Reviews & Analysis

Johnson and Irwig discuss a community of biological males who desire emasculation and commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures.

Seminal plasma is a potential source of biomarkers of male reproductive system disorders. Drabovich et al. describe the development of seminal plasma proteomics and the progress towards the clinical use of biomarkers of male infertility and prostate cancer.

In this Review, Murphy and colleagues collate the disparate published data, enabling a better understanding of the mechanisms behind chronic pelvic pain syndrome and providing insight into ways to enhance the efficacy of treatment.

Unfortunately, the noble aims of the Melbourne Consensus statement on the early detection of prostate cancer lack rigour, failing to take into account the breadth of evidence in this field; as a result, they fall disappointingly short of providing clarity on this important issue.

Currently, numerous systems exist for the identification of high-risk prostate cancer, but few of these systems can guide treatment strategies. A new stratification tool that uses common diagnostic factors can help to predict outcomes after radical prostatectomy. The tool aids physicians in the identification of appropriate candidates for aggressive, local treatment.

Cystinuria is a rare genetic disease leading to frequent stone formation owing to defective dibasic amino acid transport in the renal tubules and small bowel. This Review discusses current understanding cystinuria and describes its medical management from the perspective of a large UK based clinic.

Focal therapy of prostate cancer enables treatment of the index lesion while sparing the rest of the gland and surrounding vital structures, thereby decreasing the risk of morbidity. As clinicians acknowledge its potential, the recently published multidisciplinary consensus is timely and provides new insight into trial design for focal therapy.

New research shows that high-risk and intermediate-risk prostate cancers are being treated with brachytherapy alone, deviating from both guidelines and expert opinion. These findings should force intense introspection and scrutiny amongst clinicians, and encourage them to consider whether they are practicing evidence-based medicine.

Advances in available treatments for metastatic renal cell carcinoma affect the prevalence, morbidity, and mortality associated with skeletal-related events (SREs) owing to metastatic bone lesions. A newly published report shows that the prevalence and in-hospital mortality of SRE-associated hospitalizations are decreasing, while the associated costs are increasing.

BPH–LUTS and erectile dysfunction commonly coexist, and both respond to phosphodiesterase 5 inhibitors. In the opinion of Cellek et al., the underlying pathology of both conditions can be explained by microvascular dysfunction, a vicious cycle of hypoxia, vasoconstriction, altered smooth muscle contractility, and degeneration of autonomic neurons and ganglia.

In addition to surgical transurethral resection of the bladder tumour, intravesical chemotherapy with mitomycin C (MMC) is commonly used for the treatment of non-muscle-invasive bladder cancer. In this Review, approaches to optimizing MMC therapy through enhanced delivery, as well as maintenance and/or combination treatment regimens, are discussed.

Although multiple systemic treatment options are available for men with castration-resistant prostate cancer, there is a paucity of data regarding optimal sequencing of these drugs. A recent study suggests that cabazitaxel exerts antitumour activity in men who have been pretreated with docetaxel and abiraterone or enzalutamide.

A newly published randomized controlled trial shows that pelvic floor muscle training can significantly reduce prolapse symptoms compared with provision of a prolapse lifestyle advice leaflet and no muscle training. However, the important role of surgery in the treatment of these women must be taken into account.

Epidemiological studies suggest that the prevalence of prostate cancer in Asian men is lower than the rates observed in Asian populations resident in Western countries and in native Western individuals. Conversely, the proportion of prostate cancer cases that are metastatic seems to be higher in Asian countries. In this Review, these trends and the factors that might underlie them, particularly the influence of screening programmes, are comprehensively discussed.

Over the past decade, laser techniques have become an established alternative to transurethral resection for the treatment of benign prostatic obstruction. Rieken and Bachmann provide a comprehensive, evidence-based overview of laser treatment, including the physical properties of lasers that lend themselves to prostatic surgery and the clinical differences between the techniques.

Sentinel lymph node biopsy is used for tumour staging of many cancers. In new research, a fluorescent, radiolabelled tracer gave equivalent radiographic localization and improved visualization of sentinel nodes in penile cancer, compared with current standard tracers, but technical and financial considerations could influence its widespread use.

A lack of evidence exists regarding the role of nonsystemic treatments for men with metastatic prostate cancer. According to a recently published series of patients with metastatic disease at diagnosis, primary tumour treatment could improve rates of patient survival.

A recent retrospective study reporting increased risk of cardiovascular events and death with testosterone therapy has received extensive media attention. However, the authors' conclusions are highly questionable given the extensive data manipulation and serious methodological errors. Indeed, a rich body of literature strongly suggests that testosterone therapy offers cardiovascular benefits.

Urology nursing practice is rapidly developing around the world in response to technological advances, the expansion of service needs, and the increasing subspecialization of urology. Here, Helen Crowe provides unique insight into the successes and challenges of advanced urology nursing and the changing face of this specialty.

Illicit drug use can result in a wide spectrum of urological manifestations, which urologists should be able to recognize in their patients. Here, the authors summarize the known or reported urological complications of illicit drug use, providing relevant information on the pathophysiology and clinical presentation of these manifestations.