Publications by authors named "Tetsuya Yumioka"

19 Publications

  • Page 1 of 1

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

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

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

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

Cross-Sectional Investigations of Pre- and Post-Operative Renal Global Function and Renal Parenchymal Volumetry in Both Partial and Radical Nephrectomy Utilizing Film-Based Technology.

Curr Urol 2019 May;12(3):127-133

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

Objectives: To investigate pre- and post-operative renal global function and renal parenchymal volume (RPV) in both partial nephrectomy (PN) and radical nephrectomy (RN) utilizing film-based technology.

Patients And Methods: The patient cohort consisted of 81 and 82 cases with T1 tumors (≤ 7 cm) treated by PN and RN, respectively. Renal global function was assessed using the estimated glomerular filtration rate (eGFR), and RPV was measured using a Synapse Vincent volumetric analyzer which creates a reconstructed image from a computed tomography scan. Renal global function and RPV were evaluated pre-operatively and 6 months post-operatively.

Results: The percent eGFR decline of PN cases was significantly reduced compared with RN cases (p < 0.0001). Post-operative RPV of the contralateral side was significantly increased compared with pre-operative RPV (p < 0.0001) in RN cases. The percent change of the contralat-eral side RPV was slightly increased in RN compared with PN cases (p = 0.1881). A strong positive correlation was noted between post-operative eGFR and post-operative total RPV (r = 0.69, p < 0.0001), and a strong negative correlation was noted between percent eGFR decline and post-operative total RPV (r = -0.63, p < 0.0001).

Conclusions: Prominent compensatory renal hypertrophy occurred within 6 months after RN. Post-operative renal functional outcome was closely correlated with the post-operative total RPV. In addition to RPV, further studies to unravel post-operative renal function from multifactorial aspects including surgical factors and intrinsic medical disease should be performed in the future.
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http://dx.doi.org/10.1159/000489430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613317PMC
May 2019

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

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

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

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

Risk stratification model, including preoperative serum C-reactive protein and estimated glomerular filtration rate levels, in patients with upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy.

Int Urol Nephrol 2015 Aug 24;47(8):1335-41. Epub 2015 Jun 24.

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8504, Japan.

Purpose: To investigate the prognostic indicators, including clinicopathological and preoperative hematological factors, in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC), and to develop a prognostic factor-based risk stratification model.

Methods: The clinicopathological data and preoperative parameters were collected from 345 UTUC patients treated with RNU without neoadjuvant therapy, retrospectively. The prognostic values of preoperative hematological parameters and clinicopathological factors were evaluated. Then, a risk stratification model was developed to predict poor survival after RNU using the regression coefficients of multivariate analysis.

Results: In multivariate analysis, high serum C-reactive protein (CRP) levels (≥0.5 mg/dl), low estimated glomerular filtration rate (eGFR) levels (<50 ml/min/1.73 m(2)), Eastern Cooperative Oncology Group Performance status ≥1, number of tumor foci >1, tumor grade (G3), positive LN, and positive surgical margin were independent factors predicting poor cancer-specific survival (CSS). Patients were stratified into three groups, and the risk stratification model revealed significant differences in CSS between the three subgroups. The 5-year CSS in patients at low, intermediate, and high risk was 92.7, 75.4, and 31.5 %, respectively.

Conclusion: This study indicates that preoperative hematological markers, such as low eGFR and high CRP levels predict a poor survival in patients with UTUC. Our risk stratification model may provide physicians with useful prognostic information for identifying patients who may be candidates for multimodal treatment.
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http://dx.doi.org/10.1007/s11255-015-1033-xDOI Listing
August 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

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