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Directory of Authors from the Journal and their last article.

John T LeppertView Articles

Volume 7, Number 3Meeting Reviews

Best of the AUA 2005 Annual Meeting

Meeting Review

Ellen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamArie S BelldegrunJohn P SteinJohn T LeppertJohn S LamStephen J Freedland

Prostate cancerBenign prostatic hyperplasiaBladder cancerKidney cancerLower urinary tract symptomsBotulinum toxinVesicoureteral refluxProstate-specific antigenOveractive bladderPeyronie’s diseaseNomogramsPediatric urologyCryptorchidismVasectomy reversalChronic prostatitisBlockers5-reductase inhibitorsTrospium chlorideRenal stonesProstate volumeMedical Therapy ofProstatic Symptoms (MTOPS) studyMinimally invasive therapiesPremature ejaculationProstate Cancer Prevention TrialTyrol PSA Screening ProjectUrothelial cancer

John T RathbunView Articles

Volume 19, Number 3Case Review

High Postprostatectomy Prostate-specific Antigen Level Prior to Salvage Radiation Therapy Is Not Always a Bad Sign

John T RathbunThomas M SchroederSteven C Eberhardt

Although radical prostatectomy is a popular treatment modality for clinically localized prostate cancer, 10-year biochemical recurrence can reach 28%. Before salvage radiation therapy (SRT), prostate-specific antigen (PSA) values alone should be used cautiously in predicting SRT eligibility. A long, slow PSA rise may suggest locally confined disease still amenable to SRT; corresponding imaging to identify potential gross recurrence is useful. Patients with local disease may safely benefit from higher doses of radiation. [Rev Urol. 2017;19(3):190–194 doi: 10.3909/riu0754] © 2017 MedReviews®, LLC

Prostate-specific antigenRadical prostatectomySalvage radiation therapy

John T WeiView Articles

Volume 8, Supplement 3Review Articles

Economic Impact of Surgical Intervention in the Treatment of Benign Prostatic Hyperplasia

Photoselective Vaporization of the Prostate

John M HollingsworthJohn T Wei

The economic burden of benign prostatic hyperplasia (BPH) on our health care system is significant and likely to continue to grow given the burgeoning elderly population. Coincident with the rising number of annual physician office visits and expenditures for BPH has been a dramatic shift in the disease’s management, from surgical to medical care. However, long-term cost data call into question the appropriateness of medical therapy as the initial treatment approach for all men with BPH, particularly those with moderate to severe symptoms. Although there has been a paradigm shift away from traditional BPH surgery, there has been renewed interest in the treatment of BPH with novel surgical techniques and minimally invasive surgeries. The economics of surgical interventions for BPH are discussed. [Rev Urol. 2006;8(suppl 3):S9-S15]

Benign prostatic hyperplasiaEconomicsSurgical procedures, minimally invasiveTransurethral resection of prostate

John VoytasView Articles
Jonathan A ColemanView Articles

Volume 19, Number 4Case Review

Irreversible Electroporation for Prostate Cancer as Salvage Treatment Following Prior Radiation and Cryotherapy

Katie S MurrayOguz AkinJonathan A Coleman

Salvage treatment options after localized primary treatment failure of prostate cancer are limited and associated with risk for serious complications. We report on the management details of a 57-year-old African American man treated with partial-gland ablation using irreversible electroporation following local recurrence after brachytherapy and prior salvage cryoablation. Therapeutic and functional outcomes were assessed by conventional means, including serum prostate-specific antigen values and prostate biopsy results. [Rev Urol. 2017;19(4):268–272 doi: 10.3909/riu0755] © 2018 MedReviews®, LLC

Prostate cancerFocal therapyIrreversible electroporationSalvage therapy

Jonathan AndersonView 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

Jonathan BatillerView Articles

Volume 17, Number 1Original Research

Hemostasis During Urologic Surgery: Fibrin Sealant Compared With Absorbable Hemostat

David M. AlbalaJerome B RiebmanRichard KocharianBogdan IlieJohn AlbaneseJessica ShenLiza OvingtonJonathan Batiller

In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components&mdash;fibrinogen and thrombin&mdash;that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding. [Rev Urol. 2015;17(1):25-30 doi: 10.3909/ricm0647] © 2015 MedReviews®, LLC

BleedingHemostasisHemostaticsFibrin tissue adhesiveUrologic surgical proceduresSurgical technique

Jonathan E HowardView 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

Jonathan E. ShoagView Articles

Volume 23, Number 1Prostate Cancer

Contemporary Approaches to Diagnosing Prostate Cancer

Ashley E. RossAlon LazarovichAaron S. DahmenAbhinav SidanaJack MillotJonathan E. ShoagHangcheng FuJohn Eifler

The diagnosis of prostate cancer (PCa) has changed substantially over the last decade. An increased understanding of disease behavior has led to the development of more specific biomarkers that may limit the numbers of prostate biopsies performed as well as the overdiagnosis of low-grade disease. We have concurrently seen the refinement of imaging techniques such as multiparametric magnetic resonance imaging (mpMRI), which can also limit overdiagnosis and aid in the discovery of clinically significant disease. We now have various options for performing ultrasound-guided biopsies, including transperineal and transrectal approaches. In this article, we gather perspectives on contemporary pathways toward the diagnosis of PCa from experts practicing in large urology practice groups and academia.

