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Article: The role of PET/CT imaging in penile cancer.

Ottenhof, Sarah R / Vegt, Erik

2017 Volume 6, Issue 5, Page(s) 833–838

Abstract: Positron emission tomography (PET) imaging ... ...

Abstract	Positron emission tomography (PET) imaging with
Language	English
Publishing date	2017-11-08
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2851630-8
ISSN	2223-4691 ; 2223-4691 ; 2223-4683
ISSN (online)	2223-4691
ISSN	2223-4691 ; 2223-4683
DOI	10.21037/tau.2017.04.36
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Article ; Online: Management of the penile squamous cell carcinoma patient after node positive radical inguinal lymph node dissection: current evidence and future prospects.

de Vries, Hielke M / Ottenhof, Sarah R / van der Heijden, Michiel S / Pos, Floris J / Horenblas, Simon / Brouwer, Oscar R

Current opinion in urology

2020 Volume 30, Issue 2, Page(s) 223–228

Abstract: Purpose of review: The level of evidence for current (adjuvant) treatment strategies after node positive inguinal lymphadenectomy is relatively low because of a paucity of prospective studies and controversy exist between the two major guidelines. The ... ...

Abstract	Purpose of review: The level of evidence for current (adjuvant) treatment strategies after node positive inguinal lymphadenectomy is relatively low because of a paucity of prospective studies and controversy exist between the two major guidelines. The present review aims to provide a review of current literature on the available treatment options of patients after a tumor positive inguinal lymph node dissection. Recent findings: Patients without inguinal extranodal extension or less than two tumor positive inguinal nodes are at low risk of ipsilateral pelvic nodal disease. Patients with pN1 disease are unlikely to benefit from adjuvant treatment, whereas patients with pN2 disease might benefit from adjuvant radiotherapy. For patients with high risk of pelvic nodal disease, prophylactic pelvic lymph node dissection (PLND) is advised by current guidelines. The InPACT study investigates whether adjuvant chemoradiotherapy could be used instead of prophylactic PLND. Subgroup analyses of retrospective cohorts suggest that patients with pN3 disease based on tumor positive pelvic nodes may benefit from adjuvant radiotherapy or chemotherapy. Given the weak level of evidence and substantial toxicity associated with current regimens, adjuvant chemotherapy cannot be generally recommended. Summary: Despite current treatment strategies, patients with pN2-pN3 disease still have a poor prognosis. Prospective international multicenter studies are necessary to identify the best treatment options for patients with advanced node positive penile squamous cell carcinoma.
MeSH term(s)	Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Carcinoma, Squamous Cell/therapy ; Combined Modality Therapy/adverse effects ; Combined Modality Therapy/trends ; Humans ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Staging ; Penile Neoplasms/pathology ; Penile Neoplasms/surgery ; Penile Neoplasms/therapy ; Prognosis ; Prospective Studies ; Retrospective Studies ; Risk Assessment
Language	English
Publishing date	2020-01-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1091792-5
ISSN	1473-6586 ; 0963-0643
ISSN (online)	1473-6586
ISSN	0963-0643
DOI	10.1097/MOU.0000000000000714
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Article ; Online: Distinct Patterns of Myeloid Cell Infiltration in Patients With hrHPV-Positive and hrHPV-Negative Penile Squamous Cell Carcinoma: The Importance of Assessing Myeloid Cell Densities Within the Spatial Context of the Tumor.

Rafael, Tynisha S / de Vries, Hielke M / Ottenhof, Sarah R / Hofland, Ingrid / Broeks, Annegien / de Jong, Jeroen / Bekers, Elise / Horenblas, Simon / de Menezes, Renée X / Jordanova, Ekaterina S / Brouwer, Oscar R

Frontiers in immunology

2021 Volume 12, Page(s) 682030

Abstract: Comprehensive analysis of tumor infiltrating myeloid cells in the tumor microenvironment of penile squamous cell carcinoma (PSCC) is lacking. In this retrospective study, for the first time, PSCC resection specimens (N = 103) were annotated into the ... ...

