU without neoadjuvant chemotherapy.
• Smoking history included smoking status (current, former or never), quantity of cigarettes per day (CPD), smoking duration in years and years since smoking cessation. Cumulative smoking exposure was categorized as light short-term (≤19 CPD and ≤19.9 years), moderate (all combinations except light short-term and heavy long-term), and heavy long-term (≥20 CPD and ≥20 years).
• Uni- and multivariable competing risk regression models were used to assess the associations with outcomes.

• Overall, 244 (28.2%), 297 (34.4%) and 323 (37.4%) patients were never, former and current smokers, respectively.
• There were no differences in smoking status, quantity and duration between the genders.
• In female ever smokers, 30 (9.6%), 121 (38.9%) and 67 (21.5%) were light short-term, moderate and heavy long-term smokers, respectively. Compared with men, female current smokers were more likely to experience disease recurrence in univariable analysis (P = 0.013).
• In heavy long-term smokers, female gender was significantly associated with disease recurrence (hazard ratio [HR] 1.7; P = 0.03) and cancer-specific mortality (HR 2.0; P = 0.009) in multivariable analysis that adjusted for standard clinico-pathological features.
• In female patients only, smoking quantity, duration and cumulative exposure were associated with disease recurrence and cancer-specific mortality on multivariable analyses (P ≤ 0.025).

• The impact of smoking on UTUC outcomes after RNU is gender-specific.
• Females who are current and heavy long-term smokers experience worse outcomes than their male counterparts.
• Further research is needed to elucidate the molecular mechanisms underlying the gender-specific differential effect of smoking on UTUC outcomes.

• To identify the different factors that are associated with pain perceived during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx), with special focus on the role of transrectal probe configuration.

• We analysed prospective data on 1114 patients undergoing TRUS-guided PBx at our institute from January 2007 to August 2010.
• Patients completed questionnaires based on a 10-point visual analogue pain scale related to the consecutive steps of PBx: probe insertion, application of periprostatic nerve block (PPNB) and the obtaining of PBx cores.
• The variables of interest were age, prostate volume, DRE findings, number of previous biopsies, probe type and the number of retrieved cores.
• All variables were correlated to pain scores using multivariate regression analysis.

• At the probe insertion step, end-fire probes were more painful than side-fire probes.
• The Siemens G50^TM with metal, short plastic and long plastic needle guides (Siemens, Munich, Germany) had higher pain scores than the B&K probe (Bruel & Kjaer Medical, Copenhagen, Denmark; P = 0.09, 0.008 and 0.003, respectively).
• For pain at the PPNB application step, all G50^TM guide subtypes and the Sonoline Prima probe (Siemens) had higher pain scores than the B&K probe, but this only reached statistical significance for the G50^TM probe with short plastic guide (P = 0.03).
• On obtaining PBx cores, all G50^TM subtypes had higher pain scores when compared with the B&K probe (P = 0.59, 0.38 and 0.69, respectively).

• The probe design and needle guide affect pain during each step of TRUS-guided PBx.
• Both the B&K and Sonoline Prima probes caused less pain when compared with the G50^TM probe, regardless of needle guide.

• Between January 2008 and March 2012, 3041 patients underwent RARP at our institution by a single surgeon (V.P.).
• In all, 44 patients were considered morbidly obese with a body mass index (BMI) of ≥40 kg/m².
• A propensity score-matched analysis was conducted using multivariable analysis to identify comparable groups of patients with a BMI of ≥40 and <40 kg/m².
• Perioperative, pathological outcomes and complications were compared between the two matched groups.

• There was no significant difference in operative time. However, the mean estimated blood loss was higher in morbidly obese patients, at a mean (sd) of 113 (41) vs 130 (27) mL (P = 0.049).
• Anastomosis was more difficult in morbidly obese patients (P = 0.001).
• There were no significant differences in laterality, ease of nerve sparing, or transfusion rate between the groups.
• There were no intraoperative complications in either group. Postoperative pathological outcomes were similar between the groups.
• Differences in positive surgical margins and ease of nerve sparing approached statistical significance (P = 0.097, P = 0.075 respectively). Postoperative complication rates, pain scores, length of stay and indwelling catheter duration were similar in the groups.

• RARP in morbidly obese patients is technically demanding. However, it can be accomplished with acceptable morbidity and resource use.
• In the hands of an experienced surgeon, it is a safe procedure and offers beneficial clinical outcomes.

• Data were collected prospectively from 1478 patients newly diagnosed with UCB in the West Midlands from January 1991 to June 1992 (Cohort 1), and from 1168 patients newly diagnosed with UBC within the same region from December 2005 to April 2011 (Cohort 2).
• Gender, age, smoking history, and tumour grade, stage, type, multiplicity and size at presentation were compared using a Pearson chi-square test or Cochran–Armitage trend test, as appropriate.

• Cohort 2 had a higher proportion of male patients (P = 0.021), elderly patients (P < 0.001), grade 3 tumours (P < 0.001), Ta/T1 tumours (P = 0.008), multiple tumours (P < 0.001), and tumours of ≤2 cm in diameter (P < 0.001).

• There were significant differences between the cohorts.
• These differences are potentially explained by an ageing population, changes in grading practices, improved awareness of important symptoms, improved cystoscopic technology, and reductions in treatment delays.
• Regional cohorts remain important for identifying changes in tumour and patient characteristics that may influence disease management in the UK and beyond.

• We reviewed 451 patients with prostate cancer with a GS of 6 on biopsy, who underwent radical prostatectomy without neoadjuvant treatment.
• As a preoperative variable, we assessed the independent effect of prostate volume on GS upgrading.
• To evaluate the association between prostate volume and GS upgrading, we developed multivariate models with volumetric pathological variables, including postoperative tumour volume and percent tumour volume (tumour volume as a percentage of prostate volume).

• GS upgrading was observed in 194 patients (43.0%).
• As a preoperative variable, smaller prostate volume was an independent predictor of GS upgrading.
• In regression analysis, prostate volume and postoperative tumour volume were inversely correlated.
• On multivariate analysis including volumetric pathological variables, tumour volume was a strong independent factor influencing GS upgrading, and prostate volume lost statistical significance after adjusting for tumour volume.
• Percent tumour volume was inversely correlated with GS upgrading after adjusting for tumour volume.

• Smaller prostate volume was an independent predictor of GS upgrading as a preoperative variable.
• The inverse relationship between prostate volume and GS upgrading seems to be attributable to cancer biology, which was represented by tumour volume in our study. Percent tumour volume was also inversely associated with GS upgrading.
• These results suggest that biological factors and sampling error both play important roles in GS upgrading.

• To perform a comprehensive analysis of the outcomes and costs for treatments for small renal masses (SRM) using a population-based approach. Partial nephrectomy may be associated with improved survival, although level-one evidence has questioned this survival advantage.

• Using Surveillance, Epidemiology and End Results–Medicare data, we identified 1682 subjects who were diagnosed with SRM from 2005 to 2007.
• Treatment included open radical nephrectomy (ORN; n = 404), minimally-invasive radical nephrectomy (MIRN; n = 535), open partial nephrectomy (OPN; n = 330), minimally-invasive partial nephrectomy (MIPN; n = 160), ablation (n = 211) and surveillance (n = 42).
• Postoperative complications, renal insufficiency diagnosis, overall mortality, cancer-specific mortality and postoperative costs were compared.
• Covariates were balanced before outcomes analysis using propensity score methods.

• Although the use of nephron-sparing surgery (NSS) increased over the study period, radical nephrectomy remained the predominant approach for SRM in 2007.
• Minimally-invasive approaches had shorter lengths of stay (P < 0.001), whereas open approaches had more overall complications, respiratory complications and intensive care unit admissions (all P < 0.003).
• MIRN and ORN were associated with more peri-operative medical complications, acute renal failure, haemodialysis use and long-term chronic renal insufficiency diagnosis vs NSS (all P < 0.001).
• Ablation, MIRN and ORN were associated with the highest overall mortality rates (P < 0.001), whereas MIRN and ORN were associated with the highest cancer-specific mortality rates (P < 0.001).
• Treatment costs were lowest for surveillance ($2911) followed by ablation ($10 730), MIRN ($15 373), MIPN ($15 695), OPN ($16 986) and ORN ($17 803).

• Although not the predominant treatment approach for SRM over the study period, the use of NSS increased and was associated with improved survival, fewer complications and less renal insufficiency.
• Minimally-invasive approaches confer lower costs.

• To evaluate the likelihood of developing de novo erectile dysfunction (ED) after anterior urethroplasty and to determine if this likelihood is influenced by age, stricture length, number of previous procedures or timing of evaluation.

• PubMed, Embase, Cochrane, and Google Scholar databases were searched for the terms ‘urethroplasty’, ‘urethral obstruction’, ‘urethral stricture’, ‘sexual function’, ‘erection’, ‘erectile function’, ‘erectile dysfunction’, ‘impotence’ and ‘sexual dysfunction’.
• Two reviewers evaluated articles for inclusion based on predetermined criteria.

• In a meta-analysis of 36 studies with a total of 2323 patients, de novo ED was rare, with an incidence of 1%.
• In studies that assessed postoperative erectile function at more than one time point, ED was transient and resolved at between 6 and 12 months in 86% of cases.

• Men should be counselled regarding the possibility of transient or permanent de novo ED after anterior urethroplasty procedures.
• Increasing mean age was associated with an increased likelihood of de novo ED, but this was not statistically significant.

• Bladders of nine male guinea pigs were dissected and treated in wells containing 2 mL Krebs' solution and 1 μM of the specific PDE5 inhibitor vardenafil at 36 °C for 30 min.
• After stimulating tissues with 100 μM of the nitric oxide (NO) donor diethylamine-NONOate for 10 min, the tissues were snap-frozen and 9–10 μm sections were cut.
• Sections were examined for cGMP immunoreactivity and also stained for vimentin, a marker for interstitial cells and the neuromarkers protein gene product 9.5 (PGP9.5), synaptic vesicle protein 2 (SV2), neurofilament (NF) and calcitonin gene-related peptide (CGRP), using the two-step indirect immunohistochemistry technique.

