Current Urology Reports

Lower urinary tract symptoms (LUTS) in men have, until recently, been assumed to arise from bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia. Given this presumption, all manifestations (obstructive and irritative) of LUTS have been presumed to be responsive to therapy for prostatic disorders such as α-blockade (with or without the relatively recent addition of 5α-reductase inhibitors) or surgical intervention for benign prostatic hyperplasia. However, evidence demonstrates that persistence of irritative urinary symptoms is often encountered in men despite presumed adequate management of their obstructive complaints. Although antimuscarinic drugs have been found to be effective for irritative urinary symptoms attributed to the overactive bladder syndrome, concern regarding the use of this class of drugs in men with even potential coexistent BOO has limited the use of these drugs. Data are now accumulating that suggest that the antimuscarinic class may be used in men with bothersome, irritative symptoms, despite the presence of BOO (as defined by symptoms and urodynamics) and with a reasonable expectation of efficacy and little added risk. Critical evaluation of this evidence suggests that a role may exist for the antimuscarinic class in management of LUTS in men. However, areas of incomplete knowledge, including the risk associated with long-term (greater than 3 months) use of these drugs and the value of the antimuscarinic class as monotherapy in men with LUTS, still remain to be investigated.

Để cung cấp một bối cảnh kinh tế nhằm xem xét các lựa chọn điều trị cho tăng sinh tuyến tiền liệt lành tính (BPH). Để đạt được mục đích này, bài tổng quan này cung cấp một so sánh về chi phí của liệu pháp kết hợp y tế, điều trị phẫu thuật và các liệu pháp tại văn phòng cho BPH từ quan điểm của người chi trả. Phân tích chi phí Medicare từ cơ sở của các tác giả, cũng như chi phí thuốc bán lẻ tại địa phương, chứng minh rằng có sự chênh lệch lớn về chi phí của các phương pháp điều trị BPH thường được sử dụng. Trong nghiên cứu này, các can thiệp cho BPH đã đạt được sự tương đương về chi phí với liệu pháp kết hợp y tế trong khoảng thời gian từ 6 tháng đến 8 năm. Có vô số lựa chọn để quản lý những người đàn ông có triệu chứng BPH. Nên thận trọng không chỉ xem xét sở thích của bác sĩ phẫu thuật và các yếu tố cá nhân của bệnh nhân khi lựa chọn phương pháp điều trị mà còn nắm rõ tác động kinh tế mà các liệu pháp BPH khác nhau mang lại.

Endopyelotomy has benefited from abundant confirmatory investigations, and significant progress in different technical modalities has occurred. Retrograde techniques, including the Acucise (Applied Medical, Laguna Hills, CA) cutting balloon and the ureteroscopic Holmium laser incision, are becoming preferred approaches while the other modalities retain their specific indications. Long-term results and potential complications have been carefully studied and reported. Better identification of risk factors has prompted precise preoperative investigations and allowed for careful patient selection, leading to improved results. These results approach those of open pyeloplasty, but with minimal morbidity.

Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.

Urethral dilation is an effective method of treating children with neurogenic bladders who have poor bladder compliance, high leak point pressure, and are unresponsive to standard therapy with anticholinergic medications and clean intermittent catheterization. Urethral dilation can be successfully applied to boys and girls and has few side effects. There are no demonstrated long-term effects on continence. However, the use of urethral dilation has been limited by two factors: 1) general disregard given to urethral dilation when applied to children and adults with recurrent urinary tract infections and lower urinary tract symptoms, and 2) the general efficacy of conventional therapy that limits the number of children who may actually benefit from the procedure.

To evaluate the utility of cadaveric models for kidney transplant (KT) surgery training. Medline® and PubMed® databases were searched for English and Spanish language articles published describing different learning models used in KT formation. We evaluated the use of cadavers preserved by Thiel’s embalming method (TEM) as KT simulation models. Students were divided in groups of 4 people: four trainees mentored by an expert in KT surgery. Among the trainees were surgical residents and low-experience surgeons. A total of 39 TEM preserved bodies were used, of which 75 viable renal grafts were obtained. In each cadaver, two complete transplantation processes were performed, each consisting of en bloc nephrectomy with the trunk of aorta and inferior vena cava, bench surgery and perfusion with saline of the organ, and KT surgery. As with any surgical procedure, learning KT surgery is a stepwise process that requires years of dedication. The models available for the surgical simulation of KT surgery allow to practice and achieve dexterity in performing the procedure in a safe and reproducible way. Training on TEM-preserved corpses offers a highly realistic model for the surgical simulation of KT surgery.