Nature Reviews Urology最新文献

英文中文

How urology can embrace the patient-centric precision focal therapy approach for localized prostate cancer. 泌尿外科如何采用以患者为中心的精确局灶治疗方法治疗局限性前列腺癌。

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-03-20 DOI: 10.1038/s41585-026-01136-9

Sudharshanan Balaji,Herbert Lepor,Thomas J Polascik

引用次数: 0

Extrachromosomal DNA in urothelial carcinoma: mechanisms and clinical applications. 尿路上皮癌的染色体外DNA：机制和临床应用。

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-03-19 DOI: 10.1038/s41585-026-01134-x

Conghui Li,Zhiqiang Hu,Weimin Zhang,Yongling Ji,Fubing Wang,Yuchen Zeng,Sanju Sinha,Fengbiao Mao,Chunhua Lin,Wei Lv

Extrachromosomal DNA (ecDNA) has emerged as a major driver of genomic instability and rapid tumour evolution in urothelial carcinoma. In urothelial carcinoma, ecDNA amplifies oncogenes, reshapes 3D chromatin interactions, reprogrammes transcription and modulates the tumour-immune interface. Together, these features fuel intratumour heterogeneity, accelerate APOBEC3-associated mutational evolution and contribute to aggressive disease. Advances in sequencing and imaging technologies have greatly expanded our understanding of ecDNA biology. Importantly, ecDNA can be detected through non-invasive liquid biopsies, including urine and plasma, and inferred from standard histopathology slides via digital pathology. These observations suggest that ecDNA could be a valuable adjunct biomarker, enhancing current strategies for early detection, patient stratification and dynamic monitoring of treatment response.

染色体外DNA （ecDNA）已成为尿路上皮癌基因组不稳定和肿瘤快速进化的主要驱动因素。在尿路上皮癌中，ecDNA放大癌基因，重塑三维染色质相互作用，重编程转录并调节肿瘤免疫界面。总之，这些特征促进了肿瘤内的异质性，加速了apobec3相关的突变进化，并促进了侵袭性疾病。测序和成像技术的进步极大地扩展了我们对ecDNA生物学的理解。重要的是，ecDNA可以通过非侵入性液体活检（包括尿液和血浆）检测到，并通过数字病理学从标准组织病理学切片中推断出来。这些观察结果表明，ecDNA可能是一种有价值的辅助生物标志物，可以增强当前早期检测、患者分层和治疗反应动态监测的策略。

引用次数: 0

Prostate cancer screening: weighing the benefits and harms. 前列腺癌筛查：利弊权衡。

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-03-06 DOI: 10.1038/s41585-026-01133-y

Nikhil Mayor,Hashim U Ahmed

引用次数: 0

Revisiting the dual role of androgens and oestrogens in mammalian sex differentiation with a focus on genitalia. 重访雄激素和雌激素在哺乳动物性别分化中的双重作用，重点是生殖器。

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-03-04 DOI: 10.1038/s41585-026-01132-z

Emilie Elmelund,Monica K Draskau,Melanie K Stewart,Deidre M Mattiske,Andrew J Pask,Terje Svingen

Androgen signalling is the primary driver of male sexual differentiation in mammals, directing masculinization during a crucial fetal window. In male fetuses, high levels of fetal androgens, mainly from the testes, promote male reproductive tract development through androgen receptor activation, whereas low levels of androgens in female fetuses enable the development along the female pathway. This androgen-centric view of reproductive development has long dominated the field, casting oestrogens as passive bystanders. However, both historical and emerging evidence challenges this narrative, pointing to an active role of oestrogens in shaping reproductive development through complex, tissue-specific interactions with androgen pathways. Oestrogen receptors are expressed in developing reproductive tissues of both sexes, and disruptions in oestrogen signalling - shown in genetic and pharmacological models - can lead to reproductive abnormalities. Oestrogens might counteract androgen action at the tissue level and modulate androgen receptor expression, independently of effects on androgen production. Moreover, combined exposure to anti-androgens and oestrogenic compounds can amplify developmental disruptions, underscoring the importance of hormonal crosstalk. These findings question the adequacy of an androgen-only model, especially when assessing endocrine disruptors. Understanding the role of oestrogens is essential for interpreting normal development and chemical risks. Reproductive differentiation seems to depend on the integrated balance between androgen and oestrogen pathways, rather than on isolated signals.

