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Since 2003, duty hours for US resident physicians have been restricted to 80 h per week. For the first time, a study in a surgical population now demonstrates a reduction in mortality and morbidity associated with the working-hour reform.
In the UK, a patient's residential address can determine whether they have access to certain treatments. An audit of the effect of this 'postcode lottery' on the survival of patients with advanced renal cell carcinoma suitable for treatment with sorafenib or sunitinib highlights the iniquities that can plague such allocation systems.
The R.E.N.A.L. system for classifying tumors aims to predict the surgical challenges of partial nephrectomy. However, the factors involved in surgical planning are many and complex, and are not adequately addressed in this simplified system. The inclusion of oncological features and a 'surgical skills factor' might contribute to its widespread utility.
Data from a retrospective multicenter study have revealed that the presence of urinary collecting system invasion portends a worse outcome in patients with organ-confined disease. Evidence that cancer has spread into the collecting system, in the context of other adverse prognostic factors, should prompt clinicians to instigate closer follow-up of patients after nephrectomy.
The use of PSA testing as a screening tool for prostate cancer is limited by its low specificity. New data offer insight into how genotypic information might be incorporated into PSA screening approaches to enhance their accuracy.
Denosumab, an inhibitor of RANKL, improves bone mineral density and reduces the incidence of fractures in men who receive androgen deprivation therapy (ADT) for prostate cancer. At present, however, a lack of comparison with potent bisphosphonates limits the assessment of its utility in the prevention of ADT-induced bone loss.
There is a trend towards increasing the number of cores sampled during ultrasound-guided prostate biopsy in an attempt to increase the likelihood of detecting malignancy. Here, the authors' analysis of current data indicates that this 'saturation' approach is best used to improve histological characterization of cancer, and for monitoring of men with a rising PSA level despite previous negative biopsy.
Laparoendoscopic single-site surgery (LESS) represents an exciting development in the field of minimally invasive surgery. In this Review, authors from Greece and Germany discuss the challenges facing LESS, highlight the potential of new specialized technology in this arena, and provide an overview of contemporary clinical experience with this approach in urologic surgery.
Shock wave lithotripsy (SWL) represents the only noninvasive surgical treatment for urinary tract stones. Drawing on their considerable experience, Lingeman and colleagues outline the current utility and limitations of SWL, and highlight the technological advances that hold promise for improving the safety and efficacy of this treatment modality in the future.
Topical treatment of neuropathic bladder has been suggested as a viable alternative to oral anticholinergic therapy in children, offering greater efficacy and reduced side effects. Lazarus reviews the current status of intravesical oxybutynin use, warning that although it has proven effective in some studies, there remains a low level of evidence.
A 32-year-old man, with a left-to-right crossed fused kidney containing a 25 mm stone, underwent laparoscopic nephrolithotomy for calculus removal. The authors provide a comprehensive description of the procedure, focusing on its role in patients with renal fusion anomalies where the stone burden is too large for extracorporeal shock wave lithotripsy.
Although rare, life-threatening hemorrhage remains a challenging complication of transurethral resection of the prostate (TURP). In this Case Study, authors from Singapore present a 74-year-old man with benign prostatic hyperplasia who experienced post-TURP hemorrhage, complicated by TURP syndrome, which was ultimately successfully treated by bilateral selective arterial prostatic embolization.
