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

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

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

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

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

BACKGROUND: Robot-assisted surgery is widely performed for renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombi. Although many chemotherapeutic options are available for the treatment of unresectable RCC, there are very few reports on robot-assisted radical nephrectomy (RARN) with inferior vena cava thrombectomy (IVCT) after presurgical treatment with immune checkpoint inhibitors and tyrosine kinase inhibitors. We believe that pre-surgical treatment can provide minimally invasive surgical benefits to high-risk patients during the perioperative period. CASE DESCRIPTION: A 77-year-old male with right RCC that invaded the IVC (cT3bN0M0, Mayo classification level III) underwent pembrolizumab and axitinib combination therapy because he had high surgical risk due to angina pectoris. The level of the tumor thrombus decreased from level III to II, and RARN with IVCT was then performed. Surgery was performed without complications, and the patient was discharged on postoperative day seven. The pathological diagnosis was clear cell RCC (ypT3b, G2). Adjuvant chemotherapy using pembrolizumab monotherapy is still ongoing. CONCLUSIONS: In this report, the inferior vena cave tumor thrombus level was down staged from level III to level II by treatment with pembrolizumab and axitinib. RARN with IVCT was safely performed without complication completely under robotic assistance.

DOI： 10.21037/tcr-23-1547

PubMed

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

今回,骨盤リンパ節郭清術標準化ワーキンググループで,閉鎖,内腸骨,外腸骨,総腸骨,仙骨前面領域の解剖学的定義が定められた.このうち,閉鎖領域は,頭側が外腸骨血管と内腸骨血管の分岐部,尾側が副閉鎖静脈から閉鎖管,外側縁が外腸骨静脈から骨盤壁,内閉鎖筋,内側縁が膀胱下腹筋膜外側,背側縁が仙骨神経叢前面と定められた.本稿では閉鎖リンパ節郭清のうち,内側アプローチ(外腸骨静脈内側から内閉鎖筋をみるアプローチ)の方法について説明する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J07650&link_issn=&doc_id=20240919390006&doc_link_id=10.11302%2Fjserjje.37.2_242&url=https%3A%2F%2Fdoi.org%2F10.11302%2Fjserjje.37.2_242&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

今回,骨盤リンパ節郭清術標準化ワーキンググループで,閉鎖,内腸骨,外腸骨,総腸骨,仙骨前面領域の解剖学的定義が定められた.このうち,閉鎖領域は,頭側が外腸骨血管と内腸骨血管の分岐部,尾側が副閉鎖静脈から閉鎖管,外側縁が外腸骨静脈から骨盤壁,内閉鎖筋,内側縁が膀胱下腹筋膜外側,背側縁が仙骨神経叢前面と定められた.本稿では閉鎖リンパ節郭清のうち,内側アプローチ(外腸骨静脈内側から内閉鎖筋をみるアプローチ)の方法について説明する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J07650&link_issn=&doc_id=20240919390006&doc_link_id=10.11302%2Fjserjje.37.2_242&url=https%3A%2F%2Fdoi.org%2F10.11302%2Fjserjje.37.2_242&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publisher：(一社)日本癌学会  

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

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

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

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

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Language：Japanese   Publisher：日本腎泌尿器疾患予防医学研究会  

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

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Language：Japanese   Publisher：日本腎泌尿器疾患予防医学研究会  

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

超高齢化社会に突入した現代医療においては,あらゆる診療科の患者の年齢層が高齢化しており,老年病専門医以外の医師も高齢者の診療を行わなければならない.尿失禁や過活動膀胱,骨盤臓器脱などは高齢者に多くみられる疾患であり,治療選択において高齢者特有の配慮が必要となる.QOL疾患である骨盤臓器脱の治療では,解剖学的に修復するのみならず,下部尿路症状といわれる排尿機能や蓄尿機能や排便機能,そして性機能といった随伴する症状の改善にも取り組む必要がある.仙骨腟固定術は,数ある骨盤臓器脱手術の中でこれら随伴症状の改善を含めた手術成績やメッシュ関連合併症が少ないことにおいて優れた術式といえるが,手術時間や頭低位,気腹下手術といった点で他の術式より高侵襲な手術とされる.ただ,手術可能な年齢の上限がなくなりつつある現代医療においては,高齢という理由だけで手術術式を決めることはない.代わりに高齢者特有の問題であるフレイル,サルコペニアや認知機能低下などが,治療選択の重要な因子となる.本稿では,高齢者に対する仙骨腟固定術の現状と望まれる周術期管理について報告する.(著者抄録)

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

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

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

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

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

急性陰嚢症は,陰嚢の急激な疼痛や腫脹をきたす疾患の総称である。最重要の鑑別疾患は精巣捻転であり,精巣捻転に対する診断・治療の遅れは精巣喪失につながる。目の前の精巣を救うために,すべての泌尿器科医が精巣捻転を含む急性陰嚢症の診断・治療に習熟していることが望ましい。一方,泌尿器科医であっても急性陰嚢症の対応に苦慮する場面は少なくない。精巣捻転の鑑別における現状と,精巣捻転に対応できる泌尿器科医になるためには何が重要かを考察する。(著者抄録)

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

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

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

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

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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

Intraductal carcinoma of the prostate (IDCP) has recently attracted increasing interest owing to its unfavorable prognoses. To effectively identify the IDCP-specific gene expression profile, we took a novel approach of characterizing a typical IDCP case using spatial gene expression analysis. A formalin-fixed, paraffin-embedded sample was subjected to Visium CytAssist Spatial Gene Expression analysis. IDCP within invasive prostate cancer sites was recognized as a distinct cluster separate from other invasive cancer clusters. Highly expressed genes defining the IDCP cluster, such as MUC6, MYO16, NPY, and KLK12, reflected the aggressive nature of high-grade prostate cancer. IDCP sites also showed increased hypoxia markers HIF1A, BNIP3L, PDK1, and POGLUT1; decreased fibroblast markers COL1A2, DCN, and LUM; and decreased immune cell markers CCR5 and FCGR3A. Overall, these findings indicate that the hypoxic tumor microenvironment and reduced recruitment of fibroblasts and immune cells, which reflect morphological features of IDCP, may influence the aggressiveness of high-grade prostate cancer.

DOI： 10.3390/ijms25094818

PubMed

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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

急性陰嚢症は,陰嚢の急激な疼痛や腫脹をきたす疾患の総称である。最重要の鑑別疾患は精巣捻転であり,精巣捻転に対する診断・治療の遅れは精巣喪失につながる。目の前の精巣を救うために,すべての泌尿器科医が精巣捻転を含む急性陰嚢症の診断・治療に習熟していることが望ましい。一方,泌尿器科医であっても急性陰嚢症の対応に苦慮する場面は少なくない。精巣捻転の鑑別における現状と,精巣捻転に対応できる泌尿器科医になるためには何が重要かを考察する。(著者抄録)

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

症例は79歳,男性。帯状疱疹罹患後から尿閉が持続したため,間欠自己導尿(CIC)を導入した。CICを4ヵ月継続した頃に外尿道口の腫瘤を認めた。形状及び組織診から尖圭コンジローマと診断し凍結療法にて外尿道口腫瘤は消失した。膀胱鏡で尿道内を観察したところ尿道全長にわたる多発腫瘤を認め,生検で尿道尖圭コンジローマと診断した。CICを中止後,膀胱瘻造設術を行い,Holmium YAGレーザーを用いた尿道腫瘍焼灼術を施行した。尿道内に残存病変を認めたため,5-フルオロウラシル(5-FU)を用いた尿道内注入療法を週1回,計7回施行した。本療法の前後で有意な有害事象は認めず,腫瘤は消失し,現在まで再発は認めていない。尖圭コンジローマの好発部位は,男性では陰茎包皮,冠状溝,亀頭,外尿道口,肛門周囲等であるが,尿道に生じることは比較的まれである。一方で,外尿道口尖圭コンジローマ症例の57.1%に尿道尖圭コンジローマを認めたとの報告もあり,外尿道口コンジローマを認めた場合には膀胱鏡での観察が望まれる。尿道尖圭コンジローマのリスク因子は不明だが,本症例の病態はCICによる尿道内播種と推察した。尿道尖圭コンジローマの治療法はレーザー焼灼術,外科的切除など様々な報告があり,それぞれに合併症や高い再発率などの問題点が指摘されている。根治切除困難な尿道尖圭コンジローマに対する5-FU尿道内注入療法は有用と考えられる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BACKGROUND: To investigate the impact of different urinary diversion (UD) techniques on the peri- and postoperative complications of robot-assisted radical cystectomy (RARC) with ileal conduit. METHODS: We retrospectively analyzed 373 patients undergoing RARC with ileal conduit at 11 institutions in Japan between April 2018 and December 2021. Propensity score weighting was performed to adjust for confounding factors such as age, sex, body mass index, performance status, American Society of Anesthesiologists score, previous abdominal surgery, neoadjuvant chemotherapy, and preoperative high T stage (≥ cT3) and high N stage (≥ cN1). Perioperative complications were then compared among three groups: extracorporeal, intracorporeal, and hybrid urinary diversion (ECUD, ICUD, and HUD, respectively). RESULTS: A total of 150, 68, and 155 patients received ECUD, HUD, and ICUD, respectively. Bowel reconstruction time and UD time were significantly shorter in the ECUD group (p < 0.001), and console time was significantly longer and blood loss was significantly higher in the ICUD group (p < 0.001). For postoperative complications (Clavien-Dindo Classification grade ≥ 3), surgical site infection (p = 0.004), pelvic abscess (p = 0.013), anastomotic urine leak (p = 0.007), and pelvic organ prolapse (p = 0.011) significantly occurred in the ECUD group. For all grades, ileus was more common in the HUD group, whereas anastomotic stricture was more common in the ECUD group compared with the other groups (p < 0.05). CONCLUSIONS: Severe complications did not increase after HUD and ICUD compared with ECUD; however, console time tended to be longer and blood loss was slightly higher during RARC.

DOI： 10.1007/s10147-023-02425-8

PubMed

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：日本尿路結石症学会  

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

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

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

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Language：Japanese   Publisher：日本夜尿症・尿失禁学会  

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

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

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

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

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

OBJECTIVES: The use of radical prostatectomy is increasing with the rising incidence of prostate cancer. We assessed the surgical trends related to radical prostatectomy using data from a multi-center, retrospective cohort study, the MICAN (Medical Investigation Cancer Network) study, which was conducted in all the urology-related medical facilities in Ehime Prefecture, Japan. METHODS: We compared data from the MICAN study with prostate biopsy registry data collected in Ehime between 2010 and 2020 and recorded the surgical trends. RESULTS: There was a significant increase in the mean age of patients with positive biopsies, and the positivity rate increased from 46.3% in 2010 to 60.5% in 2020, while the number of biopsies obtained decreased. The number of radical prostatectomies performed increased over the years, with robot-assisted radical prostatectomy becoming the predominant procedure. In 2020, robot-assisted radical prostatectomies accounted for 96.0% of the surgeries performed. The age at surgery also gradually increased. Of the registered patients aged ≤75 years, 40.5% underwent surgery in 2010, compared with 83.1% in 2020. The prevalence of surgery also increased from 4.6% to 29.8% in patients aged >75 years. There was a gradual increase in the proportion of high-risk cases, from 29.3% to 44.0%, but a decrease in that of low-risk cases, from 23.8% in 2010 to 11.4% in 2020. CONCLUSIONS: We have shown that the number of radical prostatectomies performed in Ehime is increasing in patients aged both ≤75 and >75 years. The proportion of low-risk cases has decreased, while that of high-risk cases has increased.

DOI： 10.1111/iju.15178

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

Neuroendocrine prostate carcinoma (NEPC) accounts for less than 1% of prostate neoplasms and has extremely poorer prognosis than the typical androgen receptor pathway-positive adenocarcinoma of the prostate (ARPC). However, very few cases in which de novo NEPC and APRC are diagnosed simultaneously in the same tissue have been reported. We report herein a 78-year-old man of de novo metastatic NEPC coexisting with ARPC treated at Ehime University Hospital. Visium CytAssist Spatial Gene Expression analysis (10× genetics) was performed using formalin-fixed, paraffin-embedded (FFPE) samples. The neuroendocrine signatures were upregulated in NEPC sites, and androgen receptor signatures were upregulated in ARPC sites. TP53, RB1, or PTEN and upregulation of the homologous recombination repair genes at NEPC sites were not downregulated. Urothelial carcinoma markers were not elevated. Meanwhile, Rbfox3 and SFRTM2 levels were downregulated while the levels of the fibrosis markers HGF, HMOX1, ELN, and GREM1 were upregulated in the tumor microenvironment of NEPC. In conclusion, the findings of spatial gene expression analysis in a patient with coexisting ARPC and de novo NEPC are reported. The accumulation of cases and basic data will help with the development of novel treatments for NEPC and improve the prognosis of patients with castration-resistant prostate cancer.

