Review ArticlesFocal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial ExperienceTreatment UpdateDan SperlingNeil MendhirattaTed LeeHerbert LeporFocal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions. [Rev Urol. 2014;16(2):55-66 doi: 10.3909/riu0615] © 2014 MedReviews® LLCProstate cancerFocal therapyTargeted therapyLaser ablation
Review ArticlesProton Beam Therapy for Localized Prostate Cancer 101: Basics, Controversies, and FactsTreatment UpdateSujay A VoraWilliam W WongSameer R KeoleSteven E SchildRobert G FerrigniPaul E AndrewsEric S WisenbaughProton beam therapy for prostate cancer has become a source of controversy in the urologic community, and the rapid dissemination and marketing of this technology has led to many patients inquiring about this therapy. Yet the complexity of the technology, the cost, and the conflicting messages in the literature have left many urologists ill equipped to counsel their patients regarding this option. This article reviews the basic science of the proton beam, examines the reasons for both the hype and the controversy surrounding this therapy, and, most importantly, examines the literature so that every urologist is able to comfortably discuss this option with inquiring patients. [Rev Urol. 2014;16(2):67-75 doi: 10.3909/riu0601] © 2014 MedReviews®, LLCProstate cancerProton beam therapyExternal beam radiation therapyIntensity
Review ArticlesSolitary Renal Fossa Recurrence of Renal Cell Carcinoma After NephrectomyTreatment ReviewZahoor FaziliMartin SheriffMohammed SheikhJi-Jian ChowKamran AhmedRenal cell carcinoma without metastasis responds well to surgical excision but is known to recur postnephrectomy. In a small but significant number of patients this recurrence is not accompanied by metastasis, which is important as these people benefit from further surgery. We examined 20 articles from the current literature to ascertain how best to treat this condition. Surgical management renders better results than conservative or medical therapies. Readily available investigations such as blood tests and computed tomography can help determine the right patients for surgery in an evidence-based fashion. Current findings have allowed us to suggest a protocol for the treatment of solitary renal fossa recurrence of postnephrectomy renal cell carcinoma. There are further opportunities for study in validating our protocol, and in novel renal cell carcinoma treatment strategies that have not been tested on solitary renal fossa recurrences. [Rev Urol. 2014;16(2):76-82 doi: 10.3909/riu0598] © 2014 MedReviews®, LLCComplicationsManagementRenal cancerRecurrenceNephrectomy
Review ArticlesTreating Interstitial Cystitis/Bladder Pain Syndrome as a Chronic DiseaseManagement ReviewDavid C BoschPhilip C BoschThe management of interstitial cystitis/bladder pain syndrome (IC/BPS) is both frustrating and difficult. The etiology is uncertain and there is no definitive treatment. Consequently, both patients and doctors tend to be unhappy and unsatisfied with the quality of care. The American Urological Association (AUA) provides a guideline for the diagnosis and treatment of IC/BPS. Recommended first-line treatments include patient education, self-care practices, behavior modifications, and stress management. Management of IC/BPS may be also improved if both patients and doctors treat this condition as a chronic disease. This article reviews the AUA first-line treatments for IC/BPS and considers the benefits of treating this condition as a chronic disease. [Rev Urol. 2014;16(2):83-87 doi: 10.3909/riu0603] © 2014 MedReviews®, LLCBladder pain syndromeInterstitial cystitisChronic diseaseAutoimmune diseases
Coding CornerHow to Code for Magnetic Resonance Imaging–informed Prostate Biopsies[Rev Urol. 2014;16(2):88-89 doi: 10.3909/riu0613] © 2014 MedReviews®, LLC
Meeting ReviewsProstate Cancer ScreeningHighlights From the 29th European Association of Urology CongressStacy Loeb[Rev Urol. 2014;16(2):90-91 doi: 10.3909/riu0616] © 2014 MedReviews®, LLCProstate cancer screeningProstate-specific antigenEuropean Randomized Study of Screening for Prostate CancerRotterdam Prostate Cancer Risk Calculator
Case ReviewImmunoglobulin G4–related Retroperitoneal Fibrosis of the PelvisMatthew GretzerErika BracamontePeter M SadowAnthony DyerRetroperitoneal fibrosis (RPF) is a rare disease characterized by the replacement of normal tissue with fibrosis and/or inflammation. In this case, a 68-year-old man presented with RPF in the pelvis, a rare location for this disease. Biopsies were performed, which showed elevated levels of C-reactive protein, erythrocyte sedimentation rate, and, most importantly, immunoglobulin G4 (IgG4). It has been postulated that IgG4-related sclerosing disease is a systemic disease. Treatment has been successful with systemic corticosteroids. [Rev Urol. 2014;16(2):92-94 doi: 10.3909/riu0594] © 2014 MedReviews®, LLCRetroperitoneal fibrosisSerum immunoglobulin G4
Case ReviewSolitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal EtiologiesJoel M SumfestJared M BieniekTiffany A PerkinsPolymicrobial bacterial infections are commonly found in cases of Fournier gangrene (FG), although fungal growth may occur occasionally. Solitary fungal organisms causing FG have rarely been reported. The authors describe a case of an elderly man with a history of diabetes who presented with a necrotizing scrotal and perineal soft tissue infection. He underwent emergent surgical debridement with findings of diffuse urethral stricture disease and urinary extravasation requiring suprapubic tube placement. Candida albicans was found to be the single causative organism on culture, and the patient recovered well following antifungal treatment. Fungal infections should be considered as rare causes of necrotizing fasciitis and antifungal treatment considered in at-risk immunodeficient individuals. [Rev Urol. 2014;16(2):95-98 doi: 10.3909/riu0595] © 2014 MedReviews®, LLCFournier gangreneFournier’s Gangrene Severity IndexCandida albicans