Comment

In April 2025, the US executive administration announced universal 10% tariffs on all imported products, in addition to reciprocal tariffs for select foreign nations. As trade negotiations evolve, it is essential to recognize and evaluate the profound implications these economic policies hold for healthcare systems.

Advances in molecular profiling technologies that capture both genotype and phenotype, coupled with an improved understanding of the biological mechanisms underlying prostate cancer progression, set new molecular biomarkers for advancement into the clinic to improve prognostication, therapy selection and disease monitoring for patients with prostate cancer.

The management of metastatic renal cell carcinoma (RCC) has undergone a major transformation, with median survival increasing from <1 year to ~5 years. However, biomarker development in RCC has lagged, largely because the most effective therapies, such as immune checkpoint inhibitors and VEGFR tyrosine kinase inhibitors, act on the tumour microenvironment rather than directly on tumour cells. Although predictive biomarker development in RCC remains challenging, selected tools such as circulating biomarkers and tissue-based RNA signatures are shaping a personalized approach to care, with some emerging biomarkers showing clinical potential, and additional biomarkers poised to enter clinical practice.

Bladder cancer is a biologically heterogeneous disease, and ongoing efforts in biomarker research aim to support personalized treatment approaches. Circulating tumour DNA is approaching clinical integration through prospective trials, whereas other markers remain investigational owing to technical limitations, inconsistent findings and lack of validation. Rigorous biomarker-driven trials and cost-effectiveness studies are needed to enable the integration of molecular tools into routine practice. Biomarkers might ultimately lead to rational treatment de-escalation or escalation, improving outcomes while minimizing harm and cost.

Despite recognized sex-based differences in healthcare requirements, women continue to experience substantial disparities in treatment, diagnosis and research. This ‘gender health gap’ manifests through increased emergency wait times, dismissal of symptoms and inadequate research prioritization. Patient advocacy groups have emerged as powerful forces for change, successfully lobbying governments and raising awareness through social media. Addressing these disparities requires increased research funding, sex-specific study designs, improved medical education curricula and continued patient advocacy.

Quantum computing can revolutionize surgery by accelerating the training of artificial intelligence models on large, diverse datasets, advancing robotic autonomy and facilitating a detailed study of biological structures and materials on a very minute scale. Substantial technical, financial and regulatory challenges must be overcome for the successful implementation of quantum computing in urology.

Telesurgery, also known as remote surgery, has emerged as a revolutionary paradigm in urology. The use of telesurgery and its applications in urological procedures is characterized by lights and shadows that challenge surgeons and international surgical societies to regulate this promising field.

Pronouns are small but mighty words. However, the conscious use of gender-neutral pronouns has recently led to heated discussions and has been implicated in legislation and cases of employment termination. Importantly, failing to respect a person’s pronouns can lead to real harm in physical and psychological health.

The surgical care of patients with differences in sex development (DSD) or intersex traits has historically been the domain of paediatric subspecialties. However, as patients defer surgeries until later in life, providers are needed to help close this emerging clinical care gap for the LGBTQIA+ community.

Medical terminology requires periodic updates based on the input of affected communities and/or to reflect advances in scientific understanding. An update to terminology to replace the terms ‘ambiguous’ and ‘atypical’ as descriptors of external genital anatomy in the intersex, variations of sex characteristics and differences of sex development (i/VSC/DSD) field could be an important step forwards in the field.

Burnout in healthcare is not merely a by-product of overwork, but a systemic issue driven by a culture of relentless productivity and insufficient support. Self-care practices such as exercise and mindfulness offer temporary relief, but do little to address the root causes of burnout embedded in the healthcare system. By promoting self-compassion and collaboration over competition, healthcare can move beyond burnout, restoring the ‘human being’ in every ‘human doing’ and creating a sustainable, supportive system for all.

Prostate cancer is the most common cancer in men, yet disparities persist in screening, diagnosis and treatment among populations with low socioeconomic status. Minority groups face barriers to clinical trial inclusion including limited awareness and financial challenges. Promoting diversity in clinical trials is crucial for inclusivity, improving treatment efficacy and achieving equitable health outcomes in prostate cancer care.

Humanitarian surgical missions provide substantial benefits to the involved surgeon and to the recipient communities. These missions should be planned and executed with the final aim to train local teams to implement innovative or standard surgical techniques.

The Government’s commitment to a Men’s Health Strategy in England, announced by Wes Streeting, the Secretary of State for Health and Social Care, on 28 November 2024, is a welcome development. The implementation of a strategy will hopefully lead to improved access to services and health outcomes for men and boys.

Literature about prostate cancer in transgender women is growing, but many questions remain unanswered. Unique challenges exist in the identification of transgender women that can slow or even impair research advances in this field. Reframing our thinking about the identification of this population is imperative to help advance both research and clinical care.

Women are under-represented in surgery and are particularly subject to the intrinsically gendered practice of pimping in the clinical learning environment. The potential downstream effects of this continued practice have considerable implications on gender disparities within surgical disciplines.

The incidence of detrusor underactivity is projected to rise owing to an ageing population and the increasing prevalence of diabetes, but therapeutic options remain limited. Successful bladder contractions have been yielded in studies of bladder pacing in animals. However, anatomical incongruities highlight the need for human trials. Bladder pacing in humans through electrical stimulation has shown some potential, although sustainable protocols are lacking owing to detrusor–sphincter dyssynergia and patient discomfort during trials. Thus, manometric studies in brain-dead patients might serve as a model for developing an implantable bladder pacing device to restore contractility.

Artificial intelligence (AI) is transforming prostate cancer management from diagnosis to treatment. AI tools have been designed for the analysis of digitized histopathology and MRI scans, generation of synthetic CT scans and improvement of robotic surgical outcomes. This progress underscores the need for regulation and the development of safe, ethical and non-biased software.

Declining birth rates are drawing attention to male reproductive health, with infertility receiving overdue interest. Alongside genetic and environmental factors, lifestyle behaviours are a key risk factor. Exploring how lifestyle behaviour links to mental health and its interplay with sexual function and fertility can improve understanding of trends in live births and improve men’s health overall.

Recently, several therapeutic strategies in prostate cancer have been granted regulatory approval based on progression-free survival benefits alone, which is a relative change in the therapeutic development of prostate cancer treatments. Previously, overall survival was a requirement for approvals. Whether this approach is warranted or beneficial to patients remains unclear.