DOI： 10.3390/ijms24108955

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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

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

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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

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

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

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

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

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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

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

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

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

The present study aimed to evaluate the optimal timing of radium-223 chloride (Ra-223) administration among patients with bone metastasis from castration-resistant prostate cancer (BmCRPC). Patients, who were diagnosed with BmCRPC and treated with Ra-223 therapy between October, 2016 and January, 2022, were reviewed. The survival time was calculated from the initiation of Ra-223 administration. The time from the diagnosis of BmCRPC to the initiation of Ra-223 administration was identified as a potential prognostic factor. A total of 51 patients were examined in the present study. Ra-223 was administered as the first- and second-line therapy (earlier Ra-223 administration) in 32 patients and as the third- to fifth-line therapy (later Ra-223 administration) in 19 patients. In the multivariate analysis, which considered the potential prognosis, the difference in survival times between patients who received early and late Ra-223 administration was not significant [hazard ratio (HR), 2.67; 95% confidence interval (CI), 0.79-9.07; P=0.11]. By contrast, an incomplete Ra-223 administration (HR, 128.03; 95% CI, 10.59-1548.42; P<0.01) and higher levels of prostate-specific antigen prior to Ra-223 administration (HR, 7.86; 95% CI, 2.7-27.24; P<0.01) were independent factors, significantly associated with a poorer prognosis. The timing of Ra-223 administration did not significantly affect the survival of patients from the initiation of treatment. Further studies are thus required to determine the optimal timing for Ra-223 administration.

DOI： 10.3892/mi.2023.98

PubMed

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

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

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

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

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

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

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

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

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

右腎盂癌腎門部リンパ節転移に対して,ロボット支援下に腎尿管全摘除術・リンパ節郭清術を施行した症例を経験したので報告する。症例は74歳女性,病期はcT3N2M0と診断。化学療法施行しPRであり,ロボット支援下に手術を行った。Da Vinci Xiを使用し,4thアームのプログラスプにより良好な視野を確保でき,リンパ節郭清は広範囲に施行可能であった。リンパ節郭清含め,腎尿管全摘除術においてロボット支援下手術は有用であった。(著者抄録)

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

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

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

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

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

神経内分泌前立腺癌(NEPC)は、アンドロゲン非依存性増殖を示し急速に進行する予後不良な疾患である。NEPCの遺伝学的発生機序に関しては不明な点が多く、今後さらなる解析によりNEPCの病態解明や診断・治療マーカーの導出が期待される。今回われわれは欧米人前立腺癌患者の約50%と最も多い染色体異常であるTMPRSS2-ERG融合遺伝子に注目した。当院での神経内分泌分化前立腺癌症例における病理学的ERG発現を検索し、診断マーカーとしての可能性を検討した。(著者抄録)

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

神経内分泌前立腺癌(NEPC)は、アンドロゲン非依存性増殖を示し急速に進行する予後不良な疾患である。NEPCの遺伝学的発生機序に関しては不明な点が多く、今後さらなる解析によりNEPCの病態解明や診断・治療マーカーの導出が期待される。今回われわれは欧米人前立腺癌患者の約50%と最も多い染色体異常であるTMPRSS2-ERG融合遺伝子に注目した。当院での神経内分泌分化前立腺癌症例における病理学的ERG発現を検索し、診断マーカーとしての可能性を検討した。(著者抄録)

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

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

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

症例は57歳女性。原疾患:逆流性腎症。生体腎移植後13年目のスクリーニングCTで移植腎下極内側に5cm大の乏血性の腫瘤性病変を指摘された。他臓器に転移所見なく、腎温存が可能と考え、開放移植腎部分切除術を施行した。周囲組織との癒着が著明にあり剥離に難渋したが、腫瘍と腎門部を同定できた。腎血管は遮断しカニュレーションを行いユーロコリンズ液で腎灌流後に腎部分切除を行った。術後尿瘻をきたしたが尿管ステント留置と経皮的ピッグテールカテーテル留置で改善した。病理結果はpapillary RCC type1、pT1b、RM0。術後9ヵ月のフォローで再発なし、腎機能も術前と同等である。腎移植後に発生する腎癌の多くは自己腎に発生し、移植腎に発生するのはまれとされる。腎部分切除や経皮的凍結療法といった腎温存治療を行うことで、移植腎機能を温存でき、腫瘍学的にも良い結果をもたらすと考える。(著者抄録)

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

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

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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

現在,9割を超える泌尿器科医,小児外科医が精巣捻転修復後の対側精巣の固定を行うと回答している。そして,日本泌尿器科学会やEAU guidelinesでも,精巣捻転修復後に対側精巣を固定すると記載されている。しかし,対側固定を支持する学術的な根拠は記載されていない。今回,我々は精巣捻転修復時の対側精巣の固定(対側固定)の有用性について見直した。そもそも,対側固定を行う根拠として,精巣捻転における患側精巣の低い救済率,そして,解剖学的理由(bell-clapper deformity:BCD)による対側精巣の可能性が挙げられる。しかし,精巣捻転の発生頻度は低い(0.0086%)。また,対側固定そのものの合併症を考慮すると対側固定を行わないという選択肢もある。まとまったエビデンスはないものの,患者,家族,そして医療従事者の精神的ストレスを考慮すると対側固定は有用な手技といえる。(著者抄録)

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

現在,9割を超える泌尿器科医,小児外科医が精巣捻転修復後の対側精巣の固定を行うと回答している。そして,日本泌尿器科学会やEAU guidelinesでも,精巣捻転修復後に対側精巣を固定すると記載されている。しかし,対側固定を支持する学術的な根拠は記載されていない。今回,我々は精巣捻転修復時の対側精巣の固定(対側固定)の有用性について見直した。そもそも,対側固定を行う根拠として,精巣捻転における患側精巣の低い救済率,そして,解剖学的理由(bell-clapper deformity:BCD)による対側精巣の可能性が挙げられる。しかし,精巣捻転の発生頻度は低い(0.0086%)。また,対側固定そのものの合併症を考慮すると対側固定を行わないという選択肢もある。まとまったエビデンスはないものの,患者,家族,そして医療従事者の精神的ストレスを考慮すると対側固定は有用な手技といえる。(著者抄録)

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

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

Immune checkpoint inhibitor (ICI) therapy increases the risk of immune-related adverse events (irAEs). In particular, combination checkpoint blockade (CCB) targeting inhibitory CTLA-4 and PD-1 receptors could lead to irAEs at a higher rate than ICI monotherapy. Management of irAEs is important while using ICIs. However, there are no reliable biomarkers for predicting irAEs. The aim of this study was to elucidate early B cell changes after CCB therapy in patients with renal cell carcinoma (RCC) and verify whether B cells can be a predictor of irAEs. This prospective cohort study was conducted with 23 Japanese patients with metastatic RCC. An increase in the proportion of CD21lo B cells and CD21lo memory B cells was confirmed following CCB therapy. Although there were no differences in clinical outcomes between irAE and no-irAE groups, the proportion of CD21lo B cells at baseline was lower in the irAE group, with a significant increase after the first cycle of CCB therapy. Further analysis revealed a moderate correlation between irAEs and CD21lo B cell levels at baseline (area under the curve: 0.83, cut-off: 3.13%, sensitivity: 92.3, specificity: 70.0). This finding indicates that patients with low baseline CD21lo B cell levels warrant closer monitoring for irAEs. The clinical registration number by the Certified Review Board of Ehime University is No. 1902011.

DOI： 10.3390/jpm12060888

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Publishing type：Research paper (scientific journal)   Publisher：American Society of Clinical Oncology (ASCO)  

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Background: Prostate-specific membrane antigen (PSMA) is highly expressed in poorly differentiated, metastatic, and castration-resistant prostate cancers. Recently, 68Ga-PSMA positron emission tomography/computed tomography has been successfully developed as an effective diagnostic tool for prostate cancer. However, the pathophysiological functions of PSMA in prostate tumors remain unclear. Methods: We examined the protein expression of PSMA in tumor endothelial cells in human prostate tumors by immunohistochemistry. Prostate cancer tissues were resected from patients with prostate cancer via robotic surgery in 2019 at Ehime University. In vitro, we prepared conditioned medium derived from a PSMA-positive human prostate cancer cell line, LNCaP, cultured on collagen I gels. We then examined PSMA expression in human umbilical vascular endothelial cells (HUVECs) cultured with the conditioned medium. We assessed angiogenic activities by treating HUVECs with LNCaP-derived conditioned medium using a tube formation assay that mimics angiogenesis. Results: Immunohistochemical positivity of PSMA and CD31, a marker of endothelial cells, and PSMA-expressing tumor endothelial cells were observed in four of 33 prostate cancer patients (12.1%). We also found that the 10,000 ´ g pellet fraction of the LNCaP-derived conditioned medium containing PSMA-positive membranes, including microvesicles, transformed HUVECs from “PSMA-negative” to “PSMA-positive.” Mass spectrometry revealed that the fraction contained an important growth factor. Furthermore, treating HUVECs with the 10,000 ´ g pellet fraction of the LNCaP-derived conditioned medium significantly promoted tube formation, mimicking angiogenesis in a PSMA-dependent manner. Conclusions: Our findings revealed the existence of PSMA-positive tumor endothelial cells in human prostate tumors, which were found to enhance tumor angiogenesis in prostate cancer tissues. The endocytic process related to these PSMA-positive microvesicles in normal endothelial cells might be an attractive target to develop novel anti-angiogenic drugs, which could inhibit the transformation of normal endothelial cells into tumor endothelial cells (Watanabe et al., The Prostate. 2021. in press).

DOI： 10.1200/jco.2022.40.6_suppl.141

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

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

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

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

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

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Language：English  

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of heparin. Additionally, although heparin can affect kidney transplantation, there only have been a few reports on this condition. Here, we report a case wherein surgery was safely performed with preoperative plasmapheresis in a patient with HIT. CASE PRESENTATION: The patient was a 48-year-old woman who was on dialysis because of immunoglobulin A nephropathy. Immediately after the initiation of dialysis, the patient experienced repeated arteriovenous fistula occlusion and thrombocytopenia and had a positive HIT antibody test result. Subsequently, she received an ABO-incompatible living-donor kidney transplantation from her spouse. The surgery was performed without using anticoagulants because HIT antibodies disappeared with preoperative plasmapheresis. Eighteen months after surgery, her kidney function remained stable, and there was no recurrence of HIT. CONCLUSION: Preoperative plasmapheresis is useful for patients with HIT.

DOI： 10.1016/j.transproceed.2021.11.012

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

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Language：Japanese   Publisher：日本尿路結石症学会  

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

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

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

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

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

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

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

BACKGROUND: Patients with very-high-risk prostate cancer (VHRPCa) have earlier biochemical recurrences (BCRs) and higher mortality rates. It remains unknown whether extended robot-assisted laparoscopic prostatectomy (eRALP) without neoadjuvant or adjuvant therapy can improve the outcomes of VHRPCa patients. We aimed to determine the feasibility and efficacy of eRALP as a form of monotherapy for VHRPCa. METHODS: Data from 76 men who were treated with eRALP without neoadjuvant/adjuvant therapy were analyzed. eRALP was performed using an extrafascial approach. Extended pelvic lymph node (LN) dissection (ePLND) included nodes above the external iliac axis, in the obturator fossa, and around the internal iliac artery up to the ureter. The outcome measures were BCR, treatment failure (defined as when the prostate-specific antigen level did not decrease to <0.1 ng/ml postoperatively), and urinary continence (UC). Kaplan-Meier, logistic regression, and Cox proportional-hazards model were used to analyze the data. RESULTS: The median operative time was 246 min, and median blood loss was 50 ml. Twenty-one patients experienced postoperative complications. Median follow-up was 25.2 months; 19.7% of patients had treatment failure. Three-year, BCR-free survival rate was 62.0%. Castration-resistant prostate cancer-free survival rate was 86.1%. Overall survival was 100%. In 55 patients who had complete postoperative UC data, 47 patients (85.5%) recovered from their UC within 12 months. Clinical stage cT3b was an independent preoperative treatment failure predictor (p = 0.035), and node positivity was an independent BCR predictor (p = 0.037). The small sample size and retrospective nature limited the study. CONCLUSIONS: This approach was safe and produced acceptable UC-recovery rates. Preoperative seminal vesicle invasion is associated with treatment failure, and pathological LN metastases are associated with BCR. Therefore, our results may help informed decisions about neoadjuvant or adjuvant therapies in VHRPCa cases. PRECIS: Extended robot-assisted laparoscopic prostatectomy and extended pelvic lymph node dissection without adjuvant therapy is safe and effective for some patients with very-high-risk prostate cancer. The clinical stage and node positivity status predicted monotherapy failure, which may indicate good adjuvant therapy candidate.

DOI： 10.1002/cam4.4308

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

DOI： 10.1002/pros.24237

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/pros.24237

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

BACKGROUND: Currently, immunotherapy is indicated for patients with metastatic RCC or unresectable RCC, but there is no indication for immunotherapy in the neoadjuvant setting. We report a case in which the combined use of nivolumab and ipilimumab and sequential TKI therapy enabled surgical treatment. CASE PRESENTATION: A 71-year-old female was diagnosed with a metastatic clear-cell renal cell carcinoma with a level IV tumor thrombus. She was started on nivolumab-ipilimumab therapy, and was switched to pazopanib monotherapy because the tumor thrombus progressed within the right atrium. The tumor shrank to resectable status with sequential therapy. She then underwent right nephrectomy and thrombectomy. Pathological analysis showed 10-20% residual tumor in the primary tumor, but no viable cells in tumor thrombus. She remains clinically disease-free 1 year after surgery. CONCLUSION: This case suggests the utility of sequential immune-targeted therapy as neoadjuvant therapy in advanced renal cell carcinoma.

