Reviews & Analysis

This Review discusses how ageing complicates the already compromised neurogenic lower urinary tract in men with spinal cord injury. The authors present the unique urological challenges faced by this population and propose a patient-centred framework to achieve personalized and lifelong care in these patients.

This article provides consensus-based statements from an international panel of bladder cancer experts on the use of active surveillance in non-muscle invasive bladder cancer. Consensus statements cover several aspects of active surveillance, including terminology, eligibility criteria and treatment triggers, providing a framework to guide clinical practice and trial design in this space.

Preclinical and clinical evidence shows that maternal exercise can contribute to the cardiometabolic health of offspring. Recent tantalizing findings also point to several paternal factors, notably sperm microRNAs, that can mediate the intergenerational transmission of exercise benefits.

In this Review, the authors synthesize current knowledge of extrachromosomal DNA in urothelial carcinoma. By consolidating rapidly evolving evidence, this Review provides a comprehensive framework for understanding extrachromosomal DNA biology in urothelial carcinoma and its implications for precision oncology.

This Perspective presents historical and emerging evidence supporting a role of oestrogen signalling in male sexual differentiation, challenging the traditional androgen-centric view of reproductive development. Understanding the interplay between these two hormones is important to understanding development and also chemical risk, considering the susceptibility of these systems to disruption from exogenous substances.

In this Review, the authors describe and discuss the unique challenges of paediatric urinary tract infections including diagnosis, prevention and management, potential for adverse sequelae and key knowledge gaps.

In this Review, the authors discuss the causal role of current androgen deprivation therapy in prostate cancer progression, hormone refractoriness and double-null prostate cancer development. They highlight the underlying regulatory mechanisms by which androgen deprivation therapy elevates hepatocyte growth factor–hepatocyte growth factor receptor (HGF–MET) and WNT–β-catenin signalling, elevating exportin 1 (XPO1) and ribosomal protein activation to induce tumour aggressiveness, metastasis and double-null prostate cancer development.

Surgical menopause occurs in premenopausal women who undergo radical cystectomy with bilateral oophorectomy to treat bladder cancer. This Review discusses the pathophysiology of surgical menopause in these patients and highlights current strategies to mitigate associated symptoms and long-term health risks.

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.

The phase III IMvigor011 trial shows that postoperative circulating tumour DNA (ctDNA) can guide adjuvant immunotherapy after cystectomy, improving outcomes in patients with ctDNA-positive tumours while identifying patients with excellent prognosis without treatment. In an era of intensified perioperative therapy, these findings might shift the focus from whom to treat towards when treatment can be safely withheld or stopped.

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.

Management of erectile dysfunction has previously focused on symptom management, but attention is now being directed towards interventions that facilitate and retain natural erectile ability, treating the underlying cause of the disorder. In this Perspective article, the authors discuss the potential of electrical neurostimulation of the penis, which is in early stages of development as a restorative therapy, targeting the penile-nerve supply that is impaired by disease states, injury or ageing.

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