JournalTOCs

Therapeutic Advances in Urology
Journal Prestige (SJR): 1.171

Citation Impact (citeScore): 3
Number of Followers: 4

This is an Open Access Journal

Open Access journal
ISSN (Print) 1756-2872 - ISSN (Online) 1756-2880
Published by Sage Publications

[1099 journals]

Corrigendum
- Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-07-06T06:33:52Z
  DOI: 10.1177/1756287219863170
  Issue No: Vol. 11 (2019)
Long-term use of noble metal alloy coated urinary catheters reduces
recurrent CAUTI and decreases proinflammatory markers
- Authors: Birgitta Magnusson, Ylva Kai-Larsen, Petter Granlund, Åke Seiger, Lena Lindbo, Javier Sanchez, Dorota Johansson
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:The objective of this study was to investigate a case of a permanently (suprapubic) catheterized woman with neurogenic bladder dysfunction. The patient had suffered from recurrent catheter-associated urinary tract infections (CAUTIs) since 2009, despite several prevention approaches and attempts. In 2013, the patient’s catheter was substituted for the BIP Foley Catheter, coated with a noble metal alloy (NMA) of gold, silver, and palladium.Method:This is a retrospective–prospective clinical case study covering 4 years history for the control catheters and up to 2.5 years for the anti-infective BIP Foley Catheter. CAUTI incidences, symptoms, antibiotics, catheter performance, and comfort were evaluated. Levels of proinflammatory cytokines were measured pre- and post-substitution to BIP Foley Catheter in urine of the case and of four other permanently catheterized patients. In addition, the levels of noble metals were assessed in urine of the case subject during use of the BIP Foley Catheter.Results:While using control catheters, the patient experienced symptomatic CAUTIs requiring antibiotics almost every month for 4 years. After 1 month with the BIP Foley Catheter, the symptoms disappeared, and the patient remained free of symptomatic CAUTIs and antibiotic treatment for the following 2.5 years, despite bacteriuria. The patient was satisfied with the comfort during insertion, use, and removal of the BIP Foley Catheter. Urinary levels of the proinflammatory cytokines interleukin (IL)-6, IL-8, and tumor necrosis factor alpha (TNFα) decreased towards normal levels post catheter type substitution. Traces of noble metals detected in a few urine samples were ⩽4% of the permitted daily exposure. The levels of the noble metals gold, silver, and palladium remaining on the BIP Foley Catheter after use were the same as for unused catheters.Conclusion:Long-term use of a NMA-coated catheter was associated with cessation of frequent CAUTIs. The catheter was experienced as comfortable and inflammatory markers were reduced with time. The coating was stable, with no significant metal release into urine and is therefore safe for patient use.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-06-19T05:46:56Z
  DOI: 10.1177/1756287219854915
  Issue No: Vol. 11 (2019)
To switch or not to switch' A real-life experience using dexamethasone
in combination with abiraterone
- Authors: Elisa Zanardi, Davide Soldato, Maria Maddalena Latocca, Carlo Cattrini, Francesco Boccardo
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a ‘steroid switch’ from prednisone to dexamethasone. A total of 26 patients, both chemonaïve (14 patients) or pretreated with docetaxel (12 patients), with biochemical and/or limited radiological progression, were enrolled in this trial. Primary endpoint was prostate specific antigen (PSA) 30 defined as the proportion of patients with a PSA level decline 30% or more after 6 weeks of treatment with abiraterone acetate + dexamethasone. Secondary endpoints were: a PSA50 rate (defined as the proportion of patients with PSA decline of 50% or more after 12 weeks on abiraterone acetate + dexamethasone), biochemical and radiological progression-free survival (bPFS and rPFS, respectively), benefit from subsequent treatment and identification of biomarkers of response. Primary endpoint was reached in 46.2% of patients (12 patients), and two patients had an objective partial response on computed tomography scan. Median bPFS and rPFS were 5.3 months and 11.8 months. We present a case series of 11 patients who were consecutively treated with a steroid switch at our institution from January 2016 to August 2018 to investigate if this strategy could be used in a ‘real-life’ setting. We observed a PSA30 response in two patients (18%), median bPFS was 4.77 months (95% confidence interval [CI] 2.5–14.6) and median rPFS was 7.2 months (95% CI 3.8–15.5). Seven patients had a radiological stable disease as best response to steroid switch. Three patients were being still treated with abiraterone acetate + dexamethasone at data cut-off time. Our case series confirms that switching from prednisone to dexamethasone during abiraterone acetate treatment produces biochemical and radiological responses in both a predocetaxel and a postdocetaxel setting, providing a clinical benefit in mCRPC patients. However, to date, there is no clear indication as to which patient could benefit most from this kind of strategy.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-06-11T12:24:00Z
  DOI: 10.1177/1756287219854908
  Issue No: Vol. 11 (2019)
Efficacy and tolerability of Roystonea regia lipid extract (D-004) and
terazosin in men with symptomatic benign prostatic hyperplasia: a 6-month
study
- Authors: Raúl Guzmán, Julio C. Fernández, Manuel Pedroso, Lilia Fernández, José Illnait, Sarahí Mendoza, Ana T. Quiala, Zunilda Rodríguez, Jilma Mena, Aylim Rodíguez, Marbelis Campos, Carlos Sánchez, Yanet Alvarez, Gladys Jiménez
