Objective : To evaluate the safety and efficacy of contact laser vaporization of the prostate (CVP) for symptomatic benign prostatic hyperplasia (BPH). Materials and Methods : From May 2017 to November 2019, 90 patients with BPH underwent CVP at our institution. Patients were assessed preoperatively and at 1, 3, 6, 12, and 24 months postoperatively including their IPSS, QOL score, maximum flow rate, and post-void residual urine volume. Results : The mean age was 71.3±6.4 years. The preoperative prostate volume was 101.1±37.7 mL. The operative time was 102.9±28.0 minutes, and total applied laser energy was 450±128 kJ. The procedure was completed successfully in all patients with no intraoperative complications. None of the patients required blood transfusion postoperatively. All of the parameters were improved and comparable with values in the Japanese clinical trial after surgery. Conclusions : CVP was an effective and safe procedure for BPH patients.

  Objective : To investigate treatment outcomes of ureterorenoscopy (URS) for upper urinary tract stones by combination therapy of dusting and fragmentation with extraction in our patients.

  Materials and Methods : We reviewed 108 patients who underwent URS from May 2016 to October 2018. At first, dusting was done using low energy and high frequency until stone volume became smaller. Then, fragmentation was done using higher energy and lower frequency until stone fragments were broken down to 2-3 mm, and fragments were extracted using a basket. The primary outcome was the stone free rate (SFR) as determined by non-contrast CT after one month.

  Results : The average size of kidney stones and ureteral stones were 20 and 12 mm, respectively. The SFR of kidney stones and ureteral stones in the first URS were 71％ and 93％, respectively. The final SFR were 81％ and 100％, respectively.

  Conclusion : The combination therapy of dusting and fragmentation with extraction was effective for SFR. Especially, basket extraction during URS was essential for complete stone removal.

To clarify the clinical course of relatively large renal stones treated by conservative therapy, we evaluated renal units (RUs) of patients with upper urinary tract stones who visited the institutions of Nara Urological Research and Treatment Group. We defined patients who were stone-free as no active stone ≧4 mm in maximum diameter and evaluated the stone-free rate (SFR) as the primary endpoint. We examined 38 RUs with stone (s) ≧10 mm in diameter of the renal pelvis or calyxes without any ureteral stone (s), and treated them with conservative therapy. The estimated SFR at 2 years is 20.8% by Kaplan – Meier’s survival curve method. As the RUs lost to follow-up had reached 50%, it is imperative to improve the method adopted for giving out information regarding future risks and to place emphasis on the importance of follow-up for relatively large, but silent, kidney stones while not missing the timing of treatment to avoid renal damage.

  We aimed to compare perioperative outcomes and postoperative complications between transperitoneal and retroperitoneal laparoscopic adrenalectomy.

  Ninety consecutive patients who underwent laparoscopic adrenalectomy from July 2005 to August 2019 were retrospectively reviewed. Patients were divided into 2 groups according to the approach : transperitoneal or retroperitoneal. Groups were compared regarding perioperative outcomes and postoperative complications. Fifty-two and 38 received transperitoneal and retroperitoneal approaches, respectively. Clinical and preoperative characteristics were similar in the groups.

  There was no difference in the operative time, length of hospital stay, or postoperative complications. The volumes of blood loss were significantly larger in the transperitoneal group than retroperitoneal group (mean : 110.7 vs. 39.9 mL, respectively p＝0.021). Four patients in the transperitoneal group underwent conversion to open surgery.

  In conclusion, transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy led to comparable perioperative outcomes and postoperative complications.

  We evaluated the effect of the learning curve of laparoscopic partial nephrectomy (LPN) the surgical outcomes for cT1aN0M0 renal tumors. From August 2006 to May 2018, LPN were performed for 306 cases of renal tumors at our hospital. All cases were classified into 3 groups ; group 1, case No1-100, group 2, case 101-200 and group 3, case 201-306. We picked-up cT1aN0M0 cases only from each group, so 95 of group 1, 75 of group 2 and 76 of group 3 were entered into this study. WIT (min) were 29 in group 1, 20 in group 2 and 17 in group 3 (p＜0.001). Separated renal function were calculated by MAG3 renal scintigraphy before operation, after 6 M, 1 Y, however, there were no significant differences between this 3 groups.

  In conclusion, the learning curve of LPN can shorten WIT, however, can not improve ipsilateral renal function.

