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

OBJECTIVES: Cystic renal tumors (cRT) pose technical challenges during robot-assisted partial nephrectomy (RAPN) due to the risk of cyst rupture, yet their true impact on perioperative outcomes remains unclear. This study aimed to evaluate the surgical and pathological outcomes of RAPN for cRT compared with solid renal tumors (sRT). MATERIALS AND METHODS: We retrospectively analyzed 694 consecutive RAPN cases (2016-2023) at a high-volume center. Tumors were categorized as sRT (n = 609), partially cystic renal tumors with < 50% cystic component (pcRT), and cRT with ≥ 50% cystic component. Patient background, perioperative outcomes, resection techniques, and oncological results were compared. The SIB score was used as a surrogate measure for tumor resection method, distinguishing between enucleation, enucleoresection, and resection. RESULTS: Among these 694 cases, 609 (88%), 36 (5%) and 49 (7%) cases were classified into sRT, pcRT and cRT groups, respectively. Age, BMI, RENAL score, or clinical stage showed no differences among the three groups, and tumor size of pcRT and cRT was significantly larger than that of sRT (P = 0.067). No significant differences were observed in operative time, warm ischemia time, blood loss, trifecta achievement, or positive surgical margins. Pathologic up-grade was noted in 28 cases (2.6%) in sRT, while none were noted in pcRT and cRT. Multivariate analysis of predictive factors for WIT, trifecta, and pentafecta, showed that cystic tumor was not identified as predictive factors. CONCLUSIONS: RAPN for cystic renal tumors is safe and feasible, with perioperative, pathological, and functional outcomes comparable to solid tumors. The proportion of cystic components did not adversely influence outcomes, supporting the application of standard resection techniques for both cystic and solid tumors. RAPN should be considered a reliable first-line surgical option for cystic tumors when technically feasible.

DOI： 10.1007/s11701-025-03001-0

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OBJECTIVE: To compare complications, perioperative outcomes, postoperative renal function, and recurrence-free survival (RFS) between robot-assisted partial nephrectomy (RAPN) for hilar and non-hilar tumors. METHODS: We retrospectively analyzed the medical records of patients who underwent RAPN between March 2016 and August 2023. Patient demographic characteristics were adjusted using 1:1 propensity score matching. RESULTS: A total of 618 patients (524 with non-hilar tumors and 94 with hilar tumors) were analyzed. Hilar tumors exhibited a larger tumor size, higher RENAL nephrometry score (RNS), and greater complexity than non-hilar tumors pre-matching (all p < 0.05). Propensity score matching resulted in 77 patients per group, with no significant baseline differences except for the L factor of the RNS. Before propensity score matching, hilar tumors were associated with a higher frequency of renal artery/vein clamping and intraperitoneal approaches, as well as significantly longer operative and warm ischemia times than non-hilar tumors. However, after matching, these differences were no longer significant. The adverse event rate was not significantly different between the hilar and non-hilar tumor groups. Trifecta achievement rates were significantly lower in hilar tumors before matching (p < 0.001) but were comparable after matching (p = 0.325). No significant differences were observed in the postoperative eGFR, preservation at 1, 3, and 12 months, or pentafecta rates. Before matching, RFS was significantly lower in hilar tumors (p = 0.015); however, this difference was not significant after matching (p = 0.186). CONCLUSION: Hilar tumors showed similar complications, renal function, and recurrence-free survival rates as non-hilar tumors, indicating that RAPN is safe and feasible for hilar tumors.

DOI： 10.1111/iju.70156

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

The objective of this study is to evaluate mechanical tension on the renal parenchyma during partial nephrectomy using a novel index and compare the effects of different suture techniques on strain in a simulated model. A kidney-shaped urethane resin model with surface markers was created to measure deformation. Three-dimensional scanning assessed deformation before and after suturing. Strain values were calculated using finite-element shape functions on a triangular mesh. Distance from the centerline of the suture was also measured. The standard suturing method was defined as continuous stitches using self-retaining barbed sutures. Based on this standard, variations were introduced in suture material, suturing technique (continuous or interrupted), number of stitches, and the distance from the defect edge. Seven suture patterns were tested. Deformation values were higher when sutures were placed farther from the defect margin and lower when placed closer. Interrupted, tight, sparse, and multifilament suture patterns produced strain values similar to those of the standard technique. Narrow suture pattern tended to have longer distances from the centerline than the wide suture pattern. Interrupted and multifilament suture patterns also showed slightly longer distances than the standard pattern. This is the first study to visualize and quantify strain distribution during renorrhaphy using deformation values. The findings suggest that the distance of suture placement from the limbus may impact parenchymal strain. Despite limitations such as a small sample size and use of simulated models, these results offer insights into optimizing renorrhaphy techniques to minimize tissue stress. Future studies with larger sample sizes are warranted.

DOI： 10.1007/s11701-025-02580-2

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

The significance of "L" score in the radius (R), exophytic/endophytic (E), nearness (N), anterior/posterior (A), location (L); RENAL nephrometry scoring system remains unestablished compared to other subscores. This study assessed the influence of the "L" score on surgical and functional outcomes of RAPN, dividing renal tumors into medial and lateral relative to the kidney's central line, to explore its impact on "L" score utility. A retrospective analysis was conducted on 668 RAPN patients, with 405 having medial and 263 lateral renal tumors. Patients who underwent RAPN were retrospectively analyzed, including 405 with medial renal tumors and 263 with lateral renal tumors. In medial tumors, the "L" score independently predicted non-achievement of trifecta (P = 0.011) and pentafecta (P = 0.032). In lateral tumors, the "L" score did not predict non-achievement of these outcomes. In conclusion, significance of the "L" score on surgical outcomes differs between medial and lateral tumors and it is strongly associated with outcomes in medial tumors, whereas its predictive value in lateral tumors is less marked. The RENAL nephrometry score lacks differentiation between medial and lateral tumors; therefore, surgeons should interpret "L" scores with caution.

