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Castiglione, M. Albersen and T. Esen G. Shaw, D. Lewis, J. Boren, A. Ramos-Montoya, D. Soloviev, R. Bielik, K. Brindle, D. Ingels, A. Thong, M.

Saar, M. Valta, R. Nolley, J. Santos, H. Zhao, D. Hambrock, C. Hoeks, C. Hulsbergen-Van De Kaa, T. Scheenen, J. Bouwense, I.

Van Oort, F. Huisman, J. Montorsi, I. Van Oort who accepted the award on behalf of T. Hambrock, T. Esen and J. Catto E.

Cha, L-A. Tirsar, C. Schwentner, P. Christos, C. Mian, J. Hennenlotter, T. Martini, A. Stenzl, A. Pycha, S.

Shariat, B. Montorsi, E. Cha, T. Mulders, V. Mirone, L. Arenas Da Silva, L. Bonfils, M. Meinung, M. Kelsen, G. Raue, C. Hitschler, B.

Ungricht, M. Widmer, T. Makris, N. Walter, T. Grainger, R. Knudsen, L. Aarvig, B. Staying alive as long as possible to defeat the insurance company laughs.

Seriously, I finished in writing a paper for the British Medical Journal about medicine and bureaucracy, and the impact on medical decisions.

Appendectomy- as a student. The first thing that strikes you is when you make the first incision and the amount of pressure you make.

I fiddled around and just made a little scratch. I would still be a surgeon. I would hate sitting in an office looking at the computer or fiddling with paper.

The Letters of P. Quite fun, that would entertain you. To reach this age when nothing surprises you.

In general, anything a politician would do now would not surprise me. I collect and restore old cars. It takes up a lot of space.

Luckily I got a bit of land. The oldest one is a Morris Minor. The most recent is a Lotus When I go to bed and read. The ESAU session, on the other hand, will focus on managing infertility which will cover topics such as ejaculatory disturbances and duct obstruction, vasovasostomy, varicocele therapy, sperm retrieval and epididymovasostomy.

The second and last day will open with live surgeries on penile and urethral reconstruction for lichen sclerosus BXO , and a follow-up surgical session on penile implants.

The live surgery sessions, which will be conducted in accordance with the recently issued EAU Guidelines on ethical live surgeries, will be directly transmitted from the operating theatres of the UCLH Education Centre in London to the meeting rooms.

Moderated commentary and interactive audience feedback will guide the programme to further prompt insightful discussions.

The ESGURS debates will tackle the following topics: management of bladder neck contractures after prostate cancer treatment, with focus on either reconstruction versus endoscopic procedures; full length anterior strictures, i.

Stefan Buntrock Chief of Urology Klinik am Kurpark Bad Wildungen DE The reason why it is so difficult for both doctors and patients to talk about intimate topics is simple: it is taboo.

Only a minority of us have been brought up with a proper education about sex, by our parents or at school. Medical school did not prepare us how to talk to patients about sex and neither did we get any training during residency.

Sexual symptoms are not uncommon problems which are irrelevant for diagnostic purposes or the successful treatment of a disease.

On the one hand they can indicate or are linked to serious underlying causes like cardiovascular disease. PDE-5 inhibitors might temporarily restore erectile function but what if the partner does not accept them?

What if she gets the impression that his attraction to her is based on a pharmacological reaction?

Conversely, the incidence and prevalence of sexual health problems is high. On the other hand, sexual symptoms can be due to personal and interpersonal crises, resulting in significant reductions of individual quality of life.

It is therefore important to first address sexual issues before surgical procedures which may have a detrimental effect on sexual life.

But even if the tumour can be resected, health might be more difficult to restore. This is because health has something to do with how we feel about ourselves.

Any physician should be able to take a sexual history, provide basic information and deal with misconceptions a couple may have about sex.

Psychosexual treatment methods, on the other hand, belong in the hands of the specially-trained expert. December 5, was a historic date.

The examination was intended for physicians who work in the field. But the more interesting question is: why should anybody not work in this area of medicine?

Sexual problems result from an abundance of causes and could be encountered frequently in daily practice if only doctors would dare to ask.

Some basic knowledge and skills in sexual medicine should therefore be mandatory for any one practicing medicine.

Sexual function serves this purpose. We all have basic needs that go beyond water, food, clothing and shelter. As social beings we need emotional warmth, acceptance, the need to feel close to others and be socially secure.

It is a multi-layered phenomenon that involves complex dimensions such as relationship, lust and reproduction.

