The Role of Aquablation for the Surgical Treatment of LUTS/BPH
AbstractPurpose of ReviewTo explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement.Recent FindingsWith the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes.SummaryThe functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the ...
Source: Current Urology Reports - June 21, 2019 Category: Urology & Nephrology Source Type: research

Cost Comparison of Benign Prostatic Hyperplasia Treatment Options
In this study, interventions for BPH reached cost equivalence with combination medical therapy within 6 months to 8 years.SummaryA myriad of options for managing men with symptomatic BPH exist. It is prudent not only to consider surgeon preference and patient-specific factors when selecting a treatment but also to understand the economic impact different BPH therapies confer. (Source: Current Urology Reports)
Source: Current Urology Reports - June 19, 2019 Category: Urology & Nephrology Source Type: research

Emerging Treatments for Erectile Dysfunction: a Review of Novel, Non-surgical Options
AbstractPurpose of ReviewTo review novel, non-surgical therapies for erectile dysfunction (ED).Recent FindingsRecently, a landmark study identified theSIM1 locus, involved in the leptin-melanocortin pathway, as an independent risk factor for ED and a potential target for novel therapies. The recent literature otherwise has focused on low-intensity shock wave therapy (LiSWT), with several randomized trials and meta-analyses suggesting therapeutic efficacy.SummaryThere are few novel oral agents for ED. There is growing evidence suggesting efficacy of intracavernosal stem cells therapy and low-intensity shock wave therapy (Li...
Source: Current Urology Reports - June 18, 2019 Category: Urology & Nephrology Source Type: research

Sperm Morphology: History, Challenges, and Impact on Natural and Assisted Fertility
AbstractPurpose of ReviewThe classification of morphologically normal sperm has been progressively redefined. Concurrently, our understanding of the significance of sperm morphology in relation to male factor infertility has evolved. In this review, we will discuss the evolution of sperm morphology assessment and factors that contribute to its measurement variability. We will examine the impact of sperm morphology on natural pregnancy, IUI, IVF, and ICSI outcomes.Recent FindingsThere is a lack of consensus on sperm morphology classification, technique, and inter-observer grading variability. Current evidence suggests sperm...
Source: Current Urology Reports - June 15, 2019 Category: Urology & Nephrology Source Type: research

Outcomes of Surgery in Peyronie ’s Disease Following Intralesional Collagenase Clostridium Histolyticum Injections
AbstractPurpose of ReviewTo explore the potential hurdles surgeons may encounter when preforming surgical correction of penile curvature in patients with Peyronie ’s Disease following intralesional collagenase clostridium histolyticum injections.Recent FindingsAlthough limited data exists, retrospective analysis of surgeon experiences in surgical treatment of refractory penile curvature in patients with Peyronie ’s disease appears to not result in more post-operative complications and may only slightly increase intra-operative difficulty.SummaryAs the use of intralesional collagenase clostridium histolyticum co...
Source: Current Urology Reports - June 14, 2019 Category: Urology & Nephrology Source Type: research

Malone Antegrade Continence Enemas vs. Cecostomy vs. Transanal Irrigation —What Is New and How Do We Counsel Our Patients?
AbstractPurpose of ReviewNo gold standard exists for managing neurogenic bowel dysfunction, specifically in individuals with spina bifida. Since the International Children ’s Continence Society published its consensus document on neurogenic bowel treatment in 2012, an increased focus on why we must manage bowels and how to improve our management has occurred. This review provides updated information for clinicians.Recent FindingsA surge in research, mostly retrospective, has been conducted on the success and satisfaction of three types of management for neurogenic bowel. All three management techniques have relativel...
Source: Current Urology Reports - June 10, 2019 Category: Urology & Nephrology Source Type: research

BPH: Why Do Patients Fail Medical Therapy?
AbstractPurpose of ReviewIn this article, we review why patients may fail medical therapy for benign prostatic hyperplasia (BPH) and by doing so, gain a better understanding of the disease process and how to optimize the care of these patients.Recent FindingsA growing body of literature has attempted to better characterize the various mechanisms by which patients develop BPH as well as identify predictors of disease progression and treatment failure.SummaryBPH is a heterogenous disease process. A more personalized approach to treatment, including patient selection for medical or surgical management, would allow us to optim...
Source: Current Urology Reports - June 6, 2019 Category: Urology & Nephrology Source Type: research

