Charles Mazeaud, Natalia Hernandez, Ricardo R Gonzalez
{"title":"Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction.","authors":"Charles Mazeaud, Natalia Hernandez, Ricardo R Gonzalez","doi":"10.1007/s11934-023-01165-6","DOIUrl":"https://doi.org/10.1007/s11934-023-01165-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>There is no consensus on preoperative functional testing prior to surgeries for benign prostatic obstruction causing lower urinary tract symptoms (LUTS).</p><p><strong>Recent findings: </strong>Surgical 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. In this narrative review of the literature, we report recent findings and controversies regarding the benefits and downside of UDS, and the use of other less-invasive approaches to achieve this goal. The lack of strong evidence for or against performing UDS was surprising. Prospective UDS data may not predict surgical outcomes if there is no consensus on criteria that directs surgical intervention. However, confirming the presence of BOO and characterizing the bladder function to identify detrusor over- and underactivity may help counselling and setting patient's post-operative expectations. Urocuff, a non-invasive testing offers promising results to address this problem with a less-invasive assessment of BOO. We emphasize better pre-operative characterization of patients to confirm BOO and better define subgroups to improve surgical decision-making.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9944514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isabel Sanz-Gómez, Oriol Angerri, Michael Baboudjian, Andrés Kanashiro, Sílvia Gracia, Félix Millán, Francisco Sánchez-Martín, Bhaskar Somani, Juan Antonio Galan-Llopis, Yazeed Barghouthy, Esteban Emiliani
{"title":"Role, Cost, and Availably of Urinary pH Monitoring for Kidney Stone Disease-A Systematic Review of the Literature.","authors":"Isabel Sanz-Gómez, Oriol Angerri, Michael Baboudjian, Andrés Kanashiro, Sílvia Gracia, Félix Millán, Francisco Sánchez-Martín, Bhaskar Somani, Juan Antonio Galan-Llopis, Yazeed Barghouthy, Esteban Emiliani","doi":"10.1007/s11934-023-01166-5","DOIUrl":"https://doi.org/10.1007/s11934-023-01166-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Urinary 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.</p><p><strong>Recent findings: </strong>A total of 9 articles were included (1886 urinary pH measurements). They reported information about urinary dipsticks, portable electronic pH meters and electronic strip readers, amongst other methods. Accuracy was compared with a laboratory pH meter (gold standard). Urinary dipsticks were found to be not accurate enough to guide clinical decision making and portable electronic pH meters showed promising results. Urinary dipsticks are neither precise nor accurate enough. Portable electronic pH meters seem to be more accurate, easy to use, and cost-effective. They are a reliable source for patients to use at home in order to prevent future episodes of nephrolithiasis.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10317951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mriganka Mani Sinha, Vineet Gauhar, Lazaros Tzelves, Tzevat Tefik, Rifat Burak Ergul, Patrick Juliebø-Jones, Bhaskar K Somani
{"title":"Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?","authors":"Mriganka Mani Sinha, Vineet Gauhar, Lazaros Tzelves, Tzevat Tefik, Rifat Burak Ergul, Patrick Juliebø-Jones, Bhaskar K Somani","doi":"10.1007/s11934-023-01167-4","DOIUrl":"https://doi.org/10.1007/s11934-023-01167-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Robotic 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.</p><p><strong>Recent findings: </strong>A 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 (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10233196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ultrasound-Guided PCNL - Why Are We Still Performing Exclusively Fluoroscopic Access?","authors":"David T Tzou, Thomas O Tailly, Karen L Stern","doi":"10.1007/s11934-023-01163-8","DOIUrl":"https://doi.org/10.1007/s11934-023-01163-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>While urologists are traditionally taught to perform percutaneous nephrolithotomy (PCNL) utilizing exclusively fluoroscopy, ultrasound has emerged as a safe alternative. This article showcases the major reasons why ultrasound-guided access should be considered the first-line approach for performing access for PCNL.</p><p><strong>Recent findings: </strong>There 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. Ultrasound-guided PCNL is not only an achievable skill for urologists to learn but provides multiple advantages over traditional fluoroscopic access. As every effort should be given to help reduce radiation exposure for kidney stone patients as well as performing surgeons and operating theater personnel, endourologists should strive to add this technique to their armamentarium.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Fastenau, Kunj Jain, Aleksandar Popovic, Evan Kovac
