Pain: Tailoring treatment of chronic pelvic pain | PDF (92 KB)
p517 | doi:10.1038/nrurol.2009.174
Table of contents
October 2009 Vol 6 No 10
Research Highlights
Prostate cancer: Further data on sipuleucel-T immunotherapy | PDF (49 KB)
p518 | doi:10.1038/nrurol.2009.171
Prostate cancer: Suspension stitch aids post-RALP continence recovery | PDF (133 KB)
p518 | doi:10.1038/nrurol.2009.172
Pain: Targeting anesthesia to the pelvic plexus for prostate biopsy | PDF (47 KB)
p519 | doi:10.1038/nrurol.2009.170
Web tool predicts repeat biopsy result | PDF (48 KB)
p519 | doi:10.1038/nrurol.2009.182
Prostate cancer: Survival with metastases improved by clodronate | PDF (48 KB)
p519 | doi:10.1038/nrurol.2009.185
Stones: Tamsulosin does not increase the rate of expulsion | PDF (81 KB)
p520 | doi:10.1038/nrurol.2009.175
In brief
Sexual dysfunction | Testicular cancer | PDF (47 KB)
p520 | doi:10.1038/nrurol.2009.190
Bladder cancer: DNA changes can distinguish muscle-invasive from papillary tumors | PDF (53 KB)
p521 | doi:10.1038/nrurol.2009.173
BPH: 
-Blockers mitigate exacerbation of heart failure by 
-antagonists | PDF
(113 KB)
p521 | doi:10.1038/nrurol.2009.187
Urothelial carcinoma: Removing lymph nodes extends the life of patients without metastases | PDF (50 KB)
p522 | doi:10.1038/nrurol.2009.183
Sexual dysfunction: Finasteride to treat recurrent priapism in sickle cell anemia | PDF (110 KB)
p522 | doi:10.1038/nrurol.2009.186
News and Views
Urinary incontinence: Relative efficacy of retropubic and transobturator slings
Elizabeth R. Mueller
p523 | doi:10.1038/nrurol.2009.193
Insertion of midurethral synthetic slings is now the cornerstone surgical approach to treatment of stress urinary incontinence. A group from Poland randomized 537 women to synthetic sling placement using either a retropubic or transobturator technique. The investigators found both procedures to be equally effective in curing or improving the condition.
Health policy: Do end-of-life discussions have a role in health care reform?
Leonard G. Gomella
p524 | doi:10.1038/nrurol.2009.192
Considerable costs are incurred when caring for patients with terminal cancer in their last few days of life. With the debate over health care reform in the US being at center stage, focusing primarily on cost reduction, how can we best serve our cancer patients in their final days?
Stones: Impact of dose reduction on CT detection of urolithiasis
M. Hammad Ather & Wasim A. Memon
p526 | doi:10.1038/nrurol.2009.196
Patients undergoing CT for the evaluation of stone disease are likely to receive high levels of radiation over time. Although the results from small studies using simulation software suggest that using a reduced radiation dose has little effect on calculi detection, larger prospective randomized studies are required to produce clinically applicable results.
Prostate cancer: Optimizing the duration of androgen deprivation therapy
Eric M. Horwitz
p527 | doi:10.1038/nrurol.2009.194
EORTC 22961 is the latest trial to investigate the optimum duration of adjuvant androgen deprivation therapy for patients with locally advanced prostate cancer. The results conclusively show superiority of long-term over short-term treatment, and the former protocol should, therefore, be considered standard of care in this setting.
Prostate cancer: How can we improve the health of men who receive ADT?
Philip J. Saylor & Matthew R. Smith
p529 | doi:10.1038/nrurol.2009.195
Clinical research in recent years has produced a deepening appreciation of the metabolic consequences of androgen deprivation therapy. On the basis of this knowledge, proactive management of risk factors for diabetes and cardiovascular events is appropriate in men who receive this treatment for prostate cancer.
Prostatitis: Clinical phenotyping of patients with pelvic pain
Richard B. Alexander
p531 | doi:10.1038/nrurol.2009.197
Despite a plethora of clinical trials, no treatment has shown consistent success for symptomatic management in patients with chronic prostatitis–chronic pelvic pain syndrome. Subdividing this heterogeneous patient population according to phenotype, and selecting therapy accordingly, represents an important step forward in the treatment of this disorder.
Reviews
Management of distal anterior urethral strictures
Jeremy B. Tonkin & Gerald H. Jordan
p533 | doi:10.1038/nrurol.2009.181
In this Review, Tonkin and Jordan draw on their clinical experience to discuss the etiology, diagnosis and management of distal anterior urethral stricture disease. They highlight that curative open surgery, such as graft or flap urethroplasty, should be preferred over repeated minimally invasive procedures in order to optimize patient outcomes.
Enhancing the efficacy of cancer vaccines in urologic oncology: new directions
Sergei Kusmartsev & Johannes Vieweg
p540 | doi:10.1038/nrurol.2009.177
Cancer vaccines, which stimulate the host immune response to malignant disease, have generally failed to induce durable clinical responses in patients, partly owing to tumor-mediated suppression of the host immune system. Here, Kusmartsev and Vieweg explore ways of targeting these tumor-mediated changes to enhance the efficacy of vaccine therapy for urologic cancers.
Male infertility: a risk factor for testicular cancer
James M. Hotaling & Thomas J. Walsh
p550 | doi:10.1038/nrurol.2009.179
A growing body of evidence supports an epidemiologic association between male infertility and testicular germ cell tumor; however, few population-based studies have investigated this relationship. In this Review, Hotaling and Walsh explore the epidemiologic data linking the two disorders, and discuss the potential mechanisms that underlie this association.
Differential diagnosis of chronic pelvic pain in women: the urologist's approach
Sophie G. Fletcher & Philippe E. Zimmern
p557 | doi:10.1038/nrurol.2009.178
Chronic pelvic pain in women is a challenging clinical entity that is frequently encountered by urologists. The diagnostic process can be laborious, and often requires multidisciplinary collaboration. In this Review, the authors discuss the key issues in the diagnosis of this disorder, highlighting the importance of a thorough patient history to direct subsequent investigations.
Case Studies
Bilateral renal hemorrhage due to polyarteritis nodosa wrongly attributed to blunt trauma
Ihab El Madhoun, Niall G. Warnock, Anu Roy & Colin H. Jones
p563 | doi:10.1038/nrurol.2009.180
In this Case Study, El Madhoun and colleagues describe the diagnosis and management of a patient with bilateral renal hemorrhage caused by polyarteritis nodosa. The perirenal bleeding was at first attributed to trauma experienced 1 week before the initial presentation, but review of the case at a subsequent hospital admission identified the true cause of the bilateral hemorrhage.
A rare case of renal infarction caused by infective endocarditis
Rasheed Zakaria, Vhari Forsyth & Tomas Rosenbaum
p568 | doi:10.1038/nrurol.2009.176
Zakaria and colleagues describe the case of a previously healthy 29-year-old man with renal infarction. The nonspecific nature of his presenting symptoms caused a delay in diagnosis. The authors provide a comprehensive account of the presenting features, and of diagnostic tests that can distinguish renal infarction from more common conditions.
