摘要:

Purpose of reviewBladder cancer is a very frequent disease and represents the second most common genitourinary neoplasm. The most prevalent form of the disease, superficial bladder cancer, can recur in more than 70% of cases, despite correct management. Any way to improve our disease diagnostic and treatment policy is therefore welcome.Recent findingsThis review covers the following topics: (1) endoscopic tools: standard cystoscopy versus fluorescence cystoscopy and virtual endoscopy; (2) bladder cancer staging: histopathological analysis developments and imaging techniques (positron emission tomography, magnetic resonance imaging, computed tomography); (3) cytology and ancillary procedures (ImmunoCyt and fluorescence in-situ hybridization test, and others); (4) first-generation (bladder tumour antigen, nuclear matrix protein 22, telomerase repeat amplification protocol) and second-generation (loss of heterozygosity, minichromosome maintenance 5, DNA methylation, microsatellite) urine and serum markers.SummaryNew diagnostic and therapeutic (endoscopic) tools in superficial bladder cancer should eventually modify our disease management policy. Fluorescence cystoscopy detects carcinomain situwith a high accuracy, and seems to have a positive impact on reducing residual tumour and recurrence rate. A more specific staining of tissue specimens facilitates histological analysis and helps achieve better staging, especially in T1 diseases. Improving the sensitivity of cytology for low-grade diseases, ancillary procedures to classic cytology such as fluorescence in-situ hybridization and ImmunoCyt tests, may reduce the number of unpleasant cystoscopies in surveillance protocols of selected groups of patients. Second-generation urine markers such as loss of heterozygosity, microsatellite, minichromosome maintenance 5, with a high level of accuracy, show great potential for influencing bladder cancer detection and screening policy.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo analyse recent advances in intravesical instillation therapy for superficial bladder cancer.Recent findingsAlthough intravesical bacillus Calmette-Guérin has been used for many years in the treatment of superficial bladder cancer, its mechanism of action remains unclear, its poor tolerance remains a problem, the prediction of its efficacy has still to be validated, and its long-term effects on progression and survival are controversial. The exact timing and place of intravesical chemotherapy needs to be better defined, as well as the place of some new molecules. Finally, new approaches need to be explored for overcoming the limitations of the usual intravesical agents.SummaryNo dramatic advances have been made in understanding the mechanisms of action of bacillus Calmette-Guérin during the past year. However, a careful dissection of this complex immunological pathway continues and immunological criteria are promising for predicting the response to bacillus Calmette-Guérin. Evidence has been accumulating to suggest that a dose reduction during the initial treatment remains effective and reduces side-effects. In addition, bacillus Calmette-Guérin maintenance therapy is useful for high-risk patients. However, long-term tolerance remains an important issue, and the optimal protocol has not yet been defined. On the other hand, it has been proved that intravesical chemotherapy, when administered early after transurethral resection, is effective in preventing frequent recurrences, whereas maintenance chemotherapy is ineffective. Finally, new approaches, including instillations of activated immune cells or targeted gene therapy, are being explored.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewComprehensive reviews of lifestyle changes and dietary supplements that may prevent bladder cancer are needed in order to facilitate discussions between clinicians and patients.Recent findingsNovel data exist that numerous lifestyle/diet and dietary supplements may lower the risk of this disease. For example, reducing arsenic exposure, incorporating dietary changes, and vitamin E supplements continue to accumulate research that supports their use with some patients at a higher risk for this disease. Regardless, smoking cessation seems to have the largest impact on reducing risk and incorporating these other changes after smoking cessation may reduce an individual's risk to an even greater extent.SummaryHowever, a large percentage of cases of individuals diagnosed with this cancer apparently have no known etiology. Diets lower in calories or possibly specific sub-types of fat, and higher in fruits and especially vegetables, seem to provide some protection. Other dietary/supplement options may affect risk, but these benefits could be seriously attenuated by smoking. Dietary selenium, but currently not selenium supplements, may also affect risk, especially in non-smokers. Dietary vitamin E, and vitamin E supplements, may provide some protection. Non-selective (e.g. non-steroidal anti-inflammatory drugs) and selective cyclooxygenase-2 inhibitors are generating interest because bladder tumors seem to contain higher concentrations of this enzyme. Drinking-water quality, especially arsenic concentrations, may seriously affect risk. Providing recommendations for patients with regard to some of these lifestyle modifications is currently recommended because the majority of these alterations are also recommended currently for cardiovascular or general oncology disease reduction.