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GoserelinView Articles
Gosha-jinki-ganView Articles

Volume 15, Number 3Review Articles

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

Overactive bladderHerbal medicineGosha-jinki-ganHachi-mi-jio-ganBuchu (Barosma betuline)Cleavers (Galium aparine)Cornsilk (Zea mays)Horsetail (Equisetum)Ganoderma lucidumResinferatoxinCapsaicin

GossypibomaView Articles

Volume 18, Number 4Case Review

Gossypiboma Manifesting as Urachal Mass

Nirmish SinglaAhmed Q HaddadChristopher CefaluVitaly Margulis

Gossypiboma (retained surgical sponge) occurs between 1 in 1000 and 1 in 1500 of all intra-abdominal operations. Patients with gossypibomas may present asymptomatically or with nonspecific symptoms, such as abdominal pain or bloating; identification frequently relies on imaging. Results of imaging alone, however, may appear nonspecific, and the gossypiboma may mimic other masses, such as neoplasms, hematomas, or abscesses. They require surgical removal for definitive diagnosis and treatment. Herein we present an unusual case of gossypiboma masquerading as an urachal mass in a 75-year-old woman. Diagnostic evaluation, natural history, and prevention of retained surgical materials are discussed. [Rev Urol. 2016;18(4):239-241 doi: 10.3909/riu0703] © 2016 MedReviews®, LLC

GossypibomaUrachal massSurgical errorsPatient safety

GoutView Articles

Volume 9, Number 1Review Articles

Uric Acid Nephrolithiasis: Recent Progress and Future Directions

Management Update

Dean G AssimosTin C Ngo

The prevalence of urolithiasis has been increasing for the past few decades in industrialized nations. Uric acid calculi account for a significant percentage of urinary stones. Certain risk factors may be involved in the pathogenesis of uric acid nephrolithiasis, including hyperuricosuria, low urinary volume, and persistently low urinary pH. Patients with medical conditions that promote profound hyperuricosuria are at high risk of developing uric acid calculi. These conditions include chronic diarrheal states; myeloproliferative disorders; insulin resistance, including diabetes mellitus; and monogenic metabolic disorders, such as Lesch-Nyhan syndrome. Computed tomography can provide a definitive diagnosis. Except in cases in which there is severe obstruction, progressive azotemia, serious infection, or unremitting pain, the initial treatment of patients with uric acid nephrolithiasis should be medical dissolution therapy because this approach is successful in the majority of cases. A thorough review of the epidemiology and pathophysiology of uric acid nephrolithiasis is crucial for the diagnosis, treatment, and prevention of stones in patients with this condition. [Rev Urol. 2007;9(1):17-27]

UrolithiasisUric acid nephrolithiasisHyperuricosuriaGout

grade migrationView Articles

Volume 20, Number 3Original Research

Histologic Changes in Prostate Cancer Detected Subsequent to the 2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening Recommendation

Ann E AndersonCarl A OlssonHugh J LaveryDeepak Kapoor

We report changes in the histopathology of prostate cancer diagnosed in a large urology group practice after the final United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen screening. All prostate biopsies performed from 2011 through 2015 in a large urology group practice were retrospectively reviewed; 2012 was excluded as a transition year. The changes in biopsy data in years following the USPSTF decision (2013-2015) were then compared with baseline (2011). A total of 10,944 biopsies were evaluated during the study period. Positive biopsy rates rose from 39.1% at baseline to 45.2% in 2015 (P < 0.01) with a marked shift toward more aggressive cancer throughout the study period. The absolute number of patients presenting with Gleason Grade Group 4 or 5 increased from 155/year at baseline to 231, 297, and 285 in 2013, 2014, and 2015, respectively (P < 0.05), unrelated to age or racial changes over time. Black men represented 16% of the cohort. Since the USPSTF recommendation against prostate cancer screening, trends toward a substantial upward grade migration and increased volume of cancers were noted in a cohort of nearly 11,000 patients in a real- world clinical practice. Additionally, continuing reductions in cancer detection in the United States may exacerbate these trends. [Rev Urol. 2018;20(3):125–130 doi: 10.3909/riu0815] © 2018 MedReviews®, LLC

