Foreword


Emmanuele A Jannini is a Professor of Endocrinology and Sexology at the University of L’Aquila in Italy. He is Chairman of the Scientific Board of the Italian Society of Andrology and Sexual Medicine, Chairman of the Educational Committee and a Member of the Standard Committee of the International Society for Sexual Medicine and Chairman of the Educational Committee of the European Academy of Andrology. He has written numerous articles on premature ejaculation, erectile dysfunction, androgen pathophysiology and molecular biology of the testis.


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elcome to the latest issue of European Urological Review, one of the best resources for the clinical urologist. I am particularly happy to welcome you because… I am not an urologist, and for me to write this foreword demonstrates how modern urology is not a closed, narrow scientific environment, but rather a growing field of medicine open to different disciplines, such as endocrine andrology and sexual medicine.


The requirement for close collaboration is discussed at length in this issue, particularly in prostate cancer. Far from being just a surgical problem the second most prevalent male cancer is a dramatic challenge: we have several questions that require evidence-based answers. Shall we actively screen for prostate cancer or should we wait for scheduled health check-ups? What are the best imaging techniques in prostate cancer? When the cancer is cured, how to prevent osteoporosis and other symptoms of androgen-deprivation therapy? The median age of prostate cancer is lowering dramatically and, at the same time, diagnostic ability is developing, therapeutic tools are continuously updated and the number of successfully treated patients is exceptionally high. For all these reasons, attention to the quality of life of cancer survivors seems to be one of the most important tasks for clinical urologists, who are currently re-evaluating the dogma that the cured patient must be hypogonadal indefinitely.


However, uro-oncology does not concern only prostate cancer. Other frequent cancers of urological interest are kidney carcinomas. What is the future of next-generation targeted therapies in renal cell carcinoma? Is there a role for surgery in the era of targeted agents? What is the best medical therapy for advanced kidney cancer and bladder cancer, and how to use the biomarkers in the diagnosis of this neoplasia? Furthermore, the reader will find interesting aspects of testicular cancer, adjunctive surgery in men undergoing residual tumour resection following chemotherapy and the consequences of these therapies on the male fertility potential. This issue also addresses classic urological arguments, such as shock wave lithotripsy, i.e. back to basics, or alternatively, should the sonic ureteric calculi method be pursued, and prolapse in the older woman – a frequent condition in urogynaecology.


Sexual medicine in terms of HIV, reproductive care and premature ejaculation is dealt with in this issue. For unexplained reasons, the relationship between the prostate and ejaculation has been largely neglected by urologists, but has attracted increasing interest following the pioneering work of my laboratory. As a consequence of this neglect, the most frequent and the most ‘urological’ sexual symptom – premature ejaculation – is often not considered by the clinical urologist. When we first demonstrated that prostate inflammation/infections are relatively frequent in patients with premature ejaculation and that this sexual symptom is in turn common in subjects with prostatitis, most urologists were sceptical. This scepticism was particularly illogical: prostatic inflammation may alter sensations arising from the male genital tract, so that the man is unable to recognise the emission phase, which is a main mechanism leading to premature ejaculation. Frequently after my meetings, lectures and congresses I hear statements such as: “I never seen ejaculatory disorders in prostatic inflammations in my office”. When I ask “How frequently do you ask for loss of ejaculatory control in your prostatic patients?” invariably the answer is: never.


However, this is an old story. After several other papers appeared around the world, which confirmed my findings and further demonstrated the association between prostate and premature ejaculation and the effectiveness of treating prostatitis in this sexual symptom, the need for evaluation of prostatic health in patients with premature ejaculation is clearly stated in guidelines, such as those recently produced by the European Urological Association.


An impressive panel of experts has advised European Urological Review, and the contents address some of the most important areas of modern urology. I am confident that this issue will be an important point of reference for clinicians. n


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© TOUCH BRIEFINGS 2010


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