Altaf Mangera

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (59)182.57 Total impact

  • Altaf Mangera, Christopher R. Chapple
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    ABSTRACT: To review and evaluate the evidence from contemporary evidence-based guidelines regarding the assessment of men with urinary urgency and/or incontinence.
    Current Opinion in Urology 08/2014; · 2.12 Impact Factor
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    ABSTRACT: Family studies and twin studies demonstrate that lower urinary tract symptoms and pelvic organ prolapse are heritable. This review aimed to identify genetic polymorphisms tested for an association with lower urinary tract symptoms or prolapse, and to assess the strength, consistency, and risk of bias among reported associations. PubMed and HuGE Navigator were searched up to May 1st 2014, using a combination of genetic and phenotype keywords, including nocturia, incontinence, overactive bladder, prolapse and enuresis. Major genetics, urology and gynecology conference abstracts were searched from 2005-2013. We screened 889 abstracts, and retrieved 78 full texts. 27 published and 7 unpublished studies provided data on polymorphisms in or near 32 different genes. Fixed and random effects meta-analyses were conducted using co-dominant models of inheritance. We assessed the credibility of pooled associations using the interim Venice criteria. In pooled analysis, the rs4994 polymorphism of the ADRB3 gene was associated with overactive bladder (OR 2.5, 95%CI 1.7-3.6, n=419). The rs1800012 polymorphism of the COL1A1 gene was associated with prolapse (OR 1.3, 95%CI 1.0-1.7, n=838) and stress urinary incontinence (OR 2.1, 95%CI 1.4-3.2, n=190). Other meta-analyses, including those for polymorphisms of COL3A1, LAMC1, MMP1, MMP3 and MMP9 did not show significant effects. Many studies were at high risk of bias from genotyping error or population stratification. In conclusion, these meta-analyses provide moderate epidemiological credibility for associations of variation in ADRB3 with overactive bladder, and variation of COL1A1 with prolapse. Clinical testing for any of these polymorphisms cannot be recommended based on current evidence.
    American Journal of Obstetrics and Gynecology 08/2014; · 3.97 Impact Factor
  • Altaf Mangera, Christopher R. Chapple
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    ABSTRACT: Urethral stricture disease affects many men worldwide. A number of options exist for the treatment of this disease ranging from the more simple intermittent self dilatation, urethrotomy and dilatation, to the more technically demanding anastomotic and substitution urethroplasty. We discuss the aetiology, presentation, investigation and management of this disease. With a better understanding of the underlying pathophysiology and by adequately investigating the patient an informed decision may be made leading to good patient satisfaction and surgical success rates.
    Surgery (Oxford) 06/2014; · 3.11 Impact Factor
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    ABSTRACT: To review the use of non-hormonal pharmacotherapies in the treatment of lower urinary tract symptoms (LUTS) due to presumed benign prostatic hyperplasia (BPH). A search of the PUBMED database was conducted for the terms BPH, LUTS, bladder outlet obstruction, alpha-adrenoceptor blockers, anti-muscarinics, and phosphodiesterase-5-inhibitors. Medical therapy has long been established as the accepted standard of care in the treatment of male LUTS. The aim of treatment is improvement in symptoms and quality of life whilst minimizing adverse effects. The agents most widely used as 1(st) line therapy are alpha-blockers (AB), as a standalone or in combination with 2 other classes of drug; 5-α reductase inhibitors and anti-muscarinics. AB have rapid efficacy, improving symptoms and flow rate in a matter of days, these effects are then maintained over time. AB do not impact on prostate size and do not prevent acute urinary retention or the need for surgery. Anti-mucarinics, alone or in combination with an AB are safe and efficacious in the treatment of bothersome storage symptoms associated with LUTS/BPH. Phosphodiesterase-5 inhibitors are an emerging treatment option that improve LUTS without improving flow rates. AB are the most well-established pharmacotherapy in the management of men with LUTS/BPH. The emergence of different classes of agent offers the opportunity to target underlying pathophysiologies driving symptoms and better individualize treatment.
    Indian Journal of Urology 04/2014; 30(2):194-201.
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    ABSTRACT: The assessment of men with bladder outflow obstruction relies on an adequate history and examination. Uroflowmetry and post-void residue estimation are very revealing and may be sufficient in the majority of men. The prostate-specific antigen test may be used to select men who are at a high risk of progression. In specific situations, cystometry may be required. We discuss the use of cystometry and the newer less-invasive methods of assessment that have emerged over the last few years, including ultrasound estimation of intravesical prostatic protrusion, prostatic urethra angle, detrusor wall thickness, ultrasound-estimated bladder weight, near-infrared spectroscopy and the condom catheter and penile cuff tests. Although these techniques show promise, they still require further modifications, standardization and testing in larger populations. In addition, they should be used in men where only specific questions need to be answered.
