Current Urology Reports最新文献

Purpose of review: Emerging evidence has challenged the paradigm of bladder sterility, opening new opportunities for understanding bladder cancer biology.

Recent findings: Disruption of commensal intravesical bacterial communities appears to increase risk of carcinogenesis, while the presence of specific bacterial strains has been linked to differential treatment responses. However, the interplay between urinary microbiome and bladder cancer remains incompletely defined. This review summarizes the current literature regarding the role of urinary microbiome in the pathogenesis and treatment outcomes, highlights limitations of existing studies, and outlines future directions for incorporating microbiome profiling into personalized management strategies.

Purpose of review: Point-of-care ultrasound (POCUS) has become an indispensable diagnostic and procedural tool across many medical specialties. However, formalized ultrasound training within urology residency programs remains limited. This review aims to outline a practical framework for designing and implementing a structured POCUS curriculum tailored specifically to urology training.

Recent findings: Various programs have implemented POCUS curricula, often with longitudinal instruction, modular content, hands-on training, and competency-based assessments. While urology has historically relied on sporadic exposure, often limited to prostate biopsies or intraoperative imaging, recent integration into the residency training demonstrates the utility of ultrasound amongst all urologic organs. National surveys of residents and practicing urologists reveal persistent deficiencies in both confidence and formal training opportunities, despite high interest and perceived clinical value. A review of emerging urology-specific curricula shows that programs adopting structured, multimodal approaches, combining didactics, video-based learning, supervised training, and simulation report improvements in user confidence, technical proficiency, and clinical utilization. Early data suggest that when implemented longitudinally, these frameworks can help to broaden ultrasound use in clinical settings. However, published experiences remain limited to a small number of institutions, underscoring the need for broader utilization and interventional studies. Current literature supports a structured POCUS curriculum for urology trainees, yet widespread adoption remains at an early stage. A unified framework could help standardize expectations, ensure equitable training experiences, and better prepare residents for modern practice. Multi-institutional collaboration, increased research on educational outcomes, and potential guidance from accrediting bodies will be critical to advancing ultrasound education and establishing national standards for urologic POCUS training.

Purpose of review: To provide a comprehensive review of new and emerging literature on B cells and tertiary lymphoid structures (TLS) in urothelial cancer.

Recent findings: The presence of certain subsets of B cells and TLS in MIBC are associated with improved outcomes and response to immunotherapy. However, the role in NMIBC is less clear. TLS in NMIBC is likely associated with more aggressive disease but may also be associated with improved outcomes to intravesical BCG. This review outlines an emerging potential biomarker (TLS) for predictive and prognostic outcomes for patients with urothelial cancer receiving either intravesical BCG or systemic immunotherapy. B cells play a complex role in the tumor immune microenvironment and can be either anti- or pro-tumor. Activated B cells form TLS which lead to a robust response to immunotherapy. This has led some investigators to attempt therapeutic manipulation to induce TLS in otherwise immunologically "cold" tumors.

Purpose of review: This review aims to define academic bullying, describe its prevalence and impact, and explore multi-level approaches for addressing this form of workplace mistreatment and enacting reform.

Recent findings: Academic bullying is a prevalent form of workplace mistreatment that contributes to poor patient satisfaction, physician burnout, and medical errors. Numerous factors have been proposed as potential reasons for widespread prevalence, including established hierarchy, cultural tolerance, and lack of institutional reporting processes. Evidence suggests that certain populations including women, underrepresented minority members, and LGBTQ + individuals are at greater risk of experiencing academic bullying. This review outlines academic bullying in medicine, including its definition, prevalence, and impact. Here, we describe populations at increased risk of experiencing academic bullying and consolidate proposed solutions to address this mistreatment. Main findings include that vulnerable populations include women, underrepresented minority individuals, and members of the LGBTQ + community and that future solutions include a multilevel approach at the national, institutional, and individual levels.

Purpose of review: This review evaluates the role of urine culture (UC) in preoperative assessment for endourological stone procedures. It addresses the optimal timing of UC, its predictive value compared to urinalysis, the interpretation of mixed flora, and the utility of repeat cultures after antibiotic treatment. In addition, it explores emerging molecular methods that may refine perioperative infection risk assessment.

Recent findings: UC remains the gold standard for identifying infection risk, but several controversies persist. Studies suggest urine dipstick testing can complement or even outperform UC in certain contexts, while mixed flora results often do not justify antibiotic therapy. Evidence indicates that prolonged preoperative antibiotic prophylaxis reduces postoperative sepsis in high-risk patients, though repeat UC after treatment has limited predictive value. Novel approaches such as next-generation sequencing and molecular diagnostics offer higher sensitivity but risk overdiagnosis. Preoperative UC remains indispensable for risk assessment in endourology, though its limitations demand a more nuanced, risk-adapted approach. Integration of urinalysis, selective repeat testing, and emerging molecular diagnostics could refine perioperative decision-making while supporting antimicrobial stewardship.