担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）   出版者・発行元：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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その他リンク： https://link.springer.com/article/10.1186/s12894-024-01499-4/fulltext.html

担当区分：筆頭著者,　責任著者   記述言語：英語  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Japanese Urological Association's guidelines for the treatment of renal trauma were published in 2016. In conjunction with its revision, herein, we present the new guidelines for overall urotrauma. Its purpose is to provide standard diagnostic and treatment recommendations for urotrauma, including iatrogenic trauma, to preserve organ function and minimize complications and fatality. The guidelines committee comprised urologists with experience in urotrauma care, selected by the Trauma and Emergency Medicine Subcommittee of the Specialty Area Committee of the Japanese Urological Association, and specialists recommended by the Japanese Association for the Surgery of Trauma and the Japanese Society of Interventional Radiology. The guidelines committee established the domains of renal and ureteral, bladder, urethral, and genital trauma, and determined the lead person for each domain. A total of 30 clinical questions (CQs) were established for all domains; 15 for renal and ureteral trauma and five each for the other domains. An extensive literature search was conducted for studies published between January 1, 1983 and July 16, 2020, based on the preset keywords for each CQ. Since only few randomized controlled trials or meta-analyses were found on urotrauma clinical practice, conducting a systematic review and summarizing the evidence proved challenging; hence, the grade of recommendation was determined according to the 2007 "Minds Handbook for Clinical Practice Guidelines" based on a consensus reached by the guidelines committee. We hope that these guidelines will be useful for clinicians in their daily practice, especially those involved in urotrauma care.

DOI： 10.1111/iju.15331

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：University of Tokushima Faculty of Medicine  

DOI： 10.2152/jmi.71.187

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：英語  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Active surveillance (AS) is one of the treatment methods for patients with small renal masses (SRMs; < 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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その他リンク： https://link.springer.com/article/10.1186/s12885-022-09971-w/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.jnms.2022_89-208

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：学位論文（博士）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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

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記述言語：英語  

Introduction: We encountered an extremely rare case of a nephrostomy catheter entering the right renal vein during an exchange procedure. Case presentation: An 80-year-old man underwent radical cystectomy. Urinary diversion was achieved through right percutaneous nephrostomy. After the 15th nephrostomy catheter exchange, the patient bled heavily from the catheter. We clamped the catheter immediately, and the patient became hemodynamically stable. Emergency angiography showed the nephrostomy catheter entering the renal vein from outside the renal pelvis. Under fluoroscopy, we pulled the catheter until its tip was located in the previous penetration site of the renal pelvic wall and inserted the catheter over the guidewire into the renal pelvis. Conclusions: Herein, we report an extremely rare case of a nephrostomy catheter inserted into the right renal vein during an exchange procedure. Inserting a nephrostomy catheter in the appropriate position and performing exchange under imaging guidance techniques could help clinicians avoid severe complications.

DOI： 10.1002/iju5.12276

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hem-o-lok clips are commonly used for renal artery ligation in laparoscopic renal surgery. However, failure of the renal artery ligation clips is potentially fatal. A 61-year-old man underwent hand-assisted laparoscopic nephroureterectomy using a retroperitoneal approach for left ureteral carcinoma. One hour postoperatively, he was diagnosed with hemorrhagic shock. An immediate laparotomy revealed two closed, undamaged Hem-o-lok clips around the left renal artery. Pulsatile bleeding was observed, and the renal artery was immediately ligated with non-absorbable thread. We determined that the failure of the Hem-o-lok clips on the renal artery was caused by the lack of space between the two Hem-o-lok clips and the distal renal artery cuff beyond the distal clip. To prevent a potentially fatal failure of the renal artery ligation clips, one should maintain a sufficient space between the Hem-o-lok clips and an adequate distal renal artery cuff beyond the distal clip. J. Med. Invest. 68 : 393-395, August, 2021.

