Publications by authors named "Hideto Iwamoto"

41 Publications

Impact of penile rehabilitation with phosphodiesterase-5 inhibitors on recovery of erectile function in patients undergoing robot-assisted radical prostatectomy: A propensity score-matched analysis.

Int J Urol 2021 Mar 4. Epub 2021 Mar 4.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.

Objective: To investigate the impact of penile rehabilitation on the recovery of erectile function after robot-assisted radical prostatectomy.

Methods: Patients who underwent robot-assisted radical prostatectomy in our department from 2010 to 2019 were included. For penile rehabilitation, a phosphodiesterase-5 inhibitor (tadalafil 20 mg) was administered twice a week for 1-6 months postoperatively. The International Index of Erectile Function questionnaire (question 1 and erectile function domain) and the Expanded Prostate Cancer Index Composite questionnaire (sexual function) were used.

Results: After propensity score matching, there were 79 patients in the penile rehabilitation group and 79 patients in the non-penile rehabilitation group. There was no significant difference in baseline characteristics between the two groups. Significantly higher scores were seen in the penile rehabilitation group compared with the non-penile rehabilitation group at postoperative 3, 6 and 9 months in the International Index of Erectile Function questionnaire-question 1, at 3, 6, 9 and 12 months in erectile function domain, and at 3, 6, 12 and 24 months in Expanded Prostate Cancer Index Composite questionnaire sexual function (P < 0.05). There were significant improvements in the erectile recovery rate in the penile rehabilitation group compared with the non-penile rehabilitation group in the nerve sparing (P = 0.006) and partial nerve sparing (P = 0.037) groups.

Conclusions: The present findings suggest that robot-assisted radical prostatectomy patients who undergo not only nerve sparing, but also those who undergo patial nerve sparing could benefit from penile rehabilitation using a phosphodiesterase-5 inhibitor.
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http://dx.doi.org/10.1111/iju.14527DOI Listing
March 2021

Complete response to chemotherapy in Burkitt's Lymphoma of the Bladder: A case report.

Urol Case Rep 2020 Nov 11;33:101298. Epub 2020 Jun 11.

Department of Urology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.

We report a case of a 87-year-old woman with a Burkitt's Lymphoma of the Bladder. She presented with hematuria. Cystoscopy, computed tomography and magnetic resonance imaging revealed extramural invasion of a 6-cm-sized tumor that extended from the right wall to the neck of the bladder. The histological pattern was Burkitt's lymphoma. The patient was then treated by chemotherapy. The tumor disappeared after 4 cycles of chemotherapy. The urogenital tract has been described in the literature as a primary tumor location in cases of non-Hodgkin's lymphoma, however, it is rarely the tumor site in Burkitt's lymphoma cases.
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http://dx.doi.org/10.1016/j.eucr.2020.101298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573840PMC
November 2020

Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy.

BMC Urol 2020 Oct 21;20(1):164. Epub 2020 Oct 21.

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Japan.

Background: In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP).

Methods: Retrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed.

Results: A total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02-1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18-0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18-0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP.

Conclusions: The data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.
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http://dx.doi.org/10.1186/s12894-020-00740-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579942PMC
October 2020

Effects of nerve-sparing procedures on bowel function after robot-assisted radical prostatectomy: A longitudinal study.

Int J Med Robot 2020 Dec 8;16(6):1-10. Epub 2020 Oct 8.

Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan.

Background: This study aimed to evaluate rectal pain and bowel function of the patients following robot-assisted radical prostatectomy (RARP).

Methods: We divided 296 patients who underwent RARP into two groups depending on the intervention: NS (nerve-sparing) group (bilateral NS, unilateral NS and bilateral partial NS) and non-NS group (unilateral partial NS, bilateral non-NS). Bowel function was assessed using the Extended Prostate Cancer Index Composite for 24 months after RARP.

Results: The bowel function score and rectal urgency at 1-6 months after RARP were more significantly impaired in the non-NS group than in the NS group (p < 0.05). In a multivariate analysis of factors affecting the bowel function score at 6 months after RARP, only NS procedure had a significant effect.

Conclusions: In the initial period after RARP, bowel symptoms were significantly impaired. This impairment was affected by the degree of NS. These results could guide patients in their decision to choose RARP.
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http://dx.doi.org/10.1002/rcs.2156DOI Listing
December 2020

Splice variants of lysosome‑associated membrane proteins 2A and 2B are involved in sunitinib resistance in human renal cell carcinoma cells.

Oncol Rep 2020 Nov 4;44(5):1810-1820. Epub 2020 Sep 4.

Division of Experimental Pathology, Faculty of Medicine, Tottori University, Yonago, Tottori 683‑8503, Japan.

Sunitinib, a tyrosine kinase inhibitor, is among the first‑line treatments for metastatic or advanced stage renal cell carcinoma (RCC). However, patients with RCC develop resistance to sunitinib. We have previously demonstrated that lysosome‑associated membrane protein 2 (LAMP‑2), which has three splice variants with different functions (LAMP‑2A, LAMP‑2B, and LAMP‑2C), is involved in RCC. In the present study, we examined which splice variants of LAMP‑2 contributed to sunitinib resistance in RCC cells. In vitro analysis using ACHN, human RCC cell line, revealed that the IC50 of sunitinib was significantly increased by overexpression of LAMP‑2A and LAMP‑2B, but not LAMP‑2C (P<0.01). Kaplan‑Meier survival analysis using clinical samples revealed an association between shorter survival and high expression of LAMP‑2A and LAMP‑2B, but not LAMP‑2C, in patients with RCC treated with sunitinib (P=0.01). Furthermore, high expression of LAMP‑2A and LAMP‑2B in RCC revealed a weak to moderate inverse correlation with the tumor shrinkage rate and progression‑free survival, respectively. Thus, high expression of LAMP‑2A and LAMP‑2B contributed to the acquisition of sunitinib resistance, indicating that the expression of these two variants can predict the efficacy of sunitinib treatment in patients with RCC.
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http://dx.doi.org/10.3892/or.2020.7752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551029PMC
November 2020

Oncological outcomes of a multicenter cohort treated with axitinib for metastatic renal cell carcinoma.

