Reviews & Analysis

Laparoscopic radical prostatectomy (LRP) is a product of the evolution of standard open to minimally invasive surgery. The next step on this evolutionary path has been the emergence of robotic LRP. Here, Thomas Ahlering presents his view of the comparative benefits and pitfalls of these two techniques.

Witjes and Debruyne outline how recent investigations of indications for intravesical chemotherapy might affect current strategies for the management of superficial bladder cancer. Recommendations for the use of chemotherapeutics are made on the basis of the risk of recurrence and progression of this increasingly common disease.

Developments in urologic surgery have led to the introduction of robot-assisted laparoscopic procedures. Data indicate that robot-assisted laparoscopic surgery has a shorter learning curve than conventional laparoscopic surgery, and that operative time can be reduced. In this article the data for robot-assisted prostate and bladder surgery are discussed.

The chronic symptom-complex interstitial cystitis (IC) and related conditions are difficult to diagnose and manage because no definitive diagnostic tests or effective treatments exist. The role of biomarkers, such as antiproliferative factor, in the pathogenesis of IC and their potential therapeutic applications are discussed.

Overactive bladder syndrome is a commonly diagnosed condition, but it is less common for patients to present with symptoms of incomplete bladder emptying. Both of these forms of bladder dysfunction have a number of possible causes. In this review the pathophysiology, diagnosis, and management of these conditions are discussed.

Considering the complexity of central nervous system (CNS) control of bladder function, it is not surprising that many neurologic disorders are associated with bladder dysfunction. Overactive bladder syndrome (OAB) is a common neurogenic bladder disorder. The mechanisms behind CNS control of bladder function and the pathophysiology of OAB and detrusor overactivity are discussed.

This review discusses the treatment options available to prostate cancer patients with disease recurrence following prostatectomy. It focuses on the use of radiotherapy, administered adjuvantly and as a salvage treatment. A nomogram that facilitates patient selection for salvage radiotherapy is presented.

Hollenbeck and Montie discuss the potential benefits and pitfalls of early extirpative surgery for T1 bladder cancer. The authors identify risk factors that, in their opinion, should prompt clinicians to consider radical cystectomy rather than a more conservative regimen of resection, chemotherapy and immunotherapy.

Diagnosis and treatment of chronic prostatitis are presently based on unsupported assumptions and a nonvalidated classification scheme. Here, Richard Alexander summarizes research by the Chronic Prostatitis Collaborative Research Network that challenges the assumptions and indicates that ongoing empiric administration of antimicrobial drugs to men with long-standing prostatitis should be abandoned.

Ureteral stents are essential urologic tools with a wide range of indications. The search for a biocompatible stent material that is easy to maneuver with fewer associated complications continues. This review discusses available sent materials and highlights advances that are leading to the development of more suitable materials and designs.

There are no optimal management strategies for children born with ambiguous genitalia, but careful evaluation of infants is important to ensure accurate diagnosis. When making treatment and management decisions a multidisciplinary approach is essential in order to fully consider the options available for the child. Evaluation and management of intersex conditions are discussed in this review.

Botulinum toxin is under investigation as a treatment for a variety of urologic disorders. This evidence-based review objectively analyses the data on these off-label uses of botulinum toxin. Although most of the available data relates to uses in neurogenic bladder disorders, other applications in the bladder, urethra and prostate gland are discussed.

The prognosis for patients with metastatic renal cell carcinoma (RCC) is poor and systemic therapies are generally ineffective. This review discusses the contribution that trials such as those from SWOG and EORTC have made in advancing our understanding of the value of surgical intervention, in combination with systemic therapies, in the treatment of metastatic RCC.