搜索结果：Current opinion in urology

This narrative review summarizes recent evidence (2023-2025) on the role of palliative care in urology. It focuses on utilization trends, access disparities, symptom burden, procedural palliative needs, and end-of-life (EOL) care in advanced genitourinary malignancies. PC utilization in genitourinary cancers is increasing. Inpatient palliative care use rose from 4.9 to 31.5% in renal cell carcinoma and from 5.9 to 19.0% in testicular cancer. Yet, integration into routine care remains inconsistent. Disparities persist, including lower palliative care utilization among certain ethnic groups and uninsured patients, and higher odds of receiving high-intensity EOL care among socioeconomically vulnerable populations. Symptom burden remains substantial, with up to 82% of patients reporting multiple symptoms. This underscores the need for more timely palliative care involvement and more standardized reporting. Communication gaps, particularly regarding prognosis and EOL preferences, highlight opportunities for urologists to engage more actively in initiating palliative care discussions. Procedural palliative needs, including malignant ureteral obstruction management, illustrate the direct impact of urologists in providing symptom-directed palliative care. Despite growing recognition of palliative care gaps remain in access, referral timing, and systematic assessment. Addressing disparities, enhancing interdisciplinary collaboration, and prioritizing prospective research will be essential to improve patient and caregiver-centered outcomes.

Machine learning algorithms are occupying a larger space in medical and urology applications. However, typical medical physicians are not trained on these technologies and do not master the possibilities offered by these tools, to imagine their applications in the medical field. This manuscript is indented to be a guide in the use of machine learning in different urology applications, and to demystify the available machine learning and artificial intelligence algorithms. This manuscript reviews some of their applications and potential applications to the medical and urology field. Multiple works are published on the use of machine learning in urology, with performance demonstrated to be noninferior to human experts on multiple occasions. However, the major part of the machine learning publications in urology applications are concentrated on diagnosis and/or prognosis. Advanced machine learning algorithms based on agentic artificial intelligence, able to perform decisions and causality-based treatment optimization, are rarely put to use in urology. The democratization of advanced machine learning technologies in the medical fields can accelerate the adoption of these techniques, and potentially improve the patient care through relevant suggestive decision making. This work aims to demystify the machine learning tools for medical applications, facilitate decision making and adoption of the correct tools for the correct applications, and places a roadmap for the future of machine learning in the enhancement of patient care in urology.

Increases in wealth, scientific knowledge, and resources have contributed to unprecedented improvements in overall and urologic health over the past century. However, anthropogenic greenhouse gas emissions driving these advancements are a primary driver of climate change, including a substantial share contributed from the healthcare industry itself. Reducing resource-intensive processes in urologic care has been proposed to support environmental sustainability but these initiatives could conflict with economic forces that drive progress in biomedical innovation. Paradoxically, such strategies may also have unintended consequences for human health by slowing the pipeline or scientific discovery or delivery of treatment. A balanced approach can prioritize the elimination of low-value services in order to enhance care value while simultaneously reducing environmental waste and resource consumption. In this review, we examine strategies that seek to align environmental and economic forces in urologic care delivery within a market-influenced healthcare system. Strategies to reduce low-value urologic care, including decreased reliance on single-use items, reducing use of the operating room when feasible, and judicious use of resource-intensive research methods, have potentially favorable environmental impacts. A maturing body of research has examined ways in which reductions in low-value services can be incorporated into clinical practice without compromising quality, safety, and patient outcomes. Sustainability efforts in urology can be aligned with economic realities to be effective and scalable. Strategies that reduce environmental impact should consider cost, local market, and incentives within existing healthcare systems. Aligning ecological responsibility with economic value ensures that sustainable practices can be adopted without slowing clinical progress.

The development of digital solutions has a direct impact on the modern understanding of the future of urology. Augmented reality is no exception. Specialists use it for intraoperative navigation, which positively impacts procedure metrics, especially in endoscopic surgery for stones. This review aims to determine the chronology of this technology's development and its current trends in endourologists' routine practice. In 2023-2025, studies confirmed the clinical benefits of augmented reality navigation, including reduced puncture time and decreased complication rates. At the same time, the development of intelligent systems with ultrasound/computed tomography (CT) fusion and deep learning has taken augmented reality from visualization to active optimization of the accuracy and safety of interventions. In retrograde surgery, spatial navigation and instrument tracking, complemented by cognitive-oriented and gaze-based systems, have become key areas of focus, paving the way for objective assessment of surgeons' visual strategies and personalized training. Augmented reality (AR) and mixed reality (MR) are rapidly transforming endoscopic surgery for urolithiasis: in percutaneous nephrolithotripsy (PCNL), these technologies have already reached clinical maturity as navigation tools, while in ureteroscopy (URS) and retrograde intrarenal surgery (RIRS), they are emerging as powerful cognitive and navigation platforms. Despite differences in current application scenarios, both trajectories converge toward a common goal: to make key stages of stone treatment measurable, reproducible, and less dependent on the individual experience of the surgeon. The integration of augmented reality with real-time visualization, artificial intelligence, and attention tracking systems is likely to redefine the standards of accuracy and quality in endourology in the coming years.

