Author Interviews, Gender Differences, Menopause, Urology / 15.03.2021 Interview with: Lin Yang, PhD Research Scientist/Epidemiologist Department of Cancer Epidemiology and Prevention Research Cancer Care Alberta | Alberta Health Services | Canada Adjunct Assistant Professor Departments of Oncology and Community Health Sciences University of Calgary | Canada What is the background for this study? Response: Urinary incontinence disproportionately affects women. Urinary incontinence results in significant physical, social, and psychological adverse consequences that impair women’s quality of life and contribute to considerable healthcare costs. At the moment, the contemporary prevalence and recent trends in urinary incontinence in US women are unknown. More importantly, there is a growing awareness that urinary incontinence is not part of normal aging, but very little information is available to inform prevention strategies. Therefore, we were also interested in exploring correlates of urinary incontinence in a population-based sample of US women. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, COVID -19 Coronavirus, Prostate, Prostate Cancer, Surgical Research, Urology / 01.02.2021 Interview with: David-Dan Nguyen Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital MPH (Health Policy) Student | Harvard T.H. Chan School of Public Health Medical Student | McGill University What is the background for this study? Response: The COVID-19 pandemic has forced hospitals to delay the definitive treatment of cancers via surgery or radiation therapy. While previous evidence has shown that delaying the treatment of low-risk prostate cancer is not associated with worse outcomes, treatment delays for intermediate-risk and high-risk prostate cancer are more controversial. As such, we sought to determine if delays for these disease states negatively impacted oncological outcomes. (more…)
Author Interviews, JAMA, Prostate, Prostate Cancer, Urology / 25.06.2019 Interview with: Kari Tikkinen, MD, PhD, Adjunct Professor Departments of Urology and Public Health University of Helsinki and Helsinki University Hospital Helsinki, Finland What is the background for this study? What are the main findings?  Response: Men’s choice of whether to undergo screening is value and preference sensitive: fully informed men will make different choices depending on their experience and perspective. For such decisions, shared decision-making represents an ideal approach to decision making. In shared decision-making both the patient and health care provider contribute to the medical decision-making process. The health care provider explains alternatives to patients, informs them of the best evidence regarding the anticipated consequences of a decision for or against the intervention, and helps them choose the option that best aligns with their preferences. All major guidelines of prostate cancer screening acknowledge the importance of informing men about risks and benefits of PSA screening. Shared decision-making is challenging because it requires time, knowledge, and specific skills. Prostate cancer screening decisions aids may, by summarizing the current best evidence and by supporting conversations that address what matters most to men, address these challenges. The impact of decision aids on the decision-making process is, however, uncertain. We therefore undertook a systematic review and meta-analysis of the randomized trials that have addressed the impact of decision aids in the context of prostate cancer screening.  (more…)
Author Interviews, Pharmaceutical Companies, Prostate, Urology / 31.05.2019 Interview with: Steven A. Kaplan, M.D., FACS Professor of Urology Director, The Men's Health Program Icahn School of Medicine at Mount Sinai What is the background for this study? Response: PLUS is the first large-scale trial conducted in North America and Europe specifically designed to study the effects of mirabegron in controlling residual symptoms of urinary urgency and frequency in men with benign prostatic hyperplasia (BPH) using common agents such as tamsulosin (Flomax). We explored whether mirabegron (Myrbetriq), an agent approved for the treatment of overactive bladder (OAB), improved patient outcomes when added to tamsulosin. This was a randomized, double-blind, placebo-controlled, multi-center study enrolling 715 male patients 40 years of age and older. (more…)
Author Interviews, Cancer Research, HPV, Urology / 13.05.2019 Interview with: Lael SReinstatler, MD, MPH. PGY 4 Urology Residency Dartmouth Hitchcock What is the background for this study? What are the main findings?  Response: Human Papillomavirus is an oncogenic virus associated with other genitourinary cancers including penile cancer. HPV is detectable in urine and in urethral swabs and it interacts with stratified squamous epithelium which lines the majority of the genitourinary tract. Prior research has identified HPV in bladder tumors but detection methods are inconsistent. In this study, we looked for an association with HPV serology (indicating prior HPV systemic exposure) and bladder cancer. (more…)