DOI： 10.1186/s12894-021-00891-8

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

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

骨盤臓器脱に対する腹腔鏡下仙骨腟固定術は,経腹的な外科的治療法として本邦で標準術式となっている.当院では,腹腔鏡下仙骨腟固定術100例を経験したのち,2019年2月よりロボット支援仙骨腟固定術を導入し,21例を経験した.導入初期よりロボット支援手術の特色を生かした術式への改善を試みており,特にExtra armを有効利用することで,助手の負担軽減と経腟操作を省略することができた.当院におけるロボット支援仙骨腟固定術について,従来法からの工夫を含め報告する.(著者抄録)

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

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

PURPOSE: To investigate the prognostic role of the preoperative systemic immune-inflammation index (SII) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed our multi-institutional database to identify 2492 patients. SII was calculated as platelet count × neutrophil/lymphocyte count and evaluated at a cutoff of 485. Logistic regression analyses were performed to investigate the association of SII with muscle-invasive and non-organ-confined (NOC) disease. Cox regression analyses were performed to investigate the association of SII with recurrence-free, cancer-specific, and overall survival (RFS/CSS/OS). RESULTS: Overall, 986 (41.6%) patients had an SII > 485. On univariable logistic regression analyses, SII > 485 was associated with a higher risk of muscle-invasive (P = 0.004) and NOC (P = 0.03) disease at RNU. On multivariable logistic regression, SII remained independently associated with muscle-invasive disease (P = 0.01). On univariable Cox regression analyses, SII > 485 was associated with shorter RFS (P = 0.002), CSS (P = 0.002) and OS (P = 0.004). On multivariable Cox regression analyses SII remained independently associated with survival outcomes (all P < 0.05). Addition of SII to the multivariable models improved their discrimination of the models for predicting muscle-invasive disease (P = 0.02). However, all area under the curve and C-indexes increased by < 0.02 and it did not improve net benefit on decision curve analysis. CONCLUSIONS: Preoperative altered SII is significantly associated with higher pathologic stages and worse survival outcomes in patients treated with RNU for UTUC. However, the SII appears to have relatively limited incremental additive value in clinical use. Further study of SII in prognosticating UTUC is warranted before routine use in clinical algorithms.

DOI： 10.1007/s00262-021-02884-w

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

骨盤臓器脱に対する腹腔鏡下仙骨腟固定術は,経腹的な外科的治療法として本邦で標準術式となっている.当院では,腹腔鏡下仙骨腟固定術100例を経験したのち,2019年2月よりロボット支援仙骨腟固定術を導入し,21例を経験した.導入初期よりロボット支援手術の特色を生かした術式への改善を試みており,特にExtra armを有効利用することで,助手の負担軽減と経腟操作を省略することができた.当院におけるロボット支援仙骨腟固定術について,従来法からの工夫を含め報告する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J05817&link_issn=&doc_id=20210924460009&doc_link_id=10.11302%2Fjsejje.34.217&url=https%3A%2F%2Fdoi.org%2F10.11302%2Fjsejje.34.217&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本尿路結石症学会  

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

難易度の高い手術に対しては,十分な術前評価を行い,手術計画を立て,慎重な手術を行う必要がある。また,それを達成するために技術的な修練も必要である。腎移植においても同様であり,外科医としては難易度の高い移植症例を成功に導く必要がある。ドナー腎を良好な状態で移植する際に,まず肝要なのは腎血管の確実な吻合である。複数腎動脈症例に対しては血管形成を行うことがある。一般的には端側吻合,common channel,内腸骨グラフトの使用などであろう。またドナー腎が右腎であった場合,静脈吻合に工夫を要することもある。また腎静脈が複数あり,血管径が同じ場合,多くの場合は1本sacrificeしても問題ないが,まれにoutflow blockとなることがある。当科では静脈延伸で大伏在静脈を用いることがあるが,複数の腎静脈を吻合する際にY字に形成した大伏在静脈を使用した例を報告した。必要であれば動静脈ともに形成することもあり,今回は動静脈同時に形成した症例を紹介する。その他,人工血管に吻合,あるいは人工血管を介して吻合した症例もあるが,いずれも術後経過は良好である。他に特殊症例として腎血管筋脂肪腫を除去して移植した症例,損傷したドナー腎を修復した症例,ドナー骨盤腎を移植した症例,回腸導管造設を同時に行った症例を経験したため紹介する。(著者抄録)

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

OBJECTIVE: To assess the value of preoperative albumin to globulin ratio for predicting pathologic and oncological outcomes in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy in a large multi-institutional cohort. MATERIALS AND METHODS: Preoperative albumin to globulin ratio was assessed in a multi-institutional cohort of 2492 patients. Logistic regression analyses were performed to assess the association of the albumin to globulin ratio with pathologic features. Cox proportional hazards regression models were performed for survival endpoints. RESULTS: The optimal cut-off value was determined to be 1.4 according to a receiver operating curve analysis. Lower albumin to globulin ratios were observed in 797 patients (33.6%) compared with other patients. In a preoperative model, low preoperative albumin to globulin ratio was independently associated with nonorgan-confined diseases (odds ratio 1.32, P = 0.002). Patients with low albumin to globulin ratios had worse recurrence-free survival (P < 0.001), cancer-specific survival (P = 0.001) and overall survival (P = 0.020) in univariable and multivariable analyses after adjusting for the effect of standard preoperative prognostic factors (recurrence-free survival: hazard ratio (HR) 1.31, P = 0.001; cancer-specific survival: HR 1.31, P = 0.002 and overall survival: HR 1.18, P = 0.024). CONCLUSIONS: Lower preoperative albumin to globulin ratio is associated with locally advanced disease and worse clinical outcomes in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma. As it is difficult to stage disease entity, low preoperative serum albumin to globulin ratio may help identify those most likely to benefit from intensified care, such as perioperative systemic therapy, and the extent and type of surgery.

DOI： 10.1093/jjco/hyab023

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

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

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

The management of blood pressure is a significant concern for surgeons and anesthesiologists performing adrenalectomy for pheochromocytoma. We evaluated clinical factors in pheochromocytoma patients to identify the predictors of postoperative hypotension. The medical records of patients who underwent adrenalectomy for pheochromocytoma between 2001 and 2017 were retrospectively reviewed and clinical and biochemical data were evaluated. Of 29 patients, 13 patients needed catecholamine support in the perisurgical period while 16 patients did not. There were significant differences in median age, tumor size, and blood pressure drop (maxmin) between the 2 groups (68 vs 53 years old, p=0.045; 50 vs 32 mm diameter, p=0.022; 110 vs 71 mmHg, p=0.015 respectively). In univariate logistic analysis, age > 65.5 years, tumor size > 34.5 mm, urine metanephrine > 0.205 mg/day and urine normetanephrine > 0.665 mg/day were significant predictors of prolonged hypotension requiring postoperative catecholamine support. Tumor size and urine metanephrine and urine normetanephrine levels were correlated with postoperative hypotension. These predictors may help in the safe perioperative management of pheochromocytoma patients treated with adrenalectomy.

DOI： 10.18926/AMO/62229

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

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

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Language：English  

Introduction: Transplantation, especially, of the right kidney may be difficult to properly choose the main drainage vein due to abundance of renal veins with the thin wall and the small diameter. Therefore, we report three cases, wherein anastomosis-related complications may be avoided by using a reconstructed Y-shaped major saphenous vein graft. Case presentation: The first case was a case of congestion when anastomosed with a trifurcated renal vein which ligated branch. The second case was a case of donated kidney with three renal veins, which were all short, small, and thin-walled. The third case was a case of donated kidney with four renal veins. Two of them were unused, though the other two veins were short and thin-walled with equal diameters. In all of three cases, renal veins were anastomosed with Y-shaped saphenous vein graft. Conclusion: Y-shaped saphenous vein graft is possibly effective for such reconstructions as it may prevent anastomosis-related complications.

DOI： 10.1002/iju5.12266

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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

BACKGROUND: Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN. METHODS: Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients' background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed. RESULTS: Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73). CONCLUSION: A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.

DOI： 10.1186/s12957-021-02146-0

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

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

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

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

BACKGROUND: This systematic review and meta-analysis aimed to assess the prognostic value of sequential of abiraterone (ABI) and enzalutamide (ENZ) therapy in patients with castration-resistant prostate cancer (CRPC). METHODS: PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched for articles published prior to December 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared overall survival (OS), combined progression-free survival (PFS), combined prostate specific antigen (PSA)-PFS, and PSA response rates in CRPC patients receiving sequential ABI/ENZ or vice versa. PSA response to both the first and second agents was defined as a >50% decrease in PSA achieved with each of these agents. Formal meta-analyses were performed for these outcomes. RESULTS: Ten studies with 1096 patients were eligible for the systematic review and eight studies with 643 patients for the meta-analysis. The ABI-to-ENZ sequence was significantly associated with better PFS (pooled hazard ratio (HR): 0.62, 95% confidential interval (CI): 0.49-0.78, P < 0.001), and PSA-PFS (pooled HR: 0.48, 95% CI: 0.38-0.61, P < 0.001) than the ENZ-to-ABI sequence. PSA response rates of both agents were significantly better with the ABI-to-ENZ sequence (risk ratio: 0.21, 95% CI: 0.09-0.47, P < 0.001). In contrast, treatment sequence was not significantly associated with OS (pooled HR: 0.77, 95% CI: 0.59-1.01, P = 0.055). CONCLUSIONS: ABI-to-ENZ sequential therapy in patients with CRPC was associated with better PFS, PSA-PFS, and PSA response rates. Regardless of sequencing, response to drug therapy was transient for both ABI and ENZ when either agent was used as a secondary therapy. Despite this, treatment sequencing is important to achieve the maximum possible benefit from available drugs in CRPC.

DOI： 10.1038/s41391-020-0222-6

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Other Link： http://www.nature.com/articles/s41391-020-0222-6

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

【目的】内臓脂肪(VF)の量の増加は、メタボリックシンドロームの危険因子として知られている。今回VFが増加した腎移植レシピエントの臨床転帰を調べることを目的とした。【方法】3年以上理学的所見やCTを確認した50人を対象とした。CTで臍レベルのVF面積が3年後に30%以上増加した23例(A群)と30%未満の27例(B群)を比較し、腎機能変化や虚血性血管疾患の発症について検討した。【結果】年齢、性別、または移植前のbody mass index(BMI)に有意差はなかった。透析期間はA群で有意に長く、B群で先行的腎移植(PEKT)症例が有意に多かった。3年間のVFの増加率は、A群で約80%だった。移植腎機能と生着率に関して、2群間に有意差はなかった。A群では、新規発症の虚血性血管疾患発症が有意に多く、B群では新規発症の症例はなかった。【結論】腎移植患者においてVFの増加は虚血性血管疾患の危険因子であるため、適切な運動と食事指導が必要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J06262&link_issn=&doc_id=20201211310009&doc_link_id=%2Fem0sfcrt%2F2020%2F000802%2F009%2F0231-0237%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem0sfcrt%2F2020%2F000802%2F009%2F0231-0237%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Edizioni Minerva Medica  

INTRODUCTION: The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa). EVIDENCE ACQUISITION: We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality"). EVIDENCE SYNTHESIS: After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear. CONCLUSIONS: We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.

File： Metastatis-directed therapy Minerva 2020 R19Y2020N05A0531.pdf

DOI： 10.23736/s0393-2249.20.03779-0

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

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

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

CONTEXT: The role of a nocebo response in managing urology patients is unclear. OBJECTIVE: To assess the nocebo response in randomized placebo-controlled overactive bladder (OAB) trials of pharmacological treatment by investigating the adverse events in the placebo arms. EVIDENCE ACQUISITION: PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials were searched to identify potential randomized controlled trials published from 1998 to November 2019. After evaluating the risk of bias in the selected studies, all selected full-text articles were included due to their overall acceptable quality. We extracted the event rate of the most commonly reported adverse events in the placebo arms of OAB trials, and finally, we performed a meta-analysis to calculate the cumulative rate of certain adverse events. The primary outcomes were the event rate of adverse events in the placebo arms of OAB trials of pharmacological treatment, and differences in adverse events in the placebo groups based on drug type and routes of administration. EVIDENCE SYNTHESIS: After a systematic search and risk of bias assessment, 57 trials comprising 15 446 patients were included in this systematic review. We selected 13 commonly reported adverse events for the meta-analysis. Owing to the possible differences in study samples and design, we used a random model for the analysis. The average age of the patients was 59.5 yr and 79.8% were female. Dry mouth was the most commonly evaluated adverse event reported in 57 studies comprising 15 324 patients; the mean event rate was 4.9% (95% confidence interval [CI] 0.042-0.057, p < 0.001). Constipation was the second most commonly reported adverse event in 49 studies comprising 14 556 patients; the mean event rate of constipation was 2.6% (95% CI 0.022-0.031, p < 0.001). The event rate of headache was evaluated in 33 studies comprising 10 202 patients, with a mean event rate of 3.1% (95% CI 0.026-0.037, p < 0.001). CONCLUSIONS: Dry mouth, constipation, headache, and nasopharyngitis were the most prevalent events in the included studies. The nocebo response plays a statistically significant role in causing and/or facilitating adverse events. Health care providers should have a better understanding of the positive and negative expectations associated with therapies to achieve the best possible outcomes for each individual patient. Finally, identification of the real effect of nocebo requires studies that also include a no-treatment arm. Research could help us better understand and potentially modify the nocebo response. PATIENT SUMMARY: In this meta-analysis of 57 studies comprising 15 446 patients, we reviewed the adverse events extracted from the placebo arms of randomized controlled trials studying therapies for overactive bladder. Dry mouth, constipation, headache, and urinary tract infection were the most common adverse events. Adverse events varied based on the drug type and the route of administration. Negative expectations from the therapy and giving verbal information to the patient can cause/alleviate adverse events.

