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Volume 15, Number 3

Review Articles

Use of Herbal Supplements for Overactive Bladder

Management Update

Franklin C Lowe Elizabeth Kavaler Steven A Kaplan Alexis E Te Bilal Chughtai Richard Lee

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world’s population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB. [Rev Urol. 2013;15(3):93-96 doi: 10.3909/riu0587] © 2013 MedReviews®, LLC

Overactive bladder Herbal medicine Gosha-jinki-gan Hachi-mi-jio-gan Buchu (Barosma betuline)Cleavers (Galium aparine)Cornsilk (Zea mays)Horsetail (Equisetum)Ganoderma lucidum Resinferatoxin Capsaicin

Review Articles

Prostate-Specific Antigen: Any Successor in Sight?

Diagnostic Review

Oluyemi Akinloye Mary B Ajadi Aniebietabasi S Obort

Prostate cancer (PCa) is the most frequently diagnosed malignancy and the second leading cause of cancer death in men in the United States and other parts of the world. The lifetime risk of being diagnosed with PCa is approximately 16%. At present, the only widely accepted screening tools for PCa are prostate-specific antigen (PSA) and digital rectal examination. PSA is known to be prostate specific, but not PCa specific, and hence lacks the sensitivity to detect a large number of tumors, especially during the early stages. The PSA level is also known to be affected by many factors, such as medication, inflammation (benign prostatic hyperplasia and prostatitis), and urologic manipulation; hence, the controversy regarding the appropriate level of serum PSA that should trigger a biopsy or have clinical relevance to prostate metastases. Attempts to determine the level of prostate cells in peripheral blood by reverse transcriptase polymerase chain reaction did not significantly improve cancer diagnosis or predict postoperative failure. Therefore, the search continues for a novel biomarker or a panel of markers as well as other possible interventions to improve the use of PSA. This article reviews several possibilities. [Rev Urol. 2013;15(3):97-107 doi 10.3909/riu0567] © 2013 MedReviews®, LLC

Prostate-specific antigen Prostate carcinoma Prostate diagnostic or screening test

Review Articles

Bladder Cancer After Radiotherapy for Prostate Cancer

Systematic Review

Maurizio Buscarini Federico Sergi Emanuela Altobelli Francesca Suriano

External beam radiotherapy (EBRT) is frequently used in the management of prostate cancer (PCa) as definitive, postoperative, or salvage local treatment. Although EBRT plays a central role in the management of PCa, complications remain a troubling by-product. Several studies have demonstrated an association between radiotherapy and elevated risk of acute and late toxicities. A secondary malignancy induced by initial therapy represents one of the most serious complications related to definitive cancer treatment. The radiation-related secondary primary malignancy risk increases with increasing survival time. Transitional cell carcinoma of the bladder is the most frequent secondary primary malignancy occurring after radiotherapy and is described as more aggressive; it may be diagnosed later because some radiation oncologists believe that the hematuria that occurs after prostate EBRT is normal. Some patients treated for localized PCa will subsequently develop invasive bladder cancer requiring surgical intervention. Patients with PCa treated with EBRT should be monitored closely for the presence of bladder cancer. [Rev Urol. 2013;15(3):108-112 doi: 10.3909/riu0577] © 2013 MedReviews®, LLC

Prostate cancer Bladder cancer Radiotherapy External beam radiotherapy

Review Articles

The Case for Hypofractionation of Localized Prostate Cancer

Systematic Review

Kent E Wallner Winnifred M Wong

An optimal treatment regimen for localized prostate cancer (PCa) is yet to be determined. Increasing evidence reveals a lower a/b ratio for PCa with hypofractionated radiation therapy (HFRT) regimens introduced to exploit this change in therapeutic ratio. HFRT also results in shortened overall treatment times of 4 to 5 weeks, thus reducing staffing and machine burden, and, more importantly, patient stress. This review evaluates pretreatment characteristics, outcomes, and toxicity for 15 HFRT studies on localized PCa. HFRT results in comparable or better biochemical relapse-free survival and toxicity and is a viable option for localized PCa. [Rev Urol. 2013;15(3):113-117 doi: 10.3909/riu0582] © 2013 MedReviews®, LLC

Localized prostate cancer Hypofractionation Short-course radiotherapy Dose escalation

Meeting Reviews

Best of the 2013 AUA Annual Meeting Part II

More Highlights From the 2013 American Urological Association Annual Meeting, May 4-8, 2013, San Diego, CA

Scott I Zeitlin Jacob Rajfer Ellen Shapiro

[Rev Urol. 2013;15(3):118-123 doi: 10.3909/riu2013AUA2] © 2013 MedReviews®, LLC

Febrile urinary tract infection Male infertility Exogenous testosterone therapy MicroTESE Klinefelter’s syndrome Variocele Vasectomy reversal Antibiotic resistance

Ureteral Metastasis as the Presenting Manifestation of Pancreatic Carcinoma

Qutub Ali Shilpi Gupta Nand Kishore Arvind Onkar Singh

We recently cared for a patient with adenocarcinoma of the pancreas who presented with ureteral metastasis followed by hydroureteronephrosis long before the appearance of any symptoms related to the primary lesion. The entity is extremely rare; only seven similar cases are on record in the scientific literature. No recent review exists on this topic. This encouraged us to present our case along with the previous cases of adenocarcinoma of the pancreas with ureteral metastasis that have been reported. [Rev Urol. 2013;15(3):124-130 doi: 10.3909/riu0575] © 2013 MedReviews®, LLC

Metastasis Hydronephrosis Ureter Ureteral metastasis Pancreatic adenocarcinoma

Obstructed Bifid Uretereric System Causing Unilateral Hydronephrosis

Manoj Srivastava Amyn Bhamani

Bifid ureters are a common malformation of the urinary system. In clinical practice, hydronephrosis resulting from obstruction of such a system is rare. The authors present a case involving an 88-year-old man admitted to the hospital with symptoms of renal failure, where bifid ureters were found incidentally in a hydronephrotic kidney during an emergency nephrostomy. This had been missed on a previous CT scan, resulting in a unique therapeutic dilemma. [ Rev Urol. 2013;15(3):131-134 doi: 10.3909/riu0578] © 2013 MedReviews®, LLC

Bifid ureters Hydronephrosis Nephrostomy