This issue contains three Review Articles, five Original Articles, two Short Communications and two Letters to the Editor.
I focus on the clinical studies, which reported and discussed the common, but important, matters in daily practice. Takayanagi et al. (Sapporo, Japan) retrospectively evaluated the incidence of and the risk factors for upper urinary tract recurrence (UUTR) in 362 patients undergoing a radical cystectomy for bladder cancer. Among them, 11 patients (3.0%) developed UUTR. The presence of carcinoma in situ and cancer invading the urethra are the risk factors. The authors concluded that close follow up is required for early detection of UUTR for patients at high risk. The other risk factors for UUTR reported previously are ureteral involvement and multifocal/recurrent tumors. The study further reported that periodical computed tomography (CT) could detect UUTR before the symptoms of UUTR occurred. Although the authors did not describe detailed CT findings that made a diagnosis of UUTR, non-invasive diagnostic modalities should be used to detect UUTR in the early stages. Zhang et al. (Nanjing, China) reported radiofrequency ablation (RFA) on 12 patients with synchronous bilateral renal cell carcinoma. The patients were treated with bilateral RFA or unilateral RFA accompanied with contralateral radical nephrectomy. The local tumor control rate was 93%. No death or renal failure after the procedure was reported. In patients who underwent bilateral RFA, the latest mean glomerular filtration rate (GFR) had not significantly declined compared with preoperative levels. Although the long-term outcome of GFR remains under investigation, RFA might be a promising alternative to nephron-sparing surgery for patients with bilateral renal cancer. Takazawa et al. (Tokyo, Japan) reported an outcome of flexible-ureteroscopic lithotripsy (FUL) for renal stones 2 cm or greater. Although percutaneous nephrolithotomy has been recommended as the first-line treatment for renal stones larger than 2 cm, its invasive nature might not be negligible. The recent advances in endoscopic technology might make it possible to adopt FUL as an alternative treatment. FUL is an endoscopic surgery through “the natural orifice” with less renal parenchymal damage compared with percutaneous nephrolithotomy. Although the patient selection is crucial, the potential of FUL is worth further evaluating in well-designed prospective trials. Sato et al. (Sapporo, Japan) investigated the potential use of silodosin for treating premature ejaculation. The study is an interesting trial utilizing an adverse effect of the drug as a therapeutic tool. Silodosin is a new highly selective α1A-adrenoceptor antagonist showing significant clinical efficacy for lower urinary tract symptoms. However, recent studies have reported abnormal or lack of ejaculation in a significant percentage of the patients treated with silodosin. Our recent study also found that half of the cases treated with silodosin experienced a loss of ejaculation, and in contrast, over 90% of the cases treated with naftopidil, an α1D-adrenoceptor antagonist, maintained their ejaculation (unpubl. data). The authors treated eight patients suffering from premature ejaculation with 4 mg of silodosin 2 h before sexual intercourse. Intravaginal ejaculatory latency time was significantly prolonged. Premature ejaculation profile significantly improved. However, the majority of the patients experienced decreased ejaculatory volume and discomfort during orgasm. Our unpublished data also identified decreased average scores of orgasm and satisfaction at the ejaculation in the patients treated with silodosin. Further studies with a larger number of cases are warranted to evaluate the impact of silodosin on overall sexual function and the related quality of life in patients with premature ejaculation.