Showing papers in "Current Urology Reports in 2010"
TL;DR: Active surveillance is an approach to the management of favorable-risk prostate cancer which uses the opportunity provided by the long natural history of the disease to incorporate a period of initial observation into patient management.
Abstract: Active surveillance is a solution to the widely acknowledged problem of overdiagnosis and overtreatment of clinically insignificant disease which accompanies early detection of prostate cancer using prostate-specific antigen (PSA) and biopsy. It is an approach to the management of favorable-risk prostate cancer which uses the opportunity provided by the long natural history of the disease to incorporate a period of initial observation into patient management. The basic concept is that most men diagnosed with low-grade, small-volume disease are not destined to have any clinical manifestations of the condition during their lifetime. However, a subset of patients with favorable-risk prostate cancer is at risk, due to either the presence of higher-risk disease not apparent at diagnosis or progression to a more aggressive phenotype over time. These patients can be identified with reasonable accuracy by close follow-up, including serial PSAs and biopsies, and treated effectively in most cases. The rationale, patient selection, method of follow-up, triggers for intervention, and recent results of this approach will be reviewed.
87 citations
TL;DR: The effect of known factors related to early return of urinary continence after radical prostatectomy is examined, including those known prior to surgery, and therefore possibly not modifiable, and factors that can be controlled during surgery or surgical planning.
Abstract: Success of radical prostatectomy is measured by control of cancer and return of urinary and sexual function. Urinary incontinence is generally considered the greatest impairment in immediate postoperative urinary function. Multiple factors are associated with earlier return of urinary continence after radical prostatectomy. These factors can be divided into those known prior to surgery, and therefore possibly not modifiable, and factors that can be controlled during surgery or surgical planning. In addition, various postoperative maneuvers can help hasten urinary continence. This article examines the effect of known factors related to early return of urinary continence after radical prostatectomy.
63 citations
TL;DR: For small, benign lesions, conservative management is a viable option, although no surveillance protocols have been described, and any functional lesion, potentially malignant lesions, or benign lesion more than 5 cm in diameter deserves surgical treatment.
Abstract: Adrenal cysts, first described in 1670, typically presented with abdominal pain or palpable mass. In the modern era, incidentally identified adrenal cysts are commonplace, as imaging studies have become a mainstay in patient evaluation. The rubric of adrenal cysts comprises a broad differential diagnosis, rendering definitive diagnosis and subsequent management difficult. These cysts are categorized into four subtypes: endothelial, pseudocyst, epithelial, and parasitic. Endocrine workup should rule out functional status. Radiologic differentiation is helpful; however, imaging characteristics, such as hemorrhage in a pseudocyst, can confound identification of benign versus malignant lesions. Any functional lesion, potentially malignant lesion, or benign lesion more than 5 cm in diameter deserves surgical treatment. For small, benign lesions, conservative management is a viable option, although no surveillance protocols have been described.
53 citations
TL;DR: MRI has improved lesion detection and local staging, and MRI allows functional assessment with techniques such as diffusion-weighted MRI, MR spectroscopy, and dynamic contrast-enhanced MRI.
Abstract: Prostate cancer is a common cancer in men and continues to be a major health problem. Imaging plays an essential role in the clinical management of patients. An important goal for prostate cancer imaging is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. Developments in imaging technologies, specifically magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT), have improved the detection rate of prostate cancer. MRI has improved lesion detection and local staging. Furthermore, MRI allows functional assessment with techniques such as diffusion-weighted MRI, MR spectroscopy, and dynamic contrast-enhanced MRI. The most common PET radiotracer, 18F-fluorodeoxyglucose, is not very useful in prostate cancer. However, in recent years other PET tracers have improved the accuracy of PET/CT imaging of prostate cancer. Among these, choline (labeled with 18F or 11C), 11C-acetate, and 18F-fluoride have demonstrated promising results, and other new radiopharmaceuticals are currently under evaluation in preclinical and clinical studies.
52 citations
TL;DR: The most recent advances in the biology and treatment of children with Wilms’ tumor are reviewed.
Abstract: Wilms' tumor is the most common malignant renal tumor in children. Survival has improved dramatically over time as a result of prospective randomized clinical trials conducted by the pediatric cooperative cancer groups. Current research is directed toward identifying low-risk patients for whom a reduction in treatment intensity would decrease long-term morbidity. This article reviews the most recent advances in the biology and treatment of children with Wilms' tumor.
