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1.  Peripheral neuroectodermal tumour of the kidney (Ewing’s sarcoma): Restaging with 18F-fluorodeoxyglucose (FDG)-PET/CT 
Primitive peripheral neuroectodermal tumour and Ewing’s sarcoma (PNET/EWS) were originally described as two distinct pathologic entities, although both share common stem-cell precursor and unique chromosomal abnormality. Although its incidence has increased recently, its share in all sarcomas is 1%. It is usually seen in men and women in their twenties. We present a case of a 38-year-old woman with a left renal mass detected incidentally. Magnetic resonance imaging revealed a centrally located hypervascular renal mass with diameter of 6 cm with non-homogenous contrast enhancement containing necrotic and calcific areas. The patient was diagnosed as having PNET/EWS by histopathological examination following radical nephrectomy. Para-aortic lymph node metastasis was found on imaging by 18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT).
doi:10.5489/cuaj.2286
PMCID: PMC4301969  PMID: 25624967
2.  Population perception of surgical approach in minimally invasive surgery 
Introduction:
The aim of this study was to better understand the impact that public opinion might have on surgical approaches in urologic minimally invasive surgery (MIS).
Methods:
We collected surveys from 400 participants, including the general population (n = 220) and paramedical staff (n = 180). Participants were anonymous. The survey included 16 questions on the characteristics and preference for the surgical approach if a urologic MIS were performed on them.
Results:
The responders preferred the transumbilical approach (57.0%) to the subcostal approach (43.0%). In particular, the preference for a transumbilical approach was significantly higher in females (65.1% vs. 49.3%, p = 0.0014). Similarly, when participants were divided into two groups (<50 years and ≥50 years), the preference for the transumbilical approach was significantly higher in the younger group (60.8% vs. 48.0%, p = 0.0187). Logistic regression analysis revealed that preference for this approach was about 2 times more likely to rise in the females (p = 0.032).
Conclusions:
Preference for the transumbilical approach was significantly higher young female respondents. This patient subset most values the cosmetic benefits of transumbilical approach in urologic MIS.
doi:10.5489/cuaj.2116
PMCID: PMC4301961  PMID: 25624959
3.  SmartClamp circumcision versus conventional dissection technique in terms of parental anxiety and outcomes: A prospective clinical study 
Introduction:
We prospectively analyzed parental anxiety and outcomes of the SmartClamp circumcision and the classic surgical dissection technique.
Methods:
A total of 250 boys underwent circumcision between 2009 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine in Turkey. The initial 125 children were circumcised by conventional dissection method and the remaining children were operated on with a SmartClamp device. Children in both groups were compared in terms of bleeding, infection, penile edema, operative time, cosmetic result, length of the inner mucosal layer, and parental anxiety. We used a State-Trait Anxiety Inventory (STAI) form to gauge how the circumcision affected parental anxiety. This form was completed by parents on postoperative day 2.
Results:
There were no statistically significant differences among the 2 groups in terms of age, bleeding, infection, and cosmetic displeasure (p > 0.05). The STAI scores of the parents from the SmartClamp group were statistically higher than that of the other group (p < 0.001). Penile edema was more common in the SmartClamp group (p = 0.039). However, the mean operative time was statistically shorter (p < 0.001) and the inner mucosal length was significantly longer in the SmartClamp group (p < 0.001).
Conclusion:
Circumcision with the SmartClamp device was faster. Cosmetic results and complication rates were similar. Unfortunately, this technique seemed to entail the disadvantages of longer mucosal length, penile edema, and higher parental anxiety. Urologists should keep these points in mind when choosing a technique.
doi:10.5489/cuaj.2131
PMCID: PMC4301962  PMID: 25624960
4.  Time from first detectable PSA following radical prostatectomy to biochemical recurrence: A competing risk analysis 
Introduction:
In this study, we estimated the time from first detectable prostate-specific antigen (PSA) following radical prostatectomy (RP) to commonly used definitions of biochemical recurrence (BCR). We also identified the predictors of time to BCR.
Methods:
We identified subjects who underwent a RP and had an undetectable PSA after surgery followed by at least 1 detectable PSA between 2000 and 2011. The primary outcome was time to BCR (PSA ≥0.2 and successive PSA ≥0.2) and prediction of the rate of PSA rise. Outcomes were calculated using a competing risk analysis, with univariable and multivariable Fine and Grey models. We employed a mixed effect model to test clinical predictors that are associated with the rate of PSA rise.
