The Journal of urology (J Urol )

Publisher: American Urological Association, Elsevier

Description

The most widely read publication in the field, The Journal of Urology® brings solid coverage of all the clinically relevant information needed to stay at the forefront of this dynamic field. The Journal presents investigative studies on critical areas of research and practice; survey articles providing short condensations of the best and most important urology literature worldwide; and practice-oriented reports on interesting clinical observations.

Impact factor 3.75

  • 5-year impact
    4.02
  • Cited half-life
    7.90
  • Immediacy index
    0.63
  • Eigenfactor
    0.09
  • Article influence
    1.04
  • Website
    Journal of Urology, The website
  • Other titles
    Journal of urology (Online), The journal of urology
  • ISSN
    1527-3792
  • OCLC
    42747133
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Elsevier

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
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    • Voluntary deposit by author of authors post-print allowed on authors' personal website, arXiv.org or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
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    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Several prognostic models have been proposed for metastatic renal cell carcinoma (mRCC) but none has been validated in patients receiving third-line targeted agents. We aim to evaluate the prognostic factors in patients affected by mRCC who received a third-line of targeted agent. Data about 2,065 patients affected by clear cell mRCC and treated with targeted therapies in 23 centres in Italy were retrospectively reviewed. A total of 281 patients treated with three targeted agents were included in the final analysis. Overall survival (OS) was the main outcome. Cox proportional hazards regression, followed by bootstrap validation, was used to identify independent prognostic factors. Three clinical characteristics (ECOG-PS >1, presence of metastases at diagnosis, and presence of liver metastases) and two biochemical factors (hemoglobin < LLN and neutrophils > ULN) were found to be prognostic. Patients were classified in three categories of risk based on the presence of zero or one risk factors (low-risk), two risk factors (intermediate-risk) and >2 risk factors (high-risk). The median OS was 19.7, 10.1, and 5.5 months, while the 1-year OS was 71%; 43%, and 15%, respectively. Major limit is the retrospective nature of this study and the absence of external validation. This nomogram included both clinical and biochemical prognostic factors and it may be useful for selection of patients in clinical trials and for the defining prognosis in clinical practice. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 11/2014;
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    ABSTRACT: Purpose Galectin-1 is highly expressed in various tumours and participates in various oncogenic processes. Our previous proteomics investigation demonstrated that galectin-1 is up-regulated in high grade tumours compared to non-high grade lesions. Thus the present cohort study was to clarify the correlation of galectin-1 over-expression with various clinicopathologic features and prognosis. Materials and Methods 185 cases of consecutively treated primary localized urinary bladder urothelial carcinoma were selected. Transurethral resection of the bladder tumour was carried out in all cases followed by radical cystectomy for those with T2 to T4 tumours. Pathological slides were examined for cytoplasmic galectin-1 immunoexpressions and for the correlation of galectin-1 dysregulation with various clinicopathological factors and disease-specific survival. Results Positive galectin-1 immunoexpression in tumour was significantly linked to pT status (P= 0.0295), histological grade (P= 0.037), vascular invasion (P= 0.0287) and nodal status (P=0.0012). Galectin-1 over-expression in tumour significantly predicted disease-specific survival at the univariate (P= 0.0002) and multivariate levels (P= 0.03, HR= 2.438, 95 % CI= 1.090-5.451). Results of in situ hybridization indicated that LGALS1 gene was amplified in 43 specimens in an independent cohort containing 56 snap-frozen tumour specimens. Furthermore, association analyses demonstrated that increased LGALS1 mRNA level was linked to UBUC invasiveness (P= 0.016) and LGALS1 gene amplification was significantly tied to Gal-1 protein amount in tumor (p< 0.0001). Gene amplification was also closely linked to disease-specific survival (P= 0.0006) at univariate level. Conclusions The above results revealed that galectin-1 over-expression was a possible independent factor for bladder cancer prognosis.
