The Canadian Journal of Urology (Can J Urol)

Journal description

The Canadian Journal of Urology is a peer reviewed indexed journal published six times per year. Indexed in Index Medicus/MEDLINE and Current Contents/Clinical Medicine. The Canadian Journal of Urology has been published continuously since 1994. We welcome the urological medical community to submit original research articles, review articles and practice updates. We encourage urology residents to submit to our section entitled: Resident's Corner. website: www.canjurol.com

Current impact factor: 0.98

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 0.982
2013 Impact Factor 0.905
2012 Impact Factor 0.74
2011 Impact Factor 0.641
2010 Impact Factor 0.822

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.80
Cited half-life 5.50
Immediacy index 0.39
Eigenfactor 0.00
Article influence 0.27
Website
Other titles CJU International
ISSN 1195-9479
OCLC 264791332
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The Fuhrman grading system (FGS) is the most widely utilized pathological classification and predictor of renal cell carcinoma (RCC) prognosis. The aim of this study was to test the prognostic ability of a simplified two-tier FGS. Materials and methods: We reviewed the data of 509 patients with clear cell RCC who underwent radical or partial nephrectomy between January 1994 and April 2007. The conventional four-tier (I, II, III, IV) FGS was compared to a simplified two-tier FGS in which grades land II were combined (low grade) and grades III and IV were combined (high grade). Cancer-specific survival (CSS) was calculated for each patient. Univariate and multivariate analyses were used in combination with area under the curve (AUC) of receiver operating characteristic curves to compare prognostic accuracies between grading schemes. Results: Median follow up was 81.6 months. Using the conventional FGS, the 5 year CSS for Fuhrman grades I, II, III, and IV were 74.1%, 76.0%, 57.3%, and 40.7%, respectively (p < 0.001). Using the simplified two-tier FGS, the 5 year CSS for low grade and high grade were 75.5% and 54.7%, respectively (p < 0.001). Both FGSs achieved independent predictor status in multivariate analyses. Prognostic accuracy of multivariate models between the two FGSs had nearly identical AUCs, with a c-statistic of 0.769 and 0.716 for the two-tier and conventional systems, respectively. Conclusions: Our findings indicate that the simplified FGS performs similarly to the conventional system. The use of this simplified system may promote greater continuity of pathological interpretation as well as provide a more simplified approach for clinician utilization.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology

  • No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: To investigate association of C-reactive protein (CRP), a marker of systemic inflammation, with renal functional decline patients undergoing partial nephrectomy (PN) for renal mass. Materials and methods: Retrospective study of patients who underwent PN between February2006-March 2011, with 6 months follow up. Data was analyzed between two groups: CRP increase >= 0.5 mg/L from 6 months postoperative ("CRP rise," CRPR), versus no CRP increase 0.5 ("CRP stable," CRPS). Primary outcome was change in estimated glomerular filtration rate (Delta eGFR, mL/min/1.73 m(2)), with de novo postoperative stage III chronic kidney disease (stage III-CKD, eGFR <60 milmin/1.73 m(2)) being secondary. Multivariable analysis (MVA) was conducted to identify risk factors for development of de novo stage III-CKD. Results: A total of 243 patients (206 CRPS/37 CRPR) were analyzed. Demographics and R.E.N.A.L. nephrometry scores were similar. CRPR had significantly higher median Delta eGFR (-13.7 versus -32.0 mL/min/1.73 m(2), p < 0.001) and de novo stage III-CKD at last follow up (43.2% vs. 3.7%, p < 0.001). Median time to CRP rise was 10 (IQR 6.5-12) months. Median time from CRP rise to de novo stage III-CKD was 9 (IQR 7.5-11) months. MVA found RENAL score (OR 1.89, p = 0.001), hypertension (OR 4.75, p = 0.016), and CRP rise (OR 55.76, p < 0.001) were associated with de novo stage III-CKD. Sensitivity of CRP increase 0.5 for predicting CKD was 69.6%, specificity 93.3%, positive predictive value 55.2%, and negative predictive value 96.3%. Conclusion: Rise in CRP postoperatively is independently associated with renal functional decline after PN and may be useful in identifying patients to evaluate for reno protective strategies. Further studies are requisite to clarify etiology of this association.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Orthotopic ileal neobladder has been frequently performed as urinary diversion after cystectomy over the last decades. We report an unusual complication of very large calculi in a Studer ileal neobladder. Due to its size, open cystolithotomy was performed.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: We designed a pilot study to measure preoperative sexual dysfunction risk counseling between sexual medicine experts (SME) and general urologists between monopolar/bipolar transuretheral resection of the prostate (TURP) and laser TURP (LT). Materials and methods: An emailed electronic survey was distributed to members of the North Central Section (NCS) of the American Urologic Association and the Sexual Medicine Society of North America (SMSNA). Overall, 260 (12.3%) completed the survey. Counseling for ejaculatory disorder (EjD), erectile dysfunction (ED), stricture formation and incontinence was assessed. Additional subset analysis between those SME's versus general urologist was done. Results: Overall, 82% (224) identified as general urologists and 18% (49) as SME. Two-thirds were in private practice versus academic. Over 90% of all practitioners "almost always" counsel about the possibility of EjD, with varied risk rate for LT. Overall, 62%(140) for monopolar TURP (MBT) and 60% (110) for LT "almost always" counsel about ED. There was no statistical difference between groups counseling on incontinence, strictures, EjD or ED between SME and general urologists. Conclusions: Sexual side effects of treatment for LUTS/BPH are appreciated by urologists. Most practitioners counsel about EjD, however the incidence varies between MBT and LT. Practitioners counsel their patients on ED less often than EjD. Counseling rates are not improved with those specializing in sexual medicine independent of TURP technique.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology

  • No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Bladder neck contractures (BNC) are an uncommon complication following radical prostatectomy. Occasionally, BNCs can be refractory to endoscopic approaches. We describe the effectiveness of a novel robotic-assisted laparoscopic catheterizable bladder augment in treating recalcitrant BNCs. Materials and methods: Patients undergoing robotic-assisted radical prostatectomy (RALP) between 2004-2014 who developed a postoperative BNC were identified. We documented our experience with robotic-assisted laparoscopic catheterizable bladder augment for recalcitrant BNCs. Total operative time, robotic time, estimated surgical blood, length of hospital stay, serum creatinine, complications, and postoperative course/upper tract imaging were recorded. Results: Thirty-six of 2002 RALP patients (1.8%) experienced a post-surgical BNC at 182 days post-surgery. Twenty-two (61.1%) underwent a single dilation and/or transurethral incision. Eleven (30.6%) required >= 1 procedure. Three patients (8.3%) had recalcitrant BNCs. One patient with normal bladder capacity elected open urethroplasty. The remaining two had reduced bladder capacity, detrusor overactivity and failed multiple incisions and self-catheterization. In one patient, the stricture was complete. The other patient experienced urethral leakage requiring bladder neck closure. In both patients, a robotic approach, utilizing an ileal-cecal segment as a catheterizable augment, was performed. At 16 and 89 months follow up, both are continent, with stable renal function and normal upper tracts. Conclusion: Robotic-assisted laparoscopic cat heterizable bladder augment is a viable treatment for recurrent BNCs. This approach may be particularly well suited for patients with concurrent hyperreflexia or decreased bladder capacity.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery. Material and methods: From a database of 1101 patients that underwent semi-rigid holmium laser ureterolithotripsy from 2003 to 2013, we performed a search for patients treated for ureteral stricture. Parameters analyzed included patient demographic, stone burden, and ureteral stricture characteristics. Treatment included holmium laser endoureterotomy for stenosis cm and open/laparoscopic repair for stenosis >1 cm or for failed endoscopic treatment. Outcomes and complications were assessed. Success was defined as symptom improvement and radiographic obstruction resolution. Results: Of all the patients, 32 (2.8%) evolved with ureteral stenosis and all had impacted calculi at the time of surgery. Twenty-two patients with complete follow up were studied. After a mean follow up of 18.5 months (range 3-70), the success rates for endoureterotomy and open/laparoscopic stricture repair group were 50% and 82%, respectively. The hospitalization period was significantly shorter for patients who had undergone endoureterotomy (2.7 +/- 1.4 days versus 4.8 +/- 1.4 days; p = 0.003). Only minor complications occurred in both groups. Conclusion: The rate of ureteral stricture after holmium laser ureterolithotripsy for impacted calculi is higher than reported for non-impacted stones. Holmium laser endoureterotomy for stenosis shorter than 1 cm treated half of the cases. Open/laparoscopic repair had good outcomes in cases of longer stenosis.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Fournier's gangrene is an uncommon necrotizing infection affecting the genital and perineal area. Penile involvement in particular is rare owing to its rich vascular supply. In this report, we document a case of Fournier's gangrene involving penile and urethral tissue requiring multiple debridements resulting in significant penile deformity and a non-healing wound. Eventually, the patient underwent penectomy and perineal urethrostomy creation. In this case, penectomy and perineal urethrostomy provide a functional outcome for highly refractory and complex patients with Fournier's gangrene involving penile tissue.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Spontaneous retroperitoneal hematoma (SRH) is a rare, potentially lethal entity that can arise from a variety of etiologies. We present a case of SRH secondary to hemorrhage from the right inferior adrenal artery in a 22-year-old woman. The patient presented to the emergency room with significant right flank pain, and computed tomography (CT) demonstrated a large, right-sided retroperitoneal hematoma with no identifiable etiology. Renal angiography revealed active extravasation from the right inferior adrenal artery. The patient was definitively treated with endovascular coiling of the ruptured artery, and long term follow up demonstrated resolution of the retroperitoneal hematoma.