OBJECTIVE:A locally advanced Gleason 4 + 4 prostate cancer patient who was on self-medication with intermittent anti-androgen monotherapy (iAAm) over 14 years suggested that raised testosterone was not dangerous and this suggestion needed investigating.PATIENTS:Others who were on AA continuously were recruited to ongoing audit of intermittent hormone therapy (IHT) and iAAm outcomes were compared with intermittent LHRH therapy (iLHRH or iMAB).RESULTS:Between 1994 and 2007, 111 patients sought IHT because of side effects of treatment. Forty-two M0 patients received IHT with iLHRHm or iMAB and 33 received iAAm (31 of these were M0). PSA nadir below 4 was necessary for entry. Overall survival was 87, 72 and 67% with iAAm and 73, 56 and 43% with iLHRH/MAB at 5, 8 and 10 years respectively. Overall survival was 61, 55 and 33% continued on iAAm and 56, 41, and 32% on iLHRH/MAB at 5, 8, and 10 years respectively. Multivariable analysis and matched case control analysis confirm that the maintenance of advantage for iAAm Testosterone levels in patients on iAAm compared to iLHRH therapy was more intense throughout treatment.CONCLUSION:These results complement recent progress in using bipolar androgen therapy to reverse castration resistance and add to the increasing acceptance that controlled testosterone exposure might be relevant in hormone-naïve patients.

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-10 RENDEZVOUS PROCEDURE TO TREAT COMPLEX URETERIC DISCONTINUITIES Giorgio Mazzon, Marco Bolgeri, Rebecca Dale, Vimoshan Arumuham, Clare Allen, Alex Kirkham, Navin Ramachandran, Sian Allen, Daron Smith, Tim Philp, and Simon Choong Giorgio MazzonGiorgio Mazzon More articles by this author , Marco BolgeriMarco Bolgeri More articles by this author , Rebecca DaleRebecca Dale More articles by this author , Vimoshan ArumuhamVimoshan Arumuham More articles by this author , Clare AllenClare Allen More articles by this author , Alex KirkhamAlex Kirkham More articles by this author , Navin RamachandranNavin Ramachandran More articles by this author , Sian AllenSian Allen More articles by this author , Daron SmithDaron Smith More articles by this author , Tim PhilpTim Philp More articles by this author , and Simon ChoongSimon Choong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1542AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When a ureteric stricture occurs, minimally invasive management is usually the first line approach to get the distressed patient out of a complicated situation. In the cases of failed antegrade or retrograde approaches to inserting a ureteric stent, the rendezvous procedure might be used to increase the success rate. The Rendezvous procedure involves a Uro-Radiologist using a variety of wires and catheters antegradely down to the ureteric stricture while the Urologist approaches the ureter retrogradely to visualize and attempt to straighten the stricture and to aid passage of the guidewire across the obstruction. The Urologist may need to laser through a dense ureteric stricture, laser to release a tied suture or traverse a missing section of the ureter to reach the antegrade guidewire to externalise it. Adequate tension can then be applied to straighten the ureter to aid placement of a stent. METHODS We retrospectively reviewed patients undergoing a Rendezvous procedure for ureteric discontinuities, treated between 2005 and 2014 at our Institution and completing at least a 12 month-follow up. We divided patients into two groups: late oncological/post-surgical stricture (group A), or early post-surgical obstruction, leakage or detachment (group B). If appropriate, we performed a retrograde study +/- rigid ureteroscopy to assess the stricture after 3 month from the procedure, followed by a MAG3 renogram at 6 and 12 months. RESULTS 32 patients underwent a Rendezvous procedure, 22 in group A (Mean age 59.35, range: 49-74), 10 in group B (Mean age 52.44, range: 36-63). Strictures were successfully stented in 18 out of 22 patient (82%) in the group A, 7 out of 10 in group B (70%). After successful stenting, at 12 month 9/18 of group A required no further interventions and were stent free (50%), 5 (28%) were maintained with long term stenting. Only 2 (11%) required major reconstruction, 2 patients (11%) died during follow up from