Volume 9 Issue 4, April 2012

Acute urinary retention (AUR) remains one of the greatest challenges faced by a clinician when treating BPH and bladder outlet obstruction. Most importantly, bladder outlet obstruction can be extremely distressing for the patient. A number of therapeutic options are available.

Despite great interest in the role of endothelial dysfunction as a predictor of both major adverse cardiovascular events and erectile dysfunction, there are currently no validated diagnostic tools available. A new noninvasive device has been proposed for the early detection of penile endothelial dysfunction in patients with erectile dysfunction.

Randomized trials on prostate cancer screening are limited by logistical and temporal issues. Modeling can be useful to estimate the results for alternative scenarios not examined in the studies and to explain sources of variation between trials.

Laparoendoscopic single site (LESS) surgery is increasingly performed for a multitude of urologic procedures. There has been considerable debate regarding the benefit of LESS surgery. Laboratory evaluation of acute-phase markers in patients receiving conventional laparoscopic and LESS nephrectomy provides new insight.

Studies have reported an increase in the use of nephron-sparing surgery (NSS) since 2002, but quality of life (QOL) may be decreased in patients managed with partial versus radical nephrectomy. These reports have highlighted existing challenges in ensuring delivery of NSS in appropriate candidates while balancing risks to mortality, morbidity and QOL.

Optimizing continence outcomes without compromising oncologic results is a challenge for surgeons performing radical prostatectomy. Many individual technical maneuvers can improve early recovery of continence, but as yet there is no optimized composite technique. Here, the authors propose a ten-step approach to collating these surgical maneuvers into a unified technique that could provide the best possible recovery of urinary control without risking oncologic outcomes.

Proteoglycans regulate cell behavior through interactions of their core proteins and glycosaminoglycans with extracellular matrix proteins, growth factors and chemokines. Changes in proteoglycans occur in the tumor microenvironment, but the consequences of those changes are not well understood. Here, Edwards discusses proteoglycans studied in prostate cancer, considering their roles in tumor progression and how cancers use changes in proteoglycans to promote their own survival, growth and spread.

The expanding use of prenatal ultrasonography has prompted discussion of the feasibility and capabilities of fetal intervention for urological disorders. In this Review, the authors examine the current status of prenatal intervention in fetuses with specific identifiable urologic abnormalities, with a primary focus on fetal interventions for congenital adrenal hyperplasia and lower urinary tract obstruction.

Hematuria can signify serious disease, such as urothelial cell carcinoma, renal cell cancer or urinary tract stones. Nigel Cowan provides an overview of the CT urography technique and explains why it is a suitable modality for the investigation of hematuria, including a discussion of the optimum diagnostic strategy and clinical utility.

Although it provides the standard diagnostic tool for prostate cancer, the performance of TRUS-guided biopsy is constrained by the biomechanical attributes of the sampling strategy, resulting in suboptimal detection efficiency of each core. In this Perspectives, Ahmed et al. propose using a biomedical-engineering approach—a uniform grid sampling strategy to improve the detection efficiency of prostate biopsy.