Faculty Profiles - ARAKI Motoo

Papers - ARAKI Motoo

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Nonintravesical Interventions for Preventing Intravesical Recurrence in Patients With Nonmuscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis. International journal

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Robert J Schulz, Stefano Mancon, Tamás Fazekas, Marcin Miszczyk, Anna Cadenar, Ekaterina Laukhtina, Pawel Rajwa, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Takafumi Yanagisawa, Jun Miki, Takahiro Kimura, Koichiro Wada, Pierre I Karakiewicz, Piotr Chlosta, Jeremy Teoh, Motoo Araki, Shahrokh F Shariat

Clinical genitourinary cancer 23 ( 2 ) 102306 - 102306 2025.4

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

Despite currently used intravesical therapies in non-muscle-invasive bladder cancer (NMIBC), the rate of intravesical recurrence remains very high. We aimed to evaluate the effectiveness of adding nonintravesical interventions to standard intravesical therapies to prevent intravesical recurrence. In April 2024, 3 databases were queried for prospective studies evaluating nonintravesical interventions in addition to standard intravesical therapies for NMIBC (CRD42024490988). The primary outcome was intravesical recurrence-free survival (iRFS). Standard pairwise meta-analyses were performed using hazard ratios (HR) and 95% confidence intervals (95% CI) with a random-effects model. We identified 18 eligible studies (14 RCTs and 4 prospective trials) comprising 4,593 NMIBC patients, which investigated pharmacological interventions (eg, selenium, vitamins, Lactobacillus casei, celecoxib, metformin, mistletoe lectin) and lifestyle modifications (diet). The addition of Lactobacillus casei significantly improved iRFS (HR: 0.50; 95% CI: 0.34-0.73; P < .001). A high western diet pattern significantly worsened iRFS (HR:1.48, 95%CI:1.06-2.06, P = .03). The other nonintravesical interventions were not associated with iRFS. Our comprehensive review of the published literature highlights the need for further research into the efficacy of nonvesical interventions for NMIBC. While Lactobacillus was shown to improve iRFS in 2 RCTs, additional high-quality randomized studies are required to evaluate the effectiveness of other interventions.

DOI： 10.1016/j.clgc.2025.102306

Incidence, Management, and Prevention of Gynecomastia and Breast Pain in Patients with Prostate Cancer Undergoing Antiandrogen Therapy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. International journal

Ichiro Tsuboi, Robert J Schulz, Ekaterina Laukhtina, Koichiro Wada, Pierre I Karakiewicz, Motoo Araki, Shahrokh F Shariat

European urology open science 73 31 - 42 2025.3

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

BACKGROUND AND OBJECTIVE: In patients with prostate cancer treated with antiandrogen monotherapy, gynecomastia and breast pain are relatively common. In the setting of androgen receptor pathway inhibitors (ARPIs), the incidence of these adverse events (AEs) remains unclear. In addition, the effect of prophylactic treatment on gynecomastia remains uncertain. We aimed to evaluate the incidence of gynecomastia and breast pain in prostate cancer patients treated with ARPIs compared with androgen deprivation therapy (ADT) and the effect of prophylactic treatment for these AEs due to antiandrogen therapy. METHODS: In June 2024, we queried four databases-PubMed, Scopus, Web of Science, and Embase-for randomized controlled trials (RCTs) investigating prostate cancer treatments involving antiandrogen therapy. The endpoints of interest were the incidence of these AEs due to ARPIs and the effect of prophylactic treatment for these. KEY FINDINGS AND LIMITATIONS: Eighteen RCTs, comprising 5036 patients, were included in the systematic review and meta-analysis. ARPIs included enzalutamide, darolutamide, and apalutamide. The results indicated that patients who received ARPI monotherapy had a significantly higher incidence of gynecomastia than those who received ADT monotherapy (risk ratio [RR]: 5.19, 95% confidence interval [CI]: 3.58-7.51, p < 0.001). There was no significant difference in the incidence of gynecomastia between ARPI plus ADT therapy and ADT monotherapy (RR: 1.27, 95% CI: 0.84-1.93, p = 0.2). Prophylactic tamoxifen or radiotherapy reduced significantly the incidence of gynecomastia and breast pain caused by bicalutamide monotherapy. CONCLUSIONS AND CLINICAL IMPLICATIONS: We found that ARPI monotherapy increases the incidence of these AEs significantly compared with ADT. In contrast, ARPI plus ADT therapy did not result in a higher incidence of AEs. The use of either tamoxifen or radiotherapy was effective in reducing the incidence of these AEs due to bicalutamide monotherapy. These prophylactic treatments could reduce the incidence of AEs due to ARPI monotherapy. However, further studies are needed to clarify their efficacy. PATIENT SUMMARY: Although androgen deprivation therapy (ADT) improves overall survival in patients with prostate cancer, it is associated with several complications. Androgen receptor pathway inhibitor (ARPI) monotherapy has emerged as a promising strategy for improving oncological outcomes in these patients. However, ARPI monotherapy increases gynecomastia and breast pain in prostate cancer patients compared with ADT, while ARPI plus ADT did not result in a higher incidence of adverse events.

DOI： 10.1016/j.euros.2025.01.001

Serum uric acid level is associated with renal arteriolar hyalinosis and predicts post-donation renal function in living kidney donors. International journal

Yuzuki Kano, Katsuyuki Tanabe, Masashi Kitagawa, Hitoshi Sugiyama, Tomoaki Yamanoi, Kasumi Yoshinaga, Kensuke Bekku, Shingo Nishimura, Motoo Araki, Jun Wada

PloS one 20 ( 3 ) e0320482 2025

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

Major guidelines for living-donor kidney transplantation underscore the need for pre-donation evaluation of renal function, hypertension, obesity, diabetes mellitus, and albuminuria to minimize the risk of donation from marginal donors. However, validity is yet to be established. We retrospectively investigated the relationship between clinical characteristics and histological indices in baseline renal biopsies (0-h biopsies) and whether these parameters could predict renal function in living kidney donors one year post-donation. Seventy-six living kidney donors were recruited for this study. In histological analyses, glomerulosclerosis, arteriosclerosis, arteriolosclerosis, arteriolar hyalinosis, and interstitial fibrosis and tubular atrophy scores/indices were evaluated. Post-donation serum creatinine levels in kidney donors with arteriolar hyalinosis were significantly higher than those in individuals without arteriolar hyalinosis. There was a significant correlation between baseline serum uric acid levels and the arteriolar hyalinosis index, with baseline uric acid level identified as an independent factor for hyalinosis in multiple regression analysis. Additionally, the serum uric acid level was a significant prognostic factor for post-donation serum creatinine after adjustment for baseline clinical parameters. These data demonstrate that pre-donation serum uric acid levels are associated with arteriolar hyalinosis in the kidney and could predict a decline in renal function during the first year after donation in living kidney donors.

DOI： 10.1371/journal.pone.0320482

Propensity score-matched analysis comparing robot-assisted partial nephrectomy and image-guided percutaneous cryoablation for cT1 renal cell carcinoma. International journal

Tomoaki Yamanoi, Kensuke Bekku, Kasumi Yoshinaga, Yuki Maruyama, Kentaro Nagao, Tatsushi Kawada, Yusuke Tominaga, Noriyuki Umakoshi, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Mayu Uka, Shingo Nishimura, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Takao Hiraki, Motoo Araki

Urologic oncology 42 ( 12 ) 453.e15-453.e22 2024.12

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

OBJECTIVES: This study aimed to compare the clinical outcomes of robot-assisted partial nephrectomy (RAPN) and image-guided percutaneous cryoablation (IG-PCA) for clinical T1 renal cell carcinoma. MATERIALS AND METHODS: We conducted a retrospective analysis of 679 patients with clinical T1 renal cell carcinoma treated with RAPN or IG-PCA between 2012 and 2021. Propensity scores were calculated via logistic analysis to adjust for imbalances in baseline characteristics. We compared oncological and functional outcomes between the 2 treatment groups. RESULTS: Following the matching process, 108 patients were included in each group. No patient in the RAPN group developed local recurrence. In the IG-PCA group, three patients experienced local tumor progression. The patients underwent salvage thermal ablations by the secondary technique; 2 underwent IG-PCA and 1 underwent microwave ablation, resulting in a local control rate of 100%. The Kaplan-Meier analysis showed no statistically significant differences between the groups in terms of 5-year recurrence-free survival, metastasis-free survival, and overall survival (log-rank test; P = 0.11, P = 0.64, and P = 0.17, respectively). No significant differences were observed in the 2 treatments in major and overall complication rates (P = 0.75 and P = 0.82, respectively). Both groups showed similar rates of less than 10% estimated glomerular filtration rate decline at 12 months post-treatment and 5-year renal function preservation rates (P = 0.88 and P = 0.38, respectively). CONCLUSIONS: IG-PCA demonstrated oncological outcomes comparable to those of RAPN. RAPN addressed the disadvantages of conventional procedures and allowed for safety outcomes comparable to IG-PCA.

DOI： 10.1016/j.urolonc.2024.09.012

The Impact of Concomitant Medications on the Overall Survival of Patients Treated with Systemic Therapy for Advanced or Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-analysis. International journal

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Marcin Miszczyk, Tamás Fazekas, Robert J Schulz, Stefano Mancon, Giulio Litterio, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Pawel Rajwa, Koichiro Wada, Pierre I Karakiewicz, Motoo Araki, Shahrokh F Shariat

Clinical genitourinary cancer 22 ( 6 ) 102237 - 102237 2024.12

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

Although immune checkpoint inhibitors (ICI) and/or tyrosine kinase inhibitors (TKI) are the standard treatment of advanced unresectable or metastatic renal cell carcinoma (RCC), the impact of concomitant medications remains unclear. We aimed to evaluate the impact of concomitant medications on survival outcomes in patients treated with systemic therapy for advanced unresectable or metastatic RCC. In August 2024, PubMed, Scopus, and Web of Science were queried for studies evaluating concomitant medications in patients with advanced unresectable or metastatic RCC (PROSPERO: CRD42024573252). The primary outcome was overall survival (OS). A fixed- or random-effects model was used for meta-analysis according to heterogeneity. We identified 22 eligible studies (5 prospective and 17 retrospective) comprising 16,072 patients. Concomitant medications included proton pump inhibitors (PPI) (n = 3959), antibiotics (n = 571), statins (n = 5466), renin-angiotensin system inhibitors (RASi) (n = 6615), and beta-blockers (n = 1964). Both concomitant PPI and antibiotics were significantly associated with worse OS in patients treated with ICI (PPI: HR: 1.22, P = .01, and antibiotics: HR: 2.09, P < .001). Concomitant statins, RASi, or beta-blocker were significantly associated with improved OS in patients treated with TKI (statins: HR: 0.81, P = .03, RASi: HR: 0.63, P < .001, beta-blocker: HR: 0.69, P < .001, respectively). In patients treated with ICI, RASi was significantly associated with improved OS (HR: 0.64, P = .02). Concomitant use of antibiotics or PPI with ICI can reduce its oncologic efficacy. Conversely, concomitant statins, RASi, or beta-blockers can enhance the oncologic efficacy of TKI. When initiating systemic therapy for metastatic RCC, it may be important for clinicians to assess baseline co-medications and recognize their possible positive or negative effects.

DOI： 10.1016/j.clgc.2024.102237

Partial versus Radical Nephrectomy for Small Renal Cancer: Comparative Propensity Score-Matching Analysis of Cardiovascular Event Risk.

Risa Kubota, Kensuke Bekku, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Motoo Araki

Acta medica Okayama 78 ( 6 ) 429 - 437 2024.12

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

Although partial nephrectomy (PN) is preferred over radical nephrectomy (RN) for preserving renal function in patients with cT1 renal cancer, its impact on cardiovascular events (CVe) remains controversial. This study aimed to compare PN and RN in regard to the occurrence of CVe, including cerebrovascular events and exacerbation of hypertension (HT). We retrospectively analyzed 418 consecutive patients who underwent PN or RN for cT1 renal cancer. Propensity score-matching analysis was used to adjust for imbalances between patients who underwent PN and RN, leaving 102 patients in each group. The 5-year probability of cumulative CVe incidence was 6% in the PN group and 12% in the RN group (p=0.03), with a median follow-up of 73.5 months. The statistical significance was retained after propensity score matching for patients without preoperative proteinuria (p=0.03). For all CVe including cerebrovascular events and exacerbation of HT analyzed, PN provided a lower probability of occurrence than RN in patients with small renal cancers.

DOI： 10.18926/AMO/67868

First-line therapy for metastatic renal cell carcinoma: A propensity score-matched comparison of efficacy and safety. Reviewed

Yanagisawa T, Mori K, Kawada T, Katayama S, Uchimoto T, Tsujino T, Nishimura K, Adachi T, Toyoda S, Nukaya T, Fukuokaya W, Urabe F, Murakami M, Yamanoi T, Bekku K, Komura K, Takahara K, Hashimoto T, Fujita K, Azuma H, Ohno Y, Shiroki R, Uemura H, Araki M, Kimura T, JK-FOOT study group

Urol Oncol. 42 ( 11 ) e21 - e29 2024.11

What is the identity of Gerota fascia? Histological study with cadavers. International journal

Yasuyuki Kobayashi, Kohei Edamura, Takuya Sadahira, Yusuke Tominaga, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Tomoko Kobayashi, Keita Sato, Takaaki Komiyama, Ryusuke Momota, Hideyo Ohuchi, Motoo Araki

International journal of urology : official journal of the Japanese Urological Association 2024.10

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

OBJECTIVES: The advancement of laparoscopic surgery has allowed surgeons to see finer anatomical structures during surgery. As a result, several issues have arisen regarding Gerota fascia that cannot be explained by previous interpretations, such as its various forms observed during surgery. To address these issues, we histologically examined the structure of Gerota fascia. METHODS: Specimens for study were prepared from kidneys with Gerota fascia from four cadavers, and the structure was studied histologically. Its thickness and collagen fiber area ratios were measured using ImageJ and compared to those of the epimysium of the rectus abdominis muscle. RESULTS: Connective tissue that appeared to be Gerota fascia was observed in 26 specimens. Histologically, the basic structure of Gerota fascia was a sandwich-like structure with a thin layer of thick, long collagen fibers in the central layer, and small granular collagen fibers scattered at the edges. However, not all areas observed had a similar structure; eight specimens were composed only of small granular collagen fibers. The average thickness of the Gerota fascia was 466 μm, and the area ratio of collagen was 27.1%. In contrast, the epimysium was much thicker than Gerota fascia, and its collagen fibers were much thicker and denser. CONCLUSIONS: Gerota fascia, unlike the epimysium, was a very thin and fragile layer of collagen fibers, and its structure was diverse. This explains why Gerota fascia was observed in various states during surgery. It is important for surgeons to understand the properties of Gerota fascia and to treat it appropriately.

DOI： 10.1111/iju.15596

The efficacy of adjuvant mitotane therapy and radiotherapy following adrenalectomy in patients with adrenocortical carcinoma: A systematic review and meta-analysis. International journal

Ichiro Tsuboi, Mehdi Kardoust Parizi, Akihiro Matsukawa, Stefano Mancon, Marcin Miszczyk, Robert J Schulz, Tamás Fazekas, Anna Cadenar, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Koichiro Wada, Mesut Remzi, Pierre I Karakiewicz, Motoo Araki, Shahrokh F Shariat

Urologic oncology 2024.10

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

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a high recurrence rate after surgical therapy with curative intent. Adjuvant radiotherapy (RT) and mitotane therapy have been proposed as options following the adrenalectomy. However, the efficacy of adjuvant RT or mitotane therapy remains controversial. We aimed to evaluate the efficacy of adjuvant therapy in patients who underwent adrenalectomy for localised ACC. The PubMed, Scopus, and Web of Science databases were queried on March 2024 for studies evaluating adjuvant therapies in patients treated with surgery for localized ACC (PROSPERO: CRD42024512849). The endpoints of interest were overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled in a random-effects model meta-analysis. One randomized controlled trial (n = 91) and eleven retrospective studies (n = 4,515) were included. Adjuvant mitotane therapy was associated with improved RFS (HR: 0.63, 95%CI: 0.44-0.92, p = 0.016), while adjuvant RT did not reach conventional levels of statistical significance (HR:0.79, 95%CI:0.58-1.06, p = 0.11). Conversely, Adjuvant RT was associated with improved OS (HR:0.69, 95%CI:0.58-0.83, p<0.001), whereas adjuvant mitotane did not (HR: 0.76, 95%CI: 0.57-1.02, p = 0.07). In the subgroup analyses, adjuvant mitotane was associated with better OS (HR:0.46, 95%CI: 0.30-0.69, p < 0.001) and RFS (HR:0.56, 95%CI: 0.32-0.98, p = 0.04) in patients with negative surgical margin. Both adjuvant RT and mitotane were found to be associated with improved oncologic outcomes in patients treated with adrenalectomy for localised ACC. While adjuvant RT significantly improved OS in general population, mitotane appears as an especially promising treatment option in patients with negative surgical margin. These data can support the shared decision-making process, better understanding of the risks, benefits, and effectiveness of these therapies is still needed to guide tailored management of each individual patient.

DOI： 10.1016/j.urolonc.2024.09.014

Correction: Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis. International journal

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Jakob Klemm, Stefano Mancon, Sever Chiujdea, Tamás Fazekas, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Koichiro Wada, Motoo Araki, Shahrokh F Shariat

World journal of urology 42 ( 1 ) 522 - 522 2024.9

Clinical significance of tumor location for ureteroscopic tumor grading in upper tract urothelial carcinoma. Reviewed

Katayama S, Pradere B, Grossmann NC, Potretzke AM, Boorjian SJ, Ghoreifi A, Daneshmand S, Djaladat H, Sfakianos J, Mari A, Khene ZE, D'Andrea D, Hayakawa N, Fujita K, Heidenreich A, Raman JD, Roumiguie M, Abdollah F, Breda A, Fontana M, Roupret M, Margulis V, Karakiewicz PI, Araki M, Nasu Y, Shariat SF

J Endourol. 2024.9

術前栄養状態と骨格筋評価が腎移植レシピエントの腎予後に与える影響

山野井友昭, 西村慎吾, 関戸崇了, 吉永香澄, 定平卓也, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 大西康博, 竹内英実, 田邊克幸, 森永裕士, 荒木元朗

移植 59 ( 総会臨時 ) 323 - 323 2024.9

トランス男性のホルモン治療に対する期待度の調査

森分貴俊, 富永悠介, 藤澤諒多, 奥村美紗, 堀井聡, 松本裕子, 小林知子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林泰之, 荒木元朗

日本性科学会雑誌 42 ( 2 ) 63 - 63 2024.9

Differential effect of surgical technique on intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial cancer: a systematic review and Meta-analysis. Reviewed

Tsuboi I, Matsukawa A, Kardoust Parizi M, Klemm J, Schulz RJ, Cadenar A, Mancon S, Chiujdea S, Fazekas T, Miszczyk M, Laukhtina E, Kawada T, Katayama S, Iwata T, Bekku K, Wada K, Gontero P, Rouprêt M, Teoh J, Singla N, Araki M, Shariat SF

World J Urol. 42 ( 1 ) 488 2024.8

Diagnostic Accuracy of Liquid Biomarkers for Clinically Significant Prostate Cancer Detection: A Systematic Review and Diagnostic Meta-analysis of Multiple Thresholds. Reviewed

Kawada T, Shim SR, Quhal F, Rajwa P, Pradere B, Yanagisawa T, Bekku K, Laukhtina E, von Deimling M, Teoh JY, Karakiewicz PI, Araki M, Shariat SF

Eur Urol Oncol. 7 ( 4 ) 649 - 662 2024.8

Clinical outcomes and prognostic factors in metastatic nonclear cell renal cell carcinoma treated with immuno-oncology combination therapy. Reviewed

Toyoda S, Fukuokaya W, Mori K, Kawada T, Katayama S, Nishimura S, Maenosono R, Tsujino T, Adachi T, Hirasawa Y, Saruta M, Komura K, Nukaya T, Yanagisawa T, Takahara K, Hashimoto T, Azuma H, Ohno Y, Shiroki R, Araki M, Kimura T, Fujita K, JK-FOOT study group

Jpn J Clin Oncol. 108 2024.8

LOH症候群における精神症状がテストステロン補充療法に与える影響について

富永悠介, 小林知子, 森分貴俊, 松本裕子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林泰之, 佐古智子, 杉本盛人, 渡部昌実, 荒木元朗

日本性機能学会雑誌 39 ( 2 ) 167 - 167 2024.8

当院に受診したクラインフェルター症候群患者の性機能についての検討

森分貴俊, 富永悠介, 藤澤諒多, 奥村美紗, 堀井聡, 松本裕子, 小林知子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 杉本盛人, 荒木元朗

日本性機能学会雑誌 39 ( 2 ) 169 - 169 2024.8

男性低ゴナドトロピン性性腺機能低下症(MHH)に対するテストステロン補充療法(TRT)についての検討

藤澤諒多, 富永悠介, 奥村美紗, 堀井聡, 森分貴俊, 松本裕子, 小林知子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 杉本盛人, 荒木元朗

日本性機能学会雑誌 39 ( 2 ) 170 - 170 2024.8

The durability of filter cap for OT-Balloon catheter, a novel urethral catheter for intermittent balloon catheterization Reviewed

Tomofumi Watanabe, Motoo Araki, Takuya Sadahira

Continence Reports 10 100049 - 100049 2024.6

転移性腎癌に対してPembrolizumab投与中,サイトカイン放出症候群を認めた一例

川合裕也, 西村慎吾, 長崎直也, 奥村美紗, 津川卓士, 井上翔太, 渡部智文, 関戸崇了, 堀井聡, 森分貴俊, 吉永香澄, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号2 ) 193 - 194 2024.6

上部尿路上皮癌に対するThulium:YAGレーザーとHo:YAGレーザーを用いた内視鏡下レーザー焼灼術の適応と治療成績

片山聡, 長崎直也, 津川卓士, 奥村美紗, 川合裕也, 井上翔太, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 森分貴俊, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号2 ) 190 - 190 2024.6

Homology of Escherichia coli isolated from urine and vagina and their antimicrobial susceptibility in postmenopausal women with recurrent cystitis. Reviewed International journal

Takanori Sekito, Takuya Sadahira, Hidetada Hirakawa, Ayano Ishii, Koichiro Wada, Motoo Araki

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2024.5

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

Uropathogenic Escherichia coli (UPEC) is a typical cystitis-causing organism that can migrate from the vagina to the bladder and cause recurrent cystitis (RC). Few reports have compared the characteristics of urinary and vaginal UPEC in patients with RC. We carried out molecular biological analyses of Escherichia coli (E. coli) strains and their antimicrobial susceptibility to assess the association between urinary and vaginally UPEC. We included E. coli isolated from urinary and vaginal samples at the onset of cystitis in postmenopausal women with RC between 2014 and 2019 in our hospital. Pulsed-field gel electrophoresis (PFGE) was performed using a restriction enzyme (Xba I). These sequences were compared with 17 antimicrobial susceptibilities determined by a micro-liquid dilution method. Multilocus sequence typing (MLST) and classification of extended-spectrum β-lactamase (ESBL) genotypes by multiplex polymerase chain reaction (PCR) were performed on ESBL-producing E. coli. We analyzed 14 specimens (each seven urine and vaginal) from seven patients in total. On PFGE, the similarity of urinary and vaginal E. coli per patient ranged from 89.5 to 100%, including four patients with 100% matches. MLST demonstrated that 29% (4/14 specimens) were strain sequence type 131. Two specimens contained ESBL-producing strains and identified the CTX-M-27 genotype for each specimen. For each patient, antimicrobial susceptibilities between urinary and vaginal E. coli were mostly identical. Thus, urinary- and vaginally-derived E. coli were identical in postmenopausal women with RC. Management targeting both urinary and vaginal UPEC is essential for RC, indicating the importance of a vagina-targeted approach.

DOI： 10.1016/j.jiac.2024.05.015

Circadian Rhythms Fluctuate the Treatment Effects of Intravesical Treatments on Rat Urinary Frequency Models Reviewed

Tomofumi Watanabe, Takuya Sadahira, Yusuke Tominaga, Yuki Maruyama, Naoya Nagasaki, Takanori Sekito, Kohei Edamura, Toyohiko Watanabe, Motoo Araki, Masami Watanabe

Veterinary Medicine International 2024 1 - 9 2024.5

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

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

Reply to Kun-Peng Li, Shun Wan, Chen-Yang Wang, and Li Yang's Letter to the Editor re: Tatsushi Kawada, Ekaterina Laukhtina, Fahad Quhal, et al. Oncologic and Safety Outcomes for Endoscopic Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An Updated Systematic Review and Meta-analysis. Eur Urol Focus 2023;9:236-40. International journal

Tatsushi Kawada, Ekaterina Laukhtina, Motoo Araki, Shahrokh F Shariat

European urology focus 10 ( 3 ) 492 - 492 2024.5

ロボット支援腹腔鏡下前立腺全摘術(RARP)における術後感染症に関する後方視的研究 CefazolinとSulbactam/Ampicillinの比較

三井將雄, 定平卓也, 岩田健宏, 荒木元朗, 長崎直也, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 98回・72回 np288 - np288 2024.5

腎移植後リンパ増殖症に対して,rituximab反応性による治療層別化レジメンを使用した小児例

爲房宏輔, 石田悠志, 藤原かおり, 塩飽孝宏, 吉永香澄, 西村慎吾, 鷲尾佳奈, 荒木元朗, 塚原宏一

臨床血液 65 ( 5 ) 466 - 466 2024.5

Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis. Reviewed International journal

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Jakob Klemm, Stefano Mancon, Sever Chiujdea, Tamás Fazekas, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Koichiro Wada, Motoo Araki, Shahrokh F Shariat

World journal of urology 42 ( 1 ) 252 - 252 2024.4

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

BACKGROUND: To prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection using povidone-iodine (PI) and antibiotic prophylaxis (AP). OBJECTIVE: To summarize available data and compare the efficacy of rectal disinfection using PI with non-PI methods prior to TRUS-PB. EVIDENCE ACQUISITION: Three databases were queried through November 2023 for randomized controlled trials (RCTs) analyzing patients who underwent TRUS-PB. We compared the effectiveness of rectal disinfection between PI groups and non-PI groups with or without AP. The primary outcomes of interest were the rates of overall infectious complications, fever, and sepsis. Subgroups analyses were conducted to assess the differential outcomes in patients using fluoroquinolone groups compared to those using other antibiotics groups. EVIDENCE SYNTHESIS: We included ten RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.56, 95% CI 0.42-0.74, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.54, 95% CI 0.40-0.73, p < 0.001) and fever (RR 0.47, 95% CI 0.30-0.75, p = 0.001), but not with sepsis (RR 0.49, 95% CI 0.23-1.04, p = 0.06). The use of fluoroquinolone antibiotics was associated with a lower risk of infectious complications and fever compared to non-FQ antibiotics. CONCLUSION: Rectal disinfection with PI significantly reduces the rates of infectious complications and fever in patients undergoing TRUS-PB. However, this approach does not show a significant impact on reducing the rate of sepsis following the procedure.

DOI： 10.1007/s00345-024-04941-2

Adverse events of nivolumab plus ipilimumab versus nivolumab plus cabozantinib: a real-world pharmacovigilance study. Reviewed International journal

Yurie Oka, Jun Matsumoto, Tatsuaki Takeda, Naohiro Iwata, Takahiro Niimura, Aya Fukuma Ozaki, Kensuke Bekku, Hirofumi Hamano, Motoo Araki, Keisuke Ishizawa, Yoshito Zamami, Noritaka Ariyoshi

International journal of clinical pharmacy 2024.4

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

BACKGROUND: No head-to-head clinical trials have compared the differences in adverse events (AEs) between nivolumab plus ipilimumab (NIVO-IPI) and nivolumab plus cabozantinib (NIVO-CABO) in the treatment of metastatic renal cell carcinoma (mRCC). AIM: We analysed the two largest real-world databases, the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the World Health Organization's VigiBase, to elucidate the differences in AEs between NIVO-IPI and NIVO-CABO. METHOD: In total, 40,376 and 38,022 records were extracted from FAERS and VigiBase, and 193 AEs were analysed. The reporting odds ratios (ROR) with 95% confidence interval were calculated using a disproportionality analysis (NIVO-CABO/NIVO-IPI). RESULTS: The reported numbers of immune-related AEs, including myocarditis, colitis, and hepatitis, were significantly higher with NIVO-IPI (ROR = 0.18 for FAERS and 0.13 for VigiBase). Contrarily, the reported numbers of other AEs, including gastrointestinal disorders (ROR = 2.68 and 2.92) and skin and subcutaneous tissue disorders (ROR = 2.94 and 3.55), considered to be potentiated by the combination of NIVO and CABO, were higher with NIVO-CABO. CONCLUSION: Our findings contribute to the selection and clinical management of NIVO-IPI and NIVO-CABO, which minimizes the risk of AEs for individual patients with mRCC by considering distinctive differences in the AE profiles.

DOI： 10.1007/s11096-024-01713-1

Ablation of Kidney Tumors in Patients with Substantial Kidney Impairment: Current Status. Reviewed International journal

Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Hideo Gobara, Motoo Araki, Takao Hiraki

Current oncology reports 2024.4

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

PURPOSE OF REVIEW: To review the current status of kidney tumor ablation in patients with substantial kidney impairment. RECENT FINDINGS: Few reports of kidney tumor ablation in such patients have recently been published. The reported prevalence of patients with stage 4 or 5 chronic kidney disease (CKD) among patients undergoing ablation is 2.0%-10%. In patients with stage 4 or 5 CKD, local tumor control rates were 88%-100%. The effect of ablation on CKD stage is unclear, and the observed deteriorations in kidney function are consistent with both the effect of cryoablation and the natural course of advanced CKD. According to guidelines, active surveillance may be selected. The goals of treatment are complete tumor removal and maintenance of kidney function, both of which can be met by ablation. Given the limited treatment options, ablation may play a pivotal role in the management of patients with advanced CKD.

DOI： 10.1007/s11912-024-01533-6

A Systematic Review and Meta-analysis of the Impact of Local Therapies on Local Event Suppression in Metastatic Hormone-sensitive Prostate Cancer. Reviewed International journal

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Jakob Klemm, Stefano Mancon, Sever Chiujdea, Tamás Fazekas, Marcin Miszczyk, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Pierre Karakiewicz, Koichiro Wada, Morgan Rouprêt, Motoo Araki, Shahrokh F Shariat

European urology oncology 2024.4

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

CONTEXT: It remains unclear to what extent the therapy of the primary local tumor, such as radical prostatectomy (RP) and radiation therapy (RT), improves overall survival in patients with low-volume metastatic hormone-sensitive prostate cancer (mHSPC). However, data suggest a benefit of these therapies in preventing local events secondary to local tumor progression. OBJECTIVE: To evaluate the efficacy of adding local therapy (RP or RT) to systemic therapies, including androgen deprivation therapy, docetaxel, and/or androgen receptor axis-targeted agents, in preventing local events in mHSPC patients compared with systemic therapy alone (ie, without RT of the prostate or RP). EVIDENCE ACQUISITION: Three databases and meeting abstracts were queried in November 2023 for studies analyzing mHSPC patients treated with local therapy. The primary outcome of interest was the prevention of overall local events (urinary tract infection, urinary tract obstruction, and gross hematuria) due to local disease progression. Subgroup analyses were conducted to assess the differential outcomes according to the type of local therapy (RP or RT). EVIDENCE SYNTHESIS: Overall, six studies, comprising two randomized controlled trials, were included for a systematic review and meta-analysis. The overall incidence of local events was significantly lower in the local treatment plus systemic therapy group than in the systemic therapy only groups (relative risk [RR]: 0.50, 95% confidence interval [CI]: 0.28-0.88, p = 0.016). RP significantly reduced the incidence of overall local events (RR: 0.24, 95% CI: 0.11-0.52) and that of local events requiring surgical intervention (RR: 0.08, 95% CI: 0.03-0.25). Although there was no statistically significant difference between the RT plus systemic therapy and systemic therapy only groups in terms of overall local events, the incidence of local events requiring surgical intervention was significantly lower in the RT plus systemic therapy group (RR: 0.70, 95% CI: 0.49-0.99); local events requiring surgical intervention of the upper urinary tract was significantly lower in local treatment groups (RR: 0.60, 95% CI: 0.37-0.98, p = 0.04). However, a subgroup analysis revealed that neither RP nor RT significantly impacted the prevention of local events requiring surgical intervention of the upper urinary tract. CONCLUSIONS: In some patients with mHSPC, RP or RT of primary tumor seems to reduce the incidence of local progression and events requiring surgical intervention. Identifying which patients are most likely to benefit from local therapy, and at what time point (eg, after response of metastases), will be necessary to set up a study assessing the risk, benefits, and alternatives to therapy of the primary tumor in the mHSPC setting. PATIENT SUMMARY: Our study suggests that local therapy of the prostate, such as radical prostatectomy or radiotherapy, in patients with metastatic hormone-sensitive prostate cancer can prevent local events, such as urinary obstruction and gross hematuria.

DOI： 10.1016/j.euo.2024.03.007

Trans men can achieve adequate muscular development through low-dose testosterone therapy: A long-term study on body composition changes. Reviewed International journal

Yusuke Tominaga, Tomoko Kobayashi, Yuko Matsumoto, Takatoshi Moriwake, Yoshitaka Oshima, Misa Okumura, Satoshi Horii, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Morito Sugimoto, Yasuyuki Kobayashi, Masami Watanabe, Yuzaburo Namba, Yosuke Matsumoto, Mikiya Nakatsuka, Motoo Araki

Andrology 2024.4

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

BACKGROUND: Transgender individuals undergo the gender-affirming hormone therapy (GAHT) to achieve physical changes consistent with their gender identity. Few studies are available on the long-term safety and efficacy of GAHT. OBJECTIVES: To investigate the long-term physical effects and the safety of the testosterone therapy for trans men and to assess the impact of differential hormone dose. MATERIALS AND METHODS: Trans men who initiated GAHT between May 2000 and December 2021 were included in this retrospective analysis. Physical findings (body mass index, body fat percentage (BFP), lean body mass (LBM), and grip strength), blood testing results (hemoglobin, hematocrit, uric acid, creatinine, total cholesterol, triglycerides, and total testosterone), and menstrual cessation were recorded. We assessed the effects of testosterone on body composition changes and laboratory parameters, comparing a low-dose group (≤ 62.5 mg/wk) to a high-dose group (> 62.5 mg/wk). RESULTS: Of 291 participants, 188 patients (64.6%) were in the low-dose group and 103 (35.4%) in the high-dose group. Cumulative menstrual cessation rates up to 12 months were not significantly different between groups. Both groups showed a decrease in BFP and an increase in LBM during the first year of therapy, followed by a slight increase in both over the long term. The high-dose group exhibited greater LBM gains during the first year. Higher hormone doses and lower initial LBM values were associated with LBM increases at 3 and 6 months (3 mo, P = 0.006, P < 0.001; 6 mo, P = 0.015, P < 0.001). There were no long-term, dose-dependent side effects such as polycythemia or dyslipidemia. CONCLUSION: Long-term GAHT for trans men is safe and effective. Low-dose testosterone administration is sufficient to increase LBM in trans men. Higher testosterone doses can lead to an earlier increase in muscle mass.

DOI： 10.1111/andr.13640

The Prognostic Value of Tumor Infiltrating Lymphocytes After Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. Reviewed

Kawada T, Yanagisawa T, Rajwa P, Motlagh RS, Mostafaei H, Quhal F, Laukhtina E, Pallauf M, König F, Pradere B, Araki M, Nasu Y, Shariat SF

Clin Genitourin Cancer. 22 ( 2 ) 535 - 543 2024.4

Effect of antacids on the survival of patients with metastatic urothelial carcinoma treated with pembrolizumab

Takanori Sekito, Kensuke Bekku, Satoshi Katayama, Tomofumi Watanabe, Ichiro Tsuboi, Kasumi Yoshinaga, Yuki Maruyama, Tomoaki Yamanoi, Tatsushi Kawada, Yusuke Tominaga, Takuya Sadahira, Takehiro Iwata, Shingo Nishimura, Norihiro Kusumi, Kohei Edamura, Tomoko Kobayashi, Kyohei Kurose, Takaharu Ichikawa, Yoshiyuki Miyaji, Koichiro Wada, Yasuyuki Kobayashi, Motoo Araki

Clinical Genitourinary Cancer 102097 - 102097 2024.4

脳腫瘍に対する放射線化学療法前に顕微鏡下精巣内精子採取術により精子回収が可能であったKlinefelter症候群の1例

富永悠介, 杉山星哲, 原綾英, 小林知子, 松本裕子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 枝村康平, 小林泰之, 羽原俊宏, 荒木元朗

日本生殖医学会雑誌 69 ( 1-2 ) 109 - 109 2024.4

NDUFS4 regulates cristae remodeling in diabetic kidney disease. Reviewed

Mise K, Long J, Galvan DL, Ye Z, Fan G, Sharma R, Serysheva II, Moore TI, Jeter CR, Anna Zal M, Araki M, Wada J, Schumacker PT, Chang BH, Danesh FR

Nat Commun. 15 ( 1 ) 1965 2024.3

Current status and future perspectives on robot-assisted kidney autotransplantation: A literature review. Reviewed International journal

Takanori Sekito, Tomoaki Yamanoi, Takuya Sadahira, Kasumi Yoshinaga, Yuki Maruyama, Yusuke Tominaga, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Motoo Araki

International journal of urology : official journal of the Japanese Urological Association 2024.2

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

This review presents the latest insights on robot-assisted kidney autotransplantation (RAKAT). RAKAT is a minimally invasive surgical procedure and represents a promising alternative to conventional laparoscopic nephrectomy followed by open kidney transplantation for the treatment of various complex urological and vascular conditions. RAKAT can be performed either extracorporeally or intracorporeally. Additionally, a single-port approach can be performed through one small incision without the need to reposition the patient. Of 86 patients undergoing RAKAT, 8 (9.3%) developed postoperative > Grade 2 Clavien-Dindo (CD) complications. Although the feasibility of RAKAT was established in 2014, the long-term efficacy and safety along with outcomes of this surgical approach are still being evaluated, and additional studies are needed. With improvements in the technology of RAKAT and as surgeons gain more experience, RAKAT should become increasingly used and further refined, thereby leading to improved surgical outcomes and improved patients' quality of life.