Objective : The aim of this study was to investigate the health-related quality of life (HRQOL) of patients with clinical T1 renal cell carcinoma who underwent open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN). Methods : A total of 62 patients with clinical T1 small renal cell carcinoma underwent OPN (n＝8) or LPN (n＝54). The Medical Outcomes Study 36-Item Short Form was administered before and 6 and 12 months after surgery. Results : Patients who underwent OPN showed a significantly lower score for the bodily pain domain than patients treated with LPN (p＜0.05) 12 months after surgery. Patients who underwent LPN showed a significantly higher score for the mental health domain at 12 months after surgery compared with the preoperative score (p＜0. 05). Conclusions : The results of this study indicate that OPN and LPN have different profiles regarding the recovery of HRQOL.

  In Japan, laparoscopic donor nephrectomy (L-DN) is already the standard procedure. Laparoendoscopic single-site donor nephrectomy (LESS-DN) and Reduced port surgery donor nephrectomy (RPS-DN) are also being pursued for reduced invasiveness and improved cosmesis.

  This study introduces the technique transition from L-DN to RPS-DN together with the results. We have obtained satisfactory results for pain and cosmesis while ensuring safety such as surgical results and graft function. However, there are some problems. For example, expanded indications for RPS-DN to right-sided donor nephrectomy and further improvement the cosmesis are the challenge in the future. Data from future cases should be gathered to accumulate a body of evidence for the procedure’s efficacy.

  Laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) are often complicated by postoperative urinary incontinence and sexual dysfunction. This study determined age-dependent differences in functional outcomes by dividing participating patients into nerve-sparing and non-nerve-sparing surgery groups. Overall, 307 patients who underwent LRP and 201 patients who underwent RARP were enrolled. Of these patients, 272 (non-nerve-sparing surgery : 196 patients and nerve-sparing surgery : 184 patients) were aged ≦ 70 years and 236 (non-nerve-sparing surgery : 76 patients and nerve-sparing surgery : 52 patients) ＞70 years. Continence was defined as no pad per day. Among patients who underwent non-nerve-sparing surgery, those aged ＞70-year group had significantly lower scores than that in the ≦ 70-year group at 6 and 12 months post-surgery in the urinary function summary, function subscale, and incontinence subscale score in expanded prostate cancer index composite (EPIC). The continence rate at 12 months post-surgery in the ＞70-year group was significantly lower than that in the ≦ 70-year group (30.3％ vs. 46.4％). In the nerve-sparing surgery group, no significant differences in urinary function summary score in EPIC and continence rate post-surgery were found between the two age groups. Even for patients aged ≧71 years, nerve-sparing surgery should be performed for the recovery of urinary function.

  Eight patients underwent salvage laparoscopic radical prostatectomy (SLRP) for local recurrence of prostate cancer after definitive therapy. Median postoperative follow-up time was 36.5 months. The continent rate at postoperative 12 months was 62.5％ (5/8). One (12.5％) patient presented with biochemical recurrence after SLRP. It is a technically challenging but feasible procedure. Further investigation is needed to determine the best indication of SRP.

  The significance of preoperative hormone therapy is limited below moderate risk. In this study, we examined retrospectively whether preoperative hormone therapy could be a factor for determining the success of surgery as well as patient survival. We examined two groups : a group that had an effect on histological criteria in patients with localized prostate cancer who underwent surgery, and a group that had no effect on hormone therapy. COX regression analysis showed patient originated factors such as prostate weight, seminal vesicle infiltration, and lymphatic vessel invasion significantly predicted survival without PSA recurrence in Grade 1 and lower groups, but in Grade 2 and higher groups these factors had no effects. Preoperative hormonal therapy may be effective in limited cases with large prostate gland plus seminal vesicles invasion.

  Objective : Robot-assisted laparoscopic partial nephrectomy (RAPN) has been spreading since April 2016. We evaluated the outcomes of RAPN at our hospital.

  Patients and Methods : From March 2014 to August 2018, 90 patients underwent RAPN. We examined the surgical results of RAPN in our department, and the predictors of the presence of Adherent perinephric fat (APF) and its effect on the surgical outcomes of APF.

  Results : Median surgical and console times were 214 and 106 minutes, respectively. The median Warm ischemic time : (WIT) was 19.0 minutes. The achievement rate of Trifecta was 77.7％. APF was recognized in 16 out of 34 cases. In cases with APF, the operation time tended to be longer, but WIT and Trifecta were not affected.

  Conclusion : In our department, RAPN was safely performed, and with the increase of cases, the perioperative results and the achievement rate of Trifecta were improved.

OBJECTIVE : To evaluate the outcomes of a new posterior reconstruction (PR) technique using the levator ani muscle during robot-assisted radical prostatectomy (RARP).

PATIENTS AND METHODS : We compared patients who underwent new PR during RARP (n＝43, since July 2018) with those who underwent conventional PR (n＝79, since October 2016). Urinary continence rate was examined at 1, 3, and 6 months post-surgery.