    Indian Journal of Urology 04/2014; 30(2):177-80.
  • Altaf Mangera, Christopher R Chapple
    Indian Journal of Urology 04/2014; 30(2):169.
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    European Urology Supplements 04/2014; 13(1):e594-e594a. · 3.37 Impact Factor
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    ABSTRACT: Although family studies have shown that male lower urinary tract symptoms (LUTS) are highly heritable, no systematic review exists of genetic polymorphisms tested for association with LUTS. To systematically review and meta-analyze studies assessing candidate polymorphisms/genes tested for an association with LUTS, and to assess the strength, consistency, and potential for bias among pooled associations. A systematic search of the PubMed and HuGE databases as well as abstracts of major urologic meetings was performed through to January 2013. Case-control studies reporting genetic associations in men with LUTS were included. Reviewers independently and in duplicate screened titles, abstracts, and full texts to determine eligibility, abstracted data, and assessed the credibility of pooled associations according to the interim Venice criteria. Authors were contacted for clarifications if needed. Meta-analyses were performed for variants assessed in more than two studies. We identified 74 eligible studies containing data on 70 different genes. A total of 35 meta-analyses were performed with statistical significance in five (ACE, ELAC2, GSTM1, TERT, and VDR). The heterogeneity was high in three of these meta-analyses. The rs731236 variant of the vitamin D receptor had a protective effect for LUTS (odds ratio: 0.64; 95% confidence interval, 0.49-0.83) with moderate heterogeneity (I(2)=27.2%). No evidence for publication bias was identified. Limitations include wide-ranging phenotype definitions for LUTS and limited power in most meta-analyses to detect smaller effect sizes. Few putative genetic risk variants have been reliably replicated across populations. We found consistent evidence of a reduced risk of LUTS associated with the common rs731236 variant of the vitamin D receptor gene in our meta-analyses. Combining the results from all previous studies of genetic variants that may cause urinary symptoms in men, we found significant variants in five genes. Only one, a variant of the vitamin D receptor, was consistently protective across different populations.
    European Urology 01/2014; · 10.48 Impact Factor
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    ABSTRACT: In this systematic review of the literature, a search of the PubMed database was conducted to identify articles dealing with augmentation/substitution urethral reconstruction of the anterior urethral stricture. The evidence was categorized by stricture site, surgical technique, and the type of tissue used. The committee appointed by the International Consultation on Urological Disease reviewed this data and produced a consensus statement relating to the augmentation and substitution of the anterior urethra. In this review article, the background pathophysiology is discussed. Most cases of urethral stricture disease in the anterior urethra are consequent on an ischemic spongiofibrosis. The choice of technique and the surgical approach are discussed along with the potential pros and cons of the use of a graft vs a flap. There is research potential for tissue engineering. The efficacy of the surgical approach to the urethra is reviewed. Whenever possible, a 1-stage approach is preferable from the patient's perspective. In some cases, with complex penile urethral strictures, a 2-stage procedure might be appropriate, and there is an important potential role for the use of a perineal urethrostomy in cases where there is an extensive anterior urethral stricture or where the patient does not wish to undergo complex surgery, or medical contraindications make this hazardous. It is important to have accurate outcome measures for the follow-up of patients, and in this context, a full account needs to be taken of patients' perspectives by the use of appropriate patient-reported outcome measures. The use of symptoms and a flow rate can be misleading. It is well established that with a normally functioning bladder, the flow rate does not diminish until the caliber of the urethra falls below 10F. The most accurate means of following up patients after stricture surgery are by the use of endoscopy or visualization by urethrography. Careful consideration needs to be made of the outcomes reported in the world literature, bearing in mind these aforementioned points. The article concludes with an overview of the key recommendations provided by the committee.
    Urology 01/2014; · 2.13 Impact Factor
  • Neurourology and Urodynamics 01/2014; 33(6):783-784. · 2.67 Impact Factor
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    ABSTRACT: To assess the feasibility of converting from 300IU to 200IU OnabotulinumtoxinA in patients diagnosed with either idiopathic detrusor overactivity (IDO) or neurogenic detrusor overactivity (NDO).
    Central European journal of urology. 01/2014; 67(1):35-40.
  • Journal of Clinical Urology. 12/2013; 7(1):69-71.
