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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.
In a recent retrospective institutional analysis, the prognosis of patients with muscle-invasive bladder cancer improved over time after surgical intervention. Indeed, duration of survivorship after radical cystectomy was inversely correlated with risk of mortality, suggesting that follow-up regimens should be modelled according to this parameter.
Indocyanine green dye continues to be adopted in robot-assisted surgical procedures; its role has expanded from partial nephrectomy to now include reconstructive procedures. Further studies are required to evaluate whether it is simply an interesting tool in the armamentarium or a technique that can improve patient outcomes.
Bladder cancer recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) is a common occurrence. A new nomogram, based on retrospective analysis of a large multicentre cohort, has been shown to predict the risk of intravesical recurrence. Despite limitations, this model could help clinicians to provide personalized postoperative management.
Patients treated with two or more courses of BCG for high-risk non-muscle-invasive bladder cancer are at increased risk of second-site primary tumours of the upper urinary tract and prostatic urethra. A new study highlights the importance of looking for urothelial cancer in extravesical disease sites.
In surgical procedures, there is a delicate balance between preventing thromboembolism by maintaining thromboprophylaxis, and avoiding excessive bleeding. Patients requiring treatment for urinary stones are often taking antithrombotic medication, or have an underlying bleeding disorder. This Review brings together the current recommendations for perioperative management of thromboprophylaxis in lithotripsy.
Hampson et al. discuss the epidemiology, pathogenesis, aetiology, and evaluation of anterior male urethral strictures. They also consider some current controversies in urethroplasty, such as the management of failed hypospadias repair and long or complex strictures, as well as the use of dorsal versus ventral onlay grafting.
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.