EAU-EBU Update Series RSS feed: Current Issue. The EAU-EBU Update Series (EEUS) is the bimonthly CME publication of the European Board of Urology and the European Association of Urology. Publishing commissioned reviews covering all key knowledge areas, this publication is required reading for all urologists in Europe. In addition, all qualified urologists are eligible to answer the accompanying MCQs, in order to earn EBU-CME credit points. For information on the old EAU Update Series, please go to EAU Update Series (ISSN 1570-1924)http://www.journals.elsevierhealth.com/periodicals/eeus/?rss=yesElsevier Inc.en © 2007 Published by Elsevier Inc. All rights reserved. EAU-EBU Update Series1871-259256December 2007 © 2007 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS187125920700069X/abstract?rss=yesEditorial Board10.1016/S1871-2592(07)00069-XEAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8iihttp://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS1871259207000494/abstract?rss=yesAbstract: Objectives: Provide an overview of the use of the sentinel node (SN) technique in prostate carcinoma. The relevance of nodal staging in the several stages of prostate carcinoma, technical aspects of the SN technique, indications, and lessons learned from it are discussed.Introduction: The lymph node status is relevant in all M0 tumour stages. In early prostate cancer the changes of nodal involvement are so low that invasive diagnostics are superfluous. However, the definition of this early stage is narrowing since the results of extensive node dissection have shown that previously assumed low-risk patients may harbour positive lymph nodes. On the other hand, in locally advanced cases, if the decision for external-beam radiation on the lymph node basins in combination with radiation of the prostate and 3 yr of hormonal therapy has been made, a lymph node dissection seems superfluous.Methods: SN dissection may be performed in open surgery or as a laparoscopic technique. A radioactive tracer is injected into the prostate and on γ-camera imaging it is decided which lymph nodes are the possible first landing zones for the prostate tumour. During the radioguided surgery, the excision of the SNs, a handheld γ probe is used to identify the radioactive nodes. On introducing the method in a clinic, it is important to do a conformal extensive pelvic lymph node dissection as well to ensure that logistics and the performance are reliable.Results: SN dissection is as reliable as a diagnostic tool as extended pelvic lymph node dissection. Because it may show cancer-bearing nodes outside of the region of the extended lymph node dissection, such as the presacral area, it may on occasion be even more sensitive.Discussion: The SN technique is likely to have fewer complications compared to the extended lymph node dissection. On the other hand, an extended lymph node dissection may still be indicated when the SN procedure yields only a few positive lymph nodes and definite cure is still the aim. Weighing the advantages and disadvantages of the laparoscopic versus the open SN technique is not different than in any other procedure. In the near future, sophisticated imaging techniques will identify nodes that are suspicious for micrometastases. This will make minimal invasive methods to confirm the nodal status not superfluous, but more in demand.Conclusion: When the nodal stage is important for treatment decisions, only extended dissections or the SN method will provide accurate staging. The SN procedure is less invasive and will avoid an extensive node dissection in the majority of cases.Sentinel Node Evaluation in Prostate CancerWillem Meinhardt10.1016/j.eeus.2007.07.003EAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8223231http://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS1871259207000561/abstract?rss=yesAbstract: Since Ulmsten and Petros's original description of the tension-free vaginal tape (TVT) procedure in 1995, the midurethral sling (MUS) has become first-line therapy for correction of female stress urinary incontinence (SUI). Cure rates are high for TVT and the recent tension-free trans-obturator tape (TOT) procedures, and the incidence of side effects is low. In the past few years although several studies have dealt with the incidence and prevalence of MUS-related complications, their surgical management remains an open issue. This paper presents the rationale for surgical management of MUS-linked complications, updates progress in new strategies, and tracks translation of recommendations on vaginal and urethral erosion, postoperative voiding difficulties, and de novo urgency into clinical practice.Managing Complications after Midurethral Sling for Stress Urinary IncontinenceElisabetta Costantini, Massimo Lazzeri, Massimo Porena10.1016/j.eeus.2007.07.004EAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8232240http://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS1871259207000573/abstract?rss=yesAbstract: Objective: Review the literature concerning transperineal transrectal ultrasound (TRUS)-guided prostate biopsy (PBx), providing an update on the topic.Methods: The literature review was performed using PubMed through a free text search strategy. The authors reviewed the abstracts of the retrieved records to select the relevant papers.Results: The search retrieved 196 records; 68 were relevant to the issue. No high-level evidence recommends a particular kind of preparation/prophylaxis for transperineal PBx. It can be performed with a brachytherapy template under general or spinal anesthesia, or with a local periprostatic nerve block through a single-access fan technique. In the former case, up to 50 cores are obtained; in the latter, 12–26 cores. Prostate cancer detection rates range from 24% to 51%, with figures of 27–49% in patients undergoing their first PBx for a prostate-specific antigen level of 4–10ng/ml. Such percentages are directly related to the number of cores obtained. In repeat biopsy and in prostates > 50 cc, the number of cores should be increased, paying particular attention in sampling the anterior zone. Among the studies comparing transrectal and transperineal PBx, only two demonstrated differences in detection rates in favor of the transperineal approach. Major complications are rare, with fever occurring in 0–5.2% and hospitalization in 0–1.4% of cases.Conclusion: Transperineal TRUS-guided PBx is a safe procedure, with high detection rates and wide applications both in first and in repeat sampling. Although having a strong rationale, the transperineal approach has so far not resulted in higher detection rates than transrectal biopsies.Take Home Message: Although less used than its transrectal counterpart, transperineal transrectal ultrasound-guided prostate biopsy is a safe procedure, with high detection rates and wide applications both in first and in repeat prostate sampling.Prostate Biopsy: The Transperineal ApproachAntonio Galfano, Giacomo Novara, Massimo Iafrate, Marco Cosentino, Stefano Cavalleri, Walter Artibani, Vincenzo Ficarra10.1016/j.eeus.2007.08.001EAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8241249http://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS1871259207000664/abstract?rss=yesAbstract: Antimuscarinic agents are currently the first-line therapy for overactive bladder (OAB). Many urologists believe the pharmacologic management of OAB is not altogether satisfactory. Pharmacologic research is trying to provide answers to the issues of efficacy, tolerability, and convenience of new drugs. This paper discusses the rationale underlying the development of new compounds, provides an update of progress in the search for new therapies for OAB, and tracks their translation into clinical practice. It offers an insight into the mechanism of action, efficacy, side-effects, and “market status” of several drug categories targeting the central nervous system (adrenoceptor modulators, serotonin/norepinephrine reuptake inhibitors, tachykinin modulators, opioids), neuromuscular blocking agents (botulinum toxin A), selective modulators of the afferent branch of micturition reflex (vanilloid, nociceptin/orphanin FQ), autonomic nervous system modulators (β3-agonists), potassium and calcium channel openers, and nonsteroidal anti-inflammatory drugs.The Challenge of the Overactive Bladder: From Laboratory to New DrugsMassimo Lazzeri, Massimo Porena10.1016/j.eeus.2007.08.002EAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8250258http://www.journals.elsevierhealth.com/periodicals/eeus/article/PIIS1871259207000731/abstract?rss=yesAnswers to the CME Questions Published in EAU-EBU Update Series Volume 5, Issue 510.1016/j.eeus.2007.09.001EAU-EBU Update Series 5, 6 (2007)2007-12-01EAU-EBU Update Series2007-12-0156S1871-2592(07)X0024-8259261