Current Urology Reports最新文献

Purpose of review: The evaluation and selection process of similarly qualified applicants for surgical residency positions in the United States (US) is challenging. Technical aptitude assessments may provide an opportunity to improve the selection process by offering insight into a candidate's technical skills. The use of these assessments prompts consideration of the degree to which technical aptitude in surgery is innate versus acquired. In this narrative review, we review the state of these assessments and the limitations of developing and validating these instruments.

Recent findings: Recent evidence suggests that technical aptitude can be quantified in medical students prior to selection for surgical training; however, both technical aptitude and dedicated practice of technical skills influence operative performance. In the US, technical aptitude assessments are inconsistently used in selecting candidates for surgical residency. Internationally, few countries have implemented standardized technical aptitude assessments in their surgical trainee selection processes. The development of technical aptitude assessments is ongoing worldwide. Technical aptitude assessments may help identify individuals particularly well-suited for a surgical career or those who might benefit from additional practice or remediation. The potential role of technical aptitude assessments in the selection process for surgical trainees remains uncertain. Consideration of these instruments requires an understanding of meaningful outcomes associated with particular technical assessments as well as the assessments' limitations.

Purpose of review: This narrative review aims to report upon the existing treatment evidence and strategies for managing lower urinary tract symptoms (LUTS) during treatment, including transurethral resection and intravesical therapy. This review also attempts to examine novel approaches to mitigate treatment-related lower urinary tract symptoms and improve treatment adherence.

Recent findings: There is sparse but promising evidence in improving LUTS secondary to intravesical therapy. Oral agents including phenazopyridine and hyaluronic acid, Bacillus Calmette-Guerin dose reduction, and emerging therapies including beta-3 agonists as well as Onabotulinumtoxin A injections all have demonstrated encouraging improvement in LUTS in limited research. Although recent literature explores new medications and potential strategies for managing intravesical therapy-related LUTS, further research is required to establish efficacy and new consensus on treatment strategies. Further research is also required to establish effective LUTS mitigation strategies with other emerging intravesical therapy regimens.

Purpose of review: Artificial Intelligence (AI) has produced a significant impact across various industries, including healthcare. In the outpatient clinic setting, AI offers promising improvements in efficiency through Chatbots, streamlined medical documentation, and personalized patient education materials. On the billing side, AI technologies hold potential for optimizing the selection of appropriate billing codes, automating prior authorizations, and enhancing healthcare fraud detection. The purpose of this review is to explore the current applications of AI in men's health clinics, with a focus on enhancing clinic efficiency and billing practices.

Recent findings: Current uses of AI, including AI-powered Chatbots, Large Language Models (LLM) and Natural Language Processing (NLP), are discussed with a focus on their application in men's health clinics. Additionally, the challenges associated with their implementation are highlighted.

Purpose of review: Artificial Intelligence (AI) has great potential in erectile dysfunction (ED) diagnosis and treatment. This review aims to summarize AI-based clinical decision-making in ED.

Recent findings: Based on the literature search, forty-seven articles related to AI and ED were analyzed and their findings were summarized. AI may help diagnose ED and offer treatment for it. Developing AI chatbots may also be beneficial for ED patients who are embarrassed to seek treatment. However, there are deficiencies in AI programs and a lack of accuracy in offering precise diagnoses and treatments for ED. AI technology integrates positively into ED clinical decision-making processes and needs progressive research to gain precision and efficiency.

Purpose of review: The purpose of this review is to highlight the health-related quality of life (HRQOL) burden of bladder cancer due to the disease itself and its treatments.

Recent findings: Large database studies have provided evidence that patients with bladder cancer have worse HRQOL than the general population. While transurethral resections and intravesical therapy are known to cause urinary symptoms, a large impact on HRQOL otherwise has not been demonstrated. Radical cystectomy (RC) has considerable morbidity, but after an initial adjustment period, there are favorable HRQOL outcomes. Evidence is insufficient to conclude that there are HRQOL advantages for continent versus ileal conduit urinary diversion, minimally invasive RC, or trimodal therapy. Bladder cancer and its treatment has a considerable HRQOL burden, but even among those requiring radical treatment, acceptable long term HRQOL is possible. Research on improved HRQOL assessment and translating this to personalized support are needed.

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.