Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0050
P. Dahm
This chapter summarizes an important study exploring the learning curve of surgeons performing open radical prostatectomy with clinically localized prostate cancer. The study retrospectively analyzed a large cohort of patients from several major medical centers who underwent surgery by several dozen surgeons with varying experience with regards to the outcome of freedom from biochemical recurrence. The study found a dramatic improvement in cancer control with increasing surgeon experience up to 250 prior operations but no large change with further surgeon experience. This study stands out as the first large, high-quality study in the urological literature to provide a detailed analysis of the association of surgical experience with an important clinical outcome measure. It provided compelling evidence that surgical experience with prostatectomy results in improved oncological outcomes.
{"title":"The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy","authors":"P. Dahm","doi":"10.1093/MED/9780190655341.003.0050","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0050","url":null,"abstract":"This chapter summarizes an important study exploring the learning curve of surgeons performing open radical prostatectomy with clinically localized prostate cancer. The study retrospectively analyzed a large cohort of patients from several major medical centers who underwent surgery by several dozen surgeons with varying experience with regards to the outcome of freedom from biochemical recurrence. The study found a dramatic improvement in cancer control with increasing surgeon experience up to 250 prior operations but no large change with further surgeon experience. This study stands out as the first large, high-quality study in the urological literature to provide a detailed analysis of the association of surgical experience with an important clinical outcome measure. It provided compelling evidence that surgical experience with prostatectomy results in improved oncological outcomes.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116244537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0012
J. Zabell
This chapter summarizes the findings of a population-based, observational study comparing men with clinically localized prostate cancer who received primary androgen-deprivation therapy (ADT) or were treated conservatively. The investigator used instrumental variable analysis to adjust for potential confounders. This study found no improvement in survival for men receiving primary ADT.
{"title":"Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer","authors":"J. Zabell","doi":"10.1093/MED/9780190655341.003.0012","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0012","url":null,"abstract":"This chapter summarizes the findings of a population-based, observational study comparing men with clinically localized prostate cancer who received primary androgen-deprivation therapy (ADT) or were treated conservatively. The investigator used instrumental variable analysis to adjust for potential confounders. This study found no improvement in survival for men receiving primary ADT.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134360193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0013
P. Dahm
This chapter summarizes the findings of a landmark randomized trial comparing total androgen deprivation in the form of bilateral orchiectomy plus the antiandrogen flutamide to bilateral orchiectomy alone. The study found no survival benefit but did find increased side effects from the addition of an antiandrogen.
{"title":"Bilateral Orchiectomy With or Without Flutamide for Metastatic Prostate Cancer","authors":"P. Dahm","doi":"10.1093/MED/9780190655341.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0013","url":null,"abstract":"This chapter summarizes the findings of a landmark randomized trial comparing total androgen deprivation in the form of bilateral orchiectomy plus the antiandrogen flutamide to bilateral orchiectomy alone. The study found no survival benefit but did find increased side effects from the addition of an antiandrogen.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131383499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0030
M. Risk
This chapter reviews a pivotal, single-armed observational study of consecutive patients with metastatic testicular germ cell tumor treated with a combination of bleomycin, vinblastine, and cisplatin. This study established that cisplatin-based combination chemotherapy resulted in a much better prognosis in patients with metastatic testicular cancer than historically observed with any other treatment and also resulted in high response rates.
{"title":"Cis-Diamminedichloroplatinum, Vinblastine, and Bleomycin Combination Chemotherapy in Disseminated Testicular Cancer","authors":"M. Risk","doi":"10.1093/MED/9780190655341.003.0030","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0030","url":null,"abstract":"This chapter reviews a pivotal, single-armed observational study of consecutive patients with metastatic testicular germ cell tumor treated with a combination of bleomycin, vinblastine, and cisplatin. This study established that cisplatin-based combination chemotherapy resulted in a much better prognosis in patients with metastatic testicular cancer than historically observed with any other treatment and also resulted in high response rates.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127908445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0045
P. Dahm, Jane M. Lewis
This chapter summarizes the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, a landmark trial that randomized children with vesicoureteral reflux diagnosed after a first or second febrile or symptomatic urinary tract infection to receive trimethoprim–sulfamethoxazole (TMP-SMX) prophylaxis versus placebo. It found that antibiotic prophylaxis reduced the incidence of recurrent febrile or symptomatic urinary tract infection but had little effect on renal scarring. Recurrent febrile or symptomatic urinary tract infections resistant pathogens were increased. This study provides the underpinning for guidelines that advocate for low-dose antibiotic prophylaxis for the first year of life; however, this remains an area of considerable controversy.
{"title":"Antimicrobial Prophylaxis for Children With Vesicoureteral Reflux","authors":"P. Dahm, Jane M. Lewis","doi":"10.1093/MED/9780190655341.003.0045","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0045","url":null,"abstract":"This chapter summarizes the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, a landmark trial that randomized children with vesicoureteral reflux diagnosed after a first or second febrile or symptomatic urinary tract infection to receive trimethoprim–sulfamethoxazole (TMP-SMX) prophylaxis versus placebo. It found that antibiotic prophylaxis reduced the incidence of recurrent febrile or symptomatic urinary tract infection but had little effect on renal scarring. Recurrent febrile or symptomatic urinary tract infections resistant pathogens were increased. This study provides the underpinning for guidelines that advocate for low-dose antibiotic prophylaxis for the first year of life; however, this remains an area of considerable controversy.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121898946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This chapter summarizes the results of the Stress Incontinence Surgical Treatment Efficacy (SISTEr) trial, which randomized women with stress urinary incontinence to an autologous sling procedure versus a Burch colposuspension. Overall treatment success favored the fascial sling over the Burch procedure group, as did the stress incontinence–specific success rate at 24 months. Postoperative voiding dysfunction and urge incontinence were more common in the sling group than the Burch group. These findings supported the historical shift toward slings (autologous and synthetic) versus Burch colposuspension procedures in clinical practice.
