Review Articles in 2010

Intravesical injection of botulinum toxin-A has been shown to provide effective treatment for patients with detrusor overactivity refractory to first-line treatment with anticholinergics. In this Review, the authors discuss the currently available data regarding repeated injections of botulinum toxin-A to patients with neurogenic and idiopathic detrusor overactivity, and consider the efficacy and clinical considerations of this treatment modality.

Clinical diagnosis of paraneoplastic syndromes not only leads to detection of the underlying malignancy but can also influence treatment. Here, Hong et al. outline the various syndromes associated with prostate cancer, focusing particularly on the identification of putative markers in prostate cancer tissue that might provide a link to the associated syndrome.

Urinary tract infection (UTI) is the most common type of community-acquired and hospital-acquired bacterial infection. In this Review, Prof. Foxman describes the prevalence, incidence and bacteriology of UTI, the transmission mechanisms and the development of antibiotic-resistant strains of uropathogenic bacteria, and discusses whether we need to change the way we treat patients with uncomplicated or catheter-associated UTI.

The success of lithotripsy treatment for urological stones depends partly on the stone composition. Identification of stone components and prediction of the stone's fragility before treatment begins could enable urologists to chose the most appropriate management for a patient and prevent unnecessary lithotripsy treatment. In this Review, the authors address the importance of stone composition assessment before initiation of treatment and consider the different imaging techniques able to predict stone fragility.

Urogenital dysfunction is a common problem in patients who have received treatment for rectal cancer, often due to damage to pelvic autonomic nerves. In this Review, the authors discuss the neuroanatomy of the pelvis and the surgical techniques which can result in nerve damage, as well as considering possible approaches to reducing the poor urological outcomes associated with rectal cancer treatment.

Barrington's nucleus, the pontine micturition centre, is central to a circuit involved in the coordination of pelvic visceral activity with appropriate elimination behaviors. In this Review, the authors discuss the neuroanatomy of Barrington's nucleus and its projections, and the role of this nucleus in urological disorders. They also discuss a putative role for corticotropin-releasing factor as a potential mediator of these effects.

Pelvic reconstructive surgery with concomitant hysterectomy is the standard of care for pelvic organ prolapse, even though many women would prefer to preserve their uterus and vaginal function. Zucchi et al. describe uterus-sparing procedures that have been reported, and discuss the complication rates, anatomical success rates and functional outcomes of each.

Serum tumor markers play a more critical role in testicular germ cell tumor management than in any other solid organ malignancy. Here, Barlow and colleagues discuss how the serum levels of AFP, hCG and LDH provide essential information for the differential diagnosis, staging, risk-stratification and surveillance of testicular tumors.

While the phosphodiesterase 5 (PDE5) inhibitors sildenafil, vardenafil and tadalafil have transformed the treatment of men with erectile dysfunction, a number of new PDE5 inhibitors have become available in the Far East. In this Review, the authors describe the efficacy of these new drugs, and briefly review the current state of development of other pharmacological therapies for erectile dysfunction, such as gene therapy and stem cell therapy.

Epigenetic changes, such as gain and loss of DNA methylation and altered histone modifications, are a hallmark of human cancer. The role of the epigenome in prostate cancer is well recognized. In this Review, the authors discuss the different epigenetic modifications which can contribute to cancer progression, and consider the therapeutic potential of targeting the epigenome in patients with prostate cancer.

Renal pseudoaneurysm is a rare but serious complication of renal trauma and of a number of medical procedures. In this Review, the authors provide an introduction to the subject of renal pseudoaneurysm, and discuss the diagnosis and options for treatment of this potentially life-threatening condition.

Prostate cancer localization has been greatly improved by the emergence of 3T and multiparametric MRI technologies. Raz et al. provide a clear and comprehensive description of the MRI sequences that can be used to detect prostate tumors before focusing on the patient populations that might benefit most from these technical advances.

Growing understanding of the complex cellular, neural and integrative physiology of the bladder offers new insights into the causative mechanisms of overactive bladder. Here, the authors review the diagnosis and therapy of this challenging clinical condition. They discuss new developments in our understanding of the pathophysiology of overactive bladder, and outline how these might lead to formulation of novel treatments.

Intermittent androgen suppression is neither inferior nor superior to continuous therapy for cancer control, but has significant advantages in respect to adverse effects, quality of life and cost. In this Review the authors present the key evidence supporting the efficacy of intermittent androgen suppression, and highlight how current data can be applied to everyday clinical practice.

Focal therapy has the potential to become a 'middle ground' between active surveillance and radical treatment for prostate cancer by combining minimal morbidity, cancer control, and scope for re-treatment. In this article, the authors outline the energy modalities available for use in focal therapy, review the current evidence, and discuss future directions for this type of treatment.

In 2009, the European Association of Urology published guidelines for the evaluation and management of genitourinary trauma. In this Review, the authors discuss these guideline and provide an overview for clinicians involved in the treatment of patients with renal, ureteral, bladder, urethral and genital trauma.

The PLCO and ERSPC trials have reported the long-term effects on prostate cancer mortality of PSA-based screening approaches; however, a number of controversies remain in this field. Here, Strope and Andriole discuss and interpret the results of these trials, and suggest how PSA-based screening can be improved upon in the future.

Complex interactions between malignant cells and their surrounding environment determine the fate of the evolving tumor. Karlou et al. describe the major pathways implicated in stromal-epithelial crosstalk during prostate carcinogenesis, highlighting the selective inhibitors that are available and are currently being tested as novel therapeutic strategies.

Complex urethral strictures pose a unique challenge for reconstruction and patient satisfaction. This comprehensive Review provides a guide to the management of stricture disease in the settings of previous hypospadias repair, long anterior urethral stricture disease, panurethral stricture disease, recurrent posterior distraction defects, and stricture disease after treatment for prostate cancer.

In this Review, Zuniga and colleagues discuss partial orchiectomy as a viable alternative to radical surgery for selected patients with testicular lesions. Although currently only suitable for men with bilateral germ cell tumors or a solitary testicle, organ-sparing techniques might soon be considered appropriate for men with a normal contralateral testis.