Prostate cancer is among the most common cancers worldwide, with ~1.5 million new diagnoses globally every year. The sheer mass of data becoming available on prostate cancer, as well as other types of cancer, is increasi...Prostate cancer is among the most common cancers worldwide, with ~1.5 million new diagnoses globally every year. The sheer mass of data becoming available on prostate cancer, as well as other types of cancer, is increasing exponentially. The growth of digital pathology has particularly sparked interest in developing artificial intelligence (AI) approaches to data synthesis to predict cancer grade and outcomes in men with prostate cancer. Progress has been made in this field, particularly in applications for diagnosis, prognosis and inferring molecular alterations, but several challenges remain. Variability in tissue processing and scanning contribute to dataset heterogeneity. The absence of well-annotated, multi-institutional databases hinders AI model development and generalization of model performances across clinical settings. Regulatory frameworks for AI-driven diagnostics remain nascent. Moreover, bias in training datasets skewing against under-represented demographic groups poses a fundamental challenge to developing equitable models. By mapping contemporary evidence around each of these hurdles and identifying tangible interventions, we can advance AI-augmented digital pathology towards reliable and generalizable tools to improve prostate cancer care.
Nat Rev Urol
· 2025 Dec · PMID 40751081
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Urinary tract infections are one of the most common infections, accounting for ~400 million diagnoses per year worldwide. Uncomplicated urinary tract infections (uUTIs) occur in healthy individuals with no structural or...Urinary tract infections are one of the most common infections, accounting for ~400 million diagnoses per year worldwide. Uncomplicated urinary tract infections (uUTIs) occur in healthy individuals with no structural or functional abnormalities of the urinary system and primarily affect women. Catheter-associated urinary tract infections (CAUTIs) are a type of complicated UTI affecting patients who have a urinary catheter in place, often hospitalized patients or patients with conditions that prevent them from urinating naturally. Both infections share common symptoms, diagnostics and treatment options but also differ greatly in pathophysiology, aetiology, risk factors and comorbidities. These differences could explain why antibiotic treatments - which generally lead to positive outcomes in patients with uUTIs - often fail in patients with CAUTIs. Understanding these differences could guide evidence-based insights into why treatments for CAUTIs should be different from those for uUTIs, specifically, by modifying catheters, which initiate the damage-induced segue for UTIs.
The incidence of urolithiasis is increasing globally, with a prevalence of 13% in North America and 9% in Europe. Ureteroscopy is a minimally invasive approach for treating conditions affecting the upper urinary tract, i...The incidence of urolithiasis is increasing globally, with a prevalence of 13% in North America and 9% in Europe. Ureteroscopy is a minimally invasive approach for treating conditions affecting the upper urinary tract, including urolithiasis, for which its efficacy and safety is well recognized. There is a risk of complications associated with ureteroscopy, including iatrogenic mechanical ureteric injuries. These injuries are multifactorial in nature, with ureteroscopes and auxiliary endoscopic equipment having an important role, in addition to patient and stone factors. Excessive friction and insertion forces during ureteroscope and ureteric access sheath insertion, apparatus malfunction or thermal injuries during laser lithotripsy might cause injury to the upper urinary tract. Ureteric avulsion is a serious event, which necessitates further intervention such as ureteric reimplantation or nephrectomy. Ureteric mucosal injuries can be managed with a period of ureteric stenting, although stent-related symptoms can be challenging for patients. The ability of endoscopic equipment to injure the ureter is an area that requires further study to reduce incidence and minimize patient morbidity. In this article, we review the operative mechanisms that contribute to iatrogenic mechanical ureteric injuries and discuss preventative strategies.
Cellular plasticity, the ability of cells to reprogramme and alter their fate, has a pivotal role in maintaining homeostasis and facilitating tissue regeneration after injury. The bladder urothelium, a dynamic transition...Cellular plasticity, the ability of cells to reprogramme and alter their fate, has a pivotal role in maintaining homeostasis and facilitating tissue regeneration after injury. The bladder urothelium, a dynamic transitional epithelial layer, displays a highly plastic phenotype that enables its remarkable regenerative capacity in response to wounding. During both development and repair, urothelial cells exhibit considerable plasticity through processes such as dedifferentiation, transdifferentiation and epithelial-to-mesenchymal transition. Urothelial plasticity is not only crucial for healthy tissue repair but is also involved in pathological conditions, including cancer. In bladder tumorigenesis, urothelial cells exploit plasticity to acquire new phenotypic and functional characteristics, transitioning between distinct cellular states. This plasticity contributes to tumour heterogeneity, subtype switching, progression, metastasis and resistance to therapies. These dynamic cellular transitions are regulated by intrinsic and extrinsic factors, including transcriptional and epigenetic mechanisms, as well as microenvironmental influences. Targeting urothelial plasticity could offer novel therapeutic strategies for bladder-related diseases.