Sexual and gender minority (SGM) populations face persistent inequities in urological care, stemming from stigma, biased frameworks, and inadequate clinician training. This review synthesizes current evidence on SGM-specific urological needs and highlights the importance of equity-oriented approaches to improve clinical outcomes and patient experiences. Across the urological care continuum, SGM populations experience lower cancer screening uptake, delayed diagnosis, poorer treatment-related quality of life, and unmet survivorship needs compared with cisgender and heterosexual populations. Traditional equality-based clinical guidelines frequently fail to account for anatomical diversity, gender-affirming hormone therapy, prior gender-affirming surgery, and psychosocial contexts that influence access to care and outcomes. In transgender and gender-diverse individuals, inconsistent application of organ-based screening, limited guidance following gender-affirming surgery, and under-recognition of long-term urological morbidity exacerbate inequities. Sexual and reproductive health needs, including trauma-informed care, fertility preservation, and inclusive approaches to sexual function, remain insufficiently integrated into routine urological practice. These disparities are reinforced by gaps in clinician knowledge and competence, limited collection of sexual orientation and gender identity data, and restrictive sociopolitical contexts. Equitable urological care for SGM populations requires moving beyond uniform, equality-based models toward anatomy-aware, affirming, and patient-centered care. Integrating equity principles into urological practice, education, research, and institutional policies is essential to improving outcomes and quality of care for SGM populations.

Health equity has emerged as a priority in urology, as disparities in access to care and health outcomes are driven by social, structural, and geographic factors. Women living in rural communities represent a particularly vulnerable population, given the high prevalence of chronic urologic conditions that impact quality of life and require longitudinal management. Conditions such as urinary incontinence, overactive bladder, recurrent urinary tract infections, and pelvic organ prolapse are common among women yet remain under-recognized and undertreated in rural settings. Rural women face multiple, interrelated barriers to urologic care, including geographic isolation, workforce shortages, limited health infrastructure, financial constraints, and sociocultural factors influencing care-seeking behavior. These barriers contribute to delayed diagnosis, persistent symptom burden, and diminished quality of life. Careful initiatives including telemedicine, mobile outreach, workforce development, and policy reform may help to reduce these inequities over time. This review examines disparities in women's urologic health in rural settings, focusing on the epidemiology, key barriers to care, and consequences of inequity. Emerging strategies to improve access and outcomes for rural women to improve care delivery are highlighted. Advancing health equity will ultimately require coordinated efforts across clinical practice, health systems, and policy domains.

Urinary tumor DNA (utDNA) has emerged as a promising noninvasive biomarker that may complement or reduce the need for cystoscopies in the diagnosis, surveillance, and treatment monitoring of urothelial carcinoma. Unlike plasma circulating tumor DNA (ctDNA), which is heavily diluted by hematopoietic cell-derived DNA, utDNA originates directly from tumor cell shedding into urine and often appears at higher concentrations, improving molecular detection. While there is an increasing number of publications using utDNA with promising results, most of these studies were developed from a laboratory perspective, making it difficult to find a direct clinical application. This review aims to apply a clinical perspective for potential daily practice use of utDNA testing. This review summarizes the most recent literature on the potential clinical use of utDNA for diagnosis, follow-up, and response to treatment in nonmuscle-invasive bladder cancer, muscle-invasive bladder cancer, and upper tract urothelial carcinoma. There is accumulating evidence on the potential use of utDNA for the diagnosis of urothelial carcinoma in the bladder as well as in the upper tract, while preliminary studies show promising results with sensitivities around 80-90% and specificities 90-100%, further research is needed.