• After PDE5 inhibition, cGMP was found to be present in the urothelium, suburothelial interstitial cells and endothelium of blood vessels.
• cGMP was not expressed in nerves positive for CGRP, NF and SV2, and was expressed only in very few efferent nerves positive for PGP9.5.

• Our data show that the possible sites of action of PDE5 inhibition in the bladder are the urothelium, suburothelial interstitial cells and blood vessels, rather than the bladder nerve fibres.

• In all, 82 patients undergoing LPN were randomly assigned to either the RIPC or control group, with 40 and 38 patients, respectively completing 6-months follow-up.
• RIPC was conducted after induction of anaesthesia, which consisted of three 5-min cycles of right lower limb ischaemia and 5 min of reperfusion during each cycle.
• The primary outcome was the absolute change in glomerular filtration rate (GFR) of the affected kidney by renal scintigraphy from baseline to 6 months.
• The secondary outcomes included urinary retinol-binding protein (RBP) levels measured at 24 and 48 h, serum creatinine, and estimated GFR (eGFR) at 1 and 6 months, and changes in GFR by renal scintigraphy.

• There were no differences in the change of GFR of the affected kidney at 6 months, while it was significantly decreased by 15.0% in the control group vs 8.8% in the RIPC group at 1 month (P = 0.034).
• The urinary RBP levels increased 8.4-fold at 24 h in the control group compared with a lower increase of 3.9-fold in the RIPC group (P < 0.001).
• There were no differences in the serum creatinine level or eGFR at 1 and 6 months between the two groups.

• In patients undergoing LPN, RIPC using transient lower limb ischaemia may reduce renal impairment in the short term, but failed in the longer term despite a non-significant trend in favour of RIPC.
• These novel data support the need for a larger study of RIPC during LPN surgery.

• To determine if there are differences between female patients complaining of symptoms of overactive bladder (OAB) with and without detrusor overactivity (DO).

• The present study was a cross-sectional study of consecutive women attending a one-stop urodynamic assessment clinic with OAB symptoms.
• The King's Health Questionnaire (KHQ) and a 3-day bladder diary incorporating the Patient's Perception of Intensity of Urgency Scale (PPIUS) were used to assess symptoms and health-related quality of life (HRQoL).
• The participants underwent multichannel urodynamics (UDS) according to the International Continence Society (ICS) recommendations.
• Patients whose symptom of urgency was not reproduced during the laboratory test underwent a 4-h ambulatory UDS test.

• Of the 556 patients who were included in the study, 43% were diagnosed with DO by either laboratory (227/556) or ambulatory UDS (11/39).
• There was no difference between the groups in age, body mass index (BMI), menopausal status or the presence of prolapse.
• Patients with DO had a smaller functional bladder capacity (P < 0.001), higher urgency episode frequency (P < 0.001) and larger maximum and mean urge ratings (P < 0.001).
• No significant differences were found in daytime or nocturnal micturitions between the groups.
• The presence of DO had a more negative impact on the quality of life, with a statistically significant difference between the groups in six of the domains of the KHQ.

• The present study detects objective and subjective differences between female patients with OAB with and without DO.
• Women with DO experience more significant impairment to their quality of life and have a greater degree of bladder dysfunction.

• To compare oncological outcomes in high-risk patients who underwent open retropubic radical prostatectomy (RRP) and robot-assisted RP (RARP) at a single institution. Despite equivalent oncological outcomes between open RRP and RARP, the use of RARP in men with high-risk tumours has been debated.

• A retrospective analysis of high-risk patients treated with open RRP or RARP at UCSF from 2002 to 2011 was conducted.
• The relationship between surgical approach and positive margin rate was assessed by multivariate logistic regression
• Cox proportional hazards regression assessed the effect of surgical approach on time to tumour recurrence.

• In all, 177 open RRP and 233 RARP patients made up the final cohort for analyses. The mean (SD) age was 61.6 (6.6) years and the median (range) follow-up was 27 (2–112) months.
• RARP patients had less blood loss (median 200 vs 400 mL, P < 0.01) and underwent complete bilateral nerve sparing more often (54% vs 34%, P < 0.01) than those undergoing open RRP.
• There were no differences by approach in pathological grade, stage, or positive margin rates. However, there was a trend towards higher positive margin rates with RARP early on.
• Recurrence-free survival was similar at 2 years (84% and 79%) and 4 years (68% and 66%) after open RRP and RARP, respectively (log-rank P = 0.53).

• This study is novel in that it assesses outcomes of open RRP vs RARP in a cohort of high-risk men at a single institution.
• RARP appears to be a feasible option for men with high-risk prostate cancer and displayed equivalent oncological outcomes compared with open RRP.

• In all, 102 urologists from Europe and North America participated in this retrospective on-line chart review, which was conducted between 1 April 2011 and 30 April 2012.
• Participants selected the charts of the first 10 intermediate- (defined as multiple or recurrent low-grade tumours) or high-risk (defined as any T1 and/or high-grade/G3 tumours and/or carcinoma in situ) patients who underwent transurethral resection of bladder tumour in 2009.
• Physicians retrospectively reviewed the charts and completed an on-line survey consisting of questions related to diagnosis, planned treatment, treatment status and follow-up.
• In all, 971 patients (197 intermediate-risk; 774 high-risk) were included in the analysis; frequency counts and associated percentages were used to analyse treatment variables.

• In all, 47% of intermediate-risk patients received EAU or AUA guideline-recommended intravesical therapy: intravesical chemotherapy, BCG induction therapy or BCG induction plus maintenance.
• Of the high-risk patients, 50% received maintenance BCG as recommended by the EAU and the AUA; although not recommended for high-risk NMIBC, 12.5% received intravesical chemotherapy.
• Of patients prescribed maintenance BCG, 93% were scheduled for at least 1 year of therapy.
• Notably, only 15% discontinued BCG maintenance and, of these discontinuations, 65% were due to reasons unrelated to BCG-associated adverse events.

• There is significant non-adherence to EAU and AUA guideline recommendations for BCG use in intermediate- and high-risk NMIBC.
• However, most of those patients prescribed BCG maintenance therapy are scheduled for at least 1 year of therapy, as recommended by current guidelines for NMIBC management, and BCG maintenance discontinuation is low.

• Demographic, clinical and pathological data on 13 consecutive patients with UTUC and documented MSH-2 mutation comprising 15 involved renal units were retrospectively collected.
• Ureteroscopic evaluations involved biopsy and laser treatment with combination holmium/neodymium yttrium aluminum garnet (YAG) lasers.
• Tumours were graded from 1 to 3 according to the 1973 World Health Organisation classification by a single pathologist evaluating cell block preparations.

• The mean patient age at initial presentation was 56.5 years, with six of 13 patients having metachronous bilateral UT disease.
• The mean follow-up was 59 months with a mean number of surveillances of 12.
• Of 15 affected renal units, 10/15 (67%) of initial tumours involved the ureter with mean lesion size of 17.5 mm, while five of 15 (33%) involved the intrarenal collecting system with mean lesion size of 25 mm.
• Ureteroscopy cleared 13/15 (87%) lesions and four of those 13 (31%) needed staged procedures. Renal preservation rate was 14/15 (93%) with one nephroureterectomy and one segmental ureterectomy performed.
• One patient developed metastatic UTUC after 40 months surveillance. No patient presented with bladder tumours but seven of the 13 (54%) developed them within 10 months of the initial ureteroscopy.

• Patients with LS who develop UTUC present at younger ages and appear to be more likely to have bilateral UT disease over their lifetimes vs sporadic UTUC patients.
• Ureteroscopic laser ablation offers a good renal preservation rate with reasonable cancer control in patients willing to undergo endoscopic surveillance.
• Development of new bladder tumours is common.

• To describe the contemporary trends in urinary diversion among patients undergoing radical cystectomy (RC) for bladder cancer; and elucidate whether socioeconomic disparities persist in the type of diversion performed in the USA from a population-based cohort.

• Using the Nationwide Inpatient Sample, we identified patients who underwent RC for bladder cancer between 2001 and 2008.
• Multivariable regression models were used to identify patient and hospital covariates associated with continent urinary diversion and enumerate predicted probabilities for statistically significant variables over time.

• Overall, 55 635 (92%) patients undergoing RC for bladder cancer received incontinent urinary diversion, while 4552 (8%) patients received continent diversion from 2001 to 2008.
• Receipt of continent urinary diversion increased from 6.6% in 2001–2002 to 9.4% in 2007–2008 (P < 0.001 for trend).
• Patients who were older (odds ratio [OR] 0.93; P < 0.001), female (OR 0.52; P < 0.001) and insured by Medicaid (OR 0.54; P = 0.002) were less likely to receive continent urinary diversion.
• However, patients treated at teaching (OR 2.14; P < 0.001) and high-volume hospitals (OR 2.39; P = 0.04) had higher odds of continent urinary diversion.
• Predicted probabilities of continent diversion remained lower for female patients, Medicaid insurance status, and non-teaching and medium/low-volume hospitals over time.

• In this nationally representative sample of hospitals from 2001 to 2008, the use of continent diversion in RC gradually increased.
• Although variations in urinary diversion exist by hospital teaching status, case volume, patient gender and primary health insurance, increased attention in expanding the use of continent diversions may help reduce these disparities for patients undergoing RC for bladder cancer.

• To compare reductions in nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men.

• Participants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of α-blocker therapy run-in and who had ≥1 nightly episode of nocturia.
• Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques).
• Seven-day bladder diaries were used to calculate reductions in mean nocturia.