Prostatic neoplasmsBiomarkersMagnetic resonance imaging (MRI)

Jonathan H RossView Articles
Jonathan HendersonView Articles
Jonathan I EpsteinView Articles
Jonathan KaufmanView Articles

Volume 12, Number 4Review Articles

State of the Art in Intravesical Therapy for Lower Urinary Tract Symptoms

State of the Art

Michael B ChancellorJonathan KaufmanVikas TyagiMichele AnthonyPradeep Tyagi

Intravesical therapy is the routine first-line treatment for effectively delaying or preventing the recurrence of bladder cancer. This route of drug administration has also shown tremendous promise in the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS) and potentially overactive bladder to justify investments for further improvements. This review takes a bird&rsquo;s eye view into the current status of intravesical therapy, with emphasis on liposomal nanoparticles, in diseases associated with lower urinary tract symptoms (LUTS). Ongoing efforts to advance the field of intravesical drug delivery include development of sustained-release drug implants and efforts to improve delivery of biotechnological products including large protein acting as neurotoxins and small interfering RNAs.[Rev Urol. 2010;12(4):e181-e189 doi: 10.3909/riu0496]© 2010 MedReviews®, LLC

Lower urinary tract symptomsInterstitial cystitisIntravesical therapyPainful bladder syndrome

Jonathan L GiddensView Articles
Jonathan L WrightView Articles

Volume 9, Number 4Review Articles

Newer Potential Biomarkers in Prostate Cancer

Diagnostic Update

Paul H LangeJonathan L Wright

Prostate-specific antigen (PSA) screening has led to a significant rise in the number of men diagnosed with prostate cancer and an associated increase in biopsies performed. Despite its limitations, including a positive predictive value of only 25%-40%, PSA remains the only generally accepted biomarker for prostate cancer. There is a need for better tools to not only identify men with prostate cancer, but also to recognize those with potentially lethal disease who will benefit from intervention. A great deal of work has been done worldwide to improve our knowledge of the genetics behind prostate cancer and the specificity of PSA by developing assays for different PSA isoforms. Common genetic alterations in prostate cancer patients have been identified, including CpG hypermethylation of GSPT1 and TMPRSS2:ERG gene fusion. Serum and urine detection of RNA biomarkers (eg, PCA3) and prostate cancer tissue protein antibodies (eg, EPCA) are being evaluated for detection and prognostic tools. This article reviews some of the promising developments in biomarkers. [Rev Urol. 2007;9(4):207-213]

Prostate-specific antigenPCA3Alpha-methylacyl-CoA racemaseAutoantibody arraysEpigenetic markersGene fusion proteinsHuman kallikreinsPSA isoformsRNA biomarkers

Jonathan M LevittView Articles

Volume 12, Number 1Review Articles

Emerging Vaccine Therapy Approaches for Prostate Cancer

Treatment Update

Kevin M SlawinGuru SonpavdeDavid M SpencerJonathan M Levitt

Prostate cancer vaccines attempt to induce clinically relevant, cancer-specific systemic immune responses in patients with prostate cancer and represent a new class of targeted, nontoxic therapies. With a growing array of vaccine technologies in preclinical or clinical development, autologous antigen-presenting cell vaccines loaded with the antigen, prostate acid phosphatase, and poxvirus vaccines targeting prostate-specific antigen have recently demonstrated a significant survival benefit in randomized trials of patients with metastatic castration-resistant prostate cancer, whereas others have failed to demonstrate any benefit. The combination of vaccines with chemotherapy, radiotherapy, and other biologic agents is also being evaluated. Efforts to optimize vaccine approaches and select ideal patient populations need to continue to build on these early successes.[Rev Urol. 2010;12(1):25-34 doi:10.3909/riu0437]

Prostate cancerImmunotherapyVaccine

Jonathan MelamedView Articles
Jonathan RubensteinView Articles

Volume 23, Number 2Coding Corner

Coding Corner: Healthcare Common Procedure Coding System Code G2211, Visit Complexity Inherent to Evaluation and Management

