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Phosphodiesterase inhibitorsView Articles
Phosphodiesterase type 5View Articles

Volume 12, Number 1Case Review

Diagnostic and Therapeutic Options for the Management of Ischemic and Nonischemic Priapism

Case Review

Jacob RajferJeffrey Bassett

Priapism is defined as persistent penile erection continuing beyond, or unrelated to, sexual stimulation. Proper diagnosis encompasses at least 2 very different pathophysiologic processes. Ischemic priapism (“low flow”) is a disorder of venous outflow and/or stasis. Nonischemic priapism (“high flow”) is a disorder of arterial flow. We present 2 cases that review each condition. The first case highlights a 32-year-old man with a medical history of sickle cell disease who presented to the emergency department complaining of a persistent, painful erection that had continued for 18 hours. The second case describes a 24-year-old man with no significant medical history who sustained trauma to his pelvis while skateboarding. Although the initial evaluation of both types of priapism is similar, pathophysiology and resulting interventions differ for each, underscoring the importance of proper diagnosis.[Rev Urol. 2010;12(1):56-63 doi: 10.3909/riu0457]

Erectile dysfunctionIschemic priapismNonischemic priapismIntracorporeal pressureCavernosal hypoxiaPhosphodiesterase type 5Distal shunts

Phosphodiesterase type 5 inhibitorView Articles

Volume 17, Number 2Review Articles

Penile Rehabilitation Strategies Among Prostate Cancer Survivors

Treatment Update

Fouad AounAlexandre PeltierRoland van Velthoven

Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. [Rev Urol. 2015;17(2):58-68 doi: 10.3909/riu0652] © 2015 MedReviews®, LLC

Prostate cancerErectile dysfunctionPenile rehabilitationPhosphodiesterase type 5 inhibitorProstaglandin E

Phosphodiesterase type 5 inhibitorsView Articles

Volume 9, Number 2Review Articles

Phosphodiesterase Type 5 Inhibitors for the Treatment of Male Lower Urinary Tract Symptoms

Treatment Update

Steven A KaplanRicardo R Gonzalez

Both lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and erectile dysfunction have a very high prevalence among aging men, and there is some clinical evidence that they may share a common pathophysiology. Consequently, several preliminary studies of phosphodiesterase type 5 inhibitors—sildenafil and tadalafil—have recently been conducted in men with concomitant erectile dysfunction and lower urinary tract symptoms to determine whether these agents are effective for the treatment of symptomatic BPH. These studies have demonstrated efficacy, both alone and in combination with an -blocker, in treating lower urinary tract symptoms along with sexual dysfunction. However, larger-scale randomized studies are necessary to determine long-term safety, efficacy, and cost effectiveness. [Rev Urol. 2007;9(2):73-77]

Benign prostatic hyperplasiaLower urinary tract symptomsErectile dysfunctionTadalafilSildenafilPhosphodiesterase type 5 inhibitors

Phosphodiesterase type 5inhibitorsView Articles

Volume 10, Number 1Review Articles

Impact of Phosphodiesterase Type 5 Inhibitors on Endothelial Function

Treatment Update

John P MulhallPatrick E Teloken

It is now known that endothelial health is essential for normal erectile function, and changes in endothelial integrity or function may lead to erectile dysfunction (ED). Because phosphodiesterase type 5 (PDE-5) inhibitors have been shown to improve endothelial function, many investigators have questioned whether PDE-5 inhibition will lead to improvement in erectile function. Data from the studies reviewed in this article show that therapy with PDE-5 inhibitors results in improvement in flow-mediated dilation, nocturnal penile tumescence and rigidity, and carotid artery intima-media thickness as well as higher scores on the Sexual Health Inventory for Men, International Index of Erectile Function, Erection Function Domain, and other instruments. Further research is needed to determine whether long-term PDE-5 inhibition can reverse ED and whether use of these agents will decrease cardiovascular morbidity in high-risk populations. [Rev Urol. 2008;10(1):26-30]

Erectile dysfunctionTadalafilSildenafilEndothelial functionPhosphodiesterase type 5inhibitors

Phosphodiesterase-5 inhibitorView Articles
Phosphodiesterase-5 inhibitorsView Articles
Photodynamic therapyView Articles

