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Genital tract tumorView Articles

Volume 17, Number 1Case Review

Adenocarcinoma of the Urethra With Mucinous Features

Arthi SatyanarayanLucas ReddAnthony DyerAndrew WrightJonathan Walker

Primary adenocarcinoma of the female urethra is a rare malignancy. Previous studies hypothesize multiple origins, including periurethral glands or intestinal metaplasia. We report a case of a 60-year-old white woman with adenocarcinoma of the urethra who initially presented with obstructive voiding complaints secondary to a urethral mass. Wide local excision revealed invasive adenocarcinoma of the urethra with mucinous features. There was intestinal metaplasia adjacent to the tumor, as well as separate identification of intestinal metaplasia along the urethra. Ultimately, the patient underwent radical cystectomy with ileal conduit urinary diversion with no evidence of recurrence, indicating the role of early identification and surgical intervention for such cases. [Rev Urol. 2015;17(1):38-41 doi: 10.3909/riu0622] © 2015 MedReviews®, LLC

UrethraUrethral adenocarcinomaSkene glandGenital tract tumorRadical cystectomy

Genitofemoral nerveView Articles

Volume 21, Number 1Case Review

Use of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of Orchialgia

Mason HoltelRobert J Baranello JrAllyson HalePatrick Springhart

Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [Rev Urol. 2019;21(1):49–52] © 2019 MedReviews®, LLC

OrchialgiaNeuropathic painTesticular painSpermatic cord blockGenitofemoral nerveParaspinal tumor

GenitourinaryView Articles

Volume 11, Number 2Case Review

Genitourinary Sarcoidosis

Edmund S SabaneghPravin K Rao

Genitourinary involvement of sarcoidosis can mimic many common urologic conditions. Although sarcoidosis is a benign inflammatory condition, it can present much like malignant or infectious conditions; thus, failed diagnosis can lead to unnecessary medications or surgical procedures. In addition, management choices for patients with scrotal findings have important implications for future fertility. Thus, this uncommon condition should be on the differential diagnosis for any urologic patient. The authors report on a patient with a scrotal mass as his presenting symptom of sarcoidosis and review the diagnosis, implications, and management of sarcoidosis involving all potential sites in the urinary tract.[Rev Urol. 2009;11(2):108-113]

UrologySarcoidosisGenitourinaryScrotal mass

Genitourinary complicationsView Articles

Volume 17, Number 2Case Review

Genitourinary Presentation of Tuberculosis

Jerry Yuan

Tuberculosis (TB) is less common in developed countries; however, the incidence of TB—especially resistant strains—is on the rise worldwide. Cases of TB manifesting as urologic complications are rare in the United States. Urologists should be aware of this potential manifestation, especially in patients who have recently immigrated to the United States or have traveled abroad for prolonged periods. Two cases are presented here to illustrate this entity. [Rev Urol. 2015;17(2):102-105 doi: 10.3909/riu0679] © 2015 MedReviews®, LLC

TuberculosisGenitourinary complications

Genitourinary foreign objectView Articles

Volume 15, Number 2Case Review

Endoscopic Management of Genitourinary Foreign Bodies

Joseph B SongYoussef S TanaghoMohammed HaseebuddinBrian M BenwayAlana C DesaiSam B BhayaniRobert S Figenshau

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of four cases of foreign object insertion into the genitourinary system and their outcomes and management. [Rev Urol. 2013;15(2):84-91 doi: 10.3909/riu0571] © 2013 MedReviews®, LLC

Foreign body insertionSoundingGenitourinary foreign objectEndoscopic extraction

Genitourinary malignancyView Articles

Volume 18, Number 4Review Articles

Smoking-related Genitourinary Cancers: A Global Call to Action in Smoking Cessation