DOI： 10.2152/jmi.68.393

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/biom9110673

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1272/jnms.JNMS.2018_85-31

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5980/jpnjurol.109.237

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We describe renal mucinous tubular and spindle cell carcinoma (MTSCC) that metastasized to the lymph nodes seven years after radical nephrectomy. An 80-year-old man was admitted for treatment of a right renal tumor. A 6.5×6.0-cm tumor in the right kidney (cT1bN0M0) revealed by abdominal computed tomography was treated by laparoscopic radical nephrectomy. The pathological findings at that time suggested papillary renal cell carcinoma type 1. Imaging findings seven years later revealed enlarged pre-caval and right external iliac lymph nodes indicative of delayed metastasis, and these were treated by laparoscopic lymphadenectomy. The pathological findings and re-evaluation of the primary tumor suggested MTSCC. The patient remains free of metastasis at 24 months of follow-up. MTSCC has been a distinct entity in the World Health Organization classification of kidney tumors since 2004. Tumors consist of tubules and cords separated by pale mucinous material in some areas, whereas others have dense cellularity without significant mucin. They are usually of low malignant potential, and metastasis has rarely been reported. To our knowledge, this is the first report of MTSCC with retroperitoneal lymph node metastasis treated by lymphadenectomy.

DOI： 10.5980/jpnjurol.108.30

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：西日本泌尿器科学会  

深在性腎損傷に対し経カテーテル的動脈塞栓術(TAE)を施行した14例を対象に、受傷後TAE施行までの時間と予後との関係について検討した。また、交通事故やその他の外傷で受診し死亡した58例を対象に、病院到着から輸血開始までの時間を調査した。TAE 14例は、腎血管単独が5例、塞栓部位が腎以外の臓器を含むのが9例で、そのうち死亡例はそれぞれ2例ずつであった。死亡例4例は、いずれも塞栓部位が腎動脈本幹で損傷がより重篤であった。受傷からTAE施行までの平均時間は生存群229分、死亡群261分で有意差は認めなかった。次いで、当院救急外来における外傷死については、58例のうちMAP輸血施行は17例で、病院到着からMAP輸血開始までの平均時間は272分であった。また、腎単独および多臓器損傷の合併を含む腎損傷は8例であった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01004&link_issn=&doc_id=20100826270001&doc_link_id=%2Fer9niuro%2F2010%2F007208%2F001%2F0429-0435%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2010%2F007208%2F001%2F0429-0435%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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65歳男性。嘔吐、右側腹部痛を主訴に当科受診。CT上、4年前に指摘されていた後腹膜腔の径17cmの多房性嚢胞が径21cmに増大していた。最初の診断は充実性成分を認めない境界明瞭な嚢胞性病変であることよりリンパ管嚢腫を疑ったが、その後のCTで周囲臓器と境界不明瞭な所見を認め、悪性の可能性を否定できず、また有症状であることから開腹後腹膜腫瘍切除術を施行した。腫瘍の周囲臓器浸潤も疑われたため周囲臓器を合併切除し、病理組織学的検査診断は慢性炎症を伴うリンパ管嚢腫であり腫瘍は完全切除であった。術後1年のCTで再発を認めていない。後腹膜原発リンパ管嚢腫に対しては手術による腫瘍の完全切除が再発予防に重要であると考えられた。(著者抄録)

