Publications by authors named "Issei Suzuki"

34 Publications

Spontaneous regression of multiple pulmonary metastases accompanied by normalization of serum immune markers following cytoreductive nephrectomy in a patient with clear-cell renal cell carcinoma.

IJU Case Rep 2021 Mar 26;4(2):95-99. Epub 2020 Dec 26.

Department of Urology Dokkyo Medical University Shimotsuga Tochigi Japan.

Introduction: The spontaneous regression of metastases, which mostly occurs after surgical resection of the primary tumor, has been described in various malignancies, including renal cell carcinoma. The involvement of the host immune system is currently postulated as the underlying mechanism.

Case Presentation: We present a case of metastatic clear-cell renal cell carcinoma that achieved complete spontaneous regression of multiple pulmonary metastases preceded by normalization of serum immune markers after cytoreductive nephrectomy. The patient remained disease free for 3 years without any systemic therapy, suggesting that postoperative normalization of serum immune markers may indicate recovery of the host immune system, which prevents tumor recurrence.

Conclusion: Monitoring of serum immune markers may be useful to identify patients with recovered immune function and, therefore, may not require systemic therapy. Similarly, the case suggests a potential role of cytoreductive nephrectomy in the contemporary management of metastatic renal cell carcinoma.
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http://dx.doi.org/10.1002/iju5.12252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924083PMC
March 2021

Utility of whole-body diffusion-weighted magnetic resonance imaging in the management of treatment-related neuroendocrine prostate cancer.

IJU Case Rep 2021 Mar 29;4(2):69-73. Epub 2020 Nov 29.

Department of Urology Dokkyo Medical University Tochigi Japan.

Introduction: Treatment-related neuroendocrine prostate cancer, a rare and aggressive malignancy that emerges during androgen deprivation therapy characterized by low serum prostate-specific antigen concentrations, is challenging to monitor because it is associated with predominantly visceral and lytic bone metastases.

Case Presentation: We describe the case of a 69-year-old man with treatment-related neuroendocrine prostate cancer in whom the treatment response could be monitored using whole-body diffusion-weighted magnetic resonance imaging in addition to serum concentrations of neuroendocrine markers. The patient responded well to platinum-based chemotherapy and achieved a complete response, as evidenced by these diagnostic modalities.

Conclusion: Our case suggests that whole-body diffusion-weighted magnetic resonance imaging is useful in disease management for treatment-related neuroendocrine prostate cancer as well as the potential evaluation of mixed responses and treatment resistance.
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http://dx.doi.org/10.1002/iju5.12242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924092PMC
March 2021

[Simple Methods to Prevent Postoperative Inguinal Hernia after Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2020 Oct;66(10):331-335

The Department of Urology, Kobe City Medical Center General Hospital.

Herein we present simple methods to prevent postoperative inguinal hernia (IH) after extraperitoneal and transperitoneal robot-assisted radical prostatectomy (RARP). Among 275 patients who underwent RARP between January 2014 and December 2016 at our institution, we evaluated 143 and 115 patients who underwent extraperitoneal-RARP (e-RARP) and transperitoneal-RARP (t-RARP), respectively, after excluding those with intraoperative detection of IH (17 patients). In the e-RARP group, all 143 patients (286 groins) underwent an IH prevention procedure. In the t-RARP group, the first 22 patients (44 groins) did not undergo an IH prevention procedure, whereas 29 patients (37 groins) with patent processus vaginalis (PPV) among the last 93 patients underwent the procedure. The IH prevention procedure during e-RARP included release of the vas deferens from the peritoneum and spermatic cord, and peritoneal dissection of the spermatic cord at the internal inguinal ring. The IH prevention procedure during t-RARP included release of the vas deferens from the peritoneum and spermatic cord, complete circumferential dissection of the peritoneum around the PPV at the level of the internal inguinal ring, and ligation of the PPV with a Hem-o- Loc○R clip. In the e-RARP group, postoperative IH occurred in 3 of the 143 patients (1.9%) during the follow-up period of 22.0±9.2 months. In the first subgroup of t-RARP, postoperative IH developed in 4 of the 22 patients (18%) during the follow-up period of 33.1±12.1 months, whereas in the last t-RARP group, postoperative IH developed in 3 of the 93 patients (3.3%) during the follow-up period of 20.1±8.6 months. Different IH prevention procedures performed in patients undergoing e-RARP and t-RARP were simple and effective in preventing postoperative IH.
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http://dx.doi.org/10.14989/ActaUrolJap_66_10_331DOI Listing
October 2020

Effect of Continued Perioperative Anticoagulant Therapy on Bleeding Outcomes Following Robot-assisted Radical Prostatectomy.

Urology 2021 Feb 25;148:151-158. Epub 2020 Nov 25.

Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan.

Objective: To assess the impact of continued perioperative anticoagulant drug administration on bleeding and complications in patients undergoing robot-assisted radical prostatectomy.

