Background/Aim: Malignant ureteral obstruction is associated with high rates of failure with traditional ureteral stents. Double-J metallic mesh ureteral stent is one of the latest options for treating malignant ureteral obstruction. However, data regarding the efficacy of using this stent in this context are limited. Thus, we retrospectively investigated the efficacy of this stent. Patients and Methods: We retrospectively analyzed the records of all patients who required double-J metallic mesh ureteral stent placement for malignant ureteral obstruction at Ishikawa Prefectural Central Hospital (Kanazawa, Japan) between October 2018 and April 2022. Primary stent patency was defined as complete or partial resolution of hydronephrosis as shown by imaging studies or successful removal of a preexisting nephrostomy tube. Stent failure was defined as unplanned stent exchange or nephrostomy tube placement for signs or symptoms of recurrent ureteral obstruction. A competing risk model was used to estimate the cumulative incidence of stent failure. Results: Double-J metallic mesh ureteral stents were placed in 63 ureters of 44 patients (13 males, 31 females). The median age of patients was 67 years (range=37-92 years). There was no grade 3 or higher complications. The overall primary patency rate was 95% (60 ureters). Stent failure occurred in seven patients (11%) during follow-up. The cumulative incidence of stent failure at 12 months after placement was 17.3%. Conclusion: Double-J metallic mesh ureteral stent is a safe, simple, and promising treatment option for malignant ureteral obstruction.

Background/Aim: Diagnostic efficacy and treatment outcome of orally administered 5 aminolevulinic acid (ALA) assessment for photodynamic diagnosis (PDD) in transurethral resection for non-muscle-invasive bladder cancer (NMIBC) in clinical practice. Patients and Methods: A retrospective analysis was performed of 105 patients who underwent PDD transurethral resection using orally administered ALA and were pathologically diagnosed with Ta, T1, or Tis at the Ishikawa Prefectural Central Hospital from December 2018 to May 2022. Results: Fluorescent light had a significantly higher sensitivity but a lower specificity in detecting carcinoma compared to white light (91.7% vs. 77.1%; p<0.05 and 43.0% vs. 85.2%; p<0.05, respectively), as well as in detecting carcinoma in situ lesions (80.4% vs. 28.6%; p<0.05 and 23.3% vs. 84.5%; p<0.05, respectively). The cumulative frequency of recurrence and progression 1 year after treatment were 26.3% and 12.3%, respectively. Multivariate analyses indicated that a Bacillus Calmette-Guérin (BCG) history instillation was an independent predictive factor for intravesical recurrence (hazard ratio=4.439; p=0.002) and disease progression (hazard ratio=8.534; p=0.005). The 1-year cumulative recurrence rates were 66.2% and 16.5%, respectively (p<0.001), and progression rates for patients with and without prior BCG intravesical instillation were 50.4% and 3.5%, respectively (p<0.001). Conclusion: Sufficient diagnostic accuracy and relatively good treatment outcome was shown in PDDtransurethral resection using ALA. However, prior BCG intravesical instillation for NMIBC patients was a poor prognostic factor of cancer recurrence and progression, and may be useful for clinicians in their postoperative follow-up.Transurethral resection of bladder tumor (TURBT) by intraoperative cancer detection under white light (WL) (1) is the standard therapy for non-muscle-invasive bladder cancer (NMIBC) in clinical practice, which accounts for approximately 70% of bladder cancers (BCs). However, about 50% of NMIBCs recur, and BC invades the muscle layer in the recurrence process in 15%-30% of cases (2). Therefore, improving TURBT quality and increasing the complete tumor resection rate is essential to reduce the recurrence risk. The protoporphyrin IX precursor called 5aminolevulinic acid (ALA) is attracting attention as a new generation photosensitive material for photodynamic diagnosis (PDD). PDD assisted TURBT using orally administered ALA has demonstrated clear advantages in Japan in terms of increased tumor detection and improved oncological outcome (3-7). Clinical data originating from Japan are not yet sufficient, although ALA was made available under the Japanese public medical insurance system in 2017.Recently, the Bacillus Calmette-Guérin (BCG) unresponsive disease concept was advocated; a group of diseases that recur despite adequate BCG intravesical therapy and are considered ineffective for reintroduction of BCG intravesical therapy (8, 9). However, it is unclear how prior BCG intravesical treatme...