The Journal of urology Impact Factor & Information

Publisher: American Urological Association, Elsevier

Journal 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.

Current impact factor: 4.47

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 4.471
2013 Impact Factor 3.753
2012 Impact Factor 3.696
2011 Impact Factor 3.746
2010 Impact Factor 3.862
2009 Impact Factor 4.016
2008 Impact Factor 3.952
2007 Impact Factor 4.053
2006 Impact Factor 3.956
2005 Impact Factor 3.592
2004 Impact Factor 3.713
2003 Impact Factor 3.297
2002 Impact Factor 3.03
2001 Impact Factor 3.19
2000 Impact Factor 2.896
1999 Impact Factor 2.486
1998 Impact Factor 2.685
1997 Impact Factor 2.719
1996 Impact Factor 2.668
1995 Impact Factor 2.792
1994 Impact Factor 2.539
1993 Impact Factor 2.231
1992 Impact Factor 1.91

Impact factor over time

Impact factor

Additional details

5-year impact 4.10
Cited half-life 9.60
Immediacy index 1.13
Eigenfactor 0.07
Article influence 1.27
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


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors pre-print on any website, including arXiv and RePEC
    • Author's post-print on author's personal website immediately
    • Author's post-print on open access repository after an embargo period of between 12 months and 48 months
    • 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
    • Author's post-print may be used to update arXiv and RepEC
    • Publisher's version/PDF cannot be used
    • Must link to publisher version with DOI
    • Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License
    • Publisher last reviewed on 03/06/2015
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Active surveillance (AS) is now the preferred treatment of choice in men with a low-risk prostate cancer. Although there is no consensus on patients who are eligible for AS, PSA above 10 is generally excluded. In an attempt to determine the validity of using PSA cutoff of 10 in counseling men considering AS, we have analyzed a multi-institution database to determine the pathologic outcome in men with PSA greater than 10 but have a histologically favorable-risk prostate cancer. Materials and methods: Prospectively maintained database on men with histologically favorable risk prostate cancer but underwent radical prostatectomy between 2003 and 2015 were queried. The cohort was categorized into three groups based on PSA levels: Low PSA (LP) (<10), Intermediate PSA (IP) (≥10 and <20), and high PSA (HP) (≥20). The associations between PSA group and adverse pathologic and oncologic outcomes were analyzed. Results: Of 2125 patients, 1327 patients were categorized as having a histologically favorable risk disease. In multivariate analyses, however, the rates of upstaging and upgrading were similar between the IP and LP group. In contrast, the HP group had higher incidences of both upstaging (p=0.02) and upgrading to ≥4+3 (p=0.046) compared to the IP group. BCR-free survival rates revealed no pair-wise inter-group differences, except between LP and HP. Conclusion: Patients with elevation of preoperative PSA levels between 10 and 20 who otherwise had histologically favorable-risk PCa were not at higher risk for having adverse pathologic outcomes when compared to men with PSA < 10.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.11.031
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    ABSTRACT: Introduction: Percutaneous Nephrolithotomy (PCNL) has high potential for morbidity or failure. There is limited data regarding risk factors for failure, and no published reports of surgical outcomes among patients with prior failed attempts at percutaneous stone removal. Methods: Patients referred to three medical centers after prior failed attempts at PCNL were identified. Retrospective chart review was performed analyzing reasons for initial failure and outcomes of salvage PCNL. Outcomes were compared to a prospectively maintained database of over 1200 patients undergoing primary procedures. Results: Thirty-one patients underwent salvage PCNL. Unsuitable access to the stone was the leading reason for failure (80%). Other reasons included infection, bleeding, and inadequate instrument availability (6.5% each). Compared to patients undergoing primary PCNL, those undergoing salvage were more likely have staghorn calculi (61.3% vs. 31.4%, p<0.01), larger maximum stone diameter (3.7 cm vs. 2.5 cm, P<0.01), and require secondary procedures (65.5% vs. 42.1%, p<0.01). There was no significant difference between cohorts for the remainder of demographics or perioperative outcomes. All patients were deemed completely stone free except one who elected to observe a 3 mm non-obstructing fragment. Conclusions: Despite the more challenging nature and prior unsuccessful attempts at treatment, outcomes of salvage PNL were no different from primary PNL when treated by experienced surgeons.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.176
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    ABSTRACT: Introduction: and Objectives: Radical cystectomy (RC) is associated with high complication and readmission rates. An understanding of root-causes for readmissions and the modifiability of factors contributing to readmissions may decrease morbidity associated with RC. We sought to characterize indications for readmission following RC and to determine whether these indications represent immutable patient disease and procedure factors or whether they are modifiable. Methods: From MarketScan databases, we identified patients under the age 65 with a diagnosis of bladder cancer undergoing RC between 2008 and 2011 readmitted within 30 days of RC. All associated ICD-9 codes within the index admission, subsequent outpatient claims, and readmission claims were independently reviewed by three surgeons to determine a root-cause for readmission. Causes were broadly categorized as being medical, surgical, or infectious, and reviewers determined whether the readmission was modifiable. Multivariate logistical regression models were used to identify factors associated with readmission. Results: 1,163 patients were included. 242 (21%) patients were readmitted within 30 days. 26% of readmissions were considered modifiable (kappa=0.71). Of non-modifiable readmissions, an infectious cause accounted for 52% and a medical cause accounted for 48%. Of the modifiable readmissions, 62% were due to surgical, 30% to medical, and 8% to infectious causes. On multivariate analysis, only discharge to a skilled nursing facility was associated with either modifiable (OR 6.12, 95% CI 2.32-16.14) or non-modifiable readmissions (OR 3.27, 95% CI 1.63-6.53). Conclusions: The majority of readmissions following RC are attributable its inherent morbidity. However, optimization of aspects of peri-cystectomy care could minimize RC's morbidity.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.175