DOI： 10.1038/s41598-025-08647-2

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

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Lower urinary tract symptoms (LUTS) significantly affect patient quality of life. Treatment options for bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) (a common cause of LUTS) are insufficient to relieve discomfort. As the incidence of BPH is increasing, new pharmacological targets for LUTS treatment are required. Corticotropin-releasing hormone (CRH) is a neuropeptide that controls normal micturition in rodents. Herein, we investigated the role of spinal CRH in regulating micturition in sham and BOO rats, and evaluated CRH as a therapeutic target for bladder dysfunction in BOO model Sprague-Dawley rats. Histological analysis, cystometry with intrathecal administration of CRH agonists/antagonists, western blotting, and real-time PCR assessed the role of CRH and its receptors (CRHR1 and CRHR2) in micturition in sham and BOO rats. CRH administration shortened the voiding interval, while pretreatment with antagonists against CRHR2 (but not CRHR1) suppressed CRH-induced frequent voiding. Western blotting confirmed CRHR1 expression in the dorsal root ganglia (DRG) and bladder, but not the spinal cord, of rats. Real-time PCR showed higher CRHR2 mRNA expression in the spinal cord and DRG than in the bladder in both groups. Overall, spinal CRH facilitates the micturition reflex via CRHR2, and is a promising therapeutic target for LUTS.

DOI： 10.1038/s41598-025-87990-w

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

DOI： 10.1016/j.compbiomed.2024.109454

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

A 79-year-old male patient with urothelial carcinoma with squamous differentiation, pT2N0M0, was referred to our hospital. A computed tomography (CT) scan showed left hydronephrosis associated with the bladder tumor and reticular shadows in the lung fields. After neoadjuvant chemotherapy with gemcitabine and cisplatin, the patient underwent robot-assisted radical cystectomy and cutaneous ureterostomy for bladder cancer on March X. On postoperative day 2, SpO2 decreased with increased oxygen demand, and a CT scan revealed a diffuse reticular shadow in both lungs. The patient was diagnosed with acute exacerbation of interstitial pneumonia (IP). Steroid pulse therapy with 1,000 mg/day methylprednisolone (mPSL) was initiated immediately, and nasal high-flow (NHF) oxygen was introduced. After a positive response to mPSL was confirmed, the patient was weaned from NHF on postoperative day 9. As the IP did not worsen, he was discharged after receiving home oxygen therapy. Six months after the acute exacerbation of IP, CT showed no tumor recurrence or progression.

DOI： 10.5980/jpnjurol.116.37

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

A 28-year-old male presented to his physician with a chief complaint of fever and cough. Contrastenhanced computed tomography revealed a 17×16×8 cm heterogeneous tumor in the anterior mediastinum, as well as right heart and inferior vena cava compression due to the tumor. He was referred to our hospital for close examination and treatment. Alpha fetoprotein (AFP) was 24,769 ng/ml, and percutaneous needle biopsy revealed a germ cell tumor with a York sac tumor component; therefore, Bleomycin, Etoposide and Cisplatin (BEP) therapy was started. Although AFP tended to decrease with BEP therapy, the tumor size remained unchanged, and right heart failure due to right heart system decompression led to cardiogenic shock. Consequently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was introduced on Day 25. Since cardiogenic shock continued even after VA-ECMO, anterior mediastinal tumor resection was attempted on Day 30 following consultation with the respiratory surgery, cardiovascular surgery, cardiology, and intensive care units. Because the tumor was strongly adherent, tumor resection was abandoned, and tumor reduction surgery was performed. Postoperatively, his cardiovascular status improved quickly, and he was weaned off VA-ECMO the day after surgery. AFP decreased to 22 ng/ml but re-elevated; therefore, EP therapy was introduced on Day 97 when AFP was 600 ng/ml. We report a case of a primary mediastinal germ cell tumor with circulatory disturbance due to cardiopulmonary compression. In cases similar to ours, multidisciplinary treatment in collaboration with multiple departments is necessary.

DOI： 10.14989/ActaUrolJap_70_12_451

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Renal and ovarian clear cell carcinoma (CCC) are both characterized by a clear cytoplasm and exhibit similar genomic alterations and clinical characteristics. We hypothesized that both CCCs may share clinical biomarker. Tissue factor pathway inhibitor 2 (TFPI2), a serine protease inhibitor, has emerged as a promising serum biomarker for ovarian CCC, and we evaluated the efficacy of TFPI2 as a biomarker for renal cell carcinoma (RCC). Serum samples were collected from patients with RCC and healthy volunteers, and TFPI2 levels were measured. Expression of TFPI2 in each cell type was evaluated using single-cell RNA sequencing. Survival analyses according to TFPI2 expression levels were performed based on publicly available databases. Serum TFPI2 was significantly elevated in patients with RCC compared to healthy volunteers, particularly those with clear cell histology. Metastatic RCC tumors exhibited higher TFPI2 than localized RCCs. Moreover, higher TFPI2 correlated with higher Fuhrman grades in clear cell RCC. Publicly available databases showed an association between TFPI2 expression and overall survival, particularly in clear cell RCC. Single-cell RNA sequencing confirmed TFPI2 expression in clear cell RCC and normal kidney tubular epithelial cells. TFPI2 has emerged as a potential serum biomarker for RCC, offering avenues for improved detection and prognostication.

