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Directory of Authors from the Journal and their last article.

Tal CohenView 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

Tanveer Iqbal DarView Articles

Volume 17, Number 4Case Review

Effectiveness of Antegrade Access in Bladder Tumors With Inaccessible Urethra

Abdul Rouf KhawajaTanveer Iqbal DarSajad MaikJavaid MagrayAshiq BhatArif Hameed BhatMohdSaleem WaniBaldev Singh Wazir

Inaccessible urethra with no retrograde endoscopic access due to multiple/diffuse strictures or multiple urethrocutaneous fistulas with acute urinary retention due to posturethral instrumentation (transurethral resection of bladder tumor [TURBT], or TURBT with transurethral resection of the prostate [TURP]), is a rare entity. Management of such a case with a bladder tumor for TURBT/surveillance cystoscopy poses a great challenge. The authors present 12 cases of bladder tumor with inaccessible urethra, 10 cases due to multiple strictures (post-TURBT and/or TURP), and 2 cases due to urethrocutaneous fistulas (post-TURBT), who presented to our emergency department with acute urinary retention. Emergent suprapubic catheterization was used as a temporary treatment method. [Rev Urol. 2015;17(4):241-245 doi: 10.3909/riu0677] © 2016 MedReviews®, LLC

Bladder tumorsSuprapubic cystostomyInaccessible urethraTract seedling

Tanya B. DorffView Articles

Volume 23, Number 2Case of the Quarter

Case of the Quarter: Kaposi Sarcoma in a Patient With Testicular Germ Cell Tumor and HIV: A Case Report and Literature Review

Daniela V. CastroDonald HannounTanya B. DorffAlexander Chehrazi-RaffleWesley YipAbhishek TripathiBenjamin MercierRegina Barragan-CarrilloHedyeh EbrahimiSalvador Jaime-Casas

Testicular germ cell tumors are the leading cause of cancer in male patients 15 to 39 years old. Extensive treatments are available, and the regimen of choice depends on clinical, laboratory, and histopathologic characteristics. Patients with HIV are at increased risk of developing solid malignancies, including testicular germ cell tumors. All patients with HIV should start on highly active antiretroviral therapy, but the drug interactions between chemotherapy for testicular germ cell tumor and highly active antiretroviral therapy have not been extensively evaluated. This case review highlights the importance of optimal therapeutic agent selection in patients with HIV and solid malignancies.

Testicular neoplasmGerm cellHIVTesticular neoplasmsSarcoma

Taoufik HarmouchView Articles

Volume 9, Number 1Reviews in Urology

Solitary Fibrous Tumor of the Kidney: A Case Report and Review of the Literature

Case Review

Imane KamaouiAfaf AmartiSanae BennisLaila ChbaniHinde El FatemiTaoufik HarmouchFadl TaziKaoutar Znati

A solitary fibrous tumor (SFT) is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localization is rare, and only 19 cases of SFT of the kidney have been described. We report a case of a large SFT clinically thought to be renal cell carcinoma arising in the kidney of a 70-year-old man. The tumor was well circumscribed and composed of a mixture of spindle cells and dense collagenous bands, with areas of necrosis or cystic changes noted macroscopically and microscopically. Immunohistochemical studies revealed reactivity for CD34, CD99, and Bcl-2 protein, with no staining for keratin, S-100 protein, or muscle markers, confirming the diagnosis of SFT. This tumor is benign in up to 90% of cases. The immunohistochemical study is the key to diagnosis. [Rev Urol. 2007;9(1):36-40]

KidneyImmunohistochemical studyRenal neoplasmSpindle cells

Tatyana A ShamliyanView Articles

Volume 11, Number 3Review Articles

Male Urinary Incontinence: Prevalence, Risk Factors, and Preventive Interventions

Systematic Review

Tatyana A ShamliyanJean F WymanRyan PingTimothy J WiltRobert L Kane

Urinary incontinence (UI) in community-dwelling men affects quality of lifeand increases the risk of institutionalization. Observational studies and randomized,controlled trials published in English from 1990 to November 2007on the epidemiology and prevention of UI were identified in several databasesto abstract rates and adjusted odds ratios (OR) of incontinence, calculateabsolute risk difference (ARD) after clinical interventions, and synthesizeevidence with random-effects models. Of 1083 articles identified, 126 wereeligible for analysis. Pooled prevalence of UI increased with age to 21% to32% in elderly men. Poor general health, comorbidities, severe physicallimitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidenceinterval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95%CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI,1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI,0.08-0.25) resulted in greater self-reported benefit compared with placebo.Radical prostatectomy or radiotherapy for prostate cancer compared withwatchful waiting increased UI. Short-term prevention of UI with pelvic floormuscle rehabilitation after prostatectomy was not consistently seen acrossrandomized, controlled trials. The prevalence of incontinence increased with ageand functional dependency. Stroke, diabetes, poor general health, radiation, andsurgery for prostate cancer were associated with UI in community-dwellingmen. Men reported overall benefit from drug treatments. Limited evidence ofpreventive effects of pelvic floor rehabilitation requires future investigation.[Rev Urol. 2009;11(3):145-165 doi:10.3909/riu0416]© 2009 MedReviews, LLC

