Review Articles in 2006

With the absence of clinical trials powered to address the issues of safety and efficacy of testosterone replacement therapy for late-onset hypogonadism, management of men with this condition is not straightforward. This Review examines the available evidence for the use of testosterone replacement therapy in men with late-onset hypogonadism and comments on how these men can be managed in the absence of definitive data.

In order to ensure that the results of histologic analyses are accurate, appropriate handling of tissue samples is essential. This Primer Review discusses tissue fixation and the morphological changes that can be induced by different methods of fixation. The medicolegal aspects of tissue harvesting and storage are also highlighted.

Improvements in detection and staging of renal cell carcinoma have led to a downward migration in the stage of tumors diagnosed. This stage migration coupled with refinements in surgical techniques has led to an increase in the use of nephron-sparing surgery. The indications and contraindications for partial nephrectomy and its associated advantages and disadvantages are discussed in this Review.

It is a decade since monoclonal antibody scans targeting prostate-specific membrane antigen (PSMA) were first approved for imaging prostate cancer soft tissue metastases. This article discusses the utility of capromab imaging in prostate cancer, reviewing its current role and developments in new, second generation, antibodies to PSMA.

Increased purinergic nerve-mediated bladder contraction associated with ageing and some bladder conditions has indicated a role for purinergic signaling in the pathophysiology of bladder dysfunction. This Review examines purinergic signaling mechanisms in bladder function and the development of purinergic antagonists that might, in time, provide treatments for a number of bladder disorders.

Neuroendocrine cancer of the prostate is a challenging disease to characterize and treat. Although there are a number of diagnostic and prognostic markers for this disease, no definitive marker exists. In this Review, the characterization of neuroendocrine differentiation and the management of patients with these tumors of the prostate are discussed.

A number of angiogenic pathways have been implicated in urologic cancers, which could hold the key to developing antiangiogenic therapies against such tumors. Promoters and inhibitors of angiogenesis in tumors of the prostate, bladder and kidneys, and their use as either tumor markers or potential anticancer treatments, are reviewed in this article.

Chronic pelvic pain syndromes are notoriously difficult to manage; little is known about their pathophysiology and most treatments are aimed at relieving the pain associated with the different disorders. This Review discusses some of the available treatments that are being used for the management of chronic pelvic pain and novel therapies that are under investigation.

Patients with bladder exstrophy present a challenge to urologists specializing in reconstruction. There are several different techniques by which repair can be achieved, each with their own associated success rates and morbidities. This article compares the techniques of staged reconstruction and complete primary repair of bladder exstrophy, highlighting the relative advantages and disadvantages associated with each method.

A goal-directed approach to managing men with male sexual dysfunction is important in order to fully understand the biological and psychological dimensions of each patient's condition. The evaluation and management of men presenting with symptoms of sexual dysfunction, and those with urologic problems and comorbid conditions that are associated with sexual problems, are discussed in this Review.

Elevated levels of nerve growth factor (NGF) in the bladders of patients with idiopathic overactive bladder syndrome, interstitial cystitis and benign prostatic hyperplasia has pointed to a role for NGF in the pathogenesis of lower urinary tract diseases. This article discusses the biology of NGF, its production in the bladder, and the mechanisms underlying its role in disorders of the lower urinary tract.

Some patients are at an increased risk of developing infection when undergoing outpatient procedures and, as a result, may require antimicrobial prophylaxis. A thorough assessment of patient risk factors is, therefore, essential. In this article the indications for prophylactic use of antibiotics in commonly performed outpatient urologic procedures and the different treatment regimens are reviewed.

Although bladder-outlet obstruction (BOO) in women is an increasingly common problem, there are currently no accepted criteria used to define this type of bladder dysfunction. This review discusses the different symptoms associated with BOO in women and the role of urodynamic testing in diagnosis. Iatrogenic BOO following incontinence surgery is also discussed.

The laparoscopic approach for treating renal tumors has become standard practice in many medical centers, and while there are no absolute contraindications to performing laparoscopic renal surgery a number of factors should be considered when making treatment decisions. This review presents the indications and contraindications for the use of laparoscopic radical and partial nephrectomy for the treatment renal cell carcinoma.

Interstitial cystitis (IC) is a poorly understood chronic condition that is difficult to diagnose and treat. The most characteristic symptom of IC is debilitating pelvic pain. This article reviews the different oral agents and other nonsurgical therapies that are available for the treatment IC, with particular emphasis on the management of pain associated with IC.