In an article by Semins et al published in Urology (2012) the authors described the incidence of UTI in just over 95,000 adults. In the overall cohort, women were 4 times more likely to be diagnosed with UTI and pyelonephritis than men. Obesity (BMI>30) was associated with higher risks for UTI and pyelonephritis in both men and women; increasing risk by 4.5 times. However, men were at higher risk for obesity-associated UTIs overall, and women are at higher risk for obesity-associated pyelonephritis. Obesity has also been associated with urological conditions such as male and female sexual dysfunction, infertility, incontinence, genitourinary malignancy, and kidney stones. The authors speculate that weight loss strategies may reduce UTI and other urological conditions.

In an article by Montaldo et al in BJUI (2012) the authors show that treatment of primary monosynaptic nocturnal enuresis (MNE) in children can be improved by combining desmopressin with oxybutynin. Two thirds of children with MNE do not respond fully to desmopressin monotherapy, but among these patients, the addition of oxybutynin increases the response rate. Nocturnal polyuria predicts response to desmopressin, whereas bladder wall thickness on ultrasound and voiding latency predict response to combination therapy with desmopressin and oxybutynin.

In an article by Wright et al in Cancer (2012) circumcision before first sexual intercourse reduced lifetime risk of prostate cancer by a relative risk of 15%. This is an interesting observation with many possible confounders which should stimulate further research rather than change practice.
The investigators analyzed data from 1754 patients and 1645 control participants collected during 2 population-based, case-control studies of prostate cancer. Data included self-reported circumcision status, age at circumcision, age at first sexual intercourse, and history of STIs or prostatitis. Of the men who reported circumcision, 91% underwent the procedure shortly after birth. Circumcision was performed after the date of first intercourse in 3.9% of patients with prostate cancer (case patients) and in 2.5% of control participants. Reduction in prostate cancer risk associated with circumcision before first sexual intercourse was apparent for case patients with less aggressive features of prostate cancer (OR, 0.88; 95% CI, 0.74 – 1.04) as well as for patients with more aggressive features (OR, 0.82; 95% CI, 0.66 – 1.00). The effect of circumcision on the risk for prostate cancer was not affected by age, STI status, study 1 vs study 2, history of prostatitis, family history of prostate cancer, education, or income level. Circumcision after first sexual intercourse was not associated with the risk for prostate cancer. They suggest that circumcision might reduce the development of prostate cancer by decreasing prostatic exposure to infectious agents and the associated inflammatory changes that may enhance carcinogenesis. They refer to data showing reduced HIV and HPV risk in circumcised men.

An article in the BJUI (2012), reviewed in BMJ (2012), assessed 2184 men in a community setting and found that 28% of them were being treated for lower urinary tract symptoms (LUTS). In these patients medical management was poor compared with surgical intervention. Both medication and surgery were effective at slowing down progression of LUTS, but patients who had undergone TURP had the fastest and best improvement in symptoms, and reduction in incontinence.

In an article by James et al in the NEJM (2012) the authors report results from the BC2001 study. They argue that the chances of loco-regional control of invasive bladder cancer by radical radiotherapy is enhanced by combining it with synchronous chemotherapy. The study randomised 360 patients to radical (or modified) radiotherapy with or without chemotherapy (5FU and MMC). Over 80% of patients had T2, TCC and all were N0, M0. At 72 months there was an approximate 12% absolute improvement in loco-regional control. At the same time there was a statistically non-significant improvement in mortality.