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AntiestrogenView Articles
Antimicrobial therapyView Articles
Antimuscarinic agentView Articles

Volume 11, Number 2Review Articles

Will the Evolution of Overactive Bladder Delivery Systems Increase Patient Compliance?

Treatment Review

Nirit Rosenblum

The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.[Rev Urol. 2009;11(2):45-51]

Overactive bladderPharmacotherapyComplianceAntimuscarinic agent

Antimuscarinic agentsView Articles
Antimuscarinic drugsView Articles

Volume 9, Number 4Review Articles

Anticholinergics and Central Nervous System Effects: Are We Confused?

Treatment Update

David R StaskinEdward Zoltan

The central nervous system (CNS) effects of anticholinergic agents have been documented in various patient populations and to varying degrees in case reports, brain-activity surrogates, and computerized cognitive testing. The older patient population with overactive bladder represents a group at increased risk of cognitive impairment and other CNS side effects associated with antimuscarinic agents. The complexity of the effect of anticholinergic agents on CNS function requires an increased level of careful investigation. Studies need to be performed in the at-risk population with multiple, validated tests at clinically prescribed doses in acute and chronic situations. These studies need to take into account the effect of commonly prescribed dosing regimens, with doses selected to represent with equivalent bladder potency. The alterations in the serum levels and parent/metabolite effects contributed by metabolic issues or drug delivery systems require special attention. [Rev Urol. 2007;9(4):191-196]

Overactive bladderElderlyAntimuscarinic drugsCNS adverse eventsCognitive impairment

Antineoplastic agentsView Articles
Antineoplastic agents, hormonalView Articles
Antiobiotic prophylaxisView Articles
Antiproliferative factor (APF)View Articles
Antisense oligonucleotidesView Articles
ApifinyView Articles

Volume 19, Number 4Review Articles

The Use of Biomarkers in Prostate Cancer Screening and Treatment

Treatment Update

Joseph Renzulli IIAshutosh K TewariShalini S YadavKamlesh K YadavJoseph M Brito IIIAshley V Alford

Prostate cancer screening and diagnosis has been guided by prostate-specific antigen levels for the past 25 years, but with the most recent US Preventive Services Task Force screening recommendations, as well as concerns regarding overdiagnosis and overtreatment, a new wave of prostate cancer biomarkers has recently emerged. These assays allow the testing of urine, serum, or prostate tissue for molecular signs of prostate cancer, and provide information regarding both diagnosis and prognosis. In this review, we discuss 12 commercially available biomarker assays approved for the diagnosis and treatment of prostate cancer. The results of clinical validation studies and clinical decision-making studies are presented. This information is designed to assist urologists in making clinical decisions with respect to ordering and interpreting these tests for different patients. There are numerous fluid and biopsy-based genomic tests available for prostate cancer patients that provide the physician and patient with different information about risk of future disease and treatment outcomes. It is important that providers be able to recommend the appropriate test for each individual patient; this decision is based on tissue availability and prognostic information desired. Future studies will continue to emphasize the important role of genomic biomarkers in making individualized treatment decisions for prostate cancer patients. [Rev Urol. 2017;19(4):221–234 doi: 10.3909/riu0772] © 2018 MedReviews®, LLC

Prostate cancerBiomarkers4KscoreProlarisPCA3Prostate Health IndexApifinyMichigan Prostate ScoreSelectMDxConfirmMDxProMarkPTEN/TMPRSS2:ERGDecipher

ApomorphineView Articles
ApoptosisView Articles
AppendicitisView Articles

Volume 13, Number 1Case Review

Appendiceal Abscess Revealed by Right Renal Colic and Hydronephrosis

Case Review

Mustapha AhsainiMoulay Hassan FarihMohamed Jamal El FassiYounes AhallalAbdelhak Khallouk

Reported is the case of a patient who had an appendiceal abscess revealed by right renal colic with fever and general fatigue. The abdominal computed tomography scan showed hydronephrosis and an appendiceal abscess surrounding and compressing the ureter. The appendix contained a stercolith and was perforated. [Rev Urol. 2011;13(1):53-55 doi: 10.3909/riu0479]

