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Volume 8, Number 3Review Articles

The Importance of Pelvic Lymph Node Dissection in Men With Clinically Localized Prostate Cancer

Diagnostic Review

Alan W PartinH Ballentine CarterMohamad E Allaf

Despite advances in noninvasive staging, pelvic lymph node dissection (PLND) remains the most accurate means of detecting lymph node metastases in men with clinically localized prostate cancer. Nomograms exist that can identify patients at low risk for lymphatic metastases according to preoperative information. In general, it seems reasonable to omit PLND in men with a biopsy Gleason sum of 6 or less and a prostate-specific antigen level of 10 ng/mL or less. Ultimately, however, this decision should be made according to physician and patient preference, considering the low contemporary morbidity associated with PLND. When PLND is performed, studies suggest that an extended dissection maximizes the detection rate of nodal involvement. Retrospective data indicate that an extended dissection might play a therapeutic role in a subset of patients with a limited lymph node burden. However, this might be an artifact of stage migration, and prospective studies are needed to evaluate this further. [Rev Urol. 2006;8(3):112-119]

Prostate cancerNomogramsRadioimmunoscintigraphyLymphadenectomyClinical stagingMagnetic resonanceimagingAlgorithms

Alkali citrateView Articles

Volume 11, Number 3Review Articles

Hypocitraturia: Pathophysiology and Medical Management

Management Review

Dean G AssimosJack M Zuckerman

Low urinary citrate excretion is a known risk factor for the development ofkidney stones. Citrate inhibits stone formation by complexing with calciumin the urine, inhibiting spontaneous nucleation, and preventing growth andagglomeration of crystals. Hypocitraturia is a common metabolic abnormalityfound in 20% to 60% of stone formers. It is most commonly idiopathic inorigin but may be caused by distal renal tubular acidosis, hypokalemia, boweldysfunction, and a high-protein, low-alkali diet. Genetic factors, medications,and other comorbid disorders also play a role. Hypocitraturia should be managedthrough a combination of dietary modifications, oral alkali, and possiblylemonade or other citrus juice–based therapy. This review concerns thepathophysiology of hypocitraturia and the management of stone formersafflicted with this abnormality.[Rev Urol. 2009;11(3):134-144 doi:10.3909/riu0424]© 2009 MedReviews®, LLC

HypocitraturiaCitrate metabolismCitrate pathophysiologyHypocitraturia etiologiesMedical management of stone diseaseAlkali citratePotassium citrateCitrus juiceLemonade

Alpha blockadeView Articles
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Volume 10, Number 1Review Articles

Current Medical Therapies for Men With Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia: Achievements and Limitations

Treatment Update

Claus G Roehrborn

Over the last 20 years, our understanding of the pathophysiology and symptomatology of men with lower urinary tract symptoms (LUTS) has become increasingly more sophisticated. With this increase in sophistication, our utilization of various medical therapies, either alone or in combination, has also increased the understanding of the roles of individual medications, combinations of medications, and the benefits of different types of intervention. The rapid decline of the use of transurethral resection of the prostate (TURP) and other surgical procedures for benign prostatic hyperplasia (BPH) in the 1990s is due in part to the introduction of medical therapy. This article reviews the current state of medical therapy for men with LUTS and highlights its promises and its current limitations. [Rev Urol. 2008;10(1):14-25]

Benign prostatic hyperplasiaMedical therapy5-Alpha-reductase inhibitorsLower urinary tract symptomsAlpha-adrenergic receptor blockers

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Volume 21, Number 4Review Articles

Long-term Consequences of Medical Therapy for Benign Prostatic Hyperplasia

Management Update

Eric M BortnickVannita Simma-ChiangSteven A Kaplan

Benign prostatic hyperplasia (BPH) is a common disease in men. Although transurethral resection of the prostate (TURP) is the gold standard therapy for treatment of BPH and associated lower urinary tract symptoms (LUTS), many patients choose to avoid surgery and instead choose medical therapy. Until recently, medical therapy for BPH has been thought to be both safe and effective. However, new studies have shown that some of these medications can have significant neurocognitive, psychiatric, and sexual side effects, including dementia and depression. As most patients taking these medications will continue them for the long term, it is vital for physicians to explain these potential risks to the patient prior to prescribing them for a quality-of-life condition. [Rev Urol. 2019;21(4):154–157] © 2020 MedReviews®, LLC

Benign prostatic hyperplasiaMedical therapyDepressionDementia5-Alpha-reductase inhibitorsalpha-blockers

