Pub Date : 2024-06-21DOI: 10.1038/s41585-024-00897-5
Hussein Mansour, My-Anh Tran-Dang, Miles Walkden, Ekaterini Boleti, Ravi Barod, Prasad Patki, Faiz Mumtaz, Maxine G. B. Tran, Axel Bex, Soha El Sheikh
Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist’s strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour’s prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies. In this Review, the authors discuss advantages and complications associated with renal mass biopsy and provide an overview of different features of both well-recognized types of renal cell carcinoma and newly identified subtypes to improve diagnosis and management.
{"title":"Renal mass biopsy — a practical and clinicopathologically relevant approach to diagnosis","authors":"Hussein Mansour, My-Anh Tran-Dang, Miles Walkden, Ekaterini Boleti, Ravi Barod, Prasad Patki, Faiz Mumtaz, Maxine G. B. Tran, Axel Bex, Soha El Sheikh","doi":"10.1038/s41585-024-00897-5","DOIUrl":"10.1038/s41585-024-00897-5","url":null,"abstract":"Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist’s strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour’s prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies. In this Review, the authors discuss advantages and complications associated with renal mass biopsy and provide an overview of different features of both well-recognized types of renal cell carcinoma and newly identified subtypes to improve diagnosis and management.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 1","pages":"8-25"},"PeriodicalIF":12.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437223","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 : 2024-06-17DOI: 10.1038/s41585-024-00902-x
Ravi A. Madan, Edwin M. Posadas, Richard J. Lee
Recently, several therapeutic strategies in prostate cancer have been granted regulatory approval based on progression-free survival benefits alone, which is a relative change in the therapeutic development of prostate cancer treatments. Previously, overall survival was a requirement for approvals. Whether this approach is warranted or beneficial to patients remains unclear.
{"title":"Progression-free survival end points in prostate cancer: are we truly making progress","authors":"Ravi A. Madan, Edwin M. Posadas, Richard J. Lee","doi":"10.1038/s41585-024-00902-x","DOIUrl":"10.1038/s41585-024-00902-x","url":null,"abstract":"Recently, several therapeutic strategies in prostate cancer have been granted regulatory approval based on progression-free survival benefits alone, which is a relative change in the therapeutic development of prostate cancer treatments. Previously, overall survival was a requirement for approvals. Whether this approach is warranted or beneficial to patients remains unclear.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 11","pages":"646-648"},"PeriodicalIF":12.1,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141333766","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 : 2024-06-14DOI: 10.1038/s41585-024-00905-8
Quentin Mak, Julian Greig, Prokar Dasgupta, Sachin Malde, Nicholas Raison
Antibiotics are the mainstay prophylaxis and treatment for recurrent urinary tract infections (UTIs). However, antibiotic resistance is rising globally, leading to infections that are harder to treat. In view of this resistance, alternative, non-antibiotic treatments for recurrent UTIs are now being developed; among them, UTI vaccines have shown promising results.
{"title":"Promising efficacy of UTI vaccines as an alternative to antibiotics","authors":"Quentin Mak, Julian Greig, Prokar Dasgupta, Sachin Malde, Nicholas Raison","doi":"10.1038/s41585-024-00905-8","DOIUrl":"10.1038/s41585-024-00905-8","url":null,"abstract":"Antibiotics are the mainstay prophylaxis and treatment for recurrent urinary tract infections (UTIs). However, antibiotic resistance is rising globally, leading to infections that are harder to treat. In view of this resistance, alternative, non-antibiotic treatments for recurrent UTIs are now being developed; among them, UTI vaccines have shown promising results.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 12","pages":"701-702"},"PeriodicalIF":12.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319928","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 : 2024-06-13DOI: 10.1038/s41585-024-00907-6
Maria Chiara Masone
{"title":"A new signalling-based system for germ cell reprogramming","authors":"Maria Chiara Masone","doi":"10.1038/s41585-024-00907-6","DOIUrl":"10.1038/s41585-024-00907-6","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 7","pages":"390-390"},"PeriodicalIF":12.1,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141315586","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 : 2024-06-11DOI: 10.1038/s41585-024-00903-w
Kamil Malshy, Taylor Braunagel, Anna Ochsner, Borivoj Golijanin, Elias Hyams
Medical students provide an unmistakable contribution to clinical research, owing to a diverse skill set, spanning from data collection to analysis and academic writing. Being involved in clinical urology also helps students to clarify career paths and boost competitiveness for residency matches. However, medical students’ involvement encounters challenges, including time constraints and a need for honed research skills. Addressing these hurdles necessitates effective mentorship.
