• Pelvic Medicine/ Surgery
    • 1

      Female Pelvic Floor and Lower Urinary Tract Anatomy

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      Female Pelvic Floor and Lower Urinary Tract Anatomy

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    • 2

      Stress Urinary Incontinence Assessment and Conservative Treatments

      By Sidhartha Kalra, MD; Benjamin M Brucker, MD
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      Stress Urinary Incontinence Assessment and Conservative Treatments

      • SIDHARTHA KALRA, MD
      • BENJAMIN M BRUCKER, MD

      Stress urinary incontinence (SUI) is a prevailing condition affecting women’s physical, psychological, and social well-being. SUI is the most common type of urinary incontinence, with an estimated prevalence of 8 to 33%. Despite increased awareness, it is still commonly underreported. Identifying the problem and developing an individualized assessment and treatment plan are essential for achieving the best outcome and quality of life for these women. Numerous tools exist that may aid clinicians in making an appropriate diagnosis and then selecting the optimal treatment, including behavioral, medical, and surgical approaches. Although a plethora of treatment options exist for SUI, conservative management is considered an effective first-line option for most patients. The purpose of this review is to discuss the current understanding of SUI in women and to outline the evaluations and conservative management options with the best available scientific evidence.

      This review contains 3 highly rendered figures, 2 tables, and 57 references

      Key words: Stress Urinary Incontinence, Conservative management, Pelvic Floor Exercises, Pessary, Vaginal inserts, medical treatment

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    • 3

      Surgical Treatment of Female Stress Urinary Incontinence: Pubovaginal Slings

      By Alex Gomelsky, MD; Tameem Islam, MD; Umar R Karaman, MD
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      Surgical Treatment of Female Stress Urinary Incontinence: Pubovaginal Slings

      • ALEX GOMELSKY, MDProfessor and chairman, Clinical Urology, Department of Urology, Louisiana State University Health – Shreveport, Shreveport, LA
      • TAMEEM ISLAM, MDResident, Department of Urology, Louisiana State University Health – Shreveport, Shreveport, LA
      • UMAR R KARAMAN, MDResident Department of Urology, Louisiana State University Health – Shreveport, Shreveport, LA

      Autologous tissue has been used for pubovaginal sling construction for over a century. Compared with synthetic materials, fascial harvest carries additional and expected morbidity. However, by the nature of its definition, the use of autologous tissues is not associated with a significant immunogenic or any foreign body response. Randomized controlled trials have demonstrated and confirmed the durability of these procedures when compared with both colposuspensions and synthetic midurethral sling procedures. In light of the recent FDA warning regarding the use of synthetic materials for stress incontinence and pelvic organ prolapse surgery, the role of the autologous sling may be more prominent going forward. As such, the autologous pubovaginal sling remains a standard of care for the management of female stress urinary incontinence.

      This review contains 6 figures and 30 references

      Key words: autologous rectus fascia, complications, outcomes, pubovaginal sling, randomized controlled trials, stress urinary incontinence 

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    • 4

      Surgical Treatment of Female Stress Urinary Incontinence: Midurethral Slings

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      Surgical Treatment of Female Stress Urinary Incontinence: Midurethral Slings

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    • 5

      Medical Management of Neurogenic Bladder

      By Anne P Cameron, MD, FRCSC, FPMRS; John T Stoffel, MD, FPMRS
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      Medical Management of Neurogenic Bladder

      • ANNE P CAMERON, MD, FRCSC, FPMRS
      • JOHN T STOFFEL, MD, FPMRS

      In the management of neurogenic bladder (NGB), the goals are first and foremost to protect the upper tract from damage. The second treatment goal is to maintain urinary continence, but all the while maintaining the patient’s quality of life. These goals are achieved by treating most patients with NGB in a targeted fashion based on urodynamic findings. Medical therapy optimization and appropriate bladder drainage are the cornerstones of NGB management. Detrusor overactivity, poor bladder compliance, and incontinence related to these are best initially managed with antimuscarinic agents,; however, there is an increasing role for the new beta3 agonists. In the event these therapies fail, botulinum toxin is often the next choice; however,  is an expensive treatment, and some patients may be treated with combination drug therapy. Nocturnal polyuria is also extremely common in this group of patients and is quite bothersome. After other risk factors have been excluded, medical treatment with desmopressin may be a suitable alternative.

      This review contains 3 highly rendered figures, 2 tables, and 85 references


      Key words: adrenergic alpha blockers, antimuscarinics, botulinum toxin, desmopressin, imipramine, mirabegron, multiple sclerosis, neurogenic bladder, spinal cord injury

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    • 6

      Male Lower Urinary Tract Anatomy

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      Male Lower Urinary Tract Anatomy

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    • 7

      Surgical Treatment of Female Stress Urinary Incontinence: Retropubic Slings

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      Surgical Treatment of Female Stress Urinary Incontinence: Retropubic Slings

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    • 8

      Conservative Management of Male Stress Urinary Incontinence

      By Tammy Ho, MD; H Henry Lai, MD
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      Conservative Management of Male Stress Urinary Incontinence

      • TAMMY HO, MD
      • H HENRY LAI, MD

      Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter.

      This review contains 3 figures and 54 references

      Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence

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    • 9

      Surgical Treatment of Male Incontinence: Slings

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      Surgical Treatment of Male Incontinence: Slings

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    • 10

      Surgical Treatment of Male Incontinence: Artificial Urinary Sphincter

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      Surgical Treatment of Male Incontinence: Artificial Urinary Sphincter

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    • 11

      Evaluation and Conservative Management of Overactive Bladder

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      Evaluation and Conservative Management of Overactive Bladder

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    • 12

      Medications and Botulinum Toxin for Overactive Bladder

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      Medications and Botulinum Toxin for Overactive Bladder

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    • 13

      Neuromodulation for Overactive Bladder

      By Natalie Gaines, MD; Priyanka Gupta, MD; Larry Sirls, MD; Kenneth M Peters, MD
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      Neuromodulation for Overactive Bladder

      • NATALIE GAINES, MD
      • PRIYANKA GUPTA, MD
      • LARRY SIRLS, MD
      • KENNETH M PETERS, MD

      Neuromodulation is an FDA-approved treatment modality for overactive bladder. The AUA/SUFU guidelines for management of overactive bladder include neuromodulation as a third-line therapy after failure of more conservative therapies, such as behavioral modifications and pharmacotherapy. In this review, a brief history of the technology required to develop the implantable neuroprosthesis is discussed. We examine relevant neuroanatomy and the most recent discoveries for the pathophysiology of overactive bladder, and our current best understanding of the mechanism of action of neuromodulation is considered. The three routes for neuromodulation, sacral, pudendal, and posterior tibial, are discussed individually, with outcomes, complication, and cost data reviewed for each modality. Finally, an update of future developments in neuromodulation is included.

      This review contains 8 highly rendered figures, 2 tables, and 71 references

      Key words: adverse event, implantable neurostimulators, neuromodulation, overactive, percutaneous tibial nerve stimulation, pudendal neuromodulation, sacral neuromodulation, spinal nerve roots, surgical intervention, urge urinary incontinence, urinary bladder

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    • 14

      Bladder Outlet Obstruction and Retention

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      Bladder Outlet Obstruction and Retention

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    • 15

      Evaluation and Nonsurgical Treatment of Pelvic Organ Prolapse

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      Evaluation and Nonsurgical Treatment of Pelvic Organ Prolapse

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    • 16

      Surgical Treatment of Pelvic Organ Prolapse: Anterior

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      Surgical Treatment of Pelvic Organ Prolapse: Anterior

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    • 17

      Surgical Treatment of Pelvic Organ Prolapse: Posterior

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      Surgical Treatment of Pelvic Organ Prolapse: Posterior

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    • 18

      Surgical Treatment of Pelvic Organ Prolapse: Apex

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      Surgical Treatment of Pelvic Organ Prolapse: Apex

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    • 19

      Urogenital Fistulas and Urethral Diverticula

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      Urogenital Fistulas and Urethral Diverticula

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    • 20

      Evaluation of Neurogenic Bladder

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      Evaluation of Neurogenic Bladder

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    • 21

      Surgical Treatment of Neurogenic Bladder

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      Surgical Treatment of Neurogenic Bladder

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    • 22

      Painful Bladder Syndrome

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      Painful Bladder Syndrome

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    • 23

      Urodynamic Testing

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      Urodynamic Testing

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    • 24

      Surgical Treatment of Female Stress Urinary Incontinence Using Injectables

      By Dominic Lee, MBBS (Hons) (FRACS Urology); Philippe E Zimmern, MD
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      Surgical Treatment of Female Stress Urinary Incontinence Using Injectables

      • DOMINIC LEE, MBBS (HONS) (FRACS UROLOGY)Department of Urology, St George Hospital, Kogarah, New South Wales
      • PHILIPPE E ZIMMERN, MDDepartment of Urology, University of Texas Southwestern Medical Center, Dallas, TX

      Stress urinary incontinence (SUI) is a condition prevalent in adult women. Among the available treatment alternatives, minimal invasive options such as the injection of periurethral bulking agents (PBAs) remain preferable to many women because of ease of administration and very minimal postoperative morbidity. Its primary use has, however, been in the treatment of intrinsic sphincter deficiency. The quest to find the ideal agent is ongoing. Many PBAs are available, whereas some are no longer in the market. This review examines the historical aspect and indications of PBAs, the relevant surgical techniques, and current injectable agents in use and their effectiveness along with associated adverse events.


      This review contains 5 figures, 3 tables, and 51 references.

      Keywords: female, stress urinary incontinence, minimally invasive procedure, mechanism, bulking agent, intrinsic sphincter deficiency, efficacy, technique, complications

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    • 25

      Acute Testicular Torsion: Presentation and Diagnosis

      By Claudia Berrondo, MD; Robert A. Mevorach, MD; Jimena Cubillos, MD
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      Acute Testicular Torsion: Presentation and Diagnosis

      • CLAUDIA BERRONDO, MDClinical instructor in Pediatric Urology, Strong Memorial Hospital, University of Rochester, Rochester, NY, Seattle Children’s Hospital, Seattle, WA
      • ROBERT A. MEVORACH, MDChesapeake Urology for Kids, Owings Mills, MD, Nemour’s Children’s Specialty Care, Pensacola, FL, Division Chief of Pediatric Urology
      • JIMENA CUBILLOS, MDStrong Memorial Hospital, University of Rochester, Rochester, NY, Associate Professor of Clinical Urology

      Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician.

      This review contains 6 figures, 5 tables, and 34 references. 

      Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

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    • 26

      Erectile Dysfunction: Surgical Treatment (vascular and Prosthetic Surgery)

      By M Ryan Farrell, MD MPH; George A Abdelsayed, MD; Laurence A Levine, MD
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      Erectile Dysfunction: Surgical Treatment (vascular and Prosthetic Surgery)

      • M RYAN FARRELL, MD MPHDivision of Urology, Rush University Medical Center, Chicago, IL
      • GEORGE A ABDELSAYED, MDDivision of Urology, Rush University Medical Center, Chicago, IL
      • LAURENCE A LEVINE, MDDivision of Urology, Rush University Medical Center, Chicago, IL

      Surgical treatment oferectile dysfunction (ED) can be considered in men who either fail or elect to avoid further nonoperative modalities. For patients with an organic etiology of ED, a penile prosthesis can be placed. There are multiple approaches available for penile prosthesis implantation including penoscrotal, infrapubic, and subcoronal. Furthermore, the location of reservoir placement should be considered, either within the space of Retzius or at an ectopic submuscular location according to patient factors. Potential intraoperative and postoperative complications of penile prosthesis implantation are also reviewed. Alternatively, for young and otherwise healthy men with ED secondary to focal arterial insufficiency often in the setting of pelvic trauma, penile microarterial bypass surgery is an effective treatment option.

