Review Articles in 2015

PET–CT with¹¹C-labelled or ¹⁸F-labelled choline derivatives provides morphological and functional information that could overcome the limitations of conventional imaging techniques. However, the main investigations on the role of PET–CT in the diagnosis and staging of prostate cancer have been performed on a retrospective basis. In this Review the authors discuss the different results that have been reported regarding the utility of this technique in prostate cancer diagnosis and staging.

Botulinum toxin A (BoNT-A) is an approved treatment of neurogenic and idiopathic overactive bladder, and is also widely used for off-label treatment of a range of other lower urinary tract dysfunctions. Here, authors describe the effectiveness, safety and tolerability of intravesical BoNT-A injections as a treatment of a wide range of urological conditions.

Damage to the cavernous nerves during radical prostatectomy often explains the variable rates of postoperative sexual potency in men who have undergone this procedure. Thus, the implementation of nerve-sparing procedures might enable improvements in this area. In this Review, the authors describe current methods for identifying cavernous nerves during surgery, and novel approaches that have the potential to improve outcomes.

Interest is growing in minimally invasive treatment options male lower urinary tract symptoms (LUTS), and preservation of all aspects of sexual function is increasingly important for patients. Here, the authors discuss initial experimental data on new minimally invasive procedures, such as the intraprostatic injection of novel agents, and the mechanical prostatic urethral lift device—Urolift^®(Neotract, Inc., USA) for the treatment of LUTS caused by BPH.

Assessing the need for rebiopsy in patients with elevated serum PSA levels and a negative diagnosis of prostate cancer following analysis of the initial biopsy sample is a challenging, and often frustrating, clinical scenario. Here, authors describe the clinical utility of a range of approaches to guiding the need for rebiopsy, whilst also highlighting the diagnostic value of combining results of multiple tests.

Many medications that urologists prescribe in their clinical practice can have adverse effects on male reproduction through central hormonal effects, direct gonadotoxic effects, effects on sperm function or on sexual function. The authors review the known effects on sperm of several such classes of drugs and summarize information on possible alterations of sexual function when applicable.

Most kidney and ureteral stones can be considered for treatment with a noninvasive or minimally invasive approach, with improved safety and morbidity compared with traditional open surgical approaches. However, improvements in laparoscopic surgical techniques mean that nearly any open surgery can be performed in a minimally invasive fashion. Here, Borofsky and Lingeman discuss the role of these techniques in modern stone surgery.

Currently available anatomical imaging techniques are unable to reliably distinguish between the various types of renal tumours, both benign and malignant. In this Review, Gorin et al. describe how nuclear imaging techniques offer a potential noninvasive means to characterize clinically localized renal tumours, and discuss nuclear imaging tests that are currently under investigation for this purpose and might be used in the clinic in the future.

Many clinical studies looking at the effects of psychological stress on male fertility have shown that stress is associated with reduced paternity and abnormal semen parameters. This Review by Nargund describes the possible effects of psychological stress on testosterone secretion and spermatogenesis.

Ritterson Lew et al. discuss the role of glycogen metabolism in urothelial bladder cancer development and progression. They describe how alterations of enzymatic functions in this pathway influence cancer viability and consider possible future strategies for targeting the glycogen metabolism and relevant safety aspects.

Current methods for the diagnosis and monitoring of bladder cancer are invasive, and might lack the sensitivity required for detection of all types of bladder cancer. Here, authors describe the proteomic identification of biomarkers of urinary bladder cancer, findings of studies investigating individual biomarker proteins and/or panels and the clinical potential of proteomic biomarkers for the diagnosis and management of patients with bladder cancer.

Patients with spinal dysraphism can have a large variety of different urological manifestations, thus, effective clinical management of these patients can involve a range of different approaches. Here, authors describe the management of the full range of urological manifestations observed in patients with spinal dysraphism and the future challenges posed by the changing demographics of this patient population.

Bone metastases in patients with prostate cancer are a primary cause of pain, disability, and death. Body et al. review studies of bone-targeting agents in this setting, as well as the properties of both approved and novel systemic agents with regard to improving skeletal outcomes. They also discuss the place of these agents in the overall therapeutic strategy for patients with metastatic castration-resistant prostate cancer.

Flexible ureteroscopy is increasingly being used as the first-line therapy for renal stones. Although the precise stone-free rates acheived with this procedure are unknown, largely as a result of variations in stone and patient characteristics, and the choice and timing of follow-up imaging. In this Review, authors describe the effects of these variable on stone-free outcomes, and discuss the evidence surrounding active retrieval of fragments during ureteroscopy.

The genomic characterization of renal cell carcinoma (RCC) is central to the development of novel targeted therapies and multiple 'omics' platforms have identified key driver genes and commonly altered pathways. In this Review, Haddad and Margulis critically evaluate the key advances in the molecular characterization of tumour and patient factors in RCC.

'Inconspicuous penis' refers to anatomical abnormalities in which the penis looks smaller than is expected. This disorder can be divided into 'true micropenis' and 'concealed micropenis'. In this this Review, Cimador et al. define conditions associated with inconspicuous penis in children and describe appropriate medical and surgical management for these conditions.

Hypospadias is the second most common developmental abnormality in boys. Although prenatal exposure to endocrine disruptors and genetic susceptiblity are established causes of this abnormality, the aetiology remains unknown in most cases. Here Cunha et al. describe current animal models of hypospadias, highlighting the differences between mouse, rat and human penile development and hypospadias, and the need for reliable, accurate and appropriate animal models.

Obesity is a major health concern and is associated with an increased risk of nephrolithiasis, particularly in women. Bariatric surgery for weight loss is known to increase the incidence of stone formation and alter urinary chemistry profiles. In this Review, the authors summarize the problems of stone formation in the bariatric surgery population and discuss relevant dietary recommendations, current medical therapies, and new therapeutic directions for the management of stones in this population.

Robotic sacrocolpopexy (RSC) has gained popularity, owing to claims that it is associated with a reduced learning curve compared with standard laparoscopic sacrocolpopexy (LSC) and that it has equal efficacy to the gold standard, the abdominal sacrocolpopexy (ASC). Here, Sajadi and Goldman describe RSC and compare this technique with LSC and ASC.

The authors discuss the combined use of androgen deprivation therapy and image-guided radiotherapy (IGRT) in aggressive, localized prostate cancer. They also describe how it is imperative to identify the patients who would benefit from this combined-modality therapy relative to the use of IGRT alone and the opportunities for more personalized approaches in treating this disease.