{"title":"Review of Active Surveillance in Underrepresented and High-Risk Populations: Feasibility and Safety.","authors":"John Fastenau, Kunj Jain, Aleksandar Popovic, Evan Kovac","doi":"10.1007/s11934-023-01158-5","DOIUrl":"https://doi.org/10.1007/s11934-023-01158-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to investigate the current use and effectiveness of active surveillance (AS) for clinical low-risk prostate cancer (PCa) in men considered to be \"high-risk\" based on the factors of race, genetics, healthcare access, and socioeconomic status.</p><p><strong>Recent findings: </strong>Advances in molecular biomarkers and imaging have improved the detection, risk stratification, and treatment of PCa. Still, overdiagnosis and overtreatment of indolent disease remain a concern. AS is therefore the preferred option for clinical low-risk disease. Yet, because of the variability in PCa presentation based on the aforementioned environmental and genetic factors, the question remains: Is active surveillance a safe option for everyone? Provider hesitancy should not necessarily exclude high-risk men from participating in AS. Rather, clinicians should employ shared decision-making, sound clinical judgment, and stringent follow-up in order to effectively counsel AS candidates and optimize AS-related outcomes in \"high-risk\" individuals.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9633014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ellen M Cahill, John L Pfail, Melinda Z Fu, Biren Saraiya, Tina Mayer, Ryan D Stephenson, Ronald D Ennis, Lara Hathout, Matthew P Deek, Saum Ghodoussipour, Thomas L Jang
{"title":"Metastasis-Directed Therapy for Oligometastatic Castration-Sensitive Prostate Cancer: An Alternative to ADT?","authors":"Ellen M Cahill, John L Pfail, Melinda Z Fu, Biren Saraiya, Tina Mayer, Ryan D Stephenson, Ronald D Ennis, Lara Hathout, Matthew P Deek, Saum Ghodoussipour, Thomas L Jang","doi":"10.1007/s11934-023-01159-4","DOIUrl":"https://doi.org/10.1007/s11934-023-01159-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>The standard treatment of patients with metastatic prostate cancer is systemic treatment with androgen-deprivation therapy (ADT). The spectrum-based model of metastatic disease includes the presence of an oligometastatic state, an intermediary between localized and widespread metastatic disease, in which radical local treatment might improve systemic control. Our purpose is to review the literature on metastasis-directed therapy in the treatment of oligometastatic prostate cancer.</p><p><strong>Recent findings: </strong>Several prospective clinical trials have reported improvements in ADT-free survival and progression-free survival with metastasis-directed therapy of oligometastatic prostate cancer. Retrospective studies have found improvements in oncologic outcomes for patients with oligometastatic prostate cancer undergoing metastasis-directed therapy, and several recent prospective clinical trials have confirmed these results. Advancements in imaging as well as an understanding of the genomics of oligometastatic prostate cancer may allow for better patient selection for metastasis-directed therapy and the potential for cure in selected patients.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thiago Camelo Mourão, Stephania Martins Bezerra, Victor Espinheira Santos, Eder Silveira Brazão, Walter Henriques da Costa, Stênio de Cássio Zequi
{"title":"Role of the Renin-Angiotensin System Components in Renal Cell Carcinoma: A Literature Review.","authors":"Thiago Camelo Mourão, Stephania Martins Bezerra, Victor Espinheira Santos, Eder Silveira Brazão, Walter Henriques da Costa, Stênio de Cássio Zequi","doi":"10.1007/s11934-023-01160-x","DOIUrl":"https://doi.org/10.1007/s11934-023-01160-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>The physiological aspects of renin-angiotensin system (RAS) components are described in this review. Additionally, we present the main results of studies that could indicate an association between alterations in these components and cancer, particularly renal cell carcinoma (RCC).</p><p><strong>Recent findings: </strong>The RAS undergoes a series of homeostatic and modulatory processes that extend to hypertrophy, hyperplasia, fibrosis, and remodeling, as well as angiogenesis, pro-inflammatory responses, cell differentiation, stem cell programming, and hematopoiesis. The link between cancer-related inflammation and RAS signaling converge in the response to tumor hypoxia and oxidative stress mechanisms, particularly with the angiotensin type 1 receptor leading to activation of transcription factors such as nuclear factor κB (NF-κB), as well as members of the signal transducer and activation of transcription (STAT) family and HIF1⍺. Dysregulation of the physiological actions of RAS in the microenvironment of inflammation and angiogenesis promotes tumor cell growth.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin N Schmeusser, Adil A Ali, Florian J Fintelmann, Jose M Garcia, Grant R Williams, Viraj A Master, Sarah P Psutka
