Issues

Imaging Techniques in the Diagnosis of Renal Cell Carcinoma: Contemporary Trends and Future Directions

Gautam Jayram

Increasing radiographic detection of incidental small renal masses has led to a growing concern regarding overtreatment of these lesions. Given the limitations of computed tomography and magnetic resonance imaging, there is an unmet need for improved kidney imaging techniques that can provide more accurate assessments of renal lesions. This review provides a summary of established kidney imaging modalities and also those likely to be meaningful in the near future. Kidney imaging has evolved, with several modalities contributing to the overall diagnostic landscape. There is great optimism that a new era of molecular imaging in renal cell carcinoma can vastly improve diagnostic capabilities and limit unnecessary invasive procedures.

Letter From the President of LUGPA

Evan R Goldfischer

As we approach the next election, it is of utmost importance that we, as one of the strongest voices for independent medicine, engage in political advocacy. Our mission is to ensure that the independent practice of urology endures while showcasing outstanding quality and value to our patients, vendors, payers, legislators, and regulatory agencies. To achieve this, we must actively preserve our autonomy and demonstrate the highest quality standards through evidence-based practices and effective communication.

Letter From the President of LUGPA

Evan R Goldfischer

I’m thrilled to share a recap of our successful March 2024 DC Fly-In, where LUGPA members gathered in Washington, DC, to advocate for the crucial health care reforms outlined in our 2024 Legislative and Regulatory Agenda.

An interview with Shailendra Sharma, CEO, Specialty Networks

Neal D Shore

The LUGPA board, in partnership with Specialty Networks, was thrilled to announce the return of Reviews in Urology in 2024, and no one more so than Specialty Networks’ CEO, Shailendra Sharma. “We are honored for our Reviews in Urology publication to be designated as the official journal of LUGPA and to further strengthen our partnership and commitment to LUGPA’s mission of preserving and advancing the independent practice of urology,” he said. Reviews in Urology first launched in 1999 as a PubMed-indexed, quarterly journal featuring peer-reviewed research, case studies, thought leader interviews, and insights on emerging trends and research shaping the field of urology. Mr Sharma says that Specialty Networks now plans to build on the journal’s long-standing focus on cutting-edge urology advances while offering expanded coverage of a broad range of urologic conditions and specialty care concerns. Mr Sharma sat down to talk with Neal Shore, MD, editor in chief of Reviews in Urology, to discuss the journal’s history and his hopes for the future of the journal and the profession.

Contemporary Management of Bulbar Urethral Strictures

Management Review

Andrew J CohenRoss S LiaoErica SternJames E Wright

Urethral stricture disease (USD) is a progressive scar-forming disease commonly encountered by urologists and is challenging to manage. USD most frequently occurs in the bulbar urethra. Patients typically present with chronic obstructive voiding symptoms but may develop recurrent urinary tract infections, detrusor failure, or renal disease. The authors review the pathophysiology, diagnostic workup, and evidence-based management of bulbar urethral strictures (BUS). There are multiple surgical options to treat BUS. Endoscopic techniques (eg, dilation and urethrotomy) are suitable for the initial management of short strictures but new evidence-based guidelines recommend against repeated endoscopic treatment. Urethroplasty is the gold standard treatment for BUS of all lengths, with anastomotic techniques appropriate for strictures <2 cm and tissue substitution performed for longer strictures. New techniques, such as non-transecting urethroplasty, lack long-term data but may represent a paradigm shift in the field. Future treatments may utilize tissue-engineered grafts and agents that inhibit inflammation and scar formation. [Rev Urol. 2020;22(4):139–151] © 2021 MedReviews®, LLC

Failing to Prepare Is Preparing to Fail

Deepak A KapoorKathleen A Latino

[Rev Urol. 2020;22(3):91-92] © 2020 MedReviews®, LLC

Non–muscle-invasive Bladder Cancer: Overview and Contemporary Treatment Landscape of Neoadjuvant Chemoablative Therapies

