Objective To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men. Patients and methods Men aged o18 years with verified nocturia (otwo voids/night) and nocturnal urine production greater than their maximum functional bladder capacity were recruited. A 3-week dosetitration phase established the optimum desmopressin dose (0.1, 0.2 or 0.4 mg). After a 1-week 'washout' period, patients who responded in the dose-titration period were randomized to receive the optimal dose of desmopressin or placebo in a double-blind design for 3 weeks. Results In all, 151 patients entered the double-blind period (86 treated with desmopressin, 65 with placebo). In the desmopressin group 28 (34%) patients and in the placebo group two (3%) patients (P<0.001) had fewer than half the number of nocturnal voids relative to baseline; the mean number of nocturnal voids decreased from 3.0 to 1.7 and from 3.2 to 2.7, respectively, reflecting a mean decrease of 43% and 12% (P<0.001). The mean duration of the first sleep period increased by 59% (from 2.7 to 4.5 h) in the desmopressin group, compared with an increase of 21% (from 2.5 to 2.9 h) in the placebo group (P<0.001). The mean nocturnal diuresis decreased by 36% (from 1.5 to 0.9 mL/min) in the desmopressin group and by 6% (from 1.7 to 1.5 mL/min) in the placebo group (P<0.001). The mean ratio of night/24-h urine volume decreased by 23% and 1% (P<0.001), and the mean ratio of night/day urine volume decreased by 27% and increased by 3% (P<0.001) for the desmopressin and placebo groups, respectively. In the double-blind treatment period, similar numbers of patients had adverse events; 15 (17%) patients in the desmopressin and 16 (25%) patients in the placebo group. Most adverse events were mild. Serum sodium levels were <130 mmol/L in 10 (4%) patients and this occurred during dose-titration. Conclusions Orally administered desmopressin is an effective and well-tolerated treatment for nocturia in men.

This long-term study shows that desmopressin is a generally well tolerated and effective treatment for nocturia.

The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention.

ObjectiveTo compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole-body bone scintigraphy (WBS) with technetium-99m-MDP, [18F]-sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [ Patients and MethodsThe study entry criteria were biopsy-proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion-based analysis. The primary target variable was bone lesion (malignant/ benign) and the 'gold standard' was MRI. ResultsA total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non-malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; 54, 82, 78 and 81%; 91, 95, 75 and 87%, respectively. ConclusionsWe found that FCH-PET/CT and NaF-PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone-naïve prostate cancer.

Biofeedback is a method of pelvic floor rehabilitation using a surface electrode inserted into the vagina and a catheter in the rectum. Forty women with genuine urinary stress incontinence were randomized to compare the efficacy of physiotherapy and physiotherapy in combination with biofeedback. The effect of the treatment was determined by a standardized pad-weighing test. Long-term status was determined using a questionnaire after 2-3 years. Thirty-four women completed the treatment. The study showed a statistically significant better improvement in the biofeedback group. The long-term effect in the biofeedback group seemed better and the patients were more motivated for training afterwards.

This section opens with a nationwide Danish study on the risk of fractures in prostate cancer, as well as assessing the impact of exposure to androgen deprivation. The authors found that there was a marked increase in the risk of fractures, especially of the hip. Authors from the USA address the outcome of cytoreductive nephrectomy for metastatic RCC, finding that it can be predicted by the fraction of tumour volume removed. They give an informative review of the topic and describe their experience in this type of surgery. Treatment options for hormonerefractory prostate cancer are rather limited and authors from the USA present the results of a phase II trial into the use of gefitinib as a single therapy in patients with non‐metastatic refractory disease. They found an absence of PSA response but confirmed the well‐established favourable tolerability profile of this agent. OBJECTIVE To assess the risk of fracture attributable to prostate cancer, and the impact of exposure to prescribed gonadotrophin‐releasing hormone agonists and antiandrogens on this risk in a nationwide, population‐based case‐control study. PATIENTS AND METHODS Data from the Danish National Hospital Discharge Register, the National Bureau of Statistics, and the National Prescriptions Database were merged. The analysis covered 15 716 men aged >50 years presenting with a fracture at any hospital in Denmark in 2000, and 47 149 age‐matched control men. A previous diagnosis of prostate cancer had been recorded in 1.3% of controls and 2.5% of those with a fracture. RESULTS Prostate cancer was associated with an increased odds ratio (95% confidence interval) for all fractures of 1.8 (1.6–2.1), for hip fractures of 3.7 (3.1–4.4), but no increased risk of vertebral fractures. The increased fracture risk became apparent early after diagnosis and remained pronounced even in long‐term survivors. Androgen deprivation therapy (ADT) with an odds ratio of 1.7  (1.2–2.5; P < 0.01) and orchidectomy, at 1.7 (1.2–2.4; P < 0.01) added to the overall fracture risk. In all, 3.1% of hip fractures in Danish men aged >50 years are attributable to prostate cancer. CONCLUSION Prostate cancer, orchidectomy and the use of ADT are associated with a markedly greater risk of fractures, especially of the hip. The risk of hip fracture is not confined to the very old, neither is the risk made negligible by the excess mortality in patients with advanced prostate cancer.

