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Quality has no boundaries

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The new year has arrived bringing with it new expectations of success. It gives us the opportunity to reflect on 2013 and plan for the year ahead. We hope you enjoyed the new web journal www.bjui.org that we have introduced. It has certainly increased our full paper downloads each month which means that our readers do care. Thank you! Your loyalty makes the many hours of hard work – 24/7 – all worthwhile. We have an international team which allows someone, somewhere to be making constant improvements to the BJUI for your reading pleasure.

Many of our readers while congratulating us, commented that perhaps we had focussed on being of greater relevance to the younger generation. Imagine my surprise when at a recent Men’s Health meeting in London, my old chief came up to me for a discussion about the controversies of PSA testing following publication of the AUA guidelines [1] and a consensus statement from down under on blogs@BJUI [2]. He had read it all on the web much earlier than when these articles eventually make it to the print journal. Like him, many of our readers see and read an article or blog online but do not necessarily comment on it. As a new metric, we will start indicating the number of times an article is read in addition to the number of comments it receives.

At the BJUI we do not make New Years resolutions. It is much easier to act. During our editorial board meeting last October it became obvious that we were receiving high quality papers from all over the world. In this issue, we have the great pleasure of showcasing a superb article on circumcision from Uganda [3]. Men with or without HIV, which is highly prevalent in Africa, tend to heal well after circumcision. This does not appear to be affected by their CD4 counts. This is a large study, relevant to all urologists and I would urge you to read it and the accompanying editorial from Paul Hegarty [4].

This article also gave us the idea of highlighting the geographical location of the article of the month on the front cover. Another inspirational concept from Tet Yap our associate editor for design. More about that in coming editions.

Finally Maxine Sun is back with a SEER study showing that the extent of lymphadenectomy during radical nephrectomy in patients with nodal metastasis, does not affect survival. Like any database, missing entries may have confounded the results and it is critical from a scientific standpoint to understand the resultant bias [5]. For those wishing to learn health services research a good starting point is to read the Sun Blog on SEER at our web journal.

Here’s looking forward to interacting with you in 2014.

Prokar Dasgupta
Editor in Chief, BJUI

Guy’s Hospital, King’s Health Partners

References

  1. Ballentine Carter H. American Urological Association (AUA) Guideline on prostate cancer detection: process and rationale. BJU Int 2013; 112: 543–547
  2. Murphy D. The Melbourne Consensus Statement on Prostate Cancer Testing. blogs@BJUI. Available at: https://www.bjuinternational.com/bjui-blog/the-melbourne-consensus-statement-on-prostate-cancer-testing/. Accessed 20 November 2013
  3. Kigozi G, Musoke R, Kighoma N et al. Male circumcision wound healing in HIV-negative and HIV-positive men in Rakai, Uganda. BJU Int 2014; 113: 127–132
  4. Hegarty P. Circumcision – follow up or not? BJU Int 2014; 113: 2
  5. Sun M, Trinh Q-D, Bianchi M et al. Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data. BJU Int 2014; 113: 36–42

Original publication of this editorial can be found at: BJU Int 2014; 113: 1. doi: 10.1111/bju.12575

Beyond our wildest dreams

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In this podcast Prokar Dasgupta summarises the success of the BJUI over 2013. For more on podcasts, including how to record your own, go to Podcasts Made Simple.

 

If anyone had suggested to me in January 2013 that our full article downloads would increase by 15% and the Melbourne Consensus Statement on PSA testing would be viewed over 5000 times @ BJUI.org, I would have stared at them in disbelief. The launch of our web portal in addition to an innovative paper journal, has achieved just that. And much more. We remain one of the Big Three in urology with a Klout score greater than any of our colleagues. These are impossible to achieve via papyrus alone.

The common theme amongst all the fantastic innovation that our Associate Editors have introduced is the highest quality of original articles that we have attracted and published this year. I wanted to take this opportunity to highlight them and thank all our authors for sending us their best manuscripts.

The updated Partin tables (2006–11) remains our most cited paper published in 2013 [1]. It is sheer coincidence that I selected it as our first article of the month in January. It has allowed surgeons to avoid lymphadenectomy during radical prostatectomy in non-palpable Gleason 3+4 disease as the risk of a positive lymph node is <2%. The accompanying 3 minute video on the BJUI Tube channel is an excellent summary for the busy urologist.

