Acta Urologica Japonica

Robot-assisted laparoscopic radical prostatectomy (RARP) is becoming the standard treatment procedure for localized prostate cancer. The main complications associated with RARP include urinary incontinence and sexual dysfunction. In addition, acute urinary retention (AUR) after urethral catheter removal is sometimes seen. Early catheter removal is a risk factor for AUR, and administration of alphablockers before catheter removal reduces the occurrence of AUR. However, the ideal management of AUR after RARP is not known. Here we report the clinical course and treatment after AUR. We performed 279 RARPs at our institution, and AUR developed in 11 cases. In all cases, urination status was improved after placement of a urinary catheter or intermittent catheterization. Later, urethral stricture was seen in 2 out of 11 cases. Ourstudy suggests that when AUR is observed afterRARP, catheterur ination should be initially performed. If urinary retention recurs, a urinary catheter should be placed with administration of alpha-blockers. The catheter is removed after about 3 days, and administration of analgesics is effective for reducing the pain on urination. If urination status is not improved, evaluation of the urethral stricture should be considered.

Kosuke Ogawa

Yousuke Shimizu

Shoko Uketa

Noriaki Utsunomiya

Sojun Kanamaru

Hinyokika Kiyo

[Clinical Course and Treatment of Acute Urinary Retention after Robot- Assisted Laparoscopic Radical Prostatectomy : A Single Institution Experience of 11 Cases].

机器人辅助腹腔镜根治性前列腺切除术后急性尿潴留的临床过程与治疗：11例单中心经验。

From April 2007 to April 2018, we performed lymph node dissection in 305 cases of laparoscopic radical prostatectomy and 202 cases of robot-assisted radical prostatectomy at our hospital, and there were 68 cases with positive lymph node metastasis (pN1). Of these 68 cases, we examined retrospectively 62 cases in which extended lymph node dissection (ELND) was performed. The median number of removed lymph nodes was 25 (interquartile range [IQR] ; 18-34) and the median number of metastatic lymph nodes was 1 (IQR ; 1-3). Postoperative prostate-specific antigen (PSA) recurrence was observed in 40 of the 62 patients. The median time to PSA recurrence was 24 months. After univariate analysis, PSA at initial diagnosis (iPSA) of 10 ng/ml or more, pathological Gleason score (pGS) of 8 or more, total number of lymph node metastases of 2 or more, and positive surgical margin (RM＋) were found to be riskfactors of PSA recurrence. In multivariate analysis, iPSA of 10 ng/ml or more, pGS of 8 or more and RM＋ were independent riskfactors of PSA recurrence (p＜0.05). In the cases without riskfactors such as iPSA≥10, pGS≥8, and RM＋, immediate postoperative adjuvant therapy may be avoided even with pN1.

Ritsuki Yamaguchi

Shiori Murata

Hidetoshi Kokubun

Noriyuki Makita

Yohei Abe

Masashi Kubota

Naofumi Tsutsumi

Yoshio Sugino

Takuya Okada

Koji Inoue

Mutushi Kawakita

[Risk Factors for Recurrence in Patients with Pathological Lymph Node-Positive Prostate Cancer after Extended Lymph Node Dissection in Laparoscopic and Robotic-Assisted Radical Prostatectomy].

[腹腔镜和机器人辅助根治性前列腺切除术后行扩大淋巴结清扫的病理淋巴结阳性前列腺癌患者复发风险因素]

We retrospectivelyevaluated postoperative inguinal hernias (PIHs) after robot-assisted radical prostatectomy(RARP) with a technique for preventing hernias byspermatic cord isolation. Among the RARPs performed from 2016 to 2018, 191 cases were evaluated 12 or more months after surgery. In all the cases, the peritoneum was isolated from the spermatic cord by5 cm or more as a hernia prevention technique during RARP. We compared the background factors between PIH-positive and PIH-negative groups. The PIH-positive group had a significantlylower bodymass index (BMI) than the PIH-negative group (20.6 kg/m2 vs 23.8 kg/m2, p＝0.0079), but there were no significant differences in other background factors. When patients were classified into three groups byBMI, low (＜21.9 kg/m2), intermediate (21.9 to 25.5 kg/m2), and high (＞25.5 kg/m2), the rate of PIH was 8.5% for the low group, 2.1% for the intermediate group, and 0% for the high group. Our findings suggest that incidences of inguinal hernias after the preventive technique of spermatic cord isolation in RARP, and the BMIs tended to be low in the hernia cases.

Hiroyuki Shikuma

Hideki Mochizuki

Naofumi Nomura

Ryo Tasaka

Daiki Murata

Shinya Ohara

Masao Kato

Koji Mita

[Postoperative Inguinal Hernia after Robot-Assisted Radical Prostatectomy with Prevention Technique Using Spermatic Cord Isolation].

