Current opinion in urology
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Ionizing radiation is produced by many of the imaging studies used in the diagnosis, management, and follow-up of patients with urolithiasis. Knowing the small, but significant, risks of solid and hematological malignancies associated with increased radiation exposure, our purpose is to discuss new imaging modalities that limit radiation exposure without compromising the valuable information needed by clinicians for appropriate management. ⋯ Urologists who use radiographic imaging in the care of their patients, must be aware of the risks of ionizing radiation. Accordingly, every effort must be made to limit radiation exposure, especially in the most susceptible populations. In our view, low-dose CT is currently the best imaging modality for patients with urolithiasis, as it offers adequate image quality with much reduced radiation exposure.
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Prostate cancer is the most common cancer diagnosed in men and remains the second most lethal malignancy. Most patients undergoing treatment elect for radical prostatectomy or radiation. As the number of patients treated has increased and survival improved, delayed complications of these modalities has assumed increased importance. Recent studies report an increased risk of certain cancers after radiation for prostate cancer. This review aims to summarize recent data. ⋯ Radiation therapy for prostate cancer is associated with an increased risk of bladder cancer. In our series, patients presented at higher stage than expected from population-based studies of bladder cancer. Patients and their physicians should be aware of such risks when choosing therapy for prostate cancer. Hematuria following radiation therapy for prostate cancer should be investigated rather than being attributed to radiation-induced cystitis.
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Urinary tract infections (UTIs) in women comprise uncomplicated and complicated UTIs. Uncomplicated UTIs, such as acute uncomplicated cystitis and pyelonephritis, are very common infections in otherwise healthy women, with a high tendency to recur. Although severe complications are rare, their high prevalence causes remarkable costs in the healthcare systems. ⋯ A remarkable increase of antibiotic resistance is also noted in uncomplicated UTI. Therefore, prudent use of antibiotic substances in uncomplicated UTI is increasingly important.
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To evaluate the current role of robotic surgery in upper urinary tract reconstruction. ⋯ Robotic techniques provide clear advantages for minimally invasive upper tract reconstruction, though the objective benefits need further delineation. These procedures are in their early experience, and larger series with prospective randomized comparison with the standard of care are warranted. Low volume of upper tract reconstruction in general will likely require multi-institutional study. Continued study of cost-effectiveness is necessary to define the optimal role for robotic reconstruction in both medical and economic terms.
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The pediatric patient with end-stage renal disease provides a great opportunity for the involvement of the pediatric urologist because of the high incidence of associated urologic anomalies. ⋯ Preoperative, intraoperative, and postoperative evaluation is critical for the child with associated urologic disease and end-stage renal disease. Early and appropriate management may stabilize renal function and prolong the time to transplant. Due to the relatively long life expectancy of children compared with adults with end-stage renal disease, appropriate management may be of benefit to avoid the morbidity associated with renal replacement therapy. In certain children, the appropriate management and reconstruction of the genitourinary tract may allow for a planned and preemptive renal transplant, thus avoiding dialysis.