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Androgen-independent prostate cancerView Articles
Androgen-insensitiveView Articles
AndrogensView Articles
Androgens, syntheticView Articles
AndropauseView Articles
Andropause syndromeView Articles
AnejaculationView Articles

Volume 8, Supplement 4Review Articles

Current Concepts in Ejaculatory Dysfunction

Advances in Alpha-Blocker Therapy in the Management of Urological Disorders

Wayne JG HellstromJeffrey P Wolters

Although erectile dysfunction has recently become the most well-known aspect of male sexual dysfunction, the most prevalent male sexual disorders are ejaculatory dysfunctions. Ejaculatory disorders are divided into 4 categories: premature ejaculation (PE), delayed ejaculation, retrograde ejaculation, and anejaculation/anorgasmia. Pharmacologic treatment for certain ejaculatory disorders exists, for example the off-label use of selective serotonin reuptake inhibitors for PE. Unfortunately, the other ejaculatory disorders are less studied and not as well understood. This review revisits the physiology of the normal ejaculatory response, specifically explores the mechanisms of anejaculation, and presents emerging data. The neurophysiology of the ejaculatory reflex is complex, making classification of the role of individual neurotransmitters extremely difficult. However, recent research has elucidated more about the role of serotonin and dopamine at the central level in the physiology of both arousal and orgasm. Other recent studies that look at differing pharmacokinetic profiles and binding affinities of the 1-antagonists serve as an indication of the centrally mediated role of ejaculation and orgasm. As our understanding of the interaction between central and peripheral modulations and regulation of the process of ejaculation increases, the probability of developing centrally acting pharmaceutical agents for the treatment of sexual dysfunction approaches reality. [Rev Urol. 2006;8(suppl 4):S18-S25]

TamsulosinAlfuzosinRetrograde ejaculationAnejaculationEjaculatory disorders

AnemiaView Articles
AnesthesiaView Articles

Volume 10, Number 4Review Articles

Using Biopsy to Detect Prostate Cancer

Diagnostic Review

Claus G RoehrbornShahrokh F Shariat

Transrectal ultrasound-guided systemic biopsy is the recommended method in most cases with suspicion of prostate cancer. Transrectal periprostatic injection with a local anesthetic may be offered as effective analgesia; periprostatic nerve block with 1% or 2% lidocaine is the recommended form of pain control. On initial biopsy, a minimum of 10 systemic, laterally directed cores is recommended, with more cores in larger glands. Extended prostate biopsy schemes, which require cores weighted more laterally at the base (lateral horn) and medially to the apex, show better cancer detection rates without increasing adverse events. Transition zone biopsies are not recommended in the first set of biopsies, owing to low detection rates. One set of repeat biopsies is warranted in cases with persistent indication. Saturation biopsy (=20 cores) should be reserved for repeat biopsy in patients who have negative results on initial biopsy but who are still strongly suspected to have prostate cancer. [Rev Urol. 2008;10(4):262-280]

Prostate cancerBiopsyProstate-specific antigenTransrectal ultrasoundNomogramsAnesthesia

Anesthesia complicationsView Articles

Volume 15, Number 4Review Articles

Anesthetic Challenges in Robotic-assisted Urologic Surgery

Management Review

Richard L HsuAlan D KayeRichard D Urman

Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and limited access to the patient, all present anesthetic management challenges in urologic surgery. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce surgical and anesthetic complications. [Rev Urol. 2013;15(4):178-184 doi: 10.3909/riu0589] © 2014 MedReviews®, LLC

Robotic surgeryUrologic surgeryAnesthesia complicationsPneumoperitoneumPeripheral nerve injuryPatient positioning

Anesthetic considerationsView Articles

Volume 16, Number 1Review Articles

The Physiologic and Anesthetic Considerations in Elderly Patients Undergoing Robotic Renal Surgery

Management Review

Nikhil VasdevTim LaneDamian HanburyAnna Sau Kuk PoonGowrie MohanGregory BousteadJames M Adshead

A number of patients are diagnosed with renal malignancies incidentally worldwide. Once a diagnosis of a renal malignancy is established, after a careful evaluation, patients can be offered a robotic nephrectomy or partial nephrectomy. We present a review of the physiologic and anesthetic considerations in elderly patients who are being considered for robotic renal surgery. [Rev Urol. 2014;16(1):1-9 doi: 10.3909/riu0591] © 2014 MedReviews®, LLC

Robotic partial nephrectomyRobotic radical nephrectomyPhysiologic considerationsAnesthetic considerations

AngiogenesisView Articles
AngiogramView Articles

Volume 9, Number 3Case Review

Spontaneous Renal Artery Dissection

Case Review

Herbert LeporJamie A Kanofsky

Spontaneous renal artery dissection (SRAD) is a rare event, and thus may be a challenge for physicians to diagnose and treat. We report a case of SRAD in a healthy 56-year-old male who presented with flank pain, fever, and elevated white blood cell count. The patient was initially diagnosed with nephrolithiasis versus pyelonephritis and was admitted for observation. Multiple imaging modalities, including non-contrast computed tomography (CT), magnetic resonance imaging (MRI) with gadolinium, CT angiogram, and intraoperative angiogram, were used to make the final diagnosis of SRAD. The patient was treated with endovascular stent placement and is currently free of pain with normal laboratory values and blood pressure. [Rev Urol. 2007;9(3):156-160]