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe purpose of this review is to provide the clinician with an adequate summary of current potential recommendations for reducing the risk of bladder cancer recurrence so that this topic can be discussed with patients that are dealing with this specific situation.Recent findingsSeveral potential novel methods to reduce the risk of recurrence should be discussed with patients. Non-selective and selective cyclo-oxygenase 2 inhibitors have preliminary data from from laboratory and epidemiologic investigations. Several preliminary trials have found that a combination dietary supplement of vitamins and minerals or a probiotic agent (Lactobacillus casei) may impact recurrence rates. Smoking cessation may be one of the best routes for reducing recurrence and reducing the risk of overall early morbidity and mortality. Garlic or fluid intake need more clinical data.SummaryClinical recommendations for reducing the risk of bladder cancer recurrence need more attention. Preliminary data seem to support a potential role of numerous lifestyle and dietary supplement regimens. In the future, more reviews on the potential impact of reducing recurrence should be separated from reviews on prevention because these can be confusing when treated as a single subject.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo highlight recent developments in the selection of patients for bladder preservation and in the optimization of outcome after radiation.Recent findingsTechniques in the delivery of radiation continue to improve. Increasing phase II evidence indicates that bladder preservation with multimodality approaches is safe and effective in selected patients. The list of molecular markers of bladder cancer with potential clinical relevance continues to extend.SummaryThree studies on target delineation, set-up errors and organ motion during radiation show that radiation techniques can be improved considerably thereby reducing the risk of geographical miss. Two large studies with long follow-ups report excellent outcome after bladder preserving treatment strategies using concurrent chemotherapy and radiation. Results seem comparable with those reported for contemporary radical cystectomy. Molecular characterization of bladder cancer is rapidly expanding, but has up to now no established role in the selection or tailoring of treatment options for individual bladder cancer patients.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewIn this review new modalities in the diagnosis, staging and treatment of superficial and invasive bladder cancer are reviewed.Recent findingsUrinary markers still cannot replace cystoscopy in diagnosing bladder cancer. However, DNA micro-array has shown promise for diagnosis. In the treatment of superficial bladder cancer, valrubicin, pirarubicin and gemcitabine are novelties. Furthermore, a combination therapy of hyperthermia and mitomycin-C as well as photodynamic therapy seem to be safe and effective new treatment modalities. For staging, computed tomography, magnetic resonance imaging and the positron emission tomography scan are limited. Nevertheless, the pT-category, pN-category and the number of lymph nodes removed affect survival significantly and are thus useful for staging and prognosis. This indicates a need for a standardized lymph node dissection in cystectomy patients.SummaryIn the treatment of invasive bladder cancer, prostate-sparing cystectomy shows promising potency and continence results. In advanced disease, gemcitabine-cisplatin is a valuable alternative to methotrexate-vinblastine-doxorubicin-cisplatin with fewer side-effects. Finally, radical radiotherapy should be considered a valid treatment in patients with invasive bladder cancer.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewFew human studies have been performed with specific genetic endpoints coupled with erectile function or dysfunction. Most knowledge of gene expression and the function thereof on penile erection has been aqcuired in experimental models. The purpose of the present review is to give an overview of the available information obtained in studies of genes or genetic products versus erectile function or dysfunction.Recent findingsThe association of, for example, systemic vascular disease with diminished erectile function has brought attention to investigations of the distribution, in men with erectile dysfunction, of some genotype variants proposed to be involved in cardiovascular disease. Altered expression or activities of some smooth muscle regulatory components of the ischaemic, diabetic, or ageing penis have been reported.SummaryAlthough penile erection can be considered a polygenic trait, some key effectors for normal erectile function within, for example, the nitric oxide/cyclic guanosine monophosphate pathway may be identified. Findings in future population-based studies may disclose the presence of a particular mutation of a gene or gene variants that may predispose to the development of erectile dysfunction. The exact molecular pathogenesis of erectile dysfunction is not known, and may vary between different forms of erectile dysfunction. With integrated approaches in genetic, molecular, and functional investigations, we can learn more of the impact of a particular genotype on erectile function, and also identify targets for preventive, pharmacological, or molecular measures.