Volume 7 Issue 4, April 2010

Before 2009, no controlled trials of percutaneous tibial nerve stimulation (PTNS) for overactive bladder had been reported. However, publication of a randomized unblinded tolterodine-controlled trial of PTNS and the reporting of two blinded placebo-controlled studies now provide level 1b evidence of efficacy. PTNS should, therefore, be considered as a treatment option in this setting.

Accurate estimates of treatment success, complications and long-term morbidity are essential for patients to make informed medical decisions regarding treatment. Several multivariate prediction models have been developed to predict patient outcome after radical cystectomy (RC) for bladder cancer. The IBCNC postcystectomy nomogram can improve clinical decision making and therefore patient outcome. The inclusion of biomarkers might improve the accuracy of nomogram predictions in the future.

Use of a multivariable 'Riskindicator' model might increase the accuracy of screening for clinically significant prostate cancer. Such models, in conjunction with novel biomarkers, hold promise for improving the specificity of screening, and could help to reduce the number of unnecessary biopsies performed in this setting.

No established definition exists of therapeutic success after high-intensity focused ultrasound in patients with localized prostate cancer. A recent analysis has proposed a definition of biochemical failure for use in this setting. However, much work still needs to be done on identifying suitable predictors of clinical failure, and large-scale validation is certainly required.

Ischemic priapism can result in erectile dysfunction if unresponsive to treatment. A recent study advocates immediate penile prosthesis implantation in patients with treatment-refractory ischemic priapism to avoid loss of penile length and to facilitate insertion of the prosthesis. Such a protocol may well become the standard of care in future.

In this Review, authors from Stanford University discuss the differences between children and adults in the presentation and diagnosis of atraumatic, asymptomatic hematuria. In adults, evaluation focuses on distinguishing benign from malignant etiology. In children, by contrast, evaluation should focus on glomerular versus non-glomerular causes.

Urologic cancers during pregnancy are rare, but pose an important clinical challenge. Makarand Khochikar discusses the diagnosis and treatment of these cancers, which often present with symptoms that mimic common pregnancy-related disorders. Appropriate treatment is imperative, and depends on the type of cancer and the stage of pregnancy at which it is detected.

Late radiation cystitis affects up to 10% of patients who receive radiotherapy for a tumor in the pelvic region. Shaun Smit and Chris Heyns discuss the available management strategies for those with this potentially life-threatening complication, including intravesical and systemic therapies, surgical interventions and hyperbaric oxygen treatment.

Pharmacological treatments for Peyronie's disease generally have limited success. Research using cell culture systems and animal models has provided insights into the fibrotic mechanisms underlying this disease, and has revealed a novel and potentially effective application of phosphodiesterase 5 inhibitors in this context.

Stress urinary incontinence affects most men who undergo radical prostatectomy. This dysfunction will spontaneously resolve within 12 months for most patients—exercising the pelvic floor has been shown to hasten recovery. There are a number of surgical options for men in whom the condition persists.

The authors describe a patient with a persistently elevated level of human chorionic gonadotropin (hCG) during chemotherapy for suspected low-risk, metastatic nonseminomatous germ cell tumor. His hCG level was found to have been falsely elevated owing to the presence of heterophile antibodies that interfered with the hCG immunoassay.