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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

LaserView Articles
Laser ablationView Articles

Volume 9, Number 3Meeting Reviews

Best of the 2007 AUA Annual Meeting

Meeting Review

Dean G AssimosDanil V MakarovEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K Brawer

Highlights from the 2007 Annual Meeting of the American Urological Association May 19-24, 2007 Anaheim, CA [Rev Urol. 2007;9(3):133-154]

Prostate cancerObesityBenign prostatic hyperplasiaAntibiotic prophylaxisNocturiaLower urinary tract symptomsBotulinum toxinProstate-specific antigenBiomarkersPCA3TestosteroneUrinary tract infectionsUrolithiasisLaser ablationEndourologyMale voiding dysfunctionLHRH antagonistsAntimuscarinic agentsCircumcisionRepeat biopsyHuman glandularkallikreinExpectant managementCRISP-3MSPMicrovesseldensityEndoglinSurvivinTelomeresInterleukin-8PDE-5 inhibitorsAcute urinaryretention5Alpha-reductase inhibitorsDoxazosinFinasterideTransurethral microwave thermotherapyTURPPerioperative blood lossMicrobialbiofilmsHIVStem cell injection

Laser prostatec-tomyView Articles

Volume 8, Supplement 3Review Articles

Safety and Efficacy of the Potassium-Titanyl-Phosphate Laser and Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia

Photoselective Vaporization of the Prostate

Claus G Roehrborn

The currently commercially available 80-W potassium-titanyl-phosphate laser used for photoselective vaporization of the prostate in men with lower urinary tract symptoms and benign prostatic hyperplasia (BPH) is a safe and effective therapeutic alternative for a wide spectrum of prostate sizes and configurations. Efficacy data from multicenter prospective studies, comparative studies against other interventions, and single-center long-term outcomes suggest the efficacy to be at least equivalent to that of transurethral resection of the prostate, with a very good safety profile. New technological developments promise to further enhance the utility of this laser for application in BPH and urology. [Rev Urol. 2006;8(suppl 3):S16-S23]

Benign prostatic hyperplasiaLower urinary tract symptomsPotassium-titanyl-phosphate laserLaser prostatec-tomyPhotoselective vaporization of the prostate

Laser prostatectomyView Articles

Volume 8, Supplement 3Review Articles

The Next Generation In Laser Treatments and the Role of the GreenLight High-Performance System Laser

Photoselective Vaporization of the Prostate

Alexis E Te

Lasers have evolved over the past decade, with technical refinements that have resulted in a procedure that can achieve transurethral-like results in a safe and efficacious manner. The physics and characteristics of the laser light, such as wavelength and power densities, influence efficiency of treatment and safety profiles of various laser techniques and systems. The currently commercially available 80-W potassium-titanyl-phosphate laser used for photoselective vaporization of the prostate gland in men with lower urinary tract symptoms and benign prostatic hyperplasia has been shown to be a safe and effective therapeutic alternative for a wide spectrum of prostate sizes and configurations. Refinements based on clinical experience as well as progress in available technologies have produced an advanced system with improvements in beam quality and an increase in power to provide an increase in vaporization efficiency and flexibility in technique. The refinements require adjustments to current technique. The advanced technological developments enhance the utility of this laser for application in benign prostatic hyperplasia and urology. [Rev Urol. 2006;8(suppl 3):S24-S30]

Benign prostatic hyperplasiaLower urinary tract symptomsLaser prostatectomyPotassium-titanyl-phosphate laserTransurethral resection of the prostate

Laser surgeryView Articles
Laser therapyView Articles
LeiomyomaView Articles
LeiomyosarcomaView Articles
LemonadeView 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

LeptinView Articles
LeukemiaView 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

LeukocyteView Articles
LeuprolideView Articles
Leuprolide acetateView Articles

Volume 20, Number 2Original Research

Effectiveness of Subcutaneously Administered Leuprolide Acetate to Achieve Low Nadir Testosterone in Prostate Cancer Patients

Scott EggenerChristopher M PieczonkaJason HafronJoseph Renzulli IIPrzemyslaw TwardowskimDeborah M Boldt-HouleStuart Atkinson

