L A L M Kiemeney

Publications (43)110.98 Total impact

• Article: De rol van de integrale kankercentra bij de uitvoering van patient-controle onderzoek

  J.W.J. van der Gulden, L.A.L.M. Kiemeney, R.P. Heijbroek
  Tijdschrift voor sociale gezondheidszorg. 02/2013; 1993(71):126.
• Article: Risk of prostate cancer among cancer survivors in the Netherlands.

  D E G Kok, S A M van de Schans, L Liu, E Kampman, J W W Coebergh, L A L M Kiemeney, I Soerjomataram, K K H Aben
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  ABSTRACT: BACKGROUND: In parallel with increasing numbers of cancer patients and improving cancer survival, the occurrence of second primary cancers becomes a relevant issue. The aim of our study was to evaluate risk of prostate cancer as second primary cancer in a population-based setting. METHODS: Data from the Netherlands Cancer Registry were used to estimate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for prostate cancer as second primary cancer. The effect of time since first cancer diagnosis, specific first cancer sites, age, and pelvic radiotherapy was taken into account. RESULTS: Out of 551,553 male patients diagnosed with a first primary cancer between 1989 and 2008, 9243 patients were subsequently diagnosed with prostate cancer. Overall, cancer survivors showed an increased risk (SIR 1.3, 95% CI 1.2-1.3) of prostate cancer. The increased prostate cancer risk was limited to the first year of follow-up for the majority of the specific first cancer sites. More than 10 years after the first cancer diagnosis, only melanoma patients were at increased risk (SIR 1.5, 95% CI 1.2-1.9), while patients with head or neck cancers were at decreased risk (SIR 0.7, 95% CI 0.5-0.9) of being diagnosed with prostate cancer. Patients who underwent primary pelvic radiotherapy for their first cancer had a decreased risk of prostate cancer in the long term (SIR 0.5, 95% CI 0.4-0.6). CONCLUSIONS: Our data showed that cancer survivors have an increased prostate cancer risk in the first year following a first cancer diagnosis, which is most likely the result of active screening or incidental detection.
  Cancer epidemiology. 12/2012;
• Article: New insights into the aetiology of scrotal cancer, a nationwide case-control study in the Netherlands.

  R H A Verhoeven, K K H Aben, M M van Rossum, A M Reedijk, A A Botterweck, L Veerbeek, O Visser, M A van der Aa, V K Y Ho, J W W Coebergh, L A L M Kiemeney
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  ABSTRACT: Background  Although scrotal cancer is traditionally regarded as an occupational disease, there is increasing evidence that factors which are involved in cutaneous and genital carcinogenesis might play a role in the carcinogenesis of scrotal cancer. Objective  This exploratory study aimed to detect exposures that might have an aetiological relation with scrotal cancer. Methods  A nationwide population-based case-control study was conducted in the Netherlands. The patients were identified through the Netherlands cancer registry. Controls were recruited among acquaintances of the cancer registry registrars. The participants completed a questionnaire that included questions on occupational exposures, naked sunbathing, use of sunbeds, skin diseases and their treatments, treatments for cancer and sexually transmitted diseases. Age-adjusted odds-ratios (ORs) were calculated. Results  Forty-seven scrotal cancer patients and 125 controls completed the questionnaire. The patients were categorized according to histology of the scrotal tumours. Having had a skin disease (OR = 6.3, 95% CI = 1.8-22), especially psoriasis (OR = 8.7), increased the risk of squamous cell carcinomas (SCC) of the scrotum. A previous cancer diagnosis may affect the risk of scrotal basal cell carcinomas (BCC; OR = 4.9, 95% CI = 0.9-27.3). Furthermore, an association between the number of sexual partners and the occurrence of scrotal sarcoma was found. Conclusion  Scrotal SCCs may be related with skin diseases or skin disease treatments. Having had cancer may be a risk factor for a BCC of the scrotum. Scrotal sarcomas seem to be correlated with the number of sexual partners. This study suggests that scrotal cancer has characteristics of both cutaneous and genital carcinogenesis.
  Journal of the European Academy of Dermatology and Venereology 12/2012; · 2.98 Impact Factor
• Article: [The Dutch Cancer Society Cancer Risk Test].

