Reviews & Analysis

Placebo effects are a major factor in randomized control trials of treatments for interstitial cystitis/bladder pain syndrome. Two studies in the past 4 years have shown greater placebo effects than are usually reported in the literature. A recent report by Bosch investigated how these placebo effects are enhanced by education and behavioural modification strategies.

New AUA guidelines on the management of patients with kidney stones are a welcome addition to a field that, over the past few decades, has been neglected by urologists. Despite some limitations, this document is an extremely important reminder of what we can—and should—offer our stone-forming patients.

Premature ejaculation (PE) is a common ailment in men but its pathophysiology remains unclear. Updated guidelines from the International Society of Sexual Medicine attempt to aid the diagnosis and treatment of PE, and here we give our opinion on the best course of action for affected patients.

Studies suggest that there is a link between obesity and a reduced risk of low-risk cancers, but an increased risk of high-grade, lethal disease. A recent paper has attempted to further define this risk, and causes us to question whether active surveillance is an appropriate treatment option for obese patients.

Advances in knowledge, diagnostic procedures and available treatment options enable continual improvements in treatment of urogenital organs after severe trauma. The American Urological Association's first urotrauma guidelines include statements organized in a practical and straightforward manner and classified by the affected urogenital organ, to assist in the treatment of urotrauma.

Renal cell carcinoma (RCC) is the most lethal of the common urological cancers, and is increasing in incidence globally. Bhatt and Finelli present a Timeline of landmarks in four centuries of research and treatment of RCC, the most common renal cancer, discussing current therapies and future prospects.

Jannini et al. describe the evidence supporting the concept of the clitourethrovaginal (CUV) complex, and the overlap with the properties of the elusive G-spot. Consideration of the intricate anatomical relationships involved in female sexual arousal and orgasm could help to avoid damage to the CUV complex during surgery.

Few prognostic factors have been identified and successfully replicated for patients with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC). However, a new report has shown that alkaline phosphatase velocity (APV) is an independent predictor of bone-metastasis-free survival and overall survival in patients with nmCRPC.

The pathology of intermediate-risk non-muscle-invasive bladder cancer is less well-defined than both high-risk and low-risk presentations of this disease. Recently reported guidelines seek to aid clinicians in classification of intermediate-risk patients, and also provide treatment recommendations for this subgroup.

The American Urological Association has released a new guideline on the evaluation and treatment of cryptorchidism, recommending early orchiopexy as the first-line treatment for both the congenital and acquired forms of the disease; hormonal therapy is not recommended. Given similarities with current European recommendations, transatlantic consensus has been achieved.

PSA-based screening is common in the western world. However, rescreening policies are ambiguous, resulting in unnecessary testing. Recent data suggest that rescreening intervals should be decided on the basis of a baseline PSA level, but how is this recommendation likely to be received by the clinical community?

Although the androgen receptor remains active in metastatic castration-resistant prostate cancer, the heterogeneity of this disease means that response to treatment in individual patients is uncertain. Analysis of relevant tissue before and after therapy can help identify markers of response and resistance to androgen receptor signalling inhibitors.

Non-muscle-invasive bladder cancer represents 75% of primary diagnoses and is characterized by frequent recurrence but a low risk of mortality. In this Timeline article, Mertens and colleagues discuss landmark events in the detection, diagnosis, and treatment of non-muscle-invasive bladder cancer.

Cystectomy with urinary diversion is a key approach to the management of bladder cancer. This Review provides an overview of a complication that is common among the men and women who undergo such surgical treatment: sexual dysfunction. In particular, the tools that can be used to assess sexual function in this context and its effect on quality of life, the various contributory aetiological factors underlying sexual dysfunction, as well as approaches to treating sexual issues are discussed.

Detrusor underactivity (DUA) results in prolonged urinary voiding or failure to completely empty the bladder and is associated with lower urinary tract symptoms. Drake and colleagues provide an overview of the pathophysiology and management of DUA, highlighting the aetiological, diagnostic, and therapeutic challenges of this condition.

In this Review, Kauffman and colleagues summarize contemporary understanding of the molecular biology underlyingTFE3 and TFEB gene-fusion-associated (translocation) renal cell carcinomas. They discuss the candidate mechanisms and signalling pathways thought to contribute to the oncogenesis of these tumours, and describe TFE3 and TFEBfusion genetic organization.

In this Review, Smith and colleagues discuss the use of enhanced recovery programmes, which are multimodal approaches to minimize the psychological and physiological disruption—and expedite the return of normal function—after radical cystectomy. They consider the preoperative, perioperative and postoperative factors that should be incorporated into clinical care to improve patient outcomes.

A new model that predicts in vitro fertilization outcomes is planned by the Society for Assisted Reproductive Technology based on US data. However, the proposed model ignores important variables and does not address the most important clinical outcome: the birth of a healthy baby to a healthy mother.

Historically, the use of testosterone supplementation therapy (TST) for hypogonadism in men with prostate cancer has been limited by concerns that such treatment might cause progression of this androgen-dependent cancer; however, the contemporary literature indicates that TST in men with prostate cancer can be safe and, contrary to traditional thinking, that TST might actually reduce the risk of prostate cancer development. In this opinion piece, Larry Lipshultz and colleagues discuss the evidence supporting TST—in contrast with the lack of evidence against this approach—in hypogonodal men with prostate cancer.

A new case–control study shows that inflammation on biopsy is associated with diagnosis of prostate cancer. We think a large population-based prospective study, specifically designed to investigate the longitudinal association between inflammation and subsequent onset of prostate cancer, is required to elucidate the true relationship between inflammation and prostate carcinogenesis.