We evaluated operative results and oncological outcome based on 444 patients who underwent laparoscopic total prostatectomy (LRP) from January, 2007 to June, 2015 in Kure Medical Center, Chugoku Cancer Center. The median age was 70, the median initial PSA (ng/ml) was 8.678. The risk classification of D’Amico was as follows : Low : 128 cases, Intermediate : 161 cases, High : 153 cases. 432 patients underwent by retroperitoneal approach. No open conversion was necessary in all cases. Median operative time was 164 minutes. Median blood loss was 250 ml. 5-year cancer specific survival rate was 98% in all cases. Furthermore, 5-year cancer specific survival rate was 94% in high risk group and 100% in the other groups. 5-year biochemical-free survival rate was 66% in all cases. Furthermore, 5-year biochemical-free survival rate was 88% in low risk group, 62% in intermediate group and 48% in high risk group. These showed a statistically significant difference (P<0.0001). 5-year biochemical-free survival rate was 95% in both sides nerve-sparing (37 cases), 80% in unilateral nerve-sparing (134 patients), 62% in non-conserving (273 cases). These showed a statistically significant difference (p<0.0001, p<0.05). It can not stated because there is a difference in the background of cases, but not necessarily, at least nerve-sparing is the cause of PSA recurrence. Pad-free rate was 75% at 3 months after surgery, 89% at 6 months and 94% at 1 year. With respect to early postoperative urinary continence, both sides sparing, one side preserved, was good in the order without sparing. These showed a statistically significant difference in each (p = 0.002, p = 0.036). Surgical outcome of LRP is long-term stable in the point of the anti-cancer effect, and in terms of urinary continence, was considered an excellent surgical procedure.

  We analyzed the long-term results of Laparoscopic Radical Prostatectomy : LRP.
  From 2000 to 2014, 553 consecutive patients underwent LRP for a prostate cancer at our department. The median operative time was 262 minutes and median blood loss was 476ml. Complications occurred in 29.8% of patients and most were less than Clavien Grade 3, and the rectal injury occurred in 13 cases. The overall surgical margin rate was 29.7% (pT2 : 19.9%, pT3 : 41.7%). The 3-yr, 5-yr and 10-yr biological progression-free survival rates were 86.0%, 83.1% and 80.7%. Postoperatively, continence rates (0-1 pad/day) at 1-yr and 2-yr were 64.9% and 82.2%.
  The results of our study were mostly consistent with the previous reports.

  We report the outcome of the laparoscopic pyeloplasty in Kure medical center urology department. We retrospectively evaluated data on 68 ureters of 68 patients who underwent laparoscopic pyeloplasty by a diagnosis of the ureteropelvic junction obstruction (UPJO) from June, 2006 to October, 2015. Median operative time was 150 minutes. Median blood loss was 10 ml. The intraoperative and early complications rate was 2.9% and 2.9%, respectively. One case recurred in 54 months after surgery and was reoperated by laparoscopic method. At six months after surgery, a symptom was improved in all cases in 39 cases that included symptom and hydronephrosis was improved in 81%. Particularly, there were improved in 54 cases in the 58 cases preoperative hydronephrosis grade3 or more, but improved only one in the 10 cases grade2 or less. The laparoscopic pyeloplasty for UPJO was the surgical results that could become the standard operative method.

  Objectives : We compared perioperative outcomes of LPN and RAPN in terms of safety and feasibility during initial setting-up periods at Kyoto City Hospital.
  Methods : Perioperative records of the initial 22 cases of LPN and 23 cases of RAPN were collected and analyzed retrospectively.
  Results : Median operative times (OT), warm ischemic times (WIT), and estimated blood losses (EBL) for the LPN series were 304 min, 36 min, and 112 mL, while these were 338 min, 26 min, and 169 mL, for the RAPN series, respectively. These results suggest a significant reduction of WIT with robot-assistance (P<0.05). The rates of AEs graded >2 were 4.5 and 8.7% for LPN and RAPN series, respectively.
  Conclusions : WIT on minimally invasive partial nephrectomy were reduced by the aid of robotics in the initial setting-up periods of an institution.

  We performed robot-assisted laparoscopic radical prostatectomy (RALP) for 500 patients with a diagnosis of localized prostatic cancer from September 2011 to January 2015 at Chiba Cancer Center.

  Except for the age, there were no significant differences among the patient’s baseline characteristics, including BMI, PSA, clinical T-stage, Gleason score (GS), and prostate volume. Appendectomy was the most commonly performed prior surgery.

  The operative time, console time, blood loss, blood transfusion rate, pathological T-stage, lymph node metastasis, number of lymph node dissections, GS, and rate of a positive surgical margin did not differ among subjects. We observed three severe complications in the patients without prior abdominal surgery : grade 4 pulmonary embolism, grade 3b postoperative hemorrhage, and grade 3b adhesive ileus.

  Additional surgical ports were often required for patients with a past history of abdominal surgery ; however, we could perform RALP surgery safely even for them.

