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

PURPOSE: The optimal neoadjuvant regimen before radical prostatectomy (RP) in patients with high-risk (HR) prostate cancer (PCa) remains to be determined. This retrospective multicenter cohort study assessed the effectiveness and safety of neoadjuvant chemohormonal therapy (NCHT) in patients with HR-PCa undergoing robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: We reviewed the datasets of 1023 subjects who underwent RALP at nine Japanese facilities between September 2012 and October 2023. The enrolled patients were divided into two groups using propensity score matching: a RALP-alone group and those who underwent NCHT followed by RALP (NCHT group). The NCHT regimen consisted of a luteinizing hormone-releasing hormone antagonist and tegafur-uracil for at least 3 months before RALP. The primary endpoint was biochemical recurrence (BCR) after RALP. The secondary endpoint was the surgical specimen pathology findings. RESULTS: Propensity score matching identified 139 individuals for each group. Median follow-up was 18.2 months. During follow-up, BCR was observed in 41 patients (29.5%) in the RALP-alone group and 22 patients (15.8%) in the NCHT group (p = 0.010). Pathological results showed significantly more organ-confined PCa and significantly fewer positive surgical margins or lymphovascular invasion in the NCHT group than in the RALP-alone group. The 2-yr biochemical recurrence-free survival (BRFS) was 72.7% and 74.7% in the RALP-alone and NCHT groups, respectively (p = 0.086). Two patients (1.4%) experienced grade 3 liver disorder as an NCHT-related adverse event. CONCLUSION: The results suggest that NCHT can safely treat HR-PCa and may reduce the incidence of BCR when combined with RALP.

DOI： 10.1007/s11255-024-04268-2

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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)  

A regulatory mechanism for SLC family transporters, critical transporters for sodium and glucose reabsorptions in renal tubule, is incompletely understood. Here, we report an important regulation of SLC family transporter by SETD2, a chromatin remodeling gene whose alterations have been found in a subset of kidney cancers. Kidney-specific inactivation of Setd2 resulted in hypovolemia with excessive urine excretion in mouse and interestingly, RNA-sequencing analysis of Setd2-deficient murine kidney exhibited decreased expressions of SLC family transporters, critical transporters for sodium and glucose reabsorptions in renal tubule. Importantly, inactivation of Setd2 in murine kidney displayed attenuated dapagliflozin-induced diuresis and glucose excretion, further supporting that SETD2 might regulate SLCfamily transporter-mediated sodium and glucose reabsorptions in renal tubule. These data uncover an important regulation of SLC family transporter by SETD2, which may illuminate a crosstalk between metabolism and epigenome in renal tubule.

DOI： 10.1016/j.bbrc.2024.150730

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

OBJECTIVE: Artery and vein (AV) clamps can control venous bleeding in the surgical field and prevent carbon dioxide embolism, especially when large veins are expected to open. However, whether AV clamps cause more renal damage than artery-only (AO) clamps remains unclear. This study aimed to compare renal function and blood loss in surgeries using AO and AV clamps based on high RENAL nephrometry scores (RNS) in robot-assisted partial nephrectomy (RAPN). METHODS: We retrospectively analyzed the medical records of 500 patients who underwent RAPN between March 2016 and December 2021. We performed 1:1 propensity matching for these patients. RESULTS: A total of 340 patients with pathological malignancies who were followed up for at least 12 months were included in this analysis. A total of 291 patients with AO clamping and 49 patients with AV clamping were included. Overall, the AV clamp group had higher total RNSs and larger diameters than the AO clamp group. Propensity score-matched analysis included 37 patients in each clamp group. The median warm ischemia times of the AV and AO clamps were 25 and 22 min, respectively, with no significant difference. There were no statistically significant differences between the groups in the amount of blood loss, rate of acute kidney injury (AKI), or renal function at 1, 3, or 12 months post-RAPN. CONCLUSION: Compared with the AO clamp, the AV clamp did not have a detrimental impact on blood loss or renal dysfunction. Consequently, AV clamps may be considered for patients presenting with moderate-to-high-complexity RNSs.

DOI： 10.1111/iju.15567

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Language：English   Publisher：(一社)日本癌学会  

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

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例1(17歳男性)。肉眼的血尿を主訴に、前医のCT検査にて右腎腫瘤が指摘され、精査加療目的で当科へ紹介となった。症例2(61歳女性)。当院でHBVフォロー中に撮影したCTで偶発的に右腎下極の腫瘤が認められ、当科へ紹介となった。両症例とも、画像所見から乳頭状腎細胞癌が疑われ、Robot-assisted partial nephrectomyが施行された。病理組織学的に後腎性腺腫と確定診断され、いずれも経過良好で術後8日目に退院となった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01269&link_issn=&doc_id=20240903440004&doc_link_id=1390865409046350976&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390865409046350976&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

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：Oxford University Press (OUP)  

Abstract

Background

PET/CT imaging with Zirconium-89 labeled [89Zr]Zr-DFO-girentuximab, which targets tumor antigen CAIX, may aid in the differentiation and characterization of clear cell renal cell carcinomas (RCC) and other renal and extrarenal lesions, and has been studied in European and American cohorts. We report results from a phase I study that evaluated the safety profile, biodistribution, and dosimetry of [89Zr]Zr-DFO-girentuximab in Japanese patients with suspected RCC.

Methods

Eligible adult patients received 37 MBq (± 10%; 10 mg mass dose) of intravenous [89Zr]Zr-DFO-girentuximab. Safety and tolerability profile was assessed based on adverse events, concomitant medications, physical examination, vital signs, hematology, serum chemistry, urinalysis, human anti-chimeric antibody measurement, and 12-lead electrocardiograms at predefined intervals. Biodistribution and normal organ and tumor dosimetry were evaluated with PET/CT images acquired at 0.5, 4, 24, 72 h and Day 5 ± 2 d after administration.

Results

[89Zr]Zr-DFO-girentuximab was administered in six patients as per protocol. No treatment-emergent adverse events were reported. Dosimetry analysis showed that radioactivity was widely distributed in the body, and that the absorbed dose in healthy organs was highest in the liver (mean ± standard deviation) (1.365 ± 0.245 mGy/MBq), kidney (1.126 ± 0.190 mGy/MBq), heart wall (1.096 ± 0.232 mGy/MBq), and spleen (1.072 ± 0.466 mGy/MBq). The mean effective dose, adjusted by the radioactive dose administered, was 0.470 mSv/MBq. The radiation dose was highly accumulated in the targeted tumor, while any abnormal accumulation in other organs was not reported.

Conclusions

This study demonstrates that [89Zr]Zr-DFO-girentuximab administered to Japanese patients with suspected RCC has a favorable safety profile and is well tolerated and has a similar dosimetry profile to previously studied populations.

DOI： 10.1093/jjco/hyae075

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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)  

PURPOSE: To identify the risk factors for perioperative complications to prevent perioperative complications after complete ipsilateral upper urinary stone removal using flexible ureterorenoscopy. MATERIALS AND METHODS: We retrospectively examined 111 patients who underwent flexible ureterorenoscopy for ipsilateral renal stones with a diameter ≥ 5 mm at the same time as ureterorenoscopy for ureteric stones. The flexible ureterorenoscopy procedures were performed following the fragmentation technique. Patients who experienced (complication group) and did not experience (non-complication group) perioperative complications were compared. The complication group included 33 patients with Clavien-Dindo classification scores of I, II, III, or IV and/or those with a body temperature of > 37.5 ℃ during hospitalization. RESULTS: The overall stone volume, stone-free rate and procedure duration were 1.71 mL, 96.4% and 77 min, respectively. The rate of perioperative complications was 29.7% (grade 1, 2 and 3 was 23.4%, 5.4% and 0.9%, respectively). Severe complications (Clavien-Dindo grade 4) were not observed. Multivariable analysis revealed that ureteral stone volume and female patients were independent predictors of perioperative complications after flexible ureterorenoscopy (p = 0.015 and 0.017, respectively). CONCLUSIONS: This study showed that ureteral stone volume and female gender have the possibility to increase perioperative complications. These preliminary data help to select for patients who are at low risk of complications. Therefore, in these selected patients, complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy may reduce the recurrence of urolithiasis without increasing perioperative complications.

DOI： 10.1007/s11255-023-03899-1

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

Small cell carcinoma of the bladder (SCCB) is a rare cancer that accounts for approximately 1% of primary malignant bladder tumors. It is highly malignant and has a poor prognosis. Similar to small cell lung cancer, platinum-based chemotherapy is recommended as the first-line therapy, and amrubicin (AMR) is recommended as the second-line therapy, but there is no established therapy after the second line. We report a case of SCCB that was refractory to multiple chemotherapies but responded to pembrolizumab. A 77-year-old male, diagnosed with clinical stage T3N0M0 small cell carcinoma and invasive urothelial carcinoma by transurethral resection of bladder tumor (TURBT), underwent robot-assisted radical cystectomy after three cycles of neoadjuvant cisplatin-irinotecan chemotherapy, and pathological examination revealed only small cell carcinoma in his cystectomy specimen. After three courses of adjuvant carboplatin-etoposide chemotherapy, the patient developed liver and bone metastases. Furthermore, after two courses of amrubicin, we started pembrolizumab due to the progression of metastases. Metastases decreased after starting pembrolizumab and continued to decrease after discontinuation because of immunerelated adverse events (irAEs). Therefore, pembrolizumab may be an option for the treatment of refractory SCCB.

DOI： 10.14989/ActaUrolJap_70_4_93

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

Objective: Complete endophytic renal tumors (CERTs) are the most challenging for robot-assisted partial nephrectomy (RAPN). This study aimed to determine the impact of CERT on outcomes of RAPN. Methods: All RAPN cases for localized renal tumor undertaken at Yokohama City University Hospital between 2016 and 2023 were enrolled. Tumor characteristics and surgical, functional, and oncologic outcomes of RAPN were compared between CERT and non-CERT groups. Results: Consecutive 666 patients were enrolled, and 76 (11.4%) were identified as CERT (3 points of "E" score). CERT showed smaller tumor diameters (p < 0.001), more predominant hilar tumor (p = 0.029), higher "N" scores (p < 0.001) and "L" scores (p = 0.006) than non-CERT. The CERT group showed longer warm ischemia times (p < 0.001), more frequent positive surgical margins (p = 0.028), and relatively lower trifecta achievement rates (p = 0.101) than the non-CERT group. In multivariable analysis, the CERT was an independent predictor for trifecta achievement but not for pentafecta achievement. Conclusions: CERT was associated with longer warm ischemia time, positive surgical margin, and lower trifecta achievement, but not with surgical complication and pentafecta achievement in RAPN. This study suggested that CERT had limited influence on long-term renal functional preservation; however, it had strong impacts on short-term surgical outcome.

DOI： 10.1089/end.2023.0608

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

PURPOSE: There are no definitive prognostic factors for patients with pathological Grade Group 5 (pGG 5) prostate cancer (PCa) undergoing robot-associated radical prostatectomy (RARP). This study aimed to explore the prognostic factors among patients with pGG 5 PCa in a large Japanese cohort (MSUG94). METHODS: This retrospective, multi-institutional cohort study was conducted between 2012 and 2021 at ten centers in Japan and included 3195 patients. Patients with clinically metastatic PCa (cN1 or cM1) and those receiving neoadjuvant and/or adjuvant therapy were excluded. Finally, 217 patients with pGG5 PCa were analyzed. RESULTS: The median follow-up period was 28.0 months. The 3- and 5-year biochemical recurrence-free survival (BCRFS) rates of the overall population were 66.1% and 57.7%, respectively. The optimal threshold value (47.2%) for the percentage of positive cancer cores (PPCC) with any GG by systematic biopsy was chosen based on receiver operating characteristic curve analysis. Univariate analysis revealed that the prostate-specific antigen level at diagnosis, pT, pN, positive surgical margins (PSMs), lymphovascular invasion, and PPCC were independent prognostic factors for BCRFS. A multivariate analysis revealed that PSMs and PPCC were independent prognostic factors for BCRFS. Using these two predictors, we stratified BCRFS, metastasis-free survival (MFS), and castration-resistant PCa-free survival (CRPC-FS) among patients with pGG 5 PCa. CONCLUSION: The combination of PSMs and PPCC may be an important predictor of BCRFS, MFS, and CRPC-FS in patients with pGG 5 PCa undergoing RARP.

DOI： 10.1007/s00345-024-04864-y

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The influence of chronic kidney disease stage on robot-assisted partial nephrectomy outcomes remains underexplored. This study aimed to assess the impact of chronic kidney disease stage on functional and surgical outcomes of robot-assisted partial nephrectomy and identify preoperative predictors of significant postoperative 1-year renal-function loss (RFL). Clinical data of 408 patients who underwent robot-assisted partial nephrectomy at Yokohama City University Hospital between 2016 and 2023 were retrospectively reviewed. The da Vinci Surgical System was applied in all patients, and outcomes assessed included surgical parameters, postoperative estimated glomerular filtration rate, trifecta and pentafecta achievements, and complications. Significant RFL was defined as estimated glomerular filtration rate reduction ≥ 25% from baseline. Higher chronic kidney disease stages correlated with older age, hypertension, diabetes, and solitary kidneys. Postoperative estimated glomerular filtration rate decline was most pronounced in patients with chronic kidney disease stages 4-5. Although the chronic kidney disease stage did not significantly affect most surgical parameters, pentafecta achievement was higher in patients with chronic kidney disease stage 3 than in those with stages 4-5. Two patients required hemodialysis after robot-assisted partial nephrectomy. Multivariable logistic regression analysis showed that preoperative hemoglobin level and maximum tumor diameter were significant predictive factors for significant RFL. In conclusion, preoperative CKD stage did not influence on surgical outcome except for pentafecta achievement. RAPN may be feasible for patients with CKD stages 4-5 because of no rapid progression to hemodialysis induction and no procedure-related mortality. Preoperative hemoglobin levels and tumor diameter emerged as predictors of significant RFL.

DOI： 10.1007/s11701-024-01873-2

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

OBJECTIVE: In December 2021, enfortumab vedotin (EV), an antibody-drug conjugate directed against nectin-4, was approved in Japan as a new treatment after platinum-containing chemotherapy and PD-1/PD-L1 inhibitors. This study evaluated, using real-world data, the efficacy and safety of EV therapy in patients with metastatic urothelial carcinoma (mUC). MATERIALS AND METHODS: Fifty-five patients with mUC who discontinued pembrolizumab therapy due to disease progression between June 2018 and April 2023 at Yokohama City University Hospital were evaluated retrospectively. Of the 55 patients, 25 received EV therapy (EV group) and 30 did not (non-EV group). All patients who underwent EV therapy were diagnosed with disease progression after the approval of EV in Japan. RESULTS: The median (range) follow-up period after pembrolizumab discontinuation was 6.3 (0.7-31.1) months. There were eight (32.0%) deaths due to cancer in the EV group and 27 (90.0%) in the non-EV group. The overall survival (OS) after pembrolizumab discontinuation was not reached in the EV group versus 2.6 months in the non-EV group (p < 0.001). A multivariate analysis revealed that EV therapy (EV vs. non-EV group; hazard ratio 0.26; 95% confidence interval 0.16-0.41; p < 0.001) was an independent prognostic factor for OS. CONCLUSION: EV prolonged OS in mUC following pembrolizumab therapy in real-world data.

DOI： 10.1111/iju.15437

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

Abstract

Successful treatment of pediatric cancers often results in long‐term health complications, including potential effects on fertility. Therefore, assessing the male reproductive toxicity of anti‐cancer drug treatments and the potential for recovery is of paramount importance. However, in vivo evaluations are time‐intensive and require large numbers of animals. To overcome these constraints, we utilized an innovative organ culture system that supports long‐term spermatogenesis by placing the testis tissue between a base agarose gel and a polydimethylsiloxane ceiling, effectively mirroring the in vivo testicular environment. The present study aimed to determine the efficacy of this organ culture system for accurately assessing testicular toxicity induced by cisplatin, using acrosin‐green fluorescent protein (GFP) transgenic neonatal mouse testes. The testis fragments were treated with different concentrations of cisplatin‐containing medium for 24 h and incubated in fresh medium for up to 70 days. The changes in tissue volume and GFP fluorescence over time were evaluated to monitor the progression of spermatogenesis, in addition to the corresponding histopathology. Cisplatin treatment caused tissue volume shrinkage and reduced GFP fluorescence in a concentration‐dependent manner. Recovery from testicular toxicity was also dependent on the concentration of cisplatin received. The results demonstrated that this novel in vitro system can be a faithful replacement for animal experiments to assess the testicular toxicity of anti‐cancer drugs and their reversibility, providing a useful method for drug development.

DOI： 10.1002/jat.4584

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

To investigate the incidence and risk factors of inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) using a multicentric database. The present study used a multicentric database (the MSUG94) containing data on 3,195 Japanese patients undergoing RARP between 2012 and 2021. Surgical procedures utilized for IH prevention were as follows: isolation of the vas deferens, transection of the vas deferens, isolation of the spermatic vessels, and separation of the peritoneum from the internal inguinal ring. The primary and secondary endpoints were IH-free survival and any association between post-RARP IH and clinical covariates. The prophylactic effect of the above procedures were also assessed. IH prevention was attempted in 1,465 (46.4%) patients at five of the nine hospitals. During follow-up (median 24 months), post-RARP IH developed in 243 patients. The post-RARP IH-free survival rates at years 1, 2, and 3 were 94.3%, 91.7%, and 90.5%, respectively. Old age (hazard ratio [HR] 1.037; 95% confidence interval [CI] 1.014-1.061; p = 0.001), low BMI (HR 0.904; 95% CI 0.863-0.946: p < 0.001), and low hospital volume (HR 1.385; 95% CI 1.003-1.902; p = 0.048) were independently associated with IH development. None of the procedures for IH prevention were associated with IH development. Our findings may represent the current, real-world status of post-RARP IH in Japan. The prophylactic effects of the surgical procedures for IH prevention should be further investigated in well-designed, prospective studies to optimize the surgical technique.

DOI： 10.1007/s11701-023-01761-1

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

OBJECTIVE: This study aimed to investigate whether lymphovascular invasion (LVI) was associated with oncological outcomes in patients with prostate cancer (PCa) undergoing robotic-assisted radical prostatectomy (RARP). METHODS: This retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP in nine institutions in Japan. The primary endpoints were the associations between biochemical recurrence (BCR) and LVI and between BCR and clinicopathological covariates, while the secondary endpoints were the association between LVI and the site of clinical recurrence and metastasis-free survival (MFS). RESULTS: In total, 2608 patients met the inclusion criteria. At the end of the follow-up period, 311 patients (11.9%) were diagnosed with BCR and none died of PCa. In patients with pathological stage T2 (pT2) + negative resection margins (RM-), and pT3+ positive RM (RM+), LVI significantly worsened BCR-free survival (BRFS). For patients with PCa who had pT3 and RM+, the 2-year BRFS rate in those with LVI was significantly worse than in those without LVI. Patients with LVI had significantly worse MFS than those without LVI with respect to pT3, RM+, and pathological Gleason grade (pGG). In multivariate analysis, LVI was significantly associated with BRFS in patients with pT3 PCa, and with worse MFS in PCa patients with pT3, RM+, and pGG ≥ 4. CONCLUSIONS: LVI was an independent prognostic factor for recurrence and metastasis after RARP, particularly in patients with pT3 and RM+ PCa. Locally advanced PCa with positive LVI and RM+ requires careful follow-up because of the high likelihood of recurrence.

DOI： 10.1245/s10434-023-14691-x

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Background and Objectives: We aimed to examine the relationship between the inflammation-related parameters, such as the neutrophil-to-lymphocyte ratio (NLR), and the pathological findings and biochemical recurrence (BCR) in patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective multicenter cohort study of patients with PCa who underwent RARP at 10 institutes in Japan was conducted. This study enrolled 3195 patients. We focused on patients undergoing RARP who underwent the preoperative measurement of their inflammation-related parameters and who did not receive any neo- or adjuvant therapy. Data on the pre- and postoperative variables for the enrolled patients were obtained. The primary endpoint of this study was the association between BCR and the inflammation-related parameters after RARP. The secondary endpoint was the association between the inflammation-related parameters and the pathological diagnosis of PCa. Results: Data from 2429 patients with PCa who met the study's eligibility criteria were analyzed. The median follow-up period was 25.1 months. The inflammation-related parameters were divided into two groups, and cutoff values were determined based on the receiver operating characteristics. There were no statistically significant differences in biochemical recurrence-free survival for any of the parameters. In the univariate analysis, the NLR was predictive of pathological T3 and lymphovascular invasion; however, there were no significant differences in the multivariate analysis. Conclusions: The inflammation-related parameters did not significantly affect the incidence of BCR, at least among patients with PCa who underwent RARP.

DOI： 10.3390/jcm12247732

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BACKGROUND: Late-onset hypogonadism (LOH) is a condition caused by the decline of testosterone levels with aging and is associated with various symptoms, including lower urinary tract symptoms (LUTSs). Although some reports have shown that testosterone replacement treatment for LOH improves LUTSs, no large study has revealed a correlation between LUTSs and LOH. This study investigated the correlation between the severity of LOH and LUTSs in Japanese males >40 years of age using a web-based questionnaire with the Aging Males' Symptoms (AMS) scale. METHODS: We asked 2000 Japanese males to answer both the AMS and IPSS/QOL questionnaires using a web-based survey. Among these 2000 individuals, 500 individuals were assigned to each age group. RESULTS: The IPSS total score was positively correlated with the severity of AMS (shown as median [mean ± SD]): no/little group, 2 (3.67 ± 5.36); mild group, 6 (7.98 ± 6.91); moderate group, 11 (12.49 ± 8.63); and severe group, 16 (14.83 ± 9.24) (p < 0.0001). CONCLUSIONS: Individuals with higher AMS values, representing cases with severe LOH symptoms, had a higher risk of experiencing nocturia and LUTSs than those with lower AMS values.

DOI： 10.3390/jcm12247528

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

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The classical organ culture method, in which tissue is placed at the gas‒liquid interphase, is effective at inducing mouse spermatogenesis. However, due to reginal variations in the supply of oxygen and nutrients within a tissue, the progress of spermatogenesis was observed only in limited areas of a tissue. In addition, haploid cell formation and its differentiation to spermatozoon, i.e. spermiogenesis, were infrequent and inefficient. Here, we show that the polydimethylsiloxane (PDMS)-chip ceiling (PC) method, which ensures a uniform supply of nutrients and oxygen throughout the tissue by pressing it into a thin, flat shape, can provide control over the culture space. We used this method to culture testis tissue from neonatal mice, aged 1 to 4 days, and found that modulating the culture space during the experiment by replacing one chip with another that had a higher ceiling effectively increased tissue growth. This adjustment also induced more efficient spermatogenesis, with the process of spermiogenesis being particularly promoted. Meiotic cells were observed from culture day 14 onward, and haploid cells were confirmed at the end of each experiment. This technique was also shown to be a sensitive assay for testicular toxicity. Culture-space control will be a critical regulation parameter for sophisticated tissue culture experiments.

