Reviews & Analysis

With the absence of clinical trials powered to address the issues of safety and efficacy of testosterone replacement therapy for late-onset hypogonadism, management of men with this condition is not straightforward. This Review examines the available evidence for the use of testosterone replacement therapy in men with late-onset hypogonadism and comments on how these men can be managed in the absence of definitive data.

In order to ensure that the results of histologic analyses are accurate, appropriate handling of tissue samples is essential. This Primer Review discusses tissue fixation and the morphological changes that can be induced by different methods of fixation. The medicolegal aspects of tissue harvesting and storage are also highlighted.

The use of androgens to treat sexual dysfunction in women remains controversial. In this Viewpoint, the author reviews the reasons behind the widespread off-label use of testosterone products to promote female sexual wellbeing, and the safety and efficacy of these products in this setting.

Improvements in detection and staging of renal cell carcinoma have led to a downward migration in the stage of tumors diagnosed. This stage migration coupled with refinements in surgical techniques has led to an increase in the use of nephron-sparing surgery. The indications and contraindications for partial nephrectomy and its associated advantages and disadvantages are discussed in this Review.

It is a decade since monoclonal antibody scans targeting prostate-specific membrane antigen (PSMA) were first approved for imaging prostate cancer soft tissue metastases. This article discusses the utility of capromab imaging in prostate cancer, reviewing its current role and developments in new, second generation, antibodies to PSMA.

Increased purinergic nerve-mediated bladder contraction associated with ageing and some bladder conditions has indicated a role for purinergic signaling in the pathophysiology of bladder dysfunction. This Review examines purinergic signaling mechanisms in bladder function and the development of purinergic antagonists that might, in time, provide treatments for a number of bladder disorders.

This Viewpoint provides a timely review of the current status of surgical treatments for men who develop stress urinary incontinence after radical prostatectomy. The author discusses the safety and efficacy of the bone-anchored perineal sling, a procedure that has recently undergone several modifications and is arguably emerging as a viable alternative to the artificial urinary sphincter.

Neuroendocrine cancer of the prostate is a challenging disease to characterize and treat. Although there are a number of diagnostic and prognostic markers for this disease, no definitive marker exists. In this Review, the characterization of neuroendocrine differentiation and the management of patients with these tumors of the prostate are discussed.

A number of angiogenic pathways have been implicated in urologic cancers, which could hold the key to developing antiangiogenic therapies against such tumors. Promoters and inhibitors of angiogenesis in tumors of the prostate, bladder and kidneys, and their use as either tumor markers or potential anticancer treatments, are reviewed in this article.

Chronic pelvic pain syndromes are notoriously difficult to manage; little is known about their pathophysiology and most treatments are aimed at relieving the pain associated with the different disorders. This Review discusses some of the available treatments that are being used for the management of chronic pelvic pain and novel therapies that are under investigation.

This Viewpoint provides a concise overview of transobturator and retropubic techniques for the surgical treatment of female stress urinary incontinence. The authors focus on a new generation of minimally invasive devices for sling placement, including the transvaginal tape and their own distal urethral polypropylene sling.

Retrograde stone migration during ureteroscopy leads to longer operating times, more-invasive endoscopy, and an increase in residual stones and the need for secondary procedures. In this Viewpoint, the author describes his experience with the various devices developed to prevent stone migration, focusing on the Stone Cone.

Patients with bladder exstrophy present a challenge to urologists specializing in reconstruction. There are several different techniques by which repair can be achieved, each with their own associated success rates and morbidities. This article compares the techniques of staged reconstruction and complete primary repair of bladder exstrophy, highlighting the relative advantages and disadvantages associated with each method.

A goal-directed approach to managing men with male sexual dysfunction is important in order to fully understand the biological and psychological dimensions of each patient's condition. The evaluation and management of men presenting with symptoms of sexual dysfunction, and those with urologic problems and comorbid conditions that are associated with sexual problems, are discussed in this Review.

Elevated levels of nerve growth factor (NGF) in the bladders of patients with idiopathic overactive bladder syndrome, interstitial cystitis and benign prostatic hyperplasia has pointed to a role for NGF in the pathogenesis of lower urinary tract diseases. This article discusses the biology of NGF, its production in the bladder, and the mechanisms underlying its role in disorders of the lower urinary tract.

Screening for diseases is a fact of modern medicine. For prostate cancer, the issue is complex, as the overall benefit to patients is far from clear. In this Viewpoint, the advantages of early detection and treatment with PSA screening are weighed up against the risks of overdiagnosis and unnecessary treatment.