IJU this issue

Abstract

In this issue, seven Original Articles with four Editorial Comments, two Review Articles and three Urological Notes were published in the International Journal of Urology. Urinary tract infection or perioperative infection control is one of the important clinical issues for urologists. A rapid increase of carbapenem-resistant Enterobacteriaceae and its outbreak is a grave worldwide problem. Kitano et al. (Hiroshima, Japan) reviewed mechanisms behind antimicrobial resistance, and new antimicrobials to treat resistant microbes. This article concisely describes the current state of resistant microbes associated with urinary tract infections and countermeasures for antimicrobial resistance, including new antimicrobials. As the author denotes in Table 3 of that article, the World Health Organization priority list for antibiotic-resistant bacteria should be recognized by urologists. As different treatment modalities for localized prostate cancer yield similar patient outcomes, the focus in determining appropriate treatment has shifted toward health-related quality of life. Murakami et al. (Kanagawa, Japan) reviewed the impact of brachytherapy and other modalities on health-related quality of life. Except for the inferior outcome regarding urinary obstruction and irritation, brachytherapy is likely to yield similar or better health-related quality of life than other treatment modalities, such as operation, active surveillance or external beam radiation therapy. Due to scant data on prospective direct comparison among modalities and recent replacement by sophisticated technologies, such as intensity-modulated radiation therapy or robot-assisted radical prostatectomy, it seems hardly difficult to draw a convincing conclusion. Sazuka et al. (Chiba, Japan) retrospectively examined the impact of post-void residual urine volume on the risk of postoperative intravesical recurrence in 81 patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy. The authors found the presence of pyuria and a residual urine volume (defined as ≥30 mL) were associated with bladder recurrence in the multivariate analysis, and the 2-year postoperative recurrence-free rates of patients with and without a residual urine volume were 32% and 82%, respectively. Although the number of the cohort for a propensity-score match study is limited, the authors’ hypothesis is unique and is worthwhile for a large-scale prospective analysis. Choo et al. (Suwon, Korea) carried out to a web-based questionnaire survey regarding the individual treatment trend and adherence to international guidelines on non-muscle-invasive bladder cancer. Out of 2334 urologists who were active members of the Japanese Society of Urological Oncology, the Korean Urological Oncology Society and the Taiwan Urological Association, 701 (30%) responded to the survey from June 2016 to February 2017. The authors found significant differences in the management of intermediate- to high-risk non-muscle-invasive bladder cancer between Japan, Korea and Taiwan. As the authors described, East Asian countries are geographically close together, and share ethnic and sociocultural similarities, such that the survey can serve as the basis for joint efforts among East Asian urologists to develop common clinical guidelines for the management of non-muscle-invasive bladder cancer. Nephrostomy tube after percutaneous intrarenal surgeries, such as percutaneous nephrolithotomy (PCNL), sometimes prevents a short hospital stay and adversely affects patients’ quality of life. A tubeless procedure would be ideal after PCNL. Takeda et al. (Miyazaki, Japan) compared the efficacy and safety among patients who received trans-tract electrocoagulation at the end of endoscopic combined intrarenal surgery (225 patients) with that of those who did not (72 patients). Although stone number or size was in favor of the trans-tract electrocoagulation group, the nephrostomy tube-free rate and other postoperative clinical parameters were significantly higher in the trans-tract electrocoagulation group. As Kakinoki (Saga, Japan) indicated in the Editorial Comment, all patients do not always require such procedure, particularly when miniaturized PCNL is used. To clarify the necessity of hemostasis, a prospective randomized study comparing miniaturized PCNL is warranted. None declared.