DOI： 10.1038/s41598-023-39323-y

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OBJECTIVES: To investigate the predictive factors for pentafecta achievement of robot-assisted partial nephrectomy (RAPN) for intermediate highly complex renal tumors (RENAL score ≥ 7). METHODS: We retrospectively analyzed the data of 247 patients with renal tumors with a RENAL score ≥ 7 who underwent RAPN. Baseline characteristics and perioperative outcomes were compared between the pentafecta achieved group and the unachieved group. A multivariable logistic regression model was used to identify the predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. RESULTS: Of the 247 patients, 75 (30.3%) patients were in the achieved group and 172 (69.7%) patients were in the unachieved group. The median warm ischemia time and total operation time were 18 min versus 23 min (p < 0.001) and 179 min versus 201 min (p < 0.001) in the achieved and unachieved groups, respectively. In the unachieved group, six patients (3.4%) had major perioperative complications (Clavien-Dindo classification system ≥3). The median preservation rates of estimated GFR at the 1-year postoperative period were 96.5% versus 83.0% (p < 0.001) in the achieved and unachieved groups. Multivariable logistic regression models revealed that age and tumor size were independent predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. There were no significant differences in cancer-free survival between the two groups (p = 0.456). CONCLUSION: Age and tumor size were independent predictive factors for pentafecta achievement, although there was no difference in oncological outcomes between the pentafecta achieved group and the unachieved group in RAPN for cT1 renal tumors with a RENAL score ≥ 7.

DOI： 10.1111/iju.15274

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

Partial nephrectomy (PN) is the standard treatment for T1 renal cell carcinoma. PN is affected more by surgical variations and requires greater surgical experience than radical nephrectomy. Patient-specific simulations and navigation systems may help to reduce the surgical experience required for PN. Recent advances in three-dimensional (3D) virtual reality (VR) imaging and 3D printing technology have allowed accurate patient-specific simulations and navigation systems. We reviewed previous studies about patient-specific simulations and navigation systems for PN. Recently, image reconstruction technology has developed, and commercial software that converts two-dimensional images into 3D images has become available. Many urologists are now able to view 3DVR images when preparing for PN. Surgical simulations based on 3DVR images can change surgical plans and improve surgical outcomes, and are useful during patient consultations. Patient-specific simulators that are capable of simulating surgical procedures, the gold-standard form of patient-specific simulations, have also been reported. Besides VR, 3D printing is also useful for understanding patient-specific information. Some studies have reported simulation and navigation systems for PN based on solid 3D models. Patient-specific simulations are a form of preoperative preparation, whereas patient-specific navigation is used intraoperatively. Navigation-assisted PN procedures using 3DVR images have become increasingly common, especially in robotic surgery. Some studies found that these systems produced improvements in surgical outcomes. Once its accuracy has been confirmed, it is hoped that this technology will spread further and become more generalized.

DOI： 10.1111/iju.15287

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

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BACKGROUND: The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. MATERIAL AND METHODS: We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. RESULTS: The pad-free rates at 12 months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12 months of surgery did not significantly differ between the unilateral and bilateral NS groups. CONCLUSIONS: NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12 months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.

DOI： 10.1002/rcs.2593

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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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DOI： 10.1002/bco2.271

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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)日本泌尿器科学会  

症例は57歳女性.発熱と血尿を主訴に前医を受診し,精査のCTで7.2cm大の左腎腫瘍を認め当科紹介となった.腎ダイナミックCTを撮像し,左腎癌肺転移(cT2aN0M1)IMDC分類Poor risk(Interval<1year,Hb;8.4g/dL,Ca;10.7mg/dL,Plt;74.2×104/mm3)の診断であった.肺転移巣が10mmと小さく単発であったこと,さらに血尿や発熱といった症状を呈していたことから,薬物療法前に腹腔鏡下左腎摘除術を施行.病理診断は淡明型腎細胞癌でpT3であった.術後4日から乳糜漏を認め,禁食や保存加療を行うも奏効せず,術後22日にヨード化ケシ油脂肪酸エチルエステルを用いたリンパ管塞栓術を施行.右鼠径リンパ節穿刺によるアプローチで左腎門部リンパ節からの造影剤の漏出を認めた.塞栓術後のCTで造影剤の漏出がないことを確認し,術後28日に食事再開,術後29日にドレーン抜去し,術後35日に退院となった.退院後のCTで肺転移の増大を認め,Ipilimumab/Nivolumab併用療法を施行.1コース施行後の評価で肺転移巣の増大を認めPD判定となり,2ndlineはCabozantinib単剤療法を施行している.リンパ管塞栓術は,保存加療で改善しないリンパ漏に対して安全で有効な手段となりうる.(著者抄録)

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Language：English   Publisher：(一社)日本癌学会  

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

BACKGROUND: Enfortumab vedotin shows promise as a targeted therapy for advanced urothelial carcinoma, particularly in patients who have previously received platinum-based chemotherapy and an immune-checkpoint inhibitor. The EV-301 phase III trial demonstrated significantly improved overall survival and response rates compared to standard chemotherapy. However, more data, especially from larger real-world studies, are needed to further assess its effectiveness in Japanese patients. METHODS: A total of 6007 urothelial cancer patients inducted with pembrolizumab as a second-line treatment were analyzed. Among them, 563 patients received enfortumab vedotin after pembrolizumab, while 443 patients received docetaxel or paclitaxel after pembrolizumab, and all were included in the study for efficacy as a life prolonging agent. RESULTS: The enfortumab vedotin group showed a longer overall survival than the paclitaxel/docetaxel group (p = 0.013, HR: 0.71). In multivariate analysis, enfortumab vedotin induction was the independent risk factor for overall survival (p = 0.013, HR: 0.70). There were no significant differences in cancer-specific survival. CONCLUSIONS: Enfortumab vedotin prolonged the overall survival for Japanese advanced or metastatic urothelial carcinoma patients compared to paclitaxel or docetaxel after pembrolizumab treatment.

DOI： 10.3390/cancers15174227

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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：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1245/s10434-023-13856-y

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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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：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Radical prostatectomy can be performed more safely and with fewer com- plications since the advent of robot-assisted surgery. However, increased bleeding is a concern when robot-assisted radical prostatectomy includes lymph node dissection and nerve sparing. In real-world clinical practice, inexperienced surgeons sometimes perform robot-assisted radical prostatectomy. In this study, we investigated the effec- tiveness of microporous polysaccharide hemospheres as a local hemostatic agent in robot-assisted radical prostatectomy. METHODS: We retrospectively evaluated 301 patients who underwent robot-assisted radical prostatectomy at our institution between December 2017 and November 2020. The patients were divided into 2 groups according to whether their surgery was per- formed after the introduction of microporous polysaccharide hemospheres as a local hemostatic agent (group A, n = 140) or before it (group B, n = 161: historical control). RESULTS: Preoperative androgen deprivation therapy was significantly more common in group A than in group B (23 vs. 11, P = .009). Furthermore, surgeons were significantly less experienced (P < .001) and the operation time was significantly longer (260 min- utes vs. 229 minutes; P < .001) in group A than in group B. There was no significant difference in any other patient background characteristics or in the surgical outcomes between the groups. CONCLUSION: The use of microporous polysaccharide hemospheres allowed even inex- perienced surgeons to perform robot-assisted radical prostatectomy without compro- mising surgical outcomes.

DOI： 10.5152/tud.2023.22242

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

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OBJECTIVES: Depression might worsen lower urinary tract symptoms (LUTS), but the correlation is still disputed. This study examined the influence of depression on LUTS in Japanese women. METHODS: This study used a web-based questionnaire to evaluate the mental status of depression and LUTS. The mental status of depression was evaluated using the Quick Inventory of Depressive Symptomatology-Japanese version (QIDS-J), and LUTS was assessed based on the Overactive Bladder Symptom Score (OABSS) and responses to the International Consultation on Incontinence Questionnaire-Short Form. RESULTS: A total of 4151 of 5400 (76.9%) women responded to the questionnaire. The mean age was 48.3 ± 13.8 years. The OABSS gradually increased with the QIDS-J score. The incidence of overactive bladder (OAB) and urgency urinary incontinence (UUI) also increased along with the QIDS-J score. In the younger age group (20-39 years old), the risks of OAB and UUI were higher than in the elderly group (7.42 for OAB and 7.44 for UUI). CONCLUSIONS: This study revealed that worsening of LUTS was correlated with depression.

DOI： 10.1111/luts.12478

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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   Publishing type：Research paper (scientific journal)  

PURPOSE: We created a clinically applicable nomogram to predict locally advanced prostate cancer using preoperative parameters and performed external validation using an external independent validation cohort. PATIENTS AND METHODS: From a retrospective multicenter cohort study of 3622 Japanese patients with prostate cancer who underwent robot-assisted radical prostatectomy at ten institutions, the patients were divided into two groups (MSUG cohort and validation cohort). Locally advanced prostate cancer was defined as pathological T stage ≥ 3a. A multivariable logistic regression model was used to identify factors strongly associated with locally advanced prostate cancer. Bootstrap area under the curve was calculated to assess the internal validity of the prediction model. A nomogram was created as a practical application of the prediction model, and a web application was released to predict the probability of locally advanced prostate cancer. RESULTS: A total of 2530 and 427 patients in the MSUG and validation cohorts, respectively, met the criteria for this study. On multivariable analysis, initial prostate-specific antigen, prostate volume, number of cancer-positive and cancer-negative biopsy cores, biopsy grade group, and clinical T stage were independent predictors of locally advanced prostate cancer. The nomogram predicting locally advanced prostate cancer was demonstrated (area under the curve 0.72). Using a nomogram cutoff of 0.26, 464 of 1162 patients (39.9%) could be correctly diagnosed with pT3, and 2311 of 2524 patients (91.6%) could avoid underdiagnosis. CONCLUSIONS: We developed a clinically applicable nomogram with external validation to predict the probability of locally advanced prostate cancer in patients undergoing robot-assisted radical prostatectomy.

DOI： 10.1245/s10434-023-13747-2

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BACKGROUND: Birt-Hogg-Dubé (BHD) syndrome, caused by germline alteration of folliculin (FLCN) gene, develops hybrid oncocytic/chromophobe tumour (HOCT) and chromophobe renal cell carcinoma (ChRCC), whereas sporadic ChRCC does not harbor FLCN alteration. To date, molecular characteristics of these similar histological types of tumours have been incompletely elucidated. METHODS: To elucidate renal tumourigenesis of BHD-associated renal tumours and sporadic renal tumours, we conducted whole genome sequencing (WGS) and RNA-sequencing (RNA-seq) of sixteen BHD-associated renal tumours from nine unrelated BHD patients, twenty-one sporadic ChRCCs and seven sporadic oncocytomas. We then compared somatic mutation profiles with FLCN variants and RNA expression profiles between BHD-associated renal tumours and sporadic renal tumours. FINDINGS: RNA-seq analysis revealed that BHD-associated renal tumours and sporadic renal tumours have totally different expression profiles. Sporadic ChRCCs were clustered into two distinct clusters characterized by L1CAM and FOXI1 expressions, molecular markers for renal tubule subclasses. Increased mitochondrial DNA (mtDNA) copy number with fewer variants was observed in BHD-associated renal tumours compared to sporadic ChRCCs. Cell-of-origin analysis using WGS data demonstrated that BHD-associated renal tumours and sporadic ChRCCs may arise from different cells of origin and second hit FLCN alterations may occur in early third decade of life in BHD patients. INTERPRETATION: These data further our understanding of renal tumourigenesis of these two different types of renal tumours with similar histology. FUNDING: This study was supported by JSPS KAKENHI Grants, RIKEN internal grant, and the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute (NCI), Center for Cancer Research.

DOI： 10.1016/j.ebiom.2023.104596

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BACKGROUND: To investigate whether subgroups of prostate cancer patients, stratified by positive surgical margin locations, have different oncological outcomes following robot-assisted radical prostatectomy. METHODS: A retrospective multicenter cohort study in prostate cancer patients undergoing robot-assisted radical prostatectomy was conducted at 10 institutions in Japan. Pre- and post-operative outcomes were collected from enrolled patients. Biochemical recurrence and clinical and pathological variables were evaluated among subgroups with different positive surgical margin locations. RESULTS: A total of 3195 patients enrolled in this study. Data from 2667 patients (70.1% [N = 1869] with negative surgical margins and 29.9% [N = 798] with positive surgical margins based on robot-assisted radical prostatectomy specimens) were analyzed. The median follow-up period was 25.0 months. The numbers of patients with apex-only, middle-only, bladder-neck-only, seminal-vesicle-only and multifocal positive surgical margins were 401, 175, 159, 31 and 32, respectively. In the multivariate analysis, PSA level at surgery, pathological Gleason score based on robot-assisted radical prostatectomy specimens, pathological T stage, pathological N stage and surgical margin status were independent risk factors significantly associated with biochemical recurrence-free survival. Patients undergoing robot-assisted radical prostatectomy with multifocal positive surgical margins and seminal-vesicle-only positive surgical margins were associated with worse biochemical recurrence-free survival than those with apex-only, middle-only and bladder-neck-only positive surgical margins. Patients undergoing robot-assisted radical prostatectomy with apex-only positive surgical margins, the most frequent positive surgical margin location, were associated with more favorable biochemical recurrence-free survival that those with middle-only and bladder-neck-only positive surgical margins. The study limitations included the lack of central pathological specimen evaluation. CONCLUSIONS: Although positive surgical margin at any locations is a biochemical recurrence risk factor after robot-assisted radical prostatectomy, positive surgical margin location status should be considered to accurately stratify the biochemical recurrence risk after robot-assisted radical prostatectomy.

DOI： 10.1093/jjco/hyad004

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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：医学図書出版(株)  

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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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Locally advanced prostate cancer (PCa) with pathological seminal vesicle invasion (pT3b) is a very-high-risk disease associated with biochemical recurrence (BCR), local recurrence, distant metastases, or mortality following definitive therapies. This study aimed to evaluate the risk factors associated with BCR following robot-assisted radical prostatectomy (RARP) in PCa patients with pT3b. A retrospective multicenter cohort study was conducted on 3,195 patients with PCa who underwent RARP at nine domestic centers between September 2011 and August 2021. Biochemical recurrence-free survival (BRFS) after RARP in PCa patients with pT3b was the primary end-point of the study. The secondary end-point was to determine the association between BCR and covariates. We enrolled 188 PCa patients with pT3b. The median follow-up period was 32.8 months. At the end of the follow-up period, 76 patients (40.4%) developed BCR, of whom 15 (8.0%) were BCR at the date of surgery. The 1-, 2-, and 3-year BRFS rates were 76.4, 65.9, and 50.8%, respectively. Multivariate analysis identified initial prostate-specific antigen level and positive surgical margins (PSM) as significant predictors of BCR in PCa patients with pT3b undergoing RARP. In this study, we investigated the BRFS in PCa patients with pT3b. As PSM was an independent predictor of BCR in PCa patients with pT3b, these patients may require a combination of therapies to improve the BCR.

DOI： 10.1007/s11701-023-01567-1

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

BACKGROUND: Despite the widespread availability of medication choices for metastatic castration-resistant prostate cancer (mCRPC), biomarkers to predict the efficacy of each mCRPC treatment have not yet been established. This study developed a prognostic nomogram and a calculator to predict the prognosis of patients with mCRPC who received abiraterone acetate (ABI) and/or enzalutamide (ENZ). METHODS: In total, 568 patients with mCRPC who underwent ABI and/or ENZ between 2012 and 2017 were enrolled. A prognostic nomogram based on the risk factors was developed using the Cox proportional hazards regression model and clinically important factors. The discriminatory ability of the nomogram was assessed according to the concordance index (C-index). A 5-fold cross-validation was repeated 2000 times to estimate the C-index, and the means of the estimated C-index for the training and validation sets were determined. A calculator based on this nomogram was then developed. RESULTS: The median overall survival (OS) was 24.7 months. Multivariate analysis showed that the time to CRPC, pre-chemotherapy, baseline prostate-specific antigen, baseline alkaline phosphatase, and baseline lactate dehydrogenase levels were independent risk factors for OS (hazard ratio [HR]: 0.521, 1.681, 1.439, 1.827, and 12.123, p = 0.001, 0.001,  < 0.001, 0.019, and  < 0.001, respectively). The C-index was 0.72 in the training cohort and 0.71 in the validation cohort. CONCLUSIONS: We developed a nomogram and calculator to predict OS in Japanese patients with mCRPC who received ABI and/or ENZ. Reproducible prognostic prediction calculators for mCRPC will facilitate greater accessibility for clinical use.

DOI： 10.1186/s12885-023-10700-0

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

症例は61歳女性。左腎の水腎とサンゴ状結石を認め,腎瘻増設後に経皮・経尿道同時内視鏡手術(ECIRS)を施行された。その後も腎瘻からの粘液の排出が持続したため粘液産生腫瘍疑いで開腹左腎摘除術を施行した。病理診断は腎盂のvillous adenomaであった。術後2年6ヵ月後よりCTで残存尿管の拡張が認められた。腫瘍再発と考え開腹残存尿管摘除術を施行した。残存尿管には腸上皮化生が認められた。(著者抄録)

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BACKGROUND: This retrospective multicenter cohort study investigated the association of hospital volume with perioperative and oncological outcomes in patients treated with robot-assisted radical prostatectomy (RARP). METHODS: We collected the clinical data of patients who underwent RARP at eight institutions in Japan between September 2012 and August 2021. The patients were divided into two groups based on the treatment site-high- and non-high-volume hospitals. We defined a high-volume hospital as one where RARP was performed for more than 100 cases per year. RESULTS: After excluding patients who received neoadjuvant therapy, a total of 2753 patients were included in this study. In the high-volume hospital group, console time and estimated blood loss were significantly (p < 0.001) lower than that of the non-high-volume hospital group. However, the continence rate at 3 months after RARP, positive surgical margins, and prostate-specific antigen (PSA)-relapse-free survival showed no significant differences between the two groups. Furthermore, the console time was significantly shorter after 100 cases in the non-high-volume hospital group but not in the high-volume hospital group. CONCLUSIONS: A higher hospital volume was significantly associated with shorter console time and less estimated blood loss. However, oncological outcomes and early continence recovery appear to be comparable regardless of the hospital volume in Japan.

DOI： 10.1186/s12894-023-01178-w

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

(目的)当院における腎盂尿管移行部通過障害(UPJO)に対するロボット支援腹腔鏡下腎盂形成術(Robotassisted laparoscopic pyeloplasty:RALP)RALPの初期成績を検討した.(対象と方法)2008年4月から2021年10月までに当院で施行した腹腔鏡下腎盂形成術(LP)118例とRALP22例のうち,再手術症例を除外し,dismembered法で再建したLP 104例,RALP 18例を対象とした.手術成績について後方視的に解析した.また,手術の各行程の所要時間を症例毎に検討した.(結果)手術時間の中央値は,RALP群で141分で,LP群に比べて有意に短い結果であった.RALP群ではgrade 3以上の合併症は認めなかった.全例で症状の改善を認めた.RALPの縫合時間の中央値は38分であった.LPの直近20例と比較して,腎盂周囲の剥離時間,腎盂切開の時間,縫合時間でRALP群が有意に短かった.また,導入初期からコンソール時間,縫合時間は安定していた.水腎症のgradeが高い症例において,LPでは腎盂周囲の剥離と縫合時間でばらつきが大きかったが,RALPではばらつきが小さい結果であった.(結語)当院でのUPJOに対するRALPは,安全に導入されていると考えられる.今後,長期的な成績を検討し,その有効性を検証する必要がある.(著者抄録)

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

(Objective) To compare the initial results of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) for uretero-pelvic junction obstruction (UPJO). (Methods) Between April 2008 to October 2021, we identified 104 cases of UPJO where LP was performed and 18 cases where RALP was performed at our hospital. We retrospectively analyzed their perioperative outcomes. Furthermore, we recorded the operative times for each cases of LP and RALP. (Results) The median operative time for RALP was 141 minutes, which was significantly shorter than that for LP (204 minutes). No patient in the RALP group demonstrated any Clavien-Dindo complications (≥grade 3). During the observation period, improvement of symptoms was observed in all cases. The median suturing time in RALP was 38 minutes. Compared with the last 20 cases of LP, the time to expose the uretero-pelvic junction, the time of renal pelvis incision, and suturing time were significantly shorter in RALP. In addition, the console and suturing times were stable since the initial stage. In cases with a high grade of hydronephrosis, there was a large variation in the time to expose the uretero-pelvic junction and suture the renal pelvis and ureter in LP; however, this variation was smaller in RALP. (Conclusion) At our hospital, RALP for UPJO is considered to be a safe procedure. In the future, it is necessary to consider the long-term results and effectiveness of RALP.

DOI： 10.5980/jpnjurol.114.1

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In this multicenter retrospective cohort study, we aimed to evaluate whether pelvic lymph node dissection (PLND) improved biochemical recurrence (BCR) in patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy (RARP) in Japan. A multicenter retrospective cohort study of 3195 PCa patients undergoing RARP at nine institutions in Japan was conducted. Enrolled patients were divided into two groups: those who underwent RARP without PLND (non-PLND group) and those who underwent PLND (PLND group). The primary endpoint was biochemical recurrence-free survival (BRFS) in PCa patients who underwent PLND. We developed a propensity score analysis to reduce the effects of selection bias and potential confounding factors. Propensity score matching resulted in 1210 patients being enrolled in the study. The 2-year BRFS rate was 95.0% for all patients, 95.8% for the non-PLND group, and 94.3% for the PLND group (p = 0.855). For the all-risk group according to the National Comprehensive Cancer Network risk stratification, there were no significant differences between patients who did and did not undergo PLND. Based on the results of the log-rank study, PLND may be unnecessary for patients with PCa undergoing RARP.

DOI： 10.3390/cancers14235803

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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：医学図書出版(株)  

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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)西日本泌尿器科学会  

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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)  

BACKGROUND: To create a nomogram for predicting prostate cancer (PCa) with lymph node involvement (LNI) in the robot-assisted radical prostatectomy (RARP) era. METHODS: A retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP at nine institutions in Japan between September 2012 and August 2021. A multivariable logistic regression model was used to identify factors strongly associated with LNI. The Bootstrap-area under the curve (AUC) was calculated to assess the internal validity of the prediction model. RESULTS: A total of 1855 patients were enrolled in this study. Overall, 93 patients (5.0%) had LNI. On multivariable analyses, initial prostate-specific antigen, number of cancer-positive and-negative biopsy cores, biopsy Gleason grade, and clinical T stage were independent predictors of PCa with LNI. The nomogram predicting PCa with LNI has been demonstrated (AUC 84%). Using a nomogram cut-off of 6%, 492 of 1855 patients (26.5%) would avoid unnecessary pelvic lymph node dissection, and PCa with LNI would be missed in two patients (0.1%). The sensitivity, specificity, and negative predictive values associated with a cutoff of 6% were 74%, 80%, and 99.6%, respectively. CONCLUSIONS: We developed a clinically applicable nomogram for predicting the probability of patients with PCa with LNI.