What ’s New in Rezum: a Transurethral Water Vapour Therapy for BPH
AbstractPurpose of ReviewRezum is a new minimally invasive treatment for benign prostate enlargement using thermal transurethral water vapour therapy. We review the evidence with advantages and disadvantages of this technique.Recent FindingsThere are five studies reported including a randomised control trial looking at the outcomes of Rezum. The outcomes show an IPSS reduction by 45 –60%, QoL improvement with a score reduction of 37–59%, the Qmax improvement by 44–72% and the PVR reduction by 20–38%.SummaryConvective water vapour therapy using the Rezum system has been shown to have successful outco...
Source: Current Urology Reports - May 31, 2019 Category: Urology & Nephrology Source Type: research

Traditional Biofeedback vs. Pelvic Floor Physical Therapy —Is One Clearly Superior?
AbstractPurpose of ReviewPelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction.Recent FindingsToday, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training...
Source: Current Urology Reports - May 30, 2019 Category: Urology & Nephrology Source Type: research

Treatment Options for Calyceal Diverticula
AbstractPurpose of ReviewCalyceal diverticula are rare entities that can pose a significant challenge when it comes to their management. We analyse and summarise the literature with a focus on recent advances in the management of calyceal diverticula and discuss the advantages and disadvantages of each surgical technique.Recent FindingsThe identification of calyceal diverticula requires a certain level of suspicion and contrast-enhanced imaging. Conventional techniques of imaging the renal collecting system such as the classic intravenous urography are now superseded by the ease of access to contrast-enhanced CT imaging. C...
Source: Current Urology Reports - May 23, 2019 Category: Urology & Nephrology Source Type: research

Implications of the Genitourinary Microbiota in Prostatic Disease
AbstractPurpose of ReviewTo summarize recent investigation into associations between the genitourinary microbiota and prostatic disease.Recent FindingsThe genitourinary tract is not sterile. There are microbial communities (microbiota) in each niche of the genitourinary tract including the bladder, prostate, and urethra, which have been the subject of increasing scientific interest. Investigators have utilized several unique methods to study them, resulting in a highly heterogeneous body of literature. To characterize these genitourinary microbiota, diverse clinical specimens have been analyzed, including urine obtained by...
Source: Current Urology Reports - May 18, 2019 Category: Urology & Nephrology Source Type: research

Nephrolithiasis in the Obese Patient
AbstractPurpose of ReviewThe link between metabolic syndrome (MetS)/obesity and kidney stone disease (KSD) has gained importance over recent years due to the increasing prevalence and healthcare burden worldwide. This review analyses the literature exploring the link between MetS/obesity and KSD and the impact that obesity has on KSD management.Recent FindingsMetabolic syndrome has been shown to increase an individual ’s risk of developing kidney stone disease, with insulin resistance forming a core component of the pathophysiology. The body habitus of an individual also influences the type of intervention that is mo...
Source: Current Urology Reports - May 18, 2019 Category: Urology & Nephrology Source Type: research

Robotic Urologic Surgery in the Infant: a Review
AbstractPurpose of ReviewThe goal of this article is to review the current role of robotic urologic surgery in the infant population across a spectrum of diseases and procedures.Recent FindingsRobotic urological surgery has been performed in the infant population across a variety of conditions including ureteropelvic junction obstruction, vesicoureteral reflux, and duplicated and nonfunctional renal moieties. However, most of the durable evidence showing safety and success remains in the repair of the obstructed ureteropelvic junction. Included in this review are also strategies to address the limitations imposed by the un...
Source: Current Urology Reports - May 18, 2019 Category: Urology & Nephrology Source Type: research

