Current Opinion in Urology最新文献

{"title":"Genetic testing and personalized treatment for kidney stone formers.","authors":"Robert Geraghty, Sarah Howles, John Sayer","doi":"10.1097/MOU.0000000000001377","DOIUrl":"10.1097/MOU.0000000000001377","url":null,"abstract":"<p><strong>Purpose of review: </strong>Kidney stone disease (KSD) is heritable and genetic testing is becoming increasingly relevant to its management. However, it is unclear who should be offered genetic testing and what these investigations should entail. This review gives an overview of the existing evidence and future directions.</p><p><strong>Recent findings: </strong>In highly selected cohorts, genetic testing for monogenic disease can yield high diagnostic rates. These diagnoses can facilitate genetic counselling, familial testing, and targeted medical therapies.Our understanding of the role of rare intermediate effect size and common low effect size genetic variants is evolving. The clinical utility of polygenic risk scores and genetic sequencing in unselected cohorts remains uncertain.</p><p><strong>Summary: </strong>Genetic testing for monogenic KSD is advised in individuals with a strong family history and with recurrent stones. There is a need for large-scale studies, including in urology settings, to determine optimal criteria for patient selection in real world settings. Further research is required to define the role of genetic testing, including polygenic risk scores, in risk prediction, personalised management, and disease recurrence.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"283-294"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspectives and controversies in urothelial carcinoma: from treatment expansion to decision complexity.","authors":"Félix Guerrero-Ramos","doi":"10.1097/MOU.0000000000001386","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001386","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"36 3","pages":"217-218"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of bladder preservation in muscle invasive bladder cancer: key concepts and future directions.","authors":"Marie-Pier St-Laurent, Peter C Black","doi":"10.1097/MOU.0000000000001369","DOIUrl":"10.1097/MOU.0000000000001369","url":null,"abstract":"<p><strong>Purpose of review: </strong>Bladder preservation strategies for muscle-invasive bladder cancer (MIBC) are gaining renewed interest as advances in systemic therapy, imaging, and molecular biomarkers challenge the historical primacy of radical cystectomy. This review is timely given increasing rates of clinical and pathological complete response with contemporary neoadjuvant regimens and the growing exploration of response-adapted approaches, including active surveillance.</p><p><strong>Recent findings: </strong>Trimodal therapy has been an established bladder-preserving option for carefully selected patients, with long-term oncologic outcomes comparable to radical cystectomy in selected cohorts, though randomized comparisons are lacking. Intensified neoadjuvant strategies incorporating immunotherapy and antibody-drug conjugates have substantially improved oncological outcome and pathological complete response rates, expanding the population potentially eligible for bladder preservation. Concurrently, advances in multiparametric MRI, molecular subtyping, and liquid biopsy technologies have improved response assessment and risk stratification, although lack of standardization and prospective validation limits routine implementation. Early-phase trials suggest that active surveillance after clinical complete response may be feasible in highly selected patients, but long-term safety remains uncertain.</p><p><strong>Summary: </strong>Bladder preservation in MIBC is evolving toward a response-adapted paradigm that integrates novel systemic therapy, multimodal restaging, and patient-centred outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"227-234"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of augmented reality in endoscopic surgery for stones: European Association of Urology endourology up-to-date review.","authors":"Ali Talyshinskii, Bhaskar Kumar Somani","doi":"10.1097/MOU.0000000000001378","DOIUrl":"10.1097/MOU.0000000000001378","url":null,"abstract":"<p><strong>Purpose of review: </strong>The development of digital solutions has a direct impact on the modern understanding of the future of urology. Augmented reality is no exception. Specialists use it for intraoperative navigation, which positively impacts procedure metrics, especially in endoscopic surgery for stones. This review aims to determine the chronology of this technology's development and its current trends in endourologists' routine practice.</p><p><strong>Recent findings: </strong>In 2023-2025, studies confirmed the clinical benefits of augmented reality navigation, including reduced puncture time and decreased complication rates. At the same time, the development of intelligent systems with ultrasound/computed tomography (CT) fusion and deep learning has taken augmented reality from visualization to active optimization of the accuracy and safety of interventions. In retrograde surgery, spatial navigation and instrument tracking, complemented by cognitive-oriented and gaze-based systems, have become key areas of focus, paving the way for objective assessment of surgeons' visual strategies and personalized training.</p><p><strong>Summary: </strong>Augmented reality (AR) and mixed reality (MR) are rapidly transforming endoscopic surgery for urolithiasis: in percutaneous nephrolithotripsy (PCNL), these technologies have already reached clinical maturity as navigation tools, while in ureteroscopy (URS) and retrograde intrarenal surgery (RIRS), they are emerging as powerful cognitive and navigation platforms. Despite differences in current application scenarios, both trajectories converge toward a common goal: to make key stages of stone treatment measurable, reproducible, and less dependent on the individual experience of the surgeon. The integration of augmented reality with real-time visualization, artificial intelligence, and attention tracking systems is likely to redefine the standards of accuracy and quality in endourology in the coming years.