雄激素信号是哺乳动物雄性性别分化的主要驱动因素，在一个关键的胎儿窗口期指导雄性化。在男性胎儿中，高水平的雄激素（主要来自睾丸）通过雄激素受体激活促进男性生殖道发育，而女性胎儿中低水平的雄激素则使发育沿着女性途径进行。这种以雄激素为中心的生殖发育观点长期以来一直主导着这一领域，将雌激素视为被动的旁观者。然而，历史和新出现的证据都挑战了这一说法，指出雌激素通过与雄激素途径复杂的、组织特异性的相互作用，在塑造生殖发育中发挥了积极作用。雌性激素受体在发育中的两性生殖组织中都有表达，而雌性激素信号的中断——在遗传和药理学模型中显示——可能导致生殖异常。雌激素可能在组织水平上抵消雄激素的作用，调节雄激素受体的表达，而不受雄激素产生的影响。此外，同时暴露于抗雄激素和雌激素化合物可以放大发育中断，强调激素串扰的重要性。这些发现质疑了雄激素模型的充分性，特别是在评估内分泌干扰物时。了解雌激素的作用对于解释正常发育和化学风险至关重要。生殖分化似乎取决于雄激素和雌激素途径之间的综合平衡，而不是孤立的信号。

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引用次数: 0

Urinary tract infections in children. 儿童尿路感染。

IF 14.6 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-02-26 DOI: 10.1038/s41585-026-01130-1

Preeti P John, Laura Mike, Indira U Mysorekar, Juan de Dios Ruiz-Rosado, Menna Clatworthy, Laura Schwartz, Christina Ching, Denise Kimbrough, Nader Shaikh, Luis Braga, Evan Rajadhyaksha, David Hains, Joshua Watson, Brian Becknell

Bacterial urinary tract infections (UTIs) are prevalent in childhood and adolescence. Paediatric UTIs present unique challenges with respect to diagnosis, prevention and management, and the potential for adverse sequelae. Uropathogenic Escherichia coli (UPEC) accounts for the majority of UTIs and is the best studied uropathogen. Novel discoveries have advanced our understanding of host-pathogen interactions, cellular and molecular mechanisms of host defence, and risk factors for UTI recurrence. Emerging evidence also highlights an association of the gut, vaginal and urinary microbiota in influencing UTI risk and recurrence. Yet, key knowledge gaps persist regarding UTI pathogenesis, host susceptibility, optimal diagnostic and management strategies and prevention of UTI recurrence and sequelae, especially in paediatric populations. The development of standardized clinical pathways offers an opportunity to improve care consistency and outcomes by integrating evidence-based practices into routine management. As technologies evolve and understanding deepens, future efforts must integrate host, microbial and clinical insights to optimize UTI prevention and treatment in paediatric populations.

细菌性尿路感染（uti）在儿童和青少年中普遍存在。儿科尿路感染在诊断、预防和管理以及潜在的不良后遗症方面提出了独特的挑战。尿路致病性大肠杆菌（UPEC）占尿路感染的大多数，是研究最多的尿路病原体。新的发现提高了我们对宿主-病原体相互作用、宿主防御的细胞和分子机制以及尿路感染复发的危险因素的理解。新出现的证据还强调了肠道、阴道和尿液微生物群在影响尿路感染风险和复发方面的关联。然而，关于尿路感染的发病机制、宿主易感性、最佳诊断和管理策略以及预防尿路感染复发和后遗症，特别是在儿科人群中，仍然存在关键的知识空白。标准化临床路径的发展提供了一个机会，通过将循证实践整合到日常管理中来提高护理的一致性和结果。随着技术的发展和理解的加深，未来的努力必须整合宿主、微生物和临床见解，以优化儿科人群的尿路感染预防和治疗。

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引用次数: 0

Smooth muscle cell plasticity in pelvic organ prolapse. 盆腔器官脱垂的平滑肌细胞可塑性。

IF 14.6 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-02-13 DOI: 10.1038/s41585-026-01131-0

Hai Tong, Li Lin, Mai Zhang, Zhenglin He, Gengsheng Wang, Lubin Liu

引用次数: 0

ADT and activation of HGF and WNT axes in double-null prostate cancer. 双空前列腺癌中ADT与HGF和WNT轴的激活。

IF 14.6 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-02-09 DOI: 10.1038/s41585-026-01129-8

Dexter Hoi Long Leung, Yao Mawulikplimi Adzavon, Gaeul Chu, Tae Ju Park, Kristoffer Nikias, Cheong-Wun Kim, Chenmiao Liu, Zijie Sun

