Nature Reviews Urology最新文献

{"title":"The disruption of circadian rhythm as a potential mechanism of nocturia-like symptoms - a paediatric urology perspective.","authors":"María P Herrera, Cristina Dominguez","doi":"10.1038/s41585-025-01024-8","DOIUrl":"10.1038/s41585-025-01024-8","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":" ","pages":"321"},"PeriodicalIF":12.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764500","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":"Disruption of circadian rhythm as a potential pathogenesis of nocturia.","authors":"Qi-Xiang Song, Sylvia O Suadicani, Hiromitsu Negoro, Hai-Hong Jiang, Rita Jabr, Christopher Fry, Wei Xue, Margot S Damaser","doi":"10.1038/s41585-024-00961-0","DOIUrl":"10.1038/s41585-024-00961-0","url":null,"abstract":"<p><p>Increasing evidence suggested the multifactorial nature of nocturia, but the true pathogenesis of this condition still remains to be elucidated. Contemporary clinical medications are mostly symptom based, aimed at either reducing nocturnal urine volume or targeting autonomic receptors within the bladder to facilitate urine storage. The day-night switch of the micturition pattern is controlled by circadian clocks located both in the central nervous system and in the peripheral organs. Arousal threshold and secretion of melatonin and vasopressin increase at night-time to achieve high-quality sleep and minimize nocturnal urine production. In response to the increased vasopressin, the kidney reduces the glomerular filtration rate and facilitates the reabsorption of water. Synchronously, in the bladder, circadian oscillation of crucial molecules occurs to reduce afferent sensory input and maintain sufficient bladder capacity during the night sleep period. Thus, nocturia might occur as a result of desynchronization in one or more of these circadian regulatory mechanisms. Disrupted rhythmicity of the central nervous system, kidney and bladder (known as the brain-kidney-bladder circadian axis) contributes to the pathogenesis of nocturia. Novel insights into the chronobiological nature of nocturia will be crucial to promote a revolutionary shift towards effective therapeutics targeting the realignment of the circadian rhythm.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":" ","pages":"276-293"},"PeriodicalIF":12.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624559","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":"Reply to 'The disruption of circadian rhythm as a potential mechanism of nocturia-like symptoms - a paediatric urology perspective'.","authors":"Qi-Xiang Song, Sylvia Suadicani, Hiromitsu Negoro, Hai-Hong Jiang, Rita Jabr, Christopher Fry, Wei Xue, Margot S Damaser","doi":"10.1038/s41585-025-01025-7","DOIUrl":"10.1038/s41585-025-01025-7","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":" ","pages":"322-323"},"PeriodicalIF":12.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764481","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":"Towards precision medicine in clinical trials for the treatment of urologic chronic pelvic pain syndrome: lessons from the MAPP Research Network","authors":"Alisa J. Stephens Shields, J. Quentin Clemens, Michel A. Pontari, H. Henry Lai, Robert Moldwin, David A. Williams, Catherine S. Bradley, John T. Farrar, J. Richard Landis, Chris Mullins, Bruce D. Naliboff, Siobhan Sutcliffe, Stephen J. Walker, Claire C. Yang, Daniel J. Clauw","doi":"10.1038/s41585-025-01030-w","DOIUrl":"https://doi.org/10.1038/s41585-025-01030-w","url":null,"abstract":"<p>Randomized clinical trials have resulted in few approved therapies for the treatment of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively referred to as urologic chronic pelvic pain syndrome. Heterogenous patient populations, mismatches of treatments to patient phenotypes, non-specific outcomes and use of standard study designs not leveraging phenotypic heterogeneity might have contributed to the inability of previous trials to demonstrate existing efficacy. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network has identified important phenotypic characteristics associated with differential symptom severity and treatment responsiveness. Based on Multidisciplinary Approach to the Study of Chronic Pelvic Pain findings and external research, empirically informed strategies were generated for defining patient populations, specifying treatments and selecting primary outcomes for future randomized clinical trials in urologic chronic pelvic pain syndrome. Explicitly specifying the scope of eligibility criteria across heterogeneous patient subgroups defined by pain widespreadness, the presence of Hunner lesions, the presence of pain with bladder filling or relieved by voiding, the extent of chronic overlapping pain conditions, and pelvic floor tenderness is needed. Therapies should be selected based on the mechanism of action and relevance to the mechanism of pain and dominant symptomology that the patient experiences. Evidence suggests that pain and urinary symptoms should be evaluated separately. Promising trial designs for identifying effective therapies in this heterogeneous patient population include sequential multiple assignment randomized trials and adaptive designs.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"86 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889619","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":"Reconstructive urologists can address the care gap for adults with intersex traits","authors":"Maetal E. Haas Kogan, Barbara Chubak, Elizabeth R. Boskey, Steven J. Staffa, Carl G. Streed, Katharine B. Dalke, Arlene Baratz, Cecile Ferrando, Frances W. Grimstad","doi":"10.1038/s41585-025-01038-2","DOIUrl":"https://doi.org/10.1038/s41585-025-01038-2","url":null,"abstract":"The surgical care of patients with differences in sex development (DSD) or intersex traits has historically been the domain of paediatric subspecialties. However, as patients defer surgeries until later in life, providers are needed to help close this emerging clinical care gap for the LGBTQIA+ community.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"34 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889621","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":"Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP","authors":"Yu-Hsiang Lin, Kuo-Jen Lin, Chun-Te Wu","doi":"10.1038/s41585-025-01028-4","DOIUrl":"https://doi.org/10.1038/s41585-025-01028-4","url":null,"abstract":"<p>Notably, a similar vicious cycle can occur in men with benign prostatic hyperplasia (BPH). BPH-induced bladder outlet obstruction leads to increased bladder pressure, impaired bladder compliance and, ultimately, nocturia². In such circumstances, the overlapping contributions of impaired ADH secretion and heightened ANP activity could complicate the therapeutic landscape. In clinical practice, ADH analogues (such as desmopressin) are frequently used to address ADH deficiency-associated nocturnal polyuria. These treatments are effective but often fail in a subset of patients owing to several factors, including heterogeneous pathophysiological mechanisms underlying nocturnal polyuria³.</p><p>Our hypothesis that ANP antagonizes ADH-driven water reabsorption in patients with OSA⁴ provides a mechanistic insight into reported treatment resistance³. Incorporating ANP measurement into clinical evaluation could refine the treatment paradigm for nocturnal polyuria.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"30 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875997","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":"Reply to ‘Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP’","authors":"Olaf P. J. Vrooman, Mohammad S. Rahnama’i","doi":"10.1038/s41585-025-01027-5","DOIUrl":"https://doi.org/10.1038/s41585-025-01027-5","url":null,"abstract":"<p>Lin, Lin and Wu provide insightful comments regarding our article¹ on the physiological mechanisms linking obstructive sleep apnoea (OSA) with nocturia (Vrooman, O. P. J. et al. Nocturia and obstructive sleep apnoea. <i>Nat. Rev. Urol</i>. <b>21</b>, 735–753; 2024), which are thought-provoking (Lin, Y.-H., Lin, K.-J. &amp; Wu, C.-T. Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP. <i>Nat. Rev. Urol</i>. https://doi.org/10.1038/s41585-025-01028-4; 2025)². We agree that benign prostatic hyperplasia (BPH) can contribute to nocturia through bladder outlet obstruction, leading to increased intravesical pressure and impaired bladder compliance³. Indeed, these events can result in detrusor overactivity and reduced voided volumes during nocturnal urination. However, as highlighted in our Review¹, nocturia is a multifactorial condition, and alternative mechanisms influencing urine production should be considered. Specifically, nocturnal polyuria, which can coexist with lower urinary tract dysfunction in BPH, is increasingly recognized as a considerable contributor to nocturia in the ageing population⁴.