DOI： 10.1016/j.euf.2020.10.010

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

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Language：Japanese   Publisher：(一社)日本透析医学会  

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

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

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

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

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

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

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Language：English   Publisher：(一社)日本癌学会  

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

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

PURPOSE: This systematic review assessed compliance to guidelines for the management of nonmuscle-invasive bladder carcinoma (NMIBC). METHODS: The PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in November 2019 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement. RESULTS: Fifteen studies incorporating a collective total of 10,575 NMIBC patients were eligible for inclusion in this systematic review. We found that the rates of compliance were 53.0% with a single immediate intravesical instillation in patients with presumed low or intermediate risk, 37.1% with intravesical bacillus Calmette-Guerin or chemotherapy in those with intermediate risk, 43.4% with performance of a second transurethral resection in high-risk patients, 32.5% with administration of adjuvant intravesical bacillus Calmette-Guerin in high-risk patients, 36.1% with radical cystectomy in highest-risk patients, and 82.2% with cystoscopy for follow-up. CONCLUSIONS: Compliance with NMIBC guidelines remains low. Better guideline education and understanding holds the key to achieving high compliance. Strategies to improve guideline compliance at the physician level are urgently required.

DOI： 10.1016/j.urolonc.2020.06.013

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Language：Japanese   Publisher：(公社)日本生化学会  

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

PURPOSE: The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase, DRR) has been linked to oncological outcomes in several cancers. We aimed to assess the association of DRR with recurrence-free survival (RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC). METHODS: We conducted a retrospective analysis of 1117 patients diagnosed with NMIBC originating from an established multicenter database. To define the optimal pretreatment DRR cut-off value, we determined a value of 1.2 as having a maximum Youden index value. The overall population was therefore divided into two De Ritis ratio groups using this cut-off (lower, < 1.2 vs. higher, ≥ 1.2). Univariable and multivariable Cox regression analyses were used to investigate the association of DRR with RFS and PFS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index). RESULTS: Overall, 405 (36%) patients had a DRR ≥ 1.2. On univariable Cox regression analysis, DRR was significantly associated with RFS (HR: 1.23, 95% CI 1.02-1.47, p = 0.03), but not with PFS (HR: 0.96, 95% CI 0.65-1.44, p = 0.9). On multivariable Cox regression analysis, which adjusted for the effect of established clinicopathologic features, DRR ≥ 1.2 remained significantly associated with worse RFS (HR:1.21, 95% CI 1.00-1.46, p = 0.04). The addition of DRR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index = 0.683 vs. C-index = 0.681). On DCA the inclusion of DRR did not improve the net-benefit of the prognostic model. CONCLUSION: Despite the statistically significant association of the DRR with RFS in patients with NMIBC, it does not seem to add any prognostic or clinical benefit beyond that of currently available clinical factors.

DOI： 10.1007/s00345-020-03384-9

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Other Link： http://link.springer.com/article/10.1007/s00345-020-03384-9/fulltext.html

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

OBJECTIVES: To evaluate recurrence and progression risk after simultaneous endoscopic surgery of bladder cancer and benign prostatic hyperplasia (BPH), as simultaneous surgery is not an unusual scenario and theoretically simultaneous transurethral resection of bladder tumour (TURBT) and transurethral resection of the prostate (TURP) can lead to an increased risk of recurrence in the bladder neck and prostatic urethra (BN/PU). METHODS: We conducted a systematic review and meta-analysis to assess the risk of recurrence (i.e. whole bladder and/or BN/PU) and tumour progression as outcomes after a simultaneous endoscopic surgery of bladder tumour and BPH, as compared to TURBT alone. We queried PubMed and Web of Science database on 1 January 2020. We used random- and/or fixed-effects meta-analytic models in the presence or absence of heterogeneity according to the I2 statistic, respectively. RESULTS: Nine retrospective and three clinical trial studies were selected after considering inclusion and exclusion criteria. We conducted the meta-analysis on retrospective and randomised controlled trials (RCTs) separately. Eight retrospective and three RCT studies were included to assess the BN/PU recurrence risk and the summarised risk ratio (RR) was 1.02 (95% confidence interval [CI] 0.74-1.41) and 0.93 (95% CI 0.47-1.84), respectively. Five retrospective and two RCT studies were included to assess the progression risk and the summarised RR was 0.91 (95% CI 0.56-1.48) and 1.16 (95% CI 0.30-4.51), respectively. Eight retrospective and three RCT studies were included to assess the whole bladder recurrence risk and the summarised RR was 0.87 (95% CI 0.78-0.97) and 0.89 (95% CI 0.65-1.21), respectively. CONCLUSION: We did not observe any increased risk of total bladder recurrence, BN/PU recurrence, or progression after a simultaneous endoscopic surgery of bladder tumour and BPH, as compared to TURBT alone.

DOI： 10.1111/bju.15146

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

PURPOSE: Management of metastatic renal cell cancer (mRCC) has undergone a paradigm shift with immune-checkpoint inhibitors (ICI) in the first-line setting. However, direct comparative data are inadequate to inform treatment decisions. Therefore, we aimed to assess first-line therapy for mRCC and indirectly compare the efficacy and safety of currently available treatments. MATERIALS AND METHODS: Multiple databases were searched for articles published before June 2020. Studies that compared overall and/or progression-free survival (OS/PFS) and/or adverse events (AEs) in mRCC patients were considered eligible. RESULTS: Six studies matched our eligibility criteria. For OS, pembrolizumab plus axitinib [hazard ratio (HR) 0.85, 95% credible interval (CrI) 0.73-0.98] and nivolumab plus ipilimumab (HR 0.86, 95% CrI 0.75-0.99) were significantly more effective than sunitinib, and pembrolizumab plus axitinib was probably the best option based on analysis of the treatment ranking. For PFS, pembrolizumab plus axitinib (HR 0.86, 95% CrI 0.76-0.97) and avelumab plus axitinib (HR 0.85, 95% CrI 0.74-0.98) were statistically superior to sunitinib, and avelumab plus axitinib was likely to be the preferred option based on analysis of the treatment ranking, closely followed by pembrolizumab plus axitinib. Nivolumab plus ipilimumab had significantly lower rates of serious AEs than sunitinib. CONCLUSION: Pembrolizumab plus axitinib seemed to be the most efficacious first-line agents, while nivolumab plus ipilimumab had the most favorable efficacy-tolerability equilibrium. These findings may facilitate individualized treatment strategies and inform future direct comparative trials in an expanding treatment options without direct comparison between approved drugs.

DOI： 10.1007/s00262-020-02684-8

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Other Link： http://link.springer.com/article/10.1007/s00262-020-02684-8/fulltext.html

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

<title>Abstract</title>
This systematic review and meta-analysis aimed to assess the prognostic value of preoperative hematologic biomarkers in patients with urothelial carcinoma of the bladder treated with radical cystectomy. PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in September 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in patients with urothelial carcinoma of the bladder with and without pretreatment laboratoryabnormalities. Formal meta-analyses were performed for this outcome. The systematic review identified 36 studies with 23,632 patients, of these, 32 studies with 22,224 patients were eligible for the meta-analysis. Several preoperative hematologic biomarkers were significantly associated with cancer-specific survival as follows: neutrophil − lymphocyte ratio (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.11–1.29), hemoglobin (pooled HR: 0.87, 95% CI 0.82–0.94), C-reactive protein (pooled HR: 1.44, 95% CI 1.26–1.66), De Ritis ratio (pooled HR: 2.18, 95% CI 1.37–3.48), white blood cell count (pooled HR: 1.05, 95% CI 1.02–1.07), and albumin-globulin ratio (pooled HR: 0.26, 95% CI 0.14–0.48). Several pretreatment laboratory abnormalities in patients with urothelial carcinoma of the bladder were associated with cancer-specific mortality. Therefore, it might be useful to incorporate such hematologic biomarkers into prognostic tools for urothelial carcinoma of the bladder. However, given the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.

DOI： 10.1007/s10147-020-01690-1

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Other Link： http://link.springer.com/article/10.1007/s10147-020-01690-1/fulltext.html

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

PURPOSE OF REVIEW: Bacillus Calmette-Guérin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) is a new definition including patients who failed intravesical BCG therapy and should not receive more BCG because of the very low efficacy and disproportionately poor prognosis. Radical cystectomy as the standard of care for these patients is associated with significant morbidity and altered quality of life. Therefore, the FDA has accepted phase II single-arm studies as a threshold to approve new agents in this setting. RECENT FINDINGS: Efforts to find an effective and safe bladder sparing strategy for BCG unresponsive patients have not been successful yet. Studies that assess nanoparticle-bound, combination or device-assisted intravesical chemotherapy to increase drug delivery and efficacy have been partly promising but suffer from limitations. Systemic immunotherapy such as checkpoint inhibitors therapy PD1/PDL1 and intravesical immunotherapy such as rAd-IFN/Syn3 have shown satisfactory efficacy so far. SUMMARY: Although this is much effort and enthusiasm, no bladder-sparing strategy has met the criteria set for the successful alternative to radical cystectomy in BCG unresponsive NMIBC. For BCG unresponsive patients who refuse or are unfit for radical cyctectomy, there is new hope arising with novel strategies limiting the threshold for clinical use and a multitude of promising agents in clinical trials.

DOI： 10.1097/mou.0000000000000769

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

[Background and Objective] Traditional teaching has been to avoid placing the tip of the central venous catheter within the right atrium in order to reduce atrial arrhythmia and thrombosis. The aim of this study was to evaluate the relationship between the patency of a tunneled hemodialysis catheter and catheter tip location (superior vena cava: SVC/right atrium: RA). [Patients and Methods] 83 hemodialysis patients who were candidates for the insertion of a tunneled hemodialysis catheter between December 2008 and December 2019 were included in our study. Patient backgrounds (age, gender, body mass index, diabetes, anticoagulant medication and catheter tip location) were evaluated. The relationship between the patency of the catheter and catheter tip location was examined using logistic regression analysis. [Results] Univariate analysis and Kaplan-Meier curves showed that there were no statistical differences regarding catheter patency and catheter tip location between SVC and RA (HR: 0.39/95%, CI: 0.12-1.27/p = 0.12). [Conclusion] Tunneled hemodialysis catheter tip location was not associated with the patency of the catheter.

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

【緒言・目的】従来、血管内カテーテル先端は心房内に位置することは血栓形成、不整脈の誘発などの理由により避けられてきた。近年、透析患者の高齢化にともないvascular access(VA)として長期留置カテーテルの需要が高まっている。今回我々は長期留置カテーテル先端位置と開存率の関連性について後方視的に検証する。【対象・方法】2008年12月から2019年12月までの間に新規に透析長期留置カテーテルを挿入した血液透析患者83例を対象とした。カテーテル先端位置別(上大静脈内 SVC群/右心房内 RA群)に群別し、開存率を検証した。【結果】SVC群45例、RA群38例。両群間において開存率に差は認めなかったが、生存期間は有意にRA群の方が長期の生存を認めた(p<0.05)。単変量解析ではカテーテル先端位置は開存率に影響を与えなかった(HR:0.39/95%、CI:0.12-1.27/p=0.12)。【結論】透析長期留置カテーテル先端位置と開存率に関連性は認めなかった。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01004&link_issn=&doc_id=20200626150008&doc_link_id=%2Fer9niuro%2F2020%2F008202%2F008%2F0242-0246%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2020%2F008202%2F008%2F0242-0246%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

(Background] Robot-assisted partial nephrectomy (RAPN) has been rapidly gaining popularity even for high complexity renal tumors. However, the oncological outcome and safety of RAPN for high complexity renal tumors are still unclear. We evaluated the outcomes and safety of RAPN in high complexity renal tumors. (Patients and Methods) High complexity renal tumor were defined as those with a R.E.N.A.L. nephrectomy score (RNS) ≥10. We retrospectively evaluated 63 patients who had undergone RAPN between August 2016 and November 2018 at our institute. Demographic, surgical and pathological outcomes were compared between patients with RNS ≤9 (low complexity group) and RNS ≥10 (high complexity group). (Results] Of the 63 patients, six had a RNS ≥10. Patients in the high complexity group had a longer console time (104 vs 140 minutes
p=0.04), longer warm ischemic time (16 vs 35.5 minutes
p=0.006), and higher rate of urinary calyceal system closure (32% vs 83%
p=0.021) compared with those in the low complexity groups. The renal function outcomes did not differ between the two groups 1 month after surgery. There were no significant differences in the frequency of complications according to Clavien-Dindo ≥ G 3 and the rate of positive surgical margin. There was less trifecta achievement in the high complexity group (84.2% vs 16.7%
p=0.001). [Conclusions) High complexity R.E.N.A.L. tumors are associated with a lower rate of trifecta achievement, however, oncological and functional outcomes seem to be equivalent between high and low complexity tumors. Our results suggest that RAPN is a useful option in selected patients with high complexity tumors.

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

【背景】ロボット手術の登場で、高難度腎腫瘍でも部分切除が検討されるようになったが、有用性、安全性の評価はまだ不十分である。【方法】R.E.N.A.L.score(RNS)10点以上を高難度腎腫瘍と定義し、RAPN施行した63例をRNS9以下と10以上で群間比較した。【結果】RNS9以下が57例、10以上が6例。手術時間155分vs190分、コンソール時間104分vs140分(p=0.04)、WIT16分vs35.5分(p=0.006)、腎杯縫合率32% vs 83%(p=0.021)と、High complexity群で、コンソール時間、WITが有意に長く、腎杯縫合率も高かった。腎機能変化はHigh complexity群においてPOD1で有意に低下したが[-7.9% vs -25.7%(p=0.039)]、術後1、3ヵ月では有意差がなくなった。Clavien-Dindo G 3以上の合併症頻度、断端陽性率に有意差はなく、観察期間中央値24.4ヵ月で術後再発はない。【結語】高難度腎腫瘍では、WITが長くなることでTrifecta達成率は低くなるが、Oncological outcome、安全性、術後腎機能は許容でき、主要な治療選択肢の1つであると思われた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01004&link_issn=&doc_id=20200514090012&doc_link_id=%2Fer9niuro%2F2020%2F008201%2F012%2F0072-0078%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer9niuro%2F2020%2F008201%2F012%2F0072-0078%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

【背景】ロボット手術の登場で、高難度腎腫瘍でも部分切除が検討されるようになったが、有用性、安全性の評価はまだ不十分である。【方法】R.E.N.A.L.score(RNS)10点以上を高難度腎腫瘍と定義し、RAPN施行した63例をRNS9以下と10以上で群間比較した。【結果】RNS9以下が57例、10以上が6例。手術時間155分vs190分、コンソール時間104分vs140分(p=0.04)、WIT16分vs35.5分(p=0.006)、腎杯縫合率32% vs 83%(p=0.021)と、High complexity群で、コンソール時間、WITが有意に長く、腎杯縫合率も高かった。腎機能変化はHigh complexity群においてPOD1で有意に低下したが[-7.9% vs -25.7%(p=0.039)]、術後1、3ヵ月では有意差がなくなった。Clavien-Dindo G 3以上の合併症頻度、断端陽性率に有意差はなく、観察期間中央値24.4ヵ月で術後再発はない。【結語】高難度腎腫瘍では、WITが長くなることでTrifecta達成率は低くなるが、Oncological outcome、安全性、術後腎機能は許容でき、主要な治療選択肢の1つであると思われた。(著者抄録)

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

SPOP, speckle-type POZ protein is a substrate adaptor protein of the Cullin-3/RING ubiquitin E3 complex. The spop gene is the most commonly point mutated in human primary prostate cancers, but the pathological contribution of the SPOP mutations remains unclear. In this study, we investigated several known factors that are critical in the DNA--protein cross-link repair process. The depletion of SPOP or overexpression of a prostate cancer-associated SPOP mutant, F133V, in androgen receptor-positive prostate cancer cells increased the amount of topoisomerase 2A (TOP2A) in the nuclei together with the increased amount of γH2AX, an indication of DNA breaks. Tyrosyl-DNA phosphodiesterases (TDPs) and an endo/exonuclease MRE11 are enzymes that liberate TOP2A from the TOP2A-DNA cleavage complex, and thus is essential for the completion of the DNA repair process. We found that the amount of TDP1 and TDP2 was decreased in SPOP-depleted cells, and that of TDP2 and MRE11 was decreased in F133V-overexpressing cells. These results suggest that the F133V mutant exerts dominant-negative and gain-of-function effects in down-regulation of TDP2 and MRE11, respectively. We conclude that SPOP is involved in the DNA-protein cross-link repair process through the elimination of TOP2A from the TOP2A cleavage complex, which may contribute to the genome stability.

DOI： 10.1091/mbc.E19-08-0456

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

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

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

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

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

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

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

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

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

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

Laparoscopic radical cystectomy (LRC) is a standard surgical treatment for muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. LRC is a less invasive modality than conventional open surgery. Therefore, even elderly patients with invasive bladder cancer may be candidates for LRC. In this study, a comparative analysis of perioperative/oncological outcomes between elderly patients and younger patients who underwent LRC was performed to assess the feasibility of LRC in elderly patients. Sixty-eight consecutive patients who underwent LRC between October 2013 and March 2018 were enrolled and stratified into those younger than 75 years (n=37) and those ≥ 75 years old (n=31). The median follow-up period was 28.2 months. The preoperative and operative parameters and complications were similar in both groups. The 2-year overall survival (OS) was 64.4% in the younger vs. 76.4% in the elderly group (p=0.053), cancer-specific survival (CSS) was 79.3% vs. 81.7% (p=0.187), and recurrence-free survival (RFS) was 58.2% vs. 75.7% (p=0.174), respectively. No significant differences were observed in OS, CSS, or RFS between the groups. No significant differences were found between the groups with respect to peri-surgical/oncological outcomes. We conclude that LRC is feasible in elderly patients.

DOI： 10.18926/AMO/57371

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

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

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

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

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

局所進行性前立腺癌に対する一次治療としてのロボット支援下前立腺全摘術(RALP)の成績は、限られた報告しかない。そこでわれわれは、extended RALP(拡大摘除+拡大骨盤内リンパ節郭清)を行った局所進行性前立腺癌の症例(ネオアジュバントならびにアジュバント治療を施行していない約100例)を後方視的に、手術成績、周術期合併症、術後PSA再発、予後因子などを検討し報告する。(著者抄録)

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

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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

Treatment regimens for castration-resistant prostate cancer (CRPC) are divided into two types: androgen-targeted drugs and taxane-based chemotherapy. There is no clear policy as to how and when to use each drug, but it is necessary to consider and decide each case according to each individual patient. In this article, we discuss issues necessary to consider when deciding on the use of chemotherapy and we examine their usage.

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

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

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

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

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

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

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

去勢抵抗性前立腺癌(CRPC)に対する治療は、アンドロゲンを標的とした薬剤と、タキサン系の化学療法の2種類に大きく分けられる。それぞれの薬剤を、いつ、どのように使用していくかは明確な方針が存在するわけではなく、個々の患者ごとに検討して決定していくことが必要である。本稿では、特に抗がん剤の使用決定に必要なディスカッションポイントをピックアップし、抗がん剤の使いどころについて考察を行った。(著者抄録)

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

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Language：English   Publisher：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2019.37.7_suppl.120

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

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

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

A 28-year-old woman was diagnosed as having an ectopic kidney in adolescence. She desired to donate her ectopic kidney to her mother, who was diagnosed as having renal failure. The ectopic kidney was located behind the sigmoid colon with 3 renal arteries and 3 renal veins. Laparoscopic donor nephrectomy was performed by reduced port surgery using the GelPOINT access platforms at a midline incision below the umbilicus with 1 accessory port. A thin artery of the donated kidney was ligated. An artery of the upper pole was anastomosed to the internal iliac artery, and a second artery was anastomosed directly to the inferior epigastric artery. Three veins were anastomosed to the external iliac vein: 1 anastomosed directly, 1 interposed by saphenous vein graft, and 1 interposed by harvested ovarian vein. To our knowledge, this is the first successful case of transplantation using an ectopic pelvic kidney by reduced port laparoscopic donor nephrectomy.

DOI： 10.1016/j.transproceed.2018.06.016

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

Objectives: To evaluate the value of a classification of hydronephrosis on 18F-flurodeoxyglucose (FDG)-PET/CT in predicting post-operative renal function and pathological outcomes among patients with upper urinary tract urothelial carcinoma. Methods: We retrospectively reviewed 71 patients treated with nephroureterectomy (NU) for upper urinary tract urothelial carcinoma after FDG-PET/CT between 2010 and 2016. Eight patients treated with ureteral stent or nephrostomy at the time of FDG-PET/CT were excluded. We classified hydronephrosis based on renal excretion of FDG as follows: Type 0, no hydronephrosis; Type 1, hydronephrosis with FDG excretion; and Type 2, hydronephrosis without FDG excretion. eGFR was recorded before pre-operataive FDG-PET/CT examination and after nephroureterectomy. Results: Thirty-three patients (52%) had hydronephrosis, classified as Type 1 in 19 patients (30%) and Type 2 in 14 (22%). Type 2 hydronephrosis was associated with ureteral cancer and severe hydronephrosis on CT. Median changes in eGFR before and after nephroureterectomy in patients classified as Type 0, 1 and 2 were -23.9, -18.8 and 2.0 ml/min/1.73 m2, respectively. On multivariate analysis, Type 2 hydronephrosis was a significant predictor of change in eGFR (P = 0.001). Rates of muscle-invasive upper urinary tract urothelial carcinoma among Type 0, 1 and 2 patients were 37, 42 and 86%, respectively. On multivariate analysis, Type 2 hydronephrosis was a significant predictor of muscle-invasive upper urinary tract urothelial carcinoma (P = 0.032, OR 6.491). Conclusions: This classification of hydronephrosis from FDG-PET/CT is simple and useful for predicting post-operative renal function and muscle-invasive disease in patients with upper urinary tract urothelial carcinoma, especially with ureteral cancer. This classification can help in deciding eligibility for lymphadenectomy or perioperative cisplatin-based chemotherapy.

DOI： 10.1093/jjco/hyy135

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

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

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

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

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

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

腎移植において血管吻合は、腎機能発現を左右する最も重要な手技である。十分な動脈血流を移植腎に供給することはもちろん重要であるが、静脈吻合のトラブルもうっ血や術中出血の原因となり得る。今回、当院の腎移植の際に経験した、血管吻合に関するトラブルを報告する。症例は7症例で、(1)石灰化による内腸骨動脈が屈曲した症例、(2)血管形成後に分枝動脈が伸びきって血流不全をきたした症例、(3)下腹壁動脈を介在し血管形成を行ったが分枝が屈曲した症例、(4)大きな移植腎と動脈石灰化により内腸骨動脈が屈曲した症例、(5)腎静脈の1本を結紮するとout-flow blockをきたした症例、(6)静脈壁が薄く短い症例、(7)Y字形成した大伏在静脈グラフトを使用した症例。何れの症例も修復し得たが、注意深い観察と、吻合デザインの選択が重要と考えられた。(著者抄録)

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

Combined gemcitabine and cisplatin (GC) treatment is a first line chemotherapy for bladder cancer. However, acquired resistance to GC has been a major problem. To address the mechanism of gemcitabine resistance, and to identify potential biomarkers or target proteins for its therapy, we aimed to identify candidate proteins associated with gemcitabine resistance using proteomic analysis. We established gemcitabine-resistant human bladder cancer cell lines (UMUC3GR and HT1376GR) from gemcitabine-sensitive human bladder cancer cell lines (UMUC3 and HT1376). We compared the protein expression of parental and gemcitabine-resistant cell lines using isobaric tags for relative and absolute quantification (iTRAQ) and liquid chromatography tandem mass spectrometry. Among the identified proteins, ethylmalonyl-CoA decarboxylase (ECHDC1) expression was significantly increased in both of the gemcitabine-resistant cell lines compared to the respective parental cell lines. Silencing of ECHDC1 reduced ECHDC1 expression and significantly inhibited the proliferation of UMUC3GR cells. Furthermore, silencing of ECHDC1 induced upregulation of p27, which is critical for cell cycle arrest in the G1 phase, and induced G1 arrest. In conclusion, ECHDC1 expression is increased in gemcitabine-resistant bladder cancer cells, and is involved in their cell growth. ECHDC1, which is a metabolite proofreading enzyme, may be a novel potential target for gemcitabine-resistant bladder cancer therapy.

DOI： 10.3892/ol.2017.7269

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Language：English   Publisher：WILEY  

Locally advanced prostate cancer is regarded as a very high-risk disease with a poor prognosis. Although there is no definitive consensus on the definition of locally advanced prostate cancer, radical prostatectomy for locally advanced prostate cancer as a primary treatment or part of a multimodal therapy has been reported. Robot-assisted radical prostatectomy is currently carried out even in high-risk prostate cancer because it provides optimal outcomes. However, limited studies have assessed the role of robot-assisted radical prostatectomy in patients with locally advanced prostate cancer. Herein, we summarize and review the current knowledge in terms of the definition and surgical indications of locally advanced prostate cancer, and the surgical procedure and perisurgical/oncological outcomes of robot-assisted radical prostatectomy and extended pelvic lymphadenectomy for locally advanced prostate cancer.

DOI： 10.1111/iju.13441

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Language：English   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.juro.2017.02.625

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BACKGROUND: Leiomyosarcomas typically originate in smooth muscle cell. Leiomyosarcoma potentially arising from the adrenal gland is an extremely rare mesenchymal tumors associated with delayed diagnosis and poor prognosis. CASE PRESENTATION: A 34-year-old man visited our department complaining of right hypochondriac pain. Computed tomography demonstrated a solid mass measuring 5.2 cm in diameter above the right kidney, corresponding to the right adrenal gland, and a lymph node mass, which appeared to have invaded the IVC wall. Right adrenalectomy and lymphadenectomy were performed. A microscopic examination revealed primary adrenal leiomyosarcoma with lymph node metastasis. No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively. CONCLUSIONS: We experienced a very rare case of primary adrenal leiomyosarcoma. Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

DOI： 10.1186/s12957-016-0936-z

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

AIM: Docetaxel-based chemotherapy against castration-resistant prostate cancer (CRPC) has recently been shown to be effective and tolerable. The objective of this study was to retrospectively evaluate the efficacy and toxicity of low-dose docetaxel in combination with dexamethasone. METHODS: Thirty-seven CRPC patients were administered a treatment regimen consisting of 50 mg/m2 docetaxel once every 3-4 weeks and 1 mg dexamethasone daily at our institution, between November 2004 and April 2014. RESULTS: Twenty-four patients (65%) had a decrease in serum prostate-specific antigen (PSA) >50%. The median overall survival (OS) and PSA progression-free survival were 26.2 and 10.0 months, respectively. Ten of 12 patients (83%) taking analgesic agents reduced their intake because of decreased pain levels. Grade 3 febrile neutropenia occurred in 2 patients (5%). Nonhematological toxicities were less frequent but sometimes severe. Treatment-related death occurred in 2 octogenarian patients, 1 due to gastric bleeding and the other due to infective endocarditis. CONCLUSION: Low-dose docetaxel in combination with dexamethasone is feasible in Japanese CRPC patients. Hematological toxicity is less than that seen with standard docetaxel therapy, but it is necessary to monitor patients for severe nonhematological toxicities, particularly very elderly patients.