DOI： 10.1111/iju.15426

Correction: Development and Validation of a Preoperative Nomogram for Endoscopic Management Decision Making in Upper Urinary Tract Urothelial Carcinoma. International journal

Takahiro Nakamoto, Takashi Yoshida, Satoshi Katayama, Chisato Ohe, Takayuki Kawaura, Satoshi Horii, Junichi Ikeda, Yumiko Kono, Takashi Murota, Tomoki Kitawaki, Motoo Araki, Hidefumi Kinoshita

Annals of surgical oncology 31 ( 2 ) 1422 - 1422 2024.2

Development and Validation of a Preoperative Nomogram for Endoscopic Management Decision Making in Upper Urinary Tract Urothelial Carcinoma. Reviewed International journal

Takahiro Nakamoto, Takashi Yoshida, Satoshi Katayama, Chisato Ohe, Takayuki Kawaura, Satoshi Horii, Junichi Ikeda, Yumiko Kono, Takashi Murota, Tomoki Kitawaki, Motoo Araki, Hidefumi Kinoshita

Annals of surgical oncology 31 ( 2 ) 1393 - 1401 2024.2

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

OBJECTIVE: We aimed to develop and validate a preoperative nomogram that predicts low-grade, non-muscle invasive upper urinary tract urothelial carcinoma (LG-NMI UTUC), thereby aiding in the accurate selection of endoscopic management (EM) candidates. METHODS: This was a retrospective study that included 454 patients who underwent radical surgery (Cohort 1 and Cohort 2), and 26 patients who received EM (Cohort 3). Utilizing a multivariate logistic regression model, a nomogram predicting LG-NMI UTUC was developed based on data from Cohort 1. The nomogram's accuracy was compared with conventional European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) models. External validation was performed using Cohort 2 data, and the nomogram's prognostic value was evaluated via disease progression metrics in Cohort 3. RESULTS: In Cohort 1, multivariate analyses highlighted the absence of invasive disease on imaging (odds ratio [OR] 7.04; p = 0.011), absence of hydronephrosis (OR 2.06; p = 0.027), papillary architecture (OR 24.9; p < 0.001), and lack of high-grade urine cytology (OR 0.22; p < 0.001) as independent predictive factors for LG-NMI disease. The nomogram outperformed the two conventional models in predictive accuracy (0.869 vs. 0.759-0.821) and exhibited a higher net benefit in decision curve analysis. The model's clinical efficacy was corroborated in Cohort 2. Moreover, the nomogram stratified disease progression-free survival rates in Cohort 3. CONCLUSION: Our nomogram ( https://kmur.shinyapps.io/UTUC_URS/ ) accurately predicts LG-NMI UTUC, thereby identifying suitable candidates for EM. Additionally, the model serves as a useful tool for prognostic stratification in patients undergoing EM.

DOI： 10.1245/s10434-023-14514-z

当院における先行的生体腎移植の検討

吉永香澄, 関戸崇了, 丸山雄樹, 山野井友昭, 西村慎吾, 富永悠介, 定平卓也, 片山聡, 岩田健宏, 大西康博, 竹内英実, 田邊克幸, 森永裕士, 和田淳, 枝村康平, 小林知子, 小林泰之, 荒木元朗

日本臨床腎移植学会プログラム・抄録集 57回 210 - 210 2024.2

当院における生体腎移植ドナーの術後フォローアップ状況

山野井友昭, 西村慎吾, 関戸崇了, 吉永香澄, 丸山雄樹, 定平卓也, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 大西康博, 竹内英実, 田邊克幸, 森永裕士, 荒木元朗

日本臨床腎移植学会プログラム・抄録集 57回 208 - 208 2024.2

活躍する女性腎移植医女性腎移植医への期待

荒木元朗, 吉永香澄, 窪田理沙, 西村慎吾, 関戸崇了, 丸山雄樹, 定平卓也, 山野井友昭, 富永悠介, 片山聡, 岩田健宏, 別宮謙介, 枝村康平, 小林知子, 小林泰之

日本臨床腎移植学会プログラム・抄録集 57回 117 - 117 2024.2

Discontinuation of Immune-oncology Combinations due to Immune-related Adverse Events in Patients With Advanced Renal Cancers. Reviewed International journal

Kensuke Bekku, Manuela Schmidinger, Satoshi Katayama, Tatsushi Kawada, Takafumi Yanagisawa, Takehiro Iwata, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Motoo Araki, Shahrokh F Shariat

Anticancer research 44 ( 1 ) 379 - 386 2024.1

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

BACKGROUND/AIM: Patients with advanced renal cell carcinoma (aRCC) treated with immune-oncology (IO) drugs may need to discontinue the treatment when severe immune-related adverse events (irAE) occur; however, the impact of discontinuation on survival remains unknown. PATIENTS AND METHODS: This is a retrospective multicenter analysis using a database of 183 aRCC patients treated with first-line IO drugs combination. The patients were divided into two groups according to the necessity of discontinuation due to irAEs. The primary endpoint was overall survival (OS). Cox proportional hazard models determined the predictive factors on OS. RESULTS: Among a total of 135 patients who experienced irAE, 38 patients had to discontinue and 52 continued the treatment while treating irAE. When compared to patients who were able to continue treatment, discontinuation was associated with significantly higher rates of IO-IO doublet use, severe irAE (grade ≥3), steroid use, and the occurrence of immune-related pneumonitis (p=0.03, p<0.001, p<0.001, and p=0.02, respectively). The objective response rates were comparable between the two groups (discontinuation 55.6% vs. no discontinuation 56.0%, p=0.7). On univariate analysis, patients who discontinued had a significantly worse OS when compared to those who continued treatment (p=0.02). On the contrary, on multivariate analysis treatment discontinuation was not associated with poor OS (HR=1.1, p=0.9). CONCLUSION: Treatment discontinuation due to irAE was not associated with poor prognosis in aRCC patients treated with ICI-based combination therapy. Treatment discontinuation may be a reasonable treatment option for well-selected patients, specifically for those who experienced good treatment responses.

DOI： 10.21873/anticanres.16822

生体腎移植レシピエントの周術期尿路感染症リスク因子の検討

西村慎吾, 長崎直也, 奥村美紗, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号1 ) 56 - 56 2024.1

グラフト感染が契機と考えられる腎動脈破綻を認めた自家腎移植の一例

西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗, 枝木大治, 加藤源太郎

西日本泌尿器科 86 ( 増刊号1 ) 57 - 57 2024.1

高度腸骨動脈石灰化を有するレシピエントに対する脳死献腎移植の経験

吉永香澄, 西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗, 三浦望, 加藤源太郎

西日本泌尿器科 86 ( 増刊号1 ) 56 - 57 2024.1

腎提供後11年経過の若年ドナーに認めたT3a腎細胞癌の1例

原尚史, 西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 川野香, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 山野井智昭, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号1 ) 24 - 24 2024.1

腎提供後11年経過の若年ドナーに認めたT3a腎細胞癌の1例

原尚史, 西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 川野香, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 山野井智昭, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号1 ) 24 - 24 2024.1

生体腎移植レシピエントの周術期尿路感染症リスク因子の検討

西村慎吾, 長崎直也, 奥村美紗, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 86 ( 増刊号1 ) 56 - 56 2024.1

高度腸骨動脈石灰化を有するレシピエントに対する脳死献腎移植の経験

吉永香澄, 西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗, 三浦望, 加藤源太郎

西日本泌尿器科 86 ( 増刊号1 ) 56 - 57 2024.1

グラフト感染が契機と考えられる腎動脈破綻を認めた自家腎移植の一例

西村慎吾, 長崎直也, 奥村美紗, 尾地晃典, 原尚史, 川野香, 横山周平, 渡部智文, 関戸崇了, 堀井聡, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗, 枝木大治, 加藤源太郎

西日本泌尿器科 86 ( 増刊号1 ) 57 - 57 2024.1

The current status and novel advances of boron neutron capture therapy clinical trials. Reviewed International journal

Tianyun Zhou, Kazuyo Igawa, Tomonari Kasai, Takuya Sadahira, Wei Wang, Tomofumi Watanabe, Kensuke Bekku, Satoshi Katayama, Takehiro Iwata, Tadashi Hanafusa, Abai Xu, Motoo Araki, Hiroyuki Michiue, Peng Huang

American journal of cancer research 14 ( 2 ) 429 - 447 2024

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

Boron neutron capture therapy (BNCT) is a treatment method that focuses on improving the cure rate of patients with cancer who are difficult to treat using traditional clinical methods. By utilizing the high neutron absorption cross-section of boron, material rich in boron inside tumor cells can absorb neutrons and release high-energy ions, thereby destroying tumor cells. Owing to the short range of alpha particles, this method can precisely target tumor cells while minimizing the inflicted damage to the surrounding normal tissues, making it a potentially advantageous method for treating tumors. Globally, institutions have progressed in registered clinical trials of BNCT for multiple body parts. This review summarized the current achievements in registered clinical trials, Investigator-initiated clinical trials, aimed to integrate the latest clinical research literature on BNCT and to shed light on future study directions.

Clinical T1a Renal Cell Carcinoma with Solitary Diaphragmatic Metastasis in a Patient with von Hippel-Lindau Disease. Reviewed International journal

Tadataka Hirai, Mayu Uka, Toshihiro Iguchi, Kazuya Yasui, Takahiro Kawabata, Noriyuki Umakoshi, Koji Tomita, Yusuke Matsui, Yasuyuki Kobayashi, Motoo Araki, Takao Hiraki

Journal of kidney cancer and VHL 11 ( 3 ) 23 - 26 2024

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

We report the case of a 38-year-old man with two von Hippel-Lindau disease-associated T1a renal cell carcinomas (RCCs) (<2 cm in diameter) which developed into a 2.5-cm solitary diaphragmatic metastatic tumor. After diagnosis using percutaneous biopsy, the diaphragmatic metastasis and two RCCs were treated by laparoscopic resection and percutaneous cryoablation, respectively. One year after treatment, the patient survived without local recurrence or distant metastasis. This report describes a rare case of RCC metastasis in VHL disease and its treatment.

DOI： 10.15586/jkcvhl.v11i3.342

Oncological outcomes of active surveillance versus surgery or ablation for patients with small renal masses: A systematic review and quantitative analysis Reviewed

Tsuboi I., Rajwa P., Campi R., Miszczyk M., Fazekas T., Matsukawa A., Parizi MK, Schulz RJ, Mancon S., Cadenar A., Laukhtina E., Kawada T., Katayama S., Iwata T., Bekku K., Wada K., Karakiewicz PI, Remzi M., Araki M., Shariat SF

Eur Urol Oncol 2024

尿路結石治療の坂と雲～新たな時代の幕開け～結石手術における効率化・費用対効果向上のための新しいデバイスについて

富永悠介, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 荒木元朗

西日本泌尿器科 86 ( 4 ) 193 - 194 2024

特集感染症と腎疾患総論腎移植患者における感染症 Reviewed

関戸崇了, 西村慎吾, 荒木元朗

腎と透析 96 ( 6 ) 717 - 722 2024

腎移植術における血管吻合ロボット手術もふまえて

荒木元朗, 西村慎吾, 吉永香澄, 窪田理沙, 関戸崇了, 丸山雄樹, 山野井友昭, 富永悠介, 片山聡, 岩田健宏, 別宮謙介, 枝村康平, 小林知子, 小林泰之

日本血管外科学会雑誌 33 ( Suppl. ) SP2 - 5 2024

The Diagnosis and Treatment Approach for Oligo-Recurrent and Oligo-Progressive Renal Cell Carcinoma. Reviewed International journal

Kensuke Bekku, Tatsushi Kawada, Takanori Sekito, Kasumi Yoshinaga, Yuki Maruyama, Tomoaki Yamanoi, Yusuke Tominaga, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Motoo Araki, Yuzuru Niibe

Cancers 15 ( 24 ) 2023.12

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

One-third of renal cell carcinomas (RCCs) without metastases develop metastatic disease after extirpative surgery for the primary tumors. The majority of metastatic RCC cases, along with treated primary lesions, involve limited lesions termed "oligo-recurrent" disease. The role of metastasis-directed therapy (MDT), including stereotactic body radiation therapy (SBRT) and metastasectomy, in the treatment of oligo-recurrent RCC has evolved. Although the surgical resection of all lesions alone can have a curative intent, SBRT is a valuable treatment option, especially for patients concurrently receiving systemic therapy. Contemporary immune checkpoint inhibitor (ICI) combination therapies remain central to the management of metastatic RCC. However, one objective of MDT is to delay the initiation of systemic therapies, thereby sparing patients from potentially unnecessary burdens. Undertaking MDT for cases showing progression under systemic therapies, known as "oligo-progression", can be complex in considering the treatment approach. Its efficacy may be diminished compared to patients with stable disease. SBRT combined with ICI can be a promising treatment for these cases because radiation therapy has been shown to affect the tumor microenvironment and areas beyond the irradiated sites. This may enhance the efficacy of ICIs, although their efficacy has only been demonstrated in clinical trials.

DOI： 10.3390/cancers15245873

Prognostic impact of radiological tumor burden in patients with metastatic urothelial carcinoma treated with pembrolizumab Reviewed

Satoshi Katayama, Takehiro Iwata, Tasushi Kawada, Yusuke Okamoto, Yuho Sano, Yuya Kawago, Shuji Miyake, Takatoshi Moriwake, Aya Kuinose, Yuhei Horikawa, Kazuma Tsuboi, Ichiro Tsuboi, Kazuma Sakaeda, Hirokazu Nakatsuka, Atsushi Takamoto, Takeshi Hirata, Yoshinori Shirasaki, Taku Yamasaki, Hirofumi Morinaka, Naoya Nagasaki, Takafumi Hara, Akinori Ochi, Misa Okumura, Tomofumi Watanabe, Takanori Sekito, Kaoru Kawano, Satoshi Horii, Tomoaki Yamanoi, Kentaro Nagao, Kasumi Yoshinaga, Yuki Maruyama, Yusuke Tominaga, Takuya Sadahira, Shingo Nishimura, Kohei Edamura, Tomoko Kobayashi, Norihiro Kusumi, Kyohei Kurose, Yasuo Yamamoto, Morito Sugimoto, Tetsuya Nakada, Katsumi Sasaki, Tadasu Takenaka, Shin Ebara, Yoshiyuki Miyaji, Koichiro Wada, Yasuyuki Kobayashi, Motoo Araki

Urologic Oncology: Seminars and Original Investigations 2023.12

【日本移植学会2022年症例登録統計報告】腎移植臨床登録集計報告(2023) 2022年実施症例の集計報告と追跡調査結果 Reviewed

中川由紀, 三重野牧子, 市丸直嗣, 西田隼人, 中村道郎, 堀田記世彦, 尾本和也, 田崎正行, 伊藤泰平, 奥見雅由, 荒木元朗, 祖父江理, 山田保俊, 島袋修一, 剣持敬, 湯沢賢治, 日本臨床腎移植学会・日本移植学会

移植 58 ( 3 ) 189 - 208 2023.12

性同一性障害に対するフィナステリドの安全性の検討について:中間報告 Reviewed

富永悠介, 小林知子, 松本裕子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 枝村康平, 小林泰之, 渡部昌実, 荒木元朗

GID(性同一性障害)学会雑誌 16 ( 1 ) 165 - 167 2023.12

Language：Japanese Publisher：GID(性同一性障害)学会

ホルモン療法に伴う男性型脱毛症(AGA)を有する性同一性障害(GID-FTM)に対するフィナステリドの安全性・治療効果を前向きに検討した.選択基準はNorwood-Hamilton(N-H)分類II以上などで,性別適合手術後の症例は除外した.被験者にはフィナステリド0.2mgを3ヵ月経口投与し,継続可能であった症例については,1.0mgに増量しさらに3ヵ月投与した.登録した2例において,フィナステリドに関連した有害事象を認めず,6ヵ月間の内服継続が可能であった.2例ともに多血症の改善およびN-H分類で脱毛の改善を認めた.1例で1度の月経再開を認めた.フィナステリドはホルモン療法中の身体的男性化に影響を与える可能性がある.本試験においては,良好な安全性・有効性を示唆する結果が得られた.(著者抄録)

【日本移植学会2022年症例登録統計報告】腎移植臨床登録集計報告(2023) 2022年実施症例の集計報告と追跡調査結果 Reviewed

中川由紀, 三重野牧子, 市丸直嗣, 西田隼人, 中村道郎, 堀田記世彦, 尾本和也, 田崎正行, 伊藤泰平, 奥見雅由, 荒木元朗, 祖父江理, 山田保俊, 島袋修一, 剣持敬, 湯沢賢治, 日本臨床腎移植学会・日本移植学会

移植 58 ( 3 ) 189 - 208 2023.12

Geriatric nutritional risk index as a prognostic marker of first-line immune checkpoint inhibitor combination therapy in patients with renal cell carcinoma: a retrospective multi-center study. Reviewed International journal

Shogo Watari, Satoshi Katayama, Hiromasa Shiraishi, Moto Tokunaga, Risa Kubota, Norihiro Kusumi, Takaharu Ichikawa, Tomoyasu Tsushima, Yasuyuki Kobayashi, Kensuke Bekku, Motoo Araki

Discover. Oncology 14 ( 1 ) 204 - 204 2023.11

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

PURPOSE: This study aimed to investigate the effectiveness of the Geriatric Nutritional Risk Index (GNRI) in predicting the efficacy of first-line immune checkpoint inhibitor (ICI) combination therapy for metastatic or unresectable renal cell carcinoma (RCC) and associated patient prognosis. METHODS: A retrospective study was conducted using data from 19 institutions. The GNRI was calculated using body mass index and serum albumin level, and patients were classified into two groups using the GNRI values, with 98 set as the cutoff point. RESULTS: In all, 119 patients with clear cell RCC who received first-line drug therapy with ICIs were analyzed. Patients with GNRI ≥ 98 had significantly better overall survival (OS) (p = 0.008) and cancer-specific survival (CSS) (p = 0.001) rates than those with GNRI < 98; however, progression-free survival (PFS) did not differ significantly. Inverse probability of treatment weighting analysis showed that low GNRI scores were significantly associated with poor OS (p = 0.004) and CSS (p = 0.015). Multivariate analysis showed that the Karnofsky performance status (KPS) score was a better predictor of prognosis (OS; HR 5.17, p < 0.001, CSS; HR 4.82, p = 0.003) than GNRI (OS; HR 0.36, p = 0.066, CSS; HR 0.35, p = 0.072). In a subgroup analysis of patients with a good KPS and GNRI ≥ 98 vs < 98, the 2-year OS rates were 91.4% vs 66.9% (p = 0.068), 2-year CSS rates were 91.4% vs 70.1% (p = 0.073), and PFS rates were 39.7% vs 21.4 (p = 0.27), respectively. CONCLUSION: The prognostic efficiency of GNRI was inferior to that of the KPS score at the initiation of the first-line ICI combination therapy for clear cell RCC.

DOI： 10.1007/s12672-023-00816-x

Treg細胞の活性化CTLA-4非依存性免疫抑制によるCTLA-4遮断の不安定な抗腫瘍効果(Disturbed anti-tumor effect of CTLA-4 blockade by activated CTLA-4-independent immunosuppression of Treg cells)

渡部智文, 石野貴雅, 上田優輝, 長崎譲慈, 河田達志, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林泰之, 團迫浩方, 荒木元朗, 冨樫庸介

西日本泌尿器科学会総会抄録集 75回 185 - 185 2023.11

超高齢膀胱癌患者に対するロボット支援膀胱全摘除術(RARC)の外科的達成評価の検討

山野井友昭, 小林泰之, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 209 - 209 2023.11

Calciphylaxisによると考えられた陰茎亀頭部潰瘍の一例

川野香, 長尾賢太郎, 岩田健宏, 富永悠介, 片山聡, 定平卓也, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗, 平井陽至

西日本泌尿器科学会総会抄録集 75回 233 - 233 2023.11

ロボット支援下前立腺全摘除術(RARP)の周術期抗菌薬投与方法と術後感染症発生率に関する後方視的研究

長崎直也, 定平卓也, 岩田健宏, 渡部智文, 山野井友昭, 河田達志, 富永悠介, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 236 - 236 2023.11

閉経後の反復性膀胱炎を有する女性における尿および腟内の大腸菌の相同性の比較

関戸崇了, 定平卓也, 岩田健宏, 富永悠介, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 239 - 239 2023.11

当科におけるロボット支援膀胱全摘除術・体腔内尿路変向の技術継承の取り組み

山野井友昭, 小林泰之, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 37回 O - 6 2023.11

岡山大学病院におけるRAPN再発・転移症例の検討

吉永香澄, 冨永悠介, 定平卓也, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 37回 O - 3 2023.11

ロボット支援下前立腺全摘除術(RARP)の周術期抗菌薬投与方法と術後感染症発生率に関する後方視的研究

長崎直也, 定平卓也, 岩田健宏, 渡部智文, 山野井友昭, 河田達志, 富永悠介, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 236 - 236 2023.11

閉経後の反復性膀胱炎を有する女性における尿および腟内の大腸菌の相同性の比較

関戸崇了, 定平卓也, 岩田健宏, 富永悠介, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 239 - 239 2023.11

超高齢膀胱癌患者に対するロボット支援膀胱全摘除術(RARC)の外科的達成評価の検討

山野井友昭, 小林泰之, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

西日本泌尿器科学会総会抄録集 75回 209 - 209 2023.11

Calciphylaxisによると考えられた陰茎亀頭部潰瘍の一例

川野香, 長尾賢太郎, 岩田健宏, 富永悠介, 片山聡, 定平卓也, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗, 平井陽至

西日本泌尿器科学会総会抄録集 75回 233 - 233 2023.11

Treg細胞の活性化CTLA-4非依存性免疫抑制によるCTLA-4遮断の不安定な抗腫瘍効果(Disturbed anti-tumor effect of CTLA-4 blockade by activated CTLA-4-independent immunosuppression of Treg cells)

渡部智文, 石野貴雅, 上田優輝, 長崎譲慈, 河田達志, 定平卓也, 岩田健宏, 片山聡, 枝村康平, 小林泰之, 團迫浩方, 荒木元朗, 冨樫庸介

西日本泌尿器科学会総会抄録集 75回 185 - 185 2023.11

当科におけるロボット支援膀胱全摘除術・体腔内尿路変向の技術継承の取り組み

山野井友昭, 小林泰之, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 37回 O - 6 2023.11

岡山大学病院におけるRAPN再発・転移症例の検討

吉永香澄, 冨永悠介, 定平卓也, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 37回 O - 3 2023.11

AirSealがロボット支援腹腔鏡下膀胱全摘除術の臨床経過に及ぼす影響に関する検討

河田達志, 山野井友昭, 長尾賢太郎, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 37回 P - 2 2023.11

転移性去勢抵抗性前立腺癌におけるBRCA遺伝子バリアントの検討

岩田健宏, 吉永香澄, 丸山雄樹, 河田達志, 定平卓也, 富永悠介, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 渡部昌実, 渡邉豊彦, 荒木元朗

日本癌治療学会学術集会抄録集 61回 P12 - 5 2023.10

ラット頻尿モデルに対する、排尿モニタリングシステムを用いた膀胱内治療の比較検討

渡部智文, 定平卓也, 長崎直也, 富永悠介, 丸山雄樹, 渡邉豊彦, 荒木元朗

日本排尿機能学会誌 34 ( 1 ) 319 - 319 2023.9

CTLA-4の単純な阻害はTreg細胞のCTLA-4以外の免疫抑制機構の活性化を引き起こす(Anti-tumor effects of CTLA-4 blockade are distrubed by activated CTLA-4-independent immunosuppression of Treg cells)

渡部智文, 石野貴雅, 上田優輝, 長崎譲慈, 丸山雄樹, 河田達志, 定平卓也, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 團迫浩方, 荒木元朗, 冨樫庸介

日本癌学会総会記事 82回 1380 - 1380 2023.9

排尿モニタリングシステムを用いた、酢酸膀胱内投与によるラット頻尿モデルの検討

長崎直也, 定平卓也, 渡部智文, 富永悠介, 丸山雄樹, 渡邉豊彦, 荒木元朗

日本排尿機能学会誌 34 ( 1 ) 318 - 318 2023.9

ラット頻尿モデルに対する、排尿モニタリングシステムを用いた膀胱内治療の比較検討

渡部智文, 定平卓也, 長崎直也, 富永悠介, 丸山雄樹, 渡邉豊彦, 荒木元朗

日本排尿機能学会誌 34 ( 1 ) 319 - 319 2023.9

CTLA-4の単純な阻害はTreg細胞のCTLA-4以外の免疫抑制機構の活性化を引き起こす(Anti-tumor effects of CTLA-4 blockade are distrubed by activated CTLA-4-independent immunosuppression of Treg cells)

渡部智文, 石野貴雅, 上田優輝, 長崎譲慈, 丸山雄樹, 河田達志, 定平卓也, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 團迫浩方, 荒木元朗, 冨樫庸介

日本癌学会総会記事 82回 1380 - 1380 2023.9

排尿モニタリングシステムを用いた、酢酸膀胱内投与によるラット頻尿モデルの検討

長崎直也, 定平卓也, 渡部智文, 富永悠介, 丸山雄樹, 渡邉豊彦, 荒木元朗

日本排尿機能学会誌 34 ( 1 ) 318 - 318 2023.9

免疫学的ハイリスク腎移植における低用量リツキシマブを用いた脱感作療法とサイトメガロウイルス感染症 5年間の追跡調査

吉永香澄, 関戸崇了, 丸山雄樹, 山野井友昭, 西村慎吾, 大西康博, 竹内英実, 田邊克幸, 森永裕士, 枝村康平, 小林知子, 小林泰之, 和田淳, 荒木元朗

移植 58 ( 総会臨時 ) 307 - 307 2023.9

LOH症候群における各種質問票の有用性について

富永悠介, 小林知子, 松本裕子, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 枝村康平, 小林泰之, 佐古智子, 杉本盛人, 渡部昌実, 荒木元朗

日本性機能学会雑誌 38 ( 2 ) 182 - 182 2023.8

ロボット支援腹腔鏡下膀胱全摘除術における予防的全腟閉鎖術併用の試み

小林知子, 西村慎吾, 富永悠介, 宇埜誠, 吉永香澄, 丸山雄樹, 定平卓也, 片山聡, 岩田健宏, 枝村康平, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

日本女性骨盤底医学会プログラム・抄録集 25回 91 - 91 2023.8

ロボット支援腹腔鏡下膀胱全摘除術における予防的全腟閉鎖術併用の試み

小林知子, 西村慎吾, 富永悠介, 宇埜誠, 吉永香澄, 丸山雄樹, 定平卓也, 片山聡, 岩田健宏, 枝村康平, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

日本女性骨盤底医学会プログラム・抄録集 25回 91 - 91 2023.8

Staphylococcus saprophyticus感染結石による閉塞性腎盂腎炎の一例

渡部智文, 定平卓也, 丸山雄樹, 岩田健宏, 荒木元朗

日本化学療法学会雑誌 71 ( 4 ) 522 - 523 2023.7

腟細菌叢解析による反復性膀胱炎への乳酸菌腟坐剤の効果の検証

丸山雄樹, 定平卓也, 岩田健宏, 石井亜矢乃, 和田耕一郎, 荒木元朗, 光畑律子

日本化学療法学会雑誌 71 ( 4 ) 493 - 493 2023.7

腟細菌叢解析による反復性膀胱炎への乳酸菌腟坐剤の効果の検証

丸山雄樹, 定平卓也, 岩田健宏, 石井亜矢乃, 和田耕一郎, 荒木元朗, 光畑律子

日本化学療法学会雑誌 71 ( 4 ) 493 - 493 2023.7

乳酸菌由来抗菌ペプチドの探索

岩田健宏, 定平卓也, 渡部智文, 丸山雄樹, 和田耕一郎, 山本満寿美, 石井亜矢乃, 渡邉豊彦, 荒木元朗, 関戸崇之, 吉永香澄, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 光畑律子

日本化学療法学会雑誌 71 ( 4 ) 526 - 526 2023.7

Staphylococcus saprophyticus感染結石による閉塞性腎盂腎炎の一例

渡部智文, 定平卓也, 丸山雄樹, 岩田健宏, 荒木元朗

日本化学療法学会雑誌 71 ( 4 ) 522 - 523 2023.7

乳酸菌由来抗菌ペプチドの探索

岩田健宏, 定平卓也, 渡部智文, 丸山雄樹, 和田耕一郎, 山本満寿美, 石井亜矢乃, 渡邉豊彦, 荒木元朗, 関戸崇之, 吉永香澄, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 光畑律子

日本化学療法学会雑誌 71 ( 4 ) 526 - 526 2023.7

Exploration of the protein-dependent mechanism of Lactobacillus crispatus GAI98322 to prevent recurrent cystitis. Reviewed International journal

Tomofumi Watanabe, Takuya Sadahira, Hidetada Hirakawa, Peng Huang, Tianyun Zhou, Takehiro Iwata, Takanori Sekito, Ayano Ishii, Masami Watanabe, Motoo Araki

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 29 ( 10 ) 1001 - 1004 2023.6

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

OBJECTIVES: To elucidate the mechanism of Lactobacillus crispatus (L. crispatus) suppositories to prevent patients from recurrent cystitis (RC), independent from viable-Lactobacilli-bacteria- and acid-dependent ones such as hydrogen peroxide and lactate. METHODS: We used the GAI98322 strain of L. crispatus in all experiments and pH-matched. cell-free culture supernatant of L. crispatus (CFCS) was collected. The growth inhibitory activity and the biofilm formation inhibitory activity of the CFCS against uropathogenic Escherichia coli (UPEC), Extended Spectrum beta (β) Lactamase producing (ESBL+) UPEC, and Pseudomonas aeruginosa (P. aeruginosa) was assessed by agar-disk diffusion tests and crystal violet assay. Also, CFCS was subjected to mass spectrometry to specify ingredients. RESULTS: The CFCS suppressed the proliferation of E. coli, ESBL + E. coli, and P. aeruginosa. Also, the CFCS at a concentration of 40% significantly impeded the biofilm formation of these three bacteria. The aggregation-promoting factor and Lysin was detected from CFCS. CONCLUSIONS: The cell-free supernatant from the GAI98322 strain of L. crispatus inhibits the growth/biofilm formation of broad pathogens by aggregation promoting factor and lysin, which may prevent hosts from RC regardless of the antimicrobial resistance of the pathogens and even under pH modulation.

DOI： 10.1016/j.jiac.2023.06.013

Tolerability of immune checkpoint inhibitor doublet for advanced renal cell carcinoma patients with pre-dialysis chronic kidney disease or end-stage renal disease. Reviewed International journal

Kensuke Bekku, Naoya Nagasaki, Ichiro Tsuboi, Atsushi Takamoto, Satoshi Katayama, Motoo Araki

International journal of urology : official journal of the Japanese Urological Association 2023.6

アンドロロジー;Next 10 Years 男性不妊症における性機能障害について Reviewed

富永悠介, 松本裕子, 吉永香澄, 丸山雄樹, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗

西日本泌尿器科 85 ( 5 ) 324 - 329 2023.6

Staphylococcus saprophyticusによる感染結石の1例

渡部智文, 鵜川聖也, 長崎直也, 奥村美紗, 宇埜誠, 堀井聡, 吉永香澄, 丸山雄樹, 山野井智昭, 長尾賢太郎, 富永悠介, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 85 ( 増刊号2 ) 148 - 148 2023.6

RPLND後の難治性リンパ漏に対して開腹リンパ管結紮術が奏功した1例

鵜川聖也, 長崎直也, 原惇也, 松島萌希, 奥村美紗, 渡部智文, 宇埜誠, 堀井聡, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 富永悠介, 定平卓也, 岩田健宏, 片山聡, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科 85 ( 増刊号2 ) 148 - 148 2023.6

Bladder tumors with multiple cardiac metastases, with elevated serum granulocyte colony-stimulating factor. Reviewed International journal

Naoya Nagasaki, Tomofumi Watanabe, Kohei Edamura, Motoo Araki, Takuya Sadahira

The American journal of medicine 136 ( 8 ) e161-e162 2023.4

Renal cryoablation combined with prior transcatheter arterial embolization in non-dialysis patients with stage 4 or 5 chronic kidney disease: a retrospective study Reviewed

Noriyuki Umakoshi, Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Takahiro Kawabata, Kazuaki Munetomo, Shoma Nagata, Hideo Gobara, Motoo Araki, Takao Hiraki

Japanese Journal of Radiology 2023.4

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Purpose

To retrospectively evaluate cryoablation combined with prior transcatheter arterial embolization (TAE) for renal cell carcinoma (RCC) in non-dialysis patients with stage 4 or 5 chronic kidney disease (CKD).

Materials and methods

Patients with stage 4 or 5 CKD undergoing TAE and cryoablation for RCC between May 2012 and October 2021 were included. TAE was selectively performed using iodized oil with absolute ethanol or gelatin sponge 1–14 days before cryoablation. Local efficacy, safety, and changes in renal function were evaluated.

Results

Nine patients (seven men and two women; median age, 64 years; range 52–88 years) with nine RCCs (mean diameter, 3.0 ± 1.0 cm; range 1.7–4.7 cm) were included. The mean pre-treatment estimated glomerular filtration rate (eGFR) was 24.2 ± 5.6 ml/min/1.73 m² (range 10.4–29.2 ml/min/1.73 m²). The mean amount of contrast medium used in TAE was 58 ± 29 ml (range 40–128 ml). Except in one patient (grade 3 pyelonephritis), no grade ≥ 3 complications occurred. During the follow-up period (median, 18 months; range 7–54 months), no local tumor progression occurred. In two patients with pre-treatment eGFR of < 20 ml/min/1.73 m², hemodialysis was initiated at 3 and 19 months after cryoablation. At their last follow-up, the remaining seven patients showed a decrease of 6.2 ± 5.3 ml/min/1.73 m² (range 0.7–17.2 ml/min/1.73 m²) in their eGFR.

Conclusion

Cryoablation combined with TAE for RCC in non-dialysis patients with stage 4 or 5 CKD was effective and safe, with an acceptable impact on renal function.

DOI： 10.1007/s11604-023-01416-z

Other Link： https://link.springer.com/article/10.1007/s11604-023-01416-z/fulltext.html

Complications of Percutaneous Cryoablation for Renal Tumors and Methods for Avoiding Them. Reviewed

Toshihiro Iguchi, Yusuke Matsui, Koji Tomita, Mayu Uka, Noriyuki Umakoshi, Takahiro Kawabata, Kazuaki Munetomo, Shoma Nagata, Motoo Araki, Takao Hiraki

Acta medica Okayama 77 ( 2 ) 121 - 129 2023.4

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

Percutaneous cryoablation of renal tumors is widely used because of its high efficacy and safety. This high safety can be attributed, at least in part, to the visibility of the ablated area as an "ice ball". This therapy has fewer complications (incidence, 0-7.2%) and is less invasive than surgery. Minor bleeding is inevitable in most kidney-related procedures, and indeed the most common complication of this therapy is bleeding (hematoma and hematuria). However, patients require treatment such as transfusion or transarterial embolization in only 0-4% of bleeding cases. Various other complications such as ureteral or collecting system injury, bowel injury, nerve injury, skin injury, infection, pneumothorax, and tract seeding also occur, but they are usually minor and asymptomatic. However, operators should know and avoid the various complications associated with this therapy. This study aimed to summarize the complications of percutaneous cryoablation for renal tumors and provide some techniques for achieving safe procedures.