  • Altaf Mangera, Christopher Chapple
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    ABSTRACT: To evaluate and present the evidence for the use of different investigation modalities in men with benign prostatic hyperplasia/lower urinary tract symptoms (LUTS) in 2014. Cystometry remains the gold standard in differentiating obstructed from nonobstructed men with LUTS. Prostatic ultrasound measures such as the intravesical prostatic protrusion may be useful in counselling men before a trail without catheter or commencing α antagonists. Using a higher cut-off, the bladder thickness/weight measurement has a higher sensitivity but lower specificity and may allow men with obstruction to be excluded from requiring cystometry. These and other techniques such as near-infrared spectroscopy, penile cuff compression and computational flow modelling have shown good correlation with cystometry but still require more data, technical refinement and standardization, before they can be considered to be appropriate in routine clinical practice. The last few years have seen an increase in the data regarding less invasive methods of cystometry. Although these do not provide the same information as cystometry, they may have a role in answering specific questions and counselling men with benign prostatic hyperplasia/LUTS. The key to incorporating these techniques in the assessment of men will lie with standardization and use for specific indications.
    Current opinion in urology 11/2013; · 2.12 Impact Factor
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    ABSTRACT: Botulinum toxin A (BoNTA) has received regulatory approval for use in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB), but it remains unlicensed in other lower urinary tract symptoms (LUTS) indications such as nonneurogenic LUTS in men with benign prostatic enlargement (LUTS/BPE), bladder pain syndrome (BPS), and detrusor sphincter dyssynergia (DSD). To compare statistically the outcomes of high level of evidence (LE) studies with palcebo using BoNTA for LUTS indications; NDO, OAB, LUTS/BPE, BPS and DSD. We conducted a systematic review of the published literature on PubMed, Scopus, and Embase reporting on BoNTA use in LUTS dysfunction. Statistical comparison was made between high LE studies with placebo and low LE studies. In adult NDO, there are significantly greater improvements with BoNTA in daily incontinence and catheterisation episodes (-63% and -18%, respectively; p<0.01), and the urodynamic parameters of maximum cystometric capacity (MCC), reflex volume, and maximum detrusor pressure (MDP) (68%, 61%, and -42%, respectively; all p<0.01). In OAB, BoNTA leads to significant improvements in bladder diary parameters such as daily frequency (-29%), daily urgency (-38%), and daily incontinence (-59%) (all p<0.02). The urodynamic parameters of MCC and MDP improved by 58% (p=0.04) and -29% (p=0.002), respectively. The risk of urinary tract infection was significantly increased from placebo at 21% versus 7% (p<0.001), respectively; the risk of intermittent self-catherisation increased from 0% to 12% (p<0.001). Men with LUTS/BPE showed no significant improvements in International Prostate Symptom Score, maximum flow rate, or prostate volume. There were insufficient data for statistical analysis in DSD, BPS, and paediatric studies. Low LE studies were found to overestimate the effects of BoNTA in all indications, but differences from high LE studies were significant in only a few parameters. BoNTA significantly improves all symptoms and urodynamic parameters in NDO and OAB. The effect of BoNTA in treating LUTS dysfunction appears to be overestimated in lower as opposed to higher LE studies.
    European Urology 11/2013; · 10.48 Impact Factor
  • International Journal of Surgery (London, England) 10/2013; 11(8):729. · 1.44 Impact Factor
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    ABSTRACT: Assess patients' preferences in a pilot crossover study of two different electronic voiding diaries against a standard paper diary. Assess urological health professional (HP) opinions on the electronic bladder diary reporting system. Two different electronic diaries were developed: (1) electronically read diary-a card with predefined slots read by a card reader and (2) e-diary-a handheld touch screen device. Data uploaded from either electronic diary produced an electronic report. We recruited 22 patients split into two cohorts for each electronic diary, 11 completed each type of electronic diary for 3 days either preceded or followed by a standard paper diary for 3 days. Both diaries were completed on the 7th day. Patients' perceptions of both diaries were recorded using a standardized questionnaire. A HP study recruited 22 urologists who were given the paper diary and the electronic reports. Time taken for analysis was recorded along with accuracy and HP preferences. The majority of patients (82%) preferred the e-diary and only 1/11 found it difficult to use. Patients had the same preference for the electronically read diary as the paper diary. The paper diary took 66% longer to analyze than the electronic report (P < 0.001) and was analyzed with an accuracy of 58% compared to 100%. Slightly more HP (9%) preferred the electronic report to the paper diary. This proposed e-diary with its intuitive interface has overcome previous deficiencies in electronic diaries with most patients finding the format user-friendly. Electronic reports make analysis and interpretation by HP quicker and more accurate. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 09/2013; · 2.67 Impact Factor
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    ABSTRACT: Female urethral stricture (FUS) is a rare and challenging clinical entity. Several new surgical techniques have been described for the treatment of FUS, although with the limited number of reports, there is no consensus on best management. We evaluated the evidence for surgical interventions reported for treating FUS. We performed a systematic review of the PubMed and Scopus databases, classifying the results by surgical technique and type of graft in the case of graft augmentation urethroplasty. A total of 221 patients have been reported on with outcome measures after intervention for FUS. The mean age of women was 51.8 yr of age (range: 22-91). All studies were retrospective case series. There was no consistent definition of FUS nor unified diagnostic criteria. Most studies used a combination of diagnostic tests. Where aetiology was defined, idiopathic and iatrogenic stricture were the two most common causes. Ninety-eight patients underwent prior intervention for FUS, mostly urethral dilatation or urethrotomy. Success was defined as the lack of need for further intervention. Urethral dilatation, assessed in 107 patients, had a mean success rate of 47% at a mean follow-up of 43 mo. Fifty-eight patients had vaginal or labial flap augmentation, with a mean success rate of 91% at 32.1 mo of mean follow-up. Vaginal or labial graft augmentation had a mean success rate of 80% in 25 patients at a mean follow-up of 22 mo. Oral mucosal augmentation, performed in 32 patients, had a mean success rate of 94% at 15 mo of mean follow-up. No instances of de novo stress incontinence were reported. The techniques of urethroplasty all have a higher mean success rate (80-94%) than urethral dilatation (<50%), although with shorter mean follow-up. Urethroplasty in experienced hands appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.
