Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/s2666-1683(25)01737-9

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/s2666-1683(25)01701-x

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

We investigated the clinical significance of positive surgical margins (PSMs) in index tumors following radical prostatectomy (RP), with particular attention to the tumor’s zonal origin. Among 1148 patients with localized prostate cancer who underwent RPs, 973 were included after excluding those who received perioperative therapy or had incomplete data. Index tumors were categorized by zonal origin: transition zone, peripheral zone, or central zone (CZ). Overall, PSMs were observed in 26.4% of index tumors. Although CZ index tumors were relatively uncommon (6.5%), they exhibited the highest PSM rate (42.9%) and showed the most aggressive pathological features. The 5-year biochemical recurrence (BCR)-free survival rate was significantly lower in patients with PSMs in index tumors than in those with negative surgical margins (45.6% vs. 86.8%, p < 0.0001). Notably, patients with PSMs in CZ index tumors had the worst outcomes, with a 5-year BCR-free survival rate of 22.0%. Multivariate analysis identified PSMs in index tumors as an independent predictor of BCR (HR: 3.4; 95% CI: 2.5–4.5), with a similar trend observed in early recurrence. These findings highlight the prognostic significance of PSMs in index tumors during RP, especially in CZ tumors, and emphasize the importance of securing local control in these cases.

DOI： 10.3390/curroncol32080445

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Preoperative obstructive pyelonephritis (OP) increases the risk of febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). This study aimed to investigate the effect of a history of OP treated without drainage on post‑URSL fUTI. METHODS: We retrospectively reviewed the medical records of 343 consecutive patients who underwent URSL at three institutions between January 2021 and April 2024. Risk factors for post‑URSL fUTI were analyzed, and frequencies were compared among patients with a history of OP treated without drainage, those with a history of OP treated with ureteral stent (US) placement, and those without a history of OP. RESULTS: Of the 343 patients, 29 (8.5%) developed post‑URSL fUTI. Multivariate logistic regression analysis revealed that a history of OP (p < 0.001) and preoperative positive urine culture (p = 0.043) were independent risk factors for post‑URSL fUTI. The incidence of post‑URSL fUTI was significantly higher in patients with OP treated with drainage than in those without a history of OP (p < 0.001). Moreover, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in patients treated with US placement (p = 0.030). CONCLUSION: In this study, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in those treated with US placement. A history of OP treated without drainage might represent the highest risk factor for post‑URSL fUTI. Therefore, calculous pyelonephritis probably should be managed with drainage to mitigate this risk.

DOI： 10.7759/cureus.89377

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The Vesical Imaging Reporting and Data System (VI-RADS) is used to detect muscle-invasive bladder cancer, with emerging prognostic implications. Integrating imaging parameters with molecular biomarkers may improve risk stratification in bladder cancer. This study evaluated whether combining VI-RADS scores with serum cytokeratin fragment 19 (CYFRA 21-1) levels—a clinically relevant biomarker for bladder cancer—could improve overall survival (OS) prediction. We retrospectively analyzed 134 patients who underwent transurethral resection of bladder tumors, magnetic resonance imaging, and postoperative serum CYFRA 21-1 measurements. In total, 15 cancer-specific deaths were observed during follow-up. Receiver operating characteristic curve analysis identified optimal prognostic cut-off values: VI-RADS score ≥ 4 and CYFRA 21-1 level ≥ 1.8 ng/mL. The 1-, 2-, and 3-year OS in patients with both high VI-RADS scores and CYFRA 21-1 levels were 42.9%, 16.7%, and 8.3%, respectively, significantly lower than those in other groups (p &lt; 0.001, 0.002, and 0.003, respectively). Multivariate Cox proportional hazards analysis demonstrated that such patients had the poorest OS (hazard ratio: 7.51; p = 0.002). This suggests that combining VI-RADS and CYFRA 21-1 improves prognostic accuracy in bladder cancer, demonstrating potential clinical utility by informing individualized treatment strategies; however, limitations include the retrospective study design and absence of external validation.

DOI： 10.3390/curroncol32080415

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

ABSTRACT

Background

We investigated the clinical and economic outcomes of robot‐assisted radical prostatectomy (RARP) using the hinotori surgical system (H‐RARP).

Methods

The analysis was conducted on 76 and 68 patients who underwent RARP using the da Vinci surgical system (D‐RARP) and H‐RARP, respectively. Safety, oncological, and functional outcomes were compared between H‐RARP and D‐RARP. Risk factors influencing medical costs in RARP were identified via linear regression analysis.

Results

Except for longer operative time in H‐RARP, clinical outcomes were comparable. The median medical costs per case were $12,426.8 for D‐RARP and $12,548.9 for H‐RARP. Operative time (coefficient: 0.0002, p &lt; 0.001), pathological T stage (coefficient: 0.023, p = 0.030), and postoperative hospital stay (coefficient: 0.028, p &lt; 0.001) were significant factors affecting medical costs; in contrast, the type of robot‐assisted surgical system was not a significant factor.

Conclusions

H‐RARP offers clinical outcomes comparable to those of D‐RARP while maintaining equivalent medical costs.

DOI： 10.1002/rcs.70084

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Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/01.ju.0001110136.41716.b7.14

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Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2025_92-212

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Publishing type：Research paper (scientific journal)   Publisher：American Society of Clinical Oncology (ASCO)  

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Background: VI-RADS is widely used to identify muscle-invasive bladder cancer (MIBC). However, it is not known whether structural category (SC; VI-RADS based on T2-weighted images) alone is useful in diagnosing clinicopathological features and prognosis of bladder cancer. This study investigates the diagnostic performance of SC in the detection of MIBC. We also measured tumour contact length (TCL), difference in signal intensity ratio (dSIR) and coefficient of variation (CV) within the tumour on T2WI. We evaluated whether these factors could improve the diagnostic performance of SC for MIBC and explored the correlation between these morphological features and clinicopathological characteristics and prognosis. Methods: Between August 2018 and July 2023, we performed 587 transurethral resections of bladder tumours. This study includes 236 patients who underwent preoperative MRI. We first evaluated the diagnostic performance of VI-RADS and SC for MIBC. TCL, dSIR and CV were measured on T2WI. The dSIR was defined as the difference between the signal intensity (SI) of the tumour and that of the underlying muscle layer, divided by the SI of the normal muscle layer. The CV was calculated as the standard deviation of the SI within the tumour divided by the mean SI. All patients were divided into high and low SC groups and the relationship between MIBC and TCL, dSIR and CV was examined. Cut-off values for the diagnosis of MIBC and overall survival (OS) were calculated based on ROC curves for the most correlated factors in each group, which were added to the SC score to evaluate the diagnostic value. We also examined the correlation between each factor and pathological findings. Results: The diagnostic performance of VI-RADS with a cut-off score of 4 was an AUC of 0.888. Meanwhile, the diagnostic performance of SC with a cut-off score of 4 was AUC of 0.885. The association between MIBC and each factor was compared in the SC≥4 and SC≤3 groups. In the SC≥4, multivariate analysis showed significant differences in dSIR (p&lt;0.001). In the SC≤3, multivariate analysis showed TCL is significantly longer in MIBC (p&lt;0.001). The diagnostic performance was an AUC of 0.912 for suspected MIBC with SC≥4 and dSIR&lt;1.03 and SC≤3 and TCL≥36mm. In pathological features, TCL is significantly longer in high-grade (p=0.018), necrosis(p&lt;0.001), variant(p=0.002), lymph node metastasis (p&lt;0.001) and organ metastasis (p&lt;0.035). Univariate COX analysis showed that SC≥4 was risk factors for OS (HR = 2.15, P = 0.031). In the SC≥4, patients with TCL≥40 mm had worse OS (HR = 3.06, P &lt; 0.015). In the SC≤3, patients with TCL≥31 mm had worse OS (HR = 10.59, P &lt; 0.001). Conclusions: The present study showed that SC combined with dSIR and TCL has good diagnostic performance for MIBC. We also found that TCL correlates with high-grade tumor, necrosis, and variant histology. The combination of SC and TCL effectively predicts OS in bladder cancer.

DOI： 10.1200/jco.2025.43.5_suppl.690

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント・人工知能(AI)はすでに,非常に高い前立腺癌検出率を示し,Gleason gradingでは泌尿器病理専門医レベルの性能を達成している.しかし,Gleason gradingの一致率をゴールとしたアルゴリズムでは,AIはいつまでたっても予後予測においてGleason gradingを超えることはできない.・米国ではすでに前立腺癌AI診断支援システム"Paige Prostate"がFDAに認可されている.商用アルゴリズムは,トップクラスの学術アルゴリズムと同等か,それを上回る性能を示している.・本邦においては,病理診断支援AIが実臨床で普及するには,いくつかの課題が存在する.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Current guidelines lack recommendations for serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study assessed the potential of the postoperative serum C-terminus of cytokeratin 19 (CYFRA21-1, CYFRA) level, hereafter referred to as poCY, as a predictor of early progression in patients treated with RNU. METHODS: Overall, 117 patients were categorized into the high group (HG) or low group (LG) based on a poCY cutoff level of 3.5 ng/mL after excluding those who did not meet the inclusion criteria. Kaplan-Meier curves and log-rank tests were used to measure cancer-specific survival (CSS) and progression-free survival (PFS) rates. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: During a median follow-up of 34 months, the 5-year CSS and PFS rates were 79% and 66%, respectively. The HG had a significantly worse CSS and 2-year PFS than the LG. Multivariate analyses identified poCY and lymph node involvement (LNI) as independent prognostic factors. Regarding the 2-year PFS, poCY, LNI, and resection margin status (RM) emerged as independent prognostic factors. CONCLUSIONS: poCY, LNI, and RM predicted early progression following RNU in patients with UTUC. Patients with elevated poCY may benefit from adjuvant chemotherapy, irrespective of their pathological findings.

DOI： 10.1272/jnms.JNMS.2025_92-404

PubMed

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Language：Japanese   Publisher：(株)日本臨床社  

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Prostate cancer (PCa) is a clinically heterogeneous disease. Predicting clinically significant PCa with low–intermediate prostate-specific antigen (PSA), which often includes aggressive cancers, is imperative. This study evaluated the predictive accuracy of deep learning analysis using multimodal medical data focused on clinically significant PCa in patients with PSA ≤ 20 ng/mL. Our cohort study included 178 consecutive patients who underwent ultrasound-guided prostate biopsy. Deep learning analyses were applied to predict clinically significant PCa. We generated receiver operating characteristic curves and calculated the corresponding area under the curve (AUC) to assess the prediction. The AUC of the integrated medical data using our multimodal deep learning approach was 0.878 (95% confidence interval [CI]: 0.772–0.984) in all patients without PSA restriction. Despite the reduced predictive ability of PSA when restricted to PSA ≤ 20 ng/mL (n = 122), the AUC was 0.862 (95% CI: 0.723–1.000), complemented by imaging data. In addition, we assessed clinical presentations and images belonging to representative false-negative and false-positive cases. Our multimodal deep learning approach assists physicians in determining treatment strategies by predicting clinically significant PCa in patients with PSA ≤ 20 ng/mL before biopsy, contributing to personalized medical workflows for PCa management.

DOI： 10.3390/curroncol31110530

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/s2666-1683(24)01130-3

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The presence of collateral vessels (CVs) on contrast-enhanced computed tomography is a poor prognostic factor in renal cell carcinoma (RCC), but its value in small RCC (sRCC; < 4 cm) remains unknown. In this study, we investigated whether presence of CVs is a predictor of high potential for metastasis in sRCC. METHODS: We retrospectively reviewed clinical and imaging data of patients with pathologically confirmed sRCC evaluated at our institution between 2011 and 2021. All sRCCs were pathologically diagnosed by biopsy, metastasectomy, partial nephrectomy, or radical nephrectomy. CVs were defined as blood vessels of any diameter connecting the tumor with the surrounding perirenal tissues on contrast-enhanced computed tomography. The rate of metastasis-free survival (MFS), defined as the time from pathological diagnosis to confirmed metastasis, was compared among patients without CVs, those with one CV, and those with two or more CVs. RESULTS: Of 141 patients, 4 (2.8%) had metastatic sRCC at initial diagnosis. In the 137 patients with nonmetastatic sRCC, the diagnosis was pathologically confirmed following radical surgery. The median follow-up period from pathological diagnosis was 73.9 months, and the overall 5-year MFS was 93.5%. The 5-year MFS was significantly poorer in patients with two or more CVs than in those with one CV (63.8% vs. 96.3%; p = 0.0003) and those without CVs (63.8% vs. 100%; p < 0.0001). CONCLUSIONS: sRCCs with two or more CVs might have high potential for metastasis. Conversely, sRCCs without CVs might not be aggressive and be suitable for active surveillance.

DOI： 10.1007/s12672-024-01409-y

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: We encountered a case of urinary retention caused by a urethral caruncle. CASE PRESENTATION: An 86-year-old woman presented to our hospital with urinary retention. When the urinary bladder catheter was placed, a smooth, well-defined mass 20 mm in diameter was detected on the posterior wall of the external urethral meatus. The patient was diagnosed with urinary retention due to a urethral caruncle, and the mass was resected. The mass was pathologically compatible with a urethral caruncle. The patient could urinate postoperatively. Ultrasound test after surgery showed residual urine volume was 100 mL. CONCLUSION: Inspecting the urethral meatus is vital in the clinical examination of older women with voiding symptoms. A urethral caruncle is a rare cause of urinary retention. However, large urethral caruncles are at risk of causing urinary retention suggesting that resecting the urethral caruncles at an appropriate time is desirable.

DOI： 10.1002/iju5.12756

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: We describe a case of an adrenal cavernous hemangioma that was surgically resected because of tumor growth and intratumoral hemorrhage. CASE PRESENTATION: A 73-year-old woman presented with an enlarged adrenal tumor and intratumoral hemorrhage during the follow-up of an incidental adrenal tumor. A computed tomography showed that the left adrenal tumor had grown from 23 to 44 mm over 1 year. Blood tests revealed a normal metabolic profile. Paragangliomas and metastatic tumors were suspected on imaging. Laparoscopic adrenalectomy was performed to prevent tumor rupture due to further bleeding. No adhesions or bleeding were observed around the tumor during surgery. Pathological diagnosis was adrenal cavernous hemangioma. CONCLUSION: Adrenal cavernous hemangioma is difficult to distinguish preoperatively from other adrenal tumors, including malignant tumors. The intraoperative findings of this case suggest that laparoscopic adrenalectomy is a safe treatment option for relatively small adrenal cavernous hemangioma.

DOI： 10.1002/iju5.12760

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.annonc.2024.08.2090

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Prolonged laparoscopic nephroureterectomy (LNU) for upper tract urothelial cancer (UTUC) can increase the frequency of intravesical recurrence after surgery. Therefore, it is important for urological surgeons to have knowledge on preoperative risk factors for prolonged LNU. However, few studies have investigated the risk factors for prolonged LNU. We hypothesized that the quantity of perirenal fat affects the pneumoretroperitoneum time (PRT) of retroperitoneal LNU (rLNU). This study aimed to investigate the preoperative risk factors for prolonged PRT during rLNU. METHODS: We reviewed the data of 115 patients who underwent rLNU for UTUC between 2013 and 2021. The perirenal fat thickness (PFT) observed on preoperative computed tomography (CT) images was used to evaluate the perinephric fat quantity. Preoperative risk factors for PRT during rLNU were analyzed using logistic regression models. The cutoff value for PRT was determined based on the median time.The cutoff values for fat-related factors influencing PRT were defined according to receiver operating characteristic curve analysis. RESULTS: The median PRT for rLNU was 182 min (interquartile range, 155-230 min). The cutoff values of posterior, lateral, and anterior PFTs were 15 mm, 24 mm, and 6 mm, respectively. Multivariate analysis revealed that a posterior PFT ≥ 15 mm (odds ratio [OR], 2.72; 95% confidence interval, 1.04-7.08; p = 0.0410) was an independent risk factor for prolonged PRT. CONCLUSIONS: Thick posterior PFT is a preoperative risk factor for prolonged PRT during rLNU. For patients with UTUC and thick posterior PFT, surgeons should develop optimal surgical strategies, including the selecting an expert surgeon as a primary surgeon and the selecting transperitoneal approach to surgery or open surgery.

DOI： 10.1186/s12894-024-01538-0

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We present a case involving a pregnant woman who needed transurethral lithotripsy for ureteral stent removal because of the stent encrustation. CLINICAL CASE: A 34-year-old woman was diagnosed with calculous pyelonephritis, and a double-loop ureteral stent was placed in her right ureter, after which the pyelonephritis resolved. One week after her delivery, we attempted to remove the ureteral stent; however, the encrustation of the proximal and distal coils made it impossible. We then crushed the encrustation by transurethral lithotripsy and removed the ureteral stent successfully. The encrustation component was calcium phosphate, and the urinary pH during pregnancy and after delivery was 7.5. CONCLUSION: Even in pregnant patients, patients placed ureteral stents for obstructive pyelonephritis with high urine pH might need to be replaced in the short term due to concerns regarding phosphate encrustation.

DOI： 10.24546/0100490328

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: A previous report has shown that cyclooxygenase-2 inhibitors can prevent the recurrence of cystitis glandularis postoperatively. Herein, we present a case of cystitis glandularis in which the tumor volume was markedly reduced by preoperative oral administration of a cyclooxygenase-2 inhibitor. CASE PRESENTATION: A 45-year-old man with voiding difficulty and lower abdominal pain during urination was referred to our hospital. Cystoscopy revealed multiple cystitis glandularis-like edematous masses on the trigone and the neck of the bladder, completely involving the bilateral ureteral orifices. Cyclooxygenase-2 inhibitor was orally administered at the patient's request. Six weeks later, the tumor volume was markedly reduced, bilateral ureteral orifices were identified, and the voiding difficulty and pain on urination disappeared. Complete transurethral resection of the residual tumor was performed, and the pathological diagnosis was intestinal-type cystitis glandularis. CONCLUSION: Cyclooxygenase-2 inhibition can be considered a useful therapeutic strategy for cystitis glandularis.