DOI： 10.18926/AMO/65141

前立腺癌:Next 10 years～どうなる,どうする,前立腺癌～限局性前立腺癌に対するFocal therapy Reviewed

小林泰之, 枝村康平, 西村慎吾, 岩田健宏, 片山聡, 定平卓也, 小林知子, 荒木元朗

西日本泌尿器科 85 ( 4 ) 106 - 109 2023.4

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

限局性前立腺癌の治療は臨床的Insignificant cancerに対してActive surveillance,Significant cancerに対しては根治的治療が選択される。しかしながら,癌制御とQOL維持の両立の点を考慮するといずれの治療も十分とは言えない患者群が存在し,このような症例に対する治療としてFocal therapyが期待されている。Focal therapyに関する諸家らの報告では,短～中期腫瘍学的結果は良好であり,尿禁制や性機能も優れていた。本邦においては,2021年4月に日本泌尿器科学会より「前立腺癌局所治療医療機器の臨床評価方法に関するガイドライン」が出され,今後,Focal therapyのエビデンスが蓄積されていくものと期待される。(著者抄録)

Gerota fasciaとは何物なのか cadaverを用いた組織学的検討 Reviewed

小林泰之, 枝村康平, 定平卓也, 富永悠介, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 小林知子, 小見山高明, 百田龍輔, 荒木元朗

Japanese Journal of Endourology and Robotics 36 ( 1 ) 118 - 123 2023.4

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

腹腔鏡下腎摘除術において,Gerota fascia(以下:Gf)は経腹的アプローチでは膜構造として容易に認識できるが,後腹膜アプローチではその見え方が経腹的アプローチとは大きく異なり,その存在自体を認識できない症例が少なくない.今回,我々は死亡献体より腎臓と腎臓周囲臓器を一塊に摘出し,Gfに剥離操作を加えない状態で検体作成を行い,線維の走行,密度などについて組織学的検討を行った.その結果,Gfは筋上膜のような強固な膜とは構造が異なり,密度・配列など多様なコラーゲン線維のまばらな結合組織で構成されていることが分かった.すなわち,Gfが膜状構造物に観察されるのは,結合組織が剥離操作にて変化した結果の可能性があり,アプローチする方向の違いによりその形態が異なって見えることを念頭におく必要があるものと考えられる.(著者抄録)

【ロボット時代の若手への腹腔鏡教育を考える】ロボット時代の若手への腹腔鏡教育を考える腎副腎メンターの立場から Reviewed

小林泰之, 枝村康平, 定平卓也, 富永悠介, 片山聡, 岩田健宏, 西村慎吾, 小林知子, 荒木元朗

Japanese Journal of Endourology and Robotics 36 ( 1 ) 57 - 60 2023.4

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

ロボット手術の普及により,腹腔鏡手術教育は大きく変化しつつある.一番の問題点は,ロボット支援下部分切除術の普及に伴い,これまでより難易度の高い症例が腹腔鏡下腎摘除術の対象となり,相対的に初心者が行う腹腔鏡手術件数が減少していることである.加えて,手術環境の急激な変化により,初心者のトレーニング背景も複雑化してきており,手術教育もそれらに対応すべく変化が求められている.岡山大学病院では,従来通りの模範手術を核とした集団指導に加えて,ある程度の執刀経験のある術者に対して,個別指導を行い対応している.加えて,最近のWeb会議システムを用い,関連施設の垣根を超えたWeb勉強会を行っている.(著者抄録)

局所進行性膀胱癌に対する根治的膀胱全摘除術前化学療法としてのゲムシタビン、シスプラチン、パクリタキセル3剤併用化学療法の治療成績(Clinical Outcomes of Neoadjuvant Paclitaxel/Cisplatin/Gemcitabine compared with Gemcitabine/Cisplatin for Muscle-Invasive Bladder cancer)

河田達志, 別宮謙介, 片山聡, 岩田健宏, 枝村康平, 小林泰之, 津川卓士, 坪井一馬, 定平卓也, 西村慎吾, 小林知子, 江原伸, 荒木元朗

日本泌尿器科学会総会 110回 OP36 - 02 2023.4

転移性腎細胞がんに対する免疫チェックポイント阻害剤の有効性における転移部位腫瘍径の影響(The impact of metastatic tumor burden to the efficacy of immune checkpoint inhibitors for metastatic renal cell carcinoma)

岩田健宏, 片山聡, 吉永香澄, 丸山雄樹, 定平卓也, 西村慎吾, 別宮健介, 枝村康平, 小林知子, 小林泰之, 渡邉豊彦, 荒木元朗

日本泌尿器科学会総会 110回 OP25 - 05 2023.4

cT1腎癌におけるロボット支援腎部分切除(RAPN)と経皮的凍結療法(PCA)の傾向スコアマッチング解析を用いた周術期成績・術後腎機能の検討(Oncological outcomes and renal function in robot-assisted partial nephrectomy vs percutaneous cryoablation for cT1 RCC: A propensity score-matched analysis)

山野井友昭, 別宮謙介, 馬越紀行, 定平卓也, 片山聡, 岩田健宏, 宇賀麻由, 西村慎吾, 枝村康平, 小林知子, 小林泰之, 荒木元朗, 平木隆夫

日本泌尿器科学会総会 110回 PP75 - 01 2023.4

腎癌に対する経皮的凍結療法とロボット支援下腎部分切除術の対費用効果についての後方視的比較検討(Percutaneous Cryoablatin vs Robot-Assisted Partial Nephrectomy in Renal Carcinoma: Cost Analysis)

宇賀麻由, 別宮謙介, 山野井友昭, 永田翔馬, 宗友一晃, 馬越紀行, 川端隆寛, 冨田晃司, 松井裕輔, 生口俊浩, 郷原英夫, 荒木元朗, 平木隆夫

日本インターベンショナルラジオロジー学会雑誌 38 ( Suppl. ) 211 - 211 2023.4

Tumor burdenはペムブロリズマブ療法を受けた転移性尿路上皮癌患者の予後因子となる多施設共同研究(Radiological tumor burden as prognostic biomarker in patients with metastatic urothelial carcinoma treated with immune checkpoint inhibitor)

片山聡, 岩田健宏, 小林泰之, 小林知子, 枝村康平, 坪井一馬, 高本篤, 坪井一朗, 久住倫宏, 中田哲也, 佐々木克己, 和田耕一郎, 荒木元朗

日本泌尿器科学会総会 110回 OP79 - 02 2023.4

The Genotypic and Phenotypic Characteristics Contributing to Flomoxef Sensitivity in Clinical Isolates of ESBL-Producing E. coli Strains from Urinary Tract Infections Reviewed

Kazuma Sakaeda, Takuya Sadahira, Yuki Maruyama, Takehiro Iwata, Masami Watanabe, Koichiro Wada, Motoo Araki

Antibiotics 12 ( 3 ) 522 - 522 2023.3

Publishing type：Research paper (scientific journal) Publisher：MDPI AG

We carried out a molecular biological analysis of extended-spectrum β-lactamase (ESBL)-producing E. coli strains and their sensitivity to flomoxef (FMOX). Sequence type (ST) analysis by multilocus sequence typing (MLST) and classification of ESBL genotypes by multiplex PCR were performed on ESBL-producing E. coli strains isolated from urine samples collected from patients treated at our institution between 2008 and 2018. These sequences were compared with results for antimicrobial drug susceptibility determined using a micro-liquid dilution method. We also analyzed cases treated with FMOX at our institution to examine its clinical efficacy. Of the 911 E. coli strains identified, 158 (17.3%) were ESBL-producing. Of these, 67.7% (107/158) were strain ST-131 in ST analysis. Nearly all (154/158; 97.5%) were CTX-M genotypes, with M-14 and M-27 predominating. The isolated strains were sensitive to FMOX in drug susceptibility tests. Among the patient samples, 33 cases received FMOX, and of these, 5 had ESBL-producing E. coli. Among these five cases, three received FMOX for surgical prophylaxis as urinary carriers of ESBL-producing E. coli, and postoperative infections were prevented in all three patients. The other two patients received FMOX treatment for urinary tract infections. FMOX treatment was successful for one, and the other was switched to carbapenem. Our results suggest that FMOX has efficacy for perioperative prophylactic administration in urologic surgery involving carriers of ESBL-producing bacteria and for therapeutic administration for urinary tract infections. Use of FMOX avoids over-reliance on carbapenems or β-lactamase inhibitors and thus is an effective antimicrobial countermeasure.

DOI： 10.3390/antibiotics12030522

乳酸菌由来抗菌ペプチドの探索

岩田健宏, 定平卓也, 渡部智文, 丸山雄樹, 和田耕一郎, 山本満寿美, 石井亜矢乃, 渡邉豊彦, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 P - 168 2023.3

Staphylococcus saprophyticus感染結石による閉塞性腎盂腎炎の一例

渡部智文, 定平卓也, 丸山雄樹, 岩田健宏, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 P - 142 2023.3

乳酸菌由来抗菌ペプチドの探索

岩田健宏, 定平卓也, 渡部智文, 丸山雄樹, 和田耕一郎, 山本満寿美, 石井亜矢乃, 渡邉豊彦, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 P - 168 2023.3

Staphylococcus saprophyticus感染結石による閉塞性腎盂腎炎の一例

渡部智文, 定平卓也, 丸山雄樹, 岩田健宏, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 P - 142 2023.3

腟細菌叢解析による反復性膀胱炎への乳酸菌腟坐剤の効果の検証

丸山雄樹, 定平卓也, 岩田健宏, 石井亜矢乃, 和田耕一郎, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 O - 172 2023.3

腟細菌叢解析による反復性膀胱炎への乳酸菌腟坐剤の効果の検証

丸山雄樹, 定平卓也, 岩田健宏, 石井亜矢乃, 和田耕一郎, 荒木元朗

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 97回・71回 O - 172 2023.3

Activated CTLA-4-independent immunosuppression of Treg cells disturbs CTLA-4 blockade-mediated antitumor immunity. Reviewed International journal

Tomofumi Watanabe, Takamasa Ishino, Youki Ueda, Joji Nagasaki, Takuya Sadahira, Hiromichi Dansako, Motoo Araki, Yosuke Togashi

Cancer science 2023.2

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

Combination therapy with anti-cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and anti-programmed death-1 (PD-1) monoclonal antibodies (mAbs) has dramatically improved the prognosis of patients with multiple types of cancer, including renal cell carcinoma (RCC). However, more than half of RCC patients fail to respond to this therapy. Regulatory T cells (Treg cells) are a subset of highly immunosuppressive CD4+ T cells that promote the immune escape of tumors by suppressing effector T cells in the tumor microenvironment (TME) through various mechanisms. CTLA-4 is constitutively expressed in Treg cells and is regarded as a key molecule for Treg cell-mediated immunosuppressive functions, suppressing antigen-presenting cells by binding to CD80/CD86. Reducing Treg cells in the TME with an anti-CTLA-4 mAb with antibody-dependent cellular cytotoxicity (ADCC) activity is considered an essential mechanism to achieve tumor regression. In contrast, we demonstrated that only CTLA-4 blockade without ADCC activity enhanced CD28 costimulatory signaling pathways in Treg cells and promoted Treg-cell proliferation in mouse models. CTLA-4 blockade also augmented CTLA-4-independent immunosuppressive functions, including cytokine production, leading to insufficient antitumor effects. Similar results were also observed in human peripheral blood lymphocytes and tumor-infiltrating lymphocytes from patients with RCC. Our findings highlight the importance of Treg-cell depletion to achieve tumor regression in response to CTLA-4 blockade therapies.

DOI： 10.1111/cas.15756

異所性腎患者に発生したmicropapillary variantを伴う筋層浸潤性膀胱癌に対して,ロボット支援下膀胱全摘除術を施行した一例

原惇也, 堀井聡, 岩田健宏, 鵜川聖也, 長崎直也, 松島萌希, 奥村美紗, 渡部智文, 関戸崇了, 吉永香澄, 丸山雄樹, 長尾賢太郎, 山野井友昭, 富永悠介, 定平卓也, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 小林泰之

西日本泌尿器科 85 ( 増刊号1 ) 46 - 46 2023.1

膀胱内病変に対する内視鏡的局所塗布システムの確立イヌを用いた実現可能性に関する検討

定平卓也, 渡邉豊彦, 荒木元朗

間質性膀胱炎研究会誌 18 ( 1 ) np9 - np9 2023.1

Accuracy and Clinical Utility of a Tumor Grade- and Stage-based Predictive Model in Localized Upper Tract Urothelial Carcinoma. Reviewed International journal

Satoshi Katayama, Keiichiro Mori, Victor M Schuettfort, Benjamin Pradere, Hadi Mostafaei, Fahad Quhal, Pawel Rajwa, Reza Sari Motlagh, Ekaterina Laukhtina, Marco Moschini, Nico C Grossmann, Motoo Araki, Jeremy Yuen-Chun Teoh, Morgan Rouprêt, Vitaly Margulis, Dmitry Enikeev, Pierre I Karakiewicz, Mohammad Abufaraj, Eva Compérat, Yasutomo Nasu, Shahrokh F Shariat

European urology focus 8 ( 3 ) 761 - 768 2023

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

BACKGROUND: Among various clinicopathologic factors used to identify low-risk upper tract urothelial carcinoma (UTUC), tumor grade and stage are of utmost importance. The clinical value added by inclusion of other risk factors remains unproven. OBJECTIVE: To assess the performance of a tumor grade- and stage-based (GS) model to identify patients with UTUC for whom kidney-sparing surgery (KSS) could be attempted. DESIGN, SETTING, AND PARTICIPANTS: In this international study, we reviewed the medical records of 1240 patients with UTUC who underwent radical nephroureterectomy. Complete data needed for risk stratification according to the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) guidelines were available for 560 patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable logistic regression analyses were performed to determine if risk factors were associated with the presence of localized UTUC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the GS, EAU, and NCCN models in predicting pathologic stage were calculated. RESULTS AND LIMITATIONS: Overall, 198 patients (35%) had clinically low-grade, noninvasive tumors, and 283 (51%) had ≤pT1disease. On multivariable analyses, none of the EAU and NCCN risk factors were associated with the presence of non-muscle-invasive UTUC among patients with low-grade and low-stage UTUC. The GS model exhibited the highest accuracy, sensitivity, and negative predictive value among all three models. According to the GS, EAU, and NCCN models, the proportion of patients eligible for KSS was 35%, 6%, and 4%, respectively. Decision curve analysis revealed that the net benefit of the three models was similar within the clinically reasonable range of probability thresholds. CONCLUSIONS: The GS model showed favorable predictive accuracy and identified a greater number of KSS-eligible patients than the EAU and NCCN models. A decision-making algorithm that weighs the benefits of avoiding unnecessary kidney loss against the risk of undertreatment in case of advanced carcinoma is necessary for individualized treatment for UTUC patients. PATIENT SUMMARY: We assessed the ability of three models to predict low-grade, low-stage disease in patients with cancer of the upper urinary tract. No risk factors other than grade assessed on biopsy and stage assessed from scans were associated with better prediction of localized cancer. A model based on grade and stage may help to identify patients who could benefit from kidney-sparing treatment of their cancer.

DOI： 10.1016/j.euf.2021.05.002

Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository. Reviewed International journal

Takanori Sekito, Koichiro Wada, Ayano Ishii, Takehiro Iwata, Takehiro Matsubara, Shuta Tomida, Masami Watanabe, Motoo Araki, Takuya Sadahira

Frontiers in microbiology 14 1187479 - 1187479 2023

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

BACKGROUND: The vaginal microbiota can be altered by uropathogenic bacteria associated with recurrent cystitis (RC), and the vaginal administration of Lactobacillus have suggested certain effects to prevent RC. The relationship between vaginal microbiota and the development of RC has not been elucidated. We aimed to clarify the etiology of RC from vaginal microbiota and importance of vaginal Lactobacillus. METHODS: Vaginal samples obtained from 39 postmenopausal women were classified into four groups: healthy controls; uncomplicated cystitis; RC; and prevention (prevented RC by Lactobacillus crispatus-containing vaginal suppositories). Principal coordinate analysis and beta-diversity analysis was used to assess 16S rRNA gene sequencing data from the vaginal microbiome. RESULTS: Cluster analysis divided the vaginal bacterial communities among 129 vaginal samples into three clusters (A, B, and C). Fourteen of 14 (100%) samples from the RC group and 51 of 53 (96%) samples from the prevention group were in clusters B and C, while 29 of 38 (76%) samples from the healthy group and 14 of 24 (58%) samples from the uncomplicated cystitis group were in cluster A. The principal coordinate analysis showed that plots in the uncomplicated cystitis group were similar to the healthy group, indicating a large separation between the RC group and the uncomplicated cystitis group. On beta-diversity analysis, there were significant differences between the healthy group and the uncomplicated cystitis group (p = 0.045), and between the RC group and the uncomplicated cystitis group or the healthy group (p = 0.001, p = 0.001, respectively). There were no significant differences between the RC group and the prevention group (p = 0.446). The top six taxa were as follows: Prevotella, Lactobacillus, Streptococcus, Enterobacteriaceae, Anaerococcus, and Bifidobacterium. Among patients with RC, Lactobacillus was undetectable before administration of suppositories, while the median relative abundance of Lactobacillus was 19% during administration of suppositories (p = 0.0211), reducing the average cystitis episodes per year (6.3 vs. 2.4, p = 0.0015). CONCLUSION: The vaginal microbiota of postmenopausal women with RC is differed from healthy controls and uncomplicated cystitis in terms of lack of Lactobacillus and relatively dominant of Enterobacteriaceae. Vaginal administration of Lactobacillus-containing suppositories can prevent RC by stabilizing vaginal dysbiosis and causing a loss of pathogenic bacteria virulence.

DOI： 10.3389/fmicb.2023.1187479

Oncologic and safety outcomes for endoscopic surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: An updated systematic review and meta-analysis Reviewed

Kawada T, Laukhtina E, Quhal F, Yanagisawa T, Rajwa P, Pallauf M, von Deimling M, Bianchi A, Pradere B, Fajkovic H, Enikeev D, Gontero P, Roupret M, Seisen T, Araki M, Shariat SF

Eur Urol Focus 9 ( 2 ) 236 - 240 2023

" Low-dose or-number of BCG in non-muscle invasive bladder cancer: updated systematic review and meta-analysis" Reviewed

Kawada T, Yanagisawa T, Bekku K, Laukhtina E, Deimling MV, Majdoub M, Chlosta M, Pradere B, Babjuk M, Gontero P, Moschini M, Araki M, Shariat SF

Immunotherapy 15 ( 12 ) 933 - 943 2023

Impact of performance status on oncologic outcomes in patients with advanced urothelial carcinoma treated with immune checkpoint inhibitor: A systematic review and meta-analysis Reviewed

Kawada T, Yanagisawa T, Mostafaei H, Sari Motlagh R, Quhal F, Rajwa P, Laukhtina E, von Deimling M, Bianchi A, Majdoub M, Pallauf M, Pradere B, Teoh JY, Karakiewicz PI, Araki M, Shariat SF

Eur Urol Focus 9 ( 2 ) 264 - 274 2023

第332回日本泌尿器科学会岡山地方会演題抄録岡山大学病院および関連施設における進行腎癌に対する一次複合免疫療法の治療成績

別宮謙介, 坪井一朗, 和田耕一郎, 片山聡, 小林泰之, 荒木元朗, 坪井一馬, 高本篤, 久住倫宏, 中田哲也, 佐々木克己, 杭ノ瀬彩, 佐野雄芳, 川合裕也, 山本康雄, 竹中皇, 平田武志, 中塚浩一, 堀川雄平, 榮枝一磨, 山﨑拓, 石川勉, 日下信行

西日本泌尿器科 8 ( 増刊1 ) 72 2023

Sequential intravesical gemcitabine and docetaxel therapy in patients with nonmuscle invasive bladder cancer: a systematic review and meta-analysis Reviewed

Kawada T, Yanagisawa T, Araki M, Pradere B, Shariat SF

Curr Opin Urol 33 ( 3 ) 211 - 218 2023

第332回日本泌尿器科学会岡山地方会演題抄録転移性尿路上皮癌に対するペムブロリズマブの治療成績-多施設共同研究-

片山聡, 岩田健宏, 小林泰之, 長尾賢太郎, 小林知子, 別宮謙介, 枝村康平, 坪井一馬, 高本篤, 坪井一朗, 久住倫宏, 中田哲也, 佐々木克己, 山崎拓, 杭ノ瀬彩, 佐野雄芳, 川合裕也, 山本康雄, 竹中皇, 平田武志, 中塚浩一, 杉本盛人, 堀川雄平, 榮枝一磨, 白﨑義範, 森分貴俊, 和田耕一郎, 荒木元朗

西日本泌尿器科 85 ( 増刊1 ) 71 - 72 2023

The efficacy and safety outcomes of lower dose BCG compared to intravesical chemotherapy in non-muscle-invasive bladder cancer: A network meta-analysis Reviewed

Kawada T, Yanagisawa T, Bekku K, Laukhtina E, von Deimling M, Chlosta M, Pradere B, Teoh JY, Babjuk M, Araki M, Shariat SF

Urol Oncol 41 ( 6 ) 261 - 273 2023

腎虚血再灌流障害における好中球動態 Reviewed

荒木元朗

岡山医学会雑誌 135 ( 3 ) 136 - 141 2023

Significance of UGT1A6, UGT1A9, and UGT2B7 genetic variants and their mRNA expression in the clinical outcome of renal cell carcinoma. Reviewed International journal

Jun Matsumoto, Anzu Nishimoto, Shogo Watari, Hideo Ueki, Shoya Shiromizu, Naohiro Iwata, Tatsuaki Takeda, Soichiro Ushio, Makoto Kajizono, Masachika Fujiyoshi, Toshihiro Koyama, Motoo Araki, Koichiro Wada, Yoshito Zamami, Yasutomo Nasu, Noritaka Ariyoshi

Molecular and cellular biochemistry 478 ( 8 ) 1779 - 1790 2022.12

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

UDP-glucuronosyltransferase (UGT) metabolizes a number of endogenous and exogenous substrates. Renal cells express high amounts of UGT; however, the significance of UGT in patients with renal cell carcinoma (RCC) remains unknown. In this study, we profile the mRNA expression of UGT subtypes (UGT1A6, UGT1A9, and UGT2B7) and their genetic variants in the kidney tissue of 125 Japanese patients with RCC (Okayama University Hospital, Japan). In addition, we elucidate the association between the UGT variants and UGT mRNA expression levels and clinical outcomes in these patients. The three representative genetic variants, namely, UGT1A6 541A > G, UGT1A9 i399C > T, and UGT2B7-161C > T, were genotyped, and their mRNA expression levels in each tissue were determined. We found that the mRNA expression of the three UGTs (UGT1A6, UGT1A9, and UGT2B7) are significantly downregulated in RCC tissues. Moreover, in patients with RCC, the UGT2B7-161C > T variant and high UGT2B7 mRNA expression are significantly correlated with preferable cancer-specific survival (CSS) and overall survival (OS), respectively. As such, the UGT2B7-161C > T variant and UGT2B7 mRNA expression level were identified as significant independent prognostic factors of CSS and CSS/OS, respectively. Taken together, these findings indicate that UGT2B7 has a role in RCC progression and may, therefore, represent a potential prognostic biomarker for patients with RCC.

DOI： 10.1007/s11010-022-04637-4

Bladder tuberculosis with ureteral strictures after bacillus Calmette‑Guérin therapy for urinary bladder cancer: A case report Reviewed

Yusuke Tominaga, Masanori Fujii, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Katsuyuki Kiura, Yoshinobu Maeda, Koichiro Wada, Motoo Araki

Molecular and Clinical Oncology 18 ( 2 ) 2022.12

Correction to: Correlation between renal ablation zone in contrast‑enhanced CT and non‑enhanced MRI during the early period following percutaneous cryoablation.

Noriyuki Umakoshi, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Soichiro Kajita, Motoo Araki, Toshiharu Mitsuhashi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 12 ) 1316 - 1316 2022.12

テストステロン補充療法による経時的身体変化の解析

富永悠介, 佐古智子, 松本裕子, 杉本盛人, 岩田健宏, 西村慎吾, 枝村康平, 小林泰之, 渡部昌実, 荒木元朗

GID(性同一性障害)学会雑誌 15 ( 1 ) 198 - 199 2022.12

腎移植臨床登録集計報告(2022) 2021年実施症例の集計報告と追跡調査結果

中川由紀, 三重野牧子, 市丸直嗣, 森田研, 中村道郎, 堀田記世彦, 尾本和也, 田崎正行, 伊藤泰平, 牛込秀隆, 荒木元朗, 祖父江理, 山田保俊, 島袋修一, 剣持敬, 湯沢賢治, 日本臨床腎移植学会

移植 57 ( 3 ) 199 - 219 2022.12

Feasibility of robot‑assisted radical cystectomy in a patient with an ectopic kidney: A case report Reviewed

Kohei Edamura, Takuya Sadahira, Junya Hara, Takehiro Iwata, Wataru Ando, Satoshi Horii, Kentaro Nagao, Asuyuki Kobayashi, Motoo Araki

Medicine International 3 ( 1 ) 2022.11

Cutaneous toxicity with suprabasal blisters and dyskeratosis following administration of enfortumab vedotin. Reviewed International journal

Ken-Ichi Hasui, Yoshio Kawakami, Tomoko Miyake, Yoji Hirai, Hayato Nomura, Kohei Edamura, Motoo Araki, Shin Morizane

The Journal of dermatology 2022.11

Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy. Reviewed International journal

Satoshi Katayama, Benjamin Pradere, Nico C Grossman, Aaron M Potretzke, Stephen A Boorjian, Alireza Ghoreifi, Sia Daneshmand, Hooman Djaladat, John P Sfakianos, Andrea Mari, Zine-Eddine Khene, David D'Andrea, Nozomi Hayakawa, Alberto Breda, Matteo Fontana, Kazutoshi Fujita, Alessandro Antonelli, Thomas van Doeveren, Christina Steinbach, Keiichiro Mori, Ekaterina Laukhtina, Morgan Rouprêt, Vitaly Margulis, Pierre I Karakiewicz, Motoo Araki, Eva Compérat, Yasutomo Nasu, Shahrokh F Shariat

International journal of urology : official journal of the Japanese Urological Association 30 ( 1 ) 63 - 69 2022.11

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

OBJECTIVES: Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS: Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. RESULTS: This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low-grade biopsy. CONCLUSIONS: High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.

DOI： 10.1111/iju.15061

当院におけるProteus mirabilisの薬剤感受性の推移とESBL産生株分離状況

丸山雄樹, 定平卓也, 岩田健宏, 荒木元朗, 片山聡, 西村慎吾, 別宮健介, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡邉豊彦, 和田耕一郎

西日本泌尿器科学会総会抄録集 74回 216 - 216 2022.11

横隔膜、腸腰筋、左腎に接する後腹膜脱分化型脂肪肉腫に対して横隔膜合併切除を含めた外科的治療を行った一例

松島萌希, 岩田健宏, 富永悠介, 定平卓也, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 190 - 190 2022.11

再三の細胞診検査で骨盤内再発が判明した膀胱癌の一例

鵜川聖也, 岩田健宏, 富永悠介, 定平卓也, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 227 - 227 2022.11

反復性膀胱炎の新しい予防法膀胱の外側から考える(A novel preventive approach for recurrent cystitis: thinking beyond the bladder)

関戸崇了, 定平卓也, 丸山雄樹, 岩田健宏, 石井亜矢乃, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 170 - 170 2022.11

当院におけるProteus mirabilisの薬剤感受性の推移とESBL産生株分離状況

丸山雄樹, 定平卓也, 岩田健宏, 荒木元朗, 片山聡, 西村慎吾, 別宮健介, 枝村康平, 小林知子, 小林泰之, 石井亜矢乃, 渡邉豊彦, 和田耕一郎

西日本泌尿器科学会総会抄録集 74回 216 - 216 2022.11

横隔膜、腸腰筋、左腎に接する後腹膜脱分化型脂肪肉腫に対して横隔膜合併切除を含めた外科的治療を行った一例

松島萌希, 岩田健宏, 富永悠介, 定平卓也, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 190 - 190 2022.11

反復性膀胱炎の新しい予防法膀胱の外側から考える(A novel preventive approach for recurrent cystitis: thinking beyond the bladder)

関戸崇了, 定平卓也, 丸山雄樹, 岩田健宏, 石井亜矢乃, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 170 - 170 2022.11

SPAREスコアと3Dモデルによるロボット支援腹腔鏡下腎部分切除術の予後予測

渡部智文, 定平卓也, 吉永香澄, 関戸崇了, 丸山雄樹, 枝村康平, 小林泰之, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 P - 21 2022.11

再三の細胞診検査で骨盤内再発が判明した膀胱癌の一例

鵜川聖也, 岩田健宏, 富永悠介, 定平卓也, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 渡部昌実, 渡邉豊彦, 荒木元朗

西日本泌尿器科学会総会抄録集 74回 227 - 227 2022.11

腹腔鏡下手術でここまでできる～ロボット時代を生き抜く達人技～大きな腫瘍に対する腹腔鏡・後腹膜鏡併用による腫瘍摘出術の試み

吉永香澄, 小林泰之, 冨永悠介, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 WS - 4 2022.11

ロボット支援膀胱全摘術における低分子ヘパリンによる予防的抗凝固療法の有用性

丸山雄樹, 岩田健宏, 吉永香澄, 片山聡, 小林智子, 別宮健介, 枝村康平, 小林泰之, 渡邉豊彦, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 O - 4 2022.11

仙骨腟固定術後の新規腹圧性尿失禁腹腔鏡下手術とロボット支援下手術での検討

小林知子, 佐古智子, 岩田健宏, 富永悠介, 別宮謙介, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡邉豊彦

日本泌尿器内視鏡・ロボティクス学会総会 36回 P - 1 2022.11

ロボット支援膀胱全摘除術(RARC)における体腔内(ICUD)・体腔外尿路変向(ECUD)の比較

山野井友昭, 小林泰之, 岩田健宏, 片山聡, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 渡邉豊彦, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 P - 2 2022.11

ロボット支援腹腔鏡下腎盂形成術(右側)

小林泰之, 片山聡, 岩田健宏, 西村慎吾, 別宮謙介, 枝村康平, 小林知子, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 J - 1 2022.11

当院におけるMRI/TRUS融合画像ガイド下前立腺生検初期成績の臨床的検討

長尾賢太郎, 片山聡, 岩田健宏, 西村慎吾, 高本篤, 別宮謙介, 枝村康平, 小林知子, 小林泰之, 荒木元朗

日本泌尿器内視鏡・ロボティクス学会総会 36回 P - 1 2022.11

異所性腎患者の筋層浸潤性膀胱癌に対して、RARC+ICUDを施行した一例

堀井聡, 原惇也, 岩田健宏, 長尾賢太郎, 片山聡, 別宮謙介, 枝村康平, 小林知子, 荒木元朗, 小林泰之

日本泌尿器内視鏡・ロボティクス学会総会 36回 O - 2 2022.11

Simplified PADUA REnal (SPARE) nephrometry system can describe the surgical difficulty of renal masses with high accuracy even without 3D renal models. International journal

Tomofumi Watanabe, Takuya Sadahira, Takanori Sekito, Yuki Maruyama, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki

Urology 170 132 - 138 2022.10

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

OBJECTIVES: To evaluate whether a 2-dimensional(2D) model describes the surgical difficulty of a renal mass accurately comparable to that obtained using a 3D model with the Simplified PADUA REnal nephrometry system (SPARE). METHODS: A total of 100 patients underwent RAPN in our hospital between October 2018 and May 2021. We excluded patients with CT images inappropriate for evaluation or for construction of 3D models, patients with multiple tumors, and those who underwent preoperative transcatheter arterial embolization. We conducted a retrospective analysis of the remaining patients using SPARE predictions from CT images (2D-SPARE) and SPARE predictions from 3D models (3D-SPARE). We evaluated the difference between the 2 nephrometry scores and compared them by their ability to predict the achievement of the desired surgical outcome: absence of positive margins, absence of ischemia, and absence of significant complications. RESULTS: A total of 87 patients were included in this study. Total score, and risk categorization using 3D-SPARE was significantly different from those using 2D-SPARE (p < 0.05), but in their areas under the curve (AUC), the scores and categorizations were not significantly different (score, 0.763 vs 0.742; p = 0.501; categorization, 0.711 vs 0.701; p = 0.755). CONCLUSION: The SPARE system can describe the surgical difficulty of renal masses with high accuracy even without the use of 3D renal models.

DOI： 10.1016/j.urology.2022.09.015

当院における腎移植後コロナウイルス感染症の臨床経過

吉永香澄, 関戸崇了, 丸山雄樹, 山野井友昭, 西村慎吾, 竹内英実, 田邉克幸, 森永裕士, 内田治仁, 和田淳, 枝村康平, 小林知子, 小林泰之, 荒木元朗

移植 57 ( 総会臨時 ) 262 - 262 2022.10

リツキシマブ時代における生体腎移植レシピエント周術期細菌感染症の検討

西村慎吾, 荒木元朗, 奥村美沙, 関戸崇了, 徳永素, 坪井一朗, 和田里章悟, 吉永香澄, 丸山雄樹, 山野井友昭, 窪田理沙, 小林泰之, 和田耕一郎, 渡邉豊彦

移植 57 ( 総会臨時 ) 284 - 284 2022.10

A case of successful renal transplantation of Charcot-Marie-Tooth disease associated with FSGS due to mutation of the INF2 gene

Chika Matsuoka, Yuki Taira, Ryo Sasaki, Namiko Matsumoto, Koh Tadokoro, Emi Nomura, Yuko Kawahara, Mami Takemoto, Ryuta Morihara, Akihiro Hashiguchi, Hiroshi Takashima, Hidemi Takeuchi, Motoo Araki, Koji Abe, Toru Yamashita

Neurology and Clinical Neuroscience 10 ( 5 ) 252 - 254 2022.9

Publishing type：Research paper (scientific journal)

Focal and segmental areas of glomerular sclerosis (FSGS) have various subcategories. Here, we report on a 35-year-old man who suffered from Charcot-Marie-Tooth disease (CMT) with FSGS carrying the INF2 mutation (c.206 T > C, p.L69P). The INF2 mutation might cause abnormal actin filaments of the podocytes and Schwann cells, leading to CMT associated with FSGS. He successfully underwent living donor kidney transplantation from a mother with a normal INF2 gene without any serious adverse events. Following genetic testing, the identification of the INF2 mutation allows a recipient to reduce the use of immunosuppressive drugs. Genetic testing may provide a treatment plan for kidney transplantation.

DOI： 10.1111/ncn3.12651

Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study

Hideo Gobara, Yusuke Matsui, Mayu Uka, Koji Tomita, Noriyuki Umakoshi, Motoo Araki, Jun Sakurai, Toshihiro Iguchi, Takao Hiraki

International Journal of Clinical Oncology 27 ( 10 ) 1589 - 1595 2022.8

Adverse Events of Axitinib plus Pembrolizumab Versus Lenvatinib plus Pembrolizumab: A Pharmacovigilance Study in Food and Drug Administration Adverse Event Reporting System. International journal

Jun Matsumoto, Naohiro Iwata, Shogo Watari, Soichiro Ushio, Shoya Shiromizu, Tatsuaki Takeda, Hirofumi Hamano, Makoto Kajizono, Motoo Araki, Yasutomo Nasu, Noritaka Ariyoshi, Yoshito Zamami

European urology focus 9 ( 1 ) 141 - 144 2022.7

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

No head-to-head postmarket surveillance study has compared the differences in adverse events (AEs) between two combination therapies, axitinib (AXI) + pembrolizumab (PEMBRO) and lenvatinib (LEN) + PEMBRO, against metastatic renal cell carcinoma. This study aims to highlight the comprehensive differences in AEs between these two therapies based on the real-world big data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database. In total, 28 937 records were extracted from the FAERS database, and 139 AEs grouped into the System Organ Class according to the Medical Dictionary for Regulatory Activities were analysed. Logistic regression analyses were performed, and the reporting odds ratio with a 95% confidence interval was determined. We found that the incidences of cardiac and hepatobiliary disorders for AXI + PEMBRO, and blood and lymphatic system, metabolism and nutrition, and vascular disorders for LEN + PEMBRO, all of which were associated with serious AEs, were higher than those for LEN + PEMBRO and AXI + PEMBRO, respectively. The differences in the AEs between AXI + PEMBRO and LEN + PEMBRO were not derived merely from those between AXI and LEN monotherapies. Furthermore, remarkable AE potentiation was observed for AXI + PEMBRO. As FAERS is a spontaneous reporting system comprising partially limited information, analysing more detailed relationships between AEs and patient or treatment characteristics was challenging in this study. The present study is the first to show the overall real-world postmarketing differences in AEs between AXI + PEMBRO and LEN + PEMBRO. Our novel findings will substantially improve clinical practice; we recommend comparing patients' conditions associated with the above AEs when selecting between these two therapies. PATIENT SUMMARY: Herein, we highlight the differences in adverse events (AEs) between axitinib + pembrolizumab and lenvatinib + pembrolizumab therapies using data from the real-world Food and Drug Administration Adverse Event Reporting System database aimed at patients with metastatic renal cell carcinoma. We identified AEs that needed attention in each combination. We recommend the differences in AEs to be considered when selecting these two therapies.

DOI： 10.1016/j.euf.2022.07.003

A case of tape infection 19 years after insertion of a tension-free vaginal tape sling. International journal

Tomofumi Watanabe, Tomoko Sako, Yusuke Tominaga, Takuya Sadahira, Takanori Sekito, Atsushi Takamoto, Kohei Edamura, Yasuyuki Kobayashi, Koichiro Wada, Motoo Araki

IJU case reports 5 ( 4 ) 228 - 231 2022.7

Language：English

Introduction: Tape infection after insertion of tension-free vaginal tape is a well-known but rare complication. We report a patient who experienced a subcutaneous abscess 19 years after the surgery. Case presentation: A 41-year-old woman presented with fever and lower abdominal pain. She had undergone tension-free vaginal tape insertion for stress urinary incontinence 19 years prior. She had asymptomatic dysuria. After an abscess incision and 1-week treatment with antibiotics, she underwent surgery to remove the tape and the abscess without complications. Conclusion: Tension-free Vaginal Tape insertion could be a potential risk of asymptomatic dysuria, resulting in urinary tract infection. In this case, removal of tape was necessary for controlling subcutaneous abscess resulting from the presence of tension-free vaginal tape.

DOI： 10.1002/iju5.12440

Intravesical indwelling lidocaine‑releasing devices for IC/BPS (Review)

Tomofumi Watanabe, Takuya Sadahira, Masami Watanabe, Yuki Maruyama, Koichiro Wada, Takanori Sekito, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki, Toyohiko Watanabe

World Academy of Sciences Journal 4 ( 4 ) 2022.6

Percutaneous cryoablation for clinical T3a renal cell carcinoma (< 7 cm) with segmental vein involvement or perinephric fat invasion based on preoperative evaluation of high-resolution multidetector computed tomography scan

Mayu Uka, Toshihiro Iguchi, Nanako Okawa, Yusuke Matsui, Koji Tomita, Noriyuki Umakoshi, Kazuaki Munetomo, Hideo Gobara, Motoo Araki, Takao Hiraki

Japanese Journal of Radiology 40 ( 11 ) 1201 - 1209 2022.6

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Purpose

To retrospectively assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC).

Materials and methods

Sixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 ± 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 ± 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival.

Results

Cryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6−93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.

Conclusion

Cryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.

DOI： 10.1007/s11604-022-01297-8

Other Link： https://link.springer.com/article/10.1007/s11604-022-01297-8/fulltext.html

Correlation between renal ablation zone in contrast-enhanced CT and non-enhanced MRI during the early period following percutaneous cryoablation.

Noriyuki Umakoshi, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Soichiro Kajita, Motoo Araki, Toshiharu Mitsuhashi, Hideo Gobara, Susumu Kanazawa

Japanese journal of radiology 40 ( 10 ) 1087 - 1095 2022.5

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

PURPOSE: To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation. MATERIALS AND METHODS: Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale. RESULTS: The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm3 (range, 4.3-97.4 cm3) and 30.7 ± 19.8 cm3 (range, 6.7-94.0 cm3), respectively; the difference between them was -1.17 cm3 (95% confidence interval [CI] -2.74, 0.40, P = 0.139). The Pearson's product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P < 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years. CONCLUSIONS: The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.

DOI： 10.1007/s11604-022-01285-y

尿から分離されたESBL産生大腸菌株の性状解析を踏まえたFMOXの使用法

榮枝一磨, 定平卓也, 丸山雄樹, 岩田健宏, 荒木元朗, 石井亜矢乃, 渡邉豊彦, 那須保友, 和田耕一郎, 光畑律子

日本化学療法学会雑誌 70 ( Suppl.A ) 289 - 289 2022.5

ロボット支援下前立腺全摘除術中にモノポーラシザースのチップカバーが脱落し、発見が困難であった一例

長尾賢太郎, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友, 小林泰之

Japanese Journal of Endourology and Robotics 35 ( 1 ) 168 - 172 2022.4

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)

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

Post-prostate biopsy acute bacterial prostatitis and screening cultures using selective media: An overview. International journal

Herik Acosta, Takuya Sadahira, Takanori Sekito, Yuki Maruyama, Takehiro Iwata, Motoo Araki, Kohei Ogawa, Ichiro Tsuboi, Koichiro Wada

International journal of urology : official journal of the Japanese Urological Association 29 ( 6 ) 486 - 493 2022.2

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

The development of several culture media and the availability to isolate and treat pathogens prior to a surgical procedure give us the ability to minimize treatment-related complications, and ultimately results in better outcomes for patients and avoidance of unwanted post-procedure inpatient admissions. In the last decade, an increasing incidence of multidrug-resistant Escherichia coli, especially extended-spectrum beta-lactamase-producing E. coli and fluoroquinolone-resistant pathogens, has been reported. These resistant species frequently colonize the rectal flora and gain access to the systemic circulation via the rectal plexus following a prostate biopsy. The bacteria can eventually lead to life-threatening complications, which is especially important in high-risk patients with multiple co-morbidities. Previously published studies have focused on the isolation of these pathogens with selective media before an invasive procedure and the potential benefits of incorporating the use of selective media as a mandatory pre-operative step. This preventive measure will allow us to offer a tailored prophylactic treatment that benefits patients and reduces the economic burden for the hospital.

