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Pressureflow studyView Articles
PrevalenceView Articles
PreventionView Articles
PriapismView Articles

Volume 19, Number 4Case Review

Cycling Trauma as a Cause of Arterial Priapism in Children and Teenagers

Aldo Franco De RoseIrene ParaboschiGuglielmo ManticaAlexander SzpytkoHilgard AckermannGiovanni De CaroCarlo TerroneGirolamo Mattioli

Bicycle riding has multiple beneficial cardiovascular effects; however, it is a well-documented source of significant urologic injuries. Priapism is a rare condition in children, and occurs primarily because of congenital hematologic diseases or adverse drug reactions. A pediatric clinical case and literature review of a high-flow priapism secondary to cycling trauma is described here to highlight their etiopathologic correlation. Bicycle riding trauma is a rare but possible cause of high-flow priapism in children, and a high index of suspicion should ensure appropriate management. [Rev Urol. 2017;19(4):273–277 doi: 10.3909/riu0768] © 2018 MedReviews®, LLC

PediatricTraumaPriapismCycling

Primary bladder neck obstructionView Articles
Primary care clinicianView Articles
Primary care cliniciansView Articles
Private practiceView Articles

Volume 23, Number 3Business of Urology

The Business of Independent Urologic Medicine: Caring for Patients While Operating a Business in a Post–COVID-19 Era of Private Practice

Nathan P. DillerMara Holton

Primum non nocere—“First, do no harm.” Independent medicine is challenged not only to achieve outcomes that patients value but also not to intentionally harm their business in the process. The COVID-19 pandemic and postpandemic regulatory environment have added new limitations on and restrictions to independent practices’ ability to innovate, grow, and provide stable access to meet their communities’ urologic needs. In the face of these challenges, independent medicine is at its strongest when it continues to press toward meeting its social contract with its community. Conversely, but just as importantly, society needs to be mindful of its social contract with the health care workforce.

UrologyPrivate practiceCOVID-19

Pro-inflammatory cytokineView Articles
Procedural and surgical site infectionView Articles

Volume 11, Number 4Review Articles

Skin Preparation for the Prevention of Surgical Site Infection: Which Agent Is Best?

Treatment Review

Herbert LeporMicah L Hemani

Procedural and surgical site infections create difficult and complex clinical scenarios. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure critical. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcohol-based solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for longer open surgeries with the potential for irrigation or surgical spillage, such as cystoprostatectomy, radical prostatectomy, and retroperitoneal lymph node dissection.[Rev Urol. 2009;11(4):190-195 doi: 10.3909/riu0467]© 2009 MedReviews®, LLC

Skin pathogensProcedural and surgical site infection

ProgesteroneView Articles
PrognosisView Articles
Prognostic factorsView Articles
ProgressionView Articles
ProlactinView Articles
ProlapseView Articles

Volume 18, Number 3Case Review

A Case of Pelvic Organ Prolapse in the Setting of Cirrhotic Ascites

Nima M ShahNatasha GinzburgKristene Whitmore

Ascites is commonly found in patients with liver cirrhosis. Although conservative therapy is often the ideal choice of care with these patients who also have symptomatic pelvic organ prolapse, this may fail and surgical methods may be needed. Literature is limited regarding surgical repair of prolapse in the setting of ascites. The authors present the surgical evaluation and management of a 63-year-old woman with recurrent ascites from liver cirrhosis who failed conservative therapy. With adequate multidisciplinary care and medical optimization, this patient underwent surgical therapy with resolution of her symptomatic prolapse and improved quality of life. [Rev Urol. 2016;18(3):178-180 doi: 10.3909/riu0702] © 2016 MedReviews®, LLC

AscitesCirrhosisProlapseColpocleisis

ProlarisView Articles

Volume 17, Number 3Meeting Reviews

Highlights From the 2015 American Urological Association Annual Meeting, May 15-19, 2015, New Orleans, LA

Best of the 2015 AUA Annual Meeting

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelMichael A GorinMichael K BrawerHeinz NicolaiÁine Goggins

[Rev Urol. 2015;17(3):179-189 doi:10.3909/riu0681] © 2015 MedReviews®, LLC

Active surveillanceHypospadias4KscoreProlarisStress urinary incontinencePatient phenotypingChronic pelvic pain syndromeEXO106 testMRI/US fusion biopsyOxalobacter formigenesUreteroscopic stone removalDecipher assayRadiation cystitisOccult tethered cord syndromeMRI-guided biopsy

ProMarkView Articles

Volume 19, Number 4Review Articles

The Use of Biomarkers in Prostate Cancer Screening and Treatment

Treatment Update

Joseph Renzulli IIAshley V AlfordJoseph M Brito IIIKamlesh K YadavShalini S YadavAshutosh K Tewari

