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The coming decades are poised to usher in an era of commercial spaceflight and extended duration missions beyond low-earth orbit. Urologic challenges and conditions have been central to the history of human spaceflight, and their effective management will continue to play a key role in future endeavors. Voiding equipment, such as the Universal Waste Management System aboard the International Space Station, is emblematic of the significant technical strides that have been made to improve the usability and functionality of non-terrestrial waste elimination and containment devices. Detailed investigations over the past few decades have demonstrated that crew members are at an increased risk of developing nephrolithiasis due, in large part, to the effects of microgravity. Renal calculi and their potentially debilitating effects represent one of the most significant urologic complications that could impact the success of future long duration missions. Other urologic conditions, such as urinary tract infections, urinary retention, and urinary incontinence have been well documented during flight and pose their own challenges. While preventive measures remain central to all mitigation strategies, imaging and treatment modalities such as a S-Mode ultrasound, burst wave lithotripsy, and ultrasonic propulsion are being developed and evaluated as in-flight countermeasures for urologic pathology. Parabolic flights have been conducted to develop and evaluate the feasibility of using surgical and endoscopic techniques to treat urologic conditions in microgravity. Although less often discussed, occupation-related delayed conception and the risk of radiation-induced gamete damage suggests that there may be a need for NASA to adopt a policy for Assisted Reproductive Technology for both male and female astronauts. The last 60 years of human spaceflight have provided a unique opportunity for discovery and medical technology innovation. This paper serves to highlight the advancements that will help pave the way for the next 60 years of human spaceflight.
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