The Journal of urology
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The Journal of urology · Nov 2007
Randomized Controlled Trial Multicenter StudyValidity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a european multicenter survey of 1,296 patients.
The CAPRA (Cancer of the Prostate Risk Assessment) score from the University of California, San Francisco provides a new statistical model to predict recurrence-free survival and pathological tumor stage after radical prostatectomy. It was originally developed using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. To calculate the score, which ranges from 0 to 10, 5 clinical variables are needed, ie prostate specific antigen, Gleason sum, clinical tumor grade, percentage of positive biopsies and patient age. To date, the only external validation of the CAPRA score has been conducted using the SEARCH (Shared Equal Access Regional Cancer Hospital) database. The present study uses a German database to contribute to existing validation work and to test transferability of the CAPRA score to a sample that differs fundamentally from the SEARCH sample in terms of clinical features. ⋯ Despite different clinical features in the present patient cohort and the CaPSURE data set, the accuracy of the CAPRA nomogram in predicting recurrence-free survival was high. These results underscore the effectiveness and the clinical applicability of the CAPRA score which, in addition to patient counseling, may also be used for risk stratification in clinical studies.
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The Journal of urology · Oct 2007
Randomized Controlled TrialPlasminogen activation inhibitor-1 improves the predictive accuracy of prostate cancer nomograms.
We tested whether the addition of preoperative circulating plasminogen activator inhibitor type I levels improves the accuracy of standard preoperative and postoperative models for prediction of biochemical recurrence after radical prostatectomy. ⋯ Preoperative circulating plasminogen activator inhibitor type I is a predictor of biochemical recurrence, and it enhances the accuracy of preoperative and postoperative nomograms. After external validation these nomograms may assist clinical decision making regarding treatment choice and followup as well as identification of patients at high risk for biochemical recurrence who may benefit from neoadjuvant and/or adjuvant treatment.
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The Journal of urology · Sep 2007
Randomized Controlled TrialSubcutaneous bupivacaine infiltration and postoperative pain perception after percutaneous nephrolithotomy.
Recent studies have shown a significant decrease in patient reported pain scores when the nephrostomy tube size is decreased from 22 to 10Fr. We hypothesize that patient reported pain and narcotic use could be further decreased for patients with post-percutaneous nephrolithotomy nephrostomy tubes if the incision is infiltrated with a local anesthetic. ⋯ In this preliminary pilot study no significant differences in patient reported pain scores were observed. However, a trend toward decreased postoperative narcotic use was seen in patients receiving subcutaneous Marcaine administration around the nephrostomy tube tract. Further studies are warranted to define additional measures to reduce discomfort in those requiring nephrostomy tube drainage following percutaneous nephrolithotomy.
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The Journal of urology · Aug 2007
Randomized Controlled Trial Comparative StudyEffect of intraprostatic local anesthesia during transrectal ultrasound guided prostate biopsy: comparison of 3 methods in a randomized, double-blind, placebo controlled trial.
We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy. ⋯ A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient. It decreases the level of pain and discomfort associated with the prostatic biopsy procedure.
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The Journal of urology · Aug 2007
Randomized Controlled TrialEarly initiation of aspirin after prostate and transurethral bladder surgeries is not associated with increased incidence of postoperative bleeding: a prospective, randomized trial.
Lower urinary tract operations are being increasingly performed in elderly patients, in whom aspirin intake is common for preventing cardiovascular disease. We determined the safety of early aspirin re-initiation after lower urinary tract surgeries. ⋯ Early aspirin initiation after lower urinary tract surgeries does not appear to carry an increased risk of postoperative bleeding. Thus, it may be considered in patients at high risk for cardiovascular morbidity.