Objectives : To investigate the long-term outcomes of laparoscopic radical nephrectomy for T1 renal cell carcinoma.

  Methods : Laparoscopic radical nephrectomy was performed on 363 patients with T1 renal cell carcinoma between November 1999 and December 2013. The duration of follow-up was 0-204 months (median 68 months). In 99 patients whose renal function data were available, renal function before and after operation was also compared.

  Results : The 5-year and 10-year overall survival rates were 90.1 and 80.9%, respectively. The 5-year and 10-year recurrence-free rates were 91.4 and 86.5%, respectively. The 5-year and 10-year cancer-specific survival rates were 95.5 and 90.4%, respectively. Seventeen patients died from cancer progression. The renal function outcomes at a median follow-up of 60 months (range 0-182) were analyzed. Compared with the preoperative serum creatinine and estimated eGFR, the postoperative values were significantly decreased. The baseline risk factors (age, preoperative eGFR, and BMI) were significantly associated with postoperative eGFR.

  Conclusions : Laparoscopic radical nephrectomy for clinical T1 renal cell cancer confers long-term oncological improvement. However, renal function deteriorated significantly, especially in older patients and patients with poor preoperative renal function.

  A 32-year-old man was pointed out a complete situs inversus when he was a child. He had an operation for single right ventricle at the age of 22. He took postoperative follow-up at the department of pediatric cardiology, and a blood test revealed liver dysfunction. Contrast-enhanced CT imaging found out an enhanced lobulated mass of 10mm in the right side of the aorta. Therefore he consulted the department of endocrinology. The value of noradrenaline was above limit in his blood and urine, and MIBG scintigraphy identified a tumor, which was pointed out in the former CT scan. The diagnosis was paraganglioma. He received a retroperitoneoscopic resection of the tumor. During the operation, his systolic blood pressure temporarily elevated to 180 mmHg, but his vital signs ware stable in general. The specimen was reddish brown and the margin between the tumor and the normal tissue was clear macroscopically. The pathological finding was nesting or trabecular pattern of cells with abundant granuler eosinophilic or basophilic cytoplasm. There ware no perioperative adverse events. He is now followed up at our hospital.

  Paraganglioma with a complete situs inversus is very rare, and this is the first report in our country in which the resection was performed laparoscopically.

  A 67-year-old woman was aware of right back pain during the examination for abdominal aortic aneurism. CT showed the horseshoe kidney with right hydronephrosis and a 10mm ureteral stone. Further examination revealed that the right ureter was crossed and compressed by a renal lower polar artery and aortic aneurysm. Laparoscopic ureterolithotomy was performed via transperitoneal approach. The patient was fixed on half lateral decubitus position to prepare for the emergent rupture of the aneurysm during surgery. The anterior wall of the dilated ureter was incised and the calculus was removed with a flexible cystoscope. The ureter was transected and moved to the ventral side of the crossing artery followed by uretero-uretero anastomosis. Although horseshoe kidney has been characterized by various morphological abnormalities, laparoscopic surgery was safely performed by precise anatomical recognition of the blood vessels and urinary tract with preoperative imaging studies.

  A woman in her 60s had a several-month history of repeated right abdominal pain. A right ureteral stone was suspected, and CT examination was performed. Right hydronephrosis and a hydroureter to the lower ureter were observed, but no calculus was found. Retrograde ureterography (RU) demonstrated a curlicue sign in the lower ureter, and a diagnosis of ureteral sciatic hernia was made. A mesh was laparoscopically placed and fixed between sciatic foramen and the ureter. There were no postoperative complications. The ureteral sciatic hernia has not recurred. Various surgical treatments for ureteral sciatic hernia are discussed.

  For patients undergoing percutaneous nephrolithotomy (PNL), we prepared a three-dimensional (3D) model reproducing the renal pelvicaliceal system and kidney stones in full scale and performed a preoperative simulation. We prepared a 3D model in a total of 14 cases and verified its usefulness. In all 14 cases, we could make the tract to the first candidate renal calyx that was scheduled in the simulation. In 9 cases, we achieved a stone-free status with the initial PNL. In the other 5 cases, additional treatment was required (PNL, n=4 ; ureteroscopy, n=1). The perioperative complications included a fever of >38℃ in one case, which required the prolongation of antibiotic therapy, and a myocardial infarction, which developed 48 hours after the operation in another case. There were no cases of bleeding that required blood transfusion. The preoperative simulation using a 3D model enabled a stable operation.

