Appreciation of the negative impact of chronic kidney disease has resulted in partial nephrectomy (PN) surpassing radical nephrectomy (RN) as the preferred treatment for technically feasible lesions. Indeed, the management of localized renal tumors has become focused on techniques that maximally preserve nephron quantity and quality, and therefore maximize renal function after surgery. In this issue of International Journal of Urology, Lee et al. (Seoul, Korea) reported renal function data in a large and homogeneous series of 369 patients managed by open PN for a single localized unilateral pT1a renal tumor. They concluded that there is no difference between cold and warm ischemia in renal function impairment, therefore, when hilar clamping is required, minimization of ischemia time is necessary. While minimization of surgical ischemia is achieved by early unclamping and unclamped (zero ischemia) techniques, Ota et al. (Chiba, Japan) introduced a unique method for open PN without renorrhaphy using the soft coagulation system, which has been applied to liver surgery. Ischemic time depends on the surgeon's skill for suturing of the renal parenchyma, which can cause various postoperative complications, such as false aneurysm, arteriovenous fistula and circulation disorder of the renal parenchyma. This soft coagulation technique might shorten the total ischemic time by reducing the time required for renorrhaphy, leading to preservation of renal function. Furthermore, this system seems to be a feasible device in both open and laparoscopic (robotic) PN, and therefore deserves further studies including patients with larger tumors, and central or hilar tumors. Nevertheless, RN is still currently carried out in many patients for several reasons, such as size, location or multiplicity of renal tumors, comorbidity of patients and inexperience of surgeons. Yokoyama et al. (Tokyo, Japan) developed and externally validated a prognostic model that prognosticates the risk of chronic kidney disease after nephrectomy for renal cell carcinoma, which provides important information that will be helpful in clinical decision-making regarding treatment options or follow-up strategies, especially in high-risk patients in whom PN would be technically difficult.
Lower urinary tract symptoms (LUTS) are a common problem, especially for older men and women. It has been reported that 90% of men aged 50–80 years suffer from potentially troublesome LUTS. Recent increasing evidence has pointed toward a relationship between LUTS and the presence of metabolic syndrome (MetS). Cantiello et al. (Catanzaro, Italy) carried out detailed analysis of peri-urethral prostate tissues from 80 consecutive radical prostate specimens by immunohistochemical staining, and showed that MetS was significantly associated with prostate inflammation, as well as fibrotic changes within the peri-urethral prostate tissue, suggesting the significant role of inflammatory changes induced by MetS in the formation of peri-urethral fibrosis, which could have a negative impact on urinary status. Recent reports show that many of the female patients with LUTS have associated pelvic organ prolapse, which is also believed to be associated with MetS. Obinata et al. (Tokyo, Japan) showed a significant correlation between pelvic organ prolapse and LUTS, and favorable results of pelvic floor reconstructive procedure for the improvement of LUTS. Recent studies suggest that adipose tissue is an endocrine organ because of its capacity to secrete a variety of adipokines, such as leptin, adiponectin and resistin, which have been shown to interact with both epithelial and stromal cells in the prostate gland, resulting in the contribution to eventual development of benign prostatic hyperplasia-related LUTS. In contrast, it is of interest that Gotoh et al. (Nagoya, Japan) developed regenerative treatment of male stress urinary incontinence using autologous adipose-derived regenerative cells.