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The issue of neonatal circumcision is highly controversial. In this Viewpoint, Austin discusses why he considers neonatal circumcision to be beneficial. He assesses the evidence for a protective effect of circumcision from genital cancer, urinary tract infections and sexually transmitted infections, and also the evidence for minimal adverse events associated with circumcision in neonates.
This Case Study describes a 56-year-old man who initially presented to his urologist with lower urinary tract symptoms. Four years later, a gastrointestinal stromal tumor (GIST) was diagnosed after prostate biopsy. This article discusses the role of immunohistochemistry for diagnosing GIST, and the pharmacologic and surgical management of this unusual prostatic tumor.
In this Viewpoint, the authors discuss the FDA's strategies for increasing access to new medicines for patients with serious or life-threatening illnesses. The article describes the currently available access mechanisms, and highlights the FDA's planned regulation revisions for expanding access.
Urinary tract stones and urinary tract infection are strongly associated. In this Review, Thomas and Tolley describe the pathogenesis, diagnosis and management of infection stones, and also the management of patients who develop infections as a consequence of stone disease.
The integration of molecular biomarkers into prediction models has the potential to improve the management of urothelial carcinoma of the bladder. Bolenz and Lotan outline the search for candidate biomarkers in this disease, and discuss the obstacles to their use in routine clinical practice.
The management of uncommon urological malignancies is rarely based on evidence from prospective trials, and ad hoc treatment by individual clinicians who seldom encounter the cancer is not ideal for the patient. In this article, Nicholson identifies key issues in developing a trial strategy for treating rare urological malignancies.
This Case Study describes a 60-year-old woman who presented with an enlarging subcutaneous lesion on her right flank, 6 months after having undergone treatment for transitional cell carcinoma (TCC) of the bladder. The article highlights that rare cutaneous TCC metastases can mimic common benign and inflammatory processes, and the authors suggest treatment options for such patients.
Sacral neuromodulation (SNM) has been investigated as a treatment for a range of refractory lower urinary tract disorders. In this Review, Kessler and Fowler discuss developments in SNM techniques and technology, assess patient outcomes, and consider potential mechanisms of action for this therapy.
Androgen receptor activation and signaling have a key role in the pathogenesis of castration-resistant prostate cancer. In this Review, Reid and colleagues assess the possible therapeutic strategy of inhibiting androgen biosynthesis by blocking the function of the enzyme CYP17.
This article on the ethics of gene therapy for male infertility is the third Viewpoint in the article series. Sheehan addresses issues such as 'playing God', patient consent for gene therapy trials, eugenics, and the distribution of medical resources.
The second Viewpoint in the series of articles on gene therapy for male infertility evaluates safety aspects. Lamb describes the ideal vector for DNA transfection, and draws on data from previous studies to describe the safety of various vectors under investigation.
This Viewpoint, which is the first of three articles discussing gene therapy for the treatment of male infertility, considers the feasibility of the approach. Boekelheide and Sigman initially describe the genetic causes of male infertility, and go on to discuss gene therapy approaches, and possible future directions.
Stem cell therapies and regenerative medicine promise to revolutionize the treatment of many urological disorders. Here, Aboushwareb and Atala review the techniques used to generate stem cells for therapeutic applications, and discuss their potential for reconstructing the urinary tract, treating urinary incontinence, understanding prostate dysfunction and restoring fertility.
Bacterial biofilms are common in patients with indwelling urinary catheters, and crystalline biofilms in particular can cause serious complications. In this Review, Stickler describes the biological, physical and chemical factors that can lead to crystalline biofilm formation, and the current and potential future management of crystalline biofilms.
In this Case Study, Gao et al. present a 59-year-old man with complete staghorn calculi who had previously undergone ileal ureteral replacement. The patient was successfully treated with percutaneous nephrolithotomy. The authors emphasize the essential role of CT urography in diagnosis and treatment planning in such complex cases.
This Case Study describes a 14-year-old girl with continuous urinary incontinence after resection of a vaginal septum associated with uterus didelphys. The authors discuss the diagnostic procedures undertaken, and show that MRI was effective, both preoperatively and intraoperatively, in detecting an ectopic ureter and ectopic dysplastic kidney.
Modifications and refinements of standard laparoscopic instrumentation have led to an increasing interest in the use of single-incision surgery for urological procedures. In this Review, the authors discuss the terminology for this new type of surgery, the advances in laparoscopic instrumentation, and the results of single-incision urological surgery.
Benign prostatic hyperplasia (BPH) is one of the most common urological disorders in men, and standard treatment is transurethral resection of the prostate. In this Review, Baazeem and Elhilali assess the current evidence on other surgical options for the treatment of BPH.
Wilms tumor is the most common malignancy in children, but current survival rates are high. A new aim for treatment is to reduce the morbidity associated with therapy. In this Review, Sonn and Shortliffe look at various management guidelines for the disorder, as well as the typical and unusual clinical presentations of Wilms tumor.
In this Viewpoint, Dr Donat presents the case against using frozen section analysis of distal ureters in patients undergoing cystectomy for transitional cell bladder cancer, arguing that division of the ureter at the level of the common iliac artery largely precludes the need for frozen sections in this setting.
