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Skin reactionsView Articles
Sleep disruptionView Articles

Volume 14, Number 3Review Articles

Nocturia: Focus on Etiology and Consequences

Disease State Review

Jeffrey P Weiss

Nocturia is a condition characterized by the need to awaken ≥ 1 times per night to void. Although nocturia is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine. Many people with nocturia do not seek help, accepting it as a natural consequence of aging. However, nocturia is common in men and women of all ages and has a profound impact on quality of life, especially in the young, that may be associated with increased morbidity and mortality. Nocturia as a condition deserves public health attention. [Rev Urol. 2012;14(3/4):48-55 doi: 10.3909/riu0576] © 2013 MedReviews®, LLC

NocturiaQuality of lifeSleep disruptionNighttime urine overproduction

SlingView Articles

Volume 17, Number 1Review Articles

Expectations of Stress Urinary Incontinence Surgery in Patients With Mixed Urinary Incontinence

Management Update

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients’ expectations. [Rev Urol. 2015;17(1):14-19 doi: 10.3909/riu0646] © 2015 MedReviews®, LLC

UrodynamicsMixed urinary incontinenceSlingAnti-incontinence surgery

Sling procedureView Articles
Sling proceduresView Articles
Sling surgeryView Articles
SlingsView Articles
Small cell carcinomaView Articles

Volume 12, Number 4Case Review

Neuroendocrine Tumor of the Bladder

Thomas J GuzzoZhanyong BingShailen S SehgalAlan J Wein

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

Small intestinal submucosaView Articles
Small renal massView Articles

Volume 14, Number 1Review Articles

Active Surveillance for Small Renal Masses

Management Update

Elias S HyamsMohamad E AllafJeffrey K MullinsPhillip M Pierorazio

Small renal masses (SRMs; # 4 cm in dimension) have rapidly risen in incidence in recent decades and pose an increasingly common management dilemma in urology. SRMs are biologically heterogeneous and a wide variety of treatments exist with favorable oncologic outcomes. Active surveillance (AS) has emerged as a viable option for those not desiring surgery or those who are suboptimal candidates for surgery, with < 2% of patients progressing to metastatic disease in retrospective and prospective studies. This article reviews the current data regarding AS for SRM, operational considerations for an AS program, and criteria for safely selecting patients for this treatment strategy. [ Rev Urol. 2012;14(1/2):13-19 doi: 10.3909/riu0545] © 2012 MedReviews®, LLC

Renal cell carcinomaSmall renal massActive surveillance

SmokingView Articles

Volume 17, Number 4Book Reviews

Smoking: Its Impact on Urologic Health

Management Update

David MobleyNeil Baum

Tobacco use remains the single largest preventable cause of disease and premature death in the United States, and smoking is a leading cause of cancer and death from cancer. There is also evidence that smoking is associated with several urologic diseases. Urologists have a unique opportunity to help our patients lead healthy lifestyles, which includes ending their dependence on nicotine and tobacco. This article points out the various urologic conditions associated with smoking and tobacco use with the intention of providing physicians and patients with knowledge and education regarding this connection. [Rev Urol. 2015;17(4):220-225 doi: 10.3909/riu0684] © 2016 MedReviews®, LLC

Prostate cancerBladder cancerKidney cancerInterstitial cystitisSmokingErectile dysfunction

Smoking cessationView Articles

Volume 18, Number 4Review Articles

Smoking-related Genitourinary Cancers: A Global Call to Action in Smoking Cessation