DOI： 10.1002/iju5.12728

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

A case in which a urethral catheter could not be indwelled at the start of robot-assisted laparoscopic radical prostatectomy (RARP) is reported. A 64-year-old man was admitted to the hospital for RARP with a diagnosis of prostate cancer cT2aN0M0. At the start of RARP, a pseudo-urethra was formed by inserting a urethral catheter, so surgery was started with a transabdominal posterior approach without indwelling the urethral catheter. The urethra was opened during bladder neck resection, a guide wire was inserted anterogradely, the urethra was dilated retrogradely, and a urethral catheter was indwelled. After that, the procedure was performed as usual, and the operation was completed. When the urethral catheter could not be indwelled at the start of RARP, it was possible to do so using an anterograde approach during the operation.

DOI： 10.7759/cureus.62956

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Language：Japanese   Publisher：医学図書出版(株)  

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Index tumors are the most aggressive tumors of the prostate. However, their clinical significance remains unclear. This study aimed to assess the incidence of index tumor location according to the zonal origin and whether these locations affect the prognosis after radical prostatectomy in patients with negative surgical margins.

Methods

This single-centered, retrospective study evaluated 1,109 consecutive patients who underwent radical prostatectomies. An index tumor was defined as the largest tumor in the prostate gland. We detected these locations based on McNeal's zonal origin using whole-mount sections. Biochemical recurrence (BCR) free survival curves were generated using the Kaplan–Meier method. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine the predictive factors for early BCR (within 1-year).

Results

A total of 621 patients with negative surgical margins who did not receive adjuvant therapy were included in this study. The index tumor were located in the transitional zone in 191 patients (30.8%), the peripheral zone in 399 patients (64.3%), and the central zone in 31 patients (5.0%). In total, 22 of 621 patients (3.5%) experienced early BCR and 70 patients (11.2%) experienced overall BCR at a median follow-up of 61.7 months. According to the index tumor location, the early BCR-free rates were 99.5%, 95.7 %, and 83.3% in the transitional, peripheral, and central zones, respectively. On multivariate analysis, the index tumor in the central zone was an independent predictor of early BCR with negative surgical margins following radical prostatectomy, followed by prostatectomy pathological grade, index tumor in the peripheral zone, and high prostate-specific antigen level.

Conclusions

We assessed the significance of index tumor location in patients with negative surgical margins following radical prostatectomy. Index tumors located in the central zone, although infrequent, were the strongest predictive factors for early BCR. Our results may allow urologists and patients to reconsider the therapeutic strategies for prostate cancer.

DOI： 10.1186/s12894-024-01499-4

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Other Link： https://link.springer.com/article/10.1186/s12894-024-01499-4/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)  

Cisplatin (CDDP) is a platinum-based drug with anti-cancer activity and is widely used as a standard therapy for bladder cancer. It is well known that CDDP causes cell death by increasing the generation of reactive oxygen species (ROS) and lipid peroxidation, but the mechanism of its anti-cancer effects has not been fully elucidated. There are still some problems such as chemoresistance in CDDP therapy. In the present study, we found the expression of Ca2+-independent phospholipase A2γ (iPLA2γ), which has been reported to regulate cellular redox homeostasis by inhibiting lipid peroxide accumulation, in human bladder cancer tissues. Thus, we investigated the effect of iPLA2γ knockdown on CDDP-induced bladder cancer cell death. As a result, we found that iPLA2γ knockdown significantly enhanced CDDP-induced apoptosis, intracellular and mitochondrial ROS production, cytochrome c release and caspase activation in bladder cancer cells. Moreover, mitochondrial membrane potential was decreased and peroxidation of mitochondrial phospholipids was increased by iPLA2γ knockdown. It was also shown that co-treatment of bromoenol lactone, an iPLA2 inhibitor, increased CDDP-induced apoptosis. These results indicated that iPLA2γ plays an important role in protecting bladder cancer cells from CDDP-induced apoptosis, and that iPLA2γ inhibitors might represent a novel strategy in CDDP-based multi-drug therapy.

DOI： 10.1016/j.freeradbiomed.2024.05.016

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

In patients with high-risk prostate cancer (HRPC) after radical prostatectomy (RP), biochemical recurrence (BCR) increases the risk of distant metastasis. Accordingly, additional prognostic biomarkers are required to identify the subpopulation of patients with HRPC who develop clinical recurrence (CR) after BCR. The objective of this study was to identify biomarkers in formalin-fixed paraffin-embedded (FFPE) RP samples that are prognostic for CR in patients with HRPC who experience BCR after RP (post-RP BCR). First, we performed a preliminary RNA sequencing analysis to comprehensively profile RNA expression in FFPE RP samples obtained from patients with HRPC who developed CR after post-RP BCR and found that many snRNAs were very abundant in preserved FFPE samples. Subsequently, we used quantitative polymerase chain reaction (qPCR) to compare the expression levels of highly abundant snRNAs in FFPE RP samples from patients with HRPC with and without CR after post-RP BCR (21 CR patients and 46 non-CR patients who had more than 5 years of follow-up after BCR). The qPCR analysis revealed that the expression levels of snRNA RNU1-1/1-2 and RNU4-1 were significantly higher in patients with CR than in patients without CR. These snRNAs were significantly correlated with clinical recurrence-free survival (RFS) in patients with HRPC who experienced post-RP BCR. Furthermore, snRNA RNU1-1/1-2 could serve as an independent prognostic factor for clinical RFS in post-RP BCR of HRPC cases where known prognostic factors (e.g., Gleason score) cannot distinguish between CR and non-CR patients. Our findings provide new insights into the involvement of snRNAs in prostate cancer progression.

DOI： 10.3390/cancers16091757

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Language：English  

INTRODUCTION: We present the case of a rapidly growing inferior vena cava tumor thrombus in renal cell carcinoma. CASE PRESENTATION: We present a case of a 66-year-old woman with right renal cell carcinoma with a tumor thrombus extending 2 cm into the inferior vena cava on an initial Imaging. Radical surgery was performed 6 weeks after the first visit. Intraoperatively, the tumor thrombus was confirmed to have grown near the diaphragm. The tumor was resected using an inferior vena cava clamping just below the diaphragm. The tumor thrombus and renal cell carcinoma were completely removed. There was no recurrence 6 months postoperatively. CONCLUSION: Inferior vena cava tumor thrombus in renal cell carcinoma can grow in a short period, suggesting that preoperative imaging evaluation at the appropriate time is important. Once inferior vena cava tumor thrombus of renal cell carcinoma occurs, surgery should not be delayed unless there is an urgent reason.

DOI： 10.1002/iju5.12709

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BACKGROUND: The Vesical Imaging Reporting and Data System (VI-RADS) is widely used for predicting muscle-invasive bladder cancer (MIBC). This study aimed to determine the clinicopathological significance of the VI-RADS ≧4 (VI≧4) group. METHODS: Patients who underwent transurethral resections of bladder tumors during the study period and preoperative magnetic resonance imaging were considered. The patients were pathologically diagnosed with urothelial carcinoma (UC). We first compared the results of patients with VI-RADS scores of 3 and 4 to determine the cut-off score for MIBC; thereafter, the patients were divided into the VI≧4 and VI-RADS ≦3 (VI≦3) groups using VI-RADS. The clinicopathological significance of the VI≧4 group was examined retrospectively by comparing the characteristics of each group. RESULTS: In total, 121 cases were examined, of which 28 were pathologically diagnosed with MIBC. Of the 28 MIBC cases, three (10.7%) had a VI-RADS score of ≦3, and 25 (89.3%) had a VI-RADS score of ≧4. Of the 93 NMIBC cases, 86 (92.5%) had a VI-RADS score of ≦3, and seven (7.5%) had a VI-RADS score of ≧4. The diagnostic performance of the VI-RADS with a cut-off score of 4 was 89.3% for sensitivity, 92.5% for specificity, and an area under the curve (AUC) of 0.91. Contrastingly, for a cut-off score of 3, the sensitivity was 89.3%, specificity was 62.0%, and AUC was 0.72. A VI-RADS score of ≥ 4 could predict MIBC. In the VI≧4 group, 30 of 32 (93.8%) patients had high-grade tumors. The VI≧4 group had significantly more high-grade bladder cancers than the VI≦3 group (p < 0.001 OR = 31.77 95%CI:8.47-1119.07). In addition, the VI≧4 group had more tumor necrosis (VI≧4 vs VI≦3, p < 0.001 OR = 7.46 95%CI:2.61-21.34) and more UC variant cases (VI≧4 vs VI≦3, p = 0.034 OR = 3.28 95%CI:1.05-10.25) than the VI≦3 group. CONCLUSIONS: This study suggests that VI-RADS has a high diagnostic performance in predicting MIBC and that VI-RADS could diagnose high-grade tumors, necrosis, and UC variants.

DOI： 10.1186/s12894-024-01452-5

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This study presents the enfortumab vedotin (EV) treatment analysis at our institution. We retrospectively analyzed patients with metastatic urothelial cancer (mUC) treated with EV between January 2021 and October 2023. EV was administered at 1.25 mg/kg on days 1, 8, and 15 in a 28-day cycle. Whole-body computed tomography scans were performed to assess the treatment response. Patient characteristics, treatment histories, response rates, progression-free survival, and adverse events were evaluated. Response rates were determined, and adverse events were recorded. Among the 20 patients, 70% were male and 65% had bladder tumors. Most patients had lung (65%) or lymph node (65%) metastases. The median follow-up was 11.2 months, with 45% of the patients succumbing to the disease. The overall response rate was 55%. The median progression-free and median overall survivals were 10.5 and 12.9 months, respectively. Severe adverse events occurred in 35% of patients. In this real-world study, EV demonstrated promising efficacy and manageable safety profiles in Japanese patients with mUC. The study's results were consistent with previous clinical trials, although a longer follow-up was required. Our findings support EV use as a treatment option for patients with mUC who exhibit disease progression after platinum-based chemotherapy and immune-checkpoint inhibitor therapy.

DOI： 10.3390/curroncol31020056

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BACKGROUND: Everolimus, a mammalian target of rapamycin inhibitor used as an antineoplastic drug, is associated with a remarkably high incidence of interstitial lung disease (ILD). The clinical and pathological characteristics of ILD caused by everolimus have not been thoroughly investigated; therefore, we aimed to elucidate the features of everolimus-associated ILD. METHODS: We retrospectively reviewed the medical records of patients who received everolimus for cancer treatment at our hospital. Patient backgrounds were compared between the ILD and non-ILD groups. Chest computed tomography (CT), changes in biomarkers, and lung histopathological features were analyzed for ILD cases. RESULTS: Sixty-six patients were reviewed, and ILD developed in 19. There were no differences in patient demographics between the ILD and non-ILD groups. The severity of ILD was grade 1 (G1) in 9 and grade 2 (G2) in 10 cases. Chest CT showed organizing pneumonia (OP) or a hypersensitive pneumonia pattern. The levels of lactate dehydrogenase, C-reactive protein, Krebs von den lungen-6, and surfactant protein-D (SP-D) at the onset of ILD were significantly higher than those at baseline. Analysis of G1 and G2 ILD subgroups showed a higher SP-D levels in the G2 subgroup. Five patients underwent lung biopsies; all specimens demonstrated alveolitis with lymphocytic infiltration and granulomatous lesions, and some had OP findings. CONCLUSIONS: Everolimus-associated ILD is mild and has a favorable prognosis. Patients with symptomatic ILD were more likely to have higher SP-D levels than those with asymptomatic ILD. Granulomatous lesions are an important pathological feature of everolimus-associated ILD.

DOI： 10.1272/jnms.JNMS.2024_91-211

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BACKGROUND: Epididymal injuries without ipsilateral injuries of the testicles are rare. We report a case of a solitary right epididymal injury complicated by left testicular rupture. CASE PRESENTATION: A 21-year-old man experienced scrotal trauma caused by a motorcycle accident. Bilateral swelling and tenderness of the scrotum were observed. Ultrasonography and computed tomography revealed a ruptured left testicle; therefore, surgery was performed. During surgery, the left testicle was excised because it was completely ruptured, and the right testicle and epididymis were evaluated to identify the cause of swelling of the right scrotum. The right testis was not injured; however, the right epididymis was lacerated. Subsequently, the lacerated right epididymis was repaired using sutures. A semen analysis performed at 1, 4, and 7 months after surgery revealed the absence of sperm in the semen. CONCLUSION: Epididymal injuries should be considered as differential diagnoses for scrotal trauma.

DOI： 10.1002/ams2.919

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Publishing type：Research paper (scientific journal)   Publisher：University of Tokushima Faculty of Medicine  

DOI： 10.2152/jmi.71.187

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BACKGROUND: This study aimed to investigate the preoperative risk factors for prolonged operating time in retroperitoneoscopic radical nephrectomy (RRN) for renal cell carcinoma (RCC). METHODS: We retrospectively reviewed patients treated for RRN between January 2015 and December 2021. Clinical data, including radiological findings such as visceral fat area (VFA), subcutaneous fat area (SFA), and posterior perirenal fat thickness (PFT) were collected. The operating time for RRN was analyzed using univariate and multivariate logistic regression analyses. RESULTS: A total of 79 patients were included. The median age was 66 (range: 28-88) years and 48 (60.8%) had right-sided tumors. The median tumor size was 52 (range: 12-100) mm. Median BMI, VFA, SFA, and posterior PFT were 22.9 (range: 16.3-42.2) kg/m2, 102 (range: 14-290) cm2, 124 (range: 33-530) cm2, and 6 (range: 1-35) mm. The median operating time was 248 (range: 140-458) min. Univariate logistic regression analyses revealed that a right tumor (p=0.046), tumor size >7 cm (p=0.010), and posterior PFT >25 mm (p=0.006) were preoperative risk factors for prolonged operating time in RRN. Multivariate logistic regression analyses revealed that a posterior PFT of >25 mm was an independent preoperative risk factor for prolonged operating time for RRN (p=0.008, OR: 7.29, 95% CI: 1.69-31.5). CONCLUSIONS: A posterior PFT >25 mm was an independent preoperative risk factor for the operating time of RRN. In RRN, for patients with a posterior PFT >25 mm, surgeons should develop surgical strategies, including the selection of a transperitoneal approach to surgery, to avoid prolonging the operating time.

DOI： 10.1272/jnms.JNMS.2024_91-407

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BACKGROUND: Several effective treatment modalities against metastatic castration-resistant prostate cancer (mCRPC) are available; however, an unmet clinical need persists for mCRPC treatment because resistance to these therapies is inevitable. This study aimed to evaluate the status of comprehensive genomic profiling (CGP) and its impact on subsequent treatments for patients with mCRPC at our hospital. METHODS: Between December 2020 and August 2023, we assessed 41 patients with mCRPC who underwent CGP testing at the Nippon Medical School Hospital. The testing comprised FoundationOne® CDx for 30 patients and FoundationOne® Liquid CDx for 11 patients, following the procedures outlined by the Japanese Urological Association. RESULTS: CGP testing was successfully conducted in 40 out of 41 patients (97.6%), which resulted in the identification of 140 actionable genomic alterations. The most common alteration was TP53 in 12 patients (30.0%). Twenty-three patients (57.5%) with druggable gene alterations were identified; 21 were recommended for clinical trials, four for patient-proposed healthcare services, and six for insurance-covered drugs. Consequently, genotype-matched therapy with insurance-covered drugs was administered to five patients (12.5%) with a BRCA2 mutation. Notably, none of the patients underwent clinical or prospective trials based on patient-suggested medical services. CONCLUSIONS: Our results offer insights into the real-world application of CGP testing for patients with mCRPC at a cooperative hospital for cancer genomic medicine in Japan. Thus, urologists require a comprehensive understanding of the current status of CGP testing to enhance mCRPC management.

DOI： 10.1272/jnms.JNMS.2024_91-512

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Renal abscesses require prompt diagnosis and appropriate intervention, as they can be life-threatening. However, diagnosis based solely on clinical findings is often challenging. We present the case of a 69-year-old woman with left renal masses on follow-up computed tomography (CT) after surgery for pT2aN0M0 lung carcinosarcoma. The masses were localized only in the left kidney without suspected metastatic lesions at other sites. The patient was referred to our department for further evaluation and treatment under a diagnosis of suspected metastatic lung carcinosarcoma of the left kidney. On enhanced CT, the left renal masses, the largest of which had a diameter of 40×36 mm had thick irregular walls gradually enhanced by the contrast media and an internal low-attenuation area. The masses showed heterogeneous signal intensity with a pseudocapsule on T2-weighted magnetic resonance imaging. Clinical symptoms such as fever or costovertebral angle tenderness were absent, and blood and urine tests were not sufficiently inflammatory to suggest a renal abscess. Histopathological findings on CT-guided renal biopsy revealed only inflammatory tissue and no tumor cells. However, because lung carcinosarcoma metastatic nodules could not be ruled out, laparoscopic left nephrectomy was performed for a definitive diagnosis and curative intent. The pathological diagnosis was renal abscess without malignant lesions. Here, we present a case of renal abscess mimicking metastatic lesions in a patient with lung carcinosarcoma. Accurately differentiating renal abscesses from metastatic renal tumors before treatment is often difficult. Renal abscess diagnosis should be considered through a comprehensive evaluation of the clinical findings of individual cases.