DOI： 10.1159/000440942

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Language：English   Publisher：OXFORD UNIV PRESS  

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Language：English   Publisher：OXFORD UNIV PRESS  

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

BACKGROUND: The purpose of this study was to assess the ability of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to detect upper urinary tract urothelial carcinomas (UTUC) compared with pathological examination of tissues obtained by ureteroscopic biopsy and split cytologic analysis of urine obtained after retrograde pyelography. METHODS: Clinicopathological records of patients at our institution were retrospectively reviewed. Fifty patients with clinically suspected UTUC, who were histologically diagnosed by nephroureterectomy, partial ureterectomy, or endoscopic biopsy, were included. The patient cohort included 42 men and 8 women, with a median age of 73 (range 54-92) years. RESULTS: Only 27 % of 49 patients with UTUC had positive voided urine cytology, and 33 % of 40 patients had positive split urine cytology. In addition, 40 % of 10 patients had a positive endoscopic biopsy. However, 83 % of 48 patients with UTUC had positive results from FDG-PET/CT examination. The positive predictive value of FDG-PET/CT was 95 %. There were no correlations between sensitivity and tumor stage or tumor grade. Sensitivity of FDG-PET/CT for patients with and without diabetes mellitus was 60 and 89 %, respectively. CONCLUSIONS: These preliminary results from a small number of patients revealed that FDG-PET/CT enabled effective detection of UTUC.

DOI： 10.1007/s10147-015-0817-4

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

Obesity correlates with an increased risk of developing prostate cancer (PCa) and leptin plays an important role in PCa progression. Since leptin is produced by adipocytes, the serum leptin level is higher in obese than in non-obese individuals. However, the effects of leptin remain controversial and unclear. The aim of the present study was to investigate the effect of leptin on PCa cell aggressiveness. Three human PCa cell lines (LNCaP, DU145 and PC-3) were treated with recombinant leptin for 28 days. Cell proliferation, migration, and invasion were estimated using the WST assay, a wound-healing assay, and a BD Matrigel invasion assay, respectively. The mechanism underlying the proliferative effect of leptin was investigated by cell transfections with small interfering RNA (siRNA) against the leptin receptor (ObR) or forkhead box O1 (FOXO1), and by immunocytochemistry. Long-term exposure of PCa cells to leptin enhanced their proliferation, migration and invasion. Leptin increased ObR expression and enhanced Akt phosphorylation constitutively. Leptin also increased the phosphorylation of FOXO1 via PI3K signaling and FOXO1 gene silencing enhanced PCa cell proliferation. Leptin induced the translocation of FOXO1 from the nucleus to the cytoplasm. Furthermore, the PI3K inhibitor, LY294002 suppressed this translocation. These results suggested that leptin regulated the subcellular localization of FOXO1 and induced Akt phosphorylation. Additionally, we revealed that leptin increased the expression of cyclin D1 and decreased the expression of p21 protein. In conclusion, long-term exposure to leptin increased the cell proliferation, migration, and invasion of PCa cells through inactivation of FOXO1. This inactivation resulted from exclusion of FOXO1 from the nucleus and its restriction to the cytoplasm through PI3K/Akt signaling. Our findings contribute to an understanding of the association between obesity and PCa aggressiveness.

DOI： 10.3892/ijo.2015.2845

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

We report a case of ectopic pheochromocytoma where there were negative findings for 123I-MIBG scintigraphy but positive findings for l8FDG-PET imaging. A 46-year-old woman was referred to our hospital because of hypertension pointed out by medical screening and a tumor pointed out by PET screening that was located behind the head of the pancreas. Endocrinological examinations demonstrated elevated levels of plasma and urine catecholamines with a predominance of noradrenaline, and their urine metabolites. 123I-MIBG scintigraphy did not show an accumulation of the tracer, however 18FDG-PET imaging showed an increased accumulation of the tracer within the tumor. These results were suggestive of a diagnosis of ectopic pheochromocytoma, and the tumor was resected by open surgery. The pathological diagnosis was paraganglioma. The post-operative course was uneventful and the patient has remained disease-free as of the time of writing.

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Language：English   Publisher：日本癌学会  

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

Cisplatin is currently the most effective anti-tumor agent available against bladder cancer. To clarify the mechanism underlying cisplatin resistance in bladder cancer, the present study examined the role of the aldo-keto reductase family 1 member C2 (AKR1C2) protein on chemoresistance using a human bladder cancer cell line. The function of AKR1C2 in chemoresistance was studied using the human HT1376 bladder cancer cell line and the cisplatin-resistant HT1376-CisR subline. AKR1C2 was expressed in HT1376-CisR cells, but not in the parental cells. The effect of small interfering (si) RNAs and an inhibitor targeting AKR1C2 was examined to determine whether cisplatin sensitivity can be rescued by blocking AKR1C2 expression or function. Silencing of AKR1C2 mRNA or inhibition of AKR1C2 by 5β-cholanic acid resulted in a decrease in the survival of cells following cisplatin exposure. Intracellular accumulation of reactive oxygen species (ROS) was determined using a 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA) fluorescent probe. Cisplatin exposure increased the level of intracellular ROS in HT1376 cells in a dose-dependent manner. The ROS levels in HT1376-CisR cells were significantly lower than those in HT1376 cells and knockdown of AKR1C2 mRNA significantly restored ROS levels. Cisplatin exposure did not increase intracellular ROS in HT1376-CisR cells, although the level of intracellular ROS increased in HT1376 cells following cisplatin exposure. Silencing of AKR1C2 mRNA restored the ROS increase response to cisplatin and menadione as an oxidative stressor in HT1376-CisR cells. Menadione has the function of an oxidative stressor. The silencing of AKR1C2 mRNA restored the increased ROS response to cisplatin and menadione in HT1376-CisR cells. These results indicate that induction of AKR1C2 in human bladder cancer cells aids in the development of cisplatin resistance through antioxidative effects. The results of this study indicate that AKR1C2 may be an effective molecular target for restoring cisplatin resistance.

DOI： 10.3892/ol.2013.1768

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Nishinihon Section of Japan Urological Association  

We report our initial clinical evaluation of flexible transurethral lithotripsy. Between August 2008 and March 2013,110 patients (male: 71, female: 39) with urinary lithiasis underwent a total of 128 procedures. In their initial treatment the average operative time was 105 min for all patients. The stone-free rate (SFR) was 69%, while the complication rate was 11%. In the 26 patients with stones larger than 2 cm, the average operative time was 126 min, the SFR was 50%, the complication rate was 22%, and the average number of procedures was 1.3. Our clinical results were worse than those obtained by other institutes, however it was concluded that with increased experience in performing urinary lithiasis, our results would be improved.

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Language：Japanese   Publisher：THE JAPANESE UROLOGICAL ASSOCIATION  

(Purpose) Adrenocortical carcinoma (ACC) is a rare condition associated with poor prognosis. This study aimed to evaluate the clinicopathologic characteristics and prognosis of 7 patients with ACC. (Patients and methods) The clinicopathologic characteristics, treatment, and survival of 7 patients with pathologically confirmed ACC treated at our institution between January 2002 and December 2012 were retrospectively examined. (Results) The study cohort comprised 4 male and 3 female patients (median age at diagnosis, 63 years [range, 36-71 years]). The median tumor size was 7.0 cm (range, 4.0-13.0 cm), and the median follow-up duration was 22 months (range, 9-107 months). One patient had stage I ACC, 4 had stage III, and 2 showed metastasis. The patient with stage I disease underwent laparoscopic adrenorectomy and those with stage III disease underwent adrenorectomy with the excision of adjacent organs. Four of these 5 patients are alive without recurrence at a median of 55 months (range, 22-107 months) after surgery. Of the 2 patients with metastases, 1 received combined chemotherapy with etoposide, adriamycin, and cisplatin plus mitotane without surgical resection but died 19 months later, and the other, with a solitary lung metastasis, underwent adrenorectomy and metastatectomy followed by adjuvant treatment with mitotane and is alive without recurrence at 9 months after treatment. The 3-year cause-specific survival rate was 56%. (Conclusions) Patients with advanced-stage tumors showed long-term survival with complete tumor resection at diagnosis; hence, this seems to be most beneficial treatment option for patients with ACC.

DOI： 10.5980/jpnjurol.105.79

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Nishinihon Section of Japan Urological Association  

We report a rare case of dedifferentiated retroperitoneal liposarcoma A 59-year-old woman complaining of abdominal distension was found to have a huge tumor. Abdominal enhanced CT scan showed a large lobulated left retroperitoneal mass measuring 14 cm in diameter, containing fat and soft-tissue nodules, with suggested invasion of the left kidney. One month later, the tumor had enlarged rapidly to 19 cm in diameter and had extended medially past the midline. The tumor was excised together with the left kidney as one lump. The total weight was 3,395 g. The cut surface of the tumor showed a solid mass with irregular bleeding and necrotic components. Histopathological examination revealed dedifferentiated liposarcoma with invasion of the left kidney (pT2b cNOMO). Liposarcoma which grows rapidly and becomes dedifferentiated at the same time carries a poor prognosis. Accordingly, the current patient needs to be rigorously and continuously followed up.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Igaku-Shoin Ltd  

The 72-year-old man with left renal tumor detected by computed tomography was referred to our department for the detailed examination of associated polycythemia. Polycythemia disappeared and the serum erythropoietin became decreased after left radical nephrectomy. Histopathologic examination revealed clear cell renal cell carcinoma (G2&gt
G1 &gt
G3, INFb, vl. Ly0, eg. fcl, im0. rc-inf0, rp-inf0, s-inf0. pT2a). Immunohistochemical study revealed erythropoietin expression in the carcinoma cells. Although post-operative course had been uneventful, development of the nodule in the right lung was observed at 9 postoperative month. Video assisted thoracoscope surgery was performed and histopathological examination of the resected tumor confirmed metastatic renal cell carcinoma The patient has remained disease-free to date.

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

Here, we report a case of primary intracranial tumor in a chronic hemodialysis patient in which neurosurgery was successful. A 50-year-old man who had been on hemodialysis for 4 years was admitted to our hospital with general fatigue Neurological examination on admission revealed mild restless Computed tomography and magnetic resonance imaging performed on admission revealed a large (55 mm × 40 mm) tumor mass in contact with the falx The size of this tumor rapidly increased over the next month 201Thallium-chlonde single photon emission computed tomography revealed abnormal uptake in the same location as the lesion This suggested a malignant brain tumor and surgical excision was scheduled. Two weeks prior to surgery, frequent hemodialysis was performed using nafamostat mesilate instead of heparin to prevent bleeding and to maintain electrolyte balance, and red cell concentrates and erythropoietin were administered for the improvement of anemia. A tnple lumen catheter was inserted in the right internal jugular vein in preparation for emergency continuous hemodiafiltration to maintain homeostasis of circulatory dynamics Surgery was completed without incident and the tumor was resected totally. During surgery, cerebral edema was well controlled by hyperventilation and a slightly upturned head position. Histopathological examination of the specimen confirmed atypical meningioma Continuous hemodiafiltration was performed for 24 hours after surgery, and hemodialysis was initiated on the third day after surgery. The postoperative course was uneventful. Three weeks after surgery, the patient was discharged with no neurological deficit and resumed his daily life on maintenance hemodialysis.

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BACKGROUND: This was a retrospective study to evaluate the activity and toxicity of a combined chemotherapeutic regimen of gemcitabine and carboplatin (GCa) in patients with metastatic urothelial carcinomas (UCs) with special regard to patients with highly impaired renal function. METHODS: Eleven patients whose creatinine clearance was 30 ml/min or under and who had been diagnosed with metastatic UC were treated with GCa. The patient cohort comprised 4 males and 7 females, with a median age of 74 (range 67-84) years. The median follow-up was 19 (range 1-58) months. RESULTS: Five of the 11 patients (45%) showed an objective response, with 2 achieving a clinically complete response and 3 a partial response with GCa. The grade 3/4 toxicity of the regimen was primarily hematological, including anemia (55%), neutropenia (45%), and thrombocytopenia (45%). Four patients (36%) could not complete the treatment in total. Grade 3 pneumonitis was found in one patient, and the treatment was terminated. Grade 4 febrile neutropenia occurred in the patient on hemodialysis, and the patient was forced to discontinue the chemotherapy. Another 2 patients also called off the treatment due to a pulmonary adverse event and an elevation of serum creatinine, respectively. CONCLUSIONS: GCa appears to be effective for the treatment of metastatic UCs in patients with impaired renal function, but it is necessary to pay attention to the occurrence of severe adverse events.

DOI： 10.1007/s10147-012-0466-9

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Language：English   Publisher：日本癌学会  

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BACKGROUND: To improve the prognosis of patients with urachal cancer and establish an effective chemotherapeutic regimen for distant metastases. METHODS: We conducted a retrospective study to evaluate the efficacy and safety of a modified combination of 5-fluorouracil, leucovorin and oxaliplatin (mFOLFOX6) therapy in patients with metastatic urachal cancer. RESULTS: Five patients were treated with mFOLFOX6. Their median age was 65 years (range 41-80). The median follow-up time was 42 months (range 18-46). Two of the 5 patients (40%) showed an objective response: 1 achieved a clinically complete response and 1 a partial response. The grade 3/4 toxicity associated with this regimen was primarily neutropenia, but febrile neutropenia was not observed. Oxaliplatin treatment was discontinued because of a grade 2 allergic reaction in 1 patient. Grade 2 peripheral sensory neuropathy caused by oxaliplatin was observed in 2 patients, and the OPTIMOX (stop and go) approach had to be adopted. CONCLUSIONS: mFOLFOX6 appears to be effective for the treatment of metastatic urachal cancer.

