Nature Reviews Urology最新文献

{"title":"A multi-modal approach for decision making in bladder cancer","authors":"Hasan Al-Sattar, Hao Ding, Oluchi Okoli, Somto Okoli, Aruni Ghose, Giuseppe Luigi Banna, Simon Wan, Athar Haroon, Jonathan Wong, Jeremy Teoh, Nikhil Vasdev, Eleni Efstathiou, Stergios Boussios, Sola Adeleke","doi":"10.1038/s41585-025-01122-7","DOIUrl":"10.1038/s41585-025-01122-7","url":null,"abstract":"Bladder cancer remains a major global health challenge, characterized by diagnostic uncertainty, substantial treatment costs and high recurrence rates. Current diagnostic and treatment modalities, including cystoscopy, transurethral resection of bladder tumour and standard histopathology, have limitations, including the inability to detect flat lesions, frequent understaging and interobserver variability, highlighting a crucial need for improved approaches. Advances in artificial intelligence (AI), blue-light cystoscopy, narrow-band imaging, cytology and urinary markers show promise in enhancing early detection and diagnosis. Developments in multiparametric MRI, radiomics, genomics and AI-driven algorithms for histopathological analyses have demonstrated considerable improvements in staging and risk stratification of bladder tumours, enabling personalized therapy selection and prognostication. Despite these promising developments, challenges remain regarding standardization, external validation, cost-effectiveness and ethical considerations in clinical implementation. Future research should prioritize addressing these barriers through collaborative, multi-institutional studies and robust validation frameworks. Ultimately, adopting a comprehensive multimodal strategy, such as proposed, novel, multimodal decision-making frameworks in which these advances and technologies are integrated, promises to considerably advance precision oncology in bladder cancer, improving patient outcomes and reducing health care burdens. In this Review, the authors describe and discuss how advances in artificial intelligence, genomics, radiomics and cytology can be integrated into decision-making processes to improve the management of bladder cancer.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 7","pages":"444-467"},"PeriodicalIF":13.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968429","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":"SRD5A2 and emerging therapies in androgen-driven disorders","authors":"Zongwei Wang, Boqing Gu, Christina Sharkey, Rongbin Ge, Aria F. Olumi","doi":"10.1038/s41585-025-01112-9","DOIUrl":"10.1038/s41585-025-01112-9","url":null,"abstract":"Benign prostatic hyperplasia (BPH) is one of the most prevalent urological disorders in ageing men. Medical therapies are widely used to treat BPH, but truly effective long-term treatments remain limited. Among the most commonly prescribed drugs are 5α-reductase inhibitors (5ARIs), which alleviate symptoms and slow disease progression by inhibiting steroid 5α-reductase (SRD5A) enzymes, particularly the SRD5A1 and SRD5A2 isoforms. SRD5A2, the dominant isoform in the prostate, has a pivotal role in androgen metabolism by converting testosterone into dihydrotestosterone, a potent driver of prostate growth. Proper regulation of SRD5A2 is essential to maintain the balance between androgenic and oestrogenic signalling, thereby supporting healthy prostate physiology. Emerging evidence links SRD5A2 alterations, such as genetic polymorphisms, epigenetic silencing and inflammation-induced changes to disease risk and progression, positioning these factors as promising biomarkers for personalized therapy. Beyond BPH, SRD5A2 has also been implicated as a potential therapeutic target in prostate cancer and androgenic alopecia. Thus, SRD5A2 has clinical relevance in BPH, prostate cancer and other androgen-mediated conditions. However, limitations of SRD5A2-targeted therapies need to be overcome for future strategies to enhance the efficacy of 5ARI-based treatments. SRD5A2 has clinical relevance in benign prostatic hyperplasia, prostate cancer and other androgen-mediated conditions. In this Review, the authors describe the complementary roles of α-blockers for rapid symptom relief and 5α-reductase inhibitors for disease modification and progression risk reduction in benign prostatic hyperplasia and the potential of targeting SRD5A2 in other androgen-driven disorders.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 5","pages":"319-332"},"PeriodicalIF":14.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908165","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":"Applications of AI in urology","authors":"","doi":"10.1038/s41585-025-01120-9","DOIUrl":"10.1038/s41585-025-01120-9","url":null,"abstract":"Artificial intelligence (AI) could transform the field of urology from student education through clinical procedures to writing and reporting. In this Focus issue on the applications of AI in urology, we present articles covering a broad range of the potential uses in the field.