DOI： 10.1038/s41598-024-80248-x

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Publisher：Cold Spring Harbor Laboratory  

SUMMARY

Spermatogenesis takes place in the testis, relying on the ordered turnover of differentiating cells supplied from stem cells. Classic histological analyses have revealed that this process shows hierarchical spatiotemporal patterning known as the spermatogenic cycle, wave, and descent of segmental order, indicative of currently underexplored mechanisms of tissue- and organ-scale homeostasis. Here, using mice, we conducted high-resolution, wide-field, and ‘ultra’ long-term live imaging studiesin vivoandex vivo, combined with whole-organ mapping of differentiation stages. Such trans-scale measures demonstrate how stereotypic local cell turnover is coordinated into characteristic phase waves propagating along the seminiferous tubules, further organized into organ-scale patterning over the tubule loops. Minimal mathematical modeling shows that such higher-order dynamics can emerge from the local coupling of autonomous oscillators, which are rooted in delayed feedback interplay between stem and differentiating cells via retinoic acid signaling. These findings highlight a self-organization mechanism underpinning organ-scale homeostasis and constant sperm production.

DOI： 10.1101/2024.11.03.621757

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

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

DOI： 10.1016/j.bbrc.2024.150730

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

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

DOI： 10.1111/iju.15567

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

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

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

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

Metanephric adenoma is an extremely rare disease. We describe two cases of metanephric adenoma. Case 1 : A 17-year-old male adolescent developed gross hematuria, and urinalysis revealed positive protein and occult blood. He was referred to our department for further evaluation and likely tumor removal. Contrast-enhanced computed tomography (CT) showed a neoplasm (23 mm) with poor contrast effect during the early as well as the late contrast phase. Case 2 : A 61-year-old woman presented with an incidentally detected tumor in the lower pole of the right kidney ; contrast-enhanced CT revealed a large neoplasm (10 mm) with poor contrast effect during the early as well as late contrast phase. Both patients underwent robot-assisted partial nephrectomy (RAPN) under the preoperative diagnosis of papillary renal cell carcinoma. Metanephric adenoma is histopathologically indistinguishable from papillary renal cell carcinoma preoperatively, and histopathology and immunostaining are neceaasry for accurate diasnosis.

DOI： 10.14989/ActaUrolJap_70_8_247

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

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

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

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

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

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

DOI： 10.1007/s11255-023-03899-1

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

DOI： 10.1089/end.2023.0608

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

DOI： 10.1007/s11701-024-01873-2

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

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

DOI： 10.1111/iju.15437

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Approximately 1% of the general male population has azoospermia, and nonobstructive azoospermia accounts for the majority of cases. The causes vary widely, including chromosomal and genetic abnormalities, varicocele, drug-induced causes, and gonadotropin deficiency; however, the cause is often unknown. In azoospermia caused by hypogonadotropic hypogonadism, gonadotropin replacement therapy can be expected to produce sperm in the ejaculate. In some cases, upfront varicocelectomy for nonobstructive azoospermia with varicocele may result in the appearance of ejaculated spermatozoa; however, the appropriate indication should be selected. Each guideline recommends microdissection testicular sperm extraction for nonobstructive azoospermia in terms of successful sperm retrieval and avoidance of complications. Sperm retrieval rates generally ranged from 20% to 70% but vary depending on the causative disease. Various attempts have been made to predict sperm retrieval and improve sperm retrieval rates; however, the evidence is insufficient. Further evidence accumulation is needed for salvage treatment in cases of failed sperm retrieval. In Japan, there is inadequate provision on the right to know the origin of children born from artificial insemination of donated sperm and the rights of sperm donors, as well as information on unrelated family members, and the development of these systems is challenging. In the future, it is hoped that the pathogenesis of nonobstructive azoospermia with an unknown cause will be elucidated and that technology for omics technologies, human spermatogenesis using pluripotent cells, and organ culture methods will be developed.

DOI： 10.1111/iju.15301

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

DOI： 10.3390/jcm12247528

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

DOI： 10.1111/iju.15274

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

DOI： 10.1111/iju.15287

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DOI： 10.1002/bco2.271

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BACKGROUND: Our web-based training program called "Educating Medical Professionals about Reproductive Issues in Cancer Healthcare" aims to help healthcare professionals communicate promptly with patients and survivors who are adolescents and young adults, with information pertinent to reproductive health issues such as the risk of infertility and fertility preservation. METHODS: The study participants were professional healthcare providers, including physicians, nurses, pharmacists, social workers, midwives, psychologists, laboratory technicians, genetic counselors, and dieticians. Pre- and post- and 3-month follow-up tests consisting of 41 questions were administered to measure changes in knowledge and confidence. The participants also received a follow-up survey that covered confidence, communication techniques, and practice habits. A total of 820 healthcare providers participated in this program. RESULTS: The mean total score from the pre-test to the post-test grew significantly (p < 0.01), and participants' self-confidence increased. In addition, there was a change in the behavior of healthcare providers, who began asking about patients' marital status and parity. CONCLUSION: Our web-based fertility preservation training program improved knowledge and self-confidence regarding fertility preservation issues among healthcare providers caring for adolescents and young adult cancer patients and survivors.

DOI： 10.1007/s10147-023-02366-2

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

DOI： 10.1016/j.ebiom.2023.104596

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With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.

DOI： 10.5534/wjmh.220102

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

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Introduction: Malignant bone and soft tissue tumors, commonly called sarcomas, predominantly originate in bone and soft tissues and typically affect individuals at a younger age. Following the resection of the primary tumor, treatment often necessitates radiation therapy and gonadotoxic chemotherapy, the specifics of which depend on the disease's stage Conversely, there is a notable concern regarding the potential loss of fertility due to these treatments. Consequently, it is recommended that men consider sperm cryopreservation before initiating treatment. This study aims to assess spermatogenesis in male patients diagnosed with malignant bone and soft tissue tumors before and after chemotherapy. Methods: This study involved 34 male patients diagnosed with malignant bone and soft tissue tumors and subsequently underwent sperm cryopreservation before initiating treatment. Medical records included details about the primary disease, age, marital status at presentation, semen analysis results, treatment regimen and number of courses, post-treatment semen analysis, renewal status and outcomes. Results: The mean age at the time of sperm cryopreservation was 22.8 years. The median semen volume was 2.5 mL, sperm concentration was 32.6 million/ml, and sperm motility was 38.5%. Following chemotherapy, semen analysis was conducted on 12 patients, with ifosfamide being the predominant drug used in all cases. Among these 12 patients, eight retained viable spermatozoa, and two successfully achieved spontaneous pregnancies resulting in live births. In one of the remaining four cases where no sperm were detected in ejaculate, a live birth was achieved through intracytoplasmic sperm injection using cryopreserved sperm. Discussion: While ifosfamide, the primary chemotherapy drug for patients with malignant bone and soft tissue tumors, was associated with severe impairments in spermatogenesis, recovery of spermatogenesis was observed in many cases. However, there were instances of prolonged azoospermia. Even in such cases, assisted reproduction using cryopreserved sperm remained viable for achieving parenthood. In light of these findings, offering patients the opportunity for fertility preservation is advisable.

