Review Articles

Systems pathology can overcome the limitations of more traditional pathology techniques to provide information that can be used in predicting prognosis and selecting appropriate treatments for cancer patients. This Technology Insight describes the techniques involved in systems pathology, and discusses its application in the pathologic investigation of prostate cancer and in predicting the prognosis of patients with this disease.

Studies have challenged the traditional view that the urothelium is a passive barrier to solutes and ions, and have demonstrated its sensory role in bladder function. The authors of this Review discuss the studies that have examined sensory mechanisms in the urothelium and the role these mechanisms have in the pathophysiology of bladder dysfunction.

Laparoscopy is important in the treatment of children undergoing renal surgery and for the management of nonpalpable testes. Despite this, laparoscopy is still underutilized in the treatment of urologic disorders in children, compared to adult patients. This Review discusses the most common urologic indications for laparoscopy in pediatric patients and highlights problems that are specific to this patient group.

There are a wide variety of testosterone preparations and delivery systems available for men requiring testosterone replacement therapy. The choice of preparation should be made according to patient characteristics, such as age. The authors of this Drug Insight Review discuss the pharmacokinetics of a number of testosterone preparations and their relative advantages and disadvantages in treating different patient groups.

Bladder cancer staging is essential for assisting clinicians and patients in deciding on appropriate treatments. A number of different genetic and epigenetic changes have been linked with bladder cancer and numerous prognostic markers are being developed. This Review discusses the genetic changes associated with transitional cell carcinoma of the bladder and the different biomarkers that are under investigation.

Sling surgery is the most commonly performed procedure for the treatment of female stress urinary incontinence, but can be associated with a number of complications. In this Surgery Insight Review the complications that can arise during and after surgery are discussed and techniques that can be used to either reduce the incidence of complications or to correct resulting morbidities are highlighted.

Pelvic lymph node dissection is an essential part of radical prostatectomy for the accurate staging of prostate cancer. The concept of sentinel lymph nodes in prostate cancer is being investigated as a way of reserving extended lymph node dissection for only those patients with lymph node metastases. In this Review the authors discuss radioisotope-guided sentinel lymph node dissection in prostate cancer staging.

It is now possible to use the internet to mentor and assist surgeons remotely and, with the aid of robotic systems, to conduct surgery remotely. Telementoring and telesurgery have the potential to improve the quality of care available to patients that live in remote communities where resources are limited. The authors of this Review discuss the different areas of telemedicine, their applications and associated advantages and disadvantages.

Heat shock protein 90 (HSP90) plays a major role in many cancers, including tumors of the prostate and kidney. Its function in cell regulation makes it a potential target for treatments against cancer. This Review provides insights into the role of HSP90 in urologic cancers and discusses the data from clinical trials examining the use of HSP90 inhibitors in the treatment of patients with urologic cancers.

The average age at which children are considered toilet trained is around 2.5 years, but it can take place between the ages of 1 to 5 years. When diagnosing urinary incontinence it is, therefore, important to consider a child's age. The different types and causes of urinary incontinence in children and their management are discussed in this Primer Review.

The indications for urodynamic testing and its utility in the evaluation of women with stress urinary incontinence (SUI) is a topic of debate. Urodynamic tests can be expensive and cause discomfort, and there are arguments for limiting their use to women with complicated SUI or those that have undergone treatment for SUI. This Review examines these issues and discusses the current recommendations and evidence for the use of urodynamic tests in this patient group.

Marked differences in the incidence of testicular cancer have been observed in relation to geographical area, ethnicity and time period. The authors of this Review examine the available data and discuss the trends observed in the incidence of seminoma and nonseminoma in different populations. Causes of, and risk factors for, testicular cancer and the reasons behind observed increases in incidence are also discussed.

There are a number of treatments available for men with BPH, but 5α-reductase inhibitors are the only medical treatment that can prevent BPH progression and avoid the need for surgery. This Drug Insight Review discusses the 5α-reductase inhibitors finasteride and dutasteride, their efficacy, mechanisms of action and use in men with BPH.

Small molecule inhibitors target growth-receptor signaling, cell-cycle regulation and angiogenesis, and have been the subject of much interest for their potential in treating patients with renal cancer. Although data reported at the 2006 ASCO Annual Meeting have provided further evidence of their potential, it is important that cytokine-based therapies are not forgotten. This review examines the different treatment options for patients with renal cancer.

Lymph node dissection conducted during radical cystectomy is essential for tumor staging in patients with invasive bladder cancer. It might also provide therapeutic benefits for these patients and is, therefore, considered an important part of surgical management. In this Review, the authors discuss standard and extended lymph node dissection in patients with bladder cancer.

The results of the Prostate Cancer Prevention Trial (PCPT) sparked a debate surrounding the advantages and disadvantages of using the 5-alpha reductase inhibitor finasteride as a chemoprevantative agent against prostate cancer. Over three years after the publication of the PCPT results there is still a reluctance to recommend the use of finasteride in this setting. This Review examines the PCPT data and discusses its results in light of further studies.

Deciding on a particular treatment can be difficult when a patient is presented with a range of therapies, each with their own associated chances of cure and risks of adverse effects. Decision analysis provides a more formal way of quantifying the benefits and harms associated with different treatments, which can be helpful in treatment decision making. This Primer Review provides a thorough overview of decision analysis and how it can be incorporated into clinical practice.

As men age, physiological changes take place that can result in late-onset hypogonadism. A number of comorbid conditions are thought to be implicated in the endocrinological changes associated with aging, but their role is yet to be determined. In this Review the authors discuss the pathophysiological mechanisms behind late-onset hypogonadism and age-related endocrinological changes in men.

Disruption of the neural pathways following spinal cord injury can cause detrusor–external sphincter dyssynergia (DSD), where patients have a low capacity bladder with high intravesical pressure. The main aims of treatments for DSD are to reduce intravesical pressure and to improve bladder drainage. This Review discusses the different strategies for managing DSD and their relative merits in this patient population.

Surgical techniques for the management of male infertility give some couples the chance to conceive naturally, without the aid of assisted reproductive technology (ART). In this article, microsurgical techniques for the treatment of obstructive azoospermina and varicocele are reviewed. Sperm retrieval methods for ART in men with nonobstructive azoospermia and in those for whom surgery is unsuccessful are also discussed.