Methods: Between January 2014 and January 2020, 620 patients with prostate cancer underwent robot-assisted radical prostatectomies and were retrospectively reviewed. Fourteen patients who discontinued antithrombotic therapy were excluded. Among the 606 included patients, 31 continued anticoagulant therapy during the perioperative phase (anticoagulant group). The anticoagulant group outcomes were compared with those of patients who continued clopidogrel and prasugrel (thienopyridine group = 13), aspirin monotherapy (aspirin group = 61), and no chronic antithrombotic agent (control group = 501). The primary outcome was the incidence of bleeding complications requiring transfusion, additional intervention, or readmission. Secondary outcomes were the incidence of thrombotic complications, estimated blood loss, and overall complication rates.

Results: Among the 31 patients in the anticoagulant group, 20 (65%) used directed oral anticoagulants, 11 (35%) used warfarin, and 5 used combined aspirin. Only 1 (3%) patient in the anticoagulant group required postoperative transfusion, and none required additional interventions or readmission. No significant differences were detected between the anticoagulant and other groups (anticoagulant vs thienopyridine, aspirin, and control groups) regarding bleeding complications (3% vs 8%, P = .51; 0%, P = .34; 0.4%, P = .17, respectively), thrombotic complications (3% vs 0%, P = .70; 2%, P = .56; 0.2%, P = .11, respectively), estimated blood loss (200 vs 100 mL, P = .63; 175 mL, P = .64; 165 mL, P = .74, respectively), or other high-grade complications (6% vs 0%, P = .49; 2%, P = .26; 3%, P = .24, respectively).

Conclusion: Perioperative continuation of anticoagulant use is feasible for patients undergoing robot-assisted radical prostatectomy.
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http://dx.doi.org/10.1016/j.urology.2020.08.095DOI Listing
February 2021

[Necessity of Pelvic Drain Placement after Robot-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2020 Sep;66(9):283-287

The Department of Urology, Kobe City Medical Center General Hospital.

Sixty eight patients had robot-assisted radical prostatectomy (RARP) from January 2016 to April 2017 with estimated blood loss of less than 500 ml. We compared the postoperative complication rates and the length of hospital stay between 34 of these patients who had pelvic drain placement (PD group), and the remaining 34 patients who had no drain placement (ND group). The approach was intraperitoneal in 25 patients in each group. The PD and ND groups were comparable for age (69.5 vs 70 yrs, P=0.459), clinical Gleason Score (6/7/≧8) 2/17/15 vs 3/8/23 (P=0.077), clinical stage (1c/2/3) 3/25/6 vs 1/25/8 (p=0. 539), operative time (311 vs 309 min, P=0.868), and estimated blood loss (p=0.166). The PD group had significantly higher median PSA level than the ND group (8.01 vs 6.25 ng/ml, P=0.023). Incidence of 30- day overall complications in the PD group (35 events) was lower than that in the ND group (38 events). All complications were classified as Clavien Dindo grade I. The postoperative hospital stay was 8 days in the PD group and 7 days in the ND group, showing no prolongation in the ND group. Pelvic drainage may be omitted after RARP without increasing postoperative complications or prolonging the hospital stay.
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http://dx.doi.org/10.14989/ActaUrolJap_66_9_283DOI Listing
September 2020

Case of prostate stromal tumour of uncertain malignant potential where positron emission tomography with 18F-fluorodeoxyglucose was useful for surgical planning.

BMJ Case Rep 2020 Sep 10;13(9). Epub 2020 Sep 10.

Urology, Dokkyo Medical University, Shimotsuga, Tochigi, Japan.

Stromal tumour of uncertain malignant potential of the prostate is a rare tumour with a variable clinical behaviour ranging from incidentally detected indolent tumours that never progress, to aggressive diseases almost identical to sarcomas that may invade surrounding organs or develop metastases. Surgical excision is generally recommended for local diseases; however, owing to its diverse clinical outcomes, optimal management may vary from surgery alone to wide excision combined with chemotherapy and/or radiotherapy. Therefore, preoperative evaluation of the malignant potential of the disease is essential to decide the treatment strategy. Herein, we report a case of stromal tumour of uncertain malignant potential successfully treated with minimally invasive robot-assisted radical prostatectomy alone under the diagnosis of the disease with low malignant potential based on the findings of positron emission tomography with 18F-fluorodeoxyglucose.
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http://dx.doi.org/10.1136/bcr-2020-235738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484856PMC
September 2020

Atypical oncologic failure after laparoscopic and robot-assisted radical cystectomy at a single institution.

Int J Clin Oncol 2020 Jul 18;25(7):1385-1392. Epub 2020 Apr 18.

Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.

Background: The incidence of atypical oncologic failure in patients with bladder cancer, including peritoneal carcinomatosis, and recurrences at the port site and soft tissue after laparoscopic and robot-assisted radical cystectomy are not well characterized.

Methods: We retrospectively reviewed the records of 52, 51, and 12 patients who underwent open, laparoscopic, and robot-assisted radical cystectomy, respectively, for bladder cancer from 2007 to 2018 at our institution. We identified techniques associated with atypical oncologic failure.