DOI： 10.3389/fphar.2023.1324339

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

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

DOI： 10.5980/jpnjurol.114.1

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A 57-years-old woman was referred to our urological department due to a 7.2-cm tumor in the left kidney, detected on computed tomography (CT). Dynamic CT of the kidney confirmed the diagnosis of left renal cancer, with lung metastasis (cT2aN0M1). The patient had a poor prognosis (IMDC classification), given the following risk factors: Time from initial diagnosis to initiation of systemic therapy < 1year, hemoglobin of 8.4 g/dL, calcium of 10.7 mg/dL, and platelet of 74.2×104/mm3. Laparoscopic left radical nephrectomy was performed before systemic drug treatment because the solitary lung metastasis was relatively small (10 mm) and the patient had symptoms of hematuria and fever. The pathological diagnosis was a clear cell carcinoma with renal sinus invasion (pT3a). Four days postoperatively, the patient developed lymphatic leakage, and was unresponsive to diet and conservative treatment. Lymphatic embolization with iodized poppy oil fatty acid ethyl ester was performed 22 days postoperatively. Contrast material leakage from the left renal hilar lymph node was observed before embolization. Post-embolization CT confirmed no contrast leakage. The patient resumed oral feeding on the 28th postoperative day, and the drain was successfully removed the next day. She was discharged on the 35th postoperative day. On follow-up, increased lung metastases were observed on CT. She was treated with the combination of ipilimumab and nivolumab. After one course of treatment, a CT scan showed a further increased in lung metastases (RECIST: PD). Thus, she was initiated on cabozantinib monotherapy. Lymphatic embolization may be a safe and effective treatment for lymphatic leakage that does not improve with conservative treatment.

DOI： 10.5980/jpnjurol.114.133

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INTRODUCTION: We report a case series of six patients with a chief complaint of infertility who underwent microsurgical varicocelectomy for intratesticular varicocele (ITV) after undergoing orchiopexy for undescended testis in their childhood. CASE PRESENTATION: The patients' median age was 34 years. The median age at which orchiopexy was performed was 4.5 years. All the cases of ITV were accompanied by extratesticular varicocele (ETV). All the patients underwent a microsurgical subinguinal varicocelectomy. At 3 months after operation, the ITV and ETV had disappeared in all the cases. Sperm density and motility increased in five and four patients, respectively. CONCLUSION: ITV occurs at a relatively high frequency after orchiopexy for undescended testis. Disorder of the valvular function of the testicular vein in peeling the testicular vessels was thought to be a primary cause and is often found on the left side. Doppler ultrasonography of the testis is considered important for diagnosis.

DOI： 10.1002/iju5.12498

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

DOI： 10.1016/j.isci.2022.104463

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Klinefelter syndrome and monozygotic twins are both rare. The reports of monozygotic twins with Klinefelter syndrome to have undergone fertility treatment are uncommon. This case report describes a case of 30-year-old monozygotic adult twin brothers diagnosed with nonmosaic Klinefelter syndrome following the complaint of infertility. The result of semen analysis showed cryptozoospermia (very low sperm count) and azoospermia (zero sperm count) with physical findings and lifestyles being very similar. They both underwent microtesticular sperm extraction. One had successful sperm retrieval and achieved pregnancy through intracytoplasmic sperm injection, whereas the other did not. Testicular pathological findings showed Sertoli cell-only syndrome. To the best of our knowledge, this is the first report on monozygotic adult twins both of whom underwent microtesticular sperm extraction and resulted in different outcomes.

DOI： 10.1111/and.14266

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OBJECTIVE: To evaluate the efficacy of keishibukuryogan, a traditional Kampo formula known to be an anti-Oketsu (impaired microcirculation and non-physiological blood congestion) drug, in combination with an anti-oxidant for the treatment of varicoceles. METHODS: We retrospectively analyzed 119 patients with palpable and subclinical varicoceles who were treated with 7.5 g/day of keishibukuryogan and 600 mg/day of tocopherol nicotinate. Their motile sperm concentrations at the start of medication and after 3 months were compared. As a subgroup analysis, a comparison test was carried out between patients with a high-grade varicocele and those with a low-grade varicocele. RESULTS: The mean age of the study patients was 35.6 years. Among them, 17, 41, 44 and 17 had subclinical, grade 1, grade 2 and grade 3 varicoceles, respectively. Overall, the differences in motile sperm concentration (millions/mL) before and after treatment were not significant (median 0.58, 95% confidence interval -0.12 to 1.56; P = 0.115). The results of the subgroup analysis showed that the motile sperm concentration in patients with a low-grade varicocele significantly increased (median 1.21, 95% confidence interval 0.45-2.47; P = 0.024); however, no significant improvements were seen in patients with a high-grade varicocele. CONCLUSIONS: The results of the present study showed that the combination of keishibukuryogan and an anti-oxidant had a limited effect on varicoceles, but they suggest that it is effective for the treatment of low-grade varicoceles.

