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Volume 12, Number 3Meeting Reviews

Best of the AUA Annual Meeting

Meeting Review

Dean G AssimosEllen ShapiroMichael B ChancellorJ Curtis NickelClaus G RoehrbornMichael K BrawerAkira Furuta

Highlights From the 2010 American Urological Association Meeting, May 29-June 3, 2010, San Francisco, CA [Rev Urol. 2010;12(2/3):e134-e146 doi: 10.3909/riu0500]

Autologous muscle-derived cellsNocturiaBotulinum toxinProstate-specific antigenUrosepsisShock wave lithotripsyTransrectal ultrasound prostateEscherichia coliSynthetic mesh slingProstatic urethral liftPRX3.02

Systematic prostate biopsyView Articles
Systematic reviewView Articles

Volume 18, Number 2Review Articles

Reducing Infectious Complications Following Transrectal Ultrasound-guided Prostate Biopsy: A Systematic Review

Systematic Review

Nirmish SinglaJordon T WalkerClaus G Roehrborn

A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that augmented prophylaxis and povidone-iodine bowel preparation warrant consideration in regions with high rates of antimicrobial resistance. Transperineal biopsy may be a safer, equally effective alternative to TRUS-Bx in select cases. Recent international travel appears to increase patients’ risk for experiencing infections. These findings can aid clinicians in minimizing post-TRUS-Bx infectious complications. [Rev Urol. 2016;18(2):73-89 doi: 10.3909/riu0713] © 2016 MedReviews®, LLC

Urinary tract infectionProstate biopsyTransrectal ultrasoundSystematic review

Systemic diseaseView Articles

Volume 21, Number 4Review Articles

Impact of Demographic Factors and Systemic Disease on Urinary Stone Risk Parameters Amongst Stone Formers

Original Research

Dean G AssimosKyle WoodWilliam PooreBarbara GowerCarter BoydDustin WhitakerOmotola AshorobiRobert Oster

This article examines via multivariate analysis the associations between demographic factors and systemic diseases on stone risk parameters in a stone-forming population. A retrospective chart review of adult stone formers who completed 24-hour urine collections from April 2004 through August 2015 was performed. Data was collected on age, sex, race, body mass index (BMI), and diagnoses of diabetes and hypertension. CT imaging and renal/abdominal ultrasonography (within ±6 mo) were reviewed for diagnosis of fatty liver disease. Statistical analysis included Pearson and Spearman correlation analysis, and linear and logistic regression analyses, both univariate and multivariate. Five hundred eighty-nine patients were included. Numerous urinary parameters were significant in association with demographic factors or systemic diseases in a multivariate analysis. Older age was associated with decreased calcium (Ca) excretion (P = 0.0214), supersaturation of calcium oxalate (SSCaOx; P = 0.0262), supersaturation of calcium phosphate (SSCaP; P < 0.0001), and urinary pH (P = 0.0201). Men excreted more Ca (P = 0.0015) and oxalate (Ox; P = 0.0010), had lower urine pH (P = 0.0269), and higher supersaturation of uric acid (SSUA; P < 0.0001) than women. Blacks had lower urine volume (P = 0.0023), less Ca excretion (P = 0.0142), less Ox excretion (P = 0.0074), and higher SSUA (P = 0.0049). Diabetes was associated with more Ox excretion (P < 0.0001), lower SSCaP (P = 0.0068), and lower urinary pH (P = 0.0153). There were positive correlations between BMI and Ca excretion (P = 0.0386), BMI and Ox excretion (P = 0.0177), and BMI and SSUA (P = 0.0045). These results demonstrate that demographic factors and systemic disease are independently associated with numerous risk factors for kidney stones. The mechanisms responsible for these associations and disparities (racial differences) need to be further elucidated. [Rev Urol. 2019;21(4):158–165] © 2020 MedReviews®, LLC

ObesityKidney stonesDiabetesSystemic diseaseFatty Liver

TadalafilView Articles
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Volume 5, Number 2Meeting Reviews

Advances in the Medical Treatment of Prostate Cancer, Bladder Cancer, Renal Cell Cancer, and Benign Prostatic Hyperplasia

Highlights from the XVIIth Congress of the European Association of Urology, Birmingham, UK

Claus G RoehrbornBob DjavanMesut RemziChristian Seitz

Prostate cancerBenign prostatic hyperplasiaBladder cancerLower urinary tract symptomsProstate-specific antigenRadical prostatectomyRadical nephrectomyNomogramsTamsulosinAlfuzosinFinasterideDutasterideBicalutamideBacille Calmette-GuerinPermixonRenal cell cancerTransrectal ultrasound-guided biopsyVirtual cystoscopy

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Targeted therapyView Articles
Targeted treatmentView Articles

