Current Opinion in Urology最新文献

{"title":"The role of surgical resection of the primary tumor in metastatic upper tract urothelial carcinoma: a systematic review and meta-analysis.","authors":"Mehdi Kardoust Parizi, Nirmish Singla, Morgan Rouprêt, Vitaly Margulis, Akihiro Matsukawa, Ichiro Tsuboi, Robert Schulz, Pierre I Karakiewicz, Jeremy Yuen-Chun Teoh, Francesco Soria, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001276","DOIUrl":"10.1097/MOU.0000000000001276","url":null,"abstract":"<p><strong>Purpose of review: </strong>To evaluate the role of extirpative surgery for the primary tumor in metastatic upper tract urothelial carcinoma (mUTUC).</p><p><strong>Recent findings: </strong>The PubMed, Web of Science, and Cochrane Library were searched on July 2024 to identify relevant studies according to the Preferred Reporting Items for Systematic Review (PRISMA) statement. Studies were eligible for analysis if they compared oncologic outcomes between mUTUC patients who underwent surgical resection of the primary tumor and patients who did not. Cancer-specific survival (CSS) and overall survival (OS) were assessed using multivariate logistic regression analyses. We identified 2686 reports, of which 11 articles comprising 12 833 records were selected for this systematic review. Eight and three studies used Surveillance Epidemiology and End Results (SEER) and National Cancer Database (NCDB) databases, respectively. Surgical resection of the primary tumor was significantly associated with better CSS and OS in patients with mUTUC. Among the 5353 mUTUC patients included in our meta-analysis, radical nephroureterectomy (RNU) was independently associated with better OS with a pooled hazard ratio (HR) of 0.62 [95% confidence interval (CI) 0.54-0.72, P  < 0.05]. Subgroup analyses of studies restricted to mUTUC patients with distant lymph node metastasis ( n  = 1372) revealed RNU to be independently associated with better OS with pooled HR: 0.44 (95% CI 0.28-0.67, P  < 0.05) together with systemic chemotherapy, primary tumor site in the ureter, lower T stage, and no locoregional lymph node involvement.</p><p><strong>Summary: </strong>Surgical resection of the primary tumor offers oncologic survival benefits in select patients with mUTUC. However, in the absence of data from prospective randomized studies, it is essential to evaluate each patient individually as part of a collaborative multidisciplinary shared decision working with the patient.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"284-291"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596560","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":"Antibody-drug conjugates in urothelial carcinoma: current status and future.","authors":"Samuel Ruder, Juana Martinez, Jessica Palmer, Abdul Baseet Arham, Scott T Tagawa","doi":"10.1097/MOU.0000000000001263","DOIUrl":"10.1097/MOU.0000000000001263","url":null,"abstract":"<p><strong>Purpose of review: </strong>Antibody-drug conjugates (ADCs) are quickly becoming frontline standard of care in many tumor types, including urothelial carcinoma. This review summarizes recent clinical investigations into the use of ADCs targeting nectin-4, trophoblast cell surface antigen-2 (Trop-2), human epidermal growth factor receptor 2 (HER-2), and other antigens in urothelial carcinoma.</p><p><strong>Recent findings: </strong>This review covers efficacy and toxicity data of ADCs alone and in combination with immunotherapy; mechanisms of resistance; and preclinical studies that provide biological basis for clinical approaches.</p><p><strong>Summary: </strong>Enfortumab vedotin and sacituzumab govitecan can be used in an unselected group of patients with urothelial carcinoma whereas HER-2 ADCs have only been administered in those with high expression or amplification. Most are being studied in combination with immune checkpoint inhibitors. Data supports use of enfortumab vedotin in combination with pembrolizumab as first-line therapy in metastatic/unresectable locally advanced urothelial carcinoma. Sacituzumab govitecan may be used as later-line option in these patients. HER-2 therapy is still under investigation but has many recent promising results.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"292-300"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022640","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":"Cytoreductive nephrectomy for oligometastatic clear cell renal cell carcinoma in the era of immuno-oncology.","authors":"Laura Marandino, Veronica Mollica, Riccardo Campi","doi":"10.1097/MOU.0000000000001269","DOIUrl":"10.1097/MOU.0000000000001269","url":null,"abstract":"<p><strong>Purpose of review: </strong>Advancements in immune-oncology treatments and metastasis-directed therapy (MDT) techniques have significantly transformed treatment paradigms for patients with oligometastatic clear cell renal cell carcinoma (ccRCC). Within this evolving therapeutic landscape, the role of cytoreductive nephrectomy remains a topic of debate. This review aims to synthesize recent literature regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the contemporary immune-oncology era.