Disease Outcome Update

Roman SosnowskiCory HigleyJosh GottilebMarc A Bjurlin

Smoking is a known modifiable risk factor in the development of genitourinary malignancies. Although the association has long been supported by numerous research studies, the impact of smoking cessation on the decreased risk of genitourinary malignancies is less well studied. PubMed databases were searched using the terms smoking, smoking cessation, bladder cancer, kidney cancer, prostate cancer, penile cancer, testicular cancer, their synonyms, and also targeted manual searches to perform a literature review in order to summarize the benefits of cessation on disease progression and patient outcomes including survival and morbidities. Our review yielded substantial evidence highlighting the improved outcomes observed in those diagnosed with bladder, renal, and prostate cancers. The risk of bladder cancer is reduced by up to 60% in those who were able to quit for 25 years and the risk of kidney malignancy was reduced by 50% in those who abstained from smoking for 30 years. A similar trend of reduced risk was observed for prostate cancer with those who quit for more than 10 years, having prostate cancer mortality risks similar to those that never smoked. Although the data were encouraging for bladder, renal, and prostate malignancies, there are comparatively limited data quantifying the benefits of smoking cessation for penile and testicular cancers, highlighting an opportunity for further study. The role of urologists and their impact on their patients’ likelihood to quit smoking shows more than half of urologists never discuss smoking cessation upon diagnosis of a malignancy. Most urologists said they did not provide cessation counseling because they do not believe it would alter their patients’ disease progression. Studies show urologists have more influence at changing their patients’ smoking behaviors than their primary care physicians. The diagnosis of cancer may lead to a teachable moment resulting in increased smoking quit rates. Furthermore, implementing a brief 5-minute clinic counseling session increases quit attempts and quit rates. Diagnosis of genitourinary cancers and the following appointments for treatment provide a unique opportunity for urologists to intervene and affect the progression and outcome of disease. [Rev Urol. 2016;18(4):194-204 doi: 10.3909/riu0729] © 2016 MedReviews®, LLC

SmokingRisk reductionSmoking cessationGenitourinary malignancy

Smooth muscleView Articles
Smooth muscle cellsView Articles
Social mediaView 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

Society of Urologic OncologyView Articles
Socioeconomic factorsView Articles

Volume 20, Number 3Original Research

Accuracy in 24-hour Urine Collection at a Tertiary Center

Dean G AssimosRobert OsterOmotola AshorobiDustin WhitakerCarter BoydKyle WoodRoss P HolmesLisa Harvey

There is a paucity of studies addressing the accuracy of 24-hour urine collection for assessing stone risk parameters. Collection accuracy is thought to be essential for assigning optimal therapy for stone prevention. The objective of this study was to determine factors associated with accurate and inaccurate collections. During a 2-year period (2015-2016), 241 stone formers completed 24-hour urine collections. They were divided into accurate collectors (AC), defined as at least one accurate urine collection, and inaccurate collectors (IC). Accuracy was assessed by 24-hour urine creatinine (Cr) excretion indexed to body weight (normal: males, 20-25 mg Cr/kg; females, 15-20 mg Cr/kg). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included the chi-square test, Fisher’s exact test, and the two-group t-test. Average age was 50.7 years at the time of collection; 50.2% were men, 86% were white, and 14% were black. Overall, 51.0% of collections were inaccurate. There was no statistical significance between AC and IC for gender (P = 0.85), race (P = 0.90), insurance status (P = 0.85), recurrence (P = 0.87), stone type (P = 0.57), education (P = 0.35), income (P = 0.42), or poverty (P = 0.35). Older age (P = 0.017) and having a partner (P = 0.022) were significantly associated with AC. The high rate of inaccurate 24-hour urine collections is a concern. The only factors we identified as influencing collection accuracy were age and partner status. These results underscore the importance of developing methods to improve the accuracy of collecting 24-hour urine samples. [Rev Urol. 2018;20(3):119–124 doi: 10.3909/riu0807] © 2018 MedReviews®, LLC

Kidney stonesMetabolic evaluation24-hour urine collectionaccuracyDemographicsSocioeconomic factors

Soft-tissuelesionsView Articles
SolifenacinView Articles

Volume 10, Number 2Review Articles

Concomitant Medications and Possible Side Effects of Antimuscarinic Agents

Treatment Update

Scott MacDiarmid

Antimuscarinic agents are the treatment of choice for overactive bladder syndrome; clinical experience and the literature support their efficacy, tolerability, and safety. The most common side effects experienced include dry mouth and constipation. Many commonly prescribed drugs have anticholinergic effects that could increase the anticholinergic “load” or “burden” in patients with overactive bladder, potentially increasing the frequency and severity of side effects. In addition, the adverse events associated with antimuscarinics may be more pronounced in the elderly, especially those taking multiple medications. Knowledge regarding the potential side effects associated with antimuscarinics is important so that patients can be advised and effectively treated. [Rev Urol. 2008;10(2):92-98]

Overactive bladderOxybutyninAntimuscarinic agentsElderlySide effectsTolterodineSolifenacinDarifenacinTrospium chloride

Solitary kidneyView Articles

Volume 22, Number 3Case Review

From Radical to Partial Nephrectomy in the Setting of Solitary Functioning Kidney: Neoadjuvant Treatment of Renal Cell Carcinoma

