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  • Reliable information about sexual and reproductive health and service access during coronavirus disease 2019 (COVID-19) are essential. The International Sexual Health and Reproductive Health (I-SHARE) study is led by a multi-country consortium that adopts an open science approach to achieve this goal. Future work will be needed to assess changes in sexual and reproductive health during the lifting of COVID-19 restrictions.

    • Rayner K. J. Tan
    • Kristien Michielsen
    • Joseph D. Tucker
    Comment
  • Limited information exists regarding the effects of prostate cancer therapies on sexual health outcomes in sexual and gender minority patients. As clinicians, scientists and advocates, understanding these outcomes is imperative in order to enable personalized clinical decision-making and to create a more equitable health system.

    • Daniel R. Dickstein
    • Deborah C. Marshall
    Comment
  • Patients with prostate cancer from sexual minority groups experience considerably worse quality of life following prostate cancer treatment than heterosexual patients. Improved inclusivity as well as cultural humility training at the physician, institution and system levels are warranted to address inequalities in quality-of-life outcomes.

    • David J. Benjamin
    • Arash Rezazadeh
    Comment
  • Incidence and mortality disparities between males and females exist in many diseases including bladder cancer, but the mechanisms remain unclear. To adequately address this issue, researchers must design experiments appropriately, appreciate that sex and gender are not synonymous concepts and understand that the role of both sex and gender in disease need to be elucidated.

    • Dan Theodorescu
    • Zihai Li
    • Xue Li
    Comment
  • Effective mentorship is important for developing trainees and faculty in urology. Crucial aspects of mentorship are necessary to create long-lasting mentorship relationships, to enhance faculty mentorship and to promote diversity and equity in urology. Innovative strategies to address challenges and opportunities are necessary to enhance the legacy of mentorship.

    • Hiren V. Patel
    • Nathan M. Shaw
    • Benjamin N. Breyer
    Comment
  • Recommendations for children and adolescents with single kidneys (like most survivors of Wilms tumour) for taking part in contact sporting activities are not aligned worldwide. This discrepancy can create misunderstandings regarding the perceived and real risk of abdominal impact and trauma when practising some sports.

    • Filippo Spreafico
    • Giovanna Gattuso
    • Maura Massimino
    Comment
  • Malnutrition is a potentially modifiable factor that is associated with considerable morbidity and is prevalent in patients with bladder cancer who are treated with radical cystectomy. Studies suggest a role for immuno-nutrition in optimizing patients’ nutritional status before undergoing this procedure, with the goal of improving patient outcomes.

    • Muhannad Alsyouf
    • Hooman Djaladat
    • Siamak Daneshmand
    Comment
  • Prostate cancer disproportionately affects Black men; the reason for this phenomenon is unclear. The role of the health-care provider is important in screening for prostate cancer, advising on treatment and ensuring completeness of therapy. Cultural competency is necessary in health-care providers as, for most men in Europe, Australasia and the USA, the ethnicity and/or race of the urologist will be discordant with that of the patient.

    • Francis I. Chinegwundoh
    Comment
  • Focus on quality of life after prostate cancer is vital to improve patient care. Improved assessment and proactive management of post-treatment functional outcomes is essential. Many aspects of the patients’ aftercare need to be improved in order to set up a clear path following prostatectomy. These improvements will enable a timely and efficient escalation of treatment and ameliorate patients’ survivorship experience.

    • Findlay MacAskill
    • Arun Sahai
    • Sachin Malde
    Comment
  • The new Bladder Cancer Research Centre at the University of Birmingham unifies the university’s multidisciplinary bladder cancer research activity within a single research centre, working within five core research themes to translate biomedical science into health-care benefits for patients with bladder cancer.

    • Richard T. Bryan
    • Roland Arnold
    • Douglas G. Ward
    Comment
  • Mobile health (mHealth) technologies hold great potential to advance medical care. However, widespread adoption in urology, and medicine in general, has been limited by a host of factors. Recognition of these barriers to adoption may instruct more meaningful tool development and investigation in order to unlock the full potential of these digital health tools in our field.

    • Jared S. Winoker
    • Kevin Koo
    • Brian R. Matlaga
    Comment
  • New technical modifications enable transperineal prostate biopsy to be performed in the ambulatory setting under local anaesthesia. Although a variety of techniques for administration of local anaesthetic during transperineal prostate biopsy have been described, no consensus exists regarding the most effective method to use. Thus, ample opportunity exists for procedural innovation and future study on this topic.

    • Spyridon P. Basourakos
    • Mathew J. Allaway
    • Michael A. Gorin
    Comment
  • The COVID-19 pandemic has resulted in a substantial increase in waiting times for cystoscopies, prompting concerns of delayed diagnoses and substandard surveillance of bladder cancer. Expanding the role of urinary biomarkers in diagnostic and surveillance pathways could be a strategy to address this problem, and several novel biomarkers have shown promise for this purpose.

    • Kenrick Ng
    • Krishna Vinnakota
    • Nikhil Vasdev
    Comment
  • In medicine and society exist two pandemics. One, COVID-19, has recently emerged and has been widely acknowledged. The other — systemic racism — has been silently deadly for centuries. Now is the time to recognize the impact of this other pandemic and to eradicate it.

    • Randy A. Vince Jr
    • Kristen R. Scarpato
    • Adam P. Klausner
    Comment
  • Management of rare genitourinary malignancies often depends on individual physicians’ discretion, resulting in non-standardized care. Furthermore, patients experience worse clinical outcomes than patients with common malignancies. Collaborative efforts such as the Global Society of Rare Genitourinary Tumors (GSRGT) are therefore necessary.

    • Andrea Necchi
    • Filippo Pederzoli
    • Philippe E. Spiess
    Comment
  • Exposure to urology is essential for medical undergraduates to prepare them with the competencies required to manage basic urological conditions and to generate interest in the specialty. However, despite the existence of national curricula, the lack of urological exposure and falling competition ratios indicate a need for an evaluation of urological teaching in medical schools.

    • Alexander Ng
    • Alexander Light
    • Veeru Kasivisvanathan
    Comment
  • Cancer sequencing studies have revealed that urothelial carcinomas harbour recurrent mutations in multiple genes that control epigenetics. A major challenge for basic and clinical researchers is to convert this genetic information into biological and pathological insights, as well as to tailor novel therapeutic modalities for individual patients with bladder cancer.

    • Ian J. Frew
    • H. T. Marc Timmers
    • Christian Gratzke
    Comment
  • Plastics have an integral role in our daily lives but at a considerable cost to the environment and, as we are now learning, to human health. Increased plastic exposure has been linked to compromised endocrine function, reproductive health and semen quality and, potentially, urological cancers. However, the long-term consequences of plastic exposure remain to be seen.

    • Sunil H. Patel
    • Meredith Metcalf
    • Max Kates
    Comment
  • Detection of positive nodes in men with moderate-risk to high-risk penile cancer and impalpable inguinal nodes is an important step in the therapeutic pathway. Detection using dynamic sentinel node biopsy with patent blue dye and radioisotope is associated with false negatives; indocyanine green might offer an alternative adjunct to improve detection rates.

    • Oliver Brunckhorst
    • Kamran Ahmed
    • Asif Muneer
    Comment
  • The management pathways of advanced renal cell carcinoma (RCC) have considerably evolved in the past 5 years, presenting a particular challenge during the coronavirus disease 2019 (COVID-19) pandemic. In this Comment, we propose a management algorithm on the basis of the current evidence to safely manage patients with advanced RCC during this pandemic.

    • Yasser Ged
    • Mark C. Markowski
    • Phillip M. Pierorazio
    Comment