Editorial Board About Us

Herbert Lepor

All articles from this author are listed below.

Volume 11, Number 4 KOL Interview

Advances in the Medical Treatment of Benign Prostatic Hyperplasia

In this KOL (key opinion leader) interview, Herbert Lepor, MD, co–Medical Editor of Reviews in Urology, discusses the medical treatment of benign prostatic hyperplasia (BPH).[Rev Urol. 2009;11(4):181-184 doi: 10.3909/riu0477]© 2009 MedReviews®, LLC

Volume 11, Number 4 Review Articles

Skin Preparation for the Prevention of Surgical Site Infection: Which Agent Is Best?

Treatment Review

Micah L Hemani Herbert Lepor

Procedural and surgical site infections create difficult and complex clinical scenarios. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure critical. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcohol-based solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for longer open surgeries with the potential for irrigation or surgical spillage, such as cystoprostatectomy, radical prostatectomy, and retroperitoneal lymph node dissection.[Rev Urol. 2009;11(4):190-195 doi: 10.3909/riu0467]© 2009 MedReviews®, LLC

Skin pathogens Procedural and surgical site infection

Volume 11, Number 3 Review Articles

Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials

Management Update

Julia Finkelstein Elisabeth Eckersberger Bob Djavan Helen Sadri Markus Margreiter Herbert Lepor Samir S Taneja

The advent of prostate-specific antigen (PSA) testing in the early 1980srevolutionized the diagnosis of prostate cancer. As a result of PSA testing,there has been a surge in the number of prostate cancer diagnoses. Thisreview examines the results of 2 recent landmark trials that studied the effectof screening on prostate cancer mortality: the European Randomized Study ofScreening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung,Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[Rev Urol. 2009;11(3):127-133 doi: 10.3909/riu0474]

PSA screening European Randomized Study of Screening for Prostate Cancer(ERSPC)Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Volume 11, Number 2 Review Articles

Status of Radical Prostatectomy in 2009: Is There Medical Evidence to Justify the Robotic Approach?

Treatment Review

This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1- to 2-day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.[Rev Urol. 2009;11(2):61-70]

Prostate cancer Robotic-assisted Open radical retropubic prostatectomy

Volume 12, Number 3 Meeting Reviews

Uro-Oncological Controversies in Euro-Oncology

Meeting Review

Alexander Farr Elisabeth Eckersberger Helen Sadri Markus Margreiter Mike Harik Herbert Lepor Bob Djavan

Highlights From the European Association of Urology Section of Oncological Urology, January 15-17, 2010, Vienna, Austria [Rev Urol. 2010;12(2/3):e125-e128 doi: 10.3909/riu0491]

Prostate cancer screening Bladder cancer Renal cancer Robotics Cancer mortality rates

Volume 12, Number 1 Review Articles

Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience

Treatment Update

Elisabeth Eckersberger Julia Finkelstein Helen Sadri Herbert Lepor Samir S Taneja Bob Djavan

Open radical prostatectomy (ORP) is the reference standard for the surgical management of localized prostate cancer. With wider availability of minimally invasive radical prostatectomy techniques, there is a debate regarding the standard treatment of the management of localized prostate cancer. Therefore, we reviewed the current status of laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) as compared with ORP. Because no prospective, randomized trials comparing the different techniques have been performed, outcomes must be assessed from published series by centers that focus on ORP, LRP, and RALRP. Aside from reducing the amount of blood loss, current data suggest that the most significant outcomes (cure, continence, and potency) are no better with LRP or RALRP than with conventional ORP. Therefore, in experienced hands, ORP remains the gold standard procedure. However, there is a trend toward consistently better outcomes following RALRP in comparison with LRP. In the end, individual patient outcomes can be maximized by choosing the best modality based on the patient’s comorbid medical conditions, cancer characteristics, and surgeon experience. Future studies are needed to further investigate long-term cancer control as well as functional outcomes for RALRP series.[Rev Urol. 2010;12(1):35-43 doi: 10.3909/riu0470]

Prostatic neoplasms Laparoscopy Prostatectomy Robotics

Volume 13, Number 1 Review Articles

Medical Treatment of Benign Prostatic Hyperplasia

Disease State Review

"Medical therapy for the treatment of benign prostatic hyperplasia (BPH) became an accepted standard of care in the 1990s following the reports of randomized, double-blind, placebo-controlled studies showing that finasteride, a 5-_ reductase inhibitor, and terazosin, an _-blocker, significantly improved lower urinary tract symptoms and increased peak urinary flow rates in men with BPH. This article reviews novel approaches to the pharmacological treatment of BPH. [Rev Urol. 2011;13(1):20-33 doi: 10.3909/riu0519]"

Benign prostatic hyperplasia Lower urinary tract symptoms Monotherapy

Volume 13, Number 1 Literature Reviews

Minimally Invasive Ablative Therapies for the Treatment of Prostate Cancer

Prostate Cancer

[Rev Urol. 2011;13(1):61-62 doi: 10.3909/riu0520]

Volume 14, Number 3 Review Articles

Lap Pak for Abdominal Retraction

New Technology Review

Sam S Chang Amr Fergany S Bruce Malkowicz Gary D Steinberg Herbert Lepor Ganesh Sivarajan

Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges. [Rev Urol. 2012;14(3/4):41-47 doi: 10.3909/riu0572] © 2013 MedReviews®, LLC

Retraction Postoperative adhesions Retained foreign bodies Lap Pak

Volume 14, Number 1 Review Articles

LHRH Agonists for the Treatment of Prostate Cancer: 2012

Management Review

Herbert Lepor Neal D Shore

The most recent guidelines on prostate cancer screening from the American Urological Association (2009), the National Comprehensive Cancer Network (2011), and the European Association of Urology (2011), as well as treatment and advances in disease monitoring, have increased the androgen deprivation therapy (ADT) population and the duration of ADT usage as the first-line treatment for metastatic prostate cancer. According to the European Association of Urology, gonadotropin-releasing hormone (GnRH) agonists have become the leading therapeutic option for ADT because they avoid the physical and psychological discomforts associated with orchiectomy. However, GnRH agonists display several shortcomings, including testosterone (T) surge (“clinical flare”) and microsurges. T surge delays the intended serologic endpoint of T suppression and may exacerbate clinical symptoms. Furthermore, ADT manifests an adverse-event spectrum that can impact quality of life with its attendant well-documented morbidities. Strategies to improve ADT tolerability include a holistic management approach, improved diet and exercise, and more specific monitoring to detect and prevent T depletion toxicities. Intermittent ADT, which allows hormonal recovery between treatment periods, has become increasingly utilized as a methodology for improving quality of life while not diminishing chronic ADT efficacy, and may also provide healthcare cost savings. This review assesses the present and potential future role of GnRH agonists in prostate cancer and explores strategies to minimize the adverse-event profile for patients receiving ADT. [ Rev Urol. 2012;14(1/2):1-12 doi:10.3909/riu0547 ] © 2012 MedReviews®, LLC

Wilms’ tumor Renal mass Open radical nephrectomy Multimodal therapy