DOI： 10.1272/jnms.JNMS.2024_91-609

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：日本生殖免疫学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publisher：(一社)日本癌治療学会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Introduction

We report a rare case of marked rectal stenosis due to Douglas' pouch metastasis of renal pelvic urothelial carcinoma successfully treated with enfortumab vedotin.

Case presentation

A 77‐year‐old female presented with difficulty in defecation and abdominal distension. She had received two courses of cisplatin plus gemcitabine followed by four courses of maintenance avelumab for postoperative lymph node metastasis of renal pelvic urothelial carcinoma. KL‐6 levels were elevated, and a computed tomography scan revealed an irregularly shaped large mass occupying Douglas' pouch, with marked rectal stenosis. Metastatic urothelial carcinoma was pathologically diagnosed, and enfortumab vedotin was initiated after colostomy. After 12 courses of enfortumab vedotin, metastatic lesions showed marked shrinkage and KL‐6 levels decreased.

Conclusion

Enfortumab vedotin elicited a remarkable response in treating rectal stenosis due to metastasis of renal pelvic urothelial carcinoma in Douglas' pouch. Furthermore, serum KL‐6 levels were correlated with the severity of metastatic urothelial carcinoma.

DOI： 10.1002/iju5.12645

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Language：Japanese   Publisher：(一社)日本排尿機能学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04260&link_issn=&doc_id=20230912340015&doc_link_id=10.1272%2Fmanms.19.283&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.19.283&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：医学図書出版(株)  

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BACKGROUND: To investigate the impact of Perirenal fat stranding (PRFS) on progression after radical nephroureterectomy (RNU) for renal pelvic urothelial carcinoma (RPUC) without hydronephrosis and to reveal the pathological findings of PRFS. METHODS: Clinicopathological data, including computed tomography (CT) findings of the ipsilateral PRFS, were collected from the medical records of 56 patients treated with RNU for RPUC without hydronephrosis between 2011 and 2021 at our institution. PRFS on CT was classified as either low or high PRFS. The impact of PRFS on progression-free survival (PFS) after RNU was analyzed using the Kaplan-Meier method and log-rank test. In addition, specimens including sufficient perirenal fat from patients with low and with high PRFS were pathologically analyzed. Immunohistochemical analysis of CD68, CD163, CD3, and CD20 was also performed. RESULTS: Of the 56 patients, 31(55.4%) and 25 (44.6%) patients were classified as having low and high PRFS, respectively. Within a median follow-up of 40.6 months postoperatively, 11 (19.6%) patients showed disease progression. The Kaplan-Meier method and log-rank test revealed that patients with high PRFS had significantly lower PFS rates than those with low PRFS (3-year PFS 69.8% vs 93.3%; p = 0.0393). Pathological analysis revealed that high PRFS specimens (n = 3 patients) contained more fibrous strictures in perirenal fat than low PRFS specimens (n = 3 patients). In addition, M2 macrophages (CD163 +) infiltrating fibrous tissue in perirenal area were observed in all patients with high PRFS group. CONCLUSIONS: PRFS of RPUC without hydronephrosis consists of collagenous fibers with M2 macrophages. The presence of ipsilateral high PRFS might be a preoperative risk factor for progression after RNU for RPUC patients without hydronephrosis. Prospective studies with large cohorts are required in the future.

DOI： 10.1007/s12672-023-00741-z

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Language：Japanese   Publisher：(一社)腎癌研究会  

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INTRODUCTION: Prostatic stromal sarcoma is an extremely rare malignancy of the prostate with a poor prognosis. CASE PRESENTATION: A 65-year-old man presented with dyschezia, and computed tomography showed a large prostate mass. The diagnosis was prostate stromal sarcoma by transrectal needle biopsy. Magnetic resonance imaging suggested rectal infiltration. The patient underwent 4 courses of neoadjuvant chemotherapy with gemcitabine and docetaxel hydrate followed by total pelvic exenteration. CONCLUSION: No recurrence has occurred at 5 years after the surgery. This is the first report of complete resection in prostate stromal sarcoma after neoadjuvant chemotherapy with gemcitabine and docetaxel hydrate.

DOI： 10.1002/iju5.12596

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本呼吸器学会  

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Language：Japanese   Publisher：(一社)日本呼吸器学会  

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BACKGROUND: The optimal treatment modality for locally advanced prostate cancer has not been established. Radiotherapy, hormonal therapy, and combinations of treatments are the main strategies, although the feasibility of radical prostatectomy as a first-line therapy needs to be considered. This retrospective study evaluated the long-term oncological outcome of high-risk prostate cancer treated surgically, using pathological results of the extracted specimen. The relationship between the number of risk factors and the long-term outcome was specifically analyzed. METHODS: High-risk prostate cancer patients who underwent laparoscopic radical prostatectomy at Nippon Medical School from 2000 to 2012 without neoadjuvant therapy of any kind were identified. Risk factors were prostate-specific antigen (PSA) ≥20 ng/ml, pathological ≥T3, and pathological Gleason Score ≥8. Biological failure was defined as PSA ≥0.2 ng/ml. RESULTS: A total of 222 men were identified. One patient had positive lymph node status, and there was a significant difference in surgical margin positivity (52 men, 68.4% vs 56 men 38.4%) between patients with and without biochemical failure. For patients meeting the high risk criteria with a follow-up of up to 133 months, the biochemical recurrence (BCR) -free survival rates at 5 and 10 years were 62.8% and 58.4%, respectively, with a mean time to BCR of 14.0 months. BCR-free survival rates at 5 and 10-year were 73.6% and 71.4%, respectively, with 1 risk factor, 48.7% and 34.6%, respectively, with 2 factors, and 34.5% and 34.5%, respectively, with 3 factors. A single risk factor group had a significantly better outcome than the group with multiple risk factors. The overall survival rate at 5 and 10 years were 94.6% and 93.7%, and the cancer-specific survival rate was 100% at both 5 and 10 years. CONCLUSIONS: Reasonable long-term oncological outcomes can be achieved by surgical treatment for high-risk prostate cancer. The group with 1 risk factor had a significantly better BCR-free rate than the multiple risk factor group.

DOI： 10.1272/jnms.JNMS.2023_90-210

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INTRODUCTION: We encountered an extremely rare case of a vesicocutaneous fistula due to vesical diverticulitis with stones. CASE PRESENTATION: A 78-year-old male patient presented to our department with complaints of suppurative discharge in the suprapubic area. Computed tomography revealed an enlarged prostate, a vesical diverticulum with stones located on the ventral side, and an aberrant connection between the anterior bladder wall and the external surface of the skin. The patient was diagnosed with a vesicocutaneous fistula due to vesical diverticulitis and was successfully treated with a multidisciplinary approach including vesical diverticulectomy with stone removal and nonviable tissue debridement. The patient continues to receive regular outpatient follow-ups with urinary catheter changes. CONCLUSION: Vesicocutaneous fistulas due to vesical diverticulitis with stones are extremely rare. We should be aware that a vesical diverticulum with stones located on the ventral side might pose a high-risk factor for the formation of a vesicocutaneous fistula in elderly patients.

DOI： 10.1002/iju5.12546

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Language：English   Publishing type：Research paper (scientific journal)  

The case presented is of a 47-year-old patient with an extravesical pedunculated bladder leiomyoma, which was difficult to distinguish from a retroperitoneal tumor. Preoperatively, it was suspected to be a retroperitoneal tumor and a laparotomy with tumor resection was performed. lntraoperatively, the bladder and tumor were connected by a cord-like tissue. A retrospective review of preoperative images revealed that cord-like tissue, identified intraoperatively, was also present. Bladder leiomyomas can grow as extravesical pedunculated tumors. Therefore, when the continuity between the bladder and tumor is only a cord-like object, the finding ofcontinuity is useful to diagnose with bladder leiomyoma. J. Med. Invest. 70 : 513-515, August, 2023.

DOI： 10.2152/jmi.70.513

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Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20230208420013&doc_link_id=10.1272%2Fmanms.18.397&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.18.397&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20230208420013&doc_link_id=10.1272%2Fmanms.18.397&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.18.397&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Biological or immunological differences in primary lesions between synchronous and metachronous metastatic renal cell carcinoma (mRCC) have been reported. However, the association between the tumor immune microenvironment (TIME) of primary lesions and time to metastasis remains unknown. We investigated the differences in the TIME of primary lesions based on time intervals to metastasis, mainly between the synchronous group (SG; metastasis within 3 months) and metachronous group (MG; metastasis after 3 months), and its association with clinicopathological parameters in patients with mRCC. Overall, 568 patients treated first-line with vascular endothelial growth factor receptor inhibitors comprised the analysis population (SG: N = 307 [54.0%]; MG: N = 261 [46.0%]). SG had a higher proportion of patients with poor prognostic pathological feature tumors: WHO/ISUP grade 4, necrosis, lymphovascular invasion, infiltrative growth pattern, and sarcomatoid differentiation. Regarding the TIME, more immunogenic features were seen in SG than MG, with a higher PD-L1 positivity and a lower proportion of the desert phenotype. This is the first study to examine the differences in the TIME of primary lesions in patients with mRCC based on the time intervals to metastasis. The TIME of primary lesions could affect the time to metastasis.

DOI： 10.3390/cancers14215258

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本排尿機能学会  

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Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2022_89-208

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Active surveillance (AS) is one of the treatment methods for patients with small renal masses (SRMs; &lt; 4 cm), including renal cell carcinomas (RCCs). However, some small RCCs may exhibit aggressive neoplastic behaviors and metastasize. Little is known about imaging biomarkers capable of identifying potentially aggressive small RCCs. Contrast-enhanced computed tomography (CECT) often detects collateral vessels arising from neoplastic angiogenesis in RCCs. Therefore, this study aimed to evaluate the association between SRM differential diagnoses and prognoses, and the detection of collateral vessels using CECT.

Methods

A total of 130 consecutive patients with pathologically confirmed non-metastatic SRMs (fat-poor angiomyolipomas [fpAMLs; n = 7] and RCCs [n = 123]) were retrospectively enrolled. Between 2011 and 2019, SRM diagnoses in these patients were confirmed after biopsy or surgical resection. All RCCs were surgically resected. Regardless of diameter, a collateral vessel (CV) was defined as any blood vessel connecting the tumor from around the kidney using CECT. First, we analyzed the role of CV-detection in differentiating between fpAML and RCC. Then, we evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RCC diagnosis based on CV-detection using CECT. We also assessed the prognostic value of CV-detection using the Fisher exact test, and Kaplan-Meier method and the log-rank test.

Results

The sensitivity, specificity, PPV, NPV, and accuracy of CV-detection for the diagnosis of small RCCs was 48.5, 45.5, 100, 100, and 9.5% respectively. Five of 123 (4.1%) patients with RCC experienced recurrence. CV-detection using CECT was the only significant factor associated with recurrence (p = 0.0177). Recurrence-free survival (RFS) was significantly lower in patients with CV compared with in those without CV (5-year RFS 92.4% versus 100%, respectively; p = 0.005). In addition, critical review of the CT images revealed the CVs to be continuous with the venous vessels around the kidney.

Conclusions

The detection of CVs using CECT is useful for differentiating between small fpAMLs and RCCs. CV-detection may also be applied as a predictive parameter for small RCCs prone to recurrence after surgical resection. Moreover, AS could be suitable for small RCCs without CVs.

DOI： 10.1186/s12885-022-09971-w

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Other Link： https://link.springer.com/article/10.1186/s12885-022-09971-w/fulltext.html

Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：(一社)腎癌研究会  

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Language：Japanese   Publisher：医学図書出版(株)  

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BACKGROUND: We evaluated whether the efficacy and safety of transurethral enucleation with bipolar energy (TUEB) is affected by prostate volume (PV) in the treatment of benign prostatic hyperplasia (BPH). METHODS: We retrospectively evaluated 180 patients with symptomatic BPH who underwent TUEB between 2008 and 2015. Efficacy was assessed by perioperative changes in the international prostate symptom score (IPSS), Quality of Life Score (QOLS), maximum flow rate on uroflowmetry (Qmax), and serum prostate-specific antigen level (PSA), which were recorded at 3 months postoperative. Safety was assessed by perioperative incidence of adverse events (AEs). AEs were recorded up to 2 years after surgery. Patients were divided into two groups based on PV: standard group (SG), PV < 80 mL, and large group (LG), PV ≥ 80 mL. RESULTS: A total of 132 (73%) patients were grouped in the SG, whereas 48 (27%) were grouped in the LG. No significant differences were observed in the preoperative parameters of age, IPSS, and QOLS between the two groups. However, the LG had a significantly larger PV and higher serum PSA levels. Regarding surgical outcomes, postoperative changes in IPSS, QOLS, Qmax, serum PSA, serum sodium, and hemoglobin levels did not differ significantly between the groups. However, the LG demonstrated a significantly longer operative time and heavier specimen weight. The rates of early complications, including hyponatremia, and blood transfusion, and late complications after surgery did not differ between the groups. CONCLUSION: This study demonstrated the safety and efficacy of TUEB for BPH therapy regardless of PV.

DOI： 10.1272/jnms.JNMS.2022_89-411

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BACKGROUND: Because of its low recurrence rate and safety, laparoscopic sacrocolpopexy (LSC) is an increasingly popular treatment for pelvic organ prolapse (POP). Although LSC may improve voiding function, it can also lead to de novo stress urinary incontinence. The exact effects of LSC on voiding function, and the mechanisms responsible, remain unclear. Therefore, in this study we prospectively evaluated the impact of LSC on voiding function by performing a pre- and postoperative urodynamic study of patients with stage 3 or worse POP. METHODS: Urinary status was evaluated before and 3 months after LSC. Pre- and postoperative evaluations included medical history, clinical examination, urodynamic studies, chain cystography, and residual urine volume measurement. Urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). RESULTS: The nonrecurrence rate at 3 months was 82.3%. All recurrences involved bladder prolapse. In addition to the absence of a significant change in OABSS, the improvement in IPSS suggests that subjective voiding symptoms improved. Although the maximum urinary flow rate did not significantly change, bladder volume at first sensation increased, urinary storage function improved, and residual urine volume decreased. There were no perioperative complications, and no patient reported postoperative difficulty in urination or urinary retention. The retrovesical angle significantly decreased. CONCLUSIONS: The modified LSC in women with POP provides good functional outcomes in terms of IPSS, post-void residual volume (PVR), and urinary storage function.

DOI： 10.1272/jnms.JNMS.2022_89-219

PubMed

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：Japanese   Publisher：(公社)日本薬学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Accurate prostate cancer screening is imperative for reducing the risk of cancer death. Ultrasound imaging, although easy, tends to have low resolution and high inter-observer variability. Here, we show that our integrated machine learning approach enabled the detection of pathological high-grade cancer by the ultrasound procedure. Our study included 772 consecutive patients and 2899 prostate ultrasound images obtained at the Nippon Medical School Hospital. We applied machine learning analyses using ultrasound imaging data and clinical data to detect high-grade prostate cancer. The area under the curve (AUC) using clinical data was 0.691. On the other hand, the AUC when using clinical data and ultrasound imaging data was 0.835 (p = 0.007). Our data-driven ultrasound approach offers an efficient tool to triage patients with high-grade prostate cancers and expands the possibility of ultrasound imaging for the prostate cancer detection pathway.

DOI： 10.1038/s41598-022-04951-3

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.

DOI： 10.2152/jmi.69.145

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after retroperitoneoscopic nephroureterectomy (RNU) for UTUC. METHODS: Clinicopathological and surgical information were collected from the medical records of 73 patients treated with RNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after RNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoretroperitoneum time, was analyzed using the Fisher exact test. RESULTS: During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after RNU. The 1- and 3-year IVR-free survival rates were 85.9% and 76.5%, respectively. The Fisher exact test revealed that prolonged pneumoretroperitoneum time of ≥ 210 min was a risk factor for IVR in 1 year after RNU (p = 0.0358) and positive urine cytology was a risk factor for IVR in 3 years after RNU (p = 0.0352). CONCLUSIONS: In UTUC, the occurrences of IVR in 1 and 3 years after RNU are highly probable when the pneumoretroperitoneum time is prolonged (≥ 210 min) and in patients with positive urine cytology, respectively. Strict follow-up after RNU is more probable recommended for these patients.

DOI： 10.1186/s12894-021-00932-2

PubMed

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本排尿機能学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wolters Kluwer Medknow Publications  

Purpose: Eligibility for clinical trials is very strict and only patients who satisfy various criteria can enter trials. The individual use of pazopanib has not been adequately investigated. An optimal administration regimen for pazopanib in “real-world” patients with metastatic renal cell carcinoma (mRCC) is required. Our purpose was to determine the tolerability and efficacy of first-line pazopanib with a low starting dose in patients with mRCC who were ineligible for clinical trials. Materials and Methods: This study included patients with mRCC who underwent treatment with first-line pazopanib and were previously excluded from clinical trials because they did not meet the inclusion criteria. A 400 mg pazopanib starting dose is used routinely in patients with mRCC
if tolerated, dose escalation up to 800 mg may occur. Results: We identified 18 patients with mRCC who received first-line pazopanib and were previously determined ineligible for clinical trials. Pazopanib dose was escalated in 12 patients (66.6%), to 600 mg/day in 8 patients (44.4%) and to 800 mg/day in 4 patients (22.2%), and was not escalated in 6 patients (33.3%). In 3 patients (16.7%), pazopanib was discontinued owing to intolerability. The most common frequent adverse event was elevated alanine aminotransferase levels in 6 patients (33.3%), followed by a decreased platelet count in 5 patients (27.8%) and anorexia in 5 patients (27.8%). Partial response was seen in 5 patients (27.8%) and stable disease in 10 patients (55.6%)
median progression-free survival was 11.9 months (95% confidence interval: 6.3–28.7 months). Conclusion: Our data indicated that a low starting dose of 400 mg pazopanib did not negatively affect treatment tolerability and efficacy in patients with mRCC ineligible for clinical trials. We found that lower starting doses may lead to better results. Additional studies are needed in a larger cohort and longer follow-up to attain authentic outcomes.