I had to appease a number of oncologists when Cooperberg and colleagues showed that radiation for prostate cancer was about 2.5 times more expensive than radical prostatectomy in a comprehensive lifetime cost-utility analysis [2]. Peace was rapidly established at the annual meeting of the British Uro-Oncology group (BUG) where I participated in a balloon debate on the subject this autumn.

The thematic variations continue. It seems that 12 weeks of Tadalafil is effective in ejaculatory and orgasmic dysfunction in patients with ED [3]. Sexual medicine remains an exciting section of the BJUI and I am grateful to the andrologists on our editorial board for diligently reviewing the large number of papers that we receive from investigators in this field.

And finally we had two practice changing randomised trials in stone disease. Plasma vaporisation performed better than balloon dilatation for creating PCNL tracts [4]. For the curious, there is a video demonstrating the method if you wish to learn it.

The Portland trial has a simple message that you just can’t ignore; a single dose of NSAID before ureteric stent removal prevents severe pain afterwards. This is going to become standard of care if it has not already [5].

Many of our readers will wonder why we continue with a paper journal when the web has been so successful? The map here shows our global reach, which includes a number of subscribers who prefer to, or by necessity, read the print journal (∼30%). Moreover in a BJUI Online Poll, 75% of our readers reported taking the paper journal out of its plastic sheath and reading it, with over 50% doing so within a week. The transition will thus take longer and while the web remains our main portal, the beautifully designed paper BJUI will still land on your doorstep.

Prokar Dasgupta
Editor in Chief, BJUI

Guy’s Hospital, King’s Health Partners

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: 22–29
  2. Cooperberg MR, Ramakrishna NR, Duff SB et al. Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis. BJU Int 2013; 111: 437–450
  3. Paduch DA, Bolyakov A, Polzer PK, Watts SD. Effects of 12 weeks of tadalafil treatment on ejaculatory and orgasmic dysfunction and sexual satisfaction in patients with mild to severe erectile dysfunction: integrated analysis of 17 placebo-controlled studies. BJU Int 2013; 111: 334–343
  4. Chiang PH, Su HH. Randomized and prospective trial comparing tract creation using plasma vaporization with balloon dilatation in percutaneous nephrolithotomy. BJU Int 2013; 112: 89–93
  5. Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU Int 2013; 111: 101–105
Original publication of this editorial can be found at: BJU Int 2013; 112: 1051–1052. doi: 10.1111/bju.12524

 

 

 

Impact Factor and the BJUI – Vincenzo Ficarra BJUI Associate Editor

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BJUI Associate Editor Vincenzo Ficarra, discusses the BJUI’s aim to increase the quality of papers and the journal’s Impact Factor. The rejection rate shall see an increase from 65% to 80% as a result.

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The impact of the BJUI and what influences it today: does impact factor matter?

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Over the last decade, urological researchers have been increasingly interested with, and driven by, the impact factor (IF) of the journal to which they are submitting. This bibliometric tool measures the way in which a journal receives citations of its articles over time. IF is calculated by dividing the number of current citations a journal receives for articles published in the two previous years, by the number of articles published in those same years.

Although IF represents a proxy for the popularity of a journal within its field, several academic and scientific organizations now use the IF to judge the value of a scientist or of a research team using it for national and international academic evaluations. This questionable policy has generated a vicious circle that has driven authors to prefer journals with higher IFs and, consequently, journal editorial boards (and publishers) to plan (soft or strong) strategies to increase this index. As a result a higher IF attracts the best articles in the field and increases the number of subscriptions to a journal. There are a number of potential biases influencing the IF values including self-citation, the number of articles published per year, and the type of articles accepted. We will explain how all of these nuances can play a significant role in calculating the IF.

Some journals subtly suggest that authors and reviewers cite articles published in their own journal within the references of newly submitted papers. This slightly dubious practice can bias the true value of the IF. Reassuringly when looking at the urological journals, the self-citation factor generally seems to play a limited role, as most journals have a percentage <10%. The policy of the BJUI Editorial Board does not support a self-citation practice. The decision to start each BJUI issue with some editorial comments (the Editor’s Choice section) is only to offer to readers the opportunity to have expert comment on the most important papers published within each edition. Indeed, the invited authors are only requested to cite the featured article and no others from the BJUI.

