IJU this issue

Abstract

This issue of International Journal of Urology contains 11 Original Articles, two Urological Notes, two Letters to the Editor, two Author’s reply, and three Editorial Comments. Partial nephrectomy for totally endophytic renal tumor is a surgical challenge and even if under robotic assistance, off-clamp partial nephrectomy is considered a risky procedure. Tuderti et al. (Rome, Italy) reported 56 consecutive patients with totally endophytic renal masses treated with off-clamp robotic partial nephrectomy (RAPN) in their institution. Preoperative super-selective delivery of a lipiodol-indocyanine green mixture into arterial branches feeding the renal mass provides a quick guide to identify tumor location without intraoperative ultrasound. Furthermore, it gives us a straight access to surgical area with minimal opening of Gerota’s capsule. Trifecta achievement was 91% in their patients with low operative complication rates. As Pandolfo et al. (Viriginia, USA) described in the Editorial Comment, the Editor also thinks that this procedure sacrifices visibility due to increased bleeding during the procedure. Moreover, it needs an extra step (preoperative super-selective delivery of a lipiodol-indocyanine green mixture) before surgery, which makes the procedure more complicated. With the technical advancement and accumulation of experience, the debate “on-clamp versus off-clamp” RAPN for completely endophytic renal masses will be settled in the near future. Gleason pattern 5 has been considered an independent unfavorable prognostic factor in localized and advanced prostate cancer. Morozumi et al. (Miyagi, Japan) retrospectively conducted multicenter analysis of outcomes of metastatic hormone-sensitive prostate cancer (mHSPC) with a Gleason score (GS) ≥8. They revealed that in high metastatic volume groups, hemoglobin and lactate dehydrogenase were significant factors for predicting overall survival (OS), while both Gleason pattern 5 and primary Gleason pattern 5 were not significant predictive factors after multivariate analysis. On the contrary, in the low-volume (LV) metastatic groups, only Gleason pattern 5 was an independent unfavorable predictive factor for OS after the analysis. Although there are several limitations, such as a lack of central pathology, they concluded that only in LV mHSPC patients with GS ≥8, primary Gleason pattern 5 should be considered as an unfavorable factor for the treatment strategy. As a homeostatic system, bladder storage function keeps the micturition interval constant by increasing bladder capacity during the diuretic phase, which is known as vesical adaptation response to diuresis (VARD). Matsuoka et al. (Fukushima, Japan) analyzed 94 male patients older than 65 years with lower urinary tract symptoms (LUTS). They found that 48 patients (51%) had VARD but in 46 patients (49%), VARD was lacking. Interestingly, absence of VARD was significantly associated with overactive bladder and benign prostate enlargement after adjusting for confounders. Although there are several limitations in their study, understanding of the pathophysiology underlying VARD might contribute a novel strategy for the treatment of bladder storage dysfunction in patients with LUTS. Immune checkpoint inhibitors (ICIs) therapy has become a key therapy against advanced urothelial carcinoma (UC), but there are no definitive data available for the association of the oncological outcome to first-line chemotherapy to subsequent ICIs therapy. Ozaki et al. (Hirosaki, Japan) reported their retrospective analysis of 218 patients with advanced UC who received systematic, platinum-based first-line chemotherapy. Focusing upon OS between patients treated with or without second-line ICIs therapy who had no progressive disease (PD) within four or few cycles of first-line chemotherapy (the non-PD ≤4 group), there was significant difference in the median survival (63 vs 26 months). On the contrary, in patients who had PD within four or few cycles of first-line chemotherapy (the PD ≤4 group), there was no significant difference in OS whether they were treated with ICI or not. These results suggest that the favorable response to the first-line chemotherapy was significantly associated with longer survival in patients with subsequent ICIs therapy than those without. Although we do not know the precise mechanisms of the results of the article, Miyake (Nara, Japan) commented in this issue that platinum derivatives could induce immunogenic cell death, which might enhance the antitumor activity of dendritic cells and T cells, which results in modulation of the expression of immune checkpoint molecules. Moreover, we still do not have the answer to how many first-line chemotherapy cycles will be appropriate before ICIs therapy. Consideration of introduction of antibody-drug conjugate, enfortumab vedotin for advanced UC treatment, we should accumulate more data about appropriate timing of changing armaments against this difficult disease. Unfortunately, the limited space restricts me to introduce the other excellent articles in this issue. I hope that the articles in this issue will help you in daily clinical practice. None declared.