Volume 6 Issue 10, October 2009

Insertion of midurethral synthetic slings is now the cornerstone surgical approach to treatment of stress urinary incontinence. A group from Poland randomized 537 women to synthetic sling placement using either a retropubic or transobturator technique. The investigators found both procedures to be equally effective in curing or improving the condition.

Considerable costs are incurred when caring for patients with terminal cancer in their last few days of life. With the debate over health care reform in the US being at center stage, focusing primarily on cost reduction, how can we best serve our cancer patients in their final days?

Patients undergoing CT for the evaluation of stone disease are likely to receive high levels of radiation over time. Although the results from small studies using simulation software suggest that using a reduced radiation dose has little effect on calculi detection, larger prospective randomized studies are required to produce clinically applicable results.

EORTC 22961 is the latest trial to investigate the optimum duration of adjuvant androgen deprivation therapy for patients with locally advanced prostate cancer. The results conclusively show superiority of long-term over short-term treatment, and the former protocol should, therefore, be considered standard of care in this setting.

Clinical research in recent years has produced a deepening appreciation of the metabolic consequences of androgen deprivation therapy. On the basis of this knowledge, proactive management of risk factors for diabetes and cardiovascular events is appropriate in men who receive this treatment for prostate cancer.

Despite a plethora of clinical trials, no treatment has shown consistent success for symptomatic management in patients with chronic prostatitis–chronic pelvic pain syndrome. Subdividing this heterogeneous patient population according to phenotype, and selecting therapy accordingly, represents an important step forward in the treatment of this disorder.

In this Review, Tonkin and Jordan draw on their clinical experience to discuss the etiology, diagnosis and management of distal anterior urethral stricture disease. They highlight that curative open surgery, such as graft or flap urethroplasty, should be preferred over repeated minimally invasive procedures in order to optimize patient outcomes.

Cancer vaccines, which stimulate the host immune response to malignant disease, have generally failed to induce durable clinical responses in patients, partly owing to tumor-mediated suppression of the host immune system. Here, Kusmartsev and Vieweg explore ways of targeting these tumor-mediated changes to enhance the efficacy of vaccine therapy for urologic cancers.

A growing body of evidence supports an epidemiologic association between male infertility and testicular germ cell tumor; however, few population-based studies have investigated this relationship. In this Review, Hotaling and Walsh explore the epidemiologic data linking the two disorders, and discuss the potential mechanisms that underlie this association.

Chronic pelvic pain in women is a challenging clinical entity that is frequently encountered by urologists. The diagnostic process can be laborious, and often requires multidisciplinary collaboration. In this Review, the authors discuss the key issues in the diagnosis of this disorder, highlighting the importance of a thorough patient history to direct subsequent investigations.

In this Case Study, El Madhoun and colleagues describe the diagnosis and management of a patient with bilateral renal hemorrhage caused by polyarteritis nodosa. The perirenal bleeding was at first attributed to trauma experienced 1 week before the initial presentation, but review of the case at a subsequent hospital admission identified the true cause of the bilateral hemorrhage.

Zakaria and colleagues describe the case of a previously healthy 29-year-old man with renal infarction. The nonspecific nature of his presenting symptoms caused a delay in diagnosis. The authors provide a comprehensive account of the presenting features, and of diagnostic tests that can distinguish renal infarction from more common conditions.