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Current Urology Reports

Ankur A Shah, Jeffrey C Gahan, Igor Sorokin
PURPOSE OF REVIEW: Recent advancements in minimally invasive approaches for prostate surgery have provided numerous options for surgical management of benign prostatic hyperplasia (BPH). In the setting of a large prostate, an open simple prostatectomy was previously considered the gold standard surgical treatment. However, the recently updated American Urological Association (AUA) guidelines on surgical management of BPH now consider both open and minimally invasive approaches to simple prostatectomy viable alternatives for treating large glands, depending on expertise with the techniques...
July 12, 2018: Current Urology Reports
Fabrizio Presicce, Cosimo De Nunzio, Andrea Tubaro
PURPOSE OF REVIEW: Therapeutic options for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have considerably increased in recent years. However, the ideal timing to initiate medical treatment of LUTS/BPE has not been fully established. The aim of this review was to systematically collect available evidence on the influence of early treatment on the natural history of LUTS/BPE patients. RECENT FINDINGS: A systematic literature search from January 1996 until April 2018 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Enlargement, male, medical treatment, surgical treatment, early treatment/intervention, and early intervention/treatment...
July 9, 2018: Current Urology Reports
Jason K Frankel, Yinghui Duan, Peter C Albertsen
PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) result from age-related changes in detrusor function and prostatic growth that are driven by alterations in the ratio of circulating androgens and estrogens. Alpha-adrenergic receptor blockers are commonly used to treat LUTS because they influence urethral tone and intra-urethral pressure. Molecular cloning studies have identified three α1 -adrenergic receptor subtypes (α1A , α1B , and α1D ). The α1A subtype is predominant in the human prostate but is also present in many parts of the brain that direct cognitive function...
July 3, 2018: Current Urology Reports
Akshay Sood, Daniel Cole, Firas Abdollah, Ben Eilender, Zade Roumayah, Mustafa Deebajah, Ali Dabaja, Shaheen Alanee
PURPOSE OF REVIEW: Immune checkpoint therapy has grown in prominence in the last few decades and is being increasingly utilized in treatment of advanced cancers. Although information on toxicities of these drugs is forthcoming, not much is known regarding the toxicity profile of these drugs from a sexual function standpoint. We undertook the current review to appraise the literature for endocrine/sexual side effects of anti-PD-1/PD-L1 and anti-CTLA-4 therapy. RECENT FINDINGS: Our review included 32 articles and focused primarily on the programmed death (PD) pathway...
July 3, 2018: Current Urology Reports
Katherine M Rodriguez, Alexander W Pastuszak, Mohit Khera
PURPOSE OF REVIEW: The role of testosterone in the development of prostate cancer and the safety of testosterone therapy (TTh) after prostate cancer treatment, or in the setting of active surveillance, remains controversial. There are many concerns about using TTh in men, particularly those with a history of prostate cancer, ranging from a possible increased risk of cardiovascular disease to cancer progression or recurrence. With many prostate cancer patients living longer, and hypogonadism having significant morbidity, much care must go into the decision to treat...
June 30, 2018: Current Urology Reports
Alex Borchert, David A Leavitt
PURPOSE OF REVIEW: Review how the various surgical treatments for benign prostatic hyperplasia and lower urinary tract symptoms impact on male sexual health and function. RECENT FINDINGS: The interplay between benign prostatic hyperplasia and erectile function is complex, and the conditions seem linked. Most cavitating procedures to improve male voiding will degrade ejaculatory and possibly erectile function. Many of the newer minimally invasive therapies appear to preserve sexual function in the short term while sacrificing some of the voiding improvements realized with more complete removal of the prostate adenoma...
June 19, 2018: Current Urology Reports
Mohammed A Said, Akanksha Mehta
PURPOSE OF REVIEW: Male pattern hair loss, mediated by dihydrotestosterone, is a common hair loss disorder, affecting over 50% of men over the age of 50. The 5-α reductase inhibitors, finasteride and dutasteride, are Food and Drug Administration-approved drugs for the treatment of this disorder. Several recent studies have reported adverse sexual and spermatogenic events among young men using 5-α reductase inhibitors, such as erectile dysfunction, decreased ejaculate volume, decreased libido, and infertility...
June 16, 2018: Current Urology Reports
Katherine M Fischer, Michael Louie, Phillip Mucksavage
PURPOSE OF REVIEW: Ureteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them. RECENT FINDINGS: Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this...
June 11, 2018: Current Urology Reports
Robert Carrasquillo, Kevin Chu, Ranjith Ramasamy
PURPOSE OF REVIEW: Hypogonadism and the treatment of low testosterone is increasingly a subject of medical inquiry and controversy. The few treatments that are FDA-approved such as testosterone topicals, injections, and pellets create significant demand from patients for treatments with more convenient means of administration, fewer adverse effects, and the ability to maintain male fertility. Off-label drugs are in abundant use for low testosterone, including selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors...
June 9, 2018: Current Urology Reports
Shu Pan, Stanton C Honig
Gender-affirming surgeries (GASs), previously known as gender reassignment surgeries, are surgical procedures born from plastic and reconstructive surgery, colorectal surgery, urology, and gynecology. A multidisciplinary approach is essential for the care of transgender patients. The urologist plays a vital role, both in the perioperative period and as part of continued care. This publication will review the current concepts of genital GAS as it pertains to the practicing urologist. The most utilized surgical techniques will be described along with their notable complications and management options...
