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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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  Objective：The purpose of this study was to evaluate the effects of laparoscopic partial nephrectomy with selective renal parenchymal clamping using Kidney clamp^®.
  Materials and Methods：Between October 2011 and October 2014, 42 patients who underwent laparoscopic partial nephrectomy were examined. We compared the clinical outcomes between those undergoing selective renal parenchymal clamping and renal hilar clamping.
  Results：The surgical duration and intraoperative blood loss were similar in the two groups. The ischemic time was significantly shorter using Kidney clamp^®. There was no serious complication in the groups. The postoperative eGFR tended to be better in the parenchymal clamping group.
  Conclusion：This device can be used in selected patients with peripheral tumours, but selective renal parenchymal clamping using Kidney clamp^® is feasible and safe during laparoscopic partial nephrectomy to create a bloodless operative field.
  The possibility that was superior to the renal hilar clamping was suggested in the terms of preserving the renal function.

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  We performed 100 Hand-assisted laparoscopic kidney harvest from living donor between 2003 and 2013. Average donor age was 57 years old. Right kidney was harvested in 21 cases, left kidney in 79. The procedures were performed transperitoneally in 97 cases, and extra-peritonneally in 3. In 4 cases, the procedure was converted to open surgery. Average time of pneumoperitoneum was 242±66 minutes. No case required blood transfusion. Average warm ischemia time（WIT）was 5±2 minutes and there was no delayed graft function related to kidney harvesting. According to Clavien grading, 12 grade 1 and 8 grade 2 complications were documented. Estimated glomerular filtration declined to 60.9% of preoperative level but recovered to 64.7% at 1 year. In conclusion, this procedure can attain stable graft function, without compromising donor safety.

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  Cosmetic results are superior with laparoendoscopic single-site pyeloplasty（LESS-P）than open pyeloplasty（OP）or laparoscopic pyeloplasty（LP）for ureteropelvic junction obstruction（UPJO）. We compared these 3 different procedures of OP, LP, and LESS-P with regard to the success rates and surgical morbidities. Three procedures were conducted by different surgeons：OP was performed by a pediatric urologist（KJ）；LP was performed by a certified urological laparoscopic surgeon（NM）；and LESS-P was performed by a pediatric urologist with certified urological laparoscopic skills（AK）. There were no significant differences among the 3 procedures regarding the success rate, operative time, reoperation rate, rate of complications above Clavien-Dindo G III, analgesia use, or postoperative hospital stay. Although special surgical skills are needed, LESS-P is considered to be an ideal procedure for UPJO because it is associated with more favorable cosmetic results.

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  In urology, appropriate and simulated port placement is crucial for efficient laparoscopic surgery. Insufficient considerations when positioning the camera port result in the inappropriate management of individual anatomical conditions. Even when it is positioned based on a comprehensive examination of images obtained from preoperative CT and MRI, practitioners occasionally experience a sense of difficulty or dilemma due to a slight positional change after initiating the procedure. For the appropriate management of individual patients, sufficient experience is indispensable, as it is difficult for inexperienced surgeons to position the port intuitively；therefore, simulation and imaging for approaching targets are key. Furthermore, each port should be placed while avoiding damage to subcutaneous veins and intramuscular blood vessels. The image analysis application OsiriX allows users to avoid blood vessels when placing ports and intuitively approach targets by overlaying anatomical data, the vascular system, positional relationships among organs, and tumors on the body surface and applying such information to the internal organs. This paper reports our experience of performing “mixed reality surgery” for actual patients, adopting the project mapping technique to reflect patient data as realistic images, with discussions on its educational and clinical usefulness and challenges.