Disease Outcome Update

Marc A BjurlinJosh GottilebCory HigleyRoman Sosnowski

Smoking is a known modifiable risk factor in the development of genitourinary malignancies. Although the association has long been supported by numerous research studies, the impact of smoking cessation on the decreased risk of genitourinary malignancies is less well studied. PubMed databases were searched using the terms smoking, smoking cessation, bladder cancer, kidney cancer, prostate cancer, penile cancer, testicular cancer, their synonyms, and also targeted manual searches to perform a literature review in order to summarize the benefits of cessation on disease progression and patient outcomes including survival and morbidities. Our review yielded substantial evidence highlighting the improved outcomes observed in those diagnosed with bladder, renal, and prostate cancers. The risk of bladder cancer is reduced by up to 60% in those who were able to quit for 25 years and the risk of kidney malignancy was reduced by 50% in those who abstained from smoking for 30 years. A similar trend of reduced risk was observed for prostate cancer with those who quit for more than 10 years, having prostate cancer mortality risks similar to those that never smoked. Although the data were encouraging for bladder, renal, and prostate malignancies, there are comparatively limited data quantifying the benefits of smoking cessation for penile and testicular cancers, highlighting an opportunity for further study. The role of urologists and their impact on their patients’ likelihood to quit smoking shows more than half of urologists never discuss smoking cessation upon diagnosis of a malignancy. Most urologists said they did not provide cessation counseling because they do not believe it would alter their patients’ disease progression. Studies show urologists have more influence at changing their patients’ smoking behaviors than their primary care physicians. The diagnosis of cancer may lead to a teachable moment resulting in increased smoking quit rates. Furthermore, implementing a brief 5-minute clinic counseling session increases quit attempts and quit rates. Diagnosis of genitourinary cancers and the following appointments for treatment provide a unique opportunity for urologists to intervene and affect the progression and outcome of disease. [Rev Urol. 2016;18(4):194-204 doi: 10.3909/riu0729] © 2016 MedReviews®, LLC

SmokingRisk reductionSmoking cessationGenitourinary malignancy

Genitourinary oncologyView Articles
Genitourinary pain indexView Articles

Volume 11, Number 2Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraArie S BelldegrunB ShuchF Pouliot

Prostate cancer screeningObesityBenign prostatic hyperplasiaLower urinary tract symptomsVesicoureteral refluxNephrolithiasisStress urinary incontinenceInflammationSilodosinHormonal therapyTumor markersTMPRSS2ERG4-Kallikrein panelBotulinum toxin type AMale voiding dysfunctionBenign prostatic specific antigenRoux-en-Y gastric bypass surgeryGenitourinary pain indexUPOINT clinical phenotype systemNephron-sparing surgeryWatchful waitingLaparoscopy for adrenal cortical carcinomaPartial adrenalectomyUrethral traumaPediatric urethral strictureEnteric urologic surgery

Genitourinary tractView Articles
Genitourinary tumorView Articles

Volume 14, Number 3Case Review

Two Separate Synchronous Primary Genitourinary Tumors

Matthew T SmithFrederick D TaylorWilliam P GianakopoulusRoy R Brown

A 54-year-old man presented to the office with gross painless hematuria, dysuria, and urinary frequency. He was diagnosed with renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. The article reviews the presentation, radiology, pathology, and intervention of an uncommon case of synchronous primary carcinomas, and aims to show the importance of continued clinical suspicion for multiple genitourinary primary neoplasms. [Rev Urol. 2012;14(3/4):104-107 doi: 10.3909/riu0555] © 2013 MedReviews®, LLC

HematuriaGenitourinary tumorDysuriaNeoplasmUrinary frequency

Genitourinary tumorsView Articles

Volume 10, Number 1Review Articles

Superficial Bladder Cancer: An Update on Etiology, Molecular Development, Classification, and Natural History

Treatment Update

Richard J CoteDavid Y JosephsonAnirban P MitraErik PasinJohn P Stein

Superficial “non–muscle-invasive” bladder tumors represent a heterogeneous group of cancers, including those that are (1) papillary in nature and limited to the mucosa, (2) high grade and flat and confined to the epithelium, and (3) invasive into the submucosa, or lamina propria. The goal of treatment is 2-fold: (1) to reduce tumor recurrence and the subsequent need for additional therapies and the morbidity associated with these treatments and (2) to prevent tumor progression and the subsequent need for more aggressive therapy. This update reviews important contemporary concepts in the etiology, molecular mechanisms, classification, and natural history of superficial bladder cancer. [Rev Urol. 2008;10(1):31-43]

Transitional cell carcinomaBladder neoplasmsNon–muscle-invasive tumorMolecular mechanismsGenitourinary tumors

Genomic biomarkerView 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

Genomic classifierView Articles

Volume 18, Number 1Review Articles

Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives

Management Update

Deepansh DalelaBjörn LöppenbergAkshay SoodJesse SammonFiras Abdollah

We performed a systematic literature search to identify original articles and editorials about the Decipher® Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level. [Rev Urol. 2016;18(1):1-9 doi: 10.3909/riu0706] © 2016 MedReviews®, LLC

Prostate cancerDecipher® Prostate Cancer TestGenomic classifierNeoplasm recurrenceLocal/surgeryTreatment outcome

Genomic prostate scoreView Articles

Volume 16, Number 4Review Articles

A Guide for Clinicians in the Evaluation of Emerging Molecular Diagnostics for Newly Diagnosed Prostate Cancer

