In an editorial in BMJ (2013), Paul et al discuss the introduction of robotic surgery without prior evaluation. More than 360,000 robotic surgical procedures were carried out worldwide in 2011, using the only licensed robotic system; the da Vinci system developed by Intuitive Surgical. Urologists and Gynaecologists were early adopters of the technology and in 2011 more than 100,000 radical prostatectomies and 125,000 hysterectomies were performed robotically. In USA robotic surgery has become a symbol for advanced care, however it is a very expensive technology and evidence that its use improves outcomes is scarce at best.

In an article published by Bishop et al in JCU (2013), the authors discuss the results of 100 robotic radical prostatectomies (RALP). Positive margin rate was 22% overall, with 17% for T2 disease and 50% for T3 and T4 disease. 12 month continence rates were 82%. This is the first published report of results for robotic prostatectomy from a UK district general hospital.

At the Staffordshire Urology Clinic our current standard approach to surgery is laparoscopic (keyhole) rather than robotic. Our overall positive margin rate after keyhole radical prostatectomy is lower at 15%, and incontinence rates also lower than reported in this study.

At the ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium in February 2013, Goodman and colleagues presented a paper that summarized the long-term follow-up outcomes from the Prostate Cancer Prevention Trial. The original study was conducted from 1993 to 1997 and randomly assigned men to receive either 5 mg of finasteride or placebo, with the hope of reducing the odds of developing prostate cancer. Longterm follow-up, now at 15 years, showed no significant prostate cancer survival difference between patients treated with active drug or placebo. A subset analysis of men with low risk prostate cancer that had received finasteride did, however, have a better survival, although the cause of this effect was unclear.

In an article by Ramsden and Seels published in BJUI (2011) the authors argue that there is not a literature standard for defining success in laparoscopic pyeloplasty. Studies that define success on the basis of resolution of function have success rates in excess of 95%, whereas those that use imgaing aswell have a lower rate. When success is defined strictly as resolution of pain and preserved renographic function (Derriford criteria), literature success rates range form 77-98%. The authors success rates are 85.1%

Partial nephrectomy is the standard of care for smaller renal masses. A recent review studies the different approaches of open surgery compared to laparoscopic surgery. It finds no cancer outcome differences, but supports the laparoscopic approach for reducing morbidity. However, it points out that the laparoscopic approach is a tremendously difficult technique, which limits its use to surgeons proficient in the technique.

The reference for this article is: Ranjith Ramasamy. (February 2013), Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long‐term oncological and functional outcomes in 340 patients. BJU International, 111: 189.

Interstitial cystitis/chronic pelvic pain syndrome is a difficult condition to treat, with few good treatments. A recent study of the scientific literature reviews the limited evidence for using intra-vesical GAG analogues and concludes that the benefits are marginal. However, in the absence of other good alternatives it remains an important treatment option.

The reference for this article is: Costin L. Chintea, Mohammed Belal. (February 2013), Is there enough evidence for the use of intravesical instillations of glycosaminoglycan analogues in interstitial cystitis?. BJU International, 111: 192 – 193.

In a study published by Loo et al published in Mayo Clinic Proceedings (2013) the authors studied 2630 patients with non visible haematuria. Only 1.9% had either bladder or renal cancer diagnosed. Age over 50 years and visible hematuria were the most reliable predictors of urothelial or renal cancer. Male sex and smoking history were also predictive of cancer.

Gaziano et al report the results of a large randomized controlled trial in JAMA (2012). They studied more than 14,000 men with a median follow-up of 11 years. The subjects were physicians older than 50 years of age at the time of enrollment with the aim of seeing whether cancers could be prevented. They reported that prostate cancer made up nearly half of the cancers diagnosed, and that there was no difference in the incidence of prostate cancer found between men taking placebo or those taking multivitamins. The incidence of colon cancer was also the same in both groups. However, overall, there were fewer total numbers of cancers, excluding prostate cancer, in the group that received the daily multivitamin. Side effects were few but not very major.

According to the charity Prostate Cancer UK, research into prostate cancer is poorly funded in the UK. Of all cancers, research into Leukaemia is best funded with £3903 spent per case diagnosed. Breast cancer, the most common female cancer, which has a similar death rate to prostate cancer, received more than double the annual research spend at £853 per breast cancer case diagnosed, compared to £417 for prostate cancer. Approximately 10,000 men die from prostate cancer every year in the UK.

In an article by Schröder et al published in Europe Urol (2012) the authors show that Dutesteride can delay PSA rise in patients that have failed radical treatment for prostate cancer. The study, known as the ARTS trial, recruited 294 subjects that were randomised to either Dutesteride or placebo (147 in each treatment group). Only 187 (64%) completed 24 mo of treatment. In these patients Dutasteride significantly delayed the time to PSA doubling (p<0.001); the relative risk (RR) reduction was 66 % for the overall study period. Dutasteride also significantly delayed disease progression (p<0.001); the overall RR reduction in favour of dutasteride was 59%. The incidence of adverse events (AEs), serious AEs, and AEs leading to study withdrawal were similar between the treatment groups and in line with previously published data. A limitation of the study was that investigators were not blinded to PSA levels during the study.