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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.

Clinic-based uroflowmetry is limited by a short window of data collection and inefficient data transmission. Obtaining uroflowmetry data in the home setting has the potential for increased data on voiding patterns to inform clinical decision-making. However, integration of this practice depends on optimizing technology and data management.

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.

Transgender women remain at risk of prostate cancer and warrant consideration for PSA screening. However, current PSA reference ranges and guidelines are based on data from cisgender men. As these thresholds might be inappropriate in transgender women receiving gender-affirming hormones, we recommend that these patients should undergo screening for prostate cancer at regular intervals and further evaluation for PSA >1 ng/ml or rising PSA. Furthermore patient-centred dialogues should be initiated with patients to ensure awareness of prostate cancer risk.

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.

High intensity theatre (HIT) lists are an efficient and effective measure to tackle elective surgery backlogs without compromising outcomes and safety compared with traditional elective lists. A recent pilot trial in standard and complex urological surgery at a tertiary hospital in the UK proved successful for both the patients and the staff involved.

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.

Urology is a historically male-dominated field and, although the number of women is increasing, gender equity is still far off. All members of the urology community need to work together to drive a change.

The gender gap among urologists is narrowing, but representation of women from under-represented in medicine (URiM) groups remains low. URiM women face the added challenge of contending with tokenism. Intentional sponsorship and coaching, as well as institutional efforts to establish an inclusive and equitable workplace culture, are imperative to abolish the lag in promotion and academic achievement of these women.

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.