[机器人辅助根治性前列腺切除术后腹股沟疝及采用精索隔离技术的预防措施]

To identify which patients will have difficulty during morcellation in holmium laser enucleation of the prostate (HoLEP), we analyzedthe association of preoperative factors with morcellation efficiency retrospectively. Between March 2015 andMay 2019, 129 patients with benign prostatic hyperplasia (BPH) underwent HoLEP at our institution. Based on the morcellation efficiency (morcellation volume per minute), they were classifiedinto easy (≥3 g/min, n＝81) andd ifficult (＜3 g/min, n＝48) groups. In patients who underwent computed tomography (CT) before the surgery, CT values of the prostatic adenomas were measured. The preoperative parameters were comparedbetween the two groups. Comparedwith the easy group, the morcellation time in the difficult group was significantly longer (median, 11 vs 18.5 min, ＜0.001), though prostate volume was not significantly different (median, 76.3 vs 69.3 ml, p＝0.116). The body mass index (BMI) was significantly lower in the difficult group (median, 23.2 vs 21.9 kg/m2, p＝0.007), andit was positively correlatedwith morcellation efficiency. The difference between the maximum andaverage CT values tended to be lower in the difficult group (median, 43.6 vs 39.2 HU, p＝0.066), andit was positively correlatedwith BMI andmorcellation efficiency. Morcellation appearedto be difficult in BPH patients with low BMI because of the homogeneous hardness of prostatic adenoma.

Naoto Takaoka

Naoki Terada

Go Kobori

Yuzuru Megumi

Seiji Moroi

Factors Predicting Difficulty of Morcellation during Holmium Laser Enucleation of the Prostate

预测钬激光前列腺剜除术中剜除难度因素的研究

Retrograde ureterorenoscopic lithotripsy is one of the first-line therapies for urolithiasis. In some cases, however, thisapproach may be difficult to adopt because of factorss uch asrenal/ureteral anatomic abnormalities or urinary diversion. This study aims to investigate the safety and efficacy of retrograde ureterorenoscopic lithotripsy in patients with the above-mentioned conditions. We retrospectively investigated all such patients who underwent retrograde ureterorenoscopic lithotripsy from May 2009 to December 2019 at our hospital. Stone freewas defined as the total absence of residual fragments, and successwasdefined asthe absence of hydronephrosisand residual fragmentsgreater than 4 mm at the end of 4 weeks. Complications were classified according to the modified Clavien-Dindo classification system. Twenty-one procedureswere performed in 19 patientswhos e conditionswere horseshoe kidney, ureteral duplex, cross-fused renal ectopia, cutaneous ureterostomy, ileal conduit, ureterocystoneostomy, and cystostomy. The median age was 67 (40-93) years, the median stone diameter was 9.6 (5.0-16.0) mm, the median operation time was 63 (12-158) minutes, and the complete stone-free rate and success rate were 42.9 and 71.4%, respectively. The complication rate was 19.0% ; however, no serious complications were observed. In conclusion, retrograde ureterorenoscopic lithotripsy is an effective and safe procedure for patientss uffering from urolithiasis with renal/ureteral anatomic abnormalitiesor previousurinary diversion.

Shinya Somiya

Toru Kanno

Toshifumi Takahashi

Katsuhiro Ito

Yoshihito Higashi

Hitoshi Yamada

Efficacy and Safety of Retrograde Ureterorenoscopic Lithotripsy for Patients with Renal or Ureteral Anatomic Abnormalities or Urinary Diversion

