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Directory of Authors from the Journal and their last article.

Nathan P. DillerView Articles

Volume 23, Number 3Business of Urology

The Business of Independent Urologic Medicine: Caring for Patients While Operating a Business in a Post–COVID-19 Era of Private Practice

Nathan P. DillerMara Holton

Primum non nocere—“First, do no harm.” Independent medicine is challenged not only to achieve outcomes that patients value but also not to intentionally harm their business in the process. The COVID-19 pandemic and postpandemic regulatory environment have added new limitations on and restrictions to independent practices’ ability to innovate, grow, and provide stable access to meet their communities’ urologic needs. In the face of these challenges, independent medicine is at its strongest when it continues to press toward meeting its social contract with its community. Conversely, but just as importantly, society needs to be mindful of its social contract with the health care workforce.

UrologyPrivate practiceCOVID-19

Naveen KellaView Articles

Volume 6, Number 3Meeting Reviews

Best of the 2004 AUA Annual Meeting

Highlights from the 2004 Annual Meeting of the American Urological Association, May 8-13, 2004

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamKevin M SlawinBob DjavanArie S BelldegrunMichael P O'LearyJohn S LamStephen J FreedlandYan Kit FongTheodore AnagnostouOleg ShvartsNaveen Kella

Prostate cancerRenal cell carcinomaObesityRobotic surgeryKidney stonesLaparoscopyBenign prostatic hyperplasiaBladder cancerOncologyLower urinary tract symptomsProstate-specific antigenOveractive bladderRadical prostatectomyMale infertilityUrolithiasisErectile dysfunctionPediatric urologyChronic prostatitisIncontinenceTumor markersBasic science

Navin ShahView Articles

Volume 18, Number 4Review Articles

Frequency of Gleason Score 7 to 10 in 5100 Elderly Prostate Cancer Patients

Cancer Screening Update

Navin ShahVladimir Ioffe

Men 70 to 80 years of age are known to have an increased incidence of high-grade (Gleason sum score [GSS] 7-10) prostate cancer. We determined the frequency of high-grade prostate cancer among men 70 to 80 years old in our practice. We retrospectively reviewed our 5100 prostate cancer patients who are 70 to 80 years old and who opted for radiation therapy (external radiation, brachytherapy, or combination). Data were gathered on race, prostate-specific antigen value, digital rectal examination (DRE) results, and GSS. Patients were further subdivided by age in two categories, those 70 to 75 years and 76 to 80 years, and also by time period: 2006-2010 and 2011-2015. In patients 70 to 75 years, 1426 patients had a GSS of 6 (41%) and 2042 patients had a GSS of 7 to 10 (59%). In patients 76 to 80 years old, 553 had a GSS of 6 (34%) and 1079 had a GSS of 7 to 10 (66%). In 1432 patients with an abnormal DRE result, the GSS was 6 in 376 (26%) and GSS was 7 to 10 in 1059 (74%). Based on analysis of 5100 prostate cancer patients in our practice, we determined that 61% of patients age 70 to 80 have a high-grade prostate cancer, as do 59% of patients age 70 to 75 years, and 66% of patients between age 76 and 80 years. Because biopsy underestimates the grade in GSS 6 patients by 50%, the actual frequency is approximately 80%. In patients with prostate cancer who had an abnormal DRE result, 74% had a GSS of 7 to 10—approximately 85% when accounting for biopsy under-grading. [Rev Urol. 2016;18(4):181-187 doi: 10.3909/riu0732] © 2016 MedReviews®, LLC

