Current Urology Reports最新文献

Purpose of review: Robotic assisted partial nephrectomy (RaPN) is the treatment of choice for small and resectable renal tumors offering better results in terms of blood loss, postoperative complications and length of hospital stay compared with the open partial nephrectomy (OPN), while for both techniques the risk of postoperative renal dysfunction is limited. However, the oncologic outcomes of the robotic procedure are yet to be determined. Therefore, a comprehensive research of PubMed/Medline, Embase and Scopus databases from the year 2000 till June 2024 was performed to elucidate the results related to oncologic outcomes. The ROBINS-I tool for non-randomized cohort studies was applied for the assessment of the quality of the included studies. All statistical analyses were performed with the use of STATA software version 15.0.

Recent findings: The study was registered in International Platform of Registered Systematic Review and Metaanalysis Protocols database with the registration number INPLASY202450054. Overall 11 studies with 4758 patients were included in the present systematic review and meta-analysis. No statistically significant difference between the two treatment methods was reconded for the outcomes of overall survival [HR: 1.23 (95% CI: 0.68, 2.20)- p = 0.488], disease-specific survival [OR: 2.53 (95% CI: 0.65, 9.78)- p = 0.179], progression-free survival [HR: 1.04 (95% CI: 0.60, 1.79)- p = 0.901], recurrence-free survival [HR: 0.83 (95% CI = 0.54, 1.27)-p = 0.394] and disease-free survival [OR: 1.01 (95% CI = 0.98, 1.03)-p = 0.582]. The quality of most of the included studies was deemed moderate. Despite the need for more high quality comparative studies it is assumed that these results could be helpful in decision making and in counselling patients with resectable renal tumors to whom a nephron sparing surgery may be considered.

Purpose of review: Neurogenic bladder dysfunction (NBD) is a frequent complication of neurological diseases including Parkinson's disease, multiple sclerosis, spinal cord injury, and spina bifida. Managing NBD remains challenging, especially for patients who fail to respond to standard therapies. Sacral neuromodulation (SNM), though FDA-approved for non-neurogenic conditions, is increasingly explored off-label in neurogenic populations.

Recent findings: Recent studies demonstrate that SNM can improve lower urinary tract symptoms, bladder storage, and emptying in select NBD patients. Small case series and retrospective reviews suggest reduced catheterization and medication use. Technological advances, such as closed-loop systems and MRI-compatible devices, are broadening SNM's clinical potential. SNM is emerging as a valuable, minimally invasive treatment for neurogenic bladder dysfunction. Careful patient selection and understanding of underlying pathophysiology are essential for success. As evidence grows and device innovations continue, SNM could reshape management strategies for patients with neurogenic bladder.

Purpose of review: Urothelial carcinoma is a prevalent malignancy within the United States that may involve the upper and/or lower urinary tracts. Multimodal treatment is often employed, with transurethral resection and intravesical therapy standard of care for non-muscle-invasive disease; neoadjuvant systemic therapy followed by radical cystectomy or trimodal therapy for muscle-invasive disease; and combination immune checkpoint inhibitors and antibody-drug conjugates standard of care for metastatic disease. These treatments carry risks of surgical complication or treatment-associated toxicity which can impair quality of life. Predictive biomarkers of treatment tolerability are currently limited.

Recent findings: There is emerging evidence that radiological biomarkers can predict treatment outcomes among patients with urothelial carcinoma. In this review, we evaluate the existing data on radiological biomarkers evaluable from current standard-of-care imaging in predicting treatment outcome among patients with urothelial carcinoma.

Purpose of review: The aim of this review is to evaluate recent literature surrounding the impact of new medical and surgical therapies for benign prostatic hyperplasia (BPH) on sexual health and function.

Recent findings: Recent randomized controlled trials evaluating patients treated with Optilume, Rezum, Urolift, iTind, and prostatic artery embolism reported minimal associated risks for the development of sexual dysfunction. However, these treatments provide inferior improvement in lower urinary tract symptoms (LUTS) when compared to transurethral resection of the prostate (TURP) and simple prostatectomy. Aquablation demonstrates similar improvement in LUTS while significantly minimizing ejaculatory dysfunction compared to TURP. Management of BPH must include patient counseling on the potential risks of sexual dysfunction associated with both medical and surgical therapies. Future research should be guided towards comparing minimally invasive surgical therapies to one another and collecting long-term data on the durability of these therapies on urinary and sexual function.

Purpose of review: Despite recent increased focus on urology resident wellbeing, rates of burnout remain high. Addressing this requires a multifaceted approach. This review examines recent literature to identify key strategies for fostering a positive urology residency culture to optimize training and minimize burnout.