DOI： 10.1111/iju.14824

テキストマイニングによる腎移植に関する症例報告論文の考察

関戸崇了, 荒木元朗, 吉永香澄, 丸山雄樹, 山野井友昭, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 佐古智子, 枝村康平, 小林泰之, 渡部昌実, 渡邉豊彦, 田邊克幸, 竹内英実, 喜多村真治, 杉山斉, 和田淳, 那須保友

日本臨床腎移植学会プログラム・抄録集 55回 227 - 227 2022.2

後腹膜リンパ節郭清術後の射精障害の検討

富永悠介, 佐古智子, 奥村美紗, 渡部智文, 近藤崇弘, 関戸崇了, 竹丸紘史, 堀井聡, 吉永香澄, 丸山雄樹, 山野井友昭, 長尾賢太郎, 片山聡, 定平卓也, 岩田健宏, 西村慎吾, 高本篤, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友, 松本裕子, 杉本盛人, 和田耕一郎

西日本泌尿器科 84 ( 増刊号1 ) 84 - 84 2022.1

上部尿路上皮癌に対する尿路内視鏡的治療の成績と課題

和田耕一郎, 小川貢平, 坪井一朗, 吉岡彩織, 横山周平, 小林祐介, 中島宏親, 永見太一, 山崎清玄, 小池千明, 椎名浩昭, 荒木元朗, 枝村康平, 岩田健宏, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 89 - 89 2022.1

岡山大学病院におけるBioJetシステムを用いたMRI/US融合下経会陰的前立腺生検

高本篤, 河田達志, 長尾賢太郎, 富永悠介, 渡部智文, 三宅修司, 林あずさ, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 定平卓也, 岩田健宏, 西村慎吾, 和田耕一郎, 枝村康平, 佐古智子, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 48 - 48 2022.1

全身転移を来たした成人発症の胎児型前立腺横紋筋肉腫の1例

近藤崇弘, 関戸崇了, 定平卓也, 富永悠介, 高本篤, 奥村美紗, 渡部智文, 堀井聡, 竹丸絋史, 和田里章悟, 吉永香澄, 丸山雄樹, 山野井友昭, 長尾賢太郎, 河田達志, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友, 田端雅弘, 柳井広之

西日本泌尿器科 84 ( 増刊号1 ) 53 - 53 2022.1

岡山大学におけるUTUCに対するURSの成績と課題

和田耕一郎, 丸山雄樹, 荒木元朗, 関戸崇了, 枝村康平, 定平卓也, 林あずさ, 三宅修司, 渡部智文, 吉永香澄, 和田里章悟, 長尾賢太郎, 河田達志, 富永悠介, 大岩裕子, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡辺豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 48 - 49 2022.1

待機日数56日で先行的脳死下献腎移植を行った17歳女性の1例

奥村美紗, 吉永香澄, 西村慎吾, 和田耕一郎, 荒木元朗, 渡部智文, 近藤崇弘, 関戸崇了, 堀井聡, 竹丸紘史, 和田里章悟, 丸山雄樹, 山野井友昭, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 高本篤, 佐古智子, 枝村康平, 小林泰之, 石井亜矢乃, 渡部昌実, 渡辺豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 50 - 51 2022.1

岡山大学におけるUTUCに対するURSの成績と課題

和田耕一郎, 丸山雄樹, 荒木元朗, 関戸崇了, 枝村康平, 定平卓也, 林あずさ, 三宅修司, 渡部智文, 吉永香澄, 和田里章悟, 長尾賢太郎, 河田達志, 富永悠介, 大岩裕子, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 小林泰之, 石井亜矢乃, 渡部昌実, 渡辺豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 48 - 49 2022.1

待機日数56日で先行的脳死下献腎移植を行った17歳女性の1例

奥村美紗, 吉永香澄, 西村慎吾, 和田耕一郎, 荒木元朗, 渡部智文, 近藤崇弘, 関戸崇了, 堀井聡, 竹丸紘史, 和田里章悟, 丸山雄樹, 山野井友昭, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 岩田健宏, 高本篤, 佐古智子, 枝村康平, 小林泰之, 石井亜矢乃, 渡部昌実, 渡辺豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 50 - 51 2022.1

全身転移を来たした成人発症の胎児型前立腺横紋筋肉腫の1例

近藤崇弘, 関戸崇了, 定平卓也, 富永悠介, 高本篤, 奥村美紗, 渡部智文, 堀井聡, 竹丸絋史, 和田里章悟, 吉永香澄, 丸山雄樹, 山野井友昭, 長尾賢太郎, 河田達志, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友, 田端雅弘, 柳井広之

西日本泌尿器科 84 ( 増刊号1 ) 53 - 53 2022.1

後腹膜リンパ節郭清術後の射精障害の検討

富永悠介, 佐古智子, 奥村美紗, 渡部智文, 近藤崇弘, 関戸崇了, 竹丸紘史, 堀井聡, 吉永香澄, 丸山雄樹, 山野井友昭, 長尾賢太郎, 片山聡, 定平卓也, 岩田健宏, 西村慎吾, 高本篤, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友, 松本裕子, 杉本盛人, 和田耕一郎

西日本泌尿器科 84 ( 増刊号1 ) 84 - 84 2022.1

岡山大学病院におけるBioJetシステムを用いたMRI/US融合下経会陰的前立腺生検

高本篤, 河田達志, 長尾賢太郎, 富永悠介, 渡部智文, 三宅修司, 林あずさ, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 定平卓也, 岩田健宏, 西村慎吾, 和田耕一郎, 枝村康平, 佐古智子, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 84 ( 増刊号1 ) 48 - 48 2022.1

A Novel Technique Using Fluorescent Ureteral Catheter and Flexible Ureteroscope for Safe Laparoscopic Fenestration of Lymphocele after Kidney Transplantation. International journal

Takanori Sekito, Motoo Araki, Koichiro Wada, Kasumi Yoshinaga, Yuki Maruyama, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Toyohiko Watanabe

Case reports in transplantation 2022 9948425 - 9948425 2022

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

p Identification of MICALL2 as a Novel Prognostic Biomarker Correlating with Inflammation and T Cell Exhaustion of Kidney Renal Clear Cell Carcinoma

Wenfeng Lin, Wenwei Chen, Jisheng Zhong, Hideo Ueki, Abai Xu, Masami Watanabe, Motoo Araki, Chunxiao Liu, Yasutomo Nasu, Peng Huang

JOURNAL OF CANCER 13 ( 3 ) 1214 - 1228 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：IVYSPRING INT PUBL

Purpose: The interplay of inflammation and immunity affects all stages from tumorigenesis to progression, and even tumor response to therapy. A growing interest has been attracted from the biological function of MICALL2 to its effects on tumor progression. This study was designed to verify whether MICALL2 could be a prognostic biomarker to predict kidney renal clear cell carcinoma (KIRC) progression, inflammation, and immune infiltration within tumor microenvironment (TME). Methods: We firstly analyzed MICALL2 expressions across 33 cancer types from the UCSC Xena database and verified its expression in KIRC through GEPIA platform and GEO datasets. The clinicopathological characteristics were further analyzed based on the median expression. Kaplan-Meier method, univariate and multivariate analyses were applied to compare survival outcomes. ESTIMATE and CIBERSORT algorithms were performed to assess immune infiltration, and a co-expression analysis was conducted to evaluate the correlation between MICALL2 and immunoregulatory genes. Enrichment analysis was finally performed to explore the biological significance of MICALL2. Results: MICALL2 was highly expressed in 16 types of cancers compared with normal tissues. MICALL2 expression increased with advanced clinicopathological parameters and was an independent predictor for poor prognosis in KIRC. Moreover, MICALL2 closely correlated with inflammation-promoting signatures and immune infiltration including T cell exhaustion markers. Consistently, MICALL2 involved in the regulation of signaling pathways associated with tumor immunity, tumor progression, and impaired metabolic activities. Conclusion: MICALL2 can function as a prognostic biomarker mediating inflammation, immune infiltration, and T cell exhaustion within the microenvironment of KIRC.

DOI： 10.7150/jca.66922

Medical uses for silver nitrate in the urinary tract

Sekito T, Sadahira T, Watanabe T, Maruyama Y, Watanabe T, Iwata T, Wada K, Edamura K, Araki M, Watanabe M

World Academy of Sciences Journal 4 ( 6 ) 2022

Macrophage-inducible C-type lectin activates B cells to promote T cell reconstitution in heart allograft recipients

Hasgur S, Yamamoto Y, Fan R, Nicosia M, Gorbacheva V, Zwick D, Araki M, Fairchild RL, Valujskikh A

Am J Transplant 22 ( 7 ) 1779 - 1790 2022

Enhanced visualization of female squirting. International journal

Miyabi Inoue, Yuki Sekiguchi, Noriko Ninomiya, Tomoko Kobayashi, Motoo Araki

International journal of urology : official journal of the Japanese Urological Association 29 ( 11 ) 1368 - 1370 2022

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

INTRODUCTION: Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. PURPOSE: To elucidate the mechanism of squirting. METHODS: The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided to facilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. RESULTS: Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. CONCLUSIONS: The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.

DOI： 10.1111/iju.15004

Diagnostic performance of Prostate-specific membrane antigen positron emission tomography-targeted biopsy for detection of clinically significant prostate cancer: A systematic review and meta-analysis

Kawada T, Yanagisawa T, Rajwa P, Motlagh RS, Mostafaei H, Quhal F, Laukhtina E, Aydh A, Keoning F, Pallauf M, Pradere B, Ceci F, Baltzer PAT, Hacker M, Rasul S, Karakiewicz PI, Araki M, Nasu Y, Shariat SF

5 ( 4 ) 390 - 400 2022

Influence of steep Trendelenburg position on postoperative complications: a systematic review and meta-analysis. International journal

Satoshi Katayama, Keiichiro Mori, Benjamin Pradere, Takafumi Yanagisawa, Hadi Mostafaei, Fahad Quhal, Reza Sari Motlagh, Ekaterina Laukhtina, Nico C Grossmann, Pawel Rajwa, Abdulmajeed Aydh, Frederik König, Pierre I Karakiewicz, Motoo Araki, Yasutomo Nasu, Shahrokh F Shariat

Journal of robotic surgery 16 ( 6 ) 1233 - 1247 2021.12

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

Intraoperative physiologic changes related to the steep Trendelenburg position have been investigated with the widespread adoption of robot-assisted pelvic surgery (RAPS). However, the impact of the steep Trendelenburg position on postoperative complications remains unclear. We conducted a meta-analysis to compare RAPS to laparoscopic/open pelvic surgery with regards to the rates of venous thromboembolism (VTE), cardiac, and cerebrovascular complications. Meta-regression was performed to evaluate the influence of confounding risk factors. Ten randomized controlled trials (RCTs) and 47 non-randomized controlled studies (NRSs), with a total of 380,125 patients, were included. Although RAPS was associated with a decreased risk of VTE and cardiac complications compared to laparoscopic/open pelvic surgery in NRSs [risk ratio (RR), 0.59; 95% CI 0.51-0.72, p < 0.001 and RR 0.93; 95% CI 0.58-1.50, p = 0.78, respectively], these differences were not confirmed in RCTs (RR 0.92; 95% CI 0.52-1.62, p = 0.77 and RR 0.93; 95% CI 0.58-1.50, p = 0.78, respectively). In subgroup analyses of laparoscopic surgery, there was no significant difference in the risk of VTE and cardiac complications in both RCTs and NRSs. In the meta-regression, none of the risk factors were found to be associated with heterogeneity. Furthermore, no significant difference was observed in cerebrovascular complications between RAPS and laparoscopic/open pelvic surgery. Our meta-analysis suggests that the steep Trendelenburg position does not seem to affect postoperative complications and, therefore, can be considered safe with regard to the risk of VTE, cardiac, and cerebrovascular complications. However, proper individualized preventive measures should still be implemented during all surgeries including RAPS to warrant patient safety.

DOI： 10.1007/s11701-021-01361-x

Testosterone Recovery after Neoadjuvant Gonadotropin-Releasing Hormone Antagonist versus Agonist on Permanent Iodine-125 Seed Brachytherapy in Prostate Cancer Patients: A Propensity Score Analysis.

Takehiro Iwata, Yuki Maruyama, Tatsushi Kawada, Takuya Sadahira, Satoshi Katayama, Atsushi Takamoto, Tomoko Sako, Koichiro Wada, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Acta medica Okayama 75 ( 6 ) 705 - 711 2021.12

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

Clinical Efficacy and Safety of Sitafloxacin 200 mg Once Daily for Refractory Genitourinary Tract Infections.

Takehiro Iwata, Takuya Sadahira, Yuki Maruyama, Takanori Sekito, Kasumi Yoshinaga, Shogo Watari, Kentaro Nagao, Tatsushi Kawada, Yusuke Tominaga, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki, Ayano Ishii, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu, Koichiro Wada

Acta medica Okayama 75 ( 6 ) 763 - 766 2021.12

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

腎移植における悪性腫瘍とその治療法:自己腎癌、前立腺癌、PTLDなども含めて腎移植後の前立腺癌・尿路上皮癌

荒木元朗, 吉永香澄, 丸山雄樹, 定平卓也, 山野井友昭, 西村慎吾, 佐古智子, 枝村康平, 小林泰之, 渡辺豊彦, 那須保友

日本泌尿器科学会総会 109回 SY4 - 3 2021.12

APCCC JAPAN:今こそ日本人泌尿器科医の常識を問う! M0CRPC診療 M0CRPCに対する新規ホルモン剤はどのような症例に有効か?

枝村康平, 河田達志, 定平卓也, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友

日本泌尿器科学会総会 109回 SY31 - 3 2021.12

腸骨下腹神経ブロックが鼠径部痛の緩和に有効であった、再発性鼠径ヘルニアを合併したミュラー管遺残症候群の1例

関戸崇了, 丸山雄樹, 定平卓也, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡辺豊彦, 那須保友

日本泌尿器科学会総会 109回 OP05 - 06 2021.12

Glasgow prognostic scoreは非セミノーマの胚細胞腫瘍患者において治療前にOS・PFSを予測できる

吉永香澄, 定平卓也, 関戸崇了, 和田里章悟, 丸山雄樹, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器科学会総会 109回 OP65 - 04 2021.12

反復性膀胱炎に対する乳酸菌腟坐剤の予防効果を評価する第II相試験

定平卓也, 和田耕一郎, 石井亜矢乃, 丸山雄樹, 岩田健宏, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器科学会総会 109回 AOP09 - 02 2021.12

リアルタイムイメージングを用いた腎虚血再灌流後生体マウス腎における好中球動態のタダラフィル投与による変化

丸山雄樹, 荒木元朗, 城所研吾, 十川裕史, 吉永香澄, 光井洋介, 定平卓也, 和田耕一郎, 渡部昌実, 渡邉豊彦, 柏原直樹, 那須保友

日本泌尿器科学会総会 109回 AOP13 - 06 2021.12

浸潤性膀胱癌に対する開腹膀胱全摘除術(ORC)と比較した腹腔鏡下膀胱全摘除術(LRC)の長期治療成績に関する後方視的検討

和田里章悟, 小林泰之, 河田達志, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 84 ( 2 ) 146 - 153 2021.12

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)

TVT手術19年後に発症したテープ感染の一例

渡部智文, 富永悠介, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器科学会総会 109回 PP16 - 07 2021.12

筋層浸潤性膀胱癌に対する肝細胞増殖因子の予後的価値(Prognostic value of hepatocyte growth factor for muscle-invasive bladder cancer)

片山聡, 森啓一郎, 岩田健宏, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, Shariat Shahrokh F., 那須保友

日本泌尿器科学会総会 109回 ISA03 - 08 2021.12

尿路変向術:私の工夫 RARC ICUD失敗から学んだこと

小林泰之, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 84 ( 2 ) 122 - 127 2021.12

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)

限局性上部尿路上皮癌診断における、tumor grade、tumor stageによる予測モデルの臨床的有用性の検討

片山聡, 荒木元朗, 森啓一郎, 岩田健宏, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 渡部昌実, 渡邉豊彦, Shariat Shahrokh F., 那須保友

日本泌尿器科学会総会 109回 OP19 - 01 2021.12

Tumor suppressor REIC/Dkk-3 and its co-chaperone SGTA: Two aspects of a GR inhibitor and AR activator as a modifier of the steroid signaling(和訳中)

岩田健宏, 定平卓也, 片山聡, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科学会総会抄録集 73回 175 - 175 2021.11

癌抑制因子REIC/Dkk-3とそのコシャペロンSGTA ステロイドシグナル伝達の調節因子としてのGR阻害剤とAR活性化剤の二つの側面(Tumor suppressor REIC/Dkk-3 and its co-chaperone SGTA: Two aspects of a GR inhibitor and AR activator as a modifier of the steroid signaling)

岩田健宏, 定平卓也, 片山聡, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科学会総会抄録集 73回 175 - 175 2021.11

鏡視下手術後の深部静脈血栓症早期発見を目的としたD-dimer測定の有用性

丸山雄樹, 岩田健宏, 吉永香澄, 高本篤, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 AP - 6 2021.11

腎移植後リンパ嚢腫の腹腔鏡下開窓術における蛍光尿管カテーテルと軟性尿管鏡の有用性

関戸崇了, 荒木元朗, 和田耕一郎, 吉永香澄, 西村慎吾, 枝村康平, 佐古智子, 小林泰之, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 V - 4 2021.11

ロボット支援膀胱全摘除術(RARC)における体腔内・体腔外尿路変更の検討

長尾賢太郎, 岩田健宏, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 P - 1 2021.11

当院における転移性腎細胞癌患者の免疫チェックポイント阻害剤とVEGFR-TKI併用療法の初期経験

堀井聡, 河田達志, 高本篤, 枝村康平, 小林泰之, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保知

西日本泌尿器科学会総会抄録集 73回 235 - 235 2021.11

腎癌におけるそもそもとまっとう T1a腎癌:別の「まっとう」があるはず腎凍結療法の適応を考える

山野井友昭, 小林泰之, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友, 平木隆夫

西日本泌尿器科学会総会抄録集 73回 126 - 126 2021.11

左単腎不完全重複腎盂尿管の合流部狭窄に対するロボット支援下腎盂形成術

小林泰之, 枝村康平, 和田耕一郎, 佐古智子, 西村慎吾, 岩田健宏, 荒木元朗, 渡辺豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 AV - 2 2021.11

cT1b腎腫瘍におけるロボット支援腎部分切除術(RAPN)の周術期・中長期成績の検討

山野井友昭, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 P - 10 2021.11

腎盂尿管鏡検査における生検組織診断率向上のためのPilot study

岩田健宏, 和田耕一郎, 長尾賢太郎, 富永悠介, 片山聡, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 P - 9 2021.11

当科で施行した腹腔鏡下仙骨腟固定術とロボット支援下仙骨腟固定術の比較

佐古智子, 岩田健宏, 西村慎吾, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 35回 P - 1 2021.11

UAA-AAUS guideline for M. genitalium and non-chlamydial non-gonococcal urethritis. Invited Reviewed International journal

Koichiro Wada, Ryoichi Hamasuna, Takuya Sadahira, Motoo Araki, Shingo Yamamoto

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 27 ( 10 ) 1384 - 1388 2021.10

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

Non-chlamydial non-gonococcal urethritis (NCNGU) is defined as urethritis with neither Neisseria gonorrhoeae nor Chlamydia trachomatis. Possible causative agents of NCNGU include Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Trichomonas vaginalis, and so on. Among these microorganisms, the pathogenicity of M. genitalium and T. vaginalis to the male urethra has been confirmed so far. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding NCNGU and the present guidelines were updated from previous edition. Relevant references were meticulously reviewed again and latest studies were collected. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for M. genitalium and non-chlamydial non-gonococcal urethritis.

DOI： 10.1016/j.jiac.2021.07.007

Blood concentrations of tacrolimus upon conversion from rabeprazole to vonoprazan in renal transplant recipients: Correlation with cytochrome P450 gene polymorphisms. Reviewed International journal

Shogo Watari, Motoo Araki, Jun Matsumoto, Kasumi Yoshinaga, Takanori Sekito, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Koichiro Wada, Yasuyuki Kobayashi, Hidemi Takeuchi, Katsuyuki Tanabe, Masashi Kitagawa, Hiroshi Morinaga, Shinji Kitamura, Hitoshi Sugiyama, Noritaka Ariyoshi, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Drug metabolism and pharmacokinetics 40 100407 - 100407 2021.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

We evaluated the impact of vonoprazan on blood concentrations of tacrolimus via a retrospective analysis of 52 renal transplant recipients who took tacrolimus and converted from rabeprazole to vonoprazan between August 2018 and September 2019. We compared tacrolimus trough levels upon conversion among groups that were classified based on cytochrome P450 (CYP) gene polymorphisms. CYP3A5 groups were heterozygous or homozygous for CYP3A5∗1 and CYP3A5∗3 alleles. CYP2C19 genotypes were classified as extensive (∗1/∗1), intermediate (∗1/∗2 and ∗1/∗3) or poor metabolizers (∗2/∗2, ∗2/∗3 and ∗3/∗3). Tacrolimus trough levels increased only 0.3 ng/mL upon conversion in the CYP3A5∗3/∗3 group: 5.8 [3.4-7.2] vs 6.1 [3.8-7.9]; p = 0.06. No statistically significance changes in tacrolimus levels also occurred in the CYP3A5∗1/∗1 or CYP3A5∗1/∗3 groups. Subgroup analyses of CYP3A5∗3/∗3 demonstrated low changes for all three CYP2C19 subgroups: 5.2 [4.3-6.5] vs 6.2 [4.3-7.9]; p = 0.07, 6.1 [3.4-7.2] vs 6.7 [4.6-7.9]; p = 0.12 and 5.4 [3.6-6.5] vs 4.7 [3.8-6.3]; p = 1.00, respectively. Conversion to vonoprazan thus resulted in little increase of tacrolimus trough levels, even in the group predicted to be most susceptible (CYP3A5∗3/∗3 and 2C19∗1/∗1), thus supporting the safety of concomitant use of vonoprazan with tacrolimus.

DOI： 10.1016/j.dmpk.2021.100407

Efficacy of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis: A phase II clinical trial. Reviewed International journal

Takuya Sadahira, Koichiro Wada, Motoo Araki, Ritsuko Mitsuhata, Masumi Yamamoto, Yuki Maruyama, Takehiro Iwata, Masami Watanabe, Toyohiko Watanabe, Reiko Kariyama, Yasutomo Nasu, Ayano Ishii

International journal of urology : official journal of the Japanese Urological Association 28 ( 10 ) 1026 - 1031 2021.10

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

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

Intraluminal diamond-like carbon coating with anti-adhesion and anti-biofilm effects for uropathogens: A novel technology applicable to urinary catheters. International journal

Shogo Watari, Koichiro Wada, Motoo Araki, Takuya Sadahira, Daiki Ousaka, Susumu Oozawa, Tatsuyuki Nakatani, Yuichi Imai, Junichi Kato, Reiko Kariyama, Toyohiko Watanabe, Yasutomo Nasu

International journal of urology : official journal of the Japanese Urological Association 28 ( 12 ) 1282 - 1289 2021.9

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

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

Presence of decoy cells for 6 months on urine cytology efficiently predicts BK virus nephropathy in renal transplant recipients. International journal

Takanori Sekito, Motoo Araki, Kasumi Yoshinaga, Yuki Maruyama, Takuya Sadahira, Shingo Nishimura, Koichiro Wada, Masami Watanabe, Toyohiko Watanabe, Katsuyuki Tanabe, Hidemi Takeuchi, Hiroshi Morinaga, Masashi Kitagawa, Shinji Kitamura, Hitoshi Sugiyama, Jun Wada, Hiroyuki Yanai, Yasutomo Nasu

International journal of urology : official journal of the Japanese Urological Association 28 ( 12 ) 1240 - 1246 2021.9

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To investigate the association between duration of consecutive presence of decoy cells on urine cytology and BK virus nephropathy after kidney transplantation. METHODS: In total, 121 kidney transplant recipients were retrospectively evaluated. The best duration of consecutive presence of decoy cells that could be used to predict BK virus nephropathy was analyzed using the area under the curve for each duration, and recipients were divided into two groups based on the best predictive performance. The effectiveness of SV40 immunostaining on urinary cytology was also analyzed. RESULTS: In total, 2534 urine specimens as well as SV40 immunostaining in 2241 urine specimens were analyzed. Six consecutive months of decoy cell positivity had the best predictive performance for BK virus nephropathy (area under the curve = 0.832). The incidence of BK virus nephropathy in recipients with positive decoy cells for 6 months or more consecutive months (5/44) was significantly higher than in those who had positive decoy cells for less than 6 months (0/77; P = 0.005). Decoy cell positivity had a sensitivity, specificity, positive predictive value, and negative predictive value for BK virus nephropathy of 100%, 66%, 11%, and 100% respectively. SV40 immunostaining provided slightly better specificity (68%) and positive predictive value (12%). CONCLUSIONS: The detection of decoy cells at 6 months or more on urine cytology had high predictive value for BK virus nephropathy in kidney transplant recipients. SV40 immunostaining on urine cytology added minimal diagnostic accuracy.

DOI： 10.1111/iju.14679

Feasible kidney donation with living marginal donors, including diabetes mellitus. Reviewed International journal

Kasumi Yoshinaga, Motoo Araki, Koichiro Wada, Takanori Sekito, Shogo Watari, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Kohei Edamura, Yasuyuki Kobayashi, Katsuyuki Tanabe, Hidemi Takeuchi, Masashi Kitagawa, Shinji Kitamura, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Immunity, inflammation and disease 9 ( 3 ) 1061 - 1068 2021.9

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

Comparison of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy at a medium-sized facility. Reviewed

Takehiro Iwata, Yasuyuki Kobayashi, Yuki Maruyama, Tatsushi Kawada, Takuya Sadahira, Yuko Oiwa, Satoshi Katayama, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Koichiro Wada, Kohei Edamura, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

International journal of clinical oncology 26 ( 9 ) 1714 - 1721 2021.9

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

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

ABO血液型不適合生体腎移植後の細菌感染症が急性抗体関連拒絶反応に与える影響についての検討

西村慎吾, 荒木元朗, 和田耕一郎, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 山野井友昭, 山下里美, 佐古智子, 枝村康平, 小林泰之, 渡邉豊彦, 那須保友

移植 56 ( 総会臨時 ) O11 - 1 2021.9

【これから始めるロボット支援下仙骨腟固定術】ロボット支援下仙骨腟固定術の導入に向けて

佐古智子, 岩田健宏, 西村慎吾, 高本篤, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡邉豊彦, 那須保友

Japanese Journal of Endourology 34 ( 2 ) 221 - 225 2021.9

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

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)

【RARC ICUDを行う際のpit fall】RARCにおけるECUDとICUD(回腸導管)の比較検討

小林泰之, 枝村康平, 岩田健宏, 西村慎吾, 和田耕一郎, 荒木元朗, 渡辺豊彦, 那須保友

Japanese Journal of Endourology 34 ( 2 ) 182 - 185 2021.9

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)

腎部分切除術を施行した巨大類上皮型腎血管筋脂肪腫の1例

横山周平, 富永悠介, 高本篤, 定平卓也, 関戸崇了, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 柳井広之, 那須保友

西日本泌尿器科 83 ( 3 ) 175 - 180 2021.8

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)

ハイリスク腎移植 game changers DSA陽性ハイリスク腎移植

西村慎吾, 荒木元朗, 関戸崇了, 坪井一朗, 吉永香澄, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 定平卓也, 岩田健宏, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 小林泰之, 渡邉豊彦, 那須保友

西日本泌尿器科 83 ( 3 ) 152 - 160 2021.8

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)

CT evaluation of patent artery after percutaneous cryoablation of renal cell carcinoma. Reviewed International journal

Soichiro Kajita, Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Koji Tomita, Mayu Uka, Takashi Tanaka, Motoo Araki, Hideo Gobara, Susumu Kanazawa

Diagnostic and interventional imaging 102 ( 12 ) 753 - 758 2021.6

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

PURPOSE: The purpose of this retrospective study was to determine the incidence of persistent patent artery after percutaneous cryoablation of renal cell carcinoma (RCC) and the relationship between patent arteries one month after cryoablation and early tumor progression. MATERIALS AND METHODS: One hundred and fifty-nine patients (112 men, 47 women; mean age, 63.6±14.6 [SD] years; age range: 21-91 years) who underwent percutaneous cryoablation for 186 RCCs (mean diameter, 1.9±0.6 [SD] cm; range: 0.7-4.0cm) were retrospectively included. After cryoablation, patients underwent contrast-enhanced computed tomography (CT) with ≤2-mm slice thickness within one week from cryoablation, and at one, three, and six months. The time course of patent artery in the ablated renal parenchyma after cryoablation was the primary endpoint. The relationships between patent arteries one month after cryoablation and treatment effectiveness, tumor vascularity, tumor enhancement one month after cryoablation, tumor subtype, and renal function changes were evaluated as secondary endpoints. RESULTS: CT showed patent arteries in the ablated renal parenchyma within one week in 166 RCCs (89.2%), at one month in 54 RCCs (29.0%), at three months in 8 RCCs (4.3%), and at six months in 2 RCCs (1.1%). The presence of patent artery one month after cryoablation was significantly associated with tumor enhancement at the same time point (P=0.015). There was no association between patent arteries one month after cryoablation and treatment effectiveness (P=0.693). CONCLUSION: Patent arteries in the ablated renal parenchyma are commonly observed on CT examination after percutaneous cryoablation of RCC. However, they gradually disappear and do not require specific treatment.

DOI： 10.1016/j.diii.2021.06.001

A Case of Metastatic Fumarate Hydratase-Deficient-like Renal Cell Carcinoma Successfully Managed by Ipilimumab plus Nivolumab. Reviewed

Takanori Sekito, Atsushi Takamoto, Yasuyuki Kobayashi, Masao Mitsui, Shogo Watari, Risa Kubota, Takuya Sadahira, Takehiro Iwata, Shingo Nishimura, Kohei Edamura, Tomoko Sako, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Rei Shibata, Daisuke Ennishi, Yasutomo Nasu

Acta medica Okayama 75 ( 3 ) 397 - 402 2021.6

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

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

腎門部に発生した粘液嚢胞腺癌の1例

三宅修司, 岩田健宏, 長尾賢太郎, 河田達志, 富永悠介, 定平卓也, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 久保寿夫, 柳井広之, 那須保友

西日本泌尿器科 83 ( 2 ) 100 - 105 2021.6

Language：Japanese Publisher：(一社)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)

Efficacy of holmium laser enucleation in patients with a small (less than 30 mL) prostate volume. Reviewed International journal

Ichiro Tsuboi, Yuki Maruyama, Takuya Sadahira, Nobuyoshi Ando, Yasuhiro Nishiyama, Motoo Araki, Takushi Kurashige, Takaharu Ichikawa, Ryoji Arata, Noriaki Ono, Toyohiko Watanabe, Syunji Hayata, Hiroaki Shiina, Yasutomo Nasu

Investigative and clinical urology 62 ( 3 ) 298 - 304 2021.5

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

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

Evaluation of Neutrophil Dynamics Change by Protective Effect of Tadalafil After Renal Ischemia/Reperfusion Using In Vivo Real-time Imaging. Reviewed International journal

Yuki Maruyama, Motoo Araki, Kengo Kidokoro, Yuji Sogawa, Kasumi Yoshinaga, Yosuke Mitsui, Takuya Sadahira, Koichiro Wada, Masami Watanabe, Toyohiko Watanabe, Naoki Kashihara, Yasutomo Nasu

Transplantation 106 ( 2 ) 280 - 288 2021.4

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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 (PDE) 5 inhibitor, tadalafil. METHODS: Wild-type (WT) and eNOS knockout (eNOS-KO) 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 bovine serum albumin. Tadalafil was administered orally 1 h before surgery. Both kidney pedicles were reperfused after 37° 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 WT and eNOS-KO mice. Reduced neutrophil infiltration in tadalafil groups, which was confirmed by flow cytometry, resulted in histopathologically decreased tubular injury. The expression of VCAM-1 and KIM-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.Supplemental Visual Abstract; http://links.lww.com/TP/C223.

DOI： 10.1097/TP.0000000000003803

ABO Blood Incompatibility Positively Affects Early Graft Function: Single-Center Retrospective Cohort Study. Reviewed International journal

Shogo Watari, Motoo Araki, Koichiro Wada, Kasumi Yoshinaga, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Yasuyuki Kobayashi, Hidemi Takeuchi, Katsuyuki Tanabe, Masashi Kitagawa, Hiroshi Morinaga, Shinji Kitamura, Hitoshi Sugiyama, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Transplantation proceedings 53 ( 5 ) 1494 - 1500 2021.4

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

Correcting Anemia and Native Vitamin D Supplementation in Kidney Transplant Recipients (CANDLE-KIT): a Multicenter, 2×2 Factorial, Open-label, Randomized Clinical Trial. Reviewed International journal

Yoshitsugu Obi, Naotsugu Ichimaru, Yusuke Sakaguchi, Kazuhiro Iwadoh, Daisuke Ishii, Ken Sakai, Daiki Iwami, Hiroshi Harada, Keiichi Sumida, Akinari Sekine, Kosuke Masutani, Naotake Akutsu, Takamitsu Inoue, Morikuni Nishihira, Tatsuo Yoneda, Shinichi Ito, Motoo Araki, Jun-Ya Kaimori, Katsunori Yoshida, Shigeru Satoh, Yoshifumi Ubara, Yoshitaka Isaka, Kazunari Yoshida, Yoshiharu Tsubakihara, Shiro Takahara, Takayuki Hamano

Transplant international : official journal of the European Society for Organ Transplantation 34 ( 7 ) 1212 - 1225 2021.4

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

Anemia and vitamin D deficiency are associated with allograft failure, and hence, are potential therapeutic targets among kidney transplant recipients (KTRs). We conducted a multicenter, two-by-two factorial, open-label, randomized clinical trial to examine the effects of anemia correction and vitamin D supplementation on 2-year change in eGFR among KTRs (CANDLE-KIT). We enrolled 153 patients with anemia and >1-year history of transplantation across 23 facilities in Japan, and randomly assigned them to either a high or low hemoglobin target (>12.5 vs. <10.5 g/dL) and to either cholecalciferol 1000 IU/day or control. This trial was terminated early based on the planned interim intention-to-treat analyses (α=0.034). Among 125 patients who completed the study, 2-year decline in eGFR was smaller in the high vs. low hemoglobin group (i.e., -1.6±4.5 vs. -4.0±6.9 mL/min/1.73 m2 ; P=0.021), but did not differ between the cholecalciferol and control groups. These findings were supported by the fully-adjusted mixed effects model evaluating the rate of eGFR decline among all 153 participants. There were no significant between-group differences in all-cause death or the renal composite outcome in either arm. In conclusion, aggressive anemia correction showed a potential to preserve allograft kidney function.