Diagnosis Update

Michael J KemeterPhillip G FebboSteven E CanfieldAdam S KibelH Jeffrey LawrenceJudd W Moul

Prostate-specific antigen (PSA) screening is associated with a decline in prostate cancerrelated mortality. However, screening has also led to overdiagnosis and overtreatment of clinically insignificant tumors. Recently, certain national guidelines (eg, US Preventive Services Task Force) have recommended against PSA screening, which may lead to a reverse-stage migration. Although many prostate tumors are indolent at presentation, others are aggressive and are appropriate targets for treatment interventions. Utilization of molecular markers may improve our ability to measure tumor biology and allow better discrimination of indolent and aggressive tumors at diagnosis. Many emerging commercial molecular diagnostic assays have been designed to provide more accurate risk stratification for newly diagnosed prostate cancer. Unfamiliarity with molecular diagnostics may make it challenging for some clinicians to navigate and interpret the medical literature to ascertain whether particular assays are appropriately developed and validated for clinical use. Herein, the authors provide a framework for practitioners to use when assessing new tissue-based molecular assays. This review outlines aspects of assay development, clinical and analytic validation and clinical utility studies, and regulatory issues, which collectively determine whether tests (1) are actionable for specific clinical indications, (2) measurably influence treatment decisions, and (3) are sufficiently validated to warrant incorporation into clinical practice. [Rev Urol. 2014;16(4):172-180 doi: 10.3909/riu0644] © 2014 MedReviews®, LLC

Prostate cancerBiomarkerClinical utilityGenomic prostate scoreAdverse pathologyClinical validationMolecular diagnostics

Genomic testingView Articles

Volume 18, Number 3Original Research

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score

Michael J KemeterPhillip G FebboDavid AlbalaRuixiao LuVincy JohnDylan StoyBela DenesMarybeth McCallAlan W ShindelFrank Dubeck

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making. [Rev Urol. 2016;18(3):123-132 doi: 10.3909/riu0725] © 2016 MedReviews®, LLC

Prostate cancerOncotype DX® GPSGenomic testingHealth economicsClinical utility

Genomic testsView Articles

Volume 19, Number 2Review Articles

Utilization of Individualized Prostate Cancer and Genomic Biomarkers for the Practicing Urologist

Management Update

Gregory C McMahonGordon A BrownThomas J Mueller

Prostate cancer encompasses a complex heterogeneous disease spectrum. Physicians and patients are faced with the ambiguity of who should be screened, biopsied, rebiopsied, treated, or provided with adjuvant therapy. Personalized outcomes and treatments are especially important given the varied nature of the disease, plethora of treatment options, risks of morbidity, and quality of life. Today’s practicing urologist has a multitude of tests from which to choose, creating the difficult task of appropriate use. This review focuses on two blood-, one urine-, and five genomic-based tests, which, when used in the appropriate clinical setting, can facilitate the patient-physician decision-making process. [Rev Urol. 2017;19(2):97–105 doi:10.3909/riu0730] © 2017 MedReviews®, LLC

Prostate cancerGenomic testsPersonalized medicine

GeriatricsView Articles
Germ cellView Articles

Volume 23, Number 2Case of the Quarter

Case of the Quarter: Kaposi Sarcoma in a Patient With Testicular Germ Cell Tumor and HIV: A Case Report and Literature Review

Daniela V. CastroDonald HannounTanya B. DorffAlexander Chehrazi-RaffleWesley YipAbhishek TripathiBenjamin MercierRegina Barragan-CarrilloHedyeh EbrahimiSalvador Jaime-Casas

Testicular germ cell tumors are the leading cause of cancer in male patients 15 to 39 years old. Extensive treatments are available, and the regimen of choice depends on clinical, laboratory, and histopathologic characteristics. Patients with HIV are at increased risk of developing solid malignancies, including testicular germ cell tumors. All patients with HIV should start on highly active antiretroviral therapy, but the drug interactions between chemotherapy for testicular germ cell tumor and highly active antiretroviral therapy have not been extensively evaluated. This case review highlights the importance of optimal therapeutic agent selection in patients with HIV and solid malignancies.

