Pub Date : 2025-10-10DOI: 10.1038/s41585-025-01096-6
Magdalena Görtz, Carlos Brandl, Anna Nitschke, Anja Riediger, Daniel Stromer, Michael Byczkowski, Vincent Heuveline, Matthias Weidemüller
‘Digital twins’, also called ‘digital patient twins’ or ‘virtual human twins’ — digital patient-specific models derived from multimodal health data — are a strong focus in health care and are emerging as a promising tool for improving personalized care in uro-oncology. These models can integrate clinical, genomic, imaging and histopathological information to simulate organ behaviour and disease progress as well as predict responses to treatments. The concept of digital twins has shown potential in various fields, but its application in uro-oncology is still evolving, with few assessments of their feasibility and clinical utility. The advent of artificial intelligence adds a new dimension to their development, potentially enabling the synthesis of diverse, high-quality datasets to improve modelling accuracy and support real-time decision-making. However, substantial challenges exist, including data integration, patient privacy, computational demands and ethical frameworks. In addition, the interpretability of predictions remains essential for gaining clinical trust and guiding patient-centred decisions. The use of digital twins in uro-oncology has the potential to improve patient stratification and treatment planning; however, barriers must be overcome for their successful implementation in clinical routine. By integrating new technologies, fostering interdisciplinary collaboration and prioritizing transparency, digital twins could shape the future of precision uro-oncology. This Review focuses on the clinical effects and translational potential of digital twin applications in uro-oncology, highlights challenges and discusses future directions for implementing digital twins to achieve personalized uro-oncological diagnostics and treatment.
{"title":"Digital twins for personalized treatment in uro-oncology in the era of artificial intelligence","authors":"Magdalena Görtz, Carlos Brandl, Anna Nitschke, Anja Riediger, Daniel Stromer, Michael Byczkowski, Vincent Heuveline, Matthias Weidemüller","doi":"10.1038/s41585-025-01096-6","DOIUrl":"10.1038/s41585-025-01096-6","url":null,"abstract":"‘Digital twins’, also called ‘digital patient twins’ or ‘virtual human twins’ — digital patient-specific models derived from multimodal health data — are a strong focus in health care and are emerging as a promising tool for improving personalized care in uro-oncology. These models can integrate clinical, genomic, imaging and histopathological information to simulate organ behaviour and disease progress as well as predict responses to treatments. The concept of digital twins has shown potential in various fields, but its application in uro-oncology is still evolving, with few assessments of their feasibility and clinical utility. The advent of artificial intelligence adds a new dimension to their development, potentially enabling the synthesis of diverse, high-quality datasets to improve modelling accuracy and support real-time decision-making. However, substantial challenges exist, including data integration, patient privacy, computational demands and ethical frameworks. In addition, the interpretability of predictions remains essential for gaining clinical trust and guiding patient-centred decisions. The use of digital twins in uro-oncology has the potential to improve patient stratification and treatment planning; however, barriers must be overcome for their successful implementation in clinical routine. By integrating new technologies, fostering interdisciplinary collaboration and prioritizing transparency, digital twins could shape the future of precision uro-oncology. This Review focuses on the clinical effects and translational potential of digital twin applications in uro-oncology, highlights challenges and discusses future directions for implementing digital twins to achieve personalized uro-oncological diagnostics and treatment.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 1","pages":"29-39"},"PeriodicalIF":14.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261507","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 : 2025-10-08DOI: 10.1038/s41585-025-01069-9
Karl H. Pang, Hussain M. Alnajjar, Alex Lal, Asif Muneer
Priapism is an abnormal prolonged penile erection that persists in the absence of any sexual stimulation. Priapism can be subcategorized into three types: ischaemic (low-flow or veno-occlusive), non-ischaemic (high-flow or arterial) and stuttering priapism. Ischaemic priapism is the most common subtype and is associated with multiple aetiologies, most commonly haemoglobinopathies and antipsychotic medications. The mechanisms underlying stuttering priapism are complex, and involve dysregulation of the nitric oxide signalling pathway, Rho–Rho kinase pathway, adenosine, opiorphins, oxidative stress and androgens. The investigation and management of priapism involve a stepwise approach. A clinical history, examination and a blood-gas analysis from the corpus cavernosum helps to distinguish between ischaemic and non-ischaemic subtypes. Colour Doppler ultrasonography and penile MRI can be used in more complex cases, or those with a delayed presentation. Treatment involves cavernosal blood aspiration followed by instillation of an α-adrenergic receptor agonist such as phenylephrine, proceeding to penile shunt surgery (within the first 24–48 h) if the priapism persists. Insertion of a penile prosthesis is indicated when a shunting procedure or penoscrotal decompression fails, or if a patient presents with a priapism persisting longer than 36–48 h depending on the guidelines used. For non-ischaemic priapism following failed conservative treatment, selective arterial embolization of the arteriocorporal fistula can be performed. The aetiology and pathophysiology of the different priapism subtypes help to determine the management of specific patients. Priapism — an abnormal prolonged penile erection that persists in the absence of any sexual stimulation — can be subcategorized into three types: ischaemic (low-flow or veno-occlusive), non-ischaemic (high-flow or arterial) and stuttering, also known as recurrent ischaemic, priapism. The mechanisms underlying stuttering priapism are complex and involve dysregulation of the nitric oxide signalling pathway, Rho–Rho kinase pathway, adenosine, opiorphins, oxidative stress and androgens, and treatment can target these pathways, or be surgical in approach. In this Review, the authors discuss the pathology of the different types of priapism and provide an update on the different therapeutic options available.
