INTRODUCTION:Brachytherapy is a well-established treatment of localized prostate cancer. Few studies have documented long-term results, specifically biochemical progression-free survival (bPFS) in men with brachytherapy alone, with or without short-term androgen deprivation therapy (ADT), or in combination with external beam radiotherapy (EBRT). Our aim was to analyze long-term bPFS of brachytherapy treated patients.MATERIALS AND METHODS:Retrospective analysis of 1457 patients with low and intermediate risk prostate cancer treated with brachytherapy alone (1255) or combined with EBRT (202). Six-months ADT was administrated for all EBRT combined patients and for prostate volume downsizing when >55 cc (328). Failure was by the Phoenix definition. Kaplan-Meier analysis and multivariate Cox regression estimated and compared 10-yr and 15-yr rates of bPFS.RESULTS:Median follow-up was 6.1 yr. Ten and 15-yr bPFS rates of the entire cohort were 93.2% and 89.2%, respectively. On multivariate analysis, PSA density (PSAD), ADT and clinical stage were significantly associated with failure. The most powerful independent factor was PSAD with a HR of 3.5 (95% CI, 1.7-7.4) for PSAD above 0.15. No significant difference was found between low and intermediate risks patients regardless of treatment regimen. However, comparison of two intermediate risk groups, Gleason score (GS) 7, PSA<20 ng/ml versus GS≤6 and PSA = 10-20 ng/ml, revealed 10- and 15-yr bPFS rates of 94.2% and 94.2% compared to 88.2% and 79.9%, (P = 0.022), respectively. ADT improved bPFS rates in low risk patients. The ten and 15-yr bPFS rates were 97.6% and 94.6% compared to 92.3% and 88.2%, (P = 0.020), respectively.CONCLUSIONS:Our retrospective large scale study suggests that brachytherapy provides excellent long-term bPFS rates in low and intermediate risk disease. Combination of brachytherapy with EBRT yields favorable outcomes in GS 7 intermediate risk patients and short-term ADT has a positive effect on outcomes in low risk patients. Further prospective studies are warranted to discriminate the role of adding either EBRT and/or ADT to brachytherapy protocols.

Data regarding the size of the adult penis is of great importance to both clinicians and researchers. Currently, there is no consensus regarding the preferred method for the evaluation of penile size. Various and conflicting methods are reported in the literature. We review the data on measurement methods of the flaccid, stretched, and erected penis with the aim of constructing a recommendation for best practice. A systematic search for articles on penile length and girth measurement techniques was performed using PubMed, Google Scholar, and Cochran Library. Only peer-reviewed articles published in English before August 2018 were reviewed. All authors evaluated the methods and results sections presented in each publication. Relevant, demonstrative publications are reported in this review. We did not find definitive evidence favoring one measuring method over the other. Therefore, we advocate the use of our recommendations for penile size measurement in future publications.

It has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative disorders. The retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties, yet only the retinal circulation can be directly visualized. Therefore, our aim was to assess the change induced by Sildenafil on retinal blood velocity.

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2017MP10-10 CAN UROLOGISTS ACCURATELY STAGE AND GRADE UROTHELIAL CARCINOMA BY ASSESSING ENDOSCOPIC PHOTOGRAPHS OF TUMORS? Snir Dekalo, Alexander Greenstein, Gal Keren Paz, Avi Beri, Juza Chen, Jacob Ben Chaim, Mario Sofer, Nicola Mabjeesh, and Haim Matzkin Snir DekaloSnir Dekalo More articles by this author , Alexander GreensteinAlexander Greenstein More articles by this author , Gal Keren PazGal Keren Paz More articles by this author , Avi BeriAvi Beri More articles by this author , Juza ChenJuza Chen More articles by this author , Jacob Ben ChaimJacob Ben Chaim More articles by this author , Mario SoferMario Sofer More articles by this author , Nicola MabjeeshNicola Mabjeesh More articles by this author , and Haim MatzkinHaim Matzkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.338AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Assessment of urothelial carcinoma (UC) during cystoscopy or TURBT has a significant impact on the urologist's decision making: treatment with simple outpatient fulguration, the required depth of resection and the need of immediate post-surgical intravesical therapy all depend heavily on the urologist's ability to accurately assess pre-biopsy tumor stage and grade. METHODS Photographs of 50 UC were taken at the beginning of TURBT and were presented to 7 senior urologists separately, all blind to the pathological report. Each urologist was asked to rate the tumor as low grade and noninvasive (Ta low grade), high grade and noninvasive (Ta high grade) or invasive (T1 or more). Results were compared with the final pathological findings. RESULTS The single urologist correctly predicted the tumor stage and grade in 63.5% of cases (222 of 350, average of 32 out of 50 accurate assessments). Of the 128 incorrect assessments 54 underestimated the UC and 74 overestimated it. After achieving consensus in each case it turned out that the final majority assessment was correct in 40 of 50 cases (80%). Sensitivity and specificity of the final results for the diagnosis of T1 or higher were 80% and 88.6% respectively. Sensitivity and specificity for TaLG were 83.3% and 80% respectively. Inter-rater reliability was calculated and showed fair agreement (kappa=0.27). CONCLUSIONS To our knowledge this is the first documented evaluation of urologists' ability to assess UC stage and grade using endoscopic photographs. The single urologist can usually identify stage and grade of UC but accuracy increases when multiple senior urologists examine the photos and achieve consensus. When photos of UC exist, a team of senior urologists can make an excellent decision about the type and extent of surgical treatment and plan ahead post-surgical management of the patient. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e112 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Snir Dekalo More articles by this author Alexander Greenstein More articles by this author Gal Keren Paz More articles by this author Avi Beri More articles by this author Juza Chen More articles by this author Jacob Ben Chaim More articles by this author Mario Sofer More articles by this author Nicola Mabjeesh More articles by this author Haim Matzkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 1–4% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. Although knowledge of the physiology of the DE has increased in the last two decade, our understanding of the different pathophysiological process of the causes of DE remains limited. To provide a systematic update on the pathophysiology of DE. A systematic review of Medline and PubMed for relevant publications on ejaculatory dysfunction (EjD), DE, retarded ejaculation, inhibited ejaculation, and climax was performed. The search was limited to the articles published between the January 1960 and December 2015 in English. Of 178 articles, 105 were selected for this review. Only those publications relevant to the pathophysiology, epidemiology and prevalence of DE were included. The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. Despite the many publications on this disorder, there still is a paucity of publications dedicated to the subject.

