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Urology

Volume 10  No 4 - Fall 2008

Volume 10 No 4 - Fall 2008

Table of Contents

Renewing Intimacy: Advances in Treating Erectile Dysfunction Postprostatectomy Expert Commentary
Erectile dysfunction following prostatectomy is almost universal. Herbert Lepor, MD, Professor and Martin Spatz Chairperson of Urology and Professor of Pharmacology at New York University School of Medicine and cofounder of Reviews in Urology; Andrew McCullough, MD, Director of the Sexual Health and Male Fertility and Microsurgery Programs at New York University School of Medicine; and Jason D. Engel, MD, Vice Chairman of Urology and Director of Urologic Robotic Surgery at George Washington University Hospital, discuss treatment options for erectile dysfunction postprostatectomy. [Rev Urol. 2008;10(4):245-253]
Vascular Targeted Photodynamic Therapy for Localized Prostate Cancer Treatment Update
Survival for men diagnosed with prostate cancer directly depends on the stage and grade of the disease at diagnosis. Prostate cancer screening has greatly increased the ability to diagnose small and low-grade cancers that are amenable to cure. However, widespread prostate-specific antigen screening exposes many men with low-risk cancers to unnecessary complications associated with treatment for localized disease without any survival advantage. One challenge for urological surgeons is to develop effective treatment options for low-risk disease that are associated with fewer complications. Minimally invasive ablative treatments for localized prostate cancer are under development and may represent a preferred option for men with low-risk disease who want to balance the risks and benefits of treatment. Vascular targeted photodynamic therapy (VTP) is a novel technique that is being developed for treating prostate cancer. Recent advances in photodynamic therapy have led to the development of photosynthesizers that are retained by the vascular system, which provides the opportunity to selectively ablate the prostate with minimal collateral damage to other structures. The rapid clearance of these new agents negates the need to avoid exposure to sunlight for long periods. Presented herein are the rationale and preliminary data for VTP for localized prostate cancer. [Rev Urol. 2008;10(4):254-261]
Using Biopsy to Detect Prostate Cancer Diagnostic Review
Transrectal ultrasound-guided systemic biopsy is the recommended method in most cases with suspicion of prostate cancer. Transrectal periprostatic injection with a local anesthetic may be offered as effective analgesia; periprostatic nerve block with 1% or 2% lidocaine is the recommended form of pain control. On initial biopsy, a minimum of 10 systemic, laterally directed cores is recommended, with more cores in larger glands. Extended prostate biopsy schemes, which require cores weighted more laterally at the base (lateral horn) and medially to the apex, show better cancer detection rates without increasing adverse events. Transition zone biopsies are not recommended in the first set of biopsies, owing to low detection rates. One set of repeat biopsies is warranted in cases with persistent indication. Saturation biopsy (=20 cores) should be reserved for repeat biopsy in patients who have negative results on initial biopsy but who are still strongly suspected to have prostate cancer. [Rev Urol. 2008;10(4):262-280]
Bacillus Calmette-Guérin Failures and Beyond: Contemporary Management of Non–Muscle-Invasive Bladder Cancer Management Review
In the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with intravesical BCG plus interferon have a 60% to 70% chance of a complete and durable response if they were never treated with BCG or if they failed only 1 prior induction or relapsed more than a year from induction. Intravesical gemcitabine is safe, but its usefulness for BCG-refractory patients is unclear. Valrubicin, approved for intravesical treatment of BCGrefractory CIS of the bladder, has efficacy and acceptable toxicity. Cystectomy should be considered in high-risk, non–muscle-invasive cancer, particularly if intravesical therapy failed. [Rev Urol. 2008;10(4):281-289]
New Findings in Prostate Cancer Meeting Review
Highlights from the 23rd Annual Congress of the European Association of Urology, March 26–29, 2008, Milan, Italy [Rev Urol. 2008;10(4):290-293]
New Treatments for Castration-Resistant Prostate Cancer Meeting Review
Highlights from the 44th Annual Meeting of the American Society of Clinical Oncology, May 30–June 3, 2008, Chicago, IL [Rev Urol. 2008;10(4):294-296]
Management of Localized Prostate Cancer and an Incidental Ureteral Duplication With Upper Pole Ectopic Ureter Inserting into the Prostatic Urethra Case Review
Ectopic ureters are rare congenital malformations of the renal system that most commonly present in females. It is extremely rare to encounter an ectopic ureter in an older man undergoing radical prostatectomy. We report herein a case of a 66-year-old man with prostate cancer and a complete duplication of the left renal collecting system, with an upper pole ectopic ureter and associated normal functioning renal parenchyma entering into the prostatic urethra. This anomaly was incidentally discovered on preoperative magnetic resonance imaging of the prostate. Open radical retropubic prostatectomy and a left ureteroureterostomy were performed. [Rev Urol. 2008;10(4):297-303]
Prostate Cancer: Androgen Deprivation Therapy News and Views from the Literature
[Rev Urol. 2008;10(4):305-306]
Overactive Bladder Syndrome News and Views from the Literature
[Rev Urol. 2008;10(4):306-308]