Similar Journals
|
Therapeutic Advances in Urology
Journal Prestige (SJR): 1.171  Citation Impact (citeScore): 3 Number of Followers: 3  Open Access journalISSN (Print) 1756-2872 - ISSN (Online) 1756-2880 Published by Sage Publications  [1176 journals]
|
- Prostatic stents: a narrative review of current evidence
Authors: Clara Cerrato, Vaki Antoniou, Shriya Napolean Fernandes, Sanjeev Madaan, Bhaskar Kumar Somani
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Benign prostatic hyperplasia (BPH) is a common chronic urologic condition affecting approximately 50% of men above the age of 60. As per European Association of Urology Guidelines, BPH can be treated according to a stepwise approach starting from a conservative management, a pharmacologic approach, and finally surgery. Both medical and surgical therapies have side effects, impacting on ejaculation and sexual function and patients with multiple comorbidities might not be considered surgically suitable candidates. Prostatic stents offer a minimally invasive procedures in an out-patient setting, possibly under local anaesthesia. Utilized since the 1980s, the past stents encompassed permanent (epithelializing) or temporary (non-epithelializing) devices, like the Uro-Lume (American Medical Systems, Minnetonka, MN, USA) and the Memokath, or Memotherm (Engineers & Doctors A/S, Denmark), and the biodegradable stents made of self-reinforced poly-L-lactide or braided poly lactic-co-glycolic acid. Previous stents however showed a quite high rate of complications among which pain, incontinence, infections, stent migration or blockage, and incomplete degradation that might lead to premature removal of stent. The stents currently available on the market instead are the temporary device Allium Triangular Prostatic Urethral Stent (Allium Urological Solutions, Caesarea, Israel) and the temporary stent SPANNER (AbbeyMoor Medical, Inc., Parkers Prairie, MN, USA), which might be used in case of bladder outflow obstruction, post-operatively, or for acute urinary retention. Studies showed encouraging results, in terms of effectiveness and safety improving patients’ quality of life and International Prostate Symptom Score, but longer-term studies are needed to identify the most suitable patients who might benefit from their use. Newer stents and nitinol devices are currently investigated, and we are waiting for the results of the ongoing clinical trials.
Citation: Therapeutic Advances in Urology
PubDate: 2024-05-31T05:58:20Z
DOI: 10.1177/17562872241255262
Issue No: Vol. 16 (2024)
- Mastering bladder paraganglioma for optimal treatment: a case report of
robot-assisted surgery
Authors: Angelo Orsini, Simone Ferretti, Flavia Tamborino, Rossella Cicchetti, Davide Ciavarella, Barbara Seccia, Raffaella Basilico, Antonella Colasante, Michele Marchioni, Luigi Schips
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Bladder paraganglioma is a rare neuroendocrine neoplasm, either functional or non-functional, arising from the urinary bladder. Functional variants present with catecholamine-related symptoms, while non-functional variants pose diagnostic challenges, mimicking urothelial carcinoma. Misdiagnosis risks underscore the importance of accurate identification for appropriate patient management. In this case, a 52-year-old man, diagnosed incidentally with hypertension and reported occasional post-micturition tachycardia, underwent abdominal ultrasound for known hepatic cyst follow-up, revealing an oval hypoechoic bladder mass. Initial consideration of bladder urothelial carcinoma prompted further investigation with contrast-enhanced CT scan and cystoscopy that confirmed extrinsic mass nature, and subsequent robotic-assisted partial cystectomy was performed. Histologically, the removed mass exhibited characteristic features of bladder paraganglioma. Postoperative recovery was uneventful, with resolution of post-micturition tachycardia at 1 month. Follow-up includes endocrinological evaluation and a 6-month CT scan. In conclusion, bladder paraganglioma should be considered in para-vesical mass differentials. This case highlights the importance of meticulous history collection, even in asymptomatic patients, the need for a multidisciplinary approach for accurate diagnosis and management of this rare condition, and the robotic approach as a viable option.
