Current Urology Reports最新文献

Purpose of review: The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM).

Recent findings: Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families. BoTNA offers a safe and efficacious treatment to decrease detrusor contractility and improve bladder capacity but is limited by the half-life of BoNTA agent. Percutaneous or transcutaneous PTNS offers improved voided volumes or cure in some patients but is time-intensive. SNM can be utilized in a variety of LUTD pathology with high success rate and cure but should consider cumulative anesthetic and fluoroscopic exposures for battery replacements and re-positioning for patient growth.

Purpose of review: Renal Cell Carcinoma (RCC) with invasion into the inferior vena cava (IVC) is a rare and mortal condition. Patients with RCC have an average life expectancy of no more than six months, thus requiring an aggressive surgical approach. We analyze the outcomes of patients that underwent surgery at a single medical institution.

Recent findings: The analysis of recent series of successful treatment with radical nephrectomy and IVC thrombectomy shows a 5 year survival from 45 to 69%. We found in the analyzed series that the success of the treatment in these patients depends on the resection of the renal tumor and venous thrombectomy. We found that at our medical institution nephrectomy and IVC thrombectomy with primary repair have no intraoperative mortality and no pulmonary embolism. Nephrectomy and thrombectomy of IVC is a reliable approach for patients with advance RCC.

Purpose of review: High rates of professional burnout and career choice regret among urology residents may increase professional dissatisfaction, shorten career longevity, and exacerbate urology workforce shortages. Understanding the prevalence of and risk factors for burnout may help develop interventions.

Recent findings: Up to 48% of contemporary U.S. urology residents experience burnout symptoms, including up to 70% of second-year residents. Among overlapping personal, professional, institutional, and lifestyle risk factors, barriers to accessing medical and mental health care are frequently cited as an important association in residents. Limited intervention studies suggest that providing basic needs, such as on-call meals, and facilitating physical wellness and social engagement among residents may result in sustained reductions in burnout. Urology residents continue to experience high rates of burnout and career choice regret among medical specialties. Evidence-based interventions and sustainable policies that address primary risk factors are urgently needed.

Purpose of review: In modern healthcare, the integration of artificial intelligence (AI) has revolutionized clinical practices, particularly in data management and patient visit summary creation. Manual creation of patient summary is repetitive, time-consuming, prone to errors, and increases clinicians' workload. AI, through voice recognition and Natural Language Processing (NLP), can automate this task more accurately and efficiently. Erectile dysfunction (ED) clinics, which deal with specific pattern of conditions together with an involvement of broader systemic issues, can greatly benefit from AI-driven patient summary. This scoping review examined the evidence on AI-generated patient summary and evaluated their implementation in ED clinics.

Recent findings: A total of 381 articles were initially identified, 11 studies were included for the analysis. These studies showcased various methodologies, such as AI-assisted clinical notes and NLP algorithms. Most studies have demonstrated the ability of AI to be used in real life clinical scenarios. Major electronic health record platforms are also integrating AI to their system. However, to date, no studies have specifically addressed AI for patient summary creation in ED clinics.

Purpose of review: Although there have been advancements in minimally invasive surgical techniques for radical prostatectomy, surgery can still significantly impact continence and erectile function (EF), resulting in considerable quality-of-life impairment. This review critically evaluates existing treatment options for male stress urinary incontinence (SUI) and erectile dysfunction (ED) post-robotic-assisted laparoscopic prostatectomy (RALP), alongside exploring emerging trends and discussing future directions for managing and preventing both conditions.

Recent findings: Patient history is pivotal in guiding surgical decisions, with the intensity of symptoms and their impact on the patient's life being primary influences for deciding the best treatment options for both SUI and ED. Penile rehabilitation strategies (PR) show promise in mitigating the effects of prostate cancer treatments on EF and improving overall health, though consensus is lacking on specific programs or initiation of timing for optimal recovery post-surgery. All patients undergoing RALP should receive preoperative counseling about SUI and early pelvic floor physical therapy. Fixed and adjustable slings effectively treat mild-to-moderate post-RALP SUI, while the artificial urinary sphincter is the gold standard for men with moderate or severe SUI. EF recovery after RALP faces obstacles such as patient characteristics, compliance, and cost, with no standardized PR approach. Future research should prioritize studies aiming to optimize treatment methods and enhance patient compliance.