Cancer, prostateGleason scoreAge

Neal ContiView Articles

Volume 21, Number 2Case Review

Intraperitoneal Rupture of a Synovial Sarcoma of the Kidney

Andrew StammPaul KozlowskiNeal ContiSemra OlgacJohn Paul FloresMichael J Wagner

Primary renal synovial sarcoma is an aggressive, extremely rare disease. Nearly all reported cases are characterized by SYT-SSX gene translocation (X;18)(p11;q11). We describe the case of a 43-year-old woman who presented with an intraperitoneal rupture of this rare sarcoma followed by a right radical nephrectomy. Follow-up imaging 1 month after surgery revealed peritoneal carcinomatosis. She began systemic chemotherapy with doxorubicin and dacarbazine, progressed after 3 months, and is currently receiving single-agent ifosfamide. Only one instance of intraperitoneal rupture has been reported previously. This case report contributes to the characterization of this rare disease. [Rev Urol. 2019;21(2/3):141–143] © 2019 MedReviews®, LLC

Kidney cancerOncologyRenal synovial sarcoma

Neal D ShoreView Articles

Volume 23, Number 3Bladder Cancer

Immune Checkpoint Inhibitors for the Treatment of Non–Muscle-Invasive Bladder Cancer: An Overview of Ongoing Clinical Trials

Neal D Shore

Treatment of non–muscle-invasive bladder cancer (NMIBC) is evolving, seeking new treatments to overcome the limitations of bacille Calmette-Guérin therapy and alternatives to radical cystectomy. Studies are currently evaluating the safety and efficacy of immune checkpoint inhibitors in combination with bacille Calmette-Guérin vs bacille Calmette-Guérin monotherapy for patients with high-risk NMIBC that is bacille Calmette-Guérin naive or recurrent after bacille Calmette-Guérin induction. We briefly summarize 4 studies that are evaluating intravenous immune checkpoint inhibitors (atezolizumab, durvalumab, and pembrolizumab) and 1 subcutaneous immune checkpoint inhibitor (sasanlimab). These studies may substantially change standard-of-care treatment for patients with high-risk NMIBC.

immune checkpoint inhibitorsMonoclonal antibodiesClinical trialsnon-muscle invasive bladder neoplasms

Neal PatelView Articles

Volume 17, Number 3Review Articles

Conservative Management of Urinary Incontinence in Women

Izak FaienaNeal PatelJaspreet S PariharMarc CalabreseHari Tunuguntla

Urinary incontinence in women has a high prevalence and causes significant morbidity. Given that urinary incontinence is not generally a progressive disease, conservative therapies play an integral part in the management of these patients. We conducted a nonsystematic review of the literature to identify high-quality studies that evaluated the different components of conservative management of stress urinary incontinence, including behavioral therapy, bladder training, pelvic floor muscle training, lifestyle changes, mechanical devices, vaginal cones, and electrical stimulation. Urinary incontinence can have a severe impact on our healthcare system and patients’ quality of life. There are currently a wide variety of treatment options for these patients, ranging from conservative treatment to surgical treatment. Although further research is required in the area of conservative therapies, nonsurgical treatments are effective and are preferred by some patients. [Rev Urol. 2015;17(3):129-139 doi: 10.3909/riu0651] © 2015 MedReviews®, LLC

Urinary incontinenceWomenConservative management

Ned B SteinView Articles

Volume 13, Number 2Case Review

Malignant Priapism Secondary to Metastatic Prostate Cancer: A Case Report and Review of Literature

Yu-Hsiang LinJerry J KimNed B SteinMohit Khera

Penile metastasis of cancers from other primary sites is a rare phenomenon that infrequently manifests as malignant priapism. We outline a case of an 84-year-old patient who presented with a 3-month history of painful priapism after radiation therapy for prostate adenocarcinoma. The patient underwent surgical penile exploration and cavernosal biopsy that revealed poorly differentiated cells suggestive of prostate cancer. Postoperative imaging demonstrated extensive regional and distal metastases. A review of the literature on penile metastases returned approximately 400 published cases, with priapism being the initial presentation in 20% to 50% of cases. Regardless of site of origin or subsequent management, most cases have shown very poor prognosis. [Rev Urol. 2011;13(2):90-94 doi: 10.3909/riu0508] © 2011 MedReviews®, LLC

