European Urology Research Articles

Robot-assisted kidney transplantation: update from the European Robotic Urology Section (ERUS) series.

To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd) age was 45.2(13.35)years, the mean (sd) body mass index was 27.13(19.28)kg/m2 , and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd) total surgical and re-warming time was 244(70.5)min and 53.16(15.27)min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P>0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230min, P=0.005). This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.

Knowledge gap across continents: the andrology and male infertility exposure among urology residents in the United States and Europe.

It is well established that resident's exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents' self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents' perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.

Bibliometric Analysis of the Bladder Cancer Publications Between 1975-2018

Background: Bladder cancer is one of the major health problems studied over the years. Emerging technologies on follow-up and treatment of bladder cancer increased scientific literature worldwide. Despite this, there is limited data about the bibliometric analysis of bladder cancer. Materials and Methods: The bibliometric analysis of bladder cancer publications between 1975-2018 was performed by using the Thomson Reuters Web of Science database. The VOSviewer software tool was used for arranging and setting bibliometric networks.Results: The United States of America ranked first in this field with 7963 publications and 28.3% of the world generation, followed by the Peoples Republic of China and Germany. The University of Texas System is the leading institute in published documents with 1081 papers and 3.8% of the total literature. 15.9% of the papers were printed in The Journal of Urology with 4483 manuscripts, followed by European Urology (n=867, 3.0%) and Urology (n=810, 2.8%).Conclusions: There are relatively few articles on bibliometric analysis of urologic disorders and bladder cancer. Advanced evaluation parameters have to be defined for a more confident assessment of scientific work. Bibliometric analyses can guide young clinicians in investigating new studies.

The Increased Risk of Complicated Ureteral Stones in the Era of COVID-19 Pandemic.

Background: Ureteral stone disease may be an emergent condition if the appropriate management is not performed in a timely manner. As the coronavirus disease 2019 (COVID-19) continues to spread globally, isolation and restriction orders taken by the governments have become the cores to control the pandemic. In this study, we, therefore, aimed to investigate the ureteral stone presentations in a high-volume university hospital during the COVID-19 restriction order period. Materials and Methods: The data of 149 patients who were hospitalized due to ureteral stone both during the COVID-19 pandemic restriction period and the corresponding period (non-COVID-19) of the previous year were collected and analyzed retrospectively. Unpaired Student's t-test was used to compare continuous variables. The categorical data were assessed using Chi-square and Fisher's exact tests. Results: Of 149 patients, 35 were hospitalized in the COVID-19 restrictions period. While the mean age and the stone characteristics of the two groups did not differ significantly, serum creatinine levels (1.9 ± 1.85 vs 1.15 ± 0.64) and the white blood cell counts (12.45 ± 6.54 vs 8.21 ± 4.15) at hospital admission were significantly higher in the COVID-19 restrictions group (p = 0.034 and p = 0.005, respectively). According to the priority classification recommendations of the European Urology Guidelines Office Rapid Reaction Group for urolithiasis applicable during the COVID-19 pandemic, a significant difference was observed between the two periods (X2 = 9.907, p = 0.019). In particular, the rate of emergency cases was found more than threefold in the COVID-19 period. Although there was no significant difference in terms of the grade of hydronephrosis at hospital admission between the two groups, the rates of grade 3 and 4 hydronephrosis were higher in the COVID-period group (1.8- and 3.3-fold, respectively). Conclusion: The rate of complicated ureteral stone disease significantly increased during the COVID-19 restrictions period. Urologists should prioritize the patients most in need of urgent care during COVID-19-like biosocial crisis.

Researchers explore new prognostic, predictive tools for cancer: Easily attainable markers and measurements may help to better inform treatment decision making.

Researchers explore new prognostic, predictive tools for cancer: Easily attainable markers and measurements may help to better inform treatment decision making.

