GUEST EDITORIAL ESSAY FROM ASSOCIATE EDITOR FERNANDO KIM The 45th Annual Jackson Hole Seminars Critique Panel (JHSCP) Winter Meeting in 2026 marked a milestone in academic urology, celebrating 4 decades of disciplined scientific exchange founded by Dr Ralph Hopkins. The Jackson Hole model remains distinctive: 6 high-density morning lectures delivered in fewer than 20 minutes, followed by extended afternoon and evening Critique Panels led by prior faculty and senior subspecialists. This structure functions as a live peer-review forum, prioritizing methodological scrutiny, clinical applicability, and implementation over repetition of established knowledge. The 2026 meeting defined by translational rigor, multidisciplinary innovation, and a prominent celebration of Women in Academic Urology. Dr Herbert Lepor, MD, held the prestigious role of Chair of the Critique Panel. Dr Helen L. Bernie, DO, MPH, delivered the meeting's top-ranked presentation, earning First Prize for Best Speaker. Her lecture examined the guideline-to-workflow gap in sexual dysfunction and male infertility. Although the AUA/ASRM Male Infertility Guideline acknowledges sexual conditions incompatible with semen deposition as contributors to infertility, Dr Bernie demonstrated that standardized sexual screening tools, phenotype-driven evaluation pathways, and fertility-preserving treatment algorithms remain inconsistently integrated into infertility clinics. She presented epidemiologic data showing that infertile men experience substantially higher rates of erectile dysfunction and emphasized infertility visits as high-yield opportunities to identify endocrine disorders, cardiometabolic risk, and psychological comorbidities. Her broader framework positioned sexual health as central to men's preventive care rather than a secondary complaint. The survivorship focused discussion of penile rehabilitation after radical prostatectomy reframing rehabilitation as a structured program rather than a prescription. Evidence supports early initiation particularly daily PDE5 inhibitors to enhance drug-assisted recovery and potentially mitigate penile shortening. Intracavernosal injections and vacuum erection devices remain effective but limited by adherence barriers. Institutional data from Indiana University identified predictors of improved recovery, including younger age, bilateral nerve sparing, absence of diabetes, and consistent follow-up engagement. Dr Priya Padmanabhan, MD, MPH, provided an implementation-focused synthesis of the 2025 AUA/SUFU/AUGS guideline for genitourinary syndrome of menopause (GSM). Affecting up to 70% of postmenopausal women, GSM remains underdiagnosed due to workflow barriers and patient reluctance. Emphasis on early use of local low-dose vaginal estrogen for symptomatic vulvovaginal atrophy and recurrent urinary tract infections, highlighted guideline supported safety and efficacy. Overactive bladder (OAB) was examined from both epidemiologic and device perspectives. Observational data from the BLAST COVID cohort demonstrated an increased risk of worsening OAB symptoms after SARS-CoV-2 infection, suggesting inflammatory and microvascular mechanisms. A complementary claims-based analysis showed that early minimally invasive therapy was associated with reduced medication burden, lower complication rates, and decreased costs compared with delayed escalation. Furthermore, early trials of implantable tibial nerve stimulation devices demonstrated reductions in urgency incontinence and nocturia. Dr Jodi K. Maranchie, MD, FACS, presented a survivorship-centered critique of stage IIA/IIB seminoma management. While chemotherapy and radiotherapy achieve excellent relapse-free survival, the long-term cardiovascular and metabolic consequences may be relevant to young patients. The PRIMETEST and SEMS trials support primary retroperitoneal lymph node dissection as a de-escalation strategy in carefully selected patients, maintaining overall survival while potentially reducing systemic toxicity. In high-risk non–muscle-invasive bladder cancer, data-rich presentation reviewed the expanding salvage landscape. Sequential gemcitabine/docetaxel therapy, nadofaragene firadenovec, nogapendekin alfa inbakicept, TAR-200 sustained gemcitabine delivery, and cretostimogene grenadenorepvec demonstrated encouraging response rates in bacillus calmette-guérin unresponsive disease. The evolving role of cytoreductive nephrectomy in metastatic renal cell carcinoma was reviewed in the context of CARMENA and SURTIME, reflecting the shift toward selective or deferred surgical strategies in the immunotherapy era. A translational immuno-oncology presentation explored the “CD8+ TIL paradox” in renal cell carcinoma, examining exhausted T-cell phenotypes and tertiary lymphoid structures as markers of functional antitumor immunity. Therapeutic vascular normalization and tumor blood vessel antigen peptide vaccines were discussed as strategies to enhance immune microenvironment fitness. Intravesical