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Directory of Authors from the Journal and their last article.

R Scott BraithwaiteView Articles
Raavi GuptaView Articles

Volume 11, Number 1Case Review

Renal Involvement by Chronic Myelomonocytic Leukemia Requiring Nephroureterectomy

Samir S TanejaJonathan MelamedOjas D ShahElias S HyamsRaavi Gupta

Chronic monomyelocytic leukemia (CMML) is a relatively rare clonal hematologic disorder with features of myelodysplastic syndrome and myeloproliferative disease. Renal impairment from CMML is infrequent and can result from both direct (ie, infiltrative) and indirect (eg, vasculitis, infarction) mechanisms. This case report describes a patient with refractory gross hematuria requiring nephroureterectomy with diffuse involvement of the upper tract by CMML and accompanying extramedullary hematopoiesis. Underscored are the need to maintain a broad differential diagnosis for upper tract lesions in the setting of gross hematuria, and the potential need for drastic measures to control upper tract bleeding if conservative measures fail.[Rev Urol. 2009;11(1):33-37]

Gross hematuriaSecondary malignancy of kidneyLeukemia

Rachael D SussmanView Articles

Volume 21, Number 2Review Articles

Primary Bladder Neck Obstruction

Disease State Review

Benjamin M BruckerAlice DrainRachael D Sussman

Primary bladder neck obstruction (PBNO) is a functional obstruction caused by abnormal opening of the bladder neck during the voiding phase of micturition. PBNO may present with a variety of symptoms including voiding symptoms (slow urinary stream, intermittent stream, incomplete emptying), storage symptoms (frequency, urgency, urgency incontinence, nocturia), and/or pelvic pain and discomfort. The diagnosis of PBNO can be made with videourodynamic testing, which demonstrates elevated voiding pressures with low flow, and fluoroscopic imaging demonstrating obstruction at the level of the bladder neck. Treatment options include conservative management with watchful waiting, pharmacologic management, and surgical intervention. In this article, we review the etiology, presentation, diagnosis, and treatment of PBNO in men, women, and children. [Rev Urol. 2019;21(2/3):53–62] © 2019 MedReviews®, LLC

Lower urinary tract symptomsBladder outlet obstructionPrimary bladder neck obstruction

Rachel VancavageView Articles

Volume 23, Number 3Pediatric Urology

Recent Advances in Managing Pediatric Neurogenic Bladder due to Spina Bifida

Rachel VancavageAlexandra Rehfuss

Spina bifida is the most prevalent permanently disabling birth defect in the world. It results in damage to nerve endings that negatively affect bladder function and can potentially lead to kidney failure. Management of spina bifida continues to evolve, however, improving outcomes for patients with this condition.

Neurogenic bladderUrinary bladderSpinal dysraphismMyelomeningocele

Rafaela Saint-Clair Pimentel Mafra De OliveiraView Articles

Volume 16, Number 1Case Review

Metastatic Urethral Melanoma: Case Report and Review of the Literature

Luiz Ronaldo AlbertiBruno Moraes VasconcelosRafaela Saint-Clair Pimentel Mafra De Oliveira

Melanoma is a cancer that originates from melanocytes, is predominant in adults with white skin, represents 4% of skin cancers, and has high possibility of forming metastasis. This review reports on the case of a young man, age 36 years, previously diagnosed with melanoma. The patient complained of obstructive urinary symptoms and, while he was undergoing a cystoscopy, it was discovered that he had a lesion corresponding with metastatic melanoma of the prostatic urethra, which occluded almost the entire urethra and resulted in blocked urinary flow. He underwent a transurethral resection of the prostate, followed by resection of the lesion. After the procedure, he had good urinary flow and is currently on follow-up. [Rev Urol. 2014;16(1):47-49 doi: 10.3909/riu0584] © 2014 MedReviews®, LLC

UrethraMetastasisMelanomaUrinary obstructionUrethral melanoma

Ragi DoggweilerView Articles
Rahul K NathView Articles
Raj A PersadView Articles

Volume 17, Number 3Review Articles

Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice

Management Update

Sashi S KommuRobert McArthurAmr M EmaraUtsav D ReddyChristopher J AndersonNeil J BarberRaj A PersadChristopher G Eden

There has been a recent and near exponential increase in the use of hemostatic agents and sealants to supplement the rapidly evolving methods in the surgical management of urologic patients. This article reviews the use of hemostatic agents and sealants in current urologic practice. [Rev Urol. 2015;17(3):150-159 doi: 10.3909/riu0673] © 2015 MedReviews®, LLC

HemostasisTissue adhesionUrologic surgery

Rajeev KumarView Articles

Volume 9, Number 4Review Articles

Extending the Rationale of Combination Therapy to Unresponsive Erectile Dysfunction