逆行输尿管软镜碎石术治疗肾或输尿管解剖异常或尿流改道患者的疗效和安全性

Miyazaki Urological Cancer Database (MUCD) is a web-based database containing background, treatment, and prognosis of patients with prostate, renal, and urothelial cancers diagnosed in Miyazaki. We entered information on patients diagnosed with urothelial carcinoma from 2014 to 2018 at 4 of the 17 facilities that diagnose urothelial carcinoma in Miyazaki Prefecture. We analyzed the overall survival for bladder cancer and upper urinary tract cancer, and examined its correlation with the presence of symptoms, urine cytology, and clinical TNM classification. There were 487 patients with urothelial carcinoma, comprising 372 (76%) with bladder cancer and 115 (24%) with upper tract urinary cancer. In the bladder cancer group, 301 (81%) patients had symptomatic disease and 119 (32%) had positive urine cytology. The stage according to the TNM classification was Ta-1N0, T2-4N0, N1-2M0 and M1 in 248 (67%), 94 (26%), 19 (5%) and 11 (3%) patients, respectively. In the upper urinary tract cancers group, 89 (76%) had symptomatic disease and 41 (36%) had positive urine cytology. The stage according to the TNM classification was Ta-1N0, T2-4N0, N1-2M0 and M1 in 45 (39%), 37 (32%), 11 (10%) and 22 (19%) patients, respectively. The 3-year survival rates for bladder and upper urinary tract cancer were 83.4% and 67.8%, respectively. TNM classification (≤T1 vs ≥T2≥) was significantly associated with overall survival (bladder cancer : HR＝7.07, 95% CI＝3.13-16.0, p＜0.0001 ; upper tract urinary cancer : HR＝6.33, 95% CI＝2.13-18.8, p＝0.0009). The prognosis of patients with urothelial carcinoma diagnosed in multiple institutions could be evaluated using MUCD. The clinical T stage was significantly associated with overall survival in patients with bladder cancer and patients with upper urinary tract cancer.

Shoichi Kimura

Isamu Otsuka

Tomoya Kimura

Yukiya Fujisaki

Ko Okabe

Takahiro Akioka

Masato Fujii

Chie Onizuka

Takeshi Yamazaki

Kentaro Kuroiwa

Shoichiro Mukai

Toshiyuki Kamoto

A Cohort Study on the Prognosis of Patients with Urothelial Carcinoma Using the Miyazaki Urological Cancer Database (MUCD)

基于宫崎泌尿系统癌症数据库（MUCD）的尿路上皮癌患者预后队列研究

We retrospectively analyzed 134 patients (male, n＝84 ; female, n＝50) with bladder tamponade at a regional hospital. The median age was 84.9 years. Half the patients had been prescribed antithrombotic medication. Bladder tamponade was a result of bacterial cystitis in 50 patients (37%), urinary cancer in 31 patients (23%), benign prostatic hyperplasia (BPH) in 14 patients (10%), iatrogenic injury in nine patients (7%), radiation cystitis in six patients (4%) and others in 25 patients (19%). The most common cause of bladder tamponade was bacterial cystitis. In female patients, 64% had bacterial cystitis and 42% used diapers. Of the patients with bacterial cystitis, 80% experienced dysuria. Patients with bladder tamponade had a high rate of antithrombotic drug use. Dysuria and antithrombotic drugs aggravate bladder tamponade. In an aging society, the number of patients with dysuria and antithrombotic drug use is increasing. We believe that proper urination management and involvement in the regional urination social network will decrease the number of patients with bladder tamponade.

Kaori Ozawa

Kazuya Yuhara

Hiroto Kotaka

Analysis of Bladder Tamponade at a Regional Hospital

地区医院膀胱填塞分析

Patients who contract severe renal infections often suffer from urosepsis. Therefore, early diagnosis and treatment are required. Sometimes, the treatment with antibiotics is not enough for control of the infections. Most of the patients also require surgical interventions including transurethral drainage and nephrectomy. Twenty-two patients with severe renal infections treated between April 2010 and October 2019 at our institute were evaluated retrospectively. Eleven patients had undergone nephrectomy. Open nephrectomy was performed on 10 patients. Laparoscopic nephrectomy was attempted in the other patient but was converted to open nephrectomy because severe adhesion was found around the tissues. Nephrectomy was performed by the retroperitoneal approach on 9 patients and by the transperitoneal approach on 2 patients. The reteroperitoneal approach was used on two patients who suffered postoperative colon perforation. Inflammatory involvement of renal pelvis, hilum and adjacent structures leads to dense fibrotic reaction and obliteration of tissue planes, which makes the nephrectomy procedure challenging. Therefore, it is important to choose the most appropriate nephrectomy procedure for each patient when they have contracted severe renal infections.

Yuki Oda

Shunta Hori

Nobutaka Nishimura

Takanori Yoshida

Toshitaka Uematsu

Chihiro Ohmori

Makito Miyake

Satoshi Anai

Kazumasa Torimoto

Katsuya Aoki

Nobumichi Tanaka

Tatsuo Yoneda

Kiyohide Fujimoto

Retrospective Analysis of Severe Renal Infections Requiring Nephrectomy to Control Infection

