Alternatives to whole gland treatment for localized prostate cancer: a review of novel focal therapies
Purpose of review
The mainstays of the management of clinically localized prostate cancer have historically rested upon active surveillance, radiation therapy, or radical prostatectomy. Although both radiation and surgical treatment of localized prostate cancer can achieve excellent oncologic outcomes, the subsequent potential adverse effects of urinary stress incontinence and erectile dysfunction are unappealing to patients. This has led to investigational studies centered upon focal treatment of the cancerous lesion, with the aim to improve quality-of-life outcomes. In this review, we describe numerous novel modaliti...
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: NEW FRONTIERS IN FOCAL THERAPY IN URO-ONCOLOGY: Edited by Behfar Ehdaie and Rafael Sanchez-Salas Source Type: research
The role of novel imaging in prostate cancer focal therapy: treatment and follow-up
Purpose of review
Multiparametric magnetic resonance imaging (mpMRI) has fundamentally changed how intraprostatic lesions are visualized, serving as a highly sensitive means for detecting clinically significant prostate cancer (csPCa) via image-targeted biopsy. However, limitations associated with mpMRI have led to the development of new imaging technologies with the goal of better characterizing intraprostatic disease burden to more accurately guide treatment planning and surveillance for prostate cancer focal therapy. Herein, we review several novel imaging modalities with an emphasis on clinical data reported within...
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: NEW FRONTIERS IN FOCAL THERAPY IN URO-ONCOLOGY: Edited by Behfar Ehdaie and Rafael Sanchez-Salas Source Type: research
Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer
Purpose of review
Focal therapy or partial gland ablation for nonmetastatic prostate cancer is gaining popularity not just as an alternative to active surveillance, but as an acceptable alternative to whole gland therapy in appropriate cases. This review summarizes recent evidence to help select patients for optimal outcomes.
Recent findings
Recommendations by expert panels have become less conservative with each meeting. As experience with older modalities for focal therapy grows, newer modalities continue to be introduced. We are now in a position to offer personalized treatment pathway considering nuances of ...
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: NEW FRONTIERS IN FOCAL THERAPY IN URO-ONCOLOGY: Edited by Behfar Ehdaie and Rafael Sanchez-Salas Source Type: research
Focal therapy: definition and rationale
Purpose of review
The role of focal therapy for the treatment of prostate cancer is expanding in clinical practice. The aim of this review is to introduce readers to controversies in the use of focal therapy and its rationale.
Recent findings
There is a growing body of literature regarding the short-term and medium-term cancer control parameters and quality of life outcomes. These are mostly observational studies without a comparative arm. There is a need for high-quality randomize control trials comparing these treatments to definitive standard of care interventions (e.g. surgery or radiotherapy) in appropriate...
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: NEW FRONTIERS IN FOCAL THERAPY IN URO-ONCOLOGY: Edited by Behfar Ehdaie and Rafael Sanchez-Salas Source Type: research
Editorial: Special issue on focal therapy: Updating our knowledge
No abstract available (Source: Current Opinion in Urology)
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: NEW FRONTIERS IN FOCAL THERAPY IN URO-ONCOLOGY: Edited by Behfar Ehdaie and Rafael Sanchez-Salas Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Urology)
Source: Current Opinion in Urology - May 1, 2022 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Extramammary Paget's Disease of genitourinary origin
Purpose of review
Extramammary Paget's Disease (EMPD) is an uncommon intra-epithelial malignancy, affecting primarily apocrine gland-bearing skin. EMPD is often considered an orphan diagnosis given its rarity. This review provides a contemporary overview of EMPD management.
Recent findings
The mainstay of EMPD treatment centers around a high index of suspicion to allow for an early and accurate diagnosis, wide local or Mohs micrographic surgical excision with care paid toward the margin status, and thoughtful consideration for lymphadenectomy in patients with clinically positive regional disease. There is curren...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research
Technical advances in nerve-sparing and continence preservation
Purpose of review
Urinary incontinence and erectile dysfunction are common after radical prostatectomy. These side effects greatly impact patients’ quality of life. Therefore, surgical techniques and technology tools are constantly being developed to optimize trifecta outcomes. Here we focus on advances in nerve-sparing (NS) and continence preservation.
Recent findings
New surgical techniques dedicated to preservation rather than reconstruction have been developed to improve urinary continence (UC) and NS. On the other hand, intraoperative assessment of prostatic and periprostatic structures has shown promisin...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: SPECIAL COMMENTARIES Source Type: research
Lasers in laparoscopic and robotic surgery: is there a need for them
Purpose of review
The application of lasers in treating urological disorders is a developing area. In the laparoscopic and robotic surgery, laser energy is not so popular as in the treatment of stone disease and benign prostatic hyperplasia. The aim of this review is to clarify the current status of laser applications in laparoscopic and robotic urology.
Recent findings
Laser welding of the pyeloureteral anastomosis is not performed in routine clinical practice. Most investigation of laser applications in laparoscopic and robotic urology has centered on laparoscopic partial nephrectomy and robot-assisted partial...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
Current evidence for focal laser ablation and vascular-targeted photodynamic therapy for localized prostate cancer: review of literature published in the last 2 years
Purpose of review
Currently, a significant number of patients are diagnosed with unilateral and apparently unifocal low or intermediate-risk prostate cancer (PCa). These patients are suitable for focal therapy, thus preventing radical treatment side effects without affecting cancer control. Among focal therapy energy sources, laser-based technologies have shown promising outcomes. We aimed to summarize recent data on focal laser ablation (FLA) and vascular-targeted photodynamic therapy (VTP) for PCa.
Recent findings
We selected eight studies reporting data on 1155 patients with PCa who underwent laser-based foca...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review
Purpose of review
PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS)....
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
Retrograde intrarenal surgery: laser showdown (Ho:YAG vs thulium fiber laser)
Purpose of review
Retrograde intrarenal surgery (RIRS) has always been recommended for large stones> 20 mm, using the Ho:YAG laser. The introduction of a new technology in the urological market, the thulium fiber laser (TFL) has revolutionized the endourology world because of its characteristics and significantly shorter laser-on time (LOT) and operative time, without scarifying the champ vision. The aim of this review is to evaluate the most relevant findings of the last 2 years of each laser technology, confronting Ho:YAG vs TFL, analyzing who is more suitable for performing an efficient RIRS.
Recent findings ...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
En bloc resection for nonmuscle-invasive bladder cancer: selecting a proper laser
Purpose of review
To discuss the most recent surgical lasers that have been made available to us and to evaluate their potential in performing en bloc resection of nonmuscle invasive bladder cancer.
Recent findings
Laser en bloc resection of bladder tumors (ERBT) can be performed with a number of laser systems including Ho:YAG, GreenLight, diode, Tm:YAG and thulium fiber lasers (TFL). The data that is currently available suggests that the water-targeting devices (utilizing water as a primary chromophore – Ho:YAG, Tm:YAG, TFL) may have a number of advantages over hemoglobin-targeting systems (potassium titanyl ...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
Thulium fiber laser in urology: physics made simple
Purpose of review
In this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability.
Recent findings
TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues – benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell ca...
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
Editorial
No abstract available (Source: Current Opinion in Urology)
Source: Current Opinion in Urology - February 1, 2022 Category: Urology & Nephrology Tags: LASER TECHNOLOGIES IN UROLOGY: Edited by Olivier Traxer and Dmitry Enikeev Source Type: research