    The Journal of urology 10/2014;
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    ABSTRACT: Purpose Spontaneous phasic contractions of the guinea-pig prostate stroma result from the generation of slow waves that appear to primarily rely on spontaneous Ca2+ release from the endo/sarcoplasmic reticulum and subsequent opening of Ca2+-activated chloride channels. This study investigated the voltage-dependent mechanisms in regulating slow wave frequency. Materials and Methods Changes in the membrane potential were recorded using conventional intracellular recording techniques, while simultaneously measuring the isometric tension of guinea-pig prostate lobes. Fluorescence immunohistochemistry was carried out to investigate the cellular composition of the prostate stroma. Results Depolarization induced by high K+ solution, K+ free solution or outward current injection was associated with an increase in slow wave frequency. In contrast, hyperpolarization induced by the re-addition of K+, ATP-sensitive K+ channel openers or inward current injection prevented slow wave generation. K+ channel opener-induced hyperpolarization and cessation of slow waves was reversed by glibenclamide (10 μM). Nifedipine (1-10 μM) shortened the duration of slow waves and pacemaker potentials, but often failed to prevent their generation and associated contractions. Subsequent Ni2+ (100 μM) or mibefradil (1 μM) largely suppressed slow waves and abolished residual contractions. Immunohistochemistry revealed small, interconnected smooth muscle bundles as well as vimentin-positive interstitial cells, but failed to identify a network of Kit-positive interstitial cells. Conclusions Prostate slow wave frequency is voltage-dependent due to the significant contribution of L- and T-type Ca2+ channels. Prostate slow waves may arise from the cooperation between spontaneous Ca2+ release from internal stores and plasmalemmal voltage-dependent Ca2+ channels.
    The Journal of urology 10/2014;
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    ABSTRACT: Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus.
    The Journal of urology 10/2014;
  • The Journal of urology 10/2014; 191(1):271-272.
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    ABSTRACT: Objectives Compared to T1a lesions, the natural history of untreated renal masses is >4cm is poorly understood. We sought to assess the growth kinetics and outcomes of cT1b/T2 cortical renal tumors managed with an initial period of active surveillance (AS), and compared these patients to those who underwent definitive delayed intervention. Methods Our institutional, prospectively maintained, renal tumor database was reviewed to identify enhancing solid & cystic masses managed expectantly. Clinically localized tumors >4.0 cm (≥T1b) that were radiographically followed for >6 months were included for analysis. Tumor size at presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), length of follow−up (FU), and clinical outcomes were compared between those who remained on AS or those who underwent delayed surgical intervention. Results 72 tumors >4cm in diameter (in 68 patients) were identified. 45 patients (66%) were managed solely with AS, while 23 (34%) progressed to intervention. For all lesions, the median tumor size at presentation was 4.9 cm, and the mean LGR was 0.44 cm/year. 14.7% of masses demonstrated no growth over time. Comparing patients managed exclusively with AS and those progressing to definitive intervention, no differences were noted in median tumor size at presentation (4.9 vs. 4.6 cm, p=0.79) or median CCI (3 vs. 2, p=0.6), while significant differences were seen with respect to median age at presentation (77 vs. 60 years, p=0.0002) and mean LGR (0.37 vs. 0.73 cm/year, p=0.02). Following adjustment, younger patients (OR 0.91 [CI 0.86-0.97]) and tumors with faster LGR (OR 9.1 [CI 1.7-47.8]) were more likely to undergo delayed surgical intervention. With a median FU of 32 months (mean, 38.9 ± 24.0; range 6−105), 9 patients died (13%) from other cause and no patient progressed to metastatic disease. Conclusions Localized cT1b or larger renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease at short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select patients with significant competing risks and limited life expectancy.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose To describe the clinical course of patients that achieved a clinical complete response (cT0) following neoadjuvant chemotherapy (NC) for muscle-invasive bladder cancer (MIBC), as there is no established treatment paradigm for management of these patients. Materials and Methods We performed a retrospective review of 109 patients with MIBC (≥T2 urothelial carcinoma of the bladder) that were subject to platinum-based NC at our institution from 1988-2012. Post-chemotherapy assessment of response included cytology, cystoscopy with biopsy, and cross-sectional imaging. Results 32 of 109 (29.4%) patients achieved cT0 status after NC. The mean age of the cohort was 68.3 (±9.6). Among those, 21 received methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), 8 received gemcitabine/cisplatin (GC), and three received other regimens. Seven complete responders opted for immediate radical cystectomy (RC) after completion of NC. 25 patients declined RC following achievement of cT0 status. Seven of these relapsed post completion of NC and proceeded to RC, and the remaining 18 (72%) patients have retained their bladders. Of those 18, six (18.8% of cohort) patients experienced non muscle-invasive relapses that were managed conservatively, and 12 (37.5%) patients had no recurrence. In the 25 patients who opted for bladder preservation after achieving cT0 status following NC, the 5-year cancer specific survival was 88%. Conclusions With proper counseling and identification of treatment goals, cT0 patients following NC for MIBC may have the option to retain their bladders with durable survival. Larger studies are needed to identify possible predictors of response on the clinical, pathological, and molecular levels.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose Many investigators have used number of pads to determine severity of post prostatectomy incontinence (PPI), yet the accuracy of this tool remains unproven. The aim of this study was to determine if patient’s perception of pad use and urine loss reflects actual urine loss. We also sought to identify a quality of life (QoL) measure that distinguishes patients by severity of incontinence. Materials and Methods We prospectively enrolled 235 men from 18 sites >6 months after radical prostatectomy, with incontinence requiring protection. Patients completed a questionnaire about perception of number, size and wetness of pads and a QoL question, several standardized incontinence questionnaires, and a 24-hour pad test that assessed number, size, and weight of pads. SPSS was used for statistical analysis. Results Perception of number of pads used was in close agreement with number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p<0.001). Patients with “wet” and “soaked” pads had statistically, and clinically, significantly different pad weights uniquely different from each other, and from the “almost dry” and “slightly wet”. The response to the QoL question separated men in to 4 statistically significantly different groups based on mean 24-hour pad weight. Conclusions Patients accurately describe the number, size and the degree of wetness of pads collected during a 24-hour pad test. These correlate well with actual urine loss. The single question of “To what extent does urine loss affect your quality of life?” separated men into distinct categories.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose To assess the relationship between healthcare system performance on nationally endorsed prostate cancer quality of care measures and prostate cancer treatment outcomes. Methods This is a retrospective cohort study including 48,050 men from Surveillance Epidemiology and End Results – Medicare linked data who were diagnosed with localized prostate cancer between 2004 and 2009 and followed through 2010. Based on a composite quality measure, we categorized the healthcare systems in which these men were treated into 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%) systems. We then examined the association of healthcare system-level quality of care with outcomes using multivariable logistic and Cox regression. Results Patients who underwent prostatectomy in 3-star versus 1-star healthcare systems had a lower risk of perioperative complications (odds ratio 0.80, 95% confidence interval [CI] 0.64-1.00). However, these patients were more likely to undergo a procedure addressing treatment-related morbidity (e.g., 11.3% vs. 7.8% treated for sexual morbidity, p=0.043). Among patients undergoing radiotherapy, star-ranking was not associated with treatment-related morbidity. Among all patients, star-ranking was not significantly associated with all-cause mortality (Hazard Ratio [HR] 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). Conclusion We found no consistent associations between healthcare system quality and outcomes, which questions how meaningful these measures ultimately are for patients. Thus, future studies should focus on the development of more discriminative quality measures.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose To compare outcomes of various adult continent catheterizable channels in a multi-institutional setting. Materials and Methods A retrospective review of all adults who underwent construction of a continent catheterizable channel at the Universities of Utah, Minnesota, Iowa, and Stanford from 2004-2013 and had at least 6 months of follow-up was performed. Patients were stratified by channel type: either continent cutaneous ileal cecocystoplasty (CCIC) or tunneled cutaneous channel (e.g. appendicovesicostomy, Monti channels, etc.). Our primary outcome was the need for a secondary procedure to correct stomal leakage, obstruction of the catheterizable channel, or stomal stenosis. Secondary outcomes included patient reported leakage and 30-day post-operative complications. We used Firth’s logistic regression in order to control for the heterogeneity induced by multiple institutions. Results 61 patients (31 with CCIC) were included in the study. Mean age was 41.4 years (range 22-76). Median follow up was 16 months. More patients with tunneled channels required a secondary procedure, 50% (15 of 30) compared with 13% (4 of 31) in the CCIC cohort, (OR 6.4, 95% CI; 1.8-28). The total number of required secondary procedures was also higher with tunneled channels than with CCIC (27 procedures vs 4 procedures). 29% of patients with CCIC reported stomal leakage compared with 43% of patients with tunneled channels (p=0.12). A high rate of post-operative complications was observed regardless of technique used (40% for tunneled channels and 51.7% for CCIC). Conclusions Patients with CCIC undergo fewer interventions for maintenance of their catheterizable channel compared with tunneled continent catheterizable channels.