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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

Jonathan S StarkmanRoger R Dmochowski

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

Kevin T McVaryEric E Laborde

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

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

Edward ZoltanDavid R Staskin

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

Ashutosh K TewariShalini S YadavKamlesh K YadavJoseph M Brito IIIAshley V AlfordJoseph Renzulli II

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

Moulay Hassan FarihMohamed Jamal El FassiYounes AhallalAbdelhak KhalloukMustapha Ahsaini

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 23, Number 4Prostate Cancer

Deep Learning for Magnetic Resonance Imaging–Based Radiation Therapy for Prostate Cancer: Current Status

Jessica E. ScholeyAbhejit RajagopalJulian HongPeder LarsonKe Sheng

Magnetic resonance imaging (MRI) is increasingly being used for external beam radiation therapy in the treatment of prostate cancer because of its excellent soft tissue contrast and ability to provide functional and physiologic information about tumor behavior. At the same time, deep learning has seen widespread applications in medical imaging, including for MRI-based classification and synthesis. Deep learning–based approaches are being incorporated into the MRI-guided clinical external beam radiation therapy workflow for patient simulation, contouring of targets and critical structures, treatment planning, and treatment delivery. In this review, we examine the current status of deep learning for MRI-guided prostate external beam radiation therapy.

Artificial intelligenceProstatic neoplasmsRadiotherapyMagnetic resonance imaging (MRI)Deep 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

Natasha GinzburgKristene WhitmoreNima 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