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewPhosphodiesterase 5 inhibitors are preferred by most men for the oral treatment of erectile dysfunction. In many guidelines, this therapy is recommended as first-line therapy because of convenience, high efficacy, and low rates of side-effects. Sildenafil was the first drug for the treatment of erectile dysfunction, introduced in 1998. There are now two new phosphodiesterase 5 inhibitors, vardenafil and tadalafil, for which approval was recently given in the European Union and is expected this year in the United States.Recent findingsSildenafil has proved to be a very effective medicinal product. According to initial studies, vardenafil and tadalafil have demonstrated efficacy comparable to that of sildenafil. However, fewer data are available evaluating the adverse effects of vardenafil and tadalafil, particularly on their long-term use and their use in high-risk groups. Interestingly, vardenafil and tadalafil have a higher potency than sildenafil. Moreover, the long life of tadalafil has been associated with an erectogenic potential of the drug lasting for more than 24 h. The advantage of this is the possibility of a patient engaging in sexual activity more than once after a single administration of the drug.SummaryIn the future, in addition to sildenafil, the new phosphodiesterase 5 inhibitors vardenafil and tadalafil will play an important role in the management of erectile dysfunction, depending on the patient's health profile.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis is an update of recent developments in the investigation of erectile dysfunction in the period since March 2002Recent findingsThree developments in the field of medical sexology redirected the approach towards the investigation of erectile dysfunction. First, the emergence of oral pharmacological therapy; second, the notion that sexual relationship issues have an important impact on the successful outcome of pharmacological therapy; and finally, the concept that erectile dysfunction is often a sequel or even a sentinel of cardiovascular disease. Consequently, the current evaluation of men with erectile dysfunction may be divided into two steps: a basic diagnostic evaluation for the majority of men, and specific diagnostic procedures for a small minority. The basic evaluation is aimed at the identification of the underlying pathological condition and erectile dysfunction-associated risk factors. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical and psychological conditions that manifest with erectile dysfunction. The basic evaluation consists of a comprehensive medical, sexual and psychosocial history and a physical examination. Patients who have failed first-line treatment or complicated cases qualify for specific diagnostic procedures, traditionally performed by urologists.SummaryCurrent research into the investigation of erectile dysfunction emphasizes the notion that erectile dysfunction is often a result of an interplay between medical and psychosexual conditions. Recognition of the underlying conditions and an estimation of their relative contribution to the patient's and his partner's sexual problem are key issues in the current evaluation of the man with erectile dysfunction.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review is aimed to summarize the most recent findings about this topic, by reviewing the literature published in 2002 and 2003 regarding the epidemiology, pathophysiology, diagnosis and treatment of Peyronie's disease.Recent findingsAlthough many aspects in pathophysiology, diagnosis, medical and surgical treatment of Peyronie's disease still remain under debate, recent interesting advances have been made regarding the different aspects of this condition. Topical and systemic medical therapies have been associated with varying degrees of results, depending on modalities and timing of the treatment itself. A wide range of surgical modalities have been recently developed, although the ideal surgical procedure especially in case of severe and complex curvature does not seem to be reached yet. Furthermore this condition is often associated with psychological distress that could be responsible for performance anxiety, leading to improvement of abnormalities in erectile functioning eventually associated with Peyronie's disease.SummaryPeyronie's disease consists of an acquired penile deformity caused by the formation of fibrous plaques within the tunica albuginea, leading to bio-mechanical and vascular abnormalities. In the last decade numerous advances have been made regarding pathophysiology, diagnosis and treatment of this condition, allowing for improved patient clinical prognosis. Nevertheless, although improvements in medical and surgical therapies have substantially increased the successful patients' outcome rate, Peyronie's disease is still not completely understood and its treatment remains often frustrating for the practicing urologist. Clinical presentations of this disease include penile deformities or shortening during erection, painful erection, palpable plaque or induration throughout the length of the penile shaft and erectile dysfunction.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID