Current Urology Reports最新文献

Purpose of review: Infertility affects approximately 15% of couples globally, with male-factor infertility contributing to about half of these cases. Despite advancements in reproductive medicine, particularly in surgical methods, the prevalence of male infertility remains high and underreported, often due to cultural stigmas. Traditional semen analysis, a crucial component in diagnosing male infertility, involves subjective assessments, leading to variability in results. This review explores the advancements and applications of Artificial Intelligence (AI) in diagnosing and treating male infertility, emphasizing its potential to revolutionize the field by providing reliable and efficient diagnostic tools and improving treatment outcomes.

Recent findings: Recent advances in reproductive medicine, including techniques like microdissection testicular sperm extraction and intracytoplasmic sperm injection, have improved conception rates. However, the integration of AI in andrology offers even greater promise. AI techniques, including machine learning and artificial neural networks, now provide automated and objective analysis of sperm motility, and DNA integrity, significantly improving diagnostic precision. These technologies outperform traditional methods by reducing subjectivity in sperm evaluation, identifying subtle abnormalities often missed during manual assessments, and enhancing the selection process for assisted reproductive technologies. Moreover, AI-based predictive models optimize patient selection and personalize treatment protocols, increasing success rates. AI-driven technologies hold transformative potential in the field of reproductive medicine by enhancing the accuracy and efficiency of diagnosing and treating male infertility. The automated and objective analysis offered by AI can offer the possibilities of achieving parenthood for infertile men. However, the implementation of these technologies must be carefully managed, with particular attention to ethical considerations such as bias, transparency, and data privacy. AI's role in advancing reproductive medicine is promising, but responsible deployment is essential to maximize its benefits.

Purpose of review: Digital pathology, the use of digital images for histopathologic diagnosis, is transforming the practice of pathology. This review discusses the ability of digital pathology to assist with second opinions for challenging cases in genitourinary pathology worldwide.

Recent findings: While traditional pathology is limited by physical hardware such as microscopes and glass slides, digital pathology creates opportunities for the rapid sharing of diagnostic materials with colleagues and experts worldwide. This technology can greatly facilitate sharing challenging cases from low-resource areas where pathology services or subspecialty expertise are not available. As the incidence of kidney, prostate, and testicular cancer continues to increase in both high-income and developing countries, digital pathology may be the solution for expert opinions in diagnosing urologic disease worldwide.

Purpose of review: This review evaluates the current landscape of same-day discharge (SDD) following robotic-assisted laparoscopic prostatectomy (RARP), highlighting perioperative management strategies and proposing future research directions.

Recent findings: RARP has been shown to improve perioperative outcomes including reduced blood loss, postoperative pain, and hospital length of stay (LOS) when compared to open radical prostatectomy. Recently, the question of the feasibility of SDD for RARP has been proposed, aiming to reduce postoperative complications, hospital-acquired infections, and healthcare costs. The advent of single-port robotic systems aims to further minimize postoperative morbidity. Recent literature has reported SDD for RARP is safe and feasible in appropriately selected patients, with postoperative outcomes, including complication and readmission rates, similar to inpatient RARP. Our findings show SDD can be safely implemented without compromising patient outcomes, as evidenced by similar complication, readmission, and emergency department visit rates compared to inpatient cohorts. Future research should be aimed to refining patient selection criteria, enhancing opioid-free anesthesia pathways, and exploring new surgical technologies to improve SDD outcomes.

Purpose of review: Near-infrared fluorescence imaging (NIRF) with the use of indocyanine green (ICG) has been recently adopted in pediatric urology after its well-published use in the adult population. As a powerful tool that can help delineate complex anatomy and congenital anomalies, we discuss the various applications of this imaging in minimally invasive and open surgery in pediatric urology.

Recent findings: The most reported applications of ICG in pediatric urology are within minimally invasive surgery, particularly varicoceles, renal surgery such as nephrectomies and renal tumor excision, mimicking its use in adult urology. ICG has also been applied to reconstructive urology such as ureteral reconstruction, hypospadias repair and bladder exstrophy. Despite its safety and more widespread use in pediatric surgery, all published studies in pediatric urology to date have been limited to small and single-center experiences, reflecting the novel nature of this technology in this field. ICG has been shown to be safe and effective in children, particularly in those with complex anatomy and in technically challenging surgeries. Future studies should focus on standardized protocols for children and multi-center comparative studies.

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.