  Sjoerd G Elias, Hilda G Grooters, R A Sandra Bausch-Goldbohm, Piet A van den Brandt, Ellen Kampman, Flora E van Leeuwen, Petra H M Peeters, Esther de Vries, Stefan Wigger, L A L M Bart Kiemeney
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  ABSTRACT: The Dutch Cancer Society developed the 'KWF Kanker Risico Test' (Cancer Risk Test) to improve the information available to the Dutch population regarding cancer risk factors. This Internet test, based under licence on the American 'Your Disease Risk' test, informs users about risk factors for 12 common types of cancer. The test provides an estimate of individual risk of a specific type of cancer and gives specific lifestyle advice that could lower that risk. This paper describes the development of the test, how it works, and its strengths and limitations.
  Nederlands tijdschrift voor geneeskunde 01/2012; 156(21):A4888.
• Article: DNA adducts in skin biopsies and 1-hydroxypyrene in urine of psoriasis patients and healthy volunteers following treatment with coal tar.

  J H J Roelofzen, P G M van der Valk, R Godschalk, G Dettbarn, A Seidel, L Golsteijn, R Anzion, K K H Aben, F J van Schooten, L A L M Kiemeney, P T J Scheepers
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  ABSTRACT: Coal tar ointments (CTO) are frequently used in the treatment of psoriasis and eczema, but CTO contain carcinogenic polycyclic aromatic hydrocarbons (PAH). PAH are absorbed and metabolized in the skin. In psoriasis, the skin barrier is altered and therefore, absorption and metabolism of PAH may differ from healthy skin. In this study, levels of urinary 1-hydroxypyrene and PAH-DNA adducts in the skin were studied in psoriatic patients and healthy volunteers. Three punch biopsies were taken from the lower back of 10 male volunteers and from a psoriatic plaque in 10 male patients. A surface of 6.25 cm(2) was treated with CTO. After 96 h CTO was removed and another three skin biopsies were collected from the treated area. DNA was isolated from skin biopsies and urine was collected during and after the exposure period. After 24h, a twofold lower 1-hydroxypyrene urinary excretion was observed in patients compared to healthy volunteers and after 48 h, this difference reached statistical significance (p<0.05). Over 96 h the median level of the sum of PAH-DNA adducts, analyzed by (32)P-post-labeling, increased from 3.5 before CTO administration to 21.1 adducts per 10(8) nucleotides in volunteers, and from 1.0 to 3.6 adducts per 10(8) nucleotides in patients. At 96 h, PAH-DNA levels were higher in healthy volunteers than in patients (p<0.05). Biomarkers for uptake, bioavailability and bioactivation of PAH were lower in patients compared to volunteers. These data suggest a lower risk of carcinogenic effects of CTO in psoriatic skin compared to healthy skin.
  Toxicology Letters 07/2011; 213(1):39-44. · 3.23 Impact Factor
• Article: Blood lipid levels and prostate cancer risk; a cohort study.

  D E G Kok, J G H van Roermund, K K H Aben, M den Heijer, D W Swinkels, E Kampman, L A L M Kiemeney
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  ABSTRACT: It has been hypothesized that blood lipid levels might be associated with prostate cancer risk. The aim of the present study was to evaluate the association between serum total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides and prostate cancer risk in a cohort study among 2842 Dutch men. By the end of follow-up, 64 incident cases of prostate cancer were identified. Serum total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were evaluated as potential risk factors for prostate cancer using multivariable Cox proportional hazards regression models. These analyses were restricted to men who never used cholesterol-lowering drugs (2118 men, 43 cases). Higher total and higher LDL cholesterol were significantly associated with an increased risk of prostate cancer (hazards ratios (HR) and 95% confidence interval (CI) per mmol l(-1) were 1.39 (95% CI 1.03-1.88) and 1.42 (95% CI 1.00-2.02), respectively). Similar results were observed for aggressive prostate cancer, whereas for non-aggressive prostate cancer a significant association with HDL cholesterol was found (HR 4.28, 95% CI 1.17-15.67). The results of this study suggest that blood lipid levels may influence risk of prostate cancer. However, the exact roles of different cholesterol fractions on prostate cancer aggressiveness should be further evaluated.
  Prostate cancer and prostatic diseases 07/2011; 14(4):340-5. · 2.10 Impact Factor
• Source

  Available from: PubMed Central

  Article: Downstaging of TURBT-Based Muscle-Invasive Bladder Cancer by Radical Cystectomy Predicts Better Survival.