Prostate cancerMalignant priapismPenile metastasis

Neil BaumView Articles

Volume 17, Number 4Book Reviews

Smoking: Its Impact on Urologic Health

Management Update

Neil BaumDavid Mobley

Tobacco use remains the single largest preventable cause of disease and premature death in the United States, and smoking is a leading cause of cancer and death from cancer. There is also evidence that smoking is associated with several urologic diseases. Urologists have a unique opportunity to help our patients lead healthy lifestyles, which includes ending their dependence on nicotine and tobacco. This article points out the various urologic conditions associated with smoking and tobacco use with the intention of providing physicians and patients with knowledge and education regarding this connection. [Rev Urol. 2015;17(4):220-225 doi: 10.3909/riu0684] © 2016 MedReviews®, LLC

Prostate cancerBladder cancerKidney cancerInterstitial cystitisSmokingErectile dysfunction

Neil F MariadosView Articles
Neil J BarberView Articles

Volume 17, Number 3Review Articles

Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice

Management Update

Sashi S KommuRobert McArthurAmr M EmaraUtsav D ReddyChristopher J AndersonNeil J BarberRaj A PersadChristopher G Eden

There has been a recent and near exponential increase in the use of hemostatic agents and sealants to supplement the rapidly evolving methods in the surgical management of urologic patients. This article reviews the use of hemostatic agents and sealants in current urologic practice. [Rev Urol. 2015;17(3):150-159 doi: 10.3909/riu0673] © 2015 MedReviews®, LLC

HemostasisTissue adhesionUrologic surgery

Neil MariadosView Articles

Volume 16, Number 3Review Articles

The Rationale for Optimal Combination Therapy With Sipuleucel-T for Patients With Castration-resistant Prostate Cancer

Treatment Review

Neal D ShoreRaoul S ConcepcionChristopher M PieczonkaVladimir MouravievNeil MariadosRobert B SimsMark Emberton

Immunotherapy encourages the recipient’s own immune response to destroy cancer cells, and current evidence suggests that immunotherapies may be most beneficial in early metastatic castration-resistant prostate cancer (mCRPC). Sipuleucel-T is the first therapeutic cancer vaccine to be approved by both the US Food and Drug Administration and European Medicines Agency for the treatment of asymptomatic or minimally symptomatic mCRPC. Combining immunotherapy with other treatments may have potent anticancer effects; cytoreductive therapies can release tumor antigens and promote a proinflammatory environment that could augment immunotherapies. However, some cytoreductive agents or coadministered drugs may be immunosuppressive. Understanding these interactions between different mCRPC treatment modalities may offer further potential to improve patient outcomes. [Rev Urol. 2014;16(3):122-130 doi: 10.3909/riu0637] © 2014 MedReviews®, LLC

Prostate cancerSipuleucel-TCombination therapy

Neil MendhirattaView Articles

Volume 16, Number 2Review Articles

Focal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial Experience

Treatment Update

Herbert LeporTed LeeNeil MendhirattaDan Sperling

Focal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions. [Rev Urol. 2014;16(2):55-66 doi: 10.3909/riu0615] © 2014 MedReviews® LLC

Prostate cancerFocal therapyTargeted therapyLaser ablation

Nelson N StoneView Articles

Volume 20, Number 1Original Research

Transrectal Ultrasound–guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison

Transrectal ultrasound guided prostate biopsy • Transperieneal mapping prostate biopsy • Complications

Vladimir MouravievE David CrawfordVassilios M SkouterisPaul AranguaMarios Panagiotis MetsinisMichael SkouterisGeorge ZacharopoulosNelson N Stone

