Volume 13 Issue 5, May 2016

The various clinical guidelines on the workup and initial management of a patient presenting with haematuria are based on limited scientific evidence. Survey data suggest that these guidelines are inconsistently applied, perhaps owing to variations between guidelines and the lack of higher level evidence. Nonetheless, based on existing evidence and appropriate risk stratification, Nielsen and Qaseem describe a haematuria workup that is safe, appropriately aggressive, and cost-effective.

Sexual health, even into older age, is important to many people. A new paper reports that older men with hypogonadism who take testosterone experience significant improvements in sexual activity, erectile function and libido. Testosterone therapy has long been a matter of interest (and controversy) for physicians, and this study is a landmark one that is worthy of further discussion.

Recurrences can occur in up to 30% of surgically managed patients with localized renal cell carcinoma. Existing uro-oncological guidelines differ in recommendations of surveillance protocols and identification of patients at risk. A recent study shows that the existence of differing guidelines results in inadequate harms, cancer control and costs.

A study investigating the mortality attributed to urolithiasis over a 15-year period has noted an increasing rate of death with a simultaneous rise in stone prevalence. However, the exact mechanisms by which nephrolithiasis causes death remains unclear.

Although penile cancer is a rare malignancy, it poses a challenge for the urologist as it frequently requires surgical treatment, which can be both disfiguring and emasculating. Organ-preserving approaches to surgical treatment of the primary tumour, rather than total penectomy, exemplify a major paradigm shift in the clinical management of penile cancer. In this Review, Burnett discusses the different surgical options available for penile-preserving surgery and reconstruction, and the need for careful patient selection and monitoring.

An increasing number of men with low-risk prostate cancer are being managed using active surveillance, often resulting in improved quality of life compared with men who receive treatment for low-risk disease. However, strategies that might delay disease progression and the need for treatment are currently lacking. In this Review, the authors describe the potential of exercise-based interventions to delay the progression of low-risk prostate cancer.

Erectile dysfunction affects up to 75% of men with diabetes. Here, Castela and Costa describe how diabetic endothelial dysfunction — induced by hyperglycaemia, oxidative stress, and impaired vascular repair mechanisms — is the key factor in the pathophysiology of erectile dysfunction in diabetic men.

Lower urinary tract symptoms (LUTS) occur in >80% of patients with multiple sclerosis, have a substantial negative effect upon patients' quality of life and require regular monitoring owing to the progressive nature of the underlying neurodegenerative disease. In this Review, the authors describe the optimal diagnosis, treatment and management of the wide variety LUTs that can occur in patients with multiple sclerosis.

Selection of treatment for a patient with prostate cancer is often based on age and life expectancy. However, life expectancy estimates are often calculated solely on the basis of chronological age, overlooking comorbid conditions and their severity, which affect life expectancy. Here, the authors discuss how factors other than chronological age should be used to assess life expectancy and enable the most appropriate treatment options to be selected. Older, healthy patients might be able to tolerate more-aggressive treatments than their age might indicate, and younger patients with numerous comorbid conditions could avoid harsh therapy if inappropriate.