Current Opinion in Urology最新文献

{"title":"Prostate-specific antigen doubling time in prostate cancer: a review of calculation methods and clinical implications.","authors":"Alfonso Romero Crespo, Daniel Carrasco Gomez, Nestor Manuel Sanchez Martinez, Carlos Bautista Vidal, Lydia Flores Sirvent, Rodrigo España Navarro, Emilio Garcia Galisteo","doi":"10.1097/MOU.0000000000001303","DOIUrl":"10.1097/MOU.0000000000001303","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate-specific antigen doubling time (PSADT) is a key prognostic marker in prostate cancer, especially in cases of biochemical recurrence. It guides risk stratification and therapeutic decisions, but its calculation varies significantly across institutions. This review addresses the clinical relevance of PSADT and the need for standardized methods.</p><p><strong>Recent findings: </strong>Multiple models exist for PSADT calculation, including logarithmic regression, linear models, and nadir subtraction. Logarithmic regression best reflects PSA's exponential growth but requires at least three PSA values over time. Measurement variability - due to assay differences or sampling intervals - can affect PSADT estimates by 15-40%, impacting treatment decisions. Correction tools like the Memorial Sloan Kettering Cancer Center's Excel calculator have reduced variability by up to 30-40%, improving reliability.</p><p><strong>Summary: </strong>PSADT remains a valuable tool in prostate cancer management, particularly for guiding salvage therapies in biochemical recurrence. However, its accuracy depends on the calculation method and PSA measurement quality. Integrating validated tools like the MSKCC calculator and adopting standardized approaches can enhance clinical decision-making. This review underscores the need for improved harmonization of PSADT methodology across guidelines and clinical settings.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"447-452"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining prostate cancer care: innovations and future directions in active surveillance.","authors":"Magdalena Koett, Felix Melchior, Nastasiia Artamonova, Jasmin Bektic, Isabel Heidegger","doi":"10.1097/MOU.0000000000001268","DOIUrl":"10.1097/MOU.0000000000001268","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a critical analysis of recent advancements in active surveillance (AS), emphasizing updates from major international guidelines and their implications for clinical practice.</p><p><strong>Recent findings: </strong>Recent revisions to international guidelines have broadened the eligibility criteria for AS to include selected patients with ISUP grade group 2 prostate cancer. This adjustment acknowledges that certain intermediate-risk cancers may be appropriate for AS, reflecting a heightened focus on achieving a balance between oncologic control and maintaining quality of life by minimizing the risk of overtreatment.</p><p><strong>Summary: </strong>This review explores key innovations in AS for prostate cancer, including multi parametric magnetic resonance imaging (mpMRI), genomic biomarkers, and risk calculators, which enhance patient selection and monitoring. While promising, their routine use remains debated due to guideline inconsistencies, cost, and accessibility. Special focus is given to biomarkers for identifying ISUP grade group 2 cancers suitable for AS. Additionally, the potential of artificial intelligence to improve diagnostic accuracy and risk stratification is examined. By integrating these advancements, this review provides a critical perspective on optimizing AS for more personalized and effective prostate cancer management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"439-446"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current clinical evidence in intrarenal temperature, pressure and suction during retrograde intrarenal surgery: a review of literature.","authors":"Theodoros Tokas, Vineet Gauhar, Steffi Kar Kei Yuen, Bhaskar Kumar Somani","doi":"10.1097/MOU.0000000000001270","DOIUrl":"10.1097/MOU.0000000000001270","url":null,"abstract":"<p><strong>Purpose of review: </strong>Experimental evidence suggests that intrarenal temperatures (IRTs) and pressures (IRPs) during retrograde intrarenal surgery (RIRS) with laser lithotripsy are clinically significant. Suction devices aim to facilitate RIRS and improve procedure outcomes. We present an overview of new clinical studies regarding IRT, IRP, and suction developments.</p><p><strong>Recent findings: </strong>High laser power, low irrigation, and restricted working space were directly correlated with increased IRTs. Increased irrigation flow rate and ureteral access sheath (UAS) maintained well tolerated IRTs. Baseline IRPs ranged from 16 to 17 mmHg. Intraoperative IRP monitoring maintained values below 22 mmHg. Hand-assisted pumps often increase IRPs above the safety threshold. Prolonged IRP increments were correlated to postoperative infections. Suction devices decreased operative time to less than 60 min and improved stone-free rates (SFRs) at 1 day to more than 80 and at 30 days to more than 90%.