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United States Preventive Services Task ForceView Articles

Volume 20, Number 2Original Research

Prostate Biopsy Characteristics: A Comparison Between the Pre- and Post-2012 United States Preventive Services Task Force (USPSTF) Prostate Cancer Screening Guidelines

Navin ShahVladimir IoffeThomas HuebnerIvelina Hristova

To compare prostate cancer (PCa) characteristics diagnosed by prostate biopsy (Pbx) in the 3 years before and after the 2012 United States Preventive Services Task Force (USPSTF) recommendations for PCa screening, we completed a retrospective comparative analysis of 402 sequential PCa patients diagnosed from 2010 to 2012 (3 years) with 552 PCa patients diagnosed from 2015 to 2017 (3 years). Data was collected on patient age, race, total number of biopsies performed, prostate specific antigen (PSA), Gleason sum score (GSS), and digital rectal examination (DRE). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined, Group A and Group B, prior to and after the 2012 USPSTF screening recommendations, respectively. In Group A (pre- 2012 USPSTF recommendations), 567 patients/year underwent a Pbx versus Group B, 398 patients/year, a 30% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B 184/year, a 37.3% increase post-USPSTF. Group A had high-grade PCa (GSS 7-10) in 51.5% versus Group B in 60.1%, an 8.6% increase post-USPSTF. In Group B, the total number of positive biopsies was increased by 100%. This study shows that in Group B, the Pbx rate decreased by 30% but the annual PCa detection rate increased by 37%. High-grade GSS (7-10) PCa increased by 8.6%. Despite a reduction in the total number of prostate biopsies by 30%, there was a 100% increase in the total number of positive prostate biopsies. [Rev Urol. 2018;20(2):77–83 doi: 10.3909/riu0793] © 2018 MedReviews®, LLC

Prostate cancerUnited States Preventive Services Task ForcePSA screening

Unstable bladderView Articles
UPJ obstructionView Articles
UPOINT clinical phenotype systemView Articles

Volume 11, Number 2Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraArie S BelldegrunB ShuchF Pouliot

Prostate cancer screeningObesityBenign prostatic hyperplasiaLower urinary tract symptomsVesicoureteral refluxNephrolithiasisStress urinary incontinenceInflammationSilodosinHormonal therapyTumor markersTMPRSS2ERG4-Kallikrein panelBotulinum toxin type AMale voiding dysfunctionBenign prostatic specific antigenRoux-en-Y gastric bypass surgeryGenitourinary pain indexUPOINT clinical phenotype systemNephron-sparing surgeryWatchful waitingLaparoscopy for adrenal cortical carcinomaPartial adrenalectomyUrethral traumaPediatric urethral strictureEnteric urologic surgery

Upper tract urothelial cancerView Articles

Volume 22, Number 1Review Articles

Management of Low-grade Upper Tract Urothelial Carcinoma: An Unmet Need

Management Review

Neal D ShoreJay Raman

Upper tract urothelial cancers (UTUC) are frequently managed by radical nephroureterectomy (RNU), a major operative procedure that may entail short-term morbidity and long-term decline in renal function. Kidney-sparing procedures offer a less invasive alternative to RNU for low-risk, low-grade UTUC (LG-UTUC). They are associated with similar disease-specific survival rates and better long-term renal function, albeit with a potentially increased risk of recurrence. Strategies to decrease LG-UTUC recurrence include improved risk stratification and enhanced endoscopic instrumentation. Chemoablation may represent an alternative, innovative kidney-sparing approach for LG-UTUC. [Rev Urol. 2020;22(1):1–8] © 2020 MedReviews®, LLC

Risk stratificationUpper tract urothelial cancerRadical nephroureterectomyNephron-sparing procedureLow-grade tumors

Upper tract urothelial carcinomaView Articles

Volume 16, Number 1Review Articles

Nephron-sparing Management of Upper Tract Urothelial Carcinoma

Management Review

Tommaso BrancatoFrancesca Suriano

Upper tract urothelial carcinoma (UTUC) is a relatively rare tumor, but is characterized by high rates of recurrence, morbidity, and mortality. Choice of treatment modality is generally influenced by lesion size, grade, and focality. Radical nephroureterectomy with bladder cuff excision is the gold-standard management of UTUC, although an organ-sparing approach may be beneficial in selected patients. Conservative endoscopic management of UTUC in appropriate patients has a favorable impact on quality of life and health care costs when compared with patients who progress to dialysis-dependent renal failure. Careful ureteroscopic surveillance following endoscopic management of UTUC is essential. [Rev Urol. 2014;16(1):21-28 doi: 10.3909/riu0592] © 2014 MedReviews®, LLC

Upper tract urothelial carcinomaTumor gradeNephron-sparing endoscopic treatmentTopical adjuvant chemo-immunotherapyOncologic outcomes

Upper urinary tractView Articles

Volume 15, Number 4Review Articles

Intracavitary Immunotherapy and Chemotherapy for Upper Urinary Tract Cancer: Current Evidence

