Urology News Feeds

Posterior Urethroplasty Complexity and Prognosis Can be Described by a Novel Method: Posterior Urethral Stenosis Score

Urology (Gold Journal) In Press - Thu, 09/21/2017 - 00:00
To develop a standardized PU-score (posterior urethral stenosis score), with the goal of using this scoring system as a preliminary predictor of surgical complexity and prognosis of posterior urethral stenosis.
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The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction

Urology (Gold Journal) In Press - Thu, 09/21/2017 - 00:00
To examine the effectiveness of the three primary treatments for ureteropelvic junction obstruction (i.e., open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates.
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Clinical Outcomes of the Upper Urinary Tract After Ureteral Clipping for the Treatment of Low or Non-Functioning Renal Moieties

A growing body of evidence suggest it is safe to ligate the ureter of poorly functioning renal moieties during renal transplantation. Herein, we present clinical outcomes and data on hydronephrosis progression in pediatric cases associated with ectopic ureters and obstructive ureteroceles.
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Author Reply

Urology (Gold Journal) In Press - Thu, 09/21/2017 - 00:00
We thank Poelaert et al for their editorial and for emphasizing the importance of ensuring a meaningful benefit with the treatments we provide. Our overarching objective should be to optimize our patients' quantity or quality of life.
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Editorial Comment

Urology (Gold Journal) In Press - Thu, 09/21/2017 - 00:00
With this article the authors highlight an ever important clinical question: Do we achieve any meaningful benefit for the patient with our treatments? They report the updated long-term follow-up of a matched-pair analysis on adjuvant radiotherapy (RT) for pT2pN0 prostate cancer (PCa) with a single positive surgical margin after radical prostatectomy (RP).1 Adjuvant RT was associated with less local and biochemical recurrences, but this did not seem to (significantly) translate into less distant metastases or improved overall survival.
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Nephroptosis: Causes, diagnosis, and treatment

MedicalNewsToday - Wed, 09/20/2017 - 07:00
A floating or mobile kidney is medically known as nephroptosis. In this article, we learn about causes, risk factors, and complications for this condition.
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Editorial Comment

The authors use data from the National Spina Bifida Patient Registry to assess variation in the frequency of bladder reconstruction surgeries. They demonstrated significant differences in rates of bladder reconstructive surgery among participating centers, varying as much as threefold from one center to another. Remarkably one participating center had twice the mean overall rate of bladder reconstruction surgery. Unfortunately the indications for such reconstructive surgeries (ie incontinence, upper tract deterioration or worrisome urodynamics) were not recorded in the NSBPR, which would have provided more insight into these observed practice patterns.
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Reply by Authors

The development of local recurrence in conservatively treated patients with UTUC is not a rare event. As observed in the comment, 76% of patients in our series had at least 1 episode of local recurrence, thus, corroborating data from other studies in which this event was observed in up to 90% of cases (reference 17 in article) and confirming the need for stringent followup and repeat ureteroscopic procedures.
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Editorial Comment

Upper tract transitional cell carcinoma is traditionally treated with radical nephroureterectomy. Currently at most centers endoscopic treatment of upper tract urothelial neoplasms is primarily limited to patients with small, solitary, low grade tumors. In this study from a tertiary care referral center the authors treated 92 patients with upper tract urothelial malignancies with endoscopic management via flexible ureteroscopy with holmium laser ablation. Not surprisingly the high grade tumors were associated with a significantly higher chance of disease progression.
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Reply by Authors

Ever since the pioneering work by Smith in percutaneous renal access led to the birth of endourology,1 there has been a steady evolution in technique and technology for closed manipulation of the genitourinary tract and surgical management of stone disease. Despite this evolutionary progress there remain certain arcane factors that have the potential to significantly impact patient safety and outcomes. We believe that intrarenal pressures is one of these factors.
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Editorial Comment

The paradigm of shared decision making is becoming ever more entrenched in the patient-provider dyad for decisions with multiple acceptable alternatives.1 An increasing understanding of the widely variable degree to which patients ascribe value to different aspects of treatments and expected outcomes has contributed to the widespread acceptance of this approach by patients, physicians and policymakers. Despite the acceptance of shared decision making in theory, providers face numerous barriers to executing effective shared decision making in practice.
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Calling Order to Chaos: Treatment Decision Making in Metastatic Castrate-resistant Prostate Cancer

Urology (Gold Journal) In Press - Wed, 09/20/2017 - 00:00
Treatment decision making in prostate cancer (PCa) is increasingly complex. Especially with numerous immunologic, chemotherapeutic, radiopharmaceutical, and hormonal treatment options approved by the Food and Drug Administration over the past few years, which makes issues of balancing treatment benefit, harms, and values difficult to assess.1 Castrate-resistant PCa can be treated with immunotherapy (sipuleucel-T), which involves genetically engineering immune cells, hormone therapy (abiraterone and enzalutamide), radiopharmaceuticals (radium-223), or chemotherapy (docetaxel or cabazitaxel).
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National Imaging Trends After Ureteroscopic or Shockwave Lithotripsy For Nephrolithiasis

The study of diagnostic imaging use after procedural intervention for nephrolithiasis is limited. We sought to characterize actual national imaging patterns and longitudinal trends after ureteroscopic or shockwave lithotripsy.
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Natural History of Complex Renal Cysts: Clinical Evidence Supporting Active Surveillance

To evaluate intervention rates, progression and cancer-specific survival outcomes of patients with complex renal cysts in a single center experience.
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Genomic Scores are Independent of Disease Volume in Men with Favorable Risk Prostate Cancer: Implications for Choosing Men for Active Surveillance

To determine if disease volume at prostate biopsy correlates with genomic scores among men with favorable risk prostate cancer.
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The association of polymorphisms in the gene encoding gonadotropin releasing hormone with serum testosterone level during androgen-deprivation therapy and prognosis in metastatic prostate cancer

Serum testosterone suppression during androgen-deprivation therapy (ADT) has been reported to affect ADT efficacy. However, the factors impacting hormonal variations during ADT remain unclear. Therefore, in this study, we investigated the significance of missense polymorphisms in the gene encoding gonadotropin releasing hormone (GNRH) in men treated with primary ADT for metastatic prostate cancer.
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Dynamic Patterns of Testosterone Levels within Individuals and Risk of Prostate Cancer among Hypogonadal Men: A Longitudinal Study

We proposed to investigate whether dynamic patterns of testosterone (T) levels contribute to risk of prostate cancer (PCa).
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Impact of lesion visibility on transrectal ultrasound on the prediction of clinically significant prostate cancer (Gleason score ≥ 3+4) with TRUS-MRI fusion biopsy

The purpose of this study was to estimate the impact of lesion visibility with TRUS on the prediction of CS-PCA with TRUS-MRI fusion biopsy.
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Risk stratification of ‘equivocal’ PI-RADS lesions in mp-MRI of the prostate

To systematically analyze patients with PI-RADS-3-lesions (called ‘equivocal’ according to PI-RADS v2) in multiparametric prostate MRI (mp-MRI) and MR-targeted plus systematic transrectal ultrasound-guided (TRUS-GB) biopsies as reference standard.
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