Cancer Sci 2020 Jul 12;111(7):2460-2471. Epub 2020 Jun 12.

Department of Urology, Hokkaido University Hospital, Sapporo, Japan.

The present study aimed to evaluate the efficacy of the real-world use of axitinib and to develop a prognostic model for stratifying patients who could derive long-term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with 1 or 2 systemic antiangiogenic therapy regimens at 1 of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split-sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following 4 variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil : lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model's favorable risk group might derive a long-term survival benefit from axitinib treatment.
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http://dx.doi.org/10.1111/cas.14449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385391PMC
July 2020

Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer.

Int J Clin Oncol 2020 Jul 24;25(7):1398-1404. Epub 2020 Apr 24.

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.

Background: We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection.

Methods: We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels ≥ 0.2 ng/mL; BCR-free survival rates were determined using Kaplan-Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR.

Results: Median follow-up was 27.9 (range 6.1-86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826-17.925; P < 0.001) and Gleason score (GS) ≥ 8 (HR 2.612; 95% CI 1.051-6.489; P = 0.039) were significant predictors of BCR. Patients with 1 or 2 positive LNs (n = 10) had significantly higher BCR-free survival rates than patients with ≥ 3 positive LNs (n = 5). We, therefore, stratified the patients as low-risk (GS < 8 and no positive LNs), intermediate-risk: (either GS ≥ 8 or positive LNs) and high-risk (both GS ≥ 8 and positive LNs). Their 1-year BCR-free survival rates were low-risk: 94.6%, intermediate-risk: 88.5%, and high-risk: 33.3% (P < 0.05).

Conclusions: Patients with 1-2 positive LNs and GS < 8 have low risk for BCR; close observation without immediate adjuvant hormonal therapy can be considered for these patients.
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http://dx.doi.org/10.1007/s10147-020-01682-1DOI Listing
July 2020

Health Related Quality of Life in Japanese Patients with Localized Prostate Cancer: Comparative Retrospective Study of Robot-Assisted Laparoscopic Radical Prostatectomy Versus Radiation Therapy.

Yonago Acta Med 2020 Feb 30;63(1):55-62. Epub 2020 Jan 30.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information such as the patient's age, performance status, and complications, but also the impact on quality of life (QOL) after treatment.

Our purpose was to compare health related quality of life (HRQOL) after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy in Japanese patients with localized prostate cancer retrospectively.

Methods: Patients with localized prostate cancer receiving RARP or radiotherapy at Tottori University Hospital between October 2010 and December 2014 were enrolled in a retrospective observational study with follow-up for 24 months to December 2016. The Medical Outcome Study 8-Item Short-Form Health Survey was performed before treatment and 1, 3, 6, 12, and 24 months post-treatment.

Results: Complete responses to the questionnaire were obtained from 154/227 patients receiving RARP, 41/67 patients receiving intensity-modulated radiation therapy, 35/82 patients receiving low dose rate brachytherapy, and 18/28 patients given low dose rate brachytherapy plus external beam radiation therapy. The median physical component summary score of the Medical Outcome Study 8-Item Short-Form Health Survey was significantly lower at 1 month after prostatectomy than radiotherapy, but was similar for both treatments at 3 months, and was significantly higher at 6, 12 and 24 months after prostatectomy. The median mental component summary score was also significantly lower in the prostatectomy group at 1 month, but not from 3 months onwards.

Conclusion: Our study suggested that HRQOL was inferior at 1 month after RARP, however, recovered at 3 months after RARP and was better than after radiotherapy at 6, 12, and 24 months.
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http://dx.doi.org/10.33160/yam.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028529PMC
February 2020

Postoperative inguinal hernia after robotic-assisted radical prostatectomy for prostate cancer: evaluation of risk factors and recommendation of a convenient prophylactic procedure.

Cent European J Urol 2019 6;72(4):418-424. Epub 2019 Dec 6.

Tottori University Faculty of Medicine, Department of Urology, Tottori, Japan.

Introduction: The aim of this article is to evaluate the risk factors and recommend a prophylactic procedure for preventing inguinal hernia (IH) after robotic assisted radical prostatectomy (RARP) without extra products and operative time.

Material And Methods: A total of 279 patients (558 groins) who underwent RARP at our institution from October 2010 to December 2015 were retrospectively reviewed. Age, body mass index, prostate-specific antigen, clinical T stage, prostate volume, console time and the dilatation of internal inguinal ring were evaluated as the risk factors of IH. We also investigated whether the different incision procedures of the peritoneum around the medial side of the internal inguinal ring, 'proximal incision' or 'distal incision', were related to the occurrence of IH.

Results: Postoperative IH occurred in 39 (7.5%) of 558 groins. The dilatation of the internal inguinal ring was observed in 89 of 558 (15.9%) groins. The proximal and distal incision group included 296 groins (52.8%) and 262 groins (47.2%), respectively. Univariate and multivariate analyses revealed the right side (P = 0.041), the dilatation of internal inguinal ring (P <0.01) and the distal incision (P <0.01) were significant risk factors for postoperative IH. Furthermore, the proximal incision significantly reduced the risk of postoperative IH regardless of the dilatation of internal inguinal ring.

