Not a fan of iTunes myself and its all-or-nothing sync behavior does ask for more. Fortunately, it has been possible to update the device or download purchased content directly on the device for a couple of years now.
But not pictures on the device, which was really what I care most. Maybe iCloud is better now, but it's an extra layer of blackbox I will need to worry about.
Dropbox, Box, Picturelife, Photostream, etc all give you ways to get photos without using iTunes
Photostream syncs pictures between devices. Both Directions. It's basically flawless.
pictures don't go through iTunes, they do pop iPhoto for me