[in Japanese]

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  Although the photodynamic diagnosis（PDD) of the bladder cancer is superior in sensitivity than conventional cystoscopy, higher fraction of false positivecases remain to be solved. Sixty specimens（cancer : 34, benign : 26) 7taken from PDD using 5-ALA as a photosensitizer were cytogenetically studied by FISH technique using chromosome 7, 9, 17 probe. Out of 26 benign specimens, 11 showed fluorescence, and these specimens had significantly higher variant fraction of chromosome 9 than those from non-fluorescence specimens（28% vs. 15%, p=0.0225). This result suggests false positive specimens harbor genomic alterations of chromosome 9. To delineate the relevant gene for PDD fluorescence, an array-CGH was applied for eight established bladder cancer cell lines. As a result, 9p24.1 was identified as commonly deleted region of chromosome 9, suggesting a loss of GLDC functional may play the expression of fluorescence during PDD.

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  Internally-administered photosensitizer transports into cells, and converts to photoactive fluorescence substance via several precursors, especially in cancer cells the fluorescence substance accumulates in excessive amounts. The excitation of visible light at a specific wavelength, mainly red light （excitation wavelength：600-740nm） for the photoactive fluorescence substance on low power produced reactive oxygen species, and led to cell death in cancer cells. The therapy of cancer by photochemical reactions light irradiation is photodynamic therapy （PDT）.
  5-aminolevulinic acid （5-ALA） has gotten a lot of attention recently as a new generation photosensitizing agent highly-specific to cancer. PDT mediated by 5-ALA was clinically performed as a novel therapeutic strategy for the refractory bladder carcinoma in situ （CIS）, whereas is recently performed on a clinical trial basis under doctor's initiative. This article describes the present state of PDT mediated by 5-ALA.

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[in Japanese]

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  Photodynamic diagnosis（PDD）using 5-aminolevulinic acid（5-ALA）has been described as an innovative technique for the intraoperative detection of malignant tissue, especially for the identification of surgical margin. There have been two reports in which photodynamic detection after oral administration of 5-ALA was assessed for the identification of surgical margins in nephron-sparing surgery. During the operation, the bottom of the resection site and the outer tumor border were inspected for fluorescence under blue light. Residual carcinoma was confirmed in the areas of positive PDD findings. Surgical margin is usually evaluated by means of frozen section analysis（FSA）, which is a time-consuming procedure with a limited reliability and certain probability of false negative results. PDD using orally administered 5-ALA may offer the advantage of real-time assessment of resection status and reduction of operation time. In two reports introduced here, no side effects of systemic 5-ALA administrations were observed.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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  Objective：We analyzed the oncological outcome after laparoscopic radical prostatectomy（LRP）in Kobe University Hospital.
  Methods：We collected data on the patients who underwent LRP between 2000 and 2009. We recorded PSA, Gleason score, 2002 TNM stage, perioperative parameters, postoperative complications, pathological data, recurrence and outcome.
  Results：The overall 3-yr, 5-yr and 7-yr biological progression-free survival（bPFS）was 81.5%, 73.5% and 70.0%, respectively. Surgical margins were positive in 35.9% of the cases. Positive margin rates in pT2a-b, pT2c, pT3a, and pT3b were 11.4%, 32.1%, 65.1% and 61.1%, respectively. Five-year survival rates in pT2, pT3a, and pT3b were 82.3%, 53.3% and 33.2%, respectively.
  Conclusions：Although overall bPFS results were almost identical to previous reports of LRP and retropubic radical prostatectomy, the positive margin rate was slightly high. Improvements are needed to reduce positive margin rates.