Abstract	Comprehensive analysis of tumor infiltrating myeloid cells in the tumor microenvironment of penile squamous cell carcinoma (PSCC) is lacking. In this retrospective study, for the first time, PSCC resection specimens (N = 103) were annotated into the following compartments: intratumoral tumor (IT Tumor), intratumoral stroma (IT Stroma), peritumoral tumor (PT Tumor) and peritumoral stroma (PT Stroma) compartments. We then quantified CD14+, CD68+ and CD163+ myeloid cells within these compartments using an image analysis software and assessed their association with various clinical parameters, including high-risk human papillomavirus (hrHPV) status. In the total cohort, hrHPV status, grade of differentiation, age and tumor size were associated with myeloid cell densities. hrHPV
MeSH term(s)	Biomarkers ; Biopsy ; Carcinoma, Squamous Cell/etiology ; Carcinoma, Squamous Cell/pathology ; Disease Susceptibility ; Gene Expression Profiling ; Humans ; Male ; Middle Aged ; Myeloid Cells/pathology ; Neoplasm Grading ; Neoplasm Staging ; Papillomavirus Infections/complications ; Papillomavirus Infections/virology ; Penile Neoplasms/etiology ; Penile Neoplasms/pathology ; Tumor Microenvironment
Chemical Substances	Biomarkers
Language	English
Publishing date	2021-06-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.682030
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Article ; Online: Advancements in staging and imaging for penile cancer.

Ottenhof, Sarah R / Leone, Andrew R / Horenblas, Simon / Spiess, Philippe E / Vegt, Erik

Current opinion in urology

2017 Volume 27, Issue 6, Page(s) 612–620

Abstract: Purpose of review: We review recent advancements in staging and imaging of penile cancer, including surveillance after therapy.: Recent findings: For cN0 patients, the sentinel lymph node biopsy is currently considered the preferred way for invasive ... ...

Abstract	Purpose of review: We review recent advancements in staging and imaging of penile cancer, including surveillance after therapy. Recent findings: For cN0 patients, the sentinel lymph node biopsy is currently considered the preferred way for invasive staging. It has largely replaced other modalities such as staging inguinal lymphadenectomy. Its diagnostic value increases when combined with other staging modalities such as ultrasound with fine-needle aspiration cytology (US-FNAC) or fluorodeoxyglucose-PET with computed tomography (PET/CT). In patients with palpably suspicious nodes (cN+), imaging is more useful. PET/CT has shown good accuracy in a limited number of small studies. US-FNAC can confirm nodal metastatic disease. A staging inguinal lymphadenectomy is of therapeutic value but is associated with significant morbidity. Omitting staging inguinal lymphadenectomy was recently described; one study showed well tolerated use of sentinel lymph node biopsy combined with intraoperative ultrasound-guided resection of suspicious nodes in cN+ patients. Therapeutic inguinal lymphadenectomy was only performed in the 42% of groins with metastases confirmed by disorder. For M-staging, PET/CT has shown good sensitivity, and its role should be further evaluated. Follow-up and surveillance rely on physical examination and US-FNAC. Summary: Over the past decade, staging and treatment of penile cancer have become less invasive, while survival tends to improve.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1091792-5
ISSN	1473-6586 ; 0963-0643
ISSN (online)	1473-6586
ISSN	0963-0643
DOI	10.1097/MOU.0000000000000447
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Article ; Online: F-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography Has High Diagnostic Value for Pelvic and Distant Staging in Patients with High-risk Penile Carcinoma.

Ottenhof, Sarah R / Djajadiningrat, Rosa S / Versleijen, Michelle W J / Donswijk, Maarten L / van der Noort, Vincent / Brouwer, Oscar R / Graafland, Niels M / Vegt, Erik / Horenblas, Simon

European urology focus

2021 Volume 8, Issue 1, Page(s) 98–104

Abstract: Background: For penile cancer patients with pelvic metastases, multimodal treatment is advised, but pelvic lymph node metastases are often found upon surgical resection only. Early selection for multimodal treatment requires reliable noninvasive staging. ...

