Viewpoint in 2007

Although oral phosphodiesterase 5 inhibitors have substantially improved the treatment of erectile dysfunction, unmet needs among men with erectile dysfunction still exist. This article considers the possibility of gene therapy for these patients, and discusses results from early clinical studies of gene therapy for erectile dysfunction.

In this Viewpoint article, Professor Klotz argues that active surveillance of patients with low-risk prostate cancer, followed by intervention when pre-specified criteria are fulfilled, is an approach that could prevent unnecessary overtreatment of prostate cancer. Professor Klotz describes patients eligible for this approach, the strategy for active surveillance, and the criteria for intervention.

In the October 2005 issue ofNature Clinical Practice Urology, Stapleton and Pinnock raised concerns regarding the use of nomograms in clinical practice. In this Viewpoint, the authors provide further discussion of these concerns, and present an argument advocating the use of nomograms.

Sentinel pelvic lymph node dissection is a radioisotope-guided technique that has been developed for the detection of potential lymph node metastases. In this Viewpoint, Professor Janetschek discusses the possibility that sentinel pelvic lymph node dissection could replace extended pelvic lymph node dissection in patients with prostate cancer.

Measuring PSA velocity to track prostatic pathophysiologic states is appealing for its simplicity, however, much debate continues as to its clinical value in the diagnosis and characterization of prostate cancer. Phillips and Smith discuss the significance of PSA velocity as a diagnostic measure.

Diet and lifestyle are increasingly important and often overlooked factors in male urological illnesses. In this Viewpoint the authors discuss the evidence linking obesity and erectile dysfunction and the benefits of statins. The authors suggest that a more medical approach, including lifestyle advice and medical therapy, is the way ahead for urology.

A recent study investigated the significance of occult metastases in the lymph nodes of prostate cancer patients who were originally considered node negative by histological evaluation. In this Viewpoint the authors discuss pelvic lymph node dissection and survival in prostate cancer patients with evidence of lymph node metastases.

Male factor infertility is currently difficult to diagnose and counseling patients can be challenging. After years of research into endocrine control of spermatogenesis, researchers are now investigating the genes required for male fertility. In this Viewpoint the authors discuss the major advances in the ability to diagnose genetic defects in infertile males.

It is standard procedure to place patients diagnosed with vesicoureteral reflux on prophylactic antibiotics to reduce the risk of developing urinary tract infections and renal scarring. In this Viewpoint the authors discuss the problems associated with this practice, such as poor compliance and growing resistance to antibiotics, and possible alternative treatment options for these patients.

The advent of PSA testing has led to concern that prostate cancer is being over diagnosed with consequent treatment of otherwise harmless tumors, resulting in some centers initiating active monitoring protocols. In this Viewpoint, the authors examine the evidence and argue that early intervention is favorable to active monitoring and delayed treatment.

In the first of two Viewpoint articles to discuss the ethical and practical implications of commercial kidney donation, the author argues that—despite the dearth of suitable organs available for transplantation—we as a society cannot afford to compromise on ethics.

In the second of two Viewpoint articles discussing the ethical and practical implications of commercial kidney donation, the author explains how the Iranian model of rewarded gifting for living kidney donation has revolutionized the transplantation process by completely eliminating waiting lists.

With the popularization of laparoscopic and robotic pyeloplasty has come a resurgence in the debate over the role of crossing vessels in the pathogenesis of UPJ obstruction. In this Viewpoint, the authors examine the evidence and argue that crossing vessels are implicated in the etiology of UPJ obstruction and are important because of their potential to lead to cause surgical complications if they are not recognized.

The treatment of men with lower urinary tract symptoms is controversial, and medical therapies aimed at benign prostatic enlargement are not always effective. In this Viewpoint, the author discusses the challenges of treating this patient group and argues that a variety of approaches must be considered in the management of this complex condition.

This Viewpoint documents developments in the treatment of small renal masses, focusing on the current status of laparoscopic partial nephrectomy. The authors argue that, with careful patient selection, meticulous technique and considerable laparoscopic experience, laparoscopic partial nephrectomy can be performed reproducibly and reliably with equivalent oncologic and renal functional outcomes to open surgery.

This Viewpoint discusses the concept of retroperitoneal surgical templates for lymph node dissection in patients with nonseminomatous germ cell tumors. The author evaluates the benefits and limitations of this approach and argues that the use of modified templates could increase the risk of unresected disease, leading to relapse, repeat surgery, and inferior survival.

The management of small renal masses is a subject of considerable controversy. Many benign masses are surgically removed, and evidence points to the slow growth rate of conservatively managed renal tumors, leading to the suggestion that we might be overtreating small renal masses. In the second of two Viewpoints examining this issue, the authors outline arguments in favor of surveillance therapy as an appropriate management option in selected patient groups.