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Current Opinion in Urology

Tim Nestler, Stefan Haneder, Nils G Hokamp
PURPOSE OF REVIEW: Radiological imaging techniques are a fast developing field in medicine. Therefore, the purpose of this review was to identify and discuss the latest changes of modern imaging techniques in the management of urinary stone disease. RECENT FINDINGS: The introduction of iterative image reconstruction enables low-dose and ultra-low-dose (ULD) protocols. Although current guidelines recommend their utilization in nonobese patients recent studies indicate that low-dose imaging may be feasible in obese (<30 kg/m) but not in bariatric patients...
November 9, 2018: Current Opinion in Urology
Benedikt Becker, Andreas J Gross, Christopher Netsch
PURPOSE OF REVIEW: The aim of this study was to summarize the recent innovations of the holmium laser with special respect to lithotripsy. Therefore, we reviewed and discussed the most recent and pivotal publications on this topic. RECENT FINDINGS: The current literature underlines Holmium:yttrium-aluminium-garnet (Ho:YAG) lithotripsy as a well tolerated and efficient method to treat urinary calculi. Because of modifiable adjustments of pulse energy, pulse frequency, and pulse length, especially with newer generations of holmium lasers, urologists can accurately choose between the 'fragmentation' and 'dusting' technique with its alterations...
November 6, 2018: Current Opinion in Urology
Rodrigo Suarez-Ibarrola, Simon Hein, Arkadiusz Miernik
PURPOSE OF REVIEW: To summarize the recent literature on the topic of residual stone fragments in particular novel developments in this field. RECENT FINDINGS: The urological position towards residual fragments has shifted in recent years from observation, to active retrieval with innovative methods, to algorithm-based predictions of surgical outcomes. Novel technologies have been described to extract residual fragments through magnetism, a polyethylene endoscopic pouch and a biocompatible stone adhesive...
November 6, 2018: Current Opinion in Urology
Michael D Gross, Jonathan E Shoag, Jim C Hu
No abstract text is available yet for this article.
November 6, 2018: Current Opinion in Urology
Nicholas R Brook, Paolo Dell'Oglio, Ravi Barod, Justin Collins, Alexandre Mottrie
PURPOSE OF REVIEW: Robotic training in urology can be poorly structured, lack a basic skills foundation, and may not include teaching in important nontechnical human factor skills vital to the safe delivery of robotic care. Assessment of acquired skills is not routine. There is a need for structured and standardized curricular to deliver validated training and final assessment. The present reviews the current literature on training methods for robotic surgery, and examines the evidence for their effect on performance, where available...
November 1, 2018: Current Opinion in Urology
Ankeet Shah, Nima Nassiri, Siamak Daneshmand
PURPOSE OF REVIEW: Management of extraretroperitoneal (ERP) germ cell tumor (GCT) is a complex clinical scenario faced by urologic oncologists. This article reviews the indications and approach to management of ERP GCT masses. RECENT FINDINGS: ERP GCT management starts with chemotherapy, and for any residual masses, a careful consideration of surgical intervention versus salvage chemotherapy. Decision-making regarding residual ERP masses hinges on tumor markers, and also the anatomical location...
October 16, 2018: Current Opinion in Urology
Alberto Martini, Giorgio Gandaglia, Alberto Briganti
PURPOSE OF REVIEW: The implementation of novel technologies and refinements in the surgical technique are continuously changing the urological surgical scenario. The purpose of this review is to provide surgeons with the latest and most relevant updates in the field of robot-assisted radical prostatectomy (RARP) occurred over the last 12 months. RECENT FINDINGS: A randomized-controlled trial showed comparable 24-month urinary continence and erectile function recovery between open radical prostatectomy (ORP) and RARP...
October 15, 2018: Current Opinion in Urology
Vincent De Coninck, Etienne Xavier Keller, Olivier Traxer
PURPOSE OF REVIEW: To summarize recommendations of the guidelines of the American Urological Association and European Association of Urology, and our opinion on which urinary tract stone disease patients should be metabolically evaluated at which moment and how often. RECENT FINDINGS: A standard metabolic evaluation should be performed in all stone formers to prevent recurrent disease. This includes a medical and lifestyle history, physical examination, basic urine and blood analysis, radiological examination and stone analysis...
October 15, 2018: Current Opinion in Urology
Fouad Aoun, Simone Albisinni, Roland van Velthoven
PURPOSE OF REVIEW: We summarize the evidence on accurate target definition, precise imaging, and guiding systems that are a necessary ground to targeted focal therapy. RECENT FINDINGS: Accurate target detection is based on the ability of imaging to locate and characterize precisely the tumor burden and differentiation inside the prostate. There is a clear correlation with the multiparametric MRI (mpMRI) images and the morphologic attributes of the tumor. Limitations stem from the heterogeneity and the multifocality of prostate cancer...
October 12, 2018: Current Opinion in Urology
Laura Sandbergen, Selcuk Guven, Maria Pilar Laguna
PURPOSE OF REVIEW: Currently, small renal masses account for the largest proportion of renal tumour and small renal cell carcinomas (RCC). Although partial nephrectomy, whenever possible, is recognized as the gold standard for treatment, thermal ablation has gained increasing attention as optional treatment in a population sector harbouring small renal masses/small RCCs. The purpose of this review is to update comparative outcomes between these two options of treatment. RECENT FINDINGS: Recent observational case-control and population-based cohorts applying propensity score or inverse probability treatment weighted methodology adjusting for baseline patient and tumour characteristics, compare outcomes between partial nephrectomy and thermal ablation (both cryotherapy and radiofrequency), radical nephrectomy and thermal ablation and between thermal ablation and nonsurgical management...
