Tags - Reviews in Urology

Omental wrapView Articles

Retroperitoneal fibrosis (RPF) is a rare disorder of unclear etiology characterized by chronic inflammation of the retroperitoneum, which can involve any of the retroperitoneal structures, most notably the ureters, aorta, and vena cava. Historically, open biopsy, ureterolysis, and transpositioning or omental wrapping of the involved ureter(s) have been the preferred surgical treatments of RPF, with success rates greater than 90%. More recently, successful laparoscopic biopsy, ureterolysis, and ureteral omental wrapping and intraperitonealization have been described. We report the first case in the literature of idiopathic RPF managed with robotic ureterolysis and laparoscopic omental ureteral wrapping. [Rev Urol. 2006;8(4):226-230]

Retroperitoneal fibrosis Robotic ureterolysis Omental wrap

OnabotulinumtoxinAView Articles

Volume 18, Number 3 Meeting Reviews

Highlights From the 2016 American Urological Association Annual Meeting

Benjamin M Brucker Dean G Assimos Ellen Shapiro Alan W Partin Michael B Chancellor Stacy Loeb J Curtis Nickel Michael A Gorin Michael K Brawer

More than 2000 posters, abstracts, and videos were presented at the 2016 American Urological Association (AUA) Annual Meeting, held in San Diego, CA, from May 6 to 10, 2016. The editors of Reviews in Urology have culled an enormous volume of information from this premier source and present the findings that are most relevant to the practicing urologist. [Rev Urol. 2016;18(3):159-173 doi:10.3909/riu0717] © 2016 MedReviews®, LLC

Prostate cancer Active surveillance Disorders of sexual development Nephrolithiasis Overactive bladder Microbiome OnabotulinumtoxinA Hemorrhagic cystitis Inflammation Four kallikrein assay Genomic prostate score

OncocytomaView Articles

Volume 16, Number 3 Review Articles

Role of Chemokines in Renal Cell Carcinoma

Systematic Review

Jaspreet S Parihar Hari Siva Gurunadha Rao Tunuguntla

With new frontiers of pharmaceutical therapies focusing on tumor growth and angiogenesis, understanding the interaction between immune system and tumor microenvironment has become ever more important. Chemokines and chemokine receptors appear to play an integral role in tumor characteristics. Evidence suggests CXCR4, CXCL5, CXCR7, and stromal derived factor-1 appear to be crucial in survival, growth, and metastasis of renal cell carcinoma. As the role of chemokines in renal cancer is becoming more evident, further research will lead to a better understanding of tumor biology and the development of new therapeutic targets to help improve survival. [Rev Urol. 2014;16(3):118-121 doi: 10.3909/riu0608] © 2014 MedReviews®, LLC

Renal cell carcinoma Cytokines Chemokine Oncocytoma

OncogenesView Articles

Volume 3, Number 4 Review Articles

Prostate Cancer Gene Therapy--What Have We Learned and Where Are We Going?

Treatment Update

Bob Djavan Yasutomo Nasu

Prostate cancer Gene therapy Immunomodulatory genes Suicide genes Viral vectors Oncogenes

Oncologic outcomesView Articles

Volume 16, Number 1 Review Articles

Nephron-sparing Management of Upper Tract Urothelial Carcinoma

Management Review

Tommaso Brancato Francesca Suriano

Upper tract urothelial carcinoma (UTUC) is a relatively rare tumor, but is characterized by high rates of recurrence, morbidity, and mortality. Choice of treatment modality is generally influenced by lesion size, grade, and focality. Radical nephroureterectomy with bladder cuff excision is the gold-standard management of UTUC, although an organ-sparing approach may be beneficial in selected patients. Conservative endoscopic management of UTUC in appropriate patients has a favorable impact on quality of life and health care costs when compared with patients who progress to dialysis-dependent renal failure. Careful ureteroscopic surveillance following endoscopic management of UTUC is essential. [Rev Urol. 2014;16(1):21-28 doi: 10.3909/riu0592] © 2014 MedReviews®, LLC

Upper tract urothelial carcinoma Tumor grade Nephron-sparing endoscopic treatment Topical adjuvant chemo-immunotherapy Oncologic outcomes

OncologyView Articles

Oncolytic virusView Articles

Volume 7, Number 4 Review Articles

Adenoviral Gene Therapy, Radiation, and Prostate Cancer

Therapeutic Challenges

Shawn E Lupold Ronald Rodriguez

Prostate cancer Gene therapy Radiation therapy Adenovirus Suicidegene therapy Oncolytic virus Conditionally replicating adenovirus (CRAD)

Oncotype DX® GPSView Articles

Volume 18, Number 3 Original Research

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

Michael J Kemeter Phillip G Febbo David Albala Ruixiao Lu Vincy John Dylan Stoy Bela Denes Marybeth McCall Alan W Shindel Frank 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 cancer Oncotype DX® GPS Genomic testing Health economics Clinical utility

Oocyte cryopreservationView Articles

Volume 17, Number 4 Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Malgorzata E Skaznik-Wikiel Sara Babcock Gilbert Randall B Meacham Laxmi A Kondapalli

