Abstract Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid ...transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability.
What's known on the subject? and What does the study add?
The interplay between urologists and oncologists in the treatment of prostate cancer has been long standing. Recent paradigm shifts in ...treatment are reviewed with an emphasis on how these treatments may eventually alter the dynamic equilibrium between urology and oncology specialists.
The treatment landscape for men with castration‐resistant prostate cancer (CRPC) is undergoing significant changes; a redefinition of the respective roles of oncologists and urologists will probably occur. In addition, the advent of the multidisciplinary team or coordinated‐care approach, which has been gathering momentum over the last decade, will become not simply a preference but a clear necessity. In the present review, we explore the current wave of new treatments and describe the possibility of more complex approaches to combined therapy. New treatment options include abiraterone acetate, cabazitaxel, MDV3100 (in development), radium‐223 (in development) and sipuleucel‐T. We also present the traditional roles of the urologist and oncologist in caring for patients with CRPC and discuss how these may change. Compounding the new potential for treatment success, as well as the complexity of therapeutic strategies, is the emergence of novel biomarkers to evaluate treatment efficacy and to assist in patient prognosis. The prospects for successful treatment of patients with CRPC have developed considerably so that these patients may soon have a reasonable expectation of therapeutic efficacy and meaningful extension of their lives.
What's known on the subject? and What does the study add?
Due to the fear of missing clinically significant cancer, it is often uncertain whether a repeat biopsy should be performed in men with ≥1 ...prior negative prostate biopsies but persistent suspicion of prostate cancer. However, the repeat biopsy may again be negative and a biopsy may be associated with anxiety, discomfort and complications (resulting in hospitalisation in 4.1% of men).
This review discusses strategies to optimise repeat biopsy procedures in order to better predict the biopsy outcome. Optimising repeat biopsy procedures include adjusting the location and number of cores and the use of MRI to detect suspicious areas. The use of diagnostic markers, e.g. (Prostate CAncer) gene 3, which is predictive of biopsy outcome, can aid in guiding repeat biopsy decisions and reduce the number of unnecessary and uncomfortable biopsies.
To review strategies to optimise repeat biopsy procedures and to better predict the biopsy outcome. As it is often uncertain whether a repeat biopsy should be performed in men with ≥1 previous negative prostate biopsies but persistent suspicion of prostate cancer. The repeat biopsy may also be negative and a biopsy may be associated with anxiety, discomfort and occasionally (severe) complications. A search in PubMed was performed to find English language original and review articles related to repeat prostate biopsies. Strategies to optimise repeat biopsy procedures include applying the appropriate indications and adjusting the location and number of biopsy cores. The PROGENSA™ Prostate CAncer gene 3 (PCA3) Assay is a highly prostate cancer‐specific test. A higher PCA3 Score corresponds with an increased probability of a positive repeat biopsy and including the PCA3 Score in multivariate models significantly increased their predictive accuracy for predicting repeat biopsy outcome. The PCA3 Score seems also to be predictive of future biopsy outcome. In clinical practice it is often uncertain whether a prostate biopsy should be repeated or not. Optimising repeat biopsy procedures and the use of diagnostic markers, such as PCA3, can increase the probability of a positive repeat biopsy and reduce the number of unnecessary and uncomfortable biopsies
Study Type – Therapy (symptom prevalence)
Level of Evidence 2a
What's known on the subject? and What does the study add?
Largest survey ever conducted evaluating the management of AUR in real life ...practice in a wide range of health care systems. It shows that urethral catheterization followed by a TWOC has become a standard worldwide and that α1‐blockade prior to TWOC doubles the chances of success. It also evidences important differences (hospitalization rate, duration of catheterization ...) between countries/regions reflecting lack of guidelines. This large survey also clearly identifies predictors of TWOC failure.
OBJECTIVES
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To evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real‐life practice.
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To identify predictors of successful trial without catheter (TWOC).
MATERIALS AND METHODS
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In all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross‐sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.
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Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α1‐blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.
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Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.
RESULTS
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Of the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco‐regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).
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Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.
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Most men (86%) received an α1‐blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α1‐blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).
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Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.
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In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.
CONCLUSIONS
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TWOC has become a standard practice worldwide for men with BPH and AUR.
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In most cases, an α1‐blocker is prescribed before TWOC and significantly increases the chance of success.
