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An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

of depression withLexaprcf ® Lexapro ^ * escitalopram The No.1 prescribed anti-depressant in Ireland ABBREVIATED PRESCRIBING INFORMATION: Please refer to the Summary of Product Characteristics before prescribing.Presentation: Lexapro™ tablets 5 mg, 10 mg, 15 mg and 20 mg containing escitalopram as the oxalate.Indications: Treatment of major depressive episodes.Panic disorder with or without agoraphobia.Social Anxiety Disorder.Generalised Anxiety Disorder.Obsessive Compulsive Disorder.Dosage: Treating depression: Adults: Usual dosage is 10 mg once daily.The dose may be increased to a maximum of 20 mg/day.Panic Disorder with or without agoraphobia: An initial dose of 5 mg is recommended for the first week before increasing the dose to 10 mg/day.The dose may be further increased, up to a maximum of 20 mg/day.Social Anxiety Disorder: Usual dosage is 10 mg once daily.The dose may subsequently be decreased to 5 mg or increased to a maximum of 20 mg/day.Generalised Anxiety Disorder: Initial dosage is 10 mg once daily.The dose may subsequently be increased to a maximum of 20 mg/day.Obsessive Compulsive Disorder: Initial dosage is 10 mg once daily.The dose may be increased to a maximum of 20 mg daily.Elderly (>65 yrs): Initial treatment with half the usually recommended dose and a lower maximum dose should be considered.The efficacy of Lexapro in social anxiety disorder has not been studied in elderly patients.Children and adolescents (<18 years): Not recommended.Reduced hepatic/renal function: In mild/moderately impaired hepatic function an initial dose of 5 mg/day for the first two weeks of treatment is recommended, the dose may be increased to 10 mg/day.Caution and careful dose titration advised in patients with severely reduced hepatic function.Dosage adjustment is not necessary in patients with mild or moderate renal impairment.Caution is advised in patients with severely reduced renal function (CLcr<30 ml/min).Contraindications: Hypersensitivity to escitalopram or to any of the excipients.Concomitant treatment with a nonselective, irreversible monoamine oxidase inhibitor (MAOI).Concomitant treatment with a reversible MAO-A inhibitor e.g.moclobemide or reversible non-selective MAOinhibitors e.g.linezolid.Lexapro may be started 14 days after discontinuing treatment with an irreversible MAOI.At least 7 days should elapse after discontinuing Lexapro treatment, before starting a non-selective irreversible MAOI.Pregnancy and Lactation: Lexapro should not be used during pregnancy unless clearly necessary.Neonates should be observed if maternal use of Lexapro continues into the later stages of pregnancy, particularly the third trimester.Abrupt discontinuation should be avoided during pregnancy.Refer to the full prescribing information for a list of serotonergic or discontinuation symptoms, which may occur in the neonate after maternal SSRI/SNRI use in later stages of pregnancy.Breast-feeding is not recommended during treatment.Precautions: Patients should be cautioned about the risk to their ability to drive a car and operate machinery.No pharmacokinetic or pharmacodynamic interactions are expected with concomitant alcohol intake, however the combination is not advised.Combination with serotonergic compounds is not recommended.Insulin and/or oral hypoglycaemic dosage may need to be readjusted in diabetics.Hyponatraemia has been observed rarely with SSRI use, caution required in patients at risk of hyponatraemia.Caution is advised with coadministration of ECT and in patients with a history of mania/hypomania.Caution advised with concomitant use of oral anticoagulants, products affecting platelet function and in patients with known bleeding tendencies.Avoid in patients with unstable epilepsy and monitor patients with controlled epilepsy.Stop treatment immediately if patient develops serotonin syndrome.Use at a low starting dose for panic disorders.Avoid abrupt discontinuation.Gradual discontinuation by dose tapering is advised.As with all SSRIs it is advisable to closely monitor patients for suicide and self-harm risk in the first few weeks of treatment and until significant remission occurs.Caution is advised in patients with coronary heart disease.The use of SSRIs/SNRIs has been associated with the development