Volume 9, Number 2Review Articles

Understanding the Natural Biology of Kidney Cancer: Implications for Targeted Cancer Therapy

Treatment Update

Arie S BelldegrunAllan J PantuckTobias KlatteMark D Kleid

During the past several decades, there has been a significant increase in the understanding of the biology, clinical behavior, and prognostic factors of renal cell carcinoma (RCC). Such progress has led to greater sophistication in the diagnosis and classification of RCC. Here, we review recent advances in our knowledge of the biologic characteristics of RCC that have resulted in notable achievements in staging, prognosis, patient selection, and treatment. [Rev Urol. 2007;9(2):47-56]

AngiogenesisGeneticsMolecular markersTargeted treatmentTumor-node-metastasis classification

TaxanesView Articles

Volume 9, Supplement 2Review Articles

Treatment Options for Hormone-Refractory Prostate Cancer

Androgen-Independent Prostate Cancer

Sam S Chang

Hormone-refractory prostate cancer is a disease that includes a variety of patients and represents a treatment dilemma for the practicing physician. Because of the diversity of this group, management strategies must be targeted to the clinical situations of the individual patients and their wishes. This article outlines a logical progression of treatment choices that currently exist in this rapidly evolving field, and the landmark chemotherapy trials involving docetaxel (SWOG 9916 and TAX 327) are reviewed. Although significant progress has been made in understanding and treating hormonerefractory prostate cancer, current treatments do not yet provide a cure, and important clinical trials continue to recruit patients. [Rev Urol. 2007;9(suppl 2):S13-S18]

ChemotherapyHormone-refractory prostate cancerAndrogen-independent prostate cancerTaxanes

Taxi cab syndromeView Articles

Volume 16, Number 3Review Articles

Taxi Cab Syndrome: A Review of the Extensive Genitourinary Pathology Experienced by Taxi Cab Drivers and What We Can Do to Help

Disease State Review

Alon Y MassDavid S GoldfarbOjas D Shah

This review consolidates knowledge regarding the extensive genitourinary pathology experienced by taxi cab drivers. Taxi cab, livery, truck, and other drivers all objectively and subjectively may have more voiding dysfunction, infertility, urolithiasis, bladder cancer, and urinary infections as compared with nonprofessional drivers; this is called taxi cab syndrome. Together with governmental and medical assistance, simple interventions&mdash;such as education, the addition of taxi relief stations, and possibly the use of sanitary urinary collection devices&mdash;to curb the progression of genitourinary disease in taxi drivers should be prospectively studied. It is postulated that many of these interventions may also benefit other groups of occupationally related infrequent voiders. [Rev Urol. 2014;16(3):99-104 doi: 10.3909/riu0627] This article is a US Government work, and, as such, is in the public domain in the United States of America. Published by MedReviews®, LLC

InfertilityUrolithiasisTaxi cab syndromeInfrequent voiders syndromeOccupational hazardVoiding dysfunctionProstodynia

Teflon®View Articles
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Volume 22, Number 2Review Articles

Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice

Original Research

Gary M KirshStephen F KappaChris McClainKrista WallacePaul CinquinaDon LawsonMary M SmithEarl WalzBrooke Edwards

Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service. [Rev Urol. 2020;22(2):67–74] © 2020 MedReviews®, LLC

Cost effectivenessCall centerTelehealthOrganizational efficiency

TelemedicineView Articles

Volume 23, Number 4Editorial

2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing Progress

Matthew Glans

In 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.

Telemedicinehealth care costsinsurance, healthhealth services accessibility

TelomeraseView Articles
TelomeresView Articles

Volume 9, Number 3Meeting Reviews

Best of the 2007 AUA Annual Meeting

Meeting Review

Dean G AssimosDanil V MakarovEllen ShapiroAlan W PartinMichael B ChancellorJ Curtis NickelJacob RajferClaus G RoehrbornMichael K Brawer

Highlights from the 2007 Annual Meeting of the American Urological Association May 19-24, 2007 Anaheim, CA [Rev Urol. 2007;9(3):133-154]

Prostate cancerObesityBenign prostatic hyperplasiaAntibiotic prophylaxisNocturiaLower urinary tract symptomsBotulinum toxinProstate-specific antigenBiomarkersPCA3TestosteroneUrinary tract infectionsUrolithiasisLaser ablationEndourologyMale voiding dysfunctionLHRH antagonistsAntimuscarinic agentsCircumcisionRepeat biopsyHuman glandularkallikreinExpectant managementCRISP-3MSPMicrovesseldensityEndoglinSurvivinTelomeresInterleukin-8PDE-5 inhibitorsAcute urinaryretention5Alpha-reductase inhibitorsDoxazosinFinasterideTransurethral microwave thermotherapyTURPPerioperative blood lossMicrobialbiofilmsHIVStem cell injection

TemplateView Articles

Volume 16, Number 4Review Articles

Extent of Pelvic Lymph Node Dissection During Radical Cystectomy: Is Bigger Better?