Comprehensive assessment of oncological outcomes in 186 patients with high‑risk non‑muscle‑invasive bladder cancer: A single institution retrospective study

The aims of the current study were to analyze the oncological outcomes of patients with high-risk non-invasive bladder cancer (NMIBC) and to identify prognostic factors in these patients. The present study included 186 consecutive patients who underwent transurethral resection of the bladder tumor (TURBT) between January 2007 and June 2017 at Hamamatsu University School of Medicine and were subsequently diagnosed with high-risk NMIBC according to the classification of the European Urological Association guidelines. The oncological outcomes, including recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS) in the 186 patients were evaluated. Additionally, the effects of several clinicopathologiocal parameters on these outcomes were investigated. After the initial TURBT, the second transurethral resection and intravesical bacillus of Calmette-Guerin (BCG) therapy were performed for 47 (25.3%) and 108 (58.1%) patients, respectively. During the observation period of the current study, disease recurrence, disease progression and overall deaths occurred in 54 (29.0%), 14 (7.5%) and 19 (10.2%) patients, respectively. The 5-year RFS, PFS and OS rates in the 186 patients were 66.6, 90.2 and 87.2%, respectively. Multivariate analyses using the Cox proportional hazards regression model identified the following independent factors for the oncological outcomes: Tumor multiplicity and introduction of BCG therapy for RFS (P=0.018 and P<0.008, respectively), tumor multiplicity and recurrence status for PFS (P=0.043 and P=0.029, respectively), and age and tumor multiplicity for OS (P<0.008 and P=0.041, respectively). Although management following initial TURBT was insufficient, the oncological outcomes in the present series were comparable to those in previous studies targeting high-risk patients with NMIBC. However, attention should be paid to patients with factors independently associated with poor prognostic outcomes, particularly those with multiple tumors.

PT202 - Evidence-based medicine perceptions, attitudes and skills among European urology residents

PT202 - Evidence-based medicine perceptions, attitudes and skills among European urology residents

PT203 - Annual educational expenses of European urology residents and the role of sponsorship in urology training

PT203 - Annual educational expenses of European urology residents and the role of sponsorship in urology training

A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association

To provide a clinical framework and key guideline statements to assist clinicians in the evidence-based management of Peyronie's disease (PD). We conducted a review of the published literature relevant to PD management, with an emphasis on published clinical guidelines. References used in the text have been assessed according to their level of evidence, and guideline recommendations have been graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence. The management of PD involves taking a detailed penile and sexual history, with a focused penile examination to identify plaque and hourglass deformity, and digital photographs of the erect curved (deformed) penis. Penile colour Duplex ultrasonography evaluates tunical plaque and underlying cavernosal smooth muscle and blood flow variables. The current therapy for PD can be divided into two main groups, namely, medical therapy and penile reconstructive surgery, and the patient should be counselled on the benefits and risks of each treatment option. Peyronie's disease remains a clinical challenge and presents a considerable therapeutic dilemma as the current therapy addresses existing penile curvature only and is not very effective in preventing future penile fibrosis and/or reversing underlying erectile dysfunction.

The Role of the Outstanding Professor Leopold Kasper in the Development of European Clinical Urology of the Second Half of the XIX and Early XX Centuries (to the 160th anniversary of his birth)

The development and scientific priorities of European urology of the second half of the XIX and early XX centuries are analyzed. The main dates of life and scientific and practical activity of Prof. Leopold Kasper are presented. The scientific views and thoughts of the scientist are noted. He specialized in urology under the leadership of G. Thompson, P. Freyer, F. Guyon, I. Albarran and L. Dittel after graduating from the University of Berlin in 1883. L. Kasper was the founder of a large German urological school. In addition, he is the author of many works, among which research on cystoscopy, endoscopic operations, functional diagnosis of kidneys diseases, treatment of renal tuberculosis and kidney stone disease, prostate diseases, transurethral galvanocaustics of bladder tumors, etc. are particularly distinguished. He constructed a special catheterization cystoscope (1895) through which for the first time it became possible to study the functional ability of each kidney individually, which greatly facilitated the recognition and treatment of surgical diseases of the kidneys and upper urinary tract. He improved and put into practice a functional renal test with floridzine and cryoscopic urine examination obtained from each kidney separately by catheterization of the ureters. It is noted that L. Kasper was one of the founders of the Society of German urologists, whose founding meeting was held in 1907 in Vienna. In the same year, L. Kasper, together with other prominent surgeons and urologists, founded the journal «Zeitschrift für Urologie», of which he was editor for decades. L. Kasper was an honorary member of nineteen scientific societies, including the Society of Moscow urologists, of which he was elected an honorary member in 1924.