of akathisia, increasing the dose in these patients may be detrimental.Drug Interactions: MAO inhibitors (see Contraindications/ Precautions), advise caution in use with irreversible selective MAO-B inhibitors (selegiline).Caution in use with lithium, tryptophan, serotonergic medicinal products or with products capable of lowering the seizure threshold.Avoid concomitant use with St. John's Wort.In known poor metabotisers, with respect to CYP2C19, an initial 5 mg/day dose should be used, which can be increased to 10 mg after assessment.Caution is advised with co-administration of drugs metabolised by enzymes CYP2C19 and CYP2D6.Coadministration with CYP2C19 inhibitors, and general enzyme inhibitors e.g.clmetidine may require reduction of the Lexapro dose.Caution recommended with concomitant use of products metabolised by CYP2D6 with a narrow therapeutic index and those metabolised by CYP2C19.Adverse Events: Adverse reactions are most frequent during the first or second week of treatment and usually decrease in intensity and frequency with continued treatment.Very Common (>1/10) & common (>1/100 to <1/10) adverse drug reactions are listed below.Frequencies are not placebo-corrected.Very Common: Nausea; Common:

Treat the C O r e of depression with Lexapro ® Lexapro a c r i t a l n n r a m escitalopram The No.1 prescribed anti-depressant in Ireland 1Abbreviated Prescribing Information: Please refer to the Summary of Product Characteristics before prescribing.Presentation: Lexapro™ tablets 5 mg, 10 mg, 15 mg and 20 mg containing escitalopram as the oxalate.Indications: Treatment of major depressive episodes.Panic disorder with or without agoraphobia.Social Anxiety Disorder.Generalised Anxiety Disorder.Obsessive Compulsive Disorder.Dosage: Treating depression: Adults: Usual dosage is 10 mg once daily.The dose may be increased to a maximum of 20 mg/day.Panic Disorder with or without agoraphobia: An initial dose of 5 mg is recommended for the first week before increasing the dose to 10 mg/day.The dose may be further increased, up to a maximum of 20 mg/day.Social Anxiety Disorder: Usual dosage is 10 mg once daily.The dose may subsequently be decreased to S mg or increased to a maximum of 20 mg/day.Generalised Anxiety Disorder: Initial dosage is 10 mgonce daily.The dose may subsequently be increased to a maximum of 20 mg/day.Obsessive Compulsive Disorder: Initial dosage is 10 mg once daily.The dose may be increased to a maximum of 20 mg daily.In known poor metabolisers of CYP2C19, 5 mg/day Lexapro is recommended for first 2 weeks, the dose can be increased to 10 mg after assessment.Elderly (>6S yrs): Initial treatment with half the usually recommended dose and a lower maximum dose should be considered.The efficacy of Lexapro in social anxiety disorder has not been studied in elderly patients.Children and adolescents (<18 years): Not recommended.Reduced hepatic/renal function: In mild/moderately impaired hepatic function an initial dose of 5 mg/day for the first two weeks of treatment is recommended, the dose may be increased to 10 mg/day.Caution and careful dose titration advised in patients with severely reduced hepatic function.Dosage adjustment is not necessary in patients with mild or moderate renal impairment.Caution is advised in patients with severely reduced renal function (CLcr<30 ml/min).Contraindications: Hypersensitivity to escitalopram or to any of the excipients.Concomitant treatment with a nonselective, irreversible monoamine oxidase inhibitor (MAOI).Concomitant treatment with a reversible MAO-A inhibitor e.g.moclobemide or reversible non-selective MAOinhibitors e.g.linezolid.Lexapro may be started 14 days after discontinuing treatment with an irreversible MAOI.At least 7 days should elapse after discontinuing Lexapro treatment, before starting a non-selective irreversible MAOI.Pregnancy and Lactation: Lexapro should not be used during pregnancy unless clearly necessary.Neonates should be observed if maternal use of Lexapro continues into the later stages of pregnancy, particularly the third trimester.Abrupt discontinuation should be avoided during pregnancy.Use of SSRIs during pregnancy may increase the risk of persistent pulmonary hypertension (PPHN) in the newborn.Refer to the full prescribing information for a list of serotonergic or discontinuation symptoms, which may occur in the neonate after