This issue deals with a wide range of clinical topics of urology, and contains one Review Article, 12 Original Articles, one Case Report and two Letters to the Editor. Urinary incontinence after radical prostatectomy is a big problem for patients with prostate cancer, and many urologists try to improve postoperative continent rates. Although recent systemic reviews and meta-analyses have shown that robot-assisted radical prostatectomy (RALP) has higher postoperative continence rates than retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP), urinary incontinence has remained one of the most bothersome postoperative complications, even after RARP. The Review Article by Kojima et al. (Fukushima, Japan) showed that the basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. They precisely reported three processes that consisted of preservation, reconstruction and reinforcement, helping us to modify our technique during RALP. Another topic regarding prostate cancer in this issue is pelvic lymph node dissection for prostate cancer. Mitsuzuka et al. (Sendai, Japan) investigated the role of pelvic lymph node dissection for low-risk prostate cancer using their medical records for 1268 patients undergoing open radical prostatectomy. Their conclusion is that pelvic lymph node dissection can be spared at radical prostatectomy for low-risk disease because of its poor diagnostic and therapeutic value, which is useful information when we carry out radical prostatectomy.

Open versus laparoscopic, and partial versus radical nephrectomy (RN) for T1a renal cell carcinoma (RCC) are important topics, because the use of partial nephrectomy (PN) remains low in the community setting despite its established benefits. Bianchi et al. (Milan, Italy) examined the trends of open and laparoscopic PN and RN according to sociodemographic and tumor characteristics, using the USA Surveillance, Epidemiology, and End Results Medicare-linked database. They showed that older and female patients are less likely to undergo nephron-sparing surgery, and are more likely to have a radical nephrectomy by the laparoscopic approach instead, although utilization rates of PN are increasing. Further encouragement is required to increase PN for T1a RCC. Another topic regarding RCC in this issue is RCC extending into the inferior vena cava (IVC). Kondo et al. (Tokyo, Japan) investigated the impact of histological subtypes on the survival of patients presenting with RCC extending into the IVC, using their 68 cases who underwent RN and IVC thrombectomy. Their conclusion is that patients with RCC extending into the IVC with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype, which is helpful when we decide operative indications for patients with RCC extending into the IVC.

Laparoendoscopic single site (LESS) surgery is a technical modification of conventional laparoscopy whereby the entire surgical procedure is carried out through a single abdominal wall incision. Tugcu et al. (Istanbul, Turkey) performed a prospective randomized study of LESS versus conventional transperitoneal laparoscopic pyeloplasty. A total of 39 patients were enrolled in their prospective study, and LESS pyeloplasty could offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. However, median operative time was longer in the LESS pyeloplasty group compared with the conventional laparoscopic group. Recently, a reduced port surgery using thin forceps, but not LESS, is increasing with technical advancements. In this sense, a comparison of reduced port pyeloplasty using thin forceps with LESS pyeloplasty would be interesting for evaluating the most minimally-invasive pyeloplasty.

Conflict of interest

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  2. Conflict of interest

None declared.