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Androgen deprivation therapy (ADT) is well established as a cause of osteoporosis and increased fracture risk. A study has shown that toremifene reduces fracture risk in men receiving ADT for prostate cancer. The study has substantial limitations, however, and the management of bone disease in these patients remains a challenge.
Hypothyroidism is a commonly reported side effect of treatment with sunitinib and sorafenib. A recent study has correlated development of subclinical hypothyroidism with clinical outcome, notably response rate and overall survival, in patients with metastatic renal cell carcinoma who are being treated with these drugs.
Results from a Swedish study have suggested that the risk of inguinal hernia following prostatectomy is higher in men undergoing open surgery than in those treated via a robot-assisted laparoscopic technique. Patients should be made aware of this risk during the informed consent process.
Timed voiding is an important part of urotherapy, the preferred first management option in children with urinary incontinence. A Danish randomized controlled trial has shown that the use of a watch set with alarms to remind the child to void significantly improves adherence to the timed voiding regimen, resulting in better daytime continence.
Transurethral resection of the prostate (TURP) is the gold standard treatment for obstructing benign prostatic hyperplasia (BPH), but it is limited to prostates weighing less than 100 g and is associated with substantial complications. There is thus great interest in finding alternative techniques to treat obstructing BPH.
The fact that semen analysis cannot predict fertility has long been a source of frustration for both patients and physicians. Studies have demonstrated that semen analyses have poor predictive value for fertility status. Thus, the WHO reference values for human semen characteristics are of particular interest to anyone attempting to conceive and to the professionals who must counsel these individuals.
Barrington's nucleus, the pontine micturition centre, is central to a circuit involved in the coordination of pelvic visceral activity with appropriate elimination behaviors. In this Review, the authors discuss the neuroanatomy of Barrington's nucleus and its projections, and the role of this nucleus in urological disorders. They also discuss a putative role for corticotropin-releasing factor as a potential mediator of these effects.
The involvement of androgens in the development of BPH is widely accepted, but new evidence suggests a role for estrogens too. Ho and Habib describe the prostatic expression and function of key components of each signaling pathway, paying particular attention to how therapeutic inhibition can be utilized for clinical management of BPH.
Although pTa low-grade papillary bladder tumors are at low risk for progression, one-third will recur within 5 years. With this in mind, Falke and Witjes discuss the clinical pathway of low-risk bladder cancer based on current guidelines, from diagnosis using classification systems to treatment options and recommended follow-up.
Urogenital dysfunction is a common problem in patients who have received treatment for rectal cancer, often due to damage to pelvic autonomic nerves. In this Review, the authors discuss the neuroanatomy of the pelvis and the surgical techniques which can result in nerve damage, as well as considering possible approaches to reducing the poor urological outcomes associated with rectal cancer treatment.
