A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
AbstractPurpose of ReviewReview how the various surgical treatments for benign prostatic hyperplasia and lower urinary tract symptoms impact on male sexual health and function.Recent FindingsThe interplay between benign prostatic hyperplasia and erectile function is complex, and the conditions seem linked. Most cavitating procedures to improve male voiding will degrade ejaculatory and possibly erectile function. Many of the newer minimally invasive therapies appear to preserve sexual function in the short term while sacrificing some of the voiding improvements realized with more complete removal of the prostate adenoma.Sum...
Source: Current Urology Reports - June 19, 2018 Category: Urology & Nephrology Source Type: research

The Impact of 5 α-Reductase Inhibitor Use for Male Pattern Hair Loss on Men’s Health
AbstractPurpose of ReviewMale pattern hair loss, mediated by dihydrotestosterone, is a common hair loss disorder, affecting over 50% of men over the age of 50. The 5- α reductase inhibitors, finasteride and dutasteride, are Food and Drug Administration-approved drugs for the treatment of this disorder. Several recent studies have reported adverse sexual and spermatogenic events among young men using 5-α reductase inhibitors, such as erectile dysfunction, decrea sed ejaculate volume, decreased libido, and infertility. In this review, we summarize and analyze the literature regarding the efficacy and safety of th...
Source: Current Urology Reports - June 16, 2018 Category: Urology & Nephrology Source Type: research

Ureteral Stent Discomfort and Its Management
AbstractPurpose of ReviewUreteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them.Recent FindingsThough it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder ...
Source: Current Urology Reports - June 11, 2018 Category: Urology & Nephrology Source Type: research

Novel Therapy for Male Hypogonadism
AbstractPurpose of ReviewHypogonadism and the treatment of low testosterone is increasingly a subject of medical inquiry and controversy. The few treatments that are FDA-approved such as testosterone topicals, injections, and pellets create significant demand from patients for treatments with more convenient means of administration, fewer adverse effects, and the ability to maintain male fertility. Off-label drugs are in abundant use for low testosterone, including selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors.Recent FindingsIn this review, we summarize the evidence in support of commonly ...
Source: Current Urology Reports - June 9, 2018 Category: Urology & Nephrology Source Type: research

Gender-Affirming Surgery: Current Concepts
AbstractGender-affirming surgeries (GASs), previously known as gender reassignment surgeries, are surgical procedures born from plastic and reconstructive surgery, colorectal surgery, urology, and gynecology. A multidisciplinary approach is essential for the care of transgender patients. The urologist plays a vital role, both in the perioperative period and as part of continued care. This publication will review the current concepts of genital GAS as it pertains to the practicing urologist. The most utilized surgical techniques will be described along with their notable complications and management options. (Source: Current Urology Reports)
Source: Current Urology Reports - June 7, 2018 Category: Urology & Nephrology Source Type: research

Erectile Dysfunction and Lower Urinary Tract Symptoms
AbstractPurpose of ReviewIn the past years, the relationship between lower urinary tract symptoms and erectile dysfunction has been widely explored. The aim of our systematic review is to summarize the published evidence over the past year on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).Recent FindingsRecent data support the relationship between LUTS and ED in Eastern Europe and in Asia. The role of phosphodiesterase inhibitors alone or in combination with alpha blockers to treat LUTS and ED, especially in younger patients, is strongly supported by high level of evidence.SummaryLUTS and ED are prevalen...
Source: Current Urology Reports - June 1, 2018 Category: Urology & Nephrology Source Type: research

Iron and a Man ’s Reproductive Health: the Good, the Bad, and the Ugly
AbstractPurpose of ReviewTo discuss the physiologic and pathologic effects of iron on men ’s reproductive health.Recent FindingsIron overload diseases are associated with hypogonadotropic hypogonadism, infertility, and sexual dysfunction in men. Recent findings have elucidated the roles by which iron may affect the male reproductive axis.SummaryIron is requisite for life. Iron can also catalyze the production of reactive oxygen species. To maintain balance, the human body tightly regulates dietary iron absorption. Severe iron overload disorders —e.g., hereditary hemochromatosis and β-thalassemia—occu...
Source: Current Urology Reports - June 1, 2018 Category: Urology & Nephrology Source Type: research

