Reviews & Analysis

The issue of neonatal circumcision is highly controversial. In this Viewpoint, Austin discusses why he considers neonatal circumcision to be beneficial. He assesses the evidence for a protective effect of circumcision from genital cancer, urinary tract infections and sexually transmitted infections, and also the evidence for minimal adverse events associated with circumcision in neonates.

In this Viewpoint, the authors discuss the FDA's strategies for increasing access to new medicines for patients with serious or life-threatening illnesses. The article describes the currently available access mechanisms, and highlights the FDA's planned regulation revisions for expanding access.

The management of uncommon urological malignancies is rarely based on evidence from prospective trials, and ad hoc treatment by individual clinicians who seldom encounter the cancer is not ideal for the patient. In this article, Nicholson identifies key issues in developing a trial strategy for treating rare urological malignancies.

This article on the ethics of gene therapy for male infertility is the third Viewpoint in the article series. Sheehan addresses issues such as 'playing God', patient consent for gene therapy trials, eugenics, and the distribution of medical resources.

The second Viewpoint in the series of articles on gene therapy for male infertility evaluates safety aspects. Lamb describes the ideal vector for DNA transfection, and draws on data from previous studies to describe the safety of various vectors under investigation.

This Viewpoint, which is the first of three articles discussing gene therapy for the treatment of male infertility, considers the feasibility of the approach. Boekelheide and Sigman initially describe the genetic causes of male infertility, and go on to discuss gene therapy approaches, and possible future directions.

In this Viewpoint, Dr Donat presents the case against using frozen section analysis of distal ureters in patients undergoing cystectomy for transitional cell bladder cancer, arguing that division of the ureter at the level of the common iliac artery largely precludes the need for frozen sections in this setting.

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.

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.

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.

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.

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.

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.

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.

This article is the first of two Viewpoints on the treatment of detrusor overactivity. The authors of this article advocate the use of sacral nerve modulation for this indication, and they describe the advantages of sacral nerve modulation compared with botulinum neurotoxin.

In this second Viewpoint on the treatment of detrusor overactivity, the authors describe the preclinical and clinical data that support the use of botulinum neurotoxin in patients with detrusor overactivity, and highlight the benefits of botulinum neurotoxin over the use of sacral nerve modulation.