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European Urology Focus

Mihai Dorin Vartolomei, Shoji Kimura, Liliana Vartolomei, Shahrokh F Shariat
CONTEXT: Clinical guidelines recommend testosterone replacement therapy (TRT) for adult men with late-onset testosterone deficiency (TD), with the goal of improving symptoms and elevating testosterone levels into the normal reference range. OBJECTIVE: To investigate and critically analyze the current evidence regarding the impact of TRT on depression and depressive symptoms in adult men with late-onset TD compared with placebo. EVIDENCE ACQUISITION: A systematic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials databases, and clinicaltrials...
July 14, 2018: European Urology Focus
Ryan L Steinberg, Lewis J Thomas, Michael A O'Donnell
Bacillus Calmette-Guérin (BCG) replaced early intravesical chemotherapeutic agents as the standard of care for non-muscle-invasive bladder cancer (NMIBC) with its US Food and Drug Administration approval in 1990. Multiple studies have proven the superiority of BCG to surgery alone, and to older single-agent intravesical chemotherapy regimens. However, new multiagent intravesical chemotherapy regimens have been developed and tested in recent years. Such regimens offer the possibility of better efficacy and/or tolerability compared to BCG...
July 13, 2018: European Urology Focus
Robert J Carrasquillo, Martin S Gross
CONTEXT: Over the last 4 decades, penile implant surgery has advanced significantly. Penile implant infection prevention continues to be an active area of research due to the significant patient morbidity associated with infection. OBJECTIVE: To summarize current approaches and supporting data for infection prevention. EVIDENCE SYNTHESIS: Common approaches to infection prevention include careful patient selection and preoperative evaluation, broad-spectrum antimicrobial prophylaxis, and modifications to surgical technique that minimize skin contact and postoperative hematoma formation...
July 12, 2018: European Urology Focus
Sebastiano Cimino, Paolo Verze, Luca Venturino, Paolo Alessio, Alfonso Migliara, Ciro Imbimbo, Vincenzo Mirone, Giorgio Ivan Russo, Giuseppe Morgia
BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach. OBJECTIVE: To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx...
July 12, 2018: European Urology Focus
Omar Al Hussein Alawamlh, Soo Jeong Kim, Philip S Li, Richard K Lee
There is an abundance of devices for adolescent and adult male circumcision (MC). It has been shown that the safety and efficacy of device-assisted MC are equal to or better than those for MC via conventional surgery. MC devices have the potential to simplify the procedure and increase the acceptability of circumcision among patients.
July 11, 2018: European Urology Focus
Alison Pauline Downey, Nadir I Osman, Altaf Mangera, Richard D Inman, Sheilagh V Reid, Christopher R Chapple
Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma...
July 11, 2018: European Urology Focus
Jathin Bandari, Avinash Maganty, Liam C MacLeod, Benjamin J Davies
Bacillus Calmette-Guérin (BCG) is used as first-line intravesical therapy following tumor resection of non-muscle-invasive bladder cancer. Primary producers of BCG announced shortages within the last decade, leading to a worldwide shortage. We review the literature examining the BCG shortage and propose solutions to cope with this problem.
July 10, 2018: European Urology Focus
Michael Stöckle, Kerstin Junker, Paolo Fornara
CONTEXT: Organ transplantation requires immunosuppression, which was regarded as a risk factor for tumor induction and tumor progression in all types of malignancy. Until recently, any form of active neoplasia was, therefore, regarded as contraindicative to organ transplantation. However, there is growing evidence that the increased tumor risk by immunosuppression is restricted to particular subgroups of malignancy, whereas others such as prostate cancer (PCa) are not negatively influenced...
July 10, 2018: European Urology Focus
Magnus J Grabe, Fredrik Resman
CONTEXT: Microbial resistance to antibiotics is increasing while antimicrobials are limited. Responsible use is necessary. OBJECTIVE: Describe the present acquisitions of antimicrobial stewardship programmes (ASPs) in general and in urology. EVIDENCE SYNTHESIS: Well-designed ASPs have an impact on reducing treatment duration, shortening intravenous treatment in favour of oral targeted therapy, and reducing the total antibiotic prescription...
June 30, 2018: European Urology Focus
Georg Salomon, Sandra Prues, Judith Saul, Lars Budäus, Derya Tilki, Meike Schneider, Axel Haferkamp, Markus Graefen, Katharina Boehm
BACKGROUND: Transrectal prostate biopsy (pbx) is the most frequent outpatient procedure in the urological field. Septic complications are a major health issue. OBJECTIVE: To evaluate complication rates with or without an antimicrobial lubricant. DESIGN, SETTING, AND PARTICIPANTS: A total of 1000 patients received pbx between 2013 and 2015. Information about complications was collected by a 3-wk questionnaire. Return rate was 73.2% (n=732)...
