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Urology

Volume 9, No 3 - Summer 2007

Volume 9, No 3 - Summer 2007

Table of Contents

Prostate Biopsy: Current Status and Limitations Diagnostic Update
The technique of prostate biopsy has evolved over the past 10 years to improve our ability to detect prostate cancer. Extended biopsy schemes can be performed in the office under local anesthesia and are well tolerated. In addition to detection, the role of extended biopsy schemes in refining tumor grading and risk assessment has become better defined. This review discusses the evolution of prostate biopsy techniques from the sextant scheme to the extended scheme and demonstrates the latter's utility in clinical decision making. [Rev Urol. 2007;9(3):93-98]
Oral and Non-Oral Combination Therapy for Erectile Dysfunction Treatment Update
An estimated 30 million men in the United States suffer from varying degrees of erectile dysfunction. Increasing age and comorbidities are likely to increase the number of men who are initially refractory or become refractory to phosphodiesterase (PDE)-5 inhibitors, the most popular oral therapy. Combination therapy, a concept well proved in other areas of medicine, is therefore of increasing importance. Combination oral and non-oral (intracavernosal injection and intraurethral application) therapies have been shown to salvage monotherapy. The early introduction of combination therapy has been shown to expedite both the return of natural function and PDE-5 inhibitor responsiveness in post-prostatectomy patients with no reports of serious adverse events. Larger controlled studies are needed to corroborate those encouraging findings. [Rev Urol. 2007;9(3):99-105]
Advances in the Understanding of Stress Urinary Incontinence and the Promise of Stem-Cell Therapy Treatment Update
The middle urethra and external urethral sphincter are the focus in management of stress urinary incontinence, and recent cellular-therapy research suggests a new paradigm in treatment. Cell-based therapies are most often described as using autologous multipotent stem cells procured from bone marrow in procedures that may be painful, require anesthesia, and yield low numbers of mesenchymal stem cells upon processing. In contrast, muscleand adipose-derived stem cells can be obtained easily in large quantities under local anesthesia. Instead of lifting the urethra with a sling or bulking up the urethral sphincter with collagen, we now have the potential to restore function with the use of autologous stem cells. [Rev Urol. 2007;9(3):106-112]
Twenty Years of PSA: From Prostate Antigen to Tumor Marker Diagnostic Update
The measurement of prostate-specific antigen in serum is credited with dramatic advances in the early detection of men with prostatic carcinoma. This report summarizes the history of biochemical research and the current understanding and application of prostate-specific antigen in prostate cancer diagnostics. [Rev Urol. 2007;9(3):113-123]
Is Repeat Biopsy for Isolated High-Grade Prostatic Intraepithelial Neoplasia Necessary? Point-Counterpoint
Numerous studies have cited the positive predictive value of isolated highgrade prostatic intraepithelial neoplasia (HGPIN) to the detection of cancer. Epidemiological, morphological, and molecular data support the potential for malignant transformation of HGPIN, yet no current method can discriminate which lesions will progress to clinically significant prostate cancer versus more latent lesions. Recent analyses of multiple retrospective studies have found similar rates of cancer detection following either diagnosis of isolated HGPIN or an initial negative biopsy. This may reflect increased use of extended biopsy techniques involving 10 or more cores rather than the true ability of HGPIN to undergo malignant transformation. This article discusses controversies surrounding management of an isolated diagnosis of HGPIN and whether repeat biopsy of HGPIN should be mandatory or selective in the context of other predictive values such as rising prostate-specific antigen or lesion on digital rectal examination. [Rev Urol. 2007;9(3):124-131]
Best of the 2007 AUA Annual Meeting Meeting Review
Highlights from the 2007 Annual Meeting of the American Urological Association May 19-24, 2007 Anaheim, CA [Rev Urol. 2007;9(3):133-154]
Spontaneous Renal Artery Dissection Case Review
Spontaneous renal artery dissection (SRAD) is a rare event, and thus may be a challenge for physicians to diagnose and treat. We report a case of SRAD in a healthy 56-year-old male who presented with flank pain, fever, and elevated white blood cell count. The patient was initially diagnosed with nephrolithiasis versus pyelonephritis and was admitted for observation. Multiple imaging modalities, including non-contrast computed tomography (CT), magnetic resonance imaging (MRI) with gadolinium, CT angiogram, and intraoperative angiogram, were used to make the final diagnosis of SRAD. The patient was treated with endovascular stent placement and is currently free of pain with normal laboratory values and blood pressure. [Rev Urol. 2007;9(3):156-160]