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Directory of Authors from the Journal and their last article.

Caroline C SigmanView Articles
Carolyn FronczakView Articles

Volume 13, Number 4Review Articles

Fertility and the Aging Male

Condition Review

Randall B MeachamIsiah HarrisCarolyn FronczakLauren Roth

In the United States since 1980, the birth rate in women aged > 35 years has increased by nearly 60%, whereas the birth rate for women aged 20 to 34 years has increased by only 10%. The trend in parenthood at an older age has also been seen in men. Since 1980, the fertility rate for men in their 30s has increased by 21% and for men aged 40 years and older, the rate has increased nearly 30%. In contrast, the fertility rate in men younger than age 30 years has decreased by 15%. Age-related infertility will continue to be a problem. A basic understanding of the issues is critical for health care professionals so that they can effectively counsel patients who are considering a delay in childbearing for social reasons or for those seeking fertility treatments. This review details the changes in fertility seen in the aging male. [Rev Urol. 2011;13(4):e184-e190 doi: 10.3909/riu0538] © 2011 MedReviews®, LLC

Aging maleFertilityMiscarriage ratesAge-related infertility

Carrie Lyn SammarcoView Articles

Volume 21, Number 2Review Articles

Nocturia in Patients With Multiple Sclerosis

Management Review

Benjamin M BruckerRoger R DmochowskiW Stuart ReynoldsBenoit PeyronnetXavier GaméLauren B KruppGérard AmarencoJean-Nicolas CornuLana Zhovtis RyersonCarrie Lyn SammarcoJonathan E HowardRobert W Charlson

The prevalence of nocturia in patients with multiple sclerosis (MS) is high, ranging from 20.9% to 48.8% in this population. Its underlying pathophysiology is complex and different from the non-neurogenic population. In the MS population, the pathophysiology may involve neurogenic lower urinary tract dysfunction (NLUTD) such as detrusor overactivity (NDO), detrusor-sphincter dyssynergia, or detrusor underactivity resulting in reduced bladder capacity. Nocturnal polyuria is also a significant contributor to the pathogenesis of nocturia in MS patients and may be the result of specific mechanisms such as nocturnal hypertension through autonomic cardiovascular dysfunction or lack of diurnal variation of antidiuretic hormone production (ADH) due to demyelinating lesions of the spinal cord. Nocturia might be particularly burdensome in MS patients by contributing to fatigue, a common and highly debilitating symptom in this population. There is likely a complex and multidirectional relationship between nocturia, other sleep disorders, and fatigue in the MS population that has yet to be explored. The assessment of nocturia in MS should rely upon a thorough history and physical examination. Urinalysis should be done to rule out urinary tract infection, a frequency-volume chart might help elucidating the underlying mechanisms, and post-void residual volume may be of interest to screen for urinary retention that could be asymptomatic in MS patients. Other tests such as urodynamics or polysomnography are indicated in selected patients. The treatment should be tailored to the underlying cause. The first steps involve behavioral interventions and treatment of cofactors. When possible, the predominant mechanism should be addressed first. In case of predominant NDO, antimuscarinics and beta-3 agonists should be offered as a first-line treatment and intradetrusor injections of botulinum toxin as a second-line treatment. In cases of incomplete bladder emptying, clean-intermittent self-catheterization is often used as part of multiple other interventions. In cases of nocturnal polyuria, desmopressin may be offered, inclusive of use of newer formulations (desmopressin acetate nasal spray, desmopressin orally disintegrated tablet) in countries where they are approved. [Rev Urol. 2019;21(2/3):63–73] © 2019 MedReviews®, LLC

NocturiaMultiple sclerosisFatigueDesmopressinNocturnal polyuriavoiding diary

Carter BoydView Articles

Volume 20, Number 3Original Research

Accuracy in 24-hour Urine Collection at a Tertiary Center

Dean G AssimosKyle WoodCarter BoydDustin WhitakerOmotola AshorobiRobert OsterLisa HarveyRoss P Holmes

There is a paucity of studies addressing the accuracy of 24-hour urine collection for assessing stone risk parameters. Collection accuracy is thought to be essential for assigning optimal therapy for stone prevention. The objective of this study was to determine factors associated with accurate and inaccurate collections. During a 2-year period (2015-2016), 241 stone formers completed 24-hour urine collections. They were divided into accurate collectors (AC), defined as at least one accurate urine collection, and inaccurate collectors (IC). Accuracy was assessed by 24-hour urine creatinine (Cr) excretion indexed to body weight (normal: males, 20-25 mg Cr/kg; females, 15-20 mg Cr/kg). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included the chi-square test, Fisher’s exact test, and the two-group t-test. Average age was 50.7 years at the time of collection; 50.2% were men, 86% were white, and 14% were black. Overall, 51.0% of collections were inaccurate. There was no statistical significance between AC and IC for gender (P = 0.85), race (P = 0.90), insurance status (P = 0.85), recurrence (P = 0.87), stone type (P = 0.57), education (P = 0.35), income (P = 0.42), or poverty (P = 0.35). Older age (P = 0.017) and having a partner (P = 0.022) were significantly associated with AC. The high rate of inaccurate 24-hour urine collections is a concern. The only factors we identified as influencing collection accuracy were age and partner status. These results underscore the importance of developing methods to improve the accuracy of collecting 24-hour urine samples. [Rev Urol. 2018;20(3):119–124 doi: 10.3909/riu0807] © 2018 MedReviews®, LLC

