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

We present the case of a 46-year-old man who underwent successful antegrade ureteroscopy for lithiasis in his allograft ureter. At a scheduled follow-up 15 years after transplantation, computed tomography (CT) detected a 12-mm renal stone in the renal pelvis of the transplanted kidney. During his follow-up, gross hematuria was seen
the stone moved to the ureter, causing hydronephrosis. Ultrasound and non-contrast CT revealed hydronephrosis and a 15-mm stone in the transplanted ureter. Considering the stone size, location, and the difficulty of the access to the anastomosed ureteral orifice, percutaneous ureteroscopic approach was planned. Due to the anatomical difficulty regarding his allograft kidney, we planned to prepare a 3D image and model for selecting the best percutaneous approach. The procedure was performed and a stone-free status was acquired without complication. Under precise simulation, we performed successful antegrade ureteroscopy for lithiasis in the allograft ureter supported by 3D imaging. Use of a 3D printed model may aid in a safe and effective procedure for lithiasis in the allograft kidney and ureter.

DOI： 10.1007/s00240-019-01153-x

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Introduction: Paraganglioma has been determined to be an extra-adrenal pheochromocytoma. Paraganglioma of the bladder is a rare entity, accounting for 0.06% of all bladder tumors. Case presentation: A 58-year-old woman had been annually followed up since being diagnosed with rectal cancer 5 years ago. In January 2018, follow-up computed tomography detected a bladder tumor, and she was referred to our department for a further examination. Cystoscopy revealed a submucosal tumor on her right bladder wall. We performed transurethral resection of the bladder tumor. When we first marked the tumor margin, the systolic blood pressure increased, so we abandoned resection. We performed meta-iodobenzylguanidine scintigraphy and acid urinary collection, neither of which revealed any abnormal findings. We therefore performed open partial cystectomy based on a clinical diagnosis of paraganglioma of the bladder. The pathological findings revealed paraganglioma of the bladder. Conclusion: We herein report a case of paraganglioma of the bladder.

DOI： 10.1002/iju5.12071

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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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Introduction: Testicular epidermal cysts in Klinefelter syndrome are very rare. We report a case of Klinefelter syndrome associated with a testicular epidermal cyst. To our knowledge, this is the first report showing successful spermatozoa retrieval from the affected testis. Case presentation: A 25-year-old married man was referred to our hospital with right scrotal induration, which was in lower pole of the right testis. Testicular cancer tumor markers were normal; endocrinological findings indicated hypergonadotropic hypogonadism. Semen analyses revealed azoospermia. Preoperative chromosome test result: 47, XXY karyotype; ultrasonography report: 1.9-cm internal heterogeneous echoic mass in the right testis (malignancy not discarded). Because the patient hoped for children, he underwent high orchiectomy with ipsilateral testicular sperm extraction (200 spermatozoa from normal testicular tissue) for future fertilization procedures. Tumor pathology was an epidermal cyst. Conclusion: While performing orchiectomy for testicular tumors, sperm retrieval should be attempted from normal tissues in patients planning for children.

DOI： 10.1002/iju5.12037

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Introduction: The prognosis of type 2 papillary renal cell carcinoma is often poor. We herein report a case of papillary renal cell carcinoma with liver metastasis that was successfully treated with sorafenib as a second-line therapy. Case presentation: An 82-year-old man who had undergone radical nephrectomy 5 years previously experienced biopsy-proven liver metastasis. He received sunitinib as a first-line treatment; the dose was initially 12.5 mg/day and was escalated to 25 mg/day, but it was discontinued due to several adverse events. We then switched to sorafenib as a second-line treatment, which resulted in a partial response (51% reduction in tumor size); the patient showed no recurrence 5 months after the initiation of sorafenib treatment. An immunohistochemical analysis revealed the overexpression of Raf in both the primary and metastatic tumors. Conclusion: As sorafenib blocks Raf signaling, the expression of Raf may serve as a useful predictor of the efficacy of sorafenib.

DOI： 10.1002/iju5.12035

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

DOI： 10.1016/j.eucr.2018.02.017

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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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DOI： 10.3892/mco.2017.1537

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Lenalidomide has been developed as the derivative of thalidomide that has fewer side effects. We herein report a rare case of castration-resistant prostate cancer successfully maintained using lenalidomide for multiple myeloma.

DOI： 10.1002/ccr3.1328

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

Prostate basal cell carcinoma (PBCC) accounts for 0.01% of all prostate cancers. A 68-year-old man complained of dysuria for 5 years on his initial visit. His PSA level was 3.87 ng/mL. Due to a diagnosis of benign prostate hyperplasia, he underwent transurethral resection of the prostate. A pathological examination revealed that basal cell-like atypical cells made alveolar with palisadal layout. Immunohistochemical analysis showed positive 34β12, P63, and Ki-67. Based on these findings, PBCC was diagnosed. Then, we performed radical prostatectomy. He was free from recurrence 22 months after the operation. We herein report an extremely rare case of PBCC.

DOI： 10.1159/000487389

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

Introduction. Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. Case Presentation. A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. Conclusion. We herein report a rare case of adrenal hemangioma.

DOI： 10.1155/2018/8796327

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Background: Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. Case presentation: A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/μL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. Conclusions: Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.

DOI： 10.1186/s13256-017-1473-2

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

Objectives: Recent studies have demonstrated that up-front docetaxel combined with androgen deprivation therapy (ADT) prolongs survival in some patients with metastatic hormone-naive prostate cancer (mHNPC). However, new biomarkers for selecting personalized treatment strategies for mHNPC are warranted. We evaluated the value of low-molecular-weight protein tyrosine phosphatase (LMW-PTP) expression as a prognosticator in men with mHNPC.
Methods and materials: A total of 48 men with mHNPC diagnosed from 2003 to 2009 were enrolled in this study. Prostate cancer tissues obtained by needle biopsies were immunohistochemically stained for LMW-PTP. Correlations between LMW-PTP expression and clinicopathological characteristics were then assessed.
Results: At the time of analysis, 29 (60.4%) patients were alive, whereas 15 (31.3%) and 4 (8.3%) died of prostate cancer and nonprostate cancer, respectively. Of these, 29 (60.4%) had low LMW-PTP expression and 19 (39.6%) had high expression. Median overall survival (OS) for patients with high LMW-PTP expression was not reached and that for patients with low LMW-PTP expression was 23.8 months. High LMW-PTP expression was significantly correlated with a shorter OS compared with low LMW-PTP expression (P = 0.01). Moreover, multivariate analysis showed that Gleason score (&gt;= 8 vs. &lt;= 7; HR = 5.8, 95% CI: 1.3-26.5, P = 0.02) and LMW-PTP expression (high vs. low; HR = 2.7, 95% CI: 1.0-7.2, P = 0.04) were independent prognostic factors for OS.
Conclusions: LMW-PTP is a potential biomarker to predict OS in patients with mHNPC. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.urolonc.2017.05.019

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

Background: In most cases, prostate cancer metastasizes to the lymph nodes, bone, and liver. In very rare cases, it metastasizes to the ureter. Due to the difficulty in making a preoperative diagnosis, ureteral metastasis from prostate cancer is typically diagnosed after nephroureterectomy. Case presentation: A 77-year-old Asian Japanese man with right hydronephrosis and hydroureter was referred to our hospital to undergo further examination due to the suspicion of ureteral cancer. He had been diagnosed 2 years previously with prostate cancer with a Gleason score of 4+5=9. He received radiotherapy and androgen deprivation therapy. A nephroureterectomy was performed for suspected right ureteral cancer. On the basis of a histopathological examination, poorly differentiated adenocarcinoma was suspected, and the tumor cells were positive for prostate-specific antigen immunohistochemically. Conclusions: We herein report a rare case of ureteral metastasis in castration resistant prostate cancer.

DOI： 10.1186/s13256-017-1379-z

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

We retrospectively assessed the bone scan index as a predictor of overall survival in patients with metastatic castration-resistant prostate cancer treated with enzalutamide or abiraterone acetate. Improved bone scan index after these treatments independently predicted longer overall survival.
Purpose: Bone scan index (BSI) is an objective tool for quantifying bone metastasis load. We assessed its prognostic usefulness in patients with metastatic castration-resistant prostate cancer (CRPC) treated with enzalutamide (ENZ) or abiraterone acetate (AA). Materials and Methods: We analyzed 40 patients who received ENZ or AA treatment (ENZ/AA) for metastatic CRPC. The Cox proportional hazards model and a C-index were used to investigate associations between overall survival (OS) and BSI, and patient age, prostate-specific antigen, time to CRPC, previous docetaxel use, and pain. Results: Median OS after ENZ/AA was 17.8 months. All patient deaths (n = 19; 47.5%) were from prostate cancer. In multivariate analysis, decreased BSI was an independent predictor for longer OS (hazard ratio, 8.97; P =.011). Inclusion of BSI improved the C-index from 0.721 to 0.792 in predicting OS after ENZ/AA. Conclusions: Decreased BSI after ENZ/AA independently predicts longer OS. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.clgc.2016.12.020

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

We report three patients with frequent febrile urinary tract infections (fUTI) who underwent transurethral injection therapy with Deflux for vesicoureteral reflux (VUR). The first case was in a 52-yearold woman who was initially diagnosed with right grade II and left grade I VUR at 18 years of age. She frequently experienced fUTI due to VUR. The second case was in a 29-year-old woman. At age 23, she was diagnosed with right grade III VUR when she developed fUTI. After that, she repeatedly developed fUTI. The third case was in a 40-year-old woman who had frequendy experienced fUTI since 25 years of age and had gradually become antibiotics-resistant. She was diagnosed with right grade III VUR when she was referred to our hospital. No visible reflux was confirmed by postoperative voiding cystourethrography after the patients underwent transurethral injection using Deflux. One patient developed fUTI once after surgery, but there were no perioperative complications and no recurrences. Transurethral injection using Deflux for VUR might therefore be safe and effective for treating VUR in adult female patients.