DOI： 10.3390/diagnostics12102545

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

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BACKGROUND: The ALSYMPCA trial revealed radium-223 (Ra-223) to be a life-prolonging agent for bone metastatic castration-resistant prostate cancer (CRPC). However, only 2.8% of enrolled patients in that clinical trial were Asian, and no Japanese patients were enrolled. Several retrospective studies have been published concerning Japanese bone metastatic CRPC patients receiving Ra-223. However, no study has yet reported the correlation between Ra-223 induction and the survival in Japanese bone metastatic CRPC patients. This study investigated the effect of Ra-223 as a life-prolonging agent in a large Japanese healthcare fee database. METHODS: A total of around 410 000 prostate cancer patients were extracted from this database, and 25 934 were diagnosed with CRPC. In these patients, the age, date of the CRPC diagnosis, date of Ra-223 induction, and prognosis were analyzed. RESULTS: A total of 1628 patients received Ra-223, and 6693 patients were diagnosed with bone metastasis CRPC, with the remaining 17 613 patients diagnosed with CRPC without bone metastasis. The patients who completed six courses of Ra-223 showed a significantly more favorable overall and cancer-specific survival than those who received ≤5 courses (p < 0.0001 and p < 0.0001, respectively). For time from CRPC diagnosis date to death, the Ra-223 induction group showed a significantly more favorable prognosis with regard to both the overall and cancer-specific survival than the bone metastatic CRPC patients without Ra-223 (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: Bone metastatic CRPC patients who received Ra-223 showed a significantly better prognosis than bone metastatic CPRC patients who did not receive Ra-223.

DOI： 10.1111/iju.15008

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

OBJECTIVES: To investigate whether the International Society of Urological Pathology Grade Group 4 (GG 4) subgroups have different oncological outcomes in Japanese prostate cancer (PCa) patients undergoing robotic-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: We conducted a retrospective multicentre cohort study in PCa patients undergoing RARP at 10 institutions in Japan. Pre- and post-operative variables were collected from enrolled patients. We evaluated biochemical recurrence and clinical and pathological variables in the different GG 4 subgroups. RESULTS: A total of 3195 patients were enrolled in the study. Among them, 298 patients with GG 4 tumours (pathological Gleason scores [GSs] of 3 + 5 [N = 37], 4 + 4 [N = 257] and 5 + 3 [N = 4]) based on RARP specimens were analysed. The median follow-up period was 25.2 months. The 3-year biochemical recurrence (BCR)-free survival (BCRFS) rate in the overall population was 74.5%. The 3-year BCRFS rates in the pathological GS 3 + 5, GS 4 + 4 and GS 5 + 3 subgroups were 93.8%, 71.9% and 50.0%, respectively (P = 0.01). In multivariate analysis, pathological GS based on RARP specimens, PSA levels at surgery, pathological T stage, pathological N stage and surgical margins were independent risk factors significantly associated with BCRFS. In particular, patients with pathological GSs 4 + 4 and 5 + 3 were at higher risk of BCR than patients with pathological GS 3 + 5 (hazard ratio 4.54, P = 0.03 and hazard ratio 11.2, P = 0.01, respectively). The study limitations include the lack of central pathological specimen evaluation. CONCLUSIONS: For patients with localized PCa undergoing RARP, pathological GS 4 + 4 and GS 5 + 3 were significantly associated with worse BCRFS than pathological GS 3 + 5. Pathological GS 3 + 5 may be overrated in GG 4. This observation emphasizes that primary and secondary GS should be considered to accurately stratify the risk of BCR after RARP.

DOI： 10.1002/bco2.160

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

Background and Objectives: This study's objective was to examine patients treated with robot-assisted radical prostatectomy (RARP) for intermediate-risk prostate cancer (IR-PCa), and to identify preoperative risk factors for biochemical recurrence (BCR) in these patients in Japan. Materials and Methods: We conducted a retrospective multicenter cohort study of patients with PCa who underwent RARP at 10 institutions in Japan. A total of 3195 patients were enrolled in this study. We focused on patients with IR-PCa who underwent RARP. We obtained data on pre- and postoperative covariates from the enrolled patients. Biochemical recurrence-free survival was the primary endpoint of this study. We also identified useful preoperative predictive factors for BCR in patients with IR-PCa after RARP. Results: A total of 1144 patients with IR-PCa were enrolled in this study. The median follow-up period was 23.7 months. At the end of the follow-up period, 94 (8.2%) patients developed BCR. The 2 and 3 year biochemical recurrence-free survival (BRFS) rates were 92.2% and 90.2%, respectively. Using the Kaplan-Meier method, Gleason grade (GG) 3 was significantly associated with poor BRFS compared with ≤GG 2. In multivariate analysis, GG 3 was a significant predictive factor for BCR in patients with IR-PCa. Conclusions: The results of the study indicated a significant relationship between GG 3 and post-RARP BCR in patients with IR-PCa.

DOI： 10.3390/medicina58080990

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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：(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：(公社)神奈川県医師会  

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

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INTRODUCTION: We aimed to examine the relationship between D'Amico intermediate-risk and pathological grade group 1 (pGG1) after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: In this retrospective multicenter cohort study, D'Amico intermediate-risk prostate cancer patients who did not receive neoadjuvant therapy, and underwent RARP at 10 institutions in Japan were examined for preoperative factors associated with pGG1. RESULTS: In total, we enrolled 1161 D'Amico intermediate-risk prostate cancer patients. The pGG1 and pGG ≥2 groups comprised 73 (6.3%), and 1088 (93.7%) cases, respectively. Biochemical recurrence-free survival (BCRFS) of the pGG1 group was equivalent to that of the D'Amico low-risk patients. Among the 3 D'Amico intermediate-risk factors (IRF), the pGG1-rate was 24% with prostate-specific antigen (PSA) of 10 to 20 ng/mL alone, and 30% with cT2b alone. Both groups had significantly higher pGG1-rates than other groups. Down-grading from biopsy GG ≥2 to pGG1 was relatively rare (3.9%). Patients with pGG1 were further stratified by prostate volume (PV) (cutoff, 40 cc) among patients with one IRF and PSA of 10 to 20 ng/mL. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc had a relatively good BCRFS similar to that of the D'Amico low-risk group. CONCLUSION: Among intermediate-risk prostate cancer patients, those with pGG1 have a good prognosis. Downgrading from biopsy GG ≥2 is rare, and definitive treatment may be recommended for patients with biopsy GG ≥2. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc who are eligible for RARP may be candidates for active surveillance.

DOI： 10.1016/j.clgc.2022.06.005

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PURPOSE: To ensure that the use of surgical training tools results in improvement of surgical skills, it is necessary to be able to measure and assess surgeons' skills. We established the Short-Time Power of Difference (STPOD) method as an evaluation tool for evaluating targeting technique. The STPOD method evaluates the distance from the actual movement of the forceps to the shortest linear path between two points in a short time period. We examined the effectiveness of the STPOD method as a new forceps kinematic analysis. METHODS: Six residents were categorized as novices and six urologists as experts. All participants performed box trainer training and LapPASS® Simulator training. During the procedure, objective scores (time, distance, and STPOD) were recorded. STPOD (Power) evaluated motion smoothness and STPOD (Stop) evaluated the stop time of the forceps. RESULTS: STPOD (Stop) on the right side of the experts was significantly lower than that of the novices in the box trainer. Furthermore, there were significant differences in the distances of left side and STPOD (Power) between the experts and the novices in the simulator. In the correlation of parameters between the box trainer and the simulator, time showed the strongest correlation, STPOD (Power) and distance showed a mild correlation. CONCLUSION: We showed the construct validity of STPOD (Power) and STPOD (Stop) using both the box trainer and the simulator. This method is a good evaluation tool for assessing a physician's skill; however, there are much more complex motions that are performed in actual surgery. Future studies are needed to focus on evaluation in an environment closer to actual surgery and comparing with other existing methods.

DOI： 10.1007/s11548-022-02622-2

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

Our understanding of how each hereditary kidney cancer adapts to its tissue microenvironment is incomplete. Here, we present single-cell transcriptomes of 108,342 cells from patient specimens including from six hereditary kidney cancers. The transcriptomes displayed distinct characteristics of the cell of origin and unique tissue microenvironment for each hereditary kidney cancer. Of note, hereditary leiomyomatosis and renal cell carcinoma (HLRCC)-associated kidney cancer retained some characteristics of proximal tubules, which were completely lost in lymph node metastases and present as an avascular tumor with suppressed T cells and TREM2-high macrophages, leading to immune tolerance. Birt-Hogg-Dubé (BHD)-associated kidney cancer exhibited transcriptomic intratumor heterogeneity (tITH) with increased characteristics of intercalated cells of the collecting duct and upregulation of FOXI1-driven genes, a critical transcription factor for collecting duct differentiation. These findings facilitate our understanding of how hereditary kidney cancers adapt to their tissue microenvironment.

DOI： 10.1016/j.isci.2022.104463

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INTRODUCTION: We evaluated oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) and their perioperative complications in Japan. We investigated clinical and pathological covariates to predict biochemical recurrence (BCR) after RARP. METHODS: A retrospective multicenter cohort study was conducted in RARP patients with PCa at 10 institutions in Japan. Pre- and postoperative covariates were collected from enrolled patients. The primary endpoint was defined as biochemical recurrence-free survival (BRFS). Additionally, the association between BCR and clinicopathological covariates was determined. RESULTS: We enrolled 2670 patients in this study. The median follow-up period was 26.0 months. RARP-related perioperative complications were identified in 198 patients (7.4%), including 69 patients (2.6%) with grade 3/4 complications according to the Clavien-Dindo classification. The 2-year BRFS was 88.0%. Using the Kaplan-Meier method, initial prostate-specific antigen (PSA) level of ≤7.6 ng/mL, biopsy and pathological Gleason score (GS) of ≤7, clinical and pathological T1/2, and low/intermediate risks according to the National Comprehensive Cancer Network risk classification, and negative surgical margin status had significant BRFS than their counterparts. In multivariate analysis, initial PSA, biopsy and pathological GS, clinical and pathological T stage, and surgical margin status significantly correlated with BCR after RARP. CONCLUSION: In this study, RARP achieved a lower incidence of perioperative complications than other studies.

DOI： 10.1111/ases.13074

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

症例は76歳男性。CTで右水腎、腎盂尿管移行部の腫瘤を認め右腎盂癌cT3N0M0の診断となり、腹腔鏡下右腎尿管全摘術を施行した。組織所見ではIgG4陽性細胞を含む花筵状の膠原線維の増生を背景に過形成性のリンパ組織がみられ、形質細胞分化を伴ったB細胞性腫瘍を疑う細胞が認められた。IgG4関連疾患準確診およびIgG4関連腎臓病準確診例であり、それを背景としてindolent B細胞リンパ腫を生じたと考えられた。(著者抄録)

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INTRODUCTION: To determine whether training laparoscopic nephrectomy (LN) with a virtual reality (VR) simulator improves the performance of porcine LN. METHODS: Twelve urological residents were assigned to two groups: a training and a non-training group. All participants performed baseline assessments of LN skills and time on the LapPASS® simulator. The training group received preoperative LapPASS® training. Both groups then performed LN using a porcine model. The operations were videotaped and evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) system. After porcine LN, the training group performed a final LN with the LapPASS® simulator. RESULTS: There was no significant difference in the operation time required for porcine LN. There were no significant differences in the total A (autonomy), B (bimanual dexterity), D (depth perception), or T (tissue handling) GOALS scores. However, the total E (efficiency) score in the training group was higher than that in the non-training group (P = .030). The final LN score with LapPASS® was significantly higher than the baseline (P = .004). CONCLUSIONS: The results of this study demonstrated that VR LN training improved performance in an actual operation. VR-based procedural simulation could become a vital part of the laparoscopic training program for residents.

DOI： 10.1111/ases.13005

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

症例は76歳男性。CTで右水腎、腎盂尿管移行部の腫瘤を認め右腎盂癌cT3N0M0の診断となり、腹腔鏡下右腎尿管全摘術を施行した。組織所見ではIgG4陽性細胞を含む花筵状の膠原線維の増生を背景に過形成性のリンパ組織がみられ、形質細胞分化を伴ったB細胞性腫瘍を疑う細胞が認められた。IgG4関連疾患準確診およびIgG4関連腎臓病準確診例であり、それを背景としてindolent B細胞リンパ腫を生じたと考えられた。(著者抄録)

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INTRODUCTION: Preoperative prediction of surgical difficulty of partial nephrectomy (PN) is essential to minimize the perioperative complications and to achieve a good surgical outcome. Recently, various scoring systems have been used to evaluate the difficulty of PN including R.E.N.A.L (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score. There were no scoring systems evaluating the roughness of the renal tumor surface and we hypothesized that the roughness of the renal tumor surface might affect the surgical difficulty of robot-assisted partial nephrectomy (RAPN). This study aimed to evaluate the impact of roughness of the renal tumor surface on the surgical outcome of RAPN. METHODS: Overall, 161 patients underwent RAPN performed by the same surgeon between May 2016 and April 2019. We divided those tumors into two groups, like "roughness positive (tumor with roughness of tumor surface)" and "roughness negative (tumor without roughness of tumor surface)" according to the roughness of the endophytic region on preoperative computed tomography images. Clinical and pathological outcomes were compared between the two groups. RESULTS: Eighty-five and 78 tumors were identified roughness negative and positive, respectively. Cases with roughness positive showed a significantly longer operative time, console time, and ischemia time and had greater blood loss than those with roughness negative. Significant and independent predictors of ischemia time and estimated glomerular filtration rate (eGFR) decrease were roughness of tumor surface, tumor size (not for eGFR decrease), and N score of the R.E.N.A.L nephrometry score. CONCLUSION: Roughness of renal tumor surface was significantly and positively associated with ischemia time and the eGFR decrease rate.

DOI： 10.1111/ases.13058

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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：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  

【目的】当院でロボット支援腎部分切除術(RAPN)を施行したcT1a症例とcT1b症例の手術成績を比較検討した.【対象と方法】2016年3月から2019年6月までに当院でRAPN施行した210例(T1a:177例,T1b:33例)を対象として後方視的に検討した.【結果】両群間で年齢,性別,患側,BMI,術前eGFRに有意差はみられなかったが,cT1b群でRENAL nephrometry scoreは有意に高かった.cT1b群で手術時間,気腹時間,コンソール時間,阻血時間は有意に長く,出血量もcT1b群の方が有意に多かった.両群間で輸血施行数,合併症発生率,切除断端陽性率に有意差はみられなかった.また,両群間で術前後での腎機能変化率に有意差はみられなかった.【結語】当院でのcT1b腎腫瘍に対するRAPNはcT1aに比べ手術時間,阻血時間,出血量が増えるが,合併症,切除断端,術後腎機能は同等で,安全に施行可能であった.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J05817&link_issn=&doc_id=20210924460024&doc_link_id=%2Fcs5jjend%2F2021%2F003402%2F028%2F0300-0306%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2021%2F003402%2F028%2F0300-0306%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

INTRODUCTION: In laparoscopic surgery, surgical instruments are inserted from a trocar to the target organ in a blind fashion, which carries a risk of organ injury. To clarify the risks associated with surgical instrument insertion, we measured grip strength and pushing/pressing force during surgical instrument insertion in laparoscopic surgery. METHODS: Using forceps with sensors inside a trocar, 10 urologists performed a laparoscopic procedure in pigs, in which they were asked to touch the abdominal wall. The surgeons closed their eyes during the procedure and stopped moving the forceps when they felt them come into contact with the abdominal wall. They were ordered to grip the forceps strongly or softly and to move them rapidly or slowly during the procedure. Grip strength and the pushing/pressing force when the forceps hit the abdominal wall were measured and analyzed. RESULTS: The mean pushing/pressing force when the surgeons gripped the forceps strongly and moved them rapidly (strong/rapid), strongly/slowly, softly/rapidly, and softly/slowly were 2.8, 2.0, 1.7, and 1.1 N, respectively. The pushing/pressing force was significantly greater when the surgeons gripped the forceps strongly, regardless of the forceps speed (P < .001). The pushing/pressing force was significantly greater when the surgeons moved the forceps rapidly, regardless of grip strength (P < .001). CONCLUSIONS: When surgeons insert laparoscopic instruments through trocars, the instruments should be gripped softly and moved slowly to avoid organ injuries.

DOI： 10.1111/ases.12904

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

Lymphoepithelioma-like carcinoma (LELC) of the ureter is very rare and only 14 previous cases have been reported. Here, we report a case of LELC of the ureter. A 76-year-old woman was admitted to our hospital complaining of gross hematuria. Left ureteral cancer was suspected by the imaging examination, and laparoscopic left total nephroureterectomy was performed. Histopathological examination showed pure type of LELC in the ureter. She is alive without disease recurrence at fifteen months after surgery.

DOI： 10.14989/ActaUrolJap_67_5_205

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OBJECTIVES: To assess the correlation of urine loss rate after catheter removal with long-term continence after robot-assisted radical prostatectomy. METHODS: We enrolled 163 patients on whom robot-assisted radical prostatectomy was carried out and whose urine loss rate we were able to evaluate after catheter removal. Urinary incontinence was evaluated from immediately after removal of the catheter to the date of discharge, and at 1, 3, 6 and 12 months after surgery. Urine loss rate was defined as the urine loss volume divided by the total urine volume. RESULTS: The continence rates of patients with ≤1% urine loss rate on the day of catheter removal were 100% at 6 and 12 months after surgery. A multivariate analysis proved that ≤10% urine loss rate on the day of catheter removal was a significant predictor of continence at 3 months after surgery. Furthermore, the continence rate at 12 months of patients who did not achieve ≤10% urine loss rate on the day of catheter removal was 79.5%. Among them, the continence rate at 12 months of patients who achieved ≥15% urine loss rate improvement from the day of catheter removal to the next day was 95.2%; the factor differed significantly between the continence and incontinence groups at 12 months after surgery. CONCLUSIONS: The urine loss rate on the day of catheter removal is significantly related to the acquisition of urinary continence. Furthermore, our findings suggest that long-term urinary continence can be expected, even in the event of poor urine loss rate on the day of catheter removal, if it improves on the next day.

DOI： 10.1111/iju.14488

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

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DOI： 10.1111/iju.14501

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Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare autosomal dominant disorder that results from a germline mutation in the fumarate hydratase gene (FH). Individuals with FH mutations are at risk of developing renal cell carcinoma (RCC). Patients with HLRCC-associated RCC (HLRCC-RCC) have aggressive clinical courses, but there is as yet no standardized therapy for advanced HLRCC-RCC. We report an aggressive RCC case in a 49-year-old man. Nine weeks after undergoing a total nephroureterectomy of the right kidney, he had a metastasectomy at port site. Within 14 weeks of the initial surgery, multiple recurrent tumors developed in the right retroperitoneal space. The pathological diagnosis was FH-deficient RCC. Genetic testing identified a heterozygous germline mutation of FH (c.641_642delTA), which confirmed the diagnosis of HLRCC-RCC. He received combination therapy with the immune checkpoint inhibitors (ICIs) nivolumab and ipilimumab as the first-line therapy. After 31 weeks of ICI treatment, a complete response was achieved. The disease-free condition has been prolonged for 24 months since the initial surgical treatment. This is the first case report of successful treatment of HLRCC-RCC with nivolumab plus ipilimumab. This combination immunotherapy is expected to be an effective approach to treat patients with advanced-stage HLRCC-RCC.

DOI： 10.1007/s10689-020-00195-0

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DOI： 10.1111/iju.14413

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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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AIMS: Hereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant disorder caused by germline mutations in fumarate hydratase (FH). Affected families have an increased risk of renal cell carcinoma (RCC). HLRCC-associated RCC (HLRCC-RCC) is highly aggressive. Clinicopathological information of genetically diagnosed patients with HLRCC-RCC contributes to the establishment of effective therapies. METHODS: Ten Japanese patients with HLRCC-RCC were enrolled in the study. Genetic testing for FH was carried out. Somatic mutations in FH and immunohistochemical analyses of FH and B7 family ligands (PD-L1 and B7-H3) were investigated in 13 tumours. Copy number variations were evaluated in two tumours. RESULTS: All patients had FH germline mutations. Regarding histology, most tumours had type 2 papillary architecture or tubulocystic pattern or both. All tumours were FH deficient by immunohistochemistry. Ten tumours were positive for PD-L1, and 12 tumours were positive for B7-H3. Somatic mutation analysis demonstrated loss of heterozygosity of FH in 10 tumours. Copy number variation analysis revealed uniparental disomy between 1q24.2 and 1q44 encompassing FH; gain of chromosome 2 p was also common. All patients had either metastases or residual tumours. Three patients died of HLRCC-RCC and one of colon cancer, whereas the other six are currently alive, including two without recurrence. CONCLUSIONS: HLRCC-RCCs appear to have unique molecular profiles, including PD-L1 expression. One patient had complete response to immunotherapy, which may be an option for HLRCC-RCC.

DOI： 10.1136/jclinpath-2020-206548

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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：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)  

DOI： 10.1111/iju.14240

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

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OBJECTIVES: To compare the outcomes of radical prostatectomy (RP), intensity-modulated radiation therapy (IMRT), and low-dose-rate brachytherapy (BT) using propensity score matching analysis in patients with clinically localized prostate cancer. METHODS: A group of 2273 patients with clinically localized prostate cancer between January 2004 and December 2015 at the Yokohama City University hospital were identified. The records of 1817 of these patients, who were followed up for a minimum of 2 years, were reviewed; 462 were treated with RP, 319 with IMRT, and 1036 with BT. The patients were categorized according to the National Comprehensive Cancer Network risk classification criteria, and biochemical outcomes and overall survival rates were examined. Biochemical failure for RP was defined as prostate-specific antigen (PSA) levels > 0.2 ng/ml, and for IMRT and BT as nadir PSA level + 2 ng/ml. Propensity scores were calculated using multivariable logistic regression based on covariates, including the patient's age, preoperative PSA, Gleason score, number of positive cores, and clinical T stage. RESULTS: Median follow-up was 77 months for the RP, 54 months for IMRT, and 66 months for BT patients. After the propensity scores were adjusted, a total of 372 (186 each) and 598 (299 each) patients were categorized into RP vs IMRT and RP vs BT groups, respectively. Kaplan-Meier analysis did not show any statistically significant differences in terms of overall survival rate between these groups (RP vs IMRT: p = 0.220; RP vs BT: p = 0.429). IMRT was associated with improved biochemical failure-free survival compared to RP in all risk groups (high-risk: p < 0.001; intermediate-risk: p = 0.009; low-risk: p = 0.001), whereas significant differences were observed only in the intermediate-risk group (p = 0.003) within the RP vs BT group. CONCLUSION: The results of our propensity score analysis of mid-term localized prostate cancer treatment outcomes demonstrated no significant differences in the overall survival rate. Despite the difference in biochemical failure definition between surgery and radiotherapeutic approaches, the results of this study demonstrate improved biochemical control favoring IMRT and BT as compared to RP.

