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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

Frailty and Lower Urinary Tract Symptoms
AbstractThe incidence of both frailty and lower urinary tract symptoms, including urinary incontinence, overactive bladder, underactive bladder, and benign prostatic hyperplasia, increases with age. However, our understanding of the relationship between frailty and lower urinary tract symptoms, both in terms of pathophysiology and in terms of the evaluation and management of such symptoms, is greatly lacking. This brief review will summarize definitions and measurement tools associated with frailty and will also review the existing state of the literature on frailty and lower urinary tract symptoms in older individuals. (S...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

The Role of Varicocele in Male Factor Subfertility
AbstractPurpose of ReviewVaricocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men, there has been controversy over the effectiveness of surgical treatments, patient selection, and when to administer treatment, particularly in the era of assisted reproductive technology.Recent FindingsIn line with earlier finding, recent evidence strongly suggests that varicocelectomy improves pregnancy rates and semen parameters. The currently available literature still does not clearly elucidate the answer to this question, due to ...
Source: Current Urology Reports - July 17, 2017 Category: Urology & Nephrology Source Type: research

The Effect of Targeted Therapy for Genitourinary Malignancies on Sexual Function and Fertility
AbstractPurpose of ReviewTargeted therapy for genitourinary cancer is being used at an increasing rate. These medications show great survival benefit but are relatively lacking in long-term adverse effect data. With increasing survivability, measures to improve quality of life must be considered for GU cancer and a large proponent of this is sexual function.Recent FindingsmTOR inhibitors have shown an effect on testosterone levels and may have a link to abnormal semen parameters. Tyrosine kinase inhibitors(TKIs) have shown no adverse sexual outcomes in the literature. There are laboratory links to tyrosine kinases having a...
Source: Current Urology Reports - July 15, 2017 Category: Urology & Nephrology Source Type: research

Changes in Management of Poorly Compliant Bladder in Botulinum Toxin A Era
AbstractBladder compliance is a measure of distensibility. Maladies such as myelodysplasia, myelomeningocele, spinal cord injury, multiple sclerosis and obstructive uropathy are known to decrease bladder compliance. Decrease in bladder compliance is a characteristic of neurogenic bladders. The pathophysiology of bladder compliance is complex but ultimately leads to high pressure during filling and storage phases. These high pressures lead to renal impairment, incontinence, and recurrent urinary tract infections. This review presents management of poorly compliant bladders with onabotulinumtoxinA. (Source: Current Urology Reports)
Source: Current Urology Reports - July 8, 2017 Category: Urology & Nephrology Source Type: research

Salvage Therapy Options for Local Prostate Cancer Recurrence After Primary Radiotherapy: a Literature Review
This article seeks to explore the currently utilized modalities for salvage treatment for radiorecurrent PCa. We focused our review on the oncologic outcomes and reported toxicity rates in the latest studies examining salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage high-intensity focused ultrasound (HIFU) and re-irradiation.Recent FindingsThere does not appear to be any significant difference in overall survival for more invasive salvage radical prostatectomy compared to the minimally invasive salvage approaches. Additionally, there seems to be a trend towards lower morbidity rates associated with m...
Source: Current Urology Reports - July 7, 2017 Category: Urology & Nephrology Source Type: research

Urologic Dermatology: a Review
AbstractPurpose of ReviewGenital dermatology represents a challenge to many providers. Though dermatologic lesions involving the genitalia may present to any of a number of practices, ranging from primary care to urology, gynecology, and dermatology, few training programs provide significant training regarding the diagnosis and management of genital dermatologic lesions. The purpose of this review is to provide urologists with an overview of common genital dermatological lesions that may be encountered in a clinic. The review also provides a guide to how to approach these conditions.Recent FindingsThis manuscript summarize...
Source: Current Urology Reports - June 30, 2017 Category: Urology & Nephrology Source Type: research

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass
This article aims to summarise recent developments in surgical and minimally invasive therapies in the management of small renal masses (SRMs).Recent FindingsThe incidence of the small renal mass is increasing. Standard management of the SRM is partial nephrectomy. More recently, use of ablative techniques to manage the SRM has been increasing and an exciting array of technical advances is currently being made in the field. Nephron-sparing surgery looks set to become more financially viable with the advent of newer robotic platforms and, potentially, even less invasive with the evaluation of single-port access. Real-time i...
Source: Current Urology Reports - June 29, 2017 Category: Urology & Nephrology Source Type: research

State of the Art for Treatment of Vesicovaginal Fistula
AbstractBackgroundVesico-vaginal fistulae (VVF) remain the most prevalent genitourinary fistula detrimentally impacting quality of life.Purpose of the ReviewThe purpose of this review is to examine relevant literature on management of VVF.Recent FindingsObstructed labor is the leading cause of VVF in the developing world with most repairs performed via the transvaginal approach. Conversely, the predominate etiology in industrialized nations is iatrogenic injury with an increasing trend towards abdominal repair via a minimally invasive (laparoscopic and robotic) approach. No studies have compared transvaginal repair to mini...
Source: Current Urology Reports - June 27, 2017 Category: Urology & Nephrology Source Type: research