      This review contains 6 figures, 2 tables, and 48 references. 

      Key words:erectile dysfunction, inflatable penile prosthesis, malleable penile prosthesis, surgical technique, intraoperative complications, postoperative complications, arterial revascularization

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    • 27

      Interstitial Cystitis/bladder Pain Syndrome

      By Patrick J Hensley, MD; H. Henry Lai, MD; Deborah R Erickson, MD
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      Interstitial Cystitis/bladder Pain Syndrome

      • PATRICK J HENSLEY, MDResident Physician, Department of Urology, University of Kentucky College of Medicine, Lexington, KY
      • H. HENRY LAI, MDAssociate Professor of Surgery, Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
      • DEBORAH R ERICKSON, MDProfessor of Urology

      This article describes a practical framework for the evaluation and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), based on and expanding from the American Urological Association (AUA) guideline. The key points in evaluation are (1) to recognize confusable diseases or comorbid disorders that require separate treatments, and (2) to recognize patient subtypes that require specialized treatment approaches (eg, pelvic pain and beyond, polysymptomatic and polysyndromic types, and patients with Hunner lesions). Treatment begins with education, including diet, stress reduction, and other self-care strategies, which have proven efficacy and are first line in the AUA guideline. Second-tier treatments include oral and intravesical medications. Further, the AUA guideline states that physical therapy should be offered to patients with pelvic floor tenderness if a qualified therapist is available.  For Hunner lesions, the initial recommended treatment is cystoscopy with fulguration or triamcinolone injection. Higher-tier treatments, which involve more risks, include hydrodistention, bladder botulinum toxin injection, sacral nerve stimulation, and oral cyclosporine A. The article includes a practical algorithm to help clinicians organize their thoughts while evaluating and starting therapy for patients with IC/BPS.

      This review contains 4 figures, 4 tables, and 64 references.

      Key Words: bladder pain syndrome, Hunner lesion, interstital cystitis,   polysymptomatic, polysyndromic, pelvic floor dysfuction, vulvodynia

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  • Uro-oncology
    • 1

      Localized Prostate Cancer: Active Surveillance

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      Localized Prostate Cancer: Active Surveillance

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    • 2

      Screening PSA and Early Detection (including Epidemiology and Risk Factors)

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      Screening PSA and Early Detection (including Epidemiology and Risk Factors)

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    • 3

      Quality of Life Considerations

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      Quality of Life Considerations

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    • 4

      Genetics and Pathogenesis of RCC

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      Genetics and Pathogenesis of RCC

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    • 5

      Role of Surgery in Localized Prostate Cancer

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      Role of Surgery in Localized Prostate Cancer

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    • 6

      Management of Muscle Invasive Bladder Cancer

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      Management of Muscle Invasive Bladder Cancer

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    • 7

      Systematic Therapies for Urothelial Cancer

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      Systematic Therapies for Urothelial Cancer

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    • 8

      Management of Castrate Resistant Pca: First Line Therapy

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      Management of Castrate Resistant Pca: First Line Therapy

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    • 9

      Genomic Landscape of Prostate Cancer and Opportunities of Precision Oncology

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      Genomic Landscape of Prostate Cancer and Opportunities of Precision Oncology

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    • 10

      Management of Small Renal Masses

      By Keith A Lawson , MD, MSc; Antonio Finelli , MD, MSc, FRCSC
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      Management of Small Renal Masses

      • KEITH A LAWSON , MD, MSCDivision of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON
      • ANTONIO FINELLI , MD, MSC, FRCSCDivision of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON

      The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm. 

      This review contains 6 figures, 6 tables and 63 references

      Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

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    • 11

      Naturalal History and Rx of PSA Recurrent PCA

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      Naturalal History and Rx of PSA Recurrent PCA

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    • 12

      Role of Radiotherapy in Localized Prostate Cancer

      By Joelle Helou, MD, MSc; Andrew Loblaw, MD, MSc, FRCPC
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      Role of Radiotherapy in Localized Prostate Cancer

      • JOELLE HELOU, MD, MSCRadiation Oncologist, Radiation Medicine Program, Princess Margaret Cancer Centre; Department of Radiation Oncology, University of Toronto, Toronto, ON
      • ANDREW LOBLAW, MD, MSC, FRCPCRadiation Oncologist and Clinician Scientist, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Departments of Radiation Oncology and Health Policy, Measurement and Evaluation, University of Toronto, Toronto, ON

      Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).

      This review contains 2 figures, 5 tables, 1 video and 135 refereces

      Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy

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    • 13

      Management of Metastatic Castrate Sensitive Pca

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      Management of Metastatic Castrate Sensitive Pca

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    • 14

      Surgical Managemnt of GCT of Testes

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      Surgical Managemnt of GCT of Testes

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    • 15

      Urothelial Carcinoma: Epidemiology, Pathogenesis, and Diagnosis

      By Ryan Hutchinson, MD; Yair Lotan, MD
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      Urothelial Carcinoma: Epidemiology, Pathogenesis, and Diagnosis

      • RYAN HUTCHINSON, MDAssistant Professor of Urology, Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX
      • YAIR LOTAN, MDProfessor of Urology, Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX

      Urothelial carcinoma (UC) is the primary cancer arising from the lining of the urinary tract. It is a costly disease to manage both for individual patients and the healthcare system as a whole. We present a review of the epidemiology, pathogenesis, and diagnostic pathway currently used in the management of this disease and examine current trends and avenues forward. Epidemiologically, the disease varies widely worldwide, both in frequency and in causation. Multiple agents including tobacco use, industrial exposures, Schistosoma infection, and herbal medicines all cause UCs with unique attributes. Current diagnostic management is the result of decades of technologic advancement in urology and continues to rapidly evolve both with respect to surgical devices and molecular biomarkers. Both strategies are giving providers better information to make treatment decisions than ever before. We hope to provide the reader a timely overview of these aspects of UCs and provide a strong introductory fund of knowledge that will be useful both in clinical and academic practices.

      This review contains 10 figures, 5 tables, and 49 references

      Key Words: biomarkers, bladder tumor, cancer staging, cystoscopy, diagnostic modalities, epidemiology, pathogenesis, tobacco smoking, urine cytology, urothelial carcinoma

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    • 16

      Management of Non Muscle Invasive Bladder Cancer

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      Management of Non Muscle Invasive Bladder Cancer

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    • 17

      Management of Castrate Resistant Pca: Second Line and Supportive Therapies

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      Management of Castrate Resistant Pca: Second Line and Supportive Therapies

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    • 18

      Management of Locally Advanced RCC

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      Management of Locally Advanced RCC

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    • 19

      Systematic Therapy of Testicular Cancer

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      Systematic Therapy of Testicular Cancer

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    • 20

      Biochemical Recurrence After Radical Prostatectomy

      By Dunia Khaled, MD; Scott Delacroix, MD; Brian Chapin, MD
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      Biochemical Recurrence After Radical Prostatectomy

      • DUNIA KHALED, MDResident Physician, Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA
      • SCOTT DELACROIX, MDAssociate Professor, Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA
      • BRIAN CHAPIN, MDAssistant Professor, Department of Urology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX

      After receiving local treatment, many patients will develop a biochemical recurrence (BCR) in the absence of detectable distant disease (cM0) and comprise a significant proportion (20.1%) of prostate cancer disease states. The natural history of patients with BCR ranges from those with indolent, nonprogressive, slow prostate-specific antigen (PSA)-only progression to those ultimately destined to develop metastases and progress to a cancer-specific death. Pathologic predictors of BCR, clinical progression, and cancer-specific mortality are well established in the literature, although multiple novel predictors are emerging, which are highlighted. Traditional imaging cannot reliably distinguish local versus distant microscopic metastasis at the PSA levels that have been shown to confer survival advantage for salvage radiation therapy. We review past and present imaging standards and discuss novel imaging modalities, which may improve staging and offer opportunity for novel salvage therapies, including salvage lymph node dissection and stereotactic beam radiation therapy. With an emphasis on BCR after radical prostatectomy, both curative and palliative treatments are reviewed.

      This review contains 7 figures, 6 tables and 73 references

      Key words: biochemical recurrence, clinically undetectable metastases, molecular imaging, monitoring treatment response, prostate cancer, radical prostatectomy, rising prostate-specific antigen, salvage lymph node dissection, salvage radiation 

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    • 21

      Late Stage Prostate Cancer

      By Karthik Giridhar, MD; Manish Kohli, MD
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      Late Stage Prostate Cancer

      • KARTHIK GIRIDHAR, MDOncology Fellow, Mayo Clinic, Division of Medical Oncology, Rochester, MN
      • MANISH KOHLI, MDProfessor of Oncology, Mayo Clinic, Division of Medical Oncology, Rochester, MN

      Prostate cancer remains the second leading cause of cancer death in men and encapsulates a wide spectrum of disease. This review describes recent advances in genomic sciences and summarizes the impact of emerging molecular profiling–based clinical applications in the diagnosis and management of early and advanced prostate cancer. It addresses the controversial guidelines surrounding prostate-specific antigen–based screening for prostate cancer and summarizes the recommendations from six different agencies. This review highlights landmark clinical trials in metastatic prostate cancer, focusing on developments within the last 5 years. It also summarizes the rationale for earlier use of chemotherapy for newly diagnosed prostate cancer (chemohormonal therapy) and gives an overview of ongoing research into the development of novel genome-based therapeutics.

      This review contains 4 figures, 8 tables, and 74 references.

      Key words: castration resistant, molecular profiling, prostate cancer, screening guidelines, treatment options

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    • 22

      Management of Non–muscle-invasive Bladder Cancer

      By Peter C Black , MD
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      Management of Non–muscle-invasive Bladder Cancer

      • PETER C BLACK , MDProfessor, Department of Urologic Sciences, University of British Columbia, Vancouver, BC

      Non–muscle-invasive bladder cancer (NMIBC) makes up 75% of the fifth most common cancer in North America. With a high rate of recurrence and progression, which leads to significant treatment burden for patients and high costs to healthcare systems, NMIBC poses several critical clinical challenges. Enhanced cystoscopic techniques are improving detection and optimal resection of these tumors. The administration of intravesical therapies, including especially cytotoxic chemotherapy and bacillus Calmette-Guérin (BCG) therapy, continues to evolve, and several promising agents are under development. Refined definitions of treatment failure are promoting clinical trial activity in this domain. The optimal timing of radical cystectomy for BCG therapy–unresponsive patients continues to be a key unresolved question, but advances in the molecular characterization of NMIBC are likely to enhance individualized, risk-adapted therapy in the near future.

      This review contains 3 Figures, 10 Tables and 91 references

      Key words: bladder cancer; cystoscopy; narrow band imaging; fluorescence cystoscopy; transurethral resection of bladder tumor (TURBT); intravesical chemotherapy; bacillus Calmette-Guérin (BCG) therapy; urine markers.

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    • 23

      Genomic Landscape of Prostate Cancer and Opportunities for Precision Oncology

      By Sheng-Yu Ku, PhD; Panagiotis J Vlachostergios , MD, PhD; Himisha Beltran, MD
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      Genomic Landscape of Prostate Cancer and Opportunities for Precision Oncology

      • SHENG-YU KU, PHDPostdoctoral Associate, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
      • PANAGIOTIS J VLACHOSTERGIOS , MD, PHDClinical Fellow, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
      • HIMISHA BELTRAN, MDAssociate Professor, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY

      Recent metastatic biopsy programs combined with advances in sequencing technologies have provided new insights into the genomic landscape of castration-resistant prostate cancer (CRPC), identifying actionable targets and diverse resistance mechanisms. Here, we describe the molecular features of CRPC and how these findings are being translated into the clinic. Current challenges include tumor heterogeneity, the timing and potential cooperation of multiple driver gene aberrations, and the optimal timing and use of molecular profiling in the clinic including both tissue-based and liquid biopsy biomarkers (ie, circulating tumor cells and circulating tumor DNA). We summarize potential therapeutic strategies and ongoing molecularly-driven clinical trials.