Author Interviews, BMJ, Diabetes, Prostate, Urology / 24.04.2019 Interview with: Professor Ruth Andrew PhD Chair of Pharmaceutical Endocrinology University/BHF Centre for Cardiovascular Science Queen's Medical Research Institute University of Edinburgh What is the background for this study? What are the main findings? Response: Our research group has been interested for a number of years in how stress hormones (called glucocorticoids) influence the risk of heart disease and diabetes. Glucocorticoids help us control stress and regulate how the body handles its fuel, for example the carbohydrate and fat we eat. However exposure to high levels of glucocorticoids, can increase the risk of diabetes, obesity and high blood pressure. We studied men with prostate disease who took 5α-reductase inhibitors, because over and above the beneficial actions of these drugs in the prostate, they also slow down inactivation of glucocorticoids. We had carried out some short term studies with the drugs in humans and found that they reduced the ability of insulin to regulate blood glucose. Therefore in the study we have just published in the BMJ, we examined how patients receiving these drugs long-term responded and particularly we were able to show that over an 11 year period that there was a small additional risk of developing type 2 diabetes, the type of disease common in older people, compared with other types of treatments. (more…)
Author Interviews, Depression, JAMA, Surgical Research, Urology / 14.01.2019 Interview with: Blayne Welk MD, MSc, FRCSC Associate Professor of Surgery St. Joseph's Hospital Western University What is the background for this study? What are the main findings? Response: I found that when I was referred women with midurethral sling complications, they were often quite emotional and described a significant period of time when they struggled with the complications before they were referred to someone to assess them. The study looked at the rate of depression and self-harm behavior of women who had surgery for midurethral sling complications compared to women who did not have midurethral sling complications. I found that there was an increased risk of both of these outcomes among women who had surgery for complications, however this risk was primarily present in younger women. (more…)
Author Interviews, JAMA, Urinary Tract Infections, Urology, UT Southwestern / 02.10.2018 Interview with: "Glass of Water" by Iwan Gabovitch is licensed under CC BY 2.0Professor Yair Lotan MD Chief of Urologic Oncology Holder of the Helen J. and Robert S. Strauss Professorship in Urology UT Southwestern Medical Center at Dallas Department of Urology Dallas, Texas 75390-9110 What is the background for this study? What are the main findings? Response: Urinary tract infections are extremely common in women and many women experience recurrent episodes which impact their quality of life.  There are also many women who do not drink as much water as is recommended. This study found that in healthy women with recurrent UTIs who drink less than 1.5 liters per day, the additional intake of 1.5 liters of water daily reduced the risk of recurrent infections by nearly 50%.  (more…)
Author Interviews, Endocrinology, Sleep Disorders, Testosterone, Urology / 23.05.2018 Interview with: Kristen L. Knutson, PhD Associate Professor Center for Circadian and Sleep Medicine Department of Neurology Northwestern University Feinberg School of Medicine Chicago, IL  60611​Premal Patel, MD, PGY-5 Urology University of Manitoba What is the background for this study? What are the main findings? What should readers take away from your report? Response: Within the literature there has only been small experimental studies which looked at impaired sleep and testosterone. To our knowledge, there has been no study that has evaluated sleep and testosterone using a population dataset. We utilized the National Health and Nutrition Examination Survey to assess the association of sleep with serum testosterone. NHANES examines a nationally representative sample of about ~5000 persons each year. After performing a multivariate linear regression of numerous variables within the NHANES database (age, marital status, prior co-morbidities, number of hours of sleep, etc…) we found that a reduction in the number of hours slept, increasing body mass index and increasing age were associated with lower testosterone levels. Given that this is a cross-sectional analysis, we are unable to provide causality of this relationship but we do feel it is important to counsel patients with low testosterone about the importance of living a healthy lifestyle which includes a well-balanced diet, exercise and sufficient sleep. (more…)