{"title":"Burch Colposuspension Versus Fascial Sling to Reduce Urinary Stress Incontinence","authors":"C. Dixon, Giulia I. Lane, Cynthia Fok, M. Moy","doi":"10.1056/nejmx070036","DOIUrl":"https://doi.org/10.1056/nejmx070036","url":null,"abstract":"This chapter summarizes the results of the Stress Incontinence Surgical Treatment Efficacy (SISTEr) trial, which randomized women with stress urinary incontinence to an autologous sling procedure versus a Burch colposuspension. Overall treatment success favored the fascial sling over the Burch procedure group, as did the stress incontinence–specific success rate at 24 months. Postoperative voiding dysfunction and urge incontinence were more common in the sling group than the Burch group. These findings supported the historical shift toward slings (autologous and synthetic) versus Burch colposuspension procedures in clinical practice.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131073207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0015
J. Zabell
This chapter summarizes the findings of landmark TAX 327 trial in men with castrate-refractory prostate cancer who received either docetaxel (weekly or every 3 weeks) or mitoxantrone (every 3 weeks). The study found improved overall survival, better quality of life, and similar side effects in men treated with docetaxel.
{"title":"Docetaxel Plus Prednisone or Mitoxantrone Plus Prednisone for Advanced Prostate Cancer","authors":"J. Zabell","doi":"10.1093/MED/9780190655341.003.0015","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0015","url":null,"abstract":"This chapter summarizes the findings of landmark TAX 327 trial in men with castrate-refractory prostate cancer who received either docetaxel (weekly or every 3 weeks) or mitoxantrone (every 3 weeks). The study found improved overall survival, better quality of life, and similar side effects in men treated with docetaxel.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121498352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0040
Giulia I. Lane, C. Dixon, M. Moy, Cynthia Fok
This chapter summarizes the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial, in which women without stress urinary incontinence undergoing prolapse surgery were randomized to a midurethral sling or no concomitant midurethral sling. The OPUS trial found that women randomized to undergo prophylactic concomitant midurethral sling at the time of transvaginal repair for pelvic organ prolapse had lower rates of urinary incontinence at 3 and 12 months but also experienced higher rates of adverse events such as bladder perforation, major bleeding, and urinary tract infections.
{"title":"A Midurethral Sling to Reduce Incontinence After Vaginal Prolapse Repair","authors":"Giulia I. Lane, C. Dixon, M. Moy, Cynthia Fok","doi":"10.1093/MED/9780190655341.003.0040","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0040","url":null,"abstract":"This chapter summarizes the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial, in which women without stress urinary incontinence undergoing prolapse surgery were randomized to a midurethral sling or no concomitant midurethral sling. The OPUS trial found that women randomized to undergo prophylactic concomitant midurethral sling at the time of transvaginal repair for pelvic organ prolapse had lower rates of urinary incontinence at 3 and 12 months but also experienced higher rates of adverse events such as bladder perforation, major bleeding, and urinary tract infections.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"57 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131995666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0039
Giulia I. Lane, C. Dixon, M. Moy, Cynthia Fok
This chapter summarizes the results of the Trial of Mid Urethral Slings (TOMUS), in which women with stress urinary incontinence were randomized to a retropubic midurethral sling versus a transobturator sling. Bladder perforations and voiding dysfunction occurred only in the retropubic sling group; neurologic symptoms (weakness and numbness) were significantly more common in the transobturator group. Both objective and subjective measures of treatment success at 12 months were similar. Based on this and subsequent studies, retropubic and transobturator midurethral sling approaches appear to have similar outcomes at 12 months for the treatment of stress urinary incontinence. However, the approaches differ in their adverse-event profiles.
{"title":"Retropubic Versus Transobturator Midurethral Slings for Stress Incontinence","authors":"Giulia I. Lane, C. Dixon, M. Moy, Cynthia Fok","doi":"10.1093/MED/9780190655341.003.0039","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0039","url":null,"abstract":"This chapter summarizes the results of the Trial of Mid Urethral Slings (TOMUS), in which women with stress urinary incontinence were randomized to a retropubic midurethral sling versus a transobturator sling. Bladder perforations and voiding dysfunction occurred only in the retropubic sling group; neurologic symptoms (weakness and numbness) were significantly more common in the transobturator group. Both objective and subjective measures of treatment success at 12 months were similar. Based on this and subsequent studies, retropubic and transobturator midurethral sling approaches appear to have similar outcomes at 12 months for the treatment of stress urinary incontinence. However, the approaches differ in their adverse-event profiles.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131243445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-01DOI: 10.1093/MED/9780190655341.003.0018
J. Zabell
This chapter summarizes the findings of the landmark PREVAIL trial conducted in men with castrate-resistant prostate cancer who had received prior chemotherapy comparing enzalutamide to placebo. It demonstrated improved overall survival, radiographic progression-free survival, and time to cytotoxic chemotherapy.
{"title":"Enzalutamide in Metastatic Prostate Cancer Before Chemotherapy","authors":"J. Zabell","doi":"10.1093/MED/9780190655341.003.0018","DOIUrl":"https://doi.org/10.1093/MED/9780190655341.003.0018","url":null,"abstract":"This chapter summarizes the findings of the landmark PREVAIL trial conducted in men with castrate-resistant prostate cancer who had received prior chemotherapy comparing enzalutamide to placebo. It demonstrated improved overall survival, radiographic progression-free survival, and time to cytotoxic chemotherapy.","PeriodicalId":435097,"journal":{"name":"50 Studies Every Urologist Should Know","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114349337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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