Combination Pharmacotherapy for Treatment of Overactive Bladder (OAB)
AbstractOveractive bladder syndrome (OAB) negatively affects the quality of life of patients and their interactions with society. Treatment of OAB starts with behavioral modification and then pharmacotherapy using monotherapy with either antimuscarinics or β3 agonists. The third-line more invasive approaches are the next treatment option currently recommended. Both antimuscarinic agents and β3 agonists work through a different molecular pathway. This brings up the potential of having an additive effect when using a combination treatment for patients with OAB. Currently, the potential for using combination therapy...
Source: Current Urology Reports - May 16, 2019 Category: Urology & Nephrology Source Type: research

The Use of Tissue Flaps in the Management of Urinary Tract Fistulas
AbstractUrinary tract fistulas represent a complex group of pathologies that present significant management challenges. While most such fistulas ultimately require definitive surgical management, compromised local tissue quality or other factors often render straightforward simple one layered closure challenging with a substantial risk of failure. Interpositional tissue flaps have become a mainstay of treatment in these circumstances, enabling the delivery of healthy tissue from other locations to the site of pathology. Herein, we present an overview of the assessment and management of complex urinary tract fistulas involv...
Source: Current Urology Reports - April 30, 2019 Category: Urology & Nephrology Source Type: research

Genitourinary Complications of Gender-Affirming Surgery
AbstractPurpose of ReviewGender-affirming surgery has become a more common procedure in the last 5  years. Feminizing genitoplasty typically involves inversion of penile skin as a neovagina, urethral shortening, and glans reduction to create a neoclitoris. Masculinizing genitoplasty is more complex, typically is performed in multiple stages, and has more inherent urologic risks.Recent FindingsThe most common urologic complications involve voiding dysfunction, specifically meatal stenosis or fistula to the urinary tract. Urethral stricture, fistula, urinary retention, and voiding dysfunction are very common and require...
Source: Current Urology Reports - April 30, 2019 Category: Urology & Nephrology Source Type: research

Historical and Current Practices in the Management of Fossa Navicularis Strictures
AbstractPurpose of ReviewFossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient ’s goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades.Recent FindingsIn addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach.SummaryOpen repair of fossa navicularis strictur...
Source: Current Urology Reports - April 24, 2019 Category: Urology & Nephrology Source Type: research

Improving Operating Room Efficiency
AbstractPurpose of ReviewOperating rooms are critical financial centers for hospital systems, with surgical care representing about a third of all health care spending. However, not all of the costs are appropriate or necessary, as there are sometimes significant inefficiencies in how operating rooms are utilized.Recent FindingsRecent innovations utilizing patient-centered data, systems principles from manufacturing industries, and enhanced communication processes have made significant improvements in improving operating room efficiency.SummaryBy focusing on improving communication, standardizing processes, and embracing a...
Source: Current Urology Reports - April 15, 2019 Category: Urology & Nephrology Source Type: research

Comparing Outcomes of Medical Management and Minimally Invasive Surgical Techniques for Lower Urinary Tract Symptoms due to BPH
AbstractPurpose of ReviewCompare outcomes of medical therapy as compared to minimally invasive surgical therapy (MIST) for treatment of bladder outlet obstructionRecent FindingsTreatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) remains largely driven by patient symptomatology with medical therapy or watchful waiting as the first-line management strategies. However, most patients are not adherent to prescribed medical therapies and are hesitant to accept the risks associated with more invasive therapies. Minimally invasive surgical therapies are treatments providing short-term symptom ...
Source: Current Urology Reports - April 15, 2019 Category: Urology & Nephrology Source Type: research

Outcomes and Long-term Follow-up of Patients with Cystine Stones: a Systematic Review
AbstractPurpose of ReviewCystine stone patients can be difficult to manage with frequent recurrences. We performed a systematic review with a view to assessing interventions, compliance and their long-term outcomes.Recent FindingsTen retrospective observational studies (253 patients) assessed the outcomes and long-term follow-up of cystine stone patients. The mean length of follow-up was 9.6  years (range 3.5–21.8 years). The overall mean number of surgical procedures/patient was 5.7 (range 2–9.8/patient) with the overall mean number of surgical procedures/patient/year at 0.59 (range 0.22–1.32/p...
Source: Current Urology Reports - April 15, 2019 Category: Urology & Nephrology Source Type: research