Risk factorsUrinary incontinenceRehabilitationDrug therapy

Ted LeeView Articles

Volume 15, Number 4Review Articles

Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer

Management Review

Herbert LeporTed LeeVinay PrabhuTyler R McClintock

Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer. [Rev Urol. 2013;15(4):161-177 doi: 10.3909/riu0604] © 2014 MedReviews®, LLC

Prostate cancerRadical prostatectomyHealth-related quality of life

Ted SmithView Articles
Thanmaya G ReddyView Articles

Volume 17, Number 3Review Articles

Optimizing Stone-free Rates With Ureteroscopy

Treatment Update

Dean G AssimosThanmaya G Reddy

Ureteroscopy is being increasingly utilized in the treatment and management of patients with renal and ureteral stones. Improving stone-free rates with ureteroscopy decreases the need for ancillary procedures and improves patient outcomes and satisfaction. This article reviews contemporary literature regarding the efficacy of a wide range of currently available techniques for improving stone-free rates with this procedure. [Rev Urol. 2015;17(3):160-164 doi: 10.3909/riu0665] © 2015 MedReviews®, LLC

UreteroscopyUpper urinary tract stonesStone-free rate

Theodore AnagnostouView Articles
Theresa A GuiseView 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

Thomas E KeaneView Articles

Volume 8, Supplement 1Review Articles

The Emergence of Radioimmunoscintigraphy for Prostate Cancer

Prostate Cancer Imaging

David G McLeodThomas E KeaneInger L RosnerM Scott Wingo

The ability to label tissue-specific antibodies has long been of interest for improving detection and guidance for therapeutic applications. The most studied target for prostate cancer is the prostate-specific membrane antigen, which is upregulated in prostate cancer, hormone-refractive disease, and prostate cancer metastases. Investigations using radioimmunoscintigraphy with the radiolabeled 7E11 antibody capromab pendetide have significantly improved sensitivity for prostate cancer detection compared with standard cross-sectional imaging, based on tissue confirmation of pathologic results. Over the past 5 years, significantly greater image resolution from improved camera technology and the use of co-registration to fuse functional and anatomic (computerized tomography and magnetic resonance imaging) images have dramatically enhanced prostate cancer localization. Outcomes data from several sources have spurred a resurgence in interest in this imaging modality. [Rev Urol. 2006;8(suppl 1):S20-S28]

Prostate cancerProstaScintProstate-specific membrane antigenRadioimmunoscintigraphyCapromab pendetideImage co-registrationLymph node metastasis

Thomas E MoodyView Articles

Volume 19, Number 2Review Articles

The American Urological Association’s Prostate Cancer Screening Guideline: Which Cancers Will Be Missed in Average-risk Men Aged 40 to 54 Years?

Cancer Screening Update

Thomas E MoodyCurtis L SpraitzarElizabeth EisenhartScott Tully Jr

To determine the impact of the American Urological Association’s (AUA) guideline for early detection of prostate cancer that recommends against routine screening in men aged 40 to 54 years at average risk (eg, white men without a family history of prostate cancer), we undertook a study of 973 men who previously underwent a prostate biopsy at Urology Centers of Alabama (UCA) over the 5-year period from 2010 to 2014. We retrospectively reviewed the results of the prostate biopsies performed by urologists at UCA—and, where applicable, the final surgical pathology results and compared the results by race and family history. In white men with a family history of prostate cancer, 47% had cancer and 30% had Gleason score (GS) ≥ 7 disease. In white men without a family history of prostate cancer, 32% had cancer and 23% had GS ≥ 7 disease. By comparison, in African American men with a family history of prostate cancer, 56% had cancer and 42% had GS ≥ 7 disease. In African American men without a family history, 42% had cancer and 29% had GS ≥ 7 disease. In our study, 144 of 456 (32%) of the group of average-risk men had cancer and 105 of 456 (23%) had GS ≥ 7 cancer. Had the AUA guidelines been followed, these cancers would have been missed or the diagnoses delayed. [Rev Urol. 2017;19(2):106–112 doi: 10.3909/riu0748] © 2017 MedReviews®, LLC

