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Urology

Volume 13, No 2 - 2011

Volume 13, No 2 - 2011

Table of Contents

Contemporary Management of Renal Trauma Management Update
In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach to facilitate the care of patients with renal injury. [Rev Urol. 2011;13(2):65-72 doi: 10.3909/riu0512] © 2011 MedReviews®, LLC
Impact of Stone Removal on Renal Function: A Review Treatment Review
Stone removal can improve renal function by eradicating obstruction and, in certain cases, an underlying infection. Stone-removing procedures, however, may negatively impact functional integrity. Many things may impact the latter, including the procedures used, the methods of assessing function, the time when these assessments are made, the occurrence of complications, the baseline condition of the kidney, and patient-related factors. In the majority of cases, little significant functional impairment occurs. However, there are gaps in our knowledge of this subject, including the cumulative effects of multiple procedures violating the renal parenchyma and long-term functional outcomes. [Rev Urol. 2011;13(2):73-89 doi: 10.3909/riu0515] © 2011 MedReviews®, LLC
Malignant Priapism Secondary to Metastatic Prostate Cancer: A Case Report and Review of Literature
Penile metastasis of cancers from other primary sites is a rare phenomenon that infrequently manifests as malignant priapism. We outline a case of an 84-year-old patient who presented with a 3-month history of painful priapism after radiation therapy for prostate adenocarcinoma. The patient underwent surgical penile exploration and cavernosal biopsy that revealed poorly differentiated cells suggestive of prostate cancer. Postoperative imaging demonstrated extensive regional and distal metastases. A review of the literature on penile metastases returned approximately 400 published cases, with priapism being the initial presentation in 20% to 50% of cases. Regardless of site of origin or subsequent management, most cases have shown very poor prognosis. [Rev Urol. 2011;13(2):90-94 doi: 10.3909/riu0508] © 2011 MedReviews®, LLC
Idiopathic Scrotal Calcinosis: A Non-Elucidated Pathogenesis and Its Surgical Treatment
Scrotal calcinosis (SC) is a rare, benign entity defined as the presence of multiple calcified nodules within the scrotal skin. In most cases, there are no associated symptoms. We report the case of 27-year-old man with a massive SC. Treatment was surgical with complete excision of the affected part of the scrotum wall. Histopathologically, there was no epithelial lining around the calcified nodules and no cystic structure. Therefore, our case was considered idiopathic SC [Rev Urol. 2011;13(2):95-97 doi: 10.3909/riu0481] © 2011 MedReviews®, LLC
Laparoscopic Nephrectomy for Pyonephrosis During Pregnancy: Case Report and Review of the Literature
The maternal and fetal complications of pyonephrosis during pregnancy can be devastating, thus the call for urgent but safe intervention. Laparoscopic nephrectomy has been used safely and effectively in nonpregnant patients with pyonephrotic kidney. We report on a case of a 28-year-old pregnant woman with pyonephrotic kidney that we believe to be the first such case managed by transperitoneal laparoscopic nephrectomy. A review of the reported cases of laparoscopic nephrectomy for different indications and by different approaches during pregnancy is also presented. [Rev Urol. 2011;13(2):98-103 doi: 10.3909/riu0505] © 2011 MedReviews®, LLC
New Frontiers in Imaging and Focal Therapy Highlights From the Third International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, February 24-27, 2010, Washington, DC
[Rev Urol. 2011; 13(2):104-111 doi: 10.3909/riu0523] © 2011 MedReviews®, LLC
New Findings in Benign Prostatic Hyperplasia and Incontinence Highlights From the 26th Annual Congress of the European Association of Urology, March 18-22, 2011, Vienna, Austria
[Rev Urol. 2011;13(2):112-117 doi: 10.3909/riu0526]
Peripheral Arterial Disease in Women Diagnosis and Treatment Update
