Publications by authors named "Toru Kanno"

110 Publications

The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years.

J Clin Med 2021 Mar 24;10(7). Epub 2021 Mar 24.

Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-cho, Ishida Fushimi-ku, Kyoto 601-1495, Japan.

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center.

Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019.

Results: The median follow-up was 160 (range 6-340) months, and the median patient age at diagnosis was 46 (range 12-82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0-2.6) and 0.19 (range 0-1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis ( = 0.02, 0.04, respectively).

Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.
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http://dx.doi.org/10.3390/jcm10071336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037008PMC
March 2021

Editorial Comment from Dr Kanno to Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis.

Authors:
Toru Kanno

Int J Urol 2021 Mar 13. Epub 2021 Mar 13.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

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http://dx.doi.org/10.1111/iju.14551DOI Listing
March 2021

Effect of optimal neoadjuvant chemotherapy on oncological outcomes of locally advanced bladder cancer with laparoscopic radical cystectomy: A matched-pair analysis in a multicenter cohort.

Int J Urol 2021 Mar 7. Epub 2021 Mar 7.

Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objectives: To assess the effect of optimal neoadjuvant chemotherapy of at least three cycles of cisplatin-based regimen on oncological outcomes of clinical stage T3 or higher bladder cancer treated with laparoscopic radical cystectomy.

Methods: Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. The outcomes of patients who received optimal neoadjuvant chemotherapy and those who did not receive neoadjuvant chemotherapy were compared using propensity score matching in clinical stage T3-4 or T2 cohorts, separately.

Results: Of the 455 patients screened, matched pairs of 54 patients in the clinical T3-4 cohort and 68 patients in the clinical T2 cohort were finally analyzed. In the cT3-4 cohort, the 5-year overall survival (78% vs 41%; P = 0.014), cancer-specific survival (81% vs 44%; P = 0.008) and recurrence-free survival (71% vs 53%; P = 0.049) were significantly higher in the optimal neoadjuvant chemotherapy group than in the no neoadjuvant chemotherapy group; no significant survival difference was shown between the two groups in the cT2 cohort. In the cT3-4 cohort, the incidence of local recurrence (4% vs 26%; P = 0.025) and abdominal or intrapelvic recurrence, including peritoneal carcinomatosis (7% vs 30%; P = 0.038), was significantly lower in the optimal neoadjuvant chemotherapy group.

Conclusions: Administration of optimal neoadjuvant chemotherapy has a significant survival benefit. It decreases the incidence of local and atypical recurrence patterns in patients with clinical stage T3 or higher locally advanced bladder cancer undergoing laparoscopic radical cystectomy.
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http://dx.doi.org/10.1111/iju.14533DOI Listing
March 2021

Predictors of Repeat Surgery and Stone-related Events After Flexible Ureteroscopy for Renal Stones.

Urology 2021 Mar 3. Epub 2021 Mar 3.

Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.

Objectives: To evaluate the risk of repeat surgery and stone-related events after flexible ureteroscopy (fURS) for renal stones, and to identify their predictive factors.

Patients And Methods: This was a single-center, retrospective cohort study of patients (n = 664) who underwent fURS for renal stones with or without concomitant ureteral stones between January 2012 and December 2019. The primary outcomes were time to ipsilateral stone-related surgical intervention and any stone-related event (including ipsilateral renal colic, symptomatic ureteral calculi, obstructive urinary tract infection, and surgical intervention).

Results: During median follow-up of 31.1 months, 103 (15.5%) and 135 (20.3%) patients experienced surgical intervention and any stone-related event, respectively. The estimated 2-year intervention-free survival and stone-event-free survival was 86.9% and 81.6%, respectively. On Cox multivariate analysis, younger age (hazard ratio [HR] 0.96), history of stone surgery (HR 2.17), larger preoperative stone burden (HR 1.03), and larger residual fragment (HR 1.09) showed an association with future intervention. Use of the four identified risk factors (age ≤60, history of stone surgery, stone burden ≥20 mm, and residual fragment ≥4 mm) allowed stratification of patients based on the risk of future intervention (low [score: 0-1], intermediate [2], and high [3-4] risk). The estimated 2-year intervention-free survival rates in low-, intermediate-, and high-risk groups were 96.2%, 86.4%, and 71.3%, respectively.

Conclusion: Patients undergoing fURS are at risk of future ipsilateral surgical intervention and stone-related events. Our simple predictive tool can facilitate treatment decision-making by identifying patients who are at high risk of recurrence.
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http://dx.doi.org/10.1016/j.urology.2021.02.025DOI Listing
March 2021

Indocyanine Green Fluorescence-Guided Laparoscopic Lower-Pole Heminephrectomy for Duplex Kidney in Adult.

