In an article published in Eur Urol (2012) by Vickers et al, the authors study a group of 695 men from the Scandinavian prostate cancer group. They randomised the men to watchful waiting or radical prostatectomy. Their model suggests that it is hard to justify surgery in patients with Gleason 6, T1 disease or in those patients much above 70 yr of age. Conversely, surgery seems unequivocally of benefit for patients who have Gleason 8, or Gleason 7, stage T2. For patients with Gleason 6 T2 and Gleason 7 T1, treatment is more of a judgment call, depending on patient preference and other clinical findings, such as the number of positive biopsy cores and comorbidities.

In an article published in Trends in Urology and Men’s health, Scott discusses the role of screening for urological cancer. These cancers accounted for more than 58,000 new diagnoses in UK in 2008, compared 48,000 for breast cancer. They accounted for over 20,000 deaths in 2009 compared to 35,000 for lung cancer. Screening can improve mortality for some cancer types, but screening for urological malignancies is yet to be proven. In the case of prostate cancer 2 large studies show conflicting results using PSA as the screening test; PLCO screened 38343 men with 38350 controls with a relative risk of cancer mortality favouring controls at 1.1. ERSPC, which was methodologically at better trial screened 72952 men with 89245 controls and a relative risk favouring screening of 0.80. The ERSPC study suggested that screening 100,000 men prevents 73 prostate cancer deaths, with treatment causing considerable harm; 3169 cases of erectile dysfunction, 925 cases of incontinence and 11 deaths. Screening for bladder cancer with available tools is similarly not cost effective compared to current opportunistic dipstick testing and investigation of haematuria.

An article published in N Engl J Med (2012) concluded that Women having surgery for uncomplicated stress incontinence can be spared the discomfort and inconvenience of preoperative urodynamic tests. Both women who did, and those who did not, have these tests had equal chances of successful treatment; about 77% success in both groups.

In an article by Park et al in BJUI (2012), the authors study whether repeatedly biopsying the prostate influences survival after treatment for localised prostate cancer. They conclude that neither repeating the biopsies, nor taking more cores influences survival. Whilst interesting and supported by the contemporary literature this article is based on a relatively small sample of 1147 sets of biopsies of which only 83 were repeats.

In a single centre study of 106 men, published in BJUI (2012), Dockray et al describe a cohort of men treated with penile frenuloplasty for pain and/or frenular scarring. 8% of men suffered a minor complication, such as bruising. 8% required circumcision at a later date, as their symptoms were not completely resolved, but 97% would recommend the procedure to a friend.

Badalato et al discuss the role of partial nephrectomy (PN) for large renal tumours in an article in BJUI (2012). PN is widely accepted as the standard of care for many patients with renal tumours smaller than 4 cms in maximum diameter. This large study looked at the outcomes of over 11,000 operations (including over 1,000 PN procedures) and found that survival was equivalent for both PN and radical nephrectomy even in large renal tumours of over 4 cms in size. The evidence for considering PN in the surgical care of most renal tumours is rapidly increasing.

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.