Reviews & Analysis

Although oral phosphodiesterase 5 inhibitors have substantially improved the treatment of erectile dysfunction, unmet needs among men with erectile dysfunction still exist. This article considers the possibility of gene therapy for these patients, and discusses results from early clinical studies of gene therapy for erectile dysfunction.

Radical nephrectomy has traditionally been considered the treatment of choice for localized kidney tumors. In this Case Study, Huang and Russo report a patient with an incidentally discovered small renal cortical tumor who underwent open partial nephrectomy. The authors comment on the advantages of this approach, particularly with regard to the preservation of renal function.

Obesity can predispose people to developing a number of urological conditions. In this Review the authors discuss the diagnosis and management of stone disease in obese patients, highlighting some of the challenges endourologists face with this patient group. Risk factors for stone formation are also reviewed, including gastric restriction procedures.

There are a number of treatment options available to patients with prostate cancer. In this Review the authors discuss patient selection for, and treatment success associated with, permanent prostate seed implantation brachytherapy for prostate cancer and its use in combination with other treatments such as external beam radiotherapy.

Current tests for the initial diagnosis of prostate cancer have limited sensitivity and specificity, and new biomarkers are being investigated. This Review discusses the use of molecular techniques for research into gene expression in prostate cancer and the biomarkers identified that could prove to be useful in the diagnosis and categorization of prostate cancer.

In this Viewpoint article, Professor Klotz argues that active surveillance of patients with low-risk prostate cancer, followed by intervention when pre-specified criteria are fulfilled, is an approach that could prevent unnecessary overtreatment of prostate cancer. Professor Klotz describes patients eligible for this approach, the strategy for active surveillance, and the criteria for intervention.

In the October 2005 issue ofNature Clinical Practice Urology, Stapleton and Pinnock raised concerns regarding the use of nomograms in clinical practice. In this Viewpoint, the authors provide further discussion of these concerns, and present an argument advocating the use of nomograms.

This Case Study describes a 40-year-old man who presented with abdominal pain without lower urinary tract symptoms. Following investigations, including abdominal CT and MAG3 renogram, ureteropelvic junction obstruction was confirmed. In this Case Study the diagnostic work-up in this patient and their management with laparoscopic transperitoneal dismembered Anderson–Hynes pyeloplasty is described.

This Case Study describes a 55-year-old man with a history of coronary artery disease who was diagnosed with pheochromocytoma of the left adrenal gland. The authors discuss the diagnosis of this patient and his treatment with alpha-blockade therapy combined with phenoxybenzamine before open adrenalectomy.

Following prostatectomy, many men suffer with urinary incontinence. Stress urinary incontinence (SUI) can continue to be bothersome in some men, even after treatment with conservative therapies. In this article the surgical treatments for male SUI are reviewed. The suitability and efficacy of both the artificial urinary sphincter and the more recently introduced male sling are discussed in detail.

Radical surgery for penile carcinoma produces good cure rates, but severely impacts on patients' quality of life. For a select group of patients, conservative treatments can be a suitable alternative producing good cure rates without such a negative impact on quality of life. In this Review, the different organ-sparing treatments for penile carcinoma are discussed, along with their suitability for patients with cancers of different stages.

There has been much research examining the relationship between body mass index (BMI) and the risk of developing prostate cancer and disease progression. Despite the number of studies, it has been difficult to establish how BMI might influence cancer risk and development. This Review article discusses the available data on BMI and obesity, and how these factors might influence the risk of developing prostate cancer, cancer screening and treatment.

Sentinel pelvic lymph node dissection is a radioisotope-guided technique that has been developed for the detection of potential lymph node metastases. In this Viewpoint, Professor Janetschek discusses the possibility that sentinel pelvic lymph node dissection could replace extended pelvic lymph node dissection in patients with prostate cancer.

Quality of life is an important factor that men with prostate cancer and their physicians consider when choosing an appropriate treatment option. Nerve-sparing radical prostatectomy offers the possibility of reducing postoperative complications relating to sexual, bladder and bowel dysfunction. This article reviews the techniques that can be used to improve outcomes in patients undergoing nerve-sparing surgery for prostate cancer.

Bladder cancer is a difficult disease to manage and requires long-term follow-up after treatment including the use of cystoscopy for detecting recurrence. In this Review the role of hexaminolevulinate (HAL) fluorescence cystoscopy for the detection of bladder cancer is discussed in comparison to standard, white-light cystoscopy.

The cure rate for men with testicular tumors is high and quality of life is an important consideration for these patients. This Review discusses the different conservative treatments available for testicular cancer, their efficacy and suitability for patients.

Measuring PSA velocity to track prostatic pathophysiologic states is appealing for its simplicity, however, much debate continues as to its clinical value in the diagnosis and characterization of prostate cancer. Phillips and Smith discuss the significance of PSA velocity as a diagnostic measure.

Diet and lifestyle are increasingly important and often overlooked factors in male urological illnesses. In this Viewpoint the authors discuss the evidence linking obesity and erectile dysfunction and the benefits of statins. The authors suggest that a more medical approach, including lifestyle advice and medical therapy, is the way ahead for urology.

This Case Study describes a 32-year-old pregnant woman who presented with severe pain and a left-sided giant hydronephrosis. Renal ultrasonography, intravenous urography and MAG-3 renography confirmed pelvi-ureteric junction obstruction, so a left retroperitoneoscopic nephrectomy was performed. The authors discuss the risks associated with surgical treatment of the pregnant patient.