J Endourol Case Rep 2020 29;6(4):384-387. Epub 2020 Dec 29.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

Intraoperative indocyanine green (ICG) near-infrared fluorescence guidance is a type of optical imaging technology now available to facilitate a better understanding of surgical landmarks. This case describes use of this technique during lower-pole heminephrectomy for a patient with duplex kidney. A 50-year-old woman with a left duplex system and lower-pole kidney infection underwent a laparoscopic transperitoneal lower-pole heminephrectomy. After exposing the left renal pedicles, ICG was administered through a ureteral stent inserted into the upper calix; the nonaffected ureter could be viewed, which enabled us to dissect the affected ureter connected to the lower-pole pelvis. Next, intravenous ICG administration revealed that the lower-pole kidney blood flow was not reduced. This finding prompted us to clamp the main renal artery. Furthermore, ICG injection through a nephrostomy tube helped to observe the lower-pole kidney collecting system and predict the parenchymal dissection plane location between the upper- and lower-pole kidneys. We effectively performed a lower-pole heminephrectomy through complete lower-pole urinary tract resection and maximal upper-pole parenchyma preservation. ICG fluorescence by intravenous and intraureteral administration observes relevant anatomy intraoperatively and is beneficial in patients who undergo a lower-pole heminephrectomy for duplex kidney.
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http://dx.doi.org/10.1089/cren.2020.0123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803210PMC
December 2020

Indocyanine Green Fluorescence-Guided Partial Cystectomy and Pelvic Lymphadenectomy for Urachal Carcinoma.

J Endourol Case Rep 2020 29;6(4):275-277. Epub 2020 Dec 29.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

Intraoperative indocyanine green near-infrared fluorescence guidance is an emerging optical imaging technology to facilitate better understanding of surgical landmarks. Herein, this technique was applied during the surgery for urachal carcinoma. A 50-year-old man with urachal carcinoma underwent laparoscopic partial cystectomy and pelvic lymph node dissection (PLND). Before the laparoscopic surgery, indocyanine green was injected cystoscopically around the tumor at the submucosa level. The tumor location and lymph drainage were clearly viewed. The lymphatic flow was along the superior vesical artery and the umbilical ligament. The obturator and external lymph nodes were not fluoresced. Template PLND was performed. Partial cystectomy was completed with cystoscopic monitoring of the margin and with endoscopic stapler to avoid tumor spillage. Intraoperative indocyanine green fluorescence views lymph drainage and tumor location and is useful to improve the quality of PLND and partial cystectomy.
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http://dx.doi.org/10.1089/cren.2020.0025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803199PMC
December 2020

Extremely-slow, half-number shockwave lithotripsy for asymptomatic renal stones <20 mm.

Investig Clin Urol 2021 Jan 3;62(1):72-78. Epub 2020 Dec 3.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

Purpose: To compare the treatment success rate and safety of reduced (30 shocks/min, 1,200 shocks/session) versus standard (60 shocks/min, 2,400 shocks/session) extracorporeal shockwave lithotripsy for the management of renal stones.

Materials And Methods: We retrospectively analyzed 404 patients who underwent extracorporeal shockwave lithotripsy for 5-20-mm renal stones between April 2011 and March 2019. Patients selected the reduced or standard protocol (group R and S) after explaining the potential benefits and disadvantages. The primary outcome was treatment success within 12 weeks, which was defined as no residual fragment or fragments <4 mm on ultrasonography and plain radiograph.

Results: In total, 94 and 310 patients underwent shockwave lithotripsy with a reduced and standard protocol, respectively. The background characteristics of the participants did not significantly differ. The treatment success within 12 weeks was achieved in 78 (83.0%) patients in group R and 259 (83.5%) in group S (p=0.88). The median number of the session was 3 (interquartile range, 2-4) in both groups (p=0.53). The total complication rates were 5.4% in group R and 6.1% in group S. Three (1.0%) patients in group S experienced perirenal hematoma, which was conservatively treated. The reduced protocol was not associated with treatment success in the multivariate analysis adjusted for potential confounders (odds ratio, 0.91; 95% confidence interval, 0.46-1.80; p=0.78).

Conclusions: The new treatment amendment with a slower delivery rate successfully reduced the total number of shocks need to fragment renal stones <20 mm without compromising the stone-free rate.
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http://dx.doi.org/10.4111/icu.20200285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801166PMC
January 2021

Editorial Comment to Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning.

Authors:
Toru Kanno

Int J Urol 2021 02 17;28(2):169. Epub 2020 Nov 17.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

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http://dx.doi.org/10.1111/iju.14423DOI Listing
February 2021

Decreased Recurrence of Urolithiasis After Simultaneous Ureteroscopic Surgery for Ureter and Ipsilateral Renal Calculi: Comparison to Shockwave Lithotripsy for Ureter Calculi Alone.

Urology 2021 Jan 10;147:74-80. Epub 2020 Nov 10.

Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.

Objective: To compare follow-up outcomes of ureteroscopy (URS) and shockwave lithotripsy (SWL) for ureter calculi in the setting of asymptomatic renal calculi <15 mm.

Methods: This study included 789 patients who underwent URS (n = 301) or SWL (n = 488) as primary treatment for ureter calculi and who had ipsilateral renal calculi <15 mm between January 2012 and December 2019. For the URS group, all renal calculi were simultaneously treated unless contraindicated. One-to-one matching was performed using the propensity score (PS).

