Reviews & Analysis

There has been increasing interest in the use of botulinum toxins for urological disorders because they have shown effective modulation in striated muscle. In this Review, Chancellor and colleagues look at the experimental evidence for the use of botulinum toxin type A in the lower urinary tract.

During the past 15 years, there has been extensive international research in boys with nonpalpable testis. However, the question of what the gold-standard treatment for this disorder should be still remains. This Review assesses the current data on this disorder.

The incidence of germ-cell tumors in men is increasing in Western countries for reasons that are still unknown; however, these tumors are very curable. In this Review, the authors summarize the classification of germ-cell tumors, as well as the treatment options that are available.

Sling techniques to treat female urinary stress incontinence began as invasive reappropriations of muscle. This therapy has, however, evolved into a safe and efficacious approach, for which many types of synthetic sling are now commercially available, each with its own particular characteristics. This Review tracks the evolution of this therapy and discusses current outcomes.

Men with lower urinary tract symptoms frequently do not seek medical advice. For those who do, the traditional view of a solely prostatic origin might hinder management, since growing evidence suggests an important role for nonprostatic causes. This Review clarifies terminology for symptoms and causes and presents an overview of the available medical therapies.

Overtreatment of any disease should be avoided, but the best way to achieve this goal is not always clear. Dall'Era and Konety review active surveillance as an option for men at low risk of developing prostate cancer. They discuss recently reported experiences, modern monitoring methods and the psychosocial impact of this approach.

As the requirement for organs by patients with end-stage renal disease outstrips the size of the donor pool, new sources for kidney donations must be sought. In this Review, the authors discuss the medical, surgical and particularly the psychosocial features of programs aimed at expanding the availability of living donations.

Recurrent prostatic bleeding can be challenging and frustrating for physicians and patients. Sepsis and bladder rupture are notable complications of therapy in severe cases, and more-serious, possibly fatal, events can occur in patients with comorbidities. An overview of causes and a guide to management with biochemical and functional approaches is provided.

Despite being used in practice for around 30 years, the safety of assisted reproductive technologies is still questioned. Studies are hampered by issues related to trial design and consistency of reporting. Some long-term data are, however, now available for offspring conceived after assistance by a variety of technologies. This Review aims to summarize the reported risks.

Balkan endemic nephropathy is a familial disorder that affects people living in the alluvial plains along the tributaries of the Danube River and has a strong association with upper urothelial carcinomas. Although thought to be declining in incidence, it still represents a notable problem and these authors suggest it might be more widespread than previously thought.

The use of nomograms for predicting tumor characteristics and outcomes in prostate cancer patients can be helpful in treatment decision-making. In this article the authors review several nomograms, developed since the observed stage migration in prostate cancer, that can be used to predict cancer prevalence at prostate biopsy, prognosis and pretreatment staging.

Ejaculatory dysfunction is a common and distressing problem for many men, which can adversely affect their personal relationships and quality of life. In this Review the authors discuss the physiopathological, diagnostic, and therapeutic aspects of disorders of ejaculation focusing on premature ejaculation, the most prevalent of these disorders.

Advances in assisted reproductive technologies have led to declining use of therapeutic donor insemination by urologists treating male factor infertility. Insemination by this technique is, however, still appropriate for a notable number of couples trying to conceive. This Review discusses the indications and the related outcomes, costs and psychosocial issues.

Large renal tumors of 7 cm or more in size are associated with important challenges in management. In this Review the authors discuss the different surgical management options for patients with these large tumors. Important complicating factors such as tumor thrombus are discussed and the authors also examine the use of partial nephrectomy in patients with T2 renal tumors.

The process of learning surgical skills is long, complex and involves numerous stages. The authors of this Review discuss the different processes involved in learning and assessing surgical techniques. They highlight the role of surgical simulators in training surgeons in new techniques and how they might help to improve trainee surgeons' performance and patient outcomes.

Androgen deprivation therapy (ADT) for prostate cancer is associated with decreased bone mineral density (BMD) in patients. This decreased BMD can lead to an increased risk of fractures and osteoporosis. In this article the author reviews the prevalence of bone loss in this group of patients, and discusses the implications of reduced BMD and what can be done to prevent or reduce bone loss in men undergoing ADT.