Muscle-invasive and Metastatic Bladder Cancer
For all Sections, the literature has been assessed and the guideline updated whenever relevant information was available. Of note are changes in sections:
Chapter 2 "Epidemiology and risk factors";
Sections 2.2.5 (Bladder Schistosomiasis) and 2.2.6 (Chronic urinary tract infection) have been updated.
Chapter 3 "Classification";
Section 3.3.2 (Pathologist' handling of specimens); has been expanded.
Chapter 4 "Diagnosis and staging";
Section 4.2.1.1 (MR imaging for local staging of invasive bladder cancer); literature was revisited, resulting in amended recommendations.
Chapter 8 "Non resectable tumours";
A new section 8.3 on Supportive care has been included.
Chapter 10 "Bladder-sparing treatments for localised disease"
Additional supportive evidence for TURB for selected patients has been added.
Additional supportive evidence for EBRT monotherapy in highly selected patients
The multimodality bladder-preserving (10.4) treatment section has been expanded; potential benefit will depend on low stage and complete TUR as important prognostic factors.
Chapter 12 "Metastatic disease";
Section 12.9 (Treatment of bone metastases - bisphosphonates); new literature has been added, resulting in amended recommendations.
The available new evidence on quality-of-life (Chapter 13) has been added.
Chapter 14 "Follow up";
Additional data included on recurrences and secondary urethral tumours. Also a new follow-up table has been added.
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Prostate Cancer
Revised topics
Chapter 6 "Diagnosis";
All literature has been revisited, new data has been added;
Most notably in sections 6.2.3 (PCA3 marker), 6.4.8 (Antibiotics prior to biopsy), 6.4.11 (Complications), 6.5 (Pathology of prostate needle biopsies) and 6.6.2.3 (Definition of extraprostatic extension).
In section 6.4.8 (Antibiotics prior to biopsy), the quinolones resistance related to infectious complications after biopsy.
Chapter 8 "Watchful waiting/active surveillance";
Additional data on the impact of radical prostatectomy compared to watchful waiting (WW) has been added.
Data have been added supporting that comorbidity status is the leading cause of death at ten years, especially for Charlson score = 2, irrespective of age, even for those with an aggressive tumour.
Active surveillance as appropriate for highly selected, low risk patients only. Early re-biopsy plays as an increasingly important role in the patient’s selection process.
In general, repeat biopsies are a major tool for patient follow-up.
Chapter 9 "Treatment: Radical prostatectomy";
Additional data have been included in section 9.1 (Introduction) on robot-assisted laparoscopic prostatectomy (RALP)
Added emphasis is given to the need for a multidisciplinary approach in the treatment of high-risk localised disease Section 9.4 (High-risk localised PCa).
Chapter 10 "Treatment: Definitive radiation therapy";
Additional data has been added on the various hormonal therapy options, section 10.8 (Locally advanced PCa: T3-4, N0M0).
Chapter 11 "Experimental local treatment of prostate cancer";
Additional data has been added on oncological outcomes and treatment-associated complications (Section 11.3 -HIFU of the prostate).
Additional data on salvage radical prostatectomy versus CSAP has been included (Section 16.6.2 - Salvage cryosurgical ablation of the prostate for radiation failures).
A new section has been added on salvage high-intensity focused ultrasound (HIFU).
Chapter 12 "Hormonal treatment";
Data from the largest randomised controlled trial on PCa patients relapsing after radiotherapy has been incorporated, showing that intermittent androgen-deprivation therapy (ADT) proved to be as effective as continuous ADT.
Additional data regarding bone protection and the potential role of denosumab in delaying secondary bone metastases. However, denosumab does not impact overall survival or cancer-specific survival.
Further data on androgen deprivation therapy (ADT) was included. ADT is associated with increased cardiac morbidity, not an increase in cardiac mortality. The presence of a congestive heart failure or myocardial infarction increases the mortality risk.
Chapter 15 "Follow up after hormonal treatment";
The literature has been revisited. The importance of bone- and testosterone monitoring is reinforced.
Chapter 16 "Treatment of biochemical failure after treatment with curative intent"
In section 16.4 (Evaluation of PSA progression), additional data has been added on the role of choline PET/CT in the diagnosis of men with rising PSA following radical prostatectomy.
Chapter 17 "Castration resistant prostate cancer";
For section 17.4 (Recommendations for assessing therapeutic response), new literature has been incorporated and recommendations have changed;
17.8.5.2 (Abiraterone acetate), new information has been added;
17.9.10 (Specific bone targets), information from the ENTHUSE study has been included.
New topics
Quality of life of patients with localised prostate cancer
Chapter 16, A section has been added on salvage high-intensity focused ultrasound (HIFU)
Chapter 17, Section 17.10.4 RANK ligand inhibitors
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Management of Male LUTS, incl. benign prostatic obstruction
Updated literature search
New chapter on "Assessment"
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Penile Curvature
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Male Infertility
Literature has been assessed for all sections and updated if relevant.