Chronic Scrotal Pain
This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain. (Source: Current Urology Reports)
Source: Current Urology Reports - May 31, 2018 Category: Urology & Nephrology Source Type: research

Use of Ultrasound in Male Infertility: Appropriate Selection of Men for Scrotal Ultrasound
AbstractPurpose of ReviewMale factor infertility is a complex and multifaceted problem facing the modern urologist and is identified in 30 –40% of infertile couples. This review focuses on the use of ultrasound, as an adjunct screening tool, in the initial evaluation of male infertility.Recent FindingsAccess to male reproductive urologist for assessment of male infertility is limited and about a quarter of infertile couples do not complete the male component in their infertility assessment. Ultrasound evaluation of the infertile male is low-cost and non-invasive and helps uncover underlying pathologies that may be mi...
Source: Current Urology Reports - May 28, 2018 Category: Urology & Nephrology Source Type: research

The Effect of Shift Work on Urogenital Disease: a Systematic Review
AbstractPurpose of ReviewNon-standard shift work schedules negatively impact the overall health of shift workers, and several studies have shown that shift work, specifically, is detrimental to urogenital health. The aims of this study are to systematically review the literature and determine the effect of shift work on the outcomes of hypogonadism, male infertility, lower urinary tract symptoms, and urogenital cancers.Recent FindingsRecent evidence supports associations between non-standard shift work and an increase in the frequency of prostate cancer and the severity of erectile dysfunction, lower urinary tract symptoms...
Source: Current Urology Reports - May 28, 2018 Category: Urology & Nephrology Source Type: research

Male Fertility Preservation
AbstractPurpose of ReviewWith improvements in cancer treatment outcomes and an increase in cancer survivorship, understanding the importance of fertility preservation options prior to undergoing cancer treatment is essential. Therefore, we review herein the effect of cancer and its treatment on male fertility, the rationale for sperm cryopreservation, options for sperm retrieval, ART outcomes, and experimental options.Recent FindingsRecent data update fertility outcomes with newer cancer therapies and provide longitudinal insight into survivor paternity with and without fertility preservation. Likewise, updated ART outcome...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Contemporary Review of Peyronie ’s Disease Treatment
AbstractPurposeTo analyze the literature on the current treatment options for Peyronie ’s disease (PD).Recent FindingsIntracavernosal injection therapy using collagenase clostridium histolyticum (CCH) has been widely adopted since its FDA approval in 2013. Based on the current evidence, it appears to be moderately efficacious for men with mild curvatures. Although a recent study has shown similar outcomes using a modified protocol requiring fewer injections, CCH remains an expensive medication. Surgery provides the most definitive treatment. The most common adverse effect following surgery is perceived loss of length...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

The Effect of Subclinical Varicocele on Pregnancy Rates and Semen Parameters: a Systematic Review and Meta-Analysis
AbstractPurpose of ReviewCurrent guidelines recommend against surgical repair of subclinical varicoceles (SCVs) for infertility; several studies demonstrate mixed fertility results after SCV correction. To determine whether surgical correction of SCV improves semen parameters and/or reproductive outcomes, we performed a systematic review and meta-analysis. Seven biomedical literature databases were searched through January 2018 for studies that assessed reproductive outcomes and/or change in semen parameters in men with corrected SCV compared to either (1) uncorrected SCV or (2) corrected clinical varicocele. Estimates wer...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

