MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING: TRANSRECTAL ULTRASOUND-GUIDED FUSION BIOPSY
Prostate cancer in India presents late and remains an important cause of death in men. Bansal et al.[1] present data regarding the use of multiparametric-magnetic resonance imaging transrectal ultrasound fusion biopsy in an Indian cohort of patients. Prostate cancer in India may have a different presentation compared to the West, and Indian data can help us further refine our management protocols.
PENILE URETHRAL STRICTURES
Strictures of the penile urethra are difficult to manage. Skin flaps to grafts have all been used with varying degrees of success. Joshi et al.[2] present a composite two-stage urethroplasty for complex penile strictures without balanitis xerotica obliterans (BXO). The buccal mucosal graft (BMG) was applied in the second stage and immediately tubularized. This is distinct from the commonly performed technique of applying the BMG in the first stage. Despite excluding BXO strictures, the patients included both failed hypospadias repair and other causes of urethral strictures. Residual chordee in the former group will present a challenge, but the concept that immediate tubularization will aid take of the graft due to a moist environment has merit and can improve results.
PROGNOSTICATING AND NOVEL THERAPY FOR BLADDER CANCER: THE ROLE OF MICRO-RNAS
Recurrent bladder cancer is hypothesized to be a result of field change in the transitional epithelium of the urinary tract. Markers for progression and invasiveness can help us offer management options that are tailored to the individual patient. Mitash et al.[3] review the role of cellular metabolic regulatory molecules, such as micro-RNA, which can be used as biomarkers to prognosticate or as targeted therapy for bladder cancer.
AN INCONTINENCE ACTIVITY PARTICIPATION SCALE FOR SPINAL CORD INJURY
Walia and Kaur[4] present a novel scale to measure the involvement of spinal cord injured (SCI) patients in life situations. Incontinence is a major barrier for increased participation in activities outside their homes. The scale should help urologists quantify the problems of SCI patients and follow up on the success of therapy.
EXTENDED – SPECTRUM BETA-LACTAMASE – PRODUCING, CARBAPENEM-RESISTANT UROPATHOGENS MAY BE FOSFOMYCIN SENSITIVE
Carbapenem-resistant pathogens have rapidly spread to almost all hospital settings. They remain perhaps the greatest threat to our attempts to control serious nosocomial infections. Banerjee et al.[5] discuss the role of fosfomycin in the treatment of such isolates. However, the translation of in vitro sensitivity into in vivo success and clinical usefulness of this drug remains to be seen.
DOES THE INDICATION FOR PARTIAL NEPHRECTOMY AFFECT THE COMPLICATION AND OUTCOMES?
Venkatramani et al.[6] reviewed data to see if the preoperative indications for partial nephrectomy (elective, relative, and absolute) affected the perioperative complications and outcome. The results point to fewer complications in the elective arm.
CAN STERILE WATER IRRIGATION BE A SUBSTITUTE FOR SINGLE-DOSE MITOMYCIN-C AFTER TRANSURETHRAL RESECTION OF BLADDER TUMORS?
The use of intravesical mitomycin-C immediately after transurethral resection of bladder tumor is common in an attempt to prevent tumor cell re-implantation and consequent recurrence. In a randomized controlled trial, Bijalwan et al.[7] compared continuous irrigation with sterile water to a single intravesical mitomycin C instillation and detected no significant difference.
BLADDER CANCER: WHAT THE FUTURE HOLDS?
While radical cystectomy remains the primary surgery for muscle invasive bladder cancer, the therapy is multimodal. The treatment of advanced bladder cancer has changed over the years with newer chemotherapeutic agents and molecular subtyping of the cancer. This issue has a symposium on muscle invasive bladder cancer guest edited by Kamat[8] which discusses the newer trends in therapy.
SURGICAL MANAGEMENT OF MUSCLE INVASIVE BLADDER CANCER
Treatment of muscle invasive bladder cancer continues to evolve with ongoing discussions on the use of neoadjuvant chemotherapy, extent of pelvic lymph node dissection, and an attempt on organ preservation. Kukreja and Shah[9] discuss the advances in its surgical management.
BLADDER PRESERVATION IN SELECTED CASES OF MUSCLE INVASIVE CANCER
Radical cystectomy is the gold standard for muscle invasive bladder cancer. Wade-Smelser et al.[10] review the role of bladder preservation in selected cases, indications, and oncological outcomes. The quality of life after such therapy is also discussed.
SYSTEMIC THERAPY IN BLADDER CANCER
Neoadjuvant therapy for muscle invasive disease has achieved better survival rates than primary surgery. All patients who may benefit from therapy, however, do not receive it. Pinto[11] discusses the agents used in neoadjuvant and adjuvant settings in muscle invasive disease. The role of second-line immunotherapy is also discussed.