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Directory of Authors from the Journal and their last article.

Matthew F BultitudeView Articles

Volume 13, Number 3Review Articles

Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

Management Review

Peter L RoyceMatthew F BultitudeJennifer KongRussell GruenAlex CatoNiall Corcoran

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.[Rev Urol. 2011;13(3):119-130 doi: 10.3909/riu0521] © 2011 MedReviews®, LLC

UrethraMultiple traumaRuptureUrinary bladderWounds

Matthew GretzerView Articles

Volume 16, Number 2Case Review

Immunoglobulin G4–related Retroperitoneal Fibrosis of the Pelvis

Anthony DyerPeter M SadowErika BracamonteMatthew Gretzer

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the replacement of normal tissue with fibrosis and/or inflammation. In this case, a 68-year-old man presented with RPF in the pelvis, a rare location for this disease. Biopsies were performed, which showed elevated levels of C-reactive protein, erythrocyte sedimentation rate, and, most importantly, immunoglobulin G4 (IgG4). It has been postulated that IgG4-related sclerosing disease is a systemic disease. Treatment has been successful with systemic corticosteroids. [Rev Urol. 2014;16(2):92-94 doi: 10.3909/riu0594] © 2014 MedReviews®, LLC

Retroperitoneal fibrosisSerum immunoglobulin G4

Matthew HT BuiView Articles
Matthew J WhitfieldView 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

Matthew J ZiegelmannView Articles

Volume 21, Number 2Review Articles

Evaluation and Management of Chronic Scrotal Content Pain—A Common Yet Poorly Understood Condition

Management Review

Matthew J ZiegelmannRyan FarrellLaurence A Levine

Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life. [Rev Urol. 2019;21(2/3):74–84] © 2019 MedReviews®, LLC

OrchialgiaTesticlePain inguinalDenervation

Matthew J. JonesView Articles

Volume 23, Number 1Literature Reviews

Comparison of Methods for Ureteral Patency Visualization

Michelle BoytimMatthew J. JonesAlex S. BartPavel Svintozelskiy

The most common cause of ureteral trauma occurs during open, laparoscopic, or endoscopic procedures across multiple specialties. Ureteral injuries are often unrecognized or mismanaged. Early recognition of ureteral injuries by cystoscopy allows for prompt intervention. Visualization can be enhanced using agents that color or improve the contrast of ureteral flow.

Cystoscopydiagnostic imagingindigo carminemethylene bluefluorescein

Matthew O FraserView Articles
Matthew P LierzView Articles

Volume 22, Number 2Review Articles

The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study

Original Research

Kenneth E SchmankeJordan J StiversonRosalee E ZackulaSerge G SrourMatthew P LierzFadi N Joudi

Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting. We recommend that a standard biopsy be performed alongside targeted biopsy. [Rev Urol. 2020;22(2):57–66] © 2020 MedReviews®, LLC

Health services researchProstatic neoplasmsImage-guided biopsyMultiparametric MRIAmbulatory care facilities

Matthew R SmithView Articles
Matthew RettigView Articles

Volume 22, Number 2Case Review

Leptomeningeal Carcinomatosis of Prostate Cancer: A Case Report and Review of the Literature

Elad NeemanNoriko SalamonMatthew Rettig

Leptomeningeal carcinomatosis is a rare complication of prostate cancer. It is likely underdiagnosed as suggested by autopsy studies and is expected to become more prevalent with increasing survival of prostate cancer patients. Prostate cancer leptomeningeal carcinomatosis is associated with rapid functional decline and a median survival of approximately 1 month. Diagnosis is challenging because the clinical manifestations are varied, and no gold-standard diagnostic approach exists. Treatment of prostate cancer leptomeningeal carcinomatosis is not standardized and multiple approaches have been reported, mostly as case studies. Herein we report a case of a 73-year-old patient with metastatic castration-resistant prostate cancer who presented to our clinic with subacute cognitive decline, ataxia, and urinary incontinence, and was found to have leptomeningeal carcinomatosis. [Rev Urol. 2020;22(2):80–84] © 2020 MedReviews®, LLC

Matthew T SmithView Articles

Volume 14, Number 3Case Review

Two Separate Synchronous Primary Genitourinary Tumors

Matthew T SmithFrederick D TaylorWilliam P GianakopoulusRoy R Brown

A 54-year-old man presented to the office with gross painless hematuria, dysuria, and urinary frequency. He was diagnosed with renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. The article reviews the presentation, radiology, pathology, and intervention of an uncommon case of synchronous primary carcinomas, and aims to show the importance of continued clinical suspicion for multiple genitourinary primary neoplasms. [Rev Urol. 2012;14(3/4):104-107 doi: 10.3909/riu0555] © 2013 MedReviews®, LLC

