This issue contains one Review Article, 10 Original Articles, two Case Reports and one Letter to the Editor.
Hsu et al. (Kaohsiung, Taiwan) comprehensively reviewed the current status and future of intravesical drug delivery for dysfunctional bladder. The target diseases are interstitial cystitis/bladder pain syndrome (IC/BPS), refractory overactive bladder (OAB) and hemorrhagic cystitis. The authors emphasized that the bladder is a reservoir, with an impermeable urothelium as the “blood–urine barrier”. This functional property of the urothelium hampers the absorption of substances and drugs delivered into the bladder. It is a literal “barrier” at first sight, but might be a merit as well. Intravesical therapy has several advantages over oral (systemic) therapy, such as high local concentration and less systemic toxicity. Because of the “urothelial barrier”, drugs that potentially cause serious systemic adverse effects can be applied intravesically. For example, botulinum toxin for OAB and IC/BPS has to be localized, because any systemic absorption can be fatal. Therefore, future direction of the intravesical drug delivery for dysfunctional bladder should be a combination of the locally effective, but systematically toxic, drugs with novel carriers. Also, some innovative sustained-release platforms might be required to decrease the number of invasive maneuvers for the bladder instillation.
Ellison et al. (Ann Arbor, USA) retrospectively evaluated the predictive value of the Radius, Exophytic, Nearness, Anterior, Location (RENAL) nephrometry scoring system, and the influence of its individual components on perioperative outcomes of laparoscopic or robotic partial nephrectomy. The RENAL nephrometry score has been reported to better describe renal masses and objectively predict the difficulty of resection. They found that the RENAL score has value as a predictive tool for perioperative outcomes, and distance to the renal sinus seems to have the greatest association with outcomes. Such scoring systems should facilitate a better understanding of the clinical outcomes and preoperative counselling of patients. The process of translating “tacit knowledge” into “explicit knowledge” is always important, and creates further new “tacit knowledge”, which is potentially translated into new “explicit knowledge” like the findings identified in this paper.
Fujita et al. (Osaka, Japan) assessed the impact of preoperative serum sodium concentration on the prognosis of patients with upper urinary tract urothelial carcinoma treated by nephroureterectomy. The authors first reported a low preoperative sodium level predicts a poor survival in these patients. The association of low serum sodium level with mortality in various diseases has recently been reported. Hyponatremia is a common electrolyte disorder seen in hospitalized patients with critical diseases, such as malignancies, and heart, liver and renal failure. My question on the paper is “Can additional therapies, such as neoadjuvant/adjuvant chemotherapy, improve the prognosis of patients with preoperative hyponatremia?”
Fukui et al. (Obu, Japan) evaluate the significance of intrarenal reflux (IRR) in primary vesicoureteral reflux. The management of reflux with IRR remains controversial. The authors concluded that high-grade reflux with IRR can be treated by conservative management involving low doses of prophylactic antibiotics, as possibilities of spontaneous resolution and improvement of the reflux are not affected by the presence of IRR. However, parents and physicians should remain alert to the risk of breakthrough urinary tract infection leading to renal damage in cases of high-grade reflux with IRR.