Opinion in 2011

Cisplatin-based chemotherapy is standard of care for patients with transitional cell bladder cancer; however, many of these patients suffer from renal impairment and are considered unfit for such treatment. Nicholson discusses whether this degree of caution is warranted, and what alternatives should be considered in patients for whom cisplatin is genuinely contraindicated.

Partial nephrectomy is associated with ischemia–reperfusion injury caused by vascular clamping. However, ischemia is not a vital part of the procedure, and nonclamping surgery can be carried out. In this Perspectives, the authors review the evidence regarding clamping and nonclamping partial nephrectomy, and discuss their own surgical experiences with these techniques.

Controlled tissue cooling has been used therapeutically for decades to mitigate the negative effects of traumatic, ischemic, and surgical insults. Finley proposes that since recovery of urinary continence and erectile function is improved when localized hypothermia is used during radical prostatectomy, similar benefits might be observed for other types of radical pelvic surgery.

Hydrogen sulfide is a gaseous transmitter that shares features with nitric oxide (a key gaseous transmitter in erectile function) and has been shown to be involved in vascular homeostasis. In this Perspectives, the authors present available evidence in support of a physiological role for hydrogen sulfide in penile homeostasis and propose that drugs that manipulate this molecule could be an alternative therapy for erectile dysfunction.

The high degree of etiological heterogeneity in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) represents a considerable diagnostic and management challenge. In this Perspectives article, the authors propose a new phenotyping system that they believe will help advance our understanding of the mechanistic basis of this syndrome and subsequently move us closer to developing treatments intended to cure patients with CP/CPPS.