Citation: Therapeutic Advances in Urology
PubDate: 2024-05-21T11:16:01Z
DOI: 10.1177/17562872241249603
Issue No: Vol. 16 (2024)
- Systematic review of recent advancements in antibody-drug and bicycle
toxin conjugates for the treatment of urothelial cancer
Authors: Chaim Domb, Jorge A. Garcia, Pedro C. Barata, Prateek Mendiratta, Santosh Rao, Jason R. Brown
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Antibody-drug conjugates and bicycle toxin conjugates represent a tremendous advance in drug delivery technology and have shown great promise in the treatment of urothelial cancer. Previously approved systemic therapies, including chemotherapy and immunotherapy, are often impractical due to comorbidities, and outcomes for patients with advanced disease remain poor, even when receiving systemic therapy. In this setting, antibody-drug and bicycle toxin conjugates have emerged as novel treatments, dramatically altering the therapeutic landscape. These drugs harness unique designs consisting of antibody or bicycle peptide, linker, and cytotoxic payload with more targeted delivery than conventional chemotherapy, thus eliminating malignant cells while reducing systemic toxicities. Potential targets investigated in urothelial cancer include Nectin-4, TROP2, HER2, and EphA2. Initial clinical trials demonstrated efficacy in treatment of refractory advanced urothelial cancer, as well as improvement in quality of life. These initial studies led to FDA approval of two antibody-drug conjugates, enfortumab vedotin and sacituzumab govitecan. Moreover, antibody-drug and bicycle toxin conjugates are being studied in ongoing clinical trials in frontline treatment of advanced disease as well as for localized cancer. These studies highlight the potential for additional future therapies with novel targets, novel antibodies, cytotoxic and immunomodulatory payloads, and unique structural designs enhancing efficacy and safety. There is increasing evidence that combinations with other cancer therapies, especially immunotherapy, improve treatment outcomes. The combination of enfortumab vedotin and pembrolizumab was recently approved for first-line treatment of advanced urothelial carcinoma. Despite the great promise of these novel drugs, robust predictive biomarkers are needed to determine the patients who would maximally benefit. This review surveys the rationale and current state of the evidence for these new drugs and describes future directions actively being explored.Plain language summaryReview of recent advances in novel treatments of urothelial cancerTwo new types of drugs, called antibody-drug conjugates (ADCs) and bicycle toxin conjugates (BTCs) have shown great promise in treating urothelial cancer. Both types of drugs consist of a structure targeting a specific protein on bladder cancer cells, linked to a drug that can kill cells. This allows for effective treatment of cancer with potentially less toxicity due to the targeted nature of these treatments. We discuss the potential targets in urothelial cancer and the drugs in these classes that could treat each target. Two of these drugs, enfortumab vedotin and sacituzumab govitecan, are in clinical use for cancers that have spread, while the others are in clinical trials. Moreover, the combination of enfortumab vedotin and pembrolizumab, an immunotherapy drug, has excellent results and was recently approved for first-line treatment of urothelial cancer that has spread. Additional studies are looking into these treatments for cancers that have not spread. In the future, management of side effects, determination of which patients benefit, and overcoming when the drugs become no longer effective will be important.
Citation: Therapeutic Advances in Urology
PubDate: 2024-05-21T06:08:33Z
DOI: 10.1177/17562872241249073
Issue No: Vol. 16 (2024)
- Long-term impact of commonly performed operations in pediatric urology on
reproductive and sexual health
Authors: Alexandra Geada, Dhaval Jivanji, Daniel M. Tennenbaum, Armin Ghomeshi, Raghuram Reddy, Michael Sencaj, Jamie Thomas, Daniel E. Nassau, Ranjith Ramasamy
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Introduction:Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures.Methods:To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion.Results:For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates.Conclusion:Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.Plain language summaryLong-term impact of commonly performed operations in pediatric urology on sexual healthMany men of reproductive age face sexual health challenges, prompting the creation of guidelines for identifying and addressing issues related to urogenital disorders. This study explores the impacts of common surgical procedures on reproductive and sexual health in children with urological conditions. By reviewing extensive literature, the study focuses on the long-term effects of pediatric urologic surgeries, emphasizing influential and frequently cited research for a comprehensive understanding. For conditions like chordee, surgical options such as plication or grafting may be considered. While erectile function typically remains unchanged, there might be a decrease in penile length post-surgery, which can be addressed with specific techniques. Hypospadias repair varies based on severity, with those undergoing the procedure having shorter penises. However, their sexual satisfaction, libido, and semen quality are comparable to others. Treatment of posterior urethral valves (PUV) often involves valve ablation, however some studies have shown altered semen parameters following ablation. Managing varicocele early on leads to better outcomes, and surgery is recommended if testicular atrophy is observed. Orchiopexy and orchiectomy are procedures for undescended testis (UDT) and testicular torsion in children. Pediatric urologic diseases and their surgical interventions can significantly affect sexual function and fertility in adulthood due to their multifactorial nature. While some procedures aim to preserve or enhance sexual potential such as proper urethral development, others may inadvertently impact sexual health negatively, such as necrotic testes removal. This underscores the importance of thorough diagnosis and management of pediatric urologic conditions to safeguard long-term sexual function post-surgery.
