Editorial Board About Us

Volume 10, Number 2

John P. Stein, MD, FACS 1962-2008

In Memoriam

Review Articles

The QT Interval and Selection of Alpha-Blockers for Benign Prostatic Hyperplasia

Treatment Update

Richard G Trohman Norman E Lepor Lawrence A Hill Herbert Lepor

The QT interval is the electrocardiographic manifestation of ventricular depolarization and repolarization. Drug-induced long QT syndrome is characterized by acquired, corrected QT (QTc) interval prolongation that is associated with increased risk of torsade de pointes. Every physician must recognize if the drugs he or she prescribes prolongs the QTc interval, especially if the drug is prescribed for a chronic condition in older patients who are on polypharmacy. The evolution of alpha-blockers for the treatment of benign prostatic hyperplasia has allowed the development of drugs that are easier to administer and better tolerated. Because alpha-blockers generally have equivalent efficacy, this class of drugs is typically differentiated by safety and side effects. Studies suggest that alpha-blockers may vary in regard to their effect on the QT interval, and, therefore, on their predisposition to cause potentially life-threatening ventricular arrhythmias. [Rev Urol. 2008;10(2):85-91]

Blockers Benign prostatichyperplasia Drug-induced long QT syndrome Torsade de pointes

Review Articles

Concomitant Medications and Possible Side Effects of Antimuscarinic Agents

Treatment Update

Scott MacDiarmid

Antimuscarinic agents are the treatment of choice for overactive bladder syndrome; clinical experience and the literature support their efficacy, tolerability, and safety. The most common side effects experienced include dry mouth and constipation. Many commonly prescribed drugs have anticholinergic effects that could increase the anticholinergic “load” or “burden” in patients with overactive bladder, potentially increasing the frequency and severity of side effects. In addition, the adverse events associated with antimuscarinics may be more pronounced in the elderly, especially those taking multiple medications. Knowledge regarding the potential side effects associated with antimuscarinics is important so that patients can be advised and effectively treated. [Rev Urol. 2008;10(2):92-98]

Overactive bladder Oxybutynin Antimuscarinic agents Elderly Side effects Tolterodine Solifenacin Darifenacin Trospium chloride

Review Articles

Managing Bone Loss and Bone Metastases in Prostate Cancer Patients: A Focus on Bisphosphonate Therapy

Treatment Update

Androgen deprivation therapy (ADT) and bone metastases are the most important risk factors for developing skeletal complications (eg, bone loss, pathologic fractures) in prostate cancer (PC) patients with locally advanced and metastatic disease. Bisphosphonates, which inhibit excessive osteoclast activity caused by ADT and bone metastases, have proven to be safe and effective in preventing skeletal complications and presently are the standard of care in patients with metastatic disease. Bisphosphonates should be considered for use in all PC patients with locally advanced disease initiating ADT for an intended duration of at least 1 year, especially those with a low baseline bone mineral density. [Rev Urol. 2008;10(2):99-110]

Prostate cancer Androgen deprivation therapy Skeletal-related events Bone metastasis Bone loss Bisphosphonates

Review Articles

Prostate Cancer in Elderly Men

Treatment Update

Anton Stangelberger Matthias Waldert Bob Djavan

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 cancer Elderly men Screening Quality of life Prostate-specific antigen Overtreatment

Review Articles

Critical Evaluation of Urinary Markers for Bladder Cancer Detection and Monitoring

Diagnostic Update

Shahrokh F Shariat Pierre I Karakiewizc Jose A Karam Yair Lotan

Bladder cancer is currently diagnosed using cystoscopy and cytology in patients with suspicious signs and symptoms. These tests are also used to monitor patients with a history of bladder cancer. The recurrence rate for bladder cancer is high, thus necessitating long-term follow-up. Urine cytology has high specificity but low sensitivity for low-grade bladder tumors. Recently, multiple noninvasive urine-based bladder cancer tests have been developed. Although several markers have been approved by the US Food and Drug Administration for bladder cancer surveillance, only a few are approved for detection of bladder cancer in high-risk patients. [Rev Urol. 2008;10(2):120-135]

Bladder cancer Tumor markers Cystoscopy Urine cytology

Meeting Reviews

The Multidisciplinary Approach to Defining the Urologic Chronic Pelvic Pain Syndromes

Meeting Review

J Curtis Nickel

Report from a National Institutes of Health Workshop, December 13-14, 2007, Baltimore, MD [Rev Urol. 2008;10(2):157-159]

Interstitial cystitis Chronic pelvic pain syndrome Chronic prostatitis Painful bladder syndrome Irritable bowel syndrome Fibromyalgia Chronic fatigue syndrome

Meeting Reviews

Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Finding a Way Forward in the United Kingdom

Meeting Review

Marina Cameron Meesha Patel J Curtis Nickel

Report from the First United Kingdom Symposium on Chronic Prostatitis, January 30, 2008, London, United Kingdom [Rev Urol. 2008;10(2):160-163]

Prostate Chronic pelvic pain syndrome Prostatitis Pain Psychosocial aspects of pain Alternative treatments

Leydig Cell Hyperplasia Revealed by Gynecomastia

Case Review

Mohamed Fadl Tazi Soufiane Mellas Moulay Hassan Farih Mohamed Jamal El Fassi

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]

Fertility Testicular tumor Leydig cell hyperplasia Nonseminomatous germ celltumors Gynecomastia

Literature Reviews

Erectile Dysfunction

News and Views from the Literature

Literature Reviews

News and Views from the Literature

Literature Reviews

Prostate Cancer

News and Views from the Literature

Danil V Makarov Alan W Partin