Volume 10, Number 4Review Articles

Vascular Targeted Photodynamic Therapy for Localized Prostate Cancer

Treatment Update

Herbert Lepor

Survival for men diagnosed with prostate cancer directly depends on the stage and grade of the disease at diagnosis. Prostate cancer screening has greatly increased the ability to diagnose small and low-grade cancers that are amenable to cure. However, widespread prostate-specific antigen screening exposes many men with low-risk cancers to unnecessary complications associated with treatment for localized disease without any survival advantage. One challenge for urological surgeons is to develop effective treatment options for low-risk disease that are associated with fewer complications. Minimally invasive ablative treatments for localized prostate cancer are under development and may represent a preferred option for men with low-risk disease who want to balance the risks and benefits of treatment. Vascular targeted photodynamic therapy (VTP) is a novel technique that is being developed for treating prostate cancer. Recent advances in photodynamic therapy have led to the development of photosynthesizers that are retained by the vascular system, which provides the opportunity to selectively ablate the prostate with minimal collateral damage to other structures. The rapid clearance of these new agents negates the need to avoid exposure to sunlight for long periods. Presented herein are the rationale and preliminary data for VTP for localized prostate cancer. [Rev Urol. 2008;10(4):254-261]

Vascular targeted photodynamic therapyPhotodynamic therapyProstate cancer, localizedMinimally invasive ablative treatment for prostate cancerWST-09WST-11PadoporfinPalladium bacteriopheophorbide

Photoselective vaporization of the prostateView 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

Physical therapyView Articles
Physician assistantsView Articles

Volume 23, Number 2Editorial

Advanced Practice Providers, Urology Workforce Challenges, and Reviews in Urology

Kenneth A. Mitchell

In 2015, the American Urological Association published the Consensus Statement on Advanced Practice Providers (APPs) with the goal of providing up-to-date information on the training of APPs, the scope of practice legislation, and examples of APPs in urologic practices.1 This statement was co-written by an experienced team of physicians and APPs whose purpose was to provide a unique and collaborative perspective on urology APPs. The paper was inspired by a report from an American Urological Association ad hoc committee assembled in 2008, which concluded that there were substantial workforce shortages in urology and that physician assistants and advanced practice registered nurses would provide the “best solution” for the declining urology workforce.2 In 2009, reports estimated that there were 3.1 urologists per 100 000 people in the United States and that urology was the second-oldest surgical subspecialty, with a workforce median age of 52.5 years.2 A published update in 2021, which used data from 2018, revealed that there were 3.89 urologists per 100 000 people in the United States, with 65% of urologists reporting that they were “interested” in the integration and use of APPs; 72.5% of urologists reported already incorporating an APP into their practice, accounting for nearly 41% of a physician (ie, MD or DO) full-time equivalent.2 More recent data showed the use of APPs was lowest in practices with the youngest and oldest subgroups of urologists and was highest in urban urology practices, which represent groups most likely to be affected initially due to the disproportionate geographical urology patient population density.

Physician assistantsnurse practitionershealth workforce

Physician practice patternsView 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

Physiologic 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

PhysiotherapyView Articles
PhytotherapyView Articles
Pituitary neoplasmsView Articles
Placenta accretaView Articles

Volume 11, Number 3Case Review

Placenta Percreta and the Urologist

Jacob RajferRamdev KonijetiAsghar Askari

Placenta percreta, the rarest and most severe form of placenta accreta, caninvolve the urinary bladder. Because of its propensity for severe hemorrhage,it is a potentially life-threatening condition. Although commonly discoveredat the time of delivery, antenatal diagnosis may be achieved with ultrasound,magnetic resonance imaging, and/or cystoscopy. Every attempt should bemade to minimize potential for blood loss by avoiding removal of the placentaat the time of delivery and either performing a hysterectomy or usingmethotrexate therapy to ablate the residual placenta in the postpartum period.If hemorrhage does occur during delivery, immediate surgical removalof the uterus should be considered and, depending on the severity of thehemorrhage and the depth of invasion of the placenta into the bladder,excision and/or reconstruction of the bladder may be necessary.[Rev Urol. 2009;11(3):173-176 doi: 10.3909/riu0440]© 2009 MedReviews®, LLC

Placenta percretaPlacenta accretaBladder invasion

Placenta percretaView Articles

Volume 11, Number 3Case Review

Placenta Percreta and the Urologist

Jacob RajferRamdev KonijetiAsghar Askari

Placenta percreta, the rarest and most severe form of placenta accreta, caninvolve the urinary bladder. Because of its propensity for severe hemorrhage,it is a potentially life-threatening condition. Although commonly discoveredat the time of delivery, antenatal diagnosis may be achieved with ultrasound,magnetic resonance imaging, and/or cystoscopy. Every attempt should bemade to minimize potential for blood loss by avoiding removal of the placentaat the time of delivery and either performing a hysterectomy or usingmethotrexate therapy to ablate the residual placenta in the postpartum period.If hemorrhage does occur during delivery, immediate surgical removalof the uterus should be considered and, depending on the severity of thehemorrhage and the depth of invasion of the placenta into the bladder,excision and/or reconstruction of the bladder may be necessary.[Rev Urol. 2009;11(3):173-176 doi: 10.3909/riu0440]© 2009 MedReviews®, LLC

