[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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  Objectives : To analyze initial treatment results for robot-assisted laparoscopic radical prostatectomy (RALP).
  Subjects : Patients (120) who underwent RALP from September 2011 to December 2012.
  Results : Mean hemorrhage volume was 85 ml. Two patients received only transfusion of autologous blood. There was no switch to laparotomy during surgery. Mean duration of surgery and mean console time was 273 and 204 minutes, respectively. The operator learning curve was good, with surgery becoming more stable after handling approximately 20 cases. The positive margin rate of pT2 before non-ligation of the dorsal vein complex was 40.9%, but was 8.7% after RALP introduction. According to the clinical pathway, 95.2% of patients were successfully discharged. Three- and 6-month postoperative urine prohibition rates were also good (82.1%, 100%, respectively).
  Conclusion : Even without experience of laparoscopic radical prostatectomy, the switch to RALP was successfully conducted. No complications were recorded, and this treatment is considered more beneficial to patients.

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  We retrospectively analyzed the clinical results for 121 patients with renal tumor who underwent laparoscopic nephrectomy at the University of Fukui between January 2002 and December 2012. Patients were retrospectively divided chronologically into 4 eras, as follows : era 1 : initial 16 cases ; era 2 : 33 cases, hand-assisted nephrectomy was mainly performed ; era 3 : 18 patients, procedure was performed by one of 2 fixed surgeons ; and era 4 : 54 patients, procedure was performed by surgeons under the direction of surgeons certified by the Endoscopic Surgical Skill Qualification System in urological laparoscopy. For these eras, the mean tumor sizes were 5.0, 4.3, 3.2, 3.7 cm, the median operating times were 224, 216, 186, and 202 min, the estimated blood losses were 140, 100, 28 and 20 ml, and the conversions to an open procedure were 12.5%, 0%, 5.5%, 7.4%, respectively. In the 103 renal cancer patients without metastasis, the 5-year recurrence-free survival rate and cause-specific survival rate were 89.4% and 96.7%, respectively.

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  The aim of this study was to report cases of postoperative hemorrhage following laparoscopic adrenalectomy (LA) for patients with primary aldosteronism (PA) at single institute. From 2006 to 2013, consecutive 218 patients with PA undergoing LA were analyzed. We had 123 male and 95 female with 183 unilateral (85 right, 98 left) and 35 bilateral cases. Postoperative hemorrhage was defined as more than 3 g/dl decrease of serum hemoglobin level and hemorrhage detected by CT postoperatively. Postoperative hemorrhage occurred after LA in 4 cases (1.8%) of which 1 was performed embolization, 1 was performed laparoscopic surgical management and 2 were conservatively observed. Of the total of 4 cases defined as postoperative hemorrhage, 3 cases required blood cell transfusion. CT was useful to detect postoperative hemorrhage. Early re-operative intervention is recommended depending on hemorrhage severity and patient status to decrease morbidity.

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  Although primary aldosteronism (PA) is the most common curable cause of secondary hypertension, many patients continue to require antihypertensive drugs to control their blood pressure (BP) even postoperatively. The aim of this study was to identify the predictors for complete resolution of hypertension postoperatively. Records of 102 PA patients who underwent unilateral laparoscopic adrenalectomy were reviewed. BP was confirmed to normalize in 43.1% of the patients. Multivariate analysis showed that the patients who had postoperative complete resolution of hypertension were significantly more likely to have a higher ratio of a mineralocorticoid receptor antagonist (MRA) to all preoperative antihypertensive drugs (odds ratio [OR], 10.6 ; p<0.01), a shorter duration of hypertension (OR, 5.0 ; p<0.01), and be female (OR, 4.0 ; p<0.01). Although the number of antihypertensive drug classes was reported to become one of predictors for complete resolution of hypertension, the ratio of MRA to all antihypertensive drugs could become a novel robust predictor.

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  We reviewed the results of laparoscopic nephrectomy for children with a hypoplastic or poorly functioning kidney in our department. Laparoscopic nephrectomy was performed in 10 patients including 1 boy and 9 girls. The patients’ median age was 5.5 years old. There were 8 patients with a hypoplastic kidney and an ectopic ureter, and 2 patients with a poorly functioning kidney and a megaureter or vesicoureteral reflux. Laparoscopic nephrectomy was conducted transperitoneally in 5 and retroperitoneally in 5 patients. The median operative time was 167 minutes. There was no intraoperative complication. Postoperatively, subcutaneous emphysema and fever developed in one patient each. 7 patients used an analgesic suppository once or several times, and 3 patients received no analgesics. Oral intake was started at a median of 1 day postoperatively. The median hospital stay after surgery was 4.5 days. Laparoscopic nephrectomy for a hypoplastic and poorly functioning kidney in children is a minimally invasive surgery.