Conclusions: The dilatation of the internal inguinal ring represents an important risk factor for IH after RARP. However, incising the peritoneum sufficiently close to the medial edge of the internal inguinal ring can prevent postoperative IH without extra products and time.
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http://dx.doi.org/10.5173/ceju.2019.0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979555PMC
December 2019

Sarcopenia as a significant predictive factor of neutropenia and overall survival in urothelial carcinoma patients underwent gemcitabine and cisplatin or carboplatin.

Int J Clin Oncol 2020 Jan 13;25(1):158-164. Epub 2019 Sep 13.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Tottori, 683-8504, Japan.

Background: To evaluate the relationship between sarcopenia and myelosuppression or between sarcopenia and survival outcomes in patients with urothelial carcinoma (UC) undergoing chemotherapy with gemcitabine plus cisplatin (GC) or carboplatin (GCa).

Methods: We evaluated 80 patients with UC who underwent chemotherapy between 2013 and 2017 at our institution. In total, 53 patients had metastatic UC and were ultimately included in the study. Predictive factors for myelosuppression (neutropenia, thrombocytopenia, and anemia) in all patients and overall survival (OS) in metastatic UC patients were analyzed. Sarcopenia was assessed on computed tomography before chemotherapy. Each patient's total psoas area was measured at the lumbar vertebrae (L3) and sarcopenia was defined as median values or lower. Predictive factors for myelosuppression were assessed using logistic regression analysis and survival was evaluated using Cox regression analysis.

Results: The patients' mean age was 71.6 years (range 44.4-89.2 years). Of the initial 80 patients, 39 were diagnosed with sarcopenia and 26 of 53 patients with metastatic UC were diagnosed with sarcopenia. Sarcopenia was an independent predictive factor (P = 0.030; odds ratio, 3.526; 95% confidence interval [CI] 1.128-11.01) for neutropenia on multivariate analysis. Patients without sarcopenia had a significantly longer OS compared to those with sarcopenia (P = 0.013). Sarcopenia and albumin (P = 0.045, 0.023; hazard ratio (HR), 2.309, 2.652; 95% CI 1.021-5.225, 1.141-6.165, respectively) were independent predictors of OS in multivariate analysis.

Conclusions: Sarcopenia was predictive for neutropenia associated with GC or GCa in UC patients and OS in metastatic UC.
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http://dx.doi.org/10.1007/s10147-019-01544-5DOI Listing
January 2020

The circadian rhythm of bladder clock genes in the spontaneously hypersensitive rat.

PLoS One 2019 25;14(7):e0220381. Epub 2019 Jul 25.

Division of Urology, Tottori University Faculty of Medicine, Yonago, Japan.

Circadian expression rhythms of clock gene products in the bladder are reportedly hindered by clock gene abnormalities. However, the role of clock gene products in various pathological lower urinary tract conditions is unknown. The present study examined the relationship between clock genes and voiding dysfunction in spontaneous hypertensive rats (SHR). The voluntary voiding behavior study using metabolic cages was performed in 18-weeks old male Wistar rats (control group, n = 36) and SHR (SHR group, n = 36) under 12-h light/12-h dark conditions. Bladders were harvested every 4 h at six time points (n = 6 for each time point for each group), and we analyzed the messenger RNA (mRNA) expression of several clock genes: period 2 (Per2), cryptochrome 2 (Cry2), brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 (Bmal1), circadian locomotor output cycles kaput (Clock), nuclear receptor subfamily 1, group D, member 1 (Rev-erbα), mechanosensors: transient receptor potential vanilloid channel 1 (TRPV1), TRPV4, Piezo1, and vesicular nucleotide transporter (VNUT) using real-time polymerase chain reaction. Though 24-h urination frequency for both light and dark periods was significantly higher in the SHR group, urine volume per voiding was significantly lower versus control. In controls, urine volume per voiding was significantly lower during the dark period (active phase) than the light period (rest phase); this parameter did not significantly differ between active and rest phases for SHR. SHR bladders showed significantly higher expression of Cry2 and Clock during the active phase compared to controls. In the SHR group, TRPV1, TRPV4, Piezo1, and VNUT mRNA levels were significantly higher during the active phase compared to the control group. We speculate that Cry2 and Clock may be contributing factors in the decrease of bladder capacity during the active phase in SHR through increase of TRPV1, TRPV4, Piezo1, and VNUT expression, but further research will be necessary to elucidate the precise mechanisms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220381PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658119PMC
March 2020

Flutamide as an Alternative Anti-androgen Agent and Predictor of the Efficacy of Novel Androgen Receptor-targeted Agents.

Anticancer Res 2019 Jul;39(7):3879-3885

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Background/aim: There are few reports that verify the relationship between the therapeutic effects of flutamide and novel androgen receptor-targeted agents. We aimed to evaluate the benefits of flutamide as an alternative anti-androgen agent and its effects on the efficacy of novel androgen receptor-targeted agents.

Patients And Methods: Patients with castration-resistant prostate cancer on novel androgen receptor-targeted agents without prior docetaxel therapy were included. Changes in prostate-specific antigen (PSA) level were recorded.

Results: Patients who responded well to flutamide (Flutamide effective) following initial maximum androgen blockade (MAB) showed significantly higher changes in serum PSA levels (p=0.039) and PSA-progression-free survival (PFS) rate (p=0.016) following enzalutamide therapy compared to those who did not respond well to flutamide. Multivariate analysis showed that the factor of Flutamide effective was significantly associated with a good PSA-PFS rate following enzalutamide therapy (HR=7.36, 95%CI=1.4-38.71, p=0.018).

Conclusion: Patients showing good response to flutamide following initial MAB may achieve a satisfactory PSA-PFS rate with subsequent enzalutamide therapy.
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http://dx.doi.org/10.21873/anticanres.13538DOI Listing
July 2019

Peri-operative efficacy and long-term survival benefit of robotic-assisted radical cystectomy in septuagenarian patients compared with younger patients: a nationwide multi-institutional study in Japan.