malignancy. In group B, 4/8 (50%) were stent free with no further interventions, 3/8 (38%) were maintained on long term stenting, only 1 required reconstruction. CONCLUSIONS With a combined antegrade and retrograde approach, the majority of complex ureteric stricture can be bridged and stented, avoiding major surgery in unfavourable circumstances and allows time for stabilisation and recovery of the patient. Interestingly, if successful, further interventions later may be unnecessary in up to 50% of patients. This is particularly useful in elderly patients with malignant stricture, but also in young patients with benign discontinuities and a good blood supply to the ureter. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e938-e939 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giorgio Mazzon More articles by this author Marco Bolgeri More articles by this author Rebecca Dale More articles by this author Vimoshan Arumuham More articles by this author Clare Allen More articles by this author Alex Kirkham More articles by this author Navin Ramachandran More articles by this author Sian Allen More articles by this author Daron Smith More articles by this author Tim Philp More articles by this author Simon Choong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2016MP22-19 PERI-OPERATIVE OUTCOMES OF PERCUTANEOUS STONE SURGERY IN PATIENTS WITH URINARY DIVERSIONS. Marco Bolgeri, Giorgio Mazzon, Vimoshan Arumuham, Rebecca Dale, Clare Allen, Alex Kirkham, Navin Ramachandran, Sian Allen, Daron Smith, Tim Philp, and Simon Choong Marco BolgeriMarco Bolgeri More articles by this author , Giorgio MazzonGiorgio Mazzon More articles by this author , Vimoshan ArumuhamVimoshan Arumuham More articles by this author , Rebecca DaleRebecca Dale More articles by this author , Clare AllenClare Allen More articles by this author , Alex KirkhamAlex Kirkham More articles by this author , Navin RamachandranNavin Ramachandran More articles by this author , Sian AllenSian Allen More articles by this author , Daron SmithDaron Smith More articles by this author , Tim PhilpTim Philp More articles by this author , and Simon ChoongSimon Choong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.707AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy is challenging in patients with urinary diversions. Besides the difficulties in retrograde access, these patients often present complex stones and medical comorbidities. Internationally adopted stone complexity scores place them in the highest-risk categories with lower stone-free rates. Our aim was to review the success rate and peri-operative outcomes of PCNLs for these patients in the setting of a highly specialized tertiary centre. METHODS We reviewed all PCNLs performed between 2008 and 2014 in patients with any form of urinary diversion. Stone parameters (size, density and complexity according to Guys score) and peri-operative outcomes (operative time, bleeding, changes in renal function, complications, length of stay and stone-free status) were compared between cases and 50 controls with normal lower urinary tract. Subgroup analyses were performed to compare different types of diversion (ileal vs colonic and continent vs non-continent) SPSS software was used for statistical analysis (Chi-square, Mann-Whitney U and Kruskal-Wallis test as appropriate). RESULTS 42 patients were included (5.2% of all PCNLs performed). Types of diversion included conduits, neobladders and continent diversions created for a range of benign and malignant indications. Stone complexity was higher in the diversion group (Guys score 3 or 4 in 83.3% vs 48%, p=0.001), with a higher prevalence of struvite composition and positive stone culture compared to controls (p<0.001). Ultrasound-guided access was successful in 100% of cases. Operative times were shorter (95 vs 80 min, p<0.01) owing to the absence of retrograde catheter insertion. Complication rates were similar between groups (p=0.6), but length of hospital stay was marginally longer in diversion patients (6 vs 4 days, p=0.03). Stone free rate was comparable (52.4 vs 65.3%, p=0.3). Patients with ileal conduit had a longer hospital stay compared to other types of diversion (p=0.001), while colonic continent diversions had a higher percentage of infected struvite stones (80% vs 47.1%, p<0.001). CONCLUSIONS Within a specialized tertiary centre, effectiveness and peri-operative outcomes of PCNLs in patients with urinary diversions don't appear to be compromised. Proficiency in ultrasound-guided access has the benefit of a reduced operative time, which may contribute to an uncomplicated post-operative course. The knowledge of biochemical and microbiological profiles associated with specific types of diversion could contribute to a more insightful pre- and perioperative management. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e260 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marco Bolgeri More articles by this author Giorgio Mazzon More articles by this author Vimoshan Arumuham More articles by this author Rebecca Dale More articles by this author Clare Allen More articles by this author Alex Kirkham More articles by this author Navin Ramachandran More articles by this author Sian Allen More articles by this author Daron Smith More articles by this author Tim Philp More articles by this author Simon Choong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objectives: We tested whether pressure flow studies could distinguish between patients with Benign Prostatic Hyperplasia (BPH) and urethral strictures and hypothesised that urethral strictures were associated with a lower closure pressure and increased slope of the passive urethral relation compared to benign prostatic obstruction. Patients and method: Ninety patients who had Transurethral Resection of Prostate (TURP) and 45 male patients who had an optical urethrotomy or urethral dilatation for urethral stricture disease, who had a prior urodynamics study, were evaluated. Results: Patients with urethral stricture disease had lower closure pressures than those undergoing TURP (22.07 vs. 28.4 cmH2O, p=0.0039, r=0.61). However, the slope of the passive urethral relation was indistinguishable between the two groups. Only 60% of patients with symptomatic urethral strictures were categorised as unequivocally obstructed by the Abrams-Griffiths nomogram. Conclusion: Urethral strictures are associated with lower closure pressures than prostatic obstruction; however, there was no difference in the urethral resistance relation.

OBJECTIVE:Vasectomy is a simple, reliable and effective form of permanent contraception. Clearance after vasectomy has been the subject of much debate among urologists. Poor compliance with postvasectomy semen analysis is well recognized, with rates as low as 36%. This can leave the partner at risk of an unplanned pregnancy and, consequently, the surgeon at risk of litigation. Although there is no consensus about the requirements for postvasectomy clearance, urologists usually tend to request at least two azoospermic postvasectomy semen samples (PVSSs) before labelling patients as sterile. This study investigated whether simplifying the criteria for postvasectomy clearance can result in improved compliance.MATERIAL AND METHODS:Medline, Embase and Cochrane databases were searched for studies on postvasectomy clearance. The main focus of the search was on the timing and number of PVSSs, their impact on patients' compliance and the significance of the rare non-motile sperm (RNMS).RESULTS:It has been found that patients' compliance decreases when more than one PVSS is requested. One azoospermic PVSS can be as indicative of sterility as two azoospermic samples. There have been calls for a uniform protocol recommending only one routine sperm sample taken 16 weeks postoperatively. This period will allow the vasa and seminal vesicles to become clear of spermatozoa. A significant proportion of men will have RNMS in their semen after vasectomy; only 1% will ultimately fail. Therefore, RNMS samples can, for practical purposes, be considered azoospermic and one PVSS, even if containing RNMS, should be considered sufficient for clearance.CONCLUSIONS:Provided that patients are adequately warned about the risk of vasectomy failure and appropriate consent is obtained, a single azoospermic PVSS at 16 weeks is sufficient for clearance. Patients with RNMS should be practically considered azoospermic and further sampling should be abandoned. This approach should improve patients' compliance. Evaluation in a prospective setting will be required to validate this conclusion.

