Faculty Profiles - WATANABE Toyohiko

Papers - WATANABE Toyohiko

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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

無料動画共有サービスなどSNSを利用した泌尿器科に関する啓発・教育活動 Reviewed

渡邉豊彦

日本医療マネジメント学会雑誌 24 ( Suppl, ) 238 - 238 2023.6

いま医療機関に求められる変革型リーダーとは Reviewed

渡邉豊彦

診療情報管理 34 ( 4 ) 19 - 27 2023.1

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

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

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 Reviewed

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)

【専門性と多様性を両立させる! 泌尿器科外来ベストNAVI】尿路・性器の感染症腎膿瘍

渡邉豊彦

臨床泌尿器科 76 ( 4 ) 023 - 025 2022.4

Language：Japanese Publisher：(株)医学書院

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

【専門性と多様性を両立させる! 泌尿器科外来ベストNAVI】尿路・性器の感染症膿腎症

渡邉豊彦

臨床泌尿器科 76 ( 4 ) 019 - 022 2022.4

Language：Japanese Publisher：(株)医学書院

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

【初心にかえって、TURBTの手技徹底検証!】合併症を回避するTURBTの極意 Reviewed

西村慎吾, 小林泰之, 定平卓也, 岩田健宏, 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 and Robotics 35 ( 1 ) 45 - 50 2022.4

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

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

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 2022.2

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

DOI： 10.1097/TP.0000000000003803

Medical uses for silver nitrate in the urinary tract (Review) Reviewed

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

World Academy of Sciences Journal 4 ( 1 ) 2022.1

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

DOI： 10.3892/WASJ.2022.141

Intraluminal diamond‐like carbon coating with anti‐adhesion and anti‐biofilm effects for uropathogens: A novel technology applicable to urinary catheters Reviewed 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 28 ( 12 ) 1282 - 1289 2021.12

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

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

DOI： 10.1111/iju.14675

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

Guidelines for Infection Control in the Urological Field, including Urinary Tract Management (revised second edition) Reviewed International journal

Satoshi Takahashi, Soichi Arakawa, Kiyohito Ishikawa, Jun Kamei, Kanao Kobayashi, Katsumi Shigemura, Satoru Takahashi, Yoshiki Hiyama, Ryoichi Hamasuna, Hiroshi Hayami, Satoshi Yazawa, Mitsuru Yasuda, Yoshikazu Togo, Shingo Yamamoto, Koichiro Wada, Toyohiko Watanabe

International Journal of Urology 28 ( 12 ) 1198 - 1211 2021.12

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

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

DOI： 10.1111/iju.14684

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/iju.14684

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

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 28 ( 12 ) 1240 - 1246 2021.12

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 28 ( 10 ) 1026 - 1031 2021.10

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

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

DOI： 10.1111/iju.14636

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/iju.14636

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 2021.10

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

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

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

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

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

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 2021.8

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

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 2021.7

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

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

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 2021.6

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

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

Efficacy and safety of intravesical instillation of KRP-116D (50% dimethyl sulfoxide solution) for interstitial cystitis/bladder pain syndrome in Japanese patients: A multicenter, randomized, double-blind, placebo-controlled, clinical study. Reviewed International journal

Naoki Yoshimura, Yukio Homma, Hikaru Tomoe, Atsushi Otsuka, Takeya Kitta, Naoya Masumori, Yoshiyuki Akiyama, Aya Niimi, Takahiko Mitsui, Masaharu Nanri, Takashige Namima, Mineo Takei, Akito Yamaguchi, Yuki Sekiguchi, Mitsuru Kajiwara, Shinya Kobayashi, Kaname Ameda, Yozo Ohashi, Sadaaki Sakamoto, Osamu Muraki, Toshihide Shishido, Shinji Kageyama, Koji Kokura, Homare Okazoe, Tomonori Yamanishi, Toyohiko Watanabe, Takashi Uno, Akira Ohinata, Tomohiro Ueda

International journal of urology : official journal of the Japanese Urological Association 28 ( 5 ) 545 - 553 2021.5

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

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

DOI： 10.1111/iju.14505

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 Publish Ahead of Print ( 2 ) 280 - 288 2021.4

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

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

DOI： 10.1097/tp.0000000000003803

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

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

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

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)

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

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

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 - 673 2021

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. Reviewed

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

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

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

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

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

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

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 2020.5

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

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 2020.5

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

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 guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Reviewed International journal

Noritoshi Sekido, Yasuhiko Igawa, Hidehiro Kakizaki, Takeya Kitta, Atsushi Sengoku, Satoru Takahashi, Ryosuke Takahashi, Katsuyuki Tanaka, Takashige Namima, Masashi Honda, Takahiko Mitsui, Tomonori Yamanishi, Toyohiko Watanabe

International journal of urology : official journal of the Japanese Urological Association 27 ( 4 ) 276 - 288 2020.4

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

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

DOI： 10.1111/iju.14186

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 2020.3

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

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

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

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

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

Sadahira T, Wada K, Ikawa K, Morikawa N, Mitsui M, Araki M, Fujiyoshi M, Ishii A, Watanabe M, Watanabe T, Nasu Y

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

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 2019.8

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

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

Tsuboi I, Araki M, Fujiwara H, Iguchi T, Hiraki T, Arichi N, Kawamura K, Maruyama Y, Mitsui Y, Sadahira T, Kubota R, Nishimura S, Sako T, Takamoto A, Wada K, Kobayashi Y, Watanabe T, Yanai H, Kitagawa M, Tanabe K, Sugiyama H, Wada J, Shiina H, Kanazawa S, Nasu Y

Acta medica Okayama 73 ( 3 ) 269 - 272 2019.6

Language：English

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

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

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 2019.5

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

Making a Case for Not Prescribing Antimuscarinic Drugs to Treat Overactive Bladder in Older Adults. Reviewed

Toyohiko Watanabe

The Journal of urology 201 ( 4 ) 676 - 677 2019.4

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 2019.4

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

【泌尿器科周術期パーフェクト管理】総論周術期の感染対策と抗菌薬投与

渡邉豊彦

臨床泌尿器科 73 ( 4 ) 019 - 021 2019.4

Language：Japanese Publisher：(株)医学書院

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

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

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 2019.3

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

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 2019.3

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

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 2019.2

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

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

Oiwa Y, Watanabe T, Sadahira T, Ishii A, Sako T, Inoue M, Wada K, Kobayashi Y, Araki M, Nasu Y

Acta medica Okayama 73 ( 1 ) 21 - 27 2019.2

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

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

Burned-out Prostate Cancer ? Primary Metastatic Cancer Not Detected on Repeat Biopsy. Reviewed

Mitsui Y, Sadahira T, Maruyama Y, Wada K, Tanimoto R, Sugimoto M, Araki M, Watanabe M, Yanai H, Watanabe T, Nasu Y

Acta medica Okayama 72 ( 6 ) 605 - 609 2018.12

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

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

Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors Reviewed

Yuki Maruyama, Takuya Sadahira, Yosuke Mitsui, Motoo Araki, Koichiro Wada, Ryuta Tanimoto, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Medical Oncology 35 ( 6 ) 80 2018.6

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

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

DOI： 10.1007/s12032-018-1140-5

Acute Inflammatory Syndrome Paradoxically Induced by De Novo Purine Inhibitors Synthesis Before Renal Transplantation: A Case Report and Review of the Literature Reviewed

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

Transplantation Proceedings 50 ( 3 ) 895 - 897 2018.4

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

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

DOI： 10.1016/j.transproceed.2017.12.030

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer Reviewed

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 &lt
0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

DOI： 10.1007/s10147-017-1203-1

Impact of selective media for detecting fluoroquinolone-insusceptible/extended-spectrum beta-lactamase-producing Escherichia coli before transrectal prostate biopsy Reviewed

Takuya Sadahira, Koichiro Wada, Motoo Araki, Ayano Ishii, Toyohiko Watanabe, Yoshitsugu Nasu, Masaya Tsugawa, Tadasu Takenaka, Yasutomo Nasu, Hiromi Kumon

INTERNATIONAL JOURNAL OF UROLOGY 24 ( 12 ) 842 - 847 2017.12

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

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

DOI： 10.1111/iju.13447

Ureterolithotripsy for a Ureteral Calculus at the Ureteroureterostomy of a Renal-transplant Recipient Reviewed

Yosuke Mitsui, Koichiro Wada, Motoo Araki, Takashi Yoshioka, Yuichi Ariyoshi, Shingo Nishimura, Yasuyuki Kobayashi, Katsumi Sasaki, Toyohiko Watanabe, Yasutomo Nasu

ACTA MEDICA OKAYAMA 71 ( 5 ) 449 - 452 2017.10

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

We describe a 40-year-old living-donor renal-transplant recipient who underwent successful ureterolithotripsy. He had been on hemodialysis for >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

Cost-Effectiveness Analysis of Long-Term Intermittent Self-Catheterization with Hydrophilic-Coated and Uncoated Catheters in Patients with Spinal Cord Injury in Japan Reviewed

Toyohiko Watanabe, Shingo Yamamoto, Momokazu Gotoh, Tadanori Saitoh, Osamu Yokoyama, Tatsunori Murata, Masayuki Takeda

LUTS-LOWER URINARY TRACT SYMPTOMS 9 ( 3 ) 142 - 150 2017.9

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

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

DOI： 10.1111/luts.12122

Robotic Renal Autotransplantation: First Case Outside of North America Reviewed

Motoo Araki, Koichiro Wada, Yosuke Mitsui, Takuya Sadahira, Risa Kubota, Shingo Nishimura, Takashi Yoshioka, Yuichi Ariyoshi, Kei Fujio, Atsushi Takamoto, Morito Sugimoto, Katsumi Sasaki, Yasuyuki Kobayashi, Shin Ebara, Hideki Taninishi, Hiroyuki Amano, Masashi Inui, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

ACTA MEDICA OKAYAMA 71 ( 4 ) 351 - 355 2017.8

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

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

DOI： 10.18926/AMO/55313

Antimicrobial susceptibilities of Chlamydia trachomatis isolated from the urethra and pharynx of Japanese males Reviewed

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 Reviewed

Yosuke Mitsui, Takuya Sadahira, Motoo Araki, Koichiro Wada, Ryuta Tanimoto, Yuichi Ariyoshi, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Clinical and Experimental Nephrology 22 ( 2 ) 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

A Combination Therapy of Partial Nephrectomy and Cryoablation Achieved Good Cancer Control and Renal Function in Bilateral Synchronous Renal Cell Carcinoma Reviewed

Atsushi Takamoto, Motoo Araki, Koichiro Wada, Morito Sugimoto, Yasuyuki Kobayashi, Katsumi Sasaki, Toyohiko Watanabe, Yasutomo Nasu

ACTA MEDICA OKAYAMA 71 ( 2 ) 187 - 190 2017.4

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

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

DOI： 10.18926/AMO/54989

Clinical pharmacokinetics of oral levofloxacin and sitafloxacin in epididymal tissue Reviewed

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

Efficacy and safety of 3 day versus 7 day cefditoren pivoxil regimens for acute uncomplicated cystitis: multicentre, randomized, open-label trial Reviewed

Takuya Sadahira, Koichiro Wada, Motoo Araki, Ayano Ishii, Atsushi Takamoto, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

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

DOI： 10.1093/jac/dkw424

【高齢化社会で増加する排尿障害】排尿障害を来す疾患神経因性膀胱

渡邉豊彦

臨牀と研究 94 ( 2 ) 162 - 166 2017.2

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

Diagnostic Ureteroscopy for Cases Clinically Suspected of Carcinoma in Situ of the Upper Urinary Tract Reviewed

Katsumi Sasaki, Koichiro Wada, Motoo Araki, Yasuyuki Kobayashi, Morito Sugimoto, Shin Ebara, Toyohiko Watanabe, Yasutomo Nasu

ACTA MEDICA OKAYAMA 71 ( 3 ) 227 - 232 2017

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

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

DOI： 10.18926/AMO/55205

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition Reviewed

Mitsuru Yasuda, Tetsuro Muratani, Kiyohito Ishikawa, Hiroshi Kiyota, Hiroshi Sakata, Katsumi Shigemura, Satoshi Takahashi, Ryoichi Hamasuna, Hiroshi Hayami, Hiroshige Mikamo, Shingo Yamamoto, Toyohiko Watanabe, Soichi Arakawa

JOURNAL OF INFECTION AND CHEMOTHERAPY 22 ( 9-10 ) 651 - 661 2016.9

A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis Reviewed

Koichiro Wada, Shinya Uehara, Ayano Ishii, Takuya Sadahira, Masumi Yamamoto, Ritsuko Mitsuhata, Atsushi Takamoto, Motoo Araki, Yasuyuki Kobayashi, Masami Watanabe, Toyohiko Watanabe, Katsuyuki Hotta, Yasutomo Nasu

ACTA MEDICA OKAYAMA 70 ( 4 ) 299 - 302 2016.8

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

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

DOI： 10.18926/AMO/54508

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 - 297 2016.8

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

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

DOI： 10.18926/AMO/54507

Clinical analysis of bacterial strain profiles isolated from urinary tract infections: A 30-year study Reviewed

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 22 ( 7-8 ) 478 - 482 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 poly microbial infection). We examined these isolates to identify pathogens and tested for antimicrobial susceptibility.
Results: Isolates from complicated UTI over a 30-year period revealed Pseudomonas aeruginosa (P. aeruginosa) was the most frequently isolated in the first decade (1984-1994), MRSA in the second decade (1995-2004), and Escherichia coli (E. coli) in the latest decade (2005-2014). In uncomplicated UTI examined over 20 years, E. coli was the most frequently isolated species accounting for 47-94% of isolates. Fluoroquinolone (FQs)-insusceptible E. coli were first isolated in 1994 and increased to about 35% in 2013 in patients with complicated UTI.
Conclusions: Complicated UTI involving P. aeruginosa and MRSA decreased over the last 10 years. Our data suggest that several factors such as shorter hospitalizations, shorter indwelling catheter use, and appropriate antimicrobial use has decreased colonization of P. aeruginosa and MRSA with relative increases in isolation of E. coli including FQs-insusceptible strains. We must continue our surveillance of antimicrobial-resistant bacteria isolated from urine samples and evaluate antibiograms, since their persistence in the urinary tract would be problematic. (C) 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2016.04.004

尿路性器感染症に関する臨床試験実施のためのガイドライン(第2版) ガイドラインの改訂にあたって Reviewed

荒川創一, 石川清仁, 清田浩, 坂田宏, 重村克巳, 高橋聡, 濱砂良一, 速見浩士, 三鴨廣繁, 村谷哲郎, 安田満, 山本新吾, 渡邉豊彦, 公益社団法人日本化学療法学会尿路性器感染症に関する臨床試験実施のためのガイドライン改訂委員会

日本化学療法学会雑誌 64 ( 3 ) 479 - 493 2016.5

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

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

過活動膀胱の診断と治療戦略

渡邉豊彦

兵庫県医師会医学雑誌 57 ( 2 ) 1 - 4 2015.3

Occurrence of infection following prostate biopsy procedures in Japan Japanese Research Group for Urinary Tract Infection (JRGU) - A multi-center retrospective study Reviewed

Yoshikazu Togo, Tatsuhiko Kubo, Rikiya Taoka, Yoshiki Hiyama, Teruhisa Uehara, Jiroh Hashimoto, Yuichiro Kurimura, Satoshi Takahashi, Taiji Tsukamoto, Jun Miyazaki, Hiroyuki Nishiyama, Shinichiro Kira, Hiroshi Kiyota, Satoshi Yazawa, Naoya Niwa, Hiroshi Hongo, Mototsugu Oya, Taku Kato, Mitsuru Yasuda, Takashi Deguchi, Kiyohito Ishikawa, Kiyotaka Hoshinaga, Minort Matsumoto, Katsumi Shigemura, Kazushi Tanaka, Soichi Arakawa, Masato Fujisawa, Koichiro Wada, Shinya Uehara, Toyohiko Watanabe, Hiromi Kumon, Kanao Kobayashi, Akio Matsubara, Masahiro Matsumoto, Takehiko Sho, Ryoichi Hamasuna, Tetsuro Matsumoto, Hiroshi Hayami, Masayuki Nakagawa, Shingo Yamamoto

JOURNAL OF INFECTION AND CHEMOTHERAPY 20 ( 3-4 ) 232 - 237 2014.3

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

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

DOI： 10.1016/j.jiac.2013.10.003

A prospective multi-institutional analysis according to the "Japanese guidelines for prevention of perioperative infections in urological field" Reviewed

Koichiro Wada, Shinya Uehara, Shinichiro Kira, Masahiro Matsumoto, Takehiko Sho, Yuichiro Kurimura, Jiro Hashimoto, Teruhisa Uehara, Takashi Yamane, Sojun Kanamaru, Yoshikazu Togo, Rikiya Taoka, Akira Takahashi, Yusuke Yamada, Akira Yokomizo, Mitsuru Yasuda, Kazushi Tanaka, Ryoichi Hamasuna, Satoshi Takahashi, Hiroshi Hayami, Toyohiko Watanabe, Koichi Monden, Hiroshi Kiyota, Takashi Deguchi, Seiji Naito, Taiji Tsukamoto, Soichi Arakawa, Masato Fujisawa, Shingo Yamamoto, Hiromi Kumon, Tetsuro Matsumoto

Japanese Journal of Urology 104 ( 3 ) 505 - 512 2013

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

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

DOI： 10.5980/jpnjurol.104.505

Laparoscopic management of complicated urachal remnants in adults Reviewed

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 - 650 2012.10

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

Prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae among heterosexual men in Japan Reviewed

Koichiro Wada, Shinya Uehara, Ritsuko Mitsuhata, Reiko Kariyama, Hiroyuki Nose, Shinichi Sako, Ayano Ishii, Toyohiko Watanabe, Akira Matsumoto, Koichi Monden, Satoru Uno, Tohru Araki, Hiromi Kumon

JOURNAL OF INFECTION AND CHEMOTHERAPY 18 ( 5 ) 729 - 733 2012.10

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

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

DOI： 10.1007/s10156-012-0410-y

Ureteroscopic Management of Chronic Unilateral Hematuria: A Single-Center Experience over 22 Years Reviewed

Motoo Araki, Shinya Uehara, Katsumi Sasaki, Koichi Monden, Masaya Tsugawa, Toyohiko Watanabe, Manoji Monga, Yasutomo Nasu, Hiromi Kumon

PLOS ONE 7 ( 6 ) e36729 2012.6

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

Objective: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria.
Methods: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat (TM)). Lesions identified ureteroscopically were treated with diathermy fulguration.
Results: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14-80) years and median follow-up of 139 (34-277) months. The median preoperative duration of gross hematuria was 5 (1-144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of "no lesions" was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<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

【泌尿器科ベッドサイドマニュアル】ベッドサイドトラブル対処法創感染症,創離開

渡邉豊彦

臨床泌尿器科 66 ( 4 ) 108 - 112 2012.4

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 - 29 2012.2

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

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

DOI： 10.18926/AMO/48078

Pelvic surgeons caught in the meshes of the law. Reviewed

Toyohiko Watanabe

Reviews in urology 14 ( 1-2 ) 35 - 36 2012.1

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

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 - 251 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

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women Reviewed

Tomoko Sako, Miyabi Inoue, Toyohiko Watanabe, Ayano Ishii, Teruhiko Yokoyama, Hiromi Kumon

INTERNATIONAL UROGYNECOLOGY JOURNAL 22 ( 2 ) 165 - 169 2011.2

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

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

DOI： 10.1007/s00192-010-1250-x

Cell-penetrating D-Isomer Peptides of p53 C-terminus: Long-term Inhibitory Effect on the Growth of Bladder Cancer Reviewed

Daiji Araki, Kentaro Takayama, Miyabi Inoue, Toyohiko Watanabe, Hiromi Kumon, Shiroh Futaki, Hideki Matsui, Kazuhito Tomizawa

UROLOGY 75 ( 4 ) 813 - 819 2010.4

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

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

DOI： 10.1016/j.urology.2009.10.002

The future of urodynamics: Non-invasive ultrasound videourodynamics Reviewed

Hideo Ozawa, Tatsuo Igarashi, Katsutoshi Uematsu, Toyohiko Watanabe, Hiromi Kumon

INTERNATIONAL JOURNAL OF UROLOGY 17 ( 3 ) 241 - 249 2010.3

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

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

DOI： 10.1111/j.1442-2042.2010.02447.x

【Female Urology 新たなartとevidence】腹腔鏡を併用した新しいTVM手術

渡邉豊彦

Urology View 8 ( 1 ) 94 - 99 2010.2

【食中毒】ボツリヌス神経毒素を用いた尿失禁,尿排出障害の治療

渡辺豊彦, 公文裕巳

臨床検査 53 ( 6 ) 723 - 726 2009.6

Use of Doppler ultrasound for non-invasive urodynamic diagnosis Reviewed

Hideo Ozawa, Toyohiko Watanabe, Katsutoshi Uematsu, Katsumi Sasaki, Miyabi Inoue, Hiromi Kumon

Indian Journal of Urology 25 ( 1 ) 110 - 115 2009.1

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

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

DOI： 10.4103/0970-1591.45548

Naftopidil and propiverine hydrochloride for treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and concomitant overactive bladder: A prospective randomized controlled study Reviewed

Teruhiko Yokoyama, Katsutoshi Uematsu, Toyohiko Watanabe, Katsumi Sasaki, Hiromi Kumon, Atsushi Nagai

SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 43 ( 4 ) 307 - 314 2009

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

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

DOI： 10.1080/00365590902836740

慢性前立腺炎における新しいバイオマーカーとしてのNGFの有用性について Reviewed

渡辺豊彦, 上原慎也, 荒木大司, 井上雅, 門田晃一, 雑賀隆史, 那須保友, 公文裕巳, 横山光彦

西日本泌尿器科 69 ( 10 ) 578 - 583 2007.10

Language：Japanese Publisher：西日本泌尿器科学会

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

Natural course of lower urinary tract symptoms following discontinuation of alpha-1-adrenergic blockers in patients with benign prostatic hyperplasia Reviewed

Teruhiko Yokoyama, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon, Yoshiyuki Miyaji, Atsushi Nagai

INTERNATIONAL JOURNAL OF UROLOGY 14 ( 7 ) 598 - 601 2007.7

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

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

DOI： 10.1111/j.1442-2042.2007.01784.x

Comparison of 25 and 75 mg/day naftopidil for lower urinary tract symptoms associated with benign prostatic hyperplasia: A prospective, randomized controlled study Reviewed

Teruhiko Yokoyama, Hiromi Kumon, Yoshitsugu Nasu, Hitoshi Takamoto, Toyohiko Watanabe

INTERNATIONAL JOURNAL OF UROLOGY 13 ( 7 ) 932 - 938 2006.7

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

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

DOI： 10.1111/j.1442-2042.2006.01443.x

Intravesical resiniferatoxin for patients with neurogenic detrusor overactivity Reviewed

T Watanabe, T Yokoyama, K Sasaki, K Nozaki, H Ozawa, H Kumon

INTERNATIONAL JOURNAL OF UROLOGY 11 ( 4 ) 200 - 205 2004.4

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

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

DOI： 10.1111/j.1442-2042.2003.00782.x

Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy Reviewed

T Yokoyama, J Nishiguchi, T Watanabe, H Nose, K Nozaki, O Fujita, M Inoue, H Kumon

UROLOGY 63 ( 2 ) 264 - 267 2004.2

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

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

DOI： 10.1016/j.urology.2003.09.024

移植腎機能廃絶後のacquired cystic disease of the kidney(ACDK)に発症した両側性固有腎細胞癌の1例 Reviewed

渡辺豊彦, 武田克治, 小林泰之, 朝日俊彦

西日本泌尿器科 65 ( 2 ) 65 - 68 2003.2

Language：Japanese Publisher：西日本泌尿器科学会

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

Development of noninvasive velocity flow video urodynamics using Doppler sonography. Part II: Clinical application in bladder outlet obstruction Reviewed

H Ozawa, H Kumon, T Yokoyama, T Watanabe, MB Chancellor

JOURNAL OF UROLOGY 160 ( 5 ) 1792 - 1796 1998.11

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

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

Development of noninvasive velocity flow video urodynamics using Doppler sonography - Part I: Experimental urethra Reviewed

H Ozawa, H Kumon, T Yokoyama, T Watanabe, MB Chancellor

JOURNAL OF UROLOGY 160 ( 5 ) 1787 - 1791 1998.11

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

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

Ice-water test in the urodynamic evaluation of spinal cord injured patients. Reviewed

Toyohiko Watanabe

Techniques in urology 4 ( 2 ) 87 - 91 1998.6

Publishing type：Research paper (scientific journal)

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

Inguinal cystoceles: A previously overlooked etiology of prostatism in men without bladder outlet obstruction Reviewed

H Kumon, H Ozawa, T Yokoyama, DA Rivas, T Watanabe, MB Chancellor

JOURNAL OF UROLOGY 159 ( 3 ) 766 - 771 1998.3

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

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

DOI： 10.1016/s0022-5347(01)63724-8

Early predictors of bladder recovery and urodynamics after spinal cord injury Reviewed

PJ Shenot, DA Rivas, T Watanabe, MB Chancellor

NEUROUROLOGY AND URODYNAMICS 17 ( 1 ) 25 - 29 1998

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

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

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

Gracilis urethral myoplasty: Preliminary experience using an autologous urinary sphincter for post-prostatectomy incontinence Reviewed

MB Chancellor, T Watanabe, DA Rivas, RD Hong, H Kumon, H Ozawa, Bourgeois, I

JOURNAL OF UROLOGY 158 ( 4 ) 1372 - 1375 1997.10

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

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

DOI： 10.1016/s0022-5347(01)64218-6

Fully hydrated images of Pseudomonas aeruginosa biofilm on the surface of catheter material. Reviewed

Toyohiko Watanabe

The Canadian journal of urology 4 ( 3 ) 416 - 421 1997.9

Publishing type：Research paper (scientific journal)

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

Gracilis urethromyoplasty - an autologous urinary sphincter for neurologically impaired patients with stress incontinence Reviewed

MB Chancellor, RD Hong, DA Rivas, T Watanabe, JA Crewalk, Bourgeois, I

SPINAL CORD 35 ( 8 ) 546 - 549 1997.8

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

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

DOI： 10.1038/sj.sc.3100444

Rectus urethromyoplasty of radical prostatectomy anastomosis decreases postoperative incontinence and anastomotic stricture; Technique and preliminary results Reviewed

MB Chancellor, S Strup, DA Rivas, T Watanabe, LG Gomella

JOURNAL OF UROLOGY 157 ( 1 ) 371 - 375 1997.1

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

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

In-vivo whole bladder response to anticholinergic and musculotropic agents in spinal cord injured rats Reviewed

Patrick J. Shenot, Michael B. Chancellor, David A. Rivas, Toyohiko Watanabe, Hiromi Kumon, T. Ernesto Figueroa

Journal of Spinal Cord Medicine 20 ( 1 ) 31 - 35 1997

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

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

DOI： 10.1080/10790268.1997.11719389

The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter Reviewed

T Watanabe, DA Rivas, R Smith, WE Staas, MB Chancellor

JOURNAL OF UROLOGY 156 ( 6 ) 1926 - 1928 1996.12

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

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

Gracilis muscle dynamic urethral sphincter myoplasty: Rat model experience Reviewed

T Watanabe, DA Rivas, B Huang, AW Epple, TE Figueroa, MB Chancellor

JOURNAL OF UROLOGY 156 ( 4 ) 1507 - 1510 1996.10

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

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

Urodynamics of spinal cord injury Reviewed

T Watanabe, DA Rivas, MB Chancellor

UROLOGIC CLINICS OF NORTH AMERICA 23 ( 3 ) 459 - & 1996.8

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

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

DOI： 10.1016/s0094-0143(05)70325-6

Epidemiology of current treatment for sexual dysfunction in spinal cord injured men in the USA model spinal cord injury centers. Reviewed

Toyohiko Watanabe

The journal of spinal cord medicine 19 ( 3 ) 186 - 189 1996.7

Publishing type：Research paper (scientific journal)

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

DOI： 10.1080/10790268.1996.11719430

Fascial sling correction of kinked efferent limb in patients with continent diversion and catheterization difficulty Reviewed

MB Chancellor, PJ Shenot, RD Hong, T Watanabe, DA Rivas

JOURNAL OF UROLOGY 156 ( 1 ) 162 - 163 1996.7

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

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

Intravesical capsaicin in neurologic impaired patients with detrusor hyperreflexia. Reviewed

Das A, Chancellor MB, Watanabe T, Sedor J, Rivas DA

The journal of spinal cord medicine 19 ( 3 ) 190 - 193 1996.7

Total incontinence secondary to sphincter destruction after prostate cryotherapy for recurrent prostatic carcinoma. Reviewed

Watanabe T, Rivas DA, Miettinen M, Gomella L, Chancellor MB

International journal of urology : official journal of the Japanese Urological Association 3 ( 4 ) 324 - 325 1996.7

Reversible clinical outcome after sphincter stent removal Reviewed

MB Chancellor, DA Rivas, T Watanabe, JK Bennett, JE Foote, BG Green, EW Killorin, R MacMillan

JOURNAL OF UROLOGY 155 ( 6 ) 1992 - 1994 1996.6

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

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

岡山大学泌尿器科における術後感染症の年次変遷 Reviewed

渡辺豊彦, 妹尾孝司, 井上高明

西日本泌尿器科 57 ( 3 ) 240 - 243 1995.3

Language：Japanese Publisher：西日本泌尿器科学会

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

Observation of Pseudornonas aeruginosa Biofilm with Confocal Laser Scanning Microscope Reviewed

WATANABE Toyohiko

69 ( 1 ) 114 - 122 1995.1

緑膿菌性複雑性尿路感染症に対するcarindacillin(CIPC)の再評価 Reviewed

渡辺豊彦, 竹中皇, 門田晃一

日本化学療法学会雑誌 43 ( 1 ) 89 - 95 1995.1

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

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

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

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

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

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

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

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

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

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

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

Veterinary medicine international 2024 6505595 - 6505595 2024

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

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

DOI： 10.1155/2024/6505595

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

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

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 Reviewed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

【トラブルゼロを目指した泌尿器縫合術-今さら聞けない! 開放手術のテクニック】総論感染創の縫合

丸山雄樹, 渡邉豊彦

臨床泌尿器科 76 ( 7 ) 438 - 443 2022.6

Language：Japanese Publisher：(株)医学書院

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

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

ステント付着結石により3本尿管ステント留置し2度のECIRSによりstone freeとなった1例

堀井聡, 奥村美紗, 渡部智文, 関戸崇了, 徳永素, 吉永香澄, 丸山雄樹, 山野井友昭, 長尾賢太郎, 富永悠介, 定平卓也, 片山聡, 岩田健宏, 西村慎吾, 佐古智子, 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 84 ( 増刊号2 ) 168 - 168 2022.6

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 Reviewed

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

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

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

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

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

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

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

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

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

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

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

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

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 Reviewed

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)

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

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

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

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

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

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)

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

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

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

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

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

限局性上部尿路上皮癌における腫瘍グレードと病期を中心とした予測モデルの精度と臨床的有用性(Accuracy and clinical utility of the tumor grade and stage-centered predictive model in localized upper tract urothelial carcinoma)

片山聡, 荒木元朗, 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

西日本泌尿器科学会総会抄録集 73回 173 - 173 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

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

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

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

小林泰之, 富永悠介, 長尾賢太郎, 山野井友昭, 西村慎吾, 岩田健宏, 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 35回 PD - 1 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

【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 Reviewed

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)日本泌尿器内視鏡学会

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

DOI： 10.11302/jsejje.34.221

【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 Reviewed

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)

DOI： 10.11302/jsejje.34.182

マージナルドナーから生体腎移植を受けたレシピエントの術後成績

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

移植 56 ( 総会臨時 ) O18 - 6 2021.9

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

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

DOI： 10.11386/jst.56.supplement_s474

CFIR201S変異を認めたaHUSレシピエントに対する生体腎移植の一例

山野井友昭, 荒木元朗, 和田耕一郎, 西村慎吾, 奥村美紗, 関戸崇了, 吉永香澄, 和田里章悟, 丸山雄樹, 定平卓也, 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 ) P1 - 44 2021.9

腎移植患者のタクロリムス血中濃度にボノプラザンが与える薬物相互作用の検討

和田里章悟, 荒木元朗, 松本准, 関戸崇了, 吉永香澄, 丸山雄樹, 定平卓也, 西村慎吾, 和田耕一郎, 小林泰之, 渡邉豊彦, 竹内英実, 田邊克幸, 那須保友

移植 56 ( 総会臨時 ) O16 - 2 2021.9

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

【目的】

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

【対象と方法】

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

【結果】

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

【結語】

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

DOI： 10.11386/jst.56.supplement_s323

腎移植後の尿細胞診で6ヵ月以上持続するDecoy細胞陽性所見はBKウイルス腎症の発症予測に有効である

関戸崇了, 荒木元朗, 吉永香澄, 丸山雄樹, 定平卓也, 西村慎吾, 和田耕一郎, 渡部昌実, 渡邉豊彦, 田邊克幸, 竹内英実, 和田淳, 柳井広之, 那須保友

移植 56 ( 総会臨時 ) O17 - 3 2021.9

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

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

DOI： 10.11386/jst.56.supplement_s441

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 Reviewed

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：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)

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 Reviewed

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)

腎門部に発生した粘液嚢胞腺癌の1例 Reviewed

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：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)

若年発症の前立腺炎症性偽腫瘍の1例

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 ) 11 - 11 2021.6

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

Takanori Maehara, Takuya Sadahira, Yuki Maruyama, Koichiro Wada, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Hiroyuki Yanai, Yasutomo Nasu

Urology Annals 13 ( 2 ) 119 - 124 2021.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Wolters Kluwer Medknow Publications

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

DOI： 10.4103/UA.UA_81_20

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

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)

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

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

Retroperitoneal malignant peripheral nerve sheath tumor associated with neurofibromatosis type 1: A case report Reviewed

Daijiro Soda, Takehiro Iwata, Takuya Sadahira, Yusuke Tominaga, Satoshi Katayama, Shingo Nishimura, Atsushi Takamoto, Tomoko Sako, Kohei Edamura, Yasuyuki Kobayashi, Motoo Araki, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu, Eiji Nakada, Hiroyuki Yanai

Nishinihon Journal of Urology 82 ( 6 ) 596 - 600 2021.2

Language：Japanese Publisher：The West Japan Urological Association

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

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

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

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.

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

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

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

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

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

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

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を発症した1例 Reviewed

笹岡丈人, 平田武志, 倉繁拓志, 早田俊司, 富永悠介, 光井洋介, 定平卓也, 高本篤, 小林泰之, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 82 ( 4 ) 449 - 452 2020.10

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)

腎摘除術を要した多房性気腫性腎盂腎炎の1例 Reviewed

小林宏州, 高本篤, 定平卓也, 和田耕一郎, 前原貴典, 大岩裕子, 岩田健宏, 西村慎吾, 杉本盛人, 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 82 ( 4 ) 465 - 469 2020.10

Language：Japanese Publisher：西日本泌尿器科学会

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

【泌尿器がんに対するfocal therapyの現状と展望】小径腎がんに対する経皮的ラジオ波焼灼療法の現状と展望 Reviewed

平木隆夫, 宇賀麻由, 冨田晃司, 松井裕輔, 生口俊浩, 金澤右, 荒木元朗, 小林泰之, 渡邉豊彦, 郷原英夫

泌尿器科 12 ( 3 ) 233 - 240 2020.9

【腎盂・尿管癌の治療を考える】腎盂・尿管癌における腹腔鏡下腎尿管全摘除術の適応

吉永香澄, 荒木元朗, 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, 西村慎吾, 高本篤, 和田耕一郎, 佐古智子, 枝村康平, 小林泰之, 渡部昌実, 渡辺豊彦, 那須保友

泌尿器外科 33 ( 5 ) 455 - 461 2020.5

Language：Japanese Publisher：医学図書出版(株)

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

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.

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

非淋菌性尿道炎に対する1日200mg sitafloxacin投与法 Reviewed

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)

Education of robotic surgery in the Department of Urology, Okayama University Hospital Reviewed

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

Japanese Journal of Endourology 33 ( 2 ) 221 - 224 2020

Language：Japanese Publisher：Japanese Society of Endourology

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

DOI： 10.11302/jsejje.33.221

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

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

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

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

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

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

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.

Robotic renal auto transplantation Reviewed

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.

Experience of robot-assisted radical cystectomy in Okayama University Hospital Reviewed

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.

【腹腔鏡手術〜初心者に何をどう教えるべきか〜】ロボット支援腹腔鏡下手術時代における腹腔鏡教育 Reviewed

小林泰之, 和田耕一郎, 枝村康平, 荒木元朗, 渡辺豊彦, 那須保友

Japanese Journal of Endourology 32 ( 1 ) 28 - 31 2019.4

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

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

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

経尿道的砕石術(TUL)を施行した小児腎結石症の1例 Reviewed

佐久間貴文, 和田耕一郎, 本郷智拡, 前原貴典, 高本篤, 坪井一朗, 松尾聡子, 三井將雄, 和田里章悟, 河村香澄, 丸山雄樹, 光井洋介, 窪田理沙, 大岩裕子, 定平卓也, 西村慎吾, 佐古智子, 枝村康平, 小林泰之, 石井亜矢乃, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 81 ( 2 ) 243 - 244 2019.4

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

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.

高位精巣摘除術後14年後に再発をきたしたStage I期セミノーマの1例(VERY LATE RELAPSE AND MANAGEMENT OF CLINICAL STAGE I SEMINOMA AFTER ORCHIECTOMY: A CASE REPORT) Reviewed

和田里章悟, 定平卓也, 高本篤, 丸山雄樹, 光井洋介, 和田耕一郎, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡邉昌実, 渡邉豊彦, 那須保友, 柳井広之

西日本泌尿器科 81 ( 1 ) 45 - 48 2019.2

Language：English Publisher：西日本泌尿器科学会

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

女性過活動膀胱に対する牛車腎気丸の効果と冷えとの関係について Reviewed

松本裕子, 石井亜矢乃, 山本満寿美, 松尾聡子, 佐古智子, 荒木元朗, 渡邉豊彦, 那須保友, 井上雅, 荒木詞奈子, 石戸則孝, 高本均

西日本泌尿器科 81 ( 1 ) 12 - 16 2019.2

Language：Japanese Publisher：西日本泌尿器科学会

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

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

高位精巣摘除術後14年後に再発をきたしたStage I期セミノーマの1例(VERY LATE RELAPSE AND MANAGEMENT OF CLINICAL STAGE I SEMINOMA AFTER ORCHIECTOMY: A CASE REPORT) Reviewed

和田里章悟, 定平卓也, 高本篤, 丸山雄樹, 光井洋介, 和田耕一郎, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡邉昌実, 渡邉豊彦, 那須保友, 柳井広之

西日本泌尿器科 81 ( 1 ) 45 - 48 2019.2

Language：English Publisher：西日本泌尿器科学会

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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01004&link_issn=&doc_id=20190222240009&doc_link_id=%2Fer9niuro%2F2019%2F008101%2F009%2F0045-0048%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2019%2F008101%2F009%2F0045-0048%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Robotic-assisted renal autotransplantation: Preliminary studies and future directions Reviewed

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

Urethral tumor induced by methotrexate-associated lymphoproliferative disorders: A case report Reviewed

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

Nishinihon Journal of Urology 80 ( 12 ) 678 - 683 2018.12

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

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

尿道腫瘤を認めたメトトレキサート関連リンパ増殖性疾患の1例 Reviewed

河村香澄, 丸山雄樹, 定平卓也, 光井洋介, 西村慎吾, 高本篤, 甲斐誠二, 和田耕一郎, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡部昌実, 渡辺豊彦, 那須保友, 田中健大

西日本泌尿器科 80 ( 12 ) 678 - 683 2018.12

Language：Japanese Publisher：西日本泌尿器科学会

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

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

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

再発性尿路感染症に対するプロバイオティクスの有効性 Reviewed

定平卓也, 和田耕一郎, 三井將雄, 石井亜矢乃, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 80 ( 10 ) 505 - 509 2018.10

Language：Japanese Publisher：西日本泌尿器科学会

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

THE PROMISING USE OF PROBIOTICS AGAINST RECURRENT URINARY TRACT INFECTIONS Reviewed

定平卓也, 和田耕一郎, 三井將雄, 石井亜矢乃, 荒木元朗, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 = The Nishinihon journal of urology 80 ( 10 ) 505 - 509 2018.10

Language：Japanese Publisher：西日本泌尿器科学会

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

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

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

自然消失した膀胱炎症性偽腫瘍の1例 Reviewed

丸山雄樹, 高本篤, 光井洋介, 定平卓也, 岩田健宏, 西村慎吾, 甲斐誠二, 和田耕一朗, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡辺昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 80 ( 9 ) 465 - 468 2018.9

Language：Japanese Publisher：西日本泌尿器科学会

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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01004&link_issn=&doc_id=20180926230003&doc_link_id=%2Fer9niuro%2F2018%2F008009%2F003%2F0465-0468%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2018%2F008009%2F003%2F0465-0468%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

自然消失した膀胱炎症性偽腫瘍の1例 Reviewed

丸山雄樹, 高本篤, 光井洋介, 定平卓也, 岩田健宏, 西村慎吾, 甲斐誠二, 和田耕一朗, 谷本竜太, 杉本盛人, 小林泰之, 荒木元朗, 渡辺昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 80 ( 9 ) 465 - 468 2018.9

Language：Japanese Publisher：西日本泌尿器科学会

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

超高齢時代の筋層浸潤性膀胱癌に対する低侵襲手術岡山大学における高齢者に対する腹腔鏡下膀胱全摘除術の経験 Reviewed

小林泰之, 大岩裕子, 高本篤, 和田耕一郎, 杉本盛人, 荒木元朗, 渡邉豊彦, 那須保友

西日本泌尿器科 80 ( 4 ) 132 - 136 2018.4

Language：Japanese Publisher：西日本泌尿器科学会

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

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

泌尿器科領域におけるトラブルシューティング(第88回) 人生最大の危機脱出日本泌尿器科学会総会直前に遭遇したフルニエ壊疽の1例

渡邉豊彦

泌尿器外科 31 ( 2 ) 169 - 172 2018.2

抗菌薬の臨床評価方法に関するガイドライン平成29年10月23日付け薬生薬審発1023号第3号厚生労働省医薬・生活衛生局医薬品審査管理課長通知 Reviewed

河野茂, 砂川慶介, 二木芳人, 東山康仁, 堀誠治, 荒川創一, 八木澤守正, 柳原克紀, 小笠原和彦, 小田島正明, 小野真, 加藤研一, 高橋誠, 津下宏之, 長島正人, 丸尾彰範, 佐藤淳子, 三鴨廣繁, 赤松浩彦, 大西誉光, 山崎修, 渡辺晋一, 草地信也, 竹末芳生, 小谷明弘, 弦本敏行, 松下和彦, 門田淳一, 綿貫祐司, 石川清仁, 清田浩, 重村克己, 高橋聡, 濱砂良一, 速見浩士, 村谷哲郎, 安田満, 山本新吾, 渡邉豊彦, 竹末芳生, 野口靖之, 吉村和晃, 相楽裕子, 外園千恵, 中川尚, 秦野寛, 黒野祐一, 鈴木賢二, 山中昇, 金子明寛, 山根伸夫, 岩田敏, 尾内一信, 坂田宏, 舘田一博, 抗菌薬臨床評価ガイドライン改定委員会