Author Interviews, Kidney Stones, Microbiome, Urology / 15.05.2018 Interview with: Gregory Tasian MD, MSc, MSCE Assistant Professor of Urology and Epidemiology University of Pennsylvania Perelman School of Medicine Division of Urology and Center for Pediatric Clinical Effectiveness The Children’s Hospital of Philadelphia What is the background for this study? What are the main findings? Response:  We found that five classes of commonly prescribed antibiotics were associated with an increased risk of kidney stones. These classes were sulfa drugs (e.g. Bactrim), fluoroquinolones (e.g. Cipro), cephalosporins (e.g. cephalexin), nitrofurantoin, and broad-spectrum penicillins (e.g. augmentin).  For those five classes of antibiotics, the greatest risk was found among younger patients. However, the increased risk was still significant across all ages, including for older adults with the exception of broad-spectrum penicillins, which were not associated with an increased risk of kidney stones among patients >75 years of age. We conducted this study because: 1) Prior investigations have demonstrated that changes in the gut microbiome were associated with kidney stones, 2) Antibiotics are prescribed frequently, and 3) The number of people affected by kidney stone disease has increased 70% over the last 30 years and the greatest increases have been found among children and adolescents. Our results were consistent with these previous studies, so we were not surprised with the findings although we did not know which specific classes of antibiotics would be associated with an increased risk of stones and which ones would not. (more…)
Author Interviews, JAMA, Urology / 03.10.2017 Interview with: Robert Nam, MD, FRCSC Ajmera Family Chair in Urologic Oncology Professor of Surgery University of Toronto Head, Genitourinary Cancer Site Odette Cancer Centre Sunnybrook Health Sciences Centre What is the background for this study? What are the main findings? Response: The well known potentially lethal complications of anti-thrombotic medications of cerebral and gastrointestinal bleeding complications are well known.  However, more common bleeding related complications are not well described .  In particular, gross hematuria is a well known complication of these medications but its frequency and severity is unknown.  We sought to characterize this association among a large population-based cohort consisting of over 2.5 million patients from the Province of Ontario, Canada, using hematuria-related complications was endpoints.  These were defined as undergoing invasive urologic procedures, hospital admissions or emergency visits for gross hematuria. (more…)
ASCO, Author Interviews, Cancer Research, Genetic Research / 18.05.2017 Interview with: Roy Mano, MD and David Margel, MD, PhD Department of Urology, Rabin Medical Center Petach Tikva, Israel What is the background for this study? Response: According to previous reports, male BRCA mutation carriers have a higher risk of developing malignancies of the prostate, pancreas, breast, colon and melanoma. While malignancy screening protocols for female BRCA carriers are well established and widely implemented, little is known about the optimal screening protocol for male BRCA carriers, and current screening protocols focus on malignancies of the breast and prostate rather than offer a comprehensive screening protocol for all BRCA associated malignancies. (more…)
Author Interviews, Prostate, Urology / 18.05.2017 Interview with: Dr. Nikhil K. Gupta and Kevin McVary, MD, FACS Professor, Department of Surgery Chair, Division of Urology Southern Illinois University School of Medicine What is the background for this study? Response: Male lower urinary tract symptoms due to benign prostatic hyperplasia, or LUTS due to BPH, have most commonly been treated with a combination of medication, such as alpha-blockers and 5-alpha reductase inhibitors, and surgery, such as transurethral resection of prostate (TURP) and Greenlight photovaporization of prostate (PVP). These treatments, however, have potentially serious adverse and sexual side effects. Minimally invasive surgical therapies (MIST) for LUTS due to BPH have tried to thread the needle between medications and invasive surgery, giving effective relief of symptoms with minimal anesthetic need while preserving sexual function. Previously developed MISTs have been unable to provide durable relief of symptoms, causing patients to undergo multiple treatments in a short period of time, and have been limited by prostate size and conformation, e.g. the inability to treat a middle lobe or median bar. LUTS due to BPH is also very strongly and likely causally linked with obesity, and obesity seems to have an effect on the efficacy of treatment as well, as obesity affects response to medication and tends to dampen the treatment effect of TURP. Convective Radiofrequency Water Vapor Energy ablation of the prostate, named Rezūm®, is a new MIST that uses radiofrequency to generate energy in the form of water vapor. The water vapor acts as a convective energy source and, once injected into the treatment area, distributes itself evenly within the treated tissue, causing uniform necrosis througout the treated area. This mechanism using convection is in contrast to previous technologies using conductive heat energy, which created a heat gradient with tissue closest to the heat source receiving the largest amount of energy and tissue farthest from the heat source receiving almost no energy. Thus conductive energy has a different effect on different parts of the treated area. With Rezūm, MRI studies have shown that the water vapor creates a uniform treatment effect while staying within collagen barriers, obeying natural tissue planes and affecting only the intended treatment areas. The purpose of this study was to determine the efficacy of Rezūm in treatment of LUTS due to BPH, examine the treatment's effect on sexual function, and to determine whether obesity affected treatment efficacy. (more…)