And besides the fragile interplay between body and mind, sexual function usually involves other people which make things even more complicated.

But with the complex interplay between body and mind, sexual dysfunction is common. Thus, there is a need for more doctors to specialise in this area, and establishing a qualification examination in sexual medicine is a major step to a higher level of medical care.

References 1. Sexuologie ; J Sex Med ; 1 1 : BMJ ; Int J Clin Pract ; J Sex Med ; 3: Hemorrhagic cystitis: Etiology and treatment Treatment of hemorrhagic cystitis is difficult with therapies described in literature Prof.

Causes The most common cause of hemorrhagic cystitis is bacterial infection. Escherichia Coli, Staphylococcus saprophyticus, Proteus Mirabilis, and Klebsiella are the most common organisms involved2.

Fungal infections can also cause hemorrhagic cystitis. The most common organisms are Candida Albicans, Cryptococccus neoformans, Aspergillus fumigastus and Torulopsis glabrata.

Finally, Schistosoma hematobium and Echinococcus granulosus may also be implicated. Therapy includes: immediate bladder irrigation.

Urinary tract symptoms such as frequency, urgency, nocturia and dysuria are very common. Chronic and recurrent hemorrhagic cystitis often arises Phosphoramide mustard, the active antineoplastic after radiotherapy and chemotherapy for the treatment metabolite and acrolein are toxic to the urothelium8.

The prolonged exposure of the bladder urothelium to of pelvic tumours prostate, bladder, rectal and gynaecological cancers and should be considered as acrolein may determine edema of the bladder complications of the treatment.

Infections are less mucosa, vascular dilatation and increased capillary common causes of chronic hemorrhagic cystitis exept fragility resulting in hemorrage.

The onset of hematuria usually Paediatric and immunocompromised patients are occurs within 48 hours of treatment The BK polioma virus, adenovirus type 7,11,34 and 35, Other systemic chemotherapeutic agents: Busulphan Cytomegalovirus, JC virus and Herpes virus have been alkyl sulfonate compound used for leukemia can implicated Hematuria occurs after transplant recipients.

The onset is from one to four a long interval and is related to dose. Tiaprofenic months after transplantation5. Drugs Occupational exposure to chemical substances, aniline, Topical agents can provoke a direct irritation of the a costituent of dyes, and toluidine, found in pesticides bladder mucosa.

The hematuria usually is self-limiting once the exposure to the agent is eliminated. It occurs at least after 90 days after the initiation of RT but it may occur also after 10 years of treatment Among the histological features is a progressive obliterative endoarteritis that leads to ischemia of the bladder mucosa.

Then, the mucosa ulcerates and bleeds. Neovascularity forms in the damaged areas causing the typical vascular blush seen at cystoscopy.

The newly-formed vessels are more fragile. In case of bladder distension of minor trauma or any mucosal irritation bleeding is possible.

Acute episodes usually stop in months in most of these patients Late radiations injuries are irreversible and progressive. The time interval between the treatment and development of delayed symtoms is inversely proportional to the dose received The pathophysiology of late radiation damage includes cellular depletion, fibrosis and obliterative endoarteritis The fibrosis decreases the bladder capacity and patients complain of urgency, frequency and dysuria.

In some cases incontinence may develop1. Grading of hemorrhagic cystitis A grading system for severity of hemorrhagic cystitis has been proposed by Droller 0.

If the cause is not obvious a work-up with urine cytology, upper urinary tract imaging and cystoscopy should be performed.

The patients medications should be reviewed and anticoagulants stopped. Laboratory evaluation with hemoglobin, complete blood count, blood urea, serum creatinine, coagulation profile and urine culture should be done1.

Treatment of bacterial, fungal and viral hemorrhagic cystitis Bacterial and fungal hemorrhagic cystitis are usually cured with the appropriate antibiotic and antifungal therapy according to cultures.

In case of viral cystitis, cidofovir is the drug of choice in immunosupressed patients1. Treatment of drug-induced hemorrhagic cystitis In case of drug-induced cystitis, immediate bladder irrigation is indicated.

Drugs should be stopped and in some cases, when possible, treatments delayed chemo therapy or BCG instillation for bladder cancer.

Exposure to chemicals like aniline or other agents should be eliminated. Usually hematuria is selflimiting in these cases.

Treatment of hemorrhagic cystitis due to chemotherapeutic agents Stopping the drug or reducing the dose is the primary treatment.