• A total of 127 men aged 42–88 years with ≥1 nocturia episode per night were included in the study.
• There were 76 men who had a mean of ≥2 nocturia episodes.
• Among those with ≥1 nocturia episode, behavioural treatment reduced nightly nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01).
• Participants with ≥2 episodes nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008).

• Both behavioural treatment and drug therapy reduced nocturia in men with ≥1 episode of nocturia/night when added to α-blocker therapy.
• These results were similar even when only those with ≥2 episodes of nocturia were considered.
• The addition of behavioural treatment was statistically better than bladder-relaxant therapy for nocturia.

• To explore whether a panel of kallikrein markers in blood: total, free and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2, could be used as a non-invasive alternative for predicting prostate cancer on biopsy in a screening setting.

• The study cohort comprised previously unscreened men who underwent sextant biopsy owing to elevated PSA (≥3 ng/mL) in two different centres of the European Randomized Study of Screening for Prostate Cancer, Rotterdam (n = 2914) and Göteborg (n = 740).
• A statistical model, based on kallikrein markers, was compared with one based on established clinical factors for the prediction of biopsy outcome.

• The clinical tests were found to be no better than blood markers, with an area under the curve in favour of the blood measurements of 0.766 vs. 0.763 in Rotterdam and 0.809 vs. 0.774 in Göteborg.
• Adding digital rectal examination (DRE) or DRE plus transrectal ultrasonography (TRUS) volume to the markers improved discrimination, although the increases were small. Results were similar for predicting high-grade cancer.
• There was a strong correlation between the blood measurements and TRUS-estimated prostate volume (Spearman's correlation 0.60 in Rotterdam and 0.57 in Göteborg).

• In previously unscreened men, each with indication for biopsy, a statistical model based on kallikrein levels was similar to a clinical model in predicting prostate cancer in a screening setting, outside the day-to-day clinical practice.
• Whether a clinical approach can be replaced by laboratory analyses or used in combination with decision models (nomograms) is a clinical judgment that may vary from clinician to clinician depending on how they weigh the different advantages and disadvantages (harms, costs, time, invasiveness) of both approaches.

• Between October 1984 and March 2009 a cohort of 1019 patients (877 males; 142 females; median age 44 years) with histologically confirmed NMIBC was included in this study.
• Among these patients, 74% received bacillus Calmette-Guérin (BCG)-based therapy. Complete transurethral resection of bladder tumour of all visible tumours was carried out in all patients, and the stage and grade were determined.
• Univariate analysis and multivariate Cox regression were used to identify predictors of recurrence and progression. The studied predictors included age, sex, stage, grade, associated carcinoma in situ, tumour size, multiplicity, macroscopic appearance of the tumour, history of recurrence and type of adjuvant intravesical therapy.
• Multivariate logistic regression models were used to develop the 12- and 60-month recurrence and progression predictive models. The predictive accuracy of the models was assessed for discrimination as well as calibration.

• The median (range) follow-up was 44 (6–254) months.
• On multivariate analysis, stage, multiplicity, history of recurrence and adjuvant intravesical therapy were significantly associated with recurrence, whereas for progression only tumour grade and size were significant independent predictors.
• The constructed nomograms had a 64.9% and 69.4% chance of correctly distinguishing between two patients, one destined to have a recurrence and one not at 12 and 60 months, respectively.
• The constructed nomograms had a 70.2% and 73.5% chance of correctly distinguishing between two patients, one destined to progress and one not at 12 and 60 months, respectively. All predictive models were well calibrated.

• Based on multivariate analysis of the studied prognostic factors nomograms for predicting recurrence and progression in NMIBC were constructed.
• Most of the studied patients had received BCG-based therapy, making these models more closely applicable to contemporary practice than others.
• These predictive models have reasonable discriminative ability and are well calibrated, but require external validation before they can be applied to other populations.

• We identified 60 patients with a diagnosis of recurrent febrile UTI and post-transplantation vesico-ureteric reflux (VUR) who underwent open surgical correction of reflux.
• Patient characteristics, including the aetiology of end-stage renal disease, age, time to VUR correction, type of VUR correction, serum creatinine levels, and number of UTIs before and after correction were documented.

• The median (range) age of the patients was 31.5 (9–65) years. A total of 30 patients underwent uretero-ureterostomy or pyelo-ureterostomy and 30 underwent extravesical or intravesical ureteric reimplantation.
• The median (range) creatinine levels before and after correction were 1.5 (0.8–4.5) mg/dL and 1.3 (0.7–4.5) mg/dL (P < 0.05), respectively.
• The median (range) number of UTI episodes reported before the correction surgery was 4 (3–12), whereas number of UTI episodes after the surgery was 1 (0–12), the difference being significant (P < 0.05).

• Open surgical correction of post-transplant VUR is an effective and safe method of decreasing UTI episodes and stopping reflux.
• Surgical correction of reflux may prolong the life of the renal graft.

• Fifty men presenting to an ED clinic were tested with an Endo-PAT2000 machine (Itamar Medical, Caesarea, Israel), which assessed augmentation index (AI), a measure of arterial stiffness, and reactive hyperaemia index (RHI), a measure of endothelial vasodilatation.
• Penile haemodynamics were measured and used to identify both arterial insufficiency (abnormal peak systolic velocity [PSV]) and veno-occlusive disease (abnormal end diastolic velocity [EDV]) after pharmacological erection with prostaglandin E1 using colour flow Doppler.
• Between-group comparisons were carried out using a Wilcoxon rank-sum test for continuous variables and a chi-squared test for categorical variables. Simple and multivariable logistic regression analyses were used to analyse the correlation between outcome measures.

• Using Doppler analysis, 58% of patients were found to have arterial insufficiency (abnormal PSV) and 48% had veno-occlussive disease (abnormal EDV).
• Using the Endo-PAT machine, 44% of patients were found to have increased arterial stiffness (abnormal AI) and 54% had decreased endothelial relaxation (abnormal RHI).
• Neither AI nor RHI were correlated with PSV or EDV. The closest association was between high AI and low PSV, with a sensitivity of 0.55 and specificity of 0.71.

• In our patient cohort, PAT did not reliably predict the results of penile Doppler.
• The two tests appear to measure different although potentially complementary aspects of the local and systemic vasculature.

• A consecutive series of 60 men treated with TENS for refractory CPPS was evaluated prospectively at an academic tertiary referral centre.
• The effects of treatment were evaluated by a pain diary and by the quality of life item of the National Institutes of Health Chronic Prostatitis Symptom Index at baseline, after 12 weeks of TENS treatment, and at last known follow-up.
• Adverse events related to TENS were also assessed.

• The mean (95% confidence interval, CI; range) age of the 60 men was 46.9 (43.5–50.3; 21–82) years.
• TENS was successful after 12 weeks of treatment in 29 (48%) patients and a positive effect was sustained during a mean (95%, CI; range) follow-up of 43.6 (33.2–56; 6–88) months in 21 patients. After 12 weeks of TENS treatment, mean (95% CI) pain visual analogue scale decreased significantly (P < 0.001) from 6.6 (6.3–6.9) to 3.9 (3.2–4.6).
• Patients' quality of life changed significantly after TENS treatment (P < 0.001). Before TENS, all 60 patients felt mostly dissatisfied (n = 17; 28%), unhappy (n = 28; 47%) or terrible (n = 15; 25%). After 12 weeks of TENS treatment, 29 (48%) patients felt mostly satisfied (n = 5), pleased (n = 18) or delighted (n = 6).
• No adverse events related to TENS were noted.

• TENS may be an effective and safe treatment for refractory CPPS in men, warranting randomized, placebo-controlled trials.

• To evaluate the effects and underlying mechanisms of antimuscarinic agents used to decrease in urine production in water-loaded rats.

• Urine production was measured using a cystostomy catheter in female Sprague–Dawley rats every 2 h.
• The effect of the antimuscarinic agents atropine, tolterodine and imidafenacin on urine production was investigated under water-loaded conditions, which were induced by i.p. injection of 15 mL saline.
• Blood samples were collected to determine the levels of antidiuretic hormone (ADH), aldosterone (ALD), atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) before, and 2 and 8 h after, antimuscarinic agent administration.
• To induce desensitization of C-fibre afferent nerves, resiniferatoxin (RTX)was injected s.c. or intravesically 2 days before experiments.

• Urine production increased and reached its maximum 2 h after 15 mL saline injection.
• Imidafenacin and tolterodine decreased urine production in water-loaded rats, but ADH, ALD, ANP and BNP levels were not different between imidafenacin-treated and vehicle-treated rats.
• The inhibitory effect on urine production was not found in RTX-treated rats.
• Atropine did not reduce urine production.

• These results suggest that antimuscarinic agents decrease urine volume through C-fibres in the bladder; thus, antimuscarinics with inhibitory effects on C-fibres could be beneficial for nocturia with nocturnal polyuria.

• To investigate prostate-specific antigen (PSA) accuracy in detecting prostate cancer according to body mass index (BMI) in Asian men with a PSA level of <30 ng/mL using contemporary multicore (≥12) prostate biopsy.

• We reviewed the records of 3471 patients, whose initial PSA levels were <30 ng/mL, who underwent multicore (≥12) transrectal ultrasound-guided prostate biopsy between January 2004 and May 2011.
• BMI was categorised as performed previously for the Asian population: <23, 23–24.9, 25–29.9, and ≥30 kg/m². PSA accuracy for detecting prostate cancer in each BMI group was assessed based on the receiver operating characteristics-derived area under the curve.

• The mean age and median PSA level were inversely associated with BMI; the median PSA level in each BMI category was 7.84, 7.75, 7.33 and 5.79 ng/mL, respectively (P < 0.001).
• In all, prostate cancer was detected from biopsy in 1102 (31.7%) patients.
• The PSA accuracy for predicting prostate cancer in all patients was estimated to be 0.607, and PSA accuracies in each BMI category were 0.638, 0.572, 0.613 and 0.544, respectively; there was no significant difference among the groups in terms of PSA accuracy.