This review outlines a pathology-driven framework that integrates morphology, immunophenotype, and molecular profiling to inform personalized treatment strategies in renal cell carcinoma (RCC), particularly with immunotherapy and tyrosine kinase inhibitors (TKIs). Systemic therapy for RCC has progressed from cytokine-based regimens to VEGF-targeted TKIs and, more recently, immune checkpoint inhibitors (ICIs), alone or in TKI combinations, resulting in improved survival. Yet, reliable predictive biomarkers remain an unmet need. Programmed death-ligand 1 (PD-L1) expression, while biologically relevant, offers limited clinical utility, as ICI responses occur in both PD-L1-positive and -negative tumors. Tumor microenvironment features (e.g., T-effector and myeloid inflammation signatures) and genomic alterations (e.g., PBRM1 , BAP1 , SETD2 ) provide biological and prognostic insights, but have inconsistent predictive value. Pathology remains essential for accurate histologic classification, grading, and assessment of adverse features such as sarcomatoid changes and necrosis. Molecular profiling is increasingly helpful in non-clear cell RCC, guiding targeted therapies in subtypes such as MET-driven papillary RCC. Emerging tools (liquid biopsy, spatial transcriptomics, and AI-assisted pathology) offer minimally invasive monitoring, refined immune profiling, and multiparametric biomarker integration to advance precision oncology in RCC.

The expanding range of minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) reflects a growing emphasis on individualized, anatomy-driven treatment that prioritizes symptom relief, reduced morbidity, and preservation of sexual function. This review provides a timely synthesis of MISTs, highlighting innovations in technique, key anatomical considerations, and evolving strategies for patient-centered care in the modern clinical setting. Recent studies highlight the expanding role of MISTs, such as UroLift, Rezūm, the temporary implanted nitinol device, Optilume BPH, transperineal laser ablation, and prostatic stents. Each modality shows distinct performance characteristics depending on factors such as prostate volume, intravesical prostatic protrusion, bladder neck configuration, and the presence of a median lobe. Increasing attention has also been given to preserving antegrade ejaculation, which is often a high priority for younger or sexually active patients. Concurrently, new decision aid tools are in development to support shared decision-making in concordance with patient values and treatment preferences. MISTs represent a diverse and maturing set of therapeutic options. Optimizing their use requires detailed anatomical assessment and thoughtful, individualized decision-making to align treatment with patient goals, preserve function, minimize morbidity, and reflect contemporary evidence-based standards in BPH management.

Personalised medicine has rapidly reshaped the management of urothelial carcinoma, driven by advances in tumour genomics, immune profiling and targeted drug development. This review is timely as multiple biomarker-driven therapies have recently entered routine clinical practice across disease stages, necessitating an integrated appraisal of how precision approaches should be applied and sequenced in contemporary care. Key advances include the expanding role of immune biomarkers beyond PD-L1, such as tumour mutational burden and DNA damage response alterations, to refine the use of immune checkpoint inhibitors. FGFR3 alterations represent the first validated genomic target in urothelial carcinoma, with FGFR inhibitors now established treatment options. Antibody-drug conjugates targeting Nectin-4 and HER2 have demonstrated substantial clinical activity, redefining treatment paradigms in both first-line and refractory settings. In parallel, circulating tumour DNA has emerged as a powerful dynamic biomarker for minimal residual disease detection and adjuvant treatment selection. Urothelial carcinoma has transitioned into a biomarker-driven disease, enabling more precise, biologically informed treatment decisions. Integrating genomic, immunologic and liquid biopsy biomarkers will be essential to optimise patient selection, treatment sequencing and toxicity management, and represents a critical direction for future research and clinical practice.

Kidney stone disease (KSD) is heritable and genetic testing is becoming increasingly relevant to its management. However, it is unclear who should be offered genetic testing and what these investigations should entail. This review gives an overview of the existing evidence and future directions. In highly selected cohorts, genetic testing for monogenic disease can yield high diagnostic rates. These diagnoses can facilitate genetic counselling, familial testing, and targeted medical therapies.Our understanding of the role of rare intermediate effect size and common low effect size genetic variants is evolving. The clinical utility of polygenic risk scores and genetic sequencing in unselected cohorts remains uncertain. Genetic testing for monogenic KSD is advised in individuals with a strong family history and with recurrent stones. There is a need for large-scale studies, including in urology settings, to determine optimal criteria for patient selection in real world settings. Further research is required to define the role of genetic testing, including polygenic risk scores, in risk prediction, personalised management, and disease recurrence.