Management Review

Debasish SundiRobert S SvatekMatthew E NielsenTrinity J Bivalacqua

Pelvic lymph node dissection (PLND) is a standard component of radical cystectomy (RC) for bladder cancer. The optimal anatomic PLND template remains undefined. An extended PLND template can potentially improve survival through the eradication of micrometastatic disease and improved pathologic staging. However, this benefit could be compromised by a potential increase in perioperative complications and cost. Two randomized controlled clinical trials that will clarify this question are ongoing. Many important retrospective studies have provided insights into the optimal PLND extent. Here the authors review the key evidence that informs how urologists may tailor the PLND template during RC depending on patient and tumor characteristics. [Rev Urol. 2014;16(4):159-166 doi: 10.3909/riu0626] © 2014 MedReviews®, LLC

Radical cystectomyPelvic lymph node dissectionTemplateMicrometastatic disease

Tension-free vaginal tapeView Articles
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Volume 9, Number 4Review Articles

Alpha Blockers for the Treatment of Benign Prostatic Hyperplasia

Treatment Update

Herbert Lepor

The evolution of alpha blocker therapy for benign prostatic hyperplasia (BPH) has focused on improving convenience and tolerability. Indications for treating BPH include reversing signs and symptoms or preventing progression of the disease. The indication that most commonly drives the need for intervention is relief of lower urinary tract symptoms (LUTS) with the intent of improving quality of life. Alpha blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. Four long-acting alpha 1 blockers are approved by the Food and Drug Administration for treatment of symptomatic LUTS/BPH: terazosin, doxazosin, tamsulosin, and alfuzosin. All are well tolerated and have comparable dose-dependent effectiveness. Tamsulosin and alfuzosin SR do not require dose titration. Alfuzosin, terazosin, and doxazosin have all been shown to be effective in relieving LUTS/BPH independent of prostate size. [Rev Urol. 2007;9(4):181-190]

Benign prostatic hyperplasiaLower urinary tract symptomsQuality of lifeTamsulosinAlfuzosinDoxazosinTerazosin

terminal careView Articles

Volume 23, Number 2Meet The Expert

Meet the Expert: Lillie Shockney, RN, MAS

Joelle Hamilton

Discussions with patients with cancer who are facing metastatic disease progression must be handled with empathy and compassion. In this interview, Lillie Shockney, RN, MAS, the University Distinguished Service Professor of Breast Cancer and a professor of surgery at the Johns Hopkins University School of Medicine, shares her approach to handling delicate end-of-life conversations with her patients.

Neoplasm metastasisadvanced care planningterminal carepatient-centered care

TesticleView Articles

Volume 21, Number 2Review Articles

Evaluation and Management of Chronic Scrotal Content Pain—A Common Yet Poorly Understood Condition

Management Review

Matthew J ZiegelmannRyan FarrellLaurence A Levine

Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life. [Rev Urol. 2019;21(2/3):74–84] © 2019 MedReviews®, LLC

OrchialgiaTesticlePain inguinalDenervation

TesticularView Articles

Volume 21, Number 2Reviews in Urology

Massive Intra-abdominal Germ Cell Tumors: A Case Series and Review of Literature

Nirmish SinglaAditya BagrodiaDaniel G Wong

Intra-abdominal testes are at increased risk of malignant transformation and can manifest as large abdominal masses with a wide variation in presenting symptoms. In the setting of cryptorchid or nonpalpable testes, large abdominal masses are highly suspect for germ cell tumors. Without standard guidelines, management can vary extensively. Surgical management may not be trivial and can entail a major abdominal operation in the context of a multimodal approach. The use of biopsy and serum tumor markers may effectively guide sequence of management based upon expected histology. In advanced cases, neoadjuvant chemotherapy may be pursued, and retroperitoneal lymph node dissection may be accomplished at the time of orchiectomy to minimize morbidity. The development of these massive late stage tumors reaffirms current guidelines on the early correction of cryptorchidism. [Rev Urol. 2019;21(2/3):136–140] © 2019 MedReviews®, LLC

TesticularSeminomaNonseminomatous

Testicular cancerView Articles
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Volume 9, Number 4Case Review

Bilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis Nodosa

Case Review

Donald S CrainShannon R HerreraSean P Stroup

We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy. [Rev Urol. 2007;9(4):235-238]

Testicular infarctionPolyarteritis nodosaAndrogen replacement therapy

Testicular neoplasmView 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