(Background) The purpose of this study was to investigate the current status of urologists regarding the prevention of perioperative infections in preparation for the revision of the Guidelines for the Prevention of Perioperative Infections in Urological Field (2015).

(Methods) From January 26 to March 30, 2022, we administered questionnaires to members of the Japanese Urological Association on their adherence to the guidelines and administration methods of antimicrobial prophylaxis for perioperative infections. There were 362 respondents.

(Results) The respondents reported adhering to the guidelines completely (15.5%), to some extent (55.5%), poorly (24.3%), and not at all (4.7%). Adherence rates also varied for surgical procedures, ranging from 73.8% in transurethral resection of bladder tumor to 32.9% in laparoscopic (robot-assisted) contaminated surgery. Excluding contaminated surgery and transurethral resection of prostate, where long-term administration is relatively acceptable, open clean-contaminated surgery had the highest rate of long-term administration (≥72 h) (27.2%) and transurethral resection of bladder tumor had the lowest rate (7.3%). Adherence rates for clean surgery and transurethral ureteral lithotripsy shortened to a single dose of antimicrobial agents were low.

(Conclusion) The selected antimicrobial agents were generally in compliance with the guidelines. With the exception of contaminated surgery, they were administered long-term in clean-contaminated surgery where the urinary tract and genitalia were exposed. Surgical procedures in which a single prophylactic dose of antimicrobial agents was administered had a low compliance rate. After the revision of the guidelines, it is considered important to update the clinical paths at each facility.

(Objective) To evaluate prognostic factors of metastatic urothelial carcinoma treated with immunotherapy.

(Materials and methods) Fifty patients treated with pembrolizumab at Osaka Rosai hospital during 2017-2022 were examined. The treatment efficacy was evaluated using Response Evaluation Criteria in Solid Tumors, Version 1.1.

(Results) Radical surgery was performed in 40 of 50 patients. According to the Bellmunt risk classification, which considers the performance status, presence of anemia, presence of liver metastasis, and interval from previous chemotherapy, 10 cases had risk 0; 23, risk 1; 13, risk 2; and 4, risk 3. The objective response rate (complete and partial remission) during immunotherapy was achieved in 15 cases. The median times of overall survival (OS) from first-line treatment initiation and immunotherapy initiation were 18.7 and 10.9 months, respectively. Multivariate analysis revealed lower platelet counts (<200,000/μL), increased C-reactive protein levels (≥0.75 mg/dL), and NLR (elevated neutrophil-lymphocyte rate) (≥6) to be poor prognostic factors for OS. Considering these three factors, the median OS of the low-risk (0 or 1) and high-risk (2 or 3) groups was significantly different, at 13.8 and 3.5 months, respectively (p<0.001).

(Conclusion) Early switching from immunotherapy to the next treatment should be considered for high-risk patients.

(Purpose) To translate the Female Decreased Sexual Desire Screener (DSDS) into Japanese and perform linguistic validation of the translated DSDS.

(Methods) Translation was conducted in the following order: 1) obtaining permission from the original author to create a Japanese version; 2) forward translation; 3) community review; 4) back-translation; and 5) review and approval of the back-translation by the original author. First, permission to create the Japanese version was obtained from the original author by e-mail. The initial translation was done by two urologists, and an additional four urologists then refined and completed the Japanese translation. Linguistic validation was performed as follows. For the community review, semi-structured interviews were conducted with a total of 11 participants (6 sexually active women and 5 non-sexually active women), and some wording changes were made based on the input from the participants. A total of 10 different participants were asked to respond to the questionnaire again, and additional modifications were made. The forward translation with modifications was then back-translated and e-mailed to the original author.

(Results) In accordance with the original author's comments on the back-translation, further modifications were made to the Japanese version, which was then back-translated again and confirmed and approved by the original author.

(Conclusion) After a multi-step review process, the Japanese version of the DSDS was completed with linguistic validation.

(Objective) It is well known that sperm DNA fragmentation (SDF) affects not only natural conception but also in vitro fertilization (IVF) outcomes, and the importance of sperm quality has received renewed attention. In this study, we investigated the effects of coenzyme Q10 (CoQ10), which is thought to have potent antioxidant properties, on SDF and IVF outcomes.

(Materials and methods) Patients whose SDF was measured at our clinic and diagnosed as high (>16%) were given a supplement containing CoQ10 as the main ingredient (MySeed^®) for 3 months, and then SDF, general semen analysis, and semen oxidation-reduction potential (sORP) were reanalyzed. In addition, in cases where IVF including intracytoplasmic sperm injection (ICSI) was performed before and after supplementation, laboratory results including fertilization rate, blastocyst development rate before and after supplementation were analyzed.

