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Directory of Authors from the Journal and their last article.

Michael LipkinView Articles

Volume 8, Supplement 4Review Articles

The Use of Alpha-Blockers for the Treatment of Nephrolithiasis

Advances in Alpha-Blocker Therapy in the Management of Urological Disorders

Ojas D ShahMichael Lipkin

Medical expulsion therapy has been shown to be a useful adjunct to observation in the management of ureteral stones. Alpha-1-adrenergic receptor antagonists have been studied in this role. Alpha-1 receptors are located in the human ureter, especially the distal ureter. Alpha-blockers have been demonstrated to increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage. Alphablockers promote stone passage in patients receiving shock wave lithotripsy, and may be able to relieve ureteral stent–related symptoms. In the appropriate clinical scenario, the use of a-blockers is recommended in the conservative management of distal ureteral stones. [Rev Urol. 2006;8(suppl 4):S35-S42]

Kidney stonesBlockersUreteral stones

Michael MarbergerView Articles
Michael McDonaldView Articles

Volume 19, Number 4Review Articles

A Head-to-Head Comparative Phase II Study of Standard Urine Culture and Sensitivity Versus DNA Next-generation Sequencing Testing for Urinary Tract Infections

Original Research

Vladimir MouravievDavid AlbalaMichael McDonaldDarian KamehMark E JohnsonTruls E Bjerklund Johansen

Many studies have discussed clinical practice guidelines for the treatment of cystitis and pyelonephritis. Treatment of uncomplicated urinary tract infections (UTIs) can be based on empiric antibiotic therapy. For complicated or recurrent UTIs, therapy can be based on laboratory-controlled culture and sensitivity (C&S) reports. The diagnosis of UTI by clinical criteria alone has an error rate of up to 33%. In addition, positive laboratory culture results do not always indicate a diagnosis of UTI. Comparison of urine in a conventional culture model versus DNA next-generation sequencing (NGS) to accurately identify and provide information on resistance factors (mobile genetic elements) is warranted. Our study was a head-to-head comparative phase II study of standard urine C&S versus DNA NGS testing for the diagnosis and treatment efficacy in patients with symptoms of acute cystitis based on short-term outcomes. [Rev Urol. 2017;19(4):213–220 doi: 10.3909/riu0780] © 2018 MedReviews®, LLC

Urinary tract infectionPyelonephritisCystitisDNA next-generation sequencing

Michael P O'LearyView Articles
Michael PaleseView Articles

Volume 13, Number 4Review Articles

A Review of Focal Therapy Techniques in Prostate Cancer: Clinical Results for High-Intensity Focused Ultrasound and Focal Cryoablation

Treatment Review

Colin IbertiNihal MohamedMichael Palese

The advancement of focal therapy technology for the treatment of prostate cancer (PCa) is emerging as an option for a middle ground between radical therapies and active surveillance for individuals identified with localized, low-grade PCa. Two promising techniques are high-intensity focused ultrasound (HIFU) and focal cryoablation. Both focal cryoablation and HIFU show promise, but additional prospective trials are necessary before any definitive conclusions can be made on either method’s viability. [Rev Urol. 2011;13(4):e196-e202 doi: 10.3909/riu0540] © 2011 MedReviews®, LLC

Prostate cancerHigh-intensity focused ultrasoundFocal cryoablation

Michael R PinsView Articles
Michael RiskView 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

Michael S BorofskyView Articles

Volume 17, Number 3Review Articles

The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy

Management Update

Ojas ShahHerbert LeporGanesh SivarajanMichael S BorofskyJames E Lingeman

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH. [Rev Urol. 2015;17(3):140-149 doi: 10.3909/riu0675] © 2015 MedReviews®, LLC

Lower urinary tract symptomsRobotic simple prostatectomyBenign prostatic hypertrophyGreenLight photovaporizationHolmium laser enucleation of the prostate (HoLEP)

Michael S CooksonView 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 S ManakView Articles

Volume 22, Number 4Review Articles

Application of Artificial Intelligence/Machine Vision & Learning for the Development of a Live Single-cell Phenotypic Biomarker Test to Predict Prostate Cancer Tumor Aggressiveness

Original Research

David M. AlbalaGrannum R SantJonathan S VarsanikMichael S ManakMatthew J WhitfieldBrad J HoganWendell R SuCJ JiangAshok C Chander