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: The aim was to perform a feasibility study of the new artificial sphincter device ARTUS in human cadavers. ARTUS is a new electro-mechanical device, which may prevent urethral damage due to a new working principle which is to perform only sequential pressure on successive parts of the urethra. Material and methods: The implantation of the ARTUS device was performed in six cadavers (3 males, 3 females) with different body mass indices. Subsequently the basic operation data (operation time, cuff size, length of wires, complication) were assessed. Results: The implantation of the ARTUS device is performed easily by the same technique which is commonly used for the AMS 800 implantation. The mean operation time was 20 minutes. The mean cuff size was 4.5 cm in male and 6 cm in female cadavers. The average length of the wires was 12 cm. The necessary subcutaneous pouch had to be bigger than the space used for the tubes of the AMS 800 device. The study is limited by its preclinical setting. Conclusions: Our results demonstrate that this new artificial urinary sphincter device can be easily implanted. The technical and surgical approaches are similar to those which are applied in the case of the AMS 800 device. Therefore experienced surgeons will be able to adapt their technique easily.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Numerous treatments are approved for metastatic castration-resistant prostate cancer (mCRPC), including sipuleucel-T, an FDA-approved immunotherapy. Materials and methods: In this paper we review recent data providing insights into the mechanism of action of sipuleucel-T which suggests sipuleucel-T may be most effective when administered to mCRPC patients with a low burden of disease. Published and presented data from the sipuleucel-T clinical trials NeoACT (NCT00715104), IMPACT (NCT00065442), ProACT (NCT00715078), PROTECT (NCT00779402), OpenACT (NCT00901342), STAMP (NCT01487863) and STAND (NCT01431391), individually or across trials, were included in this review. Results: Overall, a growing body of evidence supports the concept that sipuleucel-T, like some other immunotherapies, has long term effects that result in an overall survival benefit. mCRPC patients with a low tumor burden may derive a greater therapeutic benefit, since the immune response may be more robust when the disease is less advanced and immunosuppressive effects from the tumor or traditional therapies may be less marked. In addition, treatment with sipuleucel-T in early mCRPC does not preclude subsequent treatment with other approved mCRPC therapies. Conclusions: Collectively, clinical data to date suggest the optimal timing for sipuleucel-T treatment may be early in the mCRPC treatment paradigm.
    No preview · Article · Dec 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Benign prostatic hyperplasia (BPH) is arguably the most common benign disease of mankind. As men age, the prostate inexorably grows often causing troubling symptoms causing them to seek out care. While traditionally treated by transurethral resection or open surgical removal of the hypertrophied adenoma, today the urologist has numerous medical, surgical and minimally invasive techniques available. In this supplement The Canadian Journal of Urology provides a review of the various techniques and medications available today. Materials and methods: As an introduction to the supplement, the aim of this article is to review the epidemiology and economy of BPH as well as its natural history and diagnosis. A systematic review of available literature was looking for articles on BPH and its epidemiology, economics, natural history and management using PubMed database. Results: The prevalence of this condition is increasing with the population aging and so does the economic burden. The exact etiology of this condition is unknown, but some risk factors have been identified. The diagnostic and treatment of this very common disease should rely on a strong collaboration between primary care physician and urologist. Conclusion: There are multiple options in treating BPH including medical, surgical and newer minimally invasive options. The challenge with having a variety of options is to review them with the patient and help the patient select the best treatment option for their condition.
    No preview · Article · Oct 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Laser treatment of benign prostatic hyperplasia (BPH) through enucleation techniques has become increasingly more utilized in the field of urology. Laser enucleation of the prostate (LEP) is a transurethral procedure that employs several different types of lasers to dissect the adenoma from the surgical capsule in a retrograde fashion. Materials and methods: We review basic laser physics and current laser prostate enucleation techniques. Holmium-LEP (HoLEP), Thulium-LEP (ThuLEP), Greenlight-LEP (GreenLEP) and Diode-LEP (DiLEP) applications are discussed. We summarize the current literature with respect to functional outcomes and complications. Results: Although each laser device used for prostate enucleation has the same goal of removal of the adenoma from the surgical capsule, each has unique characteristics (i.e. wavelength, absorption rates) that must be understood by the practicing surgeon. Mastery of one LEP technique does not necessarily translate into facile use of an alternative enucleation energy source and/or approach. The various LEP techniques have demonstrated similar, if not superior, postoperative results to transurethral resection of the prostate (TURP), the current gold standard in the treatment of BPH. Conclusions: This article outlines the current LEP techniques and should serve as a quick reference for the practicing urologist.
