The authors of a letter replying to a comment in a urology journal have retracted their response because it contained inappropriate figures. At least, that’s the official story.
The original paper, “Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy,” came from a group at Weill Medical College of Cornell University led by Ashutosh Tewari. Published in July 2012 in European Urology, it purported to find that:
Our study reports a correlation between risk-stratified grade of NS [nerve-sparing] technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety.
The study prompted an editorial from Australian cancer specialists Declan Murphy and Anthony Costello, titled “How Can the Autonomic Nervous System Contribute to Urinary Continence Following Radical Prostatectomy? A “Boson-like” Conundrum.”
The take-home of the piece was this:
[O]ne must consider that the contention of Srivastava et al. in this current paper that a graded approach to NVB [neurovascular bundle] sparing correlates with early return of urinary continence following RARP [robot-assisted radical prostatectomy] is hypothesis generating and not proof of principle. To move this forward and in the absence of anatomic evidence that the NVB provides any relevant neural supply to facilitate male urinary continence, the urologic equivalent of the Large Hadron Collider would need to be deployed to demonstrate that the autonomic nerve supply to the penis plays any significant role in the control of male urinary continence. Until then, we must concede that other well-established factors, such as patient age, are more predictive of this important outcome.
The authors of the study were invited to rebut the Australians’ editorial, which they did in a March 2013 reply. Leading to this:
The authors of this paper have requested for it to be retracted on account of the inclusion of mislabeled, non-referenced figures. Figures 2 and 3 were inadvertently incorrectly labeled and inserted without acknowledgement of their source: A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers. Takenaka A, Hara R, Soga H, Murakami G, Fujisawa M. BJU Int. 2005;95:766–71. http://dx.doi.org/10.1111/j.1464-410X.2005.05397.x
Murphy gave us more details about the case, which offer a bit more color than does the version in the notice:
It was one of our Masters students at the University of Melbourne (doing an MD on peri-prostatic anatomy) who recognised the images in the now retracted paper. When we got the original 2005 paper out our jaws hit the floor!! We couldn’t believe they had basically added new labels onto the 2005 paper and had not referenced the paper in the text (making it less easy to spot), and this action totally changed the meaning of the images. By swapping the autonomic nervous system for the somatic, it’s like swapping black for white. It nicely supported the rebuttal of the argument we made in our editorial, but it was based on misrepresentation of other (good) work. Dr Tewari’s group have published nice work on the anatomy before and we were very surprised to see what they had done with these unreferenced images.
I let Editor in Chief Jim Catto and Managing Editor Cathy Pierce know by email before I uploaded a formal letter to the editor including the attached image which showed the misleading re-labelling. I gather that the authors wanted to issue some form of “clarification” or corrigendum initially, however, myself and Tony Costello were of the view that it should simply be retracted according to COPE and all other guidelines. It went to the Elsevier Board in July and they approved a full retraction.
You can see the images in question here (keep scrolling for author’s response):
Tewari, co-author of the original paper (and the rebuttal), told us that:
We basically have said that patients who have aggressive prostate cancer and get non nerve sparing surgery also face more urinary issues. Mostly nerve sparing is considered to be pertaining only to sexual and not to the urinary function. Not only us but few other groups have seen this trend that if we don’t save nerves patients also have urinary issues. We did not study why this could happen. However a hypothetical point was raised in a letter to editor as why this could happen- “Boson like conundrum” In order to make a point that there could be possible cross connections between sexual nerves and urinary sphincter we used images from a friend Dr Takenaka form japan who had left a deck of slides about 5 years ago when he visited New York and spend few months with our program. Based on our discussions during his visit. I was aware that he had dissected some of the nerves to highlight cross connections between various nerves involving urinary and sexual function.
My fellows went through his loaned deck of images he had left to be used for presentations and selected one which appeared to be the one showing the connection. They were all labeled in Japanese. In order to give him credit for the image, we added him as a coauthor in this response. The figure chosen was not the correct figure (there was another one that was the correct figure). Later on Dr Takenaka e mailed that the correct one was a different one showing cross connections between various nerve types.
The correct image supporting the connection has been been published by Dr Takenaka else where.
This partial image retraction does not impact any other work or publication.