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Current Opinion in Urology

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https://www.readbyqxmd.com/read/28441271/alternative-payment-models-and-urology
#1
Deborah R Kaye, David C Miller, Chad Ellimoottil
PURPOSE OF REVIEW: The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will affect physician reimbursement. Alternative payment models (APMs) are an essential component of MACRA and Medicare's vision of paying for high-value care. This review describes APMs in the context of MACRA and their impact on urology. RECENT FINDINGS: The majority of urologists will be affected by MACRA...
April 22, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28441270/improving-quality-through-clinical-registries-in-urology
#2
Mark D Tyson, Daniel A Barocas
PURPOSE OF REVIEW: In this review, we highlight the use of clinical registries for quality improvement and research purposes in urology. We focus on national and regional clinical database registries, such as the National Surgical Quality Improvement Programme, the Cancer of the Prostate Strategic Urologic Research Endeavor, the Michigan Urological Surgery Improvement collaborative and the American Urological Association Quality Registry programme. RECENT FINDINGS: It is widely known that claims-based and institutional databases are limited in their capacity to provide granular, real-time data for quality improvement purposes...
April 22, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28426464/comparative-effectiveness-in-urology-a-state-of-the-art-review-utilizing-a-systematic-approach
#3
Jathin Bandari, Charles B Wessel, Bruce L Jacobs
PURPOSE OF REVIEW: Comparative effectiveness research plays a vital role in healthcare delivery by guiding evidence-based practices. We performed a state-of-the-art review of comparative effectiveness research in the urology literature for 2016, utilizing a systematic approach. Seven high-impact papers are reviewed in detail. RECENT FINDINGS: Across the breadth of urology, there were several important studies in comparative effectiveness research, of which we will highlight two randomized controlled trials and five observational trials: radiotherapy, prostatectomy, and active monitoring have equivalent mortality outcomes in patients with localized prostate cancer; the ideal modality of patient education is yet to be determined, and written education has minimal effect on patient perception of prostate specific antigen screening; robotic prostatectomy is associated with higher perioperative complication rates on a population basis; racial disparities exist in incontinence rates after treatment for localized prostate cancer, but not in irritative, bowel, or sexual function; androgen deprivation therapy is associated with higher fracture, peripheral artery disease, and cardiac-related complications than bilateral orchiectomy; robotic and open cystectomy offer comparable cancer-specific mortality and perioperative outcomes; and bonuses for low-cost hospitals can inadvertently reward low-quality hospitals...
April 19, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28406847/nontechnical-skill-training-and-the-use-of-scenarios-in-modern-surgical-education
#4
Oliver Brunckhorst, Muhammad S Khan, Prokar Dasgupta, Kamran Ahmed
PURPOSE OF REVIEW: Nontechnical skills are being increasingly recognized as a core reason of surgical errors. Combined with the changing nature of surgical training, there has therefore been an increase in nontechnical skill research in the literature. This review therefore aims to: define nontechnical skillsets, assess current training methods, explore assessment modalities and suggest future research aims. RECENT FINDINGS: The literature demonstrates an increasing understanding of the components of nontechnical skills within surgery...
April 12, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28406846/the-value-of-simulation-based-training-in-the-path-to-laparoscopic-urological-proficiency
#5
Ben S E P Van Cleynenbreugel, Ali S Gözen, Theodoros Tokas
PURPOSE OF REVIEW: Numerous factors have reduced the training opportunities of surgical residents in the operating room. There is also the question of patient's safety. This gives a need for increased training opportunities outside the operating room. We look if there is an added value in simulation-based training (SBT) in the acquisition of laparoscopic skills. RECENT FINDINGS: Incorporating SBT into the medical students curriculum reduces surgical complication rates in the operating room...
April 12, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28403125/low-vs-high-fidelity-the-importance-of-realism-in-the-simulation-of-a-stone-treatment-procedure
#6
Piyush Sarmah, Jim Voss, Adrian Ho, Domenico Veneziano, Bhaskar Somani
PURPOSE OF REVIEW: Simulation training for stone surgery is now increasingly used as part of training curricula worldwide. A combination of low and high fidelity simulators has been used with varying degrees of 'realism' provided by them. In this review, we discuss low and high fidelity simulators used for ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) stone procedures with their advantages, disadvantages and future direction for endourological simulation surgery. The final goal will be to understand whether or not 'realism' has to be considered as a critical element in simulation for this field...
