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Urology

Volume 20, Number 1 - 2018

Volume 20, Number 1 - 2018

Table of Contents

Nocturia: Evaluation and Current Management Strategies Management Update
Nocturia is a complex condition that not only significantly affects quality of life, but may be an indicator of systemic disease. Initial assessment includes a detailed history and physical examination and completion of a frequency volume chart to help identify underlying causes, such as sleep disorders, bladder storage disorders, and polyuria. Treatment with alpha-blockers or antimuscarinic medications may help if the underlying cause is determined to be benign prostatic hyperplasia or overactive bladder, respectively. Treatment options for nocturnal polyuria have been limited to behavioral therapy and off-label use of timed diuretics and desmopressin. Desmopressin acetate nasal spray (Noctiva™, Avadel Pharmaceuticals, Chesterfield, MO) was approved by the US Food and Drug Administration in 2017 for the treatment of nocturia due to nocturnal polyuria in adults who awaken at least twice nightly and has shown efficacy in reducing nocturnal voids by $50% in up to 49% of patients in clinical trials. [Rev Urol. 2018;20(1):1–6 doi: 10.3909/riu0797] © 2018 MedReviews®, LLC
Factors Associated With Postoperative Infection After Percutaneous Nephrolithotomy Risk Factor Analysis
Numerous studies have investigated risk factors for the development of postoperative infection in percutaneous nephrolithotomy (PCNL) patients. Herein, we describe our meta-analysis of the risk factors for the prediction of post-PCNL infectious complications. We searched electronic databases using a combination of the terms percutaneous nephrolithotomy, risk factors, infection, and sepsis. The primary outcome was post-PCNL infection as defined by fever greater than 38°C or sepsis as defined by the Sepsis Consensus Definition Committee. Risk factors for infection in each study were identified and included for analysis if present in at least two studies. We used quantitative effect sizes in odds ratio to assess each endpoint. After application of criteria, 24 studies were found, of which 12 were prospective and 12 were retrospective. Of the prospective studies, preoperative urine culture, renal pelvis culture, stone culture, number of access points, hydronephrosis, perioperative blood transfusion, and struvite stone composition were found to be significantly associated with postoperative infection. Of the 12 retrospective studies, preoperative urine culture, stone cultures, number of access points, blood transfusion, stone size, and staghorn formation were associated with infection. Preoperative urine culture, stone culture, number of access points, and need for blood transfusion were consistently found to be significant factors. This indicates that the presence of bacteria in the urine/stone preoperatively as well as the amount of trauma the kidney sustains during the procedure are major predictors of postoperative infection. [Rev Urol. 2018;20(1):7–11 doi: 10.3909/riu0778] © 2018 MedReviews®, LLC
Differentiating Molecular Risk Assessments for Prostate Cancer Risk Assessment Review
It is critically important to the evolving goals of prostate biopsy to find clinically significant cancer with lethal potential and avoid detection of indolent disease. Better tests and markers are required for improved detection of clinically significant prostate cancer and avoidance of biopsies in men with indolent disease. Currently, there are myriad alternative prostate cancer risk-assessment tests available derived from serum and urine that are designed to improve the specificity for detection of “significant” prostate cancer. Herein we discuss these tests and their clinical implications. [Rev Urol. 2018;20(1):12–18 doi: 10.3909/riu0787] © 2018 MedReviews, LLC®
Transrectal Ultrasound–guided Versus Transperineal Mapping Prostate Biopsy: Complication Comparison
Herein, the authors compare morbidity in men who underwent both transrectal ultrasound–guided (TRUS) prostate biopsy and transperineal mapping biopsy (TPMB) at two institutions with extensive experience in both procedures. We also identified strategies and predictive factors to reduce morbidity for both procedures. In our study, 379 men from two institutions, of which 265 (69.9%) had a prior TRUS-guided biopsy, also had TPMB performed via a template with biopsies taken at 5-mm intervals. Men in the TRUS group had a median of 12 cores sampled whereas the TPMB group had 51.5 (range, 16-151). The median biopsy density was 1.1 core/cc prostate volume. Median age and prostate-specific antigen (PSA) level were 65 years (range, 34-86) and 5.5 ng/mL (range, 0.02-118). Of these men, 11 of 265 (4.2%) who had TRUS biopsy developed urinary tract infection compared with 3 of 379 (0.79%) of those with mapping biopsy. Infection was 14.8% in TRUS biopsy group with 13 or more cores versus 2.9% in those with 12 or less (OR, 5.8; 95% CI, 1.6-21.2; P = 0.003). No men developed retention after TRUS biopsy whereas 30 of 379 (7.9%) did following TPMB. Older age, larger prostate volume (PV), and higher core number were associated with retention. On linear regression only age (P = 0.010) and PV (P = 0.016) remained as significant associations. Men older than 65 years had 12.8% versus 3.9% (OR, 3.7; 95% CI, 1.6-8.4, P = 0.001) and PV greater than 42 cc had 13.4% versus 2.7% (OR, 5.7; 95% CI, 2.1-15.1) retention incidence. In the present study TPMB is rarely associated with infection (0.78%) but more commonly with urinary retention (7.9%). Men older than 65 years and with PV greater than 42 cc were at four to five times greater retention risk. Consideration should be given to discharging these men with a urinary catheter following TPMB. [Rev Urol. 2018;20(1):19–25 doi: 10.3909/riu0785] © 2018 MedReviews, LLC®
Best of the 2017 Society for Pediatric Urology Fall Congress
[Rev Urol. 2018;20(1):28–30 doi: 10.3909/riu0788] © 2018 MedReviews®, LLC
Bladder Cancer Academy 2018 Selected Summaries
[Rev Urol. 2018;20(1):31–37 doi: 10.3909/riu02001BCA] © 2018 MedReviews®, LLC
Management of Recurrent Non–Muscle Invasive Bladder Cancer January 2018
[Rev Urol. 2018;20(1):38–40 doi: 10.3909/riu0789] © 2018 MedReviews, LLC®
Penile Fracture Early February 2018
[Rev Urol. 2018;20(1):41–42 doi: 10.3909/riu0794] © 2018 MedReviews, LLC®
Management of Obstructive Benign Prostatic Hyperplasia With a >200 mL Gland Late February 2018
[Rev Urol. 2018;20(1):43–45 doi: 10.3909/riu0795] © 2018 MedReviews, LLC®
Management of Penile Cancer March 2018
[Rev Urol. 2018;20(1):46–48 doi: 10.3909/riu2001NYUCOM] © 2018 MedReviews, LLC®
A Potential Link: Cross-fused Renal Ectopia With Concomitant Absent Left Testicle
Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which both kidneys are located on a unilateral side of the retroperitoneal space. The ureter of the ectopic kidney is seen to pass over the midline to insert in its normal anatomic position. Frequently this anomaly goes undetected until there is radiologic screening for other purposes or when other genitourinary issues are investigated. Although frequently isolated, this condition has been reported to be associated with other congenital anomalies, genetic disorders, and various urogenital anomalies more than 50% of the time. However, we found no cases linking CFRE with a solitary testicle. This is a case of a 30-year-old man with left-to-right CFRE with concomitant absent left testicle and obstructing distal calculus. [Rev Urol. 2018;20(1):49–51 doi: 10.3909/riu0770] © 2018 MedReviews, LLC®