Pub Date : 2026-02-05DOI: 10.1038/s41585-026-01127-w
Aalamnoor S Pannu, Jacob Pan, Ethan Layne, Inderbir Gill, Giovanni E Cacciamani
{"title":"Leveraging generative AI to enhance doctor-patient communication.","authors":"Aalamnoor S Pannu, Jacob Pan, Ethan Layne, Inderbir Gill, Giovanni E Cacciamani","doi":"10.1038/s41585-026-01127-w","DOIUrl":"https://doi.org/10.1038/s41585-026-01127-w","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":" ","pages":""},"PeriodicalIF":14.6,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125905","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}
Pub Date : 2026-01-30DOI: 10.1038/s41585-026-01124-z
Elizabeth Day,Francesco Pio Bizzarri,Ciara Mackenzie,Bernadett Szabados,Adam W Nelson,Alexandra J Colquhoun,Matthew J Perry,John D Kelly,Niyati Lobo
Radical cystectomy is the gold-standard treatment for patients with muscle-invasive and very high-risk non-muscle-invasive bladder cancer. In female patients, radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall. The majority of female patients undergoing radical cystectomy are postmenopausal, but a subset of patients are premenopausal and experience surgical menopause as a result of bilateral oophorectomy. Surgical menopause results from an abrupt loss of sex steroid hormones, resulting in symptoms such as vasomotor instability and sexual dysfunction, while also increasing the long-term risk of osteoporosis, cardiovascular disease and cognitive decline. The importance of ovarian preservation during radical cystectomy is increasingly recognized; however, oophorectomy might still be indicated in selected premenopausal patients for oncological control. In these individuals, awareness and management of surgical menopause among urologists is often limited, resulting in avoidable morbidity. Thus, when surgical menopause is unavoidable, patients should be counselled regarding symptom management, cardiovascular risk and bone protection; and appropriate hormonal and non-hormonal therapeutic strategies should be implemented where indicated.
{"title":"Management of surgical menopause in female patients with bladder cancer undergoing radical cystectomy.","authors":"Elizabeth Day,Francesco Pio Bizzarri,Ciara Mackenzie,Bernadett Szabados,Adam W Nelson,Alexandra J Colquhoun,Matthew J Perry,John D Kelly,Niyati Lobo","doi":"10.1038/s41585-026-01124-z","DOIUrl":"https://doi.org/10.1038/s41585-026-01124-z","url":null,"abstract":"Radical cystectomy is the gold-standard treatment for patients with muscle-invasive and very high-risk non-muscle-invasive bladder cancer. In female patients, radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall. The majority of female patients undergoing radical cystectomy are postmenopausal, but a subset of patients are premenopausal and experience surgical menopause as a result of bilateral oophorectomy. Surgical menopause results from an abrupt loss of sex steroid hormones, resulting in symptoms such as vasomotor instability and sexual dysfunction, while also increasing the long-term risk of osteoporosis, cardiovascular disease and cognitive decline. The importance of ovarian preservation during radical cystectomy is increasingly recognized; however, oophorectomy might still be indicated in selected premenopausal patients for oncological control. In these individuals, awareness and management of surgical menopause among urologists is often limited, resulting in avoidable morbidity. Thus, when surgical menopause is unavoidable, patients should be counselled regarding symptom management, cardiovascular risk and bone protection; and appropriate hormonal and non-hormonal therapeutic strategies should be implemented where indicated.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"82 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089099","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}
Pub Date : 2026-01-28DOI: 10.1038/s41585-025-01123-6
Mehran Dabiri,Dale M Goss,Ranjith Ramasamy,Mukesh Bhakat,David K Gardner,Simon P de Graaf,Majid Ebrahimi Warkiani
Sperm DNA fragmentation is a recognized factor in male infertility with direct implications for embryo development, implantation and pregnancy outcomes. Historically, standard semen analysis has not included assessments of DNA integrity, creating a clear need for advanced diagnostic tools. DNA damage can arise through pathways such as apoptosis, oxidative stress and exposure to environmental toxins, all of which compromise reproductive potential. Several methodologies exist for measuring sperm DNA fragmentation, including the sperm chromatin structure assay, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), the Comet assay and sperm chromatin dispersion, each of which has unique advantages and limitations. Novel automated imaging platforms incorporating machine learning algorithms have emerged, enabling high-throughput, single-sperm assessment and reducing subjectivity associated with manual scoring. Species differences further complicate the understanding of DNA stability and sperm quality, especially in livestock and models of artificial insemination; nonetheless, physiological similarities between humans and species close to humans provide useful translational insights. Emerging sperm selection technologies, including microfluidics, hyaluronic acid affinity systems and magnetic-activated cell sorting, show promise in reducing DNA fragmentation, improving reproductive outcomes and decreasing pregnancy loss. As the field progresses toward increasingly personalized fertility treatments, measures of DNA integrity will remain central to optimizing assisted reproduction success rates across species.
