研究者詳細 - 岩田　健宏

論文 - 岩田　健宏

分割表示 241 件中 1 - 20 件目／全件表示 >>

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

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

Clinical genitourinary cancer 23 ( 2 ) 102306 - 102306 2025年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.clgc.2025.102306

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Significance of targeted antimicrobial prophylaxis using rectal-culture selective screening media prior to transrectal prostate biopsy: A multicenter, randomized controlled trial. 国際誌

Takuya Sadahira, Takanori Sekito, Yuki Maruyama, Takaharu Ichikawa, Yuki Kurihara, Hiromasa Shiraishi, Takafumi Sakuma, Moto Tokunaga, Yosuke Mitsui, Norihiro Kusumi, Yusuke Tominaga, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kohei Edamura, Tomoko Kobayashi, Masami Watanabe, Yoshiki Hiyama, Hiroki Yamada, Hiroki Kurata, Tsubasa Kondo, Masao Mitsui, Tadasu Takenaka, Hiroshi Kiyota, Motoo Araki, Jun Miyazaki, Satoshi Takahashi, Shingo Yamamoto, Koichiro Wada

Urology 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To examine whether antimicrobial prophylaxis based on screening rectal cultures using selective media prevented acute bacterial prostatitis following transrectal prostate biopsy (TRPB). METHODS: In this multicenter, randomized controlled trial, we enrolled 403 patients undergoing TRPB with low risks of infectious complications. Patients were randomized into a cultured group (CG) or no cultured group (NCG). In the CG, patients with positive culture results for fluoroquinolone (FQ)-resistant or extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) used piperacillin/tazobactam as prophylaxis, and those with negative culture results and in the NCG used levofloxacin. The primary endpoint was the incidence of acute prostatitis after TRPB. The secondary endpoint was the accuracy of the selective media. RESULTS: Of 373 patients (CG, 187; NCG, 186), 67 were positive, and 120 were negative for rectal culture in the CG. The overall incidence of prostatitis after TRPB was 1.1% (n=4). The incidences in the CG and the NCG were 1.6% (n=3, all negative-culture cases) and 0.5% (n=1), respectively, without significant difference (P=0.3). No prostatitis occurred in the positive-culture group. The sensitivity and specificity of the levofloxacin-insusceptible selective media were 98.1% and 94.7%, respectively. CONCLUSION: Screening with selective media before TRPB in patients with low infectious risks may provide additive value to preventing post-biopsy prostatitis. Piperacillin/tazobactam can be considered when FQ-resistant or ESBL-producing E. coli is detected.

DOI： 10.1016/j.urology.2024.12.018

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

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

Urologic oncology 42 ( 12 ) 453.e15-453.e22 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.urolonc.2024.09.012

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

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

Acta medica Okayama 78 ( 6 ) 429 - 437 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.18926/AMO/67868

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

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

Clinical genitourinary cancer 22 ( 6 ) 102237 - 102237 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.clgc.2024.102237

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Oncological Outcomes of Active Surveillance versus Surgery or Ablation for Patients with Small Renal Masses: A Systematic Review and Quantitative Analysis. 国際誌

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

European urology oncology 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND OBJECTIVE: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions. METHODS: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis. KEY FINDINGS AND LIMITATIONS: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS. PATIENT SUMMARY: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.

DOI： 10.1016/j.euo.2024.10.008

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What is the identity of Gerota fascia? Histological study with cadavers. 国際誌

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

International journal of urology : official journal of the Japanese Urological Association 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1111/iju.15596

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

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

Urologic oncology 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.urolonc.2024.09.014

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

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

World journal of urology 42 ( 1 ) 522 - 522 2024年9月

トランス男性のホルモン治療に対する期待度の調査

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

日本性科学会雑誌 42 ( 2 ) 63 - 63 2024年9月

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

Ichiro Tsuboi, Akihiro Matsukawa, Mehdi Kardoust Parizi, Jakob Klemm, Robert J Schulz, Anna Cadenar, Stefano Mancon, Sever Chiujdea, Tamás Fazekas, Marcin Miszczyk, Ekaterina Laukhtina, Tatsushi Kawada, Satoshi Katayama, Takehiro Iwata, Kensuke Bekku, Koichiro Wada, Paolo Gontero, Morgan Rouprêt, Jeremy Teoh, Nirmish Singla, Motoo Araki, Shahrokh F Shariat

World journal of urology 42 ( 1 ) 488 - 488 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

CONTEXT: Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment in patients with high-risk upper tract urothelial cancer (UTUC). However, it is unclear which specific surgical technique may lead to improve oncological outcomes in term of intravesical recurrence (IVR) in patients with UTUC. OBJECTIVE: To evaluate the efficacy of surgical techniques and approaches of RNU in reducing IVR in UTUC patients. EVIDENCE ACQUISITION: Three databases were queried in January 2024 for studies analyzing UTUC patients who underwent RNU. The primary outcome of interest was the rate of IVR among various types of surgical techniques and approaches of RNU. EVIDENCE SYNTHESIS: Thirty-one studies, comprising 1 randomized controlled trial and 1 prospective study, were included for a systematic review and meta-analysis. The rate of IVR was significantly lower in RNU patients who had an early ligation (EL) of the ureter compared to those who did not (HR: 0.64, 95% CI: 0.44-0.94, p = 0.02). Laparoscopic RNU significantly increased the IVR compared to open RNU (HR: 1.28, 95% CI: 1.06-1.54, p < 0.001). Intravesical bladder cuff removal significantly reduced the IVR compared to both extravesical and transurethral bladder cuff removal (HR: 0.65, 95% CI: 0.51-0.83, p = 0.02 and HR: 1.64, 95% CI: 1.15-2.34, p = 0.006, respectively). CONCLUSIONS: EL of the affected upper tract system, ureteral management, open RNU, and intravesical bladder cuff removal seem to yield the lowest IVR rate in patients with UTUC. Well-designed prospective studies are needed to conclusively elucidate the optimal surgical technique in the setting of single post-operative intravesical chemotherapy.

DOI： 10.1007/s00345-024-05185-w

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LOH症候群における精神症状がテストステロン補充療法に与える影響について

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

日本性機能学会雑誌 39 ( 2 ) 167 - 167 2024年8月

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

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

日本性機能学会雑誌 39 ( 2 ) 170 - 170 2024年8月

当院に受診したクラインフェルター症候群患者の性機能についての検討

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

日本性機能学会雑誌 39 ( 2 ) 169 - 169 2024年8月

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年6月

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年6月

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

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

西日本泌尿器科 86 ( 増刊号2 ) 126 - 127 2024年6月

記述言語：日本語出版者・発行元：(一社)西日本泌尿器科学会

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

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

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

日本感染症学会総会・学術講演会・日本化学療法学会学術集会合同学会プログラム・抄録集 98回・72回 np288 - np288 2024年5月

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

World journal of urology 42 ( 1 ) 252 - 252 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1007/s00345-024-04941-2

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

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

European urology oncology 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.euo.2024.03.007

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