RESULTS : At 1, 3, and 6 months post-surgery, patients with 0 urinary pads constituted 26％ vs 9％, 33％ vs 25％, and 59％ vs 42％ of the new and conventional groups, respectively, showing a significant improvement in the new PR group (p＜0.01). Multivariate analysis showed that new PR contributed to the achievement of 0 urinary pads.

CONCLUSION : A new PR technique using the levator ani muscle significantly contributed to an early recovery from urinary continence.

Purpose :

To assess the risk factors for biochemical recurrence (BCR) in patients treated with robot-assisted laparoscopic radical prostatectomy (RARP).

Methods :

The risk factors of BCR were retrospectively analyzed in patients who underwent RARP from July 2012 through June 2016, and who were followed-up for more than 3 years.

Results :

Two hundred forty-one patients were analyzed. Two-year and 3-year BCR-free survival rate were 89.6％ and 88.0％ respectively. Multivariate analysis revealed that pathological positive lymph node metastasis, extraprostatic extension, seminal vesicle invasion, lymphovascular invasion, and positive surgical margin at posterolateral site were independent risk factors for BCR.

Conclusion :

Positive surgical margin at posterolateral site was independent risk factors for BCR. It is suggested that reducing the rate of positive margin at posterolateral site might result in improving prognosis of RARP.

Objective : Mixed reality (MR), Virtual Reality (VR) technology is an indispensable technology in medical image analysis to improve spatial recognition. We applied these techniques to 3D image of preoperative patient images and examined the possibilities for navigation surgery and surgical education in urological surgery.

Methods : VR and MR navigation surgery was performed in Robotic partial nephrectomy.

Result : Compared to conventional surgery, these navigations contributed to shortening of tumor resection time and reduction of bleeding in partial renal surgery. The surgeon can intuitively experience the sense of distance of the organ dissection including the tumor and blood vessel surroundings, the spatial recognition of peripheral organs has been improved. Since HoloLens can record from the viewpoint of the surgeon, it also helped surgical education.

Conclusion : VR and MR are useful tools not only for surgical navigation but also for simulation and education.

［Objective］ The surgical outcomes and learning curve for RALP performed by a young physician at our hospital were investigated retrospectively.

［Methods］ Of 100 patients with early prostate cancer treated with RALP at our hospital between November 2017 and August 2019, the surgery was performed by a young physician in 34 cases. These patients were selected as subjects of this study. At the time of the introduction of RALP, the young physician had 8 years of experience in urology. The surgical outcomes and learning curve were investigated.

［Results］ The operative time was 189 min, the console time was 131 min, blood loss was 50 mL, and the resected stump was positive in 4 patients. Complication occurred in only one patient with difficulty in urethral catheter removal.

［Conclusion］ RALP can be safely performed by young physicians, regardless of their years of experience in urology.

  We investigated the outcome of robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer. The subjects were 404 high-risk prostate cancer patients who underwent RARP from September 2011 to February 2018, with 144 patients who underwent open radical prostatectomy (ORP) from April 2010 to January 2016 for comparison. “High-risk” was defined as a clinical stage of T3a or higher, Gleason score of 8-10, and PSA>20 ng/mL. The median operative time in RARP and ORP groups was 242 and 207 minutes, median blood loss was 55 and 880 mL, and the positive surgical margin rate was 32 and 55％ , respectively (each p＜0.01). The median time to biochemical recurrence was 45.4 and 28.0 months, respectively (p＜0.01). Compared with ORP, RARP for high-risk prostate cancer was associated with less intraoperative blood loss, a lower positive surgical margin rate, and a longer time to biochemical recurrence.

Objective : To investigate the mid-term outcomes and complications of LSC in our hospital.

Materials and Methods : We retrospectively investigated 615 patients who had received LSC from December 2012 to March 2018. Their average age was 65.8. The rate of POP-Q stage ≧ 3 was 99.7％. Eighty patients had a history of hysterectomy.

Results : The average operative time was 189 minutes, and the average blood loss was 10 mL. The perioperative complication rate was 3.6％, but patients with a history of hysterectomy had a 7.8-times higher complication rate than those without Such a history. The recurrence rate of POP-Q stage ≧2 was 3.4％ and the average follow-up period was 18.1 months. Regarding SUI, exacerbation was noted in 14.5％, the de novo rate was 37.8％, and 4.7％ required TVT. Regarding dyspareunia, the de novo and exacerbation rate was 2.8％.

Conclusions : Our LSC outcomes were excellent regarding both the recurrence rate and perioperative complication rate.