BJU InternationalVolume 100, Issue 3 p. 700-701 THE FIRST SEMEN ANALYSIS AFTER VASECTOMY: TIMING AND DEFINITION OF SUCCESS Kaka Hama Attar, Kaka Hama Attar Whipps Cross University Hospital, London, UKSearch for more papers by this authorSimon Holden, Simon Holden Whipps Cross University Hospital, London, UKSearch for more papers by this authorJohn Peters, John Peters Whipps Cross University Hospital, London, UKSearch for more papers by this authorTim Philp, Tim Philp Whipps Cross University Hospital, London, UKSearch for more papers by this author Kaka Hama Attar, Kaka Hama Attar Whipps Cross University Hospital, London, UKSearch for more papers by this authorSimon Holden, Simon Holden Whipps Cross University Hospital, London, UKSearch for more papers by this authorJohn Peters, John Peters Whipps Cross University Hospital, London, UKSearch for more papers by this authorTim Philp, Tim Philp Whipps Cross University Hospital, London, UKSearch for more papers by this author First published: 31 July 2007 https://doi.org/10.1111/j.1464-410X.2007.07072_3.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Bodiwala D, Jeyarajah S, Terry TR, Griffiths LR. The first semen analysis after vasectomy: timing and definition of success. BUJ Int 2007; 99: 727–728 2 Smith AG, Crooks J, Singh NP, Lloyd SN. Is the timing of post-vasectomy seminal analysis important? Br J Urol 1998; 81: 458–60 3 Chawla A, Bowles B, Zini A. Vasectomy follow-up: clinical significance of rare nonmotile sperm in postoperative semen analysis. Urology 2004; 64: 1212–5 4 Lemack GE, Goldstein M. Presence of sperm in the pre-vasectomy reversal semen analysis: incidence and implications. J Urol 1996; 155: 167–9 5 Smith JC, Cranston D, O’Brien T, Guillebaud J, Hindmarsh J, Turner AG. Fatherhood without apparent spermatozoa after vasectomy. Lancet 1994; 344: 30 6 Khan MA, Cranston D. Recanalization of the vas following vasectomy. Br J Urol 1997; 79: 484 7 Philp T, Guillebaud J, Budd D. Late failure of vasectomy after two documented analyses showing azoospermic semen. Br Med J (Clin Res Ed) 1984; 289: 77–79 8 Philp, T, Guillebaud J, Budd D. Complications of vasectomy: review of 16,000 patients. Br J Urol 1984; 56: 745–8 9 Dhar NB, Bhatt A, Jones JS. Determining the success of vasectomy. BJU Int 2006; 97: 773–6 10 O’Brien TS, Cranston D, Ashwin P, Turner E, MacKenzie IZ, Guillebaud J. Temporary reappearance of sperm 12 months after vasectomy clearance. Br J Urol 1995; 76: 371–2 11 Haldar N, Cranston D, Turner E, MacKenzie I, Guillebaud J. How reliable is a vasectomy? Long-term follow-up of vasectomised men. Lancet 2001; 356: 43–4 12 US Food and Drug Administration. Birth Control Guide, December 2003. Available at: http://www.fda.gov/fdac/features/1997/babytabl.html. Accessed July 2007 Citing Literature Volume100, Issue3September 2007Pages 700-701 ReferencesRelatedInformation

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 23, 2006, 9:00 am - 12:00 pm1 Apr 20061084: Endoscopic Management of Impassable Ureteric Strictures: 8 Year Experience George Lee, Susan Longhorn, Mike Kellett, Clare Allen, David Rickares, Simon Choong, and Tim Philp George LeeGeorge Lee More articles by this author , Susan LonghornSusan Longhorn More articles by this author , Mike KellettMike Kellett More articles by this author , Clare AllenClare Allen More articles by this author , David RickaresDavid Rickares More articles by this author , Simon ChoongSimon Choong More articles by this author , and Tim PhilpTim Philp More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33309-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1084: Endoscopic Management of Impassable Ureteric Strictures: 8 Year Experience." The Journal of Urology, 175(4S), pp. 348–349 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 348-349 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information George Lee More articles by this author Susan Longhorn More articles by this author Mike Kellett More articles by this author Clare Allen More articles by this author David Rickares More articles by this author Simon Choong More articles by this author Tim Philp More articles by this author Expand All Advertisement PDF DownloadLoading ...