  The indication, methods, and outcomes of pediatric single-port laparoscopic transection of the testicular vein with conservation of the lymphatic ducts and testicular artery are presented. The surgical indication is grade Ⅱ or severer with clinical symptoms (pain and discomfort feeling). The surgical procedure is basically single-port surgery through the navel using GelPoint, right-angle forceps, Indigo Carmine, and VSS. Regarding the outcome of surgery, clinical symptoms remitted without the recurrence of varix in all cases. The lymphatic duct and testicular artery conservation rates were 89 and 71%, respectively, and hydrocele did not occur after surgery in any case treated with the lymphatic duct-conserving procedure. Postoperative catch-up growth was observed in 35%.

  Between May 2008 and February 2015, rigid transurethral lithotripsy (r-TUL) for ureteral stones was performed, using a stone extractor (NTrap^®, COOK, JAPAN) in 180 patients. Retrospective analysis for risk factors for stone migration into the pelvis showed that stone size of 11 mm and more in diameter and hydronephrosis grade 3 were significant predictors for the migration. The device for r-TUL should be carefully selected as concerned with the stone size as well as hydronephrosis grade based on each patient.

  We retrospectively evaluated the efficacy and safety of PNL and f-TUL for renal stones 20-40mm. Between January 2008 and February 2015, 35 patients were treated with PNL, 48 with f-TUL. Stone-free rate (SFR) the day after the operation was achieved in 37.1% of the PNL group and 39.6% of the f-TUL group. After additional treatments, final SFR was 94.3% in the PNL group and 91.6% in the f-TUL group. SFR for stone size of 20-30mm and 31-40mm was 93.8% and 94.7% in the PNL group, 97.1% and 76.9% in the f-TUL group. Fever occurred more frequently in the PNL group than the f-TUL group. Our study suggests that f-TUL for renal stone 20-40mm has low complication and SFR comparable to PNL. Especially for selected patients with renal stone 20-30mm, f-TUL can be an alternative to PNL.

  Objective : Acute obstructive pyelonephritis often results in sepsis and can be lethal. Emergency drainage is often required. We examined the risk factors for septic shock.

  Methods : Seventy-five patients with acute obstructive pyelonephritis due to ureterolithiasis were admitted to our hospital from May 2008 to September 2014.

  Results : The patients’ median age was 71 years (range, 26-96 years). They comprised 29 males and 46 females. Emergency drainage was performed in 56 patients (ureteral stent in 50 patients and percutaneous nephrostomy in 6 patients). Eighteen patients developed septic shock ; these patients were characterized by a low performance status, medical history of a cerebrovascular disorder or dementia, and arrival by ambulance. Early drainage significantly reduced the occurrence of septic shock after admission.

  Conclusion : Early drainage and general management are essential for successful treatment of acute obstructive pyelonephritis. We must examine patients’ background and data on admission to determine their disease severity.

  Purpose : To identify the safety and efficacy of PVP using 120-W HPS for BPH.
  Patients and methods : The prospective study included 72 Japanese patients who underwent PVP. Primary outcome variables included : International Prostate Symptom Score, quality-of-life score, urinary peak flow and post-void residual urine volume at 1 to 36 months postoperatively. Secondary outcomes were urodynamic variables. Perioperative values and postoperative complications were also noted.
  Result : The mean age was 71.9 years, and the mean estimated preoperative prostate volume was 72.4 ml. The mean operating time was 92 minutes. There were no serious complications during the peri-operative period, and no patients were transfused. Significant improvement was observed in all outcome variables with significant relief of bladder outlet obstruction and detrusor overactivity, and a minimal change in detrusor contractility following PVP.
  Conclusion : PVP is considered a safe and effective treatment option for patients with BPH.

  A 34-year-old woman was referred to our department for a stone in ureteropelivic junction and multiple stones in her left kidney. She had undergone anti-reflux surgery (Glenn-Anderson technique) due to bilateral vesicoureteric reflux when she was 27-year-old. Because she demanded us to remove stones as possible as we could, we planned to perform Endoscopic Intrarenal Surgery (ECIRS) on her. Prior to ECIRS, we examined her by cystography to ensure no VUR was present, and ureteral stent was placed to make passive dilation of ureter. ECIRS was performed one week later using flexible ureteroscopy without ureteral access sheath. We removed all stones.

  Postoperative cystography showed no recurrence of VUR. To our knowledge, it is rare to perform retrograde ureteroscopy after anti-reflux surgery. ECIRS is safe and effective method for multiple renal stones after Glenn-Anderson technique.

  A 67-year-old woman with an ileal conduit underwent retrograde ureteroscopic lithotripsy. She had previously undergone radical hysterectomy and pelvic lymphadenectomy for cervical cancer at the age of 55. During adjuvant radiotherapy, she developed bilateral hydronephrosis. Bilateral percutaneous nephrostomy was performed. However, to manage recurrent urinary tract infections, she then underwent ileal conduit urinary diversion surgery at the age of 58. After surgery, no urinary tract infections occurred, but she again presented with fever and right flank pain. Computed tomography (CT) revealed a 9mm right ureteral stone impacted at the crossing of the common iliac artery bifurcation with attendant ipsilateral hydronephrosis, recognized as pyelonephritis. She underwent retrograde ureteral stent insertion under radiographic guidance. Retrograde lithotripsy was performed at a later date. At 1 year after surgery, urolithiasis and urinary tract infection have not re-occurred.