The Role of Lifestyle in Male Infertility: Diet, Physical Activity, and Body Habitus
AbstractPurpose of ReviewIncreasing attention to primary and secondary prevention of male infertility through modifiable lifestyle factors has gained traction amongst both patients and infertility specialists. In this review, the available evidence of modifiable lifestyle choices, specifically diet, physical activity, and body habitus, are evaluated.Recent FindingsStudies examining diet, exercise/physical activity, and body habitus are characterized by conflicting conclusions, difficult confounders, and imperfect end points to judge male reproductive potential. However, convincing trends have emerged implicating consumptio...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Advances in Lasers for the Treatment of Stones —a Systematic Review
AbstractPurpose of ReviewLaser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year.Recent FindingsVariable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and “cleaving only” fiber tip preparation can be beneficial for the lithotripsy procedure...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Infertility in the Aging Male
AbstractPurpose of ReviewIn many countries, the average age of paternity is rising. The negative effect of older age on fertility in women is well documented; however, less is known about the impact of paternal age on fecundity. In this review, we summarize the current knowledge of how paternal age affects semen parameters, reproductive success, and offspring health.Recent FindingsContemporary evidence confirms that aged men have worse semen parameters, including overall negative changes in sperm genetics. Reproductive outcomes with unassisted pregnancy tend to be worse with older fathers. While most current studies of ass...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Patient-Reported Outcome Measures in Urethral Reconstruction
This article reviews the tools used to assess success after urethroplasty and elaborates the need to develop a comprehensive USD-specific PROM. (Source: Current Urology Reports)
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Environmental Toxins and Male Fertility
AbstractPurpose of ReviewGlobal industrialization has increased population exposure to environmental toxins. A global decline in sperm quality over the last few decades raises questions about the adverse impact of environmental toxins on male reproductive health.Recent FindingsMultiple animal- and human-based studies on exposure to environmental toxins suggest a negative impact on semen quality, in terms of sperm concentration, motility, and/or morphology. These toxins may exert estrogenic and/or anti-androgenic effects, which in turn alter the hypothalamic-pituitary-gonadal axis (HPGA), induce sperm DNA damage, or cause s...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Diagnosis and Management of Gynecomastia for Urologists
AbstractPurpose of ReviewOur aim is to review the steps of diagnosis and management of gynecomastia with a special focus on treatment of gynecomastia associated with androgen deprivation therapy for prostate cancer.Recent FindingsRecent studies investigating tamoxifen and radiation therapy for both therapy and prophylaxis of bicalutamide-induced gynecomastia are reviewed.SummaryGynecomastia is a common clinical problem, affecting between one and two thirds of middle-aged men. Diagnosis is typically made by history and physical exam. Common causes include chronic medical conditions and medications; however, unexplained gyne...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Management of Erectile Dysfunction and Infertility in the Male Spinal Cord Injury Patient
AbstractPurpose of ReviewMen with spinal cord injury (SCI) commonly suffer from erectile dysfunction and ejaculatory dysfunction. The literature regarding the causes and treatment of these two important problems was reviewed.Recent FindingsMany of the erectile dysfunction treatments applied to able bodied individuals are also useful in the SCI population, although there are differences in the goals and results of treatment. Ejaculatory dysfunction can be treated with either penile vibratory stimulation or electroejaculation with high success rates. Pregnancies are possible, but poor quality sperm quality in male SCI patien...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Predicting and Modifying Risk for Development of Renal Failure in Boys with Posterior Urethral Valves
AbstractPurpose of ReviewThe purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk.Recent FindingsRenal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss. Refinement of urine studies may improve our ability to stratify patients into renal loss categories. Use of videourodynamics (VUDS) allows refined assessment...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Surgical Education, Simulation, and Simulators —Updating the Concept of Validity
We describe a contemporary approach to gathering construct validity evidence for the assessment of urologic trainees, for use in both clinical and simulation environments.Recent FindingsFive sources of evidence make up Messick ’s contemporary framework of validity: test content, response process, internal structure, relationship to other variables, and consequences. These are all components of construct validation and concern the accuracy, quality, reproducibility, generalizability, and wider impact of the scores genera ted by an assessment, respectively.SummaryWhen deciding the competency of a trainee, program direc...
Source: Current Urology Reports - May 17, 2018 Category: Urology & Nephrology Source Type: research