Results: The median follow-up period was 29 months. Among the 115 patients, 29 (25%) experienced oncological recurrences, and 7 (6%), 12 (10%), and 23 (20%) had atypical, local, and distant recurrences, respectively. The laparoscopic and robot-assisted radical cystectomy groups had significantly higher incidences of total atypical oncologic failure than the open radical cystectomy group (p = 0.013), including six, one, and two patients with peritoneal carcinomatosis, port site carcinomatosis, and soft tissue involvement, respectively. All 7 patients with atypical oncologic failure died of cancer; the median time from surgery to death was 9.3 months. All these patients were cT ≧ 3 and had grade 3 disease. In three patients (43%), the pathological tissue contained variants other than urothelial carcinoma. Five (71%) were among the initial twenty patients. Four patients (57%) had histories of intraoperative urine spillage or bladder perforation during transurethral resection.

Conclusions: Patients with cT ≧ 3 stage, with pathological variants other than urothelial carcinoma, and those undergoing procedures that lead to extravesical dissemination should avoid laparoscopic radical cystectomy when the procedures are first introduced.
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http://dx.doi.org/10.1007/s10147-020-01677-yDOI Listing
July 2020

Surgical outcomes and learning curve of totally intracorporeal ileal conduit urinary diversion following laparoscopic radical cystectomy at a single institution.

Asian J Endosc Surg 2020 Oct 28;13(4):532-538. Epub 2020 Feb 28.

Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan.

Introduction: Constant evaluation of the outcomes of laparoscopic intracorporeal urinary diversion is not yet established. This study aimed to describe surgical outcomes and learning curve of intracorporeal ileal conduit (ICIC) following laparoscopic radical cystectomy (LRC) at a single institution.

Methods: From June 2012 to February 2018, 38 patients with bladder cancer underwent LRC with ileal conduit at our institution. Surgical outcomes were compared between ICIC (n = 30) and extracorporeal ileal conduit (ECIC) (n = 8). The learning curve during ICIC with regard to the operative time and complication rate was compared.

Results: No significant differences in patient characteristics between the ICIC and ECIC groups were found. Comparison of outcomes between the ICIC and ECIC groups were as follows: median total operative time, 688 vs 713 minutes; urinary diversion time, 213 vs 192 minutes; and estimated blood loss, 450 vs 420 mL, respectively. The median time to walking and oral intake were similar in both groups. Rates of high-grade complications associated with urinary diversion (Clavien-Dindo grade ≥ III) were 3% in ICIC and 25% in ECIC. Although 25% of ECIC patients developed wound dehiscence (Clavien-Dindo grade IIIb), no patient in the ICIC group had postoperative wound infection. For the learning curve of ICIC (n = 30), urinary diversion time decreased significantly (27 minutes decrease per 10 cases, P = .02). Clavien-Dindo grade ≥ II complication did not occur after 20 cases.

Conclusions: LRC with ICIC could be performed safely with low incidence of severe wound infection compared with ECIC. The incidence and severity of complications also decreased with time.
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http://dx.doi.org/10.1111/ases.12793DOI Listing
October 2020

Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy.

Asian J Urol 2020 Jan 8;7(1):24-28. Epub 2019 Oct 8.

Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan.

Objective: To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy.

Methods: From May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP.

Results: Median (range) data were as follows: Patient age, 65 (19-82) years; radiographic tumor size, 30 (12-95) mm; operating time, 166 (102-294) min; warm ischemic time, 16 (7-67) min; and blood loss, 15 (0-4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3-7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%).

Conclusion: RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.
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http://dx.doi.org/10.1016/j.ajur.2019.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962716PMC
January 2020

Selective Monoarylation of Aromatic Ketones via C-H Bond Cleavage by Trialkylphosphine Ruthenium Catalysts.

J Org Chem 2019 Oct 1;84(20):12975-12982. Epub 2019 Oct 1.

Department of Chemistry, Faculty of Science and Technology , Keio University , 3-14-1 Hiyoshi , Kohoku-ku, Yokohama , Kanagawa 223-8522 , Japan.

A catalyst system consisting of RuHCl(CO)(PPr), CsF, and a styrene derivative was found to be applicable to selective monoarylation of aromatic ketones via ortho C-H bond cleavage. The reaction of 2'-methoxyacetophenone with arylboronates gave C-H arylation products without cleaving the ortho C-O bond. Acetophenone was also converted to monoarylation products with high selectivity. Cyclohexanone was found to be an effective solvent for the C-H arylation using the catalyst system.
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http://dx.doi.org/10.1021/acs.joc.9b01756DOI Listing
October 2019

[Traumatic Adrenal Injury : A Single-Institution Experience].

Hinyokika Kiyo 2019 Jul;65(7):271-275

The Department of Urology, Kobe City Medical Center General Hospital.