Abstract	Background: For penile cancer patients with pelvic metastases, multimodal treatment is advised, but pelvic lymph node metastases are often found upon surgical resection only. Early selection for multimodal treatment requires reliable noninvasive staging. Objective: To evaluate the diagnostic value of Design, setting, and participants: FDG-PET/CT scans performed in patients with clinically overt inguinal lymph node metastases and/or high-risk primary tumors (bulky T3 or T4) were retrospectively analyzed. Outcome measurements and statistical analysis: All scans were reviewed by two independent nuclear medicine physicians staging the pelvic nodes and distant metastases. FDG-PET/CT findings were compared with histology after node dissection if available, or with positive imaging or follow-up of at least 1 yr. Results and limitations: Between 2006 and 2016, 61 patients met the inclusion criteria. For staging of pelvic nodes, sensitivity was 85% (specificity 75%, negative predictive value [NPV] 90%, and positive predictive value [PPV] 65%). For the detection of distant metastases, FDG-PET/CT had a PPV of 93%. Results are limited by the retrospective design and the lack of direct comparison with CT scanning alone. Conclusions: FDG-PET/CT has high sensitivity and a high NPV for staging of pelvic lymph nodes in high-risk penile cancer. It also has a high PPV for the detection of distant metastases, which were found in 23% of patients. Therefore, FDG-PET/CT enables early selection for multimodal treatment of patients with pelvic metastases and may help avoid futile treatment of patients with distant metastases. Patient summary: We studied whether positron emission tomography with computed tomography (PET/CT) scans in patients with advanced penile cancer can detect metastases before lymph node surgery is done. PET/CT scans can detect or rule out pelvic lymph node metastases, and can detect distant metastases. This helps in making timely treatment decisions (before surgery).
MeSH term(s)	Fluorodeoxyglucose F18 ; Humans ; Lymphatic Metastasis/diagnostic imaging ; Male ; Penile Neoplasms/diagnostic imaging ; Penile Neoplasms/pathology ; Positron Emission Tomography Computed Tomography/methods ; Positron-Emission Tomography ; Radiopharmaceuticals ; Retrospective Studies ; Tomography, X-Ray Computed
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2021-03-06
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-4569
ISSN (online)	2405-4569
DOI	10.1016/j.euf.2021.02.012
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Article ; Online: Defining the Tumor Microenvironment of Penile Cancer by Means of the Cancer Immunogram.

de Vries, Hielke-Martijn / Ottenhof, Sarah R / Horenblas, Simon / van der Heijden, Michiel S / Jordanova, Ekaterina S

European urology focus

2019 Volume 5, Issue 5, Page(s) 718–721

Abstract: Current chemotherapeutic treatment for advanced penile squamous cell carcinoma has substantial side effects and no randomized data to support an overall survival benefit. Immunotherapy with checkpoint blockade is currently being tested in penile cancer ... ...

Abstract	Current chemotherapeutic treatment for advanced penile squamous cell carcinoma has substantial side effects and no randomized data to support an overall survival benefit. Immunotherapy with checkpoint blockade is currently being tested in penile cancer patients in clinical trials. The high PD-L1 expression and CD8
MeSH term(s)	Humans ; Immunotherapy ; Male ; Penile Neoplasms/immunology ; Penile Neoplasms/pathology ; Penile Neoplasms/therapy ; Tumor Microenvironment
Language	English
Publishing date	2019-03-09
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2405-4569
ISSN (online)	2405-4569
DOI	10.1016/j.euf.2019.02.019
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Article ; Online: Clinicopathological predictors of finding additional inguinal lymph node metastases in penile cancer patients after positive dynamic sentinel node biopsy: a European multicentre evaluation.