Background: The purpose of the study is to evaluate the long-term clinical outcome through biochemical no evidence of disease (bNED) rates among men with low to intermediate risk prostate cancer treated with two different brachytherapy implant techniques: preoperative planning (PP) and real-time planning (IoP). Methods: From June 1998 to July 2011, 1176 men with median age of 67 years and median follow-up of 47 months underwent transperineal ultrasound-guided prostate 125 I-brachytherapy using either PP (132) or IoP (1044) for clinical T1c-T2b prostate adenocarcinoma Gleason <8 and prostate-specific antigen (PSA) <20 ng/ml. Men with Gleason 7 received combination of brachytherapy, external beam radiation and 6-month androgen deprivation therapy (ADT). Biological effective dose (BED) was calculated using computerized tomography (CT)-based dosimetry 1-month postimplant. Failure was determined according to the Phoenix definition. Results: The 5- and 7-year actuarial bNED rate was 95% and 90% respectively. The 7-year actuarial bNED was 67% for the PP group and 95% for the IoP group (P< 0.001). Multivariate Cox regression analyses identified implant technique or BED, ADT and PSA as independent prognostic factors for biochemical failure. Conclusions: Following our previous published results addressing the limited and disappointing outcomes of PP method when compared to IoP based on CT dosimetry and PSA kinetics, we now confirm the long-term clinical, bNED rates clear cut superiority of IoP implant methodology.

The purpose of the study is to evaluate the long-term clinical outcome through biochemical no evidence of disease (bNED) rates among men with low to intermediate risk prostate cancer treated with two different brachytherapy implant techniques: preoperative planning (PP) and real-time planning (IoP).

Study Type – Diagnostic (exploratory cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Men with persistent suspicion for prostate cancer after previous negative standard transrectal biopsy series are offered saturation biopsy either transrectally or transperineally to increase cancer detection rate.A high‐risk group of men with at least two previous negative transrectal biopsies underwent transperineal template‐guided saturation biopsy. Prostate cancer was detected in 26%, predominantly in the anterior zones. PSA velocity or doubling time were the most powerful factors to predict cancer.OBJECTIVE To evaluate the detection rate and the regional location of prostate cancer in men undergoing transperineal template‐guided saturation biopsy (TTSB). PATIENTS AND METHODS In all, 92 consecutive men with at least two previous negative transrectal biopsy series who underwent a multiple‐core prostate TTSB at our centre were included in the study. Univariable and multivariable logistic regression analyses were used to address the relationship between parameters before TTSB and prostate cancer‐detection rate. Covariates consisted of age at biopsy, free and total prostate‐specific antigen (PSA), prostate volume, digital rectal examination findings, histological findings on previous biopsy, PSA velocity (PSAV), PSA‐doubling time (PSADT) and the number of previous negative biopsy sets. RESULTS Prostate cancer was diagnosed in 26% of the men. A median of 30 cores was taken by TTSB. Adenocarcinoma in >2 cores was detected in 58.5% and Gleason score ≥7 was detected in 46% of the diagnosed men. Most of the tumours (83.3%) were found in the anterior zones of the gland, with a significantly higher number of positive cores vs the posterior zones (mean 4.9 vs 1.5, P= 0.015). PSADT and PSAV were the only independent predictors of prostate cancer detection at multivariate analyses with odds ratios of 0.71 (P= 0.014) and 1.58 (P= 0.025), respectively. CONCLUSIONS TTSB has a high prostate cancer‐detection rate, especially in the anterior zones. Men after at least two previous negative transrectal biopsy series and persistent suspicion of prostate cancer, as evidenced by rapid PSA dynamics, should be offered TTSB.

