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Volume 14, Number 3

Review Articles

Lap Pak for Abdominal Retraction

New Technology Review

Sam S Chang Amr Fergany S Bruce Malkowicz Herbert Lepor Gary D Steinberg Ganesh Sivarajan

Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges. [Rev Urol. 2012;14(3/4):41-47 doi: 10.3909/riu0572] © 2013 MedReviews®, LLC

Retraction Postoperative adhesions Retained foreign bodies Lap Pak

Review Articles

Nocturia: Focus on Etiology and Consequences

Disease State Review

Jeffrey P Weiss

Nocturia is a condition characterized by the need to awaken ≥ 1 times per night to void. Although nocturia is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine. Many people with nocturia do not seek help, accepting it as a natural consequence of aging. However, nocturia is common in men and women of all ages and has a profound impact on quality of life, especially in the young, that may be associated with increased morbidity and mortality. Nocturia as a condition deserves public health attention. [Rev Urol. 2012;14(3/4):48-55 doi: 10.3909/riu0576] © 2013 MedReviews®, LLC

Nocturia Quality of life Sleep disruption Nighttime urine overproduction

a-Blockers for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: An Update on Current Clinical Evidence

Treatment Update

Naji Touma J Curtis Nickel

The pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is multifactorial, making its treatment difficult. Multimodal therapy including a- adrenergic antagonists (a-blockers), anti-inflammatory agents, and other pain treatments may provide optimal management for CP/CPPS. Although a-blockers are the most prescribed drugs for patients with CP/CPPS, not all studies support their efficacy. A recent meta-analysis of small trials suggested that treatment with a-blockers, possibly in combination with antibacterial agents, is efficacious in relieving symptoms. Third-generation a1A blockers (silodosin, tamsulosin) may provide efficacy as well as reduced cardiovascular side effects. Future research should aim to identify potential biomarkers associated with treatment response. [Rev Urol. 2012;14(3/4):56-64 doi: 10.3909/riu0557] © 2013 MedReviews®, LLC

Adrenergic alpha-1 receptor antagonists Tamsulosin Silodosin Alfuzosin Prostatitis

Review Articles

Systemic Therapy for Metastatic Renal Cell Carcinoma: A Review and Update

Management Update

Edward N Rampersaud Joshua E Logan Geoffrey A Sonn Dennis J Slamon Fairooz F Kabbinavar Arie S Belldegrun Allan J Pantuck Karim Chamie

An in-depth understanding of metastatic renal cell carcinoma (mRCC) is important so that practitioners can make informed evidenced-based decisions with patients to optimize not only quantity of life but quality of life as well. Therefore, this review focuses on the biology of mRCC as it relates to targets for therapy, as well as on the small molecules rationally designed with these targets in mind. In addition, anticipated emerging therapies are highlighted, including the new tyrosine kinase inhibitors axitinib and tivozanib, as well as new immune-based therapies such as dendritic cell-based vaccines and antibodies. We also briefly review recent reports from the emerging field of predicting drug response based on molecular markers. And finally, management of metastatic non-clear cell RCC histologies are discussed focusing on available evidence to direct decision making when assessing therapeutic options. [Rev Urol. 2012;14(3/4):65-78 doi: 10.3909/riu0562] © 2013 MedReviews®, LLC

Metastatic renal cell carcinoma Tyrosine kinase inhibitors Dendritic cell-based vaccines

Review Articles

Update on Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Treatment Update

Dean S Elterman Richard K Lee Steven A Kaplan Bilal Chughtai Alexis E Te

Many aging men will experience both erectile dysfunction (ED) and benign prostatic hyperplasia (BPH), resulting in lower urinary tract symptoms (LUTS). Basic and clinical evidence suggests common pathogenic mechanisms underlying both LUTS and ED. Decreases in the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway with age result in decreased levels of intracellular cGMP and calcium, leading to diminished smooth muscle relaxation of the bladder and prostate and worsening LUTS. Phosphodiesterase type 5 inhibitors as monotherapy in combination with a-blockers have shown efficacy in treating both LUTS and ED. Tadalafil has recently been approved by the US Food and Drug Administration for the treatment of LUTS secondary to BPH, with or without concomitant ED. [Rev Urol. 2012;14(3/4):79-86 doi: 10.3909/riu0559] © 2013 MedReviews®, LLC

Benign prostatic hyperplasia Lower urinary tract symptoms Erectile dysfunction Phosphodiesterase inhibitors Tadalafil Sildenafil Vardenafil

Meeting Reviews

Prostate Cancer Screening and Surgical Management of Localized Disease

Highlights From the 27th Annual Congress of the European Association of Urology

[Rev Urol. 2012;14(3/4):87-89 doi: 10.3909/riu0556] © 2013 MedReviews®, LLC

Prostate-specific antigen Radical prostatectomy Prostate biopsy

Meeting Reviews

Best of the 2012 AUA Annual Meeting

Highlights From the 2012 American Urological Association Meeting

Jayabalan Nirmal Stacy Loeb Dean G Assimos Ellen Shapiro Alan W Partin Michael B Chancellor J Curtis Nickel Michael K Brawer

[Rev Urol. 2012;14(3/4):90-103 doi: 10.3909/riu0563] © 2013 MedReviews®, LLC

Prostate cancer Kidney stones Autologous muscle-derived cells Radical prostatectomy Stress urinary incontinence Chronic pelvic pain syndrome Chronic prostatitis

Two Separate Synchronous Primary Genitourinary Tumors

Matthew T Smith Frederick D Taylor William P Gianakopoulus Roy R Brown

A 54-year-old man presented to the office with gross painless hematuria, dysuria, and urinary frequency. He was diagnosed with renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. The article reviews the presentation, radiology, pathology, and intervention of an uncommon case of synchronous primary carcinomas, and aims to show the importance of continued clinical suspicion for multiple genitourinary primary neoplasms. [Rev Urol. 2012;14(3/4):104-107 doi: 10.3909/riu0555] © 2013 MedReviews®, LLC

Hematuria Genitourinary tumor Dysuria Neoplasm Urinary frequency

Multibacterial Growth From a Surgical Renal Stone Culture: A Case Report and Literature Review

Patrick W Mufarrij Majid Mirzazadeh Dean G Assimos Ross P Holmes Jessica N Lange

Urinary calculi may harbor bacteria, and this may lead to deleterious events during stone fragmentation and removal. The isolation of such bacteria from surgically extracted calculi allows for the specific tailoring of antimicrobial therapy. Here, we describe a case involving percutaneous stone removal from which the stone culture demonstrated growth of five different microorganisms. The results of this culture prompted a change in the antibiotic coverage, resulting in a more targeted treatment and improved patient care. [Rev Urol. 2012;14(3/4):108-114 doi: 10.3909/riu0561] © 2013 MedReviews®, LLC

Urinary tract infection Nephrolithiasis Stone culture

Literature Reviews

Prostate Cancer

Utility of Single Nucleotide Polymorphisms in Prostate Biopsy Decisions

Richard B Hayes Stacy Loeb R Scott Braithwaite

[Rev Urol. 2012;14(3/4):115-117 doi: 10.3909/riu0551] © 2013 MedReviews®, LLC