Pub Date : 2024-04-15DOI: 10.1038/s41585-024-00879-7
Giuseppe Basile, Andrea Necchi, Gagan Prakash, Karima Oualla, Philippe E. Spiess, Peter A. S. Johnstone
Centralization of care for penile cancer has been underscored in the 2023 updated EAU–ASCO guidelines. Expertise consolidation enhances patient care, addressing penile cancer complexities from diagnosis to treatment. Centralization initiatives, like the European Reference Networks, and dedicated scientific societies have crucial roles in guiding centralized care pathways to ultimately improve patient outcomes.
{"title":"The case for centralization of care in penile cancer — respecting geographical needs","authors":"Giuseppe Basile, Andrea Necchi, Gagan Prakash, Karima Oualla, Philippe E. Spiess, Peter A. S. Johnstone","doi":"10.1038/s41585-024-00879-7","DOIUrl":"10.1038/s41585-024-00879-7","url":null,"abstract":"Centralization of care for penile cancer has been underscored in the 2023 updated EAU–ASCO guidelines. Expertise consolidation enhances patient care, addressing penile cancer complexities from diagnosis to treatment. Centralization initiatives, like the European Reference Networks, and dedicated scientific societies have crucial roles in guiding centralized care pathways to ultimately improve patient outcomes.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140553422","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 : 2024-03-25DOI: 10.1038/s41585-024-00866-y
David F. Carrageta, Sara C. Pereira, Rita Ferreira, Mariana P. Monteiro, Pedro F. Oliveira, Marco G. Alves
Diets leading to caloric overload are linked to metabolic disorders and reproductive function impairment. Metabolic and hormonal abnormalities stand out as defining features of metabolic disorders, and substantially affect the functionality of the testis. Metabolic disorders induce testicular metabolic dysfunction, chronic inflammation and oxidative stress. The disruption of gastrointestinal, pancreatic, adipose tissue and testicular hormonal regulation induced by metabolic disorders can also contribute to a state of compromised fertility. In this Review, we will delve into the effects of high-fat diets and metabolic disorders on testicular metabolism and spermatogenesis, which are crucial elements for male reproductive function. Moreover, metabolic disorders have been shown to influence the epigenome of male gametes and might have a potential role in transmitting phenotype traits across generations. However, the existing evidence strongly underscores the unmet need to understand the mechanisms responsible for transgenerational paternal inheritance of male reproductive function impairment related to metabolic disorders. This knowledge could be useful for developing targeted interventions to prevent, counteract, and most of all break the perpetuation chain of male reproductive dysfunction associated with metabolic disorders across generations. In this Review, the authors describe mechanisms through which metabolic disorders and metabolic-related hormonal status affect testes metabolism, spermatogenesis and male fertility. New findings on metabolic-related epigenetic signatures and paternal transgenerational inheritance of metabolic disorders are also discussed.
{"title":"Signatures of metabolic diseases on spermatogenesis and testicular metabolism","authors":"David F. Carrageta, Sara C. Pereira, Rita Ferreira, Mariana P. Monteiro, Pedro F. Oliveira, Marco G. Alves","doi":"10.1038/s41585-024-00866-y","DOIUrl":"10.1038/s41585-024-00866-y","url":null,"abstract":"Diets leading to caloric overload are linked to metabolic disorders and reproductive function impairment. Metabolic and hormonal abnormalities stand out as defining features of metabolic disorders, and substantially affect the functionality of the testis. Metabolic disorders induce testicular metabolic dysfunction, chronic inflammation and oxidative stress. The disruption of gastrointestinal, pancreatic, adipose tissue and testicular hormonal regulation induced by metabolic disorders can also contribute to a state of compromised fertility. In this Review, we will delve into the effects of high-fat diets and metabolic disorders on testicular metabolism and spermatogenesis, which are crucial elements for male reproductive function. Moreover, metabolic disorders have been shown to influence the epigenome of male gametes and might have a potential role in transmitting phenotype traits across generations. However, the existing evidence strongly underscores the unmet need to understand the mechanisms responsible for transgenerational paternal inheritance of male reproductive function impairment related to metabolic disorders. This knowledge could be useful for developing targeted interventions to prevent, counteract, and most of all break the perpetuation chain of male reproductive dysfunction associated with metabolic disorders across generations. In this Review, the authors describe mechanisms through which metabolic disorders and metabolic-related hormonal status affect testes metabolism, spermatogenesis and male fertility. New findings on metabolic-related epigenetic signatures and paternal transgenerational inheritance of metabolic disorders are also discussed.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209799","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 : 2024-03-21DOI: 10.1038/s41585-024-00873-z
Samuel Schmidgall, Ji Woong Kim, Axel Krieger
Autonomous surgical robots have the potential to transform surgery and increase access to quality health care. Advances in artificial intelligence have produced robots mimicking human demonstrations. This application might be feasible for surgical robots but is associated with obstacles in creating robots that emulate surgeon demonstrations.
