Volume 11 Issue 2, February 2014

The pursuit of reduced-intensity treatments for testicular cancer continued with vigour in 2013. For those with metastatic disease and poor prognoses, an alternative to bleomycin, etoposide and cisplatin chemotherapy emerged. These advances suggest we are making progress by reducing treatment intensity with personalized approaches for this highly curable malignancy.

In response to the demand for reconstructive options that preserve quality of life after cystectomy, 2013 saw considerable advances in biocompatible meshes and stem cell preparations that might recapitulate the urinary bladder. With increasing strength and functionality of these substitutes, what challenges remain?

2013 saw the publication of several reports providing insight into a range of ongoing issues in bladder cancer, from screening high-risk candidates to using blue-light cystoscopy to reduce recurrence. These data will strengthen efforts to optimize the detection and treatment of bladder cancer, benefiting patients along the cancer continuum.

In 2013, data began to emerge that shed light on several longstanding issues in female urology, from the safety of adrenergic receptor agonists and onabotulinumtoxinA for overactive bladder to the use of physical therapy and mesh suburethral slings for stress urinary incontinence.

Considerable developments in prostate cancer in 2013 have emerged from the imaging field. Hyperpolarized ¹³C-MRI can monitor metabolic activity to identify high-grade disease and treatment response, and novel PET radiotracers might identify distinct subsets of patients with advanced disease. These examples highlight the progress made at all stages of care.

Big data and computational biology brought to the forefront a number of potential actionable mutations and drug targets in clear cell renal cell carcinoma in 2013. As we continue to unravel the molecular underpinnings of tumorigenesis and progression, the clinical benefits will eventually be reaped.

In this Review, Wagenlehneret al. discuss strategies to reduce rates of severe symptomatic infection and urosepsis after prostate biopsy, such as preoperative assessment (including history of fluoroquinolone intake over the past 6 months), urine culture, targeted antibiotic prophylaxis after sampling of the rectal flora, bowel preparation, and perineal prostate biopsy.

Fowler's syndrome is a cause of urinary retention in young women that is characterized by an abnormal electromyography reading from the external urethral sphincter. This Review, describing the aetiology, pathogenesis and management of Fowler's syndrome, will serve as a guide for urologists unfamiliar with this rare clinical problem.

Erectile dysfunction (ED) is often overlooked in men with HIV, despite its high prevalence in affected men of all ages. In this Review, Santi and colleagues discuss the aetiology and social issues associated with ED in men with HIV, and provide useful advice for the clinician treating such patients.

In the past two decades, improvements to the techniques of radical hysterectomy and chemoradiotherapy for the treatment of cervical cancer have led to a reduction in the associated urological complications. This Review considers the prevalence of lower urinary tract dysfunction in the era of nerve-sparing surgery and decreased radiation fields.

BPH is one of the most common lower urinary tract diseases that predominantly affects men of advanced age. This Timeline article highlights the pivotal advances in BPH treatment (surgical and medical) from the late 19th century to the present day.