Results: After PS matching, analysis included 262 matched pairs of URS and SWL patients. The stone-free rate for ureter calculi without auxiliary procedure was 97.3% in the URS group and 93.9% in the SWL group. Any complication rates were 11.0% and 9.2% in the URS and SWL group, respectively; 1.1% of the URS patients experienced complications classified as Clavien-Dindo ≥IIIb. The estimated 2-year intervention-free survival was 88.1% in the URS group and 84.2% in the SWL group (P = 0.045). The estimated 2-year stone-event-free survival was 80.1% in the URS group and 71.0% in the SWL group (P = 0.009). Cox multivariate analysis showed that the hazard ratios of URS were 0.62 (P = 0.025) for surgical interventions and 0.64 (P = 0.008) for stone-related events after adjusting for baseline variables.

Conclusion: For patients with symptomatic ureter calculi and asymptomatic renal calculi <15 mm, URS with active treatment for renal calculi reduces future ipsilateral surgical intervention and stone-related events compared with SWL for ureter calculi.
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http://dx.doi.org/10.1016/j.urology.2020.10.041DOI Listing
January 2021

Phylogenetic and antigenic analysis of bovine parainfluenza virus type 3 isolated in Japan between 2002 and 2019.

Vet Microbiol 2020 Aug 21;247:108774. Epub 2020 Jun 21.

Division of Viral Disease and Epidemiology, National Institute of Animal Health, National Agriculture and Food Research Organization, 3-1-5 Kannondai, Tsukuba, Ibaraki, 305-0856, Japan. Electronic address:

Bovine parainfluenza virus type 3 (BPIV3) is one of the most important viral respiratory pathogens of cattle. In addition to the classical BPIV3 genotype A (BPIV3a), new genetic groups, genotype B (BPIV3b) and C (BPIV3c), have been identified and isolated in certain parts of the world. The present study aimed to investigate the genetic and antigenic characteristics of BPIV3 circulating in Japan. Seventy-three BPIV3 field strains were isolated from nasal samples of cattle between 2002 and 2019. Phylogenetic analysis of the phosphoprotein and hemagglutinin-neuraminidase genes showed that the isolates clustered into two genotypes, BPIV3a (49 %) and BPIV3c (51 %). The BPIV3a strains had more wide genetic variation than the rest of the genotypes. Additionally, new variants were obtained and designated them tentatively as subgroup 4 of the BPIV3a. The first Japanese BPIV3c was isolated in 2012, but here the BPIV3c NM2 strain was isolated from a sample collected four years earlier than the previous report. The antigenicity of ten BPIV3 strains including all three genotypes was assessed with a viral cross-neutralization test. Anti-sera against BPIV3a and BPIV3b cross-reacted well with both homologous and heterologous viruses. On the other hand, anti-sera against BPIV3c had reduced cross-reactivity to the heterologous viruses. Overall, our findings showed that genetically and antigenically divergent BPIV3 is prevalent in cattle in Japan. These results could provide a reference for molecular epidemiological characterization of BPIV3 and vaccine development.
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http://dx.doi.org/10.1016/j.vetmic.2020.108774DOI Listing
August 2020

Renal failure due to encrusted cystitis and pyelitis.

IJU Case Rep 2020 May 17;3(3):112-115. Epub 2020 Apr 17.

Department of Urology Ijinkai Takeda General Hospital Kyoto Japan.

Introduction: Encrusted cystitis and pyelitis are a rare urinary tract infection characterized by mold-like calcification of collecting system. Here, we show a case of encrusted cystitis proceeding to pyelitis during a 1-month delay in diagnosis.

Case Presentation: A 73-year-old man developed hematuria and pain during micturition while he was being treated for granulomatosis with polyangiitis and lung abscess. Cystoscopy revealed calcification of the bladder wall, and an initial diagnosis of a bladder stone was made. While awaiting surgery, the bladder wall calcification extended to the renal pelvis on both sides, with renal failure. He underwent bilateral nephrostomy replacement and bladder irrigation with Solita T1 and was administered intravenous vancomycin. Calcification almost regressed after 4 weeks of treatment.

Conclusion: Encrusted cystitis and pyelitis should be suspected if the patient shows alkaline urine and urothelial mucosa calcification. Appropriate treatment includes antibiotics, urine drainage, and chemolysis by bladder irrigation.
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http://dx.doi.org/10.1002/iju5.12158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292115PMC
May 2020

Strangulated Internal Hernia Beneath the Obturator Nerve After Laparoscopic Radical Cystectomy With Extended Pelvic Lymph Node Dissection.

Urology 2020 Nov 28;145:11-12. Epub 2020 Jul 28.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

Internal hernia beneath the vascular structures after pelvic lymphadenectomy is a rare condition. Herein, we report a case of a strangulated internal hernia beneath the obturator nerve 38 months after laparoscopic radical cystectomy with extended pelvic lymphadenectomy. Computed tomography revealed dilated small bowels and a closed loop in the pelvis. The emergency laparotomy was performed, and a strangulated internal hernia beneath the obturator nerve was observed. It is necessary to consider the possibility of internal hernia beneath the vascular structure, including the obturator nerve, after the pelvic lymph lymphadenectomy, particularly via a minimally invasive approach.
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http://dx.doi.org/10.1016/j.urology.2020.07.029DOI Listing
November 2020

The Natural History of Asymptomatic Renal Stones ≤5 mm: Comparison with ≥5 mm.