DOI： 10.1111/tri.13885

Nationwide surveillance of bacterial pathogens isolated from patients with acute uncomplicated cystitis in 2018: Conducted by the Japanese Research Group for Urinary Tract Infections (JRGU). Reviewed International journal

Koichiro Wada, Teruhiko Yokoyama, Satoshi Uno, Motoo Araki, Takuya Sadahira, Yuki Maruyama, Herik Acosta, Hirochika Nakajima, Yoshiki Hiyama, Yasuharu Kunishima, Yoshikazu Togo, Takuhisa Nukaya, Hiroki Yamada, Katsumi Shigemura, Shin Ito, Masanobu Tanimura, Kanao Kobayashi, Hiroyuki Kitano, Jun Teishima, Mitsuru Yasuda, Shinya Uehara, Ryoichi Hamasuna, Toyohiko Watanabe, Tohru Nakagawa, Hiroshi Hayami, Jun Miyazaki, Satoshi Takahashi, Naoya Masumori, Kiyohito Ishikawa, Hiroshi Kiyota, Masato Fujisawa, Soichi Arakawa, Yasutomo Nasu, Shingo Yamamoto

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 27 ( 8 ) 1169 - 1180 2021.4

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

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

抗TFE3抗体による免疫染色陽性所見からXp11.2転座型腎癌と考えられた3例 Reviewed

井上陽介, 関戸崇了, 定平卓也, 高本篤, 杉本盛人, 和田耕一郎, 荒木元郎, 那須保友

西日本泌尿器科 83 ( 1 ) 42 - 47 2021.4

Language：Japanese Publisher：西日本泌尿器科学会

1例目は27歳,女性。CTで8cm大の左腎腫瘍を認め,左腎癌cT2aN0M0と診断し,腹腔鏡下左腎摘除術を施行した。病理所見でTFE3免疫染色陽性で,Xp11.2転座型腎癌と考えられた。術後24ヵ月で傍大動脈リンパ節転移をきたし,sunitinib,axitinib投与後,現在nivolumabを投与中である。2例目は32歳,女性。CTで2cm大の緩徐に造影される左腎腫瘍を認めた。腹腔鏡下左腎部分切除術を施行し,病理所見でTFE3免疫染色陽性,Xp11.2転座型腎細胞癌と考えられた。術後50ヵ月で,再発転移を認めていない。3例目は31歳,女性。CTで右嚢胞性腎腫瘍と転移性肝腫瘍を指摘された。PET-CTで肝臓,骨,子宮に多発転移を認め,肝転移巣を生検し,未分化の尿路上皮癌と診断された。Gemcitabine+Cisplatin+Paclitaxelによる抗癌化学療法を2コース施行後,転移巣の増大,新たな転移巣(頭蓋骨,乳腺)の出現を認めた。新規転移巣を摘出し,病理所見でTFE3免疫染色陽性,最終的にXp11.2転座型腎細胞癌と考えられた。Temsirolimus投与するも,病状悪化し,第221病日に死亡した。Xp11.2転座型腎癌は若年者に多いとされる。確定診断には遺伝子検査またはFISHが求められるが,今回の3症例では施行していない。TFE3免疫染色はXp11.2転座型腎癌が疑われる際に有用である。(著者抄録)

遺伝性平滑筋腫症-腎細胞癌症候群関連腎細胞癌の術後骨転移に対してイピリムマブ・ニボルマブ併用療法が有効であった1例 Reviewed

渡部智文, 榮枝一磨, 津川昌也, 関戸崇了, 富永悠介, 高本篤, 定平卓也, 小林泰之, 荒木元朗, 渡邉豊彦, 小田和歌子, 黒田直人, 十川麗美, 山本英喜, 平沢晃, 那須保友

西日本泌尿器科 83 ( 1 ) 31 - 36 2021.4

Language：Japanese Publisher：西日本泌尿器科学会

症例は45歳,男性。X-1年9月に肉眼的血尿と右腰痛を主訴に当院を受診し,単純CTで右腎上極に長径5cm大の腫瘤を認めた。腹部造影CTでは動脈相で早期濃染,後期相でwashout patternを伴う内部不整な腫瘤を同部位に認めたが,明らかなリンパ節・他臓器転移を認めなかった。右腎癌cT1bN0M0 Stage Iと診断し,同年10月に腹腔鏡下右腎摘除術を施行した。病理所見は,腫瘍細胞は淡明細胞や好酸性細胞が乳頭状・管状の構造を取り,細胞質に好酸性の核小体および核周囲明庭を認めた。Fumarate hydratase(FH)免疫染色陰性でFH欠損腎細胞癌と診断した。術後2ヵ月で多発骨転移を認め,International Metastatic RCC Database Consortium(IMDC) intermediate riskと判断し,イピリムマブ・ニボルマブ併用療法を開始した。4コース施行後,CT上新規の転移巣や転移巣の増大を認めなかった。遺伝学的検査でFH遺伝子の病的バリアントを認め,腎細胞癌の家族歴と合わせ,遺伝性平滑筋腫症-腎細胞癌症候群(hereditary leiomyomatosis and renal cell carcinoma syndrome;HLRCC)関連腎細胞癌と診断した。現在ニボルマブ単剤投与を継続中で,骨転移増悪や新規遠隔転移は認めていない。(著者抄録)

若年発症の前立腺炎症性偽腫瘍の1例 Reviewed

佐久間貴文, 丸山雄樹, 定平卓也, 高本篤, 和田耕一郎, 小林泰之, 荒木元朗, 渡部昌実, 渡辺豊彦, 那須保友

西日本泌尿器科 83 ( 1 ) 54 - 58 2021.4

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)

Successful deceased donor kidney transplantation to a recipient with a history of COVID-19 treatment. Reviewed International journal

Kasumi Yoshinaga, Motoo Araki, Koichiro Wada, Kou Hasegawa, Takanori Sekito, Shuji Miyake, Shogo Watari, Yuki Maruyama, Takuya Sadahira, Shingo Nishimura, Katsuyuki Tanabe, Hidemi Takeuchi, Yuri Nakashima, Masaru Kinomura, Herik Acosta, Yosuke Mitsui, Risa Kubota, Hirochika Nakajima, Kohei Edamura, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Fumio Otsuka, Jun Wada, Yasutomo Nasu

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 27 ( 7 ) 1097 - 1101 2021.3

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

Impact of paclitaxel, cisplatin, and gemcitabine as first-line chemotherapy in cisplatin-fit and -unfit patients with advanced/metastatic urothelial carcinoma. Reviewed International journal

Satoshi Katayama, Yasuyuki Kobayashi, Atsushi Takamoto, Kohei Edamura, Takuya Sadahira, Takehiro Iwata, Shingo Nishimura, Tomoko Sako, Koichiro Wada, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Urologic oncology 39 ( 10 ) 731.e25-731.e32 2021.3

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

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

Photodynamic diagnostic ureteroscopy using the VISERA ELITE video system for diagnosis of upper-urinary tract urothelial carcinoma: a prospective cohort pilot study. Reviewed International journal

Koichiro Wada, Motoo Araki, Ryuta Tanimoto, Takuya Sadahira, Shogo Watari, Yuki Maruyama, Yosuke Mitsui, Hirochika Nakajima, Herik Acosta, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

BMC urology 21 ( 1 ) 45 - 45 2021.3

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4 cm in diameter: a prospective observational study. Reviewed

Hideo Gobara, Takao Hiraki, Toshihiro Iguchi, Yusuke Matsui, Jun Sakurai, Mayu Uka, Koji Tomita, Toshiyuki Komaki, Yasuyuki Kobayasi, Motoo Araki, Toyohiko Watanabe, Susumu Kanazawa

International journal of clinical oncology 26 ( 3 ) 562 - 568 2021.3

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

ロボット支援腹腔鏡下膀胱全摘除術〜現状の課題と今後の方向性〜岡山大学病院におけるRARC ICUD(回腸導管) Invited

小林泰之, 西村慎吾, 岩田健宏, 枝村康平, 和田耕一郎, 荒木元朗, 渡辺豊彦, 那須保友

日本内視鏡外科学会雑誌 25 ( 7 ) SY16 - 2 2021.3

RAPNの周術期合併症の予防と対策

小林泰之, 荒木元朗, 枝村康平, 渡辺豊彦, 那須保友

泌尿器科 13 ( 3 ) 323 - 325 2021.3

Negative impact of being underweight on the outcomes of single-session shockwave lithotripsy in patients with upper urinary tract calculi: a retrospective cohort study. Reviewed International journal

Takashi Yoshioka, Kenji Omae, Tatsushi Kawada, Yosuke Inoue, Morito Sugimoto, Tadashi Oeda, Tomoya Yamasaki, Kei Fujio, Hideo Otsuki, Shinya Uehara, Motoo Araki, Shunichi Fukuhara

World journal of urology 39 ( 2 ) 571 - 577 2021.2

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

PURPOSE: To evaluate the association between being underweight and shockwave lithotripsy outcomes. METHODS: This retrospective two-centre cohort study conducted in Japan involved 597 patients diagnosed with a single urinary tract calculus based on computed tomography and who underwent shockwave lithotripsy between 2006 and 2016. We divided the patients into four groups based on their body mass index (underweight, ≤ 18.4; normal weight, 18.5-24.9; overweight, 25-29.9; obese, ≥ 30 kg/m2). We performed multivariable logistic regression analysis and estimated the odds ratio for success of single-session shockwave lithotripsy. RESULTS: Of the 597 patients, 25 (4.2%) were underweight and 34 (5.7%) were obese. After adjusting for age, sex, calculus localisation, maximum stone length, mean stone density, and skin-to-stone distance, being underweight showed a significantly negative association with success of single-session shockwave lithotripsy (odds ratio 0.25, 95% confidence interval 0.09-0.69) compared to being normal weight. CONCLUSIONS: This study showed the negative impact of being underweight on the outcomes of shockwave lithotripsy in patients with upper urinary tract calculi. This finding provides a novel viewpoint regarding the body mass index and should aid improved treatment selection for patients with upper urinary tract calculi.

DOI： 10.1007/s00345-020-03199-8

神経線維腫症1型に合併した後腹膜悪性末梢神経鞘腫瘍の1例 Reviewed

宗田大二郎, 岩田健宏, 定平卓也, 富永悠介, 片山聡, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友, 中田英二, 柳井広之

西日本泌尿器科 82 ( 6 ) 596 - 600 2021.2

Language：Japanese Publisher：西日本泌尿器科学会

症例は30代,女性。過去に左腋窩皮膚生検で神経線維腫と診断され,特徴的な皮膚所見や家族歴などから神経線維腫症1型(NF-1;von Recklinghausen病)を疑われていたが放置していた。20XX年2月に右大腿部痛,背部痛を主訴に近医を受診しMRI,造影CTで約13cm大の後腹膜腫瘤を指摘され,L2神経根からの発生と脊柱管内の浸潤も疑われ,神経線維腫の疑いとして手術目的に当科紹介された。合同での手術が必要と考えられたため,整形外科に紹介しMRIガイド下生検で悪性末梢神経鞘腫瘍の可能性を示唆された。同年6月に腫瘍の動脈塞栓術施行後に右後腹膜腫瘍摘出術を施行し,病理結果から悪性末梢神経鞘腫瘍と診断された。術後10ヵ月現在再発認めず,外来通院中である。後腹膜原発腫瘍において悪性末梢神経鞘腫瘍は極めて稀な症例であり,有効な治療法は確立されていない。今回,後腹膜原発の悪性末梢神経鞘腫瘍の1例を経験したので,若干の文献的考察を加えて報告する。(著者抄録)

岡山大学病院における去勢抵抗性前立腺癌に対するドセタキセルの長期治療成績

河田達志, 高本篤, 横山周平, 宗田大二郎, 坪井一馬, 長尾賢太郎, 富永悠介, 岩田健宏, 西村慎吾, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 6 ) 605 - 605 2021.2

The role of Wnt signaling in male reproductive physiology and pathology. Reviewed International journal

Ruizhi Xue, Wenfeng Lin, Jingkai Sun, Masami Watanabe, Abai Xu, Motoo Araki, Yasutomo Nasu, Zhengyan Tang, Peng Huang

Molecular human reproduction 27 ( 1 ) 2021.1

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

Accumulating evidence has shown that Wnt signaling is deeply involved in male reproductive physiology, and malfunction of the signal path can cause pathological changes in genital organs and sperm cells. These abnormalities are diverse in manifestation and have been constantly found in the knockout models of Wnt studies. Nevertheless, most of the research solely focused on a certain factor in the Wnt pathway, and there are few reports on the overall relation between Wnt signals and male reproductive physiology. In our review, Wnt findings relating to the reproductive system were sought and summarized in terms of Wnt ligands, Wnt receptors, Wnt intracellular signals and Wnt regulators. By sorting out and integrating relevant functions, as well as underlining the controversies among different reports, our review aims to offer an overview of Wnt signaling in male reproductive physiology and pathology for further mechanistic studies.

DOI： 10.1093/molehr/gaaa085

The role of Wnt signaling in male reproductive physiology and pathology Reviewed International journal

Ruizhi Xue, Wenfeng Lin, Jingkai Sun, Masami Watanabe, Abai Xu, Motoo Araki, Yasutomo Nasu, Zhengyan Tang, Peng Huang

Molecular Human Reproduction 2021.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press ({OUP})

Accumulating evidence has shown that Wnt signaling is deeply involved in male reproductive physiology, and malfunction of the signal path can cause pathological changes in genital organs and sperm cells. These abnormalities are diverse in manifestation and have been constantly found in the knockout models of Wnt studies. Nevertheless, most of the research solely focused on a certain factor in the Wnt pathway, and there are few reports on the overall relation between Wnt signals and male reproductive physiology. In our review, Wnt findings relating to the reproductive system were sought and summarized in terms of Wnt ligands, Wnt receptors, Wnt intracellular signals and Wnt regulators. By sorting out and integrating relevant functions, as well as underlining the controversies among different reports, our review aims to offer an overview of Wnt signaling in male reproductive physiology and pathology for further mechanistic studies.

DOI： 10.1093/molehr/gaaa085

Long-term ureteroscopic management of upper tract urothelial carcinoma: 28-year single-centre experience. Reviewed International journal

Yuki Maruyama, Motoo Araki, Koichiro Wada, Kasumi Yoshinaga, Yosuke Mitsui, Takuya Sadahira, Shingo Nishimura, Kohei Edamura, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Manoj Monga, Yasutomo Nasu, Hiromi Kumon

Japanese journal of clinical oncology 51 ( 1 ) 130 - 137 2021.1

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

Comparison of inflammation-based prognostic scores as predictors of survival outcomes in patients with germ cell tumors. Reviewed International journal

Kasumi Yoshinaga, Takuya Sadahira, Yuki Maruyama, Yosuke Mitsui, Takehiro Iwata, Koichiro Wada, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu

Investigative and clinical urology 62 ( 1 ) 47 - 55 2021.1

Language：English Publishing type：Research paper (scientific journal) Publisher：The Korean Urological Association

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

Dual-Functional PLGA Nanoparticles Co-Loaded with Indocyanine Green and Resiquimod for Prostate Cancer Treatment. Reviewed International journal

Wenfeng Lin, Chaoming Li, Naijin Xu, Masami Watanabe, Ruizhi Xue, Abai Xu, Motoo Araki, Ruifen Sun, Chunxiao Liu, Yasutomo Nasu, Peng Huang

International journal of nanomedicine 16 2775 - 2787 2021

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

Purpose: With the advance of screening techniques, there is a growing number of low-risk or intermediate-risk prostate cancer (PCa) cases, remaining a serious threat to men's health. To obtain better efficacy, a growing interest has been attracted to develop such emerging treatments as immunotherapy and focal therapy. However, few studies offer guidance on whether and how to combine these modalities against PCa. This study was designed to develop dual-functional nanoparticles (NPs) which combined photothermal therapy (PTT) with immunotherapy and determine the anti-tumor efficacy for PCa treatment. Methods: By a double emulsion technique, the drug nanocarrier, poly(lactic-co-glycolic acid) or PLGA, was applied for co-loading of a fluorescent dye, indocyanine green (ICG) and a toll-like receptor 7/8 (TLR7/8) agonist resiquimod (R848) to synthesize PLGA-ICG-R848 NPs. Next, we determined their characteristic features and evaluated whether they inhibited the cell viability in multiple PCa cell lines. After treatment with PLGA-ICG-R848, the maturation markers of bone marrow-derived dendritic cells (BMDCs) were detected by flow cytometry. By establishing a subcutaneous xenograft model of mouse PCa, we explored both the anti-tumor effect and immune response following the NPs-based laser ablation. Results: With a mean diameter of 157.7 nm, PLGA-ICG-R848 exhibited no cytotoxic effect in PCa cells, but they significantly decreased RM9 cell viability to (3.9±1.0)% after laser irradiation. Moreover, PLGA-ICG-R848 promoted BMDCs maturation with the significantly elevated proportions of CD11c+CD86+ and CD11c+CD80+ cells. Following PLGA-ICG-R848-based laser ablation in vivo, the decreased bioluminescent signals indicated a significant inhibition of PCa growth, while the ratio of splenic natural killer (NK) cells in PLGA-ICG-R848 was (3.96±1.88)% compared with (0.99±0.10)% in PBS group, revealing the enhanced immune response against PCa. Conclusion: The dual-functional PLGA-ICG-R848 NPs under laser irradiation exhibit the anti-tumor efficacy for PCa treatment by combining PTT with immunotherapy.

DOI： 10.2147/IJN.S301552

Management of Groin Pain Using an Iliohypogastric Nerve Block in a Patient with Inguinal Hernia due to Persistent Müllerian Duct Syndrome. Reviewed International journal

Takanori Sekito, Takuya Sadahira, Masahiro Sugihara, Kohei Edamura, Motoo Araki, Yasutomo Nasu

Case reports in urology 2021 7577632 - 7577632 2021

Language：English

Persistent Müllerian duct syndrome can cause an inguinal hernia, although this is a rare occurrence; recurrent inguinal hernias can, in turn, cause ongoing groin pain. Management of groin pain plays an important role in patients' quality of life. We present our experience with a 43-year-old man who had a 2-week history of left-sided groin pain. The patient underwent laparoscopic surgery for a left inguinal hernia via the transabdominal preperitoneal approach. Right-sided cryptorchidism was noted during surgery, with a solid structure-thought to be a uterus-extending into the left inguinal canal. The diagnosis was persistent Müllerian duct syndrome, and the groin pain was relieved after a laparoscopic right orchiectomy with a bilateral preperitoneal hernia repair using a mesh. Four years later, magnetic resonance imaging performed for new-onset left groin pain showed a left inguinal hernia caused by the uterine structure. We diagnosed the recurrent hernia as the cause of his pain. Prior to performing any invasive surgical procedures, an iliohypogastric nerve block was performed using 1% lidocaine. Short-term analgesia was provided by the block, improving his quality of life. He has been followed since then and has declined surgical neurectomy. An iliohypogastric nerve block can be an effective method of controlling groin pain caused by an inguinal hernia resulting from persistent Müllerian duct syndrome; the effectiveness of the nerve block will help determine whether surgical neurectomy is indicated for permanent pain control.

DOI： 10.1155/2021/7577632

Discovery and Validation of Nitroxoline as a Novel STAT3 Inhibitor in Drug-resistant Urothelial Bladder Cancer. Reviewed International journal

Wenfeng Lin, Jingkai Sun, Takuya Sadahira, Naijin Xu, Koichiro Wada, Chunxiao Liu, Motoo Araki, Abai Xu, Masami Watanabe, Yasutomo Nasu, Peng Huang

International journal of biological sciences 17 ( 12 ) 3255 - 3267 2021

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

Repeated cycles of first-line chemotherapy drugs such as doxorubicin (DOX) and cisplatin (CIS) trigger frequent chemoresistance in recurrent urothelial bladder cancer (UBC). Nitroxoline (NTX), an antibiotic to treat urinary tract infections, has been recently repurposed for cancer treatment. Here we aimed to investigate whether NTX suppresses drug-resistant UBC and its molecular mechanism. The drug-resistant cell lines T24/DOX and T24/CIS were established by continual exposure of parental cell line T24 to DOX and CIS, respectively. T24/DOX and T24/CIS cells were resistant to DOX and CIS, respectively, but they were sensitive to NTX time- and dose-dependently. Overexpressions of STAT3 and P-glycoprotein (P-gp) were identified in T24/DOX and T24/CIS, which could be reversed by NTX. Western blot revealed that NTX downregulated p-STAT3, c-Myc, Cyclin D1, CDK4, CDK6, Bcl-xL, Mcl-1, and Survivin, which were further confirmed by Stattic, a selective STAT3 inhibitor. In vivo, NTX exhibited the significant anti-tumor effect in T24/DOX and T24/CIS tumor-bearing mice. These results suggested that NTX-induced P-gp reversal, G0/G1 arrest, and apoptosis in drug-resistant UBC were mediated by inhibition of STAT3 signaling. Our findings repurpose NTX as a novel STAT3 inhibitor to induce P-gp reversal, G0/G1 arrest, and apoptosis in drug-resistant UBC.

DOI： 10.7150/ijbs.63125

Repurposing of posaconazole as a hedgehog/SMO signaling inhibitor for embryonal rhabdomyosarcoma therapy. International journal

Jingkai Sun, Wenfeng Lin, Chaoming Li, Hideo Ueki, Ruizhi Xue, Takuya Sadahira, Hao Hu, Koichiro Wada, Na Li, Chunxiao Liu, Motoo Araki, Abai Xu, Peng Huang

American journal of cancer research 11 ( 9 ) 4528 - 4540 2021

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

Posaconazole (POS) is a novel antifungal agent, which has been repurposed as an anti-tumor drug for its potential inhibition of Hedgehog signaling pathway. Hedgehog pathway is reported to be abnormally activated in embryonal rhabdomyosarcoma (ERMS), this study aimed to reveal whether POS could inhibit Hedgehog signaling pathway in ERMS. Following POS treatment, XTT viability assay was used to determine the cell proliferation of ERMS cell lines. Protein changes related to Hedgehog signaling, cell cycle and autophagy were detected by Western blot. The cell cycle distribution was analyzed by flow cytometry. Moreover, a subcutaneous tumor mouse model of ERMS was established to assess the anti-tumor effect of POS. POS was found to inhibit tumor progression by inducing G0/G1 arrest and autophagy of RD, RMS-YM, and KYM-1 cells dose-dependently. Western blot demonstrated that POS downregulated the expressions of SMO, Gli1, c-Myc, CDK4, and CDK6, while upregulated the expressions of autophagy-related proteins. Immunofluorescence microscopy revealed a significant increase of LC3B puncta in POS-treated ERMS cells. Furthermore, POS treatment led to a significant inhibition of tumor growth in mice bearing ERMS. Our findings could provide a theoretical basis and have important clinical implications in developing POS as a promising agent against ERMS by targeting Hedgehog pathway.

A Clinical Trial Evaluating the Usefulness of Tailored Antimicrobial Prophylaxis Using Rectal-culture Screening Media Prior to Transrectal Prostate Biopsy: A Multicenter, Randomized Controlled Trial.

Takuya Sadahira, Yuki Maruyama, Yoshiki Hiyama, Hiroyuki Kitano, Hiroki Yamada, Takayuki Goto, Tsubasa Kondo, Katsumi Shigemura, Yosuke Mitsui, Takehiro Iwata, Kohei Edamura, Motoo Araki, Masami Watanabe, Tadasu Takenaka, Jun Teishima, Yasuyoshi Miyata, Kiyohito Ishikawa, Ei-Ichiro Takaoka, Jun Miyazaki, Satoshi Takahashi, Naoya Masumori, Hiroshi Kiyota, Masato Fujisawa, Shingo Yamamoto, Takafumi Sakuma, Norihiro Kusumi, Takaharu Ichikawa, Toyohiko Watanabe, Yoshitsugu Nasu, Masaya Tsugawa, Yasutomo Nasu, Koichiro Wada

Acta medica Okayama 75 ( 5 ) 663 - 667 2021

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

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

A second opinion pathology review improves the diagnostic concordance between prostate cancer biopsy and radical prostatectomy specimens

Maehara T, Sadahira T, Maruyama Y, Wada K, Araki M, Watanabe M, Watanabe T, Yanai H, Nasu Y

UROLOGY ANNALS 13 ( 2 ) 119 - 124 2021

Medical uses for phenol in the urinary tract: A possible forgotten treatment

Sadahira T, Maruyama Y, Watanabe T, Sekito T, Mitsui Y, Wada K, Araki M, Watanabe M

Medicine International 1 ( 13 ) 2021

【地方の腎移植の継続と継承-組織・指導医の取り組みと今後の展望-】岡山大学における腎移植継承の取り組み

荒木元朗, 西村慎吾, 吉永香澄, 丸山雄樹, 山野井友昭, 定平卓也, 富永悠介, 岩田健宏, 片山聡, 佐古智子, 枝村康平, 小林泰之, 那須保友

腎移植・血管外科 33 ( 2 ) 67 - 71 2021

【地方の腎移植の継続と継承-組織・指導医の取り組みと今後の展望-】岡山大学における腎移植継承の取り組み

荒木元朗, 西村慎吾, 吉永香澄, 丸山雄樹, 山野井友昭, 定平卓也, 富永悠介, 岩田健宏, 片山聡, 佐古智子, 枝村康平, 小林泰之, 那須保友

腎移植・血管外科 33 ( 2 ) 67 - 71 2021

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

1.岡山大学の腎移植の背景・歴史岡山大学泌尿器科は2009年に新しい腎移植プログラムを立ち上げ総計144例となった.成績も1年生存・生着率100%を維持している.2.人材確保医局員の確保から始まる.3.育成腎移植は幅広いテクニックが要求される.血管縫合糸は若手医師でも縫いやすく結紮もし易いGore-tex sutureを用いている.いい雰囲気でやることを心がけている.4.腎臓内科との連携術前術後連携を取るため腎移植カンファレンスを月一回行い情報共有している.5.教室内での他の領域の医師との関係腎移植チームのメンバーも腫瘍の手術やロボット手術を担当することによって腎移植のみに偏らない配慮をしている.6.働き方改革移植前後の管理の簡略化に努めている.(著者抄録)

Medical uses for phenol in the urinary tract: A possible forgotten treatment (Review). International journal

Takuya Sadahira, Yuki Maruyama, Toyohiko Watanabe, Takanori Sekito, Yosuke Mitsui, Koichiro Wada, Motoo Araki, Masami Watanabe

Medicine international 1 ( 4 ) 13 - 13 2021

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

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

Surgical treatment for a periurethral diverticulum with dysuria: A case reports

Satoko Matsuo, Ryuta Tanimoto, Morito Sugimoto, Tomoyasu Tsushima, Aya Nakamura, Takuya Sadahira, Shogo Watari, Yasuyuki Kobayashi, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu

Nishinihon Journal of Urology 82 ( 5 ) 514 - 517 2020.12

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.

Low-dose rituximab induction therapy is effective in immunological high-risk renal transplantation without increasing cytomegalovirus infection. Reviewed International journal

Kasumi Yoshinaga, Motoo Araki, Koichiro Wada, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Yasuyuki Kobayashi, Hidemi Takeuchi, Katsuyuki Tanabe, Masashi Kitagawa, Hiroshi Morinaga, Haruhito Adam Uchida, Shinji Kitamura, Hitoshi Sugiyama, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

International journal of urology : official journal of the Japanese Urological Association 27 ( 12 ) 1136 - 1142 2020.12

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

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

当院における開腹膀胱全摘術(ORC)と腹腔鏡下膀胱全摘術(LRC)の治療成績の比較

和田里章悟, 小林泰之, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

日本泌尿器科学会総会 108回 1138 - 1138 2020.12

排尿障害を伴う全周性尿道憩室に対して外科的治療を行った1例 Reviewed

松尾聡子, 谷本竜太, 杉本盛人, 津島友靖, 中村あや, 定平卓也, 和田里章悟, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 5 ) 514 - 517 2020.12

Language：Japanese Publisher：西日本泌尿器科学会

症例は46歳,女性.子宮筋腫術後フォローアップMRIで,膀胱頸部に約3cm大の嚢胞性病変を指摘されていた.X年3月,頻尿・排尿痛を主訴に前医泌尿器科を受診した.保存的加療では排尿障害の改善が得られず,精査加療のためX年11月に当院紹介となった.腹部超音波検査で残尿は認めなかったが,尿道周囲に嚢胞性病変を認めた.内診では腟前壁に弾性軟の腫瘤を認めた.経腟的嚢胞穿刺の上,インジゴカルミンを注入すると,尿道鏡下に尿道5時方向より色素の噴出を認め,尿道憩室と診断した.その後,排尿障害が軽快したため経過観察としていたが,X+1年10月に膀胱炎様症状および排尿困難が再燃し,MRIで憩室の再増大を認めたため,外科的治療の方針とした.X+2年2月,経腟的尿道憩室切除術を施行した.憩室口は縫合閉鎖,憩室壁は可及的に切除し,残存する憩室壁内腔を可及的に掻爬した後,尿道周囲筋膜・腟前壁を縫合閉鎖した.周術期合併症を認めず,術後も排尿症状なく経過している.本症例における診断および術式で工夫したポイントを,若干の文献的考察を加え報告する.(著者抄録)

【ロボット手術の教育方法-それぞれの施設での試み-】岡山大学病院泌尿器科におけるロボット手術教育の現状

小林泰之, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 定平卓也, 枝村康平, 荒木元朗, 渡辺豊彦, 那須保友

Japanese Journal of Endourology 33 ( 2 ) 221 - 224 2020.12

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

2009年にダビンチSが薬事承認、2012年にロボット支援下腹腔鏡下前立腺全摘除術が保険収載されて以来、ロボット手術は急激に普及している。岡山大学病院関連施設においても、この数年間でダビンチが急速に普及し、13台(岡山大学病院を含む)のダビンチが稼働し45名の術者が執刀を行っている。しかしながら、各々施設での手術方法、指導方法は全く同じではない。関連施設内での人事異動にともない、岡山大学病院においても、様々な背景を有する術者が在籍するようになり、同一施設内にも関わらず複数の手術方法が乱立した。この状態に当施設のロボット手術教育はうまく対応できず、2015年頃より周術期成績も悪化の傾向を示した。この問題を解決するために、腹腔鏡手術教育にて培った"手術内容を統一し手術内容の再現性を高め、短いラーニングカーブを目指す"というコンセプトを応用し、この状況を乗り越えようと試みている。(著者抄録)

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

Impact of Sarcopenia on Erectile Function after Nerve-Sparing Robot-Assisted Radical Prostatectomy. Reviewed International journal

Yosuke Mitsui, Takuya Sadahira, Yuki Maruyama, Ryota Sato, Acosta Gonzalez Herik Rodrigo, Koichiro Wada, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

The world journal of men's health 38 ( 4 ) 673 - 682 2020.11

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

PURPOSE: To determine the impact of sarcopenia on erectile functional outcomes after a nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) using patient-reported validated questionnaires. MATERIALS AND METHODS: In this retrospective study, RARP was performed on 841 patients at Okayama University Hospital, of which 132 underwent NS RARP. Erectile functional outcomes were assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite before and 1, 3, 6, and 12 months after surgery. Automated measurement of skeletal muscle at L3 was achieved using volume analyzer software and normalizing for height (cm²/m²) to calculate skeletal muscle index (SMI). Patients who had an IIEF-5≤4 comprised the group with erectile dysfunction (ED), and those with an IIEF-5≤5 made up the non-ED group. RESULTS: This study enrolled 95 patients of median age 65 years with a preoperative IIEF-5 of 16. There were no significant differences between patients with and without sarcopenia among those with preoperative IIEF-5. Postoperatively, in the ED group, SMI and preoperative IIEF-5 were significantly lower than in the non-ED group. Multiple linear regression analysis revealed that (1) both SMI and preoperative IIEF-5 were independent predictors of ED, and (2) sarcopenia and preoperative IIEF-5 were predictors of ED at 12 months after NS RARP. CONCLUSIONS: Patients with sarcopenia can have worse erectile functional outcomes after NS RARP. Sarcopenia and a lower preoperative IIEF-5 score may be predictive of postoperative ED.

DOI： 10.5534/wjmh.200036

UTUCに対するKidney-sparing surgeryの現状と課題岡山大学の手技と成績

和田耕一郎, 丸山雄樹, 荒木元朗, 小林泰之, 定平卓也, 高本篤, 佐古智子, 枝村康平, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 SY - 1 2020.11

これから始めるロボット支援下仙骨腟固定術ロボット支援腹腔鏡下仙骨腟固定術の導入に向けて

佐古智子, 岩田健宏, 西村慎吾, 高本篤, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 SY - 1 2020.11

腹腔鏡技術認定医実際の教育現場を紹介します! 岡山大学泌尿器科における腹腔鏡教育

小林泰之, 富永悠介, 枝村康平, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 荒木元朗, 渡辺豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 SY - 1 2020.11

当院におけるロボット支援腹腔鏡下腎部分切除術後再発症例の検討

河田達志, 坪井一馬, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 P - 2 2020.11

岡山大学病院におけるBioJetシステムを用いたMRI/US融合下経会陰的前立腺生検の初期

高本篤, 河田達志, 小林泰之, 岩田健宏, 西村慎吾, 佐古智子, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 O - 1 2020.11

初心者向けの新術式一筆書きHoLEPの提案と教育効果について

富永悠介, 宗田大二郎, 坪井一馬, 岩田健宏, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 O - 4 2020.11

RALP術中にモノポーラーシザースのチップカバーが脱落し、発見が困難であった一例

長尾賢太郎, 宗田大二郎, 岩田健宏, 佐古智子, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 34回 O - 2 2020.11

Combined Laparoscopic and CT Monitoring of the Ice-Ball Margin during Cryoablation for Renal Cell Carcinoma Associated with von Hippel-Lindau Disease: First Case. Reviewed

Takanori Sekito, Motoo Araki, Takao Hiraki, Mayu Uka, Toshiyuki Komaki, Yusuke Matsui, Toshihiro Iguchi, Satoshi Katayama, Kasumi Yoshinaga, Shogo Watari, Yuki Maruyama, Yosuke Mitsui, Risa Kubota, Takuya Sadahira, Shingo Nishimura, Koichiro Wada, Atsushi Takamoto, Kohei Edamura, Tomoko Sako, Yasuyuki Kobayashi, Toyohiko Watanabe, Susumu Kanazawa, Yasutomo Nasu

Acta medica Okayama 74 ( 5 ) 443 - 448 2020.10

Authorship：Corresponding author Language：English

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

ハイリスク腎移植game changers DSA陽性ハイリスク腎移植 Invited

西村慎吾, 荒木元朗, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 定平卓也, 岩田健宏, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 小林泰之, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 増刊 ) 90 - 90 2020.10

新たなin vivoイメージング技術から明らかになった、タダラフィルによる腎虚血/再灌流後好中球浸潤低下(The novel in vivo imaging techniques for visualizing neutrophil infiltration following renal ischemia/reperfusion which was reduced by tadalafil)

丸山雄樹, 荒木元朗, 城所研吾, 十川裕史, 吉永香澄, 光井洋介, 定平卓也, 和田耕一郎, 渡部昌実, 渡邉豊彦, 柏原直樹, 那須保友

西日本泌尿器科 82 ( 増刊 ) 136 - 136 2020.10

Correlation between lumbar skeletal muscle size and urinary incontinence after radical prostatectomy. Reviewed International journal

Yosuke Mitsui, Takuya Sadahira, Toyohiko Watanabe, Motoo Araki, Yuki Maruyama, Ryota Sato, Acosta Gonzalez Herik Rodrigo, Koichiro Wada, Masami Watanabe, Michael B Chancellor, Yasutomo Nasu

Lower urinary tract symptoms 12 ( 3 ) 245 - 252 2020.9

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

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

Tumor suppressor REIC/Dkk-3 and its interacting protein SGTA inhibit glucocorticoid receptor to nuclear transport. Reviewed International journal

Takehiro Iwata, Takuya Sadahira, Kazuhiko Ochiai, Hideo Ueki, Takanori Sasaki, Peng Haung, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu, Masami Watanabe

Experimental and therapeutic medicine 20 ( 2 ) 1739 - 1745 2020.8

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

Preoperative Use of Alpha-1 Receptor Blockers in Male Patients Undergoing Extracorporeal Shock Wave Lithotripsy for a Ureteral Calculus. Reviewed

Takashi Yoshioka, Kenji Omae, Tatsushi Kawada, Yosuke Inoue, Morito Sugimoto, Tadashi Oeda, Shinya Uehara, Motoo Araki, Shunichi Fukuhara

Acta medica Okayama 74 ( 4 ) 293 - 299 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical School

In this retrospective single-center cohort study, we investigated the impact of preoperative use of an alpha-1 adrenergic receptor (AR) blocker on the outcome of single-session extracorporeal shock wave lithotripsy (SWL) in 193 male patients who underwent SWL for a single ureteral calculus between 2006 and 2016. We reviewed their medical records to obtain the data on the preoperative use of alpha-1 AR blockers. The primary outcome was treatment success after single-session SWL. We performed a multivariable logistic regression analysis adjusting for clinically important confounders to examine the association between preoperative use of alpha-1 AR blockers and the treatment success of SWL. Among the 193 patients, 15 (7.8%) were taking an alpha-1 AR blocker preoperatively. A multivariable analysis showed that preoperative use of an alpha-1 AR blocker was a significant negative predictor for treatment success of SWL (adjusted odds ratio 0.17; 95% confidence intervals, 0.04-0.74). Our findings suggest that the preoperative use of an alpha-1 AR blocker was a negative predictor of treatment success of SWL in male patients with a single ureteral calculus. Clinicians should pay more attention to the preoperative drug use in determining an appropriate stone therapy modality.

DOI： 10.18926/AMO/60367

Association of Severe Microscopic Hematuria with Successful Conservative Treatment of Single Uncomplicated Ureteral Calculus: A Multicenter Cohort Study. Reviewed International journal

Satoshi Katayama, Takashi Yoshioka, Tomoko Sako, Wataru Murao, Motoo Araki, Toyohiko Watanabe, Tadasu Takenaka

European urology focus 7 ( 4 ) 812 - 817 2020.4

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

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

Clinical experience with pembrolizumab in the treatment of advanced urothelial cancer

Yusuke Tominaga, Atsushi Takamoto, Takanori Sekito, Syogo Watari, Yuko Oiwa, Risa Kubota, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Tomoko Sako, Koichiro Wada, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu

Nishinihon Journal of Urology 82 ( 1 ) 106 - 110 2020.4

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.

Factors predicting pathological upgrading after prostatectomy in patients with Gleason grade group 1 prostate cancer based on opinion-matched biopsy specimens. Reviewed International journal

Yuki Maruyama, Takuya Sadahira, Motoo Araki, Yosuke Mitsui, Koichiro Wada, Acosta Gonzalez Herik Rodrigo, Kazuaki Munetomo, Yasuyuki Kobayashi, Masami Watanabe, Hiroyuki Yanai, Toyohiko Watanabe, Yasutomo Nasu

Molecular and clinical oncology 12 ( 4 ) 384 - 389 2020.4

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

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

Quality of Life and Mental Satisfaction Improve Slowly in Preemptive Kidney Transplantation Compared With Nonpreemptive Kidney Transplantation. Reviewed International journal

Yosuke Mitsui, Motoo Araki, Yuki Maruyama, Kasumi Yoshinaga, Takuya Sadahira, Koichiro Wada, Katsuyuki Tanabe, Masashi Kitagawa, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Transplantation proceedings 52 ( 3 ) 740 - 747 2020.4

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

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

岡山大学病院における進行性尿路上皮癌に対するpembrolizumabの治療経験 Reviewed

富永悠介, 高本篤, 関戸崇了, 和田里章悟, 大岩裕子, 窪田理沙, 片山聡, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 1 ) 106 - 110 2020.4

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)

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

後腹膜悪性末梢神経鞘腫の1例

宗田大二郎, 高本篤, 荒木元朗, 角南亮輔, 関戸崇了, 佐久間貴文, 和田里章悟, 吉永香澄, 丸山雄樹, 光井洋介, 富永悠介, 大岩裕子, 窪田理沙, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 1 ) 173 - 173 2020.4

非淋菌性尿道炎に対する1日200mg sitafloxacin投与法

和田耕一郎, 定平卓也, 荒木元朗, 渡邉豊彦, 那須保友

日本化学療法学会雑誌 68 ( 2 ) 181 - 185 2020.3

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)

Development and validation of a prediction model for failed shockwave lithotripsy of upper urinary tract calculi using computed tomography information: the S3HoCKwave score. Reviewed International journal

Takashi Yoshioka, Tatsuyoshi Ikenoue, Hideaki Hashimoto, Hideo Otsuki, Tadashi Oeda, Noritaka Ishito, Ryuta Watanabe, Takashi Saika, Motoo Araki, Shunichi Fukuhara, Yosuke Yamamoto

World journal of urology 38 ( 12 ) 3267 - 3273 2020.2

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

PURPOSE: To develop and validate a new clinical prediction model that accurately predicts the failure of shockwave lithotripsy (SWL) using information obtained from non-contrast-enhanced computed tomography (NCCT). METHODS: This multicentre retrospective cohort study consecutively enrolled patients diagnosed with upper urinary tract calculi by NCCT at five hospitals in Japan from January 1, 2006 to December 31, 2016. Among the candidate predictors, we selected the six most significant predictors a priori. The main outcome was SWL failure after three sessions. Model calibration was evaluated by the calibration slope and the Hosmer-Lemeshow test. Discrimination was evaluated by the receiver-operating characteristic curves and the area under the curve (AUC). A multivariable logistic regression analysis was performed; based on the estimated β coefficients, predictive scores were generated. RESULTS: Of 2695 patients, 2271 were included. Patients were divided into the development cohort (1666 patients) and validation cohort (605 patients) according to geographical factors. We developed a clinical prediction model with scores ranging from 0 to 49 points. We named the prediction model the S3HoCKwave score based on the initials of the predictors (sex, skin-to-stone distance, size, Hounsfield units, colic, and kidney or ureter). As a result of internal validation, the optimism-corrected AUC was 0.72. In the validation cohort, the Hosmer-Lemeshow test did not show statistical significance (P = 0.33), and the AUC was 0.71 (95% confidence interval 0.65-0.76). CONCLUSIONS: The S3HoCKwave score is easy to understand, has a relatively high predictive value, and allows clinicians to make appropriate treatment selections.