Citation: Therapeutic Advances in Urology
PubDate: 2024-05-09T01:25:00Z
DOI: 10.1177/17562872241249083
Issue No: Vol. 16 (2024)
- Assessing the effectiveness and safety of lenvatinib and everolimus in
advanced renal cell carcinoma: insights from the RELIEVE study’s
analysis of heavily pretreated patients
Authors: Sebastiano Buti, Alessandro Olivari, Cristina Masini, Davide Bimbatti, Donata Sartori, Paola Ermacora, Carlo Cattrini, Maria Giuseppa Vitale, Ernesto Rossi, Claudia Mucciarini, Mimma Rizzo, Michele Sisani, Matteo Santoni, Giandomenico Roviello, Veronica Mollica, Vincenza Conteduca, Francesco Grillone, Marika Cinausero, Giuseppe Prati, Francesco Atzori, Marco Stellato, Francesco Massari, Melissa Bersanelli
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:The treatment of heavily pretreated patients with metastatic renal cell carcinoma (mRCC) represents an unmet medical need and is still challenging.Objectives:The primary objective was to assess the effectiveness of the lenvatinib plus everolimus combination and the secondary objective was the toxicity profile of this combination.Design:We conducted a longitudinal retrospective study examining mRCC patients pre-treated with one or more lines of therapy among different cancer centers in Italy.Methods:The study included patients who received the combination of lenvatinib plus everolimus as either a second-line treatment or beyond. We assessed progression-free survival (PFS), time to treatment failure (TTF), overall survival (OS), response rate (RR), and toxicity profile. In addition, we explored the potential relationship between treatment effectiveness and clinical and laboratory parameters.Results:In all, 33 patients were assessed, the median age was 60 years, 57% had an Eastern Cooperative Oncology Group performance status of 1–2 and. 63% received ⩾ 3 prior lines of therapy. 62% were ‘intermediate risk’ according to the International Metastatic Renal Cell Carcinoma Database Consortium and 30% were ‘poor risk’. The RR was 42% (no complete response), 18% stable disease. Median OS was 11.2 months (95% CI 6.8–19.9), median PFS was 6.7 months (95% CI 0.6–30.8), and median TTF was 6.7 months (95% CI 4.8–16.6). A shorter OS was significantly associated with lymph node metastases (p = 0.043, 95% CI), neutrophils/ lymphocytes ratio (NLR) ⩾ 3 (p = 0.007), hemoglobin/red cell distribution width ratio cutoff value
Citation: Therapeutic Advances in Urology
PubDate: 2024-04-17T12:30:12Z
DOI: 10.1177/17562872241244574
Issue No: Vol. 16 (2024)
- Meta-analysis of perioperative outcomes and safety of percutaneous
nephrostomy versus retrograde ureteral stenting in the treatment of acute
obstructive upper urinary tract infection
Authors: Xidong Wang, Gang Wu, Tianqi Wang, Shangjing Liu, Guixin Ding, Qiancheng Mao, Yongli Chu, Yuanshan Cui, Jitao Wu
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:The debate regarding the optimal drainage method for acute obstructive upper urinary tract infection persists, focusing on the choice between percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS).Aims:This study aims to systematically examine the perioperative outcomes and safety associated with PCN and RUS in treating acute obstructive upper urinary tract infections.Methods:A comprehensive investigation was conducted using the Medline, Embase, Web of Science, and Cochrane databases up to December 2022, following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The utilized keywords included ‘PCN’, ‘RUS’, ‘acute upper obstructive uropathy’, and ‘RCT’. Inclusion criteria encompassed studies providing accurate and analyzable data, which incorporated the total subject count, perioperative outcomes, and complication rates. The assessed perioperative outcomes included fluoroscopy time, normalization of temperature, normalization of serum creatinine, normalization of white blood cell (WBC) count, and operative time. Safety outcomes encompassed failure rate, intraoperative and postoperative hematuria, postoperative fever, postoperative pain, and postoperative nephrostomy tube or stent slippage rate. The study protocol was prospectively registered at PROSPERO (CRD42022352474).Results:The meta-analysis encompassed 7 trials involving 727 patients, with 412 assigned to the PCN group and 315 to the RUS group. The outcome of the meta-analysis unveiled a reduced occurrence of postoperative hematuria in the PCN group [odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.30–0.99, p = 0.04], along with a decreased frequency of insertion failure (OR = 0.42, 95% CI 0.21–0.81, p = 0.01). In addition, the RUS group exhibited a shorter fluoroscopy time than the PCN group (mean difference = 0.31, 95% CI 0.14–0.48, p = 0.0004).Conclusion:Given the significant impact of hematuria and catheterization failure on postoperative quality of life, the preference for PCN appears more advantageous than RUS.Plain language summaryMeta-analysis of perioperative outcomes and safety of percutaneous nephrostomy vs retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infectionThe optimal drainage method for acute obstructive upper urinary tract infection between PCN and RUS is currently debatable. Our meta-analysis found PCN performed better than RUS in hematuria and catheterization failure rate, although PCN was associated with longer exposure time.