Author Interviews, Biomarkers, Prostate Cancer, Urology / 17.05.2017 Interview with: Eric A. Klein, MD Chairman, Glickman Urological and Kidney Institute Cleveland Clinic Which of these results did you find most interesting or surprising? Response: What’s most interesting is that the IsoPSA assay redefines how PSA is measured, which links it more closely to the underlying biology of cancer. Current assays measure only the concentration of PSA, which can be affected by conditions other than cancer – BPH most commonly, but also infection and inflammation – which limits its diagnostic accuracy for finding cancer. Its been known for several decades that PSA exists in multiple different forms in the bloodstream in patients with prostate cancer. These novel molecules arise because cancer cells have deranged cellular metabolism that result in the generation of new species of PSA, making their measurement more tightly linked to the presence or absence of cancer and even the presence of high grade cancer (where cellular metabolism is even more disordered). The IsoPSA assay is the first assay to measure all of these isoforms and thus has better diagnostic accuracy for cancer. (more…)
Author Interviews, CMAJ, Pharmacology, Urology / 19.11.2016 Interview with: Emma Maund, MSc PhD Nordic Cochrane Centre What is the background for this study? Response: Duloxetine has been approved in Europe for the treatment of stress urinary incontinence in women. It is not approved for this indication in the US and Canada. Currently, reasons why marketing authorization applications are withdrawn or denied are not published by either the Canadian or the US drug agency. However, the FDA has said that a higher-than-expected rate of suicide attempts - 2.6 timer higher - was observed in the open-label extensions of controlled trials of duloxetine for stress urinary incontinence. Given the FDA’s statement about the rate of suicide attempts, we wanted to determine whether duloxetine increased the risk of suicidality, violence or their possible precursors (drug induced akathisia, an extreme type of restlessness; activation, which consists of stimulating effects such as insomnia, anxiety and agitation; emotional disturbance, such as depersonalization and derealization; or psychotic events, such as delusions and hallucinations) in the randomized phases of the trials. We therefore assessed the benefits and harms of duloxetine in stress urinary incontinence using clinical study reports, including individual patient data, of the 4 main trials submitted by Eli Lilly to the European Medicines Agency. (more…)
Author Interviews, Journal Clinical Oncology, Prostate Cancer, Surgical Research, Urology / 30.09.2016 Interview with: Eric Jacobs, PHD Strategic Director, Pharmacoepidemiology American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 What is the background for this study? What are the main findings? Response: Vasectomy is a common, inexpensive, and very effective method of long-term birth control. However, in 2014, an analysis from a large epidemiologic cohort study, the Health Professionals Follow-Up Study, found that vasectomy was associated with about 10% higher overall risk of prostate cancer and about 20% higher risk of fatal prostate cancer. Together with other researchers at the American Cancer Society, I analyzed the association between vasectomy and fatal prostate cancer among more than 363,000 men in the Cancer Prevention Study II (CPS-II) cohort, age 40 and older, who were followed for up to 30 years. This is the largest prospective analysis of vasectomy and fatal prostate cancer to date. We also examined vasectomy and prostate cancer in a subset of about 66,000 CPS-II study participants who were followed for new diagnoses of prostate cancer. We found no link between having had a vasectomy and risk of either developing or dying from prostate cancer. (more…)
