This issue covers a wide range of clinical topics of urology, and contains three Review Articles, one Perspectives in Urology, seven Original Articles, one Short Communication, one Case Report and one Letter to the Editor. There has been a long history of controversies, including some superstitions, surrounding circumcision. Most circumcisions have been carried out for religious reasons, and have also been used to decrease the likelihood of developing penile cancer, or contracting a urinary tract infection or a sexually transmitted infection. The Review Article by Hayashi et al. (Nagoya, Japan) focuses on a prophylactic basis of circumcision, helping us to learn the contemporary scientific evidence and real-world situation of this well-known issue. Another article by Shin et al. (Seoul, Korea) discusses one of the common pediatric diseases, nocturnal enuresis. Spina bifida occulta was detected in 26.9% of the children with nocturnal enuresis. The presence of spina bifida occulta significantly affects the response to treatment for nocturnal enuresis, thus it should not be overlooked.
Renal cell carcinoma has been considered to be an immune-responsive cancer, and several immunotherapeutic modalities including interferon-α or high-dose interleukin-2 have been investigated. Recently, research regarding vaccination therapy has been of special interest for the treatment of renal cell carcinoma. The Review Article by Yoshimura et al. (Osaka, Japan) reviews the present status of clinical trials, and discusses current knowledge and future perspectives of vaccine therapy in the era of recently developed targeted therapy. Small cell carcinoma of the bladder (SCCB) is a relatively rare condition, and poorly differentiated tumors are associated with more aggressive behavior and a poorer outcome than bladder urothelial carcinoma. Because of this low incidence, a consensus on the optimal treatment strategy has not been reached. Meijer et al. (Utrecht, the Netherlands) investigated the role of the sequential combination of chemotherapy and radiotherapy in the treatment of localized stage SCCB. Using a relatively large study cohort, sequential chemoradiation for limited disease SCCB results in a reasonable outcome with a high bladder preservation rate. They also showed significantly better cancer-specific survival for complete responders to induction of systemic chemotherapy. Further data accumulation is required to establish an optimal bladder-sparing strategy for patients with locally advanced SCCB.
There has been an increasing use of brachytherapy as a less invasive means to cure localized prostate cancer. Acute and late urinary toxicities are the main sequelae of the treatment. Araki et al. (Okayama, Japan) examined the predictive factors associated with Radiation Therapy Oncology Group urinary toxicity in prostate brachytherapy patients. They found that acute and late urinary toxicity after brachytherapy is strongly related to the baseline International Prostate Symptom Score and the percentage of the prostate gland that receives 100% of the prescribed dose (prostate V100). These findings help physicians, as well as patients, to make better decisions in the treatment of localized prostate cancer. From the standpoint of the natural history of male lower urinary tract symptoms, patients with moderate-to-severe voiding symptoms could be candidates for radical prostatectomy rather than brachytherapy. Although salvage radiotherapy is the only curative treatment for patients with prostate cancer showing biochemical recurrence after radical prostatectomy, it is hard to accurately know the pattern of recurrence; that is, local, distant or combined. Thus, the best candidates for salvage radiotherapy remain to be determined. Kinoshita et al. (Hirakata, Japan) evaluated the clinicopathological parameters that influence the outcome of salvage radiotherapy. They identified Gleason score of prostatectomy, prostate-specific antigen nadir after prostatectomy and positive surgical margin as independent predictors. The presence/absence of these risk factors might help to facilitate further stratification of salvage treatment.