Reviews & Analysis

Controversy exists over the safety of testosterone replacement therapy (TRT) with regard to the initiation, promotion, aggressiveness, and progression of prostate cancer. In their Review, Goldenberg and colleagues argue the importance of classic early literature on the concept of a testosterone threshold level and the implications for use and safety of TRT, as well as describe the biological effects of TRT for testosterone deficiency.

Clinical staging of muscle-invasive bladder cancer remains limited by volume criteria used to identify nodal metastases. The development of accurate predictive models that identify patients at high risk of nodal disease, such as the one described here, is essential to optimize treatment planning for this group of patients.

Extended pelvic lymph node dissection has been shown to markedly improve oncologic outcomes in patients with urothelial carcinoma of the bladder, but the value of lymphadenectomy in the management of upper tract urothelial carcinoma (UTUC) is less clear. In this Review, the authors discuss whether routine regional lymph node dissection can be recommended for UTUC on the basis of the available evidence.

Bladder management is an important aspect of the management of patients with spinal cord injury (SCI). A device capable of performing ambulatory urodynamics on individuals with SCI has recently been developed; however, the benefit of ambulatory urodynamics in patients with SCI is disputed.

A large, randomized, phase III study has shown that denosumab, a monoclonal antibody targeting RANK ligand, is more effective than zoledronic acid for preventing skeletal morbidity in castration-resistant prostate cancer. Although denosumab is convenient to administer and well tolerated, its use is likely to be limited by economic considerations.

The clear-cell variant is the most common subtype of renal cell carcinoma (RCC) and, as discussed in this Review, accurate diagnosis of clear cell RCC is important and can be a challenge. Valera and Merino describe the clinical, pathological, and radiological features of clear cell RCC as well as the factors important to prevent misdiagnosis of this disease.

Over the last decade, NMR technology has become indispensible in the diagnosis and characterization of prostate cancer. In this Review, the authors discuss the evolution of NMR in prostate cancer, from its humble beginnings, up to today's use of NMR metabolomics.

Controlled tissue cooling has been used therapeutically for decades to mitigate the negative effects of traumatic, ischemic, and surgical insults. Finley proposes that since recovery of urinary continence and erectile function is improved when localized hypothermia is used during radical prostatectomy, similar benefits might be observed for other types of radical pelvic surgery.

A recent network meta-analysis of α-blockers, antibiotics and other drug therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) found that they provided modest-to-no benefit for this condition, confirming previous findings. However, a casual reading of the article may give a false impression of the efficacy and appropriateness of these drugs.

As we strive to practice evidence-based medicine, using sophisticated analytical methods to guide our clinical decisions is alluring. Clinicians must, however, be fully aware of the influence of limited data, as with surgical procedures such as pediatric pyeloplasty, and innocent assumptions that could substantially affect the conclusions of such analysis.

In the past, premature ejaculation (PE) has been considered a psychogenic condition, treated with psychotherapy. Our growing understanding of PE pathophysiology has increased the scientific community's interest in a symptom that is seen across many sexual pathologies. Is it possible to approach PE with traditional medicine approaches, such as acupuncture?

The authors of a recent study propose to expand the criteria for “good surgical outcome” for robot-assisted laparoscopic radical prostatectomy (RARP), a relatively new procedure. Without level 1 evidence to support such clinical innovations, it is vital that surgeons adopt critical self-appraisal in order to improve the reporting of outcomes.

Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer. Here, Lawrentschuk and Klotz provide an overview of the current issues concerning this somewhat contentious regime, including how best to select patients for active surveillance, which criteria should prompt intervention, and the concept of secondary chemoprevention.

In some men, increased age is associated with a reduction in testosterone, with a range of sexual, physical and psychological symptoms. Although this syndrome is referred to by many names, late-onset hypogonadism (LOH) is the most scientifically accurate. In this Review, Huhtaniemi and Forti summarize the pathophysiology, diagnostic criteria and treatment options for LOH, and discuss the controversies that surround the LOH diagnosis and the use of androgen replacement therapy.

In this Case Study, the authors describe a patient presenting with metastatic bladder adenocarcinoma with intestinal metaplasia. Owing to the tumor's histologic similarities with colorectal cancer, the patient was treated with a FOLFOX chemotherapy regimen.

Although renal cell carcinoma (RCC) is increasing in incidence and is associated with a poor outcome, there is no molecular test to identify which patients will relapse and who will respond to targeted therapies. In this Review, the authors discuss the biochemical, histological and genetic characteristics of RCC, and why these characteristics have not been translated into a useful prognostic and predictive test for patients with kidney cancer.

Matrix metalloproteinases (MMPs) are a family of enzymes that have a number of important functions, including regulation of the extracellular matrix, angiogenesis and apoptosis. MMP dysregulation has been implicated in several disease processes. In this Review, the authors describe the role of MMPs in bladder cancer, and how these enzymes seem to have potential as diagnostic and prognostic biomarkers or as targets for therapy in patients with this disease.

Gender dysphoria—a condition in which an individual has a severe discontent with the gender they were born with—can be treated with gender reassignment surgery. In this article, Selvaggi and Bellringer draw on their considerable experience to provide an overview of gender reassignment surgery. Both male-to-female and female-to-male surgeries and their associated complications will be discussed as well as the etiopathogenesis of gender dysphoria.

Perineal radical prostatectomy (PRP) is one of the oldest surgical procedures for prostate cancer, but its use has declined over the past 30 years. New studies show that PRP is not only minimally invasive but beneficial from an economic perspective and should not yet be abandoned in the treatment of early prostate cancer.

Patients with bladder acontractility often rely on clean intermittent catheterization (CIC) for bladder emptying. A recent study has reported that successful latissimus dorsi detrusor myoplasty (LDDM) allows volitional voiding and removes the need for long-term CIC.