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

我々が経験したロボット支援下前立腺全摘除術におけるインシデントを報告する.症例は70歳代男性.手術はda Vinci Xiで行われた.術中,1stポートのインストゥルメントを入れ替えた際に,モノポーラシザースよりチップカバーが外れ,紛失した.腹腔内や術野内外をX線透視も用いて探索するも見つからず,Computed tomographyを施行したところ,1stポート造設部の皮下に迷入していた.その後は手術を再開し,合併症なく終了.チップカバーは画像と同部位の皮下より摘出された.手術映像を見返したところ,チップカバーが適切に装着されておらず,インストゥルメント交換の際にトロッカーが皮下まで抜けていたことが判明した.本件のようなインシデントを予防するためには,チップカバーの適切な装着と,インストゥルメントの正しい手順での交換および交換時の確認が必要である.(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ▼腎実質内に感染性の膿瘍を形成した状態である.▼感染経路は尿路由来の上行性,ならびに血行性である.▼すみやかな抗菌化学療法が必要である.尿路上行性であればグラム陰性桿菌,血行性であればグラム陽性球菌を想定する.▼外科的ドレナージも常に考慮しておく.

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ▼尿路閉塞による水腎症に感染が加わり,腎盂・腎杯に膿が充満した状態である.▼感染経路は尿路由来の上行性,ならびに血行性である.▼グラム陰性桿菌を主たる標的とするすみやか,かつ強力な抗菌化学療法と尿路のドレナージが治療の基本となる.▼重症化し,容易に尿性敗血症に移行する.播種性血管内凝固症候群(DIC)や多臓器不全に至ることもあり,全身状態管理が重要となる.

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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  

TURBTは泌尿器科医にとって必須な手技であり,その良し悪しが患者の予後を規定するといっても過言ではない.加えて,TURBTは個体差によるバリエーションに富んでおり,初心者のみならず熟練者であってもその難しさを痛感する手術である.そのため,それぞれの症例に応じた戦略(根治的・姑息的・診断的切除の判断,切除の手順・方法等)をたてることが重要であり,加えて合併症対策をしっかりと行うこと,システム化された指導法を確立することが重要である.今回,初心に立ち返り当院における『合併症を回避するためのポイント』を整理した.術中合併症には穿孔や出血が挙げられる.高齢者,複数回のTUR歴やBCG治療歴などによる膀胱壁菲薄化が術中穿孔リスクとなる.出血は,術中の不十分な止血操作だけでなく,抗血小板薬・抗凝固薬の内服もリスクとなる.これらの薬剤継続による出血のみならず,休薬に伴う血栓症リスクを術前に評価することも重要である.術後合併症には前立腺肥大症などによる尿道カテーテル抜去後尿閉による穿孔がある.これらの合併症対策として,1.術前に画像検査で筋層浸潤の有無を判断し,症例に応じた戦略作成をたてること,2.抗血小板・抗凝固薬の継続,中止の取り扱いを検討すること,3.システム化された指導を行うこと,が重要である.これらのポイントについて,当科で実践している手技,術前戦略が功を奏した症例などを提示しながら解説する.(著者抄録)

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BACKGROUND: Neutrophils play a major role in ischemia/reperfusion injury (IRI) in renal transplantation and acute kidney injury. However, it has been difficult to observe changes in neutrophil dynamics over time in living mice kidney. We investigate neutrophil dynamics in IRI in living mice using novel in vivo multiphoton microscope imaging techniques and characterize the renoprotective effects of a selective phosphodiesterase 5 inhibitor, tadalafil. METHODS: Wild-type and endothelial nitric oxide synthase knockout mice, a model of endothelial dysfunction, were used to establish in vivo real-time imaging in living mouse kidneys. Neutrophils were labeled green with Ly-6G monoclonal antibody, and plasma flow was labeled red with BSA. Tadalafil was administered orally 1 h before surgery. Both kidney pedicles were reperfused after 37°C warm ischemia for 45 min. RESULTS: Our novel approach revealed that neutrophils were trapped in glomerulus within a few minutes after reperfusion. They gradually increased over time and infiltrated neutrophils were observed in the tubular lumen and peritubular capillary. The neutrophils were clearly visualized rolling on peritubular capillary plexus at 3 μm/min. The administration of tadalafil significantly reduced neutrophil influx into the glomerulus in both wild-type and endothelial nitric oxide synthase knockout mice. Reduced neutrophil infiltration in tadalafil groups, which was confirmed by flow cytometry, resulted in histopathologically decreased tubular injury. The expression of vascular cell adhesion molecule 1 and kidney injury molecule 1 was partially prevented by tadalafil. CONCLUSIONS: Use of a novel technique contributed to elucidation of neutrophil dynamics after reperfusion. Tadalafil has a potential for inhibiting neutrophil infiltration in renal IRI.

DOI： 10.1097/TP.0000000000003803

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Silver nitrate has been used for centuries for the treatment of a variety of diseases and in the prevention of infection. Silver nitrate exerts astringent, cauterizing and corrosive effects, as well as antimicrobial activities. Silver nitrate injection therapy has a long history of use in urology. It is reportedly effective for hemorrhagic cystitis, interstitial cystitis, renal hematuria and chyluria. The present review article summarizes the medical applications of silver nitrate in urology. The published studies available on the medical uses of silver nitrate are essentially older and retrospective, involving smaller numbers of patients. In the absence of comparative studies with other treatments, it is thus impossible to determine the relative benefits of silver nitrate. However, the outcomes of silver nitrate therapy have been fairly well established. Silver nitrate therapy may prove to be a treatment option for patients who are poor candidates for invasive treatment. Further studies on the uses of silver nitrate however, are required, and improvements also need to be made in the injection technique to reduce the rate of complications.

DOI： 10.3892/WASJ.2022.141

Scopus

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

OBJECTIVES: To examine anti-adhesion and anti-biofilm effects of a diamond-like carbon coating deposited via a novel technique on the inner surface of a thin silicon tube. METHODS: Diamond-like carbon coatings were deposited into the lumen of a silicon tube with inner diameters of 2 mm. The surface of the diamond-like carbon was evaluated using physicochemical methods. We used three clinical isolates including green fluorescent protein-expressing Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus. We employed a continuous flow system for evaluation of both bacterial adhesion and biofilm formation. Bacterial adhesion assays consisted of counting the number of colony-forming units and visualization of adhered bacterial cells by scanning electron microscope to evaluate the diamond-like carbon-coated/uncoated samples. The biofilm structure was analyzed by confocal laser scanning microscopy on days 3, 5, 7 and 14 for green fluorescent protein-expressing Pseudomonas aeruginosa. RESULTS: The smooth and carbon-rich structure of the intraluminal diamond-like carbon film remained unchanged after the experiments. The numbers of colony-forming units suggested lower adherence of green fluorescent protein-expressing Pseudomonas aeruginosa and Escherichia coli in the diamond-like carbon-coated samples compared with the uncoated samples. The scanning electron microscope images showed adhered green fluorescent protein-expressing Pseudomonas aeruginosa cells without formation of microcolonies on the diamond-like carbon-coated samples. Finally, biofilm formation on the diamond-like carbon-coated samples was lower until at least day 14 compared with the uncoated samples. CONCLUSIONS: Intraluminal diamond-like carbon coating on a silicone tube has anti-adhesion and anti-biofilm effects. This technology can be applied to urinary catheters made from various materials.

DOI： 10.1111/iju.14675

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/iju.14675

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

The Committee for the Development of Guidelines for Infection Control in the Urological Field, including Urinary Tract Management of the Japanese Urological Association, together with its systematic review team and external reviewers, have prepared a set of practice guidelines, an abridged version of which is published herein. These guidelines cover the following topics: (i) foundations of infection control, standard precautions, route-specific precautions, and occupational infection control (including vaccines); (ii) the relationship between urologists and infection control; (iii) infection control in urological wards and outpatient clinics; (iv) response to hepatitis B virus reactivation; (v) infection control in urological procedures and examinations; (vi) prevention of infections occurring in conjunction with medical procedures and examinations; (vii) responses to urinary tract tuberculosis and bacillus Calmette-Guérin; (viii) aseptic handling, cleaning, disinfection, and sterilization of urinary tract endoscopes (principles of endoscope manipulation, endoscope lumen cleaning, and disinfection); (ix) infection control in the operating room (principles of hand washing, preoperative rubbing methods, etc.); (x) prevention of needlestick and blood/bodily fluid exposure and response to accidental exposure; (xi) urinary catheter-associated urinary tract infection and purple urinary bag syndrome; and (xii) urinary catheter-associated urinary tract infections in conjunction with home care. In addressing these topics, the relevant medical literature was searched to the extent possible, and content was prepared for the purpose of providing useful information for clinical practice.

DOI： 10.1111/iju.14684

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

DOI： 10.1111/iju.14679

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

OBJECTIVES: To prospectively assess the efficacy and safety of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis. METHODS: In this single-arm, open-label, phase II clinical trial, participants used vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus for 1 year either every 2 days or three times per week. The primary end-point was the response rate, as assessed by the number of episodes of recurrent cystitis during the year of administration. The secondary end-points were the response rate, as assessed by episodes of recurrent cystitis during the 1 year after completion of the administration period; the total number of episodes of recurrent cystitis before, during and after administration; adverse events; and changes in urine bacteria and the vaginal microbiome. RESULTS: A total of 28 women were enrolled, and 21 completed the study. A total of 18 patients achieved an effective response (86%) during administration. The suppressive effects of Lactobacillus vaginal suppositories on episodes of cystitis continued up to 1 year after the last suppository was administered. There was a significant reduction in the mean number of episodes of cystitis, both during and after administration of Lactobacillus vaginal suppositories. No treatment-related adverse events were observed. Amplicon sequencing analysis of the vaginal microbiome showed that Lactobacillus species colonized the vagina during the periods when episodes of cystitis were absent. CONCLUSIONS: Vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus effectively prevent episodes of recurrent cystitis, both during administration and for at least 1 year after administration.

DOI： 10.1111/iju.14636

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PURPOSE: This study aimed to clarify the efficacy and toxicity of first-line combination treatment with paclitaxel, cisplatin, and gemcitabine (PCG) for advanced/metastatic urothelial carcinoma (UC) in cisplatin-unfit patients compared with cisplatin-fit patients. METHODS: We conducted a retrospective study of patients who received first-line PCG. Using international consensus criteria, patients were classified into cisplatin-fit and -unfit groups. Cisplatin-unfit patients received PCG with adjustment of the cisplatin dose after assessing 24-hour urinary creatinine clearance, without modifying the administration interval. RESULTS: From 2008 to 2017, 50 patients received first-line PCG, of whom 30 and 20 were classified into the cisplatin-fit and -unfit groups. After a median follow-up of 15.0 months, the median overall survival (OS) and progression-free survival (PFS) were 15.0 and 9.8 months in all patients, 15.0 and 10.0 months in the cisplatin-fit group, and 13.2 and 9.3 months in the cisplatin-unfit group, respectively. There was no significant difference in OS (hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.69-2.54) or PFS (HR: 1.38, 95% CI: 0.74-2.55) between the groups. The overall response rate and complete response rate were 58% (95% CI: 43.2-71.8) and 32% (95% CI: 19.5-46.7) in all patients, and 55% (95% CI: 31.5-76.9) and 35% (95% CI: 15.4-59.2) in the cisplatin-unfit group, respectively. The common grade 3 of 4 adverse events experienced were neutropenia (78%), followed by thrombocytopenia (56%), anemia (46%), and febrile neutropenia (16%). The 24-hour urinary creatinine clearance did not differ significantly between the groups after one, two, or three courses of PCG. CONCLUSIONS: We found no significant difference regarding OS and PFS between the cisplatin-fit patients with a full dose of cisplatin and -unfit patients with cisplatin-dose-adjusted chemotherapy. In select cisplatin-unfit patients, PCG with dose adjustment of cisplatin may be useful for treating advanced/metastatic UC without any significant adverse events or impaired renal function compared with cisplatin-fit patients with a full dose of cisplatin.

DOI： 10.1016/j.urolonc.2021.02.029

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

DOI： 10.1016/j.dmpk.2021.100407

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OBJECTIVES: To compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM). METHODS: MDs were defined according to Japanese guideline criteria: (a) age >70-years, (b) blood pressure ≤130/80 mmHg on hypertension medicine, (c) body mass index >25 to ≤32 kg/m2 , (d) 24-h creatinine clearance ≥70 to <80 ml/min/1.73 m2 , and (e) hemoglobin A1c > 6.2 or ≤6.5 with oral diabetic medicine. Fifty-three of 114 donors were MDs. We compared donor kidney functions until 60 months postoperatively. RESULTS: No kidney function parameters were different between SDs and MDs. When comparing SD and MD + DM, MD + DM had a lower postoperative eGFR (48 vs. 41 (1 (month), p = .02), 49 vs. 40 (12, p < .01), 48 vs. 42 (24, p = .04), 47 vs. 38 (36, p = .01)) and the percentage of residual eGFR (SD vs. MD + DM: 63 vs. 57 (1 (month), p < .01), 63 vs. 57 (2, p < .01), 64 vs. 56 (12, p < .01), 63 vs. 57 (24, p < .01), 63 vs. 52 (36, p = .02)). However, when MD with a single risk factor of DM was compared to SD, the difference disappeared. Nine out of 12 (75%) MD + DM had ≥2 risk factors. CONCLUSIONS: Although long-term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.

DOI： 10.1002/iid3.470

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BACKGROUND: The aim of this study is to compare the perioperative outcomes and learning curves between intracorporeal and extracorporeal urinary diversion at our medium-sized institution. METHODS: Between January 2018 and September 2020, a single surgeon at our institution performed 46 consecutive robot-assisted radical cystectomies with ileal conduit. We compared the perioperative outcomes between patients who underwent intracorporeal versus extracorporeal urinary diversion. We also investigated learning curves for the first and last 10 patients in each group. RESULTS: The extracorporeal group had shorter overall operative time (P = 0.003) and urinary diversion time (P < 0.0001) than the intracorporeal group. The intracorporeal group had shorter length of hospital stay (P = 0.02). There was no difference in complication and readmission rates. The extracorporeal group demonstrated no difference between the first and last 10 patients for overall operative time or time for cystectomy, lymph node dissection, or urinary diversion. However, the intracorporeal group had shorter urinary diversion time for the last 10 patients compared with the first 10 patients. The first 10 patients in the extracorporeal group had shorter overall operative time than the first 10 in the intracorporeal group, but there was no difference for the last 10 patients. CONCLUSIONS: Intracorporeal urinary diversion requires longer overall operative time than extracorporeal diversion for the first 10 patients, due to longer urinary diversion time. However, there is no difference in overall operative time for the last 10 patients. The benefit of intracorporeal over extracorporeal urinary diversion was not confirmed at our medium-sized institution.

DOI： 10.1007/s10147-021-01957-1

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INTRODUCTION: The aim of this study was to monitor the development of drug-resistant bacteria isolated from acute uncomplicated cystitis (AUC) and to evaluate methodology of the survey conducted by collecting only clinical data. METHODS: We enrolled female patients at least 16 years of age diagnosed with AUC in 2018. Patient information including age, menopausal status, and results of bacteriological examination were collected and analyzed regardless of bacterial identification, antimicrobial susceptibility testing or extended-spectrum β-lactamase (ESBL) detection method. RESULTS: A total of 847 eligible cases were collected. Escherichia coli (E. coli) was the most frequently isolated bacterial species at about 70%, with proportions of fluoroquinolone-resistant E. coli (QREC) and ESBL-producing E. coli isolates at 15.6% and 9.5% of all E. coli isolates, respectively. The proportion of Staphylococcus saprophyticus (S. saprophyticus) was significantly higher in premenopausal women. Regarding the drug susceptibility of E. coli, isolates from Eastern Japan had significantly higher susceptibility to cefazolin, cefotiam and cefpodoxime and lower susceptibility to levofloxacin in postmenopausal women. ESBL-producing E. coli isolates had a high susceptibility to tazobactam-piperacillin, cefmetazole, carbapenems, aminoglycosides, and fosfomycin. In S. saprophyticus, the susceptibility to β-lactams including carbapenems was 40-60%. CONCLUSIONS: The proportions of QREC and ESBL-producing E. coli were increasing trends and lower susceptibility to LVFX in postmenopausal women was observed. Such surveillance, consisting of the collecting only clinical data, could be conducted easily and inexpensively. It is expected to be continuously performed as an alternative survey to conventional one collecting bacterial strains.

DOI： 10.1016/j.jiac.2021.03.012

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CASE PRESENTATION: A 49-year-old Asian male, who had undergone hemodialysis for >16 years, complained of a fever, dysgeusia and dysosmia, and was diagnosed with COVID-19 pneumonia based on severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (SARS-CoV-2 PCR) and computed tomography (CT). Treatment was started with oral favipiravir and ciclesonide inhalation. On the 10th day of treatment, the patient had a persistent high fever and a chest CT showed exacerbation of pneumonia, so dexamethasone was intravenously started. He was discharged after confirming two consecutive negative SARS-CoV-2 PCR tests. Three months after COVID-19 treatment, a SARS-CoV-2 PCR test was negative and he underwent a deceased donor kidney transplantation. Basiliximab induction with triple drug immunosuppression consisting of extended-release tacrolimus, mycophenolate mofetil and prednisolone, which is our regular immunosuppression protocol, was used. He was discharged on postoperative day 18 without the need for postoperative hemodialysis or any complications. The serum creatinine level was 1.72 mg/dL 95 days postoperatively and he had a favorable clinical course that was similar to deceased donor kidney recipients without a history of SARS-CoV-2 infection. CONCLUSION: We report the first case of a kidney transplantation after COVID-19 treatment in Japan and the fourth case globally. We would like to provide information about our successful case due to the anticipated increase in similar candidates in the near future.

DOI： 10.1016/j.jiac.2021.03.018

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We report a 62-year-old male with metastatic fumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC) without fumarate hydratase (FH) mutation (FH-deficient-like RCC). The International Metastatic RCC Database Consortium risk score was intermediate, and immunotherapy with nivolumab and ipilimumab (Ipi/ Nivo) was initiated. Four cycles of Ipi/Nivo and 5 cycles of nivolumab resulted in a complete response of the metastases. Hypophysitis occurred as an immune-related adverse event after four cycles of Ipi/Nivo. The prognosis of patients with FH-deficient RCC is generally poor. Few reports of FH-deficient RCC successfully treated with Ipi/Nivo have been published. Ipi/Nivo can be effective for treating FH-deficient RCC.

DOI： 10.18926/AMO/62237

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BACKGROUND: We investigated the association between ABO-incompatible (ABO-I) kidney transplantation and early graft function. METHODS: We retrospectively analyzed 95 patients who underwent living donor kidney transplantation between May 2009 and July 2019. It included 61 ABO-compatible (ABO-C) and 34 ABO-I transplantations. We extracted data on immunologic profile, sex, age, cold ischemic time, type of immunosuppression, and graft function. Two definitions were used for slow graft function (SGF) as follows: postoperative day (POD) 3 serum creatinine level >3 mg/dL and estimated glomerular filtration rate (eGFR) <20 mL/min/1.73 m2. Logistic regression analysis was performed to analyze the effect of ABO-I on the incidence of SGF. RESULTS: The characteristics between the ABO-C and ABO-I were not different. ABO-I received rituximab and plasma exchange. Patients also received tacrolimus and mycophenolate mofetil for 2 weeks and prednisolone for 1 week before transplantation as preconditioning. Of the 95 study patients, 19 (20%) and 21 (22%) were identified with SGF according to POD 3 serum creatinine level or eGFR, respectively. Multivariable analysis revealed that ABO-I significantly reduced the incidence of SGF (odds ratio, 0.15; 95% confidence interval, 0.03-0.7; P = .02), and cold ischemic time >150 min increased the incidence of SGF (odds ratio, 6.5; 95% confidence interval, 1.7-25; P = .006). Similar results were identified in POD 3 eGFR. Inferior graft function in patients with SGF was identified up to 6 months after transplantation. CONCLUSION: ABO-I reduces the incidence of SGF, which is associated with an inferior graft function up to 6 months.

DOI： 10.1016/j.transproceed.2021.03.043

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PURPOSE: To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate volume (≤30 mL). MATERIALS AND METHODS: We retrospectively evaluated 1,135 patients who underwent HoLEP at two institutions between July 2007 and March 2020. Patients who were not evaluated for the International Prostate Symptom Score (IPSS) before or after HoLEP were excluded. We divided patients into two groups according to estimated prostate volume (ePV): ≤30 (n=198) and >30 mL (n=539). The patient characteristics, IPSS, peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), and other data were compared before and after surgery in each group and between the two groups. Multivariate analysis was performed to identify the factors associated with the efficacy of HoLEP in the group with ePV ≤30 mL. RESULTS: A total of 737 patients were included in this retrospective study. ePV (23.4 mL vs. 50 mL; p<0.001) and PVR differed significantly between the two groups. The IPSS, IPSS-quality of life, PVR, and Qmax significantly improved after HoLEP in both groups. Improvements in the IPSS, IPSS-quality of life, Qmax, and PVR were greater in the >30 mL group (p<0.001), whereas operation time and morcellation time were significantly shorter in the ≤30 mL group. In the multivariate analysis, age <70 years was independently associated with improvement by HoLEP. CONCLUSIONS: HoLEP is an effective treatment for patients with a small prostate, even though the extent of improvement after HoLEP was greater in those with a larger prostate.

DOI： 10.4111/icu.20200450

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OBJECTIVE: To evaluate the efficacy and safety of intravesical KRP-116D, 50% dimethyl sulfoxide solution compared with placebo, in interstitial cystitis/bladder pain syndrome patients. METHODS: Japanese interstitial cystitis/bladder pain syndrome patients with an O'Leary-Sant Interstitial Cystitis Symptom Index score of ≥9, who exhibited the bladder-centric phenotype of interstitial cystitis/bladder pain syndrome diagnosed by cystoscopy and bladder-derived pain, were enrolled. Patients were allocated to receive either KRP-116D (n = 49) or placebo (n = 47). The study drug was intravesically administered every 2 weeks for 12 weeks. RESULTS: For the primary endpoint, the change in the mean O'Leary-Sant Interstitial Cystitis Symptom Index score from baseline to week 12 was -5.2 in the KRP-116D group and -3.4 in the placebo group. The estimated difference between the KRP-116D and placebo groups was -1.8 (95% confidence interval -3.3, -0.3; P = 0.0188). Statistically significant improvements for KRP-116D were also observed in the secondary endpoints including O'Leary-Sant Interstitial Cystitis Problem Index score, micturition episodes/24 h, voided volume/micturition, maximum voided volume/micturition, numerical rating scale score for bladder pain, and global response assessment score. The adverse drug reactions were mild to moderate, and manageable. CONCLUSIONS: This first randomized, double-blind, placebo-controlled trial shows that KRP-116D improves symptoms, voiding parameters, and global response assessment, compared with placebo, and has a well-tolerated safety profile in interstitial cystitis/bladder pain syndrome patients with the bladder-centric phenotype.

DOI： 10.1111/iju.14505

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

BACKGROUND: Neutrophils play a major role in ischemia/reperfusion injury (IRI) in renal transplantation and acute kidney injury. However, it has been difficult to observe changes in neutrophil dynamics over time in living mice kidney. We investigate neutrophil dynamics in IRI in living mice using novel in vivo multiphoton microscope imaging techniques and characterize the renoprotective effects of a selective phosphodiesterase 5 inhibitor, tadalafil. METHODS: Wild-type and endothelial nitric oxide synthase knockout mice, a model of endothelial dysfunction, were used to establish in vivo real-time imaging in living mouse kidneys. Neutrophils were labeled green with Ly-6G monoclonal antibody, and plasma flow was labeled red with BSA. Tadalafil was administered orally 1 h before surgery. Both kidney pedicles were reperfused after 37°C warm ischemia for 45 min. RESULTS: Our novel approach revealed that neutrophils were trapped in glomerulus within a few minutes after reperfusion. They gradually increased over time and infiltrated neutrophils were observed in the tubular lumen and peritubular capillary. The neutrophils were clearly visualized rolling on peritubular capillary plexus at 3 μm/min. The administration of tadalafil significantly reduced neutrophil influx into the glomerulus in both wild-type and endothelial nitric oxide synthase knockout mice. Reduced neutrophil infiltration in tadalafil groups, which was confirmed by flow cytometry, resulted in histopathologically decreased tubular injury. The expression of vascular cell adhesion molecule 1 and kidney injury molecule 1 was partially prevented by tadalafil. CONCLUSIONS: Use of a novel technique contributed to elucidation of neutrophil dynamics after reperfusion. Tadalafil has a potential for inhibiting neutrophil infiltration in renal IRI.

DOI： 10.1097/tp.0000000000003803

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BACKGROUND: The advantages of photodynamic diagnostic technology using 5-aminolevulinic acid (ALA-PDD) have been established. The aim of this prospective cohort study was to evaluate the usefulness of ALA-PDD to diagnose upper tract urothelial carcinoma (UT-UC) using the Olympus VISERA ELITE video system. METHODS: We carried out a prospective, interventional, non-randomized, non-contrast and open label cohort pilot study that involved patients who underwent ureterorenoscopy (URS) to detect UT-UC. 5-aminolevulinic acid hydrochloride was orally administered before URS. The observational results and pathological diagnosis with ALA-PDD and traditional white light methods were compared, and the proportion of positive subjects and specimens were calculated. RESULTS: A total of 20 patients were enrolled and one patient who had multiple bladder tumors did not undergo URS. Fifteen of 19 patients were pathologically diagnosed with UT-UC and of these 11 (73.3%) were ALA-PDD positive. Fourteen of 19 patients were ALA-PDD positive and of these 11 were pathologically diagnosed with UC. For the 92 biopsy specimens that were malignant or benign, the sensitivity for both traditional white light observation and ALA-PDD was the same at 62.5%, whereas the specificities were 73.1% and 67.3%, respectively. Of the 38 specimens that were randomly biopsied without any abnormality under examination by both white light and ALA-PDD, 11 specimens (28.9%) from 5 patients were diagnosed with high grade UC. In contrast, four specimens from 4 patients, which were negative in traditional white light observation but positive in ALA-PDD, were diagnosed with carcinoma in situ (CIS). CONCLUSIONS: Our results suggest that ALA-PDD using VISERA ELITE is not sufficiently applicable for UT-UC. Nevertheless, it might be better particularly for CIS than white light and superior results would be obtained using VISERA ELITE II video system. TRIAL REGISTRATION: The present clinical study was approved by the Okayama University Institutional Review Board prior to study initiation (Application no.: RIN 1803-002) and was registered with the UMIN Clinical Trials Registry (UMIN-CTR), Japan (Accession no.: UMIN000031205).

