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Directory of Authors from the Journal and their last article.

Jeffrey L CornellaView Articles
Jeffrey P WeissView Articles

Volume 14, Number 3Review Articles

Nocturia: Focus on Etiology and Consequences

Disease State Review

Jeffrey P Weiss

Nocturia is a condition characterized by the need to awaken ≥ 1 times per night to void. Although nocturia is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine. Many people with nocturia do not seek help, accepting it as a natural consequence of aging. However, nocturia is common in men and women of all ages and has a profound impact on quality of life, especially in the young, that may be associated with increased morbidity and mortality. Nocturia as a condition deserves public health attention. [Rev Urol. 2012;14(3/4):48-55 doi: 10.3909/riu0576] © 2013 MedReviews®, LLC

NocturiaQuality of lifeSleep disruptionNighttime urine overproduction

Jeffrey P WoltersView 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

Jeffrey SchockView Articles

Volume 17, Number 4Original Research

The 4Kscore® Test Reduces Prostate Biopsy Rates in Community and Academic Urology Practices

Kenneth M KernenStephen M ZappalaJason HafronBadrinath R KonetyGregory M OldfordRandy M ChudlerJeffrey SchockDanielle OsterhoutDipen J Parekh

There is significant concern regarding prostate cancer screening because of the potential for overdiagnosis and overtreatment of men who are discovered to have abnormal prostate specific antigen (PSA) levels and/or digital rectal examination (DRE) results. The 4Kscore® Test (OPKO Diagnostics, LLC) is a blood test that utilizes four kallikrein levels plus clinical information in an algorithm to calculate an individual’s percentage risk (< 1% to > 95%) for aggressive prostate cancer (Gleason score ≥ 7) on prostate biopsy. The 4Kscore Test, as a follow-up test after abnormal PSA and/or DRE test results, has been shown to improve the specificity for predicting the risk of aggressive prostate cancer and reduce unnecessary prostate biopsies. A clinical utility study was conducted to assess the influence of the 4Kscore Test on the decision to perform prostate biopsies in men referred to urologists for abnormal PSA and/or DRE results. The study population included 611 patients seen by 35 academic and community urologists in the United States. Urologists ordered the 4Kscore Test as part of their assessment of men referred for abnormal PSA and/or DRE test results. Results for the patients were stratified into low risk (< 7.5%), intermediate risk (7.5%-19.9%), and high risk (≥ 20%) for aggressive prostate cancer. The 4Kscore Test results influenced biopsy decisions in 88.7% of the men. Performing the 4Kscore Test resulted in a 64.6% reduction in prostate biopsies in patients; the actual percentage of cases not proceeding to biopsy were 94.0%, 52.9%, and 19.0% for men who had low-, intermediate-, and high-risk 4Kscore Test results, respectively. A higher 4Kscore Test was associated with greater likelihood of having a prostate biopsy (P < 0.001). Among the 171 patients who had a biopsy, the 4Kscore risk category is strongly associated with biopsy pathology. The 4Kscore Test, as a follow-up test for an abnormal PSA and/or DRE results, significantly influenced the physician and patient shared decision in clinical practice, which led to a reduction in prostate biopsies while increasing the probability of detecting aggressive cancer. [Rev Urol. 2015;17(4):231-240 doi: 10.3909/riu0699] © 2016 MedReviews®, LLC

Prostate cancerProstate-specific antigen4KscoreGleason scoreDigital rectal examinationBiopsy rateProstate cancer prognosis

Jennifer J ShoobridgeView Articles

Volume 13, Number 2Review Articles

Contemporary Management of Renal Trauma

Management Update

Jim KoukounarasKatherine A MartinNiall M CorcoranJennifer J ShoobridgePeter L RoyceMatthew F Bultitude

In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach to facilitate the care of patients with renal injury. [Rev Urol. 2011;13(2):65-72 doi: 10.3909/riu0512] © 2011 MedReviews®, LLC