MP53-11 COMPARATIVE EFFICACY OF LOCAL VERSUS SYSTEMIC SALVAGE THERAPIES FOR RADIO-RECURRENT PROSTATE CANCER: A SUB-ANALYSIS OF CCTG PR-7

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-11 COMPARATIVE EFFICACY OF LOCAL VERSUS SYSTEMIC SALVAGE THERAPIES FOR RADIO-RECURRENT PROSTATE CANCER: A SUB-ANALYSIS OF CCTG PR-7 Glenn Bauman, Keyue Ding, Joseph Chin*, Shiva Nair, Alessandra Iaboni, Juanita Crook, Laurence Klotz, David Dearnaley, Eric Horwitz, and Christopher O'Callaghan Glenn BaumanGlenn Bauman More articles by this author , Keyue DingKeyue Ding More articles by this author , Joseph Chin*Joseph Chin* More articles by this author , Shiva NairShiva Nair More articles by this author , Alessandra IaboniAlessandra Iaboni More articles by this author , Juanita CrookJuanita Crook More articles by this author , Laurence KlotzLaurence Klotz More articles by this author , David DearnaleyDavid Dearnaley More articles by this author , Eric HorwitzEric Horwitz More articles by this author , and Christopher O'CallaghanChristopher O'Callaghan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Optimal management of radio-recurrent prostate cancer remains to be defined. Androgen deprivation therapy (ADT) is widely used but may adversely affect quality of life and relegates those men with isolated local recurrence to an essentially palliative treatment. Local salvage carries a different side effect profile and potentially curative treatment intent however, no comparisons with salvage ADT exist. METHODS: We conducted a propensity matched analysis of two existing cohorts: an institutional series of whole gland cryotherapy (CRYO) and men enrolled on a multi-institutional prospective trial (NCT00003653) of ADT. [1,2] Our specific objectives were to compare time to castrate resistance, overall survival, and cancer specific survival between CRYO vs. ADT. RESULTS: There were 172 CRYO and 1119 ADT patients included in the matched analysis. Median follow-up time was 6.7 years [ADT] vs. 18.0 years [CRYO]. The median PFS was 7.0 years [ADT] vs. 10.7 years [CRYO]. On logistic regression for PFS the HR was 0.63 (95% CI 0.44, 0.89, p=0.009) favoring CRYO. The 10-year disease specific event rate was 18.5% [ADT] vs. 16.2% [CRYO], not statistically different (HR 0.69, 95% CI 0.36, 1.34, p=0.27). The median OS for the ADT cohort was 10.2 years [ADT] versus 12.3 years [CRYO].(Figure) On logistic regression for OS the HR was 0.620 (CI 0.415, 0.927, p=0.0199) favoring CRYO. A planned sub-analysis revealed no difference in these results when the CRYO patients were analyzed according to use of ADT prior to cryoablation (no CRYO patients received adjuvant ADT). CONCLUSIONS: Our results suggest that local salvage therapy with deferred ADT might be associated with improved outcomes compared to immediate salvage ADT alone. 1. N Engl J Med. 2012;367(10):895-903. 2. European Urology. 2011;60(3):405-10. Source of Funding: This analysis was funded by a Sanofi-CARO grant © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e786-e787 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn Bauman More articles by this author Keyue Ding More articles by this author Joseph Chin* More articles by this author Shiva Nair More articles by this author Alessandra Iaboni More articles by this author Juanita Crook More articles by this author Laurence Klotz More articles by this author David Dearnaley More articles by this author Eric Horwitz More articles by this author Christopher O'Callaghan More articles by this author Expand All Advertisement PDF downloadLoading ...

PD49-07 DOES REDUCED RENAL FUNCTION PREDISPOSE TO CANCER-SPECIFIC MORTALITY DUE TO RCC?

INTRODUCTION AND OBJECTIVE:A recent publication in European Urology reported an association between reduced renal function following nephrectomy and increased cancer-specific mortality (CSM) in kid...

MP74-16 VALIDATION OF THE EUROPEAN ASSOCIATION OF UROLOGY BIOCHEMICAL RECURRENCE RISK GROUPS AFTER RADICAL PROSTATECTOMY IN AN ASIAN COHORT AND SUGGESTIONS FOR REFINEMENT

INTRODUCTION AND OBJECTIVE:Recently, the novel European Urology Association (EAU) biochemical recurrence (BCR) risk grouping using prostate-specific antigen doubling time (PSADT) and pathologic Gle...