DOI： 10.1007/s00345-020-03125-y

Robotic Renal Autotransplantation: A Feasibility Study in a Porcine Model. Reviewed

Risa Kubota, Motoo Araki, Koichiro Wada, Kasumi Kawamura, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Yuichi Ariyoshi, Takehiro Iwata, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Yuzuki Kano, Masashi Kitagawa, Katsuyuki Tanabe, Hitoshi Sugiyama, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Acta medica Okayama 74 ( 1 ) 53 - 58 2020.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical School

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

生体腎移植レシピエントにおけるCT値と骨密度の関係と推移

丸山雄樹, 荒木元朗, 関戸崇了, 和田里章悟, 河村香澄, 光井洋介, 窪田理沙, 西村慎吾, 枝村康平, 小林泰之, 渡邉豊彦, 北川正史, 田邊克幸, 那須保友

日本臨床腎移植学会プログラム・抄録集 53回 200 - 200 2020.2

生体ドナー腎採取術における後腹膜鏡下手術の有用性

西村慎吾, 荒木元朗, 小林泰之, 山下里美, 関戸崇了, 坪井一朗, 河村香澄, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 和田耕一郎, 渡邉豊彦, 那須保友

日本臨床腎移植学会プログラム・抄録集 53回 209 - 209 2020.2

生体腎移植後slow graft functionのリスク因子の検討

和田里章悟, 荒木元朗, 河村香澄, 関戸崇了, 丸山雄樹, 光井洋介, 窪田理沙, 西村慎吾, 和田耕一郎, 小林泰之, 渡邉豊彦, 北川正史, 田邊克幸, 杉山斉, 和田淳, 那須保友

日本臨床腎移植学会プログラム・抄録集 53回 242 - 242 2020.2

生体腎移植後に発症したBKウイルス腎症の2例

関戸崇了, 荒木元朗, 河村香澄, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 西村慎吾, 和田耕一郎, 山下里美, 佐古智子, 枝村康平, 小林泰之, 渡邉豊彦, 加納弓月, 北川正史, 田邊克幸, 杉山斉, 和田淳, 那須保友

日本臨床腎移植学会プログラム・抄録集 53回 213 - 213 2020.2

CMV初感染の腎移植レシピエントへのリツキシマブ投与の検討

河村香澄, 荒木元朗, 関戸崇了, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 西村慎吾, 和田耕一郎, 小林泰之, 渡辺豊彦, 加納弓月, 北川正史, 田邉克幸, 杉山斉, 和田淳, 那須保友

日本臨床腎移植学会プログラム・抄録集 53回 207 - 207 2020.2

Post-ablation syndrome after percutaneous cryoablation of small renal tumors: A prospective study of incidence, severity, duration, and effect on lifestyle. Reviewed International journal

Takahiro Kawabata, Takao Hiraki, Toshihiro Iguchi, Yusuke Matsui, Mayu Uka, Yoshihisa Masaoka, Toshiyuki Komaki, Jun Sakurai, Hideo Gobara, Motoo Araki, Yasutomo Nasu, Susumu Kanazawa

European journal of radiology 122 108750 - 108750 2020.1

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

PURPOSE: To prospectively investigate the incidence, severity, duration, and effect on lifestyle of post-ablation syndrome (PAS) after percutaneous renal cryoablation. MATERIALS AND METHODS: We enrolled 39 patients (27 male and 12 female; mean age, 62 years) who underwent 40 CT-guided cryoablation sessions for pathologically proven renal cancer (mean size, 20 mm) between December 2015 and December 2017. Four symptoms attributable to PAS, i.e., fever, nausea, vomiting, malaise, and the synergistic effect of these symptoms on lifestyle by 21 days after ablation were evaluated using a questionnaire. Symptoms were graded according to the common toxicity criteria of adverse events. RESULTS: The incidences of fever, nausea, vomiting, and malaise were 100% (40/40), 20% (8/40), 20% (8/40), and 63% (25/40), respectively. Most (78/81, 96%) symptoms had begun by day 2. The highest grade of fever per session was 0 (defined as ≥37.0 °C and <38.0 °C) (n = 24), 1 (n = 15), or 2 (n = 1); that of nausea was 2 (n = 8); that of vomiting was 1 (n = 7) or 3 (n = 1); and that of malaise was 1 (n = 14) or 2 (n = 11). Most (76/81, 94%) symptoms had resolved by day 8. The average values for the maximum scores of interference with general activity and work were 3.6 and 1.1, respectively. CONCLUSION: All symptoms were generally early-onset and self-limiting, with minimal impact on lifestyle and resolution by day 8. The clinical course and impact of PAS should be acknowledged by practitioners who manage patients undergoing renal cryoablation.

DOI： 10.1016/j.ejrad.2019.108750

Advanced Renal Pelvic Carcinoma Revealed after Treatment of a Staghorn Calculus by Endoscopic Combined Intrarenal Surgery. Reviewed International journal

Ichiro Tsuboi, Yuki Maruyama, Motoo Araki, Nobuyoshi Ando, Yasuhiro Nishiyama, Ryoji Arata, Noriaki Ono

Case reports in urology 2020 9703479 - 9703479 2020

Language：English

Renal pelvis carcinoma associated with staghorn calculus is a clinically rare condition. A 66-year-old man presented with flank pain due to an 8 cm complete staghorn calculus. We performed three lithotomies using endoscopic combined intrarenal surgery and carried out intraoperative biopsy. Histopathological examinations revealed a keratinized lesion. One month later, contrast-enhanced computed tomography showed an advanced renal pelvis carcinoma. These findings demonstrate that even an intraoperative biopsy may be insufficient to diagnose a renal pelvis carcinoma associated with a staghorn calculus. The possibility of RPCa developing when treating a long-standing staghorn calculus should therefore be kept in mind.

DOI： 10.1155/2020/9703479

Nitroxoline inhibits bladder cancer progression by reversing EMT process and enhancing anti-tumor immunity. Reviewed International journal

Naijin Xu, Wenfeng Lin, Jingkai Sun, Takuya Sadahira, Abai Xu, Masami Watanabe, Kai Guo, Motoo Araki, Gonghui Li, Chunxiao Liu, Yasutomo Nasu, Peng Huang

Journal of Cancer 11 ( 22 ) 6633 - 6641 2020

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

Nitroxoline is considered to be an effective treatment for the urinary tract infections. Recently, it has been found to be effective against several cancers. However, few studies have examined the anti-tumor activity of nitroxoline in bladder cancer. The purpose of the study was to reveal the possible mechanisms how nitroxoline inhibited bladder cancer progression. In vitro assay, we demonstrated that nitroxoline inhibited bladder cancer cell growth and migration in a concentration-related manner. Western blot analysis demonstrated that nitroxoline downregulated the expressions of epithelial mesenchymal transition (EMT)-related proteins. Furthermore, treatment with nitroxoline in the C3H/He mice bladder cancer subcutaneous model resulted in significant inhibition of tumor growth. Moreover, the percentage of myeloid-derived suppressor cells (MDSC) in peripheral blood cells significantly decreased after treatment of nitroxoline. Taken together, our results suggested that nitroxoline may be used as a potential drug for bladder cancer.

DOI： 10.7150/jca.47025

生体腎移植後に急性浸潤性の再燃を呈した副鼻腔真菌症の1例

西村慎吾, 和田耕一郎, 小林泰之, 渡邉豊彦, 村井綾, 檜垣貴哉, 那須保友, 荒木元朗, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 光井洋介, 窪田理沙, 山下美里

移植 55 387_3 - 387_3 2020

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

Preventive efficacy and safety of lactobacillus vaginal suppositories in women with recurrent cystitis: A phase 2 study Reviewed

Sadahira T, Wada K, Ishii A, Maruyama Y, Iwata T, Araki M, Watanabe M, Watanabe T, Nasu Y

Eur Urol Open Sci 19 ( 2 ) 2036 - 2037 2020

ロボット支援腹腔鏡下腎部分切除術後に再発した3症例の検討

小林泰之, 荒木元朗, 枝村康平, 西村慎吾, 高本篤, 渡辺豊彦, 那須保友

腎癌研究会会報 ( 50 ) 18 - 18 2020

岡山大学病院における進行性尿路上皮癌に対するpembrolizumabの治療経験

富永悠介, 高本篤, 角南亮輔, 関戸崇了, 和田里章悟, 河村香澄, 丸山雄樹, 光井洋介, 大岩裕子, 窪田理沙, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 石井亜矢乃, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 81 ( 6 ) 656 - 656 2019.12

ロボット支援下腎動脈瘤修復術のfeasibility study

荒木元朗, 和田耕一郎, 西村慎吾, 枝村康平, 小林泰之, 渡辺豊彦, 那須保友

日本内視鏡外科学会雑誌 24 ( 7 ) MO336 - 7 2019.12

岡山大学病院におけるロボット支援腹腔鏡下腎部分切除術の検討

窪田理沙, 小林泰之, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 O - 4 2019.11

ロボット支援下腎動脈瘤修復術のfeasibility study

荒木元朗, 和田耕一郎, 河村香澄, 丸山雄樹, 光井洋介, 窪田理沙, 西村慎吾, 小林泰之, 渡辺豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 AV - 2 2019.11

Percutaneous thermal ablation for renal cell carcinoma in patients with Birt–Hogg–Dubé syndrome

Y. Matsui, T. Hiraki, H. Gobara, T. Iguchi, K. Tomita, M. Uka, M. Araki, Y. Nasu, M. Furuya, S. Kanazawa

Diagnostic and Interventional Imaging 100 ( 11 ) 671 - 677 2019.11

Publishing type：Research paper (scientific journal)

Purpose: The purpose of this study was to analyze the outcome of patients with Birt–Hogg–Dubé (BHD) syndrome who underwent percutaneous thermal ablation of renal cell carcinoma (RCC). Materials and methods: Six patients with genetically proven BHD syndrome who underwent one or more sessions of percutaneous thermal ablation for the treatment of RCC were included. There were 4 men and 2 women, with a mean age of 57.3 ± 7.5 [SD] years (range: 44–67 years). A total of 29 RCCs (1–16 tumors per patient) were treated during 20 thermal ablation sessions (7 with radiofrequency ablation and 13 with cryoablation). Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Results: Technical success was achieved in all ablation sessions (success rate, 100%). No grade 4 or 5 adverse events were observed. All patients were alive with no distant metastasis during a median follow-up period of 54 months (range: 6–173 months). No local tumor progression was found. The mean decrease in estimated glomerular filtration rate during follow-up was 10.7 mL/min/1.73 m2. No patients required dialysis or renal transplantation. Conclusion: Radiofrequency ablation and cryoablation show promising results for the treatment of RCCs associated with BHD syndrome. Percutaneous thermal ablation may be a useful treatment option for this rare hereditary condition.

DOI： 10.1016/j.diii.2019.06.009

Low risk上部尿路上皮癌に対する尿管鏡下生検の有用性についての検討

片山聡, 小林泰之, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 O - 1 2019.11

技術認定医取得における腹腔鏡下腎摘術-こうすればよくなる- 技術認定医取得における腹腔鏡下腎摘除術剥離層、出血への対応

小林泰之, 和田耕一郎, 枝村康平, 荒木元朗, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 SY - 4 2019.11

岡山大学病院におけるロボット支援根治的膀胱摘除術(RARC)の検討

大岩裕子, 小林泰之, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 荒木元郎, 渡邉豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 P - 5 2019.11

部尿路上皮癌に対する尿管鏡治療の長期成績 28年にわたる単施設の検討

丸山雄樹, 荒木元朗, 和田耕一郎, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 小林泰之, 渡辺豊彦, 那須保友

日本泌尿器内視鏡学会総会 33回 O - 3 2019.11

Clinical pharmacokinetics of oral azithromycin in epididymal tissue. Reviewed International journal

Takuya Sadahira, Koichiro Wada, Kazuro Ikawa, Norifumi Morikawa, Masao Mitsui, Motoo Araki, Masachika Fujiyoshi, Ayano Ishii, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 ( 10 ) 832 - 834 2019.10

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

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

症例から学ぶ治療変遷から読み解く腎癌治療何を、どこまで、どのように? 下大静脈腫瘍塞栓を伴う腎腫瘍の新しい手術アプローチ

荒木元朗, 小林泰之, 枝村康平, 角南亮輔, 関戸崇了, 和田里章悟, 河村香澄, 丸山雄樹, 光井洋介, 大岩裕子, 窪田理沙, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 渡辺豊彦, 渡部昌実, 那須保友, 楳田佑三, 八木孝仁

西日本泌尿器科 81 ( 増刊 ) 113 - 113 2019.10

セカンドルック前立腺生検標本を含めた病理標本の一致率の検討

定平卓也, 丸山雄樹, 光井洋介, 荒木元朗, 小林泰之, 渡辺豊彦, 那須保友

西日本泌尿器科 81 ( 増刊 ) 199 - 199 2019.10

糖尿病患者は腎部分切除術後一年で腎機能が低下する Propensity Score-Matched Analysis

河村香澄, 荒木元朗, 丸山雄樹, 光井洋介, 定平卓也, 佐古智子, 和田耕一郎, 枝村康平, 小林泰之, 渡辺豊彦, 那須保友

西日本泌尿器科 81 ( 増刊 ) 177 - 177 2019.10

反復性膀胱炎に対する乳酸菌腟坐剤の再発予防効果に関する臨床的検討

石井亜矢乃, 和田耕一郎, 光畑律子, 山本満寿美, 定平卓也, 岩田健宏, 狩山玲子, 小林泰之, 荒木元朗, 渡辺豊彦, 那須保友

西日本泌尿器科 81 ( 増刊 ) 154 - 154 2019.10

S100A11は筋浸潤性膀胱癌細胞と線維芽細胞のクロストークに関与し腫瘍進行に寄与する(S100A11 contributes to tumor progression with cross talking between muscle invasive bladder cancer cells and fibroblasts)

光井洋介, 定平卓也, 渡部昌実, 丸山雄樹, 荒木元朗, 渡邉豊彦, 阪口政清, 那須保友

西日本泌尿器科 81 ( 増刊 ) 138 - 138 2019.10

岡山大学病院における進行性尿路上皮腫瘍に対するpembrolizumabの治療経験

高本篤, 小林泰之, 大岩裕子, 片山聡, 枝村康平, 窪田理沙, 岩田健宏, 西村慎吾, 佐古智子, 和田耕一郎, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 81 ( 増刊 ) 183 - 183 2019.10

Fumarate hydratase(FH)欠損腎細胞癌によるリンパ節転移に対して、イピリムマブ+ニボルマブ併用療法が奏功した一例

関戸崇了, 高本篤, 小林泰之, 三井將雄, 和田里章吾, 窪田理沙, 岩田健宏, 枝村康平, 佐古智子, 荒木元朗, 渡邉豊彦, 柳井広之, 那須保友

西日本泌尿器科 81 ( 増刊 ) 151 - 151 2019.10

腎虚血再灌流障害における好中球動態の2光子励起顕微鏡を用いた解析

丸山雄樹, 荒木元朗, 城所研吾, 和田耕一郎, 河村香澄, 光井洋介, 定平卓也, 窪田理沙, 西村慎吾, 渡部昌実, 渡邉豊彦, 田邊克幸, 和田淳, 柏原直樹, 那須保友

移植 54 ( 総会臨時 ) 241 - 241 2019.9

前立腺癌に対するロボット支援前立腺全摘除術における前方・後方アプローチ間での術後QOLの比較

丸山雄樹, 定平卓也, 荒木元朗, 河村香澄, 光井洋介, 和田耕一郎, 谷本竜太, 小林泰之, 渡部昌実, 渡邊豊彦, 那須保友

日本排尿機能学会誌 30 ( 1 ) 255 - 255 2019.9

岡山大学病院泌尿器科における腹腔鏡教育プログラムの有用性腹腔鏡下副腎摘除術

和田里章悟, 小林泰之, 定平卓也, 岩田健宏, 西村慎吾, 高本篤, 佐古智子, 枝村康平, 和田耕一郎, 荒木元朗, 渡邉豊彦, 那須保友

Japanese Journal of Endourology 32 ( 2 ) 225 - 229 2019.9

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

当院泌尿器科では2006年から独自の腹腔鏡手術教育プログラムを作成し手術教育を行っている。2009年3月から2017年11月までに当院で腹腔鏡技術認定医トレーニング中の泌尿器科医師が執刀した腹腔鏡下副腎摘除術76症例と、当院の腹腔鏡技術認定医が行った43症例との周術期成績の比較検討を行った。プログラム対象者は合計18人(卒後6-11年目)で、1人あたりの執刀症例数は中央値4例(range:1-9)、認定医の術者は9名で中央値2例(range:1-26)であった。患者背景には大きな差は認めなかった。手術時間は認定医群で有意に短かった(p=0.0122)ものの、両群において輸血や開腹移行症例、重篤な合併症はなかった。手術時間・出血量に急激なラーニングカーブは認めなかった。系統的な手術教育により腹腔鏡手術経験の未熟な術者の初期症例においても、安定した周術期成績を残すことが出来た。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05817&link_issn=&doc_id=20191106410020&doc_link_id=%2Fcs5jjend%2F2019%2F003202%2F023%2F0225-0229%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs5jjend%2F2019%2F003202%2F023%2F0225-0229%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

ロボット補助腹腔鏡下前立腺全摘術後尿失禁の予測因子としての骨盤MRIパラメーターの有用性

定平卓也, 河村香澄, 丸山雄樹, 光井洋介, 和田耕一郎, 小林泰之, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

日本排尿機能学会誌 30 ( 1 ) 321 - 321 2019.9

サルコペニアが前立腺全摘除後の排尿関連QoLに与える影響 Expanded Prostate Cancer Index Compositeを用いた経時的変化

光井洋介, 渡邉豊彦, 定平卓也, 丸山雄樹, 和田耕一郎, 枝村康平, 小林泰之, 荒木元朗, 渡部昌実, 那須保友

日本排尿機能学会誌 30 ( 1 ) 255 - 255 2019.9

Metastatic ureteral tumor arising from gastrointestinal cancer: A report of two cases

Kasumi Kawamura, Motoo Araki, Takuya Sadahira, Yuki Maruyama, Yosuke Mitsui, Shingo Nishimura, Atsushi Takamoto, Koichiro Wada, Ryuta Tanimoto, Morito Sugimoto, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu, Hiroyuki Yanai

Nishinihon Journal of Urology 81 ( 4 ) 461 - 466 2019.8

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.

Inflammatory myofibroblastic bladder tumor with divergent behavior in a patient with spinal cord injury. Reviewed International journal

Ichiro Tsuboi, Yuki Maruyama, Takuya Sadahira, Koichiro Wada, Nobuyoshi Ando, Yosuke Mitsui, Yasuhiro Nishiyama, Ryoji Arata, Motoo Araki, Yasutomo Nasu, Noriaki Ono

IJU case reports 2 ( 4 ) 212 - 214 2019.7

Language：English

Introduction: An inflammatory myofibroblastic tumor of the bladder is rare. Some urothelial carcinoma with sarcomatoid changes may mimic an inflammatory myofibroblastic tumor. Case presentation: A 76-year-old man with indwelling urinary catheters because of a spinal cord injury presented with gross hematuria. Transurethral electrocoagulation and a resection were performed. A T2-weighted magnetic resonance imaging showed a tumor and hematoma in the bladder diverticulum that pathologically resembled an inflammatory myofibroblastic tumor. This lesion was then removed en bloc by partial cystectomy. Histology showed a squamous cell carcinoma with sarcomatoid changes. After 4 months, a computed tomography showed the lesion had expanded outside the skin adjacent to the bladder. Conclusion: Some cases of inflammatory myofibroblastic tumors have a malignant course. Urologists therefore need to be aware of the possibility of rare cases of malignant bladder myofibroblasts.

DOI： 10.1002/iju5.12085

Robotic renal auto transplantation

Motoo Araki, Koichiro Wada, Shingo Nishimura, Risa Kubota, Kasumi Kawamura, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Atsushi Takamoto, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Ayano Ishii, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Nishinihon Journal of Urology 81 ( 3 ) 314 - 320 2019.6

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.

Contrast-enhanced Computed Tomography-Guided Percutaneous Cryoablation of Renal Cell Carcinoma in a Renal Allograft: First Case in Asia. Reviewed

Ichiro Tsuboi, Motoo Araki, Hiroyasu Fujiwara, Toshihiro Iguchi, Takao Hiraki, Naoko Arichi, Kasumi Kawamura, Yuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Tomoko Sako, Atsushi Takamoto, Koichiro Wada, Yasuyuki Kobayashi, Toyohiko Watanabe, Hiroyuki Yanai, Masashi Kitagawa, Katsuyuki Tanabe, Hitoshi Sugiyama, Jun Wada, Hiroaki Shiina, Susumu Kanazawa, Yasutomo Nasu

Acta medica Okayama 73 ( 3 ) 269 - 272 2019.6

Authorship：Corresponding author Language：English Publisher：Okayama University Medical School

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

Other Link： http://search.jamas.or.jp/link/ui/2020076262

Comparison of the predictive value among inflammation-based scoring systems for bleomycin pulmonary toxicity in patients with germ cell tumors. Reviewed International journal

Maruyama Y, Sadahira T, Araki M, Mitsui Y, Wada K, Edamura K, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

International journal of urology : official journal of the Japanese Urological Association 26 ( 8 ) 813 - 819 2019.5

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

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

Comparison of longitudinal health-related quality-of-life outcomes between anterior and posterior surgical approaches to robot-assisted radical prostatectomy. Reviewed International journal

Maruyama Y, Sadahira T, Araki M, Mitsui Y, Wada K, Tanimoto R, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Journal of robotic surgery 14 ( 2 ) 255 - 260 2019.5

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

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

Experience of robot-assisted radical cystectomy in Okayama University Hospital

Yasuyuki Kobayashi, Masao Mitsui, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Koichiro Wada, Kohei Edamura, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu

Nishinihon Journal of Urology 81 ( 2 ) 122 - 127 2019.4

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.

Gosha-jinki-gan, a herbal medicine, is effective for the treatment of female patients with overactive bladder and sensitivity to the cold

Yuko Matsumoto, Ayano Ishii, Masumi Yamamoto, Satoko Matsuo, Tomoko Sako, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu, Miyabi Inoue, Shinako Araki, Noritaka Ishito, Hitoshi Takamoto

Nishinihon Journal of Urology 81 ( 1 ) 12 - 16 2019.2

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.

Clitoral Blood Flow Changes after Surgery with Tension-Free Vaginal Mesh for Pelvic Organ Prolapse Reviewed

Oiwa Yuko, Watanabe Toyohiko, Sadahira Takuya, Ishii Ayano, Sako Tomoko, Inoue Miyabi, Wada Koichiro, Kobayashi Yasuyuki, Araki Motoo, Nasu Yasutomo

Acta Medica Okayama 73 ( 1 ) 21 - 27 2019.2

Language：English Publisher：Okayama University Medical School

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

Robotic-assisted renal autotransplantation: Preliminary studies and future directions

Motoo Araki, Koichiro Wada, Kasumi Kawamura, Yuuki Maruyama, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Takashi Yoshioka, Yuichi Ariyoshi, Kei Fujio, Atsushi Takamoto, Morito Sugimoto, Katsumi Sasaki, Yasuyuki Kobayashi, Shin Ebara, Amano Hiroyuki, Masashi Inui, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Endourology Progress: Technique, Technology and training 143 - 148 2019.1

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

The Novel Combination of Nitroxoline and PD-1 Blockade, Exerts a Potent Antitumor Effect in a Mouse Model of Prostate Cancer. Reviewed International journal

Naijin Xu, Linglong Huang, Xiezhao Li, Masami Watanabe, Chaoming Li, Abai Xu, Chunxiao Liu, Qiang Li, Motoo Araki, Koichiro Wada, Yasutomo Nasu, Peng Huang

International journal of biological sciences 15 ( 5 ) 919 - 928 2019

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

Programmed cell death protein 1 (PD-1) blockade is a promising therapeutic strategy against prostate cancer. Nitroxoline has been found to have effective anticancer properties in several cancer types. We investigated the efficacy of a combination therapy involving nitroxoline and PD-1 blockade in a prostate cancer mouse model. In our in vitro analysis, we found that nitroxoline inhibited the viability and proliferation of the mouse prostate cancer cell line RM9-Luc-PSA. Additionally, nitroxoline downregulated the expressions of phospho-PI3 kinase, phospho-Akt (Thr308), phospho-Akt (Ser473), phospho-GSK-3β, Bcl-2, and Bcl-xL. Nitroxoline also downregulated programmed death-ligand 1 (PD-L1) expression levels in prostate cancer cell line and tumor tissue. In our murine prostate cancer orthotopic model, nitroxoline plus PD-1 blockade synergistically suppressed tumor growth when compared with nitroxoline or PD-1 blockade alone, leading to reductions in tumor weight, bioluminescence tumor signals, and serum prostate-specific antigen levels. Furthermore, fluorescence-activated cell sorting analysis showed that the combination strategy significantly enhanced antitumor immunity by increasing CD44+CD62L+CD8+ memory T cell numbers and reducing myeloid-derived suppressor cell numbers in peripheral blood. In conclusion, our findings suggest that nitroxoline plus PD-1 blockade may be a promising treatment strategy in patients with prostate cancer.

DOI： 10.7150/ijbs.32259

Use of single-dose perioperative antimicrobial therapy is acceptable in recipients of living-donor renal transplants in the rituximab era. Reviewed International journal

Nishimura S, Wada K, Araki M, Sadahira T, Maruyama Y, Mitsui Y, Tanimoto R, Kobayashi Y, Watanabe T, Nasu Y

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 ( 4 ) 247 - 252 2018.12

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

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

Pelvic magnetic resonance imaging parameters predict urinary incontinence after robot-assisted radical prostatectomy. Reviewed International journal

Sadahira T, Mitsui Y, Araki M, Maruyama Y, Wada K, Edamura K, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Lower urinary tract symptoms 11 ( 3 ) 122 - 126 2018.12

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

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

The 3-D Volumetric Measurement Including Resected Specimen for Predicting Renal Function AfterRobot-assisted Partial Nephrectomy. Reviewed International journal

Mitsui Y, Sadahira T, Araki M, Maruyama Y, Nishimura S, Wada K, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Urology 125 104 - 110 2018.12

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

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

Burned-out Prostate Cancer ? Primary Metastatic Cancer Not Detected on Repeat Biopsy Reviewed

Mitsui Yosuke, Sadahira Takuya, Maruyama Yuki, Wada Koichiro, Tanimoto Ryuta, Sugimoto Morito, Araki Motoo, Watanabe Masami, Yanai Hiroyuki, Watanabe Toyohiko, Nasu Yasutomo

Acta Medica Okayama 72 ( 6 ) 605 - 609 2018.12

Language：English Publisher：Okayama University Medical School

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

Other Link： http://search.jamas.or.jp/link/ui/2019286383

Loss of psoas major muscle volume during systemic chemotherapy is related to worse prognosis in testicular cancer. Reviewed International journal

Mitsui Y, Sadahira T, Araki M, Maruyama Y, Wada K, Tanimoto R, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Japanese journal of clinical oncology 49 ( 2 ) 183 - 189 2018.11

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

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

経腹的到達法による根治的腎摘除術

小林泰之, 西村慎吾, 高本篤, 佐古智子, 和田耕一郎, 枝村康平, 荒木元朗, 渡辺豊彦, 那須保友

日本泌尿器内視鏡学会総会 32回 SEP - 2 2018.11

Red nodular melanoma of the penile foreskin: A case report and literature review. Reviewed International journal

Maruyama Y, Sadahira T, Mitsui Y, Wada K, Tanimoto R, Kobayashi Y, Araki M, Watanabe M, Watanabe T, Nasu Y

Molecular and clinical oncology 9 ( 4 ) 449 - 452 2018.10

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

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

集学的治療によって長期予後が得られている進行性尿膜管癌の一例

横山周平, 杉本盛人, 松尾聡子, 坪井一郎, 河村香澄, 窪田理沙, 岩田健宏, 小林泰之, 荒木元朗, 渡邊豊彦, 那須保友, 江原伸, 宗淳一

西日本泌尿器科 80 ( 増刊 ) 181 - 181 2018.10

当院で経験した前立腺炎症性偽腫瘍の1例

佐久間貴文, 高本篤, 河村香澄, 岩田健宏, 和田耕一郎, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡邊豊彦, 柳井広之, 那須保友

西日本泌尿器科 80 ( 増刊 ) 176 - 176 2018.10

QOL向上をめざした泌尿器がん治療ロボット支援下膀胱全摘除術

小林泰之, 三井將雄, 佐古智子, 高本篤, 西村慎悟, 和田耕一郎, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 80 ( 増刊 ) 95 - 95 2018.10

Clinical impact of abdominal fat distribution measured by 3-D computed tomography volumetry on post-transplant renal function in recipients after living kidney transplantation: a retrospective study. Reviewed

Mitsui Y, Sadahira T, Araki M, Maruyama Y, Wada K, Tanimoto R, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Clinical and experimental nephrology 23 ( 3 ) 415 - 424 2018.9

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

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

Renal Function after Nephrectomy Influences the Risk of Cardiovascular Events Reviewed

Kambara Taiki, Tanimoto Ryuta, Araki Motoo, Saika Takashi, Hashimoto Hideaki, Oeda Tadashi, Tsushima Tomoyasu, Hayata Shunji, Nasu Yasutomo, Kobayashi Yasuyuki

Acta Medica Okayama 72 ( 3 ) 241 - 247 2018.6

Language：English Publisher：Okayama University Medical School

We retrospectively analyzed the factors related to postoperative cardiovascular (CV) events in patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for clinical T1 renal cell carcinoma (RCC). We identified 570 patients who underwent PN or RN for T1 renal cell carcinoma between January 1998 and December 2009 at our institution and related hospitals. We determined the cumulative incidence rate of CV events and overall survival (OS) using Kaplan-Meier survival curves with a log-rank test, and we evaluated the risk for an increase in CV events and OS using Cox proportional hazard regression. Of the 570 patients, 171 underwent PN and 399 underwent RN. The type of surgery was not significantly related with CV events. The only factor that significantly increased the risk of CV events in both the univariate (HR 2.67, p=0.006) and multivariate analyses (HR 2.14, p=0.044) was a postoperative estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m2. Postoperative eGFR was also a significant risk factor for OS in the univariate analysis (HR 2.38, p=0.0104), but not in the multivariate model. Postoperative renal function was a significant independent predictor of the incidence of subsequent CV events.

DOI： 10.18926/AMO/56069

Other Link： http://search.jamas.or.jp/link/ui/2019024724

Oncological impact of neoadjuvant hormonal therapy on permanent iodine-125 seed brachytherapy in patients with low- and intermediate-risk prostate cancer. Reviewed International journal

Takamoto A, Tanimoto R, Bekku K, Araki M, Sadahira T, Wada K, Ebara S, Katayama N, Yanai H, Nasu Y

International journal of urology : official journal of the Japanese Urological Association 25 ( 5 ) 507 - 512 2018.5

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

OBJECTIVES: To determine whether neoadjuvant hormonal therapy improves oncological outcomes of patients with localized prostate cancer treated with permanent brachytherapy. METHODS: Between January 2004 and November 2014, 564 patients underwent transperineal ultrasonography-guided permanent iodine-125 seed brachytherapy. We retrospectively analyzed low- or intermediate-risk prostate cancer based on the National Comprehensive Cancer Network guidelines. The clinical variables were evaluated for influence on biochemical recurrence-free survival, progression-free survival, cancer-specific survival and overall survival. RESULTS: A total of 484 patients with low-risk (259 patients) or intermediate-risk disease (225 patients) were evaluated. Of these, 188 received neoadjuvant hormonal therapy. With a median follow up of 71 months, the 5-year actuarial biochemical recurrence-free survival rates of patients who did and did not receive neoadjuvant hormonal therapy were 92.9% and 93.6%, respectively (P = 0.2843). When patients were stratified by risk group, neoadjuvant hormonal therapy did not improve biochemical recurrence-free survival outcomes in low- (P = 0.8949) or intermediate-risk (P = 0.1989) patients. The duration or type of hormonal therapy was not significant in predicting biochemical recurrence. In a multivariate analysis, Gleason score, pretreatment prostate-specific antigen, clinical T stage, and prostate dosimetry, primary Gleason score and positive core rate were significant predictive factors of biochemical recurrence-free survival, whereas neoadjuvant hormonal therapy was insignificant. Furthermore, neoadjuvant hormonal therapy did not significantly influence progression-free survival, cancer-specific survival or overall survival. CONCLUSIONS: In patients with low- or intermediate-risk disease treated with permanent prostate brachytherapy, neoadjuvant hormonal therapy does not improve oncological outcomes. Its use should be restricted to patients who require prostate volume reduction.

DOI： 10.1111/iju.13555

Acute Inflammatory Syndrome Paradoxically Induced by De Novo Purine Inhibitors Synthesis Before Renal Transplantation: A Case Report and Review of the Literature. Reviewed

Maruyama Y, Sadahira T, Mitsui Y, Wada K, Tanimoto R, Nishimura S, Kobayashi Y, Watanabe T, Nasu Y, Araki M

Transplantation proceedings 50 ( 3 ) 895 - 897 2018.4

Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors. Reviewed International journal

Maruyama Y, Sadahira T, Mitsui Y, Araki M, Wada K, Tanimoto R, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y

Medical oncology (Northwood, London, England) 35 ( 6 ) 80 - 80 2018.4

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

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 < 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

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer.

Takashi Kobayashi, Kent Kanao, Motoo Araki, Naoki Terada, Yasuyuki Kobayashi, Atsuro Sawada, Takahiro Inoue, Shin Ebara, Toyohiko Watanabe, Tomomi Kamba, Makoto Sumitomo, Yasutomo Nasu, Osamu Ogawa

International journal of clinical oncology 23 ( 2 ) 347 - 352 2018.4

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 < 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

Deep vein thrombosis and pulmonary embolism secondary to urinary retention: a case report. Reviewed International journal

Kawada T, Yoshioka T, Araki M, Nose H, Oeda T

Journal of medical case reports 12 ( 1 ) 78 - 78 2018.3

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

BACKGROUND: Pulmonary embolism occurs when a blood thrombus forms and travels from a vein in the body to an artery in the lung. Thrombi often develop in one of the deep veins of the legs, thighs, or pelvis, a condition known as deep vein thrombosis. In this report, we describe a rare instance of a patient who developed deep vein thrombosis and pulmonary embolism secondary to urinary retention, and we also review some of the literature. CASE PRESENTATION: A 75-year-old Japanese man visited our hospital with the complaint of lower extremity weakness. A physical examination revealed bilateral leg edema. Contrast-enhanced computed tomography showed thrombi in both the bilateral intrapelvic veins and the right pulmonary artery, with an extremely distended bladder. We diagnosed deep vein thrombosis and pulmonary embolism due to urinary retention, which was attributed to detrusor insufficiency owing to both taking an anticholinergic drug and neurogenic bladder. The patient was immediately started on both management of voiding dysfunction and anticoagulant therapy. CONCLUSIONS: We encountered a patient with deep vein thrombosis and pulmonary embolism secondary to urinary retention that could have been fatal. In such cases, clinicians should always take into account appropriate management of voiding dysfunction.

DOI： 10.1186/s13256-018-1605-3

Induction of cells with prostate cancer stem-like properties from mouse induced pluripotent stem cells via conditioned medium. Reviewed International journal

Naijin Xu, Xiezhao Li, Masami Watanabe, Hideo Ueki, Hao Hu, Na Li, Motoo Araki, Koichiro Wada, Abai Xu, Chunxiao Liu, Yasutomo Nasu, Peng Huang

American journal of cancer research 8 ( 8 ) 1624 - 1632 2018

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

Cancer stem cells (CSCs) that closely correlated with tumor growth, metastasis, provide a plausible explanation for chemoresistance and cancer relapse. CSCs are usually isolated and enriched from carcinoma cells, which is inconvenient, low-efficient, and even unreliable. Here, we converted mouse induced pluripotent stem cells (miPSCs) into prostate cancer stem-like cells with carcinoma microenvironment following exposure to conditioned medium (CM) derived from RM9, a mouse prostate cancer cell line. These transformed cells, termed as miPS-RM9CM, displayed CSCs properties, including spheroids morphology and expression of both stemness genes and cancer stem cells surface markers, such as Oct3/4, Sox2, Nanog, Klf-4, c-Myc, CD44, and CD133. In addition, in vivo transplantation experiment was performed to confirm the tumorigenicity. Furthermore, we used the model to assess conventional chemotherapeutic agent, docetaxel. The results showed that miPS-RM9CM cells exhibited increased resistance to docetaxel, however, high susceptibility to the cancer cell stemness inhibitor I (BBI-608). Our current study demonstrates that CM from cultured RM9 cells play a crucial role in the determination of cell fate from miPSCs to cancer stem-like cells and provide a potentially valuable system for the study of CSCs.

