A field on the move
AUA2026 Key Takeaways address balancing innovation, cost and durability with patient-centered outcomes.
A sweeping set of innovations, controversies and emerging technologies dominated discussions at AUA2026 Key Takeaways. The session, now available on-demand, featured eight thought-provoking discussions with experts on important topics, such as kidney oncology, benign prostate hyperplasia (BPH) and male lower urinary tract symptoms (LUTS), prostate cancer, bladder cancer, sexual dysfunction, endourology/stones, female urology and lower urinary tract reconstruction.
Collectively, the sessions highlighted the rapid acceleration of artificial intelligence (AI), personalized care, durability, promising technologies in limited use and critical barriers to improved care due to cost and real-world outcomes.
Innovation on the horizon
Daniel Joyce, MD, MS, and Peter Clark, MD, delivered a clear message during their discussion of kidney cancer: Innovation is accelerating—but adoption remains cautious. The two highlighted the promise of AI and the reality of robotics in the realm of the disease. Dr. Joyce, an assistant professor of urology at Vanderbilt University School of Medicine in Nashville, presented data showing that although single‑port robotic surgery is generating significant interest, real-world use has stagnated.
“The first question here is how are we experiencing the single-port revolution? There was an interesting study from the health services poster session that looked at sales of single-port robotic platforms. What they found is, the single port, as much push as there has been, has not changed in sales over time at all,” Dr. Joyce said. “And yet, the multiport platform continues to rise. Despite that, there is a ton of interest surrounding increased use of single ports, especially in kidney cancer, through the low anterior access retroperitoneal partial nephrectomy technique.”
Studies comparing single‑port and multiport approaches revealed no meaningful differences in complications, margin status or surgical times, though single port may offer modest benefits such as reduced pain and shorter hospital stays, he said. 
The bigger story, however, was AI. Dr. Joyce highlighted AI models capable of predicting postoperative complications and tumor characteristics from imaging, potentially replacing traditional scoring systems and improving surgical planning.
Dr. Clark, a urologic oncologist at Atrium Health and Levine Cancer Institute in Charlotte, North Carolina, tempered expectations, noting that health systems require broad, multispecialty value before adopting new technology. He emphasized that AI is likely to see faster uptake—particularly in underserved settings—while robotics must prove cost and operational scalability.
“If you think about it in the context of its use at a major center with experienced radiologists, your need for this is one level. But if you’re not in that and at a smaller institution, maybe radiology isn't quite as experienced,” Dr. Clark said. “Maybe you need more support. Rural hospital settings are where AI really helps because it’s transmissible. You don't need to be there to do it.”
Both speakers agreed AI is “here,” but biomarkers and next-generation therapies still need validation before entering routine care.
It’s personal
The key takeaway in a discussion of BPH and male LUTS marked a turning point in how clinicians approach treatment, shifting decisively toward personalized medicine. Marawan El Tayeb, MD, and Lori Lerner, MD, engaged in compelling discourse over the push for individualized care.
Dr. El Tayeb, chief of urology at Baylor Scott & White Health in Dallas, emphasized that new BPH guidelines prioritize shared decision-making, balancing symptom relief, preservation of sexual function and durability. Both stressed the importance of long-term follow-up to refine treatment selection and outcomes.
“You need to take a curated type of approach—match a procedure to the patient,” Dr. Lerner said. “It needs to involve shared decision-making and discussions with patients about what their goals are, such as ejaculatory preservation or durability. And does [the patient] want durability for the rest of their life, or are they looking for something for three to five years? The patient may be willing to have some trade-off to preserve ejaculatory and erectile function, but lower risk of incontinence. They may not get the same symptom response that they might with some other therapy. So, it’s important they understand what those trade-offs are and make sure that we counsel the patients about them.”
Dr. Lerner, chief of urology at the VA in Boston, highlighted an “explosion” of treatment options, including new minimally invasive stents and implantable devices, which are rapidly entering clinical practice. Early results are promising, but she cautioned that durability remains the most underappreciated factor.
Both speakers pointed to emerging research in prostate biology, suggesting that future therapies may be guided by molecular drivers rather than anatomy alone.
To screen or not to screen
The dual challenge facing prostate cancer, according to Simpa Salami, MD, MPH, and Kirsten Greene, MD, MAS, FACS, is underuse of screening and aggressive therapy. Both doctors called for smarter screening and stronger treatment.
He also outlined guideline changes promoting wider use of MRI and Prostate-Specific Membrane Antigen (PSMA) PET imaging, along with more flexible biopsy strategies.