42 citations
TL;DR: Overactive bladder (OAB) is a clinical syndrome characterized by urinary urgency, frequency, and nocturia with or without accompanying urinary incontinence, using this operational definition based on symptoms at presentation, urodynamic testing is not required for an initial diagnosis of OAB.
Abstract: Overactive bladder (OAB) is a clinical syndrome characterized by urinary urgency, frequency, and nocturia with or without accompanying urinary incontinence. Thus, using this operational definition based on symptoms at presentation, urodynamic testing is not required for an initial diagnosis of OAB. An increasing body of evidence suggests that, although there is a relationship between the urodynamic finding of detrusor overactivity and OAB, these are quite separate findings, and successful response to nonsurgical and surgical interventions for OAB does not depend on finding detrusor overactivity on urodynamic testing. The role of urodynamics in the setting of OAB is not well defined at present, but there are several clinical scenarios where such testing may be useful. However, at this time, the evidence to support their routine use in patients with OAB is limited.
41 citations
TL;DR: It is essential that urologists collaborate with radiologists, emergency room physicians, and other providers to appropriately balance the theoretical risks and practical benefits of ionizing radiation in the diagnosis of stone disease.
Abstract: As unenhanced computed tomography (CT) has supplanted other modalities (eg, intravenous urography, ultrasonography) as the “test of choice” for evaluation of stone disease, patients have been exposed to higher doses of ionizing radiation in both primary evaluation and follow-up. There has been progressive recognition that low doses of radiation in the range of conventional CT may increase the long-term risk of cancer in exposed patients; these data have been extrapolated from longitudinal and ongoing study of atomic bomb survivors. There have been mounting efforts to develop alternative approaches to conventional CT (eg, low-dose protocols, substitution of ultrasound/plain X-ray) to provide comparable data while reducing total radiation exposure. It is essential that urologists collaborate with radiologists, emergency room physicians, and other providers to appropriately balance the theoretical risks and practical benefits of ionizing radiation in the diagnosis of stone disease.
37 citations
TL;DR: This update summarizes recent clinical developments in the field of prostate cancer immunotherapy, with a focus on dendritic cell vaccines, virus- based vaccines, DNA-based vaccines, and cell-based vaccine.
Abstract: Prostate cancer is the second most common cause of cancer-related death in US men. Along with initial therapy using surgery, radiotherapy, or cryotherapy, hormonal therapy is the mainstay of treatment. For men with advanced (metastatic) disease, docetaxel-based chemotherapy is US Food and Drug Administration (FDA)-approved, and provides a significant survival advantage. This relative paucity of treatment options drives an ongoing quest for additional treatment modalities; among these is immunotherapy. The concept that prostate cancer is a malignancy that can be targeted by the immune system may seem counterintuitive; certainly kidney cancer and melanoma are more traditionally thought of as immune responsive cancers. However, prostate cancer arises in a relatively unique organ and may express a number of proteins (antigens) against which an immune response can be generated. More importantly, several of these agents have now demonstrated a significant survival benefit in randomized controlled clinical trials, and one agent in particular (Sipuleucel-T, Dendreon Corporation, Seattle, WA) could be FDA-approved in 2010. This update summarizes recent clinical developments in the field of prostate cancer immunotherapy, with a focus on dendritic cell vaccines, virus-based vaccines, DNA-based vaccines, and cell-based vaccines. In addition, the notion of agents that target immune checkpoints is introduced. Enthusiasm for prostate cancer immunotherapy is founded upon its potential to mediate targeted, specific, tumor cell destruction without significant systemic toxicity; however, this has yet to be fully realized in the clinical arena.
36 citations
TL;DR: Almost four decades ago, modern penile implants were introduced as a treatment of erectile dysfunction and infection associated with placement is a feared complication, and fortunately, has become less common due to a number of measures, including antibiotic-coated devices and chlorhexidine–alcohol skin preparation.
