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Current Opinion in Urology

Jale Lakes, Achim Lusch, Alessandro Nini, Peter Albers
PURPOSE OF REVIEW: The management of residual tumor masses in patients with metastatic germ cell tumor and persistently elevated tumor marker levels after first- and second-line chemotherapy usually excludes surgical resection. The lack of benefit of salvage chemotherapy in patients with persistently elevated markers implies a degree of chemotherapy resistance. However, previous studies demonstrated therapeutic efficacy for a surgical approach in these very particular patients. Therefore, we evaluated pre and postoperative factors, which help to identify suitable candidates, who could potentially benefit from tumor resection...
July 12, 2018: Current Opinion in Urology
Solomon L Woldu, Aditya Bagrodia
PURPOSE OF REVIEW: We aim to give an overview of the epidemiology and treatment trends of testicular germ cell tumors (TGCTs), with an emphasis on recent trends. RECENT FINDINGS: The incidence of TGCT appears to be increasing, particularly in developed countries, although the reasons are not well understood. There is evidence of racial differences in predisposition to TGCT, with white men having highest risk and men of African or Asian descent having lower risk...
July 12, 2018: Current Opinion in Urology
Adriana M Pedraza, Andrew J Stephenson
PURPOSE OF REVIEW: Testicular germ cell tumour (TGCT) is a common malignancy among young men. There is controversy regarding the best approach for patients with clinical stage I disease due to rates of relapse with active surveillance in contrast to overtreatment with adjuvant therapy. The aim of this review is to describe the role of prognostic factors in this setting. RECENT FINDINGS: Molecular prognostic factors have been described as a possible future aid to clinical and histologic features in the approach of patients with clinical stage I germ cell tumours...
July 3, 2018: Current Opinion in Urology
Costantine Albany
PURPOSE OF REVIEW: Despite the high cure rate of germ-cell tumors (GCTs), the 5-year survival rate for those patients with metastatic poor-risk GCT rarely exceeds 50%. The purpose of this review is to highlight past and recent discoveries in the treatment of patients with poor-risk GCT. RECENT FINDINGS: Multiple clinical trials to optimize the management of poor-risk germ-cell cancer are ongoing. First-line phase II clinical trials of dose-dense multidrug and paclitaxel-based regimens such as accelerated bleomycin, etoposide, and cisplatin (BEP), dose-dense chemotherapy and paclitaxel, ifosfamide, and cisplatin (TIP) reported promising results...
July 3, 2018: Current Opinion in Urology
Ryan P Werntz, Shane M Pearce, Scott E Eggener
PURPOSE OF REVIEW: Examine and discuss indications, technique, and outcomes for robotic retroperitoneal lymph node dissection (RPLND) for testicular cancer. RECENT FINDINGS: Open RPLND has been the longstanding standard of care for both primary and post chemotherapy RPLND. Recently, robotic RPLND has been an attractive option with the intent of reducing the morbidity associated with open surgery while providing identical oncologic efficacy. Naysayers of robotic RPLND suggest it is often inappropriately used as a staging procedure and consequently can compromise oncologic efficacy...
July 3, 2018: Current Opinion in Urology
Christoph Oing, Carsten Bokemeyer
PURPOSE OF REVIEW: Prognosis of patients with refractory or multiply relapsed germ cell cancer (GCC) is dismal with a life expectancy of a few months only. Thus, new targets and treatment options are urgently needed. Here, we review and discuss the biological basis and first clinical results of immune-checkpoint inhibition by targeting programed death 1 (PD-1) or its ligand (PD-L1) in treatment-refractory GCCs. RECENT FINDINGS: There is a biological rationale to evaluate immune-checkpoint inhibitors in refractory GCCs, as PD-L1 is often expressed and refractory tumors often display mismatch repair deficiency or microsatellite instability...
June 27, 2018: Current Opinion in Urology
Julian Veser, Mehmet Özsoy, Christian Seitz
PURPOSE OF REVIEW: To summarize the latest findings of congenital and acquired diseases related to stone formation and help understanding the multitude of cofactors related to urolithiasis. RECENT FINDINGS: Urolithiasis is related to a broad spectrum of congenital and acquired diseases and its management varies according to the stone type, underlying disease or recurrence rate, but it also changes according to recent findings and developments. As prevalence of urolithiasis is constantly increasing, identification of high-risk stone formers and early treatment is essential...
June 27, 2018: Current Opinion in Urology
Andreas Skolarikos
PURPOSE OF REVIEW: To identify the latest progression on medical treatment of urinary stones. RECENT FINDINGS: Nonsteroidal anti-inflammatory drugs should be the preferred analgesic option for patients presenting to the emergency department with renal colic. A-blockers could be of patient benefit when used for distal ureteral stones more than 5 mm in size. However, the quality of the randomized controlled studies on medical expulsive therapy (MET) is still low based on the Consolidated Standards for Reporting Trials (CONSORT) criteria...
June 22, 2018: Current Opinion in Urology
Ryan Speir, Clint Cary, Richard S Foster, Timothy A Masterson
PURPOSE OF REVIEW: The purpose of this review is to examine the historical context alongside contemporary studies in order to provide the most current recommendations for the management of patients with metastatic teratoma with malignant somatic transformation (MST). RECENT FINDINGS: The main themes in the recent literature covered herein include prognostic features, the management of early-stage disease, recommended chemotherapeutic and surgical strategies as well as recognized patterns of late relapse...
