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Objectives To investigate the eligibility for maintenance immunotherapy and its impact on the prognosis of advanced urothelial carcinoma treated with first‐line chemotherapy, as the selection biases of the eligible population in the JAVELIN Bladder 100 trial remain unclear. Methods We retrospectively evaluated 213 patients (median age, 71 years) with unresectable locally advanced or metastatic urothelial carcinoma treated with platinum‐based first‐line chemotherapy between May 2003 and April 2021. The patients were categorized into the following two groups: progressive disease (PD) within four cycles (trial ineligible group) and non‐PD within four cycles (trial eligible group). The primary outcomes were the estimated proportion of trial eligible patients for maintenance immunotherapy. The secondary outcomes were the comparison of the overall survival in the trial eligible and ineligible groups and the impact of radiologic response at the second cycle on the fourth cycle. Results Among the 213 patients, 81 (38%) were included in the trial eligible group. The trial eligible group had a significantly longer overall survival than the trial ineligible group (P < 0.001). Of 166 patients who had no PD within two cycles, 85 (51%) patients experienced PD within four cycles. Patients with a complete response or partial response at the second cycle had a significantly lower rate of PD at the fourth cycle (42%) than those with stable disease at the second cycle (59%, P = 0.031). Conclusion We observed 38% of the trial eligible population. Overall survival was significantly different between the trial eligible and ineligible groups.

Japan, where self-cut mesh is used, TVM continues to be a core option to treat POP, as surgical education has been effective in reducing mesh complications (vaginal exposure 10-12% in Western countries, 0.7-3.2% in Japan). 3,4 Because TVM using polypropylene mesh became impossible, the Japanese government approved ORIHIME ® (CROWNJUN Kouno, Chiba, Japan), a polytetrafluoroethylene mesh, in 2019.Nowadays, laparoscopic sacrocolpopexy (LSC) and robotassisted sacrocolpopexy have stolen the spotlight, and their numbers are rapidly increasing in Japan. However, LSC and robot-assisted sacrocolpopexy are also accompanied with some cases of prolapse recurrence and mesh complications. It is unwise to jump from overenthusiasm about TVM to overenthusiasm about LSC and robot-assisted sacrocolpopexy without analyzing these problems.To analyze prolapse recurrence and mesh complications, it is beneficial to ascertain the actual condition of the implanted mesh. The ultrasound is easy to carry out in daily practice; 5 however, the mesh arms cannot be visualized. Some studies tried to visualize mesh using magnetic resonance imaging, but it was difficult to differentiate mesh from surrounding scar tissue. 1 Now, Yamaguchi et al. found that polytetrafluoroethylene mesh used for TVM and LSC is radiopaque and can be visualized by 3-D computed tomography (polypropylene mesh is radiolucent). 1 Visualization of polytetrafluoroethylene mesh will contribute to evaluating mesh status in prolapse recurrence and complications, including failed passage through the sacrospinous ligament, detachment of sacral fixation, folding, shrinkage and exposure of the mesh. This study might become a breakthrough in evaluating POP mesh surgery. Further studies and standardization of mesh 3-D computed tomography visualization methods are anticipated.

Objective To elucidate the relationship between frailty and lower urinary tract symptoms (LUTS). Methods We longitudinally evaluated the temporal changes and the relationships between frailty and LUTS in 247 community‐dwelling adults (45 years or older) at baseline and at a 5‐year follow‐up. We used the Fried phenotype (phenotype‐based frailty), 5‐item modified frailty index (5i‐mFI; comorbidity‐based frailty), and frailty discriminant score (comprehensive frailty assessment) to evaluate frailty. LUTS were evaluated using the international prostate symptom score (IPSS) and overactive bladder symptom score (OABSS). Results We analyzed 247 participants with a median age of 60 years. The median IPSS and OABSS were significantly increased over the 5 years. The proportion of frail individuals did not increase significantly over the 5 years. Of the three frailty assessment tools, the 5i‐mFI score significantly increased between 2014 and 2019. Multiple linear regression analyses showed that the 5i‐mFI score was significantly associated with the severity of LUTS in 2014 to 5i‐mFI in 2019 but not with 5i‐mFI in 2014 to the severity of LUTS in 2019. Conclusion The effect of LUTS on frailty might be greater than the effect of frailty on LUTS. Further large‐scale studies are needed to elucidate the relationship between LUTS and frailty.