Abstract: Almost four decades ago, modern penile implants were introduced as a treatment of erectile dysfunction. Infection associated with placement of an implant is a feared complication, and fortunately, has become less common due to a number of measures, including antibiotic-coated devices and chlorhexidine–alcohol skin preparation. When an infection around an implant occurs, the device should be removed. An option, termed a salvage (or rescue) procedure, is cleansing the wound with a series of antiseptic solutions and replacing a new prosthesis during the same procedure, with success in the range of 85%. The alternative is to return at a later date to replace the implant. However, the latter approach is associated with a difficult insertion, a shorter erection, and a less satisfied patient. Most patients elected the salvage approach because they were highly motivated to continue sexual activity to have the implant placed initially.
36 citations
TL;DR: The concept of HRZOL is defined, what is currently known about the impact of various treatments on HRQOL is discussed, and the recent literature in this area relating to the management of localized prostate cancer is summarized.
Abstract: Many options exist for the treatment of localized prostate cancer. In the decision to choose a therapeutic option for localized disease, many variables need to be considered such as tumor characteristics, clinical stage, the patient’s overall health and life expectancy, and preferences of both the physician and patient. Another important consideration is the health-related quality of life (HRQOL) implications of a given treatment option. The importance of HRQOL relative to the potential side effects of prostate cancer treatments has grown over the past few years. Although our collective awareness has increased, objective data on HRQOL for prostate cancer treatment are lacking due to a paucity of prospective clinical trial data. This review defines the concept of HRQOL, discusses what is currently known about the impact of various treatments on HRQOL, and summarizes the recent literature in this area relating to the management of localized prostate cancer.
36 citations
TL;DR: The role of sacral neuromodulation will continue to expand as physicians and patients become increasingly aware of its therapeutic potential and widespread adoption of this clinically superior technique will most rapidly help the greatest number of patients.
Abstract: Sacral neuromodulation is increasingly used for the treatment of voiding dysfunction, pelvic pain syndromes, and gastrointestinal disorders. While increased use of this technology has led to a greater understanding of its potential as well as its limitations, difficulty persists in identifying the patients that will benefit most. Either of two trial stimulation techniques is performed before placement of a permanent neuromodulator: the monopolar percutaneous nerve evaluation and the tined quadripolar staged trial. The preponderance of recent literature asserts the superior sensitivity of the staged trial over percutaneous nerve evaluation. However, the techniques offer disparate advantages, and other issues, such as cost-effectiveness, remain largely unexplored. The role of sacral neuromodulation will continue to expand as physicians and patients become increasingly aware of its therapeutic potential. Widespread adoption of this clinically superior technique will most rapidly help the greatest number of patients.
TL;DR: The current state of telementoring and telerobotic surgery in urology is discussed and the pros and cons of this technology at the present time are examined.
Abstract: For more than 150 years, doctors have had the ability to transmit medical information to advise and assist their colleagues in remote locations via teleconsultation using a variety of communication modalities. In surgery this has evolved into the telementoring of minimally invasive procedures, particularly, robotic surgery, which have become relatively commonplace in urology. The ultimate progression to true telerobotic surgery, in which remote surgeons independently perform complex and fundamental parts of procedures at long range, is starting to occur. This article discusses the current state of telementoring and telerobotics in urology and examines the pros and cons of this technology at the present time.
TL;DR: The proposed paradigm outlines the approach to compensate for the cost involved in robotic training establishment without compromising the quality of education provided and contemplates that robotic-assisted surgery may become an integral component of residency training programs in the future.
Abstract: The advent of laparoscopic and robotic techniques for management of urologic malignancies marked the beginning of an ever-expanding array of minimally invasive options available to cancer patients. With the popularity of these treatment modalities, there is a growing need for trained surgical oncologists who not only have a deep understanding of the disease process and adept surgical skills, but also show technical mastery in operating the equipment used to perform these techniques. Establishing a robotic prostatectomy program is a tremendous undertaking for any institution, as it involves a huge cost, especially in the purchasing and maintenance of the robot. Residency programs often face many challenges when trying to establish a balance between costs associated with robotic surgery and training of the urology residents, while maintaining an acceptable operative time. Herein we describe residency training program paradigms for teaching robotic surgical skills to urology residents. Our proposed paradigm outlines the approach to compensate for the cost involved in robotic training establishment without compromising the quality of education provided. With the potential advantages for both patients and surgeons, we contemplate that robotic-assisted surgery may become an integral component of residency training programs in the future.