DOI： 10.1186/s12894-021-00819-2

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BACKGROUND: Long-term survival outcomes of patients who undergo endoscopic management of non-invasive upper tract urothelial carcinoma remain uncertain. The longest mean follow-up period in previous studies was 6.1 years. This study reports the long-term outcomes of patients with upper tract urothelial carcinoma who underwent ureteroscopic ablation at a single institution over a 28-year period. METHODS: We identified all patients who underwent ureteroscopic management of upper tract urothelial carcinoma as their primary treatment at our institution between January 1991 and April 2011. Survival outcomes, including overall survival, cancer-specific survival, upper-tract recurrence-free survival and renal unit survival, were estimated using Kaplan-Meier methodology. RESULTS: A total of 15 patients underwent endoscopic management, with a mean age at diagnosis of 66 years. All patients underwent ureteroscopy, and biopsy-confirmed pathology was obtained. Median (range; mean) follow-up was 11.7 (2.3-20.9, 11.9) years. Upper tract recurrence occurred in 87% (n = 13) of patients. Twenty percent (n = 3) of patients proceeded to nephroureterectomy. The estimated cancer-specific survival rate was 93% at 5, 10, 15 and 20 years. Estimated overall survival rates were 86, 80, 54 and 20% at 5, 10, 15 and 20 years. Only one patient experienced cancer-specific mortality. The estimated mean and median overall survival times were 14.5 and 16.6 years, respectively. The estimated mean cancer-specific survival time was not reached. CONCLUSIONS: Although upper tract recurrence is common, endoscopic management of non-invasive upper tract urothelial carcinoma provides a 90% cancer-specific survival rate at 20 years in selected patients.

DOI： 10.1093/jjco/hyaa132

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PURPOSE: The aim of this study was to compare the prognostic value of pretreatment inflammation-based scoring systems in terms of overall survival (OS) and progression-free survival (PFS) in patients with germ cell tumors (GCTs) receiving bleomycin, etoposide, and cisplatin (BEP) chemotherapy. MATERIALS AND METHODS: We evaluated 63 patients with GCTs retrospectively. The Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio, prognostic index, platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index, and albumin-to-globulin ratio (AGR) were measured in all patients before chemotherapy. To assess the predictive ability of each scoring system, areas under the receiver operating characteristic curve were calculated, and multivariate analysis was performed to identify associations between the predictive scores and OS. RESULTS: Of all the inflammation-based scoring systems, the GPS had the greatest area under the curve (0.847) for predicting OS, followed by the PNI (0.829) and AGR (0.810). Kaplan-Meier analyses revealed that the GPS, PNI, and AGR were significantly associated with OS, whereas the GPS, PLR, and PNI were significantly associated with PFS. In the multivariate analysis, the GPS was an independent predictor of OS and PFS. CONCLUSIONS: We demonstrated that the GPS was the most valuable biomarker of OS and PFS in patients with GCTs.

DOI： 10.4111/icu.20200103

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Publishing type：Research paper (scientific journal)   Publisher：Korean Society for Sexual Medicine and Andrology  

DOI： 10.5534/wjmh.200036

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Other Link： https://wjmh.org/DOIx.php?id=10.5534/wjmh.200036

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The aim of this report is to introduce an on-going, multicenter, randomized controlled trial to evaluate whether tailored antimicrobial prophylaxis guided by rectal culture screening prevents acute bacterial prostatitis following transrectal prostate biopsy (TRPB). Patients will be randomized into an intervention or non-intervention group; tazobactam-piperacillin or levofloxacin will be prophylactically administered according to the results of rectal culture prior to TRPB in the intervention group whereas levofloxacin will be routinely given in the non-intervention group. The primary endpoint is the occurrence rate of acute bacterial prostatitis after TRPB. Recruitment begins in April, 2021 and the target total sample size is 5,100 participants.

DOI： 10.18926/AMO/62782

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Phenol is a chemical compound that was first used medically as an antiseptic. At low concentrations, phenol exerts local anesthetic effects achieved through denervation; at high concentrations, it exerts a potent protein-denaturing effect that induces apoptosis. Phenol injection therapy has a long history of use in urology. It is reportedly effective for hemorrhagic cystitis, benign prostate hyperplasia, overactive bladder, hydrocele, bladder tumors, interstitial cystitis and other benign urologic diseases, and it is also used as a tool to decrease bleeding during prostate surgery. The present review article summarizes the medical applications of phenol in urological field. The articles available on the medical uses of phenol are primarily older and retrospective, involving small numbers of patients. In the absence of comparative studies with other treatments, it is impossible to determine the relative benefit of phenol. However, the treatment outcomes of phenol injection are fairly well-established. Phenol therapy may be an option for patients who are poor candidates for invasive treatment. Further studies are required, however, as are improvements in the injection technique to reduce the rate of complications.

DOI： 10.3892/mi.2021.13

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OBJECTIVES: To analyze the effect and impact of low-dose rituximab induction therapy on cytomegalovirus infection in living-donor renal transplantation. METHODS: A total of 92 recipients undergoing living-donor renal transplantation at Okayama University Hospital from May 2009 to August 2018 were evaluated retrospectively. Indications for preoperative rituximab (200 mg/body) were the following: (i) ABO major mismatch; (ii) ABO minor mismatch; (iii) donor-specific anti-human leukocyte antigen antibody-positive; and (iv) focal segmental glomerulosclerosis. We excluded four recipients who were followed <3 months, five who received >200 mg/body rituximab and seven who received prophylactic therapy for cytomegalovirus. RESULTS: There were 59 patients in the rituximab group and 17 in the non-rituximab group. Groups differed significantly in age (median age 53 vs 37 years, respectively; P = 0.04), but not in sex (male 64% vs 65%, P = 1.00), focal segmental glomerulosclerosis (3% vs 0%, P = 1.00) or percentage of cytomegalovirus-seronegative recipients of renal allografts from cytomegalovirus-seropositive donors (12% vs 18%, P = 0.68). The estimated glomerular filtration rate did not differ significantly between groups until 24 months after transplantation. Cytomegalovirus clinical symptoms (10% vs 24%, P = 0.22), including fever ≥38°C (5% vs 12%, P = 0.31) and gastrointestinal symptoms (5% vs 12%, P = 0.31), and the 5-year survival rates of death-censored graft loss (90% vs 83%, P = 0.43) did not differ significantly between groups. CONCLUSIONS: Low-dose rituximab induction therapy is effective in immunological high-risk recipients without increasing cytomegalovirus infection in the absence of valganciclovir prophylaxis.

DOI： 10.1111/iju.14382

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We report a 47-year-old Japanese female with 10 previous treatments for multiple bilateral renal cell carcinoma (RCC) associated with von Hippel-Lindau disease. The 14-mm right lower pole renal tumor was in contact with the right ureter. Laparoscopic cryoablation was performed to protect the ureter wrapped with gauze. Computed tomography (CT) monitoring was used to confirm the precise ≥ 6 mm ice-ball margin. There was no local progression at 6-months post-surgery. The serum creatinine has been stable. This is apparently the first report of combined laparoscopic and CT monitoring of an ice-ball formation and its margin during cryoablation for RCC.

DOI： 10.18926/AMO/60806

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

REIC/Dkk-3 is a tumor suppressor, and its expression is significantly downregulated in a variety of human cancer types. A previous study performed yeast two-hybrid screening and identified the small glutamine-rich tetratricopeptide repeat-containing protein α (SGTA), known as a negative modulator of cytoplasmic androgen receptor (AR) signaling, which is a novel interacting partner of REIC/Dkk-3. The previous study also indicated that the REIC/Dkk-3 protein interferes with the dimerization of SGTA and then upregulates the AR transport and signaling in human prostate cancer PC3 cells. Since the transport of some steroid receptors to nucleus is conducted similarly by dynein motor-dependent way, the current study aimed to investigate the role of SGTA and REIC/Dkk-3 in the transport of other glucocorticoid receptors (GR). In vitro reporter assays for the cytoplasmic GR transport were performed in human prostate cancer PC3 cells and 293T cells. As for the SGTA protein, a suppressive effect on the GR transport to the nucleus was observed in the cells. As for the REIC/Dkk-3 protein, an inhibitory effect was observed for the GR transport in PC3 cells. Under the depleted condition of SGTA by short-hairpin (sh)RNA, the downregulation of GR transport by REIC/Dkk-3 was significantly enhanced compared with the non-depleted condition in PC3 cells, suggesting a compensatory role of REIC/Dkk-3 in the SGTA mediated inhibition of GR transport. The current study therefore demonstrated that SGTA inhibited the cytoplasmic transport of GR in 293T and PC3 cells, and REIC/Dkk-3 also inhibited the cytoplasmic transport of GR in PC3 cells. These results may be used to gain novel insight into the GR transport and signaling in normal and cancer cells.

DOI： 10.3892/etm.2020.8819

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OBJECTIVES: Urinary incontinence is a major concern after radical prostatectomy because it can decrease quality of life. The aim of the present study was to explore the effect of preoperative skeletal muscle on urinary quality of life after robot-assisted radical prostatectomy. METHODS: A total of 762 patients underwent robot-assisted radical prostatectomy. Longitudinal health-related quality of life was evaluated using the Expanded Prostate Cancer Index Composite instrument. The skeletal muscle area at the level of the third lumbar vertebra was assessed preoperatively by computed tomography and was standardized to height to obtain the skeletal muscle index. Reduced skeletal muscle size (RSMS) was defined as a skeletal muscle index ≤ 53 or ≤ 43 cm2 /m2 in patients with a body mass index (BMI) ≥25 or < 25, respectively. RESULTS: A total of 301 patients were included in this study, of whom 91 were classified as having RSMS (30.2%). Non-RSMS patients exhibited better urinary function at 12 months (P = .012) and better urinary continence recovery at 2 weeks and 12 months (P = .033 and P = .014, respectively) after prostatectomy compared with RSMS patients. Univariate and multivariate analyses identified preoperative RSMS as a significant and independent predictor of urinary incontinence (odds ratio = 1.77, P = .028). CONCLUSIONS: Patients with RSMS had a lower urinary quality of life compared with non-RSMS patients after robot-assisted radical prostatectomy, and RSMS, independent of age or BMI, was predictive of postoperative urinary incontinence.

DOI： 10.1111/luts.12312

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BACKGROUND: Although detection of microscopic hematuria is a well-known diagnostic method for urolithiasis, its ability to predict urolithiasis treatment outcomes in adults is unknown. OBJECTIVE: To evaluate the role of microscopic hematuria in conservative treatment of ureteral calculus. DESIGN, SETTING, AND PARTICIPANTS: This cohort study involved 482 patients who were diagnosed with a single uncomplicated ureteral calculus (≤10 mm) using computed tomography and underwent conservative therapy at two Japanese community hospitals between 2013 and 2018. Patients were divided into three groups according to the severity of microscopic hematuria (no, ≤4; mild to moderate, 5-99; and severe, ≥100 red blood cells per high-power field) and as determined during the first emergency department or urologic outpatient clinic visit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A multivariate logistic regression analysis was performed to estimate the odds ratio for successful conservative therapy at 28 d after the diagnosis. Statistical significance was set at p < 0.05. RESULTS AND LIMITATIONS: Of the 482 patients, 81 (16.8%), 209 (43.4%), and 192 (39.8%) had no, mild to moderate, and severe microscopic hematuria, respectively. After adjustments for six relevant confounders, severe microscopic hematuria showed a significant association with successful conservative therapy at 28 d (adjusted odds ratio, 1.91; 95% confidence interval, 1.02-3.57; p = 0.043), whereas mild to moderate microscopic hematuria did not (adjusted odds ratio, 1.05; 95% confidence interval, 0.57-1.93; p = 0.872) when compared with no microscopic hematuria. CONCLUSIONS: Severe microscopic hematuria was significantly associated with successful conservative therapy for single uncomplicated ureteral calculus. PATIENT SUMMARY: Microscopic hematuria might have predictive value for conservative treatment of a single uncomplicated ureteral calculus. Using the presence or absence of blood in urine and other predictive factors, clinicians may lead patients with a single uncomplicated ureteral calculus to successful conservative therapy.

DOI： 10.1016/j.euf.2020.04.004

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The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.

DOI： 10.1111/iju.14186

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The present study investigated the concordance between Gleason scores assigned to prostate biopsy specimens by outside pathologists and a urological pathology expert, and determined the risk of upgrading between opinion-matched Gleason grade group (GGG) 1 biopsy specimens and radical prostatectomy specimens. Between January 2012 and May 2018, 733 patients underwent robot-assisted radical prostatectomy. Patients whose original biopsy specimens from outside hospitals were reviewed by a urological pathology expert Okayama University Hospital were included. Patients who had received neoadjuvant hormonal therapy were excluded. Logistic regression analysis was used to identify predictors of upgrading among GGG 1 diagnoses. A total of 403 patients were included in the present study. Agreement in GGG between initial and second-opinion diagnoses was present in 256 cases (63.5%). Although opinion-matched cases improved concordance between biopsy and prostatectomy specimen GGG compared with single-opinion cases (initial, 35.2%; second-opinion, 36.5%; matched, 41.4%), 71% (56/79) of cases classified as GGG 1 were upgraded after prostatectomy. Multivariate analysis revealed that prostate-specific antigen density and Prostate Imaging Reporting and Data System version 2 score were significant predictors of upgrading (odds ratio, 1.10; P=0.01; and odds ratio, 1.88; P=0.03, respectively). In conclusion, the GGG concordance rate between needle-core biopsy and radical prostatectomy specimens was higher in opinion-matched cases; however, 71% of opinion-matched GGG1 cases were upgraded after robot-assisted radical prostatectomy. Urologists should propose treatment strategies or further biopsy rather than active surveillance for patients with GGG1 and a high PSAD and/or PI-RADS score.

DOI： 10.3892/mco.2020.1996

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BACKGROUND AND AIMS: Preemptive kidney transplantation (PEKT) is recognized as the best therapy to avoid dialysis. However, it is not clear whether PEKT recipients experience an improvement in quality of life (QoL) after kidney transplantation (KT) that exceeds that of non-PEKT recipients, since PEKT recipients have not experienced the heavy burden of dialysis. The aim of this study was to compare the changes in QoL for PEKT and non-PEKT recipients following transplantation. METHODS: Patients included in this study underwent living donor KT in our hospital. We excluded patients with incomplete SF-36 scores and with factors that could affect QoL, such as complications or rejection. QoL was assessed by the Short Form 36-Item Health Survey version 2.0 preoperatively and 3 and 12 months postoperatively. RESULTS: Eighty-eight patients underwent living donor KT in our hospital. Twelve PEKT and 20 non-PEKT recipients were enrolled in this retrospective study. In the non-PEKT group, both the physical and mental domain scores dramatically improved from baseline at 3 months, and remained at a similar level at 12 months. In contrast, in the PEKT group, only 1 domain of the physical and mental score improved at 3 months, and the social functioning score gradually improved at 12 months. Although the mental component score showed significant improvement in the non-PEKT group, it did not change in the PEKT group. CONCLUSIONS: The improvement of QoL after transplantation is more evident in the non-PEKT group. PEKT recipients have less mental satisfaction than non-PEKT recipients.

DOI： 10.1016/j.transproceed.2020.01.042

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We investigated the feasibility of robotic renal autotransplantation (RAT) in a porcine model to reduce invasiveness of RAT. Five pigs underwent robotic RAT using the da Vinci® robotic system. A robotic left nephrectomy was performed in all cases. Robotic RAT was performed on the left side in all but one case. Four ports were used. In 3 cases, the kidney was taken out through the GelPort® and irrigated on ice with Ringer's solution. In 2 cases, a complete intracorporeal robotic RAT was performed. An end-to-side anastomosis was performed between the renal vein and the external iliac vein and between the renal artery and the external iliac artery. Ureteroneocystostomy was also performed in 2 cases. All cases were performed robotically without open conversion. The median (IQR) console time was 3.1 (0.7) h, and the operative time was 3.8 (1.1) h. The estimated blood loss was 30 (0) ml. The warm ischemia time was 4.0 (0.2) min, and the cold ischemia time was 97 (17) min. Intracorporeal transarterial hypothermic renal perfusion was feasible in the 2 complete intracorporeal robotic RAT cases by using a perfusion catheter through a laparoscopic port. Robotic RAT has the potential to be a new minimally invasive substitute for conventional open surgery.

DOI： 10.18926/AMO/57953

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OBJECTIVES: Chlamydia trachomatis is one of the major pathogens causing acute epididymitis. Azithromycin (AZM) has a good efficacy against C. trachomatis; however, the ability of AZM to penetrate into human epididymal tissue has not yet been fully elucidated. Here, we examined the appropriate dosage of oral AZM for human epididymal tissue by site-specific pharmacokinetic/pharmacodynamic (PK/PD) analysis. METHODS: Patients with prostate cancer who underwent orchiectomy were included in this study. All patients received a 1-g dose of AZM before orchiectomy. Both epididymal tissue and blood samples were collected during surgery, and the drug concentrations were measured by high-performance liquid chromatography. All concentration-time data were analyzed with a three-compartment model with first-order absorption and elimination processes to simulate AZM concentrations in serum and epididymal tissue. RESULTS: A total of 10 patients were enrolled in the current study. For the observed values, the ratio of the epididymal concentration to the serum concentration was 5.13 ± 3.71 (mean ± standard deviation). For the simulated values, the maximum concentrations were 0.64 μg/mL at 2.42 h in serum and 1.96 μg/g at 4.10 h in epididymal tissue. The 24-h concentrations were 0.239 μg/mL in serum and 0.795 μg/g in epididymal tissue. CONCLUSIONS: The penetration of oral AZM into human epididymal tissue was examined to assess the potential application of AZM for the treatment of acute epididymitis. Based on the previous reports mentioning drug-susceptibility of C. trachomatis, multiple doses of oral AZM 1 g would be recommended for epididymitis based on the site-specific PK/PD.

DOI： 10.1016/j.jiac.2019.05.011

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OBJECTIVE: To compare the predictive value of pretreatment inflammation-based scoring systems in patients with germ cell tumors receiving first-line bleomycin-based chemotherapy. METHODS: Retrospectively, we evaluated 57 patients with germ cell tumors. Bleomycin pulmonary toxicity was defined as the presence of asymptomatic decline in pulmonary function tests, pulmonary symptoms or interstitial pneumonia on computed tomography in the absence of infection. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, albumin-to-globulin ratio, Prognostic Nutritional Index, Glasgow Prognostic Score and C-reactive protein were measured in all patients. To assess the predictive ability of each scoring system, the area under the receiver operating characteristic curve was calculated, and multivariate analysis was carried out to identify the predictive scores associated with bleomycin pulmonary toxicity. RESULTS: Of the 57 patients, 15 patients developed bleomycin pulmonary toxicity. The neutrophil-to-lymphocyte ratio had the highest area under the curve value (0.763) of all inflammation-based scoring systems, followed by the Prognostic Nutritional Index (0.749). In multivariate analysis, the neutrophil-to-lymphocyte ratio (odds ratio 11.5; P = 0.009) and Prognostic Nutritional Index (odds ratio 9.07; P = 0.013) were independently associated with development of bleomycin pulmonary toxicity. As these two independent markers were combined, the area under the curve achieved the highest value (0.822). CONCLUSIONS: The present study shows that the neutrophil-to-lymphocyte ratio and Prognostic Nutritional Index are independent risk factors for development of bleomycin pulmonary toxicity. The combination of the neutrophil-to-lymphocyte ratio and Prognostic Nutritional Index seems to have superior predictive value compared with other inflammation-based scoring systems.

DOI： 10.1111/iju.14017

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Nephron-sparing treatment should be offered whenever possible to avoid dialysis in allograph cases. Cryoablation is a new treatment option for treating small-sized renal cell cancer (RCCs). We report a case of RCC arising in a kidney allograft treated by cryoablation. To our knowledge, this is the first case in Asia of RCC in a renal allograft treated using cryoablation. Contrast-enhanced CT-guided percutaneous renal needle biopsy and cryoablation were used to identify the RCC, which could not be identified by other techniques. The postoperative course was uneventful. Contrast-enhanced CT also showed no recurrence or metastases at the 6-month follow-up.

DOI： 10.18926/AMO/56871

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Increasingly, studies have explored health-related quality-of-life (HRQOL) outcomes after robot-assisted radical prostatectomy (RARP). Nevertheless, no study has compared differences between anterior and posterior surgical approaches. The aim of this study is to assess differences of HRQOL following these two surgical approaches. From January 2012 to September 2017, 653 patients underwent RARP at our institution. We included patients who underwent operations by three experienced surgeons with interchangeability of role as console operator, and who could evaluate preoperatively the Expanded Prostate Cancer Index Composite (EPIC) score. Patients treated with neoadjuvant hormonal therapy were excluded. HRQOL was assessed using the EPIC score, and the questionnaire was administered at 6 timepoints: the baseline survey was conducted within 3 months before the surgery, and follow-up surveys were conducted at 2 weeks, 1, 3, 6, and 12 months after surgery. We defined the minimal clinically important difference (MCID) as half the standard deviation of the baseline score for each domain. A total of 201 patients were included in this retrospective study. Of these, 146 patients underwent RARP using an anterior surgical approach and 55 patients underwent a posterior approach. The clinical characteristics had no significant differences except for median prostate volume between the anterior and posterior groups (27 ml vs 29 ml, p = 0.049). There were no significant differences between the two groups in score decline beyond the MCID in any domain at any timepoint. Our study demonstrates no significant differences in HRQOL between anterior and posterior surgical approaches to RARP.

DOI： 10.1007/s11701-019-00975-6

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OBJECTIVE: Urinary incontinence (UI) is a major prostate cancer (PCa) treatment-related morbidity. It has been reported that post-prostatectomy UI is related to the width of the pelvic floor muscles (PFM) and the length of the urethra. However, the details of these anatomical parameters are unknown. The aim of this study was to investigate whether preoperative pelvic parameters or anatomical parameters of the urethra, as measured by magnetic resonance imaging (MRI), are correlated with UI. METHODS: Between 2010 and 2017, 571 patients with localized PCa underwent robot-assisted radical prostatectomy (RARP) at Okayama University Hospital. Patients treated by a single experienced surgeon were included in the study. Preoperative prostate volume, obturator internal muscle, anal sphincter muscle, levator ani muscle (LAM), urethra wall thickness (UWT), and membranous urethral length (MUL) were measured by MRI. Patients were divided into two groups depending on leakage status 1 year after RARP using Expanded Prostate Index Composite Item 1. RESULTS: Seventy patients were included in this retrospective study. Based on leakage status, 37 and 33 patients were allocated to the no-leakage and leakage groups, respectively. There were significant differences between the two groups in age (P = 0.03), MUL (P < 0.001), UWT (P = 0.03), and LAM (P = 0.001). Multivariate logistic regression analyses revealed that MUL and LAM predicted UI 1 year after RARP. CONCLUSIONS: Pelvic parameters measured by MRI before RARP may be useful in the prediction of UI. In particular, MUL and LAM can predict postoperative UI by strict definition.

DOI： 10.1111/luts.12245

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DOI： 10.1016/j.juro.2018.09.061

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OBJECTIVE: The aim of this study was to evaluate the efficacy of single-dose perioperative antimicrobial therapy as infection prophylaxis in recipients of living-donor renal transplants in the rituximab era. PATIENTS AND METHODS: Between 2009 and 2017, 84 recipients underwent living-donor renal transplantation (LDRT) at Okayama University Hospital; 3 with vascular/urinary complications requiring additional surgery were excluded from this analysis. Data including recipient characteristics, antimicrobial prophylaxis and administration of rituximab were retrospectively examined for an association with perioperative infections. Prophylactic antimicrobial agents, selected according to the Results of preoperative urine cultures, were administered just before incision. Perioperative infections, which consisted of surgical site infections, remote infections, and urinary tract infections, were defined as a positive culture indicating required administration of additional antimicrobial agents. RESULTS: Among the 81 recipients, prophylactic cefazolin, ampicillin/sulbactam, and others were administered to 66 (82%), 13 (16%), and 2 (3%) recipients, respectively. Twenty-one (26%) received single-dose antimicrobial prophylaxis, while 60 (74%) received multiple doses up to 7 days. Rituximab was used in 59 (72.8%) recipients. The incidence of urinary tract infection, surgical site infection and remote infection was 13 (16%), 1 (1%), and 0, respectively. Univariate analysis could not demonstrate any significant risk factors for postoperative urinary tract infections, including a single dose vs multiple doses of antimicrobial therapy (P = 0.069) and administration of rituximab (P = 0.717). CONCLUSIONS: Our data suggest that the use of single-dose perioperative antimicrobial therapy is acceptable for prophylaxis of infections in patients undergoing LDRT, even in the rituximab era.

DOI： 10.1016/j.jiac.2018.11.013

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ▼SSI予防抗菌薬はβ-lactamase阻害薬配合ペニシリン系または第一・二世代セファロスポリン系抗菌薬を基本とする.▼抗菌薬は手術開始30分前から手術開始直前までに投与する.▼尿路が開放される可能性のある手術で尿路感染症がある場合,術前に原因菌に感受性のある抗菌薬による治療を行う.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01561&link_issn=&doc_id=20190412170008&doc_link_id=10.11477%2Fmf.1413206518&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1413206518&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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BACKGROUND: Excessive visceral fat may decrease renal function because of metabolic derangements. The aim of this study was to evaluate the impact of abdominal fat distribution on renal function of recipients after kidney transplantation using the visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio. METHODS: Seventy-nine patients underwent living kidney transplantation from 2009 to 2017. Patients without a correct measurement of VAT and SAT, follow-up of < 6 months, or with kidney transplant rejection or a virus infection were excluded. VAT and SAT were calculated automatically by 3-D volume analyzer software in recipients prior to living kidney transplantation. Our primary aim was to identify abdominal fat distribution measured by CT associated with renal dysfunction (estimate glomerular filtration rate; eGFR < 45) at 6 month post renal transplantation in recipient. RESULTS: Fifty-eight living kidney recipients were included in this retrospective study: 30 for the high VAT/SAT ratio group; 28 for the VAT/SAT low group. Multiple logistic regression analysis showed the VAT/SAT ratio and pre-donor eGFR were associated with eGFR < 45 ml/min/1.73 m2. An increase in VAT/SAT ratio was associated independently with the incidence of decreased renal function. CONCLUSION: This finding indicates that adipose tissue distribution is an important predictor of the outcome of living kidney transplantation in recipients.