Edenfield RC, Bash JC, Shorey-Kendrick LE
… +9 more, D'Mello RJ, Rice-Stitt TL, Hagen OL, Graham JA, Orwig KE, Easley CA, Hedges JC, Hanna CB, Lo JO
Nat Rev Urol
· 2025 Nov · PMID 40624316
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Male fertility is complex and influenced by genetic, hormonal, environmental and lifestyle factors. However, limitations to human studies necessitate the use of reliable preclinical models to better understand the underl...Male fertility is complex and influenced by genetic, hormonal, environmental and lifestyle factors. However, limitations to human studies necessitate the use of reliable preclinical models to better understand the underlying mechanisms of male fertility. Rhesus macaques (Macaca mulatta), with their close genetic and physiological similarities to humans, offer an invaluable model for male reproductive health studies. The suitability of rhesus macaques for studying male infertility is based on similarities in spermatogenesis, hormonal cycles and the way in which assisted reproductive technologies can be applied, and key differences and similarities between human and rhesus macaque sperm structure, function and cryopreservation techniques highlight the translational potential of findings derived from macaque models. Furthermore, insights into the epigenetic and proteomic characteristics of sperm in both species improve understanding of how these findings can help to advance clinical diagnostics, male contraception and fertility preservation and illuminate the regulatory omics of normal reproduction. Thus, the rhesus macaque model offers critical insights into male fertility and studies in this species could contribute to advances in therapies for male infertility.
Non-clear cell renal cell carcinomas (nccRCC) include diverse subtypes such as papillary, oncocytic and chromophobe, collecting duct, molecularly defined and other rare histological subtypes, each associated with unique...Non-clear cell renal cell carcinomas (nccRCC) include diverse subtypes such as papillary, oncocytic and chromophobe, collecting duct, molecularly defined and other rare histological subtypes, each associated with unique clinical, pathological, genetic and molecular features as well as therapeutic challenges. Surgical resection remains the primary approach for the treatment of localized nccRCC but optimal outcomes depend on tumour stage and the patient's overall health. Clinically established treatment guidelines tailored for patients diagnosed with nccRCC are limited owing to the molecular and histological heterogeneity of nccRCC. Progress has been made in systemic therapy for metastatic disease but nccRCC treatment still poses challenges as patients experience variable treatment responses to immunotherapy, targeted therapies, chemotherapy and some combination strategies. Molecular biomarkers as well as established techniques, such as immunohistochemical and genetic analysis, have a crucial role in early detection, prognosis prediction and personalization of targeted therapies for nccRCC. The increasing identification of potential signatures and actionable molecular targets will aid in the clinical decision-making for patients diagnosed with these rare tumours towards optimization of the therapeutic response and treatment outcomes.
Benedetti DJ, Cost NG, Ehrlich PF
… +15 more, Evageliou N, Fialkowski E, Parsons LN, Vallance KL, Renfro LA, Hong AL, Aldrink JH, Pater L, Paulino AC, Sandberg JK, Smith EA, Treece AL, Dome JS, Geller JI, Mullen EA
Nat Rev Urol
· 2025 Nov · PMID 40542227
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Patients with Wilms tumour have benefited from the results of decades of large collaborative clinical trials, leading to improved care. In the National Wilms Tumor Study Group and now Children's Oncology Group (COG) tria...Patients with Wilms tumour have benefited from the results of decades of large collaborative clinical trials, leading to improved care. In the National Wilms Tumor Study Group and now Children's Oncology Group (COG) trials, risk stratification evolved and expanded with each generation of studies and, therefore, ensuring that each patient receives the appropriate therapy has become increasingly complex. A new risk stratification system has been developed that forms the basis of the upcoming COG favourable-histology Wilms tumour (FHWT) study. Topics of diagnostic and prognostic uncertainty, such as the findings of tumour pulmonary emboli or extra-abdominal lymphadenopathy at diagnosis, will be integrated into the central review determination of staging of FHWT by committee consensus to facilitate clinical classification for therapeutic studies. Clear documentation of the elements of current risk stratification are of particular importance as refinement of the classification of patients with FHWT continues in an effort to optimize research, personalize treatment and provide an educational resource.
Declining fertility, overlooked mental health, and reduced life expectancy underscore the urgent need for renewed attention to men's health. A semen analysis, traditionally used to assess fertility, holds untapped potent...Declining fertility, overlooked mental health, and reduced life expectancy underscore the urgent need for renewed attention to men's health. A semen analysis, traditionally used to assess fertility, holds untapped potential as a tool for promoting lifestyle changes and preventing chronic diseases in men. Spermatogenesis is highly sensitive to environmental and lifestyle factors and can be an early indicator of overall health. Disruptions in this process can signal underlying systemic issues and predict long-term health risks, including cardiovascular disease and metabolic disorders. An increasing number of men seek to engage in preconception care, as fertility is closely tied to a man's sense of masculinity, identity and aspirations for fatherhood. In this context, a semen analysis can be a powerful motivator to encourage healthy behaviours and proactive health management. By incorporating semen analysis into primary care, health care providers can leverage men's desire for fatherhood as an entry point to discuss broader health concerns, such as mental well-being, nutrition and physical activity. This approach would address immediate reproductive health, and also promote long-term wellness, helping to reduce the burden of chronic disease in men.