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  Laparoscopic radical prostatectomy（LRP）has the advantages of intraoperative bleeding and magnified view comparing to retropubic radical prostatectomy （RRP）. Anatomical understanding due to its magnified view has lead to many modifications and improvements of surgical technique. Recently, continence, potency and cancer control, named trifecta, are thought to be the surgical endpoint of radical prostatectomy. Outcome of LRP has been reported to be comparative to that of RRP in recent reports. However, the factors influenced continence recovery have not been elucidated completely and number of improvements such as intrafascial nerve-sparing and reconstruction of rhabdosphincter, have been reported to achieve early continence recovery. Long-term outcome after LRP has not been evaluated well. In this report, surgical outcome including trifecta after LRP in the literatures was reviewed and compared to that of our institute. From January 2007, 232 patients were performed LRP in Jikei University Hospital. Nerve-sparing surgery was performed in 165 patients. Positive surgical margin rate was 28.9% in all and 15.4% in pT2 cases. Continence was recovered in more than 95% of patients 1 year after surgery. Patients performed nerve-sparing surgery showed significant earlier continence recovery comparing to patients without nerve-sparing. Nerve-sparing surgery also showed significant advantage for sexual function recovery after surgery. From the point of view of trifecta, surgical outcome of LRP seems to be comparative to RRP. Further improvements for the recovery of sexual function are required to achieve higher level of trifecta.

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[in Japanese]

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  The Endoscopic Surgical Skill Qualification system in Urological Laparoscopy started in 2004 with the cooperation of the societies of surgical subspecialties. Over these past 6 years, a total of 906 urologists applied to the system, and 564 were qualified after skill assessments on non-edited videotapes, resulting in a pass rate of 62.3%. The pass rates of the first, second and more than third-time applicants were 62.2%, 64.1% and 55.6%, respectively. The pass-or-fail agreement rate among the 2 referees on each video tape assessment was 65.7%. Although statistical analyses on the results of the video assessments by each referees revealed that several referees deviated significantly from the other referees, the final pass rates of the videos assessed by each referee were statistically similar among the various referees. In the near future, further improvements in the reliability of video assessments by referees and the validation of the usefulness of this system will be required.

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[in Japanese]

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[in Japanese]

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  Objective：To describe our initial experience with retroperitoneoscopic nephrectomy utilizing a GelPort as the main access platform together with a muscle-splitting approach.
  Patients and methods：Between March and August 2009, we performed 8 retroperitoneoscopic nephrectomies utilizing a GelPort. A transverse incision was made along the skin fold, and the flank abdominal muscles were split without cutting. We used standard straight instruments throughout the dissection process.
  Results：The median operative duration and median estimated blood loss were 215 min（range 140-380 min）and 65 ml（range 20-280 ml）, respectively. All cases were completed without conversion or serious complications. Complete convalescence took a mean of 24.8 +/-6.5 days. Postoperative follow-up at 1 month showed good cosmetic appearance of wounds as well as high patient satisfaction.
  Conclusion：Retroperitoneoscopic nephrectomy utilizing a GelPort together with a muscle-splitting approach is technically feasible. The required convalescence period is short, and excellent cosmesis is achievable.

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  We commenced hand-assisted living donor nephrectomy in 2003. In this report, we compared the results of 42 cases of laparoscopic surgery and those of 36 cases of open one to assess the feasibility of the laparoscopic donor nephrectomy. We made comparative study on the operation time, the amount of blood, the duration of hospital stays, and the analgesic use frequency. The operation time for laparoscopic surgery was significantly longer, while the amount of blood and the duration of hospital stays for laparoscopic surgery were significantly shorter. The safety and the less invasiveness of laparoscopic donor nephrectomy are in the process of being established and our study has provided evidences to support this notion.

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  Objective：The sexual function after laparoscopic radical prostatectomy with extra-fascial dissection was evaluated.
  Patients and methods：Electrical stimulation of neurovascular bundle was performed on 28 consecutive patients with localized prostate cancer. The nerve-sparing procedure was divided into 3 groups；a）inter-, or intra-fascial dissection, b）extra-fascial dissection, and c）wide resection. Sexual function was assessed pre- and post-operatively using the Expanded Prostate Cancer Index Composite questionnaire（EPIC Japanese version）.
  Results：Five（56%）of 9 neurovascular bundles performed extra-fascial dissection were preserved electrophysiologically. The postoperative potency rate of patients performed unilateral extra-fascial dissection was 0%, 33%, 33%, and 67% at 6 months, 12 months, 18 months, and 24 months after surgery, respectively. The sexual function score was low pre-, and postoperatively, however, the sexual bother score was relatively high pre-, and postoperatively.
  Conclusions：Extra-fascial dissection had a possibility to restore the erectile function after laparoscopic radical prostatectomy.