DOI： 10.4103/UROS.UROS_145_20

Scopus

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Language：Japanese   Publisher：医学図書出版(株)  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/iju5.12276

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/iju5.12276

Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：日本医科大学医学会  

82歳。ペットボトルによる自慰後に陰茎がペットボトルの口から抜けなくなり、発熱、陰茎腫脹をきたした。前医にて陰茎絞扼症による尿閉の診断で膀胱瘻造設が行われた。陰茎根部から腹壁にかかる皮膚壊死、尿道損傷、敗血症の合併を認め、緊急陰茎全摘術後に複数回のデブリードマン、残存尿道摘除、抗生剤投与を行った。初診より12ヵ月経過現在、経過良好である。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04260&link_issn=&doc_id=20210301380004&doc_link_id=%2Fcw1nimed%2F2021%2F001701%2F005%2F0021-0024%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2021%2F001701%2F005%2F0021-0024%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本医科大学医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04260&link_issn=&doc_id=20210301380004&doc_link_id=10.1272%2Fmanms.17.21&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.17.21&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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BACKGROUND: Transrectal ultrasonography (TRUS)-guided prostate biopsy is the conventional method of diagnosing prostate cancer. TRUS-guided prostate biopsy can occasionally be associated with severe complications. Here, we report the first case of a prostate abscess with aneurysms and spondylodiscitis as a complication of TRUS-guided prostate biopsy, and we review the relevant literature. CASE PRESENTATION: A 78-year-old man presented with back pain, sepsis, and prostate abscesses. Twenty days after TRUS-guided prostate biopsy, he was found to have a 20-mm diameter abdominal aortic aneurysm that expanded to 28.2 mm in the space of a week, despite antibiotic therapy. Therefore, he underwent transurethral resection of the prostate to control prostatic abscesses. Although his aneurysm decreased to 23 mm in size after surgery, he continued to experience back pain. He was diagnosed as having pyogenic spondylitis and this was managed using a lumbar corset. Sixty-four days after the prostate biopsy, the aneurysm had re-expanded to 30 mm; therefore, we performed endovascular aneurysm repair (EVAR) using a microcore stent graft 82 days after the biopsy. Four days after the EVAR, the patient developed acute cholecystitis, and he underwent endoscopic retrograde biliary drainage. One hundred and sixty days after the prostate biopsy, all the complications had improved, and he was discharged. A literature review identified a further six cases of spondylodiscitis that had occurred after transrectal ultrasound-guided prostate biopsy. CONCLUSIONS: We have reported the first case of a complication of TRUS-guided prostate biopsy that involved prostatic abscesses, aneurysms, and spondylodiscitis. Although such complications are uncommon, clinicians should be aware of the potential for such severe complications of this procedure to develop.

DOI： 10.1186/s12894-021-00780-0

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：University of Tokushima Faculty of Medicine  

DOI： 10.2152/jmi.68.393

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Laparoscopic radical nephrectomy (LRN) is the standard surgical treatment for localized renal cell carcinoma. LRN can be performed using a transperitoneal or retroperitoneal approach. We report a case of a complication specific to the retroperitoneal approach. A 63-year-old woman with localized right renal cell carcinoma was treated with retroperitoneal LRN. During placement of the first port, tumor vessels were damaged by a balloon dilator. Massive hemorrhage from the retroperitoneal cavity required conversion to retroperitoneal laparotomy to stop the bleeding. When laparotomy was performed, active bleeding had already ceased. The bleeding was caused by damage to the tumor vessels from the balloon dilator. Subsequent nephrectomy was performed without other complications. This case suggests that the transperitoneal approach is safer than the retroperitoneal approach when a tumor is located laterally and contains many tumor vessels.

DOI： 10.1272/jnms.JNMS.2021_88-412

PubMed

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント ・尿管癌に対する尿管部分切除術(SU)の適応拡大に向けて,将来的な展望を示した.・ランダム化比較試験ができないためエビデンスレベルは低いが,適応として,(1)切除可能な尿管癌,(2)術後単回膀胱内注入療法,(3)cT2～4の中部尿管癌に対するリンパ節郭清,(4)pT2～4/pN+/PSM+の症例に対する術後化学療法を提唱する.・以上の結果を後ろ向きに腎尿管全摘除術(RNU)と比較することで,SUを選択すべき症例の適応が明らかになる可能性がある.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Plasmacytoid urothelial carcinoma (PUC) of the urinary bladder is a variant of urothelial carcinoma that carries a poor prognosis. The epithelial-mesenchymal transition (EMT) has been demonstrated to contribute to tumor progression. As the cause of the increased aggressiveness of PUC is unknown, we investigated PUC and EMT-related marker expression. METHODS: A total of 633 bladder carcinoma cases diagnosed from 2006 to 2015 at the Nippon Medical School Hospital were analyzed. Twelve patients were found to have plasmacytoid histology and diagnosed with PUC. Slides were evaluated for percentage of plasmacytoid variant, and stained for E-cadherin, N-cadherin, Vimentin, Fibronectin and Snail expression. RESULTS: The incidence of PUC was 1.9% (12/633). The median patient age at diagnosis was 71 years (range, 60-80 years) and the male-female ratio was 11:1. All but three patients had stage T2b or higher. The median overall survival was 10 months. In 10/12 cases, Snail and N-cadherin were positive. Vimentin was positive in 9/12 cases. Fibronectin was positive in 8/12 cases. While E-cadherin was negative in 10/12 cases. Nine cases showed > 10% plasmacytoid component. Eight of the nine patients (88.9%) with > 10% plasmacytoid component died. CONCLUSIONS: The results indicate that PUC may induce EMT and may be associated with high invasion.

DOI： 10.1186/s12894-020-00641-2

PubMed

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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BACKGROUND: Robot-assisted surgery and pure laparoscopic surgery are available for minimally invasive radical prostatectomy (MIRP). The differences in anesthetic management between the two MIRPs under combined general and epidural anesthesia (CGEA) remain unknown. This study therefore aimed to determine the effects of robot-assisted surgery on anesthetic and perioperative management for MIRP under CGEA. METHODS: A retrospective observational study was performed by obtaining data from the patients' electronic medical records. Demographic data, intraoperative parameters, postoperative complications, and hospital stays after the MIRPs were compared between patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) and those with pure laparoscopic radical prostatectomy (LRP). RESULTS: There were no differences in the patients' background data between the 102 who underwent RALP and 112 who underwent LRP. Anesthesia and surgical times were shorter in the RALP group than in the LRP group. Consumption of anesthetics, including intravenous opioids, and epidural ropivacaine, was less in the RALP group. Although the estimated blood loss and volume of colloid infusion were lower in the RALP group, the volume of crystalloid infusion was larger. Intraoperative allogeneic transfusion was not required in either group. There were no differences in incidents of postoperative cardiopulmonary complications or postoperative nausea and vomiting (PONV) in either MIRP group. Hospital stays after the procedure were shorter in the RALP group. CONCLUSIONS: Robot-assisted surgery required varied consumption of anesthetics and infusion management during MIRP under GCEA. It also shortened the postoperative hospital stay without increasing the rates of postoperative complications.

DOI： 10.1272/jnms.JNMS.2021_88-304

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: While high body mass index (BMI) and visceral obesity are reportedly associated with a prolonged duration of laparoscopic radical nephrectomy (LRN) via the transperitoneal approach, factors that might prolong the retroperitoneal approach remain unknown. We therefore investigated factors associated with prolonged LRN using a retroperitoneal approach applied by non-expert surgeons. METHODS: We defined surgeons who were not certified to perform laparoscopic surgery by the Japanese Society of Endourology as non-experts. We retrospectively reviewed the medical records of 59 consecutive patients with renal cell carcinoma treated with LRN using the retroperitoneal approach by non-experts at our hospital between 2014 and 2019. Relationships between surgical duration and age, sex, body mass index, visceral fat area (VFA) and subcutaneous fat area (SFA), laterality and location of the tumor, length of major tumor axis (tumor length), clinical T stage, ipsilateral adrenalectomy and specimen weight were analyzed using Spearman rank correlation coefficients. RESULTS: The surgical duration positively correlated with ipsilateral adrenalectomy (rs = 0.3162, p = 0.0147) and specimen weight (rs = 0.3103, p = 0.0168), but not with BMI (rs = 0.2016, p = 0.1257) or VFA (rs = 0.0185, p = 0.8894). CONCLUSIONS: Factors associated with prolonged LRN via the retroperitoneal approach implemented by non-expert surgeons are ipsilateral adrenalectomy and specimen weight.

DOI： 10.1272/jnms.JNMS.2021_88-302

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of laparoscopic partial cystectomy with a transurethral (TU) resectoscope by the see-through technique for patients with BE are reported. MATERIALS AND METHODS: From January 2008 to February 2016, 12 cases of symptomatic BE were seen in our institution. The chief complaints of 9 cases were micturition pain during menstruation. Preoperative cystoscopy showed a bladder mass with blueberry spots. All surgeries were performed under general anesthesia. Laparoscopic surgery was performed with a fan of 4 ports in the lower abdomen. First, the uterus and bilateral ovaries were checked. Then, the TU resectoscope was inserted. When the affected bladder wall was identified, it was again observed with the laparoscopic light source off, which made it possible to observe the twilight leaking inside from the bladder. This twilight came from the light source of the TU resectoscope via the unaffected bladder wall. In contrast, the thickness of the affected wall prevented the light from inside the bladder from passing through it. We call this the "see-through technique." The tumor was then safely dissected with both laparoscopic and TU resection procedures. Finally, the bladder was sutured by laparoscopic procedures using absorbable sterile surgical suture. The urethral catheter was removed after cystography 7 days after the operation. RESULTS: The surgical margins of all cases were negative. There has been no recurrence of BE so far in any patients. There were no major adverse events perioperatively and the urinary symptoms improved in all cases. CONCLUSIONS: By laparoscopic partial cystectomy assisted with a TU resectoscope and see-through technique, the edge of BE could be easily and precisely identified. These procedures are effective and safe for BE surgical treatment.

DOI： 10.1159/000503795

PubMed

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Language：Japanese   Publisher：(公社)日本薬学会  

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Language：Japanese   Publisher：(公社)日本薬学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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The lipid cell variant of urethral carcinoma (UC) is rare and poorly understood clinicopathologically. A nodular tumor detected in the bladder of an 87-year-old man with asymptomatic gross hematuria was transurethrally resected, and high-grade UC, lipid cell variant, was diagnosed pathologically. The tumor cells resembled lipoblasts and contained numerous cytoplasmic vacuoles. Immunohistochemically, the tumor cells stained positive for the epithelial markers CK7, CK20, EMA, CAM5.2, and 34betaE12 and negative for vimentin and S100. Focal positivity for adipophilin was detected in cytoplasm but not in the vacuoles. These findings suggest that the patient had lipid-producing UC.

DOI： 10.1272/jnms.JNMS.2019_86-602

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Language：Japanese   Publisher：(公社)日本皮膚科学会  

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Deep learning algorithms have been successfully used in medical image classification. In the next stage, the technology of acquiring explainable knowledge from medical images is highly desired. Here we show that deep learning algorithm enables automated acquisition of explainable features from diagnostic annotation-free histopathology images. We compare the prediction accuracy of prostate cancer recurrence using our algorithm-generated features with that of diagnosis by expert pathologists using established criteria on 13,188 whole-mount pathology images consisting of over 86 billion image patches. Our method not only reveals findings established by humans but also features that have not been recognized, showing higher accuracy than human in prognostic prediction. Combining both our algorithm-generated features and human-established criteria predicts the recurrence more accurately than using either method alone. We confirm robustness of our method using external validation datasets including 2276 pathology images. This study opens up fields of machine learning analysis for discovering uncharted knowledge.

DOI： 10.1038/s41467-019-13647-8

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Deep learning algorithms have achieved great success in cancer image classification. However, it is imperative to understand the differences between the deep learning and human approaches. Using an explainable model, we aimed to compare the deep learning-focused regions of magnetic resonance (MR) images with cancerous locations identified by radiologists and pathologists. First, 307 prostate MR images were classified using a well-established deep neural network without locational information of cancers. Subsequently, we assessed whether the deep learning-focused regions overlapped the radiologist-identified targets. Furthermore, pathologists provided histopathological diagnoses on 896 pathological images, and we compared the deep learning-focused regions with the genuine cancer locations through 3D reconstruction of pathological images. The area under the curve (AUC) for MR images classification was sufficiently high (AUC = 0.90, 95% confidence interval 0.87-0.94). Deep learning-focused regions overlapped radiologist-identified targets by 70.5% and pathologist-identified cancer locations by 72.1%. Lymphocyte aggregation and dilated prostatic ducts were observed in non-cancerous regions focused by deep learning. Deep learning algorithms can achieve highly accurate image classification without necessarily identifying radiological targets or cancer locations. Deep learning may find clues that can help a clinical diagnosis even if the cancer is not visible.

DOI： 10.3390/biom9110673

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)西日本泌尿器科学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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DOI： 10.1007/s00262-019-02396-8

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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DOI： 10.21873/anticanres.13784

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

前立腺全摘除術の時期について TURP後3-4ヵ月は期間を空けてから前立腺全摘除術を行った方がよいと考える。注意点 TURP後では膀胱頸部が開大し、膀胱頸部の再建が必要となる可能性が高い。もっとも注意すべき点は前立腺床が開大しているため膀胱頸部や膀胱三角部の位置関係が判りにくくなることである。そのため尿管口の損傷や前立腺組織の取り残しなどが生じる可能性があり輪郭の確認も重要である。ロボット手術では視野が狭くなる傾向があるため、適宜カメラを引いた視野による膀胱や前立腺の位置関係の確認を行い思い込みによる前立腺組織への切り込みや尿管口損傷を回避する必要がある。多角的アプローチ1.後方アプローチ 直腸を意識しながら膀胱直腸窩の腹膜を切開し精嚢腺精管を露出し剥離切離します。膀胱背側と精管精嚢腺をしっかり剥離することで前立腺の輪郭を明瞭にする。2.側方アプローチ 膀胱前立腺境界部に生ずるくぼみを目安にバイポーラ鉗子にて剥離を進め、前立腺底部と膀胱外側との間の三角形の脂肪組織に到達する。さらに剥離を進めretrotrigonal layerを視認したらモノポーラハサミにて鋭的に切離し先ほど剥離した精嚢腺精管を保持し術野に露呈する。3.前方アプローチ 膀胱を頭側に牽引し、左右の鉗子で膀胱頸部を挟むようにピンチングを行い、膀胱前立腺移行部のラインを定める。ある程度膀胱頸部が温存できたら膀胱を切開し、膀胱頸部背側の離断に移る。尿道の背側粘膜を牽引しながら、常に一定の厚さの膀胱壁を意識しながら膀胱筋層寄りで切離を進める。retrotrigonal layerを視認し切開し離断を終える。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J05817&link_issn=&doc_id=20191106410004&doc_link_id=%2Fcs5jjend%2F2019%2F003202%2F006%2F0147-0151%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2019%2F003202%2F006%2F0147-0151%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Publishing type：Research paper (scientific journal)  

© 2018 Background: Whether antithrombotic agents should be stopped before prostate biopsy is unsettled. We investigated the impact of antithrombotic agents on bleeding complications after prostate biopsy. Materials and methods: Among the patients who underwent transrectal ultrasound-guided prostate biopsy from June 2006 to December 2013 at Ebina General Hospital, Kanagawa, Japan, 1817 cases were retrospectively assessed. Patients were divided into two groups: those not taking antithrombotic agents (control group) and those taking them (experimental group). The frequency and severity of bleeding complications after the procedure were compared. The severity of bleeding events was graded using the Common Terminology Criteria for Advanced Events vol. 4.0. Results: Hemorrhagic complications were classified into grades 1 to 3. Patients with complications of Grade 2 and above needed treatment. As for the Grade 1 event, there were no differences between two groups. The frequency of more than Grade 2 bleeding events was 1.7% and 3.5% in the control and experimental group, respectively; the odds ratio was 2.18 (P = 0.039). Grade 3 events occurred in seven patients of the control group (0.5%) and four patients of the experimental group (1.2%). Conclusions: The present study showed that continuation of antithrombotic agents increased the frequency of hemorrhagic complications requiring intervention. It suggests that attention should be paid to the patients taking antithrombotic agents before prostate biopsy.

