Urology News

Ureteroscopy assisted retrograde nephrostomy: a new technique for percutaneous nephrolithotomy (PCNL)
Retrograde nephrostomy was first developed by Lawson et al. in 1983, and Hunter et al. reported 30 cases of retrograde nephrostomy in 1987. This procedure uses less radiation exposure and has a shorter duration compared with the previous percutaneous nephrostomy techniques. Retrograde nephrostomy using Lawson's procedure was reported in the late 1980s by several authors. But since then, few studies have been reported about this procedure due to the development of ultrasonography assisted percutaneous nephrostomy. With the arrival and development of the flexible ureteroscope (URS) both observation and manipulation in the renal pelvis are now easily achieved. The present procedure provides less radiation exposure, less bleeding, and a shorter procedure than previous percutaneous nephrostomy techniques. Using this procedure, after the needle has exited through the skin, no further steps are required in preparation for dilatation. In the present study, we continuously visualised from puncture to inserting the nephron-access sheath with the URS.

Percutaneous Nephrolithotomy Versus Extracorporeal Shock Wave Lithotripsy for Moderate Sized Kidney Stones
This article sought to compare the outcomes of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for moderate sized (1-2 cm) upper and middle pole renal calculi in regards to stone clearance rate, morbidity, and quality of life.  They were randomized to receive either ESWL or PNL. The SF-8 quality of life survey was administered preoperatively and at 1 week and 3 months postoperatively. PNL established a stone-free status of 95% and 85% at 1 week and 3 months, respectively, whereas ESWL established a stone-free status of 17% and 33% at 1 week and 3 months, respectively. Retreatment in ESWL was required in 67% of cases, with 0% retreatment in PNL. PNL more often establishes stone-free status, has a more similar complication profile, and has similar reported quality of life at 3 months when compared with ESWL for moderate-sized kidney stones. PNL should be offered as a treatment option to all patients with moderate-sized kidney stones in centers with experienced endourologists.

Panel Says Prostate Test Does Not Save Lives
Healthy men do not need prostate cancer screening with prostate specific antigen (PSA) because the test does not save lives and often leads to unnecessary testing, interventions, and treatment, the United States Preventive Services Task Force (USPSTF) is expected to recommend in an update to its prostate cancer screening guidelines. According to a report in the New York Times, the recommendation will be announced Tuesday and is based on a USPSTF-commissioned study, which failed to show a clear benefit from prostate cancer screening with PSA.

Is joint hypermobility associated with vesico-ureteral reflux? An assessment of 50 patients
Recent studies have already shown associations between generalized joint hypermobility (GJH) and voiding and defecation dysfunction and/or slow transit constipation. Changes in extracellular matrix composition in vesico-ureteric junction of vesico-ureteral reflux (VUR) patients were also observed previously. This study is the first to assess joint mobility as a parameter for connective tissue composition in vesico-ureteral reflux. We convincingly demonstrate that VUR patients have significantly more hypermobile joints compared to controls and this provides a new angle to the intriguing subjects of development of VUR and susceptibility to VUR. The findings in this article confirm our clinical observation of an increased rate of joint hypermobility in patients with VUR. We speculate that an altered composition of the connective tissue may contribute to the severity of the (pre-existing) VUR phenotype.

Serum testosterone level as a predictor of biochemical failure after radical prostatectomy for localized prostate cancer
The precise relationship between serum testosterone (T) and prostate cancer (PCa) incidence and progression is controversial. Low pre-treatment serum T correlates with higher risk of BF after radical prostatectomy, and T may possess biological information about PCa progression potential. This article investigated serum testosterone levels as a predictor for biochemical failure (BF) after radical retropubic prostatectomy (RRP). This was a prospective cohort study with 227 patients and a median follow-up of 7.7 years. In multivariate analysis with age, PSA, and biopsy Gleason score, testosterone levels >11 nmol/L were an independent predictor for reduced risk of BF. Overall a low pretreatment serum testosterone levels correlate with a higher risk of BF, and testosterone may possess biological information about prostate cancer progression potential, which makes it an independent predictor of biochemical failure after RRP.

Prostate-specific antigen (PSA) rise still a good marker of prostate cancer in men treated with dutasteride
Previous studies used the decrease in PSA after 6 months of dutasteride treatment as a new ‘baseline’ PSA value from which subsequent rises may serve as a warning for prostate cancer; however, PSA tends to continue to decrease as dutasteride treatment continues. By comparing positive biopsy rates in the REDUCE study using any rise from nadir in the dutasteride arm and standard PSA decision criteria (NCCN) in the placebo arm, we demonstrated that the ability to detect prostate cancer and high grade prostate cancer is maintained with dutasteride treatment.  Using treatment-specific biopsy thresholds, the present study shows that the ability of PSA kinetics to detect high grade prostate cancer is maintained with dutasteride compared with placebo in men with a previous negative biopsy.