de Vries, Hielke M / Lee, Hack Jae / Lam, Wayne / Djajadiningrat, Rosa S / Ottenhof, Sarah R / Roussel, Eduard / Kroon, Bin Klaas / de Jong, Igle Jan / Oliveira, Pedro / Alnajjar, Hussain M / Albersen, Maarten / Muneer, Asif / Sangar, Vijay / Parnham, Arie / Ayres, Benjamin / Watkin, Nick / Horenblas, Simon / Stuiver, Martijn M / Brouwer, Oscar R

BJU international

2022 Volume 130, Issue 1, Page(s) 126–132

Abstract: Objective: To develop a predictive model for additional inguinal lymph node metastases (LNM) at inguinal lymph node dissection (ILND) after positive dynamic sentinel node biopsy (DSNB) using DSNB characteristics to identify a patient group in which ILND ...

Abstract	Objective: To develop a predictive model for additional inguinal lymph node metastases (LNM) at inguinal lymph node dissection (ILND) after positive dynamic sentinel node biopsy (DSNB) using DSNB characteristics to identify a patient group in which ILND might be omitted. Patients and methods: We conducted a retrospective study of 407 inguinal basins with a positive DSNB in penile cancer patients who underwent subsequent ILND from seven European centres. From the histopathology reports, the number of positive and negative lymph nodes, presence of extranodal extension and size of the metastasis were recorded. Using bootstrapped logistic regression, variables were selected for the clinical prediction model based on the optimization of Akaike's information criterion. The area under the curve (AUC) of the receiver-operating characteristic curve was calculated for the resulting model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Results: Of the positive DSNBs, 64 (16%) harboured additional LNM at ILND. Number of positive nodes at positive DSNB (odds ratio [OR] 2.19, 95% confidence interval (CI) 1.17-4.00; P = 0.01) and largest metastasis size in mm (OR 1.06, 95% CI 1.03-1.10; P = 0.001) were selected for the clinical prediction model. The AUC was 0.67 (95% CI 0.60-0.74). The DCA showed no clinical benefit of using the clinical prediction model. Conclusion: A small but clinically important group of basins harbour additional LNM at completion ILND after positive DSNB. While DSNB characteristics were associated with additional LNM, they did not improve the selection of basins in which ILND could be omitted. Thus, completion ILND remains necessary in all basins with a positive DSNB.
MeSH term(s)	Humans ; Lymph Node Excision ; Lymph Nodes/pathology ; Lymphatic Metastasis/pathology ; Male ; Models, Statistical ; Neoplasm Staging ; Penile Neoplasms/pathology ; Penile Neoplasms/surgery ; Prognosis ; Retrospective Studies ; Sentinel Lymph Node Biopsy/methods
Language	English
Publishing date	2022-01-07
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	1462191-5
ISSN	1464-410X ; 1464-4096 ; 1358-8672
ISSN (online)	1464-410X
ISSN	1464-4096 ; 1358-8672
DOI	10.1111/bju.15678
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Article ; Online: Expression of Programmed Death Ligand 1 in Penile Cancer is of Prognostic Value and Associated with HPV Status.

Ottenhof, Sarah R / Djajadiningrat, Rosa S / de Jong, Jeroen / Thygesen, Helene H / Horenblas, Simon / Jordanova, Ekaterina S

The Journal of urology

2016 Volume 197, Issue 3 Pt 1, Page(s) 690–697

Abstract: Purpose: PD-L1 (programmed death ligand 1) inhibits T-cell function and prevents tumor eradication. This is facilitated by PD-L1 positive tumor cells and PD-L1 positive immune cells, and can be prevented by anti-PD-1 (programmed death 1)/PD-L1 ... ...

