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Urology

Volume 18, No 1 - 2016

Volume 18, No 1 - 2016

Table of Contents

Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives Management Update
We performed a systematic literature search to identify original articles and editorials about the Decipher® Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level. [Rev Urol. 2016;18(1):1-9 doi: 10.3909/riu0706] © 2016 MedReviews®, LLC
The Role of Antibiotic Prophylaxis in Percutaneous Nephrolithotomy Prophylactic Management Update
Postoperative sepsis is the most common cause of mortality after percutaneous nephrolithotomy (PCNL) procedures. Studies investigating the use of antibiotics in PCNL patients have shown that prophylactic antibiotic regimens can reduce the rate of postoperative infectious complications. In addition, several studies have identified risk factors for sepsis development that can help guide antibiotic treatment and perioperative care overall. This has led the American Urological Association to recommend antibiotic prophylaxis for PCNL as a best practice policy statement. However, despite prophylaxis, postoperative sepsis has continued to remain the leading cause of mortality in PCNL patients. In addition, multiple antibiotic protocols exist within the guideline realms. This review assesses the development and role of antibiotic prophylaxis for PCNL procedures. [Rev Urol. 2016;18(1):10-14 doi: 10.3909/riu0699A] © 2016 MedReviews®, LLC
Nephrolithometric Scoring Systems to Predict Outcomes of Percutaneous Nephrolithotomy Management Update
Currently, there is no single agreement upon an ideal predictive model that characterizes the complexity of renal stones and predicts surgical outcomes following percutaneous nephrolithotomy (PCNL). New predictive tools have recently emerged to systematically and quantitatively assess kidney stone complexity to predict outcomes following PCNL: the Guy’s Stone Score, the CROES nomogram, S.T.O.N.E. nephrolithometry, and S-ReSC score. An ideal scoring system should include variables that both influence surgical planning and are predictive of postoperative outcomes. This review discusses the strengths, weaknesses, and commonalities of each of the above scoring systems. Additionally, we propose future directions for the development and analysis of surgical treatment for stone disease, namely, the importance of assessing radiation exposure and patient quality of life when counseling patients on treatment options. [Rev Urol. 2016;18(1):15-27 doi: 10.3909/riu0693] © 2016 MedReviews®, LLC
Falls in the Elderly Secondary to Urinary Symptoms Prevention and Management Update
<p>Falls and fractures have a significant impact on our patients, their families, and caregivers, and cost the health care system billions of dollars. Each year, millions of adults aged 65 and older fall. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. Because many patients with falls and subsequent fractures have urologic conditions, urologists are positioned to help with the prevention of these significant and costly injuries. This article discusses the epidemiology of falls and fractures, and the urologic comorbidities that increase their risk. [Rev Urol. 2016;18(1):28-32 doi: 10.3909/riu0686] © 2016 MedReviews®, LLC</p>
The State of Independent Urology
[Rev Urol. 2016;18(1):33-34 doi: 10.3909/riu0708] © 2016 MedReviews®, LLC
Associated Medical Professionals, Syracuse, NY
[Rev Urol. 2016;18(1):35-37 doi: 10.3909/riu0710] © 2016 MedReviews®, LLC
Percutaneous Procedure CPT Code Update
[Rev Urol. 2016;18(1):38-43 doi: 10.3909/riu0707] © 2016 MedReviews®, LLC
How Would You Manage?
[Rev Urol. 2016;18(1):44-45 doi: 10.3909/riu0709] © 2016 MedReviews®, LLC
Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults
A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. [Rev Urol. 2016;18(1):46-50 doi: 10.3909/riu0689] © 2016 MedReviews®, LLC
Adenomatoid Tumor of the Testis Arising From the Tunica Albuginea
Adenomatoid tumors are the most common paratesticular tumor. Although they primarily arise from the epididymis, they can rarely occur as an isolated intratesticular mass. These tumors are benign and surgical excision is curative. We present a case of a 36-year-old man diagnosed with an intratesticular adenomatoid tumor. [Rev Urol. 2016;18(1):51-53 doi: 10.3909.riu0690] © 2016 MedReviews®, LLC
Ureteral Stone Associated With a Middle Blind Ending of a Bifid Ureter
A blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter. [Rev Urol. 2016;18(1):54-56 doi: 10.3909/riu0688] © 2016 MedReviews®, LLC