NephrectomyRenal injuryBlunt traumaAngiogenesis

Jennifer KongView Articles

Volume 13, Number 3Review Articles

Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

Management Review

Niall CorcoranAlex CatoRussell GruenJennifer KongMatthew F BultitudePeter L Royce

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.[Rev Urol. 2011;13(3):119-130 doi: 10.3909/riu0521] © 2011 MedReviews®, LLC

UrethraMultiple traumaRuptureUrinary bladderWounds

Jeremy B MyersView Articles
Jeremy PW HeatonView Articles
Jeremy SlawinView Articles

Volume 16, Number 4Case Review

Intratesticular Epidermoid Cyst Masquerading as Testicular Torsion

Jeremy SlawinKevin M Slawin

Epidermoid cysts are benign tumors that comprise approximately 1% of all testicular masses. They usually present as painless masses that can be identified on scrotal ultrasound as well-demarcated intratesticular lesions with mixed echogenicity. This case report describes a rare presentation of an extremely large intratesticular epidermoid cyst with clinical and radiologic findings more consistent with testicular torsion. The sizeable cyst obliterated the surrounding testicular parenchyma, causing it to appear on scrotal Doppler ultrasound as a testicle devoid of blood flow. This obliteration also resulted in failure to identify a testicular mass on physical examination or imaging. The current literature contains previous reports of extratesticular epidermoid cysts presenting as torsion; however, this is the first report of an intratesticular epidermoid cyst presenting in this manner. Though smaller cysts may be managed effectively with testicular-sparing surgery, optimal management of a cyst this size requires orchiectomy. [Rev Urol. 2014;16(4):198-201 doi: 10.3909/riu0633] © 2014 MedReviews®, LLC

Epidermoid cystTesticular torsionAcute testicular painIntratesticularDoppler

Jerome B RiebmanView Articles

Volume 17, Number 1Original Research

Hemostasis During Urologic Surgery: Fibrin Sealant Compared With Absorbable Hemostat

Bogdan IlieRichard KocharianJerome B RiebmanDavid M. AlbalaJessica ShenJonathan BatillerLiza OvingtonJohn Albanese

In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components—fibrinogen and thrombin—that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding. [Rev Urol. 2015;17(1):25-30 doi: 10.3909/ricm0647] © 2015 MedReviews®, LLC

BleedingHemostasisHemostaticsFibrin tissue adhesiveUrologic surgical proceduresSurgical technique

Jerome PietrasView Articles

Volume 14, Number 1Case Review

Adult Wilms’ Tumor With a Unique Presentation of High-Grade Fever, Photophobia, and Headache

Marcella NachmannJerome PietrasJay Krishnan

Wilms’ tumor is the second most common tumor in children, accounting for 6% to 7% of all childhood tumors. However, in adults, it is a rare occurrence. The true incidence of adult Wilms’ tumor is difficult to ascertain because of its rarity in the adult population. A review of literature demonstrates that fewer than 300 cases have been reported worldwide. Treatment guidelines in adults have not been established, although reported prognosis is worse for adults compared with children because the disease is more advanced in adults at the time of diagnosis. Reported here is a case of adult Wilms’ tumor presenting as high-grade fever and abnormal laboratory values. [ Rev Urol. 2012;14(1/2):31-34 doi: 10.3909/riu0541] © 2012 MedReviews®, LLC

Wilms’ tumorRenal massOpen radical nephrectomyMultimodal therapy

Jerry A RajuView Articles

Volume 17, Number 4Case Review

Acromegaly Presenting as Erectile Dysfunction: Case Reports and Review of the Literature

Rousseau GamaJohn A InglisKate E ShipmanJerry A Raju

Erectile dysfunction (ED) is a common yet complex condition. The authors report two cases of acromegaly presenting with ED and hypogonadotropic hypogonadism. Surgical cure of the acromegaly was associated with either an improvement or resolution of hypogonadotropic hypogonadism-associated ED. Active acromegaly should be considered in the differential diagnosis of ED presenting with supporting clinical features, particularly hypogonadotropic hypogonadism. [Rev Urol. 2015;17(4):246-249 doi: 10.3909/riu0676] © 2016 MedReviews®, LLC