maternal SSRI/SNRI use in later stages of pregnancy.Breast-feeding is not recommended during treatment.Precautions: Patients should be cautioned about the risk to their ability to drive a car and operate machinery.No pharmacokinetic or pharmacodynamic interactions are expected with concomitant alcohol intake, however the combination is not advised.Combination with serotonergic compounds is not recommended.Insulin and/or oral hypoglycaemic dosage may need to be readjusted in diabetics.Hyponatremia has been observed rarely with SSRI use, caution required in patients at risk of hyponatremia.Caution is advised with coadministration of ECT and in patients with a history of mania/hypomania.Caution advised with concomitant use of oral anticoagulants, products affecting platelet function and in patients with known bleeding tendencies.Avoid in patients with unstable epilepsy and monitor patients with controlled epilepsy.Stop treatment immediately if patient develops serotonin syndrome.Use at a low starting dose for panic disorders.Avoid abrupt discontinuation.Gradual discontinuation by dose tapering is advised.As with all SSRIs it is advisable to closely monitor patients for suicide and self-harm risk in the first few weeks of treatment and until significant remission occurs.Caution is advised in patients with coronary heart disease.The use of SSRIs/SNRIs has been associated with the development of akathisia, increasing the dose in these patients may be detrimental.Drug Interactions: MAO inhibitors (see Contraindications/ Precautions), advise caution in use with irreversible selective MAO-B inhibitors (selegiline).Caution in use with lithium, tryptophan, serotonergic medicinal products or with products capable of lowering the seizure threshold.Avoid concomitant use with St. John's Wort.Caution is advised with co-administration of drugs metabolised by enzymes CYP2C19, CYP3A4 and CYP2D6.Co-administration with CYP2C19 inhibitors, and general enzyme inhibitors e.g.cimetidine may require reduction of the Lexapro dose.Lexapro is an inhibitor of CYP2D6, caution is advised with concomitant use of drugs (particularly those with a narrow therapeutic index) mainly metabolized by CYP2D6.Adverse Events: Adverse reactions are most frequent during the first or second week of treatment and usually decrease in intensity and frequency with continued treatment.Frequencies are not placebo-corrected.Very Common (>1/10): Nausea.Common (>1/100 to < 1/10): Weight increased, insomnia, somnolence, dizziness, paraesthesia, tremor, sinusitis, yawning, diarrhoea,

So many symptoms... Treat the C O r e of depression with Lexa pre Lexapro o c r i t a l n n r a m escitalopram The No.1 prescribed anti-depressant in Ireland ABBREVIATED PRESCRIBING INFORMATION: Please refer to the Summary of Product Characteristics before prescribing.Presentation: Lexapro™ tablets 5 mg, 10 mg, 15 mgand 20 mg containing escitalopram as the oxalate.Indications: Treatment of major depressive episodes.Panic disorder with or without agoraphobia.Social Anxiety Disorder.Generalised Anxiety Disorder.Obsessive Compulsive Disorder.Dosage: Treating depression: Adults: Usual dosage is 10 mg once daily.The dose may be increased to a maximum of 20 mg/day.Panic Disorder with or without agoraphobia: An initial dose of 5 mg is recommended for the first week before increasing the dose to 10 mg/day.The dose may be further increased, up to a maximum of 20 mg/day.Social Anxiety Disorder: Usual dosage is 10 mgonce daily.The dose may subsequently be decreased to 5 mg or increased to a maximum of 20 mg/day.Generalised Anxiety Disorder: Initial dosage is 10 mgonce daily.The dose may subsequently be increased to a maximum of 20 mg/day.Obsessive Compulsive Disorder: Initial dosage is 10 mgonce daily.The dose may be increased to a maximum of 20 mg daily.Elderly {>65 yrs): Initial treatment with half the usually recommended dose and a lower maximum dose should be considered.The efficacy of Lexapro in social anxiety disorder has not been studied in elderly patients.Children and adolescents (<18 years): Not recommended.Reduced hepatic/renal function: In mild/moderately impaired hepatic function an initial dose of 5 mg/day for the first two weeks of treatment is recommended, the dose may be increased to 10 mg/day.Caution and careful dose titration advised in patients with severely reduced hepatic