A Reddish Submucosal Tumor after Nephrectomy Reviewed

Sadahira Takuya, Wada Koichiro, Tanimoto Ryuta, Araki Motoo

Internal Medicine 57 ( 12 ) 1793 - 1794 2018

Impact of selective media for detecting fluoroquinolone-insusceptible/extended-spectrum beta-lactamase-producing Escherichia coli before transrectal prostate biopsy. Reviewed International journal

Takuya Sadahira, Koichiro Wada, Motoo Araki, Ayano Ishii, Toyohiko Watanabe, Yoshitsugu Nasu, Masaya Tsugawa, Tadasu Takenaka, Yasutomo Nasu, Hiromi Kumon

International journal of urology : official journal of the Japanese Urological Association 24 ( 12 ) 842 - 847 2017.12

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

OBJECTIVES: To investigate the prevalence of fluoroquinolone-insusceptible and/or extended-spectrum beta-lactamase-producing Escherichia coli colonizing in the male rectum before transrectal prostate biopsy. METHODS: We 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. RESULTS: Rectal 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. CONCLUSIONS: The 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

Exogenous DKK-3/REIC inhibits Wnt/beta-catenin signaling and cell proliferation in human kidney cancer KPK1 Reviewed

Jiaqi Xu, Takuya Sadahira, Rie Kinoshita, Shun-Ai Li, Peng Huang, Koichiro Wada, Motoo Araki, Kazuhiko Ochiai, Hirofumi Noguchi, Masakiyo Sakaguchi, Yasutomo Nasu, Masami Watanabe

ONCOLOGY LETTERS 14 ( 5 ) 5638 - 5642 2017.11

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

The third member of the Dickkopf family (DKK-3), also known as reduced expression in immortalized cells (REIC), is a tumor suppressor present in a variety of tumor cells. Regarding the regulation of the Wnt/beta-catenin signaling pathway, exogenous DKK-1 and DKK-2 are reported to inhibit Wnt signaling by binding the associated effectors. However, whether exogenous DKK-3 inhibits Wnt signaling remains unclear. A recombinant protein of human full-length DKK-3 was used to investigate the exogenous effects of the protein in vitro in KPK1 human renal cell carcinoma cells. It was demonstrated that the expression of phosphorylated (p-)beta-catenin (inactive form as the transcriptional factor) was increased in KPK1 cells treated with the exogenous DKK-3 protein. The levels of non-p-beta-catenin (activated form of beta- catenin) were consistently decreased. It was revealed that the expression of transcription factor (TCF) 1 and c-Myc, the downstream transcription factors of the Wnt/beta-catenin signaling pathway, was inhibited following treatment with DKK-3. A cancer cell viability assay confirmed the anti-proliferative effects of exogenous DKK-3 protein, which was consistent with a suppressed Wnt/beta-catenin signaling cascade. In addition, as low-density lipoprotein receptor-related protein 6 (LRP6) is a receptor of DKK-1 and DKK-2 and their interaction on the cell surface inhibits Wnt/beta-catenin signaling, it was examined whether the exogenous DKK-3 protein affects LRP6-mediated Wnt/beta-catenin signaling. The LRP6 gene was silenced and the effects of DKK-3 on the time course of the upregulation of p-beta-catenin expression were subsequently analyzed. Notably, LRP6 depletion elevated the base level of p-beta-catenin; however, there was no significant effect on its upregulation course or expression pattern. These findings indicate that exogenous DKK-3 upregulates p-beta-catenin and inhibits Wnt/beta-catenin signaling in an LRP6-independent manner. Therefore, exogenous DKK-3 protein may inhibit the proliferation of KPK1 cells via inactivating Wnt/beta-catenin signaling.

DOI： 10.3892/ol.2017.6833

Ureterolithotripsy for a Ureteral Calculus at the Ureteroureterostomy of a Renal-transplant Recipient Reviewed

Mitsui Yosuke, Wada Koichiro, Araki Motoo, Yoshioka Takashi, Ariyoshi Yuichi, Nishimura Shingo, Kobayashi Yasuyuki, Sasaki Katsumi, Watanabe Toyohiko, Nasu Yasutomo

Acta Medica Okayama 71 ( 5 ) 449 - 452 2017.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical School

We describe a 40-year-old living-donor renal-transplant recipient who underwent successful ureterolithotripsy. He had been on hemodialysis for >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

Other Link： http://search.jamas.or.jp/link/ui/2018271332

Overexpression of REIC/Dkk-3 suppresses the expression of CD147 and inhibits the proliferation of human bladder cancer cells

Yuhei Horikawa, Masami Watanabe, Takuya Sadahirai, Yuichi Ariyoshi, Yasuyuki Kobayashi, Motoo Araki, Koichiro Wada, Kazuhiko Ochiai, Shun-Ai Li, Yasutomo Nasu

ONCOLOGY LETTERS 14 ( 3 ) 3223 - 3228 2017.9

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

Our group previously developed an adenoviral vector encoding the REIC/Dkk-3 gene (Ad-REIC), a tumor suppressor, for cancer gene therapy. The Ad-REIC agent induces apoptosis and inhibits invasion in a number of cancer cell lines; however, the molecular mechanisms underlying its effects remain unclear. Cluster of differentiation 147 (CD147), also known as extracellular matrix metalloproteinase inducer (EMMPRIN), is a key molecule that promotes cancer proliferation and invasion. In order to elucidate the therapeutic mechanism of Ad-REIC, its effect on the expression of CD147 in human bladder cancer KK47 cells was investigated. Treatment with Ad-REIC markedly downregulated the expression of CD147 and significantly inhibited cellular proliferation. Since the expression of CD147 is reported to be under the positive control of mitogen-activated protein kinase (MAPK) signaling and the c-Myc protein, the correlations between the expression of CD147 and the activation of MAPKs or the expression of c-Myc were examined. Unexpectedly, no positive correlation was observed between the level of CD147 and the potential regulators that were assessed, indicating that another signaling pathway is responsible for the downregulation of CD147. The results from the present study demonstrate that Ad-REIC treatment can significantly downregulate the expression of CD147 in bladder cancer cells. Downregulation of the cancer-progression factor CD147 may be a novel mechanism that underlies the therapeutic effects of Ad-REIC treatment.

DOI： 10.3892/ol.2017.6548

Robotic Renal Autotransplantation: First Case Outside of North America

Araki Motoo, Wada Koichiro, Mitsui Yosuke, Sadahira Takuya, Kubota Risa, Nishimura Shingo, Yoshioka Takashi, Ariyoshi Yuichi, Fujio Kei, Takamoto Atsushi, Sugimoto Morito, Sasaki Katsumi, Kobayashi Yasuyuki, Ebara Shin, Taninishi Hideki, Amano Hiroyuki, Inui Masashi, Watanabe Masami, Watanabe Toyohiko, Nasu Yasutomo

Acta Medica Okayama 71 ( 4 ) 351 - 355 2017.8

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

Other Link： http://search.jamas.or.jp/link/ui/2018212384

Antimicrobial susceptibilities of Chlamydia trachomatis isolated from the urethra and pharynx of Japanese males

Seiji Kai, Koichiro Wada, Takuya Sadahira, Motoo Araki, Ayano Ishii, Toyohiko Watanabe, Koichi Monden, Satoshi Uno, Tohru Araki, Yasutomo Nasu

JOURNAL OF INFECTION AND CHEMOTHERAPY 23 ( 8 ) 512 - 516 2017.8

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

The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy

Yosuke Mitsui, Takuya Sadahira, Motoo Araki, Koichiro Wada, Ryuta Tanimoto, Yuichi Ariyoshi, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Clinical and Experimental Nephrology 1 - 6 2017.7

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

Successful microscopic renal autotransplantation for left renal aneurysm associated with segmental arterial mediolysis

Takashi Yoshioka, Motoo Araki, Yuichi Ariyoshi, Koichiro Wada, Noriyuki Tanaka, Yasutomo Nasu

JOURNAL OF VASCULAR SURGERY 66 ( 1 ) 261 - 264 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

Segmental arterial mediolysis (SAM) is an uncommon, nonarteriosclerotic vascular disease. SAM is characterized by lysis of arterial media and can lead to aneurysm formation. The renal arteries are the third most common arteries associated with SAM. We report the case of a 32-year-old man with left renal artery aneurysm associated with SAM. We successfully performed left renal autotransplantation using microscopic vascular reconstruction. SAM is characterized by vascular fragility; therefore, microscopic surgery is favorable for treating aneurysms associated with SAM.

DOI： 10.1016/j.jvs.2016.09.039

Diagnostic Ureteroscopy for Cases Clinically Suspected of Carcinoma in Situ of the Upper Urinary Tract

Sasaki Katsumi, Wada Koichiro, Araki Motoo, Kobayashi Yasuyuki, Sugimoto Morito, Ebara Shin, Watanabe Toyohiko, Nasu Yasutomo

Acta Medica Okayama 71 ( 3 ) 227 - 232 2017.6

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

Other Link： http://search.jamas.or.jp/link/ui/2018065400

A Combination Therapy of Partial Nephrectomy and Cryoablation Achieved Good Cancer Control and Renal Function in Bilateral Synchronous Renal Cell Carcinoma

Takamoto Atsushi, Araki Motoo, Wada Koichiro, Sugimoto Morito, Kobayashi Yasuyuki, Sasaki Katsumi, Watanabe Toyohiko, Nasu Yasutomo

Acta Medica Okayama 71 ( 2 ) 187 - 190 2017.4

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

Other Link： http://search.jamas.or.jp/link/ui/2018020781

BENEFICAL EFFECT OF HYDROGEN SULFIDE ON RENAL ISCHEMIA-REPERFUSION INJURY IN CLAWN MINIATURE SWINE

Yuichi Ariyoshi, Mitsuhiro Sekijima, Takahiro Murokawa, Hisashi Sahara, Motoo Araki, Yasutomo Nasu, Kazuhiko Yamada

JOURNAL OF UROLOGY 197 ( 4 ) E77 - E78 2017.4

Clinical pharmacokinetics of oral levofloxacin and sitafloxacin in epididymal tissue

Takuya Sadahira, Koichiro Wada, Kazuro Ikawa, Norifumi Morikawa, Hiroaki Kurahashi, Takashi Yoshioka, Yuichi Ariyoshi, Yasuyuki Kobayashi, Motoo Araki, Ayano Ishii, Masami Watanabe, Shinya Uehara, Toyohiko Watanabe, Yasutomo Nasu

JOURNAL OF INFECTION AND CHEMOTHERAPY 23 ( 4 ) 214 - 217 2017.4

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

IMPACT OF THE 20 G ALL-SEEING NEEDLE AND 4.8 FR MICRO PCNL WITH THE HIGH DEFINITION IMAGE GUIDE (HDIG) SYSTEM

Koichiro Wada, Hiromi Kumon, Ryuta Tanimoto, Yosuke Mitsui, Takuya Sadahira, Atsushi Takamoto, Yasuyuki Kobayashi, Katsumi Sasaki, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu

JOURNAL OF UROLOGY 197 ( 4 ) E376 - E377 2017.4

PREEMPTIVE KIDNEY TRANSPLANTATION RECIPIENTS ARE NOT AS MENTALLY SATISFIED AS NON-PREEMPTIVE PATIENTS

Yuichi Ariyoshi, Motoo Araki, Yosuke Mitsui, Koichiro Wada, Toyohiko Watanabe, Yasutomo Nasu

JOURNAL OF UROLOGY 197 ( 4 ) E394 - E394 2017.4

CT VOLUMETRY OF THE KIDNEY IS A COST EFFECTIVE ALTERNATIVE TO MAG3 SCAN IN PREDICTING RENAL FUNCTION AFTER DONOR NEPHRECTOMY

Yosuke Mitsui, Takuya Sadahira, Motoo Araki, Shingo Nishimura, Koichiro Wada, Yasuyuki Kobayashi, Toyohiko Watanabe, Yasutomo Nasu

JOURNAL OF UROLOGY 197 ( 4 ) E80 - E80 2017.4

岡山大学病院におけるロボット支援腎部分切除術の経験

小林泰之, 荒木元朗, 谷本竜太, 西村慎吾, 高本篤, 堀川雄平, 和田耕一郎, 杉本盛人, 佐々木克己, 渡邊豊彦, 那須保友

日本泌尿器科学会総会 105回 SKH12 - 3 2017.4

Early Chimerism After Liver Transplantation Reflects the Clinical Course of Recurrent Hepatitis C. International journal

Masashi Utsumi, Akinobu Takaki, Yuzo Umeda, Kazuko Koike, Stephanie C Napier, Nobukazu Watanabe, Susumu Shinoura, Ryuichi Yoshida, Daisuke Nobuoka, Tetsuya Yasunaka, Takahiro Oto, Motoo Araki, Kazuhide Yamamoto, Toshiyoshi Fujiwara, Takahito Yagi

Annals of transplantation 22 156 - 165 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：INT SCIENTIFIC LITERATURE, INC

BACKGROUND Human leukocyte antigen (HLA) mismatch is a characteristic feature of post-orthotopic liver transplantation (OLT) hepatitis C. To investigate the importance of donor HLA-restricted immune cells in post-OLT hepatitis C recurrence, we analyzed the frequency of donor chimerism and the clinical course of post-OLT hepatitis C. MATERIAL AND METHODS We analyzed peripheral blood chimerism in 11 HCV-reinfected patients with post-HLA mismatched OLT. Patients were divided into 2 groups: the OLT chronic hepatitis C (CHC) group (n=8), exhibiting active hepatitis C recurrence; and the OLT-persistently normal ALT (PNALT) group (n=3), without active hepatitis. Chimerism was analyzed by flow cytometry using donor-specific anti-HLA antibodies in peripheral blood mononuclear cells from 1-100 days after OLT. Kidney (n=7) and lung (n=7) transplant recipients were also analyzed for comparison. As immune cells from the donor liver might contribute to post-OLT chimerism, the characteristics of perfusates from donor livers (n=10) were analyzed and defined. RESULTS Donor-derived cells were frequently observed in liver and lung transplant recipients. The frequency of donor-derived cells from the B cell subset was significantly higher in peripheral blood from OLT-CHC group than in that of the OLT-PNALT group. B cells, however, were not the predominant subset in the perfusates, indicating that inflow of donor-derived cells alone did not cause the chimerism. CONCLUSIONS Chimerism of B cells is frequent in liver transplant patients with early recurrence of hepatitis C. We propose that monitoring of early chimerism could facilitate early detection of chronic hepatitis C recurrence, although we need more cases to investigate.

DOI： 10.12659/AOT.900494

Synergistic effects of the immune checkpoint inhibitor CTLA-4 combined with the growth inhibitor lycorine in a mouse model of renal cell carcinoma Reviewed

Xiezhao Li, Peng Xu, Chongshan Wang, Naijin Xu, Abai Xu, Yawen Xu, Takuya Sadahira, Motoo Araki, Koichiro Wada, Eiji Matsuura, Masami Watanabe, Junxia Zheng, Pinghua Sun, Peng Huang, Yasutomo Nasu, Chunxiao Liu

ONCOTARGET 8 ( 13 ) 21177 - 21186 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：IMPACT JOURNALS LLC

Renal cell carcinoma (RCC) management has undergone a major transformation over the past decade; immune checkpoint inhibitors are currently undergoing clinical trials and show promising results. However, the effectiveness of immune checkpoint inhibitors in patients with metastatic RCC (mRCC) is still limited. Lycorine, an alkaloid extracted from plants of the Amaryllidaceae family, is touted as a potential anti-cancer drug because of its demonstrative growth inhibition capacity (induction of cell cycle arrest and inhibition of vasculogenic mimicry formation). Moreover, T cell checkpoint blockade therapy with antibodies targeting cytotoxic T-lymphocyte associated protein 4 (CTLA-4) has improved outcomes in cancer patients. However, the anti-tumor efficacy of combined lycorine and anti-CTLA-4 therapy remains unknown. Thus, we investigated a combination therapy of lycorine hydrochloride and anti-CTLA-4 using a murine RCC model. As a means of in vitro confirmation, we found that lycorine hydrochloride inhibited the viability of various RCC cell lines. Furthermore, luciferase-expressing Renca cells were implanted in the left kidney and the lung of BALB/c mice to develop a RCC metastatic mouse model. Lycorine hydrochloride and anti-CTLA-4 synergistically decreased tumor weight, lung metastasis, and luciferin-staining in tumor images. Importantly, the observed anti-tumor effects of this combination were dependent on significantly suppressing regulatory T cells while upregulating effector T cells; a decrease in regulatory T cells by 31.43% but an increase in effector T cells by 31.59% were observed in the combination group compared with those in the control group). We suggest that a combination of lycorine hydrochloride and anti-CTLA-4 is a viable therapeutic option for RCC patients.

DOI： 10.18632/oncotarget.15505

Efficacy and safety of 3 day versus 7 day cefditoren pivoxil regimens for acute uncomplicated cystitis: multicentre, randomized, open-label trial. Reviewed International journal

Takuya Sadahira, Koichiro Wada, Motoo Araki, Ayano Ishii, Atsushi Takamoto, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

The Journal of antimicrobial chemotherapy 72 ( 2 ) 529 - 534 2017.2

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, β-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 5-9 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

The Prostate in Female? Clear Cell Adenocarcinoma in a Female Urethral Diverticulum Reviewed

Takuya Sadahira, Yuuki Maruyama, Motoo Araki, Yasuyuki Kobayashi, Toyohiko Watanabe, Yasutomo Nasu

UROLOGY 99 E25 - E26 2017.1

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

URETEROLYSIS WITH OMENTAL WRAP FOR BILATERAL HYDRONEPHROSIS SECONDARY TO RETROPERITONEAL FIBROSIS : A CASE REPORT Reviewed

79 ( 1 ) 12 - 15 2017

Value of percutaneous needle biopsy of small renal tumors in patients referred for cryoablation Reviewed

Toshihiro Iguchi, Takao Hiraki, Hideo Gobara, Hiroyasu Fujiwara, Jun Sakurai, Yusuke Matsui, Motoo Araki, Yasutomo Nasu, Susumu Kanazawa

MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES 26 ( 2 ) 86 - 91 2017

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

Purpose: To retrospectively evaluate the safety and diagnostic yield of needle biopsy of small renal tumors, and the clinical consequences of performing needle biopsy in patients referred for percutaneous cryoablation before their treatment.
Material and methods: Biopsy was performed for 120 tumors (mean diameter, 2.2 cm) in 119 patients. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the two groups. All cryoablation procedures were divided into two groups: procedures with or without simultaneous biopsy. The rates of benign or non-diagnostic tumors in each group were compared.
Results: After performing 120 initial and eight repeat biopsies, Grade 1 bleedings occurred in 44 cases. Six tumors were non-diagnostic and 114 were pathologically diagnosed. There were no significant variables between the diagnostic and non-diagnostic biopsies. Unnecessary cryoablation was avoided in nine benign lesions by performing biopsy in advance. Cryoablation performed simultaneously with biopsy included significantly more benign or non-diagnostic tumors than cryoablation performed after biopsy (15.2% vs. 1.4%; p =.01).
Conclusions: Percutaneous biopsy of small renal tumors referred for cryoablation was a safe procedure with high diagnostic yield. The confirmation of pathological diagnosis prior to cryoablation is necessary because patients with benign tumors can avoid unnecessary treatment.

DOI： 10.1080/13645706.2016.1249889

Adenovirus vector carrying REICIDKK-3 gene: neoadjuvant intraprostatic injection for high-risk localized prostate cancer undergoing radical prostatectomy Reviewed

H. Kumon, Y. Ariyoshi, K. Sasaki, T. Sadahira, M. Araki, S. Ebara, H. Yanai, M. Watanabe, Y. Nasu

CANCER GENE THERAPY 23 ( 11 ) 400 - 409 2016.11

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

As the First-In-Human study of in situ gene therapy using an adenovirus vector carrying the human REIC (reduced expression in immortalized cell)/Dkk-3 gene (Ad-REIC), we conducted neoadjuvant intraprostatic injections in patients with high-risk localized prostate cancer undergoing radical prostatectomy (RP). Patients with recurrence probability of 35% or more within 5 years following RP, as calculated by Kaftan's nomogram, were enrolled. Patients received two ultrasound-guided intratumoral injections at 2-week intervals, followed by RP 6 weeks after the second injection. After confirming the safety of the therapeutic interventions with initially planned three escalating doses of 1.0 x 10(10), 1.0 x 10(11) and 1.0 x 10(12) viral particles (vp) in 1.0-1.2 ml (n=3, 3 and 6), an additional higher dose of 3.0 x 10(12) vp in 3.6 ml (n=6) Was further studied. All four DLs including the additional dose level-4 (DL-4) were feasible with no adverse events, except for grade 1 or 2 transient fever. Laboratory toxicities were grade 1 or 2 elevated aspartate transaminase/alanine transaminase (n=4). Regarding antitumor activities, cytopathic effects (tumor degeneration With cytolysis and pyknosis) and remarkable tumor-infiltrating lymphocytes in the targeted tumor areas were detected in a clear dose-dependent manner. Consequently, biochemical recurrence-free survival in DL-4 was significantly more favorable than in patient groups DL-1+2+2:

DOI： 10.1038/cgt.2016.53

The Efficacy of Rituximab in High-risk Renal Transplant Recipients. Reviewed

Motoo Araki, Koichiro Wada, Yosuke Mitsui, Risa Kubota, Takashi Yoshioka, Yuichi Ariyoshi, Yasuyuki Kobayashi, Masashi Kitagawa, Katsuyuki Tanabe, Hiroshi Sugiyama, Jun Wada, Masami Watanabe, Toyohiko Watanabe, Katsuyuki Hotta, Yasutomo Nasu

Acta medica Okayama 70 ( 4 ) 295 - 7 2016.8

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical 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

Clinical analysis of bacterial strain profiles isolated from urinary tract infections: A 30-year study. Reviewed International journal

Koichiro Wada, Shinya Uehara, Masumi Yamamoto, Takuya Sadahira, Ritsuko Mitsuhata, Motoo Araki, Yasuyuki Kobayashi, Ayano Ishii, Reiko Kariyama, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 22 ( 7 ) 478 - 82 2016.7

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 polymicrobial 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.

DOI： 10.1016/j.jiac.2016.04.004

Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients Reviewed

Takashi Yoshioka, Hideo Otsuki, Shinya Uehara, Toshihiro Shimizu, Wataru Murao, Koji Fujio, Kei Fujio, Koichiro Wada, Motoo Araki, Yasutomo Nasu

ACTA MEDICA OKAYAMA 70 ( 3 ) 159 - 166 2016.6

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

Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '< 65 group' (< 65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the '>= 75 group' (>= 75 years old, n=39). The patients 'characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the >= 75 group had a significantly higher prevalence of hypertension compared to the < 65 group. Compared to the < 65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the >= 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the >= 75 group were similar to those of the < 65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors.

DOI： 10.18926/AMO/54414

A Case of Metastatic Urachal Cancer Including a Neuroendocrine Component Treated with Gemcitabine, Cisplatin and Paclitaxel Combination Chemotherapy Reviewed

Shin Ebara, Yasuyuki Kobayashi, Katsumi Sasaki, Motoo Araki, Morito Sugimoto, Koichirou Wada, Kei Fujio, Atsushi Takamoto, Toyohiko Watanabe, Hiroyuki Yanai, Yasutomo Nasu

ACTA MEDICA OKAYAMA 70 ( 3 ) 223 - 227 2016.6

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

The induction of antigen-specific CTL by in situ Ad-REIC gene therapy Reviewed

Y. Ariyoshi, M. Watanabe, S. Eikawa, C. Yamazaki, T. Sadahira, T. Hirata, M. Araki, S. Ebara, Y. Nasu, H. Udono, H. Kumon

GENE THERAPY 23 ( 5 ) 408 - 414 2016.5

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

An adenovirus vector carrying the human Reduced Expression in Immortalized Cell (REIC)/Dkk-3 gene (Ad-REIC) mediates simultaneous induction of cancer-selective apoptosis and augmentation of anticancer immunity. In our preclinical and clinical studies, in situ Ad-REIC gene therapy showed remarkable direct and indirect antitumor effects to realize therapeutic cancer vaccines. We herein aimed to confirm the induction of tumor-associated antigen-specific cytotoxic T lymphocytes (CTLs) by Ad-REIC. Using an ovalbumin (OVA), a tumor-associated antigen, expressing E.G7 tumor-bearing mouse model, we investigated the induction and expansion of OVA-specific CTLs responsible for indirect, systemic effects of Ad-REIC. The intratumoral administration of Ad-REIC mediated clear antitumor effects with the accumulation of OVA-specific CTLs in the tumor tissues and spleen. The CD86-positive dendritic cells (DCs) were upregulated in the tumor draining lymph nodes of Ad-REIC-treated mice. In a dual tumor-bearing mouse model in the left and right back, Ad-REIC injection in one side significantly suppressed the tumor growth on both sides and significant infiltration of OVA-specific CTLs into non-injected tumor was also detected. Consequently, in situ Ad-REIC gene therapy is expected to realize a new-generation cancer vaccine via anticancer immune activation with DC and tumor antigen-specific CTL expansion.

DOI： 10.1038/gt.2016.7

Factors Predicting Adhesion between Renal Capsule and Perinephric Adipose Tissue in Partial Nephrectomy Reviewed

Yasuyuki Kobayashi, Hiroaki Kurahashi, Yuko Matsumoto, Koichiro Wada, Katsumi Sasaki, Motoo Araki, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu

ACTA MEDICA OKAYAMA 70 ( 2 ) 69 - 74 2016.4

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<0.05). Predictive factors were a positive CT finding for fibroid structure and comorbidity of hypertension (p<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

ADVANCED TWO-STEP TRANSCRIPTIONAL AMPLIFICATION AS A NOVEL SYSTEM FOR DETECTING VIABLE BLADDER CANCER CELLS

Takuya Sadahira, Masami Watanabe, Motoo Araki, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu

JOURNAL OF UROLOGY 195 ( 4 ) E610 - E610 2016.4

The gender specific risk factors for prolonged hospitalization due to acute pyelonephritis in a Japanese tertiary emergency center Reviewed

Risa Muneishi, Ryuta Tanimoto, Koichiro Wada, Philip Hsiao, Jun Eguchi, Motoo Araki, Toyohiko Watanabe, Yasutomo Nasu, Naoki Akebi

JOURNAL OF INFECTION AND CHEMOTHERAPY 22 ( 1-2 ) 108 - 111 2016.1

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

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

Feasibility of Neoadjuvant Ad-REIC Gene Therapy in Patients with High-Risk Localized Prostate Cancer Undergoing Radical Prostatectomy. International journal

Hiromi Kumon, Katsumi Sasaki, Yuichi Ariyoshi, Takuya Sadahira, Motoo Araki, Shin Ebara, Hiroyuki Yanai, Masami Watanabe, Yasutomo Nasu

Clinical and translational science 8 ( 6 ) 837 - 40 2015.12

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

In a phase I/IIa study of in situ gene therapy using an adenovirus vector carrying the human REIC/Dkk-3 gene (Ad-REIC), we assessed the inhibitory effects of cancer recurrence after radical prostatectomy (RP), in patients with high risk localized prostate cancer (PCa). After completing the therapeutic interventions with initially planned three escalating doses of 1.0 × 10(10) , 1.0 × 10(11) , and 1.0 × 10(12) viral particles (VP) in 1.0-1.2 mL (n = 3, 3, and 6), an additional higher dose of 3.0 × 10(12) VP in 3.6 mL (n = 6) was further studied. Patients with recurrence probability of 35% or more within 5 years after RP as calculated by Kattan's nomogram, were enrolled. They received two ultrasound-guided intratumoral injections at 2-week intervals, followed by RP 6 weeks after the second injection. Based on the findings of MRI and biopsy mapping, as a rule, one track injection to the most prominent cancer area was given to initial 12 patients and 3 track injections to multiple cancer areas in additional 6 patients. As compared to the former group, biochemical recurrence-free survival of the latter showed a significantly favorable outcome. Neoadjuvant Ad-REIC, mediating simultaneous induction of cancer selective apoptosis and augmentation of antitumor immunity, is a feasible approach in preventing cancer recurrence after RP. (199).

DOI： 10.1111/cts.12362

Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP). Reviewed International journal

Xiao Gu, Motoo Araki, Carson Wong

Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 24 ( 6 ) 364 - 71 2015

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

PURPOSE: Urinary incontinence is one of the major prostate cancer treatment-related morbidities. We review our initial robot-assisted laparoscopic prostatectomy (RALP) experience, focusing on post-surgery continence rates. MATERIAL AND METHODS: Two-hundred and thirty-three consecutive patients were identified from a prospectively maintained RALP database. A bladder neck sparing dissection was preferentially performed during transperitoneal RALP. On postoperative day 5 or 6 (clinic logistics), the urethral catheter was removed following a normal cystogram. RESULTS: Median operative time was 190 minutes and estimated blood loss was 75 mL. Three (1.3%) patients required bladder neck reconstruction, while 198 (85.0%) had bilateral, 20 (8.6%) had unilateral and 15 (6.4%) did not undergo nerve sparing prostatectomy. One-hundred and ninety-nine (85.4%) patients had negative surgical margins. Median hospitalization and urethral catheter duration were 1.0 and 5.0 days, respectively. At six weeks, a median 1.0 pad per day usage was reported and mean AUASS and QoL were significantly improved from baseline (p < 0.05). Of the 220 patients having a minimum three-month follow-up, 152 (69.1%) achieved urinary continence without pads. Age, AUASS, QoL, prostate volume and prior TUR surgery independently had significant impact on early continence rate (p < 0.05). CONCLUSION: A bladder neck sparing dissection allows for early return of urinary continence following RALP without compromising cancer control.

DOI： 10.3109/13645706.2015.1027711

Ectopic calcification: importance of common nanoparticle scaffolds containing oxidized acidic lipids. Reviewed International journal

Hiromi Kumon, Eiji Matsuura, Noriyuki Nagaoka, Toshio Yamamoto, Shinya Uehara, Motoo Araki, Yukana Matsunami, Kazuko Kobayashi, Akira Matsumoto

Nanomedicine : nanotechnology, biology, and medicine 10 ( 2 ) 441 - 50 2014.2

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

UNLABELLED: The term nanobacteria, sometimes referred to as nanobacteria-like particles (NLPs), is presently recognized as a misnomer for inert calcified nanoparticles. However, misinterpretation of its propagation as a living organism still continues. Ultrastructural and elemental analyses, combining immuno-electron microscopy with an original NLP isolate (P-17) derived from urinary stones, and an IgM monoclonal antibody (CL-15) raised against P-17 have now revealed that, oxidized lipids with acidified functional groups were key elements in NLP propagation. Lamellar structures composed of acidic/oxidized lipids provided structural scaffolds for carbonate apatite crystals. During in vitro culture, lipid peroxidation induced by γ-irradiation of FBS was a major cause of accelerated NLP propagation. In pathological tissue samples from hyperlipidemic atherosclerosis-prone mice, CL-15 co-localized with fatty plaques, macrophage infiltrates and osteocalcin staining of aortic valve lesions. These observations indicate that naturally occurring NLP composed of mineralo-oxidized lipids complexes are generated as by-products rather than etiological agents of chronic inflammation. FROM THE CLINICAL EDITOR: The term "nanobacteria-like particles (NLPs)" is presently recognized as a misnomer for inert calcified nanoparticles as opposed to living organisms. This study convincingly demonstrates that naturally occurring NLPs composed of mineralo-oxidized lipid complexes are generated as by-products rather than etiological agents of chronic inflammation.

DOI： 10.1016/j.nano.2013.08.010

Robot-assisted radical prostatectomy: modified ultradissection reduces pT2 positive surgical margins on the bladder neck. Reviewed

Motoo Araki, Wooju Jeong, Sung Yul Park, Young Hoon Lee, Yasutomo Nasu, Hiromi Kumon, Sung Joon Hong, Koon Ho Rha

Acta medica Okayama 68 ( 1 ) 35 - 41 2014

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical School

The purpose of this study was to compare the positive surgical margin (PSM) rates of 2 techniques of robot-assisted radical prostatectomy (RARP) for pT2 (localized) prostate cancer. A retrospective analysis was conducted of 361 RARP cases, performed from May 2005 to September 2008 by a single surgeon (KHR) at our institution (Yonsei University College of Medicine). In the conventional technique, the bladder neck was transected first. In the modified ultradissection, the lateral border of the bladder neck was dissected and then the bladder neck was transected while the detrusor muscle of the bladder was well visualized. Perioperative characteristics and outcomes and PSM rates were analyzed retrospectively for pT2 patients (n＝217), focusing on a comparison of those undergoing conventional (n＝113) and modified ultradissection (n＝104) techniques. There was no difference between the conventional and modified ultradissection group in mean age, BMI, PSA, prostate volume, biopsy Gleason score, and D'Amico prognostic criteria distributions. The mean operative time was shorter (p＜0.001) and the estimated blood loss was less (p＜0.01) in the modified ultradissection group. The PSM rate for the bladder neck was significantly reduced by modified ultradissection, from 6.2% to 0% (p＜0.05). In conclusion, modified ultradissection reduces the PSM rate for the bladder neck.

DOI： 10.18926/AMO/52142

Other Link： http://search.jamas.or.jp/link/ui/2014376397

A rare complication: misdirection of an indwelling urethral catheter into the ureter. Reviewed

Tsutomu Ishikawa, Motoo Araki, Takeshi Hirata, Masami Watanabe, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

Acta medica Okayama 68 ( 1 ) 47 - 51 2014

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

Other Link： http://search.jamas.or.jp/link/ui/2014376399

Comparison of 7 α1-adrenoceptor Antagonists in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia:A Short-term Crossover Study Reviewed

Araki Tohru, Monden Koichi, Araki Motoo

Acta Medica Okayama 67 ( 4 ) 245 - 251 2013.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University Medical School

A crossover study was conducted to identify the best α1-adrenoceptor (α1AR) antagonist for individual patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). One hundred thirteen patients (mean age 70.8 years) were enrolled. All patients met BPH clinical study guidelines. Seven agents were utilized:tamsulosin 0.2mg, silodosin 8mg, urapidil 60mg, naftopidil 50mg, prazosin 1mg, terazosin 2mg, and doxazosin 1mg. Patients were initially prescribed tamsulosin or silodosin for a week and then urapidil for a week. Two weeks later, they were prescribed the better of the 2 agents for a week and a new agent for the next week. This cycle was repeated until all 7 agents were tested. Efficacy was evaluated with the International Prostate Symptom Score. The agent rankings were doxazosin (25 [22%]), silodosin (22 [19%]), urapidil (19 [17%]), naftopidil (17 [15%]), terazosin (12 [11%]), tamsulosin (11 [10%]), prazosin (7 [6%]). Only 12 patients (11%) changed agents after the crossover study was completed. The major reason was adverse events (83%). We found that each of the 7 α1AR antagonists has its own supporters. Further, the one-week crossover study was useful in identifying the best agent for the treatment of each individual with LUTS.

DOI： 10.18926/AMO/51069

Other Link： http://search.jamas.or.jp/link/ui/2014082878

Predictive factors for acute and late urinary toxicity after permanent interstitial brachytherapy in Japanese patients. International journal

Ryuta Tanimoto, Kensuke Bekku, Norihisa Katayama, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki, Mitsuhiro Takemoto, Hiroyuki Yanai, Yasutomo Nasu, Hiromi Kumon

International journal of urology : official journal of the Japanese Urological Association 20 ( 8 ) 812 - 7 2013.8

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

OBJECTIVES: To describe the frequency of and to determine predictive factors associated with Radiation Therapy Oncology Group urinary toxicity in prostate brachytherapy patients. METHODS: From January 2004 to April 2011, 466 consecutive Japanese patients underwent permanent iodine-125-seed brachytherapy (median follow up 48 months). International Prostate Symptom Score and Radiation Therapy Oncology Group toxicity data were prospectively collected. Prostate volume, International Prostate Symptom Score before and after brachytherapy, and postimplant analysis were examined for an association with urinary toxicity, defined as Radiation Therapy Oncology Group urinary toxicity of Grade 1 or higher. Logistic regression analysis was used to examine the factors associated with urinary toxicity. RESULTS: The rate of Radiation Therapy Oncology Group urinary toxicity grade 1 or higher at 1, 6, 12, 24, 36 and 48 months was 67%, 40%, 21%, 31%, 27% and 28%, respectively. Grade 2 or higher urinary toxicity was less than 1% at each time-point. International Prostate Symptom Score was highest at 3 months and returned to normal 12 months after brachytherapy. On univariate analysis, patients with a larger prostate size, greater baseline International Prostate Symptom Score, higher prostate V100, higher prostate V150, higher prostate D90 and a greater number of seeds had more acute urinary toxicities at 1 month and 12 months after brachytherapy. On multivariate analysis, significant predictors for urinary toxicity at 1 month and 12 months were a greater baseline International Prostate Symptom Score and prostate V100. CONCLUSIONS: Most urinary symptoms are tolerated and resolved within 12 months after prostate brachytherapy. Acute and late urinary toxicity after brachytherapy is strongly related to the baseline International Prostate Symptom Score and prostate V100.

DOI： 10.1111/iju.12050

Testosterone replacement elevates the serum uric acid levels in patients with female to male gender identity disorder. Reviewed

Hiroaki Kurahashi, Masami Watanabe, Morito Sugimoto, Yuichi Ariyoshi, Sabina Mahmood, Motoo Araki, Kazushi Ishii, Yasutomo Nasu, Atsushi Nagai, Hiromi Kumon

Endocrine journal 60 ( 12 ) 1321 - 7 2013

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japan Endocrine Society

Gender identity disorder (GID) results from a disagreement between a person's biological sex and the gender to which he or she identifies. With respect to the treatment of female to male GID, testosterone replacement therapy (TRT) is available. The uric acid (UA) level can be influenced by testosterone; however, the early effects and dose-dependency of TRT on the serum UA concentration have not been evaluated in this population. We herein conducted a dose-response analysis of TRT in 160 patients with female to male GID. The TRT consisted of three treatment groups who received intramuscular injections of testosterone enanthate: 125 mg every two weeks, 250 mg every three weeks and 250 mg every two weeks. Consequently, serum UA elevation was observed after three months of TRT and there was a tendency toward testosterone dose-dependency. The onset of hyperuricemia was more prevalent in the group who received the higher dose. We also demonstrated a positive correlation between increased levels of serum UA and serum creatinine. Since the level of serum creatinine represents an individual's muscle volume and the muscle is a major source of purine, which induces UA upregulation, the serum UA elevation observed during TRT is at least partially attributed to an increase in muscle mass. This is the first study showing an association between serum UA elevation and a TRT-induced increase in muscle mass. The current study provides important information regarding TRT for the follow-up and management of the serum UA levels in GID patients.

