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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...
April 27, 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...
April 27, 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...
April 26, 2018: Current Opinion in Urology
Taylor Capretz, Roshan M Patel, Zhamshid Okhunov
PURPOSE OF REVIEW: This article provides a review of recent advances and issues regarding the controversial topic of renal mass biopsy (RMB). The purpose of this review is to provide an update on the current status of renal biopsy based on recently published literature. Here, we particularly focus on articles that have been published within the last 12 months. RECENT FINDINGS: The main topics covered in this review are the approach, diagnostic accuracy and risks related to RMB...
April 24, 2018: Current Opinion in Urology
Aaron A Laviana, Matthew J Resnick
PURPOSE OF REVIEW: Over the past several years, there has been an increasing focus on improving the 'value' of healthcare delivered, defined as the ratio of clinical outcomes to the costs incurred to achieve them. The former U.S. Secretary of Health and Human Services Sylvia Burwell announced in 2015 that the majority of healthcare payments in the Medicare and Medicaid programmes will align with value by 2018. Although this has yet to fully mature, numerous health systems have restructured with a goal of improving the value of care delivered to their populations...
April 24, 2018: Current Opinion in Urology
Parth K Modi, David Portney, Brent K Hollenbeck, Chad Ellimoottil
PURPOSE OF REVIEW: Telehealth, or the remote delivery of healthcare services using telecommunications technology, has the potential to revolutionize the delivery of healthcare and contribute to ongoing efforts to provide high-value care. RECENT FINDINGS: We discuss several categories of telehealth that have been applied to healthcare. Several of these approaches, in particular video visits and teleconsultations, have promising early data demonstrating the significant benefits of telehealth technology with respect to the quality of care, access, cost savings, and patient experience...
April 24, 2018: Current Opinion in Urology
Jaime O Herrera-Caceres, Michael A S Jewett
PURPOSE OF REVIEW: With this review, we describe the most recent advances in active surveillance as well as diagnosis and management of small renal masses (SRMs). RECENT FINDINGS: We discuss diagnosis, differentiation of solid from cystic lesions, risk prediction and treatment of the SRM. A better understanding of the disease facilitates the use of more conservatory treatments, such as active surveillance. Active surveillance has been increasingly accepted not only for SRM, but also for larger tumors and even metastatic patients...
April 24, 2018: Current Opinion in Urology
Matteo Fontana, Luca Boeri, Emanuele Montanari
PURPOSE OF REVIEW: Postbiopsy infections (PBIs) are among the most common complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). This article discusses the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs. RECENT FINDINGS: Risk stratification is a powerful tool for identifying TRUSPB candidates whom warrant additional preventive measures. Bowel preparation with povidone-iodine-based enemas and needle disinfection with formalin solution are simple and attractive strategies, but their effectiveness needs to be thoroughly assessed...
April 24, 2018: Current Opinion in Urology
Shamar Young, Jafar Golzarian
PURPOSE OF REVIEW: Over the last several years prostate artery embolization (PAE) has been developed as a minimally invasive technique for the treatment of benign prostatic hyperplasia induced lower urinary tract symptoms. This review aims to elucidate the data available on this developing technique and identify areas requiring further investigation. RECENT FINDINGS: Recent studies have demonstrated that PAE is able to deliver excellent clinical outcomes in terms of International Prostate Symptom Score, quality-of-life score, maximum urinary flow rate, post-void residual, and prostate volume reduction...
March 13, 2018: Current Opinion in Urology
Randy Vince, Lance J Hampton, Mihai D Vartolomei, Shahrokh F Shariat, Francesco Porpiglia, Riccardo Autorino
PURPOSE OF REVIEW: Robotic assisted simple prostatectomy (RASP) represents a minimally invasive evolution of traditional open simple prostatectomy for the surgical treatment of severe lower urinary tract symptoms (LUTS) because of benign prostatic enlargement (BPE). Aim of the present review is to summarize the most recent evidence on this novel procedure, and to better define its current role in the surgical armamentarium for the treatment of BPE. RECENT FINDINGS: Several studies demonstrated that RASP can be safely and effectively performed in centers with sufficient expertise...
March 9, 2018: Current Opinion in Urology
Eu Chang Hwang, Shreyas Gandhi, Jae H Jung
PURPOSE OF REVIEW: To date it is unclear whether the selectivity of new alpha-blockers to alpha-adrenergic receptor subtypes translates into more clinical benefits and less adverse effects in clinical practice. We performed a systematic review of the two new Abs silodosin and naftopidil. With the availability of numerous alpha-blockers to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, the findings of this review will be highly relevant to the field of urology...