TL;DR: The following minimally invasive therapeutic modalities are reviewed: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation.
Abstract: Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial cystitis/painful bladder syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis or treatment of CPPS. The diagnosis is often challenging and is determined by elimination. Multiple treatment modalities exist, ranging from physical therapy to surgery. We discuss minimally invasive therapies for treatment of this complex of symptoms. Although data suggest reasonable efficacy of several medications, multimodal therapy remains the mainstay of treatment. We review the following minimally invasive therapeutic modalities: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation. We report data supporting their use and efficacy and highlight the limitations of each.
TL;DR: Midurethral sling surgery has become the new gold standard for the management of stress urinary incontinence and when standard conservative therapy for OAB fails, sling incision, sacral neuromodulation, and botulinum toxin may be useful adjuncts.
Abstract: Midurethral sling surgery has become the new gold standard for the management of stress urinary incontinence. A significant number of patients will have preoperative symptoms of overactive bladder (OAB), including urgency, frequency, nocturia, and/or urgency urinary incontinence; however, 5% to 25% of women will report persistent, worsening, or de novo OAB after sling surgery. Some cases of OAB after sling surgery are known complications that should be recognized promptly and corrected, including urinary tract infection, urinary tract foreign body, and bladder outlet obstruction. For the remainder, the diagnosis and management of idiopathic postoperative OAB can be complicated. Preoperative clinical and urodynamic factors, as well as the choice of sling, may be helpful in predicting these patients and counseling them appropriately. When standard conservative therapy for OAB fails, sling incision, sacral neuromodulation, and botulinum toxin may be useful adjuncts.
TL;DR: Biofeedback has been shown to be very effective in children to correct incontinence secondary to dysfunctional voiding, as well as in treating giggle incontinent and to help resolve vesicoureteral reflux.
Abstract: Significant progress has been made over the past 15 years regarding the development of bladder control and the evaluation and management of pediatric voiding dysfunction. Incontinence is a problem of significant social consequence that is commonly due to dysfunctional voiding (ie, discoordination between the detrusor and the external sphincter). Biofeedback was introduced in 1979 but was relatively forgotten until the late 1990 s. Nonanimated biofeedback relates sphincter activity to electromyographic activity as reflected as tracing on a computer screen or auditory feedback. This successful modality was exclusively available until recently when animated biofeedback became available, allowing for a more rapid grasp of the physiologic event to be modulated. Biofeedback has been shown to be very effective in children to correct incontinence secondary to dysfunctional voiding, as well as in treating giggle incontinence and to help resolve vesicoureteral reflux.
TL;DR: A magnetic anchoring and guidance system uses instruments that can be inserted through a laparoscopic port site into the abdomen and then controlled through coupling with an externally held magnet, allowing positioning of intra-abdominal instruments that do not require a separate transabdominals trocar.
Abstract: A magnetic anchoring and guidance system uses instruments that can be inserted through a laparoscopic port site into the abdomen and then controlled through coupling with an externally held magnet. Use of these tools can improve the ergonomics of laparoscopic surgery, allowing positioning of intra-abdominal instruments that do not require a separate transabdominal trocar. Further developments of this technology have occurred in multiple surgical fields, broadening their utility and improving the instrumentation.
TL;DR: A review looks at the various modalities that are available to reduce bleeding and reviews some advances in the area of hemostatic maneuvers during laparoscopic partial nephrectomies.
Abstract: The techniques for management of small renal masses (SRMs) have evolved over the past several years. Radical nephrectomy can lead to an increased risk of chronic kidney disease, and the emphasis is now shifting to nephron-conserving techniques. Partial nephrectomy is now considered a standard of care for the management of SRMs, and laparoscopic techniques are becoming popular because they are minimally invasive. The kidneys are extremely vascular organs, and renal hemorrhage is a major cause of morbidity after laparoscopic partial nephrectomies. Control of bleeding and management of calyceal injuries can be difficult and make the procedure technically challenging. This review looks at the various modalities that are available to reduce bleeding and reviews some advances in the area of hemostatic maneuvers during laparoscopic partial nephrectomies.
TL;DR: This review evaluates the current literature on robotic adrenalectomy, its indications, as well as its advantages and limitations compared with other forms of surgical management of adrenal pathology.
