antigen (PSA) level of ≤ 10 ng/mL, a Gleason sum of ≤ 7 and a prostate volume of ≤ 50 mL. This group was randomly divided in those having SV-RPP (147 men) and a classical RPP (171); men in the third group with adverse factors were offered a classical RRP (190). The main endpoint of the trial was the early continence rate at 4 weeks after surgery. RESULTSThe oncological outcome of patients treated with SV-RPP was no different from that of RPP or RRP. Continence rates (0-1 pad/day) at 4 weeks and 12 months after SV-RPP were 61.7% and 96.3%, respectively, and significantly higher than with RPP ( P < 0.023) and RRP ( P < 0.005). The transfusion rates (3.4%), anastomotic leaks (6.6%) and mean operative duration (90 min) were significantly lower. CONCLUSIONSSV-RPP is a better technique in reducing complications during and after surgery for selected patients. Leaving the SV in place did not increase the short-term PSA relapse rates. As the operation was significantly faster and with better early recovery, SV-RPP might be justified if the long-term oncological data confirm the efficacy of the approach. KEYWORDSprostate cancer, radical prostatectomy, perineal, nerve-sparing, seminal vesiclesparing Study Type -Therapy (RCT) Level of Evidence 1b OBJECTIVETo report a new and improved seminal vesicle-sparing (SV) technique of radical perineal prostatectomy (RPP) as an option for patients with localized prostate cancer, which is currently competing with the retropubic RP (RRP), endoscopic and robotic approaches.

OBJECTIVES In bicuspid aortic valves (BAV), commissural orientation (CO) varies between 180° and close to 120°. Postoperative CO has a strong effect on repair durability, and different repair approaches have been proposed according to CO; it is thus important for aortic repair. A precise, simple and reproducible determination by preoperative echocardiography would facilitate intraoperative decision-making. We compared 4 different methods of determination of CO in BAV. METHODS Preoperative transoesophageal echocardiograms of 62 patients with BAV were analysed. CO was measured using either the coaptation centre or the geometric centre of the root. The geometric centre of the root was determined through approximation using a circle or an ellipse, or the midpoint of a line between the centre of the non-fused and the fused sinuses. RESULTS The 3 different geometric methods led to almost identical results (interclass coefficient 0.98–0.99), with the line segment being the easiest to use. The use of the coaptation centre was associated with the underestimation of commissural angle of up to 30° compared to the geometric centre; the discrepancy was significant and most pronounced for asymmetric BAV (140–160°; P = 0.005). CONCLUSIONS CO can reproducibly be determined using a line segment between the centre of the non-fused and fused sinuses. The use of the coaptation centre can lead to misleading results, in particular in asymmetric BAVs.

What ' s known on the subject? and What does the study add? Treatment recommendations such as interdisciplinary guidelines are always based on scientifi c publications. However, high-quality studies are very often focused on single-centre series of selected cases. Health care research has failed to provide comprehensive information that describes the clinical reality of prostate cancer management even in smaller centres. This is a health care research study with 17 participating centres. Any prostate cancer centre can use the internet-based database http://prostata-ca.net , at no additional cost, to collect and analyze data for quality management, to conduct consecutive follow-up assessments, and to compare their data with the averages recorded by all other centres. The database also enables time trend analysis of certain quality parameters in an annual comparison.Study Type -Therapy (individual cohort) Level of Evidence 2b OBJECTIVES• To report our experience with an Internet-based multicentre database that enables tumour documentation, as well as the collection of quality-related parameters and follow-up data, in surgically treated patients with prostate cancer.• The system was used to assess the quality of prostate cancer surgery and to analyze possible time-dependent trends in the quality of care. PATIENTS AND METHODS• An Internet-based database system enabled a standardized collection of treatment data and clinical fi ndings from the participating urological centres for the years 2005 -2009. • An analysis was performed aiming to evaluate relevant patient characteristics (age, pathological tumour stage, preoperative International Index of Erectile Function-5 score), intra-operative parameters (operating time, percentage of nerve-sparing operations, complication rate, transfusion rate, number of resected lymph nodes) and postoperative parameters (hospitalization time, re-operation rate, catheter indwelling time).• Mean values were calculated and compared for each annual cohort from 2005 to 2008. The overall survival rate was also calculated for a subgroup of the Berlin patients. RESULTS• A total of 914, 1120, 1434 and 1750

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The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 93 patients with LV hypertrophy (LVH), either due to pressure overload or hypertrophic cardiomyopathy (HCM), and in 39 healthy volunteers. In 50 patients with LVH, outflow acceleration (gradients ranging from 19 to 130 mm Hg) was induced or accentuated by at least one provocative situation independently of LVH aetiology. In normal persons LV outflow remained unchanged. Calcium antagonist treatment reduced outflow acceleration. It is concluded that dynamic LV gradients are a non-specific flow abnormality in the spectrum of LVH that merits consideration.