Review Articles in 2021

Sperm analysis has a central role in diagnosing and treating male factor infertility. Emerging techniques have been developed that enable improved analysis of sperm motility, morphology and genetics to help overcome current limitations in accuracy and consistency, and improve sperm selection for infertility treatment.

The formation of kidney stones is governed by the same principles as other stone systems. These ‘diagenetic phase transitions’ that create human kidney stones reflect the environment within the kidney during stone formation and could, therefore, improve understanding of urolithiasis and enable future treatment development. In this wide-ranging and unique Review, the authors explain how kidney stone formation parallels that of other stone systems such as stony corals, travertine in Roman aqueducts, stalactites and agates, and describe how the new field of GeoBioMed could be harnessed to improve patient care.

In this Review, the authors discuss how machine learning can improve sperm selection, focusing on the near-term, achievable machine learning methods based on available assessments of selected sperm and the areas in which the most considerable gains are possible.

Non-metastatic CRPC (nmCRPC) is a heterogeneous, man-made disease stage that has received increased attention. Historically, few options were available to treat nmCRPC; however, three novel nonsteroidal antiandrogens, enzalutamide, apalutamide and darolutamide, are now available for men with this disease.

Devices designed to enhance and diversify sexual pleasure are useful in clinical practice; however, many taboos still seem to exist and the scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use is sparse. In this Review, Dewitte and Reisman discuss the clinical use of sex toys and sexual devices, as well as sexually explicit media, across a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties.

Incontinence is a common complication of radical prostatectomy and can have a considerable effect on quality of life for men who have survived prostate cancer. In the past, management of postoperative incontinence has focused on rehabilitation and postsurgical management, but prehabilitation, in the form of pelvic floor muscle exercises and training, has the potential to improve postprostatectomy continence outcomes, provide patients with agency for their own health and improve quality of life in men who have been treated for prostate cancer.

Ductal adenocarcinoma of the prostate is the most common variant histological subtype of prostate cancer. The diagnosis can be challenging and evidence for treatment is predominantly based on retrospective data. This Review discusses the histopathology, characteristics, treatment options and future molecular targets for treatment of this disease.

Survival of patients with metastatic prostate cancer has improved with the approval of second-generation androgen receptor antagonists. This Review discusses common genomic alterations leading to inevitable resistance to this therapy, and potential alternative therapeutic targets for treatment.

Asia is traditionally considered to have a low incidence of prostate cancer, but the incidence and mortality of prostate cancer have rapidly increased across the continent. Taking into account this intracontinental and intercontinental heterogeneity, translational studies are required in order to develop ethnicity-specific treatment strategies.

Currently, ~95% of patients with testicular germ cell tumour are cured. Although cured, these men face potential late adverse effects and reduced quality of life. This Review outlines these adverse effects with recommendations on how to minimize their severity.

Prostate cancer lends itself to gene therapies, and multiple aspects of prostate cancer care make gene therapy an appealing treatment option for this common malignancy. Although laboratory and preclinical advances have not yet resulted in oncologically relevant outcomes in the clinic, future studies offer great promise for gene therapy to become established in prostate cancer treatment.

Accurate selection of patients with low-risk prostate cancer for active surveillance relies upon conventional clinical staging and grading criteria. New approaches in imaging as well as novel serum-, urine- and tissue-based biomarkers have been developed to reduce initial misclassification and predict risk of disease progression.

Transient receptor potential (TRP) channels have an important role in sensory mechanisms of the lower urinary tract. Vanneste et al. discuss the involvement of TRP channels in normal and abnormal bladder sensations and their potential as therapeutic targets.

Many patients with muscle-invasive bladder cancer are currently excluded from cisplatin-based neoadjuvant chemotherapy owing to renal impairment. Here, Jiang and colleagues present an update on cisplatin-induced nephrotoxicity in muscle-invasive bladder cancer and highlight a multidisciplinary and patient-centred approach to treatment decision-making.

Surgical ergonomics in urology has been understudied and underemphasized. This Review characterizes the burden of musculoskeletal injury in urologists and focuses on various ergonomic considerations relevant to the urology surgeon.