KOL InterviewManagement Options for NocturiaRoger R DmochowskiHerbert Lepor[Rev Urol. 2018;20(2):53–55 doi: 10.3909/riu0811] © 2018 MedReviews®, LLC
Review ArticlesInfertility in Patients With Klinefelter Syndrome: Optimal Timing for Sperm and Testicular Tissue CryopreservationManagement UpdateDorota J HawksworthApril A SzafranPhilip W JordanAdrian S DobsAmin S HeratiMale factor infertility is a complex issue presenting many diagnostic and management challenges. It is responsible for about 50% of all causes of infertility and thus carries significant medical, financial, and psychological implications for the couples struggling with conception. Klinefelter syndrome is the most common chromosomal male anomaly associated with male infertility. This review focuses specifically on non-obstructive azoospermia secondary to Klinefelter syndrome and discusses controversies surrounding fertility management in patients with this genetic disorder. [Rev Urol. 2018;20(2):56–62 doi: 10.3909/riu0790] © 2018 MedReviews®, LLCKlinefelter syndromeNon-obstructive azoospermiaSperm retrieval
Original ResearchEffectiveness of Subcutaneously Administered Leuprolide Acetate to Achieve Low Nadir Testosterone in Prostate Cancer PatientsJoseph Renzulli IIChristopher M PieczonkaJason HafronPrzemyslaw TwardowskimDeborah M Boldt-HouleStuart AtkinsonScott EggenerEvidence suggests lower nadir testosterone levels during the first year of androgen deprivation therapy improve advanced prostate cancer clinical outcomes. We evaluated pivotal trials for subcutaneously administered leuprolide acetate (1-, 3-, 4-, and 6-month doses) to determine nadir testosterone levels. Pooled analysis showed 99%, 97%, and 91% of patients reached nadir testosterone ≤20, ≤10, and ≤5 ng/dL respectively (median ≤3 ng/dL). Across all available categories, ≥88% of patients reached nadir testosterone ≤5 ng/dL, and <3% experienced a microsurge. Achievement and maintenance of low nadir testosterone levels may improve progression-free survival and time to onset of castrate-resistant prostate cancer. [Rev Urol. 2018;20(2):63–68 doi: 10.3909/riu0798] © 2018 MedReviews®, LLCProstate cancerAndrogen deprivation therapyLHRH agonistsLeuprolide acetateNadir testosterone
Original ResearchBalancing Confounding and Generalizability Using Observational, Real-world Data: 17-gene Genomic Prostate Score Assay Effect on Active SurveillanceMichael J KemeterPhillip G FebboSteven CanfieldJohn HornbergerRandomized, controlled trials can provide high-quality, unbiased evidence for therapeutic interventions but are not always a practical or viable study design for certain healthcare decisions, such as those involving prognostic or predictive testing. Studies using large, real-world databases may be more appropriate and more generalizable to the intended target population of physicians and patients to answer these questions but carry potential for hidden bias. We illustrate several emerging methods of analyzing observational studies using propensity score matching (PSM) and coarsened exact matching (CEM). These advanced statistical methods are intended to reveal a “hidden experiment” within an observational database, and so refute or confirm a potential causal effect of assignment to an intervention and study outcome. We applied these methods to the Optum™ Research Database (ORD; Eden Prairie, MN) of electronic health records and administrative claims data to assess the effect of the 17-gene Genomic Prostate Score® (GPS™; Genomic Health, Redwood City, CA) assay on use of active surveillance (AS). In a traditional multivariable logistic regression, the GPS assay increased the use of AS by 29% (95% CI, 24%-33%). Upon applying the matching methods, the effect of the GPS assay on AS use varied between 27% and 80% and the matched data were significant among all algorithms. All matching algorithms performed well in identifying matched data that improved the imbalance in baseline covariates. By using different matching methods to assess causal inference in an observational database, we provide further confidence that the effect of the GPS assay on AS use is statistically significant and unlikely to be a result of confounding due to differences in baseline characteristics of the patients or the settings in which they were seen. [Rev Urol. 2018;20(2):69–76 doi: 10.3909/riu0799] © 2018 MedReviews, LLC®Prostate cancerActive surveillanceEvidence-based practiceComparative effectiveness researchGenomic biomarkerPropensity scoreMatching