A J FarhaShaker DakhilK James KallailNicole G FarhaDavid D Watson

Immunotherapy has revolutionized the treatment of metastatic renal cell carcinoma (RCC). This case evaluates the use of neoadjuvant immunotherapy for localized RCC in a patient with solitary functioning kidney. A retrospective chart review was conducted between September 2019 and January 2020 on a single patient. Before treatment, the tumor was 7 cm × 8 cm × 8.5 cm. The patient trialed nivolumab + ipilimumab then cabozantinib. The tumor shrunk to 6.3 cm × 5.5 cm and was removed via partial nephrectomy. This case demonstrates the efficacy of immunotherapy in neoadjuvant treatment of RCC. Expansion of guidelines could allow for patients with RCC to undergo partial nephrectomy. [Rev Urol. 2020;22(3):126-129] © 2020 MedReviews®, LLC

Renal cell carcinomaImmunotherapyNeoadjuvant immunotherapySolitary kidney

Somatic DNA testView Articles

Volume 22, Number 4Review Articles

Low Penetrance Germline Genetic Testing: Role for Risk Stratification in Prostate Cancer Screening and Examples From Clinical Practice

Management Update

A Karim KaderChristopher J KanePaul DatoKelly K BreeFranklin GaylisGerald L Andriole

Broad-based prostate-specific antigen (PSA) screening has saved lives but at a substantial human and financial cost. One way of mitigating this harm, while maintaining and possibly improving the benefit, is by focusing screening efforts on men at higher risk. With age, race, and family history as the only risk factors, many men lack any reliable data to inform their prostate cancer (PCa) screening decisions. Complexities including history of previous negative biopsies, interpretation of negative and/or equivocal mpMRI findings, and patient comorbidities further compound the already complicated decisions surrounding PCa screening and early detection. The authors present cases that provide real-world examples of how a single nucleotide polymorphism–based test can provide patients and providers with personalized PCa risk assessments and allow for development of improved risk-stratified screening regimens. [Rev Urol. 2020;22(4):152–158] © 2021 MedReviews®, LLC

Prostate cancer screeningRisk stratificationSomatic DNA testGermline DNA testsSingle nucleotide polymorphism DNA test

Somatostatin receptor scintigraphyView Articles
SorafenibView Articles

Volume 17, Number 4Case Review

Sorafenib-induced Scrotal Eczema

Selahattin Caliskan

Sorafenib is an orally active, small-molecule multikinase inhibitor that blocks tumor cell proliferation and angiogenesis. Studies have shown that it is a highly potent, selective inhibitor of vascular endothelial growth factor receptors 2 and 3, platelet-derived growth factor-β, RAF, FLT-3, and c-Kit. This drug was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. We report a case of a patient treated with sorafenib for metastatic renal cell carcinoma who developed scrotal eczema. [Rev Urol. 2015;17(4):250-251 doi: 10.3909/riu0648] © 2016 MedReviews®, LLC

SorafenibScrotal eczemaHand-foot skin reaction

SoundingView Articles

Volume 15, Number 2Case Review

Endoscopic Management of Genitourinary Foreign Bodies

Sam B BhayaniRobert S FigenshauAlana C DesaiBrian M BenwayMohammed HaseebuddinYoussef S TanaghoJoseph B Song

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of four cases of foreign object insertion into the genitourinary system and their outcomes and management. [Rev Urol. 2013;15(2):84-91 doi: 10.3909/riu0571] © 2013 MedReviews®, LLC

Foreign body insertionSoundingGenitourinary foreign objectEndoscopic extraction

SoyView Articles
SpecializationView Articles

Volume 18, Number 3Review Articles

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care

Health Care Economics

Neal D ShoreDana Jacoby

Changes involving the health care economic landscape have affected physicians’ workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non–physician-owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations. [Rev Urol. 2016;18(3):143-150 doi: 10.3909/riu0726] © 2016 MedReviews®, LLC

