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Prophylaxis of Pulmonary Embolism in Kidney Transplant Recipients
AbstractPurpose of ReviewKidney transplant recipients have an increased risk of pulmonary embolism; however, thromboprophylaxis poses a challenge as the risk of thrombosis must be balanced against the risk of bleeding. This review summarizes the evidence on whether thromboprophylaxis is required in kidney transplantation.Recent FindingsIncidence of venous thromboembolism, comprising pulmonary embolism and deep venous thrombosis, is increased in kidney transplant recipients compared to the general population, with augmented risk of death and graft loss. Findings suggest a benefit of prophylaxis with heparin and mechanical p...
Source: Current Urology Reports - February 23, 2018 Category: Urology & Nephrology Source Type: research

Disparities in Female Pelvic Floor Disorders
AbstractPurpose of ReviewPelvic floor disorders include urinary incontinence, pelvic organ prolapse, fecal incontinence, and other sensory and emptying abnormalities of the lower urinary and gastrointestinal tracts which are widely prevalent among women and largely undertreated. Many disparities exist among women with pelvic floor disorders which may affect prevalence estimates and treatment options offered.Recent FindingsFindings suggest that there are many disparities among women with pelvic floor disorders including age, race, inadequate knowledge, access to care, and socioeconomic status.SummaryBetter understanding dis...
Source: Current Urology Reports - February 23, 2018 Category: Urology & Nephrology Source Type: research

Hysteropexy: an Option for the Repair of Pelvic Organ Prolapse
AbstractPurpose of ReviewWomen have an estimated 12.6% lifetime risk of undergoing surgery for pelvic organ prolapse in the USA (Wu et al. in Obstet Gynecol 123(6): 1201 –6,2014). Surgical repair of uterovaginal prolapse most commonly includes hysterectomy and vaginal vault suspension; however, the value of concomitant hysterectomy is uncertain, and there appears to be growing interest in uterine conservation. Multiple procedures have evolved using a variety of approaches. The aim of this paper is to review uterine sparing (hysteropexy) prolapse repair techniques and outcomes.Recent FindingsSeveral randomized control...
Source: Current Urology Reports - February 23, 2018 Category: Urology & Nephrology Source Type: research

Long-term Management of Ureterocele in Duplex Collecting Systems: Reconstruction Implications
AbstractPurpose of ReviewSignificant variance exists in the management of duplex collecting system ureteroceles (DSU). There is a great spectrum in classification, management, and surgical interventions. The practice of performing bladder level operations for vesicoureteral reflux (VUR) and trigonal anatomic distortion, either after ureterocele puncture or in a single setting, has come into question as to whether all DSU patients require it. In this review, we sought to discuss DSU management trends and the need for bladder reconstruction in these patients, as well as to describe our institution ’s practices.Recent F...
Source: Current Urology Reports - February 23, 2018 Category: Urology & Nephrology Source Type: research

Current Treatment of Pediatric Bladder and Prostate Rhabdomyosarcoma
This article aims to review the complex RMS classification system and treatment of BP RMS, with a focus on developing aspects of treat ment.Recent FindingsRecent advancements in technology are responsible for most of the progress in RMS treatment. PET-CT scanning has been shown to be superior to conventional metastatic workup. The use of proton beam therapy and brachytherapy to reduce the side effects of radiation is also showing promise.SummaryAll cooperative oncology groups agree on surgical biopsy for diagnosis and staging of BP RMS. Patients are then grouped and risk classified before receiving chemotherapy. Regardless...
Source: Current Urology Reports - February 22, 2018 Category: Urology & Nephrology Source Type: research

Current State of Fetal Intervention for Lower Urinary Tract Obstruction
AbstractPurpose of the ReviewIn this article, we explore the origins of intervention of fetal lower urinary tract obstruction, and we specifically discuss the background and recent outcomes of vesicoamniotic shunt placement and fetal cystoscopy. The article seeks to provide a comprehensive overview of the field while bringing the reader quickly up to speed on the pertinent literature and the critical data that are available to guide decision-making regarding intervention.Recent FindingsAppropriate patient selection for fetal intervention remains challenging despite advances in prenatal imaging. Both a randomized controlled...
Source: Current Urology Reports - February 22, 2018 Category: Urology & Nephrology Source Type: research

Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment
AbstractPurpose of ReviewObesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population.Recent FindingsWhile increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) s...
Source: Current Urology Reports - February 22, 2018 Category: Urology & Nephrology Source Type: research

The Role of the Genitourinary Microbiome in Pediatric Urology: a Review
AbstractPurpose of ReviewIn this review, we highlight the effects of the microbiome on urologic diseases that affect the pediatric patient.Recent FindingsPerturbations in the urinary microbiome have been shown to be associated with a number of urologic diseases affecting children, namely urinary tract infection, overactive bladder/urge urinary incontinence, and urolithiasis.SummaryRecently, improved cultivation and sequencing technologies have allowed for the discovery of a significant and diverse microbiome in the bladder, previously assumed to be sterile. Early studies aimed to identify the resident bacterial species and...
Source: Current Urology Reports - February 22, 2018 Category: Urology & Nephrology Source Type: research

Modern Theories of Pelvic Floor Support
AbstractPurpose of ReviewWeakened pelvic floor support is believed to be the main cause of various pelvic floor disorders. Modern theories of pelvic floor support stress on the structural and functional integrity of multiple structures and their interplay to maintain normal pelvic floor functions. Connective tissues provide passive pelvic floor support while pelvic floor muscles provide active support through voluntary contraction. Advanced modern medical technologies allow us to comprehensively and thoroughly evaluate the interaction of supporting structures and assess both active and passive support functions. The pathop...
Source: Current Urology Reports - February 12, 2018 Category: Urology & Nephrology Source Type: research

Pharmacotherapy for Nocturia
AbstractPurpose of ReviewTo assess current pharmacological principles used for treatment of nocturia/nocturnal polyuria.Recent FindingsThe pathophysiology of nocturia is often multifactorial, but two main mechanisms have been identified, occurring alone or in combination: low functional bladder capacity and nocturnal polyuria. The multifactorial pathophysiology not only implies several possible targets for therapeutic intervention but also means that it is unlikely that one treatment modality including drugs will be successful in all patients. Drugs approved for the treatment of male LUTS and male and female OAB are known ...
Source: Current Urology Reports - February 9, 2018 Category: Urology & Nephrology Source Type: research

Kidney Autotransplantation: Between the Past and the Future
AbstractPurpose of ReviewThe practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords “autologous transplantation” and “kidney.”Recent FindingsEarly...
Source: Current Urology Reports - February 5, 2018 Category: Urology & Nephrology Source Type: research

Evolution of the Application of Techniques Derived from Abdominal Transplant Surgery in Urologic Oncology
AbstractPurpose of ReviewThe techniques derived from abdominal transplant surgery have become a major actor in recent surgical evolution by providing a more optimal solution for urologic malignancies hosted in the upper abdomen. To describe in detail the objectives, rationale, relevant milestones, and surgical maneuvers of the so-called transplant techniques as applied to complex urologic oncology cases.Recent FindingsThe transplant-based surgical approach aims to decrease perioperative complications by improving tumor accessibility and field visibility through an enhanced exposure (via the use of a transverse incision, a ...
Source: Current Urology Reports - February 5, 2018 Category: Urology & Nephrology Source Type: research

Renal Embolization: Current Recommendations and Rationale for Clinical Practice
AbstractPurpose of ReviewRenal embolization (RE) is a minimally invasive endovascular procedure performed primarily by interventional radiology that can be used to treat a variety of urologic conditions including malignant renal tumors, angiomyolipomas, renal trauma, and complications following biopsy. The following review examines renal embolization indications, technique, and potential complications.Recent FindingsRenal embolization is a versatile therapeutic and adjunctive tool for many acute and chronic urologic conditions. RE has become a first-line therapy for renal trauma in lower grade injuries and increasing in pr...
Source: Current Urology Reports - February 5, 2018 Category: Urology & Nephrology Source Type: research

