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ABSTRACT: The clinical need for characterising small renal masses (SRMs) is increasing due to their rising incidental detection. This increase is especially seen in younger and older generations and concerns mainly SRMs. Diagnostics is mainly made by contrast-enhanced CT or MRI. However, these imaging methods fail to accurately distinguishing benign from malignant SRMs. Other disadvantages of CT or MRI are high costs, the use of ionizing radiation, nephrotoxicity induced by iodine contrast agents or nephrogenic systemic fibrosis (NSF) induced by gadolinium contrast agents. Contrast-enhanced ultrasound (CEUS) is based on ultrasonography and microbubbles to real-time visualize the renal blood flow without the use of nephrotoxic agents or ionizing radiation. This comprehensive review evaluates the capabilities of CEUS in the diagnostics of benign (angiomyolipomas, cysts, oncocytomas, pseudotumors) and malignant masses (renal cell carcinomas), and focuses on possible future treatment.
Current Urology Reports 01/2013;
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ABSTRACT: OBJECTIVES: To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses (SRMs) including technique description, indications and outcomes. METHODS: A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies with >20 participants, patient characteristics, efficacy and safety data were included. RESULTS:No randomised controlled trials (RCTs)were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA) for SRMs were selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6, and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated lesions were pathologically confirmed RCC. Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were limited by a relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%. CONCLUSIONS: Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes with a low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring organs.
Archivos españoles de urología 01/2013; 66(1):41-53.
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J Beyer,
P Albers,
R Altena,
J Aparicio,
C Bokemeyer,
J Busch,
R Cathomas,
E Cavallin-Stahl,
N W Clarke,
J Claßen, [......],
G Rosti,
R Salvioni,
M Schrader,
S Schweyer,
F Sedlmayer,
A Sohaib,
R Souchon,
T Tandstad,
C Winter,
C Wittekind
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J Beyer,
P Albers,
R Altena,
J Aparicio,
C Bokemeyer,
J Busch,
R Cathomas,
E Cavallin-Stahl,
N W Clarke,
J Claßen, [......],
G Rosti,
R Salvioni,
M Schrader,
S Schweyer,
F Sedlmayer,
A Sohaib,
R Souchon,
T Tandstad,
C Winter,
C Wittekind
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ABSTRACT: In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European consensus on diagnosis and treatment of germ-cell cancer: a report of the European Germ-Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377-1399; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53: 478-496; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 2008; 53: 497-513]. A panel of 56 of 60 invited GCC experts from all across Europe discussed all aspects on diagnosis and treatment of GCC, with a particular focus on acute and late toxic effects as well as on survivorship issues.The panel consisted of oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists, who are all actively involved in care of GCC patients. Panelists were chosen based on the publication activity in recent years. Before the meeting, panelists were asked to review the literature published since 2006 in 20 major areas concerning all aspects of diagnosis, treatment and follow-up of GCC patients, and to prepare an updated version of the previous recommendations to be discussed at the conference. In addition, ∼50 E-vote questions were drafted and presented at the conference to address the most controversial areas for a poll of expert opinions. Here, we present the main recommendations and controversies of this meeting. The votes of the panelists are added as online supplements.
Annals of Oncology 11/2012; · 6.43 Impact Factor
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ABSTRACT: On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established.
This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer.
Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned.
There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended.
These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
Actas urologicas españolas 12/2011; 36(3):127-45. · 0.46 Impact Factor
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ABSTRACT: In modern medicine the profound use of abdominal imaging has led to a dramatic change of presentation of renal tumors. Smaller tumors and therefore more benign masses are being discovered, and as systemic use of renal mass biopsies is not recommended by the general guidelines, an appropriate tool to assess the biology of renal tumors is highly desirable. Apart from new developments of currently applied diagnostic modalities, several research groups focus on the potential of optical diagnostic techniques to contribute to the diagnostic process of renal tumors. They use the interaction of light with biological tissue to gather information on the optical properties of a tissue sample and therefore providing information on the histological composition of this tissue in a non-invasive manner and in real-time. In this review we provide an overview of novel diagnostic techniques starting with the future of conventional diagnostics like Contrast-enhanced ultrasonography (CEUS) and positron emission tomography-computed tomography (PET-CT) followed by optical technologies that are potentially employed in the nearby future to improve the diagnostic process of renal tumors with a focus on optical diagnostic techniques.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology 09/2011; 63(3):213-25.
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ABSTRACT: To define in which patients who present with microscopic or macroscopic hematuria CT urography (CTU) is indicated as an imaging mode for the upper urinary tract (UUT).