Ureteral stents are an integral part of daily urological clinical practice, but in case of ureteral stents inadvertently left in place or forgotten, they can lead to a range of complications. Managing retained DJ stents presents a complex challenge for urologists, involving various aspects such as surgery, legal implications, and financial factors both for the patient as for the health system. Ensuring proper follow-up of patients poses a significant challenge even in nowadays in everyday clinical urological practice as it involves efficient urologist-patient communication. In modern society, smartphones have become an essential part of daily lives, providing a convenient and reliable way to store and access information through certain applications. Is it the best way to go for stent tracking? We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library and Scopus and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The tracking mechanisms include electronic medical records algorithms, mobile or chat applications, and computer-based applications. Prior to the implementation of a tracking system, hospitals experienced varying rates of stent loss or delayed removal, ranging from 0% to 13%. Through the implementation of a tracking mechanism, the occurrence of lost or delayed removal has been significantly reduced to 1%. Stent tracking systems have proven to be highly effective in reducing the incidence of delayed removal of ureteral stents. Nevertheless, the widespread applicability of these systems is limited due to their primarily tailored design for institutions, while before implementing their use as a standard of care, more solid data through randomized trials is needed.

While robot-assisted surgery has rapidly expanded within reconstructive urology, debate persists regarding where it can be applied most effectively and where open surgery remains the more suitable option. The question is no longer whether robot-assisted reconstruction is feasible, but rather when it represents the most appropriate approach. Recent evidence indicates that both open and robot-assisted techniques achieve comparable short-term outcomes in the management of vesicourethral anastomotic stenosis, despite addressing a highly heterogeneous condition. Similarly, robot-assisted intracorporeal radical cystectomy offers no demonstrable advantage over open radical cystectomy with respect to key clinical outcomes. A notable emerging trend is the decline in continent urinary diversions, possibly reflecting the technical challenges of robot-assisted intracorporeal reconstruction and evolving institutional preferences. Open surgery remains the standard for perineal and external genital reconstructive procedures, whereas robot-assisted approaches are best suited for transabdominal reconstructions. Deep vesicourethral anastomotic stenoses involving the external sphincter should be managed through an open transperineal approach. Notably, during the decade of widespread robotic adoption, the rate of continent urinary diversions has declined significantly.

Urethral complications remain a major source of morbidity following gender-affirming genital surgery, particularly in the setting of masculinizing procedures requiring urethral lengthening. This review summarizes recent advances in the epidemiology, prevention, and reconstructive management of urethral complications, with a focus on principles relevant to reconstructive urologists. Urethral complications are uncommon after feminizing genital surgery but occur frequently following masculinizing surgery, with pooled rates of strictures and fistulae approaching 50% after phalloplasty. Recent studies emphasize the heterogeneity of these complications, highlighting the importance of timing, anatomical location, and surgical technique. Improved classification systems, such as the Montréal classification, aim to standardize reporting. Preventive strategies - including careful patient selection, expectation management, hair removal protocols, optimized flap design, tissue interposition, and staged reconstruction - are increasingly recognized as critical but remain underreported. Reconstructive management must be individualized, as outcomes are influenced by tissue vascularity and prior interventions. Staged urethroplasty appears to offer the most durable results for complex strictures, while prolonged urinary diversion may allow conservative resolution of selected fistulae. Urethral complications after masculinizing gender-affirming genital surgery are common and complex. Emphasis on prevention, standardized reporting, and individualized reconstructive strategies is essential to improve long-term urinary outcomes.

Although urethral stricture is not highly prevalent, it remains a persistent reconstructive challenge due to its risk of recurrence despite advances in surgery. In parallel, experimental and translational research has expanded rapidly, particularly in animal modelling, fibrosis biology, and tissue engineering. This review highlights recent and clinically relevant developments in experimental and translational models of urethral stricture disease, with emphasis on reproducibility, biological relevance, and translational potential. Recent studies have refined experimental urethral stricture models by prioritizing standardization, reproducibility, and functional assessment. Human molecular profiling has improved understanding of fibrotic mechanisms and helped anchor experimental findings to clinical disease. Tissue engineering has shifted from passive structural replacement toward biologically active and adaptive biomaterials designed to modulate the regenerative microenvironment. While several approaches show promise in large animal models and early clinical studies, translation remains limited and heterogeneous. Experimental and translational research has generated important insights into urethral stricture disease and introduced innovative regenerative strategies. However, increasing experimental sophistication has not yet translated into clear clinical benefit. Approaches that combine reproducibility, functional relevance, and surgical practicality are most likely to impact future clinical practice, while cautious interpretation of early translational and clinical data remains essential.