  Objectives : To evaluate the difference of the stone densities determined by standard computed tomography (SDCT) and low-dose computed tomography (LDCT) among patients with urolithiasis.

  Methods : We investigated 28 subjects who underwent SDCT and LDCT for urolithiasis with calculi sized 6 mm or greater. In each case, SDCT was performed at the initial examination followed by LDCT during the follow-up period, during which the stone density in the central part of each calculus and the effective dose (ED) required for examination were measured.

  Results : There was no significant difference for the average stone density between SDCT and LDCT. Among patients with stone density >900 HU, the stone density upon LDCT was significantly lower (P = 0.023). The mean EDs were 6.6 mSv with SDCT and 1.6 mSv with LDCT ( P<0.001).

  Conclusion : Among patients with high stone densities, the stone density upon LDCT showed lower values as noise increased. Taking into consideration the influence of stone density in LDCT, it is necessary to use SDCT and LDCT properly in accordance with the purpose of the examination.

  Objectives : Treatment of renal calculus ≧2 cm is challenging. According to previous guidelines, patients with large renal calculi ≧2cm, including staghorn calculi, can undergo percutaneous nephrolithotripsy (PNL) first. Even though it has been reported that transurethral lithotripsy (TUL) -assisted PNL (TAP) is safe and effective for these patients, there is still a lack of adequate evidence about the feasibility of TAP. So we introduced TAP, and investigated the clinical outcomes of endoscopic management for the total stone size ≧2cm in our department.

  Patients and Methods : We evaluated a total of 75 patients who underwent TAP in 38 cases, TUL in 31 cases, PNL in 5 cases, and 1 case of laparoscopic pyelolithotomy for the total renal stone size ≧2cm between March 2012 and November 2016，retrospectively. Basically TAP was selected for the maximum diameter ≧30 mm, TUL was selected for the maximum diameter <20mm, others were case by case.

  Results : We treated 13 cases with complete staghorn, 12 cases with partial staghorn, and 33 cases with single, 17 cases with multiple calculus, and the success rate was 61.5%, 100%, 97%, and 94.1%, respectively. Complications included one blood transfusion, five fevers over 38.5 ℃, one renal pelvic injury, two ureteral injuries, but no severe complications occurred. The mean surgical time was 149 minutes. The mean hospital stay was 9.5 days.

  Conclusions : The outcomes of our study have demonstrated that TAP is a safe and effective treatment modality, especially in the treatment for the large renal calculi.

  To determine predictors of beach balls (BB) during HoLEP.

  Methods : Our 248 HoLEP cases were retrospectively reviewed. Patients were classified into BB (n=51) and non-BB (n=197) groups. We evaluated the relationship between the presence of BB and clinical factors, including age, BMI, PSA, estimated prostatic volume, dutasteride treatment, imaging findings and pyuria. The type of morcellator tube was also analyzed.

  Results : The 51patients with BB demonstrated a 27-minute longer morcellation time, significantly increased median PSA (4.69 vs 6.84, p = 0.016) and prostate volumes (53.1 vs 81.9, p＜0.001). On logistic regression analysis, prostatic volume was significantly associated with BB (OR 1.03, p＜0.001), though PSA wasn’t independent after adjustment. 2nd generation tubes had a 3.69 times (p=0.005) higher risk for BB compared to 1st generation.

  Conclusions : The presence of BB requires time-consuming morcellation. Prostatic volume and tube type were associated with a higher risk for BB.