We conducted a prospective study on consecutive patients who attended a modern protocol-driven hematuria clinic from January 2006 to February 2010. Standard tests (history taking, physical examination, urinalysis via dipstick method, ultrasonography of kidneys and bladder performed by urologists, cystoscopy, and cytology) were directed to all patients, whereas the mode of additional UUT imaging (ultrasonography by a radiologist or four-phase CTU/magnetic resonance (MR) urography (MRU) when CTU was contraindicated) was selected according to a risk factor-based management algorithm. The added value of cross-sectional urography (CTU/MRU) supplementary to ultrasonography (by urologists) to detect renal masses, UUT tumors, and stones was assessed. Univariate and multivariate analysis on predictive factors for cross-sectional urography result were performed.
From the total of 841 patients, lesions that might account for hematuria could not be identified in 462 (54.9%), whereas in 250 (29.7%) and 124 (14.7%) patients, hematuria was from benign and malignant disease, respectively. Cross-sectional urography revealed relevant UUT lesions in 73 of 525 (13.9%) patients. Only result of ultrasonography (odds ratio [OR] 7.7, 95% confidence interval [CI] 4.0-14.9), P<0.001) and type of hematuria (OR 2.6, 95% CI 1.3-5.1, P=0.01) were significant predictors for cross-sectional urography result. In 44 of 456 (9.6%) patients with no abnormalities on ultrasonography, CTU/MRU revealed that these were false negatives, with most lesions missed being stones. In 253 of 309 (81.9%) patients with macroscopic hematuria, no lesions were detected in the UUT on CTU/MRU, in contrast to 199 of 216 patients (92.1%) with microscopic hematuria.
For patients who present with microscopic hematuria, ultrasonography is sufficient to exclude significant UUT disease. For patients with macroscopic hematuria, the likelihood of finding UUT disease is higher, and a CTU as a first-line test seems justified.
Journal of endourology / Endourological Society 08/2011; 25(11):1733-40. · 1.75 Impact Factor
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ABSTRACT: Traditionally the placement of a nephrostomy tube at the conclusion of percutaneous nephrolithotomy is considered the standard of care. However, the need for nephrostomy tube placement has been questioned by numerous authors. We evaluated the literature regarding tubeless percutaneous nephrolithotomy, and determined potential candidates for tubeless percutaneous nephrolithotomy and whether this procedure can be considered the new standard of care for complex stone removal.
A MEDLINE search was conducted between May 1997 and January 2010 to detect studies reporting tubeless percutaneous nephrolithotomy. "Nephrolithiasis," "percutaneous nephrolithotomy," "tubeless" and "lithotripsy" were used as medical subject headings (MeSH) key words. Additional citations were identified by reviewing the reference lists of the included articles. All relevant articles were reviewed for indications, outcomes and complications.
The data obtained from 50 reports document comparable complication rates between tubeless and standard percutaneous nephrolithotomy. Tubeless percutaneous nephrolithotomy demonstrated advantages such as less pain, less debilitation, less costs and a shorter hospital stay. Mean stone-free rates for tubeless percutaneous nephrolithotomy were as high as 89%.
Tubeless percutaneous nephrolithotomy appears to be safe and efficacious in uneventful procedures, in children, in obese patients, in simultaneous bilateral procedures, in supracostal access and in renal units with coexisting anatomical anomalies. Nephrostomy tube placement should still be considered in certain cases such as those with more than 2 nephrostomy access tracts, those necessitating a second look and those with intraoperative complications such as significant bleeding or collecting system perforation.
The Journal of urology 10/2010; 184(4):1261-6. · 4.02 Impact Factor
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ABSTRACT: All urinary stones may not need prompt active treatment. The aim of our study was to identify urinary stones that can be actively monitored safely.
We performed a systematic review of the natural history and the role of active monitoring for urinary stones.
Thirty-seven studies have selected. Of symptomatic ureteral calculi <4 mm, 38% to 71% will pass spontaneously while only 4.8% of stones <2 mm will need intervention during surveillance. Follow-up with history, physical examination, urinalysis, and plain radiography every 2 weeks for 1 month is necessary. If spontaneous passage does not occur within this period, intervention is recommended. When shockwave lithotripsy for caliceal stones is prospectively compared with observation, there is no difference in stone-free rates (28% vs 17%), need for additional treatment (15% vs 21%), or visits to a general practitioner (18.5% vs 20.8%). Patients under observation may need more invasive procedures and may be more commonly left with residual stone fragments >5 mm (58% vs 30%). Isolated, nonuric acid calculi <4 mm may be most amenable to active monitoring. Physical examination, urinalysis, and CT scan performed on an annual basis up to year 2 or 3, followed by intervention, are recommended. Lower pole stones <10 mm could be actively monitored on an annual basis by alternating ultrasonoraphy with CT scan, provided the patients are adequately informed. Up to 58.6% and 43% of patients with residual fragments after shockwave and percutaneous lithotripsy, respectively, may become symptomatic or require intervention during follow-up. Noninfected, asymptomatic fragments, <4 mm postextracorporeal lithotripsy, and <2 mm postpercutaneous surgery could be followed expectantly on an annual basis, in combination with medical therapy.