</p><p><strong>Summary: </strong>Despite the limited clinical evidence, IRTs during RIRS correlate directly with laser power and reversely correlate with irrigation flow rate and UAS use. Intraoperative IRP monitoring prevents hazardous increments. Manual pump irrigation causes extremely high IRPs. There is a possible relation between prolonged IRP increments and infectious complication development. Using suction UAS or flexible and navigable sheaths (FANS) improves operative times and SFRs, while more studies regarding direct in-scope suction (DISS) efficiency and safety are needed.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"390-398"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring, monitoring and reporting intrarenal pressure: a practical guide to endourologists from section of EAU Endourology.","authors":"Steffi Kar Kei Yuen, Bhaskar Somani, Vineet Gauhar","doi":"10.1097/MOU.0000000000001284","DOIUrl":"10.1097/MOU.0000000000001284","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"399-411"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging strategies: conservative management of upper tract urothelial carcinoma.","authors":"Orel Hemo, Tomer Hasdai, Hen Hendel, Asaf Shvero, Nir Kleinmann, David Lifshitz","doi":"10.1097/MOU.0000000000001290","DOIUrl":"10.1097/MOU.0000000000001290","url":null,"abstract":"<p><strong>Purpose of review: </strong>Upper tract urothelial carcinoma (UTUC) is a rare yet aggressive malignancy, representing 5-10% of urothelial cancers. While radical nephroureterectomy (RNU) has traditionally offered excellent oncological control, it compromises renal function. Recent advancements have shifted the paradigm toward kidney-sparing strategies in select cases. This review highlights innovations in UTUC diagnosis and conservative management, focusing on emerging imaging techniques, noninvasive biomarkers, and minimally invasive treatments.</p><p><strong>Recent findings: </strong>Advances in multiparametric MRI and radiomics have improved diagnostic accuracy and risk stratification. Moreover, noninvasive biomarkers - including circulating tumor DNA, microRNAs, and urinary methylation assays - provide promising tools for early detection and surveillance. Kidney-sparing approaches such as endoscopic laser ablation and segmental ureterectomy have demonstrated comparable oncologic outcomes in low-risk patients. Moreover, topical therapies, including intracavitary treatments like UGN-101, offer a promising minimally invasive option.</p><p><strong>Summary: </strong>The conservative management of UTUC is evolving, driven by advancements in imaging, molecular diagnostics, and minimally invasive treatments. While kidney-sparing approaches are increasingly utilized in low-risk patients, further prospective studies are needed to validate their efficacy.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"315-322"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicities of taxane-based chemotherapy in prostate cancer.","authors":"Akihiro Matsukawa, Takafumi Yanagisawa, Paweł Rajwa, Takahiro Kimura","doi":"10.1097/MOU.0000000000001296","DOIUrl":"10.1097/MOU.0000000000001296","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite recent developments in the treatment of advanced prostate cancer (PCa), taxanes, including docetaxel (DOC) and cabazitaxel (CBZ), remain pivotal in management. DOC has shown efficacy for patients with metastatic hormone-sensitive prostate cancer, whereas CBZ plays a key role in the post-DOC setting. However, taxane-based therapies are associated with significant toxicities. We aimed to provide a comprehensive overview of the incidence, risk factors, and management strategies for taxane-related toxicities to optimize outcomes.</p><p><strong>Recent findings: </strong>Neutropenia and febrile neutropenia are life-threatening complications. Primary prophylactic granulocyte-colony stimulating factor (G-CSF) is recommended for CBZ. In contrast, evidence of its use with DOC is limited but should be considered for high-risk patients. Other common toxicities, such as nausea/vomiting, fatigue, neuropathy, and skin disorder, are generally nonlife-threatening but can significantly impair patients' quality of life (QoL). Tailored patient selection and individualized management strategies are essential for minimizing toxicities and ensuring treatment continuity.