DOI： 10.1007/s10157-018-1643-6

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OBJECTIVE: To investigate the relationship between postoperative renal function and resected cortex margin volume calculated by a 3-dimensional reconstruction technique based on the resected specimen, and to determine predictors of renal function after robot-assisted partial nephrectomy. METHODS: A total of 114 patients underwent robot-assisted partial nephrectomy from 2014 to 2018. Patients without a 1 mm slice computed tomography or renal scintigraphy were excluded. We identified the margins of the tumor from each resected specimen with 2 mm margin being added as the ischemic margin. The volume of the renal cortex was calculated automatically using 3-dimensional volume analyzer software. The total margin volume was excluded from the ipsilateral cortex volume to calculate the cortex volume split. Predicted estimated glomerular filtration rate (eGFR) was calculated using the change in cortex volume and then compared with the actual eGFR. RESULTS: Eighty-two patients were included in this retrospective study. Sixty-six patients (80%) were cT1a. A strong correlation was observed between renal scintigraphy split and pre- and postoperative cortex volume split (Pearson correlation coefficient r = 0.9330 and 0.8742, respectively). The predicted eGFR correlated strongly with post 1, 3, 6, and 12 months eGFR (r = 0.8929, 0.9294, 0.9320, and 0.8952, respectively). Preoperative relative renal function and total cortex margin volume were independent risk factors for decreasing postoperative renal function. CONCLUSION: This precise volumetric assessment that includes the resected margin is an alternative to renal scintigraphy for predicting postoperative relative renal function. The healthy cortex margin volume calculated by the reconstruction technique is an independent risk factor of decreasing postoperative renal function.

DOI： 10.1016/j.urology.2018.12.020

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Objective: In several cancers, the loss of skeletal muscle is well associated with oncological outcome. However, its effect is unknown in testicular cancer. This study evaluated the prognostic impact of psoas major muscle volume loss during systemic chemotherapy. Methods: This was a retrospective study of patients who underwent chemotherapy from 2008 to 2017. Psoas major muscle volume was calculated by volume analyzer software, and its loss was calculated during systemic chemotherapy. The patients were divided according to muscle volume loss: Group 1 (<20%) and Group 2 (≥20%). The losses were compared with Kaplan-Meier curves, and a Cox proportional hazard model was applied to test predictors of poor prognosis. Results: Fifty patients were included. Seventeen were classified into Group 1, and 33 into Group 2. The Kaplan-Meier curves revealed that the progression-free and the overall survival of Group 1 were significantly better than those of Group 2 (P = 0.002, P = 0.03, respectively). A multivariate analysis identified psoas major muscle volume loss as a significant and independent predictor of poor prognosis. Conclusions: Patients with psoas major muscle volume loss during chemotherapy had a significantly worse prognosis than those without loss.

DOI： 10.1093/jjco/hyy166

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We measured basal clitoral blood flow by Doppler sonography to determine whether tension-free vaginal mesh(TVM) affects the clitoral blood flow and sexual function in women with pelvic organ prolapse (POP). We performed a prospective study of 22 patients who underwent TVM for POP. Clitoral blood flow was measured by Doppler ultrasound. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the clitoral arteries were measured preoperatively and at 1, 3, and 6 months postoperatively. Female sexual function was also investigated with the Female Sexual Function Index (FSFI). The mean PI and RI were increased at 1 month and significantly decreased at 6 months postoperatively (p<0.05). In contrast, the mean PSV and EDV decreased at 1 month postoperatively and increased at 6 months postoperatively. These four parameters recovered to baseline levels at 6 months following surgery. Total FSFI scores improved significantly from 10.2±7.9 at baseline to 18.2±8.9 at 6 months postoperatively. Color Doppler ultrasonography is potentially useful in measuring clitoral blood flow in patients treated with TVM for POP. Prospective long-term studies are needed to evaluate the utility of this modality as a diagnostic and prognostic tool for female sexual dysfunction.

DOI： 10.18926/AMO/56455

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Metastatic prostate cancer (PCa) cases that cannot be detected on repeat prostate biopsy are extremely rare. Our patient was a 51-year-old Japanese man diagnosed as metastatic PCa by histopathological examination of lesions obtained bone biopsy and lymph node dissection. The primary tumor was not detected after repeated prostate biopsy. Metastatic PCa was diagnosed based on immunohistochemical staining: PSA, AR, P504S, and NKX3.1 of bone and lymph node with metastasis. We speculate that the primary PCa was "burned-out," demonstrating remote metastases with no apparent primary tumor in the prostate. Burned-out PCa may be difficult to diagnose and treat due to its rarity.

DOI： 10.18926/AMO/56380

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Humana Press Inc.  

Bleomycin pulmonary toxicity (BPT) has been well described in patients with germ cell tumors treated with bleomycin etoposide and cisplatin chemotherapy (BEP). To assess the prognostic impact of BPT, we retrospectively identified 52 patients who underwent bleomycin etoposide and cisplatin chemotherapy from 2008 to 2017 in our institution, and evaluated the risk factors of BPT and its effect on prognosis. Patients who had received chemotherapy at another institution were excluded. BPT was defined as bleomycin discontinuation in response to pulmonary function test decline, pulmonary symptoms, or interstitial pneumonia on computed tomography without infection. We divided the patients into two groups according to this definition: BPT and non-BPT. Their median age was 34.2 years, and their median body mass index was 22.8 kg/m2. Twenty patients had a smoking history, 37 were diagnosed with non-seminoma, and 20 had lung metastasis. The median cumulative bleomycin dose was 270 mg/body. Fifteen patients were classified into the BPT group and 37 into the non-BPT group. Only body mass index &lt
22 was identified as a predictor of BPT in multivariable logistic models. Age or use of granulocyte-colony stimulating factor did not have a significant impact. Kaplan–Meier analysis revealed that the presence of BPT had no significant impact on either 5-year overall survival or progression-free survival. Lower body mass index can increase the risk of BPT in patients with germ cell tumors undergoing BEP. However, discontinuation of bleomycin with BPT does not adversely influence the survival outcomes.

DOI： 10.1007/s12032-018-1140-5

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

Background: Mycophenolate mofetil (MMF) and mizoribine (MZR) are increasingly used as immunosuppressive agents for organ transplantation and chronic inflammation. We report a patient with rheumatoid arthritis who had an acute inflammatory syndrome triggered by preoperative immunosuppression therapy with both MMF and MZR. Case report: A 41-year-old woman with IgA nephropathy was referred to our department for living donor renal transplantation. She had rheumatoid arthritis that was adequately treated with prednisolone 5 mg once a day and salazosulfapyridine 2000 mg once a day. MMF 1000 mg twice a day was started for desensitization therapy. Three days later, the patient developed arthritis in the joints of her left hand and elevated inflammatory markers. On day 7, MMF was switched to MZR 150 mg 3 times a day. However, the symptoms extended to both shoulders and the joints of the right foot
MZR was discontinued. The arthritis and inflammatory markers improved. Two months later, the patient was rechallenged with MMF followed by MZR, resulting in a similar clinical course as previously. Tacrolimus (TAC) 3 mg twice a day and everolimus (EVL) 0.5 mg twice a day were introduced as alternative immunosuppressant therapies. No arthritis occurred. ABO-compatible living donor renal transplantation was successfully performed. The patient received TAC, EVL, prednisolone, rituximab, and basiliximab, and her postoperative course was uneventful without arthritis or rejection. At 9 months postoperatively, the serum creatinine was 0.79 mg/dL. Conclusions: Acute inflammatory syndrome is an extremely rare complication triggered by preoperative immunosuppression therapy. If antimetabolites cannot be used in immunologically high-risk patients, transplantation becomes very difficult. Clinicians should keep in mind this paradoxical reaction.

DOI： 10.1016/j.transproceed.2017.12.030

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

Background: Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). Methods: We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Results: Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p &lt
 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

DOI： 10.1007/s10147-017-1203-1

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

ObjectivesTo investigate the prevalence of fluoroquinolone-insusceptible and/or extended-spectrum beta-lactamase-producing Escherichia coli colonizing in the male rectum before transrectal prostate biopsy.
MethodsWe carried out a prospective cohort study of men undergoing transrectal prostate biopsy. CHROMagar Orientation originally supplemented with levofloxacin and CHROMagar Orientation/extended-spectrum beta-lactamase were used for detecting fluoroquinolone-insusceptible and extended-spectrum beta-lactamase-producing Escherichia coli. Rectal specimens were collected before prostate biopsy, and the results of cultures in the selective medium were compared with drug susceptibility measured by standard methods. Targeted prophylactic antimicrobials were administered to patients with drug-resistant Escherichia coli and the incidence of postoperative prostatitis was investigated. In the case of prostatitis, pathogens preoperatively isolated from the rectum and those from urine were compared using pulsed-field gel electrophoresis.
ResultsRectal colonization of fluoroquinolone-insusceptible or extended-spectrum beta-lactamase-producing Escherichia coli was detected in 217 of 694 (31.3%) and 85 of 640 (13.3%) participants, respectively. The sensitivity and specificity of fluoroquinolone-insusceptible selective media were 96.8% and 88.2%, respectively. A total of 618 participants underwent transrectal prostate biopsy, and postoperative acute prostatitis was observed in four of 618 (0.6%) participants. Escherichia coli strains isolated preoperatively from the rectum and postoperatively from urine were found to be identical.
ConclusionsThe present findings showed accuracy and performance of the selective media. Screening cultures before transrectal prostate biopsy using selective media seems to be helpful for guiding antibiotic prophylaxis and thus decreasing the rate of post-biopsy acute prostatitis.

DOI： 10.1111/iju.13447

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

We describe a 40-year-old living-donor renal-transplant recipient who underwent successful ureterolithotripsy. He had been on hemodialysis for &gt;15 years pre-transplant and underwent ureteroureterostomy along with the surgery. One year post-transplant, ultrasound examination demonstrated hydronephrosis, and CT showed a 6-mm ureteral calculus at the ureteroureterostomy site. No pain and no elevated serum creatinine were present. As the ureter was easily accessed, we performed a ureterolithotripsy, which would confirm whether a suture caused the calculus. Despite ureteral tortuosity, laser stone fragmentation succeeded. The calculus was completely removed with an antegrade guidewire. Mild postoperative ureteral stenosis resolved with a temporary ureteral stent without balloon dilation. Ureterolithotripsy is effective even in renal transplant recipients with ureteroureterostomy.

DOI： 10.18926/AMO/55445

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

ObjectivesTo evaluate the cost effectiveness of disposable, hydrophilic-coated catheters in Japan.
MethodsA Markov decision model previously applied in a European study was used to evaluate the cost effectiveness of intermittent self-catheterization (ISC) with hydrophilic-coated catheters in Japanese spinal cord injury (SCI) patients suffering from chronic urinary retention from a lifetime perspective. To adjust the model to a Japanese setting, relevant Japanese data regarding the baseline risk of urinary tract infection (UTI), the average age at onset of SCI, costs, and general mortality were extracted from published literature, national statistics, or the opinions of Japanese experts. The direct medical costs, quality-adjusted life years (QALYs) and life years gained (LYG) were calculated from the payers' perspective. An annual discount rate of 2% was applied to both the costs and the effects.
ResultsThe incremental cost of hydrophilic-coated catheters was 1 279 886 yen (US$ 10 578 at an exchange rate of US$ 1 = 121 yen) per SCI patient, but they yielded an additional 0.334 QALYs and 0.781 LYG compared with uncoated catheters. The incremental cost-effectiveness ratio (ICER) of hydrophilic-coated catheters vs. uncoated catheters was 3 826 351 yen/QALY (US$ 31 623/QALY) gained and 1 639 562 yen/LYG (US$ 13 550/LYG).
ConclusionsThe ICER of 3.8 million yen (US$ 31 405) falls well within the Japanese societal willingness to pay per QALY gained; therefore, hydrophilic-coated catheters can be considered highly cost-effective in Japan compared with uncoated catheters. However, because of the lack of relevant studies, a number of key parameters could not be based on Japanese data, and further research among people with SCI in Japan is recommended.

DOI： 10.1111/luts.12122

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

A 38-year-old woman with a 2.7-cm left ureteral stenosis requiring chronic ureteral stent exchange elected to undergo robotic renal autotransplantation. Left ureteropelvic junction obstruction (UPJO) was also suspected. Robotic donor nephrectomy contributed to the fine dissection for desmoplastic changes. The kidney was removed through a Gelport and examined on ice. UPJO was not seen. An end-to-side robotic anastomosis was created between the renal and external iliac vessels. The console time was 507 min, and the warm ischemia time was 4 min 5 sec. She became stent-free. Robotic renal autotransplantation is a new, minimally invasive approach to renal preservation.

DOI： 10.18926/AMO/55313

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

Objectives: Sexually transmitted infections due to Chlamydia trachomatis (C. trachomatis) are a worldwide public health problem. The aim of this study was to investigate the drug susceptibilities of C. trachomatis strains isolated from the urethra and pharynx of Japanese males.
Methods: Urethral and pharyngeal swabs were collected between 2013 and 2014 from Japanese males with urethritis. Using a McCoy cell line, 18 chlamydial strains were isolated from urethra in 18 patients and 7 from the pharynx in 7 of the 18 patients. The minimum inhibitory concentrations (MICs) of levofloxacin (LVFX) and azithromycin (AZM) were measured using the standard method of the Japanese Society of Chemotherapy.
Results: The MICs of LVFX and AZM against urethral chlamydial strains were 0.125-0.5 mu g/mL and 0.125-0.25 mu g/mL, respectively. In pharyngeal strains, the MICs of LVFX and AZM were 0.125-0.25 mu g/mL and 0.125-0.25 mu g/mL, respectively. In 7 patients with chlamydial strains isolated from both the urethra and pharynx, the MICs of LVFX between these strains were identical in 3 of 6 patients (no growth was observed for one pharyngeal strain), while the MICs of AZM between these strains were identical in all 6 patients (not performed for one patient).
Conclusions: Our data suggest that C. trachomatis strains isolated from the urethra and pharynx of Japanese males are susceptible to LVFX and AZM. Although measuring the MICs of chlamydial strains is labor intensive, it is a significant surveillance tool for treating chlamydial infections and preventing the spread of STIs. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2017.04.005

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

Background: Contrast-enhanced CT is necessary before donor nephrectomy and is usually combined with a Tc-99m-mercapto-acetyltriglycine (MAG3) scan to check split renal function (SRF). However, all transplant programs do not use MAG3 because of its high cost and exposure to radiation. We examined whether CT volumetry of the kidney can be a new tool for evaluating SRF. Methods: Sixty-three patients underwent live donor nephrectomy. Patients without a 1.0 mm slice CT or follow-up for &lt
12 months were excluded leaving 34 patients’ data being analyzed. SRF was measured by MAG3. Split renal volume (SRV) was calculated automatically using volume analyzer software. The correlation between SRF and SRV was examined. The association between the donor’s postoperative estimated glomerular filtration rate (eGFR) and predicted eGFR calculated by MAG3 or CT volumetry was analyzed at 1, 3, and 12 months post nephrectomy. Results: Strong correlations were observed preoperatively in a Bland–Altman plot between SRF measured by MAG3 and either CT cortex or parenchymal volumetry. In addition, eGFR after donation correlated with SRF measured by MAG3 or CT volumetry. The correlation coefficients (R) for eGFR Mag3 split were 0.755, 0.615, and 0.763 at 1, 3 and 12 months, respectively. The corresponding R values for cortex volume split were 0.679, 0.638, and 0.747. Those for parenchymal volume split were 0.806, 0.592, and 0.764. Conclusion: Measuring kidney by CT volumetry is a cost-effective alternative to MAG3 for evaluating SRF and predicting postoperative donor renal function. Both cortex and parenchymal volumetry were similarly effective.

DOI： 10.1007/s10157-017-1454-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

We report the case of a 58-year-old Japanese man with bilateral synchronous renal cell carcinoma (RCC). The diameters of the right and left tumors were 56 and 69 mm, respectively. Both tumors were endophytic. Cryoablation with prophylactic embolization was performed for the left tumor, and 1 month later, a right open partial nephrectomy was performed. No recurrence was observed during a 16-month follow-up, and the serum creatinine level has been stable. The prognosis of bilateral synchronous RCC is better than that of dialysis patients. The novel approach of combining cryoablation and partial nephrectomy can achieve good cancer control and renal function in bilateral RCC.

DOI： 10.18926/AMO/54989

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

Objectives: This study aimed to investigate the penetration of fluoroquinolones into human epididymal tissue.
Methods: The penetration of levofloxacin (LVFX) 500 mg or sitafloxacin (STFX) 100 mg into epididymal tissue was examined. Patients with prostate cancer who were referred for orchiectomy were included. LVFX 500 mg (n = 9) or STFX 100 mg (n = 9) was administered orally 1 h before orchiectomy, and 0.5 g of epididymal tissue and blood samples were collected simultaneously during surgery. Drug concentrations were measured by high-performance liquid chromatography, and patient characteristics and adverse events were analyzed.
Results: The mean ratio of the epididymal concentration to the serum concentration was 1.48 +/- 0.45 for LVFX and 1.54 +/- 0.81 for STFX. For LVFX, the simulated curves estimated the following: maximum concentrations (Cmax) of 8.84 mu g/ml in serum and 14.1 mu g/g in epididymal tissue and area under the concentration-time curve for 24 h (AUC(24)) of 68.5 mu g h/ml in serum and 108.9 mu g h/g in epididymal tissue. For STFX, the Cmax was 1.22 mu g/ml in serum and 1.66 mu g/g in epididymal tissue, and the AUC24 was 9.58 mu g h/ml in serum and 13.1 mu g h/g in epididymal tissue. Neither treatment-related adverse events nor postoperative urogenital infections were observed.
Conclusions: The results of this study suggest that oral administration of LVFX 500 mg or STFX 100 mg achieves effective epididymal concentrations for treatment of epididymitis. (C) 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2016.12.010

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

Background: Fluoroquinolone-non-susceptible Escherichia coli isolated from patients with acute uncomplicated cystitis are a matter of increasing concern. Cefditoren pivoxil is an oral, beta-lactamase-stable, extended-spectrum cephalosporin that is effective against fluoroquinolone-non-susceptible bacteria.
Objectives: To evaluate the clinical and microbiological efficacies of cefditoren pivoxil against acute uncomplicated cystitis and to determine the optimal duration of cefditoren pivoxil treatment.
Methods: We compared 3 and 7 day regimens of cefditoren pivoxil in a multicentre, randomized, open-label study.
Results: A total of 104 female patients with acute uncomplicated cystitis were enrolled and randomized into 3 day (n = 51) or 7 day (n = 53) treatment groups. At first visit, 94 bacterial strains were isolated from the 104 participants of which 81.7% (85/104) were E. coli. Clinical and microbiological efficacies were evaluated 59 days following administration of the final dose of cefditoren pivoxil. The clinical efficacies of the 3 and 7 day groups were 90.9% (40/44) and 93.2% (41/44), respectively (P = 1.000). The microbiological efficacies of the 3 and 7 day groups were 82.5% (33/40) and 90.2% (37/41), respectively (P = 0.349). There were no adverse events due to cefditoren pivoxil treatment, with the exception of a mild allergic reaction in one patient, after which the cefditoren pivoxil was exchanged for another antimicrobial.
Conclusions: Cefditoren pivoxil is safe and effective for uncomplicated cystitis, with no significant differences in clinical and microbiological efficacies between 3 and 7 day regimens.

DOI： 10.1093/jac/dkw424

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Language：Japanese   Publisher：大道学館出版部  

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Language：English   Publisher：ELSEVIER SCIENCE INC  

Urethral diverticular clear cell adenocarcinoma in a female patient is extremely rare. This tumor sometimes displays a characteristic image on magnetic resonance imaging, surrounding the urethra like the prostate does in men. We report a patient with this tumor who underwent cystourethrectomy and ileal conduit diversion. We think that imaging studies could be useful to make the appropriate diagnosis. UROLOGY 99: e25-e26, 2017. (C) 2016 Elsevier Inc.

DOI： 10.1016/j.urology.2016.10.021

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

We elucidate the fate of cases clinically suspected of carcinoma in situ (Cis) of the upper tract with serial ureteroscopy. Of 143 patients who underwent ureteroscopy for suspected upper tract urothelial carcinoma (UTUC) between January 2008 and February 2016, 12 cases with consistently positive urine cytology and poorly detectable upper-tract malignancies by imaging were reviewed. In these 12 patients, 19 ureteroscopy procedures (25 renal units) were performed. Vesical random biopsy was performed before the 1st ureteroscopy to exclude malignancy of the bladder in all 12 cases. Median follow-up was 42 (13-67) months. Positive biopsy results at the 1st ureteroscopy were obtained in 3 (25%) patients and all were diagnosed wth Cis of the upper tract. Two (17%) of 9 patients who were negative or inconclusive at the 1st ureteroscopy were finally diagnosed as UTUC, but plural ureteroscopy procedures were needed for the diagnoses in both. Carcinoma of the bladder appeared in 5 (42%) patients during follow-up, despite the earlier ruling out of vesical malignancy. Four (33%) of those 5 patients never developed upper-tract urothelial carcinoma during follow-up. Caution is required before undertaking radical surgery for cases clinically suspected of Cis of the upper tract. In our experience, only 42% of such patients developed UTUC; another 33% eventually developed carcinoma of the bladder without UTUC.

DOI： 10.18926/AMO/55205

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

DOI： 10.1016/j.jiac.2016.07.018

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Urinary tract infections (UTIs) are the most common bacterial infections in women, and many patients experience frequent recurrence. The aim of this report is to introduce an on-going prospective phase II clinical trial performed to evaluate the preventive effectiveness of Lactobacillus vaginal suppositories for prevention of recurrent cystitis. Patients enrolled in this study are administered vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus every 2 days or 3 times a week for one year. The primary endpoint is recurrence of cystitis and the secondary endpoints are adverse events. Recruitment began in December 2013 and target sample size is 20 participants.

DOI： 10.18926/AMO/54508

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Although graft survival following renal transplantation (RTx) has improved, outcomes following highrisk RTx are variable. Preexisting antibodies, including donor-specific antibodies (DSA), play an important role in graft dysfunction and survival. We have designed a study to investigate the safety and efficacy of anti-CD20 monoclonal antibodies (rituximab) in high-risk RTx recipients. Major eligibility criteria include: 1) major and minor ABO blood group mismatch, 2) positive DSA. Thirty-five patients will receive 200 mg/body of rituximab. The primary endpoint is the incidence of B cell depletion. This study will clarify whether rituximab is efficacious in improving graft survival in high-risk RTx recipients.

DOI： 10.18926/AMO/54507

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

Objectives: We analyzed bacterial strains isolated from urine samples of patients with urinary tract infections (UTI) at Okayama University Hospital over a 30-year period to characterize trends in species and antimicrobial susceptibilities.
Methods: Clinical isolates were collected from in- and out-patients with pyuria and bacteriuria who were treated between 1984 and 2014 (one episode per patient and plural isolates were counted in poly microbial infection). We examined these isolates to identify pathogens and tested for antimicrobial susceptibility.
Results: Isolates from complicated UTI over a 30-year period revealed Pseudomonas aeruginosa (P. aeruginosa) was the most frequently isolated in the first decade (1984-1994), MRSA in the second decade (1995-2004), and Escherichia coli (E. coli) in the latest decade (2005-2014). In uncomplicated UTI examined over 20 years, E. coli was the most frequently isolated species accounting for 47-94% of isolates. Fluoroquinolone (FQs)-insusceptible E. coli were first isolated in 1994 and increased to about 35% in 2013 in patients with complicated UTI.
Conclusions: Complicated UTI involving P. aeruginosa and MRSA decreased over the last 10 years. Our data suggest that several factors such as shorter hospitalizations, shorter indwelling catheter use, and appropriate antimicrobial use has decreased colonization of P. aeruginosa and MRSA with relative increases in isolation of E. coli including FQs-insusceptible strains. We must continue our surveillance of antimicrobial-resistant bacteria isolated from urine samples and evaluate antibiograms, since their persistence in the urinary tract would be problematic. (C) 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2016.04.004

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

In minimally invasive partial nephrectomy (MIPN), it is important to preoperatively predict the degree of difficulty of tumor resection. When severe adhesions occur between the renal capsule and perinephric adipose tissue, detachment can be difficult. Preoperative prediction of adhesion is thought to be useful in the selection of surgical procedure. Subjects were 63 patients of a single surgeon who had received MIPN between April 2008 and August 2013 at Okayama University Hospital. Of these patients, this study followed 47 in whom the presence or absence of adhesions between the renal capsule and perinephric adipose tissue was confirmed using intraoperative videos. Data collected included: sex, BMI, CT finding (presence of fibroids in perinephric adipose tissue), comorbidities and lifestyle. Adhesion was observed in 7 patients (14.9). The mean operative time was 291.6min in the adhesion group, and 226.3min in the group without. The increased time in the adhesions group was significant (p&lt;0.05). Predictive factors were a positive CT finding for fibroid structure and comorbidity of hypertension (p&lt;0.05). In MIPN, difficulty of surgery can be affected by the presence of adhesion of the perinephric adipose tissue. Predicting such adhesion from preoperative CT is thus important.