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  The objective of this study was to retrospectively compare the impact of body mass index（BMI）on perioperative outcomes between open radical nephrectomy（ORN）and laparoscopic RN（LRN）for patients with renal cell carcinoma（RCC）. This study included a total of 220 consecutive patients with clinically localized RCC, of whom 112 and 108 underwent ORN and LRN, respectively. In this study, these patients were divided into the following two groups according to BMI：non-obese group（n = 120, BMI 25 kg/m² or less）and obese group（n = 100, BMI greater than 25 kg/m²）. In the overall patient group, all parameters related to perioperative outcomes except for operative time favored LRN compared with ORN with significant differences. However, in the non-obese group, there were no significant differences in estimated blood loss and interval until permission to discharge between these two surgical approaches, while in the obese group, there was no significant difference in operative time between the two approaches, although the remaining parameters in LRN were significantly superior to those in ORN. Collectively, these findings suggest that the less invasive nature of LRN appears to be more pronounced in the obese group than in the non-obese group.

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  We retrospectively attempted to identify obesity indexes which affected operative difficulty in 48 transperitoneal laparoscopic donor nephrectomy（TN） and 44 retroperitoneoscopic donor nephrectomy（RN）. We measured fat thickness and fat areas on preoperative computerized tomography （CT） images. These factors were used to categorize the subjects into the obesity and non-obesity groups with each median value. The operative time and estimated blood loss were compared between the two groups. There was no statistically significant difference between any indexes and intraoperative factors in the TN group. The patients in the obesity group categorized by perirenal fat thickness and visceral fat area in RN had significantly greater estimated blood loss than those in the non-obesity group. Furthermore, patiens in the obesity group categorized by perirenal fat area in RN had significantly greater estimated blood loss and longer operating time than those with the non-obesity group. The results indicate that the visceral fat, especially perirenal fat measured using CT scan imaging influences operating time and estimated loss in RN, but not in TN.

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  We assessed our experience performing of laparoscopic nephroureterectomy with regard to cancer control and safety. Between October 2000 and June 2009, a total of 54 laparoscopic nephroureterectomies ［hand-assisted laparoscopic surgery（HALS, 33）or pure laparoscopic surgeries（PLS, 21）］ were performed for renal pelvic and ureteral cancer at our institution. The charts were retrospectively reviewed with emphasis on the assessment of tumor recurrence, incidence of complications, and operating time.
  The median patient age at surgery was 74 years. The median operating time was 230 minutes, and the median estimated blood loss was 201 ml. The 5-year cancer-specific survival rate for laparoscopic nephroureterectomy was 78.9%. There was no significant difference between the HALS group and the PLS group with respect to operating time and estimated blood loss, but the rates of complications tended to be higher in the HALS group. Regarding oncological outcomes, no significant difference was found in the bladder-recurrence rate and cancer-specific survival rate of the HALS group and the PLS group at the 3-year follow-up.
  Laparoscopic nephroureterectomy for renal pelvic and ureteral cancer provided excellent oncological results. In addition, although the rates of complications tended to be higher initially, laparoscopic nephroureterectomy could be performed safely. However, further follow-up is required to evaluate the long-term results in terms of cancer outcome.