function.Dosage adjustment is not necessary in patients with mild or moderate renal impairment.Caution is advised in patients with severely reduced renal function (CLcr<30 ml/min).Contraindications: Hypersensitivity to escitalopram or to any of the excipients.Concomitant treatment with a nonselective, irreversible monoamine oxidase inhibitor (MAOI).Concomitant treatment with a reversible MAO-A inhibitor e.g.moclobemide or reversible non-selective MAO-inhibitors e.g.linezolid.Lexapro may be started 14 days after discontinuing treatment with an irreversible MAOI.At least 7 days should elapse after discontinuing Lexapro treatment, before starting a non-selective irreversible MAOI.Pregnancy and Lactation: Lexapro should not be used during pregnancy unless clearly necessary.Neonates should be observed if maternal use of Lexapro continues into the later stages of pregnancy, particularly the third trimester.Abrupt discontinuation should be avoided during pregnancy.Refer to the full prescribing information for a list of serotonergic or discontinuation symptoms, which may occur in the neonate after maternal SSRI/SNRI use in later stages of pregnancy.Breast-feeding is not recommended during treatment.Precautions: Patients should be cautioned about the risk to their ability to drive a car and operate machinery.No pharmacokinetic or pharmacodynamic interactions are expected with concomitant alcohol intake, however the combination is not advised.Combination with serotonergic compounds is not recommended.Insulin and/or oral hypoglycaemic dosage may need to be readjusted in diabetics.Hyponatraemia has been observed rarely with SSRI use, caution required in patients at risk of hyponatraemia.Caution is advised with coadministration of ECT and in patients with a history of mania/hypomania.Caution advised with concomitant use of oral anticoagulants, products affecting platelet function and in patients with known bleeding tendencies.Avoid in patients with unstable epilepsy and monitor patients with controlled epilepsy.Stop treatment immediately if patient develops serotonin syndrome.Use at a low starting dose for panic disorders.Avoid abrupt discontinuation.Gradual discontinuation by dose tapering is advised.As with all SSRls it is advisable to closely monitor patients for suicide and self-harm risk in the first few weeks of treatment and until significant remission occurs.Caution is advised in patients with coronary heart disease.The use of SSRIs/SNRIs has been associated with the development of akathisia, increasing the dose in these patients may be detrimental.Drug Interactions: MAO inhibitors (see Contraindications/ Precautions), advise caution in use with irreversible selective MAO-B inhibitors (selegiline).Caution in use with lithium, tryptophan, serotonergic medicinal products or with products capable of lowering the seizure threshold.Avoid concomitant use with St. John's Wort.In known poor metabolisers, with respect toCYP2C19,an initial 5 mg/day dose should be used, which can be increased to 10 mg after assessment.Caution is advised with co-administration of drugs metabolised by enzymes CYP2C19 and CYP2D6.Co-administration with CYP2C19 inhibitors, and general enzyme inhibitors e.g.cimetidine may require reduction of the Lexapro dose.Caution recommended with concomitant use of products metabolised by CYP2D6 with a narrow therapeutic index and those metabolised by CYP2C19.Adverse Events: Adverse reactions are most frequent during the first or second week of treatment and usually decrease in intensity and frequency with continued treatment.Very Common (>1/10) & common (>1/100 to <1/10) adverse drug reactions are listed below.Frequencies are not placebo-corrected.Very Common: Nausea; Common:

I • mm Sodium Valproate/Valproic Acid Epilim* ABBREVIATED PRESCRIBING INFORMATION.PRESENTATION Epilim Enteric 200mg Gastro-resistant Coated Tablets and Epilim Enteric 500mg Gastro-resistant Coated Tablets: Enteric coated tablets containing 200 mg, and 500 mg sodium valproate, respectively.Epilim lOOmg Crushable Tablets containing 100 mg sodium valproate.Epilim Syrup 200mg/5ml Oral Solution and Epilim Liquid 200mg/5ml Oral Solution (sugar free) both containing 200 mg sodium valproate per 5 ml.Epilim Chrono 200mg, Epilim Chrono 300mg, and Epilim Chrono 500mg Prolonged Release Tablets: Prolonged release tablets containing a mixture of sodium valproate and valproic acid equivalent to 200 mg, 300 mg and 500 mg sodium valproate respectively.Epilim Intravenous 400mg powder and solvent for solution for injection or infusion: 400mg sodium valproate freeze-dried powder per vial.INDICATIONS Treatment of generalised, partial or other epilepsy.Treatment and prevention of mania associated with bipolar disorders (Chrono only).Epilim IV -For short-term therapy, where oral treatment is not possible.DOSAGE AND ADMINISTRATION ^du/ts: titrate until seizure control is achieved.Initially 600 mg/day increasing in steps of 200 mg at 3 day intervals to a maximum dose of 2500 mg/day (target dose range 20-30 mg/kg/day).Children over 20 kg: initially 400 mg/day increasing in steps to a maximum dose of 35 mg/kg/day (target dose range 20-30 mg/kg/day).Children under 20 kg: initially 20 mg/kg/day -the dose may be increased in severe cases provided that plasma levels are monitored; above 40mg/kg/day chemistry and haematology should be monitored.Epilim Chrono should not be used in this group of patients, due to the tablet size and need for dose titration.Dosage in Bipolar Disorder (Epilim Chrono): Initially 20 mg/kg/day.Adjust according to individual response.Recommended daily dose 1,000 -2,000mg (max 3,000mg).Epilim IV Patients already satisfactorily treated with Epilim may be continued at their current dosage using continuous or repeated infusion.Other patients may be given a slow intravenous injection over 3-5 minutes, usually 400-800mg depending on body weight (up to lOmg/kg) followed by continuous or repeated infusion up to a maximum of 2500 mg/day.Epilim IV should be replaced by oral Epilim therapy as soon as practicable.Combination therapy; levels of Epilim and co-administered anticonvulsants may be affected and optimum dosage is determined by seizure control.Adjust dose in renal impairment and in the elderly.CONTRAINDI-CATIONS Active liver disease, family or personal history of severe hepatic dysfunction, especially drug related.Porphyria.PRECAUTIONS Hepatic dysfunction: liver function tests are advised before therapy and during the first six months, especially in patients at risk or with a history of liver disease.Blood cell count, bleeding time and coagulation tests advised before therapy to avoid bleeding complications.Pancreatitis, especially in young children.Hyperammonaemia: metabolic tests are advised before therapy in those at risk.Systemic lupus erythematosus.Risk of weight gain.Discontinuation should be done under the supervision of a specialist.Monotherapy is recommended in children under 3 years but benefits and risks should be considered.May cause false positives in urine testing for diabetes.Women of childbearing potential.INTERACTIONS Epilim affects the following drugs: antipsychotics, MAOIs, antidepressants, benzodiazepines, phenobarbital, primidone, phenytoin, carbamazepine, lamotrigine, zidovudine, vitamin K-dependent anticoagulants.Drugs which affect Epilim: phenytoin, phenobarbital, carbamazepine, felbamate, mefloquine, chloroquine, highly protein bound agents (e.g.aspirin), cimetidine, erythromycin, carbapenem antibiotics, colestyramine.Other interactions: Caution advised when using Epilim with newer anti-epileptics.USE IN PREGNANCY AND LACTATION Women ofchildbearing potential: should receive specialist neurological advice of the risks and benefits of continuing anti-epileptic medication throughout pregnancy.Anticonvulsant monotherapy is preferable in divided doses at lowest effective dose.Epilim should not be discontinued during pregnancy without assessment of the benefits versus risks.Risk in the neonate: Rare reports of haemorrhagic syndrome (related to hypofibrinaemia) in neonates whose mothers received sodium valproate during their pregnancy.Afibrinaemia has also been reported and may be fatal.Neonatal platelet counts, fibrinogen plasma levels and coagulation status should be fully investigated.Lactation: Epilim is excreted in breast milk in concentrations between 1 to 10%.SIDE EFFECTS Occassional: congenital and familial/genetic disorders, transient Gl disorders, sedation,