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  Purpose：In our hospital, neoadjuvant hormonal therapy（NHT）has been performed before surgery to achieve down-staging of high-risk patients and reduce the prostatic volume. In this study, we clinically reviewed patients who underwent laparoscopic radical prostatectomy after NHT.
  Materials and Methods：The subjects were 30 patients who underwent this procedure between June 2012 and May 2014, with a mean age of 65.3 years in the NHT group and 68.3 years in the non-NHT group. The mean iPSA level was 10.8 and 10.7 ng/mL, respectively. The mean preoperative prostatic volume was 24.3 and 30.6 mL, respectively. The mean NHT period was 8.27 months. The clinical stage was evaluated as cT1c in 14 patients, cT2 in 8, and cT3 in 8. GS was 6 or lower in 9 patients, 7 in 12, and 8 or higher in 9. For surgery, retroperitoneal/ anterograde approaches were used in all patients. After the posterior wall was reinforced, vesicourethral anastomosis was performed using Biosyn™（continuous suture）and Lapra-Ty™.
  Results：The mean duration of surgery was 208.2 and 201.8 minutes in NHT and non-NHT groups, respectively. The mean volume of blood loss was 573.5 and 600.4 mL, respectively. The mean catheterization period was 5.3 and 5.9 days, respectively. Histological treatment responses were assessed in the NHT group. The grade was evaluated as 0b in 3 patients, 1 in 3, 2 in 4, and 3b in 11. Two patients（6.7%）had a positive resection margin（RM）.
  Conclusion：In high-risk patients, the proportion of those with favorable histological responses to NHT was relatively high. Furthermore, there were no differences in the duration of surgery or volume of blood loss between NHT and non-NHT groups. The proportion of stump tumor cell-positive patients was low.

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  Objective：The aim of this study was to evaluate the influence of laparoscopic radical prostatectomy （LRP）on lower urinary tract symptoms（LUTS）.
  Materials and Methods：Total 620 patients underwent LRP in our hospital between 2006/4 and 2012/6. Data on the international prostate symptom score（IPSS）, quality of life（QOL）, and University of California at Los Angeles prostate cancer index before and at 3, 6, and 12 months after LRP were available for 196 of them.
  Results：After LRP, urinary function and QOL recovered significantly earlier in patients with LUTS than in those without LUTS. Additionally, in patients with LUTS, the postoperative IPSS and QOL improved significantly after the operation. The preoperative IPSS was the only independent predictor for recovery of QOL within 6 months after LRP.
  Conclusion：QOL recovered earlier in patients with LUTS than in those without LUTS after LRP, and patients with LUTS showed symptom-improvement after LRP.

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  We compared the surgical outcomes in patients with or without pre-operative bowel preparation before laparoscopic radical cystectomy（LRC）and ileal urinary diversion（IUD）. All patients undergoing LRC and IUD between February 2010 and May 2014 were enrolled in this study. Seventeen patients who did not receive bowel preparation（NBP group）were compared with 17 who did（BP group）. The two groups showed a similar age, sex distribution, rate of diabetes mellitus, rate of history of abdominal surgery, and body mass index. The incidences of post-operative ileus were comparable between the two groups. Moreover, the groups did not show a significant difference regarding the frequency of post-operative complications. The median duration of hospital stay after surgery was 22 days in the NBP group, and 32 days in the BP group; however, there was no significant difference. Our results clearly demonstrated that LRC with IUD could be successfully performed without preoperative bowel preparation.

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  We performed laparoscopic surgeries for 100 cases of intraperitoneal testis. There were 14 difficult cases（18 testes）, and we verified the reasons for the difficulty
①Error of identification between gonadal vessels and spermatic duct blood vessels due to a long vas. 5 cases（6 testes）
②Spleno gonadal fusion. 1 case（1 testis）
③Intraperitoneal germ cell showing false-negative results on HCG tests. 1 case（1 testis）
④Beckwith-Wiedemann syndrome. 3 cases（5 testes）
⑤A history of surgery for peritonitis. 1 case（2 testes）
⑥Prune belly syndrome. 1 case（1 testis）
⑦Transverse testicular ectopia. 2 cases（2 testes）
  If the contralateral testis dose not exhibit compensatory hypertrophy, it is highly recommended to use MRI.
  There are some cases of intraperitoneal germ cells that show false negative results on HCG tests, so we need to conduct careful observation.
  For intraperitoneal testis, it is very important to conduct a thorough examination in order to prevent the occurrence of a germ cell tumor in the future.

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  Purpose：We have treated prostatic utricles using various techniques. We recently started laparoscopic surgery for such prostatic utricles. We investigated clinical outcomes following laparoscopic excision of prostatic utricles in our hospital.
  Study Design：We retrospectively reviewed the data on 5 cases of laparoscopic excision of prostatic utricles performed between 1992 and October 2014 in our institute. We analyzed the operation time, blood loss, and postoperative complications.
  Results：The mean operative time was 159±19.4 minutes, with an average blood loss of 6.6±3.1 mL. There were no postoperative complications categorized as GradeⅠ-Ⅴ in the Clavien-Dindo classification.
  Conclusions：The laparoscopic excision of prostatic utricles is a very useful technique, offering more favorable visualization than open surgery.