Citation: Therapeutic Advances in Urology
PubDate: 2024-04-12T08:38:13Z
DOI: 10.1177/17562872241241854
Issue No: Vol. 16 (2024)
- A phase III, single-arm, 6-month trial of a wide-dose range oral
testosterone undecanoate product
Authors: James S. Bernstein, Om P. Dhingra
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Oral testosterone undecanoate (TU) formulations may provide effective, safe, and easily titratable testosterone replacement therapy.Objective:Demonstrate efficacy and safety of a novel oral TU formulation.Design:An open-label, single-arm, multi-center trial treated 155 hypogonadal men for 180 days. Treatment began at 200 mg TU twice daily with meals; doses were titrated over two 28-day cycles to between 100 and 800 mg TU daily, measuring average testosterone (T Cavg) after 90 days. Ambulatory blood pressure monitoring (ABPM) occurred at baseline, 120, and 180 days.Methods:Titrations used a randomized blood sample taken 3-, 4-, or 5-h post-morning dose. Outcomes used sodium fluoride/ethylenediaminetetraacetate plasma testosterone (T) values; serum results were also reported. Blood pressure (ABPM and in-clinic) was evaluated for change from baseline.Results:After titration, 87.8% of KYZATREX™ treated participants (worse-case scenario) and 96.1% of 90-day completers achieved eugonadal mean plasma T values. Serum T Cavg was 452 ng/dL and maximum T concentrations (T Cmax) met all FDA criteria. Participant eugonadal percentages were comparable across subgroups for age, weight, and body mass index. Diet had no effect on participant eugonadal percentages. KYZATREX was well tolerated, with no drug-related serious adverse events (SAE) and one adverse drug reaction (hypertension) observed in 2% or more of participants. Systolic ambulatory blood pressure increased 1.7 mmHg (95% confidence interval: 0.3–3.1). At baseline, 36% of 155 participants were receiving anti-hypertensive medication and 22% were diabetic. No dose increases occurred in existing anti-hypertensive medication; five participants (3.2%) started anti-hypertensive medication.Conclusion:KYZATREX provided safe and effective testosterone levels within the normal range in hypogonadal male study participants.Clinical trial registration:URL: https://clinicaltrials.gov/ unique identifier NCT04467697, conducted under NCT03198728. Post-completion, clinicaltrials.gov requested creation of the separate NCT04467697 identifier. All subjects were recruited under NCT03198728.
Citation: Therapeutic Advances in Urology
PubDate: 2024-04-11T04:45:03Z
DOI: 10.1177/17562872241241864
Issue No: Vol. 16 (2024)
- Treatment modalities for paediatric functional daytime lower urinary tract
disorders: an updated review
Authors: Naveen Wijekoon, Aniruddh Deshpande
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Paediatric functional bladder disorders especially those causing daytime symptoms are a common cause of significant psychosocial and/or physical morbidity and impaired quality of life. Despite the availability of many therapeutic modalities, a significant number of children appear to be refractory to treatment and continue to have symptoms. In this review, we aim to evaluate the current evidence in the use of existing and novel therapeutic options for the management of daytime lower urinary tract disorders in children. We also aim to highlight the controversies around the terminology and diagnosis of paediatric lower urinary tract dysfunction (LUTD) and specific conditions. The article will then provide a reasonable critique of the existing and emerging treatment modalities in functional daytime LUTD in children including their mode of action, efficacy, indications, and recent advances. These include standard urotherapy, specific urotherapy comprised of biofeedback, alarm therapy and electrical neural stimulation and pharmacotherapy involving selective and non-selective anticholinergics, ß3 adrenergic agonists, alpha blockers and botulinum toxin. A better understanding of this common clinical problem may help clinicians achieve better profiling of these children’s diagnoses to further enable specific, targeted treatment.Plain language summaryA review article about new treatment options for otherwise healthy children with long-term urinary symptoms occurring during the daytimeManagement of paediatric functional daytime LUT disorders is complex and may benefit from a combination of treatment modalities. Urotherapy and anticholinergics appear to be effective in the majority however, non-responders warrant careful re-evaluation to characterize the specific type of LUTD to target appropriate treatment. Various novel therapies and adjuncts have been shown effective and range from smartphone apps, bladder alarms, neuromodulation systems and more effective drug delivery systems. Despite being effective, non-selective antimuscarinics are less favoured for long-term use in children due to the side-effect profile. Therefore, more selective anticholinergics, ß3 agonists and combination treatment options are being evaluated to improve compliance while maintaining/enhancing treatment efficacy. Use of alpha blockers and intravesical injection of botulinum toxin have shown promising results especially in refractory cases.
