Review Articles in 2016

In this Review, the authors summarize current knowledge of sperm-specific epigenetic signatures and diet-induced epigenetic effects on sperm quality. They also discuss transgenerational effects of the sperm epigenome on offspring health.

Imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones and guidelines differ regarding the optimal initial imaging modality. In this Review, Brisbane and colleagues discuss the advantages and disadvantages of CT, ultrasonography, MRI and kidney, ureter, bladder (KUB) plain film radiography for stone imaging and propose an algorithm for imaging patients with acute stones.

Simulation has become widely accepted as a supplementary method of training in urological skills, with the greatest number of procedure-specific models and subsequent validation studies carried out in the field of endourology. Skills simulators have been created for laparoscopic and robot-assisted surgery, but only a limited number of validated models are available for open procedures. In this Review, Aydin and colleagues discuss the various modalities of simulators available to urologists and suggest a curriculum for structured surgical training.

Overactive bladder in children is a surprisingly common syndrome that can persist into adulthood. Evidence increasingly suggests that this syndrome can be explained by neurological changes or comorbidities. Here, the author describes the causes, symptoms and management of paediatric patients with overactive bladder.

Robot-assisted radical cystectomy (RARC) is an evolving technique for the treatment of muscle-invasive bladder cancer (MIBC); however, its effectiveness compared with open radical cystectomy is debated. In this Review the authors discuss the specific areas of evidence that are critically important for supporting the continuing use of RARC for MIBC and the considerable progress that has been made in this regard.

Medical expulsive therapy (MET) has been widely used for the management of ureteral stones for the past two decades, despite limited evidence on the effectiveness of this approach. In the past year, data from two clinical trials has called the continued use of MET into question. Here, the authors consider the role of MET in the managment of ureteral stones, in light of this improved level of evidence.

Nocturia is a very common condition with major sequelae for affected patients. It leads to impaired quality of life and is associated with numerous morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. In this Review, the authors discuss the clinical relevance of nocturia and the need for treatment. They describe the various aetiologies of the condition and discuss a contemporary approach to its treatment and management, including methods to tailor treatment strategies to individual patients.

Mathieu et al. review current data on the effect of lymphovascular invasion on disease outcomes in patients with bladder cancer and assess its utility in informing clinical decision-making as a prognostic marker or indicator for early intervention.

Gender dysphoria — distress associated with being assigned to the wrong gender and experiencing oneself as the nonnatal gender — can affect individuals of any age. However, treatment of gender-dysphoric children and adolescents is controversial. In this Review, Costa and colleagues discuss the data supporting hormonal treatment to delay puberty in gender-dysphoric children, and the considerations for managing these patients.

Cannabinoid receptors and their agonists, endocannabinoids, can be detected throughout the urinary tract. However, despite a paucity of well-tolerated agents for patients with lower urinary tract symptoms (LUTS), clinical targeting of this system has remained largely overlooked. In this Review, the authors describe the current evidence for a role of cannabinoids in micturition and as a treatment for LUTS.

Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture has a reported prevalence of up to 10%, and such strictures have serious consequences that can lead to loss of kidney function and infectious complications. Here, the authors discuss the pathophysiology, diagnosis, risk factors, and management of ureteroenteric anastomotic strictures and describe ways in which stricture risk can be minimized.

The management of advanced renal cell carcinoma (RCC) has dramatically changed over the past decade. In this Review, the authors discuss the development of novel immunotherapies to treat RCC, including inhibitors of checkpoint receptors, vaccines, T-cell agonists, and chimeric antigen receptor T cells.

Extreme hypofractionation of radiotherapy is a novel treatment modality for patients with organ-confined prostate cancer. Arcangeli and Greco summarize the results of clinical trials investigating moderate and extreme hypofractionation regimens, highlight challenges to the routine use of extreme hypofractionation and discuss areas for further clinical research.

The genomic landscape of testicular germ cell tumour (TGCT) risk is dominated by inherited genetic factors, which are highly polygenic in nature. Here, the authors discuss results from genome-wide association studies that have identified risk loci associated with TGCT risk.KIT–KITLGsignalling is currently the major pathway that is implicated in TGCT formation.

The prostate gland is the major male reproductive gland involved in male fertility. In this Review, the authors discuss the reproductive function of the prostate gland, summarizing physiological and molecular mechanisms that connect prostate homeostasis with male fertility and describing how these mechanisms are associated with prostatic diseases. They highlight the central role of Zn²⁺and citrate in regulating activities of the prostate epithelium, discuss the influence of bacteria-related prostate inflammation on male fertility, and note the potential role of prostatic inflammation in the development of prostatic hyperplastic growth and prostate carcinogenesis.

Laparoscopic techniques are subject to continuous change and benefit from new developments. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, it is associated with considerable costs. In this Review, Rassweiler and Teber discuss technical improvements, developing technologies and speculate on the future of minimally invasive surgery and laparoscopy in urology.

Several oncolytic viruses for the treatment of urological cancers have been investigated in clinical trials. Delwar et al. summarize the challenges encountered to the success of these agents and discuss strategies to improve effectiveness and safety.

Androgen deprivation therapy in men with prostate cancer is associated with several adverse effects. Østergren and colleagues review the use of exercise interventions to improve physical functioning and mitigate fatigue, changes in body composition and components of metabolic syndrome.

Treatment of infertility-related hormonal dysfunction in men requires an understanding of the hormonal basis of spermatogenesis. However, the best method for accurately determining male androgenization status remains elusive and the tools available for inferring the intratesticular hormonal environment are unreliable. In this Review, the authors discuss the status of our knowledge for diagnosis and treatment of this condition.

The prostate glycoproteome can undergo a wide range of different alterations during the occurrence and progression of prostate cancer, which might explain some of the interpatient heterogeneity in disease severity and outcomes. In this Review, the authors describe the potential for alterations in the glycoproteome to provide biomarkers and/or clinical targets for the prognosis and/or treatment of prostate cancer.