{"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}
{"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}
{"title":"Minimizing overtreatment and maximizing oncologic outcomes in upper tract urothelial carcinoma.","authors":"Ali H Zahalka, Vitaly Margulis","doi":"10.1097/MOU.0000000000001238","DOIUrl":"10.1097/MOU.0000000000001238","url":null,"abstract":"<p><strong>Purpose of review: </strong>An update on the latest advances in the management of upper tract urothelial carcinoma (UTUC), with an emphasis on strategies to optimize oncologic outcomes while minimizing overtreatment.</p><p><strong>Recent findings: </strong>Recent high-quality trials have changed the landscape of UTUC treatment. Emerging tools including 3D histology and measurement of cell free tumor DNA may improve diagnostic accuracy of disease grading and staging, and be used in monitoring treatment response. Novel therapies show promise of reducing low-grade UTUC disease recurrence at the cost of significant side-effects. Platinum-based neoadjuvant chemotherapy in high-grade/muscle-invasive disease showed complete pathological response in a subset of patients, but difficult to predict responders. Adjuvant platinum-based chemotherapy exhibited a clear survival benefit, but immunotherapy did not, suggesting possible overtreatment with these agents. Molecularly-targeted therapies in metastatic UTUC have shown the greatest recent oncologic advances, but exhibit a high adverse event-rate.</p><p><strong>Summary: </strong>Low-grade UTUC has the potential for overtreatment, as it exhibits low metastatic-potential and excellent survival. For high-grade and advanced-stage UTUC, these carry high mortality rates and require more aggressive treatment, but studies are limited by inaccurate grading and staging which can lead to overtreatment especially in the neoadjuvant setting. Emerging technologies will help improve diagnostic accuracy and noninvasive monitoring of treatment response.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"35 1","pages":"96-102"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767509","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 biologic landscape and therapeutic implications of upper tract urothelial cancer.","authors":"Evangelia Vlachou, Jeannie Hoffman-Censits, Nirmish Singla","doi":"10.1097/MOU.0000000000001233","DOIUrl":"10.1097/MOU.0000000000001233","url":null,"abstract":"<p><strong>Purpose of review: </strong>Management of upper tract urothelial cancer (UTUC) has been largely extrapolated from bladder cancer due to its rarity; however, unique biological and clinical differences between UTUC and bladder cancer have been uncovered. The purpose of this review is to present the current therapeutic landscape of UTUC with an emphasis on biologically driven rationale.</p><p><strong>Recent findings: </strong>Prospective trials for patients with high-risk localized UTUC have shown improved outcomes with adjuvant and neoadjuvant platinum-based chemotherapy. However, the timing of therapy relative to nephroureterectomy may impact platinum eligibility due to renal functional decline following surgery. In recent years, emerging therapeutic classes including immune checkpoint inhibition, antibody drug conjugates, and targeted therapies have emerged as tolerable alternatives to platinum-based chemotherapy in treating metastatic disease. Biomarker-selected therapies, including those targeting HER2 and FGFR3, have shown encouraging results and are relevant to UTUC based on increased expressions of these targets; however, no prospective study to date has been powered to assess the effect of these modern treatments on patients with UTUC specifically.</p><p><strong>Summary: </strong>Unique biological insights into UTUC pathogenesis and risk factors have expanded the therapeutic landscape for these patients beyond conventional platinum-based chemotherapeutic approaches. Novel therapeutic classes have emerged to guide more precise approaches in treating patients with urothelial cancer, with a need for further trials powered specifically to the UTUC population.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"89-95"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460034","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}
Raj R Bhanvadia, Zine-Eddine Khene, Vitaly Margulis
{"title":"Perioperative systemic therapy, current paradigm and ongoing clinical trials in upper tract urothelial cancer.","authors":"Raj R Bhanvadia, Zine-Eddine Khene, Vitaly Margulis","doi":"10.1097/MOU.0000000000001237","DOIUrl":"10.1097/MOU.0000000000001237","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide a comprehensive overview of existing and future paradigms for perioperative systemic therapy in the treatment of upper tract urothelial carcinoma.</p><p><strong>Recent findings: </strong>Contemporary treatment paradigms for the management of upper tract urothelial carcinoma focus on use of neoadjuvant cisplatin based chemotherapy for high grade disease primarily based on two small single arm phase II clinical trials. More robust evidence from a phase III randomized clinical trial exists for the use of adjuvant platinum based chemotherapy for invasive disease after radical nephroureterectomy, but there are significant concerns about renal function and platinum eligibility after nephroureterectomy. There are currently ongoing clinical trials for nonplatinum based perioperative systemic therapies including checkpoint inhibitors/immunotherapy as well as antibody-drug conjugates, but currently no recommendation can be made for these approaches.</p><p><strong>Summary: </strong>Current evidence supports neoadjuvant cisplatin chemotherapy in the setting of high grade disease or concern for significant renal dysfunction after radical nephroureterectomy or platinum based adjuvant chemotherapy in eligible patients with advanced disease after surgery. While there is no established role for nonplatinum based therapies yet, multiple ongoing trials exploring use of immunotherapies and antibody-drug conjugates as monotherapy or combination may provide new therapeutic options in this population.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"83-88"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496736","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":"Upper tract urothelial carcinoma: conservative management - intraluminal adjuvant therapy, and surveillance.","authors":"Rinat Lasmanovich, Asaf Shvero, Nir Kleinmann","doi":"10.1097/MOU.0000000000001240","DOIUrl":"10.1097/MOU.0000000000001240","url":null,"abstract":"<p><strong>Purpose of review: </strong>In recent years, intraluminal therapies have become a valid alternative for low grade upper tract urothelial carcinoma (UTUC) patients, as overall survival and cancer-specific survival rates were shown to be comparable to those achieved with radical nephroureterectomy for selected cases. Nonetheless, endoscopic treatment has its limitations. As technology progresses and the demand for endoscopic treatments increases, intraluminal chemotherapy and immunotherapy instillations within the upper tract have increasingly become the subject areas of research.</p><p><strong>Recent findings: </strong>The main intraluminal therapies and relevant instillation approaches are reviewed in this study, including recent publications and their main outcomes. The recurrence rates demonstrated in the literature strengthen the notion that patients with UTUC following current intraluminal treatments have a better prognosis than in the past. Updated relevant guidelines regarding surveillance among this population are also reviewed and summarized.</p><p><strong>Summary: </strong>The treatment of upper tract urothelial carcinoma is clinically challenging. Developments in recent years show promising results in this field and ongoing research with new developments is emerging. Further studies are required to better understand the contribution of intraluminal therapies to the management of this disease.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"68-74"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557379","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}