KidneyRenal arteryDissectionAngiogramEndovascular stenting

AngiographyView Articles
AngiomyolipomaView Articles

Volume 9, Number 2Reviews in Urology

Angiomyolipoma of the Left Ureterovesical Junction

Case Review

Elias S HyamsJohn Provet

Angiomyolipoma (AML) is a benign tumor that typically consists of 3 tissue elements: thick-walled blood vessels, smooth muscle cells, and adipocytes. The most common location for AML is renal; however, extrarenal AML has been described. Reports of extrarenal AML within the genitourinary tract are rare. We report a case of AML at the left ureterovesical junction and the evaluation and management decisions regarding this lesion. [Rev Urol. 2007;9(2):84-88]

AngiomyolipomaImmunohistochemical stainingUreterovesical junction

Anorectal malformationsView Articles

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

anteriorView Articles

Volume 21, Number 2Case Review

A Case of Squamous Cell Carcinoma of the Anterior Urethra in a Man

Navin ShahThomas HuebnerShannon Cherone

Squamous cell carcinoma (SCC) of the anterior urethra in men is rare, comprising less than 1% of all urologic cancers. The mean age at diagnosis is 60 years and it is nearly twice as common in black men compared with white men. We detail a case of SCC of the anterior urethra in a man presenting with an inguinal mass, meatal stenosis, and balanitis. [Rev Urol. 2019;21(2/3):133–135] © 2019 MedReviews®, LLC

UrethraSquamous cell carcinomaanteriorHPV p16

Anti-androgen monotherapyView Articles
Anti-incontinence surgeryView Articles

Volume 17, Number 1Review Articles

Expectations of Stress Urinary Incontinence Surgery in Patients With Mixed Urinary Incontinence

Management Update

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients’ expectations. [Rev Urol. 2015;17(1):14-19 doi: 10.3909/riu0646] © 2015 MedReviews®, LLC

UrodynamicsMixed urinary incontinenceSlingAnti-incontinence surgery

Anti-inflammatory therapyView Articles
AntiandrogensView Articles
Antiangiogenic therapyView Articles

Volume 9, Supplement 1Review Articles

Current Standard and Investigational Approaches to the Management of Hormone-Refractory Prostate Cancer

New Directions in the Management of Advanced Prostate Cancer

Andrew J ArmstrongDaniel J GeorgePrateek Mendiratta

Prostate cancer is a common cause of death in men and remains incurable in the metastatic setting. In 2004, 2 landmark trials using docetaxel-based chemotherapy, TAX 327 and SWOG 99-16, showed a survival benefit for the first time in metastatic, hormone-refractory prostate cancer. Current research suggests that several distinct mechanisms of androgen-refractory disease may converge in patients with disease progression on androgen deprivation therapy. These findings have identified several potential targets for therapeutic intervention. Current standard and investigational treatment options for this disease are discussed, including chemotherapy and rapidly evolving therapies in phase II/III trials involving antiangiogenic therapies, signal transduction inhibitors, immunomodulatory agents, and nuclear receptor targets. In light of a growing array of treatment options and an increasingly chronic natural history, this review supports a multidisciplinary care approach to these patients, including medical oncologists, urologists, and radiation oncologists, to optimize survival and quality of life. [Rev Urol. 2007;9(suppl 1):S9-S19]

ChemotherapyZoledronic acidHormone-refractory prostate cancerAntiangiogenic therapySignal transduction inhibitorsImmunomodulatory agents

Antibiotic prophylaxisView 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

Antibiotic resistanceView Articles
Antibiotic therapyView Articles
AntibioticprophylaxisView Articles
AnticholinergicView Articles
Anticholinergic agentsView Articles
Anticholinergic medicationsView Articles

Volume 8, Number 3Review Articles

Management of Overactive Bladder With Transdermal Oxybutynin

Treatment Update

Roger R DmochowskiJonathan S Starkman

In clinical trials, transdermal oxybutynin (OXY-TDS) has shown comparable efficacy and improved tolerability when compared with conventional pharmacotherapy. Systemic anticholinergic adverse effects are comparable to those with placebo, most likely owing to avoidance of first-pass hepatic metabolism and conversion of oxybutynin to N-desethyloxybutynin. OXY-TDS has predictable pharmacokinetic absorption and elimination parameters, as shown in both in vitro and in vivo studies. Consistent plasma concentrations of oxybutynin avoid labile peak and trough concentrations seen with immediaterelease formulations, paralleling extended-release drug delivery. This novel drug delivery system has unique dermatologic skin application site reactions, including erythema and pruritus. Skin reactions are usually mild and can be minimized by varying the site of patch application. Most eczematous dermatologic reactions can be appropriately treated with a moderately potent topical corticosteroid cream. A small percentage of patients will discontinue therapy as a result of bothersome application site skin reactions. [Rev Urol. 2006;8(3):93-103]

Overactive bladderTolterodineAnticholinergic medicationsOxybutinin

AnticholinergicsView Articles

Volume 11, Supplement 1Review Articles

Medical Management of Lower Urinary Tract Symptoms

Advances in the Pharmacologic Treatment of BPH

Eric E LabordeKevin T McVary

Lower urinary tract symptoms (LUTS) are a common complaint among aging men and are often caused by benign prostatic hyperplasia (BPH). A number of medical treatments for LUTS/BPH exist, such as α-blockers, 5α-reductase inhibitors, anticholinergics, phosphodiesterase type 5 (PDE5) inhibitors, and combination therapies. Agonist binding of the α1A-adrenergic receptor (AR), causing prostatic smooth muscle contraction, has been attributed to cause some LUTS. Therefore, medical therapy has aimed to block the α1A-AR and improve LUTS. Determining which therapy to choose must take into account individual patient factors as well as cost and patient choice.[Rev Urol. 2009;11(suppl 1):S19–S25 doi: 10.3909/riu11S1S0004]© 2009 MedReviews®, LLC

Lower urinary tract symptomsPhosphodiesteraseCombination therapyBlockers5-reductase inhibitorsAnticholinergicsBenign prostatichyperplasia