Traumatic adrenal injury is quite rare. From January 2008 to March 2018, out of 287 patients with genitourinary trauma, 23 patients (8%) were diagnosed with traumatic adrenal injury at Kobe City Medical Center General Hospital. We retrospectively reviewed the medical records and assessed the traumatic category, image findings and outcome. All 23 patients were bluntly injured. The causes of traumatic adrenal injury were motor vehicle accident (11 patients : 48%) and falls (9 patients : 39%). The majority of injuries occurred on the right side (18 patients : 78%). Associated injuries occurred in all 23 patients, most frequently in the liver (57%) and ribs (57%). Extravasation of contrast materials was identified on computed tomography (CT) in 4 patients (17%). Although 22 patients (96%) were conservatively managed, only 1 patient was treated by transcatherter arterial embolization because of hypotension. One patient died of intraabdominal bleeding. To our knowledge, the present study is the largest on traumatic adrenal injury in Japan.
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http://dx.doi.org/10.14989/ActaUrolJap_65_7_271DOI Listing
July 2019

Comparison of perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy: Comparative outcomes of cT1a versus cT1b renal tumors.

Int J Urol 2019 09 30;26(9):885-889. Epub 2019 Jun 30.

Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Objectives: To assess the perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy for cT1b renal tumors compared with cT1a.

Methods: From February 2015 to May 2018, 100 robot-assisted partial nephrectomy patients who underwent robot-assisted partial nephrectomy without renorrhaphy for renal tumors were included. We retrospectively reviewed the medical records, and compared the perioperative outcomes of 66 and 34 patients for cT1a and cT1b tumors, respectively. Inner suture was carried out in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft-coagulation system was used, and absorbable hemostats were placed on the resection bed.

Results: The median tumor size and RENAL nephrometry score were significantly different between the two groups (cT1a vs cT1b: 23.5 vs 45 mm, P < 0.001, 6 vs 8, P < 0.001). The median operating time and warm ischemic time were significantly longer in the cT1b group than in the cT1a group (154 vs 184 min, P < 0.001; 14 vs 21 min, P < 0.001). The median blood loss was not significantly different (2.5 vs 50 mL, P = 0.109). The positive surgical margin rate was 4.5% versus 11.7% (P = 0.22). Postoperative complications classified as Clavien-Dindo grade III or higher were port-site herniation (one patient), acute cholecystitis (one patient) and pseudoaneurysm (one patient) in the cT1b group. Urinary leakage was not observed in the two groups.

Conclusions: Robot-assisted partial nephrectomy without renorrhaphy using the soft-coagulation system and absorbable hemostats appears to be feasible for renal or cT1b tumors. However, longer warm ischemic time and a high rate of complications can be expected compared with cT1a tumors.
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http://dx.doi.org/10.1111/iju.14046DOI Listing
September 2019

[A Case of Systemic Polyarteritis Nodosa Presenting with Scrotal Pain].

Hinyokika Kiyo 2019 Apr;65(4):127-131

The Department of Urology, Kobe City Medical Center General Hospital.

A 76-year-old man with a history of hypertension was admitted with high fever and left scrotal pain. Laboratory findings revealed high serum C-reactive protein levels. The left epididymis appeared to be swollen on computed tomography. The patient was diagnosed with bacterial epididymitis and treatment with antibiotics was initiated. Despite treatment, his left scrotal pain and fever did not improve. Additionally, he developed right scrotal and posterior neck pain. For histopathological diagnosis, a left high orchiectomy was performed and the findings revealed thickened arteriolar walls with infiltration of inflammatory cells around the testis, leading to a final diagnosis of systemic polyarteritis nodosa. Treatment with steroids led to complete resolution of the patient's systemic pain and inflammation.
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http://dx.doi.org/10.14989/ActaUrolJap_65_4_127DOI Listing
April 2019

[A Case of Renal Oncocytosis with Bilateral Multiple Renal Masses].

Hinyokika Kiyo 2019 Apr;65(4):111-116

The Department of Pathology, Kobe City Medical Center General Hospital.

A 63-year-old man with microscopic hematuria underwent contrast-enhanced CT, which showed multiple bilateral renal masses. Percutaneous biopsy results indicated renal oncocytosis. The tumors remained unchanged for 3 years. Renal oncocytosis is a very rare tumor, but it is an established disease entity characterized by numerous oncocytic tumors and diffuse (sporadic) renal parenchymal epithelial oncocytic changes on an analysis histopathology. Although renal oncocytosis can be sporadic or part of Birt-Hogg-Dube syndrome (BHDS), our case did not associate with BHDS because of absence of lung cyst.
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http://dx.doi.org/10.14989/ActaUrolJap_65_4_111DOI Listing
April 2019

Fulminant type 1 diabetes mellitus induced by pembrolizumab in a patient with urothelial carcinoma: A case report.

Urol Case Rep 2019 May 15;24:100849. Epub 2019 Feb 15.

Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan.

A case of fulminant type 1 diabetes mellitus secondary to administration of pembrolizumab in a patient with urothelial carcinoma is presented. Eight days after the third infusion of pembrolizumab, the patient presented with complaints of malaise and anorexia. The patient's laboratory data showed a blood glucose level of 1092mg/dl with ketonuria and negative for glutamic acid decarboxylase antibody. As leaving ketoacidosis by insulin therapy, pembrolizumab therapy was continued without delay. After administration of another eight infusions of pembrolizumab, the patient's disease was stable without new severe side effects.
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http://dx.doi.org/10.1016/j.eucr.2019.100849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562295PMC
May 2019

A case of Ewing sarcoma family tumor of the kidney treated with robotic-assisted partial nephrectomy.

