It is well known that pelvic organ prolapse (POP) has various degrees characterized by its severity and non-specific bladder, bowel, and sexual symptoms. A lot of surgical procedures for POP repair can be done via vaginal or laparoscopic route, with or without mesh graft. Recently, laparoscopic surgery for POP repair has been gaining popularity and one of the most established surgeries for POP repair is laparoscopic sacrocolpopexy (LSC). Aside from LSC, other surgical procedures have been reported in literatures. In this paper, we introduce five laparoscopic procedures for POP repair that we have been performing in our hospital : Basic LSC, LSC with two separate mesh-fixation, Laparoscopic Sacral Hysteropexy (uterine preservation LSC), Laparoscopic Lateral Suspension, and Laparoscopic Sacrospinous Ligament Fixation with mesh. It is assumed that the choice of appropriate surgical procedure for each POP case may provide an effective surgical outcome.

  Multi-parametric magnetic resonance imaging (MRI) has been increasingly used to diagnose significant prostate cancer (sPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of sPC. This novel technique contributes to the development of tailor-made medicine as focal therapy, which cures the sPC while preserving the anatomical structures related to urinary and sexual function. High-intensity focused ultrasound (HIFU) is an extracorporeal ablative technology that delivers ultrasonic energy to pinpoint foci only millimeters. Because the area involved in a single HIFU treatment is extremely small, only minor temperature changes are observed outside of the focal zone, making it an attractive modality for focal therapy. Reported short-term oncological and functional outcomes indicate that focal therapy with HIFU can plausibly cure cPCa while preserving continence and erectile function.

  The purpose of ureteral stent placement after transurethral ureterolithotripsy (TUL) is to help stones pass and prevent hydronephrosis and infection. However, stent-related symptoms lower patient’s QOL and, also encourage use of painkillers.

  From January 2018 to June 2019, we underwent TUL without postoperative ureteral stent placement (hereinafter called Stentless TUL) on 21 patients and examined the results. The median age was 63 years old, the stone location was R2 : 2, U1 : 6, U2 : 3, U3 : 10, and the median stone major axis was 8 mm. The median operation time was 27 minutes, and endoscopic stone free was confirmed in all cases. There were no serious postoperative complications. From these results, it was considered we can perform Stentless TUL safely in some cases, and should expand the indications in the future.

  We created two type’s phantom stone like 10 mm ball stone and 20 mm cube stone which were produced by Bego stone plus and water (5 : 1). In ball type’s stone, laser fiber was directly located with the face of stone. Laser fiber was located with the alongside of phantom stone in cube stone. Practical laser setting is 1.5×10 Hz with various pulse duration including short, middle, long pulse range whose setting were repeatedly irradiated for 1-minitues. In results, in fiber tip directly located against stone surface, stone dust was significantly generated in whole laser setting (p＜0.05). The longer pulse duration like short, middle, and long range, the lower dust generation. In conclusion, fiber tip directly located against stone surface is significantly higher dust generation than one located alongside of stone surface (p＝0.001).

  In recent years, the indications for endoscopic treatment of ureteral stricture have expanded. We introduced a method of placement of dual ureteral stents after laser incision and balloon dilation for the treatment of ureteral stricture and investigated its usefulness. The subjects were 10 patients who underwent endoscopic surgery for ureteral stricture between January 2016 and March 2019. In all cases, balloon dilation was performed after laser incision. Double 4.7 Fr ureteral stents were placed and they were removed 4 to 8 weeks after the surgery. Improvement of hydronephrosis was observed in eight cases (80％). The median follow-up period was 251.5 days, and no restenosis was observed in any of the eight patients. The method of combining laser incision with balloon dilation and placement of dual ureteral stents after surgery was considered useful.

Purpose : This study was performed to evaluate the safety and efficacy of ureteroscopy (URS) for the diagnosis of upper tract urothelial carcinoma (UTUC) and to determine whether URS affects the intravesical recurrence (IVR) rate after radical nephroureterectomy (RNU).

Objectives and Methods : We conducted a retrospective analysis of 150 patients who underwent URS for diagnosis of UTUC and 126 patients who underwent RNU from January 2011 to March 2018. We analyzed the perioperative outcomes of URS and the impact of preoperative URS on IVR.

Results : Of the 150 patients, 104 were diagnosed with UTUC ; this diagnosis was made by URS in 91 of the patients (sensitivity of URS＝87.5％). Patients who did not undergo preoperative URS had a significantly better 2-year IVR-free survival rate than patients who underwent preoperative URS (68.3％ vs. 46.5％, respectively ; p＝0.0075).

Conclusion : URS is a safe and useful procedure for the diagnosis of UTUC but increases the IVR rate after RNU.

  We aimed to investigate outcomes and safety of initial robot-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN). We retrospectively investigated perioperative results and trifecta achievement rate of 52 initial LPN cases from April 2013-September 2017 and 51 initial RAPN cases from July 2017-March 2020. Between RAPN versus LPN, median BMI (24.7 kg/m² versus 23.8 kg/m²), tumor diameter (25 mm versus 20 mm), and tumor to renal sinus distance (5 mm versus 10 mm) were significantly different respectively. Blood loss, tumor volumes, warm ischemic times and rates of adverse events graded ＞3 were not different. Trifecta achievement rate was significantly higher with RAPN than LPN. eGFR preservation rates at 3 months postoperatively was significantly higher in the Trifecta achievement group than non-achievement group. From these findings, it is thought to be RAPN can be introduced safely and effectively with higher Trifecta achievement rate compared to LPN.