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    ABSTRACT: Purpose: To evaluate the efficacy and safety of External Physical Vibration Lithecbole in improving the clearance rates of lower pole renal stones after shock wave lithotripsy (SWL). Materials and methods: A total of 71 patients with lower pole renal stones (6-20mm) were prospectively randomized into two groups. In treatment group (n=34), patients were treated with External Physical Vibration Lithecbole after SWL; in control group (n=37), only SWL were given. External Physical Vibration Lithecbole was performed without anesthesia by the same team using Friend-I External Physical Vibration Lithecbole (Fu Jian Da Medical Instrument Co., Ltd, Zhengzhou, China). Stone free rate, stone expulsion rate, stone expulsion time, and incidence of complications were monitored. Results: External Physical Vibration Lithecbole was successful at assisting stone fragments discharge. The stone-free state was 76.5% in the treatment group and 48.6% in the control group (p=0.008). Stone expulsion rate on day 1, week 1 and week 3 was 76.5% (26/34), 94.1% (32/34) and 94.1% (32/34) in the treatment group compared to 43.2% (16/37), 73.0%(27/37) and 89.2%(33/37) in the control group. The mean expulsion time of the stone fragments was 11.2 mins in the treatment group and 9.17 hours in the control group (p=0.016). There was no significantly difference in complications between the two groups(P>0.05). Conclusions: External Physical Vibration Lithecbole was efficacious in helping lower pole renal stone fragments discharge, and can be used as an adjunctive method of stone minimally invasive treatment. However, there still need more investigations to confirm the efficacy.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.174
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    ABSTRACT: Purpose: Renal cell cancer (RCC) incidence is relatively low in younger patients, encompassing 3-7% of all RCC tumors. While young patients may develop renal tumors due to hereditary syndromes, some develop sporadic renal cancers without any family history or known genetic mutations. Our recent observations from clinical practice have led us to hypothesize that there is a difference in histologic distribution in the younger patients when compared to the older cohort. Methods: SEER 18-registries database was queried for all patients ≥20 years old that were surgically treated for renal cell carcinoma between the years 2001 and 2008. Patients with unknown race, grade, stage, histology and those with multiple tumors were excluded from the study. Four cohorts were created separated by gender and age ≤40 with 1,202 and 1,715 females and males, respectively, and those >40 years old with 18,353 and 30,891 females and males, respectively. Chi-square analysis was used to compare the histologic distributions between the cohorts. Results: While clear cell carcinoma was still the most common RCC subtype across all genders and ages, chromophobe RCC was the most predominant type of non-clear RCC histology in young females encompassing 62.3% of all non-clear cell RCC (p<0.0001). In all other groups, papillary RCC remained the most common type of non-clear RCC. Discussion: It is possible that hormonal factors or specific pathway dysregulations predispose younger women to develop chromophobe RCC. We hope that this work provides some new observations that could lead to further studies of gender- and histology-specific renal tumorigenesis.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.177
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    ABSTRACT: Purpose: To delineate clinical features and determine predictors of chronic kidney disease (CKD) during long-term follow-up until post-puberty in vesicoureteral reflux (VUR) patients undergoing surgical treatment. Materials and methods: The data of 101 patients who were surgically treated for VUR and had gone through puberty were analyzed. Patients received a pre- and post-operative voiding cystourethrography to assess VUR status, and a dimercaptosuccinic acid scan to assess renal cortical defects. We compared the following variables: body mass index, blood urea nitrogen, creatinine and uric acid levels, estimated-glomerular filtration rate (e-GFR), micro-albuminuria, blood pressure, renal function, and renal scarring in pre-operative and post-puberty patients. Kaplan-Meier analysis was used to predict CKD-free survival rates throughout the follow-up periods. Cox regression model was adopted to identify independent predictors of CKD. We defined CKD as e-GFR was less than 60 mL/min/1.73 m(2). Results: The median follow-up duration was 100.0 months [Interquartile range (IQR): 69.0 - 136.5]. The median age was 16 years at last follow-up (IQR: 14 - 18). Until post-puberty, 11 patients (10.9%) were diagnosed with de novo CKD. Notably, serum uric acid levels [Hazard ratio (HR)=1.96] and the presence of high-grade reflux (HR=7.40) were significant predictors of developing CKD in multivariate analysis. Conclusions: In patients who were surgically treated for VUR in childhood, pre-operative uric acid levels and high-grade reflux were independent predictors for de novo CKD development during follow-up until post-puberty. Our results offer valuable information to predict long-term renal outcomes in VUR patients undergoing surgery.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.11.004