  Treatment results of 3D laparoscopic pyeloplasty in Tatebayashi Kosei Hospital

  We report the outcome of 3D laparoscopic pyeloplasty. We retrospectively evaluated data from 21 patients from April 2014 to December 2016. The median operative time, median suturing time, and median suture numbers were 253 minutes, 64 minutes, and 13 sutures irrespectively. We compared 3D and 2D laparoscopic pyeloplasty performed by a single surgeon with regard to the operative time, suturing time, and suture numbers between the pelvis and ureter. He could perform 3D laparoscopic pyeloplasty in a shorter mean operative time (224.7→208.5 minutes) and apply an increased mean number of sutures between the pelvis and ureter (10.4→14.1 sutures) than in 2D laparoscopic pyeloplasty. All patients showed symptom improvement. The 3D laparoscopic pyeloplasty facilitated more favorable results than 2D laparoscopic pyeloplasty.

  Introduction : We report treatment outcomes of mini-incision clampless partial nephrectomy (PN) using soft coagulation (SOFT COAG) without renorrhaphy performed in our institution.

  Materials and Methods : Nineteen PN cases were included in the present study. We calculated the split estimated glomerular filtration rate (split eGFR) of both the involved and noninvolved kidney using serum creatinine levels and renal scintigraphy. We analyzed changes in split eGFR from the preoperative period through postoperative day 7.

  Results : The mean split eGFR decrease of the involved kidney was 28.5% ± 14.0%. The decrease was greater in the subgroup with ≥8 RENAL nephrometry score. In the noninvolved kidney, an increase of 8.2% ± 12.0% in split eGFR was observed.

  Conclusion : Although SOFT COAG enables clampless PN, we found that thermal injury may decrease renal function. Therefore, the indication of clampless PN by SOFT COAG should be re-considered especially in cases with high-complexity tumors.

  We reviewed the outcomes of laparoscopic radical cystectomy at the Department of Urology of the Sapporo Medical University School of Medicine. We retrospectively evaluated the cases of 78 patients who underwent laparoscopic radical cystectomy from June 2012 to September 2016. The Clavien-Dindo classification was used to evaluate early perioperative complications. The median age of the 78 patients was 69 years. The median operative time was 476 minutes and the median blood loss was 320 ml. According to the Grade 3 and higher grades of the classification, urinary tract infection, intrapelvic abscess and ileus were found in 5, 2 and 1 cases, respectively. The frequency of ileus and surgical site infection in laparoscopic surgery patients was significantly lower than in the open surgery patients in our institute’s affiliated hospitals used as a historical control. Minimally invasive laparoscopic radical cystectomy had less blood loss and fewer perioperative complications than open surgery.

  Pelvic organ prolapse (POP) and vesicovaginal fistula (VVF) are female benign pelvic floor diseases which can be treated by surgery. Robot-assisted laparoscopic surgery was performed on 5 cases of POP and 1 case of VVF in our hospital.

  POP cases : An average age of 5 cases was 63.6 y.o and 2 patients had hysterectomy before robot assisted laparoscopic sacrocolpopexy (RSC). In 3 cases, RSC was performed after subtotal hysterectomy. Consol time of RSC was 206.2 minutes on average. After 1 year, there is no recurrence of symptom in all patients. VVF case : A 51 y.o female suffered from total urinary incontinence after hysterectomy visited us. A 20 mm fistula between bladder and vagina was found by cystoscopy. Robot-assisted laparoscopic repair of VVF was administered for fisterectomy and reconstruction of bladder and vagina wall (Consol time was 120 minutes). The patient discharged on the 7th postoperative day and keeps urinary continence.

  Partial nephrectomy is the standard treatment for small renal cell tumors, however, laparoscopic partial nephrectomy (LPN) for a hilar tumor is relatively hard to treat and open procedure is often selected. Robot-Assisted Partial Nephrectomy (RAPN) is superior than LPN at the point of Warm Ischemic Time (WIT) or complications. The location of tumor vascularity and urinary tract is easy to be obtained using reconstruction of 3D vascular image and TilePro^TM, especially for a hilar tumor. In such a case, advanced techniques should be needed for sufficiently separating renal vessels and urinary tract from the tumor. Since 2010, we experienced 135 cases of RAPN, including 18 cases of hilar tumors, and there were no cases for open conversion or radical nephrectomy. Operation time, WIT, and complications were not significantly different between hilar and non-hilar tumor cohorts. RAPN could be considered a useful procedure especially for a hilar tumor.