Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu
© Borgis - Postępy Nauk Medycznych 3/2016, s. 177-181
Mikołaj Przydacz1, Łukasz Belch1, *Tomasz Gołąbek1, Sebastian Piotrowicz2, Piotr L. Chłosta1
Najnowsze osiągnięcia diagnostyczne i terapeutyczne najczęstszych chorób urologicznych
Recent advances in the diagnosis, management and treatment of the most common urological disorders
1Department of Urology, Collegium Medicum, Jagiellonian University in Kraków
Head of Department: prof. Piotr L. Chłosta, MD, PhD, FEBU, FRCS (Glasg)
2Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock
Head of Department: prof. Andrzej Borówka, MD, PhD
Streszczenie
Urologia jest dynamicznie rozwijającą się dziedziną medycyny. W ostatnich dekadach dokonano przełomowych odkryć zarówno w zakresie diagnostyki, jak i leczenia chorób układu moczowo-płciowego. Jednym z nich jest rozwój endourologii, nowo wyłonionej poddyscypliny, która nie tylko pozwala na inspekcję od wewnątrz górnego i dolnego odcinka układu moczowego, ale również jest dedykowana do leczenia nowymi sposobami chorób stercza i pęcherza moczowego. Kolejnym przykładem jest powszechna dostępność chirurgii laparoskopowej, zarówno manualnej, jak i z asystą robota. Ponadto nadal rozwijane są dotychczasowe oraz tworzone nowe metody obrazowania chorób układu moczowego, jak na przykład rezonans magnetyczny, który ewoluował od bycia standardowym badaniem anatomicznym do badania, które dostarcza informacji czynnościowych dotyczących komórek tkanek litych (obrazy ważone dyfuzyjnie), informacji na temat przepływu krwi w tkankach (obrazowanie dynamiczne z wykorzystaniem środka kontrastowego) oraz pozwala na ocenę stężenia wybranych związków w badanym narządzie (spektroskopia rezonansu magnetycznego). Z kolei najnowsze osiągnięcia w zakresie genetyki i genomiki nowotworów w sposób istotny doprowadziły do zmian w postępowaniu w przypadkach nowotworów układu moczowego. Składa się na to m.in. odkrycie nowych markerów nowotworowych ułatwiających wykrywalność, prognozowanie oraz dobór właściwego leczenia chorych.
W opracowaniu przedstwiono bieżące osiągnięcia w zakresie diagnostyki oraz leczenia nowotworów gruczołu krokowego, pęcherza i nerek, łagodnego rozrostu stercza oraz kamicy dróg moczowych.
Summary
The field of urology continues to evolve. There have been several major breakthroughs in the diagnosis and management of many urological diseases over last few decades. Just to mention the development of endourology, a subspecialty which not only does encompass visualisation of the upper and lower urinary tract but also modern management of diseases of the prostate. Other examples include ever growing field of laparoscopy or robotic urology itself to mention but the few.
Moreover, there has been a significant progress with regards to improvement of existing and development of new imaging modalities including magnetic resonance imaging which has advanced from being a standard anatomical imaging modality to one providing vital functional information about the cellularity of solid tissues (diffusion weighted imaging), perfusion parameters in neoplasms (dynamic contrast imaging), and relative concentration of intracellular metabolites (spectroscopy). Furthermore, recent advances in cancer genetics and genomics have changed our management paradigms in major urologic malignancies and have led to the development of new markers for detection, prognostication, and tailoring the most effective therapy in patients with cancers of the urinary tract.
This review discusses the recent advances in diagnosis and management of prostate, bladder, and renal cancers, as well as benign prostatic hyperplasia and urolithiasis.