</p><p><strong>Summary: </strong>Despite the wide-ranging toxicities of taxanes, they remain a cornerstone in advanced PCa treatment. Preventing and managing severe neutropenia, febrile neutropenia, and QoL-impairing toxicities are essential for maintaining treatment continuity and achieving optimal outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"453-460"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in endourology.","authors":"Bhaskar K Somani, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001285","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001285","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"35 4","pages":"313-314"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.","authors":"Carlotta Nedbal, Pietro Tramanzoli, Daniele Castellani, Vineet Gauhar, Andrea Gregori, Bhaskar Somani","doi":"10.1097/MOU.0000000000001216","DOIUrl":"10.1097/MOU.0000000000001216","url":null,"abstract":"<p><strong>Purpose of review: </strong>To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.</p><p><strong>Recent findings: </strong>A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.</p><p><strong>Summary: </strong>Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"368-376"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of laser lithotripsy for treatment of bladder calculi: evidence from a systematic literature review.","authors":"Mahir Akram, Clara Cerrato, Dmitry Enikeev, Theodoros Tokas, Bhaskar K Somani","doi":"10.1097/MOU.0000000000001250","DOIUrl":"10.1097/MOU.0000000000001250","url":null,"abstract":"<p><strong>Purpose of review: </strong>Bladder stones account for 5% of all urinary tract calculi. Contributing factors include bladder outflow obstruction, infections, foreign bodies, or neurogenic voiding dysfunction. This necessitates an effective treatment modality, and with advances in medical technology, minimally invasive techniques using lasers are being widely adopted. This systematic review aims to assess the efficacy and safety of laser lithotripsy for treating bladder stones.</p><p><strong>Recent findings: </strong>A thorough literature review (PROSPERO: CRD 42024551910) was conducted using appropriate search terms up to March 2024. Only original studies written in English, with at least 10 patients with bladder stones treated with laser, were considered with inclusion. A total of 8 studies (411 patients) were identified on screening with a mean age of 59.6 ± 8.5 years and a male: female ratio of 326 : 14. These reviews covered a geographical area of Asia, Europe, and the USA. The mean stone size was 3.7 ± 0.7 cm, and an overall stone-free rate (SFR) postlaser lithotripsy was 96%. Mean operation time was calculated to be 76.36 ± 47.10 min and an overall complication rate of 16.5% ( n  = 68), with the most common being haematuria ( n  = 22), followed by UTI ( n  = 18), incontinence ( n  = 8), urosepsis ( n  = 6), clot retention ( n  = 4), mucosal injury ( n  = 3) and urinary retention ( n  = 3). All complications were minor and there were no Clavien >II complications.</p><p><strong>Summary: </strong>Laser lithotripsy for bladder stone achieves an excellent success rate in the form of SFR, combined with a low risk of major complications, and allows concomitant treatment of enlarged prostate, and should be considered in all patients.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"331-337"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in lasers and laser technologies: what does a clinician need to know?","authors":"Andrey Morozov, Vladislav Skossyrskiy, Diana Babaevskaya, Vineet Gauhar, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001264","DOIUrl":"10.1097/MOU.0000000000001264","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on recent advancements in laser technologies used in urology, particularly in enucleation, vaporization, lithotripsy, and focal laser ablation (FLA). The growing use of the thulium fiber laser (TFL) and the development of pulsed thulium lasers (p-Tm:YAG) highlight the relevance of this review, as these innovations aim to improve precision and outcomes in urological procedures.</p><p><strong>Recent findings: </strong>Recent studies have shown the advantages of TFL in achieving precise tissue ablation, reduced retropulsion offered by the Moses technology in holmium lasers, and the potential of pulsed thulium lasers for more precise control of the effects on tissues. Additionally, FLA is gaining traction for its ability to treat localized prostate cancer with minimal collateral damage. These technologies not only optimize procedural accuracy but also reduce complications, making them safer for high-risk patients, including those receiving anticoagulants.</p><p><strong>Summary: </strong>The advancements in laser technology, including TFL, Moses technology, and pulsed thulium lasers, are improving outcomes in urological surgeries by increasing precision, reducing operative time, and minimizing complications. FLA represents a promising alternative for minimally invasive cancer treatments. Ongoing research should focus on optimizing laser parameters and exploring broader clinical applications.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"354-359"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}