      This review contains 5 figures, 2 tables and 57 references

      Key Words: androgen receptor, biomarkers, castrate-resistant prostate cancer, DNA repair, genomics, heterogeneity, precision oncology, targeted therapy, treatment resistance

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    • 24

      Local Treatment in the Management of Oligometastatic Prostate Cancer

      By Derya Tilki, MD; Christopher P Evans, MD
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      Local Treatment in the Management of Oligometastatic Prostate Cancer

      • DERYA TILKI, MDProfessor, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany,
      • CHRISTOPHER P EVANS, MDProfessor and Chairman, Department of Urologic Surgery, University of California, Davis School of Medicine, Sacramento, CA, United States

      Oncologic outcomes of patients with newly diagnosed metastatic prostate cancer (mPCa) are poor, with overall survival in the range of 44 to 60 months. The treatment paradigm for newly diagnosed mPCa is changing. Previous retrospective studies reported a survival benefit for local treatment (radical prostatectomy or radiotherapy) in addition to androgen deprivation treatment in the setting of oligometastatic prostate cancer. Several randomized clinical trials are now evaluating integration of local treatment in the approach to mPCa. The aim of this review is to summarize the studies reporting local treatment in men with mPCa at diagnosis.


      This review contains 1 table and 27 references. 

      Key Words: cytoreductive prostatectomy, hormone-naive, local treatment, metastatic prostate cancer, oligometastatic, radical prostatectomy, radiotherapy, randomized

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    • 25

      Management of Metastatic Castrate-sensitive Prostate Cancer

      By Derya Tilki, MD; Christopher P Evans, MD; Marc A Dall’era, MD
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      Management of Metastatic Castrate-sensitive Prostate Cancer

      • DERYA TILKI, MDProfessor, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany,
      • CHRISTOPHER P EVANS, MDProfessor and Chairman, Department of Urologic Surgery, University of California, Davis School of Medicine, Sacramento, CA, United States
      • MARC A DALL’ERA, MDProfessor, Department of Urologic Surgery, University of California, Davis School of Medicine, Sacramento, CA, United States

      Oncologic outcome of patients with newly diagnosed metastatic prostate cancer (mPCa) is poor. The treatment paradigm for newly diagnosed mPCa has changed. The standard of care for men with metastatic hormone-naive prostate cancer has been systemic androgen deprivation therapy (ADT). Previous randomized studies demonstrated an overall survival benefit by the addition of early chemotherapy with six cycles of docetaxel. More recently, results from randomized trials also demonstrated a survival benefit by the addition of abiraterone acetate to the ADT in men with metastatic disease. The aim of this review is to summarize the results from most recent studies, including men with newly diagnosed metastatic hormone-naive prostate cancer, focusing on chemotherapy and ADT.

      This review contains 1 figure, 2 tables, and 47 references. 

      Key Words: abiraterone acetate, androgen deprivation therapy, androgen deprivation, castrate sensitive, chemotherapy, continuous androgen deprivation, docetaxel, hormone-naive, intermittent androgen deprivation, metastatic prostate cancer

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    • 26

      Management of Castration-resistant Prostate Cancer: Second-line Therapies

      By Samer L Traboulsi, MD; Fred Saad, MD, FRCSC
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      Management of Castration-resistant Prostate Cancer: Second-line Therapies

      • SAMER L TRABOULSI, MDUro-Oncology Fellow, Division of Urology, University of Montreal Hospital Center, CHUM, Montréal, QC, Canada H2X 0A9
      • FRED SAAD, MD, FRCSCProfessor and Chariman of Urology, Director of Genitourinary Oncology, Division of Urology, University of Montreal Hospital Center, CHUM, Montréal, QC, Canada H2X 0A9

      Until 2010, the only approved life-prolonging treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) was docetaxel. Since 2010, abiraterone acetate, enzalutamide, and cabazitaxel have demonstrated overall survival (OS) benefits in the postdocetaxel setting. The COU-AA-301 trial showed an OS advantage with abiraterone acetate plus prednisone compared with placebo plus prednisone. A superior OS was also seen in the AFFIRM trial that compared enzalutamide with placebo and in the TROPIC trial that compared cabazitaxel plus prednisone with mitoxantrone plus prednisone Radium-223 dichloride has also been approved based on the ALSYMPCA trial for symptomatic patients with castration-resistant prostate cancer (CRPC) metastatic to bone only. Optimal sequencing of approved therapies remains controversial. In this chapter, we will review the approved agents in second-line treatment of CRPC and discuss the sequencing options.

      This review contains 4 figures, 5 tables, and 57 references.

      Key Words: abiraterone acetate, cabazitaxel, castration-resistant, docetaxel, enzalutamide, MDV 3100, prostatic neoplasms, radium-223 dichloride, sequencing of therapy

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    • 27

      Quality of Life Following Management of Localized Prostate Cancer

      By Louis A Aliperti, MD; Martin G Sanda, MD; Christopher P Filson, MD, MS
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      Quality of Life Following Management of Localized Prostate Cancer

      • LOUIS A ALIPERTI, MDDepartment of Urology, Emory University, Atlanta, Georgia
      • MARTIN G SANDA, MDDepartment of Urology, Emory University, Atlanta, Georgia, Winship Cancer Institute, Emory University, Atlanta, Georgia
      • CHRISTOPHER P FILSON, MD, MSDepartment of Urology, Emory University, Atlanta, Georgia, Winship Cancer Institute, Emory University, Atlanta, Georgia, Atlanta VA Medical Center, Decatur , Georgia

      With a long survivorship phase after diagnosis and treatment of prostate cancer, consideration of the impact of treatment on health-related quality of life (HRQOL) is critical. For men considering treatment of prostate cancer, the domains that are impacted include urinary, sexual, and bowel-related qualities of life. This review identifies aspects of tools measuring HRQOL and covers instruments used to measure quality of life following a diagnosis and treatment of prostate cancer. We review the impact associated with radical prostatectomy, radiation and brachytherapy, and observation on men diagnosed with prostate cancer and compare the effects that each management strategy has on sexual and urinary function.

      This review contains 3 figures, 5 tables, 44 references.

      Key Words: erectile dysfunction, expectant management, lower urinary tract symptoms, prostate cancer, radical prostatectomy, radiation therapy, quality of life, urinary incontinence

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    • 28

      Screening Prostate-specific Antigen and Early Detection

      By Matthew R Cooperberg, MD, MPH
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      Screening Prostate-specific Antigen and Early Detection

      • MATTHEW R COOPERBERG, MD, MPHProfessor of Urology, Epidemiology & Biostatistics, Helen Diller Family Chair in Urology, UCSF Department of Urology, San Francisco, CA

      Prostate cancer early detection based on screening with prostate-specific antigen (PSA) has been a highly controversial topic over the years. Early detection and treatment of high-risk prostate cancer explains a large proportion of greater than 50% reduction in age-standardized prostate cancer mortality observed since the early 1990s. However, this public health success has come at the cost of high levels of overdiagnosis of low-risk tumors, and many men have suffered from overtreatment of these entirely indolent lesions. Data from randomized trials increasingly clearly indicate a prostate cancer mortality advantage with screening. Other cohort studies, moreover, suggest that an early, baseline PSA test around age 45 or 50 years can predict cancer risk over years and decades, potentially allowing subsequent screening intervals to be personalized, further reducing both over- and underdiagnosis. Other aspects of a smarter screening paradigm include focused attention on men at higher risk based on ancestry, family history, and other factors; consideration of other variables together with PSA; selective use of secondary testing with emerging blood and urine tests; and reservation of treatment only for men at risk of prostate cancer mortality. Such an approach should be able to reduce further prostate cancer morbidity and mortality, while minimizing the harms of over-diagnosis and overtreatment.

       This review contains 4 figures, 1 table, and 88 references.

      Key Words: Prostate cancer, prostate-specific antigen, early detection, cancer screening, guidelines, risk stratification, epidemiology, PLCO, ERSPC, USPSTF, CISNET

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    • 29

      Management of Castration-resistant Prostate Cancer: First-line Therapy

      By Simon Y.F. Fu, MBChB FRACP.; Kim N. Chi, MD FRCPC
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      Management of Castration-resistant Prostate Cancer: First-line Therapy

      • SIMON Y.F. FU, MBCHB FRACP.Genitourinary clinical fellow. Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
      • KIM N. CHI, MD FRCPCProfessor of Medicine. Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC

      The development of castration-resistant prostate cancer (CRPC) heralds significant morbidity and an incurable condition. Since 2004, there are now six proven life-prolonging therapies available, including androgen receptor pathway inhibitor (ARPI) , chemotherapeutic agents, radiopharmaceutical, and immunotherapy for the first-line management of metastatic CRPC. Recent advances have seen enzalutamide and apalutamide approved by US FDA for the treatment of nonmetastatic CRPC, with darolutamide the latest ARPI demonstrating efficacy in nonmetastatic CRPC. ARPI is the treatment of choice in the first-line setting for most CRPC patients, and this approach has been endorsed by clinical guidelines and expert consensus, although treatment must be individualized. Advances in the molecular profiling of CRPC promise to select suitable patients for trials involving targeted therapy and identify biomarkers to guide treatment selection.

      This review contains 2 figures, 1 table, and 54 references.

      Keywords: abiraterone acetate, apalutamide, cabazitaxel, castration-resistant prostate cancer, docetaxel, enzalutamide, first-line treatment, radium-223, sipuleucel-T

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  • Andrology
    • 1

      Male Infertility: Epidemiology, Associated Conditions & Etiologies

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      Male Infertility: Epidemiology, Associated Conditions & Etiologies

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    • 2

      Male Infertility: Evaluation, Including Laboratory Testing

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      Male Infertility: Evaluation, Including Laboratory Testing

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    • 3

      Male Infertility: Evaluation, Including Laboratory Testing

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      Male Infertility: Evaluation, Including Laboratory Testing

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    • 4

      Male Infertility: Medical Therapy

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      Male Infertility: Medical Therapy

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    • 5

      Male Infertility: Surgical Treatment (sperm Retrieval for Obstruction, Non-obstructive Azoospermia, Management of Anejaculation)

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      Male Infertility: Surgical Treatment (sperm Retrieval for Obstruction, Non-obstructive Azoospermia, Management of Anejaculation)

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    • 6

      IVF for Male Infertility

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      IVF for Male Infertility

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    • 7

      Erectile Dysfunction: Epidemiology, Physiology and Etiologies

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      Erectile Dysfunction: Epidemiology, Physiology and Etiologies

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    • 8

      Erectile Dysfunction: Evaluation, Including Diagnostic Studies (doppler Ultrasound, Cavernosography/cavenosometry)

      By Sevann Helo, MD; Nicholas Tadros, MD MCR; Kevin T McVary, MD
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      Erectile Dysfunction: Evaluation, Including Diagnostic Studies (doppler Ultrasound, Cavernosography/cavenosometry)

      • SEVANN HELO, MD
      • NICHOLAS TADROS, MD MCR
      • KEVIN T MCVARY, MD

      Erectile dysfunction (ED) is a common condition in the aging population that can be broadly classified as organic, psychogenic, or mixed. A thorough evaluation of a patient with ED begins with acknowledging that it is intimately related to a host of medical, neurologic, and psychological conditions. Providers should be confident in their ability to obtain a relevant history, perform a targeted physical exam, and, when indicated, select appropriate diagnostic testing. Patients should also be evaluated for associated urologic conditions, including male hypogonadism and lower urinary tract symptoms, the treatment of which may improve ED symptoms. It is also important that clinicians be aware that ED may be a “sentinel event” for undiagnosed cardiovascular disease as the implications of intervention can potentially be lifesaving.

      This review contains 7 figures, 10 tables and 138 references

      Key words: cardiovascular disease, Doppler ultrasonography, erectile dysfunction, hypogonadism, lower urinary tract symptoms, male impotence, metabolic syndrome, penile tumescence, Peyronie disease, premature ejaculation, sexual desire, testosterone

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    • 9

      Erectile Dysfunction: Medical Treatment (including Premature Ejaculation)

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      Erectile Dysfunction: Medical Treatment (including Premature Ejaculation)

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    • 10

      Erectile Dysfuction: Surgical Treatment (vascular and Prostetic Surgery)

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      Erectile Dysfuction: Surgical Treatment (vascular and Prostetic Surgery)

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    • 11

      Peyronies Disease

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      Peyronies Disease

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    • 12

      Priapism

      By Uzoma A Anele, MD; Arthur L Burnett, MD, MBA
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      Priapism

      • UZOMA A ANELE, MDResident Physician, Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
      • ARTHUR L BURNETT, MD, MBAPatrick C. Walsh Distinguished Professor of Urology, Professor, Oncology Center Director, Basic Science Laboratory in Neurourology Director, Sexual Medicine and Reconstructive Urology Division, The James Buchanan Brady Urological Institute, Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD

      Priapism is a disorder of persistent penile erection unrelated to sexual arousal or desire. This pathologic condition is classified broadly into nonischemic and ischemic forms as well as a recurrent ischemic variant. The recurrent ischemic variant is particularly prevalent in patients with sickle cell disease and may commonly progress to major ischemic episodes. The ischemic form represents a urologic emergency because prolonged episodes have an increased risk of permanent erectile dysfunction. Therefore, timely intervention and treatment are essential. In this chapter, the pathophysiology and current management guidelines and strategies of priapism are reviewed. Further understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets and may lead to further therapeutic advances in the future.

      This review contains 6 figures, 6 tables, and 51 references.

      Key Words: hematology, high-flow priapism, low-flow priapism, nitric oxide, nonischemic priapism, penile prosthesis, recurrent ischemic priapism, shunt, sickle cell disease, sympathomimetic 

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    • 13

      Evaluation and Management of Testosterone Deficiency

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      Evaluation and Management of Testosterone Deficiency

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    • 14

      Epidemiology of Male Infertility

      By Omer A Raheem, MD; Thomas J Walsh, MD
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      Epidemiology of Male Infertility

      • OMER A RAHEEM, MDSenior Fellow and Acting Instructor,Department of Urology, University of Washington, Seattle, WA
      • THOMAS J WALSH, MDAssociate Professor of Urology, Department of Urology, University of Washington, Seattle, WA, USA

      Infertility is a complex and incompletely understood disease that impacts 10 to 15% of reproductive-aged couples seeking to conceive. The World Health Organization defines infertility as the failure to conceive a clinical pregnancy after 12 or more of regular unprotected sexual intercourse. It likely involves the interaction among many variables, including age, race, ethnicity, and geography, that are laid upon the foundation of genetics and chronic medical conditions and further modified by environmental factors. A plethora of contemporary epidemiologic studies have been published detailing the relationship between male infertility, medical diseases, and environmental exposures with the primary goal of better characterizing their association, identifying risk factors, and providing more effective patient counseling and subsequent treatments. In this chapter, we aim to critically analyze available data and integrate the understanding of epidemiology and male infertility in an effort to provide clear guidance to a larger audience of clinicians of various subspecialties that encounter men with reproductive challenges.

      This review contains 1 figure, 8 tables, and 62 references.

      Key Words: at-risk groups, conditions, definitions, environmental factors,epidemiology, male fertility, racial geographical, variations

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    • 15

      Medical Management of Erectile Dysfunction

      By Matthew G Cowper, BS; Andrew T Gabrielson, BA; Laith M Alzweri, MD, MRCS, FECSM; Wayne J Hellstrom, MD, FACS
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      Medical Management of Erectile Dysfunction

      • MATTHEW G COWPER, BSResearch Technician, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
      • ANDREW T GABRIELSON, BAResearcher, Department of Urology, Tulane University School of Medicine, New Orleans, LA
      • LAITH M ALZWERI, MD, MRCS, FECSMDepartment of Urology, Tulane University School of Medicine, New Orleans, LA
      • WAYNE J HELLSTROM, MD, FACSDepartment of Urology, Tulane University School of Medicine, New Orleans, LA

      The management of erectile dysfunction has made tremendous strides over the past four decades, owing to concomitant advances in our understanding of the complex neurovascular, hormonal, and psychologic processes involved in penile erectile. The field has transitioned from predominantly psychotherapy-based management to focused treatment modalities that have been rigorously tested for both safety and efficacy in the clinical setting. The etiology of the erectile dysfunction must first be ascertained through careful history-taking, physical examination, laboratory testing, and in select cases, imaging. Once the etiology is known, the urologist has numerous options in their armamentarium to improve symptomatology and quality of life. The use of psychotherapy, pharmacologic therapy, injectable therapy, intraurethral suppositories, topical agents, and vacuum-assist erection devices can be used as monotherapy or in combination to tailor treatment to patient needs. Future directions in erectile dysfunction management are focusing on therapies that alter the course of the disease and permanently restore erectile function, rather than simply treating the symptomatology. The continued advancements taking place in the preclinical setting demonstrate considerable promise for the treatment and ultimate cure for this disease.

      This review contains 6 figures, 1 table, and 50 references.

      Key Words: alprostadil, emerging therapies, erectile dysfunction, intracavernosal injection therapy, intraurethral suppository, medical management, papaverine, phentolamine, phosphodiesterase-5 inhibitors, vacuum erection device, vasoactive intestinal peptide

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    • 16

      Medical Management of Premature Ejaculation

      By Wayne J Hellstrom, MD, FACS; Laith M Alzweri, MD, MRCS, FECSM; Matthew G Cowper, BS; Andrew T Gabrielson, BA
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      Medical Management of Premature Ejaculation

      • WAYNE J HELLSTROM, MD, FACSDepartment of Urology, Tulane University School of Medicine, New Orleans, LA
      • LAITH M ALZWERI, MD, MRCS, FECSMDepartment of Urology, Tulane University School of Medicine, New Orleans, LA
      • MATTHEW G COWPER, BSResearch Technician, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
      • ANDREW T GABRIELSON, BAResearcher, Department of Urology, Tulane University School of Medicine, New Orleans, LA

      Premature ejaculation (PE) is the most common form of male sexual dysfunction across all age groups. PE is associated with negative psychological consequences including frustration, distress, and low self-confidence, which can create an obstacle while forming new partner relationships. Given the subjective and highly variable nature of sexual dysfunction, there are multiple and often inconsistent definitions PE. The International Society for Sexual Medicine provides the most comprehensive definition of PE: both acquired and lifelong PE are characterized by ejaculation that always or nearly always occurs approximately within 1 min of vaginal penetration or when the patient has a clinically bothersome reduction in intravaginal ejaculatory latency time or due to an inability to delay ejaculation in all or nearly all vaginal penetrations–all of which lead to the accumulation of negative psychosocial burden. The etiology of PE may stem from genetic predisposition or psychologic components; however, the precise mechanism has not been elucidated and likely differs from individual to individual. There is a well-established link between PE and neurotransmitter signaling through which SSRIs (selective serotonin reuptake inhibitor) have a tangible therapeutic effect. There have been significant advances in management of PE with the use of psychosexual therapy and pharmacotherapy, mainly local anesthetics and SSRIs.

       This review contains 3 figures, 2 tables, and 36 references.

      Key Words:  classification, epidemiology, male sexual dysfunction, medical management, premature ejaculation

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    • 17

      Erectile Dysfunction: Epidemiology, Physiology, and Etiologies

      By Jonathan Fainberg, MD, MPH; James A Kashanian, MD
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      Erectile Dysfunction: Epidemiology, Physiology, and Etiologies

      • JONATHAN FAINBERG, MD, MPHUrology Resident, Weill Cornell Medicine, Brady Urologic Health Center, NY
      • JAMES A KASHANIAN, MDAssistant Professor of Urology and Reproductive Medicine, Weill Cornell Medicine, Brady Urologic Health Center, NY

      ED is defined as the consistent inability to achieve or maintain an erection adequate for sexual activity. It is a widely prevalent disease, affecting approximately 20 million men in the United States alone. ED rates increase as men get older; however, ED is not necessarily a normal part of aging. Early-onset ED has been a predictor of underlying cardiovascular diseases, and most clinicians now advocate for a cardiology evaluation in men with new-onset organic ED. The most common etiology of ED is a vascular disease; however, ED can be caused by diabetes, endocrinopathies, medications, chronic illness, and trauma. Psychogenic causes of ED are also common. Physiology of the penile erection is complicated; however, its comprehensive understanding is imperative to enable a proper etiologic diagnosis of ED. Blood supply to the penis originates from the hypogastric arterial system, and nitric oxide is the primary neurotransmitter involved in penile erections. The epidemiology, physiology, and etiologies of erectile dysfunction are discussed in detail in this chapter.

      This review contains 1 figure, 2 tables, and 50 references.

      Key Words: causes of erectile dysfunction, epidemiology of erectile dysfunction, erectile dysfunction, nitric oxide, phosphodiesterase-5 inhibitors, physiology of the penile erection, psychogenic erectile dysfunction, sexual dysfunction, cyclic guanosine monophosphate, detumescence.

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    • 18

      Sperm Retrieval in the Obstructive, Nonobstructive Azoospermic and Aspermic Patients

      By Ryan Flannigan, MD; Peter N. Schlegel, MD; E. Darracott Vaughan Jr., MD
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      Sperm Retrieval in the Obstructive, Nonobstructive Azoospermic and Aspermic Patients

      • RYAN FLANNIGAN, MDAssistant Professor, Department of Urologic Sciences, University of British Columbia; Adjunct Assistant Professor, Department of Urology, Weill Cornell Medicine; Director of Male Reproductive and Sexual Medicine Research Program, Department of Urologic Sciences University of British Columbia
      • PETER N. SCHLEGEL, MDProfessor, Department of Urology, Weill Cornell Medicine; James J. Colt Professor of Urology, Weill Cornell Medicine; Urologist-in-Chief, New York Presbyterian Hospital; Chairman of Urology, Weill Cornell Medical College, Cornell University; Professor of Reproductive Medicine, Weill Cornell Medical College, Cornell University
      • E. DARRACOTT VAUGHAN JR., MDSenior Associate Dean for Clinical Affairs, Weill Cornell Medicine

      Sperm retrieval includes essential procedures in the treatment and management of male factor infertility. Appropriate diagnostic investigation is necessary to correctly identify the etiology of azoospermia among obstructive, nonobstructive (defective spermatogenesis), and aspermia. In this chapter, we discuss the necessary work-up of an individual presenting with azoospermia along with the relevant medical and surgical management to optimize success with surgical sperm retrieval.

      This review contains 7 figures, 2 tables, and 68 references. 