• The accuracy of PSA in predicting prostate cancer did not change regardless of BMI category in Asian men.
• However, as patients with higher BMIs had lower PSA levels than those with lower BMIs, it can therefore be suggested that the PSA threshold should be lower in obese men to discriminate between prostate cancer and benign conditions in the real clinical situation.

• Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS.
• Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/− USI were recommended 24-week antimuscarinic therapy.
• Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire – short form, the Patient Global Impression – Improvement and the Urinary Distress Inventory.
• Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of ‘much better’ or ‘very much better’ on the Patient Global Impression – Improvement.

• Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS.
• At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O.

• UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS.
• In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.

• In a prospective study, the prostate volume of men with SCI who underwent SDAF/SARS was measured using transrectal ultrasonography.
• The prostate volumes of these men were compared with those of men with complete SCI but who did not undergo SDAF/SARS, those of men with incomplete SCI, and those of a historical sample of able-bodied men.

• The median [25th;75th percentile] prostate volume of men who underwent SDAF/SARS (20.0 [14.0; 29.0]) and of men with complete SCI who did not undergo SDAF/SARS (20.0 [16.5; 29.0]) was significantly smaller than in the reference group (25.0 [5.0; 84.0]).
• The mean prostate volume was associated with age in the reference group (r = 0.185; P < 0.001) and in men with incomplete SCI (r = 0.284; P = 0.031), but not in men with complete SCI, irrespective of SDAF/SARS.

• The prostate volume of men with complete SCI was significantly smaller than that of able-bodied men.
• Our data imply that sustained central innervation of the prostate plays an important role in prostate growth.

• We analysed 338 patients with renal injuries who presented to our institution over a 9-year period.
• Data on demographics, clinical presentation, management and complications were recorded.

• Males comprised 74.9% of patients with renal injuries and the highest incidence was amongst those aged 20–24 years.
• Blunt injuries comprised 96.2% (n = 325) of all the renal injuries, with road trauma being the predominant mechanism accounting for 72.5% of injuries.
• The distribution of injury grade was; 21.6% grade 1 (n = 73), 24.3% grade 2 (n = 82), 24.9% grade 3 (n = 84), 16.6% grade 4 (n = 56), and 12.7% grade 5 (n = 43).
• Conservative management was successful in all grade 1 and 2 renal injuries, and 94.9%, 90.7% and 35.1% of grade 3, 4 and 5 injuries respectively.
• All but one of the 13 patients with penetrating injuries were successfully managed conservatively.

• Road trauma is the greatest cause of renal injury.
• Most haemodynamically stable patients are successfully managed conservatively.

• In all, 500 patients underwent ePLND for intermediate- or high-risk prostate cancer by one surgeon during a 48-month period. A transperitoneal laparoscopic approach was used in all patients to allow adequate access to the internal iliac vessels.
• The variables chosen as being the most important discriminators of the quality of ePLND were operating time, complication rate and lymph node (LN) yield.
• The learning curves for ePLND were calculated using the cumulative sum and cumulative average methods and the number of procedures performed until attainment of acceptable failure rates (competence levels) was calculated. LN parameters were compared with the results from the preceding 311 cases where limited PLND was undertaken.

• The median (range) preoperative PSA level was 8.0(1–62.5) ng/mL and biopsy Gleason score was 7(6–10). In all, 64% of patients had intermediate-risk and 36% had high-risk prostate cancer. There were no intraoperative blood transfusions and no conversions to open surgery. The median (range) blood loss was 200(10–1400) mL and the postoperative transfusion rate was 1.6%.
• The operating time fell at a steady rate of 2.7% after the 15th case and plateaued after 130 patients. At competence levels of 5% and 10%, the learning curve for all complications ended after 346 and 136 patients, respectively.
• At a 5% competence level the learning curve for PLND-specific complications was 40 cases and there was no learning curve at a 10% competence level.
• The overall complication rate was 7.2% of which almost half (47%) were deemed to be PLND-specific. The cumulative average of the LN counts plateaued after 150 procedures. Furthermore, the median LN count after ePLND was more than double that of the authors' historical standard PLND controls (14 vs 6, P < 0.001) and increased with experience up to the end of the series (9 to 20).
• The likelihood of LN involvement (LNI) correlated with biopsy and pathological Gleason grade, clinical and pathological stage and d'Amico risk group.

• This study suggests a learning curve of ≈130 cases for operating time, 136 cases for all complications, 40 cases for PLND-specific complications and 150 cases for LN yield.
• The risk of LNI for patients with intermediate- and high-risk prostate cancer was 8.4% and 19.4%, respectively, which suggests that a significant proportion would benefit from ePLND. It also shows that ePLND can be safely incorporated into LRP, and therefore also into robot-assisted RP, in a high-volume setting.

• To assess the efficacy and toxicity of cediranib, a highly potent inhibitor of vascular endothelial growth factor receptor tyrosine kinases, in patients with metastatic castration-resistant prostate cancer (CRPC) previously treated with docetaxel-based therapy.

• The study used a Simon two-stage trial design, which required at least two of 12 patients in the first cohort to be progression-free at 6 months.
• We enrolled a total of 35 evaluable patients who all received cediranib 20 mg orally daily.
• In a second cohort, 23 additional patients received prednisone 10 mg daily with cediranib.
• Endpoints included tumour response, progression-free survival (PFS), overall survival (OS), vascular permeability via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and toxicity.

• A total of 59 patients were enrolled, of whom 67% had received two or more previous chemotherapy regimens.
• Six of 39 patients with measurable disease had confirmed partial responses and one had an unconfirmed partial response.
• At 6 months, 43.9% of patients were progression-free; the median PFS and OS periods for all patients were 3.7 months and 10.1 months, respectively.
• We found that the DCE-MRI variables baseline transport constant (K_trans) and rate constant at day 28 were significantly associated with PFS in univariate analyses, but only baseline K_trans remained significant when considered jointly.
• The most frequent toxicities were hypertension, fatigue, anorexia and weight loss; the addition of prednisone reduced the incidence of constitutional toxicities.

• This study demonstrated that cediranib was generally well tolerated with some anti-tumour activity in highly pretreated patients with metastatic CRPC who had progressive disease after docetaxel-based therapy.

• To identify microRNAs that could be useful as prognostic markers for non-muscle-invasive (NMI) bladder carcinoma.

• Formalin-fixed, paraffin-embedded samples of 108 NMI bladder carcinomas, and 29 carcinomas invading bladder muscle were collected, and microRNA expression levels were measured using microarrays.
• For 19 samples, microdissection was performed to compare microRNA expression between the tumour and surrounding tissue.
• MicroRNAs that were found to be unrelated to the tumour itself were excluded as potential prognostic markers.

• Expression profiles identified microRNAs that were differentially expressed in NMI tumours from patients who later progressed to carcinoma invading bladder muscle compared with NMI tumours from patients that did not progress.
• The microRNA profile of tumours invading the bladder muscle was more similar to that of NMI tumours from patients who later progressed, than to that of the same-stage NMI tumours from patients who did not later progress.
• The expression level of one microRNA, miR-29c*, was significantly under-expressed in tumours that progressed and could be used to stratify patients with T1 disease into risk groups.

• MicroRNAs can be useful biomarkers for prognosis in patients with urothelial carcinoma.
• In our study, expression levels of several microRNAs, including miR-29c* identified high- and low-risk groups. These biomarkers show promise for the stratification of patients with bladder cancer.

• To describe the pathological outcomes of patients with muscle-invasive micropapillary bladder cancer who have undergone neoadjuvant chemotherapy.

• A total of 82 patients with muscle-invasive micropapillary bladder cancer were treated between 1997 and 2010.
• After excluding those with metastatic disease, micropapillary histology only at radical cystectomy (RC), and chemo-radiation as primary treatment, 44 patients remained. All patients had ≥cT2 disease before chemotherapy/surgery.
• The median follow-up after RC was 28 months.
• Neoadjuvant chemotherapy was initiated in 29 (66%) patients and all patients underwent RC (93%) or partial cystectomy (7%).

• Micropapillary histology was diagnosed at first transurethral resection in 37 (84%) patients.
• Final RC pathology revealed pT0 in 15 (34%) patients and positive lymph nodes in 13 (31%) patients.
• Down-staging to pT0 occurred in 13 (45%) of those who received neoadjuvant chemotherapy compared with two (13%) of those who did not (P = 0.049).
• Patients with pT0 disease with micropapillary histology had higher overall survival rates (25 vs. 92%) and lower rates of bladder cancer recurrence (21 vs. 79%) at the 24-month follow-up.

• Almost half of the patients responded completely to neoadjuvant chemotherapy with a pT0 rate of 45%; therefore, patients with the micropapillary variant of urothelial carcinoma should not be excluded from consideration for neoadjuvant chemotherapy.

• To examine blood transfusion rates after nephrectomy for renal masses at the population-level.

• We performed a population-based, retrospective observational study using a national discharge abstract database.
• The study cohort consisted of 10 902 patients who were treated by radical nephrectomy (RN) or partial nephrectomy (PN) for a renal mass between 1 April 2003 and 31 March 2008.
• The association between blood transfusion and various explanatory variables was examined using the chi-squared test and multivariable logistic regression.

• The overall blood transfusion rate was 18.1%.
• Transfusions occurred after 28.2%, 12.7%, 9.2% and 8.6% of open RN, open PN, laparoscopic RN and laparoscopic PN, respectively (P < 0.001).
• Transfusion rates were found to be strongly associated with age and comorbidity, such that patients aged <50 years with Charlson scores of 0 were transfused 11.2% and 14.5% of the time compared to 28.2% and 40.7% in patients aged ≥80 years with Charlson scores of ≥3, respectively (P < 0.001).
• On multivariable logistic regression, age (P < 0.001), Charlson score (P < 0.001), procedure type (P < 0.001), surgeon (P < 0.001) and hospital volume quartile (P < 0.001) were all found to be associated with the rate of blood transfusions, whereas year of surgery, sex and income quintile were not.

