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Directory of Authors from the Journal and their last article.

Ramdev KonijetiView Articles

Volume 11, Number 3Case Review

Placenta Percreta and the Urologist

Jacob RajferRamdev KonijetiAsghar Askari

Placenta percreta, the rarest and most severe form of placenta accreta, caninvolve the urinary bladder. Because of its propensity for severe hemorrhage,it is a potentially life-threatening condition. Although commonly discoveredat the time of delivery, antenatal diagnosis may be achieved with ultrasound,magnetic resonance imaging, and/or cystoscopy. Every attempt should bemade to minimize potential for blood loss by avoiding removal of the placentaat the time of delivery and either performing a hysterectomy or usingmethotrexate therapy to ablate the residual placenta in the postpartum period.If hemorrhage does occur during delivery, immediate surgical removalof the uterus should be considered and, depending on the severity of thehemorrhage and the depth of invasion of the placenta into the bladder,excision and/or reconstruction of the bladder may be necessary.[Rev Urol. 2009;11(3):173-176 doi: 10.3909/riu0440]© 2009 MedReviews®, LLC

Placenta percretaPlacenta accretaBladder invasion

Rana R. McKayView Articles

Volume 23, Number 3Prostate Cancer

Darolutamide for the Management of Metastatic Hormone-Sensitive Prostate Cancer: A Urologist-Oncologist Perspective

Paul DatoRana R. McKay

Metastatic prostate cancer accounts for 8% of all prostate cancer cases in the United States and has an estimated 5-year survival rate of 34%. Androgen-deprivation therapy (ADT) is the cornerstone of treatment for men with metastatic hormone-sensitive prostate cancer (HSPC), but there has been a recent focus on early treatment intensification through dual- or triple-therapy approaches, which have shown substantial survival benefit compared with ADT alone. Darolutamide, a distinct androgen receptor inhibitor, is the latest treatment for men with metastatic HSPC. In the Darolutamide in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer (ARASENS) trial (ClinicalTrials.gov identifier NCT02799602), darolutamide in combination with ADT and docetaxel reduced the risk of death by 32.5% (P < .001) compared with ADT plus docetaxel in men with metastatic HSPC. The most recent National Comprehensive Cancer Network guidelines (2023) support the use of triple-therapy regimens for men with high-volume metastatic HSPC, but concerns about the side effects of the short-term chemotherapy component of this regimen necessitate a comprehensive approach to providing supportive care to ensure that patients are willing to begin and remain on treatment. Effective management should involve a well-informed multidisciplinary team with patient education and support to ensure optimal treatment outcomes. Here, we review the results of the ARASENS trial and consider the implications for the management of metastatic HSPC. By showing a statistically significant reduction in risk of death, triple therapy combining darolutamide with ADT and docetaxel has emerged as a new treatment modality that may help men with metastatic HSPC achieve prolonged survival while maintaining an acceptable quality of life.

Prostatic neoplasmsDrug therapyNeoplasm metastasisAndrogen receptor antagonists

Randall B MeachamView Articles
Randy M ChudlerView Articles

Volume 17, Number 4Original Research

The 4Kscore® Test Reduces Prostate Biopsy Rates in Community and Academic Urology Practices

Jason HafronStephen M ZappalaDipen J ParekhDanielle OsterhoutJeffrey SchockRandy M ChudlerGregory M OldfordKenneth M KernenBadrinath R Konety

