Cumpanas AD, Hernandez MC, McCormac A, et al. Preoperative immersive virtual reality applied to percutaneous nephrolithotomy: a prospective randomized clinical study of surgical planning and clinical outcomes. J Urol. 2025;213(2):162-172. doi:10.1097/JU.0000000000004284

Special thanks to Drs Gabriel van de Walle and Mahmoud Mima at the University of Illinois at Chicago.

We have all treated hundreds of kidney stones in our careers. Surgical success often hinges on our ability to interpret multiple computed tomographic images and mentally reconstruct a 3D model of the kidney. But even with extensive experience, certain limitations persist. Especially in percutaneous nephrolithotomy, predicting the safest and most effective access point in each case carries an element of uncertainty. It is a skill we have tried to hone over years of experience, but what if technology could help us do it better?

Enter immersive virtual reality. These authors tested whether giving surgeons a fully interactive, 3D model of the kidney before percutaneous nephrolithotomy could improve outcomes. The results were potentially game-changing. Surgeons using immersive virtual reality changed their initial access plan in 30% of cases, had higher stone-free rates, and fewer complications. They notably found that these results were independent of the surgeon’s years of experience.

This study highlights a transformative shift in urology and surgery as a whole: technology is no longer merely assisting surgeons but is actively optimizing decision-making. While creating these models remains time intensive, advancements will soon make them a routine part of preoperative planning. In a world where professional athletes use virtual reality to enhance coaching, surgeons will also soon be able to coach themselves through a procedure before making an incision whether for a percutaneous nephrolithotomy or a complex tumor. As immersive virtual reality becomes more accessible, we are looking at the future of surgical preparation where every patient gets a truly customized approach, and the surgeon can operate with maximum confidence with the knowledge that they’ve already seen the procedure from every angle.

Tosoian JJ, Zhang Y, Meyers JI, et al. Clinical validation of MyProstateScore 2.0 testing using first-catch, non–digital rectal examination urine. J Urol. 2025;213(5):581-589. doi:10.1097/JU.0000000000004421

Special thanks to Drs Muhannad Aljoulani and Simone Crivellaro at the University of Illinois at Chicago.

How many of us have witnessed the frustration of repeated prostate biopsies, not just for the discomfort they cause, but also for the way they push patients to drop out of follow-up altogether? Undergoing a prostate biopsy isn’t something anyone looks forward to. The risks of bleeding, infection, and urinary problems are frightening, and the stress and anxiety can be overwhelming.

In this study, the authors conducted a deeper clinical validation of MyProstateScore 2.0, a urine-based assay that measures the expression of 18 cancer-specific and high-grade cancer-specific genes to provide an individualized risk assessment for clinically significant prostate cancers. This screening model had previously been validated using urine after digital rectal examination, demonstrating strong performance in detecting clinically significant prostate cancers while reducing the need for biopsies.

Using the Prostate Cancer Prevention Trial risk calculator as a reference standard, and with a population of 266 men, the MyProstateScore 2.0 once again confirmed its robust accuracy in detecting prostate cancers, maintaining a 92% sensitivity and potentially reducing unnecessary biopsies by up to 50%.

This study marks an important step forward. A test like this has the potential to redefine prostate cancer screening, shifting away from invasive procedures as the norm. Imagine a world where men could screen themselves from the comfort of home or through telehealth, reducing hospital visits and stress while keeping detection rates high.

Enemchukwu EA, Kalota S, Robertson K, et al. Gene therapy with URO-902 (pVAX/hSlo) for the treatment of female patients with overactive bladder and urge urinary incontinence: safety and efficacy from a randomized phase 2a trial. J Urol. 2025;213(4):417-427. doi:10.1097/JU.0000000000004373

Special thanks to Drs Halsie Donaldson and Mahmoud Mima at the University of Illinois at Chicago.

The symphony of a life disrupted by overactive bladder and urge urinary incontinence is a familiar, often frustrating, refrain in our urological practice. We’ve witnessed the toll of relentless frequency, the anxiety of inescapable urgency, and the indignity of involuntary leakage often despite our diligent application of conventional therapies. For these patients, could gene therapy be the answer we have all been waiting for?

Researchers studying the efficacy and safety of URO-902, a specific gene therapy, in treating this disease hint at such a possibility, a potential orchestration of genetic medicine to restore bladder harmony. This innovative gene therapy expresses a specific molecule that is part of the large potassium channels found in the bladder, which result in bladder smooth muscle relaxation.

Women with overactive bladder and urge incontinence were randomly assigned to receive endoscopic intravesical injection under local anesthetic with either gene therapy in doses of 24 mg, 48 mg, or placebo. Statistically significant improvement in micturition was seen at 12 weeks with gene therapy. Patients also experienced statistically significant improvement in urgency with higher doses. The global impression of change at 48 weeks after treatment with gene therapy was nearly 3 of 5. Urinary tract infections and blood in the urine were the most common adverse effects, which were likely a side effect of the way this medication is administered rather than the gene therapy itself. Only 1 patient in the higher-dose group experienced a temporary elevated postvoid residual that resolved spontaneously.

Early studies of this gene therapy offer exciting potential to revolutionize bladder care, altering the lives of women experiencing devastating overactive bladder and incontinence. It’s an exciting option for patients who have exhausted conventional approaches.