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.

The most widespread nondermatologic malignancy in men, prostate cancer afflicts one in six American males and kills one in 34. Growing public awareness, an aging population, and increased PSA screening has led to greater detection of early-stage disease. Among newly diagnosed cases, for example, the proportion with T3 or T4 disease fell from 19% to 4% between 1988 and 1998, and those with metastatic disease at presentation fell from 14% to 3%, according to a study by Peter Carroll, MD, and colleagues at the University of California in San Francisco Comprehensive Cancer Center (J Clin Oncol. 2005;23:8146-8151).

The characteristicsof hypertension in hemodialysis patients differ from those in the general population. In dialysis patients, accelerated age-related changes in vascular stiffness, combined with factors peculiar to uremia, contribute to a loss of large and small vessel distensibility.

The kidney consists of four basic tissue types: vessels, glomeruli, tubules, and interstitium. Each of these types may be influenced by different pathophysiologic mechanisms associated with diabetic nephropathy. Despite their variability, these mechanisms share common clinical outcomes including microalbuminuria, progesssion to end-stage renal disease, and increased risks of cardiovascular morbidity and mortality.

In the PSA era, most men with newly diagnosed prostate cancer present with clinically localized disease and are curable with surgery or radiation. Among patients with no evidence of metastasis at presentation, radical prostatectomy alone is associated with 10- and 15-year cancer-specific survival rates of 96% and 93%, respectively, and post-operative periods of biochemical progression-free survival of 77% and 75%, respectively. Approximately 25%-35% of men believed to have localized cancer fail to be cured following definitive local therapy, most of whom require some form of systemic therapy.

FOCAL SEGMENTAL glomerulosclerosis (FSGS) is not a single disease but a histologic pattern of renal damage that initially affects the glomerulus and its tubulointerstitium (Nat Clin Pract Nephrol. 2005;1:44-54). FSGS is a leading cause of nephrotic syndrome worldwide and may be found in up to 35% of nephrotic individuals.

AUTOSOMAL DOMINANT interstitial kidney disease is an under-recognized cause of kidney failure. Characterized by a very strong family history of kidney disease, it is a slowly progressive condition that leads to dialysis when patients are in their 40s or older.

EVEN THOUGH the American Urological Association has developed guidelines for numerous conditions, there are none for vasectomy. Yet this is one of the most common procedures performed by urologists, with more than 500,000 done annually in the United States.

KIDNEY DISEASE linked to diabetes, hypertension, and obesity is increasing throughout the world. It is estimated that diabetes leading to end-stage renal disease (ESRD) accounts for 40% of the patients who require kidney transplants in the United States, Europe, Japan, Australia, and New Zealand.

IN THE United States, the incidence of urinary stone disease is about 12% in men and 7% in women, and evidence suggests that these numbers are increasing. For patients who form stones, the likelihood of a recurrence is nearly 50% within five years and up to 95% over a lifetime.