  P R van Dijk, M Ploeg, K K H Aben, P C Weijerman, H F M Karthaus, J Th H van Berkel, A C Viddeleer, A Geboers, E van Boven, J A Witjes, L A L M Kiemeney
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  ABSTRACT: Differences between clinical (cT) and pathological tumor (pT) stage occur often after radical cystectomy (RC) for muscle-invasive bladder cancer. In order to evaluate the impact of downstaging on recurrence and survival, we selected patients from a large, contemporary, population-based series of 1,409 patients with MIBC. We included all patients who underwent RC (N=643) and excluded patients who received (neo)adjuvant therapy, those with known metastasis at time of diagnosis, and those with nonurothelial cell tumors. Disease outcomes were defined as recurrence-free survival (RFS) and relative survival (RS), as a good approximation of bladder cancer-specific survival. After applying the exclusion criteria, 375 patients were eligible for analysis. Tumor downstaging was found to be common after RC; in 99 patients (26.4%), tumor downstaging to non-muscle-invasive stages at RC occurred. Hydronephrosis at baseline and positive lymph nodes at RC occurred significantly less often in these patients. In 62 patients, no tumor was left in the cystectomy specimen. pT stage was pT1 in 20 patients and pTis in 17 patients. Patients with tumor downstaging have about a 30% higher RFS and RS compared to those without. Consequently, tumor downstaging is a favorable marker for prognosis after RC.
  ISRN urology. 01/2011; 2011:458930.
• Article: [Responsible cancer screening].

  André L M Verbeek, Jos A A M van Dijck, Labertus A L M Kiemeney, Mirelle J M Broeders
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  ABSTRACT: In the Netherlands, national screening programs for breast and cervical cancer are operating, whilst that for colorectal cancer is in preparation. In the meantime, experimental studies have been conducted into the effectiveness of prostate and lung cancer screening. Death from these five types of cancer is reduced by these screening investigations. However, these screening programmes also have disadvantages, such as unnecessary referral for definitive diagnosis in the hospital. The average hospital would receive on a yearly basis via screening 156 referrals of women with breast cancer, 79 for cervical cancer and nearly 1100 persons for colorectal cancer. n average general practice encounters annually 3 positive screening results for breast cancer, almost 1 referral for cervical carcinoma or an early stage thereof, and every two years a patient with CIN III. For colorectal cancer around 22 referrals can be expected yearly, of which 8 will have adenoma or cancer.
  Nederlands tijdschrift voor geneeskunde 01/2011; 155(45):A3934.
• Article: Prostate cancer: trends in incidence, survival and mortality in the Netherlands, 1989-2006.

