Current Opinion in Urology

PURPOSE OF REVIEW: The role of radical cystectomy and pelvic lymph node dissection in muscle-invasive bladder cancer (MIBC) with clinically positive lymph nodes is debated. This review examines the role of surgery in treating patients with clinical N1 and more advanced nodal involvement (N2-N3) within a multimodal treatment approach. RECENT FINDINGS: For clinical N1 disease, guidelines typically recommend neoadjuvant chemotherapy followed by surgery. However, for N2-N3 disease, guidelines vary...

PURPOSE OF REVIEW: Renal cell carcinoma (RCC) is resistant to chemotherapy. Adjuvant interferon and tyrosine kinase inhibitors were ineffective. Immune checkpoint inhibitors (ICIs), however, have shed new hope in this setting. In the current review, updated evidence of adjuvant therapy in RCC is summarized. RECENT FINDINGS: KEYNOTE-564 demonstrated survival benefits of adjuvant Pembrolizumab in RCC. EAU guidelines now recommend adjuvant pembrolizumab to ccRCC patients at an increased risk of recurrence, as defined in the study...

PURPOSE OF REVIEW: The focus of this review is to present recent literature and gaps in knowledge (GIKs) surrounding the current and future treatment and prevention of uncomplicated recurrent urinary tract infections (rUTIs) in women. RECENT FINDINGS: Recurrent urinary tract infections are common, significantly reduce quality of life, and create a substantial economic burden to the healthcare system. They are disproportionately affecting the postmenopausal women...

PURPOSE OF REVIEW: This review explores the design and endpoints of perioperative platforms in clinical trials for muscle-invasive bladder cancer (MIBC). RECENT FINDINGS: The choice of clinical trial design in perioperative platforms for MIBC must align with specific research objectives to ensure robust and meaningful outcomes. Novel designs in perioperative platforms for MIBC integrate bladder-sparing approaches. Primary endpoints such as pathological complete response and disease-free survival are highlighted for their role in expediting trial results in perioperative setting...

PURPOSE OF REVIEW: Metabolic syndrome (MetS) has emerged as a potential contributor to the development of kidney stone disease (KSD). This study aims to conduct a systematic review of the literature, and meta-analysis of the association between MetS and KSD. RECENT FINDINGS: Systematic review revealed Fifteen articles (433 201 patients) were eligible for analysis. Meta-analysis of 11 studies identified a statistically significant association between MetS and KSD with unadjusted odds ratio of 2...

PURPOSE OF REVIEW: The literature was reviewed for all noninvasive central nervous system (CNS) stimulation techniques, which includes transcranial brain or trans-spinal stimulation, in the aging population. Given the rising ubiquity of this technology, noninvasive nature, and low side-effect profile reported, this technology can have a big impact on the aging population. As patients afflicted with neurogenic disorders are living longer lives, a special emphasis is placed on the aging neurogenic population...

PURPOSE OF REVIEW: Tumor-informed circulating tumor DNA (ctDNA) is an emerging biomarker in urothelial carcinoma. Recent clinical trials have investigated the integration of ctDNA into clinical decision-making in patients with muscle-invasive bladder cancer, their findings suggest that ctDNA may potentially revolutionize the way we stratify patients to different treatment modalities. RECENT FINDINGS: ctDNA informed from TURBT specimens was found to be prognostic of disease outcomes among patients with localized nonmetastatic bladder cancer...

PURPOSE OF REVIEW: The existence of urinary microbiome in healthy individuals is now widely accepted as the longstanding belief in urinary tract sterility was disproved over a decade ago. The urinary microbiome has since been implicated in multiple urologic conditions including urinary tract infection (UTI), urinary incontinence, and bladder cancer. This review relays new findings of urinary microbiome compositional changes associated with aging and UTI susceptibility. RECENT FINDINGS: Recent advancements have established how the urinary microbiome changes over the lifespan...

PURPOSE OF REVIEW: This review critically evaluates the current state of bladder-sparing options in muscle-invasive bladder cancer (MIBC) and provides an overview of future directions in the field. RECENT FINDINGS: Bladder-sparing treatments have emerged as viable alternatives to radical cystectomy (RC) for selected patients with MIBC, especially in those who are unfit for RC or elect bladder preservation. Numerous studies have assessed the efficacy of trimodal therapy (TMT), with outcomes comparable to RC in a subgroup of well selected patients...

