Current Urology Reports最新文献

Purpose of the review: Erectile dysfunction (ED) is a highly prevalent disease, affecting over 24% of men in the United States. Factors such as privacy and accessibility often act as barriers to care for patients. With the emergence of telemedicine, direct-to-consumer (DTC) platforms have become popular avenues for patients to seek care. These platforms are especially attractive to patients with ED due to their promises of providing discrete and convenient care. Phosphodiesterase type 5 (PDE5) inhibitors remain the most commonly prescribed therapy for ED. This review evaluates recent literature over the past five years to better understand the economics of PDE5 inhibitors offered through DTC platforms.

Recent findings: Studies have shown that while DTC companies offer convenience, these medications are offered at a significantly marked up price compared to more conventional means, such as an in-person clinical visit and brick and mortar pharmacies. While DTC platforms offer a promising model for improving access to ED care, their economic trade-offs and clinical limitations must be considered. Ongoing research and transparent pricing are needed to ensure that all patients with ED can make informed choices that best meet their clinical and economic needs.

Purpose of review: This review synthesizes the recent literature on lower urinary tract symptoms in pediatric patients with congenital conditions. We will discuss emerging insights from multiple studies on pathophysiology, prevalence, clinical impact, management strategies, and long-term outcomes.

Recent findings: Surgical advancements have increased early continence rates to 80% in exstrophy-epispadias complex (EEC), but attrition of continence remains a challenge. Studies have shown 40% of males with PUV and 80% of patients with EEC report moderate or severe LUTS which significantly impact quality of life. LUTS in patients with congenital anomalies remains a challenge in pediatric urology. Patients require individualized, lifelong management strategies. Future research should include standardizing continence definitions and assessing comparative effectiveness of treatments to enhance patient-centered outcome metrics. A multidisciplinary approach is critical to promoting sustained improvements in quality of life for individuals living with congenital genitourinary anomalies.

Purpose of the review: This review provides a detailed overview of the specifics of presentation, diagnosis, and management of upper and lower urinary tract stone disease for individuals with spina bifida.

Recent findings: Recent studies highlight the significant burden of stone disease for spina bifida patients. Individuals with spina bifida require lifelong urologic care. They are more likely to have stone disease and have complications from management. This is a particularly salient issue for patients who have undergone bladder augmentation. Given the frequency and severity of these issues, it is critical that urologists be familiar with the nuances of stone disease in this population. Further strategies are needed to decrease the morbidity associated with stone disease amongst individuals with spina bifida.

Purpose of review: To systematically evaluate and synthesize the existing literature on treatment outcomes for primary bladder neck obstruction (PBNO) in women, given the absence of prior systematic reviews focused on this population.

Recent findings: Current treatment options for PBNO in women include nonsurgical alpha-adrenergic receptor blockers (AB), surgical bladder neck incision (BNI), and investigational use of onabotulinumtoxinA injections (BTX-BN). Success rates for AB and BNI are approximately 50% and 75%, respectively, while BTX-BN appears to have lower efficacy. The existing studies on PBNO treatment in women are characterized by significant heterogeneity and a lack of high-quality evidence. Standardization is needed across multiple domains, including the definition of PBNO in women, the recommended diagnostic workup, and the establishment of criteria for treatment success and failure. Investigation of risk factors for treatment failure is also needed to better inform patient counseling and management.

Purpose of review: Non-relaxing pelvic floor dysfunction (NR-PFD) is a poorly understood and underdiagnosed cause of voiding dysfunction in patients without clear anatomic or neurologic obstruction. Symptoms may include pelvic pain, urinary complaints, defecatory dysfunction, and sexual issues, but their variability makes NR-PFD challenging to recognize and manage. This review focuses on the urologic manifestations of NR-PFD and outlines current diagnostic and treatment strategies.

Recent findings: Video urodynamics and surface EMG, alongside focused physical examination, are key tools for diagnosing NR-PFD. Pelvic floor physical therapy remains the first-line treatment, with strong evidence supporting its efficacy across sexes. Adjunctive options, including biofeedback, trigger point injections, botulinum toxin, and sacral neuromodulation, can benefit patients with refractory symptoms. Cognitive behavioral therapy and integrative modalities are also increasingly utilized. NR-PFD is an underrecognized cause of functional bladder outlet obstruction and complex LUTS. Management should be individualized and multidisciplinary. Future studies are needed to standardize diagnostic criteria and refine treatment algorithms.

Purpose of review: Postoperative prolapse recurrence is not uncommon, despite advances in surgical options and techniques. There is no consensus on the optimal approach to guide counseling and management for patients with recurrent prolapse following surgical repair.

Recent findings: Risk factors for postoperative prolapse recurrence include patient factors, pelvic floor factors, and surgical approach. There are various definitions for prolapse recurrence, including anatomic measures and patient reported symptoms. The highest rate of prolapse recurrence is seen within two years of initial surgery. Retreatment for prolapse requires shared decision-making, considering the patient's symptomatology, anatomy, comorbidities, and long-term goals. There is limited data regarding the long-term success of reoperation for pelvic organ prolapse. Anatomic and patient factors that affect surgical re-treatment outcomes for recurrent prolapse are not well understood. Standardized definitions of prolapse recurrence and more long-term data are necessary to inform evidence-based treatment decisions.