Erectile dysfunctionEndocrine dysfunctionEndocrinologyAcromegalyGrowth hormone

Jerry J KimView Articles

Volume 13, Number 2Case Review

Malignant Priapism Secondary to Metastatic Prostate Cancer: A Case Report and Review of Literature

Mohit KheraNed B SteinJerry J KimYu-Hsiang Lin

Penile metastasis of cancers from other primary sites is a rare phenomenon that infrequently manifests as malignant priapism. We outline a case of an 84-year-old patient who presented with a 3-month history of painful priapism after radiation therapy for prostate adenocarcinoma. The patient underwent surgical penile exploration and cavernosal biopsy that revealed poorly differentiated cells suggestive of prostate cancer. Postoperative imaging demonstrated extensive regional and distal metastases. A review of the literature on penile metastases returned approximately 400 published cases, with priapism being the initial presentation in 20% to 50% of cases. Regardless of site of origin or subsequent management, most cases have shown very poor prognosis. [Rev Urol. 2011;13(2):90-94 doi: 10.3909/riu0508] © 2011 MedReviews®, LLC

Prostate cancerMalignant priapismPenile metastasis

Jerry WaismanView Articles
Jerry YuanView Articles

Volume 17, Number 2Case Review

Genitourinary Presentation of Tuberculosis

Jerry Yuan

Tuberculosis (TB) is less common in developed countries; however, the incidence of TB—especially resistant strains—is on the rise worldwide. Cases of TB manifesting as urologic complications are rare in the United States. Urologists should be aware of this potential manifestation, especially in patients who have recently immigrated to the United States or have traveled abroad for prolonged periods. Two cases are presented here to illustrate this entity. [Rev Urol. 2015;17(2):102-105 doi: 10.3909/riu0679] © 2015 MedReviews®, LLC

TuberculosisGenitourinary complications

Jesse N MillsView Articles
Jesse SammonView Articles

Volume 18, Number 1Review Articles

Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives

Management Update

Firas AbdollahJesse SammonAkshay SoodBjörn LöppenbergDeepansh Dalela

We performed a systematic literature search to identify original articles and editorials about the Decipher® Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level. [Rev Urol. 2016;18(1):1-9 doi: 10.3909/riu0706] © 2016 MedReviews®, LLC

Prostate cancerDecipher® Prostate Cancer TestGenomic classifierNeoplasm recurrenceLocal/surgeryTreatment outcome

Jessica E. ScholeyView 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

Jessica N LangeView Articles

Volume 14, Number 3Case Review

Multibacterial Growth From a Surgical Renal Stone Culture: A Case Report and Literature Review

Majid MirzazadehPatrick W MufarrijJessica N LangeRoss P HolmesDean G Assimos

Urinary calculi may harbor bacteria, and this may lead to deleterious events during stone fragmentation and removal. The isolation of such bacteria from surgically extracted calculi allows for the specific tailoring of antimicrobial therapy. Here, we describe a case involving percutaneous stone removal from which the stone culture demonstrated growth of five different microorganisms. The results of this culture prompted a change in the antibiotic coverage, resulting in a more targeted treatment and improved patient care. [Rev Urol. 2012;14(3/4):108-114 doi: 10.3909/riu0561] © 2013 MedReviews®, LLC

Urinary tract infectionNephrolithiasisStone culture

Jessica ShenView Articles

Volume 17, Number 1Original Research

Hemostasis During Urologic Surgery: Fibrin Sealant Compared With Absorbable Hemostat

Bogdan IlieRichard KocharianJerome B RiebmanDavid M. AlbalaJessica ShenJonathan BatillerLiza OvingtonJohn Albanese

In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components—fibrinogen and thrombin—that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding. [Rev Urol. 2015;17(1):25-30 doi: 10.3909/ricm0647] © 2015 MedReviews®, LLC

BleedingHemostasisHemostaticsFibrin tissue adhesiveUrologic surgical proceduresSurgical technique