  • The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.11.003
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    ABSTRACT: Purpose: To define sonographic biomarkers for hydronephrotic renal units that can predict the necessity of diuretic nuclear renography. Materials and methods: A cohort of 50 consecutive hydronephrotic patients of variable severity with concurrent 2D-sonograms and MAG-3 was selected. 131 morphological parameters were computed using quantitative image analysis algorithms. Machine learning techniques were then applied to identify ultrasound-based safety thresholds that agree with the half-time for washout. A best-fit model was then derived for each threshold levels of half-time that would be clinically relevant at 20, 30 and 40 minutes. Receiver operating characteristic curve analysis was performed. Sensitivity, specificity and area under the receiver operating characteristic curve were determined. The improvement obtained by the quantitative imaging method over the Society for Fetal Urology grading system and the hydronephrosis index was statistically verified. Results: For the three thresholds considered, and at 100% sensitivity, the specificities of the quantitative imaging method were 94, 70 and 74%, respectively. The area under the receiver operating characteristic curve values were 0.98, 0.94 and 0.94, respectively. The improvement obtained by the quantitative imaging method over the Society for Fetal Urology grade and the hydronephrosis index was statistically significant (p < 0.05 in all the cases). Conclusions: Quantitative imaging analysis of renal sonograms in children with hydronephrosis can identify thresholds of clinically significant washout times with 100% sensitivity to reduce the number of diuretic renograms in up to 62% of children.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.173
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    ABSTRACT: Purpose: There is paucity of data regarding the operative management of complications following robot-assisted radical cystectomy (RARC). We aimed to review the operative management of RARC-specific complications during our 10-year experience of RARC, and to assess the feasibility, safety and outcomes of robot-assisted reoperations. Materials and methods: We retrospectively reviewed all the patients who received surgical interventions for RARC-specific complications between 2005 and 2015. Univariable and multivariable logistic regression models were fit to evaluate predictors of receiving surgical intervention following RARC. Kaplan Meier curves were used to describe times to surgical interventions. Results: 92 patients (23%) received surgical interventions following RARC. Mean follow up was 27 months. The average time to any surgical intervention after RARC was 14 months. The reoperation rates were 5%, 2% and 16% at 30-d, 30-90-d, and >90-d respectively. Using the Kaplan Meier method, surgical interventions occurred at a rate of 30% at 2 years and 46% at 5 years. Interventions for uretero-ileal complications were the most common (n=48), followed by interventions for bowel obstruction, fistulae, and abdominal wall-related complications (n=11). Clavien ≥ 3 complications and receipt of neoadjuvant chemotherapy were associated with surgical interventions. Conclusions: Even in experienced hands, the long term complications of RARC are notable. 23% of our patients required surgical interventions after RARC. Our initial experience with robot-assisted management of RARC complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.171