DOI： 10.14989/ActaUrolJap-63-7-271

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

症例は67歳男性。右腎癌結腸浸潤に対して根治的右腎摘術、右半結腸合併切除術を施行した。病理結果は淡明細胞癌(G3、pT4N0M0)の診断となった。術後3ヵ月目に右肺に多発転移を認めたため、スニチニブの投与を(50mg/日)開始した。投与後9ヵ月で転移の進行を認めた。その2ヵ月後に狭心症発作と不整脈にて入院となった。その際に施行した造影CTにて右心室壁から突出する腫瘤を認め、腎細胞癌の心転移と診断した。不整脈に対してNaチャネル阻害剤を投与した。エベロリムスが32日間投与されたが、間質性肺炎が生じたため、これらの薬剤の投与を中止せざるを得なかった。エベロリムス投与終了時に副反応の精査目的で撮影されたCTにて腫瘤の著明な縮小を認めた。4年経過後も担癌状態のまま生存している。下大静脈進展を伴わない腎癌の心転移は非常に稀である。今回われわれは心筋転移に対して短期間のエベロリムス投与が有効であった1例を報告する。(著者抄録)

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

Background: Due to the recent development of laparoscopic devices, laparoscopic radical nephrectomy is the standard procedure for localized renal cell carcinoma. However, some studies have reported postoperative port site metastasis in several cancers. Case presentation: A 68-year-old Asian-Japanese man was referred to our hospital for a further examination of his right renal tumor in 2009. Due to a clinical suspicion of renal cell carcinoma, laparoscopic nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. Follow-up computed tomography revealed a mass between the internal oblique muscle of his abdomen and the transverse muscle of his abdomen in 2014. The tumor size gradually increased, and positron emission tomography-computed tomography revealed the accumulation of fludeoxyglucose in that tumor with maximum standardized uptake value of 2.7. Based on these findings, port site recurrence was suspected, and tumor resection was performed in 2017. The pathological diagnosis was metastatic clear cell renal cell carcinoma. Conclusions: Here we report a rare case of port site metastasis that was successfully treated 7 years after laparoscopic nephrectomy.

DOI： 10.1186/s13256-017-1319-y

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

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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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：泌尿器科紀要刊行会  

45歳男性。左精巣癌術後に化学療法を3コース施行されたが、3コース終了後の胸部CTにて右肺下葉に浸潤影を認めたため紹介となった。血液検査では炎症反応、腫瘍マーカーは基準値内であったが、胸部単純CTでは右S8領域に33×20mmの浸潤影、近接する胸膜の引き連れ像が認められた。気管支鏡では右肺S8領域中枢側に気管支内を閉塞する白色構造物を認め、気管支洗浄液の培養結果より、肺Maycobacterium avim complex(MAC)症と診断された。病変部が広範囲であったことから、胸腔鏡下右下葉切除術を施行した。病理組織学的に悪性所見はみられず、術後16日目の単純CTでは右肺病変の消失を認めた。術後3年6ヵ月経過現在、精巣癌、肺MAC症ともに再発を認められていない。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01269&link_issn=&doc_id=20170214300007&doc_link_id=120005980883&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F120005980883&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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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DOI： 10.1016/j.ijscr.2016.11.042

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

Introduction: We evaluated bone scan index (BSI) as a predictive biomarker for time to castration-resistant prostate cancer (CRPC) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Materials and Methods: We identified 85 consecutive mHSPC patients treated with first-line androgen deprivation therapy. We analyzed the correlations between time to CRPC and clinicopathological characteristics, including age, prostate-specific antigen (PSA) level, Gleason score, clinical TNM stage, hemoglobin, lactate dehydrogenase, C-reactive protein, and BSI. Results: The median BSI was 2.7%. Progression to CRPC occurred in 55 (64.7%) patients and the median time to CRPC was 12.9 months. In multivariate analysis, 3 significant risk factors for time to CRPC were identified: age (&gt; 73 vs. &lt;= 73 years; hazard ratio [HR] 0.53), p = 0.038, PSA level (&gt; 270 vs. = 270 ng/mL; HR 0.53, p = 0.038), and BSI (&gt; 2.7 vs. = 2.7%; HR 2.97, p &lt; 0.001). Conclusion: Age, PSA level, and BSI were found to be significant predictive factors for time to CRPC in patients with mHSPC. (C) 2017 S. Karger AG, Basel

DOI： 10.1159/000477131

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

Introduction. Xanthogranulomatous pyelonephritis (XGP) is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT) revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells
thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

DOI： 10.1155/2017/2392670

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

Introduction. Gemcitabine and cisplatin (GC) is a gold-standard first-line systemic chemotherapy for advanced urothelial carcinoma (UC). However, it may cause severe adverse effects such as renal toxicity, gastrointestinal toxicity, and neurotoxicity. Sarcopenia is the age-related loss of skeletal muscle mass. A correlation between sarcopenia and the oncological prognosis has been reported. In UC, several studies have noted that patients with sarcopenia had a greater incidence of complications and worse survival after radical cystectomy or chemotherapy. Our institute introduced gemcitabine and nedaplatin (GN) for UC patients with renal failure. We investigated whether the presence of sarcopenia predicted the prognosis of patients with advanced UC who were treated by GN chemotherapy. Methods. A total of 27 patients (male: &gt;= 21; female, n = 6) received GN therapy for metastatic UC from 2005 to 2016. The institutional review board of Yokohama City University Hospital approved this study. The psoas muscle index (PMI, cm(2)/m(2)) was calculated using this formula: right psoas muscle area (cm(2))/the square of the body height (m(2)). The overall survival (OS) of the high PMI group (male: &gt;= 2.49, female: &gt;= 2.07) and low PMI group (male: &lt; 2.49, female: &lt; 2.07) was compared. Results. Kaplan-Meier survival curves and a log-rank test revealed that the high PMI group had significantly better OS than the low PMI group (p = 0.015). The mean survival of the high and low PMI groups was 561 days and 223 days, respectively. Conclusions. In the present study, we revealed that sarcopenia (a low psoas muscle volume) might be a predictive factor for poorer overall survival in patients with advanced urothelial carcinoma who are undergoing GN chemotherapy.

DOI： 10.1155/2017/7981549

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：医学図書出版(株)  

精巣上体原発の線維性偽腫瘍は陰嚢内腫瘍の中で非常に稀な腫瘍である。患者は45歳男性で右陰嚢内腫瘤を主訴に来院した。陰嚢部超音波検査では精巣上体に境界明瞭で石灰化を伴う腫瘤を認めた。術中所見で精巣上体に限局した腫瘍であったため、精巣上体摘除術のみを施行した。病理検査の結果、精巣上体原発の線維性偽腫瘍の診断となった。術後18ヵ月経過するが、再発は認めていない。(著者抄録)

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

Foreign bodies are occasionally reported in the bladder. In most cases, the foreign body is removed via the transurethral approach. A 57-year-old male patient was referred to our hospital to undergo the retrieval of a foreign body from his bladder. However, the foreign body had become severely calcified and could not be removed transurethrally. Thus, an open bladder wall incision was necessary to remove it. We herein report a case of a foreign body in the bladder that had become calcified and which was successfully removed using a higher bladder incision approach. A careful preoperative examination should be performed to detect the characteristics of the foreign body and avoid the risk of bladder wall perforation.

DOI： 10.1016/j.ijscr.2017.02.003

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

For metastatic castration-resistant prostate cancer patients, initial prostate-specific antigen, N stage, extent of disease grade on bone scan, and previous duration of response to combined androgen blockade predicted response to an alternative antiandrogen as second-line therapy.In Japan, flutamide had been commonly used as second-line alternative antiandrogen hormonal therapy for metastatic castration-resistant prostate cancer that relapses after initial hormone therapy before new androgen pathway inhibitors became available. In this study, we attempted to identify predictive factors for efficacy of alternative antiandrogen as second-line hormone therapy.
We identified consecutive 65 patients with metastatic castration-resistant prostate cancer who were treated with alternative antiandrogen as second-line hormonal therapy (bicalutamide to flutamide). All patients were treated with combined androgen blockade initially. We analyzed correlations between progression-free survival of alternative antiandrogen and clinicopathological characteristics, including patients' ages, initial prostate-specific antigen levels, prostate-specific antigen levels at flutamide induction, Gleason scores, T stage, N stage, extent of disease grades on bone scan and previous duration of prostate cancer response to combined androgen blockade.
In univariate analysis, T stage, N stage and previous duration of response to combined androgen blockade were correlated with shorter progression-free survival. We found four significant risk factors for shorter progression-free survival in multivariate analysis: initial prostate-specific antigen level, clinical N stage, extent of disease grades and previous duration of response to combined androgen blockade.
Initial prostate-specific antigen, N stage, extent of disease grades on bone scan and previous duration of response to combined androgen blockade were the significant predictors for efficacy of alternative antiandrogen as second-line hormone therapy in patients with metastatic castration-resistant prostate cancer. These findings might support that decision-making of when to start the new androgen receptor pathway inhibitors.

DOI： 10.1093/jjco/hyw110

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

Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate. A 73-year-old male was referred to our hospital for the further examination of an elevated prostate-specific antigen level of 23.4 ng/mL. Radical prostatectomy (RP) was performed based on the diagnosis obtained by a prostate needle biopsy. The RP specimen revealed ductal adenocarcinoma of the prostate with positive capsular penetration. We herein report a rare case of ductal adenocarcinoma of the prostate.

DOI： 10.1159/000453448

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

A 36-year-old male was referred to our department for further examination of asymptomatic gross hematuria emanating from a bladder tumor. Cystoscopy revealed a broad-based tumor 40 mm in diameter. Urinary cytology was negative. Preoperative magnetic resonance imaging suggested a muscle invasive tumor. Transurethral resection was performed, and the pathological findings revealed an inflammatory myofibroblastic tumor. We herein report a rare case of bladder inflammatory myofibroblastic tumor.

DOI： 10.1159/000449372

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DOI： 10.1186/s12885-016-2443-6

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DOI： 10.14989/ActaUrolJap-62-7-361

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

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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DOI： 10.1186/s13256-016-0806-x

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DOI： 10.1186/s12885-016-2160-1

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DOI： 10.1186/s12885-016-2134-3

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DOI： 10.1186/s12885-016-2176-6

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DOI： 10.1159/000445826

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DOI： 10.1159/000442895

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

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

(Introduction) A pheochromocytoma diagnosed during pregnancy is rare, and also its fetal and maternal mortality is high if undiagnosed. We report two cases with successful pregnancy outcome with pheochromocytoma. (Case 1) A 31-years-old previously healthy woman presented at 19 week period of gestation with high blood pressure. High urine catecholamine level and a left adrenal mass recognized by magnetic resonance imaging (MRI) confirmed adrenal pheochromocytoma. The patient had good blood pressure control after we started doxazosin 4 mg daily, and Caesarean section was performed at 35 week period of gestation. Two months after delivery, laparoscopic adrenalectomy was performed and she was discharged in the absence of hypertension. (Case 2) A 31-years-old previously healthy woman presented at 29 week period of gestation with exacerbation of headache and palpitation. High urine catecholamine level and a mass recognized close to the inferior vena cava by MRI confirmed extraadrenal pheochromocytoma. The patient had good blood pressure after we started doxazosin 4 mg daily and labetalol hydrochloride 200 mg daily. Caesarean section was performed at 35 week period of gestation. One month after delivery, laparotomic resection of the tumor was performed. Seven years later, hypertension reoc-curred and there was an extraadrenal pheochromocytoma recurrence. We had a laparotomic resection for the recurrent tumor, and now she is in the absence of hypertension. (Conclusion) Pheochromocytoma should be considered as a differential diagnosis in a case of high blood pressure occurred during pregnancy. Early detection and appropriate treatment is crucial to reduce fetal and maternal mortality.

