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The opportunities and barriers for developing tumour-infiltrating lymphocyte therapy for patients with advanced genitourinary cancers. 发展肿瘤浸润性淋巴细胞治疗晚期泌尿生殖系统癌的机会和障碍。
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-26 DOI: 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.
使用肿瘤浸润淋巴细胞(til)的过继细胞治疗是一种非常成功的增强免疫治疗的模式。已经显示出晚期黑色素瘤患者的临床益处,导致FDA于2024年首次批准这种免疫方式。尽管几十年前对晚期肾细胞癌的临床试验没有显示出显著的临床益处,但最近在TIL生成过程、操作技术、制备方案和与免疫检查点抑制剂联合方面的进展,为重新探索优化TIL治疗泌尿生殖系统癌提供了新的希望。目前,TIL治疗在TIL制造、优化和递送方法方面取得了进展,这有可能提高TIL治疗在晚期泌尿生殖系统恶性肿瘤管理中的安全性和有效性。此外,创新的联合方法和新策略可以提高TIL治疗的临床可行性,并值得在治疗泌尿生殖系统癌患者的临床试验中进行评估。
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引用次数: 0
Exercise, diet and psychological support for patients with testicular cancer. 睾丸癌患者的运动、饮食及心理支持。
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-22 DOI: 10.1038/s41585-025-01089-5
Logan G Briggs,Sarah P Psutka,Matthew J Van Ligten,Kelsey L Beck,Debarshi Sinha,Vikram S Gill,Khalid Y Alkhatib,Adri M Durant,Paul A Bain,Jaxon Quillen,Christopher Dodoo,Phillip M Pierorazio,Haidar Abdul-Muhsin,Mark D Tyson,Quoc-Dien Trinh,Sara C Parke
Prehabilitative and rehabilitative exercise, psychological support and nutrition interventions have proven beneficial in many cancer populations. Testicular cancer survivors have high rates of metabolic syndrome, cardiovascular disease, hypogonadism and psychosocial issues, and might yield greater benefit from such interventions than the average cancer survivor population. Results from the few studies available in this field suggest that exercise can improve fatigue, metabolic syndrome, cardiovascular risk profile and physical performance measures (such as VO2 max), whereas psychological support programmes have been shown to improve fatigue and mental health. However, a paucity of data exists on best practices for provision of nutrition, exercise and psychological support within the testicular cancer space, patients and caregivers, highlighting the urgent need for additional work in this field. Overall, prehabilitation and rehabilitation interventions for testicular cancer are safe and efficacious, and should be implemented by clinicians at diagnosis and throughout survivorship.
康复训练、心理支持和营养干预已被证明对许多癌症人群有益。睾丸癌幸存者患代谢综合征、心血管疾病、性腺功能减退和社会心理问题的比例很高,与普通癌症幸存者相比,这些干预措施可能会带来更大的好处。该领域为数不多的研究结果表明,运动可以改善疲劳、代谢综合征、心血管风险概况和身体表现指标(如最大摄氧量),而心理支持计划已被证明可以改善疲劳和心理健康。然而,关于在睾丸癌领域、患者和护理人员中提供营养、运动和心理支持的最佳做法的数据缺乏,突出表明迫切需要在这一领域开展更多工作。总之,睾丸癌的预适应和康复干预是安全有效的,应该由临床医生在诊断和整个生存期实施。
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引用次数: 0
End of the TRUS era: transperineal biopsy takes the lead in prostate cancer detection TRUS时代的终结:经会阴活检在前列腺癌的检测中处于领先地位
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-15 DOI: 10.1038/s41585-025-01090-y
David Hennes, Abdullah Al-Khanaty, David C. Chen, Eoin Dinneen, Christa Babst, Nathan Lawrentschuk, Marlon L. Perera, Declan G. Murphy
Transrectal ultrasound-guided prostate biopsy is associated with limitations including high infection rates, sampling limitations and patient discomfort, which have led to the development of the transperineal approach. Randomized trials show that transperineal biopsy offers at least equivalent detection of clinically significant prostate cancer, providing robust evidence for a clinical practice change.