DOI： 10.1007/s00345-019-03056-3

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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：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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DOI： 10.1111/iju.14095

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BACKGROUND: We reported previously the usefulness of 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict prognosis of renal cell carcinoma (RCC) treated with molecular targeted agents. Herein we describe a preliminary research of nine patients who underwent FDG-PET/CT before and after initiation of nivolumab. METHODS: Patients with metastatic RCC who were treated by nivolumab from October 2016 to March 2017 were enrolled in this study. All patients underwent FDG-PET/CT at baseline and 1 month as a first response assessment, and contrast-enhanced or non-contrast-enhanced CT scan at 4 month as a second response assessment. Logistic regression analysis was performed to assess the association of potential predictors, including age, gender, baseline diameter, baseline maximum standardized uptake value (SUVmax), lung or not lung metastasis, elevation of SUVmax at 1st assessment, and decrease in diameter at 1st assessment with the response at 2nd assessment (decrease in the diameter ≥ 30% or not). RESULTS: There were 9 patients and 30 lesions. Mean days of first assessment with FDG-PET/CT and second assessment by CT scan from initiation of treatment were 32.3 ± 6.4, 115.5 ± 14.9, respectively. Lesions whose diameter decreased ≥30% at second assessment were defined as responding, and lesions whose diameter did not decrease ≥30% were defined as non-responding. There were 18 responding lesions, and 12 non-responding lesions. We compared change in diameter and SUVmax at first assessment with FDG-PET/CT, respectively. All lesions with decreased diameter and elevated SUVmax at first assessment with FDG-PET/CT showed responding at second assessment by CT scan, while most lesions with increased diameter and declined SUVmax at first assessment showed non-responding at second assessment. The multivariate logistic regression analyses revealed that only the elevation of SUVmax at 1 month was an independent predictor (P = 0.025, OR: 13.087, 95%CI: 1.373-124.716). CONCLUSION: Our findings suggest that the early assessment using FDG-PET/CT can be effective to predict the response of RCC to nivolumab. However, larger prospective studies are needed to confirm these preliminary results. TRIAL REGISTRATION: Registered in University Hospital Medical Information Network in JAPAN [ UMIN0000008141 ], registration date: 11 Jun 2012.

DOI： 10.1186/s12885-019-5510-y

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OBJECTIVE: Urethral stenosis is a disease in which the lumen of the urethra becomes constricted by fibrosis. Such stenoses have been treated by urethral dilation using a bougie and optical internal urethrotomy (OIU). Recently, high-pressure balloon dilation (BD) has been developed as a new treatment method for urethral stenosis. The present study compared the effectiveness of urethral dilation by BD and OIU. METHODS: Twenty-two patients of urethral stenosis were treated at Yokohama City University Medical Center between 2005 and 2015. Of these, 13 underwent BD, whereas OIU was performed in 9. BD was performed at 30 atm twice for 5 min each time. In OIU, an endoscopic knife was used to cut out the stenotic lesion in 3 directions. The endpoint was set as restenosis, which required additional surgical treatment, including BD, OIU, and the use of a urethral bougie. RESULTS: The causes of urethral stricture were endoscopic surgery (n = 7; 31.8%), development after total prostatectomy (n = 4; 18.2%), iatrogenic reasons associated with catheter insertion (n = 5; 22.7%), development after a prostate needle biopsy (n = 3; 13.6%), and unknown (n = 3; 13.6%). The site of the stenotic lesion site was the anastomosis (n = 3; 13.6%), bladder neck (n = 6; 27.3%), prostatic urethra (n = 4; 18.2%), anterior urethra (n = 7; 31.8%), and membranous urethra (n = 2; 9.1%). The stenosis-free rate was 84% for those undergoing BD and 22% for those receiving OIU. The median stenosis-free time was significantly longer after BD than OIU (1675 vs. 244 days, respectively; P < .01). CONCLUSION: The stenosis-free time was significantly longer after BD than OIU.

DOI： 10.1111/luts.12208

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Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder cancer. Robot-assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot-assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high-volume academic institutions. In the present review, we compare the totally intracorporeal robot-assisted radical cystectomy approach with open radical cystectomy and robot-assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle-invasive bladder cancer patients.

DOI： 10.1111/iju.13900

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Bentham Science Publishers B.V.  

Background: Renal transplantation is a useful option for allowing female renal failure patients of childbearing age to achieve pregnancy. However, there have been a few reports on the effects of renal transplantation on infertility treatment in male renal failure patients. We herein report two cases in which male patients underwent infertility treatment after renal transplantation. Case Presentation: Case 1: A 51-year-old Asian (Japanese) man underwent transplantation (the donor was his wife) for renal failure due to Autosomal Dominant Polycystic Kidney Disease (ADPKD). At two years after transplantation, he visited the reproduction center in our institute due to infertility. A semen analysis revealed oligoasthenozoospermia. He ultimately failed to achieve pregnancy and gave up on infertility treatment. Case 2: A 47-year-old Asian (Japanese) man underwent renal transplantation (the donor was his sister) due to renal failure caused by diabetes mellitus. At three years after renal transplantation, he visited the reproduction center in our institute for infertility. Due to ejaculation disability and the absence of sperm in the patient’s urine after masturbation, he was diagnosed with anejaculation. Thus, testicular sperm extraction (TESE) was performed. Twenty-three motile spermatozoa were successfully retrieved by microdissection TESE (micro-TESE). ICSI was subsequently performed and a good embryo was transferred. His wife achieved pregnancy and is expected to deliver this October. Conclusion: We report two cases of male infertility treatment after renal transplantation.

DOI： 10.2174/1874303X01912010001

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Introduction and Objectives: The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a simple marker of the systemic inflammatory response in critical care patients. The NLR can be easily calculated from routine complete blood counts in the peripheral blood. This parameter has been reported to be an independent prognosticator for some solid malignancies. In the present study, we examined the importance of the NLR as a prognostic marker for castration-resistant prostate cancer (CRPC) patients who received docetaxel- (DOC-) based chemotherapy. Methods: We analyzed a total of 73 patients who received DOC chemotherapy for CRPC in Yokohama City University Medical Center and affiliated hospitals. Complete blood cell counts were performed, and the NLR was calculated using the neutrophil and lymphocyte counts obtained on the same day or a few days before the initiation of DOC chemotherapy. We determined the NLR cutoff value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. Results: The median overall survival (OS) after DOC was 21.0 months (range: 2.0-51.0). The median OS was shorter in patients with a high NLR (≥2.59) than in those with a low NLR (<2.59) (12.0 versus 31.6 months, p=0.001). In the multivariate analysis, the NLR and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.643, p=0.001; hazard ratio 2.184, p=0.038, respectively). Conclusions: The higher NLR group showed a significantly poorer OS than the lower NLR group. Pre-DOC NLR might be a new marker for predicting the prognosis of patients who receive DOC chemotherapy.

DOI： 10.1155/2019/2535270

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BACKGROUND: Bladder cancers have been characterized as a tumor group in which the immunological response is relatively well preserved. Programmed death ligand 1 (PD-L1, B7-H1, CD274) has been shown to be expressed in several malignancies, including bladder cancer. However, the clinicopathological impact of this biomarker has not yet been established. In the present study, a quantitative real-time polymerase chain reaction (qPCR) was performed using paired normal and cancerous bladder cancer tissue to investigate PD-1/PD-L1 gene expression. METHODS: We examined the mRNA expression of PD-1/PD-L1 by a qPCR using 58 pairs of normal and cancerous human bladder tissue specimens. We also examined the correlation with the expressions of the STAT1 and NFAT genes, which are thought to be upstream and downstream of the PD-L1 pathway, respectively. RESULTS: There were no significant differences between normal and cancerous tissue in the expression of the PD-1 and PD-L1 genes (p = 0.724 and p = 0.102, respectively). However, PD-1 and PD-L1 were both more highly expressed in high-grade bladder cancer than in low-grade bladder cancer (p < 0.050 and p < 0.010). PD-L1 was positively correlated with the expressions of both the STAT1 (r = 0.681, p < 0.001) and the NFATc1 genes (r = 0.444. p < 0.001). CONCLUSIONS: PD-1 and PD-L1 might be a new biomarker that correlates with the pathological grade of bladder cancer. PD-L1 might function as a mediator of stage progression in bladder cancer and STAT1-NFAT pathway might associate this function.

DOI： 10.1186/s12894-018-0414-8

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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：Japanese   Publisher：日本老年泌尿器科学会  

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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)   Publisher：Elsevier USA  

Post–kidney transplantation progressive multifocal leukoencephalopathy (PML) is a rare disease on which there are very few published reports on record. PML is a demyelinating disease caused by a destructive infection of the oligodendrocytes by the JC polyomavirus. No effective therapeutic protocol has been established other than measures to revive the immune function by reducing or discontinuing the administration of immunosuppressive agents. Most cases are progressive and show a poor prognosis. We herein report a case in which renal function has been maintained for 2 years following the onset of PML, which was initially diagnosed 3 years after kidney transplantation.

DOI： 10.1016/j.transproceed.2018.02.194

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

Background: Sarcopenia is a condition in which the amount of skeletal muscle decreases. Recent studies have suggested that sarcopenia is a risk factor for the incidence of postoperative complications, longer hospitalization, and a poorer prognosis. In this study, we examined the impact of sarcopenia in association with a history of hemodialysis in renal transplantation patients. Methods: A total of 157 patients who underwent renal transplantation at Yokohama City University Medical Center (Yokohama, Japan) from 2005 to 2016 were analyzed in this study. We determined the presence of sarcopenia using the psoas muscle index (PMI). The PMI was calculated based on the left psoas muscle area of L3 (mm2) divided by the square of the body height (m2). Results: The mean/median length of time that the patients received hemodialysis was 2059/850 days. The PMI in men was significantly higher than that in women (321.9 ± 10.0 vs 226.6 ± 17.3, P &lt
.001). The group with a longer history of hemodialysis (≥851 days) showed a significantly lower PMI than the short-history group (≤850 days) (355.8 ± 15.1 vs 289.7 ± 11.3, P =.001). The PMI showed a negative correlation according to the dialysis period and a positive correlation according to the sex and triglyceride levels. Conclusions: A longer history of hemodialysis was shown to be associated with a lower PMI in renal transplantation patients. In addition, the higher PMI group showed higher serum triglyceride levels than the lower PMI group.

DOI： 10.1016/j.transproceed.2018.02.192

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

Objectives: Because of recent developments in im - munosuppressive therapy, renal transplant outcomes have improved. Although reports on the association between immunosuppressive therapy and malignant disease are available, the results are controversial. The neutrophil-to-lymphocyte ratio has been reported as an easy tumor marker for predicting the prognoses of some solid tumors. In the present study, we examined changes in neutrophil-to-lymphocyte ratio after renal transplant and discussed cases in which malignant disease developed after renal transplant. Materials and Methods: Our study included 137 patients who underwent renal transplant between August 2001 and September 2015. Four of these patients (2.9%) developed malignant disease. The neutrophil-tolymphocyte ratio was calculated based on the numbers of neutrophils and lymphocytes in the complete blood count and evaluated before and at 1, 3, 6, and 12 months and at 3 years after renal transplant. Results: The neutrophil-to-lymphocyte ratio was markedly high at 1 week and 1 month after renal transplant and gradually decreased until it became stable at 3 months posttransplant. In patients with malignant disease, there was a gradual increase in the neutrophil-to-Iymphocyte ratio after renal transplant. Conclusions: We observed dramatic differences in the neutrophil-to-lymphocyte ratio at 1 and 3 months after renal transplant. The neutrophil-to-lymphocyte ratio of patients with malignant disease after renal transplant continued to increase.

DOI： 10.6002/ect.2017.0098

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OBJECTIVES: Because of recent developments in immunosuppressive therapy, renal transplant outcomes have improved. Although reports on the association between immunosuppressive therapy and malignant disease are available, the results are controversial. The neutrophil-to-lymphocyte ratio has been reported as an easy tumor marker for predicting the prognoses of some solid tumors. In the present study, we examined changes in neutrophil-to-lymphocyte ratio after renal transplant and discussed cases in which malignant disease developed after renal transplant. MATERIALS AND METHODS: Our study included 137 patients who underwent renal transplant between August 2001 and September 2015. Four of these patients (2.9%) developed malignant disease. The neutrophil-to-lymphocyte ratio was calculated based on the numbers of neutrophils and lymphocytes in the complete blood count and evaluated before and at 1, 3, 6, and 12 months and at 3 years after renal transplant. RESULTS: The neutrophil-to-lymphocyte ratio was markedly high at 1 week and 1 month after renal transplant and gradually decreased until it became stable at 3 months posttransplant. In patients with malignant disease, there was a gradual increase in the neutrophil-to-Iymphocyte ratio after renal transplant. CONCLUSIONS: We observed dramatic differences in the neutrophil-to-lymphocyte ratio at 1 and 3 months after renal transplant. The neutrophil-to-lymphocyte ratio of patients with malignant disease after renal transplant continued to increase.

DOI： 10.6002/ect.2017.0098

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Birt-Hogg-Dubé (BHD) syndrome is a hereditary kidney cancer syndrome, which predisposes patients to develop kidney cancer, cutaneous fibrofolliculomas and pulmonary cysts. The responsible gene FLCN is a tumor suppressor for kidney cancer, which plays an important role in energy homeostasis through the regulation of mitochondrial oxidative metabolism. However, the process by which FLCN-deficiency leads to renal tumorigenesis is unclear. In order to clarify molecular pathogenesis of BHD-associated kidney cancer, we conducted whole-exome sequencing analysis using next-generation sequencing technology as well as metabolite analysis using liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry. Whole-exome sequencing analysis of BHD-associated kidney cancer revealed that copy number variations of BHD-associated kidney cancer are considerably different from those already reported in sporadic cases. In somatic variant analysis, very few variants were commonly observed in BHD-associated kidney cancer; however, variants in chromatin remodeling genes were frequently observed in BHD-associated kidney cancer (17/29 tumors, 59%). Metabolite analysis of BHD-associated kidney cancer revealed metabolic reprogramming toward upregulated redox regulation which may neutralize reactive oxygen species potentially produced from mitochondria with increased respiratory capacity under FLCN-deficiency. BHD-associated kidney cancer displays unique molecular characteristics that are completely different from sporadic kidney cancer, providing mechanistic insight into tumorigenesis under FLCN-deficiency as well as a foundation for development of novel therapeutics for kidney cancer.

DOI： 10.1093/hmg/ddy181

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Urologists frequently encounter malignant ureteral obstruction (MUO) caused by advanced urological or non-urological malignant disease, but the treatment policy is unclear. The present study examined the risk factors for predicting ureteral stent failure in patients with MUO after ureteral stent insertion and the change in the renal function after retrograde ureteral stent insertion in cases of bilateral hydronephrosis. Methods: A total of 39 patients who required ureteral stent placement for MUO at Yokohama City University Medical Center (Yokohama, Japan) between February 2007 and May 2016 were included in this study. The age, gender, type of cancer, hydronephrosis side, pre-stenting estimated glomerular filtration rate (eGFR), and eGFR increase were assessed as predictive factors for stent failure. Among these 39 patients, 25 showed bilateral hydronephrosis. Thirteen of these patients had bilateral ureteral stents placed, and the remaining 12 had a unilateral ureteral stent placed. The renal function and overall survival (OS) were analyzed between these two groups. Results: Among all 39 patients, 9 (23.1%) had stent failure. A univariate analysis revealed that causative disease (gastrointestinal cancer vs. others
p = 0.045) and laterality of hydronephrosis (bilateral vs. unilateral
p = 0.05) were associated with stent failure. A multivariate analysis revealed that only age (hazard ratio, 0.938
95% confidence interval, 0.883-0.996
p = 0.038) was associated with stent failure. A Kaplan-Meier analysis and log-rank test indicated that having a unilateral ureteral stent placed was not correlated with a lower OS rate than having bilateral ureteral stents placed (p = 0.563). Among patients with bilateral hydronephrosis, the increase in the eGFR of those who had bilateral ureteral stents placed was not significantly different from that of those who had a unilateral ureteral stent placed (p = 0.152). Conclusions: We revealed that age &gt
60 years was helpful for predicting stent failure. MUO due to gastrointestinal cancer and bilateral hydronephrosis may be predictive of stent failure. These factors may help urologists decide the optimal time to perform early percutaneous nephrostomy. These findings suggest that patients with bilateral hydronephrosis do not necessarily need to have a ureteral stent placed into both sides of the hydronephrosis.

DOI： 10.1186/s12894-018-0346-3

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は69歳女性。透析期間19年を経て2011年12月に献腎移植が施行され、Cr 1.6mg/dLで退院となった。その後尿管狭窄による急性腎盂腎炎となり尿管ステントが留置された。2012年4月に術後リンパ漏を認め、リンパ漏腹腔内ドレナージ術を施行した。尿管ステントの抜去を試みるもすぐに水腎症、急性腎盂腎炎をきたしたため、尿管ステントの定期交換を施行していた。有熱性尿路感染症を何度も繰り返し、感染のコントロールに難渋したため、開腹膀胱尿管再吻合術を施行する方針となった。2016年11月尿管再吻合術を施行した。術後5ヵ月目に尿管ステントを抜去し、現在までトラブルなく経過している。(著者抄録)

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は26歳男性。Hypoparathyroidism、Deafness and Renal dysplasia(HDR)症候群に伴う両側低形成腎による末期腎不全で25歳時に血液透析導入となった。今回、血液透析導入後11ヵ月で母親をドナーとしたABO不適合生体腎移植を施行した。現在、術後1年2ヵ月経過しているが、拒絶反応もなく、腎機能は良好に経過している。HDR症候群は副甲状腺機能低下・感音性難聴・腎形成不全を3主徴とする常染色体優性遺伝疾患で、極めて稀である。これまでHDR症候群に伴う慢性腎不全に対しての腎移植は国内外問わず報告されていないが、多様な合併症を把握し、腎移植後も副甲状腺機能低下症に伴う低Ca血症、高Ca尿症に留意し経過を見ることで、通常の腎移植例と同等の成績が得られる可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は52歳男性。50歳時に末期腎不全、心不全と診断され心エコーで重度大動脈弁閉鎖不全症を認めた。腎移植を希望されたが腎移植術時の心不全リスクが高く、血液透析を導入し機械弁による大動脈弁置換術を先行して施行した。弁置換術後1年2ヵ月で妻をドナーとする生体腎移植を施行した。周術期はワルファリンをヘパリン置換し、術前にヘパリンを中止し手術を行い出血性・血栓性合併症なく終了した。術翌日よりヘパリンを再開し、術後4日目にワルファリンを再開、術後23日目に退院した。重度弁膜症を合併する非心臓疾患患者は弁膜症治療を優先させるのが原則であるが、弁置換術後でも安全に生体腎移植術は施行可能であると考えられた。(著者抄録)

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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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PURPOSE: We investigated prospectively whether 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) can predict the overall survival (OS) of patients with advanced renal cell carcinoma (RCC) previously treated by molecular targeted therapies. METHODS: Between 2009 and 2016, 81 patients who had received single molecular targeted therapies (43 sorafenib, 27 sunitinib, 8 temsirolimus and others) and were scheduled for second line molecular targeted therapies for advanced RCC were enrolled in this prospective study. FDG PET/CT was performed after first line molecular targeted therapies, the max SUVmax (highest standardized uptake value for each patient) recorded, and its association with OS compared with those of known risk factors. The median follow-up was 15.4 months (range 0.9-97.4 months). RESULTS: The max SUVmax of the 81 subjects ranged from undetectable to 23.0 (median 7.1). Patients with high max SUVmax had a poor prognosis and multivariate analysis with established risk factors showed that it was an independent predictor of survival (p < 0.001; hazard ratio 1.156; 95% confidence interval 1.080-1.239). Subclassification of patients by max SUVmax showed that the median OS of patients with max SUVmax < 7.0 (39), 7.0-12.0 (30), and ≥ 12.0 (12) were 32.8, 15.2, and 6.0 months, respectively. These differences are statistically significant (< 7.0 versus 7.0-12.0: p = 0.0333, 7.0-12.0 versus ≥ 12.0: p = 0.0235). CONCLUSIONS: The max SUVmax by FDG PET/CT of patients with RCC evaluated after their first molecular targeted therapy predicts OS. FDG PET/CT is a useful "imaging biomarker" for patients with advanced RCC planning sequential molecular targeted therapies.

DOI： 10.1007/s00280-018-3542-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Female urethral carcinoma is a very rare disease that accounts for 0.02% of malignant diseases in female patients. Case presentation: A 70-year-old Asian Japanese woman with a urethral tumor was referred to our hospital to undergo further examination. Biopsy specimens showed urethral adenocarcinoma that was positive for prostate-specific antigen. Her serum prostate-specific antigen level before surgery was 34.4 ng/ml. Urethral tumor resection with pelvic lymph node resection was performed. Her serum prostate-specific antigen level decreased to &lt
0.01 ng/ml after surgery. Conclusions: We report a very rare case of Skene duct adenocarcinoma in a female patient with serum prostate-specific antigen elevation.

DOI： 10.1186/s13256-017-1558-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

Recent studies have revealed that transurethral resection in one piece (TURBO) has several benefits over standard transurethral resection of bladder tumor (TUR-Bt), including a higher rate of containing the bladder muscle tissue and single-block resection. Five-aminolevulinic acid (5-ALA) was approved for the detection of bladder tumor treated with TUR-Bt. A 71-year-old male patient who received right nephroureterectomy developed bladder tumor recurrence on routine cystoscopy follow-up. We planned TURBO using fluorescent light-guided cystoscopy with 5-ALA. We herein report a case of bladder tumor successfully treated with TURBO using fluorescent light-guided cystoscopy with 5-ALA to detect the tumor surgical margin.

DOI： 10.1159/000487390

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This study aimed to develop a prediction model for the operative time of flexible ureteroscopy (fURS) for renal stones. We retrospectively evaluated patients with renal stones who had been treated successfully and had stone-free status determined by non-contrast computed tomography (NCCT) 3 months after fURS and holmium laser lithotripsy between December 2009 and September 2014 at a single institute. Correlations between possible factors and the operative time were analyzed using Spearman's correlation coefficients and a multivariate linear regression model. The P value < 0.1 was used for entry of variables into the model and for keeping the variables in the model. Internal validation was performed using 10,000 bootstrap resamples. Flexible URS was performed in 472 patients, and 316 patients were considered to have stone-free status and were enrolled in this study. Spearman's correlation coefficients showed a significant positive relationship between the operation time and stone volume (ρ = 0.417, p < 0.001), and between the operation time and maximum Hounsfield units (ρ = 0.323, p < 0.001). A multivariate assessment with forced entry and stepwise selection revealed six factors to predict the operative time of fURS: preoperative stenting, stone volume, maximum Hounsfield unit, surgeon experience, sex, and sheath diameter. Based on this finding, we developed a model to predict operative time of fURS. The coefficient of determination (R2) in this model was 0.319; the mean R2 value for the prediction model was 0.320 ± 0.049. To our knowledge, this is the first report of a model for predicting the operative time of fURS treatment of renal stones. The model may be used to reliably predict operative time preoperatively based on patient characteristics and the surgeons' experience, plan staged URS, and avoid surgical complications.