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Benign prostatic hyperplasia (BPH), a common urological disease in aging men, frequently produces lower urinary tract symptoms (LUTS). Clinical studies have shown that terazosin relaxes the smooth muscle of the prostate and bladder, facilitates bladder emptying, improves LUTS, increases maximum urinary flow, and reduces the residual volume of urine. D-004, a lipid extract of the fruit of the Cuban royal palm (Roystonea regia), presents a similar efficacy to Saw palmetto. Clinical studies have demonstrated its efficacy and safety in short- and medium-term trials in patients with BPH. The objective of this study was to compare the efficacy and tolerability of D-004 with terazosin for 6 months on LUTS in patients with BPH.Methods:The present phase III study had an open, randomized, comparative design, with two parallel groups who received D-004 (320 mg/day) or terazosin (5 mg/day) for 6 months. The study included men at least 50 years of age, with evidence of the LUTS of moderate intensity according to the International Symptoms of the Prostate (IPSS). The effects on the IPSS Scale was the primary efficacy variable. The effects on the size of the prostate and the residual volume were secondary variables. The subjective self-perception of symptom relief at trial completion was a collateral outcome. Analysis was done by intention-to-treat.Results:The study included 100 men with a diagnosis of BPH, confirmed by digital rectal examination and ultrasonography, and moderate LUTS (IPSS score>7,
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-06-11T12:23:49Z
  DOI: 10.1177/1756287219854923
  Issue No: Vol. 11 (2019)
Numerical simulation modeling of the irreversible electroporation
treatment zone for focal therapy of prostate cancer, correlation with
whole-mount pathology and T2-weighted MRI sequences
- Authors: Matthijs J. Scheltema, Tim J. O’Brien, Willemien van den Bos, Daniel M. de Bruin, Rafael V. Davalos, Cees W.M. van den Geld, Maria P. Laguna, Robert E. Neal, Ioannis M. Varkarakis, Andreas Skolarikos, Phillip D. Stricker, Theo. M. de Reijke, Christopher B. Arena, Jean de la Rosette
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE.Methods:In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient.Results:A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383–750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386–580 V/cm) when the ablation zone volumes were used from the follow-up MRI.Conclusions:The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-06-07T11:36:28Z
  DOI: 10.1177/1756287219852305
  Issue No: Vol. 11 (2019)
Metabolomics analysis of blood identifies potential biomarkers and
possible treatment targets for nocturia
- Authors: Satoru Kira, Takahiko Mitsui, Tatsuya Miyamoto, Tatsuya Ihara, Hiroshi Nakagomi, Yuka Hashimoto, Hajime Takamatsu, Masayuki Tanahashi, Masahiro Takeda, Norifumi Sawada, Masayuki Takeda
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Our aim was to investigate the association between serum metabolites and nocturia.Methods:A total of 66 males aged 65–80 years were enrolled in this study and stratified according to micturition behavior, which was characterized in terms of the 24 h frequency volume chart (FVC) for 3 consecutive days, the International Prostate Symptom Score (IPSS), and quality-of-life score. The nocturia group included participants with any total IPSS and ⩾1.5 micturitions/night as the mean of 3 nights, while the control group included participants with total IPSS < 8 and
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-17T11:41:24Z
  DOI: 10.1177/1756287219850087
  Issue No: Vol. 11 (2019)
Contemporary best practice in the management of staghorn calculi
- Authors: Adam Sharbaugh, Tara Morgan Nikonow, Gregory Kunkel, Michelle Jo Semins
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging. Fortunately, advances in technology and endourology techniques have enabled urologists to effectively treat these stones with minimal morbidity to the patient. This article describes the contemporary best practices in the initial evaluation, management, and follow up of patients with staghorn calculi to help the practicing urologist navigate this complex condition.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-10T06:00:57Z
  DOI: 10.1177/1756287219847099
  Issue No: Vol. 11 (2019)
Letter to the editor re: Paratesticular sarcomas: a case series and
literature review: Keenan et al
- Authors: Michael S. Floyd, Ahmad M. Omar
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-03T07:12:53Z
  DOI: 10.1177/1756287219847098
  Issue No: Vol. 11 (2019)
Appropriate use of antibiotics: an unmet need
- Authors: Alicia López Romo, Rodolfo Quirós
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-02T12:50:47Z
  DOI: 10.1177/1756287219832174
  Issue No: Vol. 11 (2019)
Prevention of recurrent urinary tract infections: bridging the gap between
clinical practice and guidelines in Latin America
- Authors: José Antonio Ortega Martell, Kurt G. Naber, Jorge Milhem Haddad, José Tirán Saucedo, Jesús Alfonso Domínguez Burgos
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-02T12:50:40Z
  DOI: 10.1177/1756287218824089
  Issue No: Vol. 11 (2019)
Risk factors and predisposing conditions for urinary tract infection
- Authors: Oscar Storme, José Tirán Saucedo, Arturo Garcia-Mora, Manuel Dehesa-Dávila, Kurt G. Naber
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvovaginal atrophy, change of the local bacterial flora, history of UTIs during premenopause or in childhood, family history, and a nonsecretor blood type are substantiated risk factors for recurrent uncomplicated UTIs. This is a narrative review based on relevant literature according to the experience and expertise of the authors. Asymptomatic bacteriuria is generally benign; however, during pregnancy it is more common and is associated with an increased likelihood of symptomatic infection, which may harm the mother or fetus. Screening of pregnant women and appropriate treatment with antimicrobials must be balanced with the potential for adverse treatment-related outcomes; appropriate prophylaxis should be considered where possible. High-quality data are currently lacking on risks related to asymptomatic bacteriuria in pregnancy and further data in this hard-to-study population should be a primary concern for researchers. Incomplete voiding represents the primary risk factor for UTIs associated with conditions such as urinary incontinence and prolapse. Correcting the presence of residual urine remains the most effective prophylaxis in these populations. Bladder function alters throughout life; however, changes in function may be particularly profound in clinical populations at high risk of UTIs. Patients with neurogenic bladder will also likely have other evolving medical issues which increase the risk of UTIs, such as repeated catheterization and increasing residual urine volume. More aggressive antimicrobial prophylactic strategies may be appropriate in these patients. Again, the paucity of data on prophylaxis in these high-risk patients requires the attention of the research community.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-02T12:50:17Z