    No preview · Article · Oct 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: The use of complementary and alternative medications has become a multi-million dollar business in the United States and comprises more than half of all filled prescriptions for benign prostatic hyperplasia (BPH) in Europe. For the practicing urologist, understanding the phytotherapeutic agents available, their proposed mechanism of action, the research supporting their use, and their safety profiles has become increasingly important as more patients inquire into their use. Materials and methods: A comprehensive literature search was conducted to identify pertinent articles pertaining to alternative and complementary treatment options for the management of BPH. Treatments demonstrating adequate clinical data, including Serona repens, Pygeum africanum, and Secale cereal, were selected for in depth review. Results: Small clinical trials for each of the agents demonstrated mixed results while larger more soundly constructed studies found no significant benefit for the use of phytotherapy in the treatment of BPH. Conclusions: Based on the available literature, there is no evidence that phytotherapy significantly improves symptoms of BPH against placebo, despite being largely safe for ingestion. In patients with mild BPH symptoms who are reluctant to take standard pharmaceutical medications may try these agents provided that the patient understands their current limitations. Those with moderate or severe BPH should be discouraged from alternative and complementary treatments.
    No preview · Article · Oct 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Benign prostatic hyperplasia (BPH) is a common disease that affects men as they age. Historically the treatment has been primarily surgical in nature, but over the past 25 years significant advances in medical therapy have been made, sparing some men from interventional procedures. Materials and methods: This article highlights the current state-of-the-art with respect to medical therapy for lower urinary tract symptoms secondary to BPH (BPH-LUTS) including a review of landmark studies and recent areas of research in the field. Results: Alpha blockers are considered first line when treating BPH-LUTS in men with small prostates and 5-alpha reductase inhibitors (5-ARIs) are recommended in men with large symptomatic prostates. While, phosphodiesterase-5 (PDE-5) inhibitors are the mainstay of erectile dysfunction therapy, they also play a role in treating BPH-LUTS. If men have persistent irritative storage symptoms after first line BPH therapy then overactive bladder (OAB) medications can be added or substituted. Combination therapies can be used to provide short term symptom relief with long term disease management. Conclusions: Medical therapy remains the main treatment option for men suffering from BPH-LUTS. Numerous medical options are available that can be tailored to meet the individual's needs depending on their personal and prostate characteristics. An algorithmic approach, as we have defined within this article, can be a helpful guide to this decision-making process.
    No preview · Article · Oct 2015 · The Canadian Journal of Urology
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    ABSTRACT: Introduction: Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or for those who cannot tolerate first-line medications. In recent decades, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate (TURP). Nonetheless, complications are still frequently encountered in the immediate, early, and remote postoperative setting. Materials and methods: In this review, we perform an in-depth examination of contemporary treatment strategies for long term complications of surgical outlet reduction procedures. Complications encountered in the remote postoperative setting such as erectile dysfunction (ED), urethral stricture, refractory incontinence, and bladder neck contracture were identified in the literature. Results: Treatment strategies for ED after TURP do not differ from algorithms applied for ED due to other causes. Management of urethral stricture following TURP depends on the size and location of narrowing and can range from simple dilation to complex excision with grafting techniques or perineal urethrostomy. Refractory urinary incontinence requires a full diagnostic evaluation, and artificial urinary sphincter placement is efficacious for cases that do not respond to first-line medical therapy. Finally, numerous therapies for bladder neck contracture exist and vary in their invasiveness. Conclusion: Endoscopic reduction of the prostate for the male with benign prostatic obstruction via most contemporary modalities is a safe and effective means to decrease outlet resistance to urinary flow. However, late complications from these procedures still exist. Management of remote morbidity following TURP can be diagnostically and therapeutically complex, necessitating prompt referral to a genitourinary reconstruction specialist.
    No preview · Article · Oct 2015 · The Canadian Journal of Urology