Archive for category: BJUI Blog

“The most read surgical journal on the web”

It is an enormous privilege becoming the new Editor-in-Chief of the BJUI. As an academic it has been my ultimate dream. Thank you for this exciting opportunity to serve our readers and authors. I also wanted to express my gratitude to our editorial board and reviewers without whom this journal would not exist.

Early one morning during the BAUS annual meeting 2012, I had the great pleasure of having breakfast with John Fitzpatrick. He has done wonders with the BJUI and I wish to thank and congratulate him for his excellent leadership, international collaboration and innovative approach, which has established the journal as a global landmark in urology. I asked him to describe his most important contribution to the BJUI in one word. The answer without hesitation was ‘colour’.

John immediately asked me the same question. With equal conviction I uttered the words that would describe the BJUI in the next 5 years –’the web’.

The other day I made my usual trip to the Guy’s Hospital, King’s College London, library. I love reading the new journals as well as archived copies that are stored on the first floor. I have done so regularly for the last 10 years. On this occasion I requested our friendly librarian to guide me towards the new editions of Science and the N Engl J Med. Rather to my astonishment, she said that the first floor had been shut and there were no paper journals there anymore! Instead she directed me to a computer terminal where I could browse every scientific journal with my college user name and password. It was then that I realised that my own library had stopped subscribing to paper journals. I have since learned that many other libraries have done the same. Libraries and not urologists are the largest subscribers of the BJUI. If they do not want paper journals they are just not going to buy them.

Welcome to the green revolution.

Over the next few years it will be my mission to make the BJUI the most read surgical journal on the web. We have not made the mistake of assuming that this is what all our readers want. Therefore, while we make the transition to the web, the paper version continues, but with a few differences. We will be reducing the number of paper issues to once a month. Our readers have told us that as soon as the first edition comes out of its plastic cover, the next one arrives. This is often rather overwhelming for a busy urologist who may find it challenging to find the important messages. A direct result of reducing the number of volumes is that fewer papers will ultimately be published and the acceptance rate will fall to ~15%. A triage system has been introduced whereby papers that are not felt to be suitable for the new journal are returned immediately to the authors. This is not a reflection of the quality of the papers but reduces wastage of valuable time and allows the articles to be submitted elsewhere without delay.

The BJUI website www.bjui.org has been entirely redesigned and, in keeping with our main mission statement, I have gathered a dedicated new team of enthusiastic innovators. You will notice that unlike other journals we have Associate Editors for innovation, impact, web, social media and design. These are young urologists with unique skills allowing us to deliver the BJUI on an exciting web-based platform that will evolve continuously. I hope you can join us on this journey.

The busy modern surgeon has a short attention span. If we cannot attract them to our key messages within 30 seconds of reaching our landing page, it is unlikely that they will stay there for 3 minutes rather than go elsewhere. Extensive studies and searches on web-based metrics have made these facts obvious to me. These are the realities of modern academic publishing. The web-based journal will have a much wider readership, not just amongst urologists but also other doctors, nurses, students and most importantly patients and their families.

With this in mind we have introduced the ‘article of the week’, almost like the headline news of The Times. If most urologists read just this on their iPads or smart phones, rather than ever even look at the paper version, we have successfully made our point. This month one such article is the updated Partin tables. As a predictive tool, they are important to urologists and patients alike and will allow our readers to counsel patients about the potential outcomes after treatment of their prostate cancer.

Another new feature is the BJUI blog for immediacy, HuffPost style; the days of writing a letter to the editor that gets published a year later are no more. Instead, your opinions will be moderated and appear real time on the website. The debate will be timely, educational and enjoyable.

Social media, especially Twitter, will play an important role in highlighting the most important content and allowing rapid interaction during international meetings. We have engaged the services of a group specialising in social media and I urge you to follow the BJUI on Facebook and Twitter. Who knows ‘tweetations’ might become as important as the impact factor, one day soon.

