Reviews & Analysis

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.

This Viewpoint documents recent developments in the field of renal cortical tumors, focusing on the current status of open partial nephrectomy. The author argues that nephron-sparing surgery is under-utilized, and that the current trend for urologic surgeons to adopt laparoscopic radical nephrectomy as a minimally invasive alternative could have important consequences for overall renal function.

Some patients are at an increased risk of developing infection when undergoing outpatient procedures and, as a result, may require antimicrobial prophylaxis. A thorough assessment of patient risk factors is, therefore, essential. In this article the indications for prophylactic use of antibiotics in commonly performed outpatient urologic procedures and the different treatment regimens are reviewed.

Although bladder-outlet obstruction (BOO) in women is an increasingly common problem, there are currently no accepted criteria used to define this type of bladder dysfunction. This review discusses the different symptoms associated with BOO in women and the role of urodynamic testing in diagnosis. Iatrogenic BOO following incontinence surgery is also discussed.

The laparoscopic approach for treating renal tumors has become standard practice in many medical centers, and while there are no absolute contraindications to performing laparoscopic renal surgery a number of factors should be considered when making treatment decisions. This review presents the indications and contraindications for the use of laparoscopic radical and partial nephrectomy for the treatment renal cell carcinoma.

Interstitial cystitis (IC) is a poorly understood chronic condition that is difficult to diagnose and treat. The most characteristic symptom of IC is debilitating pelvic pain. This article reviews the different oral agents and other nonsurgical therapies that are available for the treatment IC, with particular emphasis on the management of pain associated with IC.

Over the years, the International Continence Society (ICS) has produced a series of standardization reports concerning the terminology of lower urinary tract function. In this Viewpoint, the authors highlight the advantages of using standardized ICS terminology in both clinical and scientific practice.

For patients with benign prostatic hyperplasia, pharmacologic treatment has emerged as an attractive alternative to surgical intervention; however, there are unresolved questions regarding nonsurgical approaches. The author reviews the evidence to address one such question: whether a combination of two drugs provides greater symptomatic relief than standard monotherapy.

Gonadotropin-releasing hormone (GnRH) agonists are commonly used to treat men with prostate cancer. The hypogonadal state induced by GnRH agonists can lead to increased bone loss and, ultimately, osteoporosis in many men. This review outlines the mechanisms involved in bone loss associated with GnRH agonists and discusses the different measures that can be utilized in the treatment and prevention of osteoporosis in this group of patients.

In order to understand the mechanisms behind abnormal gonadal development it is important to understand the process of normal development. In this review, the normal development of the gonad in mammals, and the molecular pathways and candidate genes that have been implicated in abnormal gonadal development, are discussed.

The process of angiogenesis is central to the development and spread of cancer. Modern imaging techniques are increasingly offering ways in which the markers of angiogenesis can be visualized. This article discusses the different imaging methods that can be used to assess angiogenesis in the prostate gland.

Ablative modalities are gaining currency as viable treatment options in selected renal cancer patients, but outcome data remain relatively premature. In this Viewpoint, John Pattaras and Fray Marshall discuss the limitations and uncertainties surrounding one of the most studied modalities for renal tumor ablation.

In this article by André Naudé and Chris Heyns the controversial issue of management of urethral strictures is tackled. The authors review the relative efficacy and suitability of internal urethrotomy, dilation and urethroplasty for treatment of different types of stricture. An algorithm for the initial management of strictures and treatment of recurrent strictures is included.

There is growing evidence that interstitial cells play a functional role in the urinary tract. This review by Alison Brading and Karen McCloskey focuses on what is known about specialized interstitial cells, their underlying physiology and their possible roles in regulating smooth-muscle activity and neural control in the urinary tract. The involvement of these cells in bladder pathology is also discussed.

When seeking a diagnosis in patients complaining of lower urinary tract symptoms there is a bewildering variety of questionnaires, symptom scales, measurements and urodynamic tests that can be utilized. The appropriate use of these different diagnostic tools and their associated strengths and weaknesses are discussed in this primer review by Christopher Chapple.