Profile of enfortumab vedotin in the treatment of urothelial carcinoma: The evidence to date

Nowadays the therapeutic landscape for advanced and metastatic urothelial carcinoma continues to evolve. The recent regulatory approval of enfortumab vedotin (EV) for the treatment of advanced urothelial cancer confirms the evolving role of antibody-drug conjugates. EV demonstrates a favorable profile in heavily pretreated patients with locally advanced or metastatic urothelial carcinoma. Early survival reports demonstrate a significant antitumor effectiveness along with a rather acceptable safety profile in a difficult-to-treat population. © 2021 Moussa et al

Erectile dysfunction post radical cystectomy. The role of early rehabilitation with pharmacotherapy in nerve sparing and non-nerve sparing group: A randomized, clinical trial

Objectives: No clinical studies testing erectile function (EF) post radical cystectomy (RC) were done. Our objective was to assess the effect of early pharmacologic therapy after RC using intracorporeal injection (ICI), phosphodiesterase inhibitor (PDE5i) and PDE5i+ICI. Materials and Methods: In our randomized, double-blinded study, we prospectively enrolled 160 potent male patients with invasive bladder cancer. Patients were operated by RC using the nerve-sparing (NS) or non-nerve sparing (NNS) technique. They were treated since 1 month postoperatively by different regimens (PDE5i vs. ICI vs. ICI+PDE5i). Patients were evaluated using the international index of erectile function questionnaire and were followed up regularly at 1, 3, 6, and 12 months using the same parameters. Results: One month after therapy, the mean of EF domain improved in both NS and NNS group. In the NNS group, in patients treated with ICI alone and ICI+PDE5i, the EF domain at 12 months moved to the moderate and to the mild category respectively. In patients treated by the NS approach, the mean value remained in the mild category with or without therapy. Conclusions: Early pharmacotherapy since one-month post RC using ICI and a combination of ICI+PDE5i can improve the erectile function of patients operated with a NNS approach. © 2021 Edizioni Scripta Manent s.n.c.. All rights reserved

Current and emerging gonadotropin-releasing hormone (GnRH) antagonists for the treatment of prostate cancer

Introduction:Androgen deprivation therapy (ADT) is currently the backbone treatment of metastatic prostate cancer and is also used in combination with external beam radiotherapy (EBRT). Castration may be achieved either by bilateral orchiectomy or by administration of LHRH agonists or GnRH antagonists. Areas covered: In this article, the authors assess the current and emerging role of GnRH antagonists for the treatment of prostate cancer focusing on oncological results and safety (i.e. cardiovascular risk). In addition, updated data regarding the first orally administered GnRH antagonist, relugolix, is presented. Expert opinion: Studies demonstrate that GnRH antagonists are at least equal with LHRH agonists in terms of testosterone suppression and PSA progression free survival with a major advantage being rapid testosterone suppression. Thus, the optimal group of patients included symptomatic metastatic prostate cancer patients especially if cardiovascular comorbidities or LUTS are also present. Emerging data regarding benefit of the use of GnRH antagonists in patients with concomitant cardiovascular disease are of great interest. Relugolix has emerged as the first orally administered GnRH antagonist able to achieve and maintain testosterone castration levels and it is associated with a profound reduction of major cardiovascular events. © 2021 Informa UK Limited, trading as Taylor & Francis Group

Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Aims: To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs. Methods: We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients. Results: After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001–0.059; p <.001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001–0.059; p <.001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002–0.0035; p <.001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation. Conclusions: Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC. © 2021 Wiley Periodicals LL

Perspectives on urological care in spina bifida patients

Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed. © 2021 International Advancement Center for Medicine and Health Research. All rights reserved

Inguinal lymph node metastasis of bladder carcinoma after radical cystectomy: A case report and review of literature

Introduction: Lymph node metastasis in bladder cancer (BC) is common and has been associated with a very poor prognosis. Bc rarely metastasizes to inguinal lymph nodes. Presentation of case: We reported an unusual case of right inguinal lymph node metastasis of transitional cell carcinoma of the bladder. Metastasis occurred 9 months after radical cystectomy for BC. The patient refused chemotherapy and underwent only surgical excision of lymph nodes without any adjuvant therapy. During a follow-up period of 3 years, the patient still having complete remission. Discussion: Multiple studies showed an improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients with BC. Long-term survival could be achieved for some patients with limited lymph node metastasis who underwent metastasectomy. Some studies supported the benefit of surgical consolidation after a good response to systemic chemotherapy. The best management plan for clinically node-positive BC is not established yet. Conclusion: There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes. © 2020 The Author(s

Overview of Olaparib as a treatment option for metastatic castration-resistant prostate cancer

Introduction: Men with prostate cancer undergoing castration will eventually progress. In addition to androgen receptor pathway inhibitors (like abiraterone and enzalutamide) or chemotherapy (like docetaxel), exists olaparib, a relatively new drug that interferes with the base excision repair (BER) pathway mainly due to selective inhibition of Poly ADP-ribose polymerase (PARP) 1 and 2. Areas covered: Herein, the authors evaluate the basic characteristics of olaparib, including its pharmacokinetics, mechanism of action, efficacy, and safety profile. The authors also provide their expert opinion and future perspectives for the place of this drug in the current treatment armamentarium. Expert opinion: Olaparib is the first drug to prove that genetic sequencing and precise medicine is a viable and important option for prostate cancer patients. In patients with deletions in preselected genes, its efficacy renders it as a viable option for second- or third-line management of metastatic castrate resistance prostate cancer (mCRPC). This fact, along with its acceptable toxicity profile, provide physicians with a new weapon in their armamentarium against this extremely difficult to treat disease. © 2021 Informa UK Limited, trading as Taylor & Francis Group

A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer

Introduction: Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. Areas covered: In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. Expert opinion: The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life. Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease. © 2021 Informa UK Limited, trading as Taylor & Francis Group

Perspectives on urological care in multiple sclerosis patients

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Lower urinary tract dysfunction due to MS includes a dysfunction of the storage phase or dysfunction of the voiding phase or a detrusor-sphincter dyssynergia. Baseline evaluation includes a voiding chart, an ultrasound scan of the urinary tract, urine culture, and an urodynamic study. For storage symptoms, antimuscarinics are the first-line treatment, and clean intermittent catheterization (CIC) is indicated if there is concomitant incomplete bladder emptying. Intradetrusor injections with botulinum toxin A (BTX-A), are recommended for refractory cases. Urinary diversion is rarely indicated. For patients with voiding symptoms, CIC and alpha-blockers are usually offered. Sexual dysfunction in patients with MS is multifactorial. Phosphodiesterase type 5 inhibitors are first-line therapies for MS-associated erectile dysfunction in both male and female patients. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic tests, and management of MS. Lastly, the urologic outcomes and therapies are reviewed. © 2021 International Advancement Center for Medicine and Health Research. All rights reserved