Current Urology Reports

PURPOSE OF REVIEW: While ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a 'negative', 'stoneless' or 'diagnostic' URS. We perform a systematic review to look at the rate of 'negative ureteroscopy' and risk factors associated with it. RECENT FINDINGS: From a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%...

PURPOSE OF REVIEW: Patient satisfaction with inflatable penile prosthesis (IPP) is an elective procedure that restores erectile function. RECENT FINDINGS: While the return of usable erections is almost always achieved with IPP, patients may still be unhappy with the procedure if the outcome has not met their expectations. Optimizing patient satisfaction and outcomes should incorporate considerations for pre-, intra-, and postoperative factors. Length optimization regimens and improved pain control options have dominated the recent literature...

PURPOSE OF REVIEW: The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients. RECENT FINDINGS: Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients...

PURPOSE OF REVIEW: Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies...

PURPOSE OF REVIEW: The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40 years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches. RECENT FINDINGS: Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques...

PURPOSE OF REVIEW: This review summarizes the latest reports in inflatable penile prosthesis (IPP) complication management. RECENT FINDINGS: IPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Guidance on complication management is largely limited to techniques recommended by experts within the field...

PURPOSE OF REVIEW: After radical cystoprostatectomy, patients often develop erectile dysfunction refractory to first- and second-line treatments. In this review, we summarize and analyze the literature describing the technical considerations and outcomes of penile implant surgery in bladder cancer patients with history of radical cystectomy and urinary diversion. RECENT FINDINGS: Penile prosthesis surgery in patients after radical cystectomy and urinary diversion has been infrequently described in the literature...

PURPOSE OF REVIEW: To discuss emerging alternative strategies for reservoir placement during inflatable penile prosthesis surgery. RECENT FINDINGS: Innovations in penile prosthesis design have facilitated the development of various alternative approaches for reservoir placement. Avoiding the space of Retzius is particularly appealing in patients with a history of pelvic surgery and/or radiation. The high submuscular technique utilizes a low-profile reservoir in combination with the implant's lockout valve to allow for safe placement in the potential space between the anterior abdominal wall musculature and the transversalis fascia, far cephalad from the external inguinal ring and without the need for a counter-incision...

PURPOSE OF REVIEW: Few procedures involve the ischemia-reperfusion injury to organs purposely. Two clear examples in urologic surgery consist on kidney transplantation and partial nephrectomies. RECENT FINDINGS: Mannitol is an osmotic diuretic that is commonly used in partial nephrectomies and kidney transplantation to increase renal blood flow and decrease warm-ischemia-related renal injury to preserve estimated glomerular filtration rate (eGFR). We review the current evidence for the use of mannitol and its effects on these procedures...

PURPOSE OF REVIEW: Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased. RECENT FINDINGS: According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance...

PURPOSE OF THE REVIEW: We present an updated report of renal medullary carcinoma (RMC), a rare and aggressive condition. RECENT FINDINGS: There is a majority of male patients, of African descent, in the second or third decade of life. In differential diagnosis, other tumors, such as malignant rhabdoid tumor (MRT), vinculin-anaplastic lymphoma kinase (VCL-ALK) translocation renal cell carcinoma, and collecting duct carcinoma, may present difficulties. Abnormalities of tumor suppressor gene SMARCB1 have been found in RMC...

PURPOSE OF REVIEW: An endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject. RECENT FINDINGS: In high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery...

PURPOSE OF REVIEW: To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions. RECENT FINDINGS: The frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce. Although rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame...

PURPOSE OF REVIEW: Targeting PD-1/PD-L1 immune checkpoints is a new therapeutic tool in patients with locally advanced and metastatic clear cell renal cell carcinoma (CCRCC). The purpose of this review is to offer clinicians an updated translational insight into the current status of a therapeutic alternative that may impact significantly patient's life. RECENT FINDINGS: Immune checkpoint inhibition has recently demonstrated promising results in selected CCRCC patients with respect to tumor progression and survival...

PURPOSE OF REVIEW: Approximately 25% of women in the USA suffer from pelvic floor disorders. Disorders of the anterior compartment of the pelvic floor, in particular, can cause symptoms such as incomplete urinary voiding, urinary incontinence, pelvic organ prolapse, dyspareunia, and pelvic pain, potentially negatively impacting a woman's quality of life. In some clinical situations, clinical exam alone may be insufficient, especially when patient's symptoms are in excess of their pelvic exam findings...

PURPOSE OF REVIEW: Bladder cancer (BC) is the second most common genitourinary malignancy, with a growing population of survivors globally. Over the past two decades, there has been a growing awareness of not only the oncologic, but also the quality of life ramifications of a BC diagnosis, treatment, and surveillance. In the current review, the literature surrounding the many domains that encompass bladder cancer survivorship is summarized and analyzed. RECENT FINDINGS: There have been ongoing efforts to decrease perioperative morbidity, particularly in patients undergoing radical cystectomy, with mixed results...

PURPOSE OF REVIEW: Determining the metastatic viability of suspicious retroperitoneal nodes in testicular cancer with conventional imaging is challenging. The aim of this report is to review recent evidence in the utilization of novel imaging modalities to assess viable testicular cancer nodal metastases. RECENT EVIDENCE: Testicular germ cell tumors (TCGTs) follow a predictable lymphatic metastatic spread to the retroperitoneum. Accordingly, retroperitoneal imaging is critical in staging, assessing treatment response, and evaluating for recurrence...

PURPOSE OF REVIEW: Until recently, effective treatment options for patients with advanced urothelial carcinoma were limited to platinum-based chemotherapy. In the post-platinum setting and for patients ineligible for cisplatin, minimally effective second-line chemotherapy was used and outcomes were poor. The approval of immune checkpoint inhibitors has significantly changed the treatment landscape of urothelial carcinoma. Here, we review current data demonstrating their efficacy in advanced disease and ongoing trials investigating novel combination strategies...

PURPOSE OF THE REVIEW: This review targets the latest literature on bladder preservation therapy with emphasis on trimodal therapy (TMT), highlighting its role in the management of muscle invasive bladder cancer (MIBC) and outlining future directions in bladder preservation research. RECENT FINDINGS: TMT is the most promising bladder preservation treatment modality. Comparable results to contemporary radical cystectomy series are seen in properly selected patients...

PURPOSE OF REVIEW: Bladder cancer (BCa) management had remained unchanged for 20+ years with clinicians, in contrast to many other cancer types, rarely relying on molecular characteristics to guide management. The past 5 years have yielded significant advances in our knowledge of the molecular basis of BCa and concurrent advances in systemic therapy. We aim to highlight the key developments and potential future direction of BCa management. RECENT FINDINGS: Next-generation sequencing (NGS) has drastically altered the understanding of muscle-invasive BCa (MIBC) and non-muscle invasive BCa (NMIBC)...