Finally, I wanted to especially thank Francesco Montorsi for inspiring me during dinner one autumn evening in Milan, where I had been invited to review a European Union grant application. The lesson I learnt from him was humility. As the Editor-in-Chief I always remember an important tale published by Hans Christian Andersen in 1837. ‘The Emperor’s New Clothes’ describes what happens when a vain king is paraded by two rogue weavers in his invisible new clothes through the streets of his own capital. I hope I will always manage to avoid the ‘emperor syndrome’. My job is to serve our readers and focus above all on the one thing that is of utmost importance to the BJUI – quality.

Prokar Dasgupta

Twitter: my #eurekamoment #pennydrops #babyvomit

I remember distinctly when the penny dropped for me. It was about 2am on a warm summer’s night in early January 2012 (apologies to those of you shivering in the Northern Hemisphere). I had my one-week old son in one arm, swinging between sleeping and spewing, and an iPad in my other hand, providing distraction between nappy changes and feeds. The sleep-deprivation had dulled my senses considerably and my brain was capable of no more than light reading.

It was then I read a piece in the New York Times online about the power of Twitter in medical communication. Previously, I thought Twitter was the domain of Lady Gaga, Justin Bieber, Kim Kardashian (Kim who?) and various narcissistic cricket and football players. It seemed like puerile nonsense for a generation that I no longer belonged to. However, reading this opinion piece made me think again. It was clear that there is a whole generation of significant academic clinicians, researchers and publishers who have embraced social media and who use Twitter, in particular, to disseminate their work with a speed and reach that is simply unachievable through any other medium. I was struck by various examples of how key scientific publications are first flagged on Twitter and how within hours, responses are made by key opinion leaders and these responses are again disseminated rapidly around the Twittersphere. And although none of the examples were based around urology, it was clear to me that oncologists and surgeons were getting on board the social media rollercoaster.

So between nappy changes and having wiped some baby vomit off my iPad, I logged onto Twitter and created a username. I searched for prostate cancer and urology and quickly found my way to a few key resources and super-users who seemed to have a very active Twitter presence and who were tweeting content that immediately appeared of interest to me. Within a few minutes I had identified a few highly valuable Twitter users to follow and within their lists of followers and those who they were following, I quickly built up a useful stream of tweets dropping into my timeline. And then of course, a few of these Twitterers started following me back, which was mildly exciting. Within a few days and having posted a few tweaks, I began to feel part of the Twittersphere.

As the weeks went by, I continued to be astounded by just how fast information travels on Twitter. While I get emails with the table of contents for the various journals that I subscribe to, these only drop in my inbox every few weeks. Also, because there are a number of significant journals that I do not subscribe to (non-urological mostly), there are many papers published out there that do not come immediately to my attention. Depending on which Twitter sites you follow, all key papers related to your area of interest find their way into your timeline instantaneously as soon as they are published. Not just that, very interesting comment from others also gets to you very quickly. For example, key findings in prostate cancer tend to be picked up by the major US news sites who then invite comment from key leaders in major cancer centres. A typical example is that of the PSA screening recommendations made by the United States Preventive Services Taskforce in June 2012, which provoked huge controversy. Twitter came to life and key opinion leaders such as Matt Cooperberg (@cooperberg_ucsf) helped drive the conversation through Twitter and blogs (e.g.The Huffington Post blog) at lightning speed. These comments get tweeted out and responses to these comments also get blogged and within hours of a paper being published you have news of the paper, expert comment and wider reaction…… all in 140 characters or less!

And while none of us have much time in the day to add an extra task, I find that waiting for my coffee in the morning or while the resident puts an arterial line in my next patient, there are a few spare moments in the day where the Twitter app on my iPhone comes to life. Twitter is perfectly suited to the smart phone user and that is where the majority of tweets around the world are generated from. It is also perfectly suited for one of the other very exciting areas in which I have seen Twitter play a very useful role – that of conferencing. At the EAU in Paris, a small but energetic group of Twitter users started tweeting content from various sessions at this large meeting and started engaging with other Twitter users around the world. For me, I believe conferencing is about to be transformed by the power of social media but more about that soon.

For now, at the new BJUI, we want to grow the audience and get you all to join the conversation. Through Twitter, blogging, Facebook, YouTube and other social media platforms, we are building for the future of communication in urology. The next generation of trainees will be deeply embedded in all of these platforms and will expect to be engaged through them. We are entering a new generation of medical communication – come join the conversation.