  R G H M Cremers, H E Karim-Kos, S Houterman, R H A Verhoeven, F H Schröder, T H van der Kwast, P J M Kil, J W W Coebergh, L A L M Kiemeney
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  ABSTRACT: Prostate cancer occurrence and stage distribution changed dramatically during the end of the 20th century. This study aimed to quantify and explain trends in incidence, stage distribution, survival and mortality in the Netherlands between 1989 and 2006. Population-based data from the nationwide Netherlands Cancer Registry and Causes of Death Registry were used. Annual incidence and mortality rates were calculated and age-adjusted to the European Standard Population. Trends in rates were evaluated by age, clinical stage and differentiation grade. 120,965 men were newly diagnosed with prostate cancer between 1989 and 2006. Age-adjusted incidence rates increased from 63 to 104 per 100,000 person-years in this period. Two periods of increasing incidence rates could be distinguished with increases predominantly in cT2-tumours between 1989 and 1995 and predominantly in cT1c-tumours since 2001. cT4/N+/M+-tumour incidence rates decreased from 23 in 1993 to 18 in 2006. The trend towards earlier detection was accompanied by a lower mean age at diagnosis (from 74 in 1989 to 70 in 2006), increased frequency of treatment with curative intent and improved 5-year relative survival. Mortality rates decreased from 34 in 1996 to 26 in 2007. The increase of prostate cancer incidence in the early 1990s was probably caused by increased prostate cancer awareness combined with diagnostic improvements (transrectal ultrasound, (thin) needle biopsies), but not PSA testing. The subsequent peak since 2001 is probably attributable to PSA testing. The decline in prostate cancer mortality from 1996 onwards may be the consequence of increased detection of cT2-tumours between 1989 and 1995. Unfortunately, data on the use of PSA tests and other prostate cancer diagnostics to support these conclusions are lacking.
  European journal of cancer (Oxford, England: 1990) 07/2010; 46(11):2077-87. · 4.12 Impact Factor
• Article: Should random urothelial biopsies be taken from patients with primary superficial bladder cancer? A decision analysis

  L. A. L. M. KIEMENEY, J. A. WITJES, R. P. HEIJBROEK, N. P. KOPER, A. L. M. VERBEEK, F. M. J. DEBRUYNE, The Members Of The Dutch South-East Co-Operative Urological Group
  BJU International 11/2008; 73(2):164 - 171. · 2.84 Impact Factor
• Article: [The risk of cancer in the Netherlands].

  L A L M Kiemeney, F A M O Lemmers, R H A Verhoeven, K K H Aben, C Honing, J de Nooijer, P H M Peeters, O Visser, F A Vlems
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  ABSTRACT: Calculation of valid and detailed risks of cancer from, and up to, specific ages for inhabitants of the Netherlands. Secondary analyses of cancer incidence and mortality rates. Gender and age-specific incidence rates of 56 different types of cancer were obtained from the Netherlands Cancer Registry. Gender and age-specific mortality rates were obtained from Statistics Netherlands. Using survival charts, risks of cancer were calculated from all ages and up to all ages, in steps of 5 years. The US National Cancer Institute's software programme DevCan was used for analyses. One out of every 2.3 newborn males (43.9%) and one out of every 2.6 newborn females (38.1%) in the Netherlands will develop cancer sometime during their life. The risk of developing cancer before the age of 80 is 35.9% for newborn males and 30.2% for newborn females. Women run the greatest risk of developing breast cancer (almost 13%). 50-year-old women have a risk of almost 3% of being diagnosed with breast cancer before the age of 60. Men have the greatest risk of a diagnosis of prostate cancer (almost 10%). The risk for a 50-year-old man of being diagnosed with prostate cancer within the subsequent 10 years however is less than 1%. Detailed rates of risks of cancer are useful for policy issues such as decisions to implement screening programmes, for public education, and for patient counselling, as in the field of clinical genetics. The routinely reported risks for newborns developing cancer before the age of 75 lack the necessary detail for such use.
  Nederlands tijdschrift voor geneeskunde 11/2008; 152(41):2233-41.
• Source

  Available from: PubMed Central

  Article: Maximum tumor diameter is not an independent prognostic factor in high-risk localized prostate cancer.

