The Journal of Urology
Volume 178, Issue 5 , Pages 1829-1831, November 2007

This Month in Clinical Urology

published online 17 September 2007.

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The Effect of Doxazosin, Finasteride and Combination Therapy on Nocturia in Men With Benign Prostatic Hyperplasia 

Johnson et al (page 2045) from the National Institutes of Health sponsored Medical Therapy of Prostatic Symptoms research group evaluated in a randomized prospective fashion the effect of doxazosin, finasteride and combination therapy on the incidence of nocturia in men with benign prostatic hyperplasia. Doxazosin alone or in combination reduced episodes of nocturia to a greater extent than placebo or finasteride alone. The combination of finasteride and doxazosin was not superior to doxazosin alone, and reductions in nocturia with finasteride were not statistically greater than those with placebo. However, even in patients treated with doxazosin there was only a mean reduction of 0.2 nocturia episodes compared to placebo. For some men nocturia is the most bothersome symptom of benign prostatic hyperplasia. This secondary analysis indicates that most men can expect only a modest improvement in nocturia with medical therapy. (CME credit article)

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The Prevalence of Malignancy in Satellite Renal Lesions and the Surgical Implications During Nephron Sparing Surgery 

In this retrospective study by Raz et al (page 1892) from Ramat Aviv, Israel 37 of 112 patients (32%) undergoing nephron sparing surgery for a clinically localized renal mass had an additional lesion diagnosed and excised intraoperatively. In 78% of patients the primary mass was malignant while in 79% the second mass was benign. Because all of the malignant tumors in the second masses were low grade and low stage renal cell carcinoma, the authors concluded that automatic conversion to radical nephrectomy is not required when a second renal mass is detected intraoperatively. Tumor multicentricity has always been an issue for patients undergoing nephron sparing surgery but the low rate of ipsilateral recurrence would seem to validate the conclusions of the authors.

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Transcutaneous Mechanical Nerve Stimulation Using Perineal Vibration for Female Stress Urinary Incontinence 

Sønksen et al (page 2025) from Copenhagen, Denmark found significant external urethral sphincter contractions in response to clitoral or perineal vibratory stimulation in healthy women. Although clitoral stimulation provided a greater change in peak urethral pressure, perineal stimulation was more acceptable to the patient. Of 33 women with stress urinary incontinence treated with perineal transcutaneous mechanical nerve stimulation 29 reported complete resolution or improvement in incontinence symptoms following 6 weekly treatments. The effect was durable for 3 months without the need for additional vibratory stimulation in 27 of the 29 women. This was a pilot study with no control group but the results appear to be promising and warrant further investigation.

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Responsiveness and Minimum Important Differences for the Erection Quality Scale 

The Erection Quality Scale (EQS) is a 15-item, patient completed questionnaire designed to address issues of erectile function which may be inadequately addressed by other instruments. Rosen et al (page 2076) used an 8-week, placebo controlled, randomized, multicenter clinical trial to evaluate the responsiveness and treatment sensitivity of the EQS. The EQS was administered at a screening visit, at baseline, and weeks 4 and 8 of treatment in men randomized to placebo or vardenafil. The discriminate validity of the EQS total score was demonstrated. Furthermore, the instrument seemed to provide a unique contribution to the measurement of erection quality compared to the International Index of Erectile Function erectile function domain. The authors concluded that the results of this study support the use of the EQS in clinical trials.

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Association of Obesity With Tumor Characteristics and Treatment Failure of Prostate Cancer 

Some reports have shown obesity to be associated with higher grade tumors and higher rates of disease recurrence after radical prostatectomy. In addition, some data suggest that African-American men have more adverse tumor characteristics and higher recurrence rates than European American men independent of any socioeconomic influences. Spangler et al (page 1939) from Philadelphia, Pennsylvania studied 924 patients and found a higher rate of obesity (body mass index [BMI] greater than 30 kg/m2) in African-American men. Obesity was a risk factor for biochemical recurrence in African-American men but not in European American men. The authors concluded that obesity may, in part, explain the poorer prostate cancer prognosis seen in African-American men compared to other racial and ethnic groups. If confirmed, these data would have particular relevance since obesity would be a modifiable risk factor.

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Urethral Reconstruction for Traumatic Posterior Urethral Disruption 

Cooperberg et al (page 2006) from San Francisco, California retrospectively reviewed their 25-year experience with delayed anastomotic posterior urethroplasty for posterior urethral disruption from pelvic trauma. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or mild recurrence managed successfully with a single internal urethrotomy. Of the 134 male patients analyzed 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. Of the group 22% required partial pubectomy and 4% were treated with a combined abdominal-perineal approach with total pubectomy. At a mean of 12 months after surgery 14% of the patients had a recurrent stricture but 42% of those were treated successfully with a single urethrotomy yielding an overall success rate of 93%.

