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Renal tumorView Articles

Volume 15, Number 1Review Articles

Physiologic and Anesthetic Considerations in Octogenarians Undergoing Laparoscopic Partial Nephrectomy

Management Review

Nikhil VasdevElizabeth ToddNaeem A Soomro

The number of small renal tumors detected is increasing as imaging becomes both more available and advanced, and as the population ages, with a greater proportion of patients in their 80s emerging with small and treatable renal tumors. The technique of laparoscopic partial nephrectomy is emerging and becoming ever more popular in some centers, and is potentially a safer alternative for the elderly due to improved postoperative pain, shorter hospital stay with faster return to preoperative activities, and lower rates of morbidity and mortality. We present a systematic review of the physiologic and anesthetic considerations in octogenarians undergoing the procedure, highlighting special considerations and the need for expertise throughout the multidisciplinary team when dealing with these patients, in order to minimize risk and optimize outcome. [ Rev Urol. 2013;15(1):23-31 doi: 10.3909/riu0565] © 2013 MedReviews®, LLC

Renal cell carcinomaRadical nephrectomyLaparoscopic partial nephrectomyRenal tumorOctogenarian

Renal tumorsView Articles

Volume 13, Number 3Review Articles

A Review of Current Hemostatic Agents and Tissue Sealants Used in Laparoscopic Partial Nephrectomy

Treatment Review

I GalanakisN VasdevN Soomro

Laparoscopic partial nephrectomy (LPN) is currently considered to be one of the most challenging procedures in minimally invasive urological surgery. With an increasing number of renal tumors being managed using LPN, there is now a further interest in the development of techniques and agents to reduce complications associated with the procedure. Hemostasis is of paramount importance during LPN, and hemostatic agents and tissue sealants are now being used commonly during LPN. Despite this, there is a dearth of prospective, randomized, human trials in current literature that compare the various agents. This review evaluates hemostatic agents and tissue sealants being used during LPN as an adjuvant to suturing in human studies. [Rev Urol. 2011;13(3):131-138 doi: 10.3909/riu0524] © 2011 MedReviews®, LLC

Laparoscopic partial nephrectomyRenal tumorsHemostatic agentsTissue sealantsSuturing adjuvant

Renal ultrasoundView Articles
Repeat biopsyView Articles
Repeat TURView Articles

Volume 9, Number 4Meeting Reviews

Best of the 2007 AUA Annual Meeting (2)

Meeting Review

John P Stein

Bladder Cancer Highlights from the 2007 Annual Meeting of the American Urological Association, May 19-24, 2007, Anaheim, CA [Rev Urol. 2007;9(4):220-234]

Bladder cancerQuality of lifeRisk factorsAgeCystectomyLaparoscopic surgeryIntravesical therapyPrognosisCystoscopyGenderInvasive cancerLymph node dissectionLymphovascular invasionMetastatic cancerOutcomesRepeat TURRobotic-assisted surgerySuperficial cancer

ResearchView Articles

Volume 16, Number 3Review Articles

The Emerging Role of Social Media in Urology

Technology Update

Michael J Leveridge

Social media have become so integrated into modern communications as to be universal in our personal and, increasingly, professional lives. Recent examples of social media uptake in urology, and the emergence of data to quantify it, reveal the expansion of conventional communication routes beyond the in-person forum. In every domain of urologic practice, from patient interaction through research to continuing professional development, the move online has unlocked another layer of conversation, dissemination, and, indeed, caveats. Social media have a democratizing effect, placing patients, trainees, practitioners, and thought leaders in the same arena and on equal footing. If uptake of social media in medicine even remotely parallels its rise to ubiquity in other areas, it will only expand and evolve in the coming years. For these reasons, this article presents an overview of the most recent data on the impact and potential complications of social media usage in the urologic community. [Rev Urol. 2014;16(3):110-117 doi: 10.3909/riu0640] © 2014 MedReviews®, LLC

Social mediaUrologic practiceEducationContinuing professional developmentResearch

