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In this issue

T his issue of the International Journal of Urology contains a total of 25 articles, one guideline, four review articles, 11 original articles, three urological notes, and six editorial comments. Penile cancer is rare, with a prevalence of 0.84/population 100 000/year. There is currently no established treatment for the disease due to the difficulty of conducting large-scale prospective studies. Under such circumstances, the first guideline for penile cancer in Japan was developed and published in this issue (Yamaguchi et al., Kumamoto, Japan). It is not hard to imagine that it was a challenging task to create a guideline from a small body of evidence. This guideline will be of great use in your daily practice. It is now known that a variety of gut bacteria inhabit the human intestinal tract and play an essential role in the maintenance of homeostasis. In addition, metabolites derived from the gut microbiome and the involvement of the intestinal immune environment in the immune system are believed to influence the onset and course of various diseases. The review article by Fujita et al. (Osaka, Japan) overviews the relation of diet, and androgens with prostate cancer from the perspective of gut bacteria. The latest research findings are beyond our imagination of a decade ago, including that a high-fat, diet-induced gut dysbiosis promotes prostate cancer growth, and gut microbiota is a source of testosterone. These findings have the potential for future prevention, screening, and treatment of prostate cancer. Primary aldosteronism (PA) in patients with hypertension reportedly account for up to 20%, but only a fraction of those is actually diagnosed and treated. At the time of diagnosis, many patients who have already been treated for hypertension for a long time often experience failure in normalizing blood pressure or manifesting renal dysfunction even after adrenalectomy. Lu et al. (Taipei, Taiwan) conducted a large prospective study of 328 PA patients to investigate changes in renal function after adrenalectomy and risk factors associated with worsening renal function. Lower estimated glomerular filtration rate (eGFR) after adrenalectomy was found to be associated with higher preoperative eGFR, higher preoperative systolic blood pressure, higher microalbuminuria, and lower serum potassium levels. The results of this study support the importance of early intervention to improve outcomes in PA patients. 5-aminolevulinic acid hydrochloride (5-ALA) is widely used at transurethral resection of bladder tumor to visualize bladder cancer by utilizing a property of protoporphyrin IX metabolite to accumulate in cancer cells. The 5-ALA is an amino acid that is ubiquitously synthesized in most organisms and has various roles, including involvement in the mitochondria function and immune system. Kuno et al. (Kochi, Japan) reported the novel potential of 5-ALA as a drug to prevent bladder dysfunction in cyclophosphamide-induced hemorrhagic cystitis by suppressing inflammatory cytokines. They focused on HO-1 as a key enzyme of the effect of 5-ALA, and showed that HO-1, which is increased by 5-ALA, suppresses bladder inflammation by degrading heme into biliverdin, bilirubin, and carbon monoxide, which have antioxidant and anti-inflammatory effects. It is expected that the diverse functions of 5-ALA will be useful in the treatment of various diseases in the future. Only a part of articles is presented due to space limitations, but all articles are interesting and thought-provoking, and I am certain that this issue will satisfy the readers.