J Endourol 2020 11 21;34(11):1188-1194. Epub 2020 Aug 21.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

To clarify the natural history of asymptomatic renal stones ≤5 mm in comparison with stones ≥5 mm. Calculi ≤5 mm are considered insignificant stones, but to what extent stone-related events can occur is unclear. In this retrospective study, 207 patients with asymptomatic renal stones confirmed by both CT and ultrasonography performed on the same day were enrolled. A follow-up ultrasound was performed every 6 months. The active indications for surgical intervention included stone relocations into the ureter and stone-related symptoms. The primary endpoint was the rate of surgical intervention. A total of 207 patients (71 cases with stones ≤5 mm and 136 cases with stones >5 mm) were included in this study. At a median follow-up of 3.3 years, 14 patients (20%) from the ≤5-mm group and 52 (38%) from the >5-mm group underwent surgical treatment ( = 0.0067). Moreover, 11 patients (16%) from the ≤5-mm group and 27 (20%) from the >5-mm group received surgical intervention as they manifested active indications, showing no significant difference ( = 0.44). As regards stone events, there were no significant differences in spontaneous stone passage, pain, hematuria, and stone growth. Multivariate analysis revealed that age ≤50 years and a history of stone surgery were significant factors, but stone size was not. About 20% of asymptomatic renal stones ≤5 mm require surgical treatment within 5 years.
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http://dx.doi.org/10.1089/end.2020.0336DOI Listing
November 2020

Corrigendum to "Development and evaluation of silver amplification immunochromatography kit for foot-and-mouth disease virus antigen detection" [J. Virol. Methods 275C (2019) 113736].

J Virol Methods 2020 Jun 14;280:113860. Epub 2020 May 14.

Exotic Diseases Research Station, National Institute of Animal Health, National Agriculture and Food Research Organization, Josuihoncho 6-20-1, Kodaira, Tokyo, 187-0022, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.jviromet.2020.113860DOI Listing
June 2020

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched-pair comparison in a multicenter cohort in Japan.

Int J Urol 2020 Jun 20;27(6):559-565. Epub 2020 Apr 20.

Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objectives: To compare the perioperative and oncological outcomes of pure laparoscopic intracorporeal ileal conduit urinary diversion versus extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for bladder cancer in a multicenter cohort in Japan.

Method: A total of 455 patients who underwent laparoscopic radical cystectomy carried out at 10 institutions were included in this retrospective study. The perioperative data of the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups were compared using the propensity score matching method. The Kaplan-Meier curves were obtained to elucidate time to ureteroenteric stricture, reoperation, recurrence and survival.

Results: In total, 72 matched pairs were evaluated for the final analysis. The median follow-up period was 28 and 23 months in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively. The operative time in the intracorporeal ileal conduit urinary diversion group was approximately 1 h longer than that in the extracorporeal ileal conduit urinary diversion group. The early and late postoperative complication rates were similar in both groups, except for the reduced wound-related complication rates in the intracorporeal ileal conduit urinary diversion group. The median days to regular oral food intake were 4 and 5 days in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively (P = 0.014). No significant difference was noted in the occurrence of ureteroenteric strictures and reoperation rate. Furthermore, recurrence-free, cancer-specific, and overall survival rates and recurrence patterns did not significantly differ.

Conclusions: Laparoscopic intracorporeal ileal conduit urinary diversion is a safe, feasible and reproducible procedure with similar postoperative complication rates, ureteroenteric stricture rate and oncological outcomes when compared with extracorporeal ileal conduit urinary diversion, but faster postoperative bowel recovery and decreased wound-related complication rates.
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http://dx.doi.org/10.1111/iju.14245DOI Listing
June 2020

Molecular epidemiological survey and phylogenetic analysis of bovine respiratory coronavirus in Japan from 2016 to 2018.

J Vet Med Sci 2020 Jun 9;82(6):726-730. Epub 2020 Apr 9.

Center for Animal Disease Control, University of Miyazaki, Miyazaki 889-2192, Japan.

Bovine coronavirus (BCoV) is an etiological agent of bovine respiratory disease (BRD). BRD is a costly illness worldwide; thus, epidemiological surveys of BCoV are important. Here, we conducted a molecular epidemiological survey of BCoV in respiratory-diseased and healthy cattle in Japan from 2016 to 2018. We found that 21.2% (58/273) of the respiratory-diseased cattle were infected with BCoV. The respiratory-diseased cattle had virus amounts 4.7 times higher than those in the asymptomatic cattle. Phylogenetic analyses showed that the BCoV identified in Japan after 2005 formed an individual lineage that was distinct from the strains found in other countries. These results suggest that BCoV is epidemic and has evolved uniquely in Japan.
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http://dx.doi.org/10.1292/jvms.19-0587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324836PMC
June 2020

[A Case of atypical Femoral Fracture after Dosing Denosumab].