Where Are We Headed with Neuromodulation for Overactive Bladder?
AbstractOveractive bladder (OAB) affects millions of people around the world and decreases quality of life for those affected. Over the past two decades, significant advances in treatment have transformed the lives of those with OAB. Sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and dorsal genital nerve stimulation are the most effective contemporary treatment modalities. New techniques and bio-sensing schemes offer promise to advance therapy beyond what is currently available. Current neuromodulation techniques do not use real-time data from the body or input from the patient. Incorporating this...
Source: Current Urology Reports - June 27, 2017 Category: Urology & Nephrology Source Type: research

Training in Robotic Surgery —an Overview
AbstractPurpose of ReviewThere has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks was conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon.Recent FindingsA structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of ...
Source: Current Urology Reports - June 24, 2017 Category: Urology & Nephrology Source Type: research

The Role of Robotics in the Invasive Management of Bladder Cancer
AbstractRobot-assisted radical cystectomy (RARC) has been adopted widely in many centres, owed largely to the success of robot-assisted laparoscopic prostatectomy (RALP). It aims to replicate the oncological outcomes of open radical cystectomy (ORC), while providing a shorter recovery period. Despite this, previous RCTs have failed to show a benefit for RARC over ORC. These trials have compared extracorporeal RARC (eRARC) with ORC, which requires a further incision to mobilise the bowel for urinary reconstruction with an open technique. For intracorporeal RARC (iRARC), this urinary reconstruction is performed robotically w...
Source: Current Urology Reports - June 20, 2017 Category: Urology & Nephrology Source Type: research

Adjuvant Versus Early Salvage Radiation Therapy Following Radical Prostatectomy for Men with Localized Prostate Cancer
AbstractRadical prostatectomy (RP) is now the most common definitive treatment for high-risk prostate cancer. Unfortunately, many men will have residual microscopic disease after surgery alone. Despite level 1 evidence supporting the use of adjuvant radiation therapy (ART),
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research

The use of Hormonal Therapy to Augment Radiation Therapy in Prostate Cancer: An Update
AbstractPurpose of ReviewAndrogen deprivation therapy (ADT) is an important adjunctive therapy to external beam radiation therapy (RT) for the definitive management of prostate cancer. The role of ADT is well-established for locally advanced or high-risk disease in conjunction with standard doses of RT, but less defined for intermediate-risk disease or with dose-escalated RT. The goal of this review is to summarize evidence evaluating the combination of ADT/RT, focusing on recent trials and current controversies as they pertain to the practicing clinician.Recent FindingsThe benefit of ADT on biochemical control is maintain...
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research

Prostate Biopsy in Active Surveillance Protocols: Immediate Re-biopsy and Timing of Subsequent Biopsies
AbstractPurpose of ReviewThis manuscript reviews contemporary literature regarding prostate cancer active surveillance (AS) protocols as well as other tools that may guide the management of biopsy frequency and assess the possibility of progression in low-risk prostate cancer.Recent FindingsThere is no consensus regarding the timing of surveillance biopsies; however, an immediate repeat biopsy within 12  months of diagnosis for patients considering AS confirms patients who have favorable risk disease yet also identifies patients who were undersampled initially. Studies regarding multiparametric MRI, nomograms, and bio...
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research

The Preoperative Assessment and Optimization of Patients Undergoing Major Urological Surgery
AbstractPurpose of ReviewImproving patient outcomes from major urological surgery requires not only advancement in surgical technique and technology, but also the practice of patient-centered, multidisciplinary, and integrated medical care of these patients from the moment of contemplation of surgery until full recovery. This review examines the evidence for recent developments in preoperative assessment and optimization that is of relevance to major urological surgery.Recent FindingsCurrent perioperative medicine recommendations aim to improve the short-term safety and long-term effectiveness of surgical treatments by the...
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research

The Contemporary Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Prostate Cancer
AbstractPurpose of ReviewGrowing research supports the use of multiparametric magnetic resonance imaging (mpMRI) for the evaluation of localized prostate cancer (PCa). We highlight contemporary evidence supporting its use in active surveillance (AS).Recent FindingsThe emerging approach to localized PCa favors risk-adapted screening, image-guided biopsies, and selective therapeutic interventions. mpMRI is increasingly critical to achieve each of these aims. Early evidence suggests a value of mpMRI before initial biopsy to guide fusion targeting and to rule out non-organ confined disease as well as in the initiation and seri...
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research

Radical Prostatectomy for High-risk Localized or Node-Positive Prostate Cancer: Removing the Primary
AbstractPurpose of ReviewWe reviewed the literature to determine what role, if any, radical prostatectomy should play in the treatment of high-risk and/or node-positive prostate cancer.Recent FindingsThe AUA, NCCN, and EAU all include radical prostatectomy as a treatment option for high-risk prostate cancer based on evidence that has shown improvements in biochemical-free and disease-specific survival. Lymph node-positive patients may also derive benefit from radical prostatectomy with lymph node dissection, however, only retrospective studies with high risk of selection bias have been published to date.SummaryHigh-risk pr...
Source: Current Urology Reports - June 6, 2017 Category: Urology & Nephrology Source Type: research