Objectives: Preoperative planning (PP) and intraoperative planning (IoP) are established I-125-brachytherapy techniques for the treatment of localized prostate cancer. We prospectively compared the effects of each method on reducing PSA levels.Materials and methods: One hundred eighty patients treated with brachytherapy as monotherapy without neoadjuvant androgen deprivation therapy or external beam radiation using PP (75) or IoP (105) methodologies and with >= 5 years of follow-up were included in the study. CT-based dosimetry was calculated 1 month postoperatively. PSA was obtained every 3 months for the first year and semiannually thereafter. Available PSA and dosimetric data from both groups were analyzed and compared.Results: At 5 years after brachytherapy, the probability of having a nadir PSA value < 0.5 ng/ml was 90% in the IoP group compared with 60% in the PP group (P < 0.0001). The rate of PSA decline was 3-fold faster in the IoP group than in the PP group. Dosimetry results highly favored the IoP method: mean V-100 (%) and D-90 (Gy) were 95 and 180 vs. 60 and 81 (P < 0.001), respectively.Conclusions: Our initial finding of highly superior postimplant CT dosimetry calculations of the IoP method are now substantiated by the biochemical favorable results (PSA kinetics) of this method. (C) 2012 Elsevier Inc. All rights reserved.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Our knowledge of surgical casualty in the context of sexual function is limited to few oncological operations. We assessed whether transurethral endoscopic surgery may impair sexual function and we found that these operations cause temporary postoperative sexual dysfunction, which recovers within 3 months. These findings are important in preoperative patient counseling. OBJECTIVE • To investigate whether endourological interventions are associated with postoperative sexual dysfunction. PATIENTS AND METHODS • The study comprises a consecutive and prospective series of patients, referred for endourological procedures. • General anaesthesia was used and JJ stents were placed when required. • Changes in sexual function, as assessed by the International Index of Erectile Function questionnaire that the participants filled in the day before the procedure and 1 month and up to 3 months afterwards, were analysed. RESULTS • The study group consisted of 50 men aged (mean ± sd ) 45 ± 13 years, of whom 25 underwent ureteroscopy, 9 underwent retrograde intrarenal surgery (RIRS) and 16 underwent combined RIRS and percutaneous nephrolithotomy. JJ stents were postoperatively placed in 33 patients (66%). • The study cohort self‐reported a significant decrease in erectile function ( P = 0.007), intercourse satisfaction ( P < 0.001), orgasmic function ( P = 0.001), sexual desire ( P < 0.001) and overall satisfaction ( P = 0.002) at 1 month following endourological procedures. • This dysfunction was not related to chronic disease, age, smoking, preoperative or postoperative stenting, type of procedure, operative duration or surgeon expertise. • The sexual function of all subjects returned to baseline within 3 months ( P < 0.005). Postoperative erectile function in the stented group revealed a negative tendency that did not reach statistical significance. CONCLUSIONS • Endourological procedures are associated with temporary postoperative sexual dysfunction, which completely recovers within 3 months. • The impact of postoperative stenting on sexual function was not significant. • These findings contribute to enhanced preoperative patient counselling.

INTRODUCTION:It is controversial whether or not the most frequent male sexual dysfunctions, premature ejaculation (PE) and erectile dysfunction (ED), share pathogenetic mechanisms and treatments.METHODS:Three scientists (C.McM., J.C., and A.A.), together with the Controversy's Editor (E.A.J.), with expertise in the area of medical treatment of PE, present different perspectives on the use of phosphodiesterase type 5 inhibitors (PDE5is) in PE. The psychological point of view is discussed by an expert in sexology (M.P.).MAIN OUTCOME MEASURE:Outcome measures used are expert opinions supported by the critical review of the currently available literature.RESULTS:This Controversy examines the role of nitric oxide (NO) as a neurotransmitter involved in the central and peripheral control of ejaculation, the adherence of methodology to the contemporary consensus of ideal PE drug trial design, the impact of methodology on treatment outcomes, and the role of PDE5i drugs (sildenafil, tadalafil, and vardenafil) in the treatment of PE.CONCLUSIONS:While it is evident that PDE5is are the first choice in patients with comorbid ED and PE (where one may be secondary to the other), well-designed studies on the possible use of PDE5is in PE patients without ED are still limited. The issue will be less controversial when further evidence on the role of NO and PDE5 in the mechanism of ejaculation is available.