Placenta percretaPlacenta accretaBladder invasion

PLESS studyView Articles

Volume 5, Number 3Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamBob DjavanArie S BelldegrunAllan J PantuckMesut RemziMichael DobrovitsMatthew B GretzerKazumasa Torimoto

Prostate cancerRenal cell carcinomaBenign prostatic hyperplasiaDepressionBladder cancerLower urinary tract symptomsUrinary tract infectionProstate-specific antigenNephrolithiasisOveractive bladderRadical prostatectomyPeyronie’s diseaseGleason scoreTransrectal ultrasoundErectile dysfunctionChronic prostatitis/chronic pelvic pain syndromeAcute urinary retentionInternational Prostate Symptom ScoreBacille Calmette-Guérin therapyChronic Prostatitis Symptom IndexMTOPS trialPLESS studyProstate tumor markersSELDI-TOF

Plication techniquesView Articles
PneumoperitoneumView 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

Polyarteritis nodosaView Articles

Volume 9, Number 4Case Review

Bilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis Nodosa

Case Review

Donald S CrainShannon R HerreraSean P Stroup

We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy. [Rev Urol. 2007;9(4):235-238]

Testicular infarctionPolyarteritis nodosaAndrogen replacement therapy

Positive surgical marginsView Articles
positron-emission tomographyView Articles

Volume 23, Number 4Kidney Cancer

Imaging Techniques in the Diagnosis of Renal Cell Carcinoma: Contemporary Trends and Future Directions

Gautam Jayram

Increasing radiographic detection of incidental small renal masses has led to a growing concern regarding overtreatment of these lesions. Given the limitations of computed tomography and magnetic resonance imaging, there is an unmet need for improved kidney imaging techniques that can provide more accurate assessments of renal lesions. This review provides a summary of established kidney imaging modalities and also those likely to be meaningful in the near future. Kidney imaging has evolved, with several modalities contributing to the overall diagnostic landscape. There is great optimism that a new era of molecular imaging in renal cell carcinoma can vastly improve diagnostic capabilities and limit unnecessary invasive procedures.

Carcinoma, renal cellCarcinomaKidney neoplasmsmolecular imagingpositron-emission tomography

Post-prostatectomy incontinenceView Articles

Volume 20, Number 4Review Articles

Male Slings for Post-prostatectomy Incontinence

Treatment Review

Jack M ZuckermanAlexander D Doudt

Stress urinary incontinence following radical prostatectomy can have a significant impact on a man’s quality of life. Male slings offer a perceived minimally invasive treatment option and do not require the manual dexterity necessary to operate an artificial urinary sphincter. In this review, we outline the history of male slings and discuss the various fixed and adjustable slings that are available on the market. It is important for the general urologist to understand the technical differences, outcomes, and common complications of suburethral slings. [Rev Urol. 2018;20(4):158–169 doi: 10.3909/riu080] © 2019 MedReviews®, LLC. This article is a US Government work and, as such, is in the public domain in the United States of America.

Suburethral slingMale slingPost-prostatectomy incontinence

Postoperative adhesionsView Articles

Volume 14, Number 3Review Articles

Lap Pak for Abdominal Retraction

New Technology Review

Gary D SteinbergHerbert LeporGanesh SivarajanSam S ChangAmr FerganyS Bruce Malkowicz

Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges. [Rev Urol. 2012;14(3/4):41-47 doi: 10.3909/riu0572] © 2013 MedReviews®, LLC

RetractionPostoperative adhesionsRetained foreign bodiesLap Pak

Postoperative painView Articles
Postoperative urinary continenceView Articles
Postprostatectomy incontinenceView Articles

Volume 15, Number 2Review Articles

Conservative Treatment for Postprostatectomy Incontinence

Treatment Update

Steven A KaplanRichard LeeBilal ChughtaiAlexis E Te

Postprostatectomy incontinence (PPI) is a bothersome complication of radical prostatectomy. Although most men recover from PPI, some men continue to have persistent urinary incontinence. The initial management of persistent PPI usually consists of conservative measures such as pelvic floor muscle exercises. Surgical treatments are usually not entertained for men with urinary incontinence until conservative treatments have failed. This article discusses risk factors for PPI and various options for its treatment, including biofeedback and pharmacotherapy. [Rev Urol. 2013;15(2):61-66 doi: 10.3909/riu0569] © 2013 MedReviews®, LLC

Radical prostatectomyPostprostatectomy incontinencePelvic floor muscle training

Posture and minimally invasive surgeryView Articles