      Key Words: anejaculation, azoospermia, MESA, microTESE, nonobstructive azoospermia, obstructive azoospermia, PESA, TESE, testicular biopsy

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    • 19

      Male Infertility: Surgical Treatment (varicocele, Microsurgical Reconstruction, TUR Ejaculatory Ducts)

      By Vanessa L. Dudley, MSHS; Marc Goldstein, MD, DSc (hon), FACS
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      Male Infertility: Surgical Treatment (varicocele, Microsurgical Reconstruction, TUR Ejaculatory Ducts)

      • VANESSA L. DUDLEY, MSHSAdministrative Specialist, Department of Male Reproductive Medicine, Weill Cornell Medicine, New York, NY
      • MARC GOLDSTEIN, MD, DSC (HON), FACSMatthew P. Hardy Distinguished Professor of Reproductive Medicine, and Urology, Surgeon-in-Chief, Male Reproductive Medicine and Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY

      Male factor infertility contributes to at least half of all cases of infertility in couples. The most common causes of male factor infertility are impaired sperm production due to varicoceles, obstruction of the ductal system, and genetic defects causing nonobstructive azoospermia. A majority of these underlying conditions are treatable. Even when in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) is necessary, treatment of men has been shown to improve the outcomes of IVF-ICSI and potentially increase the chances of finding sperm with microdissection sperm extraction in some cases of nonobstructive azoospermia. Important advances in the field include abundant evidence now supporting microsurgical repair of varicocele in varicocele-associated nonobstructive azoospermia prior to IVF-ICSI or attempted surgical sperm retrieval. Advances in techniques for reconstruction of obstruction is dependent on the surgeon’s skill in creating a tension-free and leak-proof mucosa-to-mucosa accurate approximation with a good blood supply and healthy mucosa and muscularis and can result in higher patency rates. Treating the men often allows upgrading men from being solely candidates for donor sperm or adoption to candidates for ICF-ICSI with surgically retrieved testicular sperm to allowing IVF-ICSI with ejaculated sperm and from IVF-ICSI with ejaculated sperm to allowing the simpler intrauterine insemination and, finally, the possibility of a naturally conceived pregnancy.

      This review contains 27 figures, 1 table, and 69 references.

      Key Words: microsurgery, obstructive azoospermia, transurethral resection of the ejaculatory duct, varicocele, vasectomy reversal, vasoepididymostomy, vasography, vasovasostomy

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  • Kidney Stones/endourology
    • 1

      Nephrolithiasis in Pregnancy

      By Eric P Raffin, MD; Vernon M Pais Jr, MD
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      Nephrolithiasis in Pregnancy

      • ERIC P RAFFIN, MD
      • VERNON M PAIS JR, MD

      Nephrolithiasis is a common condition that practicing urologists will encounter and manage. The pregnant patient presents unique challenges when it comes to the diagnosis and treatment of stones. Altered anatomy and physiology, considerations of the fetus, and various imaging and procedural contraindications make navigating the care of pregnant patients with nephrolithiasis more complex than that of the general population. This review presents an algorithmic approach to the diagnosis and management of nephrolithiasis in the pregnant patient. Certain areas that are highlighted include diagnostic imaging modalities and the pros and cons of each with regard to the pregnant patient. Also discussed in detail are various treatment options, including medical management and available surgical interventions. As renal colic is the most common reason for nonobstetric hospitalization in pregnant women, it is important that they are managed with a multidisciplinary approach.

      This review contains 2 highly rendered figures, 4 tables, and 26 references

      Key words: low-dose CT, medical expulsive therapy, nephrolithiasis, obstructive hydronephrosis, percutaneous nephrostomy, physiologic hydronephrosis, pregnancy, renal colic, resistive index, ureteral stent, ureteroscopy

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    • 2

      Pathophysiology and Treatment of Hyperoxaluria

      By Robin S Chirackal, MBBS; John C Lieske, MD
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      Pathophysiology and Treatment of Hyperoxaluria

      • ROBIN S CHIRACKAL, MBBSPostdodoctoral Fellow, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
      • JOHN C LIESKE, MDProfessor of Medicine, Renal Testing Laboratory, Department of Laboratory Medicine and Pathology, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN

      Humans cannot degrade oxalate. Thus, oxalate that is generated in the liver and/or absorbed from the intestine must be eliminated by the kidneys. Among genetic causes, primary hyperoxaluria (PH) type 1 is the most common and occurs due to deficiency of hepatic peroxisomal alanine glyoxalate aminotransferase. PH2 is caused by deficiency of lysosomal glyoxalate reductase or hydroxypyruvate reductase, whereas PH3 results from deficiency of mitochondrial 4-hydroxy-2-oxoglutarate aldolase. Enteric hyperoxaluria is caused by excessive colonic oxalate absorption due to any type of fat malabsorption. The diagnosis of hyperoxaluria is based on the history, 24-hour urine studies, and genetic testing. Early diagnosis and timely intervention are essential. To treat PH, adequate fluid intake, inhibitors of calcium oxalate crystallization (citrate or neutral phosphorus), and pyridoxine-in responsive patients are all important. Intensive dialysis and prompt kidney or combined kidney-liver transplantation are essential to minimize systemic oxalosis if renal failure occurs. Dietary modifications (low fat, low oxalate, and adequate calcium) are key for enteric hyperoxaluria. Calcium can be used as an oxalate binder. Newer modalities including oxalate degrading bacteria, oral oxalate decarboxylase preparations, and inhibitory ribonucleic acids are all under investigation.


      This review contains 9 figures, 6 tables, and 90 references.

      Key Words: bariatric surgery, calcium oxalate, dialysis, enteric hyperoxaluria, fat malabsorption, genetic testing, kidney stone, nephrolithiasis, oxalate, oxalate decarboxylase, Oxalobacter formigenes, primary hyperoxaluria, pyridoxine, transplantation, urolithiasis

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    • 3

      Management of Pediatric Nephrolithiasis

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      Management of Pediatric Nephrolithiasis

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    • 4

      Surgical Removal of Stones in Horseshoe and Pelvic Kidneys and Transplant Grafts

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      Surgical Removal of Stones in Horseshoe and Pelvic Kidneys and Transplant Grafts

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    • 5

      Pathophysiology of Calcium Stones

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      Pathophysiology of Calcium Stones

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    • 6

      Managing Complications of Percutaneous Nephrolithotomy

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      Managing Complications of Percutaneous Nephrolithotomy

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    • 7

      The Role of Diet in Stone Prevention

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      The Role of Diet in Stone Prevention

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    • 8

      Laparoscopic, Robotic, and Open Surgery for Renal and Ureteral Stones

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      Laparoscopic, Robotic, and Open Surgery for Renal and Ureteral Stones

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    • 9

      Medical Expulsive Therapy

      By Mark Silva, MD; Nina Mikkilineni, MD; Ojas Shah, MD
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      Medical Expulsive Therapy

      • MARK SILVA, MDResident in Urology, Department of Urology, Columbia University Irving Medical Center, Columbia University College of Physicians and Surgeons, New York, NY
      • NINA MIKKILINENI, MDResident in Urology, Department of Urology, Columbia University Irving Medical Center, Columbia University College of Physicians and Surgeons, New York, NY
      • OJAS SHAH, MDGeorge F Cahill Professor of Urology, Department of Urology, Columbia University Irving Medical Center, Columbia University College of Physicians and Surgeons, New York, NY

      Medical expulsive therapy (MET) for ureteral stones involves the administration of pharmaceutical agents to facilitate passage of stones by ideally increasing the rate of passage and reducing time for expulsion. Several medications have been studied for this use. The most commonly studied off-label medications include α1-antagonists and calcium channel blockers. This article reviews the data available for the use of MET and controversies in the use of medications to aid stone passage based on more recent randomized controlled trials and meta-analyses. Based on the latest guidelines, α-blockers have been the most studied medication type and may have some benefit in the passage of distal ureteral stones greater than 4 mm in size.

      This review contains 2 figures and 34 references.

      Keywords: α1-antagonists, α-blockers, calcium channel blockers, medical expulsion therapy, phosphodiesterase inhibitors, ureteral stones

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    • 10

      Managing Complications of Ureteroscopy

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      Managing Complications of Ureteroscopy

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    • 11

      Natural History of Asymptomatic Kidney Stones

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      Natural History of Asymptomatic Kidney Stones

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    • 12

      Shock Wave Lithotripsy: Application and Future Direction

      By Mathew D Sorensen, MD, MS; Michael R Bailey, PhD
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      Shock Wave Lithotripsy: Application and Future Direction

      • MATHEW D SORENSEN, MD, MS
      • MICHAEL R BAILEY, PHD

      Shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy all have an important role in the management of patients with kidney and ureteral stones. SWL remains popular with providers and is preferred by many patients. This review describes the pros and cons of these procedures, the appropriate conditions for SWL, indicators for successful outcomes for SWL, effective SWL technique, and adverse effects. Also reported are the imaging and therapeutic research to improve SWL effectiveness. This may expand the use of SWL by addressing some of SWL’s current limitations and lead to improved patient outcomes.

      This review contains 5 highly rendered figures, 3 tables, and 85 references

      Key words: burst wave lithotripsy, cavitation, comminution, coupling, endourology, kidney injury, kidney stones, minimally invasive, nephrolithiasis, shock wave lithotripsy, stone-free rate, ultrasonic propulsion, urolithiasis

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    • 13

      Pathophysiology and Treatment of Hypercalciuria and Hypercalcemic States Associated With Kidney Stone Formation

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      Pathophysiology and Treatment of Hypercalciuria and Hypercalcemic States Associated With Kidney Stone Formation

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    • 14

      Ureteroscopic Stone Treatment

      By Jacob T Ark, MD; Tracy P Marien, MD; Nicole L Miller, MD
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      Ureteroscopic Stone Treatment

      • JACOB T ARK, MDDepartment of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
      • TRACY P MARIEN, MDSharp Rees-Stealy Medical Group in San Diego, CA
      • NICOLE L MILLER, MDDepartment of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN

      Renal and ureteral stone treatment has evolved from an open operation to being entirely endoscopic. Since the inception of the natural orifice treatment of stones, there have been many more advancements in multiple aspects of the case, including smaller scopes, higher-resolution imaging, and more powerful lasers. This technological evolution in ureteroscopic stone treatment has broadened its indication as a first-line therapy by helping to attenuate the learning curve and expedite stone fragmentation and extraction. This overview includes the evolution of ureteroscopic stone treatment; however, the majority is dedicated to reviewing equipment and operative techniques pertaining to ureteroscopic stone treatment of upper tract stones.

      This review contains 10 highly rendered figures, 5 tables, and 43 references

      Key words: holmium laser, kidney, lithotripsy, nephrolithiasis, ureter, ureteral stent, ureteroscopy

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    • 15

      Pathophysiology and Treatment of Infection Stones

      By Patrick T Gomella, MD, MPH; Patrick W Mufarrij, MD
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      Pathophysiology and Treatment of Infection Stones

      • PATRICK T GOMELLA, MD, MPH
      • PATRICK W MUFARRIJ, MD

      Infection stones are a well-known clinical entity that can cause significant long-term morbidity and even mortality if not treated appropriately. Infection stones are primarily composed of magnesium ammonium phosphate and calcium carbonate apatite. These stones form in alkaline urine containing ammonium. This environment is generated by infection with urease-producing organisms. Definitive treatment is aimed at removal of all stone. Percutaneous nephrolithotomy is typically the procedure of choice. Medical therapy can be used as an adjunct to surgery or as primary treatment in patients who are not surgical candidates.

      This review contains 8 highly rendered figures, 4 tables, and 72 references

      Key words: Infection stone; struvite; percutaneous nephrolithotomy; urease; dissolution therapy; magnesium ammonium phosphate; calcium carbonate apatite

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    • 16

      Imaging for Nephrolithiasis

      By Daniel A Wollin, MD; Joanne Dale, MD; Ruiyang Jiang, MD; Stephanie Sexton, MD; Glenn M Preminger, MD
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      Imaging for Nephrolithiasis

      • DANIEL A WOLLIN, MD
      • JOANNE DALE, MD
      • RUIYANG JIANG, MD
      • STEPHANIE SEXTON, MD
      • GLENN M PREMINGER, MD

      Nephrolithiasis is a common condition that affects a large number of Americans. An imaging diagnosis is required for adequate treatment and follow-up, and a large variety of imaging modalities exist for this purpose. In this review, we discuss the advantages, disadvantages, and specific uses for a wide array of imaging methods, including plain radiography, ultrasonography, CT, and others. In addition, special attention is paid to specific clinical situations for individual tests, such as when dealing with children, pregnant women, and patients in an intraoperative setting. Approximate costs and radiation doses of each modality are discussed as well. At the conclusion of this review, the reader should understand the utility of each imaging technique, along with the optimal situation for use and reasoning for these decisions.