The number of papers published per journal volume and throughout each year is another significant factor influencing the IF value. Table 1 clearly shows the wide variability in the number of papers published from 2010–2011 in the different urologic journals. The new BJUI policy is to significantly reduce the number of published papers/year. Reflecting this decision, the BJUI Editorial Board has agreed to significantly improve the review process with the aim of selecting only the most relevant and original of the submitted manuscripts. A new rapid triage review process should allow us to select only the best 30–40% of submitted manuscripts to send to 3–4 experts for a more focused and precise review process. This mechanism has produced a significantly increased rejection rate in favour, we hope, of a better selection of topics and papers for our readership [2].

Table 1. Items cited in 2012 and items published in 2010–2011 in the most important urological journals. Data from ISI Web of Journal Citation Reports (JCR)
Abbreviated Journal Title Cites in 2012 Items published in 2010–2011 Impact Factor
EUR UROL 4.662 445 10.476
NAT REV UROL 580 121 4.793
PROSTATE 1.395 963 3.843
J UROLOGY 4.864 1316 3.696
J SEX MED 2.638 751 3.513
BJU INT 3.323 1091 3.046
WORLD J UROL 673 233 2.888
UROLOGY 2.843 1173 2.424
CURR OPIN UROL 360 164 2.195

 

Bibliometric analyses have shown that review articles are cited more frequently than full original research papers. Therefore publishing good quality review articles written by expert opinion leaders in the field represents an excellent strategy to increase a journal’s IF. Although, we recognize the impact of review articles on IF, the current policy of the BJUI remains unchanged with only relatively few review articles included in each issue. As a result we will continue to give maximal attention to the clinical and basic research papers.

Finally the IF is in many ways only an index of the popularity of a journal because it equally weights citations from highly reputed journals alongside citations from more obscure journals [1]. However a journal’s true credit is also based on the prestige of the citing journals and the Eigenfactor scores is currently used to reflect this measure. Table 2 shows that the BJUI is third of all urological journals according to this less popular bibliometric tool. Another contemporary measure of impact, particularly influenced through the internet is the “Klout Score”. This system, which uses social media analytics to rank users according to online social influence via the Klout Score, giving a numerical value between 1 and 100. The BJUI currently has a score of 56, higher than its contemporaries. Therefore we can conclude that the BJUI today is a journal with a good reputation throughout the urologic field.

Table 2. Relationship between prestige (Eigenfactor® Score) and popularity (Impact Factor score) of urological journals. Data from ISI Web of Journal Citation Reports (JCR)
Rank Abbreviated Journal Title Eigenfactor® Score Impact Factor IF rank
 1 J UROLOGY 0.08109 3.696 4
 2 EUR UROL 0.05503 10.476 1
 3 BJU INT 0.04248 3.046 7
 4 UROLOGY 0.03896 2.424 11
 5 J SEX MED 0.01738 3.513 6
 6 PROSTATE 0.01624 3.843 3
 7 J ENDOUROL 0.01571 2.074 15
 8 NEUROUROL URODYNAM 0.00897 2.674 10
 9 WORLD J UROL 0.00750 2.888 8
10 INT J UROL 0.00582 1.734 16

 

The editorial board of a traditional urological journal like the BJUI must take into consideration both the IF and other scoring systems as indicators of its popularity and prestige. The strategies we employ to give better bibliometric parameters should predominantly reflect an increase in the quality of the papers published as we must remember that the journal is primarily produced for the readership and not just for those who wish to publish in it [3].

Vincenzo Ficarra1, Associate Editor,
Ben Challacombe2, Associate Editor,
Prokar Dasgupta2, Editor in Chief

1Department of Experimental and Clinical Medical Sciences, Urology Unit, University of Udine, Italy. 2King’s Health Partners, London UK

References

  1. Franceschet M. The difference between popularity and prestige in the sciences and in the social sciences: a bibliometric analysis. J Informetr 2010; 4: 55–61
  2. Dasgupta P. The most read surgical journal on the web. BJU Int 2013; 111: 1–3
  3. Schulman CC. What you have always wanted to know about the impact factor and did not dare to ask. Eur Urol 2005; 48: 179–181

Original publication of this editorial can be found at: BJU Int 2013; 112: 873–874, doi: 10.1111/bju.12472

Increasing importance of truly informed consent: the role of written patient information

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Roger Kirby*, Ben Challacombe*†, Simon Hughes*†, Simon Chowdhury*† and Prokar Dasgupta*†
*The Prostate Centre, London W1 and †Guy’s and St Thomas’ NHS Foundation Trust Hospital, London, UK

Published as a comment article in BJU International 2013; 112: 715–716. doi: 10.1111/j.1464-410X.2012.11787.x

Video Commentary by Roger Kirby, BJUI Associate Editor.