June 22, 2018: European Urology Focus
Esteban Emiliani, Jose Daniel Subiela, Federica Regis, Oriol Angerri, Joan Palou
BACKGROUND: Urolithiasis has been reported in up to 1.8% of patients after renal transplantation. Limited data are available regarding the treatment of such patients owing to this low prevalence. OBJECTIVE: To analyse a consecutive series of 2115 renal transplantations to elucidate the prevalence of renal graft stones (RGS) and their treatment. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review was performed of a consecutive series of renal transplants from 1983 to 2017...
June 22, 2018: European Urology Focus
Mounsif Azizi, Charles C Peyton, David C Boulware, Juan Chipollini, Timothy Juwono, Julio M Pow-Sang, Philippe E Spiess
BACKGROUND: Further biomarkers are warranted to improve prognostic stratification of penile squamous cell carcinoma (PSCC) patients undergoing inguinal lymph node dissection (ILND). OBJECTIVE: To assess the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR) in PSCC patients undergoing ILND and to investigate its role in predicting pathologic node-positive (pN+) disease. DESIGN, SETTING, AND PARTICIPANTS: In total, 84 consecutive patients undergoing ILND for PSCC at our institution between 1994 and 2014 were identified...
June 21, 2018: European Urology Focus
Maximilian Burger
While photodynamic diagnosis during transurethral resection of bladder tumor seems warranted only in seemingly high-risk cases, early intravesical instillation of chemotherapy is warranted in all low-risk cases. According to the latest randomized controlled trial, data may make sense also in intermediate- and high-risk cases.
June 21, 2018: European Urology Focus
Sandro C Esteves
There is growing evidence indicating that intracytoplasmic sperm injection with testicular sperm rather than ejaculated sperm might be advantageous in achieving pregnancy for couples in which the male has high levels of sperm DNA fragmentation (SDF). Meta-analysis has shown that SDF rates are markedly lower in testicular sperm than in ejaculated sperm, and the odds of achieving pregnancy and a live birth are significantly higher.
June 19, 2018: European Urology Focus
Marc A Bjurlin, Audrey Renson, Richard Jacob Fantus, Richard Joseph Fantus
BACKGROUND: Renal trauma may be managed differently in tiered trauma systems and among those who requireinterfaculty transfer. OBJECTIVE: To evaluate the initial management of renal trauma, assess patterns of management based on hospital trauma level designation and interfacility transfer status, and analyze management trends over time. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of renal trauma from the National Trauma Data Bank 2010-2015...
June 19, 2018: European Urology Focus
Victoria Gómez-Dos Santos, Mercedes Ruiz Hernández, Francisco Javier Burgos-Revilla
BACKGROUND: Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with a better outcome than static cold storage, predominantly in marginal donors. Nevertheless, there is little evidence supporting whether graft centre of origin and donor category impact HMP results. OBJECTIVE: To identify factors impacting HMP in transplantation from marginal donors. DESIGN, SETTING, AND PARTICIPANTS: Analysis of prospectively collected cohort data of expanded criteria donor (ECD) and donor after circulatory death (DCD) categories II and III was performed...
June 18, 2018: European Urology Focus
Vital Hevia, Romain Boissier, Óscar Rodríguez-Faba, Claire Fraser-Taylor, Rhana Hassan-Zakri, Enrique Lledo, Heinz Regele, Klemens Buddde, Arnaldo Figueiredo, Jonathon Olsburgh, Alberto Breda
CONTEXT: Cancer development after kidney transplant (KT) has become a major problem, and currently, it is one of the primary causes of death in this population. Urological cancers after KT such as prostate cancer (PCa) have also increased, partly due to the increasing age of recipients and prolonged survival. PCa is the second most commonly diagnosed cancer in men, accounting for 15% of all cancers. Managing localised PCa after KT remains challenging because of treating an immunosuppressed patient with a kidney graft in the pelvic cavity...
June 16, 2018: European Urology Focus
Riccardo Bertolo, Juan Garisto, Matthew Gettman, Jihad Kaouk
Robotic urology has evolved in parallel with the development of new robotic systems. A recently conceived robotic platform, specifically designed for single-port (SP) surgery, has reignited the interest for the approach. In this review, the evolution of robotic SP surgery was analyzed. Since the first published experience with a robot-assisted SP urological procedure in 2010, despite technical adjustments, robotic SP has remained with limited diffusion. However, the limitations of the available instrumentation are going to be softened with an upcoming next-generation robotic platform...
June 15, 2018: European Urology Focus
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