      This review contains 5 highly rendered figures, 2 tables, and 85 references


      Key words: CT, diagnosis, digital tomosynthesis, fluoroscopy, follow-up, imaging, intravenous pyelography, MRI, nephrolithiasis, radiation dose, radiography, ultrasonography


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    • 17

      Epidemiology and Economics of Nephrolithiasis

      By Justin B. Ziemba, MD; Brian R. Matlaga, MD, MPH
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      Epidemiology and Economics of Nephrolithiasis

      • JUSTIN B. ZIEMBA, MDAssistant Professor of Urology in Surgery, Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
      • BRIAN R. MATLAGA, MD, MPHProfessor of Urology,Brady Urological Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD

      Nephrolithiasis is a disease that is common in both the Western and the non-Western world. Several population-based studies have demonstrated a rising incidence and prevalence of symptomatic and asymptomatic disease over the last several decades. The disease recurs frequently after an initial stone event. The environment appears to play a role in stone formation, particularly in those living in the southeastern United States. The influence of diet on the risk of nephrolithiasis is important, particularly dietary calcium and fluid intake. An increased intake of dietary calcium and fluid is consistently associated with a reduced risk of incident nephrolithiasis in both men and women. Increasing evidence suggests that nephrolithiasis is associated with systemic diseases like obesity, diabetes, and cardiovascular disease. Nephrolithiasis places a significant burden on the health care system, which is likely to increase with time.


      This review contains 4 tables and 22 references

      Key Words: diet, epidemiology, kidney calculi, nephrolithiasis

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    • 18

      Pathophysiology and Treatment of Hypocitraturia

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      Pathophysiology and Treatment of Hypocitraturia

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    • 19

      Pathophysiology and Treatment of Uric Acid Stones

      By Dustin Whitaker, Medical Student; Ava Saidian, MD; Jacob Britt, Medical Student; Carter Boyd, Medical Student; Kyle Wood, MD; Dean G Assimos, MD
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      Pathophysiology and Treatment of Uric Acid Stones

      • DUSTIN WHITAKER, MEDICAL STUDENTMedical Student, UAB School of Medicine, Birmingham, AL, United States
      • AVA SAIDIAN, MDUrology Resident, UAB Urology Department, Birmingham, AL, United States
      • JACOB BRITT, MEDICAL STUDENTUAB School of Medicine, Birmingham, AL, United States
      • CARTER BOYD, MEDICAL STUDENTUAB School of Medicine, Birmingham, AL, United States
      • KYLE WOOD, MDEndourology Fellow, UAB Urology Department, Birmingham, AL, United States
      • DEAN G ASSIMOS, MDChair of Urology, UAB Urology Department, Birmingham, AL, United States

      Uric acid is the third most common stone composition and comprises 7 to 10% of all kidney stones sent for analysis. These stones are more common with increasing age and in men. Uric acid stone disease is associated with conditions such as the metabolic syndrome and type 2 diabetes mellitus. Uric acid is produced by the enzyme, xanthine oxidase and is the final product of purine metabolism in humans. Three main factors contribute to the formation of uric acid stones: low urine pH (the most important), hyperuricosuria (rare, includes conditions such as myeloproliferative disorders and Lesch-Nyhan syndrome), and low urine volume. Uric acid stones appear radiolucent on plain radiographs and are ultimately diagnosed via stone analysis. These stones may be treated with medical expulsive therapy, dissolution therapy, or surgical intervention depending on the size, location, and clinical presentation. Urine pH manipulation therapy with potassium citrate is the first-line treatment for the prevention of uric acid stones and attempts at dissolution. Allopurinol should not be offered as the first-line therapy for uric acid stones.

       This review contains 3 figures, 1 table and 38 references

      Key Words: ammonium, diabetes mellitus, epidemiology, management, metabolic syndrome, nephrolithiasis, pathophysiology, potassium citrate, uric acid, urine pH

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    • 20

      Pathophysiology and Treatment of Cystinuria

      By Ava Saidian, MD; Carter Boyd, Medical Student; Kyle Wood, MD; Dean G Assimos, MD; Jacob Britt, Medical Student; Dustin Whitaker, Medical Student
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      Pathophysiology and Treatment of Cystinuria

      • AVA SAIDIAN, MDUrology Resident, UAB Urology Department, Birmingham, AL, United States
      • CARTER BOYD, MEDICAL STUDENTUAB School of Medicine, Birmingham, AL, United States
      • KYLE WOOD, MDEndourology Fellow, UAB Urology Department, Birmingham, AL, United States
      • DEAN G ASSIMOS, MDChair of Urology, UAB Urology Department, Birmingham, AL, United States
      • JACOB BRITT, MEDICAL STUDENTUAB School of Medicine, Birmingham, AL, United States
      • DUSTIN WHITAKER, MEDICAL STUDENTMedical Student, UAB School of Medicine, Birmingham, AL, United States

      Cystinuria is a relatively rare autosomal recessive disorder that manifests early in life and is associated with the development of kidney stones composed of cystine. It is due to mutations in two genes that are involved in the transport of cystine, neutral, and dibasic amino acids in the proximal tubule of the kidney. Patients are at risk for developing chronic kidney disease. Diagnosis is typically established with stone analysis and quantitative urinary cystine excretion. These patients may form extremely large stones requiring percutaneous nephrolithotomy. Stone-prevention strategies include dietary modifications (increased fluid intake and limitation of sodium and animal protein consumption), urine pH manipulation, and thiol-binding agents. These patients should be followed closely, and preemptive stone removal with ureteroscopy should be considered to limit the necessity for more invasive procedures.

      This review contains 2 figures and 38 references.

      Key Words: a-mercaptopropionyl glycine, amino acid transport, chronic kidney disease, cystinuria, SLC3A1, SLC7A9, thiol-binding agent, urinary pH manipulation

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    • 21

      Drug-induced Stones

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      Drug-induced Stones

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    • 22

      Management of Ureteral Strictures and Ureteropelvic Junction Obstruction

      By Sean McAdams, MD; Haidar Abdul-Muhsin, M.B.Ch.B.; Mitchell R. Humphreys, MD
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      Management of Ureteral Strictures and Ureteropelvic Junction Obstruction

      • SEAN MCADAMS, MDEndourology Fellow, Mayo Clinic, Scottsdale, AZ
      • HAIDAR ABDUL-MUHSIN, M.B.CH.B.Urology Resident, Mayo Clinic, Scottsdale, AZ
      • MITCHELL R. HUMPHREYS, MDProfessor of Urology, Mayo Clinic, Scottsdale, AZ

      The goals for management of ureteropelvic junction obstruction (UPJO) and ureteral stricture are to resolve obstruction, restore continuity, and preserve renal function while minimizing morbidity. The management of UPJO can be challenging and represents a spectrum of options that vary in the invasiveness and effective. These options include observation, long-term internal or external urinary drainage, and endoscopic or minimally invasive management. Mismanagement can potentially results in deterioration of loss of kidney function. This chapter discusses the foundations for successful management of UPJO and ureteral strictures. It also highlights the special clinical situations related to this disease entity and discusses the key advances in the field.

      This review contains 8 figures, 4 tables, and 73 references.

      Key Words: Boari flap, dismembered pyeloplasty, endopyelotomy, psoas hitch, pyeloplasty, ureteropelvic junction obstruction, ureteral obstruction, ureteral reconstruction, ureteral stricture, uretero-ureterostomy

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    • 23

      Management of Pediatric Urolithiasis

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      Management of Pediatric Urolithiasis

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  • Pediatric Urology
    • 1

      Pediatric Pyelonephritis

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      Pediatric Pyelonephritis

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    • 2

      Staged Male Bladder Exstrophy Repair

      By Timothy S. Baumgartner, MD; John P. Gearhart, MD
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      Staged Male Bladder Exstrophy Repair

      • TIMOTHY S. BAUMGARTNER, MDPediatric Urology Fellow, Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
      • JOHN P. GEARHART, MDChief of Pediatric Urology, Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

      This chapter details the latest surgical advances and outcomes in the modern surgical management of male classic bladder exstrophy to include patient selection for closure, operative considerations, newborn primary bladder and posterior urethral closure, early epispadias repair, bladder neck reconstruction with an antireflux procedure, and postoperative management. It highlights how to achieve the primary objectives of (1) a secure abdominal closure, (2) reconstruction of a functional and cosmetically acceptable penis, and (3) urinary continence with the preservation of renal function. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions.

      This review contains 3 figures, 5 tables, and 47 references.

      Key Words: Congenital defect, Bladder exstrophy, Epispadias, Reconstruction, Urinary Continence, Magnetic Resonance Imaging, Pain management, Pelvic osteotomy

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    • 3

      Female Bladder Exstrophy Repair

      By Timothy S. Baumgartner, MD; John P. Gearhart, MD
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      Female Bladder Exstrophy Repair

      • TIMOTHY S. BAUMGARTNER, MDPediatric Urology Fellow, Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
      • JOHN P. GEARHART, MDChief of Pediatric Urology, Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

      This chapter details the latest surgical advances and outcomes in the modern surgical management of female classic bladder exstrophy to include patient selection for closure, operative considerations, and outcomes. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This chapter also reviews the incidence, embryology, and anatomic considerations when approaching the treatment of the exstrophy patient.

       This review contains 4 figures, and 36 references. 

      Key Words: bladder exstrophy, congenital defect, embryology, epispadias, pelvic floor, reconstruction, sexual function, urinary continence

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    • 4

      Endoscopic Correction of Vesicoureteral Reflux

      By Michael Garcia-Roig, MD; Andrew J. Kirsch, MD, FAAP, FACS
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      Endoscopic Correction of Vesicoureteral Reflux

      • MICHAEL GARCIA-ROIG, MDAdjunct Clinical Instructor Emory University School of Medicine Atlanta, GA
      • ANDREW J. KIRSCH, MD, FAAP, FACSProfessor & Chief of Pediatric Urology Emory University School of Medicine Director, Pediatric Robotic Surgery Program Children's Healthcare of Atlanta

      Management of vesicoureteral reflux may involve a period of observation while the patient is on continuous antibiotic prophylaxis while awaiting spontaneous resolution. There are several indications for surgical correction that include non-resolution after a period of observation, parent preference, or breakthrough infections while on antibiotic prophylaxis, just to name a few. Endoscopic injection for correction of vesicoureteral reflux is an effective, minimally invasive method of treatment. Successful treatment is dependent on surgical technique, with a success rate of 77 to 94% with the double hydrodistension implantation technique (HIT) and uniform endpoints of injection. We aim to describe the double HIT technique for endoscopic injection along with tips and tricks for a successful result.  