Independent practiceCollaborationValue-based careSpecializationCompensation

SPECT/CTView Articles

Volume 8, Supplement 1Review Articles

Fused Radioimmunoscintigraphy for Treatment Planning

Prostate Cancer Imaging

Deborah A KaminskyRodney J Ellis

Advances in imaging technologies, including computerized tomography (CT) and single-photon emission tomography (SPECT), are improving the role of imaging in prostate cancer diagnosis and treatment. Hybrid (SPECT/CT) imaging, in particular, shows an increased sensitivity for identification of prostate cancer. Published studies have also recently proposed a new paradigm in the administration of radiation therapy for prostate cancer, favoring doseescalation strategies to improve tumor control for localized disease. Conventional dose-escalation protocols have previously relied primarily on margin extension to the entire prostate gland to achieve dose-escalation; extending increased risk to radiosensitive normal structures. A newer strategy proposes use of advanced imaging to confine dose-escalation to biological target volumes identified on capromab pendetide SPECT/CT-fused image sets or imageguided radiation therapy (IGRT). This strategy defines a shift in radiation dosimetry and planning from uniform glandular prescription dosing with doseescalation applied generically to the peripheral regions and margin extension; to dose-escalation confinement to discrete regions of known disease as defined by focal uptake on radioimmunoscintigraphy fusion with anatomic image sets, with minimal margin extension. The introduction of advanced imaging for IGRT in prostate cancer has also introduced an improved capability for the early-identification of patients at risk for metastatic disease, where more aggressive therapeutic interventions may prove beneficial. [Rev Urol. 2006;8(suppl 1):S11-S19]

Prostate cancerRadiotherapyBrachytherapyProstaScintSPECT/CTBiological targetvolumesSurvival

Sperm cryopreservationView Articles

Volume 17, Number 4Review Articles

Fertility Preservation Options for Men and Women With Cancer

Management Update

Laxmi A KondapalliRandall B MeachamSara Babcock GilbertMalgorzata E Skaznik-Wikiel

Approximately 0.2% of Americans aged 20 to 39 years are childhood cancer survivors. Advances in cancer detection and therapy have greatly improved survival rates for young cancer patients; however, treatment of childhood cancers can adversely impact reproductive function. Many cancer patients report a strong desire to be informed of existing options for fertility preservation and future reproduction prior to initiation of gonadotoxic cancer therapies, including surgery, chemotherapy, and radiotherapy. This article discusses, in detail, the effects of cancer treatment on fertility in men and women, and outlines both current and experimental methods of fertility preservation among cancer patients. [Rev Urol. 2015;17(4):211-219 doi: 10.3909/riu0666] © 2016 MedReviews®, LLC

Fertility preservationChildhood cancerSperm cryopreservationTesticular tissue cryopreservationSpermatogonial stem cell cryopreservationEmbryo cryopreservationOocyte cryopreservationOvarian tissue cryopreservation

Sperm retrievalView Articles

Volume 20, Number 2Review Articles

Infertility in Patients With Klinefelter Syndrome: Optimal Timing for Sperm and Testicular Tissue Cryopreservation

Management Update

Amin S HeratiAdrian S DobsPhilip W JordanApril A SzafranDorota J Hawksworth

Male factor infertility is a complex issue presenting many diagnostic and management challenges. It is responsible for about 50% of all causes of infertility and thus carries significant medical, financial, and psychological implications for the couples struggling with conception. Klinefelter syndrome is the most common chromosomal male anomaly associated with male infertility. This review focuses specifically on non-obstructive azoospermia secondary to Klinefelter syndrome and discusses controversies surrounding fertility management in patients with this genetic disorder. [Rev Urol. 2018;20(2):56–62 doi: 10.3909/riu0790] © 2018 MedReviews®, LLC

Klinefelter syndromeNon-obstructive azoospermiaSperm retrieval

Spermatic cordView Articles

Volume 13, Number 4Case Review

Benign Paratesticular Fibrous Pseudotumor With Malignant Clinical Features

Mohamed Fadl TaziMoulay Hassan FarihMohamed Jamal El FassiYounes AhallalAbdelhak KhalloukElmehdi Tazi

Paratesticular tumors are rare intrascrotal masses that grow mainly in structures containing connective tissue around the testis, epididymis, or spermatic cord. We report here on a case of a 55-year-old man with a mass in the hemiscrotum that was found to be a paratesticular fibrous pseudotumor in the orchiectomy specimen pathologic examination. From this case report and literature review, a diagnostic and therapeutic strategy is demonstrated for the management of this uncommon lesion. [Rev Urol. 2011;13(4):e203-e205 doi: 10.3909/riu0509] © 2011 MedReviews®, LLC

Paratesticular fibrous pseudotumorEpididymisSpermatic cord