Reviews & Analysis

The formation of kidney stones is governed by the same principles as other stone systems. These ‘diagenetic phase transitions’ that create human kidney stones reflect the environment within the kidney during stone formation and could, therefore, improve understanding of urolithiasis and enable future treatment development. In this wide-ranging and unique Review, the authors explain how kidney stone formation parallels that of other stone systems such as stony corals, travertine in Roman aqueducts, stalactites and agates, and describe how the new field of GeoBioMed could be harnessed to improve patient care.

In this Review, the authors discuss how machine learning can improve sperm selection, focusing on the near-term, achievable machine learning methods based on available assessments of selected sperm and the areas in which the most considerable gains are possible.

Non-metastatic CRPC (nmCRPC) is a heterogeneous, man-made disease stage that has received increased attention. Historically, few options were available to treat nmCRPC; however, three novel nonsteroidal antiandrogens, enzalutamide, apalutamide and darolutamide, are now available for men with this disease.

Devices designed to enhance and diversify sexual pleasure are useful in clinical practice; however, many taboos still seem to exist and the scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use is sparse. In this Review, Dewitte and Reisman discuss the clinical use of sex toys and sexual devices, as well as sexually explicit media, across a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties.

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.

Most localized prostate cancer can be cured with radiotherapy. Over the past decade, treatment courses have been shortened with no deterioration in cure rate or adverse effects. Now, a small phase II trial has tested whether radiation could be delivered as a single treatment.

The BJU International paper by van de Grift and colleagues includes important data outlining the long-term cosmetic and functional outcomes for masculinizing surgery in patients born with differences in sex development. This overview highlights some of the important findings and their context in what can be a controversial subject.

Incontinence is a common complication of radical prostatectomy and can have a considerable effect on quality of life for men who have survived prostate cancer. In the past, management of postoperative incontinence has focused on rehabilitation and postsurgical management, but prehabilitation, in the form of pelvic floor muscle exercises and training, has the potential to improve postprostatectomy continence outcomes, provide patients with agency for their own health and improve quality of life in men who have been treated for prostate cancer.

COVID-19 has had a substantial effect on patients with kidney stones, such as delays in care and increased anxiety and use of opioids. Mitigating these effects in the future could involve an online physician-based discussion as a part of the overall treatment strategy to help patients with their queries, apprehensions and ultimately their decision-making.

Ductal adenocarcinoma of the prostate is the most common variant histological subtype of prostate cancer. The diagnosis can be challenging and evidence for treatment is predominantly based on retrospective data. This Review discusses the histopathology, characteristics, treatment options and future molecular targets for treatment of this disease.

With increasing global life expectancy comes increasing health conditions. Robotic-assisted radical prostatectomy (RARP) is traditionally offered to patients under the age of 75 years. However, a new study on RARP in patients aged over 75 years has demonstrated outcomes that will challenge this convention.

Metagenome-wide association studies have led to the discovery of potential interactions between the microbiome and urolithiasis, but a lack of standardization has raised questions about the reproducibility, applicability and physiological relevance of metagenome-wide association study data. This Consensus Statement describes the formation of the first international consortium for microbiome in urinary stone disease — MICROCOSM — and the outcomes of a consensus meeting to develop standardized protocols for microbiome studies and generate a data repository, which are both publicly available via a secure online server.

Radical cystectomy is advocated for patients with high-risk non-muscle-invasive bladder cancer who develop disease recurrence following BCG therapy. A retrospective series suggests that a delay in radical cystectomy attributable to failure of salvage bladder-preserving therapies in this patient cohort is safe. However, a closer analysis of the study reveals inherent case selection that might limit such conclusions.

More than 50 clinical trials are currently exploring the combination of immunotherapy and other approved treatments for advanced prostate cancer. The results from a phase II trial of sipuleucel-T with or without radium-223 in patients with metastatic castration-resistant prostate cancer were recently published with intriguing findings.

Genomic alterations in metastatic castration-resistant prostate cancer can be identified in plasma circulating tumour DNA. A large cohort analysis shows reliable detection of clinically relevant alterations through targeted cell-free DNA sequencing with a commercial platform, paving the way for liquid biopsy technology to be integrated into routine clinical practice.

Survival of patients with metastatic prostate cancer has improved with the approval of second-generation androgen receptor antagonists. This Review discusses common genomic alterations leading to inevitable resistance to this therapy, and potential alternative therapeutic targets for treatment.

Asia is traditionally considered to have a low incidence of prostate cancer, but the incidence and mortality of prostate cancer have rapidly increased across the continent. Taking into account this intracontinental and intercontinental heterogeneity, translational studies are required in order to develop ethnicity-specific treatment strategies.

Currently, ~95% of patients with testicular germ cell tumour are cured. Although cured, these men face potential late adverse effects and reduced quality of life. This Review outlines these adverse effects with recommendations on how to minimize their severity.

Prostate cancer lends itself to gene therapies, and multiple aspects of prostate cancer care make gene therapy an appealing treatment option for this common malignancy. Although laboratory and preclinical advances have not yet resulted in oncologically relevant outcomes in the clinic, future studies offer great promise for gene therapy to become established in prostate cancer treatment.

An effective transurethral resection of bladder tumour (TURBT) is essential to achieve safe tumour clearance and to determine the biological potential of the cancer. Attention to surgical detail within a set-up that embraces evidence-based practice, training, quality standards, prospective audit and feedback will facilitate these objectives.