Follow-up of Temporary Implantable Nitinol Device (TIND) Implantation for the Treatment of BPH: a Systematic Review
AbstractPurpose of ReviewThe purpose of the present systematic review is to offer a narrative synthesis of the available literature regarding the role of the temporary implantable nitinol device (TIND) (Medi-Tate ®; Medi-Tate Ltd., Or Akiva, Israel) for the treatment of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), specifically focusing on the follow-up data.Recent FindingsCurrent available evidences are limited in this topic. Sample size of patients available for analysis is small. Moreover, the duration of follow-up period is intermediate and longer follow-up is required. At the avai...
Source: Current Urology Reports - April 26, 2018 Category: Urology & Nephrology Source Type: research

Surgical Management of Fossa Navicularis and Distal Urethral Strictures
AbstractPurpose of ReviewUrethral reconstruction has evolved in the last several decades with the introduction of various techniques including fasciocutaneous skin flaps and buccal mucosal grafts. However, distal urethral strictures have continued to be a reconstructive challenge due to tendency for adverse cosmetic outcomes, risks of glans dehiscence or fistula formation, and stricture recurrence.Recent FindingsThe surgical options for treatment of distal urethral strictures have changed throughout the years; however, there is no one universally accepted technique for their treatment. The current trend for treatment is sh...
Source: Current Urology Reports - April 17, 2018 Category: Urology & Nephrology Source Type: research

Single-Site Laparoscopy and Robotic Surgery in Pediatric Urology
AbstractPurpose of ReviewIn this review, we summarize research that has evaluated the role of laparoendoscopic single-site (LESS) and robotic surgery in pediatric urology, highlighting new and/or controversial ideas.Recent FindingsThe newest research developments over the last several years are studies that address generalizability of these techniques, ideal patient factors, extrapolation to more complex surgeries, and comparative studies to more traditional techniques to define the associated costs and benefits, as well as patient-centered outcomes. Specifically in the field of LESS, addressing the limitations of suboptim...
Source: Current Urology Reports - April 17, 2018 Category: Urology & Nephrology Source Type: research

Updates in the Metabolic Management of Calcium Stones
AbstractPurpose of ReviewUrinary risk factors, such as hypercalciuria, hypocitraturia, and hyperoxaluria, either in combination or alone, are associated with calcium stones. Dietary habits as well as underlying medical conditions can influence urinary risk factors. Evaluation of the conglomerate of patients ’ stone risks provides evidence for individualized medical management, an effective and patient-supported approach to prevention.Recent FindingsMany patients with stones desire prevention to avoid repeated surgical interventions. Yet, recent practice pattern assessments and health care utilization data show that m...
Source: Current Urology Reports - April 16, 2018 Category: Urology & Nephrology Source Type: research

Alternative Reservoir and Balloon Placement in Complex Patients Undergoing Urologic Prostheses
AbstractPurpose of ReviewTo evaluate contemporary rationale and techniques for ectopic reservoir/balloon placement in complex urologic prosthetics patients.Recent FindingsRecent studies have demonstrated that ectopic reservoir placement is safe and durable when compared to traditional space of Retzius placement. Complex patients exist on a spectrum from those with a previously violated retropubic space, to those with bilaterally obscured external inguinal rings and/or multiple prior prosthetic reservoirs. Ectopic placement has become more commonplace and accepted as a viable alternative strategy over the past 7  years...
Source: Current Urology Reports - April 13, 2018 Category: Urology & Nephrology Source Type: research

