Reviews & Analysis

Bladder biopsy of normal-looking mucosa, as determined by cystoscopy, might not add clinical value in patients with positive voided-urine cytology after treatment of non-muscle-invasive bladder cancer. Methods to add value to bladder biopsies, such as characterization of molecular alterations, should be considered.

Prevention of recurrent disease is the cornerstone of the management of paediatric nephrolithiasis and includes an evaluation to identify underlying causes or risk factors of stone formation. 24 h urine collection should be an initial step in the evaluation of the metabolic status of every child with urinary tract stones.

Placebo effects are a major factor in randomized control trials of treatments for interstitial cystitis/bladder pain syndrome. Two studies in the past 4 years have shown greater placebo effects than are usually reported in the literature. A recent report by Bosch investigated how these placebo effects are enhanced by education and behavioural modification strategies.

New AUA guidelines on the management of patients with kidney stones are a welcome addition to a field that, over the past few decades, has been neglected by urologists. Despite some limitations, this document is an extremely important reminder of what we can—and should—offer our stone-forming patients.

Premature ejaculation (PE) is a common ailment in men but its pathophysiology remains unclear. Updated guidelines from the International Society of Sexual Medicine attempt to aid the diagnosis and treatment of PE, and here we give our opinion on the best course of action for affected patients.

Studies suggest that there is a link between obesity and a reduced risk of low-risk cancers, but an increased risk of high-grade, lethal disease. A recent paper has attempted to further define this risk, and causes us to question whether active surveillance is an appropriate treatment option for obese patients.

Advances in knowledge, diagnostic procedures and available treatment options enable continual improvements in treatment of urogenital organs after severe trauma. The American Urological Association's first urotrauma guidelines include statements organized in a practical and straightforward manner and classified by the affected urogenital organ, to assist in the treatment of urotrauma.

Few prognostic factors have been identified and successfully replicated for patients with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC). However, a new report has shown that alkaline phosphatase velocity (APV) is an independent predictor of bone-metastasis-free survival and overall survival in patients with nmCRPC.

The pathology of intermediate-risk non-muscle-invasive bladder cancer is less well-defined than both high-risk and low-risk presentations of this disease. Recently reported guidelines seek to aid clinicians in classification of intermediate-risk patients, and also provide treatment recommendations for this subgroup.

The American Urological Association has released a new guideline on the evaluation and treatment of cryptorchidism, recommending early orchiopexy as the first-line treatment for both the congenital and acquired forms of the disease; hormonal therapy is not recommended. Given similarities with current European recommendations, transatlantic consensus has been achieved.

PSA-based screening is common in the western world. However, rescreening policies are ambiguous, resulting in unnecessary testing. Recent data suggest that rescreening intervals should be decided on the basis of a baseline PSA level, but how is this recommendation likely to be received by the clinical community?

Although the androgen receptor remains active in metastatic castration-resistant prostate cancer, the heterogeneity of this disease means that response to treatment in individual patients is uncertain. Analysis of relevant tissue before and after therapy can help identify markers of response and resistance to androgen receptor signalling inhibitors.

A new model that predicts in vitro fertilization outcomes is planned by the Society for Assisted Reproductive Technology based on US data. However, the proposed model ignores important variables and does not address the most important clinical outcome: the birth of a healthy baby to a healthy mother.

A new case–control study shows that inflammation on biopsy is associated with diagnosis of prostate cancer. We think a large population-based prospective study, specifically designed to investigate the longitudinal association between inflammation and subsequent onset of prostate cancer, is required to elucidate the true relationship between inflammation and prostate carcinogenesis.

Data are lacking on the role of histological risk factors (such as embryonal carcinoma and lymphovascular invasion) for occult metastasis in adolescents with testicular germ cell tumours. Investigators of a pilot study have now retrospectively reviewed a testis cancer database to identify risk stratification criteria in this population.

Cabazitaxel, a next-generation taxane, retains its efficacy in patients with metastatic castration-resistant prostate cancer (mCRPC) who progress on new androgen receptor (AR)-targeted agents such as abiraterone acetate or enzalutamide. These findings are reinforced by in vitro preclinical data confirming cross-resistance between abiraterone and enzalutamide, but not between cabazitaxel and AR-targeted agents.

Bone is the second most common metastatic site in patients presenting with metastatic renal cell carcinoma. Bisphosphonates have been approved to reduce bone pain and the risk of skeletal-related events (SREs) in such patients; however, new research suggests bisphosphonates do not improve survival or prevent development of SREs.

Although current guidelines do not endorse the use of primary androgen deprivation therapy (PADT) as monotherapy for localized prostate cancer, many patients continue to receive this treatment. New outcomes research confirms that there is no clear reason for use of PADT in men with localized prostate cancer.

Bladder preservation for patients with muscle-invasive bladder cancer has the potential to offer a quality-of-life advantage, but owing to the lack of randomized trials oncological equivalence to surgery has not been demonstrated. A new article provides a comprehensive overview of the current status of this procedure, but raises timely and important questions.

The recently developed International Consultation on Incontinence Questionnaire Bladder Diary is the first psychometrically validated urinary diary. It provides clinicians and researchers with an invaluable diagnostic tool that will contribute to improved management of patients with lower urinary tract symptoms, and can now be considered the gold standard of bladder diaries.