Urol Case Rep 2019 Jul 2;25:100900. Epub 2019 May 2.

Department of Urology, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.

Ewing sarcoma family tumors (ESFTs) of the kidney represents less than 1% of all renal tumors. A 45-year-old Japanese woman presented with right abdominal pain. Contrast-enhanced computed tomography showed a 12 × 8-cm right cystic renal mass. The mass was diagnosed as cystic renal cell carcinoma (RCC) and right partial nephrectomy was performed. Immunohistochemical studies showed that the tumor was positive for CD99 (membranous staining in tumoral cells), indicating ESFT. The patient is doing well without further therapy after 1 year of follow-up. To our knowledge, this is the first report of renal ESFT mimicking cystic RCC on diagnostic imaging.
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http://dx.doi.org/10.1016/j.eucr.2019.100900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6512745PMC
July 2019

5-Fluorouracil-based adjuvant chemotherapy improves the clinical outcomes of patients with lymphovascular invasion of upper urinary tract cancer and low expression of dihydropyrimidine dehydrogenase.

Oncol Lett 2019 May 28;17(5):4429-4436. Epub 2019 Feb 28.

Department of Urology, Dokkyo Medical University, Tochigi 321-0293, Japan.

Lymphovascular invasion (LVI) by urothelial carcinoma of the upper urinary tract (UC-UUT) is associated with an unfavorable prognosis. However, a high proportion of patients with UC-UUT are unable to receive the recommended doses of cisplatin-based adjuvant chemotherapy due to advanced age or renal dysfunction resulting from nephroureterectomy. Tegafur-uracil is an oral form of 5-fluorouracil whose efficacy is influenced by the activities of enzymes associated with its metabolism, such as dihydropyrimidine dehydrogenase (DPD), orotatephosphoribosyltransferase (OPRT) and thymidylate synthase (TS). The aim of the present study was to investigate the efficacy of adjuvant 5-fluorouracil chemotherapy for UC-UUT with LVI, and to assess the expression of enzymes associated with 5-fluorouracil metabolism as promising biomarkers of therapy efficacy. The present study retrospectively investigated 52 cases of UC-UUT. Following nephroureterectomy, tegafur-uracil was administered to 15 out of 30 patients with LVI who were not eligible for cisplatin-based adjuvant chemotherapy. Levels of and expression in tumor specimens were determined by reverse transcription-quantitative polymerase chain reaction, and their associations with the efficacy of adjuvant 5-fluorouracil chemotherapy were analyzed. The levels of and expression were not associated with pathological factors or outcome, although a higher expression of was associated with a poorer outcome. Adjuvant 5-fluorouracil chemotherapy significantly improved the outcome of patients with lower expression. However, the levels of and expression did not influence therapeutic efficacy. Adjuvant 5-fluorouracil chemotherapy appears to be effective for lymphovascular-invasive UC-UUT in patients with lower expression.
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http://dx.doi.org/10.3892/ol.2019.10086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444440PMC
May 2019

Tunable Direct Band Gap of β-CuGaO and β-LiGaO Solid Solutions in the Full Visible Range.

Inorg Chem 2019 Apr 15;58(7):4262-4267. Epub 2019 Mar 15.

Institute of Multidisciplinary Research for Advanced Materials , Tohoku University , 2-1-1 Katahira , Aoba-ku, Sendai , 980-8577 , Japan.

We synthesized solid solutions of β-CuGaO and β-LiGaO (i.e., β-(CuLi )GaO) by partial ion exchange of Cu in β-CuGaO with Li from LiCl in the composition range of 0 ≤ x ≤ 0.89. The energy band gap of β-CuGaO (1.47 eV) increased linearly up to 3.0 eV with increasing Li content, covering the full visible range. The crystal structures of the solid solutions were analyzed using the Rietveld method. The structural distortions of the solid solutions with respect to the ideal binary wurtzite-type structure were relatively small because of the similar ionic radii of Li, Cu, and Ga. Based on a recently proposed hypothesis relating structural distortion to the nature of the band gap (i.e., direct or indirect), it is expected that the solid solution has a direct band gap. We anticipate that this solid solution system will contribute to the realization of oxide-based optoelectronic devices.
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http://dx.doi.org/10.1021/acs.inorgchem.8b03370DOI Listing
April 2019

The energy level of the Fe-transition in BaTiO and SrTiO single crystals.

Phys Chem Chem Phys 2019 Mar;21(11):6238-6246

Technische Universität Darmstadt, Institute of Materials Science, 64287 Darmstadt, Germany.