(Results) Of the 46 patients who consented to participate in this study, 35 patients who completed to the second semen analysis were included. SDF improved significantly from 31.6% to 25.3% (p<.05) before and after supplementation. Sperm concentration, motility rate, sperm motility index (SMV) and sORP showed no statistically significant difference. When restricted to cases with high sORP (≥1.38), the differences were more pronounced as follows. SDF decreased significantly from 34.0% to 26.1% (p<.05). Similarly, there was a significant improvement in sperm concentration and SMV from 12.5 million/ml to 24.3 million/ml (p<.05) and from 73.6 to 114.4 (p<.05) respectively. When IVF outcomes were compared before and after supplementation, the blastocyst rate (42.4% vs. 51.2%) and good blastocyst rate (45.5% vs. 54.5%) showed a trend towards improvement, but no significant differences were observed due to the small sample size.

(Conclusion) Myseed^® Supplementation significantly reduced SDF, which was more pronounced in patients with higher sORP levels, suggesting that SDF and sORP may serve as clinical indicators for antioxidant use.

The patient was a 79-year-old male who underwent external-beam radiation therapy combined with hormone therapy for prostate cancer. A hydrogel SpaceOAR was implanted to prevent adverse rectal events before stereotactic radiotherapy using Cyberknife. After completion of external irradiation, the patient developed a fever and was diagnosed with a prostatic abscess based on clinical and computed tomography findings. Magnetic resonance imaging showed the prostatic abscess consistent with SpaceOAR insertion site. Despite treatment with antibiotic agents, the patient's inflammatory response did not improve. Transurethral resection of the prostatic abscess and vesicostomy were performed for drainage, following which the postoperative inflammatory response improved rapidly. In this case, the SpaceOAR may have partially penetrated into the prostatic capsule when it was implanted, and a urinary tract infection may have occurred due to urinary retention or placement of a urethral catheter, resulting in the formation of an abscess.

A 75-year-old man was hospitalized for acute pyelonephritis. Seven months earlier, he had undergone radical cystoprostatectomy and ileal conduit urinary diversion. On the second day of hospitalization, he experienced a stroke in the right cerebral hemisphere. No significant residual effects were identified. On the fifth day of hospitalization, he suffered cardiopulmonary arrest. Fortunately, he was quickly rescued by cardiopulmonary resuscitation. Blood analysis revealed severe hyperchloremic metabolic acidosis and a marked decrease in urinary chloride levels. Hyperchloremic metabolic acidosis and his physical condition quickly improved with continuous hemodiafiltration and antimicrobial treatment. The patient was discharged after stroke rehabilitation. He experienced pyelonephritis twice more, but no cancer recurrence was reported.

Osteomyelitis pubis is rare among the various complications following radical prostate cancer surgery. A 70-year-old man with type 2 diabetes mellitus was diagnosed with prostate cancer (cT2aN0M0) based on a transrectal prostate biopsy performed after an elevated PSA revealed at an examination. Subsequently, we performed a retroperitoneoscopic radical prostatectomy to resect the localized prostate cancer. No intra- or postoperative complications were observed, and the patient was discharged 10 days postoperatively. The patient visited the outpatient clinic 76 days postoperatively presenting with lower abdominal pain and difficulty walking. He had played tennis two days earlier, and thus, was presenting the symptoms. A pelvic MRI revealed inflammation in the bilateral pubic bone marrow centered on the pubic symphysis after which a diagnosis of osteomyelitis pubis was made. A urine culture revealed Pseudomonas aeruginosa and the patient was started on levofloxacin hydrate medication. Although his symptoms were ameliorated, the treatment was discontinued because of taste disturbance followed by repeated flare-ups. Consequently, the patient was switched to inpatient antibiotic treatment and was administered intravenous tazobactam piperacillin hydrate for 2 weeks, which improved his symptoms. He was discharged from the hospital after an additional 2-week course of the antibiotic treatment. One and a half years after discharge, there was no evidence of recurrent osteomyelitis pubis, urinary incontinence, and recurrent prostate cancer.

A 30-year-old man underwent a right high orchiectomy for a testicular tumor. A computed tomography (CT) scan revealed para-aortic and mediastinal lymph node and lung metastases, consequently he was diagnosed with pTxN3M1aS2 stage III B, mixed germ cell tumor (teratoma, fibrosis). The bleomycin, etoposide, and cisplatin protocol was initiated after the placement of an inferior vena cava filter for common iliac venous thrombus. Human chorionic gonadotropin (HCG) positivity was observed at the end of the fourth course despite the immediate decrease in tumor markers after the treatment's initiation. The HCG levels remained low and positive after three vinblastine sulfate, ifosfamide, and cisplatin protocol and two paclitaxel, ifosfamide, and cisplatin protocol courses. A subsequent CT scan revealed a developing lymph node metastasis; hence, retroperitoneal and mediastinal lymph node dissections were performed biphasically.

Residual tumor resection is indicated for patients with non-seminoma having localized retroperitoneal lesions or resectable lesions and high alpha-fetoprotein. However, the lymph node dissection, performed here, stabilized the patient's condition in a non-HCG-negative and HCG stain-negative state, suggesting that elevated HCG may be attributed to abnormal feedback from chemotherapy.