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Technological Innovation in the BJUI

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Time waits for no man St. Marher, 1225

Urology is arguably the leading technology driven surgical specialty. This is no accident. As surgeons we have always looked towards minimal invasion to reduce the trauma of access to our patients. One would have thought that the advent of drugs for BPH and OAB would perhaps reduce our hunger for technology.You can visit One Click Power if you are always hungry for knowing trends in technology. On the contrary, many urologists have moved on to effective alternatives to TURP such as HoLEP and having learnt the lessons from previous unproven over enthusiasm, relied on the results of high quality randomised trials before accepting the results.

The BJUI has a long history of publishing innovative manuscripts in the fields of basic science, imaging and therapeutics. We aim to bring the readership entire new paradigms in surgical diagnostics and treatment. Indeed while we enjoy #ERUS13 in sunny Stockholm, the autumn sunshine reminds us of the role played by robotics in the steady rise of technological innovation. This “sub specialty” has become so prominent that the EAU are soon accepting ERUS and its committee as an integral part of the European Association of Urology. The randomised trials, meta analysis and health technology assessments are gradually appearing in contemporary literature such that it is no longer true to say that robotics is just a fad backed up by little or poor evidence. Robotics remains one of the most highly cited parts of the BJUI and therefore together with laparoscopy has its own dedicated section. We were pleased to publish the novel method of suprapubic catheterisation as an alternative to the urethral route after robotic prostatectomy [1] which led to much conversation on the BJUI twitter page. Our readers ultimately decide whether to adopt a particular technique or technology and are now able to vote via the BJUI Poll.

Last month, Mahesh Desai demonstrated microPCNL in London. The technology is truly breathtaking. It is hard to believe that light and image transmission as well as stone disintegration can be effectively achieved via a needle so thin! We almost stopped doing robotics and were thinking of re-training to become stone surgeons. Mahesh and his team went on to back up the technology with a randomised comparison against flexible ureterorenoscopy [2]. It should come as no surprise that such an article should come from the sub-continent where stone disease is endemic.

And the technological innovations in the BJUI continue. This month we present three rather different articles for your reading pleasure. The first is an international collaboration demonstrating the ideal dose and safety of photodynamic TOOKAD therapy (a light-activated vascular occluding agent) in localised prostate cancer. Nearly 80% of patients had negative biopsies at 6 months [3]. Next we evaluate the role of PET CT in bladder cancer patients undergoing cystectomy. With almost a 20% greater pickup than standard imaging, we may be able to save a number of patients a morbid operation in the presence of metastasis. Advanced imaging may also allow better stratification of patients for neo-adjuvant chemotherapy [4]. Finally, we have an exciting paper from Iran on the use of endometrial derived stem cells for creating bladder replacements and alternatives to meshes in prolapse surgery. The immuno and scanning electron micrographic images in this paper are just stunning [5].

The BJUI intends to continue leading technological innovation in urology. We will bring our readers early phase safety data on new technologies in addition to long-term results to truly judge their efficacy and durability. We hope you enjoy reading, citing and interacting with these articles online at bjui.org and ultimately translate them to your own clinical practice.

Prokar Dasgupta, Editor in Chief, BJUI
Ben Challacombe, Associate Editor, BJUI
King’s Health Partners

References

  1. Ghani KR, Trinh Q-D, Sammon JD et al. Percutaneous suprapubic tube bladder drainage after robot-assisted radical prostatectomy: a step-by-step guide. BJU Int 2013; 112: 703–705
  2. Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 2013; 112: 355–361
  3. Azzouzi A-R, Barret E, Moore CM. TOOKAD® Soluble vascular-targeted photodynamic (VTP) therapy: determination of optimal treatment conditions and assessment of effects in patients with localised prostate cancer. BJU Int 2013; 112: 766–774
  4. Mertens LS, Fioole-Bruining A, Vegt E, Vogel WV, van Rhijn BW, Horenblas S. Impact of 18F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT) on management of patients with carcinoma invading bladder muscle. BJU Int 2013; 112: 729–734
  5. Shoae-Hassani A, Sharif S, Seifalian AM, Mortazavi-Tabatabaei SA, Rezaie S, Verdi J. Endometrial stem cell differentiation into smooth muscle cell: a novel approach for bladder tissue engineering in women. BJU Int 2013; 112: 854–863
Original publication of this editorial can be found at: doi 10.1111/bju.12431. BJUI 2013; 112: 707.

