Volume 16, Number 1

Review Articles

The Physiologic and Anesthetic Considerations in Elderly Patients Undergoing Robotic Renal Surgery

Management Review

Nikhil VasdevJames M AdsheadGregory BousteadGowrie MohanAnna Sau Kuk PoonDamian HanburyTim Lane

A number of patients are diagnosed with renal malignancies incidentally worldwide. Once a diagnosis of a renal malignancy is established, after a careful evaluation, patients can be offered a robotic nephrectomy or partial nephrectomy. We present a review of the physiologic and anesthetic considerations in elderly patients who are being considered for robotic renal surgery. [Rev Urol. 2014;16(1):1-9 doi: 10.3909/riu0591] © 2014 MedReviews®, LLC

Robotic partial nephrectomyRobotic radical nephrectomyPhysiologic considerationsAnesthetic considerations

Review Articles

Emerging Therapeutic for the Treatment of Skeletal-related Events Associated With Metastatic Castrate-resistant Prostate Cancer

CME-certified Article

Paul R Sieber

Prostate cancer is the most prevalent cancer in US and European men and the second leading cause of cancer death in those populations. It is somewhat unique in that nearly all patients who succumb to the disease will ultimately develop bone metastasis. Morbidity from bone metastasis—referred to as skeletal-related events, which include fractures, cord compression, radiation to bone, and surgery to bone—leads to significant costs and impaired quality of life. This article reviews three agents and the roles they play in the ever-changing armamentarium of treatments for metastatic castrate-resistant prostate cancer (mCRPC). The potential benefits of these agents are discussed, as well as the continuing use of these agents and their earlier introduction in the patient with progressive mCRPC with bone metastasis. [Rev Urol. 2014;16(1):10-20 doi: 10.3909/riu0609] © 2014 MedReviews®, LLC

Metastatic castrate-resistant prostate cancerSkeletal-related eventsBone metastasisZoledronic acidDenosumabRadium Ra 223 dichloride

Review Articles

Nephron-sparing Management of Upper Tract Urothelial Carcinoma

Management Review

Francesca SurianoTommaso Brancato

Upper tract urothelial carcinoma (UTUC) is a relatively rare tumor, but is characterized by high rates of recurrence, morbidity, and mortality. Choice of treatment modality is generally influenced by lesion size, grade, and focality. Radical nephroureterectomy with bladder cuff excision is the gold-standard management of UTUC, although an organ-sparing approach may be beneficial in selected patients. Conservative endoscopic management of UTUC in appropriate patients has a favorable impact on quality of life and health care costs when compared with patients who progress to dialysis-dependent renal failure. Careful ureteroscopic surveillance following endoscopic management of UTUC is essential. [Rev Urol. 2014;16(1):21-28 doi: 10.3909/riu0592] © 2014 MedReviews®, LLC

Upper tract urothelial carcinomaTumor gradeNephron-sparing endoscopic treatmentTopical adjuvant chemo-immunotherapyOncologic outcomes

Review Articles

Calyceal Diverticula: A Comprehensive Review

Disease State Review

Arthur D SmithSamih HayekNikhil WaingankarZeph Okeke

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upper-pole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upper-pole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches. [ Rev Urol. 2014;16(1):29-43 doi: 10.3909/riu0581] © 2014 MedReviews®, LLC

UreterorenoscopyCalyceal diverticulaPercutaneous nephrostolithotomyLaparoscopic surgeryShock wave lithotripsy

Coding Corner

Transitioning to ICD-10: Steps for Urologists and Urology Groups

Jonathan Rubenstein

[Rev Urol. 2014;16(1):44-46 doi: 10.3909/riu0614] © 2014 MedReviews®, LLC

Case Review

Metastatic Urethral Melanoma: Case Report and Review of the Literature

Rafaela Saint-Clair Pimentel Mafra De OliveiraBruno Moraes VasconcelosLuiz Ronaldo Alberti

Melanoma is a cancer that originates from melanocytes, is predominant in adults with white skin, represents 4% of skin cancers, and has high possibility of forming metastasis. This review reports on the case of a young man, age 36 years, previously diagnosed with melanoma. The patient complained of obstructive urinary symptoms and, while he was undergoing a cystoscopy, it was discovered that he had a lesion corresponding with metastatic melanoma of the prostatic urethra, which occluded almost the entire urethra and resulted in blocked urinary flow. He underwent a transurethral resection of the prostate, followed by resection of the lesion. After the procedure, he had good urinary flow and is currently on follow-up. [Rev Urol. 2014;16(1):47-49 doi: 10.3909/riu0584] © 2014 MedReviews®, LLC

UrethraMetastasisMelanomaUrinary obstructionUrethral melanoma

Case Review

Bladder Leiomyoma Presenting With LUTS and Coexisting Bladder and Uterine Leiomyomata: A Review of Two Cases

Raman TanwarAparajita MitraSudhir Kumar Jain

Mesenchymal tumors of the urinary bladder are a rare occurrence, the most common among them being leiomyoma of the bladder. These tumors commonly present with irritative urinary symptoms progressing gradually to obstructive symptoms as the size increases. We report on two patients who presented with lower urinary tract symptoms (LUTS). One of the patients also had concomitant bladder and uterine leiomyomata, which is the first such case to be reported in the literature. It is essential to differentiate leiomyoma from other common causes of LUTS. Cold cup biopsy has a significant false-negative rate and, in such cases, a wide local excision provides an optimal cure with excellent results. [Rev Urol. 2014;16(1):50-54 doi: 10.3909/riu0586] © 2014 MedReviews®, LLC

Lower urinary tract symptomsBladder leiomyomaUterine fibroid