  I M van Oort, J A Witjes, D E G Kok, L A L M Kiemeney, C A Hulsbergen-vandeKaa
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  ABSTRACT: Previous studies suggest that maximum tumor diameter (MTD) is a predictor of recurrence in prostate cancer (PC). This study investigates the prognostic value of MTD for biochemical recurrence (BCR) in patients with PC, after radical prostatectomy (RP), with emphasis on high-risk localized prostate cancer. RP specimens of 542 patients were evaluated with a median follow-up of 39.5 months (range 0.6-150 months). MTD was defined as the largest diameter of the largest tumor; high-risk as >or=T2c or PSA level>20 ng/ml or Gleason score>or=8 and BCR as two consecutive PSA levels>0.10 ng/ml. Proportional hazards multivariable regression models were composed to determine prognostic factors for BCR. Overall, 114 patients developed BCR after RP. The overall 5-year risk of BCR was 25% (95% CI=20.4-29.6), and median MTD was 24 mm (range 1-65). MTD in the total and high-risk group was associated with total tumor volume, volume of the largest tumor, pre-operative PSA levels, and Gleason score. In a univariable analyses, MTD was weakly associated with risk of BCR (HR=1.02 per mm increase, 95% CI=1.002-1.035, P=0.024) in the total group; in the high-risk group this association was lost (HR=1.01, 95%CI=0.99-1.03, P=0.18). Multivariable analyses indicated that positive surgical margins, higher Gleason score, advanced pathological stage, and multiple tumors were the main prognostic factors for BCR irrespective of the risk profile. MTD did not provide additional information. MTD is not an independent prognostic factor for BCR in patients treated with RP, irrespective of the risk profile.
  World Journal of Urology 06/2008; 26(3):237-41. · 2.41 Impact Factor
• Article: Expert review remains important in the histopathological diagnosis of cutaneous melanocytic lesions.

  M C R F van Dijk, K K H Aben, F van Hees, A Klaasen, W A M Blokx, L A L M Kiemeney, D J Ruiter
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  ABSTRACT: To assess the type of problems encountered in diagnosing melanocytic lesions and to evaluate the contribution of expert review. Data from 1887 lesions submitted for consultation to one of the expert pathologists of the Dutch Melanoma Working Group Pathology Panel between 1991 and 2004 were analysed. Referring pathologists can voluntarily submit lesions which are difficult to classify to the panel. Most cutaneous melanocytic lesions (n = 1217) were submitted with a presumed diagnosis by the referring pathologists. Relevant underdiagnoses of melanoma (in situ) and overdiagnoses of naevi were prevented in 12% (144/1217) and 15% (178/1217) of cases, respectively. Problematic melanocytic lesions were (i) spitzoid and dysplastic lesions, (ii) lesions with histological features that hampered the diagnosis such as regression, lymphocytic infiltrate, or a combination with other melanocytic lesions, and (iii) lesions with unusual clinical features, e.g. childhood melanoma. Remarkably, the features of the lesions that were submitted and the types of over- and under-diagnosis remained consistent from 1991 to 2004. A second opinion from an expert pathologist on problem-prone melanocytic lesions improves patient care, in our series in 27% of cases.
  Histopathology 02/2008; 52(2):139-46. · 3.08 Impact Factor
• Source

  Available from: Saskia Houterman

  Article: Testicular cancer: trends in mortality are well explained by changes in treatment and survival in the southern Netherlands since 1970.

  R H A Verhoeven, J W W Coebergh, L A L M Kiemeney, E L Koldewijn, S Houterman
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  ABSTRACT: The aim of this study was to interpret changes in mortality from testicular cancer (TC) against the background of changes in treatment and survival in the south of The Netherlands. Five-year moving average standardised mortality rates were calculated. Primary treatment and relative survival were analysed according to histology, stage and year of diagnosis. The mortality rate dropped in the period 1979-1986 and then flattened out. The types of treatment that patients received did not change significantly over time and were according to the guidelines. Ten-year relative survival for seminoma TC patients improved from 81% (67-91%) in 1970-1979 to 95% (88-100%) in 2000-2002; for non-seminoma TC patients these rates were 54% (38-68%) and 92% (85-99%), respectively. Conditional 5-year relative survival for seminoma and non-seminoma TC patients 5 years after diagnosis was 99% and 96%, respectively. In conclusion, there was an enormous increase in relative survival and a significant decrease in mortality.
  European Journal of Cancer 12/2007; 43(17):2553-8. · 5.54 Impact Factor
• Source

  Available from: hpovzw.be

  Article: Age- and gender-specific reference values of estimated GFR in Caucasians: the Nijmegen Biomedical Study.