DOI： 10.5980/jpnjurol.107.245

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

We determined whether prostate specific antigen (PSA) would decrease with immediate antiandrogen switching from bicalutamide (BCL) to flutamide (FLT) in patients receiving combined androgen blockade for advanced prostate cancer. From 2002 to 2006, 20 patients who showed PSA failure after first-line hormonal therapy with a luteinizing hormone-release hormone (LH-RH) agonist and BCL were enrolled. All patients were immediately switched from BCL to FLT, administered with an LH-RH agonist, as second-line combined androgen blockade (CAB). We evaluated the PSA response to second-line CAB. Eight patients (40%) were responsive, showing PSA decreases of at least 50%. The median (range) duration of the PSA response was 18.4 (3-26) months. Second-line CAB using FLT was effective in 40% of patients who received first-line CAB using BCL. The lower Gleason scores at the initial prostate biopsy probably reflect the response to second-line CAB. Responders showed significantly better OS and CSS in the determination of any PSA decline and 40% PSA decline. The median OS duration in nonresponders and responders (40% PSA decline) was 1433 days versus 3617 days. It is concluded that an immediate switch from BCL to FLT is effective for some CRPC patients after first-line CAB using BCL.

DOI： 10.1155/2016/4083183

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DOI： 10.1155/2016/6197353

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DOI： 10.1159/000440612

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：Elsevier USA  

Objective The aim of this retrospective study was to determine the risk of viral infection in tacrolimus-treated kidney transplant patients. Methods We analyzed kidney transplant recipients from 2002 to 2012, reporting all episodes of viral infection. All patients received induction with basiliximab followed by a standard regimen with tacrolimus, steroids, and antimetabolites. Genotypes of cytochrome P450 (CYP) 3A5 were determined with the use of the polymerase chain reaction method. Results Fifty-one patients (17 women, 34 men
mean age, 41.6 ± 65.7 years) underwent kidney transplantation with tacrolimus-based immunosuppressive therapy. Thirty patients were diagnosed with 34 viral infections, including herpes simplex, adenovirus, mumps, varicella, and cytomegalovirus (CMV). CMV was the most common viral infection. In multivariate analysis, the CYP3A5*1 allele (P =.049) and negative serology for CMV (P =.018) were factors independently associated with the incidence of viral infection. After excluding CMV infection in CMV-seropositive donor/CMV-seronegative (D+R-) recipients in the analysis, the presence of the CYP3A5*1 allele was found to be an independent risk factor for viral infection. Recipients with the CYP3A5*3/*3 genotype (nonexpressors) showed significantly higher dose-adjusted tacrolimus trough concentrations than patients with the CYP3A5*1 allele (expressors
respectively, 104.6 ± 65.6 vs 52.6 ± 62.3 ng/mL per mg/kg/d). Conclusions The CYP3A5*1 allele is associated with viral infection, possibly as a result of higher peak concentrations of tacrolimus. Further analyses, such as area under the concentration-time curve (AUC) for tacrolimus and polymorphisms of drug metabolism enzymes such as CYP3A4 are required to evaluate the influence of CYP3A5 on viral infection in kidney transplantation. © 2014 by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.transproceed.2013.11.023

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

骨転移を有する進行前立腺癌症例に対するゾレドロン酸投与の開始時期は、明確ではない。診断時Stage D2である症例(28例)に、初期治療としてホルモン療法とともにゾレドロン酸を投与した。投与6ヵ月後のPSA値、尿中NTx値、血清BAP値の推移は、いずれも著明な低下を認めた。横浜市大病院におけるゾレドロン酸未使用群22例をHistorical control群として比較すると、初期治療から再燃までの期間がHistorical control群に比べ有意に延長していることが分かった。ホルモン療法とゾレドロン酸の同時投与は、骨転移を有する進行性前立腺癌に対して有用である可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J02127&link_issn=&doc_id=20110907480021&doc_link_id=%2Faa6hngke%2F2011%2F002408%2F022%2F1311-1313%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6hngke%2F2011%2F002408%2F022%2F1311-1313%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

BACKGROUND. Although the local renin-angiotensin system (RAS) of the prostate gland is related to cell proliferation and angiogenesis, the detailed mechanism remains unclear. We examined the effects of the angiotensin II type 1 receptor (AT1R) on androgen receptor (AR) expression in prostate cancer cells.
METHODS. AR modulation by AT1R was examined by Western blot analysis, luciferase assay, and Immunocytochemical staining. The influence of AR expression by angiotensin II (Ang-II) and AT1R inhibition using siRNA was determined. Furthermore, using angiotensinogen or AT1R knockout (KO) mice, we performed quantitative real-time PCR to investigate the expression of AR.
RESULTS. Ang-II induced cell proliferation with enhancement of AR, prostate specific antigen (PSA), NF-kappa B, and c-myc, and the activity of AR and PSA promoter. Cell proliferation of LNCaP transfected with AT1R siRNA was decreased by 75% at 7 days by inhibition of AR, PSA, NF-kappa B, and c-myc. Immunocytochemical staining confirmed the suppression of AR translocation into the nucleus in AT1R siRNA cells. AT1R KO mice showed a decrease in AR expression in the prostate gland. We also found that the expression level of AT1R could modulate the transcriptional level of AR by affecting NF-kappa B and c-myc expression.
CONCLUSIONS. Knocking down of the AT1R protein resulted in significant inhibition of cell growth, associated with a marked decrease of AR protein. These results indicate that inhibition of AT1R has the potential to influence AR expression in prostate cells, and is anticipated to contribute to the development of novel therapeutic agents for prostate cancer. Prostate 71: 964-975, 2011. (C) 2010 Wiley-Liss, Inc.

DOI： 10.1002/pros.21312

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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.102.385_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.102.480_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.102.460_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.102.519_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.102.478_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.102.365_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.102.497_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.102.348_3

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

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

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

DOI： 10.5980/jpnjurol.101.397_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.101.439_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.101.436_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.101.337_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.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.101.519_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.101.512_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.101.295_1

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DOI： 10.1159/000277599

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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.101.404_4

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

We report a 44-year-old female with lymphangiomyomatosis (IAM) of the kidney and retroperitoneum. Abdominal ultrasonography revealed a right kidney tumor, and she was referred to our department. Computed tomography (CT) revealed a para-aortic phyma in addition to the tumor. We performed retroperitoneal tumorectomy and partial resection of the right kidney via laparotomy. Pathological findings suggested LAM. LAM usually induces pulmonary lesions and its prognosis is relatively unfavorable. Female hormones are considered to be involved in the aggravation of LAM. The lesion may not have reached the lung in this postmenopausal woman because of the absence of these hormones. (Hinyokika Kiyo 55 : 249-252, 2009).

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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.100.428_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.100.424_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.100.242_1

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

BACKGROUND: The aim of this study was to perform a comprehensive evaluation of angiotensin III (Ang-III) and related converting enzymes, aminopeptidase A (APA) and N (APN), in prostate cancer. METHODS: We investigated the effects of Ang-III on the in vitro growth of human prostate cancer cells and the expression of APA and APN in cells treated with Ang-III or hormonal agents. Furthermore, we performed real-time quantitative PCR to investigate the expression pattern of APA and APN in 86 prostate tissue samples including normal prostate, untreated and hormone refractory prostate cancer (HRPC). RESULTS: Ang-III stimulated cell proliferation, and the proliferative effect was inhibited by olmesartan, an AT(1) receptor blocker (ARB). Western blot analysis showed that phosphorylation of mitogen-activated protein kinase (MAPK) was enhanced by Ang-III and inhibited by olmesartan. APN mRNA level in HRPC was significantly lower than that in normal prostate and untreated prostate cancer tissue. In LNCaP cells, APN expression was augmented by Ang-III, whereas APA expression was not modulated. Hormonal agents, such as estradiol (E2) and dexamethasone (Dex), enhanced APA expression, but did not modulate APN expression in LNCaP cells. CONCLUSIONS: Our results suggest that Ang-III and related converting enzymes contribute to cell proliferation of prostate cancer, and may be implicated in cancer progression.

DOI： 10.1002/pros.20835

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

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.

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Decrease in serum prostate specific antigen (PSA) concentration is inevitably associated with antiandrogen therapy for benign prostatic hyperplasia (BPH), and might mask the presence of prostate cancer or delay its diagnosis. To determine the appropriate timepoint for determination of correct PSA value, we sequentially measured serum PSA and testosterone levels after discontinuation of antiandrogen therapy for BPH. With informed consent, 12 patients (72.8 ± 2.2* years old) with BPH were treated with allylestrenol 50 mg/day for 4 months. Serum testosterone and PSA concentrations were determined before and just after treatment, as well as every month after treatment up to 3 months. After treatment with allylestrenol for 4 months, mean serum testosterone and PSA levels were significantly decreased from 408 ± 136* to 87.9 ± 76.2* ng/dl, and from 2.81 ± 0.87* to 2.04 ± 0.82* ng/ml, respectively. The mean serum PSA level recovered to the pretreatment level within 2 months and mean serum testosterone concentration within one month after discontinuation of administration. In conclusion, during treatment of BPH with antiandrogen allylestrenol, a two-month washout is adequate for determination of correct PSA value (* : M ± SD).

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BACKGROUND: The aim of this study was to perform a comprehensive evaluation of the renin-angiotensin system (RAS) in prostate cancer. METHODS: We investigated the expression of RAS components in prostate cancer cells treated with hormonal agents. Real-time PCR data showed the expression of the AT1 receptor, angiotensin I converting enzyme (ACE), and angiotensin I/II (Ang-I/II) precursor in all 87 prostate tissue samples. RESULTS: Expression of these genes in hormone refractory prostate cancer (HRPC) was significantly higher than that in normal prostate tissue and untreated prostate cancer tissue. Western blot showed that protein expression of the AT1 receptor and Ang-I/II was enhanced in LNCaP cells cultivated in steroid-free medium. When LNCaP cells were stimulated with dihydrotestosterone (DHT), estradiol (E2), dexamethasone (DEX), or anti-androgen drugs, protein expression of the AT1 receptor and Ang-I/II was augmented. CONCLUSIONS: The present data suggest that prostatic RAS is overexpressed in HRPC tissue, and expression of its components is influenced by several kinds of hormonal stimulation.

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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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Germline mutations of the VHL gene are responsible for VHL. Approximately 70% of VHL families display small intragenic mutations detectable by sequencing, whereas partial- or whole-gene deletions have been described in the majority of the remaining families. For such large deletions, complex genetic techniques other than sequencing might have to be used. In this study, we describe an RQ-PCR assay with TaqMan fluorescent probes to detect germline VHL deletions. The RQ-PCR primer/probe sets were designed for the three VHL coding exons as well as for the 5' promoter and 3' untranslated regions. The RQ-PCR assay for 30 normal and 10 known VHL deletion control samples demonstrated high sensitivity and specificity. We then screened 29 individuals from 19 classical VHL families (16 type 1, 2 type 2A, and one type 2B) and one PHEO family, as well as four solitary suspected cases, none displaying any sequence changes, for VHL deletions by the RQ-PCR assay. We detected germline deletions in 17 (89%) classical families including 15 type 1, one type 2A, and one type 2B. We also identified two mutation carriers and two non-carriers in our family cohort. The one PHEO family and four solitary cases did not display any deletion patterns. These findings indicated that the TaqMan-based RQ-PCR assay is a simple and potent technique for the rapid, sensitive, and specific investigation of VHL genetic diagnoses that could be used profitably before more complex large-deletion detection techniques.