Review purpose: The clinical management of subclinical and symptomatic varicoceles in male infertility remains challenging. Current guidelines focus on treating men with abnormal semen analyses, but a more precise approach to identify, stratify, and prognosticate men with varicoceles and fertility issues is essential.

Recent findings: Multiple studies have utilized Artificial Intelligence (AI) to analyze clinical-demographic characteristics, semen analyses, pre-operative imaging findings, and intra-operative clinical data. These AI-driven approaches aim to discover novel biomarkers that can assess, stratify, and prognosticate men with subclinical and symptomatic varicoceles requiring early intervention. These sophisticated methodologies offer new insights and strategies for understanding normal spermatogenesis and the pathophysiology of varicocele-related male infertility. The application of AI strategies is expected to revolutionize varicocele management, enhancing male fertility and optimizing reproductive outcomes.

Purpose of review: Infertility impacts one in six couples worldwide, with male infertility contributing to approximately half of these cases. However, the causes of infertility remain incompletely understood, and current methods of clinical management are cost-restrictive, time-intensive, and have limited success. Artificial intelligence (AI) may help address some of these challenges. In this review, we synthesize recent literature in AI with implications for the clinical management of male infertility.

Recent findings: Artificial intelligence may offer opportunities for proactive, cost-effective, and efficient management of male infertility, specifically in the areas of hypogonadism, semen analysis, and interventions such as assisted reproductive technology. Patients may benefit from the integration of AI into a male infertility specialist's clinical workflow. The ability of AI to integrate large volumes of data into predictive models could help clinicians guide conversations with patients on the value of various treatment options in infertility, but caution must be taken to ensure the quality of care being delivered remains high.

Purpose of review: Transgender and non-binary patients (TGNB) undergoing gender affirming genital surgery may experience perioperative voiding dysfunction. This review aims to outline and analyze literature about gender affirming pelvic surgery urinary complications, evaluation, and treatment.

Recent findings: If a patient is seeking bottom surgery, then urinary goals and pre-operative symptoms should be discussed with respect to variable post-operative outcomes. Urologists should also be aware of the effect that gender affirming hormone therapy has on urinary symptoms. Urethral strictures and urethrocutaneous fistulae occur after feminizing and masculinizing procedures and may manifest as LUTS. Although there is no standardized approach for managing post-operative voiding issues, we present available options. The evaluation of TGNB patients is ideally affirming and tailored to the patient. Long-term urinary and voiding outcomes measurements after vaginoplasty and phalloplasty are also needed, as current validated questionnaires do not capture these symptoms well in TGNB patients.

Purpose of this review: Treatment of intermediate risk prostate cancer remains controversial. Clearly some patients with low volume favorable intermediate risk can be followed with active surveillance. Those with high volume bilateral disease need more radical whole gland therapy. The question remains on how to best treat low volume localized unfavorable intermediate risk prostate cancer (GG3) while maintaining quality of life. Focal therapy has been becoming a popular option for many patients with localized prostate cancer. Most studies looking at focal therapy for prostate cancer have been limited to GG1 and GG2, many of whom may not need treatment. We set out to review the literature evaluating the safety and efficacy of focal therapy for GG3 prostate cancer.

Recent findings: We reviewed multiple peer review articles obtained from a PubMed search. While in field biopsy recurrence rates approach 20%, failure free survival and overall survival exceeds 90%. While focal therapy for unfavorable GG3 intermediate risk prostate cancer may have higher rates of local recurrence with appropriate post procedure follow up, patients who need salvage therapy are easily identified and survival rates are very high. Focal therapy is a good option for patients with localized low volume GG3 prostate cancer without compromising cancer survival and preserving quality of life.

Purpose of review: The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes.

Recent findings: In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.