Prostate cancer remains the most frequently diagnosed malignancy in men worldwide. Most primary prostate cancer cells express the androgen receptor (AR) and rely on androgens for oncogenic growth and progression. Thus, androgen deprivation therapy (ADT) that directly targets AR-expressing prostate cancer cells has been the frontline treatment for advanced prostate cancer. However, ADT inevitably fails in most patients, resulting in castration-resistant prostate cancer development. To inhibit reactivation of AR-promoted tumour progression via residual androgens and altered AR activation, next-generation AR antagonists and inhibitors of androgen biosynthesis were developed to improve clinical outcomes. However, these therapeutic advances also induce heterogeneous resistance phenotypes. Among them, double-null prostate cancer, featuring AR-null and neuroendocrine-null cell properties, occurs in patients treated with abiraterone and enzalutamide. Emerging clinical and experimental evidence demonstrates that current ADT induces HGF and canonical WNT signalling activation, which further elevates nuclear exporting and ribosomal biogenesis to foster tumour lineage plasticity and promote diverse castration-resistant prostate cancer phenotypes and double-null prostate cancer development. These mechanistic insights remain under active investigation, but they provide therapeutic prospects for co-targeting nuclear exporting, ribosomal biosynthesis and other oncogenic pathways in combination with current ADT to forestall the lethal disease.

前列腺癌仍然是全世界男性中最常见的恶性肿瘤。大多数原发性前列腺癌细胞表达雄激素受体（AR），并依赖雄激素进行癌性生长和进展。因此，直接靶向ar表达前列腺癌细胞的雄激素剥夺疗法（ADT）已成为晚期前列腺癌的一线治疗方法。然而，在大多数患者中，ADT不可避免地失败，导致去势抵抗性前列腺癌的发展。为了通过残留雄激素和改变的AR激活来抑制AR促进肿瘤进展的再激活，研究人员开发了下一代AR拮抗剂和雄激素生物合成抑制剂来改善临床结果。然而，这些治疗进展也会诱导异质耐药表型。其中，双零前列腺癌，具有ar零和神经内分泌零细胞特性，发生在阿比特龙和恩杂鲁胺治疗的患者中。新出现的临床和实验证据表明，当前ADT诱导HGF和典型WNT信号激活，进一步提高核输出和核糖体生物发生，促进肿瘤谱系可塑性，促进多种去势抵抗性前列腺癌表型和双空前列腺癌的发展。这些机制见解仍在积极研究中，但它们为联合当前ADT共同靶向核输出、核糖体生物合成和其他致癌途径提供了治疗前景，以预防致命疾病。

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引用次数: 0

Leveraging generative AI to enhance doctor-patient communication. 利用生成式人工智能加强医患沟通。

IF 14.6 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-02-05 DOI: 10.1038/s41585-026-01127-w

Aalamnoor S Pannu, Jacob Pan, Ethan Layne, Inderbir Gill, Giovanni E Cacciamani

引用次数: 0

Fathers matter too: sperm-borne epigenetic messages link paternal exposures to next-generation health 父亲也很重要：精子传递的表观遗传信息将父亲的暴露与下一代的健康联系起来

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-02-04 DOI: 10.1038/s41585-026-01128-9

Sergio Pecorelli, Roberto Lucchini, Luca Lambertini, Giuseppe Novelli

引用次数: 0

Management of surgical menopause in female patients with bladder cancer undergoing radical cystectomy. 行根治性膀胱切除术的女性膀胱癌患者手术绝经的处理。

IF 15.3 1区医学 Q1 UROLOGY & NEPHROLOGY

Nature Reviews Urology

Pub Date : 2026-01-30 DOI: 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.

根治性膀胱切除术是肌肉浸润性和高危非肌肉浸润性膀胱癌患者的金标准治疗。对于女性患者，传统的根治性膀胱切除术包括切除子宫、卵巢、输卵管和阴道前壁。大多数接受根治性膀胱切除术的女性患者是绝经后的，但也有一部分患者是绝经前的，并且由于双侧卵巢切除术而经历了手术绝经。手术绝经是由于性类固醇激素的突然丧失，导致血管舒缩不稳定和性功能障碍等症状，同时也增加了骨质疏松症、心血管疾病和认知能力下降的长期风险。在根治性膀胱切除术中保存卵巢的重要性越来越被认识到；然而，卵巢切除术可能仍然适用于选定的绝经前患者的肿瘤控制。在这些个体中，泌尿科医生对手术绝经的认识和管理往往有限，导致可避免的发病率。因此，当手术停经不可避免时，应向患者提供有关症状管理、心血管风险和骨骼保护的咨询；适当的激素和非激素治疗策略应在指征时实施。

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