Results:
The cohort included 376 patients. The median follow-up from surgery was 60.5 months (interquartile range [IQR] 40.8–91.5) and from detectable PSA was 18 months (IQR 11–32). Only 45.74% (n = 172) had PSA values ≥0.2 ng/mL, while 15.16% (n = 57) reached the PSA level of ≥0.4 ng/mL and rising. On multivariable analysis, the values of the first detectable PSA and pathologic Gleason grade 8 or higher were consistently independent predictors of time to BCR. In the mixed effect model rate, the PSA rise was associated with time from surgery to first detectable PSA, Gleason score, and prostate volume. The main limitation of this study is the large proportion of patients that received treatment without reaching BCR. It is plausible that shorter estimated median times would occur at a centre that does not use salvage therapy at such an early state.
Conclusion:
The time from first detectable PSA to BCR may be lengthy. Our analyses of the predictors of the rate of PSA rise can help determine a personalized approach for patients with a detectable PSA after surgery.
doi:10.5489/cuaj.2147
PMCID: PMC4301963  PMID: 25624961
5.  Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience 
Introduction
We analyzed the outcomes of augmented buccal mucosa graft (BMG) dorsal onlay urethroplasty and anastomotic urethroplasty in the management of urethral stricture.
Methods:
Patients having a stricture length more than 2 cm were treated by augmented BMG dorsal onlay urethroplasty; patients with a stricture length less than 2 cm were managed by excision and end-to-end anastomotic urethroplasty. The postoperative retrograde urethrogram, micturating cystourethrogram, and uroflowmetry were compared to preoperative values. The postoperative subjective symptoms and complications were recorded and analyzed.
Results:
In total, 90 patients were included in this study. Forty-five patients had an average stricture length of 5.9 cm; they underwent BMG augmented dorsal onlay urethroplasty. Of these, 7 (15.55%) patients came with recurrence, while 38 (84.44%) were asymptomatic, in the average follow-up period of 32.8 months. The next 45 patients underwent excision of the stricture and end-to-end anastomosis. Of these, 6 (13.33%) failed on therapy and the remaining 39 (86.66%) were asymptomatic during the average follow-up period of 28.4 months.
Conclusion:
The technique of BMG dorsal onlay is easy to do, it is very reliable, has high success rate, less postoperative complications and better patient satisfaction compared to anastomotic urethroplasty. Our study has its limitations. Recurrent cases of urethroplasty and hypospadias were excluded from this study. Recurrent stricture cases were eliminated to overcome bias. Cases of hypospadias are still best treated by axial or random penile skin flap as BMG augmentation cannot create a long urethral tube. Based on our 4-year experience, we recommend BMG augmented urethroplasty long and short segment stricture of the urethra.
doi:10.5489/cuaj.2291
PMCID: PMC4301964  PMID: 25624962
6.  Mucoepidermoid carcinoma of the penis: Case report and literature review 
We describe the fifth case of mucoepidermoid carcinoma. The patient had penile ulcer with bilateral inguinal and pelvic lymphadenopathy and underwent total penectomy. After antibiotic therapy, the patient began outpatient chemotherapy, but the treatment was discontinued due to his intolerance. The patient died due to infectious complications of the inguinal lymphatic fistula 7 months after the histological diagnosis. Notably, the periurethral area was involved in the anatomopathological evaluation of the excised penis. The penile mucoepidermoid carcinoma was aggressive and the perimeatal region was involved. This case helps demystify the origins and prognosis of this rare case. More reports documenting patient characteristics and their evolution with penile mucoepidermoid carcinoma are needed.
doi:10.5489/cuaj.2126
PMCID: PMC4301965  PMID: 25624963
7.  Mucinous cystadenoma of a horseshoe kidney: A case report and literature review 
A 45-year-old man complained of a palpable mass in his left abdomen. Computed tomography showed a horseshoe kidney with a Bosniak type II complicated cyst from a left segment. Three years after his initial examination, due to the growing cystic lesion and the compression imposed on the urinary collecting system and surrounding organs, we performed a left heminephrectomy. The diagnosis was mucinous cystadenoma of the kidney. No recurrence was observed 6 months after surgery. The histopathology was unique since the inner surface of the cyst was covered by a mucin-positive columnar epithelium connected to a urothelium, with continuous transition between the two. This suggests that the mucinous tumour may have originated from a sequestered segment of the renal pelvic epithelium in the renal parenchyma.
