Review Articles

In this Review, the authors synthesize current understanding of sperm DNA fragmentation and its effects on mammalian reproduction. Reproductive consequences for fertilization, embryo development, and pregnancy outcomes and strategies aimed at reducing or preventing DNA fragmentation are examined.

In this Review, the authors examine anticipated patterns of late morbidities that could emerge as a result of current treatments for Wilms tumour. Given the importance of a patient-centred follow-up strategy, they propose a practical classification system based on the likelihood of developing therapy-related late sequelae.

Circulating tumour cells (CTCs) offer a minimally invasive biopsy strategy for prostate cancer monitoring. This Review discusses the use of CTCs at all stages of prostate cancer development and treatment, from CTC isolation and enrichment strategies to the prognostic and clinical utility of these cells in prostate cancer.

In this Review, the authors describe and discuss how advances in artificial intelligence, genomics, radiomics and cytology can be integrated into decision-making processes to improve the management of bladder cancer.

SRD5A2 has clinical relevance in benign prostatic hyperplasia, prostate cancer and other androgen-mediated conditions. In this Review, the authors describe the complementary roles of α-blockers for rapid symptom relief and 5α-reductase inhibitors for disease modification and progression risk reduction in benign prostatic hyperplasia and the potential of targeting SRD5A2 in other androgen-driven disorders.

Sexual pleasure has often been overshadowed by a focus on dysfunction and reproduction in sexual medicine, particularly in urology. In this Review, the authors discuss the need for multidisciplinary approaches to address the diverse experiences and needs of individuals across their lifespan, and how integrating pleasure into research, clinical practice, sexuality education and public health initiatives could enhance well-being, intimate relationships and overall quality of life.

This Review provides a comprehensive overview of epidemiology and molecular determinants of relapsed rhabdoid and other non-nephroblastoma childhood and adolescent kidney tumours, which are usually rare and challenging to cure. The most updated results in this field are discussed to highlight how understanding tumour biology can be used to inform therapeutic strategies in these patient populations.

This Review focuses on micro-ultrasound as a new imaging technology in prostate cancer detection, comparing micro-ultrasound performance with that of the current standard MRI. The potential of micro-ultrasound in other applications, including tumour staging and active surveillance, as well as the use of artificial intelligence to support biopsy decision-making, are also discussed, based on completed and ongoing trials.

In this Review, the authors describe the mechanisms that mediate mitochondrial sheath formation and its maintenance and function within the mature sperm. They also provide the field with a strong and up-to-date background on current data and hypotheses.

In this Review, the authors describe the pivotal role of taxanes in the treatment of prostate cancer and discuss how mechanisms that confer resistance to taxanes might be exploited to develop more effective therapeutic strategies

Atypical intraductal proliferation is a prostate biopsy finding with morphological features intermediate between high-grade prostatic intraepithelial neoplasia and intraductal carcinoma. This Review discusses histopathological features, molecular characteristics and clinical outcomes associated with AIP, and highlights the clinical implications of AIP, primarily due to the frequent association of AIP with clinically significant prostate cancer.

Persistent Müllerian duct syndrome (PMDS) is a rare difference in sex development, characterized by the presence of Müllerian duct derivatives in 46,XY individuals with male-typical development. Untreated PMDS is associated with risks of infertility and malignancy. In this Review, the authors provide an comprehensive primer on the epidemiology, pathophysiology and management of the condition, considering the need for a high index of clinical suspicion and timely intervention, raised awareness of PMDS among clinicians and multidisciplinary care to optimize outcomes for patients.

Radical cystectomy with urinary diversion is the standard of care for the treatment of localized muscle-invasive bladder cancer but is associated with severe morbidity. This Review highlights advancements in several aspects of bladder cancer care, including surgery techniques, prehabilitation measures, multimodal treatments and novel biomarkers, aimed at improving patient selection, optimizing local control and improving surgical outcomes.

In this Review, the authors describe and discuss hypoxia-associated extracellular matrix mechanisms of neutrophil recruitment, polarization and immunosuppression, how these lead to immunotherapy resistance, and potential targets to overcome ICI resistance.

In this Review, the authors describe standards informing the development and use of polygenic scores and illustrate their application to advance the clinical translation of polygenic scores to precision prostate cancer screening.

This Review focuses on the clinical effects and translational potential of digital twin applications in uro-oncology, highlights challenges and discusses future directions for implementing digital twins to achieve personalized uro-oncological diagnostics and treatment.

Priapism — an abnormal prolonged penile erection that persists in the absence of any sexual stimulation — can be subcategorized into three types: ischaemic (low-flow or veno-occlusive), non-ischaemic (high-flow or arterial) and stuttering, also known as recurrent ischaemic, priapism. The mechanisms underlying stuttering priapism are complex and involve dysregulation of the nitric oxide signalling pathway, Rho–Rho kinase pathway, adenosine, opiorphins, oxidative stress and androgens, and treatment can target these pathways, or be surgical in approach. In this Review, the authors discuss the pathology of the different types of priapism and provide an update on the different therapeutic options available.

Urinary incontinence is highly prevalent during pregnancy and in the postpartum period. This Review provides an overview of this prevalence, discussing potential mechanisms and risk factors underlying this phenomenon. The importance of preventive measures and treatment options to ameliorate the extent and the effects of urinary incontinence during this stage of life is also highlighted.

This Review discusses the potential benefits of prehabilitative interventions in patients with and survivors of testicular cancer. Although there are few studies in the field, available data suggest a benefit of prehabilitation in improving mental health and quality of life in these patients, highlighting the need for additional research in this field.

In this Review, the authors summarize how the key pathological mechanisms involved in the initiation and progression of interstitial cystitis/bladder pain syndrome can be a source of potential biomarkers to delineate the condition.