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Therapeutic Advances in Urology

Mauro Gacci, Arcangelo Sebastianelli, Pietro Spatafora, Giovanni Corona, Sergio Serni, Dirk De Ridder, Stavros Gravas, Paul Abrams
Storage lower urinary tract symptoms (LUTS) are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency and urgency incontinence. Some evidence underlines the role of metabolic factors, pelvic ischemia, prostatic chronic inflammation and associated comorbidities in the pathophysiology of storage LUTS. A detailed evaluation of the severity of storage LUTS, and the concomitance of these symptoms with voiding and postmicturition symptoms, is mandatory for improving the diagnosis and personalizing treatment...
February 2018: Therapeutic Advances in Urology
Francesco Massari, Vincenzo Di Nunno, Francesca Comito, Marta Cubelli, Chiara Ciccarese, Roberto Iacovelli, Michelangelo Fiorentino, Rodolfo Montironi, Andrea Ardizzoni
Management of advanced urogenital malignancies has profoundly changed in recent years due to the development of novel targeted drugs that have significantly improved patient's clinical outcomes. This process has been made possible mainly thanks to better knowledge of tumor genetic alterations and molecular altered pathways. Despite these remarkable results, several issues such as early detection of the disease as well as the research into early markers of recurrence or disease progression still remain an open challenge for clinical research...
February 2018: Therapeutic Advances in Urology
Davide Meani, Mladen Solarić, Harri Visapää, Rose-Marie Rosén, Robert Janknegt, Majana Soče
Background: Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) agonists is well established for the treatment of men with metastatic prostate cancer. As clear differences in efficacy, safety, or tolerability between the available LHRH agonists are lacking, the healthcare management team needs to look to practical differences between the formulations when selecting therapy for their patients. Moreover, as the economic burden of prostate cancer rises alongside earlier diagnosis and improved survival, the possibility for cost savings by using products with specific features is growing in importance...
February 2018: Therapeutic Advances in Urology
Daniel Saltzstein, Neal D Shore, Judd W Moul, Franklin Chu, Raoul Concepcion, Stephan de la Motte, John A McLane, Stuart Atkinson, Alex Yang, E David Crawford
Background: The aim of this study was to compare the pharmacokinetics (PK) and pharmacodynamics (PD) of two distinct formulations of leuprolide acetate (LA); subcutaneous (SC) injection and intramuscular (IM) injection. Methods: A total of 32 healthy men were randomized to receive a single 7.5 mg injection of SC-LA ( n = 16) or IM-LA ( n = 16) in this phase I, open-label, parallel-group study. PK was assessed via LA concentrations, and PD via serum luteinizing hormone (LH) and testosterone (T) concentrations...
February 2018: Therapeutic Advances in Urology
Omar Abdel-Rahman
Background: The objective in this paper was to validate the prognostic performance of the American Joint Committee on Cancer (AJCC) 7th and 8th systems among prostate cancer patients treated with radical prostatectomy. Methods: The surveillance, epidemiology and end results (SEER) database (2006-2014) was accessed through the SEER*Stat program and AJCC 7th and 8th editions were calculated utilizing T, N and M stages, histological grade group, as well as baseline prostatic-specific antigen (PSA)...
February 2018: Therapeutic Advances in Urology
Ruben De Groote, Alessandro Larcher, Marijn Goossens, De Raeve Hendrik, Van Der Steen Kris, Vincent De Coninck, Geert De Naeyer, Peter Schatteman, Frederiek D'Hondt, Alexandre Mottrie
We report a case of intravesical metastasis of a clear cell renal cell carcinoma. In renal cell carcinoma 16% of patients present with metastatic disease. Renal cell carcinoma can metastasize to nearly every organ, although metastatic spread to the urinary bladder is rare, with fewer than 70 described cases. The route and pattern of metastatic spread is not yet fully understood and different pathways are suggested. Gross haematuria is the presenting symptom in the majority of cases. These intravesical metastases may be synchronous or metachronous and can be solitary or part of polymetastatic disease...