Declan Murphy
@declangmurphy

 

Declan Murphy is Honorary Clinical Associate Professor at the Department of Surgery, University of Melbourne, St Vincent’s Hospital and Director of Robotic Surgery at the Peter MacCallum Cancer Centre. He had previously been consultant urological surgeon at Guys & St Thomas’ NHS Foundation Trust in London.

 

Comments on this blog are now closed.

Ten stories of 2012, part I

It is now my turn to welcome you to the BJUI blog. We [the editorial team] hope that you will be as excited as we are about the future. For my first blog posts, I decided to recap the year 2012 in ten stories. These are topics that caught my attention in 2012, and are certainly not representative of what others might think as ‘important’. Nonetheless, I hope that you will find this curated collection of some interest, and maybe stir a little controversy or two. Happy 2013!

In no particular order, part 1 of 2:

+ The re-election of Barack Obama

The bottom line is that the Patient Protection and Affordable Care Act, AKA Obamacare, will happen. What does this mean for American Urologists? Read the excellent review article by Kirk Keagan and Dave Penson on this sweeping piece of legislation aimed at addressing health care costs and disparities. From the paper: “Perhaps most germane to urologists, the ACA will restrain revenues generated from ancillary services, such as in-office imaging and via a bolstered Stark law that will prohibit physicians from referring Medicare patients to a hospital in which they have an investment or ownership interest.” Word on the street is that the AUA is not too happy. Is America ready for Cheesecake medicine?

+ Is robot-assisted radical prostatectomy really better?

Against a background of Jim Hu’s landmark JAMA paper, we learned new things with respect to the robot-assisted (RARP) vs. open RP (ORP) polemic. First, objective data shows that RARP has overtaken ORP as the main surgical approach for prostate cancer in the U.S (Link)(Link). Second, perioperative outcomes of RARP are better (Link)(Link)(Link). Third, RARP costs more. Fourth, nobody knows for functional outcomes (Link)(Link)(Link). Either way, some people really seem to hate robotic surgery, with a vengeance.

+ PSA screening – the controversy that refuses to die…

2012 will be forever (well, at least for nerdy urologists) remembered as the year the USPSTF downgraded PSA screening to a ‘D’ recommendation. In case you live in a cave, that means that “the science shows that more men will be harmed by PSA screening than will benefit. The expected harms are greater than the small potential benefit.” Nice rebuttal by Carlsson et al from MSKCC here. Nonetheless, primary care providers don’t seem to care, as up to 43.9% of men above the age of 74 were still getting screened in 2010. Conversely, in an article emphatically subtitled ‘Less is More’, the evidence shows that the incidence of prostate cancer is, for the first time in decades, decreasing. Prostatectomists, better find something else to do (just trolling, no hate mail please).

+ PSA screening – the Twitter Wars

2012 was a breakthrough year for social media in Urology. In the past year, Twitter has gained considerable traction in our field, thanks to the presence of Tweet (and real world) leaders such as Matt Cooperberg, Tony Finelli, Alex Kutikov, Mike Leveridge, Stacy Loeb, our own Declan Murphy, Dave Penson, Maxine Sun and the self-proclaimed King of Twitter himself, Ben Davies. That said, December hosted some lively exchanges on PSA screening. It started with a nicely-written-yet-a-little-oversimplistic blog post and accompanying tweet by @CBayneMD in favour of PSA screening, which led to some epic jostling between @cooperberg_ucsf (pro-screening) and @kennylinafp (against screening, wrote the evidence review for the USPSTF), amongst others. @daviesbj summary here. Oh yeah, be sure to follow me on Twitter as well as the BJUI itself.

+ The PIVOT trial

Timothy Wilt, of USPSTF fame, strikes again. Here’s one man who won’t be getting a Christmas card from an Urologist anytime soon. After representing the USPSTF at the 2012 AUA Town Hall  Meeting (brave), Wilt et al’s PIVOT trial demonstrated that “among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.” Despite its many limitations and flaws (read Ian Thompson’s excellent accompanying editorial here), the lay press suggested in light of this trial that RP does not save lives.