As for the lack of aggressive treatment, Dr. Greene, a professor and chair of urology at the University of Virginia School of Medicine in Charlottesville, addressed the practical clinical implications of that disappointing trend. Dr. Greene highlighted the importance of tumor grading in treatment decisions and raised concerns that functional outcomes from surgery—continence and erectile function—have plateaued.
Both speakers emphasized a major shift toward treatment intensification, with combination therapies significantly improving survival in advanced prostate cancer—moving the field beyond single-agent approaches.
Therapy at what cost?
In bladder cancer, the debate between more aggressive therapy and patient burden is a relevant consideration, said bladder cancer experts Bogdana Schmidt, MD, MPH, and Eila Skinner, MD.
The decision to provide Bacillus Calmette-Guérin (BCG) immunotherapy upfront for the escalation of non-muscle invasive bladder cancer has its health benefits as well as some associated toxicity, according to Dr. Schmidt. Yet, it comes at a cost.
“We know from trials presented at prior meetings and papers published that the addition of sasan, lamap, tisola, zamac or durvalumab to BCG immunotherapy in the upfront setting has a modest improvement in recurrence-free survival,” said Dr. Schmidt, a professor of urologic oncology at the University of Utah School of Medicine in Salt Lake. “But we also can see that BCG alone does pretty well here, especially if you can get the patients through these doses.”
Studies suggest many regimens are not yet cost-effective under current thresholds, Dr. Schmidt said.
Despite this promising treatment, Dr. Skinner, a professor and chair of urology at Stanford University School of Medicine in Palo Alto, California, urged caution, noting that even rare toxicities can significantly affect patients. She highlighted circulating tumor DNA (ctDNA) as one of the most promising tools emerging from the meeting.
ctDNA demonstrated a strong ability to predict recurrence and treatment response, but Dr. Skinner said its clinical use must be carefully validated before it can drive treatment decisions.
“I think there are two potential strategies that could really help with the costs and also the number of people who are getting exposed to the higher toxicity of the immunotherapy,” Dr. Skinner said. “One is to only give it to the patients that we know are very high risk. Currently, EU guidelines identify those patients.”
The other strategy, she said, would be to test the immunotherapy early in patients who aren’t immediately disease-free.
Both conclude their presentation with a forward-looking discussion of AI and biomarkers in the next era—but only if they can guide treatment, not just predict risk, they noted.
Is this a sign?
In one of the most candid sessions, sexual medicine experts Tobias Köhler, MD, MPH, FACS, and Denise Asafu-Adjei, MD, challenged the hype and pushed back against popular but unproven therapies for sexual dysfunction.
Dr. Köhler, a professor of urology at the Mayo Clinic in Rochester, emphasized that erectile dysfunction is an early marker of cardiovascular disease, often appearing years before heart attacks. He also made a strong statement on emerging therapies, suggesting shockwave, platelet-rich plasma, and stem cell treatments should not be used in routine care due to a lack of evidence.
“If you ask what's the No.1 sign before a heart attack? The answer is nothing. It just happens, right?” Dr. Köhler said. “However, we know erectile dysfunction predates the first heart attack by years. If you have a patient with an intermediate risk for erectile dysfunction, you should refer the patient for coronary calcium scores and send them off to cardiology. Something to remember.”
Continuing the discussion of the link between sexual dysfunction and cardiovascular disease, Dr. Asafu-Adjei, an assistant professor of urology at Loyola University Chicago, addressed risk stratification by looking at the capillary beds of a man’s nails. Dr. Asafu-Adjei recounted a study presented at AUA2026 using imaging to examine the area.
“I looked at the relationship between the capillaries of your nails and seeing how this correlated with microvascular disease, Dr. Asafu-Adjei said. “Sometimes we have various things that are present. And this is an interesting way for us to think about something as simple as the nails and how we look at microvascular disease.”
The session on sexual dysfunction also redefined expectations for surgical interventions. New data showed penile implant satisfaction rates are closer to 70%–75%, underscoring the need for better patient counseling and realistic expectations.
Fundamentals amid innovation
Innovation matters, but fundamentals remain critical. That’s the message Anna Zampini, MD, and John Denstedt, MD, FRCSC, delivered in their takeaway on endourology and stones.
According to Dr. Zampini, a urologist with the Cleveland Clinic in Ohio, dietary counseling and hydration remain key interventions and are still highly effective. However, she highlighted emerging evidence that GLP-1 drugs reduce stone risk and discussed new technologies, such as pressure monitoring and volumetric assessment, to improve care.
