Nature Reviews Urology最新文献

{"title":"Key lessons from AI in other endoscopic disciplines to guide the future in cystoscopy","authors":"Kristoffer Mazanti Cold, Juan Luis Vásquez","doi":"10.1038/s41585-026-01141-y","DOIUrl":"10.1038/s41585-026-01141-y","url":null,"abstract":"Since 2019, computer-aided detection (CADe) has improved the adenoma detection rate in colonoscopy. CADe tools will emerge in cystoscopy, but the urological field lacks established performance metrics and CADe validation frameworks. Key lessons can be learnt from other endoscopic disciplines to guide the development and evaluation of artificial intelligence in cystoscopy.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 10","pages":"638-639"},"PeriodicalIF":13.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680330","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 metastatic bladder cancer when money is an issue.","authors":"Jorge Esteban-Villarrubia,Guillermo de Velasco","doi":"10.1038/s41585-026-01142-x","DOIUrl":"https://doi.org/10.1038/s41585-026-01142-x","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"36 1 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666637","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":"From diversity to function: microbiome precision in RCC","authors":"Antonio Ocejo, Ritesh R. Kotecha, Martin H. Voss","doi":"10.1038/s41585-026-01140-z","DOIUrl":"10.1038/s41585-026-01140-z","url":null,"abstract":"Evidence suggests that the gut microbiome is a key regulator of systemic immunity influencing efficacy and tolerance of immune checkpoint inhibitors. Results of two trials of faecal microbiota transplantation in metastatic renal cell carcinoma provide new insights into microbiome modulation in cancer therapy.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 10","pages":"641-642"},"PeriodicalIF":13.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635702","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":"Evidence for metastasis-directed therapy in oligometastatic prostate cancer","authors":"Dorothy M. Chen, Kyle A. Blum, Jim C. Hu","doi":"10.1038/s41585-026-01139-6","DOIUrl":"10.1038/s41585-026-01139-6","url":null,"abstract":"Phase II trials have evaluated metastasis-directed therapy for oligometastatic and oligorecurrent prostate cancer and demonstrate that focused radiation is well tolerated and improves survival in selected patients, particularly when combined with androgen deprivation therapy. Phase III trials will optimize patient selection and refine combination treatment strategies.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 9","pages":"558-560"},"PeriodicalIF":13.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611927","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":"Neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury","authors":"Fiona Huang, Lucas Rempel, Matthias Walter, Jean Jacques Wyndaele, Ruth Kirschner-Hermanns, Katherine Anderson, Raza Malik, Andrei V. Krassioukov","doi":"10.1038/s41585-026-01135-w","DOIUrl":"10.1038/s41585-026-01135-w","url":null,"abstract":"The management of neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury is defined by the compounding interaction between prostate enlargement, neurogenic detrusor overactivity and detrusor-sphincter dyssynergia. The effects of spinal cord injury and an ageing bladder create unique challenges, including a 16–28-fold increased risk of urinary bladder cancer and a high prevalence of catheter-related complications. Importantly, although clean intermittent catheterization is the gold standard for treating lower urinary tract dysfunction, in many elderly patients, functional decline forces a transition to indwelling catheters, necessitating a shift in care strategy. Furthermore, prostate procedures such as transurethral resection of the prostate (TURP) and holmium laser enucleation, which are commonly carried out in older men, carry an increased risk of complications, including autonomic dysreflexia. Integrated, age-stratified guidelines are currently missing. Thus, a proactive, patient-centred framework for lifelong urological care is needed and should incorporate frailty assessments, sophisticated diagnostics to disentangle detrusor sphincter dyssynergia from prostate enlargement, and personalized management pathways to preserve renal function and quality of life. This Review discusses how ageing complicates the already compromised neurogenic lower urinary tract in men with spinal cord injury. The authors present the unique urological challenges faced by this population and propose a patient-centred framework to achieve personalized and lifelong care in these patients.