Viewpoint

The use of English language as the official language in science had an undoubtable role in moving science forward but posed an extra challenge for people whose first language is not English. In this Viewpoint, six non-Native English speakers share their experience as academics, clinicians, researchers and editors who carry out the core tasks of their jobs in a second language, and suggest potential solutions to help overcome issues associated with a linguistic barrier. Their stories show the substantial challenges that non-native English speakers have to face every day regardless of their career status, but also highlight the opportunities that this form of diversity can offer.

Diversity in medical fields is beneficial to both clinicians and patients, and Nature Reviews Urology is committed to improving the diversity of our specialty and supporting Black and under-represented minority urologists. In this Viewpoint, 12 medical students who are embarking on a career in urology describe their reasons for choosing the specialty, explain what they think can be done to increase the number of Black urologists, and describe what has led them to apply to specific programmes.

At Nature Reviews Urology, we have pledged to strive towards improving diversity in our field. As a step towards this goal, this Viewpoint presents the experiences of 10 Black urologists. Their stories illustrate the importance of perseverance and emphasize the essential role of community and mentorship to raise up our peers and colleagues, to support and encourage Black urologists and lead to a more diverse field of urology in the future.

The COVID-19 pandemic has undoubtedly put a strain on relationships. For some couples, lockdown has meant long periods of separation, whereas for others, lockdown has resulted in months of isolation together. In this Viewpoint, three experts consider the effects of the pandemic on relationships and suggest ways in which lockdown can become a positive experience for couples making love in the time of corona.

On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration.

In this Viewpoint, actor, author, and broadcaster Stephen Fry describes his prostate cancer journey alongside the same story from his surgeon, Ben Challacombe, enabling us to consider “both sides of the scalpel”.

The field of urology has undergone massive changes in the 10 years sinceNature Reviews Urology launched as Nature Clinical Practice Urology. In this Viewpoint, members of the Nature Reviews Urologyadvisory board describe what they think has been the biggest change or issue in urology over the past decade, and give their predictions for the direction of the field over the next 10 years.

The incidence of obesity, a potential risk factor for prostate disease, is rising sharply in the western world, as is the incidence of prostate tumors. In this extended Viewpoint, Kulkarni and Getzenberg propose that the relationship between obesity and prostate disease might be mediated by the autotaxin–lysophosphatidic acid (ATX–LPA) axis.

The treatment of prostate cancer is rapidly changing, and a new consensus for management is required. In this article, Oliver and Neal consider data from studies of hormone therapy, surgery, radiotherapy and active surveillance, and they discuss which options might be suitable in which patients.

This second Viewpoint on the issue of neonatal circumcision discusses why this practice might not be beneficial. Van Howe refutes claims that circumcision has a protective effect from genital cancer, urinary tract infections and sexually transmitted infections, and highlights the many adverse events that can be experienced following circumcision.

The issue of neonatal circumcision is highly controversial. In this Viewpoint, Austin discusses why he considers neonatal circumcision to be beneficial. He assesses the evidence for a protective effect of circumcision from genital cancer, urinary tract infections and sexually transmitted infections, and also the evidence for minimal adverse events associated with circumcision in neonates.

In this Viewpoint, the authors discuss the FDA's strategies for increasing access to new medicines for patients with serious or life-threatening illnesses. The article describes the currently available access mechanisms, and highlights the FDA's planned regulation revisions for expanding access.

The management of uncommon urological malignancies is rarely based on evidence from prospective trials, and ad hoc treatment by individual clinicians who seldom encounter the cancer is not ideal for the patient. In this article, Nicholson identifies key issues in developing a trial strategy for treating rare urological malignancies.

This article on the ethics of gene therapy for male infertility is the third Viewpoint in the article series. Sheehan addresses issues such as 'playing God', patient consent for gene therapy trials, eugenics, and the distribution of medical resources.

The second Viewpoint in the series of articles on gene therapy for male infertility evaluates safety aspects. Lamb describes the ideal vector for DNA transfection, and draws on data from previous studies to describe the safety of various vectors under investigation.

This Viewpoint, which is the first of three articles discussing gene therapy for the treatment of male infertility, considers the feasibility of the approach. Boekelheide and Sigman initially describe the genetic causes of male infertility, and go on to discuss gene therapy approaches, and possible future directions.

In this Viewpoint, Dr Donat presents the case against using frozen section analysis of distal ureters in patients undergoing cystectomy for transitional cell bladder cancer, arguing that division of the ureter at the level of the common iliac artery largely precludes the need for frozen sections in this setting.

In this Viewpoint, Gallagher and Bajorin advance the case for using neoadjuvant chemotherapy in muscle-invasive bladder cancer. They contend that preoperative chemotherapy in these patients would be likely to result in survival benefits similar to those seen in breast and colon cancers.

In this Viewpoint article by Dr Karl and colleagues, the authors discuss the benefits of fluorescence cystoscopy for the diagnosis of transitional cell carcinoma of the bladder, which include reduced residual tumor rate and tumor recurrence rate, and enhanced detection of carcinomain situand multifocal tumors, when compared with white-light cystoscopy.

In this Viewpoint article by Professor Kattan, the author discusses methods for predicting outcomes in patients with prostate cancer, the predictive accuracy of these methods, and why, despite the large number of nomograms already developed, further nomograms are still needed for predicting outcomes in patients with prostate cancer.