Reviews & Analysis

Urethral carcinoma is a rare malignancy, without validated treatment protocols. In particular, the role of chemotherapy remains poorly defined. In this Case Study, Nicholson and colleagues discuss a 48-year-old woman with a T4N0M0 tumor, who was successfully treated with neoadjuvant TIP (paclitaxel, ifosfamide, cisplatin) chemotherapy followed by consolidative chemoradiation therapy.

Radical cystectomy remains the gold standard for muscle-invasive bladder cancer; however, there is still debate over the best approach for managing advanced bladder cancer. In this Review, Ghoneim and Abol-Enein critically assess the current treatment options for the disorder.

Despite substantial improvement in the survival data for patients with prostate cancer, almost half of men with localized disease are not cured by surgery or radiation. In this Review Mazhar and Waxman assess the potential of using chemotherapy early in the natural history of prostate cancer.

Many patients with interstitial cystitis (IC) note that particular foods can exacerbate their symptoms. In this Review, Klumpp and Rudick propose a model, based on pelvic-organ crosstalk, for this association between pain symptoms from IC and dietary modification.

In this Case Study, Tu et al. report a 76-year-old man who presented repeatedly with bleeding from an ileal conduit, identified as being caused by an isolated varix secondary to portal hypertension. The authors highlight that portal hypertension should be considered in the differential diagnosis of hematuria from an ileal conduit.

This Case Study by Bedke and colleagues describes a 36-year-old woman who presented to a urology department with a pelvic mass of unknown etiology. The authors highlight the difficulties of diagnosing and treating an inflammatory myofibroblastic tumor of the bladder, which can easily be misdiagnosed as a malignant lesion or sarcoma. In this patient, the authors initially opted for bladder-sparing surgery with planned complete cystectomy if indicated by the final pathologic report.

This article describes the case of a 51-year-old woman with acute renal failure. Bylund and Pais detail the investigations that the patient underwent, the discovery of bilateral, multifocal malacoplakia lesions of the bladder and ureters, and the patient's management with medical therapy and surgery. This case emphasizes that upper urinary tract malacoplakia can present as an aggressive disease, but that renal preservation can be achieved.

The availability of medical information has enabled many patients to become well informed about their disease, and thus active participants in their care. In this Review, Hellenthal and Ellison look at patient decision making as it pertains to the treatment of urologic disease. The authors demonstrate that patients consider adverse-effect profile, treatment invasiveness and treatment efficacy to be important treatment outcomes.

Bone metastases are common among patients with primary breast, lung or prostate cancers. However, diagnosis of bone metastases can be difficult and is dependent on radiological evidence. In this Review, Zohar Dotan assesses the various imaging modalities that might be suitable for diagnosing bone metastases in patients with prostate cancer.

Prostate cancer has a wide spectrum of biological aggressiveness, but characterization of prostate-cancer aggressiveness at the time of diagnosis can be difficult. Tumor vascularization positively correlates with disease progression and, therefore, markers of angiogenesis could be indicators of clinical outcomes. Circulating endothelial progenitors and circulating endothelial cells play an integral part in neovascularization, and in this Review the authors discuss the potential of these cells as prognostic indicators.

In this Viewpoint, Gallagher and Bajorin advance the case for using neoadjuvant chemotherapy in muscle-invasive bladder cancer. They contend that preoperative chemotherapy in these patients would be likely to result in survival benefits similar to those seen in breast and colon cancers.

Polyarteritis nodosa is a rare systemic necrotizing vasculitis that requires urgent treatment. Asymptomatic scrotal involvement is relatively common, although symptomatic involvement is rarer. In this Case Study, Bush and colleagues highlight how urological evaluation including scrotal biopsy can enable rapid diagnosis of the disease and allow appropriate immunosuppressive therapy to be administered in a timely manner.

In patients with AIDS, urogenital tuberculosis presents both diagnostic and therapeutic challenges. In this Case Study, Figueiredo et al. present a 38-year-old man who was initially misdiagnosed as having a usual urinary tract infection. The authors use the patient to illustrate the unusual presentation and special treatment requirements of immunosuppressed patients with urogenital tuberculosis.

Distinguishing primary bladder adenocarcinoma from metastatic colorectal cancer represents a diagnostic challenge; however, a correct diagnosis can prevent the patient from receiving inappropriate treatment. Here, Izzo et al. use the case of a 71-year-old woman to highlight important issues in the diagnosis of these bladder neoplasms, with particular focus on the role of immunohistochemistry.

The signs and symptoms of testosterone deficiency can be nonspecific, and can vary according to patient age and the presence of comorbid illnesses, thereby making diagnosis of the disorder difficult. In this Review, Tostain and Blanc highlight the problems and solutions in diagnosing testosterone deficiency by looking at the signs and symptoms, diagnostic tests, and epidemiology of the disorder.

In this Viewpoint article by Dr Karl and colleagues, the authors discuss the benefits of fluorescence cystoscopy for the diagnosis of transitional cell carcinoma of the bladder, which include reduced residual tumor rate and tumor recurrence rate, and enhanced detection of carcinomain situand multifocal tumors, when compared with white-light cystoscopy.

Radical cystectomy is the preferred treatment for nonmetastatic muscle-infiltrating bladder cancer, but several researchers have proposed the use of bladder-sparing approaches. In this Review, Pansadoro and Emiliozzi discuss a variety of possible bladder-sparing approaches and the evidence supporting their use.

Many experimental studies have reported that statins, cholesterol-lowering drugs, inhibit the growth of prostate cancer cells. In this Review, Murtola and colleagues look at the current evidence on the use of statins in the prevention of prostate cancer.

The optimum management of patients with low-stage seminoma remains a matter of debate. Here, Resnick et al. detail the case of a 51-year-old man who was diagnosed with bilateral stage I testicular seminoma. The authors discuss the management of bilateral disease, addressing the implications of surgical castration and the possibility of testis-sparing approaches to treatment.

In this Viewpoint article by Professor Kattan, the author discusses methods for predicting outcomes in patients with prostate cancer, the predictive accuracy of these methods, and why, despite the large number of nomograms already developed, further nomograms are still needed for predicting outcomes in patients with prostate cancer.