Introduction
The specialty of urology is under incessant change. Much of which has resulted from improved technology and advanced equipment. Newer techniques for better diagnosis and treatment of common urological diseases have enhanced early detection rates of urological cancers, reduced the operative trauma and optimized functional outcomes. Continuous improvements in management of malignancies, erectile dysfunction, benign prostatic hyperplasia (BPH), and renal stones have led to better quality of patients’ life.
Several various alternatives have been recently investigated either to improve the diagnosis or to enhance the sensitivity of common diagnostic tools and techniques used in detection or treatment of the most popular urological diseases such as cancers, BPH and renal stones. In this review, we have looked at the latest developments within the diagnosis and management of several most common urological conditions.
Detection and monitoring of urological cancers
Renal cell carcinoma
Renal cell carcinoma (RCC) is one of the most common cancers dealt with by urologists. This malignancy is characterized by a lack of early warning signs, diverse clinical manifestations, and resistance to radiation and chemotherapy (1). As with many other forms of cancer, patient outcome depends on the cancer stage and grade at diagnosis, its histological subtype, comorbidities and patient age. The 5-year overall survival for all types of RCC is 49%, whereas the 5-year survival rate after radical nephrectomy for stage I renal cell carcinoma, is approximately 94%, and for patients with stage IV disease is not higher than 20% (2, 3).
It is therefore of utmost importance to further improve renal cell cancer detection rates at an earlier stage of the disease.
In recent years there has been an increased interest in the prognostic role of the tumor markers, which most likely will better predict the clinical disease prognosis in future. The roles of neutrophil gelatinase-associated lipocalin, C-reactive proteins, plasmatic kisspeptin, beta-2-glickoprotein-1, alph-1-antitripsin and butyrylcholinesterase have been expanding (4-6). Additionally, latest data has suggested that nutritional screening is strongly associated with overall survival in patients treated with targeted agents for advanced renal cell carcinoma (7). Few recent studies have also shown that the metabolic profiles of glycolysis and pentose phosphate pathway in renal cell carcinoma, as well as, the pretreatment measurements of systemic inflammatory response, remain very important in overall patient’s prognosis (8). More and more is known with regard to some genetic disorders, as well as other predisposing factors to renal cancer. The recent data has emphasized the role of piwi-interacting RNAs, FABP7 protein, MIR-141 expression, and, in particular, the specific miRNA role in clear cell renal carcinoma treatment. These all are being used in critical suppression of renal cell carcinoma proliferation and metastasis (9-11).
Our knowledge of predicting RCC outcomes is still under development, especially in terms of tumor size, grading, staging, lymph node involvement, and BMI in both cancer-specific and overall survival but it will inevitably grew with further advancements in analysis of cancer specific biomolecules and markers.
The role of imaging in the management of renal tumors has progressed in the past few years. The latest studies have shown that perinephric fat surface density (PnFSD) can significantly predict surgical complexity and perioperative outcomes of kidney surgery, especially robot-assisted partial nephrectomy (12). Moreover, new anatomical scoring systems for assessing technical complexity of kidney surgery have been introduced. Multiphasic computed tomography (CT), as well as the CT guided renal biopsies have become more useful than ever before in terms of diagnosis and management of small renal masses (13, 14). Targeted dual-modality imaging of renal cell carcinoma is still under investigation but preliminary results seem quite promising.
Prostate cancer
Role of MRI in prostate cancer detection
Prostate cancer (PCa) is the most common noncutaneous cancer among males (15, 16). Although prostate cancer can be slow growing, the disease accounts for approximately 10% of cancer-related deaths in men (17). The diagnostic gold standard in prostate cancer (PCa) detection is based on abnormal digital rectal examination, an elevated serum PSA, and confirmatory transrectal ultrasound guided biopsy.
In recent years, multiparametric MRI (mpMRI) has emerged as an appealing tool facilitating significant prostate cancers pick-up rate (18). New data has suggested superiority of MRI-guided biopsy over non-targeted TRUS biopsy in detection of clinically significant disease (19). The addition of mpMRI to biopsy seems to have made an important step forward towards developing an ideal diagnostic test, with greater detection of more clinically significant lesions.
Treatment of urological cancers
Expanding role of robotic surgery
Robot-assisted surgery is a technical solution using robotic systems in surgical procedures. It was developed to overcome limitations of minimally invasive procedures and to expand the capabilities of surgeons (20). This technique allows surgeons to enhance precision, flexibility and control, which are not otherwise possible with conventional techniques. It is safe, reproducible and offers several advantages to patients. With this method minimally invasive surgery is limitless. The benefits include: faster patient recovery, shorter hospital stay, less pain and blood loss, smaller risk of complications including infections, less noticeable scars. With robotic procedure surgeons can perform complex operations that would have been otherwise difficult or impossible with conventional techniques. One of the major advances offered by robot-assisted surgery are remote control and unmanned procedures.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