{"title":"An update on mechanisms and treatment options for priapism","authors":"Karl H. Pang, Hussain M. Alnajjar, Alex Lal, Asif Muneer","doi":"10.1038/s41585-025-01069-9","DOIUrl":"10.1038/s41585-025-01069-9","url":null,"abstract":"Priapism is an abnormal prolonged penile erection that persists in the absence of any sexual stimulation. Priapism can be subcategorized into three types: ischaemic (low-flow or veno-occlusive), non-ischaemic (high-flow or arterial) and stuttering priapism. Ischaemic priapism is the most common subtype and is associated with multiple aetiologies, most commonly haemoglobinopathies and antipsychotic medications. The mechanisms underlying stuttering priapism are complex, and involve dysregulation of the nitric oxide signalling pathway, Rho–Rho kinase pathway, adenosine, opiorphins, oxidative stress and androgens. The investigation and management of priapism involve a stepwise approach. A clinical history, examination and a blood-gas analysis from the corpus cavernosum helps to distinguish between ischaemic and non-ischaemic subtypes. Colour Doppler ultrasonography and penile MRI can be used in more complex cases, or those with a delayed presentation. Treatment involves cavernosal blood aspiration followed by instillation of an α-adrenergic receptor agonist such as phenylephrine, proceeding to penile shunt surgery (within the first 24–48 h) if the priapism persists. Insertion of a penile prosthesis is indicated when a shunting procedure or penoscrotal decompression fails, or if a patient presents with a priapism persisting longer than 36–48 h depending on the guidelines used. For non-ischaemic priapism following failed conservative treatment, selective arterial embolization of the arteriocorporal fistula can be performed. The aetiology and pathophysiology of the different priapism subtypes help to determine the management of specific patients. Priapism — an abnormal prolonged penile erection that persists in the absence of any sexual stimulation — can be subcategorized into three types: ischaemic (low-flow or veno-occlusive), non-ischaemic (high-flow or arterial) and stuttering, also known as recurrent ischaemic, priapism. The mechanisms underlying stuttering priapism are complex and involve dysregulation of the nitric oxide signalling pathway, Rho–Rho kinase pathway, adenosine, opiorphins, oxidative stress and androgens, and treatment can target these pathways, or be surgical in approach. In this Review, the authors discuss the pathology of the different types of priapism and provide an update on the different therapeutic options available.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 12","pages":"826-845"},"PeriodicalIF":14.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246499","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 : 2025-10-08DOI: 10.1038/s41585-025-01097-5
Mihir S. Shah, Matthew Buck
Large language models have been rapidly adopted in general and clinically; they could also be incorporated into medical education. Results of a recent study suggest that a combination of traditional learning methods and large language model use could improve learning outcomes for medical students.
{"title":"Man plus machine: large language models can augment medical student education","authors":"Mihir S. Shah, Matthew Buck","doi":"10.1038/s41585-025-01097-5","DOIUrl":"10.1038/s41585-025-01097-5","url":null,"abstract":"Large language models have been rapidly adopted in general and clinically; they could also be incorporated into medical education. Results of a recent study suggest that a combination of traditional learning methods and large language model use could improve learning outcomes for medical students.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 1","pages":"12-12"},"PeriodicalIF":14.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246500","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 : 2025-10-07DOI: 10.1038/s41585-025-01101-y
Louise Lloyd
{"title":"Kidney lymphatics in organ rejection","authors":"Louise Lloyd","doi":"10.1038/s41585-025-01101-y","DOIUrl":"10.1038/s41585-025-01101-y","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"22 11","pages":"725-725"},"PeriodicalIF":14.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245020","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 : 2025-10-06DOI: 10.1038/s41585-025-01091-x
Irene Diez-Itza
Pregnancy and childbirth involve anatomical and physiological changes in the pelvic floor that can negatively affect the urinary-continence mechanism. Thus, in both periods, the rates of urinary incontinence increase notably, with stress urinary incontinence being the most common type. The pathophysiological mechanisms involved in urinary incontinence in pregnancy and postpartum are not fully understood. Stress urinary incontinence is more closely linked to urethral sphincter deficiency than to impaired urethral support, although both conditions have been noted during pregnancy and postpartum. The primary risk factors for pregnancy-related urinary incontinence are maternal age, body mass index and parity. Postpartum, urinary incontinence is mainly associated with urinary incontinence during pregnancy and vaginal delivery. Currently, the only option to prevent urinary incontinence in pregnancy and early postpartum is performing intense pelvic floor muscle training (PFMT) during pregnancy under supervision, although the effectiveness of PFMT for treating urinary incontinence during pregnancy and postpartum has yet to be clarified. Further research is needed to assess the effect of PFMT in incontinent women during pregnancy and postpartum, and to identify women who are most likely to benefit from this treatment.
