Current opinion in urology
-
To provide an overview regarding the results of transvaginal mesh kits to determine if the known risks outweigh their benefits. ⋯ Transvaginal synthetic mesh kits have minimal to no improved clinical success over nonmesh repairs. Compounding this, mesh kits are clearly associated with multiple relatively common and unique complications without any significant proven benefit for symptomatic relief of pelvic organ prolapse and improvement of quality of life. Continued routine use will needlessly and potentially harm patients permanently without providing any significant benefit.
-
This review will focus on the strengths of transvaginal mesh-augmented repairs over traditional native tissue repairs with an emphasis on the more recent literature. ⋯ Higher complication rates involving mesh exposures have been documented in the past leading to the recent controversy; however, current mesh studies with longer term follow-up show lower and acceptable exposures with improved objective and subjective outcomes.
-
Pelvic reconstructive surgeons in the fields of urology, gynecology and urogynecology have continually adapted new techniques in pelvic organ prolapse (POP) repair in order to improve both anatomic and subjective outcomes. In the last 5 years, robotic surgery has gained a strong foothold in urologic oncology, gynecologic oncology, cardiothoracic surgery and now in female pelvic medicine. Robotic surgery has made its way into the armamentarium of POP treatment and has allowed pelvic surgeons to adapt the 'gold standard' technique of abdominal sacrocolpopexy to a minimally invasive approach with improved intraoperative morbidity and decreased convalescence. This review article aims to discuss the techniques of robotic prolapse repair as well as morbidity, cost and clinical outcomes. ⋯ Robotic-assisted pelvic floor surgery has become an important component of the pelvic surgeon's armamentarium in the treatment of symptomatic POP. Those pelvic surgeons without significant expertise in laparoscopy required for sacral dissection and intracorporeal suturing can readily learn the necessary techniques required for robotic surgery.
-
To inform readers on the ongoing activities of the Prostate cancer Research International: Active Surveillance (PRIAS) study in the light of current findings and research problems on active surveillance worldwide. ⋯ The PRIAS study is a rapidly growing registry for active surveillance of low-risk prostate cancer. The study is conducted worldwide, facilitated by an electronic Web-based decision tool with password-restricted access for physicians. Inclusion and monitoring is performed according to protocol. Over 2000 men have been included from over 100 participating centres in 17 countries in four continents. The study was initiated in December 2006. Risk reclassification on repeat biopsy during follow-up has occurred in 27% of biopsied men, although a switch towards active therapy has been performed in 22% of the total cohort.
-
Active surveillance has evolved to become a standard of care for favorable-risk prostate cancer. This article is a summary of the rationale, method, and results of active surveillance beginning in 1995 with the first prospective trial of this approach. ⋯ We observed a very low rate of prostate cancer mortality in an intermediate time frame. Among the one-third of patients who were reclassified as higher risk and retreated, PSA failure was relatively common. However, other cause mortality accounted for almost all of the deaths. Further studies are warranted to improve the identification of patients who harbor more aggressive disease in spite of favorable clinical parameters at diagnosis.