PD30-08 DOES FORCED IRRIGATION BUFFER HEAT GENERATED FROM HIGH-POWER LASER ACTIVATION DURING RETROGRADE INTRARENAL SURGERY

INTRODUCTION AND OBJECTIVE: To check the effect of forced irrigation on the maximal temperature (Tmax) generated in the pelvicalyceal system from high-power laser activation during retrograde intrarenal surgery (RIRS) METHODS: After approval from veterinary service, a 30 kg female-pig was used for this study. The pig was put in supine orientation for general anesthesia, cystoscopy, and insertion of two sensor guidewires in both ureteral orifices to the pelvicalyceal system under fluoroscopic guidance. Retrograde pyelography and a superstiff guidewires were inserted in each ureter using dual-lumen ureteral catheter. The position was then turned to prone and a percutaneous access was obtained to fix a K-type thermocouple connected to a laptop for real-time recording of temperature during laser activation. The laser fiber (200µm) was introduced through the flexible ureteroscope (Kar Storz, Germany) and activated in the center of the calyx for 20, 40 and 60 seconds under gravity irrigation while the bag at 1meter from the table and forced irritation using a standard pump (Ureteroscopy Irrigation System, COOK Medical, Cook Ireland Ltd., Limerick, Ireland) at a power of 40W and 60W from the Lumenis Pulse P120H holmium laser system. The Tmax was recorded with the use of flexible URS without UAS, UAS 10/12, UAS 12/14, and UAS 14/16. RESULTS: Under gravity irrigation: during FURS without UAS, the Tmax was 75°C and 80 °C at 40W, and 60W respectively; during FURS with UAS 10-12, the Tmax was 70 °C, 74 °C at 40W, and 60W respectively; during FURS with UAS 12-14, the Tmax was 61.5 °C and 80 °C at 40W and 60W respectively; during FURS with UAS 14-16, the Tmax was 70 °C and 74 °C at 40W, and 60W respectively (Table 1). Under forced irrigation: during FURS without UAS, the Tmax was 41°C and 42 °C at 40W, and 60W respectively; during FURS with UAS 10-12, the Tmax was 39.9 °C, 41.6 °C at 40W, and 60W respectively; during FURS with UAS 12-14, the Tmax was 36.7 °C and 44.3 °C at 40W and 60W respectively; during FURS with UAS 14-16, the Tmax was 37.2°C and 37°C at 40W, and 60W respectively (Table 1). CONCLUSIONS: Despite the high-power laser, the Tmax could be kept within limits with the use of forced irrigation. However, the effect of forced irrigation on the intra-renal pressure should be kept in mindSource of Funding: This study was partially funded by a one-year scholarship from the European Urological Scholarship Program (EUSP) to Dr. Yasser Noureldin

New patient-derived models of castrate-sensitive and castrate-resistant prostate cancer.

151 Background: There are fewer preclinical models of prostate cancer compared to other common tumours. New models that represent the diverse features of castrate-sensitive and castration-resistant prostate cancer (CRPC) are required for thorough preclinical testing of novel treatments. Therefore, the goal of the Melbourne Urological Research Alliance (MURAL) is to develop patient-derived xenografts (PDXs) spanning the clinical trajectory of prostate cancer. Methods: We grafted &gt;200 surgery, biopsy or rapid autopsy samples into testosterone-supplemented or castrated male NSG mice. Actively growing tumours were serially transplanted or grown as explants or organoids. PDXs were analysed using RNAseq, targeted genomic sequencing and histopathology review. Results: We previously reported 4 serially transplantable PDXs (Lawrence, et al., 2018, European Urology). Now we have established ~30 additional models spanning treatment naïve primary disease to CRPC. PDXs of CRPC were often from soft tissue metastases of patients who had failed docetaxel, cabazitaxel, enzalutamide, abiraterone and other contemporary treatments. Accordingly, they had diverse mechanisms of resistance, including AR mutations, genomic structural rearrangements, gene amplifications and expression of AR variants. In addition, several PDXs had AR-null phenotypes, including small cell prostate cancer. All PDXs closely reflected the genomic, transcriptomic and histopathological characteristics of the original patient tumours. As renewable sources of tissue, the PDXs could also be grown as ex vivo slice cultures and in vitro organoids, providing complementary models with different timescales and endpoints. Conclusions: We have developed a new collection of castrate-sensitive and castrate-resistant PDXs of prostate cancer, providing diverse tumours for preclinical testing of candidate treatments.

