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Directory of Authors from the Journal and their last article.

Dean AssimosView Articles

Volume 20, Number 1Review Articles

Factors Associated With Postoperative Infection After Percutaneous Nephrolithotomy

Risk Factor Analysis

Win Shun LaiDean Assimos

Numerous studies have investigated risk factors for the development of postoperative infection in percutaneous nephrolithotomy (PCNL) patients. Herein, we describe our meta-analysis of the risk factors for the prediction of post-PCNL infectious complications. We searched electronic databases using a combination of the terms percutaneous nephrolithotomy, risk factors, infection, and sepsis. The primary outcome was post-PCNL infection as defined by fever greater than 38°C or sepsis as defined by the Sepsis Consensus Definition Committee. Risk factors for infection in each study were identified and included for analysis if present in at least two studies. We used quantitative effect sizes in odds ratio to assess each endpoint. After application of criteria, 24 studies were found, of which 12 were prospective and 12 were retrospective. Of the prospective studies, preoperative urine culture, renal pelvis culture, stone culture, number of access points, hydronephrosis, perioperative blood transfusion, and struvite stone composition were found to be significantly associated with postoperative infection. Of the 12 retrospective studies, preoperative urine culture, stone cultures, number of access points, blood transfusion, stone size, and staghorn formation were associated with infection. Preoperative urine culture, stone culture, number of access points, and need for blood transfusion were consistently found to be significant factors. This indicates that the presence of bacteria in the urine/stone preoperatively as well as the amount of trauma the kidney sustains during the procedure are major predictors of postoperative infection. [Rev Urol. 2018;20(1):7–11 doi: 10.3909/riu0778] © 2018 MedReviews®, LLC

Urinary tract infectionNephrolithiasisLithotripsyPercutaneous nephrostomy

Dean G AssimosView Articles
Dean L LenzView Articles
Dean S EltermanView Articles

Volume 14, Number 3Review Articles

Update on Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Treatment Update

Steven A KaplanBilal ChughtaiAlexis E TeDean S EltermanRichard K Lee

Many aging men will experience both erectile dysfunction (ED) and benign prostatic hyperplasia (BPH), resulting in lower urinary tract symptoms (LUTS). Basic and clinical evidence suggests common pathogenic mechanisms underlying both LUTS and ED. Decreases in the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway with age result in decreased levels of intracellular cGMP and calcium, leading to diminished smooth muscle relaxation of the bladder and prostate and worsening LUTS. Phosphodiesterase type 5 inhibitors as monotherapy in combination with a-blockers have shown efficacy in treating both LUTS and ED. Tadalafil has recently been approved by the US Food and Drug Administration for the treatment of LUTS secondary to BPH, with or without concomitant ED. [Rev Urol. 2012;14(3/4):79-86 doi: 10.3909/riu0559] © 2013 MedReviews®, LLC

Benign prostatic hyperplasiaLower urinary tract symptomsErectile dysfunctionPhosphodiesterase inhibitorsTadalafilSildenafilVardenafil

Debasish SundiView Articles

Volume 16, Number 4Review Articles

Extent of Pelvic Lymph Node Dissection During Radical Cystectomy: Is Bigger Better?

Management Review

Debasish SundiRobert S SvatekMatthew E NielsenTrinity J Bivalacqua

Pelvic lymph node dissection (PLND) is a standard component of radical cystectomy (RC) for bladder cancer. The optimal anatomic PLND template remains undefined. An extended PLND template can potentially improve survival through the eradication of micrometastatic disease and improved pathologic staging. However, this benefit could be compromised by a potential increase in perioperative complications and cost. Two randomized controlled clinical trials that will clarify this question are ongoing. Many important retrospective studies have provided insights into the optimal PLND extent. Here the authors review the key evidence that informs how urologists may tailor the PLND template during RC depending on patient and tumor characteristics. [Rev Urol. 2014;16(4):159-166 doi: 10.3909/riu0626] © 2014 MedReviews®, LLC

Radical cystectomyPelvic lymph node dissectionTemplateMicrometastatic disease

Debbie ChaoView Articles
Deborah A KaminskyView Articles

Volume 8, Supplement 1Review Articles

Fused Radioimmunoscintigraphy for Treatment Planning

Prostate Cancer Imaging

Rodney J EllisDeborah A Kaminsky

Advances in imaging technologies, including computerized tomography (CT) and single-photon emission tomography (SPECT), are improving the role of imaging in prostate cancer diagnosis and treatment. Hybrid (SPECT/CT) imaging, in particular, shows an increased sensitivity for identification of prostate cancer. Published studies have also recently proposed a new paradigm in the administration of radiation therapy for prostate cancer, favoring doseescalation strategies to improve tumor control for localized disease. Conventional dose-escalation protocols have previously relied primarily on margin extension to the entire prostate gland to achieve dose-escalation; extending increased risk to radiosensitive normal structures. A newer strategy proposes use of advanced imaging to confine dose-escalation to biological target volumes identified on capromab pendetide SPECT/CT-fused image sets or imageguided radiation therapy (IGRT). This strategy defines a shift in radiation dosimetry and planning from uniform glandular prescription dosing with doseescalation applied generically to the peripheral regions and margin extension; to dose-escalation confinement to discrete regions of known disease as defined by focal uptake on radioimmunoscintigraphy fusion with anatomic image sets, with minimal margin extension. The introduction of advanced imaging for IGRT in prostate cancer has also introduced an improved capability for the early-identification of patients at risk for metastatic disease, where more aggressive therapeutic interventions may prove beneficial. [Rev Urol. 2006;8(suppl 1):S11-S19]

