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Directory of Authors from the Journal and their last article.

Shanmugasundaram Gowrie-MohanView Articles

Volume 18, Number 3Review Articles

Perioperative Considerations in Metastatic Renal Cell Carcinoma

Management Update

Kate FlavinJim AsheadTim LaneDamian HanburyPaul NathanShanmugasundaram Gowrie-Mohan

Patients with metastatic renal cell carcinoma are complex, with the potential for significant complications, and require extensive pre-, peri-, and postoperative management. This article discusses, in depth, the necessary considerations in the treatment of these patients. [Rev Urol. 2016;18(3):133-142 doi: 10.3909/riu0697] © 2016 MedReviews®, LLC

Renal cell carcinomaRadical nephrectomyCytoreductive nephrectomyMetastasis

Shannon CheroneView Articles

Volume 21, Number 1Original Research

Prostate Biopsy Features: A Comparison Between the Pre– and Post–2012 United States Preventive Services Task Force Prostate Cancer Screening Guidelines With Emphasis on African American and Septuagenarian Men

Navin ShahVladimir IoffeShannon Cherone

We compare prostate biopsy (Pbx) characteristics from 3 years prior to the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines with those of 2018, with a focus on African American (AA) men and healthy men aged 70 to 80 years. We completed a retrospective comparative analysis of 1703 sequential patients that had had a Pbx from 2010 to 2012 (3 years) with 383 patients biopsied in 2018. Data was collected on patient age, race, prostate-specific antigen (PSA), digital rectal examination (DRE), total number of biopsies performed, and Gleason sum score (GSS). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined as group A and B, Pbx prior to the 2012 USPSTF screening guidelines and that of 2018, respectively. The study population consisted of 71% high-risk AA patients. In Group A (pre-2012 USPSTF guidelines), 567 patients/year underwent a Pbx versus Group B, 383 patients/year, a 32% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B with 175/year, a 31% increase post-USPSTF. In Group B, there was a 94% relative increase in total positive biopsies. Group A had high-grade PCa (GSS 7-10) in 51.5% versus 60.5% in Group B, a 9% increase post-USPSTF. The proportion of patients with a PSA 10 ng/mL or higher was 25.4% in group A versus 29.3% in group B. The age group of 70 to 80 years demonstrated an increasing trend for patients with PSA 10 ng/mL and higher, 31% in Group A versus 38% in Group B; high-grade tumors (GSS 7-10) occurred in 61% in Group A versus 65% in Group B. After the 2012 USPSTF guidelines against PCa screening, our study shows decreased prostate cancer screening with decreased Pbx, increased PCa diagnosis, and increased high-grade (GSS 7-10) PCa. These trends were especially notable in the 70- to 80-year age group, which showed a larger proportion of total patients (compared with pre-2012 USPSTF guidelines), increased PCa grades, increased PSA levels, and a higher percentage of patients with greater than 50% positive cores. As our patient population consists of 71% AA patients, our results support aggressive PCa screening for high-risk patients, which includes AA men, men with a family history of PCa, and healthy men aged 70 to 80 years. [Rev Urol. 2019;21(1):1–7] © 2019 MedReviews®, LLC

Prostate cancerElderly menUnited States Preventive Services Task ForceScreeningProstate-specific antigen (PSA)African American Men

Shannon R HerreraView Articles

Volume 9, Number 4Case Review

Bilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis Nodosa

Case Review

Donald S CrainShannon R HerreraSean P Stroup

We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy. [Rev Urol. 2007;9(4):235-238]

Testicular infarctionPolyarteritis nodosaAndrogen replacement therapy

Shawn DuView Articles

Volume 23, Number 2Prostate Cancer

Real-World Comparison of Deep Prostate-Specific Antigen Response in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Apalutamide or Enzalutamide

Benjamin H. LowentrittIbrahim KhilfehDominic PilonShawn DuCarmine RossiFrederic KinkeadLilian DiazJill KorsiakPatrick LefebvreGordon A Brown

Deep prostate-specific antigen reduction of at least 90% (PSA90 response) after androgen receptor pathway inhibitor initiation to treat metastatic castration-sensitive prostate cancer (mCSPC) is associated with longer survival. This real-world study evaluated the proportion of androgen receptor pathway inhibitor–naive patients with mCSPC who achieved PSA90 response 6 months after initiating apalutamide or enzalutamide.