DOI： 10.1371/journal.pone.0192597

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Introduction: Horseshoe kidney is one of the most common congenital renal fusion anomalies. Due to its poor mobility and abnormal vasculature form, surgeons should pay close attention to all anatomical variations. Case Presentation: An 83-year-old woman was referred to our hospital because of left renal tumor in a horseshoe kidney incidentally found by her previous hospital. We performed laparoscopic partial nephrectomy. The pathological diagnosis was clear cell renal cell carcinoma. G2 INFα V-pT1a with a negative surgical margin. No evidence of recurrence has been noted, and the renal function is well preserved at 28 months after surgery. Conclusion: When performing laparoscopic partial nephrectomy for renal carcinoma, especially a horseshoe kidney, preoperative imaging is crucial for identifying the location of the renal vessels.

DOI： 10.1155/2018/7135180

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

Succinate dehydrogenase-deficient renal cell carcinoma (SDH-deficient RCC) is a newly introduced histological type of RCC, which is caused by loss of subunit genes of SDH. It is known to frequently demonstrate familial occurrence and be frequently associated with gastrointestinal stromal tumors and paraganglioma. To date, only 53 cases have been reported. Here, we present an additional case of SDH-deficient RCC occurring in a 40-year-old female. The tumor was histologically biphasic, consisting of tubular and solid architectures. The tumor cells possessed oval nuclei with small nucleoli, and an eosinophilic granular cytoplasm with occasional vacuoles. These cells completely lost the immunohistochemical expression of B subunit of SDH (SDHB). Consequently, the tumor was diagnosed as SDHB-deficient RCC. We identified a novel germ line mutation of the SDHB gene, and also confirmed a hemizygous deletion of the wild-type allele in the tumor cells. To define the pathological characteristics of SDH-deficient RCC, precise diagnosis and accumulation of more cases are required.

DOI： 10.1111/pin.12587

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BACKGROUND: Primary large cell neuroendocrine carcinoma of the kidney is a rare and generally very aggressive disease. We present a case of a patient with primary large cell neuroendocrine carcinoma of the kidney with cardiac metastasis. CASE PRESENTATION: A 59-year-old Japanese man presented to his previous physician with hematuria. Computed tomography revealed masses in the heart and right kidney, and fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the heart. A cardiac biopsy under transesophageal echocardiographic guidance revealed a metastatic tumor. Subsequently, multiple lung lesions were detected, and a right nephrectomy was performed after these metastases were suspected to have originated from renal carcinoma. Large cell neuroendocrine carcinoma of the kidney was ultimately diagnosed. Pancreatic metastasis was detected on computed tomography postoperatively. Three courses of chemotherapy with carboplatin and irinotecan were administered, and were temporarily effective against the metastatic lesions in the lungs and pancreas. However, our patient's general condition deteriorated with the progression of the lesions, and he died 9 months after his initial examination. CONCLUSIONS: Multi-agent chemotherapy, including platinum-based drugs was effective against large cell neuroendocrine carcinoma metastases, albeit only temporarily. This is the first reported case of large cell neuroendocrine carcinoma with cardiac metastasis.

DOI： 10.1186/s13256-017-1460-7

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Language：Japanese   Publisher：腎移植・血管外科研究会  

IgA腎症は腎糸球体メサンギウム領域へのIgAと補体C3沈着により慢性的な糸球体毛細血管炎が発症・進展し、腎機能低下を来すことが特徴である。症例は64歳男性で60歳時に原疾患不明の末期腎不全の息子に腎提供した。術後2年を過ぎた頃から蛋白尿が出現し、腎生検を施行しIgA腎症の診断となり、扁桃腺摘出後ステロイドパルス療法が施行された。現在、臨床症状なく腎機能も安定している。ドナーからのIgA沈着症は一定頻度、移植後生検で報告されており、腎提供後にドナーがIgA腎症を発症する可能性も十分考えうる。しかし本邦で腎提供後にドナーで発症した報告は少ない。今回、我々は腎提供後にIgA腎症を発症したドナーの1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Recently, sarcopenia has been reported as a new predictor for patient outcomes or likelihood of post-operative complications. The purpose of this study was to evaluate the association of the psoas muscle volume with the length of hospitalization among patients undergoing radical cystectomy. Methods: A total of 63 (80.8%) male patients and 15 (19.2%) female patients who underwent radical cystectomy for their bladder cancer in our institution from 2000 to 2015 were analyzed. The psoas muscle index (PMI) was calculated by normalizing the psoas muscle area calculated using axial computed tomography at the level of the umbilicus (cm2) by the square of the body height (m2). Longer hospitalization was defined as hospitalization exceeding 30 days after surgery. Results: The median PMIs (mean ± standard deviation) were 391 (394 ± 92.1) and 271 (278 ± 92.6) cm2/m2 in men and women, respectively. Thus, the PMIs of male patients were significantly larger than those of females (p &lt
0.001). Based on the differences in gender, we analyzed 63 male patients for a further analysis. In male patients, those hospitalized longer showed a significantly smaller PMI than those normally discharged (377 ± 93.1 vs. 425 ± 83.4
p = 0.04). Similarly, male patients with a small PMI (&lt
400) had a significantly worse overall survival (p = 0.02) than those with a large PMI (≥400). Conclusions: The presence of sarcopenia was found to be associated with significantly longer hospitalization after radical cystectomy in male patients. Furthermore, in men, a PMI &lt
400 may suggest a significantly worse prognosis.

DOI： 10.1186/s12894-017-0279-2

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Background: The neutrophil-to-lymphocyte ratio (NLR) is reported as a biomarker for some solid malignant diseases. Thus far, however, no reports of the relationship between the NLR and adrenal tumors have been published. We analyzed the utility of the preoperative NLR as a biomarker for predicting the prognosis or diagnosis of malignant disease.
Methods: A total of 59 patients with adrenal tumors (13 cases of malignant disease and 46 with benign disease) were analyzed in this study from February 2004 to June 2015 at our institute. The NLR was obtained just before adrenalectomy. The diagnosis of adrenal tumor was confirmed by a pathological examination of surgical specimens.
Results: The NLR in malignant adrenal tumor specimens was significantly higher than in non-malignant specimens (p = 0.028). Adrenocortical carcinoma (ACC) showed the highest NLR among all adrenal tumors. In ACC, the higher NLR group (NLR &gt;= 5) showed a significantly poorer overall survival than the lower NLR group (NLR &lt; 5) ( p = 0.032).
Conclusions: In adrenal tumors, a higher NLR indicates a higher incidence of malignancy. The NLR might be a new biomarker for predicting the prognosis of adrenal tumor patients.

DOI： 10.1186/s12894-017-0240-4

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

慢性腎臓病患者は様々な原因で妊娠率が低いと言われている。腎移植を行うことで性ホルモンが改善され、透析患者に比べて妊娠率の上昇を認めている。当科で腎移植後フォロー中に妊娠出産に至った4例について検討を行った。免疫抑制療法は全例で維持量であった。全例、母児ともに合併症はなく出産することができた。1例のみ出産後4年で移植腎廃絶に至ってしまった。腎移植により妊娠率は上昇したが、依然ハイリスク分娩である。移植と妊娠についてのガイドラインは現在作成中だが、妊娠前の腎機能はS-Cr1.5mg/dL前後が推奨されており、血圧管理や貧血の治療を積極的に行うことでより安全な妊娠・出産が可能であるとされている。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CANADIAN UROLOGICAL ASSOCIATION  

Introduction: We aimed to develop a scoring system to quantify the distance between the renal hilum and renal tumour, termed the modified C index (m-CI), and to predict renal functional loss (RFL) following laparoscopic partial nephrectomy (LPN).
Methods: The m-CI was measured by using computed tomography in 113 patients who underwent LPN between May 2003 and June 2014. The RFL following LPN was calculated by examining the estimated glomerular filtration rate (eGFR) and radioisotope renography one year postoperatively. The Pythagorean theorem was used to calculate the distance from the tumour centre to the renal hilum. The distance was divided by the tumour radius to obtain the m-CI. The correlation between the m-CI and the postoperative RFL were evaluated using Pearson's coefficient values. Multivariate logistic regression models were used to assess the potential predictive factors of RFL following LPN. The correlation between the m-CI and the operative time, ischemia time, and blood loss during LPN were also evaluated by the unpaired t-test.
Results: Pearson's coefficient values between the postoperative RFL and the m-CI and C index were 0.294 and 0.173, respectively. In the multivariate analysis, the resected volume (p=0.031) and m-CI (p=0.036) significantly correlated with the postoperative RFL following LPN. The operative time (p&lt;0.001), ischemia time (p=0.028), and blood loss (p=0.047) during LPN was significantly longer and larger, respectively, in the group with shorter m-CI (&lt;= 4.5) than in the group with the longer m-CI (&gt;4.5).
Conclusions: The present study demonstrates that the m-CI can predict RFL following LPN, as well as the surgical difficulty.

DOI： 10.5489/cuaj.4192

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PURPOSE: We evaluated 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) results as outcome predictors for patients with metastatic renal cell carcinoma (RCC) treated by everolimus (EVL), an inhibitor of mammalian target of rapamycin. METHODS: We retrospectively reviewed 30 patients who were treated with EVL for metastatic RCC between May 2010 and March 2015, by evaluating their FDG PET/CT result before and 1 month after starting EVL treatment. We examined the relationships between each patient's maximum standardized uptake value (max SUVmax) assessed by FDG PET/CT on progression-free survival (PFS) and overall survival (OS). RESULTS: Median PFS for all 30 patients was 3.77 months (range 0.72-24.56 months) and median OS after EVL treatment of all 30 patients was 11.67 months (range 1.0-62.98 months). Enrolled patients were divided into two groups by max SUVmax prior to EVL (median = 7.6) and at 1 month after EVL treatment (median = 5.7). PFS were significantly shorter in higher max SUVmax prior to EVL (<7.6, PFS 7.8 vs 3.5 months, log-rank P = 0.017) and at 1 month after EVL (<5.7, PFS 10.6 vs 2.7 months, log-rank P = 0.002) than lower max SUVmax. OS were also significantly shorter in higher max SUVmax prior to EVL (<7.6, OS 18.1 vs 7.5 months, log-rank P = 0.010) and at 1 month after EVL (<5.7, OS 17.2 vs 7.5 months, log-rank P = 0.009) than lower max SUVmax. Multivariate Cox hazard regression analysis indicated that max SUVmax at 1 month after EVL is an independent predictor of both PFS and OS in patients treated with EVL although univariate regression analysis showed max SUVmax before EVL is a possible predictor. CONCLUSIONS: Max SUVmax assessed by FDG PET/CT prior to EVL and at 1 month after EVL treatment can accurately predict PFS and can guide decisions on whether to continue or change treatments for patients with EVL-treated RCC who suffer from adverse events.

DOI： 10.1007/s00280-017-3275-z

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

Backround Laparoscopic surgical techniques are difficult to learn, and developing such skills involves a steep learning curve. To ensure surgeons achieve a high skill level, it is important to be able to measure and assess their skills. Therefore, it is necessary to understand the performance differences between experienced and novice surgeons, as such information could be used to help surgeons learn laparoscopic skills. We examined the differences in gripping and reaction force between experienced and novice surgeons during laparoscopic surgery.
Methods We measured the gripping force generated during laparoscopic surgery performed on pigs using forceps with pressure sensors. Several sensors, including strain gauges, accelerometers, and a potentiometer, were attached to the forceps. This study included 4 experienced and 4 novice surgeons. Each subject was asked to elevate the kidney in order to approach the renal hilus using the forceps. Throughout the experiment, we measured the gripping force and reaction force generated during the movement of the forceps in real time.
Results The experienced and novice surgeons exhibited similar reaction force levels. Conversely, gripping force differed significantly between the groups. The experienced and novice surgeons exhibited mean gripping force levels of 3.06 and 7.15 N, respectively. The gripping force standard deviation values for the experienced and novice surgeons were 1.43 and 3.54 N, respectively. The mean and standard deviation gripping force values of the experienced surgeons were significantly lower than those of the novice surgeons (P = 0.015 and P = 0.011, respectively).
Conclusions This study indicated that experienced surgeons generate weaker but more stable gripping force than novice surgeons during laparoscopic procedures.

DOI： 10.1007/s00464-016-5153-x

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Germline H255Y and K508R missense mutations in the folliculin (FLCN) gene have been identified in patients with bilateral multifocal (BMF) kidney tumours and clinical manifestations of Birt-Hogg-Dubé (BHD) syndrome, or with BMF kidney tumours as the only manifestation; however, their impact on FLCN function remains to be determined. In order to determine if FLCN H255Y and K508R missense mutations promote aberrant kidney cell proliferation leading to pathogenicity, we generated mouse models expressing these mutants using BAC recombineering technology and investigated their ability to rescue the multi-cystic phenotype of Flcn-deficient mouse kidneys. Flcn H255Y mutant transgene expression in kidney-targeted Flcn knockout mice did not rescue the multi-cystic kidney phenotype. However, expression of the Flcn K508R mutant transgene partially, but not completely, abrogated the phenotype. Notably, expression of the Flcn K508R mutant transgene in heterozygous Flcn knockout mice resulted in development of multi-cystic kidneys and cardiac hypertrophy in some mice. These results demonstrate that both FLCN H255Y and K508R missense mutations promote aberrant kidney cell proliferation, but to different degrees. Based on the phenotypes of our preclinical models, the FLCN H255Y mutant protein has lost it tumour suppressive function leading to the clinical manifestations of BHD, whereas the FLCN K508R mutant protein may have a dominant negative effect on the function of wild-type FLCN in regulating kidney cell proliferation and, therefore, act as an oncoprotein. These findings may provide mechanistic insight into the role of FLCN in regulating kidney cell proliferation and facilitate the development of novel therapeutics for FLCN-deficient kidney cancer.

DOI： 10.1093/hmg/ddw392

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

Background: Tyrosine-kinase inhibitor (TKI) targeting angiogenesis improves the prognosis of patients with metastatic renal cell carcinoma (RCC), but its effect is temporary. In order to understand the mechanism by which RCC acquires resistance to TKI, we investigated the change of glucose accumulation in RCC by FDG PET/CT when they demonstrated progression disease (PD) against TKI.
Methods: We monitored the FDG accumulation in RCC of 38 patients treated with TKI by 162 PET/CT sequentially until they were judged to demonstrate PD. Standardized uptake value (SUV), a simplified index of tissue FDG accumulation rate, was measured, and the sequential changes of max SUVmax (the highest SUV in an individual patient) was analyzed. Additionally, the expression of glucose transporter 1 (GLUT-1) and associated proteins in 786-O cells cultured under hypoxia were analyzed.
Results: The 10 patients with RCC which FDG accumulation was accelerated after beginning of TKI treatment demonstrated PD soon. The other 28 patients with RCC which FDG accumulation was suppressed by TKI showed longer progression-free survival (3.6 months vs 6.5 months, P = 0.0026), but this suppression in most cases (96%) was temporary and FDG accumulation was accelerated when tumor demonstrated PD. Interestingly, the FDG accumulation at PD was higher than that before TKI treatment in the half cases. The acceleration of FDG accumulation was suppressed by following treatment by mammalian target of rapamycin (mTOR) inhibitor. Additionally, in vitro assay demonstrated that the expression of GLUT-1 was increased in the RCC cells surviving under hypoxia condition via mTOR pathway.
Conclusions: The acceleration of glucose accumulation dependent on mTOR in RCC assessed by FDG PET/CT demonstrated acquisition of resistance to TKI. FDG PET/CT had potential as an assessment method monitoring not only the initial response but also following status of RCC during TKI treatment.

DOI： 10.1186/s12885-016-3044-0

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Xanthogranulomatous pyelonephritis (XGP) is a type of chronic suppurative renal inflammation. We present an extremely rare case of XGP concomitant with chromophobe renal cell carcinoma (RCC). A-39-year-old woman presented with transient fever and left lower abdominal pain during steroid pulse therapy for thyroid eye disease. Imaging studies including contrast-enhanced computed tomography, magnetic resonance imaging, and doppler ultrasonography, showed a 40 mm unusual mass lesion in the upper pole of the left kidney, and we could not rule out the possibility of malignancy.A left open partial nephrectomy for the renal mass was performed. Pathological examination revealed a 5 mm chromophobe RCC located beside a 30 mm XGP. The patient presented a favorable course without inflammatory episodes or tumor recurrence during the 9-month follow-up. This is the first case report of the coexistent XGP and chromophobe RCC.

DOI： 10.5980/jpnjurol.108.154

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

Introduction and Objectives. An elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be associated with a poor prognosis in several cancers. We evaluated the utility of an elevated NLR as a biomarker to predict the prognosis of metastatic castration-resistant prostate cancer (mCRPC) patients treated with cabazitaxel (CBZ). Methods. We analyzed 47 patients who received CBZ chemotherapy for mCRPC in our institutions. The NLR was calculated using the neutrophil and lymphocyte counts before CBZ chemotherapy. We determined the NLR cut-off value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. A multivariate analysis was performed to investigate the association between the NLR and the prognosis. Results. The median overall survival (OS) after CBZ was 10.0 months (range: 6.3-13.2). The median OS was shorter in patients with a high NLR (&gt;= 3.83) than in thosewith a low NLR (&lt;3.83) (5.8 versus 13.2 months, p = 0.018). In the multivariate analysis, the NLR, patient age, and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.01, p = 0.030; hazard ratio 3.10, p = 0.029; hazard ratio 12.38, p = 0.001, resp.). Conclusions. NLR might be a useful prognostic biomarker in mCRPC patients treated with CBZ.

DOI： 10.1155/2017/7538647

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Background: To investigate the impact of biological gender on operative parameters, especially operative time, in laparoscopic partial nephrectomy (LPN) for T1 renal tumor.
Methods: One hundred and eleven (28 female and 83 male) patients and 64 (20 female and 44 male) patients with renal tumors suspected to be RCC cT1aN0M0 who underwent retroperitoneal and transperitoneal LPN, respectively, were analyzed. The influence of sex on operative factors including retroperitoneal fat tissue thickness, determined on CT, was analyzed. The correlation between operative time and gender was evaluated by unpaired t-test and linear logistic regression model.
Results: In both retroperitoneal and transperitoneal LPN, the retroperitoneal fat tissue thickness was greater in men than in women. In retroperitoneal LPN, the operative time was significantly longer in men than in women. In contrast, in transperitoneal LPN, no gender difference was observed in regard to the operative time. In retroperitoneal LPN, linear logistic regression assessment showed that gender, retroperitoneal fat tissue thickness, and tumor size were significantly associated with operative time. Coefficient of determination of the prediction model was 0.317.
Conclusions: The operative time of retroperitoneal LPN is significantly correlated with gender, maximum tumor diameter, and retroperitoneal fat tissue thickness. We have developed a prediction model for the operative time of retroperitoneal LPN based on preoperative parameters. Interestingly, in transperitoneal LPN, a gender difference in operative time was not apparent, and also predicting operative time might be difficult.

DOI： 10.1186/s12885-016-2979-5

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BACKGROUND: Ureteral stenting has been a fundamental part of various urological procedures. Selecting a ureteral stent of optimal length is important for decreasing the incidence of stent migration and complications. The aim of the present study was to develop and internally validate a model for predicting the ureteral length for ureteral stent insertion. METHODS: This study included a total of 127 patients whose ureters had previously been assessed by both intravenous urography (IVU) and CT scan. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. Multiple linear regression analysis with backward selection was used to model the relationship between the factors analyzed and actual ureteral length. Bootstrapping was used to internally validate the predictive model. RESULTS: Patients all of whom had stone disease included 76 men (59.8%) and 51 women (40.2%), with the median and mean (± SD) ages of 60 and 58.7 (±14.2) years. In these patients, 53 (41.7%) right and 74 (58.3%) left ureters were analyzed. The median and mean (± SD) actual ureteral lengths were 24.0 and 23.3 (±2.0) cm, respectively. Using the bootstrap methods for internal validation, the correlation coefficient (R2) was 0.57 ± 0.07. CONCLUSION: We have developed a predictive model, for the first time, which predicts ureteral length using the following five preoperative characteristics: age, side, sex, IVU measurement, and CT calculation. This predictive model can be used to reliably predict ureteral length based on clinical and radiological factors and may thus be a useful tool to help determining the optimal length of ureteral stent.

DOI： 10.1186/s12894-016-0189-8

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

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CIG MEDIA GROUP, LP  

We here, for the first time, report that the risk of accidental tumor incision (ATI) during laparoscopic partial nephrectomy is influenced by the presence of a pseudocapsule, and, to some degree, by the tumor size. Moreover, we also show that ATI during laparoscopic partial nephrectomy is not necessarily associated with poor outcomes such as local tumor recurrence.
Background: To investigate the impact of accidental tumor incision (ATI) during laparoscopic partial nephrectomy (LPN) on the treatment outcome of LPN and to determine the predictive factors for ATI. Patients and Methods: Consecutive 156 patients with renal tumors suspicious of renal cell carcinoma cT1N0M0 undergoing laparoscopic partial nephrectomy at Yokohama City University between May 2003 and November 2014 were retrospectively evaluated. The analyzed clinical factors included maximum tumor diameter, the R.E.N.A.L. Nephrometry Score, occurrence of ATI during surgery, and the postoperative pathological findings including the presence of a pseudocapsule. Port site metastasis, tumor seeding, and local recurrence were investigated by routine follow-up computed tomography during the postoperative period. Results: Among enrolled 156 procedures, 12 (7.7%) showed ATI during surgery. Positive surgical margin and local tumor recurrence were observed in 5 and 1 cases in the non-ATI group, respectively, as compared with in no cases in the ATI group. Port site metastasis or tumor seeding was not observed in either group. Multivariate analysis indicated that pseudocapsule formation significantly correlated with ATI (P = .022) and that maximum tumor diameter was a possible predictor of ATI (P = .054). Conclusion: To our knowledge, there are no previous studies to evaluate the impact of ATI, and we here, for the first time, report that the risk of ATI is influenced by the presence of a pseudocapsule, and, to some degree, by the tumor size. Moreover, we also show that ATI during laparoscopic partial nephrectomy is not necessarily associated with poor outcomes such as local tumor recurrence. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.clgc.2015.11.013

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

ObjectiveTo identify risk factors of developing systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position for renal stone treatment.
MethodsWe retrospectively analyzed 370 consecutive patients who underwent endoscopic combined intrarenal surgery procedures in the modified Valdivia position to treat renal stones. Antibiotic therapy based on preoperative urine cultures was administered to all patients from induction of anesthesia until at least postoperative day 3. Postoperative systemic inflammation response syndrome was diagnosed if the patient met two or more systemic inflammation response syndrome criteria. A multivariate logistic regression model with backward selection was used to evaluate the relationships between the incidence of systemic inflammation response syndrome after endoscopic combined intrarenal surgery and other clinical factors.
ResultsOf the 370 patients, 61 patients (16.5%) were diagnosed with systemic inflammation response syndrome after endoscopic combined intrarenal surgery. Significant differences were found between the non-systemic inflammation response syndrome and systemic inflammation response syndrome groups with regard to female sex (29.8% vs 44.3%, P = 0.027), history of febrile urinary tract infection (16.5% vs 32.8%, P = 0.015) and number of involved calyces (2.68 vs 4.1, P &lt; 0.001). Multivariate analysis found three independent predictors of postoperative systemic inflammation response syndrome: the number of involved calyces (P = 0.017), stone surface area (P = 0.021) and history of febrile urinary tract infection (P = 0.005).
ConclusionsThe number of involved calyces larger than four, stone surface area &gt;500 mm(2) and a history of febrile urinary tract infection independently predicted the development of systemic inflammation response syndrome after endoscopic combined intrarenal surgery. This is the first study to identify the independent predictors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position.