DOI： 10.18926/AMO/54185

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Objectives: The aim of this study is to characterize the potential differences between male and female patients with acute pyelonephritis (AP) and to predict the severity of AP based on the length of hospital stay.
Methods: We conducted a retrospective medical chart review of 172 consecutive adult patients who were hospitalized in Tsuyama Central Hospital due to AP from January 2007 through June 2012. We analyzed the length of hospital stay by the proportional hazard model.
Results: A total of 172 patients were identified who were admitted to our hospital with a diagnosis of AP. Of them, 62% (106/172) were female. Except for urological malignancy, there was no significant difference between men and women in underlying disease. Out of 26 variables, univariate analysis in male showed that only urolithiasis (OR 1.75, p = 0.0294) was significantly associated with longer hospital stay, while septic shock (OR 3.18, P = 0.003), urological malignancy (OR 2.94, P = 0.002), age over 65 (OR 1.66, p = 0.018) and neurogenic bladder (OR 1.92, p = 0.014) were all associated with longer hospital stay in female patients.
Conclusions: This is the first report to identify the risk factors for prolonged hospital stay for the patients who were admitted with AP in the Japanese population. The risk factors causing prolonged hospital stay were totally different between males and females. Reviewing the medical history based on sex gender might enable a clinician to predict the severity of acute pyelonephritis during the initial evaluation. (C) 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2015.11.007

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Language：Japanese   Publisher：(一社)兵庫県医師会  

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

We retrospectively investigated the incidence of genitourinary tract infection in 5895 patients who underwent transrectal and/or transperineal prostate biopsy procedure between January and December 2011 at 46 institutions belonging to Japanese Research Group for Urinary Tract Infection (JRGU).
The total rate of genitourinary tract infection after prostate biopsy was 0.76%, while that following transrectal procedure was 0.83% and following transperineal procedure was 0.57%, which were not significantly different. In contrast, febrile infection associated with a fever (&gt;= 38 degrees C) occurred significantly more frequently after transrectal (0.71%) than transperineal (0.16%) approach (P = 0.04). Notably, in infectious cases, Escherichia coli was most frequently isolated. Of the 9 E. coli strains isolated by urine culture, 6 (66.7%) produced extended spectrum B-lactamase (ESBL) and 7 (77.8%) showed levofloxacin resistance. Similarly, of 6 E. coli strains isolated by blood culture, 4 (66.7%) produced ESBL and 6 (100%) showed levofloxacin resistance.
When the efficacy of antimicrobial prophylaxis (AMP) with levofloxacin for the patients undergoing transrectal or transperineal biopsy was compared between a single dose (500 mg) and that given for 2 or more days, no significant difference was observed for the rate of infection (transrectal: 0.82% vs. 1.04%, p = 0.94; transperineal: 0.30% vs. 0.46%, p = 0.68).
Although a single dose of levofloxacin for AMP is sufficient to prevent genitourinary infection after transrectal or transperineal prostate biopsy, and recommended in this era of increased multi-drug resistant pathogens, the increase in fluoroquinolone-resistant E. coli and ESBL-producing E. coli has emerged as a profound problem for surveillance. (C) 2013, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2013.10.003

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

(Objective) The "Japanese guidelines for prevention of perioperative infections in urological field" was edited by the Japanese Urological Association in 2007. They are the first Japanese guidelines for antimicrobial prophylaxis specifically to prevent perioperative infections in the urological field. We report here the results of a multicenter prospective study conducted to examine the validity and usefulness of these guidelines. (Patients and methods) The subjects were 513 patients who had undergone urological surgeries between July and September 2008 at 10 nationwide university institutions in the Japanese Society of UTI Cooperative Study Group. These surgeries were transurethral resection of bladder (TURBT), transurethral resection of prostate (TURP), adrenalectomy, nephrectomy, nephroureterectomy, radical prostatectomy and total cystectomy. Analysis was performed on patient information, surgical procedures, types and durations of administration of prophylactic antibiotic agents, and the presence of surgical site infections (SSI) and remote infections (RI). (Results) Of 513 patients, 387 (75.4%) were administered prophylactic antibiotic agents according to the guidelines. In these patients, the incidences of SSI and RI were 5.9% and 4.1%, respectively. Multivariate analysis showed that significant factors for SSI were the surgical risk (according to the ASA physical status classification system), diabetes, and operation time, and that the only significant factor for RI was the operation time. (Conclusions) More large-scale study and evidences are necessary in order to demonstrate the validity and usefulness of these guidelines.© 2013 The Japanese Urological Association.

DOI： 10.5980/jpnjurol.104.505

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

Objectives The traditional surgical approach for removing a urachal remnant is via a large transverse or midline infraumbilical incision. We review our experience with laparoscopic urachal cyst excision and report the efficacy and outcomes of this approach as a less morbid, minimally invasive alternative.
Methods Between August 2005 and March 2009, eight patients with a mean age of 26 years who had symptomatic urachal cysts underwent laparoscopic radical excision of the urachal remnant. Using three ports, the urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact via the umbilicus. Umbilicoplasty was performed by a plastic surgeon. We retrospectively reviewed the perioperative records to assess morbidity and outcomes.
Results All eight operations were completed successfully. No intraoperative or postoperative complications were reported at a mean follow-up of 3.2 years. Mean operative time was 147.5 min including umbilicoplasty. Pathological evaluation confirmed a benign urachal remnant in each case. There have been no recurrences of symptoms nor postoperative complications during follow-up. Mean time to full recovery, defined as return to normal life without pain, was 16 days. The patients with bladder cuff resection had a delayed full convalescence (25 vs. 13 days) due to a minimum degree of dysuria.
Conclusion A laparoscopic approach with the removal of urachal remnants via the umbilicus appears to be a safe and effective alternative with better cosmesis when compared to an open approach.

DOI： 10.1007/s00345-012-0829-x

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

Pharyngeal chlamydial and gonococcal infections can occur as a consequence of oral sex, and they also can be transmitted from the pharynx to the genital tract of sex partners. There have been many reports on the prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men; however, there have been few reports on the prevalence of these pathogens in the pharynges of heterosexual men. In this study, we determined the prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in 42 heterosexual men diagnosed with urethritis. Pharyngeal swabs and first-voided urine specimens were tested using the Gen-Probe APTIMA Combo 2 transcription-mediated amplification assay. The prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in patients with urethritis was 2.4 % (1/42) and 11.9 % (5/42), respectively. Among patients with either chlamydial or gonococcal urethritis, 9.1 % (1/11) and 25.0 % (5/20) had pharyngeal C. trachomatis or N. gonorrhoeae, respectively. Our results suggest that screening for pharyngeal colonization by N. gonorrhoeae and C. trachomatis using validated nucleic acid amplification tests should be performed in heterosexual men diagnosed with urethritis.

DOI： 10.1007/s10156-012-0410-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Objective: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria.
Methods: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat (TM)). Lesions identified ureteroscopically were treated with diathermy fulguration.
Results: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14-80) years and median follow-up of 139 (34-277) months. The median preoperative duration of gross hematuria was 5 (1-144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of "no lesions" was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p&lt;0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site.
Conclusion: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

DOI： 10.1371/journal.pone.0036729

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Language：Japanese   Publisher：(株)医学書院  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3 +/- 1.3 at baseline to 18.0 +/- 1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.

DOI： 10.18926/AMO/48078

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

OBJECTIVE
To explore whether levels of nerve growth factor (NGF) in expressed prostatic secretions (EPS) are correlated with symptom severity in chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS).
PATIENTS AND METHODS
All patients with CP/CPPS underwent a complete history and physical examination, and were scored according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).
Expressed prostatic secretion samples from 20 patients with CP/CPPS and from four asymptomatic control patients were collected and frozen, and NGF levels in EPS were measured by enzyme-linked immunosorbent assay.
Patients were asked to complete NIH-CPSI questionnaires at baseline and 8 weeks after treatment and patients with at least a 25% decrease in total NIH-CPSI score from the baseline values were classified as responders to treatment.
RESULTS
The mean (+/-SD) NGF levels in EPS of patients with CP/CPPS and asymptomatic control patients were 7409 (+/-3788) pg/mL and 4174 (+/-1349) pg/mL, respectively. The NGF level in patients with CP/CPPS correlated directly with pain severity (P = 0.014, r = 0.541).
There were no significant differences between NGF levels in EPS before and after treatment. However, successful treatment significantly decreased NGF levels in responders (P = 0.001).
CONCLUSION
Nerve growth factor might contribute to the pathophysiology of CP/CPPS as changes in NGF level in EPS occurred in proportion to pain severity. Therefore, these results suggest that NGF could be used as a new biomarker to evaluate the symptoms of CP/CPPS and the effects of treatment.

DOI： 10.1111/j.1464-410X.2010.09716.x

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

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.
A multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS.
Of the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 +/- 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 +/- 9.3 and 21.6 +/- 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores.
Our results suggest that sexual dysfunction is related to SUI.

DOI： 10.1007/s00192-010-1250-x

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

OBJECTIVES To investigate whether a single application of the membrane-permeable D-isomer of the p53 C-terminus connected with a retro-inverso version of the NH(2)-terminal 20-amino acid peptide of the influenza virus hemagglutinin-2 protein (riHA2) inhibited the growth of bladder cancer cells. The transduction of p53 using poly-arginine is useful for targeting and suppressing the growth of bladder cancer cells. However, the protein&apos;s intracellular half-life is short, and repeated application is necessary to achieve an anti-tumor effect.
METHODS The p53 carboxyl-terminal peptides covalently coupled with cell-penetrating peptides were synthesized with D- or L-amino acids. Moreover, the peptides were connected with riHA2 by a disulfide bridge. Human bladder cancer cell lines were incubated with each peptide and cell viability was assessed with the WST assay. Apoptotic cells were confirmed by Hoechst and active capase-3 staining. The p53 peptides were injected into severe combined immunodeficiency disease mice transplanted with J82 cells to investigate their anti-tumor effect on bladder tumors. A survival curve was plotted using the Kaplan-Meier method.
RESULTS A single application of cell-penetrating D- isomer peptides of the p53 C-terminus connected with riHA2 (d11R-p53C&apos;-riHA2 and dFHV-p53C&apos;-riHA2) inhibited the growth and induced the apoptosis of bladder cancer cells. The tumor-bearing mice treated only with vehicle had a mean survival time of 12 days, whereas treatment with d11R-p53C&apos;-riHA2 resulted in a long-term survival rate of 50%.
CONCLUSIONS Peptide transduction therapy using the D- isomer p53 C-terminal peptide with riHA2 may be an innovative method for the treatment of bladder cancer. UROLOGY 75: 813-819, 2010. (C) 2010 Elsevier Inc.

DOI： 10.1016/j.urology.2009.10.002

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Language：English   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Normal urine doesn&apos;t have blood cells so urine was thought not to produce Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernoulli effects) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and a probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. This method was viable to diagnose the degree of bladder outlet obstruction. The advantage of being rapid, effective, and equipped with no special attachments allows it to surpass any other non-invasive urodynamic methods. The difference between the echocardiogram and the ultrasound urodynamic system is only the frequency of obtaining velocity information: more than 50 times per minute vs once every several hours, respectively. Although the ultrasound urodynamic system is more difficult to develop than the echocardiogram, one principle is shared by both methods. The patient can void freely without interruptions, there is no contact between the penis and the equipment and it is specifically directed toward non-invasive diagnosis. The development of non-invasive Doppler ultrasound videourodynamics will dramatically expand understanding of voiding function.

DOI： 10.1111/j.1442-2042.2010.02447.x

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(株)医学書院  

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Other Link： http://search.jamas.or.jp/link/ui/2009230252

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

Objectives: A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Methods: Since normal urine does not have blood cells, urine was thought not to produce the Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernouilli effect) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and the probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. The flow-velocity curves from two sites
the distal prostatic urethra just above the external sphincter (V1) and the sphincteric urethra (V2) were plotted against time. The parameters of both the pressure-flow studies and the Doppler ultrasound urodynamic studies were compared in men who had various degrees of obstruction. Results: Functional cross-sectional area at prostatic urethra (A1), calculated by Q max/V1, was lower in the group of bladder outlet obstruction (BOO) vs. control group. Velocity ratio (VR), which was calculated by V1/V2, was the parameter having the best correlation with BOO index, though A1 had a similar correlation. This method is viable to diagnose the degree of BOO. Conclusions: The development of non-invasive Doppler ultrasound videourodynamics (Doppler UDS) will dramatically expand the information on voiding function.

DOI： 10.4103/0970-1591.45548

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS AS  

Objective. To assess the efficacy and safety of propiverine hydrochloride (antimuscarinic), naftopidil (1-adrenoceptor antagonist) or both in patients with male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia and concomitant overactive bladder (OAB). Material and methods. Men aged at least 50 years who had a total International Prostate Symptom Score (IPSS) of 8 or higher and bladder dairy documenting micturition frequency (more than eight micturitions/24 h) and urgency (more than one episode/24 h), with or without urgency urinary incontinence were randomized into three groups: group N, naftopidil (50 mg once daily) only; group P, propiverine hydrochloride (20 mg once daily); and group NP, naftopidil (50 mg once daily) plus propiverine hydrochloride (20 mg once daily) for a 4-week treatment regimen. Results. A total of 66 men, including 20 in group N, 23 in group P and 23 in group NP, were treated and 58 (87.9%) completed the 4 weeks of treatment. IPSS improved significantly in groups N and NP. Urinary frequency improved significantly in groups P and NP. Postvoid residual urine volume increased significantly in groups P and NP. Significant improvements in urgency episodes were noted in each group. One patient in group P required catheterization owing to acute urinary retention and another stopped medication because of difficulty in voiding. Conclusion. These results suggest that each treatment showed effectiveness for male LUTS with OAB. However, there are some possibilities of adverse effects with propiverine hydrochloride monotherapy.

DOI： 10.1080/00365590902836740

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

慢性前立腺炎/慢性骨盤痛症候群(CP/CPPS)16例を対象に前立腺圧出液(EPS)中の神経成長因子(NGF)を測定し、National Institutes of Health chronic prostatitis symptom index(NIH-CPSI)による臨床症状との相関を検討した。その結果、EPS中NGFはコントロール群に比べCP/CPPS群で高値を示した。CP/CPPS群では、治療後にEPS中NGF値が低下傾向を示し、NIH-CPSIにおいて特に痛みスコアの改善とEPS中NGFの低下率との間に相関を認めた。

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

Objectives: alpha 1-adrenergic blockers (alpha b) remain the first-line therapy in men with lower urinary tract symptoms (LUTS). The current published work advocates continued use of alpha b for their effect to be maintained. However, some patients decide to discontinue use of the medication after their symptoms are relieved and can keep good conditions. In this study, we investigated the natural course of LUTS after the discontinuation of successful treatment of alpha b.
Methods: Among 75 patients with LUTS who stopped alpha b medication once their symptoms improved, 60 patients (age, 50-87 years; median, 70) who could be followed for at least 12 months after discontinuation of alpha b were analyzed in this study. Evaluations included a clinical determination of the International Prostate Symptom Score (IPSS), peak flow rate (Qmax) and postvoid residual urine volume (PVR). Upon patient request or in cases of PVR more than 100 mL, administration of alpha b was resumed.
Results: Eighteen out of the 60 patients (30%) asked for re-treatment within 12 months after discontinuation (re-treatment group). The other 42 patents were able to maintain good condition without medication (discontinuation group). The IPSS was 15.9, 8.7, 10.1, 10.2, 9.7, 8.8 and 9.0, on the first visit, just before discontinuation, and 1, 3, 6, 9 and 12 months after stopping treatment among the discontinuation group, respectively. Similarly, Qmax was 10.6, 14.8, 14.2, 14.3, 14.7, 13.2 and 13.6 mL/ s, respectively. Treatment periods, prostatic volume and peak flow rates just before discontinuation of medication differed significantly between the re-treatment and discontinuation group.
Conclusions: In spite of the short follow-up periods, these results suggest that selected patients with relatively small prostatic volume and good flow rates after therapy can discontinue alpha b medication after their symptoms improve.

DOI： 10.1111/j.1442-2042.2007.01784.x

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

Background: The present study investigated the efficacy, safety, and utility of starting an alpha(1d)-selective antagonist, naftopidil, at 75 or 25 mg/day in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
Methods: In this prospective comparative study, the subjects comprised 153 patients with LUTS associated with BPH. Patients were randomized to receive either 25 mg/day (Group LD) or 75 mg/day (Group HD) of naftopidil for 4 weeks. The lower urinary tract disease symptom score (LUTDSS), the International Prostate Symptom Score (IPSS), the Quality of life assessment index, the maximum flow rate (Q(max)), and the residual urine volume were compared between the groups.
Results: In both groups, the LUTDSS and the IPSS were significantly improved at the endpoint and no significant intergroup differences were identified. However, the improvement in the Q(max) was significantly better for Group HD than for Group LD. The overall efficacy did not differ significantly between the groups. The degree of improvement in voiding symptoms and LUTDSS among patients with moderate symptoms was significantly greater for Group HD than for Group LD. The frequency of adverse reactions did not differ significantly between the groups.
Conclusions: Starting administration at 75 mg/day rather than 25mg/day is helpful for LUTS associated with BPH for patients with moderate symptoms, particularly in improving voiding symptoms. The 75 mg/day administration was considered to be a recommendable therapeutic dose in some patients.

DOI： 10.1111/j.1442-2042.2006.01443.x

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

Background: Resiniferatoxin (RTX), a substance isolated from some species of Euphobia, is a specific C-fiber neurotoxin which produces desensitization rather than excitation. At first, we performed intravesical RTX therapy on eight patients with neurogenic detrusor overactivity. After we confirmed the safety and efficacy, a Japanese RTX study group was organized and a new protocol made. The multicenter trial was performed in Japan. However, the efficacy of the treatments was different among the institutions. Therefore, we have compared the results between the first protocol and the new one at our hospital.
Methods: The first and second protocol involved the RTX solution (30 mL of 500 nM, and 100 mL of 1 muM, respectively) being instillated in the bladder for 30 min by almost the same procedures. Effects on bladder function were evaluated during treatment and at follow up.
Results: For the first and second protocols, six out of eight patients noted symptomatic improvement while two patients did not notice any change in the degree of incontinence for one month. The mean urodynamic bladder capacity had significantly increased from 138.0 +/- 64.4 mL to 227.3 +/- 112.4 mL and 133.1 +/- 43.3 mL to 247.0 +/- 102.3 mL 1 month after RTX treatment for the first and second protocols, respectively (P &lt; 0.05). No severe side-effects were seen in either group.
Conclusion: Intravesical RTX improved bladder capacity in patients with neurogenic detrusor overactivity in both protocols. The concentration of RTX did not exhibit any change in the effect and safety in our hospital. Intravesical RTX is a promising treatment for neurogenic detrusor overactivity.

DOI： 10.1111/j.1442-2042.2003.00782.x

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

Objectives. To perform a randomized comparative study to investigate the clinical effects of extracorporeal magnetic innervation (ExMI) and functional electrical stimulation (FES) on urinary incontinence after retropubic radical prostatectomy.
Methods. Thirty-six patients with urinary incontinence after radical prostatectomy were randomly assigned to three groups (12 patients each in the FES, ExMI, and control groups). For FES, an anal electrode was used. Pulses of 20-Hz square waves at a 300-mus pulse duration were used for 15 minutes twice daily for 1 month. For ExMI, the Neocontrol system was used. The treatment sessions were for 20 minutes, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 minutes, followed by a second treatment at 50 Hz for 10 minutes. For the control group, only pelvic floor muscle exercises were performed. Objective measures included bladder diaries, 24-hour pad weight testing, and a quality-of-life survey, at 1, 2, and 4 weeks and 2, 3, 4, 5, and 6 months after removing the catheter.
Results. The leakage weight during the 24 hours after removing the catheter was 684, 698, and 664 g for the FES, ExMI, and control groups, respectively. At 1 month, it was 72, 83, and 175 g (FES versus control, P &lt; 0.05) and at 2 months was 54, 18, and 92 g (ExMI versus control, P &lt; 0.05) in the FES, ExMI, and control groups, respectively. Finally, 6 months later, the average 24-hour leakage weight was less than 10 g in all groups. Quality-of-life measures decreased after surgery, but gradually improved over time in all groups. No complications were noted in any of the groups.
Conclusions. ExMI and FES therapies offered earlier continence compared with the control group after radical prostatectomy. We consider ExMI and FES to be recommendable options for patients who want quick improvement of postoperative urinary incontinence.

DOI： 10.1016/j.urology.2003.09.024

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

50歳男性.移植腎機能廃絶後のacquired cystic disease of the kidney(ACDK)に発症した両側性固有腎細胞癌の1例を経験した.移植腎機能廃絶で血液透析再導入中,血尿,下腹部痛を主訴に受診し,CTで左側固有腎に腫瘤を認め入院した.CTでは固有腎は両側ともACDKを呈し,左側固有腎下極に内部不均一な径6cm大の充実性腫瘤を認めたが,右側固有腎には明らかな腫瘤は認めなかった.ACDKに発生した左側固有腎細胞癌と診断し,経腹的両側固有腎摘除術と移植腎摘除術を施行した.摘出標本では,固有腎は左右とも多数の嚢胞が形成され,左固有腎下極の腫瘍の割面は黄白色充実性で,右固有腎上極にも割面が黄白色充実性腫瘍を認めた.移植腎は萎縮していたが,腫瘍性変化は認めなかった.病理所見は左右ともrenal cell carcinoma,clear cell carcinomaであった.術後6ヵ月で再発・転移は認めていない

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

Objectives: We have developed a totally noninvasive urodynamic technique based on the concept of Doppler sonography, which was tested in men with and without bladder outlet obstruction.
Materials and Methods: An ultrasonic image directed Doppler system with a 3.75 MHz. micro-convex electro-probe was operated transperineally using a specially devised remote control robotic holder. Uroflow rates from the urethral meatus were also measured with a flowmeter. The color Doppler ultrasound image and digital now velocity data were processed by a personal computer. Color scale data were analyzed by customized software. Multiple rectangle sample volumes could be set in any size in any position, and the resulting color encoded data were averaged. Calculation was performed every 0.5 second and a flow velocity curve in the region of interest was obtained. A total of 12 men, 6 without (controls) and 6 with bladder outlet obstruction, were evaluated by conventional pressure flow study and the new Doppler ultrasound urodynamic system. Bladder outlet obstruction was determined using the nomogram of Abrams and Griffiths. The sample volume for a flow velocity curve was set only in the prostatic urethra and, thus, maximum flow velocity in and functional cross-sectional area of the prostatic urethra were determined.
Results: Urinary stream in the male urethra was clearly detected and flow velocity in the prostatic urethra could be measured in all cases. Maximum flow rate measured by a flowmeter was significantly lower in the bladder outlet obstruction group. Maximum flow velocity by Doppler study was almost the same in the obstructed and control groups. Functional cross-sectional area, which was calculated by dividing maximum flow rate by maximum flow velocity, was lower in the bladder outlet obstruction (mean plus or minus standard deviation 0.31 +/- 0.16 cm.(2)) than control group (0.78 +/- 0.23 cm.(2)) (p = 0.006). Velocity flow plots were possible in both groups.
Conclusions: The concept of noninvasive pressure flow-like urodynamic evaluation based on Doppler ultrasound is feasible. Parameters of flow velocity as well as functional cross-sectional area can be used in the diagnosis of bladder outlet obstruction and to localize the site of obstruction.

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Purpose: We believed that a totally noninvasive video urodynamic system could be invented based on the concept of Doppler ultrasonography. To develop this system we measured flow velocity in an experimental urethra using 4 materials, including natural urine.
Materials and Methods: A cellulose tube was inserted into a standoff pad as an experimental urethra. Degassed water, distilled water, urine and liposome (multi-lamellar particles) solution comprised the 4 materials used to compare signal intensity and flow velocity at various flow rates. The flow rate from the tube was measured with a uroflowmeter. The Doppler image and digital uroflow signal data were processed by a computer.
Results: Doppler signals and flow velocity curves could be sufficiently obtained using distilled water, urine and liposome solution, while degassed water showed no Doppler signals at any flow rate. Minimum flow rate at which clear Doppler signals were continuously detected from the angle in the frontal plane was greater than 3.0 ml. per second for distilled water, greater than 1.5 for urine and greater than 0.3 for liposome solution. Maximum flow velocities were identical in these 3 materials at a flow rate of greater than 2.0 ml. per second. The functional cross-sectional area of the tube showed a constant value irrelevant to the initial flow rate.
Conclusions: Flow velocity could be measured by Doppler ultrasound above a certain minimal flow rate. Dissolved gasses have an important role in creating Doppler signals. Flow velocity, velocity related parameters and functional cross-sectional area can diagnose and localize the area of bladder outlet obstruction. Liposome solution may be helpful in detecting velocity in low flow states in future systems.

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The purpose of this study was to determine the clinical utility of the ice-water test (IWT) during urodynamic evaluation in spinal cord injured (SCI) patients. Thirty-two suprasacral SCI patients with documented detrusor hyperreflexia (DH) underwent urodynamic study and IWT. Fifteen patients had repeated testing 2 weeks later. The IWT was performed with the patient in the supine position; 100 mL of sterile saline water at 4-8 degrees C was injected manually. If cystometric capacity was <200 mL, a volume of about 50% of the individual cystometric bladder capacity was used. The cold fluid was left within the bladder for 3 minutes. The test was considered positive if an involuntary bladder contraction > or =15 cm H2O was registered. All patients with cervical or thoracic level SCI had DH, which had 100% test-retest reproducibility on urodynamics. Seventy-two percent of patients with DH had a positive IWT and 28% had a negative IWT. IWT (same volume, 2 weeks later) in 4 (27%) of the 15 repeated tests gave different responses. Autonomic hyperreflexia, manifested as systolic blood pressure increase > or =50 mm Hg within 3 minutes of ice-water instillation, occurred in 16 (57%) of 28 patients with lesions above T7. In SCI patients, the IWT did not contribute to their management because of the insensitivity and nonspecificity. Autonomic hyperreflexia can occur during evaluation. The IWT did not influence clinical management in this group of SCI patients.

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Purpose: We determine whether inguinal cystoceles, a type of extraperitoneal herniation of the bladder, are responsible for symptoms consistent with prostatism in men without bladder outlet obstruction.
Materials and Methods: From January 1996 to February 1997 inguinal cystoceles were treated with surgical repair of the floor of the inguinal canal in 8 men with a relatively long history of symptoms consistent with prostatism. The diagnosis of inguinal cystoceles was based on the filling phase of video urodynamic studies done with the patient standing. The clinical outcome of surgery was assessed using the International Prostate Symptom Score and urodynamic findings.
Results: All inguinal cystoceles studied were physically occult but clearly detected as wide-mouthed, mild protrusions of the bladder wall in the inguinal region on cystograms obtained with the patient standing. Although clear cystoceles were present on radiography on the right side in 1 case, the left side in 2 and bilaterally in 5, apparent bilateral weakness in Hesselbach's triangle was noted in all at surgery. High detrusor opening pressure and a relatively long opening time mere regarded as urodynamic parameters characteristic of this condition. These parameters and subjective symptoms dramatically improved after bilateral surgical repair of the floor of the inguinal canal.
Conclusions: Inguinal cystoceles negatively affect voiding dynamics by increasing opening pressure and opening time, indicating that they should be considered in the differential diagnosis of men with symptoms consistent with prostatism. Video urodynamics is mandatory to detect this condition, which to our knowledge has been previously overlooked on radiography and urodynamics.

