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Volume 11, Number 2

Review Articles

Will the Evolution of Overactive Bladder Delivery Systems Increase Patient Compliance?

Treatment Review

Nirit Rosenblum

The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.[Rev Urol. 2009;11(2):45-51]

Overactive bladder Pharmacotherapy Compliance Antimuscarinic agent

Review Articles

Effective Testosterone Suppression for Prostate Cancer: Is There a Best Castration Therapy?

Management Update

Leonard G Gomella

Achieving and maintaining effective suppression of serum testosterone levels in men treated with androgen ablation is one of the essential strategies in the management of prostate cancer. Historically, a serum testosterone below 50 ng/dL was considered to be the castrate level. Current data suggest that the new target for either surgical or chemical castration is a serum testosterone level of lower than 20 ng/dL in an attempt to maximize therapeutic outcomes. Testosterone breakthrough and the acute-on-chronic effects of administration of a luteinizing hormone-releasing hormone analogue may cause testosterone levels to periodically rise, sometimes to noncastrate levels. The goal of androgen ablation is to identify those agents that will most consistently achieve and maintain the lowest testosterone levels possible.[Rev Urol. 2009;11(2):52-60]

Prostate cancer Androgen ablation LHRH analogues LHRH antagonists

Review Articles

Status of Radical Prostatectomy in 2009: Is There Medical Evidence to Justify the Robotic Approach?

Treatment Review

This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1- to 2-day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.[Rev Urol. 2009;11(2):61-70]

Prostate cancer Robotic-assisted Open radical retropubic prostatectomy

Review Articles

Spinal Dysraphism: A Neurosurgical Review for the Urologist

Management Review

André A Figueiredo Luis M Pérez André N Bastos José Murillo B Netto

Spinal neural tube defects are congenital malformations of the spine and spinal cord (eg, myelomeningocele) and are frequently seen in pediatric urology practice. These neurologic problems have many consequences in a child’s life and affect different parts of the body, such as the brain, spinal cord, limbs, bladder, and bowels. Because of the complexity and neurologic aspects of spinal dysraphism, many related terms and aspects of the disease are unfamiliar to the urologist. This review addresses some of the most commonly used neurosurgical terms and concepts related to spinal dysraphism.[Rev Urol. 2009;11(2):71-81]

Spina bifida Spinal dysraphism Myelomeningocele

Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

F Pouliot B Shuch Arie S Belldegrun Naoki Yoshimura Michael K Brawer Claus G Roehrborn J Curtis Nickel Stacy Loeb Michael B Chancellor Alan W Partin Ellen Shapiro Dean G Assimos

Prostate cancer screening Obesity Benign prostatic hyperplasia Lower urinary tract symptoms Vesicoureteral reflux Nephrolithiasis Stress urinary incontinence Inflammation Silodosin Hormonal therapy Tumor markers TMPRSS2ERG 4-Kallikrein panel Botulinum toxin type A Male voiding dysfunction Benign prostatic specific antigen Roux-en-Y gastric bypass surgery Genitourinary pain index UPOINT clinical phenotype system Nephron-sparing surgery Watchful waiting Laparoscopy for adrenal cortical carcinoma Partial adrenalectomy Urethral trauma Pediatric urethral stricture Enteric urologic surgery

Genitourinary Sarcoidosis

Edmund S Sabanegh Pravin K Rao

Genitourinary involvement of sarcoidosis can mimic many common urologic conditions. Although sarcoidosis is a benign inflammatory condition, it can present much like malignant or infectious conditions; thus, failed diagnosis can lead to unnecessary medications or surgical procedures. In addition, management choices for patients with scrotal findings have important implications for future fertility. Thus, this uncommon condition should be on the differential diagnosis for any urologic patient. The authors report on a patient with a scrotal mass as his presenting symptom of sarcoidosis and review the diagnosis, implications, and management of sarcoidosis involving all potential sites in the urinary tract.[Rev Urol. 2009;11(2):108-113]

Urology Sarcoidosis Genitourinary Scrotal mass

Literature Reviews

Prostate Cancer

News and Views From the Literature

Stacy Loeb Alan W Partin

[Rev Urol. 2009;11(2):114-115]

Literature Reviews

Erectile Dysfunction

News and Views From the Literature

[Rev Urol. 2009;11(2):116]