Population ageing is changing everyday urological practice. The number of older adults is increasing, and urology already treats a patient population that is, on average, older than the general population. Consequently, older adults with urolithiasis represent a core part of contemporary endourological practice. Given this, a focused review of the available evidence is valuable to inform clinical practice. A peak in stone disease can occur in older adults who may also be less likely to present with the classical features of renal colic. As such, delayed or missed diagnosis may carry greater clinical consequences. Although the literature remains relatively limited, ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy remain feasible options in appropriately selected older adults. In this group in particular, broader health associations merit consideration, as the presence of urolithiasis in older adults may reflect overall health status in later life. The burden of urolithiasis in older adults is increasing and now represents a routine component of everyday clinical practice. Clinical presentation may differ from that seen in younger "index" patients, and complications may have a greater impact on recovery and function. Management should therefore be individualized, taking into account comorbidity, frailty, functional status, and the patient's own priorities.

Despite increasing awareness, female urethral stricture (FUS) lacks standardization of definition, diagnostic criteria, and specific treatment algorithm. This review summarizes recent advances in diagnosis, treatment modalities, and surgical outcomes reporting. The main challenges of diagnosing FUS are its nonspecific symptoms and overlapping differential diagnoses. Although a urethral caliber <14 French is commonly used, this threshold lacks diagnostic reliability. Emerging modalities, including translabial ultrasound, appear promising, but endoscopic confirmation remains essential. Urethroplasty has increasingly replaced urethral dilations in recurrent and primary FUS. Various graft materials demonstrate comparable short-term to mid-term success rates, though differences exist in donor-site morbidity, operative time, and anatomical suitability. Dorsal and ventral graft placements yield similar outcomes, with technique selection influenced mostly by stricture location and surgeon experience. Minimally invasive approaches emerge, including transurethral urethroplasties and drug-coated balloon dilation, expanding treatment options. Overall, heterogeneity in outcome measures hinders comparability across studies, underscoring the need for standardized definitions and validated PROMs to assess functional recovery. Efforts should be made to achieve homogeneity in definitions of FUS, diagnostic and treatment algorithms, and postoperative follow-up protocols. Standardization of the outcome measures following FUS repair by integrating objective micturition parameters and validated PROMs is crucial.

Burst wave lithotripsy (BWL) has emerged as a novel noninvasive approach for urinary stone management, aiming to overcome key limitations of conventional shock wave lithotripsy, including variable efficacy, pain, and tissue injury. This review examines the growing body of experimental and early clinical evidence evaluating BWL as a noninvasive, anesthesia-sparing option for urinary stone management. Recent experimental, preclinical, and first-in-human studies demonstrate that BWL can achieve efficient stone fragmentation across a range of compositions with controllable fragment size through frequency modulation. Clinical studies report high rates of stone comminution, favorable fragment profiles, and excellent tolerability in awake patients, with predominantly low-grade adverse events. Integration with ultrasonic propulsion has further improved fragment clearance and stone-free outcomes. Preclinical data also suggest a favorable renal safety profile, including in anticoagulated models. Current evidence supports BWL as a promising complementary technology for selected patients with renal and ureteral stones, offering truly noninvasive, patient-centered care. Ongoing trials will clarify its role within treatment algorithms and define optimal indications and workflows.

People experiencing homelessness (PEH) remain an understudied and underserved population in cancer care, particularly regarding access to urologic cancer treatment. This review aims to examine barriers and facilitators PEH encounter when accessing treatment for urologic malignancies. PEH are found to have increased odds of delayed or disrupted urologic oncological treatment and experience deviations from guideline-based therapy. Problems arise in treatment coordination and organisation, with communication and logistical challenges posing major barriers. Comorbidities and disadvantaged insurance status further exacerbate disparities. The lack of documented reasons for treatment interruptions limits the ability to clarify individual patient needs. Person-centred therapy, housing provision, and additional resources act as facilitators. Among the five included studies, two assessed treatment adherence, one evaluated inpatient care delivery for hospitalised PEH, one explored links between housing status, diagnostic stage, and mortality after diagnosis, and one examined time-to-treatment. Present findings indicate an association between housing instability and insufficient care along the urologic cancer pathway. Delayed or distorted therapy, persisting bias and stigma, and personal problems contribute to inequities in the received care. Proposed facilitators range from housing interventions, multidisciplinary and person-led care, to treatment adaptations and participatory approaches in therapy and future research.