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Androgen deprivation therapyView Articles
Androgen receptorView Articles

Volume 23, Number 2Prostate Cancer

Real-World Comparison of Deep Prostate-Specific Antigen Response in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Apalutamide or Enzalutamide

Benjamin H. LowentrittIbrahim KhilfehDominic PilonShawn DuCarmine RossiFrederic KinkeadLilian DiazJill KorsiakPatrick LefebvreGordon A Brown

Deep prostate-specific antigen reduction of at least 90% (PSA90 response) after androgen receptor pathway inhibitor initiation to treat metastatic castration-sensitive prostate cancer (mCSPC) is associated with longer survival. This real-world study evaluated the proportion of androgen receptor pathway inhibitor–naive patients with mCSPC who achieved PSA90 response 6 months after initiating apalutamide or enzalutamide.

Prostatic neoplasmsProstate-specific antigen (PSA)Prostate-specific antigenProstate-specific antigensCastrationAndrogen receptorAndrogen receptor antagoniststreatment effectiveness

Androgen receptor antagonistsView Articles

Volume 23, Number 3Prostate Cancer

Darolutamide for the Management of Metastatic Hormone-Sensitive Prostate Cancer: A Urologist-Oncologist Perspective

Paul DatoRana R. McKay

Metastatic prostate cancer accounts for 8% of all prostate cancer cases in the United States and has an estimated 5-year survival rate of 34%. Androgen-deprivation therapy (ADT) is the cornerstone of treatment for men with metastatic hormone-sensitive prostate cancer (HSPC), but there has been a recent focus on early treatment intensification through dual- or triple-therapy approaches, which have shown substantial survival benefit compared with ADT alone. Darolutamide, a distinct androgen receptor inhibitor, is the latest treatment for men with metastatic HSPC. In the Darolutamide in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer (ARASENS) trial (ClinicalTrials.gov identifier NCT02799602), darolutamide in combination with ADT and docetaxel reduced the risk of death by 32.5% (P < .001) compared with ADT plus docetaxel in men with metastatic HSPC. The most recent National Comprehensive Cancer Network guidelines (2023) support the use of triple-therapy regimens for men with high-volume metastatic HSPC, but concerns about the side effects of the short-term chemotherapy component of this regimen necessitate a comprehensive approach to providing supportive care to ensure that patients are willing to begin and remain on treatment. Effective management should involve a well-informed multidisciplinary team with patient education and support to ensure optimal treatment outcomes. Here, we review the results of the ARASENS trial and consider the implications for the management of metastatic HSPC. By showing a statistically significant reduction in risk of death, triple therapy combining darolutamide with ADT and docetaxel has emerged as a new treatment modality that may help men with metastatic HSPC achieve prolonged survival while maintaining an acceptable quality of life.

Prostatic neoplasmsDrug therapyNeoplasm metastasisAndrogen receptor antagonists

Androgen replacementView Articles
Androgen replacement therapyView 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

Androgen suppressionView Articles
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&rsquo; 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