doi:10.5489/cuaj.2211
PMCID: PMC4301966  PMID: 25624964
8.  A rare case of spontaneous necrosis of primary renal cell carcinoma 
A 42-year-old woman was referred to our hospital with a chief complaint of asymptomatic gross hematuria. Computed tomography revealed a 4-cm tumour in the left kidney and radical nephrectomy was performed. Microscopically, the tumour was completely necrotic and consisted of nests of cells with abundant cytoplasm and large nuclei. Immunohistochemical analysis indicated complete infarction of the chromophobe renal cell carcinoma. Two years after surgery, the patient remained recurrence-free.
doi:10.5489/cuaj.2272
PMCID: PMC4301967  PMID: 25624965
9.  A rare cause of childhood renal cysts: Xp11.2 translocation renal cell carcinoma 
Pediatric renal cysts are rare, usually asymptomatic and incidentally detected in children. Cyst associated renal cell carcinoma (RCC) or cystic RCC is extremely rare in children. Bosniak classification system has been accepted for the management of cystic renal masses. Xp11.2 translocation RCC is a recently classified distinct subtype and usually affects children and adolescents. We report the case of a 10-year-old girl with Xp11.2 translocation RCC from a cyst of the right kidney.
doi:10.5489/cuaj.2321
PMCID: PMC4301968  PMID: 25624966
10.  Excising multiple ureteral cysts endoscopically utilizing the OmniPlus-Max 80 W holmium laser 
We present a rare case of ureteral cysts in the left ureter treated by an endoscopic holmium laser. These cysts caused asymptomatic hydronephrosis in the left kidney. Complete cyst removal was performed by a ureteroscopically applied holmium laser. Six months post-procedure, the patient had no recurrence, which suggests that endoscopic excision is an optimal treatment for this disorder. Periodic ureteroscopic examination is indicated for further observation.
doi:10.5489/cuaj.2200
PMCID: PMC4301970  PMID: 25624968
11.  Castleman’s disease imitating adrenal mass in the retroperitoneal area 
Castleman’s disease (CD) is a non-clonal lymph node hyperplasia, mostly seen in the mediastinum. It has various clinical and pathological outcomes. There are different treatments because of its rare occurance and heterogenity. We present 2 cases which were referred to our clinic as retroperitoneal mass and diagnosed as CD after surgical resection.
doi:10.5489/cuaj.2266
PMCID: PMC4301971  PMID: 25624969
12.  Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels? 
Introduction:
There are several studies on the relationship between increased mean platelet volume (MPV) and varicocele. We investigated the relationship between preoperative and 6-month postoperative MPV values in patients whose varicocele was corrected with surgery.
Methods:
A total of 282 patients underwent surgery at our urology clinic between December 2011 and December 2013 for primary varicocele. We retrospectively examined the records of 61 patients who came to the 6-month postoperative follow-up. The preoperative varicocele diagnosis was made with physical examination findings and supported with colour Doppler ultrasonography.
Results:
The varicocele was grade I in 12 patients, grade II in 34 patients and grade III in 11 patients. When the preoperative and 6-month postoperative haemoglobin (Hb), MPV, mean corpuscular volume, platelet, and platelet distribution width (PDW) values were compared, there was a significant decrease in MPV (p = 0.019), and a significant increase in Hb (p < 0.001). A noticeable increase was also present in PDW, but it was not statistically significant (p = 0.058).
Conclusion:
We found that MPV increased in patients with varicocele and tended to decrease again after the varicocele was surgically corrected. However, we feel larger prospective series are needed.
doi:10.5489/cuaj.2113
PMCID: PMC4301972  PMID: 25624970
13.  Bilateral ovarian metastases from ureteric urothelial cancer: Initial case report and distinguishing role of immunohistochemistry 
Urothelial cancers of the upper tract are aggressive malignancies with a propensity for distant metastases. Transitional cell carcinoma can also develop de novo in the ovaries and differentiation between these lesions requires immunohistochemistry. We report a case of right lower ureteric urothelial carcinoma with metastases to both ovaries. To our knowledge, this is the first reported case of bilateral ovarian metastases from an upper tract primary, diagnosed with immunohistochemistry.
doi:10.5489/cuaj.2374
PMCID: PMC4301973  PMID: 25624971
14.  Name correction 
doi:10.5489/cuaj.2666
PMCID: PMC4301974  PMID: 25625337
15.  Penile and intramuscular metastases from esophageal squamous cell carcinoma: A rare case report and review of the literature 
Canadian Urological Association Journal  2014;8(11-12):E875-E877.