DOI： 10.1159/000362400

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

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Cisplatin is currently the most effective antitumor agent available against bladder cancer. However, a majority of patients eventually relapse with cisplatin-resistant disease. Chemoresistance thus remains a major obstacle in bladder cancer therapy. To clarify the molecular mechanisms underlying cisplatin resistance in bladder cancer, we established a cisplatin-resistant subline from the human bladder cancer cell line HT1376 (HT1376-CisR), and conducted large-scale analyses of the expressed proteins using two-dimensional (2D) gel electrophoresis coupled with mass spectrometry (MS). Comparative proteomic analysis of HT1376 and HT1376-CisR cells revealed 36 differentially expressed proteins, wherein 21 proteins were upregulated and 15 were downregulated in HT1376-CisR cells. Among the differentially regulated proteins, adseverin (SCIN), a calcium-dependent actin-binding protein, was overexpressed (4-fold upregulation) in HT1376-CisR, with the increase being more prominent in the mitochondrial fraction than in the cytosol fraction. SCIN mRNA knockdown significantly reduced cell proliferation with mitochondria-mediated apoptosis in HT1376-CisR cells. Immunoprecipitation analysis revealed voltage-dependent anion channels (VDACs) to be bound to SCIN in the mitochondrial fraction. Our results suggest that the VDAC-SCIN interaction may inhibit mitochondria-mediated apoptosis in cisplatin-resistant cells. Targeting the VDAC-SCIN interaction may offer a new therapeutic strategy for cisplatin-resistant bladder cancer.

DOI： 10.1016/j.molonc.2011.12.002

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Bladder cancer incidence increases with age, presumably reflecting a cumulative exposure to carcinogens and ever-increasing life expectancy. While aberrant protein expression due to DNA mutations is an essential step during oncogenesis, one recent interest has been the role of epigenetic changes in regulating bladder tumor development. Because aberrant histone acetylation has been linked to malignant diseases in several cases, histone deacetylase inhibitors have great potential as new anticancer drugs owing to their ability to modulate transcription and induce differentiation and apoptosis. We herein review the current knowledge on epigenetic issues in bladder cancer, particularly regarding histone acetylation, and discuss its implications for understanding the molecular basis and treatment of this disease.

DOI： 10.1586/era.10.230

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Language：Japanese   Publisher：The Japanese Urological Association  

(PURPOSE) Efficacy and tolerability of docetaxel-based chemotherapy against hormone-refractory prostate cancer (HRPC) has been shown lately. The objective of this study was to evaluate retrospectively the efficacy and toxicity of low-dose docetaxel in combination with dexamethasone.<br> (PATIENTS AND METHODS) Sixteen patients, with a median age of 69.5 years (range 54-85 years) , diagnosed with HRPC were administered a treatment regimen consisting of docetaxel (60-80mg/body or 50mg/m²) once every 3 or 4 weeks and dexamethasone 1mg daily at our institution between November, 2004 and March, 2010.<br> (RESLTS) The patients received a median of 11.5 cycles of treatment (range, 2-35 cycles) . Eleven of 16 patients (68.8%) had a &ge; 50% decrease in serum prostate-specific antigen. The median progression-free survival and overall survival times were 7.1 and 20.3 months, respectively. Grade 3 neutropenia occurred only in 2 patients. Infective endocarditis, gastrointestinal or cerebral hemorrhage, and compressive fracture were occurred in each patient.<br> (CONCLUSINONS) The combination of low-dose docetaxel every 3-4 weeks and dexamethasone daily was effective and well tolerated in patients with HRPC. However, it is necessary to pay continuous attention to side effects due to the frequent presence of comorbid diseases particularly in the elderly.<br>

DOI： 10.5980/jpnjurol.102.23

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

To evaluate the efficacy and toxicity of docetaxel plus prednisolone treatment in Japanese patients with hormone-refractory prostate cancer (HRPC).
From April 2004 through August 2008, we used docetaxel plus prednisolone to treat 55 HRPC patients (median age, 72 years). Eighteen patients (32.7%) had measurable soft tissue lesions, whereas 52 patients (94.5%) had bone metastases. During the 21-day treatment cycle, docetaxel (70 mg/m(2)) was administered once every 21 days and oral prednisolone (5 mg), twice daily. Prostrate-specific antigen (PSA) response, defined as a reduction of at least 50% in the baseline levels for 4 weeks, was evaluated.
The median follow-up period was 30.1 months; median overall survival, 15.3 months and median progression-free survival, 7.5 months. During follow-up, 37 patients (67.3%) achieved the PSA response, and 5 of 18 (27.8%) patients with measurable disease showed a partial response. Among the 27 patients who experienced cancer pain before treatment initiation, 15 (55.5%) reduced their analgesic drug intake. Multivariate analysis of the prognostic variables revealed a significant association between the overall survival and pain (P = 0.033). Hematological toxicity (grades 3-4) included neutropenia (87.3%), febrile neutropenia (25.5%) and thrombocytopenia (5.5%). Frequent non-hematological adverse events were general edema (52.7%), general fatigue (32.7%) and sensory neuropathy (30.9%). Three patients died of adult respiratory distress syndrome (ARDS).
Docetaxel plus prednisolone treatment is effective in Japanese HRPC patients. The main toxicity is neutropenia, which can be safely controlled by outpatient treatment with granulocyte-colony stimulating factor. However, the Japanese patients in our study developed ARDS more frequently than other patients in previous studies did.

DOI： 10.1093/jjco/hyq100

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BACKGROUND: This retrospective study aimed to determine the efficacy and toxicity of a combined chemotherapeutic regimen of gemcitabine and cisplatin (GC) for the treatment of metastatic urothelial carcinomas (UCs) in patients 80 years of age and over. PATIENTS AND METHODS: Twelve patients who were at least 80 years old and had been diagnosed with metastatic UC were treated with GC. The patient cohort consisted of 9 men and 3 women, with a median age of 83 (range 80-84) years. The median follow-up was 54 (range 14-80) months. RESULTS: Five out of the 12 patients (42%) showed an objective response, with two achieving a clinically complete response and three a partial response with GC. The median time to progression was 6 months, and the median overall survival was 14 months. The grade 3 and 4 toxicities of the regimen were primarily hematological, including anemia (33%), neutropenia (58%), and thrombocytopenia (50%). No grade 3 or 4 non-hematological toxicities were found. CONCLUSION: GC appears to be an effective and well-tolerated regimen for the treatment of metastatic UCs in very old patients.

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

This retrospective study aimed to determine the long-term effects and toxicity of a combined chemotherapeutic regimen of gemcitabine and cisplatin (GC) in the treatment of metastatic urothelial carcinomas (UCs).Seventy-one patients with metastatic UC were treated with GC (gemcitabine 1000 mg/m(2) on days 1, 8, and 15 and cisplatin 70 mg/m(2) on day 2 every 28 days). The patients were divided into 3 groups: patients who had not undergone prior chemotherapy (group 1), patients who relapsed more than 6 months after being treated with the prior cisplatin-based regimen (group 2), and patients in whom the prior cisplatin-based regimen demonstrated no effect (group 3). The median follow-up was 42 months.In group 1, 20 of the 32 patients (63%) showed an objective response, with 6 achieving a clinically complete response (CR) and 14 a partial response (PR) with GC. Ten of 32 patients (31%) and 1 of 7 patients (14%) showed objective responses in groups 2 and 3, respectively. Patients in group 2 who had previously been treated with regimens other than GC showed a better objective response (58%) than those with GC (15%). The median time to progression in group 1 was 6 months, and the median overall survival was 14 months. In all, the nonhematological toxicities associated with GC were quite mild. Grade 3-4 toxicity was primarily hematological, including anemia (19%), neutropenia (36%), and thrombocytopenia (42%).GC is therefore considered to be a highly effective and well-tolerated regimen with moderate toxicity for the treatment of metastatic UCs.

DOI： 10.1007/s10147-010-0069-2

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

OBJECTIVETo examine the expression profile of histone deacetylase (HDAC)-1 and explore its potential role in the development of bladder cancer, using valproic acid (VPA), a HDAC inhibitor, which reduces tumour growth and metastasis formation in animal models.MATERIALS AND METHODSThe study comprised clinical samples from patients with urinary bladder cancer, mouse urinary bladder tissue specimens, and two human urinary bladder cancer cell lines (HT-1376 and 5637). HDAC1 mRNA and protein expression were examined using real-time reverse transcription-polymerase chain reaction and immunohistochemical methods. Female C3H/He mice were given VPA (0, 250, 500 and 750 mg/kg body weight, intraperitoneal, every day) from the start or 4 weeks after 0.05% N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) treatment, and were humanely killed and sampled at 8 and 12 weeks.RESULTSA significantly higher level of HDAC1 mRNA was expressed in human urinary bladder cancer specimens. The immunohistochemical study showed that HDAC1 was expressed in the cytoplasm and nucleus in the specimens. BBN treatment increased HDAC1 mRNA expression in the urinary bladder. VPA administration seemed to delay the incidences of BBN-induced mouse urinary bladder tumour, possibly through p21WAF1 protein expression.CONCLUSIONThese results indicate that HDAC might be an effective molecular target for cancer therapy.

DOI： 10.1111/j.1464-410X.2009.08795.x

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

The health-related quality of life (HRQOL) after treatment of prostate cancer is examined using a new HRQOL tool. HRQOL, based on the expanded prostate cancer index composite (EPIC) and SF-8 questionnaires, was prospectively compared after either a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) at a single institute.
Between October 2005 and June 2007, 96 patients were treated by an RRP and 88 patients were treated by a PPB. A HRQOL survey was completed at baseline, and at 1, 3, 6 and 12 months after treatment, prospectively.
The general HRQOL in the RRP and PPB groups was not different after 3 months. However, at baseline and 1 month after treatment, the mental component summary was significantly better in the PPB group than in the RRP group. Moreover, the disease-specific HRQOL was worse regarding urinary and sexual functions in the RRP group. Urinary irritative/obstructive was worse in the PPB group, but urinary incontinence was worse in the RRP group and had not recovered to baseline after 12 months. The bowel function and bother were worse in the PPB group than in the RRP group after 3 months. In the RRP group, the patients with nerve sparing demonstrated the same scores in sexual function as the PPB group.
This prospective study revealed the differences in the HRQOL after an RRP and PPB. Disease-specific HRQOL is clarified by using EPIC survey. These results will be helpful for making treatment decisions.

DOI： 10.1093/jjco/hyp053

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

A previous paper reported favorable results of intra-arterial chemotherapy in combination with radiotherapy for muscle-invasive bladder cancer. The current study will update those results.
Between January 1992 and December 2006, 94 patients with confirmed muscle invasion were treated with intra-arterial chemotherapy and concurrent radiotherapy after an initial complete transurethral resection. Intra-arterial chemotherapy consisted of cisplatin (Days 1-3) and pirarubicin (Days 8-10), and radiation was administered with the chemotherapy (2 Gy/session) with a total dosage of 44 Gy. The median age was 67.0 years. There were 60 patients in T2, 19 patients in T3 and 15 patients in T4. The median follow-up period was 72.9 months in the survivors.
Among these patients, 84 patients (89.4%) obtained a complete response (CR) and 10 patients did not achieve a CR. Between the CR and non-CR patients, the clinical stage and the existence of hydronephrosis were significantly different. The cause-specific survival rates at 5 and 10 years were 76.2% and 67.5%, respectively. The overall survival rates at 5 and 10 years were 66.6% and 47.4%, respectively. A Cox proportional hazard model showed that only the cause-specific survival rate was associated with a CR after treatment. The bladder preservation rates were 89.7% at 5 years and 87.6% at 10 years. Myelosuppression was the major adverse event but it was manageable. Non-hematological sever adverse events were rare.
Bladder preservation therapy shows good survival and good bladder preservation rates. Clinical stage T2 and the absence of hydronephrosis are favorable factors.

DOI： 10.1093/jjco/hyp023

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

We report a case of radiation pneumonitis caused by a migrated seed lodged in the lung after prostate brachytherapy. A 71-year-old man underwent transperineal interstitial permanent prostate brachytherapy for localized prostate cancer. On the day after brachytherapy, a routine postimplant chest X-ray revealed migration of one seed to the lower lobe of the left lung. After 1 month, pulmonary opacities were observed in the left lower lobe but not near the seed. He was diagnosed with bacterial pneumonia, and antibiotic therapy was commenced. Two months after brachytherapy, the patient's symptoms, laboratory data and pulmonary opacities improved; however, an abnormal shadow (consolidation) developed around the migrated seed. Lung consolidation disappeared almost completely 12 months after brachytherapy without any medical treatment. The abnormal shadow probably represented radiation pneumonitis. To the best of our knowledge, this is the first report of radiation pneumonitis caused by a migrated brachytherapy seed in the lung.