Hinyokika Kiyo 2020 Jan;66(1):23-27

The Department of Urology, Ijinkai Takeda General Hospital.

For the management of patients with castration-resistant prostate cancer with bone metastases, bisphosphonates and denosumab are used to prevent skeletal related events. Osteonecrosis of the jaw and hypocalcemia have been reported in patients treated with denosumab, but there have been few reports of atypical femoral fracture (AFF). Here, we report a case of AFF after dosing denosumab. A 69-year-old man with prostate-specific antigen (PSA) level of 13.08 ng/ml was diagnosed with adenocarcinoma of the prostate, cT3a, N0, M1b, with Gleason score of 4+4=8 and bone metastases to pubis and ischium. Combined-androgen blockade therapy and denosumab were initiated in April 2014. Forty-eight months later, he had left knee pain. He had a magnetic resonance imaging of his left knee, but it showed no obvious findings. However, he had pain in the bilateral thighs and visited the department of orthopedics at our hospital. Pelvic X-ray showed thickening of the bone cortex at the lateral boarders of bilateral femur, and femoral CT showed faint fracture line in bilateral femur. He was diagnosed with AFF, and denosumab was discontinued. Ourcase suggests that we must considerthe possibility of AFF when pain around the thigh occurs after dosing denosumab.
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http://dx.doi.org/10.14989/ActaUrolJap_66_1_23DOI Listing
January 2020

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort.

Int J Urol 2020 Mar 16;27(3):250-256. Epub 2020 Jan 16.

Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objective: To investigate oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer in a Japanese multicenter cohort, and to explore the risk factors associated with recurrences due to tumor dissemination.

Method: Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. Multivariate analyses were carried out to identify the clinical parameters associated with overall recurrences together with specific recurrence types. Kaplan-Meier curves were created to elucidate time to recurrence and survival.

Results: A total of 411 patients were included after the final analysis. Postoperative pathology was T2 or higher in 196 patients (48%), and lymph node metastasis was present in 46 patients (11%). The median follow-up period was 23 months, and the 2-year recurrence-free and cancer-specific survival rates were 71.0% and 84.7%, respectively. The recurrence sites involved distant metastasis in 75 patients (18%), local recurrence in 52 patients (13%) and urinary tract recurrence in eight patients (2%). When local recurrence at the cystectomy bed (28 patients; 7%) and abdominal recurrence including peritoneal carcinomatosis or port site recurrence (17 patients; 4%), which might be caused by tumor dissemination, were combined into a single group, prolonged surgical time was a significant risk factor, in addition to high pathological stage (T3-4 and/or positive lymph nodes), positive surgical margins, and variant histology by both univariate and multivariate analyses.

Conclusions: Our study findings suggest that recurrences after laparoscopic radical cystectomy might be caused by tumor dissemination, and attention should be paid to avoid prolonged surgical time in laparoscopic radical cystectomy.
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http://dx.doi.org/10.1111/iju.14182DOI Listing
March 2020

[A Case of Transurethral Ureterolithotripsy Performed in a Morbidly Obese Patient with a Ureteral Stone].

Hinyokika Kiyo 2019 Dec;65(12):507-511

The Department of Urology, Ijinkai Takeda General Hospital.

Metabolic syndrome, such as obesity and hyperglycemia, are associated with kidney stones, and there is an association between body mass index (BMI) and urolithiasis. Treatment of urinary calculi in obese patients is not rare, but radiography images are often unclear. Here we report a case of a morbidly obese patient (BMI, 54 kg/m2) with a ureteral stone, who successfully underwent transurethral ureterolithotripsy (TUL). A 40-year-old man with gross hematuria visited a local doctor, and abdominal computed tomography (CT) showed a left kidney stone. He was admitted to another hospital, and abdominal CT showed a left ureteral stone. However, extracorporeal shock wave lithotripsy (ESWL) and TUL could not be performed because of poor quality radiography images. He was then admitted to our hospital for treatment. A left ureteral stent was placed 6 days before surgery. We successfully performed TUL using an operation table having a relatively high maximum load limit and using a high-voltage C-type arm radioscopy device. The findings in our case suggest that TUL can be successfully performed in morbidly obese patients by using appropriate operative tools.
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http://dx.doi.org/10.14989/ActaUrolJap_65_12_507DOI Listing
December 2019

[The Safety of Laparoscopic Radical Cystectomy during Initial Phases in a Japanese Multicenter Cohort].

Hinyokika Kiyo 2019 Nov;65(11):439-444

The Department of Urology, Graduate School of Medicine, Kyoto University.

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.
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http://dx.doi.org/10.14989/ActaUrolJap_65_11_439DOI Listing
November 2019

Development and evaluation of silver amplification immunochromatography kit for foot-and-mouth disease virus antigen detection.

J Virol Methods 2020 01 25;275:113736. Epub 2019 Oct 25.