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DOI： 10.5980/jpnjurol1989.97.48

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BACKGROUND: We previously demonstrated that an angiotensin II receptor blocker (ARB) had the potential to inhibit cell proliferation of prostate cancer. In this study, we examined whether an ARB could elicit an antiproliferative effect on hormone-refractory prostate cancer, clinically. METHODS: Twenty-three patients with advanced hormone-refractory prostate cancer who had already received secondary hormonal therapy using dexamethasone, and who were no longer receiving conventional therapy, were enrolled. All of the patients received candesartan 8 mg once daily per os and, simultaneously, androgen ablation. Change in prostate-specific antigen (PSA) was determined as the primary endpoint. The secondary end-point was change in performance status (PS). To investigate angiotensin II type 1 (AT1) receptor expression in prostate cancer tissue, real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) was performed, using specimens, from untreated patients with prostate cancer. RESULTS: Eight patients (34.8%) showed responsive PSA changes; six showed a decrease immediately after starting administration and two showed a stable level of PSA. Six men with a PSA decline of more than 50% showed an improvement in PS. The mean time to PSA progression (TTPP) in responders was 8.3 months (range, 1-24 months). Half of the patients showed stable or improved PS during treatment. With regard to toxic effects, only one patient showed hypotension during treatment. The RT-PCR showed that AT1 receptor expression in well-differentiated adenocarcinoma was higher than that in poorly differentiated adenocarcinoma. CONCLUSION: These data showed that an ARB had potential biological effects on prostate cancer, suggesting the usefulness of the cytostatic activity of such agents on recurrent prostate cancer.

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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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DOI： 10.5980/jpnjurol1989.95.669

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

We report a case of bilateral hydronephrosis caused by pseudolymphoma of bilateral renal pelves. A 52-year-old woman with Sjogren's syndrome and bronchial asthma was found to have bilateral hydronephrosis. Abdominal plain computerized tomography showed an irregular thickening of the bilateral renal pelves with moderate hydronephrosis. The gallium scintigraphy revealed intense tracer uptake in bilateral renal pelves. Open biopsy of the right renal pelvis was perfomed under the diagnosis of malignant lymphoma. The pathologic diagnosis was pseudolymphoma of the renal pelvis. Steroid therapy dramatically improved pseudolymphoma and hydronephrosis within a month. There were no signs of recurrence.

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We encountered 5 cases of renal transplantation from cytomegalovirus seropositive donors to cytomegalovirus seronegative recipients (D+R-) during the past 2 years in Yokohama City University Medical Center Hospital. We investigated the situation of cytomegarovirus infection after renal transplant operation on the 5 recipients. We diagnosed cytomegalovirus infection by cytomegalovirus antigenemia monitoring. We performed preemptive treatment for cytomegalovirus infection if the number of cytomegarovilus antigen (p65) positive white blood cells was more than 10/30,000. There was positive conversion of cytomegalovirus antigenemia monitoring in 4 recipients. In 3 recipients who received therapy for acute rejection or administration of anti-lymphocyte-antibodies, the number of cytomegalovirus antigen (p65) positive white blood cells was large The patients were received preemptive treatment for cytomegalovirus infection under cytomegalovirus antigenemia monitoring. No severe cytomegalovirus disease developed in these patients. But mild cytomegalovirus disease developed in 1 patient, who had thrombocytopenia and liver enzyme elevation. This patient was clinically diagnosed as ganciclovir-resistant cytomegalovirus infection. She received therapy with foscarnet and was cured successfully. Preemptive treatment for cytomegarovirus infection after renal transplantion of D-R+ was effective, but when renal transplant recipients of D+R- have other risk factors of cytomegalovirus infection, such as therapy for acute rejection or administration of anti-lymphocyte-antibody, prophylaxy treatment or earlier preemptive treatment might be more effective to prevent cytomegalovirus desease and therapy-resistant cytomegalovirus infection.

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We retrospectively analyzed the effects of naftopidil on IPSS and QOL score in 19 patients with lower urinary tract symptoms whose QOL scores were above 4, in spite of the administration of tamsulosin hydrochloride. The scores for "urgency", "stream" and "frequency"in IPSS improved in half the cases. In contrast, the scores for "straining" and "interruption" were not changed. The IPSS improved an average of 0.27 points for the parameter of stimulating symptoms, but improved only an average of 0.02 points for the parameter of obstructive symptoms. The QOL score improved in 31.6% of patients, but was aggravated in 5.3%. We conclude that a change in medication is effective and useful for some untreatable patients with lower urinary tract symptoms.

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Between June 1998 and August 2000, five patients with germ cell tumor were treated with high-dose CEI: carboplatin (1,250 mg/m2), etoposide (1,500 mg/m2), and ifosfamide (7.5 g/m2), followed by peripheral blood stem cell transplantation (PBSCT) at Yokohama City University Hospital. All patients were classified into either poor risk group of International Germ Cell Consensus Classification or advanced extent of Indiana University stage, and received one cycle of high-dose CEI after 4-6 cycles of standard PEB (cisplatin, bleomycin, vinblastin) therapy. Three of the patients achieved complete response, one achieved partial response and one achieved no change after whole treatment. There were no fatal complications and no treatment-related deaths.

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

Objective: We assessed the roles of suprapubic cystostomy in patients with neurogenic bladder and analyzed the complications and their courses. Patients and Methods: We reviewed 118 patients with neurogenic bladder managed with suprapubic cystostomy. The original diseases were spinal cord injury in 90, degenerative disease of the central nervous system in 15, spina bifida in 6, cerebral palsy in 3, pontine bleeding in 1, Parkinson's disease in 1, brain tumor in 1, and dysgenesis of the external sphincter in 1. Fifty-six (62.2%) of spinal cord-injured patients demonstrated cervical damage. Renal function, urinary pH and white blood cell values were measured and evaluated after insertion. The stone-free rate after insertion was estimated by the Kaplan-Meier method. Results: Indications for cystostomy were failure of clean intermittent catheterization in 62 (52.5%) and Crede's maneuver in 2, severe urethral damage in 30 (25.4%), replacement of urethral catheter in 3, worsening of the original disease in 15 (12.7%), deterioration of the general condition in 2, mental retardation in 2, and traumatic vesical rupture in 1. Frequent complications were formation of the bladder calculi in 30 (25%) and urinary leakage through the urethra in 11 (10%). No fatal complications occurred. The stone-free rates 5 and 10 years after insertion were 77 and 64%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group. The high urinary pit group (&gt;7.24) had a higher risk of stone formation. Conclusions: Although continuous cystostomy drainage is not considered to be ideal management for bladder emptying, some patients with neurogenic bladder may benefit from this procedure. Copyright (C) 2000 S. Karger AG, Basel.

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00083&link_issn=&doc_id=20221028010498&doc_link_id=%2Fcl8isoke%2F2022%2Ft057s1%2F011%2F0365-0365%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2022%2Ft057s1%2F011%2F0365-0365%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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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)日本臨床腎移植学会  

ミトコンドリア病が疑われた患者に対して生体腎移植を施行し、術後に心不全管理に苦慮した1例を経験したので報告する。症例は48歳女性。原因不明の末期腎不全に対し他院で腹膜透析を導入された。除水効率低下により腹膜透析の継続が困難となり、維持血液透析は困難であったため、生体腎移植を希望され当科紹介受診した。術前心エコー検査で低心機能を認めたが、冠動脈疾患はなくミトコンドリア病などの筋原性収縮障害と診断された。耐術能はあると判断され、夫をドナーとした生体腎移植を施行した。術中に施行した筋生検はミトコンドリア病と矛盾しない結果であった。術後25日目退院したが、心不全の増悪により入退院を繰り返し体液量管理に難渋した。(著者抄録)

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

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Language：Japanese   Publisher：(株)東京医学社  

ドナー特異的抗HLA抗体(HLA-DSA)陽性例の腎移植では、術後早期の急性抗体関連拒絶反応発症の危険性が高いため、術前に十分な脱感作療法を行い、術後免疫療法も強化する必要があるが、本邦では保険適用の問題から術前の脱感作療法には限界がある。今回、HLA-DSA陽性で、術前脱感作療法にリツキシマブを使用可能なABO式血液型不適合腎移植例に対して、術直後から抗ヒト胸腺細胞ウサギ免疫グロブリンを使用し良好な経過が得られた症例を経験したので、文献的考察を加えて報告した。

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Language：Japanese   Publisher：(株)東京医学社  

当院で2012～2016年に生体腎移植を施行された末期腎不全患者70例を対象とし、先行的腎移植(PEKT)群18例と非PEKT群52例に分け、諸データの比較検討を行った。調査項目は「年齢」「性別」「小児例(18歳未満)の割合」「ABO血液型不適合例の割合」「抗ドナー特異的抗体陽性例の割合」「術後3ヵ月以内の急性拒絶反応」「移植1年後のeGFR」「1年プロトコール生検でのTMR」「1年生着率」などとした。検討の結果、「小児例の割合」がPEKT群で高い傾向にあり、他の項目に有意な群間差は認められなかった。

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

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

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

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

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

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

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Language：Japanese   Publisher：(有)科学評論社  

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

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

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

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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

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

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

【はじめに】ミュラー管遺残症候群(Persistent Muellerian duct syndrome;PMDS)は、染色体構成が46XYで外性器も男性型であるにも関わらず、Mueller管抑制因子の欠乏や受容体の欠乏によりMueller管由来組織である卵管、子宮、腟上部が遺残する稀な疾患である。交叉性精巣転位(transverse testicular ectopia;TTE)の約30%に合併するとされ、鼠径ヘルニアや腹腔内精巣の精査時や術中に発見されることが一般的である。今回我々は、幼少期に他院にて右鼠径ヘルニア嵌頓の手術時にTTEを発見され左側由来の精巣切除が行われ、青年期に右停留精巣手術時にPMDSの存在が明らかとなった1例を経験したので報告する。【症例】症例は19歳の男性。0歳11ヵ月に他院で右鼠径ヘルニア嵌頓と診断され緊急手術となり、左側由来の精巣を右鼠径管内に認め、左精巣を切除された。その後、通院はなかったが、19歳時に前医受診し、無精子症と右停留精巣の診断となり、当院へ紹介、右精巣固定術の方針となった。鼠径管を開放すると、右精巣および精索を認める他、盲端となっている左精管および肥厚した袋状の組織を認めた。この袋状の組織を可及的に切除し、右精巣を陰嚢内に固定し終刀した。切除検体の病理組織所見では低円柱状の細胞の被覆がみられ、平滑筋層が裏打ちしており、子宮に類似した組織となっており、PMDSと考えられた。【結語】今回我々は、鼠径ヘルニアを契機に発見されたTTEを合併したPMDSの1例を経験した。(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：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：(一社)日本泌尿器科学会総会事務局  