• The transfusion rate after nephrectomy in general clinical practice is higher than that reported in the urological literature.
• Patient and provider factors appear to contribute to the considerable variability that exists in the observed transfusion rate.
• A more detailed understanding of these factors may help with respect to preoperative patient counselling and informed consent.

• To compare the outcomes of extracorporeal shockwave lithotripsy (ESWL) for distal ureteric stones treated using the prone and transgluteal (supine) approaches in a tertiary referral stone unit using a fourth generation lithotriptor.

• We selected consecutive patients undergoing ESWL to distal ureteric stones over 1 year, during which we changed our treatment protocol from a prone to transgluteal (supine) approach.
• Patients were treated using the Sonolith Vision Lithotriptor (Technomed Medical Systems, Vaulx-en-Velin, France).
• Outcome was assessed using plain abdominal film of kidney, ureter and bladder (KUB) X-ray taken at 2 weeks then monthly as required.
• Treatment success was defined as complete clearance of stone fragments and treatment failure was defined as persistence of stone fragments beyond 3 months or the need for ureteroscopy.

• A total of 38 patients were treated in the prone position and 72 patients using a transgluteal approach.
• Patient and stone characteristics were identical in both groups. The mean (range) stone size was 7.8 (4–16) mm.
• The proportions of patients who were stone-free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively (<0.001).
• The overall success rates for treatment within the prone and transgluteal groups were 63 and 92%, respectively (<0.001).

• Transgluteal ESWL to stones within the distal ureter leads to significantly higher stone-free rates than treatment using the prone approach.
• The majority of patients are rendered stone-free after one session of treatment and the overall success rates are similar to those of ureteroscopic management.

• To assess the prognostic impact of proteins of the receptor activator of nuclear factor κB (RANKL) pathway in serum samples from patients undergoing radical prostatectomy.

• We retrospectively determined soluble RANKL (sRANKL) and osteoprotegerin (OPG) by ELISA in serum samples of 178 patients undergoing radical prostatectomy between 2004 and 2006.
• Clinical and patient follow-up data were analysed using the Wilcoxon–Mann–Whitney test, the Kaplan–Maier method, and single variable or multifactorial Cox proportional hazards analysis.

• Higher serum sRANKL levels (P = 0.01), lower serum OPG levels (P = 0.01) and a higher sRANKL/OPG ratio (P = 0.004) were significant risk factors for biochemical recurrence (BCR).
• In multifactorial analysis, adjusted for the common risk factors for BCR, sRANKL and sRANKL/OPG ratio were confirmed as independent prognostic factors.
• Neither sRANKL nor OPG showed a clear association with histopathological factors such as pT stage, pN Gleason score or resection margin status, nor were they associated with prostate-specific antigen level.

• Greater activity of the RANKL pathway in the serum of patients with prostate cancer undergoing radical prostatectomy is a risk factor for BCR.
• The RANKL pathway seems to contribute to the biological behaviour of prostate cancer even at the organ-confined stage of the disease.

• To characterize pelvic musculoskeletal anatomy in postpubertal females with classic bladder exstrophy, and to compare this with females without bladder exstrophy.

• The authors reviewed the medical records of all females in our institutional review board-approved bladder exstrophy database of 1078 patients and identified those with classic bladder exstrophy who underwent pelvic magnetic resonance imaging (MRI) after the age of 12 years.
• Indications for MRI included haematuria, adnexal lesion, perineal fistula, non-pelvic cancer staging, abdominal wall hernia and vaginal stenosis.
• Age- and race-matched female patients without exstrophy who underwent MRI evaluation for similar indications were included for comparison.
• The MRI protocol included axial, sagittal and coronal T1- and/or T2-weighted imaging.

• The study included 30 patients with a median (range) age of 22.5 (12–55) years at time of MRI. Ten patients had bladder exstrophy while 20 control patients did not.
• A smaller percentage of levator ani was located in the anterior compartment of the pelvis in patients with bladder exstrophy compared with controls.
• The iliac wing angle, puborectalis angle, ileococcygeous angle, levator ani width, symphyseal diastasis, erectile body diastasis, posterior bladder neck distance and posterior anal distance was greater in patients with bladder exstrophy than in those without.
• The ischial angle and obturator internus angle were narrower in patients with bladder exstrophy than in those without, and there was no significant difference between levator ani surface area, sacral anal angle, sacral bladder neck angle and bladder neck erectile body distance between the two patient groups.

• In postpubertal females with bladder exstrophy, significant deviations from normal pelvimetry exist, including posterior location of the majority of the levator ani muscle, a wider ileococcygeous angle and a wider symphyseal diastasis.
• These differences are similar to those described in previous comparisons of younger children with bladder exstrophy and control children.

• To present our experience of anatomical findings for congenital completely buried penis (CCBP), which has no unanimous consensus regarding the ‘gold standard’ for surgical correction and patient eligibility, by providing our surgical technique and illustrations.

• Between February 2006 and February 2011, 22 children with a median (range) age of 4.2 (2.5–5.8) years, with CCBP underwent surgical correction by one surgeon.
• Toilet training and photographs of morning erections by parents were advised before surgery.
• The abnormal anatomical structure of buried penis during the operation was observed. The technique consisted of the release of the fundiform ligament, fixation of the subcutaneous penile skin at the base of the degloved penis, penoscrotal Z-plasty and mobilisation of the penile and scrotal skin to cover the penile shaft.

• In reflex erectile conditions, CCBP presents varying degrees of dorsal curve and shortage of penile skin.
• Dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis in all patients.
• All wounds healed well and the cosmetic outcome was good at 6-month follow-up after the repair.

• The appearance of the dorsal curve in CCBP mainly results from the traction of penile dorsal skin and the abnormal attachment of the fundiform ligament to the shaft. This abnormality can be successfully corrected by releasing the abnormal fundiform ligament and mobilising scrotal skin to cover the length of the penile shaft.

• To characterize the incidence and clinical history of gross haematuria after prostate brachytherapy.
• To identify treatment risk factors for the development of gross haematuria in this setting.

• We reviewed haematuria outcomes collected prospectively in 2454 patients treated with transperineal prostate brachytherapy over a 20-year period at a single institution.
• Patients were followed for a median of 5.9 years.
• The association of haematuria with age, pretreatment PSA, ethnicity, clinical tumour stage, Gleason score, prostate volume, isotope (iodine 125 or palladium 103), biologically effective dose (BED), external beam radiation, androgen deprivation, development of urinary retention and occurrence of biochemical failure was investigated.

• A total of 218 men (8.9%) reported gross haematuria at a median time of 772.2 days after implantation.
• Haematuria was associated with prostate volume >40 cm³ (P < 0.01), use of external beam radiation (P < 0.01), Gleason score >7 (P = 0.037), Asian ethnicity (P < 0.001), BED >200 Gy (P = 0.01), and freedom from biochemical failure (P = 0.004).
• On multivariate analysis, prostate volume >40 cm³ (P = 0.002), external beam radiation, (P = 0.001), and freedom from biochemical failure (P = 0.035) were predictors of haematuria.

• Late gross haematuria was observed in a small proportion of men after brachytherapy and may occur with considerable latency.
• Larger prostate glands, freedom from biochemical failure and external beam radiation are risk factors.

• To compare the pathological and biochemical outcomes between extended lymph node dissection (eLND) and standard lymph node dissection (sLND) in patients undergoing robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer.

• A total of 905 patients underwent robot-assisted radical prostatectomy and lymph node dissection (LND) by a single surgeon between June 2006 and January 2011. Of these, 170 patients who underwent robot-assisted eLND and 294 patients who underwent robot-assisted sLND for intermediate- or high-risk prostate cancer were included in the study.
• Propensity-score matching was performed using the preoperative variables which included age, body mass index, prostate-specific antigen, clinical stage, biopsy Gleason score 1 and 2, total number of biopsied cores, number of positive cores and prostate volumes.
• Pathological and biochemical outcomes were assessed according to the extent of LND.

• The median (range) follow-up period was 36 (12–77) months and the median number of lymph nodes removed was 21 and 12 in the eLND and sLND groups, respectively.
• Propensity-score matching resulted in 141 patients in each group. Although patients who underwent eLND had a higher clinical stage, biopsy Gleason score and number of positive cores than those treated with sLND in the entire cohort, there were no preoperative between-group differences in the matched cohort.
• In the matched cohort, lymph node metastases were detected at a significantly higher rate in the eLND than in the sLND group (12.1 vs. 5.0%, P = 0.033).
• In the matched cohort, the 3-year biochemical recurrence-free survival rates were 77.8 and 73.5% in the eLND and sLND groups, respectively, which was not significant (hazard ratio 0.85, P = 0.497).

• Robot-assisted eLND achieved an increased lymph node yield and higher detection rate of lymph node metastases; however, robotic eLND did not alter biochemical outcomes in a short-term follow-up.

• Radical cystectomy (RC) is associated with considerable morbidity. Aside from the perioperative period, RC with urinary diversion poses great potential for long-term complications and morbidity.
• Bladder preservation therapies for muscle-invasive bladder cancer (MIBC) have been developed to address the needs of two cohorts: patients with severe medical co-morbidities for whom a radical surgery is too high risk and patients with limited disease who wish to avoid radical surgery.
• The goal of achieving complete response to treatment while maintaining bladder form and function has led to the development of multimodal approaches to this disease.
• There are multiple bladder preservation options, although the trimodal approach of maximal transurethral resection with chemoradiotherapy is the most strongly supported.
• In medically operable patients (‘fit’ for surgery), there is abundant evidence to support trimodal therapy as an acceptable treatment option for highly selected patients with MIBC with favourable pathological parameters.
• While outcomes are worse for medically inoperable patients (‘unfit’ for surgery), bladder preservation approaches still offer curative potential. However, prospective trials comparing the above regimens to RC are still needed to better define their role in the treatment of MIBC.
• We present a comprehensive review of the literature and outline a practical approach to bladder preservation therapy for MIBC.