  J F M Wetzels, L A L M Kiemeney, D W Swinkels, H L Willems, M den Heijer
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  ABSTRACT: The Nijmegen Biomedical Study is a population-based cross-sectional study conducted in the eastern part of the Netherlands. As part of the overall study, we provide reference values of estimated glomerular filtration rate (GFR) for this Caucasian population without expressed risk. Age-stratified, randomly selected inhabitants received a postal questionnaire on lifestyle and medical history. In a large subset of the responders, serum creatinine was measured. The GFR was then measured using the abbreviated Modification of Diet in Renal Disease (MDRD) formula. To limit possible bias, serum creatinine was calibrated against measurements performed in the original MDRD laboratory. The study cohort included 2823 male and 3274 female Caucasian persons aged 18-90 years. A reference population of apparently healthy subjects was selected by excluding persons with known hypertension, diabetes, cardiovascular- or renal diseases. This healthy study cohort included 1660 male subjects and 2072 female subjects, of which 869 of both genders were 65 years or older. The median GFR was 85 ml/min/1.73 m(2) in 30-to 34-year-old men and 83 ml/min/1.73 m(2) in similar aged women. In these healthy persons, GFR declined approximately 0.4 ml/min/year. Our study provides age- and gender-specific reference values of GFR in a population of Caucasian persons without identifiable risk.
  Kidney International 10/2007; 72(5):632-7. · 6.61 Impact Factor
• Article: Prognostic value of p53 for high risk superficial bladder cancer with long-term followup.

  P M J Moonen, B van Balken-Ory, L A L M Kiemeney, J A Schalken, J A Witjes
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  ABSTRACT: The risk of muscle invasive disease in a high risk patient with superficial bladder cancer is up to 50%. Identifying patients at risk for progression remains an unsolved problem. A suggested prognosticator is mutations in the p53 tumor suppressor gene. We determined the value of p53 mutation, as demonstrated by mutation analysis, in a clinically selected group of high risk patients with superficial bladder cancer. p53 Mutation analysis was performed by automated sequencing of bladder wash samples of 105 patients with high risk superficial bladder cancer. The mutation and WT groups were subsequently compared with regard to mortality, progression, disease worsening and the recurrence-free period. A total of 29 patients had a mutation and 76 had WT. Median followup was 58.3 months (range 3 to 161). A total of 13 patients died of bladder cancer, including 6 of 29 with a mutation and 7 of 76 patients in the WT group. p53 Mutation had no significant prognostic value for decreased survival, progression or disease worsening. Recurrence-free survival was significantly lower in the WT group. We observed a trend toward a worse clinical outcome in high risk patients with a p53 mutation in the bladder wash. However, no significant differences were seen in clinical outcome parameters. Based on these data we conclude that the prognostic value of a p53 mutation is insufficient for individual policy making.
  The Journal of Urology 02/2007; 177(1):80-3. · 3.75 Impact Factor
• Source

  Available from: Leo J Schouten

  Article: Cigarette smoking, von Hippel-Lindau gene mutations and sporadic renal cell carcinoma.

  B A C van Dijk, L J Schouten, E Oosterwijk, C A Hulsbergen-van de Kaa, L A L M Kiemeney, R A Goldbohm, J A Schalken, P A van den Brandt
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  ABSTRACT: We investigated whether smoking is associated with mutations in the Von Hippel-Lindau (VHL) gene in 337 cases of sporadic renal cell carcinoma (RCC) among 120 852 people followed for 11.3 years; the findings suggest that smoking causes RCC independently of VHL gene mutations.
  British Journal of Cancer 09/2006; 95(3):374-7. · 5.04 Impact Factor
• Article: Sperm integrity pre- and post-chemotherapy in men with testicular germ cell cancer.

