Review Articles in 2007

Obesity can predispose people to developing a number of urological conditions. In this Review the authors discuss the diagnosis and management of stone disease in obese patients, highlighting some of the challenges endourologists face with this patient group. Risk factors for stone formation are also reviewed, including gastric restriction procedures.

There are a number of treatment options available to patients with prostate cancer. In this Review the authors discuss patient selection for, and treatment success associated with, permanent prostate seed implantation brachytherapy for prostate cancer and its use in combination with other treatments such as external beam radiotherapy.

Current tests for the initial diagnosis of prostate cancer have limited sensitivity and specificity, and new biomarkers are being investigated. This Review discusses the use of molecular techniques for research into gene expression in prostate cancer and the biomarkers identified that could prove to be useful in the diagnosis and categorization of prostate cancer.

Following prostatectomy, many men suffer with urinary incontinence. Stress urinary incontinence (SUI) can continue to be bothersome in some men, even after treatment with conservative therapies. In this article the surgical treatments for male SUI are reviewed. The suitability and efficacy of both the artificial urinary sphincter and the more recently introduced male sling are discussed in detail.

Radical surgery for penile carcinoma produces good cure rates, but severely impacts on patients' quality of life. For a select group of patients, conservative treatments can be a suitable alternative producing good cure rates without such a negative impact on quality of life. In this Review, the different organ-sparing treatments for penile carcinoma are discussed, along with their suitability for patients with cancers of different stages.

There has been much research examining the relationship between body mass index (BMI) and the risk of developing prostate cancer and disease progression. Despite the number of studies, it has been difficult to establish how BMI might influence cancer risk and development. This Review article discusses the available data on BMI and obesity, and how these factors might influence the risk of developing prostate cancer, cancer screening and treatment.

Quality of life is an important factor that men with prostate cancer and their physicians consider when choosing an appropriate treatment option. Nerve-sparing radical prostatectomy offers the possibility of reducing postoperative complications relating to sexual, bladder and bowel dysfunction. This article reviews the techniques that can be used to improve outcomes in patients undergoing nerve-sparing surgery for prostate cancer.

Bladder cancer is a difficult disease to manage and requires long-term follow-up after treatment including the use of cystoscopy for detecting recurrence. In this Review the role of hexaminolevulinate (HAL) fluorescence cystoscopy for the detection of bladder cancer is discussed in comparison to standard, white-light cystoscopy.

The cure rate for men with testicular tumors is high and quality of life is an important consideration for these patients. This Review discusses the different conservative treatments available for testicular cancer, their efficacy and suitability for patients.

Interstitial cystitis is a chronic disease of unknown origin, for which definitive diagnostic criteria remain undecided. Various epidemiological characteristics of interstitial cystitis suggest an autoimmune nature to this disorder, and clinical associations have been made with generalized autoimmune diseases, among other disease. This Review discusses these autoimmune associations and various possible causal mechanisms.

Developments in medical imaging have driven advances in minimally invasive surgery, and image-guidance is now an integral part of many urological procedures. This Review discusses developments in imaging technologies such as fluoroscopic imaging, molecular imaging, image fusion and four-dimensional ultrasonography, and their applications in urological practice.

There is much debate about which biopsy strategy is best to use in patients with suspected prostate cancer. In this Review the different biopsy templates are discussed in relation to their use for an initial prostate biopsy in men identified by PSA screening or an abnormal digital rectal examination and repeat biopsies.

The frequency of testicular microlithiasis detection has increased as imaging technologies have advanced. Associations have been made between this and various other testicular disorders, including cancer, but the causative nature of the relationship is unclear. This Review assesses the evidence for associations with testicular tumors, infertility and other benign scrotal pathologies, and how to manage patients.

With increased incidental diagnosis of renal cortical tumors and imaging advances enabling the detection of smaller tumors, the number of required surgeries is also rising. Partial nephrectomy, although attractive, is underused, possibly because of concerns over its technical complexity and a related morbidity risk. Here, nephrectomy techniques are discussed, with particular emphasis on open partial nephrectomy.

A number of management options are available for patients with upper urinary tract transitional cell carcinoma. In this Review these different treatment options are discussed along with issues of how to select the most appropriate treatment for patients with different clinical characteristics. Follow-up is also reviewed, particularly the issue of tumor recurrence in the bladder.

Acute urinary retention (AUR) is a serious medical condition that requires emergency treatment. In this Review the authors discuss the different risk factors that can contribute to the development of AUR in men and how to identify men that could be candidates for medical therapy to reduce the risk of developing AUR.

Where anticholinergic therapy fails for overactive bladder and detrusor overactivity, botulinum toxin can be an excellent alternative. Data on this therapy's mechanisms of action, optimum delivery techniques and indications are, however, still unclear. This Review discusses these issues, mainly in relation to neurogenic and idiopathic detrusor overactivity but also with new therapeutic directions in mind.

Laparoscopic surgery is widely used in urology, particularly in the treatment of prostate and renal cancers; however, laparoscopic cystectomy with urinary diversion is only just emerging for the treatment of bladder cancer. The authors of this Review discuss the advantages and disadvantages of laparoscopic compared to open surgery for the treatment of bladder cancer.

Urethral and prostatic α₁-adrenoreceptors are thought to mediate the dynamic component of benign prostatic obstruction. Pharmacologic antagonists of these receptors can notably improve symptoms, even in patients who have undergone prostatectomy. This Review provides an update on the distribution of α₁-adrenoreceptors in relevant urinary tract structures and how this might affect therapy with antagonists.

Perioperative myocardial ischemia is common in patients who undergo high-risk surgery, and might be predictive of postoperative cardiac morbidity or mortality. In this Review the authors discuss the diagnosis, monitoring and prophylaxis of perioperative myocardial ischemia and infarction in patients undergoing major urological surgery.