Exotic Diseases Research Station, National Institute of Animal Health, National Agriculture and Food Research Organization, Josuihoncho 6-20-1, Kodaira, Tokyo, 187-0022, Japan. Electronic address:

A silver amplification immunochromatography (SAI) kit for the detection of all seven serotypes of foot-and-mouth disease virus (FMDV)-FMDV-Ag SAI-was developed using the monoclonal antibody 1H5 recognizing the highly conserved N terminus region of VP2. The FMDV-Ag SAI can be used under conditions of high biosecurity containment as it does not require any apparatus. The FMDV-Ag SAI exhibited 10-100 times higher sensitivity against the five serotypes (O, A, Asia1, C, and SAT1) and similar sensitivity against SAT2 and SAT3, compared with the Svanodip® FMDV-Ag kit immunochromatography kit. The Svanodip kit showed inhibitory results with several saliva samples but not with the FMDV-Ag SAI kit. In a validation study using clinical samples (n = 132; vesicular epithelium = 92, vesicular lesion swabs = 20, saliva = 20) in Mongolia, the sensitivity of FMDV-Ag SAI in comparison with real-time reverse transcription-polymerase chain reaction revealed the following data: vesicular epithelium, 85.4% (76/89); vesicular lesion swab, 46.7% (7/17); and saliva, 36.8% (7/19). No cross-reactivity with the non-FMDV vesicular-forming viruses and taxonomically related viruses of the Picornaviridae family occurred. The FMDV-Ag SAI is a highly sensitive diagnostic tool that enables pen-side diagnosis without requiring the use of any equipment.
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http://dx.doi.org/10.1016/j.jviromet.2019.113736DOI Listing
January 2020

[A Case of Long-Term Treatment with Extracorporeal Shock Wave Lithotripsy and Follow-Up for Cystine Calculi by Cystinuria].

Hinyokika Kiyo 2019 Jun;65(6):209-213

The Department of Urology, Ijinkai Takeda General Hospital.

For the management of patients with cystinuria, forced hydration and medication have been used to prevent stone recurrence and growth, but not a few cystine stones require surgical intervention. However, the long-term follow-up data about surgical intervention for cystine stones is lacking. Here, we report a case of cystine calculi of cystinuria with many sessions of extracorporeal shock wave lithotripsy (ESWL) during the long-term follow-up period. A 13-year-old woman went to a local clinic with right flank pain in January 1993, and abdominal ultrasonography revealed right kidney stones. She was admitted to our hospital for treatment using ESWL. Analysis of the stone components revealed the stone to be composed of cystine. During the next 25 years, she received 157 sessions of ESWL and 2 sessions of transurethral ureterolithotripsy (TUL). Current examination revealed that although the lower pole of her right kidney is slightly atrophic, her renal function is stable and kidney stones remain small. Our case suggests that early intervention by ESWL could prevent stone growth and the deterioration in renal function.
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http://dx.doi.org/10.14989/ActaUrolJap_65_6_209DOI Listing
June 2019

Preoperative hydronephrosis as a predictor of postnephroureterectomy survival in patients with upper tract urothelial carcinoma: a two-center study in Japan.

Int J Clin Oncol 2020 Mar 3;25(3):456-463. Epub 2019 Sep 3.

Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminami-cho, Fushimi-ku, Kyoto, Kyoto, 601-1495, Japan.

Objective: To evaluate the predictive value of preoperative hydronephrosis for pathological outcome and prognosis in patients with upper tract urothelial carcinoma treated with nephroureterectomy.

Methods: 167 patients with UTUC treated with nephroureterectomy at our two institutions in Japan between 2002 and 2017 were retrospectively analyzed. Preoperative computed tomography scans were evaluated for the presence of ipsilateral hydronephrosis. Preoperative hydronephrosis's associations with pathological outcome and postnephroureterectomy survival were assessed.

Results: Ipsilateral hydronephrosis was present in 102 patients (61.1%). Preoperative hydronephrosis was not associated with higher pathological T stage (T3 or greater). Patients with preoperative hydronephrosis compared with patients without preoperative hydronephrosis had significantly worse recurrence-free survival (RFS) (5-year survival, 61.9% and 77.6%, respectively; p = 0.033), disease-specific survival (DSS) (5-year survival, 66.9% and 88.1%, respectively; p = 0.026), and overall survival (OS) (5-year survival, 54.5% and 80.6%, respectively; p = 0.030). A multivariate Cox regression model identified preoperative hydronephrosis and higher clinical T stage (T3 or greater) as an independent predictor of shorter RFS (p = 0.015 and 0.0009, respectively). We segregated the patients into three risk groups based on the number of these two prognostic factors: 0, favorable risk; 1, intermediate risk; 2, poor risk. The favorable-risk group had significantly better RFS (p = 0.0003), DFS (p = 0.0001), and OS (p = 0.0007) than the poor and intermediate-risk groups (RFS (p = 0.0011), DFS (p = 0.0017), and OS (p = 0.0043)).