Citation: Therapeutic Advances in Urology
PubDate: 2024-04-05T06:49:49Z
DOI: 10.1177/17562872241241848
Issue No: Vol. 16 (2024)
- A multi-institutional update on surgical outcomes after penile silicone
sleeve implantation
Authors: Alexandra R. Siegal, Kenan E. Celtik, Shirin Razdan, Michaela Sljivich, Bryan Kansas, Bhavik Shah, Laurence A. Levine, Robert J. Valenzuela
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:The increasing popularity of the silicone sleeve penile implant has been accompanied by concerns over potential risks and adverse events.Objectives:To provide multi-institutional data on safety outcomes in patients undergoing silicone sleeve penile implant surgery across high-volume implant surgeons. In addition, we discuss preventative techniques to minimize postoperative complications and the management of these events.Design and methods:We performed a retrospective analysis of men undergoing penile silicone sleeve implants between November 2020 and November 2022 with four surgeons, each from a separate institution. Perioperative and postoperative adverse events, including unsatisfactory cosmetic outcomes requiring revision, were determined by physician follow-up. Flaccid penile length and girth were measured preoperatively and postoperatively.Results:A total of 299 male patients underwent silicone sleeve implant surgery, with an average age of 42.5 ± 10.5 years and an average body mass index of 28.5 ± 4.0. The patient cohort exhibited minimal comorbidities, with 5% having hyperlipidemia, 2% being smokers, 2% having cardiovascular disease, and 1% having diabetes. Patients experienced an average increase of 4.1 ± 1.5 cm in their flaccid penile length (a 50% increase) and an average increase of 3.4 ± 1.5 cm in their flaccid girth (a 37% increase) (p
Citation: Therapeutic Advances in Urology
PubDate: 2024-04-02T01:00:14Z
DOI: 10.1177/17562872241241858
Issue No: Vol. 16 (2024)
- Targeted augmented reality-guided transperineal prostate biopsies study:
initial experience
Authors: Shenthiuiyan Theivendrampillai, Bob Yang, Mark Little, Christopher Blick
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Transperineal biopsy of magnetic resonance imaging (MRI)-detected prostate lesions is now the established technique used in prostate cancer (CaP) diagnostics. Virtual Surgery Intelligence (VSI) Holomedicine by Apoqlar (Hamburg, Germany) is a mixed reality (MR)/augmented reality (AR) software platform that runs on the HoloLens II system (Microsoft, Redford, USA). Multiparametric prostate MRI images were converted into 3D holograms and added into a MR space, enabling visualization of a 3D hologram and image-assisted prostate biopsy.Objective:The Targeted Augmented Reality-GuidEd Transperineal (TARGET) study investigated the feasibility of performing AR-guided prostate biopsies in a MR framework, using the VSI platform in patients with MRI-detected prostate lesions.Methods:Ten patients with a clinical suspicion of CaP on MRI (Prostate Imaging-Reporting and Data System, PI-RADS 4/5) were uploaded to the VSI HoloLens system. Two MR/AR-guided prostate biopsies were then acquired using the PrecisionPoint Freehand transperineal biopsy system. Cognitive fusion biopsies were performed as standard of care following the MR/AR-guided prostate biopsies.Results:All 10 patients successfully underwent MR/AR-guided prostate biopsy after 3D MR images were overlaid on the patient’s body. Prostatic tissue was obtained in all MR/AR-guided specimens. Seven patients (70%) had matching histology in both the standard and MR/AR-guided biopsies. The remaining three had ISUP (International Society of Urological Pathology) Grade 2 CaP. There were no immediate complications.Conclusion:We believe this is a world first. The initial feasibility data from the TARGET study demonstrated that an MR/AR-guided prostate biopsy utilizing the VSI Holomedicine system is a viable option in CaP diagnostics. The next stage in development is to combine AR images with real-time needle insertion and to provide further data to formally appraise the sensitivity and specificity of the technique.
Citation: Therapeutic Advances in Urology
PubDate: 2024-03-08T09:56:47Z
DOI: 10.1177/17562872241232582
Issue No: Vol. 16 (2024)
- The incidence, pathogenesis, and management of non-clear cell renal cell
carcinoma
Authors: Priyanka Naik, Harshitha Dudipala, Yu-Wei Chen, Brent Rose, Aditya Bagrodia, Rana R. McKay
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Renal cell carcinoma (RCC) is the most common type of kidney cancer and is divided into two distinct subtypes, clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC). Although many treatments exist for RCC, these are largely based on clinical trials performed in ccRCC and there are limited studies on the management of nccRCC. Non-clear cell RCC consists of multiple histological subtypes: papillary, chromophobe, translocation, medullary, collecting duct, unclassified, and other rare histologies. Due to variations in pathogenesis and therapeutic response, therapy should be tailored to specific variant histologies. For patients with localized nccRCC, surgical resection remains the gold standard. In the metastatic setting, the standard of care has yet to be clearly defined, and most guidelines recommend clinical trial participation. General therapeutic options include immunotherapy, either as monotherapy or in combination, targeted therapies such as vascular endothelial growth factor tyrosine kinase inhibitors and MET inhibitors, and chemotherapy in certain subtypes. Here we present a review of the incidence and pathogenesis of the various subtypes, as well as available clinical data to support therapeutic recommendations for these subtypes. We also highlight currently available clinical trials in nccRCC and future directions in investigating novel treatment modalities tailored to patients with variant histology.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-29T11:59:11Z
DOI: 10.1177/17562872241232578
Issue No: Vol. 16 (2024)
