Volume 11, Number 3

Review Articles

Predictive Models for Newly Diagnosed Prostate Cancer Patients

Management Update

William T LowrancePeter T Scardino

[Rev Urol.2009;11(3):117-126 doi: 10.3909/riu0456]2009 MedReviews®, LLC©Accurate risk assessment is of paramount importance to newly diagnosedprostate cancer patients and their physicians. Risk prediction models helpidentify those at high (or low) risk of disease progression and guide discussionsabout prognosis and treatment. Widely used, well-validated predictiontools are based on standard, readily available clinical and pathologic parameters,but do not include biomarkers, some of which may have an importantrole in predicting prognosis or determining therapeutic options. A newapproach, known as systems pathology, may improve the accuracy of traditionalprediction methods and provide patients with a more personalized riskassessment of clinically relevant outcomes. The ultimate goal of predictionmodels is to improve medical decision making.

Prostate cancerPrognosisStatistical modelNomogram

Review Articles

Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials

Management Update

Elisabeth EckersbergerMarkus MargreiterHelen SadriJulia FinkelsteinBob DjavanSamir S TanejaHerbert Lepor

The advent of prostate-specific antigen (PSA) testing in the early 1980srevolutionized the diagnosis of prostate cancer. As a result of PSA testing,there has been a surge in the number of prostate cancer diagnoses. Thisreview examines the results of 2 recent landmark trials that studied the effectof screening on prostate cancer mortality: the European Randomized Study ofScreening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung,Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[Rev Urol. 2009;11(3):127-133 doi: 10.3909/riu0474]

PSA screeningEuropean Randomized Study of Screening for Prostate Cancer(ERSPC)Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Review Articles

Hypocitraturia: Pathophysiology and Medical Management

Management Review

Dean G AssimosJack M Zuckerman

Low urinary citrate excretion is a known risk factor for the development ofkidney stones. Citrate inhibits stone formation by complexing with calciumin the urine, inhibiting spontaneous nucleation, and preventing growth andagglomeration of crystals. Hypocitraturia is a common metabolic abnormalityfound in 20% to 60% of stone formers. It is most commonly idiopathic inorigin but may be caused by distal renal tubular acidosis, hypokalemia, boweldysfunction, and a high-protein, low-alkali diet. Genetic factors, medications,and other comorbid disorders also play a role. Hypocitraturia should be managedthrough a combination of dietary modifications, oral alkali, and possiblylemonade or other citrus juice–based therapy. This review concerns thepathophysiology of hypocitraturia and the management of stone formersafflicted with this abnormality.[Rev Urol. 2009;11(3):134-144 doi:10.3909/riu0424]© 2009 MedReviews®, LLC

HypocitraturiaCitrate metabolismCitrate pathophysiologyHypocitraturia etiologiesMedical management of stone diseaseAlkali citratePotassium citrateCitrus juiceLemonade

Review Articles

Male Urinary Incontinence: Prevalence, Risk Factors, and Preventive Interventions

Systematic Review

Robert L KaneTimothy J WiltRyan PingJean F WymanTatyana A Shamliyan

Urinary incontinence (UI) in community-dwelling men affects quality of lifeand increases the risk of institutionalization. Observational studies and randomized,controlled trials published in English from 1990 to November 2007on the epidemiology and prevention of UI were identified in several databasesto abstract rates and adjusted odds ratios (OR) of incontinence, calculateabsolute risk difference (ARD) after clinical interventions, and synthesizeevidence with random-effects models. Of 1083 articles identified, 126 wereeligible for analysis. Pooled prevalence of UI increased with age to 21% to32% in elderly men. Poor general health, comorbidities, severe physicallimitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidenceinterval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95%CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI,1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI,0.08-0.25) resulted in greater self-reported benefit compared with placebo.Radical prostatectomy or radiotherapy for prostate cancer compared withwatchful waiting increased UI. Short-term prevention of UI with pelvic floormuscle rehabilitation after prostatectomy was not consistently seen acrossrandomized, controlled trials. The prevalence of incontinence increased with ageand functional dependency. Stroke, diabetes, poor general health, radiation, andsurgery for prostate cancer were associated with UI in community-dwellingmen. Men reported overall benefit from drug treatments. Limited evidence ofpreventive effects of pelvic floor rehabilitation requires future investigation.[Rev Urol. 2009;11(3):145-165 doi:10.3909/riu0416]© 2009 MedReviews, LLC

Risk factorsUrinary incontinenceRehabilitationDrug therapy

Meeting Reviews

New Insights in Pediatric Urology

Ellen Shapiro

Highlights From the American Academy of Pediatrics Section on Urology Meeting,October 10-13, 2008, Boston, MA[Rev Urol. 2009;11(3):166-168 doi: 10.3909/riu.0444]© 2009 MedReviews®, LLC

Lower urinary tract symptomsVesicoureteral refluxEnuresisUndescended testis

Meeting Reviews

New Findings in Prostate Cancer

Franklin E KuehhasBob Djavan

Highlights From the 24th Annual Congress of the European Association of Urology,March 17–21, 2009, Stockholm, Sweden[Rev Urol. 2009;11(3):169-172 doi:10.3909/riu0455]

Prostate cancerErectile dysfunctionUrinary incontinencePelvic lymph node dissectionStagingEuropean Randomized Study of Screening for Prostate Cancer (ERSPC)

Case Review

Placenta Percreta and the Urologist

Asghar AskariRamdev KonijetiJacob Rajfer

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

Literature Reviews

Female Urology: Training and Regulations

News and Views From the Literature

Frank CostaFrank D GrecoMichael B Chancellor

Literature Reviews

Prostate Cancer

News and Views From the Literature

Stacy LoebAlan W Partin