Early prostate cancer – which treatment do men prefer and why?
In general the literature suggests that there is a need for improvement in aiding men diagnosed with early prostate cancer in their decision making about treatment options and that our understanding of this process is inadequate. There is limited data analyzing the reasons why these men decide between potentially curative or observational treatments and data evaluating patients’ views before and after definitive therapy are scarce. This study begins the process of understanding the reasons underlying a patient’s final treatment decision. Being a prospective study, it looks at the thought processes of these men before treatment during the time the decision is made. It also documents how satisfied patients are with their choice after their treatment and whether they would choose the same treatment again. Of the 768 patients, 305 (40%) chose surgery, 237 (31%) conformal beam radiotherapy, 165 (21%) brachytherapy and 61 (8%) active surveillance. Sixty percent of men who opted for radical prostatectomy were motivated by the need for physical removal of the cancer. Conformal radiotherapy was mainly chosen by patients who feared other treatments (n = 63, 27%). Most men chose brachytherapy because it was more convenient for their lifestyle.

What is the best treatment strategy for incidentally detected small renal masses? A decision analysis
This article sought to determine the optimal treatment for incidentally detected small renal masses between radical nephrectomy, partial nephrectomy, ablative therapy (AT) and active surveillance (AS) using a decision-analytic Markov model. Outcome measures included life expectancy and quality-adjusted life expectancy. Based on current literature, our model emphasizes the importance of balance between disease control and preserving renal function on life expectancy, and justifies initial active intervention with partial nephrectomy in younger patients. These results are consistent with recent American Urological Association guidelines for the management of this disease.

Low pretreatment total testosterone (<3 ng/mL) predicts extraprostatic disease in prostatectomy specimens from patients with preoperative localized prostate cancer
The authors  investigated the relationship between pretreatment testosterone levels and pathological specimen characteristics, by prospectively examining serum androgen concentrations in a well-studied cohort of patients who underwent radical prostatectomy (RP) for localized prostate cancer. A total of 107 patients with clinically localized prostate cancer had an assay of total testosterone before laparoscopic RP at our institution. It was found that in pathological specimens, low total testosterone (<3 ng/mL) was an independent risk factor for high Gleason score (>7) and for locally advanced pathological stage (pT3 and pT4). Higher preoperative testosterone correlated with disease confined to the gland.

Does sodium bicarbonate reduce painful voiding after flexible cystoscopy? A prospective, randomized, double-blind, controlled trial
This article sought to determine if sodium bicarbonate (Ural®) reduces painful voiding after flexible cystoscopy. 300 patients over 18 years old undergoing elective flexible cystoscopy were enrolled in a randomized, double-blinded, placebo-controlled trial.  Flexible cystoscopy was performed to a standard protocol. Patients were randomised after recruitment to receive Ural® or placebo (glucose) powder four times a day for two days after the procedure. Trial outcome was assessed by estimating the change in pain incidence and severity from before to two days after by post-procedural questionnaire. Overall it was found that In the replicable context of low post-cystoscopy pain levels, we believe Ural® does not reduce painful voiding after flexible cystoscopy.

Phosphodiesterase 5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review
Phosphodiesterase 5 inhibitors improve lower urinary tract symptoms (LUTS), however the maximum urinary flow rate is not significantly affected. Also, the underlying mechanism of action of these drugs on LUTS is not well understood. This article reviewed the evidence in support of the effectiveness of phosphodiesterase 5 inhibitors in lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). It was found that Phosphodiesterase 5 inhibitors used in the clinical setting can significantly improve LUTS secondary to BPH, erectile function and quality of life. Maximum urinary flow improvement is not statistically significant. This systematic review confirms the findings of the individual studies included; however the high heterogeneity between them precluded meta-analysis and further recommendations.

Study Knocks Diagnostic Value of PSA Velocity
If prostate biopsy is based on PSA velocity alone, the number of unnecessary biopsies would be almost four times the number of additional cancers diagnosed, data from a large clinical trial showed.

In the absence of other predictive factors, PSA velocity would have identified 115 prostate cancers at a cost of 433 unnecessary biopsies, according to Andrew Vickers, PhD, of Memorial Sloan-Kettering Cancer Center in New York City and colleagues.

Botox® in Urology—Will it Become Standard of Care for Urge Urinary Incontinence?
Treatment options for patients with overactive bladder refractory to anticholinergics are limited. We assessed the dose response across a range of doses of onabotulinumtoxinA (BOTOX®) in patients with idiopathic overactive bladder and urinary urgency incontinence whose symptoms were not adequately managed with anticholinergics. In a phase 2, multicenter, randomized, double-blind study, 313 patients with idiopathic overactive bladder and urinary urgency incontinence experiencing 8 or more urinary urgency incontinence episodes a week and 8 or more micturitions daily at baseline received 50, 100, 150, 200 or 300 U intradetrusor onabotulinumtoxinA, or placebo. OnabotulinumtoxinA at doses of 100 U or greater demonstrated durable efficacy in the management of idiopathic overactive bladder and urinary urgency incontinence. A dose of 100 U may be the dose that appropriately balances the symptom benefits with the post-void residual urine volume related safety profile. For More Urology News Visit Our Urology Archives