May 2018: Current Opinion in Urology
Seth A Strope
PURPOSE OF REVIEW: Guidelines have been developed to assist physicians in the diagnosis and management of patients with lower urinary tract symptoms. These guidelines vary in the level of evidence used and the strength of their recommendations. With variations in guidelines, multiple variations in clinical practice may also been seen. RECENT FINDINGS: Although examinations of physician compliance with benign prostatic hyperplasia (BPH) guidelines date back to the 1980s, researchers have become more interested in closer examination of guideline compliance...
May 2018: Current Opinion in Urology
Philipp Dahm, Jae H Jung
No abstract text is available yet for this article.
May 2018: Current Opinion in Urology
Tyler Sheetz, Cheryl T Lee
PURPOSE OF REVIEW: As the population ages, urologic oncologists are caring for older and more vulnerable patients that must withstand complex surgical treatments. Our healthcare environment emphasizes surgical quality, reductions in length of hospital stay, reduced readmission rates, and high patient satisfaction. So those who manage urologic malignancies must be able to optimize their patients. Understanding the concept of frailty, how to diagnose it in a timely and reliable manner, appreciate its perioperative impact, and consider interventions to reduce its effects may improve surgical outcomes...
May 2018: Current Opinion in Urology
Giuseppe Magistro, Philipp Weinhold, Christian G Stief, Christian Gratzke
PURPOSE OF REVIEW: The main objective of novel minimally invasive treatment options is to provide relief of bothersome lower urinary tract symptoms (LUTS) equally effective to current standard techniques, but with a more favorable safety profile. Here we present the first clinical experience with the prostatic urethral lift (Urolift) and the convective water vapor energy ablation (Rezūm). RECENT FINDINGS: Urolift offers rapid and durable relief of LUTS with complete preservation of sexual function...
May 2018: Current Opinion in Urology
Bente T Jensen, Susanne V Lauridsen, Jørgen B Jensen
PURPOSE OF REVIEW: Whether prehabilitation in radical cystectomy adds to the effort of reducing postoperative morbidity and impairments in the survivorship phase has until recently received limited attention. This narrative review aims to summarize the current evidence base on prehabilitaion interventions focusing on the efficacy of procedure-specific interventions and the influence on postoperative outcomes. RECENT FINDINGS: Given the oncological risk, there is a relative short window to intervene and proactively optimize the patient before radical cystectomy...
May 2018: Current Opinion in Urology
Tim Large, Amy E Krambeck
PURPOSE OF REVIEW: Holmium laser enucleation of the prostate (HoLEP) has been a mainstay therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) for nearly 20 years. We briefly review current and sentinel publications that provide outcomes data after HoLEP. RECENT FINDINGS: Current literature continues to support HoLEP as a versatile and durable surgical option for men with LUTS secondary to BPH. Despite evidence supporting durable symptom relief beyond 10 years even in large prostate glands, HoLEP is still not widely available to all patients...
May 2018: Current Opinion in Urology
Joseph Acquaye, Michael S Borofsky
PURPOSE OF REVIEW: As benign prostatic hypertrophy (BPH) becomes a more common disease, there has been a dramatic rise in the number of investigational procedures being developed to manage it. We seek to present an overview of the most recently developed treatments and present clinical data related to application wherever available. RECENT FINDINGS: As a greater number of treatments become available for BPH, improved diagnostic testing could prove beneficial in helping guide patient selection...
May 2018: Current Opinion in Urology
Matthew G Crockett, Marcus J Drake
PURPOSE OF REVIEW: Benign prostatic obstruction (BPO) is a common cause of lower urinary tract symptoms (LUTS) in elderly men. However, such symptoms are often caused by primary detrusor overactivity or underactivity. Surgical management where BPO is absent or merely incidental has a lower chance of success, and exposes the patient to the potential complications of surgery. This review discusses the diagnostic challenges facing this common presentation. RECENT FINDINGS: Most evidence comes from small, historical prospective cohort studies...
May 2018: Current Opinion in Urology
Joo Yong Lee, Kang Su Cho
PURPOSE OF REVIEW: The use of 5-alpha reductase inhibitors (5ARIs) for the treatment of benign prostatic hyperplasia (BPH) and other diseases has been proposed and studied. However, the controversy about its benefits and harms for other diseases has persisted. In this review, we will discuss the newly identified effects of 5ARIs based on recently published studies. RECENT FINDINGS: These drugs are currently recommended in clinical guidelines for BPH. However, the reporting of adverse effects, including sexual dysfunction as well as neurologic, endocrine, and cardiovascular effects, have been controversial...
May 2018: Current Opinion in Urology
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