Prostatic neoplasmsProstate-specific antigen (PSA)Prostate-specific antigenProstate-specific antigensCastrationAndrogen receptorAndrogen receptor antagoniststreatment effectiveness

Shawn E LupoldView Articles
Shawn EL WasonView Articles

Volume 12, Number 4Case Review

Spontaneous Rupture of a Renal Artery Aneurysm Presenting as Gross Hematuria

Shawn EL WasonThomas Schwaab

Renal artery aneurysms (RAAs) are localized dilations of the renal artery and/or its branches. They are being found with increasing frequency as a result of unrelated abdominal imaging or on workup for hypertension. They are rarely symptomatic; however, they can be a cause of life-threatening hematuria. Discussed is the case of a previously healthy 46-year-old man presenting with flank pain and gross hematuria. It is imperative for the practicing urologist to be aware of the appropriate evaluation and management of RAAs.[Rev Urol. 2010;12(4):e193-e196 doi: 10.3909/riu0489]© 2010 MedReviews®, LLC

Renal artery aneurysmAbdominal aortographyGross hematuria

Shelby N MorrisroeView Articles
Sher Singh YadavView Articles

Volume 16, Number 3Case Review

Occult Renal Cell Carcinoma Manifesting as Nasal Mass and Epistaxis

Sher Singh YadavJanak SinghVishwas BahetiRajeev Mathur

Metastasis of renal cell carcinoma (RCC) to the nasal cavity and paranasal sinuses is rare, with fewer than 50 cases described in the literature. Nasal metastasis as the initial presentation of RCC is even rarer. Metastases to the nasal cavity usually represent advanced disease with poor outcome. The authors report a case of metastatic RCC presenting with right nasal cavity mass and epistaxis, followed by a brief review of the relevant literature. [Rev Urol. 2014;16(3):145-148 doi: 10.3909/riu0607] © 2014 MedReviews®, LLC

Renal cell carcinomaNasal metastasisEpistaxis

Shilpi GuptaView Articles

Volume 15, Number 3Case Review

Ureteral Metastasis as the Presenting Manifestation of Pancreatic Carcinoma

Onkar SinghNand Kishore ArvindShilpi GuptaQutub Ali

We recently cared for a patient with adenocarcinoma of the pancreas who presented with ureteral metastasis followed by hydroureteronephrosis long before the appearance of any symptoms related to the primary lesion. The entity is extremely rare; only seven similar cases are on record in the scientific literature. No recent review exists on this topic. This encouraged us to present our case along with the previous cases of adenocarcinoma of the pancreas with ureteral metastasis that have been reported. [Rev Urol. 2013;15(3):124-130 doi: 10.3909/riu0575] © 2013 MedReviews®, LLC

MetastasisHydronephrosisUreterUreteral metastasisPancreatic adenocarcinoma

Shilpi Singh GuptaView Articles

Volume 13, Number 2Case Review

Laparoscopic Nephrectomy for Pyonephrosis During Pregnancy: Case Report and Review of the Literature

Onkar SinghNand Kishore ArvindShilpi Singh GuptaSurbhi SahayKutub AliAnand Dharaskar

