This issue covers a variety of practical and experimental topics, and contains one Review Article, eight Original Articles, two Short Communications, one Case Report and two Letters to the Editor.

Regarding the trend of increasing interest in reduced port surgery, a timely Review Article on natural orifice transluminal endoscopic surgery (NOTES) in urological surgery by Izquierdo et al. (Barcelona, Spain) appears first. NOTES, which was first used in the early 2000s, utilizes one or more patent natural orifices of the body, and can be considered a natural evolution of laparoscopy towards the ideal of scarless surgery. The authors conclude with an assessment of the current situation, which is that pure NOTES is not yet feasible, mainly because of a lack of the surgical tools especially designed for this approach. They also state that the so-called hybrid approach is an available technique, in which a natural orifice approach is combined with the use of one or more abdominal trocars, using the natural orifice as the exit door for the specimen removal. In addition to this comprehensive review, four papers describe challenging practical topics associated with the operative management of urological cancers.

An important current problem is how to select the most suitable surgery for patients with renal cell carcinoma, and a high risk of postoperative renal insufficiency is a problem we have to seriously deal with at present. Panumatrassamee et al. (Cleveland, USA) report the results of robot-assisted (n = 15) versus laparoscopic (n = 52) partial nephrectomy in solitary kidney cases. Early comparative outcomes show that the robot-assisted approach offers significant advantages over the laparoscopic approach in terms of operative time (171 vs 225 min, P = 0.02), warm ischemia time (15 vs 19 min, P = 0.04) and hospital stay (3 vs 4 days, P = 0.03). No significant differences were found in terms of estimated blood loss, complications, margin status or median percentage change of renal function. However, an evaluation of the two methods from a cost/benefit viewpoint would need to include factors specific to different countries.

Malignant involvement of resected ureters in patients undergoing radical cystectomy for bladder cancer often presents surgical challenges. Thus, it would be beneficial if the risk of malignant ureteral involvement could be clearly estimated before surgery. Gondo et al. (Tokyo, Japan) investigated preoperative predictors of ureteral involvement in bladder malignancy. The predictors, they showed, are tumor location (involvement of vesical trigone), clinical T stage (≥cT3) and the number of tumors (≥3). These results seem worthy of further verification.

Early achievement of continence after radical prostatectomy for prostate cancer has been one goal of this type of surgery. Hoshi et al. (Kanagawa, Japan) report that a new dorsal vein complex-preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy technique provides early recovery from incontinence without adversely affecting the oncological outcome. The continence rates when using this new technique versus the conventional technique at 1, 3 and 12 months, were 57% versus 37%, 77% versus 63%, and 95% versus 90%, respectively. This new technique does not, however, offer a significant benefit regarding sexual function.

Sunitinib malate, an orally active multi-target tyrosine kinase, is the standard of care for first-line treatment for metastatic renal cell carcinoma, often used in combination with radical or partial nephrectomy, despite associated high rates of various adverse effects. Neri et al. (Florence, Italy) investigate the efficacy and drug-related toxicity of a sunitinib regimen of 50 mg/day 2 weeks on/1 week off, compared with the standard regimen of 50 mg/day 4 weeks on/2 weeks off. They state that this shorter cycle regimen can provide a high response rate while reducing drug-related toxicities.

Conflict of interest

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  2. Conflict of interest

None declared.