The Role of Urodynamics in the Pre-transplant Evaluation of Renal Transplant
AbstractPurpose of ReviewThe goal of this study is to delineate the role of advanced urologic evaluation with urodynamics prior to renal transplantation. We seek to report on its indications, possible findings, and subsequent treatment pathways.Recent FindingsThis body of literature is largely comprised of retrospective, single-site studies. Patient selection for urodynamics can be determined based on patient history and voiding symptoms. Many of these renal transplant patients have urodynamic abnormalities such as decreased bladder capacity and compliance. Appropriate treatment of these abnormalities allows for average ra...
Source: Current Urology Reports - April 5, 2019 Category: Urology & Nephrology Source Type: research

Correction to: Enhanced Endoscopy in Bladder Cancer
Author Siamak Daneshmand would like to note that this article published in Current Urology Reports inadvertently did not disclose financial information that could possibly be a conflict of interest. (Source: Current Urology Reports)
Source: Current Urology Reports - April 5, 2019 Category: Urology & Nephrology Source Type: research

Correction to: Transurethral Resection of Bladder Tumors: Improving Quality Through New Techniques and Technologies
Author Siamak Daneshmand would like to note that this article published in Current Urology Reports inadvertently did not disclose financial information that could possibly be a conflict of interest. (Source: Current Urology Reports)
Source: Current Urology Reports - April 4, 2019 Category: Urology & Nephrology Source Type: research

Management of Occult Urinary Incontinence with Prolapse Surgery
AbstractPurpose of ReviewThe purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies.Recent FindingsProspective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avo...
Source: Current Urology Reports - March 30, 2019 Category: Urology & Nephrology Source Type: research

Patient-Reported Outcome Measures (PROMs) in Pelvic Floor Disorders
AbstractPurpose of ReviewPatient-reported outcome measures (PROMs) are tools that are widely used by clinicians and researchers across different medical specialties. In this review, we examine the use of PROMs in the evaluation of female pelvic floor disorders (PFD).Recent FindingsPROM development in the assessment of urinary incontinence is more advanced than other pelvic disorders. Work is ongoing in the scientific community to improve currently available measures and create new robust tools where needed.SummaryHundreds of PROMs are available for use in the evaluation of PFD, some more rigorously validated than others. T...
Source: Current Urology Reports - March 27, 2019 Category: Urology & Nephrology Source Type: research

Knowledge Gaps in Urologic Care of Female Spinal Cord Injury Patients
AbstractPurpose of ReviewWe highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients.Recent FindingsMales account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established...
Source: Current Urology Reports - March 23, 2019 Category: Urology & Nephrology Source Type: research

Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions
This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery.Recent FindingsTAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay.SummaryFew studies focus specifically on the outcome...
Source: Current Urology Reports - March 23, 2019 Category: Urology & Nephrology Source Type: research

Understanding the Link Between Gut Microbiome and Urinary Stone Disease
AbstractPurpose of ReviewWith recent advances in sequencing technologies and increasing research into the gut microbiome (GMB), studies have revealed associations between the GMB and urinary stone disease (USD). We sought to determine whether the evidence pointed towards a few specific gut bacteria or the broader GMB network is seemingly responsible for this relationship.Recent FindingsInitially,Oxalobacter formigenes (OF) was pursued as the main link between GMB and USD given its ability to degrade oxalate in the gut. However, the latest studies consistently suggest that the entire GMB is much more likely to be involved i...
Source: Current Urology Reports - March 22, 2019 Category: Urology & Nephrology Source Type: research

Inflatable Penile Prosthesis: Considerations in Revision Surgery
AbstractPurpose of ReviewTo provide an evidence based discussion of preoperative, intraoperative, and postoperative factors that lead to successful outcomes in penile prosthesis surgery.Recent FindingsIn the preoperative period, careful patient selection, appropriate counseling, thorough evaluation, and sufficient time for physical and emotional adaptation to an inflatable penile prosthesis are the key. During surgery, the entire device should be explanted whenever possible. A drain and retain strategy for the reservoir is a safe alternative in situation where the reservoir is not easily removable. The mechanical cleansing...
Source: Current Urology Reports - March 20, 2019 Category: Urology & Nephrology Source Type: research