Hydration and forced diuresis is helpful to reduce the toxicity profile of the drugs. Continuous bladder irrigation CBI decreases the duration of exposure of the urothelium to acroelin, reducing toxicity.

The drug sodium 2-mercaptoethane sulfonate mesna iv in three doses can prevent cystitis by ifosfamide and cyclophosphamide.

Mesna is rapidly excreted by the urinary tract; the sulphydryl group complexes with the terminal methyl group of acrolein forming a non toxic thioether7.

The role of mesna in preventing hemoragic cystitis after cyclophosphamide is controversial. Two randomised controlled studies comparing mesna and hyperidratation or CBI showed no difference on the incidence of hematuria Since cyclophosphamide may produce bladder cancer transitional cell carcinoma in 2 to 5.

Treatment of hemorrhagic cystitis due to radiation Prevention with accurate tailoring of radiation field limiting the dose to the bladder is the most important approach.

New technologies like cyberknife can help in this. Continued on page 10 European Urology Today 9 Continued from page 9 Radiation-induced hemorrhagic cystitis is very difficult to treat because of the ischemic nature of the disease.

Oral agents like steroids, Vitamin E, trypsin and orgotein have been used without success1. A preliminary cystoscopy for clots evacuation and fulguration of bleeding vessels should be perfomed.

The skin of the perineum must be protected with petroleum jelly. Hyperbaric oxygen HBO therapy has been extensively used and investigated.

Bevers reported the results of a up with urine cytology, upper urinary prospective study on 40 patients treated with 20 sessions of HBO for 90 minutes.

The response rate after tract imaging and cystoscopy should three months was Chong 23 confirmed these results.

Side effects include radiation cystitis determines a reduction of baldder gluteal pain occlusion of the superior gluteal artery Shao et al reported the results of a study comparing intrvesical hyaluronic acid Surgery instillation vs HBO in 36 patients with radiationVarious surgeical procedures have been suggested.

The improvement rate showed no statistical and occlusion of the ureteral orifices39, urinary difference between the two groups. Decrease of diversions, ligation of hypogastric artery and finally frequency was significant in both groups but persisted cystectomy have been described.

Stillwell reported the in time 12 months only in HA group. Conclusions WFthe formulation of terachlorodecaoxygen iv, a Treatment of hemorrhagic cystitis is difficult.

A variety novel healing agent with immune effect inhibition of of therapies have been described. However, due to the chronic inflammatory process determined a complete rarity of this complication, large studies are lacking.

HBO seems the The first step is to insert a three-way catheter to therapy of choice even if expensive.

Surgery should be decompress the bladder, to evacuate clots and start considered as the last step for the treatment of this saline irrigation.

In some cases cystoscopic complication. The bladder should be carefully evaluated and every single site of bleeding References fulgurate.

In patients who do not respond to this 1. Manikandan R, Kumar S, Lalgudi D et al: Hemorragic treatment further therapies are needed cystitis: a challenge to the urologist.

Sodium pentosan polysulfates protects the surface of the bladder mucosa and can reduce the inflammatory response of the urothelium.

One to eight weeks are needed to reduce the degree of hematuria Instillation therapy E-aminocaproic acid inhibits fibrinolosis by preventing the activation of plasminogen to plasmin.

It is given orally, parenterally or intravesically by continuous bladder irrigation. The maximum recommended dosage in 24 hour is 30 mg. The major disadvantage is the clots formation in the bladder.

Patients should be clot-free before treatment. Alum aluminium ammonium sulphate or aluminium potassium sulphate irrigation causes protein precipitation, vasoconstriction and decreased capillary permeability Toxicity is minimal.

In children and in patients with renal failure microcytic anemia, osteomalacia, dementia, encephalopaty, metabolic acidosis have been described Silver nitrate Instillations cause a chemical coagulation and eschar at the bleeding sites.

It is instilled in the bladder as a solution at a concentration of 0. Reflux should be excluded before instillation as renal failure due to precipitation and obstruction of upper tract has been described Prostaglandin E1, E2 and F2 alfa have a cytoprotective effect by regulating mucus production They can also cause a contraction of the blood vessels in the mucosa and submucosa via membrane stabilization.

Another action is the determination of platelets aggregation. Formalin rapidly fixes the bladder mucosa through a process involving protein cross-linking Reflux should be ruled out before instillation.

Formalin must be instilled under general or spinal anesthesia since it is caustic to 10 European Urology Today Clin Oncol ; Mesna compared with continuous bladder irrigation as uroprotection during high-dose chemotherapy and transplantation: A randomized trial.