Original ResearchProstate Biopsy Characteristics: A Comparison Between the Pre- and Post-2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening GuidelinesIvelina HristovaNavin ShahVladimir IoffeThomas HuebnerTo compare prostate cancer (PCa) characteristics diagnosed by prostate biopsy (Pbx) in the 3 years before and after the 2012 United States Preventive Services Task Force (USPSTF) recommendations for PCa screening, we completed a retrospective comparative analysis of 402 sequential PCa patients diagnosed from 2010 to 2012 (3 years) with 552 PCa patients diagnosed from 2015 to 2017 (3 years). Data was collected on patient age, race, total number of biopsies performed, prostate specific antigen (PSA), Gleason sum score (GSS), and digital rectal examination (DRE). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined, Group A and Group B, prior to and after the 2012 USPSTF screening recommendations, respectively. In Group A (pre- 2012 USPSTF recommendations), 567 patients/year underwent a Pbx versus Group B, 398 patients/year, a 30% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B 184/year, a 37.3% increase post-USPSTF. Group A had high-grade PCa (GSS 7-10) in 51.5% versus Group B in 60.1%, an 8.6% increase post-USPSTF. In Group B, the total number of positive biopsies was increased by 100%. This study shows that in Group B, the Pbx rate decreased by 30% but the annual PCa detection rate increased by 37%. High-grade GSS (7-10) PCa increased by 8.6%. Despite a reduction in the total number of prostate biopsies by 30%, there was a 100% increase in the total number of positive prostate biopsies. [Rev Urol. 2018;20(2):77–83 doi: 10.3909/riu0793] © 2018 MedReviews®, LLCProstate cancerUnited States Preventive Services Task ForcePSA screening
Review ArticlesBotulinum Toxin Use in NeurourologySystematic ReviewVictor W NittiGregory VurtureBenjamin M BruckerBenoit PeyronnetXavier GaméThe use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years. Although onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) remains the only BTX-A for which use is supported by large, multicenter, randomized, controlled trials (RCT), and is therefore the only one to be licensed in the United States and Europe, a second BTX-A, abobotulinumtoxinA (Dysport®, Ipsen Biopharmaceuticals, Basking Ridge, NJ), is also supported by high-level-of-evidence studies. Other innovations in the use of BTX-A in neurourology during the past few years include the BTX switch (from abobotulinumtoxinA to onabotulinumtoxinA or the opposite) as a rescue option for primary or secondary failures of intradetrusor BTX-A injection and refinements in intradetrusor injection techniques (number of injection sites, injection into the trigone). There is also a growing interest in long-term failure of BTX-A for NDO and their management, and a possible new indication for urethral sphincter injections. [Rev Urol. 2018;20(2):84–93 doi: 10.3909/riu0792] © 2018 MedReviews®, LLCBotulinum toxinNeurogenic detrusor overactivitySphincterInjection
LUGPA NewsMember Census Shows LUGPA Practices Exhibit High Level of Innovation, Sophistication, and GrowthScott B SellingerNeal D Shore[Rev Urol. 2018;20(2):94–97 doi: 10.3909/riu0805] © 2018 MedReviews®, LLC
Meeting ReviewsHighlights From the 2018 American Urological Association Annual Meeting, May 18-21, 2018, San Francisco, CABest of the 2018 AUA Annual MeetingAlan W PartinZeyad R Schwen[Rev Urol. 2018;20(2):98–100 doi: 10.3909/riu0806] © 2018 MedReviews®, LLCProstate cancerRisk stratificationActive surveillancempMRI
NYU Case of the MonthActive Surveillance for Prostate CancerNYU Case of the Month, April 2018Stacy Loeb[Rev Urol. 2018;20(2):101–103 doi: 10.3909/riu0802] © 2018 MedReviews®, LLC
NYU Case of the MonthTesticular TorsionNYU Case of the Month, May 2018Grace S Hyun[Rev Urol. 2018;20(2):104–106 doi: 10.3909/riu0800] © 2018 MedReviews,® LLC
NYU Case of the MonthFocal Ablation of Prostate CancerNYU Case of the Month, June 2018Herbert Lepor[Rev Urol. 2018;20(2):107–111 doi: 10.3909/riu0812] © 2018 MedReviews, LLC®
Case ReviewClinical Relevance of Petit’s Triangle: A Forgotten LandmarkScott HalperinJulian SpectorDavid PennBarry ZisholtzThis rare case details a right-sided hydronephrotic kidney herniated through Petit’s triangle. Petit’s triangle is an anatomical landmark that is usually not clinically significant and only alluded to during multiple-choice examinations. This case describes the clinical ramification of this area of weakness and allows us to revisit and relearn the anatomy, and its relevance in clinical practice. [Rev Urol. 2018;20(2):112–114 doi: 10.3909/riu0796] © 2018 MedReviews®, LLCHerniaPetit’s triangleHydronephrotic kidney