Prostate cancer screening and diagnosis has been guided by prostate-specific antigen levels for the past 25 years, but with the most recent US Preventive Services Task Force screening recommendations, as well as concerns regarding overdiagnosis and overtreatment, a new wave of prostate cancer biomarkers has recently emerged. These assays allow the testing of urine, serum, or prostate tissue for molecular signs of prostate cancer, and provide information regarding both diagnosis and prognosis. In this review, we discuss 12 commercially available biomarker assays approved for the diagnosis and treatment of prostate cancer. The results of clinical validation studies and clinical decision-making studies are presented. This information is designed to assist urologists in making clinical decisions with respect to ordering and interpreting these tests for different patients. There are numerous fluid and biopsy-based genomic tests available for prostate cancer patients that provide the physician and patient with different information about risk of future disease and treatment outcomes. It is important that providers be able to recommend the appropriate test for each individual patient; this decision is based on tissue availability and prognostic information desired. Future studies will continue to emphasize the important role of genomic biomarkers in making individualized treatment decisions for prostate cancer patients. [Rev Urol. 2017;19(4):221–234 doi: 10.3909/riu0772] © 2018 MedReviews®, LLC

Prostate cancerBiomarkers4KscoreProlarisPCA3Prostate Health IndexApifinyMichigan Prostate ScoreSelectMDxConfirmMDxProMarkPTEN/TMPRSS2:ERGDecipher

Propensity scoreView Articles

Volume 20, Number 2Original Research

Balancing Confounding and Generalizability Using Observational, Real-world Data: 17-gene Genomic Prostate Score Assay Effect on Active Surveillance

Michael J KemeterPhillip G FebboSteven CanfieldJohn Hornberger

Randomized, controlled trials can provide high-quality, unbiased evidence for therapeutic interventions but are not always a practical or viable study design for certain healthcare decisions, such as those involving prognostic or predictive testing. Studies using large, real-world databases may be more appropriate and more generalizable to the intended target population of physicians and patients to answer these questions but carry potential for hidden bias. We illustrate several emerging methods of analyzing observational studies using propensity score matching (PSM) and coarsened exact matching (CEM). These advanced statistical methods are intended to reveal a “hidden experiment” within an observational database, and so refute or confirm a potential causal effect of assignment to an intervention and study outcome. We applied these methods to the Optum™ Research Database (ORD; Eden Prairie, MN) of electronic health records and administrative claims data to assess the effect of the 17-gene Genomic Prostate Score® (GPS™; Genomic Health, Redwood City, CA) assay on use of active surveillance (AS). In a traditional multivariable logistic regression, the GPS assay increased the use of AS by 29% (95% CI, 24%-33%). Upon applying the matching methods, the effect of the GPS assay on AS use varied between 27% and 80% and the matched data were significant among all algorithms. All matching algorithms performed well in identifying matched data that improved the imbalance in baseline covariates. By using different matching methods to assess causal inference in an observational database, we provide further confidence that the effect of the GPS assay on AS use is statistically significant and unlikely to be a result of confounding due to differences in baseline characteristics of the patients or the settings in which they were seen. [Rev Urol. 2018;20(2):69–76 doi: 10.3909/riu0799] © 2018 MedReviews, LLC®

Prostate cancerActive surveillanceEvidence-based practiceComparative effectiveness researchGenomic biomarkerPropensity scoreMatching

ProphylaxisView Articles

Volume 15, Number 2Review Articles

Management of Recurrent Urinary Tract Infections in Healthy Adult Women

Management Update

Victor W NittiDuane R Hickling

Recurrence after urinary tract infection (rUTI) is common in adult women. The majority of recurrences are believed to be reinfection from extraurinary sources such as the rectum or vagina. However, uropathogenic Escherichia coli are now known to invade urothelial cells and form quiescent intracellular bacterial reservoirs. Management of women with frequent symptomatic rUTI can be particularly vexing for both patients and their treating physicians. This review addresses available and promising management strategies for rUTI in healthy adult women. [Rev Urol. 2013;15(2):41-48 doi: 10.3909/riu0566] © 2013 MedReviews®, LLC

Recurrent urinary tract infectionUropathogenic Escherichia coliProphylaxis

proprietaryView Articles

Volume 23, Number 1Business of Urology

Physician-Owned Hospitals: A Look at the Numbers

Robert A. DowlingMara Holton

Physician-owned hospitals are sometimes characterized as examples of inappropriate self-referral. This perception contributes to legislation and regulation that constrain physician ownership. The true scope of physician ownership and its impact are incompletely understood. This study aimed to better define the current landscape of physician ownership in US hospitals to inform policy making in this area.

