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European Randomized Study of Screening for Prostate Cancer(ERSPC)View Articles

Volume 11, Number 3Review Articles

Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials

Management Update

Herbert LeporSamir S TanejaBob DjavanElisabeth EckersbergerJulia FinkelsteinHelen SadriMarkus Margreiter

The advent of prostate-specific antigen (PSA) testing in the early 1980srevolutionized the diagnosis of prostate cancer. As a result of PSA testing,there has been a surge in the number of prostate cancer diagnoses. Thisreview examines the results of 2 recent landmark trials that studied the effectof screening on prostate cancer mortality: the European Randomized Study ofScreening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung,Colorectal, and Ovarian (PLCO) Cancer Screening Trial.[Rev Urol. 2009;11(3):127-133 doi: 10.3909/riu0474]

PSA screeningEuropean Randomized Study of Screening for Prostate Cancer(ERSPC)Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Evaluation andView Articles
Evaluation and management servicesView Articles

Volume 23, Number 2Coding Corner

Coding Corner: Healthcare Common Procedure Coding System Code G2211, Visit Complexity Inherent to Evaluation and Management

Jonathan RubensteinMark PainterCeleste Kirschner

For this issue, we reviewed the Healthcare Common Procedure Coding System (HCPCS) level 2 code G2211. Though the code has existed for a few years, Medicare began reimbursing physicians for reporting the code in January 2024. The code is used to describe the complexity of an evaluation and management (E&M) visit associated with an ongoing, longitudinal care relationship, focusing on a circumstance rather than a specific service. The circumstance described in this code differs from the prolonged services described by Current Procedural Terminology (CPT) codes 99358 through 99418; the case management services described by CPT codes 99366 through 99368; and the chronic care management services described by CPT codes 99490, 99491, and 99437 through 99489:

Benign prostatic hyperplasiaEvaluation and management servicesCurrent Procedural Terminology codes

Evidence-based practiceView Articles

Volume 19, Number 4Review Articles

Active Surveillance Use Among a Low-risk Prostate Cancer Population in a Large US Payer System: 17-Gene Genomic Prostate Score Versus Other Risk Stratification Methods

Original Research

Michael J KemeterPhillip G FebboSteven CanfieldJohn Hornberger

Many men with low-risk prostate cancer (PCa) receive definitive treatment despite recommendations that have been informed by two large, randomized trials encouraging active surveillance (AS). We conducted a retrospective cohort study using the Optum™ Research Database (Eden Prairie, MN) of electronic health records and administrative claims data to assess AS use for patients tested with a 17-gene Genomic Prostate Score™ (GPS; Genomic Health, Redwood City, CA) assay and/or prostate magnetic resonance imaging (MRI). De-identified records were extracted on health plan members enrolled from June 2013 to June 2016 who had ≥1 record of PCa (n = 291,876). Inclusion criteria included age ≥18 years, new diagnosis, American Urological Association low-risk PCa (stage T1-T2a, prostate-specific antigen ≥10 ng/mL, Gleason score = 6), and clinical activity for at least 12 months before and after diagnosis. Data included baseline characteristics, use of GPS testing and/or MRI, and definitive procedures. GPS or MRI testing was performed in 17% of men (GPS, n = 375, 4%; MRI, n = 1174, 13%). AS use varied from a low of 43% for men who only underwent MRI to 89% for GPS-tested men who did not undergo MRI (P<001). At 6-month follow-up, AS use was 31.0% higher (95% CI, 27.6%-34.5%; P<001) for men receiving the GPS test only versus men who did not undergo GPS testing or MRI; the difference was 30.5% at 12-month follow-up. In a large US payer system, the GPS assay was associated with significantly higher AS use at 6 and 12 months compared with men who had MRI only, or no GPS or MRI testing. [Rev Urol. 2017;19(4):203–212 doi: 10.3909/riu0786] © 2018 MedReviews®, LLC

Prostate cancerActive surveillanceEvidence-based practiceComparative effectiveness researchGenomic biomarkerMagnetic resonance imaging

ExerciseView Articles

Volume 17, Number 3Review Articles

The Obesity Epidemic and Its Impact on Urologic Care

Management Update

Neil BaumDavid Mobley

Although heart disease and cancer are the number one and two causes of death in the United States, respectively, obesity is gaining speed as a contributing cause to both of those conditions, along with diabetes, arthritis, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. Nearly one-third of the adults in the United States is overweight with a body mass index (BMI) greater than 25 kg/m2, and another third of the adult population is obese, with a BMI greater than 30 kg/m2. This article reviews the root causes of obesity, the societal implications, and the implications of obesity on various urologic diseases. [Rev Urol. 2015;17(3):165-170 doi: 10.3909/riu0683] © 2015 MedReviews®, LLC

ObesityMorbid obesityBody mass indexExerciseWeight lossDietEpidemic

ExisulandView Articles
EXO106 testView Articles

Volume 17, Number 3Meeting Reviews

Highlights From the 2015 American Urological Association Annual Meeting, May 15-19, 2015, New Orleans, LA