To assess the usefulness and applications of machine vision (MV) and machine learning (ML) techniques that have been used to develop a single cell–based phenotypic (live and fixed biomarkers) platform that correlates with tumor biological aggressiveness and risk stratification, 100 fresh prostate samples were acquired, and areas of prostate cancer were determined by post-surgery pathology reports logged by an independent pathologist. The prostate samples were dissociated into single-cell suspensions in the presence of an extracellular matrix formulation. These samples were analyzed via live-cell microscopy. Dynamic and fixed phenotypic biomarkers per cell were quantified using objective MV software and ML algorithms. The predictive nature of the ML algorithms was developed in two stages. First, random forest (RF) algorithms were developed using 70% of the samples. The developed algorithms were then tested for their predictive performance using the blinded test dataset that contained 30% of the samples in the second stage. Based on the ROC (receiver operating characteristic) curve analysis, thresholds were set to maximize both sensitivity and specificity. We determined the sensitivity and specificity of the assay by comparing the algorithm-generated predictions with adverse pathologic features in the radical prostatectomy (RP) specimens. Using MV and ML algorithms, the biomarkers predictive of adverse pathology at RP were ranked and a prostate cancer patient risk stratification test was developed that distinguishes patients based on surgical adverse pathology features. The ability to identify and track large numbers of individual cells over the length of the microscopy experimental monitoring cycles, in an automated way, created a large biomarker dataset of primary biomarkers. This biomarker dataset was then interrogated with ML algorithms used to correlate with post-surgical adverse pathology findings. Algorithms were generated that predicted adverse pathology with >0.85 sensitivity and specificity and an AUC (area under the curve) of >0.85. Phenotypic biomarkers provide cellular and molecular details that are informative for predicting post-surgical adverse pathologies when considering tumor biopsy samples. Artificial intelligence ML-based approaches for cancer risk stratification are emerging as important and powerful tools to compliment current measures of risk stratification. These techniques have capabilities to address tumor heterogeneity and the molecular complexity of prostate cancer. Specifically, the phenotypic test is a novel example of leveraging biomarkers and advances in MV and ML for developing a powerful prognostic and risk-stratification tool for prostate cancer patients. [Rev Urol. 2020;22(4):159–167] © 2021 MedReviews®, LLC

Prostate cancerArtificial intelligencePhenotypic biomarkersMachine visionMachine learning

Michael S SacksView Articles
Michael SchulsterView Articles

Volume 20, Number 1Review Articles

Differentiating Molecular Risk Assessments for Prostate Cancer

Risk Assessment Review

Michael SchulsterMarc A BjurlinBenjamin Press

It is critically important to the evolving goals of prostate biopsy to find clinically significant cancer with lethal potential and avoid detection of indolent disease. Better tests and markers are required for improved detection of clinically significant prostate cancer and avoidance of biopsies in men with indolent disease. Currently, there are myriad alternative prostate cancer risk-assessment tests available derived from serum and urine that are designed to improve the specificity for detection of “significant” prostate cancer. Herein we discuss these tests and their clinical implications. [Rev Urol. 2018;20(1):12–18 doi: 10.3909/riu0787] © 2018 MedReviews, LLC®

Prostate cancerScreeningProstate-specific antigenBiomarkersPSA

Michael ScordoView Articles

Volume 19, Number 1Review Articles

Revisiting the Role of Testosterone: Are We Missing Something?

Thereapeutic Update

Vineet TyagiMichael ScordoRichard S YoonFrank A LiporaceLoren Wissner Greene

Testosterone is a pleiotropic hormone that plays an important role in the human body. Classically, testosterone was thought to be predominantly involved in androgenesis and physiology in boys and men. Through its conversion to estrogen, testosterone affects bone health, including bone density. Recently, there has been a renewed interest in the systemic role of testosterone in pain, well-being, and cardiovascular function in women and men alike. In this review, we discuss the historic significance of testosterone, its traditionally known physiology, and its molecular and cellular effects. We also discuss evidence for testosterone’s lesser known effects, including its role in women’s health. We suggest a need to revisit the clinical role of testosterone given its potential for applications to treat mood, cognitive health, and other illnesses, and its anabolic role in bone and muscle; we also suggest consideration of the current debate on risks of its use. [Rev Urol. 2017;19(1):16-24 doi: 10.3909/riu0716] © 2017 MedReviews®, LLC

