{"title":"The changing landscape of nonobstructive azoospermia.","authors":"Laurianne Rita Garabed, Ryan Flannigan","doi":"10.1097/MOU.0000000000001252","DOIUrl":"10.1097/MOU.0000000000001252","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article aims to describe new developments in the field of nonobstructive azoospermia biology, diagnostics, biomarkers, and therapeutic strategies.</p><p><strong>Recent findings: </strong>Recent studies have investigated the molecular underpinnings of cellular dysfunction that is contributing to spermatogenic dysfunction and findings suggest abnormalities across both somatic and germ cells. Biomarkers to predict the chances of sperm retrieval are being explored utilizing cell free (cf) DNA and RNA from various body fluids, in addition to a full range of transcripts and epigenetics within seminal fluid. Various approaches are being explored to optimize sperm identification from surgical specimens including microfluidic and machine learning approaches. Finally, approaches to regenerating sperm production from males with nonobstructive azoospermia are evolving to include various 3-dimensional culture techniques with integration of computational modeling.</p><p><strong>Summary: </strong>The landscape of nonobstructive azoospermia biomarkers, molecular underpinnings, technological approaches to more reliably identify sperm and novel regenerative therapeutic strategies are likely to transform the field of male reproduction in years to come.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"127-134"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738720","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}
Alexandr M Pinkhasov, David Y Yang, Elise Tentis, Matthew Ziegelmann
{"title":"Contemporary nonsurgical management of Peyronie's disease.","authors":"Alexandr M Pinkhasov, David Y Yang, Elise Tentis, Matthew Ziegelmann","doi":"10.1097/MOU.0000000000001255","DOIUrl":"10.1097/MOU.0000000000001255","url":null,"abstract":"<p><strong>Purpose of review: </strong>Peyronie's disease characterizes a condition in which there is angular curvature of the penis. We know that the most patients with Peyronie's disease will not have spontaneous resolution of their penile curvature. As such, patients who desire treatment can elect for either surgical or nonsurgical therapy. Herein, we discuss the contemporary nonsurgical management options for Peyronie's disease.</p><p><strong>Recent findings: </strong>Nonsurgical management options for Peyronie's disease include oral therapy, intra-lesional injections, and penile traction therapy. At the time of this review, there is essentially no high-level evidence demonstrating any benefit for oral therapy. Penile traction therapy has evolved over the past decade with second-generation devices demonstrating strong efficacy and more convenient treatment regimens. Intra-lesional options include collagenase Clostridium histolyticum (CCH), verapamil, and interferon alpha-2b. The IMPRESS trial garnered the strongest level of evidence (two randomized, double-blind, placebo-controlled trials) to support the safety and efficacy of CCH. Verapamil is an option supported by several urological societies; however, the evidence supporting its efficacy is inconsistent between several notable series and randomized studies. IFN alpha 2b can produce modest improvement in curvature, however, is not available for use in North America.</p><p><strong>Summary: </strong>Herein, we will discuss notable advances in nonsurgical management of Peyronie's disease.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"135-141"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913997","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}
Alex J Xu, Jessica Abou Zeki, Shubham Gupta, Kirtishri Mishra
{"title":"Future directions in transfeminine genital gender-affirming surgery: tissue substitutes and transplant.","authors":"Alex J Xu, Jessica Abou Zeki, Shubham Gupta, Kirtishri Mishra","doi":"10.1097/MOU.0000000000001266","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001266","url":null,"abstract":"<p><strong>Purpose of review: </strong>The present study reviews contemporary literature focused on uterine transplantation and tissue substitutes for the purposes of transfeminine genital gender affirming surgery (GAS). Additional background is provided for both topics to provide a more comprehensive understanding of the modern applications.</p><p><strong>Recent findings: </strong>Uterine transplant remains an experimental procedure in cisgender patients who wish to avoid surrogacy. A natural extension might be to apply these techniques to GAS. Technical barriers include anatomic differences and alterations to gender-affirming hormone administration protocols. Ethically, resource allocation, elective immunosuppression, societal response to organ donation, legal ramifications of parenthood as well as the potential, under-studied effects that such an elective procedure may have on the patient's offspring must be further investigated.Tissue substitutes have long been used in urologic reconstruction but more recently applied to gender affirmation surgery which has traditionally relied on autografting to line the neovaginal canal both in the context of primary and revision vaginoplasty. However, the advent of off-the-shelf xenografts have recently been posited to be safe and efficacious alternatives to autografts. Longer term studies are needed to validate whether these proposed methods are indeed noninferior to traditional approaches.</p><p><strong>Summary: </strong>The field of feminizing gender affirmation surgery remains an exciting frontier for surgeons and patients alike. Given the relative nascency of the specialty and its propensity to draw techniques from various surgical disciplines there exists a unique opportunity for rapid innovation to overcome challenging problems posed by these complex procedures as evidenced by discussions around applying uterine transplantation and the use of novel tissue grafting techniques.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064016","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}
