•Journal•ISSN: 2253-2447
Research and Reports in Urology
Dove Medical Press
About: Research and Reports in Urology is an academic journal published by Dove Medical Press. The journal publishes majorly in the area(s): Medicine & Prostate cancer. It has an ISSN identifier of 2253-2447. It is also open access. Over the lifetime, 464 publications have been published receiving 3984 citations. The journal is also known as: Open access journal of urology & Journal of research and reports in urology.
Topics: Medicine, Prostate cancer, Internal medicine, Cancer, Bladder cancer
Papers
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TL;DR: The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain.
Abstract: It is nearly 40 years since Bacillus Calmette-Guerin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear.
188 citations
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TL;DR: The current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury is summarized.
Abstract: Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.
176 citations
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TL;DR: This review examines the major studies that looked at the epidemiology of OAB as it relates to both sexes and addresses the level of bother and quality of life in men and women with OAB.
Abstract: Overactive bladder (OAB) is common in both men and women. It is a symptom complex that causes significant detriment to quality of life in patients. Although the prevalence of OAB is similar in both sexes, there are sex-specific differences in individual symptoms and the impact on quality of life. The coexistence of benign prostatic hyperplasia with OAB can worsen quality of life in men. This review examines the major studies that looked at the epidemiology of OAB as it relates to both sexes. It focuses on both the overall prevalence rates and the incidence of individual symptoms. This paper also addresses the level of bother and quality of life in men and women with OAB. In addition, the relationship between OAB and benign prostatic hyperplasia is reviewed.
100 citations
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TL;DR: Convective radiofrequency thermal therapy with the Rezūm system warrants consideration as a first-line treatment for LUTS/BPH as an alternative to the use of pharmaceutical agents.
Abstract: Objective This report evaluates clinical experience with the Rezūm system after US Food and Drug Administration clearance in consecutive cases accrued by multiple community urologists for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Treatment techniques for transurethral convective radiofrequency water-vapor thermal therapy and outcomes with up to 12 months' follow-up are presented. Materials and methods A total of 131 patients with moderate-severe LUTS were included in a retrospective analysis of BPH procedures with the Rezūm system. Pre- and postprocedure assessments included International Prostate Symptom Score (IPSS), quality of life, peak urinary flow rate, voided volume, and postvoid residual urine volume. Urologists used their own discretion for patient selection, with variable prostate sizes, LUTS severity, urinary retention, or presence of an obstructing median lobe. Safety signals and surgical retreatment rates were monitored prospectively. Results Men aged 47-96 years with prostates 13-183 cm3 showed significant improvement in IPSS, quality of life, and postvoid residual volume durable through 12 months after thermal therapy. Patients with either moderate (IPSS 8-19) or severe (IPSS 20-35) symptoms achieved significantly improved scores. Postprocedure adverse events normally anticipated and related to endoscopic instrumentation were transient and mild-moderate in nature. No de novo erectile or ejaculatory dysfunction was reported. Conclusion This study corroborates prior published pilot and randomized controlled trial results indicating significant relief of urinary symptoms and reproducibility of responses to thermal therapy. Convective radiofrequency thermal therapy with the Rezūm system warrants consideration as a first-line treatment for LUTS/BPH as an alternative to the use of pharmaceutical agents.
77 citations
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TL;DR: The Rezūm System convective RF thermal therapy is a minimally invasive treatment for BPH/LUTS which has no discernable effect on sexual function and provides significant improvement of LUTS that remain durable at 2 years.
Abstract: Objective: The objective of this study was to assess the
effectiveness and safety of convective radiofrequency (RF)
water vapor thermal therapy in men with lower urinary tract
symptoms (LUTS) associated with benign prostatic hyperplasia
(BPH); a pilot study design with 2-year follow-up evaluations.
Patients and methods: Men aged >=45 years with an International
Prostate Symptom Score >=13, a maximum urinary flow rate (Qmax)
<=15 mL/s, and prostate volume 20–120 cc were enrolled in a
prospective, open-label pilot study using convective RF water
vapor energy with the Rezum System. Patients were followed up
for 2 years after transurethral thermal treatment at 3
international centers in the Dominican Republic, Czech
Republic, and Sweden. The transurethral thermal therapy
utilizes radiofrequency to generate wet thermal energy in the
form of water vapor injected through a rigid endoscope into the
lateral lobes and median lobe as needed. Urinary symptom
relief, urinary flow, quality of life (QOL) impact, sexual
function, and adverseevents (AEs) were assessed at 1 week, 1,
3, 6, 12, and 24 months. Results: LUTS, flow rate, and QOL
showed significant improvements from baseline; prostate volumes
were appreciably reduced. Sexual function was maintained and no
de novo erectile dysfunction occurred. The responses evident as
early as 1 month after treatment remained consistent and
durable over the 24 months of study. Early AEs were typically
transient and mild to moderate; most were related to endoscopic
instrumentation. No procedure related to late AEs were seen.
Conclusion: The Rezum System convective RF thermal therapy is a
minimally invasive treatment for BPH/LUTS which can be
performed in the office or as an outpatient procedure with
minimal associated perioperative AEs. It has no discernable
effect on sexual function and provides significant improvement
of LUTS that remain durable at 2 years.
62 citations