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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 14.6 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. This Review provides an overview of the main applications of single-port robotic surgery in urology, presenting emerging outcomes and discussing the transformative potential of this approach.
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
Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course PSMA影像学上出现的不祥的浆液表现可能与临床过程有关
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-20 DOI: 10.1038/s41585-025-01083-x
Melissa L. Abel, Esther Mena, Liza Lindenberg, Fatima Karzai, Peter Choyke, Oliver Sartor, Ravi A. Madan
Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+ serosal-based findings on the surface of the liver and other organs might not have the same implications when seen on PSMA PET versus conventional imaging. Awareness of this phenomenon is important in assessing whether treatment escalation is truly required.
对转移性前列腺癌的认识主要是通过宏观表现来确定的,但前列腺特异性膜抗原(PSMA) PET的敏感性增加了。肝脏和其他器官表面的PSMA+血清学结果可能与PSMA PET与常规成像结果不同。认识到这一现象对于评估是否真的需要升级治疗是很重要的。
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引用次数: 0
Current and future pharmacotherapy for female sexual dysfunction 女性性功能障碍的当前和未来药物治疗
IF 14.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-20 DOI: 10.1038/s41585-025-01076-w
Yacov Reisman, Alexandra Dubinskaya, Anna Padoa
Female sexual dysfunction (FSD) is common and affects women of all ages. Between 30% and 50% of sexually active women will encounter some type of FSD at some point in their life, highlighting its importance as a public health issue. FSD goes undiagnosed and untreated in many women owing to the stigma associated with sexual health, insufficient awareness and restricted access to specialized medical care. Over the past few decades, considerable progress in understanding FSD has resulted in the development of pharmacological therapies; the treatment of FSD should be evaluated through a biopsychosocial approach to determine whether to use medication, therapy or a mix of both methods. A number of non-hormonal pharmacological treatments for FSD are available, specifically to treat hypoactive sexual desire disorder, female sexual arousal disorder, female orgasmic disorder and female genitopelvic pain disorders. Further work towards the development of future therapies will help to better support women with FSD. Despite affecting 30–50% of sexually active women, female sexual dysfunction (FSD) goes undiagnosed and untreated in many women owing to the stigma associated with sexual health, insufficient awareness and restricted access to specialized medical care. In this Review, experts in the field discuss the treatments currently available to treat FSD — including hypoactive sexual desire disorder, female sexual arousal disorder, female orgasmic disorder and female genitopelvic pain disorders — and consider the new approaches that are currently in development.
女性性功能障碍(FSD)很常见,影响所有年龄段的女性。30%至50%的性活跃妇女在其一生中的某个阶段会遇到某种类型的FSD,这突出了其作为公共卫生问题的重要性。由于与性健康有关的耻辱、认识不足和获得专门医疗服务的机会有限,许多妇女的性性功能障碍未得到诊断和治疗。在过去的几十年里,对FSD的理解取得了相当大的进展,导致了药物治疗的发展;FSD的治疗应通过生物心理社会学方法进行评估,以确定是否使用药物、治疗或两种方法的混合。目前有许多治疗性功能障碍的非激素药物治疗方法,特别是治疗性欲减退、女性性唤起障碍、女性性高潮障碍和女性生殖器盆腔疼痛障碍。对未来治疗方法的进一步研究将有助于更好地支持患有FSD的妇女。
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引用次数: 0
Economic impact of tariffs on healthcare costs in urology 关税对泌尿科医疗保健费用的经济影响
IF 15.3 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-20 DOI: 10.1038/s41585-025-01084-w
Cameron J. Britton, Brian D. Cortese, Ruchika Talwar
In April 2025, the US executive administration announced universal 10% tariffs on all imported products, in addition to reciprocal tariffs for select foreign nations. As trade negotiations evolve, it is essential to recognize and evaluate the profound implications these economic policies hold for healthcare systems.
2025年4月,美国行政当局宣布对所有进口产品征收10%的普遍关税,此外还对部分外国征收互惠关税。随着贸易谈判的发展,认识和评估这些经济政策对医疗保健系统的深远影响至关重要。
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引用次数: 0
Urinary bladder cancer needs more attention — recommendations for health care professionals and politicians in the European Union 膀胱癌需要更多的关注——这是对欧盟卫生保健专业人员和政治家的建议。
IF 14.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-08-19 DOI: 10.1038/s41585-025-01077-9
Thorsten H. Ecke, Sarah Collen, Alex Filicevas, Theodoros Yfantis, Florence Le Calvez-Kelm, Bente Thoft Jensen, Hein van Poppel
Cancer is a crucial health priority of the current European Commission and a pillar of a strong European Health Union. However, policy measures targeting cancer in the EU do not approach all types of cancer equally. Bladder cancer is the fifth most common cancer in Europe. Although bladder cancer is associated with one of the highest lifetime costs of any cancer, research funding is among the lowest. This imbalance has led to an alarming stagnation in the availability of diagnostic tools, which negatively affected the prognosis and treatment options for bladder cancer, and resulted in complex pathways for patients. The lack of bladder-cancer awareness drastically hinders early detection. Furthermore, insufficient understanding of gender differences in bladder-cancer symptoms exacerbates the gender gap, leading to worse outcomes for women. After the European elections in 2024 and the learnings from Europe’s Beating Cancer Plan, additional effort is needed to inform the policymakers in Brussels and the Member-State capitals to consider an EU agenda with ambitious policy actions targeting neglected cancers, such as bladder cancer, and close the cancer-care gap by supporting awareness and education and by ensuring access to high-quality diagnostic tools, care and treatment. In this Expert Recommendation, a group of clinicians and scientists with high expertise in crucial areas of bladder cancer joined forces, together with members from patient groups and nurses’ associations, to write ten recommendations addressed to politicians and health care professionals in the EU to increase awareness of bladder cancer and improve targeted policy actions for this neglected cancer.
癌症是当前欧洲委员会的一个重要卫生优先事项,也是一个强大的欧洲卫生联盟的支柱。然而,欧盟针对癌症的政策措施并没有平等地对待所有类型的癌症。膀胱癌是欧洲第五大常见癌症。尽管膀胱癌是所有癌症中终生成本最高的癌症之一,但研究经费却是最低的。这种不平衡导致诊断工具的可得性出现惊人的停滞,这对膀胱癌的预后和治疗选择产生了负面影响,并导致患者的途径复杂。缺乏对膀胱癌的认识严重阻碍了早期发现。此外,对膀胱癌症状的性别差异了解不足加剧了性别差距,导致女性的预后更差。在2024年欧洲选举和从欧洲战胜癌症计划中吸取教训之后,需要做出更多努力,告知布鲁塞尔和成员国首都的决策者,考虑一项针对膀胱癌等被忽视癌症的雄心勃勃的政策行动的欧盟议程,并通过支持认识和教育以及确保获得高质量的诊断工具、护理和治疗来缩小癌症护理差距。
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引用次数: 0
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Nature Reviews Urology
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