Minimally Invasive Techniques for Bladder Reconstruction
We describe the innovative minimally invasive surgical techniques in four major categories of reconstructive procedures for nLUTD: (A) ileal bladder augmentation, the use of a low morbidity open Pfannenstiel incision and the use of laparoscopy and robotics; (B) creation of a catheterizable channel, the use of laparoscopy and robotics for Mitrofanoff procedures; (C) creation of both a bladder augmentation and catheterizable channel, the use of a hand-assisted approach for the creation of a continent cutaneous ileocystoplasty; and (D) bladder neck artificial urinary sphincter implantation: the use of a robotics.SummaryPatien...
Source: Current Urology Reports - April 13, 2018 Category: Urology & Nephrology Source Type: research

Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis
AbstractPurpose of reviewTo critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury.Recent findingsThough 5 of the included 13 studies were published in the last 2 –3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC).SummaryOf the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In ...
Source: Current Urology Reports - April 13, 2018 Category: Urology & Nephrology Source Type: research

Reconstruction of Membranous Urethral Strictures
AbstractPurpose of ReviewDue to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with tr...
Source: Current Urology Reports - April 11, 2018 Category: Urology & Nephrology Source Type: research

Reconstructive Management Pearls for the Transgender Patient
We describe common surgical pitfalls in GRS and approaches for minimizing complications.Recent FindingsPenile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized. Since adoption of microvascular techniques in phalloplasty, transmasculine individuals have potential for a sensate neophallus and penetrative intercourse. Urethral complications are co...
Source: Current Urology Reports - April 11, 2018 Category: Urology & Nephrology Source Type: research

Advances in Ureteral Stent Design and Materials
This article highlights some fundamental developments that took place in these three areas of stent ’s technology, in order to contribute to the identification of an ideal stent.Recent FindingsIn addition to technological developments concerning stent ’s material, design and surface coating, the flow dynamic performance of stents has recently attracted increasing attention. Notably, it has been postulated that the local flow field in a stent is correlated with the deposition of crystals and microorganisms. These findings could potentially revol utionise future stent’s designs, and complement developments ...
Source: Current Urology Reports - April 10, 2018 Category: Urology & Nephrology Source Type: research

The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction
AbstractPurpose of ReviewThe symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children.Recent FindingsNon-invasive tests ...
Source: Current Urology Reports - April 6, 2018 Category: Urology & Nephrology Source Type: research

Benefits of Retroperitoneoscopic Surgery in Pediatric Urology
AbstractPurpose of ReviewThe aim of this review is to find out the benefits of retroperitoneoscopy for the most common urological diseases in children.Recent FindingsThe emergence of minimally invasive surgery about 20  years ago revolutionized pediatric urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied to a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. The main indicat ions of retroperitoneoscopy are presented, from the classical ablative surgery, like total or partial neph...
Source: Current Urology Reports - April 3, 2018 Category: Urology & Nephrology Source Type: research

Neuromodulation for Chronic Pelvic Pain
AbstractPurpose of ReviewChronic pelvic pain is a heterogeneous condition that often requires multiple physician visits and various treatments prior to achieving an acceptable management strategy. Neuromodulation has been used to treat chronic pelvic pain that has failed other therapies.Recent FindingsNumerous modalities of neuromodulation have been used to alleviate chronic pelvic pain with promising results.SummaryNumerous modalities of neuromodulation have demonstrated efficacy in the management of pelvic pain. Further investigation is needed to elucidate the most effective treatment modality and to identify the patient...
Source: Current Urology Reports - March 26, 2018 Category: Urology & Nephrology Source Type: research

Robotic Autotransplantation and Management of Post-transplant Anastomotic Strictures: the Future Is Here
AbstractPurpose of ReviewWe set out to review the current published experience with robotic autotransplantation. Although the experience to date is limited, this surgery appears to be safe and technically feasible. We also examined the use of the robotic surgical platform for the management of post-transplant uretero-vesical anastomotic strictures.Recent FindingsTo date, only four reported cases of robotic autotransplantation have been described with two being performed completely intra-corporeally. An intra-corporeal approach is feasible for benign conditions, while malignant masses should be inspected and dissected extra...
Source: Current Urology Reports - March 23, 2018 Category: Urology & Nephrology Source Type: research

