Volume 14, Number 1 - Reviews in Urology

The most recent guidelines on prostate cancer screening from the American Urological Association (2009), the National Comprehensive Cancer Network (2011), and the European Association of Urology (2011), as well as treatment and advances in disease monitoring, have increased the androgen deprivation therapy (ADT) population and the duration of ADT usage as the first-line treatment for metastatic prostate cancer. According to the European Association of Urology, gonadotropin-releasing hormone (GnRH) agonists have become the leading therapeutic option for ADT because they avoid the physical and psychological discomforts associated with orchiectomy. However, GnRH agonists display several shortcomings, including testosterone (T) surge (“clinical flare”) and microsurges. T surge delays the intended serologic endpoint of T suppression and may exacerbate clinical symptoms. Furthermore, ADT manifests an adverse-event spectrum that can impact quality of life with its attendant well-documented morbidities. Strategies to improve ADT tolerability include a holistic management approach, improved diet and exercise, and more specific monitoring to detect and prevent T depletion toxicities. Intermittent ADT, which allows hormonal recovery between treatment periods, has become increasingly utilized as a methodology for improving quality of life while not diminishing chronic ADT efficacy, and may also provide healthcare cost savings. This review assesses the present and potential future role of GnRH agonists in prostate cancer and explores strategies to minimize the adverse-event profile for patients receiving ADT. [ Rev Urol. 2012;14(1/2):1-12 doi:10.3909/riu0547 ] © 2012 MedReviews®, LLC

Wilms’ tumor Renal mass Open radical nephrectomy Multimodal therapy

Review Articles

Active Surveillance for Small Renal Masses

Management Update

Elias S Hyams Mohamad E Allaf Jeffrey K Mullins Phillip M Pierorazio

Small renal masses (SRMs; # 4 cm in dimension) have rapidly risen in incidence in recent decades and pose an increasingly common management dilemma in urology. SRMs are biologically heterogeneous and a wide variety of treatments exist with favorable oncologic outcomes. Active surveillance (AS) has emerged as a viable option for those not desiring surgery or those who are suboptimal candidates for surgery, with < 2% of patients progressing to metastatic disease in retrospective and prospective studies. This article reviews the current data regarding AS for SRM, operational considerations for an AS program, and criteria for safely selecting patients for this treatment strategy. [ Rev Urol. 2012;14(1/2):13-19 doi: 10.3909/riu0545] © 2012 MedReviews®, LLC

Renal cell carcinoma Small renal mass Active surveillance

Review Articles

Radical Retropubic Prostatectomy: Comparison of the Open and Robotic Approaches for Treatment of Prostate Cancer

Treatment Review

Stacy Loeb Jeffrey J Tosoian

Radical prostatectomy represents the standard of care for surgical treatment of clinically localized prostate cancer. First described in 1904, the operation became widely performed only after advances in diagnostic and surgical techniques occurred later in the century. Over time, open retropubic radical prostatectomy (RRP) became the most common operation for prostate cancer, and excellent long-term survival outcomes have been reported. More recently, minimally invasive techniques such as the robotic-assisted laparoscopic radical prostatectomy (RALRP) were introduced. Despite a lack of prospectively collected, long-term data supporting its use, RALRP has overtaken RRP as the most frequently performed prostate cancer operation in the United States. This article uses currently available data to compare oncologic, functional, and quality-of-life outcomes associated with both the open and robotic approaches to radical prostatectomy. [ Rev Urol. 2012;14(1/2):20-27 doi:10.3909/riu0552] © 2012 MedReviews®, LLC

Prostate cancer Radical retropubic prostatectomy Perioperative outcomes Robotic-assisted

Meeting Reviews

Innovation in Endourology and Minimally Invasive Surgery

Highlights From the 29th World Congress of Endourology and SWL 2011, November 30-December 3, 2011, Kyoto, Japan

Stacy Loeb James F Borin

Percutaneous nephrolithotomy Small renal mass Active surveillance Endourology

Case Review

Adult Wilms’ Tumor With a Unique Presentation of High-Grade Fever, Photophobia, and Headache

Marcella Nachmann Jerome Pietras Jay Krishnan

Wilms’ tumor is the second most common tumor in children, accounting for 6% to 7% of all childhood tumors. However, in adults, it is a rare occurrence. The true incidence of adult Wilms’ tumor is difficult to ascertain because of its rarity in the adult population. A review of literature demonstrates that fewer than 300 cases have been reported worldwide. Treatment guidelines in adults have not been established, although reported prognosis is worse for adults compared with children because the disease is more advanced in adults at the time of diagnosis. Reported here is a case of adult Wilms’ tumor presenting as high-grade fever and abnormal laboratory values. [ Rev Urol. 2012;14(1/2):31-34 doi: 10.3909/riu0541] © 2012 MedReviews®, LLC

Wilms’ tumor Renal mass Open radical nephrectomy Multimodal therapy

Literature Reviews

Pelvic Surgeons Caught in the Meshes of the Law

Main Content

Top Content

Management Review

Management Update

Treatment Review

Highlights From the 29th World Congress of Endourology and SWL 2011, November 30-December 3, 2011, Kyoto, Japan

Pelvic Organ Prolapse

Pediatric Urology

Pediatric Urology