Michael A. Aleman

Peyronie's disease compromises the durability and component-malfunction rates in patients implanted with an inflatable penile prosthesis

Study Type – Therapy (case series)
Level of Evidence 4

Survival outcomes in men receiving androgen-deprivation therapy as primary or salvage treatment for localized or advanced prostate cancer: 20-year single-centre experience

To evaluate the overall survival (OS) and disease‐specific survival (DSS) in men receiving primary androgen‐deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer.

Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer.

PURPOSE To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort. MATERIALS AND METHODS We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. RESULTS After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9%) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7%) regained EF of level 1-2 while 1 (2.9%) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7%) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively). CONCLUSIONS Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7%. Further, though erectile dysfunction is common following TCAP, 25.7% of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.

Nomogram to predict prostate cancer diagnosis on primary transrectal ultrasound-guided prostate biopsy in a contemporary series

Objective: Transrectal ultrasound-guided biopsy (TRUSB) remains the mainstay for prostate cancer (CaP) diagnosis. Numerous variables have shown associations with development of CaP. We present a nomogram that predicts the probability of detecting CaP on TRUSB. Methods: After obtaining institutional review board approval, all patients undergoing primary TRUSB for CaP detection at a single center at our institution between 2/2000 and 9/2007 were reviewed. Patients undergoing repeat biopsies were excluded, and only the first biopsy was included in the analysis. Variables included age at biopsy, race, clinical stage, prostate specific antigen (PSA), number of cores removed, TRUS prostate volume (TRUSPV), body mass index, family history of CaP, and pathology results. S-PLUS 2000 statistical software was utilized with p < 0.05 considered significant. Cox proportional hazards regression models with restricted cubic splines were utilized to construct the nomogram. Validation utilized bootstrapping, and the concordance index was calculated based on these predictions. Results: A total of 1,542 consecutive patients underwent primary TRUSB with a median age of 64.2 years (range 34.9–89.2 years), PSA of 5.7 ng/ml (range 0.3–3,900 ng/ml), number of cores removed of 8.0 (range 1– 22) and TRUSPV of 36.4 cm3 (range 9.6–212.0 cm3). CaP was diagnosed in 561 (36.4%) patients. A nomogram was constructed incorporating age at biopsy, race, PSA, body mass index, clinical stage, TRUSPV, number of cores removed, and family history of CaP. The concordance index when validated internally was 0.802. Conclusions: We have developed and internally validated a model predicting cancer detection in men undergoing TRUSB in a contemporary series. This model may assist clinicians in risk-stratifying potential candidates for TRUSB, potentially avoiding unnecessary or low-probability TRUSB.

1938 RISK OF DIABETES MELLITUS AND HYPERTENSION AFTER EXTRACORPOREAL SHOCK WAVE (ESWL) THERAPY FOR URINARY STONE DISEASE

INTRODUCTION AND OBJECTIVES: Endourologic procedures are increasingly being performed in the office. We examined the clinical outcomes and cost-effectiveness of endourologic procedures performed in the office using standard fluoroscopy under local anesthesia. METHODS: We performed a retrospective review of all patients who underwent ureteral stent placement, ureteral stent exchange, or ureteral catheterization with retrograde pyeolography or BCG instillation in the office under topical anesthesia using fluoroscopic guidance from 9/2008 12/2009. Cost data was estimated from Medicare 2010 non-facility physician fees and Ambulatory Payment Classification (APC) reimbursements. RESULTS: Procedures were attempted in 65 renal units in 38 patients (13 male, 25 female) with a mean age of 62.2 years (range 29.1–95.4 years). No procedure was terminated due to patient discomfort. Primary ureteral stent placement was successful in 23/24 (95.8%) renal units. Ureteral stent exchange was successful in 19/22 (86.4%) renal units. Ureteral catheterization with retrograde pyelography or BCG instillation was successful in 19/19 renal units. Indications for stent placement or exchange were ureteral stone (14/30, 46.7%), malignant extrinsic ureteral compression (8/30, 26.7%), benign extrinsic ureteral compression (3/30, 10%), ureteral stricture (2/30, 6.7%), ureteropelvic junction obstruction (2/30, 6.7%), and hydronephrosis of unknown etiology (1/30, 3.3%). The total cost of stent placement/stent exchange/retrograde pyelography is

PEYRONIE'S DISEASE HAS A NEGATIVE IMPACT ON THE DURABILITY AND COMPONENT MALFUNCTION RATES IN PATIENTS UNDERGOING INFLATABLE PENILE PROSTHESIS IMPLANTATION

599/

NOMOGRAM TO PREDICT PROSTATE CANCER DIAGNOSIS ON TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY IN A CONTEMPORARY SERIES

599/

207 A SURVEY OF CURRENT PRACTICES IN THE MANAGEMENT OF BLADDER TRAUMA

346 when performed in the office compared with

712 RISK OF DEVELOPMENT OF PROTEINURIA WITH ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER

2,306/

INTER-AND INTRA-SPECIALTY ANALYSIS OF “DEAD OF DISEASE” VERSUS “DEAD WITH DISEASE” IN PROSTATE CANCER: IS THIS A MEANINGFUL STUDY END-POINT?

2,306/