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2015 has seen advances in various bladder conditions. MicroRNAs might become therapeutic targets, the MAPP network characterized central neurological changes in chronic pelvic pain syndrome, and urologists were reminded to consider cognitive effects of long-term anticholinergics use. A study of obstetric vesicovaginal fistula repair shows how evidence-based research might improve public health in poorly resourced countries.
Men of African origin are disproportionately affected by prostate cancer; in this Review, McGinley and colleagues discuss the disparities in treatment, the cancer-survivorship experience, and quality-of-life outcomes, as well as aspects that might contribute to these differences including socioeconomic, cultural, and genetic factors.
Androgen deprivation combined with external beam radiotherapy improves the overall survival of patients with localized prostate cancer but might be associated with adverse effects that influence their health and quality of life. When considering this medication, clinicians must be aware of the increased risk of cardiac mortality in patients with moderate or severe comorbidity.
Mirabegron has been shown to cause relaxation of the isolated mouse urethra, partly through blockade of α1A-adrenoceptors and α1D-adrenoceptors. However, although this effect might be an interesting pharmacological in vitro observation, it seems to have no relevance for the clinical use of mirabegron in the treatment of the overactive bladder.
The interaction between tumour cells and their microenvironment has an important role in cancer pathogenesis. Alfano et al. review how dysregulation of the extracellular matrix and microbiota associated with the human epithelium might influence the development and progression of urothelial carcinomas.
The introduction of a targeted approach to treatment of prostate cancer requires the approval of novel medical devices. Here, authors describe the regulatory pathways that govern the approval of novel medical devices for clinical use. Owing to differences in legislation, these approval pathways differ substantially between the European Union and the USA, often resulting in patients receiving different treatments for prostate cancer in Europe, compared with the USA.
In 2015, population-based studies in patients with urinary stones informed us of the changing trends in contemporary stone management and identified areas for improvement. Although meta-analyses aim to provide the highest level of evidence, a randomized controlled trial of medical expulsive therapy challenged current paradigms and was the defining publication of the year.
The development of novel antiandrogens and androgen synthesis inhibitors has improved the outcomes of patients with prostate cancer; however, the issue of resistance to these therapies has also emerged. In light of these developments, unexpected interactions between these novel therapies and glucocorticoid signalling have been observed. Here, authors describe current knowledge of androgen–glucocorticoid signalling as a cause of drug resistance and disease progression in patients with prostate cancer.
HIV and bacterial sexually transmitted infection incidence remains persistently high for men who have sex with men. Results of new studies show that clinicians might be able to address this challenge by providing oral HIV pre-exposure prophylaxis and by intensifying efforts to diagnose and treat other sexually transmitted infections.
Kisspeptin, peptide hormone that signals via the G protein-coupled kisspeptin receptor (KISS1R), has been implicated in various physiological and pathophysiological processes in the urogenital system, including roles in oocyte development, spermatogenesis and sperm capacitation, as well as in kidney physiology. In this Review, Wahab et al. discuss the urogenital roles of kisspeptin signalling, and consider the potential for kisspeptin to be used as a biomarker for the diagnosis and prognosis of urogenital carcinomas.
Neural control of micturition is a complex process, involving input from many different brain regions. In this Review, Derek Griffiths describes a simplified model of neural control of micturition that incorporates current knowledge, largely derived from functional brain imaging studies of humans and experimental animals. Consideration is also given to the effects of treatments of urinary urgency on neural control of micturition.
Penile prostheses have remained the gold-standard therapy for medically refractory erectile dysfunction (ED) since their popularization. Here, Trost and colleagues discuss the considerations for penile prosthesis placement with regard to operative techniques, adjunctive procedures, and complications, as well as device design and operative technique.
Although rare, ejaculatory duct obstruction (EDO) is a surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, and should be considered within the list of differential diagnoses for men undergoing infertility investigations. In this article, the authors discuss the anatomy, embryology and pathophysiology of EDO, and consider the current optimal diagnostic and treatment options.
Biomarkers predicting response to chemotherapy in patients with muscle-invasive bladder cancer (MIBC) have the potential to better select patients for treatment and to improve outcomes of this aggressive disease. Results from a new study bring us a step closer to individualizing treatment through use of a three-gene signature to predict response to neoadjuvant chemotherapy.
Elective pelvic nodal irradiation (EPNI) remains a controversial area in prostate cancer management. Two articles published in the International Journal of Radiation, Oncology, Biology and Physics present additional data regarding the benefits of EPNI for patients with high-risk prostate cancer, suggesting that EPNI confers no benefit in overall survival or biochemical-progression-free survival.
Radical cystectomy is the standard treatment for patients with bladder cancer, but the prognosis of patients undergoing this procedure has not changed for decades. Small steps towards improvement include better selection of high-risk T1 patients, the use of perioperative chemotherapy and, maybe, robotic cystectomy.
The development of the ureteral access sheath (UAS) has enabled substantially greater use of ureteroscopy for minimally invasive management of diseases of the upper urinary tract. Here, the authors describe the advantages and risks associated with the routine use of UAS, and the potential for use of UAS by endourologists for a wider range of applications.
Effectiveness of an innovative online psychological intervention and forum was investigated in a three-arm randomized controlled trial. Improvements in several elements of psychological distress were observed in men with prostate cancer who had access to both the intervention and the forum over a 10-week period.
The results of the phase III CHAARTED trial investigating androgen deprivation therapy (ADT) plus docetaxel for men with metastatic hormone-sensitive prostate cancer challenge the long-established standard of care of ADT alone for these men. The next step will be to integrate these results into clinical practice.
Studies using rodent and adult human prostate stem-progenitor cell models indicate that exposure to bisphenol A (BPA) during development increases susceptibility of the prostate gland to premalignancy later in life. A novel human organoid model has now been generated to study the effects of BPA on embryonic human prostate development.