Active stone monitoring has a certain role in the treatment of patients with urinary stones. The success is largely dependent on the stone size, location, and composition, as well as the time after the diagnosis. Medical therapy is a useful adjunct to observation.
Journal of endourology / Endourological Society 06/2010; 24(6):923-30. · 1.75 Impact Factor
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ABSTRACT: The proportion of renal tumors found incidentally dramatically increased in the past decade. More than half of them were diagnosed in patients over 70 years of age, a population with high associated comorbidity. Nephron-sparing minimally invasive surgical procedures are aimed at treating patients with small renal tumors and multiple comorbidities. Cryotherapy stands out among all other ablative procedures because of its better mid-term oncological outcome. A non-systematic review of the literature on cryotherapy as a treatment for renal tumors was made, analyzing its indications, actual and future application techniques, results, and complications.
Actas urologicas españolas 04/2010; 34(4):309-17. · 0.46 Impact Factor
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Annals of Oncology 05/2009; 20 Suppl 4:83-8. · 6.43 Impact Factor
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Annals of Oncology 05/2009; 20 Suppl 4:89-96. · 6.43 Impact Factor
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ABSTRACT: We stratified factors affecting treatment morbidity, compared the outcomes of percutaneous nephrolithotomy procedures from a single department and provided evidence of treatment benefits when percutaneous nephrolithotomy is performed in an expert setting.
Since the department became a dedicated endourological center in 2002 we grouped all percutaneous nephrolithotomy procedures into those performed before 2002 (group 1) and after 2002 (group 2). The modified Clavien classification was used to score morbidity. Independent variables with an influence on complications were studied including stone size, operating time, operative complications, dilation device, urine culture, group allocation and lithotripsy device. Contingency and logistic regression were used for univariate and multivariate analysis.
Of the 244 percutaneous nephrolithotomy procedures 68 comprised group 1 and 176 formed group 2. Statistical preoperative differences were patient age, the use of anticoagulants and positive urinary cultures. Group 1 had a complication rate of 56.8% and group 2 had a complication rate of 37.2%. There were significant differences between the groups (p = 0.007). Almost all complications were grade 1 to 2. On univariate analysis the influence variables were urine culture (OR 1.69), group allocation (OR 2.20), stone size (OR 2.28), dilation device (OR 4.8), lithotripsy device (OR 1.22), perioperative complications (OR 2.83) and surgical time (OR 1.87). On multivariate analysis the independent factors in the complicated outcome were stone size (OR 1.25), type of lithotripsy device (OR 1.35) and incidence of perioperative complications (OR 3.71).
The dedicated setting for percutaneous nephrolithotomy at our center resulted in decreased operative time, more uneventful procedures and decreased hospitalization time. The modified Clavien morbidity score is a reliable tool for more objective outcome comparisons after renal stone treatment.
The Journal of urology 11/2008; 180(6):2489-93. · 4.02 Impact Factor
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ABSTRACT: To review the literature on the definition and incidence of leakage after laparoscopic radical prostatectomy (LRP) as well as its relation to the surgeon's technical experience, the type of urethrovesical suture, and the approach (extraperitoneal or transperitoneal).
We conducted a systematic review of the subject, consulting MEDLINE, Embase, and Cochrane library (MeSH terms "radical prostatectomy," "laparoscopy," "anastomotic leakage," and "complications"). Languages were limited to English, Spanish, and French. Selection criteria were original papers with 30 or more patients and description of the leakage rate. Data on mean catheterization days, surgical approach, and type of suture were retrieved. Papers were included after approval by two independent reviewers. Statistical analysis was performed with SPSS V. 12. A P value <0.05 was considered significant.
A total of 24 articles were identified meeting the inclusion criteria. Most of them were observational. There were no randomized controlled trials. Meta-analysis was not performed because of clinical heterogeneity. Leakage was defined in 11 of the papers, and great variation in the definition was found. On average, the incidence of anastomotic leakage was 9.7% (396/4091 patients) and ranged from 3.2% to 33%. None of the risk factors studied showed statistical significance, although some individual series demonstrated a decrease in the leakage rate with increasing surgeon experience.