日本化学療法学会雑誌 66 ( 1 ) 1 - 81 2018.1

【尿膜管遺残症に対する腹腔鏡手術-術式とその問題点】経腹膜側方アプローチによる腹腔鏡下尿膜管摘除術 Reviewed

荒木元朗, 小林泰之, 高本篤, 谷本竜太, 杉本盛人, 和田耕一郎, 渡邉豊彦, 那須保友

Japanese Journal of Endourology 30 ( 2 ) 119 - 122 2017.9

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

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

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

当院で施行した先行的腎移植(Pre-emptive Renal Transplantation:PRT)の検討 Reviewed

光井洋介, 荒木元朗, 山下里美, 吉岡貴史, 有吉勇一, 和田耕一郎, 小林泰之, 江原伸, 渡辺豊彦, 那須保友, 北川正史, 田邊克幸, 杉山斉, 和田淳

日本臨床腎移植学会雑誌 5 ( 1 ) 89 - 90 2017.7

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

後腹膜線維症に対し尿管剥離術および大網ラッピングを施行した1例 Reviewed

児島宏典, 荒木元朗, 藤尾圭, 吉岡貴史, 森聰博, 高本篤, 堀川雄平, 杉本盛人, 和田耕一郎, 佐々木克己, 小林康之, 江原伸, 渡部昌実, 渡邉豊彦, 那須保友

西日本泌尿器科 79 ( 1 ) 12 - 15 2017.1

Language：Japanese Publisher：西日本泌尿器科学会

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

Ureterolysis with omental wrap for bilateral hydronephrosis secondary to retroperitoneal fibrosis: A case report

Hironori Kojima, Motoo Araki, Kei Fujio, Takashi Yoshioka, Akihiro Mori, Atsushi Takamoto, Yuhei Horikawa, Morito Sugimoto, Koichiro Wada, Katsumi Sasaki, Yasuyuki Kobayashi, Shin Ebara, Masami Watanabe, Toyohiko Watanabe, Yasutomo Nasu

Nishinihon Journal of Urology 79 ( 1 ) 12 - 15 2017

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

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

長期透析患者に対する腎移植症例の検討 Reviewed

有吉勇一, 荒木元朗, 光井洋介, 吉岡貴史, 和田耕一郎, 小林泰之, 江原伸, 渡邉豊彦, 那須保友, 山下里美, 北川正史, 田邊克幸, 森永裕士, 杉山斉, 和田淳

日本臨床腎移植学会雑誌 4 ( 1 ) 113 - 117 2016.7

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

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

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

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

ロボット支援・開腹術における腎部分切除の工夫 Reviewed

荒木元朗, 小林泰之, 井上陽介, 児島宏典, 光井洋介, 宗政修平, 定平卓也, 吉岡貴史, 有吉勇一, 森聰博, 藤尾圭, 高本篤, 松本裕子, 堀川雄平, 和田耕一郎, 杉本盛人, 佐々木克己, 石井亜矢乃, 渡部昌実, 江原伸, 渡辺豊彦, 那須保友

西日本泌尿器科 78 ( 4 ) 194 - 195 2016.4

不完全な尿管ステント留置と移植腎動脈下極枝の閉塞により尿管穿孔を生じた生体腎移植の一例

和田耕一郎, 荒木元朗, 有森千聖, 宗石理沙, 有吉勇一, 佐々木克己, 小林泰之, 渡部昌実, 江原伸, 渡邉豊彦, 那須保友, 公文裕巳, 吉岡貴史

腎移植・血管外科 26 ( 1 ) 82 - 87 2016.3

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

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

頻回再発性膀胱炎に対する乳酸菌腟坐剤の予防効果に関する臨床的検討 Reviewed

石井亜矢乃, 山本満寿美, 和田耕一郎, 渡辺豊彦, 狩山玲子, 上原慎也, 公文裕巳

感染症学雑誌 90 ( 2 ) 260 - 261 2016.3

リツキシマブを使用した腎移植症例

有吉勇一, 荒木元朗, 光井洋介, 吉岡貴史, 和田耕一郎, 小林泰之, 渡辺豊彦, 那須保友, 山下里美

今日の移植 28 ( 6 ) 705 - 706 2015.12

尿道ステント(Memokath)を用いた尿道狭窄症の治療成績 Reviewed

和田耕一郎, 荒木元朗, 小林泰之, 佐々木克己, 江原伸, 渡邉豊彦, 佐古智子, 井上雅, 上松克利, 藤田竜二, 上原慎也, 門田晃一, 小澤秀夫, 三枝道尚, 小野憲昭, 那須良次, 大橋洋三, 津島知靖, 光畑直喜, 高本均, 那須保友, 永井敦, 公文裕巳

西日本泌尿器科 77 ( 7 ) 264 - 265 2015.7

Levofloxacin 500mg単回投与における前立腺組織移行性の検討 Reviewed

定平卓也, 和田耕一郎, 上原慎也, 山本満寿美, 光畑律子, 能勢宏幸, 石井亜矢乃, 狩山玲子, 渡辺豊彦, 公文裕巳

日本化学療法学会雑誌 63 ( 4 ) 406 - 410 2015.7

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

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

A vaccine strategy with multiple prostatic acid phosphatase-fused cytokines for prostate cancer treatment Reviewed

Kei Fujio, Masami Watanabe, Hideo Ueki, Shun-Ai Li, Rie Kinoshita, Kazuhiko Ochiai, Junichiro Futami, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon

ONCOLOGY REPORTS 33 ( 4 ) 1585 - 1592 2015.4

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

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

DOI： 10.3892/or.2015.3770

泌尿器がんの最新治療ロボット支援下腎部分切除術の現状 Reviewed

小林泰之, 荒木元朗, 平田武志, 和田耕一郎, 佐々木克己, 江原伸, 那須保友, 渡邉豊彦, 公文裕巳

西日本泌尿器科 77 ( 4 ) 124 - 128 2015.4

Language：Japanese Publisher：西日本泌尿器科学会

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

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

【泌尿器科外来パーフェクトガイド誰にでもすぐに使える!】下部尿路機能障害過活動膀胱蓄尿障害がみられる患者です

渡邉豊彦

臨床泌尿器科 69 ( 4 ) 113 - 116 2015.4

Language：Japanese Publisher：(株)医学書院

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

【泌尿器科外来パーフェクトガイド誰にでもすぐに使える!】下部尿路機能障害混合性尿失禁尿意切迫感に加え,くしゃみをすると尿が漏れるという患者です

渡邉豊彦

臨床泌尿器科 69 ( 4 ) 117 - 120 2015.4

Language：Japanese Publisher：(株)医学書院

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

シタフロキサシン100mg単回投与における精巣、精巣上体組織移行性の検討 Reviewed

定平卓也, 和田耕一郎, 山本満寿美, 光畑律子, 石井亜矢乃, 狩山玲子, 上原慎也, 渡辺豊彦, 猪川和朗, 森川則文, 公文裕巳

日本化学療法学会雑誌 63 ( 1 ) 121 - 122 2015.1

OprD欠損緑膿菌によるマウス大腿部感染モデルに対するクオラムセンシング阻害剤とビアペネムの併用効果 Reviewed

狩山玲子, 堀賢司, 村上圭史, 光畑律子, 和田耕一郎, 渡辺豊彦, 三宅洋一郎, 公文裕巳, 菅裕明, 五十嵐潤

日本化学療法学会雑誌 63 ( 1 ) 124 - 125 2015.1

経直腸的前立腺針生検におけるレボフロキサシン500mg予防的単回投与の有効性と安全性についての検討(EFFICACY AND SAFETY OF PROPHYLACTIC SINGLE-DOSE LEVOFLOXACIN 500mg FOR TRANSRECTAL PROSTATE NEEDLE BIOPSY IN JAPANESE PATIENTS: A CASE CONTROL STUDY) Reviewed

岸本涼, 和田耕一郎, 荒木元朗, 渡邉豊彦, 公文裕巳, 今村牧夫, 上原慎也, 門田晃一, 山本康雄, 石戸則孝, 高本均

西日本泌尿器科 76 ( 12 ) 453 - 459 2014.12

Language：English Publisher：西日本泌尿器科学会

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

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

新規マウス薬効評価系の構築に向けた緑膿菌性尿路バイオフィルム感染症モデルの作製

狩山玲子, 堀賢司, 村上圭史, 光畑律子, 和田耕一郎, 石井亜矢乃, 渡辺豊彦, 三宅洋一郎, 公文裕巳

緑膿菌感染症研究会講演記録 48回 64 - 67 2014.12

Language：Japanese Publisher：緑膿菌感染症研究会

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

ロボット支援腹腔鏡下前立腺全摘術における断端陽性リスクの検討 Reviewed

荒木元朗, 小林泰之, 和田耕一郎, 佐々木克己, 江原伸, 渡辺豊彦, 樋之津史郎, 那須保友, 公文裕巳

Japanese Journal of Endourology 27 ( 3 ) 269 - 269 2014.11

男子尿道、咽頭から分離されたChlamydia trachomatisのlevofloxacin、azithromycinに対する感受性 Reviewed

和田耕一郎, 松本明, 石井亜矢乃, 狩山玲子, 上原慎也, 渡辺豊彦, 宇埜智, 門田晃一, 荒木徹, 公文裕巳

日本性感染症学会誌 25 ( 2 ) 93 - 93 2014.10

横紋筋肉腫への分化を伴った精巣原発奇形腫の1例 Reviewed

岡田裕子, 和田耕一郎, 高本篤, 前原貴典, 宗石理沙, 定平卓也, 倉橋寛明, 杉本盛人, 小林泰之, 佐々木克己, 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 76 ( 9 ) 339 - 340 2014.9

前立腺癌永久密封小線源療法後のPSA bounce

高本篤, 江原伸, 谷本竜太, 小林泰之, 渡辺豊彦, 那須保友, 公文裕巳

泌尿器外科 27 ( 8 ) 1339 - 1340 2014.8

Language：Japanese Publisher：医学図書出版(株)

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

泌尿器科領域における抗癌化学療法に伴う発熱性好中球減少症に関する多施設共同調査 Reviewed

和田耕一郎, 谷本竜太, 能勢宏幸, 上原慎也, 渡辺豊彦, 速見浩士, 永井真吾, 安田満, 出口隆, 茂田啓介, 矢澤聰, 菊地栄次, 大家基嗣, 橋本次朗, 上原央久, 栗村雄一郎, 桧山佳樹, 高橋聡, 塚本泰司, 庄武彦, 濱砂良一, 宮崎淳, 東郷容和, 田岡利宜也, 中尾篤, 山本新吾, 小林加直, 松原昭郎, 石川清仁, 公文裕巳, 松本哲朗

日本化学療法学会雑誌 62 ( 3 ) 374 - 381 2014.5

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

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

マウスを用いた緑膿菌性尿路バイオフィルム感染症モデルの作製

狩山玲子, 堀賢司, 光畑律子, 村上圭史, 和田耕一郎, 石井亜矢乃, 渡辺豊彦, 三宅洋一郎, 公文裕巳

BACTERIAL ADHERENCE & BIOFILM 27 67 - 71 2014.5

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

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

岡山大学泌尿器科におけるpreemptive腎移植症例の検討

有吉勇一, 荒木元朗, 宗石理沙, 吉岡貴史, 和田耕一郎, 小林泰之, 佐々木克己, 江原伸, 渡辺豊彦, 那須保友, 公文裕巳, 清水千聖, 赤木滋, 森永裕士, 田邊克幸, 北川正史, 杉山斉, 和田淳, 槇野博史

移植 49 ( 1 ) 167 - 167 2014.5

腎盂尿管移行部狭窄症に対するAnderson-Hynes法によるロボット支援腹腔鏡下腎盂形成術 Reviewed

小林泰之, 荒木元朗, 倉橋寛明, 和田耕一郎, 佐々木克己, 江原伸, 渡辺豊彦, 那須保友, 公文裕巳, 倉繁拓志, 村尾航

Japanese Journal of Endourology 27 ( 1 ) 162 - 168 2014.4

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

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

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

Treatment of acute uncomplicated cystitis with faropenem for 3 days versus 7 days: multicentre, randomized, open-label, controlled trial.

Toyohiko Watanabe

The Journal of antimicrobial chemotherapy 2014.2

Publishing type：Research paper (scientific journal)

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

DOI： 10.1093/jac/dku014

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 2014.2

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

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

DOI： 10.18926/AMO/52144

産後1ヵ月時に尿失禁症状を有する褥婦への骨盤底筋体操指導の取り組み

石井亜矢乃, 大井伸子, 山本満寿美, 江国一二美, 佐藤久恵, 岡本真由美, 寺本直美, 真鍋明子, 大和豊子, 渡辺豊彦, 公文裕巳

日本女性骨盤底医学会誌 10 ( 1 ) 122 - 126 2013.12

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

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

Assessment of antimicrobial prophylaxis to prevent perioperative infection in patients undergoing prostate brachytherapy: multicenter cohort study Reviewed

Rikiya Taoka, Yoshikazu Togo, Tatsuhiko Kubo, Masahito Kido, Kenta Miki, Hiroshi Kiyota, Shin Egawa, Takashi Sugawara, Mitsuru Yasuda, Masahiro Nakano, Takashi Deguchi, Masashi Nishino, Kiyohito Ishikawa, Ryoichi Shiroki, Minori Matsumoto, Katsumi Shigemura, Kazushi Tanaka, Soichi Arakawa, Masato Fujisawa, Koichiro Wada, Toyohiko Watanabe, Hiromi Kumon, Kanao Kobayashi, Akio Matsubara, Takehiko Sho, Ryoichi Hamasuna, Tetsuro Matsumoto, Hiroshi Hayami, Masayuki Nakagawa, Shingo Yamamoto

JOURNAL OF INFECTION AND CHEMOTHERAPY 19 ( 5 ) 926 - 930 2013.10

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

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

DOI： 10.1007/s10156-013-0610-0

【それぞれの立場からみた泌尿器診療-専門医とプライマリ・ケア医の診療スタイルとは?-】疾患-診断と治療、主に治療について-尿路感染症専門医の立場から

和田耕一郎, 渡邉豊彦

治療 95 ( 9 ) 1628 - 1633 2013.9

腹腔鏡下膀胱全摘除術における初期経験に関する報告 Reviewed

小林泰之, 倉橋寛明, 別宮謙介, 和田耕一郎, 谷本竜太, 佐々木克己, 荒木元朗, 江原伸, 渡辺豊彦, 公文裕巳, 那須保友

西日本泌尿器科 75 ( 7 ) 352 - 358 2013.7

Language：Japanese Publisher：西日本泌尿器科学会

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

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マウスを用いた緑膿菌性尿路バイオフィルム感染症モデルの作製

狩山玲子, 堀賢司, 光畑律子, 村上圭史, 和田耕一郎, 石井亜矢乃, 渡辺豊彦, 三宅洋一郎, 公文裕巳

Bacterial Adherence & Biofilm 学術集会 27回 46 - 46 2013.7

Laparoscopic radical cystectomy: A report of our initial four cases

Yasuyuki Kobayashi, Hiroaki Kurahashi, Kensuke Bekku, Kouichiro Wada, Ryuta Tanimoto, Katsumi Sasaki, Motoo Araki, Shin Ebara, Toyohiko Watanabe, Hiromi Kumon, Yasutomo Nasu

Nishinihon Journal of Urology 75 ( 7 ) 352 - 358 2013.7

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

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

「泌尿器科領域における周術期感染予防ガイドライン」に関する多施設共同研究 Reviewed

和田耕一郎, 上原慎也, 吉良慎一郎, 松本正広, 庄武彦, 栗村雄一郎, 橋本次朗, 上原央久, 山根隆史, 金丸聰淳, 東郷容和, 田岡利宜也, 高橋彰, 山田祐介, 横溝晃, 安田満, 田中一志, 濱砂良一, 高橋聡, 速見浩士, 渡邉豊彦, 門田晃一, 清田浩, 出口隆, 内藤誠二, 塚本泰司, 荒川創一, 藤澤正人, 山本新吾, 公文裕巳, 松本哲朗, UTI共同研究会

日本泌尿器科学会雑誌 104 ( 3 ) 505 - 512 2013.5

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

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

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

タクロリムス徐放製剤によるtherapeutic drug monitoringを用いた生体腎移植

有吉勇一, 荒木元朗, 吉岡貴史, 和田耕一郎, 江原伸, 渡邉豊彦, 那須保友, 公文裕巳, 清水千聖

今日の移植 26 ( 3 ) 267 - 269 2013.5

Language：Japanese Publisher：(株)日本医学館

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

A questionnaire survey of antimicrobial prophylaxis to prevent perioperative infection in urological field in Japan Reviewed

Yoshikazu Togo, Rikiya Taoka, Shingo Yamamoto, Yoshiki Hiyama, Teruhisa Uehara, Jiroh Hashimoto, Yuichiro Kurimura, Satoshi Takahashi, Taiji Tsukamoto, Jun Miyazaki, Hiroyuki Nishiyama, Hiroshi Kiyota, Satoshi Yazawa, Mototsugu Oya, Mitsuru Yasuda, Takashi Deguchi, Kiyohito Ishikawa, Kiyotaka Hoshinaga, Minori Matsumoto, Katsumi Shigemura, Kazushi Tanaka, Soichi Arakawa, Masato Fujisawa, Koichiro Wada, Shinya Uehara, Toyohiko Watanabe, Hiromi Kumon, Kanao Kobayashi, Akio Matsubara, Masahiro Matsumoto, Takehiko Sho, Ryoichi Hamasuna, Tetsuro Matsumoto, Hiroshi Hayami, Takashi Yamane, Masayuki Nakagawa

Japanese Journal of Urology 104 ( 4 ) 579 - 588 2013

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

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

DOI： 10.5980/jpnjurol.104.579

遠隔地に居住する尿失禁患者に対する骨盤底筋体操指導の取り組み

石井亜矢乃, 大井伸子, 山本満寿美, 藤井夕子, 梶岡亘子, 中塚安美, 村島眞由美, 矢木和香, 井上雅, 大和豊子, 渡辺豊彦, 公文裕巳

日本女性骨盤底医学会誌 9 ( 1 ) 158 - 160 2012.12

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

【目的】岡山県県北居住の尿失禁患者に対し、保健師の協力の下、ビデオやテレビ機能付き携帯電話を用いて、遠隔地で骨盤底筋体操指導を行い、尿失禁症状の改善の有無を検討した。【対象・方法】健康教室に参加する尿失禁患者28名を対象とした。Incontinence Quality of Life(I-QOL)により尿失禁症状を把握し、保健師がビデオで骨盤底筋体操を指導した。1ヵ月後、保健師がテレビ機能付き携帯電話を用いて腹部や大腿を撮影し、代替収縮の有無を遠隔で確認後、再指導した。3ヵ月後、I-QOLを再調査した。【結果】年齢は80歳代が最も多く、約25%で代替収縮が認められた。I-QOLは84.9±7.2点から91.2±8.9点に有意に改善していた(p<0.05)。【結論】尿失禁症状は有意に改善しており、今後も骨盤底筋体操の啓蒙活動・指導に取り組んでいく予定である。(著者抄録)

ENDOSCOPIC TREATMENT FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA : INDICATION AND OUTCOME Reviewed

KAWAUCHI KEIICHIRO, UEHARA SHINYA, WADA KOICHIRO, KOBAYASHI YASUYUKI, SASAKI KATSUMI, ARAKI MOTOO, WATANABE TOYOHIKO, SAIKA TAKASHI, NASU YASUTOMO, KUMON HIROMI, MONDEN KOICHI, ONO NORIAKI, TSUGAWA MASAYA

74 ( 11 ) 599 - 604 2012.11

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

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? Reviewed

Ryo Kishimoto, Motoo Araki, Yuuko Seno, Toyohiko Watanabe, Takashi Saika, Yasuo Yamamoto, Noritaka Ishito, Nobuyuki Akazawa, Hitoshi Takamoto, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 26 A319 - A319 2012.9

下大静脈腫瘍塞栓を伴ったCCSK(clear cell sarcoma of the kidney)の1例 Reviewed

森聡博, 別宮謙介, 佐々木克己, 岸本涼, 石井和史, 上原慎也, 渡辺豊彦, 那須保友, 公文裕巳, 宮村能子, 柳井広之

西日本泌尿器科 74 ( 8 ) 449 - 453 2012.8

Language：Japanese Publisher：西日本泌尿器科学会

症例は1歳4ヵ月の女児。急速に進行する腹部の膨満を主訴に近医受診した。CTにて肝静脈分枝部に達する下大静脈腫瘍塞栓を伴った最大径12.0cmの右腎腫瘍を認めたため、2010年2月1日当院入院となった。腫瘍生検を施行し腎明細胞肉腫(clear cell sarcoma of the kidney:CCSK)と診断、2月13日よりNational Wilms Tumor Study(NWTS)5のプロトコールに準じた化学療法(レジメンI)を2コース施行したが腫瘍塞栓の増大を認めたため、4月1日右腎全摘除および下大静脈内腫瘍摘出術を施行した。術後腫瘍床に放射線治療(計10.8Gy)を追加し、末梢血幹細胞移植を併用した化学療法(ICE療法)を2コース施行した。化学療法終了後1年以上経過した現在まで明らかな再発、転移を認めていない。CCSKは小児腎腫瘍のうち約4%を占める程度の稀な疾患である。骨転移を起こしやすいのが特徴であり、予後は不良である。下大静脈腫瘍塞栓を伴ったCCSKの報告は非常に稀であり、本邦では本症例が2例目となる。(著者抄録)

Clear cell sarcoma of the kidney with inferior vena cava tumor thrombus in a child: A case report

Akihiro Mori, Kensuke Bekku, Katsumi Sasaki, Ryo Kishimoto, Kazushi Ishii, Shinya Uehara, Toyohiko Watanabe, Yasutomo Nasu, Hiromi Kumon, Yoshiko Miyamura, Hiroyuki Yanai

Nishinihon Journal of Urology 74 ( 8 ) 449 - 453 2012.8

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

Clear cell carcinoma of the kidney is a rare renal tumor accounting for about 4% of childhood malignant renal neoplasms, and inferior vena cava thrombus is extremely rare. In this report, we present a case of clear cell sarcoma of the kidney with inferior vena cava tumor thrombus in a child, this being the second report of clear cell carcinoma of the kidney with tumor thrombus in Japan. The patient was a 16-month-old girl, who was admitted to our hospital for investigation of a right renal tumor with inferior vena cava thrombus. At first, we performed tumor needle biopsy and made a diagnosis of clear cell sarcoma of the kidney. According to the protocol issued by National Wilms Tumor Study-5, chemotherapy comprising vincristine, doxorubicin, cyclophosphamide and etoposide was started. After 2 cycles of the chemotherapy, radical nephrectomy, thrombectomy and segmental hepatectomy were performed and complete resection was possible. Following radiotherapy to the renal bed and adjuvant chemotherapy with ifosfamide, carboplatin, and etoposide, no clinical evidence of recurrence or metastasis has been noted during the subsequent period of about 1 year.