Treatment Update

Rajeev KumarAjay NehraDiedre NienowChristopher Reece

Combination therapies aim to overcome the limitations of individual drugs by selecting diverse targets of action to enhance effectiveness synergistically. This article reviews the principles of combination therapy and its applications for benign prostatic hyperplasia and overactive bladder. It then examines pathophysiological, pharmacological, and clinical evidence for currently available drug and device combinations for erectile dysfunction that has not responded to first-line, single-agent therapy. [Rev Urol. 2007;9(4):197-206]

Benign prostatic hyperplasiaOveractive bladderErectile dysfunctionCombination therapyIntracavernosal therapyIntraurethral therapy

Rajeev MathurView Articles

Volume 16, Number 3Case Review

Occult Renal Cell Carcinoma Manifesting as Nasal Mass and Epistaxis

Sher Singh YadavJanak SinghVishwas BahetiRajeev Mathur

Metastasis of renal cell carcinoma (RCC) to the nasal cavity and paranasal sinuses is rare, with fewer than 50 cases described in the literature. Nasal metastasis as the initial presentation of RCC is even rarer. Metastases to the nasal cavity usually represent advanced disease with poor outcome. The authors report a case of metastatic RCC presenting with right nasal cavity mass and epistaxis, followed by a brief review of the relevant literature. [Rev Urol. 2014;16(3):145-148 doi: 10.3909/riu0607] © 2014 MedReviews®, LLC

Renal cell carcinomaNasal metastasisEpistaxis

Ralf HerwigView Articles

Volume 13, Number 3Review Articles

Peyronie’s Disease: Nonsurgical Therapy Options

Treatment Update

Franklin E KuehhasNenad DjakovicPeter WeiblTosev GeorgiRalf Herwig

Peyronie’s disease (PD) is a fibrous inelastic scar of the tunica albuginea, leading to penile deformity, penile curvature, shortening, narrowing, and painful erections that subsequently lead to painful or unsatisfying sexual intercourse. No consensus exists yet on the ideal management of PD. This fact is a result of our limited knowledge of its etiology and causative factors. The acute presentation of PD is treated conservatively, and surgical approachesare only attempted if severe curvature, narrowing, or indentation persists for more than 1 year; PD stability exists for at least 3 months; curvature impedes sexual intercourse; and severe penile shortening occurs. This review focuses on new developments for conservative treatment strategies for PD. [Rev Urol. 2011;13(3):139-146 doi: 10.3909/riu0528] © 2011 MedReviews®, LLC

Peyronie’s diseaseNonsurgical therapyOral medicationIntralesionaltherapyExtracorporeal shock wave therapyIontophoresisPenile traction systems

Raman TanwarView 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

Ramdev KonijetiView Articles

Volume 11, Number 3Case Review

Placenta Percreta and the Urologist

Jacob RajferRamdev KonijetiAsghar Askari

Placenta percreta, the rarest and most severe form of placenta accreta, caninvolve the urinary bladder. Because of its propensity for severe hemorrhage,it is a potentially life-threatening condition. Although commonly discoveredat the time of delivery, antenatal diagnosis may be achieved with ultrasound,magnetic resonance imaging, and/or cystoscopy. Every attempt should bemade to minimize potential for blood loss by avoiding removal of the placentaat the time of delivery and either performing a hysterectomy or usingmethotrexate therapy to ablate the residual placenta in the postpartum period.If hemorrhage does occur during delivery, immediate surgical removalof the uterus should be considered and, depending on the severity of thehemorrhage and the depth of invasion of the placenta into the bladder,excision and/or reconstruction of the bladder may be necessary.[Rev Urol. 2009;11(3):173-176 doi: 10.3909/riu0440]© 2009 MedReviews®, LLC

Placenta percretaPlacenta accretaBladder invasion

Rana R. McKayView Articles

Volume 23, Number 3Prostate Cancer

Darolutamide for the Management of Metastatic Hormone-Sensitive Prostate Cancer: A Urologist-Oncologist Perspective

Paul DatoRana R. McKay

Metastatic prostate cancer accounts for 8% of all prostate cancer cases in the United States and has an estimated 5-year survival rate of 34%. Androgen-deprivation therapy (ADT) is the cornerstone of treatment for men with metastatic hormone-sensitive prostate cancer (HSPC), but there has been a recent focus on early treatment intensification through dual- or triple-therapy approaches, which have shown substantial survival benefit compared with ADT alone. Darolutamide, a distinct androgen receptor inhibitor, is the latest treatment for men with metastatic HSPC. In the Darolutamide in Addition to Standard Androgen Deprivation Therapy and Docetaxel in Metastatic Hormone-Sensitive Prostate Cancer (ARASENS) trial (ClinicalTrials.gov identifier NCT02799602), darolutamide in combination with ADT and docetaxel reduced the risk of death by 32.5% (P < .001) compared with ADT plus docetaxel in men with metastatic HSPC. The most recent National Comprehensive Cancer Network guidelines (2023) support the use of triple-therapy regimens for men with high-volume metastatic HSPC, but concerns about the side effects of the short-term chemotherapy component of this regimen necessitate a comprehensive approach to providing supportive care to ensure that patients are willing to begin and remain on treatment. Effective management should involve a well-informed multidisciplinary team with patient education and support to ensure optimal treatment outcomes. Here, we review the results of the ARASENS trial and consider the implications for the management of metastatic HSPC. By showing a statistically significant reduction in risk of death, triple therapy combining darolutamide with ADT and docetaxel has emerged as a new treatment modality that may help men with metastatic HSPC achieve prolonged survival while maintaining an acceptable quality of life.

