Current Urology Reports最新文献

Purpose of review: This review evaluates the role of urine culture (UC) in preoperative assessment for endourological stone procedures. It addresses the optimal timing of UC, its predictive value compared to urinalysis, the interpretation of mixed flora, and the utility of repeat cultures after antibiotic treatment. In addition, it explores emerging molecular methods that may refine perioperative infection risk assessment.

Recent findings: UC remains the gold standard for identifying infection risk, but several controversies persist. Studies suggest urine dipstick testing can complement or even outperform UC in certain contexts, while mixed flora results often do not justify antibiotic therapy. Evidence indicates that prolonged preoperative antibiotic prophylaxis reduces postoperative sepsis in high-risk patients, though repeat UC after treatment has limited predictive value. Novel approaches such as next-generation sequencing and molecular diagnostics offer higher sensitivity but risk overdiagnosis. Preoperative UC remains indispensable for risk assessment in endourology, though its limitations demand a more nuanced, risk-adapted approach. Integration of urinalysis, selective repeat testing, and emerging molecular diagnostics could refine perioperative decision-making while supporting antimicrobial stewardship.

Purpose of review: Peyronie's disease (PD) is an acquired penile deformity that causes penile shortening, narrowing, erectile dysfunction, and pain. Current treatment modalities include penile traction therapy (PTT), Collagenase Clostridium histolyticum (CCh) injections, and surgical straightening procedures which have varying levels of expected deformity correction and associated side effects. Similarly, these treatments have varying levels of both out-of-pocket and total costs for the healthcare system as a whole. This review aims to summarize the current literature regarding the costs of treatment modalities available for PD.

Recent findings: Current well-supported treatment options for PD can be categorized into three groups: PTT, CCh, and surgical straightening. CCh injection therapy is gaining popularity but remains the single most expensive therapy for PD. PTT has demonstrated modest curve reduction efficacy, and may be an approachable initial therapy modality for select patients. Penile plication and penile plaque incision/excision surgery are more definitive surgical options that are less expensive than CCh injections but more expensive than PTT. While the literature continues to evolve with emerging guidelines and FDA approvals, PTT remains the lowest absolute cost option while CCh injections and penile plication surgery are the higher cost options. PTT and injection therapy are time intensive which must be taken into account in any discussion of cost-effectiveness. More research remains to be performed to consider cost-effectiveness of various treatment options for PD patients while taking into account efficacy, opportunity cost, and patient quality of life. Urologists treating patients with PD must understand the economic aspects of the evolving treatment landscape to effectively guide management for each patient to enhance quality of life and patient outcomes.

Purpose of review: This review synthesizes current evidence on therapeutic strategies for Parkinson's disease (PD)-related overactive bladder (OAB), encompassing PD-targeted treatments, pharmacologic interventions, and advanced therapies such as neuromodulation and intravesical botulinum toxin. We address the complexity of managing lower urinary tract symptoms (LUTS) in patients with PD due to progressive neurodegeneration affecting micturition control and cognitive vulnerabilities in this population.

Recent findings: A thorough review of available literature shows that chronic levodopa improves bladder capacity and reduces urgency, though acute dosing may worsen symptoms in advanced stages. Subthalamic nucleus-deep brain stimulation enhances bladder function and symptom scores, possibly by modulating basal ganglia-thalamocortical circuits. Anticholinergics are effective but pose cognitive risks, warranting careful use guided by anticholinergic burden assessments. In contrast, beta-3 agonists such as mirabegron offer a safer cognitive profile with emerging efficacy data. Finally, intravesical botulinum toxin and neuromodulation present promising third-line options, though data in PD remain limited, and larger trials are still needed to confirm their role. Optimal management of LUTS in PD requires individualized, stage-specific, multidisciplinary strategies balancing efficacy and cognitive safety. Further high-quality, disease-specific studies are essential to develop tailored treatment algorithms and improve quality of life in this growing patient population.

Purpose of review: To examine current evidence on the relationship between testosterone and lower urinary tract symptoms (LUTS) in men, focusing on endocrine, metabolic, and inflammatory mechanisms and their implications for clinical practice.

Recent findings: Recent studies demonstrate that testosterone influences bladder, prostate, and pelvic floor function through androgen-receptor pathways. Low testosterone amplifies inflammation, oxidative stress, and vascular dysfunction, while metabolic syndrome with associated hypogonadism and sleep disorders exacerbate LUTS severity. Experimental and clinical data confirm that physiologic testosterone therapy does not worsen LUTS or prostate outcomes when appropriately monitored. Testosterone deficiency contributes to LUTS through systemic, not purely anatomical, mechanisms. Restoring physiologic hormone balance and addressing metabolic and sleep factors improves urinary function and quality of life. Future research should prioritise phenotype-specific trials and integrated metabolic-endocrine-urological approaches to refine personalised care for men with LUTS and hypogonadism.

