15th Anniversary

In this Viewpoint, actor, author, and broadcaster Stephen Fry describes his prostate cancer journey alongside the same story from his surgeon, Ben Challacombe, enabling us to consider “both sides of the scalpel”.

Machine learning (ML) is revolutionizing and reshaping health care, and computer-based systems can be trained to perform complex tasks in bioinformatics, medical imaging and medical robotics. In this Review, Goldenberg et al. consider ML in the management of prostate cancer, with growing applications in diagnostic imaging, surgical interventions, skills training and assessment, digital pathology and genomics.

The penis is a diverse and rapidly evolving structure, much more complex than its fundamental function — sperm transfer — would seem to require. In this Review, experts in the field discuss the drivers of penis evolution, and consider how the penis might be an ideal characteristic on which to focus in studies to link phenotype with genotype.

Many of the bacterial components of the female urinary tract have been characterized, but the viral fraction of this community is largely unknown. Here, the authors describe the current knowledge of bacteriophages within the urinary tract and their possible contribution to urinary tract health.

This Review by Ricketts and Linehan comprehensively summarizes the findings of The Cancer Genome Atlas analyses of renal cell carcinoma and their clinical implications. The authors highlight unique and shared features of the tumour histological subtypes, their predictive power and their possible utility as therapeutic targets.

Urogenital tuberculosis can be easily overlooked owing to non-specific symptoms, varying manifestations and a lack of awareness of the disease. In this Review, Muneer and colleagues provide a comprehensive overview of the epidemiology, pathogenesis, clinical features, diagnosis and management of this disease.

Georgiadis et al. provide a comprehensive description of the available animal and human literature on sexual reward and sexual incentive motivation, highlighting the major points of convergence and divergence across species. They discuss a neural concept of human sexual behavioural control and suggest novel testable hypotheses for future sex research.

Gonorrhoea andMycoplasma genitaliuminfections are evolving to be exceedingly difficult to treat or untreatable. Unemo and Jensen provide an overview and discussion of prevalence data, diagnostics, current treatment recommendations and potential future therapies of these infections, highlighting priorities to retain their treatability.

New research indicates that the microbiota at many sites in the body, including the urinary tract, might influence urological health. Whiteside et al. review our current knowledge on the microbiome–host relationship and examine its role in the maintenance of urinary homeostasis, its utility as a predictor of the risk of disease and as a basis for the development of novel therapeutic strategies.

In this Review, the authors summarize current knowledge of sperm-specific epigenetic signatures and diet-induced epigenetic effects on sperm quality. They also discuss transgenerational effects of the sperm epigenome on offspring health.

Improved tools for diagnosis, treatment and basic research into the mechanisms of urological disease have transformed our field over the past 15 years. However, building on these advances relies on continued collaboration, teamwork and data sharing across our specialty.

As a field that embraces technology, urology has evolved quickly in the past 15 years and is likely to change at an even greater pace in the next 15. Several approaches and initiatives have the potential to improve patient care, in particular the use of telemedicine, improvements in data analytics and growth of physician collaboratives.

The future of urology holds promising new technologies but also a challenging increase in urological care needs. To translate emerging technologies and medical advances into use and accommodate the growing demand for urological services, we need strong collaboration with other health-care professionals within urology, other medical specialties and the community that surrounds our profession.