Samuel Ruder, Juana Martinez, Jessica Palmer, Abdul Baseet Arham, Scott T Tagawa
{"title":"Antibody-drug conjugates in urothelial carcinoma: current status and future.","authors":"Samuel Ruder, Juana Martinez, Jessica Palmer, Abdul Baseet Arham, Scott T Tagawa","doi":"10.1097/MOU.0000000000001263","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001263","url":null,"abstract":"<p><strong>Purpose of review: </strong>Antibody-drug conjugates (ADCs) are quickly becoming frontline standard of care in many tumor types, including urothelial carcinoma. This review summarizes recent clinical investigations into the use of ADCs targeting nectin-4, trophoblast cell surface antigen-2 (Trop-2), human epidermal growth factor receptor 2 (HER-2), and other antigens in urothelial carcinoma.</p><p><strong>Recent findings: </strong>This review covers efficacy and toxicity data of ADCs alone and in combination with immunotherapy; mechanisms of resistance; and preclinical studies that provide biological basis for clinical approaches.</p><p><strong>Summary: </strong>Enfortumab vedotin and sacituzumab govitecan can be used in an unselected group of patients with urothelial carcinoma whereas HER-2 ADCs have only been administered in those with high expression or amplification. Most are being studied in combination with immune checkpoint inhibitors. Data supports use of enfortumab vedotin in combination with pembrolizumab as first-line therapy in metastatic/unresectable locally advanced urothelial carcinoma. Sacituzumab govitecan may be used as later-line option in these patients. HER-2 therapy is still under investigation but has many recent promising results.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022640","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}
Diana Babaevskaya, Andrey Morozov, Eddie Fridman, Larisa Tsoy, Shahrokh F Shariat, Yossef Molchanov, Maxim Yakimov, Eva Compérat, Thomas R W Herrmann, Dmitry Enikeev
{"title":"En bloc resection of large bladder tumor: is it feasible and reasonable?","authors":"Diana Babaevskaya, Andrey Morozov, Eddie Fridman, Larisa Tsoy, Shahrokh F Shariat, Yossef Molchanov, Maxim Yakimov, Eva Compérat, Thomas R W Herrmann, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001265","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001265","url":null,"abstract":"<p><strong>Purpose of review: </strong>Transurethral resection of bladder tumor (TURBT) remains the basis of bladder tumor diagnosis and an effective means of treating nonmuscle invasive bladder cancer (NMIBC). There are several limitations to this procedure: TURBT may cause free floating of malignant cells in the bladder and as a result re-implantation and early recurrence. Also, it does not allow the pathologist to define the correct spatial orientation of the specimen. The development of en bloc resection of bladder tumor (ERBT) has helped overcome the abovementioned key disadvantages of TURBT. However, many urologists doubt whether this approach is feasible for treating larger tumors.</p><p><strong>Recent findings: </strong>In this review, it is shown that ERBT of large bladder tumor (>3 cm) is in fact a feasible and well tolerated method. Although there is a lack of comparative data proving its advantages over TURBT, en bloc in large tumor seems to result in better local cancer control (due to higher prevalence of detrusor specimen, lower need for re-TURBT), lower rate of relapse outside the resection area (due to lower risk of tumor cells circulation), and higher quality of pathology specimen.</p><p><strong>Summary: </strong>Despite the skepticism of some surgeons, potential difficulties caused by larger tumor size may be overcome easily, and most agree that tumor size should not limit the implementation of the method in their daily practice.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001822","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":"Differences in lasers and laser technologies: what does a clinician need to know?","authors":"Andrey Morozov, Vladislav Skossyrskiy, Diana Babaevskaya, Vineet Gauhar, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001264","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001264","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on recent advancements in laser technologies used in urology, particularly in enucleation, vaporization, lithotripsy, and focal laser ablation (FLA). The growing use of the thulium fiber laser (TFL) and the development of pulsed thulium lasers (p-Tm:YAG) highlight the relevance of this review, as these innovations aim to improve precision and outcomes in urological procedures.</p><p><strong>Recent findings: </strong>Recent studies have shown the advantages of TFL in achieving precise tissue ablation, reduced retropulsion offered by the Moses technology in holmium lasers, and the potential of pulsed thulium lasers for more precise control of the effects on tissues. Additionally, FLA is gaining traction for its ability to treat localized prostate cancer with minimal collateral damage. These technologies not only optimize procedural accuracy but also reduce complications, making them safer for high-risk patients, including those receiving anticoagulants.</p><p><strong>Summary: </strong>The advancements in laser technology, including TFL, Moses technology, and pulsed thulium lasers, are improving outcomes in urological surgeries by increasing precision, reducing operative time, and minimizing complications. FLA represents a promising alternative for minimally invasive cancer treatments. Ongoing research should focus on optimizing laser parameters and exploring broader clinical applications.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001821","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}
Nkiruka Odeluga, Robert Fisch, Tenny R Zhang, Nnenaya Mmonu
