Patients with localized prostate cancer who are on active surveillance demonstrated a low rate of active surveillance failure, prostate cancer specific mortality and metastases regardless of baseline risk.
Patients with lower BC had more severe disease characterized either by clinical symptoms, cystoscopy and pathology. Our data suggest that low BC is a biomarker for a bladdercentric manifestation of IC/BPS.
Immunosuppressive drugs are used in renal transplantation to prevent and treat rejection and their use has traditionally been limited to urologists trained in transplant surgery. However, there are other urologic conditions for which these drugs have proven efficacy. Since transplant surgery has become a small niche subspecialty within urology, most urologists are unfamiliar and uncomfortable with their use. This review will focus on the use of Cyclosporine (CyA), mycophenolate mofetil (MMF), and mammalian target of rapamycin (mTOR) inhibitors in urology outside of solid organ transplant. This includes the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) with CyA as well as the role of CyA in eosinophilic cystitis (EC) and the treatment of retroperitoneal fibrosis (RF) with MMF. Also included is the utilization of mTOR inhibitors in both advanced renal cell carcinoma (RCC) and in patients with tuberous sclerosis complex (TSC) associated angiomyolipoma (AML). Available clinical data on mTOR inhibition in autosomal dominant polycystic kidney disease (ADPKD) is also briefly presented. Specific attention is given to the indications for each agent, the available evidence surrounding their use, and the most common adverse events (AEs) and their subsequent management.
The
field of urology encompasses all benign and malignant disorders
of the urinary tract and the male genital tract. Urological disorders
convey a huge economic and patient quality-of-life burden. Hospital
acquired urinary tract infections, in particular, are under scrutiny
as a measure of hospital quality. Given the prevalence of these pathologies,
there is much progress still to be made in available therapeutic options
in order to minimize side effects and provide effective care. Current
drug delivery mechanisms in urological malignancy and the benign urological
conditions of overactive bladder (OAB), interstitial cystitis/bladder
pain syndrome (IC/BPS), and urinary tract infection (UTI) will be
reviewed herein. Both systemic and local therapies will be discussed
including sustained release formulations, nanocarriers, hydrogels
and other reservoir systems, as well as gene and immunotherapy. The
primary focus of this review is on agents which have passed the preclinical
stages of development.
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