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose Lichen sclerosus (LS) is a chronic inflammatory genital skin condition that can cause destructive urethral scarring. No prior studies have reported LS in isolated bulbar urethral stricture segments without the presence of progressive disease originating from the penile urethra. We report the incidence of LS in isolated bulbar urethral stricture segments. Materials and Methods We retrospectively reviewed 70 patients following urethroplasty for isolated bulbar stricture disease (2007-2013). Stricture specimens were re-reviewed by a single uropathologist. Cases were evaluated using common histologic features in LS including hyperkeratosis or epithelial atrophy, vacuolar degeneration of basal cells, lichenoid lymphocytic infiltrate, and presence of superepithelial sclerosis. Results Average patient age was 46.5 (19-77) years and stricture length was 3.5 (1-7) cm. Fifty-one patients (73.0%) underwent excision and primary anastomosis, and 19 (27.1%) onlay of buccal mucosal. Six patients (8.6%) developed recurrent stricture over a median follow-up of 22 (IQR 14, 44) months, of which 3 had LS. Initial pathology showed LS in 5 patients, (7.1%) (95% CI: 1.0-13.3%). On re-review of specimens using LS-specific pathologic criteria, 31 patients (44.3%) (95% CI: 32.4-56.2%), showed pathology highly suggestive (13) or diagnostic (18) for LS (p=0.0001). On pathologic re-review LS was associated with stricture recurrence. Conclusions On re-review of surgical specimens we report a significant incidence of LS in isolated bulbar strictures in men undergoing urethroplasty. The incidence of LS may be higher than reported in isolated bulbar urethral segments without evidence of distal to proximal progressive urethral disease.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose We hypothesized that establishing percutaneous nephrostomy drainage and treating with renal urine culture-specific antibiotics leads to decreased sepsis rates for patients with increased infection risk. Our objective was to analyze a single surgeon’s post-operative sepsis experience in PCNL after prior nephrostomy drainage compared to PCNL with concurrent percutaneous renal collecting system access. Materials and methods A retrospective review of patients who underwent PCNL was performed. Pertinent data collected included patient infection history, pre-PCNL urine cultures, renal calculi burden size, renal urine/stone cultures, length of stay, and sepsis/SIRS events. Results Between September 2007 and June 2012, 219 patients underwent PCNL. Sixty-seven (30.6%) patients had pre-placed nephrostomy drainage (Group 1), while 152 (69.4%) patients had concurrent percutaneous renal access (Group 2). Stone culture was positive more often in Group 1 than Group 2 (64.2% vs. 25.7%; p = 0.0001). The concordance rate of pre-PCNL renal urine culture results with stone culture results (30.6%) was higher than those for Group 1 or 2 LUT urine culture (21.4% or 7.3%). There were no SIRS/sepsis episodes in Group 1 and a 5.9% SIRS/sepsis rate in Group 2 (p = 0.043). Conclusions In this retrospective study, our data suggest that for patients at high risk for urosepsis, preoperative nephrostomy drainage with renal urine culture and culture-specific antibiotic treatment may decrease the risk of postoperative infectious complications. Stone culture is also important to obtain since many patients at high infection risk will have positive stone cultures. A prospective study is necessary to confirm these retrospective data findings.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose To compare satisfaction and treatment efficacy in men with symptomatic hypogonadism receiving clomiphene citrate (CC) or testosterone supplementation therapy (TST). Materials and Methods Men receiving CC, testosterone injections (T injections) or testosterone gels (T gels) for symptomatic hypogonadism (total testosterone < 300 ng/dL) reported satisfaction with their current treatment regimen using the quantitative androgen deficiency in aging male (qADAM) questionnaire. Results A total of 93 men on T injections, T gels, or CC (n=31 in each group), were age matched from a retrospective cohort of 1150 men on TST. We compared the men who received TST to 31 men who were not on1 TST (controls). Median serum testosterone (T) levels increased from pre-treatment levels in all men, regardless of therapy type (CC=247 to 504 ng/dL, T injections=224 to 1104 ng/dL, T gels=230 to 412 ng/dL, p<0.05). The final median serum total T levels in men on CC (504 ng/dL) was lower (p<0.01) than men taking T injections (1014 ng/dL), but similar to men on T gels (412 ng/dL, p=0.31). Despite different serum T levels, men on all three therapies reported similar satisfaction levels (qADAM=35 (CC), 39 (T injections), 36 (T gels), 34 (controls) were similar (p>0.05). Men on T injections reported a greater libido then men on CC (4 vs. 3, p=0.04), T gels (4 vs. 3, p=0.04), controls (4 vs. 3, p<0.01). Conclusions Testosterone supplementation regimens and CC are efficacious in improving serum total testosterone levels. No difference in overall hypogonadal symptoms exists between men on any TST. Despite lower serum total T levels, men taking CC and T gels report similar levels of satisfaction compared to men taking T injections.