  • The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.11.001
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    ABSTRACT: Purpose: Detection of DNA hypermethylation has emerged as novel molecular biomarker for prostate cancer (Pca) diagnosis and evaluation of prognosis. We intend to define whether a hypermethylation profile of patients with PCa under androgen deprivation (AD) predicts development of castrate-resistant prostate cancer. Material and methods: Genome-wide methylation analysis was performed using the GoldenGate Methylation Cancer Panel-I (Illumina,Inc.) on 10 normal prostates and 45 tumor samples from patients placed on AD and followed until development of castrate-resistant disease defined following EAU Guidelines criteria. Double pathologist review evaluated Gleason score, ki-67index and neuroendocrine differentiation. Hierarchical clustering analysis was performed and relationships with outcome were investigated using Cox regression and log-rank analysis. Results: We found 61 genes significantly hypermethylated in >20% of the tumors analyzed. Three clusters of patients were characterized by their DNA methylation profile, one at risk to develop earlier castrate-resistant disease (log-rank,p=0.019) and specific mortality (log-rank,p=0.002). Hypermethylation of ETV1 (HR3.75) and ZNF215 (HR2.89) predicted disease progression despite AD and hypermethylation of IRAK3 (HR13.72), ZNF215 (HR4.81) and SEPT9 (HR7.64) were independent markers of prognosis. PSA>25ng/ml, Gleason pattern 5, Ki-67index>12% and metastasis at diagnosis were also predictors of a negative response to AD. Limitations included retrospective design and limited series number. Conclusion: Epigenetic silencing of the aforementioned genes could be novel molecular markers for prognosis of advanced PCa and predict development of castrate-resistance during hormone deprivation and, consequently, disease-specific mortality. Gene hypermethylation is associated with disease progression in patients receiving hormone therapy and could be used as marker of treatment response.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.172
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    ABSTRACT: Purpose: Standardized assessment for laparoscopic skill in Urology is lacking. This work investigates whether the AUA BLUS skill tasks are valid in addressing this need. Materials and methods: This IRB-approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites. Using the Simulab EDGE device, a total of 454 recordings were collected including Peg Transfer, Pattern Cutting, Suturing, and Clip applying tasks, which together comprise the expert-determined BLUS tasks. We collected synchronized video and tool motion data for each trial. For each task, errors, time, path length, economy of motion, peak grasp force and "EDGE score" were collected. An expert faculty panel (N=5) performed GOALS evaluations on a representative subset of Peg Transfer and Suturing skill tasks (N=24, IRR=0.95). Results: Demographically-derived skill levels proved unsuitable for evaluating construct validity. Separation of mean scores by grouped skill levels was strongest for the suturing task. Objective motion metrics and errors supported construct validity vis-à-vis correlation with blinded expert video ratings (R(2) = 0.95 at p < 0.01 for motion metrics). Expert scores appeared to reward errors in suturing but not block transfer. Conclusions: BLUS skill tasks performance scoring can discriminate basic laparoscopic technical skill level. Self-reported demographics are an unreliable source for determining laparoscopic technical skill.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.087
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    ABSTRACT: Purpose: Ultrasonic propulsion is a new technology using focused ultrasound energy applied transcutaneously to reposition kidney stones. We report the findings from the first human investigational trial of ultrasonic propulsion toward the applications of expelling small stones and dislodging large obstructing stones. Materials and methods: Subjects underwent ultrasonic propulsion either awake without sedation in clinic or during ureteroscopy while anesthetized. Ultrasound imaging and a pain questionnaire were completed before, during, and after propulsion. The primary outcome was to reposition stones in the collecting system. Secondary outcomes included safety, controllable movement of stones, and movement of stones < 5 mm and ≥ 5 mm. Adverse events were assessed weekly for 3 weeks. Results: Kidney stones were repositioned in 14 of 15 subjects. Of the 43 targets, 28 (65%) showed some level of movement while 13 (30%) were displaced > 3 mm to a new location. Discomfort during the procedure was rare, mild, brief, and self-limited. Stones were moved in a controlled direction with over 30 fragments being passed by 4 of 6 subjects who previously had a lithotripsy procedure. The largest stone moved was 10 mm. One patient experienced pain relief during treatment of a large stone at the UPJ. In 4 subjects a seemingly large stone was determined to be a cluster of small passable stones once moved. Conclusions: Ultrasonic propulsion was able to successfully reposition stones and facilitate passage of fragments in humans with no adverse events associated with the investigational procedure.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.131