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 1","pages":"1-1"},"PeriodicalIF":14.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41585-025-01120-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909375","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":"Rethinking sexual pleasure in research, health care and society","authors":"Marieke Dewitte, Charmaine Borg","doi":"10.1038/s41585-025-01113-8","DOIUrl":"10.1038/s41585-025-01113-8","url":null,"abstract":"Sexual pleasure is a fundamental aspect of human sexuality and well-being, but it has often been overshadowed by the clinical focus on dysfunction and reproduction in sexual medicine, particularly in urology. The historical neglect of sexual pleasure, particularly in female and queer people, has been perpetuated by sociocultural and gender biases. However, advances in understanding and identification of research gaps help to illustrate the potential of multidisciplinary approaches that address the diverse experiences and needs of individuals across their lifespan. Integrating pleasure into research, clinical practice, sexuality education and public health initiatives has transformative potential to enhance individual well-being, intimate relationships and overall quality of life. A biopsychosocial view of the subject offers actionable strategies for redefining sexual medicine to embrace the complexity and universality of pleasure as a driver of sexual health and equity, demonstrating that it is time for a paradigm shift, positioning sexual pleasure as a vital component of sexual health. Sexual pleasure has often been overshadowed by a focus on dysfunction and reproduction in sexual medicine, particularly in urology. In this Review, the authors discuss the need for multidisciplinary approaches to address the diverse experiences and needs of individuals across their lifespan, and how integrating pleasure into research, clinical practice, sexuality education and public health initiatives could enhance well-being, intimate relationships and overall quality of life.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 5","pages":"333-349"},"PeriodicalIF":14.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902547","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":"Implantable pelvic neurostimulators to restore erectile function: from concept to practice","authors":"Arthur L. Burnett, Mikael N. Sturny, Anthony J. Costello, Philip Dundee, Sidney Glina, Nikolaos Stergiopoulos, Rodrigo A. Fraga-Silva","doi":"10.1038/s41585-025-01116-5","DOIUrl":"10.1038/s41585-025-01116-5","url":null,"abstract":"The quest for therapeutics to manage erectile dysfunction has evolved in the past few decades, with attention now directed towards interventions that facilitate and retain natural erectile ability. Electrical neurostimulation of the penis is a technique that could meet this objective. Although only in the early stages of development, this intervention could act as an authentic restorative therapy, targeting the penile-nerve supply that is impaired by disease states, injury or ageing. The concept is in accordance with well-substantiated neuromodulatory management approaches to erectile dysfunction, aimed at promoting neuronal integrity and function of the nerves, which are essential for regulating penile erections. The use of this technique is supported by intensive research over the past 150 years, from early experimental observations of erection responses following electrical stimulation of pelvic nerves to contemporary clinical investigations showing recovery of erection after implantation of pelvic neurostimulators in men with spinal-cord injury or undergoing radical prostatectomy. Thus, this therapy could be considered an emerging subspecialty, spanning the establishment of the neuroregulatory basis of penile erection and the invention of technologies that capitalize on the science of pelvic neurophysiology. The clinical use of penile neurostimulation could, therefore, offer a revolutionary new therapeutic approach in the field of sexual medicine. Management of erectile dysfunction has previously focused on symptom management, but attention is now being directed towards interventions that facilitate and retain natural erectile ability, treating the underlying cause of the disorder. In this Perspective article, the authors discuss the potential of electrical neurostimulation of the penis, which is in early stages of development as a restorative therapy, targeting the penile-nerve supply that is impaired by disease states, injury or ageing.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 7","pages":"479-488"},"PeriodicalIF":13.