• To access the effect of: male age, the cause of azoospermia (obstructive azoospermia vs non-obstructive azoospermia [NOA]), testicular histopathology, the type of sperm used (fresh vs frozen-thawed), and the use of pentoxyphilline on the intracytoplasmic sperm injection (ICSI) cycle outcome in men with azoospermia.
• To our knowledge this is the first study to comment on the outcome of ICSI in men with NOA based on testicular histopathology.

• A retrospective analysis of 137 testicular sperm extraction-ICSI cycles performed between 2001–2010, involving 103 men with azoospermia, with 26 couples having repeat cycles.

• Analysis of the results did not show any statistically significant differences in the fertilization, embryo cleavage, clinical pregnancy, live birth and miscarriage rates in relation to the male age, cuase of azoospermia, testicular histopathology, type of sperm used and the use of pentoxyphilline.

• Once sperm is found in a man with azoospermia, no other male factor seems to influence the ICSI outcome.

• To investigate the efficacy of a complex of bovine α-lactalbumin and oleic acid (bLAC) to kill urothelial cancer cells in vitro and inhibit tumour growth and progression in a high risk bladder tumour model.

• The cytotoxicity of bLAC to a large panel of urothelial cell cancer (UCC) cells was tested by the MTT (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide) assay, using bLA, the folded α-lactalbumin without oleic acid, as a control.
• The mechanism of bLAC-inducing cell death was evaluated by annexin V staining, TUNEL (terminal deoxynucleotidyl transferase mediated nick end labelling) assay and sub-G₁ DNA analysis.
• The selective bLAC cytotoxicity was examined using multicellular spheroids consisting of UCC and non-transformed fibroblasts.
• Rats bearing orthotopic tumour received intravesical instillations (twice weekly, for 3 weeks) of bLAC, bLA, BCG or saline, starting 6 days after UCC (AY-27) cell inoculation. Animals were monitored for survival, toxicity and tumour growth control.

• A dose-dependent bLAC-inducing apoptotic-like cell death was shown in UCC cells tested, including cells refractory to classic apoptosis-inducing agents, whereas bLA showed little cytotoxicity.
• bLAC selectively destroyed cancer cells in spheroids.
• Intravesical bLAC therapy demonstrated marked reduction in tumour growth/progression and significantly prolonged animal survival vs saline instillations (P = 0.004, log-rank test) and showed comparable efficacy with BCG (standard) therapy.

• The findings identify bLAC as a new candidate for UCC therapy and suggests that topical administration of bLAC alone or with BCG to prevent progression of bladder cancer warrants further exploration.

• To analyze pathological and short-term oncological outcomes in men undergoing open and minimally-invasive radical prostatectomy (MIRP) for high-risk prostate cancer (HRPC; prostate-specific antigen level [PSA] >20 ng/mL, ≥ cT2c, Gleason score 8–10) in a contemporaneous series.

• In total, 913 patients with HRPC were identified in the Johns Hopkins Radical Prostatectomy Database subsequent to the inception of MIRP at this institution (2002–2011)
• Of these, 743 (81.4%) underwent open radical retropubic prostatectomy (ORRP), 105 (11.5%) underwent robot-assisted laparoscopic radical prostatectomy (RALRP) and 65 (7.1%) underwent laparoscopic radical prostatectomy (LRP) for HRPC.
• Appropriate comparative tests were used to evaluate patient and prostate cancer characteristics.
• Proportional hazards regression models were used to predict biochemical recurrence.

• Age, race, body mass index, preoperative PSA level, clinical stage, number of positive cores and Gleason score at final pathology were similar between ORRP and MIRP.
• On average, men undergoing MIRP had smaller prostates and more organ-confined (pT2) disease (P = 0.02).
• The number of surgeons and surgeon experience were greatest for the ORRP cohort.
• Overall surgical margin rate was 29.4%, 34.3% and 27.7% (P = 0.52) and 1.9%, 2.9% and 6.2% (P = 0.39) for pT2 disease in men undergoing ORRP, RALRP and LRP, respectively.
• Biochemical recurrence-free survival among ORRP, RALRP and LRP was 56.3%, 67.8% and 41.1%, respectively, at 3 years (P = 0.6) and the approach employed did not predict biochemical recurrence in regression models.

• At an experienced centre, MIRP is comparable to open radical prostatectomy for HRPC with respect to surgical margin status and biochemical recurrence.

• To assess the safety, functional and oncological long-term outcomes of high-intensity focused ultrasound (HIFU) as a primary treatment option for localized prostate cancer (PCa).

• We conducted a retrospective single-centre study on 538 consecutive patients who underwent primary HIFU for clinically localized PCa between November 1997 and September 2009.
• Factors assessed were: biochemical disease-free survival (BDFS) according to Phoenix criteria (prostate-specific antigen nadir + 2 ng/mL); metastatic-free, overall and PCa-specific survival; salvage treatment; side effects; potency; and continence status.

• The mean (sd; range) follow-up was 8.1 (2.9; 2.1–14.0) years.
• The actuarial BDFS rates at 5 and 10 years were 81 and 61%, respectively. The 5-year BDFS rates for low-, intermediate- and high-risk patients were 88, 83 and 48%, while the 10-year BDFS rates were 71, 63 and 32%, respectively.
• Metastatic disease was reported in 0.4, 5.7 and 15.4% of low-, intermediate- and high-risk patients, respectively.
• The salvage treatment rate was 18%.
• Seventy-five (13.9%) patients died. PCa-specific death was registered in 18 (3.3%) patients (0, 3.8 and 11% in the low-, intermediate- and high-risk groups, respectively).
• Side effects included bladder outlet obstruction (28.3%), Grade I, II and III stress urinary incontinence (13.8, 2.4 and 0.7%, respectively) and recto-urethral fistula (0.7%). Preserved potency was 25.4% (in previously potent patients).

• The study demonstrates the efficacy and safety of HIFU for localized PCa.
• HIFU is a therapeutic option for patients of advanced age, in the low- or intermediate-risk groups, and with a life expectancy of ∼10 years.

• To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS).

• A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms.
• Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years.
• The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial.

• Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher.
• After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12 219, well within the threshold range (£20 000–£30 000 per QALY) typically applied in the NHS.
• Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%.

• Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK‘s NHS.

• To compare the perioperative course of patients undergoing robot-assisted limited lymph node dissection (LLND) or extended lymph node dissection (ELND) for prostate cancer.
• To examine the differential lymph node counts and rates of detection of lymph node metastases.

• Between 2008 and 2012, 406 consecutive patients with D'Amico intermediate- or high-risk prostate cancer underwent either bilateral LLND (n = 204) or ELND (n = 202) and robot-assisted laparoscopic radical prostatectomy by a single surgeon.
• The region of dissection was the obturator fossa for LLND, while ELND included, in addition, the common iliac, external iliac and internal iliac lymph nodes.
• All complications within 90 days of surgery were recorded according to a modified Clavien system.
• Clinical variables were summarized and compared. Logistic regression was used to identify predictors of complications.

• There were no differences in demographics when comparing patients who underwent ELND with those who underwent LLND.
• The median operating time was 3.0 h for the ELND cohort and 2.8 h in the LLND cohort (P < 0.001). Intraoperative blood loss was 200 mL in both cohorts. Hospital stay was longer for a small percentage of patients in the ELND cohort, with 75% of ELND patients and 85% of LLND patients staying 1 day (P = 0.004).
• No significant difference was found in the overall or major complication rates between LLND (21.6% overall; 6.9% major) and ELND (22.8% overall; 4.5% major). No difference was seen in the symptomatic lymphocele rate between LLND and ELND, 2.9 vs 2.5%, respectively.
• Overall, the lymph-node-positive rate was 12% compared with 4% for the ELND and LLND groups, respectively (P = 0.002).
• A higher Charlson comorbidity index score was associated with the development of major complications.

• ELND at the time of robot-assisted radical prostatectomy can be performed safely with minimal additional morbidity.
• Long-term oncological and functional outcomes require further study.

• To describe in patients with prostate cancer, receiving androgen-deprivation therapy (ADT): (i) knowledge, self-efficacy (SE), and health beliefs about osteoporosis (OP); (ii) current engagement in healthy bone behaviours (HBBs).
• To explore the relationships between knowledge, SE, and health beliefs, and engagement in HBBs.

• 175 patients receiving ADT by injection completed questionnaires assessing current HBBs, OP knowledge, SE, and health beliefs (motivation, perceived susceptibility, and seriousness).
• Descriptive statistics and independent samples t-tests were used to assess relationships between knowledge, SE, health beliefs, and engagement in HBBs.

• Only 38% of patients had undergone a dual X-ray absorptiometry scan in the past 2 years. OP knowledge was low (mean [sd, range] 9.6 [4.4, 0–19]) and perceived SE moderate (84.7 [24.5, 0–120]). Health motivation was fairly high (23.6 [3.1, 6–30]), but perceived susceptibility (16.8 [4.3]) and seriousness (16.8 [4.2]) of OP were low.
• Few patients met the recommendations for vitamin D intake (42%) and exercise (31%), and 15% were at risk of over-supplementation of calcium.
• Patients taking calcium supplements (P = 0.04), and meeting guidelines for vitamin D (P = 0.008) and for exercise (P = 0.002) had significantly greater knowledge than those who did not.
• Patients who were engaging in less than four of five HBBs had lower knowledge (P < 0.001) and health motivation (P = 0.01) than those who were engaging in four or all five HBBs.

