Nature Reviews Urology最新文献

{"title":"Metaverse in surgery — origins and future potential","authors":"Enrico Checcucci, Alessandro Veccia, Stefano Puliatti, Pieter De Backer, Pietro Piazza, Karl-Friedrich Kowalewski, Severin Rodler, Mark Taratkin, Ines Rivero Belenchon, Loic Baekelandt, Sabrina De Cillis, Alberto Piana, Ahmed Eissa, Juan Gomez Rivas, Giovanni Cacciamani, Francesco Porpiglia","doi":"10.1038/s41585-024-00941-4","DOIUrl":"https://doi.org/10.1038/s41585-024-00941-4","url":null,"abstract":"<p>The metaverse refers to a collective virtual space that combines physical and digital realities to create immersive, interactive environments. This space is powered by technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI) and blockchain. In healthcare, the metaverse can offer many applications. Specifically in surgery, potential uses of the metaverse include the possibility of conducting immersive surgical training in a VR or AR setting, and enhancing surgical planning through the adoption of three-dimensional virtual models and simulated procedures. At the intraoperative level, AR-guided surgery can assist the surgeon in real time to increase surgical precision in tumour identification and selective management of vessels. In post-operative care, potential uses of the metaverse include recovery monitoring and patient education. In urology, AR and VR have been widely explored in the past decade, mainly for surgical navigation in prostate and kidney cancer surgery, whereas only anecdotal metaverse experiences have been reported to date, specifically in partial nephrectomy. In the future, further integration of AI will improve the metaverse experience, potentially increasing the possibility of carrying out surgical navigation, data collection and virtual trials within the metaverse. However, challenges concerning data security and regulatory compliance must be addressed before the metaverse can be used to improve patient care.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"26 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical stimulation for the hypocontractile bladder","authors":"Nima Nassiri,&nbsp;Lauren Schafrank,&nbsp;Michael Chen,&nbsp;Madeleine Burg,&nbsp;Victor Nitti","doi":"10.1038/s41585-024-00949-w","DOIUrl":"10.1038/s41585-024-00949-w","url":null,"abstract":"The incidence of detrusor underactivity is projected to rise owing to an ageing population and the increasing prevalence of diabetes, but therapeutic options remain limited. Successful bladder contractions have been yielded in studies of bladder pacing in animals. However, anatomical incongruities highlight the need for human trials. Bladder pacing in humans through electrical stimulation has shown some potential, although sustainable protocols are lacking owing to detrusor–sphincter dyssynergia and patient discomfort during trials. Thus, manometric studies in brain-dead patients might serve as a model for developing an implantable bladder pacing device to restore contractility.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 4","pages":"190-191"},"PeriodicalIF":12.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring and improving the cradle-to-grave environmental performance of urological procedures","authors":"Joseph B. John,&nbsp;William K. Gray,&nbsp;Tim W. R. Briggs,&nbsp;John S. McGrath","doi":"10.1038/s41585-024-00937-0","DOIUrl":"10.1038/s41585-024-00937-0","url":null,"abstract":"An urgent need for societal transformation exists to reduce the environmental impact of humanity, because environmental health&nbsp;affects human health. Health care causes ~5% of global greenhouse gas emissions and other substantial and ongoing environmental harms. Thus, health-care professionals and managers must lead ongoing efforts to improve the environmental performance of health systems. Life-cycle assessment (LCA) is a methodology that enables estimation of environmental impacts of products and processes. It models environmental effects from ‘cradle’ (raw material extraction) to ‘grave’ (end of useful life) and conventionally reports a range of different impact categories. LCA is a valuable tool when used appropriately. Maximizing its utility requires rational assumptions alongside careful consideration of system boundaries and data sources. Well-executed LCAs are detailed and transparently reported, enabling findings to be adapted or generalized to different settings. Attention should be given to modelling mitigation solutions in LCAs. This important step can guide health-care systems towards new and innovative solutions that embed progress towards international climate agreements. Many urological conditions are common, recurrent or chronic, requiring resource-intensive management with large associated environmental impacts. LCAs in urology have predominantly focussed on greenhouse gas emissions and have enabled identification of modifiable ‘hotspots’ including electricity&nbsp;use, travel, single-use items, irrigation, reprocessing and waste incineration. However, the methodological and reporting quality of published urology LCAs generally requires improvement and standardization. Health-care evaluation and commissioning frameworks that value LCA findings alongside clinical outcomes and cost could accelerate sustainable innovations. Rapid implementation strategies for known environmentally sustainable solutions are also needed. This Perspectives provides an overview of life-cycle assessment and its use in urological academic literature to date. The authors explain how life-cycle assessment can be interpreted and used to help to reduce the environmental impact of urology.