 

Urological oncology in the BJUI

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Urological oncology is increasingly multi-disciplinary, and hence competitive for high impact thought leadership. Innovation leading to paradigm changes may come from a number of different ideas and sources. Effective leadership in our specialty certainly requires technical innovations in surgical treatments, but also pivotal roles in improving the process of diagnosis, staging, patient counselling, multi-modal therapy, and ultimately evidence-based clinical guidelines. The ultimate end-result of innovation is a peer reviewed publication, and at the BJUI we wish to bring you nothing but the highest quality.

Our daily lives are increasingly busy with our varying mixtures of clinical work, teaching, administration, and research. How much time do we have to read a surgical journal? It is an important part of our learning, but we must be efficient to squeeze it into a busy day. Keeping this in mind, the Editorial Board is more selective than ever in the papers that make it into the BJUI. Each paper we accept needs to represent something valuable to the reader and to our science, such as a technical innovation, large study of a new method to fix an unmet need, multi-institutional validation trial, or updated guideline. For this to work, we need fair and efficient peer reviewers, and high quality submissions.

In this month’s BJUI, we see encouraging work from multiple talented authorship groups who address a plethora of unmet needs. These papers show the diversity of impact the Editorial team is looking for in BJUI urological oncology submissions.

Prostate cancer, of course, is a common topic for new submissions and subsequent citations. In the field of localised prostate cancer and PSA screening, the recent U.S. Preventive Services Task Force (USPSTF) report was critical of our diagnostic practice results in terms of biopsy related complications and, of course, negative (a.k.a. unnecessary, a term we should drop) biopsies. I must confess that I am still stuck in the tradition of the PSA/DRE as the key driver of my recommendation for a biopsy, and several informal ‘raise your hand’ polls at meetings have produced little movement when asked if anyone has adopted newer calculators that incorporate TRUS volume. Why not change? The numbers certainly seem reasonable: an area under the curve (AUC) of 0.71 for DRE/PSA and 0.77 for the risk calculator. You can even make a crude DRE-volume estimate and improve your odds – AUC of 0.73 without and 0.77 with DRE-volume. If that sounds of interest, then perhaps the study by Carlsson et al. in this issue may interest you with their biomarker panel of kallikreins that can do the same work as the combined clinical efforts and reach AUCs of 0.76 alone, or 0.792 if you still want to add the DRE and TRUS volume. I agree with the authors, that this is perhaps a simpler model, which may allow the physician and patient some time to have a look at their risk of a positive biopsy and make a decision, rather than the idea of the last minute TRUS volume that is supposed to put the brakes on a biopsy at a certain size. With further refinement, we can all learn new thresholds for biopsy that are better selected, and in the future should always be calculated as overall cancers detected/missed and high-grade cancers detected/missed.

In addition, the USPSTF criticised the toxicity of a biopsy, and drug-resistant sepsis is an increasing problem. Symons et al. present an instructive series of transperineal biopsies and results, and they seem to have solved the sepsis problem (0.2%), but must weigh the added cost of anaesthesia, physician time, and no obvious difference in bleeding/other minor complications. I am increasingly interested in re-utilising this technique, which previously was only for third-line saturation biopsies. If you are also convinced, Kuru et al. present a tour-de-force presentation of transperineal technique, terminology, and data collection for a multi-centre collaboration.

Finally, in a must-read special article, Carter expands upon the recent AUA guidelines on PSA screening that were intensely debated, especially the recommendations against routine screening in men aged <55 years. Guidelines are an interesting area of study, and can vary in outcome based upon who is on them and what methodology/objectives are selected. If the guideline is meant to be best clinical practice, than the personnel can certainly be influential. However, if the guideline is meant to emphasise evidence-based recommendations, then in theory, any panel of experts will arrive at a similar place. This is the essential message from Carter, that the revised guidelines are meant to reflect the evidence, and currently we do not have level 1 evidence that involved screening men aged <55 years.

