Negative Biopsies with Rising Prostate-Specific Antigen. What To Do?

Introduction: Prostate-specific antigen (PSA) is the main tool of detection for prostate cancer (PCa). However, PSA has limited specificity and sensitivity in determining the presence of PCa, leading to unnecessary biopsies and the diagnosis of potentially indolent PCa. The aim of this article is to review the tools available to urologists in the clinical situation of rising PSA with prior negative biopsies. Evidence synthesis: The need for prostate biopsy is based on PSA level and/or a suspicious digital rectal examination. Ultrasound-guided biopsy is the current gold standard. The incidence of PCa detected by saturation repeat biopsy is 30–43%. Prostate health indes, prostate cancer antigen 3, and 4Kscore are available second-line tests to distinguish between malignant and benign prostate conditions, reducing the number of unnecessary biopsies. Molecular testing including ConfirmMDx (MDxHealth, Irvine, California, USA) and The Prostate Core Mitomic Test™ (PCMT) (MDNA Life Sciences, West Palm Beach, Florida, USA) are tissue tests for men with prior negative biopsy. Multiparametric magnetic resonance imaging (mpMRI) is used for lesion identification and subsequently for biopsy or treatment. In the setting of suspected PCa, the use of prostate mpMRI has shown to have a negative predictive value for clinically significant PCa of 80–96%. Conclusions: Approximately 70% of patients undergoing prostate examination will have a negative result following analysis of the biopsy sample. This negative diagnosis leads to the common clinical challenge of determining when and if a repeat biopsy should be performed. New blood, urine, tissue, and imaging tools are now available to guide this decision

Extracorporeal shockwave lithotripsy: current knowledge and future perspectives

Over the last four decades, extracorporeal shockwave lithotripsy (ESWL) has been used as an effective technique to treat kidney and ureteral stones. Nowadays, ESWL still plays a role in stone treatment and is a primary treatment option in different guidelines. New technologies are now available to endourologists, but this procedure remains valid. This narrative review will shortly illustrate the history of ESWL and its clinical applications, limits, and specific uses.</p

Complications of ureteroscopy: a complete overview

INTRODUCTION The aim of this paper was to give a complete overview of all published complications associated with ureteroscopy and their according management and prevention in current urological practice. MATERIALS AND METHODS This review was registered in PROSPERO with registration number CRD42018116273. A bibliographic search of the Medline, Scopus, Embase and Web of Science databases was performed by two authors (V.D.C. and E.X.K.). According to the Population, Intervention, Comparator, Outcome (PICO) study design approach and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards, a consensus between these authors was found relating to the thematic structure of this review. RESULTS Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death. Incidence rates on these and other complications varied extensively between the reviewed reports. CONCLUSION Ureteroscopy seems to be associated with more complications than currently reported. The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy. It may also stimulate colleagues to perform prospective studies using standardized systems for classifying complications. These are warranted to compare results among different studies, to conduct meta-analyses, to inform health care workers and to counsel patients correctly about possible risks of ureteroscopy

Undergraduate Education for Urology in Europe. Where Do We Stand?

Regardless of career intentions, junior doctors will meet patients with urological problems. There are no studies on the status of undergraduate education for urology in Europe. We designed an 18-item online survey using the platform www.surveymonkey.com to assess the current status of undergraduate education in urology. A total of 347 medical students, trainees, and urologists responded to the survey. Medical students' exposure to urology during their undergraduate career was heterogeneous. Although the quality of urology education was valued from moderate to high, urology as a speciality did not influence their future training decision making. Decision making in relation to residency training correlated with the number of hours spent on practical training, duration of urology rotation, and year of medical school in which urological exposure was introduced. The current European exposure to urology at undergraduate level is heterogeneous, with various factors influencing future decisions regarding training and specialisation. A uniform undergraduate curriculum would eliminate such heterogeneous exposure and facilitate a workforce fit for the future urological needs. PATIENT SUMMARY: Junior doctors will meet patients with urological problems in the wards, emergency departments, and primary care. Institutions should work together for a urological curriculum that fits the future clinical requirements.status: publishe