</p><p><strong>Recent findings: </strong>While no prospective data are available regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the new immune-oncology (IO) era, results from recent retrospective studies suggest that careful patient selection remains critical. Apart from patients with symptomatic primary tumors, cytoreductive nephrectomy may still play a role in the treatment of oligometastatic patients with favorable clinical features, such as no immediate need for systemic therapy, absence of adverse metastatic sites, or oligometastatic lesions amenable to MDT. Deferred cytoreductive nephrectomy may have a rationale in patients with a deep response to IO at oligometastatic sites. Prognostic biomarkers to assess the biological behavior of oligometastatic disease and identify patients most suitable for cytoreductive nephrectomy are currently lacking. Novel imaging remains under investigation, with its treatment implications in oligometastatic RCC yet to be established.</p><p><strong>Summary: </strong>Notwithstanding the lack of prospective evidence, cytoreductive nephrectomy may still play a role for selected patients with oligometastatic ccRCC. Future research efforts should aim to identify prognostic tools aiding tailored decision-making in this setting.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"301-307"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491056","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":"Future directions in transfeminine genital gender-affirming surgery: tissue substitutes and transplant.","authors":"Alex J Xu, Jessica Abou Zeki, Shubham Gupta, Kirtishri Mishra","doi":"10.1097/MOU.0000000000001266","DOIUrl":"10.1097/MOU.0000000000001266","url":null,"abstract":"<p><strong>Purpose of review: </strong>The present study reviews contemporary literature focused on uterine transplantation and tissue substitutes for the purposes of transfeminine genital gender affirming surgery (GAS). Additional background is provided for both topics to provide a more comprehensive understanding of the modern applications.</p><p><strong>Recent findings: </strong>Uterine transplant remains an experimental procedure in cisgender patients who wish to avoid surrogacy. A natural extension might be to apply these techniques to GAS. Technical barriers include anatomic differences and alterations to gender-affirming hormone administration protocols. Ethically, resource allocation, elective immunosuppression, societal response to organ donation, legal ramifications of parenthood as well as the potential, under-studied effects that such an elective procedure may have on the patient's offspring must be further investigated.Tissue substitutes have long been used in urologic reconstruction but more recently applied to gender affirmation surgery which has traditionally relied on autografting to line the neovaginal canal both in the context of primary and revision vaginoplasty. However, the advent of off-the-shelf xenografts have recently been posited to be safe and efficacious alternatives to autografts. Longer term studies are needed to validate whether these proposed methods are indeed noninferior to traditional approaches.</p><p><strong>Summary: </strong>The field of feminizing gender affirmation surgery remains an exciting frontier for surgeons and patients alike. Given the relative nascency of the specialty and its propensity to draw techniques from various surgical disciplines there exists a unique opportunity for rapid innovation to overcome challenging problems posed by these complex procedures as evidenced by discussions around applying uterine transplantation and the use of novel tissue grafting techniques.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"279-283"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064016","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":"Prostate-specific membrane antigen positron-emission tomography for novel risk-stratification of biochemical recurrence.","authors":"Madeleine J Karpinski, Claudia Kesch, Boris A Hadaschik, Wolfgang P Fendler","doi":"10.1097/MOU.0000000000001291","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001291","url":null,"abstract":"<p><strong>Purpose of review: </strong>The variety of prostate cancer aggressiveness in patients with biochemical recurrence (BCR) leads to the unmet need of accurate risk stratification. This review examined the recently published risk stratification tool using prostate-specific membrane antigen positron-emission tomography (PSMA-PET) compared to the risk categories by European Association of Urology (EAU).</p><p><strong>Recent findings: </strong>The risk stratification by EAU was proposed for patients with BCR, including the doubling time of the prostate-specific-antigen and Gleason score as predictors for survival. Although stratification into low- vs. high-risk groups reached significant differences in the external validation, C-indices determined moderate discriminative ability and the need to improve the EAU risk categories. PSMA-PET was recently validated as prognostic biomarker and PSMA-PET standardized by Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) metrics were combined to create a visual and a quantitative nomogram to predict overall survival.</p><p><strong>Summary: </strong>The unmet need to improve risk stratification for prostate cancer patients experiencing BCR was addressed with PSMA-PET PROMISE (PPP) nomograms. Although PPP nomograms are not applied for individual patient counselling yet, they can be used additionally to EAU risk categories.