  DOI: 10.1177/1756287218814382
  Issue No: Vol. 11 (2019)
An introduction to the epidemiology and burden of urinary tract infections
- Authors: Martha Medina, Edgardo Castillo-Pino
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50−60% in adult women. This is a narrative review aimed at acting as an introduction to the epidemiology and burden of UTIs. This review is based on relevant literature according to the experience and expertise of the authors. The prevalence of UTI increases with age, and in women aged over 65 is approximately double the rate seen in the female population overall. Etiology in this age group varies by health status with factors such as catheterization affecting the likelihood of infection and the pathogens most likely to be responsible. In younger women, increased sexual activity is a major risk factor for UTIs and recurrence within 6 months is common. In the female population overall, more serious infections such as pyelonephritis are less frequent but are associated with a significant burden of care due to the risk of hospitalization. Healthcare-associated UTIs (HAUTIs) are the most common form of healthcare-acquired infection. Large global surveys indicate that the nature of pathogens varies between the community and hospital setting. In addition, the pathogens responsible for HAUTIs vary according to region making adequate local data key to infection control. UTIs create a significant societal and personal burden, with a substantial number of medical visits in the United States every year being related to UTIs. European data indicate that recurrent infections are related to increased absenteeism and physician visits. In addition, quality of life measures are significantly impacted in women suffering from recurrent UTIs. Data suggest that nonantimicrobial prophylactic strategies offer an opportunity to reduce both the rate of UTIs and the personal burden experience by patients.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-05-02T12:49:57Z
  DOI: 10.1177/1756287219832172
  Issue No: Vol. 11 (2019)
Spatial distribution of biopsy cores and the detection of intra-lesion
pathologic heterogeneity
- Authors: Brian P. Calio, Sandeep Deshmukh, Donald Mitchell, Christopher G. Roth, Anne E. Calvaresi, Kim Hookim, Peter McCue, Edouard J. Trabulsi, Costas D. Lallas
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Objectives:The objective of this study was to determine if spatial distribution of multiparametric magnetic resonance imaging–transrectal ultrasound (mpMRI-TRUS) fusion biopsy cores to the index lesion reveals trends in the detection of intra-lesion Gleason heterogeneity and a more optimal prostate biopsy strategy.Methods:Index lesion was the lesion with longest diameter on T2-weighted (T2W)-MRI. In cohort 1, fusion biopsy cores biopsies were taken in areas in the center of the target as well as 1 cm laterally on each side. For cohort 2, targeted biopsies were taken from the center of the lesion only. Heterogeneity was defined as difference in maximum Gleason score obtained from fusion cores in the center of the index lesion versus cores obtained from the periphery (cohort 1), or any difference in maximum Gleason score obtained from fusion cores targeted to the index lesion (cohort 2) compared with systematic 12 cores TRUS biopsy.Results:Ninety-nine consecutive patients (35 and 64 in cohorts 1 and 2, respectively) with median age (SD) and prostate-specific antigen (PSA) of 66.9 (±5.9) and 9.7 (±8.2) respectively, were included. Age, PSA, Prostate Imaging Reporting and Data System (PI-RADS) score, and preoperative MRI lesion size were not significantly different between cohorts. Gleason heterogeneity was observed at a significantly higher rate in cohort 1 versus cohort 2 (58% versus 24%; p = 0.041). In cohort 1, cores obtained from the center of the lesion had higher Gleason score than cores obtained from the periphery of the targeted lesion in 57% of cases.Conclusions:We demonstrate that there is observable tumor heterogeneity in biopsy specimens, and that increased number of cores, as well as cores focused on the center and periphery of the largest lesion in the prostate, provide more comprehensive diagnostic information about the patient’s clinical risk category than taking nonspecific cores targeted within the tumor.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-04-29T05:56:28Z
  DOI: 10.1177/1756287219842485
  Issue No: Vol. 11 (2019)
New technologies in the management of overactive bladder: current research
and future prospects
- Authors: Serge P. Marinkovic
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Overactive bladder is characterized by frequency, urgency (wet or dry) and nocturia. These troublesome symptoms incur both a physiologic and economic cost, expected to be in excess of US$82 billion in the USA and Europe by the year 2020. Second-tier medicinal oral therapies for overactive bladder abound, but the failure rate or discontinuation at 1 year exceeds 50%. Tertiary-tier therapies involve surgical alternatives including neuromodulation of sacral nerve 3 (S3) or the posterior tibial nerve as a means to manipulate and ameliorate the above-described voiding symptoms. Sacral neuromodulation has been studied for more than 20 years, but newer, smaller, rechargeable implantable devices are in the forefront of current investigation. Hopes are that modifications to the device will eventually be possible at the patient’s home, rather than the physician’s office, with close urological/gynecologic supervision and guidance. Another means of surgical intervention for overactive bladder includes the use of a cystoscopy-guided radiofrequency probe by which energy disrupts the bladder floor neural voiding plexi. Stem cell therapy is also being evaluated for overactive bladder but is in the early stages of development.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-04-25T10:59:49Z