New chapter on Methodology
4.4.4.2 "Y chromosome: 'gr/gr' deletion" added
6.4 "Basic considerations" for varicocele updated
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Male Hypogonadism
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Urinary Incontinence
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Urolithiasis
New literature included
Chapter 2 "Classification of Stones";
2.3 X-ray characteristics
2.6 Risk groups for stone formation (Table 6)
Chapter 5 "Stone Relief";
5.3.4 Factors affecting success of MET
5.5.3 Best clinical practice
5.6.1.5.4 Puncture
5.6.1.5.7 Management of complications following PNL (new Table 14)
5.6.2.2.1 Pre-operative work up and preparations
5.6.2.2.6 Stone extraction new data added
5.6.2.2.8 Stenting prior to, and after URS
5.7.2 Laparoscopic surgery
Chapter 6 "Indication for Active Stone Removal and Selection of Procedure";
6.4 Selection of procedure for active removal of kidney stones
New literature resulting in a change of LE in the recommendation sections
Chapter 3 "Diagnosis";
3.1 Diagnostic imaging: Patient evaluation (3.1.2) for patients in whom treatment of renal stones is planned (NCCT recommended in favour of IVU)
3.2 Recommendations for repeat stone analysis in patients: (LE:2 - old listing LE:3)
Chapter 5 "Stone Relief";
5.7.2.1 Indications for laparoscopic stone surgery - recommendations (LE: 3 - old listing LE: 4)
New literature has been including in the following sections resulting in new recommendations or a change in ranking (GR)
Chapter 5 "Stone Relief";
5.7.2.1 Indications for laparoscopic stone surgery - New recommendation on large impact stones or when endoscopic lithotripsy or SWL have failed.
Chapter 6 "Indication for Active Stone Removal and Selection of Procedure";
6.4.2 Selection of procedure for active removal of kidney stones
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Paediatric Urology
This is the latest version of the Guidelines on Paediatric Urology. The printed guideline states an incorrect maximum dose of botulinum toxin in neurogenic bladder in children (Section 13.5.3.1 Botulinum toxin injections). The correct maximum dose of botulinum toxin in neurogenic bladder in children is 200 units.
Amended topics (new literature included and text revision)
Chapter 6 "Hypospadias"
Chapter 12 "Monosymptomatic enuresis"
Chapter 13 "Management of Neurogenic Bladder in Children";
13.5.3.1 Botulinum toxin injections
13.5.11 Lifelong follow-up of neurogenic bladder patients<
Chapter 15 "Vesicoureteric Reflux"
Section 16.5.3 Ureterorenoscopy
Chapter 17 "Obstructive pathology of renal duplication: ureterocele and ectopic ureter"
New topics
Chapter 10 "Urinary tract infections in children"
Chapter 20 "Post-operative fluid management in children"
Chapter 21 "Post-operative pain management in children"
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Pain Management
The current 2012 edition contains partial updates based on the available literature and two new topics were added, Section 3.4 "Denusomab" and Section 3.5 "Palliative care".
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Chronic Pelvic Pain
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Reporting Complications
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Non-Muscle Invasive (TaT1 and CIS) Bladder Cancer
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Upper Urinary Tract Urothelial Cell Carcinoma
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Muscle Invasive and Metastatic Bladder Cancer
Updated:
- Chapter 1 Introduction
- Chapter 2 Epidemiology and risk factors
- Chapter 6 Neoadjuvant chemotherapy
- Chapter 7 Radical surgery and urinary diversion
- Chapter 12 Metastatic disease
- Chapter 13 Quality of Life
New additions
- Chapter 10 (10.4 Multimodality bladder preserving strategies)
- Chapter 7 and 12: treatment algorithms
Smaller changes have been made throughout the document.
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Prostate Cancer
Updated:
- Unification of all data and tables with the new pocket version. In particular Tables 5 and 6
- Section 7.4 (Guidelines for the diagnosis and staging of PCa)
- Chapter 13 (Guidelines for primary treatment)
- Section 16.7 (Second-line therapy after treatment with curative intent)
- Chapter 17 (Castration-refractory PCa) sections 17.11-17.12 & 17.3
The existing text was revisited.
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Testicular Cancer
- The entire text was revisited and changes have been made throughout but in particular in the treatment of CS1
- Chapter 7 (Treatment of metastatic germ cell tumours)
- Chapter 8 (Follow-up)
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Non-neurogenic Male LUTS
Added:
- Chapter 4 (Surgical treatment)
The existing text was revisited
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Urological Infections
New sections:
- Chapter 2 (Classification of UTIs + tables)
- Chapter 13 (Fournier's gangrene)
Updated:
- Chapter 4 (Complicated UTIs due to urological disorders)
- Chapter 5 (Urosepsis)
- Chapter 11 (Epididymitis and orchitis, in particular section 11.1)
Smaller changes have been made throughout the document.
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Neurogenic Lower urinary Tract Dysfunction
Updated:
- Chapter 1 (Introduction)
- Chapter 2 (Risk factors and epidemiology)
- Section 4.2.3 (Drug treatment)
- Chapter 8 (Quality of Life)
Replaced:
New additions:
- Chapter 6 (UTI in NLUTD)
- Chapter 7 (Sexual (dys)function and Fertility)
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Urolithiasis
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Paediatric Urology
Replaced:
- Chapter 3 (Cryptorchidism)
- Chapter 14 (VUR)
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Lasers and Technologies
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