24

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

59

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Novara G, Ficarra V, Antonelli A et al.: Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol 2010; 58(4): 588-595.
2. Gołąbek T, Sobczyński R, Chłosta P: Rak nerki z czopem nowotworowym wrastającym do układu żylnego. Akademia Medycyny, Warszawa 2015.
3. Fay AP, Xie WL, Lee JL et al.: Characteristics of long-term and short-term survivors of metastatic renal cell carcinoma treated with targeted therapies: results from the International mRCC Database Consortium. Clin Genitourin Cancer 2015; 13(2): 150-155.
4. Delfino Duarte PA, Fumagalli AC, Wandeur V, Becker D: Urinary neutrophil gelatinase-associated lipocalin in critically ill surgical cancer patients. Indian J Crit Care Med 2015; 19(5): 251-256.
5. Hsiao W, Herrel LA, Yu C et al.: Nomograms incorporating serum C-reactive protein effectively predict mortality before and after surgical treatment of renal cell carcinoma. Int J Urol 2015; 22(3): 264-270.
6. Koie T, Ohyama C, Mikami J et al.: Preoperative butyrylcholinesterase level as an independent predictor of overall survival in clear cell renal cell carcinoma patients treated with nephrectomy. Scientific World Journal 2014; 2014: 948305.
7. Gołąbek T, Powroźnik J, Chłosta P et al.: The impact of nutrition in urogenital cancers. Arch Med Sci 2015; 11(2): 411-418.
8. Lucarelli G, Galleggiante V, Rutigliano M et al.: Metabolomic profile of glycolysis and the pentose phosphate pathway identifies the central role of glucose-6-phosphate dehydrogenase in clear cell-renal cell carcinoma. Oncotarget 2015; 6(15): 13371-13386.
9. Li Y, Wu X, Gao H et al.: PIWI-interacting RNAs are dysregulated in renal cell carcinoma and associated with tumor metastasis and cancer specific survival. Mol Med 2015; doi: 10.2119/molmed.2014.00203.
10. Zhou J, Deng Z, Chen Y et al.: Overexpression of FABP7 promotes cell growth and predicts poor prognosis of clear cell renal cell carcinoma. Urol Oncol 2015; 33(3): 113.e9-17.
11. Tang K, Xu H: Prognostic value of meta-signature miRNAs in renal cell carcinoma: an integrated miRNA expression profiling analysis. Sci Rep 2015; 5: 10272.
12. Zheng Y, Espiritu P, Hakky T et al.: Predicting ease of perinephric fat dissection at time of open partial nephrectomy using preoperative fat density characteristics. BJU Int 2014; 114(6): 872-880.
13. Mazzei FG, Mazzei MA, Cioffi Squitieri N et al.: CT perfusion in the characterisation of renal lesions: an added value to multiphasic CT. Biomed Res Int 2014; 2014: 135013.
14. Davis IC, Heilbrun ME, Tangtiang K et al.: Computed tomography-guided renal tumor biopsies: tumor imaging features affecting sample adequacy. J Comput Assist Tomogr 2013; 37(2): 171-175.
15. Arnold M, Karim-Kos HE, Coebergh JW et al.: Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory. Eur J Cancer 2013 Oct 8. pii: S0959-8049(13)00842-3.
16. Gołąbek T, Bukowczan J, Chłosta P et al.: Obesity and prostate cancer incidence and mortality: a systematic review of prospective cohort studies. Urol Int 2014; 92(1): 7-14.
17. De Angelis R, Sant M, Coleman MP et al; EUROCARE-5 Working Group: Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5 – a population-based study. Lancet Oncol 2014; 15(1): 23-34.
18. Turkbey B, Mani H, Shah V et al.: Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol 2011; 186(5): 1818-1824.
19. Mendhiratta N, Rosenkrantz AB, Meng X et al.: MRI-Ultrasound Fusion-Targeted Prostate Biopsy in a Consecutive Cohort of Men with No Previous Biopsy: Reduction of Over-Detection through Improved Risk Stratification. J Urol 2015 Jun 19. pii: S0022-5347(15)04213-5.
20. Yates DR, Vaessen C, Roupret M: From Leonardo to da Vinci: the history of robot-assisted surgery in urology. BJU Int 2011; 108(11): 1708-1713.
21. Autorino R, Zargar H, Kaouk JH: Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil Steril 2014; 102(4): 939-949.
22. Traumann M, Kluth LA, Schmid M et al.: Robot-assisted laparoscopic pyeloplasty in adults: Excellent long-term results of primary pyeloplasty. Urologe A 2015; 54(5): 703-708.
