International Journal of Urology最新文献

{"title":"Impact of Impaired Renal Function on the Efficacy and Safety of Second-Line Tyrosine Kinase Inhibitor Therapy After First-Line Immuno-Oncology Combination Therapy in Metastatic Renal Cell Carcinoma: A Japanese Multicenter Retrospective Study.","authors":"Naoki Fujita, Yuto Matsushita, Takahiro Kojima, Yukari Bando, Takahiro Osawa, Tomokazu Sazuka, Keisuke Goto, Kazuyuki Numakura, Kazutoshi Yamana, Shuya Kandori, Yoshihide Kawasaki, Takuma Kato, Makito Miyake, Kazutoshi Fujita, Kosuke Ueda, Hajime Tanaka, Ryotaro Tomida, Hiroshi Kitamura, Hideaki Miyake, Shingo Hakakeyama","doi":"10.1111/iju.70172","DOIUrl":"https://doi.org/10.1111/iju.70172","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of renal impairment at the time of second-line tyrosine kinase inhibitor (TKI) therapy initiation and rapid renal function decline during first-line immuno-oncology (IO) combination therapy on metastatic renal cell carcinoma (mRCC) patients treated with second-line TKIs.</p><p><strong>Methods: </strong>This multicenter retrospective study included 243 mRCC patients treated with first-line IO combination therapy, followed by second-line TKI therapy. Patients were divided into three groups using the estimated glomerular filtration rate (eGFR; mL/min/1.73 m²) at the time of second-line TKI therapy initiation: eGFR ≥ 60, 30 ≤ eGFR < 60, and eGFR < 30. The eGFR slope during first-line IO combination therapy was calculated using eGFR measurements when initiating first-line and second-line therapies. Multivariable Cox proportional hazards regression analyses were performed to evaluate the effects of renal impairment and eGFR slope on progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>The incidence rates of any grade and grade ≥ 3 adverse events were not significantly different among the three groups. Univariable analyses indicated that eGFR slope was not significantly associated with PFS or OS. Multivariable analyses suggested that moderate (30 ≤ eGFR < 60 mL/min/1.73 m²) and severe (eGFR < 30 mL/min/1.73 m²) renal impairment had no effects on shorter PFS, whereas severe renal impairment was independently and significantly associated with shorter OS.</p><p><strong>Conclusions: </strong>TKIs can be safely used as a second-line treatment after first-line IO combination therapy in mRCC patients with renal impairment without sacrificing oncological outcomes, except for in patients with severe renal impairment.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Experience of Robot-Assisted Nephrectomy and Nephroureterectomy Using the Novel Saroa Surgical System.","authors":"Kosuke Iwatani, Fumihiko Urabe, Shun Saito, Shota Kawano, Masataka Kubo, Hirokazu Kagawa, Naoki Uchida, Naoya Tomomasa, Takayuki Sano, Kazuhiro Takahashi, Mahito Atsuta, Shoji Kimura, Takahiro Kimura, Jun Miki","doi":"10.1111/iju.70163","DOIUrl":"https://doi.org/10.1111/iju.70163","url":null,"abstract":"<p><strong>Introduction: </strong>Robot-assisted surgery is increasingly utilized in urology, providing enhanced precision and potentially improving patient outcomes. The Saroa surgical system is a novel robotic platform featuring integrated haptic feedback and compatibility with standard laparoscopic instruments. This study reports the first clinical application of Saroa in robot-assisted radical nephrectomy (RARN) and nephroureterectomy (RANU).</p><p><strong>Methods: </strong>A single-center, retrospective analysis was conducted on 11 patients who underwent RARN or RANU using Saroa between January 2024 and March 2025. Perioperative outcomes, complications, grasping force data, and Likert scale evaluations from surgeons and assistants were analyzed.</p><p><strong>Results: </strong>All procedures were completed without conversion or major complications. No transfusions or Clavien-Dindo grade ≥ 3 complications occurred. Haptic feedback was associated with reduced grasping force (mean force: 2.94 N with feedback off vs. 0.49 N at 2.0× setting). Surgeons rated Saroa higher for haptic naturalness and grasp control, while overall satisfaction was greater with the da Vinci system. Assistants reported significantly greater technical engagement with Saroa (p = 0.042), reflecting enhanced educational value.