The maternal and fetal complications of pyonephrosis during pregnancy can be devastating, thus the call for urgent but safe intervention. Laparoscopic nephrectomy has been used safely and effectively in nonpregnant patients with pyonephrotic kidney. We report on a case of a 28-year-old pregnant woman with pyonephrotic kidney that we believe to be the first such case managed by transperitoneal laparoscopic nephrectomy. A review of the reported cases of laparoscopic nephrectomy for different indications and by different approaches during pregnancy is also presented. [Rev Urol. 2011;13(2):98-103 doi: 10.3909/riu0505] © 2011 MedReviews®, LLC

LaparoscopyNephrectomyPregnancyPyonephrosis

Shing-Hwa LuView Articles
Shyam PatnaikView Articles

Volume 21, Number 1Case Review

Ureteral Polyp Managed by Endoscopic Techniques

Tal CohenMark MemoJohn GraffShyam Patnaik

Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter. [Rev Urol. 2019;21(1):45–48] © 2019 MedReviews®, LLC

Ureteral polypEndoscopic managementUreteral filling defect

Shyam TalrejaView Articles

Volume 19, Number 1Case Review

Xanthogranulomatous Pyelonephritis Presenting as a Type IV Renal Cyst

Bosniak class IV renal cyst • Radical nephrectomy • Xanthogranulomatous pyelonephritis

Sher Singh YadavIndraneel BanerjeeVinay TomarNachiket VyasShyam Talreja

A 20-year-old woman presented to our outpatient clinic with a 5-week history of recurrent right lumbar back pain. Contrast-enhanced computed tomography scan showed a Bosniak class IV renal cyst. She was treated with radical nephrectomy. Histopathology revealed xanthogranulomatous pyelonephritis. [Rev Urol. 2017;19(1):60-63 doi: 10.3909/riu0715] © 2017 MedReviews®, LLC

Radical nephrectomyBosniak class IV renal cystXanthogranulomatous pyelonephritis

Sibylle MarihartView Articles
Silvia C FormentiView Articles

Volume 9, Supplement 2Review Articles

Breast Cancer Clinical and Translational Research: Analogies and Implications for Prostate Cancer

Androgen-Independent Prostate Cancer

Lea BaerSilvia C Formenti

Breast and prostate cancer, respectively, are the most common cancers in women and in men in the United States. The management of locally advanced prostate cancer involves a multidisciplinary approach, bearing similarity to the therapeutic approach to breast cancer. Better understanding of the molecular biology of these cancers and the identification of the role played by the cancer stem cells and the tumor microenvironment may translate into better clinical decision making regarding risk classification and treatment allocation. A systematic assessment is presented of the many parallel evolutions in defining and treating high-risk breast cancer as they pertain to prostate cancer. [Rev Urol. 2007;9(suppl 2):S28-S39]

Prostate cancerTreatmentBreast cancer

Simon D WuView Articles

Volume 8, Number 2Review Articles

Pathologic Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature

Therapeutic Challenges

John P SteinVannita Simma-ChangSimon D Wu

Orthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder. [Rev Urol. 2006;8(2):54-60]

CystectomyOrthotopic urinary diversionOrthotopic neobladderFemale bladdercancerUrethrectomyUrethral recurrence

Simon J HallView Articles

Volume 9, Supplement 1Review Articles

Clinical Experience With Gene Therapy for the Treatment of Prostate Cancer

New Directions in the Management of Advanced Prostate Cancer

Simon J HallMatthew A Stanizzi

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients. [Rev Urol. 2007;9(suppl 1):S20-S28]

Prostate cancerProstate-specific antigenGene therapy

Simone L VernezView Articles

Volume 18, Number 1Review Articles

Nephrolithometric Scoring Systems to Predict Outcomes of Percutaneous Nephrolithotomy

Management Update

Simone L VernezZhamshid OkhunovPiruz MotamediniaVincent BirdZeph OkekeArthur Smith