J Clin Oncol ; Cannon J, Linke CA, et al. Cyclophosphamide associated carcinoma of urothelium: Modalities for prevention.

Urology ; Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg ; Hyperbaric oxygen treatment for haemorrhagic cystitis.

Lancet ; Early hyperbaric oxygen theraphy improves outcome for radiation induced haemorrhagic cystitis.

Shao Y. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis.

Veerasarn V, Boonnuch W, et al. A phase II study to evaluate WF 10 in patients with late haemorrhagic radiation cystitis and proctitis.

Gynecol Oncol ; Heath JA, Mishra S, et al. Estrogen as treatment of haemorrhagic cystitis in children and adolescents undergoing bone marrow transplantation.

Bone Marrow Transplant ; Hampson S, Woodhouse C. Sodium pentosanpolysulphate in the management of haemorrhagic cystitis: Experience with 14 patients.

Eur Urol ; Arrizabalaga M, Extramiana J, et al. Treatment of massive hematuria with aluminum salts.

Br J Urol ; Choong SK, Walkden M, et al. The management of intractable hematuria. BJU ; Perazella M, Brown E. Acute aluminum toxicity and alum bladder irrigation in patients with renal failure.

Am J Kidney Dis ; Is it safe to use aluminum in the treatment of pediatric hemorrhagic cystitis? A case discussion of aluminum intoxication and review of the literature.

J Pediatr Hematol Oncol ; Anuria following silver nitrate irrigations for intractable bladder haemorrhage.

J Urol ; The rat urinary bladder produces prostacyclin as well as other prostaglandins. Prostaglandins Leukot Med ; Evaluation of carboprost tromethamine in the treatment of cyclophosphamideinduced haemorrhagic cystitis.

Cancer ; Laszlo D, Bosi A, et al. Prostaglandin E2 bladder instillation for the treatment of hemorrhagic cystitis after allogeneic bone marrow transplantation.

Haematologica ; Hemorrhagic cystitis: A review. Vicente J, Rios G, et al. Intravesical formalin for the treatment of massive hemorrhagic cystitis: Retrospective review of 25 cases.

McIvor J, Williams G, et al. Control of severe haemorrhage by therapeutic embolisation. Clin Radiol ; Glutaraldehyde cross-linked collagen occlusion of the ureteral orifices with percutaneous nephrostomy: A minimally invasive option of refractory hemorrhagic cystitis.

Hemorrhagic cystitis. Erard V, Storer B, et al. BK virus infection in haematopoietic stem cell transplant receipents: Frequency, risk factors and association with post engraftment haemorrhagic cystitis.

Clin Infect Dis ; Haemorrhagic adenovirus cystitis after renal transplantation. Transplant Proc ; Polyomavirus BK infection in blood and marrow transplant recipients.

Bone Marrow Transplantation ; Transurethral insertion of vaginal contraceptive suppository into the urinary bladder.

Wis Med J ; Ann Intern Med ; Ifosfamide and mesna. Clin Pharm ; Cox PJ. Cyclophosphamide cystitis. Identification of acrolein as the causative agent.

Biochem Pharmacol ; Cyclophosphamide- induced hemorrhagic cystitis. A review of patients. Islam R, Issacson BJ, et al.

Hemorrhagic cystitis as an unexpected adverse reaction to temozolomide: Case report. Am J Clin Oncol ; Acute hemorrhagic cystitis.

Industrial exposure to the pesticide chlordimeform. JAMA ; Cox JD, Stetz J, et al. Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen.

Oration JP. Complications following radiation therapy in carcinoma cervix and their treatment. Am J Obstet Gynecol ; Pasquier D, Hoelscher T, et al.

Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissue: A literature review. Radiother Oncol ; Droller MJ, Saral R, et al.

Prevention of cyclophosphamide- induced hemorrhagic cystitis. Mesna versus hyperhydration for the prevention of cyclophosphamide induced hemorrhagic cystitis in bone marrow transplantation.

Pre-operative staging, however, showed pulmonary hilar lesions on the left side fig. A transbronchial biopsy of the hilar lesion was done and histology was assessed as being compatible with renal cell carcinoma.

He had been surgically treated by left radical orchidectomy in December After complete staging which showed multiple pulmonary, large hepatic and retroperitoneal lymph node disease, he underwent three courses of PIE chemotherapy cisplatin, ifosfamide, etoposide with full dosage and re-staging after the second cycle which showed good response in all sites.

