Review Articles in 2021

The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. In this Review, the authors describe and discuss the placebo and nocebo effects in selected benign urological diseases.

In shared decision-making (SDM), patients and providers work together to determine the best course of action based on the current evidence and the patient’s own preferences. Tools such as decision aids can support SDM for complex decisions, but these decision aids are also associated with barriers to SDM implementation, including patient, provider and systematic challenges. In this Review, the authors discuss opportunities for and limitations of SDM in urology and female pelvic medicine and reconstruction, as well as decision aids available in the field.

Primary hyperoxalurias are a devastating family of diseases that eventually lead to end-stage renal disease. In this Review, Shee and Stoller discuss current treatment paradigms for primary hyperoxalurias, new therapeutics and their mechanisms of action, and future directions for novel research in the field.

A number of penile traction therapy and vacuum erection devices are available for the management of patients with erectile dysfunction, Peyronie’s disease, penile dysmorphophobia, before and after penile prosthesis insertion, and after radical prostatectomy. However, the optimal device for each indication differs and, for some indications, research is limited. In this Review, Sultana and colleagues present a variety of devices that are available and consider challenges such as compliance, cost and availability.

In this Review, the authors describe current sperm selection methods and the advances in selection technologies for assisted reproductive techniques, highlighting their mechanisms of selection, advantages, limitations and clinical outcomes. They also propose a conceptual sperm selection model that uses multiple selection mechanisms.

In this Review, Stewart and Baeten discuss the successes and challenges of pre-exposure prophylaxis to date, its place as part of robust strategies to reduce HIV infections, the rising rates of curable sexually transmitted diseases and their relationship with HIV prevention, and future directions for synergies in pre-exposure prophylaxis and sexually transmitted disease prevention.

Treatment for childhood cancer can cause infertility in patients who survive to adulthood. Jensen et al. discuss the options for fertility preservation in pre-pubertal and pubertal boys, covering preservation of spermatozoa and testis tissue, as well as psychological and ethical issues, and current challenges to fertility preservation.

Complications related to the use of mesh in pelvic floor reconstructive surgery are related to a number of factors. This Review discusses the foreign body response, the biomaterial properties of mesh, the patient-specific and surgical risk factors and the failings in mesh development, all of which have contributed to these complications.

Cancer recurrence after radical prostatectomy for high-risk prostate cancer is common. The addition of neoadjuvant hormonal therapy with the introduction of potent androgen receptor signalling inhibitors has gained interest in the oncological community. However, conclusions of a survival benefit with this therapy cannot currently be made and results of several phase II trials are much anticipated.

Biomarkers that can improve risk stratification of patients with prostate cancer are urgently needed. In this Review, Khoo et al. outline mass spectrometry technologies that enable the systematic discovery and targeted validation of protein-based biomarkers in prostate-associated fluids.

Anticholinergics are a common class of medication used in the treatment of overactive bladder. However, concerns have been raised over the potential association of anticholinergics and cognitive impairment or dementia. This Review discusses the clinical evidence and provides guidance for prescribing anticholinergics in at-risk populations.

Conventionally fractionated external beam radiotherapy is an effective treatment for localized prostate cancer, but long treatment programmes result in a substantial burden to patients and the health-care system, which is particularly problematic in low-income and middle-income countries (LMICs) where health-care resources might be scarce and patient funds limited. Here, the authors discuss the outcomes and benefits of hypofractionation — in terms of both oncology and economics — and how it could be used to improve prostate cancer care in LMICs.

Biochemical recurrence following radical prostatectomy for intermediate-risk and high-risk prostate cancer is common. However, not all patients with recurrence will die from their disease. This comprehensive Review from a multidisciplinary group discusses the optimal evaluation and management of these patients to ensure balance between treatment-related morbidity and cancer control.

Senescent cells and their secretome — the senescence-associated secretory phenotype (SASP) — cause a systemic pro-inflammatory state, contributing to an inflammatory microenvironment. In this article, the authors discuss the presence of senescent cells and the SASP in the ageing prostate and the evidence for a role of senescence in BPH and prostate cancer, as well as possible therapeutic targeting of these pathways in the future.

Neuroendocrine prostate cancer predominantly develops from adenocarcinoma following a period of androgen suppressive treatment. Outcomes in patients with this disease are poor; the understanding of the molecular mechanisms behind its development will improve future targeted therapy options.

Chimeric antigen receptor T cell immunotherapy for prostate cancer has the potential to be combined with other treatment modalities, such as androgen deprivation therapy, radiotherapy or chemotherapy; furthermore, new developments could improve the efficacy of chimeric antigen receptor T cell therapy and this treatment could also be applied as focal therapy for this disease.

Testosterone replacement therapy for the treatment of primary hypogonadism in men is associated with multiple adverse effects including infertility. The re-establishment of testosterone-producing cell lineages using stem-cell-based therapy has had promising results in pre-clinical studies and could be used in transplantation therapy.

Despite the success of immune checkpoint inhibition (ICI) in other tumour types, the majority of ICI-treated patients with bladder cancer fail to respond. This lack of efficacy might be attributable to a lack of pre-existing immune reactive cells within the tumour immune microenvironment, which limits the efficacy of ICI. In this Review, Li and colleagues discuss how oncolytic virus therapy acts as a strategy to attract lymphocytes before implementation of ICI and consider the data supporting the use of combination approaches using oncolytic virotherapy with ICI in bladder cancer.

Exercise improves outcomes in prostate cancer, but the mechanisms behind this are poorly understood. This Review discusses exercise-induced blood alterations, with a focus on muscle-secreted myokines, which could have both direct and indirect effects on tumour proliferation.

In this Review the authors describe advances in our understanding of the molecular determinants of urinary tract infection pathogenesis, focusing on specific host susceptibility factors and their consequences.