Female Pelvic Medicine and Reconstructive Surgery —What Does Certification Mean?
AbstractPurpose of ReviewThere are advantages and disadvantages of subspecialty certification for physicians, trainees, patients, and society at large. As female pelvic medicine and reconstructive surgery (FPMRS) became the second subspecialty of urology to offer subspecialty certification, understanding the effects of FPMRS subspecialty certification on the healthcare system is important.Recent FindingsWhile subspecialty certification may improve training, identify experts, and ultimately lead to improved patient outcomes, certification might also be unnecessary for some physicians, weaken residency training, and limit th...
Source: Current Urology Reports - March 19, 2018 Category: Urology & Nephrology Source Type: research

Asymptomatic Renal Stones —to Treat or Not to Treat
AbstractPurpose of ReviewThere are no current guidelines on the optimal management of asymptomatic renal stones. This review summarizes the current literature, focusing on more recent studies that have been done to grow the body of evidence on this topic.Recent FindingsRecent studies have found that stone size is a significant predictor of need for future surgical intervention, with>  7 mm for pediatric population and>  4 mm for residual fragments after both PNL and ureteroscopy (URS). The role of URS has been better defined with a recent RCT concluding that URS and SWL had comparable outcomes...
Source: Current Urology Reports - March 17, 2018 Category: Urology & Nephrology Source Type: research

Updates on Robotic Intracorporeal Urinary Diversions
AbstractPurpose of ReviewMore than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery.Recent FindingsIn this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles. Several potential benefits of intracorporeal urinary diversion are being investigated —such as a reduction in gastroint...
Source: Current Urology Reports - March 15, 2018 Category: Urology & Nephrology Source Type: research

Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review
AbstractPurpose of ReviewThe role of PCNL and the expertise surrounding it has expanded in recent decades. Miniaturisation of equipment and instrument size has formed a part of this innovation. Although an increasing number of studies have been performed on miniaturised PCNL (Mi-PCNL) recently, a critical appraisal on these is lacking. We therefore conducted a systematic review of the literature to evaluate the efficacy, safety and feasibility of Mi-PCNL techniques (  III complications and no mortality with only one transfusion reported from this minimally invasive technique. (Source: Current Urology Reports)
Source: Current Urology Reports - March 7, 2018 Category: Urology & Nephrology Source Type: research

Advances and Challenges in Transitional Urology: Caring for Adolescents and Young Adults with Lifelong Complex Genitourinary Conditions
AbstractPurpose of ReviewAs long-term survival with complex congenital and pediatric diseases has improved, more patients with congenital genitourinary conditions are living into adulthood. These patients can continue to face lifelong issues related to their conditions, including urinary incontinence, recurrent urinary tract infections, chronic kidney disease, and difficulties with sexual health and function.Recent FindingsThe practice of transitional urology continues to grow nationwide and abroad, and it will be important to develop evidence-based practices for coordinated transition of these patients into the adult heal...
Source: Current Urology Reports - March 7, 2018 Category: Urology & Nephrology Source Type: research

Validated Methods of Assessing Quality of Life in Stone Disease
AbstractPurpose of ReviewWith the emphasis on quality standards when determining reimbursements rates, patient reported outcomes are now of particular interest to clinicians. This review addresses health-related quality of life (HRQOL) detriments that have been studied in patients with stone disease.Recent FindingsSeveral instruments been validated for use in stone formers. Previously, generic instruments revealed decreased HRQOL in urolithiasis patients. Recently, a disease-specific tool has been developed and has provided more insight into the specific symptoms that negatively affect the patient experience.SummaryEvidenc...
Source: Current Urology Reports - March 5, 2018 Category: Urology & Nephrology Source Type: research