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962052","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":"Metastasis-directed therapy in oligometastatic and oligoprogressive renal cell carcinoma.","authors":"Shawn Dason, Shang-Jui Wang, Dominic Franceschelli, Eric A Singer","doi":"10.1097/MOU.0000000000001254","DOIUrl":"10.1097/MOU.0000000000001254","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review addresses the evolving role of metastasis-directed therapy (MDT) in the management of oligometastatic and oligoprogressive renal cell carcinoma (RCC). With advances in both surgical techniques and stereotactic ablative radiotherapy (SABR), it is timely to explore how MDT can improve patient outcomes in these distinct disease states. The review highlights the potential of MDT to delay systemic therapy and improve quality of life while noting the lack of randomized clinical trial data guiding its use.</p><p><strong>Recent findings: </strong>Recent literature emphasizes the outcomes of MDT, including metastasectomy and SABR, in managing oligometastatic and oligoprogressive RCC. Key studies suggest that MDT may prolong progression-free survival and delay systemic therapy. SABR has demonstrated high local control rates and manageable toxicity, offering a less invasive alternative to surgery. Despite these findings, there remains uncertainty about MDT's long-term impact on overall survival due to the absence of prospective randomized trials.</p><p><strong>Summary: </strong>MDT holds promise in treating RCC by offering symptom relief, improving quality of life, and potentially delaying systemic therapy. However, the long-term benefits, particularly regarding survival outcomes, remain unclear. Further research, including prospective trials, is needed to better define the role of MDT in clinical practice, particularly in the absence of clear guidelines for patient selection.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"194-204"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913998","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":"Overlooked and underserved: how healthcare fails men in the pursuit of equity.","authors":"Robert J Schulz, Heidemarie Ofner, Péter Nyirády, Pawel Rajwa, Julia Weiss, Shahrokh F Shariat, Tamás Fazekas","doi":"10.1097/MOU.0000000000001257","DOIUrl":"10.1097/MOU.0000000000001257","url":null,"abstract":"<p><strong>Purpose of review: </strong>Men face distinctive health-related challenges as a result of biological, behavioral, and sociocultural factors. In addition, the modern healthcare system does not offer men equal opportunities and options to ensure sex-specific access and delivery to health services. Men's health concerns are, indeed, often not addressed or even forgotten. In this review, we wanted to assess the impact of biology and sociocultural effects on sex-specific life-expectancy.</p><p><strong>Recent findings: </strong>Globally, men have a shorter life expectancy than women. With a 5.8 years gender gap in the USA and 5.4 in the EU-27 (both in 2022). Cardiovascular disease, cancer, and accidents continue to represent the primary causes of mortality for both genders with all having disproportional preponderance in men. In recent years, there has been a notable decline in age-adjusted mortality rates related to cancer, while there has been an increase in deaths from accidental and intentional self-harm. Moreover, in the United States, men are more likely than women to develop and die from nonsex-specific cancers. As a result, men's poor health affects productivity, absenteeism, and employment.</p><p><strong>Summary: </strong>The status of men in healthcare is complex. It is rooted in history, culture, and institutions. To address disparities, we need a comprehensive approach that includes policy reforms, sociocultural changes, and a fair and equitable public discourse. Grassroots and top-down strategies are needed to ensure a value-based societal healthcare system acknowledging the unique health needs of men.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"148-156"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913999","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":"Surgical management of testicular cancer with limited retroperitoneal disease.","authors":"Silvan Sigg, Christian Rothermundt, Christian Daniel Fankhauser","doi":"10.1097/MOU.0000000000001253","DOIUrl":"10.1097/MOU.0000000000001253","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chemotherapy offers excellent long-term survival rates for men with clinical stage II germ cell tumours. However, in this predominantly younger population, chemotherapy is associated with long-term adverse effects. Primary retroperitoneal lymph node dissection (RPLND) may serve as an alternative treatment option, preserving oncological safety while potentially reducing adverse effects in men with limited retroperitoneal disease.