Telesurgery, also known as remote surgery, has emerged as a revolutionary paradigm in urology. The use of telesurgery and its applications in urological procedures is characterized by lights and shadows that challenge surgeons and international surgical societies to regulate this promising field.

In June 2020, at the height of the COVID-19 lockdown, Nature Reviews Urology published its first Pride special issue. At the time, we were the first urology journal and the first Nature Reviews journal to produce special content for Pride. Since then, numerous journals have followed suit and highlighted the importance of inclusion and understanding of underserved populations in medicine.

Pronouns are small but mighty words. However, the conscious use of gender-neutral pronouns has recently led to heated discussions and has been implicated in legislation and cases of employment termination. Importantly, failing to respect a person’s pronouns can lead to real harm in physical and psychological health.

Gender-affirming hormone therapy for transgender men can affect their vaginal microbiome, potentially adversely influencing sexual health outcomes, specifically the occurrence of bacterial vaginosis. In this prospective longitudinal study, participants who were assigned female sex at birth with natal genitalia and reporting transgender male or nonbinary identity, aged ≥18 years and interested in initiating

Chemsex is a practice that sits at the intersection of substance use and sexuality, which is predominantly reported by men who have sex with men. Understanding the sociodynamics of chemsex is important for developing public health interventions. The ANRS-PaacX study was undertaken to improve understanding of chemsex. In this study, the perspectives of different stakeholders, namely people with chemsex

The American Urological Association (AUA) meeting has celebrated its 120th edition surrounded by gondolas, canals and warm weather. No, it wasn’t Venice, but The Venetian hotel in fabulous Las Vegas, which hosted top-level scientists, clinicians and healthcare professionals from all urology fields across the world. Stones featured prominently in the plenary session on day 2. Suction has been presented

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.

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. Nat. Rev. Urol. 21, 735–753; 2024), which are thought-provoking (Lin, Y.-H., Lin, K.-J. & Wu, C.-T. Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and

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. 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

The European Association of Urology (EAU) has celebrated its 40th congress with a successful meeting that also celebrated 50 years of the European Urology journals. 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.

Co-treating the man in a monogamous heterosexual relationship can help to prevent recurrence of bacterial vaginosis in the woman, according to the results of the open-label, randomized controlled StepUp trial. The role of the man in the transmission of bacterial vaginosis is not well understood. In this trial, the investigators sought to determine whether concurrent oral and topical antimicrobial treatment

Transfer of bacterial species during sexual intercourse occurs despite condom use and could be used in a forensic setting, according to a study published in iScience. Transfer of physical and biological material is a core tenet of forensic science. However, in crimes involving sexual assault that do not find human DNA transfer between victim and perpetrator, a criminal case can be hard to establish

Medical terminology requires periodic updates based on the input of affected communities and/or to reflect advances in scientific understanding. An update to terminology to replace the terms ‘ambiguous’ and ‘atypical’ as descriptors of external genital anatomy in the intersex, variations of sex characteristics and differences of sex development (i/VSC/DSD) field could be an important step forwards

The incorporation of magnetic resonance imaging (MRI) into the prostate cancer diagnostic workflow has substantially improved detection of clinically significant prostate cancer (defined as Gleason grade group ≥2) but also has some limitations, such as the need for sophisticated imaging facilities that are not accessible in every institution. Microultrasonography, which has an incredibly high resolution

Copulatory behaviour in rodents follows a stereotypical sequence of actions consisting in mounting, intromission and ejaculation. Different brain regions, including the nucleus accumbens (NAc), and different neurotransmitters, particularly dopamine (DA) and acetylcholine (ACh), have been shown to have a role in regulating copulatory behaviours, but the exact neural mechanisms regulating the transitions

Results from the SWOG S1011 and LEA trials show that extended pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer offers no survival benefit. Novel perioperative systemic therapies could lead to true survival improvement for patients with muscle-invasive bladder cancer undergoing radical surgery and have the potential to implement bladder-preserving strategies

Autonomic dysreflexia is a sudden rise in systolic blood pressure observed in individuals with spinal cord injury at or above the sixth thoracic spinal cord segment, often triggered by stimuli from the urinary bladder, bowel or sexual organs. Autonomic dysreflexia can cause severe complications, including stroke or death. Cardiovascular monitoring during urological procedures is crucial, particularly

The first study of personalized cancer vaccines for renal cell carcinoma with breakthrough results in the adjuvant setting has been published, showing a 100% efficacy rate and negligible toxic effects. However, important questions remain concerning long-term effectiveness.

Recognizing that human healthcare influences the health of our planet and that our environment affects human health is increasingly important. Thus, in recognition of Earth Day and to support research in this area, Nature Reviews Urology presents articles putting the field of urology into a planetary context.

Air pollution has been suggested as a potential modifiable risk factor for prostate cancer, but data remain inconsistent. Now a study of over 210,000 men from a UK biobank suggests that long-term exposure to air pollution increases prostate cancer risk. Data from 210,722 men who were free of prostate cancer at baseline were collected from the UK Biobank. The mean age of these men was 56.6 years, and

Chlorination is a common method for disinfecting drinking water but can produce potentially carcinogenic by-products, such as trihalomethanes (THMs). A new systematic review and meta-analysis was conducted to assess the association between residential THM exposure and cancer risk, and the results were published in Environmental Health Perspectives. Overall, 29 studies assessing THM concentrations in

Cadmium is a heavy metal that is often found in water systems and soil owing to its release from industrial processes. Occupational exposure is seen in those who work in production and use of nickel–cadmium batteries, phosphate fertilizers, copper and nickel smelting, and waste incineration and disposal. Furthermore, exposure in the general population can occur via cigarette smoke, water and consumption

Overexpression of free radicals induced by heavy metals such as aluminium (Al) and nickel (Ni) can be detrimental to male fertility. However, by-products of agriculture, such as peels, seeds and leaves, are rich in bioactive compounds and might, therefore, be useful as potential protectors of reproductive health. Cucumeropsis mannii is a melon whose seed is rich in alkaloids, flavonoids, glycosides

The environmental pollutant bis(2-ethylhexyl) phthalate (DEHP) induces oxidative stress, leading to impaired sperm parameters and reproductive toxicity. In a new study published in Molecular and Cellular Endocrinology, the role of glutathione S-transferase A2 (GSTA2) — a known detoxifying agent against environmental pollutants — was assessed in counteracting DEHP-induced reproductive damage.