Endogenous testosterone mirrors prostate cancer aggressiveness: correlation between basal testosterone serum levels and prostate cancer European Urology Association clinical risk classes in a large cohort of Caucasian patients.

To evaluate the association between basal total testosterone (TT) levels with the European Association of Urology (EAU) risk classes at the time of diagnosis of prostate cancer (PCA). A retrospective review of prospectively collected data was carried out between November 2014 and March 2018. Preoperative basal TT levels and PSA were measured in 601 consecutive Caucasian patients who were not under androgen deprivation and undergoing surgery at a tertiary referral center. Patients were classified into low (reference group), intermediate- and high-risk/locally advanced classes. The multinomial logistic regression model evaluated associations of TT and other clinical factors with EAU risk classes. One hundred twenty four patients (24%) were low risk, 316 (52.6%) were intermediate, 199 (16.5%) were high risk and 42 (7%) were locally advanced. Median circulating basal TT levels increased along EAU classes. TT, PSA, percentage of biopsy-positive cores and tumor clinical stage were independently associated with the high-risk class (odds ratio, OR = 1.002; p = 0.030) but were not associated with intermediate-risk or locally advanced PCA when compared to the low-risk class. TT above the median value was an independent predictor of high-risk class PCA. Basal TT levels are positively associated with low, intermediate and high EAU risk classes. The association is significant for the high-risk class when compared to the low-risk group, but was lost in locally advanced risk class. In PCA patients, high TT serum levels are associated with high-risk disease. Endogenous TT should be considered as a biological marker for assessing EAU PCA risk classes.

Quality of Clinical Practice Guidelines for the Diagnosis and Treatment of Erectile Dysfunction: A Systematic Review

IntroductionClinical practice guidelines (CPGs) guide the diagnosis and treatment of erectile dysfunction using different methodologies. Nonetheless, the quality of published CPGs is unknown. AimTo evaluate the quality of CPGs for diagnosis and treatment of patients with erectile dysfunction. MethodsThe Medline, Embase, and LILACS databases were searched using structured strategies. The evidence was complemented by searches on websites of scientific societies and guideline developers. The CPG quality was assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. Main Outcome MeasureThe outcome measure included the quality of CPGs in accordance with the AGREE II instrument score. Results17 guidelines met the selection criteria. 15 had recommendations for diagnosis, 16, had recommendations for treatment, and 1 included a follow-up. Most of the guidelines were developed in Europe (35.3%) and North America (29.4%), 2 were prepared by specialized groups (11.7%), and 1 was funded by public resources. The most common development method was the panel of experts (9 guides, 52.9%). 5 guidelines were of high quality as per the methodological rigor, as follows: Cancer Care Ontario 2016 (76.5%), European Urology Association 2018 (65.6%), American Urological Association 2018 (62.5%), American College of Physicians (62.5%), and Japanese Society for Sexual Medicine (60.4%). There was a significant relationship (P = .043) between the methodological quality of the guidelines and the funding source. Clinical ImplicationsBy knowing the quality of the clinical practice guidelines, users can make more objective decisions about their use, which has an impact on patient care. Strength & LimitationsHigh-quality CPGs frequently used in health-care practice were identified. Solely CPGs in Spanish, English, and Portuguese were included, which generates selection bias in the results. ConclusionsThe number of CPGs for erectile dysfunction developed using international standards that meet the AGREE II quality criteria is low. Scientific societies have a strong interest in developing guidelines on this topic, whereas the participation of governmental organizations is limited.Sandoval-Salinas C, Saffon JP, Corredor HA. Quality of Clinical Practice Guidelines for the Diagnosis and Treatment of Erectile Dysfunction: A Systematic Review. J Sex Med 2020;17:678–687.

The top 100 most cited manuscripts in bladder cancer: A bibliometric analysis (review article).