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  We herein report our experience in performing laparoscopic aderenalectomy between February 1993 and April 2010 at Kurume University Hospital. We performed 109 laparosopic aderenalectomies. This operation was performed using the taransperitoneal approach in 81 patients, and the retoroperitoneal approch in 28 patients.
  The mean tumor size was 26.8±13.3mm（range 7-70mm）. The mean operative time was 259±98 min（range 98-590 min）. The mean blood loss was 126±238 ml（range 5-1760 ml）. The mean postoperative admission time was 13±8 days（range 3-64 days）.
  Conversion to open surgery was required in 6 cases （4 cases due to blood loss, one case of adhesion, and one case of tumor unknown）.
  The complications occurring during surgery included 4 cases of blood loss, and one each of short hepatic vein injury, spleen injury and pemothrax.
  The postoperative complications included wound hematoma and wound infection.
  Transperitoneal approach was significantly shroter than retroperitoneal approach in operative time and postoperative hospitalization.

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  [Purpose] To evaluate the perioperative and postoperative results of the initial 31 cases of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in our hospital.
  [Methods] We retrospectively evaluated data on 31 patients who underwent laparoscopic pyeloplasty in our hospital between January 2005 and July 2010.
We investigated patients' background, perioperative, intraoperative and postoperative parameters including the surgical procedure, surgical duration, volume of blood loss, and outcome.
  [Results] We performed transperitoneal laparoscopic dismembered pyeloplasty as the standard method in all but 7 cases. The mean surgical duration was 218.8 minutes (range 127-308 min), and the mean blood loss volume was 7.3 ml. There were no complications. Postoperatively, subjective symptoms such as flank pain and pyelonephritis had disappeared in all cases, hydronephrosis had disappeared in 96.4%, and the hydronephrosis pattern of the renogram was improved in 55.6%.
  [Conclusion] We performed transperitoneal laparoscopic dismembered pyeloplasty as the standard method for ureteropelvic junction obstruction, and subjective symptoms disappeared postoperatively in all patients.

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  Purpose : To analyze clinical outcomes of transurethral lithotripsy（TUL）in patients with renal and ureteral calculi.
  Patients and Method : Between Jan. 2002 and Dec. 2009, we treated a total of 256 patients（13 renal stones（mean stone size : 8.2mm）, 104 proximal ureteral stones （8.3mm）, 53 middle ureteral stones（9.4mm）and 86 distal ureteral stones（7.6mm））using the pulsed dye laser. One hundred and fifty three patients（59%）had preoperative extracorporeal shock wave lithotripsy（ESWL, mean 2.6 sessions）.
  Results : Median operation time was 53 minutes. Proximal ureteral stone, larger size in diameter, hydronephrosis and non-expert operator were revealed as significant factors for elongation of operating time. Semirigid and flexible ureteroscope were used for 256 and 72 cases, respectively. Postoperative ureteral stents were placed in 189 cases. We experienced no severe ureteral perforation or avulsion. Only 17 patients had fevers over 38℃ postoperatively. Patients stone-free for 3 months were observed in 224 cases（89%）overall ; 11（85%）in renal, 83（81%）in proximal ureter, 48（92%）in middle ureter and 82（96%）in distal ureter. Multiple logistic regression analysis revealed that stone location（middle and distal ureter）and size（small）were independent（better）prognostic factors determining stone clearance after TUL. These success rates exceeded those of a single ESWL session which had been reported previously.
  Conclusion : Although TUL needs various innovative instruments, i.e. ureteroscopy or intracorporeal lithotriptor, it is relatively safe and showed higher success rate than that of ESWL in managing upper urinary tract stones.

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  We evaluated clinical outcomes in patients with intermediate- or high-risk prostate cancer treated using ¹²⁵I brachytherapy. From 2003 to 2009, patients with 76 intermediate-risk and 33 high-risk prostate cancers as defined by the D’Amico risk classification were treated using ¹²⁵I permanent prostate brachytherapy. Mean duration of follow-up was 37.2 months（range, 24-60 months）. Neoadjuvant hormone therapy（NHT）was administered to 72 patients, including 58 patients treated with complete androgen blockade for 6 months. Biochemical relapse rates in patients with intermediate and high risk using Phoenix definitions were 6.6% and 9.1%, respectively. NHT had no significant impact on biochemical relapse rates in patients with intermediate- and high-risk prostate cancer. A significant difference in the dose delivered to 90% of the prostate gland（D90）was seen from dose-volume histograms between the PSA failure group and the non-PSA failure group（135.1 Gy vs 158.3 Gy, p=0.036）. Radiation dose is an important factor associated with biochemical failure.