Best of the 2015 AUA Annual Meeting

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelMichael A GorinMichael K BrawerHeinz NicolaiÁine Goggins

[Rev Urol. 2015;17(3):179-189 doi:10.3909/riu0681] © 2015 MedReviews®, LLC

Active surveillanceHypospadias4KscoreProlarisStress urinary incontinencePatient phenotypingChronic pelvic pain syndromeEXO106 testMRI/US fusion biopsyOxalobacter formigenesUreteroscopic stone removalDecipher assayRadiation cystitisOccult tethered cord syndromeMRI-guided biopsy

Exogenous testosterone therapyView Articles
Expectant managementView Articles
External beam radiationView Articles
External beam radiation therapyView Articles
External beam radiotherapyView Articles
Extracorporeal shock wave lithotripsyView Articles

Volume 12, Number 3Case Review

Risk Factor Analysis and Management of Ureteral Double-J Stent Complications

Case Review

Abdelhak KhalloukYounes AhallalMohamed Jamal El FassiMoulay Hassan Farih

Double-J ureteral stents are commonly used to manage urinary obstructions. Pain, bladder irritative symptoms, and fever are usually signs of early complications related to double-J stents; late complications are more troublesome. We review 4 cases that highlight a variety of late complications with double- J stents (encrustation, migration, and fragmentation). Following a review of the literature, guidelines are established for monitoring potential risk factors as well as management strategies for prevention of possible complications when using double-J stents. [Rev Urol. 2010;12(2/3):e147-e151 doi:10.3909/riu0447]

Double-J stentExtracorporeal shock wave lithotripsyStent migrationFragmentationEncrustation

Extracorporeal shock wave therapyView Articles

Volume 13, Number 3Review Articles

Peyronie’s Disease: Nonsurgical Therapy Options

Treatment Update

Franklin E KuehhasNenad DjakovicPeter WeiblTosev GeorgiRalf Herwig

Peyronie&rsquo;s disease (PD) is a fibrous inelastic scar of the tunica albuginea, leading to penile deformity, penile curvature, shortening, narrowing, and painful erections that subsequently lead to painful or unsatisfying sexual intercourse. No consensus exists yet on the ideal management of PD. This fact is a result of our limited knowledge of its etiology and causative factors. The acute presentation of PD is treated conservatively, and surgical approachesare only attempted if severe curvature, narrowing, or indentation persists for more than 1 year; PD stability exists for at least 3 months; curvature impedes sexual intercourse; and severe penile shortening occurs. This review focuses on new developments for conservative treatment strategies for PD. [Rev Urol. 2011;13(3):139-146 doi: 10.3909/riu0528] © 2011 MedReviews®, LLC

Peyronie’s diseaseNonsurgical therapyOral medicationIntralesionaltherapyExtracorporeal shock wave therapyIontophoresisPenile traction systems

Failed radiationView Articles
FallsView Articles

Volume 18, Number 1Review Articles

Falls in the Elderly Secondary to Urinary Symptoms

Prevention and Management Update

Yousef SolimanRichard MeyerNeil Baum

Falls and fractures have a significant impact on our patients, their families, and caregivers, and cost the health care system billions of dollars. Each year, millions of adults aged 65 and older fall. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. Because many patients with falls and subsequent fractures have urologic conditions, urologists are positioned to help with the prevention of these significant and costly injuries. This article discusses the epidemiology of falls and fractures, and the urologic comorbidities that increase their risk. [Rev Urol. 2016;18(1):28-32 doi: 10.3909/riu0686] © 2016 MedReviews®, LLC

NocturiaOveractive bladderFallsFracturesUrinary tract infectionsPrevention

FatView Articles
FatigueView Articles

Volume 21, Number 2Review Articles

Nocturia in Patients With Multiple Sclerosis

Management Review

Benjamin M BruckerRoger R DmochowskiW Stuart ReynoldsBenoit PeyronnetXavier GaméLauren B KruppGérard AmarencoJean-Nicolas CornuLana Zhovtis RyersonCarrie Lyn SammarcoJonathan E HowardRobert W Charlson

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

Fatty LiverView Articles

Volume 21, Number 4Review Articles

Impact of Demographic Factors and Systemic Disease on Urinary Stone Risk Parameters Amongst Stone Formers

Original Research

Dean G AssimosKyle WoodWilliam PooreBarbara GowerCarter BoydDustin WhitakerOmotola AshorobiRobert Oster