Prostate cancerProstate cancer screeningHistopathologygrade migration

Graft-based techniquesView Articles
GreenLight photovaporizationView Articles

Volume 17, Number 3Review Articles

The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy

Management Update

Ojas ShahHerbert LeporGanesh SivarajanMichael S BorofskyJames E Lingeman

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH. [Rev Urol. 2015;17(3):140-149 doi: 10.3909/riu0675] © 2015 MedReviews®, LLC

Lower urinary tract symptomsRobotic simple prostatectomyBenign prostatic hypertrophyGreenLight photovaporizationHolmium laser enucleation of the prostate (HoLEP)

Gross hematuriaView Articles

Volume 11, Number 1Case Review

Renal Involvement by Chronic Myelomonocytic Leukemia Requiring Nephroureterectomy

Samir S TanejaJonathan MelamedOjas D ShahElias S HyamsRaavi Gupta

Chronic monomyelocytic leukemia (CMML) is a relatively rare clonal hematologic disorder with features of myelodysplastic syndrome and myeloproliferative disease. Renal impairment from CMML is infrequent and can result from both direct (ie, infiltrative) and indirect (eg, vasculitis, infarction) mechanisms. This case report describes a patient with refractory gross hematuria requiring nephroureterectomy with diffuse involvement of the upper tract by CMML and accompanying extramedullary hematopoiesis. Underscored are the need to maintain a broad differential diagnosis for upper tract lesions in the setting of gross hematuria, and the potential need for drastic measures to control upper tract bleeding if conservative measures fail.[Rev Urol. 2009;11(1):33-37]

Gross hematuriaSecondary malignancy of kidneyLeukemia

Group practiceView Articles

Volume 23, Number 1Meet The Expert

Meet the Expert: Erika Ferrozzo, MHA

David M. AlbalaErika Ferrozzo

In-office dispensaries (IODs) are frequently discussed but rarely implemented in urology private group practices. In this interview, Erika Ferrozzo, MHA, CEO of the Idaho Urologic Institute and a member of the LUGPA Executive Leadership Program’s class of 2023, explains how the Idaho Urologic Institute identified an opportunity that helped its patients experience improved adherence and ease of access to treatment and that earned the practice a year-over-year $250 000 increase in net revenue.

UrologyGroup practiceequipment and supplies

Growth factorsView Articles
Growth hormoneView Articles

Volume 17, Number 4Case Review

Acromegaly Presenting as Erectile Dysfunction: Case Reports and Review of the Literature

Jerry A RajuKate E ShipmanJohn A InglisRousseau Gama

Erectile dysfunction (ED) is a common yet complex condition. The authors report two cases of acromegaly presenting with ED and hypogonadotropic hypogonadism. Surgical cure of the acromegaly was associated with either an improvement or resolution of hypogonadotropic hypogonadism-associated ED. Active acromegaly should be considered in the differential diagnosis of ED presenting with supporting clinical features, particularly hypogonadotropic hypogonadism. [Rev Urol. 2015;17(4):246-249 doi: 10.3909/riu0676] © 2016 MedReviews®, LLC

Erectile dysfunctionEndocrine dysfunctionEndocrinologyAcromegalyGrowth hormone

Guanylate cyclase activatorsView Articles
GuevedocesView Articles
GuidelinesView Articles
Gut 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

gynecological examinationView Articles
GynecomastiaView Articles

Volume 9, Number 4Review Articles

Estrogenic Side Effects of Androgen Deprivation Therapy

Treatment Update

Michael S CooksonJames A EasthamTheresa A GuiseMichael G OefeleinMatthew R SmithCelestia Higano

Androgen deprivation therapy (ADT) is part of standard therapy for locally advanced or metastatic prostate cancer and is frequently used in men with a rising prostate-specific antigen following radical prostatectomy or radiation therapy. In some men, ADT may be administered for years or even decades. The intended therapeutic effect of ADT is testosterone deficiency. Because estrogen is a normal metabolite of testosterone, ADT also results in estrogen deficiency. ADT has a variety of adverse effects, many of which are primarily related to estrogen deficiency. Bone mineral density may decrease by 4% to 13% per year in men receiving ADT. The fracture rate for patients on ADT averages 5% to 8% per year of therapy. Hot flashes, gynecomastia, and breast tenderness are common side effects associated with ADT. In the clinic, minimum baseline testing should include weight measurement, blood pressure reading, and fasting lipid panel and serum glucose tests. Currently, there are no large outcome trials in men on ADT testing the available therapies for adverse effects. No therapies are specifically approved for treatment of adverse effects in men on ADT. Although some therapies can be used for a single indication (based upon small studies), there is currently no agent to treat the multiple estrogenic side effects of ADT. [Rev Urol. 2007;9(4):163-180]