23. Ball MW, Gorin MA, Jayram G et al.: Robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy: technique and initial outcomes. Can J Urol 2015; 22(1): 7666-7670.
24. Simone G, Gill IS, Mottrie A et al.: Indications, Techniques, Outcomes, and Limitations for Minimally Ischemic and Off-clamp Partial Nephrectomy: A Systematic Review of the Literature. Eur Urol 2015 Apr 25. pii: S0302-2838(15)00322-X.
25. Trudeau V, Gandaglia G, Shiffmann J et al.: Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: a population-based assessment of costs and perioperative outcomes. Can Urol Assoc J 2014; 8(9-10): E695-701.
26. Montorsi F, Wilson TG, Rosen RC et al.: Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012; 62(3): 368-381.
27. Autorino R, Zargar H, Mariano MB et al.: Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European-American Multi-institutional Analysis. Eur Urol 2015; 68(1): 86-94.
28. Gołąbek T, Jarecki P, Jaskulski J et al.: Modified technique for laparoscopic running vesicourethral anastomosis. Wideochir Inne Tech Maloinwazyjne 2014; 9(3): 357-361.
29. Gołąbek T, Jaskulski J, Jarecki P et al.: Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne 2014; 9(3): 362-370.
30. Ficarra V, Novara G, Ahlering TE et al.: Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012; (3): 418-430.
31. Novara G, Ficarra V, Mocellin S et al.: Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62(3): 382-404.
32. Mistretta FA, Grasso AA, Buffi N et al.: Robot-assisted radical prostatectomy: recent advances. Minerva Urol Nefrol 2015 Jun 18 [Epub ahead of print].
33. Mulders PF, De Santis M, Powles T, Fizazi K: Targeted treatment of metastatic castration-resistant prostate cancer with sipuleucel-T immunotherapy. Cancer Immunol Immunother 2015; 64(6): 655-663.
34. Ferry EK, Minnillo BJ, Maurice MJ et al.: Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States. Urology 2015; 85(6): 1399-1403.
35. Kawashima H: The present state and the future perspective of immunotherapy of renal cell carcinoma. Nihon Rinsho 2015; 73(1): 167-174.
36. Patel SP, Kurzrock R: PD-L1 Expression as a Predictive Biomarker in Cancer Immunotherapy. Mol Cancer Ther 2015; 14(4): 847-856.
37. Fuge O, Vasdev N, Allchorne P, Green JS: Immunotherapy for bladder cancer. Res Rep Urol 2015; 7: 65-79.
38. Huang Y, Zhang SD, McCrudden C et al.: The prognostic significance of PD-L1 in bladder cancer. Oncol Rep 2015; 33(6): 3075-3084.
39. Michalak J, Tzou D, Funk J: HoLEP: the gold standard for the surgical management of BPH in the 21st Century. Am J Clin Exp Urol 2015; 3(1): 36-42.
40. Chang CH, Lin TP, Chang YH et al.: Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study. BMC Urol 2015; 15: 40.
41. Jovanović M, Džamić Z, Aćimović M et al.: Usage of GreenLight HPS 180-W laser vaporisation for treatment of benign prostatic hyperplasia. Acta Chir Iugosl 2014; 61(1): 57-61.
42. Armagan A, Karatag T, Buldu I et al.: Comparison of flexible ureterorenoscopy and micropercutaneous nephrolithotomy in the treatment for moderately size lower-pole stones. World J Urol 2015 Feb 25 [Epub ahead of print].
43. Zengin K, Tanik S, Karakoyunlu N et al.: Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2-3 cm in diameter. Biomed Res Int 2015; 2015: 914231.
44. Serra S, Corona A, De Lisa A: Endoscopic combined intra renal surgery (ECIRS) in prone position. Urologia 2012; 79 (suppl. 19): 121-124.
45. Traxer O, Letendre J: Extracorporeal lithotripsy endoscopically controlled by ureterorenoscopy (LECURS): a new concept for the treatment of kidney stones-first clinical experience using digital ureterorenoscopes. World J Urol 2014; 32(3): 715-721.
46. Saglam R, Muslumanoglu AY, Tokatl? Z et al.: A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b). Eur Urol 2014; 66(6): 1092-1100.
otrzymano: 2016-02-08
zaakceptowano do druku: 2016-02-29

Adres do korespondencji:
*Tomasz Gołąbek
Department of Urology Collegium Medicum Jagiellonian University in Kraków
ul. Grzegorzecka 18, 31-531 Kraków
tel. +48 (12) 424-79-50
fax +48 (12) 424-79-70
elementare@op.pl

Postępy Nauk Medycznych 3/2016
Strona internetowa czasopisma Postępy Nauk Medycznych