British Journal of Urology International

BJU International Official journal of the British Association of Urological Surgeons and the Urological Society of Australasia

August 2005 - Vol. 96 Issue 3 Page i-469

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Editor's comment

Online publication date: 24-Jul-2005

Comments

231

How should we advise patients about the

chemoprevention of prostate cancer?

Roger S. Kirby, John M. Fitzpatrick Online publication date: 24-Jul-2005

232

A proposal for a new classification for operative

procedures for stress urinary incontinence

Paul Abrams, Paul Hilton, Malcolm Lucas, Tony Smith

233

234
Renal transplantation and manpower issues Dler Besarani, David Cranston Online publication date: 24-Jul-2005 Is premature ejaculation all in the mind?

John Dean, Ian Eardley, Geoff Hackett, Jeremy Heaton, Roger Kirby

Mini-reviews

237

Selecting therapy for maintaining sexual

function in patients with benign prostatic hyperplasia

Ajay Nehra Online publication date: 24-Jul-2005
244

250
Robotic renal and adrenal surgery: present and future

Rajeev Kumar, Ashok K. Hemal, Mani Menon Online publication date: 24-Jul-2005 Targeting bladder outlet obstruction from benign prostatic enlargement via the nitric oxide/cGMP pathway?

André Reitz, Michael Müntener, Axel Haferkamp, Markus Hohenfellner, Brigitte Schurch

254

The vital role of creativity in academic

departments

Jeremy P.W. Heaton Online publication date: 24-Jul-2005
Great Drug Classes
257 Phosphodiesterase type 5 inhibitors for erectile dysfunction

Culley C. Carson, Tom F. Lue Online publication date: 24-Jul-2005
Urological Oncology

281

Carbonic anhydrase IX and the future of

molecular markers in renal cell carcinoma

John T. Leppert, John S. Lam, Allan J. Pantuck, Robert A. Figlin, Arie S. Belldegrun

286

Therapy targeted at vascular endothelial growth

factor in metastatic renal cell carcinoma: biology, clinical results and future development

Brian I. Rini, Jeffrey A. Sosman, Robert J. Motzer

291

Multidetector computed tomography vs

magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review

Nathan Lawrentschuk, Johan Gani, Richard Riordan, Steven Esler, Damien M. Bolton

296

303
Epothilones and the next generation of phase III trials for prostate cancer

Manish S. Bhandari, Maha Hussain Online publication date: 24-Jul-2005 Tumour markers for managing men who present with metastatic prostate cancer and serum prostate-specific antigen levels of <10 ng/mL

Alison J. Birtle, Alex Freeman, John R.W. Masters, Heather A. Payne, Stephen J. Harland, contributors to the BAUS Section of Oncology Cancer Registry

308

Age-specific reference levels of serum prostate-

specific antigen and prostate volume in healthy Arab men

Elijah O. Kehinde, Olusegun A. Mojiminiyi, Mehraj Sheikh, Kaleel A. Al-Awadi, Abdallah S. Daar, Adel Al-Hunayan, Jehoram T. Anim, Aisha A. Al-Sumait

313

316 320
Analysis of peripheral blood for prostate cells after autologous transfusion given during radical prostatectomy

John T. Stoffel, Linda Topjian, John A. Libertino

Online publication date: 24-Jul-2005 New perioperative management reduces bleeding in radical retropubic prostatectomy

Martin Schostak, Klaudia Matischak, Markus Müller, Michel Schäfer, Mark Schrader, Frank Christoph, Kurt Miller

Online publication date: 24-Jul-2005 Do all patients with high-grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?

Jonathan I. Izawa, Iliana Lega, Donal Downey, Joseph L. Chin, Patrick P. Luke

324

Increasing the number of biopsy cores improves

the concordance of biopsy Gleason score to prostatectomy Gleason score

Christopher L. Coogan, Kalyan C. Latchamsetty, Jason Greenfield, John M. Corman, Barlow Lynch, Christopher R. Porter

328

330
Serum thyroid-stimulating hormone is elevated in men with Gleason 8 prostate cancer

Steven Lehrer, Edward J. Diamond, Nelson N. Stone, Richard G. Stock

Online publication date: 24-Jul-2005 Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach

Alberto Azoubel Antunes, Marcos Dall'oglio, Alexandre Crippa, Miguel Srougi

334

An office-based immunodiagnostic assay for

detecting urinary nuclear matrix protein 52 in patients with bladder cancer

Abdelfattah M. Attallah, Hanem A. Sakr, Hisham Ismail, El-Sayed K. Abdel-Hady, Ibrahim El-Dosoky

Lower Urinary Tract
341 Detrusor myectomy: long-term results with a minimum follow-up of 2 years

Sunil P.V. Kumar, Paul H. Abrams Online publication date: 24-Jul-2005
345 350
Are conventional pressure-flow measurements dependent upon filled volume?