HematuriaGenitourinary tumorDysuriaNeoplasmUrinary frequency

Matthias WaldertView Articles

Volume 10, Number 2Review Articles

Prostate Cancer in Elderly Men

Treatment Update

Bob DjavanAnton StangelbergerMatthias Waldert

Due to increasing life expectancy and the introduction of prostate-specific antigen (PSA) screening, a rising number of elderly men are diagnosed with prostate cancer. Besides PSA serum levels and Gleason score, age is considered to be a key prognostic factor in terms of treatment decisions. In men older than 70 years, treatment without curative intent may deprive the frail patient of years of life. Modern radical prostatectomy techniques are associated with low perioperative morbidity, excellent clinical outcome, and documented long-term disease control. Thus, radical prostatectomy should be considered because local treatment of organ-confined prostate cancer potentially cures disease. The huge extent of PSA screening programs may lead to overdiagnosis of prostate cancer. Not every man who is diagnosed with prostate cancer will develop clinically significant disease. This has led to the concept of expectant management for screen-detected, small-volume, low-grade disease, with the intention of providing therapy for those men with disease progression. [Rev Urol. 2008;10(2):111-119]

Prostate cancerElderly menScreeningQuality of lifeProstate-specific antigenOvertreatment

Maurizio BuscariniView Articles

Volume 15, Number 3Review Articles

Bladder Cancer After Radiotherapy for Prostate Cancer

Systematic Review

Francesca SurianoEmanuela AltobelliFederico SergiMaurizio Buscarini

External beam radiotherapy (EBRT) is frequently used in the management of prostate cancer (PCa) as definitive, postoperative, or salvage local treatment. Although EBRT plays a central role in the management of PCa, complications remain a troubling by-product. Several studies have demonstrated an association between radiotherapy and elevated risk of acute and late toxicities. A secondary malignancy induced by initial therapy represents one of the most serious complications related to definitive cancer treatment. The radiation-related secondary primary malignancy risk increases with increasing survival time. Transitional cell carcinoma of the bladder is the most frequent secondary primary malignancy occurring after radiotherapy and is described as more aggressive; it may be diagnosed later because some radiation oncologists believe that the hematuria that occurs after prostate EBRT is normal. Some patients treated for localized PCa will subsequently develop invasive bladder cancer requiring surgical intervention. Patients with PCa treated with EBRT should be monitored closely for the presence of bladder cancer. [Rev Urol. 2013;15(3):108-112 doi: 10.3909/riu0577] © 2013 MedReviews®, LLC

Prostate cancerBladder cancerRadiotherapyExternal beam radiotherapy

Maximilian RomView Articles
Mayank BaidView Articles

Volume 16, Number 3Case Review

Urethral Duplication in a 15-Year-Old: Case Report With Review of the Literature

Mayank BaidArindam Dutta

Urethral duplication is a rare congenital malformation mainly affecting men and boys. Although a number of theories have been proposed to describe this condition, the actual mechanism of this disorder is still not clear. This article highlights a case of urethral duplication in a 15-year-old boy. The malformation was characterized by the presence of continent epispadic and normal apical urethra. Retrograde urethrogram through both urethral tracts simultaneously revealed the malformation as Effmann type IIA2. The patient was not offered surgical intervention as he was asymptomatic and had no problems except for a double stream of urine. [Rev Urol. 2014;16(3):149-151 doi: 10.3909/riu0618] © 2014 MedReviews®, LLC

UrethraDuplicationMalformationAbnormality

Mbarek DoublaliView Articles

Volume 11, Number 4Case Review

Concurrent Bilateral Renal Angiomyolipoma and Renal Cell Carcinoma in a Patient With Tuberous Sclerosis Complex

Abdelhak KhalloukYounes AhallalMohamed Jamal El FassiMohamed Fadl TaziSoufiane MellasMbarek Doublali

Renal angiomyolipomas (AMLs) are often associated with tuberous sclerosis. These tumors are predominantly benign, although malignant forms do exist and are known to be associated with renal cell carcinoma. This case report describes a patient with tuberous sclerosis and massive bilateral AML. Total right nephrectomy was performed; histopathologic examination revealed the coexistence of AML and clear cell renal carcinoma in the same kidney. Because differentiation between renal cell carcinoma and AML with minimal or no fat component can be difficult, an accurate diagnosis is critical in the management of renal AML.[Rev Urol. 2009;11(4):216-218 doi: 10.3909/riu0436]© 2009 MedReviews®, LLC

Renal cell carcinomaAngiomyolipomaTuberous sclerosis

Meena DavuluriView Articles
Meesha PatelView Articles
Meghan E. RobertsView Articles

Volume 23, Number 1Literature Reviews

Methods for Prostate Cancer Risk Stratification: Serum-Based and Urine-Based Biomarkers for Biopsy Consideration

Alex S. BartRyan D. T. Badre-HumeMeghan E. RobertsGriffen KempskieAlyssa N. Giannasca

Prostate cancer (PCa) is one of the most commonly occurring cancers in men globally. In 2024, it is estimated that there will be 99 010 PCa diagnoses and 35 250 PCa-related deaths in American patients. Given the high incidence and virulence of the disease, proper screening methods are crucial to reduce overdiagnosis and overtreatment of PCa. Using biomarkers with high tumor sensitivity and specificity is therefore crucial to effectively distinguish PCa from benign tissue.

Prostate cancer

Melissa L DawsonView Articles

Volume 18, Number 3Case Review

A Novel Approach to Mesh Revision After Sacrocolpopexy

Nima M ShahMelissa L DawsonRebecca RinkoKristene E Whitmore

Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery. [Rev Urol. 2016;18(3):174-177 doi: 10.3909/riu0698] © 2016 MedReviews®, LLC

Vaginal meshMesh erosionOmental flap mobilization