Clinical and Pathologic Features of Primary Angiosarcoma of the Kidney
AbstractPurpose of ReviewPrimary angiosarcoma of the kidney is extremely rare; hence, relatively little is known regarding its clinicopathologic features and prognosis. Herein, we review the literature on primary renal angiosarcoma with emphasis on the clinical and pathologic features.Recent FindingsApproximately 64 cases have been reported in the literature, and most cases occur in the 6th –7th decade with a strong male predominance. The aetiology is unknown. Patients present with flank pain, haematuria, abdominal mass and weight loss. A considerable number of patients develop metastatic disease at diagnosis or shor...
Source: Current Urology Reports - January 31, 2018 Category: Urology & Nephrology Source Type: research

Pushing the Envelope: Laparoscopic Nephrectomy as Outpatient Surgery
AbstractPurpose of ReviewThe purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors.Recent FindingsLaparoscopic nephrectomy for patients who have kidney cancer can be performed as an outpatient surgery in well-selected, well-educated, and well-informed patients in a well-prepared hospital culture.SummaryPatient confidence, pain, and hospital culture are the most important limiting factors to the performance of laparoscopic nephrectomy as an outpatient procedure. Controlling these factors leads t...
Source: Current Urology Reports - January 27, 2018 Category: Urology & Nephrology Source Type: research

Pathological Bases and Clinical Impact of Intratumor Heterogeneity in Clear Cell Renal Cell Carcinoma
AbstractPurpose of ReviewIntratumor heterogeneity is an inherent event in tumor development that is receiving much attention in the last years since it is responsible for most failures of current targeted therapies. The purpose of this review is to offer clinicians an updated insight of the multiple manifestations of a complex event that impacts significantly patient ’s life.Recent FindingsClear cell renal cell carcinoma is the most common renal tumor and a paradigmatic example of a heterogeneous neoplasm. Next-generation sequencing has demonstrated that intratumor heterogeneity encompasses genetic, epigenetic, and m...
Source: Current Urology Reports - January 27, 2018 Category: Urology & Nephrology Source Type: research

Perianesthetic Management of Laparoscopic Kidney Surgery
AbstractPurpose of ReviewLaparoscopic kidney surgery is commonly used for living donor, partial, and total tumor nephrectomy. The successful emergence of laparoscopic technique was justified by the many benefits offered such as reduced blood loss, tissue trauma, pain, and hospital stay. However, this comes at the expense of physiologic changes and complications secondary to pneumoperitoneum, surgical technique, and patient positioning with significant challenges in anesthetic management.Recent FindingsA variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having a...
Source: Current Urology Reports - January 18, 2018 Category: Urology & Nephrology Source Type: research

Recent Developments in the Search for Urinary Biomarkers in Bladder Cancer
AbstractPurpose of ReviewThis review aims to evaluate research surrounding the utility of urinary biomarkers to detect bladder cancer and predict recurrence.Recent FindingsRecent research has focussed on the evaluation of genetic markers found in urine to provide diagnostic and prognostic information. Furthermore, the isolation and characterisation of extracellular vesicles (EVs) from the urine patients with bladder cancer provide an exciting new development in biomarker research that is set to expand in the coming years.SummaryCurrent urinary biomarker research is a broad field that encompasses the evaluation of urinary p...
Source: Current Urology Reports - November 13, 2017 Category: Urology & Nephrology Source Type: research

Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy
AbstractPurpose of ReviewBladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck...
Source: Current Urology Reports - November 7, 2017 Category: Urology & Nephrology Source Type: research

A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma
AbstractGenitourinary tract injuries account for 3 to 10% of trauma patients, and scrotal trauma is particularly prevalent in males 10 to 30  years of age. Prompt diagnosis and timely surgical intervention are essential to prevent future complications of infertility, delayed orchiectomy, infection, and testicular atrophy. While clinical examination provides valuable information, it may be inconclusive due to soft tissue swelling and dif ficult to perform due to testicular pain with palpation. Conversely, testicular rupture does not always present with pain or tenderness. Imaging can contribute additional support for s...
Source: Current Urology Reports - October 28, 2017 Category: Urology & Nephrology Source Type: research