We present a case with penile and intramuscular metastases of esophageal squamous cell carcinoma. A 61-year-old male had undergone a total esophagectomy and later developed metastatic nodules of the penis and intramuscular metastasis of the thigh. We believe this is the first report of this rare case. We describe the clinical manifestation and offer therapeutic regimen; we also summarize the relevant literature.
doi:10.5489/cuaj.2253
PMCID: PMC4250257  PMID: 25485020
16.  Multiple sensitivity phenotype in interstitial cystitis/bladder pain syndrome 
Canadian Urological Association Journal  2014;8(11-12):E758-E761.
Introduction:
Phenotypic differentiation of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) may improve our understanding of the condition, as well as the development of patient-specific treatment strategies. We identified a distinct subgroup of IC/BPS patients with a multiple sensitivity phenotype.
Methods:
We defined patients with this IC/BPS associated multiple sensitivity syndrome as having at least 3 confirmed allergies/sensitivities to medications and/or environmental factors and a diagnosis of IC/BPS. These IC/BPS patients identified with a multiple sensitivity phenotype (cases) were compared to age-matched IC/BPS patients with few or no allergies (controls) at a 1:2 ratio. Comparisons were undertaken using standardized case assessment parameters (age, duration of symptoms, medical history, Interstitial Cystitis Symptoms Index [ICSI] and pelvic pain and urinary urgency/frequency [PUF] symptom scores, and urinary, psychosocial, organ specific, infection, neurologic/systemic, tenderness [UPOINT] categorization).
Results:
The study consisted of 17 cases and 34 age-matched controls; the mean age was 55 and 56 years, respectively. There was statistically more medication and environmental allergies in the cases versus controls. Cases reported more concomitant illnesses (9.6 vs. 6.2, p < 0.001) and number of bodily systems affected (6.0 vs. 3.8, p ≤ 0.001). The prevalence of irritable bowel syndrome and fibromyalgia was higher in the case group (p = 0.028, p ≤ 0.001, respectively). Additionally, there were more reported psychiatric diseases (p = 0.019), allergic/immune diseases (p = 0.003), and pulmonary diseases (p < 0.001) in the case group. UPOINT classification differed with more patients in the case group being categorized in the psychosocial and neuropathic/systemic domains (p = 0.045, p = 0.007, respectively). Total UPOINT classification (out of 6) was also higher in cases than controls (4.6 vs. 3.2, p = 0.001, respectively).
Conclusions:
We have characterized a distinct phenotypic group of patients with IC/BPS and multiple sensitivities. The limitations of our study include the retrospective case-control matching design, biases in phenotype definition, single centre patient recruitment, and the lack of follow-up. Nonetheless, the observation of this specific phenotype suggests that further research in this group may help develop targeted therapeutic strategies for patients with a concomitant multiple sensitivity syndrome and IC/BPS.
doi:10.5489/cuaj.2031
PMCID: PMC4250237  PMID: 25485000
17.  Effect of sacral neuromodulation on female sexual function and quality of life: Are they correlated? 
Canadian Urological Association Journal  2014;8(11-12):E762-E767.
Introducton:
Sacral neuromodulation (SNM) has become an established therapy for voiding dysfunction. Additional benefits, such as improved bowel functions and bladder pain, have been reported. Improvement in female sexual function after SNM treatment has been suggested; however, reports examining the effects of SNM on female sexual functions are scarce. We evaluate the effects of SNM on female sexual function and its impact on quality of life and analyze any correlation.