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Epilim" ABBREVIATED PRESCRIBING INFORMATION.PRESENTATION Epilim Enteric 200mg Gastro-resistant Coated Tablets and Epilim Enteric 500mg Gastro-resistant Coated Tablets: Enteric coated tablets containing 200 mg, and 500 mg sodium valproate, respectively.Epilim lOOmg Crushabie Tablets containing 100 mg sodium valproate.Epilim Syrup 200mg/5ml Oral Solution and Epilim Liquid 200mg/5ml Oral Solution (sugar free) both containing 200 mg sodium valproate per 5 ml.Epilim Chrono 200mg, Epilim Chrono 300mg, and Epilim Chrono SOOmg Prolonged Release Tablets: Prolonged release tablets containing a mixture of sodium vafproate and valproic acid equivalent to 200 mg, 300 mg and 500 mg sodium valproate respectively.Epilim Intravenous 400mg powder and solvent for solution for injection or infusion: 400mg sodium valproate freeze-dried powder per vial.INDICATIONS Treatment of generalised, partial or other epilepsy.Treatment and prevention of mania associated with bipolar disorders (Chrono only).Epilim IV -For short-term therapy, where oral treatment is not possible.DOSAGE AND ADMINISTRATION Adults: titrate until seizure control is achieved.Initially 600 mg/day increasing in steps of 200 mg at 3 day intervals to a maximum dose of 2500 mg/day {target dose range 20-30 mg/kg/day).Children over 20 kg: initially 400 mg/day increasing in steps to a maximum dose of 35 mg/kg/day {target dose range 20-30 mg/kg/day).Children under 20 kg: initially 20 mg/kg/day -the dose may be increased in severe cases provided that plasma levels are monitored; above 40mg/kg/day chemistry and haematology should be monitored.Epilim Chrono should not be used in this group of patients, due to the tablet size and need for dose titration.Dosage in Bipolar Disorder (Epilim Chrono): Initially 20 mg/kg/day.Adjust according to individual response.Recommended daily dose 1,000 -2,000mg (max 3,000mg).Epilim IV-Patients already satisfactorily treated with Epilim may be continued at their current dosage using continuous or repeated infusion.Other patients may be given a slow intravenous injection over 3-5 minutes, usually 400-800mg depending on body weight (up to lOmg/kg) followed by continuous or repeated infusion up to a maximum of 2500 mg/day.Epilim IV should be replaced by oral Epilim therapy as soon as practicable.Combination therapy; levels of Epilim and co-administered anticonvulsants may be affected and optimum dosage is determined by seizure control.Adjust dose in renal impairment and in the elderly.CONTRAINDI-CATIONS Active liver disease, family or personal history of severe hepatic dysfunction, especially drug related.Porphyria.PRECAUTIONS Hepatic dysfunction: liver function tests are advised before therapy and during the first six months, especially in patients at risk or with a history of liver disease.Blood cell count, bleeding time and coagulation tests advised before therapy to avoid bleeding complications.Pancreatitis, especially in young children.Hyperammonaemia: metabolic tests are advised before therapy in those at risk.Systemic lupus erythematosus.Risk of weight gain.Discontinuation should be done under the supervision of a specialist.Monotherapy is recommended in children under 3 years but benefits and risks should be considered.May cause false positives in urine testing for diabetes.Women of childbearing potential.INTERACTIONS Epilim affects the following drugs: antipsychotics, MAOIs, antidepressants, benzodiazepines, phenobarbital, primidone, phenytoin, carbamazepine, lamotrigine, zidovudine, vitamin K-dependent anticoagulants.Drugs which affect Epilim: phenytoin, phenobarbital, carbamazepine, felbamate, mefloquine, chloroquine, highly protein bound agents (e.g.aspirin), cimetidine, erythromycin, carbapenem antibiotics, colestyramine.Other interactions: Caution advised when using Epilim with newer anti-epileptics.USE IN PREGNANCY AND LACTATION Women of childbearing potential: should receive specialist neurological advice of the risks and benefits of continuing anti-epileptic medication throughout pregnancy.Anticonvulsant monotherapy is preferable in divided doses at lowest effective dose.Epilim should not be discontinued during pregnancy without assessment of the benefits versus risks.Risk in the neonate: Rare reports of haemorrhagic syndrome (related to hypofibrinaemia) in neonates whose mothers received sodium valproate during their pregnancy.Afibrinaemia has also been reported and may be fatal.Neonatal platelet counts, fibrinogen plasma levels and coagulation status should be fully investigated.Lactation: Epilim is excreted in breast milk in concentrations between 1 to 10%.SIDE EFFECTS Occassional: congenital and familial/genetic disorders, transient Gl disorders, sedation,

