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Directory of Authors from the Journal and their last article.

Michael C OstView Articles

Volume 19, Number 2Review Articles

The Use of Intraoperative Cell Salvage in Urologic Oncology

Surgical Update

Andres F CorreaMatthew C FerroniTimothy D LyonBenjamin J DaviesMichael C Ost

Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes. [Rev Urol. 2017;19(2):89–96 doi: 10.3909/riu0721] © 2017 MedReviews®, LLC

Urologic oncologyCell salvagetransfusion

Michael CarducciView Articles
Michael ConlinView Articles
Michael D StifelmanView Articles
Michael D WeilView Articles
Michael DobrovitsView Articles

Volume 5, Number 3Meeting Reviews

Best of the 2003 AUA Annual Meeting

Highlights from the 2003 Annual Meeting of the American Urological Association, April 26-May 1, 2003

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerRandall B MeachamBob DjavanArie S BelldegrunAllan J PantuckMesut RemziMichael DobrovitsMatthew B GretzerKazumasa Torimoto

Prostate cancerRenal cell carcinomaBenign prostatic hyperplasiaDepressionBladder cancerLower urinary tract symptomsUrinary tract infectionProstate-specific antigenNephrolithiasisOveractive bladderRadical prostatectomyPeyronie’s diseaseGleason scoreTransrectal ultrasoundErectile dysfunctionChronic prostatitis/chronic pelvic pain syndromeAcute urinary retentionInternational Prostate Symptom ScoreBacille Calmette-Guérin therapyChronic Prostatitis Symptom IndexMTOPS trialPLESS studyProstate tumor markersSELDI-TOF

Michael E AldridgeView Articles

Volume 8, Number 3Meeting Reviews

Best of the 2006 AUA Annual Meeting

Meeting Review

Danil V MakarovEllen ShapiroAlan W PartinMichael B ChancellorVictor W NittiJ Curtis NickelJacob RajferClaus G RoehrbornMichael K BrawerArie S BelldegrunJohn P SteinJohn P MulhallTobias KlatteMichael E AldridgeLi-Ming SuShachi Tyagi

Highlights from the 2006 Annual Meeting of the American Urological Association May 20–25, 2006 Atlanta, GA

Prostate cancerInfertilityBenign prostatic hyperplasiaBladder cancerKidney cancerLower urinary tract symptomsBladder exstrophyOveractive bladderInterstitial cystitisStress urinary incontinencePeyronie’s diseaseSpina bifidaNeurogenic bladderErectile dysfunctionChronic pelvic pain syndromeChronic prostatitisTumor markersAndrogen replacement therapyEjaculatory dysfunctionAnorectal malformationsRenal stonesRobotic-assisted radical prostatectomy

Michael FowlerView Articles
Michael G OefeleinView Articles

Volume 9, Number 4Review Articles

Estrogenic Side Effects of Androgen Deprivation Therapy

Treatment Update

Michael S CooksonJames A EasthamTheresa A GuiseMichael G OefeleinMatthew R SmithCelestia Higano

Androgen deprivation therapy (ADT) is part of standard therapy for locally advanced or metastatic prostate cancer and is frequently used in men with a rising prostate-specific antigen following radical prostatectomy or radiation therapy. In some men, ADT may be administered for years or even decades. The intended therapeutic effect of ADT is testosterone deficiency. Because estrogen is a normal metabolite of testosterone, ADT also results in estrogen deficiency. ADT has a variety of adverse effects, many of which are primarily related to estrogen deficiency. Bone mineral density may decrease by 4% to 13% per year in men receiving ADT. The fracture rate for patients on ADT averages 5% to 8% per year of therapy. Hot flashes, gynecomastia, and breast tenderness are common side effects associated with ADT. In the clinic, minimum baseline testing should include weight measurement, blood pressure reading, and fasting lipid panel and serum glucose tests. Currently, there are no large outcome trials in men on ADT testing the available therapies for adverse effects. No therapies are specifically approved for treatment of adverse effects in men on ADT. Although some therapies can be used for a single indication (based upon small studies), there is currently no agent to treat the multiple estrogenic side effects of ADT. [Rev Urol. 2007;9(4):163-180]

Androgen deprivation therapyCardiovascular diseaseGynecomastiaOsteoporosis fractureMale hot flashes

Michael GrassoView Articles
Michael HilesView Articles
Michael J ConsoloView Articles

Volume 18, Number 4Review Articles

Barriers to Accessing Urethroplasty

Treatment Update

David O SussmanGordon A BrownMichael J ConsoloKirin K SyedChristopher RobisonJacob McFaddenDavid I ShalowitzBradley D Figler

Urethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n = 13, 15%) and concern about complications (n = 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training. [Rev Urol. 2016;18(4):188-193 doi: 10.3909/riu0731] © 2016 MedReviews®, LLC

UrethroplastyUrethral stricturesBarriersPhysician practice patterns

Michael J HarrisView Articles
Michael J KemeterView Articles

Volume 16, Number 4Review Articles

A Guide for Clinicians in the Evaluation of Emerging Molecular Diagnostics for Newly Diagnosed Prostate Cancer

Diagnosis Update

Michael J KemeterPhillip G FebboSteven E CanfieldAdam S KibelH Jeffrey LawrenceJudd W Moul

