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In medicine and society exist two pandemics. One, COVID-19, has recently emerged and has been widely acknowledged. The other — systemic racism — has been silently deadly for centuries. Now is the time to recognize the impact of this other pandemic and to eradicate it.
Management of rare genitourinary malignancies often depends on individual physicians’ discretion, resulting in non-standardized care. Furthermore, patients experience worse clinical outcomes than patients with common malignancies. Collaborative efforts such as the Global Society of Rare Genitourinary Tumors (GSRGT) are therefore necessary.
Exposure to urology is essential for medical undergraduates to prepare them with the competencies required to manage basic urological conditions and to generate interest in the specialty. However, despite the existence of national curricula, the lack of urological exposure and falling competition ratios indicate a need for an evaluation of urological teaching in medical schools.
Cancer sequencing studies have revealed that urothelial carcinomas harbour recurrent mutations in multiple genes that control epigenetics. A major challenge for basic and clinical researchers is to convert this genetic information into biological and pathological insights, as well as to tailor novel therapeutic modalities for individual patients with bladder cancer.
Plastics have an integral role in our daily lives but at a considerable cost to the environment and, as we are now learning, to human health. Increased plastic exposure has been linked to compromised endocrine function, reproductive health and semen quality and, potentially, urological cancers. However, the long-term consequences of plastic exposure remain to be seen.
Detection of positive nodes in men with moderate-risk to high-risk penile cancer and impalpable inguinal nodes is an important step in the therapeutic pathway. Detection using dynamic sentinel node biopsy with patent blue dye and radioisotope is associated with false negatives; indocyanine green might offer an alternative adjunct to improve detection rates.
The management pathways of advanced renal cell carcinoma (RCC) have considerably evolved in the past 5 years, presenting a particular challenge during the coronavirus disease 2019 (COVID-19) pandemic. In this Comment, we propose a management algorithm on the basis of the current evidence to safely manage patients with advanced RCC during this pandemic.
In response to the COVID-19 pandemic, the need to safely provide patient care meant that many health-care providers rapidly implemented and integrated telehealth into their practice. However, telehealth will continue to be an integral part of urology after the pandemic and our field should embrace telehealth and develop strategies to overcome associated challenges.
The COVID-19 pandemic has resulted in immediate effects on urological practice, in particular the vast reduction in elective surgeries. These changes are likely to have long-term effects for both patients and for urologists, which will persist even after the pandemic resolves. The many facets of COVID-19’s effects on urology remain to be seen, but they might also offer opportunities to reassess and improve patient management in urology and beyond.
Autopsy studies of latent prostate cancer provide important information for understanding the disease and, crucially, for addressing overdiagnosis. Further autopsy studies with standardized methods are needed to drive progress in this field, and studying the differences between latent and clinically significant prostate cancer might be a promising direction for future research.
Nearly 100 years since it was first used in humans as a vaccine for tuberculosis, Bacillus Calmette–Guérin (BCG) has been suggested as a possible agent to prevent coronavirus disease 2019 (COVID-19). A number of studies are underway to investigate this possibility but — even if they prove effective — many questions will remain.
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.
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.
The effects of mycobacteria in prostate cancer have not been fully elucidated. Results of early studies indicated that mycobacterial immunotherapy conferred a survival benefit in patients with advanced prostate cancer, and recent evidence supports the safety and efficacy of new mycobacterial agents in many malignancies; thus, modern, carefully designed, randomized controlled trials of mycobacterial immunotherapy for prostate cancer could be warranted.
Cancer care is currently experiencing rapid development in novel therapeutics, with an associated rise in treatment costs. These changes not only create a critical challenge for therapeutic decision-making but also highlight the need to prioritize therapies of high clinical and economic value. Health technology assessment methodology is a novel approach that could help guide value-based decision-making.
GeoBioMed, a new multidisciplinary approach, combines geology, biology, urology and microscopy to discover unorthodox treatments. Results indicate that calcium oxalate kidney stones undergo previously unforeseen cycles of repeated crystallization, dissolution, fracturing and faulting. GeoBioMed challenges clinical paradigms for in vivo stone formation and treatment as well as biomineralization in natural and engineered environments.
The future of urology holds promising new technologies but also a challenging increase in urological care needs. To translate emerging technologies and medical advances into use and accommodate the growing demand for urological services, we need strong collaboration with other health-care professionals within urology, other medical specialties and the community that surrounds our profession.