  DOI: 10.1177/1756287219844669
  Issue No: Vol. 11 (2019)
Increasing stone complexity does not affect fluoroscopy time in
percutaneous nephrolithotomy
- Authors: Annah Vollstedt, Johann Ingimarsson, Lawrence Dagrosa, Vernon Pais
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:The aim of this work was to assess whether stone complexity with the Guy’s stone score (GSS) is associated with increased intraoperative fluoroscopy time.Methods:We retrospectively reviewed records of 261 consecutive patients undergoing percutaneous nephrolithotomy between 2007 and 2015. Of these, 203 had both preoperative computed tomography for accurate staging and full intraoperative fluoroscopy and radiation dosimetry data were available. Stone complexity was assessed using GSS. A correlation between fluoroscopy time (FT) and GSS was assessed in a univariate and multivariate fashion, including parameters such as age, sex, body mass index (BMI), and number of accesses.Results:The overall mean FT was 3.69 min [standard deviation (SD) 2.77]. The overall mean Guy’s score was 2.5 (SD 1). There was a statistically significant correlation between operative time and FT (r = 0.34, p < 0.0001). There was a trend towards increasing operative time with increasing GSS (r = 0.12, p = 0.08), but there was no statistically significant correlation. There was no correlation between FT and GSS (r = 0.04, p = 0.55). On multivariable regression, accounting for sex, BMI, age, and singular versus multiple accesses, there was no significant correlation between stone complexity and FT (p = 0.893).Conclusions:In the setting of conscious efforts to reduce intraoperative radiation exposure, increasing stone complexity, as classified by GSS, did not correlate with FT on univariate or multivariate analysis. Thus, treatment of more complex stones may be undertaken without concern that there is an inevitable need for significantly increased fluoroscopy exposure to the patient or operating room staff.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-04-05T06:49:36Z
  DOI: 10.1177/1756287219840218
  Issue No: Vol. 11 (2019)
Real-time indocyanine green angiography with the SPY fluorescence imaging
platform decreases benign ureteroenteric strictures in urinary diversions
performed during radical cystectomy
- Authors: Jim K. Shen, Juzar Jamnagerwalla, Bertram E. Yuh, Mitchell R. Bassett, Avinash Chenam, Jonathan N. Warner, Ali Zhumkhawala, Jonathan L. Yamzon, Christopher Whelan, Nora H. Ruel, Clayton S. Lau, Kevin G. Chan
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY.Methods:A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance.Results:Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs (p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion (p < 0.0001). No complications attributable to the use of SPY were noted.Conclusion:Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-04-05T06:36:45Z
  DOI: 10.1177/1756287219839631
  Issue No: Vol. 11 (2019)
Pembrolizumab in the treatment of locally advanced or metastatic
urothelial carcinoma: clinical trial evidence and experience
- Authors: Michael Crist, Gopa Iyer, Miles Hsu, William C. Huang, Arjun V. Balar
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  The treatment of advanced urothelial carcinoma (UC) has dramatically changed with the advent of immune checkpoint inhibitors that disrupt the T-cell inhibitory interaction between the programmed cell death (PD)-1 receptor and its ligand (PD-L1). Pembrolizumab, a highly specific, monoclonal antibody directed against PD-1, has demonstrated clinical efficacy as well as a favorable toxicity profile, and has emerged as a new standard of care in the treatment of advanced UC. This review will summarize clinical efficacy from recent trials that led to the approval of pembrolizumab in treating platinum-refractory advanced UC as well as treating patients who are ineligible for first-line cisplatin-containing chemotherapy. While immune checkpoint inhibition has reinvigorated the treatment landscape of advanced UC and generated a great deal of optimism, only a minority of patients benefit. Combination strategies with the goal of increasing response rates are desperately needed as are biomarkers predictive of response.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-04-05T05:47:05Z
  DOI: 10.1177/1756287219839285
  Issue No: Vol. 11 (2019)
Meta-analysis of randomized controlled trials that assess the efficacy of
- Authors: Jeffrey D. Campbell, Bruce J. Trock, Adam R. Oppenheim, Ifeanyichukwu Anusionwu, Ronak A. Gor, Arthur L. Burnett
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LiESWT) for the treatment of erectile dysfunction (ED).Materials and methods:A comprehensive search of PubMed, Medline, and Cochrane databases was performed from November 2005 to July 2018. RCTs evaluating efficacy of LiESWT in the treatment of ED were selected. The primary outcomes were the mean difference between treatment and sham patients in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score 1 month after treatment, and the mean change in IIEF-EF from baseline to 1 month post-treatment. The secondary analysis considered the percentage of men whose erectile hardness score (EHS) changed from 3 after treatment. All analyses used a random effects method to pool study-specific results.Results:A total of seven RCTs provided data for 607 patients. The mean IIEF-EF 1 month post-treatment ranged from 12.8 to 22.0 in the treatment group versus 8.17–16.43 in the sham group. The mean difference between the treatment and sham groups at the 1 month follow up was a statistically significant increase in IIEF-EF of 4.23 (p = 0.012). Overall, five of the seven trials provided data on the proportion of patients with baseline EHS 3 at 1 month post-treatment. The proportions ranged from 3.5 to 90% in the treatment group versus 0–9% in the sham group and the pooled relative risk of EHS improvement for the treated versus sham group was 6.63 (p = 0.0095). No significant adverse events were reported.Conclusions:This is the first meta-analysis that evaluates RCTs exploring LiESWT as a treatment modality strictly for ED. This therapeutic strategy appears to be well tolerated with short-term benefits. However further studies exploring specific treatment regimens and long-term outcomes are needed.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-29T11:51:14Z