DOI： 10.1016/s0022-5347(01)63724-8

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

Our purpose was to determine if intact perianal (S4-5) pin sensation (PPS) and bulbocavernosus (S2-4) reflex (BCR) shortly after spinal cord injury (SCT) are predictive of bladder function recovery. Twenty-eight SCI patients (aged 18-68 years, Frankel Classification A-D, spinal injury level C4-T12), admitted within 72 hours of injury, underwent evaluation of initial PPS and BCR. The presence of intact PPS and BCR were correlated with the patient's voiding function and urodynamic evaluation results 1 year postinjury. Of the 28 patients within 72 hours of SCI, PPS was intact in 17 (60%) and absent in 11 (40%), while 15 patients (54%) demonstrated a positive BCR and 13 (46%) did not. One year after SCI, no patient with absent PPS voided unassisted, while of the 17 patients with preserved PPS, 11 (65%) were voiding spontaneously. Of these 11 patients, urodynamic evaluation revealed detrusor areflexia in 1 (9%), normal detrusor function in 2 (18%), and detrusor hyperreflexia in 8 (73%), with 3 of these 8 patients (38%) also demonstrating detrusor-sphincter dyssynergia. At 1 year postinjury, only 2 of 13 patients (15%) with an absent BCR voided spontaneously, while 9 of 15 patients (60%) with an intact BCR were able to void. Although PPS and BCR are moderately sensitive in predicting the return of spontaneous voiding, they cannot predict detrusor hyperreflexia and sphincter dyssynergia. Therefore, urodynamic study remains an essential component of initial urologic evaluation after SCI. (C) 1998 Wiley-Liss, Inc.

DOI： 10.1002/(sici)1520-6777(1998)17:1<25::aid-nau5>3.0.co;2-f

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

Purpose: We investigated the effect of a neurovascular intact gracilis muscle urethral wrap to restore urinary continence in men with severe stress urinary incontinence after radical retropubic prostatectomy.
Materials and Methods: Three men with stress incontinence after radical retropubic prostatectomy and external beam radiation therapy for adenocarcinoma of the prostate underwent gracilis urethral myoplasty. Video urodynamic evaluation and cystourethroscopy revealed Valsalva leak point pressure of less than 40 cm, water and a damaged urinary sphincter mechanism in all 3 patients, One man underwent concomitant ileocystoplasty.
Results: At 6 to 24-month followup all patients reported improved continence. Mean Valsalva leak point pressure increased from 26.3 +/- 3.2 cm. water before to 83.0 +/- 32.1 cm, water after surgery, The gracilis muscle urethral wrap did not have a deleterious effect on erectile function or ambulation, Complications included 1 wound infection.
Conclusions: An autologous gracilis muscle urinary neosphincter can be constructed in the bulbous urethra in a fashion similar to that of the artificial urinary sphincter with encouraging results in this preliminary series, The gracilis neosphincter may be an alternative to the artificial sphincter, especially in patients at higher risk for complications, such as after radiation and cryotherapy.

DOI： 10.1016/s0022-5347(01)64218-6

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We examined the applicability of environmental scanning electron microscopy (ESEM) and confocal laser scanning microscopy (CLSM) for non-invasive imaging of intact bacterial biofilms. Fully hydrated images of Pseudomonas aeruginosa biofilms developing on the silicon disks in an in vitro experimental model were detected simply but clearly by ESEM and CLSM. Three-dimensional spatial images of the bioflims were obtained by ESEM using specimens with neither drying nor conductive coating. Horizontal and vertical sectioning images of the biofilms were obtained by using CLSM in conjunction with positive fluorescence staining techniques; acridine orange and sufranin were successfully used for detection of bacterial cells in the biofilms, while extracellular polymeric substances were obtained selectively with FITC-concanavalin A. The new technology reported here is applicable to diagnostic study as well as fundamental study of biofilm-associated infections in the urinary tract.

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

Purpose: To investigate the effect of a neurovascularly intact gracilis muscle urethral wrap, to be used to restore urinary continence as a transposed urinary sphincter graft. in patients with neurogenic lower urinary tract dysfunction. Methods: Five neurologically impaired men with a denervated and damaged urinary sphincter mechanisms were treated. The etiology of sphincteric insufficiency included sphincter denervation in three patients. external sphincterotomy in one, and urethral trauma due to a chronic indwelling catheter in one, All patients underwent gracilis urethromyoplasty sphincter reconstruction. Two patients also underwent concomitant ileocystoplasty and one patient ileocystostomy because of poor bladder compliance and a bladder capacity of &lt;200 ml. Results: The gracilis urethromyoplasty functioned as a new autologous sphincter with follow-ups ranging from 6-35 months. The surgery was successful in four patients. Three of the four patients were managed with intermittent catheterization, and one managed by ileocystostomy. The fifth patient continued to require an indwelling urethral catheter. Conclusion: Gracilis urethromyoplasty achieves compression of the urethra using a neurovascularly intact muscle graft, The functional urethral closure, obtained from the gracilis muscle wrap, assures dryness, and permits intermittent self-catheterization. It also avoids the risks of infection, erosion. or malfunction associated with the artificical urinary sphincter. The potential exists for electrical stimulation of this muscle graft to allow volitional control of the neo-sphincter mechanism, and voluntary voiding.

DOI： 10.1038/sj.sc.3100444

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Purpose: To investigate the effect of rectus urethromyoplasty on vesicourethral anastomosis healing during radical retropubic prostatectomy (RRP) and in an animal model.
Materials and Methods: Three groups of 10 female rats were studied. After complete urethral transection, group A animals underwent a primary urethral anastomosis, while rectus urethromyoplasty was used to reinforce the anastomosis of the animals in group B. Group C animals served as controls. All animals underwent urodynamic evaluation one month postoperatively, then were sacrificed for histological analysis. In 3 clinical subjects at the time of RRP, a 2-3 cm x 6-8 cm. strip of rectus muscle was isolated with its blood supply intact, emanating from an inferior epigastric artery pedicle. This muscular band was used to encircle the vesico-urethral anastomosis, suspending it slightly but without tension, and securing it to the pubic symphysis.
Results: The micturition pattern, bladder capacity, and leak point pressure of the 3 groups of animals were not significantly different. Histological examination of the rectus sling revealed viable muscle with histofibroblast, collagen, and blood vessel ingrowth from the vascular rectus muscle into the urethra. Three successful clinical rectus urethromyoplasty cases were performed with over 12 months of follow-up.
Conclusions: Reinforcement of the vesico-urethral anastomosis using rectus urethromyoplasty at the time of radical prostatectomy may improve continence by increasing urethral support and mucosal coaptation. This technique may decrease the incidence of stricture formation by augmenting blood supply available for healing of the anastomosis. Rectus urethromyoplasty may be especially beneficial to patients with an increased risk of requiring adjuvant radiation therapy post-prostatectomy.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Paraplegia Society  

The purpose of this study was to compare the effect on urodynamic parameters of anticholinergic and musculotropic agents in sham injured and spinal cord injured (SCI) rats. A standard rat SCI model induced by impact trauma was employed. Cystometrograms were performed under urethane anesthesia four weeks after SCI. Bladder capacity and voiding pressure were determined at the point of micturition monitored urodynamically and visually. The effect of oxybutynin chloride (0.01 - 0.1 mg/kg), propantheline bromide (0.05 - 0.5 mg/kg) and flavoxate hydrochloride (0.1 - 1.0 mg/kg) were assessed independently in sham injured and SCI rats (n=10 in each group). Bladder capacities were 0.6±0.2 and 7.1±1.6 ml in sham and SCI rats (p&lt
0.01), respectively. Maximal filling pressure was 17.5±5 mmHg in sham and 25±5 mmHg in SCI rats (p&lt
0.05). Bladder capacity increased with all three medications. Administration of oxybutynin, propantheline and flavoxate in sham rats resulted in bladder capacities of 0.88±0.3,0.71±0.3 and 0.8±0.2 ml, respectively (p&lt
0.01 ). In SCI rats, these drugs resulted in bladder capacities of 9.8±1.1,7.9±1.3 and 8.8±2.0 ml, respectively (p&lt
0.01). No significant change in maximum filling pressure occurred. We conclude that anticholinergic and musculotropic agents caused a similar increase in bladder capacity in both sham and SCI rats. Oxybutynin enhanced bladder capacity more than propantheline or flavoxate.

DOI： 10.1080/10790268.1997.11719389

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Purpose: We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter.
Materials and Methods: A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a ''bladder chimney,'' and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues.
Results: On a scale of 0 (worst) to 5 (best) mean scores for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms.
Conclusions: Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.

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Purpose: Dynamic urethral sphincter myoplasty (skeletal muscle urinary sphincter reconstruction) using a neurovascularly intact gracilis muscle was investigated in a rat model.
Materials and Methods: In female Sprague-Dawley rats, a unilateral gracilis anticus muscle flap was dissected from the medial thigh, preserving the medial muscular insertion, vascular flow, and innervation This muscle graft was used to completely encircle the urethra and was fixed in position. Urodynamic leak point pressure (LPP) and bladder volume at leakage were measured with cystometry after 1 month, using an 18 gauge catheter placed through the bladder dome with a constant infusion rate of 0.2 mi. per minute. In addition, the effect of electrical stimulation of the gracilis myoplasty (current parameters: 1 to 10 mA, 1 to 60 Hz, 0.05 to 1 msec. duration) on intravesical leak point pressure was noted during cystometry.
Results: The gracilis muscle measured 3.8 +/- 0.3 cm. in length, 0.5 +/- 0.1 cm. in width and 0.2 +/- 0.1 cm. in thickness. Blood flow rates to the grafted and contralateral gracilis myoplasty were similar at 43 +/- 26 and 51 +/- 30 g.cm.(3), respectively (p = 0.46). The leak point pressure (LPP) of control, unstimulated gracilis myoplasty and gracilis myoplasty with electrical stimulation were 28 +/- 8, 32 +/- 12, and 85 +/- 27 mm.Hg (p &lt; 0.01). Bladder volumes at LPP in the 3 respective groups were 0.5 +/- 0.2, 0.6 +/- 0.3 and 1.2 +/- 0.6 mi (p &lt; 0.01).
Conclusions: Gracilis myoplasty is not obstructive, as substantiated by unchanged leak point pressure and leak point capacity. Myoplasty with low current stimulation, however, significantly increased LPP and leak point capacity.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO  

Historically, urologic complications have been the major source of morbidity and mortality among spinal cord injured (SCI) patients. All SCI patients should undergo urodynamic evaluation, with the initial urodynamics study done after the patient is beyond the spinal-shock phase. Management of the urinary tract in SCI individuals should be based on urodynamic principles and findings rather than on the neurologic history.

DOI： 10.1016/s0094-0143(05)70325-6

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This study is a prospective multicenter cooperative survey of the evaluation and treatment of erectile dysfunction in men with spinal cord injury (SCI). Uniform database questionnaires were completed prospectively by patients seeking therapy for erectile dysfunction. Eighty-five SCI men aged 17-68 years (mean age = 26 +/- 17) were enrolled. Mean duration of traumatic SCI was 3 +/- 3.2 years (Range = 0.3-18 years). The level of injury was cervical in 20 patients, thoracic in 31, lumbar in 29 and sacral in five. Patients were fully evaluated and then counseled as to their therapeutic options. Twenty-eight chose to use a vacuum erection device (VED), 26 preferred pharmacological penile injection and five used both intracorporeal therapy and VED. The remainder were managed with marriage and sexual counseling in 10 patients, three underwent penile prosthesis placement and two used topical pharmacotherapy. Four patients used other forms of treatment and in nine no therapy was recommended. Of the patients that used pharmacologic injection only, 74 percent used papaverine as a single agent, 20 percent used papaverine with phentolamine, five percent used prostaglandin E (PGE1) alone and one percent used a mixture. Patients using injection therapy report sexual intercourse a mean of 3 +/- 3.4 times per month as compared with 5 +/- 3.2 times per month in those using VED. Five intracorporeal injection patients developed priapism while two patients using the VED developed subcutaneous bleeding and one developed penile ischemia. We conclude that although a spectrum of erectile dysfunction treatment is present among SCI centers, VED and pharmacological penile injection are by far the two most popular methods of treatment and papaverine is the most common drug. The incidence of complications is small in the model centers.

DOI： 10.1080/10790268.1996.11719430

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

Purpose: We determined the efficacy of-using a rectus fascial sling to revise an angulated efferent limb in patients with continent urinary diversion and difficulty with intermittent catheterization.
Materials and Methods: Two spinal cord injured women who underwent modified Indiana pouch urinary diversion required revision of each efferent limb because of difficulty with catheterizatian. A strip section of anterior rectus sheath was harvested and used to fix the efferent limb in position, assuring freedom from angulation and facilitating catheterization.
Results: Both patients remained continent fell more than 2 years postoperatively and neither had further difficulties with catheterization or required additional surgery.
Conclusions: Use of the rectus fascial sling in continent urinary diversion enables fixation of the efferent limb to facilitate catheterization and enhance continence.

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DOI： 10.1080/10790268.1996.11719431

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DOI： 10.1111/j.1442-2042.1996.tb00546.x

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

Purpose: We determined whether the self-expanding sphincter stent, a potential alternative to conventional external sphincterotomy for the treatment of detrusor external sphincter dyssynergia, causes a permanent effect on the lower urinary tract.
Materials and Methods: Four spinal cord injured men with voiding symptoms of detrusor external sphincter dyssynergia as noted by complete urological evaluation, including a video urodynamic study, were treated with the self-expanding sphincter stent. However, the device was explanted 6 months or longer after insertion in all 4 cases due to stent migration (3) and difficulty with condom catheter urinary drainage (1).
Results: All stents were removed completely without damage to the urethra. Mean voiding pressure decreased from 62.5 +/- 39.4 to 20.7 +/- 6.5 cm. water after sphincter stent placement. One year after stent explantation mean voiding pressure remained unchanged from preoperative values of 58.5 +/- 21.5 cm. water. No patient had stress urinary incontinence or endoscopically apparent urethral strictures.
Conclusions: The stent can be removed even after complete epithelialization and an extended interval without damage to external sphincter function or urethral stricture formation. The urinary sphincter stent is an effective, reversible treatment for patients with detrusor external sphincter dyssynergia.

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

1991年12月までの13年間に手術を行った3926例を対象とし,術後3週間以内の有熱性感染症,ならびに創感染を中心に集計し,年次的に検討を加え,入院患者における使用抗菌薬の変遷についても検討した。1)術後有熱性合併症としての感染症は,年次的に減少しており,特に前立腺術後有熱性感染症の減少が顕著であった。2)抗菌薬総使用量の年次的推移では,第3世代セフェム,ニューキノロン薬の使用量は1987年にピークに達し,最近ではむしろ減少していた。3)術後上部尿路感染症例よりのSerratiaの分離頻度は著明に減少したが,Pseudomonasにaeruginosaについては減少傾向は認められなかった

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Other Link： http://search.jamas.or.jp/link/ui/1995197073

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CIPCはCarbenicillin (CBPC)の誘導体である。CBPCの尿路感染症由来緑膿菌235株に対するMIC70は400μg/mlと,NFLX, OFLXの100μg/mlに比しかなりの高値を示したが,CBPCでは耐性化の傾向は認められなかった。NFLX, OFLXでは,尿中での抗菌力の明らかな低下がみられるのに対し,CBPCでは尿中での抗菌力の低下は軽度であった。臨床的検討における解析対象例は21例であり,UTI判定では著効5例,有効8例,無効8例,総合有効率は61.9%であった。細菌学的効果では,投与前分離緑膿菌21株のうち12株が除菌された。投与前分離緑膿菌に対する本剤のMICは6.25〜&gt;1,600μg/mlの間に分布し,OFLXに比し高値を示した

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

Objectives. It is still not clear how the intravesical instillation of drugs affects rat urinary frequency. This study aimed to examine the dynamics of intravesical treatments’ treatment effect on rat urinary frequency models by real-time and extended monitoring using a novel continuous urination monitoring system. Methods. Nine eleven-week-old female Wistar rats were divided into three groups to receive intravesical instillation of 0.1% acetic acid (AA), 1.0% AA, or phosphate-buffered saline (PBS). Thirty minutes later, these drugs were voided, and rats were moved to a continuous urination monitoring system, UM-100. UM-100 monitored rat urination quantitatively and continuously for 24 hours. Rats were then euthanized, and histopathologic examinations using a damage score validated the severity of bladder inflammation. We used nine additional rats to determine the treatment effect of various drugs against the urinary frequency. These rats were also treated with 1.0% AA in the same way and divided into three groups (n = 3 each) to receive intravesical instillation of lidocaine, silver nitrate (AgNO₃), or dimethyl sulfoxide (DMSO), respectively. Thirty minutes later, rats were catheterized again and moved to the UM-100, and their voiding was monitored for 24 hours. Results. Intravesical instillation of AA increased the urinary frequency and decreased the mean voided volume (VV) in a concentration-dependent manner, with statistical significance at a concentration of 1.0% (urinary frequency; , mean VV; , respectively) compared with PBS. Histopathological analysis of these models demonstrated a significantly higher damage score of bladder mucosa in both 0.1% AA and 1.0% AA compared with PBS, with the severity in concordance with the clinical severity of urinary frequency (0.1% AA: , 1.0% AA: ). Moreover, intravesical instillation of lidocaine, AgNO₃, and DMSO decreased the urinary frequency. Continuous monitoring with UM-100 also demonstrated that the treatment effect of these intravesically instilled drugs occurred only at night. Conclusions. The extended monitoring of rat urination by UM-100 revealed a significant fluctuation in the treatment effect of intravesically instilled drugs between day and night. These findings may help establish novel therapies for urinary frequency.

DOI： 10.1155/2024/6505595

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Other Link： http://downloads.hindawi.com/journals/vmi/2024/6505595.xml

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OBJECTIVES: It is still not clear how the intravesical instillation of drugs affects rat urinary frequency. This study aimed to examine the dynamics of intravesical treatments' treatment effect on rat urinary frequency models by real-time and extended monitoring using a novel continuous urination monitoring system. METHODS: Nine eleven-week-old female Wistar rats were divided into three groups to receive intravesical instillation of 0.1% acetic acid (AA), 1.0% AA, or phosphate-buffered saline (PBS). Thirty minutes later, these drugs were voided, and rats were moved to a continuous urination monitoring system, UM-100. UM-100 monitored rat urination quantitatively and continuously for 24 hours. Rats were then euthanized, and histopathologic examinations using a damage score validated the severity of bladder inflammation. We used nine additional rats to determine the treatment effect of various drugs against the urinary frequency. These rats were also treated with 1.0% AA in the same way and divided into three groups (n = 3 each) to receive intravesical instillation of lidocaine, silver nitrate (AgNO3), or dimethyl sulfoxide (DMSO), respectively. Thirty minutes later, rats were catheterized again and moved to the UM-100, and their voiding was monitored for 24 hours. RESULTS: Intravesical instillation of AA increased the urinary frequency and decreased the mean voided volume (VV) in a concentration-dependent manner, with statistical significance at a concentration of 1.0% (urinary frequency; p=0.0007, mean VV; p=0.0032, respectively) compared with PBS. Histopathological analysis of these models demonstrated a significantly higher damage score of bladder mucosa in both 0.1% AA and 1.0% AA compared with PBS, with the severity in concordance with the clinical severity of urinary frequency (0.1% AA: p < 0.0001, 1.0% AA: p < 0.0001). Moreover, intravesical instillation of lidocaine, AgNO3, and DMSO decreased the urinary frequency. Continuous monitoring with UM-100 also demonstrated that the treatment effect of these intravesically instilled drugs occurred only at night. CONCLUSIONS: The extended monitoring of rat urination by UM-100 revealed a significant fluctuation in the treatment effect of intravesically instilled drugs between day and night. These findings may help establish novel therapies for urinary frequency.

DOI： 10.1155/2024/6505595

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

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

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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

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

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

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Language：Japanese   Publisher：日本感染症学会・日本化学療法学会  

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Language：Japanese   Publisher：日本感染症学会・日本化学療法学会  

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Language：Japanese   Publisher：日本間質性膀胱炎研究会  

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

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

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

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

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

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

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

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

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

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

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00083&link_issn=&doc_id=20221028010295&doc_link_id=%2Fcl8isoke%2F2022%2Fs057s1%2F058%2F0284-0284%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2022%2Fs057s1%2F058%2F0284-0284%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント ・感染創の治癒促進のためには,wound bed preparation(創面環境調整)の実践が必要で創面環境調整には,(1)壊死物質の除去,(2)滲出液のコントロール,(3)感染の制御が重要である.・創部に感染兆候を認めた場合,縫合糸やステープルを抜去のうえ,すみやかに創開放を行い,排膿ドレナージおよび十分なデブリードマンを行う.・感染創は待機的一時閉鎖を念頭に置く.3〜5日創を開放のままとし,ドレッシングを毎日交換しながら感染兆候の改善を確認し閉鎖縫合を行う.

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J01561&link_issn=&doc_id=20220719050006&doc_link_id=10.11477%2Fmf.1413207592&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1413207592&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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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  

我々が経験したロボット支援下前立腺全摘除術におけるインシデントを報告する.症例は70歳代男性.手術はda Vinci Xiで行われた.術中,1stポートのインストゥルメントを入れ替えた際に,モノポーラシザースよりチップカバーが外れ,紛失した.腹腔内や術野内外をX線透視も用いて探索するも見つからず,Computed tomographyを施行したところ,1stポート造設部の皮下に迷入していた.その後は手術を再開し,合併症なく終了.チップカバーは画像と同部位の皮下より摘出された.手術映像を見返したところ,チップカバーが適切に装着されておらず,インストゥルメント交換の際にトロッカーが皮下まで抜けていたことが判明した.本件のようなインシデントを予防するためには,チップカバーの適切な装着と,インストゥルメントの正しい手順での交換および交換時の確認が必要である.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07650&link_issn=&doc_id=20220531400028&doc_link_id=%2Fcs5robot%2F2022%2F003501%2F032%2F0168-0172%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5robot%2F2022%2F003501%2F032%2F0168-0172%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

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

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

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

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

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

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Language：English  

Laparoscopic fenestration of a postrenal transplant lymphocele is associated with a risk of renal hilar vessel and ureteral injury. Consequently, determination of the incision line is difficult. We describe a case of a 73-year-old man with postrenal transplant lymphocele who underwent a laparoscopic fenestration. We report a surgical video containing a new technique of laparoscopic fenestration using a fluorescent ureteral catheter in combination with a flexible ureteroscope. The combination of a fluorescent ureteral catheter and flexible ureteroscope during surgery enabled us to determine the incision line safely and accurately. Intraoperative real-time visualization of the lymphocele and ureter using a fluorescent ureteral catheter and a flexible ureteroscope is safer than conventional methods for laparoscopic fenestration. To the best of our knowledge, this is the first report of this novel technique.

DOI： 10.1155/2022/9948425

PubMed

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

Optimal neoadjuvant hormone therapy (NHT) for reducing prostate cancer (PC) patients' prostate volume pre-brachytherapy is controversial. We evaluated the differential impact of neoadjuvant gonadotropin-releasing hormone (GnRH) antagonist versus agonist on post-brachytherapy testosterone recovery in 112 patients treated pre-brachytherapy with NHT (GnRH antagonist, n=32; GnRH agonists, n=80) (Jan. 2007-June 2019). We assessed the effects of patient characteristics and a GnRH analogue on testosterone recovery with logistic regression and a propensity score analysis (PSA). There was no significant difference in the rate of testosterone recovery to normal levels (> 300 ng/dL) between the GnRH antagonist and agonists (p=0.07). The GnRH agonists induced a significantly more rapid testosterone recovery rate at 3 months post-brachytherapy versus the GnRH antagonist (p<0.0001); there was no difference in testosterone recovery at 12 months between the GnRH antagonist/agonists (p=0.8). In the multivariate analysis, no actor was associated with testosterone recovery. In the PSA, older age and higher body mass index (BMI) were significantly associated with longer testosterone recovery. Post-brachytherapy testosterone recovery was quicker with the neoadjuvant GnRH agonists than the antagonist, and the testosterone recovery rate was significantly associated with older age and higher BMI. Long-term follow-ups are needed to determine any differential effects of GnRH analogues on the quality of life of brachytherapy-treated PC patients.

DOI： 10.18926/AMO/62810

PubMed

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

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

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

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

【目的】腹腔鏡下膀胱全摘除術(LRC)と開腹膀胱全摘除術(ORC)の長期制癌性を検討した本邦からの報告は少数である。当院におけるLRCとORCの周術期成績と長期治療成績を後方視的に比較検討した。【対象】2012年5月から2018年6月までに施行した膀胱全摘症例のうち78例(LRC48例,ORC30例)とした。【結果】観察期間中央値はLRC群30ヵ月,ORC群43.5ヵ月であった。LRC群で男性が多く,回腸導管の割合が高かった。手術時間はLRC群で長く(p=0.038),推定出血量と輸血症例が少なかった(ともにp<0.001)。術後病理結果はLRC群でG2症例が少なかった(p=0.008)が,断端陽性率を含む他の結果に差はなかった。リンパ節郭清領域はORCで内外腸骨動脈分岐部以下,LRCで総腸骨動脈分岐部以下を基本としたが,郭清リンパ節の数とリンパ節陽性症例の割合に差はなかった。LRC群とORC群の5年全生存率,癌特異生存率,無再発生存率は72.2%と54.4%(p=0.249),77.7%と63.4%(p=0.376),71.4%と55.0%(p=0.115)であった。【結語】当院におけるLRC群の周術期成績は出血量,輸血頻度においてORC群より優れていた。制癌性についてもORC群に比しLRC群が優れている傾向を認め,リンパ節郭清領域が制癌性に影響する報告を裏付ける結果となった。(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)日本泌尿器科学会総会事務局  

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

The aim of this ongoing trial is to evaluate the clinical efficacy and safety of sitafloxacin (STFX) 200 mg once daily (QD) for 7 days in patients with refractory genitourinary tract infections, which include recurrent or complicated cystitis, complicated pyelonephritis, bacterial prostatitis, and epididymitis. The primary endpoint is the microbiological efficacy at 5-9 days after the last administration of STFX. Recruitment began in February 2021, and the target total sample size is 92 participants.