ResectionView Articles
ResidentsView Articles

Volume 8, Number 2Review Articles

The Business of Urology - Your First Job

Special Feature

Paul Brower

Young doctors nearing the end of their residency must begin to consider how to chart the course of their careers. Most residents will go into private practice. This requires a huge leap, from academia into the business world of medicine. Young doctors, long preoccupied with the clinical and academic aspects of medicine, are frequently ill-prepared for this process, having no insight as to what they can do to match themselves to the right practice or multi-specialty group. This article discusses the stages of this process, from initial geographic decisions to securing interviews, to assessing the health of a given practice, to the details of contract negotiation. [Rev Urol. 2006;8(2):71-75]

CompensationResidentsEmploymentPrivate practiceMedicarePPOHMOContract negotiation

ResinferatoxinView Articles

Volume 15, Number 3Review Articles

Use of Herbal Supplements for Overactive Bladder

Management Update

Steven A KaplanRichard LeeBilal ChughtaiAlexis E TeElizabeth KavalerFranklin C Lowe

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world’s population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB. [Rev Urol. 2013;15(3):93-96 doi: 10.3909/riu0587] © 2013 MedReviews®, LLC

Overactive bladderHerbal medicineGosha-jinki-ganHachi-mi-jio-ganBuchu (Barosma betuline)Cleavers (Galium aparine)Cornsilk (Zea mays)Horsetail (Equisetum)Ganoderma lucidumResinferatoxinCapsaicin

ResiniferatoxinView Articles
ResiniferitoxinView Articles
Response predictionView Articles
Retained foreign bodiesView 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

RetractionView 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

Retrograde ejaculationView 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

Retroperitoneal fibrosisView Articles

Volume 8, Number 4Reviews in Urology

Robotic Ureterolysis, Retroperitoneal Biopsy, and Omental Wrap for the Treatment of Ureteral Obstruction Due to Idiopathic Retroperitoneal Fibrosis

Case Review

Patrick W MufarrijMichael D Stifelman

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 fibrosisRobotic ureterolysisOmental wrap

Retroperitoneal hemorrhageView Articles
Retroperitoneal ligationView Articles
Retroperitoneal schwannomaView Articles

Volume 17, Number 3Case Review

Retroperitoneal Ancient Schwannoma: A Case Report

Selahattin ÇalIiskanGülistan GümrükçüCevdet Kaya

Schwannomas are extremely rare tumors that are composed of Schwann cells. Retroperitoneal localization comprises 0.7% to 2.6% of all schwannomas. Patients usually present with nonspecific symptoms. There are no pathognomonic features on radiologic evaluation. Preoperative biopsy is not recommended because of complication risks; however, surgery is necessary for diagnosis and treatment. Although most schwannomas are benign tumors, those that are associated with von Recklinghausen disease are malignant. Schwannomas exhibit regions of high and low cellularity, termed Antoni A and Antoni B areas, with a diffuse positivity of S100 protein on pathologic evaluation. If there are degenerative changes, such as cyst formation, hemorrhage, calcification, and hyalinization, these tumors are termed ancient schwannomas. We present a case of retroperitoneal ancient schwannoma. [Rev Urol. 2015;17(3):190-193 doi: 10.3909/riu0638] © 2015 MedReviews®, LLC

Retroperitoneal schwannomaNeurilemmomaSchwannomaRetroperitoneal tumor

Retroperitoneal tumorView Articles

Volume 17, Number 3Case Review

Retroperitoneal Ancient Schwannoma: A Case Report

Selahattin ÇalIiskanGülistan GümrükçüCevdet Kaya

Schwannomas are extremely rare tumors that are composed of Schwann cells. Retroperitoneal localization comprises 0.7% to 2.6% of all schwannomas. Patients usually present with nonspecific symptoms. There are no pathognomonic features on radiologic evaluation. Preoperative biopsy is not recommended because of complication risks; however, surgery is necessary for diagnosis and treatment. Although most schwannomas are benign tumors, those that are associated with von Recklinghausen disease are malignant. Schwannomas exhibit regions of high and low cellularity, termed Antoni A and Antoni B areas, with a diffuse positivity of S100 protein on pathologic evaluation. If there are degenerative changes, such as cyst formation, hemorrhage, calcification, and hyalinization, these tumors are termed ancient schwannomas. We present a case of retroperitoneal ancient schwannoma. [Rev Urol. 2015;17(3):190-193 doi: 10.3909/riu0638] © 2015 MedReviews®, LLC

Retroperitoneal schwannomaNeurilemmomaSchwannomaRetroperitoneal tumor

Retropubic suspensionView Articles
Reverse transcription loop-mediated isothermal amplificationView Articles

