Volume 21, Number 2

Review Articles

Primary Bladder Neck Obstruction

Disease State Review

Rachael D SussmanBenjamin M BruckerAlice Drain

Primary bladder neck obstruction (PBNO) is a functional obstruction caused by abnormal opening of the bladder neck during the voiding phase of micturition. PBNO may present with a variety of symptoms including voiding symptoms (slow urinary stream, intermittent stream, incomplete emptying), storage symptoms (frequency, urgency, urgency incontinence, nocturia), and/or pelvic pain and discomfort. The diagnosis of PBNO can be made with videourodynamic testing, which demonstrates elevated voiding pressures with low flow, and fluoroscopic imaging demonstrating obstruction at the level of the bladder neck. Treatment options include conservative management with watchful waiting, pharmacologic management, and surgical intervention. In this article, we review the etiology, presentation, diagnosis, and treatment of PBNO in men, women, and children. [Rev Urol. 2019;21(2/3):53–62] © 2019 MedReviews®, LLC

Lower urinary tract symptomsBladder outlet obstructionPrimary bladder neck obstruction

Review Articles

Nocturia in Patients With Multiple Sclerosis

Management Review

Roger R DmochowskiW Stuart ReynoldsBenoit PeyronnetXavier GaméLauren B KruppGérard AmarencoJean-Nicolas CornuLana Zhovtis RyersonCarrie Lyn SammarcoJonathan E HowardRobert W CharlsonBenjamin M Brucker

The prevalence of nocturia in patients with multiple sclerosis (MS) is high, ranging from 20.9% to 48.8% in this population. Its underlying pathophysiology is complex and different from the non-neurogenic population. In the MS population, the pathophysiology may involve neurogenic lower urinary tract dysfunction (NLUTD) such as detrusor overactivity (NDO), detrusor-sphincter dyssynergia, or detrusor underactivity resulting in reduced bladder capacity. Nocturnal polyuria is also a significant contributor to the pathogenesis of nocturia in MS patients and may be the result of specific mechanisms such as nocturnal hypertension through autonomic cardiovascular dysfunction or lack of diurnal variation of antidiuretic hormone production (ADH) due to demyelinating lesions of the spinal cord. Nocturia might be particularly burdensome in MS patients by contributing to fatigue, a common and highly debilitating symptom in this population. There is likely a complex and multidirectional relationship between nocturia, other sleep disorders, and fatigue in the MS population that has yet to be explored. The assessment of nocturia in MS should rely upon a thorough history and physical examination. Urinalysis should be done to rule out urinary tract infection, a frequency-volume chart might help elucidating the underlying mechanisms, and post-void residual volume may be of interest to screen for urinary retention that could be asymptomatic in MS patients. Other tests such as urodynamics or polysomnography are indicated in selected patients. The treatment should be tailored to the underlying cause. The first steps involve behavioral interventions and treatment of cofactors. When possible, the predominant mechanism should be addressed first. In case of predominant NDO, antimuscarinics and beta-3 agonists should be offered as a first-line treatment and intradetrusor injections of botulinum toxin as a second-line treatment. In cases of incomplete bladder emptying, clean-intermittent self-catheterization is often used as part of multiple other interventions. In cases of nocturnal polyuria, desmopressin may be offered, inclusive of use of newer formulations (desmopressin acetate nasal spray, desmopressin orally disintegrated tablet) in countries where they are approved. [Rev Urol. 2019;21(2/3):63–73] © 2019 MedReviews®, LLC

NocturiaMultiple sclerosisFatigueDesmopressinNocturnal polyuriavoiding diary

Review Articles

Evaluation and Management of Chronic Scrotal Content Pain—A Common Yet Poorly Understood Condition

Management Review

Matthew J ZiegelmannRyan FarrellLaurence A Levine

Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life. [Rev Urol. 2019;21(2/3):74–84] © 2019 MedReviews®, LLC

OrchialgiaTesticlePain inguinalDenervation

Review Articles

Prostate Cancer Screening and Management in Solid Organ Transplant Candidates and Recipients

Management Review

Herbert LeporEzequiel BecherAlex Wang

The number of solid organ transplantations is increasing worldwide. Major medical advances have allowed for incremented survival in this population, which, because approximately 50% of recipients are over age 50 years, makes for an increasingly older population of transplant survivors. This article discusses controversies and current guidelines related to prostate cancer (PCa) screening, detection, and treatment for men in the general population. The relevant literature is reviewed in order to provide insights on how to optimize PCa screening, detection, and treatment pre– and post–solid organ transplantation. There is compelling evidence that immunosuppression does not increase the risk for the development or progression of PCa following solid organ transplantation. Therefore, PCa screening, detection, or treatment should not be influenced by the impact of immunosuppression on the biology of the disease. Prostate-specific antigen (PSA) appears to be as reliable for PCa screening of transplant candidates and recipients as it is for the general population. There is no consensus on how or when it should be implemented. Evidence is also equivocal as to the suggested waiting time between treatment and transplantation. Surgery and radiation therapy appear to be safe and provide good outcomes for managing PCa in solid organ transplant candidates and recipients. However, certain precautions should be taken with this vulnerable population, especially for kidney transplant patients given the pelvic location of the renal graft. Partial gland ablation of PCa should be considered in appropriate candidates. [Rev Urol. 2019;21(2/3):85–92] © 2019 MedReviews®, LLC

Original Research

The Effect of Local Antibiogram–based Augmented Antibiotic Prophylaxis on Infection-related Complications Following Prostate Biopsy

Original Research

Raoul S ConcepcionEdward M SchaefferJeffrey A ScottNeal D ShoreDeepak A KapoorGary M Kirsh

