Reviews & Analysis

The past year has yielded multiple key studies on the underpinnings of, and optimal treatment of kidney stones. As our understanding of the pathophysiology of stones, and the optimal medical and surgical treatments improves, we will be able to optimize the quality and cost-effectiveness of care available to patients.

In this Review, Lange et al. give an overview of the main complications associated with commonly used ureteral stents and discuss novel stent designs based on metal or biodegradable materials that could help ameliorate patient discomfort and overcome current problems, such as encrustation and stenosis.

The use of robot-assisted surgery for treatment of genitourinary malignancies is increasing dramatically. Kaye and colleagues argue that consumerism, rather than surgical outcomes, drives the adoption of this expensive technology. Robotics use should be targeted to surgical situations where clinical benefit or cost-effectiveness can be demonstrated.

Heat shock proteins (HSPs) are involved in regulation of androgen receptor function, making them targets for therapeutic modulation in the treatment of castration-resistant prostate cancer (CRPC). In this Review, Azad and colleagues discuss HSPs, their roles in CRPC, and the state of current clinical research into HSP blockade.

The antiandrogen bicalutamide is commonly used in combination with medical or surgical castration in men with prostate cancer. With combined androgen blockade, the usual dose of bicalutamide is 50 mg per day, but evidence suggests that higher doses might be beneficial.

The presence of urolithiasis has been shown to be associated with an increased risk of bone fracture in men and women, particularly in adolescent males and females aged 30–39 years and 70–79 years. This increased risk of fracture in patients with urolithiasis may have important implications for public health.

The contemporary plea for a more liberal pathological definition of insignificant prostate cancer was recently challenged by Schiffmann and colleagues, who advocate a return to the original, stringent 0.5 ml tumour volume threshold. This cut-off point would render fewer men eligible for active surveillance programmes.

Management of biochemically recurrent prostate cancer can be determined by the use of nomograms based on risk factors, but this approach might not lead to selection of optimal courses of treatment for individual patients. Choline-PET–CT imaging can identify the sites of recurrence in these patients, enabling personalized treatment choices depending on the presence of localized or metastatic disease.

In the field of advanced prostate cancer, a number of therapeutic agents are now available. The sequence of administration of medications with distinct mechanisms of action, toxicities and efficacies, will have a critical role in disease outcomes. The identification of biomarkers predicting response will help to determine the appropriate therapeutic sequence.

Medical intervention for transgender adolescents is a controversial issue but a recently published article describing long-term psychological outcomes using 'the Dutch model' of care should help to silence critics and reassure the growing number of clinicians treating this patient population.

Extracellular vesicles mediate intercellular signalling and are potential sources of cancer biomarkers. Nawaz and colleagues describe the biogenesis of extracellular vesicles, and the methods available for their isolation and characterization. The authors also discuss current research into the identification of vesicle-derived biomarkers for cancers of the prostate, kidney and bladder.

Delayed diagnosis and treatment of penile cancer often result in the development of advanced disease. Shabbir et al. highlight how pooling resources and expertise can help improve disease management and review remaining challenges in prevention, diagnosis, treatment and lymph node staging.

Bone scanning for radiographical staging of prostate cancer is common; however, its current use in clinical practice is not in line with the published guidelines. A recent study comparing the performance of current practice with that of guideline recommendations found that following the American Urological Association guidelines consistently for newly diagnosed patients with prostate cancer would result in better outcomes.

During the month of November, the Movember Foundation challenges men to grow a moustache in an effort to raise vital funds and awareness for the often ignored health issues affecting the male population. Global health-care delivery and policies, which have focussed on women's, children's and minority's health for the past few decades, need now address these issues.

The field of urology has undergone massive changes in the 10 years sinceNature Reviews Urology launched as Nature Clinical Practice Urology. In this Viewpoint, members of the Nature Reviews Urologyadvisory board describe what they think has been the biggest change or issue in urology over the past decade, and give their predictions for the direction of the field over the next 10 years.

Detrusor underactivity (DUA) is a poorly understood bladder dysfunction without effective pharmacological treatments. This Review summarizes the available evidence relating to the aetiology and pathophysiology of DUA and highlights the need for further elucidation of the underlying mechanisms to enable the development of new treatment approaches.

Sexually transmitted diseases caused by bacteria, viruses and protozoa can affect the male genital tract. Gimenes and colleagues discuss the evidence for effects of sexually transmitted pathogens on semen, sperm and male infertility.

Multidiscliplinary teams (MDTs) are increasingly used to aid decision-making in the care of patients with cancer, but their clinical value can be difficult to quantify. A prospective study has now assessed the use of MDTs for patients with urological cancers. Future refinement of MDT organization is required to optimize effectiveness.

A fundamental shift in the understanding, detection and treatment of prostate cancer has occurred over the past 10 years, especially in the use of screening, active surveillance, novel therapies and radical surgery. These discoveries have changed how clinicians and patients approach prostate cancer.

The prostate is still largely assessed by random biopsy, but developments in prostate MRI and fusion with transrectal ultrasonography (TRUS) have made targeted biopsy of the prostate a reality. MRI/TRUS techniques promise to address the issues of overdiagnosis and underdiagnosis in prostate cancer.