Bladder cancer is one of the top 10 frequently occurring neoplasms worldwide and is responsible for over 150,000 deaths per annum. Bibliometric analysis helps further our knowledge of bladder cancer research, topics and trends. It is useful to identify the most influential articles and its impact pertinent to this field that has helped mould our understanding and management of bladder cancer. Search terms related to bladder cancer were compiled and used to interrogate the Thompson Reuters Web of Science indexing database. The 100 most cited manuscripts in the English language were identified and further evaluated by theme, manuscript type, journal, year of publication, author and institution. The Web of Science search returned a total of 47,381 manuscripts. The median number of citations among the top 100 was 515, ranging from 2257 to 352. The greatest number of manuscripts in the top 100 were published in the Journal of Urology (n=15), followed by the Journal of Clinical Oncology (n=14) and European Urology (n=13). The most cited paper (Stein et al. Journal of Clinical Oncology 2001, 2257 citations) reported on the long term outcomes from a large cohort of patients that underwent radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma. The most prevalent theme was the pathobiology of bladder cancer (n=37) followed by oncological treatment (n=17). The majority of manuscripts were of original research (n=79) mainly based on basic science study design and published from institutions in the USA. The pathobiology and oncological treatment of bladder cancer were the areas with most citations within the top 100. This bibliometric analysis has identified influential articles in the field on bladder cancer, which provides a useful guide to authors as to what type of article constitutes a highly citable publication in this subject.

Role of MRI in Staging of Penile Cancer

Penile cancer is one of the male-specific cancers. Accurate pretreatment staging is crucial due to a plethora of treatment options currently available. The 8th edition American Joint Committee on Cancer-Tumor Node and Metastasis (AJCC-TNM) revised the staging for penile cancers, with invasion of corpora cavernosa upstaged from T2 to T3 and invasion of urethra downstaged from T3 to being not separately relevant. With this revision, MRI is more relevant in local staging because MRI is accurate in identifying invasion of corpora cavernosa, while the accuracy is lower for detection of urethral involvement. The recent European Urology Association (EAU) guidelines recommend MRI to exclude invasion of the corpora cavernosa, especially if penis preservation is planned. Identification of satellite lesions and measurement of residual-penile-length help in surgical planning. When nonsurgical treatment modalities of the primary tumor are being considered, accurate local staging helps in decision-making regarding upfront inguinal lymph node dissection as against surveillance. MRI helps in detection and extent of inguinal and pelvic lymphadenopathy and is superior to clinical palpation, which continues to be the current approach recommended by National Comprehensive Cancer Network (NCCN) treatment guidelines. MRI helps the detection of "bulky" lymph nodes that warrant neoadjuvant chemotherapy and potentially identify extranodal extension. However, tumor involvement in small lymph nodes and differentiation of reactive vs. malignant lymphadenopathy in large lymph nodes continue to be challenging and the utilization of alternative contrast agents (superparamagnetic iron oxide), positron emission tomography (PET)-MRI along with texture analysis is promising. In locally recurrent tumors, MRI is invaluable in identification of deep invasion, which forms the basis of treatment. Multiparametric MRI, especially diffusion-weighted-imaging, may allow for quantitative noninvasive assessment of tumor grade and histologic subtyping to avoid biopsy undersampling. Further research is required for incorporation of MRI with deep learning and artificial intelligence algorithms for effective staging in penile cancer. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:1612-1629.

Low Methodological Quality of Systematic Reviews Published in the Urological Literature (2016-2018)

ObjectiveTo investigate the methodological quality of systematic reviews (SRs) published in the urological literature. MethodsPubMed was systematically searched for SRs related to questions of prevention and therapy published in 5 major urology journals (January, 2016 to December, 2018). Two reviewers followed a written a priori protocol to independently screen references in Rayyan and abstract data using a piloted form based on the 16 domains of AMSTAR-2. We performed preplanned statistical hypothesis testing by journal of publication in SPSS version 24.0. ResultsOur search identified 260 relevant references, 144 of which ultimately met inclusion criteria. The largest contributors by journal of publication were European Urology (53; 36.8%) followed by Urology (36; 25.0%), and BJU International (24; 16.6%). The most common clinical topics were oncology (64; 44.4%) and voiding dysfunction (32; 22.2%) followed by stones/endourology (14; 9.7%). Just over one-third (52; 36.2%) of reviews had a registered protocol. Nearly all studies (139; 96.5%) searched at least 2 databases. Less than one-third (46; 31.9%) also searched trial registries and one-fifth (30; 20.8%) consulted experts for additional trials. Few studies (14; 10.4%) provided a list of potentially relevant but excluded studies. Only 6 (4.2%) studies met all AMSTAR-2 critical domains as a prerequisite for high-quality reviews. ConclusionA large number of SRs are published in the urological literature each year, yet their quality is suboptimal. There is a need for educating authors, peer reviewers, and editors alike on established standards for high-quality SRs to ensure improvement in the future.