Abstract: Robotic surgery is being performed more frequently for a variety of urologic procedures. Since the first robotic adrenalectomy less than a decade ago, this modality has gained increased acceptance in the urologic community and has been employed with increased frequency in minimally invasive centers. This review evaluates the current literature on robotic adrenalectomy, its indications, as well as its advantages and limitations compared with other forms of surgical management of adrenal pathology.
TL;DR: Physicians who counsel patients and families about sports participation need to consider many factors: the type of sport, the level of play, the local sports culture, and the relative degree of risk.
Abstract: Sports participation is an important part of the lives of many children and adolescents. The risk of sustaining a genitourinary injury during sports is low. The published literature suggests that the specific risk to those patients with only one healthy kidney, ovary, or testicle is very low but not zero. Physicians who counsel patients and families about sports participation need to consider many factors: the type of sport, the level of play, the local sports culture, and the relative degree of risk. The published data suggest that major injuries to an ovary during sports are exceedingly rare. Major injuries to a testicle are also unusual. Significant kidney injuries, while uncommon, do occur and not necessarily only in the well-known collision sports.
TL;DR: A clinical phenotyping system called UPOINT is proposed to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy and how clinical Phenotyping with UPOint may improve therapy outcomes is described.
Abstract: National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes.
TL;DR: A cautious approach to candidate selection and generation of solid scientific data that would result in wide consensus on patient selection strategies and follow-up schemes would provide the tools necessary to take the path of focal therapy.
Abstract: Focal therapy for prostate cancer has emerged an interesting concept as a less morbid option for the treatment of localized low-risk disease. Despite the growing interest in focal therapy, this approach has not yet gained sufficient popularity nor provided enough data to be discussed outside the experimental application. Herein we summarize the available data on focal cryotherapy and focus on the targets to be achieved in order to increase the applicability of focal cryotherapy to clinical practice. A cautious approach to candidate selection and generation of solid scientific data that would result in wide consensus on patient selection strategies and follow-up schemes would provide the tools necessary to take the path of focal therapy. Currently available focal cryotherapy data demonstrate excellent short-term results and a favorable quality-of-life profile. Although the future role of focal treatment is debated, a growing amount of science is generated in support of this minimally invasive approach.
TL;DR: The current state of ureteral stent technology developed to address the problem of stent discomfort and infection is reviewed.
Abstract: The placement of a ureteral stent is one of the most commonly performed urologic procedures. Indwelling ureteral stents are often accompanied by significant patient morbidity, including lower urinary tract symptoms, flank pain, and urinary tract infections. This article reviews the current state of ureteral stent technology developed to address the problem of stent discomfort and infection.
TL;DR: Successful treatment of both stress urinary incontinence and urge urinaryincontinence have been shown to improve overall female sexual function scores.
Abstract: Urinary incontinence is a prevalent disorder that negatively impacts not only women’s overall quality of life but also female sexual function. Most of the literature suggests that women with urge urinary incontinence are more likely to report sexual complaints and dissatisfaction than women with stress urinary incontinence. Successful treatment of both stress urinary incontinence and urge urinary incontinence have been shown to improve overall female sexual function scores.
TL;DR: The combination of 5-α-reductase inhibitors with antimuscarinic agents or surgery are other effective treatments for men with BPH and OAB.
Abstract: Lower urinary tract symptoms (LUTS), overactive bladder, (OAB), and benign prostatic hyperplasia (BPH) are very commonly experienced in men. The mainstay of pharmacotherapy for OAB is the antimuscarinic class of drugs. There has been reluctance to prescribe these agents to men with BPH due to the risk of precipitating urinary retention. Several trials have supported the efficacy and safety of antimuscarinics in treating men with LUTS, alone, or in combination with α-blocker therapy. The combination of 5-α-reductase inhibitors with antimuscarinic agents or surgery are other effective treatments for men with BPH and OAB.
TL;DR: The risk of developing long-term complications after a UTI is extremely low, and the evidence suggests selective imaging to a select group of children at risk, as well as more selective approach based on evidence.