January 2018: Therapeutic Advances in Urology
Monica Kaminski, Rose Recco, Steven Siegel
Prostate cancer is the second leading cancer-related cause of death in the USA with the majority presenting as localized disease. In the last decade minimally invasive, robotic-assisted laparascopic, radical prostatectomy has become the most favored treatment choice. A complication that has been observed in 27% of patients is the formation of an asymptomatic lymphocele. It is a very rare complication for these to become infected, and when they do 80% have occurred 2-12 months post-procedure. In this case report the patient presented with fever and leukocytosis of unknown origin and was found to have a methicillin-resistant Staphylococcus aureus (MRSA) infected lymphocele over 2 years after a radical prostatectomy...
January 2018: Therapeutic Advances in Urology
Jayne Louise Douglas-Moore, Jonathan Goddard
Bladder pain syndrome (BPS) is a difficult disorder to diagnose and subsequently manage despite having been recognized for more than 200 years according to references in medical literature. There are currently three widely accepted guidelines on BPS: the American Urological Association Guidelines; the Royal College of Obstetricians and Gynaecologists in conjunction with the British Society of Urogynaecologists Guidelines; and the European Association of Urology Guidelines. These guidelines have similarities to each other but also significant differences...
January 2018: Therapeutic Advances in Urology
Malhar P Patel, Ariel Schulman, Kevin P Shah, John B Anderson, Thomas J Polascik
Prostate-specific antigen (PSA) screening for prostate cancer remains a controversial topic, particularly in the primary care community. Our multidisciplinary prostate screening panel at Duke University Health System, USA created a nuanced PSA screening algorithm, implemented it into the Electronic Health Record of Duke Primary Care, and conducted outreach meetings with primary care practices to support its rollout. Through this project, we identified areas of concern among primary care clinicians regarding PSA screening that we structured into two major categories: ideological opposition and logistical opposition...
January 2018: Therapeutic Advances in Urology
Reza Mehrazin, Essel Dulaimi, Robert G Uzzo, Karthik Devarjan, Jianming Pei, Marc C Smaldone, Alexander Kutikov, Joseph R Testa, Tahseen Al-Saleem
Background: The proto-oncogene c-MYC, located on chromosome 8q, can be upregulated through gain of 8q, causing alteration in biology of renal cell carcinoma (RCC). The aim of this study was to evaluate the prevalence of c-MYC through chromosome 8q gain and to correlate findings with cancer-specific mortality (CSM), and overall survival (OS). Methods: Cytogenetic analysis by conventional or Chromosomal Genomic Microarray Analysis (CMA) was performed on 414 renal tumors...
January 2018: Therapeutic Advances in Urology
Kirill Vladimirovich Kosilov, Sergey Loparev, Irina Kuzina, Alexandra Prokofyeva
Background: This study examines subjective reasons for the refusal of treatment and the state of objective status markers of various factors influencing the resistance of patients when treating overactive bladder by antimuscarinic drugs (AMs). Methods: The socioeconomic and medical parameters were studied in 2465 patients aged 18-60 years (1446 women (58.7%), 1019 men (41.3%); mean age was 52.1) taking AMs during the year. The study control was carried out by studying passport data, employers' income certificates, patients' ambulatory medical records, the use of OABq-SF and MOS SF-36 questionnaires, voiding diaries and uroflowmetry...
December 2017: Therapeutic Advances in Urology
David L Wenzler, Farris Gulli, Maureen Cooney, Michael B Chancellor, Jason Gilleran, Kenneth M Peters
Background: The etiology of interstitial cystitis (IC) is often idiopathic but can be due to Hunner's ulcers. Hyperbaric oxygen (HBO) is used to treat ulcerative disease of the superficial skin. We hypothesized that HBO can treat ulcerative IC (UIC) but would be less efficacious for non-ulcerative IC (NIC). Methods: Patients with NIC and UIC enrolled in this study. Following informed consent, demographic information was collected. A visual analog pain scale and validated questionnaires were collected; each patient underwent cystoscopy prior to treatment...