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Ideal Culture Time for Improvement in Sperm Motility From Testicular Sperm Aspirates of Men With Azoospermia 

The success of intracytoplasmic sperm injection depends partly upon the motility of testicular derived spermatozoa. By evaluating 95 men with azoospermia Morris et al (page 2087) from Ann Arbor, Michigan found an improvement in mean motility from 3% to 20% at 24 hours and 25% at 48 hours for men with obstructive azoospermia, and from 0% to 5% at 24 hours and 11% at 48 hours for men with nonobstructive azoospermia. For the obstructive azoospermia group the improvement was statistically significant. Results with processing media and Ham’s F10 + protein media were similar, although F10 seemed to provide some extra benefit in patients with nonobstructive azoospermia. The authors concluded that the ideal timing for oocyte retrieval for intracytoplasmic sperm injection correlates with 48-hour sperm incubation for obstructive azoospermia, and 24 hours for nonobstructive azoospermia and nerve injury cases. (CME credit article)

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Association of BMI With Response and Survival in Men With Metastatic Prostate Cancer 

Although a high body mass index may be associated with a higher rate of biochemical progression after definitive therapy, there have been little data about the effect of obesity in men with metastatic prostate cancer. In this analysis Montgomery et al (page 1946) combined patient cohorts from phase 3 randomized studies coordinated by the Southwest Oncology Group to evaluate the effects of obesity on androgen dependent and androgen independent metastatic prostate cancer. Higher BMI was associated with a better overall and progression-free survival in patients with androgen dependent metastatic disease. However, no significant association was found between BMI and survival in those with androgen independent prostate cancer. Because adiposity can influence growth factors and sex hormones, the response to androgen deprivation could be affected by obesity.

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Laparoscopic Pyeloplasty— A Comparison of the Transperitoneal Approach and Retroperitoneoscopy 

In a prospective randomized study Shoma et al (page 2020) from Mansoura, Egypt compared the transperitoneal and retroperitoneal approaches for laparoscopic dismembered pyeloplasty. A total of 20 patients were included in each group. Only 3 of 40 patients (1 from the transperitoneal and 2 from the retroperitoneal group) ultimately had unsuccessful outcomes. No differences were seen in perioperative complications, although the operative time for the retroperitoneal approach was 40 minutes longer, a difference which was statistically significant. That only 40 patients were included in the study limited the statistical power to detect differences. However, the results of this randomized trial are in line with other reports that show no substantial differences in outcomes for intraperitoneal vs retroperitoneal approaches.

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Ethnic Differences in Relative Risk of Idiopathic Calcium Nephrolithiasis in North America 

Using a cross-sectional design Mente et al (page 1992) from Toronto, Ontario evaluated 1,128 consecutive patients with idiopathic calcium nephrolithiasis. Compared to Europeans the relative risk of calcium nephrolithiasis was significantly higher in individuals of Arabic, West Indian, West Asian and Latin American origin, and significantly lower in those of East Asian or African background. Differences in urinary uric acid, urea, citrate, potassium, magnesium and phosphate excretion were observed in some ethic groups, but no differences were sufficient to account for the variation and relative risk of stone disease overall. The authors concluded that the differences in the propensity of calcium nephrolithiasis to develop in various ethnic groups in North America may reflect genetic susceptibility rather than environmental factors. (CME credit article)

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Sacral Neuromodulation for Urinary Voiding Dysfunction 

This study by van Kerrebroeck et al (page 2029) included 17 worldwide centers which enrolled 163 patients in a 5-year prospective multicenter trial to evaluate the long-term safety and efficacy of sacral neuromodulation. Of the participating patients 87% were female. An InterStim® device was implanted and voiding diaries were collected annually for 5 years. At 5 years after implant 68% of patients with refractory urge incontinence, 56% with urgency frequency and 71% with urinary retention had successful outcomes. Of the patients 23% required device exchange during followup, including replacement of a lead, extension or the implantable neurostimulator. (CME credit article)

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Prediction of Biochemical Recurrence-Free Survival After Radical Prostatectomy 

The Cancer of the Prostate Risk Assessment (CAPRA) is a statistical model to predict recurrence-free survival and pathological tumor stage after radical prostatectomy. The variables of prostate specific antigen, Gleason sum, clinical tumor grade, percentage of positive biopsies and patient age are included in the model. May et al (page 1957) from Berlin, Germany used data from 1,292 patients to validate the CAPRA score. Positive margins occurred in 13.1% of patients with a CAPRA score of 0 to 1 vs 62% with a score of 7 to 10 (p <0.001). Organ confined tumors were found in 97.7% of patients with a score of 0 to 1 compared to 19.3% of those with a score of 7 to 10 (p <0.001). The accuracy of the CAPRA nomogram in predicting recurrence-free survival was high, indicating the effectiveness and clinical applicability of the CAPRA score for risk stratification. (CME credit article)

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Book Reviews 

On page 2225 Ahlering reviews Prostate Cancer: Principles and Practice and Stone reviews Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction.

PII: S0022-5347(07)01932-5

doi:10.1016/j.juro.2007.07.091

The Journal of Urology
Volume 178, Issue 5 , Pages 1829-1831, November 2007

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