Systematic Review

Luca CarmignaniRoberto BianchiGabriele CozziNicola MacchioneCarlo MarenghiSara MelegariMarco RossoElena TondelliAugusto MaggioniAngelica Grasso

A review of the literature was performed to summarize current evidence regarding the efficacy of topical immunotherapy and chemotherapy for upper urinary tract urothelial cell carcinoma (UUT-UCC) in terms of post-treatment recurrence rates. A Medline database literature search was performed in March 2012 using the terms upper urinary tract, urothelial cancer, bacillus Calmette-Guérin (BCG), and mitomycin C. A total of 22 full-text articles were assessed for eligibility, and 19 studies reporting the outcomes of patients who underwent immunotherapy or chemotherapy with curative or adjuvant intent for UUT-UCC were chosen for quantitative analysis. Overall, the role of immunotherapy and chemotherapy for UUT-UCC is not firmly established. The most established practice is the treatment of carcinoma in situ (CIS) with BCG, even if a significant advantage has not yet been proven. The use of BCG as adjuvant therapy after complete resection of papillary UUT-UCC has been studied less extensively, even if recurrence rates are not significantly different than after the treatment of CIS. Only a few reports describe the use of mitomycin C, making it difficult to obtain significant evidence. [Rev Urol. 2013;15(4):145-153 doi: 10.3909/riu0579] © 2014 MedReviews®, LLC

ImmunotherapyChemotherapyBacillus Calmette-GuérinUpper urinary tractUrothelial cell carcinomaMitomycin C

Upper urinary tract stonesView Articles

Volume 15, Number 2Review Articles

Optimizing Shock Wave Lithotripsy: A Comprehensive Review

Treatment Update

Dean G AssimosPaul D McClainJessica N Lange

Shock wave lithotripsy is a commonly used procedure for eradicating upper urinary tract stones in patients who require treatment. A number of methods have been proposed to improve the results of this procedure, including proper patient selection, modifications in technique, adjunctive therapy to facilitate elimination of fragments, and changes in lithotripter design. This article assesses the utility of these measures through an analysis of contemporary literature. [Rev Urol. 2013;15(2):49-60 doi: 10.3909/riu0568] © 2013 MedReviews®, LLC

Upper urinary tract stonesShock wave lithotripsyComminution

Urachal adenocarcinomaView Articles

Volume 17, Number 1Case Review

En Bloc Robot-assisted Laparoscopic Partial Cystectomy, Urachal Resection, and Pelvic Lymphadenectomy for Urachal Adenocarcinoma

Christopher R WilliamsKeyur ChavdaPaul Abrams

Primary adenocarcinomas of the bladder and urachus are extremely rare, accounting for 0.5% to 2.0% of all bladder malignancies. During fetal development, the urachus develops into the median umbilical ligament that stretches from the umbilicus to the bladder. Adenocarcinoma accounts for 90% of all cases of urachal carcinoma. There is no consensus regarding the management of urachal carcinoma. Although the preferred treatment is wide local excision with partial or radical cystectomy, bladder-sparing management is increasing. We report a case of robot-assisted laparoscopic partial cystectomy with en bloc resection of the urachus and bilateral pelvic lymphadenectomy for urachal carcinoma. The robot-assisted laparoscopic approach allowed us to minimize surgical morbidity, postoperative pain, and convalescent time while maintaining the oncologic principle of wide local excision. [Rev Urol. 2015;17(1):46-49 doi: 10.3909/riu0630] © 2015 MedReviews®, LLC

Urachal adenocarcinomaRobotic partial cystectomyPelvic lymphadenectomy

Urachal massView Articles

Volume 18, Number 4Case Review

Gossypiboma Manifesting as Urachal Mass

Nirmish SinglaAhmed Q HaddadChristopher CefaluVitaly Margulis

Gossypiboma (retained surgical sponge) occurs between 1 in 1000 and 1 in 1500 of all intra-abdominal operations. Patients with gossypibomas may present asymptomatically or with nonspecific symptoms, such as abdominal pain or bloating; identification frequently relies on imaging. Results of imaging alone, however, may appear nonspecific, and the gossypiboma may mimic other masses, such as neoplasms, hematomas, or abscesses. They require surgical removal for definitive diagnosis and treatment. Herein we present an unusual case of gossypiboma masquerading as an urachal mass in a 75-year-old woman. Diagnostic evaluation, natural history, and prevention of retained surgical materials are discussed. [Rev Urol. 2016;18(4):239-241 doi: 10.3909/riu0703] © 2016 MedReviews®, LLC

GossypibomaUrachal massSurgical errorsPatient safety

UreterView Articles
Ureteral duplicationView Articles

Volume 18, Number 1Case Review

Ureteral Stone Associated With a Middle Blind Ending of a Bifid Ureter

Selahattin Caliskan

A blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter. [Rev Urol. 2016;18(1):54-56 doi: 10.3909/riu0688] © 2016 MedReviews®, LLC