DOI： 10.1093/jjco/hyn063

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

Objective: The health-related quality of life (HRQOL) after a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) was prospectively compared at a single institute.
Methods: Between 2003 and 2005, 122 patients were treated by RRP and 82 patients were treated by PPB. A QOL survey was completed at baseline, and 1, 3, 6 and 12 months after treatment, prospectively.
Results: The general HRQOL was not different between the RRP and PPB groups after 3 months. However, at 1 month after treatment, the general HRQOL scores, except for general health, were significantly better in the PPB group than that in the RRP group. Moreover, the disease-specific QOL was worse in urinary and sexual functions in the RRP group. Urinary function in the RRP group had not recovered to baseline after 12 months. Although the urinary function in the PPB group was better than that of the RRP group, urinary bother continued to worsen until 6 months and thereafter it recovered gradually. The bowel function was not worse in the PPB group but bowel bother was worse at 6 months in the PPB group. In the RRP group, the patients with nerve sparing demonstrated better in sexual function than those without nerve sparing, but the recovery did not reach the level of the PPB group.
Conclusions: This prospective study revealed the differences in the QOL after RRP and PPB. These results will be helpful for making treatment decisions.

DOI： 10.1093/jjco/hyn059

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Language：Japanese   Publisher：The Japanese Urological Association  

A 75-year-old man was referred to our department with prostate cancer. When our pathologist reviewed the biopsy specimen, he was diagnosed as intraductal urothelial carcinoma. Transurethral random biopsy showed the urothelial carcinoma in the prostate ducts but no cancer in the bladder. He was diagnosed as primary urothelial carcinoma of the prostate ducts (cTis pd cN0 M0), and radical cystoprostatectomy were performed. Histopathological examination showed urothelial carcinoma in situ spread along ducts and ejaculatory ducts and into seminal vesicles but there was not invasion of prostatic stroma. (pTis pd pN0 M0 Urothelial carcinoma G3 pL0 pV0) He had no adjuvant therapy, he is alive without any evidence of tumor recurrence after surgery.

DOI： 10.5980/jpnjurol1989.99.593

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Other Link： https://jlc.jst.go.jp/DN/JALC/00314232074?from=CiNii

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

Objective: To assess health-related quality of life (QOL) of bladder cancer patients following bladder preservation therapy (BPT).
Methods: Eighty patients with muscle-invasive bladder cancer had been treated between January 1992 and July 2005 at our institutions with BPT consisting of transurethral resection, intra-arterial chemotherapy and radiotherapy. Among them, 48 were alive and free from recurrence at the time of survey and were asked to participate. A total of 168 patients who had been treated for superficial bladder cancer in the same period were used as a control group. Three questionnaires, namely the International Prostate Symptom Score (IPSS), the SF-36, and the Expanded Prostate Cancer Index Composite (EPIC) were used.
Results: Thirty-three patients in the BPT group (68.8%) and 128 patients in the control group (76.2%) answered the QOL survey. There was no significant difference in age, gender and other clinical factors among these two groups. No significant difference was found between the groups according to IPSS. The QOL score of BPT was lower than that of the control group in the SF-36, but there was no significant difference without body pain (P = 0.047). There was a tendency toward a diminished physical functioning (P = 0.053) and role-physical (P = 0.064) in BPT. The EPIC scores for urinary function, especially storage and voiding symptoms, and bowel function were significantly lower in the BPT group. At multivariable analysis, body pain and bowel function were associated with the type of treatment.
Conclusion: Although some of the QOL outcome parameters after BPT were found to be lower than the control group, these differences were not significant. Overall, patients retaining their bladder had an acceptable health related QOL.

DOI： 10.1111/j.1442-2042.2008.02032.x

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.337_4

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.220_1

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.345_1

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.99.274_1

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Between April 2004 and August 2005, we used docetaxel in combination with prednisolone to treat 14 patients with hormone-refractory prostate cancer (HRPC). Docetaxel was administered at a dose of 70 mg/m2 once every 21 days and oral prednisolone 5 mg was administered twice daily concurrently on days 1-21. The treatment was continued until disease progression or unacceptable adverse events occurred. Prostate specific antigen (PSA) was used as a tumor marker. PSA response was defined as a reduction from baseline of at least 50% that was maintained for 4 weeks. Five patients had measurable soft tissue lesions, which were nodal metastases in 4 and liver metastasis in 1. The median follow-up was 8.4 months. During follow-up, 5 patients died. The median treatment cycle was 7 cycles. Manifestations of hematologic toxicity included 11 patients (78%) with grade 3/4 neutropenia and only 1 with febrile neutropenia. Two patients with gastric hemorrhage and febrile neutropenia needed hospitalization. During follow-up, 8 patients (57%) achieved a PSA reduction from baseline of at least 50%. Three patients with nodal metastases and 1 patient with liver metastasis had partial response. Combined docetaxel and prednisolone was shown to be effective and feasible in Japanese patients.

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A total of 42 patients with hormone-refractory prostate cancer received E-E therapy. Oral estramustine phosphate (EMP) was administered twice daily for a total daily dose of 560 mg every day and oral etoposide (E-E therapy, 50 mg/body/day) was given on days 1-21 and stopped on days 22-35. Treatment was continued until the disease progression was confirmed radiographically or PSA had increased from base line of at least 25%. The median follow-up period after E-E therapy was 77.4 months (range: 12.5 to 122.3). Nineteen patients (43%) achieved a PSA decrease of 50% or greater. The median survival time of the patients who had a decrease of 50% or greater in the PSA value (PSA responder) was 29.3 months and the patients who did not (PSA non-responder) was 14.1 months (p = 0.01). There were no significant differences between PSA responders and non-responders when taking into account variables. Excluding those patients with only PSA elevation, the survival time was 14.9 months with no significant difference between PSA responders and non-responders. The toxicities (grade 3 or more) were identified as anemia, leukocytopenia thrombocytopenia, cardiovascular events, and gastrointestinal and hepatic disorders, which occurred in 0, 5, 2, 2, 14, and 2% of the patients, respectively. E-E therapy was considered to be an active oral regimen and well-tolerated for outpatients with hormone-refractory prostate cancer in Japanese patients.

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Language：Japanese   Publisher：The Japanese Society for Dialysis Therapy  

Rhabdomyolysis, which is caused by various factors, may induce acute renal failure or even death, if not treated properly.<br>We encountered four cases of rhabdomyolysis with ARF from September 2001 to March 2004. All patients had been prescribed neuroleptics for long periods. Case 1 developed malignant syndrome. Forced diuresis and hemodialysis (HD) were performed simultaneously. The patient recovered and was discharged 45 days later. Case 2 was suspected of having malignant syndrome. Forced diuresis and HD were performed similarly, but the body temperature rose to over 40°C and the patient died on the fifth day after onset. Case 3 was caused by trauma. The patient was treated by forced diuresis and hemodiafiltration (HDF), and discharged after 45 days. Case 4 was caused by infection and dehydration. Only forced diuresis was applied to the patient, and he was discharged on the 81st day of hospitalization.<br>Based on our experiences with these 4 cases of rhabdomyolysis-induced ARF, forced diuresis should be applied immediately. For those of oliguria, blood purification therapy should be added simultaneously. Some reports recommend, as a blood purification therapy, HDF or plasma adsorption should be applied instead of HD for the purpose of myoglobin elimination. However, there is no solid evidence.

DOI： 10.4009/jsdt.40.67

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.98.362_4

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

(Purpose) We retrospectively evaluated the efficacy and toxicity of modified M-VAC therapy for locally advanced or metastatic urothelial carcinoma. (Patients and method) From 1993 October to 2005 February, 28 patients were treated with modified M-VAC therapy and 25 of 28 patients had lesions suitable for the evaluation. The modified regimen was the combination of methotrexate at a dose of 30 mg/m2 on day 1, vinblastine at a dose of 3 mg/m 2 on day 2, doxorubicin at a dose of 30 mg/m2 on day 2, and cisplatin at a dose of 70 mg/m2 on day 2 with courses repeated every three weeks. (Results) The median number of cycle was 3 (1-7 cycles). Six of 25 patients achieved complete response (CR) and six partial response (PR), resulting in a 48% response rate. With a median follow-up time of 65.6 months, the median survival was 9.3 months and the 1-year and 2-year survival rates were 33.5% and 9.6%, respectively. The median progression-free survival was 6.0 months. Grade 3 and 4 toxicities included neutropenia (84.4%), thrombocytopenia (40%), anemia (56%), febrile neutropenia (20%), nausea, vomiting (8%). (Conclusion) Although response rate of modified M-VAC therapy was similar to classic M-VAC therapy, but modified M-VAC therapy had shorter response duration and more frequent toxicities. We were not able to find the benefits of modified M-VAC therapy.

DOI： 10.5980/jpnjurol1989.98.589

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.98.370_3

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DOI： 10.5980/jpnjurol.98.315_1

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PubMed

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.97.475_3

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.97.293_4

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Language：Japanese   Publisher：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.97.326_3

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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

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Language：Japanese  

CiNii Books

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

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

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

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

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

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

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

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

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Language：Japanese  

CiNii Books

J-GLOBAL

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

局所進行性前立腺癌に対する一次治療としてのロボット支援下前立腺全摘術(RALP)の成績は、限られた報告しかない。そこでわれわれは、extended RALP(拡大摘除+拡大骨盤内リンパ節郭清)を行った局所進行性前立腺癌の症例(ネオアジュバントならびにアジュバント治療を施行していない約100例)を後方視的に、手術成績、周術期合併症、術後PSA再発、予後因子などを検討し報告する。(著者抄録)

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Language：Japanese   Publisher：腎癌研究会  

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Language：Japanese   Publisher：日本小児泌尿器科学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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

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

去勢抵抗性前立腺癌(CRPC)に対する治療は、アンドロゲンを標的とした薬剤と、タキサン系の化学療法の2種類に大きく分けられる。それぞれの薬剤を、いつ、どのように使用していくかは明確な方針が存在するわけではなく、個々の患者ごとに検討して決定していくことが必要である。本稿では、特に抗がん剤の使用決定に必要なディスカッションポイントをピックアップし、抗がん剤の使いどころについて考察を行った。(著者抄録)

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

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

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

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

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

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

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

症例は64歳、男性。肉眼的血尿のため近医を受診し、腎盂腎炎および前立腺肥大症に対して加療されていた。その後、骨盤内腫瘍による両側水腎症および腎機能低下を認め近医に入院された。末梢血白血球数は30000/μl以上と異常高値であり、精査加療目的にて当院に転院となった。前医で施行された経会陰的腫瘍生検の病理結果は低分化癌であり原発巣不明であった。入院後精査にて血中G-CSF高値(270.5pg/mL)、FDG-PET/CTにて脊椎および骨盤内腫瘍に高度のFDG集積を伴っていた。このため、骨盤内腫瘍+膀胱前立腺全摘除術および回腸導管造設術を施行した。摘出組織病理結果はinvasive urothelial carcinomaであった。術後1ヵ月のCTにて骨盤内の腫瘍再発およびリンパ節転移、腹膜播種を認めたためGemcitabineとCisplatin併用のGC療法を施行したところ著明な腫瘍縮小効果がみられた。しかし、その後すぐに病勢進行を認め、本人の希望にて他院でDocetaxelとGemcitabineの併用療法を施行したが効果は認めなかった。さらに、Methotrexate、Vinblastine、Doxorubicin、Cisplatin用のMVAC療法を施行されたが、術後8ヵ月目に敗血症、播種性血管内凝固のため永眠された。(著者抄録)

CiNii Books

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

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

症例は64歳、男性。肉眼的血尿のため近医を受診し、腎盂腎炎および前立腺肥大症に対して加療されていた。その後、骨盤内腫瘍による両側水腎症および腎機能低下を認め近医に入院された。末梢血白血球数は30000/μl以上と異常高値であり、精査加療目的にて当院に転院となった。前医で施行された経会陰的腫瘍生検の病理結果は低分化癌であり原発巣不明であった。入院後精査にて血中G-CSF高値(270.5pg/mL)、FDG-PET/CTにて脊椎および骨盤内腫瘍に高度のFDG集積を伴っていた。このため、骨盤内腫瘍+膀胱前立腺全摘除術および回腸導管造設術を施行した。摘出組織病理結果はinvasive urothelial carcinomaであった。術後1ヵ月のCTにて骨盤内の腫瘍再発およびリンパ節転移、腹膜播種を認めたためGemcitabineとCisplatin併用のGC療法を施行したところ著明な腫瘍縮小効果がみられた。しかし、その後すぐに病勢進行を認め、本人の希望にて他院でDocetaxelとGemcitabineの併用療法を施行したが効果は認めなかった。さらに、Methotrexate、Vinblastine、Doxorubicin、Cisplatin用のMVAC療法を施行されたが、術後8ヵ月目に敗血症、播種性血管内凝固のため永眠された。(著者抄録)

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

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

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

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

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Language：Japanese  

J-GLOBAL

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

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

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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

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

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

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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

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

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

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

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

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：愛媛医学会  

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Language：Japanese  

J-GLOBAL

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

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Language：Japanese  

CiNii Books

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：腎癌研究会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：腎癌研究会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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

腎移植において血管吻合は、腎機能発現を左右する最も重要な手技である。十分な動脈血流を移植腎に供給することはもちろん重要であるが、静脈吻合のトラブルもうっ血や術中出血の原因となり得る。今回、当院の腎移植の際に経験した、血管吻合に関するトラブルを報告する。症例は7症例で、(1)石灰化による内腸骨動脈が屈曲した症例、(2)血管形成後に分枝動脈が伸びきって血流不全をきたした症例、(3)下腹壁動脈を介在し血管形成を行ったが分枝が屈曲した症例、(4)大きな移植腎と動脈石灰化により内腸骨動脈が屈曲した症例、(5)腎静脈の1本を結紮するとout-flow blockをきたした症例、(6)静脈壁が薄く短い症例、(7)Y字形成した大伏在静脈グラフトを使用した症例。何れの症例も修復し得たが、注意深い観察と、吻合デザインの選択が重要と考えられた。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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

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