Closing this month in ‘Urological Oncology’, Cindolo et al. report an accuracy/generalizability study of the Karakiewicz nomograms for cancer-specific survival with RCC. These articles are, of course, largely statistical exercises, but very necessary, as we define populations suitable for surgery only vs those in need of neoadjuvant/adjuvant inclusion. Wong et al. conclude the month with an innovative report on office-based laser ablation of non-muscle-invasive bladder cancer using local anaesthesia, mostly in an elderly population. The study protocol allowed photodynamic diagnosis, and includes a cost analysis. The results certainly support continued use in this population where we commonly wish to avoid the morbidity of repeat general anaesthetics.

John W. Davis, MD, FACS
Associate Editor, BJUI

Original publication of this editorial can be found at: doi: 10.1111/bju.12380. BJUI 2013; 112: 531–532.

Functional urology in the BJUI

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Although urological oncology is by far our largest section, it has increasingly become evident to us that the most cited part of the BJUI is functional urology. While this may come as a surprise, it is a reflection of the high quality of submissions that appear in this section. For your reading pleasure here are three “functional” articles in this issue worthy of attention. The paper from David Ginsberg also appears on the web journal as an article of the week.

In the first of our functional urology articles this month, Sjostrom et al. once again confirm the value of PFMT for the treatment of questionnaire and interview diagnosed SUI. Further, they show that an Internet-based program, which is more detailed and requires more contact (see Table 2 in the article), is more effective than a postal-based program in this regard after 3 months of usage (follow up at 4 months). What does more effective mean? For the ICIQ-UI SF scores, minimal difference in mean score is seen in the group scoring 1–5 (slight) and 6–12 (moderate) at baseline, a difference of 8.1 to 11 seen in the group scoring 13–21 (severe and very severe) at baseline (Figure 2). I like the PGI-I as a subjective patient global assessment. The largest difference was in the “very much better” group with minimal differences elsewhere (Figure 3). It would be interesting to know whether the larger difference occurred primarily in the severe and very severe groups as well. My take away is that PFMT is effective for SUI management. One can quibble about the lack of a physical exam here, but I suspect there would have been little difference. The real question is how best to apply this concept, keeping in mind the balance between results and efficient use of healthcare resources. My hypothesis would be that of the 3 methods of post, Internet and face-to-face therapy, there would be a preferred grouping based on the level of incontinence severity and education with the confounding factors of ages, socioeconomic class and desire for treatment, the latter associated with QOL impairment. A follow up at 6 and 12 months after treatment cessation would be helpful, and I am sure this is planned by the authors.

The article by Volpe et al. shows that the same indications can be used for recommending outlet reduction via TURP in the post renal transplant as in the general population. The only issue not specified was whether the pre-TUR serum creatinine in the 5/32 patients requiring catheterization (measured before catheterization), was higher than the others and, if so, may have skewed the group results. Nevertheless, it is important to acknowledge that renal transplant patients have the same LUT issues as “normals” and, for these fragile men it may be especially important to be cognizant of LUT obstruction as a potential adverse but correctible factor for decreased renal function.

Regarding the article by Ginsberg et al. on the differences in efficacy and tolerability between 8 mg of fesoterodine, 4 mg of ER tolterodine and placebo in patients with OAB, the authors are to be commended, in my opinion, for publishing this article, which is bound to generate much controversy among those who carefully read it. It is true that this is probably the first large study to compare antimuscarinic efficacy separately in women and men. The article begins by pointing out the pharmacokinetic issues with the drug that the sponsor previously promoted as the gold standard of antimuscarinic therapy. It does show that the higher (double) dose of active agent produces a ‘better” efficacy result albeit with an increase in dry mouth frequency but not in other adverse events. A useful result of the article is to make one consider the questions of what constitutes a clinically significant result as opposed to a statistically significant one and what the mechanism is of the profound placebo effect, especially with reference to the objective parameters recorded (Fig 2). Almost 50% of women and 60% of men become diary dry on placebo. It would also be interesting to reconcile the greater (but not large) differences between the subjective or QOL measures and the objective ones. As a take home, if both drugs were similarly priced, or available through health care benefits, the choice would be obvious. If not, what would the difference be worth?

Alan J. Wein, MD, FACS, PhD(hon)
Associate Editor – Functional Urology
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

 

Original publication of this editorial can be found at: doi: 10.1111/bju.12326. BJUI 2013; 112: 277. 

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