Browsing by Author "Gryzinski, Gustavo M."

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    Nephron-sparing management of upper tract urothelial carcinoma
    (Korean Urological Association, 2021-07) Farrow, Jason M.; Kern, Sean Q.; Gryzinski, Gustavo M.; Sundaram, Chandru P.; Urology, School of Medicine
    Urothelial carcinoma of the upper urinary tract is uncommon and presents unique challenges for diagnosis and management. Nephroureterectomy has been the preferred management option, but it is associated with significant morbidity. Nephron-sparing treatments are a valuable alternative and provide similar efficacy in select cases. A PubMed literature review was performed in English language publications using the following search terms: urothelial carcinoma, upper tract, nephron-sparing, intraluminal and systemic therapy. Contemporary papers published within the last 10 years were primarily included. Where encountered, systematic reviews and meta-analyses were given priority, as were randomized controlled trials for newer treatments. Core guidelines were referenced and citations reviewed for inclusion. A summary of epidemiological data, clinical diagnosis, staging, and treatments focusing on nephron-sparing approaches to upper tract urothelial carcinoma (UTUC) are outlined. Nephron-sparing management strategies are viable options to consider in patients with favorable features of UTUC. Adjunctive therapies are being investigated but the data remains mixed. Protocol variability and dosage differences limit statistical interpretation. New mechanisms to improve treatment dwell times in the upper tracts are being designed with promising preliminary results. Studies investigating systemic therapies are ongoing but implications for nephron-sparing management are uncertain. Nephron-sparing management is an acceptable treatment modality best suited for favorable disease. More work is needed to determine if intraluminal and/or systemic therapies can further optimize treatment outcomes beyond resection alone.
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    Sexual Function in Men Undergoing Androgen Deprivation Therapy
    (Mary Ann Liebert, Inc., 2022-10-22) Gryzinski, Gustavo M.; Fustok, Judy; Raheem, Omer A.; Bernie, Helen L.; Urology, School of Medicine
    With an increase in the use of androgen deprivation therapy (ADT) in men diagnosed with prostate cancer, there are several adverse effects that accompany its utilization. Among these, sexual dysfunction has contributed to significant deleterious effects on quality of life (QoL) and overall satisfaction. This has prompted clinicians to pursue modalities of ADT that may mitigate these adverse sexual effects, which include continuous versus intermittent ADT, changes in the duration of ADT, and novel methods of cyclical androgen exposure during treatment. Importantly, this must not come at the expense of oncological outcomes. In addition, some men treated with ADT experience persistent hypogonadism and side effects from these medications that linger well after treatment is completed. In this systematic review we discuss the pharmaceutical, mechanical, and psychological methods that play an important role in the mitigation of these sexual side effects, including erectile dysfunction and decreased libido, and their uses and benefits are further discussed. Ultimately, the benefits of ADT and the possible morbidity that these men may experience from use of ADT, as well as options to minimize their side effects need to be discussed with the patient and their partner to make an informed decision and ensure patient autonomy while providing the most up-to-date evidence. Given the prevalence of prostate cancer in the aging male population, this systematic review aims to further explain the different ADT regimens and options for men, as well as discuss the sexual side effects that accompany these treatments and ways in which to mitigate these side effects to improve patient QoL.