Current urology reports
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Botulinum toxin-A (BTX-A) is well established in the management of various aspects of lower urinary tract dysfunction (LUTD). One formulation, OnabotulinumtoxinA has recently been licensed in many parts of the world for use in neurogenic detrusor overactivity (NDO), and in the US for idiopathic overactive bladder (OAB), in patient's refractory to antimuscarinics. This review article looks at recent clinical publications that examine the use of BTX-A for the treatment of LUTD with a focus on OAB, detrusor overactivity (DO), benign prostatic hyperplasia (BPH) and Painful bladder syndrome / interstitial cystitis (PBS / IC). ⋯ Repeated injections in DO appear efficacious. Results from BPH studies are mixed, and the largest randomised study in this setting has shown significant improvements in a number of parameters for a variety of OnabotulinumtoxinA doses, but none of the doses were statistically better than placebo. Few studies have been conducted in PBS / IC and larger scale randomised placebo controlled trials are required to validate its use in this setting.
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Current urology reports · Jun 2013
Review Comparative StudyProton beam radiation therapy for prostate cancer-is the hype (and the cost) justified?
Although in use for over 40 years, proton beam therapy for prostate cancer has only recently come under public scrutiny, due to its increased cost compared to other forms of treatment. While the last decade has seen a rapid accumulation of evidence to suggest that proton beam therapy is both safe and effective in this disease site, a rigorous comparison to other radiotherapy techniques has not yet been completed. In this review, we provide an in-depth look at the evidence both supporting and questioning proton beam therapy's future role in the treatment of prostate cancer, with emphasis on its history, physical properties, comparative clinical and cost effectiveness, advances in its delivery and future promise.
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Current urology reports · Jun 2013
ReviewPractical use of the new American Urological Association adult urodynamics guidelines.
In 2012, the American Urological Association published guidelines on adult urodynamics. On the basis of a review of the available evidence, they established guideline recommendations for urodynamics in adults with stress urinary incontinence/pelvic organ prolapse, overactive bladder/urinary urgency incontinence/mixed urinary incontinence, neurogenic bladder, and lower urinary tract symptoms. This article reviews the practical use of these guidelines in a clinical practice.
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The purpose of this review is to identify clinical risk factors for prostate cancer and to assess the utility and limitations of our current tools for prostate cancer screening. Prostate-specific antigen is the single most important factor for identifying men at increased risk of prostate cancer but is best assessed in the context of other clinical factors; increasing age, race, and family history are well-established risk factors for the diagnosis of prostate cancer. In addition to clinical risk calculators, novel tools such as multiparametric imaging, serum or urinary biomarkers, and genetic profiling show promise in improving prostate cancer diagnosis and characterization. Optimal use of existing and future tools will help alleviate the problems of overdiagnosis and overtreatment of low-risk prostate cancer without reversing the substantial mortality declines that have been achieved in the screening era.