Conclusion: The presence of preoperative hydronephrosis was a significant risk factor affecting survival. Our risk classification based on preoperative hydronephrosis and clinical T stage may be helpful for patient counselling and decision-making before nephroureterectomy.
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http://dx.doi.org/10.1007/s10147-019-01535-6DOI Listing
March 2020

Genetic Determinants of Virulence between Two Foot-and-Mouth Disease Virus Isolates Which Caused Outbreaks of Differing Severity.

mSphere 2019 08 14;4(4). Epub 2019 Aug 14.

Exotic Disease Research Station, National Institute of Animal Health, National Agriculture and Food Research Organization, Tokyo, Japan

Individual foot-and-mouth disease virus (FMDV) strains reveal different degrees of infectivity and pathogenicity in host animals. The differences in severity among outbreaks might be ascribable to these differences in infectivity among FMDV strains. To investigate the molecular mechanisms underlying these differences, we estimated the infectivity of O/JPN/2000 and O/JPN/2010, which caused outbreaks of markedly different scales, in cell lines, Holstein cattle, and suckling mice. Viral growth of the two strains in cells was not remarkably different; however, O/JPN/2000 showed apparently low transmissibility in cattle. Mortality rates of suckling mice inoculated intraperitoneally with a 50% tissue culture infective dose (TCID) of 10 for O/JPN/2000 and O/JPN/2010 also differed, at 0% and 100%, respectively. To identify genes responsible for this difference in infectivity, genetic regions of the full-length cDNA of O/JPN/2010 were replaced with corresponding fragments of O/JPN/2000. A total of eight recombinant viruses were successfully recovered, and suckling mice were intraperitoneally inoculated. Strikingly, recombinants having either VP1 or 3D derived from O/JPN/2000 showed 0% mortality in suckling mice, whereas other recombinants showed 100% mortality. This finding indicates that VP1, the outermost component of the virus particle, and 3D, an RNA-dependent RNA polymerase, are individually involved in the virulence of O/JPN/2010. Three-dimensional structural analysis of VP1 confirmed that amino acid differences between the two strains were located mainly at the domain interacting with the cellular receptor. On the other hand, measurement of their mutation frequencies demonstrated that O/JPN/2000 had higher replication fidelity than O/JPN/2010. Efforts to understand the universal mechanism of foot-and-mouth disease virus (FMDV) infection may be aided by knowledge of the molecular mechanisms which underlie differences in virulence beyond multiple topotypes and serotypes of FMDV. Here, we demonstrated independent genetic determinants of two FMDV isolates which have different transmissibility in cattle, namely, VP1 and 3D protein. Findings suggested that the selectivity of VP1 for host cell receptors and replication fidelity during replication were important individual factors in the induction of differences in virulence in the host as well as in the severity of outbreaks in the field. These findings will aid the development of safe live vaccines and antivirals which obstruct viral infection in natural hosts.
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http://dx.doi.org/10.1128/mSphere.00294-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695517PMC
August 2019

Reverse transcription-PCR using a primer set targeting the 3D region detects foot-and-mouth disease virus with high sensitivity.

Transbound Emerg Dis 2019 Jul 13;66(4):1776-1783. Epub 2019 May 13.

Exotic Disease Research Station, National Institute of Animal Health, National Agriculture and Food Research Organization, Kodaira, Japan.

The potential of foot-and-mouth disease (FMD) to spread extensively means that rapid and accurate methods are needed for its diagnosis. Therefore, reverse transcription-PCR (RT-PCR) plays an important diagnostic role. Here, we designed the primer set FM8/9 to amplify 644 bases in the conserved 3D region of all seven serotypes of the FMD virus (FMDV). We compared the performance of RT-PCR assays using FM8/9 with those using the primer set 1F/R, which targets the 5'-UTR, and real-time RT-PCR (rRT-PCR) assays described in the World Organization for Animal Health manual. Detection limits of the RT-PCR assays were determined for 24 strains, representing all serotypes. The sensitivities of RT-PCR assays using FM8/9 were 10 - to 10 -fold higher than those of 1F/R assays for 21 strains. To assess the validity of the methods for analysing clinical samples, sera and saliva samples collected daily from pigs and cows infected with FMDV were analysed using the four PCR assays. FM8/9 assays detected FMDV from all infected pigs and cows for longer periods than 1F/R assays, indicating that FM8/9 assays have higher sensitivity for the clinical samples. Our results suggest that the FM8/9 RT-PCR assay is highly sensitive and is therefore suitable for the diagnosis of FMD.
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http://dx.doi.org/10.1111/tbed.13202DOI Listing
July 2019

Laparoscopic radical cystectomy in octogenarians: analysis of a Japanese multicenter cohort.

Int J Clin Oncol 2019 Sep 10;24(9):1081-1088. Epub 2019 Apr 10.

Department of Urology, Kyoto University Hospital, Kyoto, Japan.

Backgrounds: This study aimed to describe the morbidity and mortality in older patients undergoing laparoscopic radical cystectomy (LRC) and compare the outcomes of LRC between octogenarians and younger patients (< 80 years) in a Japanese multicenter cohort.