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902546","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":"Relapsed rhabdoid tumours and other non-nephroblastoma childhood and adolescent kidney tumours: perspectives from the HARMONICA collaboration","authors":"Michael V. Ortiz, Francis S.P.L. Wens, Andrew L. Hong, Paola Quarello, Arnauld C. Verschuur, Elisabeth T. Tracy, Najat C. Daw, Jeffrey S. Dome, Amy L. Walz, Julia Sprokkerieft, Godelieve A. M. Tytgat, Alex Kentsis, Jaime Libes-Bander, Peter J. Schoettler, Daniela Perotti, Jarno Drost, Rajkumar Venkatramani, James I. Geller, Marry M. van den Heuvel-Eibrink","doi":"10.1038/s41585-025-01117-4","DOIUrl":"10.1038/s41585-025-01117-4","url":null,"abstract":"Paediatric kidney tumours are generally associated with a favourable survival rate. Most children are diagnosed with Wilms tumour, which has a 90% long-term survival rate with conventional front-line and salvage therapies. However, treatments and outcomes of children with relapsed non-Wilms tumours, such as malignant rhabdoid tumour of the kidney, renal-cell carcinoma (including renal medullary carcinoma), clear-cell sarcoma of the kidney, anaplastic sarcoma of the kidney and congenital mesoblastic nephroma are not well defined. Several of these non-Wilms tumours include unfavourable prognostic subtypes. Currently available data on non-Wilms tumours support advancing studies that pivot from conventional strategies towards disease-specific, biologically driven novel treatments to improve outcomes for each of these rare childhood kidney tumours. This Review provides a comprehensive overview of epidemiology and molecular determinants of relapsed rhabdoid and other non-nephroblastoma childhood and adolescent kidney tumours, which are usually rare and challenging to cure. The most updated results in this field are discussed to highlight how understanding tumour biology can be used to inform therapeutic strategies in these patient populations.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 7","pages":"429-443"},"PeriodicalIF":13.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889820","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":"Technical modifications to improve erectile function recovery after radical prostatectomy","authors":"Suma Gangidi, Gal Wald, Jim C. Hu","doi":"10.1038/s41585-025-01115-6","DOIUrl":"10.1038/s41585-025-01115-6","url":null,"abstract":"Posterior nerve-sparing modifications during radical prostatectomy aim to improve preservation of the cavernous nerves and microvasculature to enhance postoperative erectile recovery. Current techniques for this are associated with varied functional outcomes and have a number of key anatomical and technical considerations.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 8","pages":"494-496"},"PeriodicalIF":13.6,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145704319","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":"EMUC25: shaping tomorrow’s uro-oncology care","authors":"Maria Chiara Masone","doi":"10.1038/s41585-025-01119-2","DOIUrl":"10.1038/s41585-025-01119-2","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 1","pages":"9-9"},"PeriodicalIF":14.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680203","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":"Och AI the noo from SIU","authors":"Louise Lloyd","doi":"10.1038/s41585-025-01118-3","DOIUrl":"10.1038/s41585-025-01118-3","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 1","pages":"8-8"},"PeriodicalIF":14.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680048","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":"Micro-ultrasound for prostate cancer","authors":"Melis Guer, Wayne G. Brisbane, Hannes Cash, Sangeet Ghai, Laurence Klotz, Paul F. R. Wilson, Adam Kinnaird","doi":"10.1038/s41585-025-01111-w","DOIUrl":"10.1038/s41585-025-01111-w","url":null,"abstract":"The diagnostic workflow for prostate cancer detection has evolved substantially with advances in imaging technologies and biopsy techniques. Currently, MRI is the standard modality for prostate imaging in cancer detection. However, the rising incidence of prostate cancer and the limited accessibility and high cost of MRI created a growing need for more cost- and time-effective alternative imaging modalities. Micro-ultrasound (microUS), which enables prostatic ductal anatomy to be imaged with a 70-micron resolution, provides an alternative. Level 1 evidence currently shows the non-inferiority of microUS in detecting Grade Group ≥2 prostate cancer in biopsy-naive men compared with MRI. Clinical trials are ongoing to investigate microUS in various other indications. Inter-reader variability needs to be optimized, possibly through the incorporation of artificial intelligence (AI) assistance. This Review focuses on micro-ultrasound as a new imaging technology in prostate cancer detection, comparing micro-ultrasound performance with that of the current standard MRI. The potential of micro-ultrasound in other applications, including tumour staging and active surveillance, as well as the use of artificial intelligence to support biopsy decision-making, are also discussed, based on completed and ongoing trials.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 5","pages":"309-318"},"PeriodicalIF":14.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609169","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}