Reviews & Analysis

Recent advances have been exciting in the genomics of and targeted therapeutics for renal cell carcinoma (RCC). New agents have been approved for advanced RCC, a novel agent targeting hypoxia-inducible factor 2α has shown considerable promise and molecular characterization of papillary RCC provides the foundation for development of targeted therapeutic approaches for this disease.

In 2016, immunohistochemical evidence revealed major differences in the inflammatory characteristics of Hunner and non-Hunner interstitial cystitis/bladder pain syndrome (IC/BPS). Evidence has also emerged that an isomer of testosterone, etio-S, might be a urinary biomarker of IC/BPS. Intravesical botulinum toxin injections became a standard treatment of IC/BPS. Furthermore, the International Continence Society has published a new Standard for Terminology for Chronic Pelvic Pain Syndromes.

In 2015, the approval of flibanserin opened a debate about diagnosis and treatment of female sexual dysfunction. Designing clinical trials with suitable end points is difficult, but some studies indicate correlations between hormone levels and low desire. New research demonstrates opportunities for a better understanding of this multifaceted condition.

2015 has seen advances in various bladder conditions. MicroRNAs might become therapeutic targets, the MAPP network characterized central neurological changes in chronic pelvic pain syndrome, and urologists were reminded to consider cognitive effects of long-term anticholinergics use. A study of obstetric vesicovaginal fistula repair shows how evidence-based research might improve public health in poorly resourced countries.

In 2015, population-based studies in patients with urinary stones informed us of the changing trends in contemporary stone management and identified areas for improvement. Although meta-analyses aim to provide the highest level of evidence, a randomized controlled trial of medical expulsive therapy challenged current paradigms and was the defining publication of the year.

HIV and bacterial sexually transmitted infection incidence remains persistently high for men who have sex with men. Results of new studies show that clinicians might be able to address this challenge by providing oral HIV pre-exposure prophylaxis and by intensifying efforts to diagnose and treat other sexually transmitted infections.

Radical cystectomy is the standard treatment for patients with bladder cancer, but the prognosis of patients undergoing this procedure has not changed for decades. Small steps towards improvement include better selection of high-risk T1 patients, the use of perioperative chemotherapy and, maybe, robotic cystectomy.

Kidney cancer research in 2014 was characterized by a diverse array of studies. Advances were made in both the localized and the metastatic renal cell carcinoma (RCC) arenas. Importantly, significant progress was also made in our understanding of the underpinnings of RCC tumorigenesis and progression.

The past 5 years have seen some of the most significant changes in the way we view and treat prostate cancer. 2014 continues in the same spirit and will be remembered as a landmark year for practice changing studies reporting their results in surgery, chemotherapy and novel medical therapies.

Male sexual medicine has continued to evolve and several publications related to premature ejaculation, lower urinary tract symptoms, Peyronie's disease and testosterone replacement therapy have provided new insights in these fields. Our understanding has been revolutionized by these studies and clinical management in male sexual dysfunction has improved.

Publications in 2014 advanced our therapeutic armamentarium for bladder cancer. Molecular characterization might propel us into an era of targeted therapy, and immunotherapeutics might expand our options for patients with metastatic disease. We were also reminded that outcomes are inextricably linked to the quality of the transurethral resections we perform.

Benign prostatic hyperplasia (BPH) remains a hot topic in urological research—more than 800 manuscripts were published on this subject in 2014. The most important advances included improvements in the understanding of the pathophysiology of lower urinary tract symptoms (LUTS) and the medical and surgical management of BPH and LUTS, with a particular focus on new combination strategies and advances in surgical technologies.

The past year has yielded multiple key studies on the underpinnings of, and optimal treatment of kidney stones. As our understanding of the pathophysiology of stones, and the optimal medical and surgical treatments improves, we will be able to optimize the quality and cost-effectiveness of care available to patients.

In response to the demand for reconstructive options that preserve quality of life after cystectomy, 2013 saw considerable advances in biocompatible meshes and stem cell preparations that might recapitulate the urinary bladder. With increasing strength and functionality of these substitutes, what challenges remain?

In 2013, data began to emerge that shed light on several longstanding issues in female urology, from the safety of adrenergic receptor agonists and onabotulinumtoxinA for overactive bladder to the use of physical therapy and mesh suburethral slings for stress urinary incontinence.

Considerable developments in prostate cancer in 2013 have emerged from the imaging field. Hyperpolarized ¹³C-MRI can monitor metabolic activity to identify high-grade disease and treatment response, and novel PET radiotracers might identify distinct subsets of patients with advanced disease. These examples highlight the progress made at all stages of care.

The pursuit of reduced-intensity treatments for testicular cancer continued with vigour in 2013. For those with metastatic disease and poor prognoses, an alternative to bleomycin, etoposide and cisplatin chemotherapy emerged. These advances suggest we are making progress by reducing treatment intensity with personalized approaches for this highly curable malignancy.

Big data and computational biology brought to the forefront a number of potential actionable mutations and drug targets in clear cell renal cell carcinoma in 2013. As we continue to unravel the molecular underpinnings of tumorigenesis and progression, the clinical benefits will eventually be reaped.

2013 saw the publication of several reports providing insight into a range of ongoing issues in bladder cancer, from screening high-risk candidates to using blue-light cystoscopy to reduce recurrence. These data will strengthen efforts to optimize the detection and treatment of bladder cancer, benefiting patients along the cancer continuum.

In 2012, three trials of antiretroviral pre-exposure prophylaxis (PrEP) were reported, with conflicting results. Taken together with data from 2010 we now have two trials that showed no benefit and four studies that demonstrated moderate-to-high efficacy. Accordingly, it seems that PrEP might have a limited role for HIV prevention in individuals at high-risk of infection.