IJU this issue

Abstract

In this issue, a Guideline with Editorial Comment, a Review Article with Editorial Comment, five Original Articles with three Editorial Comments and a Urological Note were published in the International Journal of Urology. Interstitial cystitis/bladder pain syndrome (BPS) bothers both patients and urologists. Homma et al. (Tokyo, Japan) revised the previous guidelines completing articles identified by the PubMed database published from 2016 to 2019. In this article, the authors clearly defined Hunner-type interstitial cystitis (HIC) associated with Hunner’s ulceration and non-Hunner-type BPS featuring glomerulations or bladder bleeding after distension are different entities of disorder in terms of pathophysiology. Interestingly, HIC shows immunological inflammatory reaction accompanied by B-cell clonal expansion, which demonstrates HIC is genetically different from BPS. Urologists should keep in mind that patients should be treated differently based on the diagnosis of HIC or BPS, which requires cystoscopy to determine the presence or absence of Hunner lesions. Malignant ureteral obstruction, defined as either intrinsic or extrinsic compression caused by metastasis, lymphadenopathy or direct extension of the tumors, is an unfortunate finding that most urologists encounter in the daily practice. Tabib et al. (New York, USA) reviewed many types of ureteral stents, including tandem stents or metallic stents that aim for the resolution of malignant ureteral obstruction, and attempted to provide considerations regarding the treatment and management of malignant ureteral obstruction. Ochi et al. (Chiba, Japan) examined the anatomical relationship between the urinary system and perirenal fat using computed tomography images from 50 men, as well as macroscopic imaging in nine cadavers. They found that perirenal fat belongs to the connective tissue of the gonad and the adrenal gland. The urinary system is separated from perirenal fat, and is located on the dorsal side inside the renal fascia. The authors concluded that this anatomical finding might help aid in the isolation of periureteric fat from perinephric fat in retroperitoneoscopic donor nephrectomy. A substantial number of non-classic angiomyolipomas (AML), including fat-poor or epithelioid AML, are encountered in daily practice, and are occasionally difficult to discriminate from renal cell carcinoma. Kaneko et al. (Tokyo, Japan) retrospectively evaluated the incidence of epithelioid AML (17.9%) out of 39 renal tumors diagnosed as non-classical AML. They found that magnetic resonance imaging findings (apparent diffusion coefficient value) are potentially useful to differentiate between epithelioid and fat-poor AML. A recent trend for the treatment of metastatic castration-sensitive prostate cancer (CSPC) is upfront intensification therapy including androgen deprivation therapy (ADT) plus docetaxel, ADT plus abiraterone acetate, ADT plus enzalutamide and ADT plus apalutamide. However, indication is limited in high-risk (LATITUDE criteria) or high-volume (CHARRTED criteria) patients. Hatakeyama et al. (Hirosaki, Japan) retrospectively evaluated 679 patients with metastatic castration-sensitive prostate cancer. They found that the overall survival from the initiation of castration-resistant prostate cancer in patients with low-volume disease and those with high-volume disease was not significantly different, and concluded that upfront intensification therapy might be beneficial to patients with low-volume disease, because approximately half of patients with low-volume disease experienced metastatic castration-resistant prostate cancer progression in real-world practice. The Editorial Comment by Kato (Nagoya, Japan) is worthwhile to correctly evaluate this article. As most of the metastatic spread is reported to be in a hematogenous fashion in renal cell carcinoma, the impact of regional lymph node metastases on subsequent distant metastasis remains unknown. Yang et al. (Rochester, USA) retrospectively evaluated 1049 patients (135 pN1, 914 pN0/x) who were surgically treated at the Mayo Clinic. They found that pN1 nodal status in M0 patients treated with nephrectomy for renal cell carcinoma is associated with more frequent early metastasis to sites conferring poor prognosis when compared with pN0/x in the lung, bone and non-regional lymph nodes. Interestingly, pN1 status did not affect subsequent liver metastasis, one of the most hematogenous metastatic organs. Although this article involves several limitations, their finding might stimulate discussion of the predictive/therapeutic role of regional lymph node dissection during renal cancer surgery. None declared.