An approach to determine the defect energy levels of the Fe impurities in BaTiO3 and SrTiO3 single crystals using electrical conductance measurements is presented. The defect levels are obtained from the dependence of the activation energy of electrical transport on the oxygen vacancy concentration, which is varied by stepwise re-oxidation of a reduced sample. An energy level at 0.7-0.8 eV below the conduction band minimum ECB is identified for BaTiO3, which can be assigned to the Fe2+/3+-transition in good agreement with literature. In contrast, the conductivity of Fe-doped SrTiO3 does not show a defect energy level in the upper half of the band gap, indicating that the Fe2+/3+-transition in SrTiO3 is near the conduction band minimum. The often reported alignment of defect energy levels, which is fulfilled for the Fe3+/4+-transition in BaTiO3 and SrTiO3, does not hold for the Fe2+/3+-transition in these compounds. This limits the applicability of Fe-doped SrTiO3 as a model system for studying resistance degradation in acceptor-doped high-permittivity dielectrics.
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http://dx.doi.org/10.1039/c8cp07872fDOI Listing
March 2019

En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A single-institution experience.

Int J Urol 2019 03 3;26(3):363-368. Epub 2018 Dec 3.

Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Objective: To report the outcomes of laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma at Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Method: A retrospective review of the clinical records of five patients who underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma between 2013 and 2017 was carried out. The surgical procedure included ligation and cutting of the right renal artery, followed by kidney mobilization. The left renal vein, and the caudal and cephalad sides of the inferior vena cava thrombus were clamped using laparoscopic vascular clamps, and the inferior vena cava was incised. The free kidney and tumor thrombus were placed en bloc in a retrieval bag. Subsequently, the inferior vena cava was laparoscopically closed using a continuous suture.

Results: The median operative time, pneumoperitoneum time, blood loss and postoperative hospital stay were 316 min, 266 min, 400 mL and 7 days, respectively. The median clamp time was 28 min (range 13-105 min). One patient (20%) required a perioperative blood transfusion. The surgical margin was negative in all patients. Only one patient experienced a major complication (Clavien-Dindo grade ≥3), namely a postoperative hemorrhage requiring transarterial embolism.

Conclusion: En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a challenging yet feasible procedure for experienced surgeons in carefully selected patients. Further studies of this surgical procedure are required for standardization and safe application.
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http://dx.doi.org/10.1111/iju.13873DOI Listing
March 2019

[Off-Clamp, Non-Renorrhaphy Robot-Assisted Partial Nephrectomy : An Initial Experience in a Single Institution].

Hinyokika Kiyo 2018 Aug;64(8):323-327

The Department Of Urology, Kobe City Medical Center General Hospital.

We report the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy robotassisted partial nephrectomy (RAPN) in 7 out of 76 patients who underwent RAPN with off-clamp and nonrenorrhaphy between February 2015 and August 2017. The approach was chosen depending on the location of the tumor. Tumor enucleation was performed by using sharp incision and blunt dissection. For hemostasis, the soft-coagulation system was used and TachoSil○R was placed on the resection bed. As a rule, renorrhaphy was not performed. Median (range) patient age was 67 years (40-79), tumor size ; 14 mm (12-18), operative time ; 139 minutes (102-166), console time ; 51 minutes (41-75), estimate blood loss ; 10 ml (0-100). No patients required a perioperative blood transfusion. Median (range) tumor intraparenchymal depth was 10.4 mm (4.3-15.5) and distance from urinary collecting system was 9.3 mm (4.1-13.0). Pseudoaneurysm and urine leakage were not observed. No complications classified as Clavien-Dindo grade higher than grade 1 appeared. No cases had a positive surgical margin. Median (range) estimated glomerular filtration rate (eGFR) change rate at 3 months after surgery was 0% (-12.7-14.5). Off-clamp, non-renorrhaphy RAPN with the soft-coagulation system and TachoSil® is a feasible and safe procedure for patients carefully selected among those with superficial tumors.
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http://dx.doi.org/10.14989/ActaUrolJap_64_8_323DOI Listing
August 2018

[Evaluation of Lymphoceles by CT Scan Early after Robot-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2018 Jun;64(6):261-264

The Department of Urology, Kobe City Medical Center General Hospital.

We report the incidence and characteristics of lymphoceles after robot-assisted radical prostatectomy (RARP). Computed tomography was performed on 79 patients one month after RARP or when symptoms appeared. The lymphocele was defined as a cystic lesion over 10 mm in diameter. Symptomatic and asymptomatic lymphoceles were identified in 25% (20/79) of all cases, and in 40.9% (18/44) of the cases with lymph node dissection (LND). Symptomatic lymphoceles were identified in 2.5% (2/79) of all cases. Lymphoceles were significantly associated with LND, pathological stage over T3, longer period of indwelling drain tube,and higher volume fluid of drain tube (p<0.05). In conclusion, lymphoceles are quiet common after RARP. However, they rarely become symptomatic.
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http://dx.doi.org/10.14989/ActaUrolJap_64_6_261DOI Listing
June 2018

[A Case of Chromophobe Renal Cell Carcinoma Associated with Birt-Hogg-Dubé Syndrome].

Hinyokika Kiyo 2018 Mar;64(3):107-110

The Department of Urology, Kobe City Medical Center General Hospital.