Abstract	Purpose: PD-L1 (programmed death ligand 1) inhibits T-cell function and prevents tumor eradication. This is facilitated by PD-L1 positive tumor cells and PD-L1 positive immune cells, and can be prevented by anti-PD-1 (programmed death 1)/PD-L1 immunotherapy. In advanced penile cancer there is a need for new therapeutic strategies. We investigated PD-L1 expression in penile cancers and compared PD-L1 expression with disease specific survival, lymph node metastases at diagnosis and high risk HPV status in a large patient cohort. Materials and methods: A total of 213 primary tumors were immunohistochemically stained for PD-L1 and scored for tumor (percentage), stroma (binary) and PD-L1 positive tumor infiltrating macrophages. Additionally, PD-L1 positive tumors were scored for expression pattern, that is diffuse or predominantly present at the tumor-stroma margin. Results: Staining was successful in 200 tumors, of which 75% were high risk HPV negative. Median followup was 62 months. Of 200 tumors 96 (48%) were PD-L1 positive (scored 1% or greater), of which 59 (62%) had a marginal expression pattern and 79 (82%) were high risk HPV negative (p = 0.03). Compared to PD-L1 negative tumors, the PD-L1 expression patterns had different prognostic values in the whole cohort as well as in the high risk HPV negative subgroup. On multivariable analyses a marginal expression pattern was associated with absent lymph node metastases (OR 0.4) while diffuse expression was associated with poor survival (HR 2.58). These results were more prominent in the high risk HPV negative subgroup (OR 0.25, HR 3.92). Conclusions: PD-L1 was expressed in 48% of penile carcinomas and mainly in high risk HPV negative tumors. The pattern of expression was a prognostic factor as marginal expression was associated with absent lymph node metastases and diffuse expression was associated with poor survival.
MeSH term(s)	B7-H1 Antigen/metabolism ; Cohort Studies ; Humans ; Male ; Papillomavirus Infections/complications ; Papillomavirus Infections/metabolism ; Penile Neoplasms/metabolism ; Penile Neoplasms/mortality ; Penile Neoplasms/virology ; Predictive Value of Tests ; Prognosis
Chemical Substances	B7-H1 Antigen ; CD274 protein, human
Language	English
Publishing date	2016-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2016.09.088
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Article ; Online: Surgical and Oncological Outcomes in Patients After Vascularised Flap Reconstruction for Locoregionally Advanced Penile Cancer.

Ottenhof, Sarah R / Leone, Andrew / Djajadiningrat, Rosa S / Azizi, Mounsif / Zargar, Kamran / Kidd, Laura C / Diorio, Gregory / Mosiello, Gerard / Graafland, Niels M / Spiess, Philippe E / Horenblas, Simon

European urology focus

2018 Volume 5, Issue 5, Page(s) 867–874

Abstract: Background: Treatment of locoregionally advanced penile squamous cell carcinoma (LAPSCC) is challenging. The exact role (in terms of oncological benefit) of extensive surgery is not well established. Moreover, surgery invariably leads to large defects ... ...

Abstract	Background: Treatment of locoregionally advanced penile squamous cell carcinoma (LAPSCC) is challenging. The exact role (in terms of oncological benefit) of extensive surgery is not well established. Moreover, surgery invariably leads to large defects requiring reconstructive surgery. Rectus abdominis myocutaneous (RAM) and abdominal advancement flaps have an independent and constant blood supply, are easily harvested, and provide substantial skin coverage and soft tissue. Objective: To determine the surgical and oncological outcomes in patients with LAPSCC undergoing surgical resection with RAM flaps. Design, setting, and participants: From 2002 to 2016, a multi-institutional database identified 15 LAPSCC patients undergoing flap reconstructions. Intervention: Local surgical resection with RAM or abdominal advancement flap reconstruction. Outcome measurements and statistical analysis: Perioperative and pathologic data were collected. Postoperative complications were identified using the Clavien-Dindo classification for surgical complications. Results and limitations: Fifteen patients (median age 61 yr) were treated, ten with curative intent. Thirteen patients received induction chemotherapy. Thirteen of the 15 patients (87%) experienced wound complications, including five Clavien-Dindo grade III complications. In 11/15 patients (73%), the disease recurred (median recurrence-free interval 106 d). The majority of recurrences (91%) were locoregional, and in four cases the patient also had lesions in distant organs. Ten of the 15 patients (67%) died of their disease. The overall median follow-up interval was 10.5 mo. The study was limited by its retrospective design, the absence of quality-of-life measurements, and the cohort size. Conclusions: The results of this study show that surgical resection with reconstruction is associated with a risk of perioperative complications, including high-grade Clavien-Dindo complications. With a cure rate of 27%, surgery must be carefully considered and there is a need for alternative treatments. Lack of robust quality-of-life-data is also a serious shortcoming in the decision process for this patient category. Patient summary: Surgery in locoregionally advanced penile cancer has a low cure rate. Reconstruction of defects is surgically feasible, albeit with a high risk of complications. Furthermore, decision-making lacks robust data on quality of life after surgery.
MeSH term(s)	Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Humans ; Male ; Middle Aged ; Myocutaneous Flap/blood supply ; Neoplasm Staging ; Penile Neoplasms/pathology ; Penile Neoplasms/surgery ; Postoperative Complications/epidemiology ; Reconstructive Surgical Procedures/methods ; Rectus Abdominis/transplantation ; Retrospective Studies ; Treatment Outcome ; Urologic Surgical Procedures, Male/methods
Language	English
Publishing date	2018-02-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-4569
ISSN (online)	2405-4569
DOI	10.1016/j.euf.2018.02.002
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Article ; Online: Penile Sparing Surgery for Penile Cancer: A Multicenter International Retrospective Cohort.