Prostatic neoplasmsDrug therapyNeoplasm metastasisAndrogen receptor antagonists

Randall B MeachamView Articles
Randy M ChudlerView Articles

Volume 17, Number 4Original Research

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

Jason HafronStephen M ZappalaDipen J ParekhDanielle OsterhoutJeffrey SchockRandy M ChudlerGregory M OldfordKenneth M KernenBadrinath R Konety

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&rsquo;s percentage risk (&lt; 1% to &gt; 95%) for aggressive prostate cancer (Gleason score &ge; 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 (&lt; 7.5%), intermediate risk (7.5%-19.9%), and high risk (&ge; 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 &lt; 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

Ranjith RamasamyView Articles

Volume 16, Number 3Review Articles

Management of Erectile Dysfunction in the Hypogonadal Man: A Case-Based Review

Management Review

Jason M ScovellRanjith RamasamyNathan A WilkenJason R KovacLarry I Lipshultz

Erectile dysfunction (ED) has emerged as an important marker of cardiovascular and overall health, independent of other known conventional risk factors. ED often precedes coronary artery disease in half of affected subjects, and could indicate the presence of cardiovascular pathology. The pathophysiology and role of androgens in sexual function are described, along with the relevant literature on the effects of aging in erectile and gonadal function. The concept of testosterone supplementation (TST) in men with ED is reviewed. The authors utilize clinical vignettes to discuss the appropriate management of two clinical cases of men at different life stages who have ED in the setting of hypogonadism and propose a treatment algorithm. In patients of all ages, proper identification of the underlying pathophysiology of decreased libido and erectile function is paramount in choosing between the use of TST, phosphodiesterase type 5 inhibitors, or both, in the management of these disorders. [Rev Urol. 2014;16(3):105-109 doi: 10.3909/riu0623] © 2014 MedReviews®, LLC

HypogonadismErectile dysfunctionTestosterone supplementationPhosphodiesterase

Raoul S ConcepcionView Articles

Volume 16, Number 3Review Articles

The Rationale for Optimal Combination Therapy With Sipuleucel-T for Patients With Castration-resistant Prostate Cancer

Treatment Review

Neal D ShoreRaoul S ConcepcionChristopher M PieczonkaVladimir MouravievNeil MariadosRobert B SimsMark Emberton

Immunotherapy encourages the recipient&rsquo;s own immune response to destroy cancer cells, and current evidence suggests that immunotherapies may be most beneficial in early metastatic castration-resistant prostate cancer (mCRPC). Sipuleucel-T is the first therapeutic cancer vaccine to be approved by both the US Food and Drug Administration and European Medicines Agency for the treatment of asymptomatic or minimally symptomatic mCRPC. Combining immunotherapy with other treatments may have potent anticancer effects; cytoreductive therapies can release tumor antigens and promote a proinflammatory environment that could augment immunotherapies. However, some cytoreductive agents or coadministered drugs may be immunosuppressive. Understanding these interactions between different mCRPC treatment modalities may offer further potential to improve patient outcomes. [Rev Urol. 2014;16(3):122-130 doi: 10.3909/riu0637] © 2014 MedReviews®, LLC

Prostate cancerSipuleucel-TCombination therapy

Raul I ClavijoView Articles

Volume 16, Number 4Review Articles

Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder?

Screening Update

Raul I ClavijoMartin MinerJacob Rajfe

An erection is a mechanical event dependent primarily on corporeal vascular dynamics wherein arterial inflow and storage of blood within the corpora is greater than the egress of blood from the corpora. The most common cause of erectile dysfunction (ED) is the inability of the corporal tissue to store the blood within the corporal sinusoids once inflow into the corpora begins. This failure to store is primarily due to a corporal smooth muscle dysfunction and, in most men, is most likely an aging-related occurrence. Because the corporal smooth muscle is embryologically and physiologically indistinguishable from the smooth muscle within our arterial system, the authors hypothesize that the aging-related dysfunction that occurs within the penis also occurs within the arterial system, and that this smooth muscle dysfunction within the arterial media is most likely the cause of what is called essential hypertension. This panvascular smooth muscle myopathy could explain why hypertension is the most common comorbidity associated with ED and appears to indicate that both ED and essential hypertension are the same disorder, albeit in two different organ systems. [Rev Urol. 2014;16(4):167-171 doi: 10.3909/riu0631] © 2014 MedReviews®, LLC

HypertensionErectionEndotheliumSmooth muscle

Ravi J KumarView Articles