{"title":"Patient-reported outcomes in genital gender-affirming surgery.","authors":"Nkiruka Odeluga, Robert Fisch, Tenny R Zhang, Nnenaya Mmonu","doi":"10.1097/MOU.0000000000001262","DOIUrl":"10.1097/MOU.0000000000001262","url":null,"abstract":"<p><strong>Purpose of review: </strong>We reviewed the latest articles in patient-reported outcomes as it relates to genital gender-affirming surgery (GGAS) and provide a narrative summary of each article.</p><p><strong>Recent findings: </strong>The current landscape of patient-reported outcomes measures (PROMs) within GGAS largely consists of various ad hoc questionnaires. Within the last two years, one new PROM, validated within the transgender and gender-diverse (TGD) community, have been described.</p><p><strong>Summary: </strong>Patient-reported outcomes measures seek to elucidate the questions and answers of particular interest to patients and stakeholders of a particular population. To date, within GGAS, surgeon-reported outcomes and nonvalidated patient-reported outcomes comprise the bulk of the literature on the subject. However, there is growing interest in PROMs developed with TGD collaboration within all phases of the research process. Three new PROMs designed with and for the TGD community, are described which provides hope for continued progression of the field toward patient-centered and patient-collaborative research.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982609","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}
Ali Talyshinskii, Lazaros Tzelves, Eugenio Ventimiglia, Steffi Kar Kai Yuen, Vineet Gauhar, Oliver Traxer, Bhaskar Somani
{"title":"Technological innovation and revolution with single-use digital flexible ureteroscopes: a review from section of EAU Endourology.","authors":"Ali Talyshinskii, Lazaros Tzelves, Eugenio Ventimiglia, Steffi Kar Kai Yuen, Vineet Gauhar, Oliver Traxer, Bhaskar Somani","doi":"10.1097/MOU.0000000000001260","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001260","url":null,"abstract":"<p><strong>Purpose of review: </strong>Numerous scope-related innovations have taken place in the field of endourology. The presented analytical review is aimed at studying the technical innovations of the single-use digital flexible ureteroscopes. In November 2024, a comprehensive search was done for information on latest disposable flexible digital ureteroscopes, as well as their various unique characteristics. A thorough examination was conducted for image qualities; sizes and channels; and deflection capabilities. Furthermore, supplementary features about the latest advances were assigned to a separate group including 'Unique' solutions. Using the last search query, various innovations in flexible ureteroscopy in general were also searched and sorted into appropriate groups.</p><p><strong>Recent findings: </strong>Modern single-use flexible digital ureteroscopes are characterized by advanced technologies for transmitting light and images, miniaturization, as well as by a number of unique solutions that were previously characteristic only of semi-rigid or fiberoptic endoscopes. These include features such as integrated buttons for data recording, self-locking mechanism, separate ports, rotating shaft, direct-in-scope suction, pressure monitoring, enhanced tip control and customizable settings.</p><p><strong>Summary: </strong>Since their introduction in urology, endoscopes have undergone many changes, as illustrated by the example of single-use flexible digital ureteroscopes. The imaging quality has improved, the dimensions of both the distal tip and shaft have decreased, with over 15 manufactures producing and distributing these scopes. A lot of new additional new features are likely to enhance the efficacy and safety of ureteroscopic procedures.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946217","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 role of innovations in advancing urologic oncologic patient care.","authors":"Shahrokh Shariat, Jeremy Teoh","doi":"10.1097/MOU.0000000000001236","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001236","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"35 1","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767512","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":"Liquid biomarkers in prostate cancer: recent advancements and future directions.","authors":"Chris Ho-Ming Wong, Ivan Ching-Ho Ko, Chi Fai Ng","doi":"10.1097/MOU.0000000000001188","DOIUrl":"10.1097/MOU.0000000000001188","url":null,"abstract":"<p><strong>Purpose of review: </strong>Traditional diagnostic approaches of prostate cancer like PSA are limited by high false-positive rates and insufficient capture of tumour heterogeneity, necessitating the development of more precise tools. This review examines the latest advancements in liquid biomarkers for prostate cancer, focusing on their potential to refine diagnostic accuracy and monitor disease progression.</p><p><strong>Recent findings: </strong>Liquid biomarkers have gained prominence because of their minimally invasive nature and ability to reflect the molecular characteristics of prostate cancer. Circulating tumour cells provide insight into tumour cell dissemination and are indicative of aggressive disease phenotypes, with single-cell analyses revealing genomic instability and treatment resistance. Circulating tumour DNA offers real-time tumour genomic information, aiding in treatment decision-making in advanced prostate cancer, where it has been associated with clinical progression. MicroRNAs act as oncogenes or tumour suppressors and exhibit diagnostic and prognostic potential; however, their clinical utility is constrained by the lack of consistent validation. Extracellular vesicles contain tumour-derived biomolecules, with specific proteins demonstrating prognostic relevance. Applications of these markers to urinary testing have been demonstrated.</p><p><strong>Summary: </strong>Liquid biomarkers show potential in refining prostate cancer management. Future research should aim to integrate these biomarkers into a cohesive framework in line with precision medicine principles.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"3-12"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852000","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}