緑膿菌性尿路バイオフィルムin vitro実験モデル系におけるコリスチンの有効性評価

狩山玲子, 光畑律子, 上原慎也, 渡辺豊彦, 公文裕巳

BACTERIAL ADHERENCE & BIOFILM 25 43 - 46 2012.5

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

新規マイクロデバイスを用いた緑膿菌性尿路バイオフィルムin vitro実験モデル系において、コリスチン(CMS)の有効性評価を行った。Pseudomonas aeruginosa OP14-210株およびGFP産生OP14-210(pMF230)株を用いた。人工尿における浮遊菌に対するCMSのMICは1μg/mLであった。マイクロデバイスに菌液を接種して人工尿を20mL/hrで灌流させ、薬剤無添加と薬剤作用後のバイオフィルムを共焦点レーザー走査型顕微鏡で観察した。GFP産生株に5 x MIC濃度でCMSを作用させて72時間後のバイオフィルム形成を観察すると、薬剤無添加に比較して阻害効果を認めた。GFP産生株が24時間で形成したバイオフィルムにCMSを10〜50 x MIC濃度で24時間作用させると、薬剤無添加のバイオフィルムに比較して、厚さが約1/2〜1/6に減少し、バイオフィルムの剥離が観察された。GFP非産生株が24時間で形成したバイオフィルムにCMSを20 x MIC濃度で48時間作用させて蛍光染色して観察すると、薬剤無添加のバイオフィルムに比較して死菌イメージが増強した。本検討においてバイオフィルム形成阻害効果を認めたCMSの5〜20 x MIC濃度は、ヒトへの通常投与量で尿中に達する濃度範囲にあることから、尿路における緑膿菌性バイオフィルム感染症の治療に有効である可能性が示唆された。(著者抄録)

収縮不全随伴性排尿筋過反射と考えられた症例に対する治療経験 Reviewed

大橋輝久, 竹中皇, 佐古真一, 近藤捷嘉, 渡辺豊彦, 公文裕巳

西日本泌尿器科 74 ( 1 ) 16 - 20 2012.1

Language：Japanese Publisher：西日本泌尿器科学会

我々は尿流動態検査でDHICと考えられた40例に対して、α1遮断剤であるウラピジルを中心とした薬物療法を施行し、その有用性について検討した。3ヵ月目の効果に関し、α1遮断剤単独例は16例中12例(75.0%)抗コリン剤併用が24例中15例(62.5%)の改善率を認めた。症状別効果については排尿困難、尿意切迫感に対する改善率が100.0%であった。また12ヵ月目における効果については、α1遮断剤単独例および抗コリン剤併用例とも3ヵ月とほぼ同じ改善率を認め、症状別でも3ヵ月目の改善率と変化がなかった。以上より、DHICに対する、α1遮断剤単独あるいは抗コリン剤併用の有用性が示唆された。(著者抄録)

Clinical investigation of drug therapy for cases of detrusor hyperactivity with impaired contractile function

Teruhisa Ohashi, Tadasu Takenaka, Sinichi Sako, Katsuyoshi Kondo, Toyohiko Watanabe, Hiromi Kumon

Nishinihon Journal of Urology 74 ( 1 ) 16 - 20 2012.1

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

We assessed the efficacy and safety of a 1adrenoceptor antagonist (Urapidil) alone or combined with an antimuscarinic (oxybutynin or propiverine) in patients diagnosed with detrusor hyperactivity with impaired contractile function (DHIC). Forty patients with urodynamically proven DHIC were stratified into 2 groups, namely group 1 receiving Urapidil only and group 2 receiving Urapidil plus oxybutynin or propiverine for a 12-week treatment regimen. A total of 40 patients, including 16 in group 1 and 24 in group 2 were treated and 40 (100.0%) completed the 12 weeks of treatment. Significant improvement was noted in both group 1 (75.0%) and group 2 (62.5%) after treatment. Voiding difficulty and urinary urgency improved significantly in all patients of both group 1 and group 2. The results of this study suggest that a i-adrenoceptor antagonist alone or combined with an antimuscarinic represents an effective and relatively safe treatment modality for patients with DHIC.

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

岡山大学泌尿器科における女性外来統計と患者アンケート調査 Reviewed

井上雅, 石井亜矢乃, 大和豊子, 渡辺豊彦, 雑賀隆史, 公文裕巳

西日本泌尿器科 73 ( 9 ) 470 - 474 2011.9

Language：Japanese Publisher：西日本泌尿器科学会

当院では2003年5月に女性医師のみで診察に当たる泌尿器科女性専門外来を開設した。そこで今回、2003年から2009年までの新患患者の年次変遷を調査し、臨床的検討を行った。また、新患患者に対し、満足度と傾向についてのアンケートを施行したので報告する。新患患者数は91人(2003年)、86人(2004年)、53人(2005年)、108人(2006年)、137人(2007年)、116人(2008年)、149人(2009年)と増加傾向であった。年齢は60〜70歳代が最も多く、全体の約半数であった。疾患別では尿漏れを主訴とする腹圧性尿失禁、切迫性尿失禁、混合性尿失禁で約30%を占めており、失禁を伴わない過活動膀胱は約10%であった。2007年の骨盤臓器脱患者は9.5%であったが、2008年以降、約20%まで増加した。骨盤臓器脱以外の疾患、患者年齢ともに年次的変化は認めなかった。総手術件数は、2006年以前は10件未満であったが、2007年にTVM、TOT手術を導入し、23件(2007年)、23件(2008年)、20件(2009年)と増加した。アンケート結果はインターネットをみて受診する患者が増加していた。また、ほとんどの患者は女性外来での診察に満足していた。新患患者数は増加傾向であり、尿失禁、過活動膀胱、骨盤臓器脱、そして今後はさらに女性性機能障害も治療対象となっていくと思われ、泌尿器科女性専門外来のニーズは高まると思われた。(著者抄録)

淋菌性尿道炎患者での咽頭における淋菌の分離状況に関する検討 Reviewed

石井亜矢乃, 上原慎也, 渡邉豊彦, 狩山玲子, 公文裕巳

日本性感染症学会誌 22 ( 1 ) 108 - 113 2011.9

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

岡山近郊の3施設で加療された男性淋菌性尿道炎患者56例を対象に、咽頭における淋菌の分離状況を検討した。その結果、咽頭検体における淋菌陽性例は7例(13.0%)であった。感染の原因となった性行為はオーラルセックスのみ2例、腟性交のみ2例、オーラルセックス+腟成功1例、オーラルセックス+腟性交+ディープキス2例であった。尿道と咽頭の株がPFGE解析で同一パターンを示し、MICもほぼ同一であった症例は4例で、他の3例はPFGE解析で異なるパターンを示し、MICも異なっていた。

SAFETY AND EFFECTIVENESS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) IN PATIENTS ON ONGOING ORAL ANTIPLATELET THERAPY: A MULTICENTER PROSPECTIVE STUDY IN JAPAN Reviewed

Toyohiko Watanabe, Miyabi Inoue, Ryo Kishimoto, Katsumi Sasaki, Takashi Saika, Hiromi Kumon, Yasuhiro Nishiyama, Takaharu Ichikawa, Shuniji Hayata, Teruhiko Yokoyama, Atsuhi Nagai, Hitoshi Takamoto, Noriaki Ono

JOURNAL OF UROLOGY 185 ( 4 ) E840 - E840 2011.4

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

手術指導と安全確保岡山大学泌尿器科における腹腔鏡教育の取り組み腹腔鏡技術認定医取得を目指した Reviewed

小林泰之, 上原慎也, 渡辺豊彦, 雑賀隆史, 那須保友, 公文裕巳

西日本泌尿器科 73 ( 4 ) 161 - 164 2011.4

Language：Japanese Publisher：西日本泌尿器科学会

岡山大学泌尿器科では、安全で確実な腹腔鏡手術手技の普及を目的に、2005年より腹腔鏡教育プログラムを作成し開始している。このプログラムの大きな柱は(1)術式の標準化、(2)術者の固定、(3)段階的なトレーニングカリキュラムである。これまでに14名がこの教育プログラムに参加した。今回、このプログラムの評価を行う。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01004&link_issn=&doc_id=20110428420005&doc_link_id=%2Fer9niuro%2F2011%2F007304%2F005%2F0161-0164%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2011%2F007304%2F005%2F0161-0164%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

小径腎癌に対する腎温存手術 Reviewed

小林泰之, 上原慎也, 渡辺豊彦, 雑賀隆史, 那須保友, 公文裕巳

西日本泌尿器科 73 ( 2 ) 51 - 57 2011.2

Language：Japanese Publisher：西日本泌尿器科学会

CTや超音波検査の普及に伴い、腎癌症例のうち小径腎癌が占める割合が増えてきている。小径腎癌の治療は、制癌だけでなく、腎機能温存、低侵襲性、合併症といった様々な要素を総合的に考慮して選択することが要求される。腹腔鏡下腎部分切除術は、開腹手術に比べ低侵襲であるが、阻血時間や合併症の頻度が高い。腹腔鏡下腎部分切除術に代わる手段として、欧米や韓国ではロボット補助下腎部分切除術が行われている。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01004&link_issn=&doc_id=20110224270002&doc_link_id=%2Fer9niuro%2F2011%2F007302%2F002%2F0051-0057%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2011%2F007302%2F002%2F0051-0057%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

緑膿菌性尿路バイオフィルムin vivo感染症モデルへのリアルタイムイメージング装置の応用性に関する検討

狩山玲子, 堀賢司, 光畑律子, 上原慎也, 渡辺豊彦, 公文裕巳

緑膿菌感染症研究会講演記録 44回 98 - 103 2010.12

Language：Japanese Publisher：緑膿菌感染症研究会

ラット膀胱内に留置したポリエチレンチューブに緑膿菌バイオフィルムを形成させるin vivo実験モデル系を確立し、その実験モデル系を使用して抗菌薬の治療効果を評価した。IVIS imaging systemの応用性を検証するために、ラットのみならずマウスの膀胱内に留置したポリエチレンチューブに緑膿菌バイオフィルムを形成させ、IVIS Luminaでの観察を行った。IVIS Luminaによる観察において、貯尿時には発光を認めたが、排尿後には捉えることができず、ポリエチレンチューブに形成されたバイオフィルムのin vivo発光は検出限界以下であった。少なくとも7日間持続の再現性ある尿路バイオフィルム感染症モデルを作製することができた。経日的に測定した結果、バイオフィルム形成量と生菌数に相関性を認めた。

腹腔鏡下尿膜管遺残摘出術の8例

荒木元朗, 雑賀隆史, 荒木大司, 小林泰之, 上原慎也, 渡辺豊彦, 那須保友, 公文裕巳

Japanese Journal of Endourology and ESWL 23 ( 3 ) 160 - 160 2010.10

女性腹圧性尿失禁に対する補中益気湯の有用性に関する検討

井上雅, 横山光彦, 石井亜矢乃, 渡辺豊彦, 大和豊子, 公文裕巳

日本東洋医学雑誌 61 ( 6 ) 853 - 855 2010.9

Language：Japanese Publisher：(一社)日本東洋医学会

女性腹圧性尿失禁患者に対して補中益気湯を4週間投与し、その臨床的有用性を検討した。女性腹圧性尿失禁患者13名に対し、食前に1日3回補中益気湯7.5gを4週間投与した。治療前、治療1ヵ月後に、VAS(visual analog scale)、IQOL(Incontinence-QOL)による自覚症状の変化を観察し、また排尿日誌を用いて排尿回数、尿失禁回数の変化、パッドテストによる失禁量の変化、尿流測定による他覚的な排尿状態の変化の確認を行った。また投与終了時の患者の満足度も検討した。結果は有意差は認めなかったが、VAS、IQOLスコア、いずれも改善傾向であった。パッドテスト、失禁回数は減少傾向であった。排尿回数、最大尿流量は変化なく、患者満足度は高かった。BMI別で検討すると非肥満型では有意にVAS、IQOLの改善を認めた。補中益気湯は排尿状態に影響を及ぼさず、尿失禁の程度、証などを考慮すれば有効であることが示唆された。副作用として重篤なものは認めなかった。(著者抄録)

効果的効率的な泌尿器腹腔鏡手術医の育成効果的・効率的な泌尿器腹腔鏡手術医の育成岡山大学の取り組み Reviewed

小林泰之, 上松克利, 上原慎也, 渡辺豊彦, 雑賀隆史, 那須保友, 公文裕巳

西日本泌尿器科 72 ( 6 ) 294 - 296 2010.6

耐性菌、難治性感染症とバイオフィルムメタロ-β-ラクタマーゼ産生緑膿菌のバイオフィルム形成能およびblaIMP-1遺伝子の伝達性に関する検討

山本満寿美, 狩山玲子, 光畑律子, 石井亜矢乃, 上原慎也, 渡辺豊彦, 公文裕巳

BACTERIAL ADHERENCE & BIOFILM 23 71 - 75 2010.5

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

プラスミド性の薬剤耐性遺伝子を保有するメタロ-β-ラクタマーゼ(MBL)産生緑膿菌は、ほぼ全ての抗菌薬に高度耐性を示す傾向が強く、院内感染対策上、特に留意する必要がある。そこでMBL産生緑膿菌に着目し、バイオフィルム形成能およびblaIMP-1遺伝子の伝達性に関する検討を行った。A県3施設で分離されたIMP-1型MBL産生緑膿菌123株を対象とした。バイオフィルムアッセイにはマイクロプレートを用い、トリプトソイブイヨン培地中のバイオフィルム形成能を定量化した。フィルター法による接合伝達実験では、受容菌としてPseudomonas aeruginosa ML5017株、イミペネムとリファンピシン添加の選択培地を用いた。バイオフィルム高度形成群OD570≧1;29株(23.6%)、中等度1>OD570≧0.5;47株(38.2%)、低度0.5>OD570≧0;47株(38.2%)であった。高度・中等度形成群76株のうち、尿由来株は57株(75.0%)であった。35株の接合伝達実験を行った結果、33株でイミペネム耐性が伝達し、そのうち9株は伝達頻度が比較的高かった(10^-4〜10^-6)。PCR法およびパルスフィールドゲル電気泳動法により、24株中18株のblaIMP-1遺伝子の伝達性が確定できた。バイオフィルム形成能が高い緑膿菌は、環境中に長期に生息し、薬剤耐性遺伝子を獲得している可能性がある。MBL産生緑膿菌の伝播・拡散防止のためには、バイオフィルムを形成させないための医療・療養環境の管理が重要である。(著者抄録)

CLITORIAL BLOOD FLOW CHANGES AFTER SURGERY WITH TENSION-FREE VAGINAL MESH FOR PELVIC ORGAN PROLAPSE Reviewed

Toyohiko Watanabe, Miyabi Inoue, Ayano Ishii, Toyoko Yamato, Hiroyuki Nose, Katsutoshi Uematsu, Katsumi Sasaki, Motoo Araki, Shinya Uehara, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 183 ( 4 ) E583 - E583 2010.4

URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 23-YEAR EXPERIENCE Reviewed

Motoo Araki, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 183 ( 4 ) E494 - E494 2010.4

PD2-3 難治性過活動膀胱-神経因性膀胱-に対する治療(過活動膀胱の治療戦略-from Easy to Difficult Case-,パネルディスカッション2,第98回日本泌尿器科学会総会)

横山光彦, 永井敦, 渡邊豊彦, 公文裕巳

日本泌尿器科学会雑誌 101 ( 2 ) 135 - 135 2010

リアルタイムin vivoイメージングシステムでの緑膿菌マウス大腿部感染モデルに対するビアペネムの有効性評価

狩山玲子, 堀賢司, 落合和彦, 光畑律子, 上原慎也, 渡辺豊彦, 門田晃一, 公文裕巳

緑膿菌感染症研究会講演記録 43回 118 - 122 2009.12

Language：Japanese Publisher：緑膿菌感染症研究会

IVIS imaging systemの感染症領域への応用性を検証するため、緑膿菌マウス大腿部感染モデルを作製し、抗菌薬biapenem(BIPM)の治療効果をリアルタイムに観察した。生菌数測定の結果、BIPMは単回投与に比べ、頻回投与で有意に高い治療効果を示し、PK(pharmacokinetic)/PD(pharmacodynamic)におけるTime above MICが影響する薬剤であることが確認された。また、IVISによる測定の結果、BIPMの投与により経時的にマウス大腿部の発光強度の変化・消失のイメージが得られ、生菌数と関連性があると考えられた。更に生菌数とフォント数との関連性も確認された。

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

尿路性器感染症に関する臨床試験実施のためのガイドライン(第1版)

松本哲朗, 高橋聡, 清田浩, 安田満, 石川清仁, 高橋彰, 山本新吾, 荒川創一, 門田晃一, 村谷哲郎, 濱砂良一, 速水浩士, 公文裕巳, 渡辺豊彦, 上原慎也, 川原元司, 中川昌之, 山根隆史, 石原哲, 出口隆, 菊池達也, 内藤誠二, 野村博之, 平賀紀行, 金丸聰淳, 小川修, 守殿貞夫, 重村克巳, 田中一志, 中野雄造, 藤澤正人, 三浦徹也, 国島康晴, 塚本泰司, 松川雅則, 山田陽司, 赤坂聡一郎, 小野寺昭一, 島博基, 繁田正信, 星長清隆, 長田幸夫, 和田耕一郎, 日本化学療法学会UT, 薬効評価基準見直しのための委員会

日本化学療法学会雑誌 57 ( 6 ) 511 - 525 2009.11

Experimental and Clinical Studies on Fluoroquinolone-insusceptible Escherichia coli Isolated from Patients with Urinary Tract Infections from 1994 to 2007 Reviewed

Koichiro Wada, Reiko Kariyama, Ritsuko Mitsuhata, Shinya Uehara, Toyohiko Watanabe, Koichi Monden, Hiromi Kumon

ACTA MEDICA OKAYAMA 63 ( 5 ) 263 - 272 2009.10

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

Urinary tract infections (UTIs) due to fluoroquinolone-insusceptible Escherichia coli have become increasingly common in recent years. We investigated the potential relationships between clinical measures to combat fluoroquinolone-insusceptible E. coli and experimental analyses on E. coli isolates. Over a 14-year period from 1994 through 2007, a total of 828 E. coli isolates were collected from patients (one isolate per patient) with UTI at the urology ward of Okayama University Hospital. We analyzed the mutations in quinolone resistance-determining regions of DNA gyrase (gyrA) and topoisomerase IV (parC). The production of biofilm by these isolates was also examined and the associated medical records were retrospectively reviewed. Seven of 189 (3.7%) strains from uncomplicated UTIs and 82 of 639 (12.8%) strains from complicated UTIs were insusceptible to fluoroquinolones. Amino acid replacements of type 11 topoisomerases were frequently observed at positions 83 and 87 in GyrA and at positions 80 and 84 in ParC. No significant difference in the biofilm-forming capabilities was observed between fluoroquinolone-susceptible and -insusceptible E. coli. Our study suggests that biofilm formation of fluoroquinolone-insusceptible E. coli isolates is not a major mechanism of resistance in patients with UTI.

