Advanced nanocatalytic medicine for genitourinary diseases: Reactive oxygen modulation, precision therapeutics, and clinical translation.

Urological, kidney, and reproductive diseases comprise heterogeneous disorders, both malignant and nonmalignant, characterized by oxidative stress, inflammation, metabolic dysfunction, fibrosis, immune dysregulation, and treatment resistance. Advanced nanocatalytic medicine (NCM) offers a precise therapeutic approach by exploiting disease-associated biochemical abnormalities, including acidic pH, hypoxia, elevated hydrogen peroxide (H2O2) levels, altered glutathione (GSH) metabolism, mitochondrial dysfunction, and redox imbalance. Biocatalytic nanomaterials, including nanozymes, metallic and metal-oxide nanostructures, single-atom catalysts, hybrid platforms, biomimetic systems, and stimuli-responsive materials, enable context-dependent regulation of reactive oxygen species (ROS). Nanocatalytic platforms exploit these conserved tumor microenvironmental characteristics across ovarian, endometrial, cervical, bladder, renal cell, prostate, and upper tract urothelial cancers through Fenton/Fenton-like catalysis, ROS amplification, GSH depletion, ferroptosis induction, immune microenvironment remodeling, biomimetic targeted delivery, and image-guided precision therapy. Beyond oncology, antioxidant nanozymes have also shown therapeutic potential in selected non-malignant renal and reproductive disorders through ROS scavenging and redox restoration. These conserved mechanisms support chemodynamic therapy (CDT), catalytic phototherapy, ferroptosis regulation, metabolic modulation, immunocatalytic remodeling, biomimetic targeting, targeted drug delivery, and multimodal image-guided precision therapy for diverse genitourinary (GU) malignancies. Artificial intelligence (AI)-assisted nanozyme engineering, multi-omics stratification, organoid-guided screening, and computational modeling may accelerate personalized treatment; however, biosafety, pharmacokinetics, manufacturing, and regulatory challenges remain unresolved. Overall, the shared biochemical vulnerabilities of GU malignancies provide a unified framework for translating NCM into disease-specific precision oncology, while also offering opportunities for the treatment of selected non-malignant disorders.