Evidence suggests lower nadir testosterone levels during the first year of androgen deprivation therapy improve advanced prostate cancer clinical outcomes. We evaluated pivotal trials for subcutaneously administered leuprolide acetate (1-, 3-, 4-, and 6-month doses) to determine nadir testosterone levels. Pooled analysis showed 99%, 97%, and 91% of patients reached nadir testosterone ≤20, ≤10, and ≤5 ng/dL respectively (median ≤3 ng/dL). Across all available categories, ≥88% of patients reached nadir testosterone ≤5 ng/dL, and <3% experienced a microsurge. Achievement and maintenance of low nadir testosterone levels may improve progression-free survival and time to onset of castrate-resistant prostate cancer. [Rev Urol. 2018;20(2):63–68 doi: 10.3909/riu0798] © 2018 MedReviews®, LLC

Prostate cancerAndrogen deprivation therapyLHRH agonistsLeuprolide acetateNadir testosterone

Leydig cell hyperplasiaView Articles

Volume 10, Number 2Case Review

Leydig Cell Hyperplasia Revealed by Gynecomastia

Case Review

Mohamed Jamal El FassiMoulay Hassan FarihMohamed Fadl TaziSoufiane Mellas

Leydig cell tumors are rare and represent 1% to 3% of all tumors of the testis. Leydig cell tumors affect males at any age, but there are 2 peak periods of incidence: between 5 and 10 years and between 25 and 35 years. Their main clinical presentation is a testicular mass associated with endocrinal manifestations that are variable according to age and appearance of the tumor. Our patient, a 17-year-old adolescent, presented with an isolated and painless hypertrophy of the right mammary gland. Clinical examination found gynecomastia and no testicular mass. Hormonal levels and tumor markers were normal. Testicular sonography showed an ovular and homogeneous right intratesticular mass 6 mm in diameter. We treated the patient with an inguinal right orchidectomy. The anatomopathological study found a nodule of Leydig cell hyperplasia. The patient recovered without recurrence at 8-month follow-up. The patient opted for mammoplasty 2 months after his orchidectomy rather than wait for the spontaneous gradual regression of his gynecomastia, which requires at least 1 year. Leydig cell hyperplasia manifests in the adult by signs of hypogonadism, most frequently gynecomastia. Although many teams prefer total orchidectomy because of the diagnostic difficulty associated with malignant forms, simple subcapsular orchidectomy should become the first-line treatment, provided it be subsequently followed by close surveillance, as it preserves maximum fertility, and these tumors usually resolve favorably. [Rev Urol. 2008:10(2):164-167]

FertilityTesticular tumorLeydig cell hyperplasiaNonseminomatous germ celltumorsGynecomastia

LH-RH antagonistsView Articles

Volume 8, Number 4Review Articles

The Role of Gonadotropin- Releasing Hormone Antagonists for the Treatment of Benign Prostatic Hyperplasia

Treatment Update

Herbert Lepor

Medical therapy is the preferred first-line approach in the management of lower urinary tract symptoms in men with benign prostatic hyperplasia. The magnitude of the improvement in lower urinary tract symptoms observed in response to combination therapy (-blocker plus 5- reductase inhibitors) does not approach that achieved with prostatectomy. Various drugs have been under consideration, including BXL628, lonidamine, and phosphodiesterase inhibitors, all of which have had unacceptable side effects. The gonadotropinreleasing hormone antagonist cetrorelix is associated with dose-dependent symptom improvement and reduction of prostate volume. Elucidating the mechanism for cetrorelix-mediated improvement in lower urinary tract symptoms will likely contribute to unraveling the pathophysiology of lower urinary tract symptoms in men. [Rev Urol. 2006;8(4):183-189]

Benign prostatic hyperplasiaBlockers5-reductase inhibitorsLH-RH antagonistsCetrorelix

LHRH agonistsView Articles
LHRH analoguesView Articles

Volume 11, Number 2Review Articles

Effective Testosterone Suppression for Prostate Cancer: Is There a Best Castration Therapy?

