Reviews & Analysis

The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. In this Review, the authors describe and discuss the placebo and nocebo effects in selected benign urological diseases.

Penile cancer is a growing health-care concern worldwide. Despite its rarity, penile cancer has a disproportionate impact on some countries, as the location with the highest incidences are invariably those with low resources and few registries or trials. In this Perspective, the authors discuss how global collaboration and centralization of care can help to improve management of penile cancer worldwide, but especially in areas where resources are limited.

In shared decision-making (SDM), patients and providers work together to determine the best course of action based on the current evidence and the patient’s own preferences. Tools such as decision aids can support SDM for complex decisions, but these decision aids are also associated with barriers to SDM implementation, including patient, provider and systematic challenges. In this Review, the authors discuss opportunities for and limitations of SDM in urology and female pelvic medicine and reconstruction, as well as decision aids available in the field.

Robotic-assisted radical prostatectomy has similar oncological outcomes to open retropubic prostatectomy, but improved potency outcomes. Surgeon skill and degree of nerve sparing, patient age and preoperative potency are the greatest predictors of postoperative potency outcomes. Bhat and colleagues present potency and quality-of-life outcomes from a very high-volume robotic surgery study.

Primary hyperoxalurias are a devastating family of diseases that eventually lead to end-stage renal disease. In this Review, Shee and Stoller discuss current treatment paradigms for primary hyperoxalurias, new therapeutics and their mechanisms of action, and future directions for novel research in the field.

Sperm characteristics are routinely assessed in fertility clinics as decisive factors to select sperm for improved intracytoplasmic sperm injection (ICSI) outcomes. A recent study suggests that, in patients with non-obstructive azoospermia, no specific defect or combination of abnormalities in testicular sperm precluded chance of pregnancy, while also suggesting sperm motility and acrosome defects are the proxies relevant to ICSI outcomes.

Early studies in patients and animal models have suggested that SARS-CoV-2 can access the reproductive system and could have effects on fertility. In this Perspective, Edenfield and Easley present the evidence for mechanisms of infection of reproductive cells by SARS-CoV-2 and consider the potential for testicular dysfunction in patients who have had COVID-19.

A striking disproportionate burden of prostate cancer incidence and mortality exists between men of West African ancestry and men of European ancestry. Identifying distinct tumour genetic biomarkers and immunomodulating signals in patients with diverse genetic ancestry might reduce the disparities in prostate cancer prognosis, treatment outcomes and mortality in high-risk racial groups.

COVID-19 has been shown to be associated with a higher mortality rate in men than in women. In this Perspectives article, the authors posit that this disparity is due to a failure to invest in men’s health and discuss the biological, social and economic factors that have contributed to the sex disparities in mortality from COVID-19, as well as considering how a streamlined men’s health programme with the urologist in a central role could address these issues.

A number of penile traction therapy and vacuum erection devices are available for the management of patients with erectile dysfunction, Peyronie’s disease, penile dysmorphophobia, before and after penile prosthesis insertion, and after radical prostatectomy. However, the optimal device for each indication differs and, for some indications, research is limited. In this Review, Sultana and colleagues present a variety of devices that are available and consider challenges such as compliance, cost and availability.

Trends in vasectomy use are controversial, but rates might be declining over time. Several factors could contribute to this apparent decrease, which warrant consideration before definitive conclusions are made.

In this Review, the authors describe current sperm selection methods and the advances in selection technologies for assisted reproductive techniques, highlighting their mechanisms of selection, advantages, limitations and clinical outcomes. They also propose a conceptual sperm selection model that uses multiple selection mechanisms.

Multidrug-resistant Neisseria gonorrhoeae is a global health problem, and the development of a vaccine is considered essential for the effective control of gonorrhoea. The use of outer membrane vesicle vaccines to prevent N. gonorrhoeae infection has garnered considerable interest, and a recent study using a mouse model of experimental gonococcal infections adds support for this approach.

In this Review, Stewart and Baeten discuss the successes and challenges of pre-exposure prophylaxis to date, its place as part of robust strategies to reduce HIV infections, the rising rates of curable sexually transmitted diseases and their relationship with HIV prevention, and future directions for synergies in pre-exposure prophylaxis and sexually transmitted disease prevention.

Treatment for childhood cancer can cause infertility in patients who survive to adulthood. Jensen et al. discuss the options for fertility preservation in pre-pubertal and pubertal boys, covering preservation of spermatozoa and testis tissue, as well as psychological and ethical issues, and current challenges to fertility preservation.

The prostate is divided into the peripheral, transition and central zones, which have different prostate cancer incidences and prognoses. Differences between the zones suggest their potential roles in tumour aggressiveness, but treatment of prostate cancer remains zonal agnostic. Improved understanding of the zones and their roles in tumorigenesis could improve prostate cancer management.

Complications related to the use of mesh in pelvic floor reconstructive surgery are related to a number of factors. This Review discusses the foreign body response, the biomaterial properties of mesh, the patient-specific and surgical risk factors and the failings in mesh development, all of which have contributed to these complications.

Cancer recurrence after radical prostatectomy for high-risk prostate cancer is common. The addition of neoadjuvant hormonal therapy with the introduction of potent androgen receptor signalling inhibitors has gained interest in the oncological community. However, conclusions of a survival benefit with this therapy cannot currently be made and results of several phase II trials are much anticipated.

Trials evaluating novel therapies in the neoadjuvant setting must have clearly defined study elements and appropriately selected end points to ensure the applicability of the trial and enable interpretation of the study results. In this Perspectives, the authors describe the findings of a public workshop jointly sponsored by the US Food and Drug Administration and the Bladder Cancer Advocacy Network, which discussed key elements and end points when designing trials of neoadjuvant therapy for muscle-invasive bladder cancer.

Andolfi et al. report on the largest single-institution case series of robot-assisted laparoscopic pyeloplasty (RAL-P) in infants. Transitioning from RAL-P in older children to infants seems to have more to do with patient and port positioning, instrument size and intra-abdominal space than robotic surgical technique.