Reviews & Analysis

A number of different surgical techniques are used for the treatment of benign prostatic hyperplasia(BPH). This article by Liam Wilson and Peter Gilling reviews the different types of lasers available and their applications in ablation, coagulation and enucleation of the hyperplastic prostate for treating BPH.

Accurate staging of clinically localized prostate cancer is crucial to ensure patients receive optimal management and counseling. Despite the growing number of diagnostic modalities, however, accurate staging remains a challenge. In this Viewpoint, Mitchellet al. discuss the relative merits of tried and tested and newly emerging staging techniques.

Penile reconstructive surgery requires expertise in genital surgery, whether it is for traumatic injuries or penile cancer. The stages of initial assessment and management of traumatic penile injuries and penile cancer, and the different reconstructive techniques available, are described in this review by David Ralph and colleagues.

Developments in endourologic procedures now mean that the majority of patients with upper tract transitional cell carcinoma (UTTCC) can be offered minimally invasive treatments. Michael Ost and colleagues review the different procedures and adjuvant treatments available, and their suitability for patients with UTTCC.

The incidental finding of small renal masses is becoming a more common event as a result of widely used cross-sectional imaging techniques. This review by Alessandro Volpe and Michael Jewett discusses the risks of tumor progression, techniques for assessing tumors and the different management options available to patients with renal cell carcinoma.

Overactive bladder is a common urologic disorder with a number of etiologies and evolving treatment options. The two primary management strategies are drug therapy and sacral neurostimulation, both areas of recent developments with the emergence of new medications and refinement of surgical techniques. In this Viewpoint, Apurba Pathak and Sherif Aboseif discuss the relative merits, and drawbacks, of these very different approaches.

Retroperitoneal lymph node dissection (RPLND) is used in both the staging and management of non-seminomatous germ-cell tumors. Although a number of advantages of the laparoscopic approach have been reported over open RPLND, its use has not been supported by formal internal review board-approved studies. Brett Carver and Joel Sheinfeld discuss RPLND in the management of these tumors, both before and after chemotherapy.

Invasive urologic procedures carry the potential to cause hemorrhaging, the risk of which is greater for patients receiving long-term anticoagulation therapy. Paul Daniels reviews these risks and the management options that can be used to balance the risks of hemorrhage against the problems of venous thromboembolism, if anticoagulation therapy is stopped in this group of patients.

In this review, Fiona Burkhard and colleagues discuss the use of retroperitoneal lymph node dissection in both the staging and treatment of prostate cancer. Their discussion covers the preoperative methods used to assess lymph nodes and compares the merits and drawbacks of extended compared to limited lymphadenectomy when staging prostate cancer, and their possible influence on patient survival.

Artificial neural networks (ANNs) have been developed for various applications in prostate cancer management, but their ability to perform in this setting remains controversial. In this Viewpoint, authors from the University Hospital Charité present the case for ANNs, and argue that urologists should be using these tools in clinical decision-making.

Hitherto-neglected investigation of processes that underlie the characteristic feature of Peyronie's disease—deposition of fibrotic plaques in the penile tunica albuginea—has been kick-started by the recent development of two rat models. This update of new data is framed around the hypothesis that Peyronie's plaques are a product of perturbed interplay between profibrotic and antifibrotic factors, induced by trauma.

Diabetes mellitus is associated with a number of different vascular and neurologic problems that can lead to the development of bladder dysfunction, erectile dysfunction and retrograde ejaculation. This review by Domenico Fedele examines the mechanisms that lead to the development of these urologic problems in patients with diabetes, and discusses appropriate treatment and management options.

Up to half of patients with VHL develop malignant renal lesions. Urologists handling these cases are faced with the challenge of optimizing control of often bilateral multifocal tumors while maximizing preservation of kidney function. Robert Grubb and colleagues assess the relative merits of different management strategies, and present the molecular processes underlying VHL that might be targeted by new treatments.

The management of erectile dysfunction has been transformed since the first oral phosphodiesterase type 5 (PDE-5) inhibitor sildenafil (Viagra^®) was approved in the late 1990s. The PDE-5 inhibitors developed subsequently (tadalafil [Cialis®] and vardenafil [Levitra®]) differ in important ways from their predecessor. Here, Alberto Briganti and his colleagues compare and contrast the pharmacokinetics, pharmacodynamics, safety and efficacy of these three drugs.

A comprehensive overview of the state-of-the-art in the evaluation and treatment of male infertility, a problem with diverse etiology that affects 10% of couples. Including several simple algorithms to guide the physician's management decisions, this Review takes an evidence-based medicine approach to provide comment on the relevant merit of conservative and assisted-reproduction strategies.