DOI： 10.1016/j.prnil.2018.06.004

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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DOI： 10.14989/ActaUrolJap_65_5_163

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Language：English  

DOI： 10.1111/1346-8138.14601

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DOI： 10.1111/1346-8138.14601

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To clarify treatment patterns and outcomes for patients with unresectable or metastatic renal cell carcinoma in the molecular target therapy era in Japan. METHODS: A multicenter, retrospective medical chart review study was carried out. Patients diagnosed with unresectable or metastatic renal cell carcinoma between January 2012 and August 2015 were enrolled. Data extracted from medical records included treatment duration, grade ≥3 adverse events, reason for discontinuation for each targeted therapy and survival data until August 2016. RESULTS: Of 277 eligible patients, 266, 170 and 77 received first-, second- and third-line systemic treatment, respectively. Tyrosine kinase inhibitors were the most common first-line therapy (72.2%), followed by mammalian target of rapamycin inhibitors (14.3%) and cytokines (13.5%). Among 170 patients who received second-line treatment, tyrosine kinase inhibitor-tyrosine kinase inhibitor was the most common sequence (58.8%), followed by tyrosine kinase inhibitor-mammalian target of rapamycin inhibitor (14.1%) and cytokine-tyrosine kinase inhibitor (14.1%). With a median follow-up period of 19.8 months, median overall survival was not reached at 48 months. Patients who discontinued first-line tyrosine kinase inhibitors in <6 months showed poorer overall survival compared with patients who received first-line tyrosine kinase inhibitors for ≥6 months. CONCLUSIONS: The present analysis illustrates the contemporary treatment patterns and prognosis for patients with unresectable or metastatic renal cancer in a real-world setting in Japan. Tyrosine kinase inhibitor-tyrosine kinase inhibitor represents the most commonly used sequence. Shorter treatment duration of first-line tyrosine kinase inhibitors is associated with poorer prognosis, suggesting the need for better treatment options.

DOI： 10.1111/iju.13830

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

DOI： 10.1016/j.prnil.2019.01.003

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DOI： 10.1101/539791

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Other Link： http://orcid.org/0000-0003-0088-9324

Language：Japanese   Publishing type：Research paper (scientific journal)  

We describe a patient with thrombosis of the pampiniform plexus cured using heparin. A 40-year-old man was referred to our hospital with pain in the left scrotum. A physical examination revealed a painful, 20-mm long, beaded mass in the upper left paratesticular region. Magnetic resonance imaging and ultrasonography revealed 10-mm long thrombosis in the left pampiniform plexus, so intravenous heparin was started. The patient recovered well and was discharged on oral anticoagulation therapy after five days of hospitalization. The patient was completely asymptomatic, and ultrasonographic findings of the left testicle were normal at six months after starting treatment. We found 19 patients with thrombosis of the pampiniform plexus including the present patient, in the English and Japanese literature to date. Here, we review these 19 patients and discuss their clinical features.

DOI： 10.5980/jpnjurol.110.70

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DOI： 10.1272/jnms.JNMS.2019_86-211

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 65-year-old man was admitted to our institution with vomiting and right flank pain. Computed tomography (CT) imaging showed a 21-cm retroperitoneal multilocular cystic tumor which had been identified four years previously. It had increased from 17 to 21 cm. The initial diagnosis was cystic lymphangioma because it was a clear cystic tumor without a boundary or a solid component in the first CT, but later CT revealed an unclear boundary with surrounding organs suggesting malignancy. We decided to resect the tumor because it was symptomatic and might be malignant. The tumor was then resected along with surrounding organs because invasion was suspected. Pathological findings indicated a diagnosis of cystic lymphangioma with chronic inflammation and confirmed complete resection of the tumor. The patient has remained free of recurrence at one year after surgery. This experience indicates that cystic lymphangioma should be completely resected to prevent recurrence.

DOI： 10.5980/jpnjurol.110.52

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Language：English   Publishing type：Research paper (scientific journal)  

RATIONALE: Collecting duct carcinoma (CDC) is a rare type of nonclear renal cell carcinoma, often presenting at an advanced stage of the disease, and standard treatment guidelines have not been established. PATIENT CONCERNS: A 73-year-old man was admitted to our hospital with complaints of fever and lower right back pain. DIAGNOSES: Computed tomography revealed a poorly defined tumor of the right kidney without metastasis. The patient underwent right radical nephrectomy and was diagnosed with clinical stage T1bN0M0 renal cancer; the pathological findings showed collecting duct carcinoma. INTERVENTIONS: After nephrectomy, multiple lung metastases were found in the following month, so first-line chemotherapy of gemcitabine (1000 mg/m on days 1 and 8, every 21 days) and cisplatin (70 mg/m on day 2, every 21 days) was administered. Due to disease progression, targeted therapy with axitinib (10 mg/body) and second-line chemotherapy of paclitaxel (200 mg/m on day 1, every 21 days) and carboplatin (area under the curve of 6 on day 1, every 21 days) were subsequently administered. However, the lung metastases progressed and new metastases spread to the right adrenal gland, liver, and lymph nodes. Based on the high expression of programmed death-ligand 1 in tumor cells, we treated the patient with the immune checkpoint inhibitor nivolumab. OUTCOMES: After 2 courses of treatment, he experienced a partial response and improved performance status, and thus was discharged from the hospital. To date, the patient is on his fifth course of treatment as an outpatient without disease progression. LESSONS: The findings of our study suggest that nivolumab may be effective even if the patient has highly progressive CDC with a low PS, if PD-L1 is highly expressed in the tumor cells.

DOI： 10.1097/MD.0000000000013173

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

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Language：English   Publisher：Blackwell Publishing  

Computer technology has contributed to innovative progress in industrial infrastructures and has had a major influence on various work environments. Evaluations of work environments are routinely carried out in Western countries, but historically there has been resistance to such evaluations in Japan. In this mini-review, we discuss the current work environments of urologists in Japan. The number of urologists has increased each year, and the population density of urologists was 5.4 (per 100 000 people) in 2014. The average age of urologists in Japan was 48.9 years, and the percentage of female urologists was just 5.3%. Additionally, the geographic distribution of urologists was uneven in Japan. From projections based on population dynamics, the need for more urologists in the near future will probably increase. Because medical environments vary depending on the country, it is necessary to understand current work environments in greater detail initially. Furthermore, we should determine original measures for the establishment of satisfactory urological work environments in Japan.

DOI： 10.1111/iju.13517

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DOI： 10.1200/JCO.2018.36.6_suppl.142

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DOI： 10.1200/JCO.2018.36.6_suppl.628

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DOI： 10.1200/JCO.2018.36.6_suppl.487

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Language：English   Publishing type：Research paper (scientific journal)  

A 73-year-old man presented with right lower back pain and dysuria. Right hydronephrosis and a large pelvic large mass were seen on computed tomography (CT). Although his prostate-specific antigen (PSA) was 0.5 ng/mL, an irregularly enlarged, stony, hard prostate was palpable on digital rectal examination. A prostate tumor was suspected, and a transrectal prostate biopsy and right transurethral ureteral stent placement were performed. Histological and immunohistochemical studies revealed diffuse large B-cell lymphoma. Positron emission tomography-computed tomography showed abnormal uptake in the stomach, cecum, right obturator lymph nodes, para-aortic lymph nodes, and dorsal left kidney. No abnormal findings were seen on bone marrow histology. Clinical stage IVA was confirmed according to Ann Arbor criteria. The patient achieved a complete response after 8 cycles of combination chemotherapy with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone.

DOI： 10.1272/jnms.JNMS.2018_85-37

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To evaluate the efficacy of early transcatheter arterial embolization for hemodynamically stable patients with The American Association for the Surgery of Trauma (AAST) grade 4 blunt renal trauma. MATERIALS AND METHODS: The medical records of consecutive patients with grade 4 blunt renal trauma who were transported to our two critical care centers in Japan and treated with early transcatheter arterial embolization (TAE) between 2001 and 2013 were retrospectively reviewed. Treatment failure was defined as the need for further surgical intervention or re-embolization after initial embolization. We divided these cases into two groups, a group who survived and a group who died, investigating the factors that led to death. RESULTS: Seventeen patients underwent early TAE, with an average time between presentation and embolization for renal trauma of 125 minutes (66-214 minutes). There was no case of treatment failure. Three of the patients died, but none solely because of renal injury. Significant factors associated with patient death were the number of concomitant injured organs (p=0.04), the presence of pelvic fractures (p<0.01), and the presence of visceral injuries (p<0.01). The presence of lumber fractures (p=0.09) also tended to be associated with patient death. CONCLUSIONS: Early TAE is an effective treatment and should be actively performed for hemodynamically stable patients with grade 4 blunt renal injuries without multiple concomitant organ injuries.

DOI： 10.1272/jnms.JNMS.2018_85-31

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Posterior periurethral abscesses due to Neisseria gonorrhoeae are rare and thus difficult to diagnose and treat. We diagnosed this type of abscess using MRI and treated it conservatively.A 27-year-old man presented with perineal discomfort that had persisted for 1 week. Physical and CT findings indicated a prostate abscess, but MRI after admission revealed a multilocular mass in the posterior periurethra and polymerase chain reaction was positive for Neisseria gonorrhoeae. The posterior periurethral abscess was treated with Ceftriaxone and drainage via a cystostomy. This strategy improved the inflammation and CT confirmed the disappearance of the abscess from start of therapy in 43 days.

DOI： 10.5980/jpnjurol.109.237

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Prostacyclin (PGI(2)) synthase (PGIS) and microsomal prostaglandin (PG) E synthase-1 (PGES-1) functionally couple with inducible cyclooxygenase-2 (COX-2) as their upstream enzymes to produce PGI(2) and PGE(2), respectively. Non-steroidal anti-inflammatory drugs exert their pharmacological effects including antitumor effects by the inhibition of COX-2 and thereby suppress this PG biosynthesis. PGIS is abundantly expressed in vascular endothelial and smooth muscle cells and was shown to be critical for the regulation of platelet aggregation and vascular tone. In addition to its role in vascular regulation, PGIS was shown to be frequently down-regulated in several types of cancers, and the involvement of PGIS in carcinogenesis has been suggested. In this review, we summarize the current understanding of the roles of PGIS and PGIS-derived PGI(2) in carcinogenesis.

DOI： 10.10164/j.prostaglandins.2017.05.001

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Editorial Board of Acta Urologica Japonica  

A 63-year-old man was referred to our department because of painless hard mass in the right inguinal region. Abdominal computed tomography (CT) showed right spermatic cord mass measuring 25 mm in diameter. We performed right high orchiectomy. Histopathological diagnosis was dedifferentiated liposarcoma, which included myofibroblast components. He was alive 3 years postoperatively without recurrence.

DOI： 10.14989/ActaUrolJap_63_6_251

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Introduction: Transurethral resection of the prostate (TURF) is the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), but it has complications such as bleeding and transurethral resection syndrome. The treatment results of TURF performed by non-Japanese board-certified urologists were examined, and the results were analyzed according to the resection volume to determine how much resection volume was suitable for non-Japanese board-certified urologists.
Materials and Methods: A total of 72 cases that underwent TURF for BPH at our hospital were examined. The patients were divided into three groups by resection volume (&lt;20 g, 20-30 g, &gt;30 g). The operators were five non-Japanese board-certified urologists. Various clinical factors were examined among the three groups before and after TURF.
Results: The average operation time and resection volume were significantly different among the groups. There were more transfused cases with greater resection volume. The changes from before to after TURF in the International Prostate Symptom Score, total prostate volume, and maximum flow rate were significantly different among the three groups, but the rates of these changes were not.
Conclusions: In this study, TURF performed by non-Japanese board-certified urologists was relatively safe and achieved sufficient efficacy. Cases with resection volume less than 20 g appear the most appropriate for non-Japanese board-certified urologists.

DOI： 10.1272/jnms.84.73

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Language：Japanese   Publishing type：Research paper (scientific journal)  

IgG4-related kidney disease (IgG4-RKD) is a comprehensive term for renal lesions associated with IgG4-related disease (IgG4-RD), which is a recently recognized clinical entity characterized by a dense lymphoplasmacytic infiltrate rich in IgG4+ plasma cells with fibrosis affecting several organs. A 70-year-old woman was referred to our hospital for an abnormality at the left renal hilum detected by CT scan. Urinalysis was negative, urine cytology was rated as Class IIIa, and contrast-enhanced CT revealed left renal pelvic wall thickening without an irregular lumen and swelling of bilateral obturator lymph nodes. Ureterorenoscopy and biopsy were performed, and results showed no evidence of malignancy. Then, laparoscopic pelvic lymphadenectomy was performed. Plasma cells were the predominant infiltrating inflammatory cells; immunostaining showed marked infiltration of IgG4+ plasma cells with >10 IgG4+ plasma cells per high-power field, and the IgG4+/IgG+ cell ratio was over 40%. Serum IgG4 was extremely high. We made a final diagnosis of possible IgG4-related disease according to Comprehensive diagnostic Criteria for IgG4-related disease 2011. We report a long-term (40-month) follow-up case of IgG4-related kidney disease without therapy because there are no symptoms.

DOI： 10.5980/jpnjurol.108.229

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Publisher：Oxford University Press ({OUP})  

DOI： 10.1093/annonc/mdw499.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MARY ANN LIEBERT, INC  

Purpose: To assess whether our ureteroscopic real-time navigation system has the possibility to reduce radiation exposure and improve performance of ureteroscopic maneuvers in surgeons of various ages and experience levels. Materials and Methods: Our novel ureteroscopic navigation system used a magnetic tracking device to detect the position of the ureteroscope and display it on a three-dimensional image. We recruited 31 urologists from five institutions to perform two tasks. Task 1 consisted of finding three internal markings on the phantom calices. Task 2 consisted of identifying all calices by ureteroscopy. In both tasks, participants performed with simulated fluoroscopy first, followed by our navigation system. Accuracy rates (AR) for identification, required time (T) for completing the task, migration length (ML), and time exposed to simulated fluoroscopy were recorded. Results: The AR, T, and ML for both tasks were significantly better with the navigation system than without it (Task 1 with simulated fluoroscopy vs with navigation: AR 87.1 % vs 98.9%, P=0.003; T 355s vs 191s, P&lt;0.0001; ML 4627mm vs 2701mm, P&lt;0.0001. Task 2: AR 88.2% vs 96.7%, P=0.011; T 394s vs 333s, P=0.027; ML 5966mm vs 5299mm, P=0.0006). In both tasks, the participants used the simulated fluoroscopy about 20% of the total task time. Conclusions: Our navigation system, while still under development, could help surgeons of all levels to achieve better performances for ureteroscopic maneuvers compared with using fluoroscopic guidance. It also has the potential to reduce radiation exposure during fluoroscopy.

DOI： 10.1089/end.2015.0054

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: To investigate associations between dual-specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2) expression and survival in T1 high-grade or T2 bladder cancer patients treated with neoadjuvant chemotherapy.
Methods: The cohort under investigation comprised 44 patients who underwent neoadjuvant chemotherapy for pT1 high-grade or pT2N0M0 bladder cancer at our institution between 2002 and 2011. Immunohistochemical analysis was used to determine expression of DYRK2 in bladder cancer specimens obtained by transurethral resection before chemotherapy. Relationships between DYRK2 expression and both response to chemotherapy and survival in these patients were analyzed.
Results: DYRK2 expression was positive in 21 of 44 patients (47.7 %) and negative in 23 patients (52.3 %). In total, 20 of 21 DYRK2-positive cases showed complete response to neoadjuvant chemotherapy, whereas 11 of 23 DYRK2-negative cases did not show complete response. Sensitivity and specificity were 62.5 % and 91.7 %, respectively (P = 0.0018). In addition, disease-specific survival rate was significantly higher for DYRK2-positive patients than for DYRK2-negative patients (P = 0.017). In multivariate analysis, DYRK2 expression level was identified as an independent prognostic factor for disease-specific survival (P = 0.029). We also showed that DYRK2 mRNA expression was significantly higher in DYRK2-positive samples by immunohistochemistry than DYRK2-negative samples (P = 0.040).
Conclusions: DYRK2 expression level may predict the efficacy of neoadjuvant chemotherapy for T1 high-grade and T2 bladder cancer.

DOI： 10.1186/s12894-015-0040-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Aim: To investigate whether the insertion of a thermoexpandable metallic prostate stent (Memokath) facilitates the removal of Foley catheters in elderly patients ineligible for urethral obstruction surgery because of the potential complications involved in long-term catheter management.
Methods: A total of 37 male patients (mean age 79.8 +/- 6.2 years) ineligible for surgery under general anesthesia because of advanced age, the presence of post-cerebrovascular disorders or anticoagulant therapy use and who subsequently had a Memokath stent inserted between June 2007 and November 2009 were enrolled in the present study. Patients with spinal injury were excluded. We compared the correlation between prostatic urethral length and total prostate volume (TPV). We also evaluated the postoperative postvoid residual (PVR) and presence of pyuria, and reviewed postoperative complications and unassisted urination ability.
Results: We found a positive correlation between prostatic urethral length and TPV. After the insertion of the Memokath stent, the catheters were removed from all patients who could urinate unassisted. The PVR was &lt;50 mL in 76.4% patients, and there was a 52% improvement in pyuria after insertion of the Memokath stent. The mean postoperative follow-up duration was 33.2 +/- 16.7 months. A total of 21 patients (56.7%) were able to urinate unassisted after receiving the Memokath stent. Unassisted urination was difficult in patients with poor performance status. No serious complications were observed after insertion of the Memokath stent.
Conclusions: The Memokath stent was safe and useful for elderly patients with urethral obstruction and good performance status requiring long-term management with urethral Foley catheters.

DOI： 10.1111/ggi.12309

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Other Link： http://orcid.org/0000-0003-0088-9324

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

The patient was a 37-year-old woman who had suffered from repeated pyelonephritis. Computed tomography (CT) of the abdomen revealed a 1.9 cm retroperitoneal mass with compression of the right ureter and hydronephrosis. The patient visited our medical center and admitted. The patient underwent a simple total excision of the mass and end-toend ureteral anastomosis. The tumor involved right ovarian vein and right ureter. Histopathological diagnosis was leiomyosarcoma of the ovarian vein. At 12 months after operation, local recurrence of surroundings tissue of the right ureter and gallbladder, and inferior vena cava invasion is found. Thus, the patient underwent a right nephroureterectomy with partly resection of the inferior vena cava and en block excision of the gallbladder. While CT revealed no recurrence three months after the operation, adjuvant postoperative combination chemotherapy with gemcitabine and docetaxel was administered. Nine cases of this leiomyosarcoma arising from ovarian vein have been reported in the literature. Leiomyosarcoma arising from ovarian vein with hydronephrosis is a second example.