</p><p>We acknowledge the Correspondence authors’ focus on the interplay between atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) in influencing nocturnal urine production². The antagonistic effects of ANP on ADH-driven water reabsorption in the renal collecting ducts provide valuable mechanistic insight into treatment resistance observed with ADH analogues such as desmopressin⁵. This process is particularly relevant in patients with OSA, in whom negative intrathoracic pressures and intermittent hypoxia promote ANP secretion, counteracting ADH-mediated water retention⁶. Thus, incorporating ANP measurements into clinical evaluation might improve management of nocturnal polyuria in this patient population⁷. Nevertheless, certain challenges should be considered. ANP levels peak at night owing to negative intrathoracic pressures, so the optimal time for measurement remains uncertain. Morning samples might not accurately reflect nocturnal surges given the short half-life of ANP⁸.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"6 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876004","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":"Circulating tumour DNA and circulating tumour cells in bladder cancer — from discovery to clinical implementation","authors":"Sia V. Lindskrog, Trine Strandgaard, Iver Nordentoft, Matthew D. Galsky, Thomas Powles, Mads Agerbæk, Jørgen Bjerggaard Jensen, Catherine Alix-Panabières, Lars Dyrskjøt","doi":"10.1038/s41585-025-01023-9","DOIUrl":"https://doi.org/10.1038/s41585-025-01023-9","url":null,"abstract":"<p>Liquid biopsies, indicating the sampling of body fluids rather than solid-tissue biopsies, have the potential to revolutionize cancer care through personalized, noninvasive disease detection and monitoring. Circulating tumour DNA (ctDNA) and circulating tumour cells (CTCs) are promising blood-based biomarkers in bladder cancer. Results from several studies have shown the clinical potential of ctDNA and CTCs in bladder cancer for prognostication, treatment-response monitoring, and early detection of minimal residual disease and disease recurrence. Following successful clinical trial evaluation, assessment of ctDNA and CTCs holds the potential to transform the therapeutic pathway for patients with bladder cancer — potentially in combination with the analysis of urinary tumour DNA — through tailored treatment guidance and optimized disease surveillance.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"7 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836698","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":"Targeting TGCT","authors":"Louise Lloyd","doi":"10.1038/s41585-025-01040-8","DOIUrl":"https://doi.org/10.1038/s41585-025-01040-8","url":null,"abstract":"<p>In vitro data suggest that BRD9 could be a treatment target in testicular germ cell tumours (TGCTs). Inhibition of BRD9 in TGCT cell lines reduced their viability.</p><p>Meta-analysis of Affymetrix microarray data and immunohistochemical analysis showed that BRD9 expression was heterogeneous in TGCT cell lines and patient samples. Treatment of different TGCT cell lines with the BRD9 inhibitor I-BRD9, which is an acetylated lysine mimetic that binds to the bromodomain binding pocket of BRD9, decreased their viability in a time-dependent and a dose-dependent manner. Strong cytotoxic effects were evident in TGCT cell lines, whereas control cell lines were only slightly affected. In TGCT cell lines, I-BRD9 induced apoptosis and cell-cycle arrest in G1 phase. Specifically in embryonal carcinoma cells and seminoma cells, I-BRD9 caused downregulation of pluripotency markers and cell differentiation towards an epithelial cell fate.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"15 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827694","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":"Madrid plays host to a celebration of urology","authors":"Annette Fenner","doi":"10.1038/s41585-025-01036-4","DOIUrl":"https://doi.org/10.1038/s41585-025-01036-4","url":null,"abstract":"<p>The European Association of Urology (EAU) has celebrated its 40th congress with a successful meeting that also celebrated 50 years of the <i>European Urology</i> journals.</p><p>Despite torrential rain and storms, Madrid provided a beautiful backdrop to a meeting jam-packed with top-level research and excellent networking opportunities for attendees.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"42 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827707","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}