He underwent retroperitoneal lymphadenectomy in March with removal of all residual retroperitoneal disease; the histology of the nodes removed showed necrosis and a small area of mature teratoma.

At surgery, the hepatic lesions had also been biopsied showing necrosis figure 1. Following this, the patient received two more courses of PIE chemotherapy.

Re-staging showed shrinkage of all remaining lesions. One of the larger pulmonary lesions was surgically removed Fig.

The only marker which had been elevated was HCG which had normalized after the first three courses of chemotherapy.

Re-staging was initiated which showed further regression of the remaining known lesions. Are other diagnostic tests useful?

What treatment options are available? What is the prognosis? Case provided by O. Hakenberg, Dept. EAU guidelines are recommending four cycles of PEB chemotherapy cisplatin, etoposide, bleomycin followed by complete resection of all metastatic sites within four to six weeks as standard therapy.

In case of relapse, four cycles of cisplatin-combination Instead of this the patient only received three cycles of PEI, followed by retroperitoneal lymphadenectomy.

Histological workup showed necrosis and mature teratoma, as did the biopsies of the liver metastases and one surgically removed pulmonary lesion.

Obviously, further surgery has been calculated to be risky; therefore two more cycles of PEI have been administered showing shrinkage of all remaining lesions together with normalisation of HCG.

It may be speculated that bleomycin has been avoided because of an unreported impairment of lung function.

Why was retroperitoneal lymphadenectomy performed already after the third instead of the fourth cycle of chemotherapy leading to a delay of further cycles?

What should be done? As dramatic increase of HCG has been documented, it may be recommended to also check the brain and bones for metastases.

As there may be some vital cancer cells especially in the liver, an attempt to remove all residual lesions should be made now followed by second-line chemotherapy.

Case Study No. Retroperitoneal lymphadenectomy was performed after only three cycles of chemotherapy instead of four.

However, all removed and biopsied lesions showed necrosis with only one retroperitoneal node also showing a small amount of mature teratoma.

Surgical removal of all lesions was never an option as there were too many especially in both lungs. In view of the fact, that preoperative chemotherapy had been insufficient it was considered necessary to add two more cycles of PIE which had shown efficacy before.

Following this, the patient developed recurrence after six months. Another important objective is to have a platform that allows for the inclusion of a range of scientific papers which are considered of interest to a large readership.

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Illustrations are welcome. Reviews of books, journals and new media The patient was then restarted on PIE chemotherapy as re-staging had shown further shrinkage of all lesions.

This led to an HCG-response which was, however, comparatively slow. After two cycles, TIP chemotherapy was started together with stem cell harvesting.

Therefore, high-dose chemotherapy was started which the patient is currently undergoing. Letters to the editor Authors are welcome to submit letters to the editor.

The text of letters should be limited to words. Letters to the editor will be published as space permits.

Thus, the potential impact of eliminating smoking on the number of bladder cancer cases prevented is obviously larger for individuals at higher than at lower genetic risk.

Insulin-like growth factor receptor-binding protein 5 identified as a promising marker in urothelial carcinoma In an exemplary way the authors of this study systematically searched for and identified a new marker for urothelial cancer.

They assessed the published transcriptome of urinary bladder urothelial cancer and identified insulin-like growth factorbinding protein-5 IGFBP-5 as the most significantly up-regulated gene associated with the regulation of cell growth.

By immunohistochemistry the IGFBP-5 expression status and its associations with clinicopathological features and survival in cases of upper urinary tract urothelial carcinoma UUT and cases of urothelial bladder cancer UBC were evaluated.

Additionally, western blot analysis was performed to evaluate IGFBP-5 protein expression in human urothelial cell lines.

IGFBP-5 overexpression independently predicted poor disease-specific survival and metastasis-free survival in both groups of patients.

The authors demonstrated convincingly that IGFBP-5 plays an important role in tumour progression in urothelial carcinoma and that its overexpression is associated with advanced tumour stage and signifies poorer clinical outcome.

Source: IGFBP-5 overexpression as a poor prognostic factor in patients with urothelial carcinomas of upper urinary tracts and urinary bladder.

Cancer Res. This paper gives a detailed analysis of the risk of developing bladder cancer in a smoking population.

The analyses included up to 3, cases and 5, controls of European background in seven studies. The authors tested for multiplicative and additive interactions between smoking and 12 susceptibility loci, individually and combined as a polygenic risk score PRS.

Thirty-year absolute risks and risk differences by levels of the PRS were estimated for U. The year absolute risk of bladder cancer in U.

