Current Urology Reports最新文献

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.

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.