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"266-271"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lichen sclerosus associated urethral disease: reconstructive strategy and medical adjuncts.","authors":"Maciej Oszczudłowski, Lukasz Białek, Jakub Dobruch","doi":"10.1097/MOU.0000000000001401","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001401","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lichen sclerosus associated urethral stricture disease represents a complex and evolving reconstructive challenge due to its heterogeneous presentation, progressive course, and persistent long-term risk of recurrence. This review summarizes contemporary reconstructive strategies and adjunctive therapies, highlighting recent refinements and ongoing limitations in the available evidence.</p><p><strong>Recent findings: </strong>Recent data demonstrate a shift toward single-stage, anatomy-based urethral reconstruction in selected patients with lichen sclerosus, particularly using oral mucosa grafts, while emphasizing the need for segment-specific approaches for distal, penile, and panurethral strictures. Despite these advances, high-quality comparative evidence remains limited, with most studies being retrospective and heterogeneous in design and outcome reporting. A consistent finding across the literature is the clear contraindication to the use of genital skin grafts in lichen sclerosus. Advances in stricture classification systems, outcome assessment tools, and patient-reported measures have improved patient counseling and facilitated more standardized reporting. Topical therapies may play an adjunctive role, whereas systemic treatments remain investigational.</p><p><strong>Summary: </strong>Management of lichen sclerosus associated urethral stricture disease requires individualized, segment-specific reconstructive strategies and long-term surveillance. While recent refinements support selected single-stage approaches, further prospective, lichen sclerosus specific studies with standardized outcomes are needed to inform evidence-based recommendations.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urethral complications after gender-affirming genital surgery: prevention and reconstructive management.","authors":"Paul Neuville, François-Xavier Madec, Nicolas Morel-Journel","doi":"10.1097/MOU.0000000000001400","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001400","url":null,"abstract":"<p><strong>Purpose of review: </strong>Urethral complications remain a major source of morbidity following gender-affirming genital surgery, particularly in the setting of masculinizing procedures requiring urethral lengthening. This review summarizes recent advances in the epidemiology, prevention, and reconstructive management of urethral complications, with a focus on principles relevant to reconstructive urologists.</p><p><strong>Recent findings: </strong>Urethral complications are uncommon after feminizing genital surgery but occur frequently following masculinizing surgery, with pooled rates of strictures and fistulae approaching 50% after phalloplasty. Recent studies emphasize the heterogeneity of these complications, highlighting the importance of timing, anatomical location, and surgical technique. Improved classification systems, such as the Montréal classification, aim to standardize reporting. Preventive strategies - including careful patient selection, expectation management, hair removal protocols, optimized flap design, tissue interposition, and staged reconstruction - are increasingly recognized as critical but remain underreported. Reconstructive management must be individualized, as outcomes are influenced by tissue vascularity and prior interventions. Staged urethroplasty appears to offer the most durable results for complex strictures, while prolonged urinary diversion may allow conservative resolution of selected fistulae.</p><p><strong>Summary: </strong>Urethral complications after masculinizing gender-affirming genital surgery are common and complex. Emphasis on prevention, standardized reporting, and individualized reconstructive strategies is essential to improve long-term urinary outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-prostate-treatment stenosis and bladder neck contracture: reconstructive options and continence trade-offs.","authors":"Steffi Fauconnier, Marjan Waterloos, Wesley Verla","doi":"10.1097/MOU.0000000000001402","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001402","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review aims to summarize the most relevant literature published in 2024-2025 regarding the management of vesicourethral anastomotic stenosis (VUAS) and bladder neck contracture (BNC) after treatment of the prostate.</p><p><strong>Recent findings: </strong>We identified relevant articles focusing on novel treatment options regarding the management of VUAS and BNC, emphasizing patency rates and continence trade-offs.</p><p><strong>Summary: </strong>Vesicourethral anastomotic stenosis and bladder neck contracture represent distinct postoperative complications following radical prostatectomy and benign prostatic hyperplasia surgery, respectively. Endoscopic therapy continues to serve as first-line treatment, though reported success rates vary substantially across modalities. Emerging minimally invasive endoluminal techniques, such as transurethral incision with transverse mucosal realignment and drug-coated balloon dilation demonstrate promising early outcomes. For recalcitrant disease, reconstructive solutions including transperineal reanastomosis, buccal mucosal graft urethroplasty, and a growing spectrum of robot-assisted approaches offer encouraging patency rates with variable impacts on continence.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, diagnosis, and surgical management of urolithiasis in older adults: overview from EAU endourology.","authors":"Ali Talyshinkii, Rifat Burak Ergül, Bhaskar K Somani, Patrick Juliebø-Jones","doi":"10.1097/MOU.0000000000001403","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001403","url":null,"abstract":"<p><strong>Purpose of review: </strong>Population ageing is changing everyday urological practice. The number of older adults is increasing, and urology already treats a patient population that is, on average, older than the general population. Consequently, older adults with urolithiasis represent a core part of contemporary endourological practice. Given this, a focused review of the available evidence is valuable to inform clinical practice.