Risk difference estimates indicated that 8, cases would be prevented if elimination of smoking occurred in , men in the upper PRS Key articles 12 death donors older than 60 years compared with brain-death donors of the same age group.

This study shows that there is no difference in the effect of donor age between kidneys from circulatorydeath and brain-death donors and this will help reassure clinicians when considering potential kidneys Source: Common Genetic Polymorphisms Modify offered for transplantation.

However, the finding that increasing cold storage times is associated with the Effect of Smoking on Absolute Risk of inferior transplant outcomes for kidneys from Bladder Cancer.

In the UK, this has led to an increasing use of kidneys from circulatory-death donors. Unlike those donated after brain death these incur substantial warm ischemic injury before and during procurement, which results in poor function immediately after transplantation.

However, emerging evidence shows they provide satisfactory graft function at least in the medium term five years. Source: Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study.

Lancet ; SEER analysis shows no progress in bladder cancer survival since The purpose of the analysis was to examine the overall and stage-specific age-adjusted incidence, five-year survival and mortality rates of bladder cancer in the United States, between and For this end, a total of , bladder cancer patients were identified in the Surveillance, Epidemiology and End Results database SEER between years and Incidence, mortality, and five-year cancerspecific survival rates were calculated.

Temporal trends were quantified using the estimated annual percentage change EAPC and linear regression models.

All analyses were stratified according to disease stage and further examined according to sex, race, and age groups.

For results, the authors report an increase in the incidence rate of bladder cancer from This has led to greater acceptance at least when donors are less than 60 years.

It is therefore of increasing importance to understand if kidneys from circulatory-death donors aged older than 60 years fare any worse than kidneys from brain-death donors.

In addition, as kidneys are allocated on a national Stage-specific analyses revealed an increase incidence basis, it is important to understand any extra risks this for localised stage from During the period examined, This paper, using data from the UK transplant registry, stage-specific five-year survival rates increased for all includes all adult recipients of deceased-donor renal stages, except for that of distant metastatic disease.

Significant was defined as the need for dialysis within the first variations in incidence and mortality were recorded seven days after transplantation.

Graft function was when estimates were stratified according to sex, race, measured from the estimated glomerular filtration and age groups.

Overall, statistically significant changes were observed, although all were minor. The authors noted This study shows that there is no that little or no change in bladder cancer outcomes difference in the effect of donor age has been achieved during the period studied.

Karakiewicz, Maxine Sun. The authors thus showed that effective treatment is probably underused in the elderly accounting for their higher cancer-specific mortality.

Also, gender-specific differences seem to exist certainly in outcomes if not in management. These data must be taken into account by clinicians and obviously management should be adjusted.

Source: Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients.

British Journal of Cancer advance online publication 12 March ; doi: The authors of this study hypothesised that two-weekly administration of docetaxel would be better tolerated than threeweekly docetaxel in patients with castration-resistant advanced prostate cancer, and initiated a prospective, multicentre, randomised, phase 3 study to compare efficacy and safety.

Enrolment and treatment were done between March 1, , and May 31, The primary endpoint was time to treatment failure TTTF.

Data in the per-protocol population was assessed. The study is registered with ClinicalTrials. Neutropenic infections were reported population-based study investigates cancer-specific and competing mortality risks in bladder cancer.

Source: Anticholinergic therapy vs. OnabotulinumtoxinA for urgency urinary incontinence. Anthony G. Visco, Linda Brubaker, Holly E. Paraiso, Shawn A.

Nolen, Dennis Wallace, and Susan F. Meikle, for the Pelvic Floor Disorders Network. Funding: Sanofi. Source: Two-weekly versus three-weekly docetaxel to treat castration-resistant advanced prostate cancer: a randomised, phase 3 trial.

OnabotulinumtoxinA for urgency urinary incontinence Anticholinergic medications and onabotulinumtoxinA are used to treat urgency urinary incontinence, but data directly comparing the two types of therapy are needed.

Most patients with prostate cancer become long-term survivors of the disease and so awareness of the late complications of therapy is important.

It improves overall survival when given as an adjuvant therapy for men with high-risk tumours undergoing radiotherapy and improves quality of life for men with metastatic cancer.

Since guidelines of the National Comprehensive Cancer Network have recommended routine bone density testing before and during treatment to characterise the risk of fracture.

In addition, the American College of Physicians guidelines recommend bone density testing among men receiving treatment with ADT. However, singleinstitution data to date shows low rates of testing.