Given the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice’s current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications. [Rev Urol. 2019;21(2/3):93–101] © 2019 MedReviews®, LLC

Antibiotic prophylaxisProstateBiopsyDrug-resistant bacteria

Review Articles

Preserving Independent Urology: LUGPA’s First Decade

Review

Jonathan HendersonRichard G HarrisEvan R GoldfischerDavid C ChaikinEarl L WalzRobert D AsinofNeal D ShoreDeepak A KapoorGary M Kirsh

[Rev Urol. 2019;21(2/3):102–108] © 2019 MedReviews®, LLC

Meeting Reviews

Best of the 2019 AUA Annual Meeting: Highlights From the 2019 American Urological Association Annual Meeting, May 3-6, 2019, Chicago, IL

Gregory VurtureZeyad R SchwenMichael B ChancellorDean G AssimosBenjamin M BruckerEllen ShapiroAlan W Partin

[Rev Urol. 2019;21(2/3):109–117] © 2019 MedReviews®, LLC

UrodynamicsFebrile urinary tract infectionUnderactive bladderAutologous muscle-derived cellsFemale sexual dysfunctionPrenatal hydronephrosisCalcium oxalate kidney stoneformationFecal microbiomeUrinary oxalate excretionOpioid utilization and kidney stonesSuper pulse thulium fiber laserPediatric hypospadias repairGut microbiomeOveractive bladder symptomsVibegronMesh-related complicationsAcupunctureRobot-assisted sacrocolpopexy

NYU Case of the Month

Use of 3D Printed Models for Complex Renal Surgery: Two Case Presentations

NYU Case of the Month, May 2019

William C HuangNicole Wake

[Rev Urol. 2019;21(2/3):118–122] © 2019 MedReviews®, LLC

NYU Case of the Month

Endoscopic Diagnosis and Management of Upper Tract Urothelial Carcinoma

NYU Case of the Month, June 2019

James F Borin

[Rev Urol. 2019;21(2/3):123–126] © 2019 MedReviews®, LLC

NYU Case of the Month

Diagnosis and Treatment of Peyronie Disease With Both Dorsal and Ventral Plaques Using Doppler Ultrasound

NYU Case of the Month, July 2019

Seth D Cohen

[Rev Urol. 2019;21(2/3):127–129] © 2019 MedReviews®, LLC

NYU Case of the Month

Novel Use of Prostate Urethral Lift for a Patient With Bladder Outlet Obstruction

NYU Case of the Month, August 2019

Christopher Kelly

[Rev Urol. 2019;21(2/3):130–132] © 2019 MedReviews®, LLC

Case Review

A Case of Squamous Cell Carcinoma of the Anterior Urethra in a Man

Navin ShahThomas HuebnerShannon Cherone

Squamous cell carcinoma (SCC) of the anterior urethra in men is rare, comprising less than 1% of all urologic cancers. The mean age at diagnosis is 60 years and it is nearly twice as common in black men compared with white men. We detail a case of SCC of the anterior urethra in a man presenting with an inguinal mass, meatal stenosis, and balanitis. [Rev Urol. 2019;21(2/3):133–135] © 2019 MedReviews®, LLC

UrethraSquamous cell carcinomaanteriorHPV p16

Reviews in Urology

Massive Intra-abdominal Germ Cell Tumors: A Case Series and Review of Literature

Nirmish SinglaAditya BagrodiaDaniel G Wong

Intra-abdominal testes are at increased risk of malignant transformation and can manifest as large abdominal masses with a wide variation in presenting symptoms. In the setting of cryptorchid or nonpalpable testes, large abdominal masses are highly suspect for germ cell tumors. Without standard guidelines, management can vary extensively. Surgical management may not be trivial and can entail a major abdominal operation in the context of a multimodal approach. The use of biopsy and serum tumor markers may effectively guide sequence of management based upon expected histology. In advanced cases, neoadjuvant chemotherapy may be pursued, and retroperitoneal lymph node dissection may be accomplished at the time of orchiectomy to minimize morbidity. The development of these massive late stage tumors reaffirms current guidelines on the early correction of cryptorchidism. [Rev Urol. 2019;21(2/3):136–140] © 2019 MedReviews®, LLC

TesticularSeminomaNonseminomatous

Case Review

Intraperitoneal Rupture of a Synovial Sarcoma of the Kidney

Paul KozlowskiAndrew StammNeal ContiSemra OlgacJohn Paul FloresMichael J Wagner

Primary renal synovial sarcoma is an aggressive, extremely rare disease. Nearly all reported cases are characterized by SYT-SSX gene translocation (X;18)(p11;q11). We describe the case of a 43-year-old woman who presented with an intraperitoneal rupture of this rare sarcoma followed by a right radical nephrectomy. Follow-up imaging 1 month after surgery revealed peritoneal carcinomatosis. She began systemic chemotherapy with doxorubicin and dacarbazine, progressed after 3 months, and is currently receiving single-agent ifosfamide. Only one instance of intraperitoneal rupture has been reported previously. This case report contributes to the characterization of this rare disease. [Rev Urol. 2019;21(2/3):141–143] © 2019 MedReviews®, LLC

Kidney cancerOncologyRenal synovial sarcoma

Erratum

Correction for “Effectiveness of Subcutaneously Administered Leuprolide Acetate to Achieve Low Nadir Testosterone in Prostate Cancer Patients” Rev Urol. 2018;20(2):63-68 doi: 10.3909/riu0798

[Rev Urol. 2019;21(2/3):144] © 2019 MedReviews®, LLC