Methods:
Data were collected from January 2010 to May 2012 for all female patients who underwent SNM InterStim (Medtronic, Minneapolis, MN) therapy at a single centre in Canada. They were treated for voiding dysfunction, including refractory over-active bladder, frequency-urgency syndrome and non-obstructive urinary retention. Patients were screened by percutaneous nerve evaluation (PNE) to assess their response to therapy using a 4-day voiding diary. Patients who experienced 50% or more improvement in their voiding parameters were permanently implanted. All patients completed the Female Sexual Function Index (FSFI), Short-Form Health Survey (SF-36), and incontinence questionnaires (Urinary Distress Inventory [UDI]-6) preoperatively and 4 months postoperatively.
Results:
A total of 33 female patients had SNM therapy; 10 were excluded from the study because they were not sexually active. The indications were: refractory overactive bladder in 19, frequency-urgency syndrome in 2, and non-obstructive urinary retention in another 2 patients. SNM therapy significantly improved the total FSFI score (p = 0.011); the components of desire and orgasm showed significant improvement (p = 0.014 and p = 0.035, respectively). Age, body mass index, diagnosis, and urinary symptoms did not show significant correlation with FSFI score improvement. Quality of life showed significant improvement after SNM treatment in 5 categories. There was no correlation between improvement in quality of life and FSFI.
Conclusion:
SNM may improve female sexual function and quality of life, yet there is no correlation between the improvement in FSFI and quality of life.
doi:10.5489/cuaj.2300
PMCID: PMC4250238  PMID: 25485001
18.  Five-year follow-up of active surveillance for prostate cancer: A Canadian community-based urological experience 
Canadian Urological Association Journal  2014;8(11-12):E768-E774.
Introducton:
We assessed oncological outcomes of active surveillance (AS) using a community database and identified factors associated with disease reclassification on surveillance biopsy.
Methods:
A retrospective review was performed on 200 men on AS. Prostate-specific antigen (PSA) was measured every 3 to 6 months. Prostate biopsies were performed every 1 to 4 years, and at the individual physician’s discretion. Disease reclassification was defined as clinical T1 to cT2 progression, or histologically as >2 cores positive, Gleason score >6, or >50% core involvement on surveillance biopsy. Multivariate Cox regression analysis evaluated factors associated with disease reclassification. Kaplan-Meier survival curves were plotted.
Results:
We assessed a heterogeneous cohort of 86 patients, with a median age 67.2 years, who received ≥1 surveillance biopsies. The median follow-up was 5.2 years. The median times to first and second surveillance biopsies were 730 and 763 days, respectively. Overall, 47% of patients were reclassified on surveillance biopsy after a median 2.1 years. Factors associated with disease reclassification were PSA density >0.20 (p < 0.0001, hazard ratio [HR] 4.55, 95% confidence interval [CI] 2.116–9.782) and ≥3 positive cores (p = 0.0152, HR 3.956, 95% CI 1.304–12.003) at diagnosis, and number of positive cores on surveillance biopsy. In total, 25 (29%) patients received delayed intervention, with a median time to intervention of 2.6 years. The median time on AS was 4.4 years, with an overall survival of 95% and prostate-specific survival of 100%.
Conclusions:
Our community study supports AS to reduce over-treatment of prostate cancer. PSA density >0.20 and ≥3 cores positive are associated with disease reclassification on surveillance biopsy.
doi:10.5489/cuaj.2186
PMCID: PMC4250239  PMID: 25485002
19.  American trends in expectant management utilization for prostate cancer from 2000 to 2009 
Canadian Urological Association Journal  2014;8(11-12):E775-E782.
Introducton:
The overtreatment of early prostate cancer has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade.
Methods:
We examined prostate cancer treatment utilization from 2000 to 2009 using the National Cancer Database. EM use was analyzed in relation to other treatments and by cancer stage, age group, Charlson score, and hospital practice setting.
Results:
Overall, 109 997 (8.2%) men were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for low-stage cancers. Usage was only slightly higher in elderly patients and in patients with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%–29.8% and 15.1%–24.2%, respectively), compared to community hospitals, comprehensive cancer centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for low-stage cancers at Veterans Affairs and low-volume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings.
Conclusions:
EM utilization remained low and stable last decade, regardless of disease or patient characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in men with low-stage cancers and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.
doi:10.5489/cuaj.2073
PMCID: PMC4250240  PMID: 25485003
20.  Prostate cancer screening characteristics in men with BRCA1/2 mutations attending a high-risk prevention clinic 
Canadian Urological Association Journal  2014;8(11-12):E783-E788.