      This review contains 10 figures, 5 tables and 26 references

      Keywords: Vesicoureteral reflux, minimally invasive, febile urinary tract infection, voiding cystourethrogram, deflux, dextranomer/hyaluronic acid, children, cystoscopy, pyelonephritis, endoscopy 

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    • 5

      One Stage Proximal Hypospadias Repair

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      One Stage Proximal Hypospadias Repair

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    • 6

      Acute Testicular Torsion Presentation and Diagnosis

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      Acute Testicular Torsion Presentation and Diagnosis

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    • 7

      Acute Testicular Torsion Management

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      Acute Testicular Torsion Management

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    • 8

      Diagnosis and Staging of Genitourinary Rhabdomyosarcoma

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      Diagnosis and Staging of Genitourinary Rhabdomyosarcoma

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    • 9

      Medical Management of Genitourinary Rhabdomyosarcoma

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      Medical Management of Genitourinary Rhabdomyosarcoma

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    • 10

      Ureteral Duplication Anomalies

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      Ureteral Duplication Anomalies

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    • 11

      Diagnosis and Initial Management of Posterior Urethral Valves

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      Diagnosis and Initial Management of Posterior Urethral Valves

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    • 12

      Surgical Management of Posterior Urethral Valves

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      Surgical Management of Posterior Urethral Valves

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    • 13

      Prognosis and Long-term Management of Posterior Urethral Valve Patients

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      Prognosis and Long-term Management of Posterior Urethral Valve Patients

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    • 14

      Voiding Cystourethrography

      By Lane S Palmer, MD, FACS; Adam S Howe, MD
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      Voiding Cystourethrography

      • LANE S PALMER, MD, FACS
      • ADAM S HOWE, MD

      The voiding cystourethrogram (VCUG) is a fluoroscopic examination commonly used in pediatrics to assess the presence of vesicoureteral reflux (VUR) disease and the structure and function of the bladder and urethra. Along with hydronephrosis and febrile urinary tract infections, the indications for VCUG are vast. Protocols set in place and modern techniques have helped reduce radiation exposure during VCUG to 1.7 to 5.2 mrad. Proper patient preparation and sterile technique during catheter placement are of the upmost importance. The bladder is filled with contrast to the patient’s capacity, followed by the patient voiding. A scout film (anteroposterior [AP]) along with views of early filling (AP), bladder capacity (AP and oblique), voiding (AP and oblique), and postvoid (AP) are obtained. VUR is diagnosed, and its grading system is determined by the VCUG study. Cyclic VCUG, PIC cystography, and radionucleotide VCUG are alternative techniques in diagnosing VUR. Neurogenic bladder, along with its associated pathologies, can be easily characterized by the VCUG examination, as can cloacal and urogenital sinuses via the contrasted study. Bladder ruptures, bladder masses, urachal anomalies, functional disorders of the bladder neck, and a host of urethral pathologies (most notably posterior urethral valves) can be diagnosed by VCUG.

      This review contains 62 highly rendered figures, 6 tables, and 9 references

      Key words: voiding cystourethrography, fluoroscopy, radiology, imaging, pediatric, urology, vesicoureteral reflux

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    • 15

      Surgical Management of the Abdominal Wall for the Prune Belly (triad) Syndrome

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      Surgical Management of the Abdominal Wall for the Prune Belly (triad) Syndrome

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    • 16

      Midshaft Hypospadias Repair

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      Midshaft Hypospadias Repair

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    • 17

      Patent Urachus Diagnosis and Management

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      Patent Urachus Diagnosis and Management

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    • 18

      Diagnosis and Medical Management of Megaureter

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      Diagnosis and Medical Management of Megaureter

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    • 19

      Surgical Management of Megaureter

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      Surgical Management of Megaureter

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    • 20

      Ectopic Ureter Diagnosis Surgical Management

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      Ectopic Ureter Diagnosis Surgical Management

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    • 21

      Pediatric Minimally Invasive Pyeloplasty

      By Julia Beth Finkelstein, MD; Pasquale Casale, MD
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      Pediatric Minimally Invasive Pyeloplasty

      • JULIA BETH FINKELSTEIN, MDUrology Fellow, Boston Children’s Hospital, Harvard Medical School, Boston, MA
      • PASQUALE CASALE, MDProfessor of Urology, Icahn School of Medicine at Mount Sinai, New York, NY

      Ureteropelvic junction obstruction (UPJO) is a common urologic abnormality in children. The diagnosis is typically based on a combination of clinical symptoms, ultrasonographic findings of hydronephrosis without hydroureter, and sometimes diuretic renal scintigraphy. Acceptance of robotic technology is increasing among pediatric urologists, and robotic pyeloplasty is now commonly performed for children with UPJO, with success rates similar to open pyeloplasty and a more efficient learning curve than conventional laparoscopy. The Anderson-Hynes dismembered pyeloplasty is the standard approach for repair. When complex patient anatomy is encountered, alternative techniques can be used to tailor the procedure to the specific case. Overall, robotic pyeloplasty offers strong outcomes, low complication rates, and a minimal rate of conversion to open surgery. Although the initial cost of robotic technology may be high, human capital gain and indirect benefits from shortened hospitalizations, smaller incisions, and parental satisfaction may be valuable. 


      This review contains 10 figures, 5 tables and 42 references

      Key words: Pediatrics, Minimally invasive surgery, Robotics, Ureteropelvic junction obstruction, Pyeloplasty, Urology

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    • 22

      Diagnosis and Staging of Wilms Tumor

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      Diagnosis and Staging of Wilms Tumor

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    • 23

      Surgical Management of Wilms Tumor

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      Surgical Management of Wilms Tumor

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    • 24

      Wilms Tumor Prognosis and Long-term Management

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      Wilms Tumor Prognosis and Long-term Management

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    • 25

      Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

      By Joseph W McQuaid, MD, MPH; David A Diamond, MD
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      Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

      • JOSEPH W MCQUAID, MD, MPHPediatric Urology Fellow, Boston Children’s Hospital Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
      • DAVID A DIAMOND, MDUrologist-in-Chief, Associate Clinical Ethicist, & Senior Associate in Urology, Boston Children’s Hospital Professor of Surgery (Urology), Harvard Medical School Alan B. Retik Chair & Professor of Surgery, Harvard Medical School, Boston, MA

      The diagnosis and treatment of ureteroceles continue to evolve. Not only are the majority of patients diagnosed prenatally, but a significant proportion of cases can be dealt with in a minimally invasive, endoscopic fashion. Although a single treatment strategy for all ureteroceles is an unrealistic expectation, more valuable to the practicing urologist is an understanding of the variable anatomy and presentation of this entity and an appreciation for the breadth of treatment options at his or her disposal. This, the first of our two reviews on ureteroceles, provides the necessary background.

      This review contains 10 figures, 6 tables and 35 references

      Key words: bladder trigone, cecoureterocele, ectopic ureterocele, extravesical ureterocele, intravesical ureterocele, lower tract approach, obstructed ureterocele, reflux, transurethral incision, transurethral puncture, upper tract approach, ureterocele, ureterocele algorithm

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    • 26

      Pediatric Renal Trauma

      By Douglas A Husmann, MD
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      Pediatric Renal Trauma

      • DOUGLAS A HUSMANN, MDAnson L Clark Professor of Urology, Mayo Clinic, Rochester MN

      This review addresses the new staging criteria applied to classify renal trauma accurately. We discuss the unique differences in the etiology and management of renal trauma between adults and children. The commentary defines the differences in managing low-, medium-, and high-velocity traumatic injuries compared with blunt renal trauma, and the criteria and methods used to screen for these injuries in children are provided. Absolute and relative indications for surgical exploration of traumatic renal injuries are examined. Management of the complications of acute and delayed renal hemorrhage, asymptomatic and symptomatic urinomas, chronic pain, and hypertension is discussed. Recommendations for physical activity following the traumatic loss of a kidney are reviewed.

      This review contains 10 figures, 7 tables and 49 references

      Key words: false aneurysm, hematuria, kidney, nonpenetrating wounds, penetrating wounds, renal hypertension, renal trauma, therapeutic embolization, traumatic shock, urinoma

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    • 27

      Surgical Management of Genitourinary Rhabdomyosarcoma

      By Ahmed Abdelhalim, MD, MSc, MRCS; Zhan Tao (Peter) Wang, MD, FRCSC; Antoine E Khoury, MD, FRCSC, FAAP
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      Surgical Management of Genitourinary Rhabdomyosarcoma

      • AHMED ABDELHALIM, MD, MSC, MRCSPediatric Urology Fellow, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA; Assistant lecturer of urology, Mansoura Urology and Nephrology Center, Mansoura University, Egypt
      • ZHAN TAO (PETER) WANG, MD, FRCSCPediatric Urology Fellow, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA
      • ANTOINE E KHOURY, MD, FRCSC, FAAPProfessor and Chief of Pediatric Urology, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA

      The past few decades have witnessed unprecedented advances in the management of genitourinary rhabdomyosarcoma. The introduction of combination chemotherapy and adoption of multi-disciplinary approach in 1960s have resulted in dramatic improvement in the survival. Upfront radical surgery has been largely replaced with more conservative procedures resulting in less morbidity and improved function while maintaining survival. The discovery and incorporation of oncogenic-fusion proteins in rhabdomyosarcoma risk-stratification was another leap towards better outcomes.  Besides local control, surgery is crucial for risk-stratification, relief of urinary tract obstruction and reconstruction of urogential tract. Incomplete tumor resection has been associated with unfavorable outcome. Herein, we describe the evolution of role of surgery in the management of genitourinary rhabdomyosarcoma. Further, basics of surgical management are reviewed and areas of potential controversy are addressed.

      This review contains 11 figures, 5 tables, and 51 references.

      Keywords: rhabdomyosarcoma, children, bladder, prostate, multidisciplinary treatment, surgery, chemotherapy, cystectomy, survival, outcome, urinary diversion, fertility.

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    • 28

      Diagnosis and Management of Genitourinary Rhabdomyosarcoma

      By Ahmed Abdelhalim, MD, MSc, MRCS; Zhan Tao (Peter) Wang, MD, FRCSC; Antoine E Khoury, MD, FRCSC, FAAP; Ali Nael, MD
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      Diagnosis and Management of Genitourinary Rhabdomyosarcoma

      • AHMED ABDELHALIM, MD, MSC, MRCSPediatric Urology Fellow, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA; Assistant lecturer of urology, Mansoura Urology and Nephrology Center, Mansoura University, Egypt
      • ZHAN TAO (PETER) WANG, MD, FRCSCPediatric Urology Fellow, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA
      • ANTOINE E KHOURY, MD, FRCSC, FAAPProfessor and Chief of Pediatric Urology, University of California, Irvine, Irvine, CA, and Children’s Hospital of Orange County, Orange County, CA
      • ALI NAEL, MD,2 MD, Assistant Professor of Pediatric Pathology, Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, California and Children’s Hospital of Orange County, Orange County, CA

      Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Genitourinary RMS accounts for 15 to 25% of all RMSs and is a heterogeneous group of soft tissue tumors that vary in presentation, distribution, and prognosis. This article reviews the pathophysiology and tumor biology of RMS. It will also describe the initial approach to its diagnosis and current tumor surveillance protocols. Furthermore, this article presents the evidence behind a number of different staging and risk stratification systems currently used to guide treatment. Lastly, this article reviews future developments of investigational studies and risk stratification under investigation by a number of large international collaborative study groups.

      This review contains 17 figures, 7 tables, and 68 references.

      Keywords:  Rhabdomyosarcoma, genitourinary, staging, diagnosis, paratesticular, bladder, prostate, RMS

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    • 29

      Ectopic Ureter: Surgical Management

      By Austin Hester, MD; Anthony Atala, MD
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      Ectopic Ureter: Surgical Management

      • AUSTIN HESTER, MDResident Physician, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC
      • ANTHONY ATALA, MDChair, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC

      The ectopic ureter is an uncommon presentation in the pediatric population, seen in approximately one in 2,000 live births with a female prevalence. However, observation and conservative management have a short-lived role as many of these children are incontinent or symptomatic from an obstructed system. Urgent decompression of an infected system may be required as a temporizing measure before definitive surgical management can be pursued. In this review, we discuss the surgical options available for the ectopic ureter. This includes heminephrectomy of the nonfunctioning renal unit and reconstructive measures such as ureteral reimplantation, ureteroureterostomy, and ureteropyelostomy. We also discuss the management of the remnant ureteral stump and concomitant vesicoureteral reflux.

      This review contains 1 figure and 35 references.

