Issues

Options for the Medical Treatment of Peyronie’s Disease

KOL Interview

Laurence A LevineSanford J Siegel

[Rev Urol. 2014;16(suppl 1):S1-S5 doi: 10.3909/riu16S1S001] © 2014 MedReviews®, LLC

The Physiologic and Anesthetic Considerations in Elderly Patients Undergoing Robotic Renal Surgery

Management Review

Nikhil VasdevTim LaneDamian HanburyAnna Sau Kuk PoonGowrie MohanGregory BousteadJames M Adshead

A number of patients are diagnosed with renal malignancies incidentally worldwide. Once a diagnosis of a renal malignancy is established, after a careful evaluation, patients can be offered a robotic nephrectomy or partial nephrectomy. We present a review of the physiologic and anesthetic considerations in elderly patients who are being considered for robotic renal surgery. [Rev Urol. 2014;16(1):1-9 doi: 10.3909/riu0591] © 2014 MedReviews®, LLC

A Modest Proposal: Prostate Biopsies and In-house Pathology Laboratories

[Rev Urol. 2013;15(4):135-136 doi: 10.3909/riu0605] © 2014 MedReviews®, LLC

Use of Herbal Supplements for Overactive Bladder

Management Update

Steven A KaplanRichard LeeBilal ChughtaiAlexis E TeElizabeth KavalerFranklin C Lowe

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world’s population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB. [Rev Urol. 2013;15(3):93-96 doi: 10.3909/riu0587] © 2013 MedReviews®, LLC

Management of Recurrent Urinary Tract Infections in Healthy Adult Women

Management Update

Victor W NittiDuane R Hickling

Recurrence after urinary tract infection (rUTI) is common in adult women. The majority of recurrences are believed to be reinfection from extraurinary sources such as the rectum or vagina. However, uropathogenic Escherichia coli are now known to invade urothelial cells and form quiescent intracellular bacterial reservoirs. Management of women with frequent symptomatic rUTI can be particularly vexing for both patients and their treating physicians. This review addresses available and promising management strategies for rUTI in healthy adult women. [Rev Urol. 2013;15(2):41-48 doi: 10.3909/riu0566] © 2013 MedReviews®, LLC

Laser Prostatectomy: Holmium Laser Enucleation and Photoselective Laser Vaporization of the Prostate

Treatment Update

Yakup BostanciAmir KazzaziBob Djavan

Historically, transurethral resection of the prostate has been the gold standard for the treatment of benign prostatic hyperplasia (BPH). Laser technology has been used to treat BPH for ? 15 years. Over the past decade, it has gained wide acceptance by experienced urologists. This review provides an evidence-based update on laser surgery for BPH with a focus on photoselective laser vaporization and holmium laser enucleation of the prostate surgeries and assesses the safety, efficacy, and durability of these techniques. [Rev Urol. 2013;15(1):1-10 doi: 10.3909/riu0553] © 2013 MedReviews®, LLC

Lap Pak for Abdominal Retraction

New Technology Review

Gary D SteinbergHerbert LeporGanesh SivarajanSam S ChangAmr FerganyS Bruce Malkowicz

Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges. [Rev Urol. 2012;14(3/4):41-47 doi: 10.3909/riu0572] © 2013 MedReviews®, LLC

LHRH Agonists for the Treatment of Prostate Cancer: 2012

Management Review

Neal D ShoreHerbert Lepor

The most recent guidelines on prostate cancer screening from the American Urological Association (2009), the National Comprehensive Cancer Network (2011), and the European Association of Urology (2011), as well as treatment and advances in disease monitoring, have increased the androgen deprivation therapy (ADT) population and the duration of ADT usage as the first-line treatment for metastatic prostate cancer. According to the European Association of Urology, gonadotropin-releasing hormone (GnRH) agonists have become the leading therapeutic option for ADT because they avoid the physical and psychological discomforts associated with orchiectomy. However, GnRH agonists display several shortcomings, including testosterone (T) surge (“clinical flare”) and microsurges. T surge delays the intended serologic endpoint of T suppression and may exacerbate clinical symptoms. Furthermore, ADT manifests an adverse-event spectrum that can impact quality of life with its attendant well-documented morbidities. Strategies to improve ADT tolerability include a holistic management approach, improved diet and exercise, and more specific monitoring to detect and prevent T depletion toxicities. Intermittent ADT, which allows hormonal recovery between treatment periods, has become increasingly utilized as a methodology for improving quality of life while not diminishing chronic ADT efficacy, and may also provide healthcare cost savings. This review assesses the present and potential future role of GnRH agonists in prostate cancer and explores strategies to minimize the adverse-event profile for patients receiving ADT. [ Rev Urol. 2012;14(1/2):1-12 doi:10.3909/riu0547 ] © 2012 MedReviews®, LLC

Changing Patterns in Iatrogenic Ureteral Injuries

Treatment Review

Dean G AssimosVictoriano RomeroHaluk AkpinarJohn Smith III

Advances in laparoscopic and endoscopic surgery over the past 25 years have changed the preferred methods for performing many operations. We previously reported an increase in the number of patients treated for ureteral injury at our institution that paralleled the introduction of minimally invasive techniques. Since that report, more advanced endoscopic procedures have been introduced. We sought to determine whether the latter influenced the number of ureteral injuries managed at our institution. Reported here are the results of our retrospective study, which sought to determine if the rate of treatment of major iatrogenic ureteral injuries has changed. [Rev Urol. 2011;13(4): e179-e183 doi: 10.3909/riu0537] © 2011 MedReviews®, LLC

Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

Management Review

Peter L RoyceMatthew F BultitudeJennifer KongRussell GruenAlex CatoNiall Corcoran

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.[Rev Urol. 2011;13(3):119-130 doi: 10.3909/riu0521] © 2011 MedReviews®, LLC