Purpose : We examined whether suturing renorrhaphy increased the parenchymal reduction volume by CT in robot-assisted partial nephrectomy (RAPN).

Materials and Method : We analyzed 69 patients with a renal mass ＜4 cm in diameter who underwent RAPN between November 2013 and November 2018 at Akita University Hospital. The data of 26 patients who underwent suturing renorrhaphy and those of 43 patients who underwent medullary hemostatic suturing alone were retrospectively compared.

Results : The tumor diameter and RENAL score were not significantly different between the groups. The median operative time, warm ischemic time, and blood loss were not significantly different between the groups. Also, the median parenchymal reduction volume, decreasing rate of eGFR, and incidence rate of high-grade postoperative complications were not significantly different between the groups.

Conclusion : The addition of suturing renorrhaphy to RAPN neither significantly increased the parenchymal reduction volume nor significantly decreased the kidney function when compared with the non-renorrhaphy technique.

Objective : This study aimed to compare the surgical outcomes between laparoscopic (LRP) and robot-assisted laparoscopic (RARP) radical prostatectomy.

Materials and Method : We retrospectively investigated the surgical outcomes of 312 patients (166 LRP and 146 RARP).

Results : Backgrounds were not significantly different between patients with LRP and RARP except for preoperative PSA and history of open surgery. There was no significant difference in operative times between the groups. However, a significantly lower volume of blood loss was observed in the RARP group. No significant differences were observed in the continence rate after surgery or positive surgical margin rate between the groups. The postoperative inguinal hernia rate was significantly higher in the LRP group.

Conclusions : Patients undergoing RARP showed a significantly lower volume of blood loss and lower incidence of postoperative inguinal hernia than those receiving LRP.

  Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) has been reported to have advantages over extracorporeal urinary diversion (ECUD). These advantages include the intestinal tract not being exposed to outside air, a smaller incision, and reduced pain. However, one drawback in creating the stoma for the intracorporeal ileal conduit is that the small incision produces an insufficient visual field to remove the conduit, which can lead to an inadequately formed stoma. This, in turn, can cause ductal stenosis and bud stoma morphology. Following port construction, a stoma hole was formed, and a single-port device was indwelled with the anal side of the conduit being carefully removed from the single-port device under endoscopic observation upon completing the ICUD. This procedure made it possible to perform stoma formation during ICUD without interrupting the surgery or applying pressure to the ileal conduit.

  High-intensity focused ultrasound (HIFU) is suitable for focal therapy as it enables the ablation of any predefined region of interest. We describe patients with unilateral localized prostate cancer (prostate-specific antigen (PSA) 20 ng/mL, Gleason score 7, T2 or less) who underwent focal therapy with HIFU. HIFU ablation was delivered partially, unilaterally, or in an L-shaped pattern based on the location and shape of the tumor as determined by either biopsy or magnetic resonance imaging (MRI). HIFU ablation was performed locally as an initial therapy in 13 patients and as a salvage therapy in 19 patients. Recurrence was determined based on histological findings from biopsies as well as PSA failure according to the ASTRO definition. After the treatment, the level of PSA decreased in all patients and the tumors were no longer visible on MRI. Three patients had difficulty voiding 3 months after the treatment. Two- and three-year recurrence-free survival rates were 76 and 57％ for those who underwent focal HIFU ablation as an initial therapy and 71 and 62％ for those who underwent focal HIFU ablation as a salvage therapy, respectively. Our findings suggest that focal HIFU ablation is a safe treatment option for patients with localized prostate cancer with PSA of ≦10 ng/mL, Gleason score of ≦ 3 ＋ 4, clinical stage ≦ T2a, and biopsy core ≦2. In order to prevent recurrence, it is important to localize the tumors accurately.

  We retrospectively investigated the efficacy and the safety of the stainless mesh ureteral stent for malignant ureteral obstruction. From September 2018 to October 2020, stainless mesh stents were placed in 31 ureters of 22 patients. The primary diseases were bladder cancer in eight patients, prostate cancer in four patients, ureteral cancer in three patients, and non-urological cancer in seven patients. The causes of stenosis were extrinsic compression in eleven patients, and intrinsic stenosis due to direct invasion of the bladder tumor or ureteral tumor in ten patients. The median overall survival after stent placement was 101 days. The stent patency rate was 86％ in all patients, and by cause, extrinsic stenosis was 100％ and intrinsic stenosis was 80％, respectively. The stainless mesh ureteral stent can be placed by the same methods as before, and useful not only for extrinsic stenosis but also intrinsic stenosis due to direct invasion.

  In laparoscopic sacrocolpopexy, the proximal end of the mesh is fixed to the anterior longitudinal ligament on the disc between L5 and S1. However, it may be dangerous and difficult to fix the mesh to that point in cases of anatomical abnormality of large blood vessels. In our department, we have performed mesh fixation at the level of S1 or S2 since beginning laparoscopic sacrocolpopexy in 2013. The reason is that the vaginal axis becomes more physiological, and it is easy to obtain the flap valve effect that helps prevent recurrence of the prolapse. In addition, even in the presence of an anatomical abnormality, safe mesh fixation is possible at the level of the sacral spine. Even for surgeons who perform mesh fixation on the intervertebral disc, it may be useful to know about mesh fixation at the level of the sacral spine as an option when fixation at the same site is difficult.