DOI： 10.1111/iju.14746

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BACKGROUND: Newly emerging serious post-treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life. METHODS: We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction. MAIN FINDINGS: Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility-preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder. CONCLUSION: Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.

DOI： 10.1002/rmb2.12481

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DOI： 10.4103/aja2021112

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Cancer therapy has priority over fertility preservation. The time available for fertility preservation in patients with cancer is often very limited and depends on the condition of the underlying disease. This case report presents the results of two rounds of controlled ovarian stimulations (COSs) performed after an induced abortion. The patient had mixed phenotype acute leukemia diagnosed during early pregnancy and underwent a surgical abortion, followed by ovarian stimulation using urinary follicle-stimulating hormone (uFSH) and gonadotropin-releasing hormone (GnRH) agonists. Oocyte retrieval was subsequently performed for oocyte cryopreservation. Despite good hormonal and ultrasonic follicular growth, no oocytes were obtained. During a second COS performed at a low human chorionic gonadotropin (hCG) level (less than 100 IU/L), several mature oocytes were obtained, suggesting that higher hCG levels during COS induce the absence of mature oocytes during normal follicular growth. It is recommended to start COS post-abortion after confirming a low hCG level while considering the timing of cancer treatment.

DOI： 10.1080/09513590.2021.1950135

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PURPOSE: To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. METHODS: We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT). RESULTS: The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p < 0.001). CONCLUSION: Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.

DOI： 10.1007/s00345-020-03459-7

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PURPOSE: To identify risk factors by developing and internally validating a nomogram for preventing perioperative complications in overnight ureteral catheterization cases after fURS for kidney stones. METHODS: We retrospectively examined 309 patients with overnight ureteral catheterization after single fURS procedures for renal stones. fURS procedures were performed based on the fragmentation technique. The ureteral catheter was removed on postoperative day 1. Within this group, patients who experienced perioperative complications (complication group) were compared with those who did not experience complications (non-complication group). The complication group included 77 patients whose Clavien-Dindo classification score was I, II, III, or IV and/or those whose body temperature during hospitalization was over 37.5 °C. RESULTS: The overall stone volume, stone-free rate, incidence of perioperative complications, and procedure duration were 1.39 mL, 94.8%, 24.9%, and 62 min, respectively. Severe complications of a Clavien-Dindo level III or IV were observed in only four cases (1.3%). Multivariate assessment revealed five independent predictors of perioperative complications after fURS with overnight catheterization: age (p = 0.11), sex (p = 0.067), stone volume (p = 0.33), Hounsfield units (p = 0.16), and narrow ureter (p = 0.018). We developed a nomogram to predict perioperative complications after fURS using these parameters. CONCLUSIONS: We developed a predictive model for perioperative complications of patients with overnight catheterization after fURS for renal stones. This model could select patients who were at a low risk of complications.

DOI： 10.1007/s00345-019-03023-y

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DOI： 10.1096/fj.202000245R

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PURPOSE: The effect of combining miniaturization with endoscopic combined intrarenal surgery (ECIRS) is unclear. Thus, we compared the treatment outcomes between minimally invasive ECIRS (mini-ECIRS) using 16.5 Fr percutaneous access sheath and standard ECIRS using 24 Fr access sheath for renal stones MATERIALS AND METHODS: We retrospectively analyzed consecutive patients who underwent single session mini or standard-ECIRS in the modified Valdivia position for renal stones between April 2009 and May 2016. To adjust for patient characteristics, 77 pairs were matched using preoperative parameters including age, sex, history of febrile urinary tract infection (UTI), stone surface area, number of involved calyces, and staghorn calculi. RESULTS: The stone free rate (SFR) was similar between mini and standard ECIRS according to non-contrast computed tomography (61.1% vs. 52.0%, p = 0.388). The rate of perioperative complications exceeding grade 2 based on the Clavien-Dindo classification was similar in both groups (19.5% vs. 26.0%, p = 0.442). Severe complications exceeding grade 3 were also similar in both groups (2.6% vs. 3.9%, p > 0.99). Two cases of septic shock were noted in each group. Although there was no difference regarding bleeding-related complications (2.6% vs. 6.5%, p = 0.442), pseudoaneurysm or blood transfusion was not observed in the mini-ECIRS group. Pain visual analog scale values in the perioperative period were lower in the mini-ECIRS group (1.34 ± 1.08 vs. 1.69 ± 1.23, p = 0.062). CONCLUSIONS: This study demonstrated that, compared to standard ECIRS, mini-ECIRS maintained SFR without increasing perioperative complications, tended to reduce postoperative pain and had a potential to reduce bleeding-related complications. This report suggests the advantages of ECIRS miniaturization for renal stones.

DOI： 10.1007/s11255-020-02433-x

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Publisher：Wiley  

DOI： 10.1002/rmb2.12291

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DOI： 10.1002/bit.26822

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Other Link： http://orcid.org/0000-0002-6198-2234

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Most kidney cells are continuously exposed to fluid shear stress (FSS) from either blood flow or urine flow. Recent studies suggest that changes in FSS could contribute to the function and injury of these kidney cells. However, it is unclear whether FSS influences kidney development when urinary flow starts in the embryonic kidneys. In this study, we evaluated the influence of FSS on in vitro cultured ureteric bud (UB) cells by using a pumpless microfluidic device, which offers the convenience of conducting parallel cell culture experiments while also eliminating the need for cumbersome electronic driven equipment and intricate techniques. We first validated the function of the device by both mathematical model and experimental measurements. UB cells dissected from E15.5 mouse embryonic kidneys were cultured in the pumpless microfluidic device and subjected to FSS in the range of 0.4-0.6 dyn mm-2 for 48 h (dynamic). Control UB cells were similarly cultured in the device and maintained under a no-flow condition (static). We found from our present study that the exposure to FSS for up to 48 h led to an increase in mRNA expression levels of UB tip cell marker genes (Wnt11, Ret, Etv4) with a decrease in stalk cell marker genes (Wnt7b, Tacstd2). In further support of the enrichment of UB tip cell population in response to FSS, we also found that exposure to FSS led to a remarkable reduction in the binding of lectin Dolichos Biflorus Agglutinin. In conclusion, results of our present study show that exposure to FSS led to an enrichment in UB tip cell populations, which could contribute to the development and function of the embryonic kidney when urine flow starts at around embryonic age E15.5 in mouse. Since UB tip cells are known to be the proliferative progenitor cells that contribute to the branching morphogenesis of the collecting system in the kidney, our finding could imply an important link between the FSS from the initiation of urine flow and the development and function of the kidney.

