THE PROLIFERATION of medications to aid in the suppression of viral replication for persons with HIV infection has expanded at a pace almost unparalleled in any other field of medicine. For subspecialists who assist in the care of persons with HIV but do not prescribe the medications themselves, this proliferation of medications can certainly present challenges to keeping their education current.

FOR 30 years, lasers have been evolving for the treatment of urologic conditions. Investigators focused on lasers for BPH to achieve results similar to transurethral resection of the prostate (TURP) without the bleeding, fluid overload, blood loss, inpatient hospital stays of two to three days, and erectile dysfunction associated with TURP.

Despite current therapies, renal cell carcinoma (RCC) is often lethal. Many factors influence outcomes, including stage, grade, subtype, necrosis, and molecular attributes. Prognosis can be difficult to determine. Comprehensive staging strategies that incorporate multiple patients and tumor factors are necessary to predict survival accurately and optimize research strategies. Recently designed algorithms allow for convenient and up-to-date estimates of outcome in this rapidly evolving field.

RACIAL HEALTH care disparities are represented by measurable and significant differences in the incidence of certain diseases as well as their associated morbidity and mortality rates. In the United States, a significantly disproportionate burden of disease and morbidity is borne by African Americans when compared to their Caucasian counterparts, may contribute to the fact that African Americans have documented life expectancies seven years shorter than non-Hispanic whites.

WITH WIDESPREAD screening now the norm, prostate cancer is being detected with increasing frequency and at earlier stages than in previous years. At least 90% of cases are metastasis-free at diagnosis and most patients undergo local treatment. Patients with locally advanced disease, however, are at high risk of recurrence and thus are more challenging to manage.

HYPERTENSION is a common clinical problem in renal transplant patients, and it has important consequences for patient and graft survival. At five years after transplantation, more than 50% of patients have Stage I or Stage II hypertension and nearly 40% of patients have prehypertension.

BLADDER CANCER is projected to be the fourth most common cancer diagnosed in 2007 and the eighth most common cause of cancer-specific death in men, according to the American Cancer Society. Approximately 70% of bladder tumors present as non-muscle invasive (NMI) disease and 10%-20% will progress to muscle invasion.

A principal reason for poor outcomes among bladder cancer patients is metastatic disease during follow-up. With currently available drugs, metastatic disease to other solid organs is only curable in less than 10% of patients, according to Virginia urologist Dan Theodorescu, MD, PhD.

The use of botulinum toxin (BTX) for various non-urological indications, such as cervical dystonia, blepharospasm, and strabismus has been well accepted for more than a decade, but its application in urology has been somewhat slower in developing.

Bladder cancer caught early is often amenable to treatment, but of course late-stage and aggressive characteristics alter the prognosis for the worse. Understanding high-risk features, including aberrant histologic patterns, empowers the urologist to counsel and treat patients with greater precision.