DOI： 10.1111/iju.13124

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response, has been demonstrated to correlate with patient outcomes for various solid malignancies. We investigated the utility of the pretreatment NLR as a prognosticator in patients who presented with penile cancer. Methods: A total of 41 patients who underwent complete blood count with differential and subsequent radical penectomy from 1988 to 2014 were analyzed. We assessed the correlation between the NLR and the prognosis of penile cancer. Results: The median and mean (± SD) NLRs in 41 penile cancer patients were 3.42 and 5.03 ± 4.99, respectively. Based on the area under receiver operator characteristic curve, the cut-off value of NLR was determined to be 2.82. Patients with a high NLR (≥2.82) showed a significantly poorer cancer-specific survival (p = 0.023) than those with a low NLR. Conclusions: The pretreatment NLR may function as a biomarker that precisely predicts the prognosis in patients with penile cancer.

DOI： 10.1186/s12885-016-2443-6

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

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Background Granulomatous interstitial nephritis (GIN) is a rare renal disease, and its etiology remains unknown. We report recurrent GIN in renal allograft successfully treated with everolimus (EVR). Case Report A 22-year-old man with GIN received a kidney from his mother. On follow-up 8 months later, his serum creatinine level was increased, from 1.3 mg/dL to 1.7 mg/dL, and he had microhematuria and proteinuria. A protocol graft biopsy at 1 year after transplantation showed epithelioid granuloma with multinucleated giant cells. He received steroid pulse therapy for recurrent GIN twice, but he developed allograft dysfunction, hematuria, and proteinuria. EVR was started in combination with maintenance immunosuppressants at 28 months after transplantation. Thereafter, the serum creatinine level decreased, from 2.1 mg/dL to 1.6 mg/dL, and microhematuria and proteinuria were stable despite reduction of steroid dose. Conclusions Maintenance immunosuppressive therapy combined with EVR may be effective for the recurrence of idiopathic GIN in renal allograft.

DOI： 10.1016/j.transproceed.2016.01.034

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BACKGROUND: There is no reliable biomarker for predicting the prognosis of patients who undergo radical cystectomy for bladder cancer. Recent studies have shown that the neutrophil-to-lymphocyte ratio (NLR) could function as a useful prognostic factor in several types of malignancies. This study aimed to assess the usefulness of NLR in bladder cancer. METHODS: A total of 74 patients who underwent radical cystectomy in our institutions from 1999 to 2014 were analyzed. The NLR was calculated using the patients' neutrophil and lymphocyte counts before radical cystectomy. An immunohistochemical analysis was also performed to detect tumor infiltrating neutrophils (CD66b) and lymphocytes (CD8) in bladder cancer specimens. RESULTS: A univariate analysis showed that the patients with a high NLR (≥2.38; HR = 4.84; p = 0.007), high C-reactive protein level (>0.08; HR = 10.06; p = 0.030), or pathological lymph node metastasis (HR = 4.73; p = 0.030) had a significantly higher risk of cancer-specific mortality. Kaplan-Meier and log-rank tests further revealed that NLR was strongly correlated with overall survival (p = 0.018), but not progression-free survival (p = 0.137). In a multivariate analysis, all of these were found to be independent risk factors (HR = 4.62, 10.8, and 12.35, respectively). The number of CD8-positive lymphocytes was significantly increased in high-grade (p = 0.001) and muscle-invasive (p = 0.012) tumors, in comparison to low-grade and non-muscle-invasive tumors, respectively. CONCLUSIONS: The NLR predicted the prognosis of patients who underwent radical cystectomy and might therefore function as a reliable biomarker in cases of invasive bladder cancer.

DOI： 10.1186/s12885-016-2219-z

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BACKGROUND: Various molecular-targeting therapies have become available for the treatment of advanced renal cell carcinoma (RCC). Accurate prognostication is desirable for choosing the appropriate treatment for individual patients. (18)F-2-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) is a non-invasive tool for evaluating glucose accumulation, which can be an index of biological characteristics of cancer. We prospectively evaluated FDG PET/CT as a prognostic indicator in patients with advanced RCC. METHODS: A total of 101 patients slated for different systematic therapies for advanced RCC were enrolled between 2008 and 2014. A total of 61 patients had recurrent RCC (58 metastatic and 3 regional) and 40 patients had stage IV RCC (36 metastatic and 4 locoregional). Sixteen patients had not undergone nephrectomy. Pre-treatment FDG PET/CT was performed, and the max SUVmax (the highest SUV measurement in each patient) was recorded. The max SUVmax was compared with different clinical risk factors as prognostic indicators. The median observation period was 18 months (range 1-70 months). RESULTS: The max SUVmax of the 101 subjects ranged from undetectable to 23.0 (median 6.9). Patients with high max SUVmax had a poor prognosis. Multivariate analysis with standard risk factors revealed that max SUVmax was an independent predictor of survival (p < 0.001; hazard ratio 1.265; 95% confidence interval 1.159-1.380). A cutoff of 8.8 for max SUVmax advocated in our previous report was highly significant (p < 0.0001). When we subclassified the max SUVmax values, the median overall survival of subjects with max SUVmax < 7.0 was 41.9 months. That of subjects with max SUVmax between 7.0 and 12.0 was 20.6 months. That of subjects with max SUVmax ≥ 12.0 was 4.2 months. The differences were statistically significant. CONCLUSIONS: Pretreatment max SUVmax assessed by FDG PET/CT is a useful prognostic marker for patients with advanced RCC, providing helpful information for clinical decision making.

DOI： 10.1186/s12885-016-2097-4

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

Background: The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response in critical care patients, has been suggested as an independent prognostic factor for several solid malignancies. We investigated the utility of pretreatment NLR as a prognosticator in patients who presented with metastatic prostate cancer.
Methods: We first investigated the correlation between NLR and prostate-specific antigen (PSA) levels in 1464 men who had both tests and were found to have prostate cancer on their biopsies at our institution from 1999 to 2015. We then assessed the relationship between pretreatment NLR and the prognosis in 48 patients who were diagnosed with prostate cancer metastasized to the lymph node and/or bone.
Results: The NLR value was significantly elevated in men with higher PSA than in those with lower PSA (p &lt; 0.001). In patients with metastatic prostate cancer, NLR (cut-off point of 3.37 determined by the AUROC curve) was correlated with both cancer-specific (p = 0.018) and overall (p = 0.008) survivals.
Conclusions: Pretreatment NLR may function as a new biomarker that precisely predicts the prognosis in patients with metastatic prostate cancer.

DOI： 10.1186/s12885-016-2134-3

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Introduction and Objectives. Neutrophil-to-lymphocyte ratio (NLR) has been suggested to be a simple marker of the systemic inflammatory response in critical care patients. We previously assessed the utility ofNLR as a biomarker to predict tumor recurrence and cancer death in bladder cancer patients who underwent radical cystectomy. In this study, we evaluated the prognostic impact of NLR in bladder cancer patients who received gemcitabine and nedaplatin (GN) chemotherapy. Methods. A total of 23 patients who received GN chemotherapy for advanced bladder cancer were enrolled in this study. The cut-off point of NLR according to the sensitivity and specificity levels was derived from the area under receiver operator characteristics (AUROC) curve plotted for disease progression or overall mortality. Results. The NLR cut-off point was determined as 4.14 for both tumor progression and overall mortality. Median progression-free survival (PFS)/overall survival (OS) in the higher NLR group (NLR &gt;= 4.14) and lower NLR group (NLR &lt; 4.14) were 194/468 days versus 73/237 days, respectively. Kaplan-Meier analysis showed that higher NLR significantly correlated with poorer PFS (p = 0.011) andOS (p = 0.045). Conclusions. NLR may serve as a new biomarker to predict responses to GN-based chemotherapy in advanced bladder cancer patients and/or their prognosis.

DOI： 10.1155/2016/9846823

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

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High serum calcium (Ca) due to aberrant secretion of tumor parathyroid hormone-like hormone (PTHLH) is a well-known paraneoplastic sign and is associated with poor prognosis in patients with renal cell carcinoma (RCC). However, the status of serum Ca and tumor PTHLH expression have not been verified using the 2004 World Health Organization (WHO) renal tumor classification. We retrospectively reviewed corrected serum Ca levels at initial onset (n = 683) and/or as of recurrence (n = 71) in patients with RCC. We also examined a total of 623 renal parenchymal tumor samples for PTHLH mRNA expressions by quantitative real-time PCR. High serum Ca concomitant with PTHLH overexpression in tumors was observed exclusively in clear cell RCC but not in other non clear cell subtype tumors, including papillary, chromophobe, collecting-duct, unclassified, and other rare subtype RCCs or in benign oncocytomas and angiomyolipomas. In clear cell RCC, PTHLH expression was significantly high in male patients, and was associated with a symptomatic presentation, higher grade, and higher stage cases, whereas it was not associated with VHL gene status. Univariate analyses demonstrated that high PTHLH expression was strongly associated with poor outcome both in overall survival (OS) and disease-free survival (DFS) for patients who underwent standard nephrectomy. Further multivariate Cox analyses revealed that the PTHLH expressions remained as independent prognostic parameters for OS but not for DFS. These data suggest that the previously characterized tumor signatures of high serum Ca due to high PTHLH expression and poor prognosis are clear cell RCC-specific features, whereas these characteristics are rare in non clear cell RCCs.

DOI： 10.1002/cam4.270

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Language：Japanese   Publisher：腎移植・血管外科研究会  

67歳男性。2009年に妻(HBsAg陰性)をドナーとした血液型一致生体腎移植術を施行した。術前検査でHBsAg陰性(HBsAbおよびHBcAbは未検)。術前後で輸血は必要とせず、術後は急性拒絶などなく術後経過は良好であった。術後1年の時点で一過性の肝酵素上昇を認めたが自然に正常化した。術後3年目にHBsAg陽性が判明した。肝細胞癌や肝酵素上昇は認めなかったがHBV DNA 8.0 log10 copies/mlと高値でHBV再活性化後にHBVキャリアーとなった可能性が最も考えられた。エンテカビル内服後はHBV DNA copy数は順調に低下して、肝炎および肝細胞癌の発症なく外来で経過観察中である。(著者抄録)

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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：(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：日本VR医学会  

現在多くの腹部手術が腹腔鏡下に行われるようになり、安全性確保のため、動物やシミュレータを用いたトレーニングシステム・ツールの向上は重要である。我々は、現在Mission rehearsal型のシミュレータを開発しており、画像検査からデータを組み込むことで、術前に患者固有の手術の予行演習をすることが可能になった。今回我々は実際に4症例に対しシミュレータを利用した予行練習を行い、手術所見との比較を行った。4例は(1)腹腔鏡下右腎盂形成術(水腎症)・(2)後腹膜鏡下右腎尿管全摘術(尿管癌)・(3)後腹膜鏡下右腎部分切除術(腎臓癌)・(4)後腹膜鏡下右腎尿管全摘術(尿管癌、内臓逆位症例)であった。腎動脈・腎静脈の本数、性腺静脈・腰静脈・尿管・腫瘍の位置関係について整合性を確認し、実際の手際操作時に重要となる部分・参考となる部分に関しては術者の主観的評価を参考に検討を行った。症例(1)で腎静脈、尿管の本数、腎静脈と尿管の位置関係、症例(3)で腎静脈の本数、性腺静脈の走行にシミュレータと実際の手術所見で相違が見られたが、他はすべて一致していた。術者の感想としては4症例とも実際の手術とほぼ整合性があり、術前のイメージ作りに有用であった。4症例を通じてこのシミュレータには臓器の再現性があり、手術のリハーサルに有用であることが確認できた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J05717&link_issn=&doc_id=20131224370001&doc_link_id=10.7876%2Fjmvr.11.1&url=https%3A%2F%2Fdoi.org%2F10.7876%2Fjmvr.11.1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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

A 72-year-old man presenting with a 14-cm left renal mass, an inferior vena cava (IVC) tumor thrombus, and pulmonary metastases underwent renal mass biopsy that revealed clear cell renal cell carcinoma. Because of metastases and the extent of the tumor thrombus, sunitinib was administered, which resulted in a marked reduction in the tumor thrombus (from level III to level II after 11 weeks of treatment). Ultrasonography, preceding computed tomography, showed a slight shrinkage of the tumor thrombus level in the first 2 weeks. Therefore, ultrasound may be advantageous to monitor the IVC tumor thrombus level during the early phase of targeted therapy. © 2013 The Japan Society of Ultrasonics in Medicine.

DOI： 10.1007/s10396-013-0448-1

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

A 56-year-old man was referred to our clinic because of left lumbar pain and a left solitary renal tumor (9. 8 cm in diameter) and bilateral pulmonary metastases detected by computed tomographic scan. Pathologic diagnosis following open radical nephrectomy was papillary renal cell carcinoma, G2, pT2aN0Ml. Subsequently, the patient was sequentially treated with interleukin-2 (3 months (mo), progressive disease (PD)), interferon-alpha (3 mo, PD), and oral S-l as a clinical trial (28 mo, PD). Because of skin fibrofolliculomas, pulmonary cysts, and spontaneous pneumothorax history, Birt-Hogg-Dube (BHD) syndrome was suspected during the treatment course, despite his having no family history of the disease. Subsequent genetic testing revealed a FLCN germline mutation (c. 1285dupC). He was started on molecular-targeting therapies sequentially, i.e., sorafenib (1 mo, PD), sunitinib (4 mo, PD), and everolimus (7 mo, PD). The patient died of progressive disease at 78 mo from the initial nephrectomy and 30 mo from the start of targeted agents. Loss of FLCN function has been shown to result in the upregulation of the PI3K/mTORCl pathway in both in vitro experiments and in vivo FLCN knockout mice models. Despite its use as the sixth-line systematic treatment, the mTOR inhibitor everolimus exhibited a relatively long-term effect as compared with the previously used tyrosine kinase inhibitors and in contrast to the results in the RECORD-1 clinical trial. This finding may provide insight into the molecular mechanism of BHD-associated renal tumors.

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Language：Japanese   Publisher：(一社)日本臨床腎移植学会  

44歳女。39歳時に腎移植術を施行した。移植後3年時の定期腎生検で慢性抗体関連拒絶反応と診断したが、移植後6週からウイルス感染を繰り返していたため免疫抑制剤の増量はできず、また、血清Cr値が安定していたため経過観察とした。移植後4年時から蛋白尿が顕在化し、浮腫も出現したため、免疫抑制剤にエベロリムス(EVR)追加した。その結果、蛋白尿・浮腫とも改善し、EVR投与開始から1年5ヵ月後の現在まで血清Crは2.5mg/dL前後と安定したまま経過している。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J06262&link_issn=&doc_id=20130930330016&doc_link_id=%2Fem0sfcrt%2F2013%2F000101%2F017%2F0093-0096%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem0sfcrt%2F2013%2F000101%2F017%2F0093-0096%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は悪性高血圧で16年前より血液透析導入となった64歳女性。感作歴として妊娠歴と輸血歴があった。急性くも膜下出血にて死亡した45歳女性をドナーとした献腎移植を施行した。Flow PRA Screeningが強陽性であり、移植1時間後生検で傍尿細管毛細血管炎の存在が判明したため、抗体関連拒絶反応の診断で、バシリキシマブ、タクロリムス、ミコフェノール酸モフェチル、メチルプレドニゾロンからなる4剤の免疫抑制剤に加え、血漿交換・リツキシマブの投与を追加した。その後尿量は徐々に増加を認め、術後経過良好で退院した。術後9ヵ月経過した現在も腎機能は安定している。(著者抄録)

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

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

A 65-year-old male was referred to our clinic from orthopedics because his right gastrocnemius muscle tumor was diagnosed as a metastatic renal cell carcinoma (RCC) with clear cell/spindle cell morphology. He had right nephrectomy for RCC 18 years previously. At 17 months following the first visit to our clinic, brain, lung and right gluteus medius muscle metastases were identified on positron emission tomography-computed tomography (PET-CT). The echocardiogram for the evaluation of his heart function incidentally revealed a 3 cm nodular lesion in the right ventricular wall suggesting myocardiac metastasis. He started to take sunitinib at a standard dose of 50 mg/day. A subsequent echocardiogram during the 2nd cycle of sunitinib showed complete disappearance of the myocardiac metastasis. After the 2nd cycle, PET-CT revealed a partial response (PR) for the other metastases. He received 8 cycles of sunitinib. The best response was PR, and progression-free survival was 6 months. After that, he took everolimus for 7 months. Although the myocardiac metastasis continued to show a complete response during the treatment course, he died of progressive lung metastases at 21 months following the administration of sunitinib. Diagnosis of myocardiac metastasis of RCC during the treatment course as well as its successful treatment with molecular targeting agents has rarely been reported.

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

腎移植および副甲状腺摘出術施行後にも遷延した副甲状腺機能亢進症に対しシナカルセト投与が有効であった症例を報告する。症例は50歳男性。慢性腎不全のため31歳時に血液透析導入された後39歳で二次性副甲状腺機能亢進症に対し副甲状腺摘出術および左前腕自家移植術施行された。8年後に当院で献腎移植を施行された。移植後もiPTHおよびCa値は低下せず、外来でシナカルセト塩酸塩内服を開始した。iPTHの高値は改善されなかったが、血中Ca値は徐々に低下し正常化した。(著者抄録)

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：IOS Press  

The acquisition of physical quantities for a living body in surgery is an important and necessary step toward developing a sophisticated preoperative surgical simulator and its validation and navigation. We have developed a multimodal measuring device that minimizes interference with the movements of the surgeon. We conducted nephrectomy surgery using a laboratory animal and successfully acquired physical quantities. From this experiment, we have acquired the following preliminary result. The surgeon feels a gripping force from-3.5 to 4.4N at the handle of the forceps for dissection. We assume that this data is not far from that of a human. © 2013 The authors and IOS Press.

DOI： 10.3233/978-1-61499-209-7-312

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DOI： 10.1155/2013/124710

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DOI： 10.1155/2013/973865

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

Objective: C-reactive protein (CRP) is considered a useful serum marker for patients with RCC. However, its clinical utility in advanced metastatic renal cell carcinoma (AM-RCC), particularly in deciding whether to perform nephrectomy at the onset, is not well studied.
Patients and methods: We retrospectively evaluated 181 patients with AM-RCC, including 18 patients underwent potentially curative surgery, 111 underwent cytoreductive nephrectomy, and 52 received medical treatment only. CRP cutoff points were determined by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier and Cox regression analyses were used for survival tests.
Results: ROC analysis suggested that grouping patients according to 3 CRP ranges was a rational model. Patients with highly elevated CRP (&gt;= 67.0 mg/L) presented remarkably poor prognosis despite treatment (nephrectomy or medical treatment only). Cox regression models demonstrated that risk factors of overall survival for patients who underwent nephrectomy were the CRP ranges defined in this study (&lt;= 18.0 mg/L, &gt;18.0 and &lt;67.0 mg/L, and &gt;= 67.0 mg/L), ECOG PS (0, 1, and &gt;= 2), and number of metastatic organ sites (0-1 and &gt;= 2). The retrospective design is a limitation of this study.
Conclusion: Our study demonstrated that the serum CRP level is a statistically significant prognostic parameter for patients with AM-RCC. The data also indicated that pretreatment serum CRP level provides useful prognostic information that helps in deciding whether to perform initial nephrectomy for patients with AM-RCC.

DOI： 10.1186/1471-2407-12-337

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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)   Publisher：BIOMED CENTRAL LTD  

Background: We reported previously that F-18-2-fluoro-2-deoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) had potential for evaluating early response to treatment by tyrosine kinase inhibitors (TKIs) in advanced renal cell carcinoma (RCC). This time we investigated the relation of the early assessment by FDG PET/CT to long-term prognosis with an expanded number of patients and period of observation.
Methods: Patients for whom TKI treatment for advanced RCC was planned were enrolled. FDG PET/CT was performed before TKI treatment and after one month of TKI treatment. The relations of the FDGPET/CT assessment to progression free survival (PFS) and overall survival (OS) were investigated.
Results: Thirty-five patients were enrolled (sunitinib 19 cases, sorafenib 16 cases). The patients with RCC showing high SUVmax in pretreatment FDG PET/CT demonstrated short PFS (P =0.024, hazard ratio 1.137, 95% CI 1.017-1.271) and short OS (P =0.004, hazard ratio 1.210 95% CI 1.062-1.379). Thirty patients (sunitinib 16 cases, sorafenib 14 cases) were evaluated again after 1 month. The PFS of the patients whose SUVmax decreased &lt; 20% was shorter than that of the patients whose SUVmax decreased &gt;= 20% (P = 0.027, hazard ratio 3.043, 95% CI 1.134-8.167). The PFS of patients whose tumor diameter sum increased was shorter than that of the patient with tumors whose diameter sum did not (P =0.006, hazard ratio 4.555, 95% CI 1.543-13.448).
The patients were classified into three response groups: good responder (diameter sum did not increase, and SUVmax decreased &gt;= 20%), intermediate responder (diameter sum did not increase, and SUVmax decreased &lt; 20%), and poor responder (diameter sum increased, or one or more new lesions appeared). The median PFS of good, intermediate, and poor responders were 458 +/- 146 days, 131 +/- 9 days, and 88 +/- 26 days (good vs. intermediate P = 0.0366, intermediate vs. poor P = 0.0097, log-rank test). Additionally the mean OSs were 999 +/- 70 days, 469 +/- 34 days, and 374 +/- 125 days, respectively (good vs. intermediate P = 0.0385, intermediate vs. poor P = 0.0305, log-rank test).
Conclusions: The evaluation of RCC response to TKI by tumor size and FDG uptake using FDG PET/CT after 1 month can predict PFS and OS.

DOI： 10.1186/1471-2407-12-162

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

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Language：Japanese   Publisher：Japanese Society of Endourology  

【Purpose】To evaluate the perioperative and postoperative results of the 6 cases of laparoscopic pyeloplasty with concomitant pyelolithotomy for the treatment of ureteropelvic junction obstruction and nephrolithiasis in our hospital. <br>  【Methods】From Janualy 2005 through July 2011, 38 laparoscopic pyeloplasties were performed. Six patients had documented ureteropelvic junction obstruction and ipsilateral nephrolithiasis and underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. We investigated patients' background, surgical procedure and surgical outcome. We performed transperitoneal laparoscopic dismembered pyeloplasty for all patients. <br>  【Results】The median surgical duration was 260 minutes（range 208-284 min）, the median stone removal time was 52 minutes（range 4-63 min）and the mean blood loss volume was minimal. There were no intraoperative and postoperative complications. We could remove 13 stones out of 16 stones. <br>  【Conclusion】Laparoscopic pyeloplasty with concomitant pyelolithotomy is feasible and effective.

