Reviews & Analysis

Organ-sparing surgery for the management of penile cancer is a dogma underpinned by previous research demonstrating no change in cancer-specific survival in cases of local recurrence. However, a new multicentre study of 897 patients treated with glansectomy for penile cancer challenges this view.

This Review summarizes the manifestations of inter-tumoural and intra-tumoural heterogeneity in primary and metastatic prostate cancer, emphasizing the contribution of genomics studies and discussing the importance of phenotypic changes. The authors also critically discuss the implications for clinical management and research.

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.

Multiparametric MRI enables early detection of progression and reclassification in patients with low-risk prostate cancer on active surveillance and offers the potential to reduce unnecessary biopsies. However, the reliability and reproducibility of MRI-directed surveillance during follow-up is unclear. A recent study highlights the potential and current shortcomings of this approach.

The PRECISION trial demonstrated the ability of using multiparametric MRI to improve the diagnosis of clinically significant prostate cancer whilst reducing over-diagnosis of clinically insignificant cancer compared with systematic biopsy. Concerns remained about patients who were not biopsied owing to negative scans. A new study applies the PRECISION strategy to a contemporary cohort to answer these concerns.

MRI-guided transurethral ultrasound ablation is an exciting, minimally invasive technology with the potential to provide targeted ablation of prostate cancer tissue. At 3 years, functional outcomes remain good with 76% remaining free from salvage treatment. Future studies using a focal approach may provide evidence for widespread uptake of this technology.

Retzius-sparing prostatectomy is an alternative approach to standard robot-assisted radical prostatectomy. Many surgeons advocate this technique as data suggest that it provides better early functional results than the standard approach without compromising oncological outcomes.

New and more effective treatments are urgently needed for bladder cancer. This Review discusses the role of nectin-4 as a therapeutic target for enfortumab vedotin (an antibody–drug conjugate) in locally advanced and metastatic urothelial carcinoma and outlines related clinical data.

Many aspects of human male reproduction can be modulated by cannabinoids and endocannabinoids (eCBs). Preclinical studies have shown that the endocannabinoid system (ECS) is involved in negative modulation of testosterone secretion, but the effect of in vivo exposure to cannabinoids on spermatogenesis remains a matter of debate. An improved understanding of the complex crosstalk between cannabinoids and eCBs might enable targeting of the ECS for modulation of human fertility.

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.

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.

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.

Disruption of the circadian clock has been associated with pathological conditions including obesity, type 2 diabetes mellitus, cancer, depression and neurodegenerative diseases. Disturbed sleep patterns have now been associated with reduced erectile function. The mechanisms behind this effect are unclear but could include hypoxia signalling and low testosterone.

Antimicrobial resistance in Neisseria gonorrhoeae compromises gonorrhoea treatment worldwide. Novel and optimized treatments and/or treatment strategies that effectively eradicate the infection with low selection of resistance are imperative. A new prospective clinical study provides further evidence that resistance-guided treatment of gonorrhoea with single-dose oral ciprofloxacin is efficacious in relevant settings and can reduce the selection pressure for resistance.