Jonathan RubensteinMark PainterCeleste Kirschner

For this issue, we reviewed the Healthcare Common Procedure Coding System (HCPCS) level 2 code G2211. Though the code has existed for a few years, Medicare began reimbursing physicians for reporting the code in January 2024. The code is used to describe the complexity of an evaluation and management (E&M) visit associated with an ongoing, longitudinal care relationship, focusing on a circumstance rather than a specific service. The circumstance described in this code differs from the prolonged services described by Current Procedural Terminology (CPT) codes 99358 through 99418; the case management services described by CPT codes 99366 through 99368; and the chronic care management services described by CPT codes 99490, 99491, and 99437 through 99489:

Benign prostatic hyperplasiaEvaluation and management servicesCurrent Procedural Terminology codes

Jonathan S StarkmanView Articles

Volume 8, Number 3Review Articles

Management of Overactive Bladder With Transdermal Oxybutynin

Treatment Update

Roger R DmochowskiJonathan S Starkman

In clinical trials, transdermal oxybutynin (OXY-TDS) has shown comparable efficacy and improved tolerability when compared with conventional pharmacotherapy. Systemic anticholinergic adverse effects are comparable to those with placebo, most likely owing to avoidance of first-pass hepatic metabolism and conversion of oxybutynin to N-desethyloxybutynin. OXY-TDS has predictable pharmacokinetic absorption and elimination parameters, as shown in both in vitro and in vivo studies. Consistent plasma concentrations of oxybutynin avoid labile peak and trough concentrations seen with immediaterelease formulations, paralleling extended-release drug delivery. This novel drug delivery system has unique dermatologic skin application site reactions, including erythema and pruritus. Skin reactions are usually mild and can be minimized by varying the site of patch application. Most eczematous dermatologic reactions can be appropriately treated with a moderately potent topical corticosteroid cream. A small percentage of patients will discontinue therapy as a result of bothersome application site skin reactions. [Rev Urol. 2006;8(3):93-103]

Overactive bladderTolterodineAnticholinergic medicationsOxybutinin

Jonathan S VarsanikView Articles

Volume 22, Number 4Review Articles

Application of Artificial Intelligence/Machine Vision & Learning for the Development of a Live Single-cell Phenotypic Biomarker Test to Predict Prostate Cancer Tumor Aggressiveness

Original Research

David M. AlbalaGrannum R SantJonathan S VarsanikMichael S ManakMatthew J WhitfieldBrad J HoganWendell R SuCJ JiangAshok C Chander

To assess the usefulness and applications of machine vision (MV) and machine learning (ML) techniques that have been used to develop a single cell–based phenotypic (live and fixed biomarkers) platform that correlates with tumor biological aggressiveness and risk stratification, 100 fresh prostate samples were acquired, and areas of prostate cancer were determined by post-surgery pathology reports logged by an independent pathologist. The prostate samples were dissociated into single-cell suspensions in the presence of an extracellular matrix formulation. These samples were analyzed via live-cell microscopy. Dynamic and fixed phenotypic biomarkers per cell were quantified using objective MV software and ML algorithms. The predictive nature of the ML algorithms was developed in two stages. First, random forest (RF) algorithms were developed using 70% of the samples. The developed algorithms were then tested for their predictive performance using the blinded test dataset that contained 30% of the samples in the second stage. Based on the ROC (receiver operating characteristic) curve analysis, thresholds were set to maximize both sensitivity and specificity. We determined the sensitivity and specificity of the assay by comparing the algorithm-generated predictions with adverse pathologic features in the radical prostatectomy (RP) specimens. Using MV and ML algorithms, the biomarkers predictive of adverse pathology at RP were ranked and a prostate cancer patient risk stratification test was developed that distinguishes patients based on surgical adverse pathology features. The ability to identify and track large numbers of individual cells over the length of the microscopy experimental monitoring cycles, in an automated way, created a large biomarker dataset of primary biomarkers. This biomarker dataset was then interrogated with ML algorithms used to correlate with post-surgical adverse pathology findings. Algorithms were generated that predicted adverse pathology with >0.85 sensitivity and specificity and an AUC (area under the curve) of >0.85. Phenotypic biomarkers provide cellular and molecular details that are informative for predicting post-surgical adverse pathologies when considering tumor biopsy samples. Artificial intelligence ML-based approaches for cancer risk stratification are emerging as important and powerful tools to compliment current measures of risk stratification. These techniques have capabilities to address tumor heterogeneity and the molecular complexity of prostate cancer. Specifically, the phenotypic test is a novel example of leveraging biomarkers and advances in MV and ML for developing a powerful prognostic and risk-stratification tool for prostate cancer patients. [Rev Urol. 2020;22(4):159–167] © 2021 MedReviews®, LLC

Prostate cancerArtificial intelligencePhenotypic biomarkersMachine visionMachine learning