Women with peripheral arterial disease (PAD) are not well identified in cardiology practice, are undertreated, and have different relative risks for development of PAD than men. Recognizing that PAD is considered a coronary artery disease risk equivalent emphasizes that primary care physicians and cardiologists need to be aggressive for screening and treatment of this disorder. This article reviews the prevalence and risk factors for PAD in women, sex-based differences in development of PAD, and current screening and treatment recommendations. [Rev Cardiovasc Med. 2011;12(3):123-131 doi: 10.3909/ricm0570] © 2011 MedReviews®, LLC
Hypoglycemia and Adverse Outcomes: Marker or Mediator? Management Update
Multiple studies have shown that hypoglycemia is associated with increased mortality and a variety of adverse outcomes. Whether hypoglycemia is a mediator of adverse outcomes or simply represents a marker of critical illness has been unclear until now. Based on observational data, spontaneous (but not iatrogenic) hypoglycemia is associated with increased mortality during hospitalization for acute myocardial infarction. In the recent ADVANCE trial of patients with diabetes, intensive glucose lowering was associated with increased risk of hypoglycemia. Hypoglycemia was, in turn, associated with increased risk of macro- and microvascular events and death, and also with increased risk of noncardiac adverse events, including disorders of the digestive, respiratory, and skin systems. Based on available evidence, hypoglycemia does not appear to directly lead to death or cardiovascular events and is likely a marker for more severe illness and comorbidity burden. Nevertheless, continued efforts to avoid hypoglycemia are clearly warranted. [Rev Cardiovasc Med. 2011;12(3):132-135 doi: 10.3909/ricm0586] © 2011 MedReviews®, LLC
The Electrophysiological Properties of Ranolazine: A Metabolic Anti-Ischemic Drug or an Energy-Efficient Antiarrhythmic Agent? Treatment Update
Ranolazine, a newer anti-ischemic agent that appears to induce a more efficient utilization of adenosine triphosphate at the cellular level, has been shown to be clinically beneficial in patients with chronic stable angina. More recently, the antiarrhythmic effects of the drug have been described in patients with acute coronary syndromes, as well as in those with atrial fibrillation, when combined with other agents. Experimentally, the predominant inhibitory effects on late INa, ICa, INa-Ca, and IKs, with little or no effect on Ito or IK1, have been demonstrated. Different experimental models have shown the potential beneficial effect of the drug in both supraventricular and ventricular arrhythmias. Interestingly, despite its potential prolongation of the QT interval, ranolazine does not appear to induce ventricular arrhythmias in animal models. Whether the antiarrhythmic effect is secondary to a more efficient energy production by the cardiac cell or by its direct effect on ion channels is still unclear. The effect of ranolazine on other ionic currents, as well as its potential as a clinically relevant antiarrhythmic agent, still needs to be studied. [Rev Cardiovasc Med. 2011;12(3):136-142 doi: 10.3909/ricm0572] © 2011 MedReviews®, LLC
The Electrophysiological Properties of Ranolazine: A Metabolic Anti-Ischemic Drug or an Energy-Efficient Antiarrhythmic Agent? Treatment Update
Ranolazine, a newer anti-ischemic agent that appears to induce a more efficient utilization of adenosine triphosphate at the cellular level, has been shown to be clinically beneficial in patients with chronic stable angina. More recently, the antiarrhythmic effects of the drug have been described in patients with acute coronary syndromes, as well as in those with atrial fibrillation, when combined with other agents. Experimentally, the predominant inhibitory effects on late INa, ICa, INa-Ca, and IKs, with little or no effect on Ito or IK1, have been demonstrated. Different experimental models have shown the potential beneficial effect of the drug in both supraventricular and ventricular arrhythmias. Interestingly, despite its potential prolongation of the QT interval, ranolazine does not appear to induce ventricular arrhythmias in animal models. Whether the antiarrhythmic effect is secondary to a more efficient energy production by the cardiac cell or by its direct effect on ion channels is still unclear. The effect of ranolazine on other ionic currents, as well as its potential as a clinically relevant antiarrhythmic agent, still needs to be studied. [Rev Cardiovasc Med. 2011;12(3):136-142 doi: 10.3909/ricm0572] © 2011 MedReviews®, LLC