The evidence in the studies on urine leakage after LRP is poor. There is a lack of a uniform definition of the condition. Time frame, diagnostic method, and significance need to be standardized. This lack of definition, together with the character of the studies and the heterogeneity of the series, makes comparison difficult, precluding a proper meta-analysis.
Journal of Endourology 12/2007; 21(11):1371-9. · 1.85 Impact Factor
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A Breda,
S V Stepanian,
J Liao,
J S Lam,
G Guazzoni,
M Stifelman,
K Perry,
A Celia,
G Breda,
P Fornara, [......],
V Disanto,
F Porpiglia,
C Milani,
C Abbou,
R Gaston,
G Janetschek,
N A Soomro,
J de la Rosette, M P Laguna,
P G Schulam
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ABSTRACT: Open partial nephrectomy has emerged as the standard of care in the management of renal tumors smaller than 4 cm. While laparoscopic radical nephrectomy has been shown to be comparable to open radical nephrectomy with respect to long-term outcomes, important questions remain unanswered regarding the oncological efficacy of laparoscopic partial nephrectomy. We examined the practice patterns and pathological outcomes following laparoscopic partial nephrectomy.
A survey was sent to academic medical centers in the United States and in Europe performing laparoscopic partial nephrectomy. The total number of laparoscopic partial nephrectomies, positive margins, indications for intraoperative frozen biopsy as well as tumor size and position were queried.
Surveys suitable for analysis were received from 17 centers with a total of 855 laparoscopic partial nephrectomy cases. Mean tumor size was 2.7 cm (+/-0.6). There were 21 cases with positive margins on final pathology, giving an overall positive margin rate of 2.4%. Intraoperative frozen sections were performed selectively at 10 centers based on clinical suspicion of positive margins on excised tumor. Random biopsies were routinely performed on the resection bed at 5 centers. Frozen sections were never performed at 2 centers. Of the 21 cases with positive margins 14 underwent immediate radical nephrectomy based on the frozen section and 7 were followed expectantly.
Early experience with laparoscopic partial nephrectomy in this multicenter study demonstrates oncological efficacy comparable to that of open partial nephrectomy with respect to the incidence of positive margins. The practice of intraoperative frozen sections varied among centers and is not definitive in guiding the optimal surgical treatment.
The Journal of Urology 08/2007; 178(1):47-50; discussion 50. · 3.75 Impact Factor
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ABSTRACT: Ultrasound guided biopsies are the mainstay in the diagnosis of prostate cancer. With the aim of improving diagnostic performances different protocols of prostate biopsy have been designed. The addition of vascular contrasts to the ultrasound allows for identification of hypervascular regions more likely to be cancer. The new ultrasound modalities enhance contrast signal and specifically differentiate its signal from the tissue reflections.
A non structured review of the literature was conducted on the utility of the different ultrasound modalities and types in targeting the biopsies of the prostate.
There are four types of ultrasound guided biopsies of the prostate: ultrasound guided biopsy of hypoechoic nodes, systematic biopsy protocols, Doppler guided biopsy and Contrast Enhanced Doppler guided biopsy. In spite of the broad literature only few series possess a methodologically correct design related to the use of reference standards. The diagnostic performance of each one of the different types of biopsy varies widely. Sensitivity and specificity of ultrasound guided biopsy of hypoechoic nodes depends on the type of population included in the study but in general its positive predictive value is low. The protocols of systematic biopsy increase the sensitivity of the prostate biopsy but still specificity is low. The Doppler techniques offer a marginal benefit. Contrast Enhanced Doppler guided biopsies series have reported only a slightly increase in sensitivity and a significant improvement of the odds risk for diagnostic of prostate cancer. New arising ultrasound modalities present with promising preliminary results.
Ultrasound guided biopsy have an acceptable sensitivity in the diagnosis of prostate cancer, however specificity is overall low. Among the different ultrasound techniques only Contrast Enhanced Ultrasound improves significantly the diagnostic risk of the biopsy although the sensitivity remains quite stable. New specific contrast ultrasound techniques are currently under investigation.
Archivos españoles de urología 01/2007; 59(10):965-76.
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ABSTRACT: Cryotherapy is a curative treatment option for patients with small (<4 cm) renal-cell cancers. For the followup of ablated lesions, imaging is the only available method, but the best tool has not yet been determined. The method selected should be able to determine the presence or absence of perfusion in the area and measure the lesion. Usually, contrast-enhanced CT or MRI is used. The accompanying video shows cryotherapy treatment along with contrast-enhanced ultrasound investigations before and afterward. We used a Siemens Acuson Sequoia device with contrast pulse sequence imaging and Sonovue (Bracco) as the contrast agent. The lesion could be identified and measured easily. Because this method enables selective detection of contrast, the presence and absence of perfusion can be determined objectively.