• Most patients who are receiving ADT are not receiving appropriate screening, lack basic information about bone health, and are not engaging in the appropriate HBBs.
• These findings support the application of the Health Belief Model in this population: interventions that teach patients about the implications of bone loss, encourage proper uptake of HBBs, and promote feelings of SE could increase engagement in HBBs to prevent and manage bone loss.

• To establish whether the good prognosis of Gleason score 6 (GS6) is maintained in the setting of multiple involved cores.

• In total, 6156 men (from 1 April 2000 to 30 April 2007) with GS6 on biopsy underwent radical prostatectomy (RP) at our institution.
• The number of positive cores was correlated with the outcome at RP.

• More positive cores correlated with less organ-confined disease (P < 0.001), positive margins (P < 0.012), increasing RP grade (P < 0.001) and increased seminal vesicles/lymph node involvement (P = 0.012).
• For men with data available, the actuarial risk of being biochemically free of disease at 5 years was 93.2% when ≤6 cores were positive (812 men followed to 5 years) vs 89.1% if >6 cores were positive (41 men followed to 2 years) (P = 0.6).
• Although the predicted ‘cure rate’ of >75% probability of a tumour showing no evidence of biochemical recurrence at 10 years after RP was statistically different between cases with ≤6 vs >6 positive cores (P < 0.0001), the outcome in both groups was still favourable (90.5% vs 84%).
• Partin-like tables were generated factoring in the number of positive cores to predict organ-confined disease as a guide for urologists to perform nerve-sparing surgery.
• For example, with T1c disease, there was a ≥75% probability of organ-confined disease with one to three positive cores regardless of prostate-specific antigen (PSA) level, and the same probability was present with four to six positive cores and a PSA level of 0–4 ng/mL.

• A low Gleason score on biopsy is a powerful prognostic finding, such that this favourable outcome is maintained even in the setting of multiple positive cores with GS6.

• To study the habitat of Actinobaculum schaalii by examing groin swabs, faeces samples and vaginal swabs, and to determine whether it is a common uropathogen in patients with kidney or ureter stones.

• A quantitative real-time PCR assay was used to analyse all samples, which were collected between 2010 and 2011.
• A total of 38 patients (24 men and 14 women), with kidney or ureter stones and undergoing extracorporeal shock wave lithotripsy (ESWL), provided urine samples and had groin swabs taken. In addition, 30 faecal samples and 19 vaginal swabs that had been sent for routine microbiological examinations from patients outside the ESWL group were analysed.
• A chi-squared test was used to analyse the differences between patient groups, studying samples from urine, faeces samples, groin swabs and vaginal swabs.

• Actinobaculum schaalii was found in the urine samples from 14 (37%) patients undergoing ESWL, and in both urine and groin swabs from seven (18%) patients.
• Actinobaculum schaalii was not found in faeces samples but it was found in six (32%) of the vaginal swabs, predominantly in patients >50 years (P = 0.06).

• The study indicates that A. schaalii is a commensal found on skin, urine and vaginal mucosa in the human urogenital area and supports other investigations in its finding that the elderly are at greatest risk of being colonized with A. schaalii.

• To study characteristics of female ejaculation as perceived by healthy women.
• To evaluate whether fluid emission during sexual activity has an impact on women's or their partners' sexual lives.

• An online questionnaire consisting of 23 questions addressing the participants' characteristics, aspects of perceived female ejaculation, and its impact on women's and their partners' lives was published internationally on various online platforms.

• Over a period of 18 months, 320 women from all over the world were included in the study (excluding women below the age of 18 years and double entries).
• The women's mean age was 34.1 years (±11.1) and their mean age at first ejaculation was 25.4 years.
• Most women ejaculate a few times a week. The volume of ejaculation is approximately 2 oz (29.1%), and the fluid is usually clear as water (83.1%).
• For most women (78.8%) and their partners (90.0%), female ejaculation is an enrichment of their sexual lives, whereas 14 women (4.4%) stated that their partners were unaware of their potential ejaculation.

• Perceived female ejaculation – and its onset – occurs in women of all ages.
• Most women who ejaculate do so on a regular basis.
• Female ejaculation is an enrichment of the sexual lives of women as well as their partners.

• To investigate the potential therapeutic benefit of melatonin for chronic ischaemia-related bladder dysfunction.

• Adult male Sprague–Dawley rats were divided into control, arterial injury (AI), AI with low-dose melatonin treatment (AI-ML) and AI with high-dose melatonin treatment (AI-MH) groups. The AI, AI-ML and AI-MH groups underwent a procedure to induce endothelial injury of the iliac arteries and received a 2% cholesterol diet after AI.
• The rats in the AI-ML and AI-MH groups were treated with melatonin 2.5 or 20 mg/kg/day orally for 8 weeks after AI. The control group received a regular diet. After 8 weeks, urodynamic investigations were performed.
• Bladder tissues and iliac arteries were processed for pharmacological studies, and for immunohistochemical and histological examination.

• Iliac arteries from AI, AI-ML and AI-MH rats displayed neo-intimal formation and luminal occlusion.
• In the AI group, the micturition interval was significantly shorter, and bladder capacity and voided volume were lower than in the controls. Contractile responses of bladder strips to KCl, electrical field stimulation and carbachol were significantly lower after AI than in the controls.
• The AI bladders were found to have a significantly increased collagen ratio, oxidative stress and inducible nitric oxide synthase (NOS) expression, and decreased constitutive NOS expression compared with the controls.
• In the AI-ML and AI-MH groups, neo-intimal formation was not prevented, but there were beneficial effects on bladder function and morphology. In the AI-ML group, the beneficial effects failed to reach statistical significance.
• In the AI-MH group, melatonin significantly improved oxidative stress and NOS expression, and there were significant improvements in all the functional and morphological variables compared with the AI group.

• Arterial occlusive disease may lead to chronic bladder ischaemia and bladder hyperactivity associated with oxidative stress.
• In the model used, chronic treatment with melatonin protected bladder function and morphology, probably through its free radical scavenging and antioxidative properties.
• Melatonin may prevent oxidative damage and improve ischaemia-related bladder dysfunction.

• To compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post.

• Randomised, controlled trial conducted in Sweden 2009–2011. Computer-generated block-randomisation, allocation by independent administrator. No ‘blinding’.
• The study included 250 community-dwelling women aged 18–70 years, with SUI ≥1 time/week. Consecutive online recruitment.
• The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training.
• Primary outcomes: symptom-score (International Consultation on Incontinence Questionnaire Short Form, ICIQ-UI SF) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life, ICIQ-LUTSQoL). Secondary outcomes: (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL (EQ5D-Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires.

• In all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean (sd) changes in symptom-score were: Internet 3.4 (3.4), Postal 2.9 (3.1) (P = 0.27). The mean (sd) changes in condition-specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) (P = 0.52).
• Compared with the postal-group, more participants in the Internet-group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001).
• Health-specific QoL improved in the Internet-group (mean change 3.7 (10.9), P = 0.001), but not in the postal-group (1.9 (13.0), P = 0.13).
• Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%.

• Concerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet-based treatment was more effective.
• Internet-based treatment for SUI is a new, promising treatment alternative.

• To explore changes at chromosomes 3, 7, 17 and 9p21 in order to assess associations with bladder cancer for possible improvements of the UroVysion™ assay regarding screening.

• In all, 1609 men took part in the prospective study UroScreen. Annual screening for bladder cancer was offered to male chemical workers with former exposure to aromatic amines as a voluntary surveillance programme between 2003 and 2010.
• In all, 191 434 cells in 6517 UroVysion tests were analysed for copy number variations (CNV) at chromosome 3, 7, 17 (gains) and 9p21 (deletions) in 1595 men.
• We assessed CNVs at single or multiple loci using polysomy indices (PIs, called multiple PI and PI 3, PI 7 and PI 17).
• We calculated Spearman's rank correlation coefficients (r_s) between these PIs and receiver operating characteristic (ROC) curves with areas under the curves (AUCs). We applied Cox regression to estimate hazard ratios (HRs) to assess the risk of developing bladder cancer.

• Nine out of 21 bladder tumours detected in 20 participants (‘cases’) had a positive UroVysion test, including seven high-grade carcinomas and seven overlapping results with a positive cytology. Four cases with negative test results did not attend screening annually.
• No case was found because of a complete loss of 9p21 in at least 12 cells.
• There were strong correlations between pairwise combinations of gains at chromosome 3, 7 or 17, ranging between r_s = 0.98 and r_s = 0.99 in cases and between r_s = 0.84 and r_s = 0.88 in non-cases (P < 0.001). Associations were less pronounced with CNVs at 9p21 among cases and were lacking in non-cases.
• Estimates of the relative risk of DNA gain for developing a bladder tumour assessed with PIs (threshold 10% of cells) were 47.7 (95% confidence interval [CI] 18.3–124.1) for the multiple PI, 44.5 (95%CI 16.5–119.9) for PI 3, 34.7 (95%CI 13.1–92.1) for PI 7 and 52.4 (95%CI 20.7–132.6) for PI 17, as well as 7.9 (95%CI 3.0–20.6) for a complete loss of 9p21 (threshold 2.5% of cells), respectively.
• ROC analyses showed similar AUCs for multiple PI compared with PIs of single chromosomes 3, 7 and 17 (all AUCs between 0.79 and 0.80) and a lower AUC for a homozygous loss of 9p21 (AUC 0.72).

• The UroVysion assay showed a reasonable performance in detecting bladder cancer in the present study population and shared positive test results with cytology, which is much cheaper.
• A simpler, faster and cheaper version of the UroVysion assay might rely on the very strong correlations between gains at chromosomes 3, 7 and 17, resulting in a similar performance in detecting bladder cancer with single-probe PIs compared with the full set of these probes.
• Loss of 9p21 was less predictive for developing bladder cancer in UroScreen.

• To evaluate the outcomes in patients with node-positive prostate cancer (PCa) after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) according to the number of positive lymph nodes (LNs).
• To identify different risk groups among patients with node-positive PCa.

