Reviews in urology最新文献

Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which both kidneys are located on a unilateral side of the retroperitoneal space. The ureter of the ectopic kidney is seen to pass over the midline to insert in its normal anatomic position. Frequently this anomaly goes undetected until there is radiologic screening for other purposes or when other genitourinary issues are investigated. Although frequently isolated, this condition has been reported to be associated with other congenital anomalies, genetic disorders, and various urogenital anomalies more than 50% of the time. However, we found no cases linking CFRE with a solitary testicle. This is a case of a 30-year-old man with left-to-right CFRE with concomitant absent left testicle and obstructing distal calculus.

Salvage treatment options after localized primary treatment failure of prostate cancer are limited and associated with risk for serious complications. We report on the management details of a 57-year-old African American man treated with partial-gland ablation using irreversible electroporation following local recurrence after brachytherapy and prior salvage cryoablation. Therapeutic and functional outcomes were assessed by conventional means, including serum prostate-specific antigen values and prostate biopsy results.

The 4Kscore^® Test (OPKO Diagnostics, Woburn, MA) is a blood test utilized prior to a prostate biopsy to determine a patient's risk of high-grade prostate cancer (PCa) should the biopsy be performed, thus providing critical information in the clinical management of men with a suspicious prostate-specific antigen value or digital rectal examination result. Multiple US and European clinical studies confirmed that a prebiopsy 4Kscore Test has a high degree of discrimination for a subsequent discovery of high-grade (Gleason score ≥7) PCa. The aim of this study was to evaluate the predictive accuracy of the 4Kscore Test to discriminate between patients with and without high-grade PCa based on published clinical validation studies. A systematic review and meta-analysis of the eligible 4Kscore Test clinical validation studies was conducted. The pooled area under the curve (AUC) of the 4Kscore Test as reported from all the studies, and the heterogeneity among these studies were analyzed and repeated for subgroups of the studies. Twelve clinical validation studies were included in the meta-analysis, comprising a total of 11,134 patients. The pooled AUC to discriminate for high-grade PCa for all 12 studies was 0.81 (fixed effects 95% CI, 0.80-0.83). Restricting the analysis to the six publications that used the contemporary 4Kscore Test algorithm led to very similar results (AUC 0.81; 95% CI, 0.79-0.83). Heterogeneity was high among all of the 12 studies, as well as among the six publications that used the contemporary 4Kscore Test (Cochrane's Q test, p = 0.001 for both); however, in both cases, after exclusion of a single outlying study with a much lower AUC, heterogeneity was no longer significant (p = 0.08 and p = 0.21). The pooled estimate of 4Kscore Test discrimination (AUC) for high-grade PCa is >0.80, and is consistent across multiple US and European clinical validation studies.

Upper tract urothelial carcinoma is a relatively uncommon malignancy. The gold standard treatment for this type of neoplasm is an open radical nephroureterectomy with excision of the bladder cuff. This systematic review compares the perioperative and oncologic outcomes for the open surgical method with the alternative surgical management options of laparoscopic nephroureterectomy and robot-assisted nephroureterectomy (RANU). MEDLINE, EMBASE, PubMed, and Cochrane Library databases were searched using a sensitive search strategy. Article inclusion was then assessed by review of abstracts and full papers were read if more detail was required. In all, 50 eligible studies were identified that looked at perioperative and oncologic outcomes. The range for estimated blood loss when examining observational studies was 296 to 696 mL for open nephroureterectomy (ONU), 130 to 479 mL for laparoscopic nephroureterectomy (LNU), and 50 to 248 mL for RANU. The one randomized controlled trial identified reported estimated blood loss and length of stay results in which LNU was shown to be superior to ONU (P < .001). No statistical significance was found, however, following adjustment for confounding variables. Although statistically insignificant results were found when examining outcomes of RANU studies, they were promising and comparable with LNU and ONU with regard to oncologic outcomes. Results show that laparoscopic techniques are superior to ONU in perioperative results, and the longer-term oncologic outcomes look comparable. There is, however, a paucity of quality evidence regarding ONU, LNU, and RANU; data that address RANU outcomes are particularly scarce. As the robotic field within urology advances, it is hoped that this technique will be investigated further using gold standard research methods.

A 69-year-old morbidly obese man presented with hematuria caused by a large anterior wall bladder tumor. The mass was inaccessible for resection by standard means due to the patient's obesity and phallic length. A perineal urethrostomy was required to enable complete resection. This age-old technique is revisited for the benefit of this generation's urologists.

A 2016 meta-analysis documented a possible association between hypertension and prostate cancer. We retrospectively reviewed our 3200 prostate cancer patients that were aged 51 to 76 years to determine the frequency of hypertension. Data was gathered on age, race (African American and white), hypertension, diabetes, and body mass index (BMI). Patients were subdivided into three groups: age 51 to 60 years, age 61 to 70 years, and age 71 to 76 years. Our study population consisted of 1388 (43%) African American patients and 1812 (57%) white patients. Hypertension was found in 1013 (73%) of African American patients and 1290 (72%) of white patients. Diabetes was found in 35% of African American patients and 24% of white patients. BMI over 30 kg/m² (obesity) was found in 47% of African American patients and 45% of white patients. We found the frequency of hypertension to be 73% in African American and 72% in white patients, 18% and 44% relatively higher in African American vs white patients, respectively, compared with the general population (62% in African American vs 50% in white patients). The study also found a similar frequency of hypertension among African American and white prostate cancer patients, despite an approximate 12% difference in the general population. Based on these findings, we suggest that prostate cancer and hypertension share a common androgen-mediated mechanism and further prospective studies are recommended to confirm that hypertension is a risk factor for prostate cancer.