contrast-enhanced MRI, combining intravesical gadolinium and ferumoxitol, may improve bladder tumor visualization and potentially reduce reliance on repeated transurethral resections. Dr Nicole Streeper, MD, reviewed metabolic evaluation and medical prevention of nephrolithiasis. Emphasizing kidney stone disease as chronic and preventable, she outlined individualized management strategies based on 24-hour urine testing and metabolic phenotype. Mini-percutaneous nephrolithotomy refinements and randomized data on tranexamic acid demonstrated improvements in transfusion rates and stone-free outcomes. Dr Herbert Lepor, MD, presentation outlined his academic evolution from nerve-sparing radical prostatectomy to advancing focal therapy for prostate cancer, emphasizing quality of life preservation without compromising oncologic vigilance. He reviewed institutional experience with focal cryoablation in carefully selected men with unilateral clinically significant disease, highlighting 5-year data in 313 patients demonstrating 70% freedom from clinically significant recurrence and 89% freedom-from-failure, with no prostate cancer–specific deaths and minimal metastatic progression. He underscored the importance of accurate MRI-based index lesion identification, rigorous surveillance protocols, and favorable functional outcomes, including high continence and potency preservation rates, positioning focal therapy as a structured, evidence-based option within appropriately selected patients. Dr Mohit Khera, MD, further examined controversies surrounding testosterone therapy (TTh), particularly its relationship with prostate cancer and cardiovascular safety. Drawing on contemporary literature and the randomized TRAVERSE trial, Dr Khera demonstrated that TTh in appropriately selected hypogonadal men does not increase major adverse cardiovascular events or high-grade prostate cancer risk. He discussed Bipolar Androgen Therapy as an emerging therapeutic concept in castration-resistant prostate cancer, illustrating how modern data challenge longstanding prohibitions. Julie Riley, MD, MBA, MS, FACS, presented practical strategies to improve ureteroscopy outcomes through meticulous planning, access strategy optimization, and maintenance of low intrarenal pressure. Dr Fernando J. Kim, MD, MBA, FACS, addressed workforce maldistribution and the expanding role of locum tenens practice as a bridge to rural access gaps. Operational challenges including licensing and hospital credentialing were examined within the broader framework of health systems planning. Dr Pierluigi Bove, MD, highlighted laser enucleation, particularly Ho:YAG-based HoLEP as the emerging gold standard for benign prostatic hyperplasia, citing superior obstruction relief, reduced bleeding, and durable outcomes compared with TURP. Dr Margit Fisch, MD, FEAPU, FEBU, provided an outcomes-focused review of reconstructive challenges following gynecologic cancer therapy, reporting high success rates in ureteral reimplantation and fistula repair when performed in specialized centers. Dr Brian Flynn, MD, contextualized Functional Reconstructive Urology as an evolving academic identity centered on restoration of both form and function. Dr Gerald Andriole, MD, discussed the evolution of prostate cancer screening toward risk-adapted precision strategies incorporating biomarkers and multiparametric MRI to reduce unnecessary biopsy while maintaining early detection of clinically significant disease. Guest speaker Jason Newmyer outlined a strategic blueprint for regional urology market leadership in Hillsborough County, Florida, emphasizing physician recruitment, robotic expansion, hub-and-spoke clinic development, and performance-driven governance. Conclusion The 45th Annual Jackson Hole Winter Meeting reaffirmed the enduring strength of its structure: concise, data-dense lectures followed by rigorous critique. Across sexual medicine, oncology, urogynecology, endourology, reconstructive surgery, immunotherapy, and workforce strategy, a common theme emerged translational integration grounded in disciplined evaluation. The prominence of Women in Academic Urology was particularly notable, reflecting substantive leadership rather than symbolic inclusion. Dr Bernie's recognition as Best Speaker exemplified the Jackson Hole ethos: evidence-driven critique in service of patient-centered implementation. After 45 years, the Jackson Hole model continues to demonstrate that structured academic discourse when combined with rigorous peer interrogation remains a powerful engine for clinical innovation and durable education in Urology. FEBRUARY 2026 JUOP NEW PAPERS Clinical Trials In a prospective, IRB-approved pretrial type of design, Chung et al1 studied crewmembers on space travel missions to determine if such environments alter urinary microbiomes, using total genomic DNA extracts. The background comment is that space flights back to the 1960s have reported urinary symptoms, stone risk, and infections