经直肠超声引导的前列腺活检存在局限性,包括高感染率、采样限制和患者不适,这导致了经会阴入路的发展。随机试验表明,经会阴活检对临床意义重大的前列腺癌的检测效果至少相当,为临床实践的改变提供了有力的证据。
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引用次数: 0
Exploring promising biomarkers based on pathogenic mechanisms in interstitial cystitis/bladder pain syndrome 基于间质性膀胱炎/膀胱疼痛综合征致病机制探索有前景的生物标志物
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-11 DOI: 10.1038/s41585-025-01078-8
Kerong Xin, Siyu Wu, Rong Li, Chiyu Tan, Yuanhong Jiang, Jiazheng Yu, Xu Liu, Shijie Li, Zhenhua Li, Xiaonan Chen

Interstitial cystitis/bladder pain syndrome (IC/BPS), characterized by bladder discomfort and lower urinary tract symptoms, is often either overtreated or undertreated owing to the complexity and variability of symptoms and the lack of reliable diagnostic tools, leading to reduced quality of life and prolonged illness. The pathophysiology of IC/BPS remains unclear, with multiple hypotheses — such as autoimmune inflammation, oxidative stress and urothelial dysfunction — offering potential explanations. Consequently, a diverse range of urinary biomarkers has emerged, although their diagnostic reliability remains inconsistent. As technology advances, biomarkers are increasingly shifting towards multiplex assays, encompassing genomics, transcriptomics, proteomics and cell-based methods; however, cutting-edge research and clinical validation are not yet integrated into the limited diagnostic tools available. Clinical phenotypes from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network studies provide multi-level biomarker research — including molecular, imaging and other modalities — to support the diagnosis of IC/BPS. Integrating these observations will advance the development of precision medicine for the diagnosis of IC/BPS, thereby improving management of this complex condition.

间质性膀胱炎/膀胱疼痛综合征(IC/BPS)以膀胱不适和下尿路症状为特征,由于症状的复杂性和可变性以及缺乏可靠的诊断工具,常常被过度治疗或治疗不足,导致生活质量下降和疾病延长。IC/BPS的病理生理机制尚不清楚,多种假说——如自身免疫性炎症、氧化应激和尿路上皮功能障碍——提供了可能的解释。因此,出现了各种各样的尿液生物标志物,尽管它们的诊断可靠性仍然不一致。随着技术的进步,生物标志物越来越多地转向多种检测方法,包括基因组学、转录组学、蛋白质组学和基于细胞的方法;然而,尖端研究和临床验证尚未整合到有限的可用诊断工具中。来自多学科方法的临床表型慢性盆腔疼痛研究网络研究提供了多层次的生物标志物研究-包括分子,成像和其他模式-支持IC/BPS的诊断。整合这些观察结果将促进IC/BPS诊断的精准医学发展,从而改善对这一复杂疾病的管理。
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引用次数: 0
Low-grade non-muscle-invasive bladder cancer: molecular landscape, treatment strategies and emerging therapies 低级别非肌肉浸润性膀胱癌:分子景观、治疗策略和新兴疗法
IF 14.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-10 DOI: 10.1038/s41585-025-01072-0
Lexiaochuan Wen, Hiroko Miyagi, Philippe E. Spiess, Alice Yu, Cathy L. Mendelsohn, Wei Shen Tan, Sarah P. Psutka, Seth P. Lerner, Liang Cheng, Lars Dyrskjøt, Joshua J. Meeks, Shahrokh F. Shariat, Paolo Gontero, Benjamin Pradere, Gary D. Steinberg, Ashish M. Kamat, Roger Li
Low-grade non-muscle invasive bladder cancer is a specific category of bladder cancer with a favourable prognosis; however, its management presents several challenges. The risk of stage progression is very low, but approximately half of patients will experience recurrence within the first 5 years after diagnosis. This high propensity for recurrence, coupled with the threat of progression, mandates ongoing surveillance. However, the optimal frequency and duration of follow-up monitoring remain undefined. Current management strategies for low-grade non-muscle invasive bladder cancer rely heavily on routine office cystoscopy, with few advances in diagnostic and treatment options over the past 25 years. Our basic understanding of disease biology has substantially advanced. However, at present, considerable variations in clinical practice exist, with implications for increased financial and treatment burden for patients and health care systems. Molecular signatures and biomarker discoveries are crucial to understand disease behaviour and inform novel treatment strategies. Emerging therapies, such as advanced drug-delivery systems, immunomodulatory agents and targeted therapies, offer the potential to improve patient outcomes, streamline management and reduce the need for surveillance cystoscopies. Actionable avenues for future research in the field include prospective validation of novel biomarkers and therapies with the ultimate aim of optimizing patient care and reducing health care costs. In this Review, the authors summarize the biological features of low-grade non-muscle-invasive bladder cancer, clinical risk stratification and evidence supporting treatment strategies. They also highlight contemporary developments in monitoring and therapeutic technologies.