Alpha-methylacyl-CoA racemaseView Articles

Volume 9, Number 4Review Articles

Newer Potential Biomarkers in Prostate Cancer

Diagnostic Update

Paul H LangeJonathan L Wright

Prostate-specific antigen (PSA) screening has led to a significant rise in the number of men diagnosed with prostate cancer and an associated increase in biopsies performed. Despite its limitations, including a positive predictive value of only 25%-40%, PSA remains the only generally accepted biomarker for prostate cancer. There is a need for better tools to not only identify men with prostate cancer, but also to recognize those with potentially lethal disease who will benefit from intervention. A great deal of work has been done worldwide to improve our knowledge of the genetics behind prostate cancer and the specificity of PSA by developing assays for different PSA isoforms. Common genetic alterations in prostate cancer patients have been identified, including CpG hypermethylation of GSPT1 and TMPRSS2:ERG gene fusion. Serum and urine detection of RNA biomarkers (eg, PCA3) and prostate cancer tissue protein antibodies (eg, EPCA) are being evaluated for detection and prognostic tools. This article reviews some of the promising developments in biomarkers. [Rev Urol. 2007;9(4):207-213]

Prostate-specific antigenPCA3Alpha-methylacyl-CoA racemaseAutoantibody arraysEpigenetic markersGene fusion proteinsHuman kallikreinsPSA isoformsRNA biomarkers

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AlprostadilView Articles

Volume 9, Number 3Review Articles

Oral and Non-Oral Combination Therapy for Erectile Dysfunction

Treatment Update

An estimated 30 million men in the United States suffer from varying degrees of erectile dysfunction. Increasing age and comorbidities are likely to increase the number of men who are initially refractory or become refractory to phosphodiesterase (PDE)-5 inhibitors, the most popular oral therapy. Combination therapy, a concept well proved in other areas of medicine, is therefore of increasing importance. Combination oral and non-oral (intracavernosal injection and intraurethral application) therapies have been shown to salvage monotherapy. The early introduction of combination therapy has been shown to expedite both the return of natural function and PDE-5 inhibitor responsiveness in post-prostatectomy patients with no reports of serious adverse events. Larger controlled studies are needed to corroborate those encouraging findings. [Rev Urol. 2007;9(3):99-105]

Erectile dysfunctionPhosphodiesterase inhibitorsIntracavernosal injectionIntraurethral applicationAlprostadil

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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

American Urological AssociationView Articles
American Urological Association symptom scoreView Articles
AmericanUrological Association Symptom IndexView Articles
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Ancient schwannomaView Articles

Volume 17, Number 2Case Review

Juxta-adrenal Ancient Schwannoma: A Rare Retroperitoneal Tumor

William C HuangGanesh SivarajanDaniel A WollinPratibha ShuklaJonathan Melamed

Retroperitoneal schwannoma is a rare tumor that is often misdiagnosed as malignancy due to a concerning appearance on cross-sectional imaging. Pathology and immunohistochemistry form the gold standard for diagnosis; as such, local excision is the treatment of choice for this disease. We present two cases of juxta-adrenal ancient schwannoma that were treated with adrenalectomy and discuss the current literature regarding this entity. [Rev Urol. 2015;17(2):97-101 doi: 10.3909/riu0669] © 2015 MedReviews®, LLC

Ancient schwannomaAdrenal tumorAdrenalectomy

AndrogenView Articles
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Volume 8, Number 3Meeting Reviews

Best of the 2006 AUA Annual Meeting

Meeting Review

Danil V MakarovEllen ShapiroAlan W PartinMichael B ChancellorVictor W NittiJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerArie S BelldegrunJohn P SteinJohn P MulhallTobias KlatteMichael E AldridgeLi-Ming SuShachi Tyagi

Highlights from the 2006 Annual Meeting of the American Urological Association May 20–25, 2006 Atlanta, GA

Prostate cancerInfertilityBenign prostatic hyperplasiaBladder cancerKidney cancerLower urinary tract symptomsBladder exstrophyOveractive bladderInterstitial cystitisStress urinary incontinencePeyronie’s diseaseSpina bifidaNeurogenic bladderErectile dysfunctionChronic pelvic pain syndromeChronic prostatitisTumor markersAndrogen replacement therapyEjaculatory dysfunctionAnorectal malformationsRenal stonesRobotic-assisted radical prostatectomy

Androgen suppressionView Articles