BACKGROUND AND PURPOSE:Laparoscopic surgery is now an integral technique in the practice of urology, particularly in the management of certain urologic malignancies. Advanced laparoscopy training in urology is primarily reserved for those pursuing fellowship training and is offered both by traditional endourology fellowships and increasingly in urologic oncology fellowships. The purpose of our study was to evaluate and compare current laparoscopy training at the fellowship level.MATERIALS AND METHODS:A 17-item questionnaire was developed with support from both the Endourological Society (EUS) and Society of Urologic Oncology (SUO). Surveys were sent to program directors of fellowships recognized by the EUS and SUO. Directors were surveyed on the laparoscopic case volume, degree of oncology training, and career choice of their graduates. Data were analyzed with Wilcoxon rank-sum and Student t tests.RESULTS:Our survey had an overall response rate of 60%. Fellows performed more than 100 laparoscopies during their training period in 57% of EUS and 25% of SUO fellowship programs. Similar trends are demonstrated when analyzing robotic procedures, with 73% of EUS fellows performing more than 50 procedures compared with 43% of SUO fellows. The majority (59%) of EUS programs provide oncologic training. Between 44% and 100% of graduates from EUS and SUO fellowships obtain academic positions. The majority of SUO directors (63%) believe that fellowship training in laparoscopy should be provided in fellowships governed solely by the SUO, while 41% of EUS directors believe this training should be governed solely by the EUS.CONCLUSIONS:Endourology fellowships currently provide a greater exposure to laparoscopy and robotics than SUO fellowships. The percentage of fellows seeking academic positions is similar for EUS and SUO fellowship programs and has remained stable for several years. Directors of fellowship programs that offer advanced laparoscopic training have divergent views as to which administrative body should govern its future.

Correlation of Agent Orange exposure and prostate cancer risk is difficult due to the myriad of methods utilized to document exposure. Chamie and colleagues employ the Veterans Affairs Agent Orange Registry as confirmation of Agent Orange exposure. Despite the fact that use of registry data introduces several biases that might under‐estimate the number of exposed veterans, Chamie and colleagues demonstrate significant findings supporting the theory that Agent Orange exposure plays a role in prostate cancer pathogenesis.

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OBJECTIVE:To determine whether the survival benefit achieved with radical cystectomy (RC, the reference standard for treating muscle-invasive bladder cancer) in younger patients justifies its use in octogenarians. PATIENTS AND METHODS:We used the Surveillance Epidemiology and End Results data of the National Cancer Institute and identified 10 807 patients from 1992-2004 who were diagnosed with muscle-invasive bladder cancer, and were treated with either RC or radiotherapy. The data were analysed for age, gender, race, extent of lymphadenectomy and cause of death. We stratified the patients by age groups (<60, 60-69, 70-79 and >79 years), and used Kaplan-Meier survival analysis to compare treatment strategies by age group. RESULTS:In all, 8034 patients had RC and 2773 radiotherapy; RC was the primary method of treatment in all age groups except for octogenarians. Those who had RC had a sizeable overall survival advantage in all age groups, except for the octogenarians (18 vs 15 months). This small survival advantage improved only slightly (23 vs 15 months) when excluding patients having nodal or distant metastasis. The octogenarians who have RC with a limited pelvic lymph node dissection or RC alone receive little (16 vs 15 months) or no survival benefit. However, cancer-specific survival was significantly higher in those who had RC, including octogenarians. CONCLUSIONS:Octogenarians have some benefit to cancer-specific survival from RC if it includes a standard lymphadenectomy. The issue is how to better select the patients, as the overall survival advantage in these patients over radiotherapy is negligible.

