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As a field that embraces technology, urology has evolved quickly in the past 15 years and is likely to change at an even greater pace in the next 15. Several approaches and initiatives have the potential to improve patient care, in particular the use of telemedicine, improvements in data analytics and growth of physician collaboratives.
Cell lines are valuable tools for developing treatments to minimize disparities in prostate cancer outcomes. Nevertheless, limitations in their application, primarily from the inadequate use of ethnically diverse cell lines, continue to hinder the advance of drug leads that would equally benefit men from both African and European ancestry.
The Internet can be a valuable resource for patients, but it is also a minefield of misinformation and hidden bias. The Urology Care Foundation is attempting to mitigate this flood of inaccurate information by providing high-quality online resources for clinicians, patients and caregivers.
Current clinical issues in testicular germ cell tumour management include limited sensitivity and specificity of conventional biomarkers and, therefore, reliance on serial CT imaging in follow-up monitoring, as well as poor ability to risk stratify patients. Circulating microRNAs are likely to help overcome these challenges and, importantly, could offer cost savings to health-care systems.
Diagnosis of urinary tract infection (UTI) includes anatomical distinctions because the severity of infection and treatment decisions depend on the infected organ; however, bacterial prostatitis is usually absent from discussions regarding UTI. By considering bacterial prostatitis a UTI, we can increase understanding of the pathogenesis and immune response in the prostate to develop improved therapeutics.
Despite initial enthusiasm, poor translation of preclinical studies and high-profile scandals involving stem cell research have hindered the field of regenerative urology in recent years. However, consideration of the potential of regenerative approaches to revolutionize patient care ought to reignite interest and begin a renaissance in regenerative urology research.
Growing up in South Africa, it is not uncommon to hear the phrase ‘Africa is a tough country’ — a statement that is true on many levels, not least when it comes to managing infertility, where cultural beliefs can be an obstacle for men seeking health care and for the physicians who provide it.
Anterior urethral strictures are a common urological problem and urethrotomy has limited efficacy if repeated treatment is needed. An increasing number of studies have shown that mitomycin C has potential as an adjunct to urethrotomy for improving its success rate.
In this Comment, McGregor and Sonpavde discuss the rationale and potential for immunotherapy in advanced penile squamous cell carcinoma, highlighting associations with human papillomavirus infection and a tumour-site agnostic immunotherapy indication, which form the basis of ongoing clinical trials.
Immune checkpoint inhibitors are associated with durable and well-tolerated responses in metastatic urothelial carcinoma. Predicting which patients respond to therapy has been challenging; however, progress has been made using programmed cell death 1 ligand 1 as a biomarker and a second generation of biomarkers, which are being assessed.
Kidney stones are currently managed using laser lithotripsy and the most recent generation of laser generators have enabled the possibility of the dusting technique. Dusting avoids the use of a basket, as stone fragments are spontaneously evacuated; however, no consensus on the definition of dust currently exists.
Is gender parity in urology possible? Although the number of female urologists is increasing, a disparity remains in the gender composition of the editorial boards of the top urology journals and in urological societies.
Although sexual disorders have been widespread for millennia, sexual medicine has historically been an unofficial specialty with no standards of training or recognition. Initiatives from the European Society for Sexual Medicine have sought to cement its role in modern medicine and to encourage and support early-career physicians and sexologists in their chosen specialty.
Dutch adolescents develop their sexuality in a stepwise manner, gradually progressing from first kiss to first sexual intercourse. Adolescents who follow a stepwise sexual development are more confident and engage in less risky sexual behaviour than those who do not. Thus, the stepwise 'sexual career' is an excellent model for guiding development of age-appropriate sex education.
Women commonly experience pelvic floor damage during pregnancy and vaginal childbirth and later develop stress urinary incontinence and prolapse. Polypropylene mesh can repair abdominal hernias, but complications result when used in the female pelvic floor. In October, the Royal Society hosted a workshop to address issues surrounding pelvic floor disorders.
Novel surgical tools demand revision of our anatomical knowledge. Anatomical drawings are extraordinarily useful to describe organs and highlight surgical details, representing an exceptional method of teaching and learning. DRAW is a new non-profit website with the aim of increasing knowledge of urological surgical anatomy through submissions from urologists.
Sacral neuromodulation is used to treat refractory overactive bladder (OAB). Recent research has shown that changes in brain activity during sacral neuromodulation relate to its mechanism of action and that these changes vary with device settings. Much remains to be discovered about how sacral neuromodulation influences brain activity, but studies are now beginning to elucidate these effects.
Intratumour heterogeneity is a critical driver of cancer progression and treatment failure. TRACERx Renal is a prospective study that aims to define the evolutionary trajectories of renal cancer in space and time through multiregion and longitudinal tumour sampling.
Sexuality is an important aspect of existence and a fulfilling intimate life can be a facilitator of well-being, self-esteem, and general resilience. Moreover, it can strengthen coping, adherence, and survivorship skills of chronically ill patients. Health-care professionals should, therefore, routinely address issues of sex and intimacy.