精子DNA断裂是男性不育的一个公认因素，直接影响胚胎发育、着床和妊娠结局。从历史上看，标准的精液分析不包括DNA完整性的评估，这显然需要先进的诊断工具。DNA损伤可以通过细胞凋亡、氧化应激和暴露于环境毒素等途径产生，所有这些都会损害生殖潜力。目前存在几种测量精子DNA片段的方法，包括精子染色质结构测定、末端脱氧核苷酸转移酶dUTP nick end标记（TUNEL）、Comet测定和精子染色质分散，每种方法都有其独特的优点和局限性。结合机器学习算法的新型自动成像平台已经出现，可以实现高通量、单精子评估，并减少与人工评分相关的主观性。物种差异进一步复杂化了对DNA稳定性和精子质量的理解，特别是在牲畜和人工授精模型中；尽管如此，人类和接近人类的物种之间的生理相似性提供了有用的翻译见解。新兴的精子选择技术，包括微流体、透明质酸亲和系统和磁激活细胞分选，在减少DNA断裂、改善生殖结果和减少妊娠损失方面显示出希望。随着该领域向越来越个性化的生育治疗发展，DNA完整性的测量将仍然是优化跨物种辅助生殖成功率的核心。
{"title":"Sperm DNA fragmentation and its influence on mammalian reproduction.","authors":"Mehran Dabiri,Dale M Goss,Ranjith Ramasamy,Mukesh Bhakat,David K Gardner,Simon P de Graaf,Majid Ebrahimi Warkiani","doi":"10.1038/s41585-025-01123-6","DOIUrl":"https://doi.org/10.1038/s41585-025-01123-6","url":null,"abstract":"Sperm DNA fragmentation is a recognized factor in male infertility with direct implications for embryo development, implantation and pregnancy outcomes. Historically, standard semen analysis has not included assessments of DNA integrity, creating a clear need for advanced diagnostic tools. DNA damage can arise through pathways such as apoptosis, oxidative stress and exposure to environmental toxins, all of which compromise reproductive potential. Several methodologies exist for measuring sperm DNA fragmentation, including the sperm chromatin structure assay, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), the Comet assay and sperm chromatin dispersion, each of which has unique advantages and limitations. Novel automated imaging platforms incorporating machine learning algorithms have emerged, enabling high-throughput, single-sperm assessment and reducing subjectivity associated with manual scoring. Species differences further complicate the understanding of DNA stability and sperm quality, especially in livestock and models of artificial insemination; nonetheless, physiological similarities between humans and species close to humans provide useful translational insights. Emerging sperm selection technologies, including microfluidics, hyaluronic acid affinity systems and magnetic-activated cell sorting, show promise in reducing DNA fragmentation, improving reproductive outcomes and decreasing pregnancy loss. As the field progresses toward increasingly personalized fertility treatments, measures of DNA integrity will remain central to optimizing assisted reproduction success rates across species.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"8 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069980","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}
Pub Date : 2026-01-26DOI: 10.1038/s41585-026-01126-x
Filippo Spreafico, Giovanna Gattuso, Marta G. Podda, Olga Nigro, Valeria Colombo, Sabina Vennarini, Antonio Mastrangelo, Francesca Filippi, Giovanni Montini, Maura Massimino, Monica Terenziani
{"title":"Long-term adverse effects of modern Wilms tumour therapies: implications for monitoring","authors":"Filippo Spreafico, Giovanna Gattuso, Marta G. Podda, Olga Nigro, Valeria Colombo, Sabina Vennarini, Antonio Mastrangelo, Francesca Filippi, Giovanni Montini, Maura Massimino, Monica Terenziani","doi":"10.1038/s41585-026-01126-x","DOIUrl":"https://doi.org/10.1038/s41585-026-01126-x","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"29 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146048399","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}
Pub Date : 2026-01-16DOI: 10.1038/s41585-025-01121-8
Sophia M Abusamra,Thineskrishna Anbarasan,Daniele T Cotton,Nithesh M S Ranasinha,Robert Barber,Suzannah Bridge,Carolyn Smith,Sandy Figiel,Wencheng Yin,Jason J Davis,Simpa S Salami,Freddie C Hamdy,Richard J Bryant,Yong-Jie Lu,Ian G Mills,Claire M Edwards,Todd M Morgan,Alastair D Lamb