Blind-ending bifid ureterUreteral duplicationUreteral stoneUreteroscopic

Ureteral filling defectView Articles

Volume 21, Number 1Case Review

Ureteral Polyp Managed by Endoscopic Techniques

Tal CohenMark MemoJohn GraffShyam Patnaik

Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter. [Rev Urol. 2019;21(1):45–48] © 2019 MedReviews®, LLC

Ureteral polypEndoscopic managementUreteral filling defect

Ureteral injuryView 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

Ureteral metastasisView Articles

Volume 15, Number 3Case Review

Ureteral Metastasis as the Presenting Manifestation of Pancreatic Carcinoma

Onkar SinghNand Kishore ArvindShilpi GuptaQutub Ali

We recently cared for a patient with adenocarcinoma of the pancreas who presented with ureteral metastasis followed by hydroureteronephrosis long before the appearance of any symptoms related to the primary lesion. The entity is extremely rare; only seven similar cases are on record in the scientific literature. No recent review exists on this topic. This encouraged us to present our case along with the previous cases of adenocarcinoma of the pancreas with ureteral metastasis that have been reported. [Rev Urol. 2013;15(3):124-130 doi: 10.3909/riu0575] © 2013 MedReviews®, LLC

MetastasisHydronephrosisUreterUreteral metastasisPancreatic adenocarcinoma

ureteral neoplasmsView Articles

Volume 23, Number 4Coding Corner

Reimbursement Considerations for Instillation of Medications to Treat Low-Grade Upper Tract Urothelial Carcinoma

Jonathan RubensteinMark PainterCeleste Kirschner

Unlike non–muscle invasive bladder cancer, which can be treated with surgical and intravesical medication administration, upper tract urothelial (renal pelvis and ureter) cancer was historically treated only surgically. If a tumor could not be treated with ureteroscopic or percutaneous surgical control, removal of the kidney and ureter was often the only treatment option. When mitomycin for pyelocalyceal instillation 0.4% gel for low-grade upper urothelial cancer became commercially available, nonsurgical treatment became possible.

MitomycinAdministration intravesicalureteral neoplasms

Ureteral obstructionView Articles
Ureteral physiologyView Articles
Ureteral polypView Articles

Volume 21, Number 1Case Review

Ureteral Polyp Managed by Endoscopic Techniques

Tal CohenMark MemoJohn GraffShyam Patnaik

Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter. [Rev Urol. 2019;21(1):45–48] © 2019 MedReviews®, LLC

Ureteral polypEndoscopic managementUreteral filling defect

Ureteral stentsView Articles
Ureteral stoneView Articles

Volume 18, Number 1Case Review

Ureteral Stone Associated With a Middle Blind Ending of a Bifid Ureter

Selahattin Caliskan

A blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter. [Rev Urol. 2016;18(1):54-56 doi: 10.3909/riu0688] © 2016 MedReviews®, LLC

Blind-ending bifid ureterUreteral duplicationUreteral stoneUreteroscopic

Ureteral stonesView Articles
UreteroceleView Articles
Ureteropelvic junctionView Articles
Ureteropelvic junction obstructionView Articles
UreterorenoscopyView Articles

Volume 16, Number 1Review Articles

Calyceal Diverticula: A Comprehensive Review

Disease State Review

Zeph OkekeNikhil WaingankarSamih HayekArthur D Smith

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upper-pole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upper-pole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches. [ Rev Urol. 2014;16(1):29-43 doi: 10.3909/riu0581] © 2014 MedReviews®, LLC

UreterorenoscopyCalyceal diverticulaPercutaneous nephrostolithotomyLaparoscopic surgeryShock wave lithotripsy

UreteroscopicView Articles

Volume 18, Number 1Case Review

Ureteral Stone Associated With a Middle Blind Ending of a Bifid Ureter

Selahattin Caliskan

A blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter. [Rev Urol. 2016;18(1):54-56 doi: 10.3909/riu0688] © 2016 MedReviews®, LLC

Blind-ending bifid ureterUreteral duplicationUreteral stoneUreteroscopic

Ureteroscopic stone removalView Articles

Volume 17, Number 3Meeting Reviews

Highlights From the 2015 American Urological Association Annual Meeting, May 15-19, 2015, New Orleans, LA

Best of the 2015 AUA Annual Meeting

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelMichael A GorinMichael K BrawerHeinz NicolaiÁine Goggins

[Rev Urol. 2015;17(3):179-189 doi:10.3909/riu0681] © 2015 MedReviews®, LLC

Active surveillanceHypospadias4KscoreProlarisStress urinary incontinencePatient phenotypingChronic pelvic pain syndromeEXO106 testMRI/US fusion biopsyOxalobacter formigenesUreteroscopic stone removalDecipher assayRadiation cystitisOccult tethered cord syndromeMRI-guided biopsy

UreteroscopyView Articles
Ureterovesical junctionView 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