Author Interviews, Endocrinology, Prostate, Prostate Cancer, Testosterone, Urology / 19.09.2016 Interview with: Dr. Jesse Ory Department of Urology, Faculty of Medicine Dalhousie University, Halifax Nova Scotia, Canada What is the background for this study? What are the main findings? Response: The use of Testosterone Therapy (TT) in men diagnosed with and treated for prostate cancer (CaP) has been highly controversial for several decades. Unfortunately, this controversy is largely founded on the results of a single patient in a study by Huggins and Hodges in the 1940s [1]. This wasn't challenged until recently, when Morgentaler reviewed the literature on the topic and found no scientific basis for the assumption that TT will act like fuel on the fire of prostate cancer [2]. He also proposed a mechanism, the "saturation hypothesis" that helps account for why TT may in fact be safe for men with prostate cancer. [3]. Over the past decade, retrospective evidence has been accumulating that supports the safety of Testosterone Therapy in hypogonadal men with CaP on Active Surveillance, or in those who have been definitively treated for prostate cancer.. (more…)
Author Interviews, Prostate Cancer, Urology / 17.08.2016 Interview with: Jennifer Cullen Meyer, PhD, MPH Director of Epidemiologic Research, Center for Prostate Disease Research Assistant Professor, Norman M. Rich Dept. of Surgery, Uniformed Services University Rockville, MD 20852 What is the background for this study? Response: Men diagnosed with prostate cancer who are at low risk for cancer progression may choose to defer immediate treatment with curative intent and, instead, monitor their cancer. This strategy is referred to as “active surveillance.” The primary benefit of active surveillance is that it allows men to temporarily defer definitive cancer treatments that are known to cause decrements in health-related quality of life (HRQoL). Studies have shown that HRQoL is better in men choosing active surveillance as compared to other treatment modalities. However, prior to our study, it was not known whether men on active surveillance experience worse HRQoL than men without prostate cancer. (more…)
Author Interviews, Prostate, Prostate Cancer, Urology / 04.06.2016 Interview with: Kenneth A. Iczkowski, M.D. Department of Pathology Medical College of Wisconsin Milwaukee, WI 53226 What is the background for this study? Dr. Iczkowski: The International Society of Urological Pathology (ISUP) in 2014 proposed use of a new 5-tier grade grouping system to supplement traditional Gleason grading to facilitate prognosis stratification and treatment1. The 5 categories subsume: Gleason 3+3=6, Gleason 3+4=7, Gleason 4+3=7, Gleason 8, and Gleason 9-10. We desired to determine whether men with a highest Gleason score of 3+5=8 or 5+3=8 in their set of prostate biopsy specimens, would have differing outcomes from those with Gleason 4+4=8. Because Gleason 5 cancer has been demonstrated to have a higher biologic potential than Gleason 4, it was expected that Gleason score 8 pattern with any Gleason 5 pattern would have a worse outcome. (more…)
Author Interviews, Chemotherapy, Urology / 24.05.2016 Interview with: Alejandro Sousa, MD, PhD Department of Urology, Comarcal Hospital Monforte, Spain What is the background for this study? Dr. Sousa: Bladder Cancer management has remained stable over the past 25 years, with very little in the way of new therapies or approaches being developed. Traditional treatment using intravesical Mitomycin C for Non Muscle Invasive Bladder Cancer (NMIBC) patients is limited due it's low absorption levels. Device assisted therapies that deliver Chemo-hyperthermia offer a new hope, with the potential for improved outcomes and better disease management due the the increased drug activity and better efficacy. We wanted to investigate the optimal treatment regime for this new therapy and whether it provides a safe and effective alternative to current standard treatment. (more…)
Abuse and Neglect, Author Interviews, NYU, Pharmacology, Urology / 11.05.2016 Interview with: Dr. Jed Kaminetsky MD Clinical Assistant Professor Department of Urology NYU Langone Medical Center What is the background for this study? What are the main findings? Dr. Kaminetsky: Nocturia is a voiding disorder not well treated by available drugs for overactive bladder and benign prostatic hypertrophy. Desmopressin stimulates the kidneys to concentrate the urine which results in a greatly reduced volume of urine formation for a period of time. Serenity Pharmaceuticals has spent many years developing a low dose nasal spray version of desmopressin called Noctiva specifically for nocturia. The study reported now is a large, placebo controlled phase 3 trial to confirm the statistical efficacy and clinical benefit of this treatment for nocturia. (more…)
Author Interviews, Kidney Disease, Urology / 10.05.2016 Interview with: Hiten D. Patel, MD, MPH Resident, Urological Surgery James Buchanan Brady Urological Institute The Johns Hopkins Medical Institutions Baltimore, Maryland 21287 What is the background for this study? Dr. Patel: The study reports results of a systematic review contracted by the Agency for Healthcare Research and Quality based on input from stakeholders. Part of the motivation was due to the American Urological Association's desire to use the results as a basis to update relevant clinical guidelines. There are four major management options for clinically localized small renal masses diagnosed on imaging including active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. The body of research evaluating these management options is broad, but many of the studies performing comparative analyses have limitations. Therefore, the systematic review aimed to evaluate a number of outcomes (e.g. overall survival, cancer specific survival, local recurrence, metastasis, renal function, complications, and perioperative outcomes) based on available comparative studies in the literature. (more…)