This paper presents data on bone density testing in a large population based cohort of older men with prostate cancer in the USA who received ADT for at least one year.

Thus, as efforts to improve the delivery of cost-effective preventive care increase, measuring and incentivising the use of bone density testing for this population may be an effective strategy.

Source: Bone density testing among prostate cancer survivors treated with androgendeprivation therapy. Cancer ; Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer The authors of this EORTC trial report on the long-term results of immediate postoperative irradiation versus a wait-and-see policy in patients with prostate cancer extending beyond the prostate, aimed to confirm whether previously reported progression-free survival was sustained.

The diagnosis who were enrolled with Medicare for a year investigators analysed the primary endpoint, before diagnosis and at least six months after biochemical progression-free survival, by intention to diagnosis.

The trial is with secondary deposits; moreover, guidelines registered with ClinicalTrials. The primary outcome was the reduction from baseline in bisphosphonates in men who are mean episodes of urgency urinary incontinence per receiving ADT for localised prostate day over the six-month period, as recorded in three-day diaries submitted monthly.

Secondary cancer is a cost-effective approach. Of these 29, men were identified who had received ADT continuously for at least a year.

Receipt Of women who underwent randomization, of bone density testing was assessed from six months were treated, and had data available for the before diagnosis to one year after the initiation of primary outcome analyses.

The mean reduction in ADT. Demographic data was collected along with data episodes of urgency urinary incontinence per day over on who was treating the patient in an attempt to the course of six months, from a baseline average of identify factors associated with testing.

Overall Quality of life improved in both in vs. Black men were less likely than white men to undergo testing OR, 0.

Men living in areas with higher educational daily episodes of urgency urinary incontinence. Perhaps because the data available is based upon bone mineral density rather than fracture prevention, and therefore is not believed to be clinically relevant.

It would be interesting to understand bisphosphonate usage alongside screening as it is possible men are receiving treatment without bone density testing.

Exploratory analyses suggest that postoperative irradiation might improve clinical progression-free survival in patients younger than 70 years and in those with positive surgical margins, but could have a detrimental effect in patients aged 70 years or older.

Source: Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial EORTC trial Clearly such false positive results led to unnecessary invasive procedures but evidence suggests it also causes increased utilisation of health care resources and decreased adherence to further screening.

In women a false positive mammogram has been shown to be associated with a reduced quality of life and feelings of anxiety that lasted for at least a year.

In this study qualitative methods were used to obtain descriptions of the long-term emotional consequences for men who had an elevated PSA and one or more negative biopsies.

In this group all men had a positive screening test and one or more negative biopsies. Interviews were recorded and lasted minutes.

The data obtained was analysed by a team containing two family physicians and two sociologists using iterative cycles of readings and reflection.

As for most men, elevated PSA led to a cascade of biopsies and further PSA tests, as there is no consensus about how often biopsies should be repeated.

All subjects not unsurprisingly experienced transient anxiety while waiting for the results of their prostate biopsies.

This anxiety occurred with every biopsy, not just the first one. In addition it was possible to identify three persistent emotional responses.

The attitude and recommendation of the urologist was influential in how men responded to false positive screening tests. Indeed one man was so worried he wanted a prophylactic prostatectomy.

There was also frustration with uncertainties of PSA screening. The most common outcome after a negative biopsy was to request more frequent screening.

More common in men who had had multiple biopsies and when the urologist reassured men about their persistently elevated PSA.

This study reported significant emotional consequences that persisted for up to 24 years after the initial biopsy. This results in increased fear of cancer or increased vigilance about prostate cancer.

This data suggests we need to develop evidencebased guidelines about further testing after a negative prostate biopsy.

Source: Emotional consequences of persistently elevated PSA with negative prostate biopsies. With more than 2, beds and over 80, admissions per year, Hospital Motol is considered the largest in Czech Republic and one of the biggest in central Europe.

Associate Professor Ivan Kawaciuk led the department since its establishment until his retirement in Kawaciuk is succeeded by the author, with Prof.

Ladislav Jarolim as deputy chairman. The medical staff is composed of 13 certified urologists, four residents and an internal medicine specialist.

The department has 36 adult patient beds including a six-bed intensive care unit, four day care beds and around 3, admissions per year.

Urology procedures are performed in two operating rooms. With full-day surgical services, more than 1, patients are treated surgically every year.

