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. Urinary incontinence is highly prevalent during pregnancy and in the postpartum period. This Review provides an overview of this prevalence, discussing potential mechanisms and risk factors underlying this phenomenon. The importance of preventive measures and treatment options to ameliorate the extent and the effects of urinary incontinence during this stage of life is also highlighted.
{"title":"Urinary incontinence during pregnancy and in the postpartum period","authors":"Irene Diez-Itza","doi":"10.1038/s41585-025-01091-x","DOIUrl":"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. Urinary incontinence is highly prevalent during pregnancy and in the postpartum period. This Review provides an overview of this prevalence, discussing potential mechanisms and risk factors underlying this phenomenon. The importance of preventive measures and treatment options to ameliorate the extent and the effects of urinary incontinence during this stage of life is also highlighted.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 3","pages":"184-195"},"PeriodicalIF":14.6,"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. Adoptive cell therapy using tumour-infiltrating lymphocytes (TILs) can enhance immune-based therapies and could be applied to genitourinary cancers. Advances in TIL manufacturing, optimization and delivery methodologies have the potential to improve the safety and efficacy of TIL therapy in the management of advanced genitourinary malignancies. In this Perspective, the authors consider how and why TIL therapy warrants 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":"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. Adoptive cell therapy using tumour-infiltrating lymphocytes (TILs) can enhance immune-based therapies and could be applied to genitourinary cancers. Advances in TIL manufacturing, optimization and delivery methodologies have the potential to improve the safety and efficacy of TIL therapy in the management of advanced genitourinary malignancies. In this Perspective, the authors consider how and why TIL therapy warrants evaluation in clinical trials treating patients with genitourinary cancers.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 3","pages":"196-212"},"PeriodicalIF":14.6,"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}
Pub Date : 2025-09-22DOI: 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. This Review discusses the potential benefits of prehabilitative interventions in patients with and survivors of testicular cancer. Although there are few studies in the field, available data suggest a benefit of prehabilitation in improving mental health and quality of life in these patients, highlighting the need for additional research in this field.
{"title":"Exercise, diet and psychological support for patients with testicular cancer","authors":"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","doi":"10.1038/s41585-025-01089-5","DOIUrl":"10.1038/s41585-025-01089-5","url":null,"abstract":"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. This Review discusses the potential benefits of prehabilitative interventions in patients with and survivors of testicular cancer. Although there are few studies in the field, available data suggest a benefit of prehabilitation in improving mental health and quality of life in these patients, highlighting the need for additional research in this field.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"23 3","pages":"174-183"},"PeriodicalIF":14.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116625","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 : 2025-09-15DOI: 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.
{"title":"End of the TRUS era: transperineal biopsy takes the lead in prostate cancer detection","authors":"David Hennes, Abdullah Al-Khanaty, David C. Chen, Eoin Dinneen, Christa Babst, Nathan Lawrentschuk, Marlon L. Perera, Declan G. Murphy","doi":"10.1038/s41585-025-01090-y","DOIUrl":"https://doi.org/10.1038/s41585-025-01090-y","url":null,"abstract":"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.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"36 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059332","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}
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.
{"title":"Exploring promising biomarkers based on pathogenic mechanisms in interstitial cystitis/bladder pain syndrome","authors":"Kerong Xin, Siyu Wu, Rong Li, Chiyu Tan, Yuanhong Jiang, Jiazheng Yu, Xu Liu, Shijie Li, Zhenhua Li, Xiaonan Chen","doi":"10.1038/s41585-025-01078-8","DOIUrl":"https://doi.org/10.1038/s41585-025-01078-8","url":null,"abstract":"<p>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.</p>","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":"118 1","pages":""},"PeriodicalIF":15.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032157","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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