Background: The benefit of adjuvant chemotherapy (AC) for muscle-invasive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) is controversial. Objective: To assess the effectiveness of AC after RC for muscle-invasive UCB in contemporary European routine practice. Design, setting, and participants: By using a prospectively collected European multicenter database, we compared survival outcomes between patients who received AC versus observation after RC for locally advanced (pT3/T4) and/or pelvic lymph node-positive (pN+) muscle-invasive UCB in 2011. Intervention: AC versus observation after RC. Outcome measurements and statistical analysis: Inverse probability of treatment weighting (IPTW)-adjusted Cox regression and competing risks analyses were performed to compare overall survival (OS) as well as cancer-specific and other-cause mortality between patients who received AC versus observation. Results and limitations: Overall, 224 patients who received AC (n = 84) versus observation (n = 140) were included. The rate of 3-yr OS in patients who received AC versus observation was 62.1% versus 40.9%, respectively (p = 0.014). In IPTW-adjusted Cox regression analysis, AC versus observation was associated with an OS benefit (hazard ratio: 0.47; 95% confidence interval [CI]: 0.25-0.86; p = 0.014). In IPTW-adjusted competing risks analysis, AC versus observation was associated with a decreased risk of cancer-specific mortality (subhazard ratio: 0.51; 95% CI: 0.26-0.98; p = 0.044) without any increased risk of other-cause mortality (subhazard ratio: 0.48; 95% CI: 0.14-1.60; p = 0.233). Limitations include the relatively small sample size as well as the potential presence of unmeasured confounders related to the observational study design. Conclusions: We found that AC versus observation was associated with a survival benefit after RC in patients with pT3/T4 and/or pN+ UCB. These results should encourage physicians to deliver AC and researchers to pursue prospective or large observational investigations. Patient summary: Overall survival and cancer-specific survival benefit was found in patients who received adjuvant chemotherapy relative to observation after radical cystectomy for locally advanced and/or pelvic lymph node-positive bladder cancer. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

BACKGROUND:Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.METHODS:We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.RESULTS:In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.CONCLUSIONS:Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.

Erectile dysfunction (ED) is increasingly linked to coronary heart disease risk. Aim of this study was to test the hypothesis whether this association is due to penile atherosclerosis. We evaluated the prevalence and severity of penile atherosclerosis in relation to coronary and peripheral atherosclerosis. Between January and June 2010, a consecutive series of 31 men underwent an autopsy at the Department of Pathology at the Medical University Vienna. Atherosclerosis at the following localizations were histologically classified: right coronary artery, left coronary artery, left circumflex artery, internal iliac artery, dorsal penile artery and deep penile artery (bilateral). Coronary and peripheral atherosclerosis was present in 87.1 and 77.4% of cases. Atherosclerosis of penile arteries was detectable in only 4 men (12.9%). The only factor linked to penile atherosclerosis was diabetes (P=0.03). All other parameters as assessed according to medical history, general finding from autopsy or histological results regarding arterial lesions in general were not correlated to penile arterial lesions. In contrast to the high prevalence of atherosclerosis in general, penile arterial lesions are rarely present.

296 Background: Urothelial cancer (UC) is a common tumor with a peak in the seventh decade. Locally advanced disease has a significant risk for developing metastases. Neoadjuvant, platinum-containing, combination chemotherapy improves survival over radical cystectomy (RC). Chemotherapy with gemcitabine plus cisplatin (GC) shows equivalent efficacy with less toxicity to methotrexate-vinblastine-doxorubicin- cisplatin (MVAC) in metastatic setting. Methods: We prospectively evaluated 23 elderly pts (8 female, 15 male) with a median age of 72 years, WHO performance status 0/1, with muscle invasive UC who received neoadjuvant GC (gemcitabine 1,000 mg/m2 days 1, 8, 15 and cisplatin 70 mg/m2, day 2 q28) for 3 cycles between 2006 and 2010 prior to RC. Assessments included toxicity of GC, pathologic response, progression free survival (PFS) and overall survival (OS). Results: 21 (91.3%) out of 23 pts finished intended chemotherapy. Two refused chemotherapy due to personal reasons. According to CTCAE guidelines 43.5% developed grade 3 hematologic toxicities; 13% developed grade 4 thrombopenia. Grade 3 non-hematologic toxicities included nausea in 2 patients. In 2 (8.7%) pts grade 4 thromboembolic events occurred. There was no treatment related febrile neutropenia or death. 15 (71.4%) of the pts underwent RC. 5 (23.8%) pts refused RC due to personal reasons. 1 of them agreed second look TURB. 1 patient underwent palliative radiotherapy due to progression of disease. Out of the 16 pts 43.75% achieved pathological response (18.75% pT0 stage and 25% pT1 stage). 56.25% had muscle invasive UC. 18.75% of them nodal positive disease. All 7 pts achieving < pT2 pathologic stage remained progression-free at a median follow up of 16 months. Pts > pT2 stage had a median PFS of 14 months. Median OS was not reached yet. Conclusions: Neoadjuvant GC is a well tolerated regiment in elderly pts and it seems to be less toxic than MVAC. Prophylactic anticoagulation during treatment should be considered. Although pathologic response is lower than in previously published retrospective data we recommend neoadjuvant treatment with GC in elderly pts. [Table: see text]

The trace lengths of discontinuities from Nchanga Open Pit are a sample from a censored negative exponential distribution. Censoring probably occurs at benches on the mines walls which obscure the traces of the discontinuities. The largest trace length of a discontinuity in the distribution can be estimated from the parameters of the distribution and is substantially larger than an estimate by another method.

