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In 2015, the approval of flibanserin opened a debate about diagnosis and treatment of female sexual dysfunction. Designing clinical trials with suitable end points is difficult, but some studies indicate correlations between hormone levels and low desire. New research demonstrates opportunities for a better understanding of this multifaceted condition.
2015 has seen advances in various bladder conditions. MicroRNAs might become therapeutic targets, the MAPP network characterized central neurological changes in chronic pelvic pain syndrome, and urologists were reminded to consider cognitive effects of long-term anticholinergics use. A study of obstetric vesicovaginal fistula repair shows how evidence-based research might improve public health in poorly resourced countries.
In 2015, population-based studies in patients with urinary stones informed us of the changing trends in contemporary stone management and identified areas for improvement. Although meta-analyses aim to provide the highest level of evidence, a randomized controlled trial of medical expulsive therapy challenged current paradigms and was the defining publication of the year.
HIV and bacterial sexually transmitted infection incidence remains persistently high for men who have sex with men. Results of new studies show that clinicians might be able to address this challenge by providing oral HIV pre-exposure prophylaxis and by intensifying efforts to diagnose and treat other sexually transmitted infections.
Radical cystectomy is the standard treatment for patients with bladder cancer, but the prognosis of patients undergoing this procedure has not changed for decades. Small steps towards improvement include better selection of high-risk T1 patients, the use of perioperative chemotherapy and, maybe, robotic cystectomy.
The interaction between tumour cells and their microenvironment has an important role in cancer pathogenesis. Alfano et al. review how dysregulation of the extracellular matrix and microbiota associated with the human epithelium might influence the development and progression of urothelial carcinomas.
The introduction of a targeted approach to treatment of prostate cancer requires the approval of novel medical devices. Here, authors describe the regulatory pathways that govern the approval of novel medical devices for clinical use. Owing to differences in legislation, these approval pathways differ substantially between the European Union and the USA, often resulting in patients receiving different treatments for prostate cancer in Europe, compared with the USA.
Men of African origin are disproportionately affected by prostate cancer; in this Review, McGinley and colleagues discuss the disparities in treatment, the cancer-survivorship experience, and quality-of-life outcomes, as well as aspects that might contribute to these differences including socioeconomic, cultural, and genetic factors.
In this Review, Vignozzi and colleagues describe how metabolic syndrome and its components contribute to the development of lower urinary tract symptoms during ageing, highlighting the influence of inflammation and sex steroid imbalance. They also discuss whether lifestyle modification and weight loss are effective in prevention and treatment of this urological condition.