June 22, 2018: Current Opinion in Urology
Hanan Goldberg, Nayan Madhur, Robert J Hamilton
PURPOSE OF REVIEW: Germ cell testicular tumors (GCTTs) are the most common malignancy in young men, and the incidence is increasing worldwide. Most patients present with clinical stage I (CS1) disease, and active surveillance is being increasingly adopted as the preferred initial treatment modality. In this review, we describe the concept of conditional risk of relapse (CRR), an evolving risk estimate for CS1 GCTT patients on active surveillance who have not relapsed. RECENT FINDINGS: At diagnosis, patients are often counseled about their initial risk of relapse based on known risk factors present at diagnosis...
June 18, 2018: Current Opinion in Urology
Cesare M Scoffone, Cecilia M Cracco
PURPOSE OF REVIEW: The incidence of pediatric nephrolithiasis is on the rise, with a significant related morbidity and a concomitant relevant increase in healthcare costs. The purpose of the present review is to portray the current epidemiology and cause of renal stones in children, to provide a framework for appropriate clinical evaluation on an individual basis, and a guidance regarding treatment and prevention for the following significant risk of lifelong recurrence and deriving complications...
June 12, 2018: Current Opinion in Urology
Dimitrios Kotsiris, Konstantinos Adamou, Panagiotis Kallidonis
PURPOSE OF REVIEW: Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for the national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS: Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis...
June 11, 2018: Current Opinion in Urology
Helene Jung, Maria S Pless, Palle J S Osther
PURPOSE OF REVIEW: The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. RECENT FINDINGS: Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible...
June 6, 2018: Current Opinion in Urology
Roshan M Patel, Egor Parkhomenko, Kamaljot S Kaler, Zhamshid Okhunov, Ralph V Clayman, Jaime Landman
PURPOSE OF REVIEW: We evaluate the reasons that the majority of urologists infrequently biopsy a T1a small renal mass (SRM). RECENT FINDINGS: The majority of urologists report that a renal mass biopsy will not change their management in patients with a SRM given concerns of safety and efficacy of the biopsy. However, when comparing the safety and efficacy of SRM biopsy with neoplasms in all other major organ systems (all of which require biopsy prior to treatment), renal mass biopsy results are favorable...
July 2018: Current Opinion in Urology
Nathalie Garstka, Shahrokh F Shariat, Mesut Remzi
PURPOSE OF REVIEW: To review the current literature concerning the role of biopsy for renal masses. RECENT FINDINGS: Improvements in biopsy techniques lead to a redefinition of the role of renal mass biopsy (RMB).Additionally, several studies highlighted the safety, high diagnostic accuracy, and very low rate of clinically relevant complications of RMB. As the knowledge about the nature of renal masses has expanded, and management options for small renal masses are increasing, the current indications for RMB and its role for the management of small renal masses are also expanding...
July 2018: Current Opinion in Urology
Nicolai Hübner, Shahrokh Shariat, Mesut Remzi
PURPOSE OF REVIEW: To summarize the highest level evidence that was acquired within the last years, with regard to diagnosis of prostate cancer. With many secondary diagnostic tools becoming available, and not being mentioned in the guidelines, this review is meant to assist clinical decision-making in initial biopsy and rebiopsy settings. RECENT FINDINGS: The PROMIS Trial delivered level 1b evidence about the diagnostic accuracy of prostate multiparametric MRI (mpMRI) as a triage tool for prostate biopsy...
July 2018: Current Opinion in Urology
Adam J Gadzinski, Matthew R Cooperberg
PURPOSE OF REVIEW: Qualified clinical data registries (QCDRs) serve as a framework for quality improvement efforts, clinical research endeavors, and participation in reimbursement incentive programs. However, the measurement of quality and the recommendations to guide QCDRs in developing new quality measures is a complex process. In this review, we highlight the government policies that lead to the creation of QCDRs, how QCDR quality measures are developed, and the current QCDRs that focus on urological care...
July 2018: Current Opinion in Urology
Simpa S Salami, Arvin K George, Aaron M Udager
PURPOSE OF REVIEW: Large-scale genomic profiling has shed new light on the molecular underpinnings of renal cell carcinoma (RCC), spurring a much needed refinement of RCC subclassification based on an integrative assessment of histopathologic features and molecular alterations. At the same time, renal mass biopsies have become increasingly commonplace, necessitating ancillary tools to help guide clinical management. Herein, we briefly review our current understanding of RCC genomics, highlighting areas of possible clinical utility, as well as potential limitations, for renal mass biopsies...
July 2018: Current Opinion in Urology
Amy N Luckenbaugh, Gregory B Auffenberg
PURPOSE OF REVIEW: Physician-led quality improvement collaboratives have emerged across surgical disciplines as a means to measure and subsequently improve the quality and cost of care. In this review, we will provide an overview of recent successes within quality improvement collaboratives, as well as discuss future opportunities for such initiatives. RECENT FINDINGS: Successful quality improvement collaboratives have coupled data registries with a collegial environment to achieve data-driven improvements in care across diverse practice settings...
July 2018: Current Opinion in Urology
Douglas C Cheung, Jenny Li, Antonio Finelli
PURPOSE OF REVIEW: Prostate cancer has traditionally been diagnosed using systematic transrectal ultrasound-guided biopsy. However, given the inherent nature of sampling, a negative biopsy does not exclude clinically significant prostate cancer (csPCa), and continued controversy exists in the optimal management following initial biopsy. Numerous avenues for evaluation include multiparametric MRI (mpMRI), use of molecular biomarkers, repeat biopsy, and observation. RECENT FINDINGS: mpMRI has shown promise in guiding further biopsy management: for individuals with identified target lesions, increased accuracy and detection using combination targeted and systematic sampling has been repeatedly demonstrated in the literature as an effective strategy...
July 2018: Current Opinion in Urology
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