Altered Cognitive Functions in Men under LH-RH Therapy but not under Bicalutamide Monotherapy? Introduction: There exists strong evidence that androgens play an important role in the modulation of cognitive abilities. Androgen deprivation therapy with LH- RH agonists or antiandrogen monotherapy with bicalutamide has become the standard treat- ment in men with advanced prostate cancer. The goal of our study was to examine cognitive, emotional and quality of life functions in men with prostate cancer under LH-RH therapy and bicalutamide monotherapy. Material and Methods: In group A we evalu- ated 15 men (mean 70.5 years, range 57-81 (a) receiving adjuvant therapy with LH-RH analo- gons for > 1 a. In group B we included 12 men (mean 69.3 years, range 56-80) under bicalutamid 150 mg monotherapy > 1 a. At the time of test- ing all patients were asymptomatic, free of clini- cal metastases and PSA levels were < 0.5 ng/ml. In all patients we evaluated a neuropsychological test battery: cognitive evaluations were con- ducted by use of a battery of neuropsychological tests such as memory, attention and visualomotor speed using subtests of the Wechsler Memory Scale Revised (WMS-R) and the Nürnberger Altersinventar (NAI) test. Verbal and visual cognitions were analyzed by the Leistungsprüf- system 50+. Visuo-constructive abilities were tested by the mosaic test; depression was evaluated by the Beck's Depression Inventory (BDI). Anxiety was measured by the State and Trait Anxiety Inventory (STAI). Quality of life (QoL) was evaluated by the World Health Organi- sation Quality of Life short form (WHOQOL-Bref) questionnaire. Results: We found evidence for significant de- ficiencies in topographic (T = 39.3) and in visual long-term memory (T = 35.6) in group A, treated with LH-RH. The visual and verbal working memory reached borderline deficiencies (T = 40.7 and T = 41.7 respectively). In contrast, in group B (treated with bicalutamide) we did not find any de- ficiencies. Conclusion: Our data suggest a negative impact on certain cognitive functions in male patients treated with long-term LH-RH analogs, but not in men treated with bicalutamide. J Urol Urogy- näkol 2009; 16 (3): 11-4.

Sling suspension is a treatment option for intrinsic sphincter deficiency after radical prostatectomy. Using the retropubic pathway for implanting sling systems risks bladder perforation or bleeding, as is also the case in women. The male perineal sling described and used currently needs bone anchors and sutures to tighten the sling, using a perineal approach [1–5]. Comiter et al. [1] reported the effectiveness of the perineal bone-anchored sling in a prospective study, and Dikranian et al. [6] that the synthetic mesh graft is better than allogenic grafts. However, the question remains; are bone anchors really necessary to place a perineal sling?

In der vorliegenden Studie wird einerseits die Ursache der unterschiedlichen Spülflüssigkeitseinschwemmung und des Blutverlusts bei transurethraler Resektion (TUR) analysiert und anderseits die transurethrale Resektion der Prostata (TURP) mit der transurethralen Vaporesektion der Prostata (TUVRP) verglichen. Durch die permanente intraoperative, intravesikale Druckmessung bei insgesamt 52 Patienten und der sensiblen Registrierung des Einschwemmungsgrades mittels C2H5OH-Messung in der Expirationsluft des Patienten und einer genauen intra- und postoperativen Laboranalyse, sowie Blutgasbestimmung konnte zwischen Hoch- und Niederdruck-TUR differenziert und die positiven bzw. eher negativen Merkmale der TUVRP herausgearbeitet werden.

OBJECTIVE:To determine whether the morphological distinction between 'dysmorphic' and 'eumorphic' erythrocytes in urinary sediment differentiates microscopic haematuria (MH) from reno-parenchymal and post-renal bleeding. MATERIALS AND METHODS:The erythrocyte morphology of 2145 urinary sediments from 1391 patients with MH was evaluated by interference-contrast microscopy and compared with the osmolality, pH and specific gravity of the urine samples. RESULTS:Compared with more concentrated urine specimens, samples of < 700 mOsmol/kg showed significantly lower percentages of dysmorphic erythrocytes; there was a similar reduction in this percentage at a pH > or = 7. In addition, erythrocytes lysed in diluted or alkaline urine and therefore, under these conditions, no diagnosis could be made. CONCLUSION:The assessment of erythrocytes in urinary sediment should be performed only under 'standard conditions', i.e. in concentrated and acidic urine, > or = 700 mOsmol/kg and a pH < 7. The presence of > or = 90% dysmorphic erythrocytes in patients with asymptomatic MH, the absence of proteinuria, a normal blood pressure and normal radiological examination indicates 'reno-parenchymal MH', requiring a long-term follow-up with a routine evaluation twice a year, but no immediate treatment in most cases. In contrast, the presence of > or = 90% eumorphic erythrocytes or even 'mixed' results (10-90% eumorphic erythrocytes) indicates 'post-renal MH', requiring a complete urological evaluation.