Immunotherapy-based combinations in the first-line treatment of metastatic renal cell carcinoma with sarcomatoid features: a systematic review and network meta-analysis
Purpose of review
To perform indirect comparisons of efficacy and safety of first-line immune checkpoint inhibitor (ICI)-based combination therapies for renal cell carcinoma with sarcomatoid features (sRCC).
Recent findings
Five trials were included in our network meta-analyses comprising 568 patients. The combinations nivolumab plus ipilimumab and nivolumab plus cabozantinib achieved significant improvement of progression-free survival (PFS), overall survival (OS), and objective response rates (ORR). Nivolumab plus ipilimumab was associated with the highest likelihood of achieving a complete response. All the i...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Restaging transurethral resection in ta high-grade nonmuscle invasive bladder cancer: a systematic review
Purpose of review
The role of a re-transurethral resection (TUR) is clearly demonstrated in T1 high-grade nonmuscle invasive bladder cancer. However, its role remains controversial for Ta high-risk tumors and the recent European guidelines stated that the second look procedure could be avoided for these patients despite harboring a high-risk of both disease recurrence and progression. We aimed to evaluate the added benefit on staging, response to bacillus Calmette–Guérin and oncological outcomes of re-TUR in patients with Ta high-grade nonmuscle invasive bladder cancer.
Recent findings
Overall, we identified ...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Molecular intricacies of upper tract urothelial carcinoma and their relevance for therapy considerations
Purpose of review
The aim of this study was to give an overview of molecular alterations in upper tract urothelial carcinomas (UTUCs) and to discuss them in the context of current and prospective systemic therapies.
Recent findings
UTUCs not only share a similar molecular landscape with urothelial carcinoma of the bladder (UCB), but also have distinct molecular features that can have an impact on therapy selection. FGFR3 alterations occur with a significant higher frequency in UTUC, with up to 40% of tumours harbouring FGFR3 driver mutations compared with 20% in UCB. In addition, a substantial number of high-gra...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Lynch syndrome in urological practice: diagnosis, therapeutic strategies, and screening for upper tract urothelial carcinoma
Purpose of review
To provide a comprehensive overview of diagnosis, treatment, and screening for upper tract urothelial carcinoma (UTUC) among Lynch syndrome patients.
Recent findings
Lynch syndrome is an autosomal dominant disorder resulting from the germline mutation in the mismatch repair (MMR) system. The Lynch syndrome predisposes to early onset of a broad spectrum of tumours, among which UTUC represents the third most frequent malignancy. Since up to 10% of UTUC can be attributed to Lynch syndrome, a correct recognition of this disease provides the opportunity for patients and their relatives to be properl...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Von Hippel–Lindau disease-associated renal cell carcinoma: a call to action
Purpose of review
While the molecular and genetic bases of Von Hippel–Lindau (VHL) disease have been extensively investigated, limited evidence is available to guide diagnosis, local or systemic therapy, and follow-up. The aim of the current review is to summarize the ongoing trials both in preclinical and clinical setting regarding VHL disease management.
Recent findings
Although genotype/phenotype correlations have been described, there is considerable inter and intra-familiar heterogeneity in VHL disease. Genetic anticipation has been reported in VHL disease. From a clinical point of view, expert-opinion-ba...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Intricacies of retroperitoneal lymph node dissection for testis cancer
This article reviews the intricacies of RPLND for testis cancer.
Recent findings
Surgical management of advanced testis cancer begins with an intimate understanding of retroperitoneal anatomy and the various techniques necessary to safely extirpate tumors. Preoperatively patients should undergo comprehensive counseling and obtain up-to-date imaging along with tumor markers to assist in surgical planning and evaluation of extraretroperitoneal (ERP) disease. Surgeons must be well versed in nerve-sparing techniques to maintain ejaculatory function. Newer techniques using a midline extraperitoneal technique minimizes mo...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Management of stage I testicular cancer
Purpose of review
Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications.
Recent findings
At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into m...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Innovative systemic therapies for penile cancer
Purpose of review
The purpose of this review is to look at recent advancements and treatment options of systemic therapies to treat penile squamous cell carcinoma (PSCC). PSCC is a rare cancer that remains with limited funding for research and systemic therapy development. This review aims to discuss the most recent advancements in systemic treatments and our understanding of PSCC.
Recent findings
Neoadjuvant chemotherapy (NAC) and adjuvant therapy remain integral parts of treatment in locally advanced PSCC. New potential drug regimens are being studied to expand on the availability of first-line regimen options...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Update on penile sparing surgery for penile cancer
Purpose of review
Penile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years.
Recent findings
In this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how resear...
