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 not...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.
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 t...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.
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, cardiov...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 VO 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.
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...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.
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 appro...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.
Biasatti A, Soputro NA, Porpiglia F
… +56 more, Perdonà S, Abdollah F, Nelson R, Rogers C, Zhao LC, Ghazi A, Challacombe B, Eden C, Mattei A, Fankhauser CD, Breda A, Rocco B, Montorsi F, Briganti A, Pellegrino AA, Mottrie A, De Groote R, Haese A, Graefen M, Moschovas MC, Patel V, Simone G, Galfano A, Secco S, Bertolo R, Pandolfo SD, Pansadoro V, Carvalho FLF, Joseph JV, Ramadan M, Shakuri-Rad J, Yuh B, Nix J, Lee DI, Rais-Bahrami S, Hemal S, Eltemamy M, Beksac AT, Schwen Z, Su LM, Buscarini M, Palese M, Tewari A, Wiklund P, Cherullo EE, Vourganti S, Linehan JA, Wu Z, Stifelman M, Ahmed M, Mehrazin R, Badani K, Link RE, Crivellaro S, Kaouk J, Autorino R
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-sit...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.
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 h...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.
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. Blad...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.
Raggi D, Crupi E, Pederzoli F
… +16 more, Martini A, Briganti A, Alhalabi O, O'Donnell PH, Ross J, Gupta S, Kamat AM, Faltas BM, Black PC, Spiess PE, Grivas P, Gao J, Apolo AB, Huddart RA, Necchi A, Galsky MD
Human epidermal growth factor receptor 2 (HER2) has emerged as a crucial biomarker across various cancers, shaping therapeutic strategies and prognostic evaluations. In urothelial carcinoma, HER2 positivity rates can rea...Human epidermal growth factor receptor 2 (HER2) has emerged as a crucial biomarker across various cancers, shaping therapeutic strategies and prognostic evaluations. In urothelial carcinoma, HER2 positivity rates can reach up to 68% when HER2-low tumours (immunohistochemistry 1+) are included in the analysis. HER2 overexpression and ERBB2 genomic alterations have been linked to advanced disease stages and poor outcomes in urothelial carcinoma. Emerging evidence suggests that HER2-low tumours might be a distinct and actionable subgroup. Accurate and consistent assessment of HER2 status is increasingly vital to identify patients likely to benefit from HER2-targeted therapies, raising interest in refining thresholds for HER2 expression, aiming to predict treatment response. HER2 heterogeneity across stages and histological subtypes complicates its evaluation, with definitions of HER2 positivity differing between clinical trials and treatments. In urothelial carcinoma, HER2-targeted therapies, such as tyrosine kinase inhibitors, monoclonal antibodies and antibody-drug conjugate (ADCs) have been explored. Unlike tyrosine kinase inhibitors and monoclonal antibodies, which act through HER2-related pathways, ADCs use HER2 as a target but achieve efficacy through additional mechanisms, enabling their activity even at low HER2 expression levels. Trastuzumab deruxtecan, a novel anti-HER2 ADC, has received FDA tumour-agnostic approval for unresectable or metastatic HER2+ solid tumours, including urothelial carcinoma, after prior therapies. Interactions between HER2 protein and putative biomarkers such as EGFR, NECTIN4, PDL1 and FGFR3 genomic alterations might influence therapeutic outcomes, offering opportunities for improved patient selection and innovative combination strategies.
Considering the increasing prevalence of sexually transmitted infections, accurate diagnosis and management based on the diverse dermatological presentations of sexually transmitted infections are crucial. A strong visua...Considering the increasing prevalence of sexually transmitted infections, accurate diagnosis and management based on the diverse dermatological presentations of sexually transmitted infections are crucial. A strong visual diagnostic skill set guides clinicians towards prompt recognition, directs appropriate diagnostic testing and enables timely initiation of treatment. This procedure in turn helps to interrupt infection transmission and mitigate long-term complications. Thus, incorporating visual learning and a dermatological perspective into urology training is essential, empowering urologists to make a difference in improving sexual health outcomes and supporting public health efforts.