News & Views in 2013

In a recent retrospective institutional analysis, the prognosis of patients with muscle-invasive bladder cancer improved over time after surgical intervention. Indeed, duration of survivorship after radical cystectomy was inversely correlated with risk of mortality, suggesting that follow-up regimens should be modelled according to this parameter.

Indocyanine green dye continues to be adopted in robot-assisted surgical procedures; its role has expanded from partial nephrectomy to now include reconstructive procedures. Further studies are required to evaluate whether it is simply an interesting tool in the armamentarium or a technique that can improve patient outcomes.

Bladder cancer recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) is a common occurrence. A new nomogram, based on retrospective analysis of a large multicentre cohort, has been shown to predict the risk of intravesical recurrence. Despite limitations, this model could help clinicians to provide personalized postoperative management.

Patients treated with two or more courses of BCG for high-risk non-muscle-invasive bladder cancer are at increased risk of second-site primary tumours of the upper urinary tract and prostatic urethra. A new study highlights the importance of looking for urothelial cancer in extravesical disease sites.

In the quest for reduced morbidity from radical treatments, tissue-sparing focal therapies are being developed to treat men with localized prostate cancer. However, which patients are most suitable for these experimental therapies remains unclear. One population-based study suggests that the majority of patients are suitable candidates.

A randomized trial involving 460 women with stress urinary incontinence compared physiotherapy with midurethral-sling surgery. We question whether the results, showing higher rates of improvement and cure for surgery than for physiotherapy, should change best practice and clinical practice guideline recommendations.

After biochemical recurrence following radical prostatectomy, external beam radiation therapy (EBRT) reduces the risk of prostate-cancer-specific mortality. However, many men with a detectable serum PSA level will never experience clinical progression. New definitions of biochemical recurrence could help to determine the most appropriate candidates and time points for salvage EBRT.

A retrospective, single institution study of 450 men with biochemical recurrence after radical prostatectomy included 140 men with androgen deprivation therapy deferred until metastatic disease onset. Metastasis-free survival was an independent predictor of overall survival. This research highlights the need to develop appropriate intermediate end points to expedite prostate cancer treatment.

The International Bladder Cancer Group has proposed a new definition for disease progression in non-muscle-invasive bladder cancer that includes stage and grade progression. Although this definition will inevitably be subject to changes, it can currently be regarded as the gold standard for future trials, publications and protocols.

Post-hoc analysis of phase III data of abiraterone in men with castration-resistant prostate cancer showed that survival did not differ according to patient age (≤75 years versus >75 years). Similar analyses of other agents have reported mixed findings. Should patient age be part of decision making?

Very few studies have followed patients with renal cell carcinoma for long enough to characterize late relapses. Newly published research suggests that late-recurring tumours are more likely to be of low nuclear grade and show a better response to first-line targeted therapy than early relapsing cancers.

A recent study has reported a novel approach to primary bladder exstrophy closure without osteotomy in newborns. In this study, most patients were managed on a paediatric urology ward with an epidural catheter, with similar outcomes to patients treated in an intensive care unit with ventilation and muscle relaxation.

The American Academy of Paediatrics has revised its guidelines on the management of first UTI in children. The translation of evidence-based guidelines into clinical practice is often slow and inconsistent, but a recently published implementation study has demonstrated that rapid adoption of evidence-based UTI recommendations is achievable and beneficial.

Pelvic lymph node dissection (PLND) has an important role in staging and therapy of prostate cancer, especially for high-risk disease. A novel tool has been proposed to correctly predict the probability of node-negative status after radical prostatectomy with PLND that could help postoperative decision making.

A newly developed genetic risk score derived from studies of several single nucleotide polymorphisms has the potential to improve the prediction of prostate cancer detection on biopsy for men with PSA levels of 1–3 ng/ml. Understanding the score's characteristic differences from biomarkers is important in order to utilize it correctly.

Fetal intervention for lower urinary tract obstruction (LUTO) has been technically feasible since the 1980s, with vesicoamniotic shunting being the most commonly employed technique. Despite the recent publication of the first and only randomized trial of fetal shunting, questions linger about the long-term efficacy and clinical impact of prenatal intervention.

Although a moderate body of evidence supports the efficacy of ileovesicostomy for neurogenic bladder in adults, its use in children has been largely undocumented. However, recent data show that this procedure should be considered for a selected paediatric population.

Radium-223 is an emitter of high-energy α particles that binds selectively to areas of high bone turnover. In a recently published phase III trial, it prolonged overall survival of patients with symptomatic, castration-resistant prostate cancer with bone metastases and, as a result, has gained FDA approval for this indication.

Deviating from the most widely described approach for robot-assisted radical prostatectomy (RARP), researchers have reported the exceptional outcomes of a Retzius-sparing approach in which they pass through the pouch of Douglas and avoid transecting all structures anterior to the prostate.

Robot-assisted laparoscopic sacrocolpopexy (RSC) offers the advantages of minimally invasive surgery, especially to surgeons who do not have laparoscopic expertise. A recently published series adds to the growing body of evidence that RSC achieves comparable outcomes to the open approach with minimal morbidity.