Baumgarten, Adam / Chipollini, Juan / Yan, Sylvia / Ottenhof, Sarah R / Tang, Dominic H / Draeger, Désirée / Protzel, Chris / Zhu, Yao / Ye, Ding-Wei / Hakenberg, Oliver W / Horenblas, Simon / Watkin, Nicholas A / Spiess, Philippe E

The Journal of urology

2017 Volume 199, Issue 5, Page(s) 1233–1237

Abstract: Purpose: We evaluated recurrence outcomes of penile sparing surgery in what is to our knowledge the largest multicenter cohort of patients to date.: Materials and methods: We retrospectively identified patients treated with penile sparing surgery ... ...

Abstract	Purpose: We evaluated recurrence outcomes of penile sparing surgery in what is to our knowledge the largest multicenter cohort of patients to date. Materials and methods: We retrospectively identified patients treated with penile sparing surgery from May 1990 to July 2016 at 5 tertiary referral institutions. Treatments consisted of circumcision, wide local excision, laser therapy with or without local excision, partial or total glansectomy and glans resurfacing. The study primary end point was local recurrence-free survival, defined from initial treatment to time of local recurrence and estimated with the Kaplan-Meier method. Results: After applying study exclusion criteria 1,188 patients were included in analysis. During the median followup of 43.0 months there were 252 local recurrences (21.2%), of which 99 (39.3%) developed in year 1. Median time to local recurrence was 16.3 months and the 5-year local recurrence-free survival incidence was 73.6%. When stratified by stage, the 5-year local recurrence-free survival rate was 75.0%, 71.4% and 75.9% in Ta/Tis, T1 and T2 cases, respectively (log rank p = 0.748). Of the recurrences 58.3% were treated with repeat organ sparing procedures and the secondary partial (total) penectomy rate was 19.0%. Only margin status was significantly associated with local recurrence on multivariate analysis (p = 0.001). Study limitations included the retrospective design and the heterogeneous clinical approach. Conclusions: Penile sparing surgery can provide excellent local control for superficial penile tumors as well as for appropriately selected invasive lesions. Strict followup in the early postoperative period is highly recommended.
MeSH term(s)	Aged ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Laser Therapy/adverse effects ; Laser Therapy/methods ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging ; Organ Sparing Treatments/adverse effects ; Organ Sparing Treatments/methods ; Patient Selection ; Penile Neoplasms/mortality ; Penile Neoplasms/pathology ; Penile Neoplasms/surgery ; Penis/pathology ; Penis/surgery ; Retrospective Studies ; Survival Rate ; Urologic Surgical Procedures, Male/methods
Language	English
Publishing date	2017-11-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2017.10.045
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