When patients with congenital genitourinary conditions transition to adult care, they encounter multiple challenges, including management of multiple complex medical needs, understanding and navigating the healthcare sys...When patients with congenital genitourinary conditions transition to adult care, they encounter multiple challenges, including management of multiple complex medical needs, understanding and navigating the healthcare system, and reconciling their condition with their social and psychological development. These issues translate directly into inferior short-term and long-term health outcomes, including increased emergency room visits after 18 years of age, persistent bothersome urinary symptoms, reduced quality of life and lack of appropriate urological management into adulthood. Conversely, smooth care transition enables improved age-appropriate subspecialty care and eases the burden of care on paediatric care providers. Transitional urology aims to aid adolescents and young adults, particularly those with complex healthcare needs, in successfully transitioning from paediatric to adult care. Transitional urology is one of the top ten highest-priority research topics in urology, but the existing body of research regarding transitional care remains relatively small. Knowledge and understanding of this patient population, including models of care, quantitative assessment of transition, stakeholder perspectives, common clinical challenges and barriers to establishing and maintaining transitional care programmes, can inform transitional care. Avenues of future transitional urology research include outcomes-based studies for specific pathologies, comparisons of different care implementation models, creation and evaluation of training opportunities and validation of resources created for non-urologic care team members. An idealized transition schema is proposed as both an example and guide to ground recommendations and data.
Nat Rev Urol
· 2026 May · PMID 42103924
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Patient outcomes after robotic surgery vary widely, often reflecting differences in surgical performance. Artificial intelligence (AI) offers new ways to address this variability, with applications spanning automated ski...Patient outcomes after robotic surgery vary widely, often reflecting differences in surgical performance. Artificial intelligence (AI) offers new ways to address this variability, with applications spanning automated skills assessment and feedback, intraoperative guidance and autonomous surgery. The most credible short-range advances of AI in this space consist in generating assistive systems that enhance perception, anticipate risks and standardize feedback while remaining under surgeon control. Results from early studies suggest that AI can influence decision-making, reduce errors and shorten learning curves, particularly in areas such as augmented navigation, anatomy recognition, error detection and telesurgery support. Long-term directions include emerging vision-language-action interfaces capable of programming task-specific support through natural language. In addition to technical performance, translation of AI into clinical practice will require robust datasets, systems designed around human users, regulatory alignment and clear accountability. Ultimately, the measure of surgical AI will be patient outcomes, including reduced complications, fast proficiency acquisition and improved outcome consistency across diverse settings.
The understanding of oligometastatic prostate cancer has advanced substantially in the past two decades, reshaping both diagnostic and therapeutic paradigms. The advent of next-generation imaging, particularly prostate-s...The understanding of oligometastatic prostate cancer has advanced substantially in the past two decades, reshaping both diagnostic and therapeutic paradigms. The advent of next-generation imaging, particularly prostate-specific membrane antigen PET-CT, has improved staging accuracy, enabling patients with limited metastatic burden who might benefit from intensified local and metastasis-directed approaches to be identified. Results from randomized phase II trials support the use of metastasis-directed therapy in patients with metachronous oligometastatic prostate cancer. However, evidence for metastasis-directed therapy in de novo presentations remains preliminary but encouraging. In parallel, prostate-directed treatments such as radiotherapy and cytoreductive radical prostatectomy are under active investigation, although the role of these approaches in the era of intensified systemic therapy is yet to be fully defined. Although interest around oligometastatic prostate cancer is growing, several issues are currently unsettled, including a unified definition of oligometastatic prostate cancer; the inclusion of biological information in patient selection; optimal treatment sequencing, including the integration and duration of systemic therapy; and appropriate clinical end points.
The management of neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury is defined by the compounding interaction between prostate enlargement, neurogenic detrusor overactivity and detrusor-sph...The management of neurogenic lower urinary tract dysfunction in ageing men with spinal cord injury is defined by the compounding interaction between prostate enlargement, neurogenic detrusor overactivity and detrusor-sphincter dyssynergia. The effects of spinal cord injury and an ageing bladder create unique challenges, including a 16-28-fold increased risk of urinary bladder cancer and a high prevalence of catheter-related complications. Importantly, although clean intermittent catheterization is the gold standard for treating lower urinary tract dysfunction, in many elderly patients, functional decline forces a transition to indwelling catheters, necessitating a shift in care strategy. Furthermore, prostate procedures such as transurethral resection of the prostate (TURP) and holmium laser enucleation, which are commonly carried out in older men, carry an increased risk of complications, including autonomic dysreflexia. Integrated, age-stratified guidelines are currently missing. Thus, a proactive, patient-centred framework for lifelong urological care is needed and should incorporate frailty assessments, sophisticated diagnostics to disentangle detrusor sphincter dyssynergia from prostate enlargement, and personalized management pathways to preserve renal function and quality of life.
Contieri R, Gontero P, Hurle R
… +55 more, Afferi L, Albisinni S, Babjuk M, Birtle A, Black P, Brausi M, Bruins M, Čapoun O, Carrion A, Catto J, Choudhury A, Cimadamore A, Comperat E, Daneshmand S, D'andrea D, Del Giudice F, Escrig JLD, Hensley P, Krajewski W, Laukhtina E, Li R, Liedberg F, Lotan Y, Marcq G, Mariappan P, Mari A, Martini A, Lecomte AM, Meijer R, Mir MC, Mori K, Moschini M, Mostafid H, O'Donnell M, Palou J, Panebianco V, Perdonà S, Porten S, Psutka S, Rink M, Roupret M, Seisen T, Soloway M, Soukup V, Steinberg G, Stenzl A, Teoh JY, Tully K, van der Heijden T, van Rhijn BWG, Witjes A, Xylinas E, Kamat AM, Pradere B, Mertens LS
Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting...Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials.
Extrachromosomal DNA (ecDNA) has emerged as a major driver of genomic instability and rapid tumour evolution in urothelial carcinoma. In urothelial carcinoma, ecDNA amplifies oncogenes, reshapes 3D chromatin interactions...Extrachromosomal DNA (ecDNA) has emerged as a major driver of genomic instability and rapid tumour evolution in urothelial carcinoma. In urothelial carcinoma, ecDNA amplifies oncogenes, reshapes 3D chromatin interactions, reprogrammes transcription and modulates the tumour-immune interface. Together, these features fuel intratumour heterogeneity, accelerate APOBEC3-associated mutational evolution and contribute to aggressive disease. Advances in sequencing and imaging technologies have greatly expanded our understanding of ecDNA biology. Importantly, ecDNA can be detected through non-invasive liquid biopsies, including urine and plasma, and inferred from standard histopathology slides via digital pathology. These observations suggest that ecDNA could be a valuable adjunct biomarker, enhancing current strategies for early detection, patient stratification and dynamic monitoring of treatment response.