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AldosteronismView Articles
Alexander techniqueView Articles
AlfuzosinView Articles

Volume 5, Number 2Meeting Reviews

Advances in the Medical Treatment of Prostate Cancer, Bladder Cancer, Renal Cell Cancer, and Benign Prostatic Hyperplasia

Highlights from the XVIIth Congress of the European Association of Urology, Birmingham, UK

Claus G RoehrbornBob DjavanMesut RemziChristian Seitz

Prostate cancerBenign prostatic hyperplasiaBladder cancerLower urinary tract symptomsProstate-specific antigenRadical prostatectomyRadical nephrectomyNomogramsTamsulosinAlfuzosinFinasterideDutasterideBicalutamideBacille Calmette-GuerinPermixonRenal cell cancerTransrectal ultrasound-guided biopsyVirtual cystoscopy

AlgorithmsView Articles

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
Alpha-adrenergic receptor blockersView Articles

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

Alpha-adrenergic-receptor antagonistView Articles
Alpha-adrenore-View Articles
alpha-blockersView Articles

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

Alpha-methylacyl-CoAracemaseView Articles
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

Alternative medicineView Articles
Alternative treatmentsView Articles
ambulatory careView Articles

Volume 23, Number 4Business of Urology

Outpatient Urological Surgery: Outcomes and Cost by Site of Service in Community Practice

Robert A. DowlingJinghan ZhangSong ZhangEvan R GoldfischerDavid M. Albala

Urologic surgery is most commonly performed in 1 of 3 ambulatory settings—a physician office, a hospital outpatient setting, or an ambulatory surgery center—but differences in value among these settings are poorly understood. This study examines real-world practice patterns of community urologists and documents outcomes and costs for a set of common urologic procedures performed in outpatient settings.

Physician practice patternsAmbulatory surgical proceduresurologic diseasesambulatory care

Ambulatory care facilitiesView 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

Ambulatory surgical proceduresView Articles

Volume 23, Number 4Business of Urology

Outpatient Urological Surgery: Outcomes and Cost by Site of Service in Community Practice

Robert A. DowlingJinghan ZhangSong ZhangEvan R GoldfischerDavid M. Albala

Urologic surgery is most commonly performed in 1 of 3 ambulatory settings—a physician office, a hospital outpatient setting, or an ambulatory surgery center—but differences in value among these settings are poorly understood. This study examines real-world practice patterns of community urologists and documents outcomes and costs for a set of common urologic procedures performed in outpatient settings.

Physician practice patternsAmbulatory surgical proceduresurologic diseasesambulatory care

American Urological AssociationView Articles
American Urological Association symptom scoreView Articles
AmericanUrological Association Symptom IndexView Articles
AnalgesiaView Articles
Anastomotic strictureView Articles
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
Androgen ablationView Articles
Androgen antagonistsView Articles

Volume 23, Number 4Case Review

Exceptional Response to Radiation Therapy to the Primary Tumor in a Patient With de Novo Metastatic Prostate Cancer With High Tumor Mutation Burden

Benjamin MercierAndrew TamDaniela V. CastroSalvador Jaime-CasasAbhishek TripathiYun Rose LiRegina Barragan-Carrillo

We present the case of a patient diagnosed with de novo, low-volume metastatic prostate cancer who received first-line treatment with androgen-deprivation therapy in combination with darolutamide. The patient presented with symptoms derived from local growth from the primary tumor and received pelvic radiation therapy to the primary tumor and pelvic nodes. He experienced complete tumor regression, with high serum prostate-specific antigen declining to nondetectable levels. Next-generation genomic analysis indicated high tumor mutation burden and high microsatellite status instability. Here, we contextualize this patient’s case regarding the importance of precision genomics in radiation oncology and its potential importance for optimizing treatment.

Prostatic neoplasmsRadiation therapyNeoplasm metastasisAndrogen antagonistsprostate neoplasmcastration resistant

Androgen blockadeView Articles
Androgen deficiencyView Articles
Androgen deprivationView Articles