HistoScanning TM to Detect and Characterize Prostate Cancer —a Review of Existing Literature
AbstractPurpose of ReviewThe widely acknowledged limitations of the standard prostate cancer (PCa) diagnostic paradigm have provided an impetus to explore novel imaging modalities to diagnose, localize, and risk stratify PCa. As the body of literature focused on HistoScanning ™(HS) grows, there is need for a comprehensive review of the clinical efficacy of this technology.Recent FindingsEighteen original, English language articles were found to adequately study the use of HistoScanning ™ for prostate cancer diagnosis in the clinical setting. The articles were found by conducting a bibliographic search of PubMed...
Source: Current Urology Reports - October 24, 2017 Category: Urology & Nephrology Source Type: research

Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes
AbstractPurpose of ReviewHolmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes.Recent FindingsNew randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting.SummaryHoLE...
Source: Current Urology Reports - October 19, 2017 Category: Urology & Nephrology Source Type: research

Predictability and Practicality of Image-Based Scoring Systems for Patient Assessment and Outcome Stratification During Percutaneous Nephrolithotomy: a Contemporary Update
AbstractPreoperative nomograms offer systematic and quantitative methods to assess patient- and stone-related characteristics and their impact on successful treatment and potential risk of complication. Discrepancies in the correlation of perioperative variables to patient outcomes have led to the individual development, validation, and application of four independent scoring systems for the percutaneous nephrolithotomy: Guy ’s stone score, S.T.O.N.E. nephrolithometry, Clinical Research Office of the Endourology Society nomogram, and Seoul National University Renal Stone Complexity. The optimal nomogram should have h...
Source: Current Urology Reports - October 18, 2017 Category: Urology & Nephrology Source Type: research

Spatial Tracking of Targeted Prostate Biopsy Locations: Moving Towards Effective Focal Partial Prostate Gland Ablation with Improved Treatment Planning
AbstractThe ability to selectively characterize, localize, and predict the specific areas of the prostate gland which harbor the worst biologic behavior is requisite for optimal prostate cancer therapy, especially in the emerging field of partial prostate gland ablation (focal therapy). In this manuscript, we highlight contemporary techniques in target tracking for focal therapy planning. Multiparametric magnetic resonance imaging has emerged as a dominant strategy to localize biopsy sites most likely to contain high-grade lesions. In-bore MRI biopsy and MR/US fusion biopsy using cognitive or software-enhanced co-registrat...
Source: Current Urology Reports - October 18, 2017 Category: Urology & Nephrology Source Type: research

New Devices and Technologies for the Management of Overactive Bladder
AbstractPurpose of ReviewOveractive bladder (OAB) affects millions of people in the USA and has a significant impact on their quality of life. Despite having a number of safe and effective ways of managing refractory OAB patients, there are many promising new technologies actively being studied and developed for the treatment of this population. This review examines current new devices and technologies under study for the treatment of OAB.Recent FindingsModifications to already established therapies such as sacral nerve stimulation (SNS) or tibial nerve stimulation (TNS) are currently being studied for refractory OAB. On t...
Source: Current Urology Reports - October 18, 2017 Category: Urology & Nephrology Source Type: research

Aquablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Early Results
AbstractAquablation is a novel technique for the surgical management of bladder outlet obstruction secondary to benign prostatic hyperplasia. Following first-in-man studies, a multicenter trial was conducted with results now out to 1  year. Aquablation resulted in a mean International Prostate Symptom Score improvement of 16 points (p 
Source: Current Urology Reports - October 18, 2017 Category: Urology & Nephrology Source Type: research

Ureteroscopy for Stone Disease in Paediatric Population is Safe and Effective in Medium-Volume and High-Volume Centres: Evidence from a Systematic Review
AbstractPurpose of ReviewThe incidence of urinary stone disease among the paediatric population is increasing. Whilst there has been a rise in the number of original studies published on ureteroscopy (URS) in children, critical review still remains under-reported.Recent FindingsA Cochrane style systematic review was performed to identify all original articles on URS (minimum of 25 cases) for stone disease in paediatric patients between Jan. 1996 and Dec. 2016. Based on the number of reported cases, centres were divided into medium (25 –49 cases) and high (≥ 50 cases) volume studies.Thirty-four studies (2758 c...
Source: Current Urology Reports - October 18, 2017 Category: Urology & Nephrology Source Type: research