{"title":"Engaging medical students in urological academic research","authors":"Kamil Malshy, Taylor Braunagel, Anna Ochsner, Borivoj Golijanin, Elias Hyams","doi":"10.1038/s41585-024-00903-w","DOIUrl":"10.1038/s41585-024-00903-w","url":null,"abstract":"Medical students provide an unmistakable contribution to clinical research, owing to a diverse skill set, spanning from data collection to analysis and academic writing. Being involved in clinical urology also helps students to clarify career paths and boost competitiveness for residency matches. However, medical students’ involvement encounters challenges, including time constraints and a need for honed research skills. Addressing these hurdles necessitates effective mentorship.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 11","pages":"644-645"},"PeriodicalIF":12.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306423","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 : 2024-05-29DOI: 10.1038/s41585-024-00899-3
Lucas Galey, Ayokunle Olanrewaju, Hermann Nabi, Jean-Sébastien Paquette, Frédéric Pouliot, Étienne Audet-Walsh
For many years, PSA has been the most commonly used biomarker for prostate cancer screening and diagnosis. Although serum PSA measurement is highly sensitive, this biomarker has several limitations. Citrate, a molecule closely linked to the unique metabolism of prostate cancer, has the potential to be used as a complementary biomarker alongside PSA.
{"title":"Rediscovering citrate as a biomarker for prostate cancer","authors":"Lucas Galey, Ayokunle Olanrewaju, Hermann Nabi, Jean-Sébastien Paquette, Frédéric Pouliot, Étienne Audet-Walsh","doi":"10.1038/s41585-024-00899-3","DOIUrl":"10.1038/s41585-024-00899-3","url":null,"abstract":"For many years, PSA has been the most commonly used biomarker for prostate cancer screening and diagnosis. Although serum PSA measurement is highly sensitive, this biomarker has several limitations. Citrate, a molecule closely linked to the unique metabolism of prostate cancer, has the potential to be used as a complementary biomarker alongside PSA.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 10","pages":"573-575"},"PeriodicalIF":12.1,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174513","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 : 2024-05-23DOI: 10.1038/s41585-024-00887-7
Olaf P. J. Vrooman, Philip E. V. van Kerrebroeck, Michael R. van Balken, Gommert A. van Koeveringe, Mohammad S. Rahnama’i
Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes. In this Review, the authors provide urologists and other interested physicians with an improved understanding of the multifactorial pathophysiology underlying the correlation between obstructive sleep apnoea and nocturia. They describe current evidence, identify topics for future research, and provide practical recommendations for managing patients with this complex condition.
夜尿，即夜间尿急，是阻塞性睡眠呼吸暂停（OSA）患者的常见症状。持续气道正压治疗可减少部分患者的夜尿现象，但其潜在机制十分复杂，尚未完全明了。OSA 会影响自律神经系统、氧化应激和内皮损伤。此外，将多尿归因于心脏负荷过重和反应性钠尿的错误信号的普遍理论也有局限性。需要采取综合方法来处理 OSA 患者的夜尿问题，同时考虑到合并症、药物使用、饮酒和生活方式等因素。有效治疗 OSA 夜尿需要多学科合作，泌尿科医生应了解 OSA 对生理的潜在影响，并将患者转诊至睡眠中心进行进一步检查。除持续气道正压治疗外，口腔用具和手术阻塞治疗等其他干预措施也可能对某些患者有益。总之，了解 OSA 与夜尿症之间复杂的相互作用对于优化患者预后至关重要。
{"title":"Nocturia and obstructive sleep apnoea","authors":"Olaf P. J. Vrooman, Philip E. V. van Kerrebroeck, Michael R. van Balken, Gommert A. van Koeveringe, Mohammad S. Rahnama’i","doi":"10.1038/s41585-024-00887-7","DOIUrl":"10.1038/s41585-024-00887-7","url":null,"abstract":"Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes. In this Review, the authors provide urologists and other interested physicians with an improved understanding of the multifactorial pathophysiology underlying the correlation between obstructive sleep apnoea and nocturia. They describe current evidence, identify topics for future research, and provide practical recommendations for managing patients with this complex condition.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"21 12","pages":"735-753"},"PeriodicalIF":12.1,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087771","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}
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