DOI： 10.1063/1.5035328

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DOI： 10.1016/j.bbrc.2018.04.180

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DOI： 10.1007/s00345-018-2328-1

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DOI： 10.1371/journal.pone.0192884

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Other Link： http://orcid.org/0000-0002-6198-2234

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DOI： 10.1038/s41598-017-15799-3

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A 43-year-old man underwent extracorporeal shock wave lithotripsy (ESWL) for a left ureteral stone and implantation of a loop stent for the treatment of stone pain in February 2011. However, he was lost to follow-up before the complete removal of the stones and stent. He presented to our hospital with left back pain in March 2015. An abdominal radiograph and a noncontrast computed tomography showed extensive stone formation throughout the stent. A single cystolithotripsy and a double endoscopic combined intrarenal surgery (ECIRS)were performed. All the stones and the encrusted ureteral stent were successfully removed.

DOI： 10.14989/ActaUrolJap_62_11_585

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Language：Japanese   Publisher：日本生殖内分泌学会  

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DOI： 10.1038/srep21472

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DOI： 10.1371/journal.pone.0130171

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Twenty years ago, the transplantation of spermatogonial stem cells (SSCs) from a mouse to other recipient mice was shown to be feasible, which clearly demonstrated the functional identity of SSCs. Since then, several important new findings and other technical developments have followed, which included a new hypothesis on their cell kinetics and spermatogonial hierarchy in the testis, a culture method allowing their self-renewal and proliferation, a testis tissue organ culture method, which induced their complete differentiation up to sperm, and the in vitro induction of germ cells from embryonic stem cells and induced pluripotent stem cells. These advancements reinforced or advanced our understanding of this unique cell. Nonetheless, there are many unresolved questions in the study of spermatogonial stem cells and a long road remains until these cells can be used clinically in reproductive medicine.

DOI： 10.4103/1008-682X.154995

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DOI： 10.1038/ncomms5320

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DOI： 10.1095/biolreprod.113.108613

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A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

DOI： 10.1007/s00240-012-0517-8

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An 82-year-old male patient underwent open left lower-pole partial nephrectomy with a microwave tissue coagulator (Microtaze). Pathological findings showed clear cell renal cell carcinoma, pT1a, Fuhrman grade 2 with negative margins. Then 2 years later, he presented with urinary retention. His urine appeared cloudy and milky only after meals, but appeared normal at other times. He was diagnosed with chyluria after partial nephrectomy. Endoscopic sclerotherapy with silver nitrate was carried out, because his serum albumin decreased to 3.4 g/dL within 3 months. He had an uneventful postoperative course. His chyluria completely disappeared and has not recurred for 11 months. Although chyluria after nephrectomy is very rare, there is a possibility that the frequency of chyluria after partial nephrectomy might increase, because the number of partial nephrectomies continues to increase worldwide. We herein summarize this rare surgical complication and discuss the effectiveness of endoscopic sclerotherapy as a therapeutic tool.

DOI： 10.1111/j.1442-2042.2012.03139.x

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DOI： 10.1073/pnas.1211845109

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A 70-year-old man presented with a left scrotal swelling. A computed tomography scan showed an 8-cm left scrotal mass and no metastasis. Radical orchiectomy with high ligation of the spermatic cord was performed. The tumor was classified as a high-grade leiomyosarcoma of the left testis. An intensive follow-up including repeated computed tomography scans was performed. A computed tomography scan 34 months after the surgery showed a retroperitoneal mass in front of the left kidney. Resection of the mass was performed. Microscopically, the mass was metastatic leiomyosarcoma. Intratesticular leiomyosarcoma is rare; only 18 cases have been reported. This is the first case in which leiomyosarcoma metastasized to the retroperitoneal space postoperatively. We herein review the literature and discuss how intratesticular leiomyosarcoma metastasized to the retroperitoneal space in this patient.

DOI： 10.4103/0970-1591.102723

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A 47-year-old man presented with dysuria. The prostate-specific antigen level was 65.5 ng/mL. Retropubic radical prostatectomy and regional lymphadenectomy revealed moderately differentiated adenocarcinoma (Gleason score 3 + 4 = 7, pT2N0). Postoperative adjuvant hormonal therapy was started immediately. Three years later, hormonal therapy was changed to anti-androgen monotherapy. Monotherapy was continued for eight years and then discontinued because the PSA level was maintained at <0.04 ng/mL. However, biochemical recurrence occurred 12 months after adjuvant hormonal therapy was discontinued. A computed tomography scan showed left inguinal lymphadenopathy. Biopsy of the swollen inguinal lymph node revealed metastatic prostate cancer. We report a rare case of metastatic prostate adenocarcinoma only to the inguinal lymph nodes.

DOI： 10.5173/ceju.2012.02.art11

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A 64-year-old man presented with gross hematuria. Physical examination showed a mass under the phimotic foreskin. Circumcision revealed a 2cm polypoid tumor on the inner layer of prepuce. Tumor resection was performed and pathological diagnosis was carcinosarcoma which was composed of squamous cell carcinoma and spindle cell sarcoma. Biopsy of the scar lesions revealed residual squamous cell carcinoma and computed tomographic scan revealed swollen inguinal lymph nodes. Partial penectomy and lymph node biopsy were performed. Pathological examination revealed residual squamous cell carcinoma and no lymph node metastasis. There was no recurrence for one year. We report this very rare case of carcinosarcoma of the penis.

