Articles in 2010

Transurethral resection (TUR) is widely used to manage early-stage bladder cancer. A recent study has confirmed that a second, or restaging, TUR is associated with a lower risk of progression and cancer-related death. Restaging TUR is therefore recommended as a standard of care in patients with stage T1 bladder cancer.

Controversies remain regarding the precise cell type from which prostate cancers originate. In the last 2 years, two separate studies have arrived at apparently conflicting models for the cell type involved in prostate cancer initiation. However, these results are not mutually exclusive: there are potential solutions, and alternative views on the initiating cell derivation of prostate tumors also exist.

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.

Androgen deprivation therapy (ADT) is well established as a cause of osteoporosis and increased fracture risk. A study has shown that toremifene reduces fracture risk in men receiving ADT for prostate cancer. The study has substantial limitations, however, and the management of bone disease in these patients remains a challenge.

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.