Int J Clin Oncol 2019 Dec 23;24(12):1588-1595. Epub 2019 May 23.

Department of Urology, Tokushima University Graduate School, Tokushima, Japan.

Background: To determine the peri-operative safety and oncological value of robotic-assisted radical cystectomy (RARC) for older and younger patients in an initial Japanese RARC series.

Methods: We retrospectively analyzed the demographics, complications, peri-operative and oncological outcomes of 253 consecutive patients with bladder cancer who underwent RARC at 34 institutions in Japan between April 2009 and March 2017. The patients were assigned to groups according to ages at surgery of < 70 (younger; n = 125) and ≥ 70 (older; n = 128) years.

Results: Mean Charlson comorbidity index (p = 0.045) and the incidence of a history of previous abdominal surgery (p = 0.002) were significantly higher, whereas a history of neoadjuvant chemotherapy (p = 0.028) and neobladder (p < 0.001) were significantly lower in the older group. Mean total operative time was significantly shorter (p = 0.019) and mean estimated blood loss (p = 0.013) was significantly lower in the older group. Post-operative Grade ≥ II complications were comparable at 0-30, 31-90 and 91 days after surgery despite urinary tract associations. Rates of positive surgical margins and mean numbers of removed lymph nodes were comparable between the two groups. Although 5-year overall survival rates were significantly lower (p = 0.03) for older patients, 5-year cancer-specific (p = 0.10) and recurrence-free survival rates were comparable (p = 0.20) between the groups.

Conclusion: Using RARC potentially allows the application of less invasive procedures and cancer control for septuagenarian patients that are equivalent to those for younger patients.
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http://dx.doi.org/10.1007/s10147-019-01470-6DOI Listing
December 2019

Longitudinal study on the impact of urinary continence and sexual function on health-related quality of life among Japanese men after robot-assisted radical prostatectomy.

Int J Med Robot 2019 Aug 12;15(4):e2018. Epub 2019 Jun 12.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan.

Background: The aim of this study is to investigate the impact of robotic-assisted radical prostatectomy (RARP) on the health-related quality of life (HRQOL).

Methods: We prospectively reviewed HRQOL parameters using Short-Form Health Survey, patient self-reporting of urinary incontinence and International Index of Erectile Function, among patients who underwent RARP between 2010 and 2016.

Results: Among 249 men studied, all had significantly worse HRQOL domain scores at 1 month post operatively but 24 months after surgery, all domains reached or surpassed their baseline values. Only Bodily Pain, General Health, Role-Emotional, Mental Health domains, and Mental Health Composite were significantly improved. Improvement in urinary continence was mirrored by improvements in both Mental and Physical Component Scores.

Conclusions: Within a 2-year post-operative period, men who underwent RARP had regained their overall quality of life. The recovery of urinary continence significantly impacted the mental, physical, emotional, and social well-being of those patients.
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http://dx.doi.org/10.1002/rcs.2018DOI Listing
August 2019

The significance of predictable traumatic area by renorrhaphy in the prediction of postoperative ipsilateral renal function.

Cent European J Urol 2018 22;71(1):64-71. Epub 2017 Jan 22.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan.

Introduction: To determine the relationship between the actual renal function loss and volume loss in robot-assisted partial nephrectomy (RAPN) using a novel three-dimensional volume analyzer.

Material And Methods: We respectively evaluated the medical records of 23 consecutive patients who underwent RAPN between January 2012 and March 2016 and the data on their kidney function and parenchymal mass specific to the operated kidney. Parenchymal volume was measured by computerized tomography and reconstructed with a Synapse Vincent volumetric analyzer. Using this system, we predicted the renal vascular territory and other trauma areas involved in renorrhaphy. All measurements were taken within 3 and 6 months pre- and postoperatively, respectively.

Results: The actual postoperative renal parenchymal volume was significantly correlated with the virtual predicted residual renal volume excluding the tumor and resected margin (r = 0.435, p <0.05). The ratio of split estimated glomerular filtration rate (eGFR) postoperative/preoperative) was significantly correlated with the virtual predicted residual renal volume excluding the resected margin and the traumatic area by renorrhaphy (r = 0.401, p <0.05).

Conclusions: When predicting the reduction of renal function of the diseased side following partial nephrectomy, adding the extent of the area traumatized by renorrhaphy might be useful for predicting the postoperative split renal function of the affected kidney.
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http://dx.doi.org/10.5173/ceju.2018.1557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926639PMC
January 2017

Lysosome-associated membrane protein 2 (LAMP-2) expression induced by miR-194-5p downregulation contributes to sunitinib resistance in human renal cell carcinoma cells.

Oncol Lett 2018 Jan 15;15(1):893-900. Epub 2017 Nov 15.

Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan.

Sunitinib is a tyrosine kinase inhibitor that is used as the primary treatment in metastatic renal cell carcinoma (RCC). The main difficulty associated with its use is the development of drug resistance. In the present study, ACHN cells, a human renal cell carcinoma cell line, were used to establish sunitinib-resistant (SR) cells. Microarray analysis and reverse transcription-quantitative polymerase chain reaction revealed that miR-194-5p expression was significantly decreased in SR-ACHN cells when compared with that observed in ACHN cells (P<0.05). Transfection of miR-194-5p, though not with negative control miR, in SR-ACHN cells could significantly inhibit cell proliferation following sunitinib treatment (2.5-40 µM; P<0.05). Western blotting demonstrated that the expression of lysosome-associated membrane protein-2 (LAMP-2), which attenuates the anti-proliferative effect of sunitinib, was significantly higher in SR-ACHN than in ACHN cells (P<0.01). In addition, LAMP-2 expression was suppressed by miR-194-5p transfection in SR-ACHN cells. These data suggested that miR-194-5p downregulation may be associated with sunitinib resistance via the induction of LAMP-2 expression in human RCC.
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http://dx.doi.org/10.3892/ol.2017.7423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772808PMC
January 2018

Influence of multinerve-sparing, robot-assisted radical prostatectomy on the recovery of erection in Japanese patients.