What ' s known on the subject? and What does the study add? Staging of patients with prostate cancer is the cornerstone of treatment. However, after curative intended therapy a high portion of patients relapse with local and/or distant recurrence. Therefore, one may question whether surgical lymph node dissection (LND) is suffi ciently reliable for staging of these patients.Several imaging methods for primary LN staging of patients with prostate cancer have been tested. Acceptable detection rates have not been achieved by CT or MRI or for that matter with PET/CT using the most common tracer fl uoromethylcholine (FCH). Other more recent metabolic tracers like acetate and choline seem to be more sensitive for assessment of LNs in both primary staging and re-staging. However, previous studies were small. Therefore, we assessed the value of [18 F ] FCH PET/CT for primary LN staging in a prospective study of a larger sample and with a ' blinded ' review. After a study period of 3 years and > 200 included patients, we concluded that [18 F ] FCH PET/CT did not reach an optimal detection rate compared with LND, and, therefore, it cannot replace this procedure. However, we did detect several bone metastases with [18 F ] FCH PET/CT that the normal bone scans had missed, and this might be worth pursuing. OBJECTIVES• To assess the value of [ 18 F ] fl uoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging of prostate cancer.• To evaluate if FCH PET/CT can replace LN dissection (LND) for LN staging of prostate cancer, as about one-third of patients with prostate cancer who receive intended curative therapy will have recurrence, one reason being undetected LN involvement. PATIENTS AND METHODS• From January 2008 to December 2010, 210 intermediate-or high-risk patients had a FCH PET/CT scan before regional LND.• After dissection, the result of histological examination of the LNs (gold standard) was compared with the result of FCH PET/CT obtained by ' blinded review ' .• Sensitivity, specifi city, positive (PPV), and negative predictive values (NPV) of FCH PET/CT were measured for detection of LNe metastases. RESULTS• Of the 210 patients, 76 (36.2%) were in the intermediate-risk group and 134 (63.8%) were in the high-risk group. A medium (range) of 5 (1 -28) LNs were removed per patient.• Histological examination of removed LNs showed metastases in 41 patients. Sensitivity, specifi city, PPV, and NPV of FCH PET/CT for patient-based LN staging were 73.2%, 87.6%, 58.8% and 93.1%, respectively.• Corresponding values for LN-based analyses were 56.2%, 94.0%, 40.2%, and 96.8%, respectively.• The mean diameter of the true positive LN metastases was signifi cantly larger than that of the false negative LNs (10.3 vs 4.6 mm; P < 0.001).• In addition, FCH PET/CT detected a high focal bone uptake, consistent with bone metastases, in 18 patients, 12 of which had histologically benign LNs. CONCLUSIONS• Due to a relatively low sensitivity and a correspondingly rather low PPV, FCH PET/ CT i...

The effect of estrogens on urinary incontinence in postmenopausal women was studied in order to investigate whether estrogens could cure urge incontinence in patients without detrusor hyperreflexia and whether estrogens could raise the maximum urethral closure pressure. The trial was double-blind. The cure rate in patients woth sensory urge incontinence was significantly better with estrogen than with placebo (p < 0.05, Fourfold Table Test). There were no statistically significant changes in the maximum urethral closure pressure and the functional profile length between the estrogen- and placebo-treated groups. Biopsies from the trigone showed a similar shift as in smears from urethra and vagina in the patients treated with estrogens. None of the patients had subjective side-effects and no significant changes were found in serum cholesterol or triglyceride.