Surgical Techniques for Managing Post-prostatectomy Erectile Dysfunction
AbstractPurpose of ReviewDue to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative erectile dysfunction (ED). The aim of this study is to summarize the current literature on surgical techniques for managing post-prostatectomy erectile dysfunction.Recent FindingsThe PubMed database was searched for English-language articles published up to Jan 2017 using the following search terms: “prostatectomy AND erectile dysfunction”, “prostatectomy AND penile prostheses”, and “prostatectomy AND penile...
Source: Current Urology Reports - September 30, 2017 Category: Urology & Nephrology Source Type: research

Learning Curves for Robotic Surgery: a Review of the Recent Literature
AbstractUse of robot-assisted surgery is increasing since its advent in the 1990s. Robotic surgical training is the subject of much interest. Robotic technology would seem to facilitate training allowing more rapid attainment of competence. The safety and success of a particular surgical team depends on adequacy of training of its members. A learning curve is a way of describing the changes observed in surgical outcomes with increasing experience of the surgeon and can be used to plan training programs. The majority of published papers regarding learning curves are retrospective with small numbers of surgeons with differen...
Source: Current Urology Reports - September 23, 2017 Category: Urology & Nephrology Source Type: research

The State of Men ’s Health Services in the Veterans Health Administration
AbstractPurpose of ReviewFor many diseases that place a large burden on our health care system, men often have worse health outcomes than women. As the largest single provider of health care to men in the USA, the Veterans Health Administration (VA) has the potential to serve as leader in the delivery of improved men ’s health care to address these disparities.Recent FindingsThe VA system has made recent strides in improving benefits for aspects of men ’s health that are traditionally poorly covered, such as treatment for male factor infertility. Despite this, review of Quality Enhancement Research Initiatives ...
Source: Current Urology Reports - September 18, 2017 Category: Urology & Nephrology Source Type: research

Lifetime Radiation Exposure in Patients with Recurrent Nephrolithiasis
AbstractPatients presenting with nephrolithiasis often undergo repeated imaging studies before, during, and after management. Considering the significant risk of stone recurrence in primary stone-formers, repeated imaging studies are not uncommon. Cumulative effects of ionizing radiation exposure from various imaging studies could potentially increase the risk for developing cataracts and solid malignancies in urolithiasis patients. Therefore, practitioners planning or performing imaging studies with ionizing radiation are compelled to keep radiation exposure to humans and the environment as low as possible, thus strictly ...
Source: Current Urology Reports - September 12, 2017 Category: Urology & Nephrology Source Type: research

Characterizing Indeterminate Renal Masses with Molecular Imaging: the Role of 99m Tc-MIBI SPECT/CT
AbstractPurpose of ReviewThe majority of enhancing renal masses cannot be characterized through imaging as malignant or benign; however, such characterization could save patients from unnecessary surgery and/or biopsy and associated morbidity. Herein, we review the recent literature on the emerging use of99mTc-MIBI SPECT/CT in preoperative differentiation of enhancing renal masses.Recent FindingsRecent reports have shown that99mTc-MIBI SPECT/CT imaging can differentiate mitochondrial-rich, benign, or indolent renal masses from renal cell carcinoma. These studies demonstrate good correlation between a positive99mTc-MIBI SPE...
Source: Current Urology Reports - September 12, 2017 Category: Urology & Nephrology Source Type: research

Incidence and Management of De Novo Lower Urinary Tract Symptoms After Pelvic Organ Prolapse Repair
AbstractPurpose of reviewPelvic organ prolapse (POP) is a significant problem with many options for surgical correction. Following prolapse surgery, de novo lower urinary tract symptoms (LUTS) are not uncommon. We review the current literature on de novo lower urinary tract symptoms following POP repair and discuss the role of urodynamics in the evaluation of the prolapse patient.Recent findingsPatients with occult stress urinary incontinence (SUI) appear to be at higher risk of developing de novo SUI after POP repair. Prolapse reduction in patients undergoing urodynamic evaluation is important. Different types of POP repa...
Source: Current Urology Reports - September 12, 2017 Category: Urology & Nephrology Source Type: research