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 10","pages":"643-653"},"PeriodicalIF":13.6,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147599258","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":"Active surveillance in low-grade NMIBC — results of an international two-round modified Delphi consensus","authors":"Roberto Contieri, Paolo Gontero, Rodolfo Hurle, Luca Afferi, Simone Albisinni, Marek Babjuk, Alison Birtle, Peter Black, Maurizio Brausi, Max Bruins, Otakar Čapoun, Albert Carrion, James Catto, Ananya Choudhury, Alessia Cimadamore, Eva Comperat, Siamak Daneshmand, David D’andrea, Francesco Del Giudice, Jose Luis Domínguez Escrig, Patrick Hensley, Wojciech Krajewski, Ekaterina Laukhtina, Roger Li, Fredrik Liedberg, Yair Lotan, Gautier Marcq, Paramananthan Mariappan, Andrea Mari, Alberto Martini, Alexandra Masson Lecomte, Richard Meijer, Maria Carmen Mir, Keiichiro Mori, Marco Moschini, Hugh Mostafid, Micheal O’Donnell, Joan Palou, Valeria Panebianco, Sisto Perdonà, Sima Porten, Sarah Psutka, Michael Rink, Morgan Roupret, Thomas Seisen, Mark Soloway, Viktor Soukup, Gary Steinberg, Arnulf Stenzl, Jeremy YC Teoh, Karl Tully, Toine van der Heijden, Bas W. G. van Rhijn, Alfred Witjes, Evanguelos Xylinas, Ashish M. Kamat, Benjamin Pradere, Laura S. Mertens","doi":"10.1038/s41585-026-01137-8","DOIUrl":"10.1038/s41585-026-01137-8","url":null,"abstract":"Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials. This article provides consensus-based statements from an international panel of bladder cancer experts on the use of active surveillance in non-muscle invasive bladder cancer. Consensus statements cover several aspects of active surveillance, including terminology, eligibility criteria and treatment triggers, providing a framework to guide clinical practice and trial design in this space.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 10","pages":"691-696"},"PeriodicalIF":13.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41585-026-01137-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147585574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond maternal exercise: paternal exercise adaptations mediated by sperm microRNA signatures","authors":"Abel Plaza-Florido, Inmaculada Pérez-Prieto, Daniel A. Galvão, Alejandro Lucia","doi":"10.1038/s41585-026-01138-7","DOIUrl":"10.1038/s41585-026-01138-7","url":null,"abstract":"Preclinical and clinical evidence shows that maternal exercise can contribute to the cardiometabolic health of offspring. Recent tantalizing findings also point to several paternal factors, notably sperm microRNAs, that can mediate the intergenerational transmission of exercise benefits.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 9","pages":"561-563"},"PeriodicalIF":13.6,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524543","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":"How urology can embrace the patient-centric precision focal therapy approach for localized prostate cancer","authors":"Sudharshanan Balaji, Herbert Lepor, Thomas J. Polascik","doi":"10.1038/s41585-026-01136-9","DOIUrl":"10.1038/s41585-026-01136-9","url":null,"abstract":"Focal therapy for localized prostate cancer offers organ-sparing oncological control with functional preservation for carefully selected men, but the uptake of this approach remains limited. Prioritizing principle-based evaluation, long-term registries and aligned reimbursement will facilitate the adoption of focal therapy into guideline-endorsed standard of care.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 7","pages":"421-422"},"PeriodicalIF":13.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490002","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":"Extrachromosomal DNA in urothelial carcinoma: mechanisms and clinical applications","authors":"Conghui Li \u0000 (, ), Zhiqiang Hu \u0000 (, ), Weimin Zhang \u0000 (, ), Yongling Ji \u0000 (, ), Fubing Wang \u0000 (, ), Yuchen Zeng \u0000 (, ), Sanju Sinha, Fengbiao Mao \u0000 (, ), Chunhua Lin \u0000 (, ), Wei Lv \u0000 (, )","doi":"10.1038/s41585-026-01134-x","DOIUrl":"10.1038/s41585-026-01134-x","url":null,"abstract":"Extrachromosomal DNA (ecDNA) has emerged as a major driver of genomic instability and rapid tumour evolution in urothelial carcinoma. In urothelial carcinoma, ecDNA amplifies oncogenes, reshapes 3D chromatin interactions, reprogrammes transcription and modulates the tumour–immune interface. Together, these features fuel intratumour heterogeneity, accelerate APOBEC3-associated mutational evolution and contribute to aggressive disease. Advances in sequencing and imaging technologies have greatly expanded our understanding of ecDNA biology. Importantly, ecDNA can be detected through non-invasive liquid biopsies, including urine and plasma, and inferred from standard histopathology slides via digital pathology. These observations suggest that ecDNA could be a valuable adjunct biomarker, enhancing current strategies for early detection, patient stratification and dynamic monitoring of treatment response. In this Review, the authors synthesize current knowledge of extrachromosomal DNA in urothelial carcinoma. By consolidating rapidly evolving evidence, this Review provides a comprehensive framework for understanding extrachromosomal DNA biology in urothelial carcinoma and its implications for precision oncology.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 9","pages":"607-620"},"PeriodicalIF":13.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483698","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":"Prostate cancer screening: weighing the benefits and harms","authors":"Nikhil Mayor, Hashim U. Ahmed","doi":"10.1038/s41585-026-01133-y","DOIUrl":"10.1038/s41585-026-01133-y","url":null,"abstract":"The UK’s National Screening Committee recently recommended against population-level prostate cancer screening. Calls to override this guidance are intensifying, but acting without robust evidence might risk exposing thousands of men to unnecessary harm. Data-driven policy changes are crucial.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 10","pages":"631-632"},"PeriodicalIF":13.6,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368392","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}