There is significant concern regarding prostate cancer screening because of the potential for overdiagnosis and overtreatment of men who are discovered to have abnormal prostate specific antigen (PSA) levels and/or digital rectal examination (DRE) results. The 4Kscore® Test (OPKO Diagnostics, LLC) is a blood test that utilizes four kallikrein levels plus clinical information in an algorithm to calculate an individual&rsquo;s percentage risk (&lt; 1% to &gt; 95%) for aggressive prostate cancer (Gleason score &ge; 7) on prostate biopsy. The 4Kscore Test, as a follow-up test after abnormal PSA and/or DRE test results, has been shown to improve the specificity for predicting the risk of aggressive prostate cancer and reduce unnecessary prostate biopsies. A clinical utility study was conducted to assess the influence of the 4Kscore Test on the decision to perform prostate biopsies in men referred to urologists for abnormal PSA and/or DRE results. The study population included 611 patients seen by 35 academic and community urologists in the United States. Urologists ordered the 4Kscore Test as part of their assessment of men referred for abnormal PSA and/or DRE test results. Results for the patients were stratified into low risk (&lt; 7.5%), intermediate risk (7.5%-19.9%), and high risk (&ge; 20%) for aggressive prostate cancer. The 4Kscore Test results influenced biopsy decisions in 88.7% of the men. Performing the 4Kscore Test resulted in a 64.6% reduction in prostate biopsies in patients; the actual percentage of cases not proceeding to biopsy were 94.0%, 52.9%, and 19.0% for men who had low-, intermediate-, and high-risk 4Kscore Test results, respectively. A higher 4Kscore Test was associated with greater likelihood of having a prostate biopsy (P &lt; 0.001). Among the 171 patients who had a biopsy, the 4Kscore risk category is strongly associated with biopsy pathology. The 4Kscore Test, as a follow-up test for an abnormal PSA and/or DRE results, significantly influenced the physician and patient shared decision in clinical practice, which led to a reduction in prostate biopsies while increasing the probability of detecting aggressive cancer. [Rev Urol. 2015;17(4):231-240 doi: 10.3909/riu0699] © 2016 MedReviews®, LLC

Prostate cancerProstate-specific antigen4KscoreGleason scoreDigital rectal examinationBiopsy rateProstate cancer prognosis

Ranjith RamasamyView Articles

Volume 16, Number 3Review Articles

Management of Erectile Dysfunction in the Hypogonadal Man: A Case-Based Review

Management Review

Jason M ScovellRanjith RamasamyNathan A WilkenJason R KovacLarry I Lipshultz

Erectile dysfunction (ED) has emerged as an important marker of cardiovascular and overall health, independent of other known conventional risk factors. ED often precedes coronary artery disease in half of affected subjects, and could indicate the presence of cardiovascular pathology. The pathophysiology and role of androgens in sexual function are described, along with the relevant literature on the effects of aging in erectile and gonadal function. The concept of testosterone supplementation (TST) in men with ED is reviewed. The authors utilize clinical vignettes to discuss the appropriate management of two clinical cases of men at different life stages who have ED in the setting of hypogonadism and propose a treatment algorithm. In patients of all ages, proper identification of the underlying pathophysiology of decreased libido and erectile function is paramount in choosing between the use of TST, phosphodiesterase type 5 inhibitors, or both, in the management of these disorders. [Rev Urol. 2014;16(3):105-109 doi: 10.3909/riu0623] © 2014 MedReviews®, LLC

HypogonadismErectile dysfunctionTestosterone supplementationPhosphodiesterase

Raoul S ConcepcionView 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&rsquo;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

Raul I ClavijoView Articles

Volume 16, Number 4Review Articles

Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?

Screening Update

Raul I ClavijoMartin MinerJacob Rajfe

An erection is a mechanical event dependent primarily on corporeal vascular dynamics wherein arterial inflow and storage of blood within the corpora is greater than the egress of blood from the corpora. The most common cause of erectile dysfunction (ED) is the inability of the corporal tissue to store the blood within the corporal sinusoids once inflow into the corpora begins. This failure to store is primarily due to a corporal smooth muscle dysfunction and, in most men, is most likely an aging-related occurrence. Because the corporal smooth muscle is embryologically and physiologically indistinguishable from the smooth muscle within our arterial system, the authors hypothesize that the aging-related dysfunction that occurs within the penis also occurs within the arterial system, and that this smooth muscle dysfunction within the arterial media is most likely the cause of what is called essential hypertension. This panvascular smooth muscle myopathy could explain why hypertension is the most common comorbidity associated with ED and appears to indicate that both ED and essential hypertension are the same disorder, albeit in two different organ systems. [Rev Urol. 2014;16(4):167-171 doi: 10.3909/riu0631] © 2014 MedReviews®, LLC