</p><p><strong>Conclusions: </strong>RARN and RANU using the Saroa system appear safe and feasible, even in early clinical use. The system's compact design, tactile feedback, and cost-effectiveness suggest potential for broader adoption and training utility. Further prospective studies are warranted to confirm its clinical and educational benefits.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to First-Line Chemotherapy Predicts Response to Maintenance Avelumab Therapy in Japanese Patients With Advanced Urothelial Carcinoma.","authors":"Satoshi Inoue, Akira Hayakawa, Mikinori Kobayashi, Yuriko Nagasaka, Takanao Omi, Noritoshi Shamoto, Fumihiro Ito, Takuma Yuba, Yuri Yuguchi, Hideji Kawanishi, Kosuke Tochigi, Shusuke Akamatsu","doi":"10.1111/iju.70162","DOIUrl":"https://doi.org/10.1111/iju.70162","url":null,"abstract":"<p><strong>Objectives: </strong>The association between the response to first-line chemotherapy and maintenance of avelumab remains unclear. We identified factors associated with the response to avelumab in patients with advanced urothelial carcinoma using real-world data.</p><p><strong>Methods: </strong>We retrospectively enrolled 100 patients with advanced urothelial carcinoma treated with maintenance avelumab therapy between March 2021 and April 2024 at Nagoya University and nine affiliated hospitals. The complete/partial-response group was defined as patients with complete response or partial response as the best response to first-line chemotherapy. The stable disease group was defined as patients with stable disease as the best response to first-line chemotherapy.</p><p><strong>Results: </strong>Seven patients (7.0%) achieved complete response, 65 (65.0%) achieved partial response, and 28 (28.0%) achieved stable disease as the best response to first-line chemotherapy. Regarding avelumab therapy, the complete/partial-response group had significantly better progression-free survival than the stable disease group (median: 11.1 vs. 3.2 months, p < 0.001). In multivariate analyses, the best response to first-line chemotherapy was the only independent risk factor for progression-free survival (hazard ratio = 1.844, 95% confidence interval = 1.002-3.394; p = 0.049). Overall survival was significantly shorter in the stable disease group than in the complete/partial-response group (median: 14.1 months vs. not reached, p < 0.001). Multivariate analyses revealed significant associations between poor overall survival and performance status (hazard ratio = 2.175, 95% confidence interval = 1.030-4.592; p = 0.042) and the best response to first-line chemotherapy (hazard ratio = 4.174, 95% confidence interval = 1.975-8.824; p < 0.001).</p><p><strong>Conclusions: </strong>The best response to first-line chemotherapy may predict the clinical outcome of patients with advanced urothelial carcinoma treated with avelumab.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on \"Clinicopathological Characteristics of Upper Tract Urothelial Cancer With Loss of Immunohistochemical Expression of Mismatch Repair Proteins\".","authors":"Takashi Kobayashi","doi":"10.1111/iju.70167","DOIUrl":"https://doi.org/10.1111/iju.70167","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience With Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin as Neoadjuvant Chemotherapy in Patients With Muscle-Invasive Bladder Cancer.","authors":"Akinori Minato, Tomohisa Takaba, Katsuyoshi Higashijima, Yujiro Nagata, Ikko Tomisaki, Eiji Kashiwagi","doi":"10.1111/iju.70119","DOIUrl":"https://doi.org/10.1111/iju.70119","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances and Future Directions in Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer.","authors":"Tomokazu Kimura, Satoshi Inoue, Tomoyasu Sano, Kenji Zennami, Shusuke Akamatsu","doi":"10.1111/iju.70164","DOIUrl":"https://doi.org/10.1111/iju.70164","url":null,"abstract":"<p><p>Bladder preservation therapy has emerged as an essential alternative to radical cystectomy for muscle-invasive bladder cancer, particularly in elderly or frail patients. Trimodal therapy, combining maximal transurethral resection of bladder tumors, chemotherapy, and radiotherapy, has shown comparable oncological outcomes to radical cystectomy in selected cases. Recent advances in radiotherapy techniques and systemic therapies, including immune checkpoint inhibitors, have expanded the role of bladder-preserving strategies in the management of bladder cancer. Clinical trials investigating various combinations of radiotherapy, chemotherapy, and immune checkpoint inhibitors have redefined the treatment landscape. Observational studies have reported survival outcomes comparable to those of radical cystectomy, along with improved quality-adjusted life years. Emerging therapeutic strategies offer additional potential for improving outcomes. Bladder preservation therapy continues to evolve, with future approaches aimed at enhancing survival while preserving the quality of life.