Innovating Incrementally: Development of the Modern Inflatable Penile Prosthesis
We describe important modifications to the IPP and review available data assessing the impact of these changes. We also discuss possible changes to the IPP that would result in continued improvement.SummarySince its introduction in 1973, changes to the penile prosthesis have resulted in significant improvements in reliability, infection control, safety, and user experience. Design changes are anticipated to continue, resulting in a better and more versatile penile prosthesis. (Source: Current Urology Reports)
Source: Current Urology Reports - March 7, 2019 Category: Urology & Nephrology Source Type: research

Management of Climacturia During Inflatable Penile Prosthesis Surgery
AbstractRadical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and orgasmic dysfunctions. Climacturia is a type of orgasmic dysfunction that has been reported to occur in 20 –60% of men after radical prostatectomy. Several treatment strategies for climacturia have been evaluated and recommended including behavioral changes, use of special devices, medications, specialized therapies, and surgeries. Inflatable penile prosthesis implantation might be the treatment of cho ice when conservative management approac...
Source: Current Urology Reports - February 26, 2019 Category: Urology & Nephrology Source Type: research

Simultaneous Bilateral Endoscopic Surgery (SBES) for Bilateral Urolithiasis: the Future? Evidence from a Systematic Review
AbstractPurpose of ReviewUrolithiasis is a disease of prevalence across the world and up to a quarter of patients present with multiple stones. Most procedures carried out in this scenario are staged; however, there is a growing body of evidence to suggest bilateral simultaneous (BS) procedures are safe. We performed a systematic review to investigate and evaluate the evidence for these procedures.Recent FindingsA systematic review was conducted according to Cochrane and PRISMA checklist for all English-language articles from January 1996 to January 2018 using Medline, CINAHL, Scopus, EMBASE, Cochrane library, Clinicaltria...
Source: Current Urology Reports - February 21, 2019 Category: Urology & Nephrology Source Type: research

Optimizing Outcomes in the Virgin Penile Implant Patient
AbstractPurpose of ReviewPatient satisfaction with inflatable penile prosthesis (IPP) is an elective procedure that restores erectile function.Recent FindingsWhile the return of usable erections is almost always achieved with IPP, patients may still be unhappy with the procedure if the outcome has not met their expectations. Optimizing patient satisfaction and outcomes should incorporate considerations for pre-, intra-, and postoperative factors. Length optimization regimens and improved pain control options have dominated the recent literature. (Source: Current Urology Reports)
Source: Current Urology Reports - February 7, 2019 Category: Urology & Nephrology Source Type: research

‘Negative Ureteroscopy’ for Stone Disease: Evidence from a Systematic Review
AbstractPurpose of ReviewWhile ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a ‘negative’, ‘stoneless’ or ‘diagnostic’ URS. We perform a systematic review to look at the rate of ‘negative ureteroscopy’ and risk factors associated with it.Recent FindingsFrom a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%. Common predictors seem to be female gender, small stones, radiolucent stones and distal ureteric stones.Summa...
Source: Current Urology Reports - February 7, 2019 Category: Urology & Nephrology Source Type: research

Infection Prevention Considerations for Complex Penile Prosthesis Recipients
AbstractPurpose of ReviewThe purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients.Recent FindingsReduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients. Substance abuse is correlated with in...
Source: Current Urology Reports - February 1, 2019 Category: Urology & Nephrology Source Type: research

Damage Control Considerations During IPP Surgery
AbstractPurpose of ReviewThis review summarizes the latest reports in inflatable penile prosthesis (IPP) complication management.Recent FindingsIPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Guidance on complication management is largely limited to techniques recommended by experts within the field.SummaryAmerican Urological Association guidelines place IPP implantation as a first line erectile dysfunction treatment. However, the majority of cases are pe...
Source: Current Urology Reports - January 30, 2019 Category: Urology & Nephrology Source Type: research