Author Interviews, Urology / 03.05.2016 Interview with: Errol Singh, M.D. Urologist and CEO of PercuVision What is the background for this study? Dr. Singh: We set out to better understand the American public’s fears around Foley catheters and hopefully bring attention to the fact that hospitalizations due to infections from urinary catheters are on the rise. Interestingly enough, 20 percent of hospital patients undergo a urinary catheterization, which is the second most common procedure following intravenous therapy. The procedure, however, often leads to complications including infections mostly caused by trauma. What are the main findings? Dr. Singh: The main findings of the 2016 Urinary Catheter Fear Survey revealed that three out of five men (58 percent) are fearful of urinary catheterizations, while one out of every four men is very fearful of the procedure. Younger men also seem to be more fearful than their older counterparts. More than two-thirds (68 percent) of men ages 18-34 surveyed are fearful of urinary catheterizations, compared to 43 percent of males 65 and over. Clearly, females are less fearful, with 46 percent of women saying they are not fearful of urinary catheterizations, compared to 37 percent of men. It’s also important to note that half of all women surveyed say they fear the procedure, and 25 percent reporting they are very fearful. You can find more of the 2016 Urinary Catheter Fear Survey results on our website (more…)
Author Interviews, Urology / 11.04.2016 Interview with: Dr. H. Bob Smouse MD Interventional Radiology, Radiology OSF Saint Francis Medical Center Peoria, IL What is the background for this study? Dr. Smouse: For more than twenty years I've seen my patients with severe blockages of the ureter undergo two separate invasive procedures to implant one ureteral stent. Even though these procedures are done with interventional techniques, they require sedation, radiation, time off work, and occasionally have some level of pain and discomfort. Being able to potentially eliminate an entire invasive procedure for these patients has been a goal of mine for years. What are the main findings? Dr. Smouse: All devices tested showed 100% success in implantation and 100% success in converting from an internal-external nephroureteral catheter into an internal nephroureteral stent without the need for a second invasive procedure. (more…)
Author Interviews, Biomarkers, Mayo Clinic, Prostate, Prostate Cancer, Urology / 12.01.2016 Interview with: R. Jeffrey Karnes MD Department of Urology, Mayo Clinic, Rochester, MN 55905   MedicalResearch: What is the background for this study? What are the main findings? Dr. Karnes: Cancer recurrence following radical prostatectomy is a concern for men undergoing definitive surgical treatment for prostate cancer. Approximately 20-35% of patients develop a rising prostate specific antigen following radical prostatectomy for clinically localized prostate cancer. PSA monitoring is an important tool for cancer surveillance; however, a standard PSA cutpoint to indicate biochemical recurrence has yet to be established. Over 60 different definitions have been described in literature. This variation creates confusion for the patients and clinicians. By studying a large group of patients who underwent radical prostatectomy at Mayo Clinic, we found that a PSA cutpoint of 0.4 ng/mL is the optimal definition for biochemical recurrence. (more…)
Author Interviews, JAMA, Surgical Research, Urology / 10.09.2015 Interview with: Blayne Welk MD Assistant Professor in the Division of Urology The University of Western OntarioBlayne Welk MD Assistant Professor in the Division of Urology The University of Western Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Welk: Stress incontinence is a common problem among women. The most frequently used surgical treatment is a mesh-based midurethral sling. This procedure is commonly called a transvaginal sling, and is usually an outpatient procedure that takes about an hour in the operating room. However, there has been significant concern about some of the complications of this procedure, which include chronic pain, and mesh erosions into the urinary tract. This prompted the FDA and Health Canada to issue warnings regarding the use of transvaginal mesh, and numerous lawsuits have been launched against manufactures of transvaginal mesh products. This study by Dr Welk and colleagues identifies the long term rate of surgical treated complications among a group of almost 60,000 women who had mesh based incontinence procedures between 2002-2012. The rate of surgically treated complications at 1 year is 1.2%, however this increased to 3.3% after 10 years of followup. The FDA and Health Canada recommend that surgeons obtain training and experience in their chosen type of midurethral sling, and we demonstrated that patients of high volume surgeons (who frequently performed mesh based incontinence procedures) were 27% less likely to have one of these complications. (more…)
