IJU this issue

Abstract

This, the latest issue of the International Journal of Urology, covers a wide range of topics including three Review Articles, 17 Original Articles and eight Urological Notes. In their Review Article, Johnin et al. (Otsu, Japan) reconsider the indications for voiding cystourethrography and the procedure itself in view of the distress and anxiety it causes pediatric patients, despite the fact it is considered essential for investigation of lower urogenital tract diseases in children. The other two reviews provide up-to-date information on upper tract urothelial carcinomas and the endourological management of urolithiasis. In their Original Article, Song et al. (St. Louis, USA) report the utility of urine aquaporin 1 and perilipin 2 as new non-invasive biomarkers for distinguishing benign from malignant small renal masses. The authors have confirmed that the two biomarkers have high sensitivity and specificity for detecting clear cell and papillary renal cell carcinoma. Their results imply that the use of these markers might reduce both the number of operations for benign renal masses and the number of renal biopsies required for diagnosis of malignant renal lesions. The Original Article by Harada et al. (Kobe, Japan) provides detailed data on the treatment patterns and outcomes in patients with unresectable or metastatic renal cell carcinoma (RCC) in a real-world setting in Japan. As few previous studies have summarized such data, this study is noteworthy in clarifying the actual clinical situation in Japan. However, as immune checkpoint inhibitors are becoming a standard form of treatment for advanced RCC in the place of tyrosine kinase inhibitors, data from similar investigations carried out several years later would be interesting. In their Urological Note, Shiraishi et al. (Kobe, Japan) describe a unique case of right RCC involving the inferior vena cava in which the surgical specimen was found to have become completely necrotic after sequential treatment with pazopanib followed by nivolumab, even though the tumor mass was still present in both the right kidney and inferior vena cava extending to just above the diaphragm. This case report provides two important pieces of information. One is that sequential treatment with a tyrosine kinase inhibitor followed by nivolumab might be an optimal form of presurgical neoadjuvant therapy. The other is that a pathological response appeared to have been obtained even though the effect was not clinically complete. Clinicians sometimes encounter patients with metastatic RCC who show a good outcome after immuno-oncology drugs, even though the tumor response might not be complete. The reason for this could be related to this mechanism. Inoue et al. (Kyoto, Japan) report some important results of primary targeted focal cryotherapy for patients with magnetic resonance imaging-visible, magnetic resonance–ultrasound image fusion targeted biopsy-proven clinically localized prostate cancer. The authors found that the combination of both multiparametric magnetic resonance imaging (not only both diffusion-weighted and T2-weighted imaging, but also contrast magnetic resonance imaging) and prostate-specific antigen variables (prostate-specific antigen <4 ng/mL and rate of prostate-specific antigen decrease >50%) might provide possible follow-up criteria for suggesting the technical success of focal therapy and/or indications for follow-up biopsy. Currently, very few data are available for defining what form of biochemical control is appropriate for confirming treatment success when an appreciable proportion of the prostate gland is left untreated by focal therapy. There is also a lack of clarity regarding the optimal selection of imaging sequences for the detection of remaining (insufficiently ablated) or recurrent prostate cancer. Therefore, the authors’ criteria will be useful to other focal therapists. None declared.