Prostate cancerRadiotherapyBrachytherapyProstaScintSPECT/CTBiological targetvolumesSurvival

Deborah L HasenauView Articles
Deborah M Boldt-HouleView Articles

Volume 20, Number 2Original Research

Effectiveness of Subcutaneously Administered Leuprolide Acetate to Achieve Low Nadir Testosterone in Prostate Cancer Patients

Scott EggenerChristopher M PieczonkaJason HafronJoseph Renzulli IIPrzemyslaw TwardowskimDeborah M Boldt-HouleStuart Atkinson

Evidence suggests lower nadir testosterone levels during the first year of androgen deprivation therapy improve advanced prostate cancer clinical outcomes. We evaluated pivotal trials for subcutaneously administered leuprolide acetate (1-, 3-, 4-, and 6-month doses) to determine nadir testosterone levels. Pooled analysis showed 99%, 97%, and 91% of patients reached nadir testosterone ≤20, ≤10, and ≤5 ng/dL respectively (median ≤3 ng/dL). Across all available categories, ≥88% of patients reached nadir testosterone ≤5 ng/dL, and <3% experienced a microsurge. Achievement and maintenance of low nadir testosterone levels may improve progression-free survival and time to onset of castrate-resistant prostate cancer. [Rev Urol. 2018;20(2):63–68 doi: 10.3909/riu0798] © 2018 MedReviews®, LLC

Prostate cancerAndrogen deprivation therapyLHRH agonistsLeuprolide acetateNadir testosterone

Declan G MurphyView Articles
Deepak A KapoorView Articles

Volume 15, Number 4Original Research

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

Deepak A KapoorAnn E AndersonCarl A OlssonSavvas E MendrinosDavid G Bostwick

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%&mdash;this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLC

Prostate cancerProstate biopsyUtilization trendsNational reference laboratory

Deepak KapoorView Articles

Volume 20, Number 3Original Research

Histologic Changes in Prostate Cancer Detected Subsequent to the 2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening Recommendation

Ann E AndersonCarl A OlssonHugh J LaveryDeepak Kapoor

We report changes in the histopathology of prostate cancer diagnosed in a large urology group practice after the final United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen screening. All prostate biopsies performed from 2011 through 2015 in a large urology group practice were retrospectively reviewed; 2012 was excluded as a transition year. The changes in biopsy data in years following the USPSTF decision (2013-2015) were then compared with baseline (2011). A total of 10,944 biopsies were evaluated during the study period. Positive biopsy rates rose from 39.1% at baseline to 45.2% in 2015 (P < 0.01) with a marked shift toward more aggressive cancer throughout the study period. The absolute number of patients presenting with Gleason Grade Group 4 or 5 increased from 155/year at baseline to 231, 297, and 285 in 2013, 2014, and 2015, respectively (P < 0.05), unrelated to age or racial changes over time. Black men represented 16% of the cohort. Since the USPSTF recommendation against prostate cancer screening, trends toward a substantial upward grade migration and increased volume of cancers were noted in a cohort of nearly 11,000 patients in a real- world clinical practice. Additionally, continuing reductions in cancer detection in the United States may exacerbate these trends. [Rev Urol. 2018;20(3):125–130 doi: 10.3909/riu0815] © 2018 MedReviews®, LLC

Prostate cancerProstate cancer screeningHistopathologygrade migration

Deepansh DalelaView Articles

Volume 18, Number 1Review Articles

Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives

Management Update

Deepansh DalelaBjörn LöppenbergAkshay SoodJesse SammonFiras Abdollah

We performed a systematic literature search to identify original articles and editorials about the Decipher® Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level. [Rev Urol. 2016;18(1):1-9 doi: 10.3909/riu0706] © 2016 MedReviews®, LLC

Prostate cancerDecipher® Prostate Cancer TestGenomic classifierNeoplasm recurrenceLocal/surgeryTreatment outcome

