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UrosepsisView Articles

Volume 12, Number 3Meeting Reviews

Best of the AUA Annual Meeting

Meeting Review

Dean G AssimosEllen ShapiroMichael B ChancellorJ Curtis NickelClaus G RoehrbornMichael K BrawerAkira Furuta

Highlights From the 2010 American Urological Association Meeting, May 29-June 3, 2010, San Francisco, CA [Rev Urol. 2010;12(2/3):e134-e146 doi: 10.3909/riu0500]

Autologous muscle-derived cellsNocturiaBotulinum toxinProstate-specific antigenUrosepsisShock wave lithotripsyTransrectal ultrasound prostateEscherichia coliSynthetic mesh slingProstatic urethral liftPRX3.02

Urothelial cancerView Articles

Volume 7, Number 3Meeting Reviews

Best of the AUA 2005 Annual Meeting

Meeting Review

Ellen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamArie S BelldegrunJohn P SteinJohn T LeppertJohn S LamStephen J Freedland

Prostate cancerBenign prostatic hyperplasiaBladder cancerKidney cancerLower urinary tract symptomsBotulinum toxinVesicoureteral refluxProstate-specific antigenOveractive bladderPeyronie’s diseaseNomogramsPediatric urologyCryptorchidismVasectomy reversalChronic prostatitisBlockers5-reductase inhibitorsTrospium chlorideRenal stonesProstate volumeMedical Therapy ofProstatic Symptoms (MTOPS) studyMinimally invasive therapiesPremature ejaculationProstate Cancer Prevention TrialTyrol PSA Screening ProjectUrothelial cancer

Urothelial carcinomaView Articles
Urothelial cell carcinomaView 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

Urothelial malignanciesView Articles

Volume 8, Number 4Review Articles

Diagnostic Utility of the ImmunoCyt/uCyt+ Test in Bladder Cancer

Diagnostic Update

Badrinath R KonetyAnna BerryKirsten L Greene

Bladder cancer is a common malignancy in the United States. Although urine cytology is a useful adjunct in both diagnosis and follow-up and is highly sensitive for detecting high-grade tumors, it is limited by decreased sensitivity in detecting low-grade tumors, which constitute the majority of new diagnoses. Additional screening tests with high sensitivity and specificity for urothelial tumors of all grades are indicated to help improve the diagnostic ability of urine cytology as well as to reduce the need for frequent cystoscopies, especially in those with low-risk disease. Several assays have been developed, with the ImmunoCyt/uCyt test (DiagnoCure, Inc., Québec, Canada) being especially promising. Recent studies on the applicability and efficacy of ImmunoCyt/uCyt testing are reviewed, as are its sensitivity, specificity, and predictive value in the follow-up and screening of urothelial malignancies. [Rev Urol. 2006;8(4):190-197]

Bladder cancerCystoscopyImmunoCyt/uCyttestUrothelial malignancies

Urothelial malignancyView Articles

Volume 19, Number 1Case Review

Bladder Cancer That Metastasized to the Skin: A Unique Presentation That Signifies Poor Prognosis

Tal CohenMark MemoDaniel Ricchiuti

In the United States in 2015, an estimated 74,000 new cases of bladder cancer were diagnosed and approximately 16,000 deaths were due to bladder cancer. We present a rare case of a patient with aggressive bladder cancer who presented with multiple inguinal and scrotal skin lesions that were proven to be metastatic urothelial malignancy. Bladder malignancy can involve the skin by direct tumor invasion, hematogenous routes, lymphatic spread, and direct seeding due to iatrogenic implantation. The cutaneous lesions have an extremely variable appearance, are resistant to therapies, and signify a dismal prognosis. [Rev Urol. 2017;19(1):68-71 doi: 10.3909/riu0740] © 2017 MedReviews®, LLC

Bladder cancerCutaneous metastasisUrothelial malignancy

Urothelial tumorsView Articles
UrotheliumView Articles
Urothelium, abnormalitiesView Articles
UryxView Articles
Uterine fibroidView Articles

Volume 16, Number 1Case Review

Bladder Leiomyoma Presenting With LUTS and Coexisting Bladder and Uterine Leiomyomata: A Review of Two Cases

Sudhir Kumar JainRaman TanwarAparajita Mitra

Mesenchymal tumors of the urinary bladder are a rare occurrence, the most common among them being leiomyoma of the bladder. These tumors commonly present with irritative urinary symptoms progressing gradually to obstructive symptoms as the size increases. We report on two patients who presented with lower urinary tract symptoms (LUTS). One of the patients also had concomitant bladder and uterine leiomyomata, which is the first such case to be reported in the literature. It is essential to differentiate leiomyoma from other common causes of LUTS. Cold cup biopsy has a significant false-negative rate and, in such cases, a wide local excision provides an optimal cure with excellent results. [Rev Urol. 2014;16(1):50-54 doi: 10.3909/riu0586] © 2014 MedReviews®, LLC

Lower urinary tract symptomsBladder leiomyomaUterine fibroid

Utilization trendsView Articles

Volume 15, Number 4Original Research

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

Deepak A KapoorAnn E AndersonCarl A OlssonSavvas E MendrinosDavid G Bostwick

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%—this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLC

Prostate cancerProstate biopsyUtilization trendsNational reference laboratory

VaccineView Articles

Volume 11, Number 1Review Articles

The Role of Immunotherapy in Prostate Cancer: An Overview of Current Approaches in Development

Treatment Review

John M CormanMichael Risk

Ongoing clinical trials provide promise for the introduction of immunotherapy into the armamentarium against prostate cancer, but the precise role for immunotherapy remains to be determined. Combinations of immunotherapies may be needed to improve the response rates and the duration of response. Investigators have begun to examine the effect of immunotherapy in combination with other standard treatment, including as an adjuvant to chemotherapy or radiotherapy and as a neoadjuvant agent before prostatectomy. Although many studies examine efficacy in men with metastatic hormone-refractory prostate cancer, there is some evidence for improved responses at earlier stages of disease: the ability of the tumor to evade the immune system may be lessened with lower tumor burden, or the immune system may already be weakened in men with later stages of disease.[Rev Urol. 2009;11(1):16-27]

Prostate cancerImmunotherapyVaccine

VaccinesView Articles
Vacuum constriction deviceView Articles

Volume 8, Number 4Review Articles

Penile Rehabilitation After Radical Prostatectomy: Important Therapy or Wishful Thinking?

Management Update

Jesse N MillsRandall B MeachamJoseph E Dall'EraHari K Koul

On the basis of data accumulated thus far, it is reasonable to discuss the implementation of a “penile rehabilitation” program with patients undergoing radical prostatectomy. Central to discussions of penile rehabilitation after radical prostatectomy is evidence demonstrating significant fibrotic changes in the corpus cavernosum that occur postoperatively. Several studies have been published evaluating the efficacy of various pro-erectogenic agents. The limited data regarding intracavernous injections and vacuum constriction devices suggest that an increased percentage of treated patients experienced a return of natural erections compared with patients who received no treatment. Longer, prospective, randomized, placebo-controlled studies will be needed to confirm the utility of these treatments. Data from contemporary studies evaluating the chronic use of oral phosphodiesterase type 5 inhibitors suggest a beneficial effect on endothelial cell function among men suffering from erectile dysfunction due to a variety of causes. Limited data suggest that this effect might be seen among post-prostatectomy patients, implying a possible role for these agents in enhancing the return of sexual function in such individuals. [Rev Urol. 2006;8(4):209-215]

Radical prostatectomyErectile dysfunctionPenile rehabilitationPDE-5 inhibitorsHypoxiaIntracorporeal injectionVacuum constriction device

Vacuum erection deviceView Articles
Vacuum erection devicesView Articles
Vacuum-assisted closure devicesView Articles

Volume 10, Number 1Case Review

Use of a Vacuum-Assisted Device for Fournier’s Gangrene: A New Paradigm

Case Review

Julia GrabowskiJ Kellogg ParsonsJonathan Silberstein

Fournier’s gangrene is a necrotizing infection of the scrotum or perineum that requires aggressive surgical debridement. Radical debridement of perineal necrotizing fasciitis can leave extensive tissue defects that are difficult to close and often require multiple surgical interventions. Vacuum-assisted closure (VAC) devices have been shown to assist in a more rapid closure of these wounds, but placement of such devices in the perineum can pose significant challenges. We have had success with use of VAC devices and report our techniques for their placement. [Rev Urol. 2008;10(1):76-80]

Fournier’s gangreneVacuum-assisted closure devices

Vaginal bleedingView Articles
Vaginal meshView Articles

Volume 18, Number 3Case Review

A Novel Approach to Mesh Revision After Sacrocolpopexy

Nima M ShahMelissa L DawsonRebecca RinkoKristene E Whitmore

Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery. [Rev Urol. 2016;18(3):174-177 doi: 10.3909/riu0698] © 2016 MedReviews®, LLC

Vaginal meshMesh erosionOmental flap mobilization

Value-based careView Articles

Volume 18, Number 3Review Articles

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care

Health Care Economics

Neal D ShoreDana Jacoby

Changes involving the health care economic landscape have affected physicians’ workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non–physician-owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations. [Rev Urol. 2016;18(3):143-150 doi: 10.3909/riu0726] © 2016 MedReviews®, LLC

Independent practiceCollaborationValue-based careSpecializationCompensation

Valves, urethralView Articles
VaporizationView Articles
VardenafilView Articles
VaricoceleView Articles
VaricocelectomyView Articles
VarioceleView Articles
Vascular 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

Vascular targeted 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

Vasectomy reversalView Articles

Volume 7, Number 3Meeting Reviews

Best of the AUA 2005 Annual Meeting

Meeting Review

Ellen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamArie S BelldegrunJohn P SteinJohn T LeppertJohn S LamStephen J Freedland

Prostate cancerBenign prostatic hyperplasiaBladder cancerKidney cancerLower urinary tract symptomsBotulinum toxinVesicoureteral refluxProstate-specific antigenOveractive bladderPeyronie’s diseaseNomogramsPediatric urologyCryptorchidismVasectomy reversalChronic prostatitisBlockers5-reductase inhibitorsTrospium chlorideRenal stonesProstate volumeMedical Therapy ofProstatic Symptoms (MTOPS) studyMinimally invasive therapiesPremature ejaculationProstate Cancer Prevention TrialTyrol PSA Screening ProjectUrothelial cancer