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  Objective：Several studies showed the effectiveness of photodynamic diagnosis（PDD）with 5-aminolevulinic acid in the management of non-muscle invasive bladder cancer. In this study, we evaluated the efficacy of fluorescent light（FL）cystoscopy against only carcinoma in situ（CIS）cases.
  Materials and Methods：From 2011 to 2012, 21 cases with positive urine cytology（above class III）were enrolled. Intravesical investigation was performed by using WL and white light（WL）cystoscopy.
  Results：The sensitivity and specificity of FL cystoscopy were 96.6% and 62.7%, respectively, while those of WL cystoscopy were 41.2% and 37.2%.
  Conclusion：FL cystoscopy would be useful for CIS patients. However, a large scale prospective study is required to assess the effectiveness.

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  Purpose：To identify the preoperative predictors of ECIRS outcome for the treatment of renal stones.
  Methods：We retrospectively analyzed 267 single-session ECIRS procedures in the modified Valdivia position for the treatment of renal stones, performed between June 2010 and December 2013 in Ohguchi Higashi General Hospital. The stone free status of ECIRS was decided 1 month after the operation by non-contrast computed tomography, and was defined as the residual fragments less than 5 mm. A multivariate logistic regression model with backward selection was used to evaluate the relationship between preoperative factors and successful outcome following ECIRS.
  Results：The stone free（SF）rate was 67.4%. Stone surface area was significantly smaller in SF group（440.27 mm² vs 1037.04 mm², P<0.001）. Stone number（3.16 vs 4.55, P<0.001）, number of stone branch（0.94 vs 3.22, P<0.001）, and number of involved calyces（2.00 vs 5.05, P<0.001）were significantly fewer in SF group, respectively. The vertical distance between the tip of the Th12 and upper end of the renal stone was significantly longer in non-SF group（−1.378mm vs 16.09 mm, P<0.001）. Multivariate assessment revealed five independent predictors of ECIRS outcome（P<0.05）：the vertical distance between the tip of the Th12 and upper end of the renal stone（P=0.033）, stone surface area（P<0.001）, number of stones（P=0.042）, number of stone branches（P=0.003）, and number of involved calyces（P=0.004）.
  Conclusions：To our knowledge, this is the first report to identify the independent predictors of the ECIRS outcome.

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  We prospectively evaluated the role of instruction and visual feedback during flexible ureteroscopy（fURS）training. Participants included five residents：three who were inexperienced with fURS, and two with less than 10 fURS experiences. The trainees were divided into two groups for training：one group had a mentor, who provided instruction and visual feedback, and the other group had no mentor. We measured and evaluated task completion time（TCT）for 3 separate tasks, and scored the participants using a visual rating scale. The TCT of both groups on task 1 and 2 was significantly reduced at the end of the training period. Additionally, the reduction of TCT on task 3 was significantly greater in the mentor group compared with the non-mentor group. Compared with that of the non-mentor groups, the visual scores of the mentor group were significantly increased at the end of the training period. Thus, we suggest that mentorship, including instruction and visual feedback, is important for fURS training.

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  Objective：To evaluate the transperineal targeted biopsy with real-time fusion image of multiparametric magnetic resonance image（mpMRI）and transrectal ultrasound（TRUS）image for the diagnosis of prostate cancer.
  Methods：The patients with PSA level less than 20 ng/ml were performed mpMRI prospectively. All mpMRI images including T2WI, dynamic, DWI, and ADC map. We performed targeted biopsies for each cancersuspicious lesion and 12 systematic biopsies using the BioJet^® system（D&K Technologies GmbH, Barum, Germany）. MRI, TRUS image, and pathological findings of targeted and systematic biopsies were analyzed.
  Results：90 patients were included in the study. Median age was 68 years（50-89 years）. Median preoperative PSA value was 6.8 ng/ml（3.54-20 ng/ml）. Median preoperative prostate volume was 37 ml（22-68 ml）. The number of the cancer-detected cases was 51（57%）. Rate of positive core（38% vs. 6.0%, p<0.0001）, positive core length（8mm vs. 2mm, p<0.0001）, positive core percent（58% vs. 16%, p < 0.0001）, and Gleason score（6.5 vs. 6, p=0.001）were also significantly different between targeted and systematic biopsies. Cancer detection rate of the patients with PI-RAD classification of 4 or 5 were 52% and 82%, respectively. In 16 patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers and index lesions corresponded to the pathological results of the biopsies.
  Conclusions：The cancers detected by targeted biopsies with the present biopsy method had significantly higher grades and larger volumes length compared with those detected by the systematic biopsies. The present biopsy method has a possibility to diagnose the localization of prostate cancer.