Management Update

Leonard G Gomella

Achieving and maintaining effective suppression of serum testosterone levels in men treated with androgen ablation is one of the essential strategies in the management of prostate cancer. Historically, a serum testosterone below 50 ng/dL was considered to be the castrate level. Current data suggest that the new target for either surgical or chemical castration is a serum testosterone level of lower than 20 ng/dL in an attempt to maximize therapeutic outcomes. Testosterone breakthrough and the acute-on-chronic effects of administration of a luteinizing hormone-releasing hormone analogue may cause testosterone levels to periodically rise, sometimes to noncastrate levels. The goal of androgen ablation is to identify those agents that will most consistently achieve and maintain the lowest testosterone levels possible.[Rev Urol. 2009;11(2):52-60]

Prostate cancerAndrogen ablationLHRH analoguesLHRH antagonists

LHRH antagonistsView Articles

Volume 9, Number 3Meeting Reviews

Best of the 2007 AUA Annual Meeting

Meeting Review

Dean G AssimosDanil V MakarovEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K Brawer

Highlights from the 2007 Annual Meeting of the American Urological Association May 19-24, 2007 Anaheim, CA [Rev Urol. 2007;9(3):133-154]

Prostate cancerObesityBenign prostatic hyperplasiaAntibiotic prophylaxisNocturiaLower urinary tract symptomsBotulinum toxinProstate-specific antigenBiomarkersPCA3TestosteroneUrinary tract infectionsUrolithiasisLaser ablationEndourologyMale voiding dysfunctionLHRH antagonistsAntimuscarinic agentsCircumcisionRepeat biopsyHuman glandularkallikreinExpectant managementCRISP-3MSPMicrovesseldensityEndoglinSurvivinTelomeresInterleukin-8PDE-5 inhibitorsAcute urinaryretention5Alpha-reductase inhibitorsDoxazosinFinasterideTransurethral microwave thermotherapyTURPPerioperative blood lossMicrobialbiofilmsHIVStem cell injection

Lithium triborate laserView Articles

Volume 15, Number 1Review Articles

Laser Prostatectomy: Holmium Laser Enucleation and Photoselective Laser Vaporization of the Prostate

Treatment Update

Yakup BostanciAmir KazzaziBob Djavan

Historically, transurethral resection of the prostate has been the gold standard for the treatment of benign prostatic hyperplasia (BPH). Laser technology has been used to treat BPH for ? 15 years. Over the past decade, it has gained wide acceptance by experienced urologists. This review provides an evidence-based update on laser surgery for BPH with a focus on photoselective laser vaporization and holmium laser enucleation of the prostate surgeries and assesses the safety, efficacy, and durability of these techniques. [Rev Urol. 2013;15(1):1-10 doi: 10.3909/riu0553] © 2013 MedReviews®, LLC

Benign prostatic hyperplasiaLaser prostatectomyLithium triborate laserPotassium-titanyl-phosphate laser

Lithium triboride laserView Articles

Volume 10, Number 2Meeting Reviews

Best of the 2008 AUA Annual Meeting

Meeting Review

Dean G AssimosDanil V MakarovAlan W PartinMichael B ChancellorJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraShing-Hwa Lu

Highlights from the 2008 Annual Meeting of the American Urological Association, May 17-22, 2008, Orlando, FL [Rev Urol. 2008;10(2):136-156]

Focal therapyProstate-specific antigenShock wave lithotripsyTumor markersOveractive bladder syndromeBlockersEarly prostate cancer antigenTMPRSS2-ERGCryotherapyUltrasound-estimated bladder weightElocalcitolLithium triboride laserStone formation

LithotripsyView Articles
Local anesthesiaView Articles
Local/surgeryView 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

Localized diseaseView Articles

Volume 8, Supplement 2Review Articles

Treatment of Localized Prostate Cancer

16th International Prostate Cancer Update

E David CrawfordBulent Akduman

This article provides an overview of treatment of localized prostate cancer, which was discussed in detail in the second scientific session of the 16th International Prostate Cancer Update. The role of radical prostatectomy in localized disease was presented by Bob Djavan, MD. Benefits and risks of radical prostatectomy were addressed by Gerald Chodak, MD. Robert E. Donohue, MD, presented the role of radical prostatectomy in Gleason grade 8, 9, and 10 tumors. Impact of positive margins on outcomes after radical prostatectomy was presented by James A. Eastham, MD. E. David Crawford, MD, provided an overview of the role of targeted therapy. Indications and results of brachytherapy were presented by Mack Roach, III, MD. Finally, Michael J. Manyak, MD, described the evolution of radioimmunoscintigraphy and clinical outcomes data. [Rev Urol. 2006;8(suppl 2):S15-S21]

Prostate cancerRadical prostatectomyTargeted therapyCryotherapyBrachytherapyLocalized disease

Localized prostate cancerView Articles
Locally advanced prostate cancerView Articles