HydronephrosisRenal colicAppendicitisAbscess

AppendicovesicostomyView Articles
ArgonView Articles
Aromatase inhibitorView Articles

Volume 18, Number 2Review Articles

The Role of Estrogen Modulators in Male Hypogonadism and Infertility

Disease State Review

Jesse N MillsJacob RajferAmarnath Rambhatla

Estradiol, normally considered a female hormone, appears to play a significant role in men in a variety of physiologic functions, such as bone metabolism, cardiovascular health, and testicular function. As such, estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism. The compounds that modulate estradiol levels in these clinical conditions are referred to as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). In a certain subset of infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that SERMs and AIs can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state. This review focuses on the role these SERMs and AIs play in the aforementioned reproductive conditions. [Rev Urol. 2016;18(2):66-72 doi: 10.3909/riu0711] © 2016 MedReviews®, LLC

Selective estrogen receptor modulatorAromatase inhibitorMale infertilityHypogonadism

Artificial intelligenceView Articles

Volume 22, Number 4Review Articles

Application of Artificial Intelligence/Machine Vision & Learning for the Development of a Live Single-cell Phenotypic Biomarker Test to Predict Prostate Cancer Tumor Aggressiveness

Original Research

Ashok C ChanderCJ JiangWendell R SuBrad J HoganMatthew J WhitfieldMichael S ManakJonathan S VarsanikGrannum R SantDavid M. Albala

To assess the usefulness and applications of machine vision (MV) and machine learning (ML) techniques that have been used to develop a single cell–based phenotypic (live and fixed biomarkers) platform that correlates with tumor biological aggressiveness and risk stratification, 100 fresh prostate samples were acquired, and areas of prostate cancer were determined by post-surgery pathology reports logged by an independent pathologist. The prostate samples were dissociated into single-cell suspensions in the presence of an extracellular matrix formulation. These samples were analyzed via live-cell microscopy. Dynamic and fixed phenotypic biomarkers per cell were quantified using objective MV software and ML algorithms. The predictive nature of the ML algorithms was developed in two stages. First, random forest (RF) algorithms were developed using 70% of the samples. The developed algorithms were then tested for their predictive performance using the blinded test dataset that contained 30% of the samples in the second stage. Based on the ROC (receiver operating characteristic) curve analysis, thresholds were set to maximize both sensitivity and specificity. We determined the sensitivity and specificity of the assay by comparing the algorithm-generated predictions with adverse pathologic features in the radical prostatectomy (RP) specimens. Using MV and ML algorithms, the biomarkers predictive of adverse pathology at RP were ranked and a prostate cancer patient risk stratification test was developed that distinguishes patients based on surgical adverse pathology features. The ability to identify and track large numbers of individual cells over the length of the microscopy experimental monitoring cycles, in an automated way, created a large biomarker dataset of primary biomarkers. This biomarker dataset was then interrogated with ML algorithms used to correlate with post-surgical adverse pathology findings. Algorithms were generated that predicted adverse pathology with >0.85 sensitivity and specificity and an AUC (area under the curve) of >0.85. Phenotypic biomarkers provide cellular and molecular details that are informative for predicting post-surgical adverse pathologies when considering tumor biopsy samples. Artificial intelligence ML-based approaches for cancer risk stratification are emerging as important and powerful tools to compliment current measures of risk stratification. These techniques have capabilities to address tumor heterogeneity and the molecular complexity of prostate cancer. Specifically, the phenotypic test is a novel example of leveraging biomarkers and advances in MV and ML for developing a powerful prognostic and risk-stratification tool for prostate cancer patients. [Rev Urol. 2020;22(4):159–167] © 2021 MedReviews®, LLC

Prostate cancerArtificial intelligencePhenotypic biomarkersMachine visionMachine learning

Artificial neural networksView Articles
Artificial urinary sphincterView Articles
AscitesView Articles