Ownershipfinancial managementproprietaryhospitals

Prostaglandin EView Articles

Volume 17, Number 2Review Articles

Penile Rehabilitation Strategies Among Prostate Cancer Survivors

Treatment Update

Fouad AounAlexandre PeltierRoland van Velthoven

Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. [Rev Urol. 2015;17(2):58-68 doi: 10.3909/riu0652] © 2015 MedReviews®, LLC

Prostate cancerErectile dysfunctionPenile rehabilitationPhosphodiesterase type 5 inhibitorProstaglandin E

ProstaScintView Articles
ProstateView Articles
Prostate adenocarcinomaView Articles

Volume 13, Number 1Case Review

Squamous Cell Carcinoma of the Prostate

Case Review

Samir S TanejaRena D MalikGeorge DakwarMatthew E HardeeNicholas SanfilippoAndrew B Rosenkrantz

"Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patientís disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival. [Rev Urol. 2011;13(1):56-60 doi: 10.3909/riu0494]"

Squamous cell carcinomaProstate adenocarcinomaLower urinary tractsymptomsMultimodal treatments

Prostate biopsiesView Articles

Volume 17, Number 3Review Articles

Impact of the US Preventive Services Task Force Grade D Recommendation: Assessment of Evaluations for Elevated Prostate-specific Antigen and Prostate Biopsies in a Large Urology Group Practice Followi

Treatment Impact Assessment

Gregory C McMahonGordon A BrownKathleen F McGinley

On October 7, 2011, the United States Preventive Services Task Force (USPSTF) released their evidence statement and grade D recommendation against prostate-specific antigen (PSA)–based prostate cancer screening. Using a time series design, we assessed the effect of this recommendation upon evaluations for elevated PSA levels and prostate biopsies in our large urology group practice. We found that, despite a 24.1% increase in total visits, the 32 urologists in our practice completed 16.4% fewer evaluations for elevated PSA levels (317 fewer evaluations per month; P = .017) and 21.4% fewer prostate biopsies (42 fewer biopsies per month; P = .001) in the 2 years following the USPSTF grade D recommendation. [Rev Urol. 2015;17(3):171-177 doi: 10.3909/riu0696] © 2015 MedReviews®, LLC

Prostate cancer screeningProstate-specific antigenProstate biopsiesUnited States

Prostate biopsyView Articles
Prostate brachytherapyView Articles
Prostate cancerView Articles

Volume 23, Number 1Literature Reviews

Methods for Prostate Cancer Risk Stratification: Serum-Based and Urine-Based Biomarkers for Biopsy Consideration

Alex S. BartRyan D. T. Badre-HumeMeghan E. RobertsGriffen KempskieAlyssa N. Giannasca

Prostate cancer (PCa) is one of the most commonly occurring cancers in men globally. In 2024, it is estimated that there will be 99 010 PCa diagnoses and 35 250 PCa-related deaths in American patients. Given the high incidence and virulence of the disease, proper screening methods are crucial to reduce overdiagnosis and overtreatment of PCa. Using biomarkers with high tumor sensitivity and specificity is therefore crucial to effectively distinguish PCa from benign tissue.

Prostate cancer

Prostate cancer antigen 3View Articles

Volume 10, Number 1Review Articles

Clinical Utility of Prostate Carcinoma Molecular Diagnostic Tests

Diagnostic Update

Scott B Shappell

Instead of relying on serum prostate-specific antigen (PSA) to identify patients for prostate biopsy, new laboratory tests are needed that have improved specificity for prostate carcinoma (CaP), allow accurate classification of clinically insignificant CaPs, allow for detection of clinically significant CaP in patients without elevated serum PSA, and allow for identification of aggressive forms of CaP, which may warrant adjunctive or even molecularly targeted therapy in the future. Over the last several years, highthroughput gene expression profiling and proteinomics have led to the identification of genes and proteins that are specifically overexpressed in CaP. Molecular diagnostic techniques readily translated to the clinical laboratory have been incorporated into the development of new tests based on these novel molecular alterations in CaP. Some of these tests already have well-documented clinical utility, such as in facilitating prostate biopsy decisions, and are routinely available. The current review focuses on the biological, clinical, and laboratory aspects of the most promising of these current and nearfuture molecular CaP tests. [Rev Urol. 2008;10(1):44-69]

Molecular diagnosticsProstate carcinomaProstate cancer antigen 3Alpha-methylacyl-CoA racemaseEarly prostate cancer antigenTransmembrane protease,serine 2ERGDNARNA