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A 67-year-old man received left radical nephrectomy for left renal cell carcinoma (RCC) (clear cell carcinoma, G2, pT3bN0M0). After 9 months, he presented with an acute onset of left extremity edema. A computed tomographic (CT) scan and magnetic resonance imaging reveal recurrent renal cell carcinoma in the inferior vena cava (IVC) and the left renal fossa, thrombus in the left external vein and acute pulmonary embolism. We performed treatment with sunitinib for 5 months after anticoagulant therapy for 3 weeks. A new CT scan showed disappearance of RCC in the IVC and reduction in the size of RCC in the renal fossa. Only 11 cases are reported as recurrent RCC in the IVC. We report the first case of recurrent intracaval RCC in which sunitinib treatment was effective.

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A 39-year-old woman, who was followed because of a 4 cm asymptomatic angiomyolipoma (AML) in the left kidney, presented with an acute onset of lower left back pain in the 38th week of her first pregnancy. An ultrasound revealed an 8 cm mass suggestive of AML rupture and retroperitoneal hemorrhage. An emergency caesarean delivery was performed. A post-delivery computed tomographic scan confirmed the AML rupture and selective embolization was performed. This was a case in which the AML grew rapidly during the pregnancy ; therefore, we discuss the relationship between AML and pregnancy.

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

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We report a case of segmental testicular infarction that is a rare and usually idiopathic. The patient is a 36-year-old man who presented with acute right scrotal pain and swelling. Scrotal ultrasound demonstrated a round hypoechoic lesion and magnetic resonance imaging (MRI) findings could not rule out intratesticular hemorrhage or necrotic tissue associated with malignant neoplasm. Therefore right high orchiectomy was performed. The histopathological examination revealed segmental infarction of the testis at the upper and middle pole with coagulation necrosis.

PubMed

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Web of Science

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Web of Science

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Web of Science

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：The Japan Society of Mechanical Engineers  

DOI： 10.1299/jsmebio.2018.30.2H02

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

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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

41歳男。4年前に左腎結石症で、ESWL(extracorporeal shock wave lithotripsy)施行後、stone streetによる疼痛のため、左尿管ステント留置していたが、自己中断していた。この時点では結石分析は不明であった。今回、左背部痛を主訴に受診した。腹部単純CTにて、左尿管ステントに沿って腎臓側に最大36mm、膀胱側に最大47mmの結石形成、左水腎症、腎周囲脂肪織濃度の上昇を認めた。以上の所見より、尿管ステントの石灰化による水腎症を伴った腎盂腎炎と診断した。腎瘻造設を施行し、その後、経尿道的膀胱結石砕石術とpercutaneous nephrolithotomyとtransurethal lithotripsyの併用療法であるECIRS(endoscopic combined intrarenal surgery)を施行した。2回目のECIRSですべて抽石し、新しい尿管ステントを挿入した。術後2週間後にステント抜去を行い、その後は再発なく経過した。

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

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64歳男性。肉眼的血尿から精査目的で著者らの施設へ紹介受診となった。IVPや膀胱鏡検査等では異常はみられなかったが、包皮下に偶然、腫瘤が触知され、直視しようと試みるも真正包茎であることから確認はできなかった。陰茎腫瘍の疑いで入院後、環状切開術が施行されたが、亀頭付近の内板腹側には2cm大の有茎性非乳頭状腫瘍が認められ、これを腫瘍基部で切除し、病理学的診断を行ったところ、腫瘍は高度異型の紡錘型細胞を主体としつつも不規則な構造をした扁平上皮細胞が見受けられ、両者が相互に漸次移行しているcarcinosarcomaであった。一方、術後、手術瘢痕部の粘膜不整があったため生検を行った際、扁平上皮癌の残存がみられ、あわせてCT検査では7～15mm大の両側鼠径リンパ節腫脹が認められた。以上、これらのことより、本症例は局所残存陰茎癌と診断され、陰茎部分切除術を行った結果、術後は鼠径リンパ節増大や転移巣の出現は認められなくなった。

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67歳男。検診にて肺門部の異常陰影を疑われ、精査したが肺野に異常なく、左腎腫瘤を認めた。左腎細胞癌(clear cell carcinoma、G2、INFβ、pT3bN0M0)と診断し、経腹式根治的腎摘除術を施行した。術後9ヵ月目に急激な左下肢の浮腫と熱感が出現した。MRIおよび腹部造影CTで塞栓の増強効果を認め腰静脈からIVCへの腫瘍の浸潤を認め、腎細胞癌術後再発による下大静脈、左総腸骨静脈・左腎静脈腫瘍塞栓および左腎門部リンパ節転移と診断し、入院した。抗凝固療法を行い、左外腸骨静脈血栓と肺塞栓症は軽快し、ヘパリンナトリウムの持続静注からワルファリンカリウム内服へ変更し退院した。腎細胞癌再発に対して手術困難であるため、Sunitinibによる分子標的療法を約5ヵ月間、計5コースを継続した。リンパ節腫大は縮小し全ての静脈内腫瘍塞栓は消失した。有害事象として鼻出血、白血球減少・血小板減少、口内炎および発疹を認めたが減量や延期は必要なく、現在6コース目を施行中であった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01269&link_issn=&doc_id=20100930380003&doc_link_id=1050282676671264128&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050282676671264128&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