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservation Childhood cancer Sperm cryopreservation Testicular tissue cryopreservation Spermatogonial stem cell cryopreservation Embryo cryopreservation Oocyte cryopreservation Ovarian tissue cryopreservation

open nephroureterectomyView Articles

Volume 19, Number 1 Review Articles

Systematic Review of Open Versus Laparoscopic Versus Robot-assisted Nephroureterectomy

Systematic Review

Kamran Ahmed Emma Mullen Ben Challacombe

Upper tract urothelial carcinoma is a relatively uncommon malignancy. The gold standard treatment for this type of neoplasm is an open radical nephroureterectomy with excision of the bladder cuff. This systematic review compares the perioperative and oncologic outcomes for the open surgical method with the alternative surgical management options of laparoscopic nephroureterectomy and robot-assisted nephroureterectomy (RANU). MEDLINE, EMBASE, PubMed, and Cochrane Library databases were searched using a sensitive search strategy. Article inclusion was then assessed by review of abstracts and full papers were read if more detail was required. In all, 50 eligible studies were identified that looked at perioperative and oncologic outcomes. The range for estimated blood loss when examining observational studies was 296 to 696 mL for open nephroureterectomy (ONU), 130 to 479 mL for laparoscopic nephroureterectomy (LNU), and 50 to 248 mL for RANU. The one randomized controlled trial identified reported estimated blood loss and length of stay results in which LNU was shown to be superior to ONU (P < .001). No statistical significance was found, however, following adjustment for confounding variables. Although statistically insignificant results were found when examining outcomes of RANU studies, they were promising and comparable with LNU and ONU with regard to oncologic outcomes. Results show that laparoscopic techniques are superior to ONU in perioperative results, and the longer-term oncologic outcomes look comparable. There is, however, a paucity of quality evidence regarding ONU, LNU, and RANU; data that address RANU outcomes are particularly scarce. As the robotic field within urology advances, it is hoped that this technique will be investigated further using gold standard research methods. [Rev Urol. 2017;19(1):32-43 doi: 10.3909/riu0691] © 2017 MedReviews®, LLC

Urothelial carcinoma Robot-assisted nephroureterectomy open nephroureterectomy Laparoscopic nephroureterectomy

Open radical nephrectomyView Articles

Volume 14, Number 1 Review Articles

LHRH Agonists for the Treatment of Prostate Cancer: 2012

Management Review

Neal D Shore Herbert Lepor

The most recent guidelines on prostate cancer screening from the American Urological Association (2009), the National Comprehensive Cancer Network (2011), and the European Association of Urology (2011), as well as treatment and advances in disease monitoring, have increased the androgen deprivation therapy (ADT) population and the duration of ADT usage as the first-line treatment for metastatic prostate cancer. According to the European Association of Urology, gonadotropin-releasing hormone (GnRH) agonists have become the leading therapeutic option for ADT because they avoid the physical and psychological discomforts associated with orchiectomy. However, GnRH agonists display several shortcomings, including testosterone (T) surge (“clinical flare”) and microsurges. T surge delays the intended serologic endpoint of T suppression and may exacerbate clinical symptoms. Furthermore, ADT manifests an adverse-event spectrum that can impact quality of life with its attendant well-documented morbidities. Strategies to improve ADT tolerability include a holistic management approach, improved diet and exercise, and more specific monitoring to detect and prevent T depletion toxicities. Intermittent ADT, which allows hormonal recovery between treatment periods, has become increasingly utilized as a methodology for improving quality of life while not diminishing chronic ADT efficacy, and may also provide healthcare cost savings. This review assesses the present and potential future role of GnRH agonists in prostate cancer and explores strategies to minimize the adverse-event profile for patients receiving ADT. [ Rev Urol. 2012;14(1/2):1-12 doi:10.3909/riu0547 ] © 2012 MedReviews®, LLC

Wilms’ tumor Renal mass Open radical nephrectomy Multimodal therapy

Open radical retropubic prostatectomyView Articles

Volume 11, Number 2 Review Articles

Status of Radical Prostatectomy in 2009: Is There Medical Evidence to Justify the Robotic Approach?

Treatment Review

Herbert Lepor

This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1- to 2-day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.[Rev Urol. 2009;11(2):61-70]

Prostate cancer Robotic-assisted Open radical retropubic prostatectomy

Open surgeryView Articles

Volume 22, Number 1 Review Articles

Obesity and Kidney Stone Procedures

Management Review

Dean G Assimos Kyle Wood William Poore Carter J Boyd Nikhi P Singh

Obesity is a chronic disease that has increased in prevalence in the United States and is a risk factor for the development of nephrolithiasis. As with other medical conditions, obesity should be considered when optimizing surgical management and choosing kidney stone procedures for patients. In this review, we outline the various procedures available for treating stone disease and discuss any discrepancies in outcomes or complications for the obese cohort. [Rev Urol. 2020;22(1):24–29] © 2020 MedReviews®, LLC

Percutaneous nephrolithotomy Shockwave lithotripsy Obesity Ureterorenoscopy Robotic surgery Kidney stones Laparoscopy Open surgery