Reprod Med Biol 2018 01 10;17(1):36-43. Epub 2017 Oct 10.

Department of Urology Tottori University Faculty of Medicine Yonago Japan.

Purpose: To evaluate in Japanese patients their sexual function after robot-assisted radical prostatectomy (RARP) and to investigate the influence of the multinerve-sparing (NS) grade on their sexual function.

Methods: In total, 225 patients were reviewed with localized prostate cancer who underwent RARP at the authors' institution. They underwent RARP >3 months ago, without pre- and posthormone therapy and salvage radiation. Self-administered International Index of Erectile Function (IIEF) questionnaires were used for assessment preoperatively and 1-48 months postoperatively. In all, 129 patients were evaluated with the preoperative IIEF-Question 1 and who achieved a score of ≥2 by being divided into five NS groups. The recovery rates of erection (postoperative IIEF-Question 1 score of ≥2) were calculated by using the Kaplan-Meier analysis.

Results: Seventy-four percent of all the patients had not attempted sexual intercourse, but 60% had felt sexual desire at 24 months postoperatively. In those patients with a preoperative erection, the recovery rate of erection was 58% at 24 months after the RARP. Across the five NS groups, as the procedure was more nerve-sparing, the recovery rate of erection became significantly higher. The postoperative effects on erection in the bilateral and unilateral NS groups were significantly superior to those in the other NS groups.

Conclusion: In Japanese patients, erection after a RARP is improved with multiNS grade procedures.
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http://dx.doi.org/10.1002/rmb2.12063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768978PMC
January 2018

Comprehensive Analysis of Factors Affecting Post-partial Nephrectomy Renal Global Function.

Yonago Acta Med 2017 06 26;60(2):94-100. Epub 2017 Jun 26.

†Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: To explore new factors that are predictive of post-partial nephrectomy (PN) renal global function, we analyzed various clinico-pathological factors with a special focus on renal volume measured via three-dimensional imaging technology and histopathological parameters in non-neoplastic parenchyma.

Methods: Estimated glomerular filtration rate (eGFR) and computed tomography (CT) scan were examined pre- and 6 months. post-operatively in 52 patients treated by PN. The post-operative percent eGFR decline was employed as the measure of global renal functional deterioration. The novel factors analyzed included the percent renal parenchymal volume decline of the diseased side, contralateral and bilateral sides and the global glomerulosclerosis (GS) extent in non-neoplastic parenchyma. Renal parenchymal volumetry by CT scan was performed using SYNAPSE VINCENT (Fujifilm). Additional factors analyzed included patient demographics and comorbidities, surgical factors and tumor pathology. All factors demonstrating significant tendencies ( < 0.1) in univariate analyses were subjected to multivariate logistic regression analysis.

Results: Two groups were categorized according to the degree of eGFR decline. Groups A and B were categorized as less than 15% and greater than 15% decline, respectively. Pre-operative eGFR was significantly lower in group B than in group A. Greater than 10% global GS extent in non-neoplastic parenchyma, male gender and proteinuria were significantly more frequent in in group B than in group A. The renal volume change was not statistically significant. In multivariate logistic regression analysis, greater than 10% global GS extent in non-neoplastic parenchyma was the sole independent affecting factor for Group B.

Conclusion: Our study suggested that host factors rather than surgical factors may be useful for the prediction of post-PN renal global function. The evaluation of the global GS extent in non-neoplastic parenchyma is a promising biomarker of post-PN renal global function.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502220PMC
June 2017

Identification of MicroRNAs Involved in Resistance to Sunitinib in Renal Cell Carcinoma Cells.

Anticancer Res 2017 06;37(6):2985-2992

Division of Pathological Biochemistry, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Science, Tottori University, Tottori, Japan.

Aim: To generate sunitinib-resistant renal cell carcinoma (RCC) cell lines and identify miRNAs contributing to sunitinib resistance.

Materials And Methods: Two RCC cell lines, ACHN and RCC23, were cultured by continuous treatment with sunitinib for 3 months, with doses gradually increasing up to the 50% inhibitory concentration for each cell line. We performed microarray and quantitative real-time polymerase chain reaction analyses of sunitinib-resistant ACHN (SR-ACHN) and RCC23 (SR-RCC23) cells, as well of as sunitinib-sensitive ACHN and RCC23 cells.

Results: SR-ACHN and SR-RCC23 cells exhibited significantly higher resistance to sunitinib treatment compared to sunitinib-sensitive cells. SR-ACHN and SR-RCC23 cells were hypertrophic and contained granules in the cytoplasm. When SR-ACHN and SR-RCC23 cells were compared to ACHN and RCC23 cells, expression of miR-575, miR-642b-3p, and miR-4430 was significantly increased, while that of miR-18a-5p, miR-29b-1-5p, miR-431-3p, and miR-4521 was significantly decreased.

Conclusion: These miRNAs may contribute to sunitinib resistance in humans.
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http://dx.doi.org/10.21873/anticanres.11652DOI Listing
June 2017

Biochemical Recurrence Prediction in High-Risk Prostate Cancer Patients, Following Robot-Assisted Radical Prostatectomy.