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Prolonged catheterization is associated with an increased morbidity.
This book examines the impact since 1600 of out migration from Scotland on the homeland, the migrants, and the destinations in which they settled. It does so through a focus on the under-researched ...themes of slavery, cross-cultural encounters, economics, war, tourism, and the modern diaspora since 1945.
Lysosomal membrane permeabilization (LMP) and cathepsin release typifies lysosome-dependent cell death (LDCD). However, LMP occurs in most regulated cell death programs suggesting LDCD is not an ...independent cell death pathway, but is conscripted to facilitate the final cellular demise by other cell death routines. Previously, we demonstrated that Caenorhabditis elegans (C. elegans) null for a cysteine protease inhibitor, srp-6, undergo a specific LDCD pathway characterized by LMP and cathepsin-dependent cytoplasmic proteolysis. We designated this cell death routine, lysoptosis, to distinguish it from other pathways employing LMP. In this study, mouse and human epithelial cells lacking srp-6 homologues, mSerpinb3a and SERPINB3, respectively, demonstrated a lysoptosis phenotype distinct from other cell death pathways. Like in C. elegans, this pathway depended on LMP and released cathepsins, predominantly cathepsin L. These studies suggested that lysoptosis is an evolutionarily-conserved eukaryotic LDCD that predominates in the absence of neutralizing endogenous inhibitors.
There has been a recent increase in mumps orchitis among pubertal and postpubertal males. These outbreaks can be attributed to a reduction in the uptake of measles‐mumps‐rubella (MMR) vaccine during ...the early to mid‐1990s in children who have now matured. The mumps virus is commonly associated with extra‐salivary complications. Unvaccinated postpubertal males diagnosed with mumps virus frequently develop complications such as mumps orchitis. Therefore, it is important that urologists are familiar with the diagnosis, treatment and complications of this condition. Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility.
What’s known on the subject? and What does the study add?
Patients with BPH have traditionally been managed with ‘sequential monotherapy’ or effectively an intent to treat to failure. Thus watchful ...waiting strategies, α‐blockers, 5α‐reductase inhibitors and surgical intervention have been seen as a stepwise progression based on failure of symptom control at each level.
This paper reviews the evidence from large randomized trials which suggest a new approach of risk stratification, allowing the identification of higher risk patients for whom medical management can be optimised at an early stage. If this can be done at a primary care level, this could lead to a dramatic improvement in outcomes in men with BPH.
• Benign prostatic hyperplasia (BPH) is a common cause of bothersome lower urinary tract symptoms. In the past, the aim of drug treatment was to relieve symptoms until surgery became necessary, predominantly using an α‐blocker or a 5α‐reductase inhibitor (5ARI) as monotherapy.
• Together with improving knowledge about the pathogenesis of BPH, there is now strong evidence from large randomized trials that risk stratification and appropriate treatment with combined α‐blocker/5ARI therapy can significantly reduce the risk of disease progression and avoid long‐term complications such as acute urinary retention and surgery.
• BPH will increasingly be managed in primary care in the future and, if new management strategies based on this evidence are to be implemented cost effectively, there is a need to introduce shared care between the primary and secondary care sectors to optimise use of resources and expertise.
Prostate cancer is predominantly a disease of senior adults, i.e. those aged >70 years. With the increasing life expectancy worldwide, the burden of prostate cancer in senior adults is expected to ...increase.
The management of senior adults with localized prostate cancer is not optimal. While most senior adults have indolent disease and will not die from it, some patients with aggressive tumours will rapidly progress to an advanced stage if not adequately treated. Treatment decisions need to balance life expectancy and the benefits of therapy vs treatment‐related adverse events. Comorbidity is a crucial predictor of nonprostate cancer mortality in senior adults. Moreover, complications of curative treatments appear to be related to comorbidity to a greater degree than to chronological age. Nevertheless, there is evidence that, in everyday clinical practice, treatment decisions are strongly influenced by patient age and that a minority of senior adults with prostate cancer will benefit from curative therapy, regardless of the comorbidity. Conversely, a large proportion of senior adults will receive hormone‐deprivation therapy, although it has no curative intent and is associated with an increased risk of metabolic syndrome, cardiovascular mortality and bone fractures.
In conclusion, every effort should be made to improve the standard of care of senior adults with localized prostate cancer. There is a need for specific treatment guidelines dedicated to this population.
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