Androgen deprivation therapyCardiovascular diseaseGynecomastiaOsteoporosis fractureMale hot flashes

HA/HAase testView Articles
Hachi-mi-jio-ganView Articles

Volume 15, Number 3Review Articles

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 &ge; 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&rsquo;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

Overactive bladderHerbal medicineGosha-jinki-ganHachi-mi-jio-ganBuchu (Barosma betuline)Cleavers (Galium aparine)Cornsilk (Zea mays)Horsetail (Equisetum)Ganoderma lucidumResinferatoxinCapsaicin

Hand-assisted laparoscopy (HAL)View Articles
Hand-foot skin reactionView Articles

Volume 17, Number 4Case Review

Sorafenib-induced Scrotal Eczema

Selahattin Caliskan

Sorafenib is an orally active, small-molecule multikinase inhibitor that blocks tumor cell proliferation and angiogenesis. Studies have shown that it is a highly potent, selective inhibitor of vascular endothelial growth factor receptors 2 and 3, platelet-derived growth factor-&beta;, RAF, FLT-3, and c-Kit. This drug was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. We report a case of a patient treated with sorafenib for metastatic renal cell carcinoma who developed scrotal eczema. [Rev Urol. 2015;17(4):250-251 doi: 10.3909/riu0648] © 2016 MedReviews®, LLC

SorafenibScrotal eczemaHand-foot skin reaction

health care costsView Articles

Volume 23, Number 4Editorial

2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing Progress

Matthew Glans

In 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.

Telemedicinehealth care costsinsurance, healthhealth services accessibility

Health care dataView Articles
Health disparitiesView Articles
Health economicsView 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

Health maintenance organizationsView Articles
health services accessibilityView Articles

Volume 23, Number 4Editorial

2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing Progress

Matthew Glans

In 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.

Telemedicinehealth care costsinsurance, healthhealth services accessibility

Health services researchView Articles

Volume 22, Number 2Review Articles

The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study

Original Research

Kenneth E SchmankeJordan J StiversonRosalee E ZackulaSerge G SrourMatthew P LierzFadi N Joudi

Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting. We recommend that a standard biopsy be performed alongside targeted biopsy. [Rev Urol. 2020;22(2):57–66] © 2020 MedReviews®, LLC

Health services researchProstatic neoplasmsImage-guided biopsyMultiparametric MRIAmbulatory care facilities

health workforceView Articles

Volume 23, Number 2Editorial

Advanced Practice Providers, Urology Workforce Challenges, and Reviews in Urology

Kenneth A. Mitchell

In 2015, the American Urological Association published the Consensus Statement on Advanced Practice Providers (APPs) with the goal of providing up-to-date information on the training of APPs, the scope of practice legislation, and examples of APPs in urologic practices.1 This statement was co-written by an experienced team of physicians and APPs whose purpose was to provide a unique and collaborative perspective on urology APPs. The paper was inspired by a report from an American Urological Association ad hoc committee assembled in 2008, which concluded that there were substantial workforce shortages in urology and that physician assistants and advanced practice registered nurses would provide the “best solution” for the declining urology workforce.2 In 2009, reports estimated that there were 3.1 urologists per 100 000 people in the United States and that urology was the second-oldest surgical subspecialty, with a workforce median age of 52.5 years.2 A published update in 2021, which used data from 2018, revealed that there were 3.89 urologists per 100 000 people in the United States, with 65% of urologists reporting that they were “interested” in the integration and use of APPs; 72.5% of urologists reported already incorporating an APP into their practice, accounting for nearly 41% of a physician (ie, MD or DO) full-time equivalent.2 More recent data showed the use of APPs was lowest in practices with the youngest and oldest subgroups of urologists and was highest in urban urology practices, which represent groups most likely to be affected initially due to the disproportionate geographical urology patient population density.

Physician assistantsnurse practitionershealth workforce

Health-related quality of lifeView Articles