in otherwise healthy astronauts. With this method of urinary species identification, the study found higher bacterial loads and shifted urinary composition during orbit—suggesting a space travel related disturbance. See additional insights from our new board member Danny Darlington Carbin2 from the United Kingdom. The study from Eyrich et al3 is part of the established EDRN network (Early Detection Research Network, from the National Cancer Institute) with its prospectively collected specimens from multiple institutions. For prostate cancer screening, the lack of PSA specificity is well known and despite clear advances in MRI of the prostate for further risk stratification and biopsy related planning, secondary biomarkers may play a role to improve specificity either as a pre-MRI screener, or post MRI referee for equivocal results. The emerging trends include panels of biomarkers to improve accuracy, in depth study to determine best thresholds for risk estimation, and more recently the ability to improve logistics/convenience of specimen collection. This paper combines the established biomarkers for prostate health index (serum) and urinary PCA3/T2:ERG. The paper demonstrates improved performance of the combination in biopsy naïve men. They also explore performing the markers in sequence vs combination. This paper is a nice contribution, although clinical utility may still favor other urinary biomarker panels that can achieve similar results with a home-collection method (i.e., no blood draw and no digital rectal exam required for urine). An editorial by Ellis and Gregg4 reviews the paper and points out the lack of MRI data for this established cohort. Health Services Research Sieber et al5 used a large administrative claims data of over 10,000 patients to estimate cardiovascular events based on comorbidities for men initiating androgen deprivation therapy for advanced prostate cancer. The overall event rate was 8.9%, with diabetes, hypertension, and hyperlipidemia driving the numbers as high as 16% with all 3 vs the 1 to 2 combinations, and down to 7.3 with none. The study may help clinicians select patients for further co-management with internal medicine/cardiology. We will have an upcoming paper in the space, reporting on a large multisite study protocol and early accrual for prevention measures for cardiac events. Retrospective Study In the area of voiding dysfunction, the paper by Mittal et al6 performed a retrospective, single institution identification of patients with dysfunctional voiding in men aged 18 to 40 years who had urodynamics and met predefined inclusion/exclusion criteria (similar to a clinical trial). A standard treatment protocol had been used with baclofen and pelvic floor muscle training. The main outcome measures were improvements in symptom scores and uroflow parameters. The data are laid out nicely such that it can be a key review of this first line noninvasive therapy and setup comparisons to invasive or future therapies. See additional editorial comments from Garcia-Mora.7 In a census type study, Li et al8 looked at female representation across multiple urologic fellowship program types and residency. Several trends are reported with mostly an increase over the time period with marked increase in women in urologic oncology. Overall, the number of diversity of specialties chosen by women has increased. The data are limited to match programs run by the AUA. The discussion highlights the broader issues in our workforce. It is appropriate that this paper landed the same month as Dr Kim’s meeting review with the honored panel of guest speakers all being female and representing multiple urology subspecialties. PEOPLE, PLACES, AND THINGS The focus is on the Jackson Hole Seminars report from Dr Kim. Oddly, due to hotel renovations, the meeting had to be relocated from Teton Village, Wyoming, to Big Sky Montanna. Figure 1 shows the usual iconic Teton Mountains where there is a ski resort in there somewhere. This view is on the road North towards Yellowstone National Park—a common side trip from the meeting for winter tours on snow mobiles or snow coaches. Figures 2-4 highlight the speakers, critique panelists, and awards.Figure 1.: Places: The 2026 Jackson Hole Seminars had to relocate to Montanna from the familiar scenes of Jackson and Teton Village Wyoming. Either way, Winter Scenes are the photographer's dream. A, The elk sculpture at Jackson town square. B, Teton Mountain Range, Wyoming. C, Waterfalls in Yellowstone National Park.Figure 2.: People: (Left to right) Mohit Khera, Helen Bernie, Nicole Streeper, Gerald Andriole, Fernando J. Kim, Jodie Maranchie, Julie Riley, Priya Padmanabhan, Herbert Lepor, Brian Flynn, Pierluigi Bove, Margit Fisch.Figure 3.: People: Dr Herbert Lepor, MD (left)—Chair of the 45th Jackson Hole Seminars Critique Panel—and Dr Fernando J. Kim, MD.Figure 4.: People: Dr Helen Bernie, DO—first prize 45th Jackson Hole Seminars Critique Panel.
Kim et al. (Sun,) studied this question.