  DOI: 10.1177/1756287219838364
  Issue No: Vol. 11 (2019)
The use of penile traction therapy in the management of Peyronie's
disease: current evidence and future prospects
- Authors: Robert Valenzuela, Matthew Ziegelmann, Sam Tokar, Joel Hillelsohn
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Peyronie’s disease is a disorder of abnormal and dysregulated wound healing leading to scar formation in the tunica albuginea of the penis. Penile traction therapy has emerged as an attractive therapeutic option for men with Peyronie’s disease in both the acute and chronic phases. Currently, clinical studies are limited by lack of randomization, small cohorts, and lack of patient compliance with therapy. Despite these shortcomings, studies have shown a potential benefit with minimal morbidity. Specifically, penile traction may help to preserve or increase penile length and reduce penile curvature when used as monotherapy or as adjuvant therapy for surgical and intralesional treatments. Further study is necessary to define patient characteristics that are predictive of improved outcomes, determine the duration of treatment needed for clinical effect, and improve patient compliance.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-29T11:15:11Z
  DOI: 10.1177/1756287219838139
  Issue No: Vol. 11 (2019)
The potential risk of tumor progression after use of dehydrated human
amnion/chorion membrane allograft in a positive margin resection model
- Authors: Ricardo G. Alvim, Christopher Hughes, Alexander Somma, Karan K. Nagar, Nathan C. Wong, Stephen La Rosa, Sebastien Monette, Kwanghee Kim, Jonathan A. Coleman
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Objective:The objective of this study was to examine the impact of dehydrated human amnion/chorion membrane (dHACM) allografts on prostate and bladder cancer growth in the setting of residual disease and positive surgical margins.Materials and methods:A commercially available version of dHACM was used. Cytokines were identified and quantified, followed by comparative analysis of cell growth in two different human cell lines: prostate cancer (LNCaP) and bladder cancer (UM-UC-3), in vitro and in vivo. Tumor growth between the two groups, membrane versus no membrane implant, was compared and immunohistochemistry studies were conducted to quantify CD-31, Ki-67, and vimentin. A Student’s unpaired t-test was used to determine statistical significance.Results:The UM-UC-3 and LNCaP cells grew quicker in medium plus 10% serum and dHACM extract than in the other media (p = 0.03). A total of 28 distinct cytokines were found in the extract, 11 of which had relatively high concentrations and are associated with prostate and bladder cancer tumor progression. In vivo LNCaP model, after 10 weeks, the median tumor volume in the membrane group was almost threefold larger than the partial resection alone (p = 0.01). Two weeks after resection, in the UM-UC-3 model, the membrane group reached fourfold larger than the partial resection without membrane group (p < 0.01). In both groups, the expression of CD-31 and Ki-67 markers were similar and showed no statistical significance (p> 0.05). It was only in the LNCaP tumors that vimentin expression was significantly higher in the group without membrane compared with the membrane group (p = 0.008).Conclusion:The use of dHACM after partial tumor resection is related to faster tumor relapse and growth in prostate and urothelial cancer in vivo models, showing a potential risk of rapid local recurrence in patients at high risk of positive margins.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-29T10:44:50Z
  DOI: 10.1177/1756287219837771
  Issue No: Vol. 11 (2019)
Is ureteral stent an effective way to deliver drugs such as bacillus
Calmette-Guérin to the upper urinary tract' An experimental study
- Authors: Fernando Korkes, Willy Baccaglini, Marcel Aranha Silveira
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:We aim to evaluate the distribution in the upper urinary tract of intravesical-delivered fluids, after inducing vesicoureteral reflux (VUR) with a double J stent.Methods:In group 1 (n = 35) patients were maintained in a 20° Trendelenburg position and were evaluated after immediate insertion of ureteral stent, while in group 2 (n = 16) patients were evaluated after several days with ureteral stent placement. Patients in both groups were submitted to a cystogram with progressive volumes of iodine contrast and were evaluated according to VUR of contrast medium to the renal pelvis. Additionally, in group 2 visual confirmation was performed by endoscopic inspection of upper tract mucosal impregnation with methylene blue.Results:In group 1, after immediate insertion of ureteral stent reflux occurred in 51.4% (n = 18/35), and after several days with ureteral stent placement reflux was observed in 87.5% (n = 14/16) of patients. Reflux was progressively more frequent according to increasing bladder volume (p < 0.001). At 60 ml bladder volume no reflux was observed, while at 120 ml, 180 ml, 240 ml, 300 ml and 360 ml bladder volume reflux was observed in 14%, 25%, 41%, 55% and 63% of patients, respectively.Conclusion:Retrograde delivery of fluids such as bacillus Calmette-Guérin to the upper urinary tract through double J stents can be effective; however, it is mainly effective after several days with ureteral stent and relatively large volumes might be instilled into the bladder.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-27T10:23:28Z
  DOI: 10.1177/1756287219836895
  Issue No: Vol. 11 (2019)
Robot-assisted laparoscopic pyeloplasty versus laparoscopic pyeloplasty
for pelvi-ureteric junction obstruction in the paediatric population: a
systematic review and meta-analysis
- Authors: Samih Taktak, Oliver Llewellyn, Mohamed Aboelsoud, Shahab Hajibandeh, Shahin Hajibandeh