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開催年月日： 2018年10月

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開催年月日： 2018年10月

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今回我々は淋菌性後部尿道周囲膿瘍に対し抗菌薬投与、膀胱瘻による尿路変更及び穿刺ドレナージで保存的に治療し得た症例を経験したので報告する。症例は27歳男性。1週間続く会陰部違和感を主訴に近医受診し痔核の診断でヒドロコルチゾン軟膏を処方されたが、症状増悪したため当科紹介受診となった。身体所見では発熱と前立腺の圧痛があり、血液検査では著明な炎症所見、尿検査では膿尿を認めた。単純CTで前立腺の軽度腫大と前立腺尖部背側に低吸収域を認めたため、急性前立腺炎および前立腺膿瘍の診断で精査加療目的に入院となった。入院後の造影MRI T2強調画像にて後部尿道に6cm大の高信号を呈する多房性腫瘤を認め、さらに尿細菌培養検査ではグラム陰性球菌を検出、また淋菌クラミジアPCRにて淋菌陽性を検出した。以上から淋菌性後部尿道周囲膿瘍の診断でCeftriaxone(CTRX)4g/dayを開始した。しかし炎症所見改善せず、第7病日には排尿困難の増悪を認めたため膀胱瘻を造設した。第8病日の造影CTで膿瘍の増大を認めたため経会陰的に膿瘍穿刺し、少量の黄白色の膿を吸引した。以降炎症所見の改善を認めたため第13病日よりFosfomycin(FOM)内服を開始し第15病日に退院した。退院後、腹部単純CTにて膿瘍の消失を確認しPCRで淋菌陰性を確認した。現在感染の再発や自覚症状を認めていない。(著者抄録)

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開催年月日： 2018年4月

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開催年月日： 2017年6月

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63歳男。右鼠径部の無痛性腫瘤を主訴とした。数ヵ月前より自覚した右鼠径部の腫瘤が増大傾向を示し、精索腫瘍の疑いで紹介受診した。腹部骨盤部CTでは右精索に内部不均一な腫瘤(径25mm)が描出され、鼠径ヘルニア、右精索腫瘍の診断で右高位精巣摘除術を行ったところ、病理組織所見では異型紡錘形細胞が硝子化した膠原繊維とリンパ球浸潤を伴って束状に増殖しており、脂肪細胞は多結節状に増殖し、脂肪芽細胞もみられた。また、異型紡錘形細胞は免疫特殊染色でvimentin、αSMA、HHF35、MDM2、CDK4が陽性、CD34、S-100、desminが陰性であった。以上より、筋線維芽細胞への分化を示す線維肉腫様脱分化部分を伴う脱分化型脂肪肉腫と診断され、組織学的悪性度は中等度であった。術後3年経過現在、再発を示唆する所見は認めていないが、長期間にわたる厳重な観察が必要と考えられた。

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開催年月日： 2016年4月

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近年,前立腺全摘術に関する論文は鏡視下およびロボット支援手術がほとんどであるが,術中開腹手術への移行に備えて開腹前立腺全摘術の高等な技術をレジデントのうちに習得しておくことは必要である.今回那須赤十字病院において,経験の少ない(泌尿器科経験平均3年程度)医師3人と1人の指導者のもと,64例の開腹前立腺全摘術を施行したので,治療成績について検討した.平均手術時間は261分,平均出血量は1,270mlで全例自己血800mlを用意し使用し,1例のみ自己血以外に同種血輸血を必要とした.断端陽性率は64例中4例(6.25%)で,平均観察期間32.0ヵ月でPSA再発は2例(3.1%)に認められた.パッドフリー症例は51症例(79.7%)であった.泌尿器科経験3年程度の術者が施行した開腹前立腺全摘術では,術中侵襲がやや大きいが,癌制御と機能温存の点では良好であった.(著者抄録)

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開催年月日： 2016年4月

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開催年月日： 2016年4月

記述言語：日本語  

高齢者,特に85歳以上の超高齢者は合併症や全身状態を考慮すると,薬物療法抵抗性の排尿障害に対する経尿道的前立腺切除術(TURP)は議論がある.よって今回われわれは薬物療法抵抗性の排尿障害を有する超高齢者に対するTURPの有効性と安全性について検討した.対象は8症例で,平均年齢90歳であった.全例腰椎麻酔下でTURPを施行.平均手術時間は61分,平均前立腺切除重量は25g,輸血症例は2症例であった.全例において術中,術後の合併症はなく,術後カテーテル抜去が可能となった.また平均観察期間37.6ヵ月においても全例でカテーテルは留置されていない.以上より麻酔可能である場合の超高齢患者において,投薬にてカテーテルが抜去できない場合は有効性と安全性の面からTURPは検討してよい治療法と思われた.(著者抄録)