Dennis B LiuView Articles

Volume 15, Number 4Case Review

Splenogonadal Fusion: An Unusual Case of an Acute Scrotum

Rena D MalikDennis B Liu

We highlight a case on a normal left testicle with a fibrovascular cord with three nodules consistent with splenic tissue. The torsed splenule demonstrated hemorrhage with neutrophilic infiltrate and thrombus consistent with chronic infarction and torsion. Splenogonadal fusion (SGF) is a rather rare entity, with approximately 184 cases reported in the literature. The most comprehensive review was that of 123 cases completed by Carragher in 1990. Since then, an additional 61 cases have been reported in the scientific literature. We have studied these 61 cases in detail and have included a summary of that information here. [Rev Urol. 2013;15(4):197-201 doi: 10.3909/riu0593] © 2014 MedReviews®, LLC

Splenogonadal fusionAcute scrotum

Dennis BentleyView Articles

Volume 21, Number 1Case Review

Symptomatic Rosai-Dorfman Disease Presenting as Isolated Bilateral Perinephric Infiltration

Bryant Van LeeuwenDaniel J KmetzDennis Bentley

This case explores a rare initial presentation of Rosai-Dorfman disease isolated to the peri-renal space. Also described as sinus histiocytosis with massive lymphadenopathy, Rosai-Dorfman disease is non-neoplastic and most often presents with massive cervical lymphadenopathy, but the disease can affect any organ system. Not often considered by those in the urology community or found in urology journals, this report reviews a clinical presentation of Rosai-Dorfman disease affecting bilateral kidneys and the fundamental histopathology needed for its diagnosis. [Rev Urol. 2019;21(1):41–44] © 2019 MedReviews®, LLC

Rosai-Dorfman diseaseSinus histiocytosis with massive lymphadenopathy

Dennis J SlamonView Articles

Volume 14, Number 3Review Articles

Systemic Therapy for Metastatic Renal Cell Carcinoma: A Review and Update

Management Update

Karim ChamieJoshua E LoganEdward N RampersaudGeoffrey A SonnDennis J SlamonFairooz F KabbinavarArie S BelldegrunAllan J Pantuck

An in-depth understanding of metastatic renal cell carcinoma (mRCC) is important so that practitioners can make informed evidenced-based decisions with patients to optimize not only quantity of life but quality of life as well. Therefore, this review focuses on the biology of mRCC as it relates to targets for therapy, as well as on the small molecules rationally designed with these targets in mind. In addition, anticipated emerging therapies are highlighted, including the new tyrosine kinase inhibitors axitinib and tivozanib, as well as new immune-based therapies such as dendritic cell-based vaccines and antibodies. We also briefly review recent reports from the emerging field of predicting drug response based on molecular markers. And finally, management of metastatic non-clear cell RCC histologies are discussed focusing on available evidence to direct decision making when assessing therapeutic options. [Rev Urol. 2012;14(3/4):65-78 doi: 10.3909/riu0562] © 2013 MedReviews®, LLC

Metastatic renal cell carcinomaTyrosine kinase inhibitorsDendritic cell-based vaccines

Department Of UrologyView Articles
Dhiren S DaveView Articles

Volume 9, Number 3Point-Counterpoint

Is Repeat Biopsy for Isolated High-Grade Prostatic Intraepithelial Neoplasia Necessary?

Point-Counterpoint

Jacob RajferDhiren S DaveArnold I Chin

Numerous studies have cited the positive predictive value of isolated highgrade prostatic intraepithelial neoplasia (HGPIN) to the detection of cancer. Epidemiological, morphological, and molecular data support the potential for malignant transformation of HGPIN, yet no current method can discriminate which lesions will progress to clinically significant prostate cancer versus more latent lesions. Recent analyses of multiple retrospective studies have found similar rates of cancer detection following either diagnosis of isolated HGPIN or an initial negative biopsy. This may reflect increased use of extended biopsy techniques involving 10 or more cores rather than the true ability of HGPIN to undergo malignant transformation. This article discusses controversies surrounding management of an isolated diagnosis of HGPIN and whether repeat biopsy of HGPIN should be mandatory or selective in the context of other predictive values such as rising prostate-specific antigen or lesion on digital rectal examination. [Rev Urol. 2007;9(3):124-131]

Prostate cancerProstate biopsyRepeat biopsyProstatic intraepithelial neoplasia (PIN)High-grade PIN

Diagnostic UltrasoundView Articles
Diedre NienowView Articles

Volume 9, Number 4Review Articles

Extending the Rationale of Combination Therapy to Unresponsive Erectile Dysfunction

Treatment Update

Rajeev KumarAjay NehraDiedre NienowChristopher Reece

Combination therapies aim to overcome the limitations of individual drugs by selecting diverse targets of action to enhance effectiveness synergistically. This article reviews the principles of combination therapy and its applications for benign prostatic hyperplasia and overactive bladder. It then examines pathophysiological, pharmacological, and clinical evidence for currently available drug and device combinations for erectile dysfunction that has not responded to first-line, single-agent therapy. [Rev Urol. 2007;9(4):197-206]

Benign prostatic hyperplasiaOveractive bladderErectile dysfunctionCombination therapyIntracavernosal therapyIntraurethral therapy