IJU this issue

Abstract

T his issue of International Journal of Urology contains two Review Articles, 11 Original Articles, one Urological Note, one Letter to the Editor and four Editorial Comments. Cryptorchidism is the most common genital disorder in boys, and a risk factor for reduced fertility and testicular cancer. Mitsui (Yamanashi, Japan) discussed and reviewed the effects of environmental factors, particularly focusing on environmental endocrine disruptors. The review discusses many previously published case–control studies with regard to endocrine-disrupting chemicals and cryptorchidism, but most of them came from the USA and European countries. The study currently being carried out by the Japan Environment and Children’s Study will give us new information about the issue in Asian populations. Pembrolizumab, an antibody against programmed cell death protein 1, showed a survival benefit in platinum-resistant urothelial cancer patients compared with cytotoxic chemotherapy. Narita et al. (Hirosaki, Japan) retrospectively carried out a multicenter analysis of outcomes of pembrolizumab versus those of chemotherapy in real-world advanced urothelial cancer patients after platinum-based chemotherapy. Although there existed some confounding bias, they showed the benefit of second-line pembrolizumab over chemotherapy in real-world settings. Etoposide, ifosfamide and cisplatin (VIP) therapy is an alternative first-line chemotherapy for disseminated germ cell cancer, when there are contraindications for bleomycin administration. Previous studies showed that bleomycin, etoposide and cisplatin therapy (BEP) and VIP had equivalent efficacies, whereas hematological toxicities were more often observed in patients receiving VIP. However, most of the reports were written before the introduction of granulocyte colony-stimulating factor, and the primary prophylaxis use of pegfilgrastim, a long-acting granulocyte colony-stimulating factor agent, might contribute to the feasibility of the VIP regimen. Fujiwara et al. (Tokyo, Japan) retrospectively evaluated 154 disseminated germ cell cancer patients who received VIP treatment in their single institution. Overall, first-line VIP therapy yielded 5-year overall survival rates of 100%, 85% and 81% in the International Germ Cell Cancer Collaborative Group favorable, intermediate and poor prognosis groups, respectively. Furthermore, grade 4 neutropenia/leukopenia was significantly less commonly observed in the primary prophylaxis group than in the non-primary prophylaxis group. A major concern related to first-line VIP therapy is that there is no standard secondline chemotherapy as an optimal subsequent strategy, as a widely used second-line regimen, paclitaxel, ifosfamide and cisplatin (TIP), differs from VIP only in terms of one agent (i.e. etoposide is replaced by paclitaxel). The authors presented the paclitaxel, gemcitabine and cisplatin (TGP) regimen as a second-line setting, but information needs to be accumulated. Urethroplasty using autologous native oral mucosa graft is the standard treatment for anterior mediumto long-range urethral stricture. Karapanos et al. (Cologne, Germany) reported their experience with MukoCell urethroplasty. As Horiguchi (Saitama, Japan) commented in this issue, selecting MukoCell urethroplasty might be a good alternative method of oral mucosal grafts for urethral stricture cases without frequent urethral dilations, but the price needs to be lower for dissemination. Castellani et al. (Ancona, Italy) carried out a timely retrospective analysis of patients admitted to the emergency department during the COVID-19 pandemic lockdown period. They showed a reduction of emergency department admissions for symptomatic ureteral stones in three Italian hospitals, but the higher incidence of complicated stone disease, which could partially be explained by patients’ fear of becoming infected with COVID-19, leading to delayed presentation at the hospital. The same tendencies have been reported in other articles from other countries and we would also like to know what happens in Japan. Kanno et al. (Kyoto, Japan) provided excellent strategies to manage unexpected venous bleeding during laparoscopic nephrectomy in their Urological Note. They showed their experiences to control accidental venous bleeding by soft coagulation or by applying TachoSil. Their supplementary video clips are useful for the reader of International Journal of Urology. Unfortunately, the limited space restricts me from introducing the other excellent articles in this issue. I hope that the articles in this issue will help you in daily clinical practice.