Review ArticlesErectile Function Outcomes in the Current Era of Anatomic Nerve-Sparing Radical ProstatectomyTherapeutic ChallengesArthur L BurnettThe contemporary use of anatomic nerve-sparing radical prostatectomy, which entails preserving the autonomic nerve supply to the penis required for penile erection, has led to improved erectile function outcomes compared with what has been seen historically. However, delay of postoperative recovery of erection for as long as 2 years is common, such that dysfunctional erection status lingers as a major postoperative problem. Several possible strategies to improve overall recovery rates and to hasten postoperative recovery of erectile function are currently being advanced. These include pharmacologic rehabilitation therapy and neuromodulatory therapy. Rigorous basic scientific investigation and clinical assessment of these new strategic approaches are critically important to establish their actual therapeutic benefits. [Rev Urol. 2006;8(2):47-53]Prostate cancerRadical prostatectomyErectile dysfunctionNeuromodulationPenile erection
Review ArticlesPathologic Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the LiteratureTherapeutic ChallengesSimon D WuVannita Simma-ChangJohn P SteinOrthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder. [Rev Urol. 2006;8(2):54-60]CystectomyOrthotopic urinary diversionOrthotopic neobladderFemale bladdercancerUrethrectomyUrethral recurrence
Review ArticlesTreatment of Upper Tract Urothelial Carcinoma: A Review of Surgical and Adjuvant TherapyTreatment ReviewChristopher R PorterKalyan C LatchamsettyUpper tract urothelial carcinoma is a disease entity that has not been as extensively studied and reviewed as carcinoma of the bladder. Recent advances in technology and adjuvant therapy have changed the treatment armamentarium of oncologists and urologists. A literature review was conducted that focused on newer surgical techniques, including laparoscopy and endoscopic management of upper tract disease. Adjuvant therapy including immunotherapy, chemotherapy, and radiation is also reviewed. Nephroureterectomy with removal of a bladder cuff still remains the gold standard of treatment. However, laparoscopic nephroureterectomy is quickly becoming popular, with equivalent recurrence rates. Because of the relatively recent introduction of laparoscopy into the urologic field, long-term data with respect to recurrence rates and survival rates are not yet available. Immunotherapy has also shown promise, but with higher recurrence rates than surgery. Chemotherapy and radiation also show some improvement in recurrence rates, but there have been no randomized, prospective trials. Endoscopic management is acceptable in patients with severe medical comorbidities or solitary kidneys but requires rigorous and close follow-up. Adjuvant therapy with either chemotherapy or radiation is still debated but does offer some improvement in disease-specific survival. Randomized, prospective, placebo-controlled studies are required but are difficult to perform because of the relatively low incidence and prevalence of this disease. [Rev Urol. 2006;8(2):61-70]ImmunotherapyChemotherapyUrothelial carcinomaRadiation
Review ArticlesThe Business of Urology - Your First JobSpecial FeaturePaul BrowerYoung doctors nearing the end of their residency must begin to consider how to chart the course of their careers. Most residents will go into private practice. This requires a huge leap, from academia into the business world of medicine. Young doctors, long preoccupied with the clinical and academic aspects of medicine, are frequently ill-prepared for this process, having no insight as to what they can do to match themselves to the right practice or multi-specialty group. This article discusses the stages of this process, from initial geographic decisions to securing interviews, to assessing the health of a given practice, to the details of contract negotiation. [Rev Urol. 2006;8(2):71-75]CompensationResidentsEmploymentPrivate practiceMedicarePPOHMOContract negotiation
Meeting ReviewsA Gathering of Urologists and Urogynecologists in MontrealMeeting ReviewDae Kyung KimMichael B ChancellorA Report from the 35th Annual Meeting of the International Continence Society August 28–September 2, 2005 Montreal, Quebec, Canada [Rev Urol. 2006;8(2):76-82]Overactive bladderUrinary incontinenceVoiding dysfunctionStem cellsBotulinum toxin ATape sling proceduresColposuspensionMuscarinic receptor antagonistsNerve stimulationAjulemic acid (IP751)
Meeting ReviewsEndourology: A Basic Science and Clinical UpdateMeeting ReviewDean G AssimosHighlights from the 23rd World Congress on Endourology and the Shockwave Lithotripsy 21st Basic Research Symposium August 23–26, 2005 Amsterdam, The Netherlands [Rev Urol. 2006;8(2):83-86]LaparoscopyOncologyNephrolithiasisShock wave lithotripsyEndourologyUreteral physiologyUreteral stents