Current Urology Reports最新文献

Purpose of review: Renal transplantation has become the standard of care for patients with end-stage renal disease (ESRD) due to significant advancements across various medical and surgical fields. This review highlights the evolution of renal transplantation techniques, while also exploring the latest tools and practices that promise to further improve their outcomes.

Recent findings: Since the first successful renal transplant, numerous innovations have been implemented in the various stages of renal graft implantation. These include improved techniques in vascular and urinary anastomoses, graft positioning, and the recent emergence of modern technologies such as robotics and artificial intelligence (AI) which have shown promise in enhancing surgical performance. The field of renal transplantation is continuously evolving. As new and more efficient technologies continue to emerge, these too will become the standard of care and training. It is essential for transplant surgeons to understand the key historical developments that have led to our current level of expertise, so we can make effective use of these tools in further advancing the field.

Purpose of review: The present review explores the prevalence of musculoskeletal work-related injuries associated with endoscopic treatment of benign prostatic hyperplasia, ergonomic factors and potential current and future solutions.

Recent findings: Work-related musculoskeletal pain and injuries are prevalent in urology, with modifiable risk factors identified in the endoscopic treatment of benign prostatic hyperplasia. Future endeavors should focus on instrument design, formalized ergonomic training curricula and cultural shifts among the surgeon community. The combination of advancements in urology and a growing aging population has led to a rising volume of endoscopic treatments for benign prostatic hyperplasia. Ergonomic considerations are especially critical in endourology, where surgeons perform prolonged procedures requiring repetitive, precise movements. Optimizing ergonomics through surgeon education, training, improved operating room and instrument design, and ongoing research is essential to mitigating work-related musculoskeletal strain and enhancing surgical performance.

Purpose of review: To review the landscape of bladder preservation management and active surveillance for those who achieve clinical complete response to neoadjuvant chemotherapy.

Recent findings: Multiple cohorts of patients with clinical complete response report overall survival rates over 80% multiple years after treatment without cystectomy. Most recently, prospective clinical trials have been pursuing clinical complete response as a valid primary endpoint. Recent advances in immunotherapy and molecular biomarkers present new horizons in expanding the potential patient population as well as accuracy in prediction of pathologic complete response. While neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle-invasive bladder cancer, interest in active surveillance is growing as evidenced by the increasing number of studies. Accumulating evidence and new prospective data suggest this could be a plausible option in the future. These cohorts remain highly selected, thus generalizability is still under investigation.

Purpose of the review: To review the outcomes of robotic-assisted laparoscopic donor nephrectomy in the published literature.

Recent findings: Robotic-assisted laparoscopic donor nephrectomy has demonstrated to be a safe, efficient and effective technique of minimally invasive surgery, that offers multiple advantages to the surgeon, and good outcomes for the kidney donor and recipient. Although still a recent technique, it has been adopted by multiple centers worldwide. Robotic donor nephrectomy studies demonstrated consistent perioperative outcomes with low complication rates. Mean operative time was approximately 208 min, which is within acceptable limits. Mean warm ischemia time of 3.84 min remains well below the threshold for graft function preservation. Blood loss during is consistently low, below 150 mL, and conversion to open surgery remains rare, with a rate of 1.08%. These findings suggest that robotic-assisted procedures are feasible and safe for donor nephrectomy.

Purpose: This review offers an evaluation of the limited literature detailing the outcomes of incontinent urinary diversion in the pediatric neurogenic bladder patient. We will discuss the indications for incontinent urinary diversion, procedural options, surgical techniques, postoperative complications, and overall patient impact.

Recent findings: Incontinent urinary diversions remain a valuable treatment option for patients with neurogenic bladder especially the highly selected patient with few other options. Irrespective of the diversion chosen, postoperative complications do arise, and long-term follow-up is imperative. Ensuring the longevity and effectiveness of the diversion is critical, especially in a pediatric patient cohort with multiple long term risks including obesity- a factor that can directly impact reconstructive function. The dearth of available data highlights the need for more longitudinal studies of pediatric patient cohorts to determine true impact and risk related to incontinent urinary diversion.

Purpose of review: The purpose of this review is to provide an overview of evidence-based methods for urology programs and urologists to improve resident education as well as identify potential future research into this topic.

Recent findings: Urology residency training has evolved significantly over time. However, there is concern that graduating urology residents are not adequately prepared for independent practice. There are several reasons for this concern, including decreased surgical autonomy in training and a finite amount of time and number of cases that a resident can experience during training. There are many components of urology residency training, including didactic, simulation, intraoperative, and non-technical skills education. While many of these have been studied, there is room for better understanding into how to optimize learning opportunities in each of these domains. Currently, urologic education is heterogeneous and remains more of an art than a science.

Results: As we have long embraced evidence-based medicine, we should also push for evidence-based education in urology through continued study into how to best educate future urologists.

Purpose of review: To identify risk factors for urge urinary incontinence (UUI) in the prenatal period and following pregnancy. Characterization of prevalence of and interventions for UUI during this period were also examined.

Recent findings: A total of 1850 studies were initially identified through a database search. After removing duplicates (308 studies), 102 studies underwent full-text review following title and abstract assessment. After applying further selection criteria, 37 articles were included in the review. The studies span from 1993 to 2020 and involved sample sizes ranging from 58 to 6369 women, with participant ages averaging from under 19 to 39 years old. Body mass index, gestational diabetes mellitus, maternal age, parity, a history of urinary incontinence, and instrumental vaginal deliveries, that contribute to the onset or exacerbation of UUI. There was a large focus on patient questionnaires on symptoms. Analyzing data from over 25,000 patients, our study identifies several risk factors, both non-interventional and interventional that contribute to the onset or exacerbation of UUI. The strong focus on patient questionnaires on symptoms, and only secondary focus on quality of life, sexual function, or mental health point to a large gap in the literature where more work can be done.

Purpose of review: This review examines the imaging techniques for diagnosing spinal dysraphisms (SD), focusing on advancements in prenatal detection.

Recent findings: Prenatal ultrasound (US) is the first-line tool for detecting spinal dysraphisms, including myelomeningocele. While US is effective for early detection, it has limitations in fully characterizing defects, particularly due to factors like fetal positioning. To address these, advanced techniques such as 3D ultrasound and AI-driven algorithms have improved diagnostic accuracy. Magnetic resonance imaging (MRI) remains critical for a comprehensive evaluation, providing detailed visualization of soft tissue anomalies and assessing lesion severity. Prenatal ultrasound is essential for initial screening but often complemented by MRI for a thorough diagnosis. Innovations in imaging technologies, including AI and 3D ultrasound, promise to enhance early detection and clinical management of spinal dysraphisms.

Purpose of review: Review the current ways in which POCUS is currently being used and discuss current and future trends of POCUS training.

Recent findings: Despite broad utilization in many urologic practices, POCUS training is not routinely provided during urologic residency. Several barriers, including cost of equipment procurement and lack of expertise, prevent standardized implementation of POCUS curricula. POCUS education is valued and beneficial at all levels of training and changes in healthcare may reinforce the need for formal instruction.

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.