HypertensionErectionEndotheliumSmooth muscle

Ravi J KumarView Articles
Rebecca RinkoView 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

Regina Barragan-CarrilloView Articles

Volume 23, Number 2Case of the Quarter

Case of the Quarter: Kaposi Sarcoma in a Patient With Testicular Germ Cell Tumor and HIV: A Case Report and Literature Review

Daniela V. CastroDonald HannounTanya B. DorffAlexander Chehrazi-RaffleWesley YipAbhishek TripathiBenjamin MercierRegina Barragan-CarrilloHedyeh EbrahimiSalvador Jaime-Casas

Testicular germ cell tumors are the leading cause of cancer in male patients 15 to 39 years old. Extensive treatments are available, and the regimen of choice depends on clinical, laboratory, and histopathologic characteristics. Patients with HIV are at increased risk of developing solid malignancies, including testicular germ cell tumors. All patients with HIV should start on highly active antiretroviral therapy, but the drug interactions between chemotherapy for testicular germ cell tumor and highly active antiretroviral therapy have not been extensively evaluated. This case review highlights the importance of optimal therapeutic agent selection in patients with HIV and solid malignancies.

Testicular neoplasmGerm cellHIVTesticular neoplasmsSarcoma

Reginald C BruskewitzView Articles
Rena D MalikView 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

Ricardo R GonzalezView Articles

Volume 9, Number 2Review Articles

Phosphodiesterase Type 5 Inhibitors for the Treatment of Male Lower Urinary Tract Symptoms

Treatment Update

Steven A KaplanRicardo R Gonzalez

Both lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and erectile dysfunction have a very high prevalence among aging men, and there is some clinical evidence that they may share a common pathophysiology. Consequently, several preliminary studies of phosphodiesterase type 5 inhibitors—sildenafil and tadalafil—have recently been conducted in men with concomitant erectile dysfunction and lower urinary tract symptoms to determine whether these agents are effective for the treatment of symptomatic BPH. These studies have demonstrated efficacy, both alone and in combination with an -blocker, in treating lower urinary tract symptoms along with sexual dysfunction. However, larger-scale randomized studies are necessary to determine long-term safety, efficacy, and cost effectiveness. [Rev Urol. 2007;9(2):73-77]

Benign prostatic hyperplasiaLower urinary tract symptomsErectile dysfunctionTadalafilSildenafilPhosphodiesterase type 5 inhibitors

Richard A SantucciView Articles

Volume 18, Number 2Review Articles

Urethral Strictures and Stenoses Caused by Prostate Therapy

Treatment Update

Andres F CorreaMang L ChenRichard A Santucci

The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient’s overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty. [Rev Urol. 2016;18(2):90-102 doi: 10.3909/riu0685] © 2016 MedReviews®, LLC

Prostate cancerBenign prostatic hyperplasiaComplicationsStrictureStenosis

Richard A SteinView Articles
Richard A WatsonView Articles
Richard AlexanderView Articles
Richard B HayesView Articles
Richard BergerView Articles
Richard D UrmanView Articles

Volume 15, Number 4Review Articles

Anesthetic Challenges in Robotic-assisted Urologic Surgery

Management Review

Richard L HsuAlan D KayeRichard D Urman

Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and limited access to the patient, all present anesthetic management challenges in urologic surgery. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce surgical and anesthetic complications. [Rev Urol. 2013;15(4):178-184 doi: 10.3909/riu0589] © 2014 MedReviews®, LLC

Robotic surgeryUrologic surgeryAnesthesia complicationsPneumoperitoneumPeripheral nerve injuryPatient positioning