IJU this issue
IJU this issue
Article first published online: 23 SEP 2012
© 2012 The Japanese Urological Association
International Journal of Urology
Volume 19, Issue 10, page 893, October 2012
How to Cite
Takahashi, S. (2012), IJU this issue. International Journal of Urology, 19: 893. doi: 10.1111/j.1442-2042.2012.03104.x
- Issue published online: 23 SEP 2012
- Article first published online: 23 SEP 2012
This issue contains two Review Articles, six Original Articles, two Case Reports, one Short Communication and two Letters to the Editor.
I focus on the papers that reported and discussed important matters in daily practice. Schrader et al. (Ulm, Germany) comprehensively reviewed the effectiveness, toxicity and optimal duration of neoadjuvant therapy for patients with advanced renal cell carcinoma in the era of targeted agents. They found that neoadjuvant targeted therapy for 2–4 months shows toxicity similar to that seen in a palliative setting. At present, sunitinib seems the best choice for a neoadjuvant setting. We often experience significant decreases in size and number of metastases in patients with advanced renal cell cancer during palliative targeted therapy. However, the authors reported that the response of the primary tumor and metastases can differ markedly in the same patient. Even sunitinib leads to just a 10% decrease in primary tumor size, and 20–25% of all patients show local tumor progression during treatment. Only a few patients with a vena cava tumor thrombus achieve a significant decrease in its level, whereas progression is observed in a significant number of cases. Therefore, the authors concluded that a neoadjuvant targeted therapy should only be used in patients with localized or locally advanced renal cell carcinoma, which primarily seem to be absolutely inaccessible by (partial) nephrectomy. This is an important message for us. At present, we should not expect too much on the efficacy of targeted agents in neoadjuvant setting to hesitate or postpone performing radical nephrectomy in a tough situation. Do et al. (Leipzig, Germany) retrospectively reviewed intraoperative, pathological, functional and short-term oncological outcomes in 223 patients with prostate-specific antigen (PSA) ≥20 ng/mL who underwent minimally invasive (laparoscopic) radical prostatectomy (MIRP). The incidences of intra- and postoperative complications were found to be similar to the published literature. Pathological evaluation revealed poorly differentiated cancer in 49%, pT3/pT4 disease in 56%, positive margins in 28% and lymph node disease in 20% of the cases. Adjuvant radiotherapy was used in 62% of the patients. Biochemical recurrence-free rate at 1 year was 80%, and 98.8% of patients had good recovery of continence. The authors concluded that MIRP might be a reasonable option in prostate cancer patients with high PSA as a part of a multimodality treatment approach. Urologists are generally cautious to carry out radical prostatectomy in prostate cancer patients with high PSA, mainly because of concerns regarding lack of complete cure after surgery. However, we sometimes see patients who are “cured” after radical prostatectomy or multimodality treatment. According to the data reported by the authors, 44% of the cases had organ-confined disease (pT2). They potentially had a chance to be “cured” with radical treatment. Of course, adequate application of radical prostatectomy is mandatory to maximize the benefit of the surgery; but simultaneously, urologists had better keep the facts presented in the paper in mind. Ghani et al. (Detroit, USA) reported a case with small bowel obstruction caused by a Hem-o-lok clip 3 months after robot-assisted radical prostatectomy. The paper alerts readers of a rare, but serious, late complication related to the use of the clip. The authors suspected that the sharp jaws of the open clip might be lodged in the abdominal wall, resulting in delayed small bowel obstruction, and recommended removal of all the clips that were not adequately deployed during the surgery.