Introduction:
The prostate-specific antigen (PSA) era and resultant early detection of prostate cancer has presented clinicians with the challenge of distinguishing indolent from aggressive tumours. Mutations in the BRCA1/2 genes have been associated with prostate cancer risk and prognosis. We describe the prostate cancer screening characteristics of BRCA1/2 mutation carriers, who may be classified as genetically-defined high risk, as compared to another high-risk cohort of men with a family history of prostate cancer to evaluate the utility of a targeted screening approach for these men.
Methods:
We reviewed patient demographics, clinical screening characteristics, pathological features, and treatment outcomes between a group of BRCA1 or BRCA2 mutation carriers and age-matched men with a family history of prostate cancer followed at our institutional Prostate Cancer Prevention Clinic from 1995 to 2012.
Results:
Screening characteristics were similar between the mutation carriers (n = 53) and the family history group (n = 53). Some cancers would be missed in both groups by using a PSA cut-off of >4 ug/L. While cancer detection was higher in the family history group (21% vs. 15%), the mutation carrier group was more likely to have intermediate- or high-risk disease (88% vs. 36%). BRCA2 mutation carriers were more likely to have aggressive disease, biological recurrence, and distant metastasis.
Conclusions:
In our cohort, regular screening appears justified for detecting prostate cancer in BRCA1 and BRCA2 carriers and other high-risk populations. Lowering PSA cut-offs and defining monitoring of PSA velocity as part of the screening protocol may be useful. BRCA2 is associated with more aggressive disease, while the outcome for BRCA1 mutation carriers requires further study. Large multinational studies will be important to define screening techniques for this unique high-risk population.
doi:10.5489/cuaj.1970
PMCID: PMC4250241  PMID: 25485004
21.  Effect of dutasteride in men receiving intermittent androgen ablation therapy: The AVIAS trial 
Canadian Urological Association Journal  2014;8(11-12):E789-E794.
Introducton:
We studied the effect of dutasteride on the length of the off-treatment period in prostate cancer patients on intermittent androgen deprivation (IAD) therapy.
Methods:
We conducted a randomized, placebo-controlled Phase II trial in men with localized prostate cancer and a rising prostate-specific antigen (PSA) level post-primary treatment. Patients were randomized to dutasteride (0.5 mg/day) or placebo. All patients received androgen deprivation therapy (ADT), which was stopped at month 9 if the PSA level was <1.0 ng/mL. ADT was resumed when PSA increased to ≥5.0 ng/mL. End points included time off treatment, PSA nadir after 9 months of ADT, serum testosterone and dihydrotestosterone levels, and time to castrate-resistant prostate cancer (rising PSA while testosterone levels remain <50 ng/mL).
Results:
There were 87 evaluable patients: 49 dutasteride, 38 placebo. In total, 80 patients completed one treatment cycle: 45 dutasteride, 35 placebo. The median time off treatment for patients reaching ≥5 ng/mL was 18.6 and 16.7 months for dutasteride and placebo, respectively (p = 0.7600). The median PSA nadir at 9 months was 0.1 and 0.075 ng/mL, respectively (p = 0.4486). There were no cases of androgen-independent prostate cancer. Our study limitations include its short duration with only one treatment cycle evaluated.
Conclusions:
This small-scale Phase II randomized controlled trial showed no benefit to the addition of dutasteride to an IAD regimen.
doi:10.5489/cuaj.2332
PMCID: PMC4250242  PMID: 25485005
22.  Knowledge, attitudes, and practice patterns among healthcare providers in the prevention of recurrent kidney stones in Northern Ontario 
Canadian Urological Association Journal  2014;8(11-12):E795-E804.
Introducton:
Kidney stone recurrence is common. Preventive measures can lead to improved quality of life and costs savings to the individual and healthcare system. Guidelines to prevent recurrent kidney stones are published by various urological societies. Adherence to guidelines amongst healthcare professionals in general is poor, while adherence to preventive management guidelines regarding stone disease is unknown. To understand this issue, we conducted an online study to assess the knowledge, attitudes, and practice patterns of healthcare practitioners in Northern Ontario.
Methods:
We used the database of healthcare providers affiliated with the Northern Ontario School of Medicine, in Sudbury (East Campus) and Thunder Bay (West Campus), Ontario. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered 3 domains: knowledge, attitudes, and practice patterns. Demographic data were also collected. The survey was distributed electronically to all participants.
