Comment

The Urinary Tract Infection Global Alliance (UTIGA) — a new society in the field of urinary tract infection — has been established to promote cross-disciplinary interactions, provide access to new information, identify research needs and standardize patient management. UTIGA will also provide mentorship opportunities and patient advocacy.

Paediatric kidney tumours comprise many different subtypes, each being heterogeneous in their cellular as well as genetic composition. Advances in the past decade in 3D culture models create new opportunities for the generation of preclinical models capturing this phenotypic and genetic heterogeneity, potentially enabling the generation of patient-tailored therapies.

The world is currently in the grip of the COVID-19 pandemic. Rapid changes in medical priorities are being enforced across all health-care systems. Urologists have had to reduce or halt their clinical activity and assist on COVID-19 wards. The repercussions on urological patient outcomes for delayed treatments and diagnosis remain to be defined.

The effects of mycobacteria in prostate cancer have not been fully elucidated. Results of early studies indicated that mycobacterial immunotherapy conferred a survival benefit in patients with advanced prostate cancer, and recent evidence supports the safety and efficacy of new mycobacterial agents in many malignancies; thus, modern, carefully designed, randomized controlled trials of mycobacterial immunotherapy for prostate cancer could be warranted.

Cancer care is currently experiencing rapid development in novel therapeutics, with an associated rise in treatment costs. These changes not only create a critical challenge for therapeutic decision-making but also highlight the need to prioritize therapies of high clinical and economic value. Health technology assessment methodology is a novel approach that could help guide value-based decision-making.

GeoBioMed, a new multidisciplinary approach, combines geology, biology, urology and microscopy to discover unorthodox treatments. Results indicate that calcium oxalate kidney stones undergo previously unforeseen cycles of repeated crystallization, dissolution, fracturing and faulting. GeoBioMed challenges clinical paradigms for in vivo stone formation and treatment as well as biomineralization in natural and engineered environments.

The future of urology holds promising new technologies but also a challenging increase in urological care needs. To translate emerging technologies and medical advances into use and accommodate the growing demand for urological services, we need strong collaboration with other health-care professionals within urology, other medical specialties and the community that surrounds our profession.

As a field that embraces technology, urology has evolved quickly in the past 15 years and is likely to change at an even greater pace in the next 15. Several approaches and initiatives have the potential to improve patient care, in particular the use of telemedicine, improvements in data analytics and growth of physician collaboratives.

Cell lines are valuable tools for developing treatments to minimize disparities in prostate cancer outcomes. Nevertheless, limitations in their application, primarily from the inadequate use of ethnically diverse cell lines, continue to hinder the advance of drug leads that would equally benefit men from both African and European ancestry.

The Internet can be a valuable resource for patients, but it is also a minefield of misinformation and hidden bias. The Urology Care Foundation is attempting to mitigate this flood of inaccurate information by providing high-quality online resources for clinicians, patients and caregivers.

Current clinical issues in testicular germ cell tumour management include limited sensitivity and specificity of conventional biomarkers and, therefore, reliance on serial CT imaging in follow-up monitoring, as well as poor ability to risk stratify patients. Circulating microRNAs are likely to help overcome these challenges and, importantly, could offer cost savings to health-care systems.

Diagnosis of urinary tract infection (UTI) includes anatomical distinctions because the severity of infection and treatment decisions depend on the infected organ; however, bacterial prostatitis is usually absent from discussions regarding UTI. By considering bacterial prostatitis a UTI, we can increase understanding of the pathogenesis and immune response in the prostate to develop improved therapeutics.

Despite initial enthusiasm, poor translation of preclinical studies and high-profile scandals involving stem cell research have hindered the field of regenerative urology in recent years. However, consideration of the potential of regenerative approaches to revolutionize patient care ought to reignite interest and begin a renaissance in regenerative urology research.

Growing up in South Africa, it is not uncommon to hear the phrase ‘Africa is a tough country’ — a statement that is true on many levels, not least when it comes to managing infertility, where cultural beliefs can be an obstacle for men seeking health care and for the physicians who provide it.

Anterior urethral strictures are a common urological problem and urethrotomy has limited efficacy if repeated treatment is needed. An increasing number of studies have shown that mitomycin C has potential as an adjunct to urethrotomy for improving its success rate.

In this Comment, McGregor and Sonpavde discuss the rationale and potential for immunotherapy in advanced penile squamous cell carcinoma, highlighting associations with human papillomavirus infection and a tumour-site agnostic immunotherapy indication, which form the basis of ongoing clinical trials.

Immune checkpoint inhibitors are associated with durable and well-tolerated responses in metastatic urothelial carcinoma. Predicting which patients respond to therapy has been challenging; however, progress has been made using programmed cell death 1 ligand 1 as a biomarker and a second generation of biomarkers, which are being assessed.

Kidney stones are currently managed using laser lithotripsy and the most recent generation of laser generators have enabled the possibility of the dusting technique. Dusting avoids the use of a basket, as stone fragments are spontaneously evacuated; however, no consensus on the definition of dust currently exists.

Is gender parity in urology possible? Although the number of female urologists is increasing, a disparity remains in the gender composition of the editorial boards of the top urology journals and in urological societies.

Although sexual disorders have been widespread for millennia, sexual medicine has historically been an unofficial specialty with no standards of training or recognition. Initiatives from the European Society for Sexual Medicine have sought to cement its role in modern medicine and to encourage and support early-career physicians and sexologists in their chosen specialty.