This article examines via multivariate analysis the associations between demographic factors and systemic diseases on stone risk parameters in a stone-forming population. A retrospective chart review of adult stone formers who completed 24-hour urine collections from April 2004 through August 2015 was performed. Data was collected on age, sex, race, body mass index (BMI), and diagnoses of diabetes and hypertension. CT imaging and renal/abdominal ultrasonography (within ±6 mo) were reviewed for diagnosis of fatty liver disease. Statistical analysis included Pearson and Spearman correlation analysis, and linear and logistic regression analyses, both univariate and multivariate. Five hundred eighty-nine patients were included. Numerous urinary parameters were significant in association with demographic factors or systemic diseases in a multivariate analysis. Older age was associated with decreased calcium (Ca) excretion (P = 0.0214), supersaturation of calcium oxalate (SSCaOx; P = 0.0262), supersaturation of calcium phosphate (SSCaP; P < 0.0001), and urinary pH (P = 0.0201). Men excreted more Ca (P = 0.0015) and oxalate (Ox; P = 0.0010), had lower urine pH (P = 0.0269), and higher supersaturation of uric acid (SSUA; P < 0.0001) than women. Blacks had lower urine volume (P = 0.0023), less Ca excretion (P = 0.0142), less Ox excretion (P = 0.0074), and higher SSUA (P = 0.0049). Diabetes was associated with more Ox excretion (P < 0.0001), lower SSCaP (P = 0.0068), and lower urinary pH (P = 0.0153). There were positive correlations between BMI and Ca excretion (P = 0.0386), BMI and Ox excretion (P = 0.0177), and BMI and SSUA (P = 0.0045). These results demonstrate that demographic factors and systemic disease are independently associated with numerous risk factors for kidney stones. The mechanisms responsible for these associations and disparities (racial differences) need to be further elucidated. [Rev Urol. 2019;21(4):158–165] © 2020 MedReviews®, LLC

ObesityKidney stonesDiabetesSystemic diseaseFatty Liver

FDP testView Articles
Febrile urinary tract infectionView Articles
Fecal microbiomeView Articles

Volume 21, Number 2Meeting Reviews

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

Benjamin M BruckerDean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorGregory VurtureZeyad R Schwen

[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

Female bladdercancerView Articles

Volume 8, Number 2Review Articles

Pathologic Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature

Therapeutic Challenges

John P SteinVannita Simma-ChangSimon D Wu

Orthotopic 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

Female sexual dysfunctionView Articles

Volume 21, Number 2Meeting Reviews

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

Benjamin M BruckerDean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorGregory VurtureZeyad R Schwen

[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

FertilityView Articles
Fertility preservationView Articles

Volume 17, Number 4Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Malgorzata E Skaznik-WikielSara Babcock GilbertRandall B MeachamLaxmi A Kondapalli

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservationChildhood cancerSperm cryopreservationTesticular tissue cryopreservationSpermatogonial stem cell cryopreservationEmbryo cryopreservationOocyte cryopreservationOvarian tissue cryopreservation

Fetal diseasesView Articles
FetoproteinView Articles

Volume 13, Number 1Review Articles

&alpha;-Fetoprotein-Producing Non-Germ Cell Tumors of the Urological System

Diagnostic Review

Mona El-Bahrawy

"Elevated serum levels of _ -fetoprotein (AFP), a fetal serum protein, occur mainly in the development of hepatocellular carcinoma (HCC) or germ cell tumors, mainly yolk sac tumor. Rarely, other tumors of the urological system produce AFP. This article reviews the AFP-producing non-germ cell tumors of the urological tract reported to date. These include different types of tumors of the adrenal glands, kidney, ureter, urinary bladder, and testis. It is important for pathologists, urologists, and oncologists to be aware of such cases as the diagnosis affects the management plan for the patient. [Rev Urol. 2011;13(1):14-19 doi: 10.3909/riu0506]"

FetoproteinGerm cellTumorsUrological system

Fibrin glueView Articles

Volume 8, Number 3Review Articles

New Generation Tissue Sealants and Hemostatic Agents: Innovative Urologic Applications

Treatment Update

Dean G AssimosMichael A Traver

Control of blood loss during urologic surgery is paramount to the success of patient recovery. Hemostatic agents and tissue sealants are used routinely to prevent excess blood loss and in reconstruction during surgical repair. Some of the available products include thrombin sealant, fibrin glue, bovine serum/ albumin/glutaraldehyde, and gelatin matrix. Each of these agents differs in mechanism, cost, and application. Complications can include allergic reactions or thromboembolism and the risk of contracting bovine spongiform encephalitis or hepatitis. Many new hemostatic agents are being developed and approved. The benefits and risks of use of these agents versus conventional treatment need to be considered on a case-by-case basis by the surgeon. [Rev Urol. 2006;8(3):104-111]

HemostasisThrombin sealantsFibrin glueGelatin matrixThrombin

Fibrin tissue adhesiveView Articles

Volume 17, Number 1Original Research

Hemostasis During Urologic Surgery: Fibrin Sealant Compared With Absorbable Hemostat

David M. AlbalaJerome B RiebmanRichard KocharianBogdan IlieJohn AlbaneseJessica ShenLiza OvingtonJonathan Batiller

In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components&mdash;fibrinogen and thrombin&mdash;that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding. [Rev Urol. 2015;17(1):25-30 doi: 10.3909/ricm0647] © 2015 MedReviews®, LLC

BleedingHemostasisHemostaticsFibrin tissue adhesiveUrologic surgical proceduresSurgical technique