October 10, 2018: Current Opinion in Urology
Kemal Sarica
PURPOSE OF REVIEW: The incidence of urolithiasis has shown a prominent increase in the last two to three decades and evidence-based data have clearly indicated the certain role of obesity and overweight in both children and adults. As a certain component of metabolic syndrome, 'obesity' has been found to have a significant impact on the urinary metabolic risk factors which may be important in stone formation. In this present review article, we aimed to evaluate the possible association between obesity and urolithiasis and related risk factors...
October 10, 2018: Current Opinion in Urology
Ashish M Kamat, Paolo Gontero
No abstract text is available yet for this article.
November 2018: Current Opinion in Urology
Alireza Aminsharifi, Jean de la Rosette, Thomas J Polascik
No abstract text is available yet for this article.
November 2018: Current Opinion in Urology
Alireza Aminsharifi, Rajan T Gupta, Jiaoti Huang, Thomas J Polascik
PURPOSE OF REVIEW: The current trend in image-based identification and characterization of prostate cancer (PCa) utilizing multiparametric MRI (mpMRI) has affected diagnostic and treatment planning in terms of targeted biopsy, risk stratification and prognostic evaluation, clinical management and follow-up. However, the accuracy of MRI to detect clinically significant disease is variable between different institutions. The role of quality control initiatives to increase the concordance between clinical-imaging-histopathological data and to improve accurate targeting of the suspicious lesions cannot be overemphasized...
November 2018: Current Opinion in Urology
Nicolai Hübner, Shahrokh F Shariat, Mesut Remzi
PURPOSE OF REVIEW: The aim of this study was to summarize the latest evidence, as well as the rationale behind using focal therapy for the treatment of prostate cancer. With patients becoming more educated, knowledge of the available evidence is key when discussing treatment. RECENT FINDINGS: In older works, the natural history of prostate cancer has been described as being multifocal, driven by one index lesion. This represents the key argument for most experts, why focal therapy is feasible in prostate cancer...
November 2018: Current Opinion in Urology
Jared S Winoker, Peter A Pinto, Ardeshir R Rastinehad
PURPOSE OF REVIEW: To discuss contemporary data on the value of multiparametric MRI (mpMRI) for guiding the decision to biopsy men at risk for prostate cancer, as well as its utility in active surveillance programs. RECENT FINDINGS: Although a systematic 12-core biopsy is the current standard of care for men with increased suspicion for prostate cancer, MRI with or without targeted biopsy has been shown to reliably improve the detection of clinically significant disease following a prior negative biopsy...
November 2018: Current Opinion in Urology
Iris S G Brummelhuis, J Alfred Witjes, Edward M Messing
PURPOSE OF REVIEW: To describe the importance of risk stratification and the role of more conservative management like office fulguration, office laser ablation and active surveillance in recurrent low-grade Ta tumours. RECENT FINDINGS: Updated models have been designed for risk stratification of intermediate-risk tumours. Conservative forms of management like office fulguration or laser ablation and even active surveillance seem well tolerated; however, randomized, controlled trials are lacking...
November 2018: Current Opinion in Urology
Alexa R Meyer, Gregory A Joice, Mohamad E Allaf, Steven P Rowe, Michael A Gorin
PURPOSE OF REVIEW: To explore the current state of using prostate-specific membrane antigen (PSMA)-targeted PET imaging to aid in the diagnosis of clinically significant prostate cancer. RECENT FINDINGS: Prostate-specific antigen screening remains controversial, as it is associated with the underdetection of clinically significant prostate cancer as well as the overdetection and subsequent overtreatment of clinically insignificant disease. A diagnostic test that can accurately assess the presence of clinically significant prostate cancer and avoid detection of low-risk tumors is needed...
November 2018: Current Opinion in Urology
Andreas Bruchbacher, Francesco Soria, Melanie Hassler, Shahrokh F Shariat, David D'Andrea
PURPOSE OF REVIEW: To summarize recent findings on tissue biomarkers for nonmuscle-invasive bladder cancer (NMIBC) with an emphasis on their prognostic and predictive role. RECENT FINDINGS: Accurate risk stratification is essential and the major driver in patient counseling regarding surveillance and decision making relative to therapeutic strategies. In NMIBC, there is an unmet need for improving the accuracy of current prognostic and predictive models, which rely only on clinicopathologic features and do not reflect the biological heterogeneity of the cancer in each individual...
November 2018: Current Opinion in Urology
Francesco Soria, David D'Andrea, Kamal Pohar, Shahrokh F Shariat, Yair Lotan
PURPOSE OF REVIEW: To summarize the current knowledge about the clinical role of novel urinary markers in bladder cancer (BCa) management, from diagnosis to follow-up, from prognosis of oncological outcomes to response to intravesical therapy. RECENT FINDINGS: Urinary markers have been developed to overcome the limitations of the current available tools for the diagnosis and surveillance of BCa patients. However, to date, because of their limited performances, urinary markers are not generally used in clinical practice...
November 2018: Current Opinion in Urology
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