Urology Research

Publication Analysis 2007-2013
by Kathleen Gransalke, Labtimes 05/2016

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Highly-cited European urologists have only one thing on their mind – diagnosing and finding the best treatment for prostate cancer. Germany and Italy are the top countries for this research.

Photo: Pixabay/Markus Spiske

It was one of those studies that first makes you laugh and then makes you think – think about one of the most fundamental questions in urology: how long does it take for mammals to empty their bladders? Funnily, scientists at the Georgia Institute of Technology in Atlanta found that no matter whether you are an elephant, a dog or a human, the act of urination takes about 21 seconds (PNAS, 111(33): 11932-7). “It’s possible because larger animals have longer urethras,” lead author David Hu later explained, “The weight of the fluid in the urethra is pushing the fluid out. And because the urethra is long, flow rate is increased.” It goes without saying that this urological research gem won last year’s IgNobel Prize in the Physics category. Is European urological research, conducted between 2007 and 2013 also prize-worthy? We’re about to find out with this publication analysis.

First, let’s have a look back at the last urology publication analysis from 2010 (LT 4-2010), covering research papers, reviews and proceedings papers from 1997 to 2008. The hottest topic back then was tumours of the urogenital tract, in particular prostate cancer; England and Germany were the top two countries, respectively, in urological research.

For our current publication analysis, we again started with identifying the discipline’s specialist journals, as defined by Web of Science’s subject category Urology and Nephrology. These are the basis for the nations’ ranking. Among journals, such as European Urology or BJU International, we also discovered less well-known titles like Archivos Españoles de Urología, which also provide a somewhat different look at urological research. In Penile Representation in Ancient Greek Art, we, for instance, learn that the “representation of the over-sized and erected genitalia on vase figures or statues of ancient Greek art is related to fertility gods such as Priapus, Pan and Satyrs and there is strong evidence that imagination and legend were replacing the scientific achievements in the field of erectile function for many centuries” (Arch Esp Urol, 66(10): 911-6).

From first to third place: England

In modern times, European urologists use their imagination to, of course, advance their field. This is especially true for urologists in Germany, who took the lead position in the nations’ ranking, followed by Italy. England toppled from first to third place. These placings are based on total number of citations. When looking at the citations-per-paper ratio, different nations emerge as winners. On top, surprisingly, Russia with 56.4 citations per paper on average. This high number can be easily explained: among the 59 articles published in urology specialist journals, quite a few are multi-author guideline articles on the treatment or diagnosis of certain diseases, which are usually highly cited. This also explains Belgium’s (32.7) and the Czech Republic’s (31.3) good standing in this category.

Worldwide, European urologists wrote more papers than their US-American colleagues but those papers attracted less citations overall. During our database investigation, we came across many collaborations between European and US-American as well as Canadian scientists. Urological research hence seems to be a truly global effort.

This brings us to the discipline’s hottest research topics. As mentioned above, back in 2010, papers and reviews about prostate cancer were the ones with the highest citation numbers. Six years later, this has not changed. Prostate cancer is still one of the most researched areas in urological research and is, thus, highly cited. Our top five of the most-cited papers in urological research includes four publications that deal with this topic. Papers in first and fifth place are about the disease’s mortality rate; in places three and four are guideline papers from the European Association of Urology (EAU) that “summarise the most recent findings and put them into clinical practice” – these are updated every few years. In second place is another guideline paper from the EAU, this time about renal cell carcinoma.

Urologist or oncologist?

Who wrote those highly cited papers? Many of our top 30 highly-cited urologists. Before we have a closer look at the most-cited author ranking in urology, a few words about our selection criteria. The top papers’ topic already give you a hint that for this publication analysis the main crux is separating urologists from oncologists. Therefore, we decided that only scientists, who published the majority of their papers and reviews in urology specialist journals, or at least published more papers in urology journals than in oncology journals, will be included.

Even with this sort of cancer exclusion method, almost all of our top 30 European urologists are uro-oncologists, with a focus on prostate cancer. The Europe-wide distribution of top urologists deserves a closer look. Italy, not Germany or England, hosts the most (7) highly-cited urology researchers, including the ranking’s number one, Francesco Montorsi. Six highly-cited urologists each are affiliated with hospitals, institutes or universities in The Netherlands and Germany; and there are also five French urologists among our top 30. England’s weakening position in urology research is also documented in the authors’ ranking. Only two UK urologists made our top 30. The list also includes only one woman, Monique Roobol (9th), from the Erasmus University in ­Rotterdam.

As already mentioned, tumours of the urogenital tract, in particular tumours of the prostate, are the main focus of research for Europe’s top urologists. Topics range from genome-wide association studies, better diagnosis and drug therapy, to surgery and the identification of prognostic markers. Especially trendy in the surgery department is robot-assisted prostatectomy.

Also, other urogenital tumours, such as bladder cancer and renal cell carcinoma, are of interest for some urologists, like Jean-Jacques Patard (12th). In addition to more traditional uro-oncological research, Olivier Cussenot (26th) explores somewhat different paths to detect urological tumours as early as possible: cancer-smelling dogs. “Detection of cancer by trained dogs (characterised by a high scent ability), recognising smell of volatiles organic compounds (VOCs) in human urine samples has been studied with promising results in preliminary studies. This correlation between urine odor and presence of prostate cancer was confirmed in our own experience,” he writes in a 2010 article in Progrès en Urologie.

Among the few non-cancer topics our top European urologists address are stress incontinence (Giacomo Novara, 14th; Walter Artibani, 25th) and functional reconstruction of the lower urinary tract (Christopher Chapple, 23rd).

One paper per week

One word about the ranking’s number one, Francesco Montorsi, who gathered almost twice as many citations as Teuvo Tammela in second place. Interestingly, Montorsi also wrote thrice as many papers as most other top 30 urologists. Within seven years, the scientist managed to publish 445 papers, reviews or proceedings papers – that is 63 papers per year or 1.2 papers per week. Doubts may arise over whether the criteria for proper authorship are fulfilled with all those publications. How one of those “honorary authorships” can backfire is nicely illustrated by Lab Times’ 2010 urology research number one, Georg Bartsch.

Back then urologist, Hannes Strasser from the University of Innsbruck, performed a clinical trial, using stem cells as a treatment for urinary incontinence, that was later found to have been conducted illegally, inappropriately and fraudulently. The scandal resulted in several errata and two retractions. Co-author on the retracted studies, although insisting he had no connection to the studies, whatsoever, was department head, Bartsch.

Speaking about retractions, also in this year’s top 30, a couple of authors had to retract articles. Rodolfo Montironi (13th), for instance, retracted a study for “overlap without attribution of work previously published” aka plagiarism. And also Arnulf Stenzl (18th) was involved with two retractions. The retraction statement for the article “Generation of Pluripotent Stem Cells From Adult Human Testis”, which had already gathered more than 300 citations, says that “images presented in the original version of the article made the data appear more robust than newly conducted experiments show” aka image manipulation.

At the moment, European urology research might be biased towards oncological questions but then again, which biomedical research field isn’t?

View the Tables: Europe...and the World, Most Cited Authors...and Papers

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Last Changed: 05.10.2016