{"title":"Robots learning to imitate surgeons — challenges and possibilities","authors":"Samuel Schmidgall, Ji Woong Kim, Axel Krieger","doi":"10.1038/s41585-024-00873-z","DOIUrl":"10.1038/s41585-024-00873-z","url":null,"abstract":"Autonomous surgical robots have the potential to transform surgery and increase access to quality health care. Advances in artificial intelligence have produced robots mimicking human demonstrations. This application might be feasible for surgical robots but is associated with obstacles in creating robots that emulate surgeon demonstrations.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185034","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 : 2024-03-14DOI: 10.1038/s41585-024-00870-2
Louise Lloyd
{"title":"The ins and outs of penile erection","authors":"Louise Lloyd","doi":"10.1038/s41585-024-00870-2","DOIUrl":"10.1038/s41585-024-00870-2","url":null,"abstract":"","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":15.3,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132099","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 : 2024-03-13DOI: 10.1038/s41585-024-00865-z
Giuseppe Basile, Alessio Pecoraro, Andrea Gallioli, Angelo Territo, Camille Berquin, Jorge Robalino, Alejandra Bravo, Jorge Huguet, Óscar Rodriguez-Faba, Pavel Gavrilov, Carmen Facundo, Lluis Guirado, Josep Maria Gaya, Joan Palou, Alberto Breda
Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach. Robot-assisted kidney transplantation is gaining momentum in kidney transplantation programmes as an alternative approach to patients with end-stage renal disease. In this Review, the authors provide an overview of available evidence on robot-assisted kidney transplantation, particularly in clinically challenging scenarios.
{"title":"Robotic kidney transplantation","authors":"Giuseppe Basile, Alessio Pecoraro, Andrea Gallioli, Angelo Territo, Camille Berquin, Jorge Robalino, Alejandra Bravo, Jorge Huguet, Óscar Rodriguez-Faba, Pavel Gavrilov, Carmen Facundo, Lluis Guirado, Josep Maria Gaya, Joan Palou, Alberto Breda","doi":"10.1038/s41585-024-00865-z","DOIUrl":"10.1038/s41585-024-00865-z","url":null,"abstract":"Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach. Robot-assisted kidney transplantation is gaining momentum in kidney transplantation programmes as an alternative approach to patients with end-stage renal disease. In this Review, the authors provide an overview of available evidence on robot-assisted kidney transplantation, particularly in clinically challenging scenarios.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120189","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 : 2024-03-01DOI: 10.1038/s41585-024-00867-x
David J. Benjamin, Zhaohui Arter, Nataliya Mar, Arash Rezazadeh Kalebasty
The growing global burden of genitourinary cancers is disproportionately shouldered by low- and middle-income countries. Medical journals offer an avenue for discourse among different stakeholders to strategize and identify solutions. Thus, achieving diversity in this context is crucial to put together a heterogeneous group of stakeholders with diverse personal and cultural experiences as well as distinct problem-solving approaches.