Endoscopic Management of Ureteral Strictures: an Update
AbstractPurpose of ReviewThis review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery.Recent FindingsThere is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-na ïve patients with short (
Source: Current Urology Reports - March 2, 2018 Category: Urology & Nephrology Source Type: research

A Review of Buccal Mucosa Graft Ureteroplasty
AbstractPurpose of ReviewWe review the buccal mucosa graft (BMG) ureteroplasty literature to evaluate its utility in the management of ureteral strictures, identify indications for which it is particularly useful, and highlight refinements in surgical technique.Recent FindingsRecent reports have described the efficacy of robotic BMG ureteroplasty and the utilization of near-infrared fluorescence to assist with precise identification of the ureteral stricture margins.SummaryBMG ureteroplasty is well-suited for ureteral reconstruction as it allows for minimal disruption of the delicate ureteral blood supply and facilitates a...
Source: Current Urology Reports - March 1, 2018 Category: Urology & Nephrology Source Type: research

Surgical Management of Adult Acquired Buried Penis
AbstractPurpose of ReviewAdult acquired buried penis is a morbid condition characterized by complete entrapment of the phallus as a result of morbid obesity, post-surgical cicatrix formation, or primary genital lymphedema. Hygienic voiding is not possible and urinary dribbling is frequent with accompanying inflammation, skin breakdown, and infection from the chronic moisture. The end result is penile skin fibrosis resulting in permanent functional loss. Herein, we describe the etiology of adult acquired buried penis, advances in its surgical management, and quality of life outcomes with treatment.Recent FindingsAdult acqui...
Source: Current Urology Reports - February 28, 2018 Category: Urology & Nephrology Source Type: research

The Role of Urodynamics in Post-Prostatectomy Incontinence
AbstractPurpose of ReviewRadical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer. One of the side effects after RP impacting quality of life is urinary incontinence. Because of the impact in quality of life, more patients are seeking treatment for post-prostatectomy incontinence. Urodynamics are an important tool to help understand how prostate surgery changes bladder and urethral function. We reviewed the current literature in order to determine the role of urodynamics in post-prostatectomy incontinence.Recent FindingsStudies have been done to demonstrate the anatomical and functional c...
Source: Current Urology Reports - February 26, 2018 Category: Urology & Nephrology Source Type: research

Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease
AbstractPurpose of ReviewMale urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management.Recent FindingsOlder studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to suppo...
Source: Current Urology Reports - February 26, 2018 Category: Urology & Nephrology Source Type: research

Refractory Urethral Stricture Management: Indications for Alternative Grafts and Flaps
We describe the scope of the surgical armamentarium available to develop creative approaches and successful outcomes.Recent findingsWe discuss techniques to maximize the availability of oral mucosa, harvest and use of rectal mucosa, and developments in tissue engineering. Evolving methods to assess success of repair are also described.SummaryUrethral reconstruction for refractory urethral strictures requires proficiency with multiple methods as these strictures often require combining techniques for successful treatment. (Source: Current Urology Reports)
Source: Current Urology Reports - February 26, 2018 Category: Urology & Nephrology Source Type: research

Pelvic Organ Prolapse and Pregnancy in the Female Bladder Exstrophy Patient
AbstractPurpose of ReviewClassic bladder exstrophy (BE) remains one of the most demanding reconstructive challenges encountered in urology. In female BE patients, the long-term sequela of both primary and revision genitoplasty, as well as intrinsic pelvic floor deficits, predispose adult women to significant issues with sexual function, pelvic organ prolapse (POP), and complexities with reproductive health.Recent FindingsContemporary data suggest 30 –50% of women with BE develop prolapse at a mean age of 16 years. Most women will require revision genitoplasty for successful sexual function, although in some seri...
Source: Current Urology Reports - February 26, 2018 Category: Urology & Nephrology Source Type: research

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