    The Journal of urology 09/2014;
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    ABSTRACT: Purpose Patients currently diagnosed with low-risk prostate cancer are often over-treated and suffer from complications resulting in detriment to quality-of-life (QOL). Targeted focal therapy (TFT) is a minimally invasive procedure designed to ablate tumor foci while minimizing collateral damage in order to maintain QOL. Materials and Methods This is an IRB-approved prospective study conducted to assess the safety and efficacy of TFT using cryotherapy for men aged 40-85 years who were diagnosed with low-risk organ-confined prostate cancer (Gleason ≤ 7 (3+4) on TRUS biopsy, ≤ 50% tumor burden, and PSA <10 ng/dL) at the University of Colorado between 2006 and 2009. Patients were evaluated for eligibility after undergoing three-dimensional mapping biopsy. Median duration of follow-up was 28 months (IQR: 26 to 31 months). Results Sixty-two men with low-risk disease met the inclusion criteria. Biopsy at one year was negative in 50/62 (81%) patients. Of the 12 men who tested positive on repeat biopsy, all had a Gleason score of 3+3=6 with either one or two positive cores. The median PSA change was a decrease of 3.0 ng/dL (p < 0.01). The median AUA−SS change was a decrease of 1.5 points (p < 0.01). No significant change was observed in the SHIM score (p = 0.6). No episodes of urinary incontinence or severe side effects were observed. Conclusions TFT in carefully selected patients provides a feasible and practical option for the treatment of low-risk prostate cancer with minimal impact on QOL.
    The Journal of urology 09/2014;
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    ABSTRACT: Rectal swabs can identify men with fluoroquinolone (FQ)-resistant bacteria and reduce rates of infection after transrectal ultrasound guided prostate biopsy (TRUSB) by targeted antimicrobial prophylaxis. We evaluated the rate of FQ resistance in an active surveillance cohort with attention to factors associated with resistance and changes in resistance over time.
    The Journal of urology 08/2014;
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    ABSTRACT: Purpose: Prospective cohort studies support that statin drug users have a lower risk of aggressive prostate cancer. Whether statin drug use influences risk of screen-detected disease is less clear, possibly because of complex detection biases. Thus, we investigated this association in a setting in which men had low baseline serum PSA concentration and were screened annually. Methods: We conducted a cohort study of 9,457 men aged ≥55 years old at randomization to the placebo arm of the Prostate Cancer Prevention Trial. The men reported new use of medications quarterly. We estimated the multivariable-adjusted hazard ratio (HR) of prostate cancer (N=574 in 62,192 person-years) for use of a statin drug and duration of use during the trial using Cox proportional hazards regression. Results: Over seven years of follow up, use of a statin drug during the trial was not associated with risk of total (HR=1.03, 95% CI 0.82-1.30), lower- (HR=0.96, 95% CI 0.71-1.29), or higher-grade (HR=1.27, 95% CI 0.85-1.90) prostate cancer. Duration of use during follow-up also was not associated with risk of total (P-trend=0.7), lower- (P-trend=0.5), or higher- (P-trend=0.2) grade disease. Conclusion: These prospective results do not support the hypothesis that statin drugs protect against prostate cancer in the setting of regular prostate cancer screening.