Yonago Acta Med 2016 Dec 26;59(4):288-295. Epub 2016 Dec 26.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: High-risk prostate cancer treatment has been controversial. Some high-risk prostate cancer patients fail to respond to radical prostatectomy only. Thus, we aimed to investigate the predictive factors for biochemical recurrence (BCR) and identify patients who could achieve sufficient therapeutic effect by radical prostatectomy only.

Methods: Of 264 medical records reviewed, 141 low-intermediate-risk and 100 high-risk prostate cancer patients, excluding those who had received neoadjuvant hormone therapy, were analyzed. BCR was defined as the first increase in prostate-specific antigen levels (≥ 0.2 ng/mL), with levels not decreasing to undetectable limits, after radical prostatectomy. Log-rank test and Cox proportional hazards regression analyses were performed to determine the prognostic factors. We investigated the perioperative predictive factors for BCR and BCR-free survival rates, with the number of National Comprehensive Cancer Network (NCCN) high-risk factors for high-risk prostate cancer patients who underwent robot-assisted radical prostatectomy.

Results: Multivariate analyses showed that clinical T3 was significantly associated with BCR [hazard ratio (HR) = 4.052; 95% confidence interval (CI), 1.26-12.99; = 0.019]. Of the 100 patients, 77 had 1 high-risk factor and 23 had ≥ 2 high-risk factors; the 1-year BCR-free survival rate of patients with 1 high-risk factor and those with ≥ 2 high-risk factors was 94.8% and 69.6%, respectively. Patients with ≥ 2 high-risk factors were significantly associated with BCR ( = 0.002). No difference in BCR rate between patients with 1 high-risk factor and those with low- and intermediate-risk was found.

Conclusion: High-risk prostate cancer patients with 1 NCCN high-risk factor can be considered for robot-assisted radical prostatectomy treatment only.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214695PMC
December 2016

Urothelial Carcinoma Recurrence at an Ileal Orthotopic Neobladder and Unilateral Lower Ureter After Surgery.

Urol Case Rep 2016 Nov 17;9:27-9. Epub 2016 Sep 17.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

The recurrence of urothelial carcinoma in an orthotopic neobladder is rare. We report the case of a 61-year-old man with a muscle-invasive bladder tumor that was treated using radical cystectomy and the creation of a Studer's orthotopic neobladder. However, nine years after the cystectomy, we detected a mass at the left ureteroileal anastomosis. We successfully performed Studer's neobladder resection, urethrectomy, and left nephroureterectomy to remove the entire mass. Pathological examination revealed urothelial carcinoma with adenocarcinoma in the neobladder and adenocarcinomatous metastasis in the mesenteric lymph node.
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http://dx.doi.org/10.1016/j.eucr.2016.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030330PMC
November 2016

Transurethral En Bloc Resection of Bladder Tumor Using an Endoscopic Submucosal Dissection Technique: Preliminary Results in an Animal Model.

Yonago Acta Med 2016 Jun 29;59(2):143-8. Epub 2016 Jun 29.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: Transurethral resection of bladder tumor (TURBT) technique has been considered the routine method for removing most bladder tumors for decades. In contrast, endoscopic submucosal dissection (ESD) is the gold-standard treatment for gastrointestinal superficial tumors. We investigated the effectiveness and applicability of a new technique for en bloc bladder tumor resection using ESD procedure.

Methods: Four Landrace Large White Duroc female pigs were anesthetized with isoflurane prior endoscopic resection using a large-caliber prototype fiber bronchoscope. After local infiltration of the submucosa with sodium hyaluronate using an injector needle, a section of the target area (1.0-2.0 cm diameter circular area) was cut with the Dual Knife.

Results: In total, seven target sections were resected from the pigs. The median size of the resected sections was 1.8 cm (range 1.0-2.5 cm) and the median time taken to perform the resection of one section was 20 min (range 4-35 min). These target sections were completely resected en bloc. Although the small bladder perforations occurred on two occasions, no other short-term complications such as uncontrollable bleeding were observed.

Conclusion: This procedure is a slightly difficult in the pigs with thin bladder walls. However, this procedure with the slim flexible cystoscope may allow us to be able to remove bladder tumors using only light sedation, especially for cases when small tumor recurrence is observed during routine cystoscopy for the patients with non-muscle invasive bladder cancer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973020PMC
June 2016

Robot-assisted radical cystectomy is a promising alternative to open surgery in the Japanese population with a high rate of octogenarians.

Int J Clin Oncol 2016 Aug 20;21(4):756-763. Epub 2016 Jan 20.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Tottori, 683-8504, Japan.

Background: Japanese patients who undergo radical cystectomy have a unique feature, i.e., the ratio of octogenarians is higher than in Western patients because of the aging Japanese population. The purpose of this study was to compare perioperative outcomes, complications, and oncologic outcomes between robot-assisted radical cystectomy and open radical cystectomy.

Methods: From 2010-2015, 20 (of which 8 were octogenarians) and 40 (of which 11 were octogenarians) patients underwent robot-assisted radical cystectomy and open radical cystectomy, respectively.

Results: There was no significant difference in terms of patient demographics between the two surgical cohorts, regardless of patient age. In the octogenarian patient cohort, the rates of previous abdominal surgery and the median age-adjusted Charlson comorbidity index were higher. The median estimated blood loss, transfusion rate and the days to resumption of a regular diet were significantly lower in the robot-assisted radical cystectomy cohort, regardless of patient age. Robot-assisted radical cystectomy significantly decreased grade II or higher complications, but there were no significant differences in terms of decreasing grade III or higher complications, regardless of patient age. Positive surgical margin and the mean number of lymph nodes removed were similar between the two surgical cohorts, regardless of patient age.