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    ABSTRACT: Purpose: Our aim was to assess survival dependent on pathologic response after neoadjuvant chemotherapy (NAC) in a large multicenter patient cohort, with particular focus on the difference between absence of residual cancer (pT0) and the presence of only non-muscle invasive residual cancer (pTa, pTis, pT1). Materials and methods: We retrospectively reviewed records of patients with urothelial cancer who received NAC and underwent radical cystectomy (RC) at 19 contributing institutions from 2000-2013. Patients with cT2-4aN0M0 and eventual pN0 disease were selected for this analysis. Estimated overall survival (OS) was compared between pT0 and pTa/Tis/T1 patients. Multivariable Cox proportional hazards regression model for OS was generated to evaluate hazard ratios (HRs) for variables of interest. Results: Of 1543 patients undergoing NAC and RC during the study period, 257 were pT0N0 and 207 were pTa/Tis/T1N0. The Kaplan-Meier mean estimates of OS for pT0 and pTa/Tis/T1 patients were 186.7 mo. (95% CI [145.9-227.6]) (median 241.1) and 138 mo. (95% CI [118.2-157.8]) (median 187.4), respectively (p=0.58). In the Cox proportional hazards regression model for OS, pTa/Tis/T1N0 status (HR: 0.36 [95% CI, 0.23-0.67]) and pT0N0 status (HR: 0.28 [95% CI, 0.17-0.47]) compared to pT2N0 pathology, positive surgical margin (HR: 1.75 [95% CI, 1.07-2.86]), and receiving MVAC regimen compared to "other" regimen (HR: 0.45 [95% CI, 0.27-0.76]) were predictors of OS. Conclusions: pTa/Tis/T1N0 and pT0N0 stage on the final cystectomy specimen are strong predictors of survival in patients receiving NAC and RC. We did not discern a statistically significant difference in OS when comparing these two endpoints.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.133
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    ABSTRACT: Purpose: In 2012, the American Urological Association released a revision of their asymptomatic microscopic hematuria (AMH) guidelines. Our objectives were to assess adherence to these guidelines and to describe the prevalence of urinary tract malignancy in postmenopausal women at our institution. Materials and methods: This is a cross-sectional analysis of women over age 55 evaluated by Urogynecology or Urology from 8/2012-8/2014 for a diagnosis of AMH. Women who underwent evaluation for ≥3 RBC/HPF on microscopic urinalysis were considered "true AMH." Those who were evaluated after a dipstick with blood and had <3 RBC/HPF on urinalysis or no urinalysis were considered "positive dipstick." Demographics, laboratory values, imaging results, and cystoscopy findings were extracted from electronic medical records. Results: Our study population included 237 women (mean age 67.1±8.3 years). In our overall population 169/237(71.3%) had true AMH, 48/237(20.3%) had a positive dipstick, and 20/237(8.4%) underwent evaluation in the setting of a urinary tract infection. We detected 3(1.4%) urinary tract malignancies. One kidney cancer was identified in a 56 year-old, current smoker with a urine dipstick of 1+ blood. Two instances of bladder cancer were detected in women aged 58 and 64, one current and one nonsmoker with 6 and 42 RBC/HPF on urinalyses respectively. Conclusions: In postmenopausal women evaluated for AMH, the overall prevalence of urinary tract malignancy was low (1.4%). In our population, 28.7% underwent evaluation without meeting guideline criteria for AMH. This demonstrates an opportunity to improve adherence to existing guidelines to provide high-quality care and avoid unnecessary, expensive testing.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.136
