This issue contains two Editorials, one Audio-visual Article, one Review Article, five Original Articles, and five Letters to the Editor.
This issue starts with an Editorial from Perera (Colombo, Sri Lanka). Professor Perera is the President of the Sri Lanka Association of Urological Surgeons (SLAUS), which was formed in 1999 and has been part of the Urological Association of Asia (UAA) since 2003. In his Editorial, Perera briefly describes the history, as well as the current status, of urology in Sri Lanka. IJU hopes to contribute to the development of SLAUS and thus welcomes papers with clinical and scientific significance from urologists in Sri Lanka. The second Editorial by Sydes et al. (London, UK) reports on the experiences of an Anglo-Japanese collaboration in the STAMPEDE trial, which reminded me, to some extent, of the movie “Lost in translation”. Based on their experiences during the trial, Sydes et al. call for the placement of research officers in national research bodies in both countries to work closely with researchers. Living in the Far East, we need to recognize that our Japanese society is unique in some respects.
In their article, Zaytoun et al. (Cleveland, USA) review the dilemma of managing patients with a negative initial prostate biopsy. They emphasize that, “[a]s the first step in approaching the problem, the utmost efforts should be paid to maximally optimizing the yield of the first biopsy”. They recommend a 14-core protocol, with the additional cores being in the critical area of the apex.
In a large single-center, Rink et al. (Hamburg, Germany) report on the outcomes of radical cystectomy in elderly patients. These authors found that older patients have a higher risk of significant upstaging at final histopathology. Of course, as a result of optimization of perioperative risk factors, a longer duration between diagnosis and radical cystectomy is often necessary in elderly patients. However, reluctance in decision making may also result in adverse prognostic outcome. Fukuhara et al. (Kochi, Japan) have investigated intraoperative photodynamic diagnosis (PDD) by 5-aminolevulinic acid (ALA) for the identification of positive surgical margins (PSM) during radical prostatectomy. Intraoperative PDD was performed in 16 patient: during surgery, the resection margins inside the body were examined using a PDD system with a fluorescence laparoscope. Unfortunately, in the study, there were no cases with pathologically confirmed PSM, so there was no evidence with which to validate the effectiveness of intraoperative PDD. Further investigations are warranted to confirm the clinical utility of this attractive methodology. In their study, Kitagawa et al. (Kanazawa, Japan) evaluate the clinical characteristics and outcomes of prostate cancer patients detected in their prostate-specific antigen (PSA)-based population screen. In all, 32 769 men participated in this screening program from 2000 to 2006 and, overall, 249 cases of prostate cancer (0.76%) were diagnosed. Clinical T stage was identified in 247 patients (99.2%), and 231 (93.5%) were cases of clinically localized cancer. Of these patients, 75% underwent radical treatment. The 8-year cause-specific and overall survivals were 97.5% and 93.3%, respectively. However, this retrospective study has several limitations. For example, evaluation regarding the possibility of overtreatment was insufficient. In addition, the cost-effectiveness of the screening program to minimize social damage should be investigated. The Letter to the Editor from Fujita et al. (Osaka, Japan) reports on the retroperitoneoscopic resection of huge mucinous cystadenoma. These authors used a SAND balloon catheter, which was originally used in the resection of ovarian cysts. The appropriate, yet novel, use of the SAND catheter in this way enabled decompression of the cystic tumor without gross spillage of cystic contents and removal of the tumor through the trocar site.