Reviews & Analysis

Ancient practitioners were cognizant of the insight that would be gained by examining the interior of a patient's body. It was not until 1806, however, that Bozzini's candle-illuminated 'Lichtleiter' made this aim feasible. Here, Natalin and Landman trace the origins and development of endoscopic technology, from Bozzini's 'Lichtleiter' through Stern's 'resectoscope' to modern devices for virtual and capsule endoscopy.

In the second part of their Review on the extracellular matrix, Aitken and Bägli focus on its role in bladder regeneration. The authors describe how the composition and physical properties of matrix scaffolds can affect the growth of bladder tissue, and highlight the importance of stem cells in this emerging field.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

Data indicate that rates of seminal vesicle invasion at prostatectomy are falling, making seminal vesicle sparing surgery more viable, especially in low-risk patients. These changes can be viewed as part of a general trend towards lower-risk cancer at presentation.

The current diagnostic strategy for patients with hematuria incorporates imaging evaluation of the urinary tract to identify the source of the bleeding. Diffusion-weighted MRI offers promise in detecting and characterizing tumors and benign processes of the bladder, and might obviate the need for invasive cystoscopy in this setting.

Topical anesthetics are moderately effective treatments for premature ejaculation. In a 12 week, double-blind RCT, a metered-dose aerosol spray containing lidocaine and prilocaine (PSD502) showed a 6.3-fold increase in intravaginal ejaculatory latency times, improved all patient-reported outcomes and had no serious adverse effects.

There has been little published on the treatment of prostate cancer with external beam radiotherapy doses greater than 5 Gy per fraction.¹ New data from King and colleagues'² series of 41 patients treated with stereotactic body radiotherapy in 5 fractions of 7.25 Gy make an important contribution to our understanding of the radiobiology of prostate cancer and the tolerance of surrounding normal tissues.

Data from a long-term Scandinavian study show that the addition of radiation to long-term androgen deprivation therapy does not affect quality of life in patients with locally advanced prostate cancer. The long-term use of the antiandrogen flutamide might, however, have negatively affected quality of life outcomes for all patients in this study.

Recent meta-analyses suggest that surgical correction of varicoceles can improve the semen parameters and natural pregnancy rates of infertile men, prompting renewed interest in varicocelectomy methods. New developments, such as the use of Doppler ultrasonography during surgery, can aid the accurate identification of spermatic cord arteries during this technically challenging procedure.

The 2009 study by Hussain et al. showed that a PSA-based intermediate end point might be useful in clinical trials of advanced prostate cancer. However, overall survival (OS) will remain the required end point of phase III studies and the search for a true, robust surrogate of OS to accelerate drug development continues.

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.