Review Articles in 2016

Lower urinary tract symptoms (LUTS) occur in >80% of patients with multiple sclerosis, have a substantial negative effect upon patients' quality of life and require regular monitoring owing to the progressive nature of the underlying neurodegenerative disease. In this Review, the authors describe the optimal diagnosis, treatment and management of the wide variety LUTs that can occur in patients with multiple sclerosis.

Although penile cancer is a rare malignancy, it poses a challenge for the urologist as it frequently requires surgical treatment, which can be both disfiguring and emasculating. Organ-preserving approaches to surgical treatment of the primary tumour, rather than total penectomy, exemplify a major paradigm shift in the clinical management of penile cancer. In this Review, Burnett discusses the different surgical options available for penile-preserving surgery and reconstruction, and the need for careful patient selection and monitoring.

In this Review, Sopko and Burnett summarize strategies to mitigate adverse penile remodelling and protect erectile function in men undergoing prostatectomy. They discuss innovations for surgery, the use of phosphodiesterase type 5 inhibitors, intracavernosal injections and vacuum erection devices, as well as possible future treatments. Multidisciplinary approaches are required, but the best therapy scheme has not yet been identified.

An increasing number of men with low-risk prostate cancer are being managed using active surveillance, often resulting in improved quality of life compared with men who receive treatment for low-risk disease. However, strategies that might delay disease progression and the need for treatment are currently lacking. In this Review, the authors describe the potential of exercise-based interventions to delay the progression of low-risk prostate cancer.

Active surveillance as a management strategy for favourable-risk prostate cancer has increased in recent years, in an effort to prevent the adverse effects associated with unnecessary overtreatment of low-risk disease. However, long-term data have, in the past, been lacking, making it difficult to assess the effectiveness of this approach. In this Review, Tosoian et al. discuss the current state-of-the-art in active surveillance, reviewing the available evidence and considering future directions in the field.

Micturition requires a complex neural control system to coordinate the activities of the urinary bladder, urethra, and urethral sphincters. The specific identity of the mechanical sensor is not known, but considerable interest exists in the contribution of transient receptor potential channels to the mechanosensory functions of the urothelium. These channels could be novel targets for potential therapies that are intended to modulate micturition function.

Prostate-specific membrane antigen (PSMA) has gained increasing interest as target molecule for imaging. Several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET. PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or multiparametric MRI and⁶⁸Ga-PSMA–PET imaging has been shown to increase detection of metastatic sites, therefore, it holds great promise to improve prostate cancer management.

Erectile dysfunction affects up to 75% of men with diabetes. Here, Castela and Costa describe how diabetic endothelial dysfunction — induced by hyperglycaemia, oxidative stress, and impaired vascular repair mechanisms — is the key factor in the pathophysiology of erectile dysfunction in diabetic men.

Erectile dysfunction (ED) has detrimental effects on the quality of life of affected individuals and their sexual partners. Physicians, nurses, and clinical educators should consider this disorder as a shared health problem for the couple, and sexual partners have an important role in its management.

Active surveillance of men with prostate cancer has received increasing interest over the past decade, resulting in the publication of a wide range of different guidelines on the management of patients in active surveillance programmes, often with very different recommendations. Here, authors describe the various available guidelines and how they differ from each other, highlighting the need for an international consensus on the optimal use of active surveillance in patients with prostate cancer.

Testicular biopsy is not routinely performed in children, mainly because of concerns about damaging the developing gonad. In this Review, the authors describe how testicular biopsy could be useful for predicting fertility potential in prepubertal boys with undescended testes and also for assessing malignancy risk in these patients and those with disorders of sexual development. The authors also discuss the promise of cryopreservation of testicular tissue samples for the preservation of fertility in prepubertal boys receiving gonadotoxic chemotherapy.

In this Review, Vignozzi and colleagues describe how metabolic syndrome and its components contribute to the development of lower urinary tract symptoms during ageing, highlighting the influence of inflammation and sex steroid imbalance. They also discuss whether lifestyle modification and weight loss are effective in prevention and treatment of this urological condition.