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

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

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

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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：Japanese   Publisher：医学図書出版(株)  

症例は移植時年齢24歳男性。14歳時に白血病に対する放射線併用化学療法を施行され、治療中に神経因性膀胱に起因する膀胱尿管逆流症(vesicoureteral reflex:VUR)を指摘された。清潔間歇導尿(clean intermittent catherterization:CIC)を導入されたが通院を自己中断し、23歳時に血清Cr20mg/dLと腎機能の著明な増悪を認め血液透析を導入された。生体腎移植を希望され当科を受診したが、低コンプライアンス膀胱に伴う両側VURを認めたため下部尿路再建術を先行する二期的手術が必要と判断した。24歳時に両側VUR根治術と回腸利用膀胱拡大術を施行し、7ヵ月後に母親をドナーとする血液型適合生体腎移植を施行した。下部尿路障害を有する末期腎不全における腎移植においては、尿路再建術を先行して施行することが多い。本症例も膀胱拡大術後7ヵ月で腎移植を施行し良好に経過している。(著者抄録)

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

症例は59歳男性。糖尿病性腎症による末期腎不全に対して8年の血液透析を経て、55歳時に妻をドナーとした生体腎移植を受けた。術後4ヵ月経過頃から、労作時に胸部違和感を自覚したため、循環器内科を受診した。心尖部に最強点を置くLevine 3/6度のSystolic murmur聴取し、心臓超音波検査(UCG)にて僧帽弁前尖前方運動(SAM)を認めたことから、閉塞性肥大型心筋症(HOCM)の診断に至った。VerapamilとBisoprololの内服を開始し、速やかに症状は改善した。移植後1年生検では異常所見を認めず、SCr 0.93mg/dlと移植腎機能は安定していた為、AVシャントによる過剰心負荷予防の目的に内シャント閉鎖術を行った。移植後4年経過現在、UCGにて左室内加速血流は消失し、不整脈や心不全徴候も認めていない。(著者抄録)

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

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

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY  

Web of Science

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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   Publisher：(一社)日本移植学会  

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

初診時に骨転移を認め臓器転移のないホルモン感受性転移性前立腺癌に対し初期治療としてcombined androgen blockade療法を導入した85例を対象にtime to CRPC予測因子の解析を行った。多変量解析の結果、年齢<73歳、initial PSA<270ng/mL、bone scan index(BSI)≧2.7%がtime to CRPC不良予測因子であり、BSIの予後予測バイオマーカーとしての有用性が示唆された。(著者抄録)

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY  

Web of Science

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

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

症例1は52歳女で、18歳時より両側の膀胱尿管逆流症(VUR)が指摘され、有熱性尿路感染(fUTI)を反復し、プロピベリン内服後も右側VURが残存した。症例2は29歳女で、23歳時にfUTIを発症し、右腎萎縮と右III度のVURを認め、プロピベリン内服後もfUTIを反復した。症例3は40歳女で、25歳時よりfUTIを反復し、徐々に抗生剤に不応となり排尿時膀胱尿道撮影(VCUG)にてVURと膀胱容量の低下を認め、プロピベリン内服後もfUTIを反復した。各症例とも経尿道的Deflux注入療法を施行した結果、術後合併症なく経過しプロピベリン内服は中止となり、術後6ヵ月のVCUGにて逆流消失を確認した。症例1、2は4年9ヵ月～5年1ヵ月経過してfUTIの発症は認めない。症例3は術後2年3ヵ月にfUTIを発症し、ウラピジル内服開始となった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01269&link_issn=&doc_id=20170810460004&doc_link_id=1390290699820953984&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390290699820953984&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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

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

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

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

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

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

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

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

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

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

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

目的:当科で施行した小児精索静脈瘤に対する単孔式腹腔鏡下精索静脈瘤根治術(Laparoscopic single-site varicocelectomy:LESS-V)についてその有効性を検討した。対象と方法:当科において手術時年齢が15歳以下でLESS-Vを施行した左精索静脈瘤5例を対象とした。手術用ポートは臍部にEZアクセスとEZポートにて造設した。平均年齢は13.6歳で全例、精索静脈瘤の程度はgrade IIIであった。精巣動脈と精巣静脈を一括して切断した。結果:手術時間は70.8±14.8分(平均±標準偏差)で気腹時間は35±7.6分であった。術後合併症に創部感染症と陰嚢内残存血管拡張を1例ずつ認めたが保存的に軽快した。術後再発、陰嚢水腫はいずれも生じていない。結論:小児精索静脈瘤に対するLESS-Vは整容面に優れており、他の術式と遜色ない結果を得ることが可能で、安全で効果的に施行できる術式であると認識できた。(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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Language：Japanese   Publisher：医学図書出版(株)  

症例は30歳の男性。1年前からの排尿後の尿失禁を主訴に来院。尿管結石の既往を認めたが、明らかな尿道損傷の原因となりうる既往はなかった。抗コリン剤投与にて改善なく、尿道造影を施行したところ、外尿道口から9cmの前部尿道に約2cm大の尿道憩室を認め、それが尿失禁の原因になっていると判断し、経皮的尿道憩室切除および尿道形成術を施行した。会陰部に横切開をおき、尿道憩室を確認後、憩室壁を尿道から剥離、余剰粘膜を切除し、尿道海綿体を修復した。現在は術後2年経過し、再発なく経過良好である。小児期だけでなく成人期以降の下部尿路症状においても尿道憩室の存在を考慮する必要があると考えられた。(著者抄録)

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Language：Japanese   Publisher：(株)東京医学社  

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

腎移植後に進行性多巣性白質脳症(PML)と診断された2症例を報告する。【症例1】34歳男性。7歳時に急性進行性糸球体腎炎症候群を発症し、26歳時に父をドナーとする血液型適合腎移植を施行(抗胸腺細胞グロブリン使用)。タクロリムス(TAC)、ミコフェノール酸モフェチル(MMF)、メチルプレドニゾロン(mPSL)で維持していたが、術後8年目に頭痛で発症し、頭部MRI画像と、後に髄液PCR検査よりJCV-DNAが検出されPMLと診断した。TACをシクロスポリンへ変更し免疫抑制剤を漸減したが、全身状態悪化し死亡した。【症例2】38歳男性。低形成腎による慢性腎不全に対して36歳時に父をドナーとする血液型適合腎移植を施行(バシリキシマブ使用)。TAC、MMF、mPSLで維持していたが、術後3年目より記銘力低下を認め、頭部MRI画像でPMLを疑い、MMFをミゾリビンへ変更、TACを減量した。髄液PCR検査が陰性であったが、開頭脳生検でPMLの診断が得られた。TAC、ミゾリビンを中止し、構音障害などの後遺症は残ったが退院となった。(著者抄録)

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Language：Japanese   Publisher：金原出版(株)  

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

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

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

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

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

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

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

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

(症例1)31歳女性。妊娠19週時に高血圧を指摘され、精査にて左副腎腫瘍を認めた。血中・尿中カテコラミンが高値を示し、褐色細胞腫と診断した。ドキサゾシン4mg/日内服で血圧はコントロール良好であり、妊娠34週で帝王切開にて分娩した。出産2ヵ月後に後腹膜腔鏡下副腎摘除術を施行した。術後血圧は安定して経過している。(症例2)31歳女性。妊娠初期より動悸・頭痛を認め、妊娠29週で症状増悪し、血中・尿中カテコラミン高値とMRIで下大静脈背側に腫瘍を認め、異所性褐色細胞腫と診断された。ドキサゾシン4m/日、ラベタロール塩酸塩200mg/日にて血圧管理を行い、妊娠35週で帝王切開にて分娩した。出産1ヵ月後に開腹後腹膜腫瘍切除術を施行した。術後は降圧薬内服せず血圧は安定して経過していたが、術後7年後に同部位に再発を認め、再び開腹後腹膜腫瘍切除術を施行した。その後、再発無く経過している。妊娠中に発見された褐色細胞腫の本邦報告例は少なく、母児ともに高い死亡率を示すとの報告もあるが、2例とも術前に十分な血圧管理を行い、二期的に腫瘍摘出術を施行することで母児ともに良好な経過を得た。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01175&link_issn=&doc_id=20161109390006&doc_link_id=1390001205074827520&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001205074827520&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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   Publisher：(一社)日本移植学会  

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

症例は7歳男児。5歳時に異常高血圧を指摘され、当院小児科の精査にて右腎萎縮を伴う腎動脈狭窄を原因とする腎性高血圧が原因と判明した。計4回の経皮的バルーン腎血管形成術を施行するも、再狭窄により高血圧症状が再発するため、外科的治療目的に当科紹介となった。術中、腎生検による迅速病理組織診断にて腎組織が健常であることを確認後、右腸骨窩へ自家腎移植を施行した。現在は術後18ヵ月経過し、特に症状の再発なく経過している。内科的治療が奏効しない腎血管性高血圧に対して、自家腎移植は治療の選択肢として有用だと考えられた。(著者抄録)

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

初診時に骨転移を認め臓器転移を認めない前立腺癌症例のうち、再燃後にantiandrogen交替療法(AA:ビカルタミドをフルタミドに変更)を行った65例を対象にAA後のprogression-free survival不良予測因子の解析を行った。initial PSA≦276ng/mL、N1、EOD grade 3～4、初回ホルモン治療期間<11.3ヵ月がAAの効果不良予測因子であった。(著者抄録)

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

症例1(75歳男性)。進行膀胱癌に対する術前化学療法としてGC療法(gemcitabine+CDDP)を開始したところ、第8病日目より高度な低Na血症を呈した。一方、Na排泄亢進も認められたが、腎機能障害は認めず、甲状腺ホルモン、コルチゾール値は正常値で、ADHは測定感度以下であったことから、SIADHと診断された。以後、生理食塩水とNaCl製剤による補正を行った結果、第10病日目に低Na血症が改善後、2コース目よりはgemcitabine+nedaplatin療法へ変更し、3コース目まで施行後、膀胱全摘術を行った。症例2(54歳男性)。陰茎癌に対する術前化学療法としてTPF療法(CDDP+paclitaxel+fluorouracil)を施行したところ、第7病日目に高度な低Na血症を呈した。起立性低血圧、腎機能低下などの脱水所見とNa排泄亢進を認めたことから、RSWSと診断された。以後、Na補充と脱水補正を開始した結果、第11病日目に全身状態は改善、2コース目よりはCDDPを減量したが低Na血症の再現はなく、3コース目まで施行後、陰茎部分切除術+鼠径リンパ節郭清術を施行した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01269&link_issn=&doc_id=20160824420004&doc_link_id=1390290699733438976&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390290699733438976&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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