{"title":"Diversifying editorial boards to mitigate the global burden of genitourinary cancers","authors":"David J. Benjamin, Zhaohui Arter, Nataliya Mar, Arash Rezazadeh Kalebasty","doi":"10.1038/s41585-024-00867-x","DOIUrl":"10.1038/s41585-024-00867-x","url":null,"abstract":"The growing global burden of genitourinary cancers is disproportionately shouldered by low- and middle-income countries. Medical journals offer an avenue for discourse among different stakeholders to strategize and identify solutions. Thus, achieving diversity in this context is crucial to put together a heterogeneous group of stakeholders with diverse personal and cultural experiences as well as distinct problem-solving approaches.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013039","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}
Bladder cancer in the most advanced, muscle-invasive stage is lethal, and very limited therapeutic advances have been reported for decades. To date, cisplatin-based chemotherapy remains the first-line therapy for advanced bladder cancer. Late-line options have historically been limited. In the past few years, next-generation sequencing technology has enabled chromatin remodelling gene mutations to be characterized, showing that these alterations are more frequent in urothelial bladder carcinoma than in other cancer types. Histone modifiers have functional roles in tumour progression by modulating the expression of tumour suppressors and oncogenes and, therefore, have been considered as novel drug targets for cancer therapy. The roles of epigenetic reprogramming through histone modifications have been increasingly studied in bladder cancer, and the therapeutic efficacy of targeting those histone modifiers genetically or chemically is being assessed in preclinical studies. Results from preclinical studies in bladder cancer encouraged the investigation of some of these drugs in clinical trials, which yield mixed results. Further understanding of how alterations of histone modification mechanistically contribute to bladder cancer progression, drug resistance and tumour microenvironment remodelling will be required to facilitate clinical application of epigenetic drugs in bladder cancer. In this Perspective, the authors discuss the idea of targeting histone modifications in bladder cancer, providing a comprehensive overview of findings from preclinical and translational studies. Clinical trials in which the efficacy of molecules targeting histone modifiers was assessed in bladder cancer are also discussed.
{"title":"Targeting histone modifiers in bladder cancer therapy — preclinical and clinical evidence","authors":"Shiyu Zhang, Tianhai Lin, Xingyu Xiong, Chong Chen, Ping Tan, Qiang Wei","doi":"10.1038/s41585-024-00857-z","DOIUrl":"10.1038/s41585-024-00857-z","url":null,"abstract":"Bladder cancer in the most advanced, muscle-invasive stage is lethal, and very limited therapeutic advances have been reported for decades. To date, cisplatin-based chemotherapy remains the first-line therapy for advanced bladder cancer. Late-line options have historically been limited. In the past few years, next-generation sequencing technology has enabled chromatin remodelling gene mutations to be characterized, showing that these alterations are more frequent in urothelial bladder carcinoma than in other cancer types. Histone modifiers have functional roles in tumour progression by modulating the expression of tumour suppressors and oncogenes and, therefore, have been considered as novel drug targets for cancer therapy. The roles of epigenetic reprogramming through histone modifications have been increasingly studied in bladder cancer, and the therapeutic efficacy of targeting those histone modifiers genetically or chemically is being assessed in preclinical studies. Results from preclinical studies in bladder cancer encouraged the investigation of some of these drugs in clinical trials, which yield mixed results. Further understanding of how alterations of histone modification mechanistically contribute to bladder cancer progression, drug resistance and tumour microenvironment remodelling will be required to facilitate clinical application of epigenetic drugs in bladder cancer. In this Perspective, the authors discuss the idea of targeting histone modifications in bladder cancer, providing a comprehensive overview of findings from preclinical and translational studies. Clinical trials in which the efficacy of molecules targeting histone modifiers was assessed in bladder cancer are also discussed.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906206","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 : 2024-02-16DOI: 10.1038/s41585-023-00848-6
Yuzhi Wang, Mohit Butaney, Samantha Wilder, Khurshid Ghani, Craig G. Rogers, Brian R. Lane
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort. The evaluation and management of patients with small renal masses continue to evolve as new data-driven evidence emerges. Contemporary research in biomarkers, imaging, and machine learning shows promise in improving the understanding of small renal masses.
{"title":"The evolving management of small renal masses","authors":"Yuzhi Wang, Mohit Butaney, Samantha Wilder, Khurshid Ghani, Craig G. Rogers, Brian R. Lane","doi":"10.1038/s41585-023-00848-6","DOIUrl":"10.1038/s41585-023-00848-6","url":null,"abstract":"Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort. The evaluation and management of patients with small renal masses continue to evolve as new data-driven evidence emerges. Contemporary research in biomarkers, imaging, and machine learning shows promise in improving the understanding of small renal masses.","PeriodicalId":19088,"journal":{"name":"Nature Reviews Urology","volume":null,"pages":null},"PeriodicalIF":12.1,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747117","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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