PURPOSE OF REVIEW: Prehabilitation describes interventions that are undertaken prior to a major surgical or medical intervention with the objective of improving functional capability with the goal of improving candidacy for therapy, bolstering one's ability to withstand treatment-associated toxicity, functional decline, and facilitating accelerated recovery. The objective of this review is to detail the key tenets of prehabilitation, synthesize contemporary advances in prehabilitation science within Urologic Oncology, and discuss key methodologic trial design considerations salient to future prehabilitation investigations...

PURPOSE OF REVIEW: Financial toxicity is a significant concern for many individuals with bladder cancer, which is, overall, the most expensive malignancy, per patient. Financial toxicity, defined as the harmful effects of treatment costs on an individual's quality of life, is associated with worse outcomes and decreased quality of life. Awareness of the objective and subjective factors that contribute to financial toxicity, and ways to mitigate their effects on patients, is essential to reduce the burden of bladder cancer care...

PURPOSE OF REVIEW: There is a long history of implantation of absorbable and nonabsorbable materials to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The focus of this review is to review the development of new materials for use in the surgical management of both pelvic conditions following an unacceptable level of severe complications in the use of polypropylene mesh (PPM). We discuss current concepts relating to the development of new materials with particular reference to our experience with polyurethane mesh...

PURPOSE OF REVIEW: In light of the updated AUA/SUFU guidelines on the diagnosis and treatment of overactive bladder (OAB), increased utilization of advanced therapies is expected in the coming years. The primary aim of this review is to summarize existing outcome and safety data on the use of neuromodulation in geriatric patients, as well as highlight recent advances in neuromodulation that may be particularly advantageous in the geriatric population. RECENT FINDINGS: There are mixed data demonstrating efficacy of sacral neuromodulation by decade of life, with older individuals most often demonstrating lower odds of progressing to stage 2 implantation...

PURPOSE OF REVIEW: Several novel therapies approved by the Food and Drug Administration (FDA) and explosion of clinical trials have changed the landscape Bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC). Given the recent advancements in bladder sparing options, the role of radical cystectomy (RC) in BCG-unresponsive NMIBC remains a subject of debate. RECENT FINDINGS: All three novel agents currently approved by the FDA for BCG-unresponsive NMIBC have strict indication [carcinoma in situ (CIS)], low response rate, and short response duration...

PURPOSE OF REVIEW: To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. RECENT FINDINGS: A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'...

PURPOSE OF REVIEW: The AMS 800 has dominated the treatment of postprostatectomy urinary incontinence (PPUI) due to intrinsic sphincter deficiency (ISD) for five decades. A narrative review from June 2022 to June 2024 was conducted using 'artificial urinary sphincter' (AUS) MeSH terms in Embase. We extracted information on innovative AUS, randomized controlled trials (RCTs) or prospective studies, and systematic reviews. We evaluated the latest guidelines and consensus and analyzed current trends to discuss options for advancing AUS practices...

PURPOSE OF REVIEW: While there is an established association between the use of anticholinergic medications and its effects on cognition, the extent of this impact remains unclear. We outline recent studies addressing this topic. RECENT FINDINGS: We describe a series of recent articles discussing the risk of dementia associated with anticholinergic medication use in general, with further focus on the risk of overactive bladder (OAB) anticholinergic use, detailing short & long-term use effects, risk variation based on age and gender, and reporting alternative treatment options...

PURPOSE OF REVIEW: Older adults undergoing urologic cancer surgery have unique needs and require unique risk assessment and management. This review will discuss recent literature on brief screening tools to identify high risk older adults in the preoperative period and the role of comprehensive geriatric assessment (CGA) in identifying and addressing geriatric vulnerabilities for older adults undergoing urologic cancer surgery. RECENT FINDINGS: Frailty screening tools such as the G8 can be used to identify patients who are at an increased risk of adverse postoperative outcomes such as postoperative complications and prolonged length of stay...

PURPOSE OF REVIEW: There has been a need for an acceptable common minimum data set in the scientific literature as regards the surgical treatment of female stress urinary incontinence (SUI). Such a data set, if widely adopted, would improve the quality of the literature and allow objective comparisons between and across interventions. RECENT FINDINGS: The surgical treatment of female stress urinary incontinence has evolved considerably over the past few decades...

PURPOSE OF REVIEW: Stress urinary incontinence is a growing issue in ageing men, often following treatment for prostate cancer or bladder outflow obstruction. While implantable urological devices offer relief, infections are a significant concern. These infections can lead to device removal, negating the benefits and impacting patient outcomes. This review explores the risks and factors contributing to these infections and existing strategies to minimize them. These strategies encompass a multifaceted approach that considers patient-specific issues, environmental issues, device design and surgical techniques...