60歳男性。4年前に生体腎移植施行。導入時免疫抑制剤はBLX+CsA+MP+MMFの4剤。CsA減量目的に移植後3年時よりEVRを開始した。EVR投与開始11ヵ月に、1週間以上続く38度台の発熱と湿性咳嗽を認め当科受診。CT検査上、両側下肺野に汎小葉性のスリガラス様陰影を認めたことから、薬剤性間質性肺炎も念頭に置いて、入院後からEVR内服は中止し、細菌性およびニューモシスチス肺炎に対する抗菌薬加療を開始した。しかし、治療に反応せず症状悪化したため、間質性肺炎に対する加療としてMP 80mg/day投与を開始した。投与後速やかに解熱と呼吸苦の改善を認め、MPを漸減して入院後14日目に退院となった。発症後1年経過しているが再発なく経過している。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J06262&link_issn=&doc_id=20160819430019&doc_link_id=%2Fem0sfcrt%2F2016%2F000401%2F020%2F0142-0145%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem0sfcrt%2F2016%2F000401%2F020%2F0142-0145%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

【目的】神奈川県の腎移植施設でエベロリムス併用タクロリムス減量レジメンを策定し、有効性・安全性を検討した。【方法】BXM、PSL、MMF、TACの4剤併用で導入し、POD14よりEVRを開始してトラフ値を4〜5ng/mlに調節、TACトラフ値を4〜5ng/mlに調節、MMFは2000mgから1000mgに減量した。PSL、BXMおよび血液型不適合移植の前治療は従来通りとした。【結果】生体腎30例・献腎2例の計32例が登録された。2例で急性拒絶反応(EVR開始前の抗体関連型拒絶反応と術後10ヵ月目のborderline change)を認めたが治療に反応して、良好な腎機能を保っている。CMV感染を3例で認めた。9例で口内炎などの軽微な副作用の為、EVR投与中止となっている。【結論】当レジメンは中止がやや多かったが、CMV感染や急性拒絶の頻度は低く、免疫抑制効果を維持しながら施行可能と考えられた。(著者抄録)

J-GLOBAL

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

【目的】腹腔鏡下ドナー腎採取術におけるpowered自動縫合器の初期使用経験を検証する。【方法】腹腔鏡下ドナー腎採取術、連続8例を対象とした。腎動静脈処理において、前半4例はconventionalな自動縫合器を使用し(C群)、後半4例ではpowered自動縫合器を使用した(P群)。両群の手術所見と手術結果を比較した。【結果】P群では腎血管処理時間がやや長い傾向があったが、手ブレが少なく安定した腎血管の切断ができていた。温阻血時間、術後腎機能は両群間に有意な差を認めなかった。【結論】powered自動縫合器は腹腔鏡下ドナー腎採取術における腎血管処理に安全に使用できた。(著者抄録)

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

血中前立腺特異抗原(PSA)が3〜10ng/mlの前立腺針生検施行例のうち、生検前MRIを行わずに系統的16ヶ所生検を施行した2009年4月〜2011年3月の98例(非施行群)と、生検前MRIを施行した2011年4月〜2013年12月の169例(施行群)の癌検出率を比較した。その結果、施行群46.2%、非施行群42.9%であり、有意差は認めなかった。施行群のうち前立腺癌が疑われた65例(所見陽性群)では系統的16ヶ所生検に追加してターゲット生検(1〜2本)を行い、癌検出率は所見陽性群56.9%、所見陰性群39.4%と前者が有意に高かったが、MRI所見の有無による前立腺癌検出の感度・特異度はそれぞれ47.4%・69.2%と低かった。MRI所見による癌検出についてのROC解析では、曲線下面積は0.583であった。PSAが3〜10ng/mlの症例において系統的16ヶ所生検を行う場合、生検前MRIに基づくターゲット生検追加による癌検出率の改善は認めなかった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01269&link_issn=&doc_id=20160217420002&doc_link_id=1050564285780481664&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050564285780481664&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER SOC CLINICAL ONCOLOGY  

Web of Science

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

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER SOC CLINICAL ONCOLOGY  

Web of Science

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

神奈川県における献腎移植の現状について検討した。多臓器を含む腎臓提供の承諾が34例から得られた。これらのうち、27例が臓器提供に至り、7例が斡旋中止となった。最終的に52腎が提供・移植へと至った。このうち、膵腎同時移植および県外で移植が行われた16腎を除いた36腎のレシピエントと、そのドナー24例を対象として解析した。ドナー年齢は心停止下臓器提供(DCD)群で高く、脳死下臓器提供(DBD)群で女性の比率が高かった。温阻血時間はDCD群において有意に長かった。無尿時間の平均値はDCD群において長かった。レシピエントにおいて、移植腎喪失は36例中2例に認めた。冷阻血時間はDCD群において有意に長く、総阻血時間もDCD群で長かった。DGFはDCD群では全例で観察したが、DBD群では40%に生じた。透析離脱までの日数はDCD群で長かったが、19例は16日以内に離脱した。1年以上の経過観察期間のある症例はDCD群21例中11例、DBD群15例中5例であった。1年を超えて経過観察可能であった症例は全例が生着していた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00083&link_issn=&doc_id=20160129550013&doc_link_id=%2Fcl8isoke%2F2015%2F005004%2F013%2F0423-0428%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2015%2F005004%2F013%2F0423-0428%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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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   Publisher：(一社)日本移植学会  

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Language：Japanese  

J-GLOBAL

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

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Language：Japanese  

J-GLOBAL

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

【目的】移動性精巣は正常の亜型と考えられており原則として経過観察が望ましいとされているが、現時点でコンセンサスの得られている診療方針はない。今回、当院で経験した移動性精巣111例を検討した。【方法】2006年1月から2014年7月までに、当院に外来受診し、移動性精巣と診断された111例を対象とし、診療録を基に臨床情報を後方視的に検討した。【結果】受診時年齢は2ヵ月～11歳7ヵ月(中央値1歳8ヵ月)、紹介理由は移動性精巣の診断が15例(13.5%)で、停留精巣疑いが58例(52.3%)と約半数を占めた。移動の程度は約6割が陰嚢高位で、精巣挙筋反射の相関性は明らかではなかった。経過は経過観察継続例が67例(60.4%)、終診例が30例(27.0%)、挙上精巣例が2例(1.8%)、経過観察の診察未受診例が10例(9.0%)であった。挙上精巣となった2例は、初診時年齢が3歳6ヵ月と5歳4ヵ月で、観察期間はそれぞれ1年5ヵ月と1年8ヵ月であった。挙上精巣と診断した時点で手術を施行した。終診例30例のうち改善例は11例(36.7%)であった。【結論】移動性精巣と診断された場合、特に挙上精巣となるリスクを説明し年1回の定期診察によるフォローを精巣が下降するか思春期まで継続、あるいは患児自身に常に陰嚢内に精巣を触知しない時には受診するよう指導することが望ましいと考えた。(著者抄録)

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：English   Publisher：S. Karger AG  

Introduction: Retroperitoneal tumor is often seen in urology clinical practice. To diagnose the tumor, tumor specimens must be obtained. However, in some cases, the tumor is penetrated by vessels around the ureter, and it may be difficult to detect the optimal spot for obtaining a specimen, even when performing open surgery. Case Presentation: A 53-year-old male patient was referred to our hospital for further examination of left back pain due to hydronephrosis. Enhanced computed tomography demonstrated ureter stenosis in front of the ilium, which was surrounded by a retroperitoneal tumor. The tumor was penetrated by blood vessels
therefore, we performed an open surgical biopsy on the suspicion of a retroperitoneal tumor using ureteroscopic assistance. The diagnosis of idiopathic retroperitoneal fibrosis was made according to the biopsy. Conclusion: We herein report the first case of a ureteroscopy-assisted biopsy for the pathological diagnosis of a retroperitoneal tumor.

DOI： 10.1159/000437049

Scopus

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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：(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：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：医学図書出版(株)  

前立腺肥大症と診断した50歳以上、IPSS(International Prostate SymptomScore:国際前立腺症状スコア)8点以上かつQOLスコア4点以上の21症例を対象とした。ナフトピジル75mg/日を経口投与し、投与後1、2、3および14日目でのIPSS、QOLスコア、OABSSを投与前と比較し評価した。総IPSSは投与後2日目で有意なスコアの低下を認め、さらに投与後14日目で最大効果発現を示した。IPSS蓄尿症状スコアにおいても同様の傾向が認められた。安全性については、21例中1例に動悸が出現したが、症状は軽度であり継続投与可能であった。ナフトピジル75mg/日は早期、特に2日目から症状の改善を認め、前立腺肥大症に伴う自覚症状に対し有用であった。また、その安全性も確認された。(著者抄録)

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Language：Japanese   Publisher：(株)フォレストプリンコム  

近年、狭心症や心筋梗塞などの冠動脈疾患に対する経皮的冠動脈形成術(PCI)として薬剤溶出性ステント(DES:rug-eluting stent)が使用される場合がある。DES留置後は原則、生涯にわたり抗血小板薬の内服が必要となり、外科手術時においても抗血小板薬の中断を極力避ける必要がある。抗血小板薬を継続して手術を行う場合、出血が問題となるが、今回DES留置後で周術期に抗血小板薬継続のまま生体腎移植術を施行し、移植腎実質からの止血困難な出血に対しタコシールを使用した1例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：Japanese Urological Association  

Kidney transplantation with an Indiana pouch is very rare, and a case report about it has not been found. This is our report about a successful case of kidney transplantation in a patient with an Indiana pouch. A 32 year-old woman with end stage renal failure was referred to our hospital for living related kidney transplantation. She had undergone an Indiana pouch diversion, due to a neurogenic bladder with spina bifida and renal dysfunction, 11 years ago. However, her kidney function gradually deteriorated, and finally she was started on hemodialysis six months ago. We performed living related kidney transplantation from her mother. We transplanted a graft into her right fossa iliaca and made an anastomosis between a graft ureter and an Indiana pouch. Her postoperative course was uneventful with good graft function. Now 1 year after transplantation, she maintains good graft function without urinary tract infection dor rejection.

DOI： 10.5980/jpnjurol.106.45

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Language：English   Publisher：AMER ROENTGEN RAY SOC  

OBJECTIVE. The purpose of this study was to evaluate the usefulness of renal perfusional cortex volume for arterial input function.
MATERIALS AND METHODS. This retrospective study included 45 potential kidney donors-33 patients with aortic dissection and 12 patients with renovascular hypertension- who underwent both MDCT angiography with 0.5-mm collimation and renal Tc-99m-diethylenetriamine pentaacetic acid (DTPA) scanning using the modified Gates method. Each perfusional cortex volume for the arterial input function and parenchymal volume was measured by semiautomatic segmentation using the region-growing technique. Linear regression analysis and correlation coefficients were used to assess the impact of the cortical volume, parenchymal volume, and renal scanning glomerular filtration rate (GFR) on estimated GFR (eGFR) using a modified Modification of Diet in Renal Disease (MDRD) equation.
RESULTS. The correlation coefficient was higher for the total renal DTPA GFR adjusted for body surface area, weight-adjusted perfusion cortex volume, and adjusted total parenchyma volume in rank (r = 0.712, 0.642, 0.510, respectively, p &lt; 0.0001 for each). The coefficient of the right renal perfusional cortex volume percent with a mean value of 52.1% +/- 10.1% was 0.826 (p &lt; 0.0001) for the right renal DTPA GFR percent with a mean value of 51.0% +/- 12.1% (range, 22.0-89.5%), although the value for the right renal parenchymal volume percent with a mean value of 49.5% +/- 5.5% was 0.764 (p &lt; 0.0001).
CONCLUSION. Weight-adjusted perfusional cortex volume for arterial input function can be measured clinically and may replace renal DTPA scanning using the modified Gates method.