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Owing to the improved vision and instrument manipulation in robot-assisted procedures, we sought to evaluate the comparative outcomes of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) in a paediatric patients with pelvi-ureteric junction obstruction (PUJO).Methods:We conducted a systemic literature search of online sources, including PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and respective bibliographic reference lists. Success rate, operative time, hospital length of stay, postoperative complication rate and re-intervention rate were our primary outcomes. Combined overall effect sizes were calculated using fixed-effect or random-effects models.Results:We identified 14 observational studies reporting a total of 2254 paediatric patients with PUJO, who underwent LP (n = 1021) or RALP (n = 1233). Our analysis demonstrated that RALP was associated with a significantly higher success rate [odds ratio (OR) 2.51; 95% confidence interval (CI) 1.08–5.83, p = 0.03] and shorter length of hospital stay [mean difference (MD) −1.49; 95% CI −2.22 to −077; p < 0.0001] compared with LP. Moreover, nonsignificant reductions in postoperative complications (OR 0.61; 95% CI 0.36–1.02; p = 0.06) and re-intervention (OR 0.43; 95% CI 0.15–1.21; p = 0.11) were found in favour of RALP. There was no difference in procedure time between the two approaches (MD −0.15; 95% CI −30.22 to 29.93, p = 0.99).Conclusions:Our meta-analysis of observational studies demonstrated that RALP is safe and may have higher success rate compared with the more traditional laparoscopic approach in a paediatric population. Moreover, it may be associated with lower postoperative complications and re-intervention rates. Evidence from randomized trials is required.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-22T10:14:23Z
  DOI: 10.1177/1756287219835704
  Issue No: Vol. 11 (2019)
A retrospective analysis of patients treated with intravesical BCG for
high-risk nonmuscle invasive bladder cancer
- Authors: Julie Mariam Joshua, Meenu Vijayan, Ginil Kumar Pooleri
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Adjuvant intravesical immunotherapy with Bacillus Calmette–Guerin (BCG) is considered as the first-line agent in patients with high-risk nonmuscle invasive bladder cancer (NMIBC) after surgery. There are no data in India where there is a high prevalence of tubercle bacillus and inherent immunity against Bacillus sp. The present study aims to evaluate the outcomes of intravesical BCG in the Indian population.Methods:A retrospective study of 101 patients who underwent intravesical BCG for high-risk NMIBC between January 2006 and December 2015 was carried out in a single centre. We compared the recurrence-free rate and progression rate of patients who received induction alone and induction with maintenance BCG therapy. The safety profile of intravesical BCG therapy was also assessed in the study.Results:After a median follow up of 2 years, the disease-free survival (DFS) rates of the induction group and maintenance group were 82% and 88% respectively (p = 0.233). There was no difference in progression-free survival (PFS) rates at 2 years in those who receive maintenance BCG (95%) and those with induction BCG (94.7%; p = 0.721). A total of 69.36% of our patients had local adverse events.Conclusion:Our results suggest that maintenance therapy does not enhance the therapeutic effects of BCG in patients who respond favourably to 6 weeks of induction. Additional prospective studies are warranted in those countries where tuberculosis exposure is prevalent.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-03-05T10:18:09Z
  DOI: 10.1177/1756287219833056
  Issue No: Vol. 11 (2019)
Performing an early systematic Doppler-ultrasound fails to prevent
hemorrhagic complications after complex partial nephrectomy
- Authors: Inès Dominique, Charles Dariane, Cyril Fourniol, Thomas Le Guilchet, Sophie Hurel, Eric Fontaine, Eric Mandron, Francois Audenet, Arnaud Mejean, Marc Olivier Timsit
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN).Materials and methods:All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF).Results:Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity.Conclusions:Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-02-15T09:05:44Z
  DOI: 10.1177/1756287219828966
  Issue No: Vol. 11 (2019)
Current and emerging mechanical minimally invasive therapies for benign
prostatic obstruction
- Authors: Petros Sountoulides, Anastasios Karatzas, Stavros Gravas
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Transurethral resection of the prostate (TURP) is considered the ‘gold standard’ for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations of patients who will benefit from these MITs. It is obvious that there is a wide variation in the degree of mature of the available mechanical MITs. Time and high-quality long-term studies will decide which of these therapies will be accepted by patients and urologists. At the moment, PUL is claiming its position in the armamentarium of BPO treatment.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-02-15T04:16:43Z
  DOI: 10.1177/1756287219828971
  Issue No: Vol. 11 (2019)
Non-invasive treatment in the management of Peyronie’s disease
- Authors: Karen Randhawa, C. J. Shukla
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Peyronies disease (PD) is estimated to affect approximately 3–9% of men worldwide and maybe associated with pain, erectile dysfunction and penile deformity including shortening. The condition has significant debilitating effects on quality of life, self-esteem and psychological wellbeing in addition to sexual function. Surgical results add further to this by patients having dissatisfaction with various aspects of outcomes. Non-surgical management may allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. Several non-surgical options are currently being employed in the treatment of PD that may reduce or stabilize both objective measures (e.g. penile length and deformity) and subjective measures (including sexual function, pain and partner satisfaction). Nonsurgical management can allow patients to avoid the morbidities associated with surgery and still achieve improved functional and aesthetic outcomes. In this article we explore the current non-surgical management options for PD including oral, mechanical therapies, intralesional and topical treatments. We also briefly discuss future treatment options in the form of stem cell therapy.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-02-12T03:48:28Z
