Volume 11 Issue 5, May 2014

Concerns have been raised regarding the educational value of live surgical events (LSEs) and whether such events compromise patient safety. Now, the European Association of Urology has published a Live Surgery Policy Statement, aimed at protecting patient safety and ensuring that LSEs are conducted in an ethical and accountable manner.

Unfortunately, the noble aims of the Melbourne Consensus statement on the early detection of prostate cancer lack rigour, failing to take into account the breadth of evidence in this field; as a result, they fall disappointingly short of providing clarity on this important issue.

A new report of zoledronic acid in men with high-risk prostate cancer is the latest in a long line of negative studies that have addressed the prevention of metastasis. We must learn from these studies so that potentially useful agents are not discarded due to poor trial design in the future.

Two major trials have been performed to determine the effect of 5α-reductase inhibitors on subsequent diagnoses of prostate cancer. Both trials showed that high alcohol intake significantly increased prostate cancer risk among men allocated to the treatment arms. The recommendation that patients eliminate alcohol when taking 5α-reductase inhibitors seems appropriate.

Use of clinically active agents, such as kinase inhibitors, before nephrectomy is safe and feasible and can decrease the size of primary tumours, enabling optimization of the surgical approach. However, the overall clinical benefit of the neoadjuvant use of toxic drugs, such as axitinib, has not yet been demonstrated.

Currently, numerous systems exist for the identification of high-risk prostate cancer, but few of these systems can guide treatment strategies. A new stratification tool that uses common diagnostic factors can help to predict outcomes after radical prostatectomy. The tool aids physicians in the identification of appropriate candidates for aggressive, local treatment.

In this Review, Murphy and colleagues collate the disparate published data, enabling a better understanding of the mechanisms behind chronic pelvic pain syndrome and providing insight into ways to enhance the efficacy of treatment.

Cystinuria is a rare genetic disease leading to frequent stone formation owing to defective dibasic amino acid transport in the renal tubules and small bowel. This Review discusses current understanding cystinuria and describes its medical management from the perspective of a large UK based clinic.

Seminal plasma is a potential source of biomarkers of male reproductive system disorders. Drabovich et al. describe the development of seminal plasma proteomics and the progress towards the clinical use of biomarkers of male infertility and prostate cancer.

Optimization of the care that paediatric patients with congenital urological anomalies receive as they transition to adult health care could improve clinical outcomes and quality of life. Dan Wood discusses the challenges associated with the provision of lifelong urological care, highlighting the need for development of academic and health systems.

Johnson and Irwig discuss a community of biological males who desire emasculation and commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures.