This Month in Adult Urology

Field: Medicine (Health Sciences)

You have accessJournal of UrologyThis Month in Adult Urology1 May 2023This Month in Adult Urology D. Robert Siemens D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Innovations in Diagnosing and Managing Upper Tract Urothelial Cancer Upper tract urothelial carcinoma (UTUC) is an uncommon malignancy and is often vexing with respect to its diagnosis and treatment given the limitations of the tools at our disposal. In this issue of The Journal of Urology®, we focus on some of these management issues. Labbate et al (page 872) report on the largest experience to date on the efficacy of adjuvant mitomycin gel (UGN-101) for patients with low-risk UTUC.1 UGN-101, the reverse thermal polymer gel of mitomycin C, was given after complete endoscopic ablation in this multicenter study. Given as an adjuvant, 69% were without visible disease at first endoscopic evaluation. The concern around ureteral stenosis was evaluated and reported in 10 patients (19%). Although longer-term observations are needed to understand its safety and efficacy, the authors suggest UGN-101 may have a role as adjuvant therapy in this setting. In a similar vein, Yip et al (page 863) from New York report on another novel therapeutic approach to UTUC.2 In this first clinical report, vascular-targeted photodynamic therapy with WST-11 (padeliporfin) was tested in a phase I trial. The primary objective was safety, and in this initial evaluation no ureteral strictures were identified during follow-up. The authors describe some interesting efficacy observations bolstering future prospective trials with this approach. Finally, Ghoreifi et al (page 854) in a multicenter study from California test the accuracy of a urine-based epigenetic test for detecting UTUC.3 Using Bladder CARE, a urine-based test that measures methylation status of 3 cancer biomarkers, the authors report a sensitivity and specificity of 96% and 88%, respectively. The authors highlight that this sensitivity, much better than urinary cytology, could make this test a significant addition to our armamentarium. Basket Displacement for Lower Pole Stones Retrograde intrarenal surgery for stones ≤2 cm has become a well-established standard over time due to several technological advancements. However, stone location in the kidney, specifically those in the lower pole, remains a strong predictor of success. Yaghoubian et al (page 963), in this prospective randomized trial from New York, compare the efficacy of laser lithotripsy for stones in situ compared to displacement out of the lower pole.4 Stone-free rates were much better with basket displacement, highlighting that this simple technical modification should be considered for those with lower pole stones. Effect of Maximal Transurethral Resection on Survival in Bladder Cancer Although a well-accepted principle of bladder cancer management, the ultimate clinical benefit of maximal transurethral resection (TUR) for patients with muscle-invasive bladder cancer and subsequently receiving neoadjuvant chemotherapy is not established. Kirk et al (page 882) explore these questions in a large international, multi-institutional cohort of 785 patients.5 In multivariable models, maximal TUR was associated with downstaging at cystectomy but was not associated with overall survival. The authors conclude that maximal TUR can improve pathological response at cystectomy, a well-established prognostic factor, but the actual effects on oncologic outcomes warrant further study. An Overdue Focus on Urinary Infections Another theme of this issue of The Journal includes several original manuscripts examining commonplace issues of urinary infections with novel insights and technological tools. Ligon et al (page 928) in a multi-institutional study explore the association of cystitis cystica and recurrent urinary tract infections (UTIs).6 In this retrospective, observational cohort of women with recurrent UTIs, the presence of cystitis cystica was associated with a shorter time to next UTI. The authors conclude that identifying these lesions cystoscopically may be useful in informing future UTI risk and personalizing treatment strategies. Wolfe et al (page 937) in an international study explore the association of urinary microbiota and interstitial cystitis/bladder pain syndrome.7 To better understand any potential causative role, the authors assess the microbiome from bladder biopsy tissue. Biopsies were subjected to 16S rRNA gene sequencing and novel imaging techniques including multiplexed fluorescence in situ hybridization. Bacteria were detected in most biopsies although there was no significant difference between patients with interstitial cystitis/bladder pain syndrome and controls. This paper is an important step in understanding the relationships between urothelial and urinary microbiota. Finally, Werneburg et al (page 950) from Cleveland, Ohio investigate microbiome within the biofilms covering indwelling ureteral stents.8 Samples of stents removed from patients were analyzed by 16S next-generation sequencing and metabolomics. The authors report that all samples harbored microbiota with associations with previous antibiotic exposure. The authors conclude that these observations provide impetus to consider testing of novel materials and explore innovative strategies to reduce symptoms from pathogenic organisms for patients requiring indwelling stents. REFERENCES 1. Efficacy and safety of mitomycin gel (UGN-101) as an adjuvant therapy after complete endoscopic management of upper tract urothelial carcinoma. J Urol. 2023; 209(5):872-881. Link, Google Scholar 2. Final results of a phase I trial of WST-11 (TOOKAD soluble) vascular-targeted photodynamic therapy for upper tract urothelial carcinoma. J Urol. 2023; 209(5):863-871. Link, Google Scholar 3. A urine-based DNA methylation marker test to detect upper tract urothelial carcinoma: a prospective cohort study. J Urol. 2023; 209(5):854-862. Link, Google Scholar 4. Displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status: a prospective randomized controlled trial. J Urol. 2023; 209(5):963-970. Link, Google Scholar 5. Impact of maximal transurethral resection on pathological outcomes at cystectomy in a large, multi-institutional cohort. J Urol. 2023; 209(5):882-889. Link, Google Scholar 6. Bladder mucosal cystitis cystica lesions are tertiary lymphoid tissues that correlate with recurrent urinary tract infection frequency in postmenopausal women. J Urol. 2023; 209(5):928-936. Link, Google Scholar 7. Detection of bacteria in bladder mucosa of adult females. J Urol. 2023; 209(5):937-949. Abstract, Google Scholar 8. Ureteral stents harbor complex biofilms with rich microbiome-metabolite interactions. J Urol. 2023; 209(5):950-962. Link, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 5May 2023Page: 821-822 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information D. Robert Siemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...