Articles in 2020

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, which invades a cell through binding to the ACE2 receptor and TMPRSS2 priming. Patients with severe disease predominantly present with pneumonia-related symptoms. However, evidence suggests that COVID-19 infection also has implications for the urogenital tract. Thus, urogenital organs should be considered when treating COVID-19.

Technology for the treatment of stone disease has rapidly advanced, but a common nomenclature to communicate research and high-quality studies to assess treatment outcomes are lacking. Thus, guidelines are based on low-grade evidence and cannot make definitive recommendations in many scenarios. To improve clinical practice and patient outcomes, the endourology community must unite to address these inadequacies.

The Urinary Tract Infection Global Alliance (UTIGA) — a new society in the field of urinary tract infection — has been established to promote cross-disciplinary interactions, provide access to new information, identify research needs and standardize patient management. UTIGA will also provide mentorship opportunities and patient advocacy.

Paediatric kidney tumours comprise many different subtypes, each being heterogeneous in their cellular as well as genetic composition. Advances in the past decade in 3D culture models create new opportunities for the generation of preclinical models capturing this phenotypic and genetic heterogeneity, potentially enabling the generation of patient-tailored therapies.

In this Review, Meeks et al. summarize heterogeneity in bladder cancer and how it affects tumour biology and clinical care. They describe current knowledge of tumour evolution, genomic heterogeneity and different tumour subtypes, as well as morphological heterogeneity seen in variant bladder cancer histology. They also discuss the influence of heterogeneity on treatment decision making, drug development and clinical trial design.

The world is currently in the grip of the COVID-19 pandemic. Rapid changes in medical priorities are being enforced across all health-care systems. Urologists have had to reduce or halt their clinical activity and assist on COVID-19 wards. The repercussions on urological patient outcomes for delayed treatments and diagnosis remain to be defined.

A new study reports the 5-year patient-reported outcome data from a population-based cohort of men with localized prostate cancer. These findings in conjunction with data on survival, treatment burden and treatment cost can assist clinicians in explaining to newly diagnosed patients the likely effects of modern management options on quality of life.

Liquid biopsy techniques, especially the use of plasma circulating tumour DNA (ctDNA) analysis, are a convenient, fast and non-invasive approach to the diagnosis and monitoring of urological cancers, and could enable selection of targeted therapy before clinical and radiographic changes occur. In this Review, the authors discuss the uses of liquid biopsy and plasma ctDNA analysis in particular, and consider how it could be used in clinical practice now and in the future.

Management strategies used to treat prostate cancer often lead to treatment resistance, which can arise via a mechanism of cellular rewiring, whereby the tumour cell alters its signalling to escape the effects of therapy. Understanding these mechanisms could enable the development of improved and combination treatment regimens, to minimize treatment failures and improve outcomes.

Here, the authors discuss embryonic microRNAs that are highly expressed in testicular germ cell tumours, critically assess the clinical utility of monitoring these microRNAs in the circulation and compare their diagnostic performance with the classic serum tumour markers.