Coronary heart diseaseTestosterone replacement therapyTestosterone

Michael SkouterisView Articles

Volume 20, Number 1Original Research

Transrectal Ultrasound–guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison

Transrectal ultrasound guided prostate biopsy • Transperieneal mapping prostate biopsy • Complications

Vladimir MouravievE David CrawfordVassilios M SkouterisPaul AranguaMarios Panagiotis MetsinisMichael SkouterisGeorge ZacharopoulosNelson N Stone

Herein, the authors compare morbidity in men who underwent both transrectal ultrasound–guided (TRUS) prostate biopsy and transperineal mapping biopsy (TPMB) at two institutions with extensive experience in both procedures. We also identified strategies and predictive factors to reduce morbidity for both procedures. In our study, 379 men from two institutions, of which 265 (69.9%) had a prior TRUS-guided biopsy, also had TPMB performed via a template with biopsies taken at 5-mm intervals. Men in the TRUS group had a median of 12 cores sampled whereas the TPMB group had 51.5 (range, 16-151). The median biopsy density was 1.1 core/cc prostate volume. Median age and prostate-specific antigen (PSA) level were 65 years (range, 34-86) and 5.5 ng/mL (range, 0.02-118). Of these men, 11 of 265 (4.2%) who had TRUS biopsy developed urinary tract infection compared with 3 of 379 (0.79%) of those with mapping biopsy. Infection was 14.8% in TRUS biopsy group with 13 or more cores versus 2.9% in those with 12 or less (OR, 5.8; 95% CI, 1.6-21.2; P = 0.003). No men developed retention after TRUS biopsy whereas 30 of 379 (7.9%) did following TPMB. Older age, larger prostate volume (PV), and higher core number were associated with retention. On linear regression only age (P = 0.010) and PV (P = 0.016) remained as significant associations. Men older than 65 years had 12.8% versus 3.9% (OR, 3.7; 95% CI, 1.6-8.4, P = 0.001) and PV greater than 42 cc had 13.4% versus 2.7% (OR, 5.7; 95% CI, 2.1-15.1) retention incidence. In the present study TPMB is rarely associated with infection (0.78%) but more commonly with urinary retention (7.9%). Men older than 65 years and with PV greater than 42 cc were at four to five times greater retention risk. Consideration should be given to discharging these men with a urinary catheter following TPMB. [Rev Urol. 2018;20(1):19–25 doi: 10.3909/riu0785] © 2018 MedReviews, LLC®

ComplicationsTransrectal ultrasound guided prostate biopsyTransperieneal mapping prostate biopsy

Michael W KattanView Articles
Michel PontariView Articles
Michele AnthonyView Articles

Volume 12, Number 4Review Articles

State of the Art in Intravesical Therapy for Lower Urinary Tract Symptoms

State of the Art

Michael B ChancellorJonathan KaufmanVikas TyagiMichele AnthonyPradeep Tyagi

Intravesical therapy is the routine first-line treatment for effectively delaying or preventing the recurrence of bladder cancer. This route of drug administration has also shown tremendous promise in the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS) and potentially overactive bladder to justify investments for further improvements. This review takes a bird’s eye view into the current status of intravesical therapy, with emphasis on liposomal nanoparticles, in diseases associated with lower urinary tract symptoms (LUTS). Ongoing efforts to advance the field of intravesical drug delivery include development of sustained-release drug implants and efforts to improve delivery of biotechnological products including large protein acting as neurotoxins and small interfering RNAs.[Rev Urol. 2010;12(4):e181-e189 doi: 10.3909/riu0496]© 2010 MedReviews®, LLC

Lower urinary tract symptomsInterstitial cystitisIntravesical therapyPainful bladder syndrome

Michele BattagliaView Articles
Michelle BoytimView Articles

Volume 23, Number 1Literature Reviews

Comparison of Methods for Ureteral Patency Visualization

Michelle BoytimMatthew J. JonesAlex S. BartPavel Svintozelskiy

The most common cause of ureteral trauma occurs during open, laparoscopic, or endoscopic procedures across multiple specialties. Ureteral injuries are often unrecognized or mismanaged. Early recognition of ureteral injuries by cystoscopy allows for prompt intervention. Visualization can be enhanced using agents that color or improve the contrast of ureteral flow.

Cystoscopydiagnostic imagingindigo carminemethylene bluefluorescein

Mike HarikView Articles