Purpose of review: The origin of kidney stones is multifactorial, involving a complex interplay of genetic, metabolic, and environmental factors. This review aims to detail the relationship between the molecular pathogenesis of kidney stone disease and the impact diet can have on stone formation and patient outcomes.

Recent findings: Diet is an important part of managing kidney stones at a molecular level. Oxalate can be absorbed from the diet through the digestive system into the urine where calcium and oxalate can combine to form stones. Evidence supports that low dietary calcium contributes to first time and recurrent stones, and high dietary sodium elevates the risk of calcium stone formation. Diets high in animal protein cause high levels of urinary uric acid and calcium and low levels of urinary citrate. Low urine pH favors uric acid stone development, and fructose increases serum and urinary uric acid levels. Alternatively, consuming fruits and vegetables raises urinary pH and citrate excretion. Adequate hydration also dilutes urinary solutes and reduces supersaturation. Potassium citrate, magnesium, and calcium supplementation are thought to prevent stone formation. Diet and adequate hydration can manipulate the pathogenesis of stones to prevent recurrence and improve patient outcomes. Calcium oxalate stones are the most common, followed by calcium phosphate, uric acid, struvite, and cystine stones. By aligning nutritional interventions with stone type and metabolic profile, healthcare providers can offer non-invasive methods for improving outcomes.

Purpose of review: To summarize the current evidence on the incidence, risk factors, diagnosis, prevention, and management of incisional hernias following robotic urologic surgery.

Recent findings: Emerging evidence has highlighted both surgical and patient-related factors that influence the risk of incisional hernia. Surgical variables associated with higher incidence include midline extraction sites, midline trocar placement, prior abdominal surgery, non-bladed trocar use, and advanced tumor stage. Patient-specific contributors include visceral obesity and rectus diastasis. The financial impact is substantial, with U.S. healthcare expenditures for incisional hernia management estimated at $1.7 billion annually, underscoring the need to optimize surgical technique and patient selection to reduce this burden. Incisional hernia (IH) remains a significant postoperative complication, even with the advent of minimally invasive and robotic surgical techniques. Studies report a variable incidence of IH 0.2-6.3% following robotic prostatectomy, with rates as high as 27% in robotic nephrectomy depending on imaging modality and hernia definition. Diagnosis is commonly made with CT imaging, which remains the gold standard for preoperative planning. Although many IHs are asymptomatic, they may progress to incarceration, necessitating emergency repair with significant morbidity and mortality. Risk factors for IH are multifactorial and include patient-related variables such as obesity, smoking, COPD, diabetes, and rectus diastasis, as well as surgical factors including trocar size and type, extraction site location, and fascial closure technique. Notably, midline and bladed trocar placements are associated with higher hernia risk, while Pfannenstiel extraction and use of non-bladed trocars may be protective. Management strategies remain inconsistent, and preventive measures such as prophylactic mesh, proven effective in general surgery, have yet to be evaluated in urologic robotic procedures. This review summarizes the current literature on IH following robotic urologic surgery, with emphasis on incidence, risk factors, diagnostic modalities, preventive techniques, and potential areas for future research. Given the growing use of robotics in urology and the rising economic burden of IH, better understanding of prevention and early intervention is essential to improving outcomes and reducing healthcare costs.

Purpose of review: The goal of this paper was to identify the factors contributing to urinary incontinence in patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by performing a systematic review of the literature.

Recent findings: Our search identified 40 randomized studies. Significant heterogeneity existed in defining urinary incontinence in the literature. Many factors contribute to postoperative incontinence after HoLEP, with surgical technique seeming to play the largest role in determining continence outcomes. Refinement of surgical technique is critical to improving continence outcomes after HoLEP. Standardizing definitions of urinary incontinence will enable more reliable comparisons across studies and facilitate better-informed preoperative counseling. Continued investigation is also essential to develop interventions-whether surgical, behavioral, or pharmacologic-that enhance continence recovery and overall quality of life.

Purpose of review: The purpose of this review is to highlight relevant literature on the epidemiology and pathophysiology of renal cell carcinoma with a tumor thrombus (RCC-TT), metastatic management, and the role of systemic therapy (ST).

Recent findings: Current research indicates different prevalences and presentations by geography, with many classification systems for RCC-TT. Pathophysiology remains poorly understood for TT formation. Some patients may benefit from cytoreductive nephrectomy with tumor thrombectomy (CN-TT) as well as ST administration, but this population is poorly defined. RCC-TT is a complex disease to manage and lacks high-powered publications relative to RCC without a TT. Future research should focus on the genetics behind TT formation and propagation, CN-TT outcomes, and which patients should receive ST and the optimal timing/dosage.