DOI： 10.5980/jpnjurol.106.211

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Vesicovaginal fistulas (VVFs) caused after radiation are difficult to repair and require interposition of non-irradiated, well-vascularized tissue between urinary bladder and vagina. A 48-year-old female suffered cervical cancer and underwent radical hysterectomy followed by radiation therapy which caused VVF. The initial surgical repair performed 3 months after development of VVF, was unsuccessful because of the absence of peritoneum or omentum to interpose between urinary bladder and vagina probably due to history of cesarean section and radical hysterectomy. The second surgical repair was performed 15 months after the first surgery utilizing a rectus abdominus myofascial (RAM) interposition flap. Fifteen months after the second operation, she remains free from incontinence. This case suggests that RAM is useful even for postradiation VVF.

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Language：English   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.juro.2014.02.851

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Partial nephrectomy is now the gold standard treatment for small renal tumors. Local recurrence is a major problem after partial nephrectomy, and local recurrence in the remnant kidney after partial nephrectomy is common. CASE PRESENTATION: A 77-year-old man underwent right partial nephrectomy for a T1 right renal cell carcinoma. Microscopic examination revealed a clear cell renal carcinoma, grade 2, stage pT3a. Although the surgical margin was negative, the carcinoma invaded the perirenal fat, and vascular involvement was strongly positive. Thirty months after partial nephrectomy, an enhanced computed tomographic scan showed local recurrence of the renal cell carcinoma extending into the inferior vena cava without renal mass. Hence, we performed right radical nephrectomy and intracaval thrombectomy. Microscopic examination revealed a clear cell carcinoma grade 2, stage pT3a + b. The patient is still alive with no evidence of recurrence 10 months post-procedure. CONCLUSION: To our knowledge, local recurrence of renal cell carcinoma extending into the inferior vena cava after partial nephrectomy has not been reported in the literature. Our case report emphasizes the importance of strict surveillance of patients after partial nephrectomy, especially for those with renal cell carcinoma positive for microvessel involvement.

DOI： 10.1186/1756-0500-7-198

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Language：English   Publisher：BRAZILIAN SOC UROL  

Neither computed tomography (CT) nor intravenous pyelography (IVP) alone can diagnose tumors of renal pelvic diverticula, but magnetic resonance urography (MRU) can obtain accurate preoperative information.

DOI： 10.1590/S1677-5538.IBJU.2014.02.19

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

A 69-year-old man was admitted with the chief complaint of macroscopic hematuria Computerized tomography (CT) and ureteroscopy showed right ureter cancer. Right nephroureterectomy and partial cystectomy were performed. Histological examination revealed urothelial carcinoma of ureter (Grade3. pT3, INFfJ, lyl). The patient underwent two courses of adjuvant chemotherapy with gemcitabine and cisplatin. Three months later, abdominal CT showed a mass in his right obturatorius area The patient's white blood cell count was 34,140 cells/ul. Additionally serum analysis revealed high value of granulocyte colony stimulating factor (G-CSF), 596 pg/ml with no obvious focus. After being diagnosed with recurrent ureteral cancer producing G-CSF, the patient underwent secondary chemotherapy with gemcitabine and docetaxel. After three courses of chemotherapy, CT revealed a marked decrease in tumor size, and the value of G-CSF declined at 31 pg/nl. Subsequently, radiotherapy (60 Gy) was administered. The patient has been alive for 16 months. © 2014 The Japanese Urological Association.

DOI： 10.5980/jpnjurol.105.43

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: Neoadjuvant chemotherapy has been shown to have benefit in T1 high-grade or T2 bladder cancer. However, neoadjuvant chemotherapy fails in some patients. Careful patient selection for neoadjuvant chemotherapy is therefore needed. Several reports show that Snail is associated with resistance to chemotherapy. We hypothesized that Snail expression could predict survival in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.
Methods: The participants were 44 patients with T1 high-grade and T2 bladder cancer receiving neoadjuvant chemotherapy. Immunohistochemical analysis was used to determine Snail expression in specimens of bladder cancer obtained by transurethral resection before neoadjuvant chemotherapy. The relationships between Snail expression and patients' outcomes were analyzed.
Results: Snail expression was positive in 15 of the 44 patients (34.1%) and negative in 29 (65.9%). Disease-free survival was significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.014). In addition, disease-specific survival was also significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.039). In multivariate analysis, Snail expression level was identified as an independent prognostic factor for disease-specific survival (p = 0.020).
Conclusions: The results indicate that Snail expression may predict poor outcome in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.

DOI： 10.1186/1471-2490-13-73

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Objective: With an aging society, elderly patients increasingly require long-term placement of urethral balloon catheters. In this study, we investigated if Memokath (TM) urethral stents, when inserted from the bladder neck to distal to the urethral sphincter in elderly men being treated with urethral balloon catheters, induce incontinence, which would then be managed with adult briefs.
Patients and Methods: Of all outpatients who were being managed with urethral balloon catheters at our institution from September 2011 through March 2012,4 patients who had had problems with the catheters were included in the study. Exclusion criteria were a performance status of 1 or 2 and the ability to urinate after standard placement of the stent. After application of local anesthesia to the urethra, the Memokath (TM) stent was placed distal to the urethral sphincter under radiographic guidance in all patients.
Results: After stent placement, all patients had total incontinence and were catheter-free. Although 2 patients were receiving anticoagulant therapy before the procedure, no intraprocedural or postprocedural anticoagulant-related complications were noted.
Conclusions: Memokath (TM) stent-induced incontinence is a safe and effective treatment for patients requiring long-term placement of urethral balloon catheters who are expected to have continuing urination difficulties.

DOI： 10.1272/jnms.80.433

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PURPOSE: We evaluated usefulness of transcatheter arterial embolization (TAE) for deep renal injury, and investigated whether there is any difference in outcomes for transcatheter arterial embolization (TAE) performed for deep renal injury in a large-sized hospital (university hospital) in comparison with a middle-sized hospital (local hospital). METHODS: We retrospectively reviewed the outcomes of 42 patients with renal injury who were transported to the critical care center of Nippon Medical School (NMS) Hospital in Tokyo from April 2001 to April 2011 and 33 patients of renal injury transported to the critical care center of Ohtawara Red Cross (ORC) Hospital in Tochigi prefecture from April 2001 to April 2009. Therefore, a total of 75 patients, which is the sum of the patients presenting to both the hospitals for renal injury were reevaluated according to the guidelines developed by the Japanese Association for the Surgery of Trauma (JAST) and published in 2008. RESULTS: Forty-two patients in NMS hospital included 6 women and 36 men who were 16 to 88 years old (mean 41.6), and they were divided into Type I (16), Type II (11), and Type III (15) and were treated with bedrest (30), TAE (7), or laparotomy (5). Five patients died, but no one succumbed solely due to the renal injury. On the other hand, 33 Patients in ORC Hospital included 8 women and 25 men who were 16 to 87 years old (mean 46.6). They were divided into Type I (9). Type II (12), and Type III (12) and were treated with bedrest (24) or TAE (9). Eight patients died, but no one succumbed solely due to the renal injury. Sixteen patients were treated successfully with TAE in the 2 hospitals, and 15 of these 16 patients were divided into type III renal injury. Therefore, we believe that nephrectomy should be avoided in such patients because of the benefits offered by TAE. CONCLUSION: TAE was found to be useful for the treatment of type III renal injury in both institutions, irrespective of the size of a hospital.

DOI： 10.5980/jpnjurol.104.688

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

In this study, hemoglobin vesicle (HbV), a type of artificial oxygen carrier, was infused in a hemorrhagic shock model, and the findings were compared with those of red blood cell (RBC) transfusion to evaluate the effects on blood pressure and renal function. In rats maintained in hemorrhagic shock for 30 min under general anesthesia, either irradiated stored RBCs from the same strain or HbVs were used for resuscitation. Blood pressure, serum creatinine concentration, and creatinine clearance 24 h after shock were measured. At 2 and 24 h after shock, the kidneys were removed, and the heme oxygenase-1 (HO-1) mRNA level was measured. A histopathology study was performed 24 h after shock. In both the RBC and HbV group, blood pressure recovered significantly immediately after fluid resuscitation, and blood pressure 24 h after shock did not differ significantly between the two groups. Serum creatinine concentration and creatinine clearance 24 h after shock did not differ significantly between the two groups. After 24 h, there was no significant difference in HO-1 mRNA between the groups. In the renal histopathology samples taken at 24 h after shock, there were no obvious differences between the two groups. In conclusion, HbV transfusion improved blood pressure in a manner equivalent to RBC transfusion when administered during hemorrhagic shock, and no renal dysfunction was apparent after 24 h.

DOI： 10.1007/s10047-013-0712-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT INST ANTICANCER RESEARCH  

Aim: Zoledronic acid (ZA) reduces the risk of skeletal-related events (SREs) in castration-resistant prostate cancer (CRPC) with bone metastasis and improves quality of life. It remains unclear when clinicians should initiate ZA treatment. Patients and Methods: Hormone-naive patients were randomized to a combined androgen blockade (CAB) group or CAB with ZA group (CAB-ZA) based on Gleason score (GS) or extent of disease. The primary end-point of the study was progression-free survival (PFS) and the secondary end-point was incidence of SREs and bone pain. Results: Thirty-one and 29 patients among 60 enrolled patients were assigned to the CAB group and the CAB-ZA group, respectively. There was no significant difference in PFS between the two groups. Subgroup analyses revealed better PFS in the CAB-ZA group with GS &gt;= 8 (p=0.021). Moreover, incidence of SREs, including bone pain, was lower in the CAB-ZA group (p=0.019). Conclusion: CAB-ZA treatment was found to improve PFS for patients with prostate cancer with high GS. CAB-ZA treatment could be recommended for treatment of patients with prostate cancer.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

A 76-year-old female with advanced renal cell carcinoma had been treated with everolimus for 3 months. She visited our hospital because of a cough and fever lasting a few days. Chest X-rays showed bilateral infiltrative shadows, and a chest computed tomography scan showed homogeneous ground-glass opacities with mosaic patterns, especially in the apical region. The laboratory results revealed a decreased white blood cell count with lymphocytopenia and high levels of lactate dehydrogenase, C-reactive protein and KL-6. Pneumonitis was suspected and, therefore, everolimus therapy was interrupted. At that time, the pneumonitis was thought to be drug-induced interstitial lung disease. However, it was not possible to rule out pneumocystis pneumonia, because the patient was immunocompromised and the computed tomography findings suggested the possibility of pneumocystis pneumonia. The pneumonitis progressed rapidly and the patient developed respiratory failure, so we performed bronchoalveolar lavage to make a definitive diagnosis, and simultaneously started treatment with prednisolone and trimethoprimsulfamethoxazole to cover both interstitial lung disease and pneumocystis pneumonia. A polymerase chain reaction assay of the bronchoalveolar lavage fluid was positive for Pneumocystis carinii DNA, and the serum level of -d-glucan was significantly elevated. Thus, the patient was diagnosed with pneumocystis pneumonia, which was cured by the treatment. Interstitial lung disease is a major adverse drug reaction associated with everolimus, and interstitial lung disease is the first condition suspected when a patient presents with pneumonitis during everolimus therapy. Pneumocystis pneumonia associated with everolimus therapy is rare, but our experience suggests that pneumocystis pneumonia should be considered as a differential diagnosis when pneumonitis is encountered in patients receiving everolimus therapy.

DOI： 10.1093/jjco/hyt019

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Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder in patients with prostate cancer. However, renal involvement in DIC associated with prostate cancer has rarely been documented. Herein, we present a case of metastatic prostate cancer presenting with acute renal failure (RF) triggered by DIC. An 80 year old man with metastatic prostate cancer was treated with antihormone therapy at an outpatient clinic. He was admitted to our hospital because of severe dyspnea and progressive RF. A hemorrhagic tendency was not clinically evident. Laboratory tests exhibited a significant coagulation disorder, suggestive of DIC. Despite treatment, his RF and dyspnea worsened, and he eventually passed away. An autopsy study revealed hypertensive nephrosclerosis superimposed by fibrin rich thrombi formation involving glomerular capillaries and arterioles characteristic of DIC. Additionally, focal segmental glomerulosclerosis was identified, which was presumably secondary to the glomerular endothelial and/or podocyte injury augmented by DIC. Those findings showed that glomerular injury, which was induced and subsequently exacerbated by DIC associated with prostate cancer, highly contributed to the progression of RF in our case. A differential diagnosis of DIC should be considered when a patient with prostate cancer presents with renal dysfunction. © 2013 Ohashi et al, publisher and licensee Dove Medical Press Ltd.

DOI： 10.2147/IJNRD.S41813

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

We reported the experience with a case of plasmacytoid variant of urothelial carcinoma of urinary bladder. A 75year-old woman complained of gross hematuria. She was hospitalized to be diagnosed as the bladder tumor on abdominal CT. TUR-BT was performed and pathological finding was invasive urothelial carcinoma. But she refused radical cystectomy. 2 months later, she was hospitalized again with worsening hematuria. Simple cystectomy was performed. Histological examination revealed a plasmacytoid appearance of the infiltrating tumor cells. Immunohistochemical stains for lymphoid markers were negative. Those findings lead to the diagnosis of plasmacytoid variant of urothelial carcinoma. She died due to local recurrence for 1.5 months after simple cystectomy. © 2013 Japanese Urological Association.

DOI： 10.5980/jpnjurol.104.26

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

We experienced a case of interstitial lung disease (ILD) that occurred one year after the start of everolimus therapy for renal cell carcinoma. The pathological features included interstitial pneumonia with granuloma formation. Everolimus is known to cause ILD; however, its pathology is unclear. Granuloma-forming interstitial pneumonia associated with everolimus is uncommon, although it may be one of the pathological patterns associated with everolimus-induced ILD. This is a slow-onset case of everolimus-induced ILD in a patient with renal cell carcinoma. Physicians should thus be aware of the potential for the development of ILD at any time during the administration of everolimus therapy.

DOI： 10.2169/internalmedicine.52.8588

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Radical prostatectomy (RP) for localized prostate cancer after transurethral resection of the prostate (TUR-P) is technically difficult because of periprostatic adhesion and changes in the form of the prostate. The advantages of laparoscopic RP (LRP) over retropubic RP (RRP) include a less invasive operation through a small wound, a clearer field of vision, and reduced blood loss, and, therefore, LRP may represent the optimal method for RP after TUR-P. The present study compared clinical, oncological, and pathological outcomes between LRP and RRP after TUR-P at our institution.
Methods: Twenty patients underwent TUR-P for benign prostatic hyperplasia, followed by LRP (12 patients) or RRP (8 patients) after localized prostate cancer was diagnosed at our institution from November 1998 through December 2006. Median patient age was 67.5 years (range, 52-73 years). The median duration of follow-up was 96 months (range, 60-144 months). Operative time, volume of blood loss, duration of indwelling urethral catheter use, degree of urinary incontinence, pathological findings, oncological outcomes, and complications were compared between LRP and RRP.
Results: No significant difference in operative time or amount blood loss was recognized between LRP and RRP. Urinary incontinence in the early and late postoperative periods was significantly more severe after LRP than after RRP. Oncological outcomes and results of pathological examinations were comparable between LRP and RRP.
Conclusion: We found no significant differences in clinical, pathological, and oncological outcomes, except for urinary incontinence, between LRP and RRP. (J Nippon Med Sch 2012; 79: 416-421)

DOI： 10.1272/jnms.79.416

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Herein we describe our experience with a bone-anchored sling using a suture anchor and polypropylene mesh for the treatment of post-radical prostatectomy urinary incontinence. Eight patients with urinary incontinence as a result of intrinsic sphincter deficiency after radical prostatectomy were included in the analysis. The procedure involved piercing the pubic bone with a bone drill, inserting the suture anchor and fixing a soft or rigid polypropylene mesh to press firmly on the bulbar urethra. Urinary incontinence was significantly improved according to changes in the daily number of pads used at 1, 3 and 6 months postoperatively in comparison with preoperatively. However, no meaningful improvement at 6 months postoperatively was seen with the soft mesh. Complications included perineal pain in four cases, but pain control was achieved using non-steroidal anti-inflammatory drugs. The bone-anchored sling with a suture anchor and polypropylene mesh appears to be safe and effective for the treatment of post-radical prostatectomy urinary incontinence. Soft mesh appears inappropriate as material for the bone-anchored sling because of the progressive likelihood of worsened urinary incontinence.