  DOI: 10.1177/1756287218823671
  Issue No: Vol. 11 (2019)
Opportunities for use of radiation therapy in penile cancer based on
patterns of care in the United States from 2007 to 2013
- Authors: Xinglei Shen, William Parker, Leah Miller, Mindi TenNapel
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:Radiation therapy (RT) is an effective modality for the treatment of squamous cell carcinomas of the penis. The National Comprehensive Cancer Network recommends consideration of primary radiation for penile preservation, in surgically unresectable tumors, and as adjuvant therapy for positive margins, bulky groin nodes or pelvic nodes. We performed a population-based analysis to evaluate the usage of RT in penile cancer from 2007 to 2013.Methods:We used the Surveillance, Epidemiology and End Results (SEER) database to identify men diagnosed with squamous cell carcinoma of the penis from 2007 to 2013. Patients were grouped as early stage (T1–T2N0), locally advanced (T3–T4N0), node-positive (T1xN1–3) and metastatic. We used linear regression model to test for factors associated with adjuvant radiation in node-positive patients.Results:We identified 2200 men diagnosed with penile cancer between 2007 and 2013. Of these, 66.4% had early stage, 10.7% had locally advanced, 15.5% had node-positive, 3.2% had metastatic cancer. Among patient with early stage cancer, RT was used in 14 patients (1.0%) and postoperative radiation in an additional 45 patients (3.1%). Among 340 patients with node-positive cancer, 62.1% received surgery alone, 5.6% radiation alone, 21.8% surgery with adjuvant radiation, and 10.6% neither surgery nor radiation. Of patients who had surgery, 26.0% had adjuvant radiation. On univariate analysis, higher nodal stage (N2–3 versus N1) was associated with adjuvant radiation (p = 0.02), while there was a trend for higher T-stage (T3/T4 versus T1/T2) (p = 0.08) and history of prior malignancy (p = 0.06). On multivariate analysis, only higher nodal stage (N2–3 versus N1) was associated with use of adjuvant radiation [hazard ratio (HR) 1.94, p = 0.03].Conclusions:A small percentage of patient who are eligible for primary or adjuvant RT in the United States receive this treatment. Further work should be done to assess barriers to use of radiation in patients with penile cancer.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-02-08T08:59:20Z
  DOI: 10.1177/1756287219828972
  Issue No: Vol. 11 (2019)
A review of avelumab in locally advanced and metastatic bladder cancer
- Authors: Arpit Rao, Manish R. Patel
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Urothelial carcinoma remains a devastating disease with a poor prognosis. Though immune therapy with Bacillus Calmette–Guérin (BCG) has been used for localized bladder cancer for years, only immune-checkpoint blockade with antiprogrammed cell-death 1 (anti-PD-1) and antiprogrammed cell-death ligand 1 (anti-PD-L1) inhibitors have demonstrated improvement in survival of patients with metastatic disease. Anti-PD-L1 antibody, avelumab, was recently given United States Food and Drug Administration (FDA) accelerated approval for the treatment of recurrent/metastatic urothelial carcinoma after failure of first-line chemotherapy, marking the fifth immune checkpoint inhibitor to be given FDA approval for the treatment of metastatic urothelial cancer. The following manuscript will review avelumab, its pharmacology, and the clinical experience that has led to its approval, as well as future plans for clinical development of avelumab for the treatment or urothelial cancer.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-30T11:00:47Z
  DOI: 10.1177/1756287218823485
  Issue No: Vol. 11 (2019)
Contemporary best practice in the use of neoadjuvant chemotherapy in
muscle-invasive bladder cancer
- Authors: Gautier Marcq, Edouard Jarry, Idir Ouzaid, Jean-François Hermieu, François Henon, Jean-Christophe Fantoni, Evanguelos Xylinas
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  Background:We aimed to provide a comprehensive literature review on the best practice management of patients with nonmetastatic muscle-invasive bladder cancer (MIBC) using neoadjuvant chemotherapy (NAC).Method:Between July and September 2018, we conducted a systematic review using MEDLINE and EMBASE electronic bibliographic databases. The search strategy included the following terms: Neoadjuvant Therapy and Urinary Bladder Neoplasms.Results:There is no benefit of a single-agent platinum-based chemotherapy. Platinum-based NAC is the gold standard therapy and mainly consists of a combination of cisplatin, vinblastine, methotrexate, doxorubicin, gemcitabine or even epirubicin (MVAC). At 5 years, the absolute overall survival benefit of MVAC was 5% and the absolute disease-free survival was improved by 9%. This effect was observed independently of the type of local treatment and did not vary between subgroups of patients. Moreover, a ypT0 stage (complete pathological response) after radical cystectomy was a surrogate marker for improved oncological outcomes. High-density MVAC has been shown to decrease toxicity (with a grade 3–4 toxicity ranging from 0% to 26%) without impacting oncological outcomes. To date, there is no role for carboplatin administration in the neoadjuvant setting in patients that are unfit for cisplatin-based NAC administration. So far, there is no published trial evaluating the role of immunotherapy in a neoadjuvant setting, but many promising studies are ongoing.Conclusion:There is a strong level of evidence supporting the clinical use of a high-dose-intensity combination of methotrexate, vinblastine, doxorubicin and cisplatin in a neoadjuvant setting. The landscape of MIBC therapies should evolve in the near future with emerging immunotherapies.
