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Urology

Volume 21, Number 1

Volume 21, Number 1

Table of Contents

Prostate Biopsy Features: A Comparison Between the Pre– and Post–2012 United States Preventive Services Task Force Prostate Cancer Screening Guidelines With Emphasis on African American and Septuagenarian Men
We compare prostate biopsy (Pbx) characteristics from 3 years prior to the 2012 United States Preventive Services Task Force (USPSTF) prostate cancer (PCa) screening guidelines with those of 2018, with a focus on African American (AA) men and healthy men aged 70 to 80 years. We completed a retrospective comparative analysis of 1703 sequential patients that had had a Pbx from 2010 to 2012 (3 years) with 383 patients biopsied in 2018. Data was collected on patient age, race, prostate-specific antigen (PSA), digital rectal examination (DRE), total number of biopsies performed, and Gleason sum score (GSS). The data was analyzed to determine whether the 2012 USPSTF screening recommendations affected PCa characteristics. Two study groups were defined as group A and B, Pbx prior to the 2012 USPSTF screening guidelines and that of 2018, respectively. The study population consisted of 71% high-risk AA patients. In Group A (pre-2012 USPSTF guidelines), 567 patients/year underwent a Pbx versus Group B, 383 patients/year, a 32% reduction post-USPSTF. The annual positive Pbx rate for Group A is 134/year versus Group B with 175/year, a 31% increase post-USPSTF. In Group B, there was a 94% relative increase in total positive biopsies. Group A had high-grade PCa (GSS 7-10) in 51.5% versus 60.5% in Group B, a 9% increase post-USPSTF. The proportion of patients with a PSA 10 ng/mL or higher was 25.4% in group A versus 29.3% in group B. The age group of 70 to 80 years demonstrated an increasing trend for patients with PSA 10 ng/mL and higher, 31% in Group A versus 38% in Group B; high-grade tumors (GSS 7-10) occurred in 61% in Group A versus 65% in Group B. After the 2012 USPSTF guidelines against PCa screening, our study shows decreased prostate cancer screening with decreased Pbx, increased PCa diagnosis, and increased high-grade (GSS 7-10) PCa. These trends were especially notable in the 70- to 80-year age group, which showed a larger proportion of total patients (compared with pre-2012 USPSTF guidelines), increased PCa grades, increased PSA levels, and a higher percentage of patients with greater than 50% positive cores. As our patient population consists of 71% AA patients, our results support aggressive PCa screening for high-risk patients, which includes AA men, men with a family history of PCa, and healthy men aged 70 to 80 years. [Rev Urol. 2019;21(1):1–7] © 2019 MedReviews®, LLC
Skin Grafting Applications in Urology Treatment Review
Skin grafting is a closure technique widely used in plastic surgery. Urologists may encounter patients with diseases that lead to severe tissue loss due to infection, trauma, burns, malignancy, skin maladies, or primary lymphedema. The development and study of skin harvesting techniques to manage tissue coverage of burns has allowed for great advances and the widening application of skin grafting. As such, there is a growing recognition and application of skin grafts within urology. The aim of surgical treatment and skin grafting within urology is to preserve genital function, improve quality of life, and restore cosmetic damage. In addition to basic technique, this article reviews specific surgical methods employed in reconstruction for patients with Fournier gangrene, buried penis, and hidradenitis suppurativa. Urologists must be aware of these techniques in order to provide adequate counseling for patients considering these operations and when encountering complications. [Rev Urol. 2019;21(1):8–14] © 2019 MedReviews®, LLC
Immunotherapy in Urological Tumors Treatment Review
The past decade has seen significant improvement in our understanding of tumor biological features, which has led to use of anti-programmed-death 1 (PD-1) and anti-PD ligand-1 (PD-L1) agents and cytotoxic T lymphocytes antigen 4 (CTLA-4) inhibitors in a multitude of cancers. These immunotherapeutic agents have shown activity in melanoma, lung, head and neck, colorectal, urological, and other cancers. This article details the use of immunotherapy agents in urothelial, renal, prostate, and testicular tumors. [Rev Urol. 2019;21(1):15–20] © 2019 MedReviews®, LLC
LUGPA Expands 2019 Professional Development Opportunities
[Rev Urol. 2019;21(1):21–22] © 2019 MedReviews®, LLC
Bladder Cancer Academy 2019 Selected Summaries
[Rev Urol. 2019;21(1):23–28] © 2019 MedReviews®, LLC
Varicocele Repair in Men With Severe Oligospermia NYU Case of the Month, February 2019
[Rev Urol. 2019;21(1):32–34] © 2019 MedReviews®, LLC
Transperineal Saturation Prostate Biopsy NYU Case of the Month, March 2019
[Rev Urol. 2019;21(1):35–40] © 2019 MedReviews®, LLC
Symptomatic Rosai-Dorfman Disease Presenting as Isolated Bilateral Perinephric Infiltration
This case explores a rare initial presentation of Rosai-Dorfman disease isolated to the peri-renal space. Also described as sinus histiocytosis with massive lymphadenopathy, Rosai-Dorfman disease is non-neoplastic and most often presents with massive cervical lymphadenopathy, but the disease can affect any organ system. Not often considered by those in the urology community or found in urology journals, this report reviews a clinical presentation of Rosai-Dorfman disease affecting bilateral kidneys and the fundamental histopathology needed for its diagnosis. [Rev Urol. 2019;21(1):41–44] © 2019 MedReviews®, LLC
Ureteral Polyp Managed by Endoscopic Techniques
Fibroepithelial polyps (FEPs) are rare benign tumors of mesodermal origin. They are found in the ureters 85% of the time, with the remainder located in the renal pelvis and occasionally the bladder. FEPs can present as flank pain, lower abdominal pain, and/or gross hematuria. Previous literature reports management of these benign lesions using open surgical techniques, laparoscopic techniques, and endoscopic management. In this article, the authors present their pure endoscopic management of a large ureteral polyp and a review of the current literature outlining the etiology, clinical presentations, and management techniques for FEP of the ureter. [Rev Urol. 2019;21(1):45–48] © 2019 MedReviews®, LLC
Use of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of Orchialgia
Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [Rev Urol. 2019;21(1):49–52] © 2019 MedReviews®, LLC