With our training goals, our centre focuses on patients for major urological procedures. For example, every year 50 cystectomies, radical prostatectomies open or laparoscopic , more than kidney cancer procedures mostly laparoscopic , and 10 retroperitoneal lymph node dissections in testis cancer, among other procedures, are performed.

The outpatient clinic has facilities to perform intravesical instillation, systemic chemotherapy, cystoscopies, prostate biopsies or urodynamics.

We also collaborate with other departments in the hospital such as radiology, clinical oncology, spinal unit etc. The department provides a full range urological practice except for kidney transplantations and ESWL.

Our main focus is on onco-urology. During the last three years teams were designated for each onco-urological sub-specialty, each concentrating on implementing new procedures, evaluation of results and research activities.

The bladder cancer team conducts research in non-invasive detection and prognostic factors, investigates new imaging methods NBI, PDD and the surgical treatment of locally advanced disease.

The renal cancer team addresses new tissue and serum markers and the improvement of minimally-invasive treatment modalities.

In , the Centre for Research and Treatment of Prostate Cancer was founded with broad activities in radical surgery and basic and clinical research, including defining and using new prognostic markers and treatment modalities like immunotherapy.

For potential projects, tissue banking was initiated. Other activities include reconstructive urology, surgical operations for incontinence, BPH treatment, EBU Certified Centres treatment of urolithiasis including endoscopic surgery and metabolic counselling, treatment of congenital defects in cooperation with paediatric urologists and andrology.

Another unique activity includes services and surgical procedures dealing with transsexualism. Over operated cases mostly male to female where performed in the last 12 years.

The chairmen surrounded by the staff of the urological department The resident training programme was established based on the requirements of the Czech postgraduate education system.

The teaching programme employs a systematic training in all urological subtopics, while at the same time providing an individualised approach in mentoring residents.

In general, training is clinically oriented. Every resident has a personal written training programme, which specifies individual schedule and time periods spent on each subtopic.

Currently, there are four residents in training. Every subspecialization is guided by one or two staff members, specialized in the relevant topic.

A personal tutor assigned to each resident-in-training is responsible for fulfilling all points in the teaching programme. Special attention is paid on the training of skills in urological interventions and surgery.

Residents maintain an individual logbook with a given number of performed and assisted operations and invasive diagnostic procedures.

Residents participate in regular teaching rounds under the guidance of staff members, regular clinical conferences, pathology, radiology, oncology and other multidisciplinary conferences.

The level of knowledge and achieved skills are evaluated every six months by the personal tutor and yearly by the head of the department.

Trainees participate in all available educational courses and seminars. Presentation skills are trained during monthly scientific meetings.

Each resident is requested to prepare and present at least one lecture, every year, on a given topic. From the third residency year, residents start to present results of their research activities during the annual meeting of the national society and, if possible, in international meetings.

From their second year, residents are included in research groups and are obliged to write at least two articles in a peer-reviewed journal during their training.

Due to the success of the training system, the efficient facilities and the range of academic activities in clinical work, basic research and publications, the urology department applied for EBU certification.

The EBU certification, granted for a period of five years in October , has led to the critical appraisal of our training programme.

On the same day, in Coimbra, a team lead by Linhares Furtado performed the first renal transplant in the country despite the obstacles and the novelty of transplantation medicine.

Its two in-patient wards have a bed capacity, one for patients afflicted with various urological diseases, while the other one is dedicated to renal transplantation.

Besides renal transplantation, the department is also a centre of expertise in other urological specialties such as medical and surgical oncology and laparoscopy.

Urological care in all other areas, such as endourology, andrology, neurourology and reconstructive urology, is also provided and maintained with high international standards.

Residents keep an updated logbook to the in-patient facilities, with an estimated 24, of their practice and, at the end of each year, all medical appointments made.

The department has two residents write a detailed report on their surgical and well-equipped surgical theatres, enabling the surgical scientific activities which they also publicly discuss treatment of over 1, patients every year.

Outwith the staff. Residents are encouraged to: Training Programme for the first time in This is a mark of excellence and a commitment to maintain high residency training standards.

Furthermore, the application itself presents a valuable opportunity to gain external feedback, which is always helpful when continuous improvement is required.

We are confident that other urology departments in Portugal will also apply for EBU certification in the near future, as we are strongly committed to maintain quality standards in Portuguese urological training and practice.

Recently, a reform in the healthcare system led to the merger of our hospital with another tertiary care unit, creating the largest urology department in the country.

With this recent development we expect further improvements in patient care, staff training, and research. The programme aims to promote international exchange of urological medical skills, expertise and knowledge.

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