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| EDITORIAL |
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| Year : 2022 | Volume
: 33
| Issue : 4 | Page : 159-160 |
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Editorial
Yao-Chi Chuang
Department of Urology, The Center of Excellence in Shockwave Medicine and Tissue Regeneration, Kaohsiung Chang Gung Memorial Hospital; College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| Date of Submission | 29-Sep-2022 |
| Date of Acceptance | 11-Oct-2022 |
| Date of Web Publication | 30-Nov-2022 |
Correspondence Address:
Yao-Chi Chuang
Department of Urology, The Center of Excellence in Shockwave Medicine and Tissue Regeneration, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/UROS.UROS_102_22
How to cite this article:
Chuang YC. Editorial. Urol Sci 2022;33:159-60 |
Dear Colleagues,
In this issue, we publish one review article: Overview of the cancer behavior of upper urinary tract urothelial carcinomas (UTUCs) and discuss the appropriate management of patients with UTUCs. In addition, we have selected the articles on functional urology, including urine biomarker study, pulsed electromagnetic field (PEMF) stimulation for treating urinary incontinence (UI), ketamine cystitis in rats, and functional magnetic resonance imaging (fMRI) and possible molecular mechanisms, on surgical techniques, including extravesical laparoscopic technique for the repair of vesicovaginal fistulas, and a single surgeon's learning curve for robotic-assisted laparoscopic radical prostatectomy (RALP) performed in 2000 patients, and using polis to facilitate healing of urethra injuries in a rat model. Moreover, the impact of coronavirus disease 2019 (COVID-19) on surgeries and daily practice in urology is worthy of awareness. We publish about these topics in this issue. Finally, we hope that Urological Sciences makes it easier for readers to stay up-to-date with the hot topics in urology.
UTUC is a rare disease, and the estimated annual incidence of UTUC is 2/100,000 persons in Western countries. Conversely, in Taiwan, the prevalence of UTUCs can reach as high as 30% of all UCs. Radical nephroureterectomy (RNU) with bladder cuff excision remains the standard modality for treating UTUCs. However, the prognosis related to this disease is poor, and the recurrence rate in patients with advanced UTUC concurrently treated with RNU is high. Luo et al. provided an overview of the cancer behavior of UTUCs and discussed the appropriate management for patients with UTUC - knowledge that is mandatory for clinical practice.
The diagnosis of interstitial cystitis (IC)/bladder pain syndrome is based on patient-reported symptoms and the exclusion of other diseases with overlapping clinical presentation. Patients with bladder cancer and IC, particularly those with IC with Hunner's lesion (HIC), are most often diagnosed by cystoscopy with hydrodistension - these procedures are invasive and may be accompanied by some discomfort and side effects. Chancellor et al. compared the concentrations of urinary inflammatory cytokines (i.e., growth-related oncogene (GRO), interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP-1) in normal control, IC, overactive bladder, urinary tract infection (UTI), and bladder cancer. They concluded that the urinary concentrations of GRO were higher in the disease state than in the control. Specifically, the levels of GRO and IL-8 were higher in urine samples from patients with UTI than in controls and other bladder conditions. These findings provide preliminary data to improve our understanding of these important bladder diseases with great unmet needs.
PEMF stimulation is a nontraditional and noninvasive treatment modality for UI. Madani et al. reported that PEMF stimulation twice per week for 6 weeks is a safe and effective approach for reducing the symptoms of patients with UI in a quasi-experimental study involving 90 patients with UI. The best response to treatment was reported 6 months after treatment. They recommended using PMEF stimulation as a noninvasive treatment along with routine therapies.
Although various endoscopic and open surgical options are available for treating urethral stricture, the results are not always satisfactory. Girgin et al. suggested that preventing the formation of urethral scar is a key step for a successful treatment. They examined the effects of intraurethrally administered Anatolian propolis on the healing of urethral injury in rat models. Propolis has been shown to have antimicrobial, anti-inflammatory, and antioxidant effects and promote wound healing. They concluded that Anatolian propolis applied to the urethra seems to accelerate recovery after urethral trauma and reduces the formation of fibrosis.
The COVID-19 pandemic had the greatest impact on surgical departments because most surgeries were elective and thus should be postponed. Chiang et al. analyzed the experiences of urological practice adjustment in a tertiary medical center during the COVID-19 pandemic in Taiwan and the impact on the urological service under a level 3 epidemic alert. The results demonstrated that they postponed most elective surgeries, benign urological condition-related procedures, and outpatient visits or diagnostic outpatient examinations and procedures according to the prioritization guidelines; however, uro-oncology-related services were less affected because oncology patients have a stronger motivation for treatment. After the epidemic has slowed down, the backlog should be gradually managed based on priority.
In practice, only a few surgeons have had extensive experience in RALP. Ou et al. have reported significantly lower blood loss and blood transfusion rates after 50 cases and a significant reduction in complications after 150 RALP cases. This report advanced our understanding that the surgeon's learning curve for RALP further improved with significantly fewer minor Clavien–Dindo grade (I–II) group complications after 1000 surgeries. Cases with minor Clavien–Dindo grade (I–II) complications decreased significantly from Group I to Group II (Group I, cases 1–1000; Group II, cases 1001–2000), at 55–32 patients. The transfusion rate was 1.1% in Group I, which was significantly higher than that in Group II (0.1%).
Huang et al. used a popular rat model of ketamine-induced cystitis (KIC) (25 mg/kg/day for 28 days) to validate the micturition behavior, functional brain images, and possible molecular mechanisms of this model.
They found that the ketamine-treated rats developed bladder overactivity accompanied by enhanced fMRI signals in the periaqueductal and caudal putamen areas. In addition, alterations in bladder transcripts, including 11 genes involved in regulating NF-κB signaling of bladder inflammation and Crhr2 gene overexpression associated with vascular endothelial growth factor signaling of bladder ischemia, were identified. Both categories could be attributed to neurogenic inflammation, findings that underlie the pathophysiology of KIC in rats, and may reflect human KIC.
Vesicovaginal fistula is the most common acquired fistula of the urinary tract due to injury to the bladder at the time of obstetric, gynecological, urological, or other pelvic surgeries. Although in the standard laparoscopy approach, the bladder and vaginal wall are closed separately and flaps are interposed, in Swain et al.'s extravesical technique, cystotomy and vaginal vault suturing were not performed, which are novel. This retrospective observational study reviewed the data of 36 patients from January 2015 to January 2020.
We hope that you find these articles relevant to expanding your knowledge on urology.
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