低级别非肌性浸润性膀胱癌是膀胱癌的一个特殊类别,预后良好;然而,它的管理提出了几个挑战。阶段进展的风险非常低,但大约一半的患者在诊断后的前5年内会复发。这种高复发倾向,加上进展的威胁,需要持续监测。然而,随访监测的最佳频率和持续时间仍未确定。目前低级别非肌肉浸润性膀胱癌的治疗策略严重依赖常规的办公室膀胱镜检查,在过去的25年里,诊断和治疗方案几乎没有进展。我们对疾病生物学的基本认识有了实质性的进步。然而,目前在临床实践中存在相当大的差异,这意味着增加了患者和卫生保健系统的财政和治疗负担。分子特征和生物标志物的发现对于理解疾病行为和提供新的治疗策略至关重要。新兴疗法,如先进的药物输送系统、免疫调节剂和靶向治疗,提供了改善患者预后、简化管理和减少监测膀胱镜检查需求的潜力。该领域未来研究的可行途径包括对新型生物标志物和疗法的前瞻性验证,最终目标是优化患者护理和降低医疗成本。
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引用次数: 0
New evidence and novel techniques for assessing intraoperative margins during radical prostatectomy 评估根治性前列腺切除术术中边缘的新证据和新技术
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-08 DOI: 10.1038/s41585-025-01087-7
Siyu Huang, David C. Chen, David Hennes, Declan G. Murphy, Nathan Lawrentschuk, Marlon L. Perera
New evidence shows that NeuroSAFE, an intraoperative frozen section technique during radical prostatectomy, improves erectile function recovery. Traditional NeuroSAFE using frozen section analysis might not work for all centres, but new technologies for intraoperative margin assessment might facilitate more pragmatic alternatives during radical prostatectomy.
新的证据表明,神经安全,术中冷冻切片技术在根治性前列腺切除术,改善勃起功能的恢复。使用冷冻切片分析的传统NeuroSAFE可能不适用于所有中心,但术中边缘评估的新技术可能在根治性前列腺切除术中提供更实用的选择。
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引用次数: 0
The current landscape of single-port robotic surgery in urology 泌尿外科单端口机器人手术的现状
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-02 DOI: 10.1038/s41585-025-01081-z
Arianna Biasatti, Nicolas A. Soputro, Francesco Porpiglia, Sisto Perdonà, Firas Abdollah, Ryan Nelson, Craig Rogers, Lee C. Zhao, Ahmed Ghazi, Ben Challacombe, Christopher Eden, Agostino Mattei, Christian D. Fankhauser, Alberto Breda, Bernardo Rocco, Francesco Montorsi, Alberto Briganti, Antony A. Pellegrino, Alexandre Mottrie, Ruben De Groote, Alexander Haese, Markus Graefen, Marcio C. Moschovas, Vipul Patel, Giuseppe Simone, Antonio Galfano, Silvia Secco, Riccardo Bertolo, Savio D. Pandolfo, Vito Pansadoro, Filipe L. F. Carvalho, Jean V. Joseph, Mohammad Ramadan, Jaschar Shakuri-Rad, Bertram Yuh, Jeffrey Nix, David I. Lee, Soroush Rais-Bahrami, Sij Hemal, Mohamed Eltemamy, Alp T. Beksac, Zeyad Schwen, Li-Ming Su, Maurizio Buscarini, Michael Palese, Ash Tewari, Peter Wiklund, Edward E. Cherullo, Srinivas Vourganti, Jennifer A. Linehan, Zhenjie Wu, Michael Stifelman, Mutahar Ahmed, Reza Mehrazin, Ketan Badani, Richard E. Link, Simone Crivellaro, Jihad Kaouk, Riccardo Autorino