Radical cystectomy is a primary treatment for muscle-invasive bladder cancer but can be associated with challenges in resource-limited settings owing to limited access to specialized surgical procedures. In a new study published in BMC Urology, Taha and colleagues present a pilot study analysing perioperative complications and mortality associated with radical cystectomy at the Gezira Hospital for

The results of the NIAGARA trial have considerably advanced treatment for patients with muscle-invasive bladder cancer, establishing a new therapeutic standard for cisplatin-eligible patients. Future trials will help to answer remaining questions about perioperative treatment optimization.

Burnout in healthcare is not merely a by-product of overwork, but a systemic issue driven by a culture of relentless productivity and insufficient support. Self-care practices such as exercise and mindfulness offer temporary relief, but do little to address the root causes of burnout embedded in the healthcare system. By promoting self-compassion and collaboration over competition, healthcare can move

Bladder instillation of gentamicin is safe and effective in treating recurrent urinary tract infection that has failed to resolve with current guideline-based treatments. It also reduces the rate of antimicrobial resistance.

Prostate cancer is the most common cancer in men, yet disparities persist in screening, diagnosis and treatment among populations with low socioeconomic status. Minority groups face barriers to clinical trial inclusion including limited awareness and financial challenges. Promoting diversity in clinical trials is crucial for inclusivity, improving treatment efficacy and achieving equitable health outcomes

Bi-paternal mice that survived to adulthood have been successfully created, according to new research published in Cell Stem Cell. This advance has implications for reproductive and regenerative medicine. Previously, the instability of genomic imprinting has limited the potential of embryonic stem cells to produce viable offspring. In this study, the authors used frameshift mutations, gene deletions

Data published in the British Journal of Cancer describe the identification and analysis of four biomarkers that could be used as a real-time prognostic tool for development of castration-resistant prostate cancer (CRPC). No biomarkers are currently available to predict the onset of castration resistance. Identification of patients who are likely to stop responding to androgen deprivation therapy (ADT)

A new study published in Nature reports results from the phase I/IIa study GDFATHER, showing synergistic effects of the neutralizing anti-GDF15 antibody visugromab in combination with the anti-PD1 antibody nivolumab in patients with urothelial cancer. This trial builds on results in preclinical models showing that GDF15 blockade enhanced the efficacy of PD1-mediated immunotherapy, indicating the potential

Humanitarian surgical missions provide substantial benefits to the involved surgeon and to the recipient communities. These missions should be planned and executed with the final aim to train local teams to implement innovative or standard surgical techniques.

The path to become a urological surgeon is full of obstacles. Historically, individuals with a physical disability have faced substantial barriers in their training and practice. However, the development of the right environment can ensure that these challenges do not hinder the progress of surgeons.

The Government’s commitment to a Men’s Health Strategy in England, announced by Wes Streeting, the Secretary of State for Health and Social Care, on 28 November 2024, is a welcome development. The implementation of a strategy will hopefully lead to improved access to services and health outcomes for men and boys.

A study in Proceedings of the National Academy of Sciences has elucidated the roles of the whey acidic protein four-disulfide core (WFDC) gene cluster in spermatogenesis and sperm function. The fact that this reproductive-tract-specific cluster — comprising 11 genes in humans (SPINT3, WFDC6, EPPIN, WFDC8, WFDC9, WFDC10A, WFDC11, WFDC10B, WFDC13, SPINT4 and WFDC3) and 13 in rodents — is so well conserved

Kidney transplantation is a crucial treatment option for older adults (defined as ≥65 years old) with kidney failure, but the evaluation process for transplantation is often complex and burdensome, with many older adults not ultimately receiving a kidney. In a study published in JAMA Internal Medicine, the authors explored the experiences of older adults and their families during the kidney transplant

New data show that bitter taste transduction has an essential role maintaining male reproductive health. This process is key in the inflammatory response to inhalable particulate matter and provides a mechanism by which exposure to particulate matter adversely affects male fertility. Bitter taste molecules could be potential targets for male infertility management. A particulate matter exposure mouse

Heat shock protein 60 (HSP60), the main chaperone of the mitochondrial unfolded protein response, could be a potential therapeutic target in neuroendocrine prostate cancer (NEPC). Preclinical evidence shows that HSP60 inhibition reduces NEPC growth in vivo. In the TRAMP mouse model, oxidative phosphorylation complex activity was dysfunctional in mitochondrial fractions from tumour samples. The mitochondrial

The 2-year follow-up results of the OASIS trial, assessing the efficacy of the novel implantable tibial neuromodulation device Revi in treating urgency urinary incontinence (UUI), were published in The Journal of Urology. The Revi device is powered by an external, battery-operated wearable, which eliminates the need for an implanted battery, in turn providing more freedom margin for patients over other

Immune checkpoint inhibitor (ICI) efficacy in patients with metastatic castration-resistant prostate cancer (mCRPC) is hampered by resistance. Understanding the mechanisms underlying ICI resistance is crucial to improve therapeutic efficacy. A new study published in Nature identified a distinct macrophage subset that shows increasing abundance as the disease progresses and that is responsible for immunotherapy