Results:
A total of 68 healthcare providers completed the survey. Of these, most were primary care physicians (72%). To keep uniformity, we analyzed the data of this homogenous group. A total of 70% of the respondents were aware of the current guidelines; however, only 43% applied their knowledge in clinical practice. Most participants lacked confidence while answering most items in the attitude domain.
Conclusions:
Most primary care physician respondents were aware of the appropriate preventive measures for recurrent kidney stones; however, they do not appear to apply this knowledge effectively in clinical practice. A low response rate is a limitation of our study. Further studies involving a larger sample size may lead to information sharing and collaborative care among healthcare providers.
doi:10.5489/cuaj.1455
PMCID: PMC4250243  PMID: 25485006
23.  The pattern of urologic care among traumatic spinal cord injured patients 
Canadian Urological Association Journal  2014;8(11-12):E805-E809.
Introducton:
We assessed the urologic care patterns of traumatic spinal cord injury (TSCI) patients.
Methods:
This was a retrospective cohort study of adult TSCI patients injured between 2002 and 2012. The primary outcome was urologic consultation. The primary exposure was the year of injury. Measured covariates included lesion level, age, gender, comorbidity burden, and socioeconomic status.
Results:
We identified 1551 incident TSCI patients who were discharged from a rehabilitation hospital in Ontario between 2002 and 2012. The median follow-up time of this cohort was 5.0 (inter-quartile range [IQR] 2.9–7.5) years. Within this cohort, 74% were male, and the mean age was 48 (IQR 33–63) years. In total, 66% of patients (1022/1551) were seen by a urologist in a median of 0.7 (IQR 0.2–3.0) years after the SCI. Over the study period, there was no change in the proportion of TSCI patients being assessed by a urologist within 1 year of their initial injury (median 55.1%, p = 0.92 for the trend). An adjusted Cox proportional hazards model demonstrated that TSCI patients who were female (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66–0.92) or over 65 years of age (HR 0.70, 95% CI 0.57–0.85) were significantly less likely to be referred to a urologist.
Conclusions:
Urologists are often not involved in the care of TSCI patients, and this has not changed significantly over the last 10 years. Females and older patients are significantly less likely to be referred to a urologist.
doi:10.5489/cuaj.2403
PMCID: PMC4250244  PMID: 25485007
24.  The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy 
Canadian Urological Association Journal  2014;8(11-12):E810-E814.
Introducton:
We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN).
Methods:
We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases.
Results:
A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN.
Conclusions:
The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.
doi:10.5489/cuaj.1642
PMCID: PMC4250245  PMID: 25485008
25.  Preoperative parameters to predict incidental (T1a and T1b) prostate cancer 
Canadian Urological Association Journal  2014;8(11-12):E815-E820.
Introducton:
Prostate cancer has been found incidentally in transurethral resection of the prostate (TURP) specimens without prior diagnosis in 5% to 13% of the patients. We evaluated whether incidental prostate cancer (stages T1a and T1b) could be predicted preoperatively.
Methods:
TURP was performed in 307 patients between 2006 and 2011. Patient age, prostate-specific antigen (PSA) level, total prostate volume, transitional zone volume, PSA density, history of needle biopsy, and pathological diagnosis on TURP specimen were assessed. We analyzed the association between these parameters and prostate cancer detection.
Results:
Incidental prostate cancer was found in 31 patients (10.1%), and 13 cases (4.2%) had cancer with T1b and/or Gleason ≥7. Multivariate analysis demonstrated that age ≥75 years (odds ratio [OR] 2.58, p = 0.022), prostate volume ≤50 cc (OR 4.11, p < 0.001), and the absence of preoperative needle biopsy despite PSA ≥4 ng/mL (OR 2.65, p = 0.046) were independent risk factors. In patients who had 2 or 3 of these risk factors, incidental prostate cancer and cancer with T1b and/or Gleason ≥7 were observed in 25% to 50% and 16% to 25% cases, respectively.
Conclusions:
Older patient age, small prostate volume, and the absence of previous needle biopsy (despite a high PSA level) might be independent risk factors for detecting incidental prostate cancer, although external validation is warranted to confirm our results.
doi:10.5489/cuaj.1890
PMCID: PMC4250246  PMID: 25485009

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