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Masayuki Nakagawa M.D., Ph.D. Associate Editor

This issue features a short Review Article by Fujihara et al. (Kyoto, Japan), which describes a quantitative assessment of afferent nerve function in the lower urinary tract. It is difficult to evaluate sensory dysfunction objectively, although sensory dysfunction could be involved in various pathogenesis, such as neurogenic bladder, overactive bladder (OAB) and painful bladder symptoms. Recently, increased evidence has suggested that measurement of current perception threshold (CPT) values of A-delta and C-fibers in the lower urinary tract shows a significant correlation with clinical symptoms, conventional urodynamic variables and the efficacy of various treatments. The authors discussed the usefulness and controversial aspects of the CPT test in this review. As for treatment of OAB, Gotoh et al. (Nagoya, Japan) investigated the efficacy and safety of propiverine hydrochloride in Japanese patients with OAB. They equally allocated a total of 567 OAB patients to a propiverine group and a placebo group. The results showed that propiverine was effective by improving symptoms and quality of life (QOL) with a predictable adverse effect profile.

Drug-resistance to cisplatin is a critical issue to be solved, as there is no standard regimen without cisplatin for metastatic urothelial cancer. Joung et al. (Goyang, Korea) reported the effectiveness of third-line paclitaxel and cisplatin chemotherapy for metastatic urothelial cancer after the failure of two consecutive standard platinum-based regimens, M-VAC and GC combinations. They observed that the overall disease control rate was 42.9% and median overall survival rate was 9 months without life-threatening complications. This report shows that third-line chemotherapy can be used safely with good patient selection, although an Editorial Comment by EL-Gamal pointed out the lack of a control group in this study.

There are several treatment options other than surgery for localized prostate cancer. HIFU is one of those options; however, it is still considered experimental and investigational. Inoue et al. (Hiroshima, Japan) reported the treatment efficacy and complications of HIFU in 137 patients with T1-2 prostate cancer. They found that the 5-year disease-free rate was 78% without major complications. They concluded that HIFU was an effective, repeatable and minimally invasive treatment for low- and intermediate-risk prostate cancer. However, an Editorial Comment by Berge raised several controversial issues on the assessment method and criteria used in this study. More precise imaging technology will improve clinical outcomes of these focal therapies.

This issue also includes two Short Communications. It is controversial – which is more suitable for management of malignant extrinsic ureteral obstruction (MEUO), retrograde stent or percutaneous nephrostomy? Kamiyama et al. (Sendai, Japan) described the result of multivariate analysis for risk factors of stent failure in such cases. The results showed that gastrointestinal cancer as the primary disease, poor preoperative performance status and severe preoperative hydronephrosis are independent predictors of stent failure. Based on these results, they proposed an algorithm for the management of MEUO.

The use of complementary and alternative medicine is popular worldwide in cancer patients. Lin et al. (Taipei, Taiwan) carried out a retrospective longitudinal cohort study to investigate the trends and characteristics of Chinese medicine (CM) use among prostate cancer patients in Taiwan. The results showed that the number of CM users increased in the first year after cancer diagnosis; however, afterwards it decreased year by year. Consequently, only a 1% increase in the prevalence of CM use was observed after cancer diagnosis, as one-quarter of male residents use CM before the diagnosis of prostate cancer in Taiwan. The impact of CM on anticancer effect and QOL should be elucidated in a future study.