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開催年月日： 2015年9月

記述言語：日本語  

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開催年月日： 2015年9月

記述言語：日本語  

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開催年月日： 2014年11月

記述言語：日本語  

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開催年月日： 2014年11月

記述言語：日本語  

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開催年月日： 2014年6月

記述言語：日本語  

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開催年月日： 2014年5月

記述言語：日本語  

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開催年月日： 2014年5月

記述言語：日本語  

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開催年月日： 2014年5月

記述言語：日本語  

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開催年月日： 2013年11月

記述言語：日本語  

(目的)今回我々はTAEが深在性腎損傷に対し有用であるか、またその有用性が病院の規模で差があるか否かを検討した。(対象と方法)2001年4月から2011年4月までの日本医科大学付属病院の腎損傷42例、2001年4月から2009年4月までの大田原赤十字病院の腎損傷33例を対象とした。腎損傷分類はCTと術中所見をもとに2008年の日本外傷学会分類に準じ、主に治療法について検討した。(結果)日本医科大学付属病院42例は平均41.6歳、男性36例、女性6例、分類はI型16例、II型11例、III型15例であった。治療は保存的30例、TAE7例、手術5例で、TAE・手術はIII型に対し行われた。42例中5例死亡したが腎損傷単独の死亡例はなかった。一方大田原赤十字病院33例は平均46.6歳、男性25例、女性8例、分類はI型9例、II型12例、III型12例であった。治療は保存的24例、TAE9例、手術症例はなく、TAEはII型1例とIII型8例に行われた。33例中8例死亡したが、腎損傷単独の死亡例はなかった。両施設でTAEは16例行われ、15例はIII型でありTAEが得られなければ腎摘をした可能性があり、TAEの有用性が確認された。(結論)病院規模によらずIII型に対してTAEが多く行われており手術症例を減らす上でもTAEは有用である。(著者抄録)

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開催年月日： 2013年11月

記述言語：日本語  

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開催年月日： 2013年9月

記述言語：日本語  

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開催年月日： 2013年9月

記述言語：日本語  

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開催年月日： 2013年9月

記述言語：日本語  

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開催年月日： 2013年9月

記述言語：日本語  

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開催年月日： 2013年7月

記述言語：日本語  

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開催年月日： 2013年5月

記述言語：日本語  

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開催年月日： 2013年5月

記述言語：日本語  

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開催年月日： 2013年5月

記述言語：日本語  

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開催年月日： 2013年4月

記述言語：英語  

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開催年月日： 2013年3月

記述言語：日本語  

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開催年月日： 2013年3月

記述言語：日本語  

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開催年月日： 2013年3月

記述言語：日本語  

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開催年月日： 2013年3月

記述言語：日本語  

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開催年月日： 2012年11月

記述言語：日本語  

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開催年月日： 2012年11月

記述言語：日本語  

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開催年月日： 2012年9月

記述言語：英語  

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開催年月日： 2012年6月

記述言語：日本語  

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開催年月日： 2012年3月

記述言語：日本語  

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開催年月日： 2012年3月

記述言語：日本語  

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開催年月日： 2012年3月

記述言語：日本語  

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開催年月日： 2012年2月

記述言語：日本語  

79歳男。1997年膀胱癌に対し膀胱全摘除術、回腸導管造設術を施行した。病理診断はUC、pT1b、G2>3であった。2003年右腎盂に再発を認め、右腎尿管全摘除術を施行した。病理診断はUC、pT3、G2=3であった。2010年尿細胞診でclass Vを認め、CTで回腸導管内再発が指摘された。導管造影で導管内に陰影欠損を認めた。回腸導管摘出術、左尿管皮膚瘻造設術を施行したところ、CTで再発が疑われた部位は回腸導管の盲端で、肉眼的に右遺残尿管は認めなかった。摘出標本より回腸導管内に充実性の腫瘤を認めた。病理組織診断よりUC、G3、ly(+)、v(+)で、一部筋層に浸潤し、上皮内を置換するように伸展していた。術後8ヵ月を経過し、再発は認めなかった。

