News & Comment

Monogenic causes account for up to 20% of nephrolithiasis instances and are crucial for developing targeted treatments. Whole-exome sequencing, genome-wide association, candidate gene, and in vitro and animal functional studies are crucial to identify these mutations. Therapies targeting monogenic variants, such as RNA-interference-based treatments, have been successfully used to treat monogenic disorders.

The combination of pembrolizumab and enfortumab vedotin shows promise as a first-line therapy for advanced urothelial carcinoma. Enfortumab vedotin targets nectin-4, in turn enhancing T cell and natural killer cell activity, inhibiting immunosuppressive pathways and impeding tumour evasion. This synergy with pembrolizumab shows potential in enhancing immunotherapy for these patients.

Ureteral stents are useful devices for urological management in pregnancy. However, stent encrustation occurs in up to 13% of patients and is related to increased indwelling time. Stent encrustation can be harmful for both the mother and the fetus, increasing their morbidity and mortality. Thus, whether prevention or cure is more cost effective is pertinent.

The heterogeneous nature of non-muscle-invasive bladder cancer is a challenge for clinical trial design. Careful consideration in clinical trial design, choice of end points and adequate patient characterization is important when evaluating new therapies.

High intensity theatre (HIT) lists are an efficient and effective measure to tackle elective surgery backlogs without compromising outcomes and safety compared with traditional elective lists. A recent pilot trial in standard and complex urological surgery at a tertiary hospital in the UK proved successful for both the patients and the staff involved.

Focal ablative therapy has emerged as a treatment option in radio-recurrent prostate cancer to obtain local control of disease and spare patients severe salvage-treatment-related complications. Irreversible electroporation holds the potential to become the standard ablative modality in prostate cancer owing to reliable ablation results, the electricity-based effect and an acceptable adverse-effect profile.

Buccal mucosa graft for urethral reconstruction can be absent or insufficient in patients with failed urethral reconstruction, lichen sclerosus, alterations of the oral cavity and other contraindications. For these patients, the main alternatives are lingual, bladder and rectal mucosa grafts, and multidisciplinary teams worked to set up minimally invasive technologies to reduce morbidity and complications in donor sites.

The treatment landscape for localized prostate cancer is rapidly evolving to achieve oncological disease control, simultaneously preserving gastrointestinal and genitourinary function. Focal therapy using cryoablation is an emerging treatment for prostate cancer. Short-term and intermediate-term clinical data on focal cryoablation therapy in prostate cancer have shown promising oncological and functional outcomes.

PSA dynamics and conventional imaging methods currently used to assess biochemical recurrence of prostate cancer after definitive treatment with radiotherapy are insufficient, especially considering that different salvage options are available. Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is a novel imaging method that was shown to be more accurate than conventional imaging in prostate cancer staging, and can have a role in detecting disease recurrence after radiotherapy.

Androgen deprivation therapy potentiates cardiovascular morbidity and mortality, which is the most common cause of non-cancer-related death in patients with prostate cancer. Whether the mode of testosterone suppression affects the risk of cardiovascular adverse events is unclear, especially as the 2021 PRONOUNCE trial — which aimed to compare the cardiovascular risks of gonadotropin-releasing hormone (GnRH) antagonists with GnRH agonists — was prematurely terminated.

Transition from child-centred to adult-centred care is a crucial step for patients with a congenital urological disease. The aims are clear: preserving kidney function, continence, sexuality and fertility. No universal model for this process has been defined, but, while research continues, attention to individual patient’s needs will ensure the best results.

The treatment landscape of renal cell carcinoma is rapidly evolving, especially with the introduction and approval of immune checkpoint inhibitor combination therapies. Clinical trial data show substantial improvements in patient outcomes, and now results in the real-world setting support the use of these combinations.

Controversies over how, why and when pelvic lymph node dissection (PLND) should be performed persist. Available data suggest that a limited number of patients will experience a curative benefit from PLND, but it remains the most tried and tested diagnostic tool for staging. New techniques aim to improve noninvasive detection of diseased nodes.

Some chemotherapeutic agents can induce distinct mutational signatures in healthy cells in patients with cancer. The effect of such mutational signatures on spermatogenesis is not fully understood but is of great clinical importance for counselling patients diagnosed with cancer planning to start a family after treatment.