Volume 15, Number 4

Commentary

A Modest Proposal: Prostate Biopsies and In-house Pathology Laboratories

[Rev Urol. 2013;15(4):135-136 doi: 10.3909/riu0605] © 2014 MedReviews®, LLC

Original Research

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

Savvas E MendrinosDavid G BostwickAnn E AndersonCarl A OlssonDeepak A Kapoor

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%—this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLC

Prostate cancerProstate biopsyUtilization trendsNational reference laboratory

Review Articles

Intracavitary Immunotherapy and Chemotherapy for Upper Urinary Tract Cancer: Current Evidence

Systematic Review

Gabriele CozziLuca CarmignaniRoberto BianchiNicola MacchioneCarlo MarenghiSara MelegariMarco RossoElena TondelliAugusto MaggioniAngelica Grasso

A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence. [Rev Urol. 2013;15(4):145-153 doi: 10.3909/riu0579] © 2014 MedReviews®, LLC

ImmunotherapyChemotherapyBacillus Calmette-GuérinUpper urinary tractUrothelial cell carcinomaMitomycin C

Review Articles

The Use of In Vitro Fertilization in the Management of Male Infertility: What the Urologist Needs to Know

Management Review

Sahar M StephensDaniel M ArnettRandall B Meacham

Infertility affects approximately 10% to 20% of reproductive-age couples, many of whom may present initially to a urologist. Some couples may be treated medically to increase spontaneous conception rates; however, many will require more aggressive management with in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). IVF involves ovarian stimulation, oocyte retrieval, and fertilization outside of the body; ICSI involves injecting one sperm into the oocyte to promote fertilization. Here we provide a brief overview of IVF and ICSI along with a discussion of the risks involved to facilitate the counseling and care of the infertile couple. [Rev Urol. 2013;15(4):154-160 doi: 10.3909/riu0588] © 2014 MedReviews®, LLC

Male infertilityIn vitro fertilizationIntracytoplasmic sperm injection

Review Articles

Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer

Management Review

Vinay PrabhuTyler R McClintockHerbert LeporTed Lee

Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer. [Rev Urol. 2013;15(4):161-177 doi: 10.3909/riu0604] © 2014 MedReviews®, LLC

Prostate cancerRadical prostatectomyHealth-related quality of life

Review Articles

Anesthetic Challenges in Robotic-assisted Urologic Surgery

Management Review

Richard L HsuAlan D KayeRichard D Urman

Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and limited access to the patient, all present anesthetic management challenges in urologic surgery. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce surgical and anesthetic complications. [Rev Urol. 2013;15(4):178-184 doi: 10.3909/riu0589] © 2014 MedReviews®, LLC

Robotic surgeryUrologic surgeryAnesthesia complicationsPneumoperitoneumPeripheral nerve injuryPatient positioning

Meeting Reviews

Updates in the Care and Management of Prostate Cancer: Highlights From the 2013 Prostate Cancer World Congress, August 6-10, 2013, Melbourne, Australia

Marnique BastoÁine GogginsStacy Loeb

[Rev Urol. 2013;15(4):185-187 doi: 10.3909/riu0599] © 2014 MedReviews®, LLC

Prostate cancerActive surveillanceHealth disparitiesConsensus statement

Case Review

47,XYY Syndrome and Male Infertility

Edmund Y KoEdmund S SabaneghIna W KimArjun C Khadilkar

Men with 47,XYY syndrome present with varying physical attributes and degrees of infertility. A retrospective chart review was performed on a male infertility and genetic anomaly database. Three patients with 47,XYY were found. Each presented with . 2 years of infertility. All were tall with elevated body mass indices. Scrotal findings ranged from normal to atrophic testicles. Semen analyses demonstrated oligospermia and varying endocrine profiles. Because of the diverse phenotype and potential lack of symptoms, identification and diagnosis of men with 47,XYY syndrome may be difficult. We recommend careful screening of 47,XYY patients and referral to primary physicians for long-term follow-up for increased incidence of health-related comorbidities. [Rev Urol. 2013;15(4):188-196 doi: 10.3909/riu0580] © 2014 MedReviews®, LLC

XYY syndromeInfertility syndromes

Case Review

Splenogonadal Fusion: An Unusual Case of an Acute Scrotum

Rena D MalikDennis B Liu

We highlight a case on a normal left testicle with a fibrovascular cord with three nodules consistent with splenic tissue. The torsed splenule demonstrated hemorrhage with neutrophilic infiltrate and thrombus consistent with chronic infarction and torsion. Splenogonadal fusion (SGF) is a rather rare entity, with approximately 184 cases reported in the literature. The most comprehensive review was that of 123 cases completed by Carragher in 1990. Since then, an additional 61 cases have been reported in the scientific literature. We have studied these 61 cases in detail and have included a summary of that information here. [Rev Urol. 2013;15(4):197-201 doi: 10.3909/riu0593] © 2014 MedReviews®, LLC

Splenogonadal fusionAcute scrotum

Literature Reviews

More Aggressive Prostate Cancer in Elderly Men

Prostate Cancer

Stacy LoebAnnelies Vellekoop

[Rev Urol. 2013;15(4):202-204 doi:10.3909/riu0590a] © 2014 MedReviews®, LLC

Literature Reviews

PSA Velocity in Risk Stratification of Prostate Cancer

Prostate Cancer

Stacy LoebMarc A Bjurlin

[Rev Urol. 2013;15(4):204-206 doi:10.3909/riu0590b] © 2014 MedReviews®, LLC

Literature Reviews

Patient Perceptions and Shared Decisions About PSA Screening

Prostate Cancer

Stacy LoebDaniel Wollin

[Rev Urol. 2013;15(4):206-207 doi:10.3909/riu0600] © 2014 MedReviews®, LLC

Literature Reviews

Genetic Tests for Prostate Cancer

Prostate Cancer

Alan W PartinAdam Kern

[Rev Urol. 2013;15(4):208-209 doi:10.3909/riu0597] © 2014 MedReviews®, LLC