Journal of Endourology 07/2006; 20(7):456-8; discussion 458-9. · 1.85 Impact Factor
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ABSTRACT: To assess the efficacy, safety, and durability of the bell-shaped nitinol prostatic stent in the treatment of moderate to severe lower urinary tract symptoms caused by benign prostatic enlargement in otherwise healthy patients.
Stents were inserted in an outpatient setting under local anaesthesia. Assessments included maximum urinary flow (Qmax), postvoid residual (PVR) urine volume, International Prostate Symptom Score (IPSS), including quality of life (QoL) item, at baseline and follow-up visits.
108 men were enrolled in the trial. Stents were successfully inserted in 97% of the patients. Spontaneous voiding was achieved in all patients. After one month Qmax (+3.7 ml/s), PVR (-99 ml), IPSS (-12) and QoL (-1.7) all showed statistically significant improvements compared to baseline. Substantial improvements, however, were maintained for only one to two months. The main complications were haematuria (19%), urge incontinence (22%), and migration (15%). The median indwelling time was 105 days. The main reason for removal of stents was worsening of symptoms, which might be attributable to the tilting of stents within the prostatic urethra, found upon removal.
Insertion of the bell-shaped nitinol prostatic stent temporarily improves voiding parameters and symptom scores. Because of the limited durability, however, the bell-shaped prostatic stent is not suitable for clinical practice.
European Urology 03/2006; 49(2):353-9. · 8.49 Impact Factor
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ABSTRACT: For a simulation to be valid, it has to be close to reality, correlate with the performance in a real case, and be able to discriminate between individuals with different degrees of experience. We explored the construct validity (ability to discriminate between experienced and inexperienced subjects) of a simulation for the urethrovesical anastomosis during laparoscopic radical prostatectomy (LRP).
Dead chickens were used. After partial emptying of the corporal cavity, an 18F catheter was placed through the esophagus to the stomach. In the Pelvic Trainer, a laparoscopic section of the esophago-glandular-stomach junction and a suture between the two edges were performed in the same fashion as for a urethrovesical suture in LRP. Five subjects with different levels of experience in laparoscopy, ranging from nil to more than 250 LRPs, tested two types of suture. One-way ANOVA was used to detect differences in suturing time among the operators. A multiple comparison test was used to detect specific differences between operators.
Although suturing time had a strong negative correlation with the operator's experience, significant statistical differences in suturing time were found only between the least experienced operator and the other ones. Qualitative differences in the suture were found among operators.
This simulation correlates well with the laparoscopic (LRP) subject's experience. It can discriminate between inexperienced and experienced subjects, exhibiting moderate construct validity, but failed to reflect the different levels of experience among the most experienced subjects.
Journal of Endourology 02/2006; 20(1):69-73. · 1.85 Impact Factor
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ABSTRACT: We assessed the value of baseline PVR as predictor of the need for invasive therapy during long-term followup of patients with clinical BPH treated initially with alpha1-blockers or WW.
The records of a cohort of 942 patients with BPH treated with alpha(1)-blockers or WW were reviewed. Baseline I-PSS scores, PSA, prostate volume, uroflowmetry, pressure flow parameters and followup data were collected prospectively. Correlations between PVR and other baseline parameters were calculated. The 5-year cumulative risks of invasive therapy were calculated with the Kaplan-Meier method. After stratification of PVR by various cutoff levels (50, 100 and 300 ml), rate ratios between large and small PVRs were calculated using proportional hazards analyses.
PVR has weak (-0.2<R <0.2) correlations with other baseline parameters. With increasing PVR cutoff levels, the 5-year cumulative risk of invasive therapy for the large PVR subgroup, increases from 45% to 64% and from 15% to 21% in the alpha1-blockers and WW group, respectively. Large PVR yields a significant 2-fold up to a 4-fold increased risk of invasive therapy compared to small PVR in both treatment groups. In multivariate models these significant risk differences largely disappear, although a statistically not significant higher risk remains for the large PVR (greater than 300 ml) patients.
In general, baseline PVR has little prognostic value for the risk of BPH related invasive therapy in patients on alpha1-blocker and WW. Only patients with large PVR have a 2-fold increased risk of invasive therapy compared to patients with smaller PVR.
The Journal of Urology 01/2006; 175(1):213-6. · 3.75 Impact Factor
