Nocturia: A non-specific but important symptom of urological disease

Nocturia is a prevalent symptom that can adversely affect quality of sleep and overall quality of life leading to morbidity and even mortality. Nocturia can be due to a range of urological conditions and non-urological diseases. Nocturia can be due to an insufficient bladder capacity and/or (nocturnal) polyuria. Some of the possibly underlying non-urological diseases can be life-threatening, implying treatment priorities. Urological treatment options include alpha-adrenoceptor antagonists, muscarinic receptor antagonists and vasopressin receptor agonists. The former two have shown beneficial but small and inconsistent effects in patients assumed to have benign prostatic hyperplasia or overactive bladder, respectively. In contrast, the vasopressin analog desmopressin has consistently shown nocturia improvement in patients with proven polyuria. While supported by lower levels of evidence, lifestyle modifications are generally considered important for nocturia treatment. We conclude that nocturia is a urinary storage symptom with a major impact on patients' lives and a complex pathophysiolog

Biopsy of a renal mass: where are we now?

Purpose of review To review the most recent literature concerning renal mass biopsy with special consideration to three points: variation in results related to the standard used as comparison, biopsy in small renal masses (up to 4 cm in diameter) and the case for nondiagnostic biopsy. Recent findings The overall rate of failed and indeterminate biopsies shows a trend for improvement. However, selection bias and the lack of a uniform index test for comparison preclude a definitive statement. Fine-needle aspiration may equal results of core biopsy, but its role in the diagnostic algorithm is not yet defined. In-vivo accuracy decreases in small renal masses with the same limitations exposed for the overall literature on renal mass biopsy. When nondiagnostic biopsies are considered, there is a need for standardization of the nomenclature in order to compare results. Re-biopsies or surgery after a nondiagnostic biopsy shows malignancy in up to 75% of the cases of renal cell carcinoma. Summary There is a trend in increasing interest and accuracy on the subject of percutaneous biopsy of renal masses as well as a decreasing trend in the rate of nondiagnostic biopsies. In the small renal masses, most likely to be benign, a diagnostic percutaneous biopsy may have a definitive role. However, the higher rate of nondiagnostic results in this population calls for prospective studies with standard definitions and when possible homogenous index test to properly assess the diagnostic performance of the biops

Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

To compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones. Consecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided into LSDs and RSP. Differences between the groups were separately analysed for URS and PNL. Primary outcomes included intra- and post-operative complication rates and grades. Secondary outcomes were operation time, length of hospital stay, stone-free rate, and retreatment rate. Pearson's Chi-square analysis, Mann-Whitney U test, and logistic and linear regression were used to compare outcomes between LSDs and RSP. During the study period, we performed 666 URSs and 182 PNLs, and 151 of these procedures were LSDs. Among URSs, the overall intra-operative complication rate was 3.2% for LSDs and 2.5% for RSP (p = 0.72) and the overall post-operative complication rate was 13.7% for LSDs and 8.8% for RSP (p = 0.13). Among PNLs, the overall intra-operative complication rate was 8.9% for LSDs and 5.6% for RSP (p = 0.52) and the overall post-operative complication rate was 28.6% for LSDs and 34.9% for RSP (p = 0.40). For both URSs and PNLs, no statistically significant differences in complication grade scores were observed between LSDs and RSP. Operation time was significantly longer for LSD-URS group, but there was no difference between the PNL groups. There were no significant differences in length of hospital stay and stone-free rate. The retreatment rate was higher in the LSD-URS group compared with RSP-URS group but similar between the PNL groups. Multiple logistic regression analyses, adjusting for confounders, revealed no association between LSD and more or less favourable outcomes as compared to RSP. Live surgical demonstrations do not seem to compromise patients' safety and outcomes when performed by specialised endourologist

Investigational therapies targeted to the treatment of benign prostatic hyperplasia

Introduction: The desired goals of treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) include sustained, clinically significant improvement in symptoms and quality of life and/or slowing or preventing the progression of the condition. There is a continuing interest in research for new therapies for BPH due to the high prevalence of the condition and the unmet expectations of patients and physicians from the efficacy of available therapies. Areas covered: The aim of this paper is to provide the latest data on new medical treatments for LUTS/BPH, defined as pharmacological treatments not yet commonly available and/or currently under investigation. Articles were identified by means of a computerised Google and PubMed search and a search of the trial registries. Expert opinion: Many potential targets for future drugs have been evaluated but it is obvious that there is a wide variation in the degree of mature of each therapy. Time and high-quality studies will decide which of these potential drugs will fade away without fulfilling the initial promises. At the moment, phosphodiesterase type 5 inhibitors are claiming their position in the armamentarium of BPH treatment