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: RARE UROLOGIC CANCERS: Edited by Philippe E. Spiess and Andrea Necchi Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Urology)
Source: Current Opinion in Urology - November 30, 2021 Category: Urology & Nephrology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Orthotopic urinary diversions after radical cystectomy for bladder cancer: lessons learned last decade
Purpose of review
Orthotopic urinary diversion (OUD), or neobladder, is believed to be the gold standard for surgical bladder reconstruction following radical cystectomy though it is performed far less often than ileal conduits. As both a continent and intracavitary diversion, OUDs offer unique advantages for patients. Their utilization has decreased overall though, especially with the advent of robotic surgery. In this review, we will cover patient selection for OUD, functional outcomes (i.e., continence, sexual activity, quality of life [QoL]), and robotic orthotopic diversions.
Recent findings
OUDs have seen ...
Source: Current Opinion in Urology - October 11, 2021 Category: Urology & Nephrology Tags: MEDICAL, TECHNICAL AND FUNCTIONAL ASPECT OF VARIOUS URINARY DIVERSIONS: Edited by John P.F.A. Heesakkers and Fred Witjes Source Type: research
Patient-reported outcomes and health-related quality of life after urinary diversions
Purpose of review
To study the recent literature on health-related quality of life (HRQOL) in patients after radical cystectomy followed by urinary diversion.
Recent findings
General consensus regarding, which urinary diversion is superior in terms of HRQOL has not been reached. Although there is an increase in studies favoring the orthotopic neobladder, overall quality of these studies is poor. Other studies suggest that HRQOL outcomes in different types of urinary diversions is similar and that other factors, such as age, comorbidities and sex are more important instead. Patient choice, in consultation with th...
Source: Current Opinion in Urology - October 11, 2021 Category: Urology & Nephrology Tags: MEDICAL, TECHNICAL AND FUNCTIONAL ASPECT OF VARIOUS URINARY DIVERSIONS: Edited by John P.F.A. Heesakkers and Fred Witjes Source Type: research
Management of upper urinary tract problems after radical cystectomy for urothelial carcinoma: tips and tricks
Purpose of review
After radical cystectomy (RC) patients are at risk for both benign and malignant problems regarding the upper urinary tract (UUT). This review summarizes the recent literature and provides tips on how to manage problems of the UUT after RC.
Recent findings
Disease recurrence, kidney stones and ureteroenteric strictures (UES) are common after RC. Endourological techniques can be used to treat low-grade disease recurrence, either with a retrograde or antegrade approach. Treatment success depends on getting access to the UUT and on tumor characteristics; selecting the right approach is key. Kidney...
Source: Current Opinion in Urology - October 11, 2021 Category: Urology & Nephrology Tags: MEDICAL, TECHNICAL AND FUNCTIONAL ASPECT OF VARIOUS URINARY DIVERSIONS: Edited by John P.F.A. Heesakkers and Fred Witjes Source Type: research
The functioning and the complication rate of extreme long existing urinary diversions
This study was performed to investigate the functioning of urinary diversions constructed> 25 years earlier.
Recent findings
Most studies have a relatively shorter follow-up, mainly focussing on short term postoperative complications. Focussing on the long term, urinary tract infections (UTI) including pyelonephritis are common. Mild kidney function deterioration is described.
Summary
Retrospective study (2018–2019); 43 patients with regular follow-up at the Radboud University Medical Centre Nijmegen the Netherlands. Ileal conduit (n = 19) and ureterosigmoidostomy (n = 11) are the most common divers...
Source: Current Opinion in Urology - October 11, 2021 Category: Urology & Nephrology Tags: MEDICAL, TECHNICAL AND FUNCTIONAL ASPECT OF VARIOUS URINARY DIVERSIONS: Edited by John P.F.A. Heesakkers and Fred Witjes Source Type: research
Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?
Purpose of review
Urinary diversion (UD) with or without cystectomy is a procedure with high short term complication rates. In this review, we summarize the most relevant findings of the last 2 years.
Recent findings
The use of a prophylactic mesh decreases the risk of parastomal hernia after ileal conduit (IC) surgery without adding mesh-related complications according to a recent randomized multicentre trial. Robot-assisted surgery is increasingly applied for UD and is evolving from extra- to intra-corporeal reconstruction in both continent and incontinent diversions, but there is still a need for appropriatel...
Source: Current Opinion in Urology - October 11, 2021 Category: Urology & Nephrology Tags: MEDICAL, TECHNICAL AND FUNCTIONAL ASPECT OF VARIOUS URINARY DIVERSIONS: Edited by John P.F.A. Heesakkers and Fred Witjes Source Type: research