DOI： 10.18926/AMO/31836

質問BOX 尿路感染症の患者さんはDIC(汎発性血管内凝固)を併発して入院されることが多いので、そのときにどのような治療・ケアが行われるのかを教えてください

渡邉豊彦

泌尿器ケア 14 ( 10 ) 1000 - 1004 2009.10

尿路由来メタロ-β-ラクタマーゼ産生緑膿菌のバイオフィルム形成能および分子疫学的検討

石井亜矢乃, 狩山玲子, 光畑律子, 佐古真一, 和田耕一郎, 上原慎也, 渡辺豊彦, 門田晃一, 公文裕巳

BACTERIAL ADHERENCE & BIOFILM 22 59 - 64 2009.6

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

2001〜2006年に県下3施設で分離した尿路由来メタロ-β-ラクタマーゼ(MBL)産生緑膿菌(Pa)75株を対象に、大学泌尿器科で同時期に分離した尿路由来MBL非産生Pa66株を比較対象に、尿路由来MBL産生Paのバイオフィルム(BF)形成能を検討し、パルスフィールドゲル電気泳動(PFGE)法により遺伝子解析した。尿路由来MBL産生Pa75株のBF形成能は尿路由来MBL非産生Pa66株に比べ約3倍の高値を示した。BF形成能は施設ごとに特徴があった。PFGE解析では尿素由来MBL産生Pa75株には同一株を認めなかったが一施設において類似株を2組認めた。そのうち1株はBF形成能が同値であり分離日の隔たりが4日であることから直接的な交差感染の可能性が考えられた。別の1組は分離日の隔たりが約3ヵ月で、環境中に生息していたMBL産生Paが変異し間接的に伝播した可能性が示唆された。

URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 22-YEAR EXPERIENCE Reviewed

Motoo Araki, Shinichi Uehara, Koichi Monden, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 181 ( 4 ) 450 - 450 2009.4

尿路性器感染症に関する臨床試験実施のためのガイドライン第1版最終案

松本哲朗, 荒川創一, 村谷哲郎, 安田満, 高橋彰, 公文裕巳, 門田晃一, 渡辺豊彦, 上原慎也, 川原元司, 中川昌之, 速見浩士, 山根隆史, 石原哲, 出口隆, 菊池達也, 内藤誠二, 野村博之, 平賀紀行, 金丸聰淳, 小川修, 守殿貞夫, 重村克巳, 田中一志, 中野雄造, 藤澤正人, 三浦徹也, 国島康晴, 高橋聡, 塚本泰司, 松川雅則, 山田陽司, 赤坂聡一郎, 小野寺昭一, 清田浩, 島博基, 山本新吾, 繁田正信, 石川清仁, 星長清隆, 濱砂良一, 長田幸夫, 日本化学療法学会臨床評価法制定委員会

日本化学療法学会雑誌 57 ( 2 ) np1 - 20 2009.3

Initial Report of Hybrid Radical Prostatectomy for Prostate Cancer: Reduced Bleeding, Clear Vision, and Secure Surgical Margins Reviewed

Takashi Saika, Yasuyuki Kobayashi, Toyohiko Watanabe, Daisuke Manabe, Shin Ebara, Shinya Uehara, Yasutomo Nasu, Hiromi Kumon

ACTA MEDICA OKAYAMA 62 ( 6 ) 379 - 384 2008.12

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

To evaluate morbidity in Hybrid Radical Prostatectomy (HRP, hybridized laparoscopic and open retropubic radical prostatectomy). The operative and pathological outcomes obtained in 25 consecutive patients who underwent HRP were reviewed. The median operating time was 220min, median blood loss was 550ml, and no patient required an allogenic blood transfusion. No severe postoperative complications were observed. The surgical margin was positive in 12% of all patients, and in 1 patient with pT2 or less (4.5 %). These results indicate that HRP is safe and may be able to combine the benefits of both laparoscopic and open procedures.

DOI： 10.18926/AMO/30950

メタロ-β-ラクタマーゼ産生緑膿菌のバイオフィルム形成能と耐性遺伝子伝達性の検討

山本満寿美, 狩山玲子, 光畑律子, 石井亜矢乃, 上原慎也, 渡辺豊彦, 門田晃一, 公文裕巳, 草野展周

緑膿菌感染症研究会講演記録 42回 95 - 99 2008.12

Language：Japanese Publisher：緑膿菌感染症研究会

岡山県下3施設にて2001〜2006年の6年間に分離されたメタロβラクタマーゼ(MBL)産生緑膿菌のバイオフィルム産生能を定量化し、耐性遺伝子の伝達性に関する検討及び分子疫学的検討を行った。その結果、材料別内訳はIMP-1型遺伝子保有株(131株)では尿:84株(64.1%)・喀痰:10株・便:10株・膿:7株・血液:2株・その他:18株で、VIM-2型遺伝子保有株(12株)では血液:4株・喀痰:2株・尿1株・膿:1株・その他4株であった。MBL産生緑膿菌143株のバイオフィルム形成能をOD570値から分類すると高度形成群(OD570≧1):34株(23.8%)、中等度形成群(1>OD570≧0.5):49株(34.2%)、低形成群(0.5>OD570≧0):60株(42.0%)であった。VIM-2型遺伝子保有株は12株全てが低形成群であり、バイオフィルム形成能の平均OD750値は0.69±0.04であった。143株中83株(58.0%)がバイオフィルム高度・中等度形成群に属する菌株で、83株中61株(73.5%)は尿由来であり、他の材料株に比して高いバイオフィルム形成能示す株が多く認められた。接合伝達性を検討したIMP-1型遺伝子保有15株(バイオフィルム形成能高度・中等度・低度各5株)中、高度形成群の2株・中等度形成群の1株・低度形成群の2株の計5株にイミペネム耐性の伝達を認め、伝達頻度は10^-3〜10^-5であった。

岡山大学病院泌尿器科におけるがん薬物療法副作用対策マニュアルの有用性

玉木千尋, 名和秀起, 庵谷亜希子, 雑賀隆史, 渡邉豊彦, 相良英憲, 河崎陽一, 松永尚, 千堂年昭, 高山房子, 五味田裕, 公文裕巳, 川崎博巳

医療薬学 34 ( 10 ) 962 - 971 2008.10

Language：Japanese Publisher：(一社)日本医療薬学会

岡山大学病院泌尿器科におけるがん薬物療法副作用対策マニュアルの有用性について検討した。作成したマニュアルを病棟医師13例に配布した。6ヵ月後にアンケート調査を行い、13例より回答を得た。マニュアルの使用頻度は、週1回が30.8%、月2〜3回が30.8%、月1回が30.8%、ほとんど使わないが7.7%であった。マニュアル記載項目のなかで最も使用頻度の高い項目は、投与量・投与時間・投与スケジュール、腎障害時・肝障害時の抗がん剤減量目安、副作用モニタリングシート、米国臨床腫瘍学会で推奨されている制吐薬の組み合わせ方であった。マニュアルの有用性に関して具体的に質問して、各質問項目を4段階で評価した。それぞれで3-4の評価が8割を超えた。マニュアルが役に立つ点では、「重篤な副作用の回避」および「適切な治療の提供」が6割を超えた。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J03520&link_issn=&doc_id=20081015410009&doc_link_id=%2Fdb5pharm%2F2008%2F003410%2F009%2F0962-0971%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdb5pharm%2F2008%2F003410%2F009%2F0962-0971%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

後腹膜鏡下膀胱部分切除術を行った膀胱頂部炎症性筋線維芽細胞腫の1例

和田耕一郎, 雑賀隆史, 佐古真一, 小林泰之, 上原慎也, 渡邊豊彦, 門田晃一, 那須保友, 公文裕巳

西日本泌尿器科 70 ( 増刊 ) 203 - 203 2008.10

尿中カテコールアミン代謝産物が高値を示した副腎神経節細胞腫の1例 Reviewed

岸本涼, 渡邉豊彦, 赤澤信幸

西日本泌尿器科 70 ( 9 ) 506 - 509 2008.9

Language：Japanese Publisher：西日本泌尿器科学会

16歳女。2005年8月上旬より間歇的な左下腹部痛が出現し自然軽快したが、1ヵ月後に同部位に持続性の痛みが出現し、救急センターに受診し緊急入院となった。CTで左副腎部に4×4×7cmの上下に長く内部に石灰化を伴う腫瘍を認めた。入院1日後に尿中バニルマンデル酸(VMA)定性が陽性を示し、尿中VMA定量は4.5mg/dayと正常であったが、尿中ホモバニール酸(HVA)が6.5mg/dayと高値であった。CTで左副腎外側から下方へ、腎動静脈間へ拡がる造影効果のある長径約7cmの腫瘍を認めた。MRIではT1強調像で低信号、T2強調像で不均一な高信号を示し、周囲組織とは境界明瞭な非浸潤性の腫瘍を認め、神経節細胞腫と診断した。131I-MIBGシンチグラフィで左副腎腫瘍に集積を認め、悪性腫瘍の可能性を否定できず経腹式左副腎摘除術を施行した。腫瘍は腎動脈、腎静脈に強固に癒着し、剥離、腫瘍摘除に難渋したが、左腎を温存して腫瘍を完全に摘除した。術中迅速病理診断で神経節細胞腫と診断し可及的に腫瘍を切除した。病理組織学的所見では、異型性のない紡錘形細胞が柵状に配列し、その中にニッスル顆粒を伴う多数の島状に増殖する成熟した神経細胞群を認め神経節細胞腫の典型像を呈していた。術後施行したレノグラムで左腎は右の7割の機能を保っていた。2ヵ月後退院し再発等は認めなかった。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01004&link_issn=&doc_id=20080924330008&doc_link_id=%2Fer9niuro%2F2008%2F007009%2F008%2F0506-0509%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2008%2F007009%2F008%2F0506-0509%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

男性淋菌性尿道炎の患者背景および薬剤感受性の年次推移と尿道炎のアンケート結果 Reviewed

石井亜矢乃, 河内啓一郎, 和田耕一郎, 佐古真一, 上原慎也, 渡辺豊彦, 門田晃一, 公文裕巳, 近藤捷嘉, 大橋輝久, 村尾航, 赤澤信幸, 村田匡, 津川昌也, 中村あや, 西光雄, 水野全裕, 甲斐誠二, 那須良次, 小野憲昭, 倉繁拓志, 吉田光宏, 亀井義広

西日本泌尿器科 70 ( 7 ) 386 - 387 2008.7

【泌尿器科の最前線知っておきたい泌尿器科の新しい治療とケアの要点】過活動膀胱(OAB)に対する治療の最前線ボツリヌス毒素膀胱壁内注入療法

渡邉豊彦, 公文裕巳

泌尿器ケア 13 ( 7 ) 693 - 695 2008.7

A comparative study of the oncological long-term outcome of laparoscopic nephroureterectomy and standard nephroureterectomy for upper urinary tract transitional cell carcinoma Reviewed

Yasuyuki Kobayashi, Daisuke Manabe, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 179 ( 4 ) 291 - 291 2008.4

Ureteroscopic evaluation and treatment of chronic unilateral hematuria: A 20-year experience Reviewed

Motoo Araki, Kouichi Monden, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF UROLOGY 179 ( 4 ) 282 - 282 2008.4

1995年から2006年に分離された尿路由来フルオロキノロン耐性大腸菌に関する検討

和田耕一郎, 河内啓一郎, 佐古真一, 光畑律子, 石井亜矢乃, 上原慎也, 渡辺豊彦, 門田晃一, 狩山玲子, 公文裕巳

尿路感染症研究会記録集 ( 16 ) 21 - 22 2008

WS1-2-3 A Comparative Study of the Oncological Long-term Outcomeof Laparoscopic Nephroureterectomy and Standard Nephroureterectomy For Upper Urinary Tract Trasitionalcell Carcinoma(Urothelial Cell Cancer)

Kobayashi Yasuyuki, Saika Takashi, Watanabe Toyohiko, Uehara Shinya, Nasu Yasutomo, Kumon Hiromi

The Japanese Journal of Urology 99 ( 2 ) 146 - 146 2008

尿路感染症由来緑膿菌のバイオフィルム形成能と臨床的因子および薬剤感受性との関連性に関する検討

渡辺豊彦, 上原慎也, 光畑律子, 和田耕一郎, 石井亜矢乃, 狩山玲子, 門田晃一, 公文裕巳

緑膿菌感染症研究会講演記録 41回 94 - 98 2007.12

Language：Japanese Publisher：緑膿菌感染症研究会

1993〜2005年に当院で分離された尿路感染症由来緑膿菌166株のバイオフィルム形成能を測定し、臨床的因子(発熱・カテーテル留置の有無)、薬剤感受性との関連について検討した。結果、有熱群は非有熱群に比べてバイオフィルム形成能が有意に高く、カテーテル留置群は非留置群に比べて高い傾向にあった。薬剤感受性試験はPIPC、CAZ、IPM、GM、CPFXの5剤について行った。5剤とも耐性群と感受性あり群との間でバイオフィルム形成能に有意差を認めなかったが、いずれの薬剤もバイオフィルム高度形成群は非高度形成群に比べて耐性化傾向が強く、CPFXを除く4剤では有意差が認められた。

Preliminary report of hybrid radical prostatectomy for prostate cancer Reviewed

Takashi Saika, Yasuyuki Kobayashi, Toyohiko Watanabe, Daisuke Manabe, Shinya Uehara, Shin Ebara, Yasutomo Nasu, Hiromi Kumon

JOURNAL OF ENDOUROLOGY 21 A65 - A65 2007.10

前立腺癌におけるHybrid radical prostatectomyの初期報告良い視野、少ない出血、確実なcancer control Reviewed

雑賀隆史, 小林泰之, 渡辺豊彦, 真鍋大輔, 江原伸, 上原慎也, 那須保友, 公文裕巳

西日本泌尿器科 69 ( 10 ) 573 - 577 2007.10

Language：Japanese Publisher：西日本泌尿器科学会

限局性前立腺癌11例を対象にhybrid radical prostatectomy(HRP)を行ない、あわせて治療成績について検討した。その結果、HRPの平均手術時間は214±44分、平均カテーテル留置時間は7.2±1.6日、平均入院期間は13.3±1.5日で、従来の恥骨後式根治的前立腺摘除術(RRP:14例)と同等の成績であった。また、平均出血量は497±312gで、RRPよりも減少傾向がみられた。合併症は1例でポート挿入に伴う腹膜、腸管損傷があり修復を要した以外に、術中術後に大きな合併症はみられなかった。術後尿道造影では著明な尿漏出を認めた例はなく、切除断端陽性率は16.7%であった。術後2ヵ月のPSA検査では10例が0.01ng/ml以下、1例は0.1ng/mlまでの低下であったが、術後6ヵ月経過した時点では全例において尿禁制が得られた。

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尿路・腎疾患における超音波診断非侵襲性超音波ドプラ排尿機能検査システム

小澤秀夫, 井上雅, 渡辺豊彦, 公文裕巳

排尿障害プラクティス 15 ( 3 ) 275 - 282 2007.9

Language：Japanese Publisher：(株)メディカルレビュー社

超音波ドプラ法による尿道内の流速測定に基づく非侵襲性排尿障害検査システムを開発した。超音波探触子を遠隔操作装置で会陰部に密着させ、座位での排尿を観察した。排尿時のドプラ画像を連続する画像ファイルとして保存し、外尿道口からの尿流率を同時測定した。排尿後、画像ファイルの尿道における色調を平均化、流速を経時的に算出し、流速曲線を作成させた。さらに、機能的断面積などのパラメーターを求めたところ下部尿路閉塞(BOO)の診断に有用であった。また、尿流率と流速を同一グラフにとった流速尿流グラフでは、尿道括約筋機能の評価に応用可能と思われた。経会陰超音波ドプラ法は、非侵襲的でありかつ排尿障害診断に有用な情報が得られる。(著者抄録)

【高齢者の排尿障害の病態と対策】慢性前立腺炎による排尿障害

渡辺豊彦, 門田晃一, 公文裕巳

排尿障害プラクティス 14 ( 4 ) 307 - 314 2007.1

Language：Japanese Publisher：(株)メディカルレビュー社

近年National Institute of Health(NIH)により、前立腺炎の病態が再編され、特に新しい疾患概念として提唱される慢性前立腺炎/慢性骨盤痛症候群の病因・病態・診断について概説した。Chlamydiaなど病原微生物の関与、前立腺への逆流、前立腺液の停滞など前立腺そのものの異常、膀胱頸部機能不全(Primary bladder neck obstruction)など機能的ないし器質的下部尿路異常などがその病因として挙げられる。また最近、間質性膀胱炎との類似性が指摘されるようになり、特に慢性炎症に伴う知覚神経系の異常という共通の病態があり、膀胱・前立腺を含む骨盤内臓器の求心性知覚神経(C-fiber)の活動亢進が引き起こされていると考えられている。このように本疾患の病因は単一ではなく、これらの病因が複雑に関与し合い、また患者ごとに多様であることが病態解明を一層困難にしていると考えられ、今後のさらなる研究が必要である。(著者抄録)

Nerve growth factor in prostatic fluid as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome

Toyohiko Watanabe, Shinya Uehara, Daishi Araki, Miyabi Inoue, Koichi Monden, Takashi Saika, Yasutomo Nasu, Hiromi Kumon, Teruhiko Yokoyama

Nishinihon Journal of Urology 69 ( 10 ) 578 - 583 2007

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

Nerve growth factor (NGF) plays a key role as the peripheral mediator of several types of painful inflammatory conditions. In search of new biomarkers with which to more clearly define chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), we investigated whether or not NGF in expressed prostatic secretions (EPS) is correlated with symptom severity in CP/CPPS. All CP/CPPS patients underwent a complete history and physical examination, including the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). EPS samples from 16 patients and 3 asymptomatic controls were collected and frozen. The levels of NGF in EPS were measured by enzyme-linked immunosorbent assay. Patients were asked to complete the questionnaires of NIH-CPSI at baseline and at 8 weeks after treatment. Responders for treatment were defined as a 25% decrease in total NIH-CPSI score from the baseline values. Mean NGF in EPS of CP/CPPS patients and asymptomatic controls were 7,555 ± 3,990 pg/ml and 4,374 ± 825 pg/ml, respectively. The levels of NGF in CP/CPPS patients were correlated directly with pain severity (P = 0.042, r = 0.521), but were not correlated with urinary symptoms or the quality of life. There were no significant differences between pre-treatment and post-treatment levels of NGF in EPS. However, in responders, NGF levels were significantly decreased after successful treatment (P = 0.0165). NGF might contribute to the pathophysiology of CP/CPPS. The NGF level in EPS can change according to pain severity. Therefore, these results suggest that nerve growth factor could be used as a new biomarker to evaluate the symptoms of CP/CPPS and the effects of treatment.

前立腺癌におけるHybrid radical prostatectomy 良い視野、少ない出血、確実なcancer control

雑賀隆史, 小林泰之, 真鍋大輔, 江原伸, 上原慎也, 渡邊豊彦, 那須保友, 公文裕巳

西日本泌尿器科 68 ( 増刊 ) 124 - 124 2006.10

尿中VMAが高値を示した副腎神経節細胞腫の1例 Reviewed

岸本涼, 渡辺豊彦, 赤澤信幸

西日本泌尿器科 68 ( 5 ) 221 - 221 2006.5

urosepsisで受診した尿路結石の3例 Reviewed

和田耕一郎, 渡邉豊彦, 赤澤信幸

西日本泌尿器科 68 ( 2 ) 85 - 85 2006.2

副腎性Cushing syndromeの2例

岸本涼, 渡邉豊彦, 赤澤信幸

岡山済生会総合病院雑誌 37 31 - 35 2005.12

Language：Japanese Publisher：岡山済生会総合病院

外科的切除を行った副腎腺腫由来のCushing syndromeの2例を経験した。症例1(35歳女)。約1ヵ月前よりむくみが出現した。Cushing syndromeの疑いにて精査入院した。経腰式左副腎全摘除術を施行した。副腎不全の徴候なく順調に経過した。術後22日目に退院となり以後外来にてフォローとなった。症例2(57歳女)。1年前から糖尿病にて食事療法中であった。入院3かヵ月前の健康診断にて肝腫瘍を疑われた。CT上,肝嚢胞および左副腎に2.2cm大の腫瘤を指摘、MRIにて同部に脂肪成分を含む腺腫を指摘された。血液検査上,Cushing syndromeの疑いとして検査入院し、副腎腺腫によるCushing syndromeと診断した。経腰式左副腎全摘除術を施行した。術後20日目ごろより頭重感と頭痛が出現し、MRIにて多発性の陳旧性脳梗塞を疑われたがそのほかは大きな問題なく術後24日目に退院した。

腹圧性尿失禁に対するTVTスリング法における術後5年間の尿禁制率 Stamey法、PBNS法との比較

小澤秀夫, 上松克利, 大森弘之, 大橋輝久, 横山光彦, 渡辺豊彦, 佐々木克己, 西口潤, 公文裕巳

日本ウロギネコロジー研究会誌 2 ( 1 ) 28 - 31 2005.5

動脈塞栓で縮小した4cm超腎血管筋脂肪腫の2例

和田耕一郎, 渡邉豊彦, 赤澤信幸, 安井光太郎, 小林洋二

岡山済生会総合病院雑誌 36 50 - 54 2004.12

Language：Japanese Publisher：岡山済生会総合病院

症例1(33歳女),症例2(45歳女).いずれも腹部CT,MRIにて腎腫瘍の疑いがもたれ精査の結果,4cm超の腎血管筋脂肪腫(AML)が発見された.2例とも破裂リスクに対する予防的治療として血管造影による詳細な検討の後,選択的動脈塞栓術を行った.腫瘍成分は症例1では血管・筋成分が多く,症例2では脂肪性分が豊富であった.このことが画像検査における信号強度,造影効果,塞栓後の発熱・疼痛の強さや縮小率に影響を与えたと考えられた.術後経過は良好でいずれの症例も腫瘍は縮小した.AMLに対する予防的塞栓術は低侵襲かつ確実に腫瘍を縮小させ,症状緩和,破裂予防に有効な治療法と考えられた

後腹膜鏡下腫瘍摘出術を施行したGerota筋膜内malignant lymphomaの1例 Reviewed

佐々木克己, 渡辺豊彦, 武田克治, 朝日俊彦

西日本泌尿器科 66 ( 8 ) 534 - 536 2004.8

Language：Japanese Publisher：西日本泌尿器科学会

55歳男性.患者は左硬口蓋と右下眼瞼にMALTリンパ腫を認め,全身検索にて左後腹膜腫瘤を指摘され紹介となった.腹部CT,MRIではGerota筋膜内左腎後面に腫瘍を認めたが,生検にて確定診断が得られず,後腹膜鏡下で腫瘍摘出術を施行した.術中出血量はごく少量で,内視鏡挿入後約40分で摘出可能であった.病理組織学的にMALTリンパ腫と診断され,術後CHOP療法を行い,術後6ヵ月経過した現在,再発はみられない

Laparoscopic tumor resection for malignant lymphoma in the retroperitoneal Gerota's fascia: A case report

Katsumi Sasaki, Toyohiko Watanabe, Katsuzi Takeda, Toshihiko Asahi

Nishinihon Journal of Urology 66 ( 8 ) 534 - 536 2004.8

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

A case of retroperitoneal laparoscopic tumor resection for malignant lymphoma in the Gerota's fascia is reported. A 55-year-old man had been suffering from dizziness during the previous 1-year period. A biopsy of the right palpebral conjunctiva with little palpations was performed and a histological diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma was made. A biopsy of the left hard palate with palpation was also performed and again a diagnosis of MALT lymphoma was made. Further examinations at the Department of Internal Medicine of our hospital during hospitalization revealed a mass behind the left kidney in the retroperitoneal space. Biopsies for the mass performed under both ultrasonography and computer tomography (CT) did not provide enough tissue for histological diagnosis. The patient was referred to our department for further examination of the retroperitoneal mass. Retroperitoneal laparoscopic tumor resection was performed with the histological diagnosis of malignant lymphoma (B cell type). Following the tumor resection, chemotherapy (CHOP) was administered at the Department of Internal Medicine, with no evidence of tumor recurrence to date.