Kidney stonesMetabolic evaluation24-hour urine collectionaccuracyDemographicsSocioeconomic factors

Carter J BoydView Articles

Volume 22, Number 1Review Articles

Obesity and Its Impact on Kidney Stone Formation

Disease State Review

Dean G AssimosKyle WoodWilliam PooreCarter J BoydNikhi P SinghBarbara Gower

The prevalence of obesity is rising and places this cohort at risk for developing kidney stones. Some of the pathophysiologic responses that link obesity and kidney stone formation have been identified. Herein, we review the involved mechanisms driving this relationship and the impact of various weight loss strategies on kidney stone risk. [Rev Urol. 2020;22(1):17–23] © 2020 MedReviews®, LLC

ObesityKidney stonesDiabetesMetabolic syndromeHypertensionWeight managementObese animal models

Casey G KowalikView Articles

Volume 20, Number 1Review Articles

Nocturia: Evaluation and Current Management Strategies

Management Update

Roger R DmochowskiW Stuart ReynoldsAlan J WeinCasey G KowalikJoshua A CohnSophia DelpeMelissa R KaufmanDoug F Milam

Nocturia is a complex condition that not only significantly affects quality of life, but may be an indicator of systemic disease. Initial assessment includes a detailed history and physical examination and completion of a frequency volume chart to help identify underlying causes, such as sleep disorders, bladder storage disorders, and polyuria. Treatment with alpha-blockers or antimuscarinic medications may help if the underlying cause is determined to be benign prostatic hyperplasia or overactive bladder, respectively. Treatment options for nocturnal polyuria have been limited to behavioral therapy and off-label use of timed diuretics and desmopressin. Desmopressin acetate nasal spray (Noctiva™, Avadel Pharmaceuticals, Chesterfield, MO) was approved by the US Food and Drug Administration in 2017 for the treatment of nocturia due to nocturnal polyuria in adults who awaken at least twice nightly and has shown efficacy in reducing nocturnal voids by $50% in up to 49% of patients in clinical trials. [Rev Urol. 2018;20(1):1–6 doi: 10.3909/riu0797] © 2018 MedReviews®, LLC

Benign prostatic hyperplasiaNocturiaDesmopressinNocturnal polyuriaOveractive bladder

Celeste KirschnerView Articles
Celestia HiganoView Articles

Volume 9, Number 4Review Articles

Estrogenic Side Effects of Androgen Deprivation Therapy

Treatment Update

Michael S CooksonJames A EasthamTheresa A GuiseMichael G OefeleinMatthew R SmithCelestia Higano

Androgen deprivation therapy (ADT) is part of standard therapy for locally advanced or metastatic prostate cancer and is frequently used in men with a rising prostate-specific antigen following radical prostatectomy or radiation therapy. In some men, ADT may be administered for years or even decades. The intended therapeutic effect of ADT is testosterone deficiency. Because estrogen is a normal metabolite of testosterone, ADT also results in estrogen deficiency. ADT has a variety of adverse effects, many of which are primarily related to estrogen deficiency. Bone mineral density may decrease by 4% to 13% per year in men receiving ADT. The fracture rate for patients on ADT averages 5% to 8% per year of therapy. Hot flashes, gynecomastia, and breast tenderness are common side effects associated with ADT. In the clinic, minimum baseline testing should include weight measurement, blood pressure reading, and fasting lipid panel and serum glucose tests. Currently, there are no large outcome trials in men on ADT testing the available therapies for adverse effects. No therapies are specifically approved for treatment of adverse effects in men on ADT. Although some therapies can be used for a single indication (based upon small studies), there is currently no agent to treat the multiple estrogenic side effects of ADT. [Rev Urol. 2007;9(4):163-180]

Androgen deprivation therapyCardiovascular diseaseGynecomastiaOsteoporosis fractureMale hot flashes

Cevdet KayaView Articles

Volume 17, Number 3Case Review

Retroperitoneal Ancient Schwannoma: A Case Report

Selahattin ÇalIiskanGülistan GümrükçüCevdet Kaya

Schwannomas are extremely rare tumors that are composed of Schwann cells. Retroperitoneal localization comprises 0.7% to 2.6% of all schwannomas. Patients usually present with nonspecific symptoms. There are no pathognomonic features on radiologic evaluation. Preoperative biopsy is not recommended because of complication risks; however, surgery is necessary for diagnosis and treatment. Although most schwannomas are benign tumors, those that are associated with von Recklinghausen disease are malignant. Schwannomas exhibit regions of high and low cellularity, termed Antoni A and Antoni B areas, with a diffuse positivity of S100 protein on pathologic evaluation. If there are degenerative changes, such as cyst formation, hemorrhage, calcification, and hyalinization, these tumors are termed ancient schwannomas. We present a case of retroperitoneal ancient schwannoma. [Rev Urol. 2015;17(3):190-193 doi: 10.3909/riu0638] © 2015 MedReviews®, LLC

