Volume 11 Issue 11, November 2014

The past decade has seen many notable contributions to bladder cancer research. Here, we highlight the international efforts in the field, with findings from Europe, USA and China, as well as papers resulting from international cooperation. We anticipate the next 10 years will see even greater collaborative and international efforts.

The prostate is still largely assessed by random biopsy, but developments in prostate MRI and fusion with transrectal ultrasonography (TRUS) have made targeted biopsy of the prostate a reality. MRI/TRUS techniques promise to address the issues of overdiagnosis and underdiagnosis in prostate cancer.

Over the past decade, management of common urological problems has metamorphosed in the field of female urology and voiding dysfunction; from treatment of routine stress urinary incontinence (SUI) with synthetic sling placement, to management of refractory overactive bladder (OAB) with neuromodulation.

Several advances in kidney cancer have occurred over the past decade, including the discovery of mutations in chromatin remodelling genes and genomic heterogeneity in clear cell renal cell carcinoma (ccRCC). Altered metabolic patterns in ccRCC and papillary RCC have become apparent, and new drugs for ccRCC have been approved.

Erectile dysfunction remains a frequent sequela of radical prostatectomy, owing to injury to the cavernous nerves that innervate the penile erectile tissue. Over the last decade, many strategies have been proposed to minimize the duration of denervation and prevent irreversible structural changes from occurring in the corpora cavernosa.

A fundamental shift in the understanding, detection and treatment of prostate cancer has occurred over the past 10 years, especially in the use of screening, active surveillance, novel therapies and radical surgery. These discoveries have changed how clinicians and patients approach prostate cancer.

Treatment of erectile dysfunction by maximizing nitric oxide signalling is not effective for all aetiologies of the condition. In this Review, the authors describe the role of the Rho kinase pathway in erectile dysfunction, its interactions with the nitric oxide pathway and progress towards therapeutic modulation of Rho kinase signalling.

Ureteropelvic junction obstruction (UPJO) is characterized by impaired flow of urine from the renal pelvis to the ureter and if left untreated can significantly impair renal function. Khan and colleagues provide an overview of the diagnosis and surgical treatment of UPJO, proposing optimal management strategies for this common condition.

Detrusor underactivity (DUA) is a poorly understood bladder dysfunction without effective pharmacological treatments. This Review summarizes the available evidence relating to the aetiology and pathophysiology of DUA and highlights the need for further elucidation of the underlying mechanisms to enable the development of new treatment approaches.

The field of urology has undergone massive changes in the 10 years sinceNature Reviews Urology launched as Nature Clinical Practice Urology. In this Viewpoint, members of the Nature Reviews Urologyadvisory board describe what they think has been the biggest change or issue in urology over the past decade, and give their predictions for the direction of the field over the next 10 years.