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  Objective : The surgical procedures, outcomes, and problems of laparoscopic orchiopexy for abdominal testes were investigated.
  Subjects : The subjects were 65 patients (70 testes (T)).
  Methods : Points of this surgery are : 1) possibility of preservation of the testis, 2) the distances of the testicular artery and vein, 3) entrance of the deferent tube into the inguinal canal on the affected side, 4) and the distance of the deferent tube. Surgery was proceeded while judging these.
  Results : The postoperative testicular growth-preserving rate was 97% (37/38T) in cases treated with LO (laparoscopic orchiopexy), 71% (5/7T) in cases treated with Ⅰ sFSLO (one-staged Fowler Stephens laparoscopic orchiopexy), and 84% (16/19T) in cases treated with Ⅱ sFSLO (two-staged Fowler Stephens laparoscopic orchiopexy).
  Discussion : Blood flow to the testis could be preserved by judging the distances of the testicular artery and vein, which is an index of the necessity of the F-S method, by minimum dissection in 21 of 26T (81%). For the surgical procedure to preserve the testis by the testicular position, LO may be appropriate for a testis present in the internal inguinal ring, andⅠsFSLO or Ⅱ sFSLO may be inevitably selected for those present in the middle and renal regions.

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  We herein report the preliminary results of regimen with 45.5 Gy/7 fractions using high-dose rate (HDR) brachytherapy as monotherapy for localized prostate cancer. Between Jan. 2005 and Dec. 2011, 73 patients were treated with HDR in 45.5 Gy/7 fractions. Five patients developed PSA recurrence, and 3-year and 5-year PSA recurrence-free survival rate was 95% and 96% respectively. Two patients developed clinical recurrence, and 3-year and 5-year clinical recurrence-free survival rate was 98% and 96% respectively. Grade 2 acute and late toxicities occurred in 7 (9.6%) and 9 (12.3%) patients. From these results, HDR brachytherapy with 45.5 Gy/7 fractions might be effective and safe treatment for localized prostate cancer.

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  Objective : To report the 13-year results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer.
  Methods : A total of 872 men treated with Sonablate^® devices (Focus Surgery, Indianapolis, IN, USA) between January 1999 and October 2010 were included in this study. Biochemical failure was defined according to the Phoenix definition (prostate-specific antigen nadir : +2ng/ml).
  Results : The mean follow-up period for all patients was 50±32 months. The biochemical disease-free rates (BDFR) in patients in the low-, intermediate-, and highrisk groups at 5 and 10 years were 78, 62, and 47% and 70, 58, and 41%, respectively. The BDFR in patients treated with the latest device, SB 500 TCM, in the low-, intermediate-, and high-risk groups at 5 years were 95, 77, and 60%, respectively. The main complication was urethral stricture (18.3%).
  Conclusion : HIFU therapy is suggested to be minimally invasive and safe for patients with localized prostate cancer.

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  A transurethral bladder tumor en-bloc resection (transurethral resection of a bladder tumor in one piece : TURBO) is characterized by the removed of a bladder tumor as a single piece, without carrying out fragmentation of the tumor. A more exact pathological diagnosis is possible using TURBO. I herein report the usefulness of this treatment with regard to the oncological results and pathological diagnosis.
  An analysis of 135 cases of bladder tumors and 173 lesions treated with TURBO was carried out. The resection was carried out in the order of 1. marking, 2. mucous membrane incision, 3. horizontal excision and 4. tumor removal. The resection of the tumor was possible inside any part of the bladder, and the complication rate was within the allowable range. The majority of cases (123 ; 91.1%) contained a muscle layer in the excision sample.
  Lamina muscularis mucosae were observed in 22 of 23 pT1 examples (95.7%). Although the T1 case which did not exceed the lamina muscularis mucosae did not advance, four of seven cases had stage progression, which included invasion exceeding the lamina muscularis mucosae, and upper urinary tract recurrence was seen in one patient. The diagnosis of the depth of invasion by TURBO was accurate, and the existence of muscularis mucosae invasion was suggested to correlate with the prognosis.