DOI： 10.11302/jsejje.25.149

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Other Link： https://jlc.jst.go.jp/DN/JALC/10028431458?from=CiNii

Language：Japanese   Publisher：Japanese Society of Endourology  

DOI： 10.11302/jsejje.25.84

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Other Link： https://jlc.jst.go.jp/DN/JALC/10028431656?from=CiNii

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

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

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

A retroperitoneal angioleiomyoma was incidentally detected in a 56-year-old woman during an examination of cardiovascular disease, and referred to the department of urology. Computed tomography (CT) showed a solid tumor approximately 3 cm in diameter, enhanced heterogeneously adjacent to the right adrenal and renal vein on magnetic resonance imaging the tumor showed a low intensity in the Tl-weighted image and high intensity in T2-weighted image. These radiographic findings suggested a retroperitoneal tumor such as paraganglioma, angioma. Furthermore, because she was a carrier of Human Adult T Cell Leukemia Virus-I (HTLV-I) this tumor was suspected to have relevance to malignant lymphoma. We performed laparoscopic surgical excision of the tumor. Pathlogical diagnosis was an angioleiomyoma. Angioleiomyoma is a rare type of leiomyoma originating from smooth muscle and containing thick-walled vessels. Only a few cases of retroperitoneal angioleiomyoma have been reported.

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

Introduction. Training systems for laparoscopic surgery are useful for basic training but are not suitable for specific training corresponding to the condition of a given patient. We, therefore, have developed an unusual training system: a patient-specific simulator for laparoscopic surgery. When specific data of each individual patient are entered, this system helps surgeons perform a rehearsal operation. We applied this technique in laparoscopic surgery by using volume data obtained by multislice computed tomography imaging. Case presentation. A 39-year-old Japanese woman consulted a doctor because of back pain and underwent pyeloplasty after an examination revealed a ureteropelvic junction obstruction. Computed tomography data showed that the network of arteries and veins was very complicated. Therefore, we decided to use our simulator before performing surgery. Simulation was helpful because we could obtain information about the complicated vessel network and rehearse the procedure. Conclusions: Our simulator allows surgeons to perform a sham operation with different perspectives and tactile sensations and has received favorable reviews from users. © 2012 Yamanaka et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1752-1947-6-338

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

(Purpose) Nephron-sparing surgery for small renal tumors has gained acceptance in an attempt to preserve renal function while achieving a level of cancer control equivalent to that obtained by radical nephrectomy. Moreover, laparoscopic partial nephrectomy (LPN) has been applied to partial nephrectomy because of it is less invasive. However, LPN is a technically complex procedure and has more potential for complications than open partial nephrectomy (OPN). Using hemostatic agents is one of the options to avoid complications during LPN. Microporous polysaccharide hemispheres (MPH) are an absorbable hemostatic powder produced from purified potato starch. We compare the efficacy of this new hemostatic agent, MPH and the standard hemostatic agent, fibrin glue. (Methods) Between January 2007 and March 2011, 55 LPNs for suspected malignancy were completed by a single surgeon in Yokohama City University Hospital. We compare two sequential groups of patients: group A consisted of 12 patients in whom MPH was used (age 41-77, mean age 59.7, male: female = 10 : 2) and group B consisted of 43 patients in whom fibrin glue was used (age 22-79, mean age 60.3, male: female = 31: 12), retrospectively. These agents (MPH and fibrin glue) were applied to the partial nephrectomy bed before tying a suture in parenchymal suturing and after the renal hilum was undamped. (Results) The MPH group showed significantly less mean estimated blood loss (25.6 vs. 86.3 ml
p = 0.036). There was no significant difference in surgical duration, ischemic time or urine leakage. Postoperative complications occurred in two patients in group B, but there were no postoperative complications in group A. (Conclusions) MPH is available as an adequate hemostatic agent during LPN. There was no significant difference in the incidence of postoperative complications between MPH and fibrin glue. © 2012 Japanese Urological Association.

DOI： 10.5980/jpnjurol.103.8

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Language：Japanese   Publisher：Japanese Society of Endourology  

Purpose：We evaluated the surgical and post-operative results of laparoscopic partial nephrectomy. <br>  Methods：Between January 2007 and October 2011, 67 laparoscopics for suspected malignancy were completed in Yokohama City University Hospital. We retrospectively evaluated two sequential groups of patients：group with a retroperitoneal approach consisting of 43 patients, and group with a transperitoneal approach consisting of 24 patients <br>  Results：The mean surgical time, mean ischemic time, and mean blood loss were 171.1 minutes, 25.6 minutes, and 78.3 ml with the retroperitoneal approach and 182.3 minutes, 26.3 minutes, and 102.9 ml with the transperitoneal approach, respectively. Intra- and postoperative complications were seen in 3 cases. At present, no patient has developed local recurrence. <br>  Conclusion：The initial outcome of laparoscopic partial nephrectomy in our hospital was satisfactory in terms of both cancer control and ischemic time.

DOI： 10.11302/jsejje.25.305

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Other Link： https://jlc.jst.go.jp/DN/JALC/10028431878?from=CiNii

Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は23歳男性。慢性腎不全に対して父をドナーとした生体腎移植を施行した。術当日のドップラーエコー上、移植腎血流に問題がなかったが、術翌朝より移植腎部の疼痛が増強、無尿となった。ドップラーエコー上、移植腎静脈血栓症を疑い緊急手術を行った。移植腎の色調は不良で、移植腎を摘出し体外で腎静脈内血栓を除去後、冷却再灌流を行い色調が改善したため、再移植を行った。術後血液透析が必要となるも1週間後より徐々に尿量の増加を認め、術後33日目に透析を離脱した。その後も血清クレアチニン値の低下は緩慢であったが術後49日目に退院した。(著者抄録)

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

A 58-year-old man visited our hospital with gross hematuria. Cystoscopy revealed a papillary tumor around the left ureteral orifice. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological findings revealed a nested variant of urothelial carcinoma. Computed tomography (CT) revealed no involvement of other organs. Laparoscopic radical cystectomy and orthotopic neobladdcr substitution (Studcr methods) were performed. The histopathological stage was pT3aN0M0. Adjuvant chemotherapy (gemcitabine + cisplatin) was performed. The patient is currently free from disease at five months after the surgery.

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

We report a case of high-grade invasive urothelial carcinoma with plasmacytoid differentiation of the urinary bladder. A 75-year-old woman was referred to our hospital because of macroscopic hematuria. Cystoscopy detected a solid pedunculated bladder tumor, and a transurethral resection of the bladder tumor (TUR-Bt) and the image findings showed pT1N0M0 bladder cancer. The histopathological examination revealed the coexistence of a large component of high-grade invasive urothelial carcinoma and a small component of plasmacytoid carcinoma. Following the TUR-Bt, external beam radiotherapy and chemotherapy with gemcitabine and nedaplatin were carried out. The bladder tumor has not recurred for 2 years after the TUR-Bt.

DOI： 10.1111/j.1442-2042.2011.02880.x

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Language：English   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)日本癌治療学会  

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

A 53-year-old woman was admitted with right lower abdominal pain in November 1993. Computed tomography (GT) revealed a right renal tumor, suspected to be a renal cancer. She underwent right radical nephrectomy in December 1993. The pathological diagnosis was clear cell carcinoma, pT2, grade 2. In May 2006, follow-up CT showed a tumor arising from the left perirenal fat. Laparoscopic tumor excision was performed in August 2006. The pathological diagnosis was metastatic clear cell carcinoma.

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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DOI： 10.1159/000330192

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

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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.102.429_5

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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.102.435_6

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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.102.435_5

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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.102.526_5

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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.102.299_2

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Language：Japanese   Publisher：Japanese Society of Endourology  

[Purpose] To evaluate the perioperative and postoperative results of the initial 31 cases of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in our hospital.<br>  [Methods] We retrospectively evaluated data on 31 patients who underwent laparoscopic pyeloplasty in our hospital between January 2005 and July 2010.<br>We investigated patients' background, perioperative, intraoperative and postoperative parameters including the surgical procedure, surgical duration, volume of blood loss, and outcome.<br>  [Results] We performed transperitoneal laparoscopic dismembered pyeloplasty as the standard method in all but 7 cases. The mean surgical duration was 218.8 minutes (range 127-308 min), and the mean blood loss volume was 7.3 ml. There were no complications. Postoperatively, subjective symptoms such as flank pain and pyelonephritis had disappeared in all cases, hydronephrosis had disappeared in 96.4%, and the hydronephrosis pattern of the renogram was improved in 55.6%.<br>  [Conclusion] We performed transperitoneal laparoscopic dismembered pyeloplasty as the standard method for ureteropelvic junction obstruction, and subjective symptoms disappeared postoperatively in all patients.

DOI： 10.11302/jsejje.24.120

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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.102.404_4

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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.102.464_6

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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.102.464_3

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

Purpose. When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method. In this method, a small incision was made to approach the retroperitoneal space prior to setting trockers and thereafter a LAPDISC was placed in the incision to start the retroperitoneoscopic procedure. In this study, we compared the outcomes between the combined small skin incision method ("A method" hereinafter) and the conventional method ("B method" hereinafter). material and methods. Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications. results:. The duration of the procedure was 214.4 46.9 minutes in the A method group and 208.1 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 283.2 ml and 335.1 137.4 g in the A method group and 44.8 116 ml (p = 0.247) and 309.2 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed. conclusion:. The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery. © 2011 Ito et al
licensee BioMed Central Ltd.

DOI： 10.1186/1477-5751-10-11

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：IOS PRESS  

At the Advanced Medical Research Center at Yokohama City University School of Medicine, we have been developing a practical surgical simulator for renal surgery. Unlike already commercialized laparoscopic surgical simulators, our surgical simulator is capable of using patient-specific models for preoperative training and improvement of laparoscopic surgical skills. We have been evaluating the simulator clinically with the aim of using it in renal surgery training at Yokohama City University Hospital. The simulator can be applied to other types of laparoscopic surgery, such as gynecological, thoracic, and gastrointestinal. Here, we report on the technical aspects of the simulator.

DOI： 10.3233/978-1-60750-706-2-415

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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.102.216_1

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

Purpose: Multikinase inhibitor (MKI) is a promising drug for treatment of metastatic renal cell carcinoma (mRCC). We explained the usefulness of [(18)F]-2-fluoro-2-deoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG PET/CECT) for mRCC in evaluating the early response to MKI and in predicting progression-free survival (PFS).
Methods: Patients who planned MKI treatment for mRCC were included in this prospective study. FDG PET/CECT was performed before MKI treatment and after one cycle of MKI treatment. Evaluation of the response to MKI was assessed by PET according to the European Organization for Research and Treatment of Cancer, by CT according to the Response Evaluation Criteria in Solid Tumors and appearance of central hypoattenuation (CHA).
Results: Twelve patients were enrolled in the study. Equality of response evaluation between PET and CT was in 8 patients (partial response [PR] : 1, stable disease [SD] : 6, progressive disease [PD] : 1). Among the other 4 patients, PET showed 2 patients with PR and 2 patients with PD, in contrast to the CT finding of SD in all 4 patients. PFS according to PET response showed a statistically significant difference between PR and SD (P &lt; 0.05) and between PR and PD (P &lt; 0.05), but not between PR and SD (P = 0.083). Positive CHA in metastatic lesions after MKI treatment was confirmed in 8 patients. PFS with positive CHA was 233.8 days, while that without CHA was 75.0 days (P &lt; 0.05).
Conclusion: FDG PET/CECT shows potential for evaluating early treatment response to MKI in mRCC and for predicting PFS.

DOI： 10.1097/RLU.0b013e3181f9ddd9

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

Background: In this era of molecular targeting therapy when various systematic treatments can be selected, prognostic biomarkers are required for the purpose of risk-directed therapy selection. Numerous reports of various malignancies have revealed that 18-Fluoro-2-deoxy-D-glucose (F-18-FDG) accumulation, as evaluated by positron emission tomography, can be used to predict the prognosis of patients. The purpose of this study was to evaluate the impact of the maximum standardized uptake value (SUVmax) from 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-18-FDG PET/CT) on survival for patients with advanced renal cell carcinoma (RCC).
Methods: A total of 26 patients with advanced or metastatic RCC were enrolled in this study. The FDG uptake of all RCC lesions diagnosed by conventional CT was evaluated by F-18-FDG PET/CT. The impact of SUVmax on patient survival was analyzed prospectively.
Results: FDG uptake was detected in 230 of 243 lesions (94.7%) excluding lung or liver metastases with diameters of less than 1 cm. The SUVmax of 26 patients ranged between 1.4 and 16.6 (mean 8.8 +/- 4.0). The patients with RCC tumors showing high SUVmax demonstrated poor prognosis (P = 0.005 hazard ratio 1.326, 95% CI 1.089-1.614). The survival between patients with SUVmax equal to the mean of SUVmax, 8.8 or more and patients with SUVmax less than 8.8 were statistically different (P = 0.0012). This is the first report to evaluate the impact of SUVmax on advanced RCC patient survival. However, the number of patients and the follow-up period were still not extensive enough to settle this important question conclusively.
Conclusions: The survival of patients with advanced RCC can be predicted by evaluating their SUVmax using F-18-FDG-PET/CT. F-18-FDG-PET/CT has potency as an "imaging biomarker" to provide helpful information for the clinical decision-making.

DOI： 10.1186/1471-2407-10-667

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は62歳男性。原疾患不明の慢性腎不全の患者に対し献腎移植を行った。術後2日目呼吸苦・腹痛・不整脈出現。試験開腹施行。術中診断は特発性胆嚢穿孔に伴う急性腹膜炎で、胆嚢摘出、腹腔内洗浄ドレナージ術を施行した。術後37日目に2次的に形成された後腹膜膿瘍に対し、デブリードメンおよびドレナージ術を施行し、持続洗浄開始。術後44日目、一過性に持続洗浄の回収不良となったのを契機に、ショックとなった。腹部膨満を認め、腹部コンパートメント症候群と診断。緊急開腹することで循環動態が改善した。その後腹部は開放創のまま管理し、術後114日目閉腹術(植皮術)施行した。術後12ヵ月経過し、現在リハビリを継続している。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J02752&link_issn=&doc_id=20110208340008&doc_link_id=%2Fdl9renal%2F2010%2F002201%2F009%2F0040-0044%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl9renal%2F2010%2F002201%2F009%2F0040-0044%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Language：English   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.urology.2010.02.034

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

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

A 82-year-old man was referred to our hospital for treatment of hormone-refractory prostate cancer with liver metastases. The obstruction of intrahepatic bile ducts due to the rapid growth of liver metastases induced liver dysfunction. We administered 25 mg/m2 docetaxel on dayl and 280 mg/body estramustine phosphate on day 1 to day 3, every 4 weeks. After two courses of this combined chemothrapy, the liver metastases were markedly reduced in size with the rapid improvement of liver function.

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

(Objectives) This study is to elucidate the advantage of laparoscopic radical cystectomy (LRC) over open radical cystectomy (ORC) in an early perioperative period. (Materials and methods) We investigated the perioperative outcome of the consecutive patients who underwent radical cystectomy at Yokohama City University Hospital. The data of 11patients who underwent LRC from February 2008 to May 2009 was compared with that of 11 patients who had ORC from October 2006 to April 2009. (Results) The operative time was significantly longer in LRC (p = 0.00794)
the mean operative time for LRC and ORC was 521 and 428 minutes respectively. The blood loss was significantly smaller in LRC (p = 0.0014)
the mean volume of bleeding by LRC and ORC was 801 and 2,156 ml respectively. The date of the diet resumption after the operation comes significantly earlier in the case of LRC (p = 0.0142)
the mean number of days to the resumption after LRC and ORC were 4.6 and 9.3 respectively. The top C-reactive protein (CRP) figure was significantly lower in LRC (p = 0.0124)
the mean of peak CRP after LRC and ORC was 10.8 and 16.6 mg/dl respectively. As for postoperative complications, there were no significant differences between two groups (p = 0.375)
the rate of complications occurred after LRC and ORC was 27 and 45% respectively. Also no significant differences were observed as to the number of dissected lymph nodes among these two groups (p = 0.262)
the mean number in LRC and ORC was 10.9 and 13.7 respectively. (Conclusions) From our investigations it is appropriate to conclude that in an early perioperative period LRC has advantages over ORC: a smaller amount of blooding, an earlier date of the diet resumption, and a lower peak of CRP. LRC is less invasive than ORC, though the former takes longer time for an operation than the latter. © 2010 Japanese Urological Association.

DOI： 10.5980/jpnjurol.101.721

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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.101.206_1

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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.101.430_3

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

The case was a 67-year-old male who visited our hospital with a major complaint of macroscopic hematuria. A bladder tumor was found. When a transurethral resection of the bladder tumor was performed, the histopathological diagnosis was neuroendocrine bladder cancer. After chemotherapy with cisplatin and etoposide a partial shrinkage of the tumor was observed
however, the patient expired 7 months after the first visit. Copyright © 2010 S. Karger AG.

DOI： 10.1159/000289584

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

A 73-year-old female was operated with radical nephrectomy and cholecystectomy for renal cell carcinoma and suspected gallstones after 9 courses of sunitinib treatment. Gallbladder specimen showed gallbladder metastasis originating from the renal cell carcinoma. Gallbladder metastasis from renal cell carcinoma is rare. Here, we discuss a case of gallbladder metastasis from renal cell carcinoma. Copyright © 2010 S. Karger AG.

DOI： 10.1159/000279308

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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.101.378_1

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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.101.214_2

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

31歳男性。生体腎移植術後3ヵ月目に上腹部痛、下痢、発熱で来院。術前のCMV抗体はドナー陽性・レシピエント陰性であった。CMVアンチゲネミア陽性化を認め、胃粘膜生検でCMV感染を確認した。免疫抑制剤の減量と抗ウイルス薬を投与して解熱し、下痢、上腹部痛も改善し、CMVアンチゲネミアも陰性化した。(著者抄録)

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DOI： 10.1159/000245926

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Language：Japanese   Publisher：(一社)日本移植学会  

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

18F-FDG PETによる前立腺がんの診断は、従来難しいと考えられてきた。CTとの融合によるPET-CTの導入で、前立腺がんの診断向上の可能性があると考えられ前立腺がんの診断の有用性について検討した。PSA高値(PSA平均値17.7ng/ml)の患者27名に対して、前立腺針生検の前にPET-CTを施行し、病理結果との比較検討を行った。前立腺がんが見つかった患者でのPET-CTの陽性率は37%であった。臨床病期別でPET-CTでの陽性率は、T1cでは25%、T2aでは50%、T2cでは67%、T3aでは100%であった。T2以上の比較的進行した前立腺がんでのPET陽性率は高く、有用性が高いと考えられた。(著者抄録)

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

A 54-year-old woman consulted our hospital for further evaluation of an incidentally detected small renal mass. Abdominal computed tomography (CT) and other imaging showed a right renal mass adjacent to the Riedel's lobe. Laparoscopic right partial nephrectomy was performed under a diagnosis of suspected renal cell carcinoma. Riedel's lobe is an anatomic variant, which is a caudal extension of the right lobe of the liver. Riedel's lobe presented an obstruction during right renal surgery, but we performed the procedure successfully because we retracted the lobe medially. This procedure yielded a clear surgical field, allowing us to perform this delicate operation safely.

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

Mixed epithelial and stromal tumor of kidney (MEST-K) is a rare benign renal tumor that was first described by Michal and Syrucek in 1998. Its frequency is 0.2-0.28% of all the renal tumors. Here, we report an additional case of MEST-K occurring in a 28-year-old woman. The patient visited a hospital with complaints of lumbago and fever caused by pyelonephritis. The computed tomography revealed hydronephrosis and a cystic tumor in the right kidney, and laparoscopic right nephrectomy was performed. The resected kidney contained a cystic lesion with a grayish-white mural nodule, in the lower portion. The entire lesion measured 5 cm in diameter, and the mural nodule 2.5 cm in diameter. Histologically, the cyst was lined with tall columnar and transitional epithelia. The mural nodule showed microcystic architectures lined with tall columnar and transitional epithelia, scattered in a compact stroma. Immunohistochemically, spindle cells in the stroma were positive for smooth muscle-specific actin, and estrogen and progesterone receptors (ER and PR). Based on these findings, the tumor was diagnosed as MEST-K. MEST-K was newly introduced to the WHO classification of renal tumors, with a pathogenesis related to long-term estrogen exposure, because of ER and PR expression in the stroma. It is important to consider the possibility of this tumor when encountering cases of cystic tumor in middle-aged and older women, and men with a previous history of estrogen administration.

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

A 28-year-old man with adult-onset idiopathic male hypogonadotropic hypogonadism (MHH) is reported. He had been delivered normally and had normal puberty. He was referred to our hospital with a chief complaint of infertility. Serum levels of testosterone, luteinizing hormone, and follicle stimulating hormone (FSH) were low. Semen analysis demonstrated azoospermia. Pituitary hypofunction was suggested by gonadotropin releasing hormone (GnRH) loading test. Magnetic resonance images did not detect any abnormalities in the hypothalamic-pituitary region. After a diagnosis of adult-onset hypogonadotropic hypogonadism was established, the patient received human chorionic gonadotropin (hCG) and recombinant FSH treatment. After 5 months, his sperm count reached 6.9 X 10 6 per ml and his wife became pregnant. Adult-onset HH in most cases is caused by tumors and trauma. To our knowledge 17 cases of adult-onset idiopathic HH have been reported, and there were only 3 cases that were caused by pituitary dysfunction. This report showed that r-FSH and hCG therapy was effective in promoting fertility in a patient with adult-onset idiopathic MHH.

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

We report a case of colorectal cancer with metastasis to the upper urinary tract. A 56-year-old man had left flank pain. Ultrasonography and computed tomographic (CT) examination demonstrated left hydronephroureter and a soft-tissue structure within the left ureter. Urinary cytology of the left ureter showed class IIIb. We diagnosed him with ureteral cancer and performed left nephroureterectomy. Microscopic examination demonstrated adenocarcinoma located in ureteral and pelvic wall, especially in blood vessels, with intact mucosa and similar to adenocarcinoma of colon cancer. Therefore metastatic upper urinary tract tumor was suspected. Barium enema and positron emission tomography-CT demonstrated sigmoid colon cancer. Biopsy specimen of colon cancer demonstrated adenocarcinoma, which was consistent with the ureteral tumor. Finally we diagnosed him with metastatic upper urinary tract tumor of sigmoid colon cancer. (Hinyokika Kiyo 55 : 339-343, 2009).

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

A 66-year-old woman, who developed pulmonary tuberculosis at 17 years old, had a high fever in December, 2006. Computed tomographic (CT) scan showed a tumor in the left chalked kidney, which measured 7 cm in diameter with very low enhancement. Laboratory data showed the rise of acute phase reactants (erythrocyte sedimentation rate and c-reactive protein) and severe anemia. The cultures of sputum and urine revealed no Mycobacterium tuberculosis. With the diagnosis of left renal cell carcinoma in the chalked kidney, we performed left radical nephrectomy. Histopathological diagnosis was sarcomatoid renal cell carcinoma. Although sarcomatoid renal cell carcinoma is highly malignant and its prognosis is poor, her post-operative condition has been good without any adjuvant treatments and there have been no recurrent or metastatic lesions for 9 months. The supervention of renal cell carcinoma on renal tuberculosis is rare. The possible effects of tuberculous lesions on the development and progression of renal cell carcinoma are discussed. (Hinyokika Kiyo 55 : 253-257, 2009).

