Reviews & Analysis

Over the years, the International Continence Society (ICS) has produced a series of standardization reports concerning the terminology of lower urinary tract function. In this Viewpoint, the authors highlight the advantages of using standardized ICS terminology in both clinical and scientific practice.

For patients with benign prostatic hyperplasia, pharmacologic treatment has emerged as an attractive alternative to surgical intervention; however, there are unresolved questions regarding nonsurgical approaches. The author reviews the evidence to address one such question: whether a combination of two drugs provides greater symptomatic relief than standard monotherapy.

Gonadotropin-releasing hormone (GnRH) agonists are commonly used to treat men with prostate cancer. The hypogonadal state induced by GnRH agonists can lead to increased bone loss and, ultimately, osteoporosis in many men. This review outlines the mechanisms involved in bone loss associated with GnRH agonists and discusses the different measures that can be utilized in the treatment and prevention of osteoporosis in this group of patients.

In order to understand the mechanisms behind abnormal gonadal development it is important to understand the process of normal development. In this review, the normal development of the gonad in mammals, and the molecular pathways and candidate genes that have been implicated in abnormal gonadal development, are discussed.

The process of angiogenesis is central to the development and spread of cancer. Modern imaging techniques are increasingly offering ways in which the markers of angiogenesis can be visualized. This article discusses the different imaging methods that can be used to assess angiogenesis in the prostate gland.

Ablative modalities are gaining currency as viable treatment options in selected renal cancer patients, but outcome data remain relatively premature. In this Viewpoint, John Pattaras and Fray Marshall discuss the limitations and uncertainties surrounding one of the most studied modalities for renal tumor ablation.

In this article by André Naudé and Chris Heyns the controversial issue of management of urethral strictures is tackled. The authors review the relative efficacy and suitability of internal urethrotomy, dilation and urethroplasty for treatment of different types of stricture. An algorithm for the initial management of strictures and treatment of recurrent strictures is included.

There is growing evidence that interstitial cells play a functional role in the urinary tract. This review by Alison Brading and Karen McCloskey focuses on what is known about specialized interstitial cells, their underlying physiology and their possible roles in regulating smooth-muscle activity and neural control in the urinary tract. The involvement of these cells in bladder pathology is also discussed.

When seeking a diagnosis in patients complaining of lower urinary tract symptoms there is a bewildering variety of questionnaires, symptom scales, measurements and urodynamic tests that can be utilized. The appropriate use of these different diagnostic tools and their associated strengths and weaknesses are discussed in this primer review by Christopher Chapple.

Prostate cancer nomograms are valuable tools for the discussion of treatment options with patients, but their ability to change patient decisions or improve outcomes remains unproven. In this Viewpoint, Alan Stapleton and Carole Pinnock discuss the limitations and uncertainties surrounding these tools, such as changes in source population clinical profiles over time, and parallel changes in the usefulness of prognostic factors.

There is much debate surrounding the suitability and utility of different prognostic markers in prostate cancer. PSA doubling time (PSADT) has become an important marker in predicting the response to salvage radiotherapy and progression to metastatic disease in men with biochemical failure following local therapy. The methods of calculating PSADT and its use as a prognostic marker are discussed in this review by James Eastham.

There are a number of factors that can influence a person's risk of developing cancer. In this review focussing on transitional cell carcinoma of the bladder, Erika Wolff and colleagues discuss the genes and molecular pathways implicated in the development of bladder cancer. Models for both the mechanisms behind bladder carcinogenesis and its progression are presented.

Multiple sclerosis (MS) is commonly associated with a number of lower urinary tract symptoms (LUTS), the type and severity of which vary with regard to the gender of the patient and the severity of their MS. In their article, Vinay Kalsi and Clare Fowler review the neurologic control of bladder function and the different treatments available to patients with MS who experience LUTS. Unlicensed and possible future treatments are also discussed.

Statistical analysis is an essential part of clinical practice, since the very concept of evidence-based medicine hinges on sound interpretation of clinical data. Using the Scandinavian prostatectomy versus watchful waiting study as a practical example, Andrew Vickers presents two common errors: accepting the null hypothesis and misinterpreting the lower statistical power of overall versus cancer-specific survival, and warns of the dangers of forgetting these basic principles.

In this review, Renata Huzjan and colleagues discuss the utility of MRI and magnetic resonance spectroscopic imaging (MRSI) in the diagnosis and management of prostate cancer. MRI and MRSI provide important information on the extent, location and characteristics of tumors that is invaluable in pretreatment decision making. In order to fully exploit these techniques, a multidisciplinary approach is essential.

Priapism, particularly ischemic priapism, is uncommon in the general male population, but frequently occurs in men with hematologic dyscrasias such as sickle cell disease. In this review, Arthur Burnett focuses on the management of ischemic priapism, and stresses the need for prompt treatment in order to preserve erectile function in this group of men.

Premature ejaculation (PE) has a number of known causes, and the definition of what constitutes PE can differ. Several factors are used to assess the presence and extent of PE. Chris McMahon discusses the etiology and management of PE, and highlights the importance of selecting treatments that are appropriate to the cause of the condition