Articles in 2020

Mammalian sperm must respond to a variety of cues, and dynamic regulation of ion signalling is, therefore, essential for sperm cells to adapt to their environment. In this Review, the authors describe the ion channels and membrane receptors controlling sperm activity, in particular the principal Ca²⁺-selective plasma membrane ion channel CatSper, and consider how sperm ion channels and membrane receptors are attractive targets for therapeutics and how these signalling processes might have implications for assisted reproductive technologies.

In this Review, van de Merbel et al. provide a comprehensive overview of the current patient-derived tumour models in use for urological cancers and discuss their advantages and limitations, as well as their potential for personalized treatment.

Radical prostatectomy is increasingly used as a first-line treatment for patients with high-risk, localized prostate cancer. Here, Wilkins and colleagues highlight the heterogeneous outcomes of these men and discuss the role of this approach in individualized, multimodal prostate cancer therapy.

Animal models that naturally and spontaneously form uroliths — including domestic dogs and cats, and a variety of other captive and wild species, such as otters, dolphins and ferrets — are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.

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.

In this Review, Blum et al. summarize the current knowledge on sarcomatoid renal cell carcinoma, a diagnosis characterized by the presence of sarcomatoid dedifferentiation and a poor prognosis. They discuss the origin, presentation, molecular biology and treatment of this disease.

This Review summarizes current knowledge of the main gene fusions in genitourinary malignancies, discusses their growing importance in the understanding of the biology of tumours, and highlights their potential use as targets for precision medicine approaches.

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.

For transgender people who experience gender dysphoria as children, in whom impending puberty is unacceptable for their psychosocial health and wellness, pubertal blockade is a therapeutic option. In this Review, the authors discuss pubertal blockade and its implications for fertility preservation, surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.

In this Perspective, Connor et al. examine the current status of autonomous technologies in robotic-assisted surgery in urology and discuss the future role of the urological surgeon in an era of increasing use of automation and artificial intelligence.

Young-adult cancer survivors report psychosocial distress from infertility. National guidelines recommend pretreatment referrals for sperm cryopreservation, but a study examining use of stored semen among survivors concluded that low uptake might equate to economic unfeasibility. However, examination of sociodemographic factors and psychosocial outcomes suggests that maintaining future opportunities for parenthood might outweigh the ongoing storage costs.