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The use of robot-assisted surgery for treatment of genitourinary malignancies is increasing dramatically. Kaye and colleagues argue that consumerism, rather than surgical outcomes, drives the adoption of this expensive technology. Robotics use should be targeted to surgical situations where clinical benefit or cost-effectiveness can be demonstrated.
New androgen-receptor-targeting drugs, such as enzalutamide, provide a substantial survival benefit for patients with castration-resistant prostate cancer, but treatment resistance has been reported. In this Perspectives article, Claessens and colleagues describe the mechanisms underlying the development of such resistance and discuss their clinical relevance.
Jannini et al. describe the evidence supporting the concept of the clitourethrovaginal (CUV) complex, and the overlap with the properties of the elusive G-spot. Consideration of the intricate anatomical relationships involved in female sexual arousal and orgasm could help to avoid damage to the CUV complex during surgery.
Historically, the use of testosterone supplementation therapy (TST) for hypogonadism in men with prostate cancer has been limited by concerns that such treatment might cause progression of this androgen-dependent cancer; however, the contemporary literature indicates that TST in men with prostate cancer can be safe and, contrary to traditional thinking, that TST might actually reduce the risk of prostate cancer development. In this opinion piece, Larry Lipshultz and colleagues discuss the evidence supporting TST—in contrast with the lack of evidence against this approach—in hypogonodal men with prostate cancer.
Johnson and Irwig discuss a community of biological males who desire emasculation and commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures.
BPH–LUTS and erectile dysfunction commonly coexist, and both respond to phosphodiesterase 5 inhibitors. In the opinion of Cellek et al., the underlying pathology of both conditions can be explained by microvascular dysfunction, a vicious cycle of hypoxia, vasoconstriction, altered smooth muscle contractility, and degeneration of autonomic neurons and ganglia.
Urology nursing practice is rapidly developing around the world in response to technological advances, the expansion of service needs, and the increasing subspecialization of urology. Here, Helen Crowe provides unique insight into the successes and challenges of advanced urology nursing and the changing face of this specialty.