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-29T04:00:22Z
  DOI: 10.1177/1756287218823678
  Issue No: Vol. 11 (2019)
Efficacy and safety of fexapotide triflutate in outpatient medical
treatment of male lower urinary tract symptoms associated with benign
prostatic hyperplasia
- Authors: Neal Shore, Ronald Tutrone, Claus G. Roehrborn
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-15T04:40:24Z
  DOI: 10.1177/1756287218820807
  Issue No: Vol. 11 (2019)
Abiraterone acetate in combination with prednisone in the treatment of
metastatic hormone-sensitive prostate cancer: clinical evidence and
experience
- Authors: Karin Purshouse, Andrew S. Protheroe
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T06:48:24Z
  DOI: 10.1177/1756287218820804
  Issue No: Vol. 11 (2019)
An update on the best approaches to prevent complications in penile
prosthesis recipients
- Authors: Sarah C. Krzastek, Ryan Smith
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T06:39:24Z
  DOI: 10.1177/1756287218818076
  Issue No: Vol. 11 (2019)
Role of NLRP3 inflammasome in the development of bladder pain syndrome
interstitial cystitis
- Authors: Karol Borys Tudrej, Tomasz Piecha, Małgorzata Kozłowska-Wojciechowska
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T06:35:44Z
  DOI: 10.1177/1756287218818030
  Issue No: Vol. 11 (2019)
Paratesticular sarcomas: a case series and literature review
- Authors: Robert Anthony Keenan, Aisling U. Nic An Riogh, Andrea Stroiescu, Adrian Fuentes, Joan Heneghan, Ivor M. Cullen, Padraig J. Daly
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T06:31:44Z
  DOI: 10.1177/1756287218818029
  Issue No: Vol. 11 (2019)
Should aspirin be suspended prior to robot-assisted radical
prostatectomy' A systematic review and meta-analysis
- Authors: Arie Carneiro, Jonathan Doyun Cha, Willy Baccaglini, Fatima Z. Husain, Marcelo Langer Wroclawski, Igor Nunes-Silva, Rafael Sanchez-Salas, Alexandre Ingels, Paulo Priante Kayano, Oliver Rojas Claros, Natasha Kouvaleski Saviano Moran, René Sotelo, Gustavo Caserta Lemos
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T06:26:45Z
  DOI: 10.1177/1756287218816595
  Issue No: Vol. 11 (2019)
Optimization of renal function preservation during robotic partial
nephrectomy
- Authors: Natalie R. Swavely, Uzoma A. Anele, Francesco Porpiglia, Maria C. Mir, Lance J. Hampton, Riccardo Autorino
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T04:55:24Z
  DOI: 10.1177/1756287218815819
  Issue No: Vol. 11 (2019)
Contemporary best practice in the management of urothelial carcinomas of
the renal pelvis and ureter
- Authors: Maristella Bianconi, Alessia Cimadamore, Luca Faloppi, Mario Scartozzi, Matteo Santoni, Antonio Lopez-Beltran, Liang Cheng, Marina Scarpelli, Rodolfo Montironi
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T04:50:27Z
  DOI: 10.1177/1756287218815372
  Issue No: Vol. 11 (2019)
Anatomic robotic prostatectomy: current best practice
- Authors: Alberto Martini, Ashutosh Kumar Tewari
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T04:45:43Z
  DOI: 10.1177/1756287218813789
  Issue No: Vol. 11 (2019)
Anatomical, surgical and technical factors influencing continence after
radical prostatectomy
- Authors: Carlos Arroyo, Alberto Martini, Joanna Wang, Ashutosh K. Tewari
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-09T04:40:23Z
  DOI: 10.1177/1756287218813787
  Issue No: Vol. 11 (2019)
Detection rates of recurrent prostate cancer: 68Gallium (Ga)-labelled
prostate-specific membrane antigen versus choline PET/CT scans. A
systematic review
- Authors: Masood Moghul, Bhaskar Somani, Tim Lane, Nikhil Vasdev, Brian Chaplin, Clive Peedell, Gokul Vignesh KandaSwamy, Bhavan Prasad Rai
  Abstract: Therapeutic Advances in Urology, Volume 11, Issue , January-December 2019.
  
  Citation: Therapeutic Advances in Urology
  PubDate: 2019-01-08T09:58:09Z
  DOI: 10.1177/1756287218815793
  Issue No: Vol. 11 (2019)