1,721,317 research outputs found
Landmarks in prostate cancer diagnosis: the biomarkers
No full textThe main diagnostic biomarker in current use is prostate-specific antigen (PSA) and it is one of the recommended diagnostic tools from the European Association of Urology Guidelines on prostate cancer.
One of the challenges with PSA is that men with very low levels of PSA can harbour prostate cancer, making it difficult to set a lower limit.
Several modifications to PSA biomarker detection have been suggested to improve its sensitivity and selectivity including PSA density, free: total PSA, PSA velocity/doubling time and different PSA isoforms.
However, there remains a need to improve accuracy of diagnosis and this has led to research in to a number of promising new biomarkers.
These include genetic and blood or urine based biomarkers. The most advanced of these is prostate cancer gene 3 found in urine and developed into a commercial test in 2006.
Other promising markers include circulating tumour cells (CTC) in blood, which have been correlated with survival in castration-resistant prostate cancer. A system for evaluating CTC was approved by the USA Food and Drug Administration in 2008
Editorial comment on "Urinary bladder cancer treated with radical cystectomy: perioperative parameters and early complications prospectively registered in a national population-based database"
No full textEditorial comment on "urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based databas
The surgical spectacle: a survey of urologists viewing live case demonstrations
No full texthe ever increasing desire for instant access to information is a reflection of our times facilitated by social networks and by video and information technology. Nowadays, sport events are dissected and quantified from every possible perspective. We know almost real-time any detail of a soccer match: how many miles each player runs, how many good or bad passages of play, how many faults and so on, including if needed the details of heart rate and weight loss. The same and even more is available for example in formula one racing. Theoretically the same could easily be applied to surgical performance and it is foreseeable it will be applied, as a self-performance improvement method and as a development of one of the most popular ‘scientific and educational’ activities during surgical meetings, live case demonstrations (LCDs). All this, together with simulation, could in the near future have a tremendous impact on surgical performance and training. Twitter and Instagram show the power of the immediate real-time diffusion of events, as condensed as possible, so that the tweet or the instantaneous image can be visible and digested without losing time. Video clips follow the same concept and certainly BJUI is pioneering the use of short surgical video clips that are easily accessible and usable at any spare time of a busy day. The core issue about LCDs is that at present there is no solid scientific evidence of their educational value, and this is outlined in the paper by Elsamra et al. [1] published in this issue of BJUI, which commendably attempts to evaluate the educational benefit of LCDs in terms of perception, clearly not a very strong criterion
Reply to Arjen Noordzij and Gert van Dijk's letter to the editor re: Walter Artibani, Vincenzo Ficarra, Ben J. Challacombe, et al. EAU policy on live surgery events. Eur urol 2014;66:87-97
No full text[No abstract available
Cancer-related outcome and learning curve in retropubic radical prostatectomy: "if you need an operation, the most important step is to choose the right surgeon"
No full textEditorial – referring to the article published on pp. 960–966 of this issue - Cancer-Related Outcome and Learning Curve in Retropubic Radical Prostatectomy: “If You Need an Operation, the Most Important Step is to Choose the Right Surgeo
Dysfunctional voiding
No full textPurpose of review
Female dysfunctional voiding (FDV) is an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated or levator muscles during voiding in neurologically normal women. Despite its codified definition, because of variable causes, there is a lack of established diagnostic criteria and management. The aim of this study is to give a comprehensive, brief review of the most recent progress in the diagnosis and management of FDV.
Recent findings
Currently, there is the need to shed light on several issues in FDV, such as the use of standardized definitions, diagnostic criteria, and treatment modalities. The evaluation of the progress on these matters within 2013 helped to define some key advances in the field of female functional voiding dysfunction and urinary retention.
Summary
In 2013, many diagnostic and therapeutic questions in female voiding dysfunction remain unsolved. However, some data began to emerge. Patients with FDV did not demonstrate a difference in effortful control (effortful control is the ability to regulate one's responses to external stimuli), but did demonstrate a higher rate of surgency (surgency is a trait aspect of emotional reactivity in which a person tends towards high levels of positive affect). Toilet training method in childhood does not seem to have any long-term correlation with FDV. Training with pelvic floor physiotherapy and biofeedback still represents the first-line treatment for FDV. In the management of other causes of female voiding dysfunction, sacral neuromodulation demonstrated a satisfying long-term efficacy in the treatment of nonobstructive urinary retention
Pathophysiology of detrusor overactivity
No full textDetrusor overactivity is an “urodynamic observation characterised by spontaneous or provoked involuntary detrusor contractions during the filling phase”. The only clearly defined aetiological factor is “a relevant neurological condition”, leading to the definition of “neurogenic DO”. Neurological injuries or diseases may disrupt the normal voluntary control of micturition, causing the re-emergence of reflex micturition, resulting in DO. Many neurotransmitters are involved in detrusor overactivity genesis. Another recognised and debated cause of detrusor overactivity is certainly a bladder outflow obstruction. Morphologic bladder changes, including a progressive denervation may justify the occurrence of detrusor overactivity in patients with bladder outlet obstruction. Excluding relevant neurological diseases and local inflammations, infections, and tumours, and bladder outlet obstruction causes of detrusor overactivity may be congenital, behavioural/psychosomatic, aging-related, myogenic, secondary to pelvic floor disorders, and hypersensitivity disorders, and idiopathic. The three main proposed theories of detrusor overactivity are the myogenic theory, the neurogenic theory and the autonomous hypothesis. Unfortunately none is able to completely explain the mechanisms underlying non-neurogenic detrusor overactivity, opening the a wide and intriguing research field
Neurophysiology of micturition and pharmacotherapy of lower urinary tract dysfunction
No full textBoth humans and animals, growing up, learn to voluntarily control micturition, in order to void only under suitable social and hygienic conditions. The physiological succession of storage and voiding phases is assured by a baseline neurological mechanism that interacts with a complex neuro-anatomic system, through both related and associated activities pattern, modifiable from environmental, social and behavioural factors. Micturition, as a final product of this complex mechanism entails a careful neurological control involving both central and peripheral (somatic and autonomic) nervous system. Aging, pelvic floor disorders, hypersensitivity disorders, morphologic bladder changes, neurological diseases, local inflammations, infections, and tumours, and bladder outlet obstruction may alter the normal voluntary micturition control, leading to urinary incontinence. The main aim of pharmacotherapy is to restore the normal micturition control inhibiting the emerging pathological involuntary reflex mechanism
Editorial comment on: Impact of percutaneous suprapubic tube drainage on patient discomfort after radical prostatectomy.
No full textConclusion of the editorial comment: this paper allow us to consider a new opportunity to perform a catheterless RALP using a PST. This option can be performed easily and quickly and without significant long-term complications. Further studies are needed to confirm the potential advantage in terms of reducing catheter-related discomfort. In the meantime, the best clinical practice remains using a urethral catheter at the moment of vesico-urethral anastomosis, regardless of the surgical approach
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