    The Journal of urology 08/2014;
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    ABSTRACT: Purpose: This study was designed with three objectives: to assess perceptions of untreated hypospadias and quality of life in culturally disparate low- or middle-income countries (LMICs), to highlight the demographic and care differences of patient groups treated for hypospadias in the surgical workshop context, and to evaluate the long-term outcomes achieved by these workshop groups. Materials and Methods: Family member perceptions of hypospadias, perioperative process measures and urethrocutaneous fistula rates were compared between patients in Vietnam and Senegal treated for hypospadias through training workshops by local surgeons and pediatric urologists from the United States from 2009-2012 (n=60), with 42% of patients having previous repair attempts. Results: Over 90% of respondents surveyed felt that untreated hypospadias would affect their child’s future at least to some degree. Patient cohorts between the two sites differed from each other and published high-income country (HIC) cohorts with respect to age, weight-by-age, and frequency of reoperation. Telephone-based outcomes assessment achieved an 80% recall rate. Urethrocutaneous fistula was reported in 39% and 47% of patients in Vietnam and Senegal, respectively. Conclusions: Family members perceived that the social consequences of untreated hypospadias would be severe. Relative to patient cohorts reported in HIC practices, our patients were older, presented with more severe defects, required more reoperations and were often undernourished. Urethrocutaneous fistula rates were higher in both LMIC cohorts relative to published HIC cohorts. Our study argues that outcomes measurement is a feasible and essential component of ethical international health care delivery and improvement.
    The Journal of urology 08/2014;
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    ABSTRACT: Purpose Bladder augmentation with enterocystoplasty is the gold standard therapy for neurogenic bladder (NB). The presence of gastrointestinal segments in the urinary tract has been associated with many complications. We investigated an alternative approach using a small intestinal submucosa (SIS) as scaffold for reconstruction. Materials and Methods We selected eight candidates with poor bladder capacity and compliance for SIS cystoplasty. Candidate ages ranged from 14 to 54 years, and included 6 patients with myelomeningoceles and 2 patients with spinal cord injuries. Serial urodynamics, cystograms, ultrasonography, and serum analyses were used to assess the outcomes of surgery. Results Follow-up range was 11 to 36 months with a mean of 12 months. Compared to the pre-operative findings, there were significant increases in maximum bladder capacity (p < 0.05) at the 3- and 12-month follow-up (170.1 ± 75.7 ml pre-operatively; 365.6 ± 68.71ml at 3 months; and 385.5 ± 52.8 ml at 12 months), an increase in bladder compliance (p < 0.01) at the 12-month follow-up (5.9 ± 4.0 ml/cmH2O pre-operatively; 36.3 ± 30.0 ml/cmH2O at 12 months), and a decrease in maximum detrusor pressure (p < 0.05) at the 12-month follow-up (43.6 ± 35.7 cmH2O pre-operatively; 15.1 ± 7.6 cmH2O at 12 months). Bowel function returned promptly after surgery. No metabolic consequences were noted, and no urinary calculi were observed. Renal function was preserved. Conclusions SIS can be used as a scaffold for rebuilding a functional urinary bladder. Tissue-engineering technology provides a potentially viable option for genitourinary reconstruction in NB patients.
    The Journal of urology 08/2014;
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    ABSTRACT: Purpose Tamsulosin is associated with increased passage of ureteral stones in adults, but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. Methods We performed a multi-institutional retrospective cohort study of children ≤ 18 years who presented between 2007 and 2012 with a ureteral stone ≤ 10 mm and were managed with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Results Of 449 children with ureteral stones, 334 were eligible for inclusion, and complete data were available for 274 children from 4 institutions (99 tamsulosin; 175 analgesics alone). Following case matching, there were no differences in patient age, gender, weight, height, stone size, or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity-score matched subjects prescribed analgesics alone. In the tamsulosin cohort, 55% of ureteral stones passed versus 44% in the analgesics alone cohort (p = 0.03). In multivariate analysis adjusting for stone size and location, tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31; 95% CI 1.49-7.34). Conclusions The odds of spontaneous passage of ureteral stones were higher in children prescribed tamsulosin versus analgesics alone.
    The Journal of urology 08/2014;