The advent of the purpose-built da Vinci single-port robotic platform marks a pivotal advancement in minimally invasive urological surgery. Designed to overcome the ergonomic and technical limitations of prior single-site approaches, the single-port system enables complex procedures through a single incision, with enhanced dexterity, optimized use of confined spaces and improved cosmetic and peri-operative outcomes. The single-port system has been increasingly used across a wide range of urological indications, including robot-assisted radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation. Innovative access strategies, such as the single-port transvesical and low anterior access approaches, have facilitated regionalized and multi-quadrant surgeries without the need for repositioning or robot re-docking. These advances have translated into reduced morbidity, faster recovery and increased feasibility of opioid-sparing, same-day discharge protocols. As surgical expertise deepens and technology evolves, the single-port robotic platform stands as a refinement of minimally invasive surgery, and also as a potential paradigm shift in urological practice.

专门建造的达芬奇单端口机器人平台的出现标志着微创泌尿外科的关键进步。该系统旨在克服先前单部位入路的人体工程学和技术限制,通过单个切口实现复杂的手术,提高了灵活性,优化了密闭空间的利用,改善了美容和围手术期的结果。单端口系统已越来越多地用于广泛的泌尿外科适应症,包括机器人辅助根治性前列腺切除术,部分肾切除术,肾输尿管切除术和重建手术,如肾盂成形术和输尿管再植入术。创新的入路策略,如单孔经膀胱和低前路入路,促进了区域和多象限手术,而无需重新定位或机器人重新对接。这些进步已经转化为降低发病率、加快恢复速度和增加阿片类药物节约、当日出院方案的可行性。随着外科专业知识的加深和技术的发展,单端口机器人平台代表了微创手术的改进,也代表了泌尿外科实践的潜在范式转变。
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引用次数: 0
Reply to ‘Enhancing spatial transcriptomics in clear-cell renal cell carcinoma’ 回复“增强透明细胞肾细胞癌的空间转录组学”
IF 14.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-27 DOI: 10.1038/s41585-025-01086-8
Jesper Jespersen, Iben Lyskjær
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引用次数: 0
Enhancing spatial transcriptomics in clear-cell renal cell carcinoma 透明细胞肾细胞癌的空间转录组学增强
IF 14.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-27 DOI: 10.1038/s41585-025-01085-9
Chengming Li, Junxiu Sheng, Guangzhen Wu
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引用次数: 0
Pelvic-fascia-sparing techniques and outcomes with RARP 盆腔筋膜保留技术和RARP的结果
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-27 DOI: 10.1038/s41585-025-01079-7
Evan Suzman, Ang Li, Gal Wald, Jim C. Hu
Urinary incontinence is a common sequela of robot-assisted radical prostatectomy and adversely affects quality of life. Advances in surgical technique preserve the pelvic anatomy to mitigate postoperative urinary incontinence. Pelvic-fascia-sparing techniques such as Retzius-sparing and hood with single-port or multi-port robotic approaches can improve outcomes.
尿失禁是机器人辅助根治性前列腺切除术的常见后遗症,并对生活质量产生不利影响。手术技术的进步保留了骨盆解剖结构以减轻术后尿失禁。保留骨盆筋膜技术,如Retzius-sparing和hood单孔或多孔机器人入路可以改善预后。
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引用次数: 0
期刊
Nature Reviews Urology
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