  J R Spermon, L Ramos, A M M Wetzels, C G J Sweep, D D M Braat, L A L M Kiemeney, J A Witjes
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  ABSTRACT: While (partial) recovery of spermatogenesis, observed by means of standard semen analysis, has been seen in testicular cancer patients after chemotherapy with cisplatin, sperm genomic integrity and its implication for the patient's fertility are poorly understood. Semen and serum from 22 patients treated for testicular cancer were analysed pre- and post-chemotherapy. Besides routine semen analysis, sperm samples were evaluated by computerized karyometric image analysis (CKIA), chromomycin-A3 assay (CMA3, chromatin condensation) and TdT-mediated dUTP nick-end labelling assay (TUNEL, DNA damage). Serum FSH, LH and testosterone concentrations were measured. Ejaculate volume decreased post-chemotherapy (P<0.05). External sperm characteristics (CKIA morphometry) and sperm counts did not deteriorate after chemotherapy. An improvement in DNA condensation was assessed after chemotherapy (37 versus 50% and 47.5 versus 63.7% for CMA3 and CKIA respectively; both P<0.005); yet a high percentage of TUNEL-positive sperm was found in the samples (21 versus 25% for pre- and post-chemotherapy samples respectively). These values were significantly higher than those of a convenience sample of normozoospermic males attending pre-IVF screening. Serum FSH and LH (IU/l) increased after chemotherapy compared with pretreatment levels (8.1 versus 16.7 and 4.5 vs 6.8; both P<0.05, respectively). Despite the improvement in sperm chromatin packaging after chemotherapy, an abnormally high percentage of DNA-damaged sperm was found in these samples. As sperm quality does not reach normal levels after treatment, it remains difficult to outline the best strategy and guidance concerning fertility potential of testicular cancer patients.
  Human Reproduction 08/2006; 21(7):1781-6. · 4.47 Impact Factor
• Article: Current practice in the management of superficial bladder cancer in the Netherlands and Belgian Flanders: a survey.

  J A Witjes, D O T M Melissen, L A L M Kiemeney
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  ABSTRACT: Because there is no national guideline for the diagnosis, therapy and follow up of (superficial) bladder cancer in the Netherlands and Belgium, the actual patient management may differ between urologists. The purpose of this study is to get insight in the current way urologists diagnose, treat and follow patients with superficial bladder cancer. All practising urologists in the Netherlands (n = 293) and Flemish speaking Belgium (Flanders, n = 223) received a questionnaire with regard to the current management of patients with superficial bladder cancer. The results were compared with the guidelines provided by the European Association of Urology (EAU). Also a comparison was made between the two countries and between university and community hospitals. The results show a wide variation in current practice for superficial bladder cancer. Although the majority of urologists do not follow the EAU guidelines, current practice roughly matches these guidelines. There are no major differences between the two countries or between different types of hospitals. Discrepancies between current practice and guidelines are mostly too frequent use of techniques for the diagnosis, treatment and follow-up. In all, there is a need for clear guidelines in superficial bladder cancer and an effective implementation of such guidelines into everyday practice.
  European Urology 04/2006; 49(3):478-84. · 8.49 Impact Factor
• Article: Hypospadias: a transgenerational effect of diethylstilbestrol?

  M M Brouwers, W F J Feitz, L A J Roelofs, L A L M Kiemeney, R P E de Gier, N Roeleveld
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  ABSTRACT: In 2002, an increased risk of hypospadias was reported for sons of women exposed to diethylstilbestrol (DES) in utero, suggesting transgenerational effects of DES. The aim of this study was to further assess the association between parental DES exposure and hypospadias in a case-referent study. Cases with hypospadias were retrieved from the hospital information system. Referents were recruited via the parents of cases. Both parents completed postal questionnaires. Associations were estimated by odds ratios (OR) with 95% confidence intervals (CI). Additionally, conditional logistic regression analyses were performed for a matched subset of parents. The final database included 583 cases and 251 referents. In the initial analyses, an indication was found for an increased risk of hypospadias when mothers were exposed to DES in utero: OR=2.3 (95% CI 0.7-7.9). Conditional logistic regression resulted in a stronger risk estimate: OR=4.9 (95% CI 1.1-22.3). Paternal exposure to DES did not increase the risk. The results confirm an increased risk of hypospadias when mothers were exposed to DES in utero. However, the excess risk appears to be of much smaller magnitude than in the 2002 study. Further research on the potential health risks for the third generation is of great importance.
  Human Reproduction 04/2006; 21(3):666-9. · 4.47 Impact Factor