Reviews & Analysis

In this Case Study, Masterson and Russo report on a patient with a small renal mass who underwent hand-assisted laparoscopic partial nephrectomy and was subsequently found to have substantial locoregional and port-site recurrence. The authors highlight the importance of adherence to oncologic principles when using minimally invasive techniques to treat renal tumors.

Renal call carcinoma is frequently associated with venous tumor thrombus that involves the inferior vena cava. In this Review, Karnes and Blute examine how surgical resection of these tumors should be managed, and emphasize the tactic of operating on the inferior vena cava rather than on the kidney.

Over 200,000 new diagnoses of renal cell carcinoma are made each year in the US, Europe and Australia. Surgical resection is the standard treatment procedure for this disorder; however, there are concerns about what type of nephrectomy procedure will avoid positive surgical margins and high recurrence rates. In this Review, Lam and colleagues assess the different methods of nephrectomy and consider their associations with surgical margins and, therefore, patient prognosis.

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.

Evidence is accumulating that androgen deprivation therapy is associated with increased risks of cardiovascular and metabolic complications. In this Viewpoint, the authors discuss why they consider exercise therapy to be so important in reducing these associated risks.

In this Case Study, Tseng and Matlaga report on a 50-year-old man with a 1.5 cm lower pole renal calculus who was successfully treated with percutaneous nephrolithotomy. They discuss the management options for patients presenting with lower pole calculi and highlight the need for studies evaluating quality-of-life outcomes for the different approaches.

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.

In this Case Study, Buchler et al. report the case of 27-year-old man who had undergone right orchiectomy for testicular seminoma and was subsequently diagnosed with intratubular germ cell neoplasia of the contralateral, atrophic, testis. The controversial issue of testicular biopsy is discussed, as is the optimum management approach in the context of fertility therapy.

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.

Whether or not men over the age of 65 years should receive PSA screening for prostate cancer is a controversial issue. In this first of two Viewpoints on the topic, Whitson and Konety argue that men over 65 years old can have clinically relevant prostate cancer, that they can benefit from prostate cancer treatment, and that PSA screening is warranted in these men.

In this second Viewpoint on PSA testing in men over 65 years of age, Albertsen argues that, from a public health perspective, PSA screening should not be performed in these men. The author discusses the health problem of prostate cancer in this patient population, the accuracy of the PSA test, patient outcomes, and the harm associated with PSA testing.

The iliac-artery–ureteral fistula is a rare, but potentially lethal entity. In this Case Study by Gallo et al. the case of a 66-year-old man who presented with hematuria is used to illustrate the successful diagnosis and management of this condition using only endoscopic techniques.

In this Viewpoint article by Pelzer and Horninger, the authors describe a screening strategy for preventing the underdiagnosis of clinically relevant prostate cancer and the overdiagnosis of clinically insignificant disease. The authors argue that the ultimate goal of screening should be to detect biologically consequential disease sufficiently early to allow treatment for cure.

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.

This Viewpoint article by Siddiqi and Lewis discusses the role of surgical therapy for the treatment of erectile dysfunction. The article explains why surgical therapy will likely always remain an option for specific patients, regardless of whether or not gene therapy is approved for erectile dysfunction treatment.

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.

In this Case Study, Subramanian et al. present a patient who underwent orchiectomy for low-stage nonseminomatous germ cell tumor of the testis. The patient opted for management by surveillance, and subsequently developed a recurrent teratoma of the spermatic cord. The case illustrates the importance of combining imaging and tumor marker measurement in surveillance protocols.

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.