April 11, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28376513/the-role-of-environmental-stress-on-lower-urinary-tract-symptoms
#7
Melissa T Sanford, Larissa V Rodriguez
PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) have been associated with comorbid conditions such as anxiety and depression. In addition, stress appears to influence the development or exacerbation of LUTS. This article seeks to review literature regarding the role of environmental stress on LUTS, focusing on findings presented in the last year. RECENT FINDINGS: Numerous authors have published on the impact early childhood experiences, acute and chronic stress, and psychiatric illness play in the development of LUTS...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28376512/improving-the-evaluation-and-diagnosis-of-clinically-significant-prostate-cancer
#8
Oleksandr N Kryvenko, Jonathan I Epstein
PURPOSE OF REVIEW: This chapter describes important changes in the clinical practice and pathological interpretation of prostate cancer (PCa) that stratify PCa into insignificant and significant disease to allow for better patient management and treatment decisions. RECENT FINDINGS: Among the most important changes over the last half a decade has been the change in PCa grading. A new grading system has been developed that is more patient-centric with more accurate stratification according to risk of disease progression...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28319478/recent-developments-of-the-pelvic-floor-and-lower-urinary-tract-symptoms
#9
Karl-Dietrich Sievert
No abstract text is available yet for this article.
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28319477/emerging-techniques-in-truly-minimal-invasive-treatment-options-of-benign-prostatic-obstruction
#10
Karl-Dietrich Sievert, Thomas Kunit
PURPOSE OF REVIEW: Benign prostatic enlargement is a common age-related condition, affecting over 50% of men aged more than 60 years. Side effects of medical therapy and significant morbidity of transurethral resection of the prostate and open surgery led to the development of so-called minimally invasive procedures, with the aim to be efficient but with less morbidity and shorter or no hospitalization. For this review, a systematic literature was performed. We report recent results in different treatment options for benign prostate hypoplasia (BPH) and recommend the best minimal-invasive treatment for BPH...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28306604/role-of-mri-in-low-risk-prostate-cancer-finding-the-wolf-in-sheep-s-clothing-or-the-sheep-in-wolf-s-clothing
#11
Ivo G Schoots, Caroline M Moore, Olivier Rouvière
PURPOSE OF REVIEW: In men on active surveillance for localized prostate cancer, MRI and MRI-targeted biopsies can be used prior to confirmatory or surveillance biopsy, to detect individuals with high-grade cancer (the wolf in sheep's clothing). However, some men will have low-risk disease despite adverse MRI findings (the sheep in wolf's clothing). We review the value addition of MRI-targeted biopsies in comparison to systematic transrectal ultrasound-guided biopsies, using pathological reclassification as an end-point...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28306603/current-treatment-of-pelvic-organ-prolapse-correlated-with-chronic-pelvic-pain-bladder-and-bowel-dysfunction
#12
Bernhard Liedl, Klaus Goeschen, Leopold Durner
PURPOSE OF REVIEW: The purpose of this review is to critically analyze the relationship between symptoms of abnormal emptying of the bladder, urgency, pelvic pain, anorectal dysfunction and pelvic organ prolapse (POP) and to present evidence in order to show how many of the above mentioned symptoms can be cured or substantially improved by repair of specific pelvic ligaments. RECENT FINDINGS: In this review, we provide evidence to show how often these dysfunctions occur and how they can be cured in 42-94% by appropriate pelvic floor surgery in the longer term, up to 2 years...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28267057/female-pelvic-floor-biomechanics-bridging-the-gap
#13
Deanna C Easley, Steven D Abramowitch, Pamela A Moalli
PURPOSE OF REVIEW: The pelvic floor is a complex assembly of connective tissues and striated muscles that simultaneously counteracts gravitational forces, inertial forces, and intra-abdominal pressures while maintaining the position of the pelvic organs. In 30% of women, injury or failure of the pelvic floor results in pelvic organ prolapse. Surgical treatments have high recurrence rates, due, in part, to a limited understanding of physiologic loading conditions. It is critical to apply biomechanics to help elucidate how altered loading conditions of the pelvis contribute to the development of pelvic organ prolapse and to define surgeries to restore normal support...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28267056/active-surveillance-for-low-risk-prostate-cancer
#14
Laurence Klotz
PURPOSE OF REVIEW: The approach of active surveillance for low-risk prostate cancer has evolved in many ways since its introduction 20 years ago. There is a great deal of ongoing research addressing the molecular genetics and clinical outcome of low-risk disease, the use of MRI and biomarkers, and the role of lifestyle and dietary modifications. The major developments in the field are reviewed in this article. RECENT FINDINGS: Low risk and many cases of low-intermediate risk prostate cancer are indolent, have little or no metastatic potential, and do not pose a threat to the patient in his lifetime...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28267055/overactive-bladder-syndrome-and-lower-urinary-tract-symptoms-after-prostate-cancer-treatment