【オピオイド鎮痛薬による痛みの治療の現況と展望】強オピオイド鎮痛薬投与にあたり患者・家族に説明・伝達すべき情報

朝日俊彦, 武田克治, 渡辺豊彦

がん患者と対症療法 14 ( 2 ) 29 - 34 2003.10

Language：Japanese Publisher：(株)メディカルレビュー社

一般的にがんの告知は行われるようになってきたものの,転移・再発などの予後不良な状況では納得いく説明がまだ不十分である.そのため,モルヒネなどの麻薬処方についても,丁寧な説明が不足している.そこで,コミュニケーションの取り方や,予後不良な患者との接し方などについて述べた.更に,医師の死生観を確立させるための取り組み方についても言及した.又,一般市民や医療職を対象に,痛みに関するアンケート調査を実施した.殆ど全ての人ががんによる痛みはとってほしいと望んでいた.ところが,モルヒネの使用については肯定的な意見が少なく,むしろモルヒネに対するマイナスイメージが強い印象であった

腎癌を合併した膜性腎症の1例

高野耕志郎, 山本修平, 小林泰之, 渡辺豊彦, 武田克治, 朝日俊彦

香川県内科医会誌 39 109 - 110 2003.6

医療TOPICS 男の更年期

渡辺豊彦

看護実践の科学 28 ( 1 ) 44 - 45 2003.1

Renal cell carcinoma in bilateral native kidneys following failure of transplant graft function: A case report

Toyohiko Watanabe, Katsuji Takeda, Yasuyuki Kobayashi, Toshihiko Asahi

Nishinihon Journal of Urology 65 ( 2 ) 65 - 68 2003

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

We report a case of renal cell carcinoma occurring in bilateral native kidneys following failure of transplant graft function. A 50-year-old man with long-standing chronic renal failure secondary to chronic glomerulonephritis had been on hemodialysis for 9 years when a cadaveric renal transplant was performed on January 29, 1995. He then resumed hemodialysis because of graft failure 21 months after the transplantation. He presented with gross hematuria and lower abdominal pain on April 5, 2001. Computerized tomography (CT) demonstrated acquired cystic disease of the kidney (ACDK) in both native kidneys with a 6 cm solid mass in the left kidney. He underwent transperitoneal bilateral nephrectomy with graft removal. Histopathological examination revealed renal cell carcinoma of the clear cell subtype with a maximum diameter of 4.5 cm in the left kidney. Despite the fact that no mass lesion was noted on preoperative CT of the right native kidney, a solitary 1.5×1.2×1.0 cm clear cell carcinoma was found in the upper portion. He has remained free of evidence of recurrence or metastasis for 6 months postoperatively.

超音波ドプラを用いた非侵襲的ビデオウロダイナミクスの開発 Reviewed

小澤秀夫, 横山光彦, 渡邉雄一, 西口潤, 野崎邦浩, 佐々木克己, 二部野肇, 渡辺豊彦, 公文裕巳, Ding Yew Yoong, Chancellor Michael B.

日本神経因性膀胱学会誌 12 ( 2 ) 200 - 206 2001.12

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

超音波ドプラを用いた尿流動態検査法を開発し,下部尿路閉塞(BOO)診断のためのパタメーター設定を試みた.各排尿において,前立腺部尿道全体の最大流速をV0,尿道括約筋直上の遠位部前立腺部尿道の流速をV1,膜様部尿道の流速をV2とし,これらの部位に対応する機能的断面積を最大尿流率/流速の式により求め,又,尿道括約筋前後の流速比をVRとして求めた.これらのパラメーターとプレッシャーフロースタディーにおける閉塞パラメーター(AG number)との相関を検討した結果,BOOを診断するさいに最も有用なパラメーターはVRであると考えられた

【Overactive Bladder】Overactive Bladderの治療膀胱腔内注入療法

渡辺豊彦, 小澤秀夫, 公文裕巳

排尿障害プラクティス 8 ( 2 ) 129 - 135 2000.6

看護実践間欠式バルーン・カテーテルによる高齢者の排尿管理

濱田有美, 宮村純子, 日野洋子, 小澤秀夫, 渡辺豊彦, 公文裕巳

Urological Nursing 5 ( 1 ) 82 - 86 2000.1

Language：Japanese Publisher：(株)メディカ出版

高齢者は,夜間多尿のため,夜間に頻回の導尿が必要である.間欠式バルーン・カテーテルを使用することで不眠の解消につながり,また外出時に一定の時間のみに使用し,行動範囲が拡大することが明らかとなった.間欠式バルーン・カテーテルの使用は,清潔間欠自己導尿の有力な補助手段となり得ると共に,高齢者の排尿管理に有用である

Beneficial effect of intranasal desmopressin for men with benign prostatic hyperplasia and nocturia: preliminary results. Reviewed

Toyohiko Watanabe

Techniques in urology 5 ( 4 ) 191 - 194 1999.12

Publishing type：Research paper (scientific journal)

The aim of this study was to determine the efficacy of intranasal desmopressin in the treatment of nocturnal polyuria in men with benign prostatic hyperplasia (BPH). Twelve men with BPH were treated with intranasal desmopressin at bedtime for nocturnal polyuria. All patients underwent video-urodynamic evaluation. The number of nocturia episodes was the dependent variable. Exclusion criteria included nephrolithiasis, active urinary tact infection, and history of myocardial infarction, congestive heart failure, and angina. Ten of 12 patients improved with the intranasal desmopressin therapy. Nocturia episodes decreased from a median of 3.6 +/- 0.5 episodes/night before treatment to 1.8 +/- 1.1 episodes/night 3 months after therapy (p = .01). The American Urological Association symptom index decreased from 19 +/- 6 before treatment to 12 +/- 6 after therapy (p = .02). Hyponatremia did not occur. We conclude that intranasal desmopressin is a promising therapy for nocturnal polyuria in selected BPH patients.

治療法紹介薬物療法尿失禁レジニフェラトキシン膀胱腔内注入療法

渡辺豊彦, 小澤秀夫, 公文裕巳

排尿障害プラクティス 7 ( 4 ) 325 - 331 1999.12

EXPERIENCE OF VESICA^<TM> PERCUTANEOUS BLADDER NECK STABILIZATION FOR FEMALE URINARY STRESS INCONTINENCE Reviewed

YOKOYAMA TERUHIKO, OZAWA HIDEO, HASHIMOTO HIDEAKI, WATANABE TOYOHIKO, TSUSHIMA TOMOYASU, KUMON HIROMI

61 ( 7 ) 554 - 557 1999.7

膀胱癌肉腫の1例 Reviewed

横山光彦, 渡辺豊彦, 津島知靖, 公文裕巳, 大枝忠史

西日本泌尿器科 61 ( 2 ) 129 - 131 1999.2

Language：Japanese Publisher：西日本泌尿器科学会

84歳男,肉眼的血尿を主訴とした.膀胱鏡では6.0×5.0cm大の大きな膀胱内腫瘤が後壁から発生していた.膀胱全摘出術と尿管皮膚瘻造設術を施行した.組織学的には膀胱腫瘤は肉腫性組織,骨軟骨肉腫及び移行細胞癌から成っていた.免疫組織化学的検査では,肉腫性領域はビメンチン,S-100,トルイジンブルー染色でのメタクロマジー,及びコラーゲンが陽性であったが,ケラチンとEMAは陰性であった.癌肉腫と診断した.術後15ヵ月間,腫瘍の再発はなく良好な結果を得ている

High incidence of occult neurogenic bladder dysfunction in neurologically intact patients with thoracolumbar spinal injuries - Comment Reviewed

Perkash, I

JOURNAL OF UROLOGY 159 ( 3 ) 968 - 968 1998.3

Transurethral Balloon Laser Thermotherapy (TUBAL-T) for Symptomatic Benign Prostatic Hyperplasia

NASU Yoshitsugu, WATANABE Toyohiko, SAKURAMOTO Koushi, KUMON Hiromi

19 ( 1 ) 29 - 38 1998.3

Inguinal Cystocele : 下部尿路通過障害のない男性における前立腺症の新しい病態 : 第86回日本泌尿器科学会総会

公文裕巳, 小澤秀夫, 横山光彦, 橋本英昭, 渡辺豊彦, 大森弘之

日本泌尿器科学会雑誌 89 ( 2 ) 373 - 373 1998

超音波カラードプラによる非侵襲性下部尿路機能検査法の構築 : 第86回日本泌尿器科学会総会

横山光彦, 小澤秀夫, 渡辺豊彦, 橋本英昭, 公文裕巳, 大森弘之

日本泌尿器科学会雑誌 89 ( 2 ) 339 - 339 1998

超音波カラードプラによる非侵襲性下部尿路機能検査法の構築

横山光彦, 小澤秀夫, 渡辺豊彦, 橋本英昭, 公文裕巳, 大森弘之

日本泌尿器科学会雑誌 89 ( 2 ) 190 - 190 1998

泌尿器科領域におけるNM441の基礎的・臨床的検討 Reviewed

櫻本耕司, 藤田竜二, 渡辺豊彦

日本化学療法学会雑誌 44 ( Suppl.1 ) 429 - 437 1996.3

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

プロドラッグ型新規キノロン系経口合成抗菌薬NM441の活性本体NM394の,尿路感染症由来の教室保存株に対するMICを測定した.グラム陽性菌に対しては,同系薬剤であるciprofloxacin, ofloxacinとほぼ同等の,norfloxacinの1〜3管程度強い抗菌力を示した.グラム陰性菌に対しては,殆ど全ての菌種に強力な抗菌力を示した.NM441を1回100mgないし200mg,1日2回,5〜7日間投与し臨床的有用性を検討した.総合臨床効果は,急性単純性尿路感染症9例全てで著効,急性前立腺炎2例共に有効であった.又,複雑性尿路感染症では有効率88.9%であった.細菌学的効果では,急性単純性尿路感染症,急性前立腺炎の分離菌全てが消失した.複雑性尿路感染症の除菌率は86.2%であった

Robbins deviceを用いた細菌バイオフィルムの解析緑膿菌バイオフィルムと大腸菌バイオフィルムの比較

小野憲昭, 藤田竜二, 渡辺豊彦

BACTERIAL ADHERENCE研究会講演録 9 78 - 83 1996.1

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

形成された細菌バイオフィルムの抗菌剤に対する抵抗性に関しては,緑膿菌,大腸菌両菌株に大きな差異はなく,大腸菌バイオフィルムも緑膿菌バイオフィルムと同様に,検討した全ての薬剤に強い抵抗性を示した.特に,高濃度のOFLXの効果は,むしろ緑膿菌バイオフィルムよりも強い抵抗性を示す結果であった

Clinical studies on advantages and safety of visual laser ablation for patients with benign prostatic hyperplasia Reviewed

Yasutomo Nasu, Toyohiko Watanabe, Hiromi Kumon, Hiroyuki Ohmori

International Journal of Urology 3 ( 1 ) s53 - s54 1996

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

Since 1992, we have been performing VLAP using a right-angle laser delivery system (Urolase) for BPH patients with significant underlying nonurological diseases such as diabetes mellitus, cardiovascular, pulmonary, and maligant diseases. Sufficient clinical results have been obtained without major complications during short-term and long-term observation. In this study, we discuss the clinical advantages and safety of VLAP, compared with TURP, through analysis of the clinical procedure for VLAP for patients treated with anticoagulant agents such as waríarin. In our study of 40 patients, 8 patients were treated with anticoagulants for cardiovascular disease. During the procedure and after the operation, no significant complications were encountered except for transient postoperative bleeding. The 8 patients who received simultaneous anticoagulant therapy also underwent TURP to draw a comparison. The time taken for the procedure and the volume of the blood loss were significantly reduced by VLAP. The hemostatic nature of YAG laser energy seems to result in a technical improvement over conventional I URP for patients undergoing anticoagulant therapy. © IUA/CLJ.

DOI： 10.1111/j.1442-2042.1996.tb00087.x

ラット実験モデルにおけるGracilis Muscle Dynamic Urethral Sphincter Myoplastyの検討

Watanabe Toyohiko, Chancellor Michael B, 公文裕巳, 大森弘之

日本泌尿器科学会雑誌 87 ( 2 ) 351 - 351 1996

Basic and clinical studies on NM441 in urological field

Koushi Sakuramoto, Ryuji Fujita, Toyohiko Watanabe, Tadasu Takenaka, Kouichi Monden, Kazuhiro Hata, Noriaki Ono, Yoshitsugu Nasu, Masaya Tsugawa, Hiromi Kumon, Hiroyuki Ohmori, Katsuichi Nanba, Taiichiro Josen, Satoshi Uno, Bunzo Suyama, Michinao Saegusa, Shunji Hayata

Japanese Journal of Chemotherapy 44 ( 1 ) 429 - 437 1996

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

We studied the antibacterial activity and clinical efficacy of NM441, a new oral quinolone, which is the prodrug of the biologically active NM394. 1) Antibacterial activity: We measured the MICs of NM394 against 200 clinical isolates from urinary tract infections(UTI), and compared them with those of ofloxacin(OFLX), ciprofloxacin(CPFX), norfloxacin(NFLX), sparfloxacin(SPFX), lomefloxacin(LFLX) and tosufloxacin(TFLX). The antibacterial activities of NM394 against gram positive bacteria were a little inferior to those of SPFX, LFLX or TFLX, but were comparable to those of OFLX or CPFX. On the other hand, against gram negative bacteria, in general, antibacterial activities of NM394 were superior to those of other new quinolones. 2) Clinical efficacy: According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 100% (9/9) for uncomplicated UTI and was 88.9% (24/27) for chronic complicated UTI. Bacteriologically, 25 of 29 strains (86.2%) were eradicated for chronic complicated UTI. 3) Side effect: Nausea was observed in 1 patient (2.2%), and an abnormal laboratory finding was observed in 1 patient (2.2%), that showed transient eosinophilia.

複雑性尿路感染症に対するcefluprenamの基礎的・臨床的検討

櫻本耕司, 藤田竜二, 渡辺豊彦

日本化学療法学会雑誌 43 ( Suppl.4 ) 127 - 133 1995.11

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

1)尿路感染症由来の14菌種210株に対する本剤の最小発育阻止濃度(MIC)を測定した.グラム陽性菌に対してはIPMにはやや劣るものの,その他の対照薬(CAZ,CPZ,LMOX)より優れた抗菌力を示した.Escherichia coli, Klebsiella pneumoniae, Proteus mirabilisに対しては,本剤が最も優れた成績であった.又,Serratia marcescens, Pseudomonas aeruginosaに対しては,IPMには若干劣るものの,CAZと同等の抗菌力を示した. 2)複雑性尿路感染症14例中UTI薬効評価基準により評価可能であった12例の総合臨床効果は著効2例,有効6例,無効4例で,有効率は66.7%であった.細菌学的効果では分離菌9菌種20株中17株が消失し,除菌率は85.0%であった.副作用及び臨床検査値の異常変動は1例も認められなかった

泌尿器科領域におけるbalofloxacinの基礎的・臨床的検討

竹中皇, 藤田竜二, 渡辺豊彦

日本化学療法学会雑誌 43 ( Suppl.5 ) 324 - 329 1995.11

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

1)教室保存株14菌種210株に対する本剤のMICを測定し,OFLX及びNFLXの抗菌力と比較した.本剤のグラム陽性菌に対する抗菌力は比較対照薬剤に比し優れており,グラム陰性菌に対しては全体としてOFLXには若干劣るものの,NFLXとほぼ同等の抗菌力を示した. 2)急性単純性膀胱炎4例,複雑性尿路感染症6例及び急性細菌性前立腺炎1例に対し,8日間投与し,臨床的検討を行った.急性単純性膀胱炎例では判定可能であった3例の内2例が著効,1例が有効であった.複雑性尿路感染症では著効3例,有効1例,無効1例であった.急性細菌性前立腺炎の1例では有効であった.複雑性UTIにおける細菌学的効果では12株中11株が消失した. 3)自他覚的副作用は1例も認めず,臨床検査値異常変動もなかった

泌尿器科領域におけるpazufloxacinの基礎的・臨床的検討

渡辺豊彦, 竹中皇, 櫻本耕司

日本化学療法学会雑誌 43 ( Suppl.2 ) 363 - 376 1995.9

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

1)尿路感染症由来株14菌種207株に対するPZFXのMICを測定し,norfloxacin(NFLX), ofloxacin(OFLX)と比較検討した.グラム陽性菌に対しては,OFLXとほぼ同等,グラム陰性菌に対しては,殆どの菌種に対して対照薬より優れた抗菌力を示した.P.aeruginosaに対する本剤及び対照薬の抗菌力は年次的に耐性化傾向が認められた. 2)急性単純性膀胱炎2例,複雑性尿路感染症19例,急性前立腺炎1例,及び慢性前立腺炎3例を対象にした.急性単純性膀胱炎2例では,主治医判定で共に有効以上であった.複雑性尿路感染症17例では,総合臨床効果は,著効7例,有効5例,無効5例で有効率71%であった

Drug Sensitivity and Expression of β-lactamase in Enterococci Isolated at Okayama University Hospital Reviewed

NASU Yoshitsugu, WATANABE Toyohiko, MONDEN Koichi, SAKURAMOTO Koushi, ONO Akinori, TSUGAWA Masaya, KUMON Hiromi, OHMORI Hiroyuki, YASUI Terue

Journal of the Japanese Association for Infectious Diseases 69 ( 8 ) 919 - 923 1995.8

Language：Japanese Publisher：The Japanese Association for Infectious Diseases

The following results were obtained from a study of Enterococci isolated at the Okayama University Hospital from 1990 to 1994.<BR>1) The isolation frequency of Enterococci was about 6% for each year.<BR>2) The percentage of Enterococcus faecalis (E. faecalis) among Enterococci decreased each year, but the percentage of Enterococcus faecium (E. faecium) , and Enterococcus avium (E. avium) increased each year.<BR>3) Results of drug sensitivity tests revealed that the incidence of ofloxacin (OFLX) resistant E. faecalis and E. avium increased each year. Also, the resistance of E. faecalis to ampicillin (ABPC), the primary medication choice for treating E. faecalis, increased each year.<BR>4) A few vancomycin (VCM) non-sensitive Enterococci were isolated. These bacteria showed low-sensitivity toward ABPC, imipenem (IPM), gentamicin (GM), and OFLX, and the extent of multiple drug resistance increased each year.<BR>5) One hundred strains of Enterococci were selected to examine the expression of β-lactamase using the broth method and the iodine-starch method. However, β-lactamase producing strains were not detected.