Retroperitoneal schwannomaNeurilemmomaSchwannomaRetroperitoneal tumor

Charles M LakinView Articles

Volume 10, Number 3Case Review

Shock Wave Lithotripsy and Renal Hemorrhage

Case Review

J Kellogg ParsonsJonathan SilbersteinCharles M Lakin

Although shock wave lithotripsy is a safe and efficacious treatment for nephrolithiasis, the most common acute complication is renal hemorrhage. Shock wave–induced renal hemorrhage is a potentially devastating injury if not promptly recognized and treated appropriately. The authors report a large perirenal hematoma occurring after shock wave lithotripsy and review the causes, prevention, and treatment of shock wave–induced renal hemorrhage. [Rev Urol. 2008;10(3):236-241]

NephrolithiasisShock wave lithotripsyHematoma

Charles R PoundView Articles
Chiraag PatelView Articles

Volume 22, Number 3Review Articles

The Impact of Systematic Safety Precautions on COVID-19 Risk Exposure and Transmission Rates in Outpatient Healthcare Workers

Deepak A KapoorKathleen LatinoAnn E AndersonGillian HodesJonathan AndersonMarcus CognettiChiraag Patel

We evaluated the impact of safety protocols, including rapid testing and contact tracing, on coronavirus disease 2019 (COVID-19) risk exposure and transmission rates amongst healthcare workers in the outpatient care setting. Over an 11-week period, a total of 254 employees representing 38% of our total workforce had potential COVID-19 exposure and underwent voluntary COVID-19 testing. Data was stratified based on severity of risk exposure and job description. During this period, the probability of a COVID exposure being high risk decreased in Administrative (293.0%; P < 0.01) and Clinical (277.0%; P < 0.01) staff; simultaneously, viral transmission rates declined in Administrative (273.4%; P = 0.03) and Clinical (269.9%; P = 0.04) staff as well. Systematic safety protocols effectively reduce exposure risk and transmission rates in outpatient healthcare workers and should be ubiquitously adopted. [Rev Urol. 2020;22(3):93-101] © 2020 MedReviews®, LLC

SafetyCOVID-19 diagnostic testingContact tracing

Chris McClainView Articles

Volume 22, Number 2Review Articles

Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice

Original Research

Gary M KirshStephen F KappaChris McClainKrista WallacePaul CinquinaDon LawsonMary M SmithEarl WalzBrooke Edwards

Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service. [Rev Urol. 2020;22(2):67–74] © 2020 MedReviews®, LLC

Cost effectivenessCall centerTelehealthOrganizational efficiency

Chris SpeakerView Articles
Chris TyrrellView Articles
Christian SeitzView Articles

Volume 5, Number 2Meeting Reviews

Advances in the Medical Treatment of Prostate Cancer, Bladder Cancer, Renal Cell Cancer, and Benign Prostatic Hyperplasia

Highlights from the XVIIth Congress of the European Association of Urology, Birmingham, UK

Claus G RoehrbornBob DjavanMesut RemziChristian Seitz

Prostate cancerBenign prostatic hyperplasiaBladder cancerLower urinary tract symptomsProstate-specific antigenRadical prostatectomyRadical nephrectomyNomogramsTamsulosinAlfuzosinFinasterideDutasterideBicalutamideBacille Calmette-GuerinPermixonRenal cell cancerTransrectal ultrasound-guided biopsyVirtual cystoscopy

Christian TwissView Articles
Christina CarnegieView Articles
Christina KimView Articles
Christopher CefaluView Articles

Volume 18, Number 4Case Review

Gossypiboma Manifesting as Urachal Mass

Nirmish SinglaAhmed Q HaddadChristopher CefaluVitaly Margulis

Gossypiboma (retained surgical sponge) occurs between 1 in 1000 and 1 in 1500 of all intra-abdominal operations. Patients with gossypibomas may present asymptomatically or with nonspecific symptoms, such as abdominal pain or bloating; identification frequently relies on imaging. Results of imaging alone, however, may appear nonspecific, and the gossypiboma may mimic other masses, such as neoplasms, hematomas, or abscesses. They require surgical removal for definitive diagnosis and treatment. Herein we present an unusual case of gossypiboma masquerading as an urachal mass in a 75-year-old woman. Diagnostic evaluation, natural history, and prevention of retained surgical materials are discussed. [Rev Urol. 2016;18(4):239-241 doi: 10.3909/riu0703] © 2016 MedReviews®, LLC

GossypibomaUrachal massSurgical errorsPatient safety