Is Active Surveillance Too Active?
AbstractPurpose of ReviewMany prostate cancer active surveillance protocols mandate serial monitoring at defined intervals, including but certainly not limited to serum PSA (often every 6 months), clinic visits, prostate multiparametric MRI, and repeat prostate biopsies. The purpose of this article is to evaluate whether current protocols result in excessive testing of patients on active surveillance.Recent FindingsMultiple studies have been published in the past several years evaluating the utility of multiparametric MRI, serum biomarkers, and serial prostate biopsy for men on active surveillance. While MRI and serum bi...
Source: Current Urology Reports - July 12, 2023 Category: Urology & Nephrology Source Type: research
Real-Time and Delayed Imaging of Tissue and Effects of Prostate Tissue Ablation
AbstractPurpose of ReviewProstate ablation is increasingly being utilized for the management of localized prostate cancer. There are several energy modalities with varying mechanism of actions which are currently used for prostate ablation. Prostate ablations, whether focal or whole gland, are performed under ultrasound and/or MRI guidance for appropriate treatment plan execution and monitoring. A familiarity with different intraoperative imaging findings and expected tissue response to these ablative modalities is paramount. In this review, we discuss the intraoperative, early, and delayed imaging findings in prostate fro...
Source: Current Urology Reports - July 8, 2023 Category: Urology & Nephrology Source Type: research
Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review
AbstractPurpose of ReviewMiniaturized PCNL (mi-PCNL) for stone disease is performed under a general anesthesia. However, the role of loco-regional anesthesia in mi-PCNL and its outcomes are not well defined yet. Here, we review the outcomes and complications of loco-regional anesthesia for mi-PCNL. A Cochrane-style review was performed in accordance with the preferred reporting items for systematic reviews to evaluate the outcomes of loco-reginal anesthesia for URS in stone disease, including all English language articles from January 1980 and October 2021.Recent FindingsTen studies with a total of 1663 patients underwent ...
Source: Current Urology Reports - July 7, 2023 Category: Urology & Nephrology Source Type: research
Stereotactic Body Radiation Therapy Salvage for Lymph Node Recurrent Prostate Cancer in the Era of PSMA PET Imaging
AbstractPurpose of ReviewOur understanding of patterns of prostate cancer recurrence after primary treatment of localized disease has significantly evolved since the development of positron emission tomography (PET) agents targeting prostate cancer. Previously, most biochemical recurrences were not associated with imaging correlates when restaging with computed tomography (CT), magnetic resonance imaging (MRI), or bone scintigraphy and, hence, were typically assumed to represent occult metastases. A rising prostate specific antigen (PSA) after previous local therapy prompting a PET scan showing uptake limited to regional l...
Source: Current Urology Reports - July 3, 2023 Category: Urology & Nephrology Source Type: research
Correction: Role, Cost, and Availably of Urinary pH Monitoring for Kidney Stone Disease —A Systematic Review of the Literature
(Source: Current Urology Reports)
Source: Current Urology Reports - July 1, 2023 Category: Urology & Nephrology Source Type: research
Local Therapeutics for the Treatment of Oligo Metastatic Prostate Cancer
AbstractPurpose of ReviewMetastatic prostate cancer remains universally lethal. Although de-novo metastatic prostate cancer was historically managed with systemic therapy alone, local therapies are increasingly utilized in the early treatment of the disease, particularly in patients with oligometastatic prostate cancer (OMPC). OMPC represents an intermediate stage between clinically localized and widespread metastatic disease. Diseases classified within this stage present an opportunity for localized targeting of the disease prior to progression to widespread metastases. The purpose of this review is to discuss the contemp...
Source: Current Urology Reports - June 28, 2023 Category: Urology & Nephrology Source Type: research
Imaging Techniques to Differentiate Benign Testicular Masses from Germ Cell Tumors
AbstractPurpose of ReviewTo discuss role of different diagnostic imaging modalities in differentiation of benign testicular masses from seminomatous germ cell tumors (SGCTs) and non-seminomatous GCTs (NSGCTs).Recent FindingsNew modalities of ultrasonography, including contrast enhancement and shear wave elastography, may help differentiate between benign and malignant intratesticular lesions.SummaryUltrasonography remains the recommended imaging modality for initial evaluation of testicular masses. However, MRI can be used to better define equivocal testicular lesions on US. (Source: Current Urology Reports)
Source: Current Urology Reports - June 27, 2023 Category: Urology & Nephrology Source Type: research
Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy
AbstractPurpose of ReviewWe aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use.Recent FindingsNational urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization ...
Source: Current Urology Reports - June 14, 2023 Category: Urology & Nephrology Source Type: research
Role, Cost, and Availably of Urinary pH Monitoring for Kidney Stone Disease —A Systematic Review of the Literature
AbstractPurpose of ReviewUrinary pH is an important factor related to renal stone disease, and it plays an essential role in stone prevention. Monitoring of urinary pH by patients at home provides information that can help to assess the treatment needed by each patient. We conducted a systematic review is to assess the available evidence concerning urinary pH monitoring methods along with their accuracy, cost, and usefulness by patients with urolithiasis.Recent FindingsA total of 9 articles were included (1886 urinary pH measurements). They reported information about urinary dipsticks, portable electronic pH meters and ele...
Source: Current Urology Reports - June 14, 2023 Category: Urology & Nephrology Source Type: research
Prostatic Arterial Embolization for Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement
AbstractPurpose of ReviewProstatic artery embolization (PAE) is an emerging minimally invasive technique for lower urinary tract symptom reduction from benign prostatic hypertrophy (BPH). While the technique is becoming increasingly popular with patients and interventional radiologists, most urologists remain skeptical of the PAE ’s long-term efficacy and comparative success to the gold standard transurethral resection of the prostate.Recent FindingsPAE has been found in multiple meta-analyses to perform similarly to the gold standard transurethral resection of the prostate (TURP) with regard to patient-driven measures l...
Source: Current Urology Reports - June 14, 2023 Category: Urology & Nephrology Source Type: research
Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction
AbstractPurpose of ReviewThere is no consensus on preoperative functional testing prior to surgeries for benign prostatic obstruction causing lower urinary tract symptoms (LUTS).Recent FindingsSurgical management offers definite benefits, but the results are not always satisfactory. The urodynamic study (UDS) is the gold standard for assessing bladder outlet obstruction (BOO) which is the best predictor of surgical success. Yet, it is not recommended by our urologic societies as standard testing prior to surgery.SummaryIn this narrative review of the literature, we report recent findings and controversies regarding the ...
Source: Current Urology Reports - June 8, 2023 Category: Urology & Nephrology Source Type: research
Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?
AbstractPurpose of ReviewRobotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease.Recent FindingsA comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIR...
Source: Current Urology Reports - June 1, 2023 Category: Urology & Nephrology Source Type: research
Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know?
AbstractPurpose of ReviewTo summarise the literature on laser safety during endourological practice.Recent FindingsHolmium and Thulium Fiber laser are the two main energy sources in the current clinical practice. The latter may have superior properties, but more clinical studies are needed to formally establish this. Laser injury to urothelium is more dependent on user experience rather than laser type. Smaller laser fibres allow for lower intra-renal temperature profiles. Operators should pay close attention to laser technique including maintaining the safety distance concept and only firing the laser w hen tip is cle...
Source: Current Urology Reports - May 31, 2023 Category: Urology & Nephrology Source Type: research
Ultrasound-Guided PCNL — Why Are We Still Performing Exclusively Fluoroscopic Access?
This article showcases the major reasons why ultrasound-guided access should be considered the first-line approach for performing access for PCNL.Recent FindingsThere continues to be a need to further reduce radiation exposure in the management of kidney stone patients. This review showcases how performing ultrasound-guided PCNL has been associated with a shorter learning curve, increased patient safety, and the ability to perform x-ray free PCNL.SummaryUltrasound-guided PCNL is not only an achievable skill for urologists to learn but provides multiple advantages over traditional fluoroscopic access. As every effort should...
Source: Current Urology Reports - May 6, 2023 Category: Urology & Nephrology Source Type: research
Endourological Options for Small ( & lt; 2 cm) Lower Pole Stones — Does the Lower Pole Angle Matter?
AbstractPurpose of ReviewSmall renal stones in the lower pole are often difficult to treat. The angle of the lower pole to the renal pelvis (lower pole angle) is a limiting factor to rendering the patient stone free. This review explores the definitions of the lower pole angle, the various treatment options available, and how outcomes are influenced by the angle.Recent FindingsIt is clear the lower pole angle definition varies widely depending on described technique and imaging modality. However, it is clear that outcomes are worse with a steeper angle, especially for shock wave lithotripsy and retrograde intrarenal surger...
Source: Current Urology Reports - April 25, 2023 Category: Urology & Nephrology Source Type: research