DOI： 10.11150/kansenshogakuzasshi1970.69.919

Grepafloxacinの泌尿器科領域における基礎的・臨床的検討

竹中皇, 渡辺豊彦, 櫻本耕司

日本化学療法学会雑誌 43 ( Suppl.1 ) 397 - 404 1995.7

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

1) 尿路感染症由来菌14菌種210株に対する本剤のMICを測定し,同系薬剤であるofloxacin(OFLX), ciprofloxacin(CPFX)およびnorfloxacin(NFLX)と比較した.全体として,CPFXに劣るものの,その他の同系薬剤とほぼ同等あるいはそれ以上の抗菌力を示した.2) 急性単純性膀胱炎4例,複雑性尿路感染症28例および急性細菌性前立腺炎2例に対し,本剤を1回量100〜300mg,1日1〜2回,1〜14日間投与し,UTI薬効評価基準に準じて臨床的検討を行った.急性単純性膀胱炎4例,急性細菌性前立腺炎1例に対してはどちらも有効以上であったが,複雑性尿路感染症に対しては著効5例,有効3例,無効14例であった.細菌学的効果では25株中15株が消失した.自・他覚的副作用は1例に一過性の左半身不快感を認め,臨床検査値異常では軽度の好酸球増多,GOT・GPTの上昇を各1例に認めた

Robbins deviceを用いた緑膿菌バイオフィルムの解析緑膿菌バイオフィルムに対する各種抗菌剤の効果について

小野憲昭, 渡辺豊彦, 竹中皇

BACTERIAL ADHERENCE研究会講演録 8 95 - 100 1995.4

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

Robbins deviceをバイオフィルム・サンプラーとして用い,緑膿菌バイオフィルムで抗菌剤の効果を,ホタル・ルシフェリン・ルシフェラーゼ反応によるchemiluminescence法で測定し,更に電子顕微鏡で検討した.キノロン剤とfosfomycin(FOM)が人工尿中でも併用効果を挙げた.またレーザー走査電子顕微鏡は表層と深層での細胞密度の差を形態的に判定可能であった

共焦点レーザー走査顕微鏡による細菌バイオフィルムの観察 P.aeruginosa biofilmとS.epidermidis biofilmの比較

渡辺豊彦, 竹中皇, 櫻本耕司

BACTERIAL ADHERENCE研究会講演録 8 89 - 94 1995.4

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

新しい共焦点レーザー走査電子顕微鏡でP.aeruginosa biofilmとS.epidermidis biofilmの蛍光染色性を比較した.ともに生の状態での生物資料の観察が可能であり,前者ではsafranineとFITC-ConAで識別可能であった.後者ではsafranineの二重染色は不能で,前者と共に単染色ではacridine orangeとFITC-ConAが現時点では最も優れた染色性を示した

難治性複雑性尿路感染症に対するazithromycinとofloxacinの併用効果に関する検討 Reviewed

小野憲昭, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 43 ( 2 ) 222 - 230 1995.2

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

カテーテル留置難治性複雑性尿路感染症に対し,AZMとOFLXの併用療法は有効な方法のひとつであると考えられ,また安全性にも問題は認められず,尿路のバイオフィルム感染症に対する治療法全般を検討していくうえでも意義深いものであると考えられた

尿路感染症に対するritipenem acoxilの基礎的・臨床的検討

小野憲昭, 藤田竜二, 渡辺豊彦

日本化学療法学会雑誌 43 ( Suppl.3 ) 256 - 263 1995.1

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

1)尿路感染症由来の14菌種210株に対するritipenem(RIPM)のMICを測定し,cefaclor(CCL), cefixime(CFIX), cefotiam(CTM)と比較検討した.グラム陽性菌,特にEnterococcus faecalisでは対照薬剤より優れた抗菌力を示した.グラム陰性菌に対してはCFIX, CTMよりやや劣るものの,CCLより優れた抗菌力を示した. 2)34例の尿路感染症患者(急性単純性膀胱炎4例, 複雑性尿路感染症30例)を対象に,本剤1日量450mg〜1500mgを1日3回,3〜14日間食後投与し,UTI薬効評価基準に基づき判定した.急性単純性膀胱炎では2例が効果判定可能で,著効1例,有効1例であった.複雑性尿路感染症では,著効6例,有効18例,無効4例であった

Ritipenem acoxilの体内動態の検討 Cefotiam hexetilとの比較

小野憲昭, 藤田竜二, 渡辺豊彦

日本化学療法学会雑誌 43 ( Suppl.3 ) 286 - 291 1995.1

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

健常成人男子ボランティアにRIPM-AC,CTM-HEともに200mg錠を単回投与し,クロスオーバー法で各薬剤の血漿中濃度,及び尿中排泄を検討した.最高血漿中濃度(Cmax)は,ritipenem(RIPM)では2.09μg/ml, cefotiam(CTM)では2.85μg/mlを示した.RIPM, CTMの血漿中濃度半減期(T1/2)は,それぞれ0.56h, 0.71h, 12時間までの血漿中濃度曲線下面積(AUC0-12)はそれぞれ2.10μg・h/ml, 4.99μg・h/ml.活性体の累積尿中排泄率は12時間までで,RIPM11.3%, CTM38.9%であった

Basic and clinical studies on grepafloxacin in the urological fiel Reviewed

Tadasu Takenaka, Toyohiko Watanabe, Kohji Sakuramoto, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Yasuhiro Katayama, Akihiro Mizuno, Mikio Kishi, Ryoji Nasu

Japanese Journal of Chemotherapy 43 397 - 404 1995

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

We studied the antibacterial activity and clinical usefulness of grepafloxacin (GPFX), a new quinolone, in the urological field. 1) Antibacterial activity: The MICs of GPFX were measured against 210 clinical isolates of 14 species from urinary tract infection and compared with those of ofloxacin (OFLX), ciprofloxacin (CPFX) and norfloxacin (NFLX). In general, the antibacterial activity of GPFX was inferior to CPFX, but equal or superior to those of other control drugs. 2) Clinical efficacy: Although the clinical efficacy in acute uncomplicated cystitis and chronic bacterial prostatitis was good, the overall clinical efficacy rate according to the criteria of the UTI Committee was 36.4%(8/22) in chronic complicated UTI. Fifteen of 25 (60%) strains isolated were eradicated. 3) Side effects: Temporary discomfort of the left side of the body was observed in one case. Mild elevation of eosinophils or GOT·GPT was observed in one case. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.Supplement1_397

Pharmacokinetics of ritipenem acoxil Reviewed

Noriaki Ono, Ryuji Fujita, Toyohiko Watanabe, Tadasu Takenaka, Kouichi Monden, Satoshi Uno, Koushi Sakuramoto, Toshihide Hayashi, Kazuhiro Hata, Yoshitsugu Nasu, Masaya Tsugawa, Hiromi Kumon, Hiroyuki Ohmori, Shin Irie, Tetsuzo Kaneshige

Japanese Journal of Chemotherapy 43 286 - 291 1995

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

Ritipenem acoxil (RIPM-AC) is a new oral penem antibiotic. We investigated the pharmacokinetics of RIPM-AC and cefotiam hexetil (CTM-HE) by the cross-over method. The pharmacokinetics of RIPM-AC and CTM-HE, each orally administrated at a dose of 200 mg, were compared in healthy male volunteers. The Cmax values of ritipenem (RIPM) and cefotiam (CTM) were 2.09μgg/ml and 2.85μg/ml, respectively. The T1/2 of RIPM and CTM were 0.56 h and 0.71 h, and the AUC0-12 values were 2.10 μg·h/ml and 4.99 μg·h/ml. The mean urinary recovery rates of RIPM and CTM up to 12 h after a single oral administration were 11.3% and 38.9%. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.Supplement3_286

Basic and clinical studies on ritipenem acoxil in urinary tract infection Reviewed

Noriaki Ono, Ryuuji Fujita, Toyohiko Watanabe, Tadasu Takenaka, Kouichi Monden, Koushi Sakuramoto, Toshihide Hayashi, Kazuhiro Hata, Yoshitsugu Nasu, Masaya Tsugawa, Hiromi Kumon, Hiroyuki Ohmori, Katsuichi Nanba, Katsuyoshi Kondo, Teruhisa Ohhashi, Teruaki Akaeda, Yasuhiro Katayama

Japanese Journal of Chemotherapy 43 256 - 263 1995

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

We studied the antibacterial activity and clinical efficacy of ritipenem acoxil (RIPM-AC), a neworal penem antibiotic, in urinary tract infections. 1) Antibacterial activity: We measured the MICs of ritipenem (RIPM) against 210 clinicalisolates of 14 species from urinary tract infections and compared them with those of cefaclor (CCL), cefixime (CFIX) and cefotiam (CTM). Against gram-positive organisms, the overallantibacterial activity of RIPM was superior to that of other antibiotics. Against gram-negativeorganisms, the activity of RIPM was almost equivalent to that of other antibiotics. 2) Clinical efficacy: Four patients with acute uncomplicated cystitis (AUC) and 30 patients withchronic complicated urinary tract infection were treated with ritipenem acoxil. According to thecriteria of the Japanese UTI Committee, the overall clinical efficacy rate was 100%(2/2) for AUC and 85.7%(24/28) for chronic complicated UTI. Bacteriologically, 28 of 32 strains (87.5%) wereeradicated. 3) Side effects: No side effects were observed. Abnormal laboratory findings, however, wereobserved in 2 cases, one with slight elevations of GOT and GPT and the other with decreases in RBC, Hb and Ht. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.Supplement3_256

A study on the combined use of azithromycin and ofloxacin in refractory complicated urinary tract infection Reviewed

Noriaki Ono, Toyohiko Watanabe, Tadasu Takenaka, Koushi Sakuramoto, Toshihide Hayashi, Kazuhiro Hata, Hiromi Kumon, Hiroyuki Ohmori, Katsuyoshi Kondo, Teruhisa Ohashi, Katsuichi Namba, Teruaki Akaeda, Yasuhiro Katayama, Toshihiko Asahi, Masaya Tsugawa, Syunji Hayata, Yoshitsugu Nasu, Kazuhisa Takeda

Japanese Journal of Chemotherapy 43 ( 2 ) 222 - 230 1995

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

The efficacy and safety of combined therapy including azithromycin (AZM) and ofloxacin (OFLX) and single therapy with OFLX were compared in patients with rafractory complicated urinary tract infection (UTI) caused by catheters, to assess these methods of treating biofilm infection of the urinary tract. The subjects were patients with UTI who were treated with urethral catheter (including cystostomy). Seven days before the start of administration, the indwelling catheter was changed, and the course was observed without administration of any antimicrobial drug. Patients were registered at the time of this observation. The combined therapy group was given AZM at a single daily dose of 500 mg for 3 days and OFLX at a dose of 200 mg three times a day for 7 days. The single therapy group was given OFLX at a dose of 200 mg three times a day for 7 days. Eight days after the start of administration, the catheter was changed again. Urinary sediment and culture, and clinical tests were performed before and after the administration of drugs, and the surface of the catheter was observed by electron microscopy. Fifteen of the 37 patients were assigned to the combined therapy group and 17 to the single therapy group. The efficacy rates were 66.7% and 47.1% in the respective groups, as evaluated by the attending doctor. According to the criteria of the Japanease UTI committee, overall clinical efficacy was 60.0% in the combined therapy group and 41.2% in the single therapy group. The urine became negative for bacteria in 53.3% of the patients in the combined therapy group and 35.3% of those in the single therapy group. The bacteriological eradication rate was 91.2% in the combined therapy group and 68.8% in the single therapy group. There were no associated side effects or abnormal changes in clinical laboratory test values except for discomfort in the stomach of one patient in the combined therapy group. The inhibitory effect on biofilm formation as determined by electron microscopy tended to be superior in the combined therapy group. These results suggest that combined therapy with AZM and OFLX is an effective method of treating refractory complicated UTI in patients with a catheter. © 1995, Japanese Society of Chemotherapy. All rights reserved. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.222

Basic and clinical evaluation of carindacillin for complicated urinary tract infection caused by Pseudomonas aeruginosa Reviewed

Toyohiko Watanabe, Tadasu Takenaka, Koushi Sakuramoto, Kouichi Monden, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Masaya Tsugawa, Hiromi Kumon, Hiroyuki Ohmori, Katsuyoshi Kondo, Syunji Hayata, Yoshitsugu Nasu, Teruaki Akaeda, Yasuhiro Katayama

Japanese Journal of Chemotherapy 43 ( 1 ) 89 - 95 1995

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

We evaluated the antibacterial activity and efficacy of carindacillin (CIPC), a synthetic penicillin, in the urological field. 1) Antimicrobial activities: Statistical studies were performed on Psudomonas aeruginosa isolated from patients with urinary tract infection from 1983 to 1991. Antimicrobial activities of new quinolones against these strains were annually reduced both in Muller-Hinton broth (MHB) and in artifical urine (AU). Antimicrobial activities of new quinolones in AU were more reduced than those in MHB, but the antimicrobial activities of CIPC were less reduced in both MHB and AU than those of the new quinolones. It was considered that the antimicrobial activities of the new quinolones were reduced due to low pH and high concentrations of magnesium and calcium in AU. 2) Clinical efficacy: According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 61.9% (13/21). Bacteriologically, 21 of 34 strains (61.8%) isolated were eradicated. The eradication rate for P. aeruginosa was 57.1% (12/21). 3) Side effects: No clinical side effects or abnormal laboratory changes were observed. Based on the above results, CIPC might be useful in the treatment of urinary tract infection caused by P. aeruginosa. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.89

Basic and clinical studies on cefluprenam in urinary tract infections Reviewed

Koushi Sakuramoto, Ryuji Fujita, Toyohiko Watanabe, Tadasu Takenaka, Kouichi Monden, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Yoshitsugu Nasu, Masaya Tsugawa, Hiromi Kumon, Hiroyuki Ohmori, Katsuichi Nanba, Yasuhiro Katayama, Teruaki Akaeda

Japanese Journal of Chemotherapy 43 127 - 133 1995

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

We studied the antibacterial activity and clinical efficacy of cefluprenam (CFLP), a new injectable cephalosporin antibiotic, in urinary tract infections. 1) Antibacterial activity: The MICs of CFLP were measured against 210 clinical isolates of 14 species from urinary tract infections and compared with those of ceftazidime (CAZ), cefoperazone (CPZ), latamoxef (LMOX) and imipenem (IPM). In general, the antibacterial activity of CFLP was superior to those of other compared cephems except for IPM, but slightly inferior to that of IPM. 2) Clinical efficacy: Fourteen patients with complicated urinary tract infection were treated once or twice a day with 0.5g or 1.0g of CFLP. Out of 14, 12 cases were evaluated according to the criteria of the apanese UTI Committee. The overall clinical efficacy rate was 66.7%(8/12). Bacteriologically, 17 of 20 strains (85%) were eradicated. 3) Side effect: No clinical side effects and no abnormal laboratory changes were observed in any cases. © 1995, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1995.43.Supplement4_127

液胞型H^+-ATPaseのE.coliの膀胱付着に及ぼす影響について

那須良次, 渡辺豊彦, 櫻本耕司, 小野憲昭, 津川昌也, 公文裕巳, 大森弘之, 友近健一, 篠田純男

日本泌尿器科学会雑誌 86 ( 3 ) 791 - 791 1995

共焦点レーザー走査顕微鏡による細菌バイオフィルムの観察

渡辺豊彦, 小野憲昭, 公文裕巳, 大森弘之, 友近健一, 小熊恵二

日本泌尿器科学会雑誌 86 ( 1 ) 167 - 167 1995

前立腺肥大症に対するVLAPの臨床的検討 : 長期成績と合併症について

那須保友, 渡辺豊彦, 公文裕巳, 大森弘之, 入江伸, 西村元一, 金重哲三

日本泌尿器科学会雑誌 86 ( 1 ) 239 - 239 1995

泌尿器科領域感染症におけるbiapenemの基礎的・臨床的検討

渡辺豊彦, 竹中皇, 林俊秀

日本化学療法学会雑誌 42 ( Suppl.4 ) 486 - 496 1994.12

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

1)尿路感染症分離株14菌種210株に対するBIPMのMICを測定し,imipenem (IPM), ceftazidime (CAZ), latamoxef (LMOX)およびcefoperazone (CPZ)と比べた。全体的に見ると本剤の抗菌力は,IPMとほぼ同等,CAZ, LMOXおよびCPZより3〜4管程度優れていた。2)複雑性尿路感染症30例を対象に,本剤1回150〜450mgを1日2回,4〜8日間投与した。評価可能であった23例の総合臨床効果は著効7例,有効10例,無効6例であった。細菌学的効果では35株中,消失30株,存続5株であった。急性前立腺炎の1例は主治医判定で有効であった。副作用および臨床検査値異常変動はなかった

ニューキノロン薬のPseudomonas aeruginosaに対する抗菌力の年次推移と尿中抗菌力について

渡辺豊彦, 竹中皇, 桜本耕司

緑膿菌感染症研究会講演記録 28回 135 - 141 1994.11

Language：Japanese Publisher：緑膿菌感染症研究会

MIC測定用broth中での緑膿菌に対する抗菌力は,今回検討したニューキノロン薬すべてにおいて年次的に耐性化が認められた。また,人工尿中における抗菌力は,多くのニューキノロン薬においてMIC測定用brothと比較して3管程度低下しており,年次的にも耐性化傾向が認められた。MIC測定用brothと人工尿の組成を比較したところpH, Mg2+濃度,Ca2+濃度に相違が認められ,人工尿のpHがMIC測定用brothに比し低値であること,また,Mg2+, Ca2+など2価の陽イオン濃度が高値であることが尿中MICの上昇に関与している

複雑性尿路感染症に対するFK037の基礎的・臨床的検討

渡辺豊彦, 竹中皇, 林俊秀

日本化学療法学会雑誌 42 ( Suppl.3 ) 260 - 268 1994.10

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

1)グラム陽性菌に対してはIPMには劣るものの,CAZ, CPZより強い抗菌力を示した。グラム陰性菌のEscherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Serratia marcescensに対してはIPMとほぼ同等またはそれ以上の抗菌力を示し,CAZ, CPZより強い抗菌力を示した。Pseudomonas aeruginosaに対してはIPMには劣るものの,CAZとほぼ同等,CPZより優れた抗菌力を示した。2)評価可能であった12例の総合臨床効果は,著効3例,有効6例,無効3例で,有効率は75.0%であった。細菌学的効果では20株中18株が消失した。副作用として1例に発疹を認めたが一過性のものであった。臨床検査値異常変動は1例に好酸球増多を認めたが,軽度であり投与終了後5日目に正常化した

泌尿器科領域におけるTazobactam/Piperacillin(PIPC)の基礎的・臨床的検討

林俊秀, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 42 ( Suppl.2 ) 541 - 552 1994.10

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

1)尿路感染症分離株14菌種206株に対する本剤のMICを測定し,PIPC,sulbactam/cefoperazone (SBT/CPZ),latamoxef (LMOX),ceftazidime (CAZ)と比較した。本剤の抗菌力は,グラム陽性菌に対してはStaphylococcus epidermidisでSBT/CPZに劣るものの,PIPCとほぼ同等,LMOX, CAZより優れた抗菌力を示した。グラム陰性菌ではLMOX, CAZには劣るものの,SBT/CPZとほぼ同等,PIPCとは同等ないし1管程度優れた抗菌力を示した。2)複雑性尿路感染症37例に本剤1回1.25g〜2.5gを1日2回,4〜8日間連続点滴静注した。複雑性尿路感染症30例の総合臨床効果は著効4例,有効18例,無効8例であった。細菌学的効果では48株中,消失38株,存続10株であった。自・他覚的副作用はなかった。臨床検査値異常としてGPTの上昇を2例に,GOT, GPT, Al-P, γ-GTPの上昇を1例に,好酸球の増多を1例に認めた

共焦点レーザー走査顕微鏡による細菌バイオフィルムの観察

渡辺豊彦, 竹中皇, 林俊秀

BACTERIAL ADHERENCE研究会講演録 7 111 - 115 1994.6

緑膿菌性複雑性尿路感染症に対するcarindacillin(CIPC)の再評価 Reviewed

渡辺豊彦

日本化学療法学会雑誌 42 ( 6 ) 809 - 810 1994.6

MRSAによる尿路感染結石(腎結石)症例について

林俊秀, 渡辺豊彦, 竹中皇

BACTERIAL ADHERENCE研究会講演録 7 87 - 92 1994.6

尿路感染症に対するSY5555の基礎的・臨床的検討

林俊秀, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 42 ( Suppl.1 ) 475 - 484 1994.4

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

1)尿路感染症分離菌14菌種210株に対する本剤のMICを測定し,cefaclor(CCL),cefixime(CFIX)及びofloxacin(OFLX)と比べた。グラム陽性球菌,特にE. faecalisには対照薬より優れた抗菌力を示した。グラム陰性菌に対してはCCLより強く,CFIXとほぼ同等,OFLXにはやや劣っていた。2)急性単純性尿路感染症13例及び複雑性尿路感染症17例に本剤1回100〜300mgを1日3回,3〜7日間投与し,UTI薬効評価基準に準じ臨床的検討を行った。急性単純性尿路感染症11例中著効8例,有効3例,複雑性尿路感染症では15例中著効7例,有効4例,無効4例であった。分離菌別細菌学的効果は18株中P. aeruginosa(2株)を除く16株が消失した

Basic and clinical studies on SY5555 in the urological field

Hayashi Toshihide, Watanabe Toyohiko, Takenaka Tadasu, Hata Kazuhiro, Ono Noriaki, Kumon Hiromi, Ohmori Hiroyuki, Kondo Katsuyoshi, Ohasi Teruhisa, Akaeda Teruaki, Katayama Yasuhiro

Japanese Journal of Chemotherapy 42 ( 1 ) 475 - 484 1994

Publisher：Japanese Society of Chemotherapy

We studied the antibacterial activity and clinical efficacy of SY5555, a new oral penem antibiotic, in the urological field.<BR>1) Antibacterial activity: We determined the MICs of SY5555 against 210 clinically isolated strains of 14 species from urinary tract infections, and compared them with those of cefaclor (CCL), cefixime (CFIX) and ofloxacin (OFLX). Against gram-positive organisms, the overall antibacterial activity of SY5555 was superior to that of other antibiotics. Against gram-negative organisms the activity of SY5555 was almost equivalent to that of other antibiotics.<BR>2) Clinical efficacy: Thirteen patients with acute uncomplicated cystitis (AUC) and 17 patients with chronic complicated urinary tract infections (C-UTI) were treated with SY5555. In 11 cases of AUC, the overall clinical efficacy rate according to the criteria of the Japanese UTI Committee was 100% and all 12 strains were eradicated bacteriologically. In 15 cases of C-UTI, the overall clinical efficacy rate according to the same criteria was 73.3%. Bacteriologically, 16 of 18 strains (88.9%) were eradicated.<BR>3) Side effects: No side effects were observed in 30 cases, and no abnormal laboratory findings were noted in 24 cases

DOI： 10.11250/chemotherapy1953.42.Supplement1_475

Clinical Studies on VLAP for the Patients of BPH:Long term follow up study and analysis for the patients under anticoagulant therapy

Nasu Yasutomo, Watanabe Toyohiko, Kumon Hiromi, Ohmori Hiroyuki

THE JOURNAL OF JAPAN SOCIETY FOR LASER SURGERY AND MEDICINE 15 281 - 284 1994

Language：Japanese Publisher：Japan Society for Laser Surgery and Medicine

Since 1992, we have performed the VLAP using right angle laser derivery system (Urolase) for the patients of BPH with significant underlying non-urological diseases such as cardiovascular disease, malignant disease, DM and pulmonary disease. Sufficient clinical outcome has obtained without major complication after a short term and a long term observation. In this study, we discuss the clinical advantages and safety in comparison with TUR-P through the analysis of the clinical courses of the VLAP for the patients treated with anticoagulant agents such as warfarin. In our series of 40 cases, 8 patients were treated with anticoagulant for the reason of cardiovascular disease. During the procedure and after the operation, no significant complications were encountered except for a transient postoperative bleeding.<BR>And 8 cases with anticoagulant therapy underwent TUR-P were also analyzed as a comparison. The time of the procedure and the volume of the blood loss were significantly reduced by VLAP. The hemostatic nature of YAG laser energy seems to result in a technical improvement on conventional TUR-P for the patients under anticoagulant therapy.

