Volume 6 Issue 7, July 2009

Antimuscarinic drugs are the first-line treatment for overactive bladder. However, traditional formulations are associated with a number of adverse effects, most notably dry mouth. A study comparing a new topical gel formulation of oxybutynin to placebo has confirmed its efficacy and tolerability for treating overactive bladder.

Emerging data indicate that outcomes of surgical procedures are improved if surgery is performed in high-volume hospitals or by high-volume surgeons. This principle seems to hold true for penile prosthesis surgery, but careful consideration is necessary before adopting a 'center of excellence' model for this, or any, procedure.

Retrospective analyses of single-institution experiences are difficult to generalize to the population as a whole. The emerging trend of utilizing national datasets and disease registries provides information relatable to the average patient that may prove considerably more useful to community urologists.

An algorithm used to evaluate risk in patients with prostate cancer has been improved by taking into account the quantity of risk factors present. The adapted scheme accurately predicts disease-specific mortality, and reveals that prostate cancer is the major cause of death in patients with three or more risk factors.

Genetic linkage has recently been reported between several genomic loci and a subtype of prostate cancer that contains a fusion between the genes TMPRSS2 and ERG. These data suggest an analytical approach that might improve future studies of the genetic cause of prostate and other cancers.

A new guideline from the US has neatly summarized the evidence regarding the use of 5α-reductase inhibitors for prostate disease, but falls short of providing definitive management recommendations. It will, however, be a valuable aid to both patients and physicians in the clinical decision-making process.

The importance of prostate biopsy is undisputed, but the procedure can be excruciatingly painful for some men. Does combined anesthesia aimed at addressing the two sources of pain associated with transrectal ultrasound-guided prostate biopsy provide a more effective form of pain relief than either modality alone?

Greater surgeon experience is associated with lower recurrence rates following laparoscopic radical prostatectomy for prostate cancer. A new study shows that the learning curve for this procedure is slower than that for open surgery, and highlights the challenges of developing the unique skills that are required to master each technique.

Modern, high-resolution imaging modalities frequently reveal adrenal masses in patients being assessed for other reasons. Once discovered, algorithms that employ CT, MRI and PET—as well as modifications of these techniques—are used to narrow the very broad differential diagnosis. Here, Milton Gross and colleagues summarize what the urologist needs to know about the imaging features of etiologically distinct adrenal masses.

The development of targeted therapy for renal cell carcinoma (RCC) has changed the treatment options for patients with metastatic RCC. The authors of this Review discuss the current and future role of cytoreductive nephrectomy in combination with targeted therapies, and the rationale for presurgical therapy for this group of patients.

The discoverer of free PSA and his colleagues assess the clinical utility of this most widely used disease biomarker. The article encompasses recently published data from randomized screening trials, and the potential of PSA density, dynamics and subforms to enhance the predictive capacity of total PSA. The PSA characteristics of BPH, prostatitis and prostate cancer are summarized, and the effects of age and obesity presented.

The authors describe a 57-year-old man with paraneoplastic leukocytosis, caused by overexpression of granulocyte-colony stimulating factor from a suprarenal tumor with rhabdoid-like differentiation. This case presented several diagnostic and treatment challenges to the pathologists, surgeons, and oncologists involved, and illustrates the difficulties encountered when diagnosing and treating unusual malignancies.

The causes of blood in the ejaculate are usually benign, and the condition self-limiting. Nevertheless, many patients are worried by such a dramatic symptom. This concern, together with the small risk of malignancy, drives clinical investigation. UK-based authors have reviewed the literature in an effort to provide a clear and concise strategy for the evaluation of men with hematospermia.