#15
Suzanne Biers, Karl-Dietrich Sievert, Nikesh Thiruchelvam
PURPOSE OF REVIEW: To assess the contemporary literature on the prevalence, cause and management of lower urinary tract symptoms (LUTS) and bladder overactivity following treatment of prostate cancer with radical surgery, radiotherapy and minimally invasive therapies for localized prostate cancer, including cryotherapy and high-intensity focused ultrasound (HIFU). RECENT FINDINGS: Generally, the highest risk of urinary incontinence is after open radical prostatectomy (7-40%), although not all contemporary studies demonstrate a difference between open and laparoscopic techniques...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28234750/female-urinary-microbiota
#16
Elizabeth R Mueller, Alan J Wolfe, Linda Brubaker
PURPOSE OF REVIEW: The newly discovered female urinary microbiota has the potential to deepen our understanding of urinary tract health and disease, including common lower urinary tract conditions such as urinary incontinence and urinary tract infection. The spectrum of painful bladder disorders and other less common conditions also may benefit from additional research that includes consideration of the resident bacterial community of the female bladder. The present review provides a clinical context for the rapidly emerging research regarding the female urinary microbiota and its relationships with urinary tract conditions of interest...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28234749/role-of-mri-prebiopsy-in-men-at-risk-for-prostate-cancer-taking-off-the-blindfold
#17
Marc A Bjurlin, Andrew B Rosenkrantz, Samir S Taneja
PURPOSE OF REVIEW: We review recent literature surrounding the use of prebiopsy prostate MRI and MRI-targeted biopsy in men at risk for prostate cancer. RECENT FINDINGS: Large series have strengthened the case for the use of MRI prior to prostate biopsy to maximize the detection of clinically significant disease, reduce the detection of clinically insignificant disease, and allow for tumor localization during targeted biopsy. Prebiopsy MRI followed by targeted biopsy appears to have the ability to overcome the limitations of the standard 12-core template...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28234748/management-of-intermediate-risk-prostate-cancer-with-active-surveillance-never-or-sometimes
#18
Selma Masic, Samuel L Washington, Peter R Carroll
PURPOSE OF REVIEW: Active surveillance has become the recommended management strategy for most patients with low-risk prostate cancer (PCa), but whether surveillance criteria can be expanded without compromising oncologic outcomes is a matter of debate. Whereas there is essentially uniform consensus that those with low-risk disease can be safely managed with AS, those with intermediate-risk disease, younger men and African-American men are often excluded. RECENT FINDINGS: Outcome data for intermediate-risk patients managed by active surveillance demonstrate acceptable oncologic outcomes, but there is also evidence that such patients have higher rates of progression, adverse disease and metastatic disease...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28221220/impact-of-the-united-states-preventive-services-task-force-d-recommendation-on-prostate-cancer-screening-and-staging
#19
Renu S Eapen, Annika Herlemann, Samuel L Washington, Matthew R Cooperberg
PURPOSE OF REVIEW: In 2012, the United States Preventive Services Task Force (USPSTF) issued a grade 'D' recommendation against the use of routine prostate-specific antigen (PSA)-based screening for any men. This recommendation reflects critical misinterpretations of the available evidence base regarding benefits and harms of PSA screening and has influenced the nationwide landscape of prostate cancer screening, diagnosis, and treatment. RECENT FINDINGS: Following the USPSTF recommendation, a substantial decline in PSA screening was noted for all age groups...
May 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28221219/improving-the-evaluation-and-diagnosis-of-clinically-significant-prostate-cancer-in-2017
#20
Sigrid V Carlsson, Monique J Roobol
PURPOSE OF REVIEW: To provide an overview of the current state of the evidence and highlight recent advances in the evaluation and diagnosis of clinically significant prostate cancer, focusing on biomarkers, risk calculators and multiparametric MRI (mpMRI). RECENT FINDINGS: In 2017 there are numerous options to improve early detection as compared to a purely prostate-specific antigen (PSA)-based approach. All have strengths and drawbacks. In addition to repeating the PSA and performing clinical work-up (digital rectal examination and estimation of prostate volume), additional tests investigated in the initial biopsy setting are: %free PSA, Prostate Health Index, 4-kallikrein score, SelectMDx, and Michigan Prostate Score and in the repeat setting: %free PSA, Prostate Health Index, 4-kallikrein score, Prostate Cancer Antigen 3, and ConfirmMDx...
May 2017: Current Opinion in Urology
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