Performance of 68 Ga-PSMA PET/CT for Prostate Cancer Management at Initial Staging and Time of Biochemical Recurrence
AbstractPurpose of the ReviewRecently introduced Gallium-68 labeled PSMA-ligands such as HBED-CC (68Ga-PSMA) have shown promise for unmet diagnostic needs in prostate cancer.Recent Findings68Ga-PSMA has demonstrated improved detection rates and specificity for prostate cancer compared to standard imaging approaches. In the setting of primary disease,68Ga-PSMA appears to preferentially identify treatment-relevant intermediate and high-risk prostate cancer. There is also a growing evidence that68Ga-PSMA positron emission tomography (PET) outperforms alternative conventional imaging methods including choline-based radiotracer...
Source: Current Urology Reports - September 9, 2017 Category: Urology & Nephrology Source Type: research

Chronic Testicular and Groin Pain: Pathway to Relief
AbstractThe management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men ’s health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepr essants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this artic...
Source: Current Urology Reports - September 2, 2017 Category: Urology & Nephrology Source Type: research

Prostatic Urethral Lift Versus Transurethral Resection of the Prostate (TURP)
AbstractLower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) represent one of the most common bothersome conditions impairing quality of life in men. Its management comprises conservative treatment, pharmacotherapy, and various surgical techniques. Medication and surgical procedures provide meaningful relief of LUTS, but their therapeutic efficacy has to be counterbalanced against the associated adverse events and morbidity. With the advent of novel minimally invasive treatment options, the surgical standards are challenged for at least equally effective approaches with a much more favorable safety...
Source: Current Urology Reports - August 29, 2017 Category: Urology & Nephrology Source Type: research

African-American Prostate Cancer Disparities
AbstractPurpose of ReviewThe purpose of this review is to examine prostate cancer racial disparities specific to the African-American population.Recent FindingsAfrican-American men are more likely to be diagnosed with prostate cancer, present at an earlier age; are more likely to have locally advanced or metastatic disease at diagnosis; and have suboptimal outcomes to standard treatments.SummaryProstate cancer treatment requires a nuanced approach, particularly when applying screening, counseling, and management of African-American men. Oncological as well as functional outcomes may differ and are potentially due to a comb...
Source: Current Urology Reports - August 14, 2017 Category: Urology & Nephrology Source Type: research

Active Surveillance for Intermediate Risk Prostate Cancer
AbstractPurpose of ReviewActive surveillance is now widely utilized for the management of low-risk prostate cancer (PCa). The limits of surveillance for men with intermediate risk cancer are controversial. While there is a broad consensus that men with low-risk disease can be safely managed with AS, many potential candidates, including those with Gleason 3  + 4 disease, PSA>10, younger men and African-Americans are often excluded.Recent FindingsOutcome data for intermediate-risk patients managed by active surveillance demonstrate reasonable outcomes, but these men clearly are at higher risk for progression to ...
Source: Current Urology Reports - August 11, 2017 Category: Urology & Nephrology Source Type: research

Bladder Neck Contracture After Endoscopic Surgery for Benign Prostatic Obstruction: Incidence, Treatment, and Outcomes
AbstractPurpose of ReviewIn recent years, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate. Nonetheless, complications are still frequently encountered and bladder neck contracture (BNC) is a well-described complication after endoscopic surgery for benign prostatic obstruction (BPO). Our aim is to review and discuss the contemporary incidence, the relevant treatment strategies, and their outcomes.Recent FindingsFindings suggest that BNC is a common complication with an acceptably low incidence but can range in complexity. Most contractures were usually managed...
Source: Current Urology Reports - August 9, 2017 Category: Urology & Nephrology Source Type: research

Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation
AbstractPurpose of ReviewThis is to evaluate and discuss the literature surrounding holmium laser enucleation of the prostate (HoLEP) in patients on anticoagulation.Recent FindingsThe relationship of benign prostatic hyperplasia (BPH) to bothersome lower urinary tract symptoms (LUTS) is well established with a majority of men over the age of 60 having significant symptoms. Patients with severe enough symptoms often require surgery and with cardiovascular disease ranking as the primary cause of death in the USA, a growing number will be taking antiplatelet (AP) or anticoagulation (AC) for primary or secondary prevention of ...
Source: Current Urology Reports - August 5, 2017 Category: Urology & Nephrology Source Type: research

Convective Radiofrequency Water Vapor Thermal Therapy with Rez ūm System
AbstractPurposeLower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue.Recent FindingsThe current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety prof...
Source: Current Urology Reports - August 5, 2017 Category: Urology & Nephrology Source Type: research

Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer
This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer.Recent FindingsRates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long stri...
Source: Current Urology Reports - August 3, 2017 Category: Urology & Nephrology Source Type: research

Is There a Role for Preoperative 5 Alpha Reductase Inhibitors in Reducing Prostate Vascularity and Blood Loss?
This report will review the current literature on this topic and make attempts to determine if the use of a 5ARI before BPH-related surgery should be encouraged. (Source: Current Urology Reports)
Source: Current Urology Reports - August 1, 2017 Category: Urology & Nephrology Source Type: research

Non-neurogenic Chronic Urinary Retention: What Are We Treating?
AbstractPurpose of ReviewThis review examines current terminology used to define non-neurogenic chronic urinary retention (CUR), describes the pathophysiology of urinary retention, and highlights contemporary diagnostic and treatment algorithms.Recent FindingsThere is no standardized definition for the condition, but volumes>300  ml are commonly used to describe CUR. It is a clinical diagnosis which does not require urodynamics. Pathophysiologic causes of CUR be from myogenic, neurogenic, bladder outlet obstruction, or a combination of these sources. Treatment algorithms recommend stratifying patients with chronic ...
Source: Current Urology Reports - July 20, 2017 Category: Urology & Nephrology Source Type: research

Robotic Sacrocolpopexy —Is It the Treatment of Choice for Advanced Apical Pelvic Organ Prolapse?
AbstractPurpose of ReviewPelvic organ prolapse (POP) is a highly prevalent condition among women that, although non-life threatening, can significantly impact daily activities and quality of life (QOL). Sacrocolpopexy (SC) has been touted by many as the “gold standard,” citing superior anatomic success rates compared to transvaginal approaches for apical prolapse repair. In line with current trends throughout the surgical field, robotic-assisted laparoscopic sacrocolpopexy (RSC) has rapidly gained popularity. This review will present the most c ontemporary evidence examining RSC and discuss whether it has met c...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

Advances in Imaging in Prostate and Bladder Cancer
AbstractRecent advancements in urologic imaging techniques aim to improve the initial detection of urologic malignancies and subsequent recurrence and to more accurately stage disease. This allows the urologist to make better informed treatment decisions. In particular, exciting advances in the imaging of prostate cancer and bladder cancer have recently emerged including the use of dynamic, functional imaging with MRI and PET. In this review, we will explore these imaging modalities, in addition to new sonography techniques and CT, and how they hope to improve the diagnosis and management of prostate and bladder cancer. (S...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer
AbstractPurpose of ReviewA variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP.Recent FindingsA literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. The available data from studies ranging from randomized control trials to retrospective cohort studies suggest that mi...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

Can Long-term LUTS/BPH Pharmacological Treatment Alter the Outcomes of Surgical Intervention?
AbstractPurpose of ReviewWe have reviewed the available evidence on the impact of long-term pharmacological treatment of lower urinary tract symptoms on the outcomes of benign prostatic hyperplasia surgery.Evidence AcquisitionA systematic literature search from January 1990 to May 2017 was performed. Only references in the English language and peer-reviewed manuscripts were considered.Recent FindingsOver time, the ever-increasing use of long-term pharmaceutical treatments has considerably reduced the rate of BPH surgery in most countries. In addition, patients undergoing surgery are now generally older, more fragile and wi...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

Validity of Claims Data for the Identification of Male Infertility
AbstractPurpose of ReviewWe sought to determine whether infertile men can accurately be identified within a large insurance claims database to validate its use for reproductive health research.Recent FindingsPrior literature suggests that men coded for infertility are at higher risk for chronic disease though it was previously unclear if these diagnostic codes correlated with true infertility. We found that the specificity of one International Classification of Disease (9th edition) code in predicting abnormal semen parameters was 92.4%, rising to 99.8% if a patient had three different codes for infertility. The positive p...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

Incidence and Management of Lower Urinary Tract Symptoms After Urethral Stricture Repair
AbstractLower urinary tract symptoms (LUTS) after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on differentiating bladder dysfunction (overactive bladder, underactive bladder), from other outlet obstruction (such as benign prostatic obstruction), dysfun...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research