Author Interviews, BMJ, Urology / 09.06.2015 Interview with: Bilal Chughtai, MD & Art Sedrakyan, MD, PhD Department of Urology Weill Cornell Medical College Medical Research: What is the background for this study? What are the main findings? Response: Since 2008, the U.S. Food and Drug Administration has released number of public health notifications cautioning the use of mesh in pelvic organ prolapse (POP) surgery. Despite these notifications and subsequent public scrutiny, studies have reported a large increase of mesh use in female patients with pelvic organ prolapse during the last decade. In light of the reported rise in mesh utilization, we sought to determine the use of mesh in prolapse surgery and compare short-term outcomes of prolapse surgery with or without mesh. After identifying 7,338 and 20,653 patients who underwent prolapse repair procedures with and without mesh in a 4-year period, we found that mesh use increased 44.7%. Most patients were under 65 (62.3%), and there were more patients older than 65 years in the mesh group (44.3% versus 35.4%). Overall, complications were not common. However, patients who received mesh were more likely to experience urinary retention within 90-days and had a higher chance of having re-intervention at 1 year. Mesh use was also associated with higher risk of urinary retention in older patients (≥ 65 year olds) and re-intervention within 1 year in younger patients (<65 year olds). (more…)
Author Interviews, Testosterone, Urology / 18.05.2015

Ranjith Ramasamy MD Assistant Professor of Urology University of Interview with: Ranjith Ramasamy MD Assistant Professor of Urology University of Miami Medical Research: What is the background for this study? Dr. Ramasamy: The association between testosterone supplementation therapy (TST) and thrombotic risk in elderly men remains controversial. We evaluated the prevalence of thrombotic events and all-cause mortality in men older than 65 years with hypogonadism treated with testosterone therapy. We compared men treated with testosterone to an age and comorbidity matched cohort of hypogonadal men not treated with testosterone supplementation therapy. Medical Research: What are the main findings? Dr. Ramasamy: No man who received testosterone supplementation therapy died, whereas 6 hypogonadal men who did not receive TST died (p=0.007). There were 4 thrombotic events (1 MI - myocardial infarction, 2 CVA/TIA - stroke, 1 PE - pulmonary embolism) in men who received testosterone supplementation therapy compared to 1 event (CVA/TIA) among men who did not receive TST (p = 0.8). All the events (except one death which took place at 6 months of follow–up) occurred 2 years or more after follow–up. Strengths of the study include long follow–up (>3 years), availability of serum testosterone levels before and after therapy and of a control group (hypogonadal men not treated with TST) for comparison. Limitations included retrospective study design, and a small sample size. (more…)
Author Interviews, Baylor College of Medicine Houston, Sleep Disorders, Urology / 18.05.2015 Interview with: Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Jason Malcolm Scovell Medical Student, Ofc SA-BCM Students Baylor College of Medicine Houston, TX Medical Research: What is the background for this study? What are the main findings? Response: Sleep quality is an important component of overall health, and can both exacerbate health issues and be impaired by health problems. Shift workers, primarily those who do not work standard daylight shifts, are prone to sleep problems, a significant concern in light of the fact that up to 25% of the U.S. workforce is comprised of shift workers. As men age, the prevalence of Lower Urinary Tract Symptoms (LUTS), which include urgency, frequency, waking up at night to urinate, and difficulties with urination, increases.  Unsurprisingly, men with LUTS report poor sleep in part due to awakening repeatedly during the night. We studied a group of male shift workers, who we believe to be an ‘at-risk’ population, and found that not only do the men who report worse sleep quality have worse Lower Urinary Tract Symptoms, but also men who report difficulty falling asleep have more severe LUTS than those who do not. This latter point is significant, given that most men with LUTS can fall asleep without difficulty, but then awaken repeatedly throughout the night, and suggests that sleep difficulties in this population may be resulting in Lower Urinary Tract Symptoms rather than LUTS exclusively resulting in sleep difficulties. (more…)