Recent findings: We identified 5 key strategies for fostering a positive residency culture: wellness, safety, mentorship, education, and traditions. Proactive wellness initiatives involve providing access to health resources as well as social programming. Ensuring resident safety requires minimizing physical and psychological mistreatment while ensuring access to basic needs. Formal mentorship strengthens professional growth and personal fulfilment. Advancing resident education through structured learning models and access to key resources improves wellbeing. Institutional traditions build camaraderie, unity, and a shared sense of purpose. Creating a strong urology residency culture requires a multidimensional approach. Integrating these elements can improve resident satisfaction, reduce burnout, and strengthen both resident professional growth and patient care.

Purpose of review: This review explores new evidence in Fournier's Gangrene management, emphasizing survivorship. We highlight the shift toward skin-sparing debridement techniques, new reconstructive strategies, and highlight limited evidence on outcomes. Additionally, we examine recent evidence on diagnosis, antimicrobial therapy, adjunctive treatments, and post-operative wound care.

Recent findings: New evidence supports the feasibility of skin-sparing debridement, reducing the need for extensive reconstruction while improving primary closure rates and lowering healthcare costs. Advances in reconstructive techniques accelerate wound healing and shorten hospital stays. Optimized wound management-integrating antimicrobial solutions, negative pressure therapy, and targeted antibiotics-continues to improve recovery while minimizing morbidity and mortality. Modern Fournier's management prioritizes early recognition, tissue preservation, and early genital reconstruction. Despite advancements, gaps remain in early diagnosis and long-term outcomes after the index admission. Further research on post-reconstruction recovery is essential to refine treatment protocols and determine quality of life for affected patients.

Purpose of review: Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging has revolutionized prostate cancer detection and management. This review aims to evaluate the latest advancements in PSMA PET imaging, assess its clinical applications in various disease stages, and compare it to conventional imaging techniques. We sought to determine how PSMA PET impacts clinical decision-making, treatment strategies, and patient outcomes, with a focus on its expanding role in precision oncology.

Recent findings: Recent studies have demonstrated that PSMA PET exhibits superior sensitivity and specificity in detecting prostate cancer metastases, particularly in cases of biochemical recurrence and early-stage disease. The advent of radiolabeled PSMA ligands, such as 68Ga-PSMA-11 and 18 F-DCFPyL, has led to improved diagnostic accuracy. Furthermore, PSMA-targeted radioligand therapies (e.g., 177Lu-PSMA-617) show promising results in metastatic castration-resistant prostate cancer (mCRPC), offering a novel therapeutic avenue. Studies have also highlighted the role of PSMA PET in refining treatment plans, including guiding surgery and radiotherapy. PSMA PET imaging represents a paradigm shift in prostate cancer diagnostics, staging, and treatment monitoring. It has led to earlier and more accurate detection of metastases, significantly altering management strategies. The growing body of evidence supports its integration into standard-of-care protocols, with ongoing research focusing on optimizing its therapeutic applications. Future studies should explore cost-effectiveness, accessibility, and potential synergies with emerging systemic therapies to further enhance patient outcomes.

Purposeof review: This review examines the various ways artificial intelligence (AI) has been utilized in medical education (MedEd)and presents ideas that will ethically and effectively leverage AI in enhancing the learning experience of medical trainees.

Recent findings: AI has improved accessibility to learning material in a manner that engages the wider population. It has utility as a reference tool and can assist academic writing by generating outlines, summaries and identifying relevant reference articles. As AI is increasingly integrated into MedEd and practice, its regulation should become a priority to prevent drawbacks to the education of trainees. By involving physicians in AI design and development, we can best preserve the integrity, quality, and clinical relevance of AI-generated content. In adopting the best practices for AI use, we can maximize its benefits while preserving the ethical standards of MedEd with the goal of improving learning outcomes.

Purpose of review: Renal cell carcinoma (RCC) is a prevalent and increasingly diagnosed malignancy associated with high mortality and recurrence rates. Traditional diagnostic and therapeutic approaches have limitations due to the disease's molecular heterogeneity. This review aims to explore how the integration of omics sciences-genomics, transcriptomics, proteomics, and metabolomics-can enhance the diagnosis, prognosis, and treatment of RCC.

Recent findings: Genomic analyses have uncovered critical mutations, including VHL, PBRM1, and BAP1, which support improved risk stratification and the development of targeted therapies. Transcriptomic and spatial transcriptomic studies have provided deeper insights into RCC heterogeneity and tumor microenvironment dynamics. Proteomic investigations have revealed potential biomarkers, while metabolomic approaches have highlighted RCC-specific metabolic shifts. Despite these advancements, several challenges persist, including intratumoral heterogeneity, difficulties in multi-omics data integration, and the limited clinical validation of biomarkers. Omics-driven approaches hold significant promise for advancing precision medicine in RCC. These technologies can facilitate earlier diagnosis, guide individualized therapies, and enhance prognostic evaluations. Future research must focus on validating multi-omic biomarkers and leveraging artificial intelligence to manage complex datasets, thereby supporting more informed clinical decision-making and personalized treatment strategies.