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開催年月日： 2011年9月

記述言語：日本語  

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開催年月日： 2011年9月

記述言語：日本語  

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開催年月日： 2011年

記述言語：日本語  

今回我々は基礎疾患がなく尿道結石によるフルニエ壊疽による会陰部の膀胱直腸皮膚瘻に腹直筋皮弁を用いて形成術を行った1症例を経験した。患者は75歳男性、数日前に陰嚢の腫脹を認めたが放置し、意識障害が出現したため来院した。陰茎陰嚢は壊死しており、デブリードマン、抗菌薬の投与等で全身状態が改善したが膀胱直腸皮膚瘻を合併したため、腹直筋皮弁による再建を行った。フルニエ壊疽に膀胱直腸皮膚瘻を合併していた例は筆者が調べえた限りでは本邦初の報告である。またフルニエ壊疽の再建で皮弁を用いた例は本邦の報告では少なく、さらに皮弁の中でも腹直筋皮弁を用いた例も筆者が調べえた限りでは本邦初の報告である。また植皮術や皮弁形成術がどの位の割合で行われ、それにより早期退院の可能性を、本邦フルニエ壊疽120例について検討したが、今回の検討では退院が早まる事実はなかったが、欠損部の大きな症例では有用と思われた。(著者抄録)

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開催年月日： 2011年

記述言語：日本語  

骨盤内悪性腫瘍に対する放射線照射に起因する放射線性出血性膀胱炎はしばしば難治性であり、これまでのところ決定的な治療法が確立されていないのが現状である。今回われわれは他の保存的治療が無効であった1例の放射線性出血性膀胱炎にプレドニゾロンの経口投与による止血を試み、良好な成績を得た。プレドニゾロン10mg/日を約7週間投与し投与量を漸減したが、投与から約2週間で肉眼的血尿が消失した。プレドニゾロン投与による副作用は認められなかった。以上の経験からプレドニゾロンの経口投与は高圧酸素治療や経尿道的電気凝固術を含む放射線性出血性膀胱炎の一般的な治療法が無効の場合に試みてよい治療法と思われた。(著者抄録)

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開催年月日： 2010年8月

記述言語：日本語  

深在性腎損傷に対し経カテーテル的動脈塞栓術(TAE)を施行した14例を対象に、受傷後TAE施行までの時間と予後との関係について検討した。また、交通事故やその他の外傷で受診し死亡した58例を対象に、病院到着から輸血開始までの時間を調査した。TAE 14例は、腎血管単独が5例、塞栓部位が腎以外の臓器を含むのが9例で、そのうち死亡例はそれぞれ2例ずつであった。死亡例4例は、いずれも塞栓部位が腎動脈本幹で損傷がより重篤であった。受傷からTAE施行までの平均時間は生存群229分、死亡群261分で有意差は認めなかった。次いで、当院救急外来における外傷死については、58例のうちMAP輸血施行は17例で、病院到着からMAP輸血開始までの平均時間は272分であった。また、腎単独および多臓器損傷の合併を含む腎損傷は8例であった。

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開催年月日： 2010年1月

記述言語：日本語  

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開催年月日： 2010年1月

記述言語：日本語  

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開催年月日： 2009年10月

記述言語：日本語  

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開催年月日： 2007年12月

記述言語：日本語  

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開催年月日： 2007年12月

記述言語：日本語  

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開催年月日： 2007年10月

記述言語：日本語  

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開催年月日： 2007年10月

記述言語：日本語  

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