Kanagasabai Sahadevan, Ann S. Leonard, Robert S. Pickard

Online publication date: 24-Jul-2005 Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire

Darren Clayson, Diane Wild, Helen Doll, Karen Keating, Kathleen Gondek

360

365 368
A novel midstream urine-collection device reduces contamination rates in urine cultures amongst women

Simon R. Jackson, Mathew Dryden, Paul Gillett, Paddy Kearney, Rosemary Weatherall

Online publication date: 24-Jul-2005 How do urinary diaries of women with an overactive bladder differ from those of asymptomatic controls?

Mary P. Fitzgerald, Deborah Ayuste, Linda Brubaker

Online publication date: 24-Jul-2005 A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection

Justin W. Collins, Seamus MacDermott, Richard A. Bradbrook, Francis X. Keeley Jr, Anthony G. Timoney

Sexual Medicine
373 The management of penile fracture based on clinical and magnetic resonance imaging findings

Ahmad Abolyosr, Alaa E. Abdel Moneim, Atef M. Abdelatif, Medhat A. Abdalla, Hisham M.K. Imam

Upper Urinary Tract
379 Outcome from percutaneous nephrolithotomy in patients with spinal cord injury, using a singlestage dilator for access

Nathan Lawrentschuk, David Pan, Richard Grills, John Rogerson, David Angus, David R. Webb, Damien M. Bolton

385

Multimodal management of urolithiasis in renal

transplantation

Ben Challacombe, Prokar Dasgupta, Richard Tiptaft, Jonathan Glass, Geoff Koffman, David Goldsmith, Mohammed S. Khan

Reconstructive Urology
391 Asymptomatic bacteriuria in men with orthotopic ileal neobladders: possible relationship to nocturnal enuresis

Mohamed Abdel-Latif, Ahmed Mosbah, Magdy S. El Bahnasawy, Essam Elsawy, Atallah A. Shaaban

Paediatric Urology

397

Vesicostomy revisited: the best treatment for

the hostile bladder in myelodysplastic children?

Shelby N. Morrisroe, R. Corey O'Connor, Dana K. Nanigian, Eric A. Kurzrock, Anthony R. Stone

401

404
Inguinal hernia in female infants: a cue to check the sex chromosomes?

Asma Deeb, Ieuan A. Hughes Online publication date: 24-Jul-2005 Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs

Richard J. Butler, Jean Golding, Kate Northstone, The ALSPAC Study Team

411

Efficacy of tolterodine as a first-line treatment

for non-neurogenic voiding dysfunction in children

Semih Ayan, Kemal Kaya, Kahraman Topsakal, Hakan Kilicarslan, Gokhan Gokce, Yener Gultekin

Investigative Urology
416 The src-family kinase inhibitor PP2 suppresses the in vitro invasive phenotype of bladder carcinoma cells via modulation of Akt

George J. Chiang, Brian R. Billmeyer, David Canes, John Stoffel, Alireza Moinzadeh, Christina A. Austin, Monika Kosakowski, Kimberly M. Rieger-Christ, John A. Libertino, Ian C. Summerhayes

423

Sildenafil inhibits the formation of superoxide

and the expression of gp47^phoxNAD[P]H oxidase induced by the thromboxane A2 mimetic, U46619, in corpus cavernosal smooth muscle cells

Anthony J. Koupparis, Jamie Y. Jeremy, Saima Muzaffar, Raj Persad, Nilima Shukla

428

Loss of ryanodine receptor calcium-release

channel expression associated with overactive urinary bladder smooth muscle contractions in a detrusor instability model

Hai-Hong Jiang, Bo Song, Gen-Sheng Lu, Qian-Jun Wen, Xi-Yu Jin

Pharmaceutical review
435 Unseen forces at AUA 2005?

Michael G. Wyllie Online publication date: 24-Jul-2005
Points of Technique

437

A simple modification to the Albarran deflector

enhances endoscopic control

Kevin R. Loughlin Online publication date: 24-Jul-2005

439

Cystoscopic removal of a JJ stent using a suture

'lasso'

Govind V.S. Murthi, Peter Cuckow Online publication date: 24-Jul-2005
Letters

440

Analysis of HER2 expression in primary

urinary bladder carcinoma and corresponding metastases

Michele Gallucci, Roberta Merola, Costantino Leonardo, Enzo Maria Ruggeri, Anna Maria Cianciulli

Reply

440

441
Truls Gårdmark, Per-Uno Malmström Online publication date: 24-Jul-2005 The role of urinary urgency and its measurement in the overactive bladder symptom syndrome: current concepts and future prospects

Alison F. Brading Online publication date: 24-Jul-2005

Laparoscopy for impalpable testes

441

441 441
Stephen J. Griffin Online publication date: 24-Jul-2005 Reply

Steven Lehrer Online publication date: 24-Jul-2005 C-reactive protein is significantly associated with prostate-specific antigen and metastatic disease in prostate cancer

S. Asad Abedin Online publication date: 24-Jul-2005

442

The incidence and treatment of lymphoceles

after radical retropubic prostatectomy

Amrith Raj Rao, Roger O. Plai Online publication date: 24-Jul-2005

Surgery Illustrated

443

Simplified orthotopic ileocaecal pouch (Mainz

pouch) for bladder substitution

Joachim W. Thüroff, Ludger Franzaring, Rolf Gillitzer, Markus Wöhr, Sebastian Melchior

466

467 468
Corrigendum Online publication date: 24-Jul-2005

Abbreviations Online publication date: 24-Jul-2005

Diary Online publication date: 24-Jul-2005

EDITORIAL

This month sees the arrival of the ﬁrst in a series of articles entitled ‘Great Drug Classes’

This month sees the arrival of another pioneering BJU International initiative, the ﬁrst in a series of articles entitled ‘Great Drug Classes’. cite their favourite references (often their own) or for the pharmaceutical industry to present the most appropriate ‘representative’ data? The guidelines established by the BJU International should minimize both of these possibilities. The authors are invited by the Journal and they must construct the whole article in the context of the above template in ª10 000 words, and using an absolute
Over the last two decades, in urology and sexual health we have seen the arrival of many new major drug classes that have revolutionized patient management. Although the characteristics of individual drugs are well described (often in relation to maximum of 100 references. In general, statements will be made about the class competitors) in individual papers and reviews, as a whole and only key features of the editorial board felt that there was a void in the availability and dissemination of easily readable information. This has culminated, after several iterations, in the ﬁrst of the series of Great Drug Classes, i.e. that on phosphodiesterase inhibitors. individual drugs will be presented. Hopefully this will be a good way to focus the mind and the pen, and yet create an easily digestible article.

The editorial team would like to thank Tom Lue and Culley Carson for being the willing
In this prototype and all subsequent articles in guinea-pigs in establishing this new venture. the series, two eminent authors in the ﬁeld (generally one scientist and one clinician) have been asked to follow a distinct template covering: Introduction explaining why the drug class is important to healthcare
As you might imagine, this was made particularly difﬁcult due to the wealth of data and publications available for discussion, dissection and eventual inclusion.

professionals; historical perspective;

We at the BJU International look forward to

your comments on this style of article and suggestions for the future. It is anticipated that the series will on average appear bi-annually. To celebrate the launch of the Great Drug Classes, one member of the drug series is featured on the outside cover. background science; clinical data covering efficacy, therapeutic ratio, P_K-P_Drelationships and including an algorithm on how this fits into the contemporary management of the disease; and finally future prospects, but only as it relates to the primary indication.

Is this just an excuse for another unreadable lengthy review, giving the authors a chance to

MICHAEL G. WYLLIE

Associate Editor

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KIRBY AND FITZPATRICK

Prostate cancer represents in many ways an ideal candidate for chemoprevention, because of its high incidence and long latency to clinically signiﬁcant disease [1]. Because of this, increasingly many patients are asking their urologist directly what steps they can take to reduce their risk of being affected by the disease. If we as clinicians do not provide appropriate evidenced-based advice, then our advising higher doses of vitamin E, often patients are likely to end up taking an expensive cocktail of ‘natural’ preparations, often purchased at considerable expense from be £150 IU/day. Miller et al. [4] reported a their local health-food store.

HOW SHOULD WE ADVISE PATIENTS ABOUT THE CHEMOPREVENTION OF PROSTATE CANCER? ROGER S. KIRBY and

JOHN M. FITZPATRICK – St George’s Hospital, London, UK and Mater Misericordiae Hospital, Dublin, Ireland

Many clinicians have been in the habit of

has been evaluated in the Prostate Cancer

Prevention Trial [6]. In that study 18 882 men with a normal DRE and a PSA level of <3.0 ng/mL were randomized to either ﬁnasteride 5 mg/day or placebo, for 7 years. Prostate biopsy was advised if the PSA was >4.0 ng/mL or the DRE became abnormal. Prostate cancer was detected in 18.4% of men in the ﬁnasteride group and 24.4% in the placebo group, a 24.8% reduction (P < 0.001). However, tumours were of Gleason score 7–10 in 6.4% of the
400 IU/day, but recently published evidence suggests that the recommended dose should

meta-analysis of 19 trials, recruiting 135 967 participants; nine of 11 trials testing highdosage (<400 IU) vitamin E showed a greater risk for all-cause mortality for those on vitamin E than in controls. The difference in mortality risk in high-dosage vitamin E trials was 39 per 10 000 persons (95 CI, 3–74; P = 0.035). For low-dosage vitamin E trials, the risk difference was -16 per 10 000 persons (CI -41 to -10; P > 0.2). A dose– response analysis showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with increased risk for dosages of >150 IU/day (Fig. 1).
So what is the current evidence that there is anything now available that can safely and effectively reduce the risk of prostate cancer? This is an especially pertinent issue, as everincreasing numbers of prostate biopsies are being taken, and urologists are seeing more men who are deemed ‘high-risk’, either as result of a raised PSA level, prostatic finasteride-treated men, compared with 5.1% of the placebo group (P = 0.005), and sexual side-effects were more intraepithelial neoplasia, or a positive family history of prostate malignancy. common in the finasteride arm. The explanation for the slight preponderance of less well-differentiated tumours in the men treated with finasteride so far remains elusive. Although the result could be artefactual, because of the known effect of finasteride on prostatic epithelial architecture, there remains the worrying possibility that the effect could be real. Until the position becomes clearer, finasteride should probably not be recommended as a chemopreventive agent for prostate cancer.
Selenium is a trace nutrient essential for the activity of glutathione peroxidase, which may reduce oxidative damage to DNA. Several studies suggest a useful effect, but the best (and still indirect) evidence for its chemopreventive activity comes from the Nutritional Prevention of Cancer Study Group’s randomized trial of selenium to reduce the recurrence of skin cancer. After 10 years of follow-up (mean time on
The true safety and effectiveness of selenium and vitamin E should become clearer when the results of the SELECT study become available. This trial, which is sponsored by the USA National Cancer Institute, is a randomized, double-blind, placebocontrolled, population-based clinical trial designed to test the efficacy of selenium and vitamin E either alone or combined [5]. The target accrual is 32 400 individuals and the study duration is planned for 12 years. Unfortunately results are not expected until 2013 (SELECT details available at http:// www.crab.org/select/). treatment 4.5 years), men taking selenium at a dose of 200 mg/day had a 63–74% reduction in the risk of prostate cancer [2].
Dutasteride is a dual inhibitor of both 5areductase types 1 and 2. As such it results in suppression of dihydrotestosterone by >90%, compared with a suppression of ª70% with finasteride. The Reduction of Prostate Cancer Events trial has just completed recruiting 8000 men to receive either 0.5 mg of dutasteride or placebo for 4 years [7]. Biopsies must be negative within 6 months of accrual and repeat biopsies will be taken at 2 and 4 years. The results will not be available for some time yet, but should throw new light on the issue.
Vitamin E is the other supplement for which there is reasonable, but again indirect, evidence for a genuine chemopreventative effect in this context. In the Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial [3] there was a statistically significant reduction of both prostate cancer incidence and mortality of ª40% in men receiving 50 IU of a-tocopherol daily.
In theory, some of the most logical chemopreventative agents for prostate cancer are the 5a-reductase inhibitors. Finasteride, the first compound developed in this class, which inhibits isoenzyme type 2,

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Encouragingly, it was recently proposed that the consumption of red wine might be protective against prostate cancer [8]. Schoonen et al. interviewed 753 middle-aged patients newly diagnosed with prostate cancer, and 703 age-matched controls. Their lifelong alcohol habits, choice of beverage and prostate cancer history were assessed using an elaborate scoring process. Overall, total alcohol, beer, liquor and white wine

FIG. 1.

0.05 0.04 0.03 0.02 0.01

The dose-response relationship between vitamin E supplementation and all-cause mortality, in randomized control trials. With permission, from [4].

0
-0.01 -0.02 -0.03

consumption were not associated with the risk of prostate cancer. However, with red wine, every additional glass drunk per week showed a statistically signiﬁcant 6% decrease in relative risk. Men drinking 4–7 glasses/week were almost 25% less likely to have the disease (a relative risk reduction of 48%).

10

20

50

100

500 1000 2000

200

Vitamin E dosage, IU/d

So how should we advise patients while awaiting more data? A combination of selenium 200 mg and vitamin E at £150 IU per day may be effective, and seems unlikely to cause signiﬁcant side-effects, provided appropriate doses are used. A glass or two of red wine may be helpful, and tastes good! A myriad of other remedies are promoted as being effective [9], but in the absence of ﬁrm evidence from randomized studies or development of prostate cancer N Engl J