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  Objective：To compare clinical results of holumium laser enucleation of the prostate（HoLEP）using the 78W and the 100W energy outputs.
  Methods：From March to July 2010, 34 patients were treated by HoLEP using the 78W setting and 21 cases of HoLEP were performed by the 100W output.
  Results：There were no significant differences in enucleated tissue weight or total energy used in two groups, but the average enucleation time in the 100W group was significantly shorter.（44.8 v 50.7g, 130.5 v 127.6kJ, 49.7 v 41.8 min,P＜0.05）For enucleation efficiency, there was significant increase in the gm per minute and the kJ per minute in the 100W group. There was no significant difference in the kJ per gm.（0.89 v 1.14g/min, 2.62 v 3.08kJ/min, 3.68 v 3.07kJ/g）
  Conclusions：Faster enucleation time was achieved with the 100W as larger power output resulted in increase of gm per minute.

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  The present study was conducted to examine the intermediate and long term effects of holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia. 213 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent holmium laser enucleation of the prostate at our hospital. A total of 63, 44 and 29 patients were followed up for 36, 48 and 60 months, respectively. We evaluated the perioperative parameters, functional outcome（prostate volume, International Prostate Symptom Score, Quality of life score, maximum flow rate, average flowrate and post-void residual）, and adverse events up to 36, 48 and 60 months post-operatively. The mean age of the patients was 71.6 years. The mean prostate volume was 65.1 ml. The mean weight of the enucleated tissue was 36.8 grams. The mean catheterization time was 2.4 days. All parameters improved significantly at each time point. The effect of holmium laser enucleation of the prostate therefore successfully continued for the intermediate and long term periods（36, 48 and 60 months）.

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  The rate of urethral stricture post HoLEP is relatively high and could be problematic. We have modified the operative methods of HoLEP to reduce the occurrence of urethral stricture. We evaluated technical feasibility and perioperative outcomes of this procedure. Methods：We retrospectively reviewed post HoLEP urethral stricture rate from 188 consecutive patients treated by HoLEP which were performed by a single Urologist from January 2008 to December 2009. A group：83 patients treated in 2008 underwent HoLEP according to three-lobe technique . B group：From 2009, 188 patients received modified HoLEP treatment which was designated to minimize the injury of urethra through operation. Results：Post procedural urethral stricture was observed at 7 patients（8.4%）from A group and 2 patients（1.9%）in group B. The rate of urethral stricture post HoLEP is significantly different between these groups. Conclution：By modification of operation techniques of HoLEP, we achieved lowering the rate of post urethral stricture.

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  We investigated the occurrence of renal subcapsular hematoma and perirenal hematoma in 123 patients with kidney stones undergoing ESWL from January 2005 to May 2009 at our hospital. We examined risk factors for hematoma by comparing 28 patients with renal subcapsular hematoma or perirenal hematoma and 95 patients without hematoma. Perirenal hematoma occurred in 4 patients, among whom 3 had hypertension and were on antihypertensives. A BMI ≧25 kg/m² was significantly more common in the hematoma group than the group without hematoma. Also, a study of 180 ESWL patients revealed significant elevation of blood pressure during the procedure in the hematoma group. Risk factors for hematoma were a BMI ≧25 kg/m² and elevation of systolic blood pressure by ≧30 mmHg during ESWL. When conducting ESWL, attention should be paid to changes of blood pressure, as well as the patient‘s history, medications, and degree of obesity.

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  We performed a laparoscopic enucleation for a retroperitoneal Schwannoma, which was found incidentally. Intraoperatively, it was easy to peel the tumor from the fascicle of the nerve fibers. The postoperative course was good without neurological symptoms. This is the first report of the enucleation of the Schwannoma by laparoscopic surgery in Japan. If nerve damage is of concern during complete removal, then laparoscopic enucleation is useful for benign retroperitoneal Schwannomas.

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