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

PubMed

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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

PubMed

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Language：Japanese   Publisher：(一社)日本性科学会  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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

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

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

尿路結石症手術における内視鏡やレーザーなどのデバイスは目覚ましい進歩を遂げている。近年登場したディスポーザブル軟性尿管鏡は軽量で操作性に優れており,破損に伴うリスクが軽減され費用対効果の向上を生み出す可能性がある。経皮的腎砕石術(percutaneous nephrolithotomy;PNL)や内視鏡併用腎内手術(Endoscopic Combined Intrarenal Surgery;ECIRS)でも新しいデバイス(ClearPetraやSwiss LithoClast Trilogy)が登場しており,安全性や効率性の向上が期待されている。(著者抄録)

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

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

DOI： 10.1155/2024/6505595

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

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

Abstract

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

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

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

DOI： 10.1016/j.clgc.2024.102097

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

尿路結石症手術における内視鏡やレーザーなどのデバイスは目覚ましい進歩を遂げている。近年登場したディスポーザブル軟性尿管鏡は軽量で操作性に優れており,破損に伴うリスクが軽減され費用対効果の向上を生み出す可能性がある。経皮的腎砕石術(percutaneous nephrolithotomy;PNL)や内視鏡併用腎内手術(Endoscopic Combined Intrarenal Surgery;ECIRS)でも新しいデバイス(ClearPetraやSwissLithoClast Trilogy)が登場しており,安全性や効率性の向上が期待されている。(著者抄録)

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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

PubMed

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

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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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

PubMed

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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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：(一社)日本性機能学会  

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

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

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

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)

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

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)

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

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

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

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

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

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

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

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

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

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

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

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/iju5.12440

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

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

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

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

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

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

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

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

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

DOI： 10.18926/AMO/62820

PubMed

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

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

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

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

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

Abstract

We report a patient with adrenal incidentaloma due to synchronous and isolated metastasis from lung cancer, which is a relatively rare condition. Close checkups for incidentaloma in oncologic patients are mandatory, leading to successful operation.

DOI： 10.1002/ccr3.3996

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ccr3.3996

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

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

症例は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)

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

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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)

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

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

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

[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.

Scopus

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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

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

(Objectives) This paper aimed to report the clinical statistics on urologic diseases treated in the emergency department (ED). (Patients and methods) We retrospectively evaluated 1,480 patients diagnosed with urologic diseases in the ED between January 2013 and December 2014. We reviewed the patients' sex, age, main complaints, emergency grade, care-seeking process, hospitalization, examination items, and diagnosis. We also reviewed the correct-diagnosis rates of patients who visited the ED for the first time and were followed up at the urology department. (Results) Of the patients, 2.6% were diagnosed as having a urologic disease, with a male-to-female ratio of 1.5:1. The age distribution ranged from 0 to 101 years, with a median age of 53 years. Patients who required hospitalization accounted for 17.8%. The diagnoses were urolithiasis (546 cases), cystitis (220 cases), and pyelonephritis (137 cases), in order of frequency. The correct-diagnosis rates of urolithiasis (91.2%), benign prostatic hyperplasia (75.0%), and pyelonephritis (71.9%) were high. However, those of testicular torsion (0%), urologic neoplasm (26.7%), prostatitis (35.7%), and epididymitis (35.7%) were low. (Conclusion) In the ED, 82.2% of cases of urologic diseases were mild and did not require hospitalization. The correct-diagnosis rate of acute scrotum was low, as it was difficult to diagnose and thus difficult to manage in the ED. Therefore, urologists should cooperate with ED staff and warn them that cases of acute scrotum should be subjected to emergency consultation.

DOI： 10.5980/jpnjurol.107.239

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：岡山赤十字病院医学雑誌編集委員会  

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Language：Japanese   Publisher：岡山赤十字病院医学雑誌編集委員会  

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

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

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

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

(目的)救急における泌尿器疾患の臨床統計を行った。(方法)2013年1月から2014年12月までの2年間に当院救急外来を受診し、泌尿器疾患と診断された1,480例を対象とした。検討項目は、性別、年齢、主訴、救急区分、受診経路、入院の有無、検査内容、診断名とした。さらに初診患者のうち、泌尿器科でフォローアップされた症例において正診率を検討した。(結果)泌尿器疾患は全体の2.6%であり、男女比は1.5:1であった。年齢は0歳から101歳まで(中央値53歳)であり、入院を必要とした症例は17.8%であった。診断は尿路結石(546例)、膀胱炎(220例)、腎盂腎炎(137例)の順に多かった。泌尿器疾患の正診率は72.3%であった。疾患別では尿路結石(91.2%)、前立腺肥大症(75.0%)、腎盂腎炎(71.9%)の順に高く、一方で精巣捻転(0%)、泌尿器腫瘍(26.7%)、前立腺炎(35.7%)、精巣上体炎(35.7%)などは低かった。(結論)泌尿器疾患の82.2%が入院を必要としない軽症例であった。急性陰嚢症の正診率が低く、救急部での診断・対応は困難であった。我々泌尿器科医も救急部と連携を図り、急性陰嚢症の迅速なコンサルテーションを注意喚起することが必要である。(著者抄録)

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

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

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Language：Japanese   Publisher：岡山赤十字病院医学雑誌編集委員会  

症例は42歳、男性。尿道内へ体温計を自己挿入したところ抜去困難となり、当院救急外来を受診した。腹部X線検査および腹部超音波検査にて、膀胱から尿道にかけて挿入された異物を確認した。同日、全身麻酔下で膀胱高位切開術による膀胱異物摘出を行った。膀胱尿道異物は比較的稀な疾患であるが、挿入された異物の種類、位置等により、適切な術式を選択すべきである。(著者抄録)

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

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

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

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Language：Japanese   Publisher：(一社)日本抗加齢医学会  

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

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

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Language：Japanese   Publisher：日本赤十字社医学会  

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

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

症例は74歳男性。肺検診異常の精査にて、右腎腫瘍・多発肺転移を指摘され当科紹介受診。CT・MRIで、胸腹部の内臓が左右逆転しており、さらに右側腎臓上部に約8cm大の内部不均一な充実性腫瘤、肺には2、3cm大の結節影を認めた。以上より、完全内臓逆位症に合併した右腎癌・多発肺転移(cT2aN0M1 PUL)と診断し、腹腔鏡下根治的右腎摘除術を施行した。左側臥位で右肋骨弓下に3ポートを置き、経腹的アプローチで行った。術中所見として、内臓逆位に伴う手技の困難はあまり感じることはなかった。手術時間は4時間30分、出血量は100mlであった。完全内臓逆位症に合併した腎癌に対する腹腔鏡手術は、鏡面構造をよく理解した上で、十分なシミュレーションを行い執刀すれば操作に大きな困難はなく、安全かつ低侵襲に施行することができた。(著者抄録)

DOI： 10.11302/jsejje.27.395

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

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

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

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

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

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

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