• We evaluated 98 consecutive patients with pN1M0 PCa who underwent RP between November 1995 and May 2011.
• Kaplan–Meier and Cox proportional univariable and multivariable regression models were used to analyse the survival rates.
• Patients were divided into two groups according to number of positive LNs using the most informative positive LN theshold for predicting survival, then into three different risk groups according to number of positive LNs and pathological Gleason score (GS).

• Mean (range) follow-up was 68.4 (10–192) months.
• Patients with 1–3 positive LNs (n = 75; 76.5%) had significantly better cancer-specific survival (CSS) and overall survival (OS) compared with those with >3 positive nodes (n = 23; 23.4%; P < 0.01).
• Patients with 1–3 positive LNs and pathological GS ≤7 (Group 1) had significantly better CSS than those with >3 positive LNs or GS 8–10 (Group 2 [P = 0.015]). Group 2 patients, moreover, had significantly better CSS (P = 0.019) and OS (P = 0.021) than those with >3 positive LNs and GS 8–10 (Group 3).

• Patients with 1–3 positive LNs have higher CSS and OS rates than those with >3 metastatic LNs.
• Taking into account the pathological GS, as well as the number of positive nodes, three risk group categories with considerable differences in terms of survival can be found. Patients with LN-positive PCa should be stratified into different groups according to these two measures, to obtain a better prediction of oncological outcomes.

• To compare the prognoses associated with positive surgical margins (PSMs) according to their urethral, ureteric and/or soft tissue locations in patients with pN0 M0 bladder cancer who have not undergone neoadjuvant chemotherapy.

• A retrospective, case–control study was conducted between 1991 and 2011 using data from 17 academic centres in France.
• A total of 154 patients (cases) with PSMs met the eligibility criteria and were matched according to centre, pT stage, gender, age and urinary diversion method with a population-based sample of 154 patients (controls) from 3651 patients who had undergone cystectomies.
• The median follow-up period was 23.9 months.
• Multivariable Cox regression analysis was used to test the effects of PSMs on local recurrence (LR)-free survival, metastatic recurrence (MR)-free survival and cancer-specific survival (CSS).

• The 5-year LR-free survival and CSS rates of patients with urethral and soft tissue PSMs were lower than those in the control group.
• A significant decrease in CSS was associated with soft tissue PSMs (P = 0.003, odds ratio = 0.425, 95% confidence interval 0.283–0.647). The prognosis was not affected in cases of ureteric PSMs.

• Soft tissue PSMs were associated with poor CSS rates in patients with pN0 M0 bladder cancer.
• A correlation between urethrectomy and a reduction of the risk of LR in a urethral PSM setting was observed.

• To study prospectively the clinical value of preoperative spiral computed tomography (CT) staging of primary tumours in deciding the extent of pelvic lymph node dissection (PLND) during laparoscopic radical cystectomy (RC) in the management of bladder cancer (BC).

• Between January 2010 and December 2011, a total of 63 patients with urothelial BC received laparoscopic RC, super-extended PLND and ileac conduit.
• The super-extended PLND removed all lymphatic tissues in the boundaries at the level of the inferior mesenteric origin from the aorta (cephalad), the pelvic floor (distally), the genitofemoral nerve (laterally) and the sacral promontory (posteriorly).
• All of the operations were performed by one experienced surgeon, and all harvested lymph nodes were submitted separately.
• CT was used to evaluate the preoperative CT stage (CTx) of each primary bladder tumour.

• All patients were divided into five categories according to their CTx stages: three at CT1, seven at CT2a, 38 at CT2b, seven at CT3b, and eight at CT4a.
• All 63 procedures were completed successfully without any conversion to open surgery. The mean estimated blood loss was 450 mL, and 14 patients (22.2%) had postoperative lymphatic leakage.
• Each case was pathologically confirmed as transitional cell carcinoma with negative margins at the urethral and ureteric stumps.
• None of the patients with a low CTx stage (CT1–CT2a) had positive lymph nodes above the level of the common iliac artery bifurcation.
• There was no jump lymph node metastasis, and no positive lymph node was detected above the level of aortic bifurcation in all cases.

• Based on the preoperative CT staging, urological surgeons can determine the boundaries of PLND to reduce intraoperative injury and postoperative complications in patients with BC, especially those at the lower CTx stages (CT1 and CT2a).

• To evaluate gender-dependent disparities regarding clinical symptoms, referral patterns or treatments before diagnosis of urothelial carcinoma of the bladder (UCB).

• A consecutive series of patients with newly diagnosed UCB completed a questionnaire at the time of admission for elective transurethral resection of a bladder tumour (TURBT).
• The questionnaire surveyed the presence of haematuria, dysuria, urgency and bladder pain as well as the number of consultations and treatments before urological evaluation.
• Tumour characteristics, clinical symptoms, treatments and referrals were compared between men and women in the patient series.

• In men (n = 130) the distribution of tumour stages was pTa 62.3%, pT1 23.1% and pT ≥ 2 12.3%. The respective percentages in women (n = 38) were pTa 57.9%, pT1 23.7% and pT ≥ 2 18.4% (P > 0.05).
• The prevalence of clinical symptoms in men vs women was as follows: gross haematuria 65 vs 68%, dysuria 32 vs 44%, urgency 61 vs 47%, and nocturia 57 vs 66%, respectively (P > 0.05).
• A total of 78% of men vs 55% of women directly consulted a urologist (P < 0.05).
• Symptomatic treatment for voiding disorders/pain was given without further evaluation to 19% of men vs 47% of women 1 year before the diagnosis of UCB (P < 0.05).
• A total of 3.8% of men vs 15.8% of women received three or more treatments for urinary tract infections (UTIs) within the same time period (P < 0.05).

• In the present study there were no gender-related differences in clinical symptoms of UCB, but women were more likely to be treated for voiding complaints or alleged UTIs without further evaluation or referral to urology than men.
• Gender-dependent disparities in referral patterns exist and might delay definitive diagnosis of UCB in women.

• To explore the potential prognostic role of family history (FH) of prostate cancer and prostate cancer risk single nucleotide polymorphisms (SNPs) in patients undergoing active surveillance (AS) for prostate cancer.
• This is the first study to date, which has investigated the potential prognostic role of SNP profiles in an AS cohort

• FH data were collected from patients in the Royal Marsden Hospital AS study.
• In all, 39 prostate cancer-risk SNPs identified from published genome wide association studies (GWAS) were genotyped using the Sequenom Platform and TaqMan™ assays from available DNA.
• The cumulative genetic-risk scores for each patient were then calculated using the weighted effect estimated from previous GWAS (log-additive model).
• FH status and the genetic-risk scores were assessed against adverse outcomes in AS, time to treatment and adverse histology on repeat biopsy, using univariable and multivariable Cox regression models to address time to treatment; and binary logistic regression to address biopsy upgrade.

• Of 471 patients, 55 (13.6%) had adverse histology on repeat biopsies and 145 (30.8%) had deferred treatment.
• On univariate analysis, there was no significant relationship between FH of prostate cancer in any degree of relation, and adverse histology or time to treatment.
• For risk score analyses, 386 patients' DNA was studied; and there was also no relationship found between the calculated genetic risk scores and adverse histology or time to treatment (P = 0.573 and P = 0.965, respectively).
• The retrospective study design and the few events were the main limitation of the study.

• There is currently insufficient data to support the use of FH status or prostate cancer SNP profile risk scores as prognostic factors in AS and these should not be used to influence management decisions.
• As more genetic variants are discovered this may change and should be reassessed in multicentre AS cohorts.

• To determine whether the rate of change in total serum prostate-specific antigen (PSA) levels accurately detects prostate cancer and to evaluate whether it adds any predictive value to a single measurement of serum PSA alone, in general practice settings.

• A retrospective cohort of 219 388 community-dwelling men, aged ≥45 years, enrolled in the Kaiser Permanente Southern California health plan, with no history of prostate cancer and at least three PSA measurements, were followed from 1 January 1998 to 31 December 2007, for the development of biopsy-confirmed prostate cancer.
• Annual percent changes in total serum PSA levels were estimated using linear mixed models.
• The accuracy of prostate cancer prediction was assessed for prostate cancer overall and for aggressive disease (Gleason score ≥7) and compared with that of a single measure of PSA level using area under the receiver-operating characteristic curves (AUCs).

• The men in this cohort experienced a mean change of 2.9% in PSA levels per year and the rate of change in PSA increased modestly with age (P ≤ 0.001).
• Annual percent changes in PSA accurately predicted the presence of prostate cancer (AUC = 0.963) and aggressive disease (AUC = 0.955) and had more predictive accuracy for aggressive disease than did a single measurement of PSA alone (AUC = 0.727).

• Longitudinal measures of PSA improve the accuracy of aggressive prostate cancer detection when compared with a single measurement of PSA alone.
• Findings from this study provide insight into the usefulness of PSA velocity as a detection marker for aggressive prostate cancer.

• To identify specific risk factors for different phenotypes of hypospadias that may arise as a result of dissimilar embryonic processes in different time windows.

• A total of 405 hypospadias cases and 627 male controls were included in a Dutch case–control study.
• Medical records of cases were reviewed to determine the anatomical location of the urethral opening, while demographic, lifestyle and pregnancy-related risk factor data were obtained from self-administered questionnaires.
• Multivariable and multinomial logistic regression analyses were used to calculate effect estimates for the group containing all cases of hypospadias and for the different hypospadias phenotypes.

• Cases were subdivided into anterior (glandular and coronal; 59%), middle (penile; 29%) and posterior (penoscrotal, scrotal and perineal; 12%) hypospadias.
• Being a twin/triplet, primiparity, preterm delivery, and being small for gestational age were associated with hypospadias, particularly in posterior cases.
• Family history of hypospadias increased the risk of hypospadias, an effect that seemed to be more predominant in anterior and middle forms.