This study aims to examine the current practice patterns of Japanese urologists in treating male anterior urethral strictures and to compare these results with international trends.
A 16-item questionnaire, adapted from surveys conducted in other countries, was distributed to members of the Japanese Urological Association (JUA) in 2024. Statistical analyses, including Pearson's chi-square test and logistic regression, were performed to identify factors influencing treatment preferences.
We emailed 9898 JUA members, and 1028 (10.4%) responded. 835 (81.2%) handled five or fewer urethral stricture cases annually. While 968 (94.2%) had experience with urethral dilatation, 937 (91.1%) with direct vision internal urethrotomy (DVIU), only 308 (30.0%) had experience with excision and primary anastomosis, and 102 (9.9%) with any oral mucosal graft urethroplasty. For the two hypothetical clinical cases, referring to specialists was selected in 707 (68.8%) and 618 (60.1%), respectively, whereas urethroplasty was chosen in 133 (12.9%) and 243 (23.6%), respectively. Seven hundred seventy-four (75.3%) felt the literature supported going straight to definitive urethroplasty if necessary, and this was significantly associated with being under 50 years of age, holding instructor status, and limiting the indication for DVIU to strictures ≤ 1 cm.
Japanese urologists exhibit limited urethroplasty experience and widely utilize transurethral treatments. The majority of members prefer to refer to a specialist, indicating that, in addition to the difficulty of urethroplasty, making indication decisions is also challenging. It is hoped that evidence-based medical practice will become more widespread.
Adrenocortical carcinoma (ACC) is a rare, aggressive tumor with high recurrence rates after surgery. Although radiotherapy (RT) has historically been underutilized in ACC, modern RT techniques have renewed interest in its potential role for improving local control (LC). This study evaluated long-term outcomes and prognostic factors in high-risk localized ACC treated with adjuvant RT and mitotane.
In this multicenter retrospective study, 23 patients with localized, high-risk ACC who underwent complete surgical resection followed by adjuvant RT between 2003 and 2023 were analyzed. All received mitotane, and 21.6% also received platinum-based chemotherapy. RT was delivered using image-guided IMRT or VMAT to a median dose of 50.4 Gy, targeting the tumor bed with or without regional lymphatics. Survival was estimated using the Kaplan–Meier method, and prognostic factors were assessed with Cox regression analyses.
At a median follow-up of 84.7 months, the 5-year LC, overall survival (OS), and disease-free survival (DFS) rates were 85.5%, 58.6%, and 45.6%. Locoregional recurrence occurred in two patients (8.6%), with isolated local failure in one (4.3%). Distant metastasis (DM) developed in 47.8% and was the predominant failure pattern. On univariable analysis, age > 55 years predicted worse OS and DFS, while female sex independently predicted inferior DFS. Treatment was well tolerated, with no grade ≥ 3 RT-related toxicities.
Adjuvant RT achieves excellent LC with minimal toxicity in high-risk localized ACC. These exploratory findings, limited by small cohort size, retrospective design, and absence of a comparator group, warrant confirmation in larger prospective multicenter studies.
To compare survival outcomes between Japanese patients receiving radical cystectomy (RC) and intravesical Bacillus Calmette–Guérin (BCG) for high-risk non–muscle-invasive bladder cancer (HR-NMIBC).
This study was conducted within the Japanese Urological Oncology Group (JUOG) framework using two nationwide, multi-institutional databases: JUOG-UC-2021-RC, comprising 2674 patients with bladder cancer who underwent RC, and JUOG-UC-1901-BCG, comprising 3226 patients who received intravesical BCG. Patients were classified according to the Japanese Urological Association guideline (version 2023) risk stratification model into three cohorts: BCG-naïve standard HR-NMIBC (without aggressive factors), BCG-naïve highest-risk NMIBC (an aggressive subgroup), and BCG-unresponsive NMIBC. Metastasis-free survival (MFS) and overall survival (OS) were compared between the two interventions. Propensity score matching was applied to create well-balanced groups (BCG vs RC).
In the adjusted BCG-naïve standard HR-NMIBC subcohort, both MFS and OS were longer in the BCG-treated group than in the RC group (p = 0.15 and p = 0.027, respectively). However, no significant differences in MFS or OS were observed in the adjusted BCG-naïve highest-risk NMIBC subcohort (p = 0.20 and p = 0.47, respectively). In the adjusted BCG-unresponsive NMIBC cohort, no differences in MFS or OS were detected (p = 0.76 and p = 0.35, respectively), although long-term survival outcomes appeared better in the salvage RC group than in the BCG rechallenge group.
Our findings demonstrated that the RC group had worse outcomes than the BCG group in the BCG-naïve standard HR-NMIBC subcohort but not in the highest-risk or BCG-unresponsive cohorts. Accumulating evidence is essential to guide physicians in counseling patients with HR-NMIBC and BCG-unresponsive NMIBC.
The authors have nothing to report.
Male infertility is influenced by a variety of etiologies, including quantitative and qualitative impairments in spermatogenesis. Antioxidants scavenge reactive oxygen species (ROS), which reduce sperm motility, cause damage to DNA, and lead to subsequent apoptosis in sperm cells. This trial aimed to evaluate the effect of oral Synbiotic and a multivitamin-mineral supplement for men helping to improve male fertility (SperiGen), as an antioxidant agent, on the spermatogram in idiopathic Oligoasthenoteratozoospermia (iOAT).
This double-blind randomized clinical trial was conducted on infertile males with iOAT. Totally, 73 patients with iOAT were blindly randomized into two groups; one group received SperiGen as an antioxidant agent in addition to placebo. In the next group, in addition to SperiGen, the patients received 500 mg Synbiotic (FamiLact) on a daily basis. They continued their treatments for 3 months. Semen parameters were measured before and after the intervention.
Supplementations with a combination of Synbiotic and SperiGen compared with SperiGen and placebo significantly increased the average change of sperm progressive motility (p = 0.001), DNA fragmentation (p = 0.001), and diminished the levels of non-motile sperm (p = 0.018). Eventually, within-group analysis indicated that all parameters were significantly improved in both groups, except for non-progressive motility in the SperiGen and placebo group.
The combination of Synbiotic and SperiGen (an antioxidant supplement) appears to be much more effective than using an antioxidant alone in improving the DNA fragmentation, concentration, and progressive motility of sperm.
Trial Registration: IRCT20190810044500N6, 2020-09-05. https://irct.behdasht.gov.ir/trial/46773. https://trial.medpath.com/clinical-trial/7ad7a7af5cba37f3/evaluating-symbiotic-therapy-male-infertility
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