Current opinion in urology
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The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. ⋯ Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.
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The advent of checkpoint inhibitors has fostered great expectations for long-term outcome in cancer patients. Inhibitors of programmed death -1, programmed death ligand-1 and cytotoxic T-lymphocyte associated protein 4 are targets of contemporary cancer immunotherapy. Current phase III studies are ongoing and may define a novel treatment paradigm in metastatic renal cell carcinoma (mRCC). This review focuses on current clinical data in mRCC. ⋯ Immunotherapies have fostered great expectations on long-term overall survival in mRCC. As seen with previous cytokine treatment, long-term response is a key clinical outcome. Phase III data for previously treated patients are expected later this year and may define a novel standard for treatment. Combinational therapies have generated promising response data, indicating a potential role in treatment intensification in mRCC. Combination treatment is associated with ample toxicity, which might restrict this approach to selected patients. The major task for the future is to tailor immunotherapy for individual patients.
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Although no standard management of erectile dysfunction in prostate cancer (CaP) survivors exists, many treatment options are available. This review summarizes the current understanding of the cause and management of erectile dysfunction in CaP survivors. ⋯ To optimize recovery of erectile function and prevent loss of penile length, penile rehabilitation should be initiated expeditiously after prostatectomy or radiation. In patients with refractory erectile dysfunction, dexterous and motivated patients remain excellent candidates for first and second-line medical therapies. However, early placement of a penile prosthesis following radical prostatectomy is now a proven and viable option.
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To evaluate perioperative enhanced recovery protocols for patients undergoing radical cystectomy and urinary diversion and describe our unique protocol. ⋯ Enhanced recovery after surgery protocol includes pre, intra and postoperative evidence-based modifications for improving perioperative care of cystectomy patients. Significant shortening of hospital stay without increasing early complication or readmission rate could be achieved safely in most of the patients.
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Botulinum toxin injections into the bladder have become established in the management of refractory detrusor overactivity and overactive bladder. Mechanism of action of the toxin appears to involve both efferent and afferent nerve pathways, as well as having an antinociceptive effect. Over the years, several reports of its use in refractory bladder pain syndrome and interstitial cystitis have emerged. We review the literature with a view to assessing efficacy and adverse events in this setting. ⋯ Although botulinum neurotoxin for refractory bladder pain syndrome/interstitial cystitis appears promising, larger-scale studies with adequate follow-up and in particular randomized placebo-controlled studies are required to confirm these findings.