Abstract: Urinary tract infections (UTIs) are common in children, but the routine work-up and treatment recommendations are still controversial. Long-term complications, including renal scarring, hypertension, and renal failure, have been the main concern and the reason for use of antibiotic prophylaxis and invasive imaging techniques. In the past several years, numerous studies have been published comparing different imaging protocols and questioning the use of antibiotic prophylaxis. The latest guidelines from the United Kingdom, published in 2007, recommend more selective approach based on evidence. In this review, we critically appraise the literature published in the past 5 years. The risk of developing long-term complications after a UTI is extremely low, and the evidence suggests selective imaging to a select group of children at risk. Finding those at risk for long-term complications is yet to be determined.
TL;DR: This review focuses on emerging therapies for the treatment of castrate-resistant prostate cancer, with an emphasis on the importance of the drug targets as well as the state of current clinical trials, including those utilizing hormonal therapies, biological agents, and immunotherapy that are underway or have recently been completed.
Abstract: Prostate cancer is the most common cancer in men in the United States, and despite screening and early treatment, more than 27,000 men are predicted to die of the disease this year, almost all of whom will die of castrate-resistant, metastatic cancers that have progressed despite androgen deprivation therapy, also known as hormonal therapy. In recent years, an increased understanding of molecular mechanisms of prostate cancer progression and castration resistance has led to improved treatment strategies. This review focuses on emerging therapies for the treatment of castrate-resistant prostate cancer, with an emphasis on the importance of the drug targets as well as the state of current clinical trials, including those utilizing hormonal therapies, biological agents, and immunotherapy that are underway or have recently been completed.
TL;DR: This review article will explore recent literature exploring possible preoperative predictors of persistent overactive bladder and urgency urinary incontinence after sling surgery in women with MUI.
Abstract: Persistent overactive bladder and urgency urinary incontinence after sling surgery (pubovaginal sling or midurethral sling) in women with mixed urinary incontinence (MUI) is devastating to patients and frustrating to surgeons who perform anti-incontinence surgery. To better predict the outcomes of sling surgery in women with MUI, preoperative parameters need to be examined to accurately predict postsurgical outcomes. In this review article, we will explore recent literature exploring possible preoperative predictors of persistent overactive bladder and urgency urinary incontinence after sling surgery in women with MUI.
TL;DR: Percutaneous cryoablation (PCA) and percutaneous RFA are among the newest approaches to minimally invasive renal surgery offering excellent patient recovery, lower rates of procedure-related complications, and promising oncologic outcomes.
Abstract: The recent increase in detection of small (≤4 cm) renal cortical neoplasms has engendered changes in the management of these incidental renal tumors. There is increased interest in new forms of minimally invasive therapies, including focal renal mass ablation with cryotherapy and radiofrequency ablation (RFA). Percutaneous cryoablation (PCA) and percutaneous RFA are among the newest approaches to minimally invasive renal surgery offering excellent patient recovery, lower rates of procedure-related complications, and promising oncologic outcomes. Ablative techniques were once considered a treatment option only in highly selected cases. However, with excellent efficacy of ablative technologies having been demonstrated with intermediate-term follow-up, renal ablation has expanded to a larger patient population. Percutaneous renal ablative procedures are optimized when performed in a combined fashion, with urologists and interventional radiologists collaborating to optimize the chance of success of the ablation. This article reviews the recent advances in PCA and percutaneous RFA and offers suggestions for patient selection in contemporary urologic practice.
TL;DR: Overactive bladder (OAB) is a highly prevalent syndrome defined as “urinary urgency, usually accompanied by frequency and nocturia with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.
Abstract: Overactive bladder (OAB) is a highly prevalent syndrome defined as “urinary urgency, usually accompanied by frequency and nocturia with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.” It is known to generate a large degree of bother and can lead to significant morbidity. Augmentation cystoplasty (AC) historically has been reserved for patients refractory to conservative management. Over time, the treatment options for OAB have grown. We now have multiple pharmacological agents approved by the US Food and Drug Administration to treat OAB. In addition, neuromodulation and botulinum toxin now are viable options for patients who have suboptimal outcomes after treatment with anticholinergics and/or pelvic floor behavioral therapy. This may suggest that AC no longer is utilized as a mainstay therapy for OAB. However, despite these many possible treatment options, AC remains an important, time-tested tool in the armamentarium of the urologist to combat the patient with refractory OAB.