Urology News Feeds
Individualizing Urinary Incontinence Treatment: Research Needs Identified at a National Institute of Diabetes and Digestive and Kidney Diseases Workshop
Despite intensive work in the field, urinary incontinence (UI) treatment is characterized by unintended side effects, uncertain durability, high risk of complications, and inconsistent outcomes. Therapy is generally directed toward underlying anatomic and physiologic causes, with little attention to important cognitive, psychosocial and behavioral aspects of UI. Recognition that the variability in UI treatment success is likely driven at least in part by individual variability—combined with a demonstrated need for better outcomes for patients with UI; a torrent of technical advances involving -omic, mobile health, and data science technologies; and growth of intra- and transdisciplinary research—has made the development of a science base to enable better targeting of UI treatments based on individual patient characteristics both interesting and feasible.
Assessment of serum microRNA biomarkers for predicting reclassification of prostate cancer patients on active surveillance
Conventional clinical variables cannot accurately differentiate between indolent and aggressive prostate cancer among active surveillance patients. We investigated promising circulating miRNA biomarkers for predicting reclassification of active surveillance patients.
According to AUA/SUFU guidelines third line therapies for OAB include PTNS, onabotulinumtoxinA and SNM (reference 7 in article). Several factors may have a role in the progression to these treatments, such as access to health services, regulatory issues, associated costs, availability of specialized care, patient acceptance, and education of patients and health care professionals about specific therapeutic strategies.1
Volume 199, Number 1, Page 107, Patients and Methods, Study Population: Sentence 1 should state "We queried the University of Rochester Medical Center PCa mpMRI database (n =1001) and identified 240 patients who underwent fusion biopsy using PI-RADS, version 2 from December 2014 to December 2016."
We obviously agree that statistical, and more relevantly, clinical validation would be required to provide more certainty around the utility of diversion in slowing the progression to ESRD in the first year after diversion. Presently, diversion is to be a carefully considered “exception to the persistently quixotic rule” in the multifactorial interprofessional bladder negotiations that engulf these vulnerable infants.
The most optimal initial treatment approach for patients with posterior urethral valves remains unclear. To avoid defunctionalizing the bladder most pediatric urologists endorse primary valve ablation, when clinically possible, as preferable to vesicostomy or supravesical diversion.1 For patients with PUV at high risk for eventual end stage renal disease, urinary diversion may postpone renal failure progression compared to ablation alone (reference 7 in article). Furthermore, supravesical diversion is generally reserved for the most severe cases of PUV (reference 28 in article), thus treatment group comparison studies are inherently challenged by intrinsic selection bias.
We agree that only a few prostate cancer biomarkers are commercially available, of which most have shown relatively small incremental improvements in risk prediction.1,2 Their optimal role in the clinical setting remains incompletely defined. Nonetheless, these markers are slowly changing the way that we risk stratify patients and impacting treatment decisions. In the era of precision medicine solely relying on clinicopathological data is not enough to tailor the best treatment option for patients with localized prostate cancer, among whom there is tremendous genomic heterogeneity with variable progression across the prostate cancer risk continuum.
A cursory search for “prostate cancer” and “biomarker” on PubMed® demonstrated more than 33,000 papers with more than 2,700 published since the beginning of 2016. Despite this there are relatively few commercially available biomarkers for patients with localized prostate cancer.1 Therefore, we must ask what we are doing wrong and why laboratory efforts are not successfully being translated to the clinic. Nguyen et al sought to identify a novel biomarker which provides additional prognostic information beyond routinely available clinicopathological data.
The practice of medicine occurs on an individual level and a group level. For an individual, medical care must account for variations in physiology, anatomy and personal autonomy. On a group level, the efficacy of evaluation and treatment options, and allocation of available resources focus on groups of patients by their unifying diagnoses, symptoms or signs. In this issue are 2 articles on individual and group management issues in patients with posterior urethral valves (PUV) and febrile urinary tract infections (UTI).
Increased use of cross-sectional imaging has led to a rise in the detection of SRMs.1 Given that 15% to 20% of SRMs are benign and most the remainder harbor indolent pathology, active surveillance has become a core initial management strategy to better pair disease biology with treatment intensity.2 Complex renal cysts represent a significant opportunity to minimize overtreatment of low risk lesions since the solid component in cystic tumors rarely exceeds 3 to 4 cm and cystic RCC is associated with favorable long-term prognoses (references 15 and 21 in article).
Urologists commonly evaluate and treat patients for cystic renal masses. Historically surgery was recommended for more complex cysts (Bosniak III or IV) because of the increased risk of RCC. However, the results of a systematic review of treatments for complex cysts suggests that surgical treatment may often not be necessary (reference 11 in article). In addition, recent large series have demonstrated that progression to metastatic disease following surgery for cystic RCC is exceptionally rare,1,2 further supporting an increased role for active surveillance.
Active surveillance, a policy that has almost revolutionized the management of prostate cancer, is increasingly recognized as a preferred approach for small renal masses, which is supported by 2 studies published in this issue of The Journal of Urology.
S. Loeb, Y. Folkvaljon, J. E. Damber, J. Alukal, M. Lambe and P. Stattin
Re: Moderate Hypofractionation in High-Risk, Organ-Confined Prostate Cancer: Final Results of a Phase III Randomized Trial
G. Arcangeli, B. Saracino, S. Arcangeli, S. Gomellini, M. G. Petrongari, G. Sanguineti and L. Strigari
Re: Weight Gain and Obesity in Infants and Young Children Exposed to Prolonged Antibiotic Prophylaxis
M. B. Edmonson and J. C. Eickhoff
S. Khandige, C. A. Asferg, K. J. Rasmussen, M. J. Larsen, M. Overgaard, T. E. Andersen and J. Møller-Jensen
A. A. Ghazarian, S. P. Kelly, S. F. Altekruse, P. S. Rosenberg and K. A. McGlynn
Re: Do Histopathologic Variables Affect the Reporting of Lymphovascular Invasion in Testicular Germ Cell Tumors?
B. L. French and D. L. Zynger
Re: Surrogate End Points for All-Cause Mortality in Men with Localized Unfavorable-Risk Prostate Cancer Treated with Radiation Therapy vs Radiation Therapy plus Androgen Deprivation Therapy: A Secondary Analysis of a Randomized Clinical Trial
T. J. Royce, M. H. Chen, J. Wu, M. Loffredo, A. A. Renshaw, P. W. Kantoff and A. V. D’Amico
G. P. Guy, Jr., K. R. Yabroff, D. U. Ekwueme, S. H. Rim, R. Li and L. C. Richardson