Review Articles

Premature ejaculation is a male disorder causing distress, bother, frustration and/or avoidance of sexual intimacy. Currently available therapies are not lasting and only mildly effective. In this Review, the authors summarize currently available approved and off-label treatments for premature ejaculation, and comprehensively discuss emerging therapeutic options.

Several studies over the past few decades have suggested that sperm quality varies by geographical region and might be subject to a temporal decline worldwide. However, the data supporting these conclusions have come from studies of various methodologies and heterogeneous populations, making them unreliable. In this in-depth Review, Chevrier and colleagues discuss the data surrounding discussion of spatiotemporal trends in semen parameters and consider how these trends and the factors promoting them interact.

Diabetic bladder dysfunction (DBD) is a common complication of diabetes. Hyperglycaemia-induced oxidative stress is thought to mediate functional changes in organs and tissues affected by DBD. In this Review, the authors provide an overview of mechanisms and consequences of oxidative stress, focusing on the role of diabetes-induced oxidative stress in generating dysfunctions at the level of the urothelium, smooth muscle contractility and nerve structures involved in DBD pathogenesis.

In this Review, Joshi and colleagues describe the immune landscape of penile cancer, examine existing and novel immune-based therapeutic targets, and discuss the future directions of immune-based therapies in penile cancer based on preclinical and clinical studies.

In this Review, the authors discuss the current evidence for the use of prostate-specific membrane antigen (PSMA) PET and whole-body (WB) MRI, consider the evolving use of PSMA PET-derived and WB MRI-derived quantitative biomarkers and make recommendations for future clinical trials of these modalities.

In this Review, the authors summarize current advances in our understanding of the roles of stroma and associated extracellular matrix during bladder cancer development, describing the bladder tumour microenvironment and introducing the concept of the metastatic tumour microenvironment.

Hyperactivation of innate immunity is a disease determinant in urinary tract infections (UTIs). Modulation of innate immunity has promise as a therapy for UTIs. In this Review, the authors discuss potential mechanisms and immunomodulatory therapeutic strategies in UTIs.

Standard-of-care management of renal cell carcinoma (RCC) relies on surgery for low-risk localized disease and systemic treatment for poor-prognosis metastatic tumours, but patients with high-risk localized tumours and with metastatic disease that has a good-to-intermediate prognosis are in a grey area for treatment. In this Review, the authors provide a comprehensive overview of the current knowledge on surgery and systemic treatment in the management of metastatic and localized RCC.

In this Review, Russo and Giri describe and discuss germline testing criteria, genetic testing strategies, genetically informed screening, precision management, delivery of genetic counselling or alternative genetic services and special considerations for men with prostate cancer.

In this Review, the authors describe our current knowledge of the consequences of SARS-CoV-2 infection on the urogenital system, discussing urological symptoms and damage to organs of the genitourinary tract induced by COVID-19 infection. Moreover, the effects of COVID-19 on male fertility and sexual health are discussed.

Active surveillance is recommended for low-risk and favourable intermediate-risk prostate cancer management, but active monitoring using imaging or biopsy is necessary to compensate for initial undergrading of the tumour or to detect early progression without missing the opportunity to provide curative therapy. In this Review, the authors discuss the potential for MRI-based active monitoring for active surveillance and consider how this approach might affect patient care.

In this Review, Teoh et al. describe different mechanisms of early and late disease recurrence in non-muscle-invasive bladder cancer and discuss potential treatment options. In addition, the authors discuss the potential of molecular classification and treatment with immunotherapy and novel therapeutic agents in the future management of bladder cancer.

Patient-reported outcome measures (PROMs) have become an important tool for understanding the adverse effects of radical prostate cancer treatment and have been widely integrated into clinical practice. In this Review, the authors discuss the available PROMs for use in prostate cancer care and consider how data collection, interpretation, standardization and reporting will be crucial for the continued implementation of PROM instruments in prostate cancer pathways.

In this Review, Baures et al. discuss prostate luminal progenitor cells, covering their functional properties and potential role in prostate pathology. In addition, the authors describe different approaches to classifying these cells, and unify multiple identifiers that have been used to define prostate luminal progenitor cells.

Catstagnetti and El-Ghoneimi provide an overview of the classification, assessment and management of penile curvature associated with proximal hypospadias in children. Methods of curvature measurement and surgical techniques are detailed, in addition to discussion of the importance of patient-reported outcomes.

The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. In this Review, the authors describe and discuss the placebo and nocebo effects in selected benign urological diseases.

In shared decision-making (SDM), patients and providers work together to determine the best course of action based on the current evidence and the patient’s own preferences. Tools such as decision aids can support SDM for complex decisions, but these decision aids are also associated with barriers to SDM implementation, including patient, provider and systematic challenges. In this Review, the authors discuss opportunities for and limitations of SDM in urology and female pelvic medicine and reconstruction, as well as decision aids available in the field.

Primary hyperoxalurias are a devastating family of diseases that eventually lead to end-stage renal disease. In this Review, Shee and Stoller discuss current treatment paradigms for primary hyperoxalurias, new therapeutics and their mechanisms of action, and future directions for novel research in the field.

A number of penile traction therapy and vacuum erection devices are available for the management of patients with erectile dysfunction, Peyronie’s disease, penile dysmorphophobia, before and after penile prosthesis insertion, and after radical prostatectomy. However, the optimal device for each indication differs and, for some indications, research is limited. In this Review, Sultana and colleagues present a variety of devices that are available and consider challenges such as compliance, cost and availability.

In this Review, the authors describe current sperm selection methods and the advances in selection technologies for assisted reproductive techniques, highlighting their mechanisms of selection, advantages, limitations and clinical outcomes. They also propose a conceptual sperm selection model that uses multiple selection mechanisms.