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    ABSTRACT: Purpose: We report our experience with pelvic organ prolapse (POP) recurrence after native tissue repair for Stage 2 anterior prolapse. Materials and methods: We reviewed a prospectively maintained, IRB-approved, database of women with symptomatic Stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension (AVWS) between 1996 and 2014. Women with concurrent POP repair or hysterectomy or without 1 year follow-up were excluded. Failure was defined as ≥ Stage 2 prolapse recurrence on examination or re-operation for symptomatic POP. Outcome measures included validated questionnaires (UDI-6, QoL), physical examination, standing voiding cystourethrogram at 6 months post-operatively, further surgery for POP in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. Results: 121 women met inclusion criteria, with a mean follow-up at 5.8 ± 3.7 years. Prolapse recurrence rates were: isolated anterior (7.4%), isolated apical (10.7%), isolated posterior (8.3%), multiple compartments (19%). Surgery for recurrent prolapse included: anterior compartment: 3.3% at 1.4 ±1.0 years, apical: 9.9% at 2.8 ± 3.0 years, posterior compartment: 5.8% at 2.0 ± 1.0 years, and multiple compartments: 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and 5.7% rate of 30 day complications (all Clavien I). Conclusions: AVWS for symptomatic Stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and low anterior recurrence rate at intermediate to long-term follow-up. However, 33% required secondary prolapse compartment procedures from 0.6-13 years later, highlighting the importance of long term follow-up.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.138
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    ABSTRACT: Purpose: To evaluate and compare laser fibers claiming to have lithotripsy performance-enhancing features to a standard laser lithotripsy fiber. Materials and methods: A special polished tip (PT) fiber (AccuMax 200) and a ball-shaped tip (BT) fiber (AccuTrac) (both with a ≈240-μm core and from Boston Scientific™) were compared to a standard 272-μm core fiber (Rocamed™). The PT and BT fibers were used and re-used without preparation. The standard fiber was stripped and cleaved according to the manufacturer's instructions after each experiment. An automated laser fragmentation testing system performed multiple 30-second-long laser-lithotripsy experiments. To mimic most typical lithotripsy conditions, soft and hard stone material was used with high-frequency low-pulse energy (HiFr-LoPE; 20Hz × 0.5J) or low-frequency high-pulse energy (LoFr-HiPE; 5Hz × 2.0J) lithotripter settings. Ablation volumes and laser-fiber-tip photos before and after lithotripsy were compared. Results: The standard and BT fibers did not differ in terms of ablation volume (p=0.72) but ablated 174% and 188% more stone than the PT fiber, respectively (p<0.0001). The BT fiber exhibited remarkable fiber tip degradation after short-term use with LoFr-HiPE settings. If high-pulse energy settings (even short-term use) had been used previously, the ablation volume achieved by the PT and BT fibers at HiFr-LoPE settings declined by more than 20%. Conclusions: The standard laser fiber was as good as and sometimes even better than the specially designed fibers. The rapid degradation of the specially designed laser-fiber tips strongly limits their general usefulness but BT fibers may be very useful in very specific situations.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.135
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    ABSTRACT: Purpose: Limited information exists about whether exogenous testosterone therapy (eTT) is associated with risk of venous thrombotic events (VTE). Here, we investigate via cohort and nested-case-control analyses whether eTT administration is associated with risk of VTE in men with hypogonadism. Materials and methods: Databases were reviewed to identify men prescribed eTT and/or men with a hypogonadism diagnosis. Propensity-score 1:1 matching was used to select patients for the cohort analysis. Cases (men with VTE) were matched 1:4 with controls (men without VTE) for the nested-case-control analysis. Primary outcome was defined as incident idiopathic VTE; Cox regression and conditional-logistic regression were used to assess hazard ratios (HRs) and odds ratios (ORs), respectively. Sensitivity analyses were also performed. Results: 102,650 eTT-treated patients and 102,650 untreated patients were included in the cohort analysis after matching; 2785 cases and 11,119 controls were included in the case-control analysis. Cohort analysis revealed an HR of 1.08 for all eTT-treated patients (95% CI: 0.91, 1.27; p=0.378). Case-control analysis resulted in OR=1.02 (95% CI: 0.92, 1.13; p=0.702) for current eTT exposure and 0.92 (95% CI: 0.82, 1.03; p=0.145) for past eTT exposure. These results remained non statistically significant after stratifying by eTT-administration-route and age category. Results from most of the sensitivity analyses yielded results that were consistent. Conclusions: No significant association was found between eTT and incidents of idiopathic VTE, as well as overall VTE in men with hypogonadism; however, some discrepant findings exist for the association between injectable formulations and overall VTE risk.
    The Journal of urology 11/2015; DOI:10.1016/j.juro.2015.10.134