A 61-year-old man with a left renal mass, which was detected by ultrasound during a routine health examination, was referred to our department. The patient had a surgical history of two pneumothorax operations, and the patient's brother also had a history of pneumothorax surgery. A case of Birt-Hogg-Dubé (BHD) syndrome was suspected based on patient history. The pathological diagnosis of the resected tumor, which used robot-assisted laparoscopic partial nephrectomy, was determined to be chromophobe renal cell carcinoma (grade 2, pT1a). BHD syndrome was confirmed by genetic testing, where a nonsense mutation of exon 9 in the FOLLICULIN (FLCN) gene was detected. The patient is currently alive 10 months after surgery.
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http://dx.doi.org/10.14989/ActaUrolJap_64_3_107DOI Listing
March 2018

Elevated serum levels of cardiovascular biomarkers are associated with progression of renal cancer.

Open Heart 2018;5(1):e000666. Epub 2018 Jan 3.

Department of Urology, Dokkyo Medical University, Mibu, Tochigi, Japan.

Objective: Renal cell carcinoma (RCC) is a hypervascular tumour due to high constitutive production of vascular endothelial growth factor (VEGF), which is activated by hypoxia-inducible factor (HIF). Elevated levels of cardiovascular peptides, including brain natriuretic peptide (BNP), have been reported in patients with cancer, regardless of whether they have overt cardiovascular disease. Furthermore, it has been demonstrated that hypoxia stimulates BNP production by an HIF-dependent manner. However, the clinical implications of such cardiovascular peptides in patients with RCC have not been assessed.

Methods: In patients with clear cell RCC who underwent nephrectomy, we investigated the relationship between the serum level of BNP or N-terminal pro-BNP (NT-proBNP) and various clinicopathological characteristics, including serum VEGF and expression of BNP and HIF-2 alpha in the primary tumour.

Results: Elevated preoperative serum levels of BNP, NT-proBNP and VEGF, as well as increased tumour expression of HIF-2 alpha, were associated with a worse performance status, local invasion, distant metastasis and shorter overall survival. HIF-2 alpha expression showed a positive correlation with the preoperative serum VEGF level, while there was no relation between the serum levels of BNP/NT-proBNP and VEGF or tumour expression of HIF-2 alpha. BNP expression was very low in both tumour tissues and normal kidney tissues. Serum levels of BNP, NT-proBNP and VEGF all decreased significantly after nephrectomy.

Conclusions: Our findings suggested that the preoperative serum levels of BNP and NT-proBNP are markers of tumour progression, as well as indicators of subclinical functional and structural myocardial damage in patients with advanced RCC.
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http://dx.doi.org/10.1136/openhrt-2017-000666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761308PMC
January 2018

Significance of sarcopenia as a prognostic factor for metastatic urothelial carcinoma patients treated with systemic chemotherapy.

Int J Clin Oncol 2018 Apr 2;23(2):338-346. Epub 2017 Nov 2.

Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Shimotsuga, Tochigi, 321-0293, Japan.

Background: Recently, numerous studies have reported an association between sarcopenia and poor outcomes in various kinds of malignancies. We investigated whether sarcopenia predicts the survival of patients with metastatic urothelial carcinoma who underwent systemic chemotherapy.

Methods: We reviewed 87 metastatic urothelial carcinoma patients who underwent chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin for cisplatin-unfit patients) between 2007 and 2015. A computed tomography scan prior to chemotherapy was used for evaluating sarcopenia, and we measured three cross-sectional areas of skeletal muscle at the third lumbar vertebra and calculated the skeletal muscle index (SMI), the paraspinal muscle index (PSMI), and the total psoas area (TPA) of each patient. Predictive values of survival were assessed using Cox regression analysis.

Results: The median overall survival (OS) was 16 months (95% CI 13.5-18). Although SMI alone was not a significant predictor of shorter OS (P = 0.117) in univariate analysis, SMI stratified by the value of the body mass index (BMI) was a significant predictor of shorter OS in univariate analysis (P = 0.037) and was also an independent predictor of shorter OS in multivariate analysis (P = 0.026). PSMI and TPA were not significant prognostic factors even when stratified by BMI (P = 0.294 and 0.448), respectively.

Conclusion: Neither PSMI nor TPA could substitute SMI as a predictor for poor outcomes in metastatic urothelial carcinoma patients treated with systemic chemotherapy in our study. SMI stratified by BMI is a useful predictor of prognosis in these patients.
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http://dx.doi.org/10.1007/s10147-017-1207-xDOI Listing
April 2018

Wurtzite-Derived Quaternary Oxide Semiconductor CuZnGeO: Its Structural Characteristics, Optical Properties, and Electronic Structure.

Inorg Chem 2017 Nov 30;56(22):14277-14283. Epub 2017 Oct 30.

Institute of Multidisciplinary Research for Advanced Materials, Tohoku University , 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577, Japan.

The quaternary I-II-IV-O semiconductor, CuZnGeO, with a wurtz-kesterite structure and 1.4 eV energy band gap has been synthesized for the first time via ion exchange of precursor NaZnGeO. Its crystal structure was refined by Rietveld analysis, and the structural distortion was quantitatively evaluated based on the cation tetrahedral tilting and angle distortion indexes. The tetrahedral distortion in CuZnGeO was smaller than in AgZnGeO but larger than in β-CuGaO, suggesting an indirect band gap of CuZnGeO. Density functional theory calculations using the functional of the local density approximation with corrections for on-site Coulomb interactions indicated that CuZnGeO is an indirect semiconductor as expected from its structural feature. However, the energy difference between the direct and indirect band gaps is very small, suggesting that CuZnGeO shows strong light absorption near the band edge.
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http://dx.doi.org/10.1021/acs.inorgchem.7b02379DOI Listing
November 2017

[Clinical Study of HoLEP for the Patients with Benign Prostatic Hyperplasia who are on Oral Antithrombotics].