</p><p><strong>Recent findings: </strong>A peak in stone disease can occur in older adults who may also be less likely to present with the classical features of renal colic. As such, delayed or missed diagnosis may carry greater clinical consequences. Although the literature remains relatively limited, ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy remain feasible options in appropriately selected older adults. In this group in particular, broader health associations merit consideration, as the presence of urolithiasis in older adults may reflect overall health status in later life.</p><p><strong>Summary: </strong>The burden of urolithiasis in older adults is increasing and now represents a routine component of everyday clinical practice. Clinical presentation may differ from that seen in younger \"index\" patients, and complications may have a greater impact on recovery and function. Management should therefore be individualized, taking into account comorbidity, frailty, functional status, and the patient's own priorities.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current applications of augmented reality in urology: clinical practice, training, and future directions: an EAU endourology and YAU opinion.","authors":"Pietro Scilipoti, Olivier Traxer, Frédéric Panthier","doi":"10.1097/MOU.0000000000001397","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001397","url":null,"abstract":"<p><strong>Purpose of review: </strong>Augmented reality and related extended-reality technologies have been increasingly investigated in urology to support procedures characterized by complex three-dimensional anatomy and limited intraoperative visualization. This review synthesizes recent original evidence on augmented reality/extended-reality applications in urology across clinical practice and training, with a focus on procedural planning, intraoperative guidance, and educational outcomes.</p><p><strong>Recent findings: </strong>A total 25 studies were identified. In Endourology, randomized studies in percutaneous nephrolithotomy (58-175 patients) showed improved anatomical understanding, shorter renal access times (50-60% reduction), changes in access strategy in 30% of cases, higher stone-free rates, and fewer intermediate-grade complications, with inconsistent effects on operative duration and fluoroscopy exposure using augmented reality/extended-reality applications.In robotic urology, most evidence concerns oncological surgery. Feasibility and comparative studies in robot-assisted partial nephrectomy (20-105 patients) confirmed rapid augmented reality co-registration and acceptable perioperative safety. In radical prostatectomy, comparative and randomized data (92-133 patients) suggested lower positive surgical margin rates at preserved neurovascular bundles and improved early continence recovery, without consistent differences in short-term oncological outcomes. Applications to pelvic lymph node dissection and highly complex renal surgery remain exploratory.Educational and training applications represent the most mature domain, with randomized and validation studies (12-43 trainees) consistently demonstrating improved technical performance, procedural efficiency, and reduced cognitive workload using immersive or mixed-reality platforms, including remote training solutions.</p><p><strong>Summary: </strong>Current augmented reality/extended-reality applications in urology show reproducible benefits in anatomical understanding, procedural planning, and selected technical steps, particularly in endourology and surgical training. Clinical outcome evidence remains heterogeneous and largely limited to short-term or surrogate endpoints, while broader adoption is constrained by technical robustness, workflow integration, and scalability. Ongoing randomized studies and advances in automation and artificial intelligence-driven registration are expected to better define the role of augmented reality/extended-reality in routine urological practice.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible ureteroscopy with integrated suction, a useful innovation: a systematic review by the YAU and EAU endourology sections.","authors":"Theodoros Spinos, Lucasz Nowak, Bhaskar K Somani, Mohamed Omar, Arman Tsaturyan, Panagiotis Kallidonis, Evangelos Liatsikos, Amelia Pietropaolo","doi":"10.1097/MOU.0000000000001396","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001396","url":null,"abstract":"<p><strong>Purpose of review: </strong>Suction has been applied in retrograde intrarenal surgery (RIRS) in order to remove residual fragments (RF). The aim of this systematic review is to collect all applications of direct in-scope suction (DISS) in both clinical and experimental settings and compare DISS scopes with conventional scopes and suction ureteral access sheaths.</p><p><strong>Recent findings: </strong>According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, an a priori systematic review protocol was developed and registered with PROSPERO. PubMed, Scopus and the Cochrane Library, were screened from 5 August 2025 and 18 studies met inclusion criteria. The stone-free rates (SFR) ranged from 39.5% to 100%, while the auxiliary procedures rates ranged from 0% to 33.3%. The intraoperative complication rates ranged from 0% to 58.6%. The Grade I-II complication rates (Clavien-Dindo Classification System), ranged from 0% to 36.7%, while the Grade III-IV ones ranged from 0% to 4.5%. Seven experimental studies were in vitro and two were ex vivo.</p><p><strong>Summary: </strong>Our research showed that DISS is a feasible, safe and efficient approach for the ureteroscopic management of both renal and ureteral stones. DISS scopes can be efficiently used not only for dust or RF evacuation, but also for stone relocation and reduction of intrarenal pressure.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}