International Journal of Urology | 2021
IJU this issue
Abstract
T his issue of International Journal of Urology contains one Review Article, 14 Original Articles, one Urological Note and nine Editorial Comments. Here, I would like to introduce five Original Articles. Partial nephrectomy has become the standard treatment for T1 renal cell carcinoma (RCC). When carrying out minimally invasive techniques, it is important not to compromise oncological, functional or perioperative outcomes. Hinata et al. (Kobe, Japan) carried out a prospective multi-institutional trial to evaluate the perioperative outcomes of warm ischemia time and positive surgical margin rates in patients who underwent robot-assisted partial nephrectomy for renal hilar tumors compared with those in historical control values of laparoscopic partial nephrectomy. They successfully showed that robot-assisted partial nephrectomy resulted in a shorter warm ischemia time and comparable positive surgical margin rates in a multi-institutional setting. The Gleason score (GS) grading system is one of the strongest predictors of prostate cancer outcomes and plays a significant role in choosing a treatment modality. Milonas et al. (Kaunas, Lithuania) investigated whether the new prostate cancer grade groups (GGs) model provided more significant predictive value and better patient stratification on tumor progression after radical prostatectomy compared with the former Gleason grading. The new GGs model showed better performance in comparison with former GS models on the prediction of long-term oncological outcomes. This is partly because the new GGs divide former GS 7 into GG2 (GS 3 + 4 = 7) and GG3 (GS 4 + 3 = 7). Interestingly, in this study, GG2 showed no difference to GG1 (GS ≤6) in the prediction of clinical progression-free survival and cancer-specific survival. By contrast, GG3 and GG4 (GS 8) had similar hazard ratios in the prediction of clinical progression-free survival. There are two main management strategies for anterior urethral strictures, namely transurethral procedures, such as direct vision internal urethrotomy and urethral dilation, and urethroplasty. Although transurethral procedures are neither effective nor costeffective for the treatment of urethral structure, they have long been used excessively and inappropriately. Ojima et al. (Tokorozawa, Japan) confirmed that transurethral procedures are still often inappropriately used. There is a clear need to promote appropriate management strategies for urethral strictures among general urologists. This is an important message. Lower urinary tract symptoms often occur after low-dose-rate brachytherapy for localized prostate cancer. Nowadays, prophylactic use of alpha 1-adrenergic receptor antagonist is the most common treatment and prevention method for lower urinary tract symptoms after low-dose-rate brachytherapy. Mingagawa et al. (Nagano, Japan) carried out a randomized open-label trial comparing the efficacy of phosphodiesterase-5 inhibitor, tadalafil, and tamsulosin. In this study, the effect of tadalafil was similar to that of tamsulosin in terms of urinary quality of life and lower urinary tract function. In addition, the effect of tadalafil was superior to that of tamsulosin in terms of preventing the exacerbation of erectile dysfunction in patients with moderate and severe erectile dysfunction preoperatively. At present, no guidelines recommend the routine use of brain computed tomography (CT) for staging of RCC. They recommend it only in the presence of specific clinical or laboratory signs and symptoms of brain metastases. However, it is unclear when to use brain CT during systemic therapy for metastatic RCC. Naito et al. (Yamagata, Japan) retrospectively investigated 152 metastatic RCC patients who did not initially have brain metastasis. Routine head CT during systemic therapy for metastatic RCC detected brain metastases more in the asymptomatic phase, leading to avoiding craniotomy. However, the incidence of brain metastases was relatively low, even in these patients (16 of the 152 patients, 11%), and routine use of head CT was not significantly associated with improved brain metastasis prognosis. How do you interpret these results? Unfortunately, the limited space does not allow me to introduce all the articles. However, all the papers are interesting, informative and well-illustrated. I hope you enjoy this issue of International Journal of Urology.