Nature Reviews Urology最新文献

Notably, a similar vicious cycle can occur in men with benign prostatic hyperplasia (BPH). BPH-induced bladder outlet obstruction leads to increased bladder pressure, impaired bladder compliance and, ultimately, nocturia². In such circumstances, the overlapping contributions of impaired ADH secretion and heightened ANP activity could complicate the therapeutic landscape. In clinical practice, ADH analogues (such as desmopressin) are frequently used to address ADH deficiency-associated nocturnal polyuria. These treatments are effective but often fail in a subset of patients owing to several factors, including heterogeneous pathophysiological mechanisms underlying nocturnal polyuria³.

Our hypothesis that ANP antagonizes ADH-driven water reabsorption in patients with OSA⁴ provides a mechanistic insight into reported treatment resistance³. Incorporating ANP measurement into clinical evaluation could refine the treatment paradigm for nocturnal polyuria.

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 ANP. Nat. Rev. Urol. https://doi.org/10.1038/s41585-025-01028-4; 2025)². We agree that benign prostatic hyperplasia (BPH) can contribute to nocturia through bladder outlet obstruction, leading to increased intravesical pressure and impaired bladder compliance³. Indeed, these events can result in detrusor overactivity and reduced voided volumes during nocturnal urination. However, as highlighted in our Review¹, nocturia is a multifactorial condition, and alternative mechanisms influencing urine production should be considered. Specifically, nocturnal polyuria, which can coexist with lower urinary tract dysfunction in BPH, is increasingly recognized as a considerable contributor to nocturia in the ageing population⁴.

We acknowledge the Correspondence authors’ focus on the interplay between atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) in influencing nocturnal urine production². The antagonistic effects of ANP on ADH-driven water reabsorption in the renal collecting ducts provide valuable mechanistic insight into treatment resistance observed with ADH analogues such as desmopressin⁵. This process is particularly relevant in patients with OSA, in whom negative intrathoracic pressures and intermittent hypoxia promote ANP secretion, counteracting ADH-mediated water retention⁶. Thus, incorporating ANP measurements into clinical evaluation might improve management of nocturnal polyuria in this patient population⁷. Nevertheless, certain challenges should be considered. ANP levels peak at night owing to negative intrathoracic pressures, so the optimal time for measurement remains uncertain. Morning samples might not accurately reflect nocturnal surges given the short half-life of ANP⁸.

Liquid biopsies, indicating the sampling of body fluids rather than solid-tissue biopsies, have the potential to revolutionize cancer care through personalized, noninvasive disease detection and monitoring. Circulating tumour DNA (ctDNA) and circulating tumour cells (CTCs) are promising blood-based biomarkers in bladder cancer. Results from several studies have shown the clinical potential of ctDNA and CTCs in bladder cancer for prognostication, treatment-response monitoring, and early detection of minimal residual disease and disease recurrence. Following successful clinical trial evaluation, assessment of ctDNA and CTCs holds the potential to transform the therapeutic pathway for patients with bladder cancer — potentially in combination with the analysis of urinary tumour DNA — through tailored treatment guidance and optimized disease surveillance.

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 is an acetylated lysine mimetic that binds to the bromodomain binding pocket of BRD9, decreased their viability in a time-dependent and a dose-dependent manner. Strong cytotoxic effects were evident in TGCT cell lines, whereas control cell lines were only slightly affected. In TGCT cell lines, I-BRD9 induced apoptosis and cell-cycle arrest in G1 phase. Specifically in embryonal carcinoma cells and seminoma cells, I-BRD9 caused downregulation of pluripotency markers and cell differentiation towards an epithelial cell fate.

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 of a man in a monogamous relationship with a woman who was receiving first-line therapy for bacterial vaginosis reduced recurrence.

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. Usually, this involves isolation of a perpetrator’s sperm from the victim (who is most commonly a woman). However, such samples need to be collected quickly, and the techniques used to identify DNA and differentiate it from that of the victim are limited. Differences in the microbiomes of the penile skin and vagina are due to the largely aerobic environment of the penis (apart from potentially under the prepuce of uncircumcised men), compared with the anaerobic vagina. These differences enable transfer of taxa not normally found in each area.

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 from mounting to intromission to ejaculation remain elusive.

A new study published in Neuron investigates how ACh modulates DA dynamics in different subregions of NAc to regulate male sexual behaviours.

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 (70-μm resolution), could be a valid alternative to MRI in prostate biopsy.

The OPTIMUM randomized controlled trial was conducted to assess the non-inferiority of microultrasonography-guided biopsy compared with MRI plus conventional ultrasonography fusion-guided biopsy for the detection of clinically significant prostate cancer in biopsy-naive men, and the results were published in JAMA.