December 2017: Therapeutic Advances in Urology
Efe C Ghanney, Jaime A Cavallo, Matthew A Levin, Ramachandra Reddy, Jeffrey Bander, Maria Mella, Joanne Stone, Myron Schwartz, Kenneth Haines, Umesh Gidwani, Reza Mehrazin
Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation...
December 2017: Therapeutic Advances in Urology
Andrea Tubaro, José E Batista, Victor W Nitti, Sender Herschorn, Christopher R Chapple, Mary Beth Blauwet, Emad Siddiqui, Moses Huang, Matthias Oelke
BACKGROUND: Oral pharmacotherapies to treat overactive bladder (OAB) are used less in men despite a similar prevalence of storage symptoms as women. The efficacy and safety of once-daily mirabegron 50 mg was evaluated in male OAB patients from five phase III studies that included placebo or antimuscarinic (tolterodine ER 4 mg or solifenacin 5 mg) as a comparator. METHODS: Three pooled 12-week placebo-controlled studies (mirabegron 50 mg versus placebo) and one 12-week non-inferiority phase IIIb study (BEYOND; mirabegron 50 mg versus solifenacin 5 mg) were used for efficacy (daily micturition frequency, urgency and incontinence episodes) and safety analyses...
December 2017: Therapeutic Advances in Urology
Mladen Solarić, Anders Bjartell, Ursula Thyroff-Friesinger, Davide Meani
BACKGROUND: There are two slow-release ready-to-use forms of leuprorelin acetate (1-month and 3-month) that are available as solid, biodegradable implants for the treatment of advanced, hormone-sensitive prostate cancer. These implants have been shown to be as effective as traditional leuprorelin acetate microspheres for achieving successful testosterone suppression (⩽0.5 ng/ml) and lowering prostate-specific antigen (PSA) levels. Here we further evaluate testosterone suppression levels from four clinical trials evaluating the 3-month leuprorelin implant, including analysis below the European Association of Urology (EAU) castration level (<0...
December 2017: Therapeutic Advances in Urology
Désirée Louise Dräger, Chris Protzel, Andreas Erbersdobler, Oliver Hakenberg
No abstract text is available yet for this article.
October 2017: Therapeutic Advances in Urology
Janet Baack Kukreja, Ashish M Kamat
Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families...
October 2017: Therapeutic Advances in Urology
Nicholas R Rocco, Jack M Zuckerman
Postprostatectomy vesicourethral anastomotic stenosis (VUAS) remains a challenging problem for both patient and urologist. Improved surgical techniques and perioperative identification and treatment of risk factors has led to a decline over the last several decades. High-level evidence to guide management is lacking, primarily relying on small retrospective studies and expert opinion. Endourologic therapies, including dilation and transurethral incision or resection with or without adjunct injection of scar modulators is considered first-line management...
October 2017: Therapeutic Advances in Urology
Hande Hüsniye Telek, Omer Gokhan Doluoglu, Ayse Burcu, Gulizar Demirok, Firdevs Ornek, Ali Ayyildiz
BACKGROUND: To evaluate the effects of tolterodine on anterior segment and choroidal thickness by using the Pentacam system and optical coherence tomography (OCT) (Pentacam). METHODS: A total of 122 eyes of 61 patients (34 female; 27 male) were included in the study. All patients underwent a regular ocular examination and intraocular pressure measurements before and after 3 months of antimuscarinic drug tolterodine treatment, in addition, pupil diameter, anterior chamber depth, anterior chamber volume, anterior chamber angle, and lens thickness were measured through Pentacam (Oculus Inc...
October 2017: Therapeutic Advances in Urology
Georgios Kousournas, Asif Muneer, David Ralph, Evangelos Zacharakis
Stuttering priapism is rare and under-investigated clinical entity. Although it shares similarities with ischaemic priapism, by definition, stuttering priapism has distinct characteristics that advocate for a different management in the clinical setting. Therefore, the management of stuttering priapism aims primarily to prevent recurrence rather than the resolution of spontaneous attacks. A multimodal approach and the individualization of each case are essential because of the diversity of the condition and the plethora of proposed therapeutic strategies...
September 2017: Therapeutic Advances in Urology
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