Methods: We identified 433 patients (80 octogenarians) who underwent LRC in a retrospective multicenter database from 10 institutions. The perioperative outcomes and the 90-day and late (> 90-day) complications according to the Clavien-Dindo classification were compared between the octogenarians and younger patients. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were measured by the Kaplan-Meier method.

Results: Compared with the younger group, the octogenarian group included a significantly higher proportion of women, patients with a lower body mass index, patients with a lower preoperative albumin level, and patients with a history of abdominal surgery. The 90-day rates of all complications and major complications (grades III-V) were 50.0% and 20.0% among octogenarians and 54.7% and 16.4% among younger patients. The 90-day mortality rate among octogenarians was 3.8%. The 2-year RFS, CSS, and OS rates for octogenarians stratified by pathological stage was 95.2, 100, and 100% for ≤ pT1; 50.7, 76.6, and 56.1% for pT2; 33.6, 82.5, and 72.6% for ≥ pT3; and 23.1, 42.2, and 37.5% for pN + or distant metastasis, respectively. There was significant difference between octogenarians and younger patients only in 2-year OS for pT2 (56.1% vs 87.7%, p = 0.03).

Conclusions: This study revealed that LRC can be performed for selected octogenarians with a complication rate similar to that of younger patients. Appropriate risk evaluation and modification of surgical procedures are necessary for octogenarians.
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http://dx.doi.org/10.1007/s10147-019-01446-6DOI Listing
September 2019

Complications and reoperations after laparoscopic radical cystectomy in a Japanese multicenter cohort.

Int J Urol 2019 04 1;26(4):493-498. Epub 2019 Feb 1.

Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Objectives: To describe the complications and their surgical management after laparoscopic radical cystectomy in a Japanese multicenter cohort.

Methods: The participants were drawn from a retrospective multicenter study at 10 institutions. We identified 436 patients who underwent laparoscopic radical cystectomy with no robot assistance. Early and late complications were graded according to their Clavien-Dindo classification. The records of all patients who underwent surgical interventions for laparoscopic radical cystectomy-specific complications were also reviewed. Kaplan-Meier curves were used to describe the time to surgical intervention.

Results: The 90-day rates for overall complications, high-grade complications (Clavien-Dindo classification III-V) and mortality were 53%, 17% and 1.4%, respectively. Gastrointestinal (25%), infectious (22%) and abdominal wall-related (9%) complications were the most common. The late complication rate was 18%, and a total of 81 patients (19%) underwent surgical intervention during the median follow-up period of 22 months. The reoperation rate was 25% at 5 years. Gastrointestinal complications in the early postoperative period and abdominal wall-related complications in the late postoperative period were the main reasons for reoperation. Seven (7%) out of 100 female patients underwent emergent surgical reoperation for transvaginal bowel evisceration as a result of vaginal dehiscence.

Conclusions: Early and late postoperative complications and surgical reoperations are notable after laparoscopic radical cystectomy. Abdominal wall-related complications including vaginal dehiscence are common, and they represent the main indication for reoperation during long-term follow up.
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http://dx.doi.org/10.1111/iju.13917DOI Listing
April 2019

Pathogenesis of the attenuated foot-and-mouth disease virus O/JPN/2000 in experimentally infected pigs.

J Vet Med Sci 2018 Nov 14;80(11):1669-1675. Epub 2018 Sep 14.

Exotic Disease Research Station, National Institute of Animal Health, National Agriculture and Food Research Organization, Kodaira, Tokyo 187-0022, Japan.

We examined the pathogenesis of the attenuated foot-and-mouth disease virus (FMDV) O/JPN/2000 in pigs. The virus used in this study was passaged three times in primary bovine kidney (BK) cells and once in baby hamster kidney-21 (BHK-21) cells after isolation. A plaque assay demonstrated that this virus exhibited the small plaque (SP) phenotype. There was no clinical or histological evidence of vesicular lesions in pigs intraorally inoculated with 10 50% tissue culture infectious dose (TCID)/ml of the SP virus (SPV) of FMDV O/JPN/2000. Although fever was detected from 2 or 3 days post inoculation (dpi), there was no other prominent clinical sign up to 6 dpi. Virus shedding from saliva and nasal swab samples was not observed in any pigs inoculated with the SPV of FMDV O/JPN/2000. In the foot, mild lamellar degeneration of prickle cells in the upper layer of the stratum spinosum was histologically observed without development into vesicular or necrotic lesions. Immunohistochemical virus antigen- and terminal deoxynucleotidyl transferase-mediated dUTP-nick end labeling (TUNEL)-positive reactions observed in the foot at 1 dpi seemed to disappear after 3 and 6 dpi. Our findings suggest that the SPV of FMDV O/JPN/2000 had low pathogenicity against pigs by intraoral inoculation.
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http://dx.doi.org/10.1292/jvms.18-0377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261817PMC
November 2018

Laparoscopic intracorporeal ileal conduit after laparoscopic radical cystectomy: A modified technique to facilitate ureteroenteric anastomosis.

Int J Urol 2018 11 26;25(11):976-978. Epub 2018 Aug 26.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

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http://dx.doi.org/10.1111/iju.13782DOI Listing
November 2018