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 4","pages":"235-248"},"PeriodicalIF":12.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary bladder transplantation in humans — current status and future perspectives","authors":"Michał C. Czarnogórski,&nbsp;Krzysztof Koper,&nbsp;Piotr Petrasz,&nbsp;Malte W. Vetterlein,&nbsp;Marta Pokrywczyńska,&nbsp;Kajetan Juszczak,&nbsp;Tomasz Drewa,&nbsp;Jan Adamowicz","doi":"10.1038/s41585-024-00935-2","DOIUrl":"10.1038/s41585-024-00935-2","url":null,"abstract":"Urinary bladder vascularized allograft transplantation in humans is currently extensively being investigated worldwide, owing to the theoretical potential of this approach as a therapeutic option for individuals with end-stage, non-oncological bladder conditions or congenital bladder pathologies. To date, a successful attempt at urinary bladder autotransplantation was carried out in a heart-beating brain-dead research human donor. The robot-assisted surgical technique was shown to be optimal for performing this procedure, achieving a good performance in terms of both bladder allograft collection as well as vascular, ureterovesical and vesicourethral anastomoses. The urinary bladder vascularized allograft would be an alternative to traditional urinary diversion methods that rely on the use of intestinal segments, potentially avoiding adverse effects associated with these approaches. However, different from ileal urinary diversion, bladder transplantation would require lifelong immune suppression. Clinical trials are in progress to assess the vascularized bladder allograft transplantation technique, as well as the safety of this procedure in oncological and non-oncological indications. In this Perspective, the authors present the state of the art of vascularized composite bladder allograft transplantation in humans, discussing different surgical approaches used in the attempts carried out so far, as well as currently available diversion methods. The role of tissue engineering in the field of urinary bladder regeneration is also discussed.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 3","pages":"175-186"},"PeriodicalIF":12.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiota influence bladder tumour development","authors":"Louise Lloyd","doi":"10.1038/s41585-024-00947-y","DOIUrl":"10.1038/s41585-024-00947-y","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"576-576"},"PeriodicalIF":12.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing clinician specialty influences adherence to PrEP","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00945-0","DOIUrl":"10.1038/s41585-024-00945-0","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"577-577"},"PeriodicalIF":12.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"piRNA pathway disruption in human infertility","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00946-z","DOIUrl":"10.1038/s41585-024-00946-z","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"577-577"},"PeriodicalIF":12.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A wearable UBVM device to monitor bladder volume","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00944-1","DOIUrl":"10.1038/s41585-024-00944-1","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"577-577"},"PeriodicalIF":12.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intralesional heterogeneity on PSMA PET–CT predicts mCRPC outcomes","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00943-2","DOIUrl":"10.1038/s41585-024-00943-2","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"577-577"},"PeriodicalIF":12.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI in prostate MRI: enhancing accuracy and reducing overdiagnosis","authors":"Baris Turkbey","doi":"10.1038/s41585-024-00940-5","DOIUrl":"https://doi.org/10.1038/s41585-024-00940-5","url":null,"abstract":"Artificial intelligence can be leveraged to improve the detection of prostate cancer on magnetic resonance imaging; however, before this technology is implemented in clinical practice, further research is required.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"8 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}