DOI： 10.2214/AJR.14.12778

Web of Science

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

症例は32歳、女性。二分脊椎による神経因性排尿障害および腎後性腎不全のため、11年前にインディアナパウチ造設術を施行されていた。その後、腎不全は緩徐に進行し、6ヵ月前から血液透析を導入されていた。今回母をドナーとした血液型適合生体腎移植を施行した。導入免疫抑制剤はタクロリムス(TAC)+ミコフェノール酸モフェチル(MMF)+メチルプレドニゾロン(MP)+バシリキシマブ(BLX)を用いた。インディアナパウチへの腸管の癒着から、インディアナパウチへの移植腎尿管吻合は難しいと予想されたが、癒着は軽度であり、インディアナパウチに移植腎尿管を吻合することが可能であった。シングルJステントおよびインディアナパウチ内にバルーンを留置し終了とした。術後は粘膜によるバルーンカテーテル閉塞予防の為にインディアナパウチの洗浄を連日行った。バルーン抜去後は自己導尿としたが、夜間は間欠式バルーンを留置している。術後1年経過しているが、有熱性尿路感染症や拒絶反応の発症はなく、良好な腎機能を維持している。インディアナパウチに移植尿管を吻合した症例の報告は過去になく、極めて貴重な経験であると考え報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J01175&link_issn=&doc_id=20150130560009&doc_link_id=1390282680032581120&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282680032581120&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

症例は45歳男性。精巣腫瘍に対するcisplatin、etoposide、bleomycinの併用化学療法(以下、BEP療法)中にST上昇型急性心筋梗塞をきたし、緊急冠動脈造影検査を施行した。血栓溶解療法と血栓吸引除去術にて心筋虚血は改善し、その後化学療法を継続できた。心筋梗塞は冠動脈の粥状硬化が原因となることが多いため若年者の発症は稀であるが、精巣腫瘍の化学療法中に発症する可能性に留意し、胸痛を認めた場合は本症を鑑別に入れて、早期の診断・加療につなげることが重要だと考えられた。(著者抄録)

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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：医学図書出版(株)  

結節性硬化症(TSC)患者には高頻度に腎血管筋脂肪腫(AML)が合併する。この腫瘍は無症状で進行し、後腹膜腔への出血や腎機能障害などの重篤な障害を生じる。症例は37歳、女性。TSCと診断を受けており、これまでに両腎巨大AMLからの出血を繰り返していた。AMLのコントロール目的でEverolimusを投与。1年以上持続する腫瘍の縮小および出血の消失を認めたのでここに報告する。(著者抄録)

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Language：Japanese   Publisher：日本小児腎不全学会  

症例は15歳男児で、両側低形成腎に伴う慢性腎不全のため母親をドナーとした生体腎移植を施行した。腎移植後8ヵ月時にアデノウイルスによる出血性膀胱炎を発症したが、維持免疫抑制剤の減量を含む保存的治療により改善した。腎移植後1年時の腎生検では軽度から中程度の間質線維化および尿細管萎縮(IF/TA)を認め、定期生検入院時の看護記録から1日排尿回数が極端に少ないことが判明したため、自宅での排尿記録をつけるよう指示した。排尿記録では1回排尿量が600mL以上(最大750mL)、1日排尿回数が3回程度であるinfrequent voiderであることが確認された。臨床検査所見および臨床経過から、infrequent voidingに伴う過剰な慢性的蓄尿状態が移植腎に間質性病変をきたした原因と判断した。腹部超音波では残尿を認めず、膀胱造影でも移植腎逆流を認めないことから、経過観察したところ、移植後7年3ヵ月経過した現在、IF/TAの進行は認めず、移植腎機能も安定している。

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

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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)  

夜間頻尿特異的QOL質問票(N-QOL質問票)を用いて、1回以上の夜間頻尿を有する患者に対する塩酸プロピベリンの効果を検討した。解析症例40例(男性22例、女性18例)において、夜間排尿回数は3.7回から1.9回と有意に減少した。OABSS合計スコアも6.7から4.5へと有意に改善した。N-QOL総スコアは59.1から75.8へと有意に上昇した。2つのN-QOL下位尺度スコアもともに有意に改善した(睡眠・活力スコアは63.0から76.8へ、悩み・心配スコアは53.1から73.9へ)。塩酸プロピベリンは夜間頻尿患者のQOL改善に有効であり、安全性の高い薬剤であると考えられた。(著者抄録)

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

今回、当院での生体腎移植におけるbasiliximab(BLX)併用導入期免疫抑制療法の臨床効果について後方視的に検討した。術後6ヵ月以上経過した2000年4月以降の生体腎移植76例を対象とし、導入期免疫抑制療法におけるBLX併用の有無によりBLX+群とBLX-群に分け、急性拒絶反応及び腎移植後6ヵ月以内のウイルス感染の頻度、腎移植術後入院期間、ステロイド使用量、移植腎の生着率について比較検討した。急性拒絶反応はBLX-群では44.4%(4/9例)、BLX+群では13.4%(9/67例)で、症候性サイトメガロウイルス感染の頻度はBLX-群で高かった。移植後入院期間はBLX+群が54日、BLX-群が83日で、ステロイド使用量は術後30日時点での1日投与量及び術後30日間の累積投与量ともBLX+群はBLX-群の半量以下であった。また、移植腎の5年生着率はBLX-群が88.9%で、BLX+群は96.5%であった。BLX+群では、ABO式血液型不適合腎移植例等の免疫学的ハイリスク腎移植例を有するにも関わらず、急性拒絶反応の発生率及びステロイド投与量の減少、術後入院期間の短縮、そして移植腎生着率の改善などの利点が認められた。BLX併用導入期免疫抑制療法は、短期的には臨床的に有用な効果が得られたが、移植腎の長期生着率の改善への効果については、今後さらなる長期経過観察に基づく検討が必要である。(著者抄録)

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

【目的】Basiliximab(BLX)使用当院腎移植患者における移植後発症糖尿病(NODAT)の検討。【対象と方法】2000年～2012年6月まで術前に糖尿病の合併のない当院腎移植症例75例。BLX非使用群と使用群にわけNODAT発生頻度と背景を後方視的に検討した。【結果】非使用群は11例中2例、使用群は64例中3例の計5例にNODAT発症を認め、全例危険因子を有していた。1年以内の発症は前者のみに1例認め、両群で晩期発症例を認めた。【結論】BLX使用群では1年以内のNODAT発生を認めなかった。BLX併用の有無を問わず晩期発症を認めるため、早期発見・治療を目的に定期的糖負荷試験を行う必要がある。(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：日本小児泌尿器科学会  

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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：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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

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

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

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

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

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

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

54歳男性。陰茎包皮の腫瘤を触知し放置していたが、前医での生検で陰茎癌(高分化扁平上皮癌)と診断され、今回、手術および化学療法の可能性を検討に著者らの施設へ紹介となった。骨盤部MRIでは陰茎腫瘤は認められるものの進達度は不明であった。だが、右鼠径部には33×27×42mm、右閉鎖神経領域には30×16×31mmのリンパ節腫大がみられ、TxN3M0の診断となった。以後、海外では有効報告があるTPF(Pacrlitaxel、Cisplatin、5-Fluorouracil)療法を行なうにあたり、患者へインフォームドコンセントを十分に行い、同意を得たあと3コース施行、終了時のMRIでは右鼠径部リンパ節は82%、右骨盤内リンパ節は73%縮小が認められた。そこで、次いで陰茎部分切除術+両側鼠径リンパ節郭清術+両側骨盤内リンパ節郭清術を施行した。その結果、患者は術後1ヵ月目にTPF療法を2コース施行したが退院でき、目下も明らかな転移や再発は認められていない。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01269&link_issn=&doc_id=20140313410009&doc_link_id=1050564285742351872&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050564285742351872&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Background: The aim of this study was to evaluate induction immunosuppression therapy with basiliximab for living donor kidney transplantation at our institute. Methods: Data were analyzed for 76 patients in this retrospective study, including 67 treated using basiliximab and 9 comprising a historical control group. Results: Basiliximab significantly reduced the proportion of patients experiencing acute rejection within 6 months (9/67,13%) when compared to controls (4/9,44%). Cumulative steroid dose used within 1 month after transplantation was also lower in the basiliximab group. Five-year graft survival rate was 96.5% for the basiliximab group, compared to 88.9% for controls. Conclusion: Routine basiliximab induction significantly reduced the incidence of acute rejection, with beneficial effects on short-term kidney transplantation outcomes.

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

症例は40歳女性で、発熱・体重減少・左腰背部痛を主訴とした。腹部造影CTで左腎に一部淡い造影効果を伴う3cm大の腫瘤を認めた。リンパ節転移は認めず、骨シンチグラフィでも転移性病変を疑わせる異常集積像は認められなかった。以上より、腎細胞癌cT1aN0M0 stage 1と診断し、腹腔鏡下根治的左腎摘除術を施行した。術後も発熱が遷延し、CRP高値が持続したため抗菌薬を継続したが解熱せず、CRP・アルカリホスファターゼともに上昇が続いた。FDG-PET/CTと脊椎MRIを施行し、FDG-PET/CTで頸椎・胸椎・腰椎・胸骨・両側骨盤骨など、全身の骨に多数のFDG集積、脊椎MRIにて胸腰椎にび漫性病変を認めた。左腸骨より骨生検術を施行したところ、骨梁間に淡明な胞体をもつ異型細胞が浸潤しており、腎細胞癌の骨梁間型骨転移と診断した。temsirolimus投与を開始し、ゾレドロン酸を併用し、全7コース施行するも全身衰弱が増強し、次第に病状が悪化し永眠された。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01269&link_issn=&doc_id=20140207400006&doc_link_id=1050282810760040576&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050282810760040576&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