DOI： 10.18926/AMO/62820

PubMed

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

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

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

ロボット支援膀胱全摘除術(以下:RARC)は,本邦において2019年4月に保険適応され,導入する施設も右肩上がりに増えている。当院においても,腹腔鏡下膀胱全摘除,RARC,体腔外尿路変向(以下:ECUD)を経て2019年6月より体腔内尿路変向(以下:ICUD)を開始した。ICUDは腸管という非常に長い対象物を鏡視下の拡大視野にて扱うため,全容が見えていない状態で手術を行うこととなる。その為に初期症例においては,誰も陥りやすいpit fallがあると考えている。この度,我々が経験した失敗とその対策を提示することで,同様のトラブルが回避できれば幸いと考えている。(著者抄録)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡学会  

骨盤臓器脱に対する治療として,2010年に経腟メッシュ手術が,2014年に腹腔鏡下仙骨腟固定術が保険収載され,泌尿器科医が骨盤臓器脱に対する治療を行うことも一般的になってきている.2020年4月の診療報酬改定により,新たにロボット支援腹腔鏡下仙骨腟固定術が保険収載された.腹腔鏡下仙骨腟固定術は,正確な剥離操作を要し,深部での縫合結紮操作を多用する手術であることなど,良性疾患に対する手術でありながら手技の難易度が比較的高い術式であると考えられる.これに対して手術支援ロボットを用いることで,手術の難易度が低減されること,手術成績が向上することが期待される.当院でも2020年8月よりロボット支援下仙骨腟固定術を導入した.ロボット支援下仙骨腟固定術のメリットやデメリット,導入の意義などについて,手術導入に向けた取り組みについて述べる.(著者抄録)

DOI： 10.11302/jsejje.34.221

CiNii Article

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡学会  

岡山大学病院にて2018年1月より2020年9月までの期間に単一術者にて連続的に行われたロボット支援膀胱全摘(以下:RARC)46症例体腔外尿路変更(以下:ECUD)(23例),体腔内尿路変更(以下:ICUD)(23例)の比較検討を行った.検討項目は手術時間,推定出血量,輸血率,リンパ節郭清個数,入院日数,血液生化学データ,術後合併症とした.尿路変更に要した時間はICUD群の方が有意に長かったが,入院期間はICUD群が有意に短かった.他の周術期成績はECUDと同等であった.術者の視点では良好な拡大視野,尿管導管吻合の精緻性,同一視野で手術の流れが途切れることなく継続できることがICUDのメリットではないかと考える.(著者抄録)

DOI： 10.11302/jsejje.34.182

CiNii Article

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

【緒言】本研究の目的は、マージナルドナー(MD)から生体腎移植を受けたレシピエントの転帰を評価することであった。【方法】日本のガイドラインに基づき、(a)年齢≥70歳、(b)血圧≤130/80mmHg、(c)25<BMI≤32、(d)70≤24時間CCr<80、(e)6.2<HbA1c≤6.5あるいは経口糖尿病薬内服下でHbA1c≤6.5をMDと定義した。標準ドナー(SD)から腎提供を受けたレシピエントは61名(54％)、MDからは53名(46％)で、MDのうち糖尿病を有する者(MD+DM)は12名(11%)であった。60カ月間の血清クレアチニン、推定糸球体濾過率(eGFR)、腎移植後のeGFR残存率、尿蛋白/アルブミン・クレアチニン比などの腎機能、およびグラフト生着率を比較した。【結果】SDとMDではすべての腎機能に有意な差はなかった。移植後5年時点のGraft survivalは95 vs 84 %(p=0.09)、Death censored graft survivalは 98 vs 88 %(p=0.18)であった。SDとMD+DMを比較したところ、MD+DMでeGFRが最初の6ヶ月間はわずかに低値だが、12ヶ月以降はその差はなくなった。移植後5年時点のGraft survivalは95vs 100 %(p=0.61)、Death censored graft survivalが98 vs 100 %(p=0.66)であった。【結論】MDおよびMD+DMからの腎提供を受けたレシピエントの移植後成績は、SDからのそれと比較して差はなかった。MDを慎重に選択することにより、たとえDMを有する場合でもドナープールを拡大し得ることが示唆された。

DOI： 10.11386/jst.56.supplement_s474

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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  

【目的】

腎移植患者における新規酸分泌抑制薬ボノプラザンのタクロリムス血中濃度に対する影響を検討した。

【対象と方法】

2018年8月から2019年9月に、ラベプラゾールからボノプラザンに変更した腎移植患者を対象とした。Cytochrome P450（CYP）3A5、CYP2C19の遺伝子多型に基づき、患者群毎の内服変更前後でのタクロリムストラフ値（ng/mL）を比較した。

【結果】

全患者（n = 52）におけるトラフ値の変化に有意差はなかった（前5.5 ± 1.1、後5.8 ± 1.2、p = 0.11）。CYP3A5 poor metabolizer群 (n = 25) では、トラフ値の変化は中央値0.4ng/mLであった （前5.5 ± 1.1 ng/mL、後5.9 ± 1.2、p = 0.049）。CYP3A5 intermediate metabolizer群 (n = 23) およびCYP3A5 extensive metabolizer群 (n = 4)では、前後のトラフ値に有意差はなかった。CYP3A5 poor metabolizer群におけるCYP2C19遺伝子多型によるサブグループ解析では、いずれのCYP2C19遺伝子多型においても変化に有意差は認めなかった。

【結語】

腎移植患者においてラベプラゾールからボノプラザンへの変更はタクロリムストラフ値に臨床的意義のある変化を来さない。

DOI： 10.11386/jst.56.supplement_s323

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

【目的】腎移植後患者において、尿細胞診のDecoy細胞陽性所見の持続期間とBKウイルス腎症 (BKVN)発症予測の関連性を検討した。【方法】対象は2012年05月から2020年07月までに当院で腎移植を行った121例。尿細胞診は、腎移植後6ヶ月間は1ヶ月毎、その後の6ヶ月は1から2ヶ月毎、以降は1から3ヶ月毎に行なっている。BKVN発症予測に最適な陽性持続期間をAUC曲線にて解析し、その最適な陽性期間の持続の有無で患者を2群に分け、BKVN発症率を比較検討した。SV40免疫染色の有効性も併せて比較検討した。【結果】尿検体数は計2,534検体、SV40免疫染色は計2,241検体であった。BKVN発症予測に最適な陽性持続期間は6ヶ月であった（AUC = 0.819）。Decoy細胞陽性が6ヶ月以上持続した（decoy≧6M）群および持続が6ヶ月未満であった（decoy<6M）群に分け、decoy≧6M群 47例、SV40<6M群 74例であった。decoy ≧6M群 はdecoy <6M群 に比べ、BKVNの発症率は有意に高かった（5 vs 0, p=0.008）。decoy細胞によるBKVN発症予測の感度、特異度、陽性的中率、陰性的中率はそれぞれ100%, 64%, 11%, 100%であり、SV40免疫染色は感度、陰性的中率は同等で、特異度は68%, 陽性的中率は12%であった。【結語】6ヶ月以上のDecoy細胞陽性持続の所見はBKVN発症予測に有用である可能性が示唆された。SV40免疫染色追加に伴うBKVN発症予測精度はごくわずかに向上した。

DOI： 10.11386/jst.56.supplement_s441

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

症例は41歳,女性。2008年に結節性硬化症,両側腎血管筋脂肪腫およびIgA腎症と診断され,経過観察されていた。2015年に右腎血管筋脂肪腫より出血を認め緊急経カテーテル的動脈塞栓術を施行し,左腎血管筋脂肪腫に対しても待機的に経カテーテル的動脈塞栓術を施行した。2017年にCTで右腎尾側に新たに腫瘤を指摘され,2年の経過で12cmから20cm大に急速に増大したため2019年3月にCTガイド下針生検を実施し類上皮型腎血管筋脂肪腫と診断された。2019年5月に術前TAE後に開腹右腎部分切除術を施行した。2019年9月よりエベロリムスを開始したが,腎機能障害とHbA1cの上昇を認めたため中止した。その後,術後12ヵ月まで再発および転移を認めず経過している。(著者抄録)

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

症例は41歳,女性。2008年に結節性硬化症,両側腎血管筋脂肪腫およびIgA腎症と診断され,経過観察されていた。2015年に右腎血管筋脂肪腫より出血を認め緊急経カテーテル的動脈塞栓術を施行し,左腎血管筋脂肪腫に対しても待機的に経カテーテル的動脈塞栓術を施行した。2017年にCTで右腎尾側に新たに腫瘤を指摘され,2年の経過で12cmから20cm大に急速に増大したため2019年3月にCTガイド下針生検を実施し類上皮型腎血管筋脂肪腫と診断された。2019年5月に術前TAE後に開腹右腎部分切除術を施行した。2019年9月よりエベロリムスを開始したが,腎機能障害とHbA1cの上昇を認めたため中止した。その後,術後12ヵ月まで再発および転移を認めず経過している。(著者抄録)

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

腎移植は末期腎不全に対する腎代替療法として理想的な治療である。生体で約94%,献腎で約88%という高い5年生着率が得られており,抗ドナー抗体(Donor-Specific Antibody:DSA)陽性のハイリスク症例に対する移植も積極的に行われつつある。2019年12月にDSA陽性腎移植における術前脱感作として免疫グロブリン大量静注療法(Intravenous Immunoglobulins:IVIG)が保険適応となった。IVIGは海外ではその有効性について多くの報告があり,日本でもGame changerとなりうる。今回,当科でDSA陽性に対し術前IVIGを行った2例を含めその有用性について文献的に検討する。症例1は69歳,3次移植の男性。原疾患不明の腎不全に対し,外国にて献腎移植を施行するも,術中に超急性拒絶反応を認め即座に移植腎を摘出,2つ目の腎が移植された。移植後約12年で当科に紹介受診。移植後約20年でgraft lossに至り,妻をドナーとしたA型(Rh+)→AB型(Rh+)の血液型不一致生体腎移植が検討された。CDCXMはT,B cell共に(-),FCXMはT cell(-),B cell(+),FlowPRA Single antigenでHLA-DQ強陽性であった(nMFI=23,230)。TAC,PSLに加え術前6週前より中止していたMMFを再開し,計500mgのrituximabを3及び1週前に投与,血漿交換はDFPP3回とPEX1回,術前16日前より計5回,計140gのIVIGを行い,移植を施行した。症例2は71歳,女性。IgA腎症を原疾患とする腎不全に対して,HD導入前に当科受診。妊娠・出産歴3回,夫をドナーとしたAB型(Rh+)→AB型(Rh+)の血液型一致生体腎移植が検討された。CDCXMはT,B cell共に(-),FCXMはT cell(-),B cell(+),FlowPRA Single antigenでHLA-C,DR,DQ陽性であった(nMFI=〜5,000)。術前脱感作はTAC,MMF,PSL,計500mgのrituximabを3及び1週前に投与,血漿交換はDFPP3回とPEX1回,術前16日前より計5回,計140gのIVIGを行い,移植を施行した。2症例とも術後現在まで一度も拒絶反応を起こすことなく良好な腎機能で経過している。(著者抄録)

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

症例は79歳,男性。2年前に検診にて左腎嚢胞と診断され近医で経過観察となっていたが,増大傾向であったため当科紹介となった。造影CT検査でBosniak分類category IVの左嚢胞性腎癌を疑い,腹腔鏡下左腎摘除術を施行した。術後病理結果から,粘液嚢胞腺癌(Mucinous cystadenocarcinoma)と診断した。術後補助化学療法は行わずに経過観察としていたが,術後3ヵ月後に多発肺転移が出現し,化学療法(カルボプラチン+パクリタキセル)を開始した。5コース投与後の肺転移はSDであったため,一旦化学療法中止で経過観察の方針としたが,5ヵ月後に肺転移は増大傾向を認めたため術後14ヵ月目よりニボルマブの投与を開始した。ニボルマブ2コース投与後のCTで肺転移は縮小し,5コース投与後もPRを維持しているため現在も投与継続中である。(著者抄録)

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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 (scientific journal)   Publisher：Wolters Kluwer Medknow Publications  

Objectives: The Gleason scoring system is an essential tool for determining the treatment strategy in prostate cancer (PCa). However, the Gleason grade group (GGG) often differs between needle-core biopsy (NCB) and radical prostatectomy (RP) specimens. We investigated the diagnostic value of a second opinion pathology review using NCB specimens in PCa. Materials and Methods: We retrospectively evaluated 882 patients who underwent robot-assisted RP from January 2012 to September 2019. Of these, patients whose original biopsy specimens were obtained from another hospital and reviewed by the urological pathology expert at our institution were included in the study. Patients who received neoadjuvant hormonal therapy were excluded from the study. Weighted kappa (k) coefficients were used to evaluate the diagnostic accuracy of each review. Results: A total of 497 patients were included in this study. Substantial agreement (weighted k = 0.783) in the GGG between initial- and second-opinion diagnoses based on NCB specimens was observed in 310 cases (62.4%). Although diagnoses based on a single opinion showed moderate agreement with the GGG of RP specimens (initial: 35.2%, weighted k = 0.522
second opinion
38.8%, weighted k = 0.560), matching initial and second opinion diagnoses improved the concordance (42.9%, 133/310 cases) to substantial agreement (weighted k = 0.626). Conclusions: A second opinion of PCa pathology helps to improve the diagnostic accuracy of NCB specimens. However, over half of diagnoses that matched between the initial and second opinions differed from the diagnosis of RP specimens.

DOI： 10.4103/UA.UA_81_20

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

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

症例は19歳,男性。抗菌薬投与で改善しない排尿障害,排尿時痛を主訴に前医を受診。MRIで前立腺のT1強調像,T2強調像ともに低信号で,造影効果を伴う膀胱内に突出する腫瘤を指摘され当院紹介となった。血液,尿検査では特記事項なく,尿培養,尿細胞診は陰性であった。PSAを含め腫瘍マーカーの有意な上昇を認めなかった。膀胱鏡検査では前立腺部尿道に約35mmの非乳頭状広基性腫瘍を認めた。造影CTでは前立腺部にMRI同様の所見を認め,リンパ節腫大及び遠隔転移は認めなかった。排尿障害改善及び組織検査目的に経尿道的前立腺切除術(TUR-P)を施行した。切除組織は長紡錘形細胞の束状の増殖とリンパ球,形質細胞浸潤を認め,免疫染色でALK(anaplastic lymphoma kinase)陽性,α-smooth muscle actinが少数の細胞で陽性であり,前立腺炎症性偽腫瘍(inflammatory pseudtumor:IPT)と診断した。局所再発の可能性はあるものの,遠隔転移の可能性は低く,排尿状態の改善を得られたため経過観察の方針とした。術後10ヵ月現在で腫瘍の再燃を認めていない。(著者抄録)

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

BACKGROUND: Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4 cm in diameter. METHODS: We included patients aged ≥ 20 years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4 cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. RESULTS: From October 2013 to October 2015, 33 patients (mean age: 68 ± 14 years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0-3.4) cm. The median follow-up period was 60.1 (range 18.4-76.6) months. One patient died of non-renal cell carcinoma-related disease 46 months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3 years, and 100% and 96.8% at 5 years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. CONCLUSION: Percutaneous cryoablation for renal cell carcinoma ≤ 4 cm in diameter achieved good tumor control with a low complication frequency.

DOI： 10.1007/s10147-020-01825-4

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

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Language：Japanese   Publisher：The West Japan Urological Association  

A female patient in her thirties was diagnosed with neurofibroma by left axillary skin biopsy, and neurofibromatosis type 1 (NF-1
von Recklinghausen disease) was suspected based on characteristic skin findings (cafe-au-lait spots) and her family history. In February X, the patient consulted a doctor for right thigh and back pain. An MRI and contrast CT showed a 13 cm retroperitoneal tumor, which was suspected to have originated from the L2 nerve root and to have invaded the spinal canal. The doctor referred the patient to our department for a surgical procedure. We consulted the Department of Orthopaedic Surgery and performed an MRI-guided biopsy, which suggested the possibility of a malignant peripheral nerve sheath tumor (MPNST). In June X, we resected the right retroperitoneal tumor following arterial embolization. Pathological results confirmed it to be an MPNST. The patient has not experienced any recurrence during the 10 months since the surgery. MPNSTs are extremely rare tumors and there is no standard treatment for them because of their rarity. We experienced a case of retroperitoneal MPNST and we herein report the features of this case and present some review of the literature.

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Other Link： https://search.jamas.or.jp/link/ui/2021210988

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

A 46-year-old woman visited a urological clinic with the chief complaint of urinary frequency and dysuria. She had been examined with regular follow-up MRI following excision of a uterine fibroid, which had revealed a cystic lesion around the urethra. Her symptoms did not improve under medical treatment, so she was then referred to our hospital for further treatment. Abdominal ultrasound revealed no post-void residual urine but a cystic lesion around the urethra. Internal examination indicated an elastic soft mass below the anterior vaginal wall. Communication between the cystic lesion and the urethra was observed with cystourethroscopy when the cystic lesion was punctured in a transvaginal way and injected with indigo carmine. Her symptoms improved for a while, however, nine months later, the cystitis symptoms recurred, and MRI showed an enlarged cystic lesion. Transvaginal urethral diverticulectomy was then performed. The communication of diverticulum with the urethra was closed, and the mucosal lining within the diverticulum was removed as much as possible. The periurethral fascia and vaginal wall were closed, respectively. The patient had no perioperative complications and no recurrent urinary symptoms.

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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)日本泌尿器内視鏡・ロボティクス学会  

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

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

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

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

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

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Language：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  

免疫チェックポイント阻害剤による稀な合併症の1つである血球貪食症候群を経験したので報告する。症例は59歳の男性。検診エコーで右腎腫瘤を指摘され、当院に紹介された。造影CTで右腎中極腹側に4cm、背側に2cm大の腎癌を疑う占拠性病変を認めた。右腎癌に対して、凍結療法や腎部分切除術も考慮したが、左腎は無機能腎であったことも考慮し、ニボルマブ・イピリムマブ併用療法を開始した。2サイクル投与後7日目に下痢、発熱のため受診され、補液で加療を行うも、入院後4日目に貧血、血小板の減少とフェリチンの異常高値、CTにて肝脾腫の出現を認めた。骨髄穿刺で血球貪食像を認め、ニボルマブ・イピリムマブ併用療法による血球貪食症候群と診断された。治療としてメチルプレドニゾロンを投与後、速やかに解熱し、血球の減少やフェリチンの異常高値の改善も認めた。免疫チェックポイント阻害剤による血球貪食症候群は、少数であるが報告もあり、重症例では致死的な疾患であるため注意を要する。(著者抄録)

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

症例は55歳、女性。右腰背部痛を主訴に近医受診した。CTでClass 3Bの気腫性腎盂腎炎を認め、当院緊急搬送となった。未治療の2型糖尿病を有しており、HbA1cは13.4%であった。抗菌薬投与、血糖コントロール、ガンマグロブリン療法による保存的加療を開始したが、改善を認めなかった。CTガイド下経皮的ドレナージによる腎温存治療を最大限に検討したものの、広範で多房性にガス像を呈していたため穿刺部位を特定できず断念した。そのため入院4日後に経腰式右腎摘除術を施行した。術後の経過は良好で、入院30日後に退院となった。気腫性腎盂腎炎は腎実質やその周囲組織にガスの集簇を認める重篤な急性壊死性感染症である。適切に加療しなければ致死的となり得る疾患であるが、近年では保存的加療や経皮的ドレナージを中心とする腎温存を図る治療が多数ある。腎温存は施行できなかったが、腎摘除術を行うことで良好な経過を得られた症例を経験したので報告する。(著者抄録)

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

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

切除可能な腎盂・尿管癌において、外科的治療の標準術式は腎尿管全摘除術・膀胱部分切除術である。腹腔鏡手術は開放手術と比較して低侵襲であり、低リスク症例では前者が選択される傾向にあるが、pT3以上やリンパ節転移が疑われる症例では開放手術が推奨されている。また、腎機能に問題がある場合などに腎温存療法や化学療法が選択されることもある。本稿では腎盂・尿管癌における腹腔鏡手術の適応について考察する。(著者抄録)

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

[Introduction and objective) Pembrolizumab, a programmed death one checkpoint inhibitor, was approved as second-line treatment of advanced urothelial cancer (UC). We performed a pilot study to investigate the effect of pembrolizumab. [Methods and patients) 19 patients who were treated with pembrolizumab from April 2018 to July 2019 were retrospectively reviewed and analyzed to evaluate efficacy and safety. Pembrolizumab was administered after platinum-based chemotherapy. [Results) The median age was 68 years old
male-to-female ratio was 14:5
primary lesions were upper urinary tract, bladder and others (10, 7 and 2, respectively)
recurrence lesions were lymph nodes, lung, bone and liver (14, 9, 4 and 2, respectively). The median number of cycles was three courses (range, 1-16). The objective response rate, median progression-free survival period (PFS), and median overall survival period (OS) were 24%, 2.7 months and 9.1 months, respectively. Pembrolizumab showed a long-term effect for all responsive cases until the end of the follow-up period. Immune-related adverse events (irAE) were observed in four patients. Neutrophil-to-lymphocyte ratio was negatively correlated with PFS, but not significantly correlated with OS. [Conclusion) Pembrolizumab demonstrated a comparable efficacy and safety profile in the treatment of advanced UC. In particular, responsive cases showed a durable response. Further investigation is required to identify predictive markers that can be routinely used in clinical practice.

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

【目的】当科におけるpembrolizumabの治療成績について報告する。【対象と方法】2018年4月から2019年7月までの間に、当院で進行性尿路上皮癌に対してpembrolizumabを使用した19例を対象とした。後方視的に有効性と安全性について検討した。【結果】年齢中央値は68歳(39〜81歳)、性別は男性14例(74%)、女性5例(26%)であった。上部尿路腫瘍10例(53%)、膀胱腫瘍7例(37%)、その他2例(11%)であり、転移部位はリンパ節14例(74%)、肺9例(47%)、骨4例(21%)、肝2例(11%)であった。投与回数の中央値は3回(1〜16回)、観察期間の中央値は4ヵ月(1〜12ヵ月)であった。奏効率は24%、progression-free survival(PFS)の中央値は2.7ヵ月、overall survival(OS)の中央値は9.1ヵ月であった。PRを得られた症例(4例)では観察期間終了時点においても全例で継続可能であった。免疫関連有害事象は4例で経験した。好中球・リンパ球比とPFSは負の相関を認めた。【結論】当院におけるpembrolizumabの治療成績は他の報告と同等であった。奏効例についてはdurable responseを得られた。今後、臨床的に応用可能な効果予測因子のさらなる検討が必要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01004&link_issn=&doc_id=20200514090018&doc_link_id=%2Fer9niuro%2F2020%2F008201%2F018%2F0106-0110%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2020%2F008201%2F018%2F0106-0110%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(公社)日本化学療法学会  

臨床的に遭遇する頻度の高い尿道炎は、初診時に淋菌性か非淋菌性か鑑別してマネジメントを行う。非淋菌性尿道炎(Non-gonococcal urethritis、NGU)の場合にはクラミジア性尿道炎をまず想定するが、保険収載の関係から淋菌(Neisseria gonorrhoeae)、クラミジア(Chlamydia trachomatis)以外の病原微生物に関する検査は行うことができない。検査の性格上、一次治療を開始したあとにC.trachomatisの有無が判明する。治療失敗例では、Mycoplasma genitaliumなど、C.trachomatis以外の病原体の存在を考慮して二次治療を開始する。その際、M.genitaliumの薬剤感受性が低下していることや治療失敗例が報告されており、薬剤の選択には十分な注意が必要である。わが国のガイドラインでは、NGUに対してsitafloxacin(STFX)が推奨薬の一つとして挙げられており、良好な治療効果も報告されている。現時点ではNGUに対してazithromycin(AZM)を第一選択、STFXを第二選択として使用されることが一般的であるが、AZMによる治療失敗例だけでなく、症例によっては初期からSTFXが採用されるべきである。(著者抄録)

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Language：Japanese   Publisher：Japanese Society of Endourology  

<p>  Since robot-assisted laparoscopic radical prostatectomy in 2012 was covered by insurance, robotic surgery has rapidly spread. At the Okayama University Hospital-related facilities, da Vinci has spread rapidly over the past few years, and 13 da Vinci (including Okayama University Hospital) are in operation and 45 surgeons are operating. However, the surgical methods and instruction methods at each facility are not the same. Due to personnel changes in related facilities, surgeons with various backgrounds have become enrolled at Okayama University Hospital, and multiple surgical methods have been disrupted even within the same facility. The robot surgery education of our facility could not cope well with this situation, and the perioperative results tended to deteriorate from around 2015. In order to solve this problem, we tried to overcome this situation by applying the concept of "unifying the surgery contents, improving the reproducibility of the surgery contents and aiming for a short learning curve" cultivated in laparoscopic education.</p>

DOI： 10.11302/jsejje.33.221

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J05817&link_issn=&doc_id=20201215380007&doc_link_id=10.11302%2Fjsejje.33.221&url=https%3A%2F%2Fdoi.org%2F10.11302%2Fjsejje.33.221&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>症例は65歳男性。糖尿病性腎症による末期腎不全に対する腎移植術前CTにて右蝶形骨洞に真菌を疑う軟部影を認めたが、無症候性であった。しかしながら、移植後の免疫抑制状態で劇症型になる可能性を考慮し、移植3カ月前に内視鏡下副鼻腔手術ESSにて糸状菌塊を除去（粘膜への真菌浸潤なし）、追加治療することなく経過は安定していた。 生体腎移植については妻をドナーとしたABO不適合（術前減感作療法としてRituximab 200mg/body×1、DFPP×2、PE×1を実施、免疫抑制剤はTac-ER、MMF、PSL、Basiliximabを使用）、経過は良好でPOD18に退院となった（ Cr 1.28mg/dl ）。 移植後2カ月が経過し、右顔面痛・頭痛が出現、近医で副鼻腔洗浄や抗菌薬投与を受けるも改善せず。β-Dグルカン 53pg/mlと異常高値、副鼻腔MRIでは一部骨への浸潤を疑う軟部影を認め、再度ESSを施行、紙様板は腐骨化を認めたが真菌塊を可及的に除去した。VRCZも併用・継続し、術後1カ月でβ-Dグルカンも正常化、現在、再燃を認めていない。 浸潤性副鼻腔真菌症は副鼻腔から眼窩，海綿状静脈洞，頭蓋内へ浸潤し致死的となり、全生存率は概ね50%と、予後不良とされる。今回、予防的にESSを先行したが、腎移植後、急性浸潤性に再燃した症例を経験したので、若干の文献的考察を加えて報告する。 </p>

DOI： 10.11386/jst.55.Supplement_387_3

CiNii Article

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

DOI： 10.1016/S2666-1683(20)33968-9

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

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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

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

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

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

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

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

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

We report two cases where gastrointestinal cancer gave rise to a metastatic ureteral tumor. Case one was a 64-year-old man who was operated on for descending colon cancer in September, 2007. In 2014, he was referred to our hospital because computed tomography (CT) scan showed a tumor of the right ureter. Ureteroscopic biopsy showed a metastatic ureteral tumor arising from descending colon cancer. The patient underwent open tumor resection. Transurethral resection of a bladder tumor (TUR- BT) was required three times for treatment of tumor recurrence from the ureteral stump in an effort to control gross hematuria Case two was a 62-year-old man who underwent pylorus-preserving gastrectomy for gastric cancer in December, 2014. Follow-up CT showed right hydronephrosis and thickening of the right ureteral wall in 2017. Selective urine cytology of the right ureter revealed urothelial carcinoma, class V. Ureteroscopic biopsy of the right ureter revealed invasive urothelial carcinoma. The patient underwent retroperitoneal laparoscopic nephroureterectomy. Histological examination revealed the right ureteral tumor to be metastasis of gastric cancer.

