Most urologists in the United States have little experience with urethroplasty surgery. Most urologists erroneously believe that the literature supports a reconstructive surgical ladder for urethral stricture management. Unfamiliarity with the literature and inexperience with urethroplasty surgery have made the use of endoscopic methods inappropriately common.

No abstract

Benign prostatic hyperplasia (BPH) is the nonmalignant enlargement of the prostate gland caused by increases in number of both epithelial and stromal cells. Clinically, BPH leads to voiding dysfunction, which is most often referred to as lower urinary tract symptoms (LUTS). Historically, the only treatments for LUTS due to BPH were watchful waiting or surgery (transurethral or open prostatectomy). However, over the last 20 years medical therapy has taken a prominent role in the management of BPH. Current medical treatments for BPH include alpha-adrenergic receptor antagonists, inhibitors of the 5-alpha reductase enzyme and various phytotherapies. These agents are generally effective and safe; however, many patients are unable to tolerate the side effects or are refractory to medical management and require surgery. In light of this, many potential new therapies for the treatment of BPH are under development. Some represent a variation of current treatments, whereas others target novel molecular pathways within the prostate. The aim of this review is to examine current pharmacotherapies as well as to highlight emerging drugs that may improve our treatment of patients with LUTS secondary to BPH.

No abstract

Introduction Peyronie's disease (PD) is a poorly understood clinical entity. Aim We endeavored to determine how contemporary urologists in the United States manage PD. Methods A randomly generated mailing list of 996 practicing urologists was generated from the American Urologic Association member directory. A specifically designed survey was mailed with a cover letter and a postage-paid return envelope. Main Outcome Measure Our survey assessed several practice-related factors and asked questions of how the subject would manage various presentations of PD in their practice. Four cases were presented: case 1, a healthy 55-year-old man with painless 30° dorsal curvature of 16 months duration; case 2, a 60-year-old man with 35° dorsal curvature, 4/10 pain on visual analog scale, of 6 months duration; case 3, a 62-year-old man with painless 60° dorsal curvature and erectile dysfunction responsive to alprostadil suppository of 2 years duration; and case 4, a 50-year-old man with mid-shaft waist deformity, foreshortening, no pain/curvature/erectile dysfunction. Results Responses were received from 236 (24%) practicing urologists. Vitamin E was the preferred initial management for 70% of respondents, with observation, Potaba (Glenwood, Englewood, New Jersey, USA), colchicine, verapamil injections, and verapamil gel favored by 32, 20, 12, 7, and 10% of respondents, respectively. Fifty-seven percent of respondents performed surgery for PD, with penile prostheses, Nesbit procedure, grafting, and plication used by 76, 66, 55, and 51% of respondents, respectively. Medical therapy and/or observation was the preferred management for all of the cases except case 3, for which penile prosthesis placement and referral were the favored options by 39 and 30% of urologists, respectively. Conclusions Medical therapy is the initial treatment for PD among American urologists. Penile prosthesis is the treatment of choice in impotent patients. Most American urologists conform to recommended practice patterns in the management of PD.