DOI： 10.1111/j.1442-2042.2012.03073.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Background In 2003, the Japanese Urological Association (JUA) and Japanese Society of Endourology (JSE) established a urological laparoscopic skill qualification system, called the Endoscopic Surgical Skill Qualification System in Urological Laparoscopy of JUA and JSE (ESSQSJJ). The main goal of the system is to decrease the prevalence of complications associated with laparoscopic surgery. To validate the qualification system, perioperative outcome and the prevalence of complications in different types of urological laparoscopic surgery performed by accredited surgeons were evaluated.
Methods One hundred thirty-six surgeons who obtained the qualification in 2004 were prospectively asked to submit intraoperative and postoperative data of their latest 20 cases at the end of 2009, along with the number of laparoscopic urological surgeries performed in each year for a 5-year period (2004-2009). Intraoperative and postoperative complications were graded according to the Satava classification and modified Clavien classification, respectively.
Results Data of 2,590 urological laparoscopic surgeries of 130 surgeons, including 904 laparoscopic radical nephrectomies, 430 laparoscopic nephroureterectomies, 390 laparoscopic adrenalectomies, 320 laparoscopic radical prostatectomies, and 170 laparoscopic partial nephrectomies, were analyzed. Complications were noted in 97 (3.7%) patients. Major intraoperative complications (grade II or III) occurred in 32 (1.2%) patients, and major postoperative complications (grade III or higher) occurred in 24 (0.9%) patients. The prevalence of conversion to open surgery, allogeneic transfusion, and perioperative mortality was 2.5%, 1.6%, and 0%, respectively. The number of surgeries performed by each qualified surgeon or the role of the surgeon (main operator vs. mentor/instructor) in the surgery did not affect the prevalence of intraoperative complications or postoperative complications. The open conversion rate was significantly higher in surgeons with a low surgical volume.
Conclusions ESSQSJJ can ensure urological laparoscopic surgeons who can perform various types of urological laparoscopic surgeries with a low prevalence of perioperative complications and reasonable outcomes.

DOI： 10.1007/s00464-011-2088-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

OBJECTIVE To investigate whether metabolic syndrome is a risk factor for overactive bladder (OAB) defined by the Overactive Bladder Symptom Score (OABSS).
METHODS A digital rectal examination of the prostate and an OABSS questionnaire were conducted in 1031 men who visited our hospital for metabolic screening from April 2009 to March 2010. The OABSS includes scores for daytime frequency, nighttime frequency, urgency, and urgency incontinence. Relationships of OAB (defined as OABSS &gt;= 3 with an urgency score &gt;= 2) with metabolic syndrome diagnosed by Japan Society for the Study of Obesity (JASSO), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), and International Diabetes Federation (IDF) criteria were examined. The severity of OAB symptoms was compared among younger, middle-aged, and elderly men (&lt;50, 50-64, and &gt;= 65 years old, respectively) with and without metabolic syndrome.
RESULTS Diagnoses of metabolic syndrome were made in 16.4%, 16.9%, and 12.0% of the men using JASSO, NCEP-ATP III, and IDF criteria, respectively. Regardless of the presence of metabolic syndrome, aging was significantly associated with increased rates of moderate or severe OABSS findings and OAB defined by the OABSS. In middle-aged men, metabolic syndrome had a significant negative association with OAB rate. In elderly men, metabolic syndrome had a significant negative association with the total OABSS.
CONCLUSION A relationship between age and OAB was observed, but metabolic syndrome did not show a clear association with OAB. Our results suggest that OAB is associated with aging regardless of the presence of metabolic syndrome. UROLOGY 79: 1372-1378, 2012. (C) 2012 Elsevier Inc.

DOI： 10.1016/j.urology.2012.03.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

This report describes creation of a bone-anchored sling with the InVance (TM) system (American Medical Systems. Minnetonka, MN, USA) for the treatment of 2 patients with incontinence after radical prostatectomy. The InVance (TM) system uses a silicon-coated polyester sling positioned under the bulbar urethra via a perineal incision. The sling is attached to both ischiopubic rami by 3 titanium screws. Operative times were 157 minutes (patient 1) and 240 minutes (patient 2). Blood loss was 70 ml, (patient 1) and 10 mL (patient 2). The patients used 7 and 5 absorbent pads/day, respectively, before surgery and 1 and 0 pads/day after surgery (this datum does not appear in the main text, although the absence of incontinence is mentioned). The only major adverse event encountered was mesh infection necessitating mesh removal in patient 2. This operation appears comparatively simple and useful. (J Nippon Med Sch 2012: 79: 143-146)

DOI： 10.1272/jnms.79.143

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Recurrence of urothelial cancer in an ileal conduit after radical cystectomy is rare. A 79-year-old man suffered bladder cancer (UC cTisNOMO G2 &gt
3) and underwent total cystectomy with ileal conduit. He had recurrence of the right renal pelvis carcinoma 6 years after the total cystectomy, and was treated by right radical nephroureterectomy (pT3 G2 = 3). The patient had another episode of recurrence in the ileal conduit 13 years after the initial operation. The entire ileal conduit (UC, G3, ew (-)) was resected and left cutaneous ureterostomy was performed. This case suggests that long-term follow-up is necessary after radical cystectomy and ileal conduit for urinary diversion.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The objective of this study was to evaluate the capability of C-11-methionine (MET)-PET/CT and F-18-2-deoxy-2-fluoro-d-glucose (FDG)-PET/CT to diagnose primary prostate cancer using recently developed Gemini TF PET/CT (Philips Healthcare, Cleveland, OH).
Twenty men who had been referred for a diagnostic work-up for prostate cancer were enrolled in this study. MET- and FDG-PET/CT by high-resolution mode were carried out on the same day prior to prostate biopsy and each maximum standardized uptake value (SUVmax) was compared with the pathological findings. The regions of interest (about 100 mm(2) small round) were placed at standard 6 points of the peripheral zone and 4 points in the apex of the transitional zone in cases that had undergone biopsy of the internal gland. We summed two scores if a specimen had inhomogeneous Gleason scores (e.g. GS 7; 4 + 3) and doubled the score when the Gleason score was the same (e.g. GS 8; 4 x 2). We divided the tumors into three groups. If the summed Gleason score of the specimens was 5 or less, they were grouped as NG (no grade with the Gleason score). If the summed Gleason score was 6 or 7, the tumors were defined as LG (low Gleason score group), and if the summed Gleason score was 8, 9 or 10, the tumors were classified as HG (high Gleason score group). The mean SUVmax was calculated and one-way analysis of variance or Kruskal-Wallis test and the Tukey post hoc test were performed for statistical comparisons. The capabilities of MET and FDG for diagnosing prostate cancer were evaluated through analysis of the area under the curve of the receiver operating characteristic (ROC) curve. The cut-off levels of SUVmax for the highest accuracy were determined by the results of the ROC analysis, and the sensitivity, specificity and accuracy were calculated.
The PET images, obtained with Gemini TF PET/CT, allowed visual identification of anatomical locations within the prostate gland. Among the mean SUVmax of MET, FDG early phase and FDG delayed phase, the differences between NG and HG were all statistically significant (P &lt; 0.01). With MET the difference between NG and LG was also significant (P &lt; 0.05). And for the elevation rate from FDG early to delayed phase, the difference between NG and HG was significant (P &lt; 0.05). The cut-off SUVmax, sensitivity, specificity, accuracy for distinguishing between NG and LG + HG by MET, FDG early and delayed phase were 3.15/78.7/75.6/78.3, 2.81/61.7/80.0/70.7 and 3.00/62.8/78.9/70.7, respectively. And the same factors between NG + LG and HG were 3.76/70.1/89.7/82.6, 2.88/70.1/82.9/78.3 and 3.47/62.7/86.3/77.7, respectively.
In terms of the capability to diagnose prostate cancer of high Gleason score (a parts per thousand yen8), there was no significant difference between MET and FDG. MET appears to be useful for detecting prostate cancer of both low and high Gleason score.

DOI： 10.1007/s12149-011-0551-6

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DOI： 10.1007/s12149-012-0580-9

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

OBJECTIVES To investigate whether the metabolic syndrome is a risk factor for lower urinary tract symptoms (LUTS), as defined by the International Prostate Symptom Score (IPSS).
METHODS A total of 900 men underwent digital rectal examination of the prostate and completed an IPSS questionnaire. These men had visited our hospital for metabolic screening from April 2008 to March 2009. The IPSS includes scores for 3 questions on voiding symptoms, 3 on storage symptoms, and 1 on postmicturition symptoms. The relationships of the LUTS (determined from the IPSS subscores) with the metabolic syndrome diagnosed using the Japan Society for the Study of Obesity, 2005 National Cholesterol Education Program-Adult Treatment Panel III, and 2005 International Diabetes Federation criteria were examined. The severity of LUTS was compared among the younger, middle-age, and older men (&lt;50, 50-64, and &gt;= 65 years old, respectively) with and without the metabolic syndrome.
RESULTS A diagnosis of the metabolic syndrome was made in 16.7%, 16.6%, and 11.7% of the men using the Japan Society for the Study of Obesity, 2005 National Cholesterol Education Program-Adult Treatment Panel III, and 2005 International Diabetes Federation criteria, respectively. Regardless of the presence of the metabolic syndrome, aging was significantly associated with an increased rate of moderate or severe LUTS, except for postmicturition symptoms. In the middle-age men, the metabolic syndrome had a significant negative correlation with storage symptoms (odds ratio 0.258-0.426). In the younger and older men, LUTS was observed equally in those with and without the metabolic syndrome.
CONCLUSIONS A relationship between age and LUTS was observed; however, the metabolic syndrome did not show a clear association with LUTS. Our results suggest that LUTS is associated with aging, regardless of the presence of the metabolic syndrome. UROLOGY 77: 1432-1438, 2011. (C) 2011 Elsevier Inc.

DOI： 10.1016/j.urology.2010.12.024

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UNLABELLED: Objective. The aim of the present study was to evaluate initial learning curves of laparoscopic radical prostatectomy (LRP) with regard to complications, urinary continence, and oncologic outcome. Materials and Methods. We retrospectively reviewed 100 consecutive patients with clinically localized prostate cancer. All 100 patients underwent LRP performed by the same urologist at one institution. RESULTS: Mean operating time (208.4 ± 48.6 min), estimated blood loss (495.8 ± 436.5 mL), allogeneic blood transfusion rate (0%), and intraoperative complications diminished with surgical experience. Positive margin rate varied greatly among pathological stage (positive margin rates: pT2 = 20.5%; pT3 = 63.0%). A trend towards reduction of positive surgical margins in pT2 cases was apparent with increasing experience. Intraoperative and early complications occurred in 2.0% of patients. In all patients, 85.9% used none or no more than one pad per 24 h at 6 months postoperatively. Prostate-specific antigen recurrence was seen in only 2 patients. Conclusions. In the present series of 100 patients, our retrospective evaluation confirms that LRP provides satisfactory results.

DOI： 10.1155/2011/606505

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

We encountered a case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled rectus abdominis muscle flap (pedicled RA m-c flap). A 75-year-old man was admitted with consciousness disorder and swelling of the scrotum. The patient had noticed swelling of the scrotum 4 days before admission, but he had ignored this condition. The scrotum and the penis appeared necrotic. On the basis of clinical and radiological findings, we diagnosed this condition as Fournier's gangrene. Surgical debridement was performed in conjunction with the use of broad-spectrum antibiotics. After the patient's general condition was improved, the broad defect in the perineal tissue was covered with a pedicled rectus abdominis muscle flap. The flap was successful. In Japan, this is the first case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled RA m-c flap. In order to determine whether plastic surgery after debridement shortens the duration of hospitalization, we reviewed the cases of 120 patients with Fournier's gangrene in Japan. We conclude that plastic surgery after debridement does not shorten the duration of hospitalization, however, this procedures is very useful to deep and broad defects by Fournier's gangrene. © 2011 Japanese Urological Association.

DOI： 10.5980/jpnjurol.102.649

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Urological Association  

Hemorrhagic cystitis resulting from radiation to pelvic visceral malignant lesions often might be incurable and there have been no established definitive treatment. We experienced a case with severe radiation-induced hemorrhagic cystitis refractory to conventional therapy. The treatment with oral administration of prednisolone was performed and obtained a successful result. Gross hematuria disappeared in 2 weeks in this case. This experience suggested that oral administration of prednisolone could be considered the treatment for patients with radiation-induced hemorrhagic cystitis when usual treatments including transurethral electro-coagulation are unsuccessful. © 2011 Japanese Urological Association.

DOI： 10.5980/jpnjurol.102.600

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Objective. An antispasmodic agent and a medicine that facilitates stone expulsion are given commonly as conservative therapy for ureteral stones in Japan. The goal of this study was to compare the efficacy of the addition of various alpha(1)-blockers to the conservative therapy for spontaneous passage of ureteral stones. Material and methods. The subjects were 132 patients with stones from the upper to the lower ureter who were randomly placed into one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received daily doses of 240 mg flopropione as an antispasmodic agent and 1350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino as a medicine that facilitates stone expulsion. The other three groups received this therapy and daily doses of 30 mg urapidil, 0.2 mg tamsulosin or 50 mg naftopidil, respectively. The characteristics of the stones and stone expulsion were evaluated by urinalysis, a kidney, ureter and bladder (KUB) X-ray, ultrasound and computed tomography. Results. All patients completed the study and there were no major side-effects. There was no difference in age, stone position or stone size among the groups. Multivariate analysis using a Cox proportional hazards model indicated that the probability of stone expulsion for 1 month was increased 2.38 times (95% confidence interval 1.23-4.61) by naftopidil compared with control therapy alone (p = 0.01). Conclusion. Naftopidil in combination with an antispasmodic agent and a medicine that facilitates stone expulsion produces a significantly increased rate of ureteral stone expulsion.

DOI： 10.3109/00365599.2010.497769

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

Our aim was to evaluate the clinical significance of the negative-balance isolated pelvic perfusion (NIPP) method using ultrahigh-dose cisplatin (CDDP) for ten cases of invasive bladder cancer with poor risk such as high-grade cancer, advanced clinical stage, or appearance of hydronephrosis.
A CDDP dosage of 200-300 mg/body was used under the NIPP method. To confirm safety and efficacy, peripheral blood, pelvic arterial blood, pelvic venous blood, and urine were collected for sampling of the platinum (Pt) concentrations. These samples were investigated and compared with those following previous intraarterial chemotherapy sessions.
The Pt concentrations in pelvic blood under intraarterial chemotherapy and NIPP were 5.97 +/- A 2.06 and 24.15 +/- A 4.61 mu g/ml, respectively. By contrast, the Pt concentration in peripheral blood under NIPP was half the level under conventional intraarterial chemotherapy. No severe adverse events were found in terms of gastrointestinal and hematological toxicity, but renal function was impaired in some cases. Pathological or surgical complete response (CR) was achieved in five of ten cases (50%) in spite of the group being poor risk, and bladder preservation was possible in all the CR cases. Patients with CR experienced survival in all terms of observation.
The NIPP method was able to deliver high levels of CDDP concentration in pelvis cavity without severe adverse events. The NIPP method makes it possible to achieve CR for the patients with invasive bladder cancer with poor risk who rejected cystectomy.

DOI： 10.1007/s10147-010-0079-0

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 31-year-old man presented with edema in left lower leg and dyspnea. Computed tomographic scanning detected a right testicular tumor, multiple lung nodules, and inferior vena cava (IVG) thrombus. After insertion of an IVG filter, high inguinal orchiectomy was performed after the first combination chemotherapy. Padiological examination demonstrated an embryonal carcinoma with vascular invasion and direct tumoral extension into the right spermatic cord. According to our survey, this is the 14th case of testicular tumor with IVG thrombus in Japan.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

A primitive neuroectodermal tumor (PNET) is a small round cell tumor that arises from the nerve crest. This tumor usually occurs in the central nervous system or soft tissue, but it can occur in the kidney in rare cases. Herein we report a case with severe multiple liver metastases after surgery for right renal PNET. The patient was a 21-year-old man with a chief complaint of right abdominal pain. Hemorrhage in a right renal malignant tumor was diagnosed, and radical nephrectomy was performed. Histopathology showed bare nuclear round atypical cells with a scarce cytoplasm proliferating like a seat and nest. Some of the cells formed a rosette structure and the tumor cells were positive for CD99, leading to diagnosis of PNET. Severe multiple liver metastases occurred 6 months after surgery, and six courses of chemotherapy with ifosfamide, etoposide and doxorubicin were performed. After this treatment, residual tumor was removed, but the tumor cells were absent histologically.

DOI： 10.1007/s10147-010-0031-3

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DOI： 10.1016/j.juro.2010.02.1324

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DOI： 10.1016/j.juro.2010.02.358

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：EUROPEAN RESPIRATORY SOC JOURNALS LTD  

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease without proven effective therapy.
A multicentre, double-blind, placebo-controlled, randomised phase III clinical trial was conducted in Japanese patients with well-defined IPF to determine the efficacy and safety of pirfenidone, a novel antifibrotic oral agent, over 52 weeks. Of 275 patients randomised (high-dose, 1,800 mg.day(-1); low-dose, 1,200 mg.day(-1); or placebo groups in the ratio 2: 1: 2), 267 patients were evaluated for the efficacy of pirfenidone. Prior to unblinding, the primary end-point was revised; the change in vital capacity (VC) was assessed at week 52. Secondary end-points included the progression-free survival (PFS) time.
Significant differences were observed in VC decline (primary end-point) between the placebo group (-0.16 L) and the high-dose group (-0.09 L) (p=0.0416); differences between the two groups (p=0.0280) were also observed in the PFS (the secondary end-point). Although photosensitivity, a well-established side-effect of pirfenidone, was the major adverse event in this study, it was mild in severity in most of the patients.
Pirfenidone was relatively well tolerated in patients with IPF. Treatment with pirfenidone may decrease the rate of decline in VC and may increase the PFS time over 52 weeks. Additional studies are needed to confirm these findings.

DOI： 10.1183/09031936.00005209

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 50-year-old man visited our hospital with a complaint of painful masses in bilateral scrotums for 2 months. Ultra sonography shows isoechoic mass in both scrotum. Antibiotic was treated for 2 weeks but had no effects on scrotal swelling and testicular neoplasm cannot ruled out, so we performed bilateral high orchiectomy. Pathological examination shows necrotizing vasculaitis surrounded by glanulomas and pathologically diagnosed as Polyarteritis Nodosa in bilateral epididymis. After orchiectomy, blood examination of immunity was revealed no specific findings, that made us diagnosed as isolated PN. 2 years after operation, he had no reccurence.