Purpose of review: This contemporary review paper analyzes the impact of fluid reduction in overactive bladder and associated factors related to nephrolithiasis.

Recent findings: Historically, overactive bladder and nephrolithiasis have been considered separate urologic pathologies. However, patients with OAB symptoms often restrict fluid intake to prevent episodes of urinary incontinence with resultant supersaturated urine, which precipitates nephrolithiasis formation. Coexistent pathologies promote the relationship between overactive bladder and nephrolithiasis, including urinary tract infection-related urolithiasis, bladder stones secondary to voiding dysfunction, and genitourinary syndrome of menopause. Overactive bladder and nephrolithiasis are profoundly impacted by fluid intake. The approach to overactive bladder should aim to optimize quality of life primarily by managing symptoms to avoid patient-imposed fluid intake restriction. By promoting patient confidence to consume the recommended daily fluid intake, nephrolithiasis formation risk is reduced. Eradication of other coexistent pathologies will further reduce overactive bladder symptoms and decrease stone formation.

Purpose of review: To summarize the evolution and future of technologies and techniques that assist in providing good functional outcomes during nerve-sparing robot-assisted radical prostatectomy.

Recent findings: Recent data underscore the value of preoperative optimization, including structured weight loss and pharmacologic interventions such as GLP-1 receptor agonists, in facilitating safer and more precise nerve-sparing. Advances in imaging and surgical planning, including 3D modeling and augmented reality, have enhanced anatomic visualization and margin control. Intraoperative adjuncts such as frozen section analysis (NeuroSAFE), nerve mapping and fluorescence guidance are being evaluated to minimize neural injury. Next-generation robotic systems incorporating haptic feedback and intraoperative penile oxygen monitoring may provide real-time functional assessment. Early series suggest these technologies can improve early continence and potency recovery, though long-term validation is needed. The future of nerve-sparing prostatectomy lies in a precision-based, multimodal framework that integrates advanced imaging, intraoperative functional assessment, and patient-specific rehabilitation strategies. While robotic surgery has established a new benchmark for anatomic preservation hold promise for improving both oncologic and quality-of-life outcomes. Rigorous validation and standardized reporting will be critical to moving these innovations from investigational use into routine practice.

Purpose of review: Urosymphyseal Fistula (USF) is a rare, often debilitating condition in which the urinary tract fistulizes with the pubic bone, resulting in recurrent pubic osteomyelitis (POM) from urinary tract seeding. These injuries commonly arise in the setting of pelvic radiation and are generally preceded by instrumentation of the lower urinary tract for obstruction. USFs tend to be recognized only after patients fail to recover from multiple lower urinary tract infections, resulting in repeat hospital readmissions. While fistula closures with urinary tract reconstruction have been described, treatment of USF is often complex and is best treated via urinary diversion with pubic bone debridement in the setting of preoperative optimization and long-term postoperative antibiotic regimens. The general understanding of USF presentation, work-up, and management is largely based on retrospective reviews with small sample sizes and case reports. Here we review the etiology, diagnosis, and considerations when providing care for this complex condition and propose a management algorithm to guide care.

Recent findings: Recent data on USF remain limited, with the literature dominated by small, retrospective case series and single-institution reviews. Most published studies report on cohorts of fewer than 30 patients, often focusing on men with a history of pelvic radiotherapy and subsequent urethral manipulation for prostate cancer. There is a notable absence of formal guidance from professional societies regarding standardized preoperative evaluation, diagnostic criteria, antimicrobial regimens, surgical techniques, or follow-up protocols for this condition. The literature published in the past 18 months continues to be sparse, with fewer than 10 new publications identified, underscoring the rarity of the condition and the ongoing need for multicenter studies and consensus guidelines. The presentation of USF can be quite subtle initially, and thus its diagnosis is nuanced and requires providers maintain a low threshold for further evaluation in high-risk patients with pelvic pain and refractory urinary tract infections. Here, we propose a comprehensive management pathway, informed by the current data, data from relevant related disease processes and institutional experience, that begins with contrast-enhanced imaging, preoperative medical optimization, and early involvement of infectious disease and surgical subspecialists to support perioperative and intraoperative planning and management. Ultimately, long durations of culture-directed antibiotics as well as surgical debridement with cystectomy, pubectomy, and urinary diversion is the most definitive method for cure of this condition. Long-term, high-volume studies on management and outcomes in these patients have yet to be performed.

Purpose of review: The review aims to understand how well patients follow dietary recommendations to prevent kidney stone recurrence and to identify strategies that can enhance their compliance with these dietary guidelines.

Recent findings: The review found that adherence to dietary prevention measures for nephrolithiasis is generally low, with only about 30% of patients following recommendations. Factors affecting adherence include education, comorbidities, and misconceptions. Strategies to improve adherence include clear communication, tailored plans, and the use of technology like mHealth and telemedicine. This mini review assesses patient adherence to dietary prevention measures for nephrolithiasis and explores methods to maintain or improve it. The review identifies factors affecting adherence, such as limited education, poverty, and misconceptions about the disease. It emphasizes the importance of clear communication, tailored dietary plans, and regular monitoring by healthcare providers to enhance patient compliance and improve health outcomes.