回顾性分析需切除肾脏控制感染的重度肾感染病例

Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) is expected to be useful in preventing oversight of non-muscle-invasive bladder cancer (NMIBC) and in reducing the intravesical recurrence rate after transurethral resection of bladder tumor (TURBT). We report our initial experience with28 cases of PDD-assisted TURBT (122 samples) performed at our hospital from February 2018 to April 2019. The median age of the patients was 74.5 years, and 18 of the 28 were primary cases. Each patient underwent TURBT with oral administration of 5-ALA 20 mg/kg 3 hours before endoscopic examination. The sensitivity was 89.8% when both white light and blue light were used, which was superior to the sensitivity of 67.8% when using only white light (p＜0.01, McNemar's test). Among the first several cases, we experienced high false positivity, which suggested that some experience may be required to discriminate tumors from inflammatory lesions. In fact, the specificity and the positive likelihood ratio improved with experience. No grade 2 or higher adverse events were observed among our cases. The median follow-up period was 738 days, and 9 of 28 patients (32. 1%) had recurrence within the follow-up period. In conclusion, our initial experience with PDD-assisted TURBT demonstrated its excellent diagnostic sensitivity and safety, as previously reported.

Yusuke Sugino

Kouhei Nishikawa

Momoko Kato

Takeshi Sasaki

Manabu Kato

Satoru Masui

Yuko Yoshio

Hideki Kanda

Yoshiki Sugimura

Takahiro Inoue

[Initial Experience of Photodynamic Diagnosis-Assisted Transurethral Resection of Bladder Tumor (PDD-TURBT)].

[光动力诊断辅助膀胱肿瘤经尿道切除术的初步经验(PDD-TURBT)]。

Partial nephrectomy (PN) for small renal tumors has become increasingly common. Complications of PN include renal artery pseudoaneurysm (PA), a potentially life-threatening condition. However, the true incidence and natural history of PA after PN remain unclear. Therefore, we conducted a retrospective study of the radiographic characteristics of robotic-assisted partial nephrectomy (RAPN) observed during the postoperative period. We selected 36 consecutive patients with renal carcinoma who underwent RAPN at our institution between December 2016 and May 2019. Patients with contraindications for the use of contrast medium were excluded. A total of 31 eligible patients underwent computed tomography angiography (CTA) during the early postoperative period after RAPN and the incidence of PA was evaluated. Among the patients with PASs, asymptomatic PAs were followed without intervention and their clinical course was assessed using CTA at 1 to 3 months postoperatively. PA was identified in 5 out of 31 (16.1%) patients after RAPN. Median duration between PN and the first CTA was 6 days (range, 1-8). Median PA size was 13 mm (range, 8-17). All (100%) PAs were asymptomatic and resolved spontaneously, as verified by CTA during the late postoperative period. Median duration between identification of PA on early postoperative CTA and subsequent resolution was 92 days (range, 35-106). Our findings indicated that asymptomatic PA after PN can be followed without intervention.

Yuya Yamada

Haruka Banno

Hiroshi Fujiwara

Kensuke Hikami

Masakazu Nakashima

Masahiro Tamaki

Noriyuki Ito

[Spontaneous Resolution of Renal Artery Pseudoaneurysm after Robotic-Assisted Partial Nephrectomy].

[机器人辅助部分肾切除术后肾动脉假性动脉瘤的自发消退]

ISSN	0018-1994
h-index	16

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+5d/bs	e+/GRg: Editorial Board of Acta Urologica Japonica，uzYam8: ，dxwaWB: journal，8x2mMQ: TY4X7V
ak9yM6	A7IHrH: 1962，sQJ/D8: 0.00%，sE9og+:N.A.， wzlKC/: 0.00%

Acta Urologica Japonica

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[Clinical Course and Treatment of Acute Urinary Retention after Robot- Assisted Laparoscopic Radical Prostatectomy : A Single Institution Experience of 11 Cases].

[Risk Factors for Recurrence in Patients with Pathological Lymph Node-Positive Prostate Cancer after Extended Lymph Node Dissection in Laparoscopic and Robotic-Assisted Radical Prostatectomy].

[Postoperative Inguinal Hernia after Robot-Assisted Radical Prostatectomy with Prevention Technique Using Spermatic Cord Isolation].

Factors Predicting Difficulty of Morcellation during Holmium Laser Enucleation of the Prostate

Efficacy and Safety of Retrograde Ureterorenoscopic Lithotripsy for Patients with Renal or Ureteral Anatomic Abnormalities or Urinary Diversion

A Cohort Study on the Prognosis of Patients with Urothelial Carcinoma Using the Miyazaki Urological Cancer Database (MUCD)

Analysis of Bladder Tamponade at a Regional Hospital

Retrospective Analysis of Severe Renal Infections Requiring Nephrectomy to Control Infection

[Initial Experience of Photodynamic Diagnosis-Assisted Transurethral Resection of Bladder Tumor (PDD-TURBT)].

[Spontaneous Resolution of Renal Artery Pseudoaneurysm after Robotic-Assisted Partial Nephrectomy].