DOI： 10.5980/jpnjurol.101.570

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Objectives:
To investigate the androgen response of hormone-dependent prostate cancer cells under hypoxia and to examine the effect of geldanamycin (GA), a heat shock protein 90 (Hsp90)-specific inhibitor, on the androgen response.
Methods:
LNCaP cells were cultured with or without GA under normoxic or hypoxic conditions. Cell viability was examined in response to dihydrotestosterone (DHT). Luciferase reporter gene assay was used to measure androgen response element (ARE)- and hypoxia response element (HRE)-mediated transcriptional activities. Western blot was used to analyze the protein levels of androgen receptor (AR), hypoxia-inducible factor-1 alpha (HIF-1 alpha) and Hsp90.
Results:
The DHT-dependent growth and ARE-mediated transcriptional activities of LNCaP cells were depressed under hypoxic conditions. However, these effects were recovered after incubation with GA. In contrast, hypoxia-induced HRE-mediated transcriptional activity, which was dose-dependently increased by DHT, was suppressed by GA. The expression of AR, HIF-1 alpha and Hsp90 proteins were decreased under hypoxic conditions by adding GA.
Conclusions:
Geldanamycin increases the androgen response regardless of AR protein in hormone-dependent prostate cancer cells under hypoxic conditions.

DOI： 10.1111/j.1442-2042.2010.02450.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

We performed transurethral resection of the prostate (TUR-P) for a 66-year-old man with benign prostatic hyperplasia. Pathological examination diagnosed poorly differentiated urothelial carcinoma of the urethra with broad prostatic permeation. Random bladder biopsies showed no malignancy, but a second TUR-P revealed urothelial carcinoma in the prostate and bladder neck. Computed tomography (CT) showed lymph node metastases from para-aortic to right/left external iliac and left obturator nodes, so clinical stage T3N2M0 carcinoma of the prostatic urethra was diagnosed. Given the presence of lymph node metastases, neoadjuvant chemotherapy using cisplatin 70 mg/m(2), ifosfamide 1.2 g/m(2) and docetaxel 70 mg/m(2) (PIT) was considered. After chemotherapy, CT showed complete response (CR) of all lymph nodes. Local control in the bladder was considered to be good, so total prostatectomy and retroperitoneal lymph node dissection was selected instead of total cystoprostatectomy. Pathological findings of surgical specimens showed no residual carcinoma in the prostatic urethra or lymph nodes, although prostatic adenocarcinoma was recognized. No recurrences or metastases have been encountered as of 3 years and 5 months since surgery.

DOI： 10.1007/s10147-009-0006-4

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Language：English   Publishing type：Research paper (scientific journal)  

There are no guidelines regarding whether to perform either a radical transurethral resection of the bladder tumor (TUR-BT) or a total cystectomy after TUR biopsy for huge bladder cancer, and this decision is entrusted to each institution. Of 439 patients in whom TUR-BT was performed from 2005 through 2009, the weight of the total resected volume was &gt
50 g in 6 patients, and among these 6 patients the following variables were compared: operating time, weight of resected volume, transfusion volume, presence or absence of hydronephrosis, preoperative urinary cytology, serum cytokeratin 19 fragment (CYFRA) level, intraoperative bladder compliance, and histopathological findings. The median age, operating time, weight of resected volume, transfusion volume, and length of follow-up were 72 years, 300 minutes, 88 g, 202 mL, 16 months, respectively. The serum CYFRA level in patients with muscle-invasive cancer (11.8 ng/mL) was higher than that in patients with non-muscle-invasive cancer (5.06 ng/mL). All patients with non-muscle-invasive bladder cancer survived without recurrence. Although the mean length of follow-up was only 16 months (5-59 months), the 1 patient who was followed up for 59 months had no recurrence. In cases of muscle-invasive bladder cancer, all patients, except for a relatively recent patient, have died. In cases without muscle invasion, lymph node metastasis, distal metastasis, or preoperative renal dysfunction accompanied by hydronephrosis, with favorable bladder compliance, we believe that radical TUR-BT should be actively performed to preserve the bladder. A second TUR-BT should be performed in cases of non-muscle-invasive cancer without G3 components to treat the huge bladder cancer.

DOI： 10.1272/jnms.77.190

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PHARMACEUTICAL SOC JAPAN  

Hypoxia-inducible factor (HIF) is a heterodimer composed of HIF-alpha and -beta, and to date, three HIF-alpha subunits, HIF-1 alpha, -2 alpha, and -3 alpha, have been identified. Among these HIF-alpha subunits, HIF-1 alpha represses peroxisome proliferator activator gamma 2 gene expression and then inhibits adipogenesis, and HTF-2 alpha is induced during adipose differentiation and functions as a positive regulator of adipogenesis. We here found that like HIF-2 alpha HIF-3 alpha was induced during 3T3-L1 adipose differentiation. Reporter gene analysis revealed that HIF-2a enhanced the promoter activity, of the 5'-flanking region of the mouse HIF-3 alpha gene (nucleotides -2710 to +56), while HIT-1 alpha had no substantial effects on the promoter activity. These results suggested that HIF-2 alpha which was induced during adipogenesis, might regulate the HIF-3 alpha gene expression. Furthermore, the 5'-deletion analysis revealed that the sequence between -251 and -228 in mouse HIF-3 alpha promoter was essential in response to HIF-2 alpha. We further examined the effect of ectopic expression of HIF-3 alpha in 3T3-L1 cells on adipose differentiation and found that ectopic expression of HIF-3 alpha at the early stage of differentiation induced the expression of several kinds of adipocytes-related genes and enhanced adipogenic potential. HIF-3 alpha, which is induced by HIF-2 alpha, might function as an accelerator of adipogenesis.

DOI： 10.1248/bpb.32.1166

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The safety of a new technique, designated "transcatheter arterial embolization (TAE) with aspiration via a balloon-occluded renal drainage vein" (TAE-ABOD), for the management of large renal cell carcinomas (RCCs). The subjects were 25 patients with RCC who underwent a total of 27 sessions of TAE-ABOD. This TAE-ABOD technique incorporates two procedures: balloon occlusion of renal drainage vein and infusion of absolute ethanol into the tumor-feeding arteries during aspiration of blood via a balloon catheter, thereby reducing leakage of absolute ethanol into the systemic circulation. Our primary endpoint was to establish a safe regimen for high-dose ethanol injection therapy, and our secondary endpoint was to assess global survival of the patients. The administered dose of ethanol ranged from 0.2 to 0.5 ml/kg [median: 0.34 (SD: 0.10) ml/kg], increased in a stepwise manner. The systemic ethanol concentration was measurable in 14 patients, and was less than 0.1 mg/ml in 12 and from 0.1 to less than 0.2 mg/ml in two. There were no major complications such as renal failure or renal abscess. TAE-ABOD can safely deliver a high dose of absolute ethanol for the treatment of large RCCs.

DOI： 10.1007/s00330-008-0895-z

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.124_1

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Language：Chinese   Publishing type：Research paper (scientific journal)  

Objective: To study the status of leukocyte in the prostatic fluid obtained from patients with high PSA value. Methods: Prostatic fluid was obtained from 112 patients with high PSA value before the transrectal prostatic biopsy, and the number of leukocytes in the prostatic fluid was calculated. The relationship of leukocyte number and patients' age, PSA and prostate volume was analyzed by means of correlation analysis and t test. Results: High leukocyte density (average 5.29 × 106/mL) and total leukocyte number (average 1.58 × 106) was discoverd in prostatic fluid in all patients. Significant correlation was found among the prostatic fluid volume, total leukocyte number and prostate volume. Prostate volume and total leukocyte number was significantly higher in patients with non-prostate cancer than in patients with prostate cancer. Conclusion: It is possible that there is a relationship between elevated PSA value and high leukocyte number in the prostatic fluid in non-prostate cancer patients.

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In our continuing investigation of the significance of leukocytosis in prostatic fluid (PF), the relation of leukocytosis in PF to that in selected sections of prostate with significant inflammation was studies with whole-mount specimens obtained at radical prostatectomy from 12 patients with prostate cancer. Although leukocytosis was observed both in PF and in prostate tissue in all 12 patients, there was no correlation between the leukocyte count in PF and the intensity of inflammation. However, the ratio of macrophages among leukocytes in PF correlated with the number of ducts filled with macrophages in prostate tissue (p=0.0481). This finding was consistent with our previous finding that activation of macrophages in PF reflects active inflammation in prostate tissue. Further studies are needed to clarify the roles of macrophages and whole leukocytes in PF and prostate tissue.

DOI： 10.1272/jnms.74.210

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER ASSOC CANCER RESEARCH  

The androgen receptor (AR) is implicated in prostate cancer growth, progression, and angiogenesis. Hypoxia-inducible factor-1 (HIF-1), which transcriptionally regulates hypoxia-inducible angiogenic factors, is up-regulated in prostate cancers compared with adjacent normal tissues. HIF-1 may be involved in prostate cancer as well as the AR, but the involvement of HIF-1 in prostate cancer angiogenesis and progression has not been fully elucidated. In the present study, we found that in prostate cancer LNCaP cells dihydrotestosterone enhanced the expression of GLUT-1, one of the HIF-1 target genes, and also that hypoxia enhanced the expression of prostate-specific antigen (PSA) that is one of the AR target genes and is involved in tumor invasion. Small interfering RNA that specifically inhibits HIF-1 reduced the expression levels of PSA as well as GLUT-1. Reporter gene analysis showed that dihydrotestosterone activated the HIF-1-mediated gene expression and hypoxia enhanced the AR-induced promoter activity of human PSA gene. Deletion and site-directed mutation of the 5'-flanking region of human PSA gene revealed that the sequence ACGTG between -3951 and -3947 was essential in the response to hypoxia. Furthermore, chromatin immunoprecipitation assay indicated that HIF-1 interacts with the AR on the human PSA gene promoter. These results indicated that in prostate cancers, HIF-1 might cooperate with the AR to activate the expression of several genes related to tumor angiogenesis, invasion, and progression.

DOI： 10.1158/1541-7786.MCR-06-0226

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Language：English   Publishing type：Research paper (scientific journal)  

Introduction: Characteristics of prostatic fluid (PF), which can be obtained in large amounts during screening transrectal ultrasound just before prostate biopsy to detect prostate cancer, were investigated. These characteristics include the amount of PF obtained and the number of leukocytes in PF, which would be useful for planning cell-biological or immunological studies of leukocytes in PF and for increasing the understanding of prostatitis in elderly men. Patients and Methods: The volume of PF and the number of leukocytes in PF were measured in 50 patients suspected of having prostate cancer because of elevated levels of serum prostate-specific antigen (PSA). Correlations of the volume of PF, the number of leukocytes per milliliter, the total leukocyte number with age and prostate volume and correlation of PSA levels with the number of leukocytes per milliliter and total leukocyte number were also investigated. Results: The average patient age was 67.2 years, and PF specimens were obtained from 43 of the 50 patients (86%). The mean ± SD of PF volume, number of leukocytes in PF, and total leukocyte number were 347.65 ± 305.76 μl, 4.84 ± 6.07 × 10 6 /ml, and 1.47 ± 2.10 × 10 6, respectively. A correlation was observed only between the total leukocyte number and the volume of the transitional zone (P=0.039). Conclusions: These data provide information for investigators to plan cell-biological or immunological studies of leukocytes in PF and for understanding prostatitis in elderly men.

DOI： 10.1272/jnms.73.24

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Language：English   Publishing type：Research paper (scientific journal)  

Objectives: While reassessing the value of exfoliative cytologic examination of prostatic fluid (PF) for the diagnosis of prostate cancer, we found that PF is easily obtained with transrectal ultrasonography during prostate biopsy and that cytologic examination of PF is useful for the diagnosis of prostate cancer. Methods: The cohort included 53 consecutive patients who underwent transrectal prostate biopsy from May through September 2005. Patient age was 66.7 ± 7.24 years, and the mean concentration of prostate-specific antigen (PSA) was 15.1 ± 25.8 ng-ml. The PF for cytologic examination was obtained before biopsy, and Papanicolaou-s staining was performed. The results of cytologic examination are expressed as class 1 to 5. Results of cytologic examination and prostate tissue pathologic examination were analyzed. Patient age, PSA levels, total prostate volume (TPV), and PF volume were compared with cytologic class by means of analysis of variance. Results: The mean PF volume was 378.4 ± 245.3 μl, and the mean TPV was 38.0 ± 18.8 ml. The numbers of patient in classes 1 to 5 were 1 (1.9%), 37 (69.8%), 11 (20.7%), 1 (1.9%), and 3 (5.7%), respectively. Pathologic examination showed 23 (43.4%) cases of cancer, 27 (50.9%) cases of benign prostatic hyperplasia, and 3 (5.7%) cases of high-grade prostatic intraepithelial neoplasia. All three patients with class 5 results had prostate cancer (Gleason score, 7 to 10). All 9 patients with a PSA level greater than 16 ng-ml had biopsy-proven cancer, and 3 of these 9 patients (33.3%) were in cytology class 5. Therefore, PF cytologic examination showed a specificity of 100% and a sensitivity of 33.3% in patients with PSA levels higher than 16 ng-ml. The cytologic classes differed in PSA levels (F=8.271, P=0.000) but not in patient age, TPV, or PF volume. Conclusions: Exfoliative cytologic examination of PF is a valuable, noninvasive method for detecting prostate cancer, especially in patients with high PSA levels.

DOI： 10.1272/jnms.73.129

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING  

Purpose: Vesicourethral anastomosis in laparoscopic prostatectomy is a very difficult procedure. Our purpose in this study was to evaluate a new method using extracorporeal bladder neck traction with nylon thread for vesicourethral anastomosis during laparoscopic radical prostatectomy.
Materials and methods: A total of 10 patients underwent laparoscopic radical prostatectomy by this technique, and we evaluated anastomosis time, operative time, and postoperative status of vesicourethral anastomosis.
Results: It was possible to shorten both anastomosis time and operative time by this procedure, and to obtain a hermetic anastomosis without higher risk of incontinence, stricture, or leakage.
Conclusions: Extracorporeal bladder neck traction with nylon thread is a very useful procedure to carry out easier vesicourethral anastomosis, especially for a surgeon's initial experience in laparoscopic radical prostatectomy.

DOI： 10.1111/j.1442-2042.2005.01215.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Purpose: Isolated pelvic perfusion (IPP) therapy exposes target tissues to high doses of anticancer drugs with low systemic concentrations, but the major drawback is drug leakage into the systemic circulation, which often thwarts the increased drug concentration. In this study, the efficacy of altering the in-out flow rate during IPP in order to decrease the leakage was assessed in adult pigs. Methods: The abdominal aorta and the infrarenal vena cava were occluded with two balloon catheters, blood in the extracorporeal circuit was circulated with twin rotary pumps, and the IPP was performed with platinum. Three sets of in-out flow rates were used, and the degree of drug leakage into the systemic circulation was evaluated. The volume of blood withdrawn was equal to the volume returned (300 ml/min; group A), 5% higher (group B), or 10% higher (group C). The platinum concentrations in the pelvic circulation, systemic circulation, and urine were measured and compared. Results: The average and maximum plasma platinum concentrations in the pelvic circulation did not significantly differ among the three groups. The plasma platinum concentrations in the systemic venous circulation of the three groups significantly (P &lt; 0.01) decreased as the volume withdrawn during IPP increased. The percentage of platinum eliminated in the urine during IPP was significantly (P &lt; 0.01) lower in group B and C than in group A. Conclusions: Setting the volume withdrawn higher than the volume returned decreased leakage into the systemic circulation under isolated pelvic perfusion.

DOI： 10.1007/s00432-004-0666-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: Hypoxia-inducible factor-1 alpha (HIF-1 alpha) is a transcriptional factor that regulates genes involved in the response to hypoxia. We evaluated the effects of HIF-1a over expression on the tumorigenic potency of renal cell carcinoma VMRC cells and bladder cancer EJ cells in vitro and in vivo.
Materials and Methods: We introduced HIF-1 alpha expression vectors into VMRC and EJ cells, and generated the HIF-1 alpha over expressing cell lines VMRC-HIF1 alpha and EJ-HIF1 alpha, and the vector only transfected cell lines VMRC-neo and EJ-neo. We then evaluated in vitro cell proliferation and in vivo tumor growth of these cell lines after subcutaneous injection into athymic nude mice.
Results: In vitro studies showed that HIF-1 alpha over expression in VMRC and EJ cells accelerated cell proliferation during the confluent growth phase and rendered these cells resistant to hypoxic stress. Furthermore, in vivo studies revealed that all 4 types of cancer cells (VMRC-neo, VMRC-HIF1 alpha, EJ-neo and EJ-HIF1 alpha) formed tumors in nude mice and the size of VMRC-HIF1 alpha cell derived xenografts was much larger than that of VMRC-neo cell derived xenografts. Although HIF-1a over expression did not affect the size of EJ cell derived xenografts, histological examination showed that there was only a small area of necrosis in EJ-HIF1 alpha cell derived xenografts, whereas a large area of central necrosis was observed in EJ-neo cell derived xenografts. It was also found that HIF-1a over expression increased intratumor microvessel density in the xenografts.
Conclusions: These results suggest that HIF-1a may have important roles in bladder and renal cancer angiogenesis and proliferation.

DOI： 10.1097/01.ju.0000154343.35444.09

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