IJU this issue

Abstract

This issue contains two Review Articles, 11 Original Articles, three Urological Notes and five Editorial Comments. The number of people with diabetes rose rapidly. The prevalence in Japan is estimated to be approximately 10%. Sodium–glucose-linked transport protein 2 (SGLT2) inhibitors are newly developed drugs, used for the treatment of type 2 diabetes mellitus, that act on the proximal convoluted tubules of the nephrons to prevent resorption of glucose from the filtrate. In this issue Chandrashekar et al. (Brisbane, Australia) reviewed the urological implications of these drugs. Increased glycosuria is thought to result in genital infections and urinary tract infections. Genital infections in males, which can be increased by up to fivefold, include balanitis and balanoposthitis. SGLT2 inhibitors might also cause Fournier’s gangrene. Unexpectedly, one large-scale study failed to show the increased risk for severe and non-severe urinary tract infection events among cases treated with SGLT2 inhibitor, compared with those among cases treated with dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 agonists. Pollakiuria and nocturia, which might have impacts on quality of life, were the most prevalent lower urinary tract symptoms after initiation of SGLT2 inhibitors. Notably, the authors recommended that SGLT2 inhibitors should be ceased perioperatively, because perioperative use increases the risk of euglycemic diabetic ketoacidosis. Three original articles and one urological note on renal cell carcinoma (RCC) appear in this issue. Ishiyama et al. (Tokyo, Japan) reviewed their 23 patients who underwent extracorporeal circulation-assisted surgery with or without using deep hypothermic circulatory arrest (DHCA). They found that surgical time, estimated blood loss, perioperative complication rate, 90-day mortality rate and hospital stay days were similar between these two groups. In addition, oncological outcomes (cancer-specific and overall survival) did not differ between groups. They concluded that the use of DHCA did not result in inferior perioperative outcomes. Although DHCA often requires longer operative time and are thought to be related with platelet dysfunction and coagulopathy, the authors successfully showed the safety and usefulness of DHCA. Wakita et al. (Kobe, Japan) reported on the surgical outcomes of the complex tumors of the kidney treated with robot-assisted partial nephrectomy (RAPN). They retrospectively analyzed 348 patients who underwent RAPN at a single center; 299 had non-complex tumors (RENAL score <10) and 49 had complex tumors (RENAL score ≥10). Although more perioperative complications and lower postoperative renal function with longer ischemia time and console time were observed in the complex tumors group, positive surgical margin rate and recurrence-free survival did not differ between groups. They concluded that RAPN for complex renal tumors is safe, with no difference in oncological outcomes despite more complications and decreased renal function. For the complex tumors, radical nephrectomy or open partial nephrectomy tend to be carried out, even in this era. The authors clearly showed the effectiveness and safety, along with limitation, of RAPN for the complex tumors. Several risk factors for recurrence or survival in pT3a RCC patients have been proposed. In this issue Ohsugi et al. (Hirakata, Japan) performed a retrospective study assessing the predictors of postoperative recurrence in non-metastatic patients with pT3a RCC. Analyzing 114 patients, they identified three predictors for recurrence-free survival on multivariate analysis, perinephric fat invasion, sarcomatoid or rhabdoid features and necrosis. They found that high-risk pT3a cases with two or three of these predictors had poor prognosis, and that the recurrence-free survival was similar between high-risk pT3a cases and those with pT3b or greater. Previously, the impact of perinephric fat invasion on cancer-specific survival was analyzed using 2998 patients from the RCC registry of The Cancer Registration Committee of JUA.1 Perinephric fat invasion was associated with advanced age and aggressive pathological features, and was an independent prognostic factor in non-metastatic RCC especially in larger tumors. Nivolumab plus ipilimumab is widely used for the first-line therapy for advanced RCC. Ishihara et al. (Tokyo, Japan) reviewed their 16 advanced RCC cases without prior nephrectomy. They found that tumor response between primary and metastatic lesions was generally parallel. Interestingly, the magnitude of tumor response ranged more widely in metastatic lesions than in primary lesions. As unresectable RCC is not rare, this study provides us useful clinical information on decision-making. None declared.