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Volume 17, Number 2

Review Articles

Relationship Between Depression and Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

Mangement Update

Leanna Laor Claire Dunphy Bilal Chughtai Alexis E Te Steven A Kaplan

This article provides an overview of current data on the relationship between depression and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with a focus on pathophysiology and patient management implications. Review of the literature indicated a clear relationship between LUTS secondary to BPH and depression. It is unknown whether this relationship is bidirectional or unidirectional. Depression is associated with the impact of LUTS on quality of life in men with BPH. Research suggests that depression alters the experience of LUTS in this population. Medical and surgical treatments for BPH may impact quality of life and, therefore, depression. Results conflict on the exact nature of the relationship examined, and on the extent to which the relationship may be attributed to physiological factors such as inflammation. Practicing clinicians should consider using a brief self-administered scale to assess for depression in patients with BPH. There is a clear need for additional research to decisively determine the nature of the relationship between LUTS secondary to BPH and depression, as well as the extent to which change in either condition may be affected by the other. [Rev Urol. 2015;17(2):51-57 doi: 10.3909/riu0658] © 2015 MedReviews®, LLC

Benign prostatic hyperplasia Depression Lower urinary tract symptoms

Review Articles

Penile Rehabilitation Strategies Among Prostate Cancer Survivors

Treatment Update

Fouad Aoun Alexandre Peltier Roland van Velthoven

Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. [Rev Urol. 2015;17(2):58-68 doi: 10.3909/riu0652] © 2015 MedReviews®, LLC

Prostate cancer Erectile dysfunction Penile rehabilitation Phosphodiesterase type 5 inhibitor Prostaglandin E

A Review of Transplantation Practice of the Urologic Organs: Is It Only Achievable for the Kidney?

Treatment Update

Harry W Roberts Jack Donati-Bourne Yaseen Rajjoub Robert A Coleman

Transplantation is a viable treatment option for failure of most major organs. Within urology, transplantation of the kidney and ureter are well documented; however, evidence supporting transplantation of other urologic organs is limited. Failure of these organs carries significant morbidity, and transplantation may have a role in management. This article reviews the knowledge, research, and literature surrounding transplantation of each of the urologic organs. Transplantation of the penis, testicle, urethra, vas deferens, and bladder is discussed. Transplantation attempts have been made individually with each of these organs. Penile transplantation has only been performed once in a human. Testicular transplantation research was intertwined with unethical lucrative pursuits. Interest in urethra, bladder, and vas deferens transplantation has decreased as a result of successful surgical reconstructive techniques. Despite years of effort, transplantations of the penis, testicle, urethra, vas deferens, and bladder are not established in current practice. Recent research has shifted toward techniques of reconstruction, tissue engineering, and regenerative medicine. [Rev Urol. 2015;17(2):69–77 doi: 10.3909/riu0659] © 2015 MedReviews®, LLC

Urology Transplantation Reconstruction Tissue engineering

Review Articles

Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women

Diagnosis and Treatment Update

Leanna Laor Claire Dunphy Richard Lee Bilal Chughtai Alexis E Te Steven A Kaplan

Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI. [Rev Urol. 2015;17(2):78-83 doi: 10.3909/riu0653] © 2015 MedReviews®, LLC

Mixed urinary incontinence Detrusor overactivity Stress incontinence Urge incontinence Urodynamic stress incontinence Pelvic organ prolapse Transvaginal tape

From the President’s Desk: 2015 Updates and a Look Forward

[Rev Urol. 2015;17(2):84-85 doi: 10.3909/riu0678] © 2015 MedReviews®, LLC

LUGPA Welcomes Membership of Smaller Practices

[Rev Urol. 2015;17(2):86-87 doi: 10.3909/riu0672] © 2015 MedReviews®, LLC

Preparing for the Transition to ICD-10 by Chart Reviews of Four Urology Practice Types

Jonathan Rubenstein

[Rev Urol. 2015;17(2):88-96 doi:10.3909/riu0680] © 2015 MedReviews®, LLC

Juxta-adrenal Ancient Schwannoma: A Rare Retroperitoneal Tumor

Jonathan Melamed Ganesh Sivarajan Daniel A Wollin Pratibha Shukla William C Huang

Retroperitoneal schwannoma is a rare tumor that is often misdiagnosed as malignancy due to a concerning appearance on cross-sectional imaging. Pathology and immunohistochemistry form the gold standard for diagnosis; as such, local excision is the treatment of choice for this disease. We present two cases of juxta-adrenal ancient schwannoma that were treated with adrenalectomy and discuss the current literature regarding this entity. [Rev Urol. 2015;17(2):97-101 doi: 10.3909/riu0669] © 2015 MedReviews®, LLC

Ancient schwannoma Adrenal tumor Adrenalectomy

Genitourinary Presentation of Tuberculosis

Tuberculosis (TB) is less common in developed countries; however, the incidence of TB—especially resistant strains—is on the rise worldwide. Cases of TB manifesting as urologic complications are rare in the United States. Urologists should be aware of this potential manifestation, especially in patients who have recently immigrated to the United States or have traveled abroad for prolonged periods. Two cases are presented here to illustrate this entity. [Rev Urol. 2015;17(2):102-105 doi: 10.3909/riu0679] © 2015 MedReviews®, LLC

Tuberculosis Genitourinary complications

Long-term Survival From Muscle-invasive Bladder Cancer With Initial Presentation of Symptomatic Cerebellar Lesion: The Role of Selective Surgical Extirpation of the Primary and Metastatic Lesion

Esther Udoji Hemant Chaparala (4)Donna Hansel J Stephen Jones Joseph Sanfrancesco Ganesh K Kartha

A 59-year-old man was diagnosed with urothelial carcinoma involving an isolated cerebellar metastasis after presenting to the emergency department for headache complaints. After selective surgical excision of the symptomatic brain lesion and delayed cystectomy due to intractable hematuria, he survived 11 years without evidence of recurrence or subsequent systemic chemotherapy. He eventually expired after delayed recurrence in the lung, supraclavicular lymph node, and brain. To our knowledge, this is the only case of prolonged survival from urothelial carcinoma after selective surgical extirpation of the primary and metastatic lesion without subsequent systemic chemotherapy. [Rev Urol. 2015;17(2):106-109 doi: 10.3909/riu0643] © 2015 MedReviews®, LLC

Urothelial carcinoma Bladder cancer Metastasis Cystectomy

Literature Reviews

The Comparison of Magnetic Resonance Image–Guided Targeted Biopsy Versus Standard Template Saturation Biopsy in the Detection of Prostate Cancer

Meena Davuluri Stacy Loeb

[Rev Urol. 2015;17(2):110-111 doi: 10.3909/riu0670] © 2015 MedReviews®, LLC

Literature Reviews

Standard and Targeted Biopsy During Follow-up for Active Surveillance

Stacy Loeb Brian Weiss

[Rev Urol. 2015;17(2):112-113 doi: 10.3909/riu0670a] © 2015 MedReviews®, LLC

Literature Reviews

MRI/Ultrasound Fusion Biopsy Versus Standard 12-Core Biopsy

Stacy Loeb Brian Weiss

[Rev Urol. 2015;17(2):113-115 doi: 10.3909/riu0670b] © 2015 MedReviews®, LLC