- Carboplatin in metastatic castration-resistant prostate cancer patients
with molecular alterations of the DNA damage repair pathway: the PRO-CARBO
phase II trial
Authors: Elodie Coquan, Nicolas Penel, Justine Lequesne, Raphaël Leman, Pernelle Lavaud, Zoé Neviere, Pierre-Emmanuel Brachet, Emeline Meriaux, Aurélien Carnot, Jérémy Boutrois, Marie Castera, Nicolas Goardon, Etienne Muller, Alexandra Leconte, Antoine Thiery-Vuillemin, Bénédicte Clarisse, Florence Joly
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Introduction:DNA damage repair genes are altered in 20–35% of metastatic castration-resistant prostate cancer (mCRPC). Poly-ADP (Adénosine Diphosphate)-ribose polymerase inhibitors (PARPi) showed significant activity for these selected tumors, especially with homologous recombination repair (HRR) deficiency. These alterations could also predict platinum sensitivity. Although carboplatin was inconclusive in unselected mCRPC, the literature suggests an anti-tumoral activity in mCRPC with HHR gene alterations. We aimed to assess the efficacy of carboplatin monotherapy in mCRPC patients with HRR deficiency.Methods:This prospective multicenter single-arm two-stage phase II addressed mCRPC men with HRR somatic and/or germline alterations, pretreated with ⩾2 taxane chemotherapy regimens and one androgen receptor pathway inhibitor. Prior PARPi treatment was allowed. Enrolled patients received intravenous carboplatin (AUC5) every 21 days for 6–9 cycles. The primary endpoint was the best response rate according to adapted PCWG3 guidelines: radiological response (RECIST 1.1 criteria) and/or biological response [⩾50% prostate-specific antigen (PSA) decline].Results:A total of 15 out of 16 enrolled patients started carboplatin treatment. Genomic alterations were identified for BRCA2 (n = 5), CDK12 (n = 3), ATM (n = 3) CHEK2 (n = 2), CHEK1 (n = 1), and BRCA1 (n = 1) genes. Objective response (partial biological response + stable radiological response) was achieved in one patient (6.7%), carrying a BRCA2 mutation and not pre-treated with PARPi; stable disease was observed for five patients (33.5%). Among seven patients (46.7%) with previous PARPi treatment, four patients (57.1%) had a stable disease. The median progression-free and overall survivals were 1.9 [95% confidence interval (95% CI), 1.8–9.5] and 8.6 months (95% CI, 4.3–19.5), respectively. The most common severe (grade 3–4) treatment-related toxicities were thrombocytopenia (66.7%), anemia (66.7%), and nausea (60%). Overall, 8 (53.3%) patients experienced a severe hematological event.Conclusion:The study was prematurely stopped as pre-planned considering the limited activity of carboplatin monotherapy in heavily pre-treated, HHR-deficient mCRPC patients. Larger experience is needed in mCRPC with BRCA alterations.Trial registration:NCT03652493, EudraCT ID number 2017-004764-35.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-28T12:06:08Z
DOI: 10.1177/17562872241229876
Issue No: Vol. 16 (2024)
- Formation of vesicovaginal fistula after modified McDonald cerclage
placement: a case report with literature review
Authors: Deama AlGhamdi, Samera F. AlBasri
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Cervical cerclage is a common procedure employed to prevent preterm birth in women with cervical insufficiency. Complications such as injuries to the cervix and bladder, and premature membrane rupture are well-documented, while genitourinary fistulas are a rare occurrence. This article reports a rare case of vesicovaginal fistula (VVF) formation in a 27-year-old woman following the placement of a McDonald cervical cerclage. The patient presented with continuous watery vaginal leakage, which began during the last 2 months of her pregnancy. Clinical and cystoscopic examinations revealed the presence of a VVF, which was further confirmed through voiding cystourethrography and perineal magnetic resonance imaging. Notably, the patient had undergone the cerclage procedure 18 months prior to the onset of symptoms, making this case particularly unusual. We believe that the VVF formation was associated with the use of Mersilene tape, which may have slowly eroded through the cervix and subsequently breached the urothelium. This case underscores the importance of considering cerclage-related genitourinary fistulas as potential complications, especially when evaluating and counseling patients who have undergone cervical procedures like the McDonald technique. In conclusion, this case highlights the need for vigilant monitoring and a high index of suspicion in patients presenting with symptoms of genitourinary fistulas after such procedures. Further research and awareness in this area are warranted to better understand the risk factors and mechanisms underlying this unusual complication.Plain language summarySummaryOur patient presented with continuous watery leakage that started during the last 2 months of her pregnancy. The patient was diagnosed with an abnormal communication between the bladder and vagina following the placement of cervical Mersilene tape. After 18 months, the opening was repaired, and the patient fully recovered 2 months after surgery.Complications associated with cerclage are rare and commonly related to injuries to the cervix or bladder, premature rupture of membranes, chorioamnionitis, and bleeding, as described in published reports. This case report described the unusual complication of vesicovaginal fistula formation after the placement of a McDonald suture. We emphasize that vesicovaginal fistula can have a serious impact on social, mental, and sexual health. Any practitioner dealing with such patients should be aware of these associated health problems during management.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-22T10:25:10Z
DOI: 10.1177/17562872241232581
Issue No: Vol. 16 (2024)
- Is suction the future of endourology' Overview from EAU Section of
Urolithiasis
