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Large language models are gaining increasing interest in the medical community; however, an important but overlooked aspect of their capacity is their ability to integrate with tools. This integration greatly extends their potential application in health care.

In some instances (<5%), non-muscle-invasive bladder cancer can progress to metastatic disease without any signs of bladder muscle or lympho-vascular invasion, a condition known as metastatic non-muscle-invasive bladder cancer. In this Perspective, the authors present the available literature on metastatic non-muscle-invasive bladder cancer, and discuss the potential aetiologies underlying this condition.

The circadian rhythm has a crucial role in regulating nocturia. In this Review, the authors discuss how the brain–kidney–bladder circadian axis can lead to nocturia, prompted by the rationale that understanding these disruptions can lead to developing effective treatments targeting circadian rhythms.

In this Review, the authors provide an overview of molecular imaging in renal cell carcinoma, discussing the role of molecular imaging approaches in renal cell carcinoma diagnosis, treatment and response monitoring.

A common germline missense-encoding polymorphism in HSD3B1, called the adrenal-permissive allele, facilitates androgen synthesis from adrenal precursors via increased 3β-hydroxysteroid dehydrogenase 1 (3βHSD1). Here, the authors focus on mechanistic and clinical investigations of 3βHSD1 and the clinical consequences and potential utility of detecting adrenal-permissive allele inheritance.

High-fat diets disrupt testicular function by accumulating lipids, impairing sperm production and affecting the cytoskeleton of spermatogenic cells. This Perspective aims to understand these mechanisms to develop treatments for infertility in men with obesity.

Literature about prostate cancer in transgender women is growing, but many questions remain unanswered. Unique challenges exist in the identification of transgender women that can slow or even impair research advances in this field. Reframing our thinking about the identification of this population is imperative to help advance both research and clinical care.

Metastatic urothelial cancer exhibits substantial molecular heterogeneity compared with the primary tumour, complicating the development of accurate biomarkers. Pre-treatment metastatic biopsies capture real-time tumour biology and can enhance response predictions for targeted therapies, improving patient selection for precision oncology.

When Nature Clinical Practice Urology launched in 2004, we could not have foreseen the ways in which our field has transformed. As we celebrate our 20th anniversary — traditionally, the ‘china’ anniversary — it gives us a chance to get out the special china tea service, sit back with a cup of tea and reflect on what this journal, and the editors who work on it, have achieved.

Examination of racial disparities in prostate cancer in the USA and UK highlights systemic, socio-economic and sociocultural factors that might contribute to these differences. Understanding behavioural medicine might inform and improve the way in which the health-care system can engage with patients in minorities who are affected by this disease.

For the past 20 years, Nature Reviews Urology has evolved alongside the field, reflecting a shift towards basic research as a tool to inform clinical practice. From the latest developments in urology to the advent of telehealth, the journal has remained committed to delivering rigorous and unbiased science, accessible to a global audience.

Over the past 20 years, Nature Reviews Urology has been at the forefront of developments in the field — from championing men’s health to explaining the intricacies of the prostate cancer tumour immune microenvironment. Going forwards the journal will continue to be a leader in the field, providing an important resource for patients and physicians alike.