Reviews & Analysis

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.

New analyses show that muscle-invasive bladder cancers can be grouped into basal and luminal subtypes that are highly reminiscent of those found in breast cancer. Choi and colleagues introduce the newly identified basal and luminal subtypes of muscle-invasive bladder cancer and explain their implications for the clinical management of this disease.

Testicular torsion is a urological emergency that occurs most commonly in adolescence. In this Review, the authors discuss the pathophysiological mechanisms of testicular torsion and reperfusion injury, before summarizing the large body of preclinical data that exists regarding potential therapies, including antioxidants, hormones, vitamins and plant extracts.

Faure Walker and colleagues review the existing literature on intradiverticular bladder tumours, highlighting the challenges that exist in the management of malignant and premalignant conditions within bladder diverticula. They outline the only guidelines currently available, and provide their own recommendations for the diagnosis and treatment of these conditions.

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.

Ureteroscopy is a valuable technique for the treatment of urolithiasis and the diagnosis of other upper urinary tract pathologies, including malignancies. In this Review, the technological advances that have improved outcomes and expanded the indications for this retrograde endoscopic approach are discussed, and potential avenues for continued evolution of the methodology are highlighted.

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.

Quality-of-life assessment tools give patients and health-care providers a nuanced understanding not only of how long patients will survive, but also how well they will live. Bergman and Laviana describe the range of tools used to assess quality of life in men with prostate cancer.

A key study comparing radical prostatectomy and watchful waiting for prostate cancer has been updated with extended follow-up observation, demonstrating substantial benefits of surgery for reduced mortality mainly in younger men, but also reduced requirement for palliative treatment in older men. These findings should be interpreted within the current scenario of prostate cancer diagnosis and treatment.

Radiation therapy combined with androgen-deprivation therapy has become the standard-of-care treatment for patients with high-risk prostate cancer; however, superiority of this approach over other therapeutic options, such as surgery, has not been clearly demonstrated. This Review provides a comprehensive overview of the current status of surgery in the treatment of high-risk prostate cancer and highlights the findings that might underlie the increasing use of radical prostatectomy as the first-line treatment among patients with this disease.

Natural orifice transluminal endoscopic surgery (NOTES) can reduce or eliminate altogether the need for external incisions and might, therefore, improve the outcomes of surgery compared with open and even laparoscopic methodologies. Herein, the historical development, the current status and the future of NOTES nephrectomy, radical prostatectomy and cystectomy are discussed.

Current data suggest that early-onset prostate cancer is a distinct clinicopathological subtype of prostate cancer, with more rapid progression to disease-specific death than late-onset prostate cancer of similar stage and grade. Here, the authors discuss the epidemiology of early-onset prostate cancer and the unique challenges it poses.

Struvite stones are a subset of kidney stones that form as a result of UTI with urease-producing pathogens, and can cause significant morbidity and mortality if left untreated or treated inadequately. Here, we provide an overview of our current understanding of the microbiology, pathogenesis, treatment, and prevention of struvite stones.

Two major trials have been performed to determine the effect of 5α-reductase inhibitors on subsequent diagnoses of prostate cancer. Both trials showed that high alcohol intake significantly increased prostate cancer risk among men allocated to the treatment arms. The recommendation that patients eliminate alcohol when taking 5α-reductase inhibitors seems appropriate.

Use of clinically active agents, such as kinase inhibitors, before nephrectomy is safe and feasible and can decrease the size of primary tumours, enabling optimization of the surgical approach. However, the overall clinical benefit of the neoadjuvant use of toxic drugs, such as axitinib, has not yet been demonstrated.

A new report of zoledronic acid in men with high-risk prostate cancer is the latest in a long line of negative studies that have addressed the prevention of metastasis. We must learn from these studies so that potentially useful agents are not discarded due to poor trial design in the future.

Concerns have been raised regarding the educational value of live surgical events (LSEs) and whether such events compromise patient safety. Now, the European Association of Urology has published a Live Surgery Policy Statement, aimed at protecting patient safety and ensuring that LSEs are conducted in an ethical and accountable manner.