Authors: Victoria Jahrreiss, Carlotta Nedbal, Daniele Castellani, Vineet Gauhar, Christian Seitz, Guohua Zeng, Patrick Juliebø-Jones, Etienne Keller, Lazaros Tzelves, Rob Geraghty, Karan Rangarajan, Olivier Traxer, Joe Philip, Andreas Skolarikos, Panagiotis Kallidonis, Ewa Bres-Niewada, Bhaskar Somani
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-22T10:02:11Z
DOI: 10.1177/17562872241232275
Issue No: Vol. 16 (2024)
- The impact of prognostic group classification on prostate cancer
progression in intermediate-risk patients according to the European
Association of Urology system: results in 479 patients treated with
Authors: Antonio Benito Porcaro, Alberto Bianchi, Andrea Panunzio, Sebastian Gallina, Alessandro Tafuri, Emanuele Serafin, Rossella Orlando, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Francesca Montanaro, Giulia Marafioti Patuzzo, Francesco Artoni, Alberto Baielli, Francesco Ditonno, Riccardo Rizzetto, Alessandro Veccia, Alessandra Gozzo, Vincenzo De Marco, Matteo Brunelli, Maria Angela Cerruto, Alessandro Antonelli
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients.Objectives:To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP).Design:Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk.Methods:PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox’s proportional hazards, Kaplan–Meyer survival curves, and binomial and multinomial logistic regression models.Results:After a median (interquartile range) of 35 months (15–57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models.Conclusion:The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.Plain language summaryA study on 479 patients looked at how prognostic group classification affects progression in patients with intermediate-risk prostate cancer treated with robot-assisted radical prostatectomyProstate cancer is a serious health concern in men, and those with intermediate-risk prostate cancer may experience disease progression. Urologists use various methods to predict the risk of progression in these patients. However, sometimes the predictions are not accurate. Therefore, researchers conducted a study to identify factors that could help predict disease progression in patients with intermediate-risk prostate cancer who underwent robot-assisted surgery. This study on 479 patients found that a percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 were predictive factors of disease progression. Additionally, factors like ISUP> 2, positive surgical margins, and pelvic lymph node invasion also predicted disease progression. Patients were classified into three groups based on their clinical and pathological features: favorable, unfavorable (one negative prognostic factor), and adverse (more than one negative prognostic factor). The risk of prostate cancer progression increased as the prognosis worsened through these groups. The study concluded that a more accurate stratification of intermediate-risk prostate cancer patients is needed to manage the disease effectively.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-12T06:16:07Z
DOI: 10.1177/17562872241229260
Issue No: Vol. 16 (2024)
- Oncological outcomes in robot-assisted radical prostatectomy: the value of
PSA density as a preoperative predictive factor
Authors: Roser Vives Dilme, Juan Gómez Rivas, Laura Fernández Hernández, Irene De la Parra Sánchez, Rafael Sánchez del Hoyo, María Isabel Galante Romo, Enrique Redondo González, José Luis Senovilla Pérez, Lorena Fernández Montarroso, Jesús Moreno Sierra
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate.Objectives:The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA).Design and methods:We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months.Results:PSAD showed a significant association with PSM (p
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-08T07:22:19Z
DOI: 10.1177/17562872241229250
Issue No: Vol. 16 (2024)
- Current role of intraoperative cell salvage techniques in the management
of renal tumors with level III and IV inferior vena cava thrombus
extension
Authors: Cristian Surcel, Robert Dotzauer, Cristian Mirvald, Calin Popa, Cosmin Olariu, Catalin Baston, Mihai Harza, Constantin Gangu, Igor Tsaur, Ioanel Sinescu
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications.Objective:In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest.Design and method:In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay.Results:The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood (p
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-08T07:18:16Z
DOI: 10.1177/17562872241229248
Issue No: Vol. 16 (2024)
- BAUS South Central Regional Meeting 2024 Friday 19 January: Abstracts
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-07T06:53:21Z
DOI: 10.1177/17562872241230863
Issue No: Vol. 16 (2024)
- Randomized trial of mechanotherapy for the treatment of stress urinary
incontinence in women
Authors: Nissrine Nakib, Suzette Sutherland, Kevin Hallman, Marcus Mianulli, David R Boulware
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking.Objective:To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT).Design:This was a randomized, controlled, double-blinded trial.Materials and methods:Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)].Results:Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (p =
Citation: Therapeutic Advances in Urology
PubDate: 2024-02-07T06:51:02Z
DOI: 10.1177/17562872241228023
Issue No: Vol. 16 (2024)
- Successful bladder-sparing partial cystectomy for muscle-invasive domal
urothelial carcinoma with sarcomatoid differentiation: a case report
Authors: Mark Sultan, Ahmad Abdelaziz, Muhammed A. Hammad, Juan R. Martinez, Shady A. Ibrahim, Mahra Nourbakhsh, Ramy F. Youssef
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