Prostate-specific antigen (PSA) screening is associated with a decline in prostate cancerrelated mortality. However, screening has also led to overdiagnosis and overtreatment of clinically insignificant tumors. Recently, certain national guidelines (eg, US Preventive Services Task Force) have recommended against PSA screening, which may lead to a reverse-stage migration. Although many prostate tumors are indolent at presentation, others are aggressive and are appropriate targets for treatment interventions. Utilization of molecular markers may improve our ability to measure tumor biology and allow better discrimination of indolent and aggressive tumors at diagnosis. Many emerging commercial molecular diagnostic assays have been designed to provide more accurate risk stratification for newly diagnosed prostate cancer. Unfamiliarity with molecular diagnostics may make it challenging for some clinicians to navigate and interpret the medical literature to ascertain whether particular assays are appropriately developed and validated for clinical use. Herein, the authors provide a framework for practitioners to use when assessing new tissue-based molecular assays. This review outlines aspects of assay development, clinical and analytic validation and clinical utility studies, and regulatory issues, which collectively determine whether tests (1) are actionable for specific clinical indications, (2) measurably influence treatment decisions, and (3) are sufficiently validated to warrant incorporation into clinical practice. [Rev Urol. 2014;16(4):172-180 doi: 10.3909/riu0644] © 2014 MedReviews®, LLC

Prostate cancerBiomarkerClinical utilityGenomic prostate scoreAdverse pathologyClinical validationMolecular diagnostics

Michael J KennellyView Articles

Volume 10, Number 3Review Articles

Overactive Bladder: Pharmacologic Treatments in the Neurogenic Population

Treatment Update

Michael J KennellyWilliam B DeVoe

Patients with neurologic disease commonly develop overactive bladder (OAB) symptoms of urgency, frequency, and/or urge incontinence. Although treatment for idiopathic OAB has been extensively studied, therapy for those individuals with neurogenic-mediated OAB has not been thoroughly evaluated. Included in the present article is a description of micturition neurophysiology and a neurourologic evaluation scheme. The pharmacologic treatment options for neurogenic OAB, mainly antimuscarinics and chemical denervation, are reviewed and important studies are discussed. Management of OAB in the neurogenic population is a complex issue with no uniform treatment strategy, and individualized treatment with first-line pharmacologic therapy is often recommended. [Rev Urol. 2008;10(3):182-191]

Overactive bladderNeurogenic bladderDetrusor overactivity

Michael J LeveridgeView Articles

Volume 16, Number 3Review Articles

The Emerging Role of Social Media in Urology

Technology Update

Michael J Leveridge

Social media have become so integrated into modern communications as to be universal in our personal and, increasingly, professional lives. Recent examples of social media uptake in urology, and the emergence of data to quantify it, reveal the expansion of conventional communication routes beyond the in-person forum. In every domain of urologic practice, from patient interaction through research to continuing professional development, the move online has unlocked another layer of conversation, dissemination, and, indeed, caveats. Social media have a democratizing effect, placing patients, trainees, practitioners, and thought leaders in the same arena and on equal footing. If uptake of social media in medicine even remotely parallels its rise to ubiquity in other areas, it will only expand and evolve in the coming years. For these reasons, this article presents an overview of the most recent data on the impact and potential complications of social media usage in the urologic community. [Rev Urol. 2014;16(3):110-117 doi: 10.3909/riu0640] © 2014 MedReviews®, LLC

Social mediaUrologic practiceEducationContinuing professional developmentResearch

Michael J WagnerView Articles

Volume 21, Number 2Case Review

Intraperitoneal Rupture of a Synovial Sarcoma of the Kidney

Andrew StammPaul KozlowskiNeal ContiSemra OlgacJohn Paul FloresMichael J Wagner

Primary renal synovial sarcoma is an aggressive, extremely rare disease. Nearly all reported cases are characterized by SYT-SSX gene translocation (X;18)(p11;q11). We describe the case of a 43-year-old woman who presented with an intraperitoneal rupture of this rare sarcoma followed by a right radical nephrectomy. Follow-up imaging 1 month after surgery revealed peritoneal carcinomatosis. She began systemic chemotherapy with doxorubicin and dacarbazine, progressed after 3 months, and is currently receiving single-agent ifosfamide. Only one instance of intraperitoneal rupture has been reported previously. This case report contributes to the characterization of this rare disease. [Rev Urol. 2019;21(2/3):141–143] © 2019 MedReviews®, LLC

Kidney cancerOncologyRenal synovial sarcoma

Michael J. ShannonView Articles

Volume 23, Number 2Bladder Cancer

Integrating JELMYTO (Mitomycin) for Pyelocalyceal Solution Into Community Practice: Practical Tips for the Urologist

Michael J. ShannonSandip M. Prasad

Treatment options for upper-tract urothelial carcinoma are based on whether the patient has high-risk or low-risk disease. Low-grade tumors can be managed with nephron-sparing approaches, including ureteroscopic resection and ablation, although most patients undergoing endoscopic treatment of upper-tract urothelial cancers face a risk of recurrence. Mitomycin gel for pyelocalyceal solution provides an effective alternative therapy. In OLYMPUS, a phase 3, single-arm, open-label study, 58% of patients with low-grade disease experienced a complete response to induction therapy at 3 months. Kaplan-Meier analysis revealed an estimated 12-month durable response rate of 82%. The most common treatment-emergent adverse events were ureteric stenosis, urinary tract infection, hematuria, and flank pain (grade <3). Mitomycin gel offers a novel, kidney-sparing, nonoperative approach to managing low-grade upper-tract urothelial carcinoma.

MitomycinUrologyDrug therapyUrinary tractCarcinomaUrologic neoplasmsurinary bladder neoplasms

Michael K BrawerView Articles
Michael L RitcheyView Articles