Hinyokika Kiyo 2017 Aug;63(8):307-311

The Department of Urology, Kobe City Medical Center General Hospital.

Recently, holmium laserenucleation of the prostate (HoLEP) was associated with less bleeding compared with transurethral resection of prostate. Since 2012, we have performed HoLEP for benign prostatic hyperplasia (BPH) under continuous oral antithrombotics (OA). Between October 2004 and March 2015, 54 patients with BPH underwent HoLEP while on OA at our hospital. Eight patients underwent HoLEP without OA cessation and 46 patients with temporary OA cessation. No significant between-group difference was observed in age, prostate volume, transitional zone prostate volume, operation time, resection weight, resection weight per minute, urethral catheter duration, Hb decrease on day 1 post- HoLEP, hospital stay after HoLEP, bleeding intraoperative rate, bleeding rate after HoLEP and transfusion rate. None presented embolic complications. HoLEP was safe without OA cessation. However, highvolume BPH patients without OA cessation required intraoperative transfusion. Thus, high-volume BPH patients may benefit from OA cessation.
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http://dx.doi.org/10.14989/ActaUrolJap_63_8_307DOI Listing
August 2017

[Diagnostic Impact of 3D-CT with Retrograde Pyelography for Ureteropelvic Junction Obstruction : A Case Report].

Hinyokika Kiyo 2017 Jul;63(7):267-270

The Department of Radiology, Dokkyo Medical University.

A 26-year-old woman presented to our hospital with right costovertebral angle (CVA) pain. Ultrasonographyand computed tomography(CT) scan indicated right hydronephrosis, and MAG3 renogram showed an obstructed pattern in the right kidney. Enhanced CT scan revealed an ureteropelvic junction obstruction (UPJO) with an aberrant vessel. To clarifythe ureteropelvic junction (UPJ) structure in detail, we utilized 3D-CT with retrograde pyelography (RP), which further revealed the true pinhole ureteral stricture of UPJ unaffected bythe aberrant vessel.
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http://dx.doi.org/10.14989/ActaUrolJap_63_7_267DOI Listing
July 2017

Performance characteristics of prostate-specific antigen density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer underwent robot-assisted radical prostatectomy.

BMC Urol 2017 Jun 23;17(1):47. Epub 2017 Jun 23.

Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.

Background: Many urologic surgeons refer to biopsy core details for decision making in cases of localized prostate cancer (PCa) to determine whether an extended resection and/or lymph node dissection should be performed. Furthermore, recent reports emphasize the predictive value of prostate-specific antigen density (PSAD) for further risk stratification, not only for low-risk PCa, but also for intermediate- and high-risk PCa. This study focused on these parameters and compared respective predictive impact on oncologic outcomes in Japanese PCa patients.

Methods: Two-hundred and fifty patients with intermediate- and high-risk PCa according to the National Comprehensive Cancer Network (NCCN) classification, that underwent robot-assisted radical prostatectomy at a single institution, and with observation periods of longer than 6 months were enrolled. None of the patients received hormonal treatments including antiandrogens, luteinizing hormone-releasing hormone analogues, or 5-alpha reductase inhibitors preoperatively. PSAD and biopsy core details, including the percentage of positive cores and the maximum percentage of cancer extent in each positive core, were analyzed in association with unfavorable pathologic results of prostatectomy specimens, and further with biochemical recurrence. The cut-off values of potential predictive factors were set through receiver-operating characteristic curve analyses.

Results: In the entire cohort, a higher PSAD, the percentage of positive cores, and maximum percentage of cancer extent in each positive core were independently associated with advanced tumor stage ≥ pT3 and an increased index tumor volume > 0.718 ml. NCCN classification showed an association with a tumor stage ≥ pT3 and a Gleason score ≥8, and the attribution of biochemical recurrence was also sustained. In each NCCN risk group, these preoperative factors showed various associations with unfavorable pathological results. In the intermediate-risk group, the percentage of positive cores showed an independent predictive value for biochemical recurrence. In the high-risk group, PSAD showed an independent predictive value.

Conclusions: PSAD and biopsy core details have different performance characteristics for the prediction of oncologic outcomes in each NCCN risk group. Despite the need for further confirmation of the results with a larger cohort and longer observation, these factors are important as preoperative predictors in addition to the NCCN classification for a urologic surgeon to choose a surgical strategy.
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http://dx.doi.org/10.1186/s12894-017-0238-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481958PMC
June 2017

Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia.

Urol Case Rep 2017 Feb 28;11:47-49. Epub 2017 Jan 28.

Department of Urology, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.

We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.
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http://dx.doi.org/10.1016/j.eucr.2016.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279737PMC
February 2017