Current opinion in urology
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Mesh used for slings and pelvic organ prolapse (POP) repair has resulted in increased efficacy. Yet, the benefits of a more durable repair must be weighed against such risks as vaginal mesh extrusion and erosion and increased dyspareunia, and pelvic pain. We review the current literature on complications seen with the use of vaginal mesh for both stress urinary incontinence and POP. ⋯ Better-controlled data are needed to answer questions regarding outcomes, complications, and quality of life after transvaginal mesh prolapse procedures. The surgeon and the patient must have a proper informed consent discussion about the risks, benefits, alternatives, and indications for the use of mesh.
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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.
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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.
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The recent Food and Drug Administration approval of sipuleucel-T for metastatic castration-resistant prostate cancer and of the anticytotoxic T-lymphocyte antigen 4 antibody (Ipilimumab) for metastatic melanoma has led to a renewed interest in immunotherapy for prostate and other cancers. Ipilimumab has entered phase III testing for prostate cancer, as has a viral-based anti-prostate-specific antigen vaccine (ProstVac-VF). Complementing these phase III studies are a number of innovative phase II studies, aimed at bringing immunotherapy forward in the setting of less advanced disease, as well as a number of interesting trials combining immunotherapy with conventional therapy for prostate cancer. ⋯ Immunotherapy for prostate cancer represents an attractive treatment approach, with the currently available agent sipuleucel-T providing a significant survival benefit without appreciable toxicity. Novel approaches to improve the efficacy of this and other immune-active agents are currently under evaluation.