Reviews & Analysis

Bladder cancer outcomes are considered worse for women than for men, whereas incidence is three to four times higher in men than in women. Understanding biological phenomena and health-system factors driving these differences is essential to improve outcomes and develop novel treatment approaches.

In this Perspective, the authors highlight the ethical challenges of adopting artificial intelligence (AI) in urology and its influence on daily practice. Ethical principles for the application of AI in health care and urology are proposed to improve and oversee the use of such technologies.

The microbiota influences the body in homeostasis and disease, including cancer, and, although specific urinary and gut microbial species have been associated with an increased risk of prostate cancer, causal mechanistic data remain elusive. In this Perspective article, the authors discuss the roles of the microbiota in prostate carcinogenesis and progression, and consider how these might be leveraged for diagnosis and treatment of the disease.

The relationship between smoking, ethnicity and bladder cancer is complex and multifaceted, with substantial public and personal health as well as clinical implications. New evidence supports that targeted smoking cessation efforts among high-risk populations could reduce the burden of bladder cancer.

In this Perspective, the author uses a comparative evolutionary approach to explain renal physiology. The kidney structure and the urinary collecting system are contextualized within the evolutionary and environmental selective pressures that might have contributed to renal evolution.

Bacteria infecting tumour cells might be a promising target for triggering antitumour immune responses. Here, the authors discuss the influence of urinary tract infections on kidney and bladder cancer immunosurveillance and consider the urobiome and the effects of antibiotics.

Approximately two-thirds of small, indeterminate lesions of the testes might be benign and not require radical orchidectomy. Management strategies are evolving to include vigilant active surveillance and excisional biopsy of the lesion with further management guided by histological outcome.

Body fluid-derived stem cells (BFSCs) have been used as a stem cell source in animal models of regenerative diseases. In this Perspective, the authors present the characteristics and immunomodulatory properties of different BFSCs, focusing on the therapeutic potential of these cells in the treatment of genitourinary conditions and discussing challenges in the clinical translation of BFCSs in urinary regeneration.

In this Review, the authors present the history of cytoreductive nephrectomy, discuss controversial results from clinical trials and assess future perspectives about the role of surgery in the management pathway of patients with metastatic renal cell carcinoma.

Known modifiable risk factors for renal cell carcinoma (RCC) include smoking, obesity and hypertension. Moreover, a potential association between other factors such as diet, dyslipidaemia and physical activity with RCC incidence is also starting to be explored. In this Review, the authors describe the most relevant modifiable risk factors for RCC, discussing the potential implications for prevention and screening programmes.

Sexually transmitted infections (STIs) remain public health concerns. Doxycycline post-exposure prophylaxis to prevent STIs is a novel promising intervention, which in a new study caused an ∼65% reduction in incident STIs. However, long-term effects on STI prevalence, microbiomes and antimicrobial resistance among STI pathogens, non-STI pathogens and commensals need to be monitored.

The current serum tumour markers α-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase show limited value for testicular cancer relapse detection. A recent study highlights that false-positive elevations in follow-up monitoring are common and, conversely, many patients do not have elevations despite proven relapse. These findings highlight the potential for circulating microRNAs to be used as improved biomarkers for relapse detection.

Urine markers enable non-invasive acquisition of tumour information. The evolution towards multiplex approaches addresses bladder cancer heterogeneity and expands clinical application scenarios for urinary biomarkers. This Review provides a comprehensive overview of current status, limitations and perspectives of various urine markers.

Effects of prostate cancer treatment in sex and gender minority groups, which include gay and bisexual men, transgender women, or transfeminine people, can include altered sexual function in relation to receptive anal and neovaginal intercourse and changes to patients’ role-in-sex, as well as changes in sexual pleasure related to the loss of the prostate as a source of sexual pleasure. In this Review, the authors discuss the prostate as a sexual organ and consider the effects of prostate cancer treatment in patients from these under-represented groups, as well as discussing the need for openness and counselling in patients from sexual and gender minorities.

Current evidence suggests that adipose stromal cells, a component of peri-prostatic white adipose tissue and the tumour microenvironment, have an important role in driving aggressive prostate cancer in obesity. These cells are potential targets of therapies to suppress cancer aggressiveness in obesity.

In this Review, the authors examine the prevalence of middle lobe enlargement in benign prostatic hyperplasia (BPH). The clinical significance, presentation, pathophysiology and assessment of middle lobe obstruction is discussed. The spectrum of management options in BPH is reviewed and their applicability in middle lobe enlargement debated.

In this Perspective article, the authors summarize the roles of vitamins in calcium-containing kidney stone disease, and hypothesize implications for the gut microbiota in altering vitamin homeostasis by modulating vitamin absorption, production and chemical modification.

In this Review, the authors summarize the roles of the androgen receptor in bladder cancer development and progression, and describe the clinical applications of these roles.

In this Review, Reyes et al. provide an overview of the embryology and genetics of typical sex development, before discussing the clinical manifestations, genetic causes and phenotypic complexity of differences in sex development.

In this Consensus Statement, the authors present results from an international multi-stakeholder consensus conducted by the PIONEER consortium to identify the most important questions in the field of prostate cancer that could be addressed using big data.