Volume 19, Number 3Meeting Reviews

Best of the 2017 AUA Annual Meeting

Benjamin M BruckerDean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelMaria J Arcila-RuizSasha C Druskin

[Rev Urol. 2017;19(3):169–179 doi: 10.3909/riu0763] © 2017 MedReviews®, LLC

Percutaneous nephrolithotomyDisorders of sexual developmentBladder exstrophyProstate-specific antigenBiomarkersMicrobiomeOnabotulinumtoxinABladder pain syndromeStem cell therapyInterstitial cystitisStress urinary incontinenceKallikreinZika virusReverse transcription loop-mediated isothermal amplificationRefractory overactive bladderMeshectomyPudendal neuromodulationMedical expulsive therapyGlans groove

Risk assessmentView Articles

Volume 13, Number 4Review Articles

Review of the Literature: PCA3 for Prostate Cancer Risk Assessment and Prognostication

Diagnosis Review

Alan W PartinStacy Loeb

Prostate cancer antigen 3 (PCA3) is a novel urine-based prostate cancer biomarker that has recently been studied extensively for the prediction of prostate biopsy results and treatment outcomes. Numerous studies have demonstrated that urinary PCA3 scores are predictive of prostate cancer detection on both initial and repeat biopsy. There is conflicting evidence on the relationship between PCA3 with aggressive tumor features and treatment outcomes. This article reviews the current evidence on PCA3 as a marker for prostate cancer detection and prognosis. [Rev Urol. 2011;13(4):e191-e195 doi: 10.3909/riu0539] © 2011 MedReviews®, LLC

Prostate cancerProstatectomyProstate cancer antigen 3Risk assessment

Risk factorsView Articles
Risk reductionView Articles

Volume 18, Number 4Review Articles

Smoking-related Genitourinary Cancers: A Global Call to Action in Smoking Cessation

Disease Outcome Update

Marc A BjurlinJosh GottilebCory HigleyRoman Sosnowski

Smoking is a known modifiable risk factor in the development of genitourinary malignancies. Although the association has long been supported by numerous research studies, the impact of smoking cessation on the decreased risk of genitourinary malignancies is less well studied. PubMed databases were searched using the terms smoking, smoking cessation, bladder cancer, kidney cancer, prostate cancer, penile cancer, testicular cancer, their synonyms, and also targeted manual searches to perform a literature review in order to summarize the benefits of cessation on disease progression and patient outcomes including survival and morbidities. Our review yielded substantial evidence highlighting the improved outcomes observed in those diagnosed with bladder, renal, and prostate cancers. The risk of bladder cancer is reduced by up to 60% in those who were able to quit for 25 years and the risk of kidney malignancy was reduced by 50% in those who abstained from smoking for 30 years. A similar trend of reduced risk was observed for prostate cancer with those who quit for more than 10 years, having prostate cancer mortality risks similar to those that never smoked. Although the data were encouraging for bladder, renal, and prostate malignancies, there are comparatively limited data quantifying the benefits of smoking cessation for penile and testicular cancers, highlighting an opportunity for further study. The role of urologists and their impact on their patients’ likelihood to quit smoking shows more than half of urologists never discuss smoking cessation upon diagnosis of a malignancy. Most urologists said they did not provide cessation counseling because they do not believe it would alter their patients’ disease progression. Studies show urologists have more influence at changing their patients’ smoking behaviors than their primary care physicians. The diagnosis of cancer may lead to a teachable moment resulting in increased smoking quit rates. Furthermore, implementing a brief 5-minute clinic counseling session increases quit attempts and quit rates. Diagnosis of genitourinary cancers and the following appointments for treatment provide a unique opportunity for urologists to intervene and affect the progression and outcome of disease. [Rev Urol. 2016;18(4):194-204 doi: 10.3909/riu0729] © 2016 MedReviews®, LLC

SmokingRisk reductionSmoking cessationGenitourinary malignancy

Risk stratificationView Articles
Risk to benefit ratioView Articles

Volume 12, Number 1Review Articles

Complications of Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits?

