Volume 11 Issue 3, March 2014

A recent retrospective study reporting increased risk of cardiovascular events and death with testosterone therapy has received extensive media attention. However, the authors' conclusions are highly questionable given the extensive data manipulation and serious methodological errors. Indeed, a rich body of literature strongly suggests that testosterone therapy offers cardiovascular benefits.

The EAU has issued the first clinical practice guidelines on priapism, which have been published in short form in European Urology. Put together by the EAU panel on male sexual dysfunction, these guidelines provide an accessible, structured guide for the diagnosis and treatment of this rare clinical disorder.

A lack of evidence exists regarding the role of nonsystemic treatments for men with metastatic prostate cancer. According to a recently published series of patients with metastatic disease at diagnosis, primary tumour treatment could improve rates of patient survival.

Sentinel lymph node biopsy is used for tumour staging of many cancers. In new research, a fluorescent, radiolabelled tracer gave equivalent radiographic localization and improved visualization of sentinel nodes in penile cancer, compared with current standard tracers, but technical and financial considerations could influence its widespread use.

Few series have reported on the incidence of lymph node metastases, multimodal treatment, and long-term outcomes associated with extended pelvic lymph node dissection in large cohorts of patients with surgically treated prostate cancer. The first nomograms for predicting prognosis from such data have only recently been developed and internally validated.

Implementing a well-structured laparoscopic training curriculum during urology residency has proven to be challenging. The results of the European Training in Basic Laparoscopic Urological Skills (E-BLUS) examination show low levels of proficiency in laparoscopic techniques for urology residents completing training. What must be done to improve these standards?

Despite increased use of robot-assisted radical prostatectomy (RARP), there is still a paucity of data defining the learning curve associated with this approach. A recent study suggests superior quality-of-life outcomes and improved surgical margin rates are achievable after a long learning curve for open surgeons who undertake RARP.

Over the past decade, laser techniques have become an established alternative to transurethral resection for the treatment of benign prostatic obstruction. Rieken and Bachmann provide a comprehensive, evidence-based overview of laser treatment, including the physical properties of lasers that lend themselves to prostatic surgery and the clinical differences between the techniques.

Intravesical BCG instillation is a longstanding therapy for bladder cancer, but its mode of action is still under investigation. This Review summarises the current understanding of the requirements for effective BCG therapy, and the putative roles of normal and malignant bladder cells, as well as the immune system, in the response to BCG.

In this Review, Semins and Matlaga discuss risk factors for stone development during pregnancy and consider the diagnostic challenges that acute renal colic poses for pregnant patients. They also highlight potential stone-related complications for the mother and fetus, and specific management recommendations for this unique condition.

Illicit drug use can result in a wide spectrum of urological manifestations, which urologists should be able to recognize in their patients. Here, the authors summarize the known or reported urological complications of illicit drug use, providing relevant information on the pathophysiology and clinical presentation of these manifestations.

Urology nursing practice is rapidly developing around the world in response to technological advances, the expansion of service needs, and the increasing subspecialization of urology. Here, Helen Crowe provides unique insight into the successes and challenges of advanced urology nursing and the changing face of this specialty.