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  Objective : To investigate measures to decrease postoperative infection, sometimes encountered and problematic after transurethral lithotripsy in flexible ureterorenoscopy (f-TUL).
  Method : Between June 2006 and August 2011, 19 patients were investigated for risk factors possibly associated with postoperative infection. The presence of foreign bodies in the urinary tract and a history of infection involving the urinary stone in question for f-TUL were significantly frequent in such patients. We took measures according to the urinary tract infection guidelines by the IDSA and the EAU, and investigated 104 patients who underwent f-TUL between September 2011 and June 2012.
  Result : The rate of postoperative infection was significantly lower after countermeasures compared to before countermeasures, 5.6% versus 19.8% respectively.
  Conclusion : It is possible to markedly decrease the risk of postoperative infection by following the infection guidelines.

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  From April 2011 to October 2012, transurethral ureterolithotripsy with Holmium : YAG laser was performed on 104 patients at our institute. Systemic inflammatory response syndrome due to postoperative acute pyelonephritis following transurethral ureterolithotripsy occurred in 6 cases (5.8%), and 1 of these 6 patients developed septic shock and subsequently underwent nephrectomy. The overall stone-free rate was 72.1%. This study showed that shape of stones is risk factor for systemic inflammatory response syndrome due to postoperative acute pyelonephritis. Close consideration of each case preoperatively and accurate surgical techniques are crucial for a safe operation and the prevention of the postoperative complications.

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  We evaluated whether single-session, flexible ureteroscopy and Holmium laser lithotripsy (f-URSL) can be effective and safe for large renal stones (> 2 cm). Thirty five patients who underwent f-URSL for renal stones (> 2 cm) from September 2010 to May 2012 were enrolled, and their stone clearance and complications were retrospectively evaluated. The mean operative time was 97.8 minutes. The mean stone burden was 32.7 mm. The stone-free rates at one day, one month and three months postoperatively were 13.5%, 62.1% and 70.3%, respectively. The stone clearance increased with time (P<0.001). The stone-free rate for stones > 30 mm and < 30 mm were 52.6% and 88.8%, respectively (P=0.0129). The complication rate was 14.2%. f-URSL can successfully treat patients with stones > 2 cm with a high stone-free rate and a low complication rate.

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  Objective : The aim of this study was to evaluate the efficacy and safety, comorbidity, and incidental carcinoma occurrence associated with Holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) patients.
  Methods : All 363 patients were assessed based on the International Prostate Symptom Score (IPSS), Quality of Life index (QOL index), peak flow rate (Qmax), voided volume, and residual volume. These parameters were measured preoperatively and 1 week, 3 months and 1 year postoperatively. Perioperative comorbidity and enucleated specimens were examined.
  Results : All procedures were successfully performed without major complications. The median operation time and enucleation weight were 105 minutes and 41 grams, respectively. IPSS, QOL index, Qmax, voided volume, and residual volume significantly improved postoperatively. Twenty-four (6.6%) patients were diagnosed with incidental carcinoma. Thereafter, 5 (1.3%) patients were newly diagnosed with de novo prostate cancer.
  Conclusion : Our results demonstrate that HoLEP is a safe and effective procedure for BPH patients.

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  Between January 2005 and July 2012, 362 holmium laser enucleation of the prostate (HoLEP) operations were performed for benign prostate hyperplasia (BPH) patients in our hospital. Based on the estimated preoperative prostate volume, they were divided in to two groups : ≧ 80ml (group Ⅰ, 88 cases) and ＜ 80ml (group Ⅱ, 274 cases). We compared the postoperative voiding function, surgical perioperative parameters, and postoperative complications between the two groups. The postoperative voiding function equally improved in both groups. However, the operation time in group Ⅰ was longer than that of group Ⅱ, and removal efficacy (g/min) was better in group Ⅰ. Concerning the postoperative complications, there was no differences in the continence rate, but postoperative urinary retention was less frequent in group Ⅰ. It is concluded that HoLEP is a safe, less invasive, and effective operation for patients with BPH ≧ 80ml.

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  A 79-year-old man having non-muscle-invasive bladder cancer received a second transurethral resection of bladder tumor (TURBT). An intravesical explosion occurred during the surgery. Although resection was performed at the anterior wall of the bladder, the posterior wall of the bladder was injured. Fat tissue from the bladder was observed. No obvious leakage to the peritoneum was seen in postoperative cystography. An intravesical catheter was indwelled for 14 days and his condition finally improved without additional surgery. Although bladder explosion is a rare complication, it may lead to a serious condition. Oxygen alone from the atmosphere is not detonatable. However, when mixed with hydrogen, it may become oxyhydrogen, a highly explosive gas, and detonation may occur during TURBT. All urologists should be aware of this complication and air bubbles must be removed during resection of tumors in the bladder dome or anterior wall.

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