{"title":"Urinary incontinence during pregnancy and in the postpartum period.","authors":"Irene Diez-Itza","doi":"10.1038/s41585-025-01091-x","DOIUrl":"https://doi.org/10.1038/s41585-025-01091-x","url":null,"abstract":"Pregnancy and childbirth involve anatomical and physiological changes in the pelvic floor that can negatively affect the urinary-continence mechanism. Thus, in both periods, the rates of urinary incontinence increase notably, with stress urinary incontinence being the most common type. The pathophysiological mechanisms involved in urinary incontinence in pregnancy and postpartum are not fully understood. Stress urinary incontinence is more closely linked to urethral sphincter deficiency than to impaired urethral support, although both conditions have been noted during pregnancy and postpartum. The primary risk factors for pregnancy-related urinary incontinence are maternal age, body mass index and parity. Postpartum, urinary incontinence is mainly associated with urinary incontinence during pregnancy and vaginal delivery. Currently, the only option to prevent urinary incontinence in pregnancy and early postpartum is performing intense pelvic floor muscle training (PFMT) during pregnancy under supervision, although the effectiveness of PFMT for treating urinary incontinence during pregnancy and postpartum has yet to be clarified. Further research is needed to assess the effect of PFMT in incontinent women during pregnancy and postpartum, and to identify women who are most likely to benefit from this treatment.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"107 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235898","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 : 2025-10-02DOI: 10.1038/s41585-025-01094-8
Tessa Lord
{"title":"Reply to 'Should we screen for sleep apnoea in men with idiopathic infertility?'","authors":"Tessa Lord","doi":"10.1038/s41585-025-01094-8","DOIUrl":"https://doi.org/10.1038/s41585-025-01094-8","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"126 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209149","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 : 2025-10-02DOI: 10.1038/s41585-025-01093-9
Tathiana A Alvarenga,Matheus Brandão Vasco,Bianca Camilo Schimenes,Sergio Tufik,Monica Levy Andersen
{"title":"Should we screen for sleep apnoea in men with idiopathic infertility?","authors":"Tathiana A Alvarenga,Matheus Brandão Vasco,Bianca Camilo Schimenes,Sergio Tufik,Monica Levy Andersen","doi":"10.1038/s41585-025-01093-9","DOIUrl":"https://doi.org/10.1038/s41585-025-01093-9","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"99 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209148","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 : 2025-09-26DOI: 10.1038/s41585-025-01088-6
Marine Potez,Gabriel Roman Souza,Philippe E Spiess,Shari Pilon-Thomas,Jad Chahoud
Adoptive cell therapy using tumour-infiltrating lymphocytes (TILs) has been a very successful model of enhancing immune-based therapies. Clinical benefits have been shown for patients with advanced melanoma, leading to the first FDA approval for this immune modality in 2024. Although clinical trials conducted decades ago for advanced renal-cell cancer did not show significant clinical benefits, recent advances in the TIL generation process, manipulation techniques, preparative regimens and combination with immune checkpoint inhibitors offer new hope for reexploring optimized TIL therapy for genitourinary cancers. The current landscape of TIL therapy has seen progress in TIL manufacturing, optimization and delivery methodologies that have the potential to improve the safety and efficacy of TIL therapy in the management of advanced genitourinary malignancies. Furthermore, innovative combination approaches and novel strategies could enhance the clinical viability of TIL therapy and warrant evaluation in clinical trials treating patients with genitourinary cancers.
{"title":"The opportunities and barriers for developing tumour-infiltrating lymphocyte therapy for patients with advanced genitourinary cancers.","authors":"Marine Potez,Gabriel Roman Souza,Philippe E Spiess,Shari Pilon-Thomas,Jad Chahoud","doi":"10.1038/s41585-025-01088-6","DOIUrl":"https://doi.org/10.1038/s41585-025-01088-6","url":null,"abstract":"Adoptive cell therapy using tumour-infiltrating lymphocytes (TILs) has been a very successful model of enhancing immune-based therapies. Clinical benefits have been shown for patients with advanced melanoma, leading to the first FDA approval for this immune modality in 2024. Although clinical trials conducted decades ago for advanced renal-cell cancer did not show significant clinical benefits, recent advances in the TIL generation process, manipulation techniques, preparative regimens and combination with immune checkpoint inhibitors offer new hope for reexploring optimized TIL therapy for genitourinary cancers. The current landscape of TIL therapy has seen progress in TIL manufacturing, optimization and delivery methodologies that have the potential to improve the safety and efficacy of TIL therapy in the management of advanced genitourinary malignancies. Furthermore, innovative combination approaches and novel strategies could enhance the clinical viability of TIL therapy and warrant evaluation in clinical trials treating patients with genitourinary cancers.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"4 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153483","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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