    European Urology 08/2013; · 10.48 Impact Factor
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    ABSTRACT: Synthetic non-absorbable meshes are widely used to augment surgical repair of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); however, there is growing concern such meshes are associated with serious complications. This study compares the potential of two autologous cell sources for attachment and extra-cellular matrix (ECM) production on a biodegradable scaffold to develop tissue engineered repair material (TERM). Human oral fibroblasts (OF) and human adipose-derived stem cells (ADSC) were isolated and cultured on thermo-annealed poly-L-lactic acid (PLA) scaffolds for two weeks under either unrestrained conditions or restrained (either with or without intermittent stress) conditions. Samples were tested for cell metabolic activity (AlamarBlue® assay), contraction (serial photographs analyzed with image J software), total collagen production (Sirius red assay), and production of ECM components (immunostaining for collagen I, III, and elastin; and scanning electron microscopy) and biomechanical properties (BOSE tensiometer). Differences were statistically tested using two sample t-test. Both cells showed good attachment and proliferation on scaffolds. Unrestrained scaffolds with ADSC produced more total collagen and a denser homogenous ECM than OF under same conditions. Restrained conditions (both with and without intermittent stress) gave similar total collagen production, but improved elastin production for both cells, particularly OF. The addition of any cell onto scaffolds led to an increase in biomechanical properties of scaffolds compared to unseeded scaffolds. OF and ADSC both appear to be suitable cell types to combine with biodegradable scaffolds, in the development of a TERM for the treatment of SUI and POP. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 07/2013; 33(5). · 2.67 Impact Factor
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    A Mangera, K Khan, BT Parys
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    ABSTRACT: Objective: Urolithiasis presenting to secondary care has been proposed to be on the increase, in the United Kingdom, based on national Hospital Episode Statistics data. We aimed to assess whether there has been an increase in stone disease presenting to a district general hospital in the last 10 years.
    Journal of Clinical Urology. 07/2013; 6(4):239-242.
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    ABSTRACT: The lower urinary tract (LUT) comprises the bladder and urethra in females with the addition of the prostate in males. The function of the lower tract is the low-pressure non-volitional storage of urine it receives from the upper urinary tract followed by the voluntary expulsion of urine when socially acceptable. The LUT may be affected by functional disorders such as bladder overactivity and urinary incontinence or by obstructive disorders such as prostatic enlargement and stricture disease or alternatively by other pathologies such as carcinoma and lithiasis. A thorough knowledge and understanding of the relevant anatomy is essential in understanding the various pathophysiological mechanisms of LUT disorders and their appropriate management. We describe the anatomy of the male and female LUT between which considerable differences exist in structure and function, in addition to summarizing the histology, vasculature and neural innervation of the organs comprising the LUT.
    Surgery (Oxford) 07/2013; 31(7):319–325. · 3.11 Impact Factor

Publication Stats

178 Citations
182.57 Total Impact Points


  • 2012–2014
    • The University of Sheffield
      Sheffield, England, United Kingdom
    • The Rotherham NHS Foundation Trust
      Rotherdam, England, United Kingdom
  • 2010–2014
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
  • 2013
    • East Sussex Healthcare NHS Trust
      Eastbourne, England, United Kingdom
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
      • Department of Urology
      Newcastle-on-Tyne, England, United Kingdom