Prostate cancer is characterized by multifocality, inter- and intra-patient tumour heterogeneity, and differences in risk of progression to metastatic disease, castration resistance and lethality, which can make prognosis challenging. Consequently, sampling methods that provide accurate insight into disease phenotype to facilitate risk-stratification of patients are crucial. The variable biology of prostate cancer seems to be recapitulated in the phenotypic heterogeneity of circulating tumour cells (CTCs). CTC sampling offers a liquid biopsy method to achieve minimally invasive longitudinal sampling for disease monitoring. CTC analysis has also offered a crucial insight into aggressive phenotypes, disease metastasis and treatment response, particularly in clinical trials. The clinical use of CTC count for prognosis in advanced prostate cancer has been approved by the FDA, but is not routinely used clinically, as these cells are technically challenging to isolate and analyse. However, methodological advances continue to improve CTC enrichment and profiling. Understanding the clinical utility of CTCs and future innovations is crucial to incorporating CTCs into the clinical management of prostate cancer.
{"title":"Circulating tumour cells as a window into lethality in prostate cancer.","authors":"Sophia M Abusamra,Thineskrishna Anbarasan,Daniele T Cotton,Nithesh M S Ranasinha,Robert Barber,Suzannah Bridge,Carolyn Smith,Sandy Figiel,Wencheng Yin,Jason J Davis,Simpa S Salami,Freddie C Hamdy,Richard J Bryant,Yong-Jie Lu,Ian G Mills,Claire M Edwards,Todd M Morgan,Alastair D Lamb","doi":"10.1038/s41585-025-01121-8","DOIUrl":"https://doi.org/10.1038/s41585-025-01121-8","url":null,"abstract":"Prostate cancer is characterized by multifocality, inter- and intra-patient tumour heterogeneity, and differences in risk of progression to metastatic disease, castration resistance and lethality, which can make prognosis challenging. Consequently, sampling methods that provide accurate insight into disease phenotype to facilitate risk-stratification of patients are crucial. The variable biology of prostate cancer seems to be recapitulated in the phenotypic heterogeneity of circulating tumour cells (CTCs). CTC sampling offers a liquid biopsy method to achieve minimally invasive longitudinal sampling for disease monitoring. CTC analysis has also offered a crucial insight into aggressive phenotypes, disease metastasis and treatment response, particularly in clinical trials. The clinical use of CTC count for prognosis in advanced prostate cancer has been approved by the FDA, but is not routinely used clinically, as these cells are technically challenging to isolate and analyse. However, methodological advances continue to improve CTC enrichment and profiling. Understanding the clinical utility of CTCs and future innovations is crucial to incorporating CTCs into the clinical management of prostate cancer.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"34 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986569","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}
Pub Date : 2026-01-14DOI: 10.1038/s41585-025-01122-7
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
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.
{"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":"https://doi.org/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.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"266 1","pages":""},"PeriodicalIF":15.3,"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}
Pub Date : 2026-01-07DOI: 10.1038/s41585-025-01120-9
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.
{"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}
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