Currently, there is no single agreement upon an ideal predictive model that characterizes the complexity of renal stones and predicts surgical outcomes following percutaneous nephrolithotomy (PCNL). New predictive tools have recently emerged to systematically and quantitatively assess kidney stone complexity to predict outcomes following PCNL: the Guy’s Stone Score, the CROES nomogram, S.T.O.N.E. nephrolithometry, and S-ReSC score. An ideal scoring system should include variables that both influence surgical planning and are predictive of postoperative outcomes. This review discusses the strengths, weaknesses, and commonalities of each of the above scoring systems. Additionally, we propose future directions for the development and analysis of surgical treatment for stone disease, namely, the importance of assessing radiation exposure and patient quality of life when counseling patients on treatment options. [Rev Urol. 2016;18(1):15-27 doi: 10.3909/riu0693] © 2016 MedReviews®, LLC

Percutaneous nephrolithotomyUrolithiasisScoring systemNomograms

Sophia DelpeView Articles

Volume 20, Number 1Review Articles

Nocturia: Evaluation and Current Management Strategies

Management Update

Roger R DmochowskiW Stuart ReynoldsAlan J WeinCasey G KowalikJoshua A CohnSophia DelpeMelissa R KaufmanDoug F Milam

Nocturia is a complex condition that not only significantly affects quality of life, but may be an indicator of systemic disease. Initial assessment includes a detailed history and physical examination and completion of a frequency volume chart to help identify underlying causes, such as sleep disorders, bladder storage disorders, and polyuria. Treatment with alpha-blockers or antimuscarinic medications may help if the underlying cause is determined to be benign prostatic hyperplasia or overactive bladder, respectively. Treatment options for nocturnal polyuria have been limited to behavioral therapy and off-label use of timed diuretics and desmopressin. Desmopressin acetate nasal spray (Noctiva™, Avadel Pharmaceuticals, Chesterfield, MO) was approved by the US Food and Drug Administration in 2017 for the treatment of nocturia due to nocturnal polyuria in adults who awaken at least twice nightly and has shown efficacy in reducing nocturnal voids by $50% in up to 49% of patients in clinical trials. [Rev Urol. 2018;20(1):1–6 doi: 10.3909/riu0797] © 2018 MedReviews®, LLC

Benign prostatic hyperplasiaNocturiaDesmopressinNocturnal polyuriaOveractive bladder

Soufiane MellasView Articles

Volume 10, Number 2Case Review

Leydig Cell Hyperplasia Revealed by Gynecomastia

Case Review

Mohamed Jamal El FassiMoulay Hassan FarihMohamed Fadl TaziSoufiane Mellas

Leydig cell tumors are rare and represent 1% to 3% of all tumors of the testis. Leydig cell tumors affect males at any age, but there are 2 peak periods of incidence: between 5 and 10 years and between 25 and 35 years. Their main clinical presentation is a testicular mass associated with endocrinal manifestations that are variable according to age and appearance of the tumor. Our patient, a 17-year-old adolescent, presented with an isolated and painless hypertrophy of the right mammary gland. Clinical examination found gynecomastia and no testicular mass. Hormonal levels and tumor markers were normal. Testicular sonography showed an ovular and homogeneous right intratesticular mass 6 mm in diameter. We treated the patient with an inguinal right orchidectomy. The anatomopathological study found a nodule of Leydig cell hyperplasia. The patient recovered without recurrence at 8-month follow-up. The patient opted for mammoplasty 2 months after his orchidectomy rather than wait for the spontaneous gradual regression of his gynecomastia, which requires at least 1 year. Leydig cell hyperplasia manifests in the adult by signs of hypogonadism, most frequently gynecomastia. Although many teams prefer total orchidectomy because of the diagnostic difficulty associated with malignant forms, simple subcapsular orchidectomy should become the first-line treatment, provided it be subsequently followed by close surveillance, as it preserves maximum fertility, and these tumors usually resolve favorably. [Rev Urol. 2008:10(2):164-167]

FertilityTesticular tumorLeydig cell hyperplasiaNonseminomatous germ celltumorsGynecomastia