Conclusion: Although robot-assisted radical cystectomy has a short history in Japan, the outcomes were generally comparable to those of previous studies. In a country that is aging rapidly like Japan, robot-assisted radical cystectomy could be a valid option for the management of muscle-invasive and high-risk superficial bladder cancer.
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http://dx.doi.org/10.1007/s10147-016-0950-8DOI Listing
August 2016

Characterization of mild and severe post-radical nephrectomy renal functional deterioration utilizing histopathological evaluation of non-neoplastic nephrectomized renal parenchyma.

Int J Clin Oncol 2016 Jun 8;21(3):588-94. Epub 2015 Oct 8.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, 683-8504, Japan.

Background: We investigated factors affecting mild (MRFD) and severe renal functional deterioration (SRFD) after radical nephrectomy with a special focus on the histopathology of nephrectomized non-neoplastic renal parenchyma.

Methods: MRFD was defined as a postoperative decline of percent estimated glomerular filtration rate (eGFR) lower than the value of the mean minus standard deviation (SD). SRFD was defined as a rate greater than the value of the mean plus SD. The histopathological factors of global glomerulosclerosis (GS) and arteriosclerosis in non-neoplastic renal parenchyma and multiple clinical factors were analyzed to determine whether they affected postoperative renal functional deterioration in 100 renal cell carcinoma cases. The prognoses, including non-cancer mortality, were collected from long-term follow-up data.

Results: A higher preoperative eGFR and a higher global GS extent in non-neoplastic renal parenchyma were independently associated with MRFD and SRFD, respectively. The cardiovascular disease-specific survival rates of the SRFD group and the group with global GS extent >14 % were significantly worse than those of their counterparts.

Conclusions: This is the first report to identify global GS extent in nephrectomized non-neoplastic renal parenchyma as a factor affecting the development of life-threatening post-nephrectomy renal functional deterioration. Moreover, we are the first to advocate the importance of the characterization of favorable post-nephrectomy renal functional deterioration. The identification of MRFD and SRFD by histopathological evaluation of nephrectomized non-neoplastic renal parenchyma will contribute to personalized postoperative follow-up. It may improve follow-up of individual patients with SRFD by permitting collaboration with other clinical departments such as cardiology.
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http://dx.doi.org/10.1007/s10147-015-0909-1DOI Listing
June 2016

The Utility of the Remnant Kidney Volume/Body Surface Area Ratio and Tumor Diameter as Predictors of Postoperative Degree of Renal Functional Decline in Patients With Renal Cell Carcinoma Treated by Radical Nephrectomy.

Urology 2015 Aug 17;86(2):307-11. Epub 2015 Jul 17.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Objective: To characterize the preoperative factors affecting renal cell carcinoma patients as predictive of post-radical nephrectomy (RN) mild (M-decline) or severe (S-decline) renal functional decline and to elucidate the histopathologic features of the resected normal kidney cortex, as well as the occurrence of cardiovascular disease (CVD) in both M-decline and S-decline patients.

Materials And Methods: M-decline and S-decline were categorized as a percentage of postoperative estimated glomerular filtration rate decline of <20 and of >40, respectively. The preoperative factors analyzed were patient demographics, comorbidities, and radiographic findings, including remnant kidney status and tumor size. The factors based on postoperative information analyzed were tumor and normal cortex pathology and CVD events.

Results: In 175 patient cohort, 21 and 32 cases were categorized as M-decline and S-decline, respectively. Absence of comorbidities, larger remnant kidney volume (RKV)/body surface area (BSA) ratio, and larger tumor diameter were significantly predictive of M-decline, whereas smaller tumor diameter was significantly predictive of S-decline. The global glomerulosclerosis extent in nephrectomized normal cortex of S-decline cases was significantly higher than in other types of cases. No CVD event was observed in M-decline cases.

Conclusion: This is the first report to identify the RKV/BSA ratio as a promising predictor of post-RN degree of renal functional decline. Post-RN prevention of life-threatening outcomes according to preoperative and postoperative information, including the degree of post-RN renal functional decline and histopathology of the nephrectomized normal cortex, should be considerable in future urological tasks.
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http://dx.doi.org/10.1016/j.urology.2015.04.030DOI Listing
August 2015

High neutrophil-to-lymphocyte ratio predicts poor clinical outcome in patients with castration-resistant prostate cancer treated with docetaxel chemotherapy.

Int J Urol 2015 Sep 18;22(9):827-33. Epub 2015 Jun 18.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Objective: To evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio in patients receiving chemotherapy with docetaxel for castration-resistant prostate cancer.

Methods: A total of 57 castration-resistant prostate cancer patients treated between 2009 and 2014 were included in the present retrospective study. All patient data, including clinicopathological factors, were assessed. Univariate and multivariate Cox regression models were used to predict overall survival and progression-free survival after chemotherapy initiation.

Results: The median overall survival and progression-free survival were determined as 19.0 months (range 1-61 months) and 10.0 months (range 1-56 months), respectively. The cut-off level of the neutrophil-to-lymphocyte ratio was set as the median value of 3.5 among all patients in this study. In Kaplan-Meier analysis, the median overall survival and progression-free survival were shorter in patients with a high neutrophil-to-lymphocyte ratio compared with those with a low neutrophil-to-lymphocyte ratio (15 vs 20 months, P = 0.0125; and 9.5 vs 15 months, P = 0.0132, respectively). The overall survival and progression-free survival periods in patients with a high neutrophil-to-lymphocyte ratio were significantly shorter than those of patients with a low neutrophil-to-lymphocyte ratio (P = 0.0178 and 0.0176, respectively). In the multivariate analysis, a high neutrophil-to-lymphocyte ratio was an independent predictor of overall survival and progression-free survival (hazard ratio 2.728, 95% confidence interval 1.05-7.09, P = 0.039; and hazard ratio 2.376, 95% confidence interval 1.12-5.06, P=0.024, respectively).