Scopus

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Language：Japanese   Publishing type：Research paper (international conference proceedings)   Publisher：The West Japan Urological Association  

Renal autotransplantation (RAT) is a great surgical procedure for renal preservation, however it is underutilized due to its invasiveness. Robotic RATx has been in use since 2014. We conducted robotic RATx following a feasibility study using a porcine model. A 38-year-old woman with left ureteral stenosis was referred to us for urinary tract reconstruction. She had undergone an emergency Caesarean section for intraperitoneal bleeding secondary to left ovarian rupture four years earlier. After the surgery, she developed hypovolemic shock and disseminated intravascular coagulation (DIC) due to postoperative bleeding. Left internal iliac artery embolization saved her life. However, it resulted in a left ureteral stenosis measuring 2.7 cm that was located 5 cm from the left ureteral orifice, which required chronic ureteral stent exchange. Neither balloon dilation nor laser incision was successful. In addition, retrograde pyelography showed a possible left ureteropelvic junction obstruction. The patient was hesitant about the surgery because of its invasiveness. However, four years later, the patient elected to undergo robotic RATx. To date, only four cases of robotic RATx have been reported, including the current case. The indication of all four cases was extensive ureteral stenosis. Ileal ureter is frequently used for the treatment of extensive ureteral stenosis, but it can entail many problems including urine reabsorption resulting in metabolic acidosis. Ileal ureter is contraindicated for patients with a serum creatinine (sCr) level greater than 2 mg/dl. Even if sCr is less than 2 mg/dl, it is questionable whether sCr will remain less than 2 mg/ dl for the remainder of someone's life. Boari flap can give rise to vesicoureteral reflux causing urinary tract infection. RATx does not have those problems. Robotic RATx is a new, minimally invasive approach to renal preservation.

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Language：Japanese   Publishing type：Research paper (international conference proceedings)   Publisher：The West Japan Urological Association  

Robot-assisted radical cystectomy became listed as being covered by insurance in 2018 and accordingly, it is expected to become a popular surgical method in Japan in the future. In this study, we examined the findings of 102 patients who underwent total cystectomy (ORC, 35 cases), laparoscopic radical cystectomy (LRC, 52 cases), and robot-assisted radical cystectomy (RARC, 15 cases). The examined items were operative time, bleeding volume, postoperative complications, length of hospital stay, postoperative walking start date, postoperative pain and postoperative fever. Operative time was the shortest for RARC and bleeding volume was the lowest for RARC. Postoperative complications comprised approximately 33% (all grades) in any group. LRC and RARC were superior to ORC regarding both the period until walking start day and the period of postoperative persistent fever. Compared to ORC, patients undergoing RARC can expect an earlier recovery after surgery. In addition, patients undergoing RARC can expect stable surgical results with little difference in the postoperative course of each case.

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡学会  

ロボット手術導入後より、腹腔鏡手術の手術件数は減少し、全盛期の半分となっている。これからの腹腔鏡教育はこのことを念頭に考えていかなければならない。&quot;手術教育の根幹となる手術&quot;は腹腔鏡手術の普及に伴い開腹手術から腹腔鏡に移行したが、近年ロボット手術に移行しつつある。しかしながら、ロボット手術は腹腔鏡手術の一種であり、開腹手術から腹腔鏡手術へといった大きなシフトではなく、ロボット手術と腹腔鏡手術は並列なものと捉え、相補的な教育を行っていくことが大切だと考える。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05817&link_issn=&doc_id=20190611290006&doc_link_id=%2Fcs5jjend%2F2019%2F003201%2F009%2F0028-0031%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2019%2F003201%2F009%2F0028-0031%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

J-GLOBAL

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

The herbal medicine "gosha-jinki-gan" is effective for the treatment of patients with overactive bladder and an increase in peripheral blood flow. We prospectively assessed the relationship between the effectiveness of gosha-jinki-gan for female patients with overactive bladder and an improvement in their sensitivity to the cold. Between December 2012 and March 2016, gosha-jinki-gan 2.5 g t.i.d. was administered to a total of 56 adult female patients with overactive bladder for a period of 4 weeks. Their symptoms were assessed using the Overactive Bladder Symptom Score (OABSS), and their sensitivity to the cold was assessed using a questionnaire about the cold, based on Terasawa's diagnostic criteria. Skin temperature (at the palmar, suprapubic and plantar locations), OABSS and answers to the questionnaire about the cold were obtained at baseline and again at 4 weeks after treatment. Average age was 64 ± 13.8 years. Total OABSS improved significantly at 4 weeks (7.57 ± 3.36 vs. 6.73 ± 3.50), however skin temperature did not increase significantly. In a subgroup analysis, total OABSS was found to have improved significantly at 4 weeks (7.94 ± 3.65 vs. 6.86 ± 3.61) in the 36 women with sensitivity to the cold. However, although it showed a trend for improvement, that improvement was not statistically significant in the 20 women without sensitivity to the cold. Our findings indicated that gosha-jinki-gan improved overactive bladder symptoms more in patients with sensitivity to the cold than in patients without sensitivity to the cold.

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

Stage I期セミノーマの手術後には補助治療を行わず経過観察とするsurveillanceが現在の主流となっており、再発率は13〜20%と言われている。補助治療の有無によらず、再発の大半は手術後2年以内が占める。以降の再発は晩期再発と呼ばれ区別されているが、そのリスク因子は明確になっていない。手術後5年以降の再発は0.8%〜2.5%と報告されており、術後10年を超えての再発はさらに稀である。今回、我々は高位精巣摘除術14年後に発生したセミノーマ晩期再発を経験したので、若干の文献的考察を加え報告する。症例は40代、男性。右下腿浮腫、総腸骨リンパ節の腫大、骨盤内腫瘤を指摘され当科紹介受診した。患者は前医受診の14年前に右精巣腫瘍に対し高位精巣摘除術を行われており、セミノーマpT2N0M0 Stage IBとして術後6年間のフォローの後に終診となっていた。当科受診時にはLDH 667 U/l(120〜240U/l)、β-hCG 17.5mIU/l(&lt;0.5mIU/l)と高値を認め、骨盤内腫瘤生検によりセミノーマの再発と診断、救済化学療法としてBEP3コース、VeIP療法を3コース施行した。VeIP療法施行後、骨盤内残存腫瘤の切除を行った。摘出標本は壊死組織のみでviable cellは認めず、術後7ヵ月時点では局所再発、転移は認めていない。(著者抄録)

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

牛車腎気丸には過活動膀胱症状を改善する効果があることが知られているが、末梢血流増加作用もある。女性過活動膀胱に対し牛車腎気丸を投与し、治療効果と冷えとの関係を検討した。成人女性過活動膀胱患者56例を対象とし、TJ-107ツムラ牛車腎気丸エキス顆粒(牛車腎気丸)1日7.5gを分3で4週間投与し、治療前、治療4週目に過活動膀胱質問票(Overactive Bladder Symptom Score;OABSS)、冷えに関する質問票で症状を確認し、非接触型赤外線温度計で体表温度(手掌、恥骨上、足蹠)を測定した。他の過活動膀胱治療薬を内服している場合は変更せず継続した。平均年齢は35〜90歳(平均64.1±13.8歳)で、OABSSは治療前7.57±3.36、後6.73±3.50と有意に改善した(p=0.006)。治療前後で体表温度の有意な上昇はみられなかったが、治療前に冷えを自覚した36例(64.3%、平均65.1±13.8歳)ではOABSSが治療前7.94±3.65、後6.86±3.61と有意に改善し(p=0.004)、治療前に冷えを自覚しなかった20例(35.7%、平均62.3±13.6歳)では改善傾向はあったが有意差はなかった。このことから、治療前に冷えの自覚があるほうが、自覚のない症例に比べて牛車腎気丸による治療効果が期待でき、治療の指標になりうると考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01004&link_issn=&doc_id=20190222240003&doc_link_id=%2Fer9niuro%2F2019%2F008101%2F003%2F0012-0016%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2019%2F008101%2F003%2F0012-0016%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

Stage I期セミノーマの手術後には補助治療を行わず経過観察とするsurveillanceが現在の主流となっており、再発率は13〜20%と言われている。補助治療の有無によらず、再発の大半は手術後2年以内が占める。以降の再発は晩期再発と呼ばれ区別されているが、そのリスク因子は明確になっていない。手術後5年以降の再発は0.8%〜2.5%と報告されており、術後10年を超えての再発はさらに稀である。今回、我々は高位精巣摘除術14年後に発生したセミノーマ晩期再発を経験したので、若干の文献的考察を加え報告する。症例は40代、男性。右下腿浮腫、総腸骨リンパ節の腫大、骨盤内腫瘤を指摘され当科紹介受診した。患者は前医受診の14年前に右精巣腫瘍に対し高位精巣摘除術を行われており、セミノーマpT2N0M0 Stage IBとして術後6年間のフォローの後に終診となっていた。当科受診時にはLDH 667 U/l(120〜240U/l)、β-hCG 17.5mIU/l(&lt;0.5mIU/l)と高値を認め、骨盤内腫瘤生検によりセミノーマの再発と診断、救済化学療法としてBEP3コース、VeIP療法を3コース施行した。VeIP療法施行後、骨盤内残存腫瘤の切除を行った。摘出標本は壊死組織のみでviable cellは認めず、術後7ヵ月時点では局所再発、転移は認めていない。(著者抄録)

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Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

The indications for renal autotransplantation (RATx) include renal vascular trauma, thrombosis, stenosis, aneurysm, complex ureteral injuries, renal cell carcinoma, urolithiasis, retroperitoneal fibrosis, and loin pain-hematuria syndrome. Unfortunately, RATx is underutilized because of its invasiveness. The current gold standard approach to RATx is laparoscopic nephrectomy and open autotransplantation, which requires a large pelvic incision. Robotic-assisted renal autotransplantation (robotic RATx) is a new, minimally invasive approach that has been used since 2014. The first completely intracorporeal robotic RATx, used to repair a ureteral injury, was reported in 2014. Since then, only three cases have been reported, all from North America. After an initial porcine study, we conducted the fourth robotic RATx procedure. Robotic surgery has multiple advantages, such as providing a three-dimensional magnified view, navigating in narrow spaces, and fine suturing and dissection, which are particularly helpful in cases with desmoplastic changes. Most robotic RATx procedures have been used to repair ureteral injuries. These cases tend to have desmoplastic changes due to previous surgeries. Nephrectomy and RATx are technically challenging, hence robotic surgery may be the best option in patients with complex and severe desmoplastic changes. The disadvantages of robotic RATx include the length of surgery and cost. However, with continued use, both the operative time and the cost should decrease. In conclusion, robotic RATx is a new, minimally invasive approach to renal preservation.

DOI： 10.1007/978-981-13-3465-8_18

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

A 64-year-old woman who had recurrent fever was referred to our hospital. She had been diagnosed with rheumatoid arthritis (RA) in 2007 and treated with methotrexate (MTX) therapy since 2008. She had the same symptoms in 2015. At that time, Cervical cancer and lung metastasis were suspected from computed tomography (CT) scan. Cervical punch biopsy revealed no malignancy. The lung nodules and her symptoms disappeared on spontaneous regression. CT scan showed left pyelectasis, left ureteral stenosis, urethral tumor and various parts of lymphadenopathy. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) showed an uptake of FDG in the left renal hilar lymph node, the urethra and the nasopharynx. MTX-associated lymphoproliferative disorders (MTX-LPD) were suspected rather than metastatic urothelial carcinoma. Pathological examination of the nasopharynx biopsy showed Hodgkin's lymphoma, and Epstein-Barr-encoding region in situ hybridization (EBER-ISH) stain was positive. MTX-LPD was diagnosed. One year after MTX withdrawal, tumors of the left ureter and the urethra remain, but other lesions have shown regression in size.

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

症例は64歳、女性。2007年に関節リウマチの診断を受け、2008年よりメトトレキサート(MTX)内服中であった。2015年に繰り返す発熱で近医を受診。CTで子宮頸癌および両肺多発転移を疑われた。当院婦人科で子宮頸部パンチ生検を施行するも悪性所見なく、肺結節も自然消退したため経過観察となっていた。2017年2月、症状が再燃し近医を受診した。CTで左下葉結節影、右肺門リンパ節腫脹、腹腔内リンパ節腫脹および左腎盂拡張を認め、PET-CTで左腎門部リンパ節、尿道、上咽頭に高集積を認めた。MTX関連リンパ増殖性疾患(MTX-LPD)を疑い、施行した上咽頭生検はHodgkinリンパ腫の像を呈し、EBER-ISH陽性であった。MTX中止後は左尿管病変および尿道病変に著変はないものの、肺腫瘤とリンパ節は縮小傾向で現在経過観察中である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01004&link_issn=&doc_id=20181228180007&doc_link_id=%2Fer9niuro%2F2018%2F008012%2F007%2F0678-0683%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2018%2F008012%2F007%2F0678-0683%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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The penis is an extremely rare primary site for malignant melanomas, and the clinical presentation may vary greatly. We herein present the case of a 71-year-old male patient who presented with a 6-year history of two slow growing, asymptomatic red macules on the penile foreskin. On physical examination, the mobility of the foreskin was good, and there was no metastasis on computed tomography and magnetic resonance imaging. The patient underwent segmental circumcision for treatment and histological diagnosis, and the histological examination revealed a malignant melanoma. As cancer cells were identified at the edge of the tissue specimen and computed tomography-positron emission tomography revealed increased uptake of 18F-fluorodeoxyglucose in the penis, wider resection and a right sentinel lymph node biopsy were performed; both specimens came back negative. Two years after the surgery, there has been no evidence of locoregional recurrence or distant metastases. The aim of this report is to alert physicians to include melanoma in the differential diagnosis of red-pigmented lesions of the penile foreskin.

DOI： 10.3892/mco.2018.1697

PubMed

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

尿路感染症に対する治療として中心的な役割を果たしてきた抗菌化学療法は大きな転機を迎えている。世界的な時流として耐性菌の問題や医療経済的にも抗菌薬の使用量を減少させる方向に移行している。尿路感染症においても例外ではなく、そのマネジメントに関して治療法の見直しだけでなく予防の重要性についての議論がなされている。そのうち、これまでに様々な臨床研究において有効性が確認されつつあるプロバイオティクスが抗菌薬とは異なる尿路感染症対策として注目されている。健常な閉経前の女性の腟内においては、基本的に乳酸菌が細菌叢(フローラ)を形成しているが、月経中や閉経後は乳酸菌が減少して腸内細菌が腟内に定着することとなる。その腟がリザーバーとなって細菌を供給し、頻繁に尿路の逆行性感染を引き起こすと考えられている。すなわち、腟内を乳酸菌中心のフローラに保つことで尿路感染症の再発(反復)リスクが低くなることが期待でき、実際にプロバイオティクスを用いた多くの研究が行われている。我々が現在行っている乳酸菌製剤のほか、プロバイオティクスの経口摂取が腟内フローラに与える影響に関しても検証が進んでおり、プロバイオティクスが尿路感染症の予防や治療に寄与することが期待されている。(著者抄録)

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

尿路感染症に対する治療として中心的な役割を果たしてきた抗菌化学療法は大きな転機を迎えている。世界的な時流として耐性菌の問題や医療経済的にも抗菌薬の使用量を減少させる方向に移行している。尿路感染症においても例外ではなく、そのマネジメントに関して治療法の見直しだけでなく予防の重要性についての議論がなされている。そのうち、これまでに様々な臨床研究において有効性が確認されつつあるプロバイオティクスが抗菌薬とは異なる尿路感染症対策として注目されている。健常な閉経前の女性の腟内においては、基本的に乳酸菌が細菌叢(フローラ)を形成しているが、月経中や閉経後は乳酸菌が減少して腸内細菌が腟内に定着することとなる。その腟がリザーバーとなって細菌を供給し、頻繁に尿路の逆行性感染を引き起こすと考えられている。すなわち、腟内を乳酸菌中心のフローラに保つことで尿路感染症の再発(反復)リスクが低くなることが期待でき、実際にプロバイオティクスを用いた多くの研究が行われている。我々が現在行っている乳酸菌製剤のほか、プロバイオティクスの経口摂取が腟内フローラに与える影響に関しても検証が進んでおり、プロバイオティクスが尿路感染症の予防や治療に寄与することが期待されている。(著者抄録)

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

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

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

症例は65歳、女性。繰り返す膀胱炎様症状で前医を受診。膀胱鏡検査で膀胱後壁に腫瘤性病変を認めた。尿細胞診は陰性、CT、MRIでは炎症波及による2次性膀胱腫瘤の可能性を指摘され、経尿道的膀胱腫瘍生検を行うも病理結果では悪性所見なく炎症性変化との診断であった。症状の改善なく本年2月に当院紹介受診となった。各種自己免疫疾患の検査はいずれも陰性であった。CT、MRIを再検したがやはり炎症性腫瘤を疑われ、再度経尿道的膀胱腫瘍生検を試みた。膀胱内を観察すると腫瘤性病変は消退しており前回生検時の瘢痕を残すのみであった。瘢痕部位を再度生検し病理検査に提出したが結果は炎症所見のみで悪性所見は認めず炎症性偽腫瘍と診断した。生検後は大幅な症状の改善を認め、さらなる侵襲的な検査は行わず、経過観察とした。術後15ヵ月現在、症状の再燃を認めていない。(著者抄録)

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

症例は65歳、女性。繰り返す膀胱炎様症状で前医を受診。膀胱鏡検査で膀胱後壁に腫瘤性病変を認めた。尿細胞診は陰性、CT、MRIでは炎症波及による2次性膀胱腫瘤の可能性を指摘され、経尿道的膀胱腫瘍生検を行うも病理結果では悪性所見なく炎症性変化との診断であった。症状の改善なく本年2月に当院紹介受診となった。各種自己免疫疾患の検査はいずれも陰性であった。CT、MRIを再検したがやはり炎症性腫瘤を疑われ、再度経尿道的膀胱腫瘍生検を試みた。膀胱内を観察すると腫瘤性病変は消退しており前回生検時の瘢痕を残すのみであった。瘢痕部位を再度生検し病理検査に提出したが結果は炎症所見のみで悪性所見は認めず炎症性偽腫瘍と診断した。生検後は大幅な症状の改善を認め、さらなる侵襲的な検査は行わず、経過観察とした。術後15ヵ月現在、症状の再燃を認めていない。(著者抄録)

J-GLOBAL

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

岡山大学病院にて膀胱全摘除術を施行した81例(腹腔鏡下膀胱全摘除術(LRC)46例、開腹膀胱全摘除術(ORC)35例)を対象に、75歳以上を高齢者と定義し、75歳以上と75歳未満に層別し解析を行った。75歳以上の平均出血量(LRC 530ml、ORC 1,165ml:p=0.003)と術後14日目のヘモグロビン値(LRC 10.7g/dl、ORC 9.5g/dl:p=0.006)が統計学的に有意な差をもってLRCが優れた結果であった。平均入院日数は、75歳以上のLRC 30.4日、ORC 32.4日とLRCの方がやや短く、術後の平均歩行開始日はLRC 1.4日、ORC 2.3日(p=0.03)と統計学的に有意な差をもってLRCが早かった。術後の合併症(all grades)に関しては、75歳以上のLRC 50%、ORC 59%で、75歳未満のLRC 15.9%、ORC 33.3%に比べると高率に生じていた。今回の検討では、高齢者におけるLRCの低侵襲性が示され、また、LRCでは高齢者でも75歳未満の症例と同様の回復(術後ヘモグロビン値、歩行開始日)であった。しかしながら、高齢者ではLRCにおいても高率に術後合併症が発生しており、その適応は慎重に判断すべきである。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2018265375

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

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡学会  

尿膜管遺残は成人の0.02-2%に認められ、主に感染を来たした場合手術が考慮される。経過観察しても感染の再発率は約30%であり手術は必須ではない。本稿では経腹膜側方アプローチによる腹腔鏡下尿膜管摘除術について解説する。使用するポートは3本が多いが4本という報告も見られる。ポートの配置は右もしくは左に縦一列に置く方法が多い。我々は右下側臥位で左縦一列の3ポートで行っている。12mmカメラポートを一番頭側に置くことで尿膜管からの適切な距離が取れ、またその全長にわたって外側から描出することが可能となる。膀胱部分切除を行う場合は膀胱縫合のため正中側に5mmポートを追加する場合もある。手術は抗生剤治療で炎症が収まった後に施行することが多いため尿膜管=正中臍索がわかりにくいこともある。その際は側臍策の内側の構造物を剥離切除することによって結果的に尿膜管が摘出される。尾側はあまり深追いしすぎると膀胱損傷をきたす。切除範囲にコンセンサスはない。画像・検尿・膀胱鏡などで膀胱内への炎症の波及が認めなければ膀胱部分切除を行わないという報告があり我々も同様の考えである。臍に関しても合併切除を行う報告が多いが、臍を完全に切除しなくても再発率は0-20%と高くはない。また再発率20%とした報告は5例報告のうちの第1例目で、ポート位置のテクニカルエラーによる尿膜管不完全切除が強く疑われた症例である。我々も最近は臍切除を行わない症例が増えているが再発例を認めていない。以上、経腹膜側方アプローチによる腹腔鏡下尿膜管摘除術は、尿膜管を外側から全長にわたって確認しながら摘出が可能な優れたアプローチであり、低侵襲手術として患者のメリットも大きい。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05817&link_issn=&doc_id=20171013250002&doc_link_id=%2Fcs5jjend%2F2017%2F003002%2F003%2F0119-0122%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2017%2F003002%2F003%2F0119-0122%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

症例は62歳、男性。全身倦怠感で来院。CT、MRIにて後腹膜線維症による両側水腎症、腹部大動脈瘤(35mm)、左総腸骨動脈瘤(23mm)、右総腸骨動脈瘤(16mm)を認めた。血清Crは5.3mg/dLで腎後性腎不全の状態であったため両側尿管ステントを留置したところ血清Crは1.6mg/dLに低下した。その後3ヵ月ごとの尿管ステント交換を20ヵ月行った。経過中プレドニゾロン内服(30mg/dからの漸減5mg/d、11ヵ月)を行ったがステント抜去不可であった。またステロイド糖尿病を発症した。経過中両側尿管の狭窄が悪化、ガイドワイヤー挿入困難となった。将来的な尿管動脈瘻の出現も懸念されたため右尿管剥離、大網ラッピングを行った。Mag3腎シンチで左腎は無機能腎であったため同時に腎摘した。術後6週で尿管ステント抜去。術後9週において血清Crは1.3mg/dL、腎エコーで水腎grade II、Mag3腎シンチで3相形成が見られた。術後14ヵ月において血清Crは1.5mg/dL、腎エコーで水腎なく経過している。後腹膜線維症による水腎症に尿管剥離、大網ラッピングは有効な外科的治療である。(著者抄録)

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

The patient was a 62-year-old man who presented with general fatigue. Computed tomography and magnetic resonance imaging demonstrated bilateral hydronephrosis secondary to retroperitoneal fibrosis associated with abdominal (35 mm) and left and right common iliac aneurysms (23 and 16 mm, respectively). He was suffering acute renal failure with sCr of 5.3 mg/dL. Bilateral ureteral stents were placed and the level of sCr dropped to 1.6 mg/dL. He had been on chronic stent exchange for 20 months. Oral prednisolone (30 mg/d tapered to 5 mg/d for llmonths) did not improve the retroperitoneal fibrosis and only gave rise to steroid-induced diabetes. The bilateral ureteral stenosis became even worse and it became difficult for a guidewire to pass easily. There was concern regarding the development of ureteroarterial fistula. Mag3 renal scan demonstrated the left kidney to be non-functional. The patient underwent right ureterolysis with omental wrap and left nephrectomy. He then became stent-free without hydronephrosis. His sCr was 1.5 mg/dL 14 months post-op. Although it is underutilized in Japan, ureterolysis with omental wrap is an effective treatment option for patients with hydronephrosis secondary to retroperitoneal fibrosis.

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

【目的】近年夫婦間移植の増加や献腎移植の待機年数の延長に伴い、長期透析患者に対する腎移植が増加しており、移植前透析期間が腎移植に与える影響を検証した。【方法】2009年から2015年12月までに岡山大学病院泌尿器科で腎移植を施行した59例(生体57例、献腎2例)を対象に透析歴10年以上の症例を長期透析群とし、患者背景、免疫学的リスク、感染症、移植腎機能、手術操作、術後合併症を透析歴10年未満の短期群と比較検討した。【結果】短期群52例、長期群7例で年齢の中央値は短期群42.5歳、長期群62歳で有意な差はなかった(p=0.0959)。長期群は2例(29%)が献腎移植症例でCMV D+R-は短期群12例(23%)のみに認めた。尿管吻合時間は短期群32分、長期群40分であった。術後血清Creは短期群1.34mg/dL、長期群1.17mg/dLでありCMV血症や拒絶反応も両群間で差がなかった。【結論】長期透析患者に対する腎移植では尿管吻合に難渋する症例を認めたが、移植腎機能や合併症は短期群と同等であった。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2017011949

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

The present case report describes a case of recurrent and advanced urachal carcinoma including neuroendocrine features with iliac bone metastasis after partial cystectomy and adjuvant chemotherapy consisting of irinotecan and cisplatin in a 32-year-old man. He received gemcitabine/cisplatin/paclitaxel (GCP) combination chemotherapy, consisting of gemcitabin (1,000mg/m(2)) on day 1, 8, cisplatin (70mg/m(2)) on day 1, and paclitaxel (80mg/m(2)) on day 1 and 8. After three cycles of chemotherapy, PET-CT showed complete regression of the disease. So the patient underwent total cystoure-threctomy, and histological examination showed an almost complete pathological response. External beam radiation therapy was also given to the ileac bone metastasis regions. However, PET-CT taken 17 months after the external beam radiation showed multiple lung metastases. He received GCP chemotherapy again, which resulted in a complete response again after three cycles of chemotherapy. This is the first report on GCP chemotherapy used not only as a salvage chemotherapy but also as a rechallenge regimen for metastatic urachal cancer including a neuroendocrine component.