High-grade (HG) urothelial carcinoma (UC) with variant histology has historically been managed conservatively. The presented case details a solitary lesion of muscle-invasive bladder cancer (MIBC) with sarcomatoid variant (SV) histology treated by partial cystectomy (PC) and adjuvant chemotherapy. A 71-year-old male with a 15-pack year smoking history presented after outside transurethral resection of bladder tumor (TURBT). Computerized tomography imaging was negative for pelvic lymphadenopathy, a 2 cm broad-based papillary tumor at the bladder dome was identified on office cystoscopy. Complete staging TURBT noted a final pathology of invasive HG UC with areas of spindle cell differentiation consistent with sarcomatous changes and no evidence of lymphovascular invasion. The patient was inclined toward bladder-preserving options. PC with a 2 cm margin and bilateral pelvic lymphadenectomy was performed. Final pathology revealed HG UC with sarcomatoid differentiation and invasion into the deep muscularis propria, consistent with pathologic T2bN0 disease, a negative margin, and no lymphovascular invasion. Subsequently, the patient pursued four doses of adjuvant doxorubicin though his treatment was complicated by hand-foot syndrome. At 21 months postoperatively, the patient developed a small (
Citation: Therapeutic Advances in Urology
PubDate: 2024-01-20T05:34:27Z
DOI: 10.1177/17562872241226582
Issue No: Vol. 16 (2024)
- The natural history of benign prostatic hyperplasia-related voiding
symptoms following penile prosthesis implantation
Authors: Raevti Bole, Prajit Khooblall, Petar Bajic
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:There is a rising prevalence of benign prostatic hyperplasia (BPH)-related urinary symptoms along with erectile dysfunction in the aging male population. Therefore, assessment of lower urinary tract symptoms (LUTS) is advised before penile prosthesis surgery with some men requiring preoperative transurethral surgical management to reduce the risk of post-procedure complications. However, less is known about the natural history of men with uncomplicated LUTS who do not require surgical management for BPH before penile prosthesis.Objective:We sought to assess the natural history of BPH-related uncomplicated LUTS in men following penile prosthesis surgery.Design:Single institution retrospective review.Methods:Following institutional review board approval, we performed a retrospective review of all adult males with a preoperative diagnosis of LUTS undergoing penile prosthesis surgery at our institution from January 2017 to November 2022. The primary outcome was progression to transurethral surgery.Results:From 2017 to 2022, 211 patients with preexisting LUTS underwent penile prosthesis surgery and met all criteria for inclusion including no history of transurethral surgery. The median (interquartile range, IQR) AUA symptom score (AUA-SS) was 12 (12). Post-void residual was below 200 cc in 96.2% of patients preoperatively and 99.1% of patients after surgery. At a median (IQR) follow-up duration of 9 (23) months after surgery, 5.7% (12/211) of patients had progressed to bladder outlet surgery and 35.5% of patients endorsed LUTS bother with a median (IQR) AUA-SS of 14.5 (11.8).Conclusion:The majority of patients with uncomplicated LUTS did not require bladder outlet surgery following penile prosthesis implantation and could be managed with conservative or pharmacologic measures alone. Prostate gland size was significantly larger in patients who progressed to bladder outlet surgery. While the results are overall reassuring, further study is needed to identify specific factors associated with pursuing bladder outlet surgery in this small subset of patients.
Citation: Therapeutic Advances in Urology
PubDate: 2024-01-12T09:59:44Z
DOI: 10.1177/17562872241226579
Issue No: Vol. 16 (2024)
- Risk and benefits of penile length preservation techniques during penile
prosthesis implantation: a systematic review by the young academic
urologists sexual and reproductive health working group
Authors: Marco Falcone, Mirko Preto, Afonso Ribeiro Morgado, Ioannis Sokolakis, Selçuk Sarıkaya, Marco Capece, Paolo Capogrosso, Celeste Manfredi, Georgios Tsampoukas, Giorgio Russo
Abstract: Therapeutic Advances in Urology, Volume 16, Issue , January-December 2024.
Background:Penile shortening, frequently resulting from end-stage Peyronie’s disease (PD), has a negative impact on patients’ sexual activity and overall quality of life, especially when accompanied by Erectile dysfunction (ED). Various surgical techniques have been described to manage concomitant ED and penile shortening through penile prosthesis (PP) implantation.Objectives:To evaluate the benefits and risks of different penile length preservation techniques during PP implantation.Design:A systematic review of the available literature on the use of penile length preservation maneuvers in conjunction with PP implantation was conducted.Data sources and methods:For this systematic review, three databases (Medline, Embase and Cochrane) and clinical trial.gov were queried for relevant publications from 1 January 1990 to 1 September 2022. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Results:The qualitative analysis included 15 relevant articles involving 1186 adult patients who underwent penile length preservation techniques during PP implantation. Penile lengthening of 1–7 cm was reported. Overall, postoperative complications were described in up to 21.7% of cases. Only five studies reported functional outcomes, showing a significant improvement in postoperative period based on the administered questionnaire (e.g. IIEF – International Index of Erectile Function, EDITS – Erectile Dysfunction Inventory of Treatment Satisfaction).Conclusion:Penile length preservation procedures appear to offer a viable option for managing acquired penile shortening, particularly in cases of PD. However, they are associated with a significant risk of complications. Proper patient selection, thorough discussion of risks and benefits, and referral to high-volume centers are mandatory to achieve optimal outcomes and minimizing complications.Trial registration:PROSPERO database registration CRD42022360758.
Citation: Therapeutic Advances in Urology
PubDate: 2024-01-08T11:07:37Z
DOI: 10.1177/17562872231215177
Issue No: Vol. 16 (2024)
