Reviews & Analysis

Erectile dysfunction (ED) is a multifactorial disorder, which is strongly associated with circulating testosterone levels. In this Review, Corona and Maggi draw on their considerable clinical experience to outline the relationship between testosterone and male sexual dysfunction, and to discuss the role of testosterone replacement therapy in the treatment of ED.

Several naturally occurring substances have been implicated in the prevention of prostate cancer, but the lack of randomized controlled trials means causal effect has not yet been demonstrated. Here, the authors summarize existing data on a number of promising compounds and discuss the future direction of clinical trials in this field.

Laparoendoscopic single-site surgery (LESS) represents an exciting development in the field of minimally invasive surgery. In this Review, authors from Greece and Germany discuss the challenges facing LESS, highlight the potential of new specialized technology in this arena, and provide an overview of contemporary clinical experience with this approach in urologic surgery.

Ureteroscopy is the first-line treatment for urinary stone disease at many institutions. Techniques and indications continue to evolve. This Review covers the most current trends, controversies, and issues in ureteroscopic stone management. It summarizes the most recent evidence regarding ureteroscopic treatment of ureteral and renal stones, current standard indications, adjunct devices and instruments used during ureteroscopy, and future directions.

Shock wave lithotripsy (SWL) represents the only noninvasive surgical treatment for urinary tract stones. Drawing on their considerable experience, Lingeman and colleagues outline the current utility and limitations of SWL, and highlight the technological advances that hold promise for improving the safety and efficacy of this treatment modality in the future.

Topical treatment of neuropathic bladder has been suggested as a viable alternative to oral anticholinergic therapy in children, offering greater efficacy and reduced side effects. Lazarus reviews the current status of intravesical oxybutynin use, warning that although it has proven effective in some studies, there remains a low level of evidence.

There is a trend towards increasing the number of cores sampled during ultrasound-guided prostate biopsy in an attempt to increase the likelihood of detecting malignancy. Here, the authors' analysis of current data indicates that this 'saturation' approach is best used to improve histological characterization of cancer, and for monitoring of men with a rising PSA level despite previous negative biopsy.

The extracellular matrix has a critical role in modulating the structure and function of the urinary bladder. In this Review, Aitken and Bägli discuss how matrix properties affect bladder development and pathology, focusing on their role in the pathogenesis of strain-induced injury in bladder outlet obstruction.

Knowing when to request invasive urodynamic tests in children can be difficult, but persisting with nonbeneficial treatment is a serious failure of care. In this concise Review, authors from The Netherlands provide straightforward guidance on appropriate use of urodynamic studies in pediatric patients with overactive bladder, underactive bladder, neurogenic bladder and dysfunctional voiding.

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.

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.

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.

Chronic pelvic pain in women is a challenging clinical entity that is frequently encountered by urologists. The diagnostic process can be laborious, and often requires multidisciplinary collaboration. In this Review, the authors discuss the key issues in the diagnosis of this disorder, highlighting the importance of a thorough patient history to direct subsequent investigations.

Vesicoureteral refulx (VUR) is often a self-limiting condition, but it can lead to renal scarring and end-stage renal disease in some affected children. The author of this Review discusses the diagnosis of VUR and different management options, highlighting the need for an individualized approach when diagnosing and managing children with this condition.

The scrotum is host to numerous rare pathologies owing to its diverse and complex composition. In this Review, the authors provide a comprehensive account of the rare scrotal lesions discovered to date. They categorize these lesions by anatomical location and provide up-to-date management recommendations.

These authors from Brazil have systematically searched the literature for evidence of the utility of psychological approaches in the management of premature ejaculation. Unfortunately, few high-quality studies have been performed in this field. The authors describe the findings and limitations of the available data, and make recommendations as to the methodology of future studies.

The discovery of recurrent ETS gene fusions in prostate cancer has improved our understanding of prostate carcinogenesis and suggests novel targets for therapy. Here, Clark and Cooper discuss the variety of ETS gene fusions and their role in prostate cancer development, and outline the prognostic and therapeutic implications of this knowledge.

Erectile dysfunction following radical prostatectomy is common in men recovering from prostate cancer. The authors of this Review discuss the measures that can be taken to help preserve erectile function in men undergoing this surgery and approaches to treating men with postprostatectomy erectile dysfunction, including the concept of penile rehabilitation.

Stent-related symptoms are the cause of considerable morbidity for patients who undergo urological procedures. Here, Chew and Lange describe how urologists can limit the complications of stent placement, focusing on the ongoing development of stent technology to prevent bacterial adhesion and infection.