“I think we should continue to emphasize what we currently do, which is fluids,” said Dr. Zampini. “And I would really like to highlight [the importance of] heat maps. David Goldfarb, a nephrologist at NYU, gave a tantalizing presentation suggesting that climate change is increasing ambient global temperatures, which might be leading to more kidney stones due to dehydration and increased urine concentration. This is happening in large cities where the temperature is remarkably higher than in rural areas.”
Dr. Denstedt, a professor of urology at Western University Schulich School of Medicine & Dentistry in London, Ontario, Canada, also reinforced the importance of fluid intake for preventing stones, noting that even modest increases in intake reduce recurrence. Dr. Denstedt highlighted surgical innovations as well but warned of risks such as ureteral injury and strictures. Not surprisingly, Dr. Denstedt noted the growing role of AI in prevention, planning and diagnostics.
“We can't leave without talking about AI. Numerous studies looking at stone composition, PCNL planning, improved stone-free rates and stone prevention, for example, can help us identify which scopes are better to use, offering a more objective model and AI interpretation of imaging,” he said. “To choose or adapt your reader scopes is really exciting, as is using the technology to try to avoid tissue injury during ureteroscopy.”
Devices and the digital future
Female urology experts showcased rapid progress in both technology and therapeutics. During their session, Elizabeth Sebesta, MD, highlighted advances in implantable neuromodulation devices, which demonstrated strong results even in patients who failed prior therapies, while Quentin Clemens, MD, MSCI, a professor of urology at the University of Michigan School of Medicine in Ann Arbor, struck a cautious tone, emphasizing that while these findings are promising, more evidence is needed before changing clinical practice broadly.
Dr. Clemens addressed the rise of noninvasive urodynamics, including wearable technologies and AI-based diagnostics, which could transform how clinicians evaluate bladder function—if implemented thoughtfully.
“I think it's nice that contemporary technology is being brought to our field. It's about time. They’re noninvasive, and they’re here to stay,” Dr. Clemens said. “Additionally, you don't need a new [insurance] code to bring this to market, so the barrier has been removed because you can use the existing urodynamics code.”
From biology to transplantation
By all accounts, the takeaway session on lower urinary tract reconstruction delivered some of the meeting’s most forward-looking updates. Sarah Faris, MD, and Hunter Wessells, MD, spotlighted innovation from biology to transplantation.
Dr. Faris, associate professor of surgery at the University of Chicago, presented new research explaining why buccal grafts are so effective, pointing to their regenerative cellular activity. She also highlighted minimally invasive reconstruction techniques that are beginning to approach the success of open surgery.
“In one single-cell sequencing study presented at the meeting, they addressed why buccal mucosa was a great graft in the urethra. What they found is essentially that the urothelial epithelium is not actually dividing. The stroma cells are signaling to collagen in the epithelium at a high rate, which promotes scar tissue,” Dr. Faris said. “The buccal mucosa, basal epithelium is actively dividing and is driven by T cells. The macrophages are antifibrotic, and so what we're really doing when we do buccal urethroplasty is transporting biology design to heal the urethra.”
Dr. Wessells, a professor of urology at the University of Washington School of Medicine in Seattle, added to the discussion of lower urinary tract reconstruction by addressing the value of a non-transecting approach for anterior urethroplasty to preserve spongiosum circulation and prevent penile curvature.
“The rationale is clear. But there is possibly a trade-off on efficacy, because we know that a classic bulbar anastomotic urethroplasty is one that can cure these patients and have almost 100% efficacy,” Dr. Wessells said. “The trade-off [for a non-transecting approach] might be between 88% and 98%, and patients will want to decide which they value more: the sexual side effect they might get or the outcome.”
Their session also featured practical innovations, including electronic medical record alerts that prevent catheter-related damage to artificial sphincters, effectively eliminating a known complication.
Finally, both speakers highlighted groundbreaking work in bladder transplantation and regenerative medicine, pointing toward a future where organ repair may replace traditional reconstruction.
AI and innovation are accelerating rapidly; personalized care is becoming the standard; durability, cost and real-world outcomes remain critical barriers; and many technologies are promising—but not yet ready for widespread use.
All eight Key Takeaway presentations with slides are available on demand until Aug. 31.
- BPH/Male LUTS
- Oncology: Prostate
- Oncology: Bladder
- Oncology: Kidney
- Sexual Dysfunction
- Endourology/Stones
- Female Urology
- Lower Urinary Tract Reconstruction