June 7, 2018: Current Urology Reports
Cosimo De Nunzio, Riccardo Lombardo, Giorgia Tema, Andrea Tubaro
PURPOSE OF REVIEW: In the past years, the relationship between lower urinary tract symptoms and erectile dysfunction has been widely explored. The aim of our systematic review is to summarize the published evidence over the past year on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). RECENT FINDINGS: Recent data support the relationship between LUTS and ED in Eastern Europe and in Asia. The role of phosphodiesterase inhibitors alone or in combination with alpha blockers to treat LUTS and ED, especially in younger patients, is strongly supported by high level of evidence...
June 1, 2018: Current Urology Reports
J Scott Gabrielsen, Dolores J Lamb, Larry I Lipshultz
PURPOSE OF REVIEW: To discuss the physiologic and pathologic effects of iron on men's reproductive health. RECENT FINDINGS: Iron overload diseases are associated with hypogonadotropic hypogonadism, infertility, and sexual dysfunction in men. Recent findings have elucidated the roles by which iron may affect the male reproductive axis. Iron is requisite for life. Iron can also catalyze the production of reactive oxygen species. To maintain balance, the human body tightly regulates dietary iron absorption...
June 1, 2018: Current Urology Reports
Christopher Wu, Keith Jarvi
PURPOSE OF REVIEW: Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain. RECENT FINDINGS: Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood...
May 31, 2018: Current Urology Reports
Joseph M Armstrong, Sorena Keihani, James M Hotaling
PURPOSE OF REVIEW: Male factor infertility is a complex and multifaceted problem facing the modern urologist and is identified in 30-40% of infertile couples. This review focuses on the use of ultrasound, as an adjunct screening tool, in the initial evaluation of male infertility. RECENT FINDINGS: Access to male reproductive urologist for assessment of male infertility is limited and about a quarter of infertile couples do not complete the male component in their infertility assessment...
May 28, 2018: Current Urology Reports
Nanfu Deng, Nora M Haney, Taylor P Kohn, Alexander W Pastuszak, Larry I Lipshultz
PURPOSE OF REVIEW: Non-standard shift work schedules negatively impact the overall health of shift workers, and several studies have shown that shift work, specifically, is detrimental to urogenital health. The aims of this study are to systematically review the literature and determine the effect of shift work on the outcomes of hypogonadism, male infertility, lower urinary tract symptoms, and urogenital cancers. RECENT FINDINGS: Recent evidence supports associations between non-standard shift work and an increase in the frequency of prostate cancer and the severity of erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms, as well as worsening of semen parameters and fertility...
May 28, 2018: Current Urology Reports
Mahmoud Mima, David Greenwald, Samuel Ohlander
PURPOSE OF REVIEW: Global industrialization has increased population exposure to environmental toxins. A global decline in sperm quality over the last few decades raises questions about the adverse impact of environmental toxins on male reproductive health. RECENT FINDINGS: Multiple animal- and human-based studies on exposure to environmental toxins suggest a negative impact on semen quality, in terms of sperm concentration, motility, and/or morphology. These toxins may exert estrogenic and/or anti-androgenic effects, which in turn alter the hypothalamic-pituitary-gonadal axis (HPGA), induce sperm DNA damage, or cause sperm epigenetic changes...
May 17, 2018: Current Urology Reports
Russell P Hayden, Ryan Flannigan, Peter N Schlegel
PURPOSE OF REVIEW: Increasing attention to primary and secondary prevention of male infertility through modifiable lifestyle factors has gained traction amongst both patients and infertility specialists. In this review, the available evidence of modifiable lifestyle choices, specifically diet, physical activity, and body habitus, are evaluated. RECENT FINDINGS: Studies examining diet, exercise/physical activity, and body habitus are characterized by conflicting conclusions, difficult confounders, and imperfect end points to judge male reproductive potential...
May 17, 2018: Current Urology Reports
Taylor P Kohn, Samuel J Ohlander, Jake S Jacob, Tina M Griffin, Larry I Lipshultz, Alexander W Pastuszak
PURPOSE OF REVIEW: Current guidelines recommend against surgical repair of subclinical varicoceles (SCVs) for infertility; several studies demonstrate mixed fertility results after SCV correction. To determine whether surgical correction of SCV improves semen parameters and/or reproductive outcomes, we performed a systematic review and meta-analysis. Seven biomedical literature databases were searched through January 2018 for studies that assessed reproductive outcomes and/or change in semen parameters in men with corrected SCV compared to either (1) uncorrected SCV or (2) corrected clinical varicocele...
May 17, 2018: Current Urology Reports
Christopher J Long, Diana K Bowen
PURPOSE OF REVIEW: The purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk. RECENT FINDINGS: Renal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss...
May 17, 2018: Current Urology Reports
Daniel J Mazur, Larry I Lipshultz
PURPOSE OF REVIEW: In many countries, the average age of paternity is rising. The negative effect of older age on fertility in women is well documented; however, less is known about the impact of paternal age on fecundity. In this review, we summarize the current knowledge of how paternal age affects semen parameters, reproductive success, and offspring health. RECENT FINDINGS: Contemporary evidence confirms that aged men have worse semen parameters, including overall negative changes in sperm genetics...
May 17, 2018: Current Urology Reports
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