Treatment Update

Richard S MatulewiczGary D Steinberg

Non–muscle-invasive bladder cancer (NMIBC) is a heterogeneous subclassification of urothelial carcinoma with significant variation in individual risk of recurrence and progression to muscle-invasive disease. Risk stratification by American Urological Association (AUA) and European Association of Urology (EAU) guidelines or by using nomograms/risk calculators developed from clinical trial data can help inform patient treatment decisions but may not accurately classify all patients. Risk-adapted adjuvant (post–transurethral resection of bladder tumor [TURBT]) treatment strategies using intravesical therapies are an important means of balancing disease control with potential adverse effects. Adjuvant intravesical instillation with various chemotherapy agents and bacillus Calmette-Guérin (BCG) is well studied and associated with excellent outcomes for most patients. However, upwards of 40% of patients recur within 2 years and roughly 10% progress to muscle-invasive bladder cancer. Novel approaches and agents that aim to reduce the treatment burden associated with NMIBC are increasingly needed. We review the current landscape of NMIBC as it pertains to the use of and rationale for emerging neoadjuvant chemoablative therapies. [Rev Urol. 2020;22(2):43–51] © 2020 MedReviews®, LLC

Management of Low-grade Upper Tract Urothelial Carcinoma: An Unmet Need

Management Review

Neal D ShoreJay Raman

Upper tract urothelial cancers (UTUC) are frequently managed by radical nephroureterectomy (RNU), a major operative procedure that may entail short-term morbidity and long-term decline in renal function. Kidney-sparing procedures offer a less invasive alternative to RNU for low-risk, low-grade UTUC (LG-UTUC). They are associated with similar disease-specific survival rates and better long-term renal function, albeit with a potentially increased risk of recurrence. Strategies to decrease LG-UTUC recurrence include improved risk stratification and enhanced endoscopic instrumentation. Chemoablation may represent an alternative, innovative kidney-sparing approach for LG-UTUC. [Rev Urol. 2020;22(1):1–8] © 2020 MedReviews®, LLC

Intravesical Therapy for Non-muscle Invasive Bladder Cancer—Current and Future Options in the Age of Bacillus Calmette-Guerin Shortage

Treatment Update

Izak FaienaKarim ChamieVishnukamal GollaAndrew T Lenis

Non-muscle invasive bladder cancer (NMIBC) is a common and burdensome malignancy. A substantial proportion of patients with intermediate- and high-risk disease will progress to invasive bladder cancer and are at a significant risk for metastasis and death. Bacillus Calmette-Guerin (BCG) therapy for selected cases has been the standard of care for nearly 40 years. Unfortunately, a world-wide shortage has made BCG challenging to obtain. Furthermore, recurrences and progressions do occur. With the US Food and Drug Administration creating a clear path to drug approval for novel treatments, many therapies have been tested, including intravesical cytotoxic chemotherapy, intravesical immunotherapy, systemic immunotherapy, and novel agents, such as gene therapy and targeted therapy. In this review, we highlight ongoing clinical trials. [Rev Urol. 2019;21(4):145–153] © 2020 MedReviews®, LLC

Primary Bladder Neck Obstruction

Disease State Review

Benjamin M BruckerAlice DrainRachael D Sussman

Primary bladder neck obstruction (PBNO) is a functional obstruction caused by abnormal opening of the bladder neck during the voiding phase of micturition. PBNO may present with a variety of symptoms including voiding symptoms (slow urinary stream, intermittent stream, incomplete emptying), storage symptoms (frequency, urgency, urgency incontinence, nocturia), and/or pelvic pain and discomfort. The diagnosis of PBNO can be made with videourodynamic testing, which demonstrates elevated voiding pressures with low flow, and fluoroscopic imaging demonstrating obstruction at the level of the bladder neck. Treatment options include conservative management with watchful waiting, pharmacologic management, and surgical intervention. In this article, we review the etiology, presentation, diagnosis, and treatment of PBNO in men, women, and children. [Rev Urol. 2019;21(2/3):53–62] © 2019 MedReviews®, LLC