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  We retrospectively investigated the incidence of genitourinary tract infection following TUEB in 209 patients, after excluding those who underwent concurrent cystolithotripsy（n=18）or prostate biopsy（n=14）procedures.
  As antibiotics for prophylaxis, first-generation cephalosporin was the most frequently used, in 50.2%, followed by second-generation cephalosporin, in 39.2%, while a single dose was the most frequent, in 37.8%, and two-days administration was prescribed for 27.8%.
  The rate of genitourinary tract infection following TUEB was 2.9%, which included acute prostatitis in 1.9% and acute epididymitis in 1.0%.
  The preoperative residual urine volume was a significant risk factor for febrile infection（P=0.04）. There was no significant difference between the single- and multiple-dose groups regarding the incidence of febrile infection in the presence of preoperative pyuria（P=1.00, 1.00, respectively）.
  To determine the optimal dosing period for prophylactic antibiotic administration in TUEB patients, a prospective randomized study is essential.

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  We evaluated the long-term outcomes of transrectal high-intensity focused ultrasound（HIFU）for patients with localized prostate cancer（T1-T2）. Two hundred two patients（low 52, intermediate 94, high risk 56）were treated using the Sonablate 500^® and followed for over 12 months. Recurrence was judged using Phoenix definition, positive histological findings. In 12-137 months follow-up, no patients was died by prostate cancer. Of the 198 patients who underwent the histological examinations of the prostate in 6 months or later after HIFU, 20 were positive for cancer cells. The 5-year recurrent free survival rate was 95%, 82% and 60% in the low-, intermediate- and high-risk, respectively. There were no major postoperative complications, but dysuria（48 cases）, incontinence（22 cases,）and urethral stricture（13 cases）occurred during follow-up. HIFU is safe, repeatable and effective, particularly for low and intermediate risk group, and should be considered as an option for localized prostate cancer.

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  The aim of this study is to propose the new nomenclature of renal calices and morphological classification of pelvicaliceal system. We investigated 237 kidneys by three-dimensional images of CT-Urography. We systematically named each renal calyx into five level：top（T）, upper（U）, middle（M）, lower（L）, and bottom（B）. The upper, middle and lower calices are usually found in pairs：anterior（A）and posterior（P）. When a compound calyx is counted as one calyx, the total number of renal calices is most often eight. We classified the form of the pelvicaliceal system into type I（68.4%）and type II（31.6%）by the difference in the branch patterns. The type I is subclassified into three types：type Ia（56.5%）which is the standard type, type Ib（4.6%）where the renal pelvis is large in a convex shape, and type Ic（7.2%）where the renal pelvis is small in a concave shape.

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  A 22-year-old woman was referred to our hospital with chief complaint of left flank pain and fever. She was diagnosed as left pyonephrosis associated with left ureteropelvic junction obstruction of horseshoe kidney. We performed a laparoscopic left heminephrectomy, because any conservative treatment was not successful, and renal function of left moiety significantly reduced. The feeding vessels consisted of two arteries, which of them directly supplied the lower pole of the kidney from aorta. As the presence of double inferior vena cava, we required very careful manner to the left half kidney and isthmus. A Endo-GIA™（60AXT）divided the isthmus with excellent hemostasis and needed no additional suture. Total operative time was 270 minutes and estimated blood loss was negligible. Laparoscopic heminephrectomy for a horseshoe kidney becomes very useful surgical procedure by fully preoperative consideration of feeding arteries of the horseshoe kidney and selection of device with the isthmusectomy.

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