Testicular neoplasmGerm cellHIVTesticular neoplasmsSarcoma

Germ cell aplasiaView Articles

Volume 17, Number 1Case Review

Rare Case of Monozygotic Twins Diagnosed With Klinefelter Syndrome During Evaluation for Infertility

Edmund S SabaneghYagil Barazani

Although neither Klinefelter syndrome nor monozygotic twins are particularly rare (1/667 male births and 3-4/1000 live births, respectively), the occurrence of both in the same pregnancy (ie, identical twins with Klinefelter syndrome) is exceedingly rare and has only been reported three times previously in the literature. This report describes the fourth ever reported case of monozygotic twins with Klinefelter syndrome (who presented to our male fertility clinic with failure to conceive) and sheds interesting light on the reproductive concordance observed with this rare clinical entity. To our knowledge, this is the first reported case of monozygotic twins with Klinefelter syndrome that describes the infertility workup and outcomes of microsurgical testicular sperm extraction. [Rev Urol. 2015;17(1):42-45 doi: 10.3909/riu0628] © 2015 MedReviews®, LLC

Klinefelter syndromeMicrosurgical testicular sperm extractionAzoospermiaSertoli only syndromeGerm cell aplasia

Germline DNA testsView Articles

Volume 22, Number 4Review Articles

Low Penetrance Germline Genetic Testing: Role for Risk Stratification in Prostate Cancer Screening and Examples From Clinical Practice

Management Update

Gerald L AndrioleFranklin GaylisKelly K BreePaul DatoChristopher J KaneA Karim Kader

Broad-based prostate-specific antigen (PSA) screening has saved lives but at a substantial human and financial cost. One way of mitigating this harm, while maintaining and possibly improving the benefit, is by focusing screening efforts on men at higher risk. With age, race, and family history as the only risk factors, many men lack any reliable data to inform their prostate cancer (PCa) screening decisions. Complexities including history of previous negative biopsies, interpretation of negative and/or equivocal mpMRI findings, and patient comorbidities further compound the already complicated decisions surrounding PCa screening and early detection. The authors present cases that provide real-world examples of how a single nucleotide polymorphism–based test can provide patients and providers with personalized PCa risk assessments and allow for development of improved risk-stratified screening regimens. [Rev Urol. 2020;22(4):152–158] © 2021 MedReviews®, LLC

Prostate cancer screeningRisk stratificationSomatic DNA testGermline DNA testsSingle nucleotide polymorphism DNA test

Giggle incontinenceView Articles

Volume 13, Number 1Review Articles

Infantile Enuresis: Current State-of-the-Art Therapy and Future Trends

Disease State Review

Franklin E KuehhasNenad DjakovicMarkus Hohenfellner

"Enuresis nocturna is a widespread problem among children, with up to 25% of all children possibly suffering from this condition. Several therapeutic modalities are currently available. This article reviews current state-of-the-art therapies, highlights current literature, and provides an update on recent developments within the field of enuresis nocturna. [Rev Urol. 2011;13(1):1-5 doi: 10.3909/riu0498]"

DesmopressinEnuresis nocturnaAlarm therapyImipramineReboxetineGiggle incontinenceMethylphenidatePelvic floor muscle exercise

Glans grooveView Articles

Volume 19, Number 3Meeting Reviews

Best of the 2017 AUA Annual Meeting

Benjamin M BruckerDean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelMaria J Arcila-RuizSasha C Druskin

[Rev Urol. 2017;19(3):169–179 doi: 10.3909/riu0763] © 2017 MedReviews®, LLC

Percutaneous nephrolithotomyDisorders of sexual developmentBladder exstrophyProstate-specific antigenBiomarkersMicrobiomeOnabotulinumtoxinABladder pain syndromeStem cell therapyInterstitial cystitisStress urinary incontinenceKallikreinZika virusReverse transcription loop-mediated isothermal amplificationRefractory overactive bladderMeshectomyPudendal neuromodulationMedical expulsive therapyGlans groove

Gleason scoreView Articles
GlomerulationsView Articles
GlycolysisView Articles
Gonadal veinView Articles

Volume 19, Number 3Case Review

Surgical Solution to an Intracorporeal Nickel Allergy

Andrew StammPaul KozlowskiJared Brandenberger

A previously healthy 30-year-old man with a symptomatic varicocele underwent gonadal vein embolization using nickel vascular plugs. He developed a painful hypersensitivity to his nickel plugs and elected to pursue laparoscopic excision and proximal gonadal vein ligation. In the operating room, the gonadal vein was isolated from the ureter, and ligated proximal to the cephalad plug and distal to the caudal coil. His pain is completely resolved 5 months after surgery. Metal allergies are well documented in orthopedics and cardiology implants, but there are a limited number of case reports of metal allergies after varicocele embolization. Interestingly, nickel is the most common type of metal hypersensitivity. [Rev Urol. 2017;19(3):195–197 doi: 10.3909/riu0769] © 2017 MedReviews®, LLC

VaricoceleMetal allergyNickelCoil embolizationGonadal vein

Gonadotropin-releasing hormoneView Articles
Gonadotropin-releasing hormone agonistsView Articles
Gonadotropin-releasing hormone antagonistView Articles