Volume 18, Number 3Case Review

A Case of Pelvic Organ Prolapse in the Setting of Cirrhotic Ascites

Kristene WhitmoreNatasha GinzburgNima M Shah

Ascites is commonly found in patients with liver cirrhosis. Although conservative therapy is often the ideal choice of care with these patients who also have symptomatic pelvic organ prolapse, this may fail and surgical methods may be needed. Literature is limited regarding surgical repair of prolapse in the setting of ascites. The authors present the surgical evaluation and management of a 63-year-old woman with recurrent ascites from liver cirrhosis who failed conservative therapy. With adequate multidisciplinary care and medical optimization, this patient underwent surgical therapy with resolution of her symptomatic prolapse and improved quality of life. [Rev Urol. 2016;18(3):178-180 doi: 10.3909/riu0702] © 2016 MedReviews®, LLC

AscitesCirrhosisProlapseColpocleisis

Association of Reproductive Health ProfessionalsView Articles
AtrasentanView Articles
AUA GuidelinesView Articles

Volume 8, Supplement 4Review Articles

Update on the American Urological Association Guidelines for the Treatment of Benign Prostatic Hyperplasia

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

Steven A Kaplan

The updated 2003 American Urological Association (AUA) Guidelines for the treatment of benign prostatic hyperplasia (BPH) are the culmination of an exhaustive effort predicated on scientifically accepted methods of reviewing the medical literature. In this second publication of the guidelines, a multidisciplinary panel reviewed a new meta-analysis of outcome data from the BPH literature from before and after 1994. The major differences between the 2 guidelines are the changes in our understanding of the biology of the prostate and the introduction of new therapies. The vast majority of randomized controlled trials, particularly with respect to minimally invasive therapies and progression of BPH, were performed after the release of the 1994 guidelines. Also, the most recent AUA panel carefully reviewed unpublished data to make the guidelines as timely as possible. Studies that were subsequently published included those on the value of combination medical therapy for BPH. The panel agreed on updated recommendations for the treatment of moderate-to-severe lower urinary tract symptoms associated with BPH, and diagnostic algorithms were revised. The durability and utility of the present guidelines should exceed that of its predecessor. [Rev Urol. 2006;8(suppl 4):S10-S17]

Benign prostatic hyperplasiaLower urinary tract symptomsCombination therapy5-reductase inhibitorsAUA GuidelinesAUA Symptom Scores

AUA screening guidelineView Articles

Volume 19, Number 2Review Articles

The American Urological Association’s Prostate Cancer Screening Guideline: Which Cancers Will Be Missed in Average-risk Men Aged 40 to 54 Years?

Cancer Screening Update

Curtis L SpraitzarScott Tully JrElizabeth EisenhartThomas E Moody

To determine the impact of the American Urological Association’s (AUA) guideline for early detection of prostate cancer that recommends against routine screening in men aged 40 to 54 years at average risk (eg, white men without a family history of prostate cancer), we undertook a study of 973 men who previously underwent a prostate biopsy at Urology Centers of Alabama (UCA) over the 5-year period from 2010 to 2014. We retrospectively reviewed the results of the prostate biopsies performed by urologists at UCA—and, where applicable, the final surgical pathology results and compared the results by race and family history. In white men with a family history of prostate cancer, 47% had cancer and 30% had Gleason score (GS) ≥ 7 disease. In white men without a family history of prostate cancer, 32% had cancer and 23% had GS ≥ 7 disease. By comparison, in African American men with a family history of prostate cancer, 56% had cancer and 42% had GS ≥ 7 disease. In African American men without a family history, 42% had cancer and 29% had GS ≥ 7 disease. In our study, 144 of 456 (32%) of the group of average-risk men had cancer and 105 of 456 (23%) had GS ≥ 7 cancer. Had the AUA guidelines been followed, these cancers would have been missed or the diagnoses delayed. [Rev Urol. 2017;19(2):106–112 doi: 10.3909/riu0748] © 2017 MedReviews®, LLC

Prostate cancerProstate-specific antigenAUA screening guidelineAverage-risk men

AUA symptom scoreView Articles
AUA Symptom ScoresView Articles

Volume 8, Supplement 4Review Articles

Update on the American Urological Association Guidelines for the Treatment of Benign Prostatic Hyperplasia