Treatment Review

Alan W PartinEdward M SchaefferStacy Loeb

The American Urological Association Best Practice Policy states that although pelvic lymph node dissection (PLND) is commonly done with radical prostatectomy, its morbidity must be considered, particularly in cases in which it offers little additional information. The benefits of PLND include more accurate staging and reassurance for the patient. In addition, PLND may be therapeutic for men with lymph node metastases and may result in long-term biochemical cure for selected node-positive patients. However, the incidence of node positivity is declining, and accordingly a greater number of lymphadenectomies must be performed to benefit 1 patient. In addition to the associated cost, PLND has the potential for morbidity, including lymphoceles, thromboembolic events, ureteral injury, and neurovascular injury. Patients and physicians should therefore assess the risk/benefit ratio associated with PLND on an individual basis to permit informed treatment decisions.[Rev Urol. 2010;12(1):20-24 doi:10.3909/riu0422]

Prostate cancerRadical prostatectomyPelvic lymph node dissectionUreteral injuryLymph node metastasesRisk to benefit ratioLymphoceleThromboembolic eventsVascular injuryNerve injury

RNAView Articles

Volume 10, Number 1Review Articles

Clinical Utility of Prostate Carcinoma Molecular Diagnostic Tests

Diagnostic Update

Scott B Shappell

Instead of relying on serum prostate-specific antigen (PSA) to identify patients for prostate biopsy, new laboratory tests are needed that have improved specificity for prostate carcinoma (CaP), allow accurate classification of clinically insignificant CaPs, allow for detection of clinically significant CaP in patients without elevated serum PSA, and allow for identification of aggressive forms of CaP, which may warrant adjunctive or even molecularly targeted therapy in the future. Over the last several years, highthroughput gene expression profiling and proteinomics have led to the identification of genes and proteins that are specifically overexpressed in CaP. Molecular diagnostic techniques readily translated to the clinical laboratory have been incorporated into the development of new tests based on these novel molecular alterations in CaP. Some of these tests already have well-documented clinical utility, such as in facilitating prostate biopsy decisions, and are routinely available. The current review focuses on the biological, clinical, and laboratory aspects of the most promising of these current and nearfuture molecular CaP tests. [Rev Urol. 2008;10(1):44-69]

Molecular diagnosticsProstate carcinomaProstate cancer antigen 3Alpha-methylacyl-CoA racemaseEarly prostate cancer antigenTransmembrane protease,serine 2ERGDNARNA

RNA biomarkersView Articles

Volume 9, Number 4Review Articles

Newer Potential Biomarkers in Prostate Cancer

Diagnostic Update

Paul H LangeJonathan L Wright

Prostate-specific antigen (PSA) screening has led to a significant rise in the number of men diagnosed with prostate cancer and an associated increase in biopsies performed. Despite its limitations, including a positive predictive value of only 25%-40%, PSA remains the only generally accepted biomarker for prostate cancer. There is a need for better tools to not only identify men with prostate cancer, but also to recognize those with potentially lethal disease who will benefit from intervention. A great deal of work has been done worldwide to improve our knowledge of the genetics behind prostate cancer and the specificity of PSA by developing assays for different PSA isoforms. Common genetic alterations in prostate cancer patients have been identified, including CpG hypermethylation of GSPT1 and TMPRSS2:ERG gene fusion. Serum and urine detection of RNA biomarkers (eg, PCA3) and prostate cancer tissue protein antibodies (eg, EPCA) are being evaluated for detection and prognostic tools. This article reviews some of the promising developments in biomarkers. [Rev Urol. 2007;9(4):207-213]

Prostate-specific antigenPCA3Alpha-methylacyl-CoA racemaseAutoantibody arraysEpigenetic markersGene fusion proteinsHuman kallikreinsPSA isoformsRNA biomarkers

RobotView Articles

Volume 11, Number 1Review Articles

Robotic Image-Guided Needle Interventions of the Prostate

Technology Update

Alan W PartinPierre C MozerDan Stoianovici

Prostate biopsy and needle-directed prostate therapies are currently performed free-handed or with needle external templates under ultrasound guidance. Direct image-guided intervention robots are modern instruments that have the potential to substantially enhance these procedures. These may increase the accuracy and repeatability with which needles are placed in the gland. The authors’ group has developed a robot for precise prostate targeting that operates remotely alongside the patient in the magnetic resonance imaging scanner, as guided according to the image.[Rev Urol. 2009;11(1):7-15]

ProstateRobotDirect image-guided intervention (DIGI)MRI compatible