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

A 52-year-old male presented with flank pain and was diagnosed as having right ureteropelvic junction obstruction (UPJO) at another hospital. He underwent trans uretheral balloon dilation, but the symptom recurred. Thereafter, he was referred to our hospital for additional treatment. Abdominal dynamic computed tomography showed right hydronephrosis. The ureteropelvic junction seemed to be caught between a parapelvic cyst and crossing vessel. We successfully performed laparoscopic pyeloplasty with unroofing of the parapelvic cyst. To date, the patient has remained free of symptoms for four months postoperatively.

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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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.100.354_2

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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.100.424_1

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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.100.475_4

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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.100.318_2

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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.100.185_2

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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.100.467_1

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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.100.278_4

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

Background: In the present study, we compared 12-with 8-core biopsy in patients with prostate-specific antigen (PSA) levels of 4.0-20.0 ng/ml. We also examined whether the free/total (F/T) PSA ratio is useful for cancer detection in 12-core biopsy. Methods: A total of 419 men with PSA level between 4.0 and 20.0 ng/ml underwent transrectal ultrasound-guided transperineal needle biopsies of the prostate. Of these men, 235 underwent 8-core biopsy and 184 underwent 12-core biopsy. We compared the cancer detection rate between the 8- and 12-core biopsy groups by analyzing the PSA value, and especially the F/T PSA ratio. Results: The cancer detection rate in the 12-core group (35.9%) was significantly higher than in the 8-core group (23.8%). In cases of PSA level of 4.0-20.0 ng/ml with F/T PSA ratio less than 0.11, the cancer detection rate was 53.1% in the 12-core biopsy group. Performing 12-core biopsy resulted in a marked difference of cancer detection rate between men with F/T PSA ratio less than 0.11 and those with more than 0.12 in gray zone PSA (48.2% and 17.5%, respectively). Conclusions: Twelve-core biopsy can achieve a higher detection rate of prostate cancer than 8-core biopsy using F/T PSA ratio. Copyright (C) 2009 S. Karger AG, Basel

DOI： 10.1159/000209358

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

Silodosin (URIEF®), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1 A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.

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Language：Japanese   Publisher：腎移植・血管外科研究会  

症例は45歳女性。IgA腎症を原病とした慢性腎不全に対して、いとこでもある夫をドナーとした生体腎移植を施行。組織適合はHLA2ミスマッチでダイレクトクロスマッチはT、Bいずれも陰性、血液型は不一致(O+→A+)であった。免疫抑制療法はbasiliximab、CsA、MMF、MPの4剤で導入した。術中より速やかに初尿を認め、血清Crの低下がやや緩慢ではあったものの術後5日目に1.62mg/dlまで低下した。その後術後6日目に急性拒絶反応を生じたがステロイドパルス療法にて改善した。このときカルシニューリン阻害剤をCsAからFKに変更した。再度14日目に血清Crが2.52mg/dlまで上昇、ステロイドパルス療法が無効で、血漿交換にて一時的に効果があるものの尿量、血清Crは安定しなかった。移植腎生検にて傍尿細管毛細血管のC4d陽性、シングルビーズアンチゲンテストで抗ドナーHLA抗体(DR9)が陽性であることから抗体関連型拒絶反応と診断し術後20日目にリツキシマブ200mgを投与。その後、血清Cr値は1.1前後で安定し、術後60日で退院となった。また、10ヵ月以上経過した現在まで拒絶反応やリツキシマブ投与に伴う副作用を認めていない。術後早期に生じた抗体関連型拒絶反応に対してリツキシマブを使用し奏効した1例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：The Japanese Urological Association  

CMV infection is uncommon in our practice except kidney transplantation. We report a case of cytomegalovirus enterocolitis during standard chemotherapy for testicular cancer. A 31-year-old male presented to his local urologist in January, 2006 with left scrotal swelling. He was diagnosed as left testicular tumor and underwent radical orchiectomy. Pathological examination showed Mixed germ cell tumor (seminoma, yolk sac, embryonal). Four months later, follow-up CT scan revealed multiple metastasis in lung and para aortic lymph nodes. The patient was referred to our institution for further consultation. During 3^rd cycle of standard BEP chemotherapy, laboratory data showed severe bone marrow suppression and he subsequently presented prolonged spike fever with watery diarrhea. Despite intensive diagnostic examination including colon fiberscopy, those symptoms remained undiagnosed. One month later, the patient recovered with conservative treatment and serological data showed slightly elevated anti-CMV Ig-M, Ig-G antibody. Immunohistological examination demonstrated CMV positive inclusion bodies in colorectal mucosa. Accordingly the patient's complication was finally diagnosed as CMV enterocolitis. Significant immunosuppression leading to severe colitis by CMV infection or reactivation can occur after standard chemotherapy. It is necessary to screen for CMV infection in patients with prolonged fever with diarrhea during chemotherapy.

DOI： 10.5980/jpnjurol1989.99.551

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Other Link： https://jlc.jst.go.jp/DN/JALC/00311652912?from=CiNii

Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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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.99.400_3

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Language：Japanese   Publisher：(一社)日本移植学会  

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

Objectives: Laparoscopic adrenalectomy has become an effective option for aldosteronoma. We evaluated the retroperitoneal approach with regard to safety, efficacy, invasiveness and cost-benefit ratio in patients with primary aldosteronism.
Methods: Between July 1999 and June 2005, we carried out a total of 195 retroperitoneoscopic adrenalectomies (RA) in one hospital, including 108 on the left and 87 on the right, in 78 men and 113 women aged 20-78 years (mean age 48.2 years) with aldosteronoma. Average adrenal tumor size was 16 mm (range 10-32 mm). The 195 operations were divided into 10 groups of 20 operations each, and the mean duration and estimated blood loss for each group were compared.
Results: The mean operating time and intraoperative blood loss in RA were 93.2 +/- 37.4 (45-210) min and 68.5 +/- 53.2 (5-210) mL, respectively. Compared to group 1 (cases 1-20), a statistically significant decrease in operative time and estimated blood loss were seen in and after group 4 (&gt;= case 61, 94.5 +/- 30.3 vs 139.2 +/- 44.7 min, P &lt; 0.01), and in and after group 5 (&gt;= case 81, 67.5 +/- 50.5 vs 120.5 +/- 60.9 mL, P &lt; 0.01), respectively. No differences were found in duration of surgery and estimated blood loss between left and right sided tumors (P &gt; 0.05). The mean postoperative hospital stay was 4.5 +/- 1.2 days. Postoperative complications, including hematoma and wound infection, occurred in 4.1% of patients.
Conclusions: Retroperitoneoscopic adrenalectomy for aldosteronoma is a safe, effective, and minimally invasive approach with an advantageous cost-benefit ratio. With accumulated experience, it can expedite the learning curve for RA.

DOI： 10.1111/j.1442-2042.2007.01860.x

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

A 48-year-old woman underwent a renal transplantation from her sister. The graft functioned immediately. She received induction immunosuppressive therapy, including basiliximab, tacrolimus hydrate, mycophenolate mofetil and methylprednisolone. Her urinary output decreased on the first postoperative morning. Plasma exchange for 3 days and conversion from tacrolimus hydrate to cyclosporine partially improved graft function. Graft biopsies on the fifth postoperative day suggested an acute humoral rejection. On the seventh postoperative day, she experienced high fever, disorientation, hypertension and severe upper abdominal pain with a bulk of bloody stool. Graft function deteriorated again. Gastrointestinal fiberscopy showed severe duodenitis with bleeding. Following seven successive daily plasma exchanges with hemodialysis and reconversion to low dose tacrolimus hydrate, the systematic symptoms and graft function gradually improved. Two years after transplantation, graft function was good with a serum creatinine level of 1.0 mg/dL. The patient did not experience any further gastrointestinal symptoms.

DOI： 10.1111/j.1442-2042.2007.01572.x

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

We present a 67-year-old male with a rare case of collecting duct carcinoma producing granulocyte colony-stimulating factor. He was referred to us with lumbago and fever. Laboratory testing showed leukocytosis and computed tomography revealed a left renal mass. After chemotherapy with gemcitabine and nedaplatin, computed tomography showed a partial response. A left nephroureterectomy was performed. The histopathological diagnosis was collecting duct carcinoma producing granulocyte-colony-stimulating factor. White blood cell levels were reduced to 9900/mm(3). No recurrence was detected after completion of adjuvant chemotherapy and the patient was discharged from the hospital. However, 3 months later, computed tomography revealed multiple lung metastasis. Nedaplatin- based chemotherapy was administered but computed tomography after chemotherapy identified a progressive disease. The patient died 9 months after the operation.

DOI： 10.1111/j.1442-2042.2006.01711.x

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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

We report a rare case of uterine corpus metastasis from superficial bladder cancer. A 78-year-old female presented with abnormal vaginal bleeding. She received transurethral resection of bladder tumor (TUR-Bt) two years previously, and the pathological findings were transitional cell carcinoma (TCC) grade 3 pT1. Eight courses of BCG instillation were performed postoperatively. There was no recurrence of bladder cancer when vaginal bleeding occurred. Cytology of vaginal discharge was class V, and transitional cell carcinoma suspected. Pathological finding of transvaginal uterine corpus biopsy was TCC. We diagnosed metastases to uterine corpus from bladder cancer.

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

We investigated the feasibility, safety, and anti-tumor activity of combination chemotherapy with gemcitabine and nedaplatin (GN therapy) in patients with urological cancer. A total of 12 patients were enrolled in the current study. Histological characteristics in this study were 9 patients of urothelial carcinoma (UC), 2 patients of squamous cell carcinoma of the ureter (SCC), and 1 patient of renal collecting-duct carcinoma (CDC). All UC and one SCC were treated with GN therapy as second line chemotherapy. Other 2 patients were treated as induction chemotherapy. Systematiccombination chemotherapy consisting of gemcitabine (1,000 mg/m 2 on day 1 and 8) and nedaplatin (80 mg/ m 2 on day 1) was performed. 5 partial responses and 7 stable diseases were achieved in 12 assessable patients and corresponded to an over all response rate of 42%. 2 (22%) of 9 patients of UC, all patients of SCC and CDC responded to GN therapy. Grade 3 and 4 toxicity was primarily hematologic. The result of current study suggests that GN therapy may be an effective treatment for patients with SCC and CDC. On the other hand, UC as second line chemotherapy was notsuccessful.

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

We reported a case of laparoscopic heminephroureterectomy for ureter cancer in a horseshoe kidney. A 59-year-old woman presented with frequency and diagnosed as left lower ureter cancer with a horseshoekidney. We performed transperitoneal laparoscopic nephroureterectomy. Feeding vessels were four arteries and two veins. Isthmus of the horseshoe kidney was divided using LCS and hemostasis was made using monopolar shears. Operating time was 300 minutes. Total Blood loss was 400 ml. Laparoscopic pyeloplasty or ishmusectomy to benign disease of the horseshoe kidney is often reported, but that of heminephrectomy to malignancy is seldom reported. Laparoscopic Heminephectomy for a horseshoe kidney is difficult surgery for aberrant vessels and isthmus, so it tends to be avoided for safety. But if anatomical consideration about aberrant vessels etc is well done and we operate carfully, so we will be able to do it for safety and small invasive opration.

DOI： 10.5980/jpnjurol1989.98.786

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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.98.512_3

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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.98.411_4

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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.98.420_1

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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.98.300_1

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

In August 2000, a 62-year-old woman presented to another municipal hospital with macroscopic hematuria. Transurethral resection of bladder tumor (TUR-Bt) was performed. The pathological diagnosis was transitional cell carcinoma (TCC), G2 &gt
squamous cell carcinoma (SCC). TUR-Bt repeated in July 2003 indicated recurrence. The pathological diagnosis was TCC, G2. She was referred to our hospital in August 2003 because she desired bladder preservation. After cystoscopy and random biopsy, pathological diagnosis was TCC with squamous differentiation, G1-G2, pTis. She received 7 weekly intravesical bacillus Calmette-Guerin (BCG) instillations. In April 2004, TUR-Bt was repeated and multiple recurrences were found. The pathological diagnosis was TCC with squamous differentiation, G1-G2, pTa. She received 10 weekly intravesical Pirarubicin hydrochroride instillations. In August cystoscopy and random biopsy were performed for evaluation of the intavesical instillation treatment. Pathological diagnosis was atypical squamous cells. In November, cystoscopy revealed recurrence of a bladder tumor. After admission, a small papillary tumor and multiple flat lesion biopsies demonstrated SCC without obvious invasion. The patient underwent cystectomy. There were widespread areas of full thickness squamous atypia. Most of the bladder did not show appearance of typical TCC, but the final pathological diagnosis was TCC because the case developed from TCC and could not be diagnosed as pure SCC. The diagnosis of SCC in situ of bladder is difficult, and this may contribute to its rarity.

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

A 28-year-old woman with end-stage renal disease due to congenital hypoplasia and vesicoureteric reflux in the bilateral kidneys received a renal transplant from her 52-year-old mother. She became pregnant 3 years later. The serum creatinine level was 1.6 mg/dL with a creatinine clearance of 27.3 mL/min/1.48 m(2) just prior to pregnancy. Her graft showed hydronephrosis at 12 weeks of pregnancy. At 25 weeks a double J-type stent catheter was placed, without exposure to radiation, because of progressive deterioration of the graft hydronephrosis. Hydronephrosis partially improved, but her serum creatinine level further increased to 2.3 mg/dL. She delivered a healthy boy by routine caesarean section at 34 weeks of pregnancy. Computed tomography demonstrated the ureter wedged between the gravid uterus and the graft. The catheter was removed 10 days postpartum. Six months later, ultrasonographic study did not show hydronephrosis and the serum creatinine level was 2.0 mg/dL.

DOI： 10.1111/j.1442-2042.2006.01409.x

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

A 46-year-old man complained of lower abdominal pain, and his abdominal and pelvic computed tomographic scan revealed left hydronephrosis and a huge tumor (9 × 9 cm) in the left distal ureter involving the left iliac vessel that was considered unresectable. Histological diagnosis showed squamous cell carcinoma, and histoculture drug response assay (HDRA) suggested the effectiveness of gemcitabine and nedaplatin. A cycle of adjuvant chemotherapy consisting of MEG (methotrexate 30 mg/m 2: day 1 and 15, epirubicin 50 mg/m 2: day 1, and cisplatin 50 mg/m 2: day 2 and 3) was performed as a first line chemotherapy, but the size of the ureteral tumor did not change. He was treated with 3 cycles of systematic combination chemotherapy consisting of gemcitabine (1,000 mg/m 2: day 1 and 8) and nedaplatin (80 mg/m 2: day 1). After 2 courses of chemotherapy, the tumor size was reduced by 50% (PR
RECIST guidelines) and the tumor markers (SCC, CYFRA, NSE, CEA, and CA19-9) dropped to within the normal range. There were no serious adverse events except for grade 3 neutropenia which spontaneously recovered. However, because the tumor size was not reduced after the third cycle of chemotherapy, we applied external beam radiation to the primary lesion and the metastatic retroperitoneal lymph node site. No evidence of residual tumor progression has been found for 6 months after radiation therapy. We concluded that GN chemotherapy may be useful for patients with squamous cell carcinoma of the ureter.

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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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.97.543_1

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Language：Japanese   Publisher：横浜市立大学医学会  

横浜市立大学付属市民総合医療センターでは,2001年4月より腎移植時の免疫抑制にミコフェノール酸モフェチル(MMF)を追加し,カルシニューリンインヒビターとステロイドの投与量を減量できるようになった.MMFを使用した15例(MMF群)と,使用以前の7例(non-MMF群)を比較した.生存率は共に100%で,6ヵ月,1年生着率はMMF群で100%,86%,non-MMF群ではどちらも87%であった.移植6ヵ月後の血清クレアチニン濃度は,MMF群1.3mg/dl,non-MMF群1.8mg/dlであった.拒絶反応は71%から33%に低下し,サイトメガロウイルス感染の発生頻度も71%から47%に低下した.しかしMMFの副作用の一つである消化器症状が20%の患者に発生した.今後,免疫抑制剤の更なる改善により更に安全な腎移植を探っていく必要がある

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Language：Japanese   Publisher：(一社)日本移植学会  

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

BACKGROUND: Although patients with prostate cancer with metastatic lesions initially respond to androgen ablation therapy, most patients ultimately develop a hormone-refractory state. Effective treatment for men with hormone-refractory prostate cancer (HRPC) has not been established. We performed a clinical study of docetaxel in HRPC patients, and evaluated its efficacy. METHODS: Nine patients with HRPC were administered 55 mg/m2 docetaxel, every 3 weeks, simultaneously with hormonal therapy, with a luteinizing hormone-releasing hormone analog, and daily oral dexamethasone. Change in serum prostate-specific antigen (PSA) was determined as the primary endpoint. RESULTS: The mean age of the patients was 64 years (range, 49 to 76 years). Median follow-up time was 8.5 months (range, 5.3 to 16.7 months). In eight patients whose pretreatment serum PSA was elevated, six patients (75.0%) had a PSA decline of more than 50%, and four (50.0%) had a PSA decline of more than 75%. Median time to progression for all patients was 7.9 months (range, 0.0 to 11.6 months; 95% confidence interval [CI], 0.0 to 26.3). The median overall survival was 8.5 months (range, 5.3 to 16.7 months; 95% CI, 8.1 to 13.8). Four of six patients (66.7%) with pain before treatment obtained pain relief and were able to discontinue analgesic agents. This regimen was well tolerated. Grade 3 or 4 neutropenia or leukocytopenia without fever was seen in three patients (33.3%). Only one patient required administration of granulocyte-colony stimulating factor because of neutropenia. No other grade 3 or 4 toxicity was observed. CONCLUSION: Docetaxel was an active agent in Japanese HRPC patients, and was well tolerated in this population. To establish its efficacy and safety in Japanese HRPC patients, a large-scale study in Japan is warranted.

DOI： 10.1007/s10147-005-0490-0

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Language：Japanese   Publisher：(一社)日本移植学会  

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

Two patients with testicular tumors whose serum α-fetoprotein (AFP) persisted to show an abnormally high concentration are reported. Case 1 : A 42-year-old male who had been suffering from chronic hepatitis, underwent left high orchiectomy for a left testicular tumor in 1998. Diagnosis was an authentic stage I seminoma. In 2002, chemotherapy was performed for a metastatic seminoma revealed as a solitary mass in the mediastinum by radiographic studies, and histologically confirmed to be a metastatic seminoma. Although lymph nodes were gradually reduced in size, the serum AFP and transaminase levels remained at an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) revealed elevation of only peak 1 which implied that the chronic hepatitis was due to liver dysfunction. After a 10-month follow-up the levels of both AFP and transaminase decreased, and the patient was disease-free. Case 2: In 2002, a 30-year-old male underwent left high orchiectomy for a left testicular tumor, and histological examination revealed seminoma, immature and mature teratoma, embryonal carcinoma. The serum AFP was elevated to 45 ng/ml. Diagnosis was authentic stage I. After 2 courses of chemotherapy, the serum AFP remained at an abnormally high concentration. However, there were no new lesions. The serum AFP level was not elevated in any of the family members. The subfraction profile with LCA revealed elevation of only peak 1, which implied that there were no viable lesions. After a 24-month follow-up AFP was about 20 ng/ml and the patient was disease-free.

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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.96.350_1

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

In April 2001, we introduced a new immunosuppression regimen including mycophenolate mofetil (MMF) with a reduced dose of calcineurin inhibitor and methylprednisolone for kidney transplantation. In this study, we evaluated the survival rates and complications in patients recieving MMF (n = 15: MMF group), compared to those of patients treated without MMF (n = 7: non-MMF group). The one-year patient survival rates were 100% in both groups. Six months and one year graft survivals in the MMF group were 100% and 86%, respectively. In contrast, the 6-months graft survival was 87% in the non-MMF groups. In the MMF group, two patients lost their graft because of post transplant glomerular nephritis and interstitial nephritis in the 11 th post transplant month. One patient lost the graft by acute rejection in the 4 th post transplant month in the non-MMF group. The frequency of post-transplant acute rejections and antigenemia-positive CMV infections was reduced to 33% and 47% in the MMF group, compared with 71% and 71% in the non-MMF group, respectively. However, adverse gastrointestinal events occurred in 3 patients (20%) and MMF treatments were discontinued in three patients in the MMF group. In kidney transplantation, immunosuppressive treatment using MMF, low-dose calcineurin inhibitor, and methylprednisolone may be an effective and safe option, but further evaluation is needed.

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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.96.242_1

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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.96.142_4

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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

A case of retroperitoneal liposarcoma with reactive pleural effusion is reported. A 58-year-old male who complained of weight gain and edema had visited another clinic in May, 2002. Computed tomography revealed a retroperitoneal tumor, 11 × 9 × 9.5 cm in size, surrounding his right kidney and bilateral pleural effusion. Complete resection of the tumor and right kidney was performed with a transperitoneal approach. Though the tumor was limited within Gerota's fascia, we noted two liters of abdominal ascites. Surgical specimen was histologically diagnosed as well differentiated liposarcoma. The post operative course was uneventful. The pleural effusion disappeared, and serum total protein level was normalized. He has remained free of disease for one year.

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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.95.524_3

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

(Purpose) Retroperitoneoscopic radical nephrectomy (RRN) has been performed at Yokohama City University Medical Center since May 2002. Three surgeons have become skilled in performing RRN without major complications. We investigated the outcomes of the surgery and attempt to clarify whether the technique we adopted is suitable to perform this procedure safely. (Patients and Methods) Between May 2002 and June 2003, 14 patients suspected of renal cell carcinoma underwent retroperitoneoscopic radical nephrectomy at Yokohama City University Medical Center. The surgical procedure is shown below. In a lateral position, a lumbar oblique incision 6 cm long is made to approach the retroperitoneal space. Under direct vision, the ureter is dissected and Gerota's fascia is dissected from the peritoneum and the psoas muscle to signalize the subsequent dissection line. After the dissection, hand port device was attached to the skin and three 12-mm trocars were placed. The subsequent procedures are performed by retroperitoneoscopic surgery with carbon dioxide insufflation. The isolated kidney was removed through the incision that was made initially. We investigated the outcomes of this procedure. (Results) The mean surgical duration was 244.4 minutes and mean blood loss was 217.9 ml. Conversion to open surgery was required in one case due to bleeding and in one case due to incomplete management of a small artery. Blood transfusion was not required in any case. There were no major complications during the perioperative period. (Conclusions) The three operators have become skilled in performing RRN safely with this technique.

DOI： 10.5980/jpnjurol1989.95.669

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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.95.525_3

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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)   Publisher：LIPPINCOTT WILLIAMS & WILKINS