Conclusion: The present study results suggest that the neutrophil-to-lymphocyte ratio is a useful prognostic factor in patients with castration-resistant prostate cancer treated by docetaxel chemotherapy. These findings might be useful in determining treatment strategies in the future.
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http://dx.doi.org/10.1111/iju.12839DOI Listing
September 2015

Robot-assisted radical prostatectomy in an initial Japanese series: the impact of prior abdominal surgery on surgical outcomes.

Int J Urol 2015 Mar 25;22(3):278-82. Epub 2014 Nov 25.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.

Objectives: To evaluate the influence of prior abdominal surgery on surgical outcomes of robot-assisted radical prostatectomy in an early single center experience in Japan.

Methods: We reviewed medical records of patients with localized prostate cancer who underwent robot-assisted radical prostatectomy from October 2010 to September 2013 at Tottori University Faculty of Medicine, Yonago, Tottori, Japan. Patients with prior abdominal surgery were compared with those with no prior surgery with respect to total operative time, port-insertion time, console time, positive surgical margin and perioperative complication rate. Furthermore, the number of patients requiring minimal adhesion lysis was compared between the two groups.

Results: Of 150 patients who underwent robot-assisted radical prostatectomy, 94 (63%) had no prior abdominal surgery, whereas 56 patients (37%) did. The mean total operative time was 329 and 333 min (P = 0.340), mean port insertion time was 40 and 34.5 min (P = 0.003), mean console time was 255 and 238 min (P = 0.145), a positive surgical margin was observed in 17.9% and 17.0% patients (P = 0.896), and the incidence of perioperative complications was 25% and 23.4% (P = 0.825), respectively, in those with and without prior abdominal surgery. In the prior abdominal surgery group, 48 patients (80.4%) required adhesion lysis at the time of trocar placement or while operating the robotic console.

Conclusion: Robot-assisted radical prostatectomy appears to be a safe approach for patients with prior abdominal surgery without increasing total operative time, robotic console time, positive surgical margin or the incidence of perioperative complications.
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http://dx.doi.org/10.1111/iju.12678DOI Listing
March 2015

Anatomical dimensions using preoperative magnetic resonance imaging: impact on the learning curve of robot-assisted laparoscopic prostatectomy.

Int J Urol 2015 Jan 11;22(1):74-9. Epub 2014 Sep 11.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Objective: To evaluate the impact of anatomical dimensions as measured using preoperative magnetic resonance imaging on the outcomes of robot-assisted laparoscopic prostatectomy.

Methods: We retrospectively reviewed 100 consecutive robot-assisted laparoscopic prostatectomy procedures that were carried out by a single surgeon at the Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. Preoperative clinical data and anatomical measurements, including the calculated prostate volume pelvic cavity index, were determined based on preoperative magnetic resonance imaging, and their effects on console time, estimated blood loss and surgical margin status were compared.

Results: Body mass index, the prostate anteroposterior diameter, and the prostate volume-to-pelvic cavity index ratio were all significantly correlated with console time and estimated blood loss, based on a univariate analysis (P < 0.05). The prostate craniocaudal diameter, prostate transverse diameter and prostate volume also correlated with console time. However, based on the multiple linear regression analysis, only the prostate volume-to-pelvic cavity index ratio was found to be a significant predictor of console time and estimated blood loss. Furthermore, when the 100 total cases were divided into 50 early cases and 50 late cases, the prostate volume-to-pelvic cavity index ratio correlated with console time and estimated blood loss only in the early group, and not in the late group. In contrast, anatomical measurements had no significant effect on surgical margin status.

Conclusion: Magnetic resonance imaging can be a valuable adjunct to robot-assisted laparoscopic prostatectomy. Our data show that patients with larger prostates and narrow, deep pelvises might present more difficulty in robot-assisted laparoscopic prostatectomy procedures. However, the present data also show that this problem can be overcome by an experienced operator with improved surgical techniques.
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http://dx.doi.org/10.1111/iju.12602DOI Listing
January 2015

The Efficacy of Target Biopsy of Suspected Cancer Lesions Detected by Magnetic Resonance Imaging and/or Transrectal Ultrasonography during Initial Prostate Biopsies: Comparison of Outcomes between Two Physicians.

Yonago Acta Med 2014 Mar 28;57(1):53-8. Epub 2014 Apr 28.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori 683-8504, Japan.

Background: The efficacy of adding target prostate biopsy (PBx) of suspected cancer lesions identified on magnetic resonance imaging (MRI) and/or transrectal ultrasonography (TRUS) to initial systematic PBx was evaluated. Moreover, the outcomes were compared between 2 physicians.

Methods: We retrospectively investigated 238 patients who underwent first-time PBx in our hospital. All patients were examined with prostate MRI before PBx. Fourteen systematic biopsies were obtained in all patients. When a suspected lesion was present on MRI and/or TRUS, the lesion was the target of target PBx.

Results: The overall detection rate of prostate cancer (PCa) was 45% (106/238). With target PBx, the PCa detection rate was 32% overall, while that of suspected lesions seen only on MRI was 32%, that of suspected lesions seen only on TRUS was 8% and that of suspected lesions seen on both MRI and TRUS was 52%. The same tendency was shown for each physician. Comparing systematic PBx and target PBx, the overall rate of Gleason score (GS) upgrading with target PBx was 13%. The rate of PCa detected only by systematic PBx was 95%. There was no significant difference between the 2 physicians.

Conclusion: In initial PBx, the addition of target PBx of suspected cancer lesions detected by MRI and/or TRUS to systematic PBx might not be useful to improve the cancer detection rate. However, it may enable more accurate risk classification and detection of minute cancers with a high GS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110692PMC
March 2014