Prostate cancerProstate-specific antigenAUA screening guidelineAverage-risk men

Thomas E VellingView Articles
Thomas HeftyView Articles

Volume 18, Number 2Case Review

Endoscopic Management of Bladder Diverticula

Claudio JeldresKhanh N PhamThomas HeftyJohn M Corman

A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual ­ 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. [Rev Urol. 2016;18(2):114-117 doi: 10.3909/riu0701] © 2016 MedReviews®, LLC

Bladder diverticulumEndoscopicFulguration

Thomas HuebnerView Articles

Volume 19, Number 1Review Articles

Prostate Biopsy Characteristics: A Comparison Between Pre- and Post-United States Preventive Service Task Force Prostate Cancer Screening Guidelines of 2012

Cancer Screening Assessment

Navin ShahVladimir IoffeThomas HuebnerRichard Hum

This article compares prostate cancer (PCa) characteristics diagnosed by prostate biopsy in the years before and after the 2012 United States Preventative Service Task Force (USPSTF) recommendations against PCa screening. We completed a retrospective comparative analysis of 402 sequential PCa biopsy-diagnosed patients in 2010 to 2012 (3 years) with 269 PCa patients diagnosed in 2015 to 2016 (18 months). Data were collected on patient age, total number of biopsies performed, prostate-specific antigen level, Gleason sum score, and digital rectal examination results. The data were analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. [ Rev Urol. 2017;19(1):25-31 doi: 10.3909/riu0745] © 2017 MedReviews®, LLC

Prostate cancerCancer screening

Thomas J GuzzoView Articles

Volume 12, Number 4Case Review

Neuroendocrine Tumor of the Bladder

Alan J WeinShailen S SehgalZhanyong BingThomas J Guzzo

Small cell carcinoma (SCC) of the bladder is a rare and aggressive tumor associated with a poor prognosis. It often presents at a later stage than urothelial carcinoma of the bladder, and comprises less than 1% of bladder malignancies. A number of treatment algorithms have been used to treat bladder SCC, including cystectomy, partial cystectomy, radiotherapy, chemoradiotherapy, chemotherapy alone, and neoadjuvant/adjuvant chemotherapy. Presented is a case of SCC of the bladder, and the epidemiology, prognosis, and current treatment algorithms for patients with bladder SCC are reviewed.[Rev Urol. 2010;12(4):e197-e201 doi: 10.3909/riu0492]©2010 MedReviews®, LLC

Bladder cancerNeuroendocrine tumorsSmall cell carcinoma

Thomas J MuellerView Articles

Volume 19, Number 2Review Articles

Utilization of Individualized Prostate Cancer and Genomic Biomarkers for the Practicing Urologist

Management Update

Gregory C McMahonGordon A BrownThomas J Mueller

Prostate cancer encompasses a complex heterogeneous disease spectrum. Physicians and patients are faced with the ambiguity of who should be screened, biopsied, rebiopsied, treated, or provided with adjuvant therapy. Personalized outcomes and treatments are especially important given the varied nature of the disease, plethora of treatment options, risks of morbidity, and quality of life. Today’s practicing urologist has a multitude of tests from which to choose, creating the difficult task of appropriate use. This review focuses on two blood-, one urine-, and five genomic-based tests, which, when used in the appropriate clinical setting, can facilitate the patient-physician decision-making process. [Rev Urol. 2017;19(2):97–105 doi:10.3909/riu0730] © 2017 MedReviews®, LLC

Prostate cancerGenomic testsPersonalized medicine

Thomas J PolascikView Articles
Thomas M SchroederView Articles

Volume 19, Number 3Case Review

High Postprostatectomy Prostate-specific Antigen Level Prior to Salvage Radiation Therapy Is Not Always a Bad Sign

John T RathbunThomas M SchroederSteven C Eberhardt

Although radical prostatectomy is a popular treatment modality for clinically localized prostate cancer, 10-year biochemical recurrence can reach 28%. Before salvage radiation therapy (SRT), prostate-specific antigen (PSA) values alone should be used cautiously in predicting SRT eligibility. A long, slow PSA rise may suggest locally confined disease still amenable to SRT; corresponding imaging to identify potential gross recurrence is useful. Patients with local disease may safely benefit from higher doses of radiation. [Rev Urol. 2017;19(3):190–194 doi: 10.3909/riu0754] © 2017 MedReviews®, LLC

Prostate-specific antigenRadical prostatectomySalvage radiation therapy

Thomas M WheelerView Articles