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biofeedback Therapy in the Treatment of Children With Dysfunctional Voiding: Does the Presence of Overactive Bladder Affect Treatment Outcomes?","authors":"Furkan Adem Canbaz, Gonca Gerçel, Gülce Kadakal Köken, Sefa Sağ","doi":"10.1111/iju.70171","DOIUrl":"https://doi.org/10.1111/iju.70171","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated biofeedback therapy for treating dysfunctional voiding (DV) and examined how overactive bladder (OAB) affects treatment outcomes.</p><p><strong>Methods: </strong>Files of children treated with biofeedback therapy for DV between November 2022-November 2023 were retrospectively analyzed. Data collected included demographics, clinical information, dysfunctional voiding symptom scores (DVSS), and uroflowmetry (UF) parameters. Patients were categorized into two groups: Group 1 (DV with OAB) and Group 2 (DV without OAB). Clinical success meant cessation of electromyography (EMG) activity, resolution of symptoms, and improved UF parameters. Treatment outcomes were evaluated using the International Children's Continence Society recommendations.</p><p><strong>Results: </strong>The study comprised 32 children: 15 in Group 1 (11 girls, 4 boys; mean age: 8.7 ± 3.7 years) and 17 in Group 2 (15 girls, 2 boys; mean age: 7.7 ± 1.9 years). The overall complete response rate was 65.6% (n = 21), and the partial response rate was 21.9% (n = 7). Success rates of Group 1 and Group 2 were similar (complete response: 60.0% vs. 70.6%, p > 0.05; partial response: 20.0% vs. 23.5%, p > 0.05). Both groups showed significant DVSS reduction (p < 0.05). EMG cessation occurred in 84.4% of patients. Postvoid residual volume (%) decreased significantly in Group 2 (p = 0.002) but not in Group 1 (p > 0.05).</p><p><strong>Conclusions: </strong>Biofeedback therapy effectively treats DV, with OAB presence not impacting treatment success.</p><p><strong>Trial registration: </strong>UMIN000055031.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on \"Risk Model for Lymph Node-Positive Prostate Cancer After Radical Prostatectomy\".","authors":"Yozo Mitsui, Koichi Nakajima","doi":"10.1111/iju.70166","DOIUrl":"https://doi.org/10.1111/iju.70166","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In This Issue.","authors":"Takahiko Mitsui","doi":"10.1111/iju.70170","DOIUrl":"https://doi.org/10.1111/iju.70170","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perirenal Fat in Disease Progression: From Inflammatory Mediator to Therapeutic Target.","authors":"Eiji Kashiwagi","doi":"10.1111/iju.70158","DOIUrl":"https://doi.org/10.1111/iju.70158","url":null,"abstract":"<p><p>Perirenal fat (PRF), the adipose tissue that encases the kidneys, has long been considered a passive energy reservoir and mechanical buffer. However, emerging evidence has identified PRF as a biologically active visceral fat depot that secretes adipocytokines, inflammatory mediators, and other bioactive molecules, and thereby contributes to the pathogenesis and progression of several systemic diseases. PRF is associated with renal cell carcinoma, cardiovascular disease, chronic kidney disease, obesity, and metabolic syndrome. In renal cell carcinoma, PRF thickness correlates positively with tumor stage and negatively with prognosis. In cardiovascular and renal disorders, PRF accumulation is linked to elevated blood pressure and impaired renal function. Furthermore, PRF promotes a pro-inflammatory microenvironment that exacerbates chronic kidney disease and metabolic abnormalities. These findings underscore the clinical relevance of PRF, both as a diagnostic and prognostic marker and a potential target for therapeutic intervention. This review provides a comprehensive overview of the roles of PRF in disease development and progression and emphasizes its emerging significance in clinical practice.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}