Current Opinion in Urology最新文献

{"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":"Small tools, big impact and redefining endourology: the paradigm shift of ureteroscopy for large stones and percutaneous nephrolithotomy for small stones - a literature review.","authors":"Maria Florencia Frascheri, Pablo Contreras, Dmitry Enikeev, Arman Tsaturyan, Giorgio Bozzini, Bhaskar K Somani","doi":"10.1097/MOU.0000000000001283","DOIUrl":"10.1097/MOU.0000000000001283","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aim to review the evolving paradigm in endourology, where technology has led us to manage small stones with ureteroscopy (URS) and large stones with miniaturized percutaneous nephrolithotomy (mPCNL) techniques. We analyse recent literature, their findings, emerging trends and newer technologies that are helping redefine modern day endourology in pushing these boundaries.</p><p><strong>Recent findings: </strong>A significant trend is the use of smaller devices to treat larger stones via ureteroscopy, and to treat smaller stones via percutaneous nephrolithotomy (PCNL). Improved laser technologies, smaller single use ureteroscopes and nephroscopes, suction access sheaths, all play a key role in this.The use of suction sheaths and vacuum assisted devices allows to control intrarenal pressure and help in reducing infectious and other complications whilst improving the stone-free rate (SFR). The treatment choice often depends on surgical expertise and available resources, guided by anatomical factors, stone composition and patient-specific considerations.</p><p><strong>Summary: </strong>The management of kidney stone disease has undergone a paradigm shift. While ureteroscopy is being done for larger renal stones, miniaturised PCNL is being done for small stones. This has been driven by a surge in technology, but a tailored and patient-centred approach is needed, and must be helped by guidelines and a multidisciplinary approach.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"347-353"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779314","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":"Immunotherapy toxicities in genito-urinary cancers: insights and challenges for clinicians.","authors":"Chiara Mercinelli, Chiara Carli, Rosanna Di Vita, Maria Oliveri, Luca Galli, Andrea Necchi","doi":"10.1097/MOU.0000000000001295","DOIUrl":"10.1097/MOU.0000000000001295","url":null,"abstract":"<p><strong>Purpose of review: </strong>The advent of immunotherapy has completely transformed cancer treatment, particularly in genitourinary malignancies, where immune checkpoint inhibitors (ICIs) are now a cornerstone in bladder and kidney cancer management. However, their use introduces a distinct spectrum of immune-related adverse events (irAEs), necessitating a thorough understanding of their incidence, mechanisms, and management. This review explores the safety profile of ICIs in genitourinary cancers, addressing their impact in both localized and metastatic settings.</p><p><strong>Recent findings: </strong>Recent studies highlight the diverse nature of irAEs, which can affect multiple organ systems with varying severity. While ICIs have demonstrated durable responses, their toxicity profile differs significantly from conventional therapies, requiring vigilant monitoring and prompt intervention. Notably, combination therapies, such as PD-1/PD-L1 inhibitors with CTLA-4 blockade or chemotherapy, may increase the risk of severe irAEs. Emerging data suggest that preexisting autoimmune conditions and specific patient subgroups may be more susceptible to toxicity, emphasizing the need for individualized risk assessment.</p><p><strong>Summary: </strong>This review highlights the need for continuous monitoring, effective management strategies, and further research to better understand the mechanisms of irAEs and improve the well tolerated use of immunotherapy in genitourinary cancers. Clinicians should be aware of the incidence of immunotherapy-related adverse events in order to early identify them.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"461-466"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984947","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}

{"title":"Genetics of male infertility.","authors":"Christian Corsini, Edoardo Pozzi, Andrea Salonia","doi":"10.1097/MOU.0000000000001287","DOIUrl":"10.1097/MOU.0000000000001287","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to outline the role of genetic abnormalities, including chromosomal anomalies, single-gene mutations, epigenetic changes, and mitochondrial DNA (mtDNA) defects, in male factor infertility.</p><p><strong>Recent findings: </strong>Recent advances in genetic research have brought incredible new perspectives to understanding male infertility, thanks in large part to next-generation sequencing. Chromosomal abnormalities like Klinefelter syndrome and Y chromosome microdeletions remain key contributors, with new insights into their variable presentations and impact on sperm retrieval. Advanced discoveries in genes such as CFTR and ADGRG2 have reframed our approach to conditions like CBAVD, while epigenetic disruptions and mitochondrial DNA mutations are revealing previously unrecognized mechanisms behind impaired spermatogenesis and sperm motility. Rare copy number variations and genetic syndromes like Kallmann and Noonan further underscore the complex interplay between systemic disorders and male fertility.</p><p><strong>Summary: </strong>The field of genetic infertility is rapidly evolving, offering new insights into the molecular mechanisms behind impaired spermatogenesis and fertility. These findings highlight the importance of integrating genetic testing into infertility evaluations to guide personalized management strategies.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"489-496"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779307","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 of serum, urine, and tissue-based prostate cancer biomarkers.","authors":"Veerain K Gupta, Brian D Cortese, Ruchika Talwar","doi":"10.1097/MOU.0000000000001293","DOIUrl":"10.1097/MOU.0000000000001293","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate cancer remains a leading malignancy among men in the United States. While prostate-specific antigen (PSA) screening improves early detection, it also leads to over-diagnosis and over-treatment. Biomarkers offer a promising solution for risk stratification and guiding treatment decisions. This review examines the cost-effectiveness of serum, urine, and tissue-based biomarkers to assess their impact on healthcare expenditures and clinical decision-making.</p><p><strong>Recent findings: </strong>Serum-based biomarkers like 4Kscore and PHI reduce unnecessary biopsies and healthcare costs. Urine-based biomarkers, including SelectMDx and ExoDx Prostate IntelliScore (EPI), have shown potential to optimize prostate cancer detection while being more cost-effective than some serum-based alternatives. Tissue-based biomarkers, such as OncotypeDx and Decipher, help in treatment selection, though their economic impact varies. Economic analyses suggest that biomarkers can enhance clinical decision-making while reducing healthcare expenditures, but real-world validation remains limited.</p><p><strong>Summary: </strong>Prostate cancer biomarkers improve risk stratification and may lower healthcare costs. However, variations in cost-effectiveness, reimbursement policies, and guideline recommendations limit widespread adoption. Prospective studies are needed to validate real-world cost savings and refine biomarker integration into clinical practice. Addressing financial and policy challenges is essential to ensure equitable access and maximize their impact on prostate cancer management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"412-417"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957259","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}