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

Steven A Kaplan

The updated 2003 American Urological Association (AUA) Guidelines for the treatment of benign prostatic hyperplasia (BPH) are the culmination of an exhaustive effort predicated on scientifically accepted methods of reviewing the medical literature. In this second publication of the guidelines, a multidisciplinary panel reviewed a new meta-analysis of outcome data from the BPH literature from before and after 1994. The major differences between the 2 guidelines are the changes in our understanding of the biology of the prostate and the introduction of new therapies. The vast majority of randomized controlled trials, particularly with respect to minimally invasive therapies and progression of BPH, were performed after the release of the 1994 guidelines. Also, the most recent AUA panel carefully reviewed unpublished data to make the guidelines as timely as possible. Studies that were subsequently published included those on the value of combination medical therapy for BPH. The panel agreed on updated recommendations for the treatment of moderate-to-severe lower urinary tract symptoms associated with BPH, and diagnostic algorithms were revised. The durability and utility of the present guidelines should exceed that of its predecessor. [Rev Urol. 2006;8(suppl 4):S10-S17]

Benign prostatic hyperplasiaLower urinary tract symptomsCombination therapy5-reductase inhibitorsAUA GuidelinesAUA Symptom Scores

augmentationView Articles

Volume 19, Number 1Review Articles

Urinary Tract Stone Development in Patients With Myelodysplasia Subjected to Augmentation Cystoplasty

Management Update

Dean G AssimosErika B BuntBetsy D HopsonGuaqiao WangCourtney L Shephard

Patients with myelodysplasia who have undergone augmentation cystoplasty are at risk for urinary tract stones. We sought to determine the incidence and risk factors for stone development in this population. The charts of 40 patients with myelodysplasia who have undergone augmentation cystoplasty were reviewed. None had a prior history of urinary tract stones. All patients were seen on an annual basis with plain abdominal imaging, renal ultrasonography, and laboratory testing. Statistical analysis included a multivariable bootstrap resampling method and Student’s t-test. Fifteen (37.5%) patients developed stones, 14 with bladder stones and 1 with a solitary renal stone, at a mean of 26.9 months after augmentation. Five (33.3%) developed recurrent bladder stones. The patient with a renal stone never developed a bladder stone. The mean follow-up for the stone formers was 117.2 months and for non–stone formers was 89.9 months. The stone incidence per year was 6.8%. Risk factors included a decline in serum chloride after augmentation (P = .02), female sex, younger age at time of augmentation, longer time period since augmentation, and bowel continence. A significant proportion of patients with myelodysplasia subjected to augmentation cystoplasty develop urinary tract stones, predominantly in the bladder. Dehydration may play a role in development of lower urinary tract stones as the decline in serum chloride suggests contraction alkalosis, which could lead to constipation and improved bowel continence. Therefore, improved hydration should be a goal in this cohort. [Rev Urol. 2017;19(1):11-15 doi: 10.3909/riu0741] © 2017 MedReviews®, LLC

NephrolithiasisSpina bifidaNeurogenic bladderaugmentationcystoplasty

Autoantibody arraysView Articles

Volume 9, Number 4Review Articles

Newer Potential Biomarkers in Prostate Cancer

Diagnostic Update

Jonathan L WrightPaul H Lange

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

Autoimmune diseasesView Articles

Volume 16, Number 2Review Articles

Treating Interstitial Cystitis/Bladder Pain Syndrome as a Chronic Disease

Management Review

David C BoschPhilip C Bosch

The management of interstitial cystitis/bladder pain syndrome (IC/BPS) is both frustrating and difficult. The etiology is uncertain and there is no definitive treatment. Consequently, both patients and doctors tend to be unhappy and unsatisfied with the quality of care. The American Urological Association (AUA) provides a guideline for the diagnosis and treatment of IC/BPS. Recommended first-line treatments include patient education, self-care practices, behavior modifications, and stress management. Management of IC/BPS may be also improved if both patients and doctors treat this condition as a chronic disease. This article reviews the AUA first-line treatments for IC/BPS and considers the benefits of treating this condition as a chronic disease. [Rev Urol. 2014;16(2):83-87 doi: 10.3909/riu0603] © 2014 MedReviews®, LLC

Bladder pain syndromeInterstitial cystitisChronic diseaseAutoimmune diseases