Quoc-Dien Trinh
@qdtrinh

 

Quoc-Dien Trinh is a minimally-invasive urologist and co-director of the Cancer Prognostics and Health Outcomes Unit. His research focuses on patterns of care, costs and outcomes in prostate cancer treatment.

 

Comments on this blog are now closed.

 

 

Editorial: What have we learned from the Partin table update?

The controversies surrounding a physician’s best treatment strategy advice to an individual patient with clinically localized prostate cancer create a continuing need for advanced statistics. Historically, the Partin tables [1] were one of the first statistical tools that physicians and patients found readily usable. The tables have been updated and always focused on prediction of pathologic stage from standard clinical variables. The next commonly cited/used tool was the Kattan nomogram [2] that carried the prediction the next step to the endpoint of biochemical relapse. By 2008, Shariat et al catalogued over 100 predictive tools published from 1966 to 2007 on various endpoints of prostate cancer [3].

 

 

 

What have we learned from this update of the Partin tables?

  1. The pre-operative grade distribution has shifted up slightly with no change in prostatectomy grade/stage distribution. The authors discuss possible causes such as changes in interpreting the Gleason scoring system, shifts in selection for surgery away from lower grade patients, and a possible plateau in stage migration.
  2. The tables have split off Gleason 3+4, 4+3, 8, and 9–10, and found the latter significantly more aggressive, while Gleason 4+3 and 4+4 are more similar. Gleason 9–10 must have a pattern 5 component >5% and may therefore have more aggressive biology. On the other hand, two cases of prostate cancer may have identical volumes of 4 pattern, but if one adds additional 3 pattern, that additional tumour foci paradoxically lowers the sum to 7, but perhaps not the risk of non-organ confined stage.
  3. In the past, the tables were commonly used to predict pT3 stage, with possible change in management away from surgery as that risk increased. Clearly the literature on surgery for higher risk disease has matured, and augmented by the adjuvant/salvage radiation literature such that it is less likely to use the tables for this reason any more. On the other hand, prediction of N1 disease for the purpose of omitting a lymph node dissection remains a useful tool. In this update, using a <2% cut-off you would essentially omit all node dissections in Gleason 6 with PSA < 10 and cT1c/cT2a, while continuing with a dissection for any dominant Gleason 4 pattern. It is noteworthy that this experience was largely based upon standard templates, and those advocating extended templates will find these N1 rates too low. Indeed, when our center adopted the extended template using a robotic technique, the N1 rate for high-risk disease was 39% and 9% for intermediate risk [4]. Moving forward, what tools do we need to provide useful statistics to our patients? Updating old tools with more contemporary patient cohorts is certainly a worthy exercise. Multicentre study based tools will be required for endpoints such as positive surgical margins, quality of life, biochemical recurrence, and other endpoints that may be significantly affected by the experience of the treating physician. Beyond this, the next step should be adaptive nomograms that update in real time rather than en masse every 4–5 years [5].

John W. Davis
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

References
1 Eifler JB, Feng Z, Lin BM et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 2013; 111: 26–33
2 Kattan MW, Eastham JA, Stapleton AM et al. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 1998; 90: 766–71
3 Shariat SF, Karakiewicz PI, Roehborn CG, Kattan MW. An updated catalog of prostate cancer predictive tools. Cancer 2008; 113: 3075–99
4 Davis JW, Shah JB, Achim M. Robot-assisted extended pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP): a video-based illustration of technique, results, and unmet patient selection needs. BJUI 2011; 108: 993–8
5 Vickers AJ, Fearn P, Scardino PT et al. Why can’t nomograms be more like Neflix? Urology 2010; 75: 511–3

Read the full article

Editorial Commentary: Rising to the Challenge

BJUI Editorial Commentary: Rising to the Challenge.
Roger S. Kirby and John M. Fitzpatrick

Before 1995 there were effectively no charities in the UK the aim of which was to support research, education and training in urology. As a consequence, around that time, four charitable organisations sprung up and have since gone on to flourish; now, together, they raise >£20 million per year.

Kirby RS, Fitzpatrick JM. Rising to the challenge. BJU Int 2012, Vol 110, Issue 11.

Read the full article
© 2022 BJU International. All Rights Reserved.