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We, urologists, think ourselves more or less familiar with urine leak, and often believe it will heal with time. This condition is seldom life-threatening, which is quite different from fecal leak after abdominal surgery. Conservative management is thus the preferred approach most of the time. Nevertheless, prolonged vesicourethral anastomotic urine leak after radical prostatectomy annoys both patients and physicians. In this issue of International Journal of Urology, Lim et al. (Seoul, Korea) reported their experience in cystoscopic injection of N-butul-2-cyanoacrylate and fibrin glue to treat anastomotic urine leak. A total of 10 such patients were treated at a mean time from radical prostatectomy of 16.0 days (range 12–27 days). Admittedly, there is no such definition of anastomotic leak sufficient to justify any intervention. They claim secondary fibrosis and the surrounding scar formation can lead to bladder neck contracture if only managed conservatively. Some accept this, but others might reject the idea. If effective, why don't we administer the same regimen around the anastomosis during surgery? Upfront administration should at least make it much easier to prevent or shorten the duration of urine leakage. Some surgeons prefer to use biodegradable glues over the prostatic bed for the purpose of complete hemostasis. Applying some of the glues to the anastomotic site is not of great significance. As the incidence of “massive” anastomotic urine leak in the authors' experience was just 0.5% (10 out of 1828 patients), the idea of routine use of such biological glues might not be well justified. Nevertheless, this is the first report of expanding the use of fibrin glue to the treatment of anastomotic urine leak after radical prostatectomy. The observed effectiveness might just reflect natural wound healing, as their definition of “prolonged” urine leak is still somewhat elusive. A more scientifically sound comparative study is warranted.

Kampo is oriental herbal medicine. It originated in China, and was the mainstay in Japanese medicine until around 1870. Because of the nature of mostly “experience-based” at first, the therapeutic system is not simple and easily understandable. Recently, a more scientific approach of dissecting its mechanisms of action has been used, and the unique pharmacological effects of the plant extract have been elucidated. Nishihata et al. (Wakayama, Japan) reported the effect of Kampo extract on urinary stone formation. Gorin-san, which contains Sanshishi and Takusha, could ultimately prove to be useful for the prophylaxis of urolithiasis in humans. Organizing high-quality clinical trials to prove their hypothesis would be the next step.

Precise assessment of intra- and extraglandular tumors is essential when planning and recommending treatment in prostate cancer. Hara et al. (Tokyo, Japan) reported on the ability of preoperative 3.0 tesla magnetic resonance imaging for predicting side-specific extracapsular extension. Their prediction model possessed satisfactory sensitivity (93.9%) and a negative predictive value (93.7%). However, the specificity (29.8%) and positive predictive value (30.6%) were not satisfactory. They considered this model to be suitable for the use of predicting the non-extracapsular extension side, and showed the potential of modern imaging modalities to compensate for current diagnostic dilemmas in this field of urological oncology. Such models always require extra validation. The results based on their method of prostatic biopsy using an end fire probe might not apply to others. One of the issues is that findings on biopsy cores are very often complicated because of the variety of sampling methods.

Further technological, conceptional innovation and accumulation of wisdom will open the gate to the possibility of newer intervention, and a more sophisticated approach in the near future.

Conflict of interest

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  2. Conflict of interest

None declared.