      Key words: cutaneous ureterostomy, ectopic ureter, renal duplication anomalies, heminephrectomy, ureteral reimplantation, ureteropyelostomy, ureteroureterostomy

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    • 30

      Ectopic Ureter: Diagnosis and Medical Management

      By Austin Hester, MD; Anthony Atala, MD
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      Ectopic Ureter: Diagnosis and Medical Management

      • AUSTIN HESTER, MDResident Physician, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC
      • ANTHONY ATALA, MDChair, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC

      The ectopic ureter is an uncommon presentation in the pediatric population with a 6 to 1 female-to-male prevalence. From an embryologic standpoint, ectopic ureters form as a result of failure of proper development of the urogenital sinus with ectopic development of the ureteral orifice. They are most often associated with a duplicated collecting system. The location of the orifice is most commonly in the posterior urethra. Diagnosis is usually made with a combination of multiple imaging modalities, including ultrasonography, voiding cystourethrography, nuclear scintigraphy, and sometimes CT or MRI. In this review, we detail the origin of the ectopic ureter and discuss diagnosis and medical management.

       This review contains 1 figures and 29 references.

      Key words: CT, cystourethrography, ectopic ureter, MRI, renal duplication anomalies, ultrasonography, voiding nuclear scintigraphy

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    • 31

      Diagnosis and Medical Management of Prune Belly (triad) Syndrome

      By Pankaj P. Dangle, MD, MCh; David B. Joseph, MD, FACS, FAAP
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      Diagnosis and Medical Management of Prune Belly (triad) Syndrome

      • PANKAJ P. DANGLE, MD, MCHAssistant Professor, Department of Urology, University of Alabama at Birmingham, Children’s of Alabama, Birmingham, AL
      • DAVID B. JOSEPH, MD, FACS, FAAPProfessor of Urology, University of Alabama at Birmingham, Children’s of Alabama, Chief of Pediatric Urology, Beverly P. Head Endowed Chair in Pediatric Urology, Children’s of Alabama, Birmingham, AL

      Incidence of prune belly syndrome (PBS) has remained stable for several decades; advances have been made in prenatal diagnosis with the aid of advanced US and magnetic resonance technology. Use of fetal MRI as an adjunct to US, especially in the setting of oligohydramnios, anhydramnios, and maternal obesity, makes additional imaging methods potentially beneficial. MRI is currently accepted as a valuable technique for fetal anomalies assessment. Addition of three- and four-dimensional US has improved specificity to the traditional two-dimensional imaging. The following discusses the in utero assessment, neonatal and childhood evaluation, and management of PBS.

      This review contains 5 figures, 2 tables, and 48 references.

      Key Words: Eagle-Barrett, fast-scanning MRI, fetal ultrasonography, in utero hydronephrosis, prune belly syndrome, triad syndrome, vesicoamniotic shunt,pediatric renal insufficiency

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    • 32

      Surgical Management of the Urinary Tract for the Prune-belly (triad) Syndrome

      By David B. Joseph, MD, FACS, FAAP
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      Surgical Management of the Urinary Tract for the Prune-belly (triad) Syndrome

      • DAVID B. JOSEPH, MD, FACS, FAAPProfessor of Urology, University of Alabama at Birmingham, Children’s of Alabama, Chief of Pediatric Urology, Beverly P. Head Endowed Chair in Pediatric Urology, Children’s of Alabama, Birmingham, AL

      Urinary reconstruction is tempting based on the impressive abnormal findings that are revealed on imaging. The abnormal appearance of the urinary system by itself is not enough to warrant reconstruction. Reconstruction should only be undertaken when there is clear clinical evidence that stagnant urine leads to urinary tract infections and/or obstruction that is associated with renal compromise. This chapter describes temporary and permanent upper and lower urinary reconstructions. Particular consideration is given to the pathophysiology of prune belly syndrome and the disproportionate dilation and dysfunction of the distal ureter when undertaking ureteral remodeling. The techniques of ureteral folding and formal excisional ureteral tapering are described stressing the importance of vascular preservation. The role of reduction cystoplasty is placed in perspective of short- and long-term benefits.

      This review contains 18 references.

      Key Words: Eagle-Barrett syndrome, megacystis, megaureter, prune-belly syndrome, tapered ureteral reimplant, triad syndrome, ureteral reconstruction, urinary diversion, bladder reduction.

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    • 33

      Medical Management of Wilms Tumor

      By Sei-Gyung K. Sze, MD; Elisabeth T. Tracy, MD; Jonathan C. Routh, MD, MPH; Henry E. Rice, MD; Daniel S. Wechsler, MD, PhD
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      Medical Management of Wilms Tumor

      • SEI-GYUNG K. SZE, MDDivision of Pediatric Hematology-Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC
      • ELISABETH T. TRACY, MDDivision of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
      • JONATHAN C. ROUTH, MD, MPHDivision of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
      • HENRY E. RICE, MDDivision of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
      • DANIEL S. WECHSLER, MD, PHDAflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA

      Wilms tumor (WT) is the most common renal tumor of childhood and accounts for 5-7% of all childhood cancers. Remarkable progress in the treatment of WT has been made in the last several decades through collaborative clinical trials in the United States and Europe. With a multimodal approach including chemotherapy, surgery, and radiation therapy, overall survival for WT is greater than 90%. However, there remains a subgroup of patients for which cure remains a challenge, and late effects of therapy are significant. New insights into clinical and biologic prognostic markers are being used to improve risk stratification and to tailor therapy to individual patients. Current treatment strategies aim to maintain excellent survival while reducing late effects for low-risk patients and optimize therapy to improve cure rates for high-risk patients.

      This review contains 1 figures, 4 tables, and 45 references. 

      Key Words: chemotherapy, COG, kidney neoplasms, nephroblastoma, NWTS, pediatric cancer, radiotherapy, treatment outcome, SIOP, Wilms tumor

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  • Competency-based Surgical Care
    • 1

      Professionalism in Surgery

      By Jo Shapiro, MD, FACS; K. Christopher McMains, MD, PhD, MS
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      Professionalism in Surgery

      • JO SHAPIRO, MD, FACSAssociate Professor, Otolaryngology, Harvard Medical School, Boston, MA
      • K. CHRISTOPHER MCMAINS, MD, PHD, MS

      The medical profession continues to be challenged along the entire range of its cultural values and its traditional roles and responsibilities. This review explores the meaning of professionalism, translating the theory of professionalism into practice, and the future of surgical professionalism. A table offers the elements of the American College of Surgeons’ Code of Professional Conduct. This review contains 22 references.

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    • 2

      Uroneurology

      By Jai H Seth, MBBS, MRCS, BSc, MSc; Jalesh N. Panicker, MBBS, MD, DM, MRCP
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      Uroneurology

      • JAI H SETH, MBBS, MRCS, BSC, MSCSpecialist Registrar and Research Fellow in Urology, Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, London, United Kingdom
      • JALESH N. PANICKER, MBBS, MD, DM, MRCPConsultant in Uro-Neurology, Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Institute of Neurology, London, United Kingdom

      The function of the pelvic organs, including the lower urinary tract (LUT), is controlled by a complex network of nerves. This leaves patients with neurologic disease vulnerable to LUT and pelvic organ dysfunction. Physicians often come across urogenital complaints in their patients with neurologic disease, the symptoms of which can result in significant distress and loss of dignity and quality of life. Due to the health and economic burden that accompanies neurogenic pelvic organ dysfunction, it is important for clinicians to understand the common forms of dysfunction, essential investigations, and modes of management. This chapter covers bladder dysfunction from a physician’s perspective. Topics include neurologic control of the LUT, large bowel, and sexual functions; male and female sexual response; neurogenic bladder dysfunction and its management; diagnostic evaluation; management of neurogenic sexual dysfunction; management of erectile dysfunction; ejaculatory dysfunction; sexual dysfunction in women; and fecal incontinence. Figures illustrate efferent innervation of the LUT, neurologic detrusor overactivity, a urethral pressure profile in a patient with Fowler syndrome, an example bladder diary, an example bladder scan, and normal and obstructed flow patterns. Tables list common causes of injury at the suprapontine, suprasacral, and infrasacral levels and storage and voiding systems.

      This chapter contains 6 highly rendered figures, 2 tables, 53 references, 1 teaching slide set, and 5 MCQs.

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    • 3

      Urinary Incontinence and Overactive Bladder Syndrome

      By Kristie A. Greene, MD; Lennox Hoyte, MD, MSEECS
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      Urinary Incontinence and Overactive Bladder Syndrome

      • KRISTIE A. GREENE, MDFellow, Female Pelvic Medicine and Reconstructive Surgery, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL
      • LENNOX HOYTE, MD, MSEECSAssociate Professor and Director, Female Pelvic Medicine and Reconstructive Surgery, University of South Florida College of Medicine, Director, Urogynecology, and TGH-Pelvic Floor Disorders Group, Tampa General Hospital, Tampa, FL

      Urinary incontinence falls into two broad categories: stress incontinence and urge incontinence. Stress urinary incontinence occurs when urethral closure pressure cannot increase sufficiently to compensate for a sudden increase in intra-abdominal pressure, as from a cough or Valsalva maneuver. Urge urinary incontinence occurs when an unintended bladder contraction creates an insuppressible urge to void, leading to urinary leakage. When women have signs and/or symptoms of both stress and urge incontinence, it is referred to as mixed urinary incontinence. Overactive bladder syndrome is defined by the Standardization Subcommittee of the International Continence Society (ICS) as urinary urgency, with or without urge incontinence and usually with frequency and nocturia. Nocturia, which is often associated with urinary frequency, is defined as a need to urinate that awakens the person during the night. This chapter discusses the epidemiology and physiology of urinary incontinence and overactive bladder syndrome in women, as well as diagnosis and treatment. Tables list foods and beverages that may cause urinary frequency and urgency; features of urge incontinence, stress incontinence, and mixed incontinence; American Urologic Association (AUA) guidelines regarding level of evidence and indications for adult urodynamics; and currently available antimuscarinic drugs and their dosages, selectivity, efficacy, and side effects. Figures depict the journal of someone with mixed incontinence, a typical urodynamics suite, a urodynamic study of someone with detrusor overactivity, incontinence pessaries, and transobturator and retropubic slings.

      This review contains 5 figures, 5 tables, and 44 references.

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  • Basic Surgical and Perioperative Considerations
    • 1

      Postoperative Management of the Hospitalized Patient

      By Edward Kelly, MD, FACS
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      Postoperative Management of the Hospitalized Patient

      • EDWARD KELLY, MD, FACS

      Effective surgical treatments are available for a wide variety of diseases in the modern era; at the same time, surgical interventions have become increasingly complex and specialized. The contemporary surgeon must coordinate evaluation and management of patients with multiple medical diagnoses and shepherd these patients through an increasingly elaborate process of medical and surgical care. To provide effective care, the organ systems–oriented approach is key. This approach, demonstrated in the following review, guides the practitioner through each organ system in order and can be used to generate a differential diagnosis for each system and a comprehensive problem list for each patient. The comprehensive problem list and surgical care plan have found new interest as extended recovery after surgery (ERAS) pathways.

      This review contains 107 references and 5 tables.

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    • 2

      Urologic Infections

      By Tatyana Vayngortin, MD; Nisa S Atigapramoj, MD
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      Urologic Infections

      • TATYANA VAYNGORTIN, MDPediatric Emergency Medicine Fellow, Department of Emergency Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
      • NISA S ATIGAPRAMOJ, MDAssistant Clinical Professor of Pediatrics and Emergency Medicine, Department of Emergency Medicine, UCSF Benioff Children’s Hospital, San Francisco, CA

      Urinary tract infections (UTIs) affect people of all ages. Although the incidence of invasive bacterial diseases continues to decline, the prevalence of UTIs in febrile pediatric patients continues to remain a focus for serious bacterial infection in this population. In older age groups, symptoms become more obvious and present more classically. Clinical practice guidelines have been developed because morbidity can be dependent upon the rapid identification of a UTI with prompt initiation of appropriate antimicrobials. This review provides a summary for the evaluation of UTIs with discussion of diagnosis and management. 

      This review contains 6 figures, 5 tables and 47 references

      Key words: antibiotics, cystitis, pyelonephritis, urinary tract infection, uropathogens

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