A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation
AbstractPurpose of ReviewInflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection ra...
Source: Current Urology Reports - January 30, 2019 Category: Urology & Nephrology Source Type: research

A Contemporary Evaluation of Peyronie ’s Disease During Penile Prosthesis Placement: MOST, MUST, and More
AbstractPurpose of ReviewThe use of penile implant for the treatment of both erectile dysfunction and Peyronie ’s disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie’s treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that we re not treated with the traditional approaches.Recent FindingsAdvancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. The goal of these operations is...
Source: Current Urology Reports - January 30, 2019 Category: Urology & Nephrology Source Type: research

Penile Implant Considerations in the Bladder Cancer Survivor
AbstractPurpose of ReviewAfter radical cystoprostatectomy, patients often develop erectile dysfunction refractory to first- and second-line treatments. In this review, we summarize and analyze the literature describing the technical considerations and outcomes of penile implant surgery in bladder cancer patients with history of radical cystectomy and urinary diversion.Recent FindingsPenile prosthesis surgery in patients after radical cystectomy and urinary diversion has been infrequently described in the literature. Recent studies have shown that the three-piece inflatable penile prosthesis can be placed safely after signi...
Source: Current Urology Reports - January 28, 2019 Category: Urology & Nephrology Source Type: research

Reservoir Placement Considerations During Inflatable Penile Prosthesis Surgery
AbstractPurpose of ReviewTo discuss emerging alternative strategies for reservoir placement during inflatable penile prosthesis surgery.Recent FindingsInnovations in penile prosthesis design have facilitated the development of various alternative approaches for reservoir placement. Avoiding the space of Retzius is particularly appealing in patients with a history of pelvic surgery and/or radiation. The high submuscular technique utilizes a low-profile reservoir in combination with the implant ’s lockout valve to allow for safe placement in the potential space between the anterior abdominal wall musculature and the tr...
Source: Current Urology Reports - January 28, 2019 Category: Urology & Nephrology Source Type: research

Use of Mannitol for Ischemia Reperfusion Injury in Kidney Transplant and Partial Nephrectomies —Review of Literature
AbstractPurpose of ReviewFew procedures involve the ischemia-reperfusion injury to organs purposely. Two clear examples in urologic surgery consist on kidney transplantation and partial nephrectomies.Recent FindingsMannitol is an osmotic diuretic that is commonly used in partial nephrectomies and kidney transplantation to increase renal blood flow and decrease warm-ischemia-related renal injury to preserve estimated glomerular filtration rate (eGFR).SummaryWe review the current evidence for the use of mannitol and its effects on these procedures. (Source: Current Urology Reports)
Source: Current Urology Reports - January 26, 2019 Category: Urology & Nephrology Source Type: research

Imaging of Unusual Renal Tumors
AbstractPurpose of ReviewRenal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased.Recent FindingsAccording to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipo...
Source: Current Urology Reports - January 21, 2019 Category: Urology & Nephrology Source Type: research

Renal Medullary Carcinoma: a Report of the Current Literature
We present an updated report of renal medullary carcinoma (RMC), a rare and aggressive condition.Recent FindingsThere is a majority of male patients, of African descent, in the second or third decade of life. In differential diagnosis, other tumors, such as malignant rhabdoid tumor (MRT), vinculin-anaplastic lymphoma kinase (VCL-ALK) translocation renal cell carcinoma, and collecting duct carcinoma, may present difficulties. Abnormalities of tumor suppressor gene SMARCB1 have been found in RMC. Reported symptoms were hematuria, pain, weight loss, respiratory distress, palpable mass, cough, and fever. Most patients present ...
Source: Current Urology Reports - January 17, 2019 Category: Urology & Nephrology Source Type: research

Vascular Injury During Urologic Surgery: Somebody Call My Mother
AbstractPurpose of ReviewTo provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions.Recent FindingsThe frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce.SummaryAlthough rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame. Appropriate knowledge of the ...
Source: Current Urology Reports - January 16, 2019 Category: Urology & Nephrology Source Type: research

Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review
AbstractPurpose of ReviewAn endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject.Recent FindingsIn high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery.SummaryThere are few studies that specifically report the experience w...
Source: Current Urology Reports - January 16, 2019 Category: Urology & Nephrology Source Type: research

A Critical Insight into the Clinical Translation of PD-1/PD-L1 Blockade Therapy in Clear Cell Renal Cell Carcinoma
AbstractPurpose of ReviewTargeting PD-1/PD-L1 immune checkpoints is a new therapeutic tool in patients with locally advanced and metastatic clear cell renal cell carcinoma (CCRCC). The purpose of this review is to offer clinicians an updated translational insight into the current status of a therapeutic alternative that may impact significantly patient ’s life.Recent FindingsImmune checkpoint inhibition has recently demonstrated promising results in selected CCRCC patients with respect to tumor progression and survival. The decision to treat these patients with immune checkpoint inhibitors (ICI) relies on the immunoh...
Source: Current Urology Reports - January 15, 2019 Category: Urology & Nephrology Source Type: research

Use of Dynamic MRI of the Pelvic Floor in the Assessment of Anterior Compartment Disorders
AbstractPurpose of ReviewApproximately 25% of women in the USA suffer from pelvic floor disorders. Disorders of the anterior compartment of the pelvic floor, in particular, can cause symptoms such as incomplete urinary voiding, urinary incontinence, pelvic organ prolapse, dyspareunia, and pelvic pain, potentially negatively impacting a woman ’s quality of life. In some clinical situations, clinical exam alone may be insufficient, especially when patient’s symptoms are in excess of their pelvic exam findings. In many of these patients, dynamic magnetic resonance imaging (dMRI) of the pelvic floor can be a valuab...
Source: Current Urology Reports - November 13, 2018 Category: Urology & Nephrology Source Type: research

Bladder Cancer Survivorship
AbstractPurpose of ReviewBladder cancer (BC) is the second most common genitourinary malignancy, with a growing population of survivors globally. Over the past two decades, there has been a growing awareness of not only the oncologic, but also the quality of life ramifications of a BC diagnosis, treatment, and surveillance. In the current review, the literature surrounding the many domains that encompass bladder cancer survivorship is summarized and analyzed.Recent FindingsThere have been ongoing efforts to decrease perioperative morbidity, particularly in patients undergoing radical cystectomy, with mixed results. There i...
Source: Current Urology Reports - November 9, 2018 Category: Urology & Nephrology Source Type: research

Molecular Imaging for Evaluation of Viable Testicular Cancer Nodal Metastases
AbstractPurpose of ReviewDetermining the metastatic viability of suspicious retroperitoneal nodes in testicular cancer with conventional imaging is challenging. The aim of this report is to review recent evidence in the utilization of novel imaging modalities to assess viable testicular cancer nodal metastases.Recent EvidenceTesticular germ cell tumors (TCGTs) follow a predictable lymphatic metastatic spread to the retroperitoneum. Accordingly, retroperitoneal imaging is critical in staging, assessing treatment response, and evaluating for recurrence. Conventional computed tomography (CT) imaging is effective in diagnosing...
Source: Current Urology Reports - November 9, 2018 Category: Urology & Nephrology Source Type: research

Immunotherapy for Urothelial Carcinoma: Current Evidence and Future Directions
AbstractPurpose of ReviewUntil recently, effective treatment options for patients with advanced urothelial carcinoma were limited to platinum-based chemotherapy. In the post-platinum setting and for patients ineligible for cisplatin, minimally effective second-line chemotherapy was used and outcomes were poor. The approval of immune checkpoint inhibitors has significantly changed the treatment landscape of urothelial carcinoma. Here, we review current data demonstrating their efficacy in advanced disease and ongoing trials investigating novel combination strategies.Recent FindingsSince May 2016, five agents targeting the p...
Source: Current Urology Reports - November 7, 2018 Category: Urology & Nephrology Source Type: research