DOI： 10.1507/endocrj.EJ13-0203

Other Link： http://search.jamas.or.jp/link/ui/2014187638

岡山大学病院におけるロボット補助下前立腺全摘術の初期経験

平田武志, 小林泰之, 荒木元朗, 江原伸, 上原慎也, 渡邊豊彦, 雑賀隆史, 那須保友, 公文裕巳

Japanese Journal of Endourology 25 ( 3 ) 242 - 242 2012.11

Laparoscopic management of complicated urachal remnants in adults. International journal

Motoo Araki, Takashi Saika, Daiji Araki, Yasuyuki Kobayashi, Shinya Uehara, Toyohiko Watanabe, Kiyoshi Yamada, Yasutomo Nasu, Hiromi Kumon

World journal of urology 30 ( 5 ) 647 - 50 2012.10

Authorship：Lead author,　Corresponding author 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

直腸癌膀胱尿管転移と膀胱尿路上皮癌を同時に認めた1例

榮枝一磨, 有吉勇一, 別宮謙介, 佐々木克己, 小林泰之, 荒木元朗, 江原伸, 渡邊豊彦, 那須保友, 公文裕巳

西日本泌尿器科 74 ( 10 ) 591 - 591 2012.10

CAN EXPERIENCE OF TURP SHORTEN THE LEARNING CURVE FOR HOLEP?

Kishimoto Ryo, Araki Motoo, Seno Yuuko, Watanabe Toyohiko, Saika Takashi, Yamamoto Yasuo, Ishito Noritaka, Akazawa Nobuyuki, Takamoto Hitoshi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF ENDOUROLOGY 26 A319 2012.9

DOES THE LENGTH OF EXPOSED URETHRAL INFLUENCE THE SURGICAL MARGINS ON LAPAROSCOPIC PROSTATECTOMY? Reviewed

Ryuta Tanimoto, Yasuyuki Kobayashi, Katsumi Sasaki, Motoo Araki, Shin Ebara, Shinya Uehara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 26 A308 - A308 2012.9

LAPAROSCOPIC HEMINEPHRECTOMY IN A HORSESHOE KIDNEY: CASE REPORT

Yasuyuki Kobayashi, Ryuta Tanimoto, Taiki Kanbara, Takehiro Iwata, Motoo Araki, Katsumi Sasaki, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 26 A506 - A507 2012.9

The clinical impact of pathological review on selection the treatment modality for localized prostate cancer in candidates for brachytherapy monotherapy. Reviewed International journal

Ryo Kishimoto, Takashi Saika, Kensuke Bekku, Hiroyuki Nose, Fernando Abarzua, Yasuyuki Kobayashi, Motoo Araki, Hiroyuki Yanai, Yasutomo Nasu, Hiromi Kumon

World journal of urology 30 ( 3 ) 375 - 8 2012.6

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

AIM: To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed Gleason grade (GG) migration and the final treatment decision in a cohort of patients designated for permanent prostate brachytherapy (PPB). METHODS: From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospitals were referred to our hospital for PPB monotheray. All pathologic slides of prostate biopsies were reviewed by a single PGU. Patients ultimately selected their treatment modality from our recommendations based on the review. Indication for PPB monotherapy was the NCCN classification of patients as good or intermediate risk. In addition, patient with Primary GG 4 was regarded as unadapted case. RESULTS: Six cases were reinterpreted as no cancer (2.4%). GG change occurred in 94 cases (38.1%) of which 77 (81.9%) were upgraded and 17 (18.1%) downgraded. Of the total 247 patients, 86 (34.8%) changed therapies and 30 (12.1%) did so based on the pathologic slide review. CONCLUSIONS: Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.

DOI： 10.1007/s00345-011-0738-4

The impact of neoadjuvant hormone therapy on the permanent I-125-seed brachytherapy for low- or intermediate-risk prostate cancer. Reviewed

Ryuta Tanimoto, Kensuke Bekku, Shin Ebara, Motoo Araki, Hiroyuki Yanai, Norihisa Katayama, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF CLINICAL ONCOLOGY 30 ( 5 ) 2012.2

Predictive factors for acute and late urinary toxicities after permanent prostate brachytherapy. Reviewed

Ryuta Tanimoto, Kensuke Bekku, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki, Norihisa Katayama, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF CLINICAL ONCOLOGY 30 ( 5 ) 2012.2

Laparoscopic-assisted tension-free vaginal mesh: an innovative approach to placing synthetic mesh: transvaginally for surgical correction of pelvic organ prolapse. Reviewed

Toyohiko Watanabe, Miyabi Inoue, Ayano Ishii, Toyoko Yamato, Masumi Yamamoto, Katsumi Sasaki, Yasuyuki Kobayashi, Motoo Araki, Shinya Uehara, Takashi Saika, Hiromi Kumon

Acta medica Okayama 66 ( 1 ) 23 - 9 2012

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

Ureteroscopic management of chronic unilateral hematuria: a single-center experience over 22 years. Reviewed International journal

Motoo Araki, Shinya Uehara, Katsumi Sasaki, Koichi Monden, Masaya Tsugawa, Toyohiko Watanabe, Manoji Monga, Yasutomo Nasu, Hiromi Kumon

PloS one 7 ( 6 ) e36729 2012

Authorship：Lead author 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™). 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<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

URETEROSCOPIC MANAGEMENT FOR UPPER TRACT UROTHELIAL CARCINOMA: LONG-TERM SINGLE INSTITUTION EXPERIENCE Reviewed

Araki Motoo, Uehara Shinya, Watanabe Toyohiko, Koichi Monden, Masaya Tsugawa, Yasuyuki Kobayashi, Shin Ebara, Saika Takashi, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 25 A177 - A177 2011.11

Nerve growth factor level in the prostatic fluid of patients with chronic prostatitis/chronic pelvic pain syndrome is correlated with symptom severity and response to treatment. Reviewed International journal

Toyohiko Watanabe, Miayabi Inoue, Katsumi Sasaki, Motoo Araki, Shinya Uehara, Koichi Monden, Takashi Saika, Yasutomo Nasu, Hiromi Kumon, Michael B Chancellor

BJU international 108 ( 2 ) 248 - 51 2011.7

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

Detection and isolation of nanobacteria-like particles from urinary stones: long-withheld data. Reviewed International journal

Hiromi Kumon, Akira Matsumoto, Shinya Uehara, Fernando Abarzua, Motoo Araki, Ken Tsutsui, Ken-ichi Tomochika

International journal of urology : official journal of the Japanese Urological Association 18 ( 6 ) 458 - 65 2011.6

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

OBJECTIVES: To report our experimental results on detection and isolation of nanobacteria-like particles (NLP) from urinary stone samples. METHODS: From March 2001 to August 2003, 47 urinary stone samples from Japanese patients and 18 from Paraguayan patients were collected and used for compositional analysis, direct survey of NLP by scanning electron microscopy (SEM) and their cultural isolation. For the isolation, culturing was carried out using strict aseptic techniques. Dulbecco's modified Eagle medium with 10% gamma-irradiated fetal bovine serum was used based on the original method described by Kajander and Ciftçioglu. RESULTS: Positive NLP detection rates for Japanese and Paraguayan patient samples were 61.7% (29/47) and 66.7% (12/18), respectively. Positive NLP isolation rates for Japanese patient samples were 20.6% (7/34) and 20.0% (2/10) for Paraguayan patient samples. In the initial isolation, markedly different periods of incubation time were needed for each of the nine cases (6-220 days; median 36 days). Positive detection and isolation were obtained in stone samples with or without calcium phosphate. Growth modes and morphogenesis of NLP were divided into two phases; rod-shaped NLP was detected mainly as a floating form growing in culture medium and spherical NLP with a characteristic apatite shell was detected as an attached form growing on the surface of culture dishes. CONCLUSIONS: Lifeless calcifying nanoparticles can be isolated from various human urinary stones, cultured in cell culture mediums and show two characteristic growth phases.

DOI： 10.1111/j.1442-2042.2011.02763.x

URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 24-YEAR EXPERIENCE Reviewed

Motoo Araki, Shinya Uehara, Koichi Monden, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 185 ( 4 ) E556 - E557 2011.4

CHANGES IN CLITORIAL BLOOD FLOW FOLLOWING SURGERY WITH TENSION-FREE VAGINAL MESH FOR PELVIC ORGAN PROLAPSE Reviewed

Toyohiko Watanabe, Miyabi Inoue, Ayano Ishii, Toyoko Yamato, Motoo Araki, Shinya Uehara, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 185 ( 4 ) E685 - E685 2011.4

ロボット支援腹腔鏡下前立腺全摘除術の初期経験

雑賀隆史, 上原慎也, 渡邊豊彦, 小林泰之, 荒木元朗, 佐々木克己, 上松克利, 能勢宏幸, 岸本涼, 別宮謙介, 神原太樹, 那須保友, 公文裕巳

西日本泌尿器科 73 ( 4 ) 201 - 201 2011.4

術前6週間の免疫抑制とリツキサンを用いて成功した免疫学的ハイリスク生体腎移植症例の1例

河内啓一郎, 荒木元朗, 小武家誠, 上松克利, 小林泰之, 雑賀隆史, 那須保友, 公文裕巳, 齋藤和英, 高橋公太

移植 45 ( 5 ) 535 - 536 2010.10

CLITORIAL BLOOD FLOW CHANGES AFTER SURGERY WITH TENSION-FREE VAGINAL MESH FOR PELVIC ORGAN PROLAPSE Reviewed

Watanabe Toyohiko, Inoue Miyabi, Ishii Ayano, Yamato Toyoko, Nose Hiroyuki, Uematsu Katsutoshi, Sasaki Katsumi, Araki Motoo, Uehara Shinya, Saika Takashi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF UROLOGY 183 ( 4 ) E583 2010.4

URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 23-YEAR EXPERIENCE Reviewed

Araki Motoo, Uehara Shinya, Watanabe Toyohiko, Saika Takashi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF UROLOGY 183 ( 4 ) E494 2010.4

OMINOUS AZITHROMYCIN RESISTANCE TREND OF GONOCOCCAL URETHRITIS IN JAPAN

Motoo Araki, Shinya Uehara, Ayano Ishii, Hiroyuki Nose, Toyohiko Watanabe, Satoshi Uno, Koichi Monden, Tohru Araki, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 183 ( 4 ) E317 - E317 2010.4

Robot-assisted laparoscopic radical prostatectomy in the Asian population: modified port configuration and ultradissection. Reviewed International journal

Wooju Jeong, Motoo Araki, Sung Yul Park, Young Hoon Lee, Hiromi Kumon, Sung Joon Hong, Koon Ho Rha

International journal of urology : official journal of the Japanese Urological Association 17 ( 3 ) 297 - 300 2010.3

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY-BLACKWELL PUBLISHING, INC

We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports were placed medially and caudally in patients with a small pelvis to avoid interference between the ports and the pelvis (modified port configuration). Lymph node dissection is carried out in the external iliac, obturator and infraobturator area. The dissection on the lateral border of the bladder neck is carried out until it reaches the seminal vesicle (ultradissection). After transection of the bladder neck, vasa seminal vesicles are dissected further. Neurovascular bundles are preserved in selected patients. The dorsal venous complex (DVC) and the urethra are transected without suturing. Urethrovesical anastomosis is carried out with 3-0 monocryl running suture, incorporating with the edge of DVC. The puboprostatic collar and bladder are incorporated by 3-0 monocryl running suture (puboperineoplasty). Between November 2007 and September 2008, RARP was carried out using this technique in 182 patients. Median height, weight, body mass index and prostate-specific antigen (PSA) were 168 cm, 68 kg, 24 kg/M(2) and 7.1 ng/mL, respectively. Mean operative time was 192 min and average blood loss was 250 mL. Median catheterization time was 8 days. Positive surgical margin rates for pT2, pT3 and pT4 disease was 12.7, 48 and 100%, respectively. Intraoperative complication rate was 2.7%. Fifty-five patients completed a minimum of 10 months follow up. Their continence rate was 91%. RARP is a safe and feasible surgical modality for prostate cancer among Asian patients with a small pelvis. Our technique achieves a precise bladder neck dissection.

DOI： 10.1111/j.1442-2042.2010.02480.x

Role of patient-physician dialogue in selecting the type of urinary diversion. International journal

Devendar Katkoori, Murugesan Manoharan, Motoo Araki, Mark S Soloway

Urologia internationalis 84 ( 1 ) 40 - 4 2010

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

INTRODUCTION: We analyze patient-physician dialogue prior to radical cystectomy (RC) when choosing the type of urinary diversion (UD). METHODS: 132 patients operated by one surgical team between 2003 and 2005 were included. Physician's recommendation, patient's decision and UD (neobladder (NB) or ileal conduit (IC)) performed were analyzed. Patients were grouped based on age, considering that age is often a limiting factor for NB. RESULTS: When offered either NB or IC, 85% (49/58) in group I (<70 years) and 55% (12/22) in group II (> or =70 years) elected NB. An IC was suggested for 16% (11/69) in group I and 65% (41/63) in group II. Six patients (2 in group I, 4 in group II) wanted a NB even though an IC was suggested. CONCLUSIONS: Counseling patients is important. When an IC was suggested, over 80% accepted this advice. When both were offered, younger patients usually elected a NB. Older patients preferred an IC.

DOI： 10.1159/000273464

腹腔鏡下尿膜管遺残摘出術の4例

荒木元朗, 雑賀隆史, 上原慎一, 那須保友, 小林泰之, 渡邊豊彦, 公文裕巳

日本内視鏡外科学会雑誌 14 ( 7 ) 344 - 344 2009.12

CTガイド下RFAが困難であったVHL随伴腎癌に対する腹腔鏡補助下RFAの経験

上松克利, 雑賀隆史, 郷原秀夫, 三村秀文, 荒木元朗, 石井亜矢乃, 小林泰之, 那須保友, 金澤右, 公文裕巳

Japanese Journal of Endourology and ESWL 22 ( 3 ) 165 - 165 2009.11

前立腺癌に対するHybrid radical prostatectomyのOncological outcomes

雑賀隆史, 小林泰之, 上原慎也, 荒木元朗, 高尾彰, 上杉達也, 那須保友, 公文裕巳

日本癌治療学会誌 44 ( 2 ) 428 - 428 2009.9

URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 22-YEAR EXPERIENCE Reviewed

Araki Motoo, Uehara Shinichi, Monden Koichi, Watanabe Toyohiko, Saika Takashi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF UROLOGY 181 ( 4 ) 450 2009.4

A Clinical Investigation of the Mechanism of Loxoprofen, a Non-steroidal Anti-inflammatory Drug, for Patients with Nocturia Reviewed

Araki Tohru, Yokoyama Teruhiko, Araki Motoo, Furuya Seiji

Acta Medica Okayama 62 ( 6 ) 373 - 378 2008.12

Language：English Publisher：Okayama University Medical School

<p>We previously reported the effectiveness of loxoprofen sodium (loxoprofen), a non-steroidal anti-inflammatory drug, for patients with lower urinary tract symptoms (LUTS) complaining of nocturia. In this study, we explored the mechanism of loxoprofen in the treatment of nocturia. Fifty-six patients complaining of nocturia were enrolled. They took a single 60-mg tablet of loxoprofen at bedtime for 14 days. The effects of this treatment were assessed by bladder diaries. Nocturia improved (nocturia decreased ≥1 void/night) in 40 patients (71.4%). Nocturnal urine volume was reduced in 31 of 40 (77.5%) without nocturnal single-void volume increase. Nocturnal single-void volume increased in 4 of 40 (10.0%) without nocturnal urine volume reduction. Two of 40 (5.0%) demonstrated both nocturnal urine volume reduction and nocturnal single-void volume increase. Three (7.5%) were exceptions to the above. In conclusion, the main mechanism of loxoprofen is the reduction of nocturnal urine volume for the treatment of nocturia and the second mechanism is the increased bladder capacity.</p>

DOI： 10.18926/AMO/30949

Other Link： http://search.jamas.or.jp/link/ui/2009175789

Catheter-free 120W lithium triborate (LBO) laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH). Reviewed International journal

Massimiliano Spaliviero, Motoo Araki, Jay B Page, Carson Wong

Lasers in surgery and medicine 40 ( 8 ) 529 - 34 2008.10

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

INTRODUCTION AND OBJECTIVE: We evaluate the safety and efficacy of catheter-free LBO laser PVP for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS: We prospectively evaluated our initial LBO laser PVP experience and the need for urethral catheterization. RESULTS: Seventy consecutive patients were identified. 49 (70%) were discharged without (C-) and 21 (30%) were discharged with (C+) a urethral catheter. There were no significant differences in pre-operative parameters, including age (C-: 65+/-10 vs. C+: 69+/-9 years), AUASS (C-: 22+/-6 vs. C+: 21+/-6), Qmax (C-: 10+/-4 vs. C+: 8+/-3 ml/second), PVR (C-: 62+/-105 vs. C+: 57+/-82 ml) and prostate volume (C-: 65+/-35 vs. C+: 86+/-53 ml). There were no significant differences in laser time and energy usage. AUASS, Qmax and PVR values showed significant improvement within each group (P<0.05), but there were no significant differences between the two groups. All were outpatient procedures. 2/70 (2.9%) patients required catheter reinsertion in C+. The overall incidence of adverse events was low and did not differ between the two groups. CONCLUSIONS: Our experience suggests that catheter-free LBO laser PVP is safe and effective for the treatment of LUTS secondary to BPH.

DOI： 10.1002/lsm.20678

Short-term outcomes of Greenlight HPS laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH). Reviewed International journal

Massimiliano Spaliviero, Motoo Araki, Carson Wong

Journal of endourology 22 ( 10 ) 2341 - 7 2008.10

Language：English Publishing type：Research paper (scientific journal) Publisher：MARY ANN LIEBERT INC

PURPOSE: We evaluated our initial experience with the GreenLight HPS laser, a technologically improved version of the potassium-titanyl-phosphate (KTP) laser for PVP. MATERIALS AND METHODS: Transurethral PVP was performed using a GreenLight HPS side-firing laser system. Patients had American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, Sexual Health Inventory for Men (SHIM) score, serum prostate specific antigen (PSA), maximum flow rate (Qmax) and post void residual (PVR) determinations and volumetric prostate measurements with transrectal ultrasonography (TRUS). Laser and operative times and energy usage were recorded. AUASS, QoL, SHIM, Qmax and PVR were evaluated 1, 4, 12, 24, and 52 weeks post-surgery. Serum PSA and TRUS were obtained at 12 weeks and serum PSA was repeated at 52 weeks. RESULTS: Seventy consecutive patients with a median age of 67 (45-86) years underwent GreenLight HPS laser PVP from July 2006 through March 2008. Median prostate volume was 61.6 (20.9-263.0) mL with a median PSA of 1.4 (0.1 -10.1) ng/mL. Mean laser and operative times and energy usage were 13 (3-34) minutes, 30 (6-100) minutes and 85 (11-235) kJ, respectively. All were outpatient procedures with 49 (70%) patients catheter-free at discharge. No urethral strictures or urinary incontinence were noted. Median AUASS decreased from 22 to 8, 6, 5, 5, and 4 (p<0.001) while the median Qmax increased from 9.4 to 20.4, 20.3, 21.2, 18.8, and 20.0 mL/s (p<0.001) during the follow-up period. CONCLUSIONS: At one year, our experience suggests that GreenLight HPS laser PVP is safe and effective for treating lower urinary tract symptoms secondary to BPH.

DOI： 10.1089/end.2008.9708

High-power potassium-titanyl-phosphate laser photoselective vaporization prostatectomy for symptomatic benign prostatic hyperplasia. Reviewed International journal

Motoo Araki, Po N Lam, Carson Wong

Journal of endourology 22 ( 6 ) 1311 - 4 2008.6

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：MARY ANN LIEBERT INC

BACKGROUND AND PURPOSE: Potassium-titanyl-phosphate (KTP) laser photoselective vaporization prostatectomy (PVP) is a relatively new technology for the management of lower urinary-tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We review our initial experience. PATIENTS AND METHODS: We prospectively evaluated our initial 12-month experience with 80 W KTP laser PVP. All had American Urological Association symptom score (AUASS), American Society of Anesthesiologists (ASA) risk score, serum prostate-specific antigen (PSA), maximum flow rate (Qmax), and postvoid residual (PVR) determinations and transrectal ultrasonography. RESULTS: There were 160 consecutive patients identified, with a mean age of 69.7 years (range 34-88 yrs) and a mean ASA score of 2.4 (range 1-4). The mean prostate volume was 72.3 cm(3) (range 20.3-261 cm(3)), with a mean PSA level of 2.2 ng/mL (range 0.1-17.9 ng/mL). Mean laser time and energy usage were 33.4 minutes (range 4-165 min) and 99.0 kJ (range 11.3-524 kJ), respectively. All were outpatient procedures with 96 (60%) patients catheter-free at discharge. Twenty-eight patients need catheter drainage for 1 week. Urinary-tract infections developed in 13 patients. Fourteen patients had clinically insignificant hematuria for more than 1 week. Bladder neck contractures that necessitated intervention developed in three patients. Three patients had persistent urinary retention. No urethral strictures or urinary incontinence were noted. Mean AUASS decreased significantly from 23 to 13, 9, 8, 7, and 6 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Qmax and PVR values also showed statistically significant improvement. CONCLUSION: Our initial results demonstrate that KTP laser PVP is safe and effective for the management of LUTS secondary to BPH.

DOI： 10.1089/end.2008.0140

Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. Reviewed International journal

Ithaar H Derweesh, Hazem R Ismail, David A Goldfarb, Motoo Araki, Lingmei Zhou, Charles Modlin, Venkatesh Krishnamurthi, Stuart M Flechner, Andrew C Novick

BJU international 101 ( 11 ) 1415 - 9 2008.6

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

OBJECTIVE: To investigate the effect of placing a prophylactic drain during renal transplantation on the incidence of lymphocele, wound complication and deep venous thrombosis (DVT) in renal transplant recipients induced with sirolimus vs calcineurin inhibitors (CNI), as sirolimus-based immunosuppression is a risk factor for the formation of fluid collections after transplantation. PATIENTS AND METHODS: We analysed 165 consecutive adult renal transplant patients at our institution between January 2004 and February 2005. Group 1 (84) did not receive an intraoperative drain and group 2 (81) did. Recipients were analysed within each group based on immunosuppression (sirolimus or CNI) and whether they had wound complication, fluid collection, lymphocele treatment, or DVT. RESULTS: In group 1 and 2, respectively, the wound complication rate was 22.6% vs 13.6% (P = 0.134), the fluid collection rate 45.2% vs 16.% (P < 0.001), the lymphocele treatment rate 19.0% vs 2.5% (P = 0.001) the DVT rate 14.3% vs 4.9% (P = 0.043) the fluid collection rate (for CNI) 26.5% vs 16.0% (P = 0.246), the lymphocele treatment rate (for CNI) 5.9% vs 0% (P = 0.084), the fluid collection rate (sirolimus) 58.0% vs 16.1% (P < 0.001) and lymphocele treatment rate (sirolimus) 28% vs 6.5% (P = 0.018). Multivariate analysis of risk factors for fluid collection showed significance for no drain (odds ratio 3.30, P = 0.002), associated wound complication (2.41, P = 0.041) and sirolimus (2.48, P = 0.015). CONCLUSIONS: Placing a drain during transplantation decreased the incidence of fluid collection, lymphocele treatment and DVT. The reduction of fluid collection and lymphocele were significant for patients treated with sirolimus. We recommend placing a drain in patients undergoing induction with sirolimus-based immunosuppression.

DOI： 10.1111/j.1464-410X.2007.07427.x

Ureteroscopic evaluation and treatment of chronic unilateral hematuria: A 20-year experience Reviewed

Araki Motoo, Monden Kouichi, Uehara Shinya, Watanabe Toyohiko, Saika Takashi, Nasu Yasutomo, Kumon Hiromi

JOURNAL OF UROLOGY 179 ( 4 ) 282 2008.4

Decreased efficiency of potassium-titanyl-phosphate laser photoselective vaporization prostatectomy with long-term 5 alpha-reductase inhibition therapy: is it true? Reviewed International journal

Motoo Araki, Po N Lam, Daniel J Culkin, Carson Wong

Urology 70 ( 5 ) 927 - 30 2007.11

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: 5 Alpha-reductase inhibitors (5ARIs) reduce angiogenesis in benign prostatic tissue. This has been postulated to affect the efficiency of the potassium-titanyl-phosphate (KTP) laser during photoselective vaporization prostatectomy (PVP), which has hemoglobin as its primary chromophore. We evaluate KTP laser PVP as treatment for benign prostatic hyperplasia (BPH) in patients on long-term 5ARIs. METHODS: We prospectively evaluated our initial 12 month KTP laser PVP experience with patients without or with 5ARIs. Transurethral PVP was performed with the use of an 80W KTP side-firing laser system. Voiding trials were performed 2 hours after surgery. International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) were measured preoperatively and at 1, 4, 12, 24, and 52 weeks after surgery. RESULTS: One hundred sixty consecutive patients were identified, of which 117 were not on a 5ARI and 43 were on either finasteride or dutasteride for at least 6 months. Mean prostate volumes were 72.8 +/- 49.5 cm3 and 70.8 +/- 49.1 cm3 (P = 0.39), respectively. There were no significant differences in the parameters of laser time (32.0 +/- 27.6 minutes and 37.0 +/- 36.2 minutes) and energy usage (97.4 +/- 91.6 kJ and 103.3 +/- 86.0 kJ). All were outpatient procedures with the majority of patients catheter-free at discharge. All patients were able to discontinue their prostate medications after surgery. IPSS, Qmax, and PVR values showed significant improvement within each group, but the degree of improvement between the 2 groups did not show statistical significance. CONCLUSIONS: Our experience suggests that 5ARIs do not have a detrimental effect on the efficiency and efficacy of KTP laser PVP.

Lack of progress in early diagnosis of bladder cancer. Reviewed International journal

Motoo Araki, Alan M Nieder, Murugesan Manoharan, Yulong Yang, Mark S Soloway

Urology 69 ( 2 ) 270 - 4 2007.2

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

OBJECTIVES: The stage of presentation of prostate cancer has changed dramatically in the past two decades, largely because of prostate-specific antigen screening and increased public awareness regarding the disease. Recently, strides have been made in the validation, development, and approval of bladder cancer (BC) markers. We sought to evaluate whether any stage migration has occurred for patients with BC during the same period. METHODS: A total of 351 and 1262 patients underwent radical cystectomy and radical retropubic prostatectomy, respectively, between 1992 and 2005 by one surgeon. The patients were divided into two consecutive groups: group 1 (1992 to 1998) and group 2 (1999 to 2005). The baseline and pathologic characteristics of the patients were compared. RESULTS: No differences were found in the clinical or pathologic staging between the two groups of patients undergoing radical cystectomy. The 5-year overall and disease-specific survival also was not different between the two groups. For patients with prostate cancer, those in group 2 presented at a younger age, with a lower prostate-specific antigen level, and had a lower clinical stage. Group 2 patients had a decrease in the incidence of extracapsular extension, a decreased tumor volume, and a decrease in the incidence of Gleason 8 to 10 tumors. CONCLUSIONS: During two consecutive periods, our patients with prostate cancer presented with the cancer at an earlier stage and had more favorable pathologic features after radical retropubic prostatectomy. However, our patients with BC did not demonstrate any stage migration. Physicians need to be more aggressive in diagnosing BC, especially in patients at high risk of the disease. Risk factors must be emphasized, urine markers should be used in a screening strategy, and the indications for radical cystectomy should be liberalized.

DOI： 10.1016/j.urology.2006.10.016

High incidence of delayed renal graft function. Reviewed International journal

Motoo Araki, David Goldfarb, Robert Fairchild

Transplantation 83 ( 1 ) 101 - 2 2007.1

Expression of IL-8 during reperfusion of renal allografts is dependent on ischemic time. Reviewed International journal

Motoo Araki, Nader Fahmy, Lingmei Zhou, Hiromi Kumon, Venkatesh Krishnamurthi, David Goldfarb, Charles Modlin, Stuart Flechner, Andrew C Novick, Robert L Fairchild

Transplantation 81 ( 5 ) 783 - 8 2006.3

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

BACKGROUND: Ischemia/reperfusion injury is an inherent consequence of solid organ transplantation that increases tissue inflammation and negatively impacts organ transplant function and survival. This study investigated the expression levels of chemokine and chemokine receptor genes in living versus cadaver donor renal allografts before and after reperfusion. METHODS: This study involved 39 renal transplant patients (19 cadaveric and 20 living donor). The ischemia biopsy was taken just before graft declamping and the reperfusion biopsy 30 min after declamping. Whole-cell RNA was isolated and chemokine (IL-8, CCL2/MCP-1, CXCL10/IP-10 and CCL5/RANTES) and chemokine receptor (CCR2 and CCR5) expression was tested by quantitative PCR. RESULTS: Just prior to declamping, ischemic cadaveric donor grafts had higher expression of CXCL10/IP-10 but not IL-8 or CCL2/MCP-1 than living donor grafts. IL-8 expression increased 50% from ischemia to reperfusion in living donor grafts but increased more than 13-fold during reperfusion of cadaver donor grafts. Increased total ischemia time induced greater IL-8 expression during reperfusion. MCP-1 expression also increased during reperfusion of living and cadaver donor grafts but differences were not observed between the two groups of grafts. RANTES, CCR2, and CCR5 expression did not change in ischemic vs. reperfusion biopsies. CONCLUSIONS: The expression of chemokines directing neutrophil and macrophage recruitment increases during reperfusion of living and cadaveric donor renal allografts. Expression levels of IL-8 correlate with the ischemic time imposed on the renal graft. Early tissue injury may be attenuated by strategies antagonizing chemokines directing the recruitment of neutrophils and macrophages into kidney grafts.

DOI： 10.1097/01.tp.0000198736.69527.32

Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mTOR inhibitor drugs. Reviewed International journal

Motoo Araki, Stuart M Flechner, Hazem R Ismail, Lawrence M Flechner, Lingmei Zhou, Ithaar H Derweesh, David Goldfarb, Charles Modlin, Andrew C Novick, Charles Faiman

Transplantation 81 ( 3 ) 335 - 41 2006.2

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

BACKGROUND: The aim of this study was to evaluate the incidence and risk factors for posttransplant diabetes mellitus (PTDM; defined as new insulin use and/or new hyperglycemia) in 528 kidney recipients using different immunosuppressive agents. METHODS: Maintenance therapy included mycophenolate mofetil or azathioprine plus glucocorticoids in combination with Group I cyclosporine (263); Group II tacrolimus (60); or Group III sirolimus (205). RESULTS: The mean follow-up was 39.2 (range 9.0-103.8) months. Overall, the number of patients needing insulin was 7.4% (39/528). The incidences for Groups I, II, and III of 7.6%, 11.7%, and 5.9%, respectively, were not statistically different. Characteristics of patients with PTDM included older age (P=0.007); greater body weight (kg) at transplant, 6 months, and 12 months, respectively (P<0.001); greater BMI (kg/m2) at transplant, 6 months, and 12 months, respectively (P<0.001); more acute rejection episodes 28.2% vs. 13.5% (P=0.012); and increased incidence in African Americans (P=0.03). Multivariable analysis demonstrated increased risk for PTDM (defined as new insulin use) for tacrolimus, (hazard ratio [HR] 3.794, P=0.007); treated rejections (HR 2.491, P=0.0115); age (HR 1.407, P=0.0116); and BMI (HR 1.153, P<0.0001). New insulin use occurred sooner and with less total glucocorticoid dose for tacrolimus patients. If PTDM is defined as all cases of new hyperglycemia, then no immunosuppressive drug group demonstrated an increased risk. CONCLUSION.: The risk for developing PTDM is greatest among older recipients, and those obese at the time of transplant; those given steroid pulse therapy were at exceptionally high-risk. PTDM risk reduction should focus on weight loss in the obese end-stage renal disease population prior to transplant.

DOI： 10.1097/01.tp.0000195770.31960.18

Fate of donor kidney: laparoscopic versus open technique. Reviewed International journal

Mahesh C Goel, Charles S Modlin, Araki M Mottoo, Ithaar H Derweesh, Stuart M Flechner, Steven Streem, Inderbir Gill, David A Goldfarb, Andrew C Novick

The Journal of urology 172 ( 6 Pt 1 ) 2326 - 30 2004.12

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

PURPOSE: Laparoscopic donor nephrectomy (LDN) is an increasingly accepted modality for procuring donor kidneys for transplantation. We analyzed and compared the short and long-term outcomes of living transplant allografts from kidneys procured by laparoscopic or open donor (ODN) technique and managed with a single immunosuppression regimen in each group. MATERIALS AND METHODS: Records of recipients who underwent living (laparoscopic or open) donor nephrectomy were reviewed from August 1999 to July 2001 for LDN and from January 1994 to December 1999 for ODN. Patients included were on a single immunosuppression regimen particular to each group. Sirolimus, mycophenolate mofetil and prednisone were given to the LDN group, and calcineurin inhibitor (FK-506 or cyclosporine), mycophenolate mofetil and prednisone were given to the ODN group. Excluded from study were patients with prior kidney transplant or patients not receiving immunosuppression as previously described. Also excluded from study were patients lost to followup before 1 year. Data were retrieved retrospectively from case notes or from the transplant database and analyzed using SAS software (SAS Institute, Cary, North Carolina). RESULTS: A total of 71 patients from the LDN group and 60 patients from the ODN group qualified for the study. Demographic data are comparable in both groups except for the significantly longer followup in the ODN group. Serum creatinine was 2.2 and 1.8 mg/dl at postoperative day 4, 1.3 and 1.3 mg/dl at day 10, and 1.3 and 1.4 mg/dl at 1 month in the LDN and ODN groups, respectively. Time to achieve nadir serum creatinine was 8.7 versus 6.6 days for LDN and ODN groups, respectively (p = not significant). Delayed graft function was noted in 5 of 71 (7%) in the LDN group and 3 of 60 (5%) in the ODN group (p = 0.5). In the LDN group 13 (18%) patients had a serum creatinine of greater than 1.5 mg/dl at postoperative day 30 compared to 6 (10%) in the ODN group (p = 0.06). Mean serum creatinine at 1 year was lower for LDN recipients (p = not significant). But at last followup this difference became statistically significant in favor of LDN. Mean followup was 939 versus 2,046 days for LDN versus ODN, respectively (p <0.0001). Recipient mean hospital stay was 5.2 versus 6.7 days for LDN versus ODN, respectively (p = 0.08). There were 8 of 78 (10.2%) episodes of acute rejection in the LDN group compared to 22% in the ODN group (p = 0.08). The complication rate (ureteral vascular, lymphocele, acute rejection and wound) was 11% in LDN compared to 15% in the ODN group. Long-term graft function, graft survival and patient survival in the LDN group were comparable to the ODN group. CONCLUSIONS: Early graft recovery is slower in LDN allografts, although not statistically significant, but long-term function in the LDN group is significantly better compared to the ODN group. Laparoscopic donor kidneys take longer to achieve nadir serum creatinine, but this does not influence long-term outcome and results.

DOI： 10.1097/01.ju.0000144716.30222.12

Cytokines and chemokines: roles in the pathophysiology and the therapy of ischemia and reperfusion injury Invited

Motoo Araki, Austin D. Schenk, Robert L. Fairchild

Current Opinion in Organ transplantation 2004 Jun; 9 (2): 139-144 2004

[A case of focal xanthogranulomatous pyelonephritis difficult to differentiate from renal cell carcinoma]. Reviewed

Motoo Araki, Yasunobu Hashimoto, Masayuki Nanri, Shiro Onituka, Osamu Ryoji, Hayakazu Nakazawa, Hiroshi Toma, Yutaka Yamaguchi

Hinyokika kiyo. Acta urologica Japonica 48 ( 10 ) 621 - 4 2002.10

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal)

A 34-year-old female with left flank pain persisting for 3 months consulted us on 19 Feb, 2001. Ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and renal angiography revealed a cystic renal tumor in the upper pole of the left kidney invading the spleen, and paraaortic lymph node swelling. Left radical nephrectomy combined with splenectomy and partial diaphragmectomy was performed under a tentative diagnosis of renal cell carcinoma. However, histopathological findings revealed xanthogranulomatous pyelonephritis (XGP). XGP is a rare, severe, chronic inflammatory disease characterized by accumulation of lipid laden macrophages. XGP is classified as diffuse or focal type. Preoperative diagnosis of focal XGP is difficult because of radiological similarities to renal cell carcinoma. Our case was more difficult to diagnose because she showed few signs of inflammation and had no history of urinary tract infection or stones.

Molecular epidemiological studies of Staphylococcus aureus in urinary tract infection. Reviewed International journal

Motoo Araki, Reiko Kariyama, Koichi Monden, Masaya Tsugawa, Hiromi Kumon

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 8 ( 2 ) 168 - 74 2002.6

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Japan

In recent years, the increasing incidence of urinary tract infection (UTIs) caused by Staphylococcus aureus has been noted at the urology ward, Okayama University Hospital. We investigated the molecular epidemiological characteristics of 139 UTI isolates, including 45 methicillin-sensitive S. aureus (MSSA) and 94 methicillin-resistant S. aureus (MRSA), collected over a 10-year period from 1990 to 1999. The antibiotic resistance genes ( mecA, aph(3')-III, aac(6')-aph(2"), ant(4')-I) and the toxin genes (tst, sea, seb, and sec) were detected by using multiplex polymerase chain reaction (PCR). Since 1996, the prevalence of the ant(4')-I, tstand secgenes has increased markedly in coagulase type II S. aureus possessing the mecA gene (MRSA). The presence of toxin genes in MRSA was higher than that in MSSA; 66.0% and 26.7% for tst, 7.4% and 4.4% for sea, 24.5% and 8.9% for seb, and 66.0% and 28.9% for sec, respectively. In the review of medical records, it was found that febrile episodes occurred in 12 of 72 patients with monomicrobial UTI caused by S. aureus. For the febrile patients, S. aureus isolates with both the tst and sec genes were found significantly more often (11 of 12; 91.7%) than those without the tst and sec genes ( P = 0.0484). Molecular typing of MRSA isolates, by using random amplified polymorphic DNA analysis and pulsed-field gel electrophoresis analysis, revealed no apparent clonality of these isolates over the 10 years, suggesting that most of the recent MRSA infections are not due to cross-infection in the urology ward.

DOI： 10.1007/s101560200029

Cutaneous metastatic carcinoma of the penis: Suspected metastasis implantation from a bladder tumor Reviewed

T Miyamoto, A Ikehara, M Araki, T Akaeda, M Mihara

JOURNAL OF UROLOGY 163 ( 5 ) 1519 - 1519 2000.5

Radiographic diagnosis of acute renal failure . Invited

Motoo Araki, Yasutomo Nasu

Kidney and hemodialysis special version acute renal failure, 9, 391-395, 2000 2000

A case of renal laceration with urinoma treated without surgical intervention.

Motoo Araki, Yoshinori Shirasaki, Teruaki Akaeda

Tsuyama Central Hospital Journal 1999

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