Reviews & Analysis

Very few studies have followed patients with renal cell carcinoma for long enough to characterize late relapses. Newly published research suggests that late-recurring tumours are more likely to be of low nuclear grade and show a better response to first-line targeted therapy than early relapsing cancers.

In this Review, Heyns et al. provide an update on the urological complications associated with HIV and AIDS in men treated during the ART era, focusing on papers published within the past decade.

A recent study has reported a novel approach to primary bladder exstrophy closure without osteotomy in newborns. In this study, most patients were managed on a paediatric urology ward with an epidural catheter, with similar outcomes to patients treated in an intensive care unit with ventilation and muscle relaxation.

The American Academy of Paediatrics has revised its guidelines on the management of first UTI in children. The translation of evidence-based guidelines into clinical practice is often slow and inconsistent, but a recently published implementation study has demonstrated that rapid adoption of evidence-based UTI recommendations is achievable and beneficial.

Pelvic lymph node dissection (PLND) has an important role in staging and therapy of prostate cancer, especially for high-risk disease. A novel tool has been proposed to correctly predict the probability of node-negative status after radical prostatectomy with PLND that could help postoperative decision making.

A newly developed genetic risk score derived from studies of several single nucleotide polymorphisms has the potential to improve the prediction of prostate cancer detection on biopsy for men with PSA levels of 1–3 ng/ml. Understanding the score's characteristic differences from biomarkers is important in order to utilize it correctly.

Fetal intervention for lower urinary tract obstruction (LUTO) has been technically feasible since the 1980s, with vesicoamniotic shunting being the most commonly employed technique. Despite the recent publication of the first and only randomized trial of fetal shunting, questions linger about the long-term efficacy and clinical impact of prenatal intervention.

Although a moderate body of evidence supports the efficacy of ileovesicostomy for neurogenic bladder in adults, its use in children has been largely undocumented. However, recent data show that this procedure should be considered for a selected paediatric population.

Radium-223 is an emitter of high-energy α particles that binds selectively to areas of high bone turnover. In a recently published phase III trial, it prolonged overall survival of patients with symptomatic, castration-resistant prostate cancer with bone metastases and, as a result, has gained FDA approval for this indication.

Children with vesicoureteral reflux (VUR), who are already at high risk of renal injury, are at particular risk for bladder and bowel dysfunction (BBD). In this Review, Elder and Diaz describe the association between BBD and VUR, the evaluation for BBD, and its management in children with VUR.

Sexual dysfunction—including erectile dysfunction, ejaculatory abnormalities and orgasmic disorders—is a commonly reported adverse effect of prostate cancer therapies. In this Perspectives article, Cormie and colleagues make a case for the use of exercise as a therapeutic option to ameliorate sexual dysfunction in prostate cancer survivors.

In this Review, Sávio and Nguyen discuss the use of robot-assisted laparoscopic surgery (RALS) for the management of common paediatric urological problems, identifying unique challenges associated with performing RALS in children and ways to address these challenges.

Nocturnal enuresis, daytime urinary incontinence, lower urinary tract symptoms and faecal incontinence are more common in children with special needs than in typically developing children. This Review provides an overview of the neglected topic of incontinence in children and adolescents with special needs, focusing on those with intellectual disabilities and attention deficit hyperactivity disorder.

Deviating from the most widely described approach for robot-assisted radical prostatectomy (RARP), researchers have reported the exceptional outcomes of a Retzius-sparing approach in which they pass through the pouch of Douglas and avoid transecting all structures anterior to the prostate.

In this Review, the authors consider the various mpMRI-targeted biopsy techniques that have been used since the introduction of MRI-guided prostate biopsy in 1986, as well as the different aspects of defining and hitting a target, and result reporting for men with treatment-naive prostate cancer undergoing mpMRI-targeted biopsy.

Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). The authors describe the evolution of both the prostate biopsy techniques, focusing on the clinical implications of the transperineal approach and the potential future directions for prostate biopsy.

BCG is not a defined strain but a family of regional substrains with marked genetic differences. In this Review, the authors discuss the mechanisms by which BCG immunotherapy induces its antitumour activity and treatment-limiting toxicity, and the effect that genetic and phenotypic differences between BCG substrains might have on these effects.

Robot-assisted laparoscopic sacrocolpopexy (RSC) offers the advantages of minimally invasive surgery, especially to surgeons who do not have laparoscopic expertise. A recently published series adds to the growing body of evidence that RSC achieves comparable outcomes to the open approach with minimal morbidity.

In this Review, the authors discuss the novel, technologically advanced radiotherapy modalities for the primary treatment of men with prostate cancer. Advancements in image-guided and intensity-modulated techniques are discussed, focusing on how these modalities contributed to the development of high-dose-rate brachytherapy, stereotactic body radiotherapy and particle beam therapy.

Postoperative infection is one of the most common complications of percutaneous nephrolithotomy (PCNL), and postoperative sepsis is one of the most detrimental. Kreydin and Eisner describe the incidence and pathogenesis of sepsis after PCNL, before discussing the available literature regarding risk factors, prevention and future treatment possibilities.