DOI： 10.2530/jslsm1980.15.Supplement_281

Clinical Study on Visual Laser Assisted Prostatectomy(VLAP).

Thermal Medicine 10 ( 2 ) 126 - 130 1994

Basic and clinical studies on biapenem in genito-urinary infections

Toyohiko Watanabe, Tadasu Takenaka, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Keigo Kinugawa, Hiroyoshi Tanaka, Mototaka Takada, Katsuichi Nanba, Katsuji Takeda, Toshihiko Asahi, Satoshi Uno, Taiichiro Jousen

CHEMOTHERAPY 42 486 - 496 1994

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

We studied the antibacterial activity and clinical efficacy of biapenem (BIPM), a new carbapenem antibiotic, in the genito-urinary, infections. 1) Antibacterial activity: We measured the MICs of BIPM against clinical isolates (210 strains of 14 species) from urinary tract infections, and compared them with those of imipenem (IPM), ceftazidime (CAZ), latamoxef (LMOX) and cefoperazone (CPZ). In general, antibacterial activities of BIPM were almost equal to those of IPM, but superior to those of other control drugs. 2) Clinical efficacy: According to the criteria of Japanese UTI committee, the overall clinical efficacy rate was 73.9%(17/23) for chronic complicated UTI. Bacteriologically, 30 of 35 strains (85.7%) were eradicated. 3) Side effect: Clinical side effects and abnormal laboratory changes were not observed in any cases. © 1994, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.42.Supplement4_486

Basic and clinical studies of tazobactam/piperacillin in the urological field

Toshihide Hayashi, Toyohiko Watanabe, Tadasu Takenaka, Kouji Sakuramoto, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Katsuyoshi Kondo, Yasuhiro Katayama, Teruaki Akaeda, Shunji Hayata, Toshihiko Asahi, Daisuke Yamada

CHEMOTHERAPY 42 541 - 552 1994

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

We studied the antibacterial activity and clinical efficacy of a new combined drug, tazobactam/piperacillin (TAZ/PIPC), prepared at a ratio of 1: 4, in the urological field. 1) Antibacterial activity: We measured the MICs of TAZ/PIPC against clinical isolates (206 strains of 14 species) from urinary tract infections, and compared them with those of piperacillin (PIPC), sulbactam/cefoperazone (SBT/CPZ), latamoxef (LMOX), and ceftazidime (CAZ). Against gram-positive bacteria, the antibacterial activity of TAZ/PIPC was almost equal to that of PIPC, but was superior to that of other control drugs, whereas against Staphylococcus epidermidis, the activity of TAZ/PIPC was inferior to that of SBT/CPZ. Against gram-negative bacteria the antibacterial activity of TAZ/PIPC was almost equal to that of SBT/CPZ and equal to or twice that of PIPC but inferior to that of LMOX and CAZ. 2) Clinical efficacy: According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 73.3%(22/30) for chronic complicated UTI. Bacteriologically, 38 of 48 strains (79.2%) were eradicated. 3) Side effects: No subjective side effects were observed in this investigation. Liver dysfunction in three cases and eosinophilia in one case were observed, but these were not severe. © 1994, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.42.Supplement2_541

Temafloxacinの泌尿器科領域における基礎的・臨床的検討

畠和宏, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 41 ( Suppl.5 ) 537 - 546 1993.12

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

1)健常人ボランティア5名に本剤300mgを単回経口投与した時の前立腺液内濃度は,1,2,4時間後でそれぞれ0.33,0.71,0.66μg/mlで,対血清比は0.32,0.35,0.43であった。2)尿路感染症分離菌14菌種209株に対する本剤のMICを測定し,同系薬剤であるofloxacin,ciprofloxacin,enoxacinおよびnorfloxacinと比べた。全体としてCPFXには劣るものの,その他の同系薬剤とほぼ同等の抗菌力を示した。3)本剤を経口投与し,UTI薬効評価基準に準じて判定した総合臨床効果は,急性単純性膀胱炎の2例は著効1例,有効1例,複雑性尿路感染症13例では著効3例,有効6例,無効4例であった。細菌学的効果では14株中12株が消失した。細菌性前立腺炎2例の主治医判定は1例が有効で,1例はやや有効であった

腎機能障害者におけるcefozopran点滴静注時の薬物体内動態および投与設計について

竹中皇, 渡辺豊彦, 林俊秀

日本化学療法学会雑誌 41 ( Suppl.4 ) 147 - 153 1993.12

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

健常成人及び種々の程度の腎機能障害患者におけるCZOP単回点滴静注時の体内動態を,血中濃度はHPLC法,尿中濃度はBioassay法にて測定した。1)健常成人並びに種々の程度の腎機能障害患者に対し,CZOPを1回1.0g,30分間で点滴静注し,two-compartment modelを適用して薬動力学的に解析を加えた。健常成人におけるCZOPの血中半減期T1/2(β)は2.20時間,β相の消失速度定数βは0.321/hであり,腎機能障害の程度に応じてT1/2(β)は延長し,βは低下していた。投与開始24時間後迄の累積尿中回収率は健常成人70.0%であり,Ccrが30ml/min未満の高度腎機能障害患者では32.5%と低下していた

Cefozopranの泌尿器科領域における基礎的・臨床的検討

畠和宏, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 41 ( Suppl.4 ) 309 - 318 1993.12

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

1)尿路感染症分離株14菌種206株に対するcefozopranのMICを測定し,imipenem(IPM),ceftazidime(CAZ),latamoxef(LMOX)およびcefoperazone(CPZ)と比較した。本剤の抗菌力はIPMより1管程度劣っているものの全菌種でおしなべて高い抗菌力を示し,CAZとほぼ同等,LMOX,CPZに比し1〜2管程度優れていた。2)複雑性尿路感染症59例,急性前立腺炎2例に本剤を1回250mg,500mg,1000mgまたは2000mg(力価),1日1回または2回,4〜10日間連続点滴静注した。評価可能であった複雑性尿路感染症47例の総合臨床効果は著効10例,有効27例,無効10例であった。細菌学的効果では47株中,消失41株,存続6株であった。急性前立腺炎で評価可能2例の総合臨床効果は有効2例であり,2例ともに菌は陰性化した

粘液産生性前立腺癌の1例 Reviewed

渡辺豊彦, 畠和宏, 那須保友

西日本泌尿器科 55 ( 11 ) 1654 - 1657 1993.11

コレステロール結晶含有腎嚢胞の1例 Reviewed

渡辺豊彦, 那須保友, 公文裕巳

西日本泌尿器科 55 ( 11 ) 1658 - 1661 1993.11

腎機能障害時における注射用塩酸バンコマイシン(VCM)の薬物体内動態およびその投与設計について Reviewed

竹中皇, 渡辺豊彦, 林俊秀

日本化学療法学会雑誌 41 ( 10 ) 1079 - 1089 1993.10

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

注射用塩酸VCMの腎機能障害患者における投与設計につき検討を加えた。1)健常成人ならびに種々の程度の腎機能障害者に対し,VCMを1回0.5g,60分間で点滴静注し,two-compartment modelを適用して薬動力学的に解析を加えた。健常成人におけるVCMの血中半減期T1/2(β)は3.08時間,β相の消失速度定数βは0.233/hであり,腎機能障害の程度に応じてT1/2(β)は延長し,βは低下していた。また,投与開始24時間後までの累積尿中回収率は健常成人96.3%であり,腎機能障害の程度に応じて低下していた。2)血中濃度の解析によって得られた種々のパラメーターの中で,βをCcrに応じて変化するパラメーターとして投与設計を行った。この投与設計の妥当性は連続投与時の血中濃度の実測値と理論値との一致により確認され,腎機能障害の程度に応じた具体的な投与設計として有用性の高いものと考えられた

泌尿器科領域におけるloracarbefの基礎的・臨床的検討

渡辺豊彦, 竹中皇, 林俊秀

日本化学療法学会雑誌 41 ( Suppl.3 ) 310 - 317 1993.8

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

1)抗菌力:尿路感染症由来菌14菌種205株に対する本剤のMICを測定し,同系薬剤と比較検討した。全体としてCCLとほぼ同等,Staphylococcus epidermidis,Klebsiella oxytocaに対してはCCLより優れた抗菌力を示した。2)前立腺液移行:本剤200mg単回投与後の前立腺圧出液中濃度は全体としてばらつきが大きいものの,4時間後で0.48±0.16μg/ml(n=4)であった。3)臨床効果:16例の尿路感染症患者,急性細菌性前立腺炎1例を対象に,本剤1回量200〜400mgを1日2〜3回,3〜7日間食後投与し,UTI薬効評価基準に準じ臨床的検討を行った。急性単純性膀胱炎に対しては2例とも著効,急性単純性腎盂腎炎の1例は著効,複雑性尿路感染症に対しては著効4例,有効3例,無効1例であった。用量別には,1日400mg投与群が2例中2例,600mg投与群が8例中7例,800mg投与群が2例中2例が有効以上であった。細菌学的効果は91.7%(11/12)という高い除菌率であった

尿路感染症に対するS-1108の基礎的・臨床的検討

小野憲昭, 渡辺豊彦, 竹中皇

日本化学療法学会雑誌 41 ( Suppl.1 ) 448 - 455 1993.6

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

1)尿路感染症由来菌14菌種202株に対する本剤のMICを測定し,同系薬剤であるcefaclor(CCL),cefixime(CFIX),cefteram(CFTM)と比較した。全体として,CFIX,CFTMとほぼ同等,CCLに比し2〜6管優れた抗菌力を示した。2)急性単純性膀胱炎4例および複雑性尿路感染症24例を対象に,本剤75〜150mgを1日3回,3〜7日間投与した。急性単純性膀胱炎では効果判定可能の2例はいずれも著効であった。複雑性尿路感染症に対しては著効8例,有効8例,無効3例であり,用量別には1日225mg投与群で4例全例,300mg投与群で10例中9例,450mg投与群では5例中3例が有効以上であった。細菌学的効果では投与前分離菌10菌種22株の内21株が消失した。投与後出現菌としては5菌種5株が認められた。自・他覚的副作用および臨床検査値の異常変動は1例もなかった

両側重複腎盂尿管に合併した膀胱尿管逆流症(VUR)の1例

井上高明, 郭春鋼, 渡辺豊彦

福山医学 ( 3 ) 149 - 153 1993.3

Basic and clinical studies on temafloxacin in urogenital infections Reviewed

Kazuhiro Hata, Toyohiko Watanabe, Tadasu Takenaka, Satoshi Uno, Toshihide Hayashi, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Katsuichi Nanba, Katsuyoshi Kondo, Shin Irie, Tetsuzo Kaneshige

CHEMOTHERAPY 41 537 - 546 1993

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

The penetration into prostatic fluid, antibacterial activity and clinical usefulness of temafloxacin (TMFX), a new quinolone, were studied. 1) The concentrations of TMFX in the prostatic fluid were 0.33, 0.71 and 0.66 μg/ml at 1, 2 and 4 hours after a single administration of 300 mg of TMFX, and the ratios to serum level (prostatic fluid/serum) were 0.32, 0.35 and 0.43, respectively. 2) We determined the MICs of TMFX against clinical isolates (209 strains of 14 species) from urinary tract infections, and compared them with those of ofloxacin (OFLX), ciprofloxacin (CPFX), enoxacin (ENX) and norfloxacin (NFLX). The antibacterial activity of TMFX was inferior to that of CPFX but almost equal to those of other control drugs. 3) The overall clinical efficacy rate, evaluated according to the criteria of the Japanese UTI Committee, was 100% (2/2) in acute uncomplicated cystitis and 69.2% (9/13) in chronic complicated UTI. Bacteriologically, 12 of 14 strains (85.7%) were eradicated. Two patients with chronic prostatitis were evaluated as good and fair by the doctors. 4) No drug-related side effects, including abnormal laboratory findings, were observed in any of the 17 cases. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.Supplement5_537

Pharmacokinetics of vancomycin and dosage planning in patients with renal insufficiency Reviewed

Tadasu Takenaka, Toyohiko Watanabe, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Tetsuzou Kaneshige, Katsuichi Nanba, Hiroyuki Omori

CHEMOTHERAPY 41 ( 10 ) 1079 - 1089 1993

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

We assessed the pharmacokinetics and dosage regimen of vancomycin in patients with renal insufficiency. 1) Vancomycin (VCM), 500 mg, was administered to healthy volunteers and patients with varying degrees of impaired renal function by 60-minute drip infusion. Serum levels of VCM after a single dose were assayed by FPIA and urinary levels by bioassay. Pharmacokinetic parameters were determined using a two-compartment model. In healthy volunteers, mean T1/2(β) was 3.08h and mean β was 0.233/h. As the degree of renal insufficiency became more severe, T1/2(β) became more prolonged and β decreased. The mean 24-h urinary excretion rate was 96.3% in the healthy volunteers and decreased in accordance with the severity of the renal insufficiency. 2) To plan the dosage regimen, β was selected as a parameter which varied in accordance with the degree of impaired renal function as determined on the basis of creatinine clearance. The appropriateness of this regimen was confirmed in a multiple-dose study. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.1079

Pharmacokinetics and dosage planning of cefozopran in patients with renal insufficiency Reviewed

Tadasu Takenaka, Toyohiko Watanabe, Toshihide Hayashi, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Katsuichi Nanba, Tetsuzou Kaneshige, Hiroyuki Ohmori

CHEMOTHERAPY 41 147 - 153 1993

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

We investigated pharmacokinetics of cefozopran (CZOP), a new cephem antibiotic, in patients with renal insufficiency. Serum levels of CZOP after a single administration were assayed by HPLC and urinary levels by Bioassay. 1) 1.0g CZOP were administered to healthy volunteers and patients with varying degrees of impaired renal function by 30minutes drip infusion. Pharmacokinetic parameters were determined using a two-compartment model. In healthy volunteers, the mean values of T1/2 (β) was 2.20h and β was 0.321/h. As proceeded the renal insufficiency, T1/2 (β) was prolonged and β was decreased. The mean urinary excretion rate within 24h was 70.0% in healthy volunteers and decreased to 32.5% in Patients with severe renal insufficiency whose creatinine clearrance (Ccr) were below 30ml/min. 2) To plan a regimen, β was selected as the parameter which varied in accordance with the degree of impaired renal function as measured by Ccr. A recommended dosing regimen in patients with renal insufficiency was studied. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.Supplement4_147

Basic and clinical studies on loracarbef in the urological field Reviewed

Toyohiko Watanabe, Tadasu Takenaka, Toshihide Hayasi, Kazuhiro Hata, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori

CHEMOTHERAPY 41 310 - 317 1993

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

We studied the antibacterial activity and efficacy of loracarbef (LCBF), a new carbacephem antibiotic, in the urological field. 1) Antibacterial activity: The MICs of LCBF were measured against 205 clinical isolates of 14 species from urinary tract infections and compared with those of cefixime (CFIX), cefteram pivoxil (CFTM-PI) and cefaclor (CCL). In general, the antibacterial activities of LCBF were almost equal to those of CCL. 2) Clinical efficacy in complicated urinary tract infection was evaluated according to the criteria of the Japanese UTI Committee. The clinical response in 8 evaluable patients was considered excellent in 4, moderate in 3 and poor in 1. Seven (87.5%) of 8 strains isolated were eradicated. 3) The concentration of LCBF in expressed prostatic secretion (EPS) was studied after oral administration of the drug at a dose of 200 mg. Four hours after the administration of LCBF, the concentration in EPS reached 0.48±0.16 μg/ml (n=3), and the ratio between serum and EPS was 0.28±0.12. 4) Side effects: Diarrhea and abdominal pain were observed in 1 patient. Both symptoms were mild and transient. Based on the above findings, it is considered that LCBF is useful in the treatment of urinary tract infection. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.Supplement3_310

TRANSRECTAL HYPERTHERMIA FOR THE TREATMENT OF CHRONIC PROSTATITIS

Kumon Hiromi, Ono Noriaki, Uno Satoshi, Hayashi Toshihide, Hata Kazuhiro, Takenaka Tadasu, Watanabe Toyohiko, Ohmori Hiroyuki

The Japanese Journal of Urology 84 ( 2 ) 265 - 271 1993

Publisher：The Japanese Urological Association

A total of 36 cases with chronic non-bacterial and non-chlamydial prostatitis or prostatodynia underwent 5 weekly, 1-hour sessions of transrectal microwave hyperthermia (43°C) to the prostate.<br>All patients had a long history of the condition and failed to respond to a variety of conventional treatments. The efficacy of the treatment was evaluated by the effects on subjective symptoms and/or on white blood cells in expressed prostatic secretions. Concerning the overall clinical efficacy, excellent results were obtained in 11 (30.6%), good in 8 (22.2%), fair in 8 (22.2%) and poor in 9 (25.2%). Although minor complications were noted in 5 cases (anal pain; 2, hematospermia; 1, hematuria; 1), all cases received full sesseions. These results indicated the usefulness of the hyperthermia for this benign condition, which has so far responded poorly to the conventional therapy.

DOI： 10.5980/jpnjurol1989.84.265

Other Link： http://search.jamas.or.jp/link/ui/1993200743

Basic and clinical studies on S-1108 in urinary tract infections

Noriaki Ono, Toyohiko Watanabe, Tadasu Takenaka, Toshihide Hayashi, Kazuhiro Hata, Hiromi Kumon, Hiroyuki Ohmori, Katsuiehi Nanba, Yoshikatsu Kondou, Teruhisa Ohhashi, Teruaki Akaeda

CHEMOTHERAPY 41 448 - 455 1993

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

We studied the antibacterial activity and efficacy of S-1108, a new cephem antibiotic, in urinary tract infections. 1) Antibacterial activity : The MICs of S-1006 were measured against 202 clinical isolates of 14 species from urinary tract infections and compared with those of cefaclor (CCL), cefixime (CFIX) and cefteram (CFTM). In general, the antibacterial activity of S-1006 was almost equal to that of CFIX and CFTM, but superior to that of CCL. 2) Clinical efficacy : According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 84.2% (16/19) for chronic complicated UTI. Bacteriologically, 21 of the 22 strains isolated (95.4%) were eradicated. 3) Side effects : No clinical adverse reactions and no abnormal laboratory findings were observed. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.Supplement1_448

Renal cyst with cholesterol crystals: A case report

T. Watanabe, Y. Nasu, H. Kumon, H. Ohmori

Nishinihon Journal of Urology 55 ( 11 ) 1658 - 1661 1993

Mucinous adenocarcinoma of the prostate: A case report

T. Watanabe, K. Hata, Y. Nasu, H. Ohmori

Nishinihon Journal of Urology 55 ( 11 ) 1654 - 1657 1993

Basic and clinical studies of cefozopran in the urological field

Kazuhiro Hata, Toyohiko Watanabe, Tadasu Takenaka, Toshihide Hayashi, Noriaki Ono, Hiromi Kumon, Hiroyuki Ohmori, Katsuyoshi Kondo, Katsuichi Nanba, Teruaki Akaeda, Nobuyuki Akazawa, Nobuyuki Akazawa, Yasuhiro Katayama

CHEMOTHERAPY 41 309 - 318 1993

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

We studied the antibacterial activity and clinical efficacy of cefozopran (CZOP), a new cephalosporin antibiotic, in the urological field. 1) Antibacterial activity : We measured MICs of CZOP against clinical isolates (206 strains of 14 species) from urinary tract infections, and compared them with those of imipenem (IPM), ceftazidime (CAZ), latamoxef, and cefoperazone. In general, the antibacterial activities of CZOP were almost equal to those of CAZ but superior to those of other control cephems, and slightly inferior to those of IPM. 2) Clinical efficacy: According to the criteria of the Japanese UTI Committee, the overall clinical efficacy rate was 78.7 % (37/47) for chronic complicated UTI. Bacteriologically, 41 of 47 strains (87.2 %) were eradicated. As regards 2 cases of acute bacterial prostatitis, overall clinical efficacy was moderate and strains were eradicated in both cases. 3) Side effects: No clinical side effects were observed. Concerning laboratory findings, transient elevation of GOT and GPT were noted in two cases, eosinophilia in one case and a transient elevation of s-Cr in one case. © 1993, Japanese Society of Chemotherapy. All rights reserved.

DOI： 10.11250/chemotherapy1953.41.Supplement4_309

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