Opioid utilization and kidney stonesView Articles

Oral medicationView Articles

Volume 13, Number 3 Review Articles

Peyronie’s Disease: Nonsurgical Therapy Options

Organizational efficiencyView Articles

Volume 22, Number 2 Review Articles

Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice

Original Research

Gary M Kirsh Stephen F Kappa Chris McClain Krista Wallace Paul Cinquina Don Lawson Mary M Smith Earl Walz Brooke Edwards

Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service. [Rev Urol. 2020;22(2):67–74] © 2020 MedReviews®, LLC

Cost effectiveness Call center Telehealth Organizational efficiency

Orthotopic neobladderView Articles

Volume 8, Number 2 Review Articles

Pathologic Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature

Therapeutic Challenges

John P Stein Vannita Simma-Chang Simon D Wu

Orthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder. [Rev Urol. 2006;8(2):54-60]

Cystectomy Orthotopic urinary diversion Orthotopic neobladder Female bladdercancer Urethrectomy Urethral recurrence

Orthotopic urinary diversionView Articles

Volume 8, Number 2 Review Articles

Pathologic Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the Literature

Therapeutic Challenges

John P Stein Vannita Simma-Chang Simon D Wu

Orthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder. [Rev Urol. 2006;8(2):54-60]

Cystectomy Orthotopic urinary diversion Orthotopic neobladder Female bladdercancer Urethrectomy Urethral recurrence

Osteitis pubisView Articles

Volume 19, Number 3 Review Articles

Osteitis Pubis: A Rare Cause of Suprapubic Pain

Diagnosis and Treatment Review

Patrick Mufarrij Patrick Gomella

Osteitis pubis is a noninfectious inflammatory condition affecting the pubic symphysis. First described in a series of patients undergoing urologic procedures, it is an uncommon cause of lower abdominal and suprapubic pain. However, this condition can cause significant morbidity in patients affected, often requiring lengthy recovery periods. Given its rarity, the diagnosis and management is challenging, as many urologists are unfamiliar with the condition and may ascribe the constellation of symptoms as expected side effects from a recent surgical procedure. This review describes the urologic considerations for osteitis pubis, its potential etiologies, and clinical findings, and identifies treatment strategies for this potentially debilitating condition. [Rev Urol. 2017;19(3):156–163 doi: 10.3909/riu0767] © 2017 MedReviews®, LLC

Postoperative pain Osteitis pubis Suprapubic pain

OsteopeniaView Articles

Volume 11, Number 4 Review Articles

The Impact of Prostate Cancer and Hormonal Therapy on Bone

Management Review

Gerald L Andriole

Large-scale studies agree that the observed decline in prostate cancer mortality that began in the early 1990s, shortly after prostate-specific antigen testing was introduced in the United States, is most likely explained by more widespread treatment of prostate cancer, including hormonal therapy. Practitioners should be aware of the risk of the development of osteoporosis and of skeletal side effects related to hormonal therapy to optimize the care of men with prostate cancer.[Rev Urol. 2009;11(4):185-189 doi: 10.3909/riu0469]© 2009 MedReviews®, LLC

Androgen deprivation therapy Hormone deprivation therapy Bonedestruction Osteoporosis Osteopenia

OsteoporosisView Articles

Volume 5, Supplement 1 Supplement

New Advances in the Treatment of Hypogonadism in the Aging Male

Christopher P Steidle

Testosterone replacement therapy Hypogonadism Erectile dysfunction Osteoporosis Andropause syndrome

Osteoporosis fractureView Articles

Volume 9, Number 4 Review Articles

Estrogenic Side Effects of Androgen Deprivation Therapy

Treatment Update

Michael S Cookson James A Eastham Theresa A Guise Michael G Oefelein Matthew R Smith Celestia 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 therapy Cardiovascular disease Gynecomastia Osteoporosis fracture Male hot flashes

OutcomesView Articles

Volume 5, Supplement 6 Supplement

Optimizing Outcomes of Oral Therapy for Patients with Erectile Dysfunction

James H Barada

Erectile dysfunction Outcomes Phosphodiesterase-5 inhibitors

Outcomes measuresView Articles

Volume 2, Number 3 Review Articles

Selecting Candidates for Radical Prostatectomy

Therapeutic Challenges

Herbert Lepor

Prostate-specific antigen Cancer, prostate Prostatectomy, radical Neoplasm metastasis Outcomes measures

Ovarian tissue cryopreservationView Articles

Volume 17, Number 4 Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Malgorzata E Skaznik-Wikiel Sara Babcock Gilbert Randall B Meacham Laxmi A Kondapalli

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservation Childhood cancer Sperm cryopreservation Testicular tissue cryopreservation Spermatogonial stem cell cryopreservation Embryo cryopreservation Oocyte cryopreservation Ovarian tissue cryopreservation

Overactive bladderView Articles

Volume 1, Number 3 Meeting Reviews

Mapping the Future for Incontinence Treatment Worldwide

First International Consultation on Incontinence

Michael B Chancellor

Urethra Overactive bladder Urinary incontinence Bladder World Health Organization

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