39歳女性(1経妊0経産)。患者は2年前、検診の超音波検査(US)で左腎に高エコー腫瘤を指摘され、著者らの施設へ受診となった。CTで左腎血管筋脂肪腫(AML)と診断され、大きさ4cm弱で無症状のため経過観察としていたが、今回、妊娠38週4日目に突然の左腰痛が生じ、USで左腎に径8cm大の腫瘤が認められ、AMLの破裂が疑われた。母体の循環動態は安定していたが、胎児心拍数図で遅発一過性徐脈や胎児遷延徐脈がみられ、緊急帝王切開が行われたところ、術中左後腹膜下に血腫様腫瘤が透見され、術後のCTで左腎AML破裂と診断された。直ちに選択的腎動脈塞栓術を行った結果、術中に左腎動脈上極からの腫瘍血管の分岐とAMLからの造影剤の血管外漏出が確認され、腫瘍血管を塞栓した。以後、母子ともに経過良好で、入院14日目に退院となった。尚、退院6ヵ月後のCTでは左腎AMLは径3cmに縮小していた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01269&link_issn=&doc_id=20100611420002&doc_link_id=1050282676670969088&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1050282676670969088&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

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

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

56歳男。患者は左側腹部痛を主訴とした。腹部CTでは左水腎と水尿管症、左尿管の下端には腫瘤性病変が認められた。一方、逆行性腎盂造影では左上部尿管に表面3cmにわたる狭窄がみられ、細胞診ではclass IIIbが確認された。以上より、本症例は原発性左尿管癌の疑いで左尿管全摘術が施行され、病理組織学的に消化管原発悪性腫瘍の腎盂、尿管の粘膜下層への転移が最も疑われた。そこで、直ちに原発巣の検索を行ったところ、大腸内視鏡でS状結腸にBorrmann 2型大腸癌が認められた。更に同部位の生検の結果、左腎盂・尿管の病変と酷似した中分化型腺癌であり、S状結腸癌の腎盂尿管転移と診断された。また、この他にCEA、CA19-9の上昇、便潜血検査陽性が認められた。以後、術前には認めていなかった骨、肝、肺、膵への転移も出現したため、患者は化学療法目的で転科となった。しかし、症状は急速に進行し、心タンポナーデが生じ、化学療法は断念となった。尚、検索した限り、転移性尿管腫瘍は我が国では本症例を含め99例の報告があるが、大腸からの転移は9例を認めるのみであった。

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

66歳女。発熱を主訴とした。17歳時に肺結核の既往があった。抗生剤点滴治療により発熱・全身症状は改善したが、CRPが4mg/dlで推移した。腹部単純レントゲン検査にて左腎に著明な石灰化を認め、腹部CTでは左漆喰腎の下極にほとんど造影されない7×4×4cm大の腫瘤を認めたため、腎細胞癌の疑いで根治的左腎摘除術を施行した。摘出された腎の下部外側に被膜を伴う黄色から灰白色の腫瘤を認め、腎上部にも石灰化を伴う乾酪壊死巣を認めた。病理組織診断は肉腫様変化を主体とした淡明細胞型腎細胞癌であり、結核性肉芽腫も認めたが抗酸菌染色およびPCR検査で結核菌を同定することはできなかった。術後はサイトカイン療法を行わず、9ヵ月間再発を認めていない。

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

36歳男。右陰嚢部痛および腫大を主訴とした。超音波検査で右精巣内部に線状の低エコー領域を伴う楕円形のモザイク様構造を認め、MRIでは同部にT1強調像でやや高信号・T2強調像で低信号を示す領域を認めた。腫瘍内出血や腫瘍内壊死も考慮されたため、インフォームドコンセントのもと右高位精巣摘除術を施行した。病理組織所見では、精巣上中極は区域性の出血壊死像を示し、周囲の精細管構造との境界は明瞭であった。あきらかな梗塞の原因は特定できず、特発性精巣区域性梗塞と診断した。

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01175&link_issn=&doc_id=20090323230455&doc_link_id=10.5980%2Fjpnjurol.100.242_1&url=https%3A%2F%2Fdoi.org%2F10.5980%2Fjpnjurol.100.242_1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

28歳男。息切れと全身倦怠感を自覚し、同時期より黒色便も出現した。近医にて貧血を認め、上部消化管内視鏡で十二指腸球部を大きく占拠する表面平滑な粘膜下腫瘍様病変を認めたが、活動性出血はなく、生検病理所見は慢性炎症性変化であった。腹部CTでは十二指腸に淡い造影効果を伴う径3cmの腫瘤を認め、超音波内視鏡では等～高エコーの内部均一な粘膜下腫瘍様で、Brunner腺過形成を最も考えたが、GISTなどの悪性腫瘍も否定できなかった。小腸造影では隆起性病変は有茎性で、十二指腸下行脚にあることが判明した。黒色便・貧血は持続し、下部消化管検索では異常がなく、出血シンチでは明らかな集積を認めなかったが、十二指腸腫瘤が出血源と考え、開腹術により腫瘤を切除した。病理組織学的所見で線維性間質を背景に、粘液産生性の円柱上皮細胞が構成する中小腺管の小葉形成性の増生を認め、Brunner腺過形成と診断した。術後経過良好で、7日目に軽快退院した。

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：金原出版(株)  

正常新生児として管理されていた男児で,生後5日に上肢に間代発作が出現した.生後6日目の自然睡眠時脳波は,優勢な基礎波に左右差は認めないが,時に左右差のある高振幅徐波(theta pointu alternant)を認めた.良性特発性新生児けいれん(BINC)と診断した.フェノバルビタール(PB)の開始により,その後は間代発作もなく,哺乳力,体重増加とも良好であったが,生後12日目には上肢にミオクローヌスが出現した.ミオクローヌスは睡眠時のみ出現し,覚醒と同時に消失した.ミオクローヌスに一致した突発性放射はみられなかった.良性新生児睡眠時ミオクローヌス(BNSM)と診断した.PBの継続により,生後2ヵ月でミオクローヌスは消失した.生後3ヵ月でPBを中止したが,その後,けいれんはなく,正常な発達を認めている

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Language：Japanese   Publisher：(一社)日本透析医学会  

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