EVR追加によるCNIの減量によって、移植腎の長期生着が期待されているが、TAC+EVR併用de novoレジメンの報告は少ない。神奈川県内の5移植施設で共通のEVR+TAC de novoレジメンを策定した。対象は成人の生体・献腎移植。EVRをPOD14より2mg/Dayで開始し、トラフ濃度(C0)を4～5ng/mLに調整。EVR開始後にTAC-ERを4～5ng/mLに、MMFは1,000mgに減量した。PSLやBXMは従来通り。現時点での6例はすべて血液型適合移植で平均年齢は47.2歳、HLA mismatchはAB/DR:1.67/0.83。全症例で2ヵ月目までにs-Cr値は2.0mg/dLを切り、急性拒絶やCMV感染を認めていない。高脂血症を2例、蛋白尿、口内炎、創離開をそれぞれ1例に認めた。EVR投与量は当初は変動したが、2ヵ月後には1～1.75mgに落ち着いた。EVRのC0は平均4.78±1.76(1.3～8.99)ng/mLと調節にやや苦慮した。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J06262&link_issn=&doc_id=20131218480013&doc_link_id=%2Fem0sfcrt%2F2013%2F000102%2F013%2F0201-0205%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem0sfcrt%2F2013%2F000102%2F013%2F0201-0205%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本老年泌尿器科学会  

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

症例は69歳男性。65歳時に狭心症(前下行枝末梢90%狭窄)に対し薬剤溶出性ステント(DES)を留置されていた。DES留置後は抗血小板療法が不十分であるとステント血栓症を発症することが知られており、アスピリン継続のまま生体腎移植を施行した。術中、術後に輸血を必要としたが、重篤な出血合併症やステント血栓症を認めず、安全に手術および周術期管理を行うことが可能であった。(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：(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：(公社)神奈川県医師会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese  

Our patient was a 31-year-old man who presented with right flank pain. Computed tomography revealed multiple tumors in the liver and lungs, with marked elevation of serum human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels. In addition, no testicular abnormalities were detected by palpation or ultrasonography. On the bases of these results, the patient was diagnosed with extragonadal germ cell tumor and was therefore started on chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the result of a subsequent blood test showed marked pancytopenia at the initial stage of treatment. We speculated that the cause of anemia was not only bone marrow suppression but also intratumoral hemorrhage, collectively termed choriocarcinoma syndrome. After conservative treatment involving blood transfusion and administration of granulocyte colony-stimulating factor, he recovered. After several chemotherapy sessions, the levels of all tumor markers returned to normal. Finally, the patient underwent hepatectomy for residual tumors
but, the resected specimen showed no viable cancer cells. Currendy, the patient is free from disease since the last chemotherapy session, administered 5 months ago.

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

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

31歳男性。右側腹部痛を主訴に近医を受診、腹部エコーにて多発肝腫瘍を指摘され、著者らの施設へ紹介となった。精査加療目的で入院後、腫瘍マーカーのHCGとAFPの異常高値が認められたが、両側精巣の触診や超音波所見では異常は認められなかった。以上より、本症例は性腺外胚細胞腫瘍の多発肺転移、多発肝転移、傍大動脈リンパ節転移と診断され、導入化学療法としてBEP療法が行われた。だが、1コース開始から第9病日目に著明な汎血球減少が生じ、腫瘍内部出血が考えられたが、CTでも明らかな出血源は同定できず、保存的に経過観察となった。以後、腫瘍マーカー半減期が反応不良と判断して4コース目からはBEP療法からTIP療法に変更、2コース目までは21日周期で減量することなく施行可能であったものの、TIP療法3コース目以降はgrade 4の血小板減少が認められ、抗癌剤の減量はしなかった一方、投与周期は延長せざるを得なかった。だが、計7コースの施行で腫瘍マーカーの正常化とあわせて化学療法により肺転移と傍大動脈リンパ節転移は消失、残存した肝転移巣に対しては拡大右葉切除+外側区域切除+尾状部分切除術が施行された。その結果、最終化学療法後5ヵ月時点で腫瘍マーカーの上昇や画像上の再発は認めず、目下は厳重経過観察中である。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01269&link_issn=&doc_id=20130605440011&doc_link_id=1050845760699957376&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050845760699957376&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

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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   Publisher：(公社)神奈川県医師会  

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

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

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

2000年4月から2010年4月までの10年間に当院にて高位精巣摘除術を行った精巣胚細胞腫瘍症例69例に対し臨床的検討を行った。Seminomaが42例、Nonseminomatous germ cell tumor(NSGCT)が27例であった。Seminoma症例は再発および癌死例はなく、NSGCTでは5年生存率は90.4%、5年非再発率は72.6%と諸家の報告とほぼ同様だった。NSGCT stage Iではサーベイランス群の半分が再発しており、サーベイランスとする場合は厳重な観察が必要と考えられた。(著者抄録)

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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：Japanese   Publisher：腎移植・血管外科研究会  

目的:腎移植術での血管吻合時の動脈遮断困例について検討を行うこと。対象と方法:2000年1月から2012年6月までの当院腎移植例83例を対象とした。動脈遮断困難例は、腎移植時に中枢側のsingle clampで動脈遮断が不能であった症例と定義し、後方視的に検討した。結果:動脈遮断困難例を4例認め、全例生体腎移植で外腸骨動脈吻合例であった。これら4例中3例は糖尿病性腎症を原病とする末期腎不全患者であり、外腸骨動脈にメンケベルグ型動脈石灰化を認めた。結語:糖尿病性腎症を原病とする慢性腎不全患者は、メンケベルグ型動脈石灰化を合併することが多く、移植時の動脈血流遮断に難渋する可能性がある。(著者抄録)

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

症例は12歳男児。外傷性尿道球部完全断裂のため当科受診し、受傷後6ヵ月時に経会陰式尿道端々吻合術を施行した。術後経過は良好であったが、徐々に尿勢低下を認め、術後6ヵ月時に吻合部の膜様狭窄に対し内尿道切開術を施行した。しかし、3ヵ月後に再狭窄を認めたため、全身麻酔下に尿道バルーン拡張術を施行した。その後、再狭窄は認めず、術後3年経過した現在も尿勢は保たれており残尿もなく、外来経過観察中である。(著者抄録)

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

平成15年から平成23年までの間に当院で手術を施行した陰茎癌の症例14例を対象に臨床的検討を行った。平均年齢は67.8歳であり、腫瘍径の平均は4.8cmであった。StageはIが9例、IIが2例、IIIが0例、IVが3例であった。平均観察期間は67.4ヵ月で、観察期間中に14例中5例で再発またはprogressionをきたし、3例が癌死した。またadjuvant chemotherapyとしてMPB(MTX、CDDP、BLM)を5例に施行した。(著者抄録)

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Language：English   Publisher：PUBLIC LIBRARY SCIENCE  

Purpose: For patients with metastatic castration-resistant prostatic cancer (mCRPC), docetaxel plus prednisone leads to superior survival and a higher response rate compared with mitoxantrone plus prednisone. We analyzed the efficacy of long-term treatment with &gt;= 10 cycles of docetaxel, and validated the risk group classification in predicting overall survival (OS) in Japanese patients with mCRPC.
Patients and Methods: Fifty-two patients with mCRPC were administered 55 mg/m(2) docetaxel and 8 mg dexamethasone, every 3 or 4 weeks, simultaneously with hormonal therapy and daily oral dexamethasone. They were divided into two groups, short-term (9 or fewer cycles) and long-term (10 or more cycles). Four risk factors including the presence of anemia, bone metastases, significant pain and visceral metastases were utilized for the risk group classification.
Results: Fourteen patients (27%) had an elevation of PSA in spite of docetaxel treatment, while 23 patients (44%) had a decline in PSA level, including 9 patients (17%) whose PSA level declined by &gt;= 50%. The median duration of OS after the initiation of this therapy was 11.2 months in the short-term group and 28.5 months in the long-term group. The good risk group showed a significant difference in OS compared with the intermediate and poor risk groups (P&lt;.001). The median number of cycles of treatment was 14, 4 and 3 for each risk group, respectively (p&lt;.01).
Conclusions: The present study indicated that &gt;= 10 cycles of this docetaxel therapy can significantly prolong survival in Japanese men with CRPC. This risk group classification for men with mCRPC at the initiation of this chemotherapy is useful.

DOI： 10.1371/journal.pone.0048186

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

75歳男。膀胱尿路上皮癌に対する膀胱全摘術の2ヵ月後に後頸部痛、回転性眩暈、嘔気が出現した。頭部造影MRIにて右小脳に径3cm、左頭頂葉に径5mmの腫瘤を認め、転移性脳腫瘍と診断した。右小脳腫瘍は開頭腫瘍摘出術を行い、左頭頂葉腫瘍はガンマナイフ治療を行った。年齢および遅発性高次脳機能障害を危惧してMEN療法を3コース行い、6ヵ月毎の経過観察を行っている。脳転移診断後18ヵ月現在、再発は認めない。なお、膀胱尿路上皮癌の脳転移は稀で、本邦における報告は今までに本症例を含めて13例である。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J01269&link_issn=&doc_id=20121105390004&doc_link_id=1050001335748037248&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050001335748037248&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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   Publisher：(一社)日本排尿機能学会  

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

2010年4月に画像誘導放射線治療(Image Guided Radiation Therapy:IGRT)が保険収載された。IGRTにより前立腺に対してより正確に、より高線量の照射が可能となり、正常組織への線量を低減することが可能となった。この技術により前立腺癌に対する放射線外照射治療成績の改善が期待されている。当院では2010年3月に前立腺癌に対するIGRTを導入し、2012年4月までに62例に照射を終了した。これらの初期治療成績について検討したので報告する。(著者抄録)

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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：日本小児泌尿器科学会  

閉塞性乾皮性亀頭炎(BXO)は、真性包茎に関連した包皮口の狭小化を伴うものが多い。今回われわれは、有熱性尿路感染を契機に発見され包皮に異常を認めず外尿道口のみに膜状癒着をみとめたBXOの1例を経験したので報告する。症例は12歳男児。39.7℃の発熱を主訴に近医受診し、膿尿に加え、血液検査上、白血球増多とCRPの上昇を認め、CT上急性巣状細菌性腎炎(AFBN)の診断で、当院小児科入院。抗生剤治療を受け解熱後に、本人から数年前より尿線が細く腹圧をかけ排尿していたという訴えがあり、当科紹介となった。陰茎は仮性包茎で、幼少児時に母によりステロイド軟膏を用いた包皮輪拡張処置が施されており、包皮に異常はなく翻転も容易であったが、外尿道口は膜状に癒着閉塞しており、ピンホール状であった。排尿時膀胱尿道造影(VCUG)では両側膀胱尿管逆流(VUR)を認めた。狭窄の原因はBXOと臨床的に判断しまたVURの原因もしくは増悪因子になっていると考えた。切開後ステロイド軟膏処置を行ったが1ヵ月後には外尿道口が再度膜状に癒着していたため、全麻下に外尿道口形成術を行った。術後5ヵ月の時点でVURは消失し排尿もスムーズであり現在まで再狭窄を認めていない。自験例は真性包茎ではないが、真性包茎例ではBXOを認める症例も少なくはない。小児で排尿障害や尿路感染症を認めた場合はBXOも念頭に入れる必要がある。(著者抄録)

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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

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

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

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

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

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

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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  

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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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