Herein, the authors compare morbidity in men who underwent both transrectal ultrasound–guided (TRUS) prostate biopsy and transperineal mapping biopsy (TPMB) at two institutions with extensive experience in both procedures. We also identified strategies and predictive factors to reduce morbidity for both procedures. In our study, 379 men from two institutions, of which 265 (69.9%) had a prior TRUS-guided biopsy, also had TPMB performed via a template with biopsies taken at 5-mm intervals. Men in the TRUS group had a median of 12 cores sampled whereas the TPMB group had 51.5 (range, 16-151). The median biopsy density was 1.1 core/cc prostate volume. Median age and prostate-specific antigen (PSA) level were 65 years (range, 34-86) and 5.5 ng/mL (range, 0.02-118). Of these men, 11 of 265 (4.2%) who had TRUS biopsy developed urinary tract infection compared with 3 of 379 (0.79%) of those with mapping biopsy. Infection was 14.8% in TRUS biopsy group with 13 or more cores versus 2.9% in those with 12 or less (OR, 5.8; 95% CI, 1.6-21.2; P = 0.003). No men developed retention after TRUS biopsy whereas 30 of 379 (7.9%) did following TPMB. Older age, larger prostate volume (PV), and higher core number were associated with retention. On linear regression only age (P = 0.010) and PV (P = 0.016) remained as significant associations. Men older than 65 years had 12.8% versus 3.9% (OR, 3.7; 95% CI, 1.6-8.4, P = 0.001) and PV greater than 42 cc had 13.4% versus 2.7% (OR, 5.7; 95% CI, 2.1-15.1) retention incidence. In the present study TPMB is rarely associated with infection (0.78%) but more commonly with urinary retention (7.9%). Men older than 65 years and with PV greater than 42 cc were at four to five times greater retention risk. Consideration should be given to discharging these men with a urinary catheter following TPMB. [Rev Urol. 2018;20(1):19–25 doi: 10.3909/riu0785] © 2018 MedReviews, LLC®

ComplicationsTransrectal ultrasound guided prostate biopsyTransperieneal mapping prostate biopsy

Nelson Neal StoneView Articles
Nenad DjakovicView Articles

Volume 13, Number 3Review Articles

Peyronie’s Disease: Nonsurgical Therapy Options

Treatment Update

Franklin E KuehhasNenad DjakovicPeter WeiblTosev GeorgiRalf Herwig

Peyronie’s disease (PD) is a fibrous inelastic scar of the tunica albuginea, leading to penile deformity, penile curvature, shortening, narrowing, and painful erections that subsequently lead to painful or unsatisfying sexual intercourse. No consensus exists yet on the ideal management of PD. This fact is a result of our limited knowledge of its etiology and causative factors. The acute presentation of PD is treated conservatively, and surgical approachesare only attempted if severe curvature, narrowing, or indentation persists for more than 1 year; PD stability exists for at least 3 months; curvature impedes sexual intercourse; and severe penile shortening occurs. This review focuses on new developments for conservative treatment strategies for PD. [Rev Urol. 2011;13(3):139-146 doi: 10.3909/riu0528] © 2011 MedReviews®, LLC

Peyronie’s diseaseNonsurgical therapyOral medicationIntralesionaltherapyExtracorporeal shock wave therapyIontophoresisPenile traction systems

Nermarie VelázquezView Articles
Nestor Gonzalez-CavidadView Articles
Niall CorcoranView 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

Niall M CorcoranView Articles

Volume 13, Number 2Review Articles

Contemporary Management of Renal Trauma

Management Update

Jennifer J ShoobridgeNiall M CorcoranKatherine A MartinJim KoukounarasPeter L RoyceMatthew F Bultitude

In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach to facilitate the care of patients with renal injury. [Rev Urol. 2011;13(2):65-72 doi: 10.3909/riu0512] © 2011 MedReviews®, LLC

NephrectomyRenal injuryBlunt traumaAngiogenesis

Nicholas SanfilippoView Articles

Volume 13, Number 1Case Review

Squamous Cell Carcinoma of the Prostate

Case Review

Samir S TanejaRena D MalikGeorge DakwarMatthew E HardeeNicholas SanfilippoAndrew B Rosenkrantz

"Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patientís disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival. [Rev Urol. 2011;13(1):56-60 doi: 10.3909/riu0494]"

Squamous cell carcinomaProstate adenocarcinomaLower urinary tractsymptomsMultimodal treatments