In this issue of International Journal of Urology, six Review Articles with three Editorial Comments, four Original Articles and two Urological Notes were published. Husmann (Rochester, USA) reviewed 385 patients that have experienced an enteric bladder augmentation as a result of spina bifida or bladder exstrophy, using either the ileum or colon. Based on the finding of increasing complications with body mass index, the author concluded long-term follow-up evaluations and the nutritional management of patients undergoing an enteric bladder augmentation are necessary to prevent the long-term sequela of this procedure. As the reviewer notes in the Editorial Comment, urologists should bear in mind that complicated surgeries are not a goal, but the start of a new daily care routine of their bladder. Takeuchi et al. (Fukuoka, Japan) reviewed the mechanism of immunological tolerance induced by cyclophosphamide (CY) and other immune factors in kidney transplantation. The authors established their own CY-induced experimental chimera mouse model consisting of intravenous injection of allogeneic bone marrow and spleen cells, followed by intraperitoneal injection of CY. In this model, they showed destruction of allo-reactive T cells by CY. Interestingly, they modified their tolerance system for the experimental treatment of malignancy. Inamoto et al. (Osaka, Japan) compared the oncological and quality of life results of bladder preservation therapy including trimodal therapy with that of radical cystectomy, and concluded that trimodal therapy has emerged as a potential alternative treatment option for muscle-invasive bladder cancer. As muscle-invasive bladder cancer is a systemic disease, trimodal therapy might become an attractive alternative when considering the combination or adjuvant setting of immuno-oncology drugs because of the abscopal effect as a result of radiation therapy. Several interesting Original Articles have been published. Nishioka et al. (Osaka, Japan) reported the utility and safety of high-dose mizoribine combination therapy using cyclosporine and tacrolimus as calcineurin inhibitors in patients undergoing kidney transplant from a Japanese multicenter study that enrolled 156 kidney transplant patients between 2009 and 2013. The authors concluded that two calcineurin inhibitors yielded equivalent efficacy, and high-dose (6 mg/kg at the start) mizoribine in combination with calcineurin inhibitors basiliximab, and corticosteroids can provide effective immunosuppression. This study is worthwhile, not only for showing the utility and safety of this regimen, but also for showing the commitment of Japanese urologists to kidney transplantation worldwide. Urakami et al. (Tokyo, Japan) studied DNA mismatch repair proteins for 143 patients with upper urinary tract urothelial cancer, and found seven (5%) had loss of mismatch repair proteins, so-called microsatellite instability (MSI). Malignant tumors show an inherent genetic instability that can be classified as MSI or chromosomal instability. Although the frequency of MSI was reportedly higher in upper urinary tract urothelial cancer than bladder cancer, the figure and clinical characteristics were almost identical to bladder cancer (9/100; 9%, all with a low grade without tumor progression; Yamamoto T. Clin Cancer Res 2006; 12: 2752). Study of the genetic status of MSI will be more important because of the higher mutational burden than chromosomal instability with a good response to immuno-oncology drugs. Unfortunately, other interesting papers could not be published in this issue due to limited space. None declared.
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Jun 1, 2019
Nelson J Chao + 2
Open Access
