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Urology

Volume 10, No 3 - Summer 2008

Volume 10, No 3 - Summer 2008

Table of Contents

Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice Diagnostic Update
A specific marker for early prostate cancer would fill an important void. In initial evaluations of the prostate cancer antigen 3 (PCA3) gene vis-à-vis serum prostate-specific antigen (PSA) levels, the gene offers great promise. At the cellular level, PCA3 specificity for cancer is nearly perfect because of the gross overexpression of the gene by cancer cells. As a clinical test for early prostate cancer, heightened specificity is also seen in urine containing prostate cells from men with the disease. PCA3 gene testing holds valuable potential in PSA quandary situations: (1) men with elevated PSA levels but no cancer on initial biopsy; (2) men found to have cancer despite normal levels of PSA; (3) men with PSA elevations associated with varying degrees of prostatitis; and (4) men undergoing active surveillance for presumed microfocal disease. [Rev Urol. 2008;10(3):175-181]
Overactive Bladder: Pharmacologic Treatments in the Neurogenic Population Treatment Update
Patients with neurologic disease commonly develop overactive bladder (OAB) symptoms of urgency, frequency, and/or urge incontinence. Although treatment for idiopathic OAB has been extensively studied, therapy for those individuals with neurogenic-mediated OAB has not been thoroughly evaluated. Included in the present article is a description of micturition neurophysiology and a neurourologic evaluation scheme. The pharmacologic treatment options for neurogenic OAB, mainly antimuscarinics and chemical denervation, are reviewed and important studies are discussed. Management of OAB in the neurogenic population is a complex issue with no uniform treatment strategy, and individualized treatment with first-line pharmacologic therapy is often recommended. [Rev Urol. 2008;10(3):182-191]
Nutraceuticals in Prostate Disease: The Urologist’s Role Treatment Update
Interest in and use of complementary and alternative therapies, especially nutraceuticals, is high in prostate disease. These therapies have shown potential in benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Some have produced results equal to or better than pharmaceuticals currently prescribed for BPH. In category III prostatitis, some nutraceuticals may offer relief to patients who get little from standard therapy. Because it is becoming apparent that inflammation may play a role in the progression of BPH and development of prostate cancer, nutraceuticals, which commonly have anti-inflammatory properties, may play a role. These therapies have also shown potential in prostate cancer treatment and prevention, especially those that also reduce cardiovascular events or risk. Nevertheless, uses of some nutraceuticals in prostate disease have had less desirable consequences, showing lack of efficacy, adulteration, and/or severe side effects or drug interactions. By ensuring that these therapies undergo careful study for effectiveness, quality, and safety, urologists can look forward to adding them to their evidence-based armamentarium for prostate disease. [Rev Urol. 2008;10(3):192-206]
Urogenital Tuberculosis: Update and Review of 8961 Cases from the World Literature Treatment Update
The AIDS epidemic caused unexpected worldwide levels of tuberculosis, even in developed countries where the incidence used to be low. Patients with urogenital tuberculosis in developed countries have fewer specific symptoms and lower rates of delayed diagnoses compared with patients from other countries. As a result, the disease tends to be less serious, with more patients presenting without significant lesions of the upper urinary tract on diagnosis. These data point to a correlation of the timing of diagnosis with the severity of urogenital tuberculosis. A systematic search for urogenital tuberculosis, regardless of symptoms, is warranted for early detection. [Rev Urol. 2008;10(3):207-217]
Hypercalcemic States Associated With Nephrolithiasis Management Update
Although kidney stone formation due to hypercalcemic states is rare, it is important for urologists to understand the pathophysiology of these conditions, methods of diagnosis, and treatments. This should foster a quicker diagnosis and institution of appropriate therapy. The latter typically leads to the attenuation of kidney stone activity. Moreover, these patients have a systemic disease, and therapy has other health benefits. [Rev Urol. 2008;10(3):218-226]
Best of the 2008 AUA Annual Meeting Meeting Review
Highlights from the 2008 Annual Meeting of the American Urological Association, May 17-22, 2008, Orlando, FL [Rev Urol. 2008;10(3):227-228]
Urodynamics, Incontinence, and Neurourology Meeting Review
Highlights from the Society for Urodynamics and Female Urology Annual Winter Meeting, February 28-March 2, 2008, Miami, FL [Rev Urol. 2008;10(3):229-231]
Advances in Sexual Medicine Meeting Review
Highlights from the 2007 Winter Meeting of the Sexual Medicine Society of North America, December 6-9, 2007, Chicago, IL [Rev Urol. 2008;10(3):232-235]
Shock Wave Lithotripsy and Renal Hemorrhage Case Review
Although shock wave lithotripsy is a safe and efficacious treatment for nephrolithiasis, the most common acute complication is renal hemorrhage. Shock wave–induced renal hemorrhage is a potentially devastating injury if not promptly recognized and treated appropriately. The authors report a large perirenal hematoma occurring after shock wave lithotripsy and review the causes, prevention, and treatment of shock wave–induced renal hemorrhage. [Rev Urol. 2008;10(3):236-241]