{"title":"Imaging Techniques to Determine Degree of Sarcopenia and Systemic Inflammation in Advanced Renal Cell Carcinoma.","authors":"Benjamin N Schmeusser, Adil A Ali, Florian J Fintelmann, Jose M Garcia, Grant R Williams, Viraj A Master, Sarah P Psutka","doi":"10.1007/s11934-023-01157-6","DOIUrl":"https://doi.org/10.1007/s11934-023-01157-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to provide an up-to-date understanding regarding the literature on sarcopenia and inflammation as prognostic factors in the context of renal cell carcinoma (RCC).</p><p><strong>Recent findings: </strong>Sarcopenia is increasingly recognized as a prognostic factor in RCC. Emerging literature suggests monitoring quantity of muscle on successive imaging and examining muscle density may be additionally informative. Inflammation has prognostic ability in RCC and is also considered a key contributor to development and progression of both RCC and sarcopenia. Recent studies suggest these two prognostic factors together may provide additional prognostic ability when used in combination. Ongoing developments include quality control regarding sarcopenia research and imaging, improving understanding of muscle loss mechanisms, and enhancing clinical incorporation of sarcopenia via improving imaging analysis practicality (i.e., artificial intelligence) and feasible biomarkers. Sarcopenia and systemic inflammation are complementary prognostic factors for adverse outcomes in patients with RCC. Further study on high-quality sarcopenia assessment standardization and expedited sarcopenia assessment is desired for eventual routine clinical incorporation of these prognostic factors.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10330545/pdf/nihms-1900776.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vineet Gauhar, Carlo Giulioni, Nariman Gadzhiev, Virgilio De Stefano, Jeremy Yuen-Chun Teoh, Ho Yee Tiong, Kazumi Taguchi, Giulio Milanese, Andrea Benedetto Galosi, Bhaskar Kumar Somani, Daniele Castellani
{"title":"An Update of In Vivo Application of Artificial Intelligence and Robotics for Percutaneous Nephrolithotripsy: Results from a Systematic Review.","authors":"Vineet Gauhar, Carlo Giulioni, Nariman Gadzhiev, Virgilio De Stefano, Jeremy Yuen-Chun Teoh, Ho Yee Tiong, Kazumi Taguchi, Giulio Milanese, Andrea Benedetto Galosi, Bhaskar Kumar Somani, Daniele Castellani","doi":"10.1007/s11934-023-01155-8","DOIUrl":"https://doi.org/10.1007/s11934-023-01155-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Kidney puncture is a key step in percutaneous nephrolithotomy (PCNL). Ultrasound/fluoroscopic-guided access to the collecting systems is commonly used in PCNL. Performing a puncture is often challenging in kidneys with congenital malformations or complex staghorn stones. We aim to perform a systematic review to examine data on in vivo applications, outcomes, and limitations of using artificial intelligence and robotics for access in PCNL.</p><p><strong>Recent findings: </strong>The literature search was performed on November 2, 2022, using Embase, PubMed, and Google Scholar. Twelve studies were included. 3D in PCNL is useful for image reconstruction but also in 3D printing with definite benefits seen in improving anatomical spatial understanding for preoperative and intraoperative planning. 3D model printing and virtual and mixed reality allow for an enhanced training experience and easier access which seems to translate into a shorter learning curve and better stone-free rate compared to standard puncture. Robotic access improves the accuracy of the puncture for ultrasound- and fluoroscopic-guided access in both supine and prone positions. The potential advantage robotics are using artificial intelligence to do remote access, reduced number of needle punctures, and less radiation exposure during renal access. Artificial intelligence, virtual and mixed reality, and robotics may play a key role in improving PCNL surgery by enhancing all aspects of a successful intervention from entry to exit. There is a gradual adoption of this newer technology into clinical practice but is yet limited to centers with access and the ability to afford this.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9954476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Residency Surgical BPH Training Paradigms from MIST to HOLEP.","authors":"Thaiphi Luu, Ricardo R Gonzalez","doi":"10.1007/s11934-023-01153-w","DOIUrl":"https://doi.org/10.1007/s11934-023-01153-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Benign prostatic hyperplasia (BPH) is a common medical condition of older men that often requires medical or surgical therapy. Surgical options for BPH have grown exponentially over the last two decades. The numerous options and/or lack of access to them can make it challenging for new trainees to gain proficiency. We examine the literature for available BPH surgical simulators, learning curves, and training pathways.</p><p><strong>Recent findings: </strong>Each BPH surgical therapy has a learning curve which must be overcome. There is an abundance of TURP simulators which have shown face, content, and construct validity in the literature. Similarly, laser therapies have validated simulators. Newer technologies do have available simulators, but they have not been validated. There are strategies to improve learning and outcomes, such as having a structured training program. Simulators are available for BPH surgical procedures and some have been implemented in urology residencies. It is likely that such simulation may make urologists more facile on their learning curves for newer technologies. Further studies are needed. Future directions may include integration of simulator technology into training pathways that include surgical observation and proctorship.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9457728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}