Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the Pu...Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.展开更多
Prostate cancer(PCa)is the second most common cancer in men with 17 million new cases in 2018 and 27 million new cases expected by 2040[1].Mortality is however declining which may reflect improvements in the treatment...Prostate cancer(PCa)is the second most common cancer in men with 17 million new cases in 2018 and 27 million new cases expected by 2040[1].Mortality is however declining which may reflect improvements in the treatments available[2].One such treatment is the robot-assisted laparoscopic prostatectomy(RALP)which was first performed in 2000 at the Department of Urology of Frankfurt University in Germany.Initial adoption was limited due to the lack of data supporting its safety and efficacy in terms of functional and oncological outcomes until the landmark studies published by Menon et al.[3,4].This paved the way for further studies such as the Swedish LAPRO trial.This revealed a moderate advantage for erectile dysfunction with RALP,compared to open radical retropubic prostatectomy(RRP),and no significant difference between the two in terms of cancer relapse at the 24-month follow-up[5].Consequently,the Da Vinci Robot is currently used worldwide,with an estimated 300000 urology procedures being performed in 2018[6].展开更多
Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶12...Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.展开更多
Background:Pathological involvement of the seminal vesicle poses a treatment dilemma following robotic prostatectomy.Margin status plays an important role in deciding further management.A wide range of treatment optio...Background:Pathological involvement of the seminal vesicle poses a treatment dilemma following robotic prostatectomy.Margin status plays an important role in deciding further management.A wide range of treatment options are available,including active monitoring,adjuvant radiotherapy,salvage radiotherapy,and occasionally androgen deprivation therapy.Patients undergoing postoperative radiotherapy tend to have higher risk of urinary and bowel morbidities.The recent RADICALS-RT concluded that adjuvant radiotherapy did not have any benefit compared with salvage radiotherapy.We aim to audit the incidence,margin status,and management of T3b cancer cases at our center.Materials and methods:A retrospective analysis was conducted of all patients diagnosed with pathological T3b(pT3b)prostate cancer following robotic-assisted laparoscopic prostatectomy from January 2012 to July 2020.Preoperative parameters analyzed included prostate-specific antigen(PSA),T stage,and age.A chi-square test and 2-tailed t test were used to determine the relationship between categorical and continuous variables,respectively.Kaplan-Meier survival curves were generated to assess overall survival in patients with pT3b prostate cancer and used to compare unadjusted progression-free survival among those who underwent adjuvant and salvage radiotherapy.Results:A total of 83(5%)of 1665 patients who underwent robotic prostatectomy were diagnosed with pT3b prostate cancer between January 2012 and July 2020.Among these,36 patients(44%)did not receive any radiotherapy during follow-up,compared with 26 patients(31%)who received adjuvant radiotherapy and 21(25%)who received salvage radiotherapy.The median age of our cohort was 64(SD,6.4)years.Mean PSA at presentation was 12.7 pg/L.Positive margins were seen in 36 patients(43%);however,there was no statistically significant difference between treatment groups(p=0.49).The median overall survival was 96%.There was no significant difference between the adjuvant and salvage groups in terms of biochemical progression-free survival(p=0.66).Five-year biochemical progression-free survival was 94%for those in the adjuvant radiotherapy group and 97%for those in the salvage radiotherapy group.Conclusions:Our audit corroborates with the recently concluded RADICALS-RT study,although we had fewer patients with positive margins.Radiotherapy can be avoided in patients with T3b prostate cancer,even if margin is positive,until there is definitive evidence of PSA recurrence.In keeping with the conclusion of RADICALS-RT,salvage radiotherapy may be preferable to adjuvant radiotherapy.展开更多
文摘Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.
文摘Prostate cancer(PCa)is the second most common cancer in men with 17 million new cases in 2018 and 27 million new cases expected by 2040[1].Mortality is however declining which may reflect improvements in the treatments available[2].One such treatment is the robot-assisted laparoscopic prostatectomy(RALP)which was first performed in 2000 at the Department of Urology of Frankfurt University in Germany.Initial adoption was limited due to the lack of data supporting its safety and efficacy in terms of functional and oncological outcomes until the landmark studies published by Menon et al.[3,4].This paved the way for further studies such as the Swedish LAPRO trial.This revealed a moderate advantage for erectile dysfunction with RALP,compared to open radical retropubic prostatectomy(RRP),and no significant difference between the two in terms of cancer relapse at the 24-month follow-up[5].Consequently,the Da Vinci Robot is currently used worldwide,with an estimated 300000 urology procedures being performed in 2018[6].
文摘Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
文摘Background:Pathological involvement of the seminal vesicle poses a treatment dilemma following robotic prostatectomy.Margin status plays an important role in deciding further management.A wide range of treatment options are available,including active monitoring,adjuvant radiotherapy,salvage radiotherapy,and occasionally androgen deprivation therapy.Patients undergoing postoperative radiotherapy tend to have higher risk of urinary and bowel morbidities.The recent RADICALS-RT concluded that adjuvant radiotherapy did not have any benefit compared with salvage radiotherapy.We aim to audit the incidence,margin status,and management of T3b cancer cases at our center.Materials and methods:A retrospective analysis was conducted of all patients diagnosed with pathological T3b(pT3b)prostate cancer following robotic-assisted laparoscopic prostatectomy from January 2012 to July 2020.Preoperative parameters analyzed included prostate-specific antigen(PSA),T stage,and age.A chi-square test and 2-tailed t test were used to determine the relationship between categorical and continuous variables,respectively.Kaplan-Meier survival curves were generated to assess overall survival in patients with pT3b prostate cancer and used to compare unadjusted progression-free survival among those who underwent adjuvant and salvage radiotherapy.Results:A total of 83(5%)of 1665 patients who underwent robotic prostatectomy were diagnosed with pT3b prostate cancer between January 2012 and July 2020.Among these,36 patients(44%)did not receive any radiotherapy during follow-up,compared with 26 patients(31%)who received adjuvant radiotherapy and 21(25%)who received salvage radiotherapy.The median age of our cohort was 64(SD,6.4)years.Mean PSA at presentation was 12.7 pg/L.Positive margins were seen in 36 patients(43%);however,there was no statistically significant difference between treatment groups(p=0.49).The median overall survival was 96%.There was no significant difference between the adjuvant and salvage groups in terms of biochemical progression-free survival(p=0.66).Five-year biochemical progression-free survival was 94%for those in the adjuvant radiotherapy group and 97%for those in the salvage radiotherapy group.Conclusions:Our audit corroborates with the recently concluded RADICALS-RT study,although we had fewer patients with positive margins.Radiotherapy can be avoided in patients with T3b prostate cancer,even if margin is positive,until there is definitive evidence of PSA recurrence.In keeping with the conclusion of RADICALS-RT,salvage radiotherapy may be preferable to adjuvant radiotherapy.