DOI： 10.18926/AMO/54423

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PubMed

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

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

尿管の血流不全と不完全なステント留置による尿路合併症を経験した。症例は42歳のO型男性。血液透析歴2年。44歳A型の姉をドナーとした血液型不適合生体腎移植を施行した。グラフトに2本の腎動脈が認められ、下極枝は下腹壁動脈と端々吻合し、尿管膀胱吻合に尿管ステントを留置した。術後2日目に下極枝が閉塞、術後5日目のCTでステントの近位ループが腎盂より遠位側に認められた。術後16日目に手術創より尿が流出し、腎瘻を造設した。術後17日目に腎盂尿管移行部近位で移植尿管-自己尿管吻合を施行し、術後22ヵ月でs-Cr:1.49mg/dlで経過良好である。複数腎動脈例では可及的な血行再建と、適切な尿管ステント留置が尿路合併症の予防に重要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本感染症学会  

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Language：Japanese   Publisher：(株)日本医学館  

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

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Language：Japanese   Publisher：(公社)日本化学療法学会  

フルオロキノロン系薬は濃度依存性に殺菌作用を示し、尿路性器感染症においても広く使用されている。近年は淋菌や大腸菌、緑膿菌などにおいてフルオロキノロン耐性化が問題となっているが、2009年にフルオロキノロン系薬の一つであるレボフロキサシン500mg製剤が販売開始となり、それまでの100mg製剤の投与に比べPK-PD理論に沿う投与法となった。今回、レボフロキサシン500mg単回投与の前立腺組織に対する移行性を検討した。対象は経尿道的前立腺切除術(TUR-P)を予定された患者で同意が得られた症例。尿路性器感染症を有する症例や1週間以内のフルオロキノロン系薬の投与歴のある患者、腎機能低下症(推定糸球体濾過量eGFR30mL/min/1.73m2以下)例は除外した。手術開始2時間前にレボフロキサシン500mgを経口摂取し、手術開始時に前立腺組織0.5gと血液を採取した。薬物濃度は液体クロマトグラフィータンデム質量分析(LC-MS/MS)法で測定し、患者背景や有害事象とともに解析した。エントリーされた5例の平均年齢は72.5±3.5歳、平均前立腺容積は56±21mL、術前の平均前立腺特異抗原(PSA)値は3.56±2.17ng/mL、推算糸球体濾過量eGFRは65.1±13.6mL/min/1.73m2であった。平均切除重量は25.0±13.0gで、術後平均7±3日で退院した。抗菌薬によると思われる有害事象、術後の尿路感染症はみられなかった。1例からGleason score:3+2の腺癌が検出された。血清中のレボフロキサシン濃度は平均5.97±0.50μg/mL、前立腺組織中のレボフロキサシン濃度は平均6.65±2.95μg/gであった。平均対血清比(前立腺組織内濃度/血清中濃度:T/S比)は1.115±0.445で、レボフロキサシンの高用量投与でも良好な前立腺組織への移行が示された。また有害事象や術後の感染症もみられず、臨床的にもレボフロキサシン500mg製剤の安全性、有用性が示唆された。(著者抄録)

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

Immunotherapy is one of the attractive treatment strategies for advanced prostate cancer. The US Food and Drug Administration (FDA) previously approved the therapeutic vaccine, sipuleucel-T, which is composed of autologous antigen-presenting cells cultured with a fusion protein [prostatic acid phosphatase (PAP) and granulocyte-macrophage colony-stimulating factor (GMCSF)]. Although sipuleucel-T has been shown to prolong the median survival of patients for 4.1 months, more robust therapeutic effects may be expected by modifying the vaccination protocol. In the present study, we aimed to develop and validate a novel vaccination strategy using multiple PAP-fused cytokines for prostate cancer treatment. Using a super gene expression (SGE) system that we previously established to amplify the production of a recombinant protein, significant amounts of PAP-fused cytokines [human GMCSF, interleukin-2 (IL2), IL4, IL7 and mouse GMCSF and IL4] were obtained. We examined the activity of the fusion proteins in vitro to validate their cytokine functions. A significant upregulation of dendritic cell differentiation from monocytes was achieved by PAP-GMCSF when used with the other PAP-fused cytokines. The PAP-fused human IL2 significantly increased the proliferation of lymphocytes, as determined by flow cytometry. We also investigated the in vivo therapeutic effects of multiple PAP-fused cytokines in a mouse prostate cancer model bearing prostate-specific antigen (PSA)- and PAP-expressing tumors. The simultaneous intraperitoneal administration of PAP-GMCSF, -IL2, -IL4 and -IL7 significantly prevented tumor induction and inhibited the tumor growth in the PAP-expressing tumors, yet not in the PSA-expressing tumors. The in vivo therapeutic effects with the multiple PAP-fused cytokines were superior to the effects of PAP-GMCSF alone. We thus demonstrated the advantages of the combined use of multiple PAP-fused cytokines including PAP-GMCSF, and propose a promising prostatic antigen-vaccination strategy to enhance the therapeutic effects.

DOI： 10.3892/or.2015.3770

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

小径腎癌に対するロボット支援下腎部分切除術(Robot assisted laparoscopicpartial nephrectomy以下:RALPN)は、腹腔鏡下腎部分切除術の弱点を補う手術方法として欧米を中心に広く行われている。岡山大学病院では、当院倫理委員会の承認を経て、2012年9月より本手術を開始し、これまでに10例に対し施行した。年齢中央値60歳(range:42〜71)、BMI 24.4kg/m2(同:20.2〜30.9)、腫瘍径2.5cm(同:1.1〜3.1)、RENAL nephrometry score 6(同:4〜9)、アプローチは経腹膜的4例、後腹膜的6例。手術時間230分(同:180〜400)、WIT 21分(同:9〜38)、出血量10ml(同:10〜150)、術前の平均eGFRは82.2ml/min/1.73m2、術後1ヵ月目の平均eGFRは73.4ml/min/1.73m2であった。切除断端はすべて陰性で、術後合併症や輸血を要した症例はなかった。術後入院日数は7日(同:6〜9)であった。近年、腎部分切除術の術後患側腎機能に影響を与える因子は、一定の阻血時間の条件では、阻血時間よりも腫瘍切除に伴う腎実質喪失が重要な因子であるとの報告がなされている。これまで腹腔鏡下腎部分切除術の手術手技は、いかに阻血時間を短縮するかが大きなテーマであったが、今後はこの腎実質喪失をいかにして少なくするかにシフトしていくと考えている。将来的には、腫瘍切除に関して腫瘍周囲の血管走行などを考慮した術前プランニングを行い、これらへの侵襲を必要最小限にする試みが重要であると考えられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01004&link_issn=&doc_id=20150428370002&doc_link_id=%2Fer9niuro%2F2015%2F007704%2F002%2F0124-0128%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2015%2F007704%2F002%2F0124-0128%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医学書院  

＜Point＞OABの診断,治療方針の決定,治療効果の判定のすべてにおいて,排尿記録は有用なツールである。初期治療後,症状が改善しない場合は,漫然と治療を継続するのではなく,他疾患の存在を疑うべきである。抗コリン薬はそれぞれ薬理作用,有効性,副作用の発現率が異なるため,複数の薬剤を試して,patient-orientedな治療の確立を目指すべきである。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

＜Point＞混合性尿失禁では,腹圧性,切迫性尿失禁の比重で治療方針が変わる。切迫性の比重が高いときには,抗コリン薬をはじめとする薬物療法が中心になる。腹圧性の比重が高いときには,薬物療法や骨盤底筋訓練から開始するが,効果不良なら手術も考慮する。(著者抄録)

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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

今回我々は、経直腸的前立腺針生検施行時における抗菌薬の予防的投与において、術前レボフロキサシン(LVFX)500mgの単回投与の有効性と安全性について前向きに検討を行った。倉敷成人病センターにおいて院内の倫理委員会承認後、全患者に同意を取った上で2010年1月から2011年2月まで、検査数時間前にLVFX 500mgの経口単回投与を行った。参加患者には退院前に症状、合併症についての質問票を配布し、次回外来受診時に回収、解析を行った。期間中134名の患者が登録され、100名の患者より質問票を回収した。LVFX由来と思われる合併症は全例で認められず、1例において急性前立腺炎から敗血症へ移行した症例を認めた。今回の検討では生検後前立腺炎の発症頻度は従来報告と比べ同程度であり、LVFXの生検前単回投与は、既存の予防法と同等の有効性と安全性を有することが示唆された。(著者抄録)

CiNii Article

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2015138263

Language：Japanese   Publisher：緑膿菌感染症研究会  

ICR系マウス(雄)を用い、発光性緑膿菌の培養液中にポリエチレンチューブ(PT)を浸漬してバイオフィルムを形成させ、経尿道的にマウス膀胱内に留置し、緑膿菌性尿路バイオフィルム感染症モデルを作製した。感染実験開始6日前からアンピシリン含有水を3日間飲水させた。IVIS Luminaによる観察では、比較対照の大腿部感染モデルではプラスミド上に発光オペロンをコードしたPseudomonas aeruginosa PAO1-lux1株は、染色体上にコードしたP.aeruginosa Xen 5株やXen 41株より10〜100倍高い発光量を示し、染色体上にコードしたP.aeruginosa PAO1-lux2株はXen 5株やXen 41株と同程度の発光量を示した。尿路感染モデルではプラスミド上にコードしたP.aeruginosa PAO1-lux1株は半数のマウスでPT挿入2時間後に膀胱の発光像を認めたが、以後は発光が不安定で生菌数との関連性はなかった。染色体上にコードしたP.aeruginosa PAO1-lux2株の発光は1週間安定であった。

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本性感染症学会  

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

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

前立腺癌に対する密封小線源療法は、優れたQOL保持やPSA非再発率などの長期治療成績が本邦でも確立されつつある。密封小線源療法後のフォローアップにおいてはPSA bounceに代表される特徴的な症候が認められる。PSA bounceについては、定義により異なるが、密封小線源療法を施行した症例全体の15〜87%に認められる一般的な症候であり、若い症例に多く認められる傾向や、PSA bounceを呈した症例は良好な予後が期待される報告が近年続いている。治療後3年以内のPSA bounceであるならば、まずは腰を構えて経過観察することが重要である。(著者抄録)

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Language：Japanese   Publisher：(公社)日本化学療法学会  

泌尿器科領域における精巣腫瘍、尿路上皮癌に対する抗癌化学療法は高頻度に行われているが、発熱性好中球減少症(febrile neutropenia:FN)に関する泌尿器科領域に特化した検討は少ない。今回、泌尿器癌に対する抗癌化学療法に伴うFNについて、後ろ向きに多施設共同調査を施行した。対象はUTI共同研究会に所属する泌尿器科メンバーの所属する10大学病院で、2010年1月から2011年12月に尿路上皮癌および精巣腫瘍に対して抗癌化学療法が開始された326症例、883コースとした。FNは326例中66例(20.2%)、883コース中81コース(9.2%)に認められ、治療として抗菌薬と顆粒球コロニー刺激因子(granulocyte-colony stimulating factor:G-CSF)の投与はそれぞれ69コース(85.2%)、77コース(95.1%)で投与されていた。一方、発熱を伴わない好中球減少症に対して抗菌薬とG-CSFはそれぞれ5コース(2.2%)、144コース(62.1%)で投与され、予防的投与として抗菌薬よりもG-CSFが頻用されていた。統計学的な検討では、尿路上皮癌において単変量・多変量解析ともに化学療法レジメンの種類のみ有意差がみられ(GC vs GCP;p=0.0073、GC vs M-VAC;p&lt;0.0001)、精巣腫瘍における単変量・多変量解析ではEPよりBEPで有意にFNの発症率が高かった。泌尿器科領域においても、さらに大規模で前向きなエビデンスを蓄積していくことでFNに対して適切なマネジメントを行っていくことが可能であると考えられる。(著者抄録)

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Language：Japanese   Publisher：日本バイオフィルム学会  

ラット尿路バイオフィルム感染症(膀胱内異物)モデルを応用してマウスモデルの作製を行い、その実験モデル系を使用して、IVIS imaging systemの応用性の検証ならびに経口抗菌薬の治療効果を検討した。前培養したPseudomonas aeruginosa PAO1-lux株の菌液中、螺旋形に形状記憶したポリエチレンチューブ(PT)を浸漬・浸盪培養してバイオフィルムを形成させた後、経尿道的に麻酔下のICR系マウス(雌、6〜7週齢)の膀胱内に留置し、尿道口を2時間閉鎖した。感染菌の排尿を確認したマウスを用いて5日後から抗菌薬の経口投与(1日1回)を開始した。最終投与翌日に膀胱内のPTを取り出し、生菌数を算出した。本膀胱内異物モデルは感染が21日以上持続し、PT挿入5日後の難治化した状態から14日間の長期抗菌薬投与による治療実験が可能であった。PT付着の生菌数を指標とした治療効果は、プルリフロキサシン(10mg/kg)単剤投与群の7〜14日間投与で認めた。また、プルリフロキサシン(10mg/kg)とホスホマイシン(100mg/kg)との併用群では、14日間投与で治療効果が増強した。IVIS Luminaによる感染病巣の観察では、約半数のマウスにおいてPT挿入2時間後に膀胱の発光像を確認したが、以降は発光が不安定で生菌数との関連性はなかった。今後、発光性緑膿菌の改良により、可視的で定量的な薬効評価系の確立を目指す。(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)日本泌尿器内視鏡学会  

岡山大学病院では、学内の倫理委員会の承認を経て2012年11月より成人の腎盂尿管移行部狭窄症に対しロボット支援腹腔鏡下腎盂形成術を開始した。2013年4月までに単一術者により3例施行した。手術は全例ロボット支援下に手術は完遂され、開腹への移行はなかった。手術時間は220分-267分、コンソール時間は162分-180分、推定出血量は10ml以下であった。術後合併症は認めず退院し、再入院や再手術は2013年8月現在認めていない。当施設でのロボット支援腹腔鏡下腎盂形成術の手術方法及び成績を報告し、問題点や今後の展望につき検討する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05817&link_issn=&doc_id=20140527170024&doc_link_id=%2Fcs5jjend%2F2014%2F002701%2F027%2F0162-0168%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2014%2F002701%2F027%2F0162-0168%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Publishing type：Research paper (scientific journal)  

OBJECTIVES: The increasing prevalence of resistant bacteria such as fluoroquinolone-resistant or extended-spectrum β-lactamase-producing strains in pathogens causing acute uncomplicated cystitis has been of concern in Japan. Faropenem sodium is a penem antimicrobial that demonstrates a wide antimicrobial spectrum against both aerobic and anaerobic bacteria. It is stable against a number of β-lactamases. METHODS: We compared 3 and 7 day administration regimens of faropenem in a multicentre, randomized, open-label, controlled study. RESULTS: In total, 200 female patients with cystitis were enrolled and randomized into 3 day (N = 97) or 7 day (N = 103) treatment groups. At the first visit, 161 bacterial strains were isolated from 154 participants, and Escherichia coli accounted for 73.9% (119/161) of bacterial strains. At 5-9 days after the completion of treatment, 73 and 81 patients from the 3 day and 7 day groups, respectively, were evaluated by intention-to-treat analysis; the microbiological efficacies were 58.9% eradication (43/73), 20.5% persistence (15/73) and 8.2% replaced (6/73), and 66.7% eradication (54/81), 6.2% persistence (5/81) and 7.4% replaced (6/81), respectively (P = 0.048). The clinical efficacies were 76.7% (56/73) and 80.2% (65/81), respectively (P = 0.695). Adverse events due to faropenem were reported in 9.5% of participants (19/200), and the most common adverse event was diarrhoea. CONCLUSIONS: The 7 day regimen showed a superior rate of microbiological response. E. coli strains were in general susceptible to faropenem, including fluoroquinolone- and cephalosporin-resistant strains.

DOI： 10.1093/jac/dku014

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated normally positioned and functioning ureteral orifices. Although the placement of an indwelling urethral catheter is a comparatively safe procedure, one must keep in mind that this complication can occur, particularly in female patients with neurogenic bladder. CT without contrast is a noninvasive, definitive diagnostic tool.

DOI： 10.18926/AMO/52144

Web of Science

PubMed

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Language：Japanese   Publisher：日本女性骨盤底医学会  

【目的】産後1ヵ月健診時、保健指導担当と母乳育児担当の助産師の協力の下、尿失禁症状を有する褥婦に対し、ビデオと骨盤底筋筋電位評価装置を用いて骨盤底筋体操(PFMT)指導を行い、尿失禁症状の改善の有無を検討した。【対象・方法】産後1ヵ月健診時、尿失禁が継続している褥婦12人を対象とした。Incontinence Quality of Life(I-QOL)により自覚症状を把握し、PFMTのビデオを視聴した後、骨盤底筋筋電位評価装置を用いて指導を行った。指導1ヵ月後もテレビ機能付き携帯電話での母乳育児相談時にはPFMTの実施状況を確認した。指導3ヵ月後、骨盤底筋筋電位評価装置を用いてPFMTの再指導を行いI-QOLで評価した。【結果】褥婦の平均年齢は37.2歳であった。骨盤底筋筋電位は14.5±4.1μVから19.2±10.6μVに変化し(p=0.10)、I-QOLは81.4±7.9点から87.2±9.8点に有意に改善していた(p=0.03)。【結論】尿失禁症状は有意に改善しており、今後も尿失禁を有する褥婦に対して、PFMTの啓蒙活動・指導に取り組んでいきたい。(著者抄録)

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

To propose an appropriate prophylactic antimicrobial therapy for patients undergoing brachytherapy, we evaluated the relationships between various antimicrobial prophylaxis (AMP) protocols and the incidence of postimplant infections in a multicenter cohort study conducted in Japan. The records of 826 patients with localized prostate cancer who underwent a transperineal I-125 brachytherapy procedure between January 2009 and December 2010 were retrospectively reviewed. Perioperative infections, including surgical site and remote infections, were recorded up to postoperative day 30. A total of 6 (0.73 %) patients had a perioperative infection following seed implantation, of whom all received AMP for 1 or more days. None of the patients who received a single-dose protocol of AMP using fluoroquinolone p.o. or penicillin with a beta-lactamase inhibitor i.v. developed a perioperative infection. Statistical analysis showed that a single-dose protocol was more significantly related to a lower risk of perioperative infection as compared to the other AMP protocols examined (p = 0.045). Furthermore, our results indicated that bacteriuria and preoperative hair removal were risk factors of perioperative infection with statistical significance (p = 0.007, p = 0.004). Analysis of patient clinical parameters, including age, American Society of Anesthesiologists score, diabetes mellitus, prostate volume, numbers of implanted seeds and needle punctures, operation time, and indwelling duration time of the Foley catheter, did not reveal significant differences in terms of perioperative infection. Our results indicated that a single-dose AMP protocol is sufficient to prevent perioperative infections following seed implantation. On the other hand, AMP is only one of several measures to prevent perioperative infectious complications. It is necessary to know that the patient must have no bacteriuria and that preoperative hair removal should be avoided.

DOI： 10.1007/s10156-013-0610-0

Web of Science

PubMed

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Language：Japanese   Publisher：(株)南山堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00821&link_issn=&doc_id=20130905030020&doc_link_id=%2Faf5thrpc%2F2013%2F009509%2F021%2F1628-1633%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faf5thrpc%2F2013%2F009509%2F021%2F1628-1633%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

腹腔鏡下膀胱全摘除術(Laparoscopic radical cystectomy、LRC)は、これまで限られた施設でのみ先進医療で行うか、もしくは自費診療でのみ施行可能であったが、2012年度の診療報酬改定により保険診療として施行可能となった(腹腔鏡下膀胱悪性腫瘍手術:89,380点)。岡山大学泌尿器科では、2011年より本術式導入の準備を進め、2012年7月より本手術を開始し、これまでに4例施行した。1例目:2010年右腎盂癌に対し右腎尿管全摘除術の既往あり。左腎盂癌に対し全尿路全摘除術(後腹膜鏡下左腎尿管全摘除術+LRC)を施行(手術時間:450分(LRC190分)出血量:700ml)。2例目:2011年4月尿管癌に対し右腎尿管全摘除術の既往あり。膀胱癌(BCG無効上皮内癌)に対しLRC+尿管皮膚瘻(手術時間:390分 出血量:1000ml)。3例目:膀胱癌(cT2N0M0)に対しLRC+リンパ節郭清(郭清領域:総腸骨、外腸骨、内腸骨、閉鎖、摘出リンパ節数:31個)、小切開下に回腸導管造設術施行(手術時間:510分 出血量:500ml)。4例目:膀胱癌(cT2N0M0)に対しLRC+リンパ節郭清(郭清領域:総腸骨、外腸骨、内腸骨、閉鎖、摘出リンパ節数:19個)、回腸導管造設術施行(手術時間:550分 出血量:335ml)。LRCの導入時の問題点としては手術適応、リンパ節郭清、尿路変向の手技などが挙げられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01004&link_issn=&doc_id=20130729210002&doc_link_id=%2Fer9niuro%2F2013%2F007507%2F002%2F0352-0358%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2013%2F007507%2F002%2F0352-0358%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本バイオフィルム学会  

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

Although previously, laparoscopic radical cystectomy (LRC) has been performed as advanced medicine only within limited institutions, it can now be performed using national health insurance according to the medical treatment fee revision of 2012. We began preparing for LRC from 2011 in our institution and we performed LRC for the first timein July 2012. To date, we have performed LRC in four cases. First case : we performed LRC and left retroperitoneal nephroureterectomy for left renal pelvic cancer. Operative time was 450 minutes (LRC, 190 minutes) and estimated blood loss was 700 ml. Second case : we performed LRC for bladder cancer (BCG failure). Operative time was 390 minutes and estimated blood loss was 1000 ml. Third case : we performed LRC and lymphadenectomy for bladder cancer (cT2N0M0). Operative time was 510 minutes and estimated blood loss was 500 ml. Fourth case: we performed LRC and lymphadenectomy for bladder cancer (cT2N0M0). Operative time was 550 minutes and estimated blood loss was 335 ml. As regards problems at the time of introduction of LRC, indication, lymphadenectomy, and urinary tract diversion, etc. are discussed.

Scopus

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

(目的)2007年に日本泌尿器科学会が編集した「泌尿器科領域における周術期感染予防ガイドライン」は我が国初の泌尿器科、周術期に特化した感染予防ガイドラインである。今回、その妥当性、有用性を検証するため多施設で前向きに調査、解析を行った。(方法)対象は2008年7月から9月に全国の10施設において泌尿器科領域の手術を受けた513例。手術の内訳は経尿道的膀胱腫瘍切除術、経尿道的前立腺切除術、副腎摘除術、腎摘除術、腎尿管全摘除術、前立腺全摘除術、膀胱全摘除術である。患者背景、術式、予防投与した抗菌薬の種類と投与期間、SSI(Surgical Site Infection:手術部位感染)とRI(Remote Infection:遠隔感染)の有無を解析した。(結果)513例のガイドライン遵守率は75.4%であった。ガイドラインを遵守していた387例におけるSSI、RIの発生率はそれぞれ5.9、4.1%であった。SSIについてはASA(American Society of Anesthesiologists)手術リスク、糖尿病と手術時間が、RIについては手術時間が発生に寄与していた。(結語)同ガイドラインの妥当性、有用性の検証にはさらなる大規模な調査やエビデンスの蓄積が必要と考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01175&link_issn=&doc_id=20130529400003&doc_link_id=10031159424&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10031159424&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(株)日本医学館  

2010年7月〜2012年4月に行った生体腎移植10例を対象に、タクロリムス徐放製剤の薬物動態、拒絶反応頻度、腎毒性について検討した。免疫抑制剤はグラセプター、ミコフェノール酸モフェチル(MMF)、ステロイド、バシリキシマブ(BXM)の4剤を使いABO血液型不適合症例には抗CD20モノクローナル抗体のリツキシマブを投与、移植前血漿交換とし二重濾過血漿交換療法(DFPP)と全血漿交換を併用し、脾摘を回避した。レシピエントの平均年齢は51.6歳、原疾患は慢性糸球体腎炎4例、多発性嚢胞腎・糖尿病性腎症各2例、アルポート症候群・IgA腎症各1例であった。2例は先行的腎移植であった。グラセプターの平均トラフ値(ng/mL)と平均血清クレアチニン値(mg/dL)は各1週後、8.22、1.80、2週後、6.84、1.67、4週後、4.55、1.48、8週後、3.53、1.37、12週後、3.73、1.39、24週後、3.99、1.46であった。AUCと各測定時間での血中濃度の相関はC24での相関が最も強く、次にC2であった。移植後1ヵ月、1年後の移植腎生検で拒絶反応はなくCNI毒性が2例にみられた。低用量のタクロリムス徐放製剤でも生体腎移植の拒絶反応は少なく安全なことが示唆された。

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

(Purpose): To survey the present condition of administration method of the antimicrobial prophylactic (AMP) agents for the perioperative infection in Japan on revising "The Japanese guidelines for prevention of perioperative infections in urologic field (2006)". (Patients and methods): With the approval of the Japanese Urological Association (JUA) in 2011, all of the principal urological training institutions certified by JUA (n = 836) were encouraged to participate to survey their adherence to the JUA guidelines (published in 2006) for AMP to prevent perioperative infection in urological field, and 446 (53.3%) institutions responded to the questionnaire. (Results): The rates of following the JUA guidelines of, "completely", "mainly", "not too much", and "not at all" were 6.5%, 69.7%, 22.0% and 1.6%, respectively. The guidelines were followed for open clean operations in 48.5%, open clean-contaminated operations in 66.4%, open contaminated operations in 61.8%, laparoscopic clean operations in 54.1%, laparoscopic clean-contaminated operations in 61.2%, transurethral resection of bladder tumor in 71.5%, transurethral resection of prostate in 68.9%, ureteroscopy and transurethral ureterolithotomy in 68.2%, prostate biopsy in 43.2%, and cystoscopy were in 42.2%, respectively. However, in terms of duration of AMP administration, the longer duration than those recommended by the guidelines were observed for clean surgery, transurethral resection of bladder tumor, ureteroscopy and transurethral ureterolithotomy, prostate biopsy, and cystoscopy. (Conclusions): In terms of kinds of AMP, the guidelines were almostly followed in all operative procedures. However, the duration of AMP administration were longer than those recommended by the guidelines. On revision of "Japanese guidelines for prevention of perioperative infections in urologie field (2006)", these data would be taken into consideration to avoid dissociation between the guidelines and the practical side in the urologists. © 2013 The Japanese Urological Association.

DOI： 10.5980/jpnjurol.104.579

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