You have accessJournal of Urology1 Apr 2008LYMPHADENECTOMY IN THE ELDERLY; IS THE SMALL SURVIVAL BENEFIT SEEN IN OCTOGENARIANS ATTRIBUTED TO SURGICAL PERFORMANCE? Karim Chamie, Brian Hu, Ralph W deVere White, and Lars M Ellison Karim ChamieKarim Chamie More articles by this author , Brian HuBrian Hu More articles by this author , Ralph W deVere WhiteRalph W deVere White More articles by this author , and Lars M EllisonLars M Ellison More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61559-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LYMPHADENECTOMY IN THE ELDERLY; IS THE SMALL SURVIVAL BENEFIT SEEN IN OCTOGENARIANS ATTRIBUTED TO SURGICAL PERFORMANCE?." The Journal of Urology, 179(4S), p. 530 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 530 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Karim Chamie More articles by this author Brian Hu More articles by this author Ralph W deVere White More articles by this author Lars M Ellison More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2008AGENT ORANGE EXPOSURE, VIETNAM WAR VETERANS AND THE RISK OF PROSTATE CANCER Karim Chamie, Ralph W deVere White, and Lars M Ellison Karim ChamieKarim Chamie More articles by this author , Ralph W deVere WhiteRalph W deVere White More articles by this author , and Lars M EllisonLars M Ellison More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60429-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "AGENT ORANGE EXPOSURE, VIETNAM WAR VETERANS AND THE RISK OF PROSTATE CANCER." The Journal of Urology, 179(4S), pp. 149–150 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 149-150 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Karim Chamie More articles by this author Ralph W deVere White More articles by this author Lars M Ellison More articles by this author Expand All Advertisement PDF downloadLoading ...

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Objectives Brachytherapy is a widely used treatment for localized prostate cancer (CaP) and is only appropriate as monotherapy I-or low-risk cancer. The predicted response to therapy is defined by the pretreatment parameters, of which the biopsy Gleason grade is central. However, the biopsy grade often misrepresents the true pathologic grade. We examined the impact of incorrect biopsy grading on brachytherapy Outcomes.Methods We constructed a decision analytic model to assess the theoretical performance of brachytherapy for a theoretical cohort of men with Gleason score 6 Cal? who underwent radical prostatectomy. The variables regarding biopsy Gleason scores and the correlation with the surgical specimen findings were generated from the institutional data. The ranges for these variables, biochemical performance of brachytherapy, costs, and disease state utilities, were obtained from a data review.Results For the base case, 67% of biopsy grades correlated with the pathologic grade. With this concordance, 8% of failures could be attributed, in part, to undergrading. On the basis of the model assumptions, as concordance worsened to 50%, the rate of undergraded failures increased to 12%. After adjusting for the quality of life associated with higher-grade disease and the risk of biochemical failure, the aggregate cost of treatment of biopsy grade 6 disease was increased by 8% because of undergrading ($75,700 versus $81,500 per case). The bulk of this effect was the cost of failure among patients with undergraded disease.Conclusions Brachytherapy for Gleason score 6 disease is reported to have excellent results. Undergrading of prostate biopsies can negatively affect clinical outcomes and increase treatment costs. Although the risk is low, it should be considered when counseling patients with CaP.

You have accessJournal of UrologyPodium 37, Monday, May 21, 2007, 3:30 - 5:30 pm1 Apr 20071227: Perceptions of Current and Future Directions for Laparoscopic Fellowship Training Stanley A. Yap, Lars M. Ellison, and Roger K. Low Stanley A. YapStanley A. Yap More articles by this author , Lars M. EllisonLars M. Ellison More articles by this author , and Roger K. LowRoger K. Low More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31441-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1227: Perceptions of Current and Future Directions for Laparoscopic Fellowship Training." The Journal of Urology, 177(4S), p. 404 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 404 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Stanley A. Yap More articles by this author Lars M. Ellison More articles by this author Roger K. Low More articles by this author Expand All Advertisement PDF DownloadLoading ...

OBJECTIVE The purpose of this report is to describe an alternative, using a transhepatic route, to CT guidance of radiofrequency ablation of renal masses. CONCLUSION In four supine patients, radiofrequency ablation of a right renal mass was performed under sonographic guidance. The radiofrequency ablation needle was placed transhepatically into the mass. Color sonography was useful in guiding needle placement and avoiding intervening vessels in the liver and kidney. This technique may be used in selected patients as an alternative to CT guidance of radiofrequency ablation.

We report a case of traumatic testicular injury resulting in significant loss of both tunica albuginea and seminiferous tubules. Secondary to the substantial tissue loss, our approach to surgical reconstruction required a certain degree of creativity. The injury was managed by creating a single midline testis with two distinct blood supplies. The use of this novel technique was necessary to achieve closure of the tunica albuginea. This case demonstrates the importance of the use of nontraditional reconstructive maneuvers to avoid orchiectomy, given the potential long-term health issues regarding infertility and androgen production.