</p><p><strong>Recent findings: </strong>The rate of negative surgical specimens (pN0) in primary RPLND series varies between 4% and 16% in seminoma and 12-29% in nonseminoma, respectively. This suggests that early restaging, novel biomarkers, and/or percutaneous biopsies should be considered to minimize overtreatment. In stage II seminoma, three prospective RPLND series with follow-up periods ranging from 22 to 51 months report recurrence rates between 6% and 30%. In contrast, only retrospective data are available for stage II nonseminoma, with follow-up periods and recurrence rates yet to be fully defined. Following primary RPLND with confirmed viable cancer, adjuvant chemotherapy reduces recurrence risk. In cases of recurrence after primary RPLND, first-line chemotherapy remains a highly effective salvage option. Ongoing research is needed to identify risk factors for contralateral retroperitoneal disease to refine surgical templates and to determine predictors of recurrence, allowing for more personalized decisions regarding the use of adjuvant chemotherapy and follow-up strategies.</p><p><strong>Summary: </strong>Men with clinical stage II germ cell tumours may benefit from RPLND due to its lower risk of long-term side effects. Chemotherapy is an effective salvage treatment if needed. Although RPLND is a safe and promising option, further studies are required to better understand relapse risks and to tailor treatment plans based on individual patient factors.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"178-188"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863542","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":"Prostatectomy and other local treatments for oligometastatic prostate cancer: recent and ongoing trials.","authors":"Andrew M Fang, Landan P MacDonald, Justin R Gregg, Bilal A Siddiqui, Chad Tang, Brian F Chapin","doi":"10.1097/MOU.0000000000001251","DOIUrl":"10.1097/MOU.0000000000001251","url":null,"abstract":"<p><strong>Purpose of review: </strong>Oligometastatic prostate cancer (OMPCa) is an intermediary state between localized and disseminated metastatic disease that has historically been treated with androgen deprivation therapy (ADT) and more recently with additional systemic therapies in combinations. However, cytoreductive control of the primary tumor may offer an opportunity to control the disease and enhance the response from systemic treatment. In this review, the use of local therapy to the prostate including cytoreductive prostatectomy (CRP), whole pelvis radiotherapy (RT), and focal therapies will be evaluated in the treatment of patients with newly diagnosed OMPCa.</p><p><strong>Recent findings: </strong>Retrospective studies have demonstrated that some patients with OMPCa may indeed benefit from CRP. With preliminary trials demonstrating that CRP is safe and feasible, there are several phase II and III trials that are currently underway to investigate the role of CRP among patients with OMPCa. Results from several clinical trials have demonstrated that RT and ADT may benefit patients with OMPCa. Lastly, the evidence for focal and cryotherapy remains limited and further clinical trials are required.</p><p><strong>Summary: </strong>OMPCa is a unique disease state that may benefit from local therapy to the primary tumor. Further study is required to guide treatment selection and patient candidacy. Several trials specifically are awaited to better define the treatment options for patients.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"171-177"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738715","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":"A narrative review on the performance and outcomes of penile and scrotal surgery in the ambulatory setting.","authors":"Jainik Shah, Maximilian G Fidel, Ahmed Mousa Almuhanna, Dhiraj S Bal, Premal Patel","doi":"10.1097/MOU.0000000000001243","DOIUrl":"10.1097/MOU.0000000000001243","url":null,"abstract":"<p><strong>Purpose of review: </strong>Following the COVID-19 pandemic, surgical wait times have surged, creating a backlog in elective urological procedures. This review aims to address the need to explore ambulatory care for penile and scrotal surgeries, which can offer benefits by shifting these procedures away from traditional inpatient settings.</p><p><strong>Recent findings: </strong>Recent studies confirm the safety and efficacy of performing penile and scrotal procedures in an ambulatory setting using local anesthesia (LA) or loco-sedative techniques. Of 616 reviewed cases, over 90% of patients expressed high satisfaction with LA and reported minimal postoperative complications. Pain management advancements, particularly the use of liposomal bupivacaine, reduced the need for opioids postoperatively. Importantly, no intraoperative complications or hospital admissions were reported, and adverse events were managed conservatively. The data highlighted in this review supports a move towards outpatient surgeries as a safe alternative to inpatient care for select cases.</p><p><strong>Summary: </strong>This review highlights the strong potential for ambulatory urological surgeries to alleviate surgical backlogs significantly, while reducing strain on hospital resources, and maintaining high levels of patient satisfaction. As evidence continues to grow on the safety, feasibility, and effectiveness of LA in office-based procedures, expanding ambulatory urological will be quintessential in modernizing patient care and reducing healthcare burdens.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"142-147"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575117","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}