Reviews & Analysis

Erectile dysfunction (ED) is a multifactorial disorder, which is strongly associated with circulating testosterone levels. In this Review, Corona and Maggi draw on their considerable clinical experience to outline the relationship between testosterone and male sexual dysfunction, and to discuss the role of testosterone replacement therapy in the treatment of ED.

Several naturally occurring substances have been implicated in the prevention of prostate cancer, but the lack of randomized controlled trials means causal effect has not yet been demonstrated. Here, the authors summarize existing data on a number of promising compounds and discuss the future direction of clinical trials in this field.

Data from a retrospective multicenter study have revealed that the presence of urinary collecting system invasion portends a worse outcome in patients with organ-confined disease. Evidence that cancer has spread into the collecting system, in the context of other adverse prognostic factors, should prompt clinicians to instigate closer follow-up of patients after nephrectomy.

The use of PSA testing as a screening tool for prostate cancer is limited by its low specificity. New data offer insight into how genotypic information might be incorporated into PSA screening approaches to enhance their accuracy.

Denosumab, an inhibitor of RANKL, improves bone mineral density and reduces the incidence of fractures in men who receive androgen deprivation therapy (ADT) for prostate cancer. At present, however, a lack of comparison with potent bisphosphonates limits the assessment of its utility in the prevention of ADT-induced bone loss.

Since 2003, duty hours for US resident physicians have been restricted to 80 h per week. For the first time, a study in a surgical population now demonstrates a reduction in mortality and morbidity associated with the working-hour reform.

In the UK, a patient's residential address can determine whether they have access to certain treatments. An audit of the effect of this 'postcode lottery' on the survival of patients with advanced renal cell carcinoma suitable for treatment with sorafenib or sunitinib highlights the iniquities that can plague such allocation systems.

The R.E.N.A.L. system for classifying tumors aims to predict the surgical challenges of partial nephrectomy. However, the factors involved in surgical planning are many and complex, and are not adequately addressed in this simplified system. The inclusion of oncological features and a 'surgical skills factor' might contribute to its widespread utility.

Although rare, life-threatening hemorrhage remains a challenging complication of transurethral resection of the prostate (TURP). In this Case Study, authors from Singapore present a 74-year-old man with benign prostatic hyperplasia who experienced post-TURP hemorrhage, complicated by TURP syndrome, which was ultimately successfully treated by bilateral selective arterial prostatic embolization.

Laparoendoscopic single-site surgery (LESS) represents an exciting development in the field of minimally invasive surgery. In this Review, authors from Greece and Germany discuss the challenges facing LESS, highlight the potential of new specialized technology in this arena, and provide an overview of contemporary clinical experience with this approach in urologic surgery.

Ureteroscopy is the first-line treatment for urinary stone disease at many institutions. Techniques and indications continue to evolve. This Review covers the most current trends, controversies, and issues in ureteroscopic stone management. It summarizes the most recent evidence regarding ureteroscopic treatment of ureteral and renal stones, current standard indications, adjunct devices and instruments used during ureteroscopy, and future directions.

A 32-year-old man, with a left-to-right crossed fused kidney containing a 25 mm stone, underwent laparoscopic nephrolithotomy for calculus removal. The authors provide a comprehensive description of the procedure, focusing on its role in patients with renal fusion anomalies where the stone burden is too large for extracorporeal shock wave lithotripsy.

Shock wave lithotripsy (SWL) represents the only noninvasive surgical treatment for urinary tract stones. Drawing on their considerable experience, Lingeman and colleagues outline the current utility and limitations of SWL, and highlight the technological advances that hold promise for improving the safety and efficacy of this treatment modality in the future.

Topical treatment of neuropathic bladder has been suggested as a viable alternative to oral anticholinergic therapy in children, offering greater efficacy and reduced side effects. Lazarus reviews the current status of intravesical oxybutynin use, warning that although it has proven effective in some studies, there remains a low level of evidence.

There is a trend towards increasing the number of cores sampled during ultrasound-guided prostate biopsy in an attempt to increase the likelihood of detecting malignancy. Here, the authors' analysis of current data indicates that this 'saturation' approach is best used to improve histological characterization of cancer, and for monitoring of men with a rising PSA level despite previous negative biopsy.

Robot-assisted partial nephrectomy is an emerging technique that potentially provides advantages over conventional laparoscopic approaches. A retrospective multi-institutional study suggests that robotic technology offers improved outcomes in this setting, even in hands experienced with laparoscopic surgery; however, additional data validating these findings and evaluating complication rates and surgical margins are needed.

Tyrosine kinase inhibitors delay tumor progression and have a favorable adverse effect profile in patients with metastatic renal cell carcinoma; however, the impact of these treatments on objective clinical outcomes remains unknown. Updated results from two landmark phase III randomized trials now demonstrate the effect of sunitinib and sorafenib on survival.

A bladder preserving protocol comprising combined external-beam radiotherapy and interstitial brachytherapy for the treatment of bladder cancer has been reported as a viable alternative to cystectomy. However, we have concerns regarding the oncological efficacy of this approach and believe important quality of life issues need to be addressed.

The extracellular matrix has a critical role in modulating the structure and function of the urinary bladder. In this Review, Aitken and Bägli discuss how